PSYCHIATRIC HOSPITAL CAPACITY,HOMELESSNESS, AND CRIME AND ARREST RATES*

As a result of developments in pharmacology, stricter standards for involuntary commitment, and changes in public expenditures, there has been a dramatic decline in the capacity of public psychiatric hospitals to maintain America's most severely mentally ill. Psychiatric deinstitutionalization has led to an increased presence of persons with mental illness in urban areas, many “falling through the cracks” of community‐based services. This is hypothesized to have contributed to homelessness, crime, and arrests. Individual‐level research has documented disproportionate and increasing numbers of mentally ill persons in jails and prisons. It has also found higher rates of violence and arrest among persons with mental illness compared to the general population. This study takes a macro‐level social control approach and examines the relationships between psychiatric hospital capacity, homelessness, and crime and arrest rates using a sample of eighty‐one U.S. cities. I find that public psychiatric hospital capacity has a statistically significant negative effect on crime and arrest rates, and that hospital capacity affects crime and arrest rates in part, through its impact on homelessness. In addition, I find no crime‐reducing effect of private and general psychiatric hospital capacity.     

监狱精神病罪犯问题及法律规制

对精神健康问题的关注程度标志着一个国家文明程度的提升,相应地对精神病人的刑事处遇政策也体现了一个国家刑事法治的发达水平,目前,监狱精神病犯人数有所增加,对这些特殊人群的关爱和保障要尽快提上议事日程,应当结合监狱的具体实际,建立罪犯服刑能力鉴定机制,强化“司法审查关”;构建强制治疗程序,发挥其防卫社会、治疗疾病和保障人权的功能;在监狱系统设立专门的精神病医院或监区,以维护监狱安全和保障罪犯权利。     

Jones v. Gerhardstein: the involuntarily committed mental patient's right to refuse treatment with psychotropic drugs

The question of whether an involuntary committed mental patient has a fundamental right to refuse treatment with psychotropic drugs continues to be a subject of much debate. Over the past twenty-five years, psychotropic drugs have become the most common form of treatment for the mentally ill. For many patients, these drugs provide substantial benefits; for others, however, they produce severe, sometimes debilitating, side effects. Because of the possibility of serious harm to the patient and because of the potential for abuse of drug treatment by psychiatric staffs, the mental health bar generally has argued for increased procedural protection for mental patients. In Jones v. Gerhardstein, the Wisconsin Supreme Court responded to these concerns by requiring that a judicial hearing be held on the issue of a patient's competency to refuse treatment before the attending physician may administer medication without the patient's consent. This Note discusses the controversy between the legal and medical communities over treatment refusal by mentally ill patients in light of the impact of the Jones decision on institutional practice and on refusing patients. The author argues that the strictly rights-based analysis used by the Jones court has done little to benefit involuntarily committed mental patients. The author suggests alternative ways of approaching treatment refusal that might be more responsive to the distinctive needs of the mentally ill.     

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.     

Involuntary detention and treatment of the mentally ill: China's 2012 Mental Health Law

The long-awaited Mental Health Law of China was passed on 26 October 2012 and took effect on 1 May 2013. Being the first national legislation on mental health, it establishes a basic legal framework to regulate mental health practice and recognizes the fundamental rights of persons with mental disorders. This article focuses on the system of involuntary detention and treatment of the mentally ill under the new law, which is expected to prevent the so-called “Being misidentified as mentally disordered” cases in China. A systematic examination of the new system demonstrates that the Mental Health Law of China implicitly holds two problematic assumptions and does not provide adequate protection of the fundamental rights of the involuntary patients. Administrative enactments and further national legislative efforts are needed to remedy these flaws in the new law.     

Forensic mental health law reform in Japan: from criminal warehousing to broad-spectrum specialist services?

Since the 1980s Japan has undergone a number of mental health law reforms culminating in the 2005 forensic law. This added to its enactments on involuntary commitment, long-term aged care and substitute decision making, bringing Japan into focus as an industrialized state now possessed of a full package of civil and forensic provisions. This article seeks to demonstrate that the new forensic law cannot achieve its own stated goals without seeking to put into place financial and administrative supports aimed to integrate the myriad of patient populations that will be inevitably affected by the new forensic system. In order to avoid the widespread syndrome that has already been experienced internationally of warehousing mentally ill offenders in jails, it is critical that the Japanese government develop effective and culturally sensitive techniques for dealing with low risk populations through a diversionary process. Furthermore, although the legislation addresses serious crimes, it is imperative that policies be put into place to avoid directing young offenders, violent patients from the general hospital system, the developmentally handicapped, already convicted persons found in hospital settings and problematic cases in the correctional system, to the new forensic units established by the legislation. It is only though contemplating unintended outcomes of the legislation that the Japanese government will be able to avoid the ongoing stigmatization and prolonged institutionalization of mentally ill populations. Despite apparent cultural differences internationally vetted human rights requirements must be properly protected, not only in the forensic context, but throughout the mental health system at large. The coordination of services and the development of specialty training are necessary conditions for the realization of improved and humane conditions for mentally ill persons in Japan.     

Review of point-of-reception mental health screening outcomes in an Australian Prison

The point-of-reception into prison is a critical juncture as it provides early opportunities to identify mental illness and initiate treatment. Although large numbers of mentally ill prisoners are received into prison each day, research investigating mental health screening outcomes at the point-of-reception is limited. This study aimed to address this gap by examining reception screening outcomes for all prisoners received into an Australian prison during 2009 (n?=?4229). Overall, 19% of all prisoners were mentally ill, and another 20% had a history of psychiatric illness that required ongoing care. Mentally ill prisoners had a higher risk of suicide or self-harm and required more observation than other prisoners. At reception, no mentally ill prisoners were transferred to the state’s forensic hospital and few were transferred to the prison’s mental health unit, or provided support service referrals. These findings highlight that outcomes made at the point-of-reception are heavily influenced by the availability of prison mental health resources.     

Sexual offenders with serious mental illness: prevention, risk, and clinical concerns

Individuals with serious and persistent mental illness who have also engaged in illegal sexual behavior present a unique challenge for our legal and clinical systems. Frequently, these individuals may engage in problematic sexual behaviors which result in hospitalization rather than incarceration, and an overburdened and resource-deficient public community mental health system is ill-equipped to address the seriousness of these sexual behaviors. We have a rather limited understanding of how prevention programs, intervention strategies, and risk assessment would work with this population. Here we evaluate data from a sample of 245 inpatient psychiatric sexual offenders in a forensic mental health setting and compare these with what information has already been presented in some of the literature. Through an examination of seriously mentally ill sexual offenders and their clinical presentation, legal history, and risk management concerns, we illustrate a variety of tertiary prevention needs. Future directions in the area of prevention and risk management for seriously mentally ill sexual offenders are also discussed.     

PARENTS IN DISTRESS

State legislatures and courts continue to struggle with the issue of providing reunification services to mentally ill parents. Recent case law highlights the lack of uniformity among the states and the courts in establishing a standard for a state's duty to provide reunification services to mentally ill parents. This article examines how inconsistencies among the courts work against mentally ill parents in their pursuit of family reunification. Furthermore, the article discusses the inadequacies of servcies offered to mentally ill parents. The author argues that society and mentally ill parents benefit from imposing a duty on provide reunification services to mentally ill parents.     

PARENS PA TRIAE: Poltergeist of Mental Health Law

This article examines the uncanny resiliency of an ancient doctrine called parens patriae despite legislative and judicial attempts to restrict its use in involuntary commitment proceedings of the mentally ill. Attempts by the legislature and courts to reduce parens patriae rationales, which are heavily promoted by the medical profession, have emphasized police power rationales and have followed two general strategies. One strategy sets up a number of procedural steps that provide monitoring of individual rights at critical junctures during the commitment process. The second strategy attempts to establish multiple criteria that must be met before any commitment decision can by made. It is pointed out that legislatures, and to some extent the courts, have focused on the procedural strategy, while neglecting the more substantive issue of behavioral criteria. It is argued that the lack of attention to the second strategy, specifically in relation to clear definitions and rigorous criteria, have created the impetus for the medical-psychiatric profession to continue its dominance in involuntary commitment proceedings under the guise of parens patriae.     

Who is Diverted? Case Selection for Court‐Monitored Mental Health Treatment

Specialized courts raise questions about the decisions that bring some defendants into such courts and keep others out. Because of risks perceived in diverting mentally ill defendants, decisions to select defendants for mental health courts are especially interesting. I estimate a model of the decision to divert defendants into court‐monitored mental health treatment. I find that gender and age combine to disadvantage young male defendants and older female defendants. The findings point to the importance of structuring selection processes in the design of specialized courts. They shed light on the consequences of including treatment personnel in justice system decisions.     

Chapter 2: The Legal Position and Organizational Forms of Forensic Psychiatric Expert Examination

The practical task of forensic psychiatry, which is one of the subdivisions of psychiatry, is to give an expert evaluation, on assignment from investigatory agencies and courts, and to devise and recommend measures for the prevention of socially dangerous acts by the mentally ill. Forensic psychiatric expert examination, like forensic medical, criminal, or any other type of expert examination, aids agencies of justice in establishing the facts in a case. Forensic psychiatric expert examination is called upon to assist the investigator and the court in determining whether an individual is a criminal or a legally irresponsible, mentally ill person; whether a person sentenced to a prison term should, because of mental illness, be released before his time is served; whether the investigator and the court may pursue the interrogation of a witness or victim with mental disorders, and whether the testimony of such persons may be used as court evidence. Such an expert examination is necessary in a civil suit in deciding the question of an individual's competence.     

Court Discretion

All mention of specific types and dimensions of dangerous behavior, given by witnesses in testimony in 414 civil commitment hearings of allegedly dangerous mentally ill adults in one state, was recorded to see how such evidence affects court decision. A positive association between involuntary commitment and evidence of dangerous behavior as defined by appellate courts was found. Commitments increased with movement up a continuum of action and physical harm and with recency and recurrency. Much of the variance in involuntary commitment is explained by court concern with substantive justice.     

Professional attitudes regarding treatment and punishment of incest: Comparing police,child welfare,and community mental health

Brief case histories involving incest were presented to police officers, child welfare workers, and community mental health practitioners in a rural area in Canada. Intervention priorities involving “treatment versus punishment” were assessed across the three professional groups for each specific case vignette. Attitudes were assessed on three factors: perpetrator mentally ill rather than criminal, view regarding treatment of victims and mothers, and support for court mandated treatment. Police and community mental health practitioners had significantly different attitudes as to whether perpetrators of child sexual abuse should be viewed more as criminals or as mentally disturbed. Both mental health and child welfare staff differed significantly from police with a less punitive view towards victims and their mothers. All three profressional groups showed no difference in their modest endorsement of the use of mandated treatment by the courts. Gender was not found to influence response to case vignettes.     

Prevalence of Criminal Thinking among State Prison Inmates with Serious Mental Illness

To examine the prevalence of criminal thinking in mentally disordered offenders, incarcerated male (n = 265) and female (n = 149) offenders completed measures of psychiatric functioning and criminal thinking. Results indicated 92% of the participants were diagnosed with a serious mental illness, and mentally disordered offenders produced criminal thinking scores on the Psychological Inventory of Criminal Thinking Styles (PICTS) and Criminal Sentiments Scale-Modified (CSS-M) similar to that of non-mentally ill offenders. Collectively, results indicated the clinical presentation of mentally disordered offenders is similar to that of psychiatric patients and criminals. Implications are discussed with specific focus on the need for mental health professionals to treat co-occurring issues of mental illness and criminality in correctional mental health treatment programs.     

Attitudes among stakeholders towards compulsory mental health care in Norway

Objectives

The Norwegian Mental Health Care Act allows use of coercion under certain conditions. Even though the current practice has been criticized, little empirical data exist about the attitudes towards compulsory mental health care.

Method

This study used Q-methodology to identify prototypical attitudes and to test possible differences of attitudes between groups of stakeholders towards the use of coercion in mental health care. Sixty-two respondents who represented six groups with different roles in mental health care participated: former patients, relatives of psychiatric patients, members of supervisory commissions, psychiatrists, other physicians, and lawyers.The participants were asked to assess the degree to which they agreed on 30 statements concerning use of coercion for the mentally ill.

Results

Three factors that in a meaningful way express different attitudes towards the question were found. The most widely shared attitude stated that a trusting relationship between patient and therapist is more important than the right to have an attorney. This attitude gives partial support to the present Mental Health Care Act. However, the second most common attitude argues that involuntary hospitalization, if necessary, should be decided in a court and not by the hospital doctor.

Conclusions

Differences in attitude could partly be explained by the respondents' role in mental health care. Both psychiatrists and “somatic” physicians expressed more agreement with the present legislation than the other stakeholders. The findings may have implications for the legal protection of mental health care patients.     

Applications for release by Australians in Victoria found not guilty of offences of violence by reason of mental impairment

Much research in relation to mental illness and the law has concentrated upon when accused persons are entitled to avail themselves of the defence of not guilty by reason of insanity or mental impairment. However, the decision as to when persons found not guilty by such pleas should be released step by step back into the community involves difficult analyses of the risk of recidivism by persons who have committed serious acts of violence whilst mentally ill. This article analyses some 70 cases heard by the Supreme Court of Victoria in Australia since the jurisdiction to make such decisions has been transferred from the executive arm of government to the judiciary. The jurisprudence generated by the Victorian Supreme Court constitutes Australia's most developed law in relation to prediction of dangerousness. This article evaluates the different and subtle dynamics that have influenced the judges in an increasingly sophisticated way to grapple with the phenomenon of mental illness in deciding when persons who have already killed can safely be released from involuntary detention status within the confines of a forensic psychiatric institution back into the general community.     

论精神病人的民法监护——以民事强制住院司法实践为视角

目前．世界多数国家关于精神病人强制住院的立法都直接与广义上的监护法律相联系。监护制度在保护民事行为能力欠缺的精神障碍患者的身心安全和提供必要的住院及医疗措施方面发挥了重要作用。然而,由于我国关于精神病人监护制度的法律规定较为简陋和滞后,导致了实践中,特别是在涉及民事强制住院措施适用时,很多精神病人的人身自由和健康权益并没有得到有效照管,甚至受到严重侵害,由此引起的医疗纠纷和诉讼也日益增多。在此试图对我国精神病人民法监护制度进行解构分析,以期为进一步完善适合我国国情的精神病人监护制度和维护精神病人健康权益提供一些立法建议。     

Mental Health Court Outcomes: A Comparison of Re-Arrest and Re-Arrest Severity Between Mental Health Court and Traditional Court Participants

Mental health courts have been proliferating across the country since their establishment in the late 1990's. Although numerous advocates have proclaimed their merit, only few empirical studies have evaluated their outcomes. This paper evaluates the effect of one mental health court on criminal justice outcomes by examining arrests and offense severity from one year before to one year after entry into the court, and by comparing mental health court participants to comparable traditional criminal court defendants on these measures. Multivariate models support the prediction that mental health courts reduce the number of new arrests and the severity of such re-arrests among mentally ill offenders. Similar analysis of mental health court completers and non-completers supports the prediction that a "full dose" of mental health treatment and court monitoring produce even fewer re-arrests.     

Jails in the United States: the phenomenon of mental illness in local correctional facilities

During the last decade, the number of mentally ill inmates in local jails has increased while courts have imposed standards of inmate care upon jail administrators which require appropriate treatment of that inmate group. While jail administrators are seeking assistance from mental health agencies as well as additional resources to deal with these problems, little specific information is presently available about the numbers and correlates of jail inmates nationally that are mentally ill; their prior contacts with mental health agencies, criminal histories, employment backgrounds, etc; and the services jails presently offer to that population. In addition, little is known by geographic region or by jail capacity. Such information is essential in developing future strategies to manage that population. This paper is a preliminary contribution to the development of that information. In addition, the data analysis can serve as a base line against which to evaluate in the structure of the mentally ill jail inmate population as well as changes in services provided by jails by comparing this analysis to future jail surveys conducted by the Bureau of Jail Statistics (BJS) or the National Institute of Justice. The research will be a secondary analysis of the Survey of Inmates of Local Jails, 1983, conducted by BJS, (made available through the Inter-University Consortium for Political and Social Research: University of Michigan, First Edition, Fall, 1985, #8274). In general an exploratory approach was used; however, a loglinear model has been asked to further refine and explore the phenomena of the mentally ill in jails.