Research often takes a collaborative effort to accomplish the goals that aim to improve our health knowledge or health services in Saskatchewan. SHRF supports these efforts through our Collaborative Innovation Development grant. Meet one SHRF-funded team and see how they are bringing their expertise and experiences together to accomplish their research goals.
Studying the Relationship Between Attachment, Recidivism and Psychiatric Treatment Utilization in Forensic Outpatients with Mental Illness
Why is this Research Important? Criminality and mental health illness represent a combination that is complex and costly to treat. According to the Annual Report of the Office of the Correctional Investigator, in 2014-2015, almost half of incoming male federal offenders suffered from psychiatric conditions, and up to a quarter had fetal alcohol spectrum disorder (FASD).
Clinical reality shows that most offenders have traumatic pasts that continue to be reflected in their struggling relationships and their lack of trust in others. This inherently leads to instability in the relationships they have with their treating teams and lack of commitment to medical advice offered, further perpetuating mental illness and increasing the risk of relapse into criminal behavior (recidivism).
The ability to trust and relate to others is captured very well in the individual attachment, which is a pervasive pattern developed early in life through interactions with caregivers. Adult attachment moderately reflects the early relationships in one’s life, by influencing the way adults feel and behave in their close adult relationships. Therefore, adult attachment also reflects the impact of early trauma on the individual’s current psychological health and relationships. In fact, our research team has been able to show that in psychiatric outpatients, adult attachment impacts patient’s interaction with the mental health services, including interactions with mental health care practitioners and the use of medication and psychotherapy.
These previous findings are therefore relevant in offenders with mental disorders (OMDs) whose collaboration with treatment teams are often disrupted and treatment compliance is limited. With the help of SHRF’s Collaborative Innovation Development grant program, our team of researchers is currently investigating the relationship between attachment, recidivism and mental health treatment utilization in OMDs. Our team includes clinicians, facilitators, patient and family advisors and end-users who each play an important role in shaping, performing and interpreting the research.
The Objectives of the Study
Explore the concept of attachment in the context of previous trauma, in the community forensic population.
Relate the impact of attachment style on mental health care utilization by exploring medication use and visits to mental health professionals.
Explore recidivism risk and ability to modulate conflict through forgiveness.
How Will the Team Conduct the Research?
Participants are currently being recruited from the outpatient clinics of five psychiatrists working with the OMD population.
Participants are evaluated by skilled staff, trained in the interviewing of OMD population, and the use of a series of questionnaires meant to assess history of childhood trauma, adult attachment, capacity to forgive and recidivism risk.
A one year retrospective chart review will determine the cost-to-treat each participant based on the number and length of appointments with a psychiatrist as well as the filled prescriptions and mental health related hospital visits and stays.
Convictions will be verified by RCMP offending records.
More About the Team
Leading the team are Dr. G. Camelia Adams and Dr. Mansfield Mela.
Dr. Adams is an outpatient psychiatrist with expertise in psychotherapy and research pertaining to adult attachment. Dr. Adams has investigated the role of attachment in the presentation of psychiatric illness and mental health utilization in the general psychiatric population. She is also a member on the advisory board of the Centre for Forensic Behavioural Sciences and Justice Studies.
Dr. Mela has 16 years of experience as a forensic psychiatrist, working both with the inpatient and outpatient offenders with mental illness. Dr. Mela is a member of the Saskatchewan Review Board, an executive committee member for the Centre for Forensic Behavioural Science and Justice Studies as well as executive board member of the Saskatchewan FASD Network.
Patient and family advisors are currently playing an active role in the research project, providing feedback on the direction of the study, design, data collection, analysis, and ensuring translational nature of the study.
Ms. Anita Andreen brings over 20 years of experience working with OMDs through the Salvation Army as a correctional case worker.
Dr. Anne McKenna is a retired paediatrician with over 30 years of experience who worked with children who often experienced a variety of traumas, such as physical, sexual, emotional or neglect.
Knowledge Users will play an integral role in supporting and implementing the findings of the study.
Andrea Kotlar-Livingston is the Executive Director of the FASD Network of Saskatchewan with broad experience in the needs of FASD individuals as well as the role played by community services in meeting these needs. With approximately 25% of OMDs in the general population, as well as our study, having FASD, it is critical that the network has information on this population in order to best support their clients.
Dr. Olajide Adelugba is the clinical director at the Regional Psychiatric Centre in Saskatoon, SK, which treats individuals who have committed offences who also suffer from a mental disorder.
The research coordinators, Andrew Wrath and Tara Anderson, will be primarily responsible for conducting interviews and completing questionnaires with participants.
The clinical supporters of our recruitment are: Dr. Stephen Adams, Dr. Akin Peluola, Dr. Stefan Brennan and Dr. M. Farrukh Rahmani, Saskatoon outpatient psychiatrists who are actively referring their patients to the study.
In addition, we have the valuable support of the following team members:
Dr. Brian Rector, Executive Director of the Research and Evidence-Based Excellence wing of the Provincial Ministry of Justice, who’s involvement in assessing findings will strengthen the development of an intervention in future research projects;
Dr. Prosanta Mondal, biostatistician, who will oversee and conduct the data analysis at project completion;
Dr. Izabela Szelest, Research Facilitator, who will be responsible for liaising with patient family advisors, and contributing to the overall supervision of the process.
Exploring the level of attachment insecurity of the OMD population in Saskatchewan.
Understanding the role of attachment and ability to forgive in preventing recidivism in this population.
Identifying potential targets for intervention, either in the interpersonal domain or in forgiveness ability of OMDs
Improving mental health care utilization of OMDs based on individual characteristics.