Treatment of mental health and forensic populations
by: Kathryn Seifert, Ph.D.
It is not possible to assess and or treat a mental health population without also interfacing with forensic issues such as legal offenses, courts, violence, sexual behavior problems, delinquency, crime, not guilty by reason of insanity, addiction, and others. The training and approaches to population mental health is different from that of a legal population. So what should you do if a person has two questions? We need to be trained for clients Cross doubly affected.
How are different populations of mental health of the population is composed primarily Axis I disorders such as bipolar disorder, schizophrenia, major depression, PTSD and anxiety disorders. daily operations is a continuum. Recovery is quick for some and slow for others and is also on a continuum. Well controlled intermittent mild to moderate episodes of a mood or anxiety disorders are not necessarily interfere with daily functioning. Someone with severe, chronic schizophrenia or mood disorder requiring periodic hospitalizations and extensive community support, have impaired daily functioning. Goals for these people are often the pro-social and involve being an active member of society. A therapist can be pretty sure that the client of mental health, no medical-legal issues will be relatively honest in all interactions and the therapist can take more than what he she says at face value. The emphasis on a force model works well when no personality disorder is involved.
A population can be legally defined as having personality disorders, interpersonal difficulties, behavioral problems, multiple problems and life long courses at different levels of dysfunction or difficulty. Again, this population fills the full range of daily functioning effectively. However, social functioning is often the most serious threat. There are issues of trust, appropriate relationships, the ego centrism, moral development, honesty, manipulation, and danger to self and others. They often have a negative view of self and others, especially authority figures. Moral development is often delayed in leaving the egocentric stage of development. This means that what serves the self is what counts and empathy for others and the ability to have an honest relationship with another person is not yet developed. Their objectives are often selfish. The ability to understand the importance of the interests of the group through laws and rules that we voluntarily follow, can not be understood. Many, if not most, have a history of abuse, neglect or exposure to domestic violence. The assessment and interventions with this population is necessarily different than those for people without Axis II disorders or stroke. People with medico-legal problems are not always speak the truth because of their lack of trust in relationships. The therapist can not take what he she says at face value. The therapist must separate the sincere handling moves to self-gain. The internal borders are such that the therapist needed to establish the external borders for them. Information should be verified with other sources of information.
How different assessment tools
In a population mental health evaluation can be done very effectively through instruments such as the MMPI-A, BASC, and MCI. These self-assessment tools are quite sufficient for this population and will better understand the psychological dynamics and mental illness, if present. Self-evaluation is not so much a problem as it is in the legal population, where the third party verification is more important. However, when a young person has multiple problems, mental health and forensic science, a combination of tools is preferred.
tools of forensic assessment rely less on self-assessment because of trust issues and because it is not always in the best interest of the client to be completely honest. assessment instruments self-evaluation can be used, but third and official reports should also be used in the evaluation phase of a forensic assessment. The courts are concerned with public safety, hence the need for tools to assess the future risk of dangerousness to others. Risk of aggression and future problems of sexual behavior that were derived from statistical models (actuarial tools) should be part of the evaluation The clinical evaluation of the risk of future dangerousness is somewhat better than chance. Although risk assessments are not perfect, they are better than clinical judgments in this field.
How are different interventions? Serious mental illness, while the often chronic, can often be very effectively treated with medication and therapy. At the end of the continuum over the operation, the therapy may be beneficial, psychotherapy, family or cognitive-behavioral. Therapists are trained to accept what the client presents and start where the client operates and how the client sees the world. Customers are generally highly motivated and seek treatment voluntarily. They accept responsibility for their behavior and make changes in their lives. Using a model of forces is often very effective. Many people recover fully and lead to quite "normal", not broken lives. When someone is on the lower end of the continuum, with all major disturbances in daily functioning (work and family), despite medication and therapy, major support for housing, employment, and activities daily life and medication is necessary for a very long time, perhaps a lifetime. However, their goals in life are often more pro-social. Serlf directed care works well with the population of mental health, without Axis II diagnoses.
In the area of intervention, different approaches are needed for the legal population. A certain level of family dysfunction and social development is usually between generations and life. These customers are often court ordered evaluation or treatment or have significant problems at work or within the family bring others to an assessment or treatment for them. They do not always accept responsibility for their actions or to change. There are skills gaps that must be addressed, such as social skills, anger management and resolution of problems. You can not take what these clients say at face value. Third party information is always necessary. That's because you have to trust someone to be honest with them and most of these people have been abused, neglected and victims of domestic violence and treatment of an arm length of other suspect is a strategy adaptation that is difficult to abandon. This population often has multiple problems so that Multi-systemic Therapy that approaches many areas that must be addressed is often effective (treating the whole person). Group work and therapy for injuries are also good tools. Self-directed treatment can be effective because of the need to protect themselves from what may seem like a dangerous world. Feeding, setting clear limits, and structure are essential in this work. Motivational interviewing and stages of change can be very useful. When customers have questions on mental health and forensic arenas, both approaches must be utilized to the extent possible.
ConclusionsClients in a mental health facility ranges from simple diagnosis of serious mental illness to the dual diagnosis of serious mental illness and personality disorder and or forensic legal question. The approaches to these dissimilar populations is unique when clients are dually diagnosed, both approaches are necessary. The assessments and treatment for a mental health population can be autonomous and based forces. However, the approach of the legal population can be self-directed, because the client's goals are often antisocial and cons of defining the interests of society. The therapist or evaluator can not accept what the client says at face value, for not being honest is part of the mess that the therapist is treating. Motivational interviewing seems to blend the perspectives of mental health and traditional forensic science in a way that is beneficial for the client and society.
About the author
Dr. Kathryn Seifert has over 30 years experience in mental health, substance abuse, and criminal justice. She is the author of the CARE and numerous articles. Mr. Seifert has lectured internationally on youth and family violence and trauma. http:careforusall.com