“At the higher end we’ll see people who have committed offences such as murder, attempted murder, rape, child sexual abuse, who also have a major mental disorder,” explains Elizabeth Stirling when I ask what categories of offenders she works with day-to-day as a forensic social worker.
“At the lower end of the spectrum, if you can call it that, we’ll take someone from another ward that maybe can’t cope because the person has set fire to their room, or assaulted a staff member,” she adds.
Stirling is a senior practitioner with Edinburgh’s forensic service. She spends most of her week working from the Orchard Clinic, a four-ward medium-secure unit in the grounds of the Royal Edinburgh psychiatric hospital.
Stirling manages two social workers at the clinic and, when we meet, she’s pleased that funding has just been secured to add a third social work post. The team provides mental health support for people with various offending backgrounds. They take referrals from various sources including prisons, the courts, the community and hospitals.
Many of the team’s clients will often be subject to civil legislation, for example being detained under Scotland’s Mental Health Act. Several are subject to criminal legislation, such as ‘restriction orders’ imposed by courts where a person is deemed a serious risk to the public.
“With restriction orders, the risk of harm is deemed significant enough that the Scottish Government needs to be informed about everything to do with that patient’s progress. It can involve an awful lot of work,” Stirling says.
Difficult to engage and risky
So what is life like as a forensic social worker? Stirling explains that a lot of her team’s work is about building relationships with “a group of people that can be quite hard to reach, difficult to engage and quite risky”. Helping people readjust into life in the community after long periods in secure facilities is also “a huge challenge”.
“On the one hand they’re desperate to get their freedom back but on the other hand they are absolutely terrified,” she says.
Her social workers also do work with the families and victims of offenders. Stirling recalls a case where a man whose mental illness had gone undiagnosed had ended up at the Orchard clinic on a compulsion order after committing an offence while unwell.
“That was really devastating for his family and his children to come to terms with so there was a lot of work done with social work and the doctor about education about mental health. It was about helping them cope with something that was pretty hard for them,” she explains.
And how hard is it for social workers to cope working with people that may have committed some fairly traumatic offences? Does it offer a tough test of the anti-discriminatory values that are at the core of social work practice?
“Sometimes it’s more challenging than others,” Stirling admits. Many of her clients have been “let down by the system” and have been “very, very unwell” at the time that they committed their offence. A lot of people, when they have recovered, are often horrified by what they have done.
Different empathy levels
But there are also cases, Stirling says, where someone has a mental illness but their offending behaviour has had nothing to do with it. For example, a person may have stabbed someone simply because they were angry and in a fight.
“So you might have different empathy levels. I’d be lying if I said that there aren’t times when you think ‘that’s actually pretty grim’ but in all the time I’ve worked in this field there have been very few people that I have disliked, only maybe one or two,” Stirling says.
People come to forensic social workers “not to be judged, but for rehabilitation”, Stirling explains. Her team are not there to “excuse” or justify people’s behaviour but to treat someone as a ‘whole person’ and manage their care in that context, even in cases that involve the most taboo offences.
“Sex offenders are multi-faceted. They are not just that horrible person who committed that sex offence. They are also somebody’s son, somebody’s brother. They might be quite good at art, they might have a good sense of humour. A lot are very repulsed by themselves, self-harm rates and the likes can be quite high at times,” says Stirling.
“When you see that context, you see a whole picture of somebody. I fundamentally believe in the right of people to be rehabilitated. In most cases I think that’s possible but I do accept that there is a very rare group of people who are motivated for intrinsic reasons to commit horrible offences.”
The highly emotive nature of a lot of offences, particularly those of a violent or sexual nature, means many of Stirling’s clients face a lot of discrimination. Tabloid tales of “psychos” don’t help matters and there can even be stigma from other mental health service users, she says.
When Stirling identified the need for an advocacy forum to offer forensic service users a “safe space” to talk about their issues, the idea was met with resistance by some service user advocates. One patient representative told Stirling: “I really don’t understand why these people are entitled to any support. I think it’s disgusting.”
Loving the job
So how did Stirling end up in this line of social work? She tells me she has always been fascinated in offending and confesses to watching all “the high-brow, to utterly trashy” crime documentaries and police dramas on TV. After completing an undergraduate psychology degree she decided to move to Edinburgh to train as a social worker.
Five months after qualifying she saw a forensic post advertised at the Orchard clinic. She loved the look of the job but was convinced the fact she’d only relatively recently qualified would kill her chances of getting it. Stirling’s mum, a mental health social worker at the time, encouraged her to go for it anyway.
“She just said ‘well they’ll put your application in the bin if they don’t want it’. And I got it.”
Stirling says she “loved the job from the first minute”. She valued the autonomy given to social workers in the clinic, helped by the fact that they are the only non-NHS members of the team. The Orchard Clinic is also “really forward thinking” in terms of their approach to recovery, she says, and working “with the kind of people that others might struggle with” is fascinating.
Would Stirling recommend forensic work to social work students? She says there are parts of the job that are challenging – the bureaucracy, the stigma and “the systems you come up against” – but stresses that these are likely to exist in whichever social work specialism trainees choose.
“The best thing here is that you can really develop therapeutic relationships with people, because you can work with them right from their conviction through to discharge,” says Stirling. “That’s a real journey that you go on and I think it’s pretty rewarding.”
And for any social workers hooked on The Killing, Broadchurch and other crime dramas, how does real life forensic work compare?
“It’s just as interesting actually but it’s not as glamorous. I love finding out about people’s backgrounds and for the most part, people are quite simply not as evil as the characters in these things,” she says. “I really, really enjoy it.”