Danny Sullivan

Managing risks of violence in a youth mental health service: a service model description

Aim: There is a significant relationship between experiencing a severe mental illness, particularly psychosis, and exhibiting violent or offending behaviour. Reducing, if not preventing, the risks of violence among patients of mental health services is clinically warranted, but models to address this are limited.

Involuntary outpatient treatment

The use of involuntary outpatient treatment in people with a mental illness is increasing. We review the policy, ethical and practical implications of this trend, draw parallels with other areas of medical care, and briefly discuss alternative and possibly more effective strategies for increasing adherence with psychiatric care.

Child pornography offenders detected by surveillance of the Internet and by other methods

BACKGROUND Availability of child pornography on the Internet has created new opportunities for offending. It has been noted that many people charged with offences relating to this had not previously been identified as sexual offenders against children. AIM Our aim was to compare the characteristics of people charged with child pornography offences as a result of police monitoring of the Internet with those detected by other means. We hypothesised that those apprehended via the Internet would be more likely to be older and less likely to have severe psychiatric disorder or to have been previously charged with a sexual offence involving contact with a child than those identified by other means. METHODS Data were extracted from the findings of clinical examinations by the authors either in the course of preparing reports for court, or in the course of providing treatment. RESULTS There were 52 men detected by police Internet surveillance and 53 men detected by other means, the latter including 16 men who had not been charged with an offence at the time of referral. Those detected via the Internet were more likely to be in possession of very large quantities of child pornography. Those detected by other means were more likely to have major psychiatric and substance abuse disorders and to report childhood sexual abuse. A subgroup analysis of the 89 people who were facing charges at the time of the assessment found that the only significant differences were in the amount of material and the history of sexual abuse. CONCLUSIONS The men recruited to this study, conducted over a period of nearly 10 years, reflect the changing nature of the technology used to commit this type of offence in that time. The characteristics of the subjects did not confirm the stereotype of an Internet child pornography offender who was high functioning and otherwise well adjusted and carried a low risk of other types of offences.

Videoconferencing and forensic mental health in Australia.

Videoconferencing is in common use in Australian forensic mental health services. It provides opportunities to link remote prisons, courts, and psychiatric clinics with distant specialist services, and enables a range of activities including assessment, treatment and feedback, expert testimony, education, and inter-service planning. These functions are acceptable to patients and clinicians, and in Australia videoconferencing minimizes disruption to small services and their patients, who might otherwise face lengthy journeys. In particular, marginalized patient groups, including indigenous people and prisoners, may receive better services. The evidence base supports use of videoconferencing despite a number of practical, legal, and clinical issues that may reduce its effectiveness compared with face-to-face assessments. Videoconferencing technologies are critical to effective forensic mental health services in Australia.

Kick'n'On: Helping Young Males Kick Back into Life

Abstract Young men with psychotic disorders have persistently poorer outcomes in social functioning when interventions aimed at arresting social isolation are not implemented. Recent literature has indicated that it is important to develop rehabilitation programmes that are based on areas of needs that are identified by the participants. To assist in the design of a group programme, a qualitative (focus group) investigation of the perceptions of young males concerning male roles and identity in today’s society was conducted. The participants were six young males with psychotic disorders who had been referred to an Australian regional rehabilitation service to address poor social functioning and social isolation. Three main themes emerged from the focus groups. These were role models, concept of what is a man, and societal expectations. The findings were used to develop a group programme called Kick’n’On.

Justifications and Rationalizations for the Civil Commitment of Sex Offenders

In response to rising community concern about the release of convicted child sex offenders, most states of Australia have enacted legislation to use civil commitment proceedings to extend detention and supervision after the expiry of the original sentences. This article considers the arguments for and against this form of legislation. The arguments in favour of the civil commitment of sex offenders are for further treatment so as to decrease the likelihood of child sex assaults once the offender is released, in order to prevent child sex offences during the period of extended detention, and because previous sentences are seen to be inadequate according to current community standards. We then consider the arguments against preventative detention, which include abandoning the presumption of innocence with regard to future offences and the high probability of detaining some offenders who will not reoffend because of the unreliability of risk assessment. We express our concerns about laws that overthrow longstanding legal principles and pass much of the responsibility for decisions regarding commitment from courts to psychiatrists. Despite the unsatisfactory nature of these laws and the cumbersome procedure required to administer them, the political reality is that these laws are unlikely to ever be repealed. Hence we also consider how the laws should be applied.

Forensic mental health

The dedication of an edition of the Journal to forensic mental health and to the mentally disordered offender reflects broad cultural changes and alterations in mental health services: forensic psychiatry is now a distinct subspecialty rather than a practice of dilettantes, and most mental health services now grapple daily with the issues raised by criminal and violent behaviours. Although providing opinions to civil and criminal courts remains part of forensic practice, it is now but a small part. The core business of a forensic mental health professional is now:

Covert and Implicit Influences on the Interpretation of Violence Risk Instruments

Forensic mental health practitioners are frequently asked to estimate the risk of future violence. Legal decisions concerning the sentencing, management and disposition of offenders often rely on the advice of such testimony. The burgeoning use of violence risk instruments in these settings undoubtedly injects a level of scientific rigour into forensic evaluations for courts and tribunals. Yet scrutiny of the inherent limitations of both risk instruments and the inferences and formulations drawn from them are often veiled by the disciplines endorsement for such approaches. Misconceptions about the validity and dependability of present-day risk assessments and expert infallibility persist. The furtive influences that shape both the (mis)interpretation and miscommunication of risk instruments in legal settings necessitate discussion.

Evidence-Based Mental Health Law: The Case for Legislative Change to Allow Earlier Intervention in Psychotic Illness

Psychosis is a relatively common and severe mental disorder that results in impaired judgment and reasoning and is associated with an increased incidence of violence in the period before the initiation of treatment. Studies published since the Mental Health Act 1990 (New South Wales) was enacted have shown that the period before the emergence of acute symptoms (the prodrome) and first episode of illness carries a greatly increased risk of violence. It is also established that the longer-term prognosis is improved by early initiation of treatment. We believe the New South Wales Mental Health Act should be amended to reflect the scientific evidence of an increased risk of violence in the early stage of illness and the harm arising from delaying treatment. Emerging psychosis should be regarded as a medical emergency and the threshold for compulsory treatment for people in the early phase of psychotic illness should be lower.

Integrating Individual and Group-based Offence-focussed Psychological Treatments: Towards a Model for Best Practice

This review explored outcomes of individual and group-based offence-focussed psychological treatments in studies published between 1 January 1990 and 31 August 2014. Very few high-quality studies using individual treatments (n = 13) were identified. There were even fewer comparisons of individual versus group-based treatment (n = 2); several studies incorporating both individual and group-based treatment components for high-risk high-need clients were also identified. Extant findings suggest comparable outcomes for group-based and individual treatment. In concluding, we adopt a pragmatic perspective and propose a model for conceptualising the role of individual treatment in offender rehabilitation and its relationship to group-based offence-focussed treatments. Group-based treatments are promoted due to their larger evidence base. Individual interventions may prepare clients for group treatment, and/or promote treatment gains when stable internal factors impair responsivity. Individual treatments may also help prevent high-risk clients from engaging in problem behaviours that may result in their removal from the programme. On occasions, individual treatments may be necessary to provide another treatment pathway when group treatments are not possible. Identifying and attending to responsivity factors through both individual and group-based treatments increases the likelihood that rehabilitation efforts are sensitive to each participants needs.