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Dr Fiona Black, Clinical Psychologist High Security Inpatient Service, The Park Centre for Mental Health delivered this presentation at the 2013 Social Determinants of Health conference. The conference brought together health, social services and public policy organisations to discuss how social determinants affect the health of the nation and to consider how policy decisions can be targeted to reduce health inequities. The agenda facilitated much needed discussion on new approaches to manage social determinants of health and bridge the gap in health between the socially disadvantaged and the broader Australian population. For more information about the event, please visit the conference website: http://www.informa.com.au/social-determinants.
Citation preview
Social Correlates in
Forensic Mental Health
Dr. Carrick Anderson Psychiatric Registrar
Dr. Fiona Black Clinical Psychologist
Social Determinants of Health Conference – Sydney – December 2013
Outline Health
Mental health
Forensic mental health
Forensic mental health in Queensland
Queensland’s forensic psychiatric hospital
Case example
Treating illness and managing risk
Treatment vs intervention vs prevention
Future directions
Health / Mental Health
“A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
World Health Organization December 2013
AH&MRC definition of health: “not just the physical wellbeing of an individual, but refers to the social, emotional, and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole of life view and includes the cyclical concept of life-death-life”.
National Aboriginal Health Strategy 1989
Mental Health The 2007 National Survey of Mental Health and Wellbeing
estimates that almost half of Australians aged 16-85
experienced a mental disorder over their lifetime.
Each year 1 in 5 Australians in this age range are estimated
to experience symptoms of a mental disorder
The Australian Bureau of Statistics causes of deaths 2011 –
6 suicides per day. This may be underreported. Men are four
times more likely to die by suicide than women. Australian
Indigenous people are 2.5 to 3 times more likely to die by
suicide than others. There are 180 suicide attempts per day.
Mental Health Global burden of disease attributable to mental and substance
abuse disorders: findings from the Global Burden of Disease Study 2010 published in Lancet 2013.
Premature mortality as Years of Life Lost (YLL) from cause of death estimates for 1980-2010 from 187 countries was calculated. Years Lived with Disability was calculated. Disability-adjusted life years (DALYs) were derived from the sum of YLDs and YLLs.
Findings were mental and substance use disorders accounted for 7.4% of all DALYs worldwide. They were the leading cause of YLDs worldwide. Depressive disorders accounted for 40%, anxiety disorders 15%, combined drug and alcohol use disorders 20%, and schizophrenia for 7%. The highest proportion of DALYs occurred in people aged between 10 and 29 years.
In view of the magnitude of their contribution, improvement in population health is only possible if countries make the prevention and treatment of mental and substance use disorders a priority.
Mental Health Estimating treatment rates for mental disorders in Australia
Untreated mental disorders incur major economic costs and
personal suffering.
The percentage of Australians with a mental disorder who
received treatment for that disorder each year between 2006-
07 and 2009-10
The estimated treatment rate increased from 37% to 46% oer
that time – this was attributed to the introduction of the Better
Access programme.
Mental Health (continued) Lots of factors mentioned in relation to physical health that are
exacerbated in and complicated by mental illness
Distance (statewide services)
Income (public vs private)
Education (onset of mental illness)
Indigenous disparity
Accommodation and homelessness
Unemployment
Loss of hope/fear of failure
Smoking
Other substance use
Obesity
Jurisdictional division
Transport
Communication/language/health literacy
Gambling
Acquired Brain Injury
Religious/spiritual factors
Mental Illness
Social factors that contribute to development of mental illness
Early development critical
Vulnerability
Abuse and neglect
Social factors that perpetuate mental illness
Stigma, access to services
Social factors that contribute to recovery/rehabilitation
Housing
Famly, social, intimiate relationships
Best outcomes:
Least comorbidity
Early intervention
Good response to medication
Multidisciplinary work
Forensic Mental Health
Even further complicated by offending behaviour which in
itself is a multifactorial social problem.
Patients in forensic mental health often have complicated
comorbidities:
Mental illness
Personality disorder
Acquired brain injury / intellectual impairment
Substance use
Forensic Mental Health in
Queensland
Court Liaison Service (CLS)
Prison Mental Health
Service (PMHS)
High Security Inpatient
Service (HSIS)
Community Forensic
Mental Health Service
(CFOS)
Queensland’s Forensic Psychiatric
Hospital
Classified patients
Prisoners – serious violent offences
Hospitalised for assessment and treatment
Forensic patients
Found of unsound mind in relation to serious violent offence
Hospitalised for treatment rather than going through criminal
justice system
Gain leave through Mental Health Review Tribunals
Queensland’s Forensic Psychiatric
Hospital (continued) General passage through Queensland’s forensic psychiatric
hospital
Admission, stabilisation of mental illness
Addressing problematic behaviour
Engagement in psychotherapy, occupational therapy
Social work – family and community engagement
Community access, rehabilitation focus
Treating Illness and Managing Risk What are Patient A’s health needs?
What are Patient A’s forensic needs?
Forensic mental health – dual role
One and the same?
Social correlates of health equate with risk factors for violent
behaviour
HCR-20 (Webster, Douglas, Eaves & Hart, 1997)
H1 Previous Violence
H2 Young Age at First
Violent Incident
H3 Relationship Instability
H4 Employment Problems
H5 Substance Misuse
Problems
H6 Major Mental Illness
H7 Psychopathy
H8 Early Maladjustment
H9 Personality Disorder
H10 Prior Supervision
Failure
C1 Lack of Insight
C2 Negative Attitudes
C3 Active Symptoms of Major Mental Illness
C4 Impulsivity
C5 Unresponsive to Treatment
R1 Plans Lack Feasibility
R2 Exposure to Destabilisers
R3 Lack of Personal Support
R4 Non-compliance with Remediation Attempts
R5 Stress
Treatment / Intervention
(Prevention) For Patient A, a lot of his treatment needs are also the areas
that require intervention to ameliorate or manage risk
If we had had the opportunity, these would have been the
same areas for early intervention
Future Directions Clinicians to be aware of broader policies and drivers within
health – work to a common vision (nationally)
Increase profile of mental health
Holistic approach to health – physical, mental, social, spiritual
Importance of inter-agency relationships
Importance of research and evidence based practice
Early community action can prevent even high security hospitalisation
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