Advance directives in a correctional setting.

Using advance directives to preconsent to mental health treatment is a promising approach to contending with the quandary posed by patients suffering from severe mental health illness, particularly those in a prison setting. The implementation of advance directives represents unfamiliar territory because it focuses on the patient's ability to preconsent to treatment rather than the commonly interpreted prerefusal of treatment. The challenge of consenting in the prison system generates a set of unique problems. The environment in which the instrument is signed can impose significant pressures and therefore result in a viable legal challenge. The prison setting is the most coercive environment in which a patient can be treated, particularly when the patient is mentally ill. Mentally ill prisoners signing preconsent for treatment advance directives have an opportunity for unprecedented relief yet may also experience pressure to select treatments desirable to the prison staff. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The influence of perceived mental illness on interpersonal relations.

This study was carried out to measure the influence of general attitudes toward mental illness on 2 aspects of interpersonal interaction: an S's performance on a motor task requiring cooperative effort and the perception of another after having interacted with him on the task. Ss were undergraduates who were induced to believe their coworker was either "normal" or had been mentally ill. The results indicate that perceiving the coworker as mentally ill is associated with better task performance, possibly because of the greater threat posed by a successful peer in comparison to that posed by a person believed to be maladjusted and inadequate. It was also found that when a coworker is viewed as mentally ill, Ss prefer to work alone rather than with him and blame him for inadequacies in the joint performance even though objective measures do not justify these responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of cancellation in an Oregon involuntary commitment program

The problem of attrition from mental health care programs before such services begin is poorly understood. The present research has identified several variables which predict first appointment cancellations for Oregon involuntary commitment petitioners in behalf of potential clients. The value of such variables is discussed in terms of petitioner attrition from involuntary commitment programs, mental health needs of those petitioning for the involuntary commitment of "allegedly mentally ill" persons, increased mental health program efficiency, and economic benefits for underbudgeted and understaffed mental health care programs. Recommendations to improve community mental health programs in general, and involuntary commitment programs in particular are presented.     

Police perspectives on responding to mentally ill people in crisis: perceptions of program effectiveness

In this study, we sampled sworn police officers from three law enforcement agencies (n = 452), each of which had different system responses to mentally ill people in crisis. One department relies on field assistance from a mobile mental health crisis team, a second has a team of officers specially trained in crisis intervention and management of mentally ill people in crisis, and a third has a team of in-house social workers to assist in responding to calls. Calls involving mentally ill people in crisis appear to be frequent and are perceived by most of the officers to pose a significant problem for the department; however, most officers reported feeling well prepared to handle these calls. Generally, officers from the jurisdiction with a specialized team of officers rated their program as being highly effective in meeting the needs of mentally ill people in crisis, keeping mentally ill people out of jail, minimizing the amount of time officers spend on these calls, and maintaining community safety. Officers from departments relying on a mobile crisis unit (MCU) and on police-based social workers both rated their programs as being moderately effective on each of these dimensions except for minimizing officer time on these calls where the MCU had significantly lower ratings.     

Laryngeal cancer: quality-of-life and cost-effectiveness

The purpose of this paper is to review the current literature in relation to mental illness and criminal behaviour. The material presented for discussion was selected from forensic and general psychiatric literature. However, a number of important publications, policy documents and independent reports were used to explore the debate surrounding this subject. Contemporary studies of prison populations in the UK and abroad illustrated the difficulty in relating mental illness to crime. Papers presenting research in the UK revealed important implications for mental health policy and the way in which the penal system deals with mentally disordered offenders. The literature reviewed provided arguments for and against an association between mental illness and criminal behaviour. Methodological problems associated with criminological and psychiatric research were addressed in relation to the exploration of whether people suffering from a mental illness are more dangerous or violent than other people. Research papers focusing on public reaction to mentally ill people living in the community provided important considerations when addressing mental illness and criminal behaviour in the context of care in the community policy. This paper will be of interest to a broad range of mental health professionals, particularly those working with individuals who have a history of mental illness and violent behaviour, or mental health professionals working with mentally disordered offenders.     

The status of the mentally ill in Jewish law

The Jewish law goes into great detail discussing the status of the mentally ill. There are many aspects to this question over and above the legal aspects of such a person's rights, obligations, doing business, etc. What is the Halachic approach to a mentally ill person in general? Is this person subject to the code of Jewish law the same as the normal Jew? Should we make an effort to help this type of person fulfil the commandments and prevent him or her from transgressing them or perhaps since such a person is incapable of controlling his or her behaviour, there is no purpose in these efforts? Marriage and divorce are other serious issues to which the Jewish law gives special attention in this context. Marriage must be entered into by a rational and judicious person or the act will not be valid. A very serious problem arises when a husband is mentally ill and due to that halachically cannot divorce his wife and she remains an Agunah. The situation is more complicated as the definition of mentally ill encompasses a broader spectrum of cases. Which psychiatric disorders come under the definition of a mentally ill person who is unable to control his or her behaviour? Which symptoms attest the inability of a person to enter into marriage or to grant a divorce? The Talmud discusses these matters in several places and the Halacha bases its rulings on their conclusions.     

Building bridges: Psychologists and families of the mentally ill.

Describes problems faced by families of the mentally ill, particularly since the caregiving system in the US provides only incomplete solutions. Psychologists have provided important support to family members coping with seriously mentally ill relatives; however, psychology's response has been incomplete. Families have helped themselves in the initiation in 1979 of the National Alliance for the Mentally Ill (NAMI), an advocacy and education organization that originated as a network of mutual support groups. The history of communication between NAMI and the American Psychological Association (APA) is outlined. The need for "building bridges" between psychologists and families of the mentally ill resulted in 2 conferences between APA and NAMI. Other steps to enhance communication between psychologists and these families are listed, including communication with legislatures and the general public about public policy agendas on mental health services and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does captopril have a direct pro-apoptotic effect?

Police departments in the 194 U.S. cities with a population of 100,000 or more were surveyed in 1996 to identify strategies they used to obtain input from the mental health system about dealing with mentally ill persons. A total of 174 departments responded (90 percent). Ninety-six departments had no specialized response for dealing with mentally ill persons. Among the 78 departments with special programs, three basic strategies were found: a police-based specialized police response, a police-based specialized mental health response, and a mental-health-based specialized mental health response. At least two-thirds of all departments, even those with no specialized response program, rated themselves as moderately or very effective in dealing with mentally ill persons in crisis.     

Tennessee's failed managed care program for mental health and substance abuse services

In July 1996, Tennessee initiated a managed mental health and substance abuse program called TennCare Partners. This publicly funded "carve-out" experiment started chaotically and soon deteriorated into a crisis. Many patients did not receive care or lost continuity of care, and the traditional "safety net" mental health system nearly disintegrated. This qualitative case study sought to ascertain the impact of the TennCare Partners program. It points out that the program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population. States contemplating similar reforms should strive to protect vulnerable patients by risk-adjusting capitation payments and by focusing resources on care for severely mentally ill persons. States should also minimize program complexity and ensure the accountability of managed care networks for their patients' behavioral health care needs.     

The companion program: Implementing the manpower recommendations of the joint commission on mental illness and health.

There are many barriers to successful recruitment of professional and subprofessional personnel in the mental health professions. The companion program "recruits students from… universities to serve as volunteer companions to mentally ill patients for a full academic year. Students are invited to either select or be assigned to a chronic patient who has minimal or no contact with individuals outside the hospital, and to meet with this patient for one hour on a weekly basis throughout the school year… . The goal that is stressed throughout is that the student must build a feeling of companionship between himself and the patient." The program appears to be "a very significant method for altering the attitudes of people." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some national developments in the utilization of nontraditional mental health manpower.

Discusses the recruitment of nonprofessional personnel to help provide sufficient manpower to serve the mentally ill and emotionally disturbed. A review of national developments during the past 2 decades reveals that without national or other coordinated leadership the critical needs of the mentally ill consumer at the local level coalesced with striking changes in (a) the mental health delivery system (the concept of the therapeutic community), and (b) sociopolitical areas (community colleges, career ladder, and related new frontier and great society programs) to produce these new types of mental health manpower. The recent influx of national institute of mental health monies to support these training programs for nontraditional mental health workers will further accelerate these developments. (36 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criminalizing mental disorder: The comparative arrest rate of the mentally ill.

Notes that there has been a great deal of speculation that mentally ill persons are being processed through the criminal justice system rather than the mental health system. To date, this thesis has been based more on intuition than on empirical research. Data from a study of 1,382 police–citizen encounters are presented that suggest that the mentally ill are indeed being criminalized. Specifically, it was found that, for similar offenses, mentally disordered citizens had a significantly greater chance of being arrested than non-mentally-disordered persons. This finding has public policy implications for the basic tenets of the community mental health movement, as well as for optimal functioning of the criminal justice system. Several public policy modifications are suggested. (56 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study

OBJECTIVES: To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. DESIGN: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. SETTING: Netherlands, 1994. MAIN OUTCOME MEASURES: Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages. RESULTS: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (> or = 95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively. CONCLUSIONS: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people.     

Strategies for maintaining optimal wellness in the chronic mentally ill

TOPIC: Ways the chronic mentally ill avoid loss of control and the importance of both the therapeutic environment and the nurse-patient relationship in helping them do this. PURPOSE: To examine the strategies people with chronic mental illness use to prevent loss of control and maintain health, and ways nurses can help with this process. SOURCE: Findings from a previously published study of seven chronically mentally ill clients in a rural day-treatment center. CONCLUSIONS: Four properties related to the core variable of "preventing loss of control" are relationships, feelings, good attitude, and functional activity. These properties must be examined within the context of the therapeutic environment as well as the nurse-patient relationship.     

Mental illness and mental retardation: Message from the President of the United States relative to mental illness and mental retardation.

2 health problems of critical size and tragic impact are mental illness and mental retardation. "There are now about 800,000 such patients in this Nation's institutions—600,000 for mental illness and over 200,000 for mental retardation." A 3-fold attack is proposed: (a) Ascertain causes and eradicate them. (b) Strengthen underlying resources of knowledge and of skilled manpower. (c) Strengthen and improve facilities serving the mentally ill and mentally retarded. A national program for mental health is proposed which emphasizes comprehensive community mental health centers, improved care in state mental institutions, and expansion of research activities and increase in professional manpower. A national program to combat mental retardation emphasizing prevention, community services, and research is also proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic and racial differences in perceptions of dangerousness of persons with mental illness

Ethnic and racial differences in the stigma associated with mental illness in the general population were examined through secondary analysis of data from a survey of a nationally representative sample (N = 1,468) on attitudes toward homeless and homeless mentally ill people. American Indian (1 percent of the sample), Asian-Pacific Islander (1.5 percent), black (10 percent), and Hispanic respondents (4 percent) were compared with white respondents (82 percent) to determine if the groups differed in their perception of the dangerousness of mental patients and if contact with mentally ill persons moderated ethnic and racial differences in perceptions of dangerousness. Asian and Hispanic respondents perceived mental patients as significantly more dangerous than did white respondents. Increased contact with mentally ill people was associated with lower levels of perceived dangerousness among white respondents but not among black respondents.     

The criminalization of the mentally ill: Speculation in search of data.

Examines the evidence for the speculation that mentally ill persons who would previously have been treated within mental hospitals are now processed through the criminal justice system and constitute an ever-increasing proportion of the jail population. Three factors underlie this speculation: the increase in mentally ill persons residing in the community, police handling of the mentally ill, and evidence that persons thought to be dangerous are among the most unwanted clients of mental health agencies. Three types of research are explored: archival studies, investigations of police decision making, and studies of the prevalence of mental disorder among jail detainees. It is concluded that the research literature, albeit methodologically flawed, offers at least modest support for the contention that the mentally ill are being processed through the criminal justice system. (81 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Illness, Responsibility, and Intervention.

In a recent article (Amer. Psychologist, 1961, 16, 69-74; see record 1962-03334-001), Ausubel has questioned Szasz' position that mental illness is a disease process only by virtue of its having been so labeled. While Szasz' position seems to imply that the mentally ill patient is responsible for his behavior rather than being a passive participant in an ego-alien disease process, Ausubel contends that most mentally ill patients should be considered to be victims of a disease process and accorded the same exemption from ethical considerations as is enjoyed by people with any illness. While both positions seem to be well argued, it appears that the authors have neglected a possible alternative to the two extremes of responsibility versus no responsibility in the so-called mental illness (or any other illness, for that matter). The current author suggests that at different points in the longitudinal process we call mental illness, patients' responsibility for their behavior will vary. An analogy we might use in discussing responsibility in mental illness is peptic ulcer. During the preulcer phase when anxiety is the dominant symptom, we can and should hold the individual responsible for learning more effective methods for meeting the stresses of life than he now employs. Similarly, during the postulcer phase, we can and should hold the individual responsible for not utilizing his ulcer for secondary gain. However, during the ulcer phase when the gastric hyperacidity actually erodes the gastric mucosa, the ulcer per se follows physiological laws more closely than it does psychosocial laws. Perhaps this alternate view of patient responsibility during any pathological process will help the helping professions to clarify their responsibilities in the treatment of the "sick" individual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pre- and postsynaptic neurotoxic effects of dopamine demonstrated by intrastriatal injection

The coexistence of psychiatric and substance abuse problems within the same patient occurs with significant frequency. These patients present serious challenges to a health care system which has traditionally treated mental health and substance abuse in separate venues, with differing and sometimes contradictory treatment modalities. Few studies exist on the treatment of the "dual diagnosis" patient utilizing an integrated approach, where both problems are addressed by the same staff on a single inpatient ward. We describe such a program in which dual diagnosis patients on one ward are separated into two different treatment tracks based upon the severity of their psychiatric illness. Follow-up measures at 3 months after discharge are compared for patients from each treatment track, with no significant difference found for the five outcome variables studied. This suggests that chronically mentally ill inpatients may benefit from integration of attention to their substance abuse problems with psychiatric treatment.     

Review of The mental hospital in the 21st century.

Reviews the book, The mental hospital in the 21st century by Emmanuel Persad, Shane S. Kazarian, and Llewellyn W. Joseph (1992). The authors not only review past endeavors in the delivery of mental health services but speculate as to the role the mental hospital may take in the years to come. The starting point for this book is a conference entitled "The Role of the Mental Hospital in the 21st Century" sponsored by the London Psychiatric Hospital in October 1990. The book features 20 brief chapters regrouped in three sections. In all, 29 contributors mainly from Canada, bring forth varying perspectives on the role of the mental hospital. The real contribution of this book is that it puts into perspective the magnitude of the challenge that confronts the major stakeholders in developing a comprehensive and balanced system of mental health services. The present book could serve as a starting point for some serious debate among the stakeholders about the way the mentally ill are treated and to determine how the role of the mental hospital should change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)