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Megan Morse, Community Forensic Mental Health Service: A Day in the Life of a Clinical Nurse Consultant in their Role as Court Liaison Officer
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Megan Morse, Community Forensic Mental Health Service: A Day in the Life of a Clinical Nurse Consultant in their Role as Court Liaison Officer

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Meg Morse, Clinical Nurse Consultant, Court Liaison Officer (Toowoomba), Community Forensic Mental Health Service delivered this presentation at the 2013 National Forensic Nursing conference. The …

Meg Morse, Clinical Nurse Consultant, Court Liaison Officer (Toowoomba), Community Forensic Mental Health Service delivered this presentation at the 2013 National Forensic Nursing conference. The annual event promotes research and leadership for Australia’s forensic nursing community. For more information about the conference and to register, please visit the website: http://www.healthcareconferences.com.au/forensicnursing

Published in: Health & Medicine

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  • 1. Mental Health Court Liaison Service A program of the Queensland Forensic Mental Health Service – Southern and Central Areas Meg Morse Clinical Nurse Consultant Court Liaison Service Forensic Mental Health Toowoomba Mental Health Court Liaison Service Queensland Forensic Mental Health Service Southern and Central Area Health Services
  • 2. QUEENSLAND FORENSIC MENTAL HEALTH SERVICE (QFMHS) MULTIDISCIPLINARY CLINICAL TEAMS COURT LIAISON SERVICE (CLS) PRISON MENTAL HEALTH PROGRAM (PMHS) HIGH SECURITY INPATIENT PROGRAM (HSIS) COMMUNITY FORENSIC OUTREACH PROGRAM (CFOS)
  • 3. Court Liaison Service - Purpose      Timely identification of people with mental illness Facilitate access to assessment & treatment Appropriate advice, referral and treatment Protection and advocacy for vulnerable individuals entering the criminal justice system Provide a point of contact between MHS and the criminal justice system
  • 4. The QLD Mental Health Act 2000       Commenced in 2002 Drafted to reflect contemporary clinical practice and community expectations Forensic Provisions – decisions about criminal responsibility Classified provisions – admission of mentally ill offenders from court or custody Authorised Mental Health Practitioner – appointed by the Director of Mental Health Involuntary Treatment Orders vs voluntary treatment, suspension of court matters
  • 5. Our work environment Left – Cathy in the Courthouse office Above – Meg in Watch house medical office
  • 6. The Watch House - Toowoomba
  • 7. What happens at Toowoomba Court Liaison day to day         7:30am review of prisoners in watch house Liaise with treating teams for clients in custody Referral to appropriate services - DMHS, PMHS, GP Advise on mental health care in watch house Written and verbal feedback to the magistrate, legal representatives and police prosecutions Invoke Mental Health Act if required Participation in the district Forensic Network meetings monthly, plus tele-link for project meeting Court lists checked for all Magistrates courts in the region – 20 other courts, not all operate every day
  • 8. What else does a day entail?      Ensuring magistrate, defence and prosecutions informed of people appearing before the courts on an Involuntary Treatment Order under MHA2000 Provide support and assistance to court staff regarding Justice’s Examination Order applications Liaison with District Mental Health Service staff about voluntary clients/inpatients charged with offences Liaison with legal representatives Presenting information about the court liaison service to other organisations
  • 9. COURT Appearances WH Beds Brisbane (2.1m) 28616 84 Southport (.5m) 19081 40 Townsville (.17m) 13443 46 Cairns (.15m) 9407 35 Maroochydore 6726 19 10600 16 Ipswich 8034 16 Roma 724 ? Caboolture 5059 10 Mackay 4480 22 Toowoomba 6063 22 Beenleigh (.05m) From the Magistrates annual report 2008
  • 10. Who refers people to MH Court Liaison? • Watch House staff (most common) • Magistrates – rare in Toowoomba • Legal representatives (occasionally) • Forensic Medical Officer (not in Toowoomba) • Treating team of District MHS (occasional) • Self-referral The Watch house staff routinely ask certain questions on reception, including • Are you or have you been a patient under the Mental Health Act • Have you had thoughts of self harm or suicide in the past • Do you have a mental or physical illness • Do you require medication for any condition These health screens are made available for the CLO to review in the morning
  • 11. Where do the referrals coming from to CLS? Referral Sources ( in %s) Court related = magistrate or legal rep 11.4 Others = client or their family, DMHS or PMHS CLS generated 5.7 Watch House 51.6 Court related 31.3 Other Watch house CLS generated Toowoomba Referral Sources July 2008 – June 2010
  • 12. What are the provisional or established diagnoses we see? Assessed Disorders ( in %s) No diagnosable illness Substance use disorders Sustances Psychosis Mood d/o Anxiety d/o Personality other 12 Psychotic disorder not unwell 19.5 Z-codes Personality disorder 27.8 4.5 3.7 11.8 Anxiety disorder 20.6 Mood disorder Based on recorded diagnostic outcomes for 374 clients July 2008 to June 2010
  • 13. Who are CLO referrals being made to (July 2008-June 2010): Onward Referrals by CLS percentage 292 42 (12 R&R) 24 10 DMHS A+D 17 67 Other Nil 70 60 50 40 30 20 10 0 PMHS GP This shows the proportion of the 443 clients that received each type of referral
  • 14. What doesn’t the court liaison service do?      Prescribe or administer medication Assume responsibility for care or safety of clients in Watch House Medico-legal reports Advise on legal or bail matters Risk assessments for legal purposes
  • 15. Problems we encounter       Availability of acute beds for Classified patients Availability of high secure beds Referral pathways for 17 year olds and younger Accessing pertinent information regarding client’s past or present treatments – improvements since introduction of CIMHA (QHealth MH Database) Accessing additional services for people with intellectual disabilities – Disability Services QLD Requests from courts and solicitors to give more information regarding capacity to instruct or direction regarding ‘bail undertakings’
  • 16. The Continuity of Care Project ‘Waving the mentally ill inmate away from the prison gate…is simply a recipe for disaster’ The Courier-Mail 19 September 2009
  • 17. The Continuity of Care Project The Queensland Forensic Mental Health Service Continuity of Care project aims to ensure that every voluntary patient of the Prison Mental Health Service who is released from prison through a Magistrate’s Court is engaged in a collaborative discharge plan at the point of release to ensure that the mental health treatment option of their choice is facilitated.
  • 18. Why?    Historically difficult to track consumers moving in and out of the criminal justice system Follow up is difficult to facilitate and consumers do not receive the continuity of care that is required Research indicates the vulnerable time for consumers is the first two weeks post custody (e.g. suicide risk, recidivism)
  • 19. How?    Branches of the Forensic Mental Health Service are collaborating to ensure continuity of care for their ‘in custody’ patients through the magistrate court system Plan of action in the event of discharge and practical ‘default’ position i.e. getting consent and contact details Assessment of the patient at court by CLO’s [even if release not expected]
  • 20. How? [cont]  Using Justice database [QWIC] and other internal mechanisms- next court dates are ascertained  Rudimentary discharge plan and basic decisions about ongoing care are made by PMHS staff and the patient [over 90% of patients are voluntary]
  • 21. Overview of Phone-in patients Jun 2011-Jul 2012: Resolutions (N= 130 / 127 patients) 11 6 34 22 In treatment GP Sentenced Clinical closure Remains Remanded Lost 20 37 For Toowoomba, Warwick, Cunnamulla, Dalby Courts (June 2011-Jul 2012)
  • 22. Points for further consideration re: discharges – initial study 2008-10   92.7% (50 of the 55) of those referred to DMHS attended for their follow up assessment Movement through the criminal justice system is very swift (40.6% did not have the opportunity of ANY mental health doctor consultations whilst in custody) so a ‘default discharge plan’ is invaluable
  • 23. Implications 1. Unpredictable discharges from court are a potent source for the breakdown of treatment continuity of care for this complex and high need population 2. The CCP shows that it is possible to deliver continuity of care for patients at the most unpredictable point in the custodial process 3. Each court appearance for each patient needs to be considered an event worthy of scrutiny 4. Has required intensive ‘individual’ work from all branches of the forensic service
  • 24. Over to you…. QUESTIONS / COMMENTS