Handbook of Forensic Mental Health

Keith Soothill, Paul Rogers, Mairead Dolan

• Publisher: Willan
• Year: 2012
• ISBN:
  9781136308796
• Edition: 1
• Topic: Diritto
• Subtopic: Scienza forense

This is a comprehensive reference book on the subject of forensic mental health, looking at what forensic mental health is and its assessment, management and treatment. It focuses on key topics and the issues underpinning them in contemporary society.

The book includes:

• an account of the historical development of forensic mental health, along with a description of the three mental health systems operating in the UK
• an in-depth analysis of the forensic mental health process and system, including an analysis of the different systems applied for juveniles and adults
• an examination of the main issues in forensic mental health including sex offending, personality disorders and addiction
• a breakdown of the key skills needed for forensic mental health practice.

This is an authoritative reference book which will be a crucial text for practitioners, academics and students in the forensic mental health field.

Part 1

Setting the Scene – The Administrative and Social Framework

Keith Soothill

Understanding forensic mental health is a complex task. Indeed, what is forensic mental health is contentious. In Chapter 1 Paul Rogers and Keith Soothill insist on the need to recognise and embrace the fact that the boundaries of the subject area are ‘fuzzy’. Furthermore, what complicates the picture is that the area is dynamic. Certainly there have been massive changes over the past decade and a half. Soothill and Rogers capture part of this in recognising that there are now a variety of professional voices involved. No longer is it the preserve of the discipline of forensic psychiatry. Forensic psychology, mental health nursing, social work and occupational therapy are professions that have become more closely involved in the forensic field. Now interdisciplinary working is a critical issue. Also, users are increasingly attempting to have a more credible voice. There has been a greater investment in research in recent years, but Soothill and Rogers are cautious about the current situation. They suggest that there is a dearth of thinking about this very important area of research activity. The very maintenance and development of forensic mental health is at risk.

In Chapter 2 Lindsay Thomson makes a very important contribution in reminding us that in the United Kingdom there is not one forensic mental health system, but four. The four systems reflect the countries that make up the UK – England, Northern Ireland, Scotland and Wales. Rarely have the intricacies of the similarities and the differences between the four systems been so carefully detailed. Practitioners need to know the administrative and legal frameworks within which they are working. Thomson points out that we are at a very interesting stage in the development of forensic mental health services in the UK. Will the effects of devolved power lead to more differences in the care and management of mentally disordered offenders? Astutely, Thomson notes that this could create an opportunity for naturalistic experiments comparing system effects for the issues posed by mentally disordered offenders are similar throughout the UK, assuming that our populations are the same.

In Chapter 3 David Forshaw provides a very readable account of the origins and early development of forensic mental health. Here he captures how closely the development of the field has been entwined with the development of the discipline of psychiatry. He captures its origins within the broader historical context. However, while there are underlying historical forces at play, it is fascinating how the growth of mental health legislation is so often the response to very dramatic and unusual events. Moral outcries and moral panics are not phenomena unique to the late twentieth and early twenty-first centuries. How does all this relate to the present? The present is often shaped by being trapped by the past and trying to overthrow those trappings. Without historical knowledge it is impossible to know what is new. After all, Clement Attlee, the British Prime Minster after the Second World War, maintained in a speech in 1950 that ‘I think the British have the distinction above all other nations of being able to put new wine into old bottles without bursting them’. Of course, there is never a definitive history and the way that other disciplines have become increasingly embroiled in forensic work is perhaps another history that still needs to be told.

Reference

Attlee, C. (1950) Speech, Hansard, 24 October 1950, col. 2705.

Chapter 1

Understanding forensic mental health and the variety of professional voices

Paul Rogers and Keith Soothill

Introduction

The aim of this chapter is not to rehearse or summarise all the issues that will be presented in this book, but to try to set the scene by painting with a broad brush. What is forensic mental health? Where is it ‘done’? When is it done? By whom is it done and onto whom? And finally, and most crucially, how can we develop an understanding of the issues?

What is forensic mental health?

Semantics is often an appropriate start to a project. But probing the meaning of words can also be offputting. Establishing precise definitions can be tedious and, like medieval philosophers seeking the ‘philosopher’s stone’ by which they could turn base metal into gold, the task may be impossible to accomplish. Interestingly when one of us went to a meeting recently, the person chairing the group started with the line ‘We really don’t want to be too definitive about this definition lark!’ Our aim is a rather different one. From the outset we are trying to establish the boundaries of the domain of forensic mental health. Again there are difficulties, for the boundaries are not clear. However, our message is a clear one. We need both to recognise and embrace the fact that the boundaries of our subject area are ‘fuzzy’.

Recognising ‘fuzziness’ takes the pressure off. What is regarded as the domain of forensic mental health in one historical era may be different from that of another era. There will also be differences between individual professions, different services and different countries in terms of what they see as the boundaries of forensic mental health. In short, there are no absolutes that we must seek.

‘Forensic mental health’ would not be a term in general use 40 years ago and there are still those around who are reluctant to embrace it. Up until recently, forensic psychiatry was the dominant term with multi-professional staff working in forensic psychiatric units or services. The term, forensic mental health, reflects the movement away from services which are determined by a medical/illness model and towards a health/prevention model.

Mullen (2000: 307) defines forensic mental health as:

… an area of specialisation that, in the criminal sphere, involves the assessment and treatment of those who are both mentally disordered and whose behaviour has led, or could lead, to offending.

We would like to extend this to also include offenders who are not currently mentally disordered but have the propensity to be so. Thus forensic mental health takes a preventative approach to both offending and mental ill health.

Where is forensic mental health done?

Forensic mental health can occur anywhere within health and is not the sole bastion of what we would traditionally consider forensic mental health clinicians. If we concentrate on offenders, then mental health issues are abundant in police stations, prisons, probation services, psychiatric hospitals and back in the community. Patients who offend and who have mental health problems come into contact with all aspects of health and public service. The police custody sergeant is as concerned with deaths in custody as the ward manager in a high-security hospital. The probation officer is just as concerned with understanding how a person’s mental disorder is linked to their offending as a social worker who is working with a family where domestic violence occurs, initiated by someone with mental health problems. The simple answer to ‘where’ does forensic mental health occur is that it is everywhere. Furthermore, the greater the understanding that non-forensic mental health clinicians have about the potential for offending among those with mental disorder, the greater the possibility of early detection where problems may be developing. This is crucial and a consideration for the future if we wish to try and divert people from the laborious and lengthy ‘offender pathways’ that currently exist. Investment in prevention and diversion at the earliest possible point must be the goals of all health and public service employees and organisations. Why wait until sentencing to determine if a person is mentally ill when it can be done at the point of arrest? Why wait to intervene after an offence has occurred, when crisis resolution and home treatment could have stopped the offending in the first place? Put simply, the need for forensic mental health and the fact that it is becoming a growth industry must be viewed as a failure in the other sections of health. Surely the goal of health services should be to prevent offending at all costs?

Who does forensic mental health?

Forensic mental health covers a wide plethora of professions if we agree that the focus of such work is the reduction of offending in those with mental health problems or mental health problems in those who have offended. This forensic mental health industry is ever-expanding. Generally speaking, there are the five main professions: forensic psychiatry, forensic psychology, mental health nursing, social work and occupational therapy. It is questionable as to whether mental health nursing, social work and occupational therapy have a claim to a ‘forensic’ label.

Forensic psychiatry

Forensic psychiatry is ‘that part of psychiatry which deals with patients and problems at the interface of the legal and psychiatric systems’ (Gunn 2004: S1). Furthermore, Gunn argued that ‘such a definition implies a speciality that does not travel easily, and the practice of forensic psychiatry does vary considerably from one country to another’. Gunn (2004: S1) also defined forensic psychiatry in this paper as ‘ the prevention, amelioration, and treatment of victimization that is associated with mental disease’. Here lies the problem: many people can have differing views about what forensic psychiatry is or isn’t. Put simply, forensic means legal and therefore forensic psychiatry can cover a plethora of people who have come into contact with the legal system and have a mental disorder.

Mullen (2000) argues that simplistic definitions of forensic psychiatry based upon literal meanings to acting exclusively as handmaidens to the court are constraining. Mullen suggests that defining forensic psychiatry in terms of the assessment and treatment of the mentally abnormal offender delineates an area of concern that could potentially engulf much of mental health.

Forensic psychology

Forensic psychology is defined as being:

… devoted to psychological aspects of legal processes in courts. The term is also often used to refer to investigative and criminological psychology: applying psychological theory to criminal investigation, understanding psychological problems associated with criminal behaviour, and the treatment of criminals. (British Psychological Society 2007)

Both forensic psychiatry and forensic psychology have one unique aspect which helps with the forensic ‘identity’ that the other professions of nursing, social work and occupational therapy do not: that of specialised and recognised training.

Forensic mental health nursing

It has been argued that there is no such thing as a forensic mental health nurse. Whyte (1997, 2000) has consistently argued that forensic mental health nursing is exactly the same as mental health nursing. Quite simply, Whyte has a very strong case as there is no separate forensic training, and all nurses working in forensic mental health are mental health nurses working with a population that is ‘forensic’. Collins (2000: 39) states that:

There has always been substantial debate surrounding the ‘forensic nurse’ ever since the term came into regular use ... criticisms of the role range from ‘glorified custodians’ to a homogeneous group who strut around swinging a capacious bunch of keys, in a quest for domination of those under their care.

Many dispute these arguments and desperately try to make a case that forensic mental health nursing is a separat...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• List of figures and tables
• List of abbreviations
• Notes on contributors
• Preface and Acknowledgements
• Part 1: Setting the Scene – The Administrative and Social Framework
• Part 2: Understanding the Forensic Mental Health Process and the Systems
• Part 3: Developing a Knowledge Base – Key Issues in Forensic Mental Health
• Part 4: Skills for Forensic Mental Health Practitioners
• Glossary
• Index