The psychodynamics of forensic mental health nursing

Aiyegbusi, Anne

doi:10.1080/08037060802450720

Cited by 11 publications

(6 citation statements)

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“…Caring for individuals that society chronically marginalises can lead to complex emotions, such as feelings of disgust, repulsion and fear; however, staff are often not provided the supportive reflective space required to explore these intense feelings (Jacob et al, 2008). It is recognised that the staff-patient relationship can be challenging for both staff and patients (Adshead, 2004;Aiyegbusi, 2009b) but the introduction and maintenance of positive relationships within care hold an important therapeutic value (Middleton, 2017;Marshall and Adams, 2018). Clinical supervision is crucial for managing relationships to promote a therapeutic environment (Aiyegbusi, 2009b).…”

Section: Discussionmentioning

confidence: 99%

“…It is recognised that the staff-patient relationship can be challenging for both staff and patients (Adshead, 2004;Aiyegbusi, 2009b) but the introduction and maintenance of positive relationships within care hold an important therapeutic value (Middleton, 2017;Marshall and Adams, 2018). Clinical supervision is crucial for managing relationships to promote a therapeutic environment (Aiyegbusi, 2009b). Moreover, it has been noted that those employed with non-clinical staff roles would benefit greatly from clinical supervision.…”

Section: Discussionmentioning

confidence: 99%

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Inpatient Institutional Care: The Forced Social Environment

et al. 2021

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The landscape of mental health recovery is changing; there have been calls for a shift from the clinical expertise being the dominant voice within mental healthcare towards a more personalised and collaborative service that supports those in need of mental healthcare to define what recovery is for the individual. Within this new recovery movement, there has been a recognition of the importance of the social environment in which individuals are situated and the relationship of this to mental health and wellbeing. Included in this is the importance of an individual’s role within society and the ways in which knowledge, such as experts by experience, can hold an important value. The argument then, is that social connectedness forms part of the recovery journey and that relationships can help us develop or re-connect with who we are in powerful ways. Such a view has only been strengthened by the recent and ongoing global COVID-19 pandemic. Within the UK, discussions of the importance of our wellbeing have become commonplace within the context of restricted social contact. With this heightened awareness of how the social contributes to wellbeing, it is important to consider the environments in which those in receipt of mental healthcare are situated. One of which is institutionalised care, where it is commonplace to restrict social contact. For example, by virtue of being within a locked environment, individuals’ freedom of movement is often non-existent and thus contacts with those not residing or working within the institution is restricted. While such restrictions may be deemed necessary to protect the individual’s mental health, such environments can be unintentionally toxic. Data are presented from an ethnography that was conducted within an inpatient forensic mental health hospital in the UK to highlight the problematic social environment which some individuals experience. Key interpersonal issues are presented, such as, trust, racism, the threat of physical violence and bullying that was experienced by staff and residents at the hospital. Consideration is given to the coping strategies enacted by residents and the pathologising of such behaviour. The consequences on interpersonal wellbeing are explored.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inpatient Institutional Care: The Forced Social Environment

et al. 2021

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“…Aiyegbusi () stated that it is the clinician's task to assist FP to recover their lives. Such a task requires a skilled and supported environment that encourages clinicians to achieve excellence in their work.…”

Section: Discussionmentioning

confidence: 99%

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

Harris

Happell

Manias

2014

Int J Mental Health Nurs

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Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those individuals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and individual interviews with hospital and community-based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.

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“…It is possible that staff concerns about professionalism are used as a rationalisation for avoiding emotional closeness with forensic patients. Aiyegbusi [ 37 ] attributes forensic nursing staff's avoidance of emotional connection to a fear of identification with, on the one hand, the index offences committed and, on the other, the personal histories of abuse and neglect that patients have invariably experienced. Irrespective of the underlying reason, participants clearly linked staff’s beliefs about ‘professionalism’ to reduced understanding of patients.…”

Section: Discussionmentioning

confidence: 99%

De-escalation of conflict in forensic mental health inpatient settings: a Theoretical Domains Framework-informed qualitative investigation of staff and patient perspectives

et al. 2022

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Background Violence and other harms that result from conflict in forensic inpatient mental health settings are an international problem. De-escalation approaches for reducing conflict are recommended, yet the evidence-base for their use is limited. For the first time, the present study uses implementation science and behaviour change approaches to identify the specific organisational and individual behaviour change targets for enhanced de-escalation in low and medium secure forensic inpatient settings. The primary objective of this study was to identify and describe individual professional, cultural and system-level barriers and enablers to the implementation of de-escalation in forensic mental health inpatient settings. The secondary objective was to identify the changes in capabilities, opportunities and motivations required to enhance de-escalation behaviours in these settings. Methods Qualitative design with data collection and analysis informed by the Theoretical Domains Framework (TDF). Two medium secure forensic mental health inpatient wards and one low secure mental health inpatient ward participated. 12 inpatients and 18 staff participated across five focus groups and one individual interview (at participant preference) guided by a semi-structured interview schedule informed by the TDF domains. Data were analysed via Framework Analysis, organised into the 14 TDF domains then coded inductively within each domain. Results The capabilities required to enhance de-escalation comprised relationship-building, emotional regulation and improved understanding of patients. Staff opportunities for de-escalation are limited by shared beliefs within nursing teams stigmatising therapeutic intimacy in nurse-patient relationships and emotional vulnerability in staff. These beliefs may be modified by ward manager role-modelling. Increased opportunity for de-escalation may be created by increasing service user involvement in antipsychotic prescribing and modifications to the physical environment (sensory rooms and limiting restrictions on patient access to ward spaces). Staff motivation to engage in de-escalation may be increased through reducing perceptions of patient dangerousness via post-incident debriefing and advanced de-escalation planning. Conclusions Interventions to enhance de-escalation in forensic mental health settings should enhance ward staff’s understanding of patients and modify beliefs about therapeutic boundaries which limit the quality of staff-patient relationships. The complex interactions within the capabilities-opportunities-motivation configuration our novel analysis generated, indicates that de-escalation behaviour is unlikely to be changed through knowledge and skills-based training alone. De-escalation training should be implemented with adjunct interventions targeting: collaborative antipsychotic prescribing; debriefing and de-escalation planning; modifications to the physical environment; and ward manager role-modelling of emotional vulnerability and therapeutic intimacy in nurse-patient relationships.

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The psychodynamics of forensic mental health nursing

Cited by 11 publications

References 0 publications

Inpatient Institutional Care: The Forced Social Environment

Inpatient Institutional Care: The Forced Social Environment

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

De-escalation of conflict in forensic mental health inpatient settings: a Theoretical Domains Framework-informed qualitative investigation of staff and patient perspectives

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