Mock Individual Assessment Final Draft

Forensic Mental Health Professional Individual Assessment Report

Course FP6020

IDENTIFYING INFORMATION

Name: Mr. H

Age: 24 years

Sex: Male

Offense: 2nd Degree Murder

Date of Offenses: February 2015

Date of Admission: April 2016

Evaluator: Antoinette Dent

Date of Report: April 13, 2016

Not Guilty By Reason of Insanity Assessment

Introduction

This report was prepared as part of a routine assessment protocol for individuals recently adjudicated Not Guilty by Reason of Insanity (NGRI) and placed in Temporary Custody of the Commissioner of the Department of Behavioral Health and Developmental Services (DBHDS) pursuant to Virginia Code Section 19.2-182.2. The purpose of the report is to evaluate Mr. H’s current psychological functioning, risk factors for aggression, and treatment/risk management recommendations. The strange behaviors could be linked to substance abuse. However, the defendant does not abuse drugs. Proximity could also be traced to impacts of mental health, but Mr. H has never been recorded any circumstance where he suffered from mental health. This makes not guilty because by reason of insanity the most appropriate alternative evaluation for the case. However, this cannot be determined without necessary conducting a thorough investigation and assessment of the defendant since there may be possibilities of other external forces. The evaluation thus offers a rich information background that would provide details about the life of the defendant towards determining the accurate causes of his behavior rather than assumptions. Also, the evaluation seeks to useidentify the proper psychological tests that would be deemed fit for this situation and even determine the appropriate diagnosis. Comment by Tiffany Love Longman: You are referring to the wrong code/referral question. Please see the sample Mental State at the Time of the Offense report I gave you from the ILPPP. Comment by Tiffany Love Longman: This is a lot of information in the introduction…and a lot of the statements you make seem contradictory. Again, please look at the sample I gave you.

Reason for Referral Comment by Tiffany Love Longman: You did not actually define the referral question.

The reason the case has been referred to me is to help with a forensic report that can be trusted towards establishing the truth behind the behavior of Mr. H. The report will provide the basis for overall judgment of the defendant and is what will set him free or prove his guilt. The defendant faces murder charges in which there seems to be dissatisfaction in the sense that his actions that led to the death of the neighbor for whom he is being charged for must have been influenced by an external force. This has not yet been proved and hence the need for my help with the forensic assessment to produce a report that will be used for the final judgment. Comment by Tiffany Love Longman: The judge determines guilt or innocence. Your report is supposed to determine if Mr. H meets the criteria for the insanity defense. Comment by Tiffany Love Longman: What do you mean external force?

I wish to find out various things about the Mr. H during the evaluation. First, I will seek to establish the proper background of the client including the family history concerning cases of mental health, and any other relevant situations to the case such as insanity. There are incidences, in which the client hears a strange voice that commands his actions. This could be associated with mental health problems or insanity. A proper evaluation will, however, reveal the truth of the matter and will rely on the client’s response as well. Also, I will examine the client’s life on substance abuse and the general behavior and attitude. I wish to find out whether Mr. H is temperamental and gets annoyed easily. Weird actions such as the one involving the case have been in the past and even today caused by people who are high-tempered and cannot control their anger. Comment by Tiffany Love Longman: Violence?

The client has an equally significant role during the assessment. He has to be present for the interview questions regarding personal life and that of the family. His behavior, attitude and general response will be observed towards providing more information about the psychological tests that will be necessary for the case.

Presentation Comment by Tiffany Love Longman: This section is supposed to be a mental status exam. Please cut out areas that are not related to that.

The defendant displays a positive behavior throughout the interview. At least, his responses to the

interview questions are sincere. However, he does not answer some of the questions tentatively to the best of my knowledge. A close examination reveals a disturbed mind, and this may be linked to his act of killing the neighbor. Even though the defendant, at first, feels justified by his action or behavior, as the interview continued he begins to feel remorseful and regrets his behavior. This is not the first time Mr. H acts this way since similar behavior had previously been observed when called upon to answer for the charge. These may be attributed to his mental status, in which he seems to be unconscious at certain points during the interview and later regains consciousness. Comment by Tiffany Love Longman: This is contradictory. Comment by Tiffany Love Longman: This is colloquial. You want to use appropriate clinical language. Comment by Tiffany Love Longman: Unconscious? Like passed out? That does not make sense…

Mr. H is cooperative and is more than willing to respond to the questions whenever he is asked about current functioning and his family. However, he appears sad and this all illustrated on his face as well as the manner he gives his responses. He appears devastated and at some point tends to be distracted by what happens in the surrounding. Due to this, it was rather difficult to get his attention towards focusing on the interview. He would concentrate for a maximum of 10 minutes after which he would shift the attention to something else though he would always get back to the interview upon intervening with things he seemed to like such as humor.

The defendant had problems with recall and immediate memory. He would always take longer periods thinking and recollect giving the answers. This also has something to do with the challenges of shorter concentrations. The thought processes as shown by the defendant were not orderly and most of the time he would not give appropriate answers without the second attempt. I realized the need for the second attempt in every question and had to be patient to give more time so that he could think. About the estimation of intelligence and comprehension, the client demonstrated a moderate level of intelligence and seemingly, he was only disturbed by problems of recall and immediate memory.

Poor speech coherence, however, interferes with the client’s reasoning ability and most cases, he tends to get upset by certain questions. The mood swings were evident in his behavior, and this affects some of the responses. When asked about his general take on his act, the client looks remorseful and feels sorry for the death of the neighbor. At some point, he also keeps silent and does not give any answer to the questions.

Current Life Situation

Mr. H currently faces charges of second-degree murder and the investigator has not been convinced about his reaction towards the case. As a matter of fact, the investigator feels he is being manipulated when the defendant only feels remorseful as the interview progresses. It is difficult and not clear to determine whether Mr. H is truly sorry for the offense since he admitted killing the neighbor and is justified with the act because the neighbor had failed to listen to him upon his request to stop playing music loudly. He has to face the charges all alone since the family members including his mother, and the other siblings are not involved in this case. However, family support is accepted regarding company, advice, and other related assistance that the defendant may require until the final judgment is reached.

The client’s perception of the offense keeps on varying as whenever he experiences the mood swings. It is again difficult to judge him from his ever-evolving perception about the offense. This makes it unclear on his stand as far as the offense is concerned and thereby the need for the forensic assessment to establish the truth of the matter. A close evaluation will aid in revealing some of the relevant information concerning his character or behavior that has left the investigator and the family surprised. Since he has never been involved any other murder case apart from this case, leave alone any other minor criminal activity, it will be necessary to go the extra mile to look into his personal life carefully. Again, the forensic assessment will play a critical role in this part.

Currently, the client has shown auditory hallucinations resulting in a lot of stress. The auditory hallucinations, in which he hears the strange voice is one of the primary stressors in the defendant’s life at the moment. He seems disturbed and has no peace. The same voice that he claims had commanded him to commit the crime had been experienced by the client previously. He recalls of an incidence where he had an encounter with the voice while he drove to a grocery one year before the offense. Despite expressing feelings of satisfaction and justification for his act, he sometimes feels remorseful and must be regretting why he killed the man next who lived next door. Comment by Tiffany Love Longman: You don’t want to make assumptions in forensic reports. It should always be based in facts, test findings, and observable behavior.

Background Information

The 24-year old is the first born in a family of three; he has two other siblings, one sister, and a brother. He has been taken care of by the mother after the death of his father two years ago. At his age, many prefer to continue living under their parents’ roof, but Mr. H decided to move out since he wanted to be independent. He has regularly received the mother’s support who has promised to take care of him till he gets some good job since he has just graduated from college. Comment by Tiffany Love Longman: Poor grammar

Psychological History

Psychological history of the client plays a critical role in understanding the strange behavior. The psychological assessment will explore the mind of the client towards exploring what he thinks in reality regardless of the outward appearance. This is necessary so that no wrong conclusion or judgment is made concerning the case. The client has never been treated for a psychological disordercases. However, it is vital to conduct the assessment to reveal or disclose valuable information that can lead to the cause of the act of killing. Psychological assessment will be extended to the family lineage towards determining if there have been similar cases in the family. An indication of the mental problems in the family lineage will give a clue of possible influences of similar experiences on the client and thus the need for the forensic assessment. Comment by Tiffany Love Longman: Colloquial Comment by Tiffany Love Longman: You do not usually see commentary such as this in forensic reports. Please look at the samples. Comment by Tiffany Love Longman: But you are doing a forensic assessment…so it has already ben determined it was needed.

Substance Use History

Comment by Tiffany Love Longman: Too much commentary/opinion. Only state the facts.

Many people of the client’s age (24 years old) tend to involve a lot of drug and substance abuse. The situation has facilitated and promoted a lot of criminal activities and generally immorality in the society. Conducting a forensic assessment of drug and substance abuse is necessary to evaluate the character and behavior of the client. Drugs and substances such as marijuana, cocaine, and alcohol, alcohol are assessed in this case. The use of such drugs is evaluated based on the client’s experiences of hallucinations. However, the forensic assessment reveals no history of drug and substance in the life of the client or the family.

Since the client has no records of substance and drug abuse, it is of no use assessing the other details of drug abuse including frequency of present use, what sustains it, how it began, and periods of sobriety, previous attempts, and number of relapses. However, it will be relevant to conduct deeper forensic assessment on the family history concerning drug and substance abuse. This would be substantial in relating the act and behavior of the client to previous cases of drug abuse in the family that could be having links to the current situation of the Mr. H. Comment by Tiffany Love Longman: You need to discuss his substance abuse history. If that information is not available in the vignette, make it up. The assignment is assuming that you have done a clinical interview with the client, which would include asking him about substance abuse. Comment by Tiffany Love Longman: You are commenting on what you plan to do, but that is not the intention of the assignment. You are supposed to report on the information you obtained in your assessment, which would have included interviewing the client and collateral sources (e.g., family).

Medical History

Medical history is another area that will offer assistance in establishing the cause of the strange behavior. Here, mental disorders including schizophrenia, organic brain syndromes, bipolar disorder, and psychotic disorders. An evaluation for bipolar disorder is necessary for this case as the client experiences mood swings and depression. The elevated mood plays a critical role and is referred to as hypomania or mania depending on the severity of the condition. This might have connections with the manner in which the client reacts to different situations surrounding him. On the other hand, forensic evaluations on organic brain syndrome will help in matching the possible impaired function as shown by the client with the possible similar conditions in the family. Client’s behavior is perceived to be abnormal since he has never been involved in such cases. Therefore, evaluations on schizophrenia will be helpful in establishing whether the defendant has any problems with understanding reality and social behavior. One symptom that would support this forensic assessment would be the weird happenings, in which the character hears voices that command him. About the psychotic disorders, forensic assessment on the family history will help in establishing any problems with the client’s mind and try to relate it to the possible similar conditions in the family lineage. The client has never? been diagnosed with any of these mental disorders and hence has never received any treatments on the same. However, evaluating the medical history of the family will be critical towards finding similar or related conditions that match the client’s current situation. Comment by Tiffany Love Longman: I’m not sure why this sentence is here. Comment by Tiffany Love Longman: Comment on his mental health history. If you don’t have that information make it up. Comment by Tiffany Love Longman: Colloquial Comment by Tiffany Love Longman: Just describe the families medical history.

Objective Testing

Objective testing is crucial to decision making in forensic assessment. Objective tests are deemed for fit for this case since they encourage the use of restricted response formats including those that allow ordinal scale rating or false or correct answers. The approach helps in obtaining information from the reports of the forensic evaluation containing the different tests that aid with the proper legal decisions or judgments. The assessment employs different tests that are discussed below.

Minnesota Multiphasic Personality Inventory, 2nd edition (MMPI-2) Comment by Tiffany Love Longman: In these sections you are supposed to make up hypothetical test findings that you think will fit your case. And then proceed to describe what these findings mean in reference to the client.

MMPI-2 is widely researched and used the standardized psychometric test in addressing adult psychopathology and personality. MMPI-2 is useful in the assessment in the development of treatment plans for the client. Also, the test assists with different diagnosis and help in answering legal questions concerning the forensic assessment and the case. Other uses of the test include screening job candidates and in therapeutic assessment procedures. MMPI-2 suits adults who are 18 years and above and thus the test is favorable for this case. It involves 567 items that are suitable for achievement and IQ tests. Comment by Tiffany Love Longman: This is not relevant to this report. Comment by Tiffany Love Longman: The MMPI-2 is a personality test. Im not sure why you are referring to cognitive or achievement tests?

Comment by Tiffany Love Longman: The MCMI and MMPI are both personality measures. You should choose one of the two. There is no need for both of them.

Million Clinical Multiaxial Inventory-4th edition (MCMI-IV)

The psychological assessment tool provides information on psychopathology such as on the specific psychiatric disorders as outlined in DSM-5. MCMI-IV is equally meant for persons above 18 years and comfortably suits the forensic assessment concerning Mr. H. The test is particularly intended for psychiatric patients or clients and should not be used on the general adolescents or populations. The test is also based on theory, and its organizations or structure takes the multiaxial format. MCMI-IV is modeled to include four scales including 15 for personality disorder, 10 for the clinical syndrome, 5 for validity and 45 for personality facet.

Beck Depression Inventory

The test comprises of 21 questions with multiple choices for self-report inventory and plays critical role in measuring the depression level. The test measures the two components of depression including somatic component and a physical component such as loss of appetite and mood respectively.

WeschlerWechsler Adult Intelligence Scales, 4th Edition (WAIS 4) Comment by Tiffany Love Longman: Do you need to administer this test in order to determine if Mr. H meets the criteria for NGRI? Another test to consider is the RCRAS, which is related to the sanity defense.

The test aims at measuring the cognitive ability in both older adolescents and adults. It comprises of ten core subtests as well as five supplemental subtests. It includes index scores for similarities and matrix reasoning, and vocabulary and information. It helps in measuring the cognitive abilities that appear less vulnerable to the processing and impairments, as well as the working memory.

Diagnostic Impressions

Findings

The client does not resist and admits he killed the neighbor. Though he tends to justify his act, he feels sorry at some point. Also, the killing must have been triggered by an abnormal experience in his life that had once appeared to him. The other negative features including mood swings, depression, problems with memory, and anger could be linked to the influence of the external force in client’s life.

Comment by Tiffany Love Longman: You are supposed to list the diagnosis or diagnoses you think the client meets criteria for according to the DSM-5

Diagnostic Impressions

A restructured scale is used for its overlapping items and interscale correlation. Comment by Tiffany Love Longman: I am not sure what you are referring to here?

The possible results are interpreted as shown below:

RCd abbreviated as dem and is all about democratization measures distress that is associated with depression, hopelessness, anxiety, and low self-esteem.

RC1 abbreviated as som addresses somatic complaints and measures the client’s tendency to experience physical symptoms that are medically unexplainable.

RC2 abbreviated as Ipe addresses low positive emotions and measures the client’s link to anhedonia (a common feature of depression)

RC3 (cyn) and addresses cynicism, in which the client’s anger, hostility and impaired interpersonal relationship.

RC4 (asb) and addresses client’s antisocial behavior including deceit, impulsivity, and social norms.

RC6 (per) addresses ideas of persecution including paranoid delusions, mistrust, and interpersonal suspiciousness.

RC7 (dne), addresses dysfunctional negative emotions including anxiety, feelings of resentful and victimization, fear or worry.

RC8 (abx), addresses the aberrant experiences including unusual perception and thinking and risk for psychosis.

RC9 (hpm), addresses hypomanic activation including the client’s excitability and aggression.

Conclusion Comment by Tiffany Love Longman: You conclusion section is supposed to include your opinion, based on the facts of the case, regarding whether Mr. H meets the criteria for NGRI. Please choose a standard, like the VA standard, Federal or ALI (see the powerpoint presentation) and discuss whether he meets each of the required sections.

The client generally shows resentful feelings, he is disturbed with mood swings, depressed, and has impaired interpersonal relationships. These are coherent with the scores on the restructured scale including RC7, RC8, RC6, RC1, and RC 2. These features are not much different with the personal observation, in which the client feels remorseful and has elevated moods. The findings directly matches and are linked to the referral questions including the family history of drug and substance abuse, mental health problems, and the general behavior.

Recommendations

The client does not resist the interview questions and instead cooperates during the whole process. He should not be convicted of murder since he does not seem to recognize his action at the time of killing as a wrong act. Otherwise, he would have tried to resist. What the client requires is mental check up to establish the status of his mind. He has never abused drugs, and there is no possible link to the killing. The purpose of the forensic assessment is to determine the client’ stand or position as far as the trial is concerned. Mr. is disturbed even during the interview with little concentration together with elevated moods. He requires proper medical including proper psychopathology assessment to help improve his memory and mind status before it is late. Comment by Tiffany Love Longman: I am not sure what this sentence means. Comment by Tiffany Love Longman: Colloquial Comment by Tiffany Love Longman: This also does not make sense.

Respectfully,

Antoinette Dent April 13, 2016

References

McMurran, M., Khalifa, N., & Gibbon, S. (2013). Forensic mental health. Routledge.

Heilbrun, K., DeMatteo, D., Holliday, S. B., & LaDuke, C. (Eds.). (2014).Forensic mental health

assessment: A casebook. Oxford University Press (UK).

Sörman, K., Edens, J. F., Smith, S. T., Svensson, O., Howner, K., Kristiansson, M., & Fischer, H.

(2014). Forensic mental health professionals’ perceptions of psychopathy: A prototypicality analysis of the Comprehensive Assessment of Psychopathic Personality in Sweden. Law and human behavior, 38(5), 405.