Mental illness and violence: A brief review of research and assessment strategies

Examinations of the relationship between mental disorders and violent behavior can be found throughout history and across cultures. Many examples of the cultural and social construction of dangerousness and mental illness also have appeared during the modern era. This article examines the evolution of thought and research regarding the relationship between mental illness and violence, from studies in the early twentieth century through the more recent MacArthur Violence Risk Assessment Study. In addition, the article explores the state of knowledge and practices surrounding the assessment and management of violence risk among individuals with mental illness.     

Epidemiologie psychischer Störungen

The discipline of epidemiology not only contributes to knowledge regarding the distribution and prevalence of mental disorders but also to a better understanding of their causes and consequences. This article focuses on the prevalence and disease burden. Epidemiological studies show that mental disorders are more common than previously thought and that they are associated with a particularly high societal burden. Costs of illness are higher in mental disorders compared to many widespread somatic conditions because of their high prevalence, chronic course, young age of first onset and the profile of disability. The extent of inability to work due to mental disorders is rising steadily although a general decline in absenteeism has been observed across other disease types. This raises the question of whether mental disorders have increased recently. Furthermore, the general need for treatment is discussed as well as the corresponding mental health care options. Finally, it has been found that, despite the quantitatively relatively well-developed health care system in Germany, there are still signs of a significant undertreatment in the field of psychotherapy.     

Using Systems of Care to Reduce Incarceration of Youth with Serious Mental Illness

Youth with serious mental illness come into contact with juvenile justice more than 3 times as often as other youth, obliging communities to expend substantial resources on adjudicating and incarcerating many who, with proper treatment, could remain in the community for a fraction of the cost. Incarceration is relatively ineffective at remediating behaviors associated with untreated serious mental illness and may worsen some youths' symptoms and long-term prognoses. Systems of care represent a useful model for creating systems change to reduce incarceration of these youth. This paper identifies the systemic factors that contribute to the inappropriate incarceration of youth with serious mental illness, including those who have committed non-violent offenses or were detained due to lack of available treatment. It describes the progress of on-going efforts to address this problem including wraparound and diversion programs and others utilizing elements of systems of care. The utility of systems of care principles for increasing access to community-based mental health care for youth with serious mental illness is illustrated and a number of recommendations for developing collaborations with juvenile justice to further reduce the inappropriate incarceration of these youth are offered.     

心理障碍的文化建构--健康心理学发展中的新趋向

西方心理学发展过程中的文化转向使得文化在心理障碍建构中的作用日益突出,主要表现为:象征功能、建构功能、指导功能和唤起功能。相应地,文化对于心理障碍的建构主要通过文化基础的主观经验、悲伤惯用语、诊断、治疗和结果来进行。此种建构方式将促使心理障碍的诊断和治疗走出传统的疾病中心治疗范式,更加关注人文因素的强大作用。     

An examination of the effects of mental disorders as mitigating factors on capital sentencing outcomes

Mentally ill and emotionally disturbed offenders comprise a significant component of those whose criminal conduct has swept them into the criminal justice system, including a subset who are tried and convicted of capital murder. The present study employs the population of capital cases advanced to penalty phase in the state of North Carolina (1990–2009) to examine whether presentation to the jury of the statutory mitigators of extreme mental and emotional disturbance and capacity impaired, and specific mental illness diagnoses, often referred to as mental disorders, at the sentencing phase mitigate against a sentence of death. Mental disorders included mood disorders, psychotic disorders, anxiety disorders, brain disorders, multiple mental illness diagnoses, learning disabilities, and personality disorders. Results from these 835 cases indicate that with the exception of one, the diagnosis of a learning disability, the capital jury's acceptance of various mental health conditions does not effectively mitigate against a capital sentence. In addition, jury rejection of a diagnosis of mental illness or the two mental health statutory mitigators, capacity impaired and extreme emotional disturbance, as a mitigating factor has a counter-mitigating effect in that it significantly increases the odds of a death penalty recommendation by about 85–200%.     

Differences in attributions of mental illness and social distance for portrayals of four mental disorders

For individuals with mental illness, others' perceptions of mental illness often limit integration into communities. Perceptions of mental illness manifest as social stigma in the form of social distance and may depend on individuals' attributions of the origins of mental illness. 180 university students completed a survey on attribution of mental illness and social distance across several disorders (psychiatric and physical). Participants indicated greater social distance for severe mental illness (i.e., schizophrenia) than less severe mental illness and physical illness. More desire for social distance may be related to unfamiliarity with severe mental illness rather than less severe mental and physical illnesses. Greater understanding of how individuals perceive mental illness can inform efforts to educate the public.     

The cultural approach of ethnopsychiatry: A review and critique

Ethnopsychiatrists have consistently maintained that the perceptions, inclinations, and behavior of mentally ill persons are never a simple reflection of their illness: the mentally ill tend to behave in some ways in some cultural contexts and in other ways in others. This pathoplasticity shows, we are told, that abnormality is, primarily, the manifestation of a phenotype, not a genotype. Hence, any diagnosis and treatment of the affected individual must be grounded in some knowledge of the environment within which he or she functions. Postulating the existence of such an intimate and harmonious connection between psychopathology and social conditions, however, overlooks a pivotal distinction: while it is true that local norms and values can and do affect most neurotic presentations, those same standards have at best a marginal influence on psychotic reactions. Some pathogenic features are so overwhelming that they will be expressed in any environment. Accordingly, I conclude, we shall have progressed significantly in our understanding of the nature of mental disorders once we begin to associate neuroses with culture and psychoses with biology.     

Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives

Individuals with mental illness and addiction comprise at least half of the patients in most mental health treatment systems. This combination results in increased risk for frequent psychiatric relapses, poor medication compliance, violence, suicide, legal problems, and high utilization of the emergency room or inpatient services. Traditional mental health and addiction treatments have not adequately addressed these co-occurring disorders due to clinical interventions, programs, and system flaws that have not addressed the individual's needs. Integrated treatment requires both an understanding of mental illness and addiction and the means to integrate and modify the traditional treatment approaches in both the mental health and addiction treatment fields. There is strong evidence to support the efficacy and effectiveness of integrated treatment in this population. All mental health clinicians should become experienced and skilled in the core psychotherapy approaches to treating substance use disorders, including motivational enhancement therapy, relapse prevention (cognitive-behavioral therapy), and 12-step facilitation. In addition, integrated treatment includes integrating medications for both addiction and mental illness with the behavioral therapies and other psychosocial interventions. This article reviews the clinical intervention, program, and system components of integrated treatment and specific clinical interventions for this population.     

Obsessive-compulsive spectrum disorders: cross-national and ethnic issues

Epidemiological and clinical data from a variety of cultural and geographic settings on obsessive-compulsive disorder (OCD), and many of the obsessive-compulsive spectrum disorders, suggest that this is a group of disorders with a good degree of transcultural homogeneity. However, the content and themes that predominate in patients with these disorders, and the course of illness, can be shaped by cultural, ethnic, and religious experiences. Across cultures, OCD is commonly comorbid with mood, anxiety, and impulse-control disorders. However, little is known about the mechanisms by which culture and ethnicity may affect the expression of OCD and related disorders. Cross-national comparative studies exploring culturally influenced differences in clinical course, treatment outcome, including ethnogenetic differences in drug response, and prognosis are needed.     

Performance of the CJDATS Co-Occurring Disorders Screening Instruments (CODSIs) among minority offenders

Previous research has shown the performance of the CJDATS Co-Occurring Disorders Screening Instruments (CODSI-MD and SMD)--six- and three-item instruments to screen for any mental disorder (CODSI-MD) and for severe mental disorders (CODSI-SMD), respectively--to be comparable or superior to other, longer instruments. This study tested the stability of the performance of the CODSI-MD and SMD across three racial/ethnic groups of offenders entering prison substance abuse treatment programs (n = 353), consisting of 96 African American, 120 Latino, and 137 White admissions. The Structured Clinical Interview (SCID) was used to obtain DSM-IV Axis I and II diagnoses; a lifetime SCID diagnosis of a mental disorder or a severe mental disorder was the criterion against which the CODSI-MD and SMD were validated. Results showed no statistical differences in sensitivity or specificity for either the CODSI-MD or SMD across the African American, Latino, and White prisoner groups. The value of the CODSI-MD and SMD as brief screens for mental disorders among offenders with diverse racial/ethnic backgrounds is discussed.     

Autonomy and relatedness in psychopathology and treatment: a cross-cultural formulation

A cross-cultural view of psychopathology is proposed, contending that there are two basic systems of self-organization. These two systems of self-organization, labeled autonomy and relatedness, are essential to a person's well-being regardless of the culture or society to which the person belongs. The degree of autonomy and relatedness required to maintain mental health in a specific society is affected by cultural mores. People in collectivistic (primarily non-Western) cultures require high levels of relatedness and moderate levels of autonomy to maintain mental health. People in individualistic (primarily Western) cultures require high levels of autonomy and moderate levels of relatedness to maintain mental health. This view, based on a review of past work in various areas of psychology, is discussed in the context of various forms of psychotherapy existing in individualistic and collectivistic cultures.     

Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem

This paper examines the issue of poverty among people with serious mental illness (SMI), positioning it as a key issue to be confronted by community mental health systems and practitioners. The paper reviews three perspectives on poverty, considering how each sheds light on poverty among people with SMI, and their implications for action: (a) monetary resources, (b) basic needs, and (c) capabilities. The paper argues that community mental health programs and systems are currently unable to address poverty as they are overly focused on individual‐level interventions that, on their own, cannot raise people out of poverty. The paper calls for a social justice value, informed by the concept of citizenship, as a necessary complement to the recovery concept that has informed community mental health practice for almost 25 years. Finally, the paper argues that community psychologists, with their concepts, methods, and values, are well positioned to contribute to this important issue. However, it also contends that addressing poverty requires collaboration from community psychologists with researchers and practitioners from other fields and domains of expertise to begin to make progress.     

The Worldviews of Healing Traditions in the East and West: Implications for Psychology of Religion

This article will compare the worldviews of psychotherapy traditions in Eastern and Western culture, particularly the therapeutic factors and principles indigenous to the Chinese culture. The author will first define the meaning of culture and psychotherapy from a postmodern anthropological approach. By referring to history and literature in the study of cultural psychology, a comparison will be made between the value systems lying behind therapeutic methods used in the East and West. This includes the worldviews on the body and mind, the self, mental health, relationship, community, healing, and spirituality. Lastly, a famous Chinese legend will be used as an example to illustrate how worldview differences between the East and West determine the goals and process of psychotherapy. It is hoped that psychology of religion would be sensitive to the underlying worldviews across different cultures, without imposing its definition of “mental health” and method of “healing,” as different religions embody different cultural traditions as well. It is argued that whether spirituality or religion is helpful to the wellbeing of local people, it should be defined by the local persons and expressed in their mother tongue. Hence a psychology of religion for Chinese people should respect its customs of healing and particular set of worldviews.     

Indigenous Healing Practices in Malawi

One of the most important areas of African culture in which the significant presence of traditional beliefs can be seen is through sickness and healing. In many traditional cultures, illness is thought to be caused by psychological conflicts or disturbed social relations that create a disequilibrium expressed in the form of physical or mental problems. In Malawi, traditional healing has been practised for centuries even before colonialisation. It is said that about 80 per cent of the population utilise traditional healers and medicine for their health needs. This paper sets out several of the issues and controversies that surround traditional healing and medicine in Malawi. An overview of the traditional Malawian theory of illness, the diversity of healing practices for somatic and psychosocial disorders, the socio-cultural context of healing and cultural interpretations of disease and intervention are provided. The problem of efficacy and scientific validation of traditional medicine is discussed.     

South African Hindu Psychologists’ Perceptions of Mental Illness

Conceptualisations of mental illness are not universally applicable, as culture shapes the expression, perceptions and treatment preferences thereof. By focusing on the perceptions of Hindu psychologists regarding mental illness, this study aimed to provide a deeper understanding of the impact that religious beliefs have on such conceptualisations. Semi-structured interviews were conducted with six Hindu psychologists around the Johannesburg area, South Africa. Responses were analysed using thematic content analysis. From the findings, it was evident that religion plays a critical role in the understanding and treatment of mental illness. Hindu beliefs around psychological disturbances were salient. Additionally, it was found that a tension existed between psychologists’ awareness of the influential function of religion, particularly amongst collectivistic communities such as the Hindu community, and their occupational understandings and practices, which are deeply rooted in Western thought. Furthermore, it was suggested that the fear of stigma prevented Hindu clients from reaping the benefits of seeking help from culturally competent psychologists.     

Cultural Influences on Perceptions of Health, Illness, and Disability: A Review and Focus on Autism

This conceptual paper considers the role of culture in shaping family, professional, and community understanding of developmental disabilities and their treatments. The meanings of health, illness, and disability vary greatly across cultures and across time. We use Bronfenbrenner’s ecological model to provide a theoretical framework for examining disability, with special attention to autism spectrum disorders. Cultural beliefs about the cause of a disorder influence families’ decision-making about what treatments to use and what outcomes to expect. Autism provides an example that is especially challenging, as there is no agreed-upon cause. Also, an overwhelming array of treatments is available in the West for autism, including behavioral, cognitive, pharmaceutical, sensory, relational, vitamin, and diet therapies. Other cultures contribute additional views on cause (e.g., Karma, Allah’s will) and treatments (e.g., acupuncture, herbal medicines, Ayurveda). We suggest how a broad cultural view can help us understand treatments and the treatment delivery system of a nation and a culture. For the best course of care, professionals need to understand and respect families’ views of autism and work toward mutually agreeable treatments that may involve a combination of biomedical and cultural practices. Although a family-focused, open teamwork model that aims to acknowledge the context of the child, take into consideration the strengths and limitations of the child and the family, and introduce appropriate, sustainable, and sensitive interventions is regarded as best practice in the United States, it will take sensitive work to find out whether it will suit other cultural groups across the world.     

A Study of the Multiple and Complex Needs of Australian Young Adult Offenders

Youth offending is an important issue; it has significant social, psychological, interpersonal, and financial impacts on the society. International research has shown that young offenders generally have multiple and complex needs across a wide range of domains; however, research examining the depth and breadth of difficulties faced by young offenders in Australia is lacking. Arguably, such information is critical to help guide the development of valid preventative and treatment initiatives. This article describes a study examining the prevalence of mental illness, low intelligence, psychopathy, risk for reoffending, and criminogenic needs in 75 youth and young adult offenders in Victoria, Australia. Results suggest that the prevalence of mental illness and low intelligence is high in this population. Most (86%) of the sample had likely Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I disorders (including mood, anxiety, substance use, eating, and psychotic disorders); 15% had a Full Scale Intellectual Quotient (FSIQ) below 70; and an additional 25.7% had an FSIQ in the borderline range. The majority (80%) of the sample was considered to be at a high or very high risk of reoffending. The high prevalence of mental health issues found in this population highlights the need for comprehensive and multifaceted assessment, and for psychosocial treatment and management to be comprehensive, addressing clinical, criminogenic, and social domains.     

Parental Inconsistency: A Third Cross-Cultural Research on Parenting and Psychological Adjustment of Children

Inconsistency in parenting is a factor that may influence children’s mental health. A questionnaire, measuring three parental inconsistencies (temporal, situational, and father-mother inconsistency) was administered to adolescents in nine countries to assess its association with adolescents’ psychological disorders. The results show that parental inconsistency varies across cultures. Temporal inconsistency is not correlated with the other two inconsistencies. Temporal and father–mother inconsistencies, but not the situational inconsistency, were associated with adolescents’ psychological disorders. The associations between parental inconsistency and psychological disorders differed across cultures.     

Improving access to psychological treatments: lessons from developing countries

Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed.     

Mechanisms and the current state of deep brain stimulation in neuropsychiatry

Deep brain stimulation (DBS) is established as a therapy for movement disorders, and it is an investigational treatment in other neurologic conditions. DBS precisely targets neuroanatomical targets deep within the brain that are proposed to be centrally involved in the pathophysiology of some neuropsychiatric illnesses. DBS is nonablative, offering the advantages of reversibility and adjustability. This might permit therapeutic effectiveness to be enhanced or side effects to be minimized. Preclinical and clinical studies have shown effects of DBS locally, at the stimulation target, and at a distance, via actions on fibers of passage or across synapses. Although its mechanisms of action are not fully elucidated, several effects have been proposed to underlie the therapeutic effects of DBS in movement disorders, and potentially in other conditions as well. The mechanisms of action of DBS are the focus of active investigation in a number of clinical and preclinical laboratories. As in severe movement disorders, DBS may offer a degree of hope for patients with intractable neuropsychiatric illness. It is already clear that research intended to realize this potential will require a very considerable commitment of resources, energy, and time across disciplines including psychiatry, neurosurgery neurology, neuropsychology, bioengineering, and bioethics. These investigations should proceed cautiously.