Working Effectively with Mental Health Clients
A Methodical Approach To Recognizing Mental Disorders and Cognitive Deficits Presented by: Lyn McRainey, PhD Caryll S. Alpert, AFPD Outline: • Why look for mental disabilities in each client? • What is a mental disability? – Mental illness – Intellectual disability/Cognitive Deficit/Mental Retardation • How do we find mental disabilities, in 3 steps? – Early Indicators – Information Sources – Assessment What are YOUR defense team obligations? “My job is to help you. . .” Why look at every client? • Model Rules Professional Conduct – 1.4(b), 1.14 • Case law – Failure to investigate a mental deficiency can be ineffective assistance • Special role of defense counsel • Odds are good “Imprisonment has become the response of first resort to far too many of the social problems that burden people.” Angela Davis MENTAL LIMITATIONS CAN AFFECT LEGAL STRATEGIES: Competency Juvenile transfers Detention/bond considerations Validity of waivers, voluntariness and other suppression issues • Plea negotiations • Trial considerations/negating intent • Sentencing • • • • DSM‐V • DSM 1952 106 mental disorders • DSM‐II 1968 182 mental disorders • DSM‐III 1980 265 mental disorders • DSM‐IV 1994 297 mental disorders • DSM‐V 315 mental disorders 2013 MENTAL ILLNESS: 1. Maladaptive responses in domain of emotions 2. May respond to therapy and/or medication 3. Can come and go throughout a lifetime INTELLECTUAL DISABILITY/ COGNITIVE DEFICIT/ MENTAL RETARDATION: 1. Deficits in cognitive and adaptive domains 2. Not curable 3. Present before age 18. Lasts a lifetime. Define the issues: • Mental illness • Intellectual/Cognitive disability • Both? STEP ONE: FIND EARLY INDICATORS For each client, consciously and deliberately look for early indicators of mental disability “…an obsession with drugs, delusions of power, paranoid tendencies… still, enough of my problems. What can I do for you?” “This is my ‘depressed stance’” What are some early indicators of mental illness? Some indicators of mental illness: Emotionally charged behavior History of multiple incarcerations Unrealistic view of the situation History of drug or alcohol addiction or abuse History of suicide attempts Multiple out of home placements History of sexual, emotional, or physical abuse Perseveration – can't move from topic to topic History of psychotropic medication What are some early indicators of intellectual disabilities/cognitive deficits/mental retardation? Some indicators of intellectual disabilities/MR: Limited vocabulary Difficulty answering questions Immature behavior Saying what he/she thinks you want to hear Can't describe facts or details History of special education History of dropping out of school Difficulty finding or keeping employment STEP TWO: INFORMATION SOURCES Gather full information about your client CHECKLIST FOR INFORMATION SOURCES: • • • • • • • • Client Interview Family Interview School Records Medical Records Mental Health Records Disability Records Military Records Other sources? CLIENT INTERVIEWS What can you get? School history Medical history Job history Family history Relationship status How do you talk about sensitive issues? Listen to what your client says AND how he says it. Ask the obvious. FAMILY INTERVIEWS: What can you get? Information about pregnancy and birth Family physical and mental health status Developmental sequences Teachers’ impressions Remember, family members may have issues similar to your client. Ask for comparisons. SCHOOL RECORDS • What can you get? – Attendance – Standardized test scores – Teacher comments – Discipline records – Number of moves SCHOOL RECORDS— SPECIAL EDUCATION • What can you get? – Diagnosis – Programs – Annual IEPs • Yearly grade equivalent • Behavior • Strengths and areas of concern • Parental concerns and involvement SCHOOL RECORDS– SPECIAL EDUCATION (con’t) • 13 federal categories of SPED • Eight categories require IQ testing: – – – – – – – – Learning disability Speech/language impairment Health impairment (ADHD) Intellectual disability Emotional disturbance Autism Developmental delay Traumatic brain injury 37% 22% 11% 7% 6% 6% 6% >1% SCHOOL RECORDS– SPECIAL EDUCATION (con’t) • Five categories do not require IQ testing: – Multiple disabilities – Visual impairment – Orthopedic impairment – Hearing impairment – Deaf/blind impairment <1% <1% <1% <1% <1% IQ TESTS Verbal IQ Nonverbal IQ Full Scale IQ or Composite IQ or General Intellectual Ability (GIA) VERBAL IQ What is this called? NONVERBAL IQ Three clients with the same FS IQ of 76: Ted Verbal IQ – 55 Nonverbal IQ – 99 Adam Verbal IQ – 98 Nonverbal IQ – 56 John Nonverbal IQ – 75 Verbal IQ – 78 STEP THREE: ASSESSMENT Review your findings. If appropriate, hire a suitable expert. “Have a seat Kermit. What I’m about to tell you might come as a big shock…” “I’ve always been crazy to keep me from going insane.” Waylon Jennings
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