Recovery, turning points and forensics: views from the ward in an English high secure facility

Abstract

Purpose – The authors offer up an example of recovery in a high-secure setting. The purpose of this paper is to highlight how an individual account of recovery and the academic literature offer up related and important perspectives that have serious clinical utility. Design/methodology/approach – First the context is outlined. The biographical account is then deployed to describe the experience of being detained in an English high-secure facility using recovery as a framework for elucidation. This is often referred to in recovery as accessing the views of the “expert by experience”. In a thematic way this author details his understanding of recovery, what worked and what did not. This account is then contrasted with the academic literature and research at the same site. Social anthropology acts as the theoretical backdrop. This debate informs some clinical implications and issues for practice. Findings – Recovery can be a highly relevant concept in a high-secure context. The author found that the biographical account of the “patient” can offer the observer some insights for practice. The authors noted that the collective themes of previous research where consistent to this account. The authors found the use of recovery principles helped the person receiving care fulfil his potential. Nevertheless, forensic recovery implies a forensic past. This complicates recovery and placed limits on the own use of the principles. Social implications – The authors argue that recovery is highly relevant to the context and particularly important to people who are often stigmatized for multiple reasons including their, “illness”, their “crime”, and their social situation. The paper implies that forensic recovery is more problematic than mainstream recovery. Key events mark out issues. Originality/value – This is the first co-produced paper surrounding recovery in high-secure care.

Looking back, looking forward: Recovery journeys in a high secure hospital

“…Identification of a recovery journey for the institution, moving on from previous criticisms, reflect the more personal journeys of redemption that cooperative and engaged service users are embarked upon. In that sense we concur with Chandley and Rouski's () conclusions that, for high secure services, the recovery path is well worth taking, but ‘if this is a journey there is a long way to go’. Despite a single hospital focus, the research has wider international appeal when considering the felt impact of secure environments upon recovery practices.…”

“…Recovery practices can be meaningful in high secure hospitals, despite various constraining factors (Adshead et al ; Drennan & Aldred ; Ferrito et al ). A small number of first‐hand accounts attest to challenges but also affirm a meaningful recovery trajectory is possible for people detained in such services (Chandley & Rouski ; Coffey ; McKeown et al ; Moore et al ). The requirement for substantial security measures will always have an impact and necessitate some adaptations compared to less restrictive environments.…”

“…The value of warm, effective, consistent relationships and communication is evident in this study and is emphasized in published first‐person accounts (Tapp et al ). For example, the service user voice in the Chandley and Rouski () co‐authored paper, also located in Ashworth, notes how simple factors assist in building trust, such as staff doing what they say they are going to do, smiling, or offering explanations for refusals. This person also stresses the importance of the key recovery concept hopefulness, bound up with identified turning points on a personal journey, including coming to terms with the past and being able to envisage future goals beyond the hospital.…”

“…Recovery has been explored as an organizing concept within UK secure services, with interesting developments in all four high secure hospitals – Ashworth (Chandley & Rouski ; Chandley et al ; Davies & Abbot ), Broadmoor (Adshead ; Adshead et al ; Ayres et al ; Drennan & Aldred ; Dworkins & Adshead ; Ferrito et al ; Hayward & Ayres ; Maguire & Merrick ; Moore et al ) and Rampton (Madders & George ; Souter ; Völlm et al ) in England and The State Hospital in Scotland (Laithwaite & Gumley ; Laithwaite et al ; Walker & Langton ). In Ashworth, where this study was sited, initiatives include designated staff and service user recovery champions for each ward who also meet centrally for strategic purposes, widespread use of a collaborative recovery measure (the Recovery Star Secure ‐ http://www.outcomesstar.org.uk/), implementation of an in‐house recovery college, and an action research project focused upon recovery practices at ward level (Chandley & Rouski ; Chandley et al ). Practitioners at Ashworth and other secure units have assisted ImROC to produce practice development guidance (Drennan et al ).…”

How Could Co-production Principles Improve Mental Health Spiritual and Pastoral Care (Chaplaincy) Services?

“…They define co-A and deliver support together, recognising that both partners have vital contributions to make in . Researchers who have mental health staff report that the they consider human qualities of warmth and sensitivity more important than specific therapeutic approaches (Chandley andRouski, 2014, Forrest et al, 2000).…”