Does Mental Illness Impact the Incidence of Crime and Victimisation among Young People?

Risk factors of involuntary referral by police to ER psychiatric services for patients with a severe mental illness: A GEE analysis

This study aimed to identify risk factors for involuntary referral by police to emergency room (ER) psychiatric services for community-based patients with a mental illness via a generalized estimating equation (GEE) analysis. The analysis was based on data from the Management Information System of Psychiatric Care (MISPC) system for patients with a severe mental illness in Taipei, Taiwan and registered referral records of the police. Data on 6378 patients aged ≥20 years were used in this study, including 164 patients who were involuntarily referred to the ER by the police and 6214 patients who were not during the period of January 1, 2018 to December 31, 2020. GEEs were utilized to explore possible risk factors of repeated involuntary referral to ER psychiatric services for patients with a severe mental illness. The logistic regressions indicated that patients defined as "severe" according to the Mental Health Act of Taiwan (crude odds ratio (OR): 3.840, 95 % confidence interval (CI): 2.407-6.126), with a disability (crude OR: 3.567, 95 % CI: 1.339-9.501), with two or more family members with a psychiatric disorder (crude OR: 1.598, 95 % CI: 1.002-2.548), with a history of a suicide attempt (crude OR: 25.582, 95 % CI: 17.608-37.167), and with a history of domestic violence (crude OR: 16.141, 95 % CI: 11.539-22.579) were positively associated with involuntary referral to ER psychiatric services. However, age (crude OR: 0.971, 95 % CI: 0.960-0.983) and the MISPC score (crude OR: 0.834, 95 % CI: 0.800-0.869) were inversely associated with involuntary referral to ER psychiatric services. After adjusting for demographics and potential confounders, we found that patients defined as "severe" (Exp (β): 3.236), with a disability (Exp (β): 3.715), with a history of a suicide attempt (Exp (β): 8.706), and with a history of domestic violence (Exp (β): 8.826), as well as age (Exp (β): 0.986) and the MISPC score (Exp (β): 0.902) remained significantly associated with repeated involuntary referral to ER psychiatric services. In conclusion, community-based mentally ill patients with a history of a suicide attempt, with a history of domestic violence, with a severe illness, and with a profound level of disability were highly associated with involuntary referral to ER psychiatric services. We suggest that community mental health case managers identify significant factors associated with involuntary referral to ER psychiatric services to accordingly arrange case management plans.

The case for a diversion option to trauma-informed community-based primary mental health services for young people following early encounters with police

AIM

There is a convergence between the peak age of onset of mental illness, offending behaviour and associated risk of crime victimization. This study compared self-reported childhood maltreatment and mental health outcomes among a cohort of help-seeking young people who disclosed either a prior criminal charge, crime victimization, or both, to those who did not report any such experiences. The outcomes may inform the development of a diversion option for young people at a first or early encounter with police.

METHODS

The Transitions Study (N = 802; mean age = 18.3 years; 66% female) baseline and 12-month follow-up data were analysed in relation to childhood maltreatment (Childhood Trauma Questionnaire) and changes in mental health (Kessler Psychological Distress Scale and Social and Occupational Functioning Assessment Scale) among young people attending headspace centres in Australia. Outcomes were compared between those young people reporting a prior criminal charge and/or crime victimization and those who did not.

RESULTS

Young people who reported a prior criminal charge or crime victimization reported higher frequency and severity of childhood maltreatment, than those who did not. Both groups reported a reduction in psychological distress following youth mental health service access at 12-month follow-up, however functional improvement was only evident for young people who did not report a prior criminal charge or crime victimization.

CONCLUSIONS

Higher rates of reported childhood maltreatment and reduced psychological distress following service access supports trialling a diversion option to a trauma-informed community-based primary mental health service for young people following an early encounter with police.

Association of aggressivity at adolescence and criminality to severe assault exposure among former adolescent psychiatric inpatients

This study investigated the associations of adolescent aggression, and criminality, to severe hospital-treated assault exposures among young adults (n = 508) with a history of adolescent psychiatric inpatient treatment between 2001-2006. Participants were interviewed during hospitalization using K-SADS-PL to assess psychiatric disorders, and to obtain information on aggressivity. Data on crimes committed were obtained from the Finnish Legal Register Centre, and the treatment episodes for assault exposures from the Finnish National Care Register for Health Care, up to end of 2016. Predictors for severe assault exposure were male sex (OR = 2.1), short temperedness (OR = 2.4), non-violent offending (OR = 2.6), and violent offending (OR = 4.8). These results indicate that the participants most vulnerable to severe assaults were those suffering from a continuum of aggressivity across their lifetime. Our findings can be utilized to identify adolescents at risk of severe assault exposure, and to reduce this risk by focusing on appropriate treatments for these vulnerable adolescents.