Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause... more
Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection. Main text This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection. Conclusions Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.
Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause... more
Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection. Main text This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection. Conclusions Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.
Introduction“Head banging” is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated the prevalence and correlates of head banging behaviour in... more
Introduction“Head banging” is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated the prevalence and correlates of head banging behaviour in clinical populations.MethodHead banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis.ResultsTwo hundred and twenty nine incidents of head banging were recorded, occurring approximately every three days in each service. The prevalence of the behaviour between individual patients varied widely, ranging from one to 38 incidents within one year. Women and patients with intellectual disability appeared more likely to engage in head banging. Qualitative incident reports...
Background/Aims: In Australia, national data indicate that the rate of seclusion use in public forensic mental health inpatient settings has almost tripled since 2008, with the number of patients being admitted to these settings being... more
Background/Aims: In Australia, national data indicate that the rate of seclusion use in public forensic mental health inpatient settings has almost tripled since 2008, with the number of patients being admitted to these settings being secluded more often but for shorter durations. The aim of this study was to describe and analyse the use of seclusion within an adult forensic mental health inpatient setting in Australia. The study also sought to compare and examine the characteristics of patients who experienced seclusion and those who did not.
Methods: This quantitative study was achieved by completing a retrospective case file audit. Data were collected on all patients admitted to the adult forensic mental health inpatient unit during a 6-month period (January to June 2016). Data were obtained from medical records including age, sex, ethnicity, primary and secondary diagnosis, referral source and previous admissions to acute and forensic mental health inpatient settings.
Results: During the 6-month study period, 117 admissions to the service occurred involving 109 patients. There were 61 seclusion events involving 20 (18%) patients. Data indicated that patient gender and diagnosis increased the likelihood of a seclusion event occurring.
Conclusions: Seclusion was used on a small number of patients who presented a high risk, specifically young, white men with a diagnosis of schizophrenia or a psychotic disorder and drug-related symptoms. Identifying patient characteristics that increase the risk of seclusion is important so that services can design early intervention strategies to enhance patient safety.
Research on the influence of nursing staff composition and use of seclusion in the forensic mental health inpatient settings is sparse. Nursing staff composition refers to staffing levels, roles, gender ratio and skill mix of the ward... more
Research on the influence of nursing staff composition and use of seclusion in the forensic mental health inpatient settings is sparse. Nursing staff composition refers to staffing levels, roles, gender ratio and skill mix of the ward teams. Internationally, the rates of seclusion in some forensic mental health inpatient settings have increased over the past 10 years despite global efforts to reduce and eliminate its use. Aim: To examine whether the use of seclusion in a forensic mental health inpatient setting can be attributed to staffing composition or to contextual factors such as day of the week, month or other clinical factors. Method: Retrospective data collection was conducted using seclusion data, daily ward reports and staff rosters. Data were collected for all shifts in the hospital over a six-month period. Results: Three staffing variables were identified as having an influence on the use of seclusion: the number of registered nurses on duty, the presence of the shift coordinator and having a lead nurse on shift. Discussion: Senior nurse oversight and guidance are important factors in assisting staff to identify clinical deterioration and intervene early which may assist services reduce the use of seclusion. Implications for practice: As staffing levels and composition are modifiable, the results of this study may assist nurse leaders to consider workforce improvements to reduce seclusion use.
Background/Aims Seclusion and restraint use in health care is controversial. Such practices occur more frequently in forensic mental health settings than in acute mental health settings. There is growing interest in staff factors and... more
Background/Aims Seclusion and restraint use in health care is controversial. Such practices occur more frequently in forensic mental health settings than in acute mental health settings. There is growing interest in staff factors and their influence on such practices. The aim of this review was to identify and appraise studies that explore whether nursing staff characteristics, including age, gender, ethnicity and physical stature, influenced the use of these practices in forensic mental health settings. Methods Eight electronic databases were searched to identify research studies published between 2010–2020. The search yielded 1085 articles, three of which fulfilled the inclusion criteria. Results There was no significant correlation between age, gender and experience and the tendency to use seclusion and restraint. No studies examined ethnicity, physical stature, seniority or role. Conclusions The results demonstrate a paucity of research on nursing staff characteristics and their...
Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause... more
Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection. Main text This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection. Conclusions Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.
Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause... more
Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection. Main text This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection. Conclusions Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.
Background: Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause... more
Background: Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection. Main text: This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection. Conclusions: Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.
Au cours des vingt dernières années, plusieurs changements sociaux et politiques ont contribué à la transformation des pratiques d’intervention en psychiatrie. Ces changements sont notamment expliqués par le rapprochement continuel des... more
Au cours des vingt dernières années, plusieurs changements sociaux et politiques ont contribué à la transformation des pratiques d’intervention en psychiatrie. Ces changements sont notamment expliqués par le rapprochement continuel des espaces hospitaliers et de justice. L’objectif de cet article est de discuter de la contribution du concept d’hétérotopie pour l’étude de ce phénomène et s’appuie sur les résultats d’une recherche ethnographique réalisée dans l’un de ces espaces, la Commission d’examen. Les considérations théoriques et méthodologiques de ce projet, de même que le rôle de la Commission d’examen, seront d’abord discutées. La première partie de cet article portera sur la juxtaposition des espaces hospitaliers et de justice et ses conséquences sur les relations existantes entre les acteurs intra- et extra-juridiques. La dernière partie de cet article s’intéressera à la signification clinique de la judiciarisation et plus particulièrement des espaces de justice en santé mentale pour le travail infirmier.
Forensic psychiatric institutions are tasked with both containment and transformation; with securely policing the border between institution and society and readying patients for return to the community. Forensic institutions can thus be... more
Forensic psychiatric institutions are tasked with both containment and transformation; with securely policing the border between institution and society and readying patients for return to the community. Forensic institutions can thus be theorised as a form of ‘rite of passage’, engaged in a process of transformation which both navigates and demarcates social limits. This article contributes to literature on risk and control in clinical institutions by offering a novel theoretical synthesis of features of rites of passage and liminality, as facilitated by an art project in a forensic setting. Through the prism of the Graffiti and Wellbeing Project (GWP), an arts initiative, we explore the ways in which forensic institutions thus offer or impede opportunities for transformation. The project engendered a space for the transformation of difficult emotions and histories through the medium of art creating a liminal space of transformation within the confines of a secure institution. Drawing on Douglas, Kristeva and Bahktin, we argue that forensic institutions largely attempt to manage their own transgressive, marginal status, and the abject experiences of patients, through a recourse to order, suppression and sublimation. We argue for a wider range of responses to the transgressive and marginal experiences and behaviours prevalent in forensic settings, drawing on examples from the GWP.
Societies allocate to specific child protection and forensic services a threefold task of assessing and caring for vulnerable children and treating some of the most deprived, troubled and dangerous adults while protecting others from... more
Societies allocate to specific child protection and forensic services a threefold task of assessing and caring for vulnerable children and treating some of the most deprived, troubled and dangerous adults while protecting others from their destructive attacks. These responsibilities give rise to a range of anxieties as professional staff find themselves sandwiched between these possibly, contradictory demands. This chapter considers the predicament of social workers in child protection services and that of staff working in forensic group care settings.
Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia’s mental health services. Whilst legislation, organization and practice changes have all contributed to a... more
Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia’s mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty-two nurses were recruited from one Australian forensic mental health service. Data were collected using semi-structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high-risk patient cohort.
Nursing stations that were set up to enable nurses to observe patients, have also become goldfish bowls within which nursing staff can be constantly observed and scrutinised by them. This reciprocal process of observation and scrutiny in... more
Nursing stations that were set up to enable nurses to observe patients, have also become goldfish bowls within which nursing staff can be constantly observed and scrutinised by them. This reciprocal process of observation and scrutiny in itself creates what we have called a perverse panopticon (Scanlon and Adlam 2011a) in which all are observed and related to by all – through conscious and intentional scrutiny, as well as the more primitive forms of unconscious communication rooted in processes of projective and introjective identification.
Rather than socialising, the perverse panopticon provides a context within which pro-social forces can be corrupted and staff, as the arbiters of some of these would-be pro-social forces, can become contaminated. In their contaminated states of mind, they then present a clear and present danger to those who they watch over. As was the case with Foucault’s historical lazar-houses and the fictional citizens of Camus’ plague-stricken town, the anxiety of the perverse panopticon gives rise to a very real psycho-somatic fear of relationally transmitted dis-eases as well as the omnipresent threat that it might manifest itself as real physical violence. It is as if the very atmosphere of the ward is contaminated by a terrifying yet invisible environmental pollution which cannot easily be symbolised, nor can it be avoided or ignored –regardless of whether or not one is a wearer of the ‘white coat’.
In the forensic treatment setting each party is watching the other for any sign of the aggression, violence or seduction which might put them in harm’s way. There is a persistent threat to psychic survival faced both by the workers and the patients inhabiting these boundariless universes where the intrusiveness of looking and being looked at is everywhere. In this perverse and ‘unboundaried’ environment the very real dangerousness of the patient mirrors the ways in which they experience themselves as endangered by the boundariless and perverted advances of the would-be helper and vice versa. In these settings there is nowhere for either sub-group to hide.
One peculiar characteristic of forensic work is that the capacity of the patients to act out their violent states of mind is what has resulted in their entering into treatment, rather than any more conscious motivation for treatment or... more
One peculiar characteristic of forensic work is that the capacity of the patients to act out their violent states of mind is what has resulted in their entering into treatment, rather than any more conscious motivation for treatment or recovery. This fact of their involuntary patient status means that patients’ survival is literally dependent upon, if not actively under threat from, the treatment they receive from the system of care. Disastrously this hostile dependency has, from time to time, resulted in a number of mental health workers being killed and injured by their patients and many more reports into the various ways and means in which such patients have been subjected to interpersonal and institutional mistreatment.
The focus of this chapter will be on the persistent threat to psychic survival faced both by nurses and patients in forensic settings, how these threats become manifest in the dynamic interplay between nurses (and others with the multi-disciplinary team) and those mentally disordered offender patients who are perceived to be dangerous. Our starting point is that these threats are both real and imagined and are brought about by the enforced proximity (or the avoidance of it) between nurses and patients within forensic settings.
As a central part of their role in working with mentally disordered offenders in secure settings, frontline workers such as mental health nurses are expected, on behalf of us all, to keep watch over their patients. They must observe and... more
As a central part of their role in working with mentally disordered offenders in secure settings, frontline workers such as mental health nurses are expected, on behalf of us all, to keep watch over their patients. They must observe and assess their movements, their progress and regress, whilst themselves being subject to scrutiny, inspection and surveillance from the wider system of care. The fact of the patients' involuntary status means that they are both dependent upon and under threat from the treatment they receive from their watchers. They too are ever vigilant and always on watch for potential threats arising from the enforced proximity with their watchers in the ward as well as from the wider judicial review systems. Disastrously the hostile dependency that is at the heart of these reciprocal roles is, from time to time, enacted in more overt violence, resulting in significant numbers of injuries, affronts and offences on both sides. There is nowhere for either group to hide to escape the scrutiny of the other. With reference to Jeremy Bentham's Panopticon (Bentham, 1995) and Michel Foucault's (1975) exploration of Bentham's ideas, our aim is to present a systems-psychodynamic exploration of the ways in which the potentially corrosive effects of these dangerous liaisons are played out between these would-be watchers and their hyper-vigilant charges. We also discuss the ever-present dynamics of shame and shaming: the illicit libidinal excitements that become invested in 'the gaze' and in the reciprocal roles of voyeur and exhibitionist as they pass between the watcher(s) and the watched in this perverse panopticon.
Approximately 210 patients are admitted each year to the Western Australian State Forensic Mental Health Service, and most present with psychotic illness, along with other physical and mental comorbidities. In 2010, a healthy lifestyle... more
Approximately 210 patients are admitted each year to the Western Australian State Forensic Mental Health Service, and most present with psychotic illness, along with other physical and mental comorbidities. In 2010, a healthy lifestyle programme, which included a formal exercise programme coordinated by an exercise physiologist, was introduced at the service. A self-report questionnaire was developed to obtain feedback on the programme, and 56 patients completed the questionnaire during the 6-month evaluation period. As well as providing patients with access to regular physical activity, the programme also supports the recovery philosophy, where patients work in partnership with forensic mental health staff. Overall, patients reported that the programme assisted them to manage their psychiatric symptoms, as well as improving their level of fitness, confidence, and self-esteem. In addition, patients received education about the importance of regular exercise to their mental health, and the role exercise plays in preventing chronic illness and obesity. While the benefits of exercise on mental health outcomes for people with depression and anxiety are well established, this evaluation adds to the evidence that such programmes provide similar benefits to people who have a psychotic illness and are hospitalized in an acute secure setting.