Adolescent sex offenders with mental retardation: Literature review and assessment considerations

Working with adolescent sex offenders can be a difficult challenge. When an offender also suffers from mental retardation, this challenge increases. Unfortunately, this has been a largely ignored population, and clinicians working with this group often find little empirical work to assist them. Yet, many theorists posit that addressing sexual offending behavior when the offender is an adolescent may help prevent that behavior from continuing into adulthood. This is important because adult sexual offenders are often very difficult to treat. The current paper begins by reviewing literature on social deficits of individuals who have mental retardation. These deficits may contribute to aberrant sexual behavior among adolescents. The focus of the paper is then a review of literature on adolescent sex offenders, including those with mental retardation. We conclude this review with suggestions for assessment of adolescent sex offenders and with recommendations for future directions.     

Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study

This quasi-experimental non-equivalent comparison group study examines outcomes for participants in eight programs conducting criminal justice diversion for people with co-occurring serious mental illness and substance use disorders compared with jail detainees eligible for diversion, but who were processed through standard criminal justice methods without diversion. Nearly 2000 participants were interviewed at baseline, and 1500 at 3 month and 1300 at 12 month follow-up to baseline. In these interviews, outcome measures of re-arrest, mental health functioning, substance abuse, quality of life, and service utilization were obtained. Those diverted were more likely to have received mental health counseling, mental health medication, and mental health hospitalization than those not enrolled in a diversion program, but were equally likely to have received substance abuse counseling. Overall, the differences in proportions receiving services between the two groups were small, even when these differences were statistically significant. The effect associated with diversion differed somewhat across the individual sites. However, overall cross-site pooled analyses revealed no outcome differences between groups on measures of mental health symptoms, substance use, criminal justice recidivism, or quality of life. Although the immediate benefit of diversion as an access mechanism to community treatment is indicated in pooled cross-site results, such access was driven by more coercive (pre-booking and court) models and results suggest that effecting substantially greater access to services or services use did not occur. The findings also suggest that mental health, substance abuse, and criminal justice outcomes remain dependent on the treatment intervention received, perhaps moderated by type of diversion intervention, rather than on a generic and initial diversion event.     

Familiarity with and social distance from people with mental illness: Testing the mediating effects of prejudiced attitudes

The purpose of this study was to examine prejudiced attitudes as a factor associated with social distance from people with mental illness. A total of 289 university students from Greece completed written measures assessing social distance from, prejudiced attitudes about, and familiarity with mental illness. A structural equation model with manifest variables was tested. Participants who reported to be more familiar with mental illness held stronger social care and weaker prejudiced beliefs, and consequently expressed a less strong desire for social distance. Implications of the results and suggestions for future research are outlined. Copyright © 2011 John Wiley & Sons, Ltd.     

Healthcare's greatest challenge: providing services for people with severe mental illness in managed care

The delivery of services for people with severe mental illness (SMI) is described as healthcare's most difficult challenge because SMI patients suffer from the combined effects of conditions that have 1) a chronic course, 2) disabling consequences, and 3) a high risk of poverty. The fundamental advantages of managed care for persons with chronic, disabling conditions are discussed along with an examination of how well these assumptions hold in actual practice for persons with SMI. The legal risks assumed by clinicians in managed care are reviewed, including the inherent risk of discriminating against high cost enrollees, such as patients with SMI. Finally, recommendations are made regarding the measures that might be taken to increase the "match" between the principles of managed care and the specialized needs of people with severe mental illness.     

The power of a place: Opening the college classroom to people with serious mental illness

Presented the structure and implementation of a university-based practicum course on social relationships for people with serious mental illness and college undergraduates. Grounded in an ecological view of social settings, cooperative learning models of education and mutual help principles, the practicum was designed to create a collaborative classroom setting where undergraduates and people with serious mental illness could both develop and enhance their own interpersonal skills and social network ties. The practicum demonstrates how a university can use its resources to help address community needs while simultaneously enhancing its mission of teaching and research. The role of social context in creating collaborative relationships among participants and the use of the university as a community resource are discussed.     

Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co-occurring substance use disorders

In recent years, jail diversion programs for people with serious mental illness and co-occurring substance use disorders have received increasing attention and have rapidly grown in number. Previous studies suggest that jail diversion programs have the potential to achieve positive outcomes. The present study reports findings from 6 jail diversion programs (3 pre-booking and 3 post-booking) participating in a federally-funded research initiative to assess the effectiveness of jail diversion programs for people with co-occurring disorders. Diverted and non-diverted groups were compared on self-reported outcomes at 12 months following diversion. The findings suggest that jail diversion reduces time spent in jail without increasing the public safety risk, while linking participants to community-based services. Jail diversion costs and the implications of these results for jail diversion programs and future research are discussed.     

The unwanted child and mental illness: A brief,selective review

A commonly held belief is that the unwanted child is at risk for emotional disorders. This article teases out the aspects of unregulated fertility that are likely to result in an unwanted child and examines the evidence that suggest their relationship to mental illness.Samuel O. Okpaku, M.D., Ph.D., is in private practice.     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.     

Legal issues in maximum security institutions for people with mental illness: liberty,security, and administrative discretion

This article explores four legal issues relevant to the provision of care in secure hospitals. These include the current status of right to treatment litigation; the potential impact of the Americans with Disabilities Act; new developments in laws governing restraint and seclusion; and the need for uniform institutional policies on risk assessment. These issues illustrate the potential conflicts between individual autonomy and institutional control that have been at the heart of mental health law for three decades. The article suggests that because of the diminishing oversight provided by the federal judiciary, institutional custodians have a particular obligation to ensure that individual rights are not overwhelmed by concerns with security.     

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.     

Microaggressions: The experience of individuals with mental illness

The main objective of the study was to investigate the types of microaggressions experienced by individuals with mental illness (MI) based on this marginalized group status. This study included 4 focus groups, comprised of 18 individuals diagnosed with MI(es). The researchers qualitatively identified four themes (a) conveying stereotypes against individuals with MI (i.e. assumptions of inferiority, seeking attention or being dramatic, assumptions of coldness, bringing MI upon themselves, and using MI as an excuse), (b) invalidating the experience of having a MI (i.e. doubting existence, doubting severity, and avoiding acknowledgment of the MI), (c) defining a person by their disorder, and (d) misuse of terminology. Participants revealed the main perpetrators (i.e. family, friends, and professionals) of the microaggressions. The researchers discuss: how the identified themes compare to the three categories of microaggressions (i.e. microinsults, microinvalidations, and microassaults); similarities and differences between the current results and previously identified racial, gender, and sexual orientation microaggressions perpetrated in daily interactions and in therapeutic settings; and the perpetrators of microaggressions as they relate to prejudicial attitudes and social distance. Finally, the authors make recommendations for practitioners and researchers.     

Demon or disorder: A survey of attitudes toward mental illness in the Christian church

The present study assessed the attitudes and beliefs that mentally ill Christians encountered when they seek counsel from the church. Participants (n?=?293) completed an anonymous online survey in relation to their interactions with the church. Analysis of the results found that while a majority of the mentally ill participants were accepted by the church, approximately 30% reported a negative interaction. Negative interactions included abandonment by the church, equating mental illness with the work of demons, and suggesting that the mental disorder was the result of personal sin. Analysis of the data by gender found that women were significantly more likely than men to have their mental illness dismissed by the church and/or be told not to take psychiatric medication. Given that a religious support system can play a vital role in recovery from serious mental disorders, these results suggest that continued education is needed to bring the Christian and mental health communities together.     

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.