Virtual Interviewing and Diversity Among Psychiatry Residents.

OBJECTIVE: Psychiatry residency program directors were surveyed regarding their impression of the impact virtual interviewing had on the perceived and actual diversity of individuals selected for interviews and residency training. METHODS: A link to an anonymous survey was sent to 299 psychiatry residencies. Psychiatry program directors provided information about their programs and rated their perception of the impact of virtual interviewing on candidates they interviewed and matched. They also reported the demographic information of incoming residency classes for 2020-2023. This data was assessed for differences in the average number of residents by each diversity category and interview format (i.e., in person or virtual) and between diversity categories and cohorts. A linear trend analysis assessed whether the number of residents in each demographic category had a significant change over time. RESULTS: Sixty-five program directors (21.7%) provided at least partial data. Half of the responding program directors believed that virtual interviewing had increased the diversity of interviewed applicants, but there were no statistically significant differences in the average number of incoming residents who were identified as women or were in an Underrepresented in Medicine category when comparing the in-person interview year (2020) and the virtual interview years (2021-2023). CONCLUSIONS: The analyzed data demonstrated that the type of interview (in-person vs virtual) did not appear to affect the diversity of incoming psychiatry residents. Ongoing efforts to increase diversity, equity, inclusion, and belonging should be paired with measurements of their impact.

Critical Gaps in Assisted Outpatient Treatment Research in the United States.

In 2023, the White House included the implementation and improvement of assisted outpatient treatment in a list of under-researched strategies to support recovery and long-term treatment engagement for people with serious mental illness. Assisted outpatient treatment is a community-based, court-ordered, mental health treatment program for a subset of individuals with serious mental illness who have a history of difficulty adhering to treatment and staying well while living in the community. There is research supporting the use of assisted outpatient treatment for this specific population, however, the majority focuses on limited geographic regions, specific program organizations, and is outdated. Meanwhile, assisted outpatient treatment programs have increasingly been adopted by counties and states across the country. More research is needed to ensure that assisted outpatient treatment programs are being implemented in the most effective and equitable way possible. In this paper, the authors identify several key gaps in the current literature base relating to the effectiveness and implementation of assisted outpatient treatment.

Contextual Factors of Mental Health Crisis Calls to Law Enforcement: A Brief Report.

Law enforcement officers are frequent first responders to people experiencing mental health or suicide crises. Yet, as communities consider expanding crisis response options, we know very little about the nature of these calls that could inform decision making about which crisis response is best suited for the situation. This study is an exploratory, descriptive assessment of contextual factors, both individual and situational, of mental health and suicide crisis calls. Our dataset includes 166 calls to 9-1-1 related to a mental health emergency or suicide crisis. The majority were calls related to suicide (125 calls, 75%), which included more contextual factors than mental health crisis calls. Most calls resulted in the subject being transferred to the local emergency department (60%) or were resolved on scene (12%). Police use of force was rare, and no arrests were reported. The implications of these findings for communities developing alternatives to law enforcement crisis response are discussed.

Approaching Jail Diversion and Prevention of Criminal Legal System Involvement Simultaneously.

Despite prolific jail diversion initiatives, people with serious mental illness continue to be overrepresented in the criminal legal system. This continued overrepresentation has led to recent calls to address social determinants of health and criminal risk factors rather than to allocate new resources to diverting people from the criminal legal system. This shift toward prevention by addressing social factors that influence health and criminal legal outcomes should occur alongside a continued focus on diversion to understand what works and for whom. An effective, well-funded, and comprehensive community-based mental health services system could serve as the ultimate intercept for preventing criminal legal system involvement.

Crisis Intervention Team Program Leadership Must Include Psychiatrists.

Crisis intervention team (CIT) programs are partnerships between police and mental health community members developed with little involvement from psychiatrists. This article argues that psychiatrists should be one of the CIT program leaders to facilitate the transfer of persons in crisis from law enforcement to mental health care, make admission and civil commitment decisions, offer real-time telemedical support to officers or co-responders in the field, and collaborate with first responders in integrating responses to 911 and 988 calls.

Los programas del equipo de intervención en crisis (CIT, por sus siglas en inglés) son asociaciones entre la policía y miembros de la comunidad de salud mental desarrolladas con poca participación de psiquiatras. El presente artículo sostiene que los psiquiatras deberían ser uno de los líderes de los programas del CIT para facilitar la transferencia de personas en situaciones de crisis del principio de aplicación de la ley a la atención de salud mental, tomar decisiones de admisión y confinamiento civil, ofrecer apoyo de telemedicina en tiempo real a oficiales y servicios de intervención conjunta en el área y colaborar con los servicios de emergencia en la integración de respuestas para las llamadas al 911 y 988.

The Rapid Risk of Violence Screen (RROVS): a Brief Violence Risk Screening Tool for People in a Community Behavioral Health Setting.

The Rapid Risk of Violence Screen (RROVS) is a brief screening tool that is designed for use in community-based behavioral health service settings to identify people who may need comprehensive violence risk assessment. This study examined the association between the RROVS total score and future criminal justice involvement including violent offenses. Results from this study suggest that the RROVS screening tool has predictive validity as it is associated with later criminal justice involvement with a violent offense. The RROVS may be a helpful tool for community-based behavioral health providers to screen incoming clients for violence risk to inform whether additional assessment for violence potential is warranted.

Childhood Adversity, Proximal Stressors and PTSD Among People with Severe Mental Illness: An Exploratory Study.

The purpose of this exploratory study is to: (1) assess prevalence of childhood adversities and posttraumatic stress disorder (PTSD); (2) assess their association, and; (3) explore whether proximal sources of stress affect this relationship and/or have an association with PTSD among people with severe and persistent psychological disorders. Using data from 141 respondents, we assess the extent to which individuals in this population experienced 17 PTSD symptoms, various correlates to probable PTSD, and the most relevant of these factors in a multivariate logistic regression. Overall, 27% of the participants met study criteria for probable PTSD and each symptom was reported by at least 18% of the sample. Multivariate logistic regression models indicated that interpersonal conflict and being a victim of a crime were significantly related to probable PTSD. We discuss these findings in relation to treatment and course of disease for people suffering from severe and persistent mental illness experiencing a traumatic event.

Meeting the Needs of Justice-Involved People With Serious Mental Illness Within Community Behavioral Health Systems.

The overrepresentation of people with serious mental illness in the criminal justice system is a complex problem. A long-standing explanation for this phenomenon, the criminalization hypothesis, posits that policy changes that shifted the care of people with serious mental illness from psychiatric hospitals to an underfunded community treatment setting resulted in their overrepresentation within the criminal justice system. This framework has driven the development of interventions to connect people with serious mental illness to needed mental health and substance use treatment, a critical component for people in need. However, the criminalization hypothesis is a limited explanation of the overrepresentation of people with serious mental illness in the criminal justice system because it downplays the social and economic forces that have contributed to justice system involvement in general and minimizes the complex clinical, criminogenic, substance use, and social services needs of people with serious mental illness. A new approach is needed that focuses on addressing the multiple factors that contribute to justice involvement for this population. Although the authors' proposed approach may be viewed as aspirational, they suggest that an integrated community-based behavioral health system-i.e., intercept 0-serve as the focal point for coordinating and integrating services for justice-involved people with serious mental illness.

Association Between Hospitalization and Delivery of Assisted Outpatient Treatment With and Without Assertive Community Treatment.

OBJECTIVE: This study examined hospitalizations for individuals receiving assisted outpatient treatment (AOT), some of whom also received assertive community treatment (ACT). We examined whether participation in AOT, as well as in AOT paired with ACT services, was associated with reduced hospitalizations. METHODS: Data were collected for 74 people who were receiving AOT for at least 6 months. Comparisons were made between those receiving AOT with ACT and those receiving AOT without ACT. Changes were examined in number and days of hospitalization before, during, and after AOT on an annualized basis. RESULTS: AOT was associated with reduced hospitalizations and hospital days during and after the court order. Participating in AOT without ACT was associated with fewer hospitalizations during and after AOT and fewer days hospitalized after the court order ended. CONCLUSIONS: Individuals whose needs can be met with less intensive services while under an AOT order may not require ACT.

The Perceived Impact of Sequential Intercept Mapping on Communities Collaborating to Address Adults with Mental Illness in the Criminal Justice System.

Sequential intercept mapping is an approach to address the overrepresentation of adults with mental illness in the criminal justice system. This approach follows the sequential intercept model, a nationally recognized framework conceptualizing the linear movement of people with mental illness through the criminal justice system. During the sequential intercept mapping process, community stakeholders identify service and policy gaps and opportunities to address the needs of this target population. This qualitative study describes the perceived impact of sequential intercept mapping among community stakeholders. Sequential intercept mapping appears to be well-received, with the potential to improve collaboration and enhance community policy and practices.

Pharmacy and Medical Students' Mental Health Symptoms, Experiences, Attitudes and Help-Seeking Behaviors.

Objective. To examine and compare the prevalence of mental health problems, help-seeking attitudes, and perceptions about mental health problems among US pharmacy and medical students. Methods. A cross-sectional analysis was conducted using existing, anonymous survey data collected in the Healthy Minds Study during the 2015-2016 academic year. The analysis included 482 students (159 pharmacy students and 323 medical students) from 23 institutions in the United States. Analyzed topics included demographic characteristics, mental health status and symptoms, substance abuse, stigma related to mental health, help-seeking behaviors and attitudes, and mental health treatment perceptions. Results. Pharmacy and medical students experienced similar rates of depression (18% met clinical cut-offs), but pharmacy students were more likely to meet clinical cutoffs for anxiety (21% vs 11%). Pharmacy students were less likely to seek help from student counseling services (only 11% vs 49%) and also less likely to know where to seek help on campus if needed. Pharmacy students also reported having higher levels of stigma regarding mental health treatment. Conclusion. There are differences between pharmacy and medical students with regards to their experience of mental health symptoms, willingness to seek help, and perception of stigma. Despite the small sample, this analysis of national data indicates that opportunities exist to improve campus-based mental health education and offerings for pharmacy and medical students.

Sequential Intercept Mapping: Developing Systems-Level Solutions for the Opioid Epidemic.

Sequential intercept mapping, a community-based application of the sequential intercept model, was recently adapted in Ohio to address the complex challenge of the opioid crisis. Sequential intercept mapping for opioids provides a framework for criminal justice, mental health and addictions treatment providers, family members and opioid-involved individuals, and other stakeholders to develop community-based responses that emphasize prevention, regulation, and treatment for opioid dependency, with a goal of reducing unintended deaths and overdoses. The authors describe a promising approach to using sequential intercept mapping to address the opioid crisis.

A Comparison of Participants in Two Community-Based Programs: Assisted Outpatient Treatment and a Mental Health Court.

OBJECTIVE: Mental health courts and assisted outpatient treatment (AOT) are tools to help people with serious mental illness engage in treatment and avoid or reduce institutionalization. As both programs become increasingly prevalent, questions remain about whether people with severe mental illness who receive AOT have the same characteristics, histories, and service needs as those who participate in mental health courts. If there are differences, each program may require assessments and interventions tailored to the specific characteristics and needs of participants. METHODS: This study examined administrative criminal justice and mental health services data for 261 people with serious mental illness who participated in AOT, a mental health court, or both over seven years. RESULTS: Three percent of the sample participated in both programs. Compared with participants in mental health court, participants in AOT were older, less likely to have an alcohol use disorder, and more likely to have a schizophrenia spectrum disorder than a bipolar disorder. The participants' histories of crisis mental health service utilization, hospitalization, and incarceration prior to program entry varied significantly by program. CONCLUSIONS: The findings suggest that there are differences among individuals with serious mental illness who are served by AOT and mental health court programs. AOT participants had greater engagement with mental health services, and a significant portion of AOT participants also had a prior criminal history that placed them at risk of future justice involvement. Program administrators need to recognize and address the clinical and criminogenic needs that place individuals at risk of becoming hospitalized and incarcerated.

Interventions That Target Criminogenic Needs for Justice-Involved Persons With Serious Mental Illnesses: A Targeted Service Delivery Approach.

This research describes the development of a targeted service delivery approach that tailors the delivery of interventions that target criminogenic needs to the specific learning and treatment needs of justice-involved people with serious mental illnesses (SMI). This targeted service delivery approach includes five service delivery strategies: repetition and summarizing, amplification, coaching, low-demand practice, and maximizing participation. Examples of how to apply each strategy in session are provided, as well as recommendations on when to use each strategy during the delivery of interventions that target criminogenic needs. This targeted service delivery approach makes an important contribution to the development of interventions for justice-involved people with SMI by increasing the chances that people with SMI can participate fully in and benefit from these interventions that target criminogenic needs. These developments come at a critical time in the field as the next generation of services for justice-involved people with SMI are being developed.

Interventions That Target Criminogenic Needs for Justice-Involved Persons With Serious Mental Illnesses: A Targeted Service Delivery Approach.

This research describes the development of a targeted service delivery approach that tailors the delivery of interventions that target criminogenic needs to the specific learning and treatment needs of justice-involved people with serious mental illnesses (SMIs). This targeted service delivery approach includes five service delivery strategies: repetition and summarizing, amplification, active coaching, low-demand practice, and maximizing participation. Examples of how to apply each strategy in session are provided, as well as recommendations on when to use each strategy during the delivery of interventions that target criminogenic needs. This targeted service delivery approach makes an important contribution to the development of interventions for justice-involved people with SMI by increasing the chances that people with SMI can participate fully in and benefit from these interventions that target criminogenic needs. These developments come at a critical time in the field as the next generation of services for justice-involved people with SMI are being developed.

Translating Interventions that Target Criminogenic Risk Factors for use in Community Based Mental Health Settings.

This study explored facilitators and barriers associated with engaging criminogenic interventions in community mental health service settings. Focus groups and guided large group discussions were conducted with 46 consumers, providers and administrators. Results suggest that participants were generally supportive of offering criminogenic interventions to justice involved persons with serious mental illness in community based mental health service settings. Key issues to consider when engaging criminogenic interventions in community mental health service settings include identifying sustainable funding sources, providing adequate training for staff, and tailoring the delivery and pace of the content to the particular treatment needs of SMI participants.

Exploring the relationship between criminogenic risk assessment and mental health court program completion.

The two primary goals of mental health courts are to engage individuals with severe mental illness in the criminal justice system with clinical mental health services and to prevent future involvement with the criminal justice system. An important factor in helping to achieve both goals is to identify participants' level of clinical needs and criminogenic risk/needs. This study seeks to better understand how criminogenic risk affects outcomes in a mental health court. Specifically, we explore if high criminogenic risk is associated with failure to complete mental health court. Our subjects are participants of a municipal mental health court (MHC) who completed the Level of Services Inventory-Revised (LSI-R) upon entry to the program (N=146). We used binary logistic regression to determine the association between termination from the program with the total LSI-R. Our findings suggest that, net of prior criminal history, time in the program and clinical services received, high criminogenic risk/need is associated with failure to complete mental health court. In addition to providing clinical services, our findings suggest the need for MHCs to include criminogenic risk assessment to identify criminogenic risk. For participants to succeed in MHCs, both their clinical and criminogenic needs should be addressed.

Disease Burden Among Individuals with Severe Mental Illness in a Community Setting.

This study examines the prevalence of comorbid physical health conditions within a community sample of individuals with severe mental illness (SMI), compares them to a matched national sample without SMI, and identifies which comorbidities create the greatest disease burden for those with SMI. Self-reported health status, co-morbid medical conditions and perceived disease burden were collected from 203 adults with SMI. Prevalence of chronic health conditions was compared to a propensity-matched sample without SMI from the National Comorbidity Survey-Replication (NCS-R). Compared to NCS-R sample without SMI, our sample with SMI had a higher prevalence of seven out of nine categories of chronic health conditions. Chronic pain and headaches, as well as the number of chronic conditions, were associated with increased disease burden for individuals with SMI. Further investigation of possible interventions, including effective pain management, is needed to improve the health status of this population.