Nursing dangerousness, dangerous nursing and the spaces in between: learning to live with uncertainties

One peculiar characteristic of forensic work is that the capacity of the patients to act out their violent states of mind is what has resulted in their entering into treatment, rather than any more conscious motivation for treatment or recovery. This fact of their involuntary patient status means that patients survival is literally dependent upon, if not actively under threat from, the treatment they receive from the system of care. Disastrously this hostile dependency has, from time to time, resulted in a number of mental health workers being killed and injured by their patients and many more reports into the various ways and means in which such patients have been subjected to interpersonal and institutional mistreatment. The focus of this chapter will be on the persistent threat to psychic survival faced both by nurses and patients in forensic settings, how these threats become manifest in the dynamic interplay between nurses (and others with the multi-disciplinary team) and those mentally disordered offender patients who are perceived to be dangerous. Our starting point is that these threats are both real and imagined and are brought about by the enforced proximity (or the avoidance of it) between nurses and patients within forensic settings. Discussion of these issues may be timely, since it has been argued forcefully that a review of mental health policies is necessary because of the failure of statutory mental health and criminal justice services effectively to resolve the dilemma of how to manage people with personality disorder who are, or are thought to be, dangerously anti-social and have not been successfully housed within existing secure provision.