CIT in context: the impact of mental health resource availability and district saturation on call dispositions

The goals of Crisis Intervention Team (CIT) programs include improving safety during encounters between police and persons with mental illnesses, diverting persons with mental illnesses away from the criminal justice system, and increasing referral and access to mental health services. CIT is a systemic intervention, and as such, its implementation and effectiveness are influenced by existing practices and infrastructures. However, little research has considered the context in which CIT programs are implemented. In this paper, we present research on CIT in four Chicago police districts that vary in terms of two contextual factors hypothesized to influence the impact of CIT training on how calls involving persons with mental illnesses are resolved. Using data from 112 patrol officers in four Chicago police districts, we consider the impact of mental health services availability and CIT saturation (the percentage of district personnel that are CIT certified). Findings indicate that CIT training increased direction to mental health services primarily in districts with greater availability of mental health services. In districts with low service availability, higher CIT saturation increased direction to mental services. The opposite pattern emerged for contact only or informal call resolution. No effects were found for arrest as a call outcome.     

A case of factitious pedophilia

Factitious disorder involves feigning, exaggerating, or self-inducing physical and/or psychological ailments with the goal of assuming the "sick" or "patient" role. In turn, the sick role entitles the factitious disorder patient to care, nurturance, and protection; it also exempts one from usual responsibilities. In this paper, we present the first reported case of factitious pedophilia. Although it seems counterintuitive, this middle-aged man has falsely claimed or exaggerated sexual desire for minors ostensibly to remain in a state hospital; indeed, he has remained in the same inpatient facility for more than 20 years as a result of his deceptions. At times, his reports have included disconfirmed claims of bizarre accidents and other physical travails. This case enlarges the literature on factitious psychological disorders and shows that some individuals may falsify paraphilic behaviors, although clearly minimization of these behaviors remains more common.     

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.     

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.     

农村公共文化的“衰弱”与“滞后”——以甘肃省为例

农村公共文化事业的发展,不仅是新农村建设的重要方面,也是构建和谐社会的重要议题。以甘肃为例,审视农村文化建设现状,不难发现,其存在着"公""私"文化发展不对称、公共文化总量短缺和结构失衡等问题。从体制层面来考察,主要原因是农村文化发展机制的"偏移"。为此,应当通过体制、机制的完善和创新,逐步实现城乡文化的一体化发展。     

Elderly sexual offenders: two unusual cases*

The aim of this case report is to describe two cases of sexual abuse by elderly subjects for which the Judge commissioned an expert psychiatric-forensic opinion. The elderly are generally believed to commit nonviolent crimes, whereas the two cases we observed feature forcible rape committed by elderly offenders, who showed no form of mental disease and had rationally planned their offense. They had never previously committed similar acts and had no history of homosexuality; both had been married for many years before the death of their wives and had adult children. Finally, no previous episodes of rape emerged in their personal histories during interrogations. The sociocultural context in which the crimes were committed was identical and arouses interest as regards both the method employed and how the crimes were discovered. The legal authorities then commissioned accurate investigations including medicolegal and psychiatric-forensic evaluations of the offenders and their victims.     

Schools,Neighborhoods, and Adolescent Conflicts: A Situational Examination of Reciprocal Dynamics

Youths' exposure to school violence is ecologically patterned, occurring disproportionately in public schools located in urban disadvantaged communities. We know less, however, about how situational processes and environmental contexts shape school violence. In addition, limited research has examined the reciprocal nature of school and neighborhood conflicts. Here we draw from a qualitative study of violence in the lives of African American youths from a disadvantaged inner‐city community to examine young men's experiences with school‐based violence. Specifically, we investigate two questions: (1) how conflicts are shaped by the school setting, and (2) how and when such conflicts unfold and spill over between neighborhoods and schools. Our findings highlight the importance of examining the situational and ecological contexts of youth violence to further illuminate its causes and consequences.     

(Dis)order in the Court: Examining Neighborhood Disorder Prosecutions in Miami-Dade County

Abstract

This study examines race, space, perceptions of disorder, and nuisance crime prosecution in Miami-Dade County, Florida. Research has examined nuisance policing, yet little attention has been devoted to nuisance crime prosecutions, especially at the neighborhood level. Aggregating data on defendants arrested for nuisance offenses from 2012 to 2015 up to the neighborhood level, we estimate count models for pretrial detention, case acceptance, conviction, and sentencing outcomes in neighborhoods. We find two patterns of nuisance crime prosecution. Drug disorder prosecutions are concentrated in economically disadvantaged neighborhoods with large Black defendant populations, suggesting a more suppressive treatment of these “marginalized” spaces. In contrast, greater enforcement of homelessness and alcohol nuisance crimes in White non-Hispanic neighborhoods suggests disorder prosecutions are also used to impose order and containment in more economically “prime” spaces. These countervailing patterns highlight the spatial contingency of nuisance enforcement, whereby prosecutors differentially enforce nuisance crimes in prime and marginalized spaces.     

Public Satisfaction with Police Control of Disorder Crime: Does the Public Hold Police Accountable?

This study expands the research on public satisfaction with the police by attempting to disentangle the relationships among disorder crime incidents reported to the police, residents' perceptions of disorder, and citizen satisfaction with police performance on order maintenance. The police accountability model and the demographic model are utilized to predict the variation of public satisfaction with police control of disorder (SWPD). The data used in this analysis were derived from a random-sample telephone survey of 1,215 Houston residents. Crime data were provided by the Houston Police Department and further extracted from the area surrounding each individual respondent's residence surveyed by using Geographic Information Systems technology. The main findings are that while the actual incidence of disorder crime had no direct impact on residents' perceptions of police performance on order maintenance, it did have a significant direct impact on their perceptions of disorder. This shows the utility of the accountability model in future research. Moreover, it was found that global satisfaction with police crime prevention was an important predictor of public SWPD in their immediate neighborhood.     

Reforming the Mental Health Act 1983: an approved social worker perspective

The government green paper, 'Reform of the Mental Health Act 1983', was published in November 1999, for consultation by end of March 2000. This article offers comment on the operation of the Mental Health Act 1983 and the proposals for change, from an approved social worker perspective. Under the Mental Health Act 1983, approved social workers undertake social assessments of mental health crises, deciding upon the need for compulsory admission and treatment. To the debate on legislative change they bring a detailed social perspective on the processes and outcomes of statutory mental health intervention. Approved social workers' main concerns relate to the social context of mental health need, the availability of social resources, civil liberties, protections for people subject to statutory mental health interventions and the effective regulation of practice and services. Current proposals include options that would significantly reduce approved social worker involvement in decisions about compulsory admission and treatment; the implications of this are discussed.