1 / 8

Involuntary Certification

Scott Woodside, LL.B, MD, FRCPC Centre for Addiction & Mental Health. Involuntary Certification. Involuntary Certification. Outline Factors considered in determining whether to admit or discontinue a Form 1 Risk for violence against self or others Lack of competence to care for oneself.

nonnie
Télécharger la présentation

Involuntary Certification

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Scott Woodside, LL.B, MD, FRCPC Centre for Addiction & Mental Health Involuntary Certification

  2. Involuntary Certification • Outline • Factors considered in determining whether to admit or discontinue a Form 1 • Risk for violence against self or others • Lack of competence to care for oneself

  3. Risk for Violence . . . • Multi-faceted construct • Nature: what kind of violence • Severity: how serious • Frequency: how often • Imminence: how soon • Likelihood: probability of violence occurring

  4. ER Assessment of risk for violence: • Statistical measures best for estimating long-term risk of violence but impractical in ER • Have to rely on clinical indicators of risk in deciding whether to certify or not • Clinicians actually reasonably good at identifying risk of violence over short-term (hours to days)

  5. Indicators of increased risk for violence: (Kaplan & Sadock) • Expressed intent to harm • Presence of a victim • Frequent/open threats • Concrete plan • Access to instruments of violence • Previous history of violence/loss of control • Chronic anger/hostility • Callous/lack of compassion • Views self as victim • Anti-authority • Childhood abuse/deprivation • Early loss of parent • Conduct Hx • Reckless driving

  6. Indicators of risk for violence (HCR-20) – structured approach • Historical Factors (Fixed/Static): • Previous violence (frequency/severity) • Young age (under 20) • Relationship instability (unstable/conflicted intimate R/S) • Employment problems (unstable pattern) • Substance use problems (serious impairment) • Major mental illness • Psychopathy (PCL-R or PCL-SV score) • Early maladjustment (serious conduct problems or victimization) • Personality disorder (any non-psychopathic disorder) • Prior supervision failure

  7. Indicators of risk for violence (HCR-20) cont’d • Clinical Factors (dynamic/current): • Lack of insight (Dx or need for Tx) • Negative attitudes (procriminal/antisocial/ pessimistic/anti-authority) • Active sx of MMI (disturbance of thought, affect, perception) • Impulsivity (Behavioural, cognitive, affective) • Unresponsive to treatment (resistant or refractory) • Especially important re: imminence

  8. Indicators of risk for violence (HCR-20) cont’d • Risk Management Factors (dynamic/future): • Plans lack feasibility (no plans, unsuitable, unrealistic) • Exposure to destabilizers (weapons, substances, victims) • Lack of personal support (personal, emotional) • Noncompliance with remediation (cannot, will not comply with Tx) • Stress (serious psychosocial stressors, fragile)

More Related