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

Abstract

Purpose – The purpose of this paper is to derive from an on-going, innovative, project to explore the concept, and application, of “recovery” in the care and clinical management of patients detained in one UK high-security hospital. Design/methodology/approach – Utilising a qualitative, action research, methodology the aim was to involve forensic mental health nurses in a collaborative, client-centred approach to identification and resolution of dilemmas in the process of planning care for offender-patients. Findings – In this context the authors identify constraints and contradictions involved in employing recovery principles in institutions critics refer to as part of the disciplinary apparatus of psychiatric and social control; where the taken for granted lives, and relations, of an incarcerated population are measured by the calendar, not the clock. Research limitations/implications – Protective practices remain highly relevant in high-secure practice. Safety, an important value for all can by and large be achieved through recovery approaches. The humanistic elements of recovery can offer up safe and useful methods of deploying the mental health nurse on the ward. Many nurses have the prerequisite approach but there remains a wide scope to enhance those skills. Many see the approach as axiomatic though nurse education often prepares nurses with a biomedical view of the ward. Practical implications – Currently, philosophical tenets of recovery are enshrined in contemporary health policy and professional directives but, as yet, have not been translated into high-secure settings. Drawing on preliminary findings, attention is given to the value of socially situated approaches in challenging historic dominance of a medical model. Social implications – It is concluded that recovery could be a forerunner of reforms necessary for the continued relevance of high-secure care into the twenty-first century. Originality/value – This research is located in high-secure setting. The social situation is marked by the extent of the isolation involved. A value is in this situation. First it is akin to the isolation of the tribe utilised by many anthropologists for their ability to adopt the “social laboratory” status to test out theories of behaviour in industrial society. The authors urge others to utilise this research in this way. Second, the situation represents the locus of so many of societies dilemmas, paradoxes and fears that moral issues morph from what is the mundane in wider society. In this way humanistic approaches are tested via action research with nurses in some rigouous ways.

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

“…Reflections involve a sense of both looking back, into personal histories and the chequered history of the institution, and looking forward, often, but not exclusively, with the sort of hope implied in standard definitions of recovery. Arguably, recovery represents both the antithesis of the received view of high secure regimes and, seemingly paradoxically, the strategic adoption of recovery in these institutions may be the ‘key to progress’ (Chandley et al : 205).…”

“…Chandley et al . () remark that many nurses working in high secure settings have the necessary skills and experience to apply recovery approaches in this context, and that effective relational skills are majorly important in this regard, but there is also room for further learning and enhancement of these skills across care teams.…”

“…One impediment to uptake and implementation of recovery ideals and practices among the majority staff group is the emphasis within nurse education of bio‐medical understandings of care, and the more general subordination of all disciplines under psychiatry. Arguably, these tendencies are as prominent within the relatively isolated forensic sector as in the mainstream (Chandley et al ) though, as has been noted, much progress has been made in this context and practices around involvement and recovery can in some regards be superior in certain secure settings (McKeown et al ).…”

“…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 ).…”

“…Consequently, Chandley et al . () at Ashworth suggest that the recovery concept can play an essential role in demonstrating the continuing relevance of high secure hospitals amidst various historical and contemporary criticisms of their legitimacy (see Pilgrim ).…”