A journey to somewhere

The term ‘forensic psychiatry patients’ describes patients whose mental illness has led them to behave in a way that brings them into conflict with the law. The patients in this project are detained in conditions of low and medium security. Tricky Hat Productions is working at the clinic with these patients as part of a three-year residency. The aim is to create and perform live theatre events and public installations. The project is funded by NHS Tayside Innovations, and has recently been awarded additional funding from Creative Scotland’s Arts and Criminal Justice Fund to work with the carers of the patient group.

Tricky Hat makes theatre with and about hard-to-reach people. We believe that being involved in a creative process allows patients to escape their illness and offers them a chance to develop as a person and find a voice. The sessions do not focus on their illness or why they are there.

Many use the arts as an outlet to balance their life through reading, films, art, gardening and creating

The theme of the residency is ‘Journeys’ and was inspired by the move to the new facility at Rohallion Secure Care Clinic (previously patients were cared for in the Murray Royal Hospital). The concept of journeys runs through the project: from the past to the present, from where we are and where we want to be, from fractured relationships to harmony, and the spaces between the patients and their carers.

We use weekly drama, music and digital art sessions to cover a range of interests, allowing patients who have limited autonomy to make positive choices. Some patients may come to the digital art sessions only, while others create music or devise new theatre pieces. The model is designed to allow patients to engage at different levels depending on their interests and where they are in their recovery. It also means that performances and installations can be done in public places, but can include contributions from patients who may not be able to leave the secure clinic. Patients are able to make a positive impact in the community through this work.

Often patients who take part will have a history of insidious deterioration into mental disorder, which has compromised their ability to engage in education and the expressive arts. Their early lives may have been characterised by family dysfunction, so opportunities for normal child development and imaginative play have been limited, making it more difficult to develop empathy.

Working with Tricky Hat has allowed patients to fulfil potential that they had been unaware of. Many use the arts as an outlet to balance their life through reading, films, art, gardening and creating. The restrictions imposed on patients who are mentally disordered offenders can make these very normal activities difficult. We have afforded this group the chance to develop new but also very normal ways of approaching distress and difficulty.

It can be hard for people to see psychiatric patients in a positive way. By allowing them to contribute artistically, we provide an effective way of connecting with other people. Imaginative work and creativity also offer the opportunity to see things from a different angle – stepping into someone else’s shoes gives the patients a chance to see a situation differently. This is the basis for empathy and remorse.

With carers (family and others), the work is about using creativity and an artistic process to explore the space between them and the patients. The carers of mentally disordered offenders are doubly disadvantaged: they are distressed and anxious about the effects of mental illness on the life of the patient, and suffer the stigma of being related to the offending behaviour. They often experience frustration and alienation in attempting to seek help for the patient. Working with us has allowed the carers to express the feelings that are hard to share with others. For many carers there are limited chances to speak about the patient in a positive light. Performances give them some good news to relate to friends and family. The old-fashioned Scottish wish to parents of a newborn baby that the child be “like the world” has a special poignancy when you consider the carers for this patient population.

The forensic psychiatry multidisciplinary teams have to maintain a positive perspective when dealing with patients whose progress and improvement can be glacially slow. Performances by Tricky Hat and patients have injected energy and purpose into the service, allowing the staff to see that they have not done just the basics but they have allowed for benefit and reciprocity to the patients; two of the fundamental principles underpinning the Mental Health (Care and Treatment) (Scotland) Act 2003.

Fiona Miller is Artistic Director of Tricky Hat Productions and Dr Karen Richard is Consultant Forensic Psychiatrist at NHS Tayside.
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