Care-Oriented Practice In At-Risk Units: Risks, Realities and the Role of Multi-Disciplinary Teams

Abstract

At-Risk Units (ARUs), which contain and prevent suicide and self-harm among prisoners, have been criticised for their isolating, non-therapeutic nature. This thesis explores the potential for care-oriented practice to develop in ARUs at two prisons, with a particular emphasis on the role that multi-disciplinary teams and an enhanced healthcare presence can play in achieving this goal. Adopting a qualitative framework, this research draws upon nineteen interviews with nursing, forensic and custodial ARU staff from Hawkes Bay Regional Prison (HBRP) and Rimutaka Prison (RP). This research found that while normative care-oriented operational safeguards and legal frameworks underpin current ARU policies, they can often become shaped, or in some cases inhibited, by managerial adherence to compliance, risk-management priorities, limited resourcing, staffing issues and a punitive prison culture. However, in instances where multi-disciplinary teams are well resourced, have open channels of communication and operate within health-focused ARU environments, as evidenced in the current workings of RP, positive care-oriented responses to ‘at-risk’ prisoners can be better provided. The thesis concludes by noting that incremental reforms to the current framework may be useful in enhancing care-oriented ARU practice. However, even with change, the question remains whether correctional ARUs can stem burgeoning mental health issues and ‘at-risk’ behaviours among prisoners.