A retrospective records study of patterns in mental health and criminal justice service use by people found not criminally responsible on account of mental disorder

2021 ◽  
Vol 31 (5) ◽  
pp. 331-342
Author(s):  
Adam D. Vaughan ◽  
Ashley N. Hewitt ◽  
Simon N. Verdun‐Jones ◽  
Johann Brink
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Mental Disorder ◽  
Service Use ◽  
Not Criminally Responsible

scholarly journals Mental health provision for young offenders: service use and cost

2006 ◽  
Vol 188 (6) ◽  
pp. 541-546 ◽  
Author(s):  
Barbara Barrett ◽  
Sarah Byford ◽  
Prathiba Chitsabesan ◽  
Cassandra Kenning
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Young People ◽  
Health Services ◽  
Criminal Justice System ◽  
Depressed Mood ◽  
Justice System ◽  
Service Use ◽  
Young Offenders ◽  
The Relationship

BackgroundThe full costs of accommodating and supporting young people in the criminal justice system are unknown. There is also concern about the level of mental health needs among young offenders and the provision of appropriate mental health services.AimsTo estimate the full cost of supporting young people in the criminal justice system in England and Wales and to examine the relationship between needs, service use and cost.MethodCross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, conducted in six geographically representative areas of England and Wales.ResultsMental health service use was low despite high levels of need, particularly in the community Monthly costs were significantly higher among young people interviewed in secure facilities than in the community ($4645 v. $ 1863; P < 0.001). Younger age and a depressed mood were associated with greater costs.ConclusionsYoung people in the criminal justice system are a significant financial burden not only on that system but also on social services, health and education. The relationship between cost and depressed mood indicates a role for mental health services in supporting young offenders, particularly those in the community.

scholarly journals Mental health service use and need for care of Australians without diagnoses of mental disorders: findings from a large epidemiological survey

2017 ◽  
Vol 26 (6) ◽  
pp. 596-606 ◽  
Author(s):  
I. Bobevski ◽  
A. Rosen ◽  
G. Meadows
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Disorder ◽  
Service Use ◽  
Stepped Care ◽  
Mental Health Service Use ◽  
Considerable Proportion ◽  
Treatment Pathways ◽  
Epidemiological Surveys

Aims.While epidemiological surveys worldwide have found a considerable proportion of people using mental health services not to have a diagnosis of a mental disorder, with possible implications of service overuse, other work has suggested that most people without a current diagnosis who used services exhibited other indicators of need. The aims of the present study were, using somewhat different categorisations than previous work, to investigate whether: (1) Australians without a diagnosis of a mental disorder who used mental health services had other indicators of need; and (2) how rate and frequency of service use in Australia related to level of need, then to discuss the findings in light of recent developments in Australian Mental Health Policy and other epidemiological and services research findings.Methods.Data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) 2007 was analysed.Results.Most people using mental health services had evident indicators of need for mental health care (MHC), and most of those with lower evident levels of need did not make heavy use of services. Only a small proportion of individuals without any disorders or need indicators received MHC (4%). Although this latter group comprises a fair proportion of service users when extrapolating to the Australian population (16%), the vast majority of these individuals only sought brief primary-care or counselling treatment rather than consultations with psychiatrists. Access and frequency of MHC consultations were highest for people with diagnosed lifetime disorders, followed by people with no diagnosed disorders but other need indicators, and least for people with no identified need indicators. Limitations include some disorders not assessed in interview and constraints based on survey size to investigate subgroups defined, for instance, by socioeconomic advantage and disadvantage individually or by characteristics of area.Conclusions.MHC for individuals with no recognised disorders or other reasonable need for such care may be occurring but if so is likely to be an area-specific phenomenon. Rather than revealing a large national pool of treatment resources being expended on the so-called ‘worried well’, the findings suggested a generally appropriate dose–response relationship between need indicators and service use. Definitive ascertainment of area-specific disparities in this national pattern would require a different survey approach. Government proposals for widespread introduction of stepped-care models that may seek to divert patients from existing treatment pathways need to be implemented with care and well informed by local data.

Alternatives and Closing Remarks

2019 ◽  
pp. 312-318
Author(s):  
Thomas L. Hafemeister
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Mental Disorder ◽  
Criminal Justice System ◽  
Justice System ◽  
Forensic Mental Health ◽  
Mental Health Courts

The concluding chapter, Chapter 12, notes alternatives—such as diversion and mental health courts—to the commonly employed criminal justice proceedings that are being explored in the hope that they may be better suited for processing defendants with a mental disorder and thereby help to resolve some of the thorniest issues faced by the criminal justice system and society. It closes by reiterating the challenging nature of this field and stresses the important role that forensic mental health evaluators and their evaluations can play.

Combined effect of mental disorder and low social support on care service use for mental health problems in the Dutch general population

2002 ◽  
Vol 32 (2) ◽  
pp. 311-323 ◽  
Author(s):  
M. TEN HAVE ◽  
W. VOLLEBERGH ◽  
R. BIJL ◽  
J. ORMEL
Keyword(s):  
Mental Health ◽  
Social Support ◽  
General Population ◽  
Mental Disorder ◽  
Service Utilization ◽  
Service Use ◽  
Mediating Effect ◽  
Mental Health Service Use ◽  
Functional Impairments ◽  
General Population Study

Background. People with a mental disorder have high rates of service utilization for emotional or addiction problems. Little is known about the role of functional impairments and low social support in such service use. This article investigates: (1) whether the presence of multiple functional impairments mediates the link between mental disorder and service use; and (2) whether social support modifies that association.Methods. Data were derived from the Netherlands Mental Health Survey and Incidence Study, NEMESIS, a prospective general population study. Predictors of service use (mental disorder; functional impairments; social support) were recorded in the second wave of the study, and service use in the third wave.Results. Persons with a DSM-III-R disorder and persons with multiple functional impairments were three to seven times as likely to use primary or mental health care. People with low perceived social support were two to three times as likely to use them, and living alone increased the likelihood by 30% to 80%. The effect of mental disorder on service use was mediated by multiple functional impairments. In people with a mental disorder, low levels of social support intensified mental health service use.Conclusion. Service utilization by people with mental problems can be better understood through a model incorporating: (1) independent effects of mental disorder, functional impairments and social support on service use; (2) a mediating effect of multiple functional impairments on the link between mental disorder and service use; and (3) interaction effects of mental disorder and low social support on service use.

Mental Disorder Comorbidity in Te Rau Hinengaro: The New Zealand Mental Health Survey

2006 ◽  
Vol 40 (10) ◽  
pp. 875-881 ◽  
Author(s):  
Kate M. Scott ◽  
Magnus A. McGee ◽  
Mark A. Oakley Browne ◽  
J. Elisabeth Wells
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Health Service ◽  
Mental Disorder ◽  
Mood Disorders ◽  
Health Survey ◽  
Service Use ◽  
Mental Health Service Use ◽  
Clinical Approach ◽  
Mental Health Survey

Objective: To show the extent and patterning of 12 month mental disorder comorbidity in the New Zealand population, and its association with case severity, suicidality and health service utilization. Method: A nationwide face-to-face household survey was carried out in October 2003 to December 2004 with 12 992 participants aged 16 years and over, achieving a response rate of 73.3%. The measurement of mental disorder was with the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Comorbidity was analysed with hierarchy, consistent with a clinical approach to disorder count. Results: Comorbidity occurred among 37% of 12 month cases. Anxiety and mood disorders were most frequently comorbid. Strong bivariate associations occurred between alcohol and drug use disorders and, to a lesser extent, between substance use disorders and some anxiety and mood disorders. Comorbidity was associated with case severity, with suicidal behaviour (especially suicide attempts) and with health sector use (especially mental health service use). Conclusion: The widespread nature of mental disorder comorbidity has implications for the configuration of mental health services and for clinical practice.

Overview of Forensic Mental Health Assessments

2019 ◽  
pp. 43-76
Author(s):  
Thomas L. Hafemeister
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Mental Disorder ◽  
Criminal Justice System ◽  
Mental Health Treatment ◽  
Justice System ◽  
Forensic Mental Health ◽  
Health Treatment ◽  
Clinical Evaluations ◽  
Health Assessments

Chapter 2 presents an overview of forensic mental health assessments and their deployment within the criminal justice system. This chapter describes how forensic mental health assessments are conducted, the multiple steps taken in the course of these assessments, and the challenges and tensions associated with providing them within the criminal justice system. In addition, it delineates their distinctive nature and how they differ from clinical evaluations and mental health treatment. This chapter also discusses a key question that frequently arises in conjunction with these assessments, namely, distinguishing a genuine report of a mental disorder and its impact from malingering (i.e., the faking of an illness), and strategies for making this distinction.

Unqualified Acquittal versus Insanity: Mental Disorder as an Evidentiary Issue, Not an Affirmative Defense

2000 ◽  
Vol 28 (1) ◽  
pp. 49-75
Author(s):  
David L. Goldberg
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Mental Disorder ◽  
Justice System ◽  
Case Law ◽  
Insanity Defense ◽  
Mens Rea ◽  
Criminal Defendant ◽  
Criminal Defense ◽  
Affirmative Defense

Although the insanity defense has been present in our criminal justice system for centuries, this paper discusses the utility of the defense as compared with that of an evidentiary attack on the mental elements of the crime itself. By reviewing insanity acquittal data and analyzing the substantive insanity defense and rules of evidence along with the progeny case law, we conclude that the insanity defense does not always provide the greater criminal defense option when mental health is in issue. There exists what this article refers to as “element negation,” which enables a criminal defendant to achieve complete acquittal based on a lack of the requisite mens rea in any charged crime. Because element negation is a viable defense to any crime, and it encompasses any evidence that would be used to proffer an insanity argument, mental disorder as evidence can be governed by the rules of criminal procedure and evidence, which may render the affirmative insanity defense a less appealing option.

Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services

2009 ◽  
Vol 24 (6) ◽  
pp. 356-364 ◽  
Author(s):  
A.G. Crocker ◽  
G. Côté
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Mental Disorder ◽  
Systems Of Care ◽  
Psychiatric Hospitals ◽  
Criminal Code ◽  
Not Criminally Responsible ◽  
Forensic Psychiatric

AbstractFollowing psychiatric deinstitutionalization and changes in involuntary civil commitment laws, many individuals with severe mental disorders have been receiving mental health services through the back door, that is, the criminal justice system. Significant changes to the section of Criminal Code of Canada dealing with individuals with mental disorders have led to significant annual increases in the number of individuals declared Not criminally responsible on account of mental disorder (NCRMD), many of whom are directed to civil psychiatric settings. The goal of the present study was to describe the psychosociocriminological and risk characteristics of individuals found NCRMD remanded to civil psychiatric hospitals (CPH) compared to a forensic psychiatric hospital (FPH). This study was conducted between October 2004 and August 2006 in the sole FPH of the province of Québec and two large CPH in the Montréal metropolitan area. The final sample for the current study consisted of 96 men: 60 from the FPH and 36 from the two CPH. Results indicate that individuals in both settings have similar psychosociocriminal profiles, including PCL-R scores, but that individuals in CPH have higher scores in the Risk subscale of the HCR-20 than do their counterparts in the FPH. This difference is due to a higher score on two items: exposure to destabilizing factors and noncompliance with remediation attempts. Results are discussed in terms of the need for civil psychiatric settings to implement risk assessment and management programs into their services, and the need for further research into forensic mental health services.

scholarly journals Service Use for Mental Health Reasons: Cross-Provincial Differences in Rates, Determinants, and Equity of Access

2005 ◽  
Vol 50 (10) ◽  
pp. 614-619 ◽  
Author(s):  
Helen-Maria Vasiliadis ◽  
Alain Lesage ◽  
Carol Adair ◽  
Richard Boyer
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Health Service ◽  
Mental Disorder ◽  
Resource Use ◽  
Service Use ◽  
Well Being ◽  
Medical System ◽  
Health Service Use ◽  
Health And Well Being

Objectives: In 2002, Canada undertook its first national survey on mental health and well-being, including detailed questioning on service use. Mental disorders may affect more than 1 person in 5, according to past regional and less comprehensive mental health surveys in Canada, and most do not seek help. Individual determinants play a role in health resource use for mental health (MH) reasons. This study aimed to provide prevalence rates of health care service use for MH reasons by province and according to service type and to examine determinants of MH service use in Canada and across provinces. Methods: We assessed the prevalence rate (95% confidence interval [CI]) of past-year health service use for MH reasons, and we assessed potential determinants cross-sectionally, using data collected from the Statistics Canada Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). We estimated models of resource use with logistic regression (using odds ratios and 95%CIs). Results: The prevalence of health service use for MH reasons in Canada was 9.5% (95%CI, 9.1% to 10.0%). The highest rates, on average, were observed in Nova Scotia (11.3%; 95%CI, 9.6% to 13.0%) and British Columbia (11.3%; 95%CI, 10.1% to 12.6%). The lowest rates were observed in Newfoundland and Labrador (6.7%; 95%CI, 5.3% to 8.0%) and Prince Edward Island (7.5%; 95%CI, 5.8% to 9.3%). In Canada, the general medical system was the most used for MH reasons (5.4%; 95%CI, 5.1% to 5.8%) and the voluntary network sector was the least used (1.9%; 95%CI, 1.7% to 2.1%). No difference was observed in the rate of service use between specialty MH (3.5%; 95%CI, 3.2% to 3.8%) and other professional providers (4.0%; 95%CI, 3.7% to 4.3%). In multivariate analyses, after adjusting for age and sex, the presence of a mental disorder was a consistent predictor of health service use for MH across the provinces. Conclusions: There is up to a twofold difference in the type of service used for MH reasons across provinces. The primary care general medical system is the most widely used service for MH. Need remains the strongest predictor of use, especially when a mental disorder is present. Barriers to access, such as income, were not identified in all provinces. Different sociodemographic variables played a role in service seeking within each province. This suggests different attitudes toward common mental disorders and toward care seeking among the provinces.

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