The nature of police involvement in mental health transfers

During the course of their duties, police regularly have contact with mentally ill persons who are experiencing psychiatric crisis and require some form of mental health transfer. This study examined 2611 unique mental health transfers completed by police in the Australian state of Victoria over an eight-month period in 2009–2010. The overwhelming majority of mental health transfers performed by police during this period were the result of unplanned calls for assistance. Although police frequently requested assistance from other services, these were often not available. The study findings support a substantial body of anecdotal evidence from police citing lengthy involvement with people experiencing mentally illness, with the average mental health transfer consuming 2.5?h of police time. The frontline responses of police to people in psychiatric crisis need to be more formally acknowledged and creative solutions need to be sought with health and welfare services to better meet the needs of those who are falling between the cracks of community mental health care services.     

Policing the deinstitutionalized mentally ill: Toward an understanding of its function

Although the police have long been recognized as a community health resource in the United States, this role has expanded significantly over the past several decades as a result of the deinstitutionalization movement. From a critical perspective, this article provides an analysis of the relationship between this enlarged police role and the current American socio-political order, in general, and the welfare state in particular. It is argued that in the course of handling the mentally ill the police carry out a number of functions for both the welfare state and the socio-political order, and in doing so, shore-up the social conditions which have inhibited the development of a positive, long-term care policy for the mentally ill. This article discusses three such functions and identifies an alternative social arrangement; one in which the police would not have to serve as a support for liberal-capitalism and its attendant inadequate welfare state.     

The Co-occurrence of Child and Intimate Partner Maltreatment in the Family: Characteristics of the Violent Perpetrators

This study considers the characteristics associated with mothers and fathers who maltreat their child and each other in comparison to parents who only maltreat their child. One hundred and sixty-two parents who had allegations of child maltreatment made against them were considered. The sample consisted of 43 fathers (Paternal Family—PF) and 23 mothers (Maternal Family—MF) who perpetrated both partner and child maltreatment, together with 23 fathers (Paternal Child—PC) and 26 mothers (Maternal Child—MC) who perpetrated child maltreatment only. In addition, 2 fathers (Paternal Victim—PV) and 23 mothers (Maternal Victim—MV) were victims of intimate partner maltreatment and perpetrators of child maltreatment and 7 fathers (Paternal Non-abusive Carer—PNC) and 15 mothers (Maternal Non-abusive Carer—MNC) did not maltreat the child but lived with an individual who did. Within their family unit, 40.7% of parents perpetrated both intimate partner and child maltreatment. However, fathers were significantly more likely to maltreat both their partner and child than mothers and mothers were significantly more likely to be victims of intimate partner violence than fathers. PF fathers conducted the highest amount of physical and/or sexual child maltreatment while MC and MV mothers perpetrated the highest amount of child neglect. Few significant differences between mothers were found. PF fathers had significantly more factors associated with development of a criminogenic lifestyle than PC fathers. Marked sex differences were demonstrated with PF fathers demonstrating significantly more antisocial characteristics, less mental health problems and fewer feelings of isolation than MF mothers. MC mothers had significantly more childhood abuse, mental health problems, parenting risk factors and were significantly more likely to be biologically related to the child than PC fathers. This study suggests that violent families should be assessed and treated in a holistic manner, considering the effects of partner violence upon all family members, rather than exclusively intervening with the violent man. Requests for reprints should be sent to Louise Dixon, Center for Forensic and Family Psychology, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.     

The right of caregivers to access health information of relatives with mental illness

This article reviews the legal, ethical and practical challenges of complying with the Ontario Personal Health Information Protection Act (PHIPA) within the context of a Canadian mental health system that is overburdened and under resourced. The advent of deinstitutionalization has placed significantly increased responsibilities on the families of mentally ill individuals. While research evidences that involving family members in the care of their mentally ill relatives improves treatment outcomes, mental health practitioners constantly face the challenge of engaging family caregivers while also complying with privacy laws. The authors propose an Ontario Caregiver Recognition Act (OCRA) to formally recognize family caregivers as informal health information custodians based on the practice of other jurisdictions which incorporate the rights of family members actively engaged in providing care to their mentally ill relatives.     

Mothers of Violent Children with Mental Illness: How They Perceive Barriers to Effective Help

The goal of the present study was to understand how mothers perceive and experience barriers to effective help for their violent child with mental illness. Data from ethnographic interviews with 26 self-identified mothers of violent children with mental illness were analyzed using grounded theory and focused coding. Our study identified three themes that represent barriers to help: (1) denial of mental illness and severity of violence by treatment providers, extended family, and non-family members; (2) limited access to quality treatment and supports; and (3) a recurring cycle from optimism to hopelessness. To inform policy makers and practitioners on how best to remove these barriers, we draw comparisons between the current sample and survivors of intimate partner violence. Our paper concludes with recommendations for mental health practitioners and family intervention specialists.     

Children's experiences of domestic violence: developing an integrated response from police and child protection services

Police notifications of incidents of domestic violence to child protection services constitute an acknowledgement of the harm that domestic violence inflicts on children. However, these notifications represent a substantial demand on child welfare services and the outcomes for children and victims of domestic violence have been questioned. This paper presents findings from the first UK study to examine these notifications in depth and examines the interface between the police and child protection services in responding to domestic violence incidents. The research reports on police interventions in 251 incidents of domestic violence involving children; the communication of information to child protection services and the subsequent filtering and service response. Social workers found that notifications conveyed little information on children's experiences of domestic violence. Forty per cent of families notified had had no previous contact with child protection services in that area, but those cases most likely to receive social work assessment or intervention were those where the case was already open. Notifications triggered a new social work intervention in only 5% of cases. The study also identified a range of innovative approaches for improving the co-ordination of police and child protective services in relation to children's exposure to domestic violence. Arrangements that maximized opportunities for police and social workers to share agency information appeared to offer the best option for achieving informed decisions about the appropriate level of service response to children and families experiencing domestic violence.     

Gender difference or indifference? Detective decision making in sexual assault cases

Prior research examining sexual assault case decision making has failed to account for the demographic characteristics of the criminal justice practitioners charged with making case decisions. Inclusion of such information is important because it provides researchers with a greater understanding of how criminal justice practitioners' own gender, race, age, and past experiences affect their judgments. This study seeks to examine whether gender differences exist in detectives' arrest decisions in sexual assault cases. Victim, suspect, incident, and detective characteristics are collected from police case and investigatory files on 328 criminal sexual assault cases involving adult female victims reported to a large Midwestern police department in 2003. Logistic regression is used to determine whether detective gender predicted the odds of arrest after controlling for incident, victim, and suspect characteristics. It is hypothesized that cases involving female detectives would be more likely to result in arrest after controlling for other incident, victim, and suspect characteristics. However, contrary to expectations, female detectives are significantly less likely than male detectives to arrest suspects in sexual assault cases even after controlling for the influence of other factors shown to predict arrest. The findings support prior research that suggests female practitioners may not necessarily be more sensitive toward female victims despite previous assumptions that this would hold true. The findings suggest that efforts to hire female police officers for the purposes of dealing with female-related victimization may ultimately undermine efforts to improve victim experiences with the criminal justice system. They further suggest that both researchers and police administrators need to rethink the best ways to serve female victims beyond hiring mandates.     

A comparison of the ability of experts and non-experts to differentiate between adult and child human bite marks using receiver operating characteristic (ROC) analysis

Fifty colour prints of human bite marks were sent to 109 observers who were asked to decide using a six point rating scale, whether the marks had been produced by the teeth of an adult or a child. The observers consisted of accredited senior forensic dentists, accredited junior forensic dentists, general dental practitioners, final year dental students, police officers and social workers. The results were compared against a “gold standard” which was the actual verdict from the case. Comparison of the results between the groups of observers and the standard was made using Receiver Operating Characteristics (ROC) methodology. The best decisions were made by senior/junior experts or final year dental students. General dental practitioners and police officers were least able to differentiate correctly between adult and child bite marks. The effect of training is important and its effects need to be assessed in more detail in future studies.     

Police use of TASERs in the restraint and transport of persons with a mental illness

The mentally ill are overrepresented in the statistics of individuals killed or injured by police and it is understandable that police would seek a weapon, such as a TASER, that is less lethal than a firearm. However, it appears that use of TASERs is not without risk, especially in certain groups, including the mentally ill. The risk of injury to vulnerable people with a mental illness from TASER weapons must be weighed against the risk that escalation to lethal force may cause if a person with an acute mental illness requires restraint. When police officers are carrying out their duties under mental health legislation it is recommended that TASERs be used only when an individual is imminently likely to sustain or to cause grievous bodily harm. This article recommends changes to the Western Australian Police TASER training programs and proposes mandatory medical assessments after the use of TASER restraint.     

Child murder committed by severely mentally III mothers: an examination of mothers found not guilty by reason of insanity. 2005 Honorable Mention/Richard Rosner Award for the best paper by a fellow in forensic psychiatry or forensic psychology

Forensic hospital records of 39 severely mentally ill mothers adjudicated Not Guilty by Reason of Insanity for filicide (child murder by parents) were analyzed to describe characteristics preceding this tragedy and to suggest prevention strategies. Almost three-quarters of the mothers (72%) had previous mental health treatment. Over two thirds (69%) of the mothers were experiencing auditory hallucinations, most frequently command hallucinations, and half (49%) were depressed at the time of the offense. Over one third (38%) of the filicides occurred during pregnancy or the postpartum period, and many had a history of postpartum psychosis. Almost three-quarters (72%) of the mothers had experienced considerable developmental stressors, such as death of their own mother or incest. Maternal motives for filicide were predominantly "altruistic" (meaning murder out of love) or "acutely psychotic" (occurring in the throes of psychosis, without rational motive). Psychiatrists should perform careful risk assessments for filicide in mothers with mental illnesses.     

Incarcerated Mothers of Minor Children: Physical Health,Substance Use,and Mental Health Needs

Mothers of minor children serving sentences in a large Midwestern jail were screened for potential substance use problems and asked to report their physical and mental health status and treatment experiences. Of mothers screened for substance use problems, 72.1% had positive findings on the AUDIT-12, 56.7% reported at least one serious physical health problem, and 67.1% had received mental health treatment. More than two-thirds (68.8%) of the 240 mothers reported a co-occurring condition, and a third (33.8%) reported problems in all three spheres (substance use, mental health, and physical health). The relationship among the three health-related problems is examined as well as the characteristics of mothers related to having co-occurring health conditions. Given that the overwhelming majority of mothers reported more than one health-related problem, the changes to policy and practice need to avoid simplistic solutions.     

The assessment of mother-child interactions in physically abusive and nonabusive families

Physically abusive mothers and their children were compared with matched nonabusive mothers and their children in a laboratory playroom setting. Parenting skills, as well as mother-child interaction patterns, were assessed using three different tasks designed to create varying levels of parental stress and child frustration. Mother-child interactions were observed and coded. Questionnaire measures of knowledge of child behavior and a measure of social desirability were also administered. Discriminant function analyses revealed that 10 of the 11 abusive mothers and 10 of the 12 control mothers could be correctly identified, representing an 87% classification rate. The main difference between the two groups was in the overall rate of activity. Abusive mothers engaged in significantly less behavior toward their children than control mothers; behavior rates were essentially similar for both groups of children. Abusive mothers contingently praised appropriate behavior significantly less often than controls, and abused children complied significantly less often to requests. The implications of these findings for the understanding and treatment of abusive parent-child interactions were discussed.     

Suicide in children,adolescents and young adults

As suicides of children, adolescents and young adults occur very seldom and only few case reports and more comprehensive studies are available in forensic literature, the autopsy records of the Bonn Institute of Forensic Medicine and the database of the Bonn police authorities from 1989 to 1998 were retrospectively analysed for this phenomenon. This search revealed 37 respective suicides involving 23 male (62%) and 14 female (38%) victims. The ages ranged from 10 to 21 years with the prevalence sharply increasing in adolescents and young adults. Independent from sex, the victims almost unexceptionally applied hard suicide methods like hanging, running over by a train or jump from the height. As for the psychological background, current conflicts with a sweetheart, within the family or at school on the background of mental illness or chronically disturbed family structures were encountered as prevailing factors.     

A Qualitative Examination of the Self-Medicating Hypothesis Among Female Juvenile Offenders

Substance misuse among criminally delinquent youth has typically been described as a concurrent part of their participation in risky and delinquent behavior. Using Khantzian’s self-medication hypothesis, this article presents an alternative view by presenting qualitative data which suggests that substance misuse for female juvenile offenders may serve as self-medication for mental health problems stemming from early trauma, often at the hands of their families. Based on the narratives of 30 female juvenile offenders, this article examines the lived experiences of girls with childhood trauma and substance misuse, followed by arrest and incarceration. The paper concludes with recommendations for juvenile justice and child welfare practitioners.     

Police officer attitudes and use of discretion in situations involving the mentally ill. The need to narrow the focus

Research to date has very effectively highlighted the fact that the mentally ill are vulnerable to systematic criminalization. The reasons cited for this range from decreasing mental health resources, to restrictive civil commitment statutes, to increased numbers of mentally ill citizens in the community as a result of deinstitutionalization. However, the research has also shown that the presence of a criminalization phenomenon is not yet generalizable. The prevailing research emphasizes a macro-level approach, using either archival data or large groups of police-citizen contacts without regard for factors intrinsic to the police-citizen exchange. This article examined two such variables (police-citizen contact type and police officer type) to illustrate the need to narrow the focus in the research. We contend that our emphasis moves the criminalization debate forward and helps provide a more comprehensive understanding of the interaction between the police and the mentally ill. Further, we submit that by controlling for these two variables, research findings will more likely be generalizable and replicable.     

An Investigation of Mental Health and Personality in Swedish Police Trainees upon Entry to the Police Academy

This study aimed at personality and mental health status of Swedish police trainees considering gender differences; and at relationships between personality and mental health. 103 individuals were investigated by means of the SCL-90-R and the Temperament and Character Inventory (TCI) upon entry to the police academy. By contrast, the police trainees were mentally much healthier than individuals from the general population. They reported low Harm Avoidance and their character dimensions were more developed in terms of strength, responsibility and reliability. Harm Avoidance (positively) and Self-Directedness (negatively) were found to be associated with all facets of psychopathology. The good mental health and mature personality characteristics reported by trainees, particularly the females, suggest that they have the strength to master the stressful situations which they will face in their professional lives. In order to prevent possible psychological disturbances later in life, due to the high level of distress in their work, the development of trainees’ personality in terms of particular coping skills should be regarded as an integral part of their professional training at the police academy.     

Mental health issues and the Canadian criminal justice system**

The critics assert that a significant proportion of incarcerated individuals suffers from mental health issues, i.e. ‘the criminalization hypothesis.’ The current paper reviews the scholarly literature to address five interrelated questions: (1) What are the risks of those classified as mentally ill for committing crimes and, in particular, violent crimes? (2) As the gatekeepers to the criminal justice system, what happens during ‘first encounters’ between the police with those who have mental illnesses? (3) What community-based services are available for effective diversions as an alternative to incarceration for those with mental illnesses? (4) What are the impacts of treatment options upon those experiencing mental illnesses while incarcerated, including the impact upon recidivism? (5) What types of pre-release planning and community responses have the most positive effects to help reduce recidivism and assist offenders in coping with mental health issues in the Canadian context? After summarizing key evidence pertaining to these questions, the paper presents case studies as exemplars of ‘best practices’ to illustrate promising directions conducive to integrated, holistic, and effective responses at the intersection of the criminal justice and mental health systems.     

Experiences of Stalking Victims and Requests for Help in Three European Countries. A Survey

Previous research by the Modena Group on Stalking (MGS) regarding awareness and recognition of stalking by police officers and general practitioners using case scenarios showed significant differences across three countries. It was also hypothesized that victims used different pathways when seeking help. To explore the experience of requesting help by victims of stalking in different European countries a detailed survey was completed by 391 victims of stalking in Belgium (n = 145), Italy (n = 126) and Slovenia (n = 120). The research confirmed the significant intensity and duration of stalking and psychological distress for victims. Victims used several pathways to survive stalking. Some victims reported that informal interventions they or family/friends implemented were effective, but the majority had to have recourse to helping agencies. Significant differences in help seeking behaviour were found between the three countries. In Belgium victims contacted the police, as well as other helping agencies, more often and more precociously than in Italy and Slovenia. Restriction orders against the stalker were considered the most effective intervention. Police were regarded as the least supportive agency, taking victims less seriously, and not being particularly effective at stopping the stalkers. Police were ranked after family/friends, lawyers and colleagues, with regards effectiveness, except in Belgium, where Police’s effectiveness was ranked second after lawyers. Stalking often requires the mobilization of multiple helping agencies by victims and it is important that victims are aware of what help is available to them and that agencies become more sensitive to their needs.     

The influence of personal history of abuse and gender on clinicians' judgments of child abuse

Two extra-legal factors were examined for their influence on professionals' decisions to report child abuse: having been abused as a child oneself, and the gender of the child, the parent, and the professional. One hundred and one men and women who worked regularly with children in mental health settings rated a series of scenarios presented as cases from a protective service agency. Participants made several judgments regarding the case including the severity of the parent's behavior, the likely effect on the child, whether the situation was abusive, and whether the case should be reported to a social service agency. Despite some interpretive limitations, the results generally support the hypothesis that extra-legal factors influence the perceptions of professionals who are mandated to report a suspected incident of abuse.     

PLC or TLC: is outpatient commitment the/an answer?

The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.