Why forensic mental health nursing is such a rewarding career

A challenging role where compassion and advocacy go hand in hand with public protection

I have worked in forensic mental health for almost 20 years, working my way up from staff nurse to service manager of the Edenfield Centre, a 161-bed Medium Secure Forensic Mental Health Unit in Manchester. 

Forensic mental health is a fascinating, unique and challenging field, but as a nursing student it wasn’t an area I really considered as my career.

After qualifying as a mental health nurse in 1995, I worked in acute services, psychiatric intensive care and in prisons. But my interest in the relationship between mental health and the complexities of offending made forensic services seem like a natural pathway.

Double stigma of poor mental health and a record of offending

In forensic services, you will work with patients who have committed serious criminal offences, often violent crimes. Forensic patients are often stigmatised, both for their mental health issues and their offending. Many have also been victims, which has a big impact on their own offending and route into services. 

‘Throughout my career, the teams I have worked with have been committed, engaged and supportive of each other as well as their patients’

Forensic nurses have to engage therapeutically with patients who often do not trust services. It is therefore vital that we develop trusting and safe relationships, with boundaries, that are collaborative and supportive but also challenge patients to take responsibility and develop robust coping strategies. 

Therapeutic relationships and management of risk

One of the main roles of forensic nurses is the assessment and management of risk. This is specifically related to risk to others, but we are seeing an increase in the number of patients who are self-harming.  

Developing therapeutic relationships enables us to assess the patient’s risk, develop meaningful, collaborative care plans and support the patient towards discharge. 

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No day is the same in forensic nursing; there is routine and structure but this can change, and we have to ensure we can support patients and provide care in the least restrictive environment, because a restrictive setting can cause stress to both patients and staff.

Admission to a medium secure forensic mental health unit – a decision not taken lightly

All our patients are referred to the service and have to be assessed by a nurse and doctor for suitability – admission criteria for a medium secure unit is ‘immediate risk to others’, with patients detained under the Mental Health Act. Patients in England and Wales are also subject to restrictions from the Ministry of Justice, so it is a big decision to admit. 

‘Our role is to ensure the patient stays motivated, acting as their advocate and delivering compassionate, non-judgemental, patient-centred care while also considering public protection’

We take patients from prisons, other secure hospitals and general adult wards. Many will be in our care for more than a year, sometimes longer, so we take a longitudinal view of care and recovery.

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All our patients are acutely unwell on admission. They are at their most vulnerable, scared and likely to have psychosis, so need support and care for a quick recovery and discharge back into the community or to another hospital with less restrictions. 

Nurses balance patient-centred care with public protection considerations

Our role is to ensure the patient stays motivated, acting as their advocate and delivering compassionate, non-judgemental, patient-centred care while also considering public protection.

One of the main challenges you may face is understanding the complex relationship between offending behaviour and mental health. You will need excellent communication skills, especially non-verbal, as well as self-awareness and the ability to reflect on your practice.

Preceptorship and newly qualified nurses, and enhanced supervision

At the Edenfield Centre, you will be provided with enhanced clinical and managerial supervision which will also help you build resilience and maintain your own health and well-being. Reflective practice and de-briefs are part of routine support for all nursing staff, and you will have the opportunity to develop your skills and engage in further training. 

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Newly qualified nurses can work in a range of clinical settings, such as male acute admission, women’s service, pre-discharge and rehabilitation wards. A preceptorship programme is provided for all new nurses, with ongoing supervision by a designated practice development nurse.

Working in a forensic hospital or unit is very similar to other mental health units. Many nursing staff take on more advanced clinical roles, such as those of advanced nurse practitioner (ANP) and nurse therapist.   

As service manager, my role is to support staff to aid patients’ recovery, challenge stigma and provide a safe and therapeutic environment to support transition into the community.

Awareness of individuals’ circumstances

I have a master’s degree in advanced practice in psychosocial interventions (PSI), which has enabled me to work more independently and clinically with patients. This training led to an ANP role which I held for several years, working closely with the forensic consultant in formulating care and supporting the wider nursing team. 

As a PSI therapist, I also worked closely with families and carers, supporting them to understand why their relative was unwell and ‘did what they did’. We need to remember that the circumstances leading to an admission have been traumatic for the patient, victim (if there is one) and the family, who are often left to cope alone.

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Relatives and carers often bear the stigma as much as the patient, which can leave them feeling isolated. Seeing a patient grow, and feel safe and secure again with their relatives, is a hugely rewarding part of my role.

A supportive and inspiring practice setting

The future remains challenging but exciting in forensic mental health. Services are changing to meet the needs of patients, and we are always looking at ways to improve our ward environments and clinical models. 

Throughout my career in forensic mental health, the teams I have worked with have been committed, engaged and supportive of each other as well as their patients. It is hugely rewarding seeing staff develop their careers, becoming nurse practitioners and ward managers, leading their own teams and inspiring newly qualified nurses.   

Stephen Clarke is service manager (forensic) of the Edenfield Medium Secure Mental Health Unit, part of Greater Manchester Mental Health NHS Foundation Trust. He will host a workshop, A day in the life of a forensic nurse, at the RCNi Nursing and Careers Jobs Fair in Manchester on 6 February. 

Find out about RCNi’s Manchester jobs and careers fair