Dr Jennifer Wells1, Ms Melanie Mitchell1, Ms Brownhalls Jessica
1Qld Forensic Mental Health Service, Brisbane, Australia
There is limited research guiding targeted therapeutic approaches with those with serious mental disorder who engage in behaviours that can lead to criminal charges. Examples of such behaviours include stalking, sexual violence / deviance, and violent threats. At best such behaviour causes distress &/or disruption to the lives of others and at worst it threatens their safety. Forensic behaviours often also cause distress and/or damage to the clients themselves.
General mental health services are tasked with developing appropriate treatment plans for mentally ill clients engaging in forensic behaviours with often limited knowledge or training in this area. This presents a unique challenge to mental health treating teams. Specialist forensic mental health services can assist with assessment of risk using research based methods and validated risk assessment tools. In addition, forensic clinicians often provide adjunctive therapies but what guides these clinicians in fulfilling this treatment role?
This research evaluates the role of therapy targeting forensic behaviours and shines a light on the techniques that were effective. Referral notes, risk assessments and therapy records were reviewed for clients who engaged in therapy with the Queensland Forensic Mental Health Service between 2011 and 2016. Of the cases referred for therapy, 49% targeted stalking, 30% sexual violence, and 15% repeated violence including making threats. Overall there was a moderate attrition rate with destabilising factors resulting in therapy termination. Successful therapy was associated with “buy in” from clients, rapport, relationships with treating teams, and a highly individualised, formulation driven approach. The overall finding was that forensic therapy is complex and changeable. To be effective forensic clinicians must be ‘therapeutic chameleons’, able to rapidly change therapeutic modality to respond to the complex needs of the client. The results will be discussed with a focus on strategies that enhanced therapy and those related to disengagement from therapy.
Dr Jennifer Wells has 18 years experience in various fields including Community Mental Health and Forensic Mental Health Services in Tasmania and Queensland. Her current position involves the provision of specialist risk assessments and psychological intervention for problem behaviour as part of the Community Forensic Outreach Service in Brisbane.