Recognition and understanding of goals and roles: The key internal features of mental health court teams

The increasing involvement of people with mental illness in the criminal justice system has led to the formation of specialty programs such as mental health courts (hereafter MHCs). We discuss MHCs and the teams serving these courts. Specifically, we examine team members' perceptions of MHC goals and their own and others' roles on the MHC team. Using a semi-structured interview instrument, we conducted 59 face-to-face interviews with criminal justice and mental health treatment personnel representing 11 Ohio MHCs. Findings from our qualitative data analyses reveal that MHC personnel understand individuals' roles within the teams, recognize and appreciate the importance of different roles, and share common goals. MHCs could foster this level of understanding and agreement by working to recruit and retain individuals with experience in or willingness to learn about both the criminal justice and mental health systems. Future research should explore the impact of MHC team functioning on client outcomes.     

The Patients’ Rights Directive (2011/24/EU) – Providing (some) rights to EU residents seeking healthcare in other Member States

This article presents the main elements of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare, commonly known as the Patient’s Rights Directive. It is the latest EU initiative with regard to European Health Care and the Single Market. The main elements of the Directive contain provisions related to the prior authorisation of health care in another Member State, the reimbursement of such health care and the removal of unjustified obstacles to achieving these aims.These provisions largely reflect the recent case law of the European Court of the Justice (ECJ). Amongst these are provisions involving the use of personal data. Such provisions will engage data protection issues and will have to be carried out according to the data protection directives. Alongside this primary aim of codifying ECJ case law the Patient’s Rights Directive also introduces novel initiatives aimed at fostering cross border cooperation between various elements of national healthcare systems.Part 1 of this contribution will describe the legal basis and the aims of the PRD, Part 2 will describe the principle obligations placed on the Member States with regard to reimbursement, Parts 3 and 4 will describe other informational and procedural requirements placed upon the Member States of Treatment and Affiliation. Finally Part 5 will outline some of the novel initiatives that have been included in the PRD.The increases in the frequency of cross border-treatment that this directive attempts to facilitate are likely to see a concurrent increase in cross-border patient information flows. Such data flows will be subject to the Union’s provisions on Data Protection. It remains uncertain whether the EU’s Data Protection regime will act as inhibitor to cross-border medical treatment or rather represent a gold standard that allows patients to engage in such activities with peace of mind. The Patient’s Rights Directive will form part of the EU’s future e-Health strategy which envisages a large increase in the fluidity of patient data. A discussion of this directive is therefore merited in this journal.     

PARTNERS IN THE PROCESS: HOW ATTORNEYS PREPARE THEIR CLIENTS FOR CUSTODY EVALUATIONS AND LITIGATION

We surveyed 113 family attorneys regarding what they did to prepare their clients for child custody evaluations and litigation. Findings revealed that participants saw child custody evaluations as useful on a variety of levels and effective in settling cases. In general, participants reported using professionally acceptable procedures, appropriately advocated for their clients, and dealt with complaints in a reasonable fashion. Referrals to mental health professionals in advance of a child custody evaluation were generally made to provide support rather than for evaluation or test preparation. Work product reviews by mental health consultants were infrequent, although such reviews were seen as highly useful by those who used them. Lastly, participants reported that allegations of parental alienation and domestic violence were often used to gain leverage in custody cases. Implications for practice are discussed for both attorneys and evaluators.     

The mental health needs of incarcerated youth in British Columbia, Canada

The purpose of the study was to identify the current prevalence of mental disorders and mental health needs among incarcerated male and female youths in Canada, and to present these data in the context of rates found in other jurisdictions. One hundred forty male and 65 female incarcerated young offenders in British Columbia were screened with the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2); provisional psychiatric diagnoses were assessed with the Diagnostic Interview Schedule for Children Version IV (DISC-IV); abuse history and aggressive symptoms of Conduct Disorder (CD) were coded from file information. Nearly all youths (91.9% of males and 100% of females) met the criteria for at least one mental disorder. Substance abuse and dependence disorders were highly prevalent (85.5% of males and 100% of females). Aggressive forms of CD were common (72.9% of males and 84.3% of females), as were exposure to physical abuse (60.8% of males and 54.3% of females) and sexual abuse (21.2% of males and 42.4% of females). Female youths had significantly higher odds of presenting with: (1) substance abuse/dependence disorders; (2) current suicide ideation; (3) sexual abuse; (4) PTSD; (5) symptoms of depression and anxiety; (6) Oppositional Defiant Disorder; and (7) multiple mental disorder diagnoses. Male youths had significantly higher odds of presenting with aggressive symptoms of CD. Overall, rates of mental disorder among this sample of serious and violent young offenders were higher than rates previously reported for incarcerated youths — both in Canada and in other jurisdictions.     

Repealing Federal Oversight of State Health Policy: Lessons from the Boren Amendment

The Boren Amendment is frequently cited as an example where judicial involvement markedly shaped the implementation of federal legislation. Unlike other controversial health policies, Boren was eventually rescinded by Congress. Results indicate that the Amendment was repealed because changing socioeconomic, political, and programmatic conditions combined with policy‐oriented learning to facilitate a shift in policy venue away from the judiciary toward the President and Congress. This is because during the devolutionary climate of the mid‐to‐late 1990s, both the executive and legislature proved more conducive to the policy image promulgated by state officials that the Amendment unnecessarily restricted state discretion, than the policy image promulgated by providers that without the Amendment, low reimbursement levels would compromise access and quality. Data for this analysis derive from archival documents, secondary sources, and 101 interviews with state and federal experts.     

Upset over Air Pollution: Analyzing Upset Event Emissions at Petroleum Refineries

The Clean Air Act (CAA) controls routine emissions at petroleum refineries, by creating limits and penalties for excess emissions. The CAA offers provisions for upset events, air emissions released because of unforeseen or unavoidable circumstances, if companies report the emissions and take corrective action. States enforce upset event rules and many states provide exemptions for a variety of circumstances, which may allow upset emissions to become a substantial, yet mostly unregulated source of emissions. We catalog the quantity and type of emissions generated during upset events at 18 Texas petroleum refineries from 2003 to 2008. We find that upset events occur frequently at these facilities and are collectively large in magnitude, emitting a combined total of 75 million lbs of emissions. In a select number of cases, single upset events exceeded annual emissions reported to the Toxics Release Inventory. Future research should assess the accuracy of upset event reporting and impact of upset events on environmental health.     

Overriding Psychiatric Advance Directives: Factors Associated with Psychiatrists' Decisions to Preempt Patients' Advance Refusal of Hospitalization and Medication

Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override was less likely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system.     

当代大学生心理健康状况分析及对策

目前,大学生心理健康状况不容乐观,大学生的心理问题是多方面原因综合造成的。预防和解决大学生心理问题,应做好大学生的心理引导和研究工作,同时还应切实提高广大教职工心理健康教育的意识和能力,营造良好的校园环境,使我们所培养的学生能得到全面的发展,成为有用的人才。     

大学生心理健康护理策略探析

高校开展心理健康教育除了采用举办讲座、开设课程等普及有关心理卫生知识外,更重要的是通过传播、教育手段使大学生具备自我心理保健意识,提高他们的心理适应、心理自助、心理调节的能力,增强其心理免疫力,维护心理平衡,促进良好的心理素质的形成。加强大学生心理健康教育及护理的目标不仅在于达到产生干预个体心理健康倾向的效应,而且还在于产生群体心理健康倾向的效应。