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112 results

Page 1 of 6

  • Chapter 10 - Forensic Psychiatry

  • Edited by Christopher C. H. Cook, Andrew Powell
  • Book: Spirituality and Psychiatry
  • Published online: 07 October 2022
  • Print publication: 20 October 2022, pp 195-206

  • Summary

    This chapter discusses how issues of spirituality present in forensic psychiatric practice, and especially in the treatment of offenders with mental health disorders. The context of the work of forensic psychiatric services is described. Then three domains of forensic psychiatric practice (the medico-legal, secure psychiatric care and existential forensic psychiatry) are explored, and the ways in which issues of spirituality arise are considered. The chapter concludes with some comments about the importance of the forensic psychiatrist keeping an open mind that can change, in order that his or her patients may experience change. The work draws on the author’s experience of forensic and prison services in England and Wales; prisoners are referred to mainly as ‘he’ because the majority of both offenders and prisoners are male.

  • Impact of homicide by a psychiatric patient on forensic psychiatrists: national survey

  • Gillian Mezey, Renarta Rowe, Gwen Adshead
  • Journal: BJPsych Bulletin / Volume 45 / Issue 3 / June 2021
  • Published online by Cambridge University Press: 26 October 2020, pp. 183-189
  • Print publication: June 2021
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  • Aims and method

    To explore the experiences and support needs of consultant forensic psychiatrists, whose patients had committed homicide while under their care. We circulated a survey to all forensic psychiatrists in the UK, through the Royal College of Psychiatrists, asking about their experiences of a homicide by a patient under their care. Respondents were invited to discuss their experiences further in a structured telephone interview and themes were identified from these discussions. Data were analysed quantitatively and qualitatively.

    Results

    One-third of the 86 respondents had had at least one patient who had committed a homicide while under their care. Of these, over three-quarters (78%) reported that the homicide had a significant impact on their personal life, professional life and/or mental/physical health. For some respondents, the impact was severe and long term. Respondents generally felt that they would have been helped by receiving more support in the aftermath of the homicide.

    Clinical implications

    Greater recognition is needed of the impact on treating psychiatrists of homicide by a patient and more support is needed for affected clinicians. Further research is necessary, including the effects of such events on colleagues in other specialties and examination of the costs versus the benefits of mandatory inquiries after homicides.

  • An introduction to clinical ethics in psychiatry

  • Gwen Adshead, Jeremy Cave
  • Journal: BJPsych Advances / Volume 27 / Issue 1 / January 2021
  • Published online by Cambridge University Press: 23 July 2020, pp. 20-25
  • Print publication: January 2021
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  • The Royal College of Psychiatrists’ continuing professional development (CPD) module on clinical ethics in psychiatry by Pearce & Tan describes some common ethical dilemmas in psychiatric practice and the work of clinical ethics committees in analysing these dilemmas. In this article we build upon their work and offer additional exploration of the nature of ethical dilemmas in psychiatry. We also build upon the models of reasoning that are described in the module and suggest ways for psychiatrists to think about ethical dilemmas when a clinical ethics committee is not available.

  • Author’s reply

  • Gwen Adshead, Mayura Deshpande, K. W. M. (Bill) Fulford
  • Journal: The British Journal of Psychiatry / Volume 214 / Issue 5 / May 2019
  • Published online by Cambridge University Press: 23 April 2019, p. 307
  • Print publication: May 2019
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  • Explanatory paradigms for professional boundary violations: Commentary on… boundary violations in therapy and sexual boundary violations

  • Gwen Adshead
  • Journal: BJPsych Advances / Volume 24 / Issue 6 / November 2018
  • Published online by Cambridge University Press: 22 October 2018, pp. 384-385
  • Print publication: November 2018
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  • In this commentary, I draw on Hook & Devereux to explore the role of insecure attachment in boundary-violating doctors. I also explore the potential contribution of personality dysfunction in that small proportion of doctors who breach professional boundaries.

    DECLARATION OF INTEREST

    G. A. worked with Dr Hook at St George's Hospital, London, and has also worked at the Clinic for Boundaries Studies, where he has worked.

  • Montgomery and shared decision-making: implications for good psychiatric practice

  • Gwen Adshead, David Crepaz-Keay, Mayura Deshpande, K.W.M (Bill) Fulford, Veryan Richards
  • Journal: The British Journal of Psychiatry / Volume 213 / Issue 5 / November 2018
  • Published online by Cambridge University Press: 19 October 2018, pp. 630-632
  • Print publication: November 2018
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  • The 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.

    Declaration of interest

    None.

  • Psychotherapeutic leadership and containment in psychiatry

  • Russell Gibson, Alex Till, Gwen Adshead
  • Journal: BJPsych Advances / Volume 25 / Issue 2 / March 2019
  • Published online by Cambridge University Press: 24 August 2018, pp. 133-141
  • Print publication: March 2019
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  • Leadership is a key role for psychiatrists, with many models that can be adopted depending in part on the nature of the individual and their training, the primary task of the team and the nature of the organisation. In this article we suggest a new concept and model of leadership, ‘psychotherapeutic leadership’. We discuss the theoretical background to this model, its benefits and the implications for training and professional development.

    LEARNING OBJECTIVES

    • • Understand the concept and role of the psychiatrist in providing psychotherapeutic leadership at an individual patient, team and organisational level

    • • Explore how applying an understanding of psychodynamic principles in practice can provide containment in psychiatry and aid clinical leadership

    • • Understand the role of psychotherapeutically informed approaches in recognising factors influencing staff morale and burnout

    DECLARATION OF INTEREST

    None.

  • Security of mind: 20 years of attachment theory and its relevance to psychiatry

  • Gwen Adshead
  • Journal: The British Journal of Psychiatry / Volume 213 / Issue 3 / September 2018
  • Published online by Cambridge University Press: 16 August 2018, pp. 511-513
  • Print publication: September 2018
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  • In this editorial, I suggest that no psychiatrist should be without a working knowledge of attachment theory, and it is a capability that all trainees should cover in the proposed new curriculum. I have focused on three domains of research to argue that attachment theory is relevant to practicing psychiatrists.

    Declaration of interest

    None.

  • 25 - Personality disorders: risks and recovery

  • from Part IV - Women and specific disorders
    • By Gwen Adshead, Consultant Forensic Psychiatrist at Ravenswood House, Southern Health Foundation Trust
  • Edited by Kathryn M. Abel, Rosalind Ramsay
  • Book: The Female Mind
  • Published online: 02 January 2018
  • Print publication: 01 October 2017, pp 161-166

  • Summary

    Coralina's story

    Coralina is a 27-year-old woman who went to her local mental health service after self-harming (cutting and overdosing). She said she heard a voice telling her to harm herself and others. She contacted Social Services because she was concerned that she might harm her 4-year-old daughter, but was very distressed when Social Services took her daughter into foster care.

    Although Coralina had a long history of contact with mental health services, she had never been an in-patient, and she had always tried her best with the therapies and medications offered to her. She has looked up her symptoms on the internet and thinks she has borderline personality disorder; she wants help urgently and Social Services want an opinion about any risk to the child.

    The psychiatrist asked detailed questions about Coralina's experience of herself, her life and her relationships with others. She asked about Coralina's experience of being cared for as a child, especially her experience of being looked after when ill, hurt or distressed. The psychiatrist assessed both Coralina's social functioning generally and her capacity to make and maintain relationships with partners, parents and siblings.

    By doing this, the psychiatrist was looking at Coralina's strengths as well as vulnerabilities, trying to make an assessment of how severe the problems are, and the extent to which Coralina uses unhelpful, destructive coping strategies. She agreed with Coralina that the most likely diagnosis was a mild–moderate degree of borderline personality disorder. The good news was there are now a variety of evidence-based therapies that will help; the bad news was that Coralina's local NHS trust did not provide all of them and there was a long waiting list.

    The psychiatrist agreed to support Coralina with regular psychiatric management while she waited for therapy. She also liaised with Social Services so that the work with Social Services and the psychiatric work with Coralina went hand in hand.

    The initial period was stormy, but gradually Coralina began to trust her psychiatrist. She agreed to share care with the local authority. Her daughter was placed with family members who made it possible for Coralina to see her regularly and therefore maintain a good relationship with her. Eventually, Coralina got access to a specialist therapy group for mothers with borderline personality disorder, where she is making good progress.

  • Ethical dilemmas in psychiatry: When teams disagree

  • Edward Silva, Alex Till, Gwen Adshead
  • Journal: BJPsych Advances / Volume 23 / Issue 4 / July 2017
  • Published online by Cambridge University Press: 02 January 2018, pp. 231-239
  • Print publication: July 2017
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  • Many ethical dilemmas in medicine are associated with highly unusual clinical situations and are an almost daily challenge for mental health teams. We describe the ethical issues that arose in relation to a significant difference of opinion between team members about using nasogastric clozapine in the treatment of a severely ill patient. We discuss how conflicting emotions and perspectives within teams acquire ethical significance and how negotiation and reflection are essential for good-quality ethical reasoning to take place.

    Learning Objectives

    • Understand the different effects and importance of reasoning and emotions in moral decision-making

    • Use a clinical scenario involving a difficult and controversial procedure to explore the impact of social persuasion in moral decision-making

    • Consider the effects of heuristics against rational thinking

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