Special Needs in Forensic Mental Health - Women - Essay Example

Special Needs in Forensic Mental Health -- Women Overview of Case Study Sue is a 28 year old female who is accused of sex offences against one of her children. She is currently residing in a female prison. Sue also is reported to have problems with drugs and alcohol, she has problems with interpersonal relationships and she has anti-social behaviour. She was given an IQ test that said she was at the borderline range of intellectual functioning. She has been sexually molested when she was a child and currently she is attempting to express her feelings and is able to at least talk about the people around her. Overview of Critical Issues Sue is a young woman who has several issues that present her as a possible threat to society, which is why she is incarcerated. It is interesting that the social worker sees her as "innocent" and that she feels that the drug and alcohol abuse has contributed to her being able to interact with her children. Although this may be true, there is another issue that should be addressed that include her fear of abandonment and anti-social behaviour. This behaviour, along with her ambivalence towards her children could be an indication of an attachment injury that she received during the sexual abuse. Sue would not have been able to attach well to her parents because her father was bipolar and her mother suffered from chronic depression. Her parents history of mental illness would also mean that her parents were unable to bond with her or take care of even her basic needs. From the case study, the counsellor cannot ascertain whether Sue is mentally ill or whether the drugs and alcohol are responsible for her behaviour. She may be mentally impaired since her IQ results are within "borderline range of intellectual functioning," She could have mental retardation either intellectually or environmentally. How Sues Critical Issues Impact Women Sue was raised by a depressed mother and a bipolar father. This indicates that her needs probably were not met as a child and that her home life was very erratic, so attachment may have happened but not in a very positive way. According to Sorbello, Eccleston, Ward & Jones (2002), female offenders who have been abused or neglected have a "higher rate of psychological dysfunction than men" (p. 200). For Sue, this is shown through her need for alcohol and drugs. Although the case study does not specifically comment on whether Sue is bipolar or suffering from depression, her drug and alcohol problems could be triggered by episodes of depression. This would be something that the mental health practitioner should examine. Because Sue was sexually abused as a child, this issue must be addressed at some point. This issue is true for many women who are incarcerated and it is a larger issue for women then for men (Sorbello et al, 2002). In fact, 85% of incarcerated women have been sexually abused as opposed to 25% to 40% in the general female population. De Zulueta further states that "People with childhood histories of trauma make up almost the entire criminal justice population of the USA" (p. 4). Sues anti-social behaviour could be related to her alcoholism and drug use or it could be related to lack of attachment with her caregivers. There is a body of research that has been done in this area to show that attachment is very important to women and that it affects their behaviour. As an example, de Zulueta stats that children who are abused have developed insecure attachments because they did not have a "mental representation of a responsive caregiver in times of need" (p. 4). This would be true in Sues case because of the history of mental illness in her primary caregivers. In these cases, the children find other ways to access the caregiver and choose strategies for survival. One strategy they find is called disorganized attachment behaviour. The children react to their environment as though they have Post Traumatic Stress Disorder (PTSD). These women have difficulty dealing with long separations away from their parents and often "seem to freeze in trance-like states" (p. 6) because they are frightened by the caregivers return. As adults, this behaviour has often been ob served in women as certain triggers can move them back into this type of behaviour: "The terrifying or terrified behaviour of these caregivers leaves their infants in a state of fear without solution since the secure base is represented by the attachment figure has become the source of terry" (Main And Hesse, 1992, as quoted in de Zulueta, 2006, p. 6). Because Sues family has a history of mental illness and Sue was sexually abused, attachment theory may bring another opportunity for Sue to delve deeper into her healing. Anti-social behaviour can also be a result of lack of early attachment. Rich (2006) observed that in recent years, attachment theory has been used to show that an individuals sense of connection to other people and then to the society "has a powerful … influence on the development and exercise of antisocial and criminal behaviour" (p. 16). He also points out that "Early attachment experiences" (p. 16) can be a risk factor for later anti-social behaviour, and they can set in motion the path to criminality. Golder, Gillmore, Spieker and Morrison (2005), studied whether attachment theory was helpful for a t risk women who abused drugs and alcohol, but who also had children. The results of their study showed that attachment theory was helpful for these women, particularly when they had given birth as adolescents. They found that women with insecure attachments "Were more likely to engage in risky behaviour" (p. 188) than women who were securely attached. These studies support the use of attachment theory in work with Sue. Sue showed ambivalence towards the idea of visitation with her children. Women who are incarcerated have difficulty with understanding how their children will be cared for when they are incarcerated. Because Sue is accused of sexually abusing her child, she may fear never seeing them again. This may mean that she needs to withdraw from them in order to survive her incarceration. This may mean there is a need for parenting skills and for Sue to understand more about children in general. Implementation of Strategies Many times women who are incarcerated have mental health issues. The research supports various strategies to help them deal with specific issues. To this researcher, specific strategies are important to help these women live more fully whether they are in prison for a long or short term. There are many studies that support using strategies. Ferszt and Erickson-Owens (2008) studied women who were pregnant in prison. An estimated 6-10% of women who enter prison are pregnant. Unfortunately, these women usually do not receive the prenatal assistance they need. Many spend six months to a year in prison after they have their children, but it is important to note that many stay longer. The researchers found that these women also had educational needs that were unmet. These researchers created a pilot group of nine women and taught them about labour, delivery and other topics relevant to having children. They provided six, one and a half hour sessions. The goals for the group included: 1. "To improve the physical and psychosocial well-being of pregnant incarcerated women through education and support" (Ferszt and Erickson-Owens, p. 57). 2. To provide an environment where the women could discuss specific issues with professionals without fear. 3. To help women develop a network together so they would have support after the program. The women were also asked for topics they were interested in for more information and these topics were used in the first few weeks. Halfway through the program, they found that the meetings had to be less structured and more fluid, so they made this adjustment. The results of this group showed that the women were able to gain the knowledge they needed, and many stayed after they had their children, which gave the researchers more information to gear some of the classes towards parenting skills. There were many challenges for Ferszt and Erickson-Owens when they began the program and they suggest that it is important when creating programs in prisons that certain factors are addressed. As an example, having the wardens approval is very important as a first step. Also, a good relationship with correctional staff and other people within the profession so that a clear reporting mechanism can be established so that any problems that occur can be addressed immediately. The idea of parenting classes would be very important for Sue and women who are incarcerated. Although they must do time for their crimes, there are many needs that may not be met unless the prison offers the type of assistance that is needed. Hills (2004) points out that there is an "Ever increasing presence of women in the criminal justice system" (p. 1) and many are able to be diverted into a diversion court or mental health court. There are many issues that women who are in these programs must have addressed when they are moving through the process. There are challenges with "Gender specific, and trauma specific" (Hills, p. 1) issues that must be taken into consideration. Hills also states that 12.2% of women who enter jail have "serious mental illness" (p. 2), and 72% "present a co-occurring substance use disorder" (p. 2); many are mothers with several children. These investigations that have been done show that women who have mental illness, the co-occurrence is usually a part of their situation. Mental illness, major depression, bipolar disorder and substance abuse usually are synonymous for women who are incarcerated according to Hills. Hills also suggests that there are several negative outcomes for women with mental illness who have co-occurring disorders but did not receive treatment for these disorders. Some of these negative outcomes include: 1. An increased risk of relapse or rehospitalisation. 2. Greater risk of depression and/or suicide ideology 3. Increased psychotic symptoms. 4. Inability to manager their daily needs and/or their finances. 5. They often stopped taking their medication or stopped other treatments. 6. Increased risky behaviour and vulnerability towards HIV infection (Hills, 2004). This information suggested that an integrated mental health model should be used in these situations that addressed both the mental illness and the substance abuse. Some of the issues that have been shown as needs include frequent involvement in destructive relationships because of physical and sexual trauma, inadequate health care systems, and issues with children. If these issues are not addressed, "they will distract her from focusing on necessary cognitive and behavioural changes that will help her achieve symptom stabilization" (Hills, p. 6). In Sues case, as stated previously, her major issues must be addressed so that she will be able to become a more fully functioning member of society. Special Needs of Women in Criminal Justice Systems From the time that a woman enters the criminal justice system, the differences for her are different than the experience for men. There are several issues that need to be addressed before women come to the justice system that can create problems for them. As an example, many women are poor and uneducated when they enter the system. Because of this, many are unable to post their bail. Many women are disadvantaged "due to their overall lower socioeconomic status" (Covington and Bloom, 2003, p. 8). Many are also unemployed, which puts them at a disadvantage that is larger than for men. Covington and Bloom suggest that "the war on drugs became a war on women" (p. 8) because the prisons are largely filled with women who have substance abuse problems. This being said, African-American women have been affected more by drug abuse convictions than men in general. The majority of women who are incarcerated have two children on the average and they are usually the custodial parent at the time of their incarceration (Covington and Bloom, 203). There is a need to focus more on community programs that help women prevent the situations that stop them from committing crimes. These programs also need to help women meet their needs that, when unmet, put them at risk for committing crimes. These needs include "housing, physical and psychological safety, education, job training and opportunities, community based substance abuse treatment, economic support, positive female role models and a community response to violence against women" (Covington and Bloom, p. 14). There is no doubt that if Sue had received assistance from her community in helping with parenting skills and with substance abuse, that her life may have been different. Andrews and Banta (2003) further clarify the need for attachment work, especially when looking at delinquency or anti-social behaviour. They identify the factors of poor parenting skills and child abuse as two factors that can alter attachment between the caregiver and child. They suggest that the reasons identification with apparent is necessary is because it helps the learning process, especially when parents are "emotionally warm and fair disciplinarians" (p. 207). In this type of environment, a child also learns to internalize values and behaviours from their parents. These researchers acknowledge that as children become adolescents, their attachments will change from the parent-child bond to bonds with other adults and they make bonds in the general society. However, there is a point during this time where there are no other attachments being made and neither old nor new attachments are functioning fully. During this time, controls are also loosened for the child and some experts hypothesize that this is the time when delinquency may occur (Andrews and Bonta, 2003). Current Service Provisions for Women Although it can be said that women who suffer from mental illness should have intervention in many areas, the fact is that they do not always receive what they need. Bartlett and Kesteven (2010) studied various forms of care for mentally disordered individuals and they found that many organizations did not have the manpower to work effectively with this population. In many organizations, staff do not have the skills to work with individuals who are mentally disordered or there is a delay in the transfer of these offenders to mental health facilities. In some situations, especially for those on probation, there was a lack of clinical expertise in the staff. According to Bartlett and Kesteven, these issues have created a difficult position for the medical personnel involved. Bartlett (2010) points out that men and women are different in how they offend and in the way in which they do crime. However, because the criminal justice system is set up for men and run by a majority of male leaders, it is difficult to present the needs that are specific to women. Bartlett acknowledges that women have special needs that are different from those of men. She recommends designing programs that are specific to women that address PTSD, and that help prison staff understand the different needs for women and that these needs are different from men and should be treated differently. Bartlett also suggested that women should not be in prison, but they should be treated through community programs or community diversion programs that are geared more toward their needs. Hicks (2004) studied the effects of ethnicity, race and culture on the needs of women in forensic mental health. This research suggested that the factors that involve race, culture and ethnicity were important to take into consideration when working with ethnic populations. The reason this is important is because "individuals from ethnic minorities may present with different signs and symptoms of psychiatric illness or with different ways of communicating their distress" (p. 23). This information is important when dealing with women who are incarcerated because a large majority of them are minorities. Through this research, it is clear that women are a special population that needs to be treated differently then men. Conclusion When looking at Sues case, there are a variety of issues that must be addressed that are common to all women who are incarcerated. A large majority of them have mental health issues along with drug and alcohol abuse, symptoms of PTSD, attachment challenges and depression. These challenges must be addressed if the individual is going to have a full life whether they are in prison for a short or long term. Most women have children to take into consideration along with a variety of other issues that were part of what brought them to the criminal justice system. It is important for mental health practitioners to be able to understand this information so they can more effectively work with women. References Andrews, D.A. and Bontak J. (2003). The psychology of criminal conduct. OH: Anderson Publishing. Bartlett, A. (2010). "Gender, crime and violence in forensic mental health" in Bartlett, A., and McGauley, G. (2010) Forensic mental health: Concepts, systems and practice. NY: Oxford University Press. 54-65. Barlett, A. and McGauley, G. (Eds). (2010). Forensic mental health: Concepts, systems and practice. NY: Oxford University Press. Bartlett, A. and Kestevens, S. (2010). "Current service provision for mentally disordered offenders" in Bartlett, A. and McGauley,G. (2010). Forensic mental health: Concepts, systems and practice. 351-358. Covington, S.S. and Bloom, B.E. (2003). "Gendered justice: Women in the criminal justice system" in Gendered Justice: Addressing female offenders. 3-24. De Zulueta, F. (2006). Inducing traumatic attachment in adults with a history of child abuse: Forensic applications. The British Journal of Forensic Practice. 8 (3), 4- 15. Retrieved April 4, 2010 from psycINFO (AN:2006-12915-002. Ferszt, G.G. and Erickson-Owens, D.A. (2008). Development of an educational/support group for pregnant women in prison. Journal of Forensic Nursing [J Forensic nurs]. 4 (2) 55-60. Retrieved March 31, 2010 from Medline database (AN: 18522603). Golder, S., Gilmore, M.R., Spieker, S., and Morrison, D. (2005). Substance use, related problem behaviours and adult attachment in a sample of high risk older adolescent women. Journal of Child & Family Studies. 14 (2), 181-193. doi: 10.1007/s10826-005- 5046-6 Hicks, J.W. (2004"). Ethnicity, race and forensic psychiatry: Are we color blind? Retrieved April 2, 2010 from http://Beloit.edu/~newb/fall2009/ hicks%20race%20based%20ptsd.pdf Hills, H. (2004). The special needs of women with co-occurring disorders diverted from the criminal justice system. The National Gains Centre for People with Co- occurring Disorders in contact with the Justice System and TAPA Centre for Jail Diversion. Retrieved April 2, 2010 from http://www.gainscenter.samsha.gov /pdfs/courts/WomeAndSpects.pdf Rich, P. (2006). From theory to practice: The application of attachment theory to assessment and treatment in forensic mental health services. Criminal Behaviour & Mental Health, 16 (4), 211-216. doi: 10.1002/cbm.629 Sorbello, L., Eccleston, L., Ward, T. & Jones, R. (i2002). Treatment needs of female offenders: A review. Australian Psychologist. 37 (3). 198-205. Read More