Journal of the American Academy of Psychiatry and the Law最新文献

Many jurisdictions are focused on pretrial reform aimed at reducing pretrial detention for nonviolent misdemeanors. How this reform affects people with mental illness, who have historically experienced lengthier and higher rates of pretrial detention, remains unknown. This qualitative study explores state laws and practices related to pretrial detention of people with mental illness across the United States, with a focus on perceptions about if and how, mental illness influences likelihood of appearance in court, dangerousness, and likelihood of jail detention. Statutes of all 50 states and the District of Columbia related to pretrial detention were reviewed, followed by semistructured interviews with 25 state forensic mental health directors and 15 judges who preside over first appearances or arraignments. The results highlight how state laws afford wide discretion to judges to determine the impact of mental illness on pretrial release. Judges and forensic mental health directors perceive this discretion as leading to a higher likelihood of detaining people with mental illness charged with misdemeanors, often for perceived concerns related to likelihood of appearance, unmet social service needs, and public perceptions of dangerousness. These findings have important implications for ongoing pretrial reform, improvement in community supports, and diversionary behavioral health services.

The overrepresentation of persons with mental illness in carceral settings has led to justifiable concerns about their wellbeing and the appropriateness of their care. Correctional officers may be the first point of recognition and management for incarcerated persons experiencing mental illness. Correctional officers thus unknowingly participate in mental health care without a formally recognized mental health care role or knowledge of mental health educational best practice standards. This article reviews the small literature linking specific factors in mental health educational interventions for correctional officers to improvement in knowledge, skills, attitudes, and potentially to incarcerated persons' mental health outcomes. Synthesizing that literature with the authors' experience in creating a mental health educational program for correctional officers at a large provincial detention center in Ontario, Canada, we propose a five-principle framework to guide such programs. We propose such programs be intentionally designed and evaluated with educational and quality improvement best practices in mind, an inclusive attitude toward participants and the intersectional factors in mental health in carceral settings, the use of interactive teaching methods, consideration of instructor relatability, and integration of educational programs into broader philosophical changes in carceral institutions.

Clinicians face the prospect of mandated reporting when a patient reports, either during the intake appointment or during the course of addiction treatment, their risky substance use-related behavior around a child. Beyond legal considerations, many factors might influence a clinician's decision whether or not to report the case to child protective services (CPS). Although there is literature regarding mandated reporting in the setting of pre- or perinatal substance use, there is limited literature regarding the mandated reporting obligation in the setting of postnatal substance use around children. We survey the relevant statutes and regulations in the 51 jurisdictions of the United States regarding postnatal mandated reporting for substance-related parental abuse and neglect. Drawing from these results, we identify areas of legal obligation, areas open to interpretation, and areas that remain unaddressed. We further propose a clinical framework for determining whether to make a CPS report in the course of addiction treatment. In the current state of significant variability in mandated reporting regulation, clinicians must consider the safety of the child, the well-being of the family, stigma toward individuals with substance use disorder, maintenance of the conditions necessary for the patient to engage with addiction treatment, and what the law requires.

Youth on the autism spectrum who engage in delinquent or violent crimes can be adjudicated to juvenile correctional settings. These settings, which are meant to successfully reintegrate youth back into the community through education, counseling, and skills programs, are often ill-equipped to navigate the unique needs of youth on the autism spectrum. As a result, autistic youth in juvenile correctional settings often do poorly, minimizing the likelihood that successful reintegration occurs. The purpose of this review is to summarize the literature on the prevalence of autistic youth in correctional settings and their needs, as well as the standard of care often afforded to them in these settings. Finally, we will present suggested strategies informed by the literature whereby adjudicated autistic youth are provided services and support that are feasible in a correctional setting and align with autism-informed, evidence-based practices.

This mixed methods study examined initial and reevaluation reports of youth opined incompetent to proceed to investigate the impact of community interventions on changes in functional abilities. Using a structured quantitative chart review and an inductive and deductive qualitative coding scheme, we coded court-ordered, juvenile competence reports for 73 youth (85% male; ages 9-19, M_age = 14.07, SD = 2.36) opined incompetent. Upon reevaluation, 51 youth were opined to remain incompetent, and 22 were opined competent by the evaluator. No age differences were observed between youth who remained incompetent and those who were remediated. Higher IQ scores were associated with successful remediation of understanding, appreciation, decision-making, and assisting counsel. Thematic analysis suggested that stabilization in place of residence and family functioning were often noted for remediated youth. School functioning and mental status at the time of the evaluation may be indicative of competence abilities and highlight existing skill deficits. Results highlight the complexity of factors influencing juvenile adjudicative competence and how stabilization of placement, school, and family functioning may be useful points of intervention, particularly when focused remediation efforts are not available.

Juvenile correctional programs that focus solely on safety, education, and structure yield suboptimal outcomes. Youth in these facilities often have learning disorders, and adaptive challenges, have been exposed to severe trauma, and have mental disorders, including autism spectrum disorder. Consequently, rehabilitation programs must be comprehensive, individualized, developmentally informed, and trauma-informed to achieve better outcomes. It is imperative that staff receive training to identify, intervene in, and report specific behaviors. This approach broadens staff skill sets, addresses the rehabilitation needs of a larger group of youth, generates data that facilitate accurate diagnoses and treatment planning, and enhances the likelihood of equitable rehabilitation for all youth.

Recovery-oriented models are rarely taught to care providers, and knowledge is insufficient on the practical challenges of implementing recovery-oriented care in secure settings with consistency and fidelity. This study identifies the knowledge, skills, and education needs of forensic care staff related to the practice and implementation of secure recovery. Our mixed-methods approach using a needs assessment survey and focus groups found that most (73.2-77.8%) staff surveyed (n = 108) reported "excellent" or "good" knowledge and understanding of recovery-oriented care. Fewer (43.5%) staff felt confident in their ability to administer risk and recovery-oriented assessment tools in forensic settings. The conceptual domains of knowledge, skills, and education needs were clear in focus group data. Data reflected a varied understanding among staff regarding secure recovery principles and variation as to what recovery "looks like" in practice. Participants perceived a lack of available training and support when commencing employment in forensic mental health, and specific gaps in knowledge and training were noted in relation to the structured risk and recovery tools used in our program. Results from this study will be used to improve forensic patient care through implementation of a tailored educational curriculum in secure recovery for forensic staff.