Sectioned Research Articles

Insights from California on Involuntary Commitment for Substance Use.

Involuntary commitment (IC) for the treatment of substance use disorders is a highly controversial and poorly understood practice, with California offering a striking example. The state's involuntary commitment laws, known collectively as Lanterman-Petris-Short, authorized IC for grave disability related to chronic alcoholism. These provisions remain shrouded in obscurity, and data on their usage are lacking. Amid the ongoing debate over the utility of IC as a tool to treat severe substance use disorders and legislation expanding IC for substance use disorders (SUDs) in California and other states, this article highlights the need to better study the use and effectiveness of existing legislation as well as to consider upstream interventions, such as expansion of community-based treatment models.

Involuntary Commitment #3

Involuntary Commitment #3

Area-level factors associated with variation in involuntary psychiatric hospitalisation across England: a cross-sectional, ecological study.

Involuntary hospitalisations for mental health care are rising in many high income countries, including England. Looking at variation between areas can help us understand why rates are rising and how this might be reversed. This cross-sectional, ecological study aimed to better understand variation in involuntary hospitalisations across England. The unit of analysis was Clinical Commissioning Groups (CCGs), NHS bodies responsible for delivering healthcare to local areas in England. 205 CCGs were included in the analysis. Demographic, clinical, and socioeconomic variables at CCG-level were extracted from national, open access data bases. The outcome variable was the rate of involuntary hospitalisation for psychiatric care under the 1983 Mental Health Act in 2021/22. There was a four-fold difference between the CCGs with the highest and lowest involuntary hospitalisations. In an adjusted analysis, CCGs with a higher percentage of severe mental illness in the population, higher percentage of male population, and higher community and outpatient mental health care use showed a higher rate of involuntary hospitalisation. Depression, urbanicity, deprivation, ethnicity, and age were not strongly associated with involuntary hospitalisation after adjustment. These variables explained 10.68% of the variation in involuntary hospitalisations across CCGs. Some demographic and clinical variables explained variation in involuntary hospitalisation between areas in England, however, most of the variance was unexplained. Complex relationships between urbanicity, deprivation, age, and ethnicity need to be further explored. The role of other influences, such as variation in service organisation or clinical practice, also need to be better understood.

Development of a Vignette-Based Instrument to Assess Psychiatric Involuntary Hospitalization Decision-Making

The decision to hospitalize a psychiatric patient against their will is an ethically and clinically complex problem. While there is variation in rates of involuntary hospitalization (IH) across different settings, we lack a tool to measure individual differences in IH decision-making. This study used a mixed-methods approach to develop and validate a vignette-based instrument designed to assess the decision to hospitalize psychiatric cases and confidence in IH decision-making. The instrument was tested locally inn= 31 psychiatrists, and the results were replicated in a national sample (n= 238). The results showed variation in IH rates across the eight vignettes. Mixed-effects models found significant variability in confidence ratings across both vignettes and participants, supporting the validity of this instrument to assess IH decision-making.

Views and experiences of involuntary civil commitment of people who use drugs in Massachusetts (Section 35)

BackgroundInvoluntary civil commitment (ICC) is a court-mandated process to place people who use drugs (PWUD) into substance use treatment. Research on ICC effectiveness is mixed, but suggests that coercive drug treatment like ICC is harmful and can produce a number of adverse outcomes. We qualitatively examined the experiences and outcomes of ICC among PWUD in Massachusetts. MethodsData for this analysis were collected between 2017 and 2023 as part of a mixed-methods study of Massachusetts residents who disclosed illicit drug use in the past 30-days. We examined the transcripts of 42 participants who completed in-depth interviews and self-reported ICC. Transcripts were coded and thematically analysed using inductive and deductive approaches to understand the diversity of ICC experiences. ResultsParticipants were predominantly male (57 %), white (71 %), age 31–40 (50 %), and stably housed (67 %). All participants experienced ICC at least once; half reported multiple ICCs. Participants highlighted perceptions of ICC for substance use treatment in Massachusetts. Themes surrounding ICC experience included: positive and negative treatment experience’s, strategies for evading ICC, disrupting access to medications for opioid use disorder (MOUD), and contributing to continued substance use and risk following release. ConclusionsPWUD experience farther-reaching health and social consequences beyond the immediate outcomes of an ICC. Findings suggest opportunities to amend ICC to facilitate more positive outcomes and experiences, such as providing sufficient access to MOUD and de-criminalizing the ICC processes. Policymakers, public health, and criminal justice professionals should consider possible unintended consequences of ICC on PWUD.

Involuntary Commitment: Opinions Regarding Patient Autonomy, Legal Parameters, and Behavioral Services Care Delivery.

Involuntary Commitment: Opinions Regarding Patient Autonomy, Legal Parameters, and Behavioral Services Care Delivery.

Involuntary Commitment: A Humanitarian Treatment.

Involuntary Commitment: A Humanitarian Treatment.

Ending Involuntary Commitment for People With Treatment-Resistant Mental Illness and Grave Disability.

Ending Involuntary Commitment for People With Treatment-Resistant Mental Illness and Grave Disability.

Civil Commitment for People With Substance Use Disorders: Balancing Benefits and Harms.

Civil Commitment for People With Substance Use Disorders: Balancing Benefits and Harms.

Other Specified Paraphilic Disorder: Patterns of Use in Sexually Violent Predator Evaluations.

"Sexually violent predator" (SVP) legislation requires, in part, that an individual has a mental abnormality that causes difficulty in controlling sexual behavior. Previous research has found paraphilia not otherwise specified (NOS) as one of the most prevalent diagnoses proffered in SVP evaluations. However, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) modified paraphilia NOS diagnosis in two ways. First, this diagnosis was divided into two new diagnostic categories: other specified paraphilic disorder (OSPD) and unspecified paraphilic disorder. Second, OSPD required an added specifier to indicate the individual's source of sexual arousal. To date, no study has systematically explored how the revision to paraphilia NOS has affected diagnoses within SVP evaluations. The current study explored the frequency and diagnostic reliability of paraphilic disorders in a sample of 190 adult men evaluated for SVP civil commitment using the DSM-5. Results indicated that OSPD was the second most common paraphilic disorder, next to pedophilic disorder. However, there was poor to fair agreement (kappa= 0.21,p< .01) between independent evaluators in providing this diagnosis. Additionally, the two most common OSPD specifiers were non-consent and hebephilia, despite recent debate and rejection of these constructs from the DSM-5. While these constructs were the most prevalent, the specifiers contained quite varied terminology, suggesting vague diagnostic tendencies within these evaluations. Given that the presence of a mental abnormality is the cornerstone to the constitutionality of SVP commitment, diagnostic practices should be based in reliable and valid techniques.

Police officers’ perception of mentally disordered people: a national survey in Japan

ABSTRACT The treatment of offenders with mental disorders is an important issue in forensic mental health. In most countries, police officers working in the community are the first to deal with patients at risk of harming themselves or others. However, police officers’ perceptions and opinions of their practice in dealing with such patients have not been adequately investigated in Japan. We conducted a national survey to gather police officers’ opinions regarding their diversion practice for people with mental disorders and interorganizational collaboration. A total of 241 police officers participated in the study. Many participants were aware of the national mental health care scheme of administrative involuntary hospitalization in their daily work. However, many participants complained about public health centers and psychiatrists. These complaints seem to stem partly from the differences between organizational structures, lack of resources, and communication gaps. Many participants felt they lacked the opportunity to learn more about mental health literacy. Better collaborative care for people with mental disorders requires mutual relationships between the police, public health centers, and psychiatrists to promote a deeper understanding of community mental health.

Latest findings highlight the continuing uncertainty over the utility of compulsory psychiatric treatment in the community.

Community treatment orders (CTOs) have been introduced in many jurisdictions with evidence of increasing use over time as well as a disproportionate use in marginalised populations. Rates of CTOs also vary widely, both internationally and within the same country, for reasons that are poorly understood. This is despite evidence for effectiveness being mixed and, as a result, there have been calls for a reappraisal of this type of legislation. In the UK, a parliamentary committee on reforming the existing Mental Health Act recommended abolishing CTOs other than for people in the criminal justice system. Two recent Australian papers based on large state-wide administrative data-sets give conflicting results and came to markedly different conclusions regarding the desirability of reducing CTO rates. The debate about the effectiveness of CTOs therefore remains unresolved. This is of concern beyond Australia, as other jurisdictions such as England, Scotland and Canada have similar clinician-initiated orders.

Comparative analysis of the clinical and social characteristics of persons with organic mental disorders suffering from mental retardation who have repeatedly committed socially dangerous acts

BACKGROUND: The study of various characteristics of mentally ill persons suffering from mental disorders that influence the possibility of committing a repeated socially dangerous act. This has been one of the most urgent tasks of forensic psychiatry in recent years. The identification of such factors will significantly improve the secondary prevention of crime among the mentally ill. AIM: The purpose of the study — a comparative analysis of clinical and social characteristics in patients with mental retardation and organic psychological disorders (hereinafter referred to as DIS) who have repeatedly committed socially dangerous acts (hereafter referred to as DIS) and the identification of factors specific to patients with mental retardation that contribute to the commission of repeated DIS. Design: comparative study. MATERIALS AND METHODS: The comparative study included 65 patients diagnosed with mild and moderate mental retardation (who made up the main group A) and 45 patients with organic mental disorders (who made up the comparative group B) had repeatedly committed socially dangerous acts (OOD), who had been recognised as insane and who had undergone two or more periods of court-ordered compulsory medical treatment (hereafter referred to as MMMT) of various types. The study was carried out both in the form of a personal questionnaire and through a retrospective study of the patients' medical records. Correlation and comparative analysis were the main research methods used in the thesis. RESULTS: A number of clinical and social characteristics such as: hereditary burden of exogenous diseases (r +0.58, pi 0.05); single lifestyle (r +0.33, pi 0.05); urban place of residence (r +0.21, pi 0.05) increase the risk of repeated OOD, and are specific predictors for patients with mental retardation. A number of characteristics had a negative impact on the possibility of repeated OOD and negative correlations: the absence of any hereditary burden (r –0.44, pi 0.05), the presence of severe endogenous heredity (r –0.35, pi 0.05), living in rural areas (r –0.21, pi 0.05), concomitant alcohol dependence (r –0.29, pi 0.05). CONCLUSION: The data obtained will form the basis for the development of practical recommendations for secondary forensic psychiatric prevention, specifically for this nosological group, as well as methods for predicting and preventing recurrent DIS.

The Use of Telepsychiatry Services in Emergency Settings: Scoping Review.

Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP's effectiveness in the ED setting, as well as the process of implementing TP in this setting. This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting. The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors. A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting. Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP's effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment.

Examination of Cases Who Admitted to the Emergency Department of a Mental Health Hospital in 2020

Objective: This study aimed to retrospectively examine the sociodemographic and clinical characteristics of cases who admitted to the emergency department of a mental health hospital in 2020. Material and Methods: Cases who admitted to the emergency department of XXX Mental Health and Diseases Hospital between 01.01.2020 and 31.12.2020 were included. Sociodemographic and clinical data of the cases were accessed through the patient record system. Results: The total number of applications to the XXX MHDH emergency department between the specified dates was 7071 [5262 (74.4%) male and 1809 (25.6%) female].Sixty-four percent of the cases admitted through the Social Security Institution and 28% through the Ministry of Justice. Seven thousand fifty-five cases (99.7%) were the Republic of Turkey citizens. Three thousand two hundred fifty-four (46.0%) of the cases were evaluated within the scope of medical examination, 1599 (22.6%) were injection, 156 (2.2%) were involuntary hospitalization, and 1887 (26.7%) were judicial illegal substance screening. While 5877 (83.1%) of the cases left the emergency department after examination, 1194 (16.9%) were hospitalized at XXX MHDH. Two thousand one hundred forty-six (30.3%) of the cases were diagnosed with general psychiatric examination, 866 (12.2%) were anxiety spectrum disorders, 1464 (20.7%) were schizophrenia spectrum disorders, and 1658 (23.4%) were bipolar spectrum disorders. A statistically significant difference was found between male and female cases in terms of health insurance (p

Клинико-психологические факторы в контексте правосознания больных шизофренией, совершивших общественно опасные деяния

&lt;p style="text-align: justify;"&gt;The work is aimed at the study of clinical and psychological factors that determine the legal consciousness of schizophrenia patients who have committed SDA. The materials of an empirical study obtained on a sample of schizophrenia patients undergoing compulsory treatment in a psychiatric hospital are presented. The study involved male 62 patients aged 18 to 35 years. Methods of pathopsychological research: Dembo&amp;mdash;Rubinstein&amp;rsquo;s &amp;ldquo;Self-assessment&amp;rdquo;, MMPI, &amp;ldquo;The level of subjective control&amp;rdquo; by Rotter, &amp;ldquo;Ways of coping behavior&amp;rdquo; by Lazarus, pathopsychological functional tests &amp;mdash; &amp;ldquo;Exclusion of objects&amp;rdquo;, &amp;ldquo;Pictogram&amp;rdquo;. The pathopsychological features reflecting significant differences in the patients&amp;rsquo; legal consciousness have been established. New psychological information confirms the need to personalize psychological support during compulsory treatment. The key aspects of psychological work aimed at the prevention of socially dangerous behavior are the consideration of the attitude of patients to the disease and to the committed offense, as well as their individual psychological characteristics in order to reduce maladaptive and criminogenic behavioral stereotypes and the transformation of defects of legal consciousness.&lt;/p&gt;

의료용 마약류 오남용에 대한 대응 방안

The social problems caused by the misuse of medical drugs are increasing. Therefore, countermeasures to reduce the misuse of medical drugs are needed. First, as a way to control the supply of medical drugs, it is necessary to increase the number of medical drug monitoring personnel, link the NIMS with the drug safety service system, revise the Act so that it can be reported immediately after the prescription of the drug for medical use, establish a legal basis for reporting the plan to dispose of medical drugs to the authorities when medical institutions and pharmacies are closed, establish a legal basis for a total ban on business if the reporting of drug handling details is violated, improve medical drug return regulations under the Narcotics Control Act, establish objective standards for re-issuance of medical licenses, strengthen medical drug education for doctors and pharmacists, restrict medical drug prescription qualifications, improve the system to handle medical drugs only at high-level hospitals, and introduce a system to require identification through the introduction of a fingerprint search system when prescribing medical drugs. Second, as a way to curb the demand for misuse of medical drugs, the following are required: The establishment of an infrastructure for collecting and disposing of medical drugs at home, establishing an investigative organization specializing in medical drugs, strengthening the iInternet monitoring system, education and promotion of the harmfulness of medical drugs, introducing compulsory treatment and education order systems, introducing a drug treatment and testing system, and integrating medical drug offenders for treatment purposes.

Clinical and Psychopathological Features of Patients with Paranoid Schizophrenia with Non-Suicidal Auto-Aggression on Compulsory Treatment

Clinical and Psychopathological Features of Patients with Paranoid Schizophrenia with Non-Suicidal Auto-Aggression on Compulsory Treatment

Involuntary psychiatric hospitalisation – differences and similarities between patients detained under the mental health act and according to the legal guardianship legislation

BackgroundInvoluntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL.MethodsWe conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care.ResultsCases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low.ConclusionWe found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field.

Impact of the SARS-CoV-2 Pandemic on Hospitalizations in an Acute Psychiatric Ward.

The Sars-CoV-2 pandemic imposed unprecedented and drastic changes in health care organizations all over the world. To evaluate the impact of the pandemic on hospitalizations in an acute psychiatric ward. We retrospectively identified and compared acute psychiatric hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena during the pre-pandemic (n = 1858) and pandemic period (n = 1095), from 01/01/2017 to 31/12/2022. Data were statistically analyzed using STATA12. We collected 1858 hospitalizations in the pre-pandemic and 1095 in the pandemic. During the pandemic, we observed a progressively sharp reduction in voluntary hospitalizations, whereas involuntary ones remained stable with an increase in 2022 (p < 0.001), longer hospital stays (12.32 mean days vs 10.03; p < 0.001), longer periods of involuntary hospitalizations (8.45 mean days vs 5.72; p < 0.001), more frequent aggressive behaviour (16.10% vs 9.12%; p < 0.001) and referral to psychiatric communities at discharge (11.04% vs 6.13%; p < 0.001); non-Italians (p = 0.001), people with disability pension (p < 0.001) and Support Administrator (p < 0.001) were more frequently hospitalized. During the pandemic, voluntary psychiatric hospitalizations decreased, but not involuntary ones, and the most vulnerable people in serious clinical conditions were hospitalized.