A brief history of the criminalization of mental illness.

This article traces the history of the way in which mental disorders were viewed and treated, from before the birth of Christ to the present day. Special attention is paid to the process of deinstitutionalization in the United States and the failure to create an adequately robust community mental health system to care for the people who, in a previous era, might have experienced lifelong hospitalization. As a result, far too many people with serious mental illnesses are living in jails and prisons that are ill-suited and unprepared to meet their needs.

APA's amicus curiae program: Bringing psychological research to judicial decisions.

An important part of the American Psychological Association's (APA) mission is to advance psychological science "to promote health, education, and public welfare." Organizations with powerful influence on human welfare include state and federal appellate courts, especially the U.S. Supreme Court. Initially, APA's amicus briefs focused on issues of importance to both individual psychologists and public policy. As the program evolved, APA increasingly focused on informing the courts about psychological science relevant to important legal issues, including criminal, civil, juvenile, education, disability, and human rights law. These briefs, and the science that supported them, consistently challenged stereotypical beliefs of laypeople with solid, easily understood empirical research. APA impartially advocates for the use of psychological science research findings by the courts, not on behalf of parties. Volunteer experts, including representatives of relevant APA divisions, participate in creating APA briefs. On occasion, other scientific organizations may join with APA in its filings. The measure of an amicus brief is broader than citations in appellate decisions. Although APA's briefs have been cited many times by courts, a broader impact of APA briefs is seen by references to psychosocial research provided by APA in decisions where its briefs were not specifically cited. APA briefs are being read and are affecting major legal decisions. For APA, the relevant question is not whether its briefs "prevailed" in a case but whether the court was able to render a more informed decision. An important benefit of APA's amicus program has been advancing both the reputation of psychological science and APA. (PsycINFO Database Record

Pilot Implementation and Preliminary Evaluation of START:AV Assessments in Secure Juvenile Correctional Facilities.

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) is a new structured professional judgment guide for assessing short-term risks in adolescents. The scheme may be distinguished from other youth risk assessment and treatment planning instruments by its inclusion of 23 dynamic factors that are each rated for both vulnerability and strength. In addition, START:AV is also unique in that it focuses on multiple adverse outcomes-namely, violence, self-harm, suicide, unauthorized leave, substance abuse, self-neglect, victimization, and general offending-over the short-term (i.e., weeks to months) rather than long-term (i.e., years). This paper describes a pilot implementation and preliminary evaluation of START:AV in three secure juvenile correctional facilities in the southern United States. Specifically, we examined the descriptive characteristics and psychometric properties of START:AV assessments completed by 21 case managers on 291 adolescent offenders (250 boys and 41 girls) at the time of admission. Results provide preliminary support for the feasibility of completing START:AV assessments as part of routine practice. Findings also highlight differences in the characteristics of START:AV assessments for boys and girls and differential associations between the eight START:AV risk domains. Though results are promising, further research is needed to establish the reliability and validity of START:AV assessments completed in the field.

Commentary: two sides to every story--the need for objectivity and evidence.

Dr. Thomas Gutheil, in his article, "Boundaries, Blackmail, and Double Binds: A Pattern Observed in Malpractice Consultation," provides readers with some important and useful recommendations regarding the avoidance of real or perceived boundary violations and how to avoid the pitfalls of difficult therapy. However, in doing so, he moved away from the usual even-handedness and objectivity that characterizes his work. Forensic mental health professionals rely on evidence, and always wait until they have carefully considered both (or all) relevant sides of an issue before rendering an opinion.

On the role of correctional officers in prison mental health.

This article discusses the role of correctional line staff in treatment of prison inmates with serious mental illness. The authors assert that many roles and duties traditionally attributed to clinicians can and often should be performed not only by mental health professionals, but by line staff such as correctional officers and nurses. Moreover, the optimal climate for effective treatment is one in which mental health professionals and line staff work collaboratively, especially since line staff alone are in contact with inmates 24 hours per day. The specific activities which comprise mental health treatment in prison are described as: 1) counseling and psychotherapy-talking with inmates, 2) consultation-talking about inmates, 3) special housing, activities, and behavioral programs, and 4) medication. Case examples demonstrate how correctional officers, nurses, and other line staff perform each of these activities. Recognition and nurturance of these activities will improve the quality of services and reduce stress on staff and inmates alike. Consultation with line staff, joint training, and use of multi-disciplinary treatment teams are advocated as methods of reaching these goals.

Architectural design of a secure forensic state psychiatric hospital.

This article describes the architectural design of a secure forensic state psychiatric hospital. The project combined input from staff at all levels of the client organization, outside consultants, and a team of experienced architects. The design team was able to create a design that maximized patient dignity and privacy on one hand, and the ability of staff to observe all patient activity on the other. The design centers around 24-bed units, broken into smaller living wings of eight beds each. Each eight-bed living wing has its own private bathrooms (two) and showers (two), as well as a small living area solely reserved for these eight patients and their guests. An indoor-outdoor dayroom allows patients to go outside whenever they choose, while allowing staff to continue observing them. The heart of the facility is a large treatment mall, designed to foster the acquisition of social, emotional, cognitive, and behavioral skills that will help patients to safely return to their communities.