Stock selection in a high-security psychiatric hospital
SPOTLIGHT
Stock selection in a high security psychiatric hospital: considerations
Synopsis
The nature of life in a high secure psychiatric hospital means that certain restrictions must be in place, to protect the welfare of patients. At the same time librarians have a responsibility to promote intellectual freedom. Where can the librarian working in a secure environment draw the line when it comes to contentious material?
Background
The State Hospitals Board for Scotland provides assessment, treatment and care in conditions of special security for individuals with mental disorder who, because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting. It is a national service for Scotland and Northern Ireland.
The State Hospital patients' library is located at the centre of the Patient Activity and Recreation Service (PARS) within the hospital. It is intended to emulate a public library, with fiction and non-fiction books, DVDs, CDs and videogames. There is also a weekly reading group, where participants read and comment on short stories, poetry and recent news articles.
Library services for forensic populations
Although The State Hospital provides secure services for patients who are unwell, and not prisoners, it is useful to remember that the provision of library services to secure institutions is the subject of guidance by the Chartered Institute of Library and Information Professionals (CILIP). This guidance advises that librarians consider that the primary concern of the institution is security, and certain types of material are inappropriate; however, the guidance states that:
There is also a danger in prisons of over-emphasising the effect that reading can have on an individual, and this has led in some cases, to librarians being asked to remove certain types of fiction or certain authors from library shelves. In reality, prisoners are exposed to a variety of media - newspapers, magazines, television, radio, the content of which is not controlled by the prison. Why, therefore, should the content of their recreational reading be controlled? (1)
Censorship is an important area of concern to staff working in secure environments. It is important to keep security concerns foremost when considering material to be purchased for such libraries. It is important not to appear to promote violence, or provide materials which may turn patients against their own care and treatment plans.
However, Curry states that:
At the same time, they [prison staff] must strive to find a balance between rigid and over-reaching censorship that isolates inmates, perhaps impeding their re-integration into society, and open access to all information, some of which prisoners may misuse. (2)
In addition, The International Federation of Library Associations and Institutions (IFLA) Statement on Libraries and Intellectual Freedom states that Libraries shall acquire, organize and disseminate information freely and oppose any form of censorship (3). Although libraries in psychiatric hospitals and prisons are environments of special security, the librarian remains bound to the ethical code of his or her profession.
Material Selection Issues
A number of resource types which may cause concern were identified by Curry in her study of Canadian prison libraries (2). These include sexually explicit materials; materials with derogatory racial statements / themes; maps; computer manuals; gay / lesbian materials; newspapers and home repair manuals. Also identified were restrictions on materials about bomb making; books on infamous inmates currently in our prison and materials that aggrandise or glorify violence.
Here are some resource types which deserve more detail:
Anti-psychiatry
Anti-psychiatry is perceived to be challenging the core assumptions of psychiatry (4). One of the two main practitioners associated with the discipline, RD Laing, was concerned about the amount of power held by the authorities, and the lack of autonomy of the service user. This may be of concern to those working in secure psychiatric settings. In his own writings, Szasz suggested that as mental illness is merely a social construction, the compulsory detention of distressed persons is a total violation of their civil rights (4). Just as this viewpoint may encourage lack of compliance with treatment, it is vital to reflect all viewpoints in any library's collection, and allow users to make up their own minds.
Self-help / Psychology
The provision of these types of materials has been the subject of much discussion of late, owing to the focus on 'Books on Prescription' and 'Healthy Reading' initiatives in many local authorities and health boards and trusts (5). They allow patients to gain insight into their illnesses and treatment and may help to promote a sense of autonomy. Equally, they have a number of features that may be considered as disadvantages. Firstly, some patients may be disappointed by their experience of self help, and may become depressed because of what they see as their failure. Secondly, they may have literacy problems which restrict their access to the material (this should be tackled by the hospital or prison's education department). Finally, they may be overwhelmed by the language used by the authors, which may contain clinical terms and jargon.
True Crime
This type of material is abundant in public libraries, as well as some of those in secure settings. As the reader may be enthusiastic about the subject, they are likely to encourage engagement with reading, and thus could be seen as a gateway to other reading material, in turn, boosting literacy levels.
There are also concerns about this type of material. The descriptions of crimes may legitimise their own crimes, if indeed they have committed any, and may impede their recovery. Some patients may even be the subjects of these books, a fact which has privacy implications. In addition, it may not be helpful to read all about the 'gory details' of crimes.
Enquiry Reports
The reports of committees of enquiry are freely available in the public domain, If a secure library wishes to emulate the service provided by public libraries, then these should be available there also. There are privacy implications, as patients would not want the details of their life, care and treatment to be available to all other patients.
Films / Music / Video Games
Popular gangster rap often contains violent and misogynistic content. Films with an 18 certificate indicate adult content. These types of materials may be available to patients or prisoners in their room or cell.
The use of video games in secure psychiatric settings is supported by Gooch and Living. Playing computer games is considered to be an active leisure activity, which may help the recovery process and may also be a useful relapse prevention strategy (6). There are two theories of the effects of playing video games, which may be extended to the use of films and music. The first, social learning theory, suggests that playing aggressive games encourages aggressive behaviour. The second is catharsis theory, which suggests that playing aggressive games allows for the release of aggression in a non-physical way, thus preventing further violent behaviour. Video games may also be used to create a sense of control for the player, and allows him / her to practice the use of cognitive skills, such as lateral thinking, decision making, concentration, memory and problem solving skills.
On the other hand, much evidence exists to support the theory that the consumption of violent material such as violent films and videogames leads to the user becoming violent. Steward and Follina (7) reviewed evidence which showed that exposure to media violence affects a person's behaviour negatively and has been noted to have a detrimental effect on pro-social behaviour, both in the long and short term. This is a particular concern when providing resources to forensic populations, whose risk of violence is higher than a non-forensic population.
Conclusion
This article attempts to describe some of the considerations associated with choosing stock for libraries in secure settings, including psychiatric hospitals and prisons. It is clear that some materials should definitely not be included in library stock, such as those about escape methods, bomb-making and pornography. There are also concerns about the link between the consumption of media violence and negative behaviour. At the same time it is important to create a sense of access, not barriers, and to adhere to ethical codes and guidelines on the provision of library services in these environments.
Bibliography
1. CILIP Prison Libraries Group. Prison Libraries Training Pack [Web page]. 2006 [Cited 15 August 2007]. http://www.cilip.org.uk/specialinterestgroups/bysubject/prison/publications/trainingpack
2. Curry A. Canadian federal prison libraries: a national survey. Journal of Librarianship and Information Science. 2003; 35(3): 141 - 152
3. IFLA. Statement on libraries and intellectual freedom [Web page]. 1999 [Cited 15 August 2007] http://www.ifla.org/faife/policy/iflastat/iflastat.htm
4. Coppock V. Critical perspective on mental health. London: Routledge; 2000
5. Dobson R. GPs prescribe self help books for mental health problems. Br Med J. 2006; 326: 1285
6. Gooch P, Living R. The therapeutic use of video games within secure forensic settings: A review of the literature and application to practice. The British Journal of Occupational Therapy. 2003; 67(8): 332 - 341
7. Steward JH, Follina F. Informing policies in forensic settings: a review of research investigating the effects of exposure to media violence in challenging / offending behaviour. British Journal of Forensic Practice. 2006; 8(2): 31 - 46
Further Reading
CILIP Prison Libraries Group http://www.cilip.org.uk/specialinterestgroups/bysubject/prison
Violence and the media: An exploration of cause, effect and the First Amendment.
http://www.freedomforum.org/publications/first/violenceandmedia/violenceandthemedia.pdf
Information Ethics
www.infoethics.org.uk http://www.infoethics.org.uk
Szasz T. The myth of mental illness. London: Harper and Row; 1984
Clare Thomson
Librarian
The State Hospital
Carstairs