Toward an Integrated Model of Violence and Mental Health: Perceptions, Assessment, and Treatment

Size: px

Start display at page:

Download "Toward an Integrated Model of Violence and Mental Health: Perceptions, Assessment, and Treatment"

Prudence Evans
5 years ago
Views:

1 Toward an Integrated Model of Violence and Mental Health: Perceptions, Assessment, and Treatment Saskatoon, May 8 th Daryl G. Kroner 1

2 What Lens? Tendency for one of two lens Based on training, discipline, life experiences Mental health lens Criminal justice lens Answer: Both But,... 2

3 Either Lens? If mental health, then this lens Treatment to the exclusion of other criminogenic needs Morgan et al., 2012 Criminal justice lens If criminal justice, then this lens Odd behavior becomes a risk factor 3

4 Hard to integrate 1. Increased complexity 2. Differential perception 3. Resistance to criminalize mental illness 4. Research paradigm 5. Conflicting purposes and polices 6. Putting two different kinds together 4

5 Hard to Integrate: 1. Increased Complexity These clients are perceived as mad, bad, and dangerous Skeem and Eno Louden (2006) Role of substance abuse By itself, is a powerful destabilizer But it also impacts and interacts with both the mental health and criminalness areas Rarely does substance abuse not make an additional contribution, regardless of the outcome Mental health area, substance abuse will exasperate one s mental illness by using substances to self-medicate symptoms, loss of control for medication adherence, exposure to high risk environments, and eroding social support (Swartz et al., 1998) 5

6 Increased Complexity These mad, bad, and dangerous clients are watched more closely by definition, more information is going to be available 6

7 Hard to Integrate: 2. Differential Perception Evokes pity, the other evokes more punitive sentiments we profess compassion for the mentally ill and struggle understanding behaviours that derive from illness. We do not extend the same compassion to those we label as evil, manipulative, conniving, and deceitful. Freeman Professional organizations 7

8 Hard to Integrate: 3. Resistance to Criminalize Mental Illness Perception that mental illness is predominantly responsible for criminal justice involvement will likely have the view that an offender s criminalness will view criminalizing those with mental illness (Draine et al., 2002). 8

9 Hard to Integrate: 4. Research Paradigm Reductionistic 9

10 Research Paradigm Psychopathology Crime Axis I Repeat offender Schizophrenia Predictors General characteristics High risk Genetic contributions Case Management 10

11 Hard to Integrate: 5. Conflicting Purposes and Policies Mi to adapt and be productive within a community Offender reduce recidivism 11

12 Hard to Integrate: 6. Two Kinds A case Default position 12

13 Reasons for having Criminal Justice as the Lens Much of criminal justice policy is guided by riskbased strategies Formally or informal Prison placement Re-entry / release Supervision Sentencing Cannot be ignored 13

14 Reasons for having Criminal Justice as the Lens 1. Perceived Risk of CJ involved clients with MI 2. It is still a Behavior issue 3. Proportion is small 4. Criminal Justice system basic orientation 14

15 1. Perceived Risk Risk gets overestimated A risk perception study Presented risk scenarios Three scenarios Randomly assigned Half base rate information Half no base rate information Goal: Estimate risk (%) 15

16 Light lines represent 95% confidence intervals. Standard deviation is captured by the shape of the cat eye. Dots are data points beyond the 95% confidence intervals. 16

17 Mean and Error Plots of Mental Health Scenario Risk Estimates Risk Level Estimate (Percentage) Schizo Bipolar Alcohol Schizo Bipolar Alcohol No Base Rate (N = 99) Base Rate (N = 58) 17

18 1. Perceived Risk Risk gets overestimated Overestimation of risk impacts: Individual Unnecessary restrictions Criminal justice policy Overuse of intervention and supervision Legislation Unduly harsh penalties for crimes 18

19 2. Behaviour Outcome Criminal Justice outcome are of a behavioural nature 19

20 3. Proportion is Small The number of criminal justice involved with mental illness is small The number of events attributed to mental illness is small 20

21 4. Criminal Justice System Basic Orientation Key aspect of the Criminal Justice system Safety Protection Expressed through Risk 21

22 Criminal Justice System Where do we start? Broad, Risk Five Level system 22

23 Five Levels Level I Level II Level III Level IV Level V 23

24 Profile: Level I Criminogenic needs: none or transitory Non-Criminogenic needs: none or transitory Resources: clearly identifiable personal and social resources Reoffending Base Rate: same as non-offender community at large (e.g., <5%) Correctional Strategies: Human services: unnecessary/ direct to social services if desired Community Supervision: minimal as not necessary for compliance Custody: counterproductive Outcomes: Short-term: No change in probability of re-offending Life Course: Desistance 24

25 Level II Profile: Criminogenic needs: Few, if any, more acute than chronic. Non-Criminogenic needs: Few if any, transitory and quick to respond Resources: Clearly identifiable personal and social resources Reoffending Base Rate: Higher than individuals without a criminal record but lower than typical offender Correctional Strategies: Human services: Brief interventions: social problem solving aided through existing community services. Community Supervision: simple case management with minimal supervision for compliance Custody: may be productive for crisis management but unnecessary long-term Outcomes: Short-term: Probability of re-offending reduces quickly to non-offender levels (Category I) Life Course: Desistance (i.e., one and done) 25

26 Level III Profile: Criminogenic needs: Some; may be severe in one or two discrete needs or less chronic/severe across multiple needs Non-Criminogenic needs: Some; typical to offenders Resources: Some identifiable personal and social resources, sporadic use Reoffending Base Rate: Same as the average rate for offenders as a group Correctional Strategies: Human services: Structured services target criminogenic needs over months; (e.g. ~ hours of service); assist with non-criminogenic needs/responsivity factors. Community Supervision: Change focused supervision with supervision for enhance engagement and compliance Custody: may support short-term risk management Outcomes Short-term: Probability of re-offending can significantly with appropriate strategies BUT still higher than community at large (Category II) Life Course: Expected involvement in crime over time but desistance possible over years 26

27 Level IV Profile: Criminogenic needs: Multiple; may be chronic in one or two discrete needs and moderate in others Non-Criminogenic needs: Multiple, moderate to severe. Resources: Few identifiable personal and social resources, sporadic prosocial use Reoffending Base Rate: Higher than the rate of typical offender Correctional Strategies: Human services: Structured comprehensive services target multiple criminogenic needs over lengthy period with community follow-ups and supports (e.g. ~ 300+ hours of service); assist with non-criminogenic needs/responsivity factors. Community Supervision: Intensive and change focused supervision with supervision for enhance engagement and compliance as well as risk management Custody: may be productive for short-term risk management and beginning treatment Outcomes: Short-term: Probability of re-offending can with appropriate strategies BUT still average for offender population at large. Life Course: Chronic offending rate shows gradual decline with appropriate services and time (i.e., years/decades). 27

28 Level V Profile: Criminogenic needs: Multiple, chronic and entrenched Non-Criminogenic needs: Multiple, moderate to severe Resources: Few identifiable personal and social resources; use for procriminal pursuits Reoffending Base Rate: 85% re-offending rate (Top 5% of offenders) Correctional Strategies: Human services: Structured comprehensive services target multiple criminogenic needs over years ideally prior to community release (e.g. ~ 300+ hours of service); assist with noncriminogenic needs/responsivity factors Community Supervision: Long-term supervision begins with intensive/risk management focus and gradual change to change focus (Category IV) with success over time Custody: incapacitation for community safety, long-term change strategy starts with behavioral management Outcomes Short-term: Probability of re-offending still significantly higher than offender population even with appropriate long-term correctional strategies Life Course: Chronic offending rate gradually declines over decades or advanced age, cascade within custody envirnoments 28

29 Calculating Risk Level I Requirement: Risk Scores & Recidivism of Population Recidivis 1.00 Risk Scores Distribution Base Rate ~.40 Median 0.00

30 Principled Approach Risk Levels principled 1. based on a set of given procedures involving normative and criterion-referenced psychometric principles 2. this approach can be applied to most risk assessment instruments. 30

31 Upper Boundary ~5% Recidivism Calculating Risk Levels 2 Level I: Upper Boundary Level V: Lower Boundary Lower Boundary ~85% Recidivism 1.00 Cat I Cat V ~0.85 ~0.40 Level I: Risk Score Cutoff Level V: Risk Score Cutoff ~

32 Level III: Risk Score Cutoffs Calculating Risk Categories 3 Category III: Boundaries Boundaries = Appropriate Treatment Effect Size Odds Ratio: ±1.44 Lev III 1.00 ~0.85 Lev II Level IV ~0.40 Lev I Lev V ~

33 Integration Level I Principles Evidence Level II Principles Evidence Level III Principles Evidence 33

34 Integration Level IV Principles Evidence Level V Principles Evidence 34

35 Benefits of a CJ Risk-based Lens RNR Responsibility Freedom 35

36 Applications Context Different approaches Violence prediction vs. reduction 36

37 Toward an Integrated Model of Violence and Mental Health: Perceptions, Assessment, and Treatment Daryl G. Kroner 37

From Case Management to Change Agent: Integrating RNR and Cognitive-Behavioral Principles

From Case Management to Change Agent: Integrating RNR and Cognitive-Behavioral Principles Guy Bourgon, Ph.D., C. Psych. Cog Summit: Keynote Minnesota. February 5, 2016 Things that make me go What is the