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Hancq ES, Munetz M, Silver SC, Parker HA, Bonfine N. Critical Gaps in Assisted Outpatient Treatment Research in the United States. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01377-z. [PMID: 38687427 DOI: 10.1007/s10488-024-01377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/02/2024]
Abstract
In 2023, the White House included the implementation and improvement of assisted outpatient treatment in a list of under-researched strategies to support recovery and long-term treatment engagement for people with serious mental illness. Assisted outpatient treatment is a community-based, court-ordered, mental health treatment program for a subset of individuals with serious mental illness who have a history of difficulty adhering to treatment and staying well while living in the community. There is research supporting the use of assisted outpatient treatment for this specific population, however, the majority focuses on limited geographic regions, specific program organizations, and is outdated. Meanwhile, assisted outpatient treatment programs have increasingly been adopted by counties and states across the country. More research is needed to ensure that assisted outpatient treatment programs are being implemented in the most effective and equitable way possible. In this paper, the authors identify several key gaps in the current literature base relating to the effectiveness and implementation of assisted outpatient treatment.
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Affiliation(s)
| | - Mark Munetz
- Northeast Ohio Medical University, Rootstown, OH, USA
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2
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Starks SL, Kelly EL, Castillo EG, Meldrum ML, Bourgois P, Braslow JT. Client Outreach in Los Angeles County's Assisted Outpatient Treatment Program: Strategies and Barriers to Engagement. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:839-854. [PMID: 36081900 PMCID: PMC9447859 DOI: 10.1177/1049731520949918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose Assisted Outpatient Treatment (AOT) programs can compel treatment-refusing individuals to participate in mental health treatment via civil court order. In California's AOT programs, individuals first must be offered 30 days of outreach services and can accept services voluntarily. This study examines the use of outreach strategies in an AOT program with the potential for voluntary or involuntary enrollment. Methods Outreach staff completed a survey in which they reported and rated outreach strategies and barriers to treatment for 487 AOT-referred individuals. Results Outreach staff reported using a broad array of strategies to persuade and engage clients. Supportive and persuasive strategies were most common. More coercive strategies, including court order, were used when needed. More clients enrolled voluntarily (39.4%) than involuntarily (7.2%). Conclusions Outreach, coupled with the strategic used of potential court involvement, can lead to voluntary enrollment of treatment-refusing individuals with many, often severe, barriers to engaging in outpatient treatment.
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Affiliation(s)
- Sarah L. Starks
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Erin L. Kelly
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Enrico G. Castillo
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
- Los Angeles County Department of Mental Health
| | - Marcia L. Meldrum
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Joel T. Braslow
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
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3
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Untreated Mental Illness Has Created a National Tragedy: A Pandemic of Homelessness. J Clin Psychopharmacol 2022; 42:115-117. [PMID: 35135977 DOI: 10.1097/jcp.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Simes JT, Jahn JL. The consequences of Medicaid expansion under the Affordable Care Act for police arrests. PLoS One 2022; 17:e0261512. [PMID: 35020737 PMCID: PMC8754343 DOI: 10.1371/journal.pone.0261512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND & METHODS National protests in the summer of 2020 drew attention to the significant presence of police in marginalized communities. Recent social movements have called for substantial police reforms, including "defunding the police," a phrase originating from a larger, historical abolition movement advocating that public investments be redirected away from the criminal justice system and into social services and health care. Although research has demonstrated the expansive role of police to respond a broad range of social problems and health emergencies, existing research has yet to fully explore the capacity for health insurance policy to influence rates of arrest in the population. To fill this gap, we examine the potential effect of Medicaid expansion under the Affordable Care Act (ACA) on arrests in 3,035 U.S. counties. We compare county-level arrests using FBI Uniform Crime Reporting (UCR) Program Data before and after Medicaid expansion in 2014-2016, relative to counties in non-expansion states. We use difference-in-differences (DID) models to estimate the change in arrests following Medicaid expansion for overall arrests, and violent, drug, and low-level arrests. RESULTS Police arrests significantly declined following the expansion of Medicaid under the ACA. Medicaid expansion produced a 20-32% negative difference in overall arrests rates in the first three years. We observe the largest negative differences for drug arrests: we find a 25-41% negative difference in drug arrests in the three years following Medicaid expansion, compared to non-expansion counties. We observe a 19-29% negative difference in arrests for violence in the three years after Medicaid expansion, and a decrease in low-level arrests between 24-28% in expansion counties compared to non-expansion counties. Our main results for drug arrests are robust to multiple sensitivity analyses, including a state-level model. CONCLUSIONS Evidence in this paper suggests that expanded Medicaid insurance reduced police arrests, particularly drug-related arrests. Combined with research showing the harmful health consequences of chronic policing in disadvantaged communities, greater insurance coverage creates new avenues for individuals to seek care, receive treatment, and avoid criminalization. As police reform is high on the agenda at the local, state, and federal level, our paper supports the perspective that broad health policy reforms can meaningfully reduce contact with the criminal justice system under historic conditions of mass criminalization.
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Affiliation(s)
- Jessica T. Simes
- Department of Sociology, Boston University, Boston, MA, United States of America
| | - Jaquelyn L. Jahn
- Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
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5
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Lamberti JS, Katsetos V, Jacobowitz DB, Weisman RL. Psychosis, Mania and Criminal Recidivism: Associations and Implications for Prevention. Harv Rev Psychiatry 2021; 28:179-202. [PMID: 32251070 DOI: 10.1097/hrp.0000000000000251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
People with mental illness are overrepresented throughout the criminal justice system, including jail, prison, probation, and parole populations. Yet much disagreement remains about why this problem exists and how best to address it. This article specifically examines empirical evidence regarding the question of whether psychosis and mania are associated with criminal recidivism, and whether this association is predictive or causal in nature. Review of the current literature suggests that psychotic and manic symptoms are associated with increased likelihood of arrest and incarceration. In addition, current evidence shows that pharmacotherapy can reduce criminal recidivism among justice-involved adults with psychosis or mania. However, the extent to which the association between psychosis, mania, and criminal justice system involvement is causal remains uncertain. Also, the literature suggests that most crimes committed by people with schizophrenia spectrum disorders or bipolar I disorder may be driven by factors other than their psychotic or manic symptoms. These established "criminogenic needs" are more common among people with severe mental disorders than in the general population. For optimal prevention, those who serve justice-involved adults with psychosis or mania in community settings should consider addressing the full range of factors that potentially drive their criminal justice system involvement.
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Affiliation(s)
- J Steven Lamberti
- From the Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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6
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McDermott BE, Ventura MI, Juranek ID, Scott CL. Role of Mandated Community Treatment for Justice-Involved Individuals With Serious Mental Illness. Psychiatr Serv 2020; 71:656-662. [PMID: 32212909 DOI: 10.1176/appi.ps.201900456] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research has suggested that increased length of mandated community treatment for individuals with a serious mental disorder leads to better outcomes, but few studies have described whether these outcomes are maintained after treatment ends. The goal of this study was to evaluate the impact of court-mandated treatment on outcomes for individuals found not guilty by reason of insanity (NGRI) and released to the community. METHODS Ninety-three patients who were found to be NGRI participated in this study. Rearrest rates were compared for three groups: patients released to the community with court-mandated treatment (conditional release), patients who were conditionally released but later "restored to sanity" with no further court supervision, and patients released from the hospital to the community by the court with no court-imposed conditions. Patients were followed for an average of 4.83 years after discharge. RESULTS Nearly half (43.8%) of the patients released to the community without court-mandated supervision were arrested for another offense in the study period, compared with 8.2% of patients released under the supervision of the conditional release program. In contrast, those who were restored to sanity and ultimately released unconditionally had higher arrest rates (25%). CONCLUSIONS This study suggests that court oversight on an ongoing basis may be necessary to help justice-involved individuals with a serious mental disorder avoid the criminal justice system and remain engaged in community treatment. More research is needed to determine whether these findings can be extrapolated to civil commitment procedures.
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Affiliation(s)
- Barbara E McDermott
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
| | - Maria I Ventura
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
| | - Isah Dualan Juranek
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
| | - Charles L Scott
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
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7
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Robertson AG, Easter MM, Lin HJ, Khoury D, Pierce J, Swanson J, Swartz M. Gender-specific participation and outcomes among jail diversion clients with co-occurring substance use and mental health disorders. J Subst Abuse Treat 2020; 115:108035. [PMID: 32600621 DOI: 10.1016/j.jsat.2020.108035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/16/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Abstract
Men and women with co-occurring substance use disorders and mental illness are at relatively high risk for becoming involved in the criminal justice system. Programs, such as post-booking jail diversion, aim to connect these individuals to community-based treatment services in lieu of pursuing criminal prosecution. Gender appears to have an important influence on risk factors and pathways through the criminal justice system, which in turn may influence how interventions like jail diversion work to engage men and women in treatment services and reduce recidivism. Different circumstances, levels of engagement, and outcomes by gender may be related to both person-level characteristics and external factors such as availability of gender-specific services and resources. This mixed-methods study identified specific ways in which men and women use services and reoffend after being diverted, and complemented those findings with in-depth insights from program clinicians about how program experiences and resources differ in important ways by gender. We matched and merged administrative records from 2007 to 2009 for 16,233 adults from several state agencies in Connecticut, and included data on demographic characteristics, clinical diagnoses, outpatient and inpatient behavioral health treatment utilization, arrest, and incarceration. Using propensity analysis, the 1693 men and women who participated in the statewide jail diversion program were matched to respective comparison groups of nondiverted men and women. We used longitudinal multivariable regression analyses to estimate the effects of jail diversion participation on treatment utilization, arrest, and incarceration, separately for men and women. We conducted three focus groups with jail diversion clinicians from around the state (n = 21) to gain in-depth insight from them about how circumstances, program experiences, and resources differ by gender in important ways; these subjective clinician insights complement the quantitative analyses of diversion outcomes for men and women. For both men and women, diversion was associated with reductions in risk for incarceration and increases in utilization of outpatient treatment services. For men only, diversion was associated with higher utilization of inpatient mental health care. No differences in treatment or criminal justice outcomes were observed in models that compared men and women directly. Major themes from the focus groups included: the existence of too few inpatient and residential resources for women with co-occurring disorders; different challenges to treatment engagement that men and women face; and a need for more effective, gender-specific services for all program participants. Results from this mixed-methods study offer information on gender-specific program outcomes and surrounding circumstances that can help programs to better understand and address unique risks and needs for men and women with co-occurring substance use and mental health disorders who are involved in the criminal justice system.
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8
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Weich S, Duncan C, Twigg L, McBride O, Parsons H, Moon G, Canaway A, Madan J, Crepaz-Keay D, Keown P, Singh S, Bhui K. Use of community treatment orders and their outcomes: an observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Community treatment orders are widely used in England. It is unclear whether their use varies between patients, places and services, or if they are associated with better patient outcomes.
Objectives
To examine variation in the use of community treatment orders and their associations with patient outcomes and health-care costs.
Design
Secondary analysis using multilevel statistical modelling.
Setting
England, including 61 NHS mental health provider trusts.
Participants
A total of 69,832 patients eligible to be subject to a community treatment order.
Main outcome measures
Use of community treatment orders and time subject to community treatment order; re-admission and total time in hospital after the start of a community treatment order; and mortality.
Data sources
The primary data source was the Mental Health Services Data Set. Mental Health Services Data Set data were linked to mortality records and local area deprivation statistics for England.
Results
There was significant variation in community treatment order use between patients, provider trusts and local areas. Most variation arose from substantially different practice in a small number of providers. Community treatment order patients were more likely to be in the ‘severe psychotic’ care cluster grouping, male or black. There was also significant variation between service providers and local areas in the time patients remained on community treatment orders. Although slightly more community treatment order patients were re-admitted than non-community treatment order patients during the study period (36.9% vs. 35.6%), there was no significant difference in time to first re-admission (around 32 months on average for both). There was some evidence that the rate of re-admission differed between community treatment order and non-community treatment order patients according to care cluster grouping. Community treatment order patients spent 7.5 days longer, on average, in admission than non-community treatment order patients over the study period. This difference remained when other patient and local area characteristics were taken into account. There was no evidence of significant variation between service providers in the effect of community treatment order on total time in admission. Community treatment order patients were less likely to die than non-community treatment order patients, after taking account of other patient and local area characteristics (odds ratio 0.69, 95% credible interval 0.60 to 0.81).
Limitations
Confounding by indication and potential bias arising from missing data within the Mental Health Services Data Set. Data quality issues precluded inclusion of patients who were subject to community treatment orders more than once.
Conclusions
Community treatment order use varied between patients, provider trusts and local areas. Community treatment order use was not associated with shorter time to re-admission or reduced time in hospital to a statistically significant degree. We found no evidence that the effectiveness of community treatment orders varied to a significant degree between provider trusts, nor that community treatment orders were associated with reduced mental health treatment costs. Our findings support the view that community treatment orders in England are not effective in reducing future admissions or time spent in hospital. We provide preliminary evidence of an association between community treatment order use and reduced rate of death.
Future work
These findings need to be replicated among patients who are subject to community treatment order more than once. The association between community treatment order use and reduced mortality requires further investigation.
Study registration
The study was approved by the University of Warwick’s Biomedical and Scientific Research Ethics Committee (REGO-2015-1623).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Craig Duncan
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Orla McBride
- School of Psychology, Ulster University, Londonderry, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | | | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Patrick Keown
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Swaran Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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9
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Stansfield R, Doherty E. Neighborhood health, social structure and family violence. SOCIAL SCIENCE RESEARCH 2019; 81:12-22. [PMID: 31130191 DOI: 10.1016/j.ssresearch.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/27/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
Within a large field of family violence research, a slowly growing body of literature has examined community-level variables to explain variation in violence. Studies investigating the role of ecological factors have largely been informed by social disorganization theory. This represents considerable progress, but the community context also includes many ecological factors yet to be considered by studies examining family violence, and as such, successful neighborhood interventions have been limited. Furthermore, few community-level studies have explored whether serious family violence is geographically clustered. The current study used police calls for service data to examine how the health context of a community is associated with family violence. Accounting for spatial dependence, a higher prevalence of self-reported mental illness in a neighborhood related to family violence, although a higher prevalence of physical health difficulties was negatively associated with family violence. These results carry implications that can inform community-based efforts, particularly in economically disadvantaged neighborhood, aimed at reducing family violence.
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Affiliation(s)
| | - Erin Doherty
- Rutgers - Camden, 405-407 Cooper Street, Camden, NJ, 08102, USA.
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10
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Falconer E, El-Hay T, Alevras D, Docherty JP, Yanover C, Kalton A, Goldschmidt Y, Rosen-Zvi M. Integrated multisystem analysis in a mental health and criminal justice ecosystem. HEALTH & JUSTICE 2017; 5:4. [PMID: 28332099 PMCID: PMC5362563 DOI: 10.1186/s40352-017-0049-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/01/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Patients with a serious mental illness often receive care that is fragmented due to reduced availability of or access to resources, and inadequate, discontinuous, and uncoordinated care across health, social services, and criminal justice organizations. This article describes the creation of a multisystem analysis that derives insights from an integrated dataset including patient access to case management services, medical services, and interactions with the criminal justice system. METHODS Data were combined from electronic systems within a US mental health ecosystem that included mental health and substance abuse services, as well as data from the criminal justice system. Cox models were applied to test the associations between delivery of services and re-incarceration. Additionally, machine learning was used to train and validate a predictive model to examine effects of non-modifiable risk factors (age, past arrests, mental health diagnosis) and modifiable risk factors (outpatient, medical and case management services, and use of a jail diversion program) on re-arrest outcome. RESULTS An association was found between past arrests and admission to crisis stabilization services in this population (N = 10,307). Delivery of case management or medical services provided after release from jail was associated with a reduced risk for re-arrest. Predictive models linked non-modifiable and modifiable risk factors and outcomes and predicted the probability of re-arrests with fair accuracy (area under the receiver operating characteristic curve of 0.67). CONCLUSIONS By modeling the complex interactions between risk factors, service delivery, and outcomes, systems of care might be better enabled to meet patient needs and improve outcomes.
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Affiliation(s)
- Erin Falconer
- ODH, Inc., 508 Carnegie Center, Princeton, NJ 08540 USA
| | - Tal El-Hay
- IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825 Israel
| | - Dimitris Alevras
- IBM Global Business Services, 1475 Phoenixville Pike, West Chester, PA 19380 USA
| | | | - Chen Yanover
- IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825 Israel
| | - Alan Kalton
- IBM Research, Catholic University of Eastern Africa, P.O Box 62157 Bogani E Rd, Nairobi, Kenya
- Present Address: Ernst & Young, 1 Maagplatz, 8005 Zürich, Switzerland
| | - Yaara Goldschmidt
- IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825 Israel
| | - Michal Rosen-Zvi
- IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825 Israel
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11
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Van Dorn RA, Desmarais SL, Rade CB, Burris EN, Cuddeback GS, Johnson KL, Tueller SJ, Comfort ML, Mueser KT. Jail-to-community treatment continuum for adults with co-occurring substance use and mental disorders: study protocol for a pilot randomized controlled trial. Trials 2017; 18:365. [PMID: 28778175 PMCID: PMC5545037 DOI: 10.1186/s13063-017-2088-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. METHODS/DESIGN Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections' implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated. DISCUSSION Findings have the potential to improve both jail- and community-based treatment services for adults with CODs as well as inform methods for conducting rigorous pilot implementation and evaluation research in correctional settings and as inmates re-enter the community. Findings will contribute to a growing area of work focused on interrupting the cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among adults with CODs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02214667 . Registered on 10 August 2014.
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Affiliation(s)
- Richard A Van Dorn
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA.
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Candalyn B Rade
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Elizabeth N Burris
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Gary S Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kiersten L Johnson
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA
| | - Stephen J Tueller
- Risk Behavior and Family Research Program, RTI International, Research Triangle Park, Durham, NC, 27709, USA
| | - Megan L Comfort
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, 02215, USA
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12
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Lamb HR, Weinberger LE. Understanding and Treating Offenders with Serious Mental Illness in Public Sector Mental Health. BEHAVIORAL SCIENCES & THE LAW 2017; 35:303-318. [PMID: 28612397 DOI: 10.1002/bsl.2292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 09/25/2016] [Accepted: 01/16/2017] [Indexed: 06/07/2023]
Abstract
This article begins with the history of the rise and fall of the state hospitals and subsequent criminalization of persons with serious mental illness (SMI). Currently, there is a belief among many that incarceration has not been as successful as hoped in reducing crime and drug use, both for those with and those without SMI. Moreover, overcrowding in correctional facilities has become a serious problem necessitating a solution. Consequently, persons with SMI in the criminal justice system are now being released in large numbers to the community and hopefully treated by public sector mental health. The issues to consider when releasing incarcerated persons with SMI into the community are as follows: diversion and mental health courts; the expectation that the mental health system will assume responsibility; providing asylum and sanctuary; the capabilities, limitations, and realistic treatment goals of community outpatient psychiatric treatment for offenders with SMI; the need for structure; the use of involuntary commitments, including assisted outpatient treatment, conservatorship and guardianship; liaison between treatment and criminal justice personnel; appropriately structured, monitored, and supportive housing; management of violence; and 24-hour structured in-patient care. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- H Richard Lamb
- Keck School of Medicine, University of Southern California; and USC Institute of Psychiatry, Law and Behavioral Sciences, Los Angeles, CA, U.S.A
| | - Linda E Weinberger
- Keck School of Medicine, University of Southern California; and USC Institute of Psychiatry, Law and Behavioral Sciences, Los Angeles, CA, U.S.A
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Swartz MS, Bhattacharya S, Robertson AG, Swanson JW. Involuntary Outpatient Commitment and the Elusive Pursuit of Violence Prevention. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:102-108. [PMID: 27777274 PMCID: PMC5298526 DOI: 10.1177/0706743716675857] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Involuntary outpatient commitment (OPC)-also referred to as 'assisted outpatient treatment' or 'community treatment orders'-are civil court orders whereby persons with serious mental illness and repeated hospitalisations are ordered to adhere to community-based treatment. Increasingly, in the United States, OPC is promoted to policy makers as a means to prevent violence committed by persons with mental illness. This article reviews the background and context for promotion of OPC for violence prevention and the empirical evidence for the use of OPC for this goal. METHOD Relevant publications were identified for review in PubMed, Ovid Medline, PsycINFO, personal communications, and relevant Internet searches of advocacy and policy-related publications. RESULTS Most research on OPC has focussed on outcomes such as community functioning and hospital recidivism and not on interpersonal violence. As a result, research on violence towards others has been limited but suggests that low-level acts of interpersonal violence such as minor, noninjurious altercations without weapon use and arrests can be reduced by OPC, but there is no evidence that OPC can reduce major acts of violence resulting in injury or weapon use. The impact of OPC on major violence, including mass shootings, is difficult to assess because of their low base rates. CONCLUSIONS Effective implementation of OPC, when combined with intensive community services and applied for an adequate duration to take effect, can improve treatment adherence and related outcomes, but its promise as an effective means to reduce serious acts of violence is unknown.
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Affiliation(s)
- Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sayanti Bhattacharya
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Allison G. Robertson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jeffrey W. Swanson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Castells-Aulet L, Hernández-Viadel M, Jiménez-Martos J, Cañete-Nicolás C, Bellido-Rodríguez C, Calabuig-Crespo R, Asensio-Pascual P, Lera-Calatayud G. Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up. BJPsych Bull 2015; 39:196-9. [PMID: 26755954 PMCID: PMC4706131 DOI: 10.1192/pb.bp.114.047464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 11/23/2022] Open
Abstract
Aims and method To evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared. Results No statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two. Clinical implications The findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.
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Silverstein SM, Del Pozzo J, Roché M, Boyle D, Miskimen T. Schizophrenia and violence: realities and recommendations. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/23744006.2015.1033154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stettin B. An advocate's observations on research concerning assisted outpatient treatment. Curr Psychiatry Rep 2014; 16:435. [PMID: 24532265 DOI: 10.1007/s11920-013-0435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brian Stettin
- Treatment Advocacy Center, 200 N. Glebe Rd., Suite 730, Arlington, VA, 22203, USA,
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Desmarais SL, Van Dorn RA, Johnson KL, Grimm KJ, Douglas KS, Swartz MS. Community violence perpetration and victimization among adults with mental illnesses. Am J Public Health 2014; 104:2342-9. [PMID: 24524530 DOI: 10.2105/ajph.2013.301680] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In a large heterogeneous sample of adults with mental illnesses, we examined the 6-month prevalence and nature of community violence perpetration and victimization, as well as associations between these outcomes. METHODS Baseline data were pooled from 5 studies of adults with mental illnesses from across the United States (n = 4480); the studies took place from 1992 to 2007. The MacArthur Community Violence Screening Instrument was administered to all participants. RESULTS Prevalence of perpetration ranged from 11.0% to 43.4% across studies, with approximately one quarter (23.9%) of participants reporting violence. Prevalence of victimization was higher overall (30.9%), ranging from 17.0% to 56.6% across studies. Most violence (63.5%) was perpetrated in residential settings. The prevalence of violence-related physical injury was approximately 1 in 10 overall and 1 in 3 for those involved in violent incidents. There were strong associations between perpetration and victimization. CONCLUSIONS Results provided further evidence that adults with mental illnesses experienced violent outcomes at high rates, and that they were more likely to be victims than perpetrators of community violence. There is a critical need for public health interventions designed to reduce violence in this vulnerable population.
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Affiliation(s)
- Sarah L Desmarais
- Sarah L. Desmarais and Kiersten L. Johnson are with the Department of Psychology, North Carolina State University, Raleigh. Richard A. Van Dorn is with the Behavioral Health Epidemiology Program, RTI International, Durham, NC. Kevin J. Grimm is with the Department of Psychology, Arizona State University. Kevin S. Douglas is with the Department of Psychology, Simon Fraser University, Burnaby, British Columbia. Marvin S. Swartz is with the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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Affiliation(s)
- Kevin Rice
- California ROC Program, West Valley Detention Center, Rancho Cucamonga, CA, USA
- Liberty Healthcare Corporation, Bala Cynwyd, PA, USA
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Allnutt SH, Ogloff JRP, Adams J, O'Driscoll C, Daffern M, Carroll A, Nanayakkara V, Chaplow D. Managing aggression and violence: the clinician's role in contemporary mental health care. Aust N Z J Psychiatry 2013; 47:728-36. [PMID: 23695380 DOI: 10.1177/0004867413484368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE From time to time misconceptions about violence risk assessment raise debate about the role mental health professionals play in managing aggression, with associated concerns about the utility of violence risk assessment. This paper will address some of the misconceptions about risk assessment in those with serious mental illness. METHODS The authors have expertise as clinicians and researchers in the field and based on their accumulated knowledge and discussion they have reviewed the literature to form their opinions. RESULTS This paper reflects the authors' views. CONCLUSION There is a modest yet statistical and clinically significant association between certain types of mental illness and violence. Debate about the appropriateness of clinician involvement in violence risk assessment is sometimes based on a misunderstanding about the central issues and the degree to which this problem can be effectively managed. The central purpose of risk assessment is the prevention rather than the prediction of violence. Violence risk assessment is a process of identifying patients who are at greater risk of violence in order to facilitate the timing and prioritisation of preventative interventions. Clinicians should base these risk assessments on empirical knowledge and consideration of case-specific factors to inform appropriate management interventions to reduce the identified risk.
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Yoon J, Bruckner TA, Brown TT. The association between client characteristics and recovery in California's comprehensive community mental health programs. Am J Public Health 2013; 103:e89-95. [PMID: 23865662 DOI: 10.2105/ajph.2013.301233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In November 2004, California voters passed the Mental Health Services Act, which allocated more than $3 billion for comprehensive community mental health programs. We examined whether these county-level programs, known as "full service partnerships," promoted independent living arrangements (i.e., recovery) among their clients. METHODS We used Markov chain models to identify probabilities of residential transitions among 8 living arrangements (n = 9208 adults followed up to 4 years). We modeled these transitions on the basis of patterns of program participation and clinical and sociodemographic characteristics. RESULTS Interrupted program participation and substance abuse were significantly associated with a reduced likelihood of independent living and a greater probability of homelessness and incarceration. Persons with schizophrenia were the least likely to live independently, followed by persons with bipolar disorder. Compared with Whites, non-Whites were more frequently found to be homeless or in jail. CONCLUSIONS Clients with sustained enrollment in California's comprehensive community mental health programs appear most likely to transition to independent living. The likelihood of this transition, however, shows a disparity in that ethnic minority clients appear least likely to transition to independent living.
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Affiliation(s)
- Jangho Yoon
- Jangho Yoon is with the Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis. Tim A. Bruckner is with the Department of Public Health Planning, Policy and Design, University of California, Irvine. Timothy T. Brown is with the Berkeley Center for Health Technology and the Department of Health Policy and Management, University of California, Berkeley
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Court-mandated outpatient psychiatric care for a pregnant woman with psychosis: a unique bridge to alliance. J Psychiatr Pract 2013; 19:247-53. [PMID: 23653083 DOI: 10.1097/01.pra.0000430510.82885.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe the case of a young pregnant woman with refractory schizoaffective disorder and how we reached a decision to apply for court-mandated outpatient psychiatric treatment (Assisted Outpatient Treatment or AOT). The patient was stable when we made this application as a preventive measure, given her serious prior episodes of illness. While there has been court-mandated outpatient obstetrical treatment, as far as we know this is the first report of mandated outpatient psychiatric treatment in connection with pregnancy. The ultimate benefit of this AOT application was the development of a therapeutic alliance and improved voluntary adherence to treatment, and a safe outcome to the pregnancy.
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Link BG, Epperson MW, Perron BE, Castille DM, Yang LH. Arrest outcomes associated with outpatient commitment in New York State. Psychiatr Serv 2011; 62:504-8. [PMID: 21532076 PMCID: PMC5826718 DOI: 10.1176/ps.62.5.pss6205_0504] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether assisted outpatient treatment (AOT) under New York's "Kendra's Law" is associated with reduced arrests for violent and nonviolent offenses. METHODS Arrest records of 183 study participants attending outpatient clinics in New York City, 86 of whom were ever and 97 of whom were never assigned to AOT, were compiled to yield 16,890 months of observation. For each month the data indicated whether an arrest did or did not occur and whether a participant was or was not assigned to AOT. Generalized estimating equations and fixed-effects analyses were used to compare arrest rates within different periods (before, during or shortly after, and more than six months after) for those ever assigned and between the ever- and never-assigned groups. RESULTS For those who received AOT, the odds of any arrest were 2.66 times greater (p<.01) and the odds of arrest for a violent offense 8.61 times greater (p<.05) before AOT than they were in the period during and shortly after AOT. The group never receiving AOT had nearly double the odds (1.91, p<.05) of arrest compared with the AOT group in the period during and shortly after assignment. CONCLUSIONS Outpatient commitment under Kendra's Law in New York State is associated with a reduced risk of arrest. The coercion necessitated by application of the law may forestall, at least for some people, the potentially more potent and consequential coercion they would have experienced in the criminal justice system.
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Affiliation(s)
- Bruce G Link
- New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
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