“Swimming against the tide”: conditional discharge from medium secure care
| DOI | https://doi.org/10.1108/JFP-06-2019-0023 |
| Date | 13 February 2020 |
| Published date | 13 February 2020 |
| Pages | 57-69 |
| Author | Tanya McDonnaugh,Alan Underwood,Amanda Williams |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
“Swimming against the tide”: conditional
discharge from medium secure care
Tanya McDonnaugh, Alan Underwood and Amanda Williams
Abstract
Purpose –The purpose of this paper is to explore the experiences of mentally disordered offenders
(MDOs) conditionallydischarged from secure hospitals on a restrictiveSection of the Mental Health Act
(Section37/41).
Design/methodology/approach –Data were derivedfrom seven semi-structured interviewsfrom three
forensiccommunity teams.
Findings –Thematic analysisidentified seven predominant themes: (1) the uncertaintyof the discharge
timeframe; (2) fear of jeopardising discharge; (3) progress; (4) engagement with community life; (5)
barriers to socialengagement; (6) evolving identity and (7) someone to turn to. Findingsare discussed in
relationto the recovery model and the good lives model.
Practical implications –The findings highlight the importance of fostering trust between MDOs and
their care teams to encourage help-seeking. They also suggest that resources should be sequenced
appropriately throughout the discharge process, to match the ‘‘window of engagement’’and maximize
impactand effectiveness.
Originality/value –This research gained rarely obtained first-hand perspectives from MDOs, with the
findingscontributing to a more effective evaluation of the dischargepathway.
Keywords Rehabilitation, Recovery, Desistance, Forensic, Good lives model, Inpatient, Reintegration,
Mentally disordered offenders, Thematic analysis, Recoverymodel, Section 37/41
Paper type Research paper
Introduction
Discharge from psychiatric hospitals is often challenging, characterised by loneliness,
unemployment, stigma and fear of relapse (Nolan et al.,2011). Conditional discharge from
a secure forensic psychiatric hospital presents additional challenges from added
restrictions and the dual role of effectivetreatment and public protection.
Medium secure settings provide treatment to people with a severe and enduring mental
health problem who are assessed to be a risk to others(NHS England, 2018). All individuals
are detained under the Mental Health Act (MHA) (1983, as amended 2007), commonly
under Section 37/41, a hospital order following recommendation of treatment rather than
prison after a criminal conviction. Detention has no fixed end date but must be reviewed
every 12 months by process of tribunal (Ministry of Justice, 2009a).
Discharge is sought when the continuing risk can be safely managed with community
resources and is preceded by a lengthy preparation period for the patient and his/her care
team (MOJ, 2009a). When conditionally discharged into the community most restricted
patients will remain under Section 41 for some time subject to certain conditions and liable
to be recalled to hospital if these conditionsare not upheld (Ministry of Justice, 2018).
The management and mitigationof risk is arguably the main focus throughout the discharge
process, thus most research literature in this area examines reoffending and readmission.
Tanya McDonnaugh is
based at the Division of
Psychology and Language
Sciences, University
College London, London,
UK.
Alan Underwood is based
at the Stalking Threat
Assessment Centre
(STAC), London, UK.
Amanda Williams is based
at the Clinical, Educational
and Health Psychology,
University College London,
London, UK.
Received 9 June 2019
Revised 26 November 2019
Accepted 11 January 2020
DOI 10.1108/JFP-06-2019-0023 VOL. 22 NO. 2 2020, pp. 57-69, ©Emerald Publishing Limited, ISSN 2050-8794 jTHE JOURNAL OF FORENSIC PRACTICE jPAGE 57
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