Crime, violence, and behavioral health: collaborative community strategies for risk mitigation

CNS Spectrums ◽  
2015 ◽  
Vol 20 (3) ◽  
pp. 241-249 ◽  
Author(s):  
Debra A. Pinals
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Mental Illness ◽  
Substance Use ◽  
Behavioral Health ◽  
Risk Mitigation ◽  
Management Strategies ◽  
Public Mental Health ◽  
Criminal Recidivism ◽  
Risk Management Strategies

Criminal conduct is not always violent, and violence does not always lead to criminal charges. Moreover, crime and violence have multifaceted etiologies. Most violence in society is not attributable to mental illness. Where there is a small relationship between violence and mental illness, the risk of violence increases for individuals with substance use histories. Underlying trauma can also play a role. Antisocial attitudes, behaviors, and peer groups further increase the risk that individuals, including those with mental illness, will find themselves at risk of criminal recidivism. Criminal histories among public mental health populations, and mental health and substance use disorders among criminal populations are each higher than general population comparisons. Care within behavioral health settings should therefore target decreased criminal recidivism and decreased violence as part of recovery for those individuals at risk, using trauma-informed approaches and peer supports. Interventions that show promise bring criminal justice and behavioral health systems together, and include police-based diversion, specialty courts, court-based alternatives to incarceration, and coordinated re-entry programs. This article reviews these options along with specific risk management strategies, such as using risk, needs, and responsivity factors as a means of improving overall outcomes for persons with mental illness, while minimizing their risk of further criminalization and victimization.

Assessment of coexisting psychosis and substance misuse: complexities, challenges and causality

2020 ◽  
Vol 27 (1) ◽  
pp. 38-48
Author(s):  
Rajan Nathan ◽  
Emily Lewis
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Mental Illness ◽  
Substance Use ◽  
Mental Health Service ◽  
Health Service ◽  
Clinical Experience ◽  
Substance Misuse ◽  
Evidence Base ◽  
Mental Health Clinicians

SUMMARYSubstance misuse worsens the prognosis for people suffering psychosis and places them at risk of being denied appropriate mental health service interventions. To increase the chances of its success, the plan of management for patients with coexisting psychosis and substance misuse should be based on a valid formulation of their problems, which in turn is dependent on the clinician having (a) a thorough understanding of the bidirectional and changing ways that substance use and mental illness symptoms can interact, (b) an awareness of their own biased implicit assumptions about causality in explaining these interactions and (c) a framework for assessment and formulation. This article addresses these three areas with reference to the evidence base and to clinical experience in a way that guides mental health clinicians in the assessment of patients with coexisting psychosis and substance misuse.

The Impact of Perceived Need for Treatment on Risk of Arrest and Violence Among People With Severe Mental Illness

2007 ◽  
Vol 34 (2) ◽  
pp. 197-210 ◽  
Author(s):  
Eric B. Elbogen ◽  
Sarah Mustillo ◽  
Richard van Dorn ◽  
Jeffrey W. Swanson ◽  
Marvin S. Swartz
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Psychiatric Treatment ◽  
Management Strategies ◽  
Public Mental Health ◽  
Need For Treatment ◽  
Perceived Need ◽  
Risk Management Strategies ◽  
Demographic Covariates ◽  
The Impact

One clinical strategy for managing risk of arrest and violence among people with severe mental illness (SMI) involves targeting potentially treatable factors related to these risks. The current study examines the association between individuals’ perceived need for psychiatric treatment and their risk of arrest and violence among people with SMI. Adults meeting criteria for psychotic and affective disorders receiving public mental health services in four states are interviewed ( N = 907), with 26% reporting being arrested or violent in the past year. Participants in this group are more likely to deny needing psychiatric treatment. Multivariate analyses confirm this pattern for participants both arrested and violent, controlling for clinical and demographic covariates. As a result, clinical interventions that address a patient’s perceived need for psychiatric treatment, such as compliance therapy and motivational interviewing, appear to hold promise as risk management strategies for clinicians providing services for individuals with SMI.

scholarly journals Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults with Serious Mental Illness: An Open, Non-Randomized Trial in the Context of COVID-19 (Preprint)

2020 ◽  
Author(s):  
Ajeng J Puspitasari ◽  
Dagoberto Heredia ◽  
Brandon J Coombes ◽  
Jennifer R Geske ◽  
Melanie T Gentry ◽  
...  
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Mental Illness ◽  
Behavioral Health ◽  
Suicide Risk ◽  
Psychiatric Hospitalization ◽  
Patient Level ◽  
Cohen’S D ◽  
Cohen's D ◽  
Day Program

BACKGROUND In the context of COVID-19, many behavioral health services transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome. OBJECTIVE This single-arm, non-randomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person to a video teletherapy group during COVID-19. METHODS Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess program effectiveness for improving quality of mental health, depression, anxiety, and suicide risk. RESULTS Patients (N = 76) started the program between March to August of 2020. Feasibility was established with 70 (92.1%) completing the program, mean attendance of 14.43 (SD = 1.22) days, and 71 (94.7%) had at least one behavioral health aftercare service scheduled prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvement on depression (95% Cl: -3.6 to -6.2; Cohen’s d = 0.77; p < 0.0001), anxiety (95% Cl: -3.0 to -4.9; Cohen’s d = 0.74; p < 0.0001), overall suicide risk (95% Cl: -0.5 to-0.1; Cohen’s d = 0.41; p = 0.019), wish to live (95% Cl: 0.3 to 1.0; Cohen’s d = 0.39; p = 0.0005), wish to die (95% Cl: -0.2 to-1.4; Cohen’s d = 0.52; p = 0.011), and overall mental health (95% Cl: 1.5 to 4.5; Cohen’s d = 0.39; p = 0.0003) from admission to discharge. CONCLUSIONS Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements on psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials.

Comment: ‘Devining’ The Role of the Consultant Psychiatrist in a Public Mental Health Service

1998 ◽  
Vol 32 (5) ◽  
pp. 612-615 ◽  
Author(s):  
Alan Rosen
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Public Mental Health ◽  
Consultant Psychiatrist ◽  
Persistent Mental Illness ◽  
Public Mental Health Service ◽  
Key Players ◽  
Recovery Program

We admitted to ourselves, …and to our colleagues that we cannot treat people with severe and persistent mental illness as independent practitioners, and asked to be key players on the multidisciplinary team (Extract from A 12-Step Recovery Program for Psychiatrists [1]).

scholarly journals Access to public mental health services among older adults with severe mental illness

2009 ◽  
Vol 24 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Todd P. Gilmer ◽  
Victoria D. Ojeda ◽  
Dahlia Fuentes ◽  
Viviana Criado ◽  
Piedad Garcia
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Public Mental Health ◽  
Public Mental Health Services

An Efficient Nurse Practitioner–Led Community-Based Service Model for Delivering Coordinated Care to Persons With Serious Mental Illness at Risk for Homelessness

2017 ◽  
Vol 24 (2) ◽  
pp. 101-108 ◽  
Author(s):  
Jeannemarie Baker ◽  
Jasmine L. Travers ◽  
Penelope Buschman ◽  
Jacqueline A. Merrill
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Quality Care ◽  
Coordinated Care ◽  
Community Based ◽  
Provide Quality Care

BACKGROUND: Access to mental health care is a struggle for those with serious mental illness (SMI). About 25% of homeless suffer from SMI, compared with 4.2% of the general population. OBJECTIVE: From 2003 to 2012, St. Paul’s Center (SPC) operated a unique model to provide quality care to the homeless and those at risk for homelessness, incarceration, and unnecessary hospitalization because of SMI. Data were available for analysis for the years 2008 to 2010. DESIGN: The SPC was developed, managed, and staffed by board-certified psychiatric/mental health nurse practitioners, offering comprehensive mental health services and coordinated interventions. RESULTS: All clients were housed and none incarcerated. From 2008 to 2010, only 3% of clients were hospitalized, compared with 7.5% of adults with SMI. Clinical, academic, and community partnerships increased value, but Medicaid reimbursement was not available. CONCLUSION: Mental health provisions in the recently passed 21st Century Cures Act support community mental health specialty treatment. The SPC provides a template for similar nurse practitioner–led models.

“Broken windows”: Relationship between neighborhood conditions and behavioral health among low-income African American adolescents

2016 ◽  
Vol 23 (4) ◽  
pp. 527-537 ◽  
Author(s):  
Dexter R Voisin ◽  
Dong Ha Kim
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
African American ◽  
Behavioral Health ◽  
Low Income ◽  
Mental Health Problems ◽  
African American Youth ◽  
African American Adolescents ◽  
Broken Windows ◽  
Neighborhood Conditions

This study explored the association between neighborhood conditions and behavioral health among African American youth. Cross-sectional data were collected from 683 African American youth from low-income communities. Measures for demographics, neighborhood conditions (i.e. broken windows index), mental health, delinquency, substance use, and sexual risk behaviors were assessed. Major findings indicated that participants who reported poorer neighborhood conditions compared to those who lived in better living conditions were more likely to report higher rates of mental health problems, delinquency, substance use, and unsafe sexual behaviors. Environmental factors need to be considered when addressing the behavioral health of low-income African American youth.

scholarly journals High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems

2019 ◽  
Vol 23 (4) ◽  
pp. 835-846
Author(s):  
Julie H. Levison ◽  
Margarita Alegría ◽  
Ye Wang ◽  
Sheri L. Markle ◽  
Larmiar Fuentes ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Behavioral Health ◽  
Mental Health Problems ◽  
Health Problems ◽  
Latino Immigrants
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