A Critical Review of Mental Health Court Liaison Services in Australia: A first national survey

Mental health Court Liaison Services have emerged in Australia as a key part of the response to the over-representation of people with mental illness in the criminal justice system. These specialist services aim to intervene early in the criminal justice process by identifying mentally ill individuals at the post-charge, pre-sentence stage, providing timely advice to courts and linkage with treatment providers. To date there has been no systematic comparison of the various models of court liaison in each of the Australian jurisdictions, and little is known about their effectiveness. This article presents the findings of the first national survey of Court Liaison Services. In the absence of clear national guidelines, services have formed independently of each other, shaped by the jurisdictional legislation and health services. While services were found to have similar aims, variation exists in their human resources, clinical processes, geographic coverage, and their ability to provide equitable access.     

Variations in Mental Health Courts: Challenges, Opportunities, and a Call for Caution

Mental health courts have quickly proliferated in the United States and represent an attempt to expand legal leverage and enhanced treatment access to select persons with severe mental illness who are also involved in the criminal justice system. A national survey of mental health courts has begun to elucidate the procedural, clinical, and operational aspects of these courts and the defendants they adjudicate. A secondary analysis of survey data was performed to determine the similarities and differences among these courts. Results revealed large variability among existing mental health courts across multiple domains. The implications of this variability are discussed in terms benefits and limitations.     

Mental Health Diversion Courts: Some Directions for Further Development

Recent years have seen a growth in the number of specialist courts operating in Australia, including those which aim to address the needs of mentally disordered offenders. This article describes some of the key characteristics of mental health courts, using case studies from the most established court in Australia, the South Australian Magistrates Court Diversion Program (MCDP). This is followed by a consideration of some factors that may affect the future development of this type of program. It is concluded that there is a need to pay careful attention to issues of risk assessment and risk management if the dual goals of improving both the health of individual and the safety of the community are to be realised.     

Persons with Severe Mental Disorders in the Criminal Justice System: Challenges and Opportunities

Persons with schizophrenia and other severe mental disorders are at risk for falling through the cracks between the criminal justice and mental health systems. This article is based on a panel discussion between representatives from both systems that recently convened at a regional conference to discuss integration of services. The purpose of the panel discussion was to identify challenges and opportunities related to integrating mental health and criminal justice services at each phase of the criminal justice process. A synopsis of the discussion is presented, along with new models of service delivery designed to prevent the inappropriate arrest and incarceration of persons with severe mental disorders.     

Commentary: Hispanic Access to Health/Mental Health Services

Currently, the Hispanic population of the United States is growing very rapidly. Despite the significance of this growth and the fact that it is expected that Hispanics will be soon the largest ethnic minority group in this country, the access to health/mental health care for the Hispanic population is rather limited. Many factors are currently affecting the Hispanics' access to health/mental health care services. Among them, cultural and language barriers, insufficient numbers of Hispanic manpower in the health care professions, low educational and socioeconomic levels, the high number of uninsured Hispanics, and ethnic and racial prejudices and discrimination. In this commentary, I address the factors that interfere with the Hispanics' access to health/mental health care, and advance recommendations geared to alleviate and/or resolve this critical problem.     

Prison Mental Health In-reach: The Effect of Open Referral Pathways

In England and Wales, mental health in-reach teams manage high levels of mental disorder in prisons, but problems with reception screening and referral triage have been identified. As one potential solution, we examined the effect of an open referral pathway upon one in-reach team by evaluating its referrals and caseload across two time periods (in 2008 and 2011). There was a doubling of team referrals (from 101 to 203) with significantly improved identification of people with no mental health history. There was further evidence for a lowering of thresholds for referral and assessment, an approach that can be seen as helpful within a system that is known to under-identify mental health problems. Despite limitations, this evaluation offers some evidence for the effectiveness of open referral systems. It also raises questions about the potential effects of liaison and diversion services that are presently being piloted for national introduction.     

Pathways to Psychiatry Care among Children with Mental Health Problems

Many children with mental health problems in Egypt, as in many other countries, do not receive the help they need. Investigating the pathways of care is crucial for the early detection and treatment of these children. This study examined referral patterns and the duration of untreated psychiatric illness of 350 children attending two urban clinical settings in Egypt. Diagnoses were made using the Kiddie Schedule for Affective Disorder and Schizophrenia for School-aged children present and lifetime (K-SADS-PL), Child behavior checklist (CBCL,) and the Stanford-Binet Intelligence Scale. For 46.3%, the most distressing symptom was behavioral problems. A delay in seeking psychiatric help was found. positive family history, and lower socioeconomic class were associated with delays in psychiatric consultation. For 39.7% of patients, the first contact was with a psychiatrist. Most children were referred by relatives. Awareness programs are needed to increase knowledge about and to decrease the duration of untreated illness.     

Elderly patients and the Mental Health Act 1983

A retrospective casenote review was performed on all patients over 65 years of age in one health district who were detained under the Mental Health Act 1983 during the first 6 years of its operation. There were 132 episodes of detention affecting 120 patients. Fifty-three percent were for organic illness and 47% for functional illness. The organically ill were detained most commonly because the carer was no longer able to cope or, for those living alone, because of self-neglect. The functionally ill were most commonly detained in the interests of their health only. The majority (52/64) of patients with dementia were not discharged to their previous address after being detained, most of these (29/64) being discharged to residential care. Twenty-seven percent of the whole sample died within a year of being detained, a rate higher than that in the general population. Only nine tribunals were held in the study period.     

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.     

A Proposal for the Improvement of Mental Health Service Delivery to Barrators,Contemnors and the Courts That Have to Deal with Them

The temporary deprivation of liberty may be necessary to achieve order in the courts. However, imprisonment can have serious impacts on people with mental health problems, and for that reason it should be avoided if alternative dispositions can be made. Where should we strike a balance between liberty and detention when a querulous litigant is disrupting court processes?     

Preparation of Mental Health Clinicians to Work With Children With Co-Occurring Autism Spectrum Disorders and Mental Health Needs

ABSTRACT

Up to 70% of children with autism spectrum disorders (ASD) have a co-occurring mental health disorder; however, many clinicians feel unprepared to serve children with complex co-occurring conditions. This study surveyed 64 mental health clinicians working in 21 publically-funded mental health agencies in a large urban setting to explore their preparation and supports for providing mental health services to children with ASD and other developmental disabilities. Results indicated that only half of clinicians received training in ASD/DD in their professional education, with social workers least likely to have had such training. Only half of clinicians felt confident to diagnose mental health problems or provide interventions to children with ASD/DD; those with training on ASD/DD during their professional education were more likely to report confidence. Agency supports were lacking, with just 16% of therapists having supervisors with expertise in ASD/DD, and only 23% receiving training in ASD/DD at their agency. Participants from county agencies were less likely to have agency supports for their work in ASD/DD compared to participants from private non-profit agencies. Implications are discussed for enhancing education and training to meet the mental health needs of children with ASD/DD.     

Mental health care in Egypt: Review of current state,policy, and needs

This study aims to analyze the new Egyptian mental health law from a rights perspective in order to measure its compatibility with established human rights principles and the international standards that guide the practice of the mental health care. At the same time, the study considers the status of psychiatric care and basic mental health services for people with mental disorders in Egypt after several recent national upheavals along with the national prevalence of psychiatric disorders in the country. It will address the needs and the challenges facing current practice, with a discussion of some suggestions for improvements. Relevant data bases were searched (Medline, PubMed, and Cochrane library of systemic reviews and clinical trials) with the following Mesh terms: “mental disorders,” “substance-related disorders,” “Egyptian Mental Health systems,” and “Egyptian Mental health laws.” Articles published since 2000 were prioritized. In the latest years, a considerable gap between mental healthcare needs and available services in Egypt has been documented. There is comprehensive mental health legislation to enforce the rights of persons with mental disorders; but there is a lack of firm policy for implementation of interventions. The transformation of hospital-based to community-based mental health and the building of accessible services are necessary. Egypt urgently needs a national assessment of the deficiencies of its mental health system. The assessment would provide evidence and reliable information on existing needs and the barriers to accessing mental health care. The outputs of such an assessment will be helpful in finding locally and culturally sensitive solutions to reduce the mental health gap and can then be used in lobbying public opinion to rectify these conditions.     

Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy

Objective:

To investigate whether the significant and substantive findings from a previous study of youth mental health literacy (MHL) could be replicated using the same methods in another population.

Method:

We examined the impact of a curriculum resource, the Mental Health and High School Curriculum Guide (The Guide), taught by usual classroom teachers on students’ knowledge and attitudes related to mental health and mental illness in Canadian secondary schools. Survey data were collected before, immediately after, and 2 months after implementation of The Guide by teachers in usual classroom teaching. We conducted paired-sample t tests and calculated the Cohen d value to determine outcomes and impact of the curriculum resource application.

Results:

One hundred fourteen students were matched for analysis of knowledge data and 112 students were matched for analysis of attitude data at pre-intervention, post-intervention, and 2-month follow-up time periods. Following classroom exposure to the curriculum resource, students’ knowledge scores increased significantly and substantively, compared with baseline (P < 0.001, d = 1.11), and this was maintained at 2-month follow-up (P < 0.001, d = 0.91). Similar findings for attitude improvement were found (P < 0.001, d = 0.66), and this improvement was maintained at 2-month follow-up (P < 0.001, d = 0.52).

Conclusions:

These findings corroborate those from a previous study conducted in a different location. Taken together these results suggest a simple but effective approach to improving MHL in young people by embedding a classroom resource, delivered by usual classroom teachers in usual school settings.     

Does System Reform Reduce Geographic Variation in Mental Health System Performance

Substantial regional variation in health service use has been reported for both general medical and mental health services. It is unknown however, whether regional variation is reduced during periods of major system reform. Data from the Department of Veterans Affairs’ are used to examine performance measures for its 22 regional networks from 1996 to 2001, a period of major system reform. Out of 21 mental health performance measures the coefficient of variation (the standard deviation divided by the mean) increased for 16 measures and declined for only 5. Although regional variation increased only slightly on 12 of these 16 measures it appears system reform clearly does not reduce regional variation across the board and it may in fact increase such variation for some aspects of care.     

Stigmatizing Attitudes About Mental Illness and Allocation of Resources to Mental Health Services

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.