Fiona Black,The Park Centre for Mental Health: Effective and Strategic Mental Health Programs


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Dr Fiona Black, Clinical Psychologist High Security Inpatient Service, The Park Centre for Mental Health delivered this presentation at the 2013 Social Determinants of Health conference. The conference brought together health, social services and public policy organisations to discuss how social determinants affect the health of the nation and to consider how policy decisions can be targeted to reduce health inequities. The agenda facilitated much needed discussion on new approaches to manage social determinants of health and bridge the gap in health between the socially disadvantaged and the broader Australian population. For more information about the event, please visit the conference website:

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Fiona Black,The Park Centre for Mental Health: Effective and Strategic Mental Health Programs

  1. 1. Social Correlates in Forensic Mental Health Dr. Carrick Anderson Psychiatric Registrar Dr. Fiona Black Clinical Psychologist Social Determinants of Health Conference – Sydney – December 2013
  2. 2. Outline  Health  Mental health  Forensic mental health  Forensic mental health in Queensland  Queensland’s forensic psychiatric hospital  Case example  Treating illness and managing risk  Treatment vs intervention vs prevention  Future directions
  3. 3. Health / Mental Health  “A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. World Health Organization December 2013  AH&MRC definition of health: “not just the physical wellbeing of an individual, but refers to the social, emotional, and cultural wellbeing of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their Community. It is a whole of life view and includes the cyclical concept of life-death-life”. National Aboriginal Health Strategy 1989
  4. 4. Mental Health  The 2007 National Survey of Mental Health and Wellbeing estimates that almost half of Australians aged 16-85 experienced a mental disorder over their lifetime.  Each year 1 in 5 Australians in this age range are estimated to experience symptoms of a mental disorder  The Australian Bureau of Statistics causes of deaths 2011 – 6 suicides per day. This may be underreported. Men are four times more likely to die by suicide than women. Australian Indigenous people are 2.5 to 3 times more likely to die by suicide than others. There are 180 suicide attempts per day.
  5. 5. Mental Health  Global burden of disease attributable to mental and substance abuse disorders: findings from the Global Burden of Disease Study 2010 published in Lancet 2013.  Premature mortality as Years of Life Lost (YLL) from cause of death estimates for 1980-2010 from 187 countries was calculated. Years Lived with Disability was calculated. Disabilityadjusted life years (DALYs) were derived from the sum of YLDs and YLLs.  Findings were mental and substance use disorders accounted for 7.4% of all DALYs worldwide. They were the leading cause of YLDs worldwide. Depressive disorders accounted for 40%, anxiety disorders 15%, combined drug and alcohol use disorders 20%, and schizophrenia for 7%. The highest proportion of DALYs occurred in people aged between 10 and 29 years.  In view of the magnitude of their contribution, improvement in population health is only possible if countries make the prevention and treatment of mental and substance use disorders a priority.
  6. 6. Mental Health  Estimating treatment rates for mental disorders in Australia  Untreated mental disorders incur major economic costs and personal suffering.  The percentage of Australians with a mental disorder who received treatment for that disorder each year between 200607 and 2009-10  The estimated treatment rate increased from 37% to 46% oer that time – this was attributed to the introduction of the Better Access programme.
  7. 7. Mental Health (continued)  Lots of factors mentioned in relation to physical health that are exacerbated in and complicated by mental illness                 Distance (statewide services) Income (public vs private) Education (onset of mental illness) Indigenous disparity Accommodation and homelessness Unemployment Loss of hope/fear of failure Smoking Other substance use Obesity Jurisdictional division Transport Communication/language/health literacy Gambling Acquired Brain Injury Religious/spiritual factors
  8. 8. Mental Illness  Social factors that contribute to development of mental illness  Early development critical  Vulnerability  Abuse and neglect  Social factors that perpetuate mental illness  Stigma, access to services  Social factors that contribute to recovery/rehabilitation  Housing  Famly, social, intimiate relationships  Best outcomes:     Least comorbidity Early intervention Good response to medication Multidisciplinary work
  9. 9. Forensic Mental Health  Even further complicated by offending behaviour which in itself is a multifactorial social problem.  Patients in forensic mental health often have complicated comorbidities:     Mental illness Personality disorder Acquired brain injury / intellectual impairment Substance use
  10. 10. Forensic Mental Health in Queensland  Court Liaison Service (CLS)  Prison Mental Health Service (PMHS)  High Security Inpatient Service (HSIS)  Community Forensic Mental Health Service (CFOS)
  11. 11. Queensland’s Forensic Psychiatric Hospital  Classified patients  Prisoners – serious violent offences  Hospitalised for assessment and treatment  Forensic patients  Found of unsound mind in relation to serious violent offence  Hospitalised for treatment rather than going through criminal justice system  Gain leave through Mental Health Review Tribunals
  12. 12. Queensland’s Forensic Psychiatric Hospital (continued)  General passage through Queensland’s forensic psychiatric hospital  Admission, stabilisation of mental illness  Addressing problematic behaviour  Engagement in psychotherapy, occupational therapy  Social work – family and community engagement  Community access, rehabilitation focus
  13. 13. Treating Illness and Managing Risk  What are Patient A’s health needs?  What are Patient A’s forensic needs?  Forensic mental health – dual role  One and the same?  Social correlates of health equate with risk factors for violent behaviour
  14. 14. HCR-20 (Webster, Douglas, Eaves & Hart, 1997)  H1 Previous Violence  H2 Young Age at First Violent Incident  H3 Relationship Instability  H4 Employment Problems  H5 Substance Misuse Problems  H6 Major Mental Illness  H7 Psychopathy  H8 Early Maladjustment  H9 Personality Disorder  H10 Prior Supervision Failure  C1 Lack of Insight  C2 Negative Attitudes  C3 Active Symptoms of Major Mental Illness  C4 Impulsivity  C5 Unresponsive to Treatment  R1 Plans Lack Feasibility  R2 Exposure to Destabilisers  R3 Lack of Personal Support  R4 Non-compliance with Remediation Attempts  R5 Stress
  15. 15. Treatment / Intervention (Prevention)  For Patient A, a lot of his treatment needs are also the areas that require intervention to ameliorate or manage risk  If we had had the opportunity, these would have been the same areas for early intervention
  16. 16. Future Directions  Clinicians to be aware of broader policies and drivers within health – work to a common vision (nationally)  Increase profile of mental health  Holistic approach to health – physical, mental, social, spiritual  Importance of inter-agency relationships  Importance of research and evidence based practice  Early community action can prevent even high security hospitalisation  Contact details: