From Hospital to Community: Perspectives on Forensic Pathways for Adults With Intellectual Disabilities

Adults with intellectual disabilities and forensic histories often experience prolonged hospital stays and delayed discharge, yet evidence on how forensic pathways support safe and timely transition to the community remains limited.

A qualitative, multi-perspective study was conducted within a large healthcare organisation in England. Semi-structured interviews and focus groups were undertaken with service users (n = 11), family members/carers (n = 5), and multidisciplinary staff (n = 18), alongside two co-production workshops with 92 professionals. Data were analysed using reflexive thematic analysis.

Discharge was experienced as a cyclical and unstable process rather than a linear event. Three interrelated themes emerged: (1) establishing readiness and foundations for continuity, (2) maintaining coordination and coherence across the care trajectory, and (3) sustaining community living while preventing re-entry into institutional care.

Supporting safe and sustainable discharge requires continuity-focused integrated pathways beginning at admission and extending beyond discharge to reduce repeated cycles of admission.