Psychiatric services最新文献

Given the recent expansion of the U.S. Immigration and Customs Enforcement's (ICE's) jurisdiction to include previously protected areas, including hospitals, physicians are now more likely to encounter ICE officers. However, guidance from lawmakers, institutions, and professional societies on how to navigate these encounters is limited and, at times, contradictory. This column focuses on an interaction between ICE and psychiatry in an emergency setting to explore some challenges that individual physicians, particularly psychiatrists, may face when attempting to practice within legal constraints and ethical guidelines, highlighting the need for more robust guidance.

Objective: Despite substantial interest in identifying and addressing patients' social needs in health care settings, little is known about the characteristics of mental health organizations associated with providing social care services (SCSs; i.e., services that may help to address patients' social needs). This study aimed to characterize the prevalence of 10 SCSs among mental health organizations in the United States.

Methods: Cross-sectional data from the Substance Abuse and Mental Health Services Administration's 2018-2020 National Mental Health Services Survey (2018, N=11,580; 2019, N=12,355; 2020, N=12,109 organizations) were used to characterize SCS provision by mental health organizations. Poisson and logistic regression analyses were used to identify characteristics of mental health organizations that were associated with SCS provision.

Results: The proportion of organizations offering SCSs increased between 2018 and 2020. The number and types of SCSs varied by organization type, ownership, primary treatment focus, and whether integrated treatment for co-occurring mental and substance use disorders was offered. For example, U.S. Department of Veterans Affairs Medical Centers offered an average of 5.31 SCSs during the study period, compared with 2.27 offered by partial hospitalization or day treatment organizations. Public agencies offered an average of 3.95 SCSs, compared with 2.26 offered by private for-profits.

Conclusions: This study examined the prevalence of SCSs provided by mental health organizations in order to promote research addressing the social needs of patients with mental illness. Extensive variation across organization types suggests that the uneven provision of social care may contribute to inequities in service access, indicating the need for policies and incentives to encourage SCS implementation.

Objective: The use of court-ordered mental health treatment through programs such as assisted outpatient treatment (AOT) carries substantial ramifications for the welfare of individuals with serious mental health conditions.

Methods: In this review, the authors used a narrative methodology and performed an interpretive synthesis of existing U.S.-based literature (2008-2023) on AOT implementation and outcomes.

Results: The search yielded 21 peer-reviewed articles published between 2009 and 2022 that assessed various aspects and outcomes of AOT. Although many of these studies generally supported the use of AOT, most used a limited data set (i.e., AOT program data from New York or Ohio between 1999 and 2007). Much of the latest research on AOT did not include attention to possible mechanisms to explain observed outcomes. The emerging literature suggests that increased outreach and less coercive tactics may lead to better outpatient treatment outcomes. However, more research, especially from the point of view of individuals enrolled in AOT programs, is needed.

Conclusions: The authors strongly recommend that research into these interventions be broadened and include more geographic locations. A greater emphasis should be placed on identifying potential disparities, developing a better understanding of AOT-specific mechanisms of change, and continuing efforts to identify and use high-quality comparison groups.

Objective: Involuntary civil commitment statutes codify the process of involuntary admission to a health care facility. Many statutes assign law enforcement to preside over custody and transportation during the commitment process, which can be traumatizing to people taken into custody. States and localities are seeking to develop alternative crisis response approaches that reduce law enforcement involvement. This study aimed to document variations in state laws pertaining to custody and transportation during involuntary civil commitment.

Methods: The research team analyzed statutes (in effect as of March 1, 2024) of 50 states and the District of Columbia governing custody and transportation during involuntary civil commitment.

Results: Although every state and the District of Columbia had laws pertaining to responsibility for custody and transportation during involuntary civil commitment, laws varied on the entities that were allowed to transport individuals being considered for involuntary civil commitment and when non-law enforcement transport was permissible. Only seven states barred non-law enforcement transportation under any circumstance: Alabama, Georgia, Indiana, Maryland, Missouri, Montana, and Wyoming. However, even in the 44 jurisdictions where alternative transportation was permitted, law enforcement often served as the default transporter because of a lack of available alternatives.

Conclusions: Laws specifying responsibility for transport of people being considered for involuntary civil commitment vary by state, and the statutory opportunities to implement non-law enforcement transport are plentiful. Research is needed to guide policy making and implementation regarding involuntary civil commitment.