Forensic Focus – serie

People who use forensic mental health services are defined by the fact that they have violated boundaries, often in many ways. For clinicians employed to work therapeutically with this client group however, the capacity to initiate and maintain boundaries is critical to safety as well as to good treatment outcomes. This book provides a thorough introduction to the subject of professional and therapeutic boundaries and their particular complexities within forensic mental health settings. The contributors, all experts in their respective fields, address the challenges of establishing working boundaries within forensic mental health services from multiple perspectives. They explore the ways in which boundaries can be initiated and maintained in different areas of forensic mental health work, including in psychotherapy, mental health nursing, arts therapies, forensic psychiatry and family therapy, and when working with different client groups, including children and adolescents, offenders with severe personality disorders in high security settings and sex offenders. Consideration is also given to boundaries and homicide, maternal boundary violations and boundaries in a forensic learning disability service.This authoritative, interdisciplinary resource will support all forensic mental health practitioners in this crucial aspect of their work.

Adolescents with developmental disabilities are a complex population who require specialised treatment and care. This interdisciplinary text examines the processes involved in working with this client group in forensic settings, and explores the ways in which their needs differ from those of other young people who engage in high risk behaviour or offending. The book covers assessment, intervention and treatment options for adolescents with a wide range of developmental disabilities, including autism spectrum disorders, acquired brain injury, developmental traumatology, and complex comorbidities. It describes the obstacles, challenges and opportunities to consider when working with this population, and the role played by various professionals, including forensic psychiatry and psychology, occupational therapy, physiotherapy, education, art psychotherapy and social work. The book also outlines the issues to consider when working in secure and community settings as well as the legal aspects of working with this client group, and the complex issues surrounding risk assessment. The first comprehensive account of forensic issues in adolescents with developmental disabilities, this book will be an indispensible primary resource for a wide range of professionals, including child and adolescent psychiatrists, community psychiatric nurses, developmental paediatricians, social workers and youth workers, lawyers and advocates.

This groundbreaking book explores the psychodynamics and socio-politics of the forensic therapeutic milieu, addressing some of the most difficult and complex issues facing practitioners. It sets out a psycho-social framework for understanding the predicament and the needs of those who live in and those who work in forensic mental health settings. It brings to life the thinking of those working on the frontline in an increasingly difficult and hostile environment, and draws together fresh and stimulating approaches to engagement with highly complex individuals who present challenges to traditional models of psychiatric assessment and treatment.Contributors with considerable clinical experience and expertise from a range of disciplines consider the ethical, emotional and intellectual challenges of their work, and describe ways in which genuine containment and change can be achieved despite numerous perceived assaults on therapeutic relationships, and on the therapeutic milieu itself. Combining clinical case studies with organisational perspectives and clear descriptions of theoretical processes, they explore key issues including the challenges of maintaining role-appropriate, 'boundaried' relationships; the tensions between public protection and individual confidentiality; questions of risk and responsibility; duty of care and respect for individual liberty; the challenges posed by inter-professional tensions and rivalries; as well as specific clinical dilemmas. The difficulties they experience in fulfilling specific therapeutic roles in the face of uncertainties about the funding and commissioning of their services are addressed, and the final part of the book outlines some of the ways in which individuals, particular services and whole organisations may protect themselves when under attack.This unique and highly original book is essential reading for all those working, or training to work, in both forensic and non-forensic inpatient therapeutic milieux and for academics and lay readers interested in the societal dynamics of inclusion and exclusion that are replicated and magnified in these settings.

This book looks at what happened when the government of Victoria, Australia, enacted special legislation to detain one person with a severe antisocial personality disorder on the grounds of his presumed dangerousness, despite the fact that he did not fit within the ordinary criteria of mental illness or criminality. In doing so, it interfered with the law's protection of civil rights and also with professional distinctions between a certifiable mental illness and the broader concept of mental disorder. The ensuing legal processes highlighted the ambiguous, contingent and negotiable nature of the boundary between badness and madness.The issues raised by this case transcend a government's singular action, highlighting matters such as the duty of care in a forensic setting; diagnostic uncertainties; debates about treatment; the responsibility of politicians to protect the community; and the difficulties inherent in translating clinical concepts into an acceptable legal format. Neither Bad Nor Mad analyses the interaction between psychiatry and the law in an absorbing account of one case with extensive ramifications.

Violence and Mental Disorder takes the debate about violence into new territory by increasing our understanding of the wide range of factors associated with the commission of violence. This comprehensive and critical review of the literature is intended for a broad audience, including clinicians, researchers and policy makers working in this complex area. It is a much-needed resource for mental health professionals whose day-to-day work involves assessing and managing those thought to be at risk of engaging in acts of violence.

Personality Disorder (PD) is one of the most difficult psychological conditions to classify and treat and in the past literature on the subject has tended to neglect the invaluable viewpoint of sufferers themselves. Drawing on extensive research carried out in conjunction with service users, Heather Castillo seeks to adjust this imbalance and looks at the classification and treatment of PD from the service users' viewpoint. This book emphasises the need for health professionals to reassess their approach to the condition and allows those with PD to effectively define themselves and their illness. With a wide range of case study material and analysis, this book is essential reading for mental health professionals, workers in the voluntary and forensic sectors and service users themselves.

John Woods presents a theoretical approach and practical suggestions for mental health practitioners working therapeutically with young people who have abused. Drawing on his long-standing experience, he has developed an integrated theory that bridges the gap between existing cognitive behavioural and psychoanalytic approaches. He shows how this individual treatment model can be applied in a range of contexts including residential settings, group and family work, as well as in individual work.In-depth case studies throughout the book demonstrate how exploring the individual's whole life-course within a psychoanalytic framework enables connections to be drawn between possible childhood abuse and subsequent abusive behaviour. Guidelines are presented on working with the problems of self-destructiveness, masochism and depression facing the young abused/abuser and the impact of sexual abuse on sexuality, gender identity and sexual orientation. This is an instructive and thought-provoking text for all mental health practitioners and allied professionals working with adolescents who sexually offend.

As a psychodynamic theory of both normal development and psychopathology, attachment theory has particular utility for forensic psychiatry. A Matter of Security provides an attachment theory based account of the development of arousal and affect regulation, which offers a new way of thinking about mental disorders in offenders. This book also discusses the development of personality in terms of interpersonal functioning and relationships with others, which is essential to understanding both interpersonal violence and abnormal personality development. Attachment theory also offers a model of therapeutic work with patients that have particular resonance with forensic work because it uses the language of security. This collection focuses on attachment theory applied to forensic psychiatry and psychotherapy.

A pressing need for the integration of current practice, research and service development is addressed in this comprehensive book, which explores the experience of work with women in secure mental health settings.The first section offers different perspectives on the needs and situations of this minority population. It includes consideration of the differing needs of women and men, and key environmental and therapeutic issues highlighted by recent research and service provision. Further chapters cover clinical illustrations of work with women in different settings, including descriptions of integrated multi-disciplinary practice, discussion of the experience of female patients and staff on a mixed sex ward, and exploration of therapeutic groupwork. The final section offers practice guidelines and frameworks for both individual staff and professional teams. At a time when the government's national agenda for mental health has focused on specialist secure provision for women, this book is essential reading for all those working in this challenging area.

Sexual Offending and Mental Health draws together theoretical, clinical and mental health issues for the range of professionals working in the community and in-patient settings with sex offenders and those who have behaved in sexually inappropriate ways.The contributors describe current influential models of sexual offending and the developmental, psychological and social factors involved. They discuss the prevalence of personality and mental disorders in known sex offenders and the impact these disorders have on their treatment and management. They describe clinical work with individuals, their partners and families, and also consider the impact of this work on professionals. The book includes an outline of current approaches to risk assessment, an overview of the recent changes in legislation in England and Wales, and suggestions for multi-disciplinary management in the community.This book will be essential reading for professionals working in health or criminal justice settings with people who have committed sexual offences or whose sexual behaviour has caused concern for others.

Personality Disorder offers a comprehensive and accessible collection of papers that will be practically useful to practitioners working in secure and non-secure settings with patients who have personality disorders.This book brings together fourteen classic papers, which address the impact that working with personality disorder patients can have on staff. It also offers theoretical explanations for personality disorder, and explores other issues such as the concept of boundaries in clinical practice, psychiatric staff as attachment figures and the relationship between severity of personality disorder and childhood experiences. Each paper is introduced with contextual material, and is followed by a series of questions that are intended to be used as educational exercises.This book will be essential reading for clinical and forensic psychologists, psychiatrists, community psychiatric nurses, social workers and students.

Working in any area of mental health nursing presents complex issues regarding the nurse-patient relationship. For those working in prolonged clinical contact with offenders, relationships with patients and colleagues can be particularly emotionally intense and sometimes difficult to express. This book attempts to understand and articulate the emotional labour of forensic nursing and explores the challenge of establishing and maintaining therapeutic relationships with offenders. The first book to consider the emotional and relational component of forensic mental health nursing, the chapters cover a number of specialist forensic areas from this psychodynamic perspective, such as women's services, services for people with personality disorders, intensive care, high security psychiatric hospitals, medium secure units and services for adolescent offenders. A chapter on therapeutic communities is also included, along with chapters on challenging relational phenomena such as working with hate and the difficulties of managing difference when working in environments that produce high levels of anxiety. Therapeutic Relationships with Offenders provides essential information for mental health nurses working in the forensic field and will be of interest to any professionals working with challenging populations and people with personality disorders.

Violent crimes committed by the mentally disordered attract academic and public attention. They raise issues of moral responsibility and public protection. This study systematically analyses the principles underlying those legal and medical devices which enable the courts to make special arrangements for the mentally disordered.Buchanan examines three fundamental precepts in criminal law: justification, excuse and mitigation. A defendant who has been proved guilty can usually have his or her sentence reduced only where one of these three principles applies. The way that the courts interpret notions of responsibility and choice may influence the outcome considerably. For mentally disordered offenders, the matter becomes even more complicated - this is where the psychological and psychiatric aspects of justification, excuse and mitigation come into play. The author combines a jurisprudential analysis of the above with a discussion of current legal provision for mentally disordered offenders in England and America. This thought-provoking book will be of particular interest to a wide range of professionals in the forensic field, as well as to academics specialising in mental health law and the philosophy of psychiatry.

`This book is an invaluable resource for all healthcare professionals working with women in secure services. It offers an insight into the needs of an often reviled but vulnerable client group.'-Journal of Advanced Nursing`The Editors have successfully maintained a readable and thought-provoking style in a multi-author text and the book can be recommended to all mental health professionals in this field'.-The Mental Health Review, Vol 10 Issue 3`This publication is aimed at practitioners who work with women in secure settings. There is relatively little material available which integrates practice, research and service development issues in this challenging area, and this publication fills an important gap. The first section explores and explains the theoretical issues which should underpin relevant policies and practices by the different practitioners operating in this, somewhat neglected, field. The section covers matters such a gender and forensic mental health, the vulnerability of women in prison, and women's pathways into and through secure mental health services. The second focuses on practice issues including challenges for forensic mental health nurses; experiences of women patients, and lessons for practice from a women's group in a medium secure setting. The final section explores key themes for service development. This is a thought-provoking and authoritative resource.' - Care and Health Magazine`This is an honest and open review of the challenges faced by staff working with women in secure mental health settings, and current research, thinking and developments in service provision. It's contributors provide a rich multi-disciplinary perspective, in welcome contrast to the medical model that more usually drives high and medium secure units…Contributors question current practice in, for example, the management of aggression and the use of response teams, discussing these interventions from the viewpoints of service users and suggesting more positive alternative approaches…well-written and intense insight into working with this challenging client group.' -Mental Health TodayA pressing need for the integration of current practice, research and service development is addressed in this comprehensive book, which explores the experience of work with women in secure mental health settings.The first section offers different perspectives on the needs and situations of this minority population. It includes consideration of the differing needs of women and men, and key environmental and therapeutic issues highlighted by recent research and service provision. Further chapters cover clinical illustrations of work with women in different settings, including descriptions of integrated multi-disciplinary practice, discussion of the experience of female patients and staff on a mixed sex ward, and exploration of therapeutic groupwork. The final section offers practice guidelines and frameworks for both individual staff and professional teams. At a time when the government's national agenda for mental health has focused on specialist secure provision for women, this book is essential reading for all those working in this challenging area.

Written by experts in the growing field of forensic mental health care, this book explores current and emerging interventions in forensic nursing and the care of the mentally disordered offender, with an emphasis on clinical practice and clinical competence. It explores the practical issues facing forensic nurses, such as environment and safety issues, as well as the possible emotional trauma of such a role. It examines a range of intervention strategies, such as exercise, which has often been used as an occupational time-filler, but also offers real therapeutic benefits. The contributors cover a range of diverse perspectives from the care of women in secure services, severely assaultive patients and sex offenders, the role of inpatient therapy and nurse therapists and the importance of spiritual nursing and educational interventions. The book also examines the client group itself and considers new roles for nurses in the light of recent research.The contributors to this volume take a wide-ranging approach, providing a comprehensive overview of current and future therapeutic interventions for forensic mental health care. Therapeutic Interventions for Forensic Mental Health Nurses is essential reading for all practitioners, nurses and educators in the forensic nursing field.

This book looks at what happened when the government of Victoria, Australia, enacted special legislation to detain one person with a severe antisocial personality disorder on the grounds of his presumed dangerousness, despite the fact that he did not fit within the ordinary criteria of mental illness or criminality. In doing so, it interfered with the law's protection of civil rights and also with professional distinctions between a certifiable mental illness and the broader concept of mental disorder. The ensuing legal processes highlighted the ambiguous, contingent and negotiable nature of the boundary between badness and madness.The issues raised by this case transcend a government's singular action, highlighting matters such as the duty of care in a forensic setting; diagnostic uncertainties; debates about treatment; the responsibility of politicians to protect the community; and the difficulties inherent in translating clinical concepts into an acceptable legal format. Neither Bad Nor Mad analyses the interaction between psychiatry and the law in an absorbing account of one case with extensive ramifications.

Personality Disorder (PD) is one of the most difficult psychological conditions to classify and treat and in the past literature on the subject has tended to neglect the invaluable viewpoint of sufferers themselves. Drawing on extensive research carried out in conjunction with service users, Heather Castillo seeks to adjust this imbalance and looks at the classification and treatment of PD from the service users' viewpoint. This book emphasises the need for health professionals to reassess their approach to the condition and allows those with PD to effectively define themselves and their illness. With a wide range of case study material and analysis, this book is essential reading for mental health professionals, workers in the voluntary and forensic sectors and service users themselves.

A contemporary case-based discussion of ethical dilemmas faced by researchers in forensic mental health, this book offers useful guidance to anyone planning research in this field. It focuses on problems frequently encountered, such as issues of capacity to consent in forensic settings and the meaning of consent to participate. Chapters cover issues such as the procurement of consent among incarcerated people; the ability of young people to provide consent; the effects of culturally specific lay beliefs about mental illness; confidentiality; multidisciplinary approaches; and ethics in risk assessment research. The contributors address questions such as whether research can be therapeutic, and whether it is ever reasonable to compromise patient confidentiality for the wider benefits of publishing research.Based on empirical data from researchers' own experiences, this comprehensive book will be essential reading for anyone planning research in the area of forensic mental health, and all whose work is in this area.

John Woods presents a theoretical approach and practical suggestions for mental health practitioners working therapeutically with young people who have abused. Drawing on his long-standing experience, he has developed an integrated theory that bridges the gap between existing cognitive behavioural and psychoanalytic approaches. He shows how this individual treatment model can be applied in a range of contexts including residential settings, group and family work, as well as in individual work.In-depth case studies throughout the book demonstrate how exploring the individual's whole life-course within a psychoanalytic framework enables connections to be drawn between possible childhood abuse and subsequent abusive behaviour. Guidelines are presented on working with the problems of self-destructiveness, masochism and depression facing the young abused/abuser and the impact of sexual abuse on sexuality, gender identity and sexual orientation. This is an instructive and thought-provoking text for all mental health practitioners and allied professionals working with adolescents who sexually offend.

As a psychodynamic theory of both normal development and psychopathology, attachment theory has particular utility for forensic psychiatry. A Matter of Security provides an attachment theory based account of the development of arousal and affect regulation, which offers a new way of thinking about mental disorders in offenders. This book also discusses the development of personality in terms of interpersonal functioning and relationships with others, which is essential to understanding both interpersonal violence and abnormal personality development. Attachment theory also offers a model of therapeutic work with patients that have particular resonance with forensic work because it uses the language of security. This collection focuses on attachment theory applied to forensic psychiatry and psychotherapy.

The first comprehensive account of forensic nursing and its role within the wider professional team, the aim of this book is to provide a multidisciplinary perspective on the training needed to work with mentally disordered patients, as well as to examine the key characteristics of the forensic nursing role. An international group of contributors, from a wide range of disciplines, provides a well-rounded, comparative view of the forensic nursing profession.The chapters are a rich contribution of cross-cultural thinking on the many dilemmas and challenges facing nurses, psychiatrists, psychologists and other health care practitioners, working with specific client groups. Each contributor has utilised empirical data to analyse relevant issues, such as: professional standards; effectiveness of preparation for nurses working within secure environments; day to day and long term challenges facing nurses; clinical effectiveness; the dilemma of security versus practice; how forensic nursing differs from other kinds of nursing; and what forensic nurses can contribute to other mental health care disciplines. Examples of how research findings may be integrated into practice, will be of interest not only to forensic nurses, but also to significant sectors of the mental health care field.

The contributors to this wide-ranging volume are experts from a range of psychiatric, criminal justice, legal and ethical backgrounds, and, uniquely, include patients who recount their own experience of forensic care settings. They examine and explore the central theoretic issues, such as culture, power, difference and participation, and relate them to examples of current practice, and to the improvement of future service provision. They identify techniques and approaches which will improve care and treatment.Race, Culture and Ethnicity in Secure Psychiatric Practice: Working with Difference. provides essential information and analysis which exposes society's view of minorities and the influence these views may have on care professionals working in psychiatric and criminal justice systems. It suggests practical steps for improvement to ensure a more equitable and culturally sensitive service provision.

Sexual Offending and Mental Health draws together theoretical, clinical and mental health issues for the range of professionals working in the community and in-patient settings with sex offenders and those who have behaved in sexually inappropriate ways.The contributors describe current influential models of sexual offending and the developmental, psychological and social factors involved. They discuss the prevalence of personality and mental disorders in known sex offenders and the impact these disorders have on their treatment and management. They describe clinical work with individuals, their partners and families, and also consider the impact of this work on professionals. The book includes an outline of current approaches to risk assessment, an overview of the recent changes in legislation in England and Wales, and suggestions for multi-disciplinary management in the community.This book will be essential reading for professionals working in health or criminal justice settings with people who have committed sexual offences or whose sexual behaviour has caused concern for others.

Personality Disorder offers a comprehensive and accessible collection of papers that will be practically useful to practitioners working in secure and non-secure settings with patients who have personality disorders.This book brings together fourteen classic papers, which address the impact that working with personality disorder patients can have on staff. It also offers theoretical explanations for personality disorder, and explores other issues such as the concept of boundaries in clinical practice, psychiatric staff as attachment figures and the relationship between severity of personality disorder and childhood experiences. Each paper is introduced with contextual material, and is followed by a series of questions that are intended to be used as educational exercises.This book will be essential reading for clinical and forensic psychologists, psychiatrists, community psychiatric nurses, social workers and students.

Working in any area of mental health nursing presents complex issues regarding the nurse-patient relationship. For those working in prolonged clinical contact with offenders, relationships with patients and colleagues can be particularly emotionally intense and sometimes difficult to express. This book attempts to understand and articulate the emotional labour of forensic nursing and explores the challenge of establishing and maintaining therapeutic relationships with offenders. The first book to consider the emotional and relational component of forensic mental health nursing, the chapters cover a number of specialist forensic areas from this psychodynamic perspective, such as women's services, services for people with personality disorders, intensive care, high security psychiatric hospitals, medium secure units and services for adolescent offenders. A chapter on therapeutic communities is also included, along with chapters on challenging relational phenomena such as working with hate and the difficulties of managing difference when working in environments that produce high levels of anxiety. Therapeutic Relationships with Offenders provides essential information for mental health nurses working in the forensic field and will be of interest to any professionals working with challenging populations and people with personality disorders.

Working with Sex Offenders in Prisons and through Release to the Community is the first study of its kind to look at a wide range of issues and problems relating to the management of sexual offenders in prisons and their reintegration into the community. Spencer's analysis of the delivery of prison-based offence-specific programmes, both within the broader context of criminal justice systems and the community provides valuable insight into the relationship between prisons and other agencies dealing with sex offenders. Spencer makes a strong case for implementing treatment for sexual offenders within prisons, as well as the need for support and supervision in the community once released. His multi-agency approach is an innovative and cohesive strategy for effective interventions, and highlights major issues which need to be addressed so that programmes stand a chance of succeeding in a penal setting.The issues involved in the setting up of programmes, the creation of the right environment, and the support and training of staff, are universally applicable; as are discussions of risk assessment, the links between victims and offenders, sex offenders in special hospitals, women as sex abusers, the use of pornography and sexual offender notification. This book is essential reading, not only for specialists in the field, but also for students and professionals working in related areas.

People who use forensic mental health services are defined by the fact that they have violated boundaries, often in many ways. For clinicians employed to work therapeutically with this client group however, the capacity to initiate and maintain boundaries is critical to safety as well as to good treatment outcomes. This book provides a thorough introduction to the subject of professional and therapeutic boundaries and their particular complexities within forensic mental health settings. The contributors, all experts in their respective fields, address the challenges of establishing working boundaries within forensic mental health services from multiple perspectives. They explore the ways in which boundaries can be initiated and maintained in different areas of forensic mental health work, including in psychotherapy, mental health nursing, arts therapies, forensic psychiatry and family therapy, and when working with different client groups, including children and adolescents, offenders with severe personality disorders in high security settings and sex offenders. Consideration is also given to boundaries and homicide, maternal boundary violations and boundaries in a forensic learning disability service.This authoritative, interdisciplinary resource will support all forensic mental health practitioners in this crucial aspect of their work.

Adolescents with developmental disabilities are a complex population who require specialised treatment and care. This interdisciplinary text examines the processes involved in working with this client group in forensic settings, and explores the ways in which their needs differ from those of other young people who engage in high risk behaviour or offending. The book covers assessment, intervention and treatment options for adolescents with a wide range of developmental disabilities, including autism spectrum disorders, acquired brain injury, developmental traumatology, and complex comorbidities. It describes the obstacles, challenges and opportunities to consider when working with this population, and the role played by various professionals, including forensic psychiatry and psychology, occupational therapy, physiotherapy, education, art psychotherapy and social work. The book also outlines the issues to consider when working in secure and community settings as well as the legal aspects of working with this client group, and the complex issues surrounding risk assessment. The first comprehensive account of forensic issues in adolescents with developmental disabilities, this book will be an indispensible primary resource for a wide range of professionals, including child and adolescent psychiatrists, community psychiatric nurses, developmental paediatricians, social workers and youth workers, lawyers and advocates.

This groundbreaking book explores the psychodynamics and socio-politics of the forensic therapeutic milieu, addressing some of the most difficult and complex issues facing practitioners. It sets out a psycho-social framework for understanding the predicament and the needs of those who live in and those who work in forensic mental health settings. It brings to life the thinking of those working on the frontline in an increasingly difficult and hostile environment, and draws together fresh and stimulating approaches to engagement with highly complex individuals who present challenges to traditional models of psychiatric assessment and treatment.Contributors with considerable clinical experience and expertise from a range of disciplines consider the ethical, emotional and intellectual challenges of their work, and describe ways in which genuine containment and change can be achieved despite numerous perceived assaults on therapeutic relationships, and on the therapeutic milieu itself. Combining clinical case studies with organisational perspectives and clear descriptions of theoretical processes, they explore key issues including the challenges of maintaining role-appropriate, 'boundaried' relationships; the tensions between public protection and individual confidentiality; questions of risk and responsibility; duty of care and respect for individual liberty; the challenges posed by inter-professional tensions and rivalries; as well as specific clinical dilemmas. The difficulties they experience in fulfilling specific therapeutic roles in the face of uncertainties about the funding and commissioning of their services are addressed, and the final part of the book outlines some of the ways in which individuals, particular services and whole organisations may protect themselves when under attack.This unique and highly original book is essential reading for all those working, or training to work, in both forensic and non-forensic inpatient therapeutic milieux and for academics and lay readers interested in the societal dynamics of inclusion and exclusion that are replicated and magnified in these settings.