Models Of Forensic Psychology Case Study Social Work Essay

Andrew is fifteen. He has been accused of sexually assaulting his younger sister and may be charged with this in the near future. Some of his family have a history of mental disorder and he has a history of learning and behavioural difficulties, as a result of which he has been attending a residential special school.

He does not acknowledge the accusations against him and is reluctant to discuss them.

INFORMATION FROM INTERVIEW -

Andrew presents as a tall, slim-built youth who is restlessly anxious, looking away for most of the interview, and repeatedly yawning in an exaggerated manner to indicate how little he wants to be involved in the discussion. Despite this he is essentially polite in manner and answers all questions, at least in some measure. His apparent level of intelligence puts him in the mild range of impairment, and he is also very sensitive to anything that he thinks puts him at a disadvantage or makes him look "thick". He has some social skills, although these are not always used and sometimes he appears socially disinhibited.

He has a reasonable vocabulary and powers of speech. There are no behavioural stereotypies (repetitive apparently purposeless movements) and no perseverative behaviour (continuance of behaviours after their original purpose has been served). However, his powers of concentration are limited and he is easily distracted from discussion. His attention is focused on his perceived likelihood that he will automatically go to prison, regardless of whether he is charged or not. He hopes that a combination of his medical history and denial of the allegations will be enough to get him through any legal processes.

Andrew says he hasn't been charged with anything "because I ain't done nowt". Nevertheless he is able to say that 'sexual assault' means "trying to make somebody do something - have sex, how to make babies" and that 'penetration' means "putting a finger up someone - up (the) clitoris of women".

He has already been officially asked on one occasion about "for what's going on now basically" but can describe no details and says that he "ain't bothered because I haven't done it".

CURRENT CIRCUMSTANCES -

Andrew has his own room at his special school and has made one or two friends. The activity that he enjoys most, and gets most from, is "studying motor vehicles" and he has developed an ambition to become a mechanic.

He comes home for some weekends and for holiday periods.

At present he feels he "hasn't got a life anymore". This is both because of the possible pending charges and because he feels "people are dropping dead around me". A "close friend (female)" of his died recently, and his life has not felt the same since his father died unexpectedly the day before his birthday four ago, and his paternal grandmother died about a year afterwards.

He would like to become a motor mechanic, but thinks this will not be possible, unless he can get training in prison, because of his possible court case.

PERSONAL AND FAMILY HISTORY -

He is the youngest member of his family, although his own list of his siblings and half-siblings is slightly different to that provided by his family.

His father died from a heart attack and his mother has a lot of problems with her health.

He was excluded from his first school for "throwing a brick at a teacher or something like that - they were doing my head in all the time".

MEDICAL HISTORY -

He has been diagnosed as having "ADHD" (Attention deficit hyperactivity disorder), and says that this is why he is at boarding school. He says that he "used to get all mad and hate people and take it out on them" but that this has improved more recently.

Two years ago he tried to hang himself with two belts because he "just felt like it - I couldn't be bothered living anymore - I did it for fun - I thought it was funny". He also tried to cut his wrist, and still has a faint scar from this. He continues to have periodic thoughts about a quick premature death as a way of not having "to put up with living anymore". Although these thoughts reflect a depressed view of life there is no indication that he currently has a depressive illness.

He has previously taken the antihyperactivity drug Ritalin, but has now discontinued this and describes it as "doing my head in".

SEXUAL DEVELOPMENT HISTORY -

He first became sexually aware at a very young age, as a result of being given information either by one of his sisters or a friend. His father told him not to have sex until he was older so as to avoid having children.

His strongest sexual experience so far has been with a girlfriend who he described as "the nicest person you could meet - even though my sister called her a 'smackhead'".

He denies the allegations about his sister and describes them as "all lies".

Questions -

What identifiable risks, giving your reasons, does Andrew present a) in the short term and b) in the longer term? Rank them once in their order of certainty, and again in their order of importance.

Construct an interview strategy to help investigating police officers further question Andrew about the allegations regarding his sister, explaining your rationale.

Case Study 2

Mr D Case Study

Read the following case study carefully. Using your knowledge of risk assessment, mental disorders and offending behaviour and interview and treatment strategies answer the following questions:

Describe the type(s) of mental disorder Mr D may be suffering from

Consider whether those disorders are likely to contribute to the risk he poses of future violence

Identify those risks that Mr D poses to himself and others

Consider whether you would discharge Mr D from hospital at this time and give your reasons why

(Point 5 is optional) Highlight what challenges Mr D may pose in treatment and how you might overcome them.

Background

Early Childhood

Mr D was born to a 16 year old mother and conceived following a one night stand. Mr D recalled an unsettled childhood due to his mother handing over his care to her parents. Mr D described how he liked living with his grandparents, however he also described how his grandfather frequently used alcohol and his grandmother was strict and did not allow him to socialise with other children. Behavioural problems were noted from the age of 4.

Throughout this time period Mr D began having severe tantrums which involved hitting and kicking and Mr D was referred to the Children's Hospital at the age of 8. This followed a severe attack levied against his grandfather involving a knife. Throughout the interview process Mr D remained closed about his relationship with his grandfather. Later reports indicate he was sexually abused by his grandfather but Mr D refuses to discuss this subject.

Mr D was taken into care at the age of 8, where again he reported an unsettled period of time characterised by isolation and bullying. Mr D was able to live with a foster family whom he described as supportive for the next two years and it is of note that there were no behavioural difficulties noted for Mr D within this time period. Mr D appeared to settled with this family and their two sons, which allowed him to form secure attachments with this family. Unfortunately the family needed to emigrate to South Africa, and although he was asked to go with them, Mr D chose to remain close to his grandparents.

Mr D spent the next five years in Children's homes, interspersed by foster placements which broke down. Mr D returned to live with his grandparents following this period. Previous reports indicate conflicting points of view about this time period, some indicating that Mr D had more positive relationships with his grandparents and mother at this time, but with others highlighting that his grandparents did not really speak to him.

Education and employment

Mr D attended approximately five different schools as he was moved due to his living situation changing. Mr D recalled an unsettled period of time at school as he was bullied. He also described himself as 'hyper, I would scream and shout a lot' and recalled finding lessons boring. Records indicate that Mr D began refusing school at the age of 4 and has a significant history of truancy throughout his education. Mr D left school with no qualifications but school reports describe him as exceptionally bright.

Mr D has never been in formal employment. After leaving school he was unemployed for 2 years as he reported he could not find a job that interested him and he was having difficulties with his mental health. Following this, Mr D has been detained due to the conviction for his index offence.

Substance and alcohol misuse

Mr D reports a substantial history of cannabis use and a history of binge drinking.

Psychiatric History

Mr D first came into contact with mental health services at the age of 8 when he was admitted to the Children's Hospital for 6 weeks following a violent attack on his grandfather. An ECG and neurological examination at the time were found to be normal, however Mr D's mother recalled a 'black patch' being found. Following this Mr D was referred to an Adolescent Unit at the age of 14 due to behaviour problems such as refusing to attend school and standing naked in the window. Later that year, Mr D was admitted to the hospital and was described by the doctor as an 'isolated and withdrawn individual, having no self confidence who responded with aggressive outbursts when frustrated'. Mr D self-harmed by cutting his arms with a piece of glass.

After being convicted of two incidents of indecent exposure at the age of 17, Mr D received outpatient treatment initially, but following another charge for indecent exposure Mr D was admitted as an inpatient. At this point he was talking about injuring people before they had the chance to injure him.

On the 9th April 1987 Mr D was again charged with indecent exposure and was remanded under section 35 of the Mental Health Act (1983). During his assessment there, it was noted that he was hearing voices telling him to commit acts of violence. No specific diagnosis was made at this time, although a condition of residence and psychiatric treatment was made. Following his 18th birthday he was moved to Arnold Lodge Hospital. Whilst there it is reported that Mr D's mental health appeared to deteriorate and violence towards others increased. At the age of 20 Mr D was transferred to a Hostel in Liverpool as it was thought that he would benefit from integration with other people, however three months after this he was discharged after assaulting another resident.

Mr D managed to live in the community on his own for approximately two and a half years before he committed his index offence. At this point he was remanded to HMP Hull for approximately 2 months. Mr D attempted to hang himself during his first night in custody. He was then transferred to Wathwood hospital due to him exhibiting paranoid ideation and experiencing auditory hallucinations commanding him to harm a female prison officer.

Whilst at Wathwood Hospital, initially Mr D's presentation seemed to improve to the point that he was granted conditional discharge by a Mental Health Review Tribunal, however at this point Mr D's fixation with a female member of staff began to cause concern. Mr D began exposing himself to female members of staff and his mental health deteriorated. Mr D's presentation continued to decline over the next two years in terms of incidents of violence, aggression and sexually inappropriate. His mental health also fluctuated with episodes of paranoid ideation, delusions, thoughts of harming himself and incidents of aggression.

Forensic History

Mr D has three previous convictions for offences of indecent exposure. There are seven previous convictions for driving offences (e.g. driving whilst under the influence, reckless driving, driving without a license, insurance and MOT) and 4 convictions of acquisitive offending (2 offences of shoplifting and2 burglary offences). Mr D has no other convictions for violent offences apart from the index offence, however there has been other violence evident in Mr Driver's past when he has been a patient in hospital.

Index Offence

Mr D was convicted of the murder of his neighbour. The offence occurred in the context of ongoing difficulties Mr D was experiencing with his neighbours in terms of loud music they were playing in the early hours of the morning. Mr D had raised this problem with his neighbours and it is reported that they responded to this in a less than positive way. Mr D then tried to involve the council to alleviate the problem, however this appeared to have had no effect. On the day of the index offence, the victim was taking his rubbish out and Mr D approached him from behind and struck him once in the back with a 5 inch bladed knife. Mr D immediately ran away from the scene and made his way to the Family and Community Services Department with whom he was in regular contact and the police were contacted and Mr D was subsequently arrested. The victim had removed the weapon himself and in the meantime had made his way to nearby premises to seek assistance. He later died of his injuries in hospital.

Mr D's account of the offence is that he had been living next to neighbours who were 'noisy'. He said he had lived next to them for about six months and 'I kept knocking, asking them to turn it down, they just said it was their house'. When asked how many times this had occurred Mr D said, 'probably approached them about 5 or 6 times'. Mr D stated that he didn't phone the police at all, but that he did phone the housing association. He said that nothing happened as a result of this and the music continued.

On the last occasion that Mr D asked for the music to be turned down before he committed the index offence Mr Driver stated 'he started threatening me and said 'I'm not turning the music down' and was arguing. I can't remember what was being said, but I just kept asking him to turn it down. He was shouting and I think I hit him first, we had a scuffle and the police were called. The Police told me to get in touch with the housing association'. Following this incident Mr D said that a few weeks passed and the music continued. Mr D stated that he had been going out shopping he had been carrying the same knife that he eventually stabbed the victim with.

On the day of the index offence, Mr D reported being woken at 9am by music being played. He stated, 'I felt really stressed and angry. I got up, got dressed, I was standing in my kitchen and could hear it (the music) and I saw him going to the bin. I'd come to the end of how I was feeling and looking for a way out'. Mr D stated, 'I got a knife and stabbed him in the lower back. When asked what might have happened to resolve the situation had the index offence not occurred Mr D said, 'If I hadn't seen him, I probably would have gone on carrying the knife and gone round to his house'. In terms of why Mr D felt he committed the offence, he stated, 'I couldn't stand them playing loud music'. Mr D went onto say 'Yes I regret it, its led to me being kept in hospital. There is nothing else I could have done. He deserved it because he wouldn't turn down his music'.

Assessments

Wechsler Adult Intelligence Scale -3rd edition (WAIS III)

This assessment examines general cognitive abilities, specifically thinking and reasoning skills. It explores non-verbal reasoning skills, spatial processing skills, visual-motor integration, attention to detail and acquired knowledge such as verbal reasoning and comprehension. Mr D presented with a full scale IQ of 130.

International Personality Disorder Examination

Mr D was assessed for personality disorder using the International Personality Disorder Examination (IPDE: Loranger; 1999). The IPDE is a semi-structured clinical interview developed to assess personality disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV; American Psychiatric Association, 1994) and the International Classification of Diseases, 10th revision (ICD-10; World Health Organisation, 1992). Mr D's current presentation indicates that definite diagnoses of Antisocial and Narcissistic personality disorders are warranted. The Antisocial features most relevant in Mr D include a lack of concern for the feelings of others, reckless behaviour, consistent irresponsibility, disregard for rules and punishment, low tolerance to frustration leading to acts of aggression and violence, and a proneness to rationalise and blame others for his own behaviour. The Narcissistic features which Mr D presents with include a grandiose sense of self-importance, a belief that he should be treated differently, an overinflated sense of self-entitlement, arrogance in his behaviour and attitudes, a persistent pattern of taking advantage of others to achieve his own ends and an unwillingness to recognise or identify with the feelings of others.

Psychopathy Checklist Revised (PCL-R

The Hare Psychopathy Checklist Revised (PCL-R, Hare 1991, 2003) is a rigorous psychological assessment, widely regarded as the standard measure of psychopathy in research, clinical and forensic settings. It measures different aspects of a person's emotional experience, the way they relate to others, how they go about getting what they want and their behaviour. High levels of psychopathic traits as measured by the PCL-R are associated with high rates of re-offending and future violence (however a low PCL-R score alone does not imply low risk) and can impact on responsivity to therapeutic intervention. Mr D presented with moderate levels of psychopathic traits which fell just below the diagnostic cut off for psychopathic disorder. Items that he scored on include failure to accept responsibility for his actions, irresponsibility, lack of remorse, callous disregard for others, grandiose sense of self worth, manipulation and early childhood problems.

Presentation in interview

Mr D presented as a difficult and challenging patient to interview. He was dismissive at times, questioning my experience, qualifications and competence. He stated that psychology was not a proper science and would prefer to talk to the 'proper doctor' i.e. the psychiatrist. Mr D appeared to have some knowledge of psychiatry and psychology and used technical terms throughout. He appeared to have little insight into his mental disorder stating that he does need to take medication and that everyone is like him. Mr D stated he does not under stand why anyone would think he poses a risk to people and that he should be discharged from hospital immediately.

Case Study 3

Ms W Case Study

Read the following case study carefully. Using your knowledge of risk assessment, mental disorders and offending behaviour and interview and treatment strategies answer the following questions:

Describe the type(s) of mental disorder Ms W may be suffering from

Consider whether those disorders are likely to contribute to the risk she poses of future violence

Consider what techniques/strategies/considerations you would use when interviewing Ms W

Highlight what further areas of work you may wish to undertake with Ms W (concentrating on what areas of her presentation you would like to explore/assess further and why)

Background

Early childhood

Ms W was the eldest child of three, the other two children being boys. Ms W recalled an unhappy childhood due to the sexual abuse she experienced from her father (for which he received a conviction) and then the emotional detachment that was apparent between her mother and herself. Social services records support Ms W's account of her early childhood. In addition to being sexually abused by her father, Ms W also reported being sexually abused by an uncle and a next door neighbour.

Ms W also reported that the relationship between her mother and father was a turbulent one and although she did not witness any physical violence, she did hear arguments which resulted in her repeatedly banging his head against the wall through the stress this caused. Ms W's behaviour became uncontrollable both within school and the community, in terms of fighting at school and committing petty crime such as shoplifting.

Whilst still living with her parents, at the age of 14, Ms W became involved in a relationship with a man who was much older than her, in his 60's. This further contributed to the deterioration between Ms W and her parents, and her parents subsequently placed her in care. Ms W remained in care until the age of 17, and upon leaving she was given support from social services and moved into independent housing in which she was happy on her own.

Education and employment

Ms W reported that her school performance was average; teachers would not have found her a management problem, but that she did get distracted easily. Whilst at school she was subject to bullying from peers and this resulted in her engaging in fights outside of school. Ms W left school with no formal qualifications.

Ms W obtained employment as soon as she left school and worked as a 'packer', a cleaner and in a pet shop. All of the employment she engaged in was in a short period after school, with her last job being held at the age of 20. Ms W reported that the last job she had needed to leave because her mental health was causing her difficulties and she needed to attend various appointments.

Following this period of employment, Ms W was unemployed for the next 16 years due to mental health, drug and alcohol difficulties. Ms W claimed incapacity benefits and before coming into custody she reported having an income of approximately £800 per month.

Substance and alcohol misuse

Ms W reported that she began drinking at the age of 14 or 15 as she would visit pubs with her partner at the time. She suggested that she became a heavy drinker at age 20 and that she needed alcohol every day as otherwise she would suffer with withdrawal symptoms. Ms W would consume approximately 12 cans of Stella a day or 2 bottles of 2 litre Cider. Ms W's drinking caused her health problems in the form of liver failure and pancreatitis. Ms W was under the influence of alcohol when committing the index offence and this followed a period where she had tried to go through a detoxification process without medical support. It is of note that Ms W reported hearing voices whilst she completed this 'home detoxification' process.

In terms of drug use, Ms W remembered beginning to use substances at around the age of 18. She reports using acid tabs, microdots, magic mushrooms, speed, heroin (smoking) and cannabis. She also reported that she would take prescription medication if the opportunity arose. Ms W recalls that she would use whenever she had the money to do so and that she would frequently take drugs and drink at the same time. She estimated that she would spend approximately £14 per day, but that this would depend on what funds she had available at the time. In the early 1990s Ms W was diagnosed with drug induced psychosis.

Psychiatric history

Ms W first recalled being in contact with psychiatric services in her 20s. She was first seen by a psychiatrist due to the hallucinations she was experiencing and she voluntarily stayed in hospital for a few months. Ms W had spent time in group mental health homes and has had support from psychiatrists, CPNs and social workers.

Ms W had attempted to commit suicide on a number of occasions through taking overdoses. She was diagnosed with depression in her late 20s and has been on a number of anti depressant drugs which she combined with drink and non prescription drugs.

Whilst in custody Ms W was taking antidepressants, anxiolytics and anti psychotics. The latter were prescribed due to Ms W experiencing hallucinations and also mood instability. Ms W had most recently been diagnosed with 'Generalised Anxiety Disorder with features of depersonalisation and derealisation'.

Forensic history

Ms W had three previous convictions. Two were received in 1989 which were both fraud offences, and then the third in 1990 for burglary and theft of a non dwelling. Ms W cannot recall specific details regarding the situations. Ms W had no other convictions for violent offending, apart from the index offence, but there has been other violence present in Ms W's past especially within interpersonal relationships.

Index offence

The offence occurred in the shared home of Ms W and her partner. Two weeks before the index offence occurred, police had been called to the home after Ms W had taken an overdose of her partner's medication. When Ms W's partner had attempted to summon help, Ms W threatened her with a knife to try and prevent this. On the 10th June 2006 when the offence occurred, it was alleged that Ms W had been drinking cider from the early hours of the morning. Ms W insists that she was so drunk that she has no recall of the stabbing which then occurred and all that she remembered was seeing the blood on her partner's stomach. After stabbing her partner in the stomach she then threatened to cut her throat with the knife. The stab wounds caused a near fatal injury. The victim was able to summons help by activating the emergency pull cord for the accommodation's warden.

Assessments

Wechsler Adult Intelligence Scale -3rd edition (WAIS III)

This assessment examines general cognitive abilities, specifically thinking and reasoning skills. It explores non-verbal reasoning skills, spatial processing skills, visual-motor integration, attention to detail and acquired knowledge such as verbal reasoning and comprehension. Ms W presented with a full scale IQ of 75. The assessment showed that Ms W processes information more effectively when presented visually rather than verbally and that she struggles to concentrate for long periods of time.

International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ)

This assessment is a screening questionnaire which indicates whether there are certain personality traits which need further investigation using the full International Personality Disorder Examination assessment. The IPDE-SQ indicated the possible presence of paranoid, schizotypal, emotionally unstable, avoidant and dependent personality disorders but this should not be considered as a formal diagnosis.

Millon Clinical Multiaxial Inventory III (MCMI-III)

This assessment is used to evaluate elements of personality and also pathological syndromes within psychiatric populations. On this occasion the MCMI- III was used to provide a more comprehensive picture of Ms W's personality and presentation in combination with the outcome of the IPDE-SQ. This measure was not used to diagnose personality disorder but to contribute to the understanding of Ms W's presentation. The Millon highlighted that Ms W presented with anxiety, drug dependence and post traumatic stress disorder and may possible present with thought disorder and major depression.

Presentation in interview

Ms W presented as a shy, pleasant individual with very low confidence and who suffered with anxiety. It was evident that she was lacking in confidence in terms of speaking to people and being sure of her own opinions. She had also seemed to struggle in terms of her level of concentration.

Over the course of the sessions Ms W's mood could be quite volatile, changing from happy to depressed in the period of a couple of hours. Ms W consistently spoke of thoughts of self harm throughout the sessions and when feeling depressed would project these feelings onto others as having caused them. Ms W also presented at times as quite paranoid in terms of thinking that people were talking about her. Ms W also disclosed that she was experiencing visual hallucinations particularly when she felt stressed.