Ada M.L. Hui

Coercive Measures in Forensic Settings: Findings from the Literature

The use of coercive measures, namely restraint, seclusion and involuntary medication, remain controversial methods of practice within forensic psychiatry. Ethical and moral debates surrounding the use of coercive measures are compounded by the need to balance care, safety, and security. Despite such tensions, limited research has been conducted in this area. This paper examines the prevalence of coercive measures and factors associated with their use specifically within forensic psychiatry. A systematic review was conducted and fifteen empirical studies were identified, each examining the use of coercive measures in forensic inpatient psychiatry, reported in papers published between January 1980 and January 2012. Findings suggest that patients who are younger or newly admitted tend to be secluded most often. Findings relating to gender, ethnicity and patient diagnoses, however, are equivocal. Patients tend to perceive experiences of coercive measures negatively. Staff perceptions however, appear to be determined by their role in governing or practicing coercive interventions. Findings are discussed in light of variations in hospital settings, policies and sociocultural traditions. While the uses of coercive measures appear to be influenced by a combination of all patient, staff, and environmental factors, further research is required to explore each of these aspects in greater detail.The use of coercive measures, namely restraint, seclusion and involuntary medication, remain controversial methods of practice within forensic psychiatry. Ethical and moral debates surrounding the use of coercive measures are compounded by the need to balance care, safety, and security. Despite such tensions, limited research has been conducted in this area. This paper examines the prevalence of coercive measures and factors associated with their use specifically within forensic psychiatry. A systematic review was conducted and fifteen empirical studies were identified, each examining the use of coercive measures in forensic inpatient psychiatry, reported in papers published between January 1980 and January 2012. Findings suggest that patients who are younger or newly admitted tend to be secluded most often. Findings relating to gender, ethnicity and patient diagnoses, however, are equivocal. Patients tend to perceive experiences of coercive measures negatively. Staff perceptions however, appear to be determined by their role in governing or practicing coercive interventions. Findings are discussed in light of variations in hospital settings, policies and sociocultural traditions. While the uses of coercive measures appear to be influenced by a combination of all patient, staff, and environmental factors, further research is required to explore each of these aspects in greater detail.

Arts In-Reach: taking 'bricks off shoulders' in adult mental health inpatient care.

Accessible summary •  This research report is focusing upon arts activities on inpatient mental health units in the UK. •  There is little current research about such activities. •  People are often bored and feel powerless on inpatient wards. •  Engaging with arts activities can help increase peoples social interactions and also help people to express themselves. Abstract This article reports upon a research study focusing on a programme of work called Arts In-Reach. The programme was designed to provide a participatory arts programme for the adult mental health inpatient wards in a city in the UK. The aim of the research study was to explore the experiences of people who have engaged with the Arts In-Reach programme of work. Eleven qualitative interviews were conducted among participants of the programme. Consistent with other research, this study reveals how people on the wards often feel powerless and bored. The feelings of boredom are exacerbated as people recover. Participating in the arts groups has alleviated some of those feelings. Furthermore, participation has also increased peoples social interactions and given opportunity for self-expression. The arts activities also provide a distraction for people and some appreciated being able to talk about matters other than their ‘illness’. The arts activities helped people to think about their future and how they might take their artwork forward. For some people, thinking about the future helped with restoring a sense of hope, a quality imperative for recovery.

The Uses of Coercive Measures in Forensic Psychiatry: A Literature Review

Coercive measures are controversial within healthcare and require closer inspection, particularly within forensic psychiatry, where security-orientated restrictions are commonplace. The uses of coercive measures are often justified as a necessity for maintaining safety. Yet, these interventions are in stark contradiction to the autonomous person-centered philosophies that healthcare professionals are trained with, and that healthcare services purport to provide. The examinations of these practices are timely, particularly in light of international legislations to reduce and even eliminate the uses of such interventions and where studies have suggested that coercive methods might have paradoxical effects in provoking further violent and aggressive behaviours [American Psychiatric Association et al. (Learning from each other: Success stories and ideas for reducing restraint/seclusion in behavioural health. 2003); Goren et al. (Journal of Child and Family Studies 2(1):61–73, 1993); National Mental Health Working Group 2005; NICE (Violence and aggression: short term management in mental health, health and community setting. NICE, 2015); Queensland Government (Policy statement on reducing and where possible eliminating restraint and seclusion in Queensland mental health services. http://www.health.gld.gov.uk/mentalhealth/docs/sandrpolicy_081030.pdf, 2008); The MacArthur Research Network (The MacArthur coercion study. http://www.macarthur.virginia.edu/coercion.html, 2004); National Association of State Mental Health Directors (Violence and coercion in mental health settings: Eliminating the use of seclusion and restraint. http://www.nasmhpd.org/general_files/publications/ntac_pubs/networks/SummerFall2002.pdf, 2002)].

Institutional and Emotion Work in Forensic Psychiatry: Detachment and Desensitisation

Mental health professionals are frequently tasked with balancing care, safety and security. They are obliged to meet professional, organisational and institutional standards. Yet these roles, expectations and practices are often contentious, whilst personal feelings and values are often ignored. This raises questions about processes that attempt to reconcile personal, professional and organisation conflict, about how workers manage their emotions, and ultimately, what impacts these have upon those conducting such work, as well as those receiving care.

“Write here, sanctuary” Creative writing for refugees and people seeking asylum

ABSTRACT Background: There are few research studies reporting findings from creative writing groups amongst refugees and people seeking asylum. This study evaluates the educational, wellbeing, social and satisfaction outcomes of writing groups across three cities in the UK. Methods: This study employs a mixed-method design comprising: a thematic analysis of writers’ (facilitators) diaries, demographic and satisfaction survey and 14 qualitative interviews. Results: The project delivered a creative writing programme for refugees and people seeking asylum in three UK cities. This evaluation has determined that it provided both educational and wellbeing outcomes for 144 attendees. Participants asserted that they had improved their English language and wellbeing. Satisfaction was extremely high across the cities. Participants reported increased confidence and an increased sense of hope. Conclusions: Professionally led creative writing groups may be effective in enabling people to help come to terms with past experiences and find ways of coping for the future.

A community arts programme for older people: an evaluation

Purpose This paper presents an evaluation of a community based arts programme for older people in Nottinghamshire. Design The evaluation was conducted using a combination of pre and post-initiative quantitative questionnaires and qualitative focus group interviews. This article focuses upon the findings from the focus groups. Findings Participants reported feeling more positively about ageing and being more motivated to pursue new opportunities at the end of the programme. Five themes emerged from the focus group interviews, namely i) age and ageing, ii) the finished product, iii) new opportunities, iv) aspirations and the future and v) personal benefits. These related to increased confidence, having greater creative expression, meaningful occupation and opportunities for socialisation. Social Implications The programme was found to be successful in helping individuals feel more positive about their age, to feel more confident and motivated, to engage with others through mutual creativity, as well as to challenge negative social stereotypes of older people. Originality/Value The paper will be of relevance and value to those working with older people and those with an interest in the arts. This evaluation demonstrates the diversity of the older population with older citizen’s voices being at the heart of the programme.