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Forensic Mental Health Nursing: Forensic Aspects of Acute Care
Quay books, Jan 2007, Pages: 310
Timely text considering the problems associated with violent and aggressive behaviour. The book includes chapters written by service and considers the care of the patient with a forensic problem from the carer's perspective.
This book is one of a series that emerged from a discussion, in a National Forensic
Nurses’ Research and Development Group meeting, about how the Group could contribute to the development of forensic nursing, and more widely, mental health nursing. As with the first book, a seed was planted and this book was born! This text is aimed at helping nurses working in acute areas to care for and to manage those forensic patients who, for whatever reason, find themselves in an acute inpatient area.
Forensic means ‘of the law’, and is based on the Latin word forum, meaning ‘what is out of doors’ (Soanes, 2002). The Ancient Romans met outside in fora (the plural of forum) for public meetings, political debates and public legal hearings to try offenders (Parker, 1985). In the United Kingdom, forensic mental health nurses work with the relatively small proportion of individuals whose mental health problems are associated with offending behaviours. Forensic mental health nurses work in a variety of settings. These include: high secure hospitals and medium and low secure units; court diversion schemes (e.g., in magistrates’ courts); prisons and young offender institutions and police stations (Kettles et al., 2002; McClelland et al., 2001; Wix and Humphreys, 2005). Some nurses registered in learning disability nursing work in these services (Rowe and Lopes, 2003).
However, the majority of mental health nurses work with individuals with histories of offending in (non-forensic) settings (including acute admission wards; services for children and young people and older people; therapeutic communities; and facilities for treatment and recovery), as well as with individuals with problematic substance use (Kettles et al., 2002; Woods, 2004). Alyson McGregor Kettles, Richard Byrt and Phil Woods.
There is an increasing need for forensic knowledge in acute mental health care. Acute inpatient psychiatric care services provide safety and security for patients and others. Amongst other reasons, patients are admitted to acute inpatient areas because of the risk to self and others; self-neglect; and serious mental health problems (Bowers, 2005, p. 1). As more forensic units are commissioned, and more patients who have been discharged from forensic areas are being cared for in the community, there is an increasing likelihood that these individuals may re-enter services through the acute inpatient areas. There is also the transition for some forensic patients, either up or down through differing security levels, as they enter forensic services or are rehabilitated from high, medium and low security services (Collins, 2000; Collins and Davies, 2005).
Some patients are brought in to a place of safety by the police and this place of safety is the local acute mental health ward. Other patients are diverted from custody or admission is arranged by social workers and their colleagues. Not only this, but substantial demands are being made on acute inpatient services caused by the more challenging symptoms of those who are admitted. Howard (2004, p. 1) points out that community staff are supporting less severely ill patients. Consequently, individuals with high levels of risk to self and/or others are admitted. Furthermore, there is an increase in the number of admissions complicated by problematic substance use (Higgins et al., 1999; Watson, 2001), which is a known compounding and co-morbidity factor in criminal behaviour (Hawkins et al., 1992; Champney- Smith, 2002; McMurran, 2002).
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