Making Judgments: How Blame Mediates the Influence of Rape Myth Acceptance in Police Response to Sexual Assault.

As research continues to describe negative experiences and high case attrition within sexual assault cases reported to the police, it is important to better understand the role of first-responding police officers. This study surveyed a sample of sworn police officers ( N = 174) from one department in a midsized city in the Great Lakes region to examine the effect of individual police officer characteristics, rape myth acceptance (RMA), attributions of blame, and case characteristics from a hypothetical vignette, on officer perceptions of a "good" case and behavioral intentions. Results found that although RMA predicts both perceptions of the case and behavioral intentions to respond in ways indicative of perceived seriousness, RMA is mediated by attributions of suspect blame. Victim alcohol use was found to decrease an officer's likelihood of responding more vigorously, showing less likelihood of calling a detective or arresting the suspect, if identified. Future research should begin to connect not only case characteristics but also individual police officer characteristics, attitudes, and attributions of blame, with real case outcomes, in addition to hypothetical scenarios.

Police and mental health responses to mental health crisis in the Waikato region of New Zealand.

New Zealand police report a high level of involvement with people in mental health crisis, something that has been reported in the international literature in recent decades. Involvement of police represents a coercive pathway to care and is likely to be associated with use of force. The aim of this study was to investigate the clinical, legal, and social characteristics of individuals subject to police response in the Waikato region of New Zealand. Data were also collected on characteristics of police response, including use of force, time of day, and disposition. Use of force, most commonly use of handcuffs, occurred in 78% of cases involving police. The study showed that Maori were overrepresented in police responses, but no more likely than Europeans to experience use of force. Almost half those subject to police response were not subsequently admitted to hospital, raising questions about the need for and nature of police response in these cases. Because mental health nurses are often part of police response, nurses need to take cognisance of their relationship with police and contribute to any initiatives that can reduce coercion in the pathway to care, and improve service users' experience in mental health crises.

Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates.

BACKGROUND: In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics. METHODS: To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data. RESULTS: Ninety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02-1.43), but not with baseline working alliance or a past history of involuntary admission. CONCLUSIONS: We demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans. TRIAL REGISTRATION: ISRCTN11501328 Registered 13th March 2008.

The nature and extent of police use of force in encounters with people with behavioral health disorders.

Previous research studies have examined the treatment of people with mental illnesses by the police. Much available data support the adoption of the Crisis Intervention Team (CIT) model. A key issue in CIT development has been reduction in the use of force by CIT officers, and it is suggested that such adoption does accomplish such reduction. However, to date, scant research compares variation in police use of force by CIT officers across populations with mental illnesses, co-occurring disorders, and substance abuse disorders, as compared to their non-disordered peers. Using data from the Portland Police Bureau, a police agency in which all patrol officers have been trained in the CIT model, we analyze whether police use-of-force differs across these groups. Police use-of-force data were collected for 4211 incidents from the Portland Police Bureau from 2008 to 2011. Results indicate that people perceived as having comorbid behavioral health disorders were generally more likely to have force used against them, and more likely to be perceived as resistant, than people that were perceived as having only substance use disorder, only mental health disorders, or no apparent behavioral health disorders. People with co-occurring disorders are more likely to be perceived as violently resisting police officers and have force used against them. Further, people with no perceived disorders are more likely to have a firearm pointed at them in use-of-force encounters, but also the least likely to be perceived as resisting.

Police Officer Schema of Sexual Assault Reports: Real Rape, Ambiguous Cases, and False Reports.

While extensive research has studied sexual assault reporting behaviors and described negative experiences with the criminal justice system among victim-survivors, fewer studies have explored police officer attitudes, knowledge, and thought processes that may affect victims' perceptions of negative interactions and unsatisfactory outcomes within reported sexual assault cases. This study explores police officer understanding of the definition of sexual assault and characteristics that influence their perceptions and response. Ten police officers were interviewed within one police department in a midsized city in the Great Lakes region. The study uses a modified grounded theory approach. Findings suggest that officers employ distinct schema of reported sexual assaults. Case characteristics, perceived credibility of the victim, and types of evidence formed categorizations of false reports, ambiguous cases, and legitimate sexual assaults. Police officers describe the ways in which perceptions of the case may or may not influence the response and point to areas for improvement within police procedure. The study findings provide insight into recommendations for improved police interviewing and response to reported sexual assaults.

[Crisis Cards for the Prevention of Compulsory Hospitalization]. / Krisenkarten zur Prävention von Zwangseinweisungen.

OBJECTIVE: To assess early signs of mental-health crises, treatment-specific demands and individual coping strategies from the subjective patients' perspective, and to categorize these specifications on the patients' crisis cards. METHODS: A sample of 108 psychiatric patients with severe mental disorders is currently taking part in an intervention programme targeting the reduction of compulsory re-admission to psychiatry. As part of the programme, patients fill in a crisis card. Data are analysed by a qualitative approach using content analysis. RESULTS: A variety of early signs of a crisis was specified by the psychiatric patients, most often negative emotions/thoughts (48 %). Likewise, the analysis revealed a wide range of treatment-specific preferences and individual strategies to cope with mental-health crises. CONCLUSIONS: Drawing up a crisis card in collaboration with a patient and discussing its contents might be used as a treatment resource and be beneficial to increase the patient's empowerment. Essential for the long-term prevention of mental-health crises and relapses is the regular reflection of the contents of a patient's crisis card.

Psychiatric Boarding in Washington State and the Inadequacy of Mental Health Resources.

Psychiatric boarding is a term derived from emergency medicine that describes the holding of patients deemed in need of hospitalization in emergency departments for extended periods because psychiatric beds are not available. Such boarding has occurred for many years in the shadows of mental health care as both inpatient beds and community services have decreased. This article focuses on a 2014 Washington State Supreme Court decision that examined the interpretation of certain sections of the Washington state civil commitment statute that had been used to justify the extended boarding of detained psychiatric patients in general hospital emergency departments. The impact of this decision on the state of Washington should be significant and could spark a national debate about the negative impacts of psychiatric boarding on patients and on the nation's general hospital emergency services.

Faculty perceptions of accommodations, strategies, and psychiatric advance directives for university students with mental illnesses.

OBJECTIVE: Universities across the country struggle with the legal and ethical dilemmas of how to respond when a student shows symptoms of serious mental illness. This mixed-method study provides information on faculty knowledge of mental health problems in students, their use of available accommodations and strategies, and their willingness to accept psychiatric advance directives (PADs) as helpful interventions for managing student crises. METHOD: Participants were 168 faculty members at a large, public, Southern university. A web-based survey was used to collect quantitative self-report data as well as qualitative data in the form of open-ended questions. Quantitative data are presented with descriptive statistics. Qualitative data were analyzed using thematic analysis. RESULTS: The majority of faculty surveyed have an overall supportive stance and are willing to provide accommodations to students with a mental illness. The most common advantage faculty see in a PAD is support of student autonomy and choice, and the primary concern voiced about PADs is that students with mental illness will have poor judgment regarding the contents of the PADs they create. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: PADs may be effective recovery tools to help university students with mental illnesses manage crises and attain stability and academic success. For PADs to be effective, university faculty and administration will need to understand mental illnesses, the strategies students need to manage mental health crises, and how PADs can play a role in supporting students.

The relationship of interpersonal conflict handling styles and marital conflicts among Iranian divorcing couples.

BACKGROUND: Various research studies have suggested that among other variables that couples remain married if they successfully manage their interactions (marital communication based on acceptance of individual differences, problem solving skills, forgiveness, collaborative decision making, empathy and active listening) and constructively manage conflict. PURPOSE: The study was aimed at examining the relation of conflict handling styles and marital conflicts among divorcing couples. METHODS: As a descriptive -comparative study 60 couples out of 440 couples referred to the Crisis Intervention Center of the Isfahan Well-being Organization have selected. The tools implemented were Marital Conflicts (Barati & Sanaei, 1996) and Interpersonal Conflict Handling Styles Questionnaires (Thomas-Kilman, 1975). Their total reliabilities were, respectively, 0.74 and 0.87. RESULTS: Findings showed that there are no significant differences among their conflict handling styles and marital conflicts. Also, there was positive correlation between avoidance and competition styles and negative one between compromise, accommodation, and cooperation styles with marital conflicts. That is, these styles reduced couples' conflicts. Finally, wives had tendency to apply accommodation style and husbands tended to use accommodation and cooperation styles to handle their conflicts. CONCLUSIONS: It is suggested to be studied couples' views toward their own styles to handle marital conflicts and holding training courses to orient couples with advantages and disadvantages of marital conflict handling styles.

Mental health emergency transport: the pot-holed road to care.

Police have, historically, been the first point of contact for people experiencing a mental health crisis in the Australian community. Changes in the NSW Mental Health Act 2007 extended the powers and responsibilities for involuntary transport to paramedics and accredited mental health practitioners. The Mental Health Act also allows for police assistance to other agencies during transport of people living with mental illness if there are serious safety concerns. Involuntary intervention for people living with mental illness is based on risk-of-serious-harm criteria under the Mental Health Act, implying serious deterioration before the Act may be invoked. At the point of risk of serious harm, police involvement may be more frequently required according to the acuity of the situation. If the legal basis of non-consensual treatment under the Mental Health Act was lack of capacity, it would provide a more comprehensive legal and ethical basis for early intervention. Police contact is intensified in rural and remote regions, particularly after hours, where crisis assessments and intervention by health services are further stretched. Further reducing police involvement using strategies that increase access to consensual pathways of care for people living with mental illness, particularly for people in regional and remote areas, is desirable but not likely in the foreseeable future.

[Systemic reading, another way of thinking to apprehend situations of elderly abuse]. / La lecture systémique, une autre façon de penser pour intervenir dans les situations de maltraitance de la personne âgée.

In 2007, a national call number was created to receive reports of ill-treatment for aged or handicapped subjects, and departmental platforms of phone-tapping were organized. Professionals of listening receive the calls for assistance or confidences of distresses related to ill treatments. They should initiate a relationship and assess the danger of the condition, therefore, in a systemic paradigm, performing a double task. According to the systemic approach, ill-treatments are usually the product of interaction and not that of an individual. They do not only concern individuals which suffer or undergo ill treatment but a system including all people leaving at home and social environment. To apprehend the complex relationships of ill treatments by professional of listening requires clarification of the situation together initiating a relation of confidence between the person calling and the professional. Therefore, the requests necessary for clarification should not be intrusive but create conditions of an exchange of information allowing a co-construction with the person calling for help. To accommodate a call for a critic situation, we need to take into account the context and not to be focused on the search of the causes of ill-treatment.

[The possibility or coercion treatment? Anorexia nervosa--legal regulations. A case report]. / Mozliwosc czy przymus leczenia? Anoreksja psychiczna--uregulowania prawne. Opis przypadku.

Anorexia nervosa is diagnosed on the basis of well-defined diagnostic criteria and requires treatment, as it is associated with the highest mortality rate of all mental illnesses. In Poland, anorexia nervosa is not considered a mental illness, although the opinion of researchers and clinicians are divided. To reduce the death rate of AN correct and early diagnosis, appropriate treatment starting immediately and the appropriate regulations to allow people to take the AN treatment against their will are necessary. In our work, we presented the treatment of patients with severe mental anorexia with a predominance of restrictive behavior as well as the issue of regulations relating to the compulsory treatment of people with eating disorders.

Legal issues affecting children with preexisting conditions during public health emergencies.

Among the millions of children in the United States exposed to public health emergencies in recent years, those with preexisting health conditions face particular challenges. A public health emergency may, for example, disrupt treatment regimens or cause children to be separated from caregivers. Ongoing shortages of pediatricians and pediatric subspecialists may further exacerbate the risks that children with preexisting conditions face in disaster circumstances. The US Department of Homeland Security recently called for better integration of children's needs into all preparedness activities. To aid in this process, multiple legal concerns relevant to pediatricians and pediatric policymakers must be identified and addressed. Obtaining informed consent from children and parents may be particularly challenging during certain public health emergencies. States may need to invoke legal protections for children who are separated from caregivers during emergencies. Maintaining access to prescription medications may also require pediatricians to use specific legal mechanisms. In addition to practitioners, recommendations are given for policymakers to promote effective pediatric response to public health emergencies.

La valoración del riesgo autolítico y sus repercusiones médico-legales / Self-harm risk assessment and its medical and legal implications

Valoración del riesgo autolítico. Existen numerosas guías clínicas que especifican las variables que deben registrarse en los informes clínicos para evaluar el riesgo autolítico. Sin embargo, estas recomendaciones no siempre se siguen. Repercusiones médico-legales. La evaluación del riesgo autolítico da lugar a frecuentes demandas de responsabilidad profesional. No obstante, en las sentencias del Tribunal Supremo son escasas las condenas tanto en el campo penal como en el civil. Conclusiones. En el informe clínico de una tentativa de suicidio, se recomienda una evaluación clínica completa, conforme a la lex artis. Además, emplear protocolos y escalas clínicas puede tener valor legal y puede ser muy útil para mejorar la forma en que se documente la información, así como aumentar la exhaustividad de la evaluación clínica. Con independencia de los instrumentos utilizados para la evaluación, siempre debe dejarse constancia en la historia clínica de los resultados de dicha evaluación(AU)

Self-harm risk assessment. Numerous clinical guidelines specify the variables that must be recorded in the clinical reports to assess the risk of self-harm. However, these recommendations are not always implemented. Medical and legal implications. This assessment involves frequent professional liability claims. However, with regard to Supreme Court judgments, convictions are rare in both criminal and civil law. Conclusions. When compiling a clinical report of a suicide attempt, we recommend a complete clinical evaluation according to the lex artis. In addition, following protocols and clinical scales can have legal value and be very useful to improve the way information is documented, as well as improve the completeness of the clinical evaluation. Regardless of the tools used for assessment, results should always be recorded in the medical record(AU)