Forensic mental health services as a risk escalator: A case study of ideals and practice

Abstract

Medium/low secure units occupy a central role in forensic mental health care, bridging high secure and community services. Although outcomes, assessed in terms of readmission and identified reoffending, have been evaluated, little research exploring processes underlying attempted rehabilitation for offenders diagnosed as having mental health problems has been undertaken. The present qualitative study built upon previous research completed in a Northern England medium/low secure forensic mental health care institution for adults with learning disabilities . It was carried out in a medium/low secure forensic mental health care Unit located in London. In phase one, 43 staff, including general managers, doctors, nurses, psychologists and occupational therapists were interviewed about their philosophy of care, views about risk management for forensic mental health patients and perceptions of the Unit. In phase two, 10 case studies of patients were undertaken. As far as possible, patients were interviewed twice over a period of 11-20 months, and staff were asked about their progress. Two case conferences were observed. Data were analysed using the metaphorical concept of a rehabilitative risk escalator around three themes carried forward from the previous study: organisational issues; patient active risk management; and multiprofessional collaboration.

The problems of offenders with mental disorders: A plurality of perspectives within a single mental health care organisation

“…These conditions may involve generic organisational factors or features of the form of human service in question. In terms of organisational structure, the degree of conflict between the professions illustrated above might be associated with its troubled organisational history (Heyman et al, 2004).…”

“…A more detailed account of the study methodology is given by Heyman, Shaw, Davies, Godin & Reynolds (2004). The Unit which provided the setting for the present study is located in a deprived inner-city area of London.…”

Multidisciplinary Teamwork in a UK Regional Secure Mental Health Unit a Matter for Negotiation?

“…The study methodology (see Heyman et al, 2004) will be outlined only briefly for the purposes of the present paper which offers a theoretical exploration of multidisciplinary interactions. The Unit which provided the setting for the present study is located in a deprived, inner-city area of London.…”

Playing the game: service users’ management of risk status in a UK medium secure forensic mental health service

“…Risk assessment is therefore central to the functioning of forensic mental health services, providing a way to balance service user autonomy with safety. In this way forensic mental health services operate as risk escalators (Heyman, et al 1998;Heyman et al 2004); that is they function as systems that operate to manage defined risks. Compromises are made between security and autonomy as the service user moves through the system.…”