Including the excluded: high security hospital user perspectives on stigma, discrimination, and recovery

The purpose of this paper is to document reflections on experiences of stigma and discrimination as described by predominantly black and ethnic minority (BME) service users in a high security hospital via a slow‐open therapy group. Service users from BME are known to have higher drop‐out rates and poorer treatment outcomes in non‐forensic therapy settings (Rathod et al.). Further, they are over‐represented in forensic services and often disengage, because their views and feelings are poorly understood (Ndegwa).

Thematic analysis was applied to a sample of electronically stored running records of group sessions, in which experiences of care, discrimination, hope, despair, and recovery were shared.

Over a three‐year period, 18 forensic patients participated in the group. Group members' reflections on detention, offending and illness were collected. Themes relating to isolation and distance, other barriers to recovery and strategies for coping “against the odds”, are illustrated via anonymised material from the sessions.

Stigma and discrimination are difficult concepts to hold in mind, and are therefore difficult to access. Nevertheless, their effects can be so all encompassing for patients in high security that hope is hard to sustain. The extent to which the themes generated by this sample are representative of those pertinent to others in similar secure settings is inevitably beyond the scope of this paper.

Service users can, and do, share ideas about possibilities for surviving despite their past. Their comments shed light on barriers to engagement for this potentially marginalized population, and possibilities for improving the capacity of the clinical service to hear their voices on an issue of such importance to their potential for recovery.

Specific attention to the perspectives of all service recipients on the impact of illness and their recovery is required in a modern health service, where inclusion is a guiding principle.

Interventions for addressing stigma for the most marginalized are infrequently described, but are potentially relevant for all.