Power and control: forensic community mental health nurses’ perceptions of team‐working, legal sanction and compliance

Abstract

This is the second of two papers reporting on a descriptive mixed methods study of community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Forensic community mental health nurses (FCMHNs) have a body of experience of working with mentally disordered offenders in the community. A number of these patients will be subject to conditions on discharge. This in effect acts as compulsory community treatment with the sanction of recall to hospital. This paper examines nurses' perceptions of team-working, legal powers and their effects upon compliance. Findings include that FCMHNs express general satisfaction with their input to decision-making but some concerns were raised that challenge the ethic of team-working. Respondents were broadly in favour of increased professional responsibility, although this may be related to a quest for status. A pragmatic if equivocal support for the use of compulsion in community mental healthcare was also expressed.

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

“…found that staff working in a small medium secure unit evoked rigid professional boundaries when reflecting on ethical dilemmas set by the researcher, even when asked to focus on multidisciplinary working. Forensic mental health nurses express support multidisciplinary teamwork but to experience their relative lack of status as an obstacle to participation (Robinson and Kettles, 1998;Coffey and Jenkins, 2002). These findings, similar to those obtained in other healthcare settings (e.g.…”

“…Similar conclusions have been drawn in other healthcare arenas. Far from promoting collaboration, multidisciplinary interaction appears, paradoxically, to reinvoke professional boundaries (Cott, 1998;Brown et al, 2000;Coffey and Jenkins, 2002;Hugman, 2003).…”

Proposed changes to the Mental Health Act of England and Wales: research indicating future educational and training needs for mental health nurses

“…Even where mental health nurses are not directly involved in the invoking of MHA legislation they are frequently indirectly involved through alerting concerns to those professionals who are empowered. Currently, mental health nurses in England and Wales will be engaged with supervision orders within their role as care coordinator, often requiring users to attend treatment sites or to reside at a particular residence (Coffey & Jenkins 2002).…”

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

“…Their liminal status (Warner & Gabe, 2004) invites attention from a range of services and professions, and raises the mind/body problem. The dominant position of doctors in forensic mental health services encourages medical interpretation (Whyte & Brooker, 2001;Coffey & Jenkins, 2002). However, its fitness for purpose has been strongly challenged, particularly in relation to the problematic concept of psychopathy/personality disorder (Manning 2000).…”