Staff from five professional areas (psychiatrists and psychiatric assistants, psychologists and students in psychology, nurses, social workers and correctional officers) were asked to complete a questionnaire.(4) The questionnaire asked respondents to list the two coping techniques they used most frequently to deal with four basic situations with patients: mentally ill patients toward whom they are sympathetic, but for whom they see little realistic hope for improvement; personality-disordered patients whom they dislike, but who have a realistic chance of early release because of a limited criminal history; a seemingly intact patient who has committed a particularly heinous crime (such as murdering a child or infant) out of character with the individual's life history; and, last, a violent encounter with a patient requiring forced placement in a safety room.

In addition, respondents were asked to rate how stressful they found their jobs, how long they had worked at the forensic unit, how much personal satisfaction they derived from their work and their gender, age and professional group.

Results relating to staff's perceived role and coping strategies for each of the four scenarios described above were examined separately. The raw data were also initially broken down by professional group, but due to the small numbers in each group, the results were grouped together.

The sample consisted of 18 staff members: 2 correctional officers, 3 registered nurses, 3 psychiatrists, 4 psychiatric assistants, 2 psychologists and 2 psychology students, 1 recreational staff member and 2 social workers.

Five types of roles clearly emerged from the participants' written responses. They were helping, assessment, custodial, empathetic and agent of the judiciary. The distribution of these assumed roles is summarized in Table 1.

Answers to the questions about how staff cope revealed six different coping styles. These were distancing, intellectualization, reliance on collegial support, resignation (i.e., acceptance of the permanence of the problem), authoritarian stance, and sublimation (i.e., seeing good in one's work or patients). The distribution of these coping styles in response to the four patient situations is given in Table 2.

In the case of dealing with a violent patient, the majority of staff responded with intellectualization.

The figure shows the levels of stress and satisfaction among the various groups of staff. Most groups experienced approximately equivalent levels of job stress and job satisfaction. There were two exceptions to this trend: psychology staff experienced lower stress levels and higher satisfaction levels, and psychiatric assistants had marginally lower satisfaction levels. The latter finding may be related to the assistants' sense of remoteness from decision-making processes.

This study represented an initial attempt to examine issues that are central to involved, competent and efficient management of a forensic custodial unit. Unfortunately, the size of the study sample in this one forensic unit was not large enough to justify generalizations. However, the results suggest directions for future work that should involve a multicentre design. Such a design would allow for comparison among different types of staff at various types of institutions (i.e., forensic versus detention centre versus prison). A larger study could also look at relationships among various coping styles, job stress and satisfaction. More effective coping styles could be encouraged to help alleviate stress for the betterment of management, staff and inmates or patients alike.

A final note concerns the type of individual who works in the various settings. It has been noted previously5 that people who choose to work dally with the mentally ill, criminal element of society represent a special segment of the population. The data presented here suggest that at least part of their make-up includes taking on a helping role, even when they do not empathize with their clients. It may be their ability to distance themselves and their commitment to help others that mark the forensic mental health staff.