Risk factors for recidivism in individuals receiving community sentences: a systematic review and meta-analysis.

OBJECTIVE: We aimed to systematically review risk factors for criminal recidivism in individuals given community sentences. METHODS: We searched seven bibliographic databases and additionally conducted targeted searches for studies that investigated risk factors for any repeat offending in individuals who had received community (non-custodial) sentences. We included investigations that reported data on at least one risk factor and allowed calculations of odds ratios (ORs). If a similar risk factor was reported in three or more primary studies, they were grouped into domains, and pooled ORs were calculated. RESULTS: We identified 15 studies from 5 countries, which reported data on 14 independent samples and 246,608 individuals. We found that several dynamic (modifiable) risk factors were associated with criminal recidivism in community-sentenced populations, including mental health needs (OR = 1.4, 95% confidence interval (CI): 1.2-1.6), substance misuse (OR = 2.3, 95% CI: 1.1-4.9), association with antisocial peers (OR = 2.2, 95% CI: 1.3-3.7), employment problems (OR = 1.8, 95% CI: 1.3-2.5), marital status (OR = 1.6, 95%: 1.4-1.8), and low income (OR = 2.0, 95% CI: 1.1-3.4). The strength of these associations was comparable to that of static (non-modifiable) risk factors, such as age, gender, and criminal history. CONCLUSION: Assessing dynamic (modifiable) risk factors should be considered in all individuals given community sentences. The further integration of mental health, substance misuse, and criminal justice services may reduce reoffending risk in community-sentenced populations.

Deinstitutionalization and other factors in the criminalization of persons with serious mental illness and how it is being addressed.

One of the major concerns in present-day psychiatry is the criminalization of persons with serious mental illness (SMI). This trend began in the late 1960s when deinstitutionalization was implemented throughout the United States. The intent was to release patients in state hospitals and place them into the community where they and other persons with SMI would be treated. Although community treatment was effective for many, there was a large minority who did not adapt successfully and who presented challenges in treatment. Consequently, some of these individuals' mental condition and behavior brought them to the attention of law enforcement personnel, whereupon they would be subsequently arrested and incarcerated. The failure of the mental health system to provide a sufficient range of treatment interventions, including an adequate number of psychiatric inpatient beds, has contributed greatly to persons with SMI entering the criminal justice system. A discussion of the many issues and factors related to the criminalization of persons with SMI as well as how the mental health and criminal justice systems are developing strategies and programs to address them is presented.

Optimization strategies for the organization of mental healthcare.

AIM: The aim of this paper is to analyse the main issues and obstacles to optimizing the organization of mental healthcare and the strategies that should be applied by presenting the examples from practice. RESULTS: Outcomes of mental healthcare are in relation with 'improved legislation' and the introduction of up-to-date management and economic concepts including continuous treatment model, in addition to the advantages and disadvantages in the provision of mental healthcare within primary and secondary inpatient and outpatient healthcare. Some of these lessons are learned from reforms implemented in Serbia.

The Patient-to-Prisoner Pipeline: The IMD Exclusion's Adverse Impact on Mass Incarceration in United States.

A component of the 1965 Medicaid Act, the Institutions for Mental Diseases ("IMD") Exclusion was supposed to be a remedy for the brutal, dysfunctional mental healthcare system run through state hospitals. In the years since Medicaid was created, the IMD Exclusion has instead barred thousands of those in need of intensive, inpatient treatment from receiving it. As a result, many severely mentally ill individuals are left without adequate care and without a home. They struggle in the street where they are otherized by those in their community and are susceptible to confrontational episodes with law enforcement. Many are ultimately incarcerated, where they are thrust into an abusive environment known to exacerbate mental health issues. This Note's central contention is that the IMD Exclusion creates an access gap for the poorest Americans who suffer from mental illness. Subsequently, prisons and jails fill that gap to the detriment of those individuals. The Note will proceed first by explaining the IMD Exclusion and how it applies to state-run medical care services and facilities. This Note will discuss the nationwide movement, in the 1950s through the 1960s and '70s, to deinstitutionalize notoriously abusive state psychiatric hospitals, a movement that culminated in the passage of the Medicaid Act in 1965, along with the IMD Exclusion. This Note will then shift focus to criticize the practical effects of the IMD Exclusion and its extensive role in the mass incarceration issue today. In doing so, this Note will identify the major weaknesses of the IMD Exclusion and explain how these weaknesses create an access gap for mentally ill persons, while simultaneously making them more vulnerable to contact with the police and the criminal justice system.

Perception of family members regarding the support group conducted in a psychiatric intervention ward. / Percepção dos familiares acerca do grupo de apoio realizado em uma unidade de internação psiquiátrica.

OBJECTIVE: To analyze the perception of relatives of patients with mental disorders about the support group in a psychiatric hospitalization ward. METHOD: This is a research with a qualitative, exploratory an descriptive approach, performed at a General Hospital in Rio Grande do Sul with ten relatives of patients who had been participating in a weekly support group. Data collection took place in October 2016, through semi-structured interviews. A thematic content analysis was used for the treatment of data, whence emerged the category: Perception of family members about the support group. RESULTS: The relatives perceive the group as a space that gives them strength and support, allowing for listening and experience exchange among its members, giving information on the disease and treatment, safety, and inserting the family in the treatment. FINAL CONSIDERATIONS: The support group can be understood as a strategic action of caring for the family, affecting their lives and the treatment of those who are hospitalized.

An analysis of the federal funding for mental health care in Brazil.

This article analyzes spending on mental health by the Brazilian Ministry of Health between 2001 and 2014. It is documental research of the Brazilian Ministry of Health's databases. It analyzes the data using descriptive statistical analysis. Total spending on mental health for the period 2001 to 2014 shows a percentage increase in resources destined for outpatient care, but this increase is a reallocation from hospital services to community-based services and total resources for the mental health program remain at an average of 2.54% of the total health budget. Within outpatient expenditure, spending on medications remains high. Professionals committed to psychiatric reform fight to guarantee that a small fraction of the surplus appropriated by the state is directed towards social policies.

Creating a science of homelessness during the Reagan era.

UNLABELLED: POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. CONTEXT: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. METHODS: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. FINDINGS: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. CONCLUSIONS: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.

[Persons held in preventive detention (§ 66 Criminal Code): characteristics of offenders and the impact on prospects for successful completion of therapy]. / Sicherungsverwahrte (§ 66 StGB): Merkmale der Täter und ihre Bedeutung für die Erfolgsaussichten eines therapeutischen Vollzugs.

With its verdict in May 2011 the German Federal Constitutional Court declared the current law for preventive detention unconstitutional and obliged the legislative bodies to undertake a freedom- and treatment-oriented reform. Psychiatrists and psychotherapists are bound to provide therapeutic concepts. Currently there is a lack of information on the intended clientele. In our study we examined 26 persons serving preventive detention, 32 regular prisoners and 29 non-delinquent probands. The groups were matched according to age and intelligence. We gathered sociodemographic data, criminal records and conducted the tests SCID I, SCID II und PCL-R, K-FAF and BIS-11 to obtain diagnoses and characteristics. Based on this information, the HCR-20 and GAF were performed. In comparison to regular prisoners and non-delinquents, the group of those serving preventive detention is characterised by medium to advanced age, antisociality, psychopathy, substance abuse or addiction, aggressivity, a strong criminal record, years of imprisonment, insufficient educational and vocational training and a high risk of recidivism. In our examination of persons serving preventive detention, we demonstrate that this clientele is a group of recidivists difficult to treat. The current laws and a lack of early intervention programs have prevented and delayed their timely and possibly successful treatment. From a psychiatric point of view, there is a strong need for new therapeutic concepts to meet this challenge.

[The objectives of the reform of hospitalisation under restraint in psychiatry]. / Les objectifs de la réforme de l'hospitalisation sous contrainte en psychiatrie.

The law of July 5th, 2011 reforms legislation dating from June 27th, 1990. It adds elements identified as missing from the original text over the course of the years following its application. The systematic intervention of a liberties and detention judge could counterbalance the measures simplifying hospitalisation under restraint. Stricter monitoring of "unwieldy" patients is also included in measures which enable treatment under restraint to be given through outpatient care.

Trends on schizophrenia admissions during the deinstitutionalisation process in Spain (1980-2004).

BACKGROUND: The deinstitutionalisation reform in Spain started after 1980 with the aim of reducing the need for hospitalisation, length of stay and the number of psychiatric hospital beds, as well as fostering psychiatric patient's involvement in the community. The aim of this study was to review how this reform process has affected the management of schizophrenic patients from 1980 to 2004. METHODS: Longitudinal (1980-2004) study describing variables related to hospital morbidity in schizophrenia patients. RESULTS: Hospital admission rate has gradually increased from 1980 to 2004 from 3.71 admissions per 10,000 inhabitants to 5.89, respectively. Considering the type of admission, emergency or elective, whilst the latter has slightly decreased from 2.24 in 1980 to 1.72 in 2004, the first has almost tripled from 1.47 to 4.17. The point-prevalence of schizophrenic patients receiving inpatient treatment each year has decreased 78% in this period. Length of stay, in days per admission episode, has also decreased from 148 days in 1980 to 35 days in 2004. CONCLUSION: One of the main impacts of the psychiatric health care reform in Spain has been the considerable reduction in hospital capacity devoted to schizophrenic patients, based on the significant decrease in point-prevalence. Thus, it seems relevant to design new studies to quantify the resource reallocation to other areas of care, such as pharmacological treatment and community services.

The meaning of community rehabilitation for schizophrenia patients in Israel.

In the year 2000, a law was passed in Israel, known as the Law for Community Rehabilitation of the Mentally Disabled. The Community Rehabilitation Law was intended to provide a "package of services" that will allow people who suffer from mental illness and were hospitalized, to return to their community. This research, by using qualitative research methods, tried to understand and explore the meaning of rehabilitation and return to the community under the new legislative setting from the viewpoint and experiences of the participants themselves. Fifteen schizophrenic patients were interviewed in this research. All the participants were institutionalized in the past and released for rehabilitation in the community under Israel's new act. The data were collected after all interviews were recorded and analyzed. The qualitative data analysis exposed a continuous process of four conceptual categories: (1) Viewing institutionalization as transformation from the "normal" to the "abnormal"; (2) Viewing institutionalization as a process moving from the "abnormal" back to the "normal"; (3) Viewing the return to the community as "re-birth"; and finally, (4) Viewing community-based rehabilitation as reality, which enables normality alongside mental illness. This research presents a theoretical model that provides the meanings and experiences of the participants as a continuity, in which the whole process of moving from the community to the institution and back to the community is represented as one continuous process integrated in each other. Within this continuing process, the community-based rehabilitation legislation serves as a key component, well-integrated within the whole continuum that allows people with mental illness to return to "normality" within the community.

[First initiatives for social integration of the mentally ill in one phase of pre-deinstitutionalization. The example of Saint-Jean-de-Dieu, 1910-1950]. / Premières initiatives d'intégration sociale des malades mentaux dans une phase de pré-désinstitutionnalisation. L'exemple de Saint-Jean-de-Dieu, 1910-1950

This article on the first initiatives of social integration of the mentally ill, using the example of the Hôpital St-Jean-de-Dieu, explores the implementation of a period of deinstitutionalization in the early decades of the 20th century. Our study is situated in the recent historiography that offers a rereading of the period just prior to the Quiet Revolution in Quebec. We intend to contribute by demonstrating that the policies, strategies and practices of the Sisters of Providence and the psychiatrists of St-Jean-de-Dieu developed a system of deinstitutionalization that reintegrated patients into their family as early as the 1910s, half a century before the first wave of deinstitutionalization of the 1960s was orchestrated by the authors of the Bédard report.

A house divided: deinstitutionalization, medicare and the Canadian Mental Health Association in Saskatchewan, 1944-1964.

Defined as a set of distinct processes that included the declining use of large psychiatric institutions and the increasing use of outpatient services and general hospitals, deinstitutionalization occurred earlier in Saskatchewan than other provinces in Canada. It was led by a CCF government dedicated to major change across a number of sectors including mental health, assisted by one of the most influential and well-organized social movement organizations of the 1950s, the Saskatchewan Division of the Canadian Mental Health Association (SCMHA). However, by the late 1950s and early 1960s, the SCMHA opposed the CCF government's policy priority on medicare which it felt came at the expense of mental health care, in particular the implementation of a regional psychiatric hospital system called the Saskatchewan Plan. As a consequence, the SCMHA, once such a powerful ally of the CCF government in health reform, formed a strategic and temporary coalition with the anti-medicare forces in the province. Given the fact that a number of medical staff within the government's department of public health were prominent members of the SCMHA, the CCF government found that it occupied an increasingly divided house at the very time it was struggling to introduce medicare in the midst of civil unrest and a doctors' strike.

From closed ranks to open doors: Elaine and John Cummings' mental health education experiment in 1950s Saskatchewan.

During late 1951 and early 1952, married couple, social biologist Elaine Cumming and psychiatrist John Cumming, led a mental health education experiment in Indian Head, Saskatchewan. The study, which was intended to inform strategies toward deinstitutionalization, sought to determine if attitudes regarding mental illness could be changed through commonly used educational practices. It was shaped by the shared interests of powerful philanthropic, charitable, psychiatric, academic and governmental bodies to create healthier citizens and a stronger democratic nation through expert knowledge. However, in addition to the disappointing findings indicating that attitudes remained unchanged, the town appeared to close ranks against the research team. Nonetheless, the Cummings' later association with sociologists at Harvard University enabled them to interpret the results in a way that lent the study credibility and themselves legitimacy, thus opening the door to their careers as very successful researchers and policy-makers.

Deinstitutionalization and vocational rehabilitation for mental health consumers in Nova Scotia since the 1950s.

In this paper we explore the broader policy determinants of the de-hospitalization of mental patients in Nova Scotia between the 1950s and 1980s and trace the background to the development of occupational rehabilitation programs in the community. For employment programs, the government chose to rely on non-profit NGOs as the suppliers of services. As a case study of such an organization, we examine the evolution of LakeCity Employment Services Association as a resource for people living with mental disabilities.

Deinstitutionalization reconsidered: geographic and demographic changes in mental health care in British Columbia and Alberta, 1950-1980.

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.

Visiting the mentally ill: volunteer visitors at Saskatchewan hospital, Weyburn 1950-1965.

This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.

[The psychiatric revolution in Quebec, 1950-1962. From asylum to community psychiatry and the open door]. / La révolution psychiatrique au Québec, 1950-1962. De l'asile à la psychiatrie communautaire et l'open-door.

Psychiatry opens to the world at a time when the very basis of psychiatric practice, namely the asylum, is called into question. Studies appear in Quebec and Canadian journals concurrent to the introduction of new formulas for care, such as the delivery of psychiatric services in general hospitals and clinics, that allow patients to be treated outside the walls of psychiatric hospitals. In addition, postwar psychiatry takes an optimistic view toward the future of children with impairments through the creation of specialized schools and workshops. From the mid-20th century onward, the thinking in psychiatry centres on the open door.

The end of the asylum (town): community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn.

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.