| No longer is it possible to assess and/or treat a mental | | | | problems that have been derived from statistical |
| health population without also interfacing with forensic | | | | models (actuarial tools) should be part of the evaluation |
| issues such as legal infractions, Courts, violence, sexual | | | | since clinical assessment of risk of future |
| behavior problems, delinquency, crime, Not Guilty by | | | | dangerousness is only a little better than chance. While |
| Reason of Insanity, substance abuse, and others. The | | | | risk assessments are not perfect, they are better than |
| training and approaches to the mental health population | | | | clinical judgment in this area.How are Interventions |
| is different than that for a forensic population. So what | | | | Different?Major Mental Illnesses, while often chronic, |
| is to be done, if a person has both issues? We must | | | | can often be very effectively treated with medication |
| be cross trained for dually affected clients.How Are | | | | and therapy. At the higher functioning end of the |
| the Populations DifferentA Mental Health population is | | | | continuum, therapy can be supportive, |
| comprised primarily Axis I disorders, such as Bipolar | | | | psychotherapeutic, family, or cognitive behavioral. |
| Disorder, Schizophrenia, Major Depression, PTSD, and | | | | Therapists are trained to accept what the client |
| Anxiety Disorders. Daily functioning is on a continuum. | | | | presents and start where the client is functioning and |
| Recovery is quick for some and slow for others and is | | | | how the client sees the world. The clients are usually |
| also on a continuum. Well controlled intermittent, mild to | | | | self-motivated and seek therapy voluntarily. They |
| moderate episodes of a mood or anxiety disorder will | | | | accept responsibility for their behaviors and for making |
| not necessarily interfere with daily functioning. | | | | changes in their lives. Use of a strengths model is |
| Someone with severe, chronic Schizophrenia or Mood | | | | often very effective. Many people recover fully and |
| Disorder requiring periodic hospitalizations and | | | | lead quite "normal," non-disrupted lives. When someone |
| extensive community support, will have impairment in | | | | is on the lower end of the continuum, with major |
| daily functioning. Goals for these folks are often | | | | disruption in every day functioning (work and |
| pro-social and involve being an active member of | | | | family),despite medication and therapy, major supports |
| society. A therapist can be fairly sure that the mental | | | | for housing, jobs, and activities of daily living and |
| health client without forensic issues will be relatively | | | | medication are needed for a very long time, perhaps a |
| honest in his or her interactions and the therapist can | | | | life time. However, their life goals are often still |
| take most of what he/she says at face value. An | | | | pro-social. Serlf-directed care works well with the |
| emphasis on a strengths model works well when no | | | | mental health population without Axis II diagnoses.In the |
| personality disorder is involved.A forensic population | | | | area of intervention, different approaches are needed |
| can be defined as having personality disorders, | | | | for the forensic population. Some level of social and |
| interpersonal difficulties, behavioral problems, multiple | | | | family dysfunction is generally intergenerational and |
| problems and life long courses of various levels of | | | | lifelong. These clients are often Court ordered to an |
| dysfunction or difficulty. Again, this population fills the full | | | | assessment or therapy or they are having significant |
| spectrum of effective daily functioning. However, social | | | | problems at work or within the family causing others to |
| functioning is often the most severe impairment. There | | | | seek assessment or therapy for them. They do not |
| are issues of trust, appropriate relationships, ego | | | | always accept responsibility for their actions or for |
| centrism, moral development, honesty, manipulation, and | | | | changing. There are skill deficits that need to be |
| danger to self and others. They often have a negative | | | | addressed, such as social skills, anger management, |
| view of themselves and others, especially authority | | | | and problem solving. You cannot take what these |
| figures. Moral development is often delayed leaving | | | | clients say at face value. Third party information is |
| them at the egocentric stage of development. This | | | | always needed. This is because you need to trust |
| means that what serves the self is what matters and | | | | someone in order to be honest with them and most of |
| empathy for others and the ability to have an honest | | | | these folks have been abused, neglected, or exposed |
| relationship with another person may not yet have | | | | to domestic violence and a suspicious arm's length |
| developed. Their goals are often self-serving.The | | | | treatment of others is a coping strategy that is difficult |
| capacity to understand the importance of the best | | | | to give up.This population often has multiple problems |
| interest of the group through laws and rules that we | | | | so that Multi-systemic Therapy that approaches many |
| voluntarily follow, may not be well understood. Many, if | | | | areas that need to be addressed is often effective |
| not most, have histories of childhood abuse, neglect, or | | | | (treating the whole person). Group work and trauma |
| exposure to domestic violence. The assessment and | | | | therapies are also good tools. Self-directed therapy |
| interventions with this population is necessarily different | | | | may not be effective because of the need to protect |
| that those for a people with no Axis II disorder or trait. | | | | oneself from what may appear to be an unsafe world. |
| The people with forensic issues do not always tell the | | | | Nurturing, setting good boundaries, and structure are |
| truth because of their lack of trust in relationships. The | | | | essential in this work. Motivational interviewing and |
| therapist cannot take what he/she says at face value. | | | | stages of change can be very helpful. When clients |
| The therapist must separate the sincere from the | | | | have issues in the mental health and forensic arenas, |
| manipulative moves for self-gain. The internal | | | | both approaches must be used to the extent |
| boundaries are such that they need the therapist to | | | | possible.ConclusionsClients in a mental health setting |
| put external boundaries into place for them. Information | | | | range from the single diagnosis of a major mental |
| must be checked with other sources of | | | | Illness to the dual diagnosis of a major mental illness |
| information.How Assessment Tools DifferIn a mental | | | | and a personality disorder and/or forensic/legal issue. |
| health population, assessment can quite effectively be | | | | The approaches to these dissimilar populations is |
| done through instruments such as the MMPI-A, BASC, | | | | unique when clients are dually diagnosed, both |
| and MACI. These self-report tools are quite sufficient | | | | approaches are needed. Assessments and treatment |
| for this population and will elucidate psychological | | | | for a mental health population can be self-directed and |
| dynamics and mental illness, if present. Self-report is | | | | strengths based.However, the approach for the |
| not as much of an issue as it is in the forensic | | | | forensic population cannot be self-directed because |
| population, where third party verification is more | | | | the client's goals are often antisocial and by definition |
| important. However when a youth has multiple | | | | counter to the best interests of society. The therapist |
| problems, both mental health and forensic, a | | | | or evaluator cannot accept everything the client says |
| combination of tools is preferred.Forensic evaluation | | | | at face value because not being honest is part of the |
| tools rely less on self-report because of the trust | | | | disorder that the therapist is treating. Motivational |
| issues and because it is not always in the client's best | | | | interviewing seems to blend the views of traditional |
| interest to be completely truthful. Self-report | | | | mental health and forensics in a way that is beneficial |
| assessment instruments can be used, but third party | | | | for the client and society.Dr. Kathryn Seifert has over |
| and official reports should also be used in the | | | | 30 years experience in mental health, addictions, and |
| evaluation phase of a forensic assessment. Courts | | | | criminal justice work. She has authored the CARE and |
| are concerned with public safety, therefore, the need | | | | numerous articles. Dr. Seifert has lectured internationally |
| for tools that assess future risk of dangerousness to | | | | on youth and family violence and trauma. |
| others. Risk of future aggression and sexual behavior | | | | |