The Rikers Island Hot Spotters: Defining the Needs of the Most Frequently Incarcerated

We used "hot spotting" to characterize the persons most frequently admitted to the New York City jail system in 2013.

We used our Correctional Health Services electronic health record to identify 800 patients admitted in 2013 who returned most since November 2008. We compared them to a randomly selected control group of 800 others admitted in 2013, by using descriptive statistics and cross-tabulations, including data through December 2014.

The frequently incarcerated individuals had a median of 21 incarcerations (median duration 11 days), representing 18 713 admissions and $129 million in custody and health costs versus $38 million for the controls. The frequently incarcerated were: 

• significantly older (42 vs 35 years), 
• and more likely to have serious mental illness (19% vs 8.5%) 
• and homelessness (51.5% vs 14.7%) in their record. 
• Significant substance use was highly prevalent (96.9% vs 55.6%). 
• Most top criminal charges (88.7%) for the frequently incarcerated were misdemeanors; assault charges were less common (2.8% vs 10.4%). 

Frequently incarcerated persons have chronic mental health and substance use problems, their charges are generally minor, and incarceration is costly. Tailored supportive housing is likely to be less costly and improve outcomes.

Via: http://ht.ly/SB6Xh Purchase full article at: http://goo.gl/tg5GQO

By: MacDonald R1, Kaba F1, Rosner Z1, Vise A1, Weiss D1, Brittner M1, Skerker M1, Dickey N1, Venters H1.

• 1All of the authors are with the New York City Department of Health and Mental Hygiene, Bureau of Correctional Health Services, Queens, NY.

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Deinstitutionalization and The Rise of Violence

The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. 

The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. 

Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. 

Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.

Via: http://ht.ly/Ss9Pl Purchase the full article at: http://goo.gl/jDpmVx

By: Fuller Torrey E1.

• 1Department of Psychiatry,Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA; Stanley Medical Research Institute,Chevy Chase, Maryland, USA.

Association Between Number of Psychiatric Disorders and Violent Reoffending in Male Released Prisoners

Error bars are 95% CIs.

Read more at: http://ht.ly/S88T2

By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.

• 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.

Probability of Violent Reoffending by Sex, Time After Release, and Psychiatric Disorder Status

Error bars are 95% CIs.

Read more at: http://ht.ly/S88T2

By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.

• 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.

Psychiatric Disorders & Violent Reoffending: A National Cohort Study of Convicted Prisoners in Sweden

Reoffending and presence of psychiatric disorders are common in prisoners worldwide. However, whether psychiatric disorders are risk factors for reoffending is still unknown. We aimed to examine the association between psychiatric disorders, including substance use disorder, and violent reoffending.

We did a longitudinal cohort study of 47 326 prisoners who were imprisoned since Jan 1, 2000, and released before Dec 31, 2009, in Sweden. We obtained data for diagnosed psychiatric disorders from both inpatient and outpatient registers, and sociodemographic and criminological factors from other population-based registers...

Diagnosed psychiatric disorders were associated with an increased hazard of violent reoffending in male and female prisoners, and these associations were independent of measured sociodemographic and criminological factors, and, in men, remained substantial after adjustment for unmeasured familial factors. However, findings differed between individual diagnoses and sex. We found some evidence of stronger effects on violent reoffending of alcohol and drug use disorders and bipolar disorder than of other psychiatric disorders. Alcohol use disorder seemed to have a greater effect in women than in men. The overall effects of psychiatric disorders did not differ with severity of crime. The hazard of violent reoffending increased in a stepwise way with the number of diagnosed psychiatric disorders. Assuming causality, up to 20% of violent reoffending in men and 40% in women was attributable to the diagnosed psychiatric disorders that we investigated.

Certain psychiatric disorders are associated with a substantially increased hazard of violent reoffending. Because these disorders are prevalent and mostly treatable, improvements to prison mental health services could counteract the cycle of reoffending and improve both public health and safety. National violence prevention strategies should consider the role of prison health.

Read more at: http://ht.ly/S88T2

By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.

• 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.

Wait Time To What? Could Reducing Wait Times for Child Mental Health Services Worsen Outcomes?

Below: Theoretical pathways linking shortened wait times to different clinical outcomes

Addressing wait times for health interventions is a Canadian priority (Mendelsohn, 2002). In response, multiple wait time reduction initiatives have been launched. Chief among these is a key component of the federal-provincial “10-year Plan to Strengthen Health Care” (Health Canada, 2006) with associated monitoring to track progress in priority areas (Canadian Institute for Health Information, 2014). While mental illness was not one of the five priority areas (cancer care, cardiac care, diagnostic imaging, joint replacement, and sight restoration) identified in this initiative, mental illness has been designated in some priority lists, with some including a focus on children. A case in point exists in Alberta whereby children’s mental health was identified as one of six priority areas for access standards which led to child wait time benchmark recommendations (Access Standards Working Group Children’s Mental Health Subcommittee, 2009) and a performance indicator of percent of children receiving scheduled mental health treatment within 30 days (Government of Alberta, 2014). Unfortunately, reports of clinical outcomes from child mental health service wait time reduction initiatives seem nonexistent despite potential benefits and harms...

Read more at: http://ht.ly/ROOel HT https://twitter.com/UCalgaryMed

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Prevalence of Psychosis in Black Ethnic Minorities in Britain: Analysis Based on Three National Surveys

Below:  The ethnic composition of the population and the putative prevalence of psychosis

A considerable excess of psychosis in black ethnic minorities is apparent from clinical studies, in Britain, as in other developed economies with white majority populations. This excess is not so marked in population surveys. Equitable health service provision should be informed by the best estimates of the excess. We used national survey data to establish the difference in the prevalence of psychosis between black ethnic groups and the white majority in the British general population.

People from black ethnic minorities had an excess prevalence rate of psychosis compared with the white majority population. The OR, weighted for study design and response rate, was 2.72 (95 % CI 1.3–5.6,p = 0.002). This was marginally increased after controlling for potential confounders (OR = 2.90, 95 % CI 1.4–6.2, p = 0.006).

The excess of psychosis in black ethnic minority groups was similar to that in two previous British community surveys, and less than that based on clinical studies. Even so it confirms a considerable need for increased mental health service resources in areas with high proportions of black ethnic minority inhabitants.

Read more at:  http://ht.ly/RmsNU HT https://twitter.com/ucl

'A Burden on the County': Madness, Institutions of Confinement & the Irish Patient in Victorian Lancashire

Below:  Number of Irish and non-Irish patients admitted to Rainhill Asylum, 1854–1882

This article explores the responses of the Poor Law authorities, asylum superintendents and Lunacy Commissioners to the huge influx of Irish patients into the Lancashire public asylum system, a system facing intense pressure in terms of numbers and costs, in the latter half of the nineteenth century. In particular, it examines the ways in which patients were passed, bartered and exchanged between two sets of institution—workhouses and asylums. In the mid-nineteenth century removal to asylums was advocated for all cases of mental disorder by asylum medical superintendents and the Lunacy Commissioners; by its end, asylum doctors were resisting the attempts of Poor Law officials to ‘dump’ increasing numbers of chronic cases into their wards. The article situates the Irish patient at the centre of tussles between those with a stake in lunacy provision as a group recognised as numerous, disruptive and isolated.

Read at:   http://ht.ly/QnoPH HT @ucddublin

Global Burden of Mental, Neurological & Substance Use Disorders

Below:  Absolute Disability-adjusted life years (DALYs) Attributable to Mental, Neurological, and Substance Use Disorders, by Age, 2010

Below:  Age-Standardized DALY Rates Attributable to Mental, Neurological, and Substance Use Disorders, by Region

Below:  Proportion of Global YLDs and YLLs Attributable to Mental, Neurological, and Substance Use Disorders, 2010

Results
In 2010, mental, neurological and substance use disorders accounted for 10.4% of global DALYs, 2.3% of global YLLs and, 28.5% of global YLDs, making them the leading cause of YLDs. Mental disorders accounted for the largest proportion of DALYs (56.7%), followed by neurological disorders (28.6%) and substance use disorders (14.7%). DALYs peaked in early adulthood for mental and substance use disorders but were more consistent across age for neurological disorders. Females accounted for more DALYs in all mental and neurological disorders, except for mental disorders occurring in childhood, schizophrenia, substance use disorders, Parkinson’s disease and epilepsy where males accounted for more DALYs. Overall DALYs were highest in Eastern Europe/Central Asia and lowest in East Asia/the Pacific.

Conclusion
Mental, neurological and substance use disorders contribute to a significant proportion of disease burden. Health systems can respond by implementing established, cost effective interventions, or by supporting the research necessary to develop better prevention and treatment options.

Via:  http://ht.ly/Qmgpt  HT @UQ_News