Dr Gwen Adshead Jonathan Coe Dr John Hook

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1 WE NEED TO TALK ABOUT MISCONDUCT RCPSYCH 13/4/16 Dr Gwen Adshead Jonathan Coe Dr John Hook

2 Exercise Today 1. Introduction / current issues in misconduct 2. Who is at risk of misconduct? 3. Evaluating misconduct 4. Interventions & remediation Slide 2

3 Completion 01 Introduction / current issues in misconduct Slide 3

19 Completion 02 Who is at risk of misconduct? Slide 19

20 Completion What are the conditions which enable misconduct? Slide 20

21 Completion 03Evaluating misconduct Slide 21

22 p 3 Referral Details 3 Purpose of Report 3 Legal Proceedings 3 Allegations/Findings 4 Documentation and Third Party Interviews Used in Preparing This Report 5 Psychological Tests Administered 5 History of Presenting Complaint 8 Sequelae to Presenting Complaint 10 Family History 14 Family Psychiatric History 14 Personal History 17 Education History 18 Work History 19 Premorbid Personality 20 Past Medical History 20 Past Psychiatric History 21 Forensic History 21 Previous Professional Complaints 21 The Interview 23 Results of Third Party Interviews 28 General Practice & Hospital Records 28 Psychological Test Results 31 Interpretation of Results 31 Formulation 36 Diagnosis 36 Prognosis 37 Formulation of Risk Factors 38 Summary of Risk and Protective Factors Currently Operative 39 Assessment of Amenability to Interventions 40 Recommendations for Interventions 41 Summary 43 Expert s Declaration 44 Appendix 1 47 Appendix 2 Slide 22

23 Completion 04 Interventions & remediation Slide 23

24 Completion So, what s wrong with these guys? Slide 24

25 Completion 1. Uninformed/naïve 2. Healthy or mildly neurotic 3. Severely neurotic and/or socially isolated 4. Impulsive character disorders 5. Sociopathic or narcissistic character disorders 6. Psychotic or borderline personalities. 7. Bipolar disorders. Schoener and Gonsiorek (1989) Slide 25

26 Type Description of profile Rehabilitation? 1. Naïve 2. Normal and/or mildly neurotic 3. Severely neurotic and/or socially isolated 4. Impulse Control Disorders 5. Sociopathic or Narcissistic personality disorders 6. Psychotic and severe borderline disorders 7. Sex offenders 8. Medically disabled 9. Masochistic/ selfdefeating These individuals usually respond well to appropriate retraining unless their psychological and interpersonal naiveté is characterological rather than situational. Generally have one victim. These are good prospects for rehabilitation. Tend to be repeat offenders. Therapists in this group vary in their potential for rehabilitation because of their longstanding intra-psychic and life problems. Generally repeat offenders. Clinical experience indicates that these individuals cannot be rehabilitated and therefore should be removed from positions where they can harm others. Repeat offenders most often. Their manipulativeness extends to appearing remorseful when caught and making a show of participation in a rehabilitation program. In fact, they are almost always impervious to character change and should be removed from positions of clinical responsibility. The future behaviour of these individuals tends to be unpredictable, and therefore they are not considered amenable to rehabilitation and reinstatement as clinical professionals. These are paedophiles and other aggressive sex offenders. They commit offenses that would be criminal even outside the context of therapy. Health care and clerical professions offer such a temptation to reoffend that these are generally not considered appropriate work settings for such individuals. Neurological impairments or bipolar mood disorders. The rehabilitation potential of medically impaired therapists depends on the treatability of their medical condition. Their deeply dysfunctional personality structure makes their prognosis for rehabilitation guarded. Maybe Yes Maybe No No No No Maybe Probably No Slide 26 Gutheil & Brodsky Preventing Boundary Violations in Clinical Practice

27 Completion 1. Psychotic disorders 2. Predatory psychopathy and paraphilias 3. Lovesickness 4. Masochistic surrender. Gabbard and Lester 1995 Slide 27

28 Clinic for Boundaries Studies professionalboundaries.org.uk Slide 28

The patient s name, date of birth, current ward/address, and key worker s name.

The patient s name, date of birth, current ward/address, and key worker s name. MHR/RCPsych-NI/DHSSPS-Feb04 1 Update Sept 2011 GUIDANCE NOTES ON THE PREPARATION OF MEDICAL REPORTS FOR THE MENTAL HEALTH REVIEW TRIBUNAL In essence this guidance proposes that the medical report should