Forensic Mental Health Nursing Flashcards
give a brief summary of the paragraphs under the following headings;
Legal Status:
Fitness to Plead
If a mental illness prevents a person from understanding the proceedings, instruction from his/her lawyer or understanding the nature of the charge then the court may not go ahead with proceedings
give a brief summary of the paragraphs under the following headings;
Legal Status:
Not guilty by reason of insanity.
Proven they were unwell at the time of the offence and did not understand the nature and quality of the act or did not know it was wrong
Social Disadvantage, explain
Forensic clients are at more risk of victimisation, bullying and gang affiliation. Poor unemployment and fiscal disadvantage often results in this client group living in poorer socioeconomic areas where populations may all be in the same situation. A serious consideration for considering recovery and rehabilitation. Sometimes stigma forces people back to these areas for acceptance, this is not only in relation to illness but criminal history too. Forensic clients often don’t see recovery as a hopeful opportunity, rather survival.
Forensic Moodle Book)
What is a special patient?
Someone found not guilty by reason of insanity by the courts or has been found probable to have committed a serious, imprisonable offence but is unfit to stand trial
According to Mezey et al (2010) There are 3 major barriers to recovery that forensic clients identified what are they?
. The stigma of being an offender
- Having a major mental illness
- Cramped and overcrowded conditions
Discuss how we (as nurses) can support the recovery process when choice, autonomy and freedom is limited by legislation and the environment.
How can we maintain ethical standards in secure environments? Focus upon beneficence and non-maleficence. Autonomy is restricted but not negated. One simple solution is emphasis upon the environment as a therapeutic intervention with the goal being to work towards the least restrictive environment which can be achieved in most instances (except remandees and convicted prisoners). This gives the client choice on whether he/she wants to engage and participate in his/her treatment; yes this sounds coercive but the forensic mental health client is in hospital for a serious reason and needs to address these problems, beneficence is about achieving the best possible outcome for the client, which is ultimately a safe discharge. We can consider this to be paternalism, but compulsory treatment is by its very nature a paternalistic act. Where we breach ethical boundaries is using paternalism such as withholding personal items, restricting movement to coerce behaviour and justifying this by creating local ‘policies’ that only serve to eliminate potential risk rather than manage it.
identify what mental health nursing strategies could be used to treat and/or manage these factors.
e.g. Barriers to release
having a sentence or limitations on movement can be challenging for implementing a care plan for recovery. However we can make use of the resources we have within the confines of the environment. For example, exercise, use of gyms, gym equipment, yoga, circuit training and aerobics. Planning a realistic future and mapping goals can also prepare for release, assessing skills, such as financial planning, crisis management and advanced directives can all be prepared for discharge planning.
identify what mental health nursing strategies could be used to treat and/or manage these factors.
Prior supervision failure
Exploring the past and why the person was not engaging is very useful for future planning. How the person feels they will manage their illness/circumstances in the future and what strategies they feel will be useful are all important risk management strategies.
Q1. Why is it essential that forensic mental health nurses manage their personal feelings and values related to offending behaviour?
Risks around moral judgement can impact upon the development of trust and the therapeutic relationship. Many people with offending backgrounds have experienced mistrust, trauma and negative responses from authority which may impact upon their behaviour. How the nurse responds to this is crucial as viewing clients as being ‘dangerous or bad’ can result in a lack of engagement and care. Nurses who focus upon the offences and allow personal feelings to dominate clinical perspective results in ineffective practice. Equally inappropriate is the belief that the offending behaviour is not the concern of the nurse. It is the offending and antisocial behaviours that distinguish this population and avoiding these behaviours will result in poor care and poor recovery outcomes.
What does it mean by ‘double stigma’? How can we minimise this?
Double stigma refers to both criminality and mental illness where attitudes are misinformed, ignorant and fearful. Not helped by negative media portrayal. This stigma impacts upon self-esteem and self-respect and can result in avoidance of trying new things, community integration and education. We often avoid what we fear!
