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Rodwin AH, Banya M, Shimizu R, Jaccard J, Lindsey MA, Munson MR. Childhood adversities and suicidal ideation among young adults with serious mental illnesses: The mediating roles of perceived stress, dispositional hope, and mental health hope. J Affect Disord 2024:S0165-0327(24)01584-2. [PMID: 39299587 DOI: 10.1016/j.jad.2024.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 09/13/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Rates of suicidality are high among young adults and minoritized groups are disproportionately affected. Despite evidence that adverse childhood experiences (ACEs) may increase suicide-related risk, the underlying mechanisms through which ACEs may impact suicidal ideation (SI) remain poorly understood, especially among marginalized young adults with serious mental illnesses (SMI) such as schizophrenia-spectrum, major depressive, and bipolar disorders. This study examines associations between ACEs and SI, and whether perceived stress, dispositional hope, and mental health hope may mediate the relationship. METHODS The sample consisted of 114 young adults of color with SMI who participated in a larger randomized trial. Data were analyzed using a structural equation modeling (SEM) approach. RESULTS Young adults with more ACEs reported higher perceived stress, which in turn, was associated with more SI. Higher perceived stress was associated with lower dispositional and mental health hope. Although dispositional hope was negatively associated with SI on a bivariate level, neither dispositional nor mental health hope was significantly associated with SI in the multivariate SEM. This suggests that over and above perceived stress, hope does not appear to be associated with SI. LIMITATIONS Key limitations include a cross-sectional design, a modest sample size, and an assessment of select ACEs. CONCLUSION Addressing stress-related processes may be one promising target for suicide prevention efforts in the context of ACEs. Policy interventions focused on the allocation of resources and changing environments that are stress and trauma-inducing are needed to reduce the occurrence of ACEs and their negative sequelae.
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Affiliation(s)
- Aaron H Rodwin
- Silver School of Social Work, New York University, New York, NY, USA.
| | - Moiyattu Banya
- Silver School of Social Work, New York University, New York, NY, USA
| | - Rei Shimizu
- School of Social Work, University of Alaska, Anchorage, AK, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, NY, USA
| | - Michael A Lindsey
- Silver School of Social Work, New York University, New York, NY, USA
| | - Michelle R Munson
- Silver School of Social Work, New York University, New York, NY, USA
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Bartl G, Stuart R, Ahmed N, Saunders K, Loizou S, Brady G, Gray H, Grundy A, Jeynes T, Nyikavaranda P, Persaud K, Raad A, Foye U, Simpson A, Johnson S, Lloyd-Evans B. A qualitative meta-synthesis of service users' and carers' experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update. BMC Psychiatry 2024; 24:476. [PMID: 38937705 PMCID: PMC11209989 DOI: 10.1186/s12888-024-05914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users' and carers' experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. METHODS We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users' or carers' experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. RESULTS Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. CONCLUSIONS Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences. PROTOCOL REGISTRATION The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).
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Affiliation(s)
- Gergely Bartl
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Katherine Saunders
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sofia Loizou
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Grainne Brady
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Hannah Gray
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Andrew Grundy
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Tamar Jeynes
- Lived Experience Working Group, University College London, London, UK
| | - Patrick Nyikavaranda
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Karen Persaud
- Lived Experience Working Group, University College London, London, UK
| | - Ari Raad
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Una Foye
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alan Simpson
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Johnson
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Camden and Islington National Health Service Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK.
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Wood HJ, Jones N, Eack SM, Chengappa KNR, Prasad KM, Kelly C, Montrose D, Schooler NR, Ganguli R, Carter CS, Keshavan MS, Sarpal DK. Over 30 years of STEP: The Pittsburgh experience with first-episode psychosis. Early Interv Psychiatry 2024. [PMID: 38637133 DOI: 10.1111/eip.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
AIMS For over 30 years, combined research and treatment settings in the US have been critical to conceptualizing care for first-episode psychosis (FEP). Here we describe an early example of such a context, the Services for the Treatment of Early Psychosis (STEP) clinic, which is affiliated with the University of Pittsburgh. METHODS We describe STEP's historical roots and establishment in the early 1990s; STEP's research and treatment contributions, alongside its growth and ongoing leadership. RESULTS Research-based clinics, like STEP, preceded and helped pave the way for the Recovery After an Initial Schizophrenia Episode project in the US and the ensuing Coordinated Specialty Care (CSC) approach, now widely adopted in the US. Early clinic-based research at STEP helped establish protocols for psychopharmacology, the relevance of effective early treatment, including psychosocial approaches, and highlighted disparities in treatment outcomes across race/ethnicity. Multidisciplinary collaboration and dialogue with consumers contributed to early treatment, combining psychosocial and pharmacological approaches. STEP adopted CSC and is situated within a bi-state Learning Health System. STEP has retained a relatively unique 5-year treatment model and exists within continuum of care ideally suited to studying psychotic illness and treatment outcomes. CONCLUSIONS STEP remains the largest academic FEP clinic in Pennsylvania. Academic FEP clinics like STEP will have a critical role within Learning Health Systems nationally to model participatory approaches, sustain early intervention treatment quality and ongoing treatment developments.
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Affiliation(s)
- Helen J Wood
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - K N Roy Chengappa
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Konasale M Prasad
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christian Kelly
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Debra Montrose
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Nina R Schooler
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Rohan Ganguli
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Deepak K Sarpal
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Baker M, Sorensen J. The 988 suicide hotline-Lifeline or letdown? A pre-post policy analysis. Front Public Health 2024; 12:1337362. [PMID: 38694977 PMCID: PMC11061396 DOI: 10.3389/fpubh.2024.1337362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
Suicide has emerged as an urgent threat in recent years as COVID-19 impaired the health and economic wellbeing of millions of Americans. According to the Centers for Disease Control and Prevention, the impact of COVID-19 and the ongoing opioid epidemic has "taken a mental, emotional, physical, and economic toll on individuals, families, and communities," increasing the need for innovative solutions to prevent suicide on a national scale. The National Suicide Hotline Designation Act of 2020 established 988 as the universal telephone number for suicide prevention and represents a key federal intervention to address this crisis. However, research on 9-8-8's effectiveness is limited, given the Act's recent enactment and implementation at the federal and state levels. This policy analysis investigates how and to what extent the mental health crisis system in Georgia has improved since the implementation of the 2020 Act as well as the implications of state law on population-level mental health outcomes. Georgia is used as a nationally representative case study for two reasons: (1) Georgia had a robust statewide suicide hotline prior to 2020, providing solid infrastructure on which federal expansion of a suicide hotline number could be built, and (2) the conflicting characteristics of Georgia's mental health system represent several different pockets of the U.S., allowing this analysis to apply to a broad range of states and locales. The paper draws on takeaways from Georgia to propose state and national policy recommendations for equitable interventions to prevent and respond to this form of violence.
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Affiliation(s)
- Michaella Baker
- Pritzker School of Law, Northwestern University, Chicago, IL, United States
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Dil L, Mérelle S, Lommerse N, Peen J, So P, Van R, Zoeteman J, Dekker J. Gender-specific pathways in mental health crisis in adolescents, from consultation to (in)voluntary admission: a retrospective study. BMC Psychiatry 2024; 24:235. [PMID: 38549065 PMCID: PMC10976791 DOI: 10.1186/s12888-024-05680-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND A strong increase in mental health emergency consultations and admissions in youths has been reported in recent years. Although empirical evidence is lacking, gender differences in risk of admission may have contributed to this increase. A clearer understanding of the relationship, if any, between gender and various aspects of (in)voluntary care would help in more evidence-based service planning. METHODS We analysed registry data for 2008-2017 on 3770 outpatient emergencies involving young people aged 12 to 18 years from one urban area in the Netherlands, served by outreaching psychiatric emergency services. These adolescents were seen in multiple locations and received a psychosocial assessment including a questionnaire on the severity of their problems and living conditions. Our aims were to (a) investigate the different locations, previous use of mental health service, DSM classifications, severity items, living conditions and family characteristics involved and (b) identify which of these characteristics in particular contribute to an increased risk of admission. RESULTS In 3770 consultations (concerning 2670 individuals), more girls (58%) were seen than boys. Boys and girls presented mainly with relationship problems, followed by disruptive disorders and internalizing disorders. Diagnostic differences diminished in hospitalisation. More specifically, disruptive disorders were evenly distributed. Suicide risk was rated significantly higher in girls, danger to others significantly higher in boys. More girls than boys had recently been in mental health care prior to admission. Although boys and girls overall did not differ in the severity of their problems, female gender predicted admission more strongly. In both boys and girls severity of problems and lack of involvement of the family significantly predicted admission. Older age and danger to others significantly predicted admission among boys, whereas psychosis, suicidality and poor motivation for treatment predicted admission among girls. CONCLUSION There are different pathways for youth admission, which can partly be explained by different psychiatric classifications as well as gender-specific differences with regard to age, suicide risk, danger to others and the influence of motivation for treatment. Finally, for both genders, family desire for hospitalisation is also an important predictor.
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Affiliation(s)
- Linda Dil
- NPI, Arkin, Buikslotermeerplein 420, 1025 WP, Amsterdam, The Netherlands.
- Department of Clinical Psychology, VU Faculties, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
| | - Saskia Mérelle
- Research Department 113 Zelfmoordpreventie, Paasheuvelweg 25, 1105 BP, Amsterdam, The Netherlands
| | - Nick Lommerse
- Research Department Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Jaap Peen
- Research Department Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Pety So
- Youz, Center for Youth Mental Healthcare, Lupinestraat 1, 2906CV, Capelle a/d IJssel, The Netherlands
| | - Rien Van
- NPI, Arkin, Domselaerstraat 126, 1093 MB, Amsterdam, The Netherlands
| | - Jeroen Zoeteman
- Psychiatric Emergency Service, Arkin, 1 e Constantijn Huijgensstraat 38, 1054 BR, Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Clinical Psychology, VU Faculties, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
- Research Department Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
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Mark TL, Henretty K, Gibbons BJ, Zarkin GA. Association of Arizona's Implementation of a Behavioral Health Crisis Response System With Suicide Hospitalizations. Psychiatr Serv 2024; 75:148-154. [PMID: 37554005 DOI: 10.1176/appi.ps.20220628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE In July 2022, the 988 Suicide and Crisis Lifeline went live. The Lifeline is part of larger federal and state efforts to build comprehensive behavioral health crisis response systems that include mobile crisis units and crisis diversion and stabilization centers. Comprehensive response systems are anticipated to reduce hospitalizations for suicide and other behavioral health crises; however, research testing this assumption has been limited. The authors used Arizona-a state known for its comprehensive crisis system-to determine the association between state implementation of a comprehensive behavioral health crisis response system and suicide-related hospitalizations. METHODS A comparative interrupted time-series (CITS) design was used to compare changes in suicide-related hospitalizations after the 2015 implementation of Arizona's crisis response system (N=215,063). Data were from the 2010-2019 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Nevada (N=84,091 hospitalizations) was used as a comparison state because it is a western state that had not yet implemented a comprehensive crisis system and had available HCUP SID data. The CITS model included controls for time-varying differences in state demographic composition. RESULTS From 2010 to 2014 to 2019, annual suicide-related hospitalizations in Arizona increased from 122.0 to 324.2 to 584.5, respectively, per 100,000 people, and in Nevada, hospitalizations increased from 94.7 to 263.2 to 595.5, respectively, per 100,000 people. Arizona's crisis response system was associated with a significant relative decrease in the quarterly trend of 2.57 suicide-related hospitalizations per 100,000 people (p=0.033). CONCLUSIONS More research is needed to understand how the implementation of a comprehensive crisis response system may affect suicide-related hospitalizations.
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Betz ME, Bowen DM, Rowhani-Rahbar A, McCourt AD, Rivara FP. State Reporting Requirements for Involuntary Holds, Court-Ordered Guardianship, and the US National Firearm Background Check System. JAMA HEALTH FORUM 2023; 4:e233945. [PMID: 37976049 PMCID: PMC10656649 DOI: 10.1001/jamahealthforum.2023.3945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Firearm violence is a leading cause of death in the US. There is broad public agreement that individuals at high risk of perpetrating violence should not be allowed to purchase or possess firearms. The National Instant Criminal Background Check System (NICS) is a national system intended to stop firearm purchases or possession by prohibited persons, but there is heterogeneity in how states interact with and report data to NICS. Objective To examine variability in state requirements for NICS reporting for mental health prohibitions. Design and Setting This cross-sectional study in the US reviewed current statutes for all 50 states and the District of Columbia (enacted through the 2021 legislative session) regarding reporting mental health prohibitions to NICS or state systems. Data were analyzed from October 2022 to April 2023. Main Outcomes and Measures For each state, the following were recorded: reliance on Federal Bureau of Investigation vs state point of contact for NICS checks; regulation requiring or allowing reporting to NICS for 3 hypothetical cases; and details on reporting responsibility and time frame. The number of NICS listings for adjudicated mental health reasons was obtained, and state rates per 1000 population were calculated. To compare states, we developed 3 hypothetical cases of individuals with risk of firearm violence, whether possibly temporary (involuntary commitment for decompensated psychosis, or involuntary short-term psychiatric hold for suicidal ideation) or chronic and progressive (court-appointed guardianship for dementia). Results A total of 39 states required and 5 allowed reporting to NICS for court-ordered, involuntary psychiatric hospitalization. Thirteen states required and 5 allowed reporting to NICS when a court determines an individual is mentally incompetent to manage their affairs (with or without guardianship). Two states required NICS reporting for short-term emergency psychiatric holds. Five states and the District of Columbia had no legislation explicitly requiring or allowing NICS reporting in the 3 scenarios. Conclusions and Relevance In this cross-sectional study of state laws, there was substantial heterogeneity in NICS reporting requirements and lack of clarity around processes. This raises questions about the ability of NICS to be used to block firearm purchases or possession by individuals with court-identified high risk of perpetrating violence toward themselves or others.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver
| | - Deirdre M. Bowen
- Seattle University School of Law, Seattle, Washington
- Firearm Injury and Policy Research Program, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Alexander D. McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frederick P. Rivara
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
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Pope LG, Patel A, Fu E, Zingman M, Warnock A, Ellis S, Ashekun O, Watson A, Wood J, Compton MT. Crisis Response Model Preferences of Mental Health Care Clients With Prior Misdemeanor Arrests and of Their Family and Friends. Psychiatr Serv 2023; 74:1163-1170. [PMID: 37070262 PMCID: PMC11408879 DOI: 10.1176/appi.ps.20220363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The overrepresentation of people with serious mental illnesses in the criminal legal system has spurred the development of crisis response models to improve or reduce police response to a mental health crisis. However, limited research has explored preferences for crisis response, and no research in the United States has examined the responses desired by mental health care clients or their family members. This study aimed to understand the experiences of people with serious mental illnesses interacting with police and to learn about their preferences for crisis response models. The authors interviewed 50 clients with serious mental illnesses and a history of arrest who were enrolled in a randomized controlled trial of a police-mental health linkage system, as well as 18 of their family members and friends. Data were coded with deductive and inductive approaches and were grouped into larger themes. Clients and family or friends described needing a calm environment and empathy during a crisis. They selected a nonpolice response as their first choice and response from a crisis intervention team as their last choice among four options, highlighting the importance of trained responders and past negative interactions with police. However, they also noted concerns about safety and the shortcomings of a nonpolice response. These findings build understanding about clients' and family members' preferences for crisis response and highlight concerns that are relevant for policy makers.
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Affiliation(s)
- Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Ashnee Patel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - En Fu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Michael Zingman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Amanda Warnock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Samantha Ellis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Oluwaytoyin Ashekun
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Amy Watson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Jennifer Wood
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
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Alvarez K, Polanco-Roman L, Breslow AS, Molock S. Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Am J Psychiatry 2022; 179:422-433. [PMID: 35599542 PMCID: PMC9765395 DOI: 10.1176/appi.ajp.21101001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Correspondence: Kiara Alvarez, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | | | - Aaron Samuel Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Sherry Molock
- Department of Psychological & Brain Sciences, The George Washington University, Washington, DC
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