The provision of services for alcohol problems: A community perspective for understanding access

Alcohol use is related to numerous health and social problems. The article describes the prevalence of alcohol problems and dependence across a county and its institutions. While high rates of problem drinking were found across health, mental health, criminal justice, welfare, drug, and alcohol programs, the proportion was highest for primary health clinics, the criminal justice system, and welfare agencies. This also was the case when the county's most serious alcohol problem cases—individuals who were alcohol dependent—were examined. Thus it may be useful to develop screening procedures, mainstream treatment interventions in non-alcohol specialty agencies, and include non-specialty agencies in services research on access.     

II. Risk factors for juvenile justice system referral among children in a public mental health system

The objective of this study is to identify, through the use of secondary data, risk factors for juvenile justice system involvement among children entering a public mental health system. Data-sharing agreements between juvenile justice and mental health systems enabled investigators to examine criminal referrals among 645 children between the ages of 10 to 17 who entered community-based public mental health programs in King County, Washington, over the course of a single year. Univariate and logistic regression analyses were performed. Adjusting for age, gender, and ethnicity, children involved in the public mental health system who had juvenile justice referrals were more likely than children involved in the mental health system without juvenile justice referrals to have parents with a history of incarceration, to abuse drugs and/or alcohol, and to have experienced physical abuse. The study shows that some children who receive public mental health services are at particular risk of having an encounter with the juvenile justice system. Understanding the characteristics and experiences of youth who use multiple service systems has important implications for children's mental health services delivery.     

I. Risk of juvenile justice system referral among children in a public mental health system

This study established the risk of police referral among a cohort of children who were recipients of public mental health services. Investigators used secondary data to calculate the incidence of criminal referral among 645 children, ages 10 to 17, who entered community-based public mental health programs in King County, Washington. Children receiving public mental health services were nearly three times more likely to be referred to the juvenile justice system compared to children of similar age and gender in the general population. Relative risks were particularly high for younger children (10–13 years) and for children of Hispanic, Native American, and Caucasian origin. Understanding the characteristics and experiences of children who use multiple-service systems has important implications for services delivery. In addressing the needs of youth who have both mental illness and criminal involvement, age- and culturally specific interventions and advocacy efforts are warranted.     

Alcohol and drug problems among diverse health and social service populations.

OBJECTIVES. This study responds to clinical and research interest in identifying alcohol- and drug-related problems in health and social service agency populations. These problems are associated with a variety of illnesses and social problems, and community agencies serve important screening functions. METHODS. Indicators of problematic alcohol and drug use are compared across representative samples of clients within a county's alcohol, mental health, and drug treatment systems; hospital emergency rooms; primary health clinics; criminal justice and welfare systems; and general population. RESULTS. Agencies followed a consistent rank ordering in the prevalence of substance abuse indicators. Highest prevalences were found in the populations of behavioral health agencies, including alcohol, drug, and mental health treatment facilities and criminal justice, followed by welfare agencies. General medical agencies served populations with the lowest prevalence and problem severity. CONCLUSION. Health and social service agencies provide significant opportunities for the screening and referral of individuals with problematic alcohol and drug use. Although behavioral agencies have higher potential for referral and intervention, general medical services may be more effective in conducting prevention and early case-finding activities.     

The treatment of child and adolescent mental health problems in primary care: a systematic review

BACKGROUND: There is significant potential to increase the accessibility and effectiveness of child and adolescent mental health services through the involvement of primary care professionals and the delivery of interventions in the primary care setting. However, little is known about the actual clinical and cost-effectiveness of such service delivery. OBJECTIVE: The aim of the study was to review systematically the evidence concerning the effectiveness of interventions for child and adolescent mental health problems in primary care, and interventions designed to improve the skills of primary care staff. METHODS: Searches were made of The Cochrane Clinical Trials Register, MEDLINE, PSYCINFO, EMBASE and CINAHL, together with correspondence with subject experts and authors of studies, and checking of references in identified papers. RESULTS AND CONCLUSIONS: There was some preliminary evidence that treatments by specialist staff working in primary care were effective, although the quality of included studies was variable and no data were available on the cost-effectiveness of interventions. Equally, some educational interventions show potential for increasing the skills and confidence of primary care staff, but controlled evaluations were rare and few studies reported actual changes in professional behaviour or patient health outcomes. A significant programme of research is required if the potential for child and adolescent mental health services in primary care is to be realized in an effective and efficient way.     

Offenders who are mothers with and without experience in prostitution: differences in historical trauma, current stressors, and physical and mental health differences

BackgroundWomen offenders are a growing population in the criminal justice system; most are mothers. A subset of these women have a history of prostitution. Despite more recent research identifying the needs of women offenders who are mothers, those with and without experience in prostitution are still generally represented in the literature as a homogenous group.MethodsThis study examined the differences between mothers who indicated that they had engaged in prostitution with those who had not. The data were from a survey of offending mothers in a Midwestern city and was based on 889 respondents. Approximately 20% of the women indicated that they had engaged in prostitution at some point in their lives.FindingsMothers with histories of prostitution reported more exposure to violence, witnessing crime, living in areas with high drug activity, and having a higher rate of physical and mental health problems.ConclusionsHealth care professionals who interact with mothers in the criminal justice system who have histories of prostitution should be careful to assess for a history of trauma and its psychological consequences. Along with increased health care needs, interventions are needed to help these women obtain basic needs such as stable housing outside of high crime and high drug-use areas and to receive targeted psychological services that respond to the unique trauma suffered by this subpopulation of offenders.     

Health promotion and illness prevention: a biopsychosocial perspective

The biomedical model of disease, in which health is viewed as the absence of disease, is becoming obsolete. Burgeoning health care costs coupled with an increased focus on health promotion and illness prevention have created new demands on the health care delivery system. A biopsychosocial model of health care--in which disease is seen as an interplay between environmental, physical, behavioral, psychological, and social factors--can integrate mental health services into the primary care sector. Social workers, as primary providers of psychosocial care, can close the gap between physical health and mental health services. Strategies for implementing the biopsychosocial model, methods to evaluate its effectiveness, potential problems, and recommendations for future research are discussed.     

Music‐making for health and wellbeing in youth justice settings: mediated affordances and the impact of context and social relations

Young people in the criminal justice system experience significant health and wellbeing issues that often stem from poverty and disadvantage and, in turn, are linked with offending and reoffending behaviour. There is ongoing interest in interventions such as participatory music programmes that seek to foster social reintegration, support mental wellbeing and equip young offenders with life skills, competencies and emotional resilience. However, there is a need for a situated understanding of both positive and negative experiences that shape potential outcomes of music projects. This article reports on a research study undertaken between 2010 and 2013 with 118 young people aged 13–21 years across eight youth justice settings in England and Wales. Using mixed methods we explored the experiences of young people and their responses to a participatory music programme led by a national UK arts charity. Here, we explore the impact of young people's encounters with music and musicians with reference to the notion of ‘musical affordances’ (DeNora 2000 , 2003 ). We examine the ways that such affordances, including unintended outcomes, are mediated by features of the youth justice environment, including its rules and regulations, as well as issues of power, identity and social relations.     

Social model treatment and individuals with dual diagnoses: An ethnographic analysis of therapeutic practice

Concurrent substance and psychiatric problems have been shown to significantly reduce the probability of successful treatment outcomes while increasing vulnerability to a range of troubles including homelessness, incarceration, physical health problems, and criminal victimization. This article presents an ethnographic analysis of treatment processes in a residential social model treatment program specifically designed for individuals with dual diagnoses in an effort to inform current debates with empirically grounded knowledge regarding therapeutic practice itself. The article focuses on four fundamental themes bearing on therapeutic practice in this residential program: social model treatment; the formulation of clinical identities; recovery, personal responsibility, and authority; and the measurement of therapeutic success. In conclusion, the article suggests that the central role played by program residents in the therapeutic process deserves particular attention and makes recommendations regarding mental health services delivery that, if followed, might invigorate treatment efficacy.     

Challenges to HIV prevention in psychiatric settings: perceptions of South African mental health care providers

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.     

Justice System Involvement Into Young Adulthood: Comparison of Adolescent Girls in the Public Mental Health System and in the General Population

We compared arrest onset and frequency and types of charges between a statewide cohort of adolescent girls in the public mental health system and girls of the same age in the general population to investigate important differences that could have policy or intervention implications. Girls in the public mental health system were arrested at earlier ages more frequently and were charged with more serious offenses than were girls in the general population. Our results strongly argue for cooperation between the public mental health and justice systems to provide mental health and offender rehabilitation in their shared population.Males predominate in the juvenile and criminal justice systems, but females are becoming increasingly involved in them as well.^1,2 Among youths with justice system involvement, psychiatric disorders are more prevalent among females than males.^3–6 Adolescent girls receiving intensive mental health treatment are at high risk of arrest,⁷ with one third of those receiving adolescent public mental health services arrested by age 18 years, and nearly one half by age 25 years. Female offender prevention and reduction interventions are in their infancy^8,9; thus, it is an opportune time to identify factors that may be important considerations in treatment that differentiates between girls involved in the justice system who are and are not recipients of adolescent public mental health services. We compared arrest prevalence, onset age, age-specific risk of arrest, and charge types at age 7 to 25 years of recipients of adolescent public mental health services and females in the general population.     

Health Care Reform,Behavioral Health,and the Criminal Justice Population

The 2010 Patient Protection and Affordable Care Act (ACA) has a number of important features for individuals who are involved with the criminal justice system. Among the most important changes is the expansion of Medicaid to more adults. The current study estimates that 10% of the total Medicaid expansion could include individuals who have experienced recent incarceration. The ACA also emphasizes the importance of mental health and substance abuse benefits, potentially changing the landscape of behavioral health treatment providers willing to serve criminal justice populations. Finally, it seeks to promote coordinated care delivery. New care delivery and appropriate funding models are needed to address the behavioral health and other chronic conditions experienced by those in criminal justice and to coordinate care within the complex structure of the justice system itself.     

The explanatory models of mental health amongst low-income women and health care practitioners in Lusaka, Zambia

There is currently much debate about the cultural construction and specificity of mental health. It is thus not surprising that explanatory models, which look at the meaning of illness for those suffering from it, have been widely used within the mental health field. This paper considers the significance of explanatory models and presents a study comparing the explanatory models of mental ill health used by urban women in low-income groups and local health care practitioners in ZAMBIA: To measure mental ill-health status, an instrument recommended by the World Health Organization was used - the Self Reporting Questionnaire, 20 items (SRQ 20). To obtain explanatory models, Kleinman's classic eight questions were adapted. The terms used by the practitioners to define and explain the mental health problems of women in low-income groups were 'stress and depression', with these two concepts being used interchangeably. In contrast, the phrase most frequently used by the women was 'problems of the mind'. The professionals regarded the experience of depression itself as a manifestation of ill health. For the women, however, only the physical symptoms were defined as ill health. There was a common agreement, however, that the women's socioeconomic situation as a major causal factor. Both groups identified the home environment as a key determinant, particularly the quality of marital relationships. Greater awareness of explanatory models may have beneficial effects on mental health policy and planning, both at national levels (where recognition of the true prevalence and burden of mental ill health should have an impact on public health policy) and at the level of local implementation (where training of health professionals to take patients' explanatory models into account might contribute towards the diagnosis of mental health problems).     

Parental involvement with the criminal justice system and the effects on their children: a collaborative model for researching vulnerable families

Despite the existing body of research examining the effects of imprisonment on incarcerated adults, as of yet, there is no solid empirical evidence for understanding the effects of parental involvement with the criminal justice system involvement (CJSI) on children and families. Accordingly, Columbia University-New York State's Child Psychiatric Epidemiology Group (CPEG), supported by a strong collaboration with The Bronx Defenders, a holistic public defender providing free legal representation, is conducting a longitudinal study examining the effects of parental involvement with the criminal justice system on this population. The study aims to understand, over time, the impact of parental CJSI on their children's mental health, including the effects of the collateral legal damage of CJSI (such as eviction and deportation), substance use, the development of risky behaviors leading to the child's potential involvement with the criminal justice system, as well as protective factors and identification of potential intervention points, which has the ability to inform public policy.     

Prevalence of Children’s Mental Health Problems and the Effectiveness of Population-Level Family Interventions

The prevalence of mental health problems among children and adolescents is of growing importance. Intervening in children’s mental health early in life has been shown to be more effective than trying to resolve these problems when children are older. With respect to prevention activities in community settings, the prevalence of problems should be estimated, and the required level of services should be delivered. The prevalence of children’s mental health disorders has been reported for many countries. Preventive intervention has emphasized optimizing the environment. Because parents are the primary influence on their children’s development, considerable attention has been placed on the development of parent training to strengthen parenting skills. However, a public-health approach is necessary to confirm that the benefits of parent-training interventions lead to an impact at the societal level. This literature review clarifies that the prevalence of mental health problems is measured at the national level in many countries and that population-level parenting interventions can lower the prevalence of mental health problems among children in the community.Key words: child, mental health, prevalence, family intervention, evaluation     

The criminal justice/mental health system and the mentally retarded, mentally ill defendant

The mentally retarded, mentally ill defendant calls attention to problems in the relationship between the legal and the mental health systems. This study looks at what happens to a group of retarded offenders found incompetent to stand trial. The study examines differences in court processing and final disposition between mentally retarded and nonretarded defendants found incompetent to stand trial. Virtually all subjects were diagnosed as being psychotic. The mentally ill, retarded defendants spend significantly more time in the hospital, more time in the hospital waiting to be returned to jail, and more total time incarcerated in the criminal justice/mental health system. At a final disposition hearing mentally ill, retarded defendants were significantly more likely to be rehospitalized and less likely to be released to the community. No mentally ill, retarded defendant in this study went to prison. The longer periods of incarceration may stem from an underlying lack of understanding about the ability of retarded defendants to achieve competency. Differences in court disposition may result from a court/mental health professional tendency to select dispositions which are thought to be more 'humane'.     

Criminal Justice Involvement after Release from Prison following Exposure to Community Mental Health Services among People Who Use Illicit Drugs and Have Mental Illness: a Systematic Review

Illicit drug use and mental illness are common among people in prison and are associated with higher rates of reoffending and reimprisonment. We conducted a systematic review, searching MEDLINE, Embase, and PsycINFO to January 10, 2022, for studies reporting criminal justice involvement following exposure to community mental health services among people released from jail or prison who use illicit drugs and have mental illness. Our search identified 6954 studies; 13 were eligible for inclusion in this review. Studies were separated into three broad categories based on community mental health service type. Eleven of 13 studies reported a reduction in criminal justice involvement among participants exposed to community mental health services compared to a comparison group. Findings indicate a need to expand and improve integration and referral mechanisms linking people to community mental health services after jail or prison release, alongside a need for tailored programs for individuals with complex illicit drug use and mental health morbidities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-022-00635-5.     

The changing role of the social worker in the mental health system

The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons. Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served. Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.