Paul Godin

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.

Supervision and control: A community psychiatric nursing perspective

Community psychiatric nursing has long been seen as an integral part of comm unity mental health care. However, recent changes to the way in w hich this care is organised and delivered has resulted in changing work patterns for all mental health w orkers. Of these changes the introduction of the supervision register and supervised discharge have perhaps been the m ost controversial. This study reports on in-depth interview s w ith community psychiatric nurses (CPNs) about how they perceive their work in the light of supervision and other changes. The findings suggest that CPNs are concerned about not only the adverse effects of supervision upon their clients and relationships with them but also about the controlling effect supervision has upon them. The consequences of these findings are discussed in relation to possible implications for multi-disciplinary practice and inter-professional shared learning.

Risk: An introduction

in risk society. Health, Risk & Society, 12 (4), 345–356. Kukla, R., 2007. Ethics and ideology in breastfeeding advocacy campaigns. Hypatia, 21 (1), 157–180. Lee, E., 2007. Infant feeding in risk society. Health, Risk & Society, 9 (3), 295–309. Lee, E., 2008. Living with risk in the age of ‘intensive motherhood’: Maternal identity and infant feeding. Health, Risk & Society, 10 (5), 467–477. Murphy, E., 2004. Risk, maternal ideologies, and infant feeding. In: J. Germov and L. Williams, eds. A sociology of food and nutrition. Oxford: Oxford University Press, 200–219. Wolf, J., 2007. Is breast really best? Risk and total motherhood in the National Breastfeeding Awareness Campaign. Journal of Health Politics, Policy and Law, 32 (4), 595–636.

Beyond the risk society: Critical reflections on risk and human security

This book brings together chapters from a ‘cast of experts’ working in diverse fields of social science who all have a particular interest in risk theory. Though the chapters are fairly selfcontained, I found it quite enjoyable to read the book from cover to cover. I rarely felt tempted to skip over pages. I found myself most intrigued by the chapters that covered topics that I knew least about, namely: crime, economics, work and culture. There are also chapters on sociology, psychology, social policy, health, sexuality, media, environment and politics. Each chapter concludes with a set of study questions, as can often be found in sociology textbooks for A level or first degree students. However, the book is far from elementary, though by no means unclear. The study questions made me glad I didn’t have to do an exam on them. The authors of the chapters explore, critique and (to a greater or lesser extent) develop risk theory in relation to present day society. Perhaps most of all I enjoyed Peter McMylor’s chapter, ‘Economics and risk,’ in which he disputes the Beck assertion that the biggest epochal transformation to affect our time was that which changed class society into risk society, where we are no longer divided by the distribution of goods but rather by the distribution of bads. McMylor argues that the really big risk we do face today, as in class society, is capitalism itself. Though he of course acknowledges Marx as the founder figure of economic sociology, he uses the Durkheim theorist Polanyi to challenge Beck’s theory that the transformation from modernity to late modernity was epochal. Polanyi, McMylor instructs us, identified a far greater and longer lasting transformation in the development of the ‘market society’ in which the economy ceased to be embedded within the overall society. The market society created the individual and, in its advanced form, what Beck and Giddens call ‘individualization.’ McMylor notes the economic crises of our times, such as pension funds going bust. Polanyi’s work, McMylor points out, is particularly useful here as Polanyi draws attention to how the development of market society involved a ‘double movement’ towards individualized risktaking and collectivist movements that developed ways of ameliorated the diswelfares of such risk. McMylor concludes that we need to understand how this movement and counter movement of the market society of today operate to deal with such issues as the collapse of pensions. Though pensions may bore many people, late middle-aged people like myself, who are concerned to avoid poverty in old age within late modern society (that will blame me for my own plight), see pensions as very important, and thus interesting. Apart from risks to my health, the risk of poverty is my utmost concern. In their chapter on work and risk, Tombs and Whyte similarly accuse Beck of paying too little attention to economic factors. Drawing on detailed figures on the deaths, injuries and life years lost from work, they point out that this reality is overlooked by Beck in his book The Health, Risk & Society, September 2007; 9(3): 343 – 347