Problem
Demographics - single male, nil dependents, identifies as Aboriginal, lives alone in a rural town in New South Wales. Currently 42-years of age.
Social determinants - known history of childhood traumas and was removed from his mother's care at 4-years of age. Raised by his paternal grandparents with limited contact with his 4-siblings. Sporadic employment with nil formal qualifications. Education completed mid-year 7. Difficulties noted with literacy and numeracy. Supported by his grandparents whilst in custody and they are prepared to be involved with his ongoing mental health care.
Relevant Past Incidences - has been involved in multiple incidents involving theft, assault occasioning grievous bodily harm, drink driving offences, larceny, property damage, stalk and intimidate, assault police, and common assault. Initial contact with police occurred at 14-years of age. Long periods of incarceration since 17-years of age.
Legal Status - Mr X has been incarcerated for 4-years as a forensic patient after being giving a limiting term in the District Court of NSW for an index offence of alleged homicide. He has been remanded to Long Bay Hospital where he has completed his limiting term without further incidence. He is to be released from custody as a forensic patient subject to conditions (with the provision of structured mental health care) under Section 47 (1) (b) of the NSW Mental Health (Forensic Provisions) Act 1990.
Previous legal orders - has been placed under a community treatment order 5-years ago with case management provided by the community mental health team. Previous diversion from the local court of NSW under a mandated treatment order, pursuant to Section 32 of the NSW Mental Health (Forensic Provisions Act 1990). Nil breaches of either order documented but information from maternal grandparents inform us of poor adherence to psychotropic medications.
Psychiatric Diagnosis - diagnosed with paranoid schizophrenia whist in custody when 18-years of age. Significant cluster b personality traits consistent with a diagnosis of antisocial personality disorder. Long history of substance misuse disorder (alcohol and cannabis).
Current treatment - clopixol depot 400mgs monthly, olanzapine 20mgs nocte. Prior to custody, known poor compliance to pharmacological treatments and mandated treatment orders.
Planned care providers - community mental health team case management and general practitioner
• Question I: What legal, biological, psychological, environmental, and social-occupational treatments are to be considered and how can these be incorporated into a community managed treatment plan
• Question II: What are the anticipated problems that may arise within the community that require addressing and how should Mr X be managed?
• Question III: Evaluate the protective factors that Mr X has and what is his risk of offending in a violent manner in the future? How should this risk be assessed?
• Question IV: Provide a management plan to manage the identified risks and Mr X's mental health.