ABSTRACT
Working in those areas where forensic mental health and the law meet is both rewarding and fascinating, but it also gives rise to some ethical dilemmas for forensic practitioners. Within the criminal context, what is at stake is public protection through a determination of the individual's guilt or innocence, whereas for healthcare professionals what is at stake is the patient's best interest. As Adshead and Sarkar (2007) point out:
Psychiatrists may be experiencing what Erik Erikson summarised as tension between identity and role confusion. On the one hand, they have clear duties to their patients, and mental illness is taken seriously as a medical condition. On the other hand, they apparently have duties to the society, which are both confused and diffuse. Whose agent are they? (p. 422)
In the treatment setting, this role confusion is evident in relation to security. Physical, relational and procedural security measures are all integral to the operation of secure mental health facilities. Inevitably, there will be competing interests between therapy and security. While there has been much debate on how security and therapy can be reconciled in the patient's best interest, security often takes priority over other therapeutic issues. This is particularly so in high-security hospitals (Exworthy and Gunn 2003; Tilt et al. 2000).