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Tsai J, Christian NJ, Szymkowiak D. Patterns of Psychiatric Medication Prescriptions for Veterans in Treatment Courts and Other Specialty Courts. J Psychiatr Pract 2024; 30:119-129. [PMID: 38526399 DOI: 10.1097/pra.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Psychiatric medications can serve as important tools for addressing behavioral health issues among criminal justice-involved (CJI) veterans. This study used national data on 12,790 CJI veterans in the U.S. Department of Veterans Affairs (VA) Veterans Justice Outreach program from 2019 to 2020 to compare patterns of psychiatric medication prescriptions among veterans who entered a veterans treatment court (n = 6975), another specialty court (SC; n = 414), or no-SC (n = 5401). Different classes of medications were examined, including antidepressants, stimulants, antipsychotics, benzodiazepines, and medications for substance use disorders. The results showed that 60.2% of the total sample was prescribed a psychiatric medication within 1 year of entering the Veterans Justice Outreach program. There was no significant difference in overall psychiatric prescribing among veterans treatment court, other SC, and no-SC groups, but there were a few differences in certain classes of psychiatric medications. Moreover, about 7.8% of veterans who were in the no-SC group and were prescribed psychiatric medications did not have a psychiatric diagnosis. Veterans who were younger, non-Hispanic white, married, with a VA service-connected disability rating, had a diagnosis of mental and/or substance use disorder, and used more VA health care services were more likely to have been prescribed psychiatric medication. Together, these findings illustrate the essential role of psychiatric medications in courts and programs that serve CJI veterans, as well as the important link between VA service engagement and psychiatric prescriptions.
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Garritsen K, Janković M, Masthoff E, Caluwé ED, Bogaerts S. The Role of Dynamic Risk and Protective Factors in Predicting Violent Recidivism: Intellectual Ability as a Possible Moderator? INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:207-234. [PMID: 35227118 PMCID: PMC10773168 DOI: 10.1177/0306624x221079695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study investigated which risk and protective factors, based on the 14 clinical indicators of the Historical-Clinical-Future Revised, significantly predicted violent recidivism in a sample of 315 male forensic psychiatric patients. Additionally, it was investigated whether these associations were moderated by intellectual ability. Regarding risk factors, a stronger influence of risky network members, and higher levels of hostility, impulsivity, and addiction significantly predicted violent recidivism. Likewise, regarding protective factors, poorer social and labor skills, and a lower degree of patient's acceptance of crime responsibility were significant predictors of violent recidivism. Contrary to our expectations, better coping skills and more insight into risky behaviors that can lead to relapse also contributed significantly to an increased likelihood of violent recidivism. Intellectual ability had no significant moderating effect on the associations between the factors and violent recidivism. The results offer an insight into which factors need to be prioritized during treatment.
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Affiliation(s)
| | - Marija Janković
- Tilburg University, The Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands
| | | | - Stefan Bogaerts
- Tilburg University, The Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands
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Williams T, Rollings-Mazza P. Understanding psychosis. Nursing 2023; 53:22-28. [PMID: 37734014 DOI: 10.1097/01.nurse.0000977564.10896.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT Psychotic behavior is often unpredictable; thus, there can be an increased risk of violence toward others and oneself. This article details the etiology and diagnosis of psychosis and nursing interventions to provide appropriate care.
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Affiliation(s)
- Tommy Williams
- Tommy Williams is a clinical research and informatics nurse and Pamela Rollings-Mazza is the chief medical officer of PrimeCare Medical, Inc
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Jacob MFF, Razali S, Ali NF, Khamis J, Ahmad Y. Prevalence and risk factors contributing to recidivism among patients admitted to Forensic Unit Hospital Permai Johor Bahru Malaysia. Asian J Psychiatr 2023; 79:103325. [PMID: 36395701 DOI: 10.1016/j.ajp.2022.103325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/18/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Muhammad Farhan Fitri Jacob
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh, Selangor, Malaysia; Department of Psychiatry and Mental Health, Hospital Selayang, Ministry of Health, Gombak, Selangor, Malaysia.
| | - Salmi Razali
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh, Selangor, Malaysia.
| | - Nur Faizah Ali
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh, Selangor, Malaysia.
| | - Johari Khamis
- Department of Forensic Psychiatry, Hospital Permai, Ministry of Health, Johor Bahru, Johor, Malaysia.
| | - Yuhaniz Ahmad
- School of Quantitative Sciences, Universiti Utara Malaysia, Sintok, Kedah, Malaysia.
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Machetanz L, Huber D, Lau S, Kirchebner J. Model Building in Forensic Psychiatry: A Machine Learning Approach to Screening Offender Patients with SSD. Diagnostics (Basel) 2022; 12:diagnostics12102509. [PMID: 36292198 PMCID: PMC9600890 DOI: 10.3390/diagnostics12102509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Today’s extensive availability of medical data enables the development of predictive models, but this requires suitable statistical methods, such as machine learning (ML). Especially in forensic psychiatry, a complex and cost-intensive field with risk assessments and predictions of treatment outcomes as central tasks, there is a need for such predictive tools, for example, to anticipate complex treatment courses and to be able to offer appropriate therapy on an individualized basis. This study aimed to develop a first basic model for the anticipation of adverse treatment courses based on prior compulsory admission and/or conviction as simple and easily objectifiable parameters in offender patients with a schizophrenia spectrum disorder (SSD). With a balanced accuracy of 67% and an AUC of 0.72, gradient boosting proved to be the optimal ML algorithm. Antisocial behavior, physical violence against staff, rule breaking, hyperactivity, delusions of grandeur, fewer feelings of guilt, the need for compulsory isolation, cannabis abuse/dependence, a higher dose of antipsychotics (measured by the olanzapine half-life) and an unfavorable legal prognosis emerged as the ten most influential variables out of a dataset with 209 parameters. Our findings could demonstrate an example of the use of ML in the development of an easy-to-use predictive model based on few objectifiable factors.
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Barnett P, Steare T, Dedat Z, Pilling S, McCrone P, Knapp M, Cooke E, Lamirel D, Dawson S, Goldblatt P, Hatch S, Henderson C, Jenkins R, K T, Machin K, Simpson A, Shah P, Stevens M, Webber M, Johnson S, Lloyd-Evans B. Interventions to improve social circumstances of people with mental health conditions: a rapid evidence synthesis. BMC Psychiatry 2022; 22:302. [PMID: 35484521 PMCID: PMC9047264 DOI: 10.1186/s12888-022-03864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Poor social circumstances can induce, exacerbate and prolong symptoms of mental health conditions, while having a mental health condition can also lead to worse social outcomes. Many people with mental health conditions prioritise improvement in social and functional outcomes over reduction in clinical symptoms. Interventions that improve social circumstances in this population should thus be considered a priority for research and policy. METHODS This rapid evidence synthesis reports on randomised controlled trials of interventions to improve social circumstances across eight social domains (Housing and homelessness; money and basic needs; work and education; social isolation and connectedness; family, intimate and caring relationships; victimisation and exploitation; offending; and rights, inclusion and citizenship) in people with mental health conditions. Economic evaluations were also identified. A comprehensive, stepped search approach of the Cochrane library, MEDLINE, Embase, PsycINFO, Web of Science and Scopus was conducted. RESULTS One systematic review and 102 randomised controlled trials were included. We did not find RCT evidence for interventions to improve family, intimate and caring relationships and only one or two trials for each of improving money and basic needs, victimisation and exploitation, and rights, inclusion and citizenship. Evidence from successful interventions in improving homelessness (Housing First) and employment (Individual Placement and Support) suggests that high-intensity interventions which focus on the desired social outcome and provide comprehensive multidisciplinary support could influence positive change in social circumstances of people with mental health conditions. Objective social isolation could be improved using a range of approaches such as supported socialisation and social skills training but interventions to reduce offending showed few benefits. Studies with cost and cost-effectiveness components were generally supportive of interventions to improve housing and vocational outcomes. More research is needed to ensure that social circumstances accompanied by high risks of further exacerbation of mental health conditions are adequately addressed. CONCLUSIONS Although there is a large body of literature examining how to support some aspects of life for people with mental health conditions, more high-quality evidence is required in other social domains. Integration into mental health services of interventions targeting social circumstances could significantly improve a number of social outcomes.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. .,Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK.
| | - Thomas Steare
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Zainab Dedat
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Stephen Pilling
- grid.83440.3b0000000121901201Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK ,grid.452735.20000 0004 0496 9767National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Paul McCrone
- grid.36316.310000 0001 0806 5472Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Martin Knapp
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eleanor Cooke
- grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust and MH Policy Research Unit, London, UK
| | - Daphne Lamirel
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Sarah Dawson
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Peter Goldblatt
- grid.83440.3b0000000121901201Department of Epidemiology & Public Health, Institute of Health Equity, University College London, London, UK
| | - Stephani Hatch
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Kings College London, London, UK ,grid.13097.3c0000 0001 2322 6764ESRC Centre for Society and Mental Health, Kings College London, London, UK
| | - Claire Henderson
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Kings College London, London, UK ,grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Rachel Jenkins
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neurology, Kings College London, London, UK
| | - T K
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Karen Machin
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Alan Simpson
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK ,grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Kings College London, London, UK ,grid.13097.3c0000 0001 2322 6764Florence Nightingale Faculty of Nursing, Kings College London, Midwifery & Palliative care, London, UK
| | - Prisha Shah
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Martin Stevens
- grid.13097.3c0000 0001 2322 6764NIHR Policy Research Unit On Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Martin Webber
- grid.5685.e0000 0004 1936 9668International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, England
| | - Sonia Johnson
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
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Warner AR, Glazier S, Lavagnino L, Ruiz A, Hernandez S, Lane SD. Inpatient early intervention for serious mental illnesses and post-discharge criminal involvement in a high-volume psychiatric hospital setting. J Psychiatr Res 2021; 143:285-291. [PMID: 34530339 DOI: 10.1016/j.jpsychires.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
Individuals with serious mental illness (SMI) are at increased risk for arrest and incarceration relative to the same-community population without SMI. Publicly-funded inpatient psychiatric hospitals usually feature short lengths of stay and limited opportunities for extended services that might impact criminal justice involvement after discharge. This study examined the influence of an early intervention program for SMI at a high-volume public psychiatric hospital on involvement in the criminal justice system post-discharge. The Early Onset Treatment Program (EOTP) is an extended service intervention program for uninsured patients who are within 5 years of SMI onset. Criminal justice records (number of arrests with conviction, days of incarceration) were obtained for EOTP participants (n = 164) and comparison patients (n = 164) matched on demographics, diagnosis, and discharge date via propensity score matching. Data were zero-inflated and analyzed using hurdle models, controlling for prior arrests. The EOTP group was less likely to be convicted of at least one crime post-discharge (0 arrests vs. > 0, p < .001), and spent fewer days incarcerated (if incarcerated ≥1 day, p < .03). Participation in the EOTP service was linked to reduced likelihood of post-discharge arrest and days incarcerated. Several alternative variables may contribute to this preliminary observation, including length of stay, medication adherence, longer environmental stability, and individual patient characteristics.
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Affiliation(s)
- Alia R Warner
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Stephen Glazier
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Luca Lavagnino
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Ana Ruiz
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Sarah Hernandez
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA
| | - Scott D Lane
- Louis A. Faillace, MD, Department of Psychiatry & Behavioral Sciences, UTHealth McGovern Medical School UTHealth Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, 77054, TX, USA.
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Multivariable modelling of factors associated with criminal convictions among people experiencing homelessness and serious mental illness: a multi-year study. Sci Rep 2021; 11:16610. [PMID: 34400747 PMCID: PMC8368183 DOI: 10.1038/s41598-021-96186-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
People experiencing homelessness and serious mental illness exhibit high rates of criminal justice system involvement. Researchers have debated the causes of such involvement among people experiencing serious mental illness, including what services to prioritize. Some, for example, have emphasized mental illness while others have emphasized poverty. We examined factors associated with criminal convictions among people experiencing homelessness and serious mental illness recruited to the Vancouver At Home study. Participants were recruited between October 2009 and June 2011. Comprehensive administrative data were examined over the five-year period preceding study baseline to identify risk and protective factors associated with criminal convictions among participants (n = 425). Eight variables were independently associated with criminal convictions, some of which included drug dependence (RR = 1.53; P = 0.009), psychiatric hospitalization (RR = 1.44; P = 0.030), an irregular frequency of social assistance payments (compared to regular payments; 1.75; P < 0.001), and prior conviction (RR = 3.56; P < 0.001). Collectively, findings of the present study implicate poverty, social marginalization, crises involving mental illness, and the need for long-term recovery-oriented services that address these conditions to reduce criminal convictions among people experiencing homelessness and serious mental illness.
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Assess characteristics of forensic assertive community treatment programs. ABSTRACT Forensic assertive community treatment (FACT) has emerged internationally as an intervention strategy for people with serious mental disorders who are involved with the criminal justice system. Studies to date have shown marked variability, however, in FACT program design and operation. Based upon a literature review and relevant experience, the authors present their perspective on the essential elements of FACT. Given that FACT is an adaptation of the evidence-based assertive community treatment (ACT) model, it is recommended that FACT programs maintain a high-fidelity ACT component. FACT programs should also have both mental health and criminal justice admission criteria because service recipients are involved in both service systems. For optimal effectiveness, FACT team clinicians must partner with criminal justice agencies that provide community-based supervision to their patients. Prospective FACT enrollees should receive a clear explanation of the program, including how their respective mental health and criminal justice service providers will work collaboratively with them to prevent incarceration. FACT programs should also use risk/need assessment to inform treatment planning, evidence-based mental health and community correctional practices to promote both wellness and public safety, and shared training to promote effective collaboration. Additional elements to consider include housing, medical care, and transitional services. These elements are presented and discussed, including a rationale and evidence to support each component. The article concludes with introduction of a FACT fidelity scale, the Rochester Forensic Assertive Community Treatment Scale (R-FACTS). By operationalizing essential FACT elements, the R-FACTS is designed to support FACT program development, implementation, and dissemination in a more consistent and measurable manner.
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