Treatment, deterrence or labelling: mentally disordered offenders’ perspectives on social control

Dixon, Jeremy

doi:10.1111/1467-9566.12313

Cited by 5 publications

(7 citation statements)

References 34 publications

(49 reference statements)

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“…In fact, the view of this paper is that the use of labels (e.g. mentally disordered offenders) elicits a negative ethos for those who live with these and for those who utilise them (Dixon, 2015).…”

Section: Participant Observationmentioning

confidence: 92%

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: Participant Observationmentioning

confidence: 92%

Inpatient Institutional Care: The Forced Social Environment

et al. 2021

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“…The risk of harm to others is rarer, carries a significant negative outcome for the victim and substantial anxieties for workers and for the mental health system . Risk assessment practices occur within this wider context of concern about possible negative outcomes and uncertain consequences for both the individual being assessed and the assessor.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, efforts continue to focus on developing actuarial (meaning measurement) and hence supposedly more scientific mechanisms for identifying and predicting future risk behaviours . The predictive accuracy of risk assessment in mental health care is fraught with problems such that even the best actuarial tools perform substantially below that which is commonly acceptable in other branches of healthcare . Reviews have repeatedly noted significant limitations of measurement scales and poor quality assessments with a consistent recommendation that scales are not used for routine clinical practice and calling for a focus on the individual patient …”

Section: Introductionmentioning

confidence: 99%

“…[19][20][21] The risk of harm to others is rarer, carries a significant negative outcome for the victim and substantial anxieties for workers and for the mental health system. 22,23 Risk assessment practices occur within this wider context of concern about possible negative outcomes and uncertain consequences for both the individual being assessed and the assessor. Within the mental health system, there is a contrast between risks perceived to be high profile/low probability (such as dangerous behaviour exhibited by the mentally ill) which call for intervention, and low profile/high probability risks (such as medication effects) that are seemingly accepted without concern.…”

Section: Introductionmentioning

confidence: 99%

“…[26][27][28] The predictive accuracy of risk assessment in mental health care is fraught with problems such that even the best actuarial tools perform substantially below that which is commonly acceptable in other branches of healthcare. 29,23 Reviews have repeatedly noted significant limitations of measurement scales and poor quality assessments with a consistent recommendation that scales are not used for routine clinical practice and calling for a focus on the individual patient. 30,31 While certain risks take centre stage, more rarely the risks the person themselves are presented with are considered.…”

Section: Introductionmentioning

confidence: 99%

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Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning

Coffey

Cohen

Faulkner³

et al. 2016

Health Expectations

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BackgroundCommunication and information sharing are considered crucial to recovery‐focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety.ObjectiveUsing data from our cross‐national mixed‐method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans.DesignThematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template.FindingsParticipants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment.ConclusionsDespite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.

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