Initial evidence of vowel space reduction in a subset of individuals with schizophrenia

OBJECTIVE

Acoustic phonetic measures have been found to correlate with negative symptoms of schizophrenia, thus offering a path toward quantitative measurement of such symptoms. These acoustic properties include F1 and F2 measurements (affected by tongue height and tongue forward/back position, respectively), which determine a general "vowel space." Among patients and controls, we consider two phonetic measures of vowel space: average Euclidean distance from a participant's mean F1 and mean F2, and density of vowels around one standard deviation of mean F1 and of F2.

METHODS

Structured and spontaneous speech of 148 participants (70 patients and 78 controls) was recorded and measured acoustically. We examined correlations between the phonetic measures of vowel space and ratings of aprosody obtained using two clinical research measures, the Scale for the Assessment of Negative Symptoms (SANS) and the Clinical Assessment Interview for Negative Symptoms (CAINS).

RESULTS

Vowel space measurements were significantly associated with patient/control status, attributed to a cluster of 13 patients whose phonetic values correspond to reduced vowel space as assessed by both phoenetic measures. No correlation was found between phonetic measures and relevant items and averages of ratings on the SANS and CAINS. Reduced vowel space appears to affect only a subset of patients with schizophrenia, potentially those on higher antipsychotic dosages.

CONCLUSIONS

Acoustic phonetic measures may be more sensitive measures of constricted vowel space than clinical research rating scales of aprosody or monotone speech. Replications are needed before further interpretation of this novel finding, including potential medication effects.

Prevalence of Food Insecurity and Living in a Food Desert among Individuals with Serious Mental Illnesses in Public Mental Health Clinics

Very little is known about the prevalence of food insecurity-and living in a food desert-among persons with serious mental illnesses, such as schizophrenia and major mood disorders. This study evaluated those prevalences and assessed for associations with six other variables. Surveys were conducted with 300 patients with a psychotic or mood disorder receiving outpatient services at five community mental health agencies in Washington, D.C. The prevalences of low food security and very low food security were 68.9% and 46.8%, compared to national rates of 13.7% (13.2% in Washington, D.C.) and 5.4% (4.8% in Washington, D.C.). 50.0% of participants lived in food desert census tracts, which was associated with both severe and morbid obesity (p = .02 and p = .03, respectively). Additional research, evaluation of clinical implications, and potential policy approaches to these concerning social determinants of physical and mental health, in an already vulnerable patient population, are warranted.

Associations Between Adverse Childhood Experiences and Tobacco, Alcohol, and Drug Use Among Individuals with Serious Mental Illnesses in Public-Sector Treatment Settings

Adverse childhood experiences (ACEs) increase risk of substance use disorders (SUDs). Little research has focused on individuals with serious mental illnesses (SMI), despite their high prevalence of both ACEs and SUDs. We combined two datasets from prior studies (n = 299 and n = 240, total n = 539) that measured ACEs and made research diagnoses for SUDs. When controlling for other variables-age, gender, race, diagnostic category (psychotic disorder versus mood disorder), and study site (Washington, DC-area versus southeast Georgia)- in logistic regression models, ACE score was associated with tobacco use, presence of any SUD, alcohol use disorder, cannabis use disorder, and cocaine use disorder. Each one-unit increase in the ACE score increased the odds of SUD-related outcomes by 9-18%. Clinicians, program planners, and researchers should be aware of the powerful and long-lasting impact of ACEs, and the need for thorough screening and assessment of both SUDs and ACEs among patients with SMI.

Opening Doors to Recovery: A Randomized Controlled Trial of a Recovery-Oriented Community Navigation Service for Individuals With Serious Mental Illnesses and Repeated Hospitalizations

Objective: Opening Doors to Recovery (ODR) is a community navigation and recovery support model created in southeast Georgia by diverse, collaborative stakeholders. Following promising results from a quasi-experimental study, this randomized controlled trial hypothesized that, among patients with serious mental illnesses being discharged from inpatient psychiatric settings, compared to those randomized to traditional case management (CM) services, those randomized to ODR would have (1) lower likelihood of hospitalization, fewer hospitalizations, and fewer inpatient days; (2) lower likelihood of arrest, fewer arrests, and longer time to arrest; and, secondarily, (3) greater housing satisfaction and housing stability; and (4) higher scores on several scales measuring recovery-related constructs. Methods: 240 individuals with Structured Clinical Interview for DSM-5 Disorders-based psychotic or mood disorders, functional impairment, and repeated hospitalizations were randomized (December 2014 to June 2018) to ODR or CM. Hospitalization and arrest data were collected from State agencies after 12 months, and housing- and recovery-related measures were collected in person, longitudinally at 4, 8, and 12 months. Intention-to-treat analyses were conducted. Effects of dropout were accounted for, and sensitivity analyses were run. Results: ODR was associated with fewer days hospitalized (RR = 0.86, P = .001), a lower incidence of arrests (OR = 0.35, P < .0005), and longer time to arrest (HR = 0.42, P = .001). In addition, measures of housing satisfaction (Cohen d = 0.45) and recovery (Cohen d = 0.33) were significantly more improved in ODR patients compared to CM patients. Conclusions: The ODR model appears to have advantages over more traditional CM services and could fill a gap in the service array. Studying the mediators of success, cost benefit, dissemination, fidelity, and financing of the model is warranted. Trial Registration: ClinicalTrials.gov identifier: NCT04612777.

Misdemeanor Charges Among Individuals With Serious Mental Illnesses: A Statewide Analysis of More Than Two Million Arrests

OBJECTIVE

Reducing the overrepresentation of individuals with serious mental illnesses in the criminal legal system requires a better understanding of the charges for which they are most commonly arrested. This study aimed to compare violent offenses, penal code classifications, Uniform Crime Reporting (UCR) codes, and specific charges in arrests among individuals with and individuals without serious mental illnesses.

METHODS

The authors analyzed all arrests (N=2,224,847) in New York State during 2010-2013. Medicaid data and the state mental health authority's records were used to create an indicator of serious mental illness for each arrest.

RESULTS

Among arrests involving individuals with the serious mental illness indicator (N=91,363), 7.3% were for violent offenses, compared with 7.6% of arrests involving individuals without the indicator. Among 10 penal code classifications, class B felonies and class A misdemeanors were more likely in arrests among those with the indicator than among those without it. Of the 14 UCR codes examined, seven were more common in arrests with the serious mental illness indicator. Criminal trespass was among the most common charges in arrests involving individuals with the indicator.

CONCLUSIONS

Most arrests involving people with serious mental illnesses were for misdemeanors, specifically class A misdemeanors, and this class comprised a larger proportion of arrests for those with the indicator than of arrests for those without it. New approaches are needed to address the situations-usually related to socioeconomic disadvantage-that result in individuals with mental illnesses receiving misdemeanor charges and cycling through the criminal legal system.

A Community Navigation Scale for Persons With Serious Mental Illnesses

OBJECTIVE

The recovery paradigm in the context of serious mental illnesses pertains to several characteristics of community functioning, adjustment, and integration, among other constructs. Additional rating scales would be beneficial for measuring various facets of community functioning for research that is recovery oriented as opposed to symptom focused. The Community Navigation Scale was developed as part of the Opening Doors to Recovery project to address several aspects of navigating community resources.

METHODS

After item development, the 21-item Community Navigation Scale was used across two studies with 340 participants who had serious mental illnesses. Factor analysis revealed three potential factors, and subscales were computed.

RESULTS

The social and physical well-being subscale (seven items, Cronbach's α=0.82) addressed community involvement, volunteering, finding enjoyable activities, and engaging in positive health behaviors. The accessing external resources subscale (nine items, Cronbach's α=0.80) tapped one's ability to obtain needed resources, ranging from medications to housing and from small appliances to classes in the community. The home and self-maintenance subscale (five items, Cronbach's α=0.73) measured abilities around shopping, cooking, cell phone use, house cleaning, and personal grooming and hygiene. Initial validity of the subscales was suggested through correlations with the Multnomah Community Ability Scale (r=0.65, 0.55, and 0.41 for social and physical well-being, accessing external resources, and home and self-maintenance, respectively).

CONCLUSIONS

The Community Navigation Scale assesses dimensions of community functioning among persons with serious mental illnesses and may add to the array of research and clinical measures pertinent to recovery outcomes. Additional research on its psychometric properties is warranted.

Prevalence and Correlates of Four Social Determinants in a Statewide Survey of Licensed Mental Health Services

OBJECTIVE

This analysis examined the distribution of four social determinants of health among recipients of state-licensed mental health services and analyzed relationships between determinants and individuals' clinical and demographic characteristics.

METHODS

With data from the New York State Office of Mental Health 2017 Patient Characteristics Survey (N=103,416), prevalences of four social determinants (education, employment, housing, and criminal legal involvement) among mental health service recipients were described. Results were stratified to explore differences by diagnosis, gender, race and ethnicity, and region of residence.

RESULTS

High proportions had low education (20.9%), unemployment (79.1%), homelessness (8.2%), and criminal legal involvement (12.2%), surpassing statistics for the general state population. Prevalences of alcohol-related, drug-related, and psychotic disorders were higher among these groups than were prevalences of other diagnoses. People of color and male recipients were overrepresented among those with adverse social determinants.

CONCLUSIONS

Results highlight the magnitude of social adversity among those receiving mental health services, as well as potential inequities.

Characterizing Arrests and Charges Among Individuals With Serious Mental Illnesses in Public-Sector Treatment Settings

OBJECTIVE

Individuals with serious mental illnesses are overrepresented in all facets of the legal system. State-level criminal histories of patients with serious mental illnesses were analyzed to determine the proportion who had been arrested and number of lifetime arrests and charges, associations of six variables with number of arrests, and the most common charges from individuals’ first two arrests and most recent two arrests.

METHODS

A total of 240 patients were recruited at three inpatient psychiatric facilities and gave consent to access their criminal history. Information was extracted from Record of Arrest and Prosecution (RAP) sheets for lifetime arrests in Georgia.

RESULTS

A total of 171 (71%) had been arrested. Their mean±SD lifetime arrests were 8.6±10.1, and mean lifetime charges were 12.6±14.6. In a Poisson regression, number of arrests was associated with lower educational attainment, Black or African American race, the presence of a substance use disorder, the presence of a mood disorder, and female sex. Common early charges included marijuana possession, driving under the influence of alcohol, and burglary and shoplifting. Common recent charges included probation violations, failure to appear in court, officer obstruction–related charges, and disorderly conduct.

CONCLUSIONS

Findings point to a need for policy and program development in the legal system (e.g., pertaining to charges such as willful obstruction of an officer), the mental health community (e.g., to ensure that professionals know about clients’ legal involvement and can partner in strategies to reduce arrests), and social services sectors (to address charges, such as shoplifting, often related to material disadvantage).

"If This Is an Emergency, Hang up and Dial 911" in the Era of 988

The recent implementation of 988 as a behavioral crisis hotline is a critical opportunity for improving crisis care across the United States. The bold vision for 988 is to offer individuals experiencing a mental health crisis a rapid entry into a coordinated crisis system and reduce reliance on 911 (and prevent a police response when it is not warranted). In this Open Forum, the authors suggest that mental health professionals have a role to play in educating their clients about when to use 988. Promoting 988 will also depend on answering key questions about what constitutes a crisis and how 988 is being implemented at a local level.

The Association Between Neighborhood Poverty and Hippocampal Volume Among Individuals at Clinical High-Risk for Psychosis: The Moderating Role of Social Engagement

Reductions in hippocampal volume (HV) have been associated with both prolonged exposure to stress and psychotic illness. This study sought to determine whether higher levels of neighborhood poverty would be associated with reduced HV among individuals at clinical high-risk for psychosis (CHR-P), and whether social engagement would moderate this association. This cross-sectional study included a sample of participants (N  =  174, age-range = 12-33 years, 35.1% female) recruited for the second phase of the North American Prodrome Longitudinal Study. Generalized linear mixed models tested the association between neighborhood poverty and bilateral HV, as well as the moderating role of social engagement on this association. Higher levels of neighborhood poverty were associated with reduced left (β  =  -0.180, P  =  .016) and right HV (β  =  -0.185, P  =  .016). Social engagement significantly moderated the relation between neighborhood poverty and bilateral HV. In participants with lower levels of social engagement (n  =  77), neighborhood poverty was associated with reduced left (β  =  -0.266, P  =  .006) and right HV (β = -0.316, P  = .002). Among participants with higher levels of social engagement (n = 97), neighborhood poverty was not significantly associated with left (β  =  -0.010, P  =  .932) or right HV (β  =  0.087, P  =  .473). In this study, social engagement moderated the inverse relation between neighborhood poverty and HV. These findings demonstrate the importance of including broader environmental influences and indices of social engagement when conceptualizing adversity and potential interventions for individuals at CHR-P.

Using the Theory of Planned Behavior to Understand How Crisis Intervention Team (CIT) Training Facilitates Police Officers' Mental Health Referrals

The Theory of Planned Behavior posits that behaviors are predicted by one's intention to perform them; intention is driven by attitude toward the behavior, subjective norm, and perceived behavioral control. We used this theory to predict Crisis Intervention Team (CIT)-trained and non-CIT officers' intention to facilitate referral of persons with suspected mental illnesses to mental health services. CIT-trained (n = 251) and non-CIT (n = 335) officers from six law enforcement agencies participated. CIT-trained officers had significantly greater scores on all constructs. Theory constructs fit the data well, and fit did not differ meaningfully between the two groups. Direct and indirect predictors together accounted for 28% and 21%, respectively, of variance in behavioral intention. Attitude was the strongest predictor. Intentions to facilitate mental health referrals may be driven by the same factors among CIT-trained and non-CIT officers, but CIT officers, even at a median of 22 months after training, have significantly higher scores on those factors.

An Intersectional Approach to Ethnoracial Disparities in Pathways to Care Among Individuals With Psychosis in Coordinated Specialty Care

Importance

Intersecting factors of social position including ethnoracial background may provide meaningful ways to understand disparities in pathways to care for people with a first episode of psychosis.

Objective

To examine differences in pathways to care by ethnoracial groups and by empirically derived clusters combining multiple factors of social and clinical context in an ethnoracially diverse multisite early-intervention service program for first-episode psychosis.

Design, Setting, and Participants

This cohort study used data collected on individuals with recent-onset psychosis (<2 years) by clinicians with standardized forms from October 2013 to January 2020 from a network of 21 coordinated specialty care (CSC) programs in New York State providing recovery-oriented, evidence-based psychosocial interventions and medications to young people experiencing early psychosis.

Exposures

Ethnoracial group and other factors of social position (eg, insurance status, living situation, English fluency, geographic region) intersecting with first-contact experiences (ie, type of first service, referral source, and symptoms at referral).

Main Outcomes and Measures

Outcome measures were time from onset to first contact, first contact to CSC, and onset to CSC.

Results

The total study sample consists of 1726 individuals aged 16 to 30 years and included 452 women (26%), 1263 men (73%), and 11 (<1%) with another gender enrolled in the network of CSC programs. The total sample consisted of 153 Asian (9%), 599 Black (35%), 454 Latinx (26%), and 417 White individuals (24%). White individuals had a significantly shorter time from onset to first contact (median [IQR], 17 [0-80] days) than Asian (median [IQR], 34 [7-94] days) and Black (median [IQR], 30 [1-108] days) individuals but had the longest period from first contact to CSC (median [IQR], 102.5 [45-258] days). Five distinct clusters of individuals emerged that cut across ethnoracial groups. The more disadvantaged clusters in terms of both social position and first-contact experiences had the longest time from onset to first contact, which were longer than for any single ethnoracial group.

Conclusions and Relevance

In this cohort study of individuals with recent-onset psychosis, time-to-treatment outcomes differed by ethnoracial group and by empirically derived clusters combining multiple factors of social and clinical context. The examination of disparities in durations to treatment through an intersectional, ethnoracial lens may improve understanding of the inequities resulting from the various intersecting factors that may compound delays in treatment initiation.

Modeling the effects of Crisis Intervention Team (CIT) training for police officers: How knowledge, attitudes, and self-efficacy drive de-escalation skills and referral decisions

OBJECTIVE

Prior research on Crisis Intervention Team (CIT) training for police officers has demonstrated improvements in knowledge, attitudes, self-efficacy, and stigma, but how these factors work together to influence behavioral outcomes like de-escalation skills and referral decisions remains unstudied.

METHOD

251 CIT-trained and 335 non-CIT officers completed in-depth surveys measuring these six constructs. We used structural equation modeling to test fit of the data to our hypothesized model and made indicated changes to improve fit.

RESULTS

An alternate 8-path model (with three paths originally hypothesized being removed) fit reasonably well, and allowing path coefficients to differ for CIT and non-CIT groups resulted in models with similar fit statistics.

CONCLUSION

CIT training enhances knowledge and attitudes, both of which have beneficial effects on stigma. Though an important outcome itself, lower stigma does not have an effect on de-escalation skills and referral decisions, though self-efficacy clearly does.

Failure to Appear: Mental Health Professionals' Role Amidst Pretrial Justice Reform

Pretrial detention reform is keeping people who have been arrested on low-level charges out of jail while they await trial. This reform has implications for people with serious mental illnesses who are overrepresented in the criminal legal system and who can now stay connected to families, employment, community supports, and treatment providers while their cases are processed. However, such reforms may have uniquely negative consequences for those with serious mental illnesses. In this Open Forum, the authors argue that it is critical for mental health professionals to understand what pretrial reform entails and to incorporate planning around clients' criminal legal system involvement into their routine clinical work.

The associations between area-level residential instability and gray matter volumes from the North American Prodrome Longitudinal Study (NAPLS) consortium

INTRODUCTION

Area-level residential instability (ARI), an index of social fragmentation, has been shown to explain the association between urbanicity and psychosis. Urban upbringing has been shown to be associated with reduced gray matter volumes (GMV)s of brain regions corresponding to the right caudal middle frontal gyrus (CMFG) and rostral anterior cingulate cortex (rACC). We hypothesize that greater ARI will be associated with reduced right CMFG and rACC GMVs.

METHODS

Data were collected at baseline as part of the North American Prodrome Longitudinal Study Phase 2. Counties where participants resided during childhood were geographically coded using the US Census to area-level factors. ARI was defined as the percentage of residents living in a different house 5 years ago. Generalized linear mixed models tested associations between ARI and GMVs.

RESULTS

This study included 29 healthy controls (HC)s and 64 clinical high risk for psychosis (CHR-P) individuals who were aged 12 to 24 years, had remained in their baseline residential area, and had magnetic resonance imaging scans. ARI was associated with reduced right CMFG (adjusted β = -0.258; 95% CI = -0.502 to -0.015) and right rACC volumes (adjusted β = -0.318; 95% CI = -0.612 to -0.023). The interaction term (ARI-by-diagnostic group) in the prediction of both brain regions was not significant, indicating that the relationships between ARI and regional brain volumes held for both CHR-P and HCs.

CONCLUSIONS

ARI may adversely impact similar brain regions as urban upbringing. Further investigation into the potential mechanisms of the relationship between ARI and neurobiology, including social stress, is needed.

Voluntary Registries: Filling the Critical Information Gap in First Response to Mental Health Crises

We argue that voluntary mental health registries integrated into the 9-1-1 system, where patients and caregivers can establish a repository of this information, will help fill this information gap by enabling first responders to quickly understand the context of a call for service with a mental health component, and to make better informed decisions. Despite valid concerns about privacy, stigma, and the potential misuse of protected health information, such registries, if carefully designed and administered, can improve the health outcomes of 9-1-1 calls for service involving mental health-related crises.

Social Fragmentation and Schizophrenia: A Systematic Review

Objective: Accumulating evidence implicates social context in the etiology of psychosis. One important line of epidemiologic research pointing to a potentially causal role of social context pertains to what is termed social fragmentation. The authors conducted a systematic review of the relationship between area-level social fragmentation and psychosis. Data Sources: Three databases (MEDLINE, PsycINFO, and Web of Science) were searched from inception to May 2, 2021. There were no language restrictions. Search terms were those that identify the area-level orientation, social fragmentation, sample, and outcome. Study Selection: Inclusion criteria were the following: (1) social environment measured at the area level with (2) psychosis outcomes (incidence rates, prevalence of psychosis or schizophrenia, age at onset of psychosis, psychotic symptom severity, and duration of untreated psychosis). In total, 579 research articles were identified, and 19 were eligible to be included in this systematic review. Data Extraction: Two reviewers independently screened, extracted data from, and coded all articles. Results: Evidence from 14 of 19 articles indicates that area-level characteristics reflecting social fragmentation are associated with higher psychosis rates and other outcomes of psychosis even after controlling for other area-level characteristics including deprivation, social capital, race/ethnicity, and urbanicity and individual-level characteristics including age, sex, migrant status, and socioeconomic status. Conclusions: In conclusion, this review finds evidence that measures of area-level social fragmentation are associated with higher psychosis rates. Further research into mechanisms is needed to better characterize this association.

Association between residential instability at individual and area levels and future psychosis in adolescents at clinical high risk from the North American Prodrome Longitudinal Study (NAPLS) consortium

OBJECTIVE

Accumulating evidence supports an association between residential instability and increased risk for psychosis, but the association between residential instability and conversion to psychosis among adolescents at clinical high risk (CHR) is unclear. In this study, we determined whether individual-level and area-level residential instability and their interaction are associated with conversion to psychosis within two years.

METHODS

Data were collected as part of the North American Prodrome Longitudinal Study Phase 2. Individual-level residential instability, defined as having ever moved during lifetime, was derived from the Life Events Scale. Area-level residential instability, defined as the percentage of people who were not living in the same house five years ago, was derived from the U.S. Decennial Censuses.

RESULTS

This study included 285 adolescents at CHR (including 36 subjects who later converted to full psychosis). We found that individual-level residential instability was associated with conversion (adjusted OR = 2.769; 95% CI = 1.037-7.393). The interaction between individual-level and area-level residential instability was significant (p = 0.030). In a subgroup of CHR participants who have never moved (n = 91), area-level residential instability during childhood was associated with conversion (adjusted OR = 1.231; 95% CI = 1.029-1.473). Conversely, in a subgroup of CHR participants who resided in residentially stable areas during childhood (n = 142), the association between individual-level residential instability and conversion remained significant (adjusted OR = 15.171; 95% CI = 1.753-131.305).

CONCLUSIONS

These findings suggest that individual-level and area-level residential instability may be associated with conversion to psychosis.

Computational linguistic analysis applied to a semantic fluency task: A replication among first-episode psychosis patients with and without derailment and tangentiality

Automated tools do not yet exist to measure formal thought disorder, including derailment and tangentiality, both of which can be subjectively rated using the Scale for the Assessment of Positive Symptoms after a clinical research interview. CoVec, a new automated tool, measures the semantic similarity among words averaged in a five- and ten-word window (Coherence-5 and Coherence-10, respectively). One prior report demonstrated that this tool was able to differentiate between patients with those types of thought disorder and patients without them (and controls). Here, we attempted a replication of the initial findings using data from a different sample of patients hospitalized for initial evaluation of first-episode psychosis. Participants were administered a semantic fluency task and the animal lists were analyzed with CoVec. In this study, we partially replicated the prior findings, showing that first-episode patients with derailment had significantly lower Coherence-5 and Coherence-10 compared with patients without derailment. Further research is warranted on this and other highly reliable and objective methods of detecting formal thought disorder through simple assessments such as semantic fluency tasks.

Adversity in childhood/adolescence and premorbid tobacco, alcohol, and cannabis use among first-episode psychosis patients

AIM

Premorbid substance use is widely recognized as a crucial factor in early psychosis. We explored the effects of childhood/adolescent adversity on premorbid tobacco, alcohol, and cannabis use. We hypothesized that adversity in childhood would be associated with an increased likelihood of use, and amount of intake, of tobacco, alcohol, and cannabis. We analysed which domains of adversity have the greatest impact.

METHODS

First-episode psychosis patients were enrolled from six inpatient psychiatric units in Atlanta, Georgia and Washington, D.C. Premorbid substance use was thoroughly measured, and childhood/adolescent adversity was rated using 14 scales/subscales. Factor analysis was used to reduce these scales/subscales to the three domains of adversity (termed Violence and Environmental Adversity, Interpersonal Abuse, and Neglect and Lack of Connectedness). Regression analyses determined associations between adversity domains and premorbid substance use.

RESULTS

Our sample (n = 247) primarily consisted of African Americans (86.2%) and males (74.5%). Violence and Environmental Adversity was significantly associated with five of six substance use variables and marginally associated with the sixth. Interpersonal Abuse was unassociated with substance use, and Neglect and Lack of Connectedness was associated only with a lower likelihood cannabis use. When Violence and Environmental Adversity results were stratified by gender, effects on tobacco use and amount of tobacco use were stronger among females.

CONCLUSIONS

Childhood/adolescent trauma and adversity have meaningful associations with premorbid substance use in first-episode psychosis patients. First-episode psychosis and clinical high-risk treatment settings may benefit from expanding the assessment of childhood/adolescent adversity to include factors pertaining to violence exposure and adversities beyond abuse and neglect.

Police Reform From the Perspective of Mental Health Services and Professionals: Our Role in Social Change

Calls to defund and reform police agencies have been emphasized in recent public discourse. Demands range from shuttering police agencies to shifting resources and responsibility for responding to noncriminal social and behavioral health vulnerabilities to the health and social services sector. This Open Forum discusses how police officers became primary responders to behavioral health concerns, how this arrangement disproportionately and negatively affects communities of color, and several solutions to these circumstances. The mental health field must advocate for the policies and resources needed to address urgent mental health needs and crisis response. Several conditions for successful outcomes that do not further compound racial inequities are discussed.

The Impact of Crisis Intervention Team Response, Dispatch Coding, and Location on the Outcomes of Police Encounters with Individuals with Mental Illnesses in Chicago

The Crisis Intervention Team (CIT) model has been implemented in over 3,000 communities across the USA. Research to date has shown beneficial results in terms of officers' knowledge, attitudes, self-efficacy, stigma, and force preferences. This study aimed to broaden the lens on the implementation context of CIT to examine whether factors in the environment and response process affect how calls are resolved. This study focused on several factors-CIT response, call location, and upstream decisions to pre-identify calls as mental health-related-that may impact call outcomes. Our findings suggest that CIT response, dispatch coding, and the places where calls originate play a role in shaping outcomes. More research is needed to unpack the effects of this wider CIT implementation environment.

Screening and Treatment of Tobacco Use Disorder in Mental Health Clinics in New York State: Current Status and Potential Next Steps

The prevalence of smoking is higher among individuals with serious mental illnesses than the general population. Evidence-based practices exist for tobacco cessation, but little is known about mental health clinics' tobacco cessation treatment practices/protocols. Mental health clinics in New York State were surveyed about their tobacco use treatment protocols and outdoor-smoking policies. One-third of clinics were not providing individual counseling for tobacco use disorder, 39% were not prescribing nicotine replacement therapy, and nearly half reported not prescribing bupropion or varenicline. Even smaller proportions reported implementing other clinical practice guidelines, with only 25.2% providing staff training and 20.3% having a dedicated staff member for coordinating tobacco use disorder treatment. Regarding outdoor smoke-free policies, 38% of clinics reported not allowing any tobacco use anywhere on grounds. Despite some successes, many clinics do not provide evidence-based tobacco use treatments, meaning important opportunities exist for mental health clinics and oversight agencies to standardize practices.

Associations Between Childhood and Adolescence Adversity and Risk for Arrest Among Patients With First-Episode Psychosis

OBJECTIVE

The authors assessed associations between childhood and adolescent adversity and arrest among individuals with first-episode psychosis (FEP). The authors also sought to determine which domains of adversity had the greatest impact and whether associations varied by gender.

METHODS

Data were analyzed from 247 patients with FEP admitted to inpatient psychiatric units between August 2008 and June 2013. Analyses focused on self-reported history of arrest and seven scales of past adversity, with 14 subscales reduced to three factors. Binary logistic regression and negative binomial regression determined associations between the three childhood adversity factors and having ever been arrested and number of arrests, respectively.

RESULTS

Past experience of violence and environmental adversity was significantly (p<0.001) associated with both history of arrest (odds ratio=2.29) and number of arrests (β=0.60), and this association was stronger for female patients than for male patients.

CONCLUSIONS

Findings suggest a need to address both past adversity and criminal justice system involvement in the context of early psychosis specialty care.

Development, item analysis, and initial reliability and validity of three forms of a multiple-choice mental health literacy assessment for college students (MHLA-c)

Despite increasing rates of mental health disorders among college students, there are a limited number of validated mental health literacy measures that can be quickly administered and scored in this population. We developed a 54-item multiple-choice measure, consisting of three forms with 18 items on each form. Our items focus on knowledge of more than 20 mental health disorders including their etiology, risk factors, diagnoses, symptoms, treatment, course, and outcome, as well as the application of this knowledge to real world situations. Data were collected on three independent samples of undergraduate students enrolled at an urban public university system in the northeast United States: pilot (n=292), test refinement (n=1,272), and validation (n=683). Basic demographics for the combined test refinement and validation samples were: age=22 ± 4.9 years; 62.2% female; 71.7% non-White. We report on the development of the Mental Health Literacy Assessment-college (MHLA-c) and provide support for its reliability and validity. We also provide descriptive statistics, stratified by gender, college major, and personal experience with a mental health issue to enable its use in diverse settings. The MHLA-c may be useful in measuring knowledge of mental health disorders and related topics among college students. Moreover, the availability of parallel forms will facilitate its use within educational or interventional studies that employ pre-post testing designs.