Clinical hopes and public fears in forensic mental health

Carroll, Andrew; Lyall, Mark; Forrester, Andrew

doi:10.1080/14789940410001703282

Cited by 39 publications

(36 citation statements)

References 49 publications

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“…People experiencing mental illness will usually become the responsibility of forensic hospitals when their behaviour is deemed a threat to others. The public is protected through containment of the patient and by specialist and ethical treatment in preparation for a return to the community (Carroll et al . 2004).…”

Section: Factors Influencing the Use Of Seclusion In A Forensic Hospitalmentioning

confidence: 99%

Seclusion reduction in a forensic mental health setting

Maguire¹,

Young²,

Martin

2011

Psychiatric Ment Health Nurs

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Seclusion has become a contentious practice and initiatives have commenced to reduce or eliminate its use. This paper presents the initiatives that were introduced during a seclusion reduction project that was undertaken at an Australian forensic hospital. These initiatives are based on the six core strategies that have been successfully used in North America to reduce seclusion. However, there are challenges (patient characteristics, prisoner culture and ensuring safety) and opportunities (longer admissions, higher staff-patient ratio, staff confidence, sound risk assessment and management) that can influence projects to reduce seclusion in a forensic hospital. During this project, the frequency (mainly multiple seclusions of patients) and duration of seclusion events were reduced but there was less reduction in the number of patients that were secluded. It is possible that the strategies were successfully supported by the identified opportunities to reduce the frequency and duration of seclusion but the challenges were significantly powerful in the early period of admission to prompt the need for seclusion. Reducing seclusion in a forensic hospital is a complex undertaking as nurses must provide a safe environment while dealing with volatile patients and may have little alternative at present but to use seclusion after exhausting other interventions.

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Section: Factors Influencing the Use Of Seclusion In A Forensic Hospitalmentioning

confidence: 99%

Seclusion reduction in a forensic mental health setting

Maguire¹,

Young²,

Martin

2011

Psychiatric Ment Health Nurs

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“…Even employing the most sophisticated risk assessment and management strategies, some degree of reoffending is inevitable, which may be attributable to 'unknowable' factors, or factors unrelated to the patients' illness [6] and do not necessarily indicate program failure. It is also known that the highest incidence of reoffending occurs in the immediate post-discharge period.…”

Section: Performance Indicators For Forensic Servicesmentioning

confidence: 99%

Insanity Acquittee Outcomes in New Zealand

Skipworth

Brinded

Chaplow

et al. 2006

Aust N Z J Psychiatry

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“…The purpose of this detention is seen as twofold: care and treatment for the patient (for their own sake as well as in order to reduce future risk) and protection of the public from harm from the offender. This dual role can cause dilemmas for the practitioner who has potentially incompatible duties to the patient, third parties and the wider community [1][2][3]. As Robertson and Walter [4] observed: ''In psychiatric ethics, the dual-role dilemma refers to the tension between psychiatrists' obligations of beneficence towards their patients, and conflicting obligations to the community, third parties, other healthcare workers, or the pursuit of knowledge in the field''.…”

Section: Introduction Forensic Psychiatrymentioning

confidence: 99%

Ethical issues of long-term forensic psychiatric care

Völlm

Βartlett

McDonald

2016

Ethics, Medicine and Public Health

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Summary Forensic psychiatry is a subspecialty of clinical psychiatry that operates at the interface between law and psychiatry. It is concerned with patients who have a mental disorder as well as having committed an offence, often serious. Forensic psychiatric institutions are highcost/low-volume services that impose significant restrictions upon their residents. Patients may be detained in those services against their will for lengthy periods, potentially life-long. The purpose of this detention is seen as two-fold: care and treatment for the patient and protection of the public from harm from the offender. Here we review the ethical issues around such longterm detention. We base our observations on a review of relevant literature and from focus groups with professionals working in forensic psychiatric settings. Additionally, we visited three institutions in the UK where long-stay forensic psychiatric patients receive care. A number of factors have been identified contributing to long-term stay (long-stay) in forensic psychiatric care, including organisational factors (e.g., lack to beds in less secure settings) and patient characteristics (severity of psychopathology and offending). Long-stay in a forensic psychiatric setting -which is often longer than had the patient received a prison sentence for the same offence -poses significant ethical and human rights issues, particularly when it is unclear * Corresponding author. Please cite this article in press as: Völlm B, et al. whether the treatments offered benefit the patient and when risk management considerations may outweigh the best interests of the patient. The main topics of concern identified by our participants included ''system failures'', ''avoidance of warehousing'', ''importance of hope'', ''denial'' and long-stay units and ''quality of life''. Participants were concerned that the system is set up in a way that does not allow patients with complex and long-term needs to move to more appropriate, less restrictive settings and that the issue of ''long-stay'' is met with denial. In order to avoid warehousing and maintain hope, those we spoke to felt it was important to not give up on patients and continue to deliver treatment, almost regardless of its effect. Providing long-stay patients with a good quality of life was seen as important, though we found that the stated ambitions were not always matched by the reality of the units we visited. Despite the stated need to provide something ''different'' for long-stay patients, the units were nevertheless very restrictive in their approach (e.g., prohibition of sexual expression). Professionals seemed to lack a more ambitious and creative vision to create something truly distinct. We discuss possible solutions, including explicitly maximising the quality of life of those detained, limiting the time of detention to equal the sentence length of non-disordered offenders and locating the public protection function of the management of mentally disordered offenders within the criminal justice rather than the he...

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Clinical hopes and public fears in forensic mental health

Cited by 39 publications

References 49 publications

Seclusion reduction in a forensic mental health setting

Seclusion reduction in a forensic mental health setting

Insanity Acquittee Outcomes in New Zealand

Ethical issues of long-term forensic psychiatric care

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