Lisa Reynolds

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.

Serious games for mental health

Today the use of digital technology available to inform, train and educate is ubiquitous, with everyday lives seemingly becoming immersed in technology (Howard-Jones 2011). Further, the recently published UK digital strategy provides the structure to enable free access to digital skills training for everyone in the UK (Department for Culture Media and Sport 2017). As part of the digital technology toolset, serious games hold the promise of relatively low risk experiential learning-curves that are engaging, fun and desirable.

StreetWise: A Valid Ecology for a Serious Game in a Secure Forensic Mental Health Setting☆

To ascertain their readiness to be discharged from care, secure forensic mental health service users are often given restricted access to their local communities. However, this can be stressful for the service user and expose the public to potential risks. Therefore, new research was undertaken to explore whether a computer-based serious game could enable service users to explore their responses to community based risk situations in a safe environment. Creating a serious game for use in a secure forensic mental health setting is itself both novel and problematic, and the initial research sought to test the feasibility and acceptance of the game. This paper reports first results from working with service users to develop a prototype game that accurately describes their experiences and expectations to lay the foundations for a clinically effective tool and achieve acceptance.

Risk assessment and management in mental health nursing

Risk assessment and management is a core element of mental health practice, and all nurses need to be aware of the risks surrounding them and their patients in order to create a safe working environment. Risk Assessment and Management in Mental Health Nursing explores issues including context and definitions of risk, risk assessment tools and techniques, strategies for preventing risk situations, suicide, self-harm, neglect, forensic aspects of risk, substance misuse, ethical considerations, , victimology, risk to others and risk to se