Editor’s letter 2015 No. 14

[box] Last month, our Editor-in-Chief did a stretch in a forensic unit [/box]

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Murder is a complicated thing. So complicated in fact that society is drawn so easily to lengthy, rumbling media campaigns about those who commit the crime. The battle that each of us has is trying to comprehend the circumstances, both physical and emotional, that led someone to act in the way that they did. Therein lies the intrigue; we know that, as fellow humans, we too are capable of feeling and acting the same things.

Yet, someone who commits murder is marginalised as being something altogether different from us, no longer worthy of the benefits of our society. Worse still, to be mentally ill at the time of the crime; two separate stigmas, one on top of the other, bringing the full weight of society’s fear on top of you. When I told friends that I’d chosen forensic psychiatry for my specialist choice module, they were intrigued by the people that I may meet and intensely fearful for my safety at the same time. They thrust their hand towards the flame but withdrew long, long before their fingertips ever were to burn.

Many people do not understand the true relationship between crime and mental illness. If you asked the general public to explain it they would somehow cross wires between mental illness and criminality. The blame for this mentality lies squarely at the feet of our notoriously sensationalist gutter press, it is they that have lead to many not realising that those with mental illness are far more likely to be the victims of crime than the perpetrators.

Rather than the clinical cul-de-sac asylums of old, steeped in steampunk Victoriana, what you find when you enter a modern forensic unit is an environment entirely conducive to change. There are patient workshops, groups, therapy sessions. There are even employment opportunities. Although there is an importance placed upon discussing the past, the index offence, and the symptoms that they experienced in the build up, planning for the future is just as important. In the same way that someone with a stroke needs rehabilitation, so does someone experiencing a severe psychotic episode within forensic services; nobody should ever be left behind.

The passion that you are met with from both staff and service users is palpable as soon as you step across the threshold. Forensic psychiatrists live and breathe their specialty, they advertise their career in a way that I’ve never seen before in medicine. They’re so happy with their lot — the fascinating medicine and fabulous work/life balance — that they try their damnedest to convince all and sundry to make the same decision they did. The patients too, despite teething problems here and there, come to respect the work that the doctors, nurses, psychologists and occupational therapists do with them. One patient I met ran out of superlatives to describe his psychologist, another praised the OT who is helping him to overcome his financial concerns and gambling addictions. The cynics may say that this is all about managing risk, that the intensity of the work must be high in order to justify returning patients to society, but it is far more simple than that. The problem is multifactorial and so the solution too requires many different inputs.

It doesn’t stop at discharge either, this holism lark. Patients are followed up in the community, are offered supported housing options, in order to give them the greatest chance of reintegration and recovery.

Very quickly you become acclimatised to the airlock system as you enter the building. Very quickly you become acclimatised to the keys. Similarly, you become acclimatised to the fact that every day you talk with people who’ve committed crimes. And guess what? They’re just like you and I.


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