Infrahumanisation: the nurse versus the guard phenomenon in forensic psychiatric practice in Zimbabwe
| Date | 11 May 2015 |
| Pages | 149-164 |
| DOI | https://doi.org/10.1108/JFP-10-2014-0038 |
| Published date | 11 May 2015 |
| Author | VIRGININIA DUBE-MAWEREWERE |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Infrahumanisation: the nurse versus the
guard phenomenon in forensic psychiatric
practice in Zimbabwe
Virgininia Dube-Mawerewere
Dr Virgininia Dube-Mawerewere
is Psychiatric Nurse Practitioner
at the Health Studies, University
of South Africa, Pretoria, South
Africa and Department of
Mental Health Education,
Ingutsheni Central Hospital,
Bulawayo, Zimbabwe.
Abstract
Purpose –The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation
of forensic psychiatric patients in special institutions in Zimbabwe.
Design/methodology/approach –The study used the grounded theory approach utilising a mixed
sequential dominant status design (QUAL/Quant). Pierre Bourdieu’s conceptual canon of field, habitus
and capital was used as a theoretical point of departure by the research study. Confirmatory retrospective
document review of 119 patients’files was also done to substantiate the nurses’experiences. Theoretical
sampling of relatives was also done.
Findings –Findings and results revealed that nurses seemed to experience infrahumanisation, a
subtler form of dehumanisation. The infrahumanisation was embodied in the unpleasant context in which
nurses were expected to perform their mandate of championing rehabilitation of forensic psychiatric
patients. The guards who represented the prison system seemed to possess all forms of capital in the
prison system (where special institutions are housed): the prison cultural capital, social capital
and economic capital. This capital seemed to represent symbolic power over the disillusioned and
voiceless nurses. Guards attended to and discussed patients and relatives issues instead of nurses. This
form of misrecognition of the nurses culminated in dominance and reproduction of the interests of the prison
system which underlined the established order of realities in the rehabilitation of forensic psychiatric
patients in special institutions at the time of the study. The nurses’lived experience was confirmed by
theoretically sampled by relatives of forensic psychiatric patients who also participated in the research study.
Nurses’powerlessness was also reflected in the patients’files in which in which care was largely not
documented.
Research limitations/implications –The study focused on the nurses experiences related to
rehabilitation of male forensic psychiatric patients and not on female forensic psychiatric patients because
there were important variables in the two groups that were not homogenous. For the little documentation
that was done, there was also a tendency nurses to document negative rather than positive events and
trends. The documents/files of patients had therefore a negative bias which was a major limitation to
this study.
Practical implications –There is a need for major revision of the revision of the role of the nurse in the
forensic psychiatric setting. Collaboration as academia, practice, professional organisations and regulatory
bodies would foster a nurse led therapeutic jurisprudence in the future of rehabilitation of forensic psychiatric
patients in Zimbabwe.
Social implications –There is a need for major revision of the revision of the role of the nurse in the forensic
psychiatric setting.
Originality/value –This is the first description of the position of nurses’seconded to special institutions
in Zimbabwe and will go a long way in realigning conflictual policy documents guiding care of forensic
psychiatric patients in special institutions.
Keywords Nurse, Zimbabwe Mental Health Act, Zimbabwe Prison Act, Guard, Special institution,
Zimbabwe Prison Service Standing Orders
Paper type Research paper
Received 24 October 2014
Revised 15 February 2015
Accepted 20 February 2015
DOI 10.1108/JFP-10-2014-0038 VOL. 17 NO. 2 2015, pp. 149-164, © Emerald Group Publishing Limited, ISSN 2050-8794
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JOURNAL OF FORENSIC PRACTICE
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PAG E 14 9
The Zimbabwe National Mental Health Policy (Zimbabwe, 2004) specifies that special institutions
are run by a team comprising of a resident psychiatrist, psychiatric nurse practitioner, general
medical officer, clinical psychologist, social worker, occupational therapist and rehabilitation
technician. According to Part 14, Section 107 of the Zimbabwe Mental Health Act (Zimbabwe
1996a, p. 107), a “special institution”is a special psychiatric unit within a prison setting that is
used for detaining patients. It is, however, unclear what practices and procedures the psychiatric
team should follow related to rehabilitation during the detention of forensic psychiatric
patients. Forensic psychiatric patients seem to volley between the special institutions, the civil
psychiatric hospital and back to the special institution. This study endeavours to understand this
predicament by interviewing nurses involved with forensic psychiatric practice and reviewing
documents of patients who had already received a service and had been discharged.
Discourses in forensic psychiatry practice
In a study conducted by Livingston and Nijdam-Jones (2012) to develop strategies that would
propel forensic psychiatric care in settings that served British Columbia, Canada, participants
included staff, forensic psychiatric patients and other service partners. The findings pointed to the
fact that patient-centred care in forensic psychiatric settings is beneficial if it addresses issues
of fear and safety among health workers. The study also revealed that personal patient recovery
depended on howempowered the patient was, andalso the degree of his/her internalised stigma.
The results further indicated that placing the emphasis on recovery-oriented care in forensic
psychiatricpractice significantly improves patient engagement and compliance to servicesoffered.
Reporting on a Polish study in 1994, Ciszewski and Sutula (2000) outline how forensic psychiatric
patients were cared for in generic psychiatric hospitals alongside patients admitted for medical
reasons only. The wards had no security and 7 per cent of the patients reportedly escaped.
Additionally, rehabilitation, re-socialisation and treatment were ineffective because the hospital
did not have any therapeutic programme other than psychotropic medication. The results of the
study support the observation of Mason (2006) who challenged mental health professionals
working in forensic psychiatric settings by stating that they have become too dependent on use
of psychotropic drugs; in fact, to the extent that the utilisation of psychotherapeutic interventions
have become obscured.
The Irish Mental Health Commission (2011) tables a philosophy of forensic mental health care
that would address the problems highlighted by Mason (2006) and Ciszewski and Sutula (2000).
That is:
▪Every patient is supposed to have a care plan that is specific to his or her psychiatric,
psychological, psychosocial and spiritual needs.
▪Forensic psychiatric patients are to be involved in the process of caring for them in such a way
that the care plan reflects their individual circumstances and expected outcomes.
▪An advocacy system should be available to the patients and this should be structured to
accommodate these service users.
▪Forensic mental health care should avail a map of continuum of care such that there is a fluid
movement of patients through the rehabilitation process.
▪The families of forensic psychiatric patients should be offered a peer support system so that
they interact and assist each other.
▪A forensic psychiatric patient is supposed to have a key worker who is expected to coordinate
all activities of that particular patient’s care for the duration of their admission. This key worker
also facilitates the flow of the patient through the system either to transfer or discharge.
▪The philosophy also spells out that the forensic psychiatric patient should play a part during
multidisciplinary reviews of their own care.
Zimbabwe’s position
The aforementioned expectations are met by the developed world (e.g. in British Columbia)
where there are pathways of seeking forensic psychiatric care from both the judicial-legal and
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