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Biomedical subjects

H R Lamb

Publications and source records attributed to H R Lamb.

At least 19 recordsLinked to original sources
PubMed1999

Community treatment of severely mentally ill offenders under the jurisdiction of the criminal justice system: a review.

OBJECTIVE: Very large numbers of severely mentally ill persons now fall under the jurisdiction of the criminal justice system. A number of conditions are placed on those who are returned to the community, including specific ones related to treatment. This paper reviews the principles and practice of forensic outpatient mental health treatment. METHODS: MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1978, and all pertinent references were obtained. RESULTS AND CONCLUSIONS: Community treatment of severely mentally ill offenders who fall under the jurisdiction of the criminal justice system has important differences from treatment of nonoffenders, which focuses on alleviation of symptoms. Patients must comply with legal restrictions on their behavior, and treatment first addresses a patient's risk of harm to the community. Mentally ill offenders are often resistant to treatment. The mental health system may be disinclined to treat them due to their resistance and their criminal history, especially a history of violence. It is critical to identify a treatment philosophy that strikes a balance between individual rights and public safety and includes clear treatment goals, a close liaison between treatment staff and the criminal justice system, adequate structure and supervision, treatment staff who are comfortable with using authority, interventions for managing violence, incorporation of the principles of case management, appropriate and supportive living arrangements, and a recognition of the role of family members and significant others in treatment.

Case Management↗
PubMed1998

Persons with severe mental illness in jails and prisons: a review.

OBJECTIVE: The presence of severely mentally ill persons in jails and prisons is an urgent problem. This review examines this problem and makes recommendations for preventing and alleviating it. METHODS: MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1970, and all pertinent references were obtained. RESULTS AND CONCLUSIONS: Clinical studies suggest that 6 to 15 percent of persons in city and county jails and 10 to 15 percent of persons in state prisons have severe mental illness. Offenders with severe mental illness generally have acute and chronic mental illness and poor functioning. A large proportion are homeless. It appears that a greater proportion of mentally ill persons are arrested compared with the general population. Factors cited as causes of mentally ill persons' being placed in the criminal justice system are deinstitutionalization, more rigid criteria for civil commitment, lack of adequate community support for persons with mental illness, mentally ill offenders' difficulty gaining access to community treatment, and the attitudes of police officers and society. Recommendations include mental health consultation to police in the field; formal training of police officers; careful screening of incoming jail detainees; diversion to the mental health system of mentally ill persons who have committed minor offenses; assertive case management and various social control interventions, such as outpatient commitment, court-ordered treatment, psychiatric conservatorship, and 24-hour structured care; involvement of and support for families; and provision of appropriate mental health treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1997

The new state mental hospitals in the community.

OBJECTIVE: The study examined a 95-bed locked community facility (an institute for mental disease), one of 40 such facilities in California to which patients with increasingly difficult problems in management have been referred over the past few years as an alternative to more highly structured state hospitals. The purpose was to determine the characteristics of patients admitted to such facilities and assess whether the facilities are adequate for treating them. METHODS: A hundred and one randomly selected patients in one institute for mental disease were studied by record review and by discussion of each case with staff. RESULTS: The patients were characterized by psychotic diagnoses; the presence of psychotic symptoms even though they took antipsychotic medications in the facility; and histories of previous hospitalizations, serious violence against persons, poor medication compliance, and substance abuse. Ninety-nine percent had been admitted under psychiatric conservatorship. Forty-four percent had been violent toward persons during the current admission, and the level of bizarre, socially inappropriate behavior in the facility was high. CONCLUSIONS: Despite a high-quality rehabilitation program, treating and rehabilitating difficult-to-manage patients normally treated in state hospitals in a facility that had a considerably lower degree of structure had become increasingly difficult and dangerous. The use of community alternatives to state hospitalization, which is often driven by lower costs and an ideology that highly structured care is seldom needed, is not suitable for all patients.

Adolescent↗
PubMed1996

Court intervention to address the mental health needs of mentally ill offenders.

OBJECTIVE: The authors examined the outcomes of mental health consultation provided to a municipal court and the court's resulting interventions for mentally ill persons who committed minor crimes. One aim of the consultation program was to avoid criminalization of mentally ill people who committed minor offenses. METHODS: Clinical and forensic records of 96 persons charged with misdemeanors and referred to a clinical psychologist court consultant for evaluation were studied. Determination of good versus poor outcome during a one-year follow-up period was based on clients' status during the year after the court's disposition. Poor outcome was defined as the occurrence of one or more of four events during the follow-up year: psychiatric hospitalization, arrest, significant physical violence against persons, and homelessness. RESULTS: Fifty-six defendants (58 percent) were mandated to receive judicially monitored mental health treatment, as recommended by the psychologist court consultant, and 33 of them (59 percent) had a good one-year outcome. The relationship was statistically significant. CONCLUSIONS: Nonclinicians in the criminal justice system should have psychiatric assistance in making appropriate dispositions for mentally ill persons. If the judge is considering mental health treatment as a condition for eliminating or reducing punishment, then, to the extent justified by the law and the nature of the offense, the judge should both mandate and monitor the treatment on an ongoing basis.

Adolescent↗
PubMed1995

Outcome for psychiatric emergency patients seen by an outreach police-mental health team.

OBJECTIVE: The study examined whether outreach teams of mental health professionals and police officers could assess and make appropriate dispositions for psychiatric emergency cases in the community, even in situations involving violence or potential violence. The study also assessed whether such teams could reduce criminalization of mentally ill persons. METHODS: One hundred and one consecutive referrals to law enforcement-mental health teams in Los Angeles were studied through records review. Subjects' status during a six-month follow-up period was also examined. RESULTS: Referral had a high rate of past criminal arrests, violence, and major psychopathology. Sixty-three had a history of violence against persons, 59 had a criminal arrest history, 79 had prior psychiatric hospitalizations, and 66 were serious substance abusers. At referral, 70 manifested severe psychiatric symptoms, 20 were overtly violent, and 29 others exhibited threatening behavior. However, only two of the group were arrested; 80 were taken to hospitals. At six-month follow-up of 85 referrals, 22 percent had been arrested (12 percent for crimes of violence), and 42 percent had been rehospitalized. CONCLUSIONS: Outreach emergency teams composed of a police officer and a mental health professional are able to deal appropriately with persons who have acute and severe mental illness, a high potential for violence, a high incidence of substance abuse, and long histories with both the criminal justice and mental health systems. Such teams apparently avoid criminalization of the mentally ill.

Adult↗
PubMed1994

A century and a half of psychiatric rehabilitation in the United States.

Psychiatric rehabilitation, which is aimed at helping persons who have long-term mental illness to develop their capacities to the fullest possible extent, has been an integral part of psychiatric treatment in the U.S. since the beginnings of moral treatment in the early 19th century. The author outlines broad historical developments and prominent current modalities and models of psychiatric rehabilitation, including the introduction of family care, the day hospital, social skills training, psychoeducation, and the Fountain House model. He discusses the conceptual underpinnings of the field, such as the need to work with the healthy part of the patient and changes in views on vocational rehabilitation. Current concerns include the possibility of overselling rehabilitation and of misusing the term "recovery."

Day Care, Medical↗
PubMed1993

When there are almost no state hospital beds left.

The number of state hospital beds nationwide has been reduced to 40 per 100,000 population; in California, nonforensic state hospital beds have decreased to 8.3 per 100,000. The main effects of this reduction are becoming more evident. Most seriously affected have been the new generation of chronically and severely mentally ill persons who have reached adulthood since deinstitutionalization. Those who need intermediate or long-term hospitalization and cannot receive it may become even more desperate and psychotic; may avoid treatment entirely; and may turn to drug abuse and become homeless or incarcerated in jail. Moreover, the small number of long-stay beds can lead to a breakdown in the public mental health system and attempts to avoid responsibility for persons who need both acute and long-term hospitalization. This avoidance can be manifested by raising admission criteria for acute treatment or shifting responsibility to other systems. The authors recommend providing intermediate and long-stay hospitalization to the extent needed.

Adolescent↗
PubMed1993

Therapeutic use of conservatorship in the treatment of gravely disabled psychiatric patients.

In California conservatorship is a legal mechanism that allows an individual or agency (the conservator) to act on behalf of a gravely disabled mentally ill person (the conservatee) to determine what arrangements are necessary to provide adequate food, clothing, shelter, and treatment, including hospitalization when indicated. Conservatorship can play an important role in clinical management and treatment, particularly if the gravely disabled person does not have close family involvement and support, as case histories indicate. The benefits of conservatorship can be greatly enhanced by combining it with case management. When family members are appointed as conservators, skilled clinical staff can help them use the leverage of conservatorship therapeutically. By giving up some of their freedom, many conservatees who would ordinarily need to be hospitalized for long periods are able to retain most of their independence and their community status.

Activities of Daily Living↗
PubMed1993

Ensuring services for persons with chronic mental illness under national health care reform.

People with chronic mental illness present complex challenges for the design of health care financing reforms. In this position statement from the committee on psychiatry and community of the Group for the Advancement of Psychiatry, the authors describe chronic and severe mental illnesses as psychiatric illnesses that require acute and ongoing psychiatric assessment and treatment, as chronic medical diseases that require ongoing rehabilitative services, and as persistent disabilities that need ongoing supportive care and social services. Any proposal for health care reform must ensure parity of chronic psychiatric illnesses with other psychiatric conditions. It must also reimburse psychiatric rehabilitation at parity with other medical rehabilitation and provide equal access to and reimbursement for broad ancillary health services that reduce costs and improve quality of life.

Chronic Disease↗
PubMed1993

Lessons learned from deinstitutionalisation in the US.

Deinstitutionalisation is at an advanced stage in the US, both in duration, and in reduction in state hospital beds. The new generation of chronically and severely mentally ill persons has posed the greatest problems. They no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. Resistance to treatment and substance abuse are problems. Early proponents of deinstitutionalisation believed it would be cheaper, better, and give the mentally ill their freedom. In reality, good community care does not cost less. While a number of community programmes in the US have been impressive, they have served only a small proportion of the total population of severely mentally ill persons. More freedom has been of benefit for many, but has proved difficult for some patients. Some patients have been deinstitutionalised who cannot be effectively treated in the community. The homeless mentally ill epitomise all these problems.

Attitude to Health↗
PubMed1992

Conservatorship for gravely disabled psychiatric patients: a four-year follow-up study.

OBJECTIVE: The authors examined the conservatorship process in California by studying a group of psychiatric patients for whom conservatorship was sought; their goal was to determine its effectiveness both during and after the period of conservatorship. METHOD: The subjects were 60 county psychiatric hospital inpatients 18-60 years old for whom temporary (30-day) conservatorships were obtained and who were followed for 4 years. The patients' courses over the 4 years were assessed in terms of whether 1-year conservatorships were obtained, stability (number and length of psychiatric hospitalizations, arrests, serious physical violence, and homelessness), and presence or absence of family support. RESULTS: The patients proved to be a severely mentally ill and disabled group. Thirty-five (58%) were granted a 1-year conservatorship sometime during the 4-year study period, and 25 (42%) were not. Both family support and conservatorship appeared to be related to the patients' stability. When one or both were present, there was a significantly greater likelihood of stability. CONCLUSIONS: The authors believe that for a considerable number of chronically and severely mentally ill individuals, conservatorship would play an important role in their clinical management and treatment by helping to eliminate their chaotic life styles, their cycle of admission and discharge from hospitals and jails, and/or their living on the streets, particularly when family support is absent.

Adolescent↗
PubMed1992

Perspectives on effective advocacy for homeless mentally ill persons.

To make appropriate treatment and public policy recommendations to address the problems of homeless mentally ill persons, it is important to differentiate the homeless mentally ill population from the homeless population in general. Effective advocacy for homeless mentally ill persons should have realistic goals that address the specific needs of that population rather than attempt to change the basic problems of society. The effective advocacy that has secured services for developmentally disabled persons can serve as a model. Mental health professionals' limited response to the problems of homeless mentally ill persons has further stigmatized mentally ill persons in general; one of the most powerful actions mental health professionals could take to fight stigma would be to help provide treatment and residential alternatives for homeless mentally ill persons. The recommendations of both the first and the second American Psychiatric Association task forces on the homeless mentally ill are discussed.

Chronic Disease↗