Screening for severe mental disorder in jails

Despite the demonstrated prevalence of severe mental disorder among jail detainees and the legal mandate to provide mental health services, most jails do not have the resources to incorporate traditional, time-consuming psychological assessment techniques into their routine intake process. As a result, a number of mentally ill jail detainees remain undetected and untreated. This study outlines the development of the Referral Decision Scale (RDS), which detects persons who have a high probability of having a severe mental disorder so that they can be given a complete diagnostic evaluation. The 14-item RDS was statistically derived using discriminant analysis from data collected via the NIMH Diagnostic Interview Schedule on 728 randomly selected male jail detainees and then validated on 1,149 prison inmates. The final validated version of the RDS had an overall sensitivity of 0.791, specificity of 0.987, and positive and negative predictive value of 0.791 and 0.013, respectively. Since these statistics far exceed current detection rates, the RDS is likely to facilitate the diversion of mentally ill detainees in situations where it is impractical to administer psychological examinations to all incoming inmates. Training requirements for the RDS and directions for future research are discussed.This research was supported in part by National Institute of Mental Health under grant No. R01MH37988. We would like to thank Karl Kilgore, Stuart Michaels, John Lyons, Karen Abram, Richard White, and Christine Davidson for their statistical insights and helpful comments. James Collins is due special thanks for making his North Carolina prison data available. We are also grateful to Philip Hardiman, Thomas Monahan, and Ronald Simmons for their cooperation with the data-collection process.     

A. Reviews: general

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Rapid death due to group A streptococcal infections. Necrotizing fasciitis and acute bacterial myositis.

Soft tissue infections due to the group A Streptococcus are difficult to diagnose and rapidly fatal. They may present to the forensic pathologist as an "obscure autopsy". Death may occur within or outside the hospital and with or without a history of fulminant infection or predisposing factors. It is important for the pathologist to exclude this condition through awareness of its existence and by appropriate dissection with retention of materials for microbiological and histological examination.     

Imposing Procedural Constraints on State Administrative Agencies: An Empirical Investigation of Competing Explanations

Scholars have offered different explanations for administrative procedures. One general approach stresses the importance of normative theory as a determinant of institutional choice, while two other perspectives emphasize the interests and political influence of pressure groups and legislators. To test these models, this study uses comparative state data to predict the adoption of three types of administrative procedures-legislative rule review, procedural requirements opening up the rulemaking process to public participation, and economic impact analysis. The findings suggest that factors associated with the adoption of one kind of administrative requirement may not be associated with the use of others. The analysis also suggests that, while ideology, political culture, and party competition intermittently affect the adoption of particular administrative procedures, they do not always have the kinds of effects that are suggested by the traditional state policy making literature.