Attitudinal and Organisational Barriers to the Introduction of Long-Stay Services

  • Ruth McDonaldEmail author


This chapter presents and discusses findings from interviews and focus groups with staff working in the field of forensic psychiatry. It identifies some changes happening in service provision for ‘long-stay’ patients, although the extent of formalisation and codification in relation to these new ways of working have been, at best, patchy. Implementing change in organisations is a difficult process. Embedding and sustaining change so that it becomes institutionalised requires a great deal of effort. The chapter uses ‘institutional theory’ to examine change and barriers to change in the field of forensic psychiatry. Institutional theory is concerned with understanding how the routines, norms and actions become established and taken for granted (i.e. institutionalised) by those who work in organisations, as well as in the wider field in which they are situated. A number of barriers to more extensive and formalised change are identified.



This work represents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by the author in this publication are those of the author and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care.


  1. 1.
    Scott WR. Institutions and organizations. Thousand Oaks: SAGE; 2008.Google Scholar
  2. 2.
    Scott WR. Conceptualizing organizational fields: linking organizations and societal systems. In: Derlien H, Gerhardt U, Scharpf FW, editors. Systemrationalitat und Partialinteresse. Baden-Baden: Nomos Verlagsgesellschaf; 1994. p. 203–21.Google Scholar
  3. 3.
    Lawrence TB, Suddaby R. Institutions and institutional work. In: Clegg S, Hardy C, Lawrence T, Nord W, editors. The SAGE handbook of organization studies. London: SAGE; 2006. p. 215–53.CrossRefGoogle Scholar
  4. 4.
    Pilgrim D. Inside Ashworth. Oxford: Radcliffe; 2007.Google Scholar
  5. 5.
    Shepherd J, Boardman J, Slade M. Making recovery a reality. London: The Sainsbury Centre for Mental Health; 2008.Google Scholar
  6. 6.
    Coid J, Maden T. Should psychiatrists protect the public? BMJ. 2003;326:406.CrossRefGoogle Scholar
  7. 7.
    Reay T, Hinings CR. Managing the rivalry of competing institutional logics. Organ Stud. 2009;30(6):629–52.CrossRefGoogle Scholar
  8. 8.
    Harty MA, Shaw J, Thomas S, Dolan M, Davies L, Thornicroft G, Carlisle J, Moreno M, Leese M, Appleby L, Jones P. The security, clinical and social needs of patients in high security psychiatric hospitals in England. J Forensic Psychiatry Psychol. 2004;15:208–21.CrossRefGoogle Scholar
  9. 9.
    Uslu M, Mok M. Longstay in the Netherlands documentary, 2009. Accessed 12 Aug 2016.
  10. 10.
    Scales K. Doing what makes sense: locating knowledge about person-centred care in the everyday logics of long-term care, PhD Thesis, University of Nottingham; 2014.Google Scholar
  11. 11.
    Martin JP. Hospitals in trouble. Oxford: Basil Blackwell; 1984.Google Scholar
  12. 12.
    Salize HJ, Dressing H. Placement and treatment of mentally-ill offenders - legislation and practice in member states, European Commission, Central Institute of Mental Health, Final Report February 15, 2005.Google Scholar
  13. 13.
    Department of Health. The NHS plan. London: Department of Health; 2000.Google Scholar
  14. 14.
    Turner T, Salter T. Forensic psychiatry and general psychiatry: reexamining the relationship. Br Psychol Bull. 2008;32:2–6.Google Scholar
  15. 15.
    Centre for Workforce Intelligence. Medical specialty workforce factsheet. London: CWI; 2010.Google Scholar
  16. 16.
    Völlm B, Edworthy R, Holley J, Talbot E, Majid S, Duggan C, Weaver T, McDonald R. Characteristics and needs of long-stay patients in high and medium secure settings in The UK: implications for service organisation. Health Serv Delivery Res. 2017;5:11.Google Scholar
  17. 17.
    Currie G, Lockett A, Finn R, Martin G, Waring J. Institutional work to maintain professional power: recreating the model of medical professionalism. Organ Stud. 2012;33:937–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Manchester Business SchoolManchesterUK

Personalised recommendations