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Journal cover: The British Journal of Forensic Practice

The British Journal of Forensic Practice

ISSN: 1463-6646
Currently published as: Journal of Forensic Practice

Online from: 1999

Subject Area: Health and Social Care

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Including the excluded: high security hospital user perspectives on stigma, discrimination, and recovery


Document Information:
Title:Including the excluded: high security hospital user perspectives on stigma, discrimination, and recovery
Author(s):Anna Williams, (Assistant Psychologist, Reading, UK), Estelle Moore, (Lead Clinical and Forensic Psychologist at Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK), Gwen Adshead, (Consultant Forensic Psychotherapist at Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK), Anthony McDowell, (Clinical Nurse Specialist at Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK), James Tapp, (Research Assistant Psychologist at Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK)
Citation:Anna Williams, Estelle Moore, Gwen Adshead, Anthony McDowell, James Tapp, (2011) "Including the excluded: high security hospital user perspectives on stigma, discrimination, and recovery", The British Journal of Forensic Practice, Vol. 13 Iss: 3, pp.197 - 204
Keywords:Discrimination, Mental disorder, Mental illness, Offenders, Recovery, Secure hospitals, Stigma
Article type:Research paper
DOI:10.1108/14636641111157841 (Permanent URL)
Publisher:Emerald Group Publishing Limited
Acknowledgements:The authors would like to pay tribute to the patients who allowed them to present aspects of their discussions in this paper; to their colleagues Mickey Gopie, Sarita Bose and Bob Simmonds; and to Kevin Murray for supporting this component of the hospital's group therapy service.
Abstract:

Purpose – The purpose of this paper is to document reflections on experiences of stigma and discrimination as described by predominantly black and ethnic minority (BME) service users in a high security hospital via a slow-open therapy group. Service users from BME are known to have higher drop-out rates and poorer treatment outcomes in non-forensic therapy settings (Rathod et al.). Further, they are over-represented in forensic services and often disengage, because their views and feelings are poorly understood (Ndegwa).

Design/methodology/approach – Thematic analysis was applied to a sample of electronically stored running records of group sessions, in which experiences of care, discrimination, hope, despair, and recovery were shared.

Findings – Over a three-year period, 18 forensic patients participated in the group. Group members' reflections on detention, offending and illness were collected. Themes relating to isolation and distance, other barriers to recovery and strategies for coping “against the odds”, are illustrated via anonymised material from the sessions.

Research limitations/implications – Stigma and discrimination are difficult concepts to hold in mind, and are therefore difficult to access. Nevertheless, their effects can be so all encompassing for patients in high security that hope is hard to sustain. The extent to which the themes generated by this sample are representative of those pertinent to others in similar secure settings is inevitably beyond the scope of this paper.

Practical implications – Service users can, and do, share ideas about possibilities for surviving despite their past. Their comments shed light on barriers to engagement for this potentially marginalized population, and possibilities for improving the capacity of the clinical service to hear their voices on an issue of such importance to their potential for recovery.

Social implications – Specific attention to the perspectives of all service recipients on the impact of illness and their recovery is required in a modern health service, where inclusion is a guiding principle.

Originality/value – Interventions for addressing stigma for the most marginalized are infrequently described, but are potentially relevant for all.



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