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.     

Assessing the influence of the Columbine shooting on federal sentencing outcomes

School shootings are not a new phenomenon in the United States or internationally. In comparison to other acts of violence experienced by youth, such tragedies are uncommon but garner extensive media attention. The Columbine High School shooting received more attention across a broader range of issues than any other school shooting, with only the Sandy Hook tragedy rivaling it for media attention. In the aftermath of the Columbine shooting, public sentiment regarding violence in schools became a central point of contention that bred fear and panic. Given the embeddedness of judges within the larger community context and the effects of community characteristics on sentencing outcomes, we wondered if the Columbine shooting – via moral panic and community upheaval – might have had an impact on judges imposing criminal sentences. To assess the effect of the Columbine shooting on judicial decision-making outcomes, the current study uses United States Sentencing Commission data from 1998 through 2001. In doing so, it contributes to the extant literature concerning the embeddedness of judges within communities and answers recent call for more research on the temporal context of sentencing disparities.     

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.     

Psychosocial treatment in the 21st century

Over the past 50 years, psychosocial treatment has played an increasingly prominent role in helping persons with mental illness live in communities rather than in institutions. This paper briefly reviews evidence for and discusses three forms of treatment-assertive community treatment, supported employment, and cognitive behavior treatment-which have been studied extensively and are widely accepted as effective interventions. Forces are discussed that have shaped these and other psychosocial treatment over the past five decades. Despite the accumulated evidence, many questions remain about the cost-effectiveness and applicability of these treatments in specific populations and service environments. The development of these and other treatments has been, and continues to be, shaped by concerns about rising health care costs, a heightened emphasis on evidence-based treatment and by consumers taking a more active role in determining the services, and outcomes that are most helpful to them.     

TEMPO: A contemporary model for police education and training about mental illness

Given the increasing number of interactions between police and people with mental illnesses (PMI), there has been widespread interest in the development of education for police about how best to interact with PMI. This paper reflects the review of current practice in a variety of jurisdictions across Canada as well as in the United States (U.S.), the United Kingdom (U.K.) and Australia; it proposes a comprehensive model of learning based on the literature that addresses not only the content in the narrow sense but also the importance of broader contextual knowledge and understanding in developing effective education and training. Embedded in the principles articulated in the Mental Health Strategy for Canada, the TEMPO (Training and Education about Mental illness for Police Organizations) model is a multilevel learning strategy for Canadian police personnel. Learning objectives and key principles are articulated in order to ensure the model is applicable to a wide range of police agencies and individual jurisdictional needs. In addition to providing a firm basis of factual knowledge for police personnel, the resultant model embraces a human rights/anti-stigma philosophy, provides for a range of education appropriate to diverse police audiences, emphasizes a systems approach to police/mental health liaison activities and addresses issues related to the delivery and implementation of police education and training.     

Clinical Considerations for the Treatment of Latency Age Children in Residential Care

Children in the United States are exposed to alarmingly high rates of violence and trauma. Notable are the rates of maltreatment among children and the heightened risk for both out of home placement and an array of developmental, behavioral, and psychosocial sequelae. Despite these risks, little information is available on effective interventions and services designed to address the complex needs of youth in residential treatment settings. To effectively respond to their unique developmental, behavioral, and emotional needs, trauma-informed interventions and services must be provided to support optimal outcomes. To this end, this paper delineates the prevalence of children in residential care secondary to chronic maltreatment and other trauma exposures, identifies behavioral and emotional issues through the theoretical framework of complex trauma, highlights the importance of organizational capacity to deliver trauma-informed services, and describes effective clinical interventions that are often used in residential treatment. Clinical considerations and recommendations are also provided.     

Mental illness in the eyes of the law: examining perceptions of stigma among judges and attorneys

In response to the increasing numbers of mentally ill persons placed under the care of correctional institutions, community-based diversion programs have been established to address the unique needs and challenges of this vulnerable population. Given that legal personnel may serve as gatekeepers in placement decisions, and the lack of existing research examining their attitudes toward offenders with mental illness, the present study aimed to evaluate perceptions of dangerousness and treatment need among a sample of judges, prosecutors, and public defenders across the state of Mississippi. While controlling for age, results of a factorial MANCOVA revealed that public defenders, relative to both judges and prosecutors, endorsed more compassionate attitudes about defendants with mental illnesses. Furthermore, political ideology did not significantly influence attitudes toward mentally ill offenders. While judges and prosecutors endorsed more negative stereotypes about mental illness and perceived mentally ill defendants as a greater risk to the community, mean scores across groups suggested moderately positive attitudes overall. Study limitations, implications for correctional mental health providers, and directions for future research are discussed.     

Patterns of Practice in Mental Health Courts: A National Survey

Mental health courts (MHCs) represent an important new development at the interface of the criminal justice and mental health systems. MHCs are criminal courts for persons with mental illness that were in part created to divert this population from jail/prison into community treatment. MHCs are proliferating rapidly despite limited knowledge regarding their characteristics or their efficacy. We surveyed the entire population of adult MHCs in the United States, n = 90. In the past 8 years, MHCs have been created in 34 states, with an aggregate current caseload of 7,560 clients in MHCs nationally. Most courts (92%) reported using jail as a sanction for noncompliance, if only rarely. Further, jail sanction use was significantly predicted by increased judicial supervision and number of felons in the court. Implications for MHCs and social monitoring are discussed.     

The constitutionality of current legal barriers to telemedicine in the United States: analysis and future directions of its relationship to national and international health care reform

The current health care crisis in the United States compels a consideration of the crucial role that telemedicine could play towards deploying a pragmatic solution. The nation faces rising costs and difficulties in access to and quality of medical services. Telemedicine can potentially help to overcome these challenges, as it can provide new cost-effective and efficient methods of delivering health care across geographic distances. The full benefits and future potential of telemedicine, however, are constrained by overlapping, inconsistent, and inadequate legal and regulatory frameworks, as well as the repertoire of standards imposed by state governments and professional organizations. Proponents of these barriers claim that they are necessary to protect public health and safety, and that the U.S. Constitution gives states exclusive authority over health and safety concerns. This Article argues that such barriers not only fail to advance these public policy goals, but are unconstitutional when they restrict the practice of telemedicine across state and national borders. Furthermore, the interstate and international nature of telemedicine calls for increasing the centralized authority of the federal government; this position is consistent with the U.S. Constitution and other governing principles. Finally, this Article observes that the U.S. experience bears some similarities to that of other nations, and represents a microcosm of the international community's need and struggle to develop a uniform telemedicine regime. Just as with state governments in the U.S., nations are no longer able to view health care as a traditional domestic concern and must consider nontraditional options to resolve the dilemmas of rising costs and discontent in the delivery of health care to their people.     

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.     

Simulated evidence on the prospects of treating more drug-involved offenders

Despite a growing consensus among scholars that substance abuse treatment is effective at reducing offending, strict eligibility rules and budgetary considerations greatly limit the impact that current models of therapeutic jurisprudence can have on public safety in the United States. A question of pressing importance for U.S. drug policy is whether it is beneficial to expand application of this model to treat every offender in need and, if so, whether a set of evidence-based, going-to-scale strategies can be developed to prioritize participation. We use evidence from several sources to construct a synthetic dataset for answering the question: What are the benefits we can reasonably expect by expanding treatment to drug-involved offenders? We combine information from the National Survey on Drug Use and Health (NSDUH) and the Arrestee Drug Abuse Monitoring (ADAM) program to estimate the likelihood of various arrestee profiles having drug addiction or dependence problems. We use the same sources to also develop prevalence estimates of these profiles among arrestees nationally. We use information in the Drug Abuse Treatment Outcome Study (DATOS) to compute expected crime-reducing benefits of treating various types of drug-involved offenders under different treatment modalities. We find that annually nearly 1.5 million (probably guilty) arrestees in the U.S. are at risk of abuse or dependence and that treatment alone could avert several million crimes that these individuals would otherwise commit. Results vary by treatment modality and arrestee traits and those results are described herein.     

Mental health and human rights: the role of the law in developing a right to enjoy the highest attainable standard of mental health in Australia

Article 12(1) of the International Covenant on Economic, Social and Cultural Rights requires governments to recognise "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health". However, the traditional focus of mental health laws on the treatment and detention of those with low-prevalence serious mental illnesses may have skewed resources such that the development of a right to mental health for all individuals with mental illnesses has been stymied. In Australia, a number of inquiries and reports have found that while legislation has been changed to comply with human rights principles, access to mental health care and follow-up post-hospitalisation need critical attention. This article outlines a five-year project aimed at exploring how mental health laws can help develop and support a right to enjoy the highest attainable standard of mental health.     

On the “Economic Dilemma” within the Performing Arts

This article contributes to our understanding public art at the local level by providing analysis of local government public art programs. A survey was conducted with cities and towns in Arizona that have public art programs. The article begins by defining public art and explaining how government funding for public art began in the United States. Next, it highlights the benefits of public art. Public art program funding sources, budgets, maintenance, personnel, and promotion techniques are discussed for the cities/towns surveyed. Last, recommendations are provided for cities/towns seeking to create or expand their public art programs.     

Missing voices: polling and health care

Examining data on the recent health care legislation, we demonstrate that public opinion polls on health care should be treated with caution because of item nonresponse--or "don't know" answers--on survey questions. Far from being the great equalizer, opinion polls can actually misrepresent the attitudes of the population. First, we show that respondents with lower levels of socioeconomic resources are systematically more likely to give a "don't know" response when asked their opinion about health care legislation. Second, these same individuals are more likely to back health care reform. The result is an incomplete portrait of public opinion on the issue of health care in the United States.     

15 years later: Post 9/11 support for increased security and criminalizing muslims

Islamophobia appears to be growing, becoming a mainstream ideology in the United States. Despite the current spike in anti-Islamic sentiment and fear of the Islamic “other,” these ideas are not new and can be traced back to the September 11, 2001, terrorist attacks. Using survey data collected only months after the attacks (N = 422), this study uses an integrated threat framework to examine predictors of public support for increased security in the United States. The results show that perceived personal threat and support for policies that criminalize Muslims predict support for security policies that compromise civil liberties. This is especially true among older individuals, conservatives, individuals less inclined towards individual freedom, and those living in the Northeast or in the South.     

A configurational analysis of 44 US mass shootings: 1975–2015

This study identifies the conditions under which civilian shooter events in the United States become mass episodes of killing. Hitherto, researchers have examined many individual-level variables associated with mass shootings including personal deprivation, family problems, mental illness, among others. Apart from a handful of quantitative studies, scholars have yet to provide a comparative scope to the multiplicity of factors that are influential in bringing about a mass murder. Adopting fuzzy-set qualitative comparative analysis, this study analyses (n = 44) civilian acts of violence that took place from 1975 to 2015 in which some shootings resulted in few deaths and others turned into mass bouts of killing. Empirical results reveal that no variables on their own are sufficient or necessary in accounting for the outcome of a mass shooting. Rather, configurations of causal conditions provide sufficient pathways and new insight into the particular circumstances under which a mass shooting is apt to take place in. The most salient of configurations tell us that mass shootings are prominently influenced by the combination of severe/multiple mental illnesses, a large number/high-powered guns and weak state gun law legislation. Another pathway reveals that mass shootings are also influenced by the interaction of radical ideology, severe/multiple mental illnesses, and high-state level gun ownership.     

Mental disorder and probation policy and practice: A view from the UK

This article is concerned with the manner in which offenders with mental illnesses serving community sentences are identified and treated by the probation service in the UK. It presents the results of recent research examining the prevalence levels of current and lifetime mental illness, substance misuse, and dual diagnosis and suicide rates amongst those serving community sentences in the UK. These high levels of mental disorder are not being addressed by probation policy or practice in a manner that is effective or sensitive. The article concludes by considering the relevance of innovative approaches to the treatment of offenders with mental illnesses in the community currently being adopted in the US to the UK.     

Community-based care for people with severe mental illness in Canada

The development of mental health services for people with severe mental illness has in many ways paralleled that in other countries, particularly the United States. As reliance on inpatient psychiatric care has been sharply reduced, a wide range of community supports have been developed. Several distinct institutional and legal features have contributed to shaping the nature of these community supports, which are described herein. At present, the result is a highly fragmented system of care. Key evidence-based practices, notably assertive community treatment, supported employment, and integrated treatment for concurrent severe mental illness and substance use disorder, achieve considerable integration at the clinical level, but remain relatively unavailable in most provinces. The policy of regionalization of services risks inhibiting the development of such practices, which require more centralized technical assistance and monitoring. An evolutionary approach of gradually introducing integrated, evidence-based programs may provide the most feasible strategy for improving the system.     

Racial Bias in the Criminal Justice System: Shifting the Focus from Outcome to Underlying Causes

Abstract Over-representation of minority offenders in all phases of the criminal justice system has been recognized as a problem in the United States. Much controversy surrounds the question of whether the criminal justice system is “racist.” This inquiry goes beyond the traditional emphasis on the symptoms of racial disparity within the system, and asks whether differences exist between racial groups in their exposure to psychosocial factors that are found to relate to delinquency. The purpose of the study was to expose possible personal, familial, and societal causes of racial over-representation rather than merely place blame on the criminal justice system. The study examined institutionalized delinquent offenders. Among the findings are ones that indicate that blacks report significantly less access to intermediary treatment resources such as psychiatric and drug treatment facilities, community treatment referrals, and placement in foster homes. Blacks were over-represented in the more serious offense levels for both current and prior offenses. Whites were over-represented in mental dysfunction measures of chronic alcohol and drug abuse, suicide attempts, institutionalization in psychiatric or drug treatment facilities, and running away from home. The difference in racial representation raises some critical questions of possible inequality in exposure to environmental factors related to criminal behavior and unequal access and referral to intermediate treatment services prior to incarceration.