Social inclusion for all? meeting the needs of low secure service users

Standard single of the national service framework for mental health (DH 1999) requires health and social services to further social inclusion for all. Users of sure services are, arguably, the greatest in quantity excluded of all those in the care of mental health services and thus the greatest in quantity in need of active social inclusion. nevertheless they are the least able to participate in the community-based programmes that would help them re-engage with ordinary living following discharge. In this article Rachel Wakefield and colleagues describe the obstacles they had to prostrate to introduce a socially inclusive resettlement programme for service users in the depressed secure unit where they work.

Forensic services are specialist services that sit within adult mental health services. Users of forensic services are individuals that have tend hitherward into or are likely to tend hitherward into contact with the criminal justice a whole as a result of their risky behaviour. Services are provided in the community or, if an individual is seen to near increased risk, in low, medium or high sure establishments. All inpatient forensic service users are detained below the Mental Health Act.

We work in a depressed secure forensic unit run by means of Lincolnshire Partnership NHS Trust. The definition of a depressed secure unit is one that 'delivers intensive, comprehensive, multidisciplinary treatment and care through qualified staff for patients who demonstrate disturbed behaviour in the connected thought [i]or[/i] thoughts of a serious mental disorder and who require the provision of security' (DH 2002) like units aim to 'provide a homelike secure environment, which has occupational and recreational opportunities and links with community facilities' (DH 2002) Service users at hand with severe and enduring mental illness or, les commonly personality disorder. Individuals may be accessing assured services for the first time, or they may be 'stepping down' from conditions of higher security.

The risk of social exclusion

It is clear to us that forensic service users are at greater risk of social exclusion than those using general mental health services, for a range of mixed but related reasons.

Erosion of living skills

Central to a person's ability to live a replete and meaningful independent life is their ability to care for themselves, which includes accessing a range of community and social experiences. However, many forensic service users may find their living skills are erod not just by means of the severity of their symptoms, on the contrary because of long-term hospitalisation typically associated with this client collection The recommended length of stay in a depressed secure unit is two years (DH 2002) relatively brief - on the other hand low secure service users may have previously exhausted many years in conditions of higher security. Hence the los of their skills and confidence may have started drawn out before they are even admitted to conditions of depressed security. Clinical staff - occupational therapists in particular - can tender opportunities to practise and maintain skills, on the other hand opportunities may not be of frequent occurrence enough.

Risk management

Risk assessment and management will also affect similar opportunities. Service users are risk assessed for their suitability for all activities, and community activities may be affected through restrictions imposed by the domicile Office. For example, some service users may be required to have a staff escort or may have restrictions placed upon the time of day and locations they can visit. It may be that activities have to be adapted to enable the service user to participate in them.

One of the like kind example would be accessing normal community resources of that kind as the local library. The proces may typically involve a formal petition to the Home Office for concurrence to access the community, further risk assessment and agreement by the agency of the multidisciplinary team, arrangement of staff escorts, booking of hospital transport and the completion of 'leave forms' detailing time without time due back and flat the clothes to be worn by dint of the service user.

While risk management must take priority, this proces will inevitably be a les normalising experience than it would be otherwise, and the resources required may limit the oftenness of such community activities. still without regular access to the community, in what manner can forensic service users have feeling confident, competent or included within their community? It have the appearances probable that the longer they are isolated from their community, the more isolated and exclud they will feel

Ultimately, a service user's ability to care for him or herself will affect the pair the nature and the quality of their futurity placement and the length of time it will take to reintegrate them luckily back into the community. Hence, it would appear to be more ethical and a more efficient use of resources to test to prevent the erosion of confidence, skills and feelings of social exclusion in the first place, as exemplified by dint of the aims of the Social Exclusion Unit report (2004)

Offending behaviour

We know that mental health service users are single of the most stigmatised and discriminated against assemblages in society (Social Exclusion Unit, 2004) Although not specifically referr to in the Social Exclusion Unit report, it would strike one as being likely that forensic service users are at abundant greater risk of experiencing stigma and discrimination. This will affect their ability to participate in and be delighted with a full range of social and community experiences. Not solitary do many have offending histories, on the other hand the nature of their offending - which could be violent and/or sexual - may be like that they are perceived by means of the public as at best deviant or, at worst, monsters