Colorado Criminal Domestic Violence Cases – The Role of Mental Health Assessment in Colorado Domestic Violence Cases
What follows is from an Article written by and for Colorado Judges on the role of mental illness in Colorado Domestic Violence cases. It is instructive and helpful to understand how to defend these cases through an appropriate inquiry into the reasons why someone may find themselves charged with a Colorado Domestic Violence Crime.
Mental Health Issues In Definitions in Colorado Domestic Violence Cases
In the context of domestic violence offender treatment, mental health assessment refers to the process of assessing an offenders current mental health status and identifying any factors that might directly impact level of risk for future violence or for re-offense. Some mental health conditions (e.g., social anxiety) may also indirectly increase level of risk by interfering with effective involvement in interventions.
Whereas a mental health assessment tends to cover a fairly broad domain, a mental health evaluation refers to a more formal procedure, normally requested by the court or other referral source. This evaluation normally targets a specific clinical question or issue (e.g., capacity to participate in treatment). A mental health evaluation may incorporate various sources of information, including psychological testing, into a written report that details significant findings.
Assessment of Mental Health Disorders in DV Cases
Consideration should be given to whether or not there are contributing factors to the offenders mental health history or to his/her current status that may increase level of risk. Various aspects of an offenders mental health history or current status that should be assessed include, but are not limited to the following:
1. Psychotic disorders (e.g., schizophrenia, schizoaffective disorder, delusional disorder)
2. Mood disorders (e.g., bipolar disorder, major depression)
3. Anxiety disorders (e.g., post-traumatic stress disorder, panic disorder, obsessive compulsive disorder)
4. Personality disorders with anger, impulsivity, and poor behavioral controls personality disorders, or psychopathic/antisocial, borderline, narcissistic, or histrionic personality features).
Personality disorders have also been identified as a risk factor for spousal assault. Further, personality disorders have been associated with increased risk for criminal behavior, including violence and violent recidivism and recidivistic spousal assault.
5. Past neurological trauma and/or current neurological symptoms
When mental health factors are identified in the assessment, a variety of issues should be considered:
1. What is the severity of the mental health condition?
2. Are symptoms current or historical?
3. Have symptoms ever resulted in psychiatric hospitalization?
4. Has an aspect of the mental health disorder (i.e., a delusion or hallucination) motivated or triggered past violence toward others?
5. Has an aspect of the mental disorder (i.e., a delusion or hallucination) motivated or triggered past suicide attempts or threats?
6. To what extent do symptoms disrupt or interfere with aspects of the offenders everyday life? (e.g., work, relationships)
7. Is there a concurrent substance abuse disorder that contributes toward an increase or worsening of symptoms?
8. Is the offender actively compliant with medication management?
The empirical literature suggests a positive correlation between psychosis and past violence and that treated psychosis is associated with a decreased risk for violent recidivism. Psychotic and/or manic symptoms are associated with an increased short-term risk for violence and that these symptoms may be associated specifically with spousal assault
Additionally, certain anxiety disorders may interfere with effective participation in treatment Most, if not all DSM-IV-R Axis I disorders can now be effectively treated with medication, psychotherapy, or both. Therefore, treatment becomes a significant mediating factor in the degree to which the disorder contributes toward ongoing risk of future violence or re-offense. Intervention is likely to be effective, though in some cases long-term treatment is the only effective intervention.
Assessment questions related to mental health treatment may include the following:
1. Is the offender currently in treatment? (e.g., medications, psychotherapy)
2. How long has the offender been in treatment?
3. Is the offender compliant with treatment?
4. Has treatment been effective or helpful?
5. Has the offender been involved in any violent or abusive behavior while in treatment?
6. Are offender symptoms currently being managed?
Measurement of Mental Health Disorders in Colorado Domestic Violence Cases
All approved providers should perform an initial screening or preliminary assessment. When further assessment is needed, the approved provider will perform this if he/she has the appropriate qualifications, or he/she will refer the offender to an approved provider who is qualified.
A variety of psychometric instruments or tests may be useful in assessing an offenders mental health status. Some lengthy instruments, such as the MMPI-2, are restricted in their use based upon clinical training qualifications or specific course work involving a given instrument. Other brief instruments, such as the Beck Depression Inventory, have less specialized training requirements. Such instruments are typically used to supplement or augment collateral information, such as the clinical interview.
A few possible instruments that may be used to assess mental health status include, but are not limited to the following:
1. Minnesota Multiphasic Personality Inventory (MMPI-2)
2. Millon Clinical Multiaxial Inventory (MCMI-3)
3. Personality Assessment Inventory( PAI-2)
4. Mini Mental Status Exam (MMSE)
5. Beck Depression Inventory (BDI-2)
6. Beck Anxiety Inventory (BAI)
Research studies have indicated that domestic violence offenders tend to possess several types of personality clusters when tested utilizing the MCMI-3. The main clusters exhibited by domestic violence offenders include the following:
a) Dependent, which constitutes about 35 percent of the offender population
b) Narcissistic, which constitutes about 50 percent of the offender population
c) Antisocial, which involves a multitude of various associated personality elevations and constitutes about 15 percent of the offender population
Research has suggested that personality disorders are not correlated with risk of re-offense. However, clinical expertise sometimes reveals that offenders with certain personality elevations respond better to treatment when the clinical interventions are presented in a manner consistent with their specific personality.
2. A history of significant central nervous system trauma (e.g., traumatic brain injury, seizures or epilepsy, brain disease) has been identified as other factors that can contribute toward impulsive violence or aggressive behavior. More specifically, frontal and/or temporal lobe dysfunction has been shown to be associated with various types of violent offending.