Mental health consultation to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants—psychologists and psychiatrists—with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions. © 1998 John Wiley & Sons, Ltd.     

The evolution of the tattoo in defiance of the immutable definition of deviance: current perceptions by law enforcement of tattooed arrestees

Tattoos have made their way from prisons to fashion runways, but are they still perceived by law enforcement as marks of deviance? The purpose of this study is to examine law enforcement arrest patterns to determine the relationship between tattoos and offense charges. This study analyzes a random sample of arrestees from a large county in the Southern U.S. Using logistic regression models, the relationship between tattoos, tattoo location, number of offense charges, and severity of offense charges is examined.     

Perspectives of people with mental health problems at hot spots: Attitudes and perceptions of safety,crime, and the police

People who live in places with high levels of crime and disorder are more likely to experience mental illness compared with those who do not live in these types of place (Weisburd et al., 2018; Weisburd & White, 2019). The increased police presence on high crime streets may also increase the likelihood that these individuals will encounter law enforcement. There is a strong body of literature focused on the relationship between neighborhoods and the physical and mental health of residents (e.g. Arcaya et al., 2016; Duncan & Kawachi, 2018; Leventhal & Brooks‐Gunn, 2003), but there are very few studies that look at the perceptions of people with mental illness directly, particularly as they relate to the environment of the street on which they live and attitudes toward the police. In turn, existing studies generally look at the most serious mental health problems (e.g. schizophrenia), ignoring more common mental health concerns such as post‐traumatic stress disorder (PTSD) and depression. This paper uses self‐report data from a large in‐person survey of people who live on crime hot spot and non‐hot spot streets in order to assess attitudes among a broader group of persons with mental health problems. Furthermore, we examine the interaction between living in crime hot spots and non‐hot spots and perceptions of these residents. Our findings in this broader sample confirm earlier studies that identify greater fear and less trust of the police among persons with mental illnesses. At the same time, our findings suggest that fear of crime and perceptions of police are moderated by living in a crime hot spot.     

Psychiatric disorders among employment requiring firearms

Individuals who carry guns as a requirement of employment frequently experience hazards that can be stress inducing, violent, traumatizing, or cause personal injury. This study used data from the Collaborative Psychiatric Epidemiological Surveys (CPES; n = 20,013), to examine mental health diagnoses of individuals that ever worked at a job requiring a firearm. Consistent with existing literature, the findings indicated that those who worked in professions requiring a firearm showed similar risk of mental health diagnoses as law enforcement officers which includes symptoms of trauma, mood disorders, and alcohol use. Further, race/ethnic differences emerged in patterns of mental health diagnoses, suggesting sociocultural differences influence diagnoses. These findings indicate the necessity for further investigation of the understudied area of mental health of those within employment positions that require firearms.     

The Tarasoff Warning and the Duty to Protect

Summary

Since the case of Tarasoff v. Regents of the University of California, mental health professionals have had an explicit legal duty to warn potential adult victims of violence. Subsequent case law expanded this standard to a broader duty-to-protect. Primary health care providers are increasingly treating psychiatric patients for whom the duty to protect is applicable. However, these providers are often unaware of the legal, ethical, and clinical issues involved. Assessment of violence risk should include demographic, psychiatric, and social dimensions. Interventions include notifying law enforcement authorities, potential victims, and possible use of psychiatric hospitalization to prevent aggressive behavior. The duty-to-protect as a standard-of-care has been applied to several other clinical situations, including impaired driving capacity, high-risk HIV behavior, and child sexual abuse. The article includes a step-by-step clinical protocol for evaluation and intervention in dangerous situations.     

Influence of character strengths on mental health stigma

We examined traits of open-mindedness, kindness, hope, and social intelligence in the context of mental health stigma. Stigma – a process that objectifies and dehumanizes a person who has mental illness – diminishes people’s ability to control their behavior as coping with stigma requires self-regulation. Exploring mental health stigma through the lens of character strengths allows for understanding individual differences and kinds of characteristics that help decrease the ramifications associated with stigma of mental health. Several tasks explored the effects of character strengths on implicit and explicit mental health stigma: implicit association task, measures of willingness to interact with those with a mental health disorder, and a social distance task of self, friend, and person with a disorder. Character strengths of social intelligence and kindness were indicative of less stigma of mental health. More open-minded individuals tended to not hold individuals diagnosed with a mental health disorder personally responsible for acquiring that disorder.     

Managing a stigmatized identity—evidence from a longitudinal analysis about people with mental illness

Previous research about coping with the stigma of mental illness mostly relied on cross‐sectional or qualitative research designs. In the present study, the consequences of ten identity management strategies for mental illness stigma were observed in a longitudinal design. Cross‐lagged analyses were used to describe the influence of the strategies on the frequency of stigma experiences and on mental health in a two‐wave panel of people with mental illness (n = 367, 79% repeated response rate). Selective disclosure and information seeking emerged as adaptive identity management strategies, whereas overcompensation and withdrawal led to lower mental health. Results were mostly unaffected by demographic and psychiatric variables. The results support an empowerment model of stigma resilience that portrays stigmatized people as active constructors of their social world.     

Psychiatry under tyranny: A report on the political abuse of Romanian psychiatry during the ceausescu years

Romanians suffered incredible deprivations of every sort during the decades of Communist dictatorship. Most of the country’s 1,000 psychiatrists, and most of their patients, were victimized by the political system. A few psychiatrists actively engaged in practices amounting to torture. Many, however, became willing or unwilling participants in the political abuse of their profession. Such political abuses were fostered by abusive legislation and abusive law enforcement by the secret police. Abuses included: mass detentions in psychiatric hospitals of dissidents and political undesirables; abusive interpretation of the laws in detaining persons not suffering from mental illness; false, politically motivated diagnoses and treatment; and detention in secret facilities.     

A qualitative study of primary health care access, barriers and satisfaction among people with mental illness

Research has found that a substantial proportion of individuals with mental illness have high morbidity and mortality rates, and high under-diagnosis of major physical illnesses. Furthermore, people with a mental illness tend not to seek out or utilise health care services. The reasons for the negative attitudes and behaviour towards health care services among this population have not been investigated. This paper presents findings from a study that investigated the health care service needs of people with mental illness (n = 20), and views from health care providers (n = 16) regarding access to these services by people with a mental illness. Results indicated that psychiatric patients identified a range of barriers to their health care usage and low levels of health care satisfaction. These views were shared with health care professionals. Reasons for these findings and strategies to address these problems so that there is better access to health care services for people with mental illness are discussed.     

Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement’s aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.     

Mental health attitudes among Middle Eastern/North African individuals in the United States

ABSTRACT

Middle Eastern/North African (MENA) individuals may have heightened risk for developing mental health problems due to unique cultural stressors. However, traditional cultural and religious practices and beliefs socialised within the family environment may reduce the likelihood of seeking mental health services. This qualitative study aimed to better understand the intersection of cultural, religious, and mental health attitudes among MENA individuals. Semi-structured telephone interviews were conducted with MENA adults who had received therapy services (N?=?13) and were analysed for emergent themes. Respondents reported lack of understanding of mental illness within their communities, and prominent levels of perceived and self-stigma. Families and religious practices/beliefs played an important role in responding to mental illness. Results suggest that incorporating psychoeducation and community awareness campaigns alongside religious services may help to reduce barriers to receiving mental health treatment.     

Participatory Action Research

Abstract

Traditionally, mental health research has been conducted exclusively by professionals with little input and participation from individuals with mental illness themselves. Participatory action research (PAR) provides a more dynamic method of research, giving individuals the opportunity to become activists and advocates by influencing the direction of mental health research. This paper outlines important differences between PAR methodology and traditional research, with an emphasis on the differing roles of persons with mental illness in the two models. PAR is consistent with the recovery movement in several ways: both approaches value self-definition, empowerment, and experiential knowledge. As an example, this paper describes one project that incorporates principles of the participatory action research paradigm.     

The benefits of self-forgiveness on mental health: Evidence from correlational and experimental research

Previous research on self-forgiveness is mixed. Some argue self-forgiveness may have a salutary influence on mental health problems following an offense, whereas others suggest it may provide an excuse to reoffend. In two studies, we provide correlational and experimental evidence for the salutary effects of self-forgiveness following an offense. In Study 1 (N = 100), self-forgiveness was associated with lower levels of disordered eating behavior. In Study 2 (N = 462), participants recalled a drinking-related transgression, and were randomly assigned to a self-forgiveness or neutral priming condition. Results revealed that participants in the self-forgiveness condition reported significantly more self-forgiving beliefs and fewer feelings of remorse and self-condemnation than participants in the neutral priming condition to the degree that participants believed their drinking was the cause of the offense. These findings highlight the salutary effects of self-forgiveness.     

Characteristics and outcomes of insanity acquittees in Oklahoma

The insanity defense is perhaps the most vigorously debated topic at the interface of the legal and mental health systems. This article addresses the need for empirical evidence by providing data on insanity acquittees and their later outcomes in Oklahoma, a jurisdiction not previously studied. Information was obtained on the demographic, legal, psychiatric, hospitalization, and post-hospitalization characteristics of all 61 defendants acquitted not guilty by reason of insanity (NGRI) and treated on the state forensic unit during a 5-year period. Insanity acquittees had few resources, significant psychopathology, and extensive involvement with the legal and mental health systems prior to the NGRI offense. Follow-up of three groups of discharged patients--those released at an initial court review, those who completed the NGRI treatment program, and those who absconded from the forensic unit--revealed that those who escaped from the unit had significantly more arrests and subsequent legal charges than regularly discharged patients.     

Trying But Failing: Implicit Attitude Transfer Is Not Eliminated by Overt or Subtle Objectivity Manipulations

People with mental illness experience discrimination, paternalistic treatment, and avoidance. To facilitate assessment of such experiences, the authors developed the Multifaceted Stigma Experiences Scale. It assesses four dimensions of experienced stigma in interpersonal interaction: hostile discrimination, benevolent discrimination, taboo, and denial. The influence of stigma experiences on mental health was modeled in a two-wave panel with persons with mental illness (N = 367, 79% repeated response rate). Results indicate that both subtle and blatant forms of stigma constitute a barrier to recovery and may be interpreted as attempts to increase social distance and reinforce the existing social order.     

Understanding community re-entry of former prisoners with mental illness: a conceptual model to guide new research

Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.     

The Evolving Position of the American Psychiatric Association on Firearm Policy (1993–2014)

Before the Supreme Court's 2008 decision in District of Columbia v. Heller, the American Psychiatric Association's position on gun policy reflected the strong gun control perspective championed by the nation's public health establishment. After Heller declared that an individual's right to bear arms is constitutionally protected, the APA refocused its attention on the specific aspects of firearm policy that implicate the interests and rights of persons with mental illness. Psychiatrists are mindful of the need to curtail firearm access by persons with mental disorders that elevate the risk of suicide or violence to others, but they are also opposed to stigmatization, discrimination, and unfair treatment of individuals based on mental illness. Although civil commitment is an acceptable basis for prohibiting access to firearms, other adjudications of conduct indicative of elevated risk should also be included. Every state should provide a fair and reasonable process for restoring firearm rights after a suitable waiting period based on individualized assessment of whether the person remains at an elevated risk. However, restricting firearm rights of persons solely on the basis of a diagnosis of a mental disorder or voluntary treatment, whether in-patient or outpatient, discourages treatment and would be counterproductive. Copyright © 2015 John Wiley & Sons, Ltd. (original adopted by the American Psychiatric Association 2014).     

Where Have All the Children Gone? Movement from Child to Adult Mental Health Systems

The mental health histories of the 448 children 15 and 16 years of age who were admitted to state-operated children's psychiatric inpatient services in New York during 1982 were reviewed for the 11 year period through April 1993, Thirty-three percent were served as adults (after age 18) in the state-operated adult civil mental health system; 42% of these individuals were still receiving services at the end of the period. 113 of the 146 individuals served as adults were served only in the civil system. Thirteen percent of the cohort received some of their mental health services as adults in the state-operated adult forensic mental health system due to criminal law involvement. This includes nine percent who received mental health services while they were inmates in state prisons. Twenty four of the 57 forensic clients received services as adults only in the forensic system. Diagnostic, demographic, and service history characteristics of the groups were compared to foster an early understanding of policy and programmatic issues related to movement from the child mental health system to the adult system. Baseline (1982) information was used to identify predictors of later service utilization.     

Visualizing the relationship among indicators for lone actor terrorist attacks: Multidimensional scaling and the TRAP‐18

This validation study analyses data from a sample of North American terrorist attackers (n = 33) and non‐attackers (n = 23) through the lens of the Terrorist Radicalization Assessment Protocol (TRAP‐18; Meloy, 2017) utilizing a multivariate statistical approach – multidimensional scaling – to visualize potential clustering (co‐occurrence) of risk factors. Rarely done in terrorism research, the results plotted in two‐dimensional space show the clustering and co‐occurrence of most of the eight proximal warning behaviors among the attackers, but not among the non‐attackers, and less of a clustering and association of distal characteristics, but their presence in both attackers and non‐attackers. These findings provide further empirical support for the rational‐theoretical model of the TRAP‐18, a structured professional judgment instrument for threat assessment of lone actor terrorists. It advances the quantitative analysis of operationally relevant and behaviorally observable indicators for use by law enforcement and counterterrorism professionals and their consultants. Findings are discussed in relation to other research on pre‐offense behaviors of lone actor terrorists, and recommendations are made for both operational use and further research.     

Psychology Internships in the Treatment of Severe Mental Illness: Implications for Training in Academic Medical Centers

Despite an increasing focus over the past 2 decades by federal and state governments on the care of persons with severe mental illness, psychologists remain underrepresented among behavioral health professionals working with this population. Within the discipline there is growing concern about the need to adequately train, recruit, and retain psychologists in this specialty. This is a particular concern in academic medical settings where the overall severity of illness among those receiving psychiatric services continues to increase. The purpose of this qualitative research study was to intensively examine the experience of predoctoral interns engaged in treating individuals with severe mental illness in an academic medical center in order to identify the professional developmental experiences and training needs of those learning to care for this population. This analysis, conducted with semistructured interviews at four points during the internship year, yielded a series of recommendations for improving internship training and recruiting psychologists to this specialty.