Symptom Validity Testing in Claimants with Alleged Posttraumatic Stress Disorder: Comparing the Morel Emotional Numbing Test, the Structured Inventory of Malingered Symptomatology, and the Word Memory Test

In independent medical examinations, unjustified claims of posttraumatic stress disorder (PTSD) are to be expected at an increased rate. In a prospective study, consecutive cases of patients claiming PTSD who underwent independent neuropsychiatric evaluation were analyzed. For 61 adult patients, results of three symptom validity tests (Morel Emotional Numbing Test, Structured Inventory of Malingered Symptomatology, and Word Memory Test) were available. Seventy percent of all claimants showed probable negative response bias in at least one of the three tests, 25% in all three tests. High probability of negative response bias was associated with symptom overreporting and demonstration of cognitive deficits in performance tests. The results indicate that high rates of uncooperativeness must be expected in civil forensic patients with claimed PTSD. A multi-method approach to the assessment of response distortion in PTSD claimants is indicated.     

Detention under the Mental Health Act: balancing rights,risks and needs for services

Mental health law has to balance considerations of both justice, and health and welfare. In the political climate of the 1990s mental health services have become targeted on those with serious mental illness, to address the objectives of containing risks and limiting service expenditure. This paper identifies that increasing rates of detention under the Mental Health Act through the 1990s in a particular region, disproportionately involve longer-term detentions (under section 3), men, and people with serious mental illnesses. Those detained are likely to experience social difficulties. Changes in legislation are imminent, and the paper concludes that thought should be given to the amount of statutory intervention in the lives of seriously mentally ill people, and to the principle of reciprocity in relation to those coerced for lesser periods. Services should seek to address the issues of social exclusion which are reflected in the circumstances of those detained.     

Ethical Considerations in the Development and Application of Mental and Behavioral Nosologies: Lessons from DSM-5

We are not likely to find a diagnostic system as “unethical,” per se, but rather find that it creates ethical concerns in its formulation and application. There is an increased risk of misuse and misunderstanding of the DSM-5 particularly when applied to forensic assessment because of documented problems with reliability and validity. For example, when field tested, the American Psychiatric Association reported diagnostic category kappa levels as acceptable that were far below the standard level of acceptability. The DSM-5 does not offer sensitivity and specificity levels and thus psychologists must keep this in mind when using or teaching this manual. Also, especially in light of concerns about diagnostic inflation, we recommend that psychologists exercise caution when using the DSM-5 in forensic assessments, including civil and criminal cases. Alternatives to the DSM-5, such as the International Classification of Diseases and the Psychodynamic Diagnostic Manual are reviewed.     

Implementing the Mental Health Act 2007 in British general practice: Lessons from Ireland

Changes in mental health legislation (e.g. Mental Health Act 2007 in England and Wales, Mental Health Act 2001 in Ireland) have generally improved adherence to international human rights standards, but also present challenges to primary care providers. When mental health legislation was substantially reformed in Ireland, 62.9% of general practitioners (GPs) felt the new legislation was not user-friendly. Majorities of GPs who felt the legislation affected their practice reported increased workloads (85%) and various other difficulties (53%). GPs who had received training about the legislation were more likely to find it user-friendly (43% versus 30.9%), and informal training (e.g. from colleagues) was just as likely as formal training to be associated with a GP finding it user-friendly. With similar changes to mental health legislation being introduced in England and Wales, it is significant that informal training is just as good as formal training in helping GPs work with new mental health legislation.     

Gray Matters: Gender Differences in the Physical and Mental Health of Older Inmates

Although there has been a substantial increase in the number of older female inmates incarcerated in the United States, there has been little scholarly attention paid to this population. The purpose of this study is to extend the current understanding of older inmates by examining gender differences in their physical and mental health. Bivariate analyses of one of the largest known samples of older female inmates (n = 142) revealed significant gender differences. Older female inmates reported a greater number of physical health conditions and mental health disorders in all three time periods: in their lifetimes, since admission to prison, and in the previous year. This research informs the need for gender-specific health programming for older female inmates.     

新冠肺炎疫情下司法精神医学鉴定的应对

新冠肺炎疫情已被公认为全球性重大挑战。已经、正在,同时仍将对人类社会的诸多方面产生深远的影响。新冠肺炎疫情下司法精神医学鉴定面临诸多挑战,通过梳理疫情下已实施的有关司法鉴定方面的做法、经验,分析涉疫情主要犯罪类型,开展司法精神医学远程鉴定具有必要性和可行性。但应关注其局限性,实施之前应制定相应的操作规范。     

A Prescription for Violence: The Legacy of Colonization in Contemporary Forensic Mental Health and the Production of Difference

In this paper I will argue, through the example of the “treatment” of racialized minorities diagnosed with mental illness, that the mental health system (including its unique laws, production of different identity categories and ruling disciplines), with its dogmatic adherence to and reliance on alleged expert opinion and internal inquiry, allows for the erasure of subaltern voices. Often we hear about a tragic incident as reported by the media about someone diagnosed with a mental illness who has committed a crime. These representations routinely present the person as violent, aggressive, uncontrollable, and unpredictable. Repeatedly the voice of the accused is not represented; his or her social, historical, and political contexts are not considered relevant. The technologies of the criminal justice and mental health system’s use of physical or chemical restraint, coercive treatment, or practices such as deportation are also not reported, thus reproducing systems of harm. We don’t get to look inside the asylum. Patients’ voices are excluded from the discursive practices, disciplinary hegemony or dominant regimes of truth within the mental health system. This creates a system impermeable to criticism, where violence continues to prevail. Through a discussion of the disproportionate criminalization and deportation of the mentally ill, the false associations between mental illness and violence, the colonial ancestry of internal inquiry, and example cases from the media, this paper reviews how these particular technologies of violence owe their inheritance to the orientalising, discursive practices and disciplinary hegemony developed during colonization that when ignored, reproduce the dehumanizing outcomes upon which they were built.     

Family Environment Characteristics and Mental Health Outcomes for Youth in Foster Care: Traditional and Group-Care Placements

Journal of Family Violence - Foster care is meant to provide a safe, temporary out-of-home placement for children exposed to maltreatment, yet little is known about how youth and foster caregivers...     

Social Correlates of Delinquency for Youth in Need of Mental Health Services: Examining the Scope Conditions of Criminological Theories

While both traditional criminological inquiry and mental health research have identified internal and external constellations of risk factors associated with juvenile offending, interdisciplinary discourse has been limited. This paper takes a step in bridging the gap between criminological literature and work in the field of children’s mental health by evaluating the combined effects of social and mental health predictors on juvenile delinquency in a sample of youth with diagnosed clinical disorders. Results of multivariate analyses indicate that both traditional social risk factors as well as indicators of the nature and severity of youths’ mental health disorders contribute to delinquency. Moreover, the influence of one well-established risk factor, self-control, on delinquency is moderated by the presence of oppositional defiant disorder. The results of this study suggest that researchers and practitioners should consider the cumulative influence of social risk factors and psychological impairment in the etiology of delinquency.     

The Importance of the Caregiver and Adolescent Relationship for Mental Health Outcomes Among Youth in Foster Care

Youth in foster care have often been exposed to in-home violence and violence exposure is associated with higher mental health concerns. This study used multiple regression mediation analyses with bootstrapping to identify specific current foster caregiver-adolescent relationship factors and their mediating qualities between in-home violence exposure and adolescent internalizing, externalizing, and trauma symptoms. Using a national dataset of adolescents in foster care (n?=?175), the results of this study suggested that an adolescent’s perception of feeling emotionally secure in their relationship with their caregiver mediated the relationships between exposure to violence and youth internalizing, externalizing, and trauma symptoms. Additionally, current foster caregiver involvement and structure mediated the associations between exposure to violence and adolescent internalizing and externalizing outcomes, but not trauma symptoms. Further discussion of the results is included. Findings have important implications for mental health interventions aimed towards youth in foster care.     

'The necessity must be convincingly shown to exist': standards for compulsory treatment for mental disorder under the Mental Health Act 1983

Current English law has few controls on the involuntary treatment of persons detained under the Mental Health Act 1983. In 2001, R (Wilkinson) v. Broadmoor Special Hospital Authority provided some hope that, in conjunction with the Human Rights Act and the European Convention on Human Rights (ECHR), meaningful substantive and procedural standards for compulsory psychiatric treatment might be developed, but that hope has not been fulfilled. Using Wilkinson and the ECHR jurisprudence as a starting point, this article considers when, if at all, compulsory psychiatric treatment might be justified. In particular, it considers the difference between the 'appropriateness' standard of the English legislation and the ECHR requirement of 'therapeutic necessity', the requirements for appropriate procedure and appropriate legislative clarity, how the courts should deal with disagreements among treating physicians, and the relevance of the capacity and best interests of the detained person.     

The Insanity Exemption to Other than Honorable Discharge for the Purpose of Claiming Benefits: The Role of the Mental Health Examiner

Former service-members are barred from veteran benefits if their character of discharge is other-than-honorable due to willful and persistent misconduct. One exception is if it is determined that the service-member was legally insane at the time of the behaviors resulting in discharge. Offering an expert opinion on a mental state years or decades in the past is complicated. Yet, cases involving such opinions are assigned to veterans affairs-based mental health professionals without additional training or resources. This article fills this gap by discussing the unique legal statutes that define insanity for the purpose of benefit eligibility. In addition, it shares available resources and highlights themes resulting from having opined in such cases and having reviewed 30 Board of Veterans Appeals decisions involving claimed insanity.     

Mental health policy for the 1990s: tinkering in the interstices

That public policy has abysmally failed the chronically mentally ill seems beyond genuine dispute. Successive reforms have foundered on the familiar shoals of overblown expectations and insufficient resources. In this paper, we review current policies affecting the chronic and disabled mentally ill, and we consider some approaches to reform. We begin by trying to identify and characterize the chronically mentally ill and their disabilities. Next, we consider the chaotic patchwork of federal and state programs that has come to replace the asylum. We then criticize several competing models of reform that we believe fail to make an empathic connection with the mentally ill. Finally, we urge a strategy of limited reform consistent with available empirical data about program effectiveness and sensitive to the likely economic, political, and legal constraints of the 1990s.