Putting mental health into mental health law

This article critiques the traditional doctrinal approach to mental health law and compares the traditional approach with a new, interdisciplinary approach known as therapeutic jurisprudence. Therapeutic jurisprudence views the law itself as a potential therapeutic agent. Examples are given of how legal rules, procedures, and the roles of legal actors may produce therapeutic or antitherapeutic results and of how the law may improve therapeutic outcomes without sacrificing the interests of justice.     

Redefining mental health law

Mental health law traditionally focuses on preserving the civil and constitutional rights of people labeled mentally ill. However, because of fundamental changes in the public mental health system. most people labeled mentally ill no longer reside in state psychiatric hospitals. As a result, the core policy issue in mental health today is assuring access to community based services, supports, and housing which enable people to live successfully in the community. Because of this different environment, the definition and scope of mental health law must be expanded dramatically if those interested in the subject are to continue to influence mental health policy. This article examines five contemporary mental health policy issues, including changes in reimbursement systems and the growth of the consumer and family movements, that illustrate the legal, policy, and research questions which will emerge in an expanded and redefined mental health law agenda. The author thanks Ingo Keilitz, Thomas Hafemeister, and Pamela Casey for their review of earlier drafts of this article.     

Private regulation in mental health

General hospitals are increasingly important sources of care for chronic and acute mental patients. Joint Commission on Accreditation of Hospitals (JCAH) standards for staffing in general hospitals require the same degree of physician supervision and control for all services, including mental health. This paper considers the economic impact of JCAH standards on the practice of psychologists in hospitals. The “voluntariness” of the standards is assessed and the evidence that these standards foster economic protectionism is considered. We conclude that in light of the demonstrated capability of nonphysician professionals, methods of quality control appropriate for physician health care in general hospitals should be reconsidered as these instutions diversify into mental health services.     

Integration and offender mental health

Integrated care can introduce seamless coordinated pathways that are focused around the individual needs of patients, helping to prevent missed opportunities for intervention. Within offender healthcare, sequential funnelling through designated areas where screening can take place, along with co-location of services, lends itself to integrated working, at least in theory. However, within the offender healthcare pathway, service fragmentation and autonomous, disconnected (often referred to as siloed) working, has historically been the norm. If commissioned and designed to ensure and incentivise connections between services, whilst developing high quality service-focused research activities, pathways could enable clinical and social interventions, and outcomes, on a public health scale for these highly morbid populations. As such, offender healthcare offers a real opportunity to model integration for wider introduction across other health and social care areas. Discussed within is the call for integration, its concept, and its role within offender healthcare.     

躯体损伤与精神损伤

躯体损伤与精神损伤作为人体相对应的损伤类型,具有不同的医学和法学特征,同时两者又保持着相互依存和相互转化的关系。躯体损伤与精神损伤不仅在分类上保持了各自的特点,在评定的具体依据上也存在较大的差异。     

The impact of mental health services on arrests of offenders with a serious mental illness

This study examines the impact of mental health services on arrests of offenders with a serious mental Illness (SMI) by assessing changes in associations between receipt of outpatient and emergency room/inpatient services and arrests one, two, and three quarters later. A variety of data sets were used for identifying 3,769 offenders who were in the Pinellas County Florida jail between 7/1/2003 and 6/30/ 2004, and 7,755 offenders who were in the Harris County Texas jail between 10/1/2005 and 9/30/2006. Arrests, out-patient and emergency room/inpatient services were assigned to one of 16 ninety-day periods between 7/1/2002 and 6/10/2006 in Pinellas County and one of 12 such periods between 10/1/2004 and 9/15/2007 in Harris County. Generalized estimating equations were used. Covariates were age, gender, race, diagnosis, and homelessness. The results were also adjusted for exposure to arrests. In Pinellas County, outpatient services significantly reduced the risks of arrests 1 quarter later by 17% (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.78-0.87, p < .001), two quarters later by 11% (OR = 0.89, 95% CI: 0.84-0.94, p < .001), and three quarters later by 9% (OR = 0.91, 95% CI: 0.86-0.96, p = .001). In Harris County, these services reduced the risk of arrest 1 quarter later by 5% (OR = 0.95, 95% CI: 0.91-0.99, p = .028), but not two and three quarters later. In Pinellas County, ER/inpatient services increased the risk of arrests by 22% (OR = 1.23, 95% CI: 1.15-1.30, p < .001), 8% (OR = 1.08, 95% CI: 1.02-1.15, p = .010) and 11% (OR = 1.11, 95% CI: 1.02-1.16, p = .001) one, two, and three quarters later. In Harris County, these services increased the risk of arrest only 1 quarter later (OR = 1.16, 95% CI: 1.11-1.22, p < .001). Results suggest that service receipt and its timing may have had some impact on the arrests of adults with a SMI and criminal justice involvement.     

Community mental health and prisons: A model for constitutionally adequate care in correctional mental health

The establishment of judicially acceptable standards of mental health care within a prison setting requires the adoption of a service-delivery model and a constant evaluation of that model in relation to individual and civil rights. This article reviews the experience of the department of corrections in one state in developing a constitutionally adequate mental health system. The report outlines the programs established, the legal basis for decisions, and recent constitutional challenges. Future trends in correctional mental health are also discussed.     

精神发育迟滞患者的犯罪学特征分析

目的探讨司法精神病学鉴定中精神发育迟滞(MR)患者的犯罪学特征。方法采用自编的司法精神病学鉴定案例登记量表,对83例MR患者的犯罪学特征进行分析,并对轻度MR与中重度MR的犯罪学特征进行比较。结果MR涉嫌犯罪者中轻度MR占62.7%,中度MR占22.9%。性犯罪占37.3%,凶杀占34.7%,财产犯罪等占28.0%。犯罪动机明确者占96.1%。有犯罪史者占34.7%。轻度MR与中重度MR两组间作案预谋(χ2=11.9,P=0.001)、作案目标确定(χ2=7.531,P=0.006)、作案动机(χ2=7.920,P=0.019)、作案类型(χ2=7.855,P=0.02)有显著性差异。结论MR涉嫌犯罪者以轻度居多,犯罪类型以性犯罪及凶杀犯罪占比例较大,大多数犯罪动机明确。轻度MR组有作案预谋、作案前确定目标者明显高于中重度MR组。中重度MR作案动机为性满足者明显高于轻度MR。