Robert L. Weisman

The Mentally Ill in Jails and Prisons: Towards an Integrated Model of Prevention

Jails and prisons have become a final destination for persons with severe mental illness in America. Addiction, homelessness, and fragmentation of services have contributed to the problem, and have underscored the need for new models of service delivery. Project Link is a university-led consortium of five community agencies in Monroe County, New York that spans healthcare, social service and criminal justice systems. The program features a mobile treatment team with a forensic psychiatrist, a dual diagnosis treatment residence, and culturally competent staff. This paper discusses the importance of service integration in preventing jail and hospital recidivism, and describes steps that Project Link has taken towards integrating healthcare, criminal justice, and social services. Results from a preliminary evaluation suggest that Project Link may be effective in reducing recidivism and in improving community adjustment among severely mentally ill patients with histories of arrest and incarceration.

INTEGRATING CRIMINAL JUSTICE, COMMUNITY HEALTHCARE, AND SUPPORT SERVICES FOR ADULTS WITH SEVERE MENTAL DISORDERS

Persons with severe mental disorders are overrepresented in our nations jails and prisons. Factors including cooccurring substance use disorders, homelessness, and lack of access to community services have contributed to this problem, as have gaps between criminal justice, healthcare, and community support systems. In order to address these issues, Project Link was developed by the University of Rochester Department of Psychiatry in collaboration with five local community agencies. Project Link is designed to prevent involvement of individuals with severe mental illness from entering the criminal justice system. While many models of diversion programs exist, they are all dependent on access to appropriate community-based services. This paper will describe the steps that Project Link has taken towards integrating criminal justice, healthcare, and community support services for individuals with severe mental disorders involved in the criminal justice system.

Persons with Severe Mental Disorders in the Criminal Justice System: Challenges and Opportunities

Persons with schizophrenia and other severe mental disorders are at risk for falling through the cracks between the criminal justice and mental health systems. This article is based on a panel discussion between representatives from both systems that recently convened at a regional conference to discuss integration of services. The purpose of the panel discussion was to identify challenges and opportunities related to integrating mental health and criminal justice services at each phase of the criminal justice process. A synopsis of the discussion is presented, along with new models of service delivery designed to prevent the inappropriate arrest and incarceration of persons with severe mental disorders.

Quetiapine in the successful treatment of schizophrenia with comorbid alcohol and drug dependence: a case report.

Background: Excluding nicotine and caffeine dependence, almost 50% of individuals with schizophrenia also meet the criteria for substance abuse or dependence. Comorbid drug abuse presents complications to the effective treatment of these patients because they have increased psychotic symptoms and poorer treatment compliance. Case Report: This report describes the case of a young man with schizophrenia and comorbid alcohol and cocaine abuse who was successfully treated with quetiapine. The patient was previously treated with olanzapine and developed priapism, which required emergency medical treatment. Conclusions: The possible utility of atypical antipsychotics in the treatment of patients with schizophrenia and comorbid substance abuse needs to be confirmed in clinical trials.

The Role of Probation in Forensic Assertive Community Treatment

OBJECTIVE Forensic assertive community treatment (FACT) is an adaptation of the assertive community treatment model designed to prevent criminal recidivism through criminal justice collaborations. A national survey was conducted to examine FACT collaborations with probation departments. METHODS Members of the National Association of County Behavioral Health and Developmental Disability Directors were surveyed to identify FACT programs. Programs reporting collaborations with probation departments were contacted to provide details. RESULTS Fifty-six percent of FACT programs (15 of 27) reported collaborating with probation departments. Probation officers were assigned an average of 29±16 hours weekly, and 80% of programs (12 of 15) reported a favorable impact of collaboration on risk of patient rearrest. Only two programs reported using standard tools to formally assess recidivism risk. The most common barrier to collaboration was differences in philosophy between FACT team clinicians and probation officers. CONCLUSIONS FACT collaborations involving probation departments are common and are viewed by most program leaders as helpful in reducing criminal recidivism.

Patient experiences of autonomy and coercion while receiving legal leverage in forensic assertive community treatment.

AbstractLegal leverage is broadly defined as the use of legal authority to promote treatment adherence. It is widely utilized within mental health courts, drug courts, mandated outpatient treatment programs, and other intervention strategies for individuals with mental illness or chemical dependency who have contact with the criminal justice system. Nonetheless, the ethics of using legal authority to promote treatment adherence remains a hotly debated issue within public and professional circles alike. While critics characterize legal leverage as a coercive form of social control that undermines personal autonomy, advocates contend that it supports autonomy because treatment strategies using legal leverage are designed to promote health and independence. Despite the controversy, there is little evidence regarding the impact of legal leverage on patient autonomy as experienced and expressed by patients themselves. This report presents findings from a qualitative study involving six focus groups with severely mentally ill outpatients who received legal leverage through three forensic assertive community treatment (FACT) programs in Northeastern, Midwestern, and West Coast cities. Findings are discussed in the context of the self-determination theory of human motivation, and practical implications for the use of legal leverage are considered.

Bridging healthcare, police, and court responses to intimate partner violence perpetrated by individuals with severe and persistent mental illness

A subgroup of individuals with severe and presistent mental illness (SPMI) commit acts of intimate partner violence (IPV). State and federal legislators have enacted statutes altering police response to IPV. Proarrest laws have curbed police discretion to a degree, and resulted in more IPV arrests. Unaware of alternative options, such as family court, mental health professionals may refer families with IPV to the police. However, perpetrators with SPMI may be inappropriate for adjudication in the criminal justice system. A singular legal response to IPV may miss the opportunity for detection and assertive treatment of SPMI, that could promote safety and reduce the likelihood of violence. Offenders with SPMI may also have difficulty comprehending court procedures. This article discusses the potential for a more flexible approach to IPV through interdisciplinary coordination and training of police, judges, attorneys, legal advocates, mental health professionals and substance abuse providers.

BRIEF REPORT Violence Prevention and Safety Training for Case Management Services

Violence inflicted by individuals with mental illness towards healthcare workers has received significant media attention. Though such incidents are relatively infrequent, they inspire reactive responses and contribute to further stigmatization of the mentally ill. Prevention of violence is an important challenge for those who train and supervise mental health workers. Project Link is an outpatient treatment program designed to reduce jail and hospital recidivism among severely mentally ill adults with histories of criminal justice system involvement. Utilizing a Safety and Violence Education (SAVE) curriculum, Project Link has successfully transitioned high-risk mentally ill individuals from the criminal justice system into the community since 1995. The SAVE curriculum uses a preventative strategy to train case managers to identify warning signs of impending violence, and to safely engage patients in community settings. This paper will present an overview of the SAVE curriculum and its development, as well as results from a preliminary evaluation of trainee satisfaction.

Embitterment in suicide and homicide-suicide

Linden (2003) has posited that a salient, negative life event can lead to the development of posttraumatic embitterment disorder (PTED), conceptualized as an adjustment disorder marked by the prolonged experience of strong emotions marked by bitterness and related feelings in an individual who had otherwise been functioning normally and prior had minimal or no diagnosable psychopathology. This novel framework warrants further study. There is a wealth of data to support that select personality traits, for example negative affectivity, provides a diathesis for the development of a wide range of mental disorders (Widiger and Trull 1992). Therefore, we hypothesize that individuals who develop PTED have, at a minimum, a diathesis or trait disposition to experience embitterment even if there are no diagnosable psychiatric conditions per se.

Eighth Amendment Claims in Prison Suicide Litigation

In Palakovic v. Wetzel , 854 F.3d 209 (3rd Cir. 2017), the Third Circuit Court of Appeals vacated and remanded the District Court for the Western District of Pennsylvanias decision to dismiss Eighth Amendment claims against prison officials and mental health care staff, brought by the parents of an