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Mental health services


17 NOV 2012

The following case study is a good practice example of how mental health professionals can help clients dealing with domestic and family violence.

Sophie, Matt and Tim

Matt and Sophie attend your Child and Adolescent Mental Health service (CAMHS) with their 14-year-old son, Tim. Tim has been referred by the school counsellor and has recently been suspended from school. Tim has a history of disruptive, aggressive behaviours at school and has been diagnosed with ADHD by a paediatrician. He is on medication for this. Tim is hostile, unresponsive and walks out of the interview on two occasions, returning each time. Tim does not look at or make eye contact with his father. Sophie is articulate and warm when she speaks, but frequently averts her eyes and she becomes silent when Matt starts to speak. When his mother speaks, Tim glares contemptuously at her.

Your service has had specialised domestic and family violence training that covered dynamics of domestic violence in families. You know the link between misdiagnosis of ADHD and a history of exposure to family violence. Your service also networks with a domestic family violence service and attends their regular seminars. You interview Matt, Sophie and Tim separately and ask directly about any experiences of domestic and family violence. You know that you may need to do this over several sessions as you may not yet have built sufficient trust, with Tim in particular.

In your interview with Matt, he tells you that Tim’s mother is ‘controlling and crazy’.

You listen to his story. You then ask Matt whether he has ever hurt anyone in the family or whether anyone in the family would ever say they were afraid of him. You tell him that asking this question is normal procedure in your service, as it is. Matt tells you that he has to discipline Tim when he gets out of control or abusive, and that Sophie would say she is afraid of him, because she is paranoid about everyone.

Your separate conversations with Tim and Sophie confirm the alarm bells for perpetration of violence that arose when you interviewed Matt alone. You are able to ask concerned and validating questions about their experiences of being afraid or being hurt, and also ask whether they have hurt anyone. These questions allow both Tim and Sophie to disclose the long history of domestic violence in their family, beginning when Sophie became pregnant with Tim.

You are able to refer Sophie to a domestic and family violence counsellor.

You consider any mandatory reporting requirements that apply to Tim and target your own interventions with him around trauma-informed practice. You coordinate a case management approach for Tim that includes staff from the Department of Education early intervention program, as well as Tim’s home teacher, youth workers and trauma-informed therapists. You involve the other workers and therapists in ongoing case management and planning. You also talk to the local police about strategies for protection from further harm for Tim, and discuss your concerns with child protection.