Stefan Luebbers

Chronic MDMA (ecstasy) use, cognition and mood.

RationaleIt has been suggested that 3,4-methylenedioxymethamphetamine (MDMA or ecstasy) causes damage to the serotonergic system, and that this damage results in cognitive and mood impairments.ObjectivesTo examine the effect of chronic MDMA usage on a wide battery of cognitive tests and psychological abilities and processes.MethodsIn the present study, the performance of 17 participants with a history of MDMA use was compared to the performance of 15 control subjects on a battery of neuropsychological tests. This battery included tests for depression, immediate word recall, delayed recall, attention and working memory.ResultsResults indicated that the MDMA group had significantly higher scores for depression than the control group, and displayed poorer delayed recall and verbal learning than controls after accounting statistically for the effects of cannabis and depression.ConclusionsThese results suggest that MDMA users exhibit difficulties in coding information into long-term memory, display impaired verbal learning, are more easily distracted, and are less efficient at focusing attention on complex tasks.

Utilization of public mental health services in a random community sample

Objective: The aim of this study was to examine patterns of service utilization in the public mental health service in the Australian state of Victoria. Lifetime contact with the public mental health system will be used to approximate lifetime prevalence for schizophrenia in the community. Method: A case-linkage design joined a statewide psychiatric register with a random sample of community members drawn from a statewide electoral roll (n = 4830). In cases where individuals had been in contact with public mental health services, their full contact history was extracted. Results: Members of the community come into contact with public mental health services for a variety of reasons, including those beyond the scope of psychiatric diagnosis and treatment, with 23% of those who made contact not receiving a psychiatric diagnosis and/or ongoing treatment. Although only 0.7% of the sample had a lifetime diagnosis of schizophrenia, these persons accounted for a significant proportion of public mental health service use. Schizophrenia-spectrum disorders were particularly prevalent among psychiatric crisis and extended care and supervision services. Conclusions: The Australian public mental health system has undergone significant reform in recent years. As a result, there has been a shift towards community-based care and a marked reduction in inpatient facilities. The public mental health system is a service that primarily serves those with a psychotic illness, thereby dictating that persons with so-called high-prevalence disorders, including affective and/or substance use disorders, seek psychiatric treatment elsewhere.

Police perceptions of their encounters with individuals experiencing mental illness: A Victorian survey:

Objectives: Police have long played a central role in the management of people experiencing mental illness. This study explored: (1) the frequency of contact between the police and people experiencing mental illness; (2) the way in which police officers’ knowledge and the sources of information used relates to various dispositions; (3) the signs, symptoms and behaviours that police officers consider are associated with mental illness; and (4) the challenges police face in this respect when performing their duties. Method: A survey was completed by 3,534 police officers in Victoria, Australia. Canonical correlations were used to explore the ‘approach styles’ of police when responding to people with a mental illness. Thematic analyses, based on grounded theory, were utilized to examine and code open-ended responses. Results/conclusions: Police reported that a considerable amount of their time each week was spent dealing with people they believed to be mentally ill. These encounters were reportedly associated with considerable practical difficulties for police, both in terms of knowing how to deal with people experiencing mental illness and how to best find appropriate supports for them. The most common results of their encounters were instigating a mental health apprehension, followed by arrest, but decision-making was influenced by the differential weight police placed on different sources of information received at the scene. Recommendations for police training, while based on practical wisdom, need to be multi-modal and should engage mental health experts in design and delivery.

A case-linkage study of crime victimisation in schizophrenia-spectrum disorders over a period of deinstitutionalisation

BackgroundDespite high rates of self-reported crime victimisation, no study to date has compared official victimisation records of people with severe mental illness with a random community sample. Accordingly, this study sought to determine whether persons with schizophrenia-spectrum disorders have higher rates of recorded victimisation than the general population, and to explore whether there have been changes in rates of recorded victimisation over a period of deinstitutionalisation.MethodsThe schizophrenia-spectrum cases were drawn from a state-wide public mental health register, comprising all persons first diagnosed with a schizophrenic illness in five year cohorts between 1975 – 2005. The criminal histories of 4,168 persons diagnosed with schizophrenic-spectrum disorders were compared to those of a randomly selected community sample of 4,641 individuals.ResultsCompared to community controls, patients with schizophrenia-spectrum disorders were significantly more likely to have a record of violent (10.1% vs. 6.6%, odds ratio 1.4) and sexually violent victimisation (1.7% vs. 0.3%, odds ratio 2.77), but less likely to have an official record of victimisation overall (28.7% vs. 39.1%, odds ratio 0.5). Over the approximate period of deinstitutionalisation, the rate of recorded victimisation has more than doubled in schizophrenia-spectrum patients, but stayed relatively constant in the general community.ConclusionsPeople with schizophrenic-spectrum disorders are particularly vulnerable to violent crime victimisation; although co-morbid substance misuse and criminality both heighten the chances of victimisation, they cannot fully account for the increased rates. Deinstitutionalisation may have, in part, contributed to an unintended consequence of increasing rates of victimisation amongst the seriously mentally ill.

Gender and ethnicity in juvenile risk assessment

Systematized risk assessment and management in juveniles is still in its infancy, and the bulk of the validation literature focuses on males as they account for a significant proportion of crime. In recent years there has been growing recognition that female arrest rates and convictions are steadily increasing and that there is a need to ensure that risk assessment tools that have been validated with males are appropriate for females, who may have different criminal trajectories. The applicability of violence risk assessment tools for ethnically diverse populations has not been extensively examined, but the limited literature suggests that there may be differences in scores for risk and protective factors across ethnic groups. To address this subject, a review of the literature on the predictive validity of current juvenile risk assessment tools was performed. This summary produced equivocal findings and a requirement for further investigation comprising cohorts with greater diversity.

Police Discretion and Encounters With People Experiencing Mental Illness: The Significant Factors

Police discretion as it applies to encounters with people experiencing mental illness has far-reaching implications. In this study, some of the factors that are related to police officers’ decisions following encounters with people experiencing mental illness were explored. Officers in Australia were presented with one of three videos depicting a police encounter with an individual who was either mentally ill, not mentally ill, or with an ambiguous mental state. Participants were asked how they would “likely” and “ideally” resolve the encounter. Discriminant function analysis revealed that officers’ responses were related to (a) the severity of symptoms presented and (b) the officers’ attitudes toward people experiencing mental illness, as measured by an attitudes questionnaire. There was a discrepancy between participants’ likely and ideal outcomes to the scenarios, which supported the well-known fact that police officers face considerable obstacles when attempting to resolve encounters with people experiencing mental illness.

Police Encounters With People Experiencing Mental Illness: The Significant Factors

Police discretion as it applies to encounters with people experiencing mental illness has far-reaching implications. In this study, some of the factors that are related to police officers’ decisions following encounters with people experiencing mental illness were explored. Officers in Australia were presented with one of three videos depicting a police encounter with an individual who was either mentally ill, not mentally ill, or with an ambiguous mental state. Participants were asked how they would “likely” and “ideally” resolve the encounter. Discriminant function analysis revealed that officers’ responses were related to (a) the severity of symptoms presented and (b) the officers’ attitudes toward people experiencing mental illness, as measured by an attitudes questionnaire. There was a discrepancy between participants’ likely and ideal outcomes to the scenarios, which supported the well-known fact that police officers face considerable obstacles when attempting to resolve encounters with people experiencing mental illness.

The nature of police involvement in mental health transfers

During the course of their duties, police regularly have contact with mentally ill persons who are experiencing psychiatric crisis and require some form of mental health transfer. This study examined 2611 unique mental health transfers completed by police in the Australian state of Victoria over an eight-month period in 2009–2010. The overwhelming majority of mental health transfers performed by police during this period were the result of unplanned calls for assistance. Although police frequently requested assistance from other services, these were often not available. The study findings support a substantial body of anecdotal evidence from police citing lengthy involvement with people experiencing mentally illness, with the average mental health transfer consuming 2.5 h of police time. The frontline responses of police to people in psychiatric crisis need to be more formally acknowledged and creative solutions need to be sought with health and welfare services to better meet the needs of those who are falling between the cracks of community mental health care services.

The Predictive Validity of Risk Assessment Approaches for Young Australian Offenders

Validation literature on the predictive ability of North American youth violence risk assessment inventories is developing across international settings. Yet no information exists on the utility of the Structured Assessment of Violence Risk in Youth (SAVRY) and the Psychopathy Checklist: Youth Version (PCL:YV),]and little research has been conducted on the Youth Level of Service/Case Management Inventory (YLS/CMI) across Australian young offender populations. The current study investigated the validity of the risk instruments on 213 young people in detention in Victoria, Australia. Findings indicated moderate to strong predictive accuracy for re-offence outcomes across the three inventories for the total sample and for males. The SAVRY was also able to identify the strength of protective factors for young female offenders. The inventories appear to be suitable prediction aides in the Australian youth justice context although further research is required to ascertain their applicability to Australian young female offenders.

The Role of Protective Factors and the Relationship With Recidivism for High-Risk Young People in Detention:

This study sought to ascertain the prevalence of protective factors and association with client risk level and future offending in a sample of 177 Australian youth in detention. The Protective Domain on the Structured Assessment of Violence Risk in Youth (SAVRY) instrument was utilized to identify protective items in the cohort. The mean number of protective factors for the entire sample was low (under two) with higher risk clients averaging less than one current protective item. Although the number of protective factors engendered criminal desistance, this effect did not extend to the highest risk young offenders. Clients who re-offended were significantly less likely to present with five out of the six SAVRY protective items. In addition, pro-social involvement and school engagement had the strongest associations with non re-offense. Clinical implications for client risk management are discussed.