The chapter looks at the ways in which decision makers (in this case Approved Mental Health Professionals [AMHPs]) construct and deconstruct their frameworks of understanding relating to the assessment of people who are diagnosed with personality disorders. It focuses on the assessment of service users who are subject to a high number of assessments and appear to occupy a disproportionate amount of mental health professionals’ time, both literally and emotionally.
The chapter is based on extracts from the author’s own research and explores the risk paradigm that AMHPs believe shapes the work that they do – in particular, a culture of blame. The factors that AMHPs believe prevent them from making decisions that they feel are in the best interest of the people they are assessing will be explored and contextualised.
The chapter also explores how theories of alienation – in particular, malignant alienation – can help AMHPs and other mental health professionals understand the negative relationship cycles that reinforce unhelpful coping strategies. A critical approach is taken towards the medicalisation and pathologising of what are essentially psychosocial behavioural reactions, and alternative interventions for managing what are perceived as service users’ unhelpful or self-defeating coping strategies are discussed.
In a timely and innovative chapter, the author (a practising occupational therapist and Approved Mental Health Professional [AMHP]) acknowledges and responds to the structural barriers and professional boundaries relating to occupational therapists undertaking the AMHP role in England and Wales. Specific professional frames are presented and the suitability and convergence of occupational therapists’ practice and values as part of compulsory decision making are outlined. The case for occupational therapist AMHPs is made creatively and with profession-specific detail. The chapter sets out how occupational therapists can continue their health-enabler role into their AMHP practice in the ways in which they consider alternatives to hospital and promote people’s independence through their clinical reasoning, decision making and communication skills. The chapter raises awareness about occupational therapists’ values and skills and how they relate to human rights work in a mental health context; in so doing, it serves as a vehicle to promote the profession and inspire therapists to train in these roles and thereby improve AMHP recruitment.
This chapter revisits, synthesises and reconciles the ideas raised in the introductory chapter and throughout the book. It summarises how the different frames connect and reviews how to practice across boundaries, emphasising that there are alternatives to rigid thinking where there is seemingly no middle ground. Suggestion are made for ongoing professionalism and practice wisdom, in keeping with policy and statutory reforms.
This concluding chapter is authored by the editors of the collection and seeks to bring together the main, overarching themes of the book. In doing so it reminds the reader of the Women, Family, Crime and Justice’s (WFCJ’s) main aims and purpose, and recaps on the work undertaken by members of the network to date. It then goes on to discuss the books two major themes: the punishment of women in the criminal justice system and experiences of violence, abuse and justice. In discussing the mentioned themes, the chapter reiterates arguments of inadequacy of current criminal justice interventions which often result in a failure to meet needs, and the need for effective social change and justice.
This chapter draws from auto/biographical reflections from working in a women’s centre. The site and all names have been anonymised but feed into a wider discussion of the troubling relationship between women’s centres and the marketisation of rehabilitation. Auto/biography provides an invaluable way of demonstrating that the feminist researcher cannot be separated from the research (Ahearne, 2021; Baldwin, 2021). Alternatives to custodial sentencing for women are often uncritically considered to be a positive step in criminal justice reform. This chapter interrogates the harms that can arise from the (mis)use of punishment in women’s centres and the empty neoliberal rhetoric of ‘empowerment’ that is not trauma-informed and does not seek to challenge the state’s powers and the feminisation of poverty. This neoliberal governance is part of commodifying service users as ‘bums on seats’. This also raises the importance of understanding ‘radical’ alternatives to imprisonment as being on a spectrum of decarceration (Terweil, 2020) and not accepting binary understandings of reform versus abolitionism.
Women and families within the criminal justice system (CJS) are increasingly the focus of research and this book considers the timely issues of intersectionality, violence and gender. With insights from frontline practice and from the lived experiences of women, the collection examines prison experiences in a post-COVID-19 world, domestic violence and the successes and failures of family support.
A companion to the first edited collection, Critical Reflections on Women, Family, Crime and Justice, the book sheds new light on the challenges and experiences of women and families who encounter the CJS.
Accessible to both academics and practitioners and with real-world policy recommendations, this collection demonstrates how positive change can be achieved.
The subject of race inequality in mental health has been scrutinised by policy makers and researchers for decades. Despite government initiatives such as ‘Delivering Race Equality in Mental Healthcare’, there seems to be an intractability in relation to the closing equality gaps. In the midst of this, one of the decision makers in compulsory mental health work – the Approved Mental Health Professional (AMHP) – is at the sharp end of the data that attracts the sternest criticism: the higher-than-average rates of detentions of racialised minorities. Though solutions may be found in attending to socio-economic obstacles to equality in mental health, practising AMHPs need to have the skills to critique and amend their own practice so that they can take account of the antecedents of poorer mental health in the lives of racialised people whom they assess, and to mitigate against the impact of their own unconscious bias and prejudices. This chapter revisits the data in relation to ethnic inequality in referrals, pathways and outcomes from Mental Health Act (MHA) assessments for racialised minorities. Drawing on the latest research, key decision-making points are analysed to identify where biases may be affecting practice. Attention is given to unconscious bias and individual skills in challenging models, practice and policies that institutionalise the disadvantage of racialised minorities.
The interface between mental capacity and mental health legislation can present a challenge for decision making. It requires a depth of thinking and a viewpoint that goes beyond a legalistic one. The reader is invited to reflect on the spirit of the legislation and on their own position and interpretations. There is an emphasis on emancipatory, values-based practice and a focus on choice. The chapter supports professionals to frame their own decision-making orientation and to use existing models, practice, policy and legal imperatives to support this. The chapter suggests that practitioners need to strike a balance between enabling people and sanctioning people, and that balance sits on a very fine line. The chapter therefore asks the reader to be aware of professional, organisational and legal boundaries and frames and to acknowledge and understand the complexities and nuances of decision making. Historical, contemporary and future frames are addressed.
The chapter evaluates the experiences of coercion inside a mental health inpatient unit. It looks at the use of seclusion and organisational responses to self-harm and aggression using a gendered analysis. The author considers reputation, where women are referred to as being ‘difficult to manage’, and their conflicts and ‘dramas’ are interpreted from a framework that values a masculine type of conflict resolution in a predominantly male environment.
There is very little in the way of research and literature in this area and this is a refreshing contribution. There is a lot of transferable knowledge here, and the reader will be further enabled to reflect on the relevance of gender and power as part of their own assessments and interventions
Women face multiple barriers during political recruitment and representational processes. Concomitantly, a burgeoning scholarship has revealed the existence of various obstacles to elected office faced by disabled people. While studies have examined the intersections between gender, race and class, we know little about how the intersection between disability and gender shapes people’s experiences. This article provides an exploratory case-study analysis of the UK. We centre the perspectives of disabled women in our analysis, drawing upon qualitative interviews undertaken with 41 disabled women candidates, politicians and party activists, as well as participant observation of online events organised to discuss disabled women and elected office. Three themes emerged from this research: first, disabled women feel that they are perceived as ‘not up to the job’; second, disabled women are ‘othered’ during recruitment processes; and, third, hyper-visibility experienced by some, but not all, disabled women can be experienced positively but mainly negatively.
