A Qualitative Study of Factors Influencing Psychiatric Nursing Practice in Australian Prisons

By Doyle, John | Perspectives in Psychiatric Care, January 1999 | Go to article overview

A Qualitative Study of Factors Influencing Psychiatric Nursing Practice in Australian Prisons


Doyle, John, Perspectives in Psychiatric Care


TOPIC. Factors influencing the practice of psychiatric nursing in Australian prisons.

METHODS. A qualitative study of psychiatric nurses (N = 30) working in a prison.

FINDINGS. The psychiatric nurses identified the following factors as influencing their work: challenging patients, threats to personal survival of patients, the technology and artifice of confinement, conflicting values of nurses and corrections staff, stigma by association, and prisoner identification of the nurses with prison administration.

CONCLUSIONS. Psychiatric nurses who work in forensic settings must adapt to less than optimal practice conditions.

Key words: Applied research, forensic nursing, forensic patients, psychiatric nursing, qualitative studies

In 1998, more than 100,000 Australian men and women will receive mental health care within Australia's prisons and correctional custodial facilities. Representative of a pluralistic and multicultural Australia, this unique client group will include Aboriginals (Native Australians), women, migrant, HIV-positive, aged, young, homosexual, developmentally disabled, and mentally ill prisoners. It will include homeless, unemployed, and a great many first-time offenders who have never known emotional stability, safety, or personal security and whose dysfunctional or socially disadvantaged backgrounds have desensitized them to victimization, violence, and exploitation. Disproportionately, many Australians entering their nation's correctional institutions will have had little educational opportunity for either a voice or a productive role in society.

The disproportionate representation of the mentally ill in prisons in the developed world is an issue of concern for mental health professionals both in Australia and internationally (Dunn, Seizer, & Tomcho, 1996; Lego, 1995; Morrison, 1996; Peternelj-Taylor & Johnson, 1996). Many offenders experience their first episode of mental illness in prison. While some offenders enter prison with a past history of psychiatric disorder, for others the stress and personal demands of adjustment to incarceration precipitate episodes of psychosis, attempted suicide, or self-mutilation.

The problems associated with the provision of quality mental health care to incarcerated offenders have been identified as diverse, complex, and pressing (Metzner, 1997). Despite offender populations being composed predominantly of young males and females under the age of 40, morbidity and mortality are significantly higher than for their counterparts in society at large. Incarcerated offenders experience a greater prevalence of psychosis, self-injury, self-harm, suicide, and chronic lifestyle diseases such as ischemia and diabetes than comparable cohorts in the general community; personality disorder, substance abuse, and comorbidity are significantly higher (Metzner). The prison psychiatric population represents those individuals in developed societies who are the victims of social injustice, inequity, and economic causation (Tumin, 1996). In Australia, as in the United States and Britain, the incarcerated population is institutionalized, concentrated, and comes largely from lower and disadvantaged socioeconomic groups.

Like other Western democracies, Australia is experiencing a crisis of corrections and criminal justice. A hardening of community attitudes toward crime and punishment, the impact of truth-in-sentencing legislation, and a decade of economic stringency have resulted in overcrowding and an almost exponential growth in prison populations (Grant, 1992).

As other forms of institutionalization decrease in Western society, the prison increasingly has become identified as the central and dominant form of confinement (Faugeron, 1996). This has occurred while other forms of restrictive custody, such as the detention of illegal immigrants and boat people and the seclusion or restraint of the mentally ill in public hospitals, have been circumscribed in recent decades by legislative and policy changes or economic stringency in public-sector spending. …

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