Meeting the Needs of Justice-Involved People With Serious Mental Illness Within Community Behavioral Health Systems.

The overrepresentation of people with serious mental illness in the criminal justice system is a complex problem. A long-standing explanation for this phenomenon, the criminalization hypothesis, posits that policy changes that shifted the care of people with serious mental illness from psychiatric hospitals to an underfunded community treatment setting resulted in their overrepresentation within the criminal justice system. This framework has driven the development of interventions to connect people with serious mental illness to needed mental health and substance use treatment, a critical component for people in need. However, the criminalization hypothesis is a limited explanation of the overrepresentation of people with serious mental illness in the criminal justice system because it downplays the social and economic forces that have contributed to justice system involvement in general and minimizes the complex clinical, criminogenic, substance use, and social services needs of people with serious mental illness. A new approach is needed that focuses on addressing the multiple factors that contribute to justice involvement for this population. Although the authors' proposed approach may be viewed as aspirational, they suggest that an integrated community-based behavioral health system-i.e., intercept 0-serve as the focal point for coordinating and integrating services for justice-involved people with serious mental illness.

Forensic patients, treating psychiatrist and the Mental Health Review Tribunal - An ethical question?

OBJECTIVE: In inpatient forensic settings, a psychiatrist is expected to wear 'Two Hats', as a treating physician and as an expert to provide risk assessments and expert advice to the judicial authorities for leave and release decisions. Although dual roles have long been accepted as an inevitable part of independent forensic practice, there are additional ethical challenges for the treating psychiatrist to provide an expert opinion. This paper examines the specific ethical ambiguities for a treating psychiatrist at the interface of legal process related to leave and release decisions in the treatment of forensic patients. CONCLUSIONS: While respect for justice is the prevailing ethical paradigm for court-related forensic work, the medical paradigm should remain the key ethical framework for psychiatrists in treatment settings. Thus, psychiatrist should be aware of possible adverse consequences in acting as forensic experts for their patients. A conscientious adherence to clinical facts and awareness of the 'Two Hats' ethical pitfall can serve as important reference points in framing the psychiatric evidence in the decision-making process and safeguard treating psychiatrist's role.

'The present state and statistical observation of mental patients under home custody', by Kure Shuzo and Kashida Goro (1918).

This text, dealing with the private confinement of the mentally ill at home, or shitaku kanchi, has often been referred to as a 'classic text' in the history of Japanese psychiatry. Shitaku kanchi was one of the most prevalent methods of treating mental disorders in early twentieth-century Japan. Under the guidance of Kure Shuzo (1865-1932), Kure's assistants at Tokyo University inspected a total of 364 rooms of shitaku kanchi across Japan between 1910 and 1916. This text was published as their final report in 1918. The text also refers to traditional healing practices for mental illnesses found throughout the country. Its abundant descriptions aroused the interest of experts of various disciplines.

[The first Mental Health Act in China 2013 : An historical step towards human rights]. / Chinas erstes Gesetz zur psychischen Gesundheit 2013 : Ein historischer Schritt auf dem Weg zu einem Menschenrecht.

In the past, the mentally ill used to be relentlessly stigmatized and their basic needs grossly neglected in China. Only the coastal cities with their Western oriented universities provided Western type mental healthcare. In general, traditional Chinese medicine (TCM) embracing medicinal herbs and acupuncture was practiced. Mental hospitals were non-existent before 1889 and care of the chronically mentally ill rested with their families and the community; however, the prevalence and spectrum of mental disorders were similar to those in Western countries. After the establishment of the People's Republic of China old-fashioned mental hospitals were founded. The "Great Leap Forward" starting in 1958 envisaged the creation of a mental healthcare system based on Soviet Union standards. Psychiatry had a strong biological orientation, and psychotherapy did not exist. Psychology was rejected as not being science and was not taught at universities before 1978. With the Reform and Opening Policy in 1978 the education of psychology was stepped up. Psychology was introduced as an academic discipline in 1978 and psychotherapy and psychosomatic medicine were established in mental healthcare. The current mental healthcare in China resembles the standard in Germany before the "Psychiatrie-Enquete" (expert commission official report). With the Mental Health Act adopted in 2013 after 27 years of planning, China has laid the legal foundation for planning and establishing a humane system of mental healthcare. The Act safeguards patients' human and individual rights and increases trust in psychiatric institutions. It guarantees the right to optimal treatment and provides legal protection in cases of malpractice.

Programa de Atención Integral al Enfermo Mental en las prisiones españolas (paiem ). Valoración tras cuatro años de funcionamiento / Comprehensive Care Program for the Mentally ill in spanish prisons (paiem ). Assessment after four years operation

Objetivo: Evaluar el programa de atención integral a los enfermos mentales (PAIEM) implantado desde hace 3 años en las prisiones españolas, con el fin de mejorar su funcionamiento y resultados. Metodología: Estudio descriptivo de los datos recogidos en un cuestionario anónimo cumplimentado por los miembros del equipo PAIEM de los centros penitenciarios. Se obtuvieron distribuciones de frecuencia de todas las variables acerca de hechos, actitudes, opiniones, experiencias, situaciones y procesos del PAIEM. Resultados: Han respondido el 91,2% de los equipos del PAIEM. Psicólogos, educadores, médicos y trabajadores sociales son los profesionales que colaboran más activamente en el PAIEM (73%-84%) y los que con más frecuencia ejercen como tutores. Los enfermos mentales se ubican habitualmente en módulos ordinarios (80%). Las actividades más utilizadas para su rehabilitación psicosocial son autocuidados (73%) y educación para la salud, preparación para la vida diaria y habilidades sociales con más del 60%. Las intervenciones con las familias son básicamente por contacto telefónico (79%). En el análisis bivariante se demuestra que los PAIEM que mejor funcionan son los que tienen una buena coordinación con el resto de los equipos técnicos, los que preparan la derivación con más de seis meses previos a la libertad y en los que las ONG’s tramitan las derivaciones. Más del 71% de los profesionales observan mejoras en carencias y discapacidades en más de la mitad de los enfermos y están mayoritariamente satisfechos (3,4/5) de su participación, aunque reconocen mayor carga de trabajo. Conclusiones: Las actividades del PAIEM son adecuadas, en especial en las fases de detección precoz, estabilización y rehabilitación y menos en la fase de reincorporación social que mejora cuando interviene el tercer sector en las derivaciones del enfermo a la red sociosanitaria extrapenitenciaria (AU)

Objective: To assess the comprehensive care program for the mentally ill in prison (PAIEM), which has been implemented for 3 years in Spanish prisons with the aim of improving processes and results. Methods: Descriptive study of the data gathered from an anonymous questionnaire completed by members of the PAIEM team in prisons. Frequency distributions were obtained of all the variables relating to facts, attitudes, opinions, experiences, situations and processes of the PAIEM. Results: 91.2% of the PAIEM teams responded. Psychologists, educators, doctors and social workers were the professionals that collaborated most actively in the PAIEM (73%-84%) and were the ones to act most frequently as tutors. The mentally ill are usually located in ordinary modules (80%). The most commonly used activities for their psycho-social rehabilitation are self care (73%), education for health, preparation for daily life and social skills (more than 60%). Interventions with families are basically by telephone (79%). Bivariate analysis showed that the PAIEMs that operate most effectively are those that coordinate well with other technical teams, that prepare referral more than six months prior to release and ones where the NGOs process the referrals. Over 71% of the professionals observed improvements of disabilities and needs in over half the patients more than half of the professionals involved are satisfied (3.4/5) with their participation, although they acknowledge that there is a greater work load. Conclusions: The activities of the PAIEM are adequate, especially in the phases of early detection, stabilisation and rehabilitation and less so in the social incorporation phase, which improves when the third sector intervenes in referrals of patients to the social health care network outside prison (AU)

Mental illness and ethnicity - being a stateless person (apatride).

The main aim of this study has been to perceive the state of mentally ill stateless person hospitalized in Psychiatric Hospital Rab, Croatia with forensic status. This is a case report of such a person, F.V., 25 years old female, with no documents and other affirmed auto and heteroanamnestic data. Her psychical state and ability of communication do not allow realization of certain autoanamnesis and in the same time she has no family or relatives to give heteroanamnestic data. It is also unknown exact date and place of birth. Only certain data were that she lived in many orphanages, refugees' camps and communes in several European countries. She immigrated illegally in Croatia where she has made some criminal acts and earned forensic status. We tried to evaluated the complex status of our patient from several points of view and tried to answer to the questions where to start and what to do with such a person to do the best for her and including her human rights. As a conclusion, we could say that holistic and individual approach to such patients has been necessary with engagement of many profiles of professionals.