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Medicine, madness and murderers: the context of English forensic psychiatric hospitals

Ruth McDonald (Alliance Manchester Business School, University of Manchester, Manchester, UK) (Centre for Primary Care, University of Manchester, Manchester, UK)
Vivek Furtado (Warwick Medical School, University of Warwick, Coventry, UK)
Birgit Völlm (University of Nottingham, Nottingham, UK)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 21 August 2017




The purpose of this paper is to add to the understanding of context by shedding light on the relationship between context and organisational actors’ abilities to resolve ongoing challenges.


The authors used qualitative data collection (interviews and focus groups with staff and site visits to English forensic psychiatry hospitals) and the analysis was informed by Lefebvre’s writings on space.


Responses to ongoing challenges were both constrained and facilitated by the context, which was negotiated and co-produced by the actors involved. Various (i.e. societal and professional) dimensions of context interacted to create tensions, which resulted in changes in service configuration. These changes were reconciled, to some extent, via discourse. Despite some resolution, the co-production of context preserved contradictions which mean that ongoing challenges were modified, but not resolved entirely.


The paper highlights the importance of viewing context as co-produced in a continuous manner. This helps us to delineate and understand its dynamic nature and its relationship with the everyday actions and beliefs of the organisational actors concerned.



Department of Health Disclaimer: the views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS or the Department of Health.

This project was funded by the National Institute for Health Research HS&DR Programme (Project No. 11/1024/06).


McDonald, R., Furtado, V. and Völlm, B. (2017), "Medicine, madness and murderers: the context of English forensic psychiatric hospitals", Journal of Health Organization and Management, Vol. 31 No. 5, pp. 598-611.



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Copyright © 2017, Emerald Publishing Limited

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