Growth of mental health services in state adult correctional facilities, 1988 to 2000

OBJECTIVE: This study examined trends in the availability and use of mental health services in state adult correctional facilities. METHODS: Results from the 1988 Inventory of Mental Health Services in State Adult Correctional Facilities of the Center for Mental Health Services were compared with those from the 2000 Census of State and Federal Adult Correctional Facilities survey of the Bureau of Justice Statistics. The two surveys were chosen because they occurred more than a decade apart, had a reasonable amount of data, and could be made comparable. RESULTS: This analysis used data from 757 state adult correctional facilities that were sampled in 1988. The number of such facilities increased to 1,097 in 2000, a 44.9 percent increase. A dramatic increase was also seen in the prison population, from 505,712 in 1988 to 1,084,625 in 2000, a 114.5 percent increase. Mental health services were offered in significantly more facilities in 2000 than in 1988. However, the relative percentage of facilities that offered mental health services decreased overall. Simultaneously, the percentage of inmates who used these services increased overall. CONCLUSIONS: The growth in prison facilities and the growth in prisoner populations are outstripping the more meager growth in mental health services. These results suggest that mental health services are becoming less available to the prison population, and service populations are becoming more concentrated in the facilities that do offer such services.     

青少年认知偏差和心理健康的关系

目的探讨青少年认知偏差的特点及其与心理健康关系。方法以中小学生认知调查量表、中国中学生心理健康量表为工具,随机抽取广州市3所中学653例中学生进行研究。结果（1）认知偏差问题总体检出率为35．4％,严重认知偏差检出率为2．9％,“过度完美”、“苛求善待”是主要认知偏差问题;（2）中度以上心理健康问题检出率为4．3％,较严重的心理健康问题检出率为0．15％,“情绪不良”、“学习压力”、“适应不良”是主要心理健康问题;（3）认知偏差与心理健康相关显著,维护自我、获得关注、苛求善待、消极态度对心理健康有预测作用,联合解释率是16．7％。结论青少年认知偏差与心理健康之间存在显著负相关,本研究提示可利用认知调节来提高中学生的心理健康水平。     

Homelessness and indicators of mental illness among inmates in New York City's correctional system.

Data from three cross-sectional samples of inmates in the New York City correctional system (N = 299, 236, and 151) were analyzed to determine the prevalence of homelessness among detainees. One-fourth to one-third of each sample had been homeless at some time during the two months before arrest, and 20 percent of the primary sample of 299 inmates had been homeless the night before arrest. Further analysis of the primary sample showed that homelessness was strongly associated with mental illness: 50 percent of those who had ever been homeless during the past three years responded positively to at least one mental illness screening question, compared with 25 percent of the never-homeless inmates. More than a third of the ever-homeless group had received mental health treatment, compared with a fifth of those who had never been homeless.     

A continuum of mental health care for children and adolescents

As an alternative to the confusing patchwork that often characterizes child and adolescent mental health care, the mental health program of a children's social welfare agency offers a continuum of inpatient and outpatient services on one campus. The program operates a 36-bed psychiatric hospital, a 38-bed residential treatment program, a partial hospital for ten children and adolescents, and a large outpatient service, and it can draw on the agency's foster care, emergency shelter, and home-based therapy services. Treatment in all the services is provided by multidisciplinary treatment teams, which have primary responsibility for coordinating a patient's transfer with other elements of the continuum and for initiating a patient's discharge. A case study illustrates some of the practical considerations that influence treatment decisions in the continuum.     

A mental health survey of community correctional clients in Canada

Probation and parole officers completed a brief survey questionnaire on 2500 community correctional clients, who were randomly selected from a total caseload of 60 000 active files. The survey instrument inquired about the mental health histories and the clinical or programme needs of these clients, most of whom (76.5%) were on probation. Among the sample, 13.2% had a known psychiatric diagnosis, including 5.0% who had been diagnosed with a schizophrenic illness, bipolar disorder or mental retardation. A total of 6.4% had at least one documented psychiatric hospitalisation. Subjects with a history of hospitalisation had an average of 4.6 psychiatric admissions and an average total of 73.2 days' stay in mental health facilities. A total of 9.0% had a rating on the Global Assessment of Functioning scale that indicated serious mental health symptoms or serious social impairment, whilst 2.0% were rated as being suicidal, grossly impaired or delusional. Collectively, 18.9% met at least one of the three criteria, whilst 8.3% of the subjects met two or more of the criteria. Disordered clients were more likely than their non-disordered counterparts to have inadequate accommodation, to live alone, and to be in an institution or on social assistance and less likely to be employed or in school. According to staff ratings, the commonest need areas for the disordered offenders were general counselling, alcohol/drug programmes, psychological services, life/social skills training, psychiatric assessment and employment. Needs were most likely to be met for medical problems and least likely for non-clinical, social services. Refusal, lack of motivation, dropping out from a service and unsuccessful previous participation accounted for approximately one-half of the unserviced needs. The importance of integrating services between health, corrections and social service agencies for disordered offenders is highlighted. Copyright © 1996 Whurr Publishers Ltd.     

A study of suicide in state mental hospitals in New York city

Suicides at five state hospitals for the mentally-ill located in NYC were studied over a 32 month period. The suicide rates at the individual hospitals appeared to be primarily related to the acuteness of inpatient population and secondarily to the socioeconomic-ethnic characteristics of the inpatient population. White young Puerto Rican male, better educated female involuntarily committed, schizophrenic, and affective disordered patients were overrepresented in the suicide group; black patients were underrepresented. From clinical data two profiles of psychiatric inpatients at high risk for suicide were constructed; 1) a male paranoid schizophrenic with previous suicide attempts involuntarily committed due to acute psychosis who hangs himself in his room or bathroom during the first weeks of hospitalization; 2) a chronic undifferentiated schizophrenic often with affective component who has been hospitalized for more than one month and who is considered by staff to be improving, but is having difficulty with discharge planning who commits suicide by jumping while out of the hospital on an authorized pass. Recommendations were made for reducing inpatient suicides.     

Crisis stabilization services for children and adolescents: A brokerage model to reduce admissions to state psychiatric facilities

There continues to be an increased interest in developing communitybased services for children and adolescents as an alternative to inpatient care. However, there has been much more talk than action in creating such alternatives. This paper describes the success of a crisis stabilization program for children and adolescents in a community mental health center which historically over-utilized the State psychiatric facility for youth. The Crisis Stabilization Program consists of three components: (1) a two-person crisis team, (2) a four-person on-call team for after hours crises, and (3) funds which the crisis team utilized to broker for a wider array of community-based services.     

Barriers to the delivery of mental health services: the New York City experience.

The author discusses some of the barriers encountered in attempting to transform New York City's fragmented mental health services into a comprehensive, nondiscriminatory, and accessible system. Among the barriers he identifies are the belief that more money alone will solve the problem; the uneven distribution of funds among the boroughs of the city and the resistance of existing agencies to redistribution; and the way in which reimbursement patterns shape the kinds of services provided. He believes the single most effective stimulus to the development of an integrated system of care would be a requirement that eligibility for reimbursement under Medicaid be based on a facility's participation in a comprehensive system of care. He emphasizes the need to remove social, rehabilitation, and other services from under the mental health umbrella and to obtain other sources of funding for them; the need for local governance of services; and the need to provide work opportunities for the more seriously disabled.     

A review of physical activity interventions on determinants of mental health in children and adolescents

The purpose of this article was to review the effects of physical activity (PA) lifestyle intervention on determinants of mental health among children and adolescents. A search was performed using the databases Academic Search Premier, CINHAL, EBSCOHost, PsycARTICLES and PsycINFO. Inclusion criteria were studies that utilized PA interventions designed to impact a determinant of mental health in a target population of 6–18 years. From this search, 537 results were identified and eight met the inclusion criteria. All studies reported an inverse relationship between PA and depression. Seven found a significant (p < 0.05) reduction in depression when various aerobic and/or resistance training exercises were introduced. Only one study found a negative correlation between very light intensity activity and determinants of psychological health (e.g. depression and anxiety); however, these results were not statistically significant. In conclusion, promoting PA appears to improve determinants of mental health, such as depression, global self-worth and self-efficacy. Recommendations for enhancing future interventions are presented.     

Hidden cost of children's outpatient mental health services: Lessons from New York state

The cost of outpatient mental health services for children is described in terms of services provided and management practices, and contrasted with spending for adult services. Staff in children's clinics experience more difficulty in fee collection, must schedule more evening hours, require more training and supervision, and have more problems in maintaining caseload standards and clinical records. Administrative staff spend more time marketing services and maintaining a positive community image, and sometimes sacrifice efficiency in the interest of social responsibility.     

Effects of internal displacement and resettlement on the mental health of Turkish children and adolescents.

AIMS: To evaluate the effects of internal displacement and resettlement within Turkey on the emotional and behavioral profile of children, age 5-18 after controlling for possible confounding and demographic variables. METHOD: We conducted a national population survey using a self-weighted, equal probability sample. We compared the CBCL, TRF and YSR responses regarding children with (n = 1644) and without (n = 1855) experience of internal displacement. We examined the effects of gender, age, paternal employment, resettlement, urban residence and physical illness. RESULTS: The children and adolescents with internal displacement had significantly higher internalizing, externalizing and total problem scores on the CBCL and YSR, and higher internalizing scores on the TRF. The effect of displacement was related to higher internalizing problems when factors like physical illness, child age, child gender and urban residence were accounted. The overall effect was small explaining only 0.1-1.5% of the total variance by parent reports, and not evident by teacher reports. DISCUSSION: To our knowledge the present study is the first to examine Turkish children and adolescents with and without experience of internal displacement. The results are consistent with previous immigration studies: child age, gender, presence of physical illness and urban residence were more important predictors of internalization and externalization problem scores irrespective of informant source.     

A note on nonprofessional judgments of mental health

Ninety Ss who had either not received or not completed formal diagnostic training made mental health judgments about 60 hypothetical persons, each of whom was represented on a 7-cue behavior profile. A comparison of these judgments with those made by 24 clinical psychologists and psychiatrists failed to reveal a significant difference between groups in terms of scope of cue utilization, magnitude of judgments, or confidence. Differences between groups were obtained, however, in terms of judgment reliability and profile cue utilization. Notable in regard to the latter was the finding that nonprofessional Ss usually ignored information of a positive nature (enthusiasm), and tended to weight heavily information about violations of legal norms.Mr. Faucher and Ms. Chapman are doctoral candidates at the University of Kansas. The research reported here was supported by NIMH Grant MH-17621-01 and by NIMH Grant MH-16437-02. The authors gratefully acknowledge the assistance of Karene Will, Bertha Ramsey, and David Purdy.     

Trends in the delivery of mental health services for children and adolescents

Current systems for delivery of mental health services to children and adolescents are woefully inefficient, inadequate, and fragmented. The author briefly reviews specific deficits and then discusses eight aspects of an integrated program that will provide easy access to appropriate mental health care for all children who need it with a minimum of stress on their families.     

儿童青少年个性特征与心理健康状况的相关研究

目的探讨儿童青少年个性特征与心理健康状况的相关性,以期从个性完善层面降低心理健康问题的发生率,为儿童青少年的心理干预提供指导。方法于2005年-2013年在重庆市招募748名6~16岁的儿童青少年及其家长,儿童青少年填写儿童版艾森克人格问卷(EPQ)以了解其个性特征,家长填写家长版长处与困难量表(SDQ)以了解孩子的心理健康状况。对EPQ和SDQ评分进行双变量相关分析。结果儿童青少年EPQ的精神质(P)、神经质(N)因子评分与SDQ的情绪问题、行为问题和同伴问题因子评分呈正相关(r=0.087~0.198,P0.05或0.01),与亲社会因子评分呈负相关(r=-0.178,-0.105,P0.05或0.01);儿童青少年EPQ的内外向(E)因子评分与SDQ的情绪问题、同伴问题因子评分呈负相关(r=-0.168,-0.164,P均0.01),与亲社会因子评分呈正相关(r=0.138,P0.01);EPQ的掩饰性(L)因子评分与SDQ的行为问题因子评分呈负相关(r=-0.089,P0.05),与亲社会因子评分呈正相关(r=0.194,P0.01);而总的困难评分与EPQ的P、N因子评分呈正相关(r=0.172,0.169,P均0.01),与E因子评分呈负相关(r=-0.127,P0.01)。结论儿童青少年的个性特征与心理健康相关,重视儿童青少年个性形成、矫正不良个性对于心理健康有重要意义。     

Patterns of utilization of outpatient mental health services by children and adolescents.

Although as many as one-fifth of children and adolescents may meet DSM-III criteria for at least one psychiatric diagnosis, data from the Minnesota Department of Human Services for 1988 show that only 20 to 38 percent of children and adolescents in the state who are eligible for medical assistance and who are potentially in need of psychiatric care are referred for or seek treatment. A study of publicly funded mental health care for youths under 18 found that in 1988 the average cost for state-supported psychiatric services per outpatient case was $520, compared with $8,556 per inpatient case. However, overall cost of state-supported mental health services for youths under 18 increased by 28 percent between 1987 and 1988, primarily due to increases in payments for inpatient care of patients with dual diagnoses of mental illness and chemical dependency.     

Long-term mental health outcome of returning migrant children and adolescents

 We examined how remigration influences the prevalence of psychiatric symptoms among children and adolescents in the long term. We investigated depressive and behavioral symptoms in 320 Finnish children and adolescents who moved back from Sweden while of school-age during the years 1984–1985 and in a series of controls. The data were gathered in two phases, with questionnaires sent to the parents, children and teachers in 1986, and with further questionnaires sent to the parents and children in 1992. Depression was measured by means of the Children’s Depression Inventory (CDI) (8) and behavioral symptoms with the Children’s Behavioral Questionnaire, filled in by the teachers (14) in the first phase and by the parents (15) in the second. We compared prevalence of these psychiatric symptoms between the migrants and controls in groups divided by age and sex in the two phases and examined how depressiveness or behavioral disturbance shortly after migration served to predict later psychiatric symptoms. The following findings emerged: The boys who moved before puberty had more psychiatric symptoms than their controls in both phases, while the best-adapted group consisted of the girls who moved before puberty. Those migrant children who moved during puberty had more psychiatric symptoms than their controls only in the second phase. The depressive features and behavioral disturbances observed among the migrants during the first phase did not lead to disturbances in the second phase, whereas an association was found between psychiatric disturbances among the native controls in the first and second phases. Accepted: 5 February 1998     

Commentary: the use of restraint and seclusion in correctional mental health

In contrast to the position taken in the American Psychiatric Association's "Resource Document on The Use of Restraint and Seclusion in Correctional Mental Health Care," this commentary proposes limiting the use of mental health restraints to the stabilization of unsafe situations during the time it takes to transfer an inmate to a psychiatric hospital. Jails and prisons are inherently nontherapeutic environments and are not adequate settings for managing mental health emergencies, such as those that require the use of restraints. Correctional conditions often contribute to the onset, and impede the resolution, of the underlying mental health crisis. Attempts to contain mental health emergencies in a correctional setting with an expanded use of restraints can compromise clinical care, overlook the root cause of many crises, impair the role of mental health professionals by blurring the distinction between mental health and security staff, and can lead to a deterioration in the standards of care.