It is no longer possible to assess and/or treat a mental health population without also interacting with forensic issues such as legal violations, courts, violence, sexual behavior problems, delinquency, crime, not guilty by reason of insanity, substance abuse, and others. . . Training and approaches for the mental health population are different than for a forensic population. So what should be done if a person has both problems? We must be trained for clients with double affectation.
How are the populations different?
A mental health population is primarily made up of Axis I disorders, such as bipolar disorder, schizophrenia, major depression, PTSD, and anxiety disorders. Daily operation is on a continuum. Recovery is fast for some and slow for others, and it’s also ongoing. Intermittent, mild to moderate, well-controlled episodes of a mood or anxiety disorder will not necessarily interfere with daily functioning. Someone with schizophrenia or a severe, chronic mood disorder that requires regular hospitalizations and extensive community support will have impaired daily functioning. The goals of these people are usually prosocial and involve being an active member of society. A therapist can be pretty sure that the mental health client without forensic problems will be relatively honest in their interactions, and the therapist can take most of what they say at face value. An emphasis on a strengths model works well when a personality disorder is not involved.
A forensic population can be defined as having personality disorders, interpersonal difficulties, behavior problems, multiple problems, and lifetime courses of various levels of dysfunction or difficulty. Again, this population fills the full spectrum of effective daily functioning. However, social functioning is often the most severe impairment. There are trust issues, appropriate relationships, self-centeredness, moral development, honesty, manipulation, and danger to self and others. They often have a negative view of themselves and others, especially authority figures. Moral development is often delayed, leaving them in the egocentric stage of development. This means that what serves oneself is what matters, and empathy for others and the ability to have an honest relationship with another person may not yet have developed. Their goals are often selfish.
The ability to understand the importance of the best interest of the group through laws and rules that we follow voluntarily, may not be well understood. Many, if not most, have a history of child abuse, neglect, or exposure to domestic violence. Assessment and interventions with this population are necessarily different from those for a person without an Axis II disorder or trait. People with forensic problems don’t always tell the truth because of their lack of trust in relationships. The therapist cannot take what he says at face value. The therapist must separate the sincere movements from the manipulative ones for his own benefit. The internal limits are such that they need the therapist to set external limits for them. The information must be checked against other sources of information.
How assessment tools differ
In a mental health population, assessment can be done quite effectively through instruments such as the MMPI-A, BASC, and MACI. These self-report tools are sufficient for this population and will clarify psychological dynamics and mental illness, if present. Self-reporting is not as big of an issue as it is in the forensic population, where third-party verification is more important. However, when a youth has multiple issues, both mental health and forensic, a combination of tools is preferred.
Forensic assessment tools rely less on self-reporting due to trust issues and because it is not always in the client’s best interest to be completely truthful. Self-report assessment instruments can be used, but official and third-party reports should also be used in the assessment phase of a forensic assessment. Courts are concerned with public safety, hence the need for tools that assess future risk of dangerousness to others. The risk of future assault and sexual behavior problems that have been derived from statistical models (actuarial tools) should be part of the assessment, as clinical assessment of future dangerousness risk is only slightly better than chance. Although risk assessments are not perfect, they are better than clinical judgment in this area.
How are the interventions different?
Serious, though often chronic, mental illnesses can often be treated very effectively with medication and therapy. At the higher functioning end of the continuum, therapy can be supportive, psychotherapeutic, family, or cognitive behavioral. Therapists are trained to accept what the client presents and start where the client is functioning and how they see the world. Clients are often motivated and willingly seek therapy. They accept responsibility for their behaviors and for making changes in their lives. Using a strengths model is often very effective. Many people make a full recovery and lead fairly “normal” lives, with no interruptions. When someone is at the low end of the continuum, with major disruption in daily functioning (work and family), despite medication and therapy, significant supports are needed for living, working, and activities of daily living. and medication for a long time. , maybe a lifetime. However, their life goals often remain prosocial. Self-directed care works well with the mental health population without Axis II diagnoses.
In the field of intervention, different approaches are needed for the forensic population. Some level of social and family dysfunction is generally intergenerational and lifelong. These clients often receive a court order for evaluation or therapy or have significant problems at work or within the family that cause others to seek evaluation or therapy for them. They don’t always accept responsibility for their actions or for changing. There are skill gaps that need to be addressed, such as social skills, anger management, and problem solving. You cannot take what these customers say at face value. Information from third parties is always needed. This is because you need to trust someone to be honest with them and most of these people have been abused, neglected or exposed to domestic violence and suspicious distant treatment of others is a difficult coping strategy. resign.
This population usually has multiple problems, so Multisystemic Therapy that addresses many areas that need to be addressed is usually effective (treating the person as a whole). Group work and trauma therapies are also good tools. Self-directed therapy may not be effective due to the need to protect yourself from what may seem like an unsafe world. Nurturing, setting good boundaries, and structure are essential in this job. Motivational interviewing and stages of change can be very helpful. When clients have problems in the mental health and forensic areas, both approaches should be used to the extent possible.
recommendations
Clients in a mental health setting range from a single diagnosis of a serious mental illness to a dual diagnosis of a serious mental illness and personality disorder and/or forensic/legal problem. Approaches for these dissimilar populations are unique when clients are dually diagnosed, both approaches are necessary. Assessments and treatment for a mental health population can be self-directed and strengths-based.
However, the forensic population approach cannot be self-directed because client goals are often antisocial and, by definition, contrary to the best interests of society. The therapist or evaluator cannot accept everything the client says at face value because not being honest is part of the disorder the therapist is treating. Motivational interviewing appears to combine the views of traditional mental health and forensic science in a way that is beneficial to the client and society.
