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Mock Forensic Individual Assessment

Case Vignette 1
An intoxicated, forty-six-year-old, Caucasian woman refuses a plea bargain and a defense counsel brining her to trial for a burglary arrest.  The woman denies the charge even though she was in possession of the neighbor’s property.   Initial interactions with police proved assaultive and she appeared to be in denial of the charges which caused her to counteract while in the jail, creating a rally protest with other inmates.  Her paranoid state increased as the police contacted her only living relative, her brother.  Her brother disclosed Ms. G is the product of a broken home and foster care system, but received no mental health treatment in the past.  Ms. G confirmed she has not received mental health treatment in the past, but refused to disclose the remainder of her personal history (Argosy University, 2013).

Argosy University

Forensic Mental Health Professional Individual Assessment Report

Course FP6020 
Name: Ms. G

Individual Assessment:

Competency to Stand Trial
Introduction 

Ms.  G is being evaluated for prove or disprove her competency to stand trial.  Ms.  G has refused public counsel and a plea bargain. She suffers from paranoid delusions that can affect her understanding of the charges brought against her.  She denies any wrongdoing despite having the neighbors stolen property in her possession.  At the time of arrest, she was intoxicated and in possession of drugs and elicited a dysphoric affect.

Reason for Referral :

Client, Ms.  G was referred for evaluation to establish her competency to stand trial.  Ms. G appeared to be intoxicated, confused, combative, and irrational causing officers to use the highest levels of constraints.  Her behavior elicited a paranoid delusional state in which she claimed to have access to higher authority over the officers (American Psychiatric Association, 2013).  Incarceration likely heightened the paranoid delusions and caused her to become fearful that officers were trying to kill her brother.  In response to delusions, she rallied inmates and created a protest and hunger strike.    Observation concluded Ms. G was confused, hyperactive, and irrationalized the charges.  Adamant she did not steal the neighbor’s property, she refused counsel representation and a plea bargain leading her to trial indicating she was disoriented at the time arrest.  Unable to engage in conversation, Ms. G was uncooperative and refused to divulge personal information and appeared with a dysphoric affect.  Her thought process and content appeared abnormal as she maintained innocence and a paranoid thought process despite being caught with the property.

Presentation 

At the time of arrest, officers reported Ms. G to be intoxicated, confused, combative, and irrational causing the use of the highest levels of constraints.  Her behavior elicited a paranoid delusional state in which she claimed to have access to higher authority over the officers (American Psychiatric Association, 2013).  Incarceration heightened the paranoid delusions and caused her to become fearful that officers were trying to kill her brother.  In response to delusions, she rallied inmates and created a protest and hunger strike.  Officer observations concluded Ms. G was confused, hyperactive, and irrationalized the charges.  Adamant she did not steal the neighbor’s property, she refused counsel representation and a plea bargain leading her to trial indicating she was disoriented at the time arrest.  

At the time of the MSE, Ms.  G was unable to engage in conversation, uncooperative, refused to divulge personal information and appeared with a dysphoric affect.  She reported with hostile responses which elevated when asked about arrest behavior and items in her possession.  Ms.  G’s mood was perceived as annoyed and aggressive as she was perceived to continuously shake her leg and roll her eyes.  Little eye contact was held with Ms. G as she tended to look through evaluator and stare at the wall.  She fidgeted often in her chair most often when asked about information she did not want to divulge or about the incident leading to her arrest.  She was oriented to person, place, and time and understood why she was arrested, though claiming her innocence and blaming officers for planting drugs on her.  She was not aware of how or when, but claims she was not in possession of any drugs at the time of arrest.   When discussing the charge of burglary, she became agitated, perceived through a harsh, loud tone in voice and flailing of hands claiming the officers arrested her to gain access to her brother so they could kill him.  Although she was unaware why officers wanted to hurt her family. Her thought process and content appeared abnormal as she maintained innocence and a paranoid thought process despite being caught with the property.  

Ms. G’s demeanor and rise in hostility indicates potential malingering in her self-perceived level of guilt.  Her refusal to divulge certain information indicates that she takes a defensive stance in regards to her sense of self-responsibility and is uncooperative.

Current Life Situation 

Per her brother, Ms.  G is a transient who has spent her adulthood moving around the country.  Her employment consists of picking up odd jobs, selling drugs, and living with boyfriends to survive.  Her brother is her only remaining relative with whom she has only intermittent contact.  

Ms. G divulged that she currently lives with her boyfriend who supports her financially with paid employment.  She tends to the “home duties”, but picks up odd jobs such as house cleaning from time to time to supplement her boyfriend’s income.  She claims that she has been homeless in the past, but that is not currently her situation.  Ms.  G stated she did not move around all the time due to not having a home, rather for the love of traveling and seeing new places. 

Background Information

Ms. G lost her parents in a car crash at age four and was placed with her brother in the foster care system.  Her and her brother were split apart and were not reunited until she was eighteen and found him with the help of a private investigator.  Only basic medical information was made available to either party indicating biological parents as healthy, loving and caring parents, who both worked to support the family.  Foster care reports explain a foster home willing to take both siblings was not available resulting in the separation.  As a young child, Ms. G began manifesting temperamental outbursts, aggressive behavior, and defiance causing her to be relocated to several foster homes as a young child.  In early adolescents, she was detained for a six-month period for assault on another adolescent.  She returned to the foster care system and began drinking and using drugs at fifteen years old.  At seventeen she was detained and served one year in the juvenile detention facility for possession with intent to sell.  She was released to a group home where she was doing well and attempted to gain her high school diploma.  The counselors in the home helped her contact a private investigator who helped her reunite with her brother.  After locating her brother, she left the group home to live with a boyfriend and started selling drugs.  She continued selling drugs and moving from boyfriend to boyfriend to survive and have a home.  She has traveled all over the United States with different boyfriends.  She has two prior burglary charges, one possession, and three assault charges.

Psychological History 

Ms.  G refused to speak of her mental health other than exposing she has never received treatment for mental health except for counseling services provided during her juvenile incarcerations and the group home.  However, drug abuse was prevalent in her early adolescence and has continued into adulthood.  Early childhood traumatic experiences imply the possibility of depression or other mental health deficiencies. Her brother verified that he was not aware that she’d ever received mental health treatment either.

Substance Use History 

At the time of arrest, Ms. G was found to be intoxicated and in possession of drugs.  Her brother indicated drug dealing as a means of survival at the age of eighteen.  Ms. G has struggled with alcohol and drugs for twenty-one years via usage and selling.  Her brother admits to drinking frequently three to four times a week and smoking marijuana daily.  Ms.  G maintains she does not use drugs, but drinks several times a week, almost daily.  However, the substance she was in possession of tested positive as methamphetamine.  Her urine screening was positive for alcohol, methamphetamine, cocaine, and marijuana.  Ms.  G claims when she was younger she smoked weed and drank with her friends, but nothing more.  When told of her positive drug screening, she claimed the results were not true and officers are lying.  A second test reported the same results from different officers.  Her denial of drug use was documented.

Medical History

Ms.  G reported that she is healthy and feels fine.  However, she has not seen a doctor in a couple of years.  She has no insurance, so she goes to the hospital emergency room only when necessary.  The last time to the hospital she had fallen and sprained her ankle.   

Objective Testing :

                   Tests Administerd

Mini-Mental State Examination-2 (MMSE-2)

The MMSE-2 is a performance-based rapid test that tests for cognitive impairments in adults (Folstein, Folstein, & White, 2010).  The initial mental health assessment indicates Ms. G likely has a diagnosis of delusional disorder, unspecified (American Psychiatry Association, 2013).  However, in Ms. G’s circumstance, she was found intoxicated and in possession of a legal substance which may have been the cause of her disorientation at the time of arrest (American Psychiatry Association, 2013).  Ms.  G lost her parents at age four and she and her brother were placed in the foster care system which resulted in sibling separation indicators of adjustment disorder in childhood (American Psychiatry Association, 2013).  Past trauma indicates PTSD with the manifestation of other mental health incapacities as a coping mechanism.

Substance Abuse Subtle Screening Inventory-3 (SASSI-3)

The SASSI-3 is a self- report screening psychometric test that allows professionals to make inferences about possible substance abuse disorders (Miller, 1983-1997).  SASSI was employed to rule out cause of irrational and delusional behavior attributed to substance use.  Although Ms.  G claimed to not have a substance use problem, SASSI results were indicative of moderate dependence of substances with inference made of alcohol, cocaine, and methamphetamine as indicated in urine screening.  

Thematic Apperception Test (TAT)

The TAT is a personality test that reveals dominant drives, sentiment, emotions, and conflicts of personality in individuals over four years of age (Murray, 1935).  The TAT was employed as part of a battery of personality testing to gain a further understanding of Ms. G’s internal personality traits.  Ms.  G elicited a pattern of fear of abandonment and loss, intoxication as cause for impulsive behaviors, and feelings of “somebody watching her”.  These findings provide support for adjustment and delusion disorders as indicated as potential diagnoses in the MSE.  

Minnesota Multiphasic Personality Test, Second Edition (MMPI-2)

The MMPI-2 is a self-administered personality inventory that evaluates personality traits, maladaptive adjustment, and symptoms of psychological illness (Drayton, 2009).  The MMPI-2 will establish the possibility of clinical syndromes, personality patterns, psychosocial stressors, and severity of disturbance (Shapse, 2016).   Exaggerated responses indicate Ms. G is dealing with stress and attempting to avoid disclosing pertinent information.  The MMPI clinical profile indicated a tendency to act impulsively in socially unacceptable manners.  However, she places blame to others and feels no responsibility for her actions.  She is highly suspicious of others and tends to blame them for her irrational and hostile frame of mind.  She fears the world and blames others for wrongly accusing her which is elicited in her negative behavior and delusional mind set.  Subtests of the MMPI-2 (MAC-R and APS) suggested high probability of substance abuse in general providing further support for the SASSI that was employed.  Interpersonal relationships encompassed her sense of dependence and insecurity with coping consisting of manipulation with little to no guilt.  

MacArthur Competence Assessment Tool – Criminal Adjudication (MacCAT-CA)

The MacCAT-CA tests areas of reasoning, appreciation, and understanding through a structured interview of a hypothetical criminal case to clarify the defendant’s ability to fully comprehend what is happening in regards to their own legal matter (Poythress, Nicholson, Otto, Edens, Bonnie, Monahan, & Hoge, 1999).  Ms.  G reported with her guard up and delusional ideations that the police had planted drugs on her and she did not burglarize the neighbor.  However, she provided enough information to emanate the factual understanding of her charges and legal proceedings she is facing.  Due to the delusions, it was difficult to determine her rational understanding of the entire situation, but she did declare she knew the mayor and other higher ups who could dismiss officers from their job indicative of her ability to rationalize the legal process and cause and effect behaviors.  The evaluator opined Ms. G is competent to stand trial.

Findings :

Diagnostic Impressions 

AXIS I: Post Traumatic Stress Disorder with delayed expression, Alcohol abuse, methamphetamine abuse, cocaine abuse

AXIS II: Delusion Disorder, unspecified

AXIS III: NONE

AXIS IV: No primary support group, unemployed, dependent on boyfriend for housing, no mental health treatment

AXIS V: GAF= 78 (Transient symptoms that manifest in response to psychosocial stressors:  mild symptoms which cause some difficulty in social and occupational functioning)

Conclusion

Ms.  G suffers from PTSD which manifested in response to the traumatic loss of her parents, incorporation into foster care at a young age, and separation from her brother.  Symptoms did not manifest immediately, rather a slow manifestation over time.  Her primary coping mechanism has been substance abuse since adolescence totaling twenty-one years.  Her substance abuse reacted with PTSD causing a manifestation of symptoms of delusional disorder causing a paranoid state of mental functioning.  Malingering and deception were ruled out.  The employment of a battery of psychological testing implicated Ms.  G as competent to stand trial as she has factual understanding of the charges, the legal process, and consequences for her behavior.

Recommendations

It is my professional opine that Ms.  G is competent to stand trial at this point in time.  Ms.  G has elicited factual understanding of her circumstance.  She has rationalized retaliation as a mean of gain as elicited in her confrontation with the officers.  Her approach and success of staging a protest and hunger strike indicate her ability to fully understand cause and effect behaviors as a reasonable accommodation.  These factors surfaced in her MMPI-2 profile as well as the McCAT-CA.  Additionally, her repeat offending history indicates her need for mental health services to address her current deficits and promote rehabilitation for reunification into general society.  Recommendations for Ms.  G include a substance abuse program as the SASSI-3 and MMPI-2 profile supported the initial impression of high probability of substance abuse in the MMSE.   Attaining sobriety holds potential to decrease delusional thoughts that cause her paranoid tendencies.  Psychotherapeutic counseling will prove beneficial to help Ms. G learn to cope with the loss of her parents and the severance of her relationship with her brother.  Other childhood traumatic experiences need to be dealt with and understood in order for her to elicit positive growth and maintain sobriety as substance abuse and risky behavior appear to be her primary coping mechanism.  Both herself and brother may benefit from family therapy to help build a positive relationship and restore from the early separation.  As an incentive to complete a mental health and substance abuse program, life skills training to help establish permanent housing and regular employment will help create a sense of independence and self-worth she probably has never felt decreasing her chance of re-offending upon release. 

Jennifer L.  Olivas, B.A.                December 20, 2016 

Final Assessment Report
Reason for Referral:

Competency to Stand Trial

Client, Ms.  G was referred for evaluation to establish her competency to stand trial.  Ms. G appeared to be intoxicated, confused, combative, and irrational causing officers to use the highest levels of constraints.  Her behavior elicited a paranoid delusional state in which she claimed to have access to higher authority over the officers.  Incarceration likely heightened the paranoid delusions and caused her to become fearful that officers were trying to kill her brother.  In response to delusions, she rallied inmates and created a protest and hunger strike.  Observation concluded Ms. G was intoxicated, confused, combative, hyperactive, and irrationalized the charges.  Adamant she did not steal the neighbor’s property, she refused counsel representation and a plea bargain leading her to trial indicating she was disoriented at the time arrest.  Unable to engage in conversation, Ms. G was uncooperative and refused to divulge personal information and appeared with a dysphoric affect.  Her thought process and content appeared abnormal as she maintained innocence and a paranoid thought process despite being caught with the property.

Current Life and Background Information

Ms.  G reported her irritation with being arrested and “framed” for possession claiming she did not steal from her neighbor.  She understood that the evaluator was there to gather information to prove that she had mental problems.  She denied that anything was wrong with her and the officers are trying to use her to gain access to and kill her brother.  

Ms.  G claimed to be healthy, only visiting doctor in the emergency room when necessary such as when she sprained her ankle.  She claims she has received only services provided to her when she was incarcerated as a juvenile and when she was in the last group home, but claims that it was just counseling to check up on her.  She did not complete high school nor a GED program.  

Currently, Ms.  G is living with her boyfriend who is her primary supporter for about six months.  She picks up house cleaning and other odd jobs from time to time to help support herself and her boyfriend.  She claims they have a good relationship, but argue sometimes because she feels like he is keeping tabs on her and doesn’t trust her.  She also claims he sometimes gets upset because she questions him about where he was.  Ms.  G never had children.  Aside from her boyfriend, Ms. G only has her brother to provide moral and emotional support, but she doesn’t get to talk with him often.

When asked why she was arrested, Ms.  G became defensive and claimed to have done nothing wrong and the officers “framed” her.  She was shocked she was being arrested and didn’t understand why, until she got to the station and learned they planted drugs on her and were trying to get to her brother.  During her arrest, she tried to defend herself because she knew she had not done anything wrong and she knew she had to fight for what was right.  She is not normally an aggressive person, unless someone is trying to get her, then she retaliates by any means possible.  She claims she was arrested so they could kill her only family member.  Her arrest history includes two juvenile incarcerations, two burglary charges, one possession, and three assault charges.  

Discussing her charges, she claimed that she did not have her neighbor’s property and has no clue what property her arrest was over because she only had her belongings like her wallet and keys.  She is adamant that she had no drugs, nor does she use drugs despite failing her drug screening.  She attributed her failed drug screening to officer’s trying to set her up so they can have her out of the way to get her brother.  Though she is not aware why they want to kill him.  She did admit to having a few drinks that day as she does most days of the week, but continually denied using drugs.

Ms.  G knew that with her prior charges, she would likely be facing “serious” jail time even with the plea bargain.  She claims to know the mayor and if she could talk to the judge, he would have to “listen to the mayor and let her out.”  She would explain to the judge what the officers were up to and he would understand why she reacted how she did because she had no stolen property and the officers are just after her brother.  She claims to have no enemies, rather friendly with most people, but maintained foul play from the officers who have tried all extremes, including poisoning her to get to her brother.  She was not bothered by any detriment officers or their families would suffer if they were relieved from their positions.

Ms.  G has no recollection of her parents, but has an intermittent relationship with her brother she wants to improve.  She was in several foster homes throughout her childhood, but would not disclose any major events sans some people were nice, some were not.  She did expose having endured a few painful disciplines that caused her run away.  She was disciplined for fighting with other kids in the home, having bad grades, and forgetting to do chores or not doing them good enough.  She was detained and incarcerated for assault and possession with intent to sell when she was a teen.  However, she claimed the other girl started the fight and the drug charge was because she was holding it for her boyfriend.  Her final thought at the end of the interview was that she’s “being honest and her brother needs protection because the officers are going to kill him, please don’t think I’m crazy.”

Ms. G has endured trauma throughout her entire life that has never been dealt with.  Her ability to exhibit a sound understanding of the events leading to and after detainment imply she is competent to stand trial and the adjudication process.  Although mental health impairments are evident and exposed through the battery of tests employed, Ms.  G elicited a factual understanding beyond negative behavior equates to punishment.  She retaliated towards officers by staging a protest and hunger strike during her confinement, inferred to be an attempt to gain access to the judge as she requested.  Consistent with delusion disorder, Ms.  G accepts no responsibility for any of her behaviors that resulted in negative consequences, rather placed blame on others.  She emanates a fear that people are “out to get her family” despite physical and scientific evidence that her thoughts are surreal.  Ms.  G consistently turns to alcohol and drugs (inferred, client denies) to cope with past traumatic events since she was fifteen years old.  Her coping mechanism has turned into a substance abuse disorder which appears to drive her irrational and hostile behaviors.  

Testing Battery

A series of tests were employed to evaluate Ms. G’s competence.  The Mini-Mental State Examination-2 (MMSE-2) is a performance-based rapid test that assesses for cognitive impairments in adults (Folstein, Folstein, & White, 2010).  The initial mental health assessment indicates Ms. G likely has a diagnosis of delusion disorder, unspecified (American Psychiatry Association, 2013).  However, in Ms. G’s circumstance, she was found intoxicated and in possession of a legal substance which may have been the cause of her disorientation at the time of arrest (American Psychiatry Association, 2013).  Ms.  G lost her parents at age four and she and her brother were placed in the foster care system which resulted in sibling separation risk factors of adjustment disorder in childhood (American Psychiatry Association, 2013).  Past trauma indicates PTSD with the manifestation of other mental health incapacities as a coping mechanism.  Additionally, at the time of her arrest, Ms. G was intoxicated and in possession of methamphetamines.  Her denial of substance abuse despite her history and current charges necessitated the use of a substance abuse screening.  The MMSE-2 indicated a marked increase of negative behavior with intoxication involved in every respect dating back to adolescence.  The MMSE-2 served as the base of Ms. G’s evaluation and indicated the need for further information gathering.

The second test employed was the Substance Abuse Subtle Screening Inventory-3 (SASSI-3) to establish the probability that Ms. G suffers from a substance abuse disorder.  The SASSI-3 is a self- report screening psychometric test that allows professionals to make inferences about possible substance abuse disorders (Miller, 1983-1997).  SASSI was employed to rule out cause of irrational and delusional behavior that can be attributed to substance use.  Despite her denial of a substance issue on the face value items, Ms. G reported higher probability on the indirectly related items which ruled out evasiveness and malingering and deception in her test.  Although Ms.  G claimed to not have a substance use problem, SASSI results were indicative of moderate dependence of substances with inference made of alcohol, cocaine, and methamphetamine as indicated in urine screening.  Despite SASSI-3 results, the traumatic history of Ms. G was indicative of PTSD and a delusion disorder which weighed as the probable cause of the substance abuse.

The third test employed was the Thematic Apperception Test (TAT).  The TAT is a personality test that reveals dominant drives, sentiment, emotions, and conflicts of personality in individuals over four years of age (Murray, 1935).  Although the TAT is not a definitive scoring test it serves as a basis to understanding the mindset of the individual.  In Ms.  G’s case, it was necessary to understand the primary drive of behavior by establishing a pattern in the thought mind set.  This would also indicate potential cause or basis of her delusional thoughts and paranoia.  The TAT was employed as part of a battery of personality testing to gain a further understanding of Ms. G’s internal personality traits.  Ms.  G elicited a pattern of fear of abandonment and loss, intoxication as cause for impulsive behaviors, and feelings of “somebody watching her”.  These findings provide support for PTSD (fear of abandonment) and delusion disorders (“watching”) as indicated as potential diagnoses in the MSE.  The TAT should not be relied upon, rather used as a support for other personality test findings such as the MMPI-2.

Next, the Minnesota Multiphasic Personality Test, Second Edition (MMPI-2) was employed.  The MMPI-2 is a self-administered personality inventory that evaluates personality traits, maladaptive adjustment, and symptoms of psychological illness (Drayton, 2009).  The MMPI-2 will establish the possibility of clinical syndromes, personality patterns, psychosocial stressors, and severity of disturbance (Shapse, 2016).   Exaggerated responses indicate Ms. G is dealing with stress and attempting to avoid disclosing pertinent information.  The MMPI clinical profile indicated a tendency to act impulsively in socially unacceptable manners.  However, she places blame to others and feels no responsibility for her actions.  She is highly suspicious of others and tends to blame them for her irrational and hostile frame of mind.  She fears the world and blames others for wrongly accusing her which is elicited in her negative behavior and delusional mind set.  Subtests of the MMPI-2 (MAC-R and APS) suggested high probability of substance abuse in general, providing further support for the SASSI that was employed.  Interpersonal relationships encompassed her sense of dependence and insecurity with coping consisting of manipulation with little to no guilt.  Her MMPI-2 profile indicates a deficit in interpersonal relationships attributed to the sudden loss of her parents, separation from her brother, and the constant change of foster homes.  Her fear of the world is attributed to her fear of abandonment and therefore recluses and copes through substance abuse.  Excessive substance abuse holds potential to bring on delusions and paranoia which is consistent with Ms. G’s ideation that the officers want to kill her brother.  This indicative of a fear of loss and abandonment and she reacts through any means to protect her brother from her delusions.  An understanding of the causes of behavior led to the understanding that Ms.  G had a functional mental status and she was cognitively sound, but areas of reasoning, appreciation and understanding needed to be assessed in order to declare competency.

The MacArthur Competence Assessment Tool – Criminal Adjudication (MacCAT-CA) tests areas of reasoning, appreciation, and understanding through a structured interview of a hypothetical criminal case to clarify the defendant’s ability to fully comprehend what is happening in regards to their own legal matter (Poythress, Nicholson, Otto, Edens, Bonnie, Monahan, & Hoge, 1999).  Ms.  G reported with her guard up and delusional ideations that the police had planted drugs on her and she did not burglarize the neighbor.  However, she provided enough information to emanate the factual understanding of her charges and legal proceedings she is facing.  Due to the delusions, it was difficult to determine her rational understanding of the entire situation, but she did declare she knew the mayor and other higher ups who could dismiss officers from their job indicative of her ability to rationalize the legal process and cause and effect behaviors.  The evaluator opined Ms. G is competent to stand trial.

Diagnosis

Post-Traumatic Stress Disorder is supported through the meeting of certain criteria of the DSM-5.  Ms.  G experienced the accidental death of her parents, was uprooted from her home and placed with strangers only to then be separated from her brother, her only living relative.  In response to the trauma, Ms.  G has internalized the events which then become triggered by any event that  appears to demonstrate potential loss or abandonment.  Her refusal to talk about her childhood indicates avoidant behaviors associated with PTSD.  Ms. G also reports fears, negative and exaggerated view of the world, and distorted cognitions of causes of events.  Also indicative of PTSD are her angry outbursts and reckless behavior that led to her arrest and displayed throughout her detainment and interview process.  Symptoms appear to be deep rooted and cause Ms. G social and occupational distress.

Delusional disorder, according to the DSM-5, manifests void of hallucinations with no marked impairment of functioning or odd behavior.  The delusions cannot be substance-induced nor can manic or major depressive episodes have manifested.  Ms.  G’s delusional encompasses the belief that she is being targeted by officers as a way for them to get to and kill her brother.  Her current delusional state rates equivalent to a 4 on the four point scale of severity due to her current accusations towards the officers.  

Additionally,  Ms. G suffers from substance abuse disorders consisting of alcohol, methamphetamines, and cocaine.  Although she denies drug use, a urine screen and a SASSI screen indicated otherwise.  The DSM-5 declares substance use disorders as a cluster of symptoms that encompass cognition, behavior, and physiological symptoms that indicate continued use despite substance-related problems.  Identifying substance abuse disorders includes the individual focuses life around the ability to use the substance even though marked impairment is evident in necessary areas such as employment or education.  Additionally, partaking in risky behavior such as burglary while intoxicated and the building of tolerance are indicative of substance abuse disorders.  Ms.  G is not able to maintain employment and has had several dealings in legal repercussions due to her substance abuse.  Her level of tolerance was not disclosed as she continues to deny the issue.

Conclusion and Recommendations

It is my professional opine that Ms.  G is competent to stand trial at this point in time.  Ms.  G has elicited factual understanding of her circumstance.  She has rationalized retaliation as a mean of gain as elicited in her confrontation with the officers.  Her approach and success of staging a protest and hunger strike indicate her ability to fully understand cause and effect behaviors as a reasonable accommodation.  These factors surfaced in her MMPI-2 profile as well as the McCAT-CA.  Additionally, her repeat offending history indicates her need for mental health services to address her current deficits and promote rehabilitation for reunification into general society.  Recommendations for Ms.  G include a substance abuse program as the SASSI-3 and MMPI-2 profile supported the initial impression of high probability of substance abuse in the MMSE.   Attaining sobriety holds potential to decrease delusional thoughts that cause her paranoid tendencies.  Psychotherapeutic counseling will prove beneficial to help Ms. G learn to cope with the loss of her parents and the severance of her relationship with her brother.  Other childhood traumatic experiences need to be dealt with and understood in order for her to elicit positive growth and maintain sobriety as substance abuse and risky behavior appear to be her primary coping mechanism.  Both herself and brother may benefit from family therapy to help build a positive relationship and restore from the early separation.  As an incentive to complete a mental health and substance abuse program, life skills training to help establish permanent housing and regular employment will help create a sense of independence and self-worth she probably has never felt decreasing her chance of re-offending upon release. 

Reflection:

Professional Role

Typically, the professional role encompasses confidentiality and privacy rights along with the declaration of not causing harm to the client (American Psychological Association, n.d.).  However, in the forensic setting, confidentiality does not exist as the professional is employed by a third party to provide services (Kalmbach & Lyons, 2006).  As a Forensic Psychologist, it is imperative to establish the professional role as a third party and outline what information will be shared outside of the client and with whom the information will be shared (Kalmbach & Lyons, 2006).  Although, one may emotionally connect as an advocate for the client, it the professional’s duty to remain objective and unbiased throughout the course of assessment and if he or she must testify (Kalmbach & Lyons, 2006).  In the event the professional is unable to gain compliance with the client in regards to an interview, he or she must make clear invalidity and limitations to those involved in the case including the court (Kalmbach & Lyons, 2006).  It is important to note that the information obtained in the assessment is not protected by confidentiality (Kalmbach & Lyons, 2006) including self-harm or thoughts of harming others, clinical diagnoses, and potential for the future.

Hypothesis

Ms.  G presented as competent to stand trial.  Competency is defined through the use of some “variant of the Dusky Standard” derived from the legal proceeding Dusky v, United States in 1960 (Roesch, Zapf, Golding, & Skeem, n.d., p.  29). The Dusky Standard declares the individual must have the ability to consult with a lawyer with a reasonable degree of rational understanding, in addition to factual understanding of the proceedings against him or her (Roesch, et al., n.d.).  Although an explicit definition of competency to stand trial does not exist,  a common practice does:  Incompetence cannot be declared independent of the legal case facts (Roesch, et al., n.d.).  Evaluators must establish the degree of the defendant’s current ability in regards to the degree of relevancy of the jurisdiction competency standards (Roesch, et.  al, n.  d.).  Due to the Dusky Standard, Ms. G was evaluated on several levels to ensure her comprehension of her legal situation and possible outcomes was intact.  

Assessment Choices

The MMSE-2 is a rapid test which indicates cognitive impairments (Folstein, Folstein, & White, 2010).  Employing the MMSE-2 allowed for brief insights on the potential causes of Ms.  G’s negative behavior.  A subjective and objective snapshot of mental status at a particular time gives the professional an idea what other evaluations are necessary for the individual (Combs, n.d.) and reveals abnormal functioning, dependency (chemical and psychological), competency to stand trial and handle incarceration (Shapse, Ph. D., 2016).   

The SASSI-3 appeared to be pertinent in evaluating Ms. G because the test utilizes direct face values and indirect questioning to establish probability of substance abuse (Miller, 1983-1997).  Due to Ms. G’s denial, it was important to verify suspicion through a test with a high validity and reliability and low potential of being able to exaggerate or malinger (Miller, 1983-1997).  Additionally, per David Pittenger, the SASSI-3 is used in psychological treatment centers to unveil the mask of substance abuse problems hidden by mental illness (Miller, 1983-1997).  In Ms. G’s case it was imperative to identify the existence of substance abuse disorder to define cause of behavior.  

The TAT was employed as a support base for further personality testing.  In the Forensic setting, the TAT would prove to be useful in the evaluation and assessment of individuals involved with violent crimes (Murray, 1935). Although Ms.  G was not currently detained for her aggression, her aggressive behavior manifested while being arrested and retaliatory behaviors surfaced during confinement.  TAT use is beneficial in establishing motives and aggression degree as well as potential triggers (Murray, 1935).  Employing the TAT would “force” Ms. G to express information she has hidden to this point.  Her story telling indicates past trauma and internal drive which was used as a determinant in her competency degree.  Additionally, it could be opined that the TAT may be useful in determining if beliefs and views are indicative of future offending.  

The most widely used psychometric test for measuring adult psychopathology is the MMPI – 2 (Drayton, 2009).  The scoring measures the actual test items against the norms by using questions that are not related to the “health” area to reduce feigning responses (Drayton, 2009).  Nine validity scales assess faking, lying, and defensiveness to indicate accuracy, validity, and reliability of results (Drayton, 2009).  The MMPI-2 established a high probability of substance dependence solidifying the initial thought.  Additionally, personality deficits were found providing support to Ms. G’s diagnoses.

During execution of the MacCAT-CA, the defendant’s ability to learn, recall, and apply new information is assessed, capacity to establish factual information and make rational decisions, and ability to appreciate consequences (Pinals, Tillbrook, & Mumley, 2006).  The MacCAT-CA has also been found useful in gathering relevant data which were inconsistent in the interview process indicating it valuable in detecting malingering and exaggerating (Pinals, Tillbrook, & Mumley, 2006).  The McCAT-CA was used to validate assessments were void of malingering and exaggeration.  Ms.  G had an intricate mental health portfolio that was originally perceived as an attempt to avoid jail time.  Ruling out exaggeration and malingering supported the hypothesis that Ms. G does suffer from mental illness.  However, she maintains the mental capacity to withstand trial which is evident in her ability to thoughtfully retaliate.

Ethical Dilemmas / Multicultural Perspectives

Testing was chosen based on appropriateness to the clients reported history and culture.  The decision was attentive to language and development as consistent with the APA Code of Ethics (American Psychiatric Association, 2013).  Personal ethical dilemmas that may have surfaced would include remaining objective knowing the client had to deal with a lifetime of trauma that has had a marked effect on her development and caused a hindrance in her maximizing her life potential.  Additionally, at the start of the project I maintained one perspective, but through the course of evaluations and as information was input, perception changed and the assessment became more objective than at the start.  A repeat offender, such as Ms. G faces harsher sentencing as the perception is “lessons are unlearned”.  However, in the case of Ms.  G, it appears that mental in compacities had been overlooked much too long.

Court Setting

It is vital to remain objective and only disclose exact answers when being questioned in court.  Having knowledge of the tests employed, their validity and reliability rates, as well as their generalization ability will prove an effective defense when testifying in court.  The posoibility of any potential bias and all efforts made to reduce personal bias should be disclosed.  Additionally, one should disclose any ethical dilemmas that may have risen during the course of the assessment.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

American Psychological Association. (n.d.). Ethical principles of psychologists and

           code of conduct including 2010 amendments. Retrieved from http://www.apa.

           org/ethics/code/principles.pdf

Argosy University. (2013). Case Vignettes. Retrieved from Argosy University, FP6020 A01 website.  Retrieved from http://vizedhtmlcontent.next.ecollege.com/pub/content/b4906a89-6b22-49c2-bf45-5035e900258e/AU_FP6020_M1_Case_Vignettes_C2.pdf

Combs,M. D., H. (n.d.). . Retrieved from https://depts.washington.edu/psyclerk/secure/mentalstatusexam.pdf

Drayton, M. (2009). The Minnesota Multiphasic Personality-2 (MMPI-2). Occupational Medicine, 59(2), 135-136. doi:10.1093/occmed/kqn182

Folstein, M.  F., Folstein, S.  E., White, T,. & Messer, M.  A.  (2010).  Mini-mental state examination, 2nd edition. Mental Measurements Yearbook, 20.  Retrieved from http://web.a.ebscohost.com.libproxy.edmc.edu/ehost/detail/detail?vid=3&sid=5cfedacc-e5c5-44f2-80f5-ec1b13f75c2a%40sessionmgr4009&hid=4201&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=test.6474&db=mmt

Kalmbach, K. C., & Lyons, P. M. (2006). Ethical issues in conducting forensic evaluations. Applied Psychology in Criminal Justice, 2(3).  http://www.apcj.org/documents/2_3_Ethics_foren.pdf

Melton, G.B., Petrila, J., Poythress, N.G., & Slobogin, C. (2008). Psychological evaluations for the courts: A handbook for mental health professionals and lawyers. (3rd Ed.) New York; Guilford Press.

Miller, G. A. (1983-1997). The substance abuse subtle screening inventory – 3. Mental Measurements Yearbook, 15.  Retrieved from: http://web.b.ebscohost.com.libproxy.edmc.edu/ehost/detail/detail?vid=15&sid=d7ca3401-3038-405f-bb8d-4ad8608b0418%40sessionmgr102&hid=102&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=test.1982&db=mmt

Murray, H.  A. (1935).  Thematic Apperception Test.  (Mental Measurements Yearbook, 8).  Retrieved from http://web.a.ebscohost.com.libproxy.edmc.edu/ehost/detail/detail?vid=3&sid=16555d4d-a5d9-4a6b-93bb-59fee2a81d8b%40sessionmgr4008&hid=4201&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=test.4841&db=mmt

Poythress, N.  G., Nicholson, R.  N.,  Otto, R.  K.,  Edens, J.  F.,  Bonnie, R.  J.,  Monahan, J.,  & Hoge, S.  K.  (1999).  MacArthur Competence Assessment Tool-Criminal Ajudication (Mental Measurements Yearbook, 20).  Retrieved from http://web.a.ebscohost.com.libproxy.edmc.edu/ehost/detail/detail?vid=13&sid=4021c487-e4a6-4486-b8b0-840b9fc26eaa%40sessionmgr4006&hid=4201&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=test.6528&db=mmt

Roesch, R., Zapf, P. A., Golding, S. L., & Skeem, Jennifer L., (n. d.). Defining and Assessing Competency to Stand Trial. Retrieved from https://www.justice.gov/sites/default/files/eoir/legacy/2014/08/15/Defining_and_Assessing_Competency_to_Stand_Trial.pdf

Shapse, Ph. D., S. N. (2016). HG. Retrieved from https://www.hg.org/article.asp?id=5100

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