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

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link City Research OnlineReynolds, L. M., Jones, J. C., Davies, J., Freeth, D. & Heyman, B. (2014). Playing the game:service users' management of risk status in a UK medium secure forensic mental health service.Health, Risk and Society, 16(3), pp. 199-209. doi: 10.1080/13698575.2014.911820 City Research Online Online is checked for eligibility for copyright before being made available in the live archive. URLs from City Research Online may be freely distributed and linked to from other web pages. Versions of researchThe version in City Research Online may differ from the final published version. Users are advised to check the Permanent City Research Online URL above for the status of the paper. EnquiriesIf you have any enquiries about any aspect of City Research Online, or if you wish to make contact with the author(s) of this paper, please email the team at publications@city.ac.uk. AbstractIn this article we examine how forensic mental health service users actively attempt to manage their risk status through playing the game of containing frustration and demonstrating compliance. The article draws on an observational study (2006 to 2009) which explored the practices of risk assessment and management within one inner city forensic mental health medium secure service in the UK. We used a grounded theory approach to explore service users and providers experiences of risk assessment and management. We interviewed forensic mental health service users and providers. We also collected data using participant and non-participant observation. Since access to forensic mental health services is tightly controlled, there are participant observation studies undertaken in these settings.We found that service users attempted to understand the system of assessment and sought to affect and reduce their risk status by engaging in overt, compliant behaviours. We argue that in doing so service users are active agents in the process of risk management. However, we indicate that there are adverse effects of this approach to risk management as the risk assessment process is subverted by the restriction of the flow of information, and service users are left with frustrations that they must contain and manage.4

StreetWise: developing a serious game to support forensic mental health service users' preparation for discharge: a feasibility study

“…This reflects ongoing difficulties with existing assessments in FMH services; with service users modifying their behaviour in response to perceived cues in the environment to reduce their risk level and increase their freedom, and service providers seeking to establish whether this change is authentic or if the user is gaming the system (Reynolds et al . ).…”

“…However, as noted by the participants, there needs to be caution in the use of the game, to avoid superficial responses through linking scoring directly to assessments of behaviour and risk (Reynolds et al . ). Although using Serious Gaming as a participatory approach for risk assessment and to promote recovery may enable movement away from compliance and a reliance of mental health nurses on bio‐medical approaches to care within FMH services (McKeown et al .…”

“…Thus, providing ecologically valid therapies and risk assessments, which are relevant to real‐life situations is an ongoing challenge for service providers (Reynolds et al . ).…”

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

“…That said, patients in these studies desired relationships that discussed risks but how risks were defined appeared to conflict with staff perspectives. Instead, patients opted to speak to fellow patients to gain support, perhaps due to the reciprocity of these relationships, and a shared understanding that a loss of personal and collective identities also constituted a risk (Coffey, ; Dixon, ; Reynolds et al, );

The patients help each other, don't trust the doctors and nurses…The patients meet in the evenings and talk about what happens day‐to‐day, keep in touch with reality, with our reality and the outside world. (Reynolds et al, :206)

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“…The patients help each other, don't trust the doctors and nurses…The patients meet in the evenings and talk about what happens day‐to‐day, keep in touch with reality, with our reality and the outside world. (Reynolds et al, :206)…”