Strength- and recovery-based approaches in forensic mental health in late modernity: Increasingly incorporating a human rights angle?

Abstract

Forensic mental health care is situated across both criminal justice and healthcare systems and is subject to political, cultural, legal and economic shifts in these contexts. The implementation of strength- and recovery-based models of care should be understood in light of these social and structural processes. Drawing on novel empirical fieldwork and the extant literature, we argue that full realisation of strength- and recovery-based principles is at odds with aspects of late modern social control. Not wholly compatible, we highlight how concepts of empowerment, autonomy, identity and connectedness can unhelpfully rub-up against the concepts of punitiveness, otherness and risk management. Conceptually this is problematic, but in frontline forensic psychiatry settings, this has real lived-experience detrimental effects for patients – as our data demonstrate. To address this, a human rights approach might be fruitful. Grounding arguments for strength- and recovery-based principles in the heuristic framework of human rights can offer a set of common values to stimulate reform in forensic mental healthcare. The right to respect for private and family life, home and correspondence under Article 8 of the European Convention on Human Rights and Fundamental Freedoms offers a particularly promising, robust and well-defined framework for these future changes – as we outline.

The Totalising Nature of Secure and Forensic Mental Health Services in England and Wales

“…For instance research has historically proven that a significant number of forensic patients have been placed at unnecessarily high levels of security ( 21 ). It has been argued with reference to empirical data and literature that the defining characteristics of late modern social control are manifest within forensic mental health services ( 22 ).…”

“…It is recognised that in secure and forensic mental health settings a culture of containment can present in which staff become increasingly unable to deliver intervention which will aid recovery and instead prioritise unsafe certainty via the deployment of restrictive measure, both direct and indirect ( 17 , 18 ). The actualisation of patient empowerment, autonomy, identity, and connectedness can conflict with and be compromised by the punitive influences of disproportionate risk aversion and other forms of containment and control ( 22 ).…”

“…Patients experience punitiveness daily via the enactment of protocols; blanket restrictions and other rules and regulations ( 22 ). The spectre of presumed public opinion and the fear of condemnation from the popular press haunts secure and forensic mental health settings and dictates and sustains a philosophy of stigmatisation and oppression.…”

“…It has been posited that grounding arguments for strength- and recovery-based principles in the heuristic framework of human rights can offer a set of common values to stimulate reform in forensic mental healthcare ( 22 ). Article 8 of the European Convention on Human Rights (ECHR) and Fundamental Freedoms (right to respect for private and family life, home and correspondence) protects individuals' “physical, psychological, or moral integrity,” “privacy,” and “identity and autonomy” ( 121 , 122 ).…”

“…It has been argued that the substantive rights contained within Art. 8 ECHR ( 122 ) are aligned with the essential components of strength- and recovery-based approaches ( 22 ). Therefore, the imposition of barriers to the enactment of these principles can be contested within a cogent human rights framework.…”