Red-teaming the panopticon^*

* panopticon n. A hypothetical prison proposed by Jeremy Bentham, having circular tiers of cells surrounding a central observation tower. American Heritage® Dictionary of the English Language, Fifth Edition. Copyright © 2016 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company.

(mobilising adaptive change in secure and forensic settings)

Abstract

In England and Wales, secure and forensic psychiatric institutions provide a high-cost, low-volume service that imposes significant restrictions upon detainees. Patients may be detained under the Mental Health Act in such settings for several years or even life, as they are deemed to present a significant risk to themselves or the public. Patients under s37/41 require the Home Office to approve any increase in their freedom. Best practice requires reoffending risk to be assessed before a patient is discharged. Evaluation of risk is an inexact actuarial science operating in a political arena, and research has indicated risk assessment tools have little positive predictive validity. There is concern amongst the wider psychiatric and judicial communities about the ethics of current practice. We examine these issues and consider means of improving risk assessment through red-teaming, increased collaboration between clinician and patient and a paradigm shift towards greater emphasis on patient self-agency.

Keywords:

• Forensic psychiatry
• offending behaviour
• psychiatric secure unit
• risk assessment
• risk prediction
• secure services

Notes

* panopticon n. A hypothetical prison proposed by Jeremy Bentham, having circular tiers of cells surrounding a central observation tower. American Heritage® Dictionary of the English Language, Fifth Edition. Copyright © 2016 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company.

Risk assessment in the context of red teaming, increased collaboration between clinician and patient and a paradigm shift towards greater emphasis on patient self-agency in secure and forensic settings.