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

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

A model process for forensic mental health screening and evaluation

This article describes an operational definition and a model process for forensic mental health examinations developed on the bases of field research, reviews of literature and other documentary materials, and a survey of forensic mental health programs. Forensic mental health screening and evaluation is defined as the process conducted by mental health personnel, at the direction of criminal justice authorities, for the purposes of delineating, acquiring, and providing information about the mental condition of client-offenders that is useful in decision making in the criminal justice system. The proposed model encompasses 14 pragmatically oriented steps within three major structural components of the examination process—delineation, acquisition, and provision—in a manner that places the entire process in the functional context of the criminal justice and mental health systems. The definition and model are aimed at practitioners, program evaluators, and policy makers to be used as a starting point for the establishment of standards against which the practices and policies relating to forensic mental health screening and evaluation can be compared and improved.The preparation of this article was supported in part by a grant (No. 79-NI-AX-0070) by the National Institute of Justice. The views expressed are those of the author and do not necessarily reflect the positions of the National Institute of Justice or the National Center for State Courts. The author thanks his colleagues for their assistance and advice during the study upon which this article is based, as well their critical reviews of earlier documents related to this work. The comments and suggestions of Amiran Elwork and an anonymous reviewer are also gratefully acknowledged.     

Observations of reintegrative shaming in a mental health court

This study compares the use of stigmatizing and reintegrative shame - as specified in Braithwaite's Crime, shame and reintegration (1989) - across traditional criminal court and mental health court settings. Items from the Global Observational Ratings Instrument were used to gather data on 87 traditional court cases and 91 mental health court cases, presided over by five different judges. The observational items capture three constructs: respect, disapproval, and forgiveness, as they apply to Braithwaite's theory. We present means tests to examine differences in shaming between court types and judges. Findings show that the mental health court is more likely to use reintegrative shaming and show respect and forgiveness for offenders, and less likely to show disapproval. Similarly, judges who preside in both court types are significantly more likely to practice reintegrative shaming in the mental health court context. We further explore these findings using field notes and illustrate those components of a mental health court that are conducive to reintegrative shaming.     

Competency to stand trial: a conceptual model for its proper assessment

The assessment of competency to stand trial is frequently fraught with conceptual confusion resulting from a failure to properly apply the data of the clinical examination to the relevant legal criteria. A basic question scheme that encompasses (1) the defendant's psychiatric status, (2) the effects of that status on his functioning, and (3) his apparent ability to participate in legal proceedings, is introduced to clarify the evaluation of fitness to stand trial. The way in which combinations of answers to three "basic questions" generate a scheme that clarifies the difficulties encountered in most competency evaluations is shown. Eight paradigm cases are generated. Five of these (competence, incompetence, mentally ill but competent, malingering, and impaired but competent) are frequently straightforward. However, the three possibilities in which a defendant meets criteria entailed by two of the three questions are inherently subject to controversy. These situations (circumscribed psychosis related to the charges, malingering in the context of mental illness, and functional deficits in the context of minor mental illness) are discussed in detail and illustrated with case material.     

Complex mixtures: A critical examination of a paper by Homer et al.

DNA evidence in criminal cases may be challenging to interpret if several individuals have contributed to a DNA-mixture. The genetic markers conventionally used for forensic applications may be insufficient to resolve cases where there is a small fraction of DNA (say less than 10%) from some contributors or where there are several (say more than 4) contributors. Recently methods have been proposed that claim to substantially improve on existing approaches [1]. The basic idea is to use high-density single nucleotide polymorphism (SNP) genotyping arrays including as many as 500,000 markers or more and explicitly exploit raw allele intensity measures. It is claimed that trace fractions of less than 0.1% can be reliably detected in mixtures with a large number of contributors. Specific forensic issues pertaining to the amount and quality of DNA are not discussed in the paper and will not be addressed here. Rather our paper critically examines the statistical methods and the validity of the conclusions drawn in Homer et al. (2008) [1].We provide a mathematical argument showing that the suggested statistical approach will give misleading results for important cases. For instance, for a two person mixture an individual contributing less than 33% is expected to be declared a non-contributor. The quoted threshold 33% applies when all relative allele frequencies are 0.5. Simulations confirmed the mathematical findings and also provide results for more complex cases. We specified several scenarios for the number of contributors, the mixing proportions and allele frequencies and simulated as many as 500,000 SNPs.A controlled, blinded experiment was performed using the Illumina GoldenGate^® 360 SNP test panel. Twenty-five mixtures were created from 2 to 5 contributors with proportions ranging from 0.01 to 0.99. The findings were consistent with the mathematical result and the simulations.We conclude that it is not possible to reliably infer the presence of minor contributors to mixtures following the approach suggested in Homer et al. (2008) [1]. The basic problem is that the method fails to account for mixing proportions.     

Empathy deficits of sexual offenders: A conceptual model

Most treatment programmes for sexual offenders include some form of victim empathy training. Although the concept of empathy has acquired diverse meanings, those interested in sexual offenders' empathy deficits are primarily concerned about the offenders' lack of compassion or sympathy for their victims. A model of empathy is presented in which uncompassionate responses are the product of three initial conditions: a) an adversarial or indifferent relationship; b) perspective-taking deficits; and c) inappropriate methods for coping with the perceived distress of others. The model suggests that empathy training should target specific deficits, and that misdirected interventions would be expected to have no effects, or even detrimental effects, on the offenders' ability to generate sympathetic, compassionate responses to victims.     

Acculturation and mental health: Response to a culturally-centered delinquency intervention

There is a dearth of research examining intervention effectiveness for ethnic minorities and few studies have investigated within-group differences in response to treatment. This study examined the prevalence of mental health problems among Anglo- and Mexican-American juveniles entering probation and their response to a comprehensive intervention designed to address drug, alcohol, and mental health in a culturally-sensitive manner. We hypothesized that all youths would demonstrate mental health improvements from pretest to posttest, and the improvements would be equal for Mexican-American youth of varying levels of acculturation and an Anglo comparison group. Participants included a total of 103 adolescents ages thirteen to eighteen years, of whom 59 percent were male and 81 percent were Mexican American. Hypotheses were supported, indicating this comprehensive, community-based intervention targeting delinquent adolescents and their families was effective in improving mental health regardless of ethnic background or level of acculturation. That is, regardless of group differences in mental health problems at intake, youth with different cultural orientations reported significantly reduced levels of internalizing and externalizing behavior problems at posttest.     

Private regulation in mental health

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

School-based mental health program development: a case study of interorganizational collaboration

Because of increased competition and financial pressure, more and more contemporary health care organizations are forming (or attempting to form) collaborative ventures. In the early 1980s, the New York City Board of Education and the New York City Department of Mental Health planned and implemented a collaborative program in the city's schools for an on-site school mental health program. In this article, I explore the difficult and attenuated process of interorganizational collaboration--including attention to the organizational, political, and interprofessional context within which such ventures are implemented--to examine how such cooperative program development can be successfully accomplished in today's competitive and complex health care arena.     

Police stress and personality factors: A conceptual model

Despite the sizeable volume of literature on police stress, little empirical research has been done on the problem, and no studies have accounted for individual differences in response to job stress. This study proposes a model which explains differential response to police stressors according to personality variables of police officers. Specific job stressors are measured by means of a Police Stress Inventory. Through canonical correlation analysis a number of personality traits are identified which correlate significantly with police stress. The personality-stress response model accounted for a sizeable proportion of responses to job stressors given by police subjects.     

Liberty: human rights and mental health

In this paper, Lord Phillips reflects on the present state of the law relating to mental health; he considers the place of the common law doctrine of necessity as the basis for the detention of patients; he reviews a number of issues arising from the jurisprudence of the European Court of Human Rights in Strasbourg and a number of recent decisions of the Court of Appeal. Finally, he considers the prospects for change in the law foreshadowed in the Government's White Paper on the Reform of Mental Health Law (2000).     

The observation of mental disorder and dangerousness in arsonists: a contemporary appraisal of changes in Dutch forensic mental health cases

In the Netherlands pre-trial forensic mental health assessments are conducted to examine whether a mental disorder was present at the time of the offence that affected the free will of a person, in which case criminal accountability is considered diminished or absent. This study aims to investigate societal changes over time in forensic mental health recommendations in arson cases. Seventy-two reports of male arsonists assessed in 1950–2010 were included in this study, 36 arsonists were assessed in the first time period (1950–1979) and 36 in the second period (1980–2010). Results show an association between DSM classification and the conclusion on criminal accountability only in the first period and an association between recidivism risk and the forensic mental health recommendation only in the later period. It is concluded that mental disorder was of greater influence on the conclusion on accountability in the first time period, whilst dangerousness played a more important role on the forensic mental health recommendation in the later time period. Our findings reflect a shift from paternalistic principles to principles of risk control and show that societal changes influence the field of forensic mental health.