Authors: Tom Dening, Professor of Dementia Research & Jen Yates, Assistant Professor in Mental Health; Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, UK
This article appears in our latest newsletter (summer 2025) which can be downloaded here.
Research involving older people in the forensic system has largely concentrated on older prisoners, see for example reviews by Di Lorito et al (2108a and b) of prevalence of mental disorders and the lived experience of older prisoners, respectively.
Within forensic mental health services, most research has focused on in-patient settings with relatively little attention to community-based patients. Claudio Di Lorito’s work reviewed the literature and found, as might be expected, high levels of mental and physical health issues among older patients (Di Lorito et al., 2018c). Obesity and diabetes are highly prevalent (Tomlin et al., 2022).
Two other important questions identified were whether there should be separate accommodation for older forensic patients, and how the prospect of discharge (usually after admissions lasting years) could be very daunting.
For the NIHR-funded ENHANCE study, led by Chris Griffiths and Kate Walker, we examined issues for older forensic patients, in particular barriers and facilitators to moving through the system, by means of
interviews with staff and patients.
Environmental (e.g., physical, structural and facilities), relational (staff, family and friends) and individual (characteristics, feelings, behaviours) factors were identified as enablers and/or obstacles to wellbeing,
recovery, progress and quality of life (Walker et al., 2023a).
We found that multidisciplinary input, an individualized approach and implementing holistic and needs-led care facilitated progress towards recovery and independence.
Barriers included lack of resources, excluding the patients in care planning, gaps in expertise and knowledge, and a lack of specialised units that could address mental health, forensic and elderly needs (Walker 2023b).
From this work, we have published a consensus guidance document on the care of older forensic patients (Tomlin et al., 2023), intended to complement the European Psychiatric Association guidance on forensic psychiatry. The main recommendations include: involve older patients in treatment and service organization decisions, adapt interventions to be responsive to this group, train staff to recognize physical vulnerabilities and cognitive decline, and embrace methods of communication developed in other areas of are, such as dementia care.
References:
- Di Lorito C, Völlm B, Dening T. (2018a) Psychiatric disorders among older prisoners: A systematic review and comparison study against older people in the community. Aging & Mental Health 22(1): 1-10. DOI: 10.1080/13607863.2017.1286453.
- Di Lorito C, Völlm B, Dening T. (2018b) A systematic review on the individual experience of ageing prisoners through a Good Lives Model framework. International Journal of Geriatric Psychiatry 33(2): 252-262. DOI: 10.1002/gps.4762.
- Di Lorito C, Völlm B, Dening T. (2018c) Ageing patients in forensic psychiatric settings: a review of the literature. International Journal of Geriatric Psychiatry 33: 1548–1555.
- Tomlin J, Walker K, Yates J, Dening T, Völlm B, Griffiths C. (2022) Older forensic mental healthcare patients in England: demographics, physical health, mental wellbeing, cognitive ability and quality of life. NIHR Open Research 2:9. doi: 10.3310/nihropenres.13248.2.
- Tomlin J, Walker K, Yates J, Dening T, Goethals K, Völlm B, Griffiths C. Care for older forensic mental health patients: a consensus guidance document. European Psychiatry 2023; 66(1): e44: 1-13. doi: 10.1192/j.eurpsy.2023.2413.
- Walker K, Yates J, Dening T, Völlm B, Tomlin J, Griffiths C. (2023a) Quality of life, wellbeing, recovery, and progress for older forensic mental health patients: a qualitative investigation based on the perspectives of patients and staff. International Journal of Qualitative Studies in Health & Well-being 18:1, 2202978, doi: 10.1080/17482631.2023.2202978.
- Walker K, Furtado V, Yates J, Dening T, Völlm B, Griffiths C. (2023b) Systems and processes that enable progress for older forensic mental health patients. International Journal of Forensic Mental Health 22(2): 93-104. doi: 10.1080/14999013.2022.2080304.
Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.
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