The Criminogenic,Clinical, and Social Problems of Forensic and Civil Psychiatric Patients

Forensic psychiatric patients consume an increasing proportion of mental health resources in Canada and the United States. To inform mental health policy and practice, we compared the criminogenic, clinical, and social problems of forensic patients to those of civilly committed psychiatric patients in two Canadian studies. We predicted that forensic patients would score higher on criminogenic problems and lower on clinical and social problems than civil patients in two studies: one comparing 83 forensic and 189 civil inpatients on a clinician-completed form, the Resident Assessment Instrument--Mental Health, at an urban mental health center, and the second comparing 423 forensic and 178 civil patients assessed at different times using the Patient Problem Survey. The two studies were quite similar in their findings, despite differences in their samples, measures, and data collection methods. In both studies, forensic patients were similar to or lower than civil psychiatric patients in all criminogenic, clinical, and social problems. We conclude that forensic mental health services would benefit greatly by drawing from knowledge accumulated in the general psychiatric literature. This finding also supports the idea that many forensic patients can be appropriately diverted to nonforensic mental health services.     

Magistrates, Magistrates Courts, and Social Change

Relatively little attention has been paid to lower courts' capacity to bring about social change, despite the fact that most citizens who come into contact with the judicial system will have their case considered (and most likely only considered) by these courts. Often these citizens experience a range of problems that are social in origin, including precarious employment, welfare dependence, financial hardship, and various health problems, including mental health and drug dependency. Magistrates courts must respond to social change and its human fallout and, in so doing, can contribute to progressive social change in a local, personal, and incremental way.     

Religious fundamentalism,religiosity, and priming: effects on attitudes,perceptions, and mock jurors’ decisions in an insanity defense case

Jurors are asked to use their personal knowledge and experience to make verdict decisions; thus, it is no surprise that their religious beliefs might influence their decisions. During legal insanity trials, jurors might also be exposed to religious stimuli (e.g. crucifix, prayer, Bible, etc.), which could evoke (prime) religious beliefs and thus influence decisions. Two studies examined whether dimensions of religiosity and religious beliefs relate to attitudes and decisions concerning mental health defenses, testing social identity theory against Allport and Ross’s religiosity hypothesis. In Study 1 (attitudes survey) and Study 2 (mock juror decision-making paradigm), religious fundamentalist beliefs consistently predicted punitive attitudes and decisions related to mental health defenses and verdicts, and this was moderated by intrinsic religiosity, such that religious fundamentalist beliefs only predicted punitiveness for individuals low in intrinsic religiosity. Also, priming fundamentalist beliefs increased punitiveness in both verdict and sentencing decisions. Combined, these results suggest that religious beliefs play a role in jurors’ verdict decisions in an insanity case, and that priming fundamentalist beliefs increases jurors’ punitiveness. Allport and Ross’s religiosity hypothesis was supported, but social identity theory was not.     

International terrorism and mental health: recent research and future directions

International terrorism has become a major global concern. Several studies conducted in North America and Europe in the aftermath of terrorist attacks reveal that international terrorism represents a significant short-term and long-term threat to mental health. In the present article, the authors clarify the concept and categories of terrorism and then present central findings from studies conducted in the United States and Europe, which mainly focus on negative impacts on mental health, such as emotional stress and PTSD. Furthermore, the authors outline experiments that focus on social interaction processes thought to be triggered by international terrorism and which are assumed to be related indirectly to mental health processes. Next, they highlight the potential positive outcomes on the resilience side, in line with the current theory on posttraumatic growth in adversity. Finally, theoretical and practical implications as well as limitations and future directions are discussed.     

Perceiving others as different: a discussion on the stigmatization of the mentally ill

This commentary on the stigmatization of people with mental illness explores social perceptions of them as dangerous and uncivilized. The authors discuss how the legal system suggests that these are people who should be ousted from the community while mental health professionals attempt to reiterate the fact that these individuals are simply human. The authors describe ways people with mental illness have been subjected to discrimination, ridicule, and humiliation. This commentary discusses multiple perspectives of mental illness, from past to present, and how those perspectives influenced social, legal, and psychological frameworks.     

The Police and CMHCs: The Transition from Penal to Therapeutic Control

The deinstitutionalization of chronic mental patients and the establishment of Community Mental Health Centers creates a new role for the police—i.e. agents of therapeutic control. In this new role, police must move beyond their traditional behaviors as agents of penal control, and play an active part in initiating patients to psychiatric treatment. Social scientists and mental health professionals recognize the need for police training in this area. Yet, little research has been devoted to the penal-therapeutic transition per se. This paper examines the social structural factors necessary for such a transition, and it illustrates the methods by which CMHC professionals can manipulate their social control environments so as to fulfill these social structural "requirements". We also discuss some non-structural barriers to police acting as agents of therapeutic control and the prospects for overcoming them.     

The gendered construction of expert discourse: An analysis of psychiatric evaluations in criminal court

According to critical literature, psychiatrization is a central feature of gendered social control. It operates in a twofold process: by orienting women to medical institutions rather than the penal system, and, for those women who do enter the criminal justice system, by favoring an interpretation of their behavior in terms of mental health problems. However, the production of gendered social control cannot be reduced to institutional decision-making; it also leaves its traces in various discursive forms. One such form is forensic psychiatrists' discourse on the offenders they evaluate. Our study analyzes these forensic reports as units of a computerized database. Our goal is to gain insight into the text by means of systematic quantitative and qualitative procedures. Even though the expert discourse is shaped by specifications requested by the court, the discourse examined here constructs two very distinct identities that do not correspond to stereotyped conceptions about femininity and masculinity.     

A Preliminary Report of Psychiatric Diagnoses in a Scottish County Sample of Persons of National Security Concern

Increasing anecdotal, empirical, and research evidence indicates mental disorder history is one of the several factors associated with increased risk of involvement in lone-actor terrorist activities. Currently, few studies have been conducted on the mental disorder histories of individuals assessed as at risk of involvement in terrorist activities (Meloy, J Threat Assess Manag 2019;6:93). This pilot study describes demographic, psychiatric, and criminal characteristics of a sample of Scottish individuals identified by the Prevent element of the U.K. national counterterrorism strategy, and outcome data after follow-up at 2 years. Twenty-three individuals were referred to Prevent as posing a national security risk from a county in Scotland. Their records were studied for psychiatric and criminal histories. Nine (39%) had previous psychiatric contact, all were “lone actors”, and none were embedded with organized terrorist groups. The most common diagnoses were substance use disorder, personality disorder, depression, and psychotic disorder. The sample displayed factors associated with increased risk of violence including previous offending, early behavioral difficulties, school problems, substance misuse, cluster B personality disordered traits. After 2 years, 44% of the mentally disordered group had re-offended. The offense types were generally similar to those prior to the individual being involved with the Prevent counter terrorism program. Only one of the mentally disordered group committed a further national security offense. In this sample, mental disorder history is overrepresented in individuals who come to the attention of the U.K. Prevent counter terrorism strategy. Further empirical studies with additional power are required to develop the empirical evidence base in this under-researched area.     

Understanding the Potential Long-term Physical and Mental Health Consequences of Early Experiences of Victimization

Victimization in the USA is a substantial concern, despite a trend of decreasing crime rates. Victims of crime face a number of short-term consequences such as physical injury, fear and anxiety, and/or loss of property. Long-term consequences of victimization, however, may often be overlooked. Using the first six waves of the National Longitudinal Study of Youth, the current study examines the relationship between early experiences of victimization and long-term physical and mental health outcomes, including general health, access to and use of health care, and health risk behaviors. Results find that individuals who are victimized before the age of 12, especially those who experienced repeated bullying, are more susceptible to a number of physical and mental health issues such as negative perceptions of physical and mental health, smoking, subsequent victimization experiences, and homelessness. Public health concerns and policy implications of these findings are also discussed.     

THE RELATIONSHIP BETWEEN LAW VIOLATION AND DEPRESSION: AN INTERACTIONS ANALYSIS*

This paper integrates arguments from differential social control theory with sociological research on mental health to develop an interactionist explanation of the relationship between law violation and depression. We focus on the possibility that law violation and depression are related because they share common antecedents, as well as the possibility that these problems mutually influence one another over time. We test hypotheses derived from our theoretical perspective using covariance structure analysis and panel data. Our results show that the relationship between law violation and depression can be explained largely by common antecedents—social‐structural positions, stressful life events, and adolescent problems shape social relationships and identities, which together influence the likelihood of both early adulthood crime and depression. We also find limited support for mutual influence.     

Variations in mental health problems, substance use, and delinquency between African American and Caucasian juvenile offenders: implications for reentry services

The incarceration of young people is a growing national problem. Key correlates of incarceration among American youth include mental health problems, substance use, and delinquency. The present study uses a statewide sample of incarcerated youth to examine racial differences in African American and Caucasian juvenile offenders' outcomes related to mental health, substance use, and delinquency. The data indicate that relative to Caucasian offenders, African American offenders report lower levels of mental health problems and substance use but higher levels of delinquent behavior such as violence, weapon carrying, and gang fighting. The data further reveal that African American offenders are more likely than Caucasian offenders to be victims of violence and to experience traumatic events such as witnessing injury and death. Recognition of these patterns may help to improve postrelease services by tailoring or adapting preexisting programs to patterns of risk factors and their relative magnitudes of effect.     

Rationing psychosocial treatments in the United States

This paper briefly reviews the recent history of psychosocial treatment for adults with severe mental illnesses in the United States. It examines the current sources and financing of such care, revealing the planned and unplanned reclassification of entitled beneficiaries and eligible patients, appropriate treatment, acceptable outcomes, and levels and sources of payment. One illustration of this phenomenon is seen in current efforts to identify and deliver only those public services that are covered by Medicaid, so as to allocate state resources only when they can be matched by federal monies. Another is the reliance on private health insurance, tied in the U.S. almost exclusively to employment, for medical care delivered under an acute, rather than a chronic care model. These analyses conclude with a discussion of the implicit and explicit mechanisms used to ration access to psychosocial treatment in the United States. The implications for individuals with serious mental illnesses, their families, and the general public are placed in historical and current policy contexts, recognizing the economic, social, and clinical variables that can moderate outcomes.     

我国农民工心理健康与保护策略研究概述(2010-2019年)

农民工从乡村到城市后,面对就业收入、子女教育、人际关系等剧烈变化的陌生环境,往往承受着较大的心理压力。过高压力可能带来诸多社会和医学问题,导致事故、酗酒、意外伤亡、自杀和家庭破裂,使社会蒙受巨大损失。解决农民工心理健康问题牵涉到社会保障、城市管理、工业发展等工作,需要政府及卫生部门、安监部门、社会保障部门等密切配合,供给有效保护农民工心理健康的社会政策。     

Intellectual disability in a prison population with anger problems in Trinidad

This paper describes the characteristics of groups of prisoners selected to take part in an anger management programme in prisons in Trinidad. Participants completed demographic measures, an IQ assessment, mental health measures and anger rating scales. Fifty-six inmates were screened with the WASI-2 and characteristics of this group are explored in this paper. The mean IQ for the group was 72.34 and 22 had a recorded IQ below 70 (37.5%). All of the respondents reported high levels of mental health problems with their mean ratings on the SCL-90 being closer to those of inpatient psychiatric group norms than non-clinical groups. A score of less than 70 on the WASI-2 is not sufficient for a diagnosis of an Intellectual Disability. Nevertheless, the results suggest that a significant number of individuals in these prisons may have an Intellectual Disability. More research is needed to help identify these individuals and provide support.     

Outpatient commitment: a therapeutic jurisprudence analysis.

This article analyzes the legal and therapeutic jurisprudence considerations raised by outpatient commitment. Although older forms of outpatient commitment have both legal and therapeutic advantages, preventive outpatient commitment raises serious legal problems and potential antitherapeutic consequences that may outweigh its claimed therapeutic value. As a result, alternatives are proposed, including wider availability of community treatment and outreach and case management services, assertive community treatment, police and mental health court diversion programs, and creative uses of advanced directive instruments and behavioral contracting. Proposals also are made for how preventive outpatient commitment can be applied more therapeutically, including hearings that accord patients a sense of procedural justice and techniques designed to motivate individuals facing such hearings to agree to accept treatment voluntarily.     

LAWYERS AND MENTAL HEALTH PROFESSIONALS WORKING TOGETHER: RECONCILING THE DUTIES OF CONFIDENTIALITY AND MANDATORY CHILD ABUSE REPORTING

Lawyers are increasingly finding themselves working in conjunction with a social worker and/or a psychologist. This dynamic can be found in organizations that take a multi‐disciplinary approach to the law, such as New York City's Legal Aid Society and Lawyers for Children. Collaborative law is another such example. Collaborative law is an increasing trend in family law; it provides a divorcing couple the opportunity to work with professionals from different disciplines, without being subject to the court system. While a multi‐disciplinary approach to the law has the ability to maximize the value of representation, it also can create tension when inconsistent duties are imposed by conflicting professional obligations. A major area of conflict is between the lawyer's duty to maintain client confidences and the mental health professional's duty to report child abuse. This Note discusses the important policies behind these opposing duties. The Note recommends amending state child abuse and neglect laws in order to eliminate the conflict between the professions' duties and allow lawyers and mental health professionals to work together more harmoniously. Amending state child abuse and neglect laws will allow for mental health professionals working with a lawyer who represents a client the same reporting duties as lawyers in the process.     

The Base Rate Study: Developing Base Rates for Risk Factors and Indicators for Engagement in Violent Extremism

Improvements have been made in identifying the prevalence of risk factors/indicators for violent extremism. A consistent problem is the lack of base rates. How to develop base rates is of equal concern. This study has two aims: (i) compare two methods for developing base rates; the Unmatched Count Technique (UCT) and direct questioning, (ii) generate base rates in a general population sample and compare these to a sample of lone-actor terrorists (n = 125). We surveyed 2108 subjects from the general population. Participants were recruited from an online access panel and randomly assigned to one of three conditions; direct survey, control, or UCT. Survey items were based on a lone-actor terrorist codebook developed from the wider literature. Direct questioning was more suitable under our study conditions where UCT resulted in deflation effects. Comparing the base rates identified a number of significant differences: (i) lone-actor terrorists demonstrated propensity indicators related to a cognitive susceptibility, and a crime- and/or violence-supportive morality more often; the general sample demonstrated protective factors more often, (ii) lone-actor terrorists demonstrated situational indicators related to a crime- and/or violence-supportive morality more often, whereas the general sample experienced situational stressors more often, (iii) lone-actor terrorists demonstrated indicators related to exposure to extremism more often. Results suggest there are measurable differences in the prevalence of risk factors between lone-actor terrorists and the general population. However, no single factor “predicts” violent extremism. This bears implications for our understanding of the interrelation of risk and protective factors, and for the risk assessment of violent extremism.     

The German Berufsgenossenschaften (institutions for statutory accident insurance and prevention): organisation, mandate and activities in the area of mental health

The present article first describes the institution of the German Berufsgenossenschaften (BGs, the institutions for statutory accident insurance and prevention) and their mandate. Besides rehabilitation and compensation, these comprise the prevention of occupational accidents and diseases, and work-related hazards. The main focus within the area of mental health is the prevention work, but rehabilitation and compensation within the German social insurance system in general, and with respect to mental health, will also be explained. Furthermore, the prevention-rehabilitation interface will be illustrated and the cooperation with the health insurance institutions will be described. In the second part, selected results of a survey regarding mental health and stress will be presented.     

A prospective comparative evaluation of a Criminal Justice Liaison and Diversion Service in Belfast

There is continued interest in the planning, development and implementation of services designed to identify detainees with mental illness and connect them to health and social services. However, currently, little is known about how best to configure, organise and deliver these services. The study employed a prospective follow-up design with a comparator group to describe and evaluate a police mental health liaison service based in Belfast. Participants were recruited from two neighbouring police stations, only one of which provided a mental health liaison service. Outcomes including mental health status, drug and alcohol misuse, risk-related behaviour and ‘administrative’ outcomes were assessed at the time of arrest and six months later. The service was successful in identifying and assessing detainees, though there appeared to be similar between-group levels of mental health problems over time. Results highlight a need to develop firmer linkages and pathways between criminal justice liaison/diversion services and routine health and social services.     

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.