A risk worth taking? Value differences and alternative risk constructions in accounts given by patients and their community workers following conditional discharge from forensic mental health services

Abstract

Patients leaving forensic psychiatric settings on conditional discharge face the challenge of achieving successful community integration, which involves not re-offending, adjusting to the local community and building support networks. Aftercare and monitoring of patients by workers ostensibly assists with integration, but is often dominated by concerns about risks to the public. Risk is seen to emanate from individuals, with steps taken to ensure intensive monitoring and, if necessary, swift return to hospital. This article shows that workers and conditionally discharged patients have distinct views about risk in community living which are driven by contrasting values and priorities; and that some of these differences are associated with the provision of care itself. A discursive analysis of accounts, drawn from 59 interviews with patients and workers, demonstrates that fears about deviant status weigh most heavily for the individual leaving hospital. Aftercare, with its focus on intensive regular visits by nurses, social workers, police and voluntary agencies, works to ‘unmask’ the person to the wider community, setting them apart as needing supervision. Discharged patients express unease that this unmasking undermines their attempts to begin new lives. Their concern suggests that significant iatrogenic risk arises from aftercare. Workers are not indifferent to this issue, but are themselves subject to public safety imperatives which require surveillance and control of individuals deemed risky. Community integration has the potential to be an important mediator in future risk behaviours. However, managing intensive aftercare without allowing for its wider visibility may jeopardise its achievement.

Keywords:

• aftercare
• deviance
• forensic psychiatry
• users views
• risk
• iatrogenic risk
• risk
• values

Acknowledgement

I would like to thank David Hughes at Swansea University for his support and advice on this project.