As the ghoulish media spotlight dims following his mental health tribunal, Ian Brady has been returned to the care of the high security psychiatric hospital, Ashworth. Just hearing the words ‘care’ and ‘Ian Brady’ in the same sentence jars the nerves. How can a person who so brutally murdered and tortured five children be cared for in any sense of the word? Yet, there are nurses who do just that.
Forensic nurses concern themselves with the care of people with a mental health problem who find themselves in the criminal justice system. They can be found working in prisons, secure hospitals and units (which range from high security like Ashworth to low security, like the one I work in), probation, court diversion, outpatient, community and recovery services. The word ‘forensic’ originates from the Roman word ‘fora’ where community decisions were made and trials conducted. So the word ‘forensic’ comes to mean ‘relating to the courts’. And if you had in mind the TV drama series, ‘Silent Witness’ where crime solving pathologists wrestle with clues left by cadavers, you’d be wide of the mark. The dark art of forensic nursing, as I once heard it described, is much more about the living than the dead.
The world of the forensic nurse is, I suspect, a poorly understood one. Forensic nurses as a group, and certainly those working in areas of high security, face challenges that the wider nursing community might consider beyond the pale.
Take, for example, compassion. That’s an attitude or attribute, call it what you like, that one would expect to see in a nurse, recent failures in standards of care notwithstanding. More than that, the #6CS vision, rolled out this year, commits nurses to the practice of intelligent kindness. How then do forensic nurses care for people like Ian Brady, people with a mental health diagnosis, who may have committed the most terrible acts, and care for them with compassion? Admittedly, such people represent a tiny minority of all patients and forensic nurses a small part of the total nursing workforce. But we are still nurses. This moral and ethical conundrum has occupied my thoughts recently. I know I’m not going to reach a definitive answer. But here’s where I’m at now.
Compassion can be not just a positive benevolent action, but the absence of a negative malevolent intention towards a person. This might translate, for example, into not spilling the lurid beans on a night out so as to keep the day to day life of someone with the public profile of Ian Brady out of the public domain. It might translate into not loosening the physical, procedural and relational boundaries, boundaries which are so crucial to the care of people with psychopathic personalities. It’s much trickier to think about a positive benevolent action. I was asked recently by @anniecoops whether I could hold the hand of a dying Ian Brady. I was shocked to hear myself say that I thought I could. But on reflection, for a forensic nurse, the question is more about ‘should’ rather than ‘could’. What therapeutic value would this seemingly harmless action have? Would I betray his victims? Would I condone his actions? And importantly, does compassion have any meaning if your patient has a hole in their soul, labelled ‘compassion’?
It’s been said that compassion is not like cake (only so much to go around before it’s all gone). Is this really true? Can all nurses care for all patients with compassion? Could you hold the hand of a dying Ian Brady?
Recommended: ‘The Psychopath Test’ by Jon Ronson. Published by Picador.