Does Transinstitutionalization Explain the Overrepresentation of People with Serious Mental Illnesses in the Criminal Justice System?

Although there is broad consensus that people with serious mental illnesses (SMI) are overrepresented in correctional settings, there is less agreement about the policy trends that may have created this situation. Some researchers and policymakers posit a direct link between deinstitutionalization and increased rates of SMI in jails and prisons, a phenomenon described as transinstitutionalization. Others offer evidence that challenges this hypothesis and suggest that it may be a reductionist explanation. This paper reviews claims from both sides of the debate, and concludes that merely increasing access to state psychiatric hospital beds would likely not reduce the number of people with SMI in jails and prisons. A more nuanced approach is recommended for explaining why people with SMI become involved in the criminal justice system and why developing effective strategies to divert them out of jails and prisons and into community-based treatment is needed to improve both their mental health and criminal justice outcomes.     

Navigating the Disability Determination Process from the Perspective of Incarcerated Adults with Serious Mental Illnesses

In the U.S. serious mental illness (SMI) is common in jails, which are often primary healthcare providers. Incarceration and healthcare are intertwined—lack of care access increases the risk of imprisonment which decreases care access. This case study explores a jail program which assists people with SMI with the disability determination process. Interviews with employees (n?=?4) and clients (n?=?25), and administrative data from jail databases on recidivism, benefit receipt, and demographics highlight the importance of reentry planning and access to resources in crime desistance, as well as how the program increased resource access, and provided feelings of hope and safety.     

HIV, STD, and Sexual Risk Reduction for Individuals with a Severe Mental Illness: Review of the Intervention Literature

Seroprevalence studies indicate that HIV infection rates are elevated among individuals with a severe mental illness (SMI) compared to the general population. The higher prevalence of HIV among individuals with SMI has prompted the development and evaluation of tailored sexual risk reduction programs for these individuals. In this paper, we review the literature on sexual risk-reduction interventions for individuals with SMI, including interventions for both uninfected and infected individuals. We discuss components of successful interventions, identify limitations in the current literature, and highlight directions for future research. Finally, we conclude with implications for clinical practice, including a discussion of the challenges and advantages to implementing sexual risk reduction interventions for individuals with SMI.     

The Stigma of Severe Mental Illness: Some Potential Solutions for a Recalcitrant Problem

Despite recent advances in the treatment of individuals with severe mental illness (SMI), their full integration into society is hindered by lingering negative attitudes towards them. In this paper, a brief overview is provided on stigmatization towards individuals with SMI, including its' impact on quality of life and self-esteem, as well as the factors which likely underlie it. Research is reviewed showing that lowered negative perceptions towards persons with SMI are associated with previous contact with this population and with presentation of empirically-based information on the association between violence and SMI. Limitations of these findings are discussed with an eye towards developing improved techniques for reducing stigma.     

Preferences for Smoking Cessation Support from Family and Friends Among Adults with Serious Mental Illness

Engaging natural supports may be a promising strategy to promote the use of evidence-based smoking cessation treatment for individuals with serious mental illness (SMI) who smoke. This qualitative study explored preferences for support for quitting from family and friends among individuals with SMI who participated in cessation treatment. Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. Open-ended questions asked during a social network interview explored participants’ preferences for more support for quitting smoking from family and friends. The qualitative data was coded and common themes were identified across the dataset. Three primary preferences emerged for smoking cessation support from family members and friends: 1) more practical support for quitting (e.g., financial help with purchasing cessation medications); 2) more emotional support for quitting (e.g., encouraging progress toward quitting); and 3) changing their own smoking behaviors in the presence of participants (e.g., don’t smoke around them or offer them cigarettes). Individuals with SMI who participated in smoking cessation treatment at community mental health centers indicated several ways that family members and friends could support their efforts to quit smoking. Understanding how people with SMI want support from family and friends to quit smoking will inform strategies to leverage these natural resources to promote the use of evidence-based smoking cessation treatment and support smoking abstinence for this population.     

Chronic disease self-management interventions for adults with serious mental illness: a systematic review of the literature

Objective

While there is strong evidence in support of chronic disease self-management programs, much less is available with regard to individuals living with serious mental illness (SMI). The objectives of this review are to identify and appraise chronic disease self-management studies tested with samples of US adults living with SMI. We include an appraisal of methodological quality of the chronic disease self-management (CDSM) studies that met our final criteria.

Methods

Systematic search methods were utilized to identify intervention studies published before 2012 that describe CDSM outcomes for adults with SMI.

Results

Eighteen unduplicated articles were identified that included outcomes of CDSM studies, while 10 met all inclusion criteria. Favorable treatment effects were observed for adults with SMI across 10 studies that took place in different types of clinical settings. CDSM studies that met all search criteria had a wide range of methodological quality, indicating that this is a nascent field of study.

Conclusions

Given the high chronic disease burden experienced by individuals with SMI combined with our nations health care reform, emphasis on self-management to improve population health, coupled with advancing the quality of research to evaluate CDSM programs for adults with SMI, is critically needed.     

Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use

OBJECTIVE: Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU. METHOD: Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA. RESULTS: Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95% confidence interval (95% CI)=0.41-0.81] and those with IDU alone (AOR=0.64; 95% CI=0.58-0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95% CI=1.64-3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95% CI=1.13-1.55) than those with neither SMI nor IDU, SMI only or IDU only. CONCLUSION: HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care.     

Gray matter atrophy pattern in elderly with subjective memory impairment

BackgroundIndividuals with subjective memory impairment (SMI) report worsening of memory without impairment in cognitive tests. Despite normal cognitive performance, they may be at higher risk of cognitive decline compared with individuals without SMI.MethodsWe used a discriminative function (a support vector machine) trained on an independent data set of 226 healthy control subjects and 191 patients with probable Alzheimer's disease (AD) dementia to characterize the baseline gray matter patterns of 24 individuals with SMI and 53 control subjects. We tested for associations of these gray matter patterns with SMI presence, cognitive performance at baseline, and cognitive decline at follow-up.ResultsIndividuals with SMI showed greater similarity to an AD gray matter pattern compared with control subjects without SMI. In addition, episodic memory decline was associated with an AD gray matter pattern in the SMI group.ConclusionsOur results indicate a link between the gray matter atrophy pattern of patients with AD and the presence of SMI. Furthermore, multivariate pattern recognition approaches seem to be a sensitive method for identifying subtle brain changes that correspond to future memory decline in SMI.     

Trauma symptoms,recovery, and participation in the Wellness Management and Recovery (WMR) program

Despite the disproportionate prevalence of posttraumatic stress disorder (PTSD) among individuals with severe mental illness (SMI), and the emergence of effective trauma-specific treatments for comorbid PTSD/SMI, PTSD remains undertreated in this population. Literature points to two reasons for such: underdiagnosing of PTSD among individuals with SMI, and lack of clinician confidence/training in trauma-specific issues. A meta-analysis found non-trauma-specific groups reduced trauma symptoms in non-SMI populations. Against this backdrop, the purpose of this study was to determine whether individuals with SMI and trauma symptoms reported reduced trauma symptoms following completion of a non-trauma-specific, recovery-focused group treatment, the Wellness Management and Recovery (WMR) program. Pre- and post-WMR data were obtained from 54 participants via the Mental Health Recovery Measure and Posttraumatic Stress Disorder Checklist. Participants reported significant improvements in mental health recovery, and significant decreases in trauma symptoms. Results suggested that WMR—a non-trauma-specific group program—may offer promise in reducing trauma symptoms among individuals with SMI who may not have access to evidence-based trauma-specific treatments and/or who may not wish to specifically address trauma issues. Further exploration of the potential of WMR participation to reduce trauma symptoms among individuals with SMI is warranted.     

Examining the Psychological Sense of Community for Individuals with Serious Mental Illness Residing in Supported Housing Environments

The psychological sense of community is an important aspect of community life; yet, it remains largely unexamined among individuals with serious mental illness (SMI). Sense of community represents the strength of bonding among community members; and this social phenomenon likely impacts the process by which individuals with SMI integrate into community life. The current study examined sense of community (SOC) for individuals with SMI by assessing the relationships between neighborhood experiences, unique factors related to SMI (e.g., mental illness diagnosis), and sense of community in the neighborhood. Participants were 402 residents of supported housing programs who used mental health services in South Carolina. Hierarchical linear regression was utilized to determine which components of community life helped to explain variability in sense of community. In total, 214 participants reported that it is very important for them to feel a sense of community in their neighborhoods. Neighbor relations, neighborhood safety, neighborhood satisfaction, neighborhood tolerance for mental illness, and housing site type emerged as significant explanatory variables of sense of community. These findings have implications for interventions aimed at enhancing SOC and community integration for individuals with SMI.     

Supported Decision Making in Serious Mental Illness

Objective: Making decisions is central to the exercise of control over one’s well-being. Many individuals with serious mental illness (SMI) experience limitations in their decision-making capacity. These individuals have often been placed under legal guardianship and substitute decision makers have been appointed to make decisions on their behalf. More recently, supported decision making (SDM) has emerged as a possible alternative in some cases. SDM involves recruitment of trusted supports to enhance an individual’s capacity in the decision-making process, enabling him or her to retain autonomy in life decisions. This overview examines issues associated with decision-making capacity in SMI, frameworks of substitute decision making and SDM, and emerging empirical research on SDM. Method: This is an overview of the medical and legal literature on decision making capacity and supported decision making for persons with SMI. Results: Many but not all individuals with SMI exhibit decrements in decision-making capacity and skill, in part due to cognitive impairment. There are no published data on rates of substitute decision making/guardianship or SDM for SMI. Only three empirical studies have explored SDM in this population. These studies suggest that SDM is viewed as an acceptable and potentially superior alternative to substitute decision making for patients and their caretakers. Conclusions: SDM is a promising alternative to substitute decision making for persons with SMI. Further empirical research is needed to clarify candidates for SDM, decisions in need of support, selection of supporters, guidelines for the SDM process, integration of SDM with emerging technological platforms, and outcomes of SDM. Recommendations for implementation of and research on SDM for SMI are provided.     

Social cognition moderates the influence of child physical abuse on inpatient psychiatric rehabilitation

Moderating effects of social cognition in the relationship between the severity of history of child physical abuse (CPA) and social functioning were examined using 12-month longitudinal data among 143 participants with severe mental illness (SMI) in an inpatient psychiatric rehabilitation program. The adverse effects of the severity of history of CPA on social functioning were compensated for by greater social inference and lower external locus of control. Specifically, despite the severity of history of CPA, individuals with intact or greater social inference showed greater social functioning than did those with lower social inference. The decrease in externality, regardless of the history of CPA, seemed to be therapeutic for individuals with SMI. Considering the heterogeneity in both SMI and CPA, the current finding sheds light on providing trauma-informed, individualized treatment and assessment planning for individuals with SMI and a history of CPA.     

Needs assessment of individuals with serious mental illness: can it help in promoting recovery?

Needs of individuals with serious mental illness (SMI) must be understood in order to promote recovery. This study examined the needs of 206 individuals with SMI and compared their perceptions with those of their professional caregivers. Needs were reported in the areas of accommodations, psychotic symptoms, daytime activity, intimate relationships, and psychological distress. Caregivers reported more met needs, while individuals themselves reported more unmet needs. Results suggest that in order to promote recovery, services for persons with SMI should be developed in accordance with patients' most prominent needs, specifically in the social and personal areas of intimate and sexual relationships.     

Psychological impact of the COVID-19 pandemic on individuals with serious mental disorders: A systematic review of the literature

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic is having a great impact on individuals from all over the world, particularly on individuals with mental disorders. Several studies found more pronounced psychiatric symptoms, notably symptoms of depression and anxiety.AIMTo assess the situation of patients with serious mental illness (SMI: Affective disorders and schizophrenia) regarding their mental health outcome during the pandemic.METHODSA systematic search using the databases PubMed and MEDLINE was conducted, employing the key words “COVID-19”, “SARS-CoV-2”, “psychiatric/mental disorder/illness”, “affective/mood disorder”, “bipolar disorder”, “(major) depression”, “schizoaffective disorder”, and “schizophrenia”. Studies that had been published up until January 9, 2021 were included. Information of studies in languages other than English and German was mostly taken from their English abstracts.RESULTSThe literature search concluded in the finding of 36 studies containing relevant clinical data. A general impairment of the mental health of individuals with SMI could be detected, particularly in individuals with affective disorders, as compared to those with schizophrenia. Compared to healthy controls, symptoms of anxiety, depression, and stress were more pronounced in individuals with SMI. Relevant factors found that impacted their mental health were age, resilience, and socioeconomic environment, especially the shortage of mental health services, lack of social support, and inadequate information about COVID-19.CONCLUSIONIn light of these results, mental health services should be reinforced, notably the use of telemental health services. Furthermore, supplying individuals with SMI with adequate information about the COVID-19 pandemic and increasing their resilience is important. When researching the impact of the COVID-19 pandemic on individuals with SMI, standardization as well as follow-up studies are needed to enable better comparability and understanding.     

A study of SMI 32-stained pyramidal cells,parvalbumin-immunoreactive chandelier cells,and presumptive thalamocortical axons in the human temproal neocortex

Immunocytochemical studies in the primate neocortex have shown that particular populations of pyramidal cells can be identified by antibody SMI 32 that recognizes a nonphosphorylated epitope of neurofilament protein, while chandelier cells (a powerful type of cortical inhibitory interneuron) and presumptive thalamocortical axons can be identified by antibodies directed against the calcium-binding protein parvalbumin (PV). We used these antibodies in correlative light and electron microscopic immunocytochemical studies to analyze certain aspects of the synaptic circuitry of human temporal neocortex. In sections cut in the tangential plane, many PV-immunoreactive chandelier cell axon terminals and apical dendrites of SMI 32-stained pyramidal cells were distributed in small clusters. Combination of immunocytochemistry for PV and SMI 32 revealed four subpopulations of pyramidal cells with regard to the immunocytochemical staining by SMI 32 and the innervation of their axon initial segments by PV-positive or -negative chandelier cell axon terminals, but there were differences in the concentration and proportion of these subpopulations by layers. Furthermore, we present electron microscopic evidence suggesting that the characteristic layer III dense band of PV-immunoreactive puncta is made up mainly of presumptive thalamocortical axon terminals. Besides, coincidence was found between the dense PV-immunoreactive band and the dendritic plexus formed by the SMI 32-stained pyramidal cells in the lower half of layer III, which leads us to think that they are probably a major target of PV-immunoreactive thalamic terminations. © 1994 Wiley-Liss, Inc.     

Investigating the association between physical health comorbidities and disability in individuals with severe mental illness

BackgroundResearch suggests that an increased risk of physical comorbidities might have a key role in the association between severe mental illness (SMI) and disability. We examined the association between physical multimorbidity and disability in individuals with SMI.MethodsData were extracted from the clinical record interactive search system at South London and Maudsley Biomedical Research Centre. Our sample (n = 13,933) consisted of individuals who had received a primary or secondary SMI diagnosis between 2007 and 2018 and had available data for Health of Nations Outcome Scale (HoNOS) as disability measure. Physical comorbidities were defined using Chapters II–XIV of the International Classification of Diagnoses (ICD-10).ResultsMore than 60 % of the sample had complex multimorbidity. The most common organ system affected were neurological (34.7%), dermatological (15.4%), and circulatory (14.8%). All specific comorbidities (ICD-10 Chapters) were associated with higher levels of disability, HoNOS total scores. Individuals with musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders were found to be associated with significant difficulties associated with more than five HoNOS domains while others had a lower number of domains affected.ConclusionsIndividuals with SMI and musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders are at higher risk of disability compared to those who do not have those comorbidities. Individuals with SMI and physical comorbidities are at greater risk of reporting difficulties associated with activities of daily living, hallucinations, and cognitive functioning. Therefore, these should be targeted for prevention and intervention programs.     

Integrating Criminal Justice,Community Healthcare,and Support Services for Adults with Severe Mental Disorders

Persons with severe mental disorders are overrepresented in our nation's jails and prisons. Factors including cooccurring substance use disorders, homelessness, and lack of access to community services have contributed to this problem, as have gaps between criminal justice, healthcare, and community support systems. In order to address these issues, Project Link was developed by the University of Rochester Department of Psychiatry in collaboration with five local community agencies. Project Link is designed to prevent involvement of individuals with severe mental illness from entering the criminal justice system. While many models of diversion programs exist, they are all dependent on access to appropriate community-based services. This paper will describe the steps that Project Link has taken towards integrating criminal justice, healthcare, and community support services for individuals with severe mental disorders involved in the criminal justice system.     

Cognitive Trajectories in Comorbid Dementia With Schizophrenia or Bipolar Disorder: The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register

ObjectivesWe aimed to compare trajectories of cognitive performance in individuals diagnosed with dementia with and without severe mental illness (SMI).DesignRetrospective cohort study.SettingWe used data from a large longitudinal mental healthcare case register, the Clinical Record Interactive Search (CRIS), at the South London and Maudsley NHS Foundation Trust (SLaM) which provides mental health services to four south London boroughs.ParticipantsOur sample (N = 4718) consisted of any individual who had a primary or secondary diagnosis of dementia from 2007 to 2018, was 50 years old or over at first diagnosis of dementia and had at least 3 recorded Mini-Mental State Examination (MMSE) scores.MeasurementsCognitive performance was measured using MMSE. Linear mixed models were fitted to explore whether MMSE trajectories differed between individuals with or without prior/current SMI diagnoses. Models were adjusted by socio-demographics, cardiovascular risk, smoking, and medication.Results and conclusionsOur results showed differences in the rate of change, where individuals with comorbid SMI had a faster decline when compared with those that have dementia without comorbid SMI. However, this association was partially attenuated when adjusted by socio-demographics, smoking and cardiovascular risk factors; and more substantially attenuated when medication was included in models. Additional analyses showed that this accelerated decline might be more evident in individuals with bipolar disorders. Future research to detangle the potential biological underlying mechanisms of these associations is needed.