The Forensic Mental Health Implications of Social Media Challenges.

Children and adults are increasingly spending time on social networking sites where they may be exposed to social media challenges. These challenges, which are essentially dares or competitions, often involve participants recording themselves performing various activities to create a short video which they then share online. Many social media challenges may be considered relatively benign, but others may involve behaviors or tasks that lead to adverse outcomes, including injury and death. In this article, the authors describe different types of social media challenges, susceptibility to risk-taking among social media users, and the potential criminal and civil legal aspects of these challenges. This article focuses on the forensic mental health implications of social media challenges, including considerations for forensic psychiatrists and other mental health professionals who may become involved in court cases related to these challenges.

The Use of Electroconvulsive Therapy on Death Row.

Despite high rates of mental illness among incarcerated people in the United States, use of electroconvulsive therapy (ECT) remains limited in jails and prisons. There are some published guidelines regarding the provision of mental health care, including ECT, in U.S. correctional facilities, but little attention has been paid to the use of ECT for individuals sentenced to death. This article examines ECT within the context of the death penalty, including court consideration of ECT in capital cases and historic uses of ECT to facilitate execution of people on death row. Given the unique clinical, legal, and ethics considerations in the use of ECT for people sentenced to death, the authors call for greater attention to these practices and propose general guidelines regarding the use of ECT in this population.

Considerations for the Writing of Certification Letters Endorsing Use of Emotional Support Animals.

Emotional support animals (ESAs) are different from service animals, therapy animals, and other disability-related assistance animals. Although pet ownership may confer psychological benefits, limited research has supported the use of ESAs to realize such benefits. If clinicians are asked to write a letter of support for use of an ESA, they need to be familiar with relevant federal, state, and local laws that regulate ESAs and with the essential components of an ESA evaluation. This article provides an overview of terminology; federal, state, and local laws related to ESAs; and clinical and ethical considerations for clinicians who decide to write these letters. The authors also review liability issues related to writing these letters, including those related to ESA aggression.

Elder Financial Exploitation in the Digital Age.

Elder financial abuse violates the dignity, mental integrity, and fundamental rights of older adults. Reports of elder financial exploitation climbed during the COVID-19 pandemic, as many older adults were targeted by perpetrators seeking to take advantage of their worries about health and finances, increased isolation, and relative lack of familiarity with the digital technologies prevalent in their everyday lives. This article examines trends in usage of electronic financial technologies by older adults and describes new technology-based mechanisms of elder financial exploitation. We review the conceptual approaches and instruments used in financial capacity assessments, as well as the limitations of their applicability to the growing cohort of older adults who have adopted modern digital technologies to manage finances. We discuss elder abuse statutes and the variations in legal definitions of protected older adults and the perpetrators who can be held accountable for elder financial exploitation. In addition, we explore new directions for elaborating current approaches to financial capacity assessments and elder protection to address the demands and perils of the technology-driven postpandemic era.

Cyberbullying and Adolescent Suicide.

The unprecedented exposure of today's youth to the Internet and technology carries many benefits but also risks such as cyberbullying and online predation. The incidences of both cyberbullying and adolescent suicide are rising in the United States, with recent Centers for Disease Control and Prevention data showing that 14.9 percent of adolescents have been cyberbullied and 13.6 percent of adolescents have made a serious suicide attempt. Cyberbullying has been associated with suicide of a victim in several recent cases, a phenomenon that has been newly termed cyberbullicide. Parents and youth are frequently unaware of the risks and potential criminal liability associated with cyberbullying. Legislation that protects against online bullying has developed from antibullying laws, and as an expansion of the requirement that schools prohibit any bullying at school or via technology that interferes with learning. Cyberbullying laws exist in certain states, but as there are no federal laws that address bullying or cyberbullying, cyberbullying is prosecuted federally via statutes governing cyberstalking. After examining the epidemiology of adolescent suicidality, cyberbullying, and cyberbullicide, this article reviews recent legislation governing cyberbullying. Finally, this article illustrates the role of the forensic psychiatrist in civil and criminal cases involving suspected cyberbullicide.

An Innovative Faculty Travel Award Program to Support Child, Elder, or Dependent Care.

This study observes how a travel award program that supports child, elder, or dependent care affected university faculty members.

The Use of Battered Woman Syndrome in U.S. Criminal Courts.

Although not recognized by any edition of the Diagnostic and Statistical Manual of Mental Disorders, battered woman syndrome (BWS) has been offered as a defense in U.S. criminal courts for several decades. This article reviews examples of criminal cases in which BWS has been used in the United States as well as the implications of BWS for the practice of forensic psychiatry. Historically raised in cases of self-defense, BWS has also been used in criminal defenses involving duress, as well as by prosecutors to explain witness recantations. Case law suggests that expert witness testimony on BWS is often admissible in jurisdictions across the United States, yet its use in criminal defenses has received mixed responses from various courts. We examine limitations on the use of BWS in criminal courts and the potential use of posttraumatic stress disorder as an alternative and more reliable diagnosis in similar legal contexts.

Grave Disability in U.S. Jails and Prisons.

Many states authorize involuntary psychiatric care on the basis of grave disability, a legal standard often defined as a person's inability to provide for basic needs because of mental illness. Mental illness is prevalent in U.S. jails and prisons, and although correctional facilities must generally provide incarcerated people with basic necessities (e.g., food, clothing, and shelter), incarcerated people may still meet criteria for grave disability. This Open Forum examines the assessment and treatment implications of grave disability in correctional contexts and ways to support the well-being of incarcerated people who may meet criteria for grave disability.

The Evolving Medicolegal Precedent for Medications for Opioid Use Disorder in U.S. Jails and Prisons.

Medications for opioid use disorder, also known as medication-assisted treatment (MAT), are critical in the treatment of opioid use disorder. Historically, inmates with opioid use disorder in U.S. jails and prisons have had difficulty accessing these medications, particularly methadone and buprenorphine. A series of recent legal cases, however, have set an evolving precedent for prisoners' rights to medications for opioid use disorder during incarceration based on the Eighth Amendment and the Americans with Disabilities Act. In addition to reviewing these cases, this article evaluates the recent clinical and research landscape in which these cases arose and highlights the need for further study into the role of medications in reducing in-prison morbidity and mortality from opioid use disorder.

Estimating Annual Numbers of Competency to Stand Trial Evaluations across the United States.

In the United States, criminal proceedings must be halted or suspended if a defendant is determined to be incompetent to stand trial. Competency to stand trial (CST) is one of the most notable intersections between psychiatry and criminal law, and evaluating defendants for CST is a key role for many forensic psychiatrists and other mental health professionals. Despite the significance of CST evaluations in U.S. criminal justice, the number of CST evaluations conducted across the country each year remains largely unknown. National estimates dating back to the 1970s have ranged from approximately 19,000 to 94,000 CST evaluations each year, but these numbers vary considerably and often stem from imprecise calculations. This article examines estimates of annual numbers of CST evaluations across the United States, the need to develop more accurate statistics, and ways to implement systems for tracking the numbers of CST evaluations across the country.

Litigation Over Sleep Deprivation in U.S. Jails and Prisons.

Incarceration can disrupt healthy sleep, and insomnia is associated with psychiatric symptoms and poor general medical health among incarcerated people. In recent years, considerable litigation has arisen over sleep deprivation in U.S. jails and prisons. This column examines litigation over conditions of incarceration, such as noise, inadequate bedding, constant illumination, medication restrictions, and early wake-up times, that may affect sleep duration and quality. The potential adverse effects of inadequate sleep on incarcerated individuals, as well as associated litigation, suggest the need for policies that reduce unnecessary sleep deprivation and promote healthy sleep in correctional facilities.

Laws and Ethics Related to Emotional Support Animals.

The use of animals for therapeutic benefit is well-established. For example, for individuals with a disability such as blindness, trained service dogs can enhance the ability to live independently and participate fully in society. An emotional support animal (ESA) is an untrained animal that is used to support a person disabled by an emotional or mental disorder. For an animal to qualify as an ESA, a mental health or medical professional needs to write a letter saying that the animal is needed for the mental health of the person with the disability. This article describes the legal framework for service animals and ESAs, as well as the differences between them. We summarize information about the Americans with Disabilities Act, the Fair Housing Act, the Air Carrier Access Act, and other laws governing an individual's right to be accompanied by a support animal. We also summarize the clinical research on ESAs and argue that, although there are few studies on the clinical effectiveness of ESAs, a broader body of research indicates that animals may have positive clinical effects on medical and mental illness. Finally, we suggest there is a need for further research and provider education on ESAs.

Effectiveness of Police Crisis Intervention Training Programs.

Approximately 1,000 people in the United States were fatally shot by police officers during 2018, and people with mental illness were involved in approximately 25 percent of those fatalities. Crisis Intervention Team (CIT) training is a specialized police curriculum that aims to reduce the risk of serious injury or death during an emergency interaction between persons with mental illness and police officers. CIT has been implemented widely both nationally and internationally. Given the increasing resources devoted to CIT, efforts to analyze its effectiveness and outcomes relative to other approaches are important. Studies of CIT and similar interventions are found within both the mental health and the criminal justice arenas, which use very different terminologies, approaches, and outcome studies, rendering unified analyses challenging. This article describes the CIT model and reviews several recent systematic analyses of studies concerning the effects of CIT. Studies generally support that CIT has beneficial officer-level outcomes, such as officer satisfaction and self-perception of a reduction in use of force. CIT also likely leads to prebooking diversion from jails to psychiatric facilities. There is little evidence in the peer-reviewed literature, however, that shows CIT's benefits on objective measures of arrests, officer injury, citizen injury, or use of force.

A Systematic Approach to the Detection of False PTSD.

Posttraumatic stress disorder (PTSD) can occur after a traumatic experience and can cause severe symptoms that interfere with a person's psychological, physical, interpersonal, occupational, and social functioning. It is important to accurately identify genuine cases of PTSD and, as part of the differential diagnosis, to rule out instances of false PTSD. False PTSD diagnoses can adversely affect treatment planning, resource management, and research. The subjective nature of stressors, stereotypic presentation of symptoms, wealth of resources detailing how to malinger PTSD, and the high stakes for individuals involved in criminal, civil, and disability evaluations create challenges for making an accurate diagnosis. This article presents a systematic approach to help clinicians and forensic evaluators distinguish genuine PTSD from false variants of the disorder. It describes the types of false PTSD to be considered as alternative diagnoses, including malingered PTSD (for external gain, such as receiving a disability pension or evading criminal consequences), factitious PTSD (for internal gain, such as assuming the victim or hero/veteran role), and misattributed PTSD (legitimate psychopathology misdiagnosed as PTSD). The authors describe clinical features and psychological testing that may be leveraged to aid in reaching a more valid diagnosis.

Risk Assessment of Online Child Sexual Exploitation Offenders.

Over the past two decades in the United States, a dramatic increase in access to the Internet has facilitated an increase in the production, viewing, and distribution of child pornography. In this context, forensic mental health professionals may be called on to estimate the risk of future violence, especially of contact sexual offenses, among individuals charged with online sexual offenses. We summarize demographic and clinical characteristics that differentiate online from contact and "mixed" offenders (those who commit both online and contact offenses), offending histories of these three groups, and the current state of knowledge regarding risk of progression from online-only to contact offending. Multiple studies suggest that online, contact, and mixed offenders demonstrate distinct profiles, and wide variations exist in the offense histories of online-offending groups. Longitudinal studies of individuals charged with online offenses are few in number and are mostly limited to detection of formal charges. Nevertheless, available studies suggest that most individuals who are charged with online offenses and who do not have histories of contact offenses are unlikely to engage in future contact offenses. Within the limitations of the current literature, we suggest guidance for the evaluation and treatment of online offenders.

A Review of Statutes and the Role of the Forensic Psychiatrist in Cyberstalking Involving Youth.

Adolescents are increasingly exposed to Internet-facilitated crime as they spend more time online. The mental health risks and legal consequences for youth involved in cyberstalking are growing areas of concern. The nature of online stalking presents several challenges regarding investigation, fair adjudication, fact-finding, and legislation. Laws governing online stalking behaviors inconsistently reference the age of a victim or perpetrator as a factor for consideration in case disposition. During adjudication, the forensic psychiatrist may be asked to evaluate the victim or perpetrator involved in cyberstalking. This article focuses on the current legal landscape governing cyberstalking behavior involving adolescents, the roles a forensic psychiatrist may assume in this context, and the opportunity to bring a developmental perspective to these cases.

Current Regulation of Mobile Mental Health Applications.

In recent years, the availability of software that is targeted toward the general public and designed to assist in the diagnosis and treatment of mental illness or to promote general mental health has expanded greatly. Regulation of more traditional health care providers and health care-associated devices is well established by statute, regulatory guidelines, and common law precedents. Applications (apps), in contrast, pose a novel regulatory challenge. This review examines the current regulatory guidelines for psychiatric mobile mental health apps, as well as the current state of case law in the psychiatric mobile mental health realm.

Sexual Harassment in Medical Schools: The Challenge of Covert Retaliation as a Barrier to Reporting.

Although Title IX, the federal law prohibiting sexual harassment in educational institutions, was enacted in 1972, sexual harassment continues to be distressingly common in medical training. In addition, many women who experience sexual harassment do not report their experiences to authorities within the medical school.In this article, the authors review the literature on the prevalence of sexual harassment in medical schools since Title IX was enacted and on the cultural and legal changes that have occurred during that period that have affected behaviors. These changes include decreased tolerance for harassing behavior; increased legal responsibility assigned to institutions; and a significant increase in the number of female medical students, residents, and faculty. The authors then discuss persisting barriers to reporting sexual harassment, including fears of reprisals and retaliation, especially covert retaliation. They define covert retaliation as vindictive comments made by a person accused of sexual harassment about his or her accuser in a confidential setting, such as a grant review, award selection, or search committee.The authors conclude by highlighting institutional and organizational approaches to decreasing sexual harassment and overt retaliation, and they propose other approaches to decreasing covert retaliation. These initiatives include encouraging senior faculty members to intervene and file bystander complaints when they witness inappropriate comments or behaviors as well as group reporting when multiple women are harassed by the same person.