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Gerritsen C, Adamo V, Fulham L, Jones R, Penney S, Tagore A, Simpson A. Evidence for the ecological validity of the Brief Jail Mental Health Screen: Positive predictive value among remanded men and women. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2022; 32:295-301. [PMID: 35988066 DOI: 10.1002/cbm.2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individuals with severe mental illness are over-represented in correctional institutions. The scarcity of mental health services in prison settings has increased the demand for tools to screen effectively for mental health need. While the need for sensitivity is widely recognised, there has been less attention to specificity of screening tools. In addition, prior studies have focussed on research-informed diagnostic performance rather than real-world service provision. OBJECTIVE To examine the performance of the Brief Jail Mental Health Screen (BJMHS) for indicating secondary mental health need in 'real world' conditions. METHODS Retrospective data were collected from 2977 individuals (2256 male) remanded in either of two correctional facilities in Ontario, Canada, who had been screened on reception as having clinically significant mental health needs by correctional health staff using the BJMHS and examined by specialist mental health staff at triage. The positive predictive value (PPV) of the BJMHS was calculated, using actual secondary mental health service referral as the performance criterion. RESULTS Overall, the positive predictive value of the BJMHS was 67.2%. It was significantly higher for men (69.5%) than women (60.1%). CONCLUSIONS While these findings add support to the use of the BJMHS in screening mental health need among people under custodial remand, its false positive rate, particularly among women suggests a need to improve its performance. One potentially important avenue for future research would be whether repeating the screen after an interval prior to specialist referral would improve efficiency.
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Affiliation(s)
- Cory Gerritsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vito Adamo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lindsay Fulham
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Roland Jones
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Penney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Abanti Tagore
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexander Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Davis JS, Zuber K. The Historical Landscape of Mental Health Evaluation and Treatment. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Casiano H, Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM. The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:492-501. [PMID: 32363932 PMCID: PMC7298584 DOI: 10.1177/0706743720919660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understand the relationship between criminal accusations, victimization, and mental disorders at a population level using administrative data from Manitoba, Canada. METHOD Residents aged 18 to 64 between April 1, 2007, and March 31, 2012 (N = 793,024) with hospital- and physician-diagnosed mental disorders were compared to those without. Overall and per-person rates of criminal accusations and reported victimization in the 2011/2012 fiscal year were examined. Relative risks were calculated, adjusting for age, sex, income, and presence of a substance use disorder. The overlap between diagnosed mental disorders, accusations, and victimization with a χ2 test of independence was studied. RESULTS Twenty-four percent (n = 188,693) of the population had a mental disorder over the 5-year time frame. Four to fifteen percent of those with a mental disorder had a criminal accusation, compared to 2.4% of the referent group. Individuals with mental disorders, especially psychotic or personality disorders, were often living in low-income, urban neighborhoods. The adjusted relative risk of accusations and victimization remained 2 to 5 times higher in those with mental disorders compared to the referent group. Criminal accusations and victimization were most prevalent among individuals with a history of attempted suicide (15.2% had an accusation and 8.1% were victims). The risk of victimization in the same year as a criminal accusation was significantly increased among those with mental disorders compared to those without (χ2 = 211.8, P < 0.001). CONCLUSIONS Individuals with mental disorders are at elevated risk of both criminal involvement and victimization. The identification of these multiply-stigmatized individuals may lead to better intervention and support.
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Affiliation(s)
- Hygiea Casiano
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Rimal P, Maru D, Chwastiak L, Agrawal P, Rao D, Swar S, Citrin D, Acharya B. Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal. BMC Psychiatry 2020; 20:46. [PMID: 32024490 PMCID: PMC7003398 DOI: 10.1186/s12888-020-2464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist reviews treatment plans for a panel of patients and provides specific clinical recommendations to improve the quality of care. Very few studies have reported data on such recommendations. This study reviews and classifies the recommendations made by consulting psychiatrists in a rural primary care clinic in Nepal. METHODS A chart review was conducted for all patients whose cases were reviewed by the treatment team from January to June 2017, after CoCM had been operational for 6 months. Free text of the recommendations were extracted and two coders analyzed the data using an inductive approach to group and categorize recommendations until the coders achieved consensus. Cumulative frequency of the recommendations are tabulated and discussed in the context of an adapted CoCM in rural Nepal. RESULTS The clinical team discussed 1174 patient encounters (1162 unique patients) during panel reviews throughout the study period. The consultant psychiatrist made 214 recommendations for 192 (16%) patients. The most common recommendations were to revisit the primary mental health diagnosis (16%, n = 34), add or increase focus on counselling and psychosocial support (9%, n = 20), increase the antidepressant dose (9%, n = 20), and discontinue inappropriate medications (6%, n = 12). CONCLUSIONS In this CoCM study, the majority of treatment plans did not require significant change. The recommendations highlight the challenge that non-specialists face in making an accurate mental health diagnosis, the relative neglect of non-pharmacological interventions, and the risk of inappropriate medications. These results can inform interventions to better support non-specialists in rural areas.
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Affiliation(s)
| | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal ,0000 0001 0670 2351grid.59734.3cDepartments of Global Health System Design and Global Health, Internal Medicine, and Pediatrics, Mount Sinai School of Medicine, New York, NY USA ,0000 0001 0670 2351grid.59734.3cArnhold Institute for Global Health, Mount Sinai School of Medicine, New York, NY USA
| | - Lydia Chwastiak
- 0000000122986657grid.34477.33Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Northwest Mental Health Technology Transfer Center, University of Washington, Seattle, WA USA
| | | | - Deepa Rao
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Sikhar Swar
- Nyaya Health Nepal, Kathmandu, Nepal ,0000 0004 0442 6252grid.415089.1Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal
| | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal ,0000000122986657grid.34477.33Department of Anthropology, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - Bibhav Acharya
- Nyaya Health Nepal, Kathmandu, Nepal ,0000 0001 2297 6811grid.266102.1Department of Psychiatry, University of California, San Francisco, CA USA
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Hensel JM, Casiano H, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM. Prevalence of mental disorders among all justice-involved: A population-level study in Canada. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 68:101523. [PMID: 32033694 DOI: 10.1016/j.ijlp.2019.101523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/07/2019] [Accepted: 11/09/2019] [Indexed: 06/10/2023]
Abstract
More than 10 million people are imprisoned around the world, with many more who encounter the justice system. However, most studies examining the mental health burden in the justice system have examined only incarcerated individuals, with few looking at both criminal offending and victimization at the population-level. This study aimed to describe the population-level prevalence of mental disorders among the entirety of justice-involved individuals in a Canadian sample. The study was conducted using linked health and justice administrative data for all residents of Manitoba, Canada ages 18-64 between April 1, 2007 and March 31, 2012. All justice involvement (crime accusations and victimizations) and inpatient and outpatient mental disorder diagnoses (mood/anxiety, substance use, psychotic, personality disorders and suicidal behavior) were retrieved. Five-year age- and sex-adjusted prevalence of mental disorders and suicidal behaviour among those with any crime accusation and any victimization were compared to the general population of Manitoba. The study found that age- and sex-adjusted prevalence of any mental disorder was significantly higher among both adults accused of a crime and those victimized (38.9% and 38.6%, respectively) compared to the general population (26.1%). Rate ratios for specific mental disorders and suicidal behaviour were 1.4-3.6 among those accused of a crime, and 1.4-3.7 among those who were victims, compared to the general population. These findings highlight the need for urgent and expanded attention to this intersection of vulnerability. Victimization is especially an area of justice-related health that requires more attention.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Hygiea Casiano
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Kolodziejczak O, Sinclair SJ. Barriers and Facilitators to Effective Mental Health Care in Correctional Settings. JOURNAL OF CORRECTIONAL HEALTH CARE 2018; 24:253-263. [PMID: 29938550 DOI: 10.1177/1078345818781566] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is estimated that one third to one half of the 2.3 million individuals inside U.S. jails and prisons have a mental illness in contrast to 18.3% of the general population. The implications of this on training mental health professionals to provide efficacious treatment inside correctional facilities, as well as planning for the rehabilitation and reintegration of incarcerated individuals, are significant and numerous. This article will present a brief history and overview of mental health services in the U.S. correctional system, as well as a discussion of the barriers to and potential facilitators of providing effective care in the future.
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