Mental health and addiction services in the criminal justice system: Where do we sit?

Toward Successful Postbooking Diversion: What Are the Next Steps?

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.

Opportunities in mental health services research.

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

Lessons learned in developing community mental health care in Australasia and the South Pacific

A Prospective Examination of Service Use by Abused and Neglected Children Followed Up Into Adulthood

Mental health care among marginalized populations in the United States

This study examined a cohort of 7,046 men who were released from the Pennsylvania State prison system between 1999 and 2002 to Philadelphia County to assess the relationships between receipt of mental health services in prison and prison exit. Administrative data on prison stays for 7,046 men released from Pennsylvania prisons to Philadelphia locations were analyzed. Of the 7,046 men, 8.7% received ongoing or intensive mental health services and 25.9% received mental health services while incarcerated. Multivariate analyses indicate that use of mental health services was positively associated with increased odds of serving the full prison sentence (as opposed to receiving parole), although the relationship between mental health services received and length of prison episode was inconclusive. Dynamics related to prison release warrant further attention in efforts to reduce the prevalence of mental illness in prisons and to facilitate community reentry for persons so diagnosed.

The author reviewed the literature published since 1972 concerning restraint and seclusion. The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search. The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Images of a young girl holding a knife were recently broadcast across television stations in Australia. The story described how Courtney Topic, a 22-year-old woman from the western suburbs of Sydney, Australia, was tasered and shot dead by police only 5 min from her family home. Prior to the shooting, Courtney, diagnosed in the past with Asperger's syndrome, left a takeaway restaurant and entered a street where she was pictured holding a soft drink cup in one hand and a large knife in the other. Minutes later, she was dead. Courtney leaves behind devastated parents and three siblings. This occurred on 10 February 2015. In the Australian context, the deinstitionalization movement, which saw the care of individuals with mental illness moved to the community often without the requisite resources, means that police officers are now the first and often only responders to mental health crises in the community (Clifford 2010; Sced 2006). Media reports for New South Wales alone indicate that police were 'tasked' to almost 43 000 mental health incidents in 2013; approximately 118 calls per day (The Daily Telegraph 2015). Sadly, such situations have become increasingly more common and more complicated (Clifford 2010), leaving police officers challenged and frustrated, often because of the perceived threat associated with individuals with a mental illness. As a consequence of this perceived threat and the police callouts related to mental health incidents, rates of fatal shootings of individuals with mental illness are now problematic in Australia and across many other countries. Fortunately, shootings by police remain relatively rare in Australia, although higher in Victoria than other states. In Victoria, it has been noted that the prevalence of police shootings, '… has aroused significant public disquiet' (Chappell 2008; p. 41). Between 1989–2011, there were 105 fatal shootings involving police, 44 (42%) of which involved the deceased having some form of mental illness, with psychotic disorders such as schizophrenia being the most common (59%) (Australian Institute of Criminology 2013). Even though police have been provided with new and less coercive techniques to disarm or disable people, shootings of individuals with a mental illness continue to be an issue of concern, nationally and internationally. Chappell (2008) argues that the use of force by police officers, especially deadly force, is a reflection of an individual's commitment to civil liberty, primarily the civil liberties of the citizens they are expected to protect. Despite international law enforcement norms stressing the use of non-violent means prior to the use of force or firearms, we continue to witness the shooting of individuals with a mental illness across the globe. Many of us have been required to disarm clients of a variety of weapons during our careers as mental health nurses. Thankfully, for most of us, these dangerous episodes have ended without harm to either party; resolution of such situations without tragic outcomes is not an unreasonable expectation (McDermott 2009). So why then do police shootings of individuals with a mental illness continue? Members of the community often perceive individuals with a mental illness as dangerous, and police officers are no different. As a result, police officers respond to individuals with a mental illness as persons of threat, often leading to unfortunate outcomes. In addition, police training for critical incidents involving threat enforces the need to shoot at the 'centre of seen mass' as the most appropriate way to defuse such situations (Meadows 2015). In cases where an armed person continues to threaten police officers, it is considered appropriate for the officer to pull a gun and to shoot at the centre of that threat in order to end the situation (Meadows 2015). Unfortunately, for individuals with a mental illness, many of whom become distressed or confused when under threat leading them to react in unpredictable ways, the end of the situation increasingly involves a fatal shooting. Police have a stressful job and in most cases conduct themselves in a professional manner (Chappell 2008). What is often lost in situations like the one described above is the impact on the police officers. Police officers involved in fatal shootings often never fully recover (Carroll 2005); their lives will never be the same after the incident. In addition, of course let us not forget the impact on the families of both shooter and victim; surely their lives would never be the same again. Experience demonstrates the best responses to people experiencing mental health crises in the community involve multi-agency cooperation and collaboration at local, regional, and national levels. Ensuring cooperation across health, welfare, community support, and emergency services and the provision of professional, timely, and safe responses to people who have a mental illness and their carers is not the sole responsibility of police. It is a whole-of-government issue requiring whole-of-government consideration and response. Deinstitutionalization and the subsequent inadequate provision of community-based mental health services have substantially contributed to the present crisis, a crisis that is shared with many countries. It reflects inadequate planning and service provision following deinstitutionalization and a lack of foresight by policy makers regarding the impact of these changes upon police services (Cotton & Coleman 2010; Teplin & Pruett 1992). Deinstitutionalization and the limited mental health services in the community have increasingly generated an expectation that the criminal justice system can deal with those who have a mental illness (or multiple illnesses) in an appropriate way. Arguably, these people should not be in the criminal justice system at all but rather should be dealt with by the health-care system. Indeed, significant numbers of those dealt with by the criminal justice system are suffering from (frequently) untreated or poorly managed mental illness. Ever increasingly, police are called to situations involving people with a mental illness and are required to intervene in some way. Research suggests that those with mental illness are three times more likely to interact with police than the general population (Cotton & Coleman 2010), and that 20–40% of those with a severe mental illness will be arrested in their lifetime (McLean & Marshall 2010). Their actions towards some of the most disenfranchised, marginalized, and powerless in society (people with a mental illness) is a sad and sorry reflection of past decisions to deinstitutionalize vulnerable mental health patients without societal investment in supports. We hope this editorial raises awareness about the issues involved in the fatal shootings of individuals with a mental illness and about the perceived threat that individuals with a mental illness pose to society. Our ultimate aim is to argue for enhanced support of police officers so they are better prepared to manage individuals with a mental illness in the community, and for innovative and collaborative care partnerships between police and mental health nurses. Hopefully, these strategies will result in practices that will reduce the number of police shootings of individuals with a mental illness in the future.

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

County-Level Estimates of Need for Mental Health Professionals in the United States

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"