Mental Health Crisis Responses and (In)Justice: Intrasystem and Intersystem Implications.

Mental health crises among people who are marginalized merit special consideration. These groups are both overserved and underserved by mental health crisis systems: over-represented in acute treatment settings by number while facing inequities in outcomes. The predisposing, precipitating, and perpetuating factors that contribute to crises, however, neither begin nor end with the mental health system. Rather, these factors are multisystemic. As an illustration of this concept, this article highlights select marginalized groups, those that have faced inequities in mental health diagnosis and treatment due to race, medical complexity, age, and criminal justice system involvement.

Systemic, Racial Justice-Informed Solutions to Shift "Care" From the Criminal Legal System to the Mental Health Care System.

The current configuration and function of U.S. societal structures drives the overrepresentation of people with serious mental illness in the criminal legal system. Although the causes are multifactorial, the mental health system poorly serves those at highest risk of criminal legal system involvement. The growth of the mental health evidence base regarding the social determinants of mental health has ushered in greater understanding of their central role in the promotion and maintenance of mental illness and health. These academic strides, however, have failed to translate into widespread care and payment policy changes. Additionally, as is the case in the criminal legal system, structural racism shapes people's experiences in the mental health care system, contributing to inequitable mental health outcomes for persons with severe mental illness from racial and ethnic minority groups. This is a critical consideration for the population involved in the criminal legal system: Black and Brown people make up more than half of those incarcerated in the United States (despite comprising just 32% of the total population). In the absence of an intersectional, antiracist, structurally informed approach, any attempt by the mental health care system to stem the overrepresentation of people with serious mental illness in the criminal legal system will fail. This article provides an overview of the current mental health care system's shortcomings in serving this population. It proposes concrete steps to address these shortcomings, with a special focus on race and social determinants of health.

Black Children and the Pressing Need for Antiracism in Child Psychiatry.

The COVID-19 pandemic abruptly upended American children's lives as schools, libraries, daycare centers, and parks closed to prevent further viral spread. The effects of the pandemic were not distributed equally. Data from the Centers for Disease Control and Prevention demonstrated COVID-19's disproportionate impact on Black communities in terms of both infection rates and mortality.1 Further, generations of structural racism in the housing, financial, educational, and occupational systems fueled unequal consequences for the social determinants of mental health.

Two Systems, One Population:: Achieving Equity in Mental Healthcare for Criminal Justice and Marginalized Populations.

The mental health system is often not readily accessible, culturally responsive, or a reliable source of effective interventions for society's most vulnerable populations. Modern-era studies estimate the number of persons diagnosed with serious mental illness in correctional facilities is more than 3 times the amount in hospitals. Understanding mass incarceration and the criminalization of mental illness is imperative to address mental health inequities. This article examines the interplay of mental health and criminal justice inequities, the historical context for the prevailing extant approaches to correctional mental health treatment, and programmatic approaches to addressing these inequities.

Tracing the origin of L-2-hydroxyglutaric aciduria in a family.

We describe late diagnosis of an adult with L-2-hydroxyglutaric aciduria (MIM 236792) on the basis of characteristic metabolite data and mutation analysis in the L2HGDH gene. The patient lacked MRI abnormalities which have been purported to be constant or typical findings in this disease. We further report the genetic status of his parents and his one living sibling. Our observations underline the clinical heterogeneity of the syndrome of L-2-hydroxyglutaric aciduria. This report emphasizes the diagnostic benefit of the assessment of urinary organic acids not only in children, but also in adult patients with unexplained neurological symptoms. The patient was determined to be compound heterozygous for two novel missense mutations in exon 4 of the gene (c.418G>C, c.446T>G), resulting in amino acid exchanges from alanine to proline (p.Ala140Pro) and leucine to arginine (p.Leu149Arg), respectively. The mother of our patient was heterozygous for Ala140Pro, and the father heterozygous for Leu149Arg only. Mutation analysis of a healthy 49-year-old third son of the non-consanguineous parents revealed a normal exon 4.