Dean is a single man of 25, who is currently an inpatient receiving care in a prison health service. Dean has had a variety of interesting jobs in carpentry, industry, and is a keen follower of premier league football teams.
Dean has a diagnosis of antisocial personality disorder, and finds it incredibly difficult to trust anybody, in part due to considerable abuse and neglect as a young boy, which resulted in profound trauma and distress for him. Dean finds it difficult to manage his impulsive agression towards others around him.
Before Dean's remand to prison, he killed a man whom he suspected of planning to murder him. Since admission, Dean has attempted to physically assult other staff and prisoners, and on one occasion, caused serious physical injury to a staff member.
Following a detailed assessment, professionals at the high secure unit have agreed to admit him. It is felt that this admission will more effectively meet his needs, and prevent any potential harm to others.
The prison nurses wonder if they should tell Dean about the transfer immediately, or on the morning of his planned departure, in a week's time. Roy has previously stated ' If I am transferred, I will smash up this place and everyone in it.'
This scenario poses a number of clinical and moral dilemmas, one of which being when to tell Dean about his transfer.
Persons frequently say that one of their core values is honesty and truth - telliing , should he be told straight away ? Or in a week's time ? What if he asks you directly ?
What do you think should happen in this scenario ?
This case study dilemma has been adapted from Coffey M., Byrt, R. (2010) Forensic Mental Health Nursing, Ethics, Debates and Dilemmas, Quay Books, London.
It is proposed that Dean is told immediately of his impending transfer to a high secure unit