Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--DoD. Final rule

This final rule is to reform CHAMPUS quality of care standards and reimbursement methods for inpatient mental health services. The rule updates existing standards for residential treatment centers (RTCs) and establishes new standards for approval as CHAMPUS-authorized providers for substance use disorder rehabilitation facilities (SUDRFs) and partial hospitalization programs (PHPs); implements recommendations of the Comptroller General of the United States that DoD establish cost-based reimbursement methods for psychiatric hospitals and residential treatment facilities; adopts another Comptroller General recommendation that DoD remove the current incentive for the use of inpatient mental health care; and eliminates payments to residential treatment centers for days in which the patient is on a leave of absence.     

Psychotropic Medication Experiences of Incarcerated Women: A Qualitative Inquiry into Conundrums of Access and Identity

The study examines narrative data from in-depth, semi-structured interviews with 25 women in a medium security prison with the hope of deepening the knowledge base related to women’s beliefs about their mental health problems, mental health care during incarceration, and especially their experiences with psychotropic medication. The findings highlight the functional role of psychotropic medication in the lives of incarcerated women, while also emphasizing problems with limited access to prescribers, preferred medications, and other forms of mental health treatment. Trauma, substance use, and the impact of medication use on sense of self all emerged as interfacing with quality of life.     

Examining the Traumatic Effects of Sexual Victimization on the Health of Incarcerated Women

Data from the 2004 Survey of Inmates in State Correctional Facilities were used to examine the effects of sexual abuse on the physical and mental health of incarcerated women. This nationally representative sample consisted of a cross-section of 2,885 female inmates ranging in age from 16 to 74. Using bivariate analysis, we made comparisons between sexually abused (n = 1,205) and non–sexually abused (n = 1,680) inmates. Abused women were more likely to report increases in health problems and mental health diagnoses, as well as other self-reported mental health conditions, such as paranoia, depressive symptoms, anger, and lifestyle changes. Respondents with extensive sexual abuse histories (multiple and across the life cycle) were also more likely to suffer higher levels of paranoia, depression, chronic health problems, and attempted suicide.     

Mental health and corrections: towards a working partnership

This paper describes the development of mental health services to the courts and correction facilities in the City of New York. The origins, structure, and functions of the interagency New York City Task Force on Prison Mental Health Services are explained. The Task Force's role in the development, promulgation, and implementation of the Minimum Standards for Mental Health Services in New York City Correctional Facilities are outlined. These standards, enacted by the New York City Board of Correction, are described and discussed.     

The Relationship of Abuse to Women’s Health Status and Health Habits

The present study examined the relationship between exposure to abuse and women’s health status and health behaviors in a sample of rural women. One hundred forty-eight women visiting a community health care center completed survey packets that included measures that assessed: exposure to abuse, impairment associated with exposure to abuse, physical and mental health problems, health behaviors, and the extent of health care usage. Results indicated that exposure to abuse was positively and significantly related to the adoption of a negative psychological perspective, which in turn was negatively correlated with physical and mental health, as well as with the practice of healthy behaviors. Results also showed that women exposed to abuse engage in less healthy behaviors and utilize more health care resources than do women with no such exposure. Implications for improving the assessment and treatment of abuse in health care settings are discussed. This article is based on a thesis completed by the first author with the same title as this report.     

Mental Health Services for Incarcerated Youth: Report from a Statewide Survey

The need for mental health care has been steadily increasing for youth coming into contact with the juvenile probation system. This paper presents the results of a statewide survey of juvenile probation departments and associated mental health, health care, court, and education personnel in California. The intent of the survey was to better understand the costs and associated contexts of caring for youth with suspected mental disorders in juvenile detention facilities. The burden of caring for these youth on detention facilities and their staffs is substantial. Implications for courts, policy planning, training, and further research are discussed.     

Actions taken in response to mental health screening at reception into prison

Screening for mental health problems on reception into custody has been criticised. However, there have been few studies on care pathways through custody as a result of screening identification. We aimed to identify what actions were taken as a result of screening positive for suicidal ideation and mental health problems. Case records for 2166 prisoners newly received into five prisons in England and documented contact with health care professionals in the following month were examined by hand over a four-month period. Altogether, 3% of prisoners were screened as having current suicidal ideas, of whom 30% had no contact with mental health services or risk assessment documentation. Another 21% of new receptions received psychotropic medication, for whom over 60% received no primary mental health assessment, and only 36% received psychotropic medication in prison. Care pathways need to be defined, and screening needs to be delivered as originally intended by initial screen for life-threatening matters, followed by a later, comprehensive assessment of health needs.     

Co-occurring mental disorders among criminal offenders

Many convicted offenders suffer from major mental disorders. These offenders commit crimes with great frequency. They do not receive mental health care and are often found in isolation cells of correctional facilities. The present investigation examined lifetime multiple disorders, measured by the DIS, among a representative sample of male penitentiary inmates. Pure forms of the major mental disorders were rare. All possible combinations of the major disorders were found to exist. No patterns of groupings of disorders were evident.     

Services and treatment for disabled infants; model guidelines for health care providers to establish infant care review committees--HHS

These are model guidelines to encourage the establishment within health care facilities, especially facilities with tertiary level neonatal care units, of committees for the purposes of educating hospital personnel and families of disabled infants with life-threatening conditions, recommending institutional policies and guidelines concerning the withholding of medically indicated treatment (including appropriate nutrition, hydration, and medication) from such infants, and offering counsel and review in cases involving disabled infants with life-threatening conditions. The publication of these model guidelines is required by section 124(b) of the Child Abuse Amendments of 1984, Pub. L. 98-457.     

The Impact Imprisonment has on Women's Health and Health Care from the Perspective of Female Inmates in Kansas

This multimethod study, conducted at the Topeka Correctional Facility during the summers of 2001, 2002, and 2003, investigated the impact of imprisonment on women's health and health care. The researcher hypothesized that 3 independent constructs—(a) extended strain, (b) level of health care received either before or during incarceration, and (c) detrimental social structural influences—could predict the health status of female inmates prior to and during incarceration. Multiple regression analyses conducted on 1 survey sample of 120 inmates revealed that only health care prior to incarceration and extended strain contributed significantly to explaining the inmates' self-perceived health status prior to and during incarceration. When life history interviews with 22 inmates were examined to determine inmates' perceptions of their health status and the health care they had received, prior to and during their imprisonment, qualitative results revealed inmates expressed dissatisfaction with the quality of health care received in prison, as well as the manner in which it was administered.     

Services and treatment for disabled infants; interim model guidelines for health care providers to establish infant care review committees--HHS. Notice of opportunity to comment

These are interim model guidelines to encourage the establishment within health care facilities, especially facilities with tertiary level neonatal care units, of committees for the purposes of educating hospital personnel and families of disabled infants with life-threatening conditions, recommending institutional policies and guidelines concerning the withholding of medically indicated treatment (including appropriate nutrition, hydration, and medication) from such infants, and offering counsel and review in cases involving disabled infants with life-threatening conditions. The publication of these interim model guidelines for public comment is required by section 124(b) of the Child Abuse Amendments of 1984, Pub. L. 98-457.     

The Swedish mental health system. Past, present, and future

In sum, the evolution, strengths, and weaknesses of the Swedish mental health system are quite similar to mental health systems in other Western countries; early reliance on stand-alone, state psychiatric hospitals, followed by deinstitutionalization and development of largely ambulatory, community mental health care. This evolution has been complicated in Sweden by the multiple levels and system components, the state, the county councils and the municipalities. Unlike the United States, but similar to Britain, community mental health care in Sweden is provided by two systems; treatment (and forensic services) by the county councils' mental health providers, and generic services by the municipalities' social welfare system. The resulting division of roles and responsibilities creates a strong need for collaboration and coordination of activities on behalf of consumers. It can also have the unintended disincentives to serving more difficult consumers. All these difficulties not withstanding, the Swedish mental health system has made major stride in providing quality, appropriate care.     

The Impact of Insanity Acquittees on Missouri's Public Mental Health System

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouri's insanity acquittees on the state's public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems.     

A rejoinder to Vaughn and Smith's “Practicing penal harm medicine in the United States: Prisoners' voices from jail”

Correctional health care has improved tremendously over the past 25 years. This rejoinder is a response to an article published in Justice Quarterly by Michael Vaughn and Linda Smith, in which they assert that the quality of correctional health care is suspect in correctional settings, and that an examination of one jail's problems with health care delivery revealed a “penal harm medicine” movement. We call into question such an assertion, claim that the penal harm medicine hypothesis cannot be proven by the data presented by Vaughn and Smith, and state that many of their conclusions are tenuous and harmful to correctional health professionals. We offer an analysis of their claims and suggest a more balanced view of correctional health care.     

The mental health service crisis of neoliberalism -- an antipodean perspective

Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.     

Using the National Diabetes Audit to improve the care of diabetes in secure hospital in-patient settings in the UK

To examine the ability of two forensic units, one high secure and one medium secure, to meet the NICE (National Institute for Health and Care Excellence) standards of care for diabetes. We applied the National Diabetes Audit programme, which uses as standards the NICE guidelines, to assess the quality of care provided for patients in two forensic units. Of the 500 patients, 200 in high secure and 300 in medium secure, 88 (17.6%) had type 2 diabetes. None had Type 1 diabetes. Of those with Type 2 diabetes, the care of 74 (84%) met all 8 NICE recommended standards. Glucose levels were lower in the medium/low secure unit compared to the higher security environment. Whilst achievement of process-based outcomes was higher than those reported nationally, achieving clinical outcomes was more challenging. High-quality diabetic care can be provided for patients in forensic units. Benchmarking physical health outcomes against national criteria in mental health inpatients is a potential method of improving outcomes.     

The Independent Medicare Advisory Committee: death panel or smart governing?

This comment explores whether health care reform legislation establishes an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." IMAC's recommendations would be implemented nationally, subject to a Congressional vote. Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations. Part I is an introduction. Part II of this article covers the history of American health care. It lays out the federal government's evolving role in the arena of public health and health care, starting in the mid-nineteenth century and continues up to the present day. Part III examines the existing process by which Medicare spending is controlled. This part focuses on the administrative procedures that control Medicare reimbursements. Part IV examines IMAC. This part discusses IMAC's statutory provisions and the administrative transparency laws IMAC would be bound to follow. The close of this part, draws on three analogies as a gauge for how IMAC will operate: Senator Tom Daschle's Federal Health Board (FHB) proposal; the administrative oversight of the Federal Reserve; and the United Kingdom's National Institute for Health and Clinical Excellence (NICE). Part V creates a snapshot of the U.S. health care system as it operates today. This part emphasizes cost, quality, and accessibility of health care, with comparisons to international and state-run health care systems. Throughout this article there are a number of words, phrases, and agencies that have been given acronyms. For convenience, an index of these acronyms is provided in an appendix following the article.     

Medical school forensic psychiatry units in health care delivery facilities rather than criminal justice institutions: an alternative model

We have presented a model for developing forensic psychiatric treatment and teaching services of a medical school Department of Psychiatry, but where these services are the basic comprehensive health care delivery system for the entire community. These offer consultative and treatment services for adult and family court clinic, psychiatric forensic services, of forensic psychiatry open bed and medium security-type bed, as well as day hospital and outpatient services. All of these are sited in the normal health care delivery system of the university teaching hospitals and its patient treatment, teaching, and research facilities. Consultative services are offered on request to the criminal justice system, but the basic health care delivery system is controlled administratively by the ordinary university teaching hospital authorities and exists as a one of a kind unit at the Royal Ottawa Hospital. The Royal Ottawa Hospital is a private nonprofit hospital, with its own Board of Trustees, and is affiliated with the medical school, as part of a major university network. We believe it important to present this model for an overall forensic psychiatric service, in contradistinction to the more commonly established forensic psychiatric facilities in state mental hospitals, in a special facility for the criminally insane, or in a criminal justice system institution such as a penitentiary. We believe that our model for forensic psychiatric facilities has great advantages for the patient. Here the patient is treated in a specialized facility (as all psychiatric patients with specialized problems should be); but one which is a specialized forensic facility, within the range of specialized psychiatric facilities that are needed by an urban community.(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV-infected prisoners: what mental health services are constitutionally mandated?

State and federal correctional facilities currently have approximately 23,000 inmates who are infected with human immunodeficiency virus (HIV). These inmates suffer from the same mental health disorders as uninfected inmates but are additionally subject to mental health problems uniquely related to their HIV infection. Many prison systems are struggling to provide minimal mental health care to uninfected inmates. How will prisoners address the additional mental health needs of the staggering number of inmates being diagnosed with AIDS and HIV? This article describes the type of mental health services that are constitutionally mandated and discusses whether and how prisons will have to respond to the distinct mental health issues related to HIV infection.