Out of sight, out of mind? Working with separation and risk when patients are away from the hospital

Risk management in all institutions can become unthinking and process-led, and in this paper we, as psychosocial nurses, have sought to convey how we think about risk at weekends for our patients at the Cassel Hospital. In contrast to many mental health inpatient settings, inpatients at the Cassel go home for the weekend. On one hand, this supports the development of their responsibility for themselves and their social relationships, and on the other, it raises difficulties around separation. These two aspects present us with questions around how to manage risk when patients are not in the hospital. We took as our starting point formal discussions with our inpatient group and nurse team, and linked the ideas that emerged from those discussions with ideas from former members of Cassel staff, drawing on psychoanalytic and psychosocial theories. A dominant theme that emerged was the existence of two selves in the patients' minds – their home self and their Cassel self, and the anxiety shared by patients and nurses about how these two selves can become integrated. Such learning can inform practitioners and policy makers interested in creating services that use relational practice as well as trauma-informed care. These principles could be considered applicable also to health, social care and criminal justice systems.