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Lamneck C, Alvarez A, Zaragoza C, Rahimian R, Trejo MJ, Lebensohn P. Assessment of immigration law enforcement presence in a teaching hospital along the US/Mexico border. Int J Equity Health 2023; 22:199. [PMID: 37770859 PMCID: PMC10540385 DOI: 10.1186/s12939-023-01934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Over the past decade, the United States (US) has seen a spike in migration across the US-Mexico border with an increase in hospital admissions of migrants and asylum-seekers under the custody of immigration law enforcement (ILE). This study aimed to determine how the presence of ILE officials affects patient care and provider experience in a teaching hospital setting. METHODS This cross-sectional online survey solicited quantitative and qualitative feedback from medical students, residents, and attending physicians (n = 1364) at a teaching hospital system with two campuses in Arizona. The survey included participant demographics and addressed participants' experience caring for patients in ILE custody, including the perception of respect, violations of patients' privacy and autonomy, and the comfort level with understanding hospital policies and patient rights. Thematic analyses were also performed based on respondent comments. RESULTS 332 individuals (24%) responded to the survey. Quantitative analyses revealed that 14% of participants described disrespectful behaviors of ILE officials, mainly toward detained patients. Qualitative thematic analyses of respondent comments revealed details on such disrespectful encounters including ILE officers violating the Health Insurance Portability and Accountability Act (HIPAA) and using intimidation tactics with patients. Nearly half of the respondents did not have knowledge of policies about ILE detainees' medical care, detainees' privacy rights, or ILE's authority in patient care. CONCLUSIONS This study points out the complexities, challenges, and ethical considerations of caring for patients in ILE custody in the hospital setting and the need to educate healthcare professionals on both patient and provider rights. It describes the lived experiences and difficulties that providers on the border face in trying to achieve equity in the care they provide to detained migrant patients.
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Affiliation(s)
- Claire Lamneck
- University of Arizona College of Medicine, Tucson, AZ, USA
| | | | | | | | - Mario Jesus Trejo
- University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Stakeholder Perspectives on Implementing a Police-Mental Health Collaborative to Improve Pathways to Treatment. J Behav Health Serv Res 2022; 49:299-314. [PMID: 35000102 PMCID: PMC8742697 DOI: 10.1007/s11414-021-09782-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
High rates of criminal justice involvement among individuals with mental illness have led to collaborative efforts between law enforcement agencies and mental health providers to improve crisis responses and pathways to treatment. The development and implementation of these police-mental health collaborations (PMHCs) have received little attention in the literature, but these processes are crucial in understanding feasibility and sustainability. The PMHC discussed here is an interagency effort to identify individuals involved with law enforcement who have unmet behavioral health needs and engage them in services. Perspectives from leaders, service providers, and clients highlight the importance of developing PMHCs that support individuals with serious mental illness at multiple points, from initial crisis to independent management of treatment. In an environment where police responses to individuals with mental health and substance use disorders are increasingly scrutinized, it is critical to highlight and evaluate ways that behavioral health and law enforcement agencies work together to collaboratively address these problems.
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Agee ER, Zelle H, Kelley S, Moore SJ. Marshaling administrative data to study the prevalence of mental illness in assault on law enforcement cases. BEHAVIORAL SCIENCES & THE LAW 2019; 37:636-649. [PMID: 31957089 DOI: 10.1002/bsl.2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Abstract
A substantial body of literature has investigated many issues surrounding police encounters with persons with mental illness. This paper focuses on a specific type of encounter - individuals with mental illness charged with assaulting officers because of their behavior during a psychiatric crisis - and uses administrative data to examine its prevalence in one state. Results suggest that individuals with mental health histories comprise a small but meaningful percentage (c. 9%) of assault on law enforcement charges, and c. 10% of these charges have an offense date within 14 days of an emergency mental health custody order, increasing the likelihood that psychiatric symptoms influenced their behavior at the time of the offense. Further results describe different categories of relevant charges, charge classifications, final dispositions, and sentences. Results are discussed in the context of outcomes for persons with mental illness and law enforcement as well as the role and limitations of forensic mental health assessment in these cases. The paper concludes with a call for similar data collection across jurisdictions.
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Affiliation(s)
- Elisha R Agee
- Institute of Law, Psychiatry, and Public Policy, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Heather Zelle
- Institute of Law, Psychiatry, and Public Policy, University of Virginia Department of Public Health Sciences, Charlottesville, VA, USA
| | - Sharon Kelley
- Institute of Law, Psychiatry, and Public Policy, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Steven J Moore
- Institute of Law, Psychiatry, and Public Policy, University of Virginia Department of Public Health Sciences, Charlottesville, VA, USA
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Parker A, Scantlebury A, Booth A, MacBryde JC, Scott WJ, Wright K, McDaid C. Interagency collaboration models for people with mental ill health in contact with the police: a systematic scoping review. BMJ Open 2018; 8:e019312. [PMID: 29588323 PMCID: PMC5875664 DOI: 10.1136/bmjopen-2017-019312] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify existing evidence on interagency collaboration between law enforcement, emergency services, statutory services and third sector agencies regarding people with mental ill health. DESIGN Systematic scoping review. Scoping reviews map particular research areas to identify research gaps. DATA SOURCES AND ELIGIBILITY ASSIA, CENTRAL, the Cochrane Library databases, Criminal Justice Abstracts, ERIC, Embase, MEDLINE, PsycINFO, PROSPERO and Social Care Online and Social Sciences Citation Index were searched up to 2017, as were grey literature and hand searches. Eligible articles were empirical evaluations or descriptions of models of interagency collaboration between the police and other agencies. STUDY APPRAISAL AND SYNTHESIS Screening and data extraction were undertaken independently by two researchers. Arksey's framework was used to collate and map included studies. RESULTS One hundred and twenty-five studies were included. The majority of articles were of descriptions of models (28%), mixed methods evaluations of models (18%) and single service evaluations (14%). The most frequently reported outcomes (52%) were 'organisational or service level outcomes' (eg, arrest rates). Most articles (53%) focused on adults with mental ill health, whereas others focused on adult offenders with mental ill health (17.4%). Thirteen models of interagency collaboration were described, each involving between 2 and 13 agencies. Frequently reported models were 'prearrest diversion' of people with mental ill health (34%), 'coresponse' involving joint response by police officers paired with mental health professionals (28.6%) and 'jail diversion' following arrest (23.8%). CONCLUSIONS We identified 13 different interagency collaboration models catering for a range of mental health-related interactions. All but one of these models involved the police and mental health services or professionals. Several models have sufficient literature to warrant full systematic reviews of their effectiveness, whereas others need robust evaluation, by randomised controlled trial where appropriate. Future evaluations should focus on health-related outcomes and the impact on key stakeholders.
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Affiliation(s)
- Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Arabella Scantlebury
- Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK
| | - Alison Booth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Wood JD, Watson AC. Improving police interventions during mental health-related encounters: Past, present and future. POLICING & SOCIETY 2016; 27:289-299. [PMID: 29200799 PMCID: PMC5705098 DOI: 10.1080/10439463.2016.1219734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
There are calls across America for police to re-imagine themselves as "guardians" rather than "warriors" in the performance of their innumerable duties. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship. At least as far back as the de-institutionalization of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through improved knowledge and attitudes about mental health vulnerabilities and needs. Building on the progress made, we suggest there are critical opportunities for a new wave of efforts that can further advance the guardianship agenda. We highlight three such opportunities: (1) Enhancing experiences of procedural justice during mental health-related encounters; (2) Building the evidence base through integrated data sets; and (3) Balancing a "case-based" focus with a "place-based" focus.
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Affiliation(s)
- Jennifer D Wood
- Department of Criminal Justice and Centre for Security and Crime Science, Temple University, Philadelphia, P.A., USA
| | - Amy C Watson
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, IL, USA
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Wood JD, Beierschmitt L. Beyond police crisis intervention: moving "upstream" to manage cases and places of behavioral health vulnerability. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:439-47. [PMID: 24629568 PMCID: PMC4142086 DOI: 10.1016/j.ijlp.2014.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Law enforcement officers continue to serve on the front lines as mental health interventionists, and as such have been subject to a wave of "first generation" reform designed to enhance their crisis response capabilities. Yet, this focus on crisis intervention has not answered recent calls to move "upstream" and bolster early intervention in the name of long-term recovery. This paper reports on findings from an action research project in Philadelphia aimed at exploring opportunities for enhanced upstream engagement. Study methods include spatial analyses of police mental health transportations from an eight year period (2004-2011) and qualitative data from twenty-three "framing conversations" with partners and other stakeholders, seven focus groups with police and outreach workers, five key informant interviews as well as document reviews of the service delivery system in Philadelphia. Recommendations include the need to move beyond a focus on what police can do to a wider conception of city agencies and business stakeholders who can influence vulnerable people and vulnerable spaces of the city. We argue for the need to develop shared principles and rules of engagement that clarify roles and stipulate how best to enlist city resources in a range of circumstances. Since issues of mental health, substance use and disorder are so tightly coupled, we stress the importance of establishing a data-driven approach to crime and disorder reduction in areas of the city we term "hotspots of vulnerability". In line with a recovery philosophy, such an approach should reduce opportunities for anti-social behavior among the "dually labeled" in ways consistent with "procedural justice". Furthermore, crime and disorder data flowing from police and security to behavioral health analysts could contribute to a more focused case management of "repeat utilizers" across the two systems. Our central argument is that a twin emphasis on "case management" and "place management" may provide the pillars needed to move upstream and strengthen interventions along a continuum of engagement.
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Affiliation(s)
- Jennifer D Wood
- Department of Criminal Justice, Center for Security and Crime Science, Temple University, 1115 Polett Walk, Gladfelter Hall, Philadelphia, PA 19122, USA.
| | - Laura Beierschmitt
- Department of Criminal Justice, Temple University, 1115 Polett Walk, Gladfelter Hall, Philadelphia, PA 19122, USA.
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Maritz J. Follow-up of Mental Care Users by Nurses in the Primary Care Setting in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2010.10820343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Blank Wilson A. How people with serious mental illness seek help after leaving jail. QUALITATIVE HEALTH RESEARCH 2013; 23:1575-1590. [PMID: 24128995 DOI: 10.1177/1049732313508476] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this study, I examined how people with serious mental illness defined and prioritized their service needs when released from jail and how these service priorities shaped the sequencing of help-seeking activities after their release. Data included ethnographic observations and interviews with the staff and clients of a mental health reentry program and responses to an open-ended questionnaire that was given to the program's clients (N = 115). Sixty-three percent of the clients identified housing and 35% identified financial assistance as one of their two most important service needs, whereas only 12% selected treatment services. These service priorities reflect a hierarchy in help-seeking activities postrelease in which clients' access to treatment services was predicated on their ability to first find sustainable economic and material support. I conclude that reentry programs need to have the resources required to meet both the basic and treatment needs of people with serious mental illness leaving jail.
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Lurigio AJ. Forty years after Abramson: beliefs about the criminalization of people with serious mental illnesses. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2013; 57:763-765. [PMID: 23740510 DOI: 10.1177/0306624x13490142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Schäfer I, Verthein U, Oechsler H, Deneke C, Riedel-Heller S, Martens M. What are the needs of alcohol dependent patients with a history of sexual violence? A case-register study in a metropolitan region. Drug Alcohol Depend 2009; 105:118-25. [PMID: 19647957 DOI: 10.1016/j.drugalcdep.2009.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Revised: 05/28/2009] [Accepted: 06/17/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sexual violence has become increasingly apparent as a factor determining more complex treatment needs in patients with substance abuse. However, empirical evidence on specific patterns of differences between patients with and without a history of sexual violence is scarce. METHODS Our sample consisted of alcohol dependent outpatients treated during a two-year period in a German metropolitan region. The analysis was based on a local case register and included all patients for whom information on lifetime sexual violence was available (N=1981; 33.4% female). In a case-control design, patients with a history of sexual violence were compared to patients without such experiences regarding a wide range of clinical and social factors indicative of potential needs. RESULTS More than 35% of the female patients and 6% of the male patients reported a history of sexual violence. Victims differed from non-victims across a variety of domains, including psychiatric symptoms and suicide attempts, legal problems, financial and family problems, previous use of services, and need for additional services during the current treatment. Patient gender emerged as a significant moderator of several of these associations. CONCLUSIONS The findings indicate that an effort needs to be made to link addiction treatment, other parts of the health care system, and further institutions, such as family services and parts of the legal system, so that the complex needs of this vulnerable population can be met in an adequate way.
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Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
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Hoch JS, Hartford K, Heslop L, Stitt L. Mental Illness and Police Interactions in a Mid-Sized Canadian City: What the Data Do and Do Not Say. ACTA ACUST UNITED AC 2009. [DOI: 10.7870/cjcmh-2009-0005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jeffrey S. Hoch
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Health Policy, Management and Evaluation, University of Toronto
| | - Kathleen Hartford
- Lawson Health Research Institute, and School of Nursing and Department of Epidemiology and Biostatistics, University of Western Ontario, London
| | - Lisa Heslop
- Family Consultant/Victim Services Unit, London Police Service, Ontario
| | - Larry Stitt
- Department of Epidemiology and Biostatistics, University of Western Ontario, London
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White P, Edwards N, Townsend-White C. Stress and burnout amongst professional carers of people with intellectual disability: another health inequity. Curr Opin Psychiatry 2006; 19:502-7. [PMID: 16874124 DOI: 10.1097/01.yco.0000238478.04400.e0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This paper summarizes trends in the research literature about stress and burnout in the lives of people who are the professional carers of people with intellectual disability. The principal time period considered was from 2004 to 2006. RECENT FINDINGS Studies reviewed here focus on several themes including inequities affecting professional carers of people with intellectual disability and the possible effects of some models of care on inequities. Implications for people with intellectual disability are also considered. SUMMARY The diaspora of people with intellectual disability into the community and their accompanying services found a whole new set of unpredicted and unprecedented challenges. Life in the community has rendered professional carers of people with intellectual disability more clearly vulnerable to stress and burnout for a variety of complex reasons, some identified and others as yet unrecognized. Lack of support and lack of role definition are particular problems. Presence of physical and mental health inequities result in major disparities in community care for people with intellectual disability.
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Affiliation(s)
- Paul White
- Mental Health Policy and Economics Group, Queensland Centre for Mental Health Research (QCMHR), Centre for Mental Health, The Park, Wacol, Queensland, Australia.
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Cuellar AE, McReynolds LS, Wasserman GA. A cure for crime: can mental health treatment diversion reduce crime among youth? JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2006; 25:197-214. [PMID: 16465707 DOI: 10.1002/pam.20162] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Youth crime is a serious social problem, as is the high proportion of young offenders in the juvenile justice system who have mental disorders. A recent policy innovation applies the theory of therapeutic jurisprudence and diverts youth with mental disorders to treatment in lieu of further court processing. The expansion of mental health diversion programs reflects an increasingly popular view that there is a causal relationship between youth mental disorders and crime. Policymakers who share this view place greater emphasis on rehabilitation and treatment as a way to reduce crime, rather than on stricter punishment. This paper considers the policy issues around youth mental health diversion programs. In addition, it evaluates the effect of a mental health diversion program for youth that was implemented in Texas. The paper finds that mental health diversion can be used effectively to delay or prevent youth recidivism.
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Draine J, Wolff N, Jacoby JE, Hartwell S, Duclos C. Understanding community re-entry of former prisoners with mental illness: a conceptual model to guide new research. BEHAVIORAL SCIENCES & THE LAW 2005; 23:689-707. [PMID: 16170791 DOI: 10.1002/bsl.642] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.
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Hartford K, Heslop L, Stitt L, Hoch JS. Design of an algorithm to identify persons with mental illness in a police administrative database. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2005; 28:1-11. [PMID: 15710445 DOI: 10.1016/j.ijlp.2004.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
North American police maintain a database to track events and information related to their involvement with the public that contain a series of electronic caution/dependency flags attached to an individual's name for internal communication. To identify persons with mental illness in a police administrative database, an algorithm was developed that was composed of (a) caution/dependency flags, (b) addresses, and (c) key search words indicative of mental illness. Based on the level of confidence of the algorithm, persons with mental illness (PMI) were then assigned to one of three categories: Definite, Probable and Possible PMI. Results for 2000 include the sociodemographic characteristics of PMI and non-PMI in the database. The mean number of contacts, types of interactions, re-involvement with a year, charges and dispositions are described. The algorithm provides a cheap, quick method to identify PMI for North American police. It enables police to monitor the effectiveness of pre-arrest diversion programs and allows researchers to analyze questions of criminalization and mental illness.
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Affiliation(s)
- Kathleen Hartford
- Scientist-Epidemiologist, Lawson Health Research Institute, Associate Professor, Faculties of Health Sciences, Medicine and Dentistry, University of Western Ontario, 375 South Street, NRA220, London, Ontario, Canada.
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Fisher WH, Normand SLT, Dickey B, Packer IK, Grudzinskas AJ, Azeni H. Managed mental health care's effects on arrest and forensic commitment. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2004; 27:65-77. [PMID: 15019768 DOI: 10.1016/j.ijlp.2003.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- William H Fisher
- Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School (UMMS), 55 Lake Avenue North, Worcester, MA 01655, USA.
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Wolff N. Risk, response, and mental health policy: learning from the experience of the United Kingdom. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2002; 27:801-832. [PMID: 12465780 DOI: 10.1215/03616878-27-5-801] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.
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Affiliation(s)
- Nancy Wolff
- Bloustein School of Planning and Public Policy, Center for Mental Health Services and Criminal Justice Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, USA
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Wolff N. (New) public management of mentally disordered offenders. Part II: A vision with promise. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2002; 25:427-444. [PMID: 12371260 DOI: 10.1016/s0160-2527(01)00099-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Nancy Wolff
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901-1293, USA.
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Wolff N. "New" public management of mentally disordered offenders: Part I. A cautionary tale. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2002; 25:15-28. [PMID: 12089776 DOI: 10.1016/s0160-2527(01)00098-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Nancy Wolff
- Health Care Policy and Aging Research, Institute for Health, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901-1293, USA.
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Elbogen EB, Tomkins AJ. From the psychiatric hospital to the community: integrating conditional release and contingency management. BEHAVIORAL SCIENCES & THE LAW 2000; 18:427-444. [PMID: 11018777 DOI: 10.1002/1099-0798(2000)18:4<427::aid-bsl387>3.0.co;2-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Psychiatric hospital recidivism has been and continues to be a persistent problem in treating individuals with chronic mental illness. Conditional release, a form of involuntary outpatient commitment, has been suggested as one possible solution. Guided by therapeutic jurisprudence, this article presents a proposal about conditional release that would maximize convergence of social values and would be empirically testable. Specifically, a scientifically validated treatment intervention for individuals with chronic mental illness, contingency management, is integrated with conditional release. From this proposal, a number of empirical hypotheses and legal questions about discharging psychiatric patients are generated and discussed.
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Affiliation(s)
- E B Elbogen
- UNL Law/Psychology Program, 238 Burnett Hall, Lincoln, NE 68588-0308, USA.
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