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Silencing and game playing; the management of risk status in a medium secure forensic mental health service


Public, Staff, Students, Alumni, Academics

Speaker: Lisa Reynolds, Divisional Lead, Health Services Research and Management Division, School of Health Sciences, City University London

EVENT LOCATION: Room A111, College Building, St John Street, City University London, EC1V 4PB.
Reserve your place by contacting Doria Pilling.
Please let us know if you have any special requirements.

Forensic mental health services are expected to ensure public safety whilst also promoting recovery and the reintegration of offenders into society (Heyman et al 2004; DH 2007). Faced with this daunting task under intense scrutiny, forensic mental health services may tacitly develop strategies of silencing dissent which serve to protect the organisation.

In this presentation strategies of silencing adopted by service users in response to the organisational ecology of one forensic mental health service will be examined. Data from a case study of an inner city medium secure forensic mental health unit in the UK will be used to explore how forensic mental health service users negotiate and manage their risk status through regulating and, in part, silencing their communication with service providers. A grounded theory methodology was used. Service users and providers were interviewed, and activities taking place within the service were observed over an eight month period. The theme of the regulation of communication to manage risk status emerged from the data analysis as an over arching category. This theme will be discussed from a service user perspective in the presentation. The implications of silencing and game playing for the provision of forensic mental health services will be considered. This will include the impact on risk assessment, decision making; and partnership working with service users.

Lisa Reynolds is a mental health nurse by background who has worked in medium, low secure and community forensic mental health provision. She is part of a research team at City University London which has undertaken participatory research with forensic mental health service users and explored risk assessment in forensic mental health care. In her role of lecturer at City Lisa works closely with mental health service users to develop teaching in the areas of risk assessment and management.


DH (2007) Best Practice Guidance: Specification for adult medium secure services. [accessed 6th December 2011]

Heyman, B., Shaw, M., Davies, J., Godin, P. and Reynolds, L. (2004) Forensic mental health services as a risk escalator: a case study of ideals and practice. Health Risk and Society, 6 (4): 307-325.

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When & where

1.00pm - 2.15pmTuesday 17th January 2012