Predictors of Criminal Sentiments Scale-Modified Scores in Outpatients with Legal System Involvement.

The Criminal Sentiments Scale-Modified (CSS-M) has been widely used as a measure of criminal attitudes. This analysis examined CSS-M scores in a large sample of outpatients with serious mental illnesses and a criminal legal system history. We compared total and subscale scores in our sample to scores from two other previously published U.S. studies in which the CSS-M was used, and evaluated associations between total CSS-M score and nine variables (age, educational attainment, gender, race, marital status, employment status, diagnostic category, substance use disorder comorbidity, and adverse childhood experiences (ACE) score). Scores were higher than in two prior U.S. studies involving other types of samples. Independently significant predictors of higher CSS-M scores included being younger (P < .001), having a higher ACE score (P < .001), being male (P = 03), not identifying as White (P < 001), not having a psychotic disorder (P < 001), and having a comorbid substance use disorder (P = 002). Future research should test the hypothesis that these factors increase risk for arrest and that arrest events, and subsequent criminal legal system involvement, are characterized by negative experiences and perceptions of poor procedural justice, which in turn underpin the negative opinions referred to as "criminal sentiments" or criminal attitudes.

Nationwide Survey on Implementation of 2011 Nuclear Regulatory Commission Policy on Release of Patients After 131I Therapy for Thyroid Cancer.

The objective of this nationwide survey was to evaluate whether there has been a change in the practice regarding hospital release of differentiated thyroid cancer patients treated with 131I since the publication of Nuclear Regulatory Commission Regulatory Issue Summary 2011-01 addressing patient release. Methods: A survey was emailed to approximately 25,000 members of ThyCa: Thyroid Cancer Survivors' Association, Inc., and was available online from March to August 2018. Responses were included from adult patients regarding their most recent 131I therapy received between 2011 and 2018 ("after 2011"). Responses to this survey were compared with those of a similar previous survey for 131I therapies received between 1997 and 2009 ("before 2009"). Results: Of the 2,136 responses, 1,111 met the inclusion criteria. A similar percentage (∼98%) of patients were given oral or written radiation safety instructions (RSIs) after 2011 and before 2009, with a shift away from nuclear medicine physicians providing instructions after 2011 (43%) in comparison with before 2009 (54%; P < 0.001). More patients were able to discuss and individualize the RSIs after 2011 (67%) than before 2009 (29%; P < 0.001). However, 2% of patients do not recall ever receiving RSIs after 2011. After 2011, more patients were treated as outpatients (87%) than before 2009 (66%; P < 0.001). For outpatients, more patients were discharged within 30 min after receiving 131I therapy after 2011 (78%) than before 2009 (72%; P = 0.002). The same percentage (0.6%) of patients traveled more than 2 h with at least 2 occupants in the vehicle within approximately 1 m of the patient after 2011 and before 2009. Immediately after therapy, a similar percentage of patients stayed in a nonprivate residence after 2011 (4%) and before 2009 (5%; P = 0.28). Of the 27 outpatients released within 30 min to nonprivate residences, 2 patients received 5.55-11.1 GBq (150-299 mCi) of 131I. Conclusion: This survey suggests that since publication of the Nuclear Regulatory Commission Regulatory Issue Summary 2011-01 on patient release after radioiodine therapy, there have been improvements in some radiation safety practices on release of outpatients, as well as improvements in patient compliance on travel and lodging.

Community treatment orders in Western Switzerland: A retrospective epidemiological study.

PURPOSE: Community treatment orders (CTOs) are legal procedures that authorise compulsory community mental health care to people affected by severe mental disorders. Nowadays, CTOs are regulated in 75 countries, with important variations in terms of legal criteria and practices. In Switzerland CTOs were introduced on the 1st January 2013, following the amendment of the Swiss Civil Code. The aim of this study was to provide a first understanding of the use of CTOs in Western Switzerland in terms of incidence and prevalence rates, population profile, orders duration and reasons for discharge. METHODS: Incidence and prevalence rates of CTOs between 2013 and 2017 were estimated. Survival analysis was used to investigate time to CTO discharge and associated factors. Logistic regression was performed to identify factors associated with CTOs' success as reason for discharge. RESULTS: CTOs' incidence rates per 100'000 inhabitants ranged between 4.8 for 2013 and 9.6 for 2017, while their prevalence raised from 4.8 to 19.5. People placed under CTO were mainly male, in their forties, of Swiss origin, single and living independently. Primarily affected by Schizophrenia, schizotypal and delusional disorders (F20-F29), they frequently presented substance use problems, and severe danger for themselves. CTOs were mainly ordered by the guardianship authority as a form of conditional release. The estimated mean time to discharge was almost three years. Not being of Swiss origin and being prescribed to take a medication were associated with longer CTO while living in hospital, as a consequence of a long-lasting hospitalisation, and having a non-medical professional in charge of the order were associated with shorter time to discharge. Neither clinical factors nor legal criteria predicted time to discharge. Moreover, spending more days under CTO increased the likelihood of success at discharge, whereas not being of Swiss origin reduced it. CONCLUSIONS: To the best of our knowledge, no previous studies have examined the CTOs' implementation in Switzerland. CTOs prevalence increased rapidly despite the lack of evidence on positive outcomes. Our results suggested that once under CTO, it takes a long time for a patient to be released, in case of both positive and negative outcomes.

Systematic Approach to Selecting and Preparing a Medical Power of Attorney in the Gynecologic Oncology Center.

PURPOSE: Advance care planning (ACP) supports national priorities of patient engagement, person-centered care, and safety. A systematic approach is uncommon in most care settings. Our institution offers all patients with cancer new to the institution an opportunity to select and prepare a medical decision maker (MDM) after social work counseling. The goals of this study were to determine the success of a systematic institutional process for selecting a prepared MDM. The primary objectives were that (1) 70% or more of new patients would have one or more documented social work ACP discussions by the third office visit within 4 months, and (2) there would be a two-fold increase in scanned medical power of attorney (MPOA) documents available in the electronic health record (EHR). The secondary objectives were (1) improved surrogate preparedness for medical decision making, and (2) to determine whether patients with metastatic disease demonstrated greater readiness for selection of an MDM than those with localized disease. MATERIALS AND METHODS: We conducted a retrospective chart review of consecutive gynecology oncology outpatients. RESULTS: Of 133 patients, 93 (70%) had metastatic disease. The median number of visits was two (one to three). Forty-seven patients (39.3%) met with social work by visit 3. Review of ACP notes suggested that most patients were in the early stages of selecting a prepared MDM. At visit 1, 39 (29.3%) reported having an advance directive document; 14 (10.5%) had an MPOA in the EHR. There was no increase by visit 3. Fewer patients with metastatic disease than those with localized cancer (32.3% v 67.5%; P = .001) had three visits; no other parameter, including presence of MPOA documents in the EHR, achieved statistical significance between groups. CONCLUSION: Current processes fail to engage patients in selecting and preparing an MDM.

A Comparison of Participants in Two Community-Based Programs: Assisted Outpatient Treatment and a Mental Health Court.

OBJECTIVE: Mental health courts and assisted outpatient treatment (AOT) are tools to help people with serious mental illness engage in treatment and avoid or reduce institutionalization. As both programs become increasingly prevalent, questions remain about whether people with severe mental illness who receive AOT have the same characteristics, histories, and service needs as those who participate in mental health courts. If there are differences, each program may require assessments and interventions tailored to the specific characteristics and needs of participants. METHODS: This study examined administrative criminal justice and mental health services data for 261 people with serious mental illness who participated in AOT, a mental health court, or both over seven years. RESULTS: Three percent of the sample participated in both programs. Compared with participants in mental health court, participants in AOT were older, less likely to have an alcohol use disorder, and more likely to have a schizophrenia spectrum disorder than a bipolar disorder. The participants' histories of crisis mental health service utilization, hospitalization, and incarceration prior to program entry varied significantly by program. CONCLUSIONS: The findings suggest that there are differences among individuals with serious mental illness who are served by AOT and mental health court programs. AOT participants had greater engagement with mental health services, and a significant portion of AOT participants also had a prior criminal history that placed them at risk of future justice involvement. Program administrators need to recognize and address the clinical and criminogenic needs that place individuals at risk of becoming hospitalized and incarcerated.

Informing Medicare's Two-Midnight Rule Policy With an Analysis of Hospital-Based Long Observation Stays.

STUDY OBJECTIVE: Outpatient observation stays are increasingly substituting for standard inpatient hospitalizations. In 2013, the Centers for Medicare & Medicaid Services adopted the controversial Two-Midnight Rule policy to curb long observation stays and better define the use of hospital-based observation services versus inpatient hospitalizations. We seek to determine the extent to which Medicare beneficiaries exposed to long observation stays (>48 hours) are clinically similar to those with short observation stays (≤48 hours) because this has relevance to the Two-Midnight Rule. METHODS: Using 100% Medicare claims data from 2008 to 2010, we identified all patients with long observation stays (>48 hours) who were admitted through the emergency department (ED). We report beneficiary characteristics, as well as crude and risk-adjusted 30-day rates of mortality, readmissions, and return ED visits stratified by observation stay length. RESULTS: Seven percent of 2.8 million observation stays were greater than 48 hours. Beneficiaries with long observation stays tended to be older, women, nonwhite, and urban residents, with a greater number of comorbid conditions. Crude rates increased with observation stay length for all 3 outcomes. However, after directly standardizing the rates, we observed the reverse trend because all adjusted rates decreased stepwise with observation stay length greater than 48 hours in a dose-response pattern. CONCLUSION: Patients with observation stays lasting longer than 48 hours are a clinically distinct population. Our findings support the conceptual underpinnings of the Two-Midnight Rule, but suggest that observation versus inpatient determinations should be based on actual length of stay rather than prospective prediction to reduce the administrative ambiguity this policy has created.

Are community treatment orders counterproductive?

OBJECTIVE: This article briefly reviews the literature pertaining to community treatment orders (CTOs) specifically how and why they are utilised and how effective mandated community treatment really is. This review discusses the use of CTOs in the context of the recovery model. CONCLUSIONS: This article highlights the shortfalls in the current CTO system while also demonstrating the increase in acute coercive care. The literature pertaining to the effectiveness of CTOs is inconsistent with more recent reviews denoting that there is now robust evidence the CTOs are not effective. Further treatment that aligns with the recovery model as oppose to mandated treatment is known to increase treatment compliance.

Compulsory community and involuntary outpatient treatment for people with severe mental disorders.

There is controversy as to whether compulsory community treatment (CCT) for people with severe mental illness (SMI) reduces health service use or improves clinical outcome and social functioning. To examine the effectiveness of CCT for people with SMI. We searched the Cochrane Schizophrenia Group's Trials Register and Science Citation Index (2003, 2008, 2012, and 2013). We obtained all references of identified studies and contacted authors where necessary. All relevant randomized controlled clinical trials (RCTs) of CCT compared with standard care for people with SMI (mainly schizophrenia and schizophrenia-like disorders, bipolar disorder, or depression with psychotic features). Standard care could be voluntary treatment in the community or another preexisting form of compulsory community treatment such as supervised discharge. We found 3 trials with a total of 752 people. Two trials compared a form of CCT called 'Outpatient Commitment' (OPC) versus standard voluntary care, whereas the third compared Community Treatment Orders with intermittent supervised discharge. CCT was no more likely to result in better service use, social functioning, mental state, or quality of life compared with either standard voluntary or supervised care. However, people receiving CCT were less likely to be victims of crime than those on voluntary care. Further research is indicated into the effects of different types of CCT as these results are based on 3 relatively small trials.

Changes to inpatient versus outpatient hospitalization: Medicare's 2-midnight rule.

Outpatient versus inpatient status determinations for hospitalized patients impact how hospitals bill Medicare for hospital services. Medicare policies related to status determinations and the Recovery Audit Contractor (RAC) program charged with postpayment review of such determinations are of increasing concern to hospitals and physicians. We present an overview and discussion of these policies, including the recent 2-midnight rule, the effect on status determinations by the RAC program, and other recent and pertinent legislative and regulatory activity. Finally, we discuss the future direction of Medicare status determination policies and the RAC program, so that physicians and other healthcare providers caring for hospitalized Medicare beneficiaries may better understand these important and dynamic topics.

Mental health court and assisted outpatient treatment: perceived coercion, procedural justice, and program impact.

OBJECTIVE: Mandated community treatment has been proposed as a mechanism to engage people with severe and persistent mental disorders in treatment. Recently, two approaches to mandate treatment through the courts have been highlighted: assisted outpatient treatment (AOT) and mental health court programs. This study examined levels of perceived coercion, procedural justice, and the impact of the program (mental health court or AOT) among participants in a community treatment system. METHODS: Data were analyzed from interviews with former AOT participants who were no longer under court supervision (N=17) and with graduates of a mental health court program (N=35). The MacArthur Admission Experience Survey, created to measure perceived coercion, procedural justice, and program impact on hospital admission, was modified to include judges and case managers. RESULTS: Mental health court graduates perceived significantly less coercion and more procedural justice in their interactions with the judge than did AOT participants. No significant difference was found between mental health court and AOT participants in perceptions of procedural justice in interactions with their case managers. Mental health court participants felt more respected and had more positive feelings about the program than did AOT participants. CONCLUSIONS: Both mental health courts and AOT programs have potentially coercive aspects. Findings suggest that judges and case managers can affect participants' perceptions of these programs by the degree to which they demonstrate procedural justice, a process that may affect the long-term effects of the programs on individuals.

Involuntary outpatient treatment for mental health problems in Switzerland: a literature review.

BACKGROUND: In 2008, the Swiss Civil Code was amended. From 1 January 2013, each Swiss canton may propose specific provisions for involuntary outpatient treatment (community treatment orders (CTOs)) for individuals with mental disorders. AIM: This review catalogues the legal provisions of the various Swiss cantons for CTOs and outlines the differences between them. It sets this in the context of variations in clinical provisions between the cantons. METHODS: Databases were searched to obtain relevant publications about CTOs in Switzerland. The Swiss Medical Association, Swiss Federal Statistical Office, Swiss Health Observatory and all the 26 Cantonal medical officers were contacted to complete the information. Conférence des cantons en matière de protection des mineurs et des adultes (COPMA), the authority which monitors guardianship legislation, and Pro Mente Sana, a patients' right association, were also approached. RESULTS: Three articles about CTOs in Switzerland were identified. Psychiatric provisions vary considerably between cantons and only a few could provide complete or even partial figures for rates of compulsion in previous years. Prior to 2013, only 6 of the 20 cantons, for which information was returned, had any provision for CTOs. Now, every canton has some form of legal basis but the level of detail is often limited. In eight cantons, the powers of the measure are not specified (for example, use of medication). In 12 cantons, the maximum duration of the CTO is not specified. German speaking cantons and rural cantons are more likely to specify the details of CTOs. CONCLUSION: Highly variable Swiss provision for CTOs is being introduced despite the absence of convincing international evidence for their effectiveness or good quality data on current coercive practice. Careful monitoring and assessment of these new cantonal provisions are essential.

Know your HINNs and when to deliver them.

Hospital-Issued Notices of Noncoverage (HINN) inform patients that they will be responsible for the bill if they choose to stay in the hospital when the care they are receiving or about to receive will not be covered by Medicare. If hospitals don't give a HINN when services aren't covered by Medicare, they can't bill patients for services later on. CMS gives hospitals the option of using Condition Code 44 to change a patient's status from inpatient to outpatient to correct an unnecessary admission, then collect payment from Medicare for Medicare Part B services. All HINNs must be signed by the patient and a copy included in their file. If the patient refuses to sign, a copy should be placed in the file with a notation of the refusal to sign.

[Elements of state coercion in health care: selected issues]. / Elementy przymusu panstwowego w sluzbie zdrowia publicznego--wybrane zagadnienia.

Polish system of public law provides for the possibility of forced subjection of a person to a medical procedure, both in case of infectious and mental illnesses. The authors discuss the cases of infectious illnesses, subject to compulsory treatment in outpatient medical care and to compulsory hospitalization, as well as the procedure protocol in case of suspicion or corroboration of an infectious illness case. Another reason for a physician's authorization to initiate a compulsory medical procedure without the patient's consent is suspicion of a mental illness; whenever the patients' behavior can endanger them, other persons or their immediate surroundings. Introduced is also a detailed description of actual status in order to illustrate an appropriate application of coercion means.

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.

Coercion and procedural justice in psychiatric care: state of the science and implications for nursing.

Coercive treatment regimens have increased in variety and intensity over the past decade and include such options as outpatient commitment (OPC) and mental health courts. The intimate involvement of nurses in coerced treatment situations in both inpatient and outpatient settings necessitates a closer examination of its effects. OPC presumably offers greater flexibility and freedom for consumers than lengthy inpatient stays but also extends the state's control over their lives beyond the institution. Although OPC has been shown to decrease rates of rehospitalization and violence, it also is associated with increased levels of perceived coercion. The relationship of the perception of coercion to treatment outcomes is complex and not clearly understood. The goal of OPC is treatment adherence and ultimately increased quality of life, but research has produced conflicting results in those areas. Numerous episodes of OPC may have a cumulative effect on the perception of coercion and contribute to treatment avoidance. However, there is evidence that the perception of coercion can be mitigated by procedural justice that is demonstrated by fairness, patient inclusion in the process, and benevolence on the part of authority figures. Implications for nursing practice and research concerning coercion, procedural justice, and OPC are discussed.