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Article
Publication date: 9 January 2018

Birgit Völlm, Shaz Majid and Rachel Edworthy

The purpose of this paper is to describe service users’ perspectives on the difference between high secure long-stay forensic psychiatric services in the Netherlands and high…

196

Abstract

Purpose

The purpose of this paper is to describe service users’ perspectives on the difference between high secure long-stay forensic psychiatric services in the Netherlands and high secure forensic psychiatric care in England. These perspectives are relevant in considering the benefits of a similar long-stay service in England.

Design/methodology/approach

A current in-patient detained in a high secure hospital in England and other mental health service users and carers with experience in forensic-psychiatric settings were asked to watch a documentary on a Dutch high secure long-stay service. Then they were invited to make comparisons between this service and high secure care in England. These perspectives were gained in the context of their membership of the Service User Reference Group of an externally funded study on long-stay in forensic-psychiatric settings in England.

Findings

The small group of participants highlighted the importance of relational security, meaningful occupation, autonomy, positive therapeutic relationships with staff and a homely environment for those with lengthy admissions and perceived these to be better met in the Dutch service. These factors might contribute to improved quality of life that services should strive to achieve, especially for those with prolonged admissions.

Practical implications

Perspectives of service users with lived experience of long-stay in forensic settings are important in informing service developments. Lessons can be learnt from initiatives to improve the quality of life in long-stay services in other countries and consideration be given on how to best manage this unique group.

Originality/value

To the authors’ knowledge this is the first study asking service users about their view on forensic services in other countries. The findings suggest that service users have valuable contributions to make to aid service developments and should be involved in similar such exercises in the future.

Details

Journal of Forensic Practice, vol. 20 no. 2
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 3 March 2020

Sana Rabab, Jack Tomlin, Nick Huband and Birgit Völlm

Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC…

231

Abstract

Purpose

Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and regulates forensic healthcare provision. The purpose of this study is to identify key concerns highlighted in CQC inspection reports of the three high-secure hospitals in England between 2010 and 2018.

Design/methodology/approach

In this qualitative study, 49 CQC inspection reports from three high-secure hospitals were subjected to thematic analysis.

Findings

Five central themes emerged: staffing and management; restrictive practice; physical environment and ward atmosphere; patients’ needs and involvement in their care; and legal and statutory matters. There was some variation in the overall quality of care between the hospitals. Positive staff–patient interactions and good practice in assessing and delivering care were consistently observed. However, enduring staff shortages within each hospital were experienced negatively and sometimes co-occurred with concerns over restrictive practices, poor care-plan procedure and inadequate legal documentation. Over time, Rampton and Broadmoor Hospitals appeared to worsen with regard to staffing levels, staff morale and management involvement. While services progressed over time in providing patients with access to advocacy and information concerning their rights, in some recent inspections it remained unclear whether patients were adequately involved in the care-plan process.

Practical implications

These findings provide preliminary indicators for areas requiring further attention from policymakers, clinicians and advocates.

Originality/value

This study appears to be the first systematic analysis of key concerns expressed in CQC reports of English high-security hospitals.

Details

The Journal of Forensic Practice, vol. 22 no. 2
Type: Research Article
ISSN: 2050-8794

Keywords

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Article
Publication date: 21 August 2017

Ruth McDonald, Vivek Furtado and Birgit Völlm

The purpose of this paper is to add to the understanding of context by shedding light on the relationship between context and organisational actors’ abilities to resolve ongoing…

206

Abstract

Purpose

The purpose of this paper is to add to the understanding of context by shedding light on the relationship between context and organisational actors’ abilities to resolve ongoing challenges.

Design/methodology/approach

The authors used qualitative data collection (interviews and focus groups with staff and site visits to English forensic psychiatry hospitals) and the analysis was informed by Lefebvre’s writings on space.

Findings

Responses to ongoing challenges were both constrained and facilitated by the context, which was negotiated and co-produced by the actors involved. Various (i.e. societal and professional) dimensions of context interacted to create tensions, which resulted in changes in service configuration. These changes were reconciled, to some extent, via discourse. Despite some resolution, the co-production of context preserved contradictions which mean that ongoing challenges were modified, but not resolved entirely.

Originality/value

The paper highlights the importance of viewing context as co-produced in a continuous manner. This helps us to delineate and understand its dynamic nature and its relationship with the everyday actions and beliefs of the organisational actors concerned.

Details

Journal of Health Organization and Management, vol. 31 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 10 May 2013

Kate Robertson, Sue Elcock, Chris Milburn, Phyllis Annesley, Jane Jones and Birgit A. Völlm

Patients in the National High Secure Healthcare Service for Women have a high prevalence of trauma and self injury. This highlights the need for specialised training of staff…

303

Abstract

Purpose

Patients in the National High Secure Healthcare Service for Women have a high prevalence of trauma and self injury. This highlights the need for specialised training of staff dealing with such women. The aim of this study was to evaluate the trauma and self injury (TASI) training programme on staff knowledge and skills.

Design/methodology/approach

A total of 135 nurses and nursing assistants participated in the TASI two‐day training course. Questionnaires allowing for quantitative and qualitative data collection were completed before and after the training. Training and confidence levels in dealing with women who self‐harm prior to the training were identified and the impact of the programme was assessed.

Findings

The majority of staff had not received any previous training on trauma and self injury. There was an increased level of confidence in working with trauma and self injury following training and staff reported an increased ability to ask for support. Self‐perceived competence improved to a greater extent in those who had not received previous training compared to those who had.

Research limitations/implications

The authors' data is limited to self‐report. Future research should use objective measures to evaluate the impact of staff training.

Practical implications

A relatively short training programme focusing on trauma and self injury appears to improve staff confidence, understanding and competence in working with women patients in a high secure setting. Similar training programmes might also be beneficial in different patient groups with complex backgrounds and behaviours.

Originality/value

This is the first report on a training programme focussing on women in high secure care who self‐harm and have experienced trauma.

Details

The Journal of Forensic Practice, vol. 15 no. 2
Type: Research Article
ISSN: 2050-8794

Keywords

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