Theoretical Underpinnings And Scope Of Practice Of Forensic Mental Health
Forensic’ means related to, or associated with, legal issues. Forensic mental health services provide assessment and treatment of people with a mental disorder and a history of criminal offending, or those who are at risk of offending. There is considerable confusion surround the role and responsibility of FMHN. Also there is ongoing debate among those who is the field about what are important factors when determining whether it merits specialty status. Literature reflects no consistent terminology used to refer to FMHNs or the work they do. The theoretical underpinnings and scope of practice of FMHN are unclear resulting in debate about its appropriateness as a specialty area of practice. This exploration of the context of FMHN
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is meaningful because failure to understand the role has the potential to marginalize the contribution of nurses and inhibit development of new knowledge to guide this nursing practice. Further it is through distinguishing the role from that off generalist mental health nurse that entitlement to specialty status could be determined.
1. Admission of client to and from mental health institution as per mental health act of Tanzania, 2008.
There are three types of admission;
1. Voluntary admission
2. Involuntary admission
3. Temporary admission
VOLUNTARY ADMISSION Any person who has attained the apparent age of eighteen years and voluntarily submit himself for mental disorder treatment should be accepted to such mental health care facility, and for a person who is under eighteen years who by his/her parents or guardian is desirous of submitting him/her for mental disorder treatment may be accepted if the parents/guardian submit such person to the officer in charge of mental health care facility If the person who is received into a mental health care facility as a voluntary patient and becomes incapable of expressing himself willingly or unwillingly to continue receiving treatment should:
a. Not kept as a voluntary patient for a longer period than 30days OR
b. Be discharged on or before the expiration of 30days, except if he or she becomes capable of expressing himself or he has been made the subject of an application in relation to involuntary admission or voluntary admission.
INVOLUNTARY ADMISSION A person received as voluntary patient in a mental health care facility and assessed by the officer in charge of a mental health care facility to be a danger to him, the community, property of his incapable of taking care of himself should be admitted for treatment and care using involuntary admission procedure. Where a person who has not attained the apparent age of eighteen years has been received in mental health care facility, has no parent or guardian or his parent or guardian is incapable of performing or refused to perform his duty, the officer in charge of the mental health care facility shall inform the District Social Welfare Officer of that fact. The District Social Welfare Officer after receiving that information, give directions for the continued admission or discharge of such patient as may be necessary.
TEMPORARY ADMISSION Any person, who is suffering from mental disorder and is likely to benefit from temporary treatment in mental health care facility but is incapable of expressing himself willingly or unwillingly to receive treatment, should be received into mental health care facility as a temporary patient for treatment and care.
DISCHARGRE
Person received as voluntary patient and assessed by the office in charge of mental health care facility, that he is no longer dangerous to himself, the community or property and is capable of taking care of himself may leave the mental health care facility subject to the procedures available to other patients not suffering from the mental disorder. Where a person who is voluntary admitted has not attain the apparent age of eighteen years, his parents or guardian may facilitate the process of leaving the mental health care facility on medical advice
2. What is FMHN? International Association of Forensic Nurses ( IAFN ) has define FMHN is the application of nursing science to public or legal proceedings where by the application of the forensic aspect of health care combined with the biosychosocial education of the Registered Nursing the scientific investigation and treatment trauma or death of victim and perpetration of abuse, violence, criminal activities and traumatic accident.
Forensic Mental Health nurse is the one who integrates nursing philosophy and theory with knowledge and skills of mental health and potentially dangerous behaviors, and where the location contains enhanced security, for patient held under the authority of the criminal justice system.
It is not proved whether the FMHN is in specialty or not because: There are a plethora of definition and inconsistencies in the use of the term making it difficult to determine whether or not forensic mental health (FMH) nursing can be considered a specialty with in nursing. Theoretical underpinning and scope of practice of FMHN are unclear, resulting in debate about its appropriateness as a specialty area of practice. Forensic Mental Health Nursing would be mental health nursing in a particular environment or with a particular population and seen as specialty practice. Literature reflects both support for (Whyte, 2002) the view that FMH nursing is under pinned by unique knowledge or skills. Expressing opposition (Cashin, 2006) asserted of that FMH nursing is merely a sub specialty of psychiatric nursing, with distinct environment or group of …show more content…
patient. Borrow (1993b) strongly advocates that FMH nursing is specialty, citing the existence of a range of phenomena which are sufficiently exclusive to confer a specialist status to the nursing role (p.903). Lyons (2009) noted further that although the knowledge base of the FMH is no doubt substantial and in cooperate nursing, mental health and criminal justice system, the ability to utilize one’s skills under onerous and stressful circumstances ( e.g. environment, risk and patient behavior.) is what really differentiate the practice from that of the MHN. Martin, (2001) maintain “Incorporating knowledge and skills related to offending behaviors into their practice will contribute significantly to the development of forensic psychiatric nursing as a clinical specialty.
Whyte (1997) conclude that as a specialty Forensic Mental Health nursing does not exit, because therapeutic incarceration does not confer entitlement to the use of the term forensic. He maintains that the work of all MHN is affected by increasing amount of criminal activities in the society and the presence of security exists in many mental health care venues now. Cashin asserted that FMH nursing is merely a sub specialty of psychiatric nursing with a distinctive environment or group of patients. Borrow (1993b) strongly advocate that FMH nursing is a specialty, citing the existence of a range of phenomena which are sufficiently exclusive to confer a specialist status to the nursing role ,this include control and custody, risk assessment, addressing behaviors ,knowledge of illness conditions, criminal activities etc.
More research is necessary to learn whether specialty status for FMHNs is appropriate and upon what basis it is supportable.
3. Challenges experienced in defining forensic mental health
nursing Literature reflects debate about the substance of the role. Some authors’ have offered definition of what they conceptualize FMHN to be albeit not without some lack of precision or exclusivity. Further concern is the lack of educational opportunities to develop and enhance skills that remain not well articulated. Ultimately have implication for recruitment and retention of nurses in this area of practice, particularly if they cannot be clearly established as a nursing and not custodial role. Peternelj-Taylor & Hufft (1997) defined mental health nursing as “the integration of mental health nursing philosophy and practice, within a social cultural context that includes the criminal justice system to provide comprehensive care to individual clients, their family and their communities. It remains challenging to define and ground the forensic mental health nursing role. A related concern is that demands competencies, skills or attributes of the role are unidentified; there can be recognition of when a nurse is adequately prepared educationally or experientially. In the UK Forensic nurse is taken to be one who practice mental health nursing (Bouttaidar et al, 2004) in spite of the absence of any reference to psychiatric or mental health in the title, thus there is considerable variance in identifying this group of nurses. Black burn (1996) proposed reflecting the term as problematic and undesirable on the basis that it refer to the environment or legal status of the patient rather than the type, quality or nature of the nursing work itself. The literature also reflects a critical view of the term forensic mental health nurse, Manson (as cited in Maeve & Vaughan, 2001, pg 54) who assert that: “There is a certain heroic &sexy attachment to the title of forensic mental health nurse is problematic. FMH nurse is articulated as one focused on assessment or court mandate psychiatric evaluation with a population defined by criminality. This ignores the work of Forensic Mental Health Nurses in ameliorating the psychiatric illness condition through therapeutic engagement in the human context. It reinforces assessment functions targeting criminality, which are not necessarily the same as therapeutic engagement. Therapeutic engagement speaks more directly to the mental health nursing work engaging the patient in meaningful and insightful dialogue, where as assessment may consist of merely observing the patient or completing an evaluative tool or checklist., including inability to articulate the nursing work that is rooted in a concern for the person associated with, yet separation from behaviors. With in the field of nursing, there is a considerable debate about the salient aspects of the forensic mental health (FMH) nursing role and the tittles used to refer to nurses doing this work. Further it is not clear if FMH nursing work is sufficiently exclusive to be considered as a specialty area of practice. Confusion about the role exists because the language and terms used to refer the FMH nurses work are inconsistent and there is wide disparity in the scope of the role in practice.
4. Quality of care provided in FMH compared to other MH settings The Canadian Nurses Association (2008) code of ethics explain that moral distress is a potential outcome for FMHNs because they practice in settings under the weight of ideology or incarceration ,security and disempowerment that constrains their nursing action, often without the power of successful negotiate a viable compromise between two.
Holes (2005) describe the impact of environment on forensic nurses a” cultural shock” when they experienced the secure forensic environment. Participant in study felt that the conditions of the locked and heavily controlled environment made it impossible to achieve the quality of psychiatric care that would have been available in non forensic environment. Features of secure environment are looks in heavy doors, basic furnishing often bolted to the floor, bars in the window and doors and the restricted access. High levels of constant observation are provided by staff using monitoring routines or by camera surveillance. FMHNs who are working with patients in high security environment do not have keys that will permit exit from the building and are released from the facility by those in a separate area authorized to do so, thus reducing the risk of hostage taking by patient in order to gain exist. In MHN patient also use be kept in locked door with bars in the window and doors but the nurses who are taking care of those patients has an access to enter to patients rooms at any time and care the patients in an accepted manner. And for those patient who are not in acute state they use to go to the recreation place and socialize under the supervision of occupational therapist. Forensic psychiatric nurse is articulated as one focused on assessment or court mandate psychiatric evaluation which a population defined by criminality. This ignores the work of FMHNs in ameliorating the psychiatric illness condition through therapeutic engagement in the human context. It reinforces assessment functions targeting criminality, which are not necessarily the same as therapeutic engagement. In MHN the therapeutic engagement is necessary. FMH environment reflect a power dynamic that requires the nurses to situate his /her nursing approaches in recognition of those parameters (rules, security and constraints) and to negotiate therapeutic endeavors within those constraints, knowing that the therapy is seen as less important than the security by all but the nurse.
5. Difference between FMHN and MHN and the reasons why forensic mental health nursing roles are different to those of other mental health nurses.
There is different in some works and other works is the same as the one which used to be done by mental health nurses. Hammer, (2000; Martin 2001) report that, No evidence that the conceptual basis of practice differ from that of other MHN Literature exploring roles distinctions between FMHN and MHN, and showed that both are research based and anecdotal accounts. Both FMHNs and MHNs interact with patients and provide care no matter how negative the behavior may be or to what intensity psychiatric symptomatology presents. Forensic mental health nursing cannot be distinguished from the other nursing roles although forensic matters are address what is missing in mental health aspect of the role. FMHN certain do have the same roles as other nurses, in terms of the provision of care and interventions through the core skills of developing appropriate nurse patient relationships (Collins, 2000:41). FMHN apply a range of skills applicable in other areas of MHN, such as skills used in the admission and assessment of clients and patients in their continued treatment, rehabilitation and recovery, skills in the administration and monitoring of psychoactive medication and in application of psychosocial intervention
Whyte (1997) argued that, although nurses working in forensic areas desired to be seen as having a unique and distinctive role, their actual duties were the same as those of general mental health nurses. Forensic mental health nurses have specific roles which differ from other mental health nurses. According to Burrow (1993:903), these differences relate to the following areas:
• The complexity of patients’ multiple pathologies.
• Individuals’ criminal behaviors and recidivism in social/cultural systems.
• Specific therapeutic/clinical competencies.
• Specific issues related to forging therapeutic relationships/ interpersonal skills/boundary issues.
• Avoiding negatively custodial care, but working safely in the reality of secure settings or measures to ensure safety in the community.
• Roles related to the criminal justice system and its workings.
• Legal issues such as the multitude of new laws, and ethics and rights-based practice.
• Responsibility to and protection of the public.
• Probability/risk, offence-specific assessment and care.
• Meeting varying safety security needs applied through differing security levels.
CONCLUSION
What is known from the literature is that forensic mental health nursing (FMHN) is a multifaceted area of practice with a need for the FMHN to be able to balance many competing factors. It is not enough to have extensive experience in an area of nursing to specialist. A case for specialist status for FMHN require recognition and codification of whatever is the extant body of knowledge specific to this nursing role. Is a unique basis of knowledge or skills set that is applicable to this type of nursing . Research targeting these outcomes could help to define the role, and highlight any distinctive features of FMHN such that the decision about specialist status could go forth. Consequently the literature reflects that the debate continues concerning whether or not there. At present there is not a sufficiently cogent argument to end the debate about entitlement to specialist status for FMHN and so it will remain unacknowledged.
is meaningful because failure to understand the role has the potential to marginalize the contribution of nurses and inhibit development of new knowledge to guide this nursing practice. Further it is through distinguishing the role from that off generalist mental health nurse that entitlement to specialty status could be determined.
1. Admission of client to and from mental health institution as per mental health act of Tanzania, 2008.
There are three types of admission;
1. Voluntary admission
2. Involuntary admission
3. Temporary admission
VOLUNTARY ADMISSION Any person who has attained the apparent age of eighteen years and voluntarily submit himself for mental disorder treatment should be accepted to such mental health care facility, and for a person who is under eighteen years who by his/her parents or guardian is desirous of submitting him/her for mental disorder treatment may be accepted if the parents/guardian submit such person to the officer in charge of mental health care facility If the person who is received into a mental health care facility as a voluntary patient and becomes incapable of expressing himself willingly or unwillingly to continue receiving treatment should:
a. Not kept as a voluntary patient for a longer period than 30days OR
b. Be discharged on or before the expiration of 30days, except if he or she becomes capable of expressing himself or he has been made the subject of an application in relation to involuntary admission or voluntary admission.
INVOLUNTARY ADMISSION A person received as voluntary patient in a mental health care facility and assessed by the officer in charge of a mental health care facility to be a danger to him, the community, property of his incapable of taking care of himself should be admitted for treatment and care using involuntary admission procedure. Where a person who has not attained the apparent age of eighteen years has been received in mental health care facility, has no parent or guardian or his parent or guardian is incapable of performing or refused to perform his duty, the officer in charge of the mental health care facility shall inform the District Social Welfare Officer of that fact. The District Social Welfare Officer after receiving that information, give directions for the continued admission or discharge of such patient as may be necessary.
TEMPORARY ADMISSION Any person, who is suffering from mental disorder and is likely to benefit from temporary treatment in mental health care facility but is incapable of expressing himself willingly or unwillingly to receive treatment, should be received into mental health care facility as a temporary patient for treatment and care.
DISCHARGRE
Person received as voluntary patient and assessed by the office in charge of mental health care facility, that he is no longer dangerous to himself, the community or property and is capable of taking care of himself may leave the mental health care facility subject to the procedures available to other patients not suffering from the mental disorder. Where a person who is voluntary admitted has not attain the apparent age of eighteen years, his parents or guardian may facilitate the process of leaving the mental health care facility on medical advice
2. What is FMHN? International Association of Forensic Nurses ( IAFN ) has define FMHN is the application of nursing science to public or legal proceedings where by the application of the forensic aspect of health care combined with the biosychosocial education of the Registered Nursing the scientific investigation and treatment trauma or death of victim and perpetration of abuse, violence, criminal activities and traumatic accident.
Forensic Mental Health nurse is the one who integrates nursing philosophy and theory with knowledge and skills of mental health and potentially dangerous behaviors, and where the location contains enhanced security, for patient held under the authority of the criminal justice system.
It is not proved whether the FMHN is in specialty or not because: There are a plethora of definition and inconsistencies in the use of the term making it difficult to determine whether or not forensic mental health (FMH) nursing can be considered a specialty with in nursing. Theoretical underpinning and scope of practice of FMHN are unclear, resulting in debate about its appropriateness as a specialty area of practice. Forensic Mental Health Nursing would be mental health nursing in a particular environment or with a particular population and seen as specialty practice. Literature reflects both support for (Whyte, 2002) the view that FMH nursing is under pinned by unique knowledge or skills. Expressing opposition (Cashin, 2006) asserted of that FMH nursing is merely a sub specialty of psychiatric nursing, with distinct environment or group of …show more content…
patient. Borrow (1993b) strongly advocates that FMH nursing is specialty, citing the existence of a range of phenomena which are sufficiently exclusive to confer a specialist status to the nursing role (p.903). Lyons (2009) noted further that although the knowledge base of the FMH is no doubt substantial and in cooperate nursing, mental health and criminal justice system, the ability to utilize one’s skills under onerous and stressful circumstances ( e.g. environment, risk and patient behavior.) is what really differentiate the practice from that of the MHN. Martin, (2001) maintain “Incorporating knowledge and skills related to offending behaviors into their practice will contribute significantly to the development of forensic psychiatric nursing as a clinical specialty.
Whyte (1997) conclude that as a specialty Forensic Mental Health nursing does not exit, because therapeutic incarceration does not confer entitlement to the use of the term forensic. He maintains that the work of all MHN is affected by increasing amount of criminal activities in the society and the presence of security exists in many mental health care venues now. Cashin asserted that FMH nursing is merely a sub specialty of psychiatric nursing with a distinctive environment or group of patients. Borrow (1993b) strongly advocate that FMH nursing is a specialty, citing the existence of a range of phenomena which are sufficiently exclusive to confer a specialist status to the nursing role ,this include control and custody, risk assessment, addressing behaviors ,knowledge of illness conditions, criminal activities etc.
More research is necessary to learn whether specialty status for FMHNs is appropriate and upon what basis it is supportable.
3. Challenges experienced in defining forensic mental health
nursing Literature reflects debate about the substance of the role. Some authors’ have offered definition of what they conceptualize FMHN to be albeit not without some lack of precision or exclusivity. Further concern is the lack of educational opportunities to develop and enhance skills that remain not well articulated. Ultimately have implication for recruitment and retention of nurses in this area of practice, particularly if they cannot be clearly established as a nursing and not custodial role. Peternelj-Taylor & Hufft (1997) defined mental health nursing as “the integration of mental health nursing philosophy and practice, within a social cultural context that includes the criminal justice system to provide comprehensive care to individual clients, their family and their communities. It remains challenging to define and ground the forensic mental health nursing role. A related concern is that demands competencies, skills or attributes of the role are unidentified; there can be recognition of when a nurse is adequately prepared educationally or experientially. In the UK Forensic nurse is taken to be one who practice mental health nursing (Bouttaidar et al, 2004) in spite of the absence of any reference to psychiatric or mental health in the title, thus there is considerable variance in identifying this group of nurses. Black burn (1996) proposed reflecting the term as problematic and undesirable on the basis that it refer to the environment or legal status of the patient rather than the type, quality or nature of the nursing work itself. The literature also reflects a critical view of the term forensic mental health nurse, Manson (as cited in Maeve & Vaughan, 2001, pg 54) who assert that: “There is a certain heroic &sexy attachment to the title of forensic mental health nurse is problematic. FMH nurse is articulated as one focused on assessment or court mandate psychiatric evaluation with a population defined by criminality. This ignores the work of Forensic Mental Health Nurses in ameliorating the psychiatric illness condition through therapeutic engagement in the human context. It reinforces assessment functions targeting criminality, which are not necessarily the same as therapeutic engagement. Therapeutic engagement speaks more directly to the mental health nursing work engaging the patient in meaningful and insightful dialogue, where as assessment may consist of merely observing the patient or completing an evaluative tool or checklist., including inability to articulate the nursing work that is rooted in a concern for the person associated with, yet separation from behaviors. With in the field of nursing, there is a considerable debate about the salient aspects of the forensic mental health (FMH) nursing role and the tittles used to refer to nurses doing this work. Further it is not clear if FMH nursing work is sufficiently exclusive to be considered as a specialty area of practice. Confusion about the role exists because the language and terms used to refer the FMH nurses work are inconsistent and there is wide disparity in the scope of the role in practice.
4. Quality of care provided in FMH compared to other MH settings The Canadian Nurses Association (2008) code of ethics explain that moral distress is a potential outcome for FMHNs because they practice in settings under the weight of ideology or incarceration ,security and disempowerment that constrains their nursing action, often without the power of successful negotiate a viable compromise between two.
Holes (2005) describe the impact of environment on forensic nurses a” cultural shock” when they experienced the secure forensic environment. Participant in study felt that the conditions of the locked and heavily controlled environment made it impossible to achieve the quality of psychiatric care that would have been available in non forensic environment. Features of secure environment are looks in heavy doors, basic furnishing often bolted to the floor, bars in the window and doors and the restricted access. High levels of constant observation are provided by staff using monitoring routines or by camera surveillance. FMHNs who are working with patients in high security environment do not have keys that will permit exit from the building and are released from the facility by those in a separate area authorized to do so, thus reducing the risk of hostage taking by patient in order to gain exist. In MHN patient also use be kept in locked door with bars in the window and doors but the nurses who are taking care of those patients has an access to enter to patients rooms at any time and care the patients in an accepted manner. And for those patient who are not in acute state they use to go to the recreation place and socialize under the supervision of occupational therapist. Forensic psychiatric nurse is articulated as one focused on assessment or court mandate psychiatric evaluation which a population defined by criminality. This ignores the work of FMHNs in ameliorating the psychiatric illness condition through therapeutic engagement in the human context. It reinforces assessment functions targeting criminality, which are not necessarily the same as therapeutic engagement. In MHN the therapeutic engagement is necessary. FMH environment reflect a power dynamic that requires the nurses to situate his /her nursing approaches in recognition of those parameters (rules, security and constraints) and to negotiate therapeutic endeavors within those constraints, knowing that the therapy is seen as less important than the security by all but the nurse.
5. Difference between FMHN and MHN and the reasons why forensic mental health nursing roles are different to those of other mental health nurses.
There is different in some works and other works is the same as the one which used to be done by mental health nurses. Hammer, (2000; Martin 2001) report that, No evidence that the conceptual basis of practice differ from that of other MHN Literature exploring roles distinctions between FMHN and MHN, and showed that both are research based and anecdotal accounts. Both FMHNs and MHNs interact with patients and provide care no matter how negative the behavior may be or to what intensity psychiatric symptomatology presents. Forensic mental health nursing cannot be distinguished from the other nursing roles although forensic matters are address what is missing in mental health aspect of the role. FMHN certain do have the same roles as other nurses, in terms of the provision of care and interventions through the core skills of developing appropriate nurse patient relationships (Collins, 2000:41). FMHN apply a range of skills applicable in other areas of MHN, such as skills used in the admission and assessment of clients and patients in their continued treatment, rehabilitation and recovery, skills in the administration and monitoring of psychoactive medication and in application of psychosocial intervention
Whyte (1997) argued that, although nurses working in forensic areas desired to be seen as having a unique and distinctive role, their actual duties were the same as those of general mental health nurses. Forensic mental health nurses have specific roles which differ from other mental health nurses. According to Burrow (1993:903), these differences relate to the following areas:
• The complexity of patients’ multiple pathologies.
• Individuals’ criminal behaviors and recidivism in social/cultural systems.
• Specific therapeutic/clinical competencies.
• Specific issues related to forging therapeutic relationships/ interpersonal skills/boundary issues.
• Avoiding negatively custodial care, but working safely in the reality of secure settings or measures to ensure safety in the community.
• Roles related to the criminal justice system and its workings.
• Legal issues such as the multitude of new laws, and ethics and rights-based practice.
• Responsibility to and protection of the public.
• Probability/risk, offence-specific assessment and care.
• Meeting varying safety security needs applied through differing security levels.
CONCLUSION
What is known from the literature is that forensic mental health nursing (FMHN) is a multifaceted area of practice with a need for the FMHN to be able to balance many competing factors. It is not enough to have extensive experience in an area of nursing to specialist. A case for specialist status for FMHN require recognition and codification of whatever is the extant body of knowledge specific to this nursing role. Is a unique basis of knowledge or skills set that is applicable to this type of nursing . Research targeting these outcomes could help to define the role, and highlight any distinctive features of FMHN such that the decision about specialist status could go forth. Consequently the literature reflects that the debate continues concerning whether or not there. At present there is not a sufficiently cogent argument to end the debate about entitlement to specialist status for FMHN and so it will remain unacknowledged.