Annette S. Crisanti

A review of the validity of self-reported arrests among persons with mental illness

illness may be influenced by cognitive distortions. Consequently, questions about the accuracy of these types of reports among a population with serious mental illness continue to be raised. The purpose of this article is to provide an overview of the research and the issues relating to the validity of self-reported arrests among persons with serious mental illness. This review is timely and warranted because of national and local reliance on criminal behavior as an indicator of the efficacy of treatment programs, such as assertive community treatment and jail diversion. Recent findings Our literature review found no apparent reason to discourage the use of self-reports to collect information on involvement with the criminal justice system among persons with serious mental illness. However, the research on which we base this conclusion is thin. Further research needs to determine the degree of validity of self-reported arrest history, and the extent to which accuracy varies among various clinical and social populations. Summary Our review of the factors that undermine validity and our suggestions for minimizing bias should aid in the critical appraisal of research that has relied on self-reported criminal behavior, and also the design of future studies.

Risk of trauma exposure among persons with mental illness in jails and prisons: what do we really know?

Purpose of review Traumatic victimization, particularly sexual abuse, is a serious problem in correctional facilities and those suffering from mental illnesses are especially vulnerable. This review examines our current knowledge regarding trauma victimization among persons with mental illness serving time in jails/prisons, considers methodological challenges, and provides recommendations for future research. Recent findings Traumatic victimization, particularly sexual abuse, has consistently been identified as a high-frequency problem within jails and prisons. Lifetime, 6-month, and 12-month prevalence rates of physical and sexual violence among incarcerated people are quite high relative to nonincarcerated populations, and women report much higher rates of most traumatic events than men. Moreover, data show that inmates with mental illnesses are up to eight times more likely to be victims of sexual abuse than nonmentally ill inmates. Summary Additional research is needed to improve our understanding of this issue and inform change efforts. Future research should include: epidemiological studies to improve our knowledge of risk factors and correlates of victimization; prospective studies to determine causality between trauma victimization and mental illness or other adverse outcome; and intervention studies to examine strategies for reducing violence and traumatic victimization inside correctional facilities, effective treatments for posttraumatic psychopathology, and improved re-entry outcomes.

Ethnoracial disparities in sexual assault among Asian Americans and Native Hawaiians/Other Pacific Islanders

CONTEXT Ethnoracial differences may exist in exposure to trauma and posttraumatic outcomes. However, Asian Americans and Native Hawaiians/other Pacific Islanders (NHOPIs) are vastly underrepresented in research pertaining to trauma and health status sequelae. OBJECTIVE To determine whether there are ethnoracial disparities in sexual trauma exposure and its sequelae for health and functioning among Asian Americans and NHOPIs. METHOD We examined data on sexual assault exposure from the 2006-2007 Hawaii Behavioral Risk Factor Surveillance System (H-BRFSS), which yielded a cross-sectional, adult, community-based probability sample (N = 12,573). Data were collected via computer-assisted random-digit landline telephone survey. Survey response rate was found to be about 48% in 2006 and 52% in 2007. The main outcome measures were demographic information, the sexual violence module of the H-BRFSS regarding unwanted sexual experiences, and questions about health lifestyles, chronic diseases and disability, and health status and quality of life. RESULTS Participants (N = 12,573) were 44.1% white, 15.0% NHOPI, and 40.9% Asian American. The NHOPIs had a higher 12-month period prevalence (2.24 per 100; 95% CI, 1.32-3.78) for any unwanted sexual experience but had a lower prevalence estimate and odds ratio for any lifetime unwanted sexual experience (prevalence: 9.38 per 100 [95% CI, 7.59-11.55]; odds ratio: 0.61 [95% CI, 0.47-0.81]) relative to whites, after adjusting for age, gender, income, and education level. Asian Americans had lower prevalence estimates for 12-month period prevalence (0.78 per 100; 95% CI, 0.44-1.39) and lower lifetime prevalence estimates and odds ratios (prevalence: 3.91 per 100 [95% CI, 3.23-4.72]; odds ratio: 0.27 [95% CI, 0.21-0.34]). The 12-month and lifetime prevalence estimates for any unwanted sexual experiences for whites were 0.71 per 100 (95% CI, 0.45-1.12) and 12.01 per 100 (95% CI, 10.96-13.14), respectively. Sexual assault experiences were highly associated with adverse health status sequelae (eg, disability, poor general health), but there were no significant ethnoracial disparities on self-reported health outcomes among those with a lifetime history of unwanted sexual experiences. CONCLUSIONS Data revealed significant ethnoracial differences between whites, Asian Americans, and NHOPIs on unwanted sexual experiences, with relative risk differing by time period. This pattern of disparity could represent early stages of a new trend in local assaultive behaviors toward NHOPIs and merits attention. Across all ethnoracial groups, a lifetime history of any unwanted sexual experience is associated with a wide range of adverse health status sequelae.

Understanding Study Attrition in the Evaluation of Jail Diversion Programs for Persons With Serious Mental Illness or Co-Occurring Substance Use Disorders

Study attrition is a problem in all community-based intervention studies using longitudinal research designs, but is compounded with hard to reach populations. High attrition poses threats to internal and external validity and may result in an inadequate sample size. The purpose of our study was to determine the characteristics associated with attrition. The study employed data from a cross-site evaluation of jail diversion programs. A self-report interview was conducted at baseline for 1,289 individuals. A 33% and 52% attrition rate was observed at the 6-month and 12-month follow-up interviews, respectively. The characteristics associated with loss to follow-up were male gender, part-time or full-time employment, drug offenses, jail days, baseline interview location, community supervision, and community geography. Knowing which individuals are more likely to attrit allows evaluators to develop targeted sampling strategies and participant engagement strategies.

A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population.

Permanent supportive housing (PSH) is an evidence-based health intervention for persons experiencing homelessness, but the impact of individual mechanisms within this intervention on health requires further research. This study examines the longitudinal impact of the mechanism of supportive housing within a peer-delivered PSH model on overall health and mental health (as measured by psychological distress and self-report of bothersome symptoms) outcomes in an ethnically diverse population. The 237 participants in the study included persons who were homeless or at risk of homelessness and who also had been diagnosed with a serious mental illness. Sixty-one percent of all participants received supportive housing. All 3 outcomes were significantly associated with quality of life indicators, recovery, and social connectedness. In addition, overall health was significantly associated with employment, age, and psychological distress. Psychological distress was associated with gender, type of housing, and history of violence or trauma. Experiencing bothersome symptoms was associated with drug use, history of violence or trauma, and psychological distress. Longitudinal models of these 3 outcomes showed that supportive housing was significantly associated with good to excellent health 6 months after baseline (odds ratio = 3.11, 95% confidence interval [1.12, 8.66]). The models also demonstrated that the supportive housing and comparison groups experienced decreased psychological distress after baseline. The results of this study demonstrate the importance of supportive housing within the context of PSH, particularly for the overall health of participants, and the positive overall impact of PSH on mental health in a diverse population.

Systemic challenges in bipolar disorder management: A patient-centered approach

As part of a series of Patient‐Centered Outcomes Research Institute‐funded large‐scale retrospective observational studies on bipolar disorder (BD) treatments and outcomes, we sought the input of patients with BD and their family members to develop research questions. We aimed to identify systemic root causes of patient‐reported challenges with BD management in order to guide subsequent studies and initiatives.

Impact of Mental Health First Aid on Confidence Related to Mental Health Literacy: A National Study With a Focus on Race-Ethnicity

OBJECTIVE Low mental health literacy (MHL) is widespread in the general population and even more so among racial and ethnic minority groups. Mental Health First Aid (MHFA) aims to improve MHL. The objective of this study was to determine the impact of MHFA on perceptions of confidence about MHL in a large national sample and by racial and ethnic subgroup. METHODS The self-perceived impact of MHFA on 36,263 people who completed the 12-hour training and a feedback form was examined. RESULTS A multiple regression analysis showed that MHFA resulted in high ratings of confidence in being able to apply various skills and knowledge related to MHL. Perceived impact of MHFA training differed among some racial and ethnic groups, but the differences were small to trivial. CONCLUSIONS Future research on MHFA should examine changes in MHL pre-post training and the extent to which perceived increases in MHL confidence among trainees translate into action.

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

This study compared 29 drugs for risk of psychiatric hospitalization in bipolar disorders, addressing the evidence gap on the >50 drugs used by US patients for treatment.

State Legislative Approach to Enumerating Behavioral Health Workforce Shortages: Lessons Learned in New Mexico

Nationally, the behavioral health workforce is in crisis because of a lack of resources, culturally responsive services, quality clinical supervision, sufficient training in evidence-based practices, and targeted recruitment and retention. Disparities in access to behavioral health care are particularly significant in New Mexico, where 25% of the population live in rural areas, and behavioral health shortages are among the highest in the nation. Additionally, as a Medicaid expansion state, New Mexico providers experience increased demand for services at a time when the state is challenged with limited workforce capacity. To address this issue, the Health Care Work Force Data Collection, Analysis and Policy Act was legislatively enacted in 2011 to systematically survey all state licensed health professionals to determine reasons for the healthcare shortage and address the shortage through policy. The Act was amended in 2012 to transfer all data to the University of New Mexico Health Sciences Center. In 2015, a total of 4,488 behavioral health providers completed a survey as a mandatory part of their license renewal. Findings from the survey indicate a dearth of licensed behavioral health providers representative of the populations served, limited access to services via Medicaid and Medicare payer sources, limited access to providers working in public health settings, and limited access to Health Information Technology. This paper describes the workforce context in New Mexico, the purpose of the legislation, the analytic findings from the survey, the policies implemented as a result of these efforts, lessons learned, and a discussion of the relevancy of the New Mexico model for other states. SUPPLEMENT INFORMATION This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

Evaluation of an evidence-based practice training for peer support workers in behavioral health care

Abstract Service provision by peer support workers (PSWs) is growing within the US behavioral health care system and research is needed to determine appropriate training and support. This study examined responses of 15 PSWs and 20 licensed behavioral health practitioners (BHPs) who participated in a one-day training of seeking safety (SS). PSWs and BHPs provided post-training feedback on satisfaction with the training and their perceived comfort level in implementing SS. Overall, PSWs and BHPs reported high satisfaction and comfort, and except for one significant difference, PSWs benefited from the training to the same extent as BHPs. Compared to BHPs, PSWs reported significantly greater improvement in their counseling ability within the SS model as a result of the training. Considering the varying levels of education and training within the field of PSWs, our results suggest that a “one-size fits all” approach to professional training may be acceptable; however, further research is warranted.