Patterns of suicide among hospitalized mentally disordered offenders

The case records of 29 mentally disordered offenders who committed suicide in a state hospital were reviewed. Information was collected on demographic and clinical characteristics; time, method and location of the suicides; and the presence of suicide indicators. Comparisons were made between the characteristics of the suicide patients and those of the current hospital population. Major findings were: 80 percent of the suicides were committed by psychotic patients and 66 percent were by patients with diagnoses which included paranoia; 48 percent of the suicide patients had been charged with or convicted of murder or attempted murder; most suicides occurred in individual patient rooms; nearly 50 percent of the patients had a history of suicide attempts; and other common indicators of suicide risk were often masked by psychotic symptomatology. Several recommendations for identifying and managing potentially suicidal patients in this population are presented.     

Co-occurring disorders among mentally ill jail detainees. Implications for public policy.

Studies have demonstrated that police often arrest the mentally ill when treatment alternatives would be preferable but are unavailable. Thus, jails may contain disproportionate numbers of severely mentally ill persons who have co-occurring disorders. Data on the co-occurrence of severe mental disorder, substance abuse, and antisocial personality disorders were gathered from 728 randomly selected male urban jail detainees. Using difference of proportions tests and loglinear analysis, the authors demonstrated that most subjects with a severe mental disorder (schizophrenia or a major affective disorder) also meet criteria for a substance abuse or antisocial personality disorder. These findings suggest several changes in public policy regarding health care delivery in correctional settings and for the general population.     

Transition planning and recidivism among mentally ill juvenile offenders

OBJECTIVES: To determine the extent to which transition planning and community service would predict lower levels of recidivism among mentally ill juvenile offenders. DESIGN: Review of legal, medical and social service records including examination of 3-month period following community release. PARTICIPANTS: Juvenile offenders incarcerated for 6 months or more (N = 44) transitioning to community. MEASURES: Child and Adolescent Functional Assessment Scale (CAFAS), sum of different documented pre- and post-release discharge planning contacts, documented community service contacts. OUTCOMES: Re-offense during the first year post-release. RESULTS: Documented community service contacts in the 3 months following discharge were rare for mental health (20.5%), substance abuse (38.6%), financial assistance (29.5%), and school placement (34.1%). The average number of different pre-release and post-release discharge planning contacts was also low, M(SD)=1.86(1.68) and M(SD)= 2.34(1.71) respectively. Post-release discharge planning and the receipt of financial assistance and mental health services were all associated with lower levels of reoffending. CONCLUSIONS: Community transition planning, including the coordination and provision of community services, is an essential component of community reintegration for juvenile offenders and is associated with lower rates of recidivism during the first year post-discharge.     

Reliability of perceptual learning style preferences of chronically mentally ill adults.

36 chronically mentally ill adults were administered the perceptual learning style items (auditory, visual, kinesthetic) from the Productivity Environmental Preference Survey. A retest was given 6 months later. Analysis showed that, although the instrument can be reliably scored, content and time sampling error more than account for the variance in these subtests. Self-reported perceptual learning style appears to be a transient phenomenon of limited practical utility in this population.     

Guilty but mentally ill: An alternative verdict

Despite opposition from professional groups such as the American Psychiatric Association and the American Bar Association, “Guilty But Mentally Ill” (GBMI) statutes now exist in at least 12 states and are being considered in others. This paper reviews the development of the GBMI alternative to the insanity defense from a historical perspective, focusing especially on the reasons for its development in Michigan, the first state to pass GBMI legislation over 9 years ago. Using the Michigan experience, the GBMI statute is reviewed in terms of its perceived purpose and its success in accomplishing that purpose. Then recommendations for future changes are made.     

Mental health needs of the chronically mentally ill elderly

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population.