Community-based forensic child and adolescent mental health services in England,Scotland and Wales: a national mapping exercise

Aim: We sought to ascertain the current nature of specialist community mental health provision for young people presenting with risk of harm to others or involvement with the youth justice system in England, Wales and Scotland. Methods: Questionnaire-based survey. Results: Fifty-five services were contacted, 48 responded and 35 of these were found to be providing some form of community mental health provision to high-risk young people. Thirteen services provided comprehensive community forensic child and adolescent mental health (FCAMH) services, whilst the remainder offered more ad hoc clinical input. Amongst the comprehensive FCAMH services, staffing, function, commissioning arrangements and population served varied widely. Conclusions: There is patchy geographical provision of comprehensive community FCAMH services across England, Scotland and Wales with heterogeneous commissioning arrangements, staffing and function. Development of a national commissioning strategy for community FCAMH services is required to ensure that the complex needs of high-risk young people are adequately addressed.     

Mental health legislation and human rights in England, Wales and the Republic of Ireland

In 2005, the World Health Organization (WHO) published its Resource Book on Mental Health, Human Rights and Legislation (Geneva: WHO) presenting a detailed statement of human rights issues which need to be addressed in national legislation relating to mental health. The purpose of this paper is to determine the extent to which revised mental health legislation in England, Wales (2007) and Ireland (2001) accords with these standards (excluding standards relating solely to children or mentally-ill offenders).Legislation in England and Wales meets 90 (54.2%) of the 166 WHO standards examined, while legislation in Ireland meets 80 standards (48.2%). Areas of high compliance include definitions of mental disorder, relatively robust procedures for involuntary admission and treatment (although provision of information remains suboptimal) and clarity regarding offences and penalties Areas of medium compliance relate to competence, capacity and consent (with a particular deficit in capacity legislation in Ireland), oversight and review (which exclude long-term voluntary patients and require more robust complaints procedures), and rules governing special treatments, seclusion and restraint. Areas of low compliance relate to promoting rights (impacting on other areas within legislation, such as information management), voluntary patients (especially non-protesting, incapacitated patients), protection of vulnerable groups and emergency treatment. The greatest single deficit in both jurisdictions relates to economic and social rights.There are four key areas in need of rectification and clarification in relation to mental health legislation in England, Wales and Ireland; these relate to (1) measures to protect and promote the rights of voluntary patients; (2) issues relating to competence, capacity and consent (especially in Ireland); (3) the role of “common law” in relation to mental health law (especially in England and Wales); and (4) the extent to which each jurisdiction wishes to protect the economic and social rights of the mentally ill through mental health legislation rather than general legislation.It is hoped that this preliminary analysis of mental health legislation will prompt deeper national audits of mental health and general law as it relates to the mentally ill, performed by multi-disciplinary committees, as recommended by the WHO.     

The Acute and Enduring Consequences of Exposure to Violence on Youth Mental Health and Aggression

The bulk of “neighborhood effects” research examines the impact of neighborhood conditions cross-sectionally. However, it is critical to understand whether the effects of neighborhood context are situational and whether they endure over time. In this study, we take seriously the notion that there are enduring consequences of exposure to deleterious neighborhood conditions. Using a rich set of longitudinal data on adolescents from the Project on Human Development in Chicago Neighborhoods, we estimate the effect of exposure to violence on both internalizing (depression and anxiety) and externalizing problems (aggression). We find that exposure to violence has both an acute and enduring effect on aggression, yet no effect on anxiety-depression, net of individual, family, peer, and neighborhood influences. Part of the enduring effect of violence exposure is explained by changes in social cognitions brought on by the exposure, yet much of the relationship remains to be explained by other causal mechanisms.     

The social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.     

Conclusion: Mental health and legal responses to the adolescent mental health crisis: Raising the bar on best interests and promoting family connectedness in divorcing families

We are currently facing an unprecedented increase in adolescent mental health problems resulting in alarmingly high levels of depression, anxiety, and suicidality. Significant mental health problems among youth pose unique challenges to families in the process of separation and divorce, as well as to family law professionals across all disciplines. The current adolescent mental health crisis calls for new ways of approaching our work with high conflict families to promote family connectedness and shift away from adversarial approaches that may exacerbate conflict and further destabilize families. As a conclusion to the special issue on adolescent mental health needs, the authors make multidisciplinary best practices recommendations and advocate for systems level changes in recognition of the needs of youth in crisis at this pivotal developmental stage.     

车文博先生对中国心理治疗与心理健康研究的开创性贡献

车文博教授在心理咨询理论的工作与贡献主要现在三个方面:其一,改革开放后首先打破禁区,率先编写了我国第一部心理治疗方法的巨著《心理治疗指南》、《心理咨询大百科全书》。倡导从生物医学模式向生物-心理-社会医学模式的转变。其二,结合社会转型与文化建设,超前地提出以人为本的健康人格新概念,并对大学生自我同一性与人格的关系进行实证研究。其三,关注大学生心理健康问题,探索大学生的压力与挫折,提出有针对性的教育对策。     

Tarasoff in Missouri: The jurisprudence of a mental health provider's duty to warn and protect non-patients of potential risks from patients

In 1976, the Supreme Court of California issued its well-known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third-party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff-related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff-like third-party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof-like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment.     

Pregnancy in prison,mental health and admission to prison mother and baby units

Little is known about the mental health of pregnant women in prison in England or the factors which impact admissions to prison mother and baby units (MBUs). Research from the UK suggests women with more ‘stable’ backgrounds and lower prevalence of mental disorder are more likely to be admitted to prison MBUs. Eighty-five pregnant women were interviewed in eight different prisons. Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) and Edinburgh Postnatal Depression Scale (EPDS) were used to assess mental health; Severity of Dependence Questionnaire (SOD-Q) for drug misuse; Alcohol Use Identification Test (AUDIT) for hazardous drinking; and the Structured Clinical Interview for DSM-IV (SCID-II) to identify personality disorder. Fifty-one per cent of participants had depression and 57% had anxiety. Those who were working prior to imprisonment were more likely to be admitted to MBUs, and those with a prior social services involvement, diagnosis of personality disorder or history of suicidality were less likely to be admitted. The high levels of depression and anxiety can have negative impacts on both the mother and her unborn child. Factors which influence MBU admission suggest those who might benefit most from MBU placement are least likely to be admitted.     

Procedural justice in mental health court: an investigation of the relation of perception of procedural justice to non-adherence and termination

Mental health courts (MHCs) operate on the principles of procedural justice (PJ). PJ highlights the importance of process over outcomes in encounters with authority. Subjective perceptions of having voice, being heard by decision-makers, and being treated with respect and concern by figures of authority are influential in assessment of fairness and in cooperation with decisions, regardless of favorability of the outcome. In this paper, we investigate MHC participant perception of PJ in interactions with MHC staff and the association between perceptions and recidivism (i.e. time in jail, new arrests, and probation violations), treatment adherence, and MHC termination. Participants from two MHC programs (n?=?80) took part in this study. Results suggest that perception of PJ during interactions with the entire MHC team is significantly associated with program termination, but not with participant behaviors during MHC. Implications for MHC practitioners and researchers are discussed.     

Referrals to a mental health criminal justice Liaison and diversion team in the North East of England

There is growing interest in the health correlates of people detained in police custody, and a number of innovations have been introduced to try to meet the complex needs of detainees. The implementation of Criminal Justice Liaison and Diversion (CJL&D) Services commissioned by the Department of Health in England is a substantial part of this investment. In this paper, we describe data from 858 detainees who were referred to the CJL&D service of a busy metropolitan police station in the North East of England. The detainees referred to the service had complex mental health needs, substance misuse and a range of vulnerabilities requiring specific intervention. The effective operation of these teams and how they interface with health and criminal justice systems also depend upon a number of systematic issues that emanate both from within the teams, and from external policy drivers.     

Mental Illness and Legal Fitness (Competence) to Stand Trial in New York State: Expert Opinion and Criminal Defendants' Psychiatric Symptoms,

Fitness to Stand Trial is a critical concept in the adjudication of justice‐involved persons. A retrospective study was conducted to examine criminal defendants' specific psychiatric symptoms and those symptoms' associations with expert opinions on Competence to Stand Trial. One hundred charts were reviewed: 50 Cases (opined as Not Fit) were compared against 50 Controls (opined as Fit) with respect to ratings on the Brief Psychiatric Rating Scale (BPRS). A significance level of 0.001 was selected a priori. Statistically significant differences were found in seven of the eighteen BPRS symptom constructs (with the highest differences in Conceptual Disorganization and Unusual Thought Content) and two of the four BPRS higher‐order syndrome factors (Thinking Disorder and Hostile‐Suspiciousness). Consistent with previous reports, psychotic symptoms are found in this study to be inversely associated with Fitness. Validity, reliability, and limitations of this study, as well as directions for future research, are discussed herein.