Court-reported competence to proceed data across the United States.

OBJECTIVE: Competence to proceed (CTP) is a constitutional protection intended to facilitate fairness and dignity of court proceedings. Researchers have estimated that between 60,000 and 94,000 defendants are evaluated for CTP each year. Yet no research has systematically identified the number of evaluations conducted each year, despite their critical role and many profound implications. We used large-scale, systematic data collection to address this knowledge gap. HYPOTHESES: Given the siloed nature of the judicial and forensic mental health systems, we anticipated incomplete data and that the number of evaluations would far exceed previous estimates. METHOD: In September 2019, we used public information requests to solicit CTP evaluation order data from the judiciaries of 50 U.S. states, the District of Columbia, and the Federal Bureau of Prisons. We accepted evaluation proxies, such as evaluations ordered or evaluations filed, from the 2018/2019 calendar/fiscal year. We used Uniform Crime Reporting data to estimate a nationwide evaluation-to-arrest ratio and annual evaluation volume. RESULTS: Twenty-five states provided data. We deemed data from 18 states acceptable while acknowledging that data likely underrepresented actual evaluation volume. By extrapolating data from these 18 states, we estimated a conservative national evaluation-to-arrest ratio of 0.015 (95% confidence interval [-0.007, 0.037]), which suggested that 15 evaluations are conducted per 1,000 arrests each year. Consequently, it seems likely that at least 140,000 evaluations are ordered each year nationwide, with several hundred people referred for evaluations each day. CONCLUSIONS: Annual CTP evaluation volume likely far exceeds previous estimates. Transparent data are difficult, if not impossible, to obtain. As a result, researchers, legal and forensic mental health professionals, and policymakers lack the ability to implement informed, constitutionally protected CTP practices. Key implications, research directions, and detailed data infrastructure recommendations are provided. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluations of competence to stand trial are evolving amid a national "competency crisis".

Across the United States, court orders for competence to stand trial (CST) evaluations and competence restoration services have been increasing much more rapidly than states can provide these services, prompting what has been called a national "competency crisis." The challenge in providing timely competence restoration services has, in several jurisdictions, prompted a change in competence evaluations. Evaluators are more often required to address broader clinical issues-such as recommending placement or addressing the urgency of hospitalization-rather than addressing only CST. This marks an evolving practice in forensic evaluation, which moves evaluators beyond the very narrow forensic question of competence and into more traditionally clinical recommendations. We describe several state examples of changing practice in order to highlight the initial barriers, and potential benefits, to addressing additional clinical issues in competence evaluations, amid a national competence crisis.

The prevalence of traumatic brain injury (TBI) among people impacted by the criminal legal system: An updated meta-analysis and subgroup analyses.

OBJECTIVE: Traumatic brain injury (TBI) is a significant public health concern and has implications for people directly impacted by the criminal legal system during arrest, conviction, incarceration, and community supervision. This meta-analysis estimated the lifetime prevalence of TBI among people supervised by the criminal legal system across settings. HYPOTHESES: Building on previous research, we hypothesized that prevalence estimates would be impacted by methodological, clinical, and demographic factors. METHOD: Eligible studies included those with adult participants supervised by the criminal legal system (i.e., prison, jail, probation, parole, inpatient/forensic hospital) and that provided sample TBI prevalence and method of ascertaining TBI history. We employed subgroup analyses and metaregression to investigate the effects of setting, TBI definition and method of detection, lifetime history of mental illness and substance use disorders, and gender. RESULTS: The sample ultimately included 64 studies totaling 52,540 participants. Using a random-effects model and logit transformation, we found that the overall estimate of TBI prevalence was 45.8% (95% confidence interval, CI [37.8, 54.1], 95% prediction interval, PI [5.5, 92.5]) across all studies and 32.0% (95% CI [25.0, 39.8], 95% PI [11.2, 63.6]) for moderate-to-severe TBI. Significant effects were found for TBI definition and method of detection on the pooled estimate. CONCLUSIONS: The prevalence of TBI among people impacted by the criminal legal system may be larger than in the general population. However, despite recent and ongoing progress in this area of study, the reliability of prevalence estimates remains limited by methodological factors related to TBI definitions and detection methods. Implications for TBI research and clinical service provision are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Technology for assessment and treatment of justice-involved youth: A systematic literature review.

OBJECTIVE: We conducted a systematic literature review of e-mental health technologies in juvenile justice contexts. HYPOTHESES: Our exploratory research questions were as follows: First, what types of e-mental health exist for justice-involved youth, their caregivers, and juvenile justice professionals? Second, what are the characteristics of studies that have examined these technologies? Third, what have studies found about the effectiveness, reliability, or validity of e-mental health in treating and assessing juvenile justice populations? And fourth, what advantages and disadvantages exist for e-mental health use in juvenile justice? METHOD: We screened 759 articles and retained 36 for review. We included articles that investigated e-mental health for the assessment or treatment of justice-involved youth and their caregivers. We excluded technologies not directly related to assessment or treatment as well as samples of at-risk youth with no justice involvement. RESULTS: We identified four types of e-mental health technologies: Interventions with technology-facilitated interpersonal communication (e.g., telehealth and mHealth), digitized intervention programs, simulation games, and computerized assessments. Most study designs were experimental/quasi-experimental or qualitative/descriptive, followed closely by repeated measures/pretest-posttest. A majority of evidence suggested that e-mental health technologies were potentially effective or valid for treatment and assessment, especially telehealth. Advantages included positive opinions of users, increased access to care, and efficiency; disadvantages included barriers to accessing technology, privacy concerns, and lack of clear effectiveness, reliability, or validity data. CONCLUSIONS: Although the available evidence for e-mental health for juvenile justice is promising, the current literature base appears generally underdeveloped and nuanced. Worthwhile future directions include continued development of technologies and more rigorously conducted studies to support further implementation of e-mental health for juvenile justice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Neuropsychological correlates of self-reported impulsivity and informant-reported maladaptive behaviour among veterans with posttraumatic stress disorder and traumatic brain injury history.

OBJECTIVE: Frontal lobe deficits resulting from traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) have been linked to impulsive behaviour. We sought to examine whether neuropsychological performance predicted self-reported impulsivity and informant-reported maladaptive behaviour. METHOD: We administered the Delis-Kaplan Executive Function System (D-KEFS) to 116 Iraq/Afghanistan-era veterans diagnosed with a history of TBI and PTSD. RESULTS: Poorer performance on D-KEFS Stroop Task (both colour and word, separately) and Trail making (letter sequencing and motor speed) tasks and higher PTSD symptom severity were associated with higher self-reported impulsivity. Trail making letter sequencing performance was negatively associated with informant-reported maladaptive behaviour. Regression analyses revealed PTSD symptom severity and Trail making letter sequencing best predicted self-reported impulsivity, even when accounting for age, sex, and education. Only Trail making letter sequencing predicted informant-reported maladaptive behaviour when accounting for other variables in the model. CONCLUSIONS: Attention and processing speed impairments and PTSD symptom severity appear to be important predictors of impulsivity and problematic behaviour among veterans. Findings have implications for theoretical models of aggression and violence and inform the assessment and treatment of individuals with TBI and PTSD.

Criminal responsibility: Meta-analysis and study space.

While some correlates of criminal responsibility (CR) outcomes are consistent, others are not. Study-level characteristics, such as sample selection, variability in the operational definition of insanity, or other unknown influences may explain discrepant findings. It is critical to systematically consolidate and assess the literature in order to guide future work. We conducted the first meta-analysis and study space analysis (see Malpass et al., ) in this area. 15 studies met inclusion criteria for the meta-analysis, which encompassed 19,500 cases. Summary effects for psycholegal cases indicated that older age, female sex, educational attainment, and unemployment were associated with insanity. Those classified insane more often had psychiatric histories and psychotic disorders. Finally, individuals opined or found insane were less likely to have criminal histories but more likely to have been opined incompetent to stand trial in the past. Importantly, virtually all summary effects were impacted by study design. Study space analyses (N = 7) revealed a dearth of literature that thoroughly addressed theoretically important variables. Taken together, the project provides a comprehensive, empirical analysis of CR correlates and a systematic call for future research.

Community member attitudes and understanding of "serious mental illness": A mixed-method study.

OBJECTIVE: "Serious mental illness" (SMI) is a priority population within mental health treatment and policy. However, there is no standard operational definition across research, clinical, and policy contexts. The use of the label has also not been evaluated regarding its association with stigma among the general public. This mixed-method study compared community members' stigma toward "SMI" with other psychiatric labels and examined community understanding and perceptions of the SMI label. METHOD: Two hundred forty-six participants recruited via Prolific read randomly manipulated vignettes describing an individual diagnosed with depression, schizophrenia, or "SMI" and completed measures of stigma and qualitative questions regarding familiarity, understanding, and perceived utility of SMI. Quantitative analyses evaluated stigma across vignettes, and qualitative analyses identified common themes across responses. RESULTS: Stigma was relatively high across vignettes, with more negative views reported toward SMI and schizophrenia compared with depression. Quantitative differences in stigma by vignette were not significant after controlling for participants' age and gender. Qualitative responses were split regarding the perceived utility of the SMI term, with noted concerns including its broadness and potential for stigma. Most participants described functional impairment or disability as characteristic of "SMI," and approximately 70% associated schizophrenia and psychotic disorders with "SMI" compared with 45% for depression. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Person-level factors were more strongly associated with stigma than psychiatric labels. However, our sample described concerns that the SMI term is vague and may exacerbate stigma. Community education and antistigma efforts should move beyond diagnostic labels in characterizing mental illness to facilitate change in attitudes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

University-Community Mental Health Training Collaboration: Teaching Criminal Legal Stakeholders About Autism.

Individuals with autism spectrum disorder (ASD) are disproportionately represented in the criminal legal system, yet ASD-specific training is rarely provided to frontline clinical staff or legal professionals. This column describes a collaboration between university researchers and a state mental health department to promote ASD awareness, knowledge, and intervention skills among clinical and legal professionals working with autistic individuals with criminal legal involvement. Descriptions of how specific needs were identified, how tailored educational workshops were developed, and how workshop efficacy was assessed are provided. Lessons learned and recommendations for researchers and health care systems interested in similar collaborations are offered.

How often does homelessness precede criminal arrest in veterans? Results from the U.S. survey of prison inmates.

Research has shown links between homelessness and criminal legal involvement in military veterans. The present study aimed to determine the magnitude and directionality of this association by investigating the incidence of, and factors associated with, homelessness preceding criminal arrest among veterans. Data on incarcerated veterans (N = 1,602) were analyzed from the 2016 Survey of Prison Inmates conducted by the U.S. Bureau of Justice Statistics. In this survey, 27% of incarcerated veterans reported homelessness 12 months before criminal arrest. In multivariable logistic regression analyses, higher odds of experiencing homelessness preceding criminal arrest were associated with younger age, non-White race, substance use disorder (with or without serious mental illness [SMI]), history of previous arrests, parental history of incarceration, and history of homelessness before age 18. These factors were found to be the same for nonveterans, as were rates of homelessness before arrest. However, incarcerated veterans were more likely to have mental disorders, including SMI, posttraumatic stress disorder (PTSD), and personality disorders. In contrast, incarcerated nonveterans were more likely to have a criminal history, including past arrests, parental incarceration, and juvenile detention. Although policymakers may be aware that some veterans they serve are at risk of criminal legal involvement, these national data reveal the magnitude and directionality of this problem: more than one in four incarcerated veterans experienced homelessness before criminal arrest. Identifying characteristics of veterans who experienced homelessness before criminal arrest directly informs service providers of demographic, historical, and clinical factors to evaluate and address to prevent criminal legal involvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reliability of the Term "Serious Mental Illness": A Systematic Review.

OBJECTIVE: The term "serious mental illness" (SMI) is widely used across research, practice, and policy settings. However, there is no consistent operational definition, and its reliability has not been systematically evaluated. The purpose of this review was to provide a comprehensive qualitative content analysis of "SMI" empirical research, including study and sample characteristics and SMI operational definitions. These data can provide important considerations for how stakeholders conceptualize SMI. METHODS: Systematic review of PsycInfo, PsycArticles, and PubMed databases from January 1, 2015, to December 31, 2019, identified 788 original empirical studies that characterized the sample as having "SMI." RESULTS: Descriptive content analysis indicated that most studies (85%) provided no operational definition for SMI. Only 15% defined the term, and an additional 26% provided examples of SMI that included only psychiatric diagnostic categories (e.g., SMI, such as schizophrenia). Of the 327 studies that provided any description of SMI, variability was noted regarding whether criteria included any mental health diagnosis (N=31) or only specified diagnoses (N=289), functional impairment (N=73), or any specified duration of symptoms (N=39). Across all studies that characterized samples as having SMI, substantial variability was noted regarding included diagnostic classifications. CONCLUSIONS: Referencing "SMI" is second nature for many stakeholders. Findings suggest that evidence-based practice and policy efforts should weigh the level of research support indicating that the construct and the term "SMI" lacks generalizability. Researchers and stakeholders are encouraged to develop precise and agreed-upon diagnostic language in their efforts to support and advocate for people with mental illnesses.

Neuropsychological deficits associated with medical conditions: Implications for psychological services in criminal legal settings.

Criminal legal system-involved populations are disproportionally impacted by chronic health conditions relative to the general population. These discrepancies are thought to be due to both health disparities and increased likelihood to engage in health-compromising behaviors. Medical conditions can significantly influence neuropsychological functioning and, in turn, thinking and behavior relevant to clinical forensic decision-making and psychological practice in criminal legal settings. The aim of this article is to review medical conditions commonly observed among system-involved populations-specifically cardiovascular disease, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), traumatic brain injury, cancer, diabetes, and medication side effects-and describe the complex and important links between these conditions, their associated neuropsychological deficits, and applications to psychological assessment and treatment in criminal legal settings. Ultimately, this discussion will be useful to staff providing psychological services in these settings by increasing their familiarity with these concepts, and providing practical applications to inform their case conceptualization, assessment, and treatment services with system-involved individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Decarceration of older adults with mental illness in the USA - beyond the COVID-19 pandemic.

PURPOSE: Aging and mental illness both represent significant public health challenges for incarcerated people in the USA. The COVID-19 pandemic has further highlighted the vulnerabilities of incarcerated people because of the risks of infectious disease transmission in correctional facilities. Focusing on older adults with mental illness, this paper aims to examine efforts to decarcerate US correctional facilities during the COVID-19 pandemic and whether these approaches may lead to sustainable reforms beyond the pandemic. DESIGN/METHODOLOGY/APPROACH: A narrative literature review was conducted using numerous online resources, including PubMed, Google Scholar and LexisNexis. Search terms used included "decarceration pandemic," "COVID-19 decarceration," "aging mental illness decarceration," "jails prisons decarceration," "early release COVID-19" and "correctional decarceration pandemic," among others. Given the rapidly changing nature of the COVID-19 pandemic, this narrative literature review included content from not only scholarly articles and federal and state government publications but also relevant media articles and policy-related reports. The authors reviewed these sources collaboratively to synthesize a review of existing evidence and opinions on these topics and generate conclusions and policy recommendations moving forward. FINDINGS: To mitigate the risks of COVID-19, policymakers have pursued various decarceration strategies across the USA. Some efforts have focused on reducing inflow into correctional systems, including advising police to reduce numbers of arrests and limiting use of pretrial detention. Other policies have sought to increase outflow from correctional systems, such as facilitating early release of people convicted of nonviolent offenses or those nearing the end of their sentences. Given the well-known risks of COVID-19 among older individuals, age was commonly cited as a reason for diverting or expediting release of people from incarceration. In contrast, despite their vulnerability to complications from COVID-19, people with serious mental illness (SMI), particularly those with acute treatment needs, may have been less likely in some instances to be diverted or released early from incarceration. ORIGINALITY/VALUE: Although much has been written about decarceration during the COVID-19 pandemic, little attention has been paid to the relevance of these efforts for older adults with mental illness. This paper synthesizes existing proposals and evidence while drawing attention to the public health implications of aging and SMI in US correctional settings and explores opportunities for decarceration of older adults with SMI beyond the COVID-19 pandemic.

Internal Consistency and Convergent Validity of the Personality Assessment Inventory English and European-Spanish Version with English/Spanish Bilinguals.

Practitioners have few personality inventory options when assessing Spanish-speakers, despite professional guidelines that encourage them to administer measures that are validated with their populations of interest. To build on research in this area, we examined the internal consistency and convergent validity of the Personality Assessment Inventory (PAI) and the Personality Assessment Inventory European-Spanish (PAIE-S) version among bilingual Latin American Spanish-speakers (final n = 53). For the PAI, 72.72% of scales and 35.48% of subscales had alphas above .70. For the PAIE-S, 50.00% of scales and 25.81% of scales met this alpha. Participants tended to score lowest on the PAI Alcohol Problems scale (T = 47.19) and the PAIE-S Warmth scale (T = 45.49). On average, participants scored highest on the PAI's Paranoia-Hypervigilance scale (T = 61.15) and the PAIE-S's Paranoia scale (T = 57.64). We identified 10 scales and subscales on which participants were significantly more likely (p < .00094) to score higher on one measure than the other. Participants more often scored higher on the PAI than the PAIE-S. All parallel scales and subscales converged at p < .00094 with the exception of the Antisocial Features-Egocentricity scale. Taken together, findings suggest taking caution when administering these measures to Latin American bilingual Spanish-speakers.