Analyzing the Relationship between Mental Health Courts and the Prison Industrial Complex.

Mental health courts (MHCs) were designed to address the high rates of incarcerated individuals with serious mental illness in the United States by providing mental health treatment and social supports to those facing criminal charges. In the setting of national uprisings and grassroots demands for abolition of the prison industrial complex (PIC), which is the broad construct of economic and sociopolitical drivers of imprisonment, we draw upon the scholarship of community activists to examine the role of MHCs within the PIC. Specifically, we explore whether MHCs exacerbate harms caused by the criminal justice system or work to reduce its oppressive power. In this analysis, we argue that MHCs can perpetuate harmful assumptions about mental illness and crime, can legitimize the harsh punishment of individuals unfairly deemed undeserving of policy intervention, and can preserve power differentials between courts and court participants. Our analysis underscores the need for a critical reassessment of the role of MHCs in communities and in the PIC. We advocate for an open discussion between community members and advocates, policymakers, and health professionals about how to address the need for mental health treatment and social support without expanding and entrenching the power of the PIC.

Clinical Outcomes of Specialized Treatment Units for Patients With Serious Mental Illness in the New York City Jail System.

OBJECTIVE: New York City's (NYC) Correctional Health Services has introduced specialized treatment units for patients with serious mental illness in the NYC jail system. With multidisciplinary mental health staffing and a coordinated approach with NYC's Department of Correction, these units expand therapeutic options for patients vulnerable to clinical instability and physical harm, including those at high risk of psychiatric medication nonadherence and those returning to jail from psychiatric hospitalization. This study evaluated the extent to which these units improve clinical outcomes for this population. METHODS: This retrospective, observational cohort study included adult males with serious mental illness with a length of jail stay of ≥14 days between January 1, 2016, and March 31, 2018. Patients on treatment units were matched with patients of similar characteristics (control group) by using propensity score matching (N=302 pairs). Rates of self-injury, injury due to violence, and psychiatric medication adherence were analyzed. RESULTS: Most patients on treatment units had diagnoses of schizophrenia spectrum and other psychotic disorders (81%), and most had a violent felony as their most severe charge (68%). Compared with patients in a control group, those on the treatment units had lower rates per 100 person-days of injury due to violence at 30 and 60 days (0.04, 95% confidence interval [CI]=0.02-0.07, and 0.03, 95% CI=0.02-0.06, respectively) and higher mean medication adherence (77% versus 55%, p<0.001). They also experienced lower rates of self-injury, although the difference was not statistically significant. CONCLUSIONS: Initial outcomes indicate substantial benefits to patients, demonstrating the value of a rehabilitative approach to psychiatric care in jail.

Life Stressors and Posttraumatic Stress Disorder in a Seriously Mentally Ill Jail Population.

Inmates represent a vulnerable population with increased rates of trauma and posttraumatic stress disorder (PTSD). However, little is known about the rates of trauma and PTSD among male inmates with acute psychiatric illness. This prospective, randomized study was conducted to assess the current rates of trauma and PTSD in this population. The sample consisted of 48 patients admitted to a hospital jail psychiatry service in New York City. Subjects were administered the Life Stressor Checklist-Revised and the Structured Clinical Interview for DSM-IV-TR Disorders, PTSD Module (SCID-I). The rate of PTSD diagnosis via SCID-I was 46.2% as compared to 2.1% diagnosis via clinical interview. All participants reported a history of at least one stressful and/or traumatic event, and many of these events occurred during incarceration. These results demonstrate that a great deal of trauma and PTSD goes unrecognized and untreated in this population, indicating the need for more effective treatment interventions.

Jail hospitalization of prearraignment patient arrestees with mental illness.

A growing number of individuals with mental illness are receiving psychiatric treatment in the criminal justice system. However, mental health problems facing individuals immediately after arrest and before arraignment have not been adequately studied. In New York City, prearraignment arrestees who require psychiatric hospitalization are temporarily transferred from police custody to correctional custody and admitted to the Bellevue Jail Psychiatry Service (BJPS) for treatment. The purpose of this study was to gain a better understanding of the impact of this jail hospitalization on the legal disposition of this vulnerable population. A retrospective chart review was conducted of 204 consecutively admitted male patient-arrestees on the BJPS. Results showed that admission to the BJPS delayed arraignment by an average of 8.03 days, with longer delays for individuals arrested outside of Manhattan. Although these delays are considered acceptable under legal precedent, concerns arise about the therapeutic impact of this practice on newly arrested individuals with severe mental illness.

Statutory definitions of mental illness for involuntary hospitalization as related to substance use disorders.

OBJECTIVE: In New York City, individuals gravely disabled by substance use disorders repeatedly present to emergency rooms yet rarely remain in treatment for more than several days and often sign out against medical advice. Although these individuals are at high risk of death and often lack the capacity to make treatment decisions, the laws in New York State are unclear about whether substance use disorders qualify as mental illnesses for the purpose of involuntary hospitalization. To better understand the national landscape of civil commitment law, with a specific focus on substance use disorders, a review was conducted of mental health statutes in all 50 states and the District of Columbia (D.C.). METHODS: Two independent reviewers examined all state mental health statutes using LexisNexis and Westlaw search engines. RESULTS: A total of 22 states, including D.C., do not reference substance use disorders in their statutory definitions of mental illness. Of the 29 that do, eight include substance use disorders and 21 explicitly exclude them. In addition, nine states have separate inpatient commitment laws specifically addressing substance use disorders. CONCLUSIONS: Civil commitment statutes vary greatly by state in terms of clarity and specificity regarding which mental illnesses are included for the purpose of involuntary hospitalization. Mental health professionals and policy makers should discuss whether individuals gravely disabled by substance use disorders, a complex and vulnerable population, should be more widely included under standard civil commitment law.

Lie detection: historical, neuropsychiatric and legal dimensions.

Lying and deception are behaviors that have been studied and discussed extensively in the scientific, philosophical and legal communities for centuries. The purpose of this article is to provide a general overview of the literature and thinking to date about deception, followed by an analysis of the efficacy and evolution of lie detection techniques. The first part explores the definitions of lying, from animal behaviorists' perspectives to philosophical theories, along with demographics and research about the prevalence of lying and characteristics of those who lie. This is followed by a discussion of possible motivations for lying, moral arguments about the legitimacy of or prohibition against lying, and developmental theorists' explanations for the growth of a human being's capacity to lie. The first section provides an introduction for the second part, a historical and critical review of lie detection techniques. Early methods, such as phrenology and truth serums are contrasted with more modern-day approaches, such as polygraphy and functional MRIs. Conclusions are drawn about whether technology has really advanced the art of detecting deception. Finally, the article enters a discussion about the law's response to lie detection methods and to deception in general. United States landmark cases, at both the state and federal level, are critiqued with regard to their impact on the admissibility into court of lie detection methods as evidence. Just as the scientific community has been wary of embracing many of these methods, so has the legal community. Through a review of the legal, scientific and pseudo-scientific issues surrounding deception, a greater understanding is reached of the complexity of this universal and morally loaded behavior.