Empathy as a Determinant of Therapeutic Outcomes in Mental Health Palmer Reg Orovwuje Consultant Forensic Social Worker & Professional Leader Forensic Mental Health Service Wellington, New Zealand Reg.Orovwuje@ccdhb.org.nz

Empathy definition Freud Stern Rogers Gellese Baron-Cohen theories of developmental psychology Stern the interactional synchrony of mother and infant Rogers seeing completely through client eyes Gellese to place ourselves in the mental shoes of others Baron-Cohen a neural matching mechanism

Cognitive empathy Acquiring & processing information Better understanding Has important affective components Not subjective emotional sympathy Influential in social relationships Effective communication Basis for our moral code Ensures inhibition of aggression

Conflicts with bio-medicine Scientific Clinical distance Detached and measured Objective medical decisions Protects clinicians from being overwhelmed Protects patients from professional bias BUT this conflicts with human relationships and experience subjective aspects of reality

Psychiatric assessment Assessments dangerousness work with people from different ethnic groups competence and capacity little published evidence on validity of risk assessment instruments in various ethnic groups biological conditions of illness insight history of violence lack of remorse non-compliance formulation of multiple hypothesis drive judgements & opinions

Empathy spectrum Zero/reduced empathy Empathy erosion borderline psychopathic personality disorder schizophrenia alcohol abuse fatigue, depression Empathy erosion corrosive emotions revenge bitter resentment blind hatred desire to protect

Forensic mental health services Non-white / indigenous people Globalization, colonization and mass immigration “triple jeopardy”: non white, mentally ill, offending Excluded from society Racism High negative statistics Conflicting values and belief systems Diverse populations Women offenders Learning difficulties

Conflict in forensic mental health service Creates conflict Reduces empathy Care, nurture, cure Control, restraint Public safety, inquiries Conflicting philosophies Criminal justice vs mental health

Patient “Bob” case study Index offence: murder Sentence: not guilty by reason of insanity

Background- early years Migrated from Pacific Nation with large family to New Zealand Family settled in low income Pacific immigrant community Traditional beliefs, language, religion Settled, amenable, popular at primary school

Background – teenage years Changed behaviour at first year at college Abusing alcohol , using cannabis Oppositional, irritable, confrontational Break up of relationship Hearing voices, auditory hallucination Presented for psychiatric assessment Thought disordered, deluded, auditory hallucinations Anti-psychotic medication prescribed Background – teenage years

Index offence Head on collision - driving fast, overtaking, hallucinations, alcohol, cannabis Killed other driver Not guilty by reason of insanity Admitted to medium secure unit Demanding Pacific staff as main key worker

Patient: empathy from Pacific staff was main reason for change Transferred to minimum secure unit High numbers of Pacific staff Key worker was Pacific Stopped smoking cigarettes Stopped using substances Settled mental state Full compliance with treatment regime Patient: empathy from Pacific staff was main reason for change

Role of forensic social workers Empathy=central legacy of social work Uniquely placed Interface of legal and service systems Work across many professional boundaries Advocates in clinical practice for Empathy against Empathy Erosion

Conclusion Understand how society works Law, systems Recognise and understand differences Build adaptable services Responsive With empathy

Empathy as a Determinant of Therapeutic Outcomes in Mental Health Palmer Reg Orovwuje Consultant Forensic Social Worker & Professional Leader Forensic Mental Health Service Wellington, New Zealand Reg.Orovwuje@ccdhb.org.nz