TESTING BOUNDARIES: THE SOCIAL CONTEXT OF PHYSICAL AND RELATIONAL CONTAINMENT IN A MAXIMUM SECURE PSYCHIATRIC HOSPITAL.

The article describes some of the history of in-patient psychiatric services and the main focus of recent policy development impacting on the organisational culture of high secure in-patient services. The social and political context for mental health services is located within the recent growth in public concerns about risk and the attendant expectations of professionals, culminating in the proposed reforms of the Mental Health Act (1983) and the development of services for patients diagnosed with severe personality disorders and assessed as being dangerous. Psychodynamic theory is applied to an analysis of working in such a setting, and the unconscious defensive processes, in the current social and political climate. The particular impact on social care services is considered. It is suggested that, in this context, the nature of the primary task challenges the management of boundaries with a resulting infusion of perverse projective processes that potentially undermine professional practices and the possibility of reflective practice. [ABSTRACT FROM AUTHOR]