Deconstructing imposed recovery - clinical perceptions of the legal and administrative framework for managing restricted mental health patients - the experience of one hospital in the independent sector

Abstract

young a (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 397–406 Deconstructing imposed recovery – clinical perceptions of the legal and administrative framework for managing restricted mental health patients – the experience of one hospital in the independent sector Aims and objectives. This paper sets out to address the potentially important issue or issues relating to mental health professionals’ views on the arrangements for the management of patients subject to a restricted hospital order. Background. Less‐than‐optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management in the context of forensic mental health. Design. Report of a survey. A grounded theory approach was used for both ‘collecting’ and ‘analysing’ the data. Method. A total of 14 mental health practitioners were interviewed regarding the legal and administrative framework for managing restricted patients and their use of a patient‐centred care model to assist restricted patients with serious mental illness to identify their self‐management needs. The research interviews were conducted between 2008 and 2009. Conclusions. ‘Imposed’ recovery and the systemic issues and the value assumptions that health professionals often bring to their interactions with clients need to be explored further. Not until we have serious debate about such issues as will health services fully translate the current rhetoric of collaborative partnership into reality for clinicians and the clients they serve. Relevance to clinical practice. Forensic practitioners must practice within a legal framework and carefully balance the needs and rights of patients against the need to protect the public from harm. Imposed recovery involves a high degree of skill and expertise in terms of risk assessment, risk decision‐making and working interprofessionally and cooperatively with government agencies.

Managing restricted patients in acute, non-secure in-patient services: clinical, ethical and resource implications of long waits for a response from the Ministry of Justice

“… 15 This raises the question of whether the use of civil sections or informal admissions are ever suitable for such high-risk patients. When assessing a patient's leave or discharge, the MoJ looks specifically at the level of risk to the public and measures that are in place to alleviate this risk, 16 aims that may overlap with the responsible clinician's judgement but are ultimately more focused on public protection than on the care and treatment of the patient. 17 This balance between public protection and treatment of the individual patient can be difficult to get right.…”

“…a clinical perspective of risk can come from the psychiatrist while a more criminological perspective of risk is provided by the MoJ. 16 General adult psychiatrists may have less experience in dealing with such patients and may prefer MoJ input as it provides a more systematic overview of risk management. 18 Some have welcomed input from the MoJ, referring to it as an external audit, while others have commented on the collective experience of the MoJ in dealing with restricted patients, which can be helpful to the lone psychiatrist.…”

The use of recovery model in forensic psychiatric settings: A Foucauldian critique

“…The authors acknowledged that such patients may possess legitimate objections to the framing of their offending behaviours, but that continued refusal to engage in the ‘work’ of recovery can only result in indefinite incarceration. When recovery becomes official institutional policy, Young (2011) cautioned of the potential of ‘imposed recovery’. Nurses are mandated to lead patients to the ‘truth’ of a new identity of personal responsibility – to homo‐economicus – to minimize their sanctions; those who fail to engage in recovery are marked as deviant and unsuitable for release in the community.…”

The development of recovery based nursing in a high-security hospital: nurturance and safe spaces in a dangerous world?

“…Others report on difficulties with adapting recovery in secure environments. For example, Young (2011) posits that criminal justice bureaucracies are "too risk centric" for recovery principles to be employed properly in secure care. Livingstone et al (2012) point to a myriad of opposing priorities, while Mezey et al (2010, p. 692) note that "most of the patients regarded their offending behaviour as a greater barrier to recovery than their illness".…”

“…"Madness" and "badness" Dangerous behaviour does not always have its origins in mental disorder (Mason, 2005). Dorkins and Adshed (2011), Young (2011) and Pouncey and Lukens (2010) tease out some fundamental issues surrounding "madness" vs "badness" from secure contexts and explore this dichotomy. The "badness" component carries a plethora of dangers to self and others.…”