Managing Clients with Psychiatric Disorders Tony Glynn & Ian

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Managing Clients with Psychiatric Disorders

• Tony Glynn Ian Curtis
• Queensland Law Society
• Soft Skills Series
• Thursday 7 April 2005

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Disclaimer

• Criminal activity no more likely within mentally
  ill populations than in the general population.
• Mental illness in a person does not predispose to
  crimes against persons or property.
• There are occasions of causal relationship
  between mental illness and some unlawful acts.

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Psychosocial

• Every crime occurs in a psychosocial context.
• It may be important for the Court, within the
  limits presumably of what is more probable than
  not, to know of the psychosocial context and the
  relevance of the persons life course to a
  particular criminal or accidental event.
• Explanation or excuse? (P Shea, 1993)

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Workplace Injuries

• The same issues can be raised about the
  psychosocial backdrop to an accident in the
  workplace.
• Often more complex.
• Factors within the life course of the employing
  entity are relevant as well as complainant
  factors.
• It requires two people to make a mistake at the
  same time for an accident to occur.

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Mental Health Gatekeepers

• Mental health gatekeepers include police, clergy,
  and legal professionals amongst others because
  these groups all have training in observation and
  substantial contact with people.
• So we could rename this presentation Mental
  Health Awareness/Gatekeeping.

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Presentations of People with Mental Health Harms

• Threat towards the self (suicide/parasuicide) or
  towards another.
• Covert (masked) illness.
• The swapping of types of suffering (eg
  depression/ alcohol).
• Major assault on one or more people.
• Colleagues in trouble with their mental health.
  Are we sufficiently aware and active? Doctors
  are not!

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Principles for Handling Overt Aggression

• The non-reciprocal approach to threat of violence
  to minimise harms.
• A violent man is a frightened man and how this
  helps you in confronting threat.
• Office architecture.
• Office crisis plans.
• Self-defence, bearing in mind that the best
  self-defence ever invented was running away.

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Health and Safety Responsibilities to Support
Staff

• The healthy workplace.
• Safety of staff.
• Issues
• Duress alarms
• Procedures for warning neighbouring staff and
  other offices of hazardous behaviours
• Evacuation plans to deal not just with fire but
  also to deal with behavioural dangers and violence

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Health Safety Comments

• If no crisis plan exists at the subject time, a
  crisis is not the time to be inventing the plan.
• The colleague next to you must have an idea what
  you are likely to do.
• If there is a plan in place, there is at least
  some chance that some people will keep to it.

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Legal Professional Management

• All have your own preferred methods for assessing
  clients.
• We all have different practices depending largely
  on how we self-select client base.
• This means that we all have differing experiences
  of professional practice, even within professions.

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National Mental Health Survey

• This 1997 work was a detailed overview of the
  prevalence of mental and substance-use disorders
  for Australia.
• In line with the 1990 United States national
  comorbidity survey.
• In line with the 1993 United Kingdom survey of
  psychiatric morbidity.

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National Mental Health Survey Questions

• How many adults in private households suffered
  from mental disorders?
• How disabled were they by their psychiatric
  impairment?
• What health services did they use and want?

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Disability

• People with mental disorders reported 14 million
  disability days each month.
• Mental disorders account for 20 of the total
  burden of disease in Australia.
• Expenditure on mental health is only 5 of the
  total health budget.
• Half the disability associated with mental
  disorders is generated by two related disorders
  the anxiety and affective (mood) disorders
• 10 is generated by one disorder schizophrenia.

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Australian Mental Health 1997

• 23 of adults reported having at least one
  psychiatric disorder in the previous 12 months.
• 14 were suffering from a disorder when
  interviewed.
• 35 had actually consulted about it.
• 50 of those disabled or having multiple
  comorbidities had consulted.
• The total prevalence in the year was 22.7 using
  the ICD-10 and 20.3 using the DSM-IV.

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Other Aspects

• Women had higher rates of mood and anxiety
  disorders and lower rates of substance use
  disorders in contrast to men.
• The elderly had lower rates for all disorders
  except cognitive impairment.
• The young had much higher rates of substance use
  disorders.
• Currently married had lower rates for all
  disorders.

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Other Aspects (contd)

• Disorders frequent with less education.
• Those employed had lower rates.
• About 4 of people admitted to suffering from 2
  or 3 or more diagnoses at the same time
  (comorbidity).

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Prevalence of Disorders in Men
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Prevalence of Disorders in Women
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Suicide

• Suicide is the leading cause of death amongst
  adult offenders in custodial settings. Inmates
  are up to ten times more likely to die from
  suicide than their counterparts in the general
  population. Custody-related deaths may account
  for up to three-quarters of all deaths amongst
  custodial clients who have not yet gone to trial
  and up to one-third of all deaths amongst
  sentenced prisoners.

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Last 100 Consecutive Medicolegal Cases of Ian
Curtis
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Last 100 Cases By Type
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Last 100 Cases By Gender
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Last 100 Cases By Age
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Last 100 Cases By Global Assessment of
Functioning Scale
DSM-IV Scale of Personal Functionality
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Medical-Psychiatric Interventionat Legal
Practice Level

• Early detection is better.
• Substantiation of expert opinion is of importance
  to the Court.
• The commissioning letter is vital. The
  commissioning letter must pose clearly the
  questions that you require to be answered.
• The question of professional fees.
• A personal and family history together with a
  plea for mercy in the last paragraph is not a
  medicolegal report.

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References

• Andrews G, Henderson S, and Hall W (2001)
  Prevalence, Comorbidity, Disability, and Service
  Utilisation Overview of the Australian National
  Mental Health Survey British Journal of
  Psychiatry, 178, pp145-153.
• Henderson S, Andrews G, and Hall W (2000)
  Australias mental health an overview of the
  general population survey Australian and New
  Zealand Journal of Psychiatry, 34, pp197-205.
• Shea P (1993) Psychiatry in Cour,t Sydney The
  Institute of Criminology.
• Stuart H (PhD) (2004) Suicide in Custody in
  Fast Facts Psychiatry Highlights 2003-04
  Malcolm Lader (ed), Oxford Health Press Limited.
• Treatment Protocol Protocol (2000) Management of
  Mental Disorders (3rd Edition). Sydney World
  Health Organization Collaborating Centre for
  Mental Health and Substance Abuse.