Crimes against people with mental illness: types, perpetrators, and influencing factors.

The current emphasis on studying why people with severe mental illness are potentially violent has overlooked the effect of violence committed against these individuals. To balance the understanding of the person-in-environment conceptualization of severe mental illness, the nature, scope, and effect of crime and victimization should be examined as part of the context in which these individuals live and function. The study reported in this article examined the nature and scope of victimization as experienced by 234 individuals with a diagnosed major mental illness; what types of victimization experiences occurred during their lifetime; what specific victimization experiences these individuals identified as the most troubling; who the perpetrators for these specific victimization experiences were; and what influence demographic and clinical characteristics played in influencing the risk of victimization among this group. The study indicates that social workers should better assess for experiences of victimization among people with mental illness and better understand the effect of such experiences on the individual's symptoms and day-to-day functioning.

Outcome of case management and comprehensive support services following policy changes in mental health care delivery.

UNLABELLED: An assessment of policy toward the care of seriously mentally ill (SMI) persons residing in a suburban Chicago community was undertaken. Results indicated the SMI population was classically "underserved." Few alternatives to a state inpatient hospital were being utilized. A policy change in SMI care was instituted by the local community mental health board which included implementation of the Unified Services Program (USP). The features of the USP were: centralized case management and outreach; and an expansion of service philosophy into a comprehensive, multidisciplinary service model of mental health delivery. METHODS: This study examined SMI service utilization, quality of life, and satisfaction with care outcomes following 12 months of USP exposure. Fifty percent of USP caseloads were randomly sampled for study participation. USP study results were compared to a large SMI population with similar exposures in another state. RESULTS: 100% of USP SMI reported to be satisfied or very satisfied with their place of residence compared to the state hospital; and 100% were satisfied or very satisfied with the USP overall. Eighty two to 100% of the study participants rated their status as better than before enrolling in USP. SMI utilized USP services, and service combinations which they find useful (88 to 100%); and felt they could not access their services without USP case managers or outreach. Compared to New York State SMI, study SMI reported similar scores, but superior ratings on "services/facilities." CONCLUSION: The study supports use of the USP for SMI living in the community, and also identified areas for programmatic improvement.

When violence happens to people with mental illness: disclosing victimization.

Of 234 adult victims of a traumatic crime who had a diagnosed mental disorder, 51% reported the crime to the police and 70% to someone else. Those identifying a family member, relative, service provider, or police officer as perpetrator were significantly less likely to report the crime. Those who lived in a group home, had a substance abuse history, or were diagnosed with schizophrenia experienced more negative responses when reporting their victimization. Implications for policy and practice are discussed.

People matter: client-reported interpersonal interaction and its impact on symptoms of schizophrenia.

The current emphasis of biological research on schizophrenia has overlooked the importance of the environment in understanding fluctuations in symptoms of this devastating mental illness. One way of reconnecting the individual with his or her environment is by better understanding the subjective experience of the illness and what environmental factors lead to changes in the symptoms of schizophrenia. This study examines the nature of the subjective experience of schizophrenia during two symptom fluctuation episodes, what individuals perceived as the most important symptom fluctuations they experienced during those episodes, and what individuals perceived as causing the fluctuations in symptoms. During both episodes individuals reported primarily mood/affect and physical symptom changes and identified interpersonal interactions as the primary cause of the symptom changes. Mental health professionals should be more aware of and better assess the role of interpersonal interaction as it relates to changes and decompensation in people with schizophrenia.

Content and context: working with mentally ill people in family therapy.

This article addresses the family's experience of caring for a mentally ill family member in the home. The focus is on how the family manages overt psychotic symptoms and the resulting interpersonal stresses. A model of intervention is proposed that allows therapists and families to examine the content and context of the psychotic material and to intervene in nonthreatening ways. This model has its base in psychoeducation and communications theory. The effectiveness of the content and context model is developed through the analysis of two case examples. The cases show the intervention to be helpful in decreasing family stress and in establishing empathic awareness between the family and the ill member. Implications for adapting this model to the psychoeducational model with the goal of enhancing the family's caretaking role are reviewed.