An exploration of four Australian forensic services to examine recovery oriented practice and educational initiatives for forensic staff in working with patients as partners to take responsibility for the improvement of their mental health.

Introduction

This report includes a review of four Australian forensic services. Recovery oriented practice is reputedly more well embedded into services in Australia, New Zealand and America. The Florence Nightingale Foundation and The Scottish Government were therefore willing to fund a travel scholarship to Queensland; Victoria; South Australia and New South Wales.

There were three aims:

• to review existing forensic in-patient and community services and discuss how they cope with the challenges of implementing recovery oriented services;
• to explore the use of psycho-education in Australian forensic services, and
• to explore the provision of staff education in Australian forensic services and share current practice ongoing in Scotland.

Findings

The overall picture is of most clinicians striving towards delivery of a recovery oriented service, but there are barriers that render the goal less attainable. These barriers commonly relate to either: infrastructure and systems; attitudes and values; education and training or culture. There is more evidence of success in Low secure units and the Community services. Both Medium and High secure services still appear to be working towards a common goal – similar to the services here in Scotland – but admit they have yet to achieve it. Where there are units with good leadership, clinical supervision / reflective practice and a practice development focus there is a healthier focus on patient-centredness and recovery oriented care.

There is evidence of psycho-education being used across some of the services, but nursing involvement is sporadic. This would seem to be an area we can offer advice and support to others as opposed to drawing upon evidence from the Australian services.

The Pre Registration training for nursing is quite different for people working in Australia and preparation to work in forensic services is extremely variable across the different States. One advantage is that Registered Nurses are well prepared to deal with physical health complaints. The predominant focus of Post Registration training seems to be about learning the basics of working with people who suffer from mental illness. This is necessary due to the reported absence of such material in the undergraduate training programme. Forensic specific training is essentially practice based.

Recommendations

• Consider the implementation of Consumer Consultants.
• Explore Trauma Informed Care initiative in collaboration with Thomas Embling Hospital.
• Consider earlier preparation for gainful employment, that is, at the high secure stage.
• Review the use of extended periods of Seclusion.
• Consider mandatory debriefing following incidents.
• Share our success with Australian services and engage in joint research projects with a view to improving patient care.

Conclusion

As a direct consequence of the study tour new opportunities have emerged for collaborative clinical, educational and research projects. The opportunity to review existing and new services in another country as an external consultant has been an enlightening process. It has enabled comparisons to be made with our own Scottish services and crystallised thinking around provision of good practice. It has become apparent, through discussion and exploration of clinical practice that we provide a robust forensic service in Scotland, with appropriately trained clinicians, yet there is always room for improvement in practice.   Good communication, valuing difference, reflecting on practice, strong leadership, having key players with common goals and a sense of focus are the elements that seem to make a difference to services. Changes in culture have worked where initially there is evidence of strong leadership and a collaborative approach, used essentially to cease poor or ill informed practice. Supportive environments through education/ training, clinical supervision and employment of leaders with positive patient-centred values have enabled patient-centred care to emerge and evolve. We can certainly learn from some of the newer initiatives introduced by our fellow clinicians in Australia, but have much to offer in return.