Howard Zonana

Crime and psychiatric disorders among youth in the US population: an analysis of the National Comorbidity Survey-Adolescent Supplement

OBJECTIVEnCurrent knowledge regarding psychiatric disorders and crime in youth is limited to juvenile justice and community samples. This study examined relationships between psychiatric disorders and self-reported crime involvement in a sample of youth representative of thexa0US population.nnnMETHODnThe National Comorbidity Survey-Adolescent Supplement (Nxa0=xa010,123; ages 13-17 years; 2001-2004) was used to examine the relationship between lifetime DSM-IV-based diagnoses, reported crime (property, violent, other), and arrest history. Logistic regression compared the odds of reported crime involvement with specific psychiatric disorders to those without any diagnoses, and examined the odds of crime by psychiatric comorbidity.nnnRESULTSnPrevalence of crime was 18.4%. Youth with lifetime psychiatric disorders, compared to no disorders, had significantly greater odds of crime, including violent crime. For violent crime resulting in arrest, conduct disorder (CD) (odds ratio ORxa0= 57.5; 95%xa0CIxa0=xa030.4, 108.8), alcohol use disorders (ORxa0= 19.5; 95% CIxa0= 8.8, 43.2), and drug usexa0disorders (ORxa0=xa016.1; 95% CIxa0= 9.3, 27.7) had the greatest odds with similar findings for violent crime with no arrest. Psychiatric comorbidity increased the odds of crime. Youth with 3xa0or more diagnoses (16.0% of population) accounted for 54.1% of those reporting arrest for violent crime.xa0Youth with at least 1 diagnosis committed 85.8% of crime, which was reduced toxa067.9% by removing individuals with CD. Importantly, 88.2% of youth with mental illness reported neverxa0having committed any crime.nnnCONCLUSIONnOur findings highlight the importance ofxa0improving access to mental health services for youthful offenders in community settings, given the substantial associations found between mental illness and crime in this nationally representative epidemiological sample.

Psychiatric Emergency Services a Decade Later

The changes in the functioning of the psychiatric component of a general hospital emergency room were assessed over the past decade. The effect of its incorporation into a community mental health center as its emergency service was seen to exert a significant increase in its utilization. Admissions increased threefold over the ten year period and the 15–21 age group increased by twice that amount. Analysis of census and social class data showed a significant effect of distance on only the lower socioeconomic groups. Diagnostic and dispositional shifts were seen as showing an increase in utilization by less disturbed patients who use the emergency room as their primary treatment resource. The rise in the drug addictions is striking and may mask other diagnoses.

Legal considerations in the child psychiatric emergency department

Clinicians who practice in the child psychiatric emergency department have the complex task of evaluating the mental health or substance abuse needs of children, adolescents, and their families during times of crisis. Adding to this challenging clinical task are multiple legal considerations with which the clinician must be familiar. The precise impact of these legal issues varies from state to state. Some of these legal considerations are present at the start of the evaluation (consent for evaluation or treatment), during the evaluation (psychiatric hospitalization), and at the end of an evaluation (mandatory reporting of suspected child abuse and duty to warn or protect third parties from harm). Other issues (confidentiality and consent for release of information) are present at all stages of the evaluation and continue long after the evaluation has been completed. Clinicians who evaluate the psychiatric needs of children and adolescents are urged to review their local state laws relating to civil commitment, confidentiality, and mandatory reporting.

Prosecuting Assaultive Psychiatric Patients

For many reasons, inpatient psychiatric units are increasingly faced with treatment and management of violent individuals. This fosters a need to consider potential institutional responses to patient violence. This paper focuses on one response--prosecution of these persons. The existing literature on this topic is reviewed. In addition, the case history of a difficult but successful prosecution of an assaultive patient is presented. This case highlighted the development of guidelines, which are outlined herein, for determining the appropriateness of seeking legal action against patients. The paper concludes with an assessment of the benefits and risks associated with patient prosecution.

Mental disorder as the cause of a crime

An offenders punishment can be reduced when a court decides that his mental disorder reduces his responsibility for what he did. Courts have sought to establish whether a mentally disordered offenders responsibility is reduced by asking whether his disorder caused the crime. Acceptance of this causation by mental disorder criterion has fluctuated, however. This may be because causal explanations are not the types of explanations we are accustomed to offering for the kinds of acts that bring defendants, and psychiatric witnesses, to court. More often, we offer what philosophers have called possibility explanations for these acts. The application of psychiatry to possibility explanations has not been widely explored. It offers the potential for the improved use of psychiatric evidence in criminal proceedings.