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Article
Publication date: 1 June 2008

Palmer Orovwuje

Various attempts have been made to understand and resolve the enduring lack of cohesiveness of multidisciplinary teams (MDTs), their dysfunctional service delivery and the…

Abstract

Various attempts have been made to understand and resolve the enduring lack of cohesiveness of multidisciplinary teams (MDTs), their dysfunctional service delivery and the feelings of distress among some of the professionals who work in them. Distortions in forensic MDTs have sometimes compromised service delivery and effective risk management. Several public inquiries relating to high‐profile incidents in forensic mental health have noted the role of dysfunctional MDTs. This paper describes the philosophy, structure, functions and achievements of a forensic community MDT in Wellington, New Zealand. It explains a model of care that is adaptable, comprehensive, effective and evidence‐based. It highlights the role of the extended MDT and embedded cultural units from which care professionals work together, share a common philosophy of care and tailor their care to the needs of the individuals or populations they serve.

Details

Mental Health Review Journal, vol. 13 no. 2
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 7 August 2019

Vivienne de Vogel, Petra Schaftenaar and Maartje Clercx

Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising…

Abstract

Purpose

Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can be complicated due to restrictions from finances or legislation and difficulties in collaboration between settings. In the Netherlands, several programs have been developed to improve continuity of forensic care. It is unknown whether professionals and clients are sufficiently aware of these programs. The paper aims to discuss this issue.

Design/methodology/approach

The experienced difficulties and needs of professionals and patients regarding continuity of forensic care were explored by means of an online survey and focus groups. The survey was completed by 318 professionals. Two focus groups with professionals (15 participants), one focus group and one interview with patients (six participants) were conducted.

Findings

The overall majority (85.6 percent) reported to experience problems in continuity on a frequent basis. The three main problems are: first, limited capacity for discharge from inpatient to outpatient or sheltered living; second, collaboration between forensic and regular mental health care; and, third, limited capacity for long-term inpatient care. Only a quarter of the participants knew the existing programs. Actual implementation of these programs was even lower (3.9 percent). The top three of professionals’ needs are: better collaboration; higher capacity; more knowledge about rules and regulation. Participants of the focus groups emphasized the importance of transparent communication, timely discharge planning and education.

Practical implications

Gathering best practices about regional collaboration networks and developing a blueprint based on the best practices could be helpful in improving collaboration between setting in the forensic field. In addition, more use of systematic discharge planning is needed to improve continuity in forensic mental health care. It is important to communicate in an honest, transparent way to clients about their forensic mental health trajectories, even if there are setbacks or delays. More emphasis needs to be placed on communicating and implementing policy programs in daily practice and more education about legislation is needed Structured evaluations of programs aiming to improve continuity of forensic mental health care are highly needed.

Originality/value

Policy programs hardly reach professionals. Professionals see improvements in collaboration as top priority. Patients emphasize the human approach and transparent communication.

Details

Journal of Forensic Practice, vol. 21 no. 3
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 1 December 2008

Max Rutherford and Sean Duggan

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and…

Abstract

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and specialist mental health treatment. There are more than 3,500 people in medium and high‐secure hospitals who have been directed there by the courts or prison system, and nearly 1,000 new admissions are received each year. Yet, the facts and figures relating to these services are patchy and not widely published. This paper builds on an earlier statistical briefing produced by the Sainsbury Centre for Mental Health in 2007, and seeks to provide an up‐to‐date and improved understanding of this area of service provision by presenting the most recent data and figures.

Details

The British Journal of Forensic Practice, vol. 10 no. 4
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 31 December 2009

Margaret Richards, Mike Doyle and Peter Cook

With permission, this paper is an edited and abridged version of an article written by Richards, Doyle and Cook for The British Journal of Forensic Practice (Richards et…

Abstract

With permission, this paper is an edited and abridged version of an article written by Richards, Doyle and Cook for The British Journal of Forensic Practice (Richards et al, 2009), detailing their literature review on family interventions in dual diagnosis and with reference to forensic mental health care. There appeared to be limited direct evidence, therefore various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

Details

Advances in Dual Diagnosis, vol. 2 no. 4
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 3 July 2021

Emily Samuels and Nicola Moran

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general…

Abstract

Purpose

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.

Design/methodology/approach

Face-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.

Findings

Four super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.

Practical implications

Interventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.

Originality/value

This study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.

Details

The Journal of Forensic Practice, vol. 23 no. 2
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 23 July 2020

Jean-Laurent Domingue, Steve F. Michel, Carole Cléroux, Tom Dobson, Jean-Michel Fréchette, Nina Fusco, Lara Jaroudi, Robert Konecki, Donna Power, Sara Richardson-Brown, Richard Robins, Tony Stufko, Sarah Telford and Whitney Wesley

Forensic mental health programs (FMHPs) in Ontario, Canada provide rehabilitation and supervision services. However, models available to guide their delivery are primarily…

Abstract

Purpose

Forensic mental health programs (FMHPs) in Ontario, Canada provide rehabilitation and supervision services. However, models available to guide their delivery are primarily adapted from fields outside of forensic mental health. To partially fill this gap, this paper aims to provide a general review of the process a multi-professional team took to develop the Integrated Forensic Program [IFP]-Ottawa Model of Risk Management & Recovery.

Design/methodology/approach

Working groups were initiated to identify the needs of patients in their local setting, conduct a literature review on care delivery models in forensic mental health and build a service delivery model specific to forensic mental health.

Findings

The resulting model places patient engagement at its centre and encompasses eight domains of need that contribute towards the patient’s recovery and the management of the safety risk they pose to the public, namely, the basic needs, diversity and spirituality, social, occupational, psychological, substance use, physical health and mental health domains.

Practical implications

The IFP-Ottawa Model of Risk Management & Recovery provides a framework to which therapeutic group services for persons in FMHPs can be aligned.

Originality/value

The leadership teams in FMHPs could use this framework and the method used for its development to ensure group services provided at their FMHPs are evidence-informed and coincide with their patients’ specific needs.

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Article
Publication date: 3 August 2012

Jean M. McQueen and Jennifer Turner

This paper aims to capture the views of forensic mental health service users; focusing on how services promote the aspiration to work, the development of skills for work…

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Abstract

Purpose

This paper aims to capture the views of forensic mental health service users; focusing on how services promote the aspiration to work, the development of skills for work, and the vocational rehabilitation process. It seeks to provide insight into forensic mental health service users' views on the barriers and enablers to accessing work together with suggestions for enhancing practice, and implications for further research.

Design/methodology/approach

Ten participants from a range of forensic mental health services throughout Scotland took part in semi‐structured interviews. Participants were involved in either paid work, voluntary work or work preparation. Interpretative phenomenological analysis (IPA) allowed exploration of an individual's lived experiences and how they make sense of this.

Findings

Service users valued the opportunity to address vocational issues at the earliest opportunity in their rehabilitation. Work had an overwhelmingly positive impact on mental health. Analysis of interview transcripts revealed three master themes: “Normalising my life”: the positive impact of work; “Gradual steps”: facing barriers; and “Practical help and encouragement”: feeling supported. There is much to gain from good multidisciplinary rehabilitation within secure hospitals and the community, with work playing an important role in recovery and symptom control. Forensic services should focus on employment and the aspiration to work early, demonstrating awareness that attitude and the aspiration to work are a much more reliable indicator of success than diagnosis and mental health symptoms.

Originality/value

Few qualitative studies have investigated service users' views of work within forensic mental health, yet such information can be crucial to enhance and improve service delivery.

Details

The British Journal of Forensic Practice, vol. 14 no. 3
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 3 November 2009

Margaret Richards, Mike Doyle and Peter Cook

Dual‐diagnosis strategies are developing in medium secure services in response to both government policies and clinical need and there has been a move towards integrated…

Abstract

Dual‐diagnosis strategies are developing in medium secure services in response to both government policies and clinical need and there has been a move towards integrated services for this patient group. Substance use that has been a feature of the index offence must be taken into account as much as psychosis or the offending behaviour. Treatment of dual diagnosis relies heavily on cognitive‐behavioural therapies. Relapse in either psychosis or substance use increases risk and re‐admission rates to medium security. This paper reviews the literature on family interventions in dual diagnosis and its applicability to forensic mental health inpatient services. As there appeared to be limited direct evidence, various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

Details

The British Journal of Forensic Practice, vol. 11 no. 4
Type: Research Article
ISSN: 1463-6646

Keywords

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Article
Publication date: 4 February 2020

Dominic Burke and Angela Cocoman

Examining the education and training needs of forensic nurses is paramount as services move from the older institutions to new care settings. The purpose of this study was…

Abstract

Purpose

Examining the education and training needs of forensic nurses is paramount as services move from the older institutions to new care settings. The purpose of this study was to identify Irish Forensic nurses perceived deficits in their knowledge and skills to assist them to provide effective seamless care for individuals with an intellectual disability within their forensic mental health service, so that appropriate training could be provided.

Design/methodology/approach

Training needs analysis (TNA) procedures are used as a way of establishing the continuing processional development of staff, as they seek to identify the gaps between the knowledge and skills of an individual and the need for further training. A training needs tool developed by Hicks and Hennessy (2011) was used and completed by nurses working in an Irish forensic mental health service. A total of 140 surveys were circulated and 74 were completed (51 per cent response).

Findings

The top priority training needs identified were for additional training in research and audit and in the use of technology. Other self-identified training needs included additional training in behavioural management for challenging behaviour, understanding mental health and intellectual disability and dual diagnosis, training in enhancing communication skills and how to work with patients who have an intellectual disability patients specific training on autistic spectrum disorders and a guide and template for advance individual care planning and for caring for the physical health needs and promoting the physical health needs of these patients.

Originality/value

Despite there being a vast range of training issues identified, the majority of nurses appear to have a clear idea of their training needs to ensure the provision of seamless care for individuals with an intellectual disability within a forensic mental health setting. This TNA has identified the specific needs of nursing staff working at different positions across the interface of intellectual disability and forensic mental health care.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 11 no. 1
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 27 July 2010

Pauline Gill, Paul McKenna, Helen O'Neill, Johnny Thompson and David Timmons

The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single…

Abstract

The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single inpatient site to a modern national forensic mental health service. Central to this transformation is the need to move from the traditional security‐focused model of care to a model of recovery. The challenge incumbent within this transformation is to incorporate a sophisticated amalgamation of the patients' needs while recognising the broad range of security requirements in a forensic setting. This paper considered that adopting an integrated care pathway (ICP) approach would provide the service with a vehicle to re‐engineer our principles and systems of care. Likewise we hypothesised that the ICP would enable us to consolidate best practices such as multi‐ disciplinary working, structured professional judgement and the involvement of the patient and their carers. Thus far it has afforded us the opportunity to examine many aspects of the care delivered within the service. It has provided a shared understanding of key standards among clinicians, service users and carers that are necessary to implement a quality care pathway. It has certainly not been a stagnant process, and the initial work often bears no resemblance to the current process. In turn, we expect that it will continue to change as the path travelled is as important as the outcome and the ICP becomes a dynamic part of the organisation.

Details

The British Journal of Forensic Practice, vol. 12 no. 3
Type: Research Article
ISSN: 1463-6646

Keywords

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