Resistance and challenge: competing accounts in aftercare monitoring

Abstract

This article explores a candidate example of competing accounts of aftercare under supervision of a discharged forensic patient and worker in one part of the UK. It is taken from a study involving 59 in-depth interviews with patients and their workers to investigate community return after detention in forensic psychiatric facilities. Fear of mental illness and associated dangerousness are embodied in discourses surrounding the forensic patient. In living with deviant labels and seeking to establish independence from the psychiatric system patients' talk demonstrates nascent identity work in an attempt to resist alternative dominant discourses. Workers however deploy occupational knowledge of risk and associated monitoring as the basis for claims of safe aftercare. Both patient and worker accounts are reflexively aware of competing versions and seek to portray the provision of aftercare monitoring in self-interested ways. Aftercare monitoring and supervision may ostensibly be about integration and rehabilitation but as this study shows risk is an ever-present concern forming an important backdrop to the attempts of patients to forge new identities and the normalising ideologies of those working with them.

Advocating for Pregnant Women in Prison

“…Care and treatment planning for FSPs incorporates judgment about risks, protective factors, available resources, and therapeutic objectives (Coffey, 2011(Coffey, , 2012Skelly, 2001). This stress can result in decompensation of mental state, which may lead to behaviors such as deliberate self-harm, harm to others, or absconding, which can compromise the transition.…”

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

“…Rather than working in partnership with providers to recover a meaningful life and identity, the forensic mental health service users in our study fostered a duplicitous relationship with providers in which the acted like compliant patients, but maintained a secret concealed community identity (Coffey 2011). Service user participants maintained this identity through underground meetings outside of working performance hours and through remembering and restating complaints, which they felt they would be able to address once discharged back to the community.…”

“…Iatrogenic risks, the harm to forensic mental health service users of dependence and institutionalisation are largely a secondary consideration. Thus the relationship between safety and service user autonomy may become unbalanced as risk discourses pervade and shape care provision which was intended to be for social integration and rehabilitation (Coffey 2011;Rose 1998). The heightened risk status of forensic mental health service users is reflected in the higher level of security within forensic services compared to generic mental health services.…”

“…Users may be unable to distance themselves from their histories of offending. Thus service users may become 'locked into deviant identities' due to their offending histories and struggle to create a new identity which would enable them to integrate into everyday life (Coffey 2011).…”

Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts

“…It was important to examine narrative accounts from different groups, in order to make differing views and tensions visible that exist between one vulnerable group, and those working with them (Briggs, 1996;Coffey, 2011). The majority of research in mental health is written from the viewpoint of professional staff, who ultimately decide what is considered evidence, with studies offering service user perspectives falling short in delivering equivalent versions (Coffey, 2011;Rose, Thornicroft & Slade, 2006). Research that upholds co-existing accounts from both staff and service users allows for contentions to be examined (Briggs, 1996).…”