Criminal Defense Attorneys and Client Suicide: Survey and Recommendations From Washington State

The connection between suicide and incarceration is well documented, in particular after recent arrest. Criminal defense attorneys may be one of the few people in meaningful contact with this population, and lawyers have a unique window into their clients' well-being. In this Viewpoint, we explore the experiences of attorneys who work with clients with suicidal thoughts and behaviors. We developed and administered a survey to criminal defense attorneys in the State of Washington, ascertaining their experiences with client suicide. A total of 44 responses were collected, with over 95% of respondents having been concerned about a client's risk for suicide. We conclude that client suicide widely impacts criminal defense attorneys, and lawyers' role with justice-involved clients uniquely positions them to be a potential asset in suicide prevention efforts.

Understanding deliberate indifference to suicide in corrections facilities: A review of recent legal cases

The US corrections system is the largest provider of mental health care in the country. Suicide is a leading cause of death in corrections facilities with rates of inmate suicide being far higher than the national average. Suicide is an event that can lead to legal action against the facility, staff, and treating health-care providers. Some claims are based on medical malpractice. In this setting, claims may also be brought based on violations of the detainee's constitutional rights. Pretrial detainees and prisoners, alike, have a constitutional right to adequate medical and psychiatric care through the Fourteenth Amendment and Eighth Amendment, respectively. But, there is limited information on constitutional claims made against correctional health-care providers for cases of inmate suicide. To help bridge this gap, the authors conducted a search of federal legal case decisions involving claims against health-care providers for deliberate indifference to a detainee's serious illness or injury in the event of attempted suicide or death by suicide over a 5 year period from 2016 to 2021. Fifteen cases were identified. Five themes emerged from the cases, which could serve as bases for claims against health-care professionals: receiving screening, mental health assessment, treatment, documentation, and attention to facility policies. The cases and their clinical significance are summarized in this article. The materials provide an overview of the problems surrounding correctional suicides and can serve as practice pointers in the corporeal setting.

The role of public health scientists within the German political discourse on the COVID-19 pandemic

Background

During the COVID-19 pandemic politics was in search of scientific evidence to underpin decision making like never before. It is remarkable that voices from public health were less noticeable than those of virologists or immunologists. The aim of our ongoing study is to explore how public health scientists perceive their role in the relationship of their discipline and politics.

Methods

We conducted 10 reflexive interviews with epidemiologists and public health scientists from Germany and collected documents (official statements and policy briefs of scientific societies). Data from both sources were analysed using situational analysis (Clarke, 2018), an approach used to map and analyse discourses in complex situations. To ensure data quality we used respondent validation.

Results

According to participants, (1) improving population health was the top priority. Politicians tended to focus on short-term goals rather than long-term consequences. (2) Recognition of public health was increased by the pandemic in Germany. (3) However, politicians favoured virology, biomedical and clinical perspectives. (4) The strong motivation of public health scientists to support politics at the beginning of the pandemic turned into disillusionment. (5) The composition of advisory boards was described as non-transparent. (6) Initiatives by the public health community were not sufficiently impactful. (7) Expectations of policymakers regarding future cooperation were not clear to participants.

Conclusions

The results present different facets of a delicate relationship between public health sciences and politics. The pandemic increased the visibility and impact of public health in Germany on the one hand but also demonstrated that the realms of public health (science) and politics were not well connected. Involving scientific expertise in politics requires more transparency and the normative assumptions underlying the logics of science and politics need to be made more explicit.

Key messages

• The potential of public health to address the covid-19 pandemic has not been sufficiently acknowledged by policymakers, and the involvement of its experts requires greater transparency.

• Reflecting on the normative assumptions underlying the different logics of public health sciences and politics can support their cooperation in the future.

Arrest and non-fatal suicide attempts among men: analysis of survey data from the National Survey on Drug Use and Health

BACKGROUND

Studies have found an association between recent arrest and suicide attempts, but the population-level significance of this link has not been reported. We estimated the population attributable risk percent (PAR%) of self-reported non-fatal suicide attempts based on recent arrest in a national sample of adult men.

METHODS

This study included men aged ≥18 who completed the 2008-2019 National Surveys on Drug Use and Health. The outcome measure was any non-fatal suicide attempts in the past year. The primary independent variable was any arrest in the past year. Major depression and substance use disorders were also included as independent variables for comparison. Descriptive statistics and multivariate logistic regression with postestimation marginal effects ascertained the PAR% of non-fatal suicide attempts for arrest, major depression, and substance use disorders, while controlling for sociodemographic covariates. All analyses applied survey weights. We disaggregated analyses by race/ethnicity.

RESULTS

In the sample of 220,261 men, arrest accounted for 8.9% (99% CI 5.1 to 12.6%, p < 0.001) of non-fatal suicide attempts, while major depression accounted for 40.3% (99% CI 35.0 to 45.1%. p < 0.001) and substance use disorders for 24.1% (99% CI 17.6 to 30.2%, p < 0.001). After disaggregating by race/ethnicity, arrest accounted for 9.5% (99% CI 4.5 to 14.3%, p < 0.001) of suicide attempts among Non-Hispanic White men and fell short of statistical significance for Non-Hispanic Black men (10.2, 99% CI - 3.0 to 21.6%, p = 0.043) and Hispanic men (8.1, 99% CI - 0.5 to 15.9%, p = 0.016).

CONCLUSIONS

Arrest accounted for nearly one in eleven non-fatal suicide attempts in a national sample of American men, which is by extension about 50,000 suicide attempts per year. Results were similar for Non-Hispanic White, Non-Hispanic Black, and Hispanic men, although there were differences in prevalence of arrest and suicide attempts. Unlike major depression, arrest is an easily identifiable event, and the period after arrest might provide an opportunity to support mental health and coping.

Associations Between Parole, Probation, Arrest, and Self-reported Suicide Attempts

This study estimated the associations between three categories of recent community criminal justice (CJ) involvement (arrest, parole, and probation) and suicide attempts, while accounting for how the categories overlap. Participants included adults aged ≥ 18 who completed the 2008-2014 National Surveys on Drug Use and Health. The outcome was self-reported suicide attempt(s) in the past 12 months (in the community or while incarcerated). Community CJ involvement included parole, probation, and/or arrest(s) during the past 12 months. Controls with no recent CJ involvement were matched to those with any recent involvement on demographics and education. We calculated the 12-month prevalence of suicide attempts for those reporting recent parole, probation, and arrest, including their overlaps. Logistic regression models estimated the associations between each category of recent CJ involvement and suicide attempts, controlling for their overlapping and covariates. There were 15,462 participants with recent community CJ involvement and 248,520 matched controls. The 12-month prevalence of suicide attempts was 3.2% for those with recent parole, 2.7% for probation, and 3.3% for arrest, which were all greater than the matched controls (1.0%, p < 0.001 for each). After controlling for overlapping and covariates, arrest was associated with suicide attempts (RR = 1.80, 99% CI 1.47-2.19), but neither parole (RR = 1.00, 99% CI 0.64-1.56) nor probation (RR = 0.81, 99% CI 0.61-1.08) were. Adults with recent arrest had higher risk of suicide attempts than those with parole, probation, or matched controls with no CJ involvement. Recent arrest may signify elevated risk and warrant increased screening and intervention.

A Review of Forensic Fellowship Training: Similar Challenges, Diverse Approaches

OBJECTIVE

As the specialty of forensic psychiatry and the numbers of justice involved individuals with mental illness continue to grow, forensic education is receiving more attention. To add to this discussion, the authors reviewed current training practices in forensic psychiatry fellowship programs.

METHODS

As part of a project funded by the state legislature looking at psychiatry and psychology training, with special focus on state hospital partnerships, the authors interviewed and surveyed forensic psychiatry fellowship program directors and conducted site visits to select programs. Given the mandate, special attention was given to programs with state hospital and psychology training affiliations.

RESULTS

The literature and fellowship directors identified several key features and challenges for forensic training programs. Forensic fellowships focused primarily on evaluations and consultations but differed in their offerings related to training in treatment, scholarship, and particular types of evaluations. Common concerns included maintaining adequate funding, variety of training experiences, adequate faculty time, and adequate institutional support. Directors described cultivating institutional support by demonstrating mutual benefit as particularly important for securing resources.

CONCLUSION

Forensic fellowships operational during the 2016-2017 academic year offered a range of forensic training activities, but experienced common challenges such as inadequate funding and faculty supervision. Empirical studies are needed to evaluate the relationship between programmatic offerings, the noted challenges, and acquired competencies.

Mental health treatment among older adults with mental illness on parole or probation

BACKGROUND

The number of older adults on parole and probation is growing at an unprecedented rate, yet little is known about the mental health needs and treatment utilization patterns among this group. The objective of this study is to compare the prevalence of serious or moderate mental illness (SMMI), and the proportion of those with SMMI who receive mental health treatment, among community-dwelling older adults on correctional supervision (parole or probation) vs. not on correctional supervision.

METHODS

Design: Cross-sectional analysis of data from the 2008-2014 National Surveys for Drug Use and Health (NSDUH).

SETTING

Population-based national survey data.

PARTICIPANTS

Older adults (age ≥ 50) who participated in the NSDUH between 2008 and 2014 (n = 44,624). Participants were categorized according to whether they were on parole or probation during the 12 months prior to survey completion (n = 379) vs. not (n = 44,245).

MEASUREMENTS

Probable SMMI was defined using a validated measure in the NSDUH. Mental health treatment included any outpatient mental health services or prescriptions over the 12 months prior to survey completion. We compared the prevalence of SMMI, and the proportion of those with SMMI who received any treatment, by correctional status.

RESULTS

Overall, 7% (N = 3266) of participants had SMMI; the prevalence was disproportionately higher among those on parole or probation (21% vs. 7%, p <  0.001). Sixty-two percent of those with SMMI received any mental health treatment, including 81% of those on parole or probation and 61% of those who were not (p <  0.001). This result remained statistically significant after logistic regression accounted for differences in sociodemographics and health.

CONCLUSIONS

SMMI is disproportionally prevalent among older adults on parole or probation, and community correctional supervision programs may be facilitating linkages to needed community-based mental health treatment.

Legislative Advocacy and Forensic Psychiatry Training

Very few residency and fellowship programs offer mandatory or elective rotations in health advocacy. Where there are formal training opportunities, they are commonly didactic or clinical community rotations, where trainees participate in a clinically oriented project with a local community organization. Fewer programs offer specific training opportunities in legislative advocacy and the legislative process. The University of Washington assembled two task forces to advise the general psychiatry residency program on training needs in the areas of (1) Forensic Psychiatry and (2) Advocacy and Public Policy. Both task forces identified, as an aspirational goal, resident involvement in legislative and regulatory processes as means of advocacy. This article describes a model curriculum in legislation developed at the University of Washington that is suitable for trainees at different stages in their professional development (including residents and fellows), and an explanation of how the curriculum supports training in forensic psychiatry. Challenges in creating the elective training opportunity are also discussed.

Colibactin biosynthesis and biological activity depend on the rare aminomalonyl polyketide precursor

The as-yet unidentified E. coli metabolite colibactin induces DNA damage in eukaryotic cells and promotes tumorigenesis. Its wide distribution in pathogenic and probiotic strains has raised great interest in its structure and biosynthesis. Here we show that colibactin formation involves a rare aminomalonyl unit used as a building block.

The Defense of Involuntary Intoxication by Prescribed Medications: An Appellate Case Review

The defense of involuntary intoxication has long been an exception to the general notion that intoxication is not a defense to criminal liability. The consumption of medications prescribed by a physician can form the basis of an involuntary-intoxication defense. In this article, I review cases where defendants relied on the use of prescribed medications for an involuntary-intoxication defense. The medications most frequently implicated by defendants are listed by name and by class. From the case law, I provide a summary of the defense and a review of the pitfalls of the defense to serve as practice pointers for forensic evaluators.

Expanding Slayer Statutes to Elder Abuse

Common law has a dictum that people must not benefit from their crimes. In years past, states have enacted slayer rules to prevent killers from inheriting from their victims. The specific criteria and applicability of slayer rules vary by jurisdiction. Recently, several states, including Washington, have expanded their slayer rules to disqualify persons from inheriting if they have been involved in abuse or financial exploitation of the deceased. Reviewed herein are the abuse disinheritance laws, the relationship of the laws to concepts of testamentary capacity and undue influence, and the relevance to forensic psychiatric evaluations.

Determining a Criminal Defendant's Competency to Proceed With an Extradition Hearing

When a criminal defendant flees from one state (often referred to as the requesting state) to another (often referred to as the asylum state), the requesting state can demand that the asylum state return the defendant through a process called extradition. Only a handful of states have considered a fugitive's right to be competent to proceed with an extradition hearing. Those states fall into three categories. Some states apply the same standard as in criminal trial competency cases. Others apply a more limited competency standard. Two have found that a fugitive has no right to be competent to proceed in an extradition hearing. The particular legal test adopted affects the nature and scope of the competency evaluation conducted by the psychiatrist or psychologist in the extradition hearing. In addition, we are not aware of any state that has considered what happens to the fugitive if he is ultimately found not competent to proceed. Legislation, either state by state or through amendments to the Uniform Criminal Extradition Act, can provide the legal and psychiatric communities with guidance in assessing competency initially and in taking appropriate steps if the fugitive is ultimately found not competent.

Competency to stand trial and defendants who lack insight into their mental illness

Forensic evaluators often assess patients who lack insight into their mental illnesses. This lack of insight can have a significant impact on the defendant's ability to make legal strategy decisions that rely on their acceptance of their mental illness. In this article, the relationship between refusing an insanity plea and competency to stand trial will be explored in the context of defendants who lack insight into their mental illness. The authors argue that an adequate competency assessment should take into account the defendant's ability to consider his available pleas rationally. Such evaluations may have the effect of negating the necessity of a Frendak inquiry in those jurisdictions that can impose the insanity defense on defendants.

In the aftermath of State v. Becker: a review of state and federal jury instructions on insanity acquittal disposition

An important topic related to the insanity defense is what jurors should be told about the disposition of a defendant found not guilty by reason of insanity (NGRI). In the federal court system, jurors are not instructed about the consequences of an NGRI verdict. State courts, however, are divided on the question. The federal precedent, Shannon v. United States, and the most recent state case to rule on NGRI juror instructions, State v. Becker, are reviewed in detail. What follows is the author's critique of the principal arguments for and against a jury instruction on NGRI disposition. The author argues in favor of a jury instruction on the consequences of an NGRI verdict.

Washington's Senate Bill 6610 on transferring provisions for persons found not guilty by reason of insanity

In Washington state, public concern about the potential dangerousness of mentally ill offenders has led to increasing legislative efforts to contain them in secure settings. A recently enacted law authorizes the transfer of persons found not guilty by reason of insanity from state psychiatric hospitals to prison facilities. The authors review the recent legislation and discuss some of the legal, policy, and clinical ramifications of the law.

The slayer statute and insanity

It is common law that persons cannot benefit from their crimes. For this reason, most states have enacted slayer rules that prevent a killer from sharing in the victim's estate. However, terms in the slayer rules, such as willful and unlawful, can be difficult to apply, as illustrated by the situation in which a slayer is found not guilty by reason of insanity. The Washington Supreme Court has recently addressed whether a man who killed his mother and was then found not guilty by reason of insanity in criminal court can inherit a portion of his mother's estate.

Sub-20 fs visible pulses with 750 nJ energy from a 100 kHz noncollinear optical parametric amplifier

We demonstrate the operation of a 100 kHz noncollinear optical parametric amplifier that is pumped by just a few microjoules of 800 nm pulses with 50 fs duration. The device delivers sub-20 fs pulses tunable from 460 nm to beyond 1 microm and pulse energies up to 750 nJ when it is pumped with 7 microJ of energy. The design of the single-stage amplifier has been carefully optimized, and the design considerations are discussed.

Bacterial symbionts: prospects for the sustainable production of invertebrate-derived pharmaceuticals

Invertebrate animals, such as sponges, tunicates and bryozoans, are among the most important sources of biomedically relevant natural products. However, as these animals generally contain only low quantities of the compounds, further pharmacological development is in most cases difficult. There is increasing evidence that many metabolites, in particular polyketides and nonribosomally synthesized peptides, are not produced by the animals themselves but by associated bacterial symbionts. This symbiont hypothesis currently attracts considerable interest, since it implicates that animal-independent production systems based on bacterial fermentation processes could be created. This review gives an overview about recent developments in the research on natural product symbiosis. Different techniques will be discussed that have been employed to pinpoint the actual producer. Since bacterial symbionts are highly fastidious and have been generally resistant to cultivation attempts, emphasis will be laid on culture-independent strategies, such as cell separation approaches and the cloning of biosynthetic genes. These strategies have provided insights into possible sources of several natural products, e.g. the bryostatins, pederin, the onnamides, swinholide A and theopalauamide. Finally, potential techniques for the generation of renewable supplies of symbiont-derived drug candidates will be discussed. Cultivation approaches and the heterologous expression of cloned biosynthesis genes from uncultured symbionts could in future provide access to several important marine drug candidates, including bryostatin 1, halichondrin or ET-743.

Real time observation of the photo-Fries rearrangement

The photo-Fries rearrangement of 4-tert-butylphenyl acetate dissolved in cyclohexane is investigated by two-color femtosecond pump probe spectroscopy. The spectral transmission changes are characterized in the visible and ultraviolet spectral region and allow for the first time to temporally resolve the primary reaction steps. We find that the photoinduced homolytic cleavage of the CO bond occurs within 2 ps and that the geminate recombination of the generated radical pair to the intermediate substituted cyclohexadienone takes 13 ps. The experimental results support a model in which the initial reaction proceeds from the originally excited pipi(*) state via a barrier to a dissociative pisigma(*) state.

Phase-coherent generation of tunable visible femtosecond pulses

Stable interference between the outputs of two noncollinearly phase-matched optical parametric amplifiers seeded by separate white-light continua has been observed. This means that the tunable visible pulses have a well-defined relative phase and that the temporal jitter between them is less than 1 fs. The residual phase variations are due to fluctuations of the pump power.

Engineering biodiversity with type II polyketide synthase genes

A very important task in the ongoing search for new clinically useful drugs is the generation of large numbers of structurally diverse compounds. The emerging field of combinatorial biosynthesis, in which nature's chemical capabilities are exploited in a combinatorial 'mix-and-match' fashion, has generated libraries of novel molecules representing great structural diversity which are not available naturally or readily generated through (combinatorial) synthesis. Novel polyketides have been generated by manipulating type II iterative polyketide synthase (PKS) systems that express a variety of combinations of a minimal PKS with ketoreductases, cyclases, and other tailoring enzymes, resulting in a set of design rules to rationally engineer new metabolites. Engineering studies with the Streptomyces coelicolor whiE (spore pigment) and the 'Streptomyces maritimus' enterocin type II PKS provide additional insight on designing diverse assemblies of aromatic, as well as nonaromatic, polyketides.

Cloning, sequencing and analysis of the enterocin biosynthesis gene cluster from the marine isolate 'Streptomyces maritimus': evidence for the derailment of an aromatic polyketide synthase

BACKGROUND

Polycyclic aromatic polyketides, such as the tetracyclines and anthracyclines, are synthesized by bacterial aromatic polyketide synthases (PKSs). Such PKSs contain a single set of iteratively used individual proteins for the construction of a highly labile poly-beta-carbonyl intermediate that is cyclized by associated enzymes to the core aromatic polyketide. A unique polyketide biosynthetic pathway recently identified in the marine strain 'Streptomyces maritimus' deviates from the normal aromatic PKS model in the generation of a diverse series of chiral, non-aromatic polyketides.

RESULTS

A 21.3 kb gene cluster encoding the biosynthesis of the enterocin and wailupemycin family of polyketides from 'S. maritimus' has been cloned and sequenced. The biosynthesis of these structurally diverse polyketides is encoded on a 20 open reading frames gene set containing a centrally located aromatic PKS. The architecture of this novel type II gene set differs from all other aromatic PKS clusters by the absence of cyclase and aromatase encoding genes and the presence of genes encoding the biosynthesis and attachment of the unique benzoyl-CoA starter unit. In addition to the previously reported heterologous expression of the gene set, in vitro and in vivo expression studies with the cytochrome P-450 EncR and the ketoreductase EncD, respectively, support the involvement of the cloned genes in enterocin biosynthesis.

CONCLUSIONS

The enterocin biosynthesis gene cluster represents the most versatile type II PKS system investigated to date. A large series of divergent metabolites are naturally generated from the single biochemical pathway, which has several metabolic options for creating structural diversity. The absence of cyclase and aromatase gene products and the involvement of an oxygenase-catalyzed Favorskii-like rearrangement provide insight into the observed spontaneity of this pathway. This system provides the foundation for engineering hybrid expression sets in the generation of structurally novel compounds for use in drug discovery.

20-50-fs pulses tunable across the near infrared from a blue-pumped noncollinear parametric amplifier

A two-stage blue-pumped noncollinearly phase matched optical parametric amplifier was used to generate near-infrared pulses that were continuously tunable from 865 to 1600 nm. The pulse lengths scaled from 20 fs at the shorter wavelengths to below 50 fs at 1600 nm, with a nearly Fourier-transform-limited bandwidth. From 200 muJ of 775-nm pump light at a 1-kHz repetition rate and a 130-fs duration, 7-2.5-muJ pulse energies were generated, corresponding to a typical quantum efficiency of 25% from blue to near-infrared light.

Induced biosynthesis of insect semiochemicals in plants

Plants under attack by a herbivore may emit characteristic volatiles that are implicated in the attraction of the natural enemies of the herbivore. The signal cascade between leaf damage and the volatile production is stimulated by high- or low-molecular-weight elicitors from the secretions of the herbivore. Besides compounds from the octadecanoid signalling pathway, several structurally non-related amino acid conjugates such as the bacterial phytotoxin coronatine, the synthetic indanoyl-isoleucine, or amino acid conjugates of linolenic acid likewise induce volatile biosynthesis. Minor changes in the amino acid moiety may result in different volatile profiles (sesqui- and diterpenoids), attributing to the amino acid substructure a specific role for the recognition and the selective induction. Volatile terpenoids (mono- and diterpenoids) are synthesised de novo along the novel deoxy-D-xylulose (DOX) pathway, while the biosynthesis of sesquiterpenes may be fuelled from both the DOX- and the mevalonate pathway. This finding may be of importance for the plant defence in case of introduction of inhibitors together with the salivary secretion of herbivores into the leaf tissue.

Cellulysin from the plant parasitic fungus Trichoderma viride elicits volatile biosynthesis in higher plants via the octadecanoid signalling cascade

Cellulysin, a crude cellulase from the plant parasitic fungus Trichoderma viride, induces the biosynthesis of volatiles in higher plants (Nicotiana plumbaginifolia, Phaseolus lunatus, and Zea mays) when applied to cut petioles by the transpiration stream. The pattern of the emitted volatiles largely resembles that from a herbivore damage or treatment of the plants with jasmonic acid (JA) indicating that cellulysin acts via activation of the octadecanoid signalling pathway. The treatment with cellulysin raises the level of endogenous JA after 30 min and is followed by a transient emission of ethylene after 2-3 h. Volatile production becomes significant after 12-24 h. Inhibitors of the JA pathway effectively block the cellulysin-dependent volatile biosynthesis.

Sub-20-fs pulses tunable across the visible from a blue-pumped single-pass noncollinear parametric converter

Femtosecond pulses with center wavelengths between 470 and 750 nm are generated in a single-stage type I BBO optical parametric amplifier pumped by a frequency-doubled 1-kHz Ti:sapphire amplifier. A high-quality white-light continuum is used as the seed. Pulse durations as short as 16 fs and pulse energies of as much as 11 microJ are observed. The quantum efficiency is ~25% for both 7- and 40-microJ pump pulses. This unique combination of ultrashort pulse duration and high conversion is made possible by noncollinear phase matching that permits a sufficiently large amplification bandwidth. Simultaneously the group velocities of the signal and the idler are effectively matched. As a result widely tunable sub-20-fs pulses can be generated in a nonlinear crystal as thick as 2 mm.