‘It's not you; it's us!’: the relevance of mental health team psychodynamics to the care of individuals with complex emotional needs

Haslam, Michael; Ellis, Sue; Plumridge, Marcia

doi:10.12968/bjmh.2021.0033

Cited by 2 publications

(1 citation statement)

References 26 publications

(29 reference statements)

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“…Violent offences and characteristics of BPD can trigger fear and frustration in staff, fostering mistrust in therapeutic relationships and influencing patient care (Beryl & Völlm, 2018). From a TIC perspective, if anxiety among staff teams remains uncontained, there is increased potential for forensic services to replicate the misuse of power that patients experience in their earlier lives (Haslam et al., 2022). Consequently, staff on forensic wards may attempt to maintain distance in their therapeutic relationships, to protect themselves from patients' distress (Lammie et al., 2010).…”

Section: Tic and Social Climate In Forensic Settings For Bpdmentioning

confidence: 99%

Using a trauma‐informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings

Rodwell,

Frith

2024

Int J Mental Health Nurs

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Tensions between therapeutic and security needs on forensic wards can create a social climate which is challenging for both mental health nurses and patients. Social climate refers to the physical, social and emotional conditions of a forensic ward which influence how these environments are experienced. For patients with borderline personality disorder (BPD), previous trauma means that the social climate of forensic settings may be experienced as retraumatising, negatively impacting the outcomes and wellbeing of both patients and mental health nurses. Trauma‐informed care (TIC) has been offered as a contemporary framework for mental health nursing in inpatient units which aims to create a therapeutic social climate. In this critical review, we drew widely on literatures examining the social climate in forensic settings, the relationships between patients with BPD and staff (including mental health nurses), and the experiences of patients with BPD in forensic and inpatient settings to draw out the implications of scrutinising these literatures through the lens of TIC. Attending to the physical, social and emotional conditions of social climate in secure settings highlights how forensic wards can mirror trauma experiences for patients with BPD. Implementing TIC in these contexts has the potential to evoke positive shifts in the social climate, thus reducing the risk of retraumatisation and leading to improved outcomes for patients and staff.

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Section: Tic and Social Climate In Forensic Settings For Bpdmentioning

confidence: 99%

Using a trauma‐informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings

Rodwell,

Frith

2024

Int J Mental Health Nurs

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Damaging dichotomies and confounding contradictions in mental health inpatient nursing: lessons learned from Orwell’s 1984

Haslam,

Harding

2024

MHRJ

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Purpose This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk. Design/methodology/approach Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears. Findings Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges. Research limitations/implications To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care. Originality/value The authors use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.

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‘It's not you; it's us!’: the relevance of mental health team psychodynamics to the care of individuals with complex emotional needs

Cited by 2 publications

References 26 publications

Using a trauma‐informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings

Using a trauma‐informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings

Damaging dichotomies and confounding contradictions in mental health inpatient nursing: lessons learned from Orwell’s 1984

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