Auditory hallucinations and paranoid and delusional thoughts

Sam is a 20-year-old who was first diagnosed with bipolar disorder at age 17. Sam has experienced several episodes of mania, including symptoms of psychosis, such as auditory hallucinations and paranoid and delusional thoughts. With treatment Sam has experienced periods of stable mood and wellbeing. However, he also sometimes uses drugs and alcohol, leading to destabilization and a return of symptoms.

Sam had a difficult upbringing marked by a neglect and experienced difficulty with peers from a young age. He engaged in frequent physical fights at school as early as Kindergarten. His single father had trouble keeping a stable home, and Sam spent many years moving from place to place and in and out of the care of extended family members.

Sam is currently single, with his last relationship having just recently ended amidst a great deal of conflict. Sam thinks of himself as a `loner` and has trouble maintaining friendships. Over the last few years Sam has been working toward completing a college diploma. However, he has had to take leaves from school to focus on his mental health. He is also generally quite impulsive and changes his mind frequently, quitting projects, relationships, and majors often.

Recently, his roommates asked him to leave their shared apartment due to an increase in his odd and disruptive behaviour. Sam`s roommates tried to support him accessing emergency room treatment without success and Sam doesn`t have a family doctor. Sam is staying in a men`s temporary shelter program until he can find stable housing, resulting in a great deal of stress for him. He has also been checking in with a support worker regularly in an effort to reconnect with treatment and to obtain employment or social support.

Yesterday, Sam got into a heated argument with his support worker. He became highly distressed and caused damage to several pieces of furniture and a wall. Police were called, and they arrived with a specialized mental health response team. They were able to support Sam until he felt calmer, and on evaluation, identified a need for emergency mental health treatment. He was charged with a single count of mischief, and recommended for a specialized diversionary mental health program. As part of the program, the judge ordered a forensic assessment to better understand the likelihood of Sam engaging in future offending or violent behaviour, and to inform the conditions and programs he should follow and complete while participating in the specialized mental health court. You have been appointed as a clinical forensic psychologist tasked with conducting a risk assessment in Sam`s case.

Questions:

1. What approach to violence risk assessment would you undertake in this case? (You only need to choose one). Justify your decision. Define and describe the approach you would select, including strengths and limitations, based on concepts covered in the course.

3. Name and describe one risk assessment tool that you would use for this evaluation. Justify your choice.

4. Identify, define, and provide an example from Sam`s case for each of the four different types of risk factors.