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The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe.

The study used the grounded theory approach utilising a mixed sequential dominant status design (QUAL/Quant). Pierre Bourdieu’s conceptual canon of field, habitus and capital was used as a theoretical point of departure by the research study. Confirmatory retrospective document review of 119 patients’ files was also done to substantiate the nurses’ experiences. Theoretical sampling of relatives was also done.

Findings and results revealed that nurses seemed to experience infrahumanisation, a subtler form of dehumanisation. The infrahumanisation was embodied in the unpleasant context in which nurses were expected to perform their mandate of championing rehabilitation of forensic psychiatric patients. The guards who represented the prison system seemed to possess all forms of capital in the prison system (where special institutions are housed): the prison cultural capital, social capital and economic capital. This capital seemed to represent symbolic power over the disillusioned and voiceless nurses. Guards attended to and discussed patients and relatives issues instead of nurses. This form of misrecognition of the nurses culminated in dominance and reproduction of the interests of the prison system which underlined the established order of realities in the rehabilitation of forensic psychiatric patients in special institutions at the time of the study. The nurses’ lived experience was confirmed by theoretically sampled by relatives of forensic psychiatric patients who also participated in the research study. Nurses’ powerlessness was also reflected in the patients’ files in which in which care was largely not documented.

The study focused on the nurses experiences related to rehabilitation of male forensic psychiatric patients and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. For the little documentation that was done, there was also a tendency nurses to document negative rather than positive events and trends. The documents/files of patients had therefore a negative bias which was a major limitation to this study.

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting. Collaboration as academia, practice, professional organisations and regulatory bodies would foster a nurse led therapeutic jurisprudence in the future of rehabilitation of forensic psychiatric patients in Zimbabwe.

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting.

This is the first description of the position of nurses’ seconded to special institutions in Zimbabwe and will go a long way in realigning conflictual policy documents guiding care of forensic psychiatric patients in special institutions.

A high and possibly increasing prevalence of mental disorders in prisoners has been demonstrated in recent surveys. Psychiatric care of prisoners is subject to wide regional variations in Germany, especially regarding inpatient treatment. Although hospitalized psychiatric patients in prison closely resemble those in forensic psychiatric secure hospitals with regard to socio‐demographic (percentage of women, age peak) and forensic characteristics (delinquency, prison experience), marked discrepancies in the diagnostic spectrum necessitate very different treatment planning based on general clinical psychiatry when considering the approach and especially the treatment duration. In Berlin, we try to develop a care structure within the prison system, which addresses inmate‐specific problems and circumstances as well as the possibility of inpatient and outpatient treatment and semihospitalization according to the principle of “equivalence”.

The purpose of this paper is to discuss human rights assessment and monitoring in psychiatric institutions from the perspectives of those whose rights are at stake. It explores the extent to which mental health service user/psychiatric survivor priorities can be addressed with monitoring instruments such as the WHO QualityRights Tool Kit.

The paper is based on the outcomes of a large-scale consultation exercise with people with personal experience of detention in psychiatric institutions across 15 European countries. The consultation took place via one focus group per country and extended to a total of 116 participants. The distinctive characteristic of this research is that it imparts an insider perspective: both the research design and the qualitative analysis of the focus group discussion transcripts were done by a social researcher who shared the identity of service user/survivor with the participants.

The paper highlights human rights issues which are not readily visible and therefore less likely to be captured in institutional monitoring visits. Key issues include the lack of interaction and general humanity of staff, receipt of unhelpful treatment, widespread reliance on psychotropic drugs as the sole treatment and the overall impact of psychiatric experience on a person's biography.

Because of the way participants were recruited, the research findings do not offer a representative picture of the human rights situation in particular countries. They point clearly, however, to new directions for human rights research in the psychiatric context.

This paper demonstrates the indispensability of experiential knowledge for not only securing and improving but also extending the understanding of human rights standards in psychiatry.

This article describes and clarifies the human rights of persons with disabilities in the context of detention in light of the recently adopted and already in force Convention on the Rights of Persons with Disabilities (the Convention). Focusing on the Convention, the article sheds light on the legality of certain forms of detention affecting persons with disabilities, the substantive and procedural requirements for their detention, and on their rights in relation to conditions of detention. This article also provides an account of the different treatments and practices inflicted on persons with disabilities in prisons and other institutions and assesses whether they constitute torture and ill treatment. The authors argue that the Convention on the Rights of Persons with Disabilities represents a paradigm shift that requires States to modify and adopt laws, policies and practices that fully respect the right to liberty of persons with disabilities, and their equal enjoyment of rights while in detention, including the right to be free from torture and ill treatment.

Begins from the premiss that job satisfaction among caring professionals is important not only for its own sake, but also for its effect on service outcomes. Presents empirical results, from four very different countries, which suggest that management‐influenced variables can help to ameliorate job dissatisfaction arising from factors such as resource constraints. Develops the thesis that cross‐cultural comparisons are a valid instrument for assessing the effect of management efforts which contribute to psychiatric satisfaction and feelings of autonomy. Establishes the need for more cross‐national investigation of the relationship of management to worker job satisfaction.

Recent international experiences of community inclusion have produced a major change in residential care for people with intellectual disability (ID). Assignment and outcome assessment through new person‐centred measures are raising increasing interest; however, the information on quality of life and accommodation is still limited. This paper aims to provide an overview of the application of quality of life models and the size of the provision of different living arrangements.

A systematic mapping of the literature of the last decade was followed by an expert guided review of the available evidence.

QoL outcomes measures of living arrangements in people with ID show conceptual and methodological challenges. The following key topics were identified: individual level: issues related to health status, behavioural problems and other personal factors (ageing, choice and empowerment); family and peers; local level: accommodation, architecture and urbanization, and economic aspects (deprivation and costs); macro level: social participation (community inclusion). The residential solutions that are currently considered of highest efficiency are small apartments in the community and “cluster centers”.

The level of quality of life is very relevant in the assessment of living arrangements in people with ID although its assessment still shows significant limitations. Some accommodation typologies seem more effective than others. New conceptual models of inclusive residential care support the convenience of a wide range of accommodation alternatives that may fit the individual needs of a highly heterogeneous population group. A unique residential alternative, albeit optimal from a community care perspective, may not be adequate for all persons with ID.

This paper aims to bring back into view some of the original ideas from which the Therapeutic Community (TC) developed today. If we forget the origins of therapeutic communities way back in the past, we cannot be in the best position to make decisions for the present. The underlying principles of the TC are a combination of social science ideas, psychotherapeutic practices and a political urgency to do something for disadvantaged people. There is a need to try to keep all branches of the past roots in play together.

Learning from the past.

The past has a relevance that must not be forgotten in present reflection.

This is a reflective exercise at the heart of the therapeutic community practice.

The purpose of this study is to investigate the informal micro-level mechanisms through which caregivers maximize their health literacy and caregiving skill-set, particularly in cases of emergent, pervasive health disorders. Specifically, I investigate how important micro-level social factors, such as lay self-education and local community networks, mitigate extensive experiences of medical uncertainty that are associated with caring for a child with autism. This study theorizes a series of processes of becoming lay health care professionals (HCP), which serve as effective health care interventions and ways to secure vital resources for patients and their families.

This study uses qualitative research methods in the form of 50 individual intensive interviews with primary caregivers of at least one child under the age of 18 with an official autism diagnosis, as well as two years of participant-observation at two primary sites that are autism parent and caregiver resource meetings, both located in Northern California.

This study first demonstrates the major institutional limits and gaps involved in health-related caregiving for children with autism. Next, I define the processes through which caregivers challenge these institutional constraints and fight for life altering resources for their families, which include becoming a lay diagnostician and expert caregiver. Here, I demonstrate a sophisticated set of health literacy skills and key local community-based ties that caregivers develop and rely on, which affords families the tools to overcome diverse institutional obstacles in health-seeking and health care access.

The families in this study are predominantly white, middle-class, and reside in California. For future research, the scope of the study could be expanded by increasing the sample size and including greater geographic and demographic diversity.

This study contributes vital, yet missing, pieces to the autism puzzle, which currently focuses on prevention, the fight for a so-called “cure,” and the role of vaccines in disorder prevalence. In the meantime, families are living with autism each day and are struggling for understanding and knowledge, and to secure adequate support services. In doing so, this study sheds light on current institutional gaps and limits in health care and delivery for children with autism, and suggests specific effective health care interventions applicable to other cases of emergent illnesses and disorders.

The purpose of this paper is to develop a medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe.

Grounded theory of the Charmaz (2006, 2014) persuasion was used. An exploratory qualitative design was utilised. The theoretical framework that was used as a point of departure was Pierre Bourdieu’s conceptual canon. Participants were purposefully and theoretically sampled. These included the judiciary, patients, patients’ family, psychiatrists, nurses, social workers, experts in forensic psychiatric practice. They were 32 in total.

The findings reflected a need to realign the dislocation and dissonance between and within the fields of the prison system, medical system, and the judiciary. The realignment was done by co-constructing a therapeutic jurisprudent medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe with participants who were stakeholders in forensic psychiatric rehabilitation.

The study was focused on male forensic psychiatric patients rehabilitation and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. However, it is possible that including females in the study could have added perspective to the study. This also limits the generalisation of findings beyond the male forensic psychiatric participants. Services beyond the experience of participants translate to the notion that findings cannot be generalised beyond the parameters of the study. Future research and service evaluation and audit need to be considered. The study findings focused on the “psychiatric” aspect and did not emphasise the “forensic” aspect of the service delivery service. Future research may need to feature physical provisions and progression pathways with reference to “forensic” risk reduction as a parallel goal.

The study calls for the following: Transformation of the medico-judicial system, adjusting legislation and restructuring of the public service; changing of public attitudes to enable implementation of the medico-judicial framework; there is need for a step by step process in the implementation of the framework in which training needs of service staff, social workers, community leaders and key stakeholders will need to be addressed; the proposed changes presented by the model will require cultural, financial and infrastructural shifts.

There is need for policy makers to re-enfranchise or rebrand forensic psychiatric rehabilitation services in Zimbabwe. This could positively involve the marketing of forensic psychiatric rehabilitation to the stakeholders and to the public. This is projected to counter the stigma, disinterest and disillusionment that run through both professionals and public alike. This will foster a therapeutic jurisprudence that upholds the dignity and rights of forensic psychiatric patients.

This work is an original contribution to forensic psychiatry in Zimbabwe. Research in that area is prohibitive because of the complexity of processes that are followed. This research is therefore ground breaking.

The purpose of this chapter is to apply structural functional theory and the concept of “unbundling” to an analysis of the deinstitutionalization and community mental health efforts that have shaped the current mental health services environment.

We examine the original goals of the institutional movement, the arguments supporting it, and the functions of the institutions that were created. We then examine the criticisms of that approach and the success of the subsequent deinstitutionalization process, which attempted to undo this process by recreating the hospitals’ functions in community settings. Finally, we address the question of whether the critical functions of psychiatric institutions have indeed been adequately recreated.

Our overview of outcomes from this process suggests that the unbundling of state hospital functions did not yield an adequate system of care and support, and that the functions of state hospitals, including social control and incapacitation with respect to public displays of deviance were not sufficiently recreated in the community-based settings.

The arguments for the construction of state hospitals, the critiques of those settings, and the current criticism of efforts to replace their functions are eerily similar. Actors involved in the design of mental health services should take into account the functions of existing services and the gaps between them. Consideration of the history of efforts at functional change might also serve this process well.