Persons with mental disorder in jails and prisons – legislation and practice in Georgia

IntroductionStatistics shows that in most countries prevalence of mental health problems are much higher among prisoners than the general population. Country approach to regulating mental health needs of persons with mental disorder who come into contact with justice system depends on variety of cultural or legal traditions, as well as on different concepts and structures of mental health care delivery.ObjectiveThe aim of the survey was to study and assess the established practice of implementation of the legal procedure relating to individuals who commit crime and have mental health problems in Georgia.MethodsQualitative analysis including desk review, in-depth interview and focus group discussion was conducted. Preceding from the research objectives the current legislation with regard of people with the mental disorder has been analyzed; the interviews on the shortcomings and problems of the implementation of the law in practice have been conducted with key informants.ResultsThe study acknowledges that recent changes in Georgian legislation imports much of the civil law standards and processes relating to admission, detention and compulsory treatment of criminal detainees with mental health problems. However, due to the ambiguous, ambivalent and incomplete nature of the aforementioned changes, the penal and administrative courts, as well as the clinicians are facing serious difficulties and confusions in their work.ConclusionsIt is discussed that there is a strong need for closer cooperation between mental health and justice systems to treat mentally disordered persons both in the system and after they are released into the community.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Tobacco smoking and mental disorders in Australian adolescents

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211009617 ◽

2021 ◽

pp. 000486742110096

Author(s):

David Lawrence ◽

Sarah E Johnson ◽

Francis Mitrou ◽

Sharon Lawn ◽

Michael Sawyer

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Mental Disorder ◽

Tobacco Smoking ◽

Mental Health Problems ◽

Health Problems ◽

Major Depressive ◽

Current Smoking ◽

Self Harm ◽

Current Tobacco

Objectives: This study aimed to (1) examine the strength of the association between mental disorders/mental health problems, risk behaviours and tobacco smoking among Australian adolescents, (2) compare rates of tobacco smoking among Australian adolescents with major depressive disorder, attention-deficit/hyperactivity disorder and/or conduct disorder in 2013/14 vs 1998, and (3) identify the extent to which an association between tobacco smoking and mental health problems among adolescents can be attributed to non-mental health risk factors. Methods: The study utilised data from the first (1998) and second (2013/14) child and adolescent components of the National Surveys of Mental Health and Wellbeing. Both surveys identified nationally representative samples of Australian young people aged 4–17 years, living in private dwellings. Information was collected from parents and 13- to 17-year-olds about mental disorders, mental health problems, risk behaviours and tobacco smoking. Results: In the 2013/14 survey, the rate of current tobacco smoking among those with a mental disorder was 20% compared to 5% in those without a mental disorder. Rates were highest for young people with conduct disorder (50%), major depressive disorder (24%) and anxiety disorders (19%). In 2013/14, 38% of current tobacco smokers had a mental disorder and 32% reported self-harm and/or suicidal ideation vs 10% and 5%, respectively, among adolescents who had never smoked. Females with mental disorders or reporting self-harm or suicidal ideation had higher rates of current smoking than males. Other significant factors associated with current smoking included school-related problems, binge eating and having had more than one sexual partner. Conclusion: While smoking rates in 13- to 17-year-olds with mental disorders had declined since 1998, the strength of the association between mental disorders and smoking had increased, especially among females. Our findings highlight the need to address the tobacco smoking among adolescents with mental disorders, particularly females.

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Natural kinds of mental disorder

Synthese ◽

10.1007/s11229-021-03239-9 ◽

2021 ◽

Author(s):

Sander Werkhoven

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Mental Disorder ◽

Mental Health Problems ◽

Natural Kinds ◽

Health Problems ◽

Abnormal Behaviour ◽

Diagnostic Categories ◽

Socially Constructed

AbstractAre mental disorders (autism, ADHD, schizophrenia) natural kinds or socially constructed categories? What is at stake if either of these views prove to be true? This paper offers a qualified defence for the view that there may be natural kinds of mental disorder, but also that the implications of this claim are generally overestimated. Especially concerns about over-inclusiveness of diagnostic categories and medicalisation of abnormal behaviour are not addressed by the debate. To arrive at these conclusions the paper opens with a discussion of kind formation in science, followed by an analysis of natural kinds. Seven principled and empirically informed objections to the possibility of natural kinds of mental disorder are considered and rejected. The paper ends with a reflection on diagnostics of mental health problems that don’t fall into natural kinds. Despite the defence of the possibility of natural kinds of mental disorder, this is likely to be the majority of cases.

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Primary Care Pediatrics and Child Psychopathology: A Review of Diagnostic, Treatment, and Referral Practices

PEDIATRICS ◽

10.1542/peds.78.6.1044 ◽

1986 ◽

Vol 78 (6) ◽

pp. 1044-1051 ◽

Cited By ~ 6

Author(s):

Elizabeth J. Costello

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Disorder ◽

Mental Health Care ◽

Mental Health Problems ◽

Primary Care Providers ◽

Health Problems ◽

Group Practices ◽

Primary Care Pediatricians

The quality of mental health care for children depends not only on specialist mental health services, but also on how effectively primary care providers identify, treat, and refer children with emotional and behavioral problems. Recent research has shown that primary care practitioners are the sole providers of mental health care to the majority of people with a mental disorder. For example, Regier et al1 calculated that in 1975 54.1% of persons with a mental disorder were treated only in a primary care or outpatient medical setting, with another 6% receiving care from both specialist mental health and primary care medical facilities. An additional 21.5% were not in treatment or received treatment from nonmedical agencies. If the data were extrapolated for all age groups, these rates would imply that only one child in five with a mental disorder is receiving specialist treatment, three are in the care of a pediatrician, and one is receiving no treatment. This would lead to the conclusion that pediatricians are, according to Regier et al,1 the de facto mental health service for most children in need of such care. It would lend support to the drive to increase pediatricians' awareness of, and training for, the mental health component of their work.2 In this paper, we review the published evidence as it applies to children. SCOPE This review includes the published studies of mental health problems diagnosed by primary care pediatricians, family practitioners, or pediatric nurse practitioners working in outpatient settings in the United States. These include private pediatric practices, group practices, health maintenance organizations (HMOs), and other types of prepaid group practices. The questions addressed are: (1) What proportion of the children seen by primary care pediatricians and their colleagues are diagnosed by them as having a mental disorder? (2) What proportion of children are referred for specialist evaluation and treatment? (3) What risk factors are associated with a higher probability of receiving a diagnosis of psychopathology? (4) How accurate are primary care pediatricians' diagnoses of mental health problems?

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COVID-19 and the Mental Health of People From Refugee Backgrounds

International Journal of Health Services ◽

10.1177/0020731420942475 ◽

2020 ◽

Vol 50 (4) ◽

pp. 415-417 ◽

Cited By ~ 1

Author(s):

Susan Rees ◽

Jane Fisher

Keyword(s):

Mental Health ◽

Health Care ◽

Health Care Delivery ◽

General Health ◽

Mental Health Problems ◽

Care Delivery ◽

Health Problems ◽

Vulnerable Population ◽

High Income ◽

Health Practitioners

Approximately 1 in 10 of the current 26 million people who are refugees reside in high-income countries. They have commonly experienced trauma related to violence, insecurity, persecution and shortage of food and medicine. Our research suggests that COVID-19 and its health and social sequalae may be triggering past traumatic reactions, exacerbating mental health problems and undermining functioning. The purpose of this article is to promptly communicate these anecdotal findings to general health practitioners to ensure informed and sensitive health care delivery to this vulnerable population.

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What is Mental Illness?

10.1093/oxfordhb/9780199579563.013.0028 ◽

2013 ◽

Author(s):

Derek Bolton

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorder ◽

Mental Health Problems ◽

Health Problems ◽

Expert Advice ◽

Related Matter ◽

Do So

The question "What is mental illness?" raises many issues in many contexts, personal, social, legal, and scientific. This chapter reviews mental health problems as they appear to the person with the problems, and to family and friends-before the person attends the clinic and is given a diagnosis-a time in which whether there really is a problem, as opposed to life's normal troubles and variations, is undecided, as also the nature of the problem, if such it be, and the related matter what kind of expert advice should be sought. Once at the clinic, a diagnosis may be given-using criteria well-worked-out in the diagnostic manuals. The chapter discusses the conceptualizations of mental disorder in the diagnostic manuals, their rationale, and what can and cannot be reasonably expected of them. There are more position statements than definitions, and while they signal many dilemmas, they do not resolve them. Attempts to do so in the surrounding literature on the concept of mental illness are reviewed in the chapter, with conclusions favoring the features emphasized in the diagnostic manuals: distress and impairment. Finally the chapter considers how far the science may help draw boundaries around mental illness.

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Risk of Mental Disorders and Difficulties or Conflict in Relationships in Young Adults

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.296 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S95-S95

Author(s):

S. Gorbeña ◽

P. Penas ◽

E. Calvete ◽

I. Crespo ◽

I. Iraurgi

Keyword(s):

Mental Health ◽

Young Adults ◽

Mental Disorders ◽

Mental Health Problems ◽

Well Being ◽

Romantic Partners ◽

Health Problems ◽

Therapeutic Interventions ◽

Psychological Well Being ◽

Competing Interest

IntroductionHigher risk of mental health problems has been linked with problems in relationships, including the experience of relational conflict with significant others and peers. Conversely, positive relations with others have been established as a key factor of psychological well being.ObjectivesWe hypothesized that psychological maladjustment will be related to the number, nature and severity of relational stressors. Furthermore, there would be a higher likelihood of risk of mental disorders for those who experience more relational hardships and of greater severity. Positive relations with others will protect from risk of mental health problems.MethodA total of 4461 university students completed a health and well-being survey, including the GHQ-12 (centesimal and 3-point cut-off scores), Ryff psychological well-being scale and a scale of 25 life stressors. Indexes of number and severity of difficulties in relationships were calculated with 10 items including romantic partners, friends, family, and classmates.ResultsCorrelations were significant. Logistic regression showed a risk effect for all stressors with OR values above 1.32. Overall perceived severity had the highest value (OR = 2.38, 95% CI = 2.16–2.61) and amongst the 10 stressors, gender related abuse/violence was also the highest (OR = 1.90, 95% CI = 1.73–2.09). Positive relations showed a protective effect (OR = 0.60, 95% CI = 0.56–0.54).ConclusionsFindings can inform health promotion, prevention and therapeutic interventions so as to improve the quality of personal relationship and conflict management skills, and to strengthen well-being associated with positive relations with others. Academic institutions committed to student welfare and the promotion of healthy environments should play a major role in young adults’ mental health.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Substance misuse in personality disorder and schizophrenia: findings and clinical implications from a high secure hospital

Journal of Forensic Practice ◽

10.1108/jfp-07-2016-0035 ◽

2017 ◽

Vol 19 (3) ◽

pp. 217-226

Author(s):

Alessandra Cappai ◽

Jodie Wells ◽

James Tapp ◽

Derek Perkins ◽

Anna Manners ◽

...

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Health Problems ◽

Mentally Disordered Offenders ◽

Treatment Needs ◽

Content Type ◽

Mentally Disordered ◽

History Of ◽

Offending Behaviour ◽

The Relationship

Purpose Substance misuse (SMU) is widely prevalent in mentally disordered offenders and is linked with violence and offending behaviour. There is however, a scarcity of literature dedicated to investigating SMU and its clinical correlates in relation to patients detained within high secure hospital settings. The purpose of this paper is to investigate the extent and severity of SMU and corresponding treatment needs in patients with a primary diagnosis of personality disorder (PD) in comparison with mental illness (MI) in a high secure hospital. Design/methodology/approach The responsible clinicians of all patients (n=240) detained in a high secure hospital were asked to record information using a SMU screening questionnaire over a ten-month period. Details requested included substance type, history of past use and assessment and treatment needs. Data were recorded and then analysed: descriptive statistics were conducted to report historical use of substances, cross tabulations and χ2 analysis explored the relationship between SMU and treatment status and diagnosis and offending behaviour and a means comparison analysis was employed to explore length of stay and treatment of SMU. Findings A total of 230 questionnaires were returned (95 per cent of the patient population). A history of SMU was reported in 88.6 per cent of the sample, with alcohol and cannabis misuse being the most prevalent. At least one substance had been abused by 74.3 per cent of the sample. In two-thirds of the sample, SMU was linked with the onset of mental health problems and symptom exacerbation, including violence. Interestingly, patients with a diagnosis of MI as compared with PD were more likely to have used substances (93.3 per cent compared to 81.9 per cent) and were more likely to need treatment for SMU (64.3 per cent compared to 36.8 per cent). In those with an MI diagnosis, SMU was more likely to be linked with violence and index offence (74.3 per cent compared to 59.0 per cent). Practical implications SMU is significantly prevalent in high risk mentally disordered offenders and linked to onset of mental health problems and offending. Patients with schizophrenia have a higher prevalence of SMU than PD and are likely to be more in need of treatment. Violence and offending are more likely to be related to SMU in schizophrenia than in PD. Originality/value This study substantiates existing evidence that SMU contributes to mental health problems and criminogenic behaviour. Furthermore, the study reports new findings that characterize differences of the relationship of SMU to offending in schizophrenia and PD in forensic psychiatric patients presenting to a high secure hospital.

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Untreated Remission of Adolescents’ Mental Health Problems: Challenging the Treatment Gap?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2213 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S222-S222

Author(s):

D. Raven ◽

F. Jörg ◽

R.A. Schoevers ◽

A.J. Oldehinkel

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Health Problems ◽

Self Report ◽

Treatment Gap ◽

Community Based ◽

Residual Symptoms ◽

First Results ◽

Competing Interest

IntroductionMental health problems are highly prevalent and are associated with a high burden, but such problems are often left untreated. This is referred to as the “treatment gap”. The question of who is most likely to remit from their mental health problems without treatment has received surprisingly little attention. A few studies do suggest that untreated remission is common in the general population, but these are in particular limited by short follow-up times.ObjectivesThe aims of this study are to describe untreated remission of mental health problems in adolescence, and to assess the extent to which mental health problems recur after untreated remission.MethodsData from the Dutch community-based cohort study TRacking Adolescents’ Individual Lives Survey (TRAILS) were used. Depressive and anxiety problems were assessed using the Youth Self-Report at ages 11, 13, and 16, and the Adult Self-Report at ages 19 and 22.ResultsPreliminary analyses show high rates of untreated remission (approximately 80% over all waves). However, a substantial proportion of remitted cases still report sub clinical levels of mental health problems at follow-up. More elaborate analyses are ongoing, and will be presented at the conference.ConclusionsFirst results suggest that untreated remission is common in adolescents. The presence of residual symptoms may point towards an elevated risk of recurrence in adolescents who remit without treatment. Further knowledge about untreated remission is of vital importance for an accurate assessment of the treatment gap, and for prevention and early intervention programmes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Mental health stigma among Oman Medical Speciality Board (OMSB) residents

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.675 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S516-S516

Author(s):

S. Musharrafi ◽

W. Al-Ruzaiqi ◽

S. Al-Adawi

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Health Problems ◽

Health Problems ◽

Mental Health Stigma ◽

Medical Speciality ◽

External Shame ◽

Cultural Teaching ◽

History Of ◽

Competing Interest

BackgroundArab/Islamic culture such as those in Oman has been prescribed to be part of “collective culture” where family is central to one's identity. It is not clear how mental illness is perceived among young doctors in Oman in the light of modernization and acculturation.AimsExplore the socio-cultural teaching impact on attitudes towards mental health problems among Omani physicians.MethodThe consenting residents were asked to fill self-reported questionnaire Attitudes towards Mental Health Problems (ATMHP). It measure: external shame (beliefs that others will look down on themselves self if one have mental health problems); internal shame (related to negative self-evaluations); and reflected shame (believing that one can bring shame to their family/community). Socio-demographic information was also sought, including age, gender and previous contact with a person with mental illness.ResultsOne hundred and seventy residents filled the questionnaire. The response rate was > 80%. The majority were female. It showed elevated scores in indices of external shame and reflected shame. However, having a history of mental distress or having contact with a person with mental illness have moderate indices external shame and reflected shame.ConclusionThis study suggests that medical education has little eroded societal teaching among physicians under training in Oman. Thus, their attitude toward mental disorder appears to be expressed in term of external shame and reflected shame, which, in turn, encapsulate cultural patterning of shame and the centrality of family identity in Oman. Such socio-cultural teaching could lay groundwork for further research to mitigate mental illness in Oman.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Pattern of Medicine Prescribing in PHC Facilities before and after earthquake in Nepal

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v20i1.28552 ◽

2021 ◽

Vol 20 (1) ◽

pp. 41-45

Author(s):

Gajendra Bahadur Bhuju ◽

Kumud Kumar Kafle ◽

Radha Raman Prasad ◽

Vabha Rajbhandari ◽

Gorkha Bahadur DC ◽

...

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Treatment Guidelines ◽

Health Workers ◽

Care Delivery ◽

Health Problems ◽

Prescribing Patterns ◽

Psychiatric Medication ◽

Prescribing Practices ◽

Before And After

Introduction: On April and May 2015, Nepal experienced two earthquakes. Many studies have focused on acute care delivery, disease outbreaks, mental health issues, and disaster relief post-earthquakes. Few others have looked at psychiatric medication prescription and health aid distribution pattern, only one study has addressed the effects of an earthquake on medication prescribing patterns and compared them to the post earthquake setting. This paper aims to examine common health problems and prescribing practices before and after the earthquake. Methods: This descriptive retrospective study was conducted within seven randomly selected health posts (HPs) located in the three most earthquake-affected districts of Bhaktapur, Kathmandu and Dhading. The patient records per month from each HP were selected from the out patient department (OPD) register by systematic random sampling for three months prior and three months after the earthquake. There were 584 and 654 encounters in the pre and post earthquake period respectively. Each patient record was analysed using WHO drug use indicators and national treatment guidelines. Results: A significant decrease in encounters receiving antibiotics and cases receiving albendazole alone in worm infestation was found in the post-earthquake period. A significant increase in prescribing antibiotics in cases of common cold was found. Conclusions: The common health problems were similar in both periods. However, prescribing practices were changed. As prescriptions related to mental health problems were lacking, there is a need for improving mental health education to the health workers.

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