The role of the mental health nurse MHN) while always having the same basic skills set will have a different emphasis within the various service settings such as Community, Acute or Forensic which is the topic of this essay
The forensic MHN specialises in the assessment and treatment of people who may be mentally ill and are normally in the criminal justice system with the service provided in a secure environment. They may also work with victims and others on the edge of the system such as those where other services are unable to cope with them due to their behaviour disrupting others (rethink 2011).
Forensic means relating to the law (Kettles et al, 2008) but for mental health nursing it has come to refer to the setting in which the service is provided.
Such settings include: * A Community forensic mental health team * Prisons. * Secure hospitals – with a range of levels from low to high
Within prisons there is the primary level of health care run by the nurse and other general practitioners who are the first point of call in most prisons. The second level is the equivalent of the community mental health teams and is the mental health In Reach team, normally only a MHN. Very few have a full multi-disciplinary team (McMurran, 2009, p.72).
Within the forensic setting the nurse faces a number of challenges.
There are ethical issues for the MHN in offering an equivalent service. Justifying access to the health care they may need and not being judgemental no matter what the morals or beliefs of the nurse can be very hard with some types of offenders who may have committed horrific crimes. The Code of Conduct by which all nurses have to abide by states we must: Care for our patients and treat each person as an individual as well as being an advocate to patients we care for. (NMC 2008)
Another issue is that the MHN won’t have ready access to the offenders and vice versa as the setting is likely to be a controlled environment and the nurse or offender would have to ask the prison officer to escort them. “Prisoners can request to see a healthcare professional by putting in a general application”. (Rethink 2011)
In some of the higher security settings the offenders might be afraid to visit the MHN as they may feel vulnerable or reluctant to get help for fear of being attacked back on the wing. They may also feel that there is a stigma that is still in some places attached to Mental Illness. The forensic MHN needs to support the client and help them to be able to access the care they need in line with the Codes of Conduct we have to abide by: Treating people as a whole ( NMC 2008)
The Therapeutic relationship is key for the mental health nurse. It about being able to organise the kind of conditions that will help to alleviate distress, to help with the process of recovery and learning and about being able to care for the service user. In the forensic setting, the natures of the work place could make this very difficult.