The Influence of New York's SAFE Act on Individuals Seeking Mental Health Treatment.

Responding to mass shootings, some states have passed gun removal laws (e.g., NYS' SAFE Act), requiring that mental health professionals report patients who might potentially harm themselves/others. The purpose of this study was to assess whether knowledge of the SAFE Act impacts patients' mental health treatment-seeking and symptom-reporting behaviors. Patients at two mental health centers were surveyed during 2014-2018. Participants were asked if they would be concerned about being reported to county government, likelihood of seeking mental health treatment, and willingness to report mental health symptoms/behaviors given the SAFE Act's provisions. 228 patients (71.5% response rate) completed questionnaires. About 18% were concerned about being reported to county government, 9% would be less likely to seek mental health treatment, and about 23% would be less willing to report mental health symptoms/behaviors. Although these behaviors were not affected for most participants, there was a small minority who were concerned and less willing to report mental health symptoms/behaviors.

Suicidal ideation among inmate-patients in state prison: prevalence, reluctance to report, and treatment preferences.

This study examined the prevalence, willingness to report, and treatment preferences for suicidal ideation among state prison inmates. The Beck Scale for Suicide Ideation (BSS) and a novel questionnaire were completed by 67 inmate-patients. The BSS score was in the high range for 15% of general population (GP) and 40% of Intermediate Care Program (ICP) patients, with 19% of ICP inmates reporting a "moderate to strong" desire to commit suicide. A majority (64% GP, 86% ICP) had prior suicide attempt(s). Forty-two percent of GP and 31% of ICP inmate-patients were unlikely to tell mental health staff about suicidal thoughts. Family contact and talking with mental health staff were preferred interventions. ICP inmates preferred staff visits and observation in their own cells, but GP inmates did not. Only a small minority (14% GP, 21% ICP) favored transfer to a crisis observation cell, but the least desired option was talking to a corrections officer. While many inmate-patients reported experiencing suicidal thoughts, they preferred not to inform staff. Almost 80% did not favor the current primary intervention: the observation cell. Alternative or supplementary options should be considered.

Forty years after Jackson v. Indiana: states' compliance with "reasonable period of time" ruling.

In Jackson v. Indiana (1972) the U.S. Supreme Court held that states may not indefinitely confine criminal defendants solely on the basis of incompetence to stand trial. The Court ruled that the commitment duration be limited based on the likelihood of restorability, but did not provide specific time limits. Nearly four decades later, there is striking heterogeneity regarding the length of confinement. As of 2007, 28 percent of the states specify 1 year or less, 20 percent specify 1 to 10 years, 22 percent link the limit to the criminal penalty for the charged offense (up to life), and 30 percent set no limit. Thus, most state statutes seem out of compliance with Jackson. While research has focused on predicting restorability and testing restoration modalities, empirical evidence about the reasonable length of time to determine restorability has not been adequately addressed. Quantitative analysis of Jackson's reasonable period of time is needed to ensure due process for incompetent felony defendants.

Survey of forensic mental health experts on pro se competence after Indiana v. Edwards.

In Indiana v. Edwards (2008) the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST), but provided little guidance for the trial court judge. This survey of forensic mental health experts studied potential PSC criteria. Sixty-eight (22.7%) forensic evaluators replied. Three McGarry criteria were reported as requiring a much higher standard for PSC: to appraise the available legal defenses (45.6%), to plan a legal strategy (51.5%), and to question and challenge witnesses (44.1%). Sixty percent agreed that standby counsel should be mandatory. Respondents opined that average abilities were sufficient for intelligence (77.9%), literacy (69.1%), and verbal ability (70.6%) were sufficient. PSC examiners may wish to assess appraisal of available legal defenses, planning a legal strategy, and questioning and challenging witnesses for a higher standard than CST. Evaluators should also assess the defendant's willingness to accept standby counsel (SBC) and the defendant's motivation for attempting a pro se defense.

Assessment of Suny Upstate Medical University's child telepsychiatry consultation program.

OBJECTIVES: The project assesses the child telepsychiatry services provided by SUNY Upstate psychiatrists to several county mental health clinics in central New York State. METHOD: Data for 45 patients was extracted from pre-consultation forms completed by the referring clinic and postconsultation summaries completed by the Upstate psychiatrists that occurred between July 13, 2009 and May 12, 2010. The study identified characteristics of patients for whom telepsychiatry consultations were sought, why they were sought, and reviewed recommended changes in therapy and medication provided by the telepsychiatry consultant. RESULTS: Analysis of the data showed that there was a large variation in patient characteristics such as age (from age 3 to 17), current living situation, and psychological symptoms. In addition to a family history of mental illness (80%), the most common symptoms were physical aggression (60.0%), defiant/oppositional behavior (57.8%), and attentional problems (55.6%). The most common reason for referral was diagnostic clarification (67%). The child telepsychiatrist recommended a change in medication for most (80.8%) of the patients who were on medications, and to begin medications for most (63.2%) who were not receiving medication at the time of consult. Further, the telepsychiatrist often recommended the addition of family therapy (71.1%) and counseling at school (17.8%). CONCLUSION: The child telepsychiatric program at Upstate seemed effective. It reached a large variety of children with significant mental disorders. The consultants provided diagnostic clarification and recommended modification of treatment for most. However, this assessment is limited as examined as it did not include follow-up information on whether consultant recommendations were followed and, if they were, whether they were effective.

A pilot survey of trial court judges' opinions on pro se competence after Indiana v. Edwards.

In Indiana v. Edwards, the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST). However, the Court refrained from elaborating a specific standard. The trial judge is in the best position to make more fine-tuned mental capacity decisions. This pilot study surveyed trial judges' opinions about PSC to help forensic evaluators structure their assessments. Eighteen of 400 New York State trial judges surveyed replied. Trial judges regarded disorders of cognitive impairment (n = 10) and psychosis (n = 4) to be potentially limiting for PSC. Responses relating to which domains should be assessed were heterogeneous, but the most common were intellectual and analytic abilities (n = 10), legal knowledge/experience (n = 9), and language abilities (n = 8). Several judges listed factors that are not traditionally part of CST evaluations, such as having a rational reason for proceeding pro se and a willingness to accept the assistance of standby counsel.

Characteristics of inmates who received a diagnosis of serious mental illness upon entry to New York State prison.

OBJECTIVE: This study investigated the characteristics of inmates who received a diagnosis of serious mental illness upon entry to a New York State prison. The number has been rapidly increasing since the 1990s. METHODS: Chart review was performed for inmates who entered prison between May 15, 2007, and June 14, 2007, and received a diagnosis of serious mental illness. RESULTS: Six percent (172 of 2,918 inmates) received a diagnosis of serious mental illness. The mean+/-SD age of these 172 patients was 36+/-9.6. A total of 167 (97%) had a prior psychiatric hospitalization, and 48 (28%) had four or more. Seventy-nine (46%) had their first hospitalization ten or more years ago. A total of 107 (62%) had a prior serious suicide attempt, 101 (59%) had prior inpatient treatment for substance abuse, and 79 (46%) had prior state prison incarceration. CONCLUSIONS: This is a very high-need population for which correctional mental health services need to plan.

State prison mental heath services recipients perception of care survey.

BACKGROUND: Studies have demonstrated the importance of patient perceptions' of mental health service quality. No studies, however, could be found that surveyed recipients in prison, despite the rapid growth of patients, and litigation in these settings. METHOD: Patients were asked to complete an anonymous survey in private, and sealed it in an envelope. RESULTS: Of 613 respondents, most were satisfied (79%), agreed they had sufficient access to therapists (78%), were involved with treatment decisions (84%), and thought the MH services they had received would help them better deal with a crisis and emotional stress (75%). There were differences among mental health programs/housing units. Several of perception questions were significantly correlated with medication compliance, admission to crisis observation cells, and receiving disciplinary infractions. DISCUSSION: Random samples were requested, but likely only a convenience sample was obtained. However, the positive results suggest the need to strive to enhance patient quality of care ratings.

Mental health service recipients and prison work release: how do the mentally ill fare compared to other inmates in prison work release programs?

The objective of this study was to compare the success rate of the mentally ill and other inmates on prison work release within gender groups. Mentally ill (MI) men (n = 42) had a higher success rate (79%) than other men (NMI) (61%) (n = 49), but this difference only approached statistical significance (p = 0.07), and mental illness did not distinguish male success/failures in regression analyses. Mentally ill women (n = 51) had a statistically significant lower success rate (58%) than other women inmates (n = 49) (83%) on work release. The difference in rates, however, only occurred in the group of women who were currently in prison due to a parole violation, not new court commitments. Regression analysis confirmed the importance of mental illness and current commitment as a parole violator. A greater number of MI men should be allowed to participate in work release. Women with mental health issues who had prior trouble on parole may need enhanced services.

Inmate suicide and time spent in special disciplinary housing in New York State prison.

OBJECTIVE: This study examined the number of days that prisoners spent in a special disciplinary housing unit in New York State prison before a suicide occurred. METHODS: Suicides that occurred between 1993 and 2003 were reviewed. RESULTS: A total of 32 suicides occurred in one-person special housing cells during the 11-year period. Inmates spent a median of 63 days in a special disciplinary housing cell before committing suicide. The aggregate median sentence these inmates were serving in special housing at the time of suicide was 298.5 days. CONCLUSIONS: Because most suicides in a special housing unit occurred within eight weeks of placement, enhanced observation of special housing inmates is warranted in that period at a minimum.

Relationships between patient, family, and significant other disposition preferences in psychiatric emergency services and the clinical symptom ratings and disposition decisions of psychiatrists.

A previous paper examined the relationship between 10 clinical ratings made by psychiatrists and 465 psychiatric emergency service (PES) dispositions. A logistic regression model explained 52% of the variance in the psychiatrist's decisions to admit to inpatient services or release. The 5 clinical ratings in the model, rated on 8-point scales, were severity of danger to self, psychosis, inability to care for self, impulse control, and depression. The current paper examines the relationships between patient and family/significant other dispositional preferences expressed in the PES, and the psychiatrist's disposition decision and the 10 clinical ratings. It found that the dispositional preferences of the patient, family, and other individuals (community clinician, police, or ambulance driver) were very consistent with the actual decision made by the PES psychiatrist. Further, it found that these preferences explained an additional 35% of the variability in the psychiatrist's decision to admit or release. Finally, the ten clinical ratings made by the PES psychiatrist explained only a small amount of the variance in the dispositional preferences, and some of the significant coefficients were in the opposite direction expected. Patient, family and other significant individuals' expressed preferences and expectations in the PES are important and should be routinely recorded in the charts. The small relationships between clinical ratings and preferences suggests that the reasons the family/significant other and the patient seeks hospital admission or release may differ with psychiatrists' reasons for disposition.

Factors related to suicide in New York state prisons.

OBJECTIVE: Examine factors related to prison suicides to aid prevention. METHOD: Review the mental health records of all 76 suicides that occurred between 1993 and 2001 in New York State Department of Correctional Services (NYSDOCS) prisons that had some contact with mental health services during their incarceration. (This represented 84% of all NYSDOCS suicides.) Extract data from the psychological autopsies for a sample of 40 of these suicides. RESULTS: Of the suicide victims with some mental health contact, 95% had a substance abuse history, 70% displayed agitation or anxiety prior to the suicide, and 48% had a behavioral change. Common stressors preceding the suicide were inmate-to-inmate conflict (50%), recent disciplinary action (42%), fear (40%), physical illness (42%), and adverse information (65%) such as loss of good time or disruption of family/friendship relationships in the community. Forty-one percent had received a mental health service within 3 days of the suicide. Compared to the about 7200 inmates actively receiving mental health services in state prison, African-Americans and patients with a Major Mood (Bi-polar or Major Depression) were under-represented. Adjustment Disorder, Schizophrenia, and Personality Disorder diagnoses were over-represented. Suicide victims were more likely to have been incarcerated for a violent crime. CONCLUSION: Mental illness, anxiety/agitation, behavior change, stressors, history of substance abuse, and non-African-American were important risk factors.

Correctional mental health services in New York: then and now.

This article chronicles the legislation, litigation, and the agency initiatives which have shaped the New York State correctional mental health system into what it is today. An historical perspective provides a context and framework for the examination of the current and future salient issues and challenges in providing a comprehensive range of mental health services in a correctional setting. The Central New York Psychiatric Center organization, which is comprised of a 206 bed maximum-security forensic hospital and a community support network of 23 prison-based mental health units was established in 1977. This article takes an in-depth look at the organization's 25-year growth and development, the implementation and outcome of some innovative treatment programs, and the unique partnership between the New York State Office of Mental Health (OMH) and the New York State Department of Correctional Services (DOCS).

Transfers to civil psychiatric inpatient services from a maximum security forensic hospital.

OBJECTIVE: To examine inpatients discharged from a forensic psychiatric hospital to a civil hospital at the completion of their correctional sentence. METHOD: Extract information from a patient database. RESULTS: About 20% of the discharges from the New York State forensic hospital that serves mentally ill state prison inmates, Central New York Psychiatric Center (CNYPC), are transferred to a civil psychiatric hospital; the remainder are returned to a correctional setting. Although their diagnoses, Global Assessment of Functioning scores, and number of prior inpatient admissions are similar, CNYPC transfers stay 1(1/2) times as long in their civil hospital admission as other civil hospital admissions. If total inpatient hospitalization before release to the community at large is considered (CNYPC plus the subsequent civil hospital), the stay is about 2(1/2) times as long. Fifty-two percent of the CNYPC transfers had been incarcerated for violent offenses and 28% are re-hospitalized within 12 months after release from the civil hospital. DISCUSSION: Longer lengths of stay in the civil hospital for these CNYPC transfers do not seem to be related to psychiatric functioning. Instead, it may be related to being harder to place in a community setting. All these CNYPC transfers have prison histories, many have a violent offense history, and all have been geographically remote from their home communities for a long time periods. As a result, the social support networks of CNYPC transfers may be weaker than those of other civil inpatients. The families and neighborhood agencies of CNYPC transfers are probably less willing to accept them on their return than those of other civil patients.Enhanced discharge planning and support services targeted specially for correctional transfers to a civil psychiatric inpatient environment should be considered. These type of service may reduce inpatient length of stay and thereby allow the inpatient resources to be used by other patients.

Central New York Psychiatric Center: an approach to the treatment of co-occurring disorders in the New York State correctional mental health system.

Central New York Psychiatric Center operates a maximum security inpatient treatment hospital and outpatient mental health services for all of the 72 New York State prisons. In this article prevalence data, patient characteristics, and interventions offered to inmates diagnosed with co-occurring mental illness and substance abuse disorders in the New York State prison system are reviewed and discussed. Available interventions have resulted from the close collaboration of the State Department of Correctional Services and State Office of Mental Health. Aspects of current programs and plans for future service developments are discussed along with implications for the treatment of an offender population diagnosed with a co-occurring disorder.

Effectiveness of the New York State Office of Mental Health Core Curriculum: direct care staff training.

The purpose was to study the New York State Office of Mental Health's Core Curriculum training program. The 3-day program included recipient recovery principles, team training, cultural competence, clinical issues, and safety. Exit questionnaires were completed by 3,732 staff members. Additionally, samples of staff and recipients of inpatient care completed pre- and posttraining questionnaires and the Ward Atmosphere Scale. Staff sampled also completed the Work Environment Scale. The training was well attended and well received. There were statistically significant increases in communication and interaction, respect for recipients of inpatient care, and increases in cultural competence levels.