A survey of national trends in psychiatric patients found incompetent to stand trial: reasons for the reinstitutionalization of people with serious mental illness in the United States

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 245-251
Author(s):  
Katherine Warburton ◽  
Barbara E. McDermott ◽  
Anthony Gale ◽  
Stephen M. Stahl
Keyword(s):  
Psychiatric Patients ◽  
National Level ◽  
District Of Columbia ◽  
The United States ◽  
Community Treatment ◽  
Specific Information ◽  
General Mental Health ◽  
Forensic Patients ◽  
State Hospitals ◽  
Incompetent To Stand Trial

Objective.Recent information indicates that the number of forensic patients in state hospitals has been increasing, largely driven by an increase in patients referred to state hospitals as incompetent to stand trial (IST). This survey was intended to broaden the understanding of IST population trends on a national level.Methods.The authors developed a 30-question survey to gather specific information on IST commitments in each state and the District of Columbia. The survey was administered to all 50 states and the District of Columbia via email. Specific individuals identified as primary administrators responsible for the care and evaluation of IST admissions in each state were contacted.Results.A total of 50 out of the 51 jurisdictions contacted completed the survey. Fully 82% of states indicated that referrals for competency evaluation were increasing. Additionally, 78% of respondents thought referrals for competency restoration were increasing. When asked to rank factors that led to an increase, the highest ranked response was inadequate general mental health services in the community. Inadequate crisis services were the second ranked reason. Inadequate number of inpatient psychiatric beds in the community was the third highest, with inadequate assertive community treatment services ranking fourth.Conclusions.Understanding the national trend and causes behind the recent surge in referrals for IST admissions will benefit states searching for ways to remedy this crisis. Our survey indicates most states are facing this issue, and that it is largely related to insufficient services in the community.

Hypoglycemia from a look-alike, sound-alike medication error

2015 ◽  
Vol 5 (4) ◽  
pp. 174-179
Author(s):  
Robin M. Milton ◽  
Nicole B. Washington ◽  
Nancy Brahm
Keyword(s):  
Medication Error ◽  
Medication Errors ◽  
Health Care Professionals ◽  
Psychiatric Patients ◽  
Well Being ◽  
The United States ◽  
Community Treatment ◽  
Drug Event ◽  
Hypoglycemic Episode ◽  
Corrective Actions

Abstract Objective To describe the effects of a look-alike, sound-alike medication error on the glycemic control and psychiatric well-being of a 23-year-old man. Case Summary A 23-year-old man presented to the university-based Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) team with a diagnosis of schizoaffective disorder, most recent episode manic, and hypertension. The patient was prescribed chlorpromazine 100 mg daily to treat symptoms of psychosis and anxiety. The anxiety, however, persisted and escalated over the following 2 weeks. Upon physical examination of the patient's medications, it was discovered that the patient was inadvertently given chlorpropamide in place of the chlorpromazine. Evaluations, clinical presentation, the medication list, and criteria for an adverse drug event indicated a probable relationship (7 of 12) between the use of chlorpropamide and a hypoglycemic episode. The medication error was noted and corrective actions were taken. Within 1 week of the corrective actions, the patient's anxiety improved. Discussion When working with psychiatric patients, it is important to physically review all medications when expected responses are not achieved or when new psychiatric or physiological symptoms present. Approximately one-fourth of medication errors in the United States are drug name confusion errors. These errors must be universally addressed by all parties involved in the medication process. Effective safeguards are available and must be implemented by manufacturers, physicians, pharmacists, nurses, and all health care professionals to prevent look-alike, sound-alike medication errors.

An overview of jail-based competency restoration

CNS Spectrums ◽  
2019 ◽  
Vol 25 (5) ◽  
pp. 624-629
Author(s):  
Scott E. Kirkorsky ◽  
Mary Gable ◽  
Katherine Warburton
Keyword(s):  
United States ◽  
State Hospital ◽  
Mentally Ill ◽  
Psychiatric Hospitals ◽  
The United States ◽  
Competency Restoration ◽  
State Hospitals ◽  
Hospital Beds ◽  
Incompetent To Stand Trial ◽  
County Jails

Forensic populations in the United States are increasing, driven largely by a rise in individuals determined to be Incompetent to Stand Trial (IST). Across most states, including California, the number of mentally ill inmates awaiting competency restoration has increased dramatically in recent years. Traditionally, competency restoration has taken place in state hospitals, but incompetent inmates often experience a significant wait for state hospital beds because of the rising demand for beds in such facilities. The resulting waitlists, which range from days to months, have led to states being held in contempt of court for violating limits placed on how long incompetent defendants can be held in jail. Therefore, alternatives to state hospitalization for IST patients have been developed, including jail-based competency (JBCT) restoration programs. JBCT programs provide restoration services in county jails, rather than in psychiatric hospitals. The following article will review the nature of JBCT programs and will emphasize the structure and evolution of such programs within California.

Deinstitutionalization and other factors in the criminalization of persons with serious mental illness and how it is being addressed

CNS Spectrums ◽  
2019 ◽  
Vol 25 (2) ◽  
pp. 173-180 ◽  
Author(s):  
H. Richard Lamb ◽  
Linda E. Weinberger
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Criminal Justice ◽  
Serious Mental Illness ◽  
Psychiatric Inpatient ◽  
The United States ◽  
Community Treatment ◽  
Mental Condition ◽  
State Hospitals ◽  
The Many

One of the major concerns in present-day psychiatry is the criminalization of persons with serious mental illness (SMI). This trend began in the late 1960s when deinstitutionalization was implemented throughout the United States. The intent was to release patients in state hospitals and place them into the community where they and other persons with SMI would be treated. Although community treatment was effective for many, there was a large minority who did not adapt successfully and who presented challenges in treatment. Consequently, some of these individuals’ mental condition and behavior brought them to the attention of law enforcement personnel, whereupon they would be subsequently arrested and incarcerated. The failure of the mental health system to provide a sufficient range of treatment interventions, including an adequate number of psychiatric inpatient beds, has contributed greatly to persons with SMI entering the criminal justice system. A discussion of the many issues and factors related to the criminalization of persons with SMI as well as how the mental health and criminal justice systems are developing strategies and programs to address them is presented.

Applicability of management guidelines for surfing resources in California

Shore & Beach ◽  
2020 ◽  
pp. 53-64
Author(s):  
Edward Atkin ◽  
Dan Reineman ◽  
Jesse Reiblich ◽  
David Revell
Keyword(s):  
New Zealand ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Management Guidelines ◽  
For Profit ◽  
Aotearoa New Zealand ◽  
Coastal Marine ◽  
Management Measures ◽  
Legal Frameworks

Surf breaks are finite, valuable, and vulnerable natural resources, that not only influence community and cultural identities, but are a source of revenue and provide a range of health benefits. Despite these values, surf breaks largely lack recognition as coastal resources and therefore the associated management measures required to maintain them. Some countries, especially those endowed with high-quality surf breaks and where the sport of surfing is accepted as mainstream, have recognized the value of surfing resources and have specific policies for their conservation. In Aotearoa New Zealand surf breaks are included within national environmental policy. Aotearoa New Zealand has recently produced Management Guidelines for Surfing Resources (MGSR), which were developed in conjunction with universities, regional authorities, not-for-profit entities, and government agencies. The MGSR provide recommendations for both consenting authorities and those wishing to undertake activities in the coastal marine area, as well as tools and techniques to aid in the management of surfing resources. While the MGSR are firmly aligned with Aotearoa New Zealand’s cultural and legal frameworks, much of their content is applicable to surf breaks worldwide. In the United States, there are several national-level and state-level statutes that are generally relevant to various aspects of surfing resources, but there is no law or policy that directly addresses them. This paper describes the MGSR, considers California’s existing governance frameworks, and examines the potential benefits of adapting and expanding the MGSR in this state.

Patient Autonomy, Capacity, and Consent

2020 ◽  
Author(s):  
Mary Donnelly ◽  
Jessica Berg
Keyword(s):  
United States ◽  
National Level ◽  
The United States ◽  
Legal Framework ◽  
National Standard ◽  
Legal Principles ◽  
Key Issues ◽  
Human Rights Norms ◽  
Law And Legislation

This chapter explores a number of key issues: the role of competence and capacity, advance directives, and decisions made for others. It analyses the ways these are treated in the United States and in selected European jurisdictions. National-level capacity legislation and human rights norms play a central role in Europe, which means that healthcare decisions in situations of impaired capacity operate in accordance with a national standard. In the United States, the legal framework is more state-based (rather than federal), and the courts have played a significant role, with both common law and legislation varying considerably across jurisdictions. Despite these differences, this chapter identifies some similar legal principles which have developed.

scholarly journals Food-Based Dietary Guidelines for Seafood Do Not Translate into Increased Long-Chain Omega-3 Levels in the Diet for U.S. Consumers

Foods ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1816
Author(s):  
Michael F. Tlusty
Keyword(s):  
United States ◽  
Fatty Acids ◽  
National Level ◽  
The United States ◽  
Dietary Guidelines ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Complete Understanding ◽  
The U.S ◽  
Long Chain

Humans under-consume fish, especially species high in long-chain omega-3 fatty acids. Food-based dietary guidelines are one means for nations to encourage the consumption of healthy, nutritious food. Here, associations between dietary omega-3 consumption and food-based dietary guidelines, gross domestic product, the ranked price of fish, and the proportions of marine fish available at a national level were assessed. Minor associations were found between consumption and variables, except for food-based dietary guidelines, where calling out seafood in FBDGs did not associate with greater consumption. This relationship was explored for consumers in the United States, and it was observed that the predominant seafood they ate, shrimp, resulted in little benefit for dietary omega-3 consumption. Seafood is listed under the protein category in the U.S. Dietary Guidelines, and aggregating seafood under this category may limit a more complete understanding of its nutrient benefits beyond protein.

scholarly journals Shooting from the ‘Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 444
Author(s):  
Charles Stoecker
Keyword(s):  
Positive Impact ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Scope Of Practice ◽  
Patient Specific ◽  
Behavioral Risk ◽  
Influenza Immunization ◽  
Immunization Rates ◽  
The Impact

In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.

scholarly journals Effectiveness of Face Coverings in Mitigating the COVID-19 Pandemic in the United States

2021 ◽  
Vol 18 (7) ◽  
pp. 3666
Author(s):  
Olukayode James Ayodeji ◽  
Seshadri Ramkumar
Keyword(s):  
Public Health ◽  
United States ◽  
District Of Columbia ◽  
Preventive Measure ◽  
The United States ◽  
Protective Measure ◽  
Sharp Change ◽  
The Public ◽  
Public Health Challenges ◽  
Effective Preventive Measure

The COVID-19 pandemic has been one of the biggest public health challenges of the 21st century. Many prevalent measures have been taken to prevent its spread and protect the public. However, the use of face coverings as an effective preventive measure remains contentious. The goal of the current study is to evaluate the effectiveness of face coverings as a protective measure. We examined the effectiveness of face coverings between 1 April and 31 December 2020. This was accomplished by analyzing trends of daily new COVID-19 cases, cumulative confirmed cases, and cases per 100,000 people in different U.S. states, including the District of Columbia. The results indicated a sharp change in trends after face covering mandates. For the 32 states with face covering mandates, 63% and 66% exhibited a downward trend in confirmed cases within 21 and 28 days of implementation, respectively. We estimated that face covering mandates in the 32 states prevented approximately 78,571 and 109,703 cases within 21- and 28-day periods post face covering mandate, respectively. A statistically significant (p = 0.001) negative correlation (−0.54) was observed between the rate of cases and days since the adoption of a face covering mandate. We concluded that the use of face coverings can provide necessary protection if they are properly used.

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