Jacqueline Davies

Forensic mental health services as a risk escalator: a case study of ideals and practice

Medium/low secure units occupy a central role in forensic mental health care, bridging high secure and community services. Although outcomes, assessed in terms of readmission and identified reoffending, have been evaluated, little research exploring processes underlying attempted rehabilitation for offenders diagnosed as having mental health problems has been undertaken. The present qualitative study built upon previous research completed in a northern England medium/low secure forensic mental health care institution for adults with learning disabilities (Heyman et al. 2002a,b). It was carried out in a medium/low secure forensic mental health care Unit located in London. In phase one, 43 staff, including general managers, doctors, nurses, psychologists and occupational therapists were interviewed about their philosophy of care, views about risk management for forensic mental health patients and perceptions of the Unit. In phase two, 10 case studies of patients were undertaken. As far as possible, patients were interviewed twice over a period of 11‐20 months, and staff were asked about their progress. Two case conferences were observed. Data were analysed using the metaphorical concept of a rehabilitative risk escalator around three themes carried forward from the previous study: organisational issues; patient active risk management; and multiprofessional collaboration.

Playing the game: service users’ management of risk status in a UK medium secure forensic mental health service

In this article we examine how forensic mental health service users actively attempt to manage their risk status through playing the game of containing frustration and demonstrating compliance. The article draws on an observational study (2006 to 2009) which explored the practices of risk assessment and management within one inner city forensic mental health medium secure service in the UK. We used a grounded theory approach to explore service users’ and providers’ experiences of risk assessment and management. We interviewed forensic mental health service users and providers. We also collected data using participant and non-participant observation. Since access to forensic mental health services is tightly controlled, there are participant-observation studies undertaken in these settings. We found that service users attempted to understand the system of assessment and sought to affect and reduce their risk status by engaging in overt, compliant behaviours. We argue that in doing so service users are active agents in the process of risk management. However, we indicate that there are adverse effects of this approach to risk management as the risk-assessment process is subverted by the restriction of the flow of information, and service users are left with frustrations that they must contain and manage.

The case of the lady who risked exploding: A study of multiple consequences and contested values

This paper explores the role of value judgements in personal risk management through an in-depth case study involving a womans treatment for anal cancer. Julia (pseudonym) agreed to have her pre-treatment medical consultation recorded, and participated in two subsequent interviews. Delving into a single case makes it possible to understand why an individual makes decisions in relation to the overall nexus of risks and benefits which they identify even though their choices may seem irrational to others. According to the colorectal nurse research interviewer, Julia ‘risked exploding’ as a result of ‘absconding’ (Julias term) from hospital in order to have sex shortly after undergoing surgery. Although not to be interpreted literally, the above phrase encapsulates Julia’s risk blindness from a clinical perspective. The article will address the question of how one person came to put herself at unnecessary risk. The question will be considered in relation to non-communication about the interconnected web of issues which troubled Julia, including cosmology, mortality, being left with an unclean, leaky body, loss of economic viability and harm to family members and to close relationships. This analytical framework complements the more usual one in which attitudes towards a particular risk object are compared across cases. The article makes a contribution, within the limits of a single case study, to advancing knowledge about the neglected topic of individual risk consciousness. It will be argued that, in the absence of such analysis, personal decision-making about risks cannot be fully understood, appropriate advice given or sensitive policies developed.

Risky trade: Infectious disease in the era of global trade

This volume contains a broad range of empirical case studies through which it aspires to ‘open-up a new field of media studies within trust studies’ (p. 22). It provides a taster of ideas and approaches to trust, particularly in relation to the manipulative tendencies of the mass media reflected in all its guises. Contributions to the book are organized in four parts, with most grouped somewhat artificially into Part 2 or Part 3, in terms of their focus either on the erosion of trust or on the potential of the media to build trust. Overall, the scope of the material is very wide and lacks coherence. It spans a period from the early twentieth to the beginning of the twenty-first centuries, a variety of media types and a number of different countries and political regimes. Despite editorial efforts to draw the material together, at the beginning via intersecting themes and at the end through the analysis of emergent themes, the material defies any easy summation and illustrates instead that the field of ‘trust studies’ (the editors’ term, p. 9) like media studies is likely to remain extremely fluid. The editors’ opening chapter in Part 1 outlines patterns of declining generalized trust and trust in key institutions, including the media, in the UK and elsewhere. It asks the key question for the book of the media’s role in bringing about the ‘Age of Suspicion,’ a notion which might be regarded as problematic. However, its emergence is only briefly addressed, and the possibility that suspicion has always characterized social relations is not raised at all. In Chapter 2, Vakir and Barlow seek to explore the relationship between trust studies and media studies. They provide a brief descriptive survey of varying definitions and social theories of trust, including those which regard it as a moral ‘social glue’ (e.g. Simmel and Durkheim) or as social capital (e.g. Fukayama and Putman), and those which consider its role in dealing with risk, uncertainty, identity and the management of complexity in late modern society (e.g. Luhman and Giddens). Rather than developing any of these approaches, the authors conclude that trust and media studies as a new field is more likely to develop by bringing together literature with a public sphere focus grounded in media studies and that with an economic focus from advertising, marketing and new media. This then constitutes the loose framework for the book. Despite acknowledgement that there are intrinsic links to be made between risk, trust and the media, these links are not much developed by contributing authors. Exceptions are to be found in studies of media representations of food and health risks (Collins, Chapter 7; Critcher, Chapter 8) and the complex trust demands made by the Internet in a ‘risk society’ (Allard, Chapter 9; McStay, Chapter 10). More prominent in the book are influences from the media, culture and communication literature through which the case studies presented explore diverse aspects of the co-option of the media by political or economic interests, their failure to promote debate and active citizenship and its manipulating tendencies. These interesting observations remain largely under-theorized, however. Health, Risk & Society Vol. 10, No. 3, June 2008, 317–320