Making progress with difficult people in high security

Wednesday, 11 May 2016

First, let me thank all those helping me to make good progress towards publication; 26% complete after 12 days. Very pleasing. Thank you.

Years ago, working in high security, a psychiatrist colleague and I would talk of how long it would take for this or that person in our care, usually a young man, horribly damaged by life and still dangerous to others, to change significantly.  The conclusion we arrived at was often surprising. On average, we thought, the time it would take was about six months. "Six months!", people would say. "Yes", we would say, "but it will take about four or five years of very hard work, extreme patience and thoughtful care before that six months begins. And when it does, we better be ready or we may have wait another five years for a second chance."

This recognition of the nature of the task underpinned all of our work, although sometimes it was hard for many staff and the organisation to tolerate because there are powerful implications that are not immediately obvious.  First, it requires a group of carers who can tolerate very slow, and sometimes, no progress for years.  Big effort without reward is hard going over years of effort, especially when all our training in health and mental health work is about achieving a 'cure' or making progress in a matter of a few weeks.  This was a ridiculous proposition back then, and remains equally ridiculous today, but frustration with lack of progress is common.  When that happens it is dangerous for everyone.  It causes caring staff to detach themselves from the task and attribute the failure to make progress to those in treatment. Staff become concerned about security as the paramount consideration and the critical relationship between person and carer, that has to be nurtured over years before rewards are reaped, to be undermined.  All of the challenging characteristics of damaged young men emerge in this situation, as do all the worst aspects of organisation and the people doing the caring.  Soon the long term strategic task of caring for someone, building trust, disconfirming bad expectations, are supplanted by the challenge of getting through the confrontation of each day.  The security minded staff are proved 'right', and the window of oppertunity for real change disappears into the distance. It takes strong, morally and professionally grounded leadership to prevent this cycle of failure from starting. It is hard to find.

In the next blog entry I will describe the academic purpose of The Last Truth and how it fits into a wider plan with more novels.  It is difficult to help those studying to be mental health and human service professionals to understand how the damage to individuals reveals itself.  The Last Truth is the start of developing the materials needed to do this.

For those interested in something else on the topic of this blog post, here is a reference to a book chapter that I recently published.

Thomas-Peter B. A. (2015 May).  Structural Violence in Forensic Psychiatry. In, D. A. Crighton and G. Towl (ed) Forensic Psychology 2nd Edition. Wiley-Blackwell

Key words; personality disorder, mental health, forensic psychiatry, psychology, treatment, structural violence

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