scholarly journals Forensic mental health professionals’ perceptions of their dual loyalty conflict: findings from a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Helene Merkt ◽  
Sophie Haesen ◽  
Ariel Eytan ◽  
Elmar Habermeyer ◽  
Marcelo F. Aebi ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Justice System ◽  
Mandated Treatment ◽  
Dual Loyalty ◽  
Qualitative Interview Study ◽  
Ethical Conflicts ◽  
Court Mandated ◽  
Treatment Settings

Abstract Background Mental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods 31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach. Results We first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. Conclusions Even though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.

scholarly journals What characterizes a good mental health professional in court-mandated treatment settings?: Findings from a qualitative study with older patients and mental health care professionals

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Helene Seaward ◽  
Tenzin Wangmo ◽  
Tobias Vogel ◽  
Marc Graf ◽  
Monika Egli-Alge ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Care Professionals ◽  
Service Providers ◽  
Interview Study ◽  
Therapist Characteristics ◽  
Good Mental Health ◽  
Qualitative Interview Study ◽  
Court Mandated ◽  
Treatment Settings

Abstract Background Therapist-related activities and characteristics such as empathy and genuineness are factors that significantly contribute to psychotherapy outcome. As they play a role in psychotherapy more generally, it can be expected that they are equally important in the treatment of court-mandated patients more specifically. At the same time, these treatment settings come with specific challenges—e.g. due to coercion and control—and it could thus be that some therapist-related characteristics might have a different empathy on the therapy. This interview study sought to investigate service providers’ and users’ perspectives on therapist-related characteristics in the context of detention. Methods We conducted a qualitative interview study with 41 older incarcerated persons mandated to treatment, and 63 mental health professionals (MHP). The data analysis followed thematic analysis. Results Patients and experts both emphasized the importance of treating patients with respect by taking a humanistic approach, that is, condemn the deeds but embrace the person and display genuine interest in supporting patients with any issue or concern that is of relevance to them. Furthermore, interviewees underscored that the coerciveness of the therapy context required to incorporate patients’ wishes into treatment planning, recognize and respond to the patients’ needs, and allow some choice within the given framework. Such inclusive attitude was deemed critical to engage and motivate patients to participate in treatment. In addition, it was emphasized that feedback and advice by the therapists need to be concrete, detailed and applied to each person’s current situation. Lastly, patients questioned MHP’s qualification when they did not progress in therapy. Discussion Our findings indicate that some therapist-related activities and characteristics are of particular importance in court-mandated settings. These include genuine interest in the patient, a respectful and positive attitude, as well as the capacity to target sensitive issues in a directive but non-confrontational manner. Further research needs to identify specific expressions and behaviors that are linked to the aforementioned characteristics in the forensic context. Our study therefore contributes to much-needed empirical research on clinician and patient perspectives on therapist characteristics and activities in the treatment of court-mandated patients.

scholarly journals Court-Mandated Patients’ Perspectives on the Psychotherapist’s Dual Loyalty Conflict – Between Ally and Enemy

2021 ◽  
Vol 11 ◽  
Author(s):  
Helene Merkt ◽  
Tenzin Wangmo ◽  
Félix Pageau ◽  
Michael Liebrenz ◽  
Corinne Devaud Cornaz ◽  
...  
Keyword(s):  
Therapeutic Alliance ◽  
Mental Health Professionals ◽  
Qualitative Interview ◽  
Interview Study ◽  
Dual Role ◽  
Therapist Characteristics ◽  
High Quality ◽  
Dual Loyalty ◽  
Qualitative Interview Study ◽  
Court Mandated

BackgroundMental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma.MethodsThis qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis.ResultsWe first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: (1) respecting the patient’s pace and perceived coercion; (2) patient health needs to be first priority; (3) clarity in roles and responsibilities; and (4) the art of communication – between transparency and unchecked information sharing.DiscussionDeveloping a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings.

scholarly journals Negotiating styles adopted by consultant psychiatrists when prescribing antipsychotics

2007 ◽  
Vol 13 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Robert Chaplin ◽  
Paul Lelliott ◽  
Alan Quirk ◽  
Clive Seale
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Therapeutic Alliance ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Qualitative Interview ◽  
Shared Decision ◽  
Adherence To Medication ◽  
Qualitative Interview Study ◽  
Improve Clinical Outcome

A good therapeutic alliance between mental health professionals and patients with psychosis can enhance adherence to medication regimens and improve clinical outcome. This article explores how the therapeutic alliance might be developed with respect to decisions to prescribe antipsychotic medication. It does this by presenting the implications for practice that arise from a recent qualitative interview study with consultant psychiatrists. We consider strategies for strengthening the therapeutic alliance, occasions when it might be appropriate to suspend shared decision-making temporarily, techniques used to enable discussion of symptoms and side-effects, and how issues of adherence are uncovered and addressed. Psychiatrists already possess considerable skills in these areas. The dissemination of these to colleagues forms an important opportunity for CPD.

scholarly journals Psychiatric assessment and diversion schemes: problems associated with brief court reports

1998 ◽  
Vol 22 (5) ◽  
pp. 303-305
Author(s):  
Clare Chambers ◽  
Jane Gill
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Criminal Justice System ◽  
Mental Health Professionals ◽  
Legal System ◽  
Health Professionals ◽  
Justice System ◽  
Specific Training ◽  
Psychiatric Assessment

Mental health professionals are becoming increasingly involved with the criminal justice system through their work in psychiatric assessment and diversion schemes. Preparation of reports for the courts requires knowledge of the legal system. Those preparing such reports need specific training for this work.

Addressing the existential dimension in treatment settings: Mental health professionals’ and healthcare chaplains’ attitudes, practices, understanding and perceptions of value

2019 ◽  
Vol 41 (3) ◽  
pp. 253-276
Author(s):  
Hilde Frøkedal ◽  
Torgeir Sørensen ◽  
Torleif Ruud ◽  
Valerie DeMarinis ◽  
Hans Stifoss-Hanssen
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Group Practice ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Existential Dimension ◽  
Treatment Settings

Research has shown that addressing and integrating the existential dimension in treatment settings reduce symptoms like anxiety, depression and substance abuse. Healthcare chaplains are key personnel in this practice. A nationwide, cross-sectional survey influenced by a mixed-methods approach was used to examine the attitudes, practices, understanding and perceptions of mental health professionals, including healthcare chaplains, regarding the value of addressing the existential dimension in treatment programmes. The existential group practice was led by the healthcare chaplains as an integrated part of specialist mental health services. A positive and open attitude towards addressing the existential dimension was identified among the informants. Despite this, a small gap between attitude and practice was reported. Existential, religious and spiritual concerns are reported as part of the existential dimension and as relevant topics to be discussed in specialist mental health services. The findings indicate that the existential group practice could have a positive influence on the co-leaders’ competence to address existential, religious and spiritual concerns; however, this should be further investigated.

Serious Mental Illness, Criminal Justice, and the Death Penalty

2020 ◽  
pp. 159-171
Author(s):  
Anna Scheyett ◽  
Katherine J. Crawford
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Criminal Justice ◽  
Criminal Justice System ◽  
Death Penalty ◽  
Serious Mental Illness ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Justice System ◽  
Community Members

This chapter addresses the intersection of mental health and the criminal justice system. Individuals with serious mental illness (SMI) are at higher risk of involvement with the criminal justice system and at greater risk of more severe sentencing. Mental Health America estimates that 20% of persons on death row have a serious mental illness. Someone who was actively mentally ill at the time of a crime, but who has received treatment and is now stable, will proceed to trial as death eligible. This chapter holds that, as the majority of mental health professionals, social workers have a responsibility for educating lawmakers, community members, and those in the criminal justice system, as well as other practitioners about the multiple levels of injustice and inequity surrounding individuals with SMI and the criminal justice system. These issues range from inadequate and inconsistent treatment in the community, jails, and prisons to differential sentencing practices.

scholarly journals Professional Interaction in Mental Health Courts: Processing Defendants with Mental Illness

2019 ◽  
Author(s):  
Monte Staton
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Symbolic Interaction ◽  
Field Research ◽  
Ethnographic Research ◽  
Mental Health Courts ◽  
Mandated Treatment ◽  
Probation Supervision

In this paper, the author presents ethnographic research and analysis of how criminal justice and mental health professionals interact with each other and with criminal defendants with mental illness in running a mental health court (MHC) program. Ethnographic field research included observations of court programs, interviews of professionals, and gathering of textual documents, at nine MHCs in a Midwestern state. In MHC criminal defendants with mental illness participate in a program of regular court appearances, probation supervision, and mandated treatment, rather than being incarcerated in jail or prison. The author utilized the symbolic interaction perspective and examined how the professionals work together to select participants and judge their performances. Professionals interact and share case documents in socially constructing the participant. They operate the program as a filter so that a relatively small number of the population of incarcerated persons with severe mental illness in the state successfully graduate from the program. Implications of these findings are discussed.

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