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Court nursing: facing 'vicarious trauma'.

How popular TV shows depict forensic psychiatry bears little resemblance to the reality mental health staff face when working in the courts and prisons, a forensic psychiatrist told the South Island court liaison nurses' conference in Christchurch in March.

"There is nothing glamorous about the misery, negativity, violence and unhappy life stories we deal with," Canterbury District Health Board forensic psychiatrist Helen Austin said in her presentation on "vicarious trauma". Describing it as the cumulative negative effects of regular exposure to traumatic material and other people's suffering and distress, she said it was not to be confused with compassion fatigue or burnout.

The explicit details in the police summary, the graphic crime scene photographs, the harrowing evidence heard in court and emotionally-charged interviews could all have significant repercussions on the psychological health of both the justice and mental health professions, she said.

There had been little formal study on the impact on those working with the perpetrators of violence, but Austin said her own research conducted among her peers nationally revealed the different ways vicarious trauma could play out. Particular cases, images and conversations could stick in their mind and negatively affect their day-to-day functioning and world view. Overestimating the likelihood of bad things happening, being overly protective of their children and a lack of trust in humanity could also occur.

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When violence involved children, or the professional identified with the victim, the negative effects tended to increase.

People could protect themselves by being aware, communicating with supervisors and having work-life balance, work diversity and community connections, Austin said.

Challenges for those with autism

Dunedin court liaison nurse James Mather drew on international research suggesting people with autistic spectrum disorders could have a lack of concern for consequences, lack of empathy and abuse of drugs and alcohol but the court often did not recognise their condition. This was "because they may come across as high functioning and don't demonstrate to the court how impaired they are".

Court nurses' work involved assessing the accused's fitness to plead and providing advice on sentencing. For those on the spectrum, having a rigid routine disrupted and being challenged in court could be immensely stressful; they struggled with prison, yet community placements could be hard to find, Mather said.

Challenges faced by court nurses were discussed, including a need for clear standards of practice that fitted within the law and ethical considerations, and being asked by judges for assessments beyond their role.

Conflict with nursing ethics

Another conflict was over the disclosure of health information in a public court. A "strong push" by judges and lawyers to access mental health histories was in direct conflict with a nurse's ethical and legal disclosure obligations, said Mather. A lack of office space also meant nurses found it hard to maintain privacy while discussing or recording clinical information and making phone calls.

Blenheim nurse Dot Rooney said the recent quashing of Teina Pora's conviction for rape and murder had led to an increased awareness of foetal alcohol spectrum disorder by the courts. Research showed people with this disorder were 10 times more likely to offend.

Christchurch court liaison nurse Jill Oetgen, who organised the conference, said it was great to get so many South Island nurses together. "We are a small group of very experienced and dedicated nurses, whose work is not often acknowledged or recognised."

Report by Hillmorton Hospital mental health nurse Bernie Burns
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Title Annotation:section & college news; portrayal of forensic psychiatry
Author:Burns, Bernie
Publication:Kai Tiaki: Nursing New Zealand
Date:May 1, 2016
Words:569
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