Dr. Sarah Desmarais | Enhancing Forensic Mental Health Service Outcomes Through Policy: The Potential, the Challenges, and a Call to Action

Many policies in the context of forensic mental health services are designed with the intention of improving outcomes for all. Well-crafted and well-implemented policies can increase the reach and effectiveness of forensic mental health services through expanded service access, improved service delivery, reduced use of unnecessarily restrictive or coercive measures, and increased safety, among other positive outcomes. Unfortunately, policies are not always formulated well or in ways that support achieving positive change, nor are they always adopted and implemented successfully. Drawing from theory, research, and case studies, this presentation will review how institutional and public policies affect individual and community-level outcomes. The presentation will first provide a brief overview of policy types and levels and how policies may enhance mental health and safety outcomes. Then, the presentation will consider contemporary challenges in developing and implementing evidence-informed policy in the forensic mental health context, including recent shifts in the perceptions of science among policymakers. The presentation will conclude with a discussion of strategies to overcome these challenges and a call to action for forensic mental health professionals to engage with policymakers in meaningful ways through research and education.

Sarah L. Desmarais, Ph.D., is President and CEO at Policy Research Associates, Inc. (PRA). PRA is a women-owned small business that is a national leader in behavioral health research, policy, and practice. As President and CEO, she is responsible for the strategic priorities of PRA and oversight of all PRA operations. The firm was founded in 1987 with one research grant and four staff in NY state, but now has approximately 75 staff located across the United States. PRA is funded by Federal and State agencies, national organizations, and foundations to provide technical assistance and training, conduct research and evaluation, and plan and facilitate major conferences and meetings.

Dr. Desmarais completed her graduate training in Forensic Psychology and Law at Simon Fraser University in 2008. She then completed a postdoctoral research fellowship in Population and Public Health at the University of British Columbia. Prior to joining PRA, Dr. Desmarais was a Professor of Psychology and University Faculty Scholar at North Carolina (NC) State University. There, she held leadership positions, serving as Director of the Center for Family and Community Engagement and as Coordinator of the Applied Social and Community Psychology Graduate Program. Before NC State, Dr. Desmarais was an Assistant Professor at the University of South Florida holding joint appointments in the departments of Mental Health Law & Policy and Community & Family Health.

Dr. Desmarais works on issues at the intersection of public health, community safety, and social justice. Her current research is focused on evidence-based practices for reducing detention rates, especially among people with behavioral health needs. Dr. Desmarais has authored more than 140 peer-reviewed publications. She is also co-author of the Short-Term Assessment of Risk and Treatability (START), as well as the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV). Dr. Desmarais has held more than $25 million in grants and contracts to support her work. Her research has been featured in international media outlets such as the Washington Post, HBO’s Last Week Tonight with John Oliver, CBC Radio, and Sky News.

Prof. Dale E. McNiel  | Advances in Assessment and Management of Risk for Violence

Assessment and management of patients’ risk of violence are important issues for mental health professionals, such as psychiatrists, psychologists, social workers, etc. Legal and professional standards have established that mental health professionals are expected to have basic competence in risk assessment for violence. Nevertheless, many practitioners receive limited training in risk assessment. Trainees are often tasked with working with potentially violent patients, and a substantial proportion of them have been the victims of patient aggression. There is a need to establish whether the scientific knowledge base concerning violence can be translated into skills that clinicians can learn.

The first part of this presentation describes research on how structured approaches to violence risk assessment can enhance clinical training of mental health professionals. Topics include the relationship between level of training and accuracy of risk assessment, the impact of training in evidence based risk assessment on clinical skills, and development of objective methods to assess the competency of individual clinicians in risk assessment. The second part of the presentation concerns mental health courts (MHCs), an increasingly widespread intervention for persons with mental disorders in the criminal justice system. Specifically, the potential of MHCs to reduce risk for violence is discussed.

Dale E. McNiel, Ph.D., is Professor Emeritus in the Department of Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco (UCSF) School of Medicine. He is a core faculty member in the UCSF Program in Psychiatry and the Law. He formerly served as Chief Psychologist at Langley Porter Psychiatric Hospital and Clinics at UCSF, and Director of the UCSF Clinical Psychology Training Program. He earned the Ph.D. in clinical psychology at the University of Arizona, and completed a postdoctoral fellowship in the Department of Psychiatry at UCSF. He is Board Certified in both Clinical Neuropsychology and Forensic Psychology by the American Board of Professional Psychology (ABPP). He is a Fellow of the American Psychological Association (Divisions of Clinical Psychology and Psychology and Law), and is a former President of the Section on Clinical Emergencies and Crises in the APA’s Division of Clinical Psychology. His research interests focus primarily on violence and mental disorder, including issues such as assessment and management of risk of violence, mental health courts, family violence and victims of violence, and self-directed violence.

Prof. Seena Fazel | New Evidence in Forensic Mental Health: Implications for Policy and Service Development

Recent evidence on risk assessment tools has shown that most currently used tools perform no better than moderately in adequately sized external validations, do not report key metrics, and were developed using dated and occasionally low quality methods. Prison health research has outlined the importance of addressing primary care and mental health, and drivers of self harm and suicide risk. New meta-analyses and intelligently designed epidemiological studies have shed light on the most effective treatments to prevent violence, including classes of psychotropic medications, and the poorer outcomes of most psychological treatments to prevent recidivism. Together, the new evidence suggests changes to how forensic and prison services assess, treat and manage people under their care, and the need to update and revise clinical guidelines to consider the highest quality and latest research. I will provide an overview of new research on risk assessment, prison and forensic mental health, and treatment for violence prevention, and discuss whether and how it can inform policy and development of healthcare services.

Seena Fazel, BSc (Hons), MBChB, MD, FRCPsych, is a professor of forensic psychiatry at the University of Oxford, where he is also Director of the Centre for Suicide Research and co-lead of the Data Science theme of Oxford Health Biomedical Research Centre. He leads a research group investigating the links between mental illness and adverse outcomes, violence and suicide risk assessment, and prison health. He continues to work clinically as a forensic psychiatrist. Seena is an expert member of the UK government’s Independent Advisory Panel on Deaths in Custody.

Powered by Wild Apricot Membership Software