My role in the review of forensic mental health services

A Q&A with the chair of the review of forensic mental health services in Scotland 

• Mental health nurse Derek Barron is chairing a review of forensic mental health services in Scotland
• It covers inpatient settings, high-, medium-and low-secure settings, community services, prisons and police custody
• The voices of those with lived experience and those of their family and carers will form a critical part of the review

Mental Health Practice asks Derek Barron, director of care at Erskine, a charity for ex-service personnel and their spouses, about the review and his role.

• What will you be doing?
In March, minister for mental health Clare Haughey announced a review of forensic mental health services in Scotland and asked me to chair it. I will be doing this one day per week while ensuring residents and staff at Erskine continue to receive the care and attention they need.

• What is the scope of the review?
The review is wide ranging, as are the services across Scotland. It will cover where those services are delivered and the links between them. To be more specific it will cover inpatient settings, high-, medium-and low-secure settings, as well as community services, prisons and police custody. An important aspect is the transitions between the various services.

• Why now?
There isn’t a single trigger that has brought about this review. The minister has assessed that now is an opportune moment to look at how we deliver forensic services in Scotland.

• What do you expect the benefits to be?
It is a good discipline to continuously review how we do things. Do we have enough capacity or too much? Is the capacity in the right or the wrong places? I’d expect the review to highlight areas of good service delivery, but also to recommend improvements. The voices of those with lived experience are critical to the review; the minister was specific that she wanted me to listen to these voices and to those of their families and carers. Right now, I don’t know what might be improved; this is the purpose of the review.

• Who do you hope to influence?
I see the role as gathering evidence from a wide range of stakeholders, examining this information and making recommendations to the minister. I suppose I would hope to influence her; after all, this is who has asked me to undertake the review. I would also hope that at the end of the review the numerous stakeholders would recognise the value of the work and be influenced in their thinking over the future strategic direction for forensic services.

• When and how will you undertake the review?
Next month there will be an introductory meeting of a large number of stakeholders, to set out what the review must cover and to gather support. It’s important that this doesn’t turn into a talking shop, so I’d be looking for people who want to put in the work around what works well and what could be better. It’s likely there will be a number of subgroups to take forward specific workstreams before bringing these back under a single review next year.

• How will you take account of the voices of service users?
The minister has been clear that the voices of those with lived experience and those of their family and carers are a critical part of the review. This chimes well with my belief that we must include those with lived experience. I used to be the mental health nurse adviser with VOX (Voice of Experience), a national mental health advocacy organisation, so it’s something I’ve always thought of as important and was delighted when the minister re-emphasised her commitment to this. The first commitment I made when I was announced as chair was to accept an invitation to speak at the Support in Mind Scotland annual conference for family and friends about accessing forensic mental health services.

• How will the outcomes affect mental health nursing?
Answering this might presuppose the outcome of the review but, by shining a light on the excellent services we have and by recommending areas for development, mental health nurses who are perhaps not working in forensic services will see it as a complex, dynamic and rewarding area of nursing and look to build a career here.

• How will the review affect nursing education and training?
If there are areas of the services that currently don’t take nursing students, the review might be a way of opening them up.

• How will care of service users be improved?
This is at the crux of the review. I’ve never worked anywhere that is perfect. With the best will in the world, all of us get settled into a system that worked when it was set up, when it was conceived. But new thinking emerges, new research becomes available, new services beyond what had once been a limited choice are set up. The review will see how each component works to care for those who use the service.

• How will community care be affected?
First, it’s important to state this review isn’t about closing inpatient units. We will always need inpatient units; they are safety-critical services. However, we need to ensure that inpatient and community services work as seamlessly as possible. Community care is crucial if we believe in positive treatment outcomes, of safely diverting people away from requiring inpatient stays to community treatment options. We already have treatment options available in police custody suites and in our prisons and we have proactive community services; I will be keen to explore how we can develop these further.

• How does the review fit in with that of mental health law?
The reviews are separate, focused on different but overlapping areas of mental health services. It’s more likely that forensic services will be influenced by the review of mental health law, rather than the other way around. However, I would expect that the law review will take cognisance of emerging findings and lived experiences from this forensic review.

• What qualities or insight do you expect to bring to the review as a nurse?
I consider the whole person. I think of them in the community where they live. However, I don’t think these are exclusively ‘nurse’ qualities or insights; any professional who puts the person using services and their community at the centre of care would bring the same outlook as mine. I also bring experience of more than 30 years working in the NHS, of being involved in service reviews and service developments.

• How can mental health nurses learn from your experience?
In chairing this review, I would hope mental health nurses will see that nothing is beyond them; it is what we bring as people and the knowledge we’ve accumulated over years of practice that open up opportunities for us and our profession.