Abstract
The forensic mental health field of study enables specialization pertaining to issues that have ethical practical implications. The discipline stretches across boundaries practicing as psychiatrists, psychologists, licensed counselors or social workers. There are diversity of areas encompassing this practice. Forensic mental health practitioners’ function can extend towards examining persons classified as criminals to determine whether they are capable of standing trial. They also work with mentally ill people in their institutional setting to enhance receptivity of care. In following pages of this document a case study along with a number of scenarios will be explored as a means of evaluating the ability of a forensic mental health practitioner to apply theoretical paradigms in resolving problematic situations in the execution of duties.
Forensic Mental Health: Ethical Dilemma
Introduction
Ethical dilemmas spread across various professional practices and are unique to every discipline. They occur in medicine, nursing, education, social work; health sciences, legal and the lists can become very exhaustive. Forensic Mental Health is no different. The uniqueness however, lies in the seriousness of legal implications that follow if inappropriate decisions are made regarding clients’ safety while detained in corrective institutions due to their diagnosed mental incompetence.
The foregoing discussion embraces three core questions. Frist a case study of a 34 year old African American woman detained for evaluation due to suspected murder. Second an assessment of her competence to be among other people and thirdly four scenarios evaluating techniques a forensic mental health practitioner can adapt in resolving workplace issues.
1. Assessment of suicide risks
Observation decision
According to forensic theorists when evaluating clients in Ms. Bates category it is important to recognize that suicide is associated with a number of underlying factors. They include filled or unfilled needs, feelings of hopelessness/ helplessness, remorse; conflicts between survival and unbearable stress; inability to resolve inner emotional pain that narrows perceived options and an impending need to escape from the present situation (Goldstein, 2006).
They were identified as separation; rejection, being unmarried; unemployed; legal troubles chronic illnesses, low socio economic status; chronic alcoholism and drug abuse; environment, biological factors which lowers serotonin levels and recurring mood disorders (Goldstein, 2005). Again Ms. Bates’ coincides with this profile. Therefore, a decision to keep her under constant observation is pertinent. Treatment should be therapeutic supervised interaction to allow her opportunity to voice her fears and reconcile her grievances with the self. Ms. Bates’ situation warrants a tier 3 interventions since she is a chronic drug user with sever suicidal tendencies
(Goldstein, 2006).
Risk and protective factors
Risks factors are related to the predisposition of Ms. Bates dying as a result of suicide and protective factors lie in her attempting, but not succeeding in the action to cause bodily harm or die. Researchers have identified risk and protective factors by comparing groups of individuals who have committed suicide with those attempting the action. The risk and protective factors vary with the individual’s particular situation (Soothill, et.al, 2008).
In Ms. Bates case the risks factors lean towards her incarceration, remorse for committing murder of a person she did not know just because she needed money, perhaps to feed her drug addiction. Also, she was unemployed; did not have a skill and was diagnosed with a learning disorder as a child. These combing forces are eminent of suicide risk factors. From this scenario her protective factors are limited based on the supervision she is offered in this correction institution. From her emotional demeanor she has very little resources for coping with her lifelong struggles to remain alive.
Precisely, these risks would intensify when she is left alone and has to go to trial. When alone in a corrective institution she has the time to reflect on all her misconceptions of life and how they have brought her to the point she is, at this time. Trial is a stressful event because already she is remorsefully concerning what she did, and facing the crime during a trial is a tremendous strain emotionally.
Additional Information
Additional data, which may help in my risk assessment, would be if she had attempted suicide previously as a teenager. How she responded to therapy previously and readiness to resolve her situation without having to commit suicide. The relevance of this additional information is to classify the type of suicidal attempts to discern when she would actually engage in the attempt.
A Previous treatment response was highlighted in this case study earlier, but a further assessment would indicate what factors created the resentment in evaluating her readiness for improved strategies of intervention. Without this additional data on Ms. Bates previous suicide excursions and treatment reassessment it is highly recommended that she receives immediate treatment at Mental Health Unit at Albany County Correctional Facility.
2. Mrs. Bates Prolife Based on Revitch and Schlesinger’s Motivational Spectrum in the classification of homicide
Assessment of Murder Potential
Revitch and Schlesinger’s Motivational Spectrum offers homicide profiles from perspectives of the crime scene itself, psychology of the individual based on personality traits and an offender classification placing the accused within categories of offenders. Further, offenders like Ms. Bates are grouped according to organized and disorganized crimes. She can be assessed as both organized and disorganized offender based on the typology of a pre-offence (Soothill et.al, 2006).
These offenders according to the theoretical premise when committing organized crimes are motivated by loss of job or failure to fit into society’s norms or social paradigm. When offences are organized they emerge from low self-esteem using the victim as an opportunity symbol to retaliate in a perceived unjust social structure (Goldstein, 2006). More importantly, Ms. Bates drug addiction/use and unemployment places her at a very high risk of continuing committing crimes fitting into the profile of person being motivated to murder due to social incompetence from childhood dysfunctions.
Overall proclivity toward violence in the future
Acknowledging that an HCR of 20 places Ms. Bates at a very high risk of committing crimes including murder in the future, my assessment offering professional evaluation of her specific needs would be to consider the differences between my assessment and the scores received. The evaluator must become aware that creating an offender’s profile through constant evaluation establishes a premise to obtain knowledge pertaining to the physical, behavioral and demographic characteristics of the offender (Keppel and Birnes, 2003).
Precisely, it relates behaviors the offender is likely to engage in after committing the crime, anticipating the time and circumstances intimating the attack. Profiles are capable of providing useful information for appropriate treatment intervention while the offender is detained at a correctional facility as the Mental Health Unit at Albany County Correctional Facility where Ms. Bates is held presently (Keppel & Birnes, 2003).
Hence, in re-evaluating the method of conducting my assessment in relation to the perceived HRC scores it would be necessary to consider what she was experiencing emotionally at the time when HCR scores were developed in relation to when my assessment was being conducted. Consequently, my judgment relating to her being high risk would not change if there is a discrepancy between my assessment and the scores.
It is imperative to note that the conditions under which this crime was committed has not changed even though her present expression of remorse. The tendency is that while still functioning within this social framework according to symbolic interactionists theoretical perspectives it is highly likely that once released Ms. Bates can commit murder crimes again if the opportunities present themselves (Slattery, 2003).
Assessment for future acts of violence
This assessment of future acts impinge upon factors that are likely to influence Ms. Bates to commit murder again as well as use drugs. The assumptions of symbolic interaction specify that human beings act toward things on the basis of the meanings they ascribe to those things; meanings of such things are emerge from the social interaction that one has with others and the society (Slattery, 2003). Insidiously, the desire to commit future crimes will not change unless the social context within which the individual operates is revolutionized. Precisely, the assumption continues to explain that ‘the meanings are handled in, and modified through, an interpretative process used by the person in dealing with the things he/she encounters (Slattery, 2003). Therefore, the propensity of committing future crimes rests with the psycho-social disposition of Ms. Bates when opportunities are available
Prognosis when treated: Classification of the motivation to kill
So far in the assessment of Ms. Bates, she has not been classified a serial killer. According to Emile Durkheim’s (1997) theories regarding suicide people who are well integrated in society and have strong religious affiliations were less likely to commit suicide (Slattery, 2003). Perhaps, one of the effective therapeutic interventions could be imitating an awareness of her spirituality in conquering addiction and distresses of life through prayers and worship. In this case study very little mention was made of her religious background when taking a social history. As such, the tendency to commit violent acts on herself as well as others can be greatly minimized with this therapeutic intervention.
Therefore, the prognosis of treatment without a spiritual input can be ineffective because she is wrestling with guilt of the murder and her own loss of self-worth. From a child she was sexually abused as well as diagnosed with an attention deficit syndrome. This placed her in a minority category of social achievement, educationally. Thus, this individual is challenged with feelings of incompetence and incapability, which must be addressed if therapeutic intervention is to be successful.
In finding out that she had a diary listing all the persons to be kill resembling her abusive step father, would necessitate further evaluation and classification based on that criterion. The classification would then change from pre-offence to disorganized personality. These offenders according to the theoretical premise display internalized anger. Often they are unattractive with previous suicide attempts and very talkative (Howitt, 2009).
Conclusion
3. Ethical Dilemmas
Responding to Correctional Officer request
According to the American Mental Health Association (AMHCA) ethical standards regarding information dissemination to a third party it would be unethical to share this with a correctional officer who is not an authorized mental health care provider. More importantly, consent of the client must be obtained before this information is shared to a thread party because this process impinges on the patient’s confidentiality (AMHCA, 2012). Consequently, my courteous response would be, ‘I cannot share this information with you because it is unethical.
Criteria for conducting child custody evaluation
As a therapist in this facility I need to realize that child custody evaluation is a legal procedure. Persons must be trained and certified to execute this process. The purpose is to make an assessment after interviewing the child and involved parents what is the best psychological environment for the child’s habitation. Psychologists are the professionals responsible for executing these duties (Goldstein, 2006).
When considering these criteria it places a therapist at an ethical dilemma even trying to institute such a procedure. I would not undertake to perform the evaluation because it is not within the boundary of my practice as a therapist to conduct such assessments and this would be communicated to my client. Perhaps, I could help in arranging for this to be completed at the earliest convenience. Besides in this case I cannot allow my feeling of the clients’ integrity allow me to overstep my professional boundaries.
Response to inmate’s concern for children with drug abuser husband and friend
I would ask permission of my client to inform protective services to conduct an investigation into the incidences and give the client a feedback if she consents. Meanwhile precautionary measures regarding establishing dual relationships ought to be considered. This could impair professional judgment and put clients and the counselor at risk.
Responding to attorney’s request to serve as expert witness
Inmate insidious threats regarding girl friend
Clearly this is an ethical dilemma related to confidentiality and sharing of client’s information upon a witness stand. Definitely, the decision to serve as a witness for an event that I did not witness is unethical from a professional perspective. According to the American Mental Health Counselors Association ethics the client’s information belongs to the client and should never be shared with a third party (AMHCA, 2012).
Further, clarifications are that case reports used for classes instructions, professional meetings, or publications must be disguised to remove personal identification of the client. Permission must be obtained from clients prior to disclosing their identity. Similarly, counseling reports and records must be stored under secure conditions. They must be disposed of safely after five years (AMHCA, 2012).Consequently, testifying as an expert witness regarding specific information about this client in public would be a breach of confidentiality. I would have to excuse the opportunity
Inmate’s insidious threats regarding girl friend
This inmate expresses dangerous murder tendencies inclusive of anger. With a history of maliciousness he must be placed on constant observation. If he is on psychotic medications the psychiatric nurse ought to be informed immediately and drug therapy instituted. Collaborative team work intervention must be undertaken to save him and his girlfriend.
References
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