Practice Resource for Forensic Training in General Psychiatry Residency Programs.

Full Document: Alonso-Katzowitz JS, Cardasis W, Cerny-Suelzer CA, et al: Practice Resource for Forensic Training in General Psychiatry Residency Programs. Journal of the American Academy of Psychiatry and the Law Online Supplement 2019, 47 (1). Available at: http://www.jaapl.org/content/47/1_Supplement.

Transferring juvenile defendants from adult to juvenile court: how Maryland forensic evaluators and judges reach their decisions.

The purpose of the study was to determine how often Maryland judges agreed with the opinions of forensic evaluators in deciding whether to transfer youthful defendants to juvenile court from adult court and to investigate which factors were most important in the opinions of the evaluators and the final decisions of the judges. Data were extracted from a sample of 200 waiver evaluations, and case outcomes were determined. Factors were examined with both univariate analysis and logistic regression models, to find correlates to and predictors of judges' decisions and evaluators' opinions. The most important factor influencing the decision of the judges was the forensic evaluators' opinions. Logistic regression analysis identified three factors that were significant predictors of the evaluator's opinion: public safety risk, history of the involvement of Department of Juvenile Services, and defendant's age at the time of the offense. The judges' decisions correlated strongly with the forensic evaluators' opinions.

Reducing inpatient suicide risk: using human factors analysis to improve observation practices.

In 1995, the Joint Commission began requiring that hospitals report reviewable sentinel events as a condition of maintaining accreditation. Since then, inpatient suicide has been the second most common sentinel event reported to the Joint Commission. The Joint Commission emphasizes the need for around-the-clock observation for inpatients assessed as at high risk for suicide. However, there is sparse literature on the observation of psychiatric patients and no systematic studies or recommendations for best practices. Medical errors can best be reduced by focusing on systems improvements rather than individual provider mistakes. The author describes how failure modes and effects analysis (FMEA) was used proactively by an inpatient psychiatric treatment team to improve psychiatric observation practices by identifying and correcting potential observation process failures. Collection and implementation of observation risk reduction strategies across health care systems is needed to identify best practices and to reduce inpatient suicides.

Resource document on the use of restraint and seclusion in correctional mental health care.

This resource document discusses the use of seclusion or restraint for purposes of mental health intervention in correctional facilities. Correctional mental health standards essentially state that seclusion or restraint, when used for health care purposes, should be implemented in a manner consistent with current community practice. The community practice was significantly impacted and revised during July 1999, after the Health Care Financing Administration defined rules for the use of seclusion and restraint in facilities that participate in Medicare and Medicaid. Since few correctional facilities are Medicare or Medicaid participants, these rules had little impact on the use of seclusion or restraint for mental health care purposes in correctional systems. Consequently, many correctional health care systems have not developed policies, procedures, or practices that are consistent with current community practice. This document provides guidance in remedying such problems, with a focus on areas relevant to timeframes, settings, and monitoring.

Lies and coercion: why psychiatrists should not participate in police and intelligence interrogations.

Police interrogators routinely use deceptive techniques to obtain confessions from criminal suspects. The United States Executive Branch has attempted to justify coercive interrogation techniques in which physical or mental pain and suffering may be used during intelligence interrogations of persons labeled unlawful combatants. It may be appropriate for law enforcement, military, or intelligence personnel who are not physicians to use such techniques. However, forensic psychiatry ethical practice requires honesty, striving for objectivity, and respect for persons. Deceptive and coercive interrogation techniques violate these moral values. When a psychiatrist directly uses, works with others who use, or trains others to use deceptive or coercive techniques to obtain information in police, military, or intelligence interrogations, the psychiatrist breaches basic principles of ethics.

Diversion to the mental health system: emergency psychiatric evaluations.

In Maryland, any citizen may petition to have individuals brought against their will for an examination by a physician. In this retrospective chart review, we evaluated the characteristics of 300 persons referred to the Johns Hopkins Hospital on emergency petitions. Sixty-one percent of petitions described individuals who made verbal or physical threats of self-harm. Forty-seven percent of the petitions described individuals who could have been arrested based on dangerousness to others or property, but were instead diverted to the emergency room for psychiatric evaluation. Although not promoted as a jail diversion program, this process has the potential to direct mentally ill citizens appropriately from the criminal justice system into the mental health system. Greater involvement of mental health professionals at all stages, including police training and participation in crisis response teams in the community, may improve this process.