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At least 19 recordsLinked to original sources
PubMed1988

Current issues in state mental health forensic programs.

The major current issues facing state and local forensic mental health programs are presented in this paper. Debates over forensic patients' rights and the insanity defense are discussed, together with many administrative problems such as the pros and cons of correctional versus mental health system program control and payment incentives for treatment. The authors cite the differing goals of correctional and mental health systems, i.e., security and treatment, as reasons for difficulties in developing needed collaboration. Guidelines are suggested to address such important issues as mixing civil with criminal patients, developing units for special populations, defining patients who can respond to treatment, and follow-up after discharge.

Adolescent↗
PubMed2025

Quantitative Outcomes for Shared Assessment and Management in Forensic Mental Health: A Meta-Analysis and Systematic Review.

Despite leading models of mental health care encouraging user involvement, users in forensic mental health (FMH) report poor involvement given the difficulty in reconciling shared approaches with risk-averse and legally mandated settings. While previous research has demonstrated qualitative benefits to shared approaches in FMH and has led to a proliferation of self-rated assessment tools, there remains to quantify agreement on self-rated tools and to clarify the impact of shared approaches on care. This meta-analysis examines (1) the correlation between clinician and user ratings, (2) the predictive validity of self-ratings for violence, and (3) the effects of shared risk management on violence and restriction in FMH. Five databases were searched from inception to April 2024, selecting for adult FMH inpatients, shared risk assessment, needs assessment or violence management as interventions, and quantitative outcomes (correlation, agreement, predictive validity, and effect on violence or restriction rates). Fifteen quantitative evaluations were retained. One of three planned meta-analyses could be conducted, with seven records providing paired clinician-user t-tests. Eleven more records provided clinical recommendations on operationalizing shared approaches. Random-effects meta-analysis showed a significant and large paired standard difference of .95 (95% CI = [.49,1.42]) across tools, with significant differences in DUNDRUM-3, DUNDRUM-4, and CANFOR sub-models. While acknowledging between-study heterogeneity, results substantiate quantitative differences where clinicians generally rate more needs and lesser progress than users across tools, showing that self-ratings can and should be used to broach collaborative discussions on needs and progress during FMH treatment. There remains an evidence gap for quantitative benefits in care outcomes and a need to standardize agreement measures for future comparisons and clinical sub-group analyses.

Humans↗
PubMed1989

Forensic mental health services provided by mental health organizations, United States, 1985.

Results from the 1985 NIMH Inventory show that 1,339 (43 percent) of the 3,118 mental health organizations surveyed provided mental health services to mentally disordered adult offenders. Almost three-fifths of these forensic services were in multiservice mental health organizations, 23 percent were in freestanding psychiatric outpatient clinics, 14 percent in State mental hospitals, 4 percent in private psychiatric hospitals, and less than 2 percent in residential treatment centers for emotionally disturbed children and freestanding psychiatric partial care organizations. About two-thirds of the 289 State mental hospitals provided forensic services; 55 percent of the 1,383 multiservice mental health organizations and 40 percent of the 756 freestanding psychiatric outpatient clinics offered these services. Psychiatric assessment was the forensic service provided by the largest number of mental health organizations. This was followed, in order, by consultation to law enforcement staff and attorneys, psychiatric outpatient care, monitoring of medication, emergency mental health care, inpatient/residential care, partial care, and emergency detention. About 200,000 mentally disordered offenders received psychiatric assessment services from mental health organizations; slightly over 100,000 were provided psychiatric outpatient care, and smaller numbers of clients received other types of forensic services. A total of 14,538 full-time equivalent (FTE) patient care staff were involved in the delivery of forensic services. In addition, State mental hospitals reported 4,525 FTE administrative and support staff serving forensic patients. Special funding for forensic services, totaling $639 million, was received by just over half of the mental health organizations with these services. About four-fifths of this funding came from State mental health agencies, with the remainder provided by sources such as State correctional agencies, State courts or other State sources, city/county jails, city/county courts, and other local public sources.

Forensic Medicine↗
PubMed1990

AIDS-related dementia and competency to stand trial: a potential abuse of the forensic mental health system?

Public health officials, hospital administrators, forensic directors, jail wardens, judges, prosecutors, and defense attorneys must confront the issue: how should cases of individuals with AIDS dementia be treated when they are found to be permanently incompetent to stand trial? Although charges are sometimes dismissed in advanced cases of dementia, the more common pattern involves placement of the defendant in a public facility while awaiting trial. The refusal of some state facilities to accept these patients raises a host of legal, moral, and medical questions that virtually every urban state's forensic system will have to consider in the near future.

AIDS Dementia Complex↗
PubMed1992

Images of law and disorder: a survey of forensic mental health professionals in Ontario, Canada.

In this article we report on a survey that was organized to expand knowledge across a range of medicolegal issues and pragmatic applications. We wanted to provide forensic professionals with an opportunity to express their views on these various forensic trends, and on their relevance for expert identities, statuses and activities across a broad spectrum of contexts and concerns. In an exploratory framework, the intention was to operationalize many of these developments in systems, laws, ideas and practices, and to present them as structured questions for the consideration of respondents representing the full complement of mental health disciplines connected to the criminal court apparatus in one Canadian province. In what follows we set out to sketch their images of law and disorder, and their specific opinions about the role of forensic practitioners, the nature of forensic assessment and decision-making, the relationship between mental disorder and crime, the application of treatment and punishment, and the overall process of criminal court adjudication and sentencing.

Attitude of Health Personnel↗
PubMed1986

Medication noncompliance in schizophrenia: codification and update.

Risk of relapse and recidivism makes the failure to take antipsychotic medication as prescribed a significant issue in forensic psychiatry. This question may arise in such contexts as the setting of bail, plea bargaining, the insanity defense, and sentencing. We have reviewed the literature on medication noncompliance in schizophrenia and present here the results, organized by topics relevant for the work of forensic mental health experts. Reported rates of noncompliance vary widely, reflecting major differences in the populations studied and the methods used as well as the complexities involved in defining noncompliant behavior. A noncompliance rate of 50 percent has been attributed globally to chronic patients, both medical and psychiatric. The tendency of significant factors to interact precludes a simple typology of noncompliance. However, environmental security and supportiveness correlate positively with adherence; whereas anxiety, paranoia, grandiosity, depression, and side effects correlate negatively. Clinicians' assessments of whether medication is being taken have proven to be unreliable. Although monitoring by chemical measurement, particularly a radioreceptor assay for urine samples, can be useful, depot injection ensures that prescribed medication is being taken. Less invasive means of promoting compliance are described; psychodynamic and ethical issues to be considered in the monitoring and promotion of compliance over extended time periods are presented. We also probe the link between medication noncompliance and behavioral relapse. The time between default and relapse is most often measured in weeks. Whether due to medication withdrawal or not, the relapse pattern of each individual tends to repeat, allowing its recognition before recidivism occurs. Restarting medication at this stage, especially with a dosage increase, is usually effective. In sum, the forensic mental health expert can now readily use a large and diverse literature to assist with a variety of significant issues.

Antipsychotic Agents↗
PubMed1986

Forensic social work in a mental health setting.

In forensic social work, a relatively new field of practice, significant contact between social work and the law is prominent. A statewide program of services to forensic psychiatric patients in Maryland demonstrates the principles and issues involved in forensic work and the widespread applicability of social work concerns in the criminal justice and mental health systems.

Adult↗
PubMed1990

Staffing of forensic inpatient services in the United States.

Data on patient census, bed capacity, and staffing levels in state-operated forensic psychiatric inpatient programs in 1986 were collected from forensic mental health directors of the 50 states and the District of Columbia. Of the 75 programs identified, 54 were based in units within larger psychiatric hospitals and 21 in freestanding hospitals. For all programs, direct-care staff-patient ratios ranged from .35 to 4, with a mean of 1.3. The ratio of filled beds to bed capacity ranged from .5 to 1.54, with a mean of .95. Nearly a fourth of the programs were over capacity. A negative relationship between filled-bed ratios and direct-care staff-patient ratios was found.

Forensic Psychiatry↗
PubMed1990

From forensic psychiatry to law and mental health.

The article gives a short overview of the most important recent developments in the field of law and mental health, moving from traditional forensic psychiatry to a broader perspective on law and mental health.

Belgium↗
PubMed1989

Mental health services research with forensic populations.

Research on the management and treatment of insanity acquittees and the right to refuse treatment illustrates the need for empirical analysis in the overlapping areas of law, mental health services, and public policy issues.

Community Mental Health Services↗
PubMed1987

Patient access to medical records in a forensic center: a controlled study.

Several psychiatric facilities have opened their records partially or completely to patients. The authors report the results of a two-part study in which 20 patients on a minimum-security unit of a forensic center were allowed to read their records and later to write in them. Staff and patient attitudes toward granting patients access to their records were measured before and during the study and were compared with staff and patient attitudes on two units where patients were not granted access. Only eight study patients actually read their charts and none wrote in them, but the majority of both study and control patients felt that access had been helpful. No significant differences in patient behaviors were found on any of the units as a result of access. Staff attitudes toward access did not differ significantly before or after the study, and few differences were found in staff charting practices.

Attitude of Health Personnel↗
PubMed1988

Emerging problems for staff associated with the release of potentially dangerous forensic patients.

Mental health professionals have been concerned recently about their liability for the actions of patients in their outpatient practices. The history of suits against clinicians for negligent release of inpatients extends back several decades since before the Tarasoff decision. The authors suggest that the same consumerism/victims' rights trends that resulted in Tarasoff and its progeny are likely to rebound again on forensic clinicians and that such pressures are likely to add to other political and social pressures that already complicate the treatment of forensic inpatients. They present three cases to illustrate the dilemmas involved in the release of forensic patients and argue that clinicians must bear significant responsibility for their current plight because of overstated claims of capacities to predict and treat aggressive behavior.

Adult↗
PubMed1989

U.S. and Soviet perspectives on the diagnosis of schizophrenia and associated dangerousness.

During a visit of U.S. senior mental health and forensic experts to the Soviet Union to assess recent changes in Soviet psychiatry, a symposium was held to discuss the U.S. and Soviet concepts of the diagnosis of schizophrenia and dangerousness associated with psychiatric illness. The basic conclusion from this exchange was that significant differences exist between the countries in both areas, as the U.S. conceptualization of schizophrenia and associated dangerousness is considerably narrower than that of Soviet practice. Clearly, future scientific exchange is warranted to examine these conceptual differences in an effort to establish a better empirical basis for assessing the most appropriate medical treatment and legal disposition for patients.

Cross-Cultural Comparison↗
PubMed1976

Decentralization of forensic services.

Decentralization of mental health services to persons in contact with the criminal justice system is essential in the application of community mental health concepts. This is feasible considering the levels of "dangerousness" of such persons, costs of the typical isolated central facility, and implications of the Supreme Court decision Jackson v. Indiana (406 U.S. 715, 1972). In Tennessee, reform began with legal review of unit records, pretrial screening in mental health centers, revision of state law, liaison with the Tennessee Board of Pardons and Paroles, and use of consultant staff. The results are positive wherever decentralization of services has been maintained.

Attitude of Health Personnel↗