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I have a masters degree in rehabilitation counseling, which means that I worked with people who had mental health issues created by or exacerbated by physical health issues. For example, I had a family whose father was electrocuted while working in the hospital. Because he was on site, doctors were able to save his life. However, he had a complete personality change and became prone to fits of physically-abusive rage. These were aspects that could not be changed, but the family had to deal with.
When I was practicing, I was a court ordered interventionist for families at risk. My population had at least one family member who was involved in the penal system AND displayed serious mental health concerns in the family including homicidal and/or suicidal ideations, and sexually deviant behaviors, among others.
The following are some things that I think writers might find helpful when constructing their plot lines. I will also offer, that if you have a specific question, you can leave it below, and I will do my best to help.
One of the main things that I want to point out is that clients who are seeing a mental health provider because they want to improve their lives and someone who is court ordered to work with a mental health provider are different.
Clinical:
* There of their own volition
* Generally honest and working hard to make improvements
* Client's privacy is protected under the law
* End goal is to become a better/happier person
Judicial orders:
* There against their will
* Typically uncooperative and uninterested in progress
* Information gleaned in the therapeutic setting does NOT fall under the same
patient confidentiality laws
* Client is aware that the information can/will be part of their trial or other legal
procedure (such as parole hearing)
* Client frequently tries to manipulate the mental health worker to influence their
testimony and outcome.
So, I dealt with a lot of deception. The two main false presentations were malingering and defensiveness.
MALINGERING - the client pretends to have a mental health issue. Usually they do this to avoid being prosecuted. Malingering runs in cycles closely copying those stories that are found in the news. Clients usually didn't make up symptoms by doing research (in my client case load). Psych disorders and medical disorders tend to be fashionable - right now bi-polar is a big diagnosis. I personally know people who have been given this designation and are medicated for it when I am very clear this is not their issue. I am not digressing - I am pointing out that even clinicians, when not paying attention, can fall into this habit as well. But if a client presented with PTSD, I would pay very close attention to their symptoms because PTSD is so prevalent in the news right now.
VIDEO QUICK STUDY (2:50)
AUDIO QUICK STUDY (2:38)
VIDEO QUICK STUDY (2:50)
AUDIO QUICK STUDY (2:38)
How could I pick out a malingerer?
* VERY dramatic. Really pushing the envelope on wacked-out (yes, the clinically
correct word) behaviors. So if your character is malingering, look up the
symptom list in the DSM V (Should be in your library) and then magnify these
behaviors.
* They drop the symptoms from time to time especially if they don't think anyone is
watching. It's hard to maintain fake symptoms for long stretches of time. It's like
constantly telling a lie; the brain is very engaged and becomes tired.
And then just to cloud things a bit, there is pseudo-malingering. That's when someone with a mental health issue pretends to have a different mental health issue because they think that will get them off the hook. Ex. Someone who is a psychopath presenting with PTSD symptoms. The mental health worker has to decide which symptoms are true and which feigned. It's a mess! But would make a GREAT PLOT TWIST!
DEFENSIVENESS - You can read this as the opposite of malingering. It's when a client, with OBVIOUS mental health issues, tries to present as stable. I had a client once who was trying to keep custody of her children. She was diagnosed schizophrenic, was non-compliant with her meds, and suicidal. When she went before the judge, she thought that the best way to keep her children in the home with her was to lie. (She was successful in keeping her six children, and the end result was catastrophic for the kids, I'm sorry to say.)
Now, while I am a counselor, typically the two titles seen in the legal system are:
Forensic Psychologists and Forensic Psychiatrists.
Forensic Psychologists
* Have masters or PhD in psychology
* Can do psych testing
* Can offer expert testimony
* Can provide treatment and evaluation of progress CANNOT prescribe
medications
* Can attempt to establish a motivation in a crime
Was it do to a substance abuse issue?
Was it do to something that had happened to that person in the past?
Was it do to a mental health disorder such as PTSD or Schizophrenia?
Forensic Psychiatrists
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| Regions of the brain affected by PTSD and stress. (Photo credit: Wikipedia) |
* Have medical degrees and residency in
psychiatry
* Can do everything that a psychologist
can do
* Can prescribe medications
* Can decide if the client is a danger to
self and community leading to an
involuntary mental health hospital stay
* Can establish if the crime was based
on a medical issue - one such issue that
is coming up in the news lately are the
brain injuries sustained in football,
and tumors growing on the brain.
Counselors, Psychologists, and Psychiatrists all:
ASSESS - evaluating people using psychological tests
Mental health workers do NOT get to make a judgement. They are only offering their expert opinions. For example, I could not declare someone insane and have someone placed in a medical facility involuntarily. I would present my information and the judge would rule about the sanity/capacity of the client.
Testing is used to help the courts understand the person being assessed
Testing is used to help the courts understand the person being assessed
Test Examples:
General personality inventories Myers-Briggs
Beck Depression Inventory
Rorschache Test Video Link to original test (9:05)
Weschler Memory Scale
Weschler Adult Intelligence Test Video Information Link (13:38)
Robert Hare's Psychopathy Checklist Animated List - Link (2:43)
Rogers Criminal Responsibility Assessment Scales Informational Link
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Psychiatrists can add physical exams:
Blood work
Toxicology reports
Electroencephalograms
Cat Scans
TREAT - psychotherapy like talk therapy, art therapy, music therapy,
behavior modification
TESTIFY
* Civil - family members of custody, guardianship, JD, medical do-not resuscitate,
disability and loss in workers comp cases and social security cases
* Criminal -
Ability to stand trial
Competency
Sentencing
Treatment of incarcerated criminals
One of the things that Forensic Mental Health Workers are trying to decide upon is competency. Someone could have been legally insane at the time of the crime. That does NOT mean that they are insane now. So the assessment looks at what was the mental health capacity in the
* past
* present - what is their mental health standing now?
Can s/he give testimony?
Stand trial?
Can this client understand what is going on?
Can they participate in their defense?
It's during the trial that the judge would decide the level of sanity during the crime. Only about 1% of cases attempts an insanity plea. 1 in 1,000 are considered insane.
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Guilty but Insane:
M'NAGHTEN RULE -
If the defendant did not or could not understand what he or she was doing, or they knew it was wrong, at the time of the crime, they are considered not guilty by reason of insanity.
VIDEO QUICK STUDY (3:33)
* Mens Rea - Guilty mind
VIDEOQUICK STUDY (7:48)
You can't have a crime WITHOUT mens rea and if you are
criminally insane you CANNOT have mens rea and therefore you CANNOT
be guilty
criminally insane you CANNOT have mens rea and therefore you CANNOT
be guilty
* Actus Reus volitional and conscious and/or omission to act. Ones mental
state can effect actus reus.
state can effect actus reus.
Sleep walking disorder
Car accident with stroke
You don't owe the duty to go to someone's aid if they are imperil (unless by
contract/law/or relationship)
contract/law/or relationship)
VIDEO QUICK STUDY (5:25) go to 1:30 to start.
Guilty but Mentally Ill:
After John Hinkley shot at Reagan the courts developed a new designation. Guilty but Mentally Ill happens when the suspect knew what he was doing was wrong BUT could not help or stop the actions because of his mental health status.
Diminished Capacity - you had the intent to commit the crime but had a mental reason for not being held completely responsible. VIDEO QUICK STUDY (:48)
See how this article influenced my plot lines in my novella MINE and my novel CHAOS IS COME AGAIN.
Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.
