Mental health workers’ experiences of using coercive measures: "You can’t tell people who don’t understand"

Abstract

This chapter explores healthcare workers’ experiences of using coercive measures within a high security hospital in England. High security hospitals represent those with the greatest restrictions placed upon patients. Security levels within these hospitals are the equivalent of Category A prisons, yet the employees working in the hospital are healthcare professionals and those accommodated in the hospital are patients, not prisoners. The challenges in balancing care and containment within these restrictive environments are frequently cited in the literature. Healthcare workers’ experiences of working within these environments, however, are rarely explored. Narrative interviews were conducted with 28 members of staff exploring their experiences of working, and of using coercive measures, in a high security hospital. The interviews were analysed using an iterative-comparative approach, whereby the processes through which mental health workers manage their feelings, roles and actions became apparent. Participants frequently spoke of the challenges they experience in reconciling security measures with their roles as healthcare practitioners. Tensions were frequently expressed between mental health workers’ professional expectations, personal feelings and perceptions of responsibility towards their work. Mental health workers describe degrees of detachment and desensitisation as ways of coping with such tensions, conflicts and challenges. All of these factors ultimately influence the decisions made, the practices conducted and care provided within high security hospitals.