Madelon Baranoski

A Peer-Support, Group Intervention to Reduce Substance Use and Criminality Among Persons With Severe Mental Illness

OBJECTIVE This study compared the effectiveness of two interventions in reducing alcohol use, drug use, and criminal justice charges for persons with severe mental illnesses: first, a community-oriented group intervention with citizenship training and peer support that was combined with standard clinical treatment, including jail diversion services, and second, standard clinical treatment with jail diversion services alone. METHODS A total of 114 adults with serious mental illness participated in a 2 x 3 prospective longitudinal, randomized clinical trial with two levels of intervention (group and peer support for the experimental condition and standard services for the control) and three interviews (baseline, six months, and 12 months). Self-report questionnaires assessed alcohol and drug use, and program databases assessed criminal justice contacts. The authors used a mixed-models analysis to assess alcohol and drug use, repeated-measures analysis of covariance to assess criminal justice charges, and correlational analyses to assess the relation between intervention participation and outcome variables. RESULTS The experimental group showed significantly reduced alcohol use in comparison with the control group. Further, results showed a significant group-by-time interaction, where alcohol use decreased over time in the experimental group and increased in the control group. Drug use and criminal justice charges decreased significantly across assessment periods in both groups. CONCLUSIONS Of the outcomes, only decreased alcohol use was attributable to the experimental intervention. Although this may be a chance finding, peer- and community-oriented group support and learning may facilitate decreased alcohol use over time.

FACTORS ASSOCIATED WITH WEAPON USE IN MATERNAL FILICIDE

The objective of this study was to identify factors associated with weapon use in a group of filicidal women. Clinical data were gathered from the charts of sixty filicidal women evaluated at Michigans Center for Forensic Psychiatry or through Connecticuts Psychiatric Security Review Board from 1970 to 1996. Factors associated with weapon use were determined using chi squares, ANCOVAS, and a logistic regression. Results were compared to national statistics for child homicide from the Department of Justice Uniform Crime Reports (UCR). Weapon was defined as knife or gun for the study. Weapons were used by one of four women in our study. Guns were used by 13% of filicidal women and knives by 12%. Odds ratio showed that psychotic women were eleven times more likely to kill their child with a weapon than their non-psychotic counterparts (11.2; p = .008). Psychosis was present in every mother who killed her child with a knife and in seven of eight women who killed their children with a gun. Younger children were less likely to be killed with weapons (ANCOVA; F = 8.28; p = .006). This finding was independent of presence or absence of maternal psychosis. These results show that psychotic women are more likely than non-psychotic women to kill their children with weapons. They also show that mothers are more likely to use weapons to kill older children than younger children.

The State of Contemporary Risk Assessment Research

The focus on assessing dangerousness in routine psychiatric practice developed when relatively little was known about factors related to violence, and the accuracy of predicting violence was distinctly below chance. Since the 1990s, however, significant research attention has been directed toward factors related to violence and mental illness, as well as toward factors related to the accuracy of risk assessment techniques. Sociodemographic and environmental variables have been identified as significant predictors of violence, as has the presence of substance abuse. However, the data on specific mental health variables are somewhat mixed. Many studies point to a modest increased risk of violence associated with major mental illness and psychosis, whereas other noteworthy studies have failed to confirm such findings. Studies of the accuracy of risk assessments indicate that both actuarial and clinical methodologies perform better than chance, although the former achieve greater statistical accuracy. Despite ongoing controversies, risk management strategies that encompass the strengths and limitations of our present knowledge are available to clinicians.

Outcomes of Court-Based Jail Diversion Programs for People with Co-Occurring Disorders

ABSTRACT Objectives: Incarceration is widely believed to be unnecessary and harmful for criminal defendants with psychiatric disorders, most of whom have co-occurring substance use problems. An increasingly popular approach for such defendants is diversion away from the criminal justice system and into treatment. In this article, we present the findings of a quasi-experimental study evaluating the post-booking, arraignment court-based model of diversion used in Connecticut. To improve upon previous quasi-experimental studies, we employ propensity scoring to compare similar defendants from courts with diversion and with no diversion programs. Methods: Persons with serious mental illness and co-occurring substance use disorders were recruited into the study from among criminal defendants in seven criminal courts with diversion programs (n = 113) and five courts without diversion programs (n = 98). Structured research interviews, including measures of mental health, substance use, criminal involvement, employment, and quality of life, were conducted at baseline and at 3 and 12 months following baseline. Additional data was collected from administrative sources in the correctional department and court system. Results: The most striking differences between the diversion and the comparison groups were that the diversion group spent significantly fewer days incarcerated in the year following the index arrest, and were also less likely to be re-incarcerated. Grouping by time differences also suggests greater improvements in life satisfaction favoring the diversion group. Conclusions: Post-booking diversion programs can successfully divert individuals with co-morbid psychiatric and substance use without increased risk to the individual or the community, and with modest improvements in life satisfaction for the defendant.

Citizenship, Community, and Recovery: A Group- and Peer-Based Intervention for Persons With Co-Occurring Disorders and Criminal Justice Histories

Group interventions for persons with co-occurring disorders of serious mental illness (SMI) and alcohol or other substance use disorders may positively affect participants’ substance use, criminal justice contacts, and transition to community supports and community living. We report on a group intervention with wraparound peer support that, in earlier research, has shown promise regarding these domains. We provide a detailed description and discussion of the intervention, including case vignettes. We also discuss future research on this intervention and offer recommendations for additional research in this area and with this target population.

Citizenship, mental illness, and the criminal justice system

The concept of citizenship in regard to persons with mental illness has gained increasing attention in recent years, but little empirical research has been conducted on this topic. In addition, little research or conceptual writing has been done on the topic of criminal justice in regard to citizenship for people with mental illness, in spite of the high incidence of criminal charges and incarceration among this group. We review our work on an applied theoretical framework of citizenship, including its origins in mental health outreach work to people who are homeless and in a jail diversion program. We then suggest the contribution the framework can make to the intersecting issues of mental illness, its criminalization in the U.S., and the goal of community integration for people with mental illness.

Forensic mental health professionals in the immigration process.

This article adds to the existing literature on the role of mental health professionals in assisting attorneys in the asylum and refugee determination process primarily in the United States. The authors describe the legal context for asylum and refugee processing, challenges in conducting evaluations, diagnostic considerations, and specific competencies needed for mental health evaluators. Various cases are presented to illustrate key points. These cases purposely do not include any identifying information of any specific client, yet they are representative of the range and scope of issues that arise in this context.