Decision making in medium security: Can he have leave?

Abstract

This qualitative study investigates how the decision is taken to grant leave to patients in a forensic psychiatric in-patient medium secure unit. This study aims to understand better the process of decision making at multidisciplinary ward rounds. The study is based in a single medium secure unit. Data were collected by a researcher from ward rounds over a period of 15 months using non-participant observation. These data were subjected to content analysis. Two main thematic dialectics emerged: risk and humanity and power and responsibility. Leave decisions were made in 96 instances and risk, per se, was seldom explicitly discussed. This study raises key questions about the balance between explicit information and implicit clinical knowledge that underpins routine clinical decisions. This study is important because it has implications for the reliance on written records in the review of clinical practice, specifically in relation to serious acts of violence committed by psychiatric patients.

Keywords:

• qualitative
• risk
• medium secure units