I wanted to share with you some key takeaways from the findings of my dissertation; “Understanding Positive Risk-Taking and Barriers to Implementation in Forensic Mental Health.”

For context, positive risk taking is the process of supporting recovery and rehabilitation by actively and carefully engaging service users in decisions and activities that have previously posed a risk, in full acknowledgement of that risk, in the hope it has a positive outcome and builds new skills.

My thematic structure from 5 interviews with forensic healthcare professionals is below for reference.

Engaging the service user is around the safe engagement of the service user within this process:

• Service users are not being engaged in their own risk assessment which would allow them to build up skills in identifying and managing their own risk.
• Seclusion is being used for more ‘difficult’ to manage service users to compensate for low staffing which is detrimental to service user progress and a huge ethical problem.

Professional Development and Confidence in Practice discussed the complexities of training to work in forensic care and the fear around being responsible for decisions that could go very wrong.

• My participants expressed concerns that primarily clinical practitioners (i.e. clinical psychologists over forensic psychologists) may not be able to work as sufficiently with forensic clients as their training backgrounds and treatment models may favour either the judicial process or the therapeutic outcome, and whilst both are needed, it is unlikely to be available.
• Healthcare professionals also battle with colleagues who are not on board with the approach of offering positive risks, sometimes due to fear, others to not believing that the experience should positive due to the reasons a person is there.

Navigating the Unique Needs of the Service User Group discusses the nuances of forensics and what makes this service different to others.

• It is identified that some professionals find it more difficult to engage in and justify positive risks when it involves certain (overrepresented) conditions, such as psychosis, and certain offenses (sexual), particularly if there are vulnerable victims, which may impact treatment opportunities regardless of other ‘good’ factors.
• Information handed over from the criminal justice system to healthcare system is often dehumanising, reductionist and causes exaggerated risk levels which increases fear and safety behaviours from healthcare staff.
• Service users are subject to the conditions and restrictions of both the healthcare services and the criminal justice system which can present conflicting interests and outcomes from each institution. Additionally, the decisions made by the criminal justice system are often done so despite caseworkers never having met or worked directly with the service user, inhibiting healthcare professionals from using their professional judgement to offer positive risk-taking opportunities.
• Service users are very often ‘in the system’ for a long time, so much so that they may begin to fear life outside of an institution and may sabotage their own progress in order to stay within a familiar institution and possibly even to go back to prison.

Much more needs to be done, and needs to change to improve this increasingly prevalent service. It is my hope that more research within this area will help to support the recovery and rehabilitation of those who are cared for in forensic mental health settings and that my findings might inspire anyone who goes on to work with mentally ill offenders to make improvements to what they find in their workplace. Whilst my study was primarily within the secure healthcare space, much is transferrable to other areas of the criminal justice system.