Search

Existing violence risk assessment studies of mental health patients focus mostly on the association of historical presence of clinical risk factors and long-term violence, with little emphasis on the short-term temporal proximity between clinically relevant risk factors and the occurrence of violent behaviors. This research examined the proximal clinical risk factors (within days to a week prior) of acute severe or fatal violence among a group of forensic patients with serious mental illness (N = 287) found Not Criminally Responsible for offenses that involved violence against person(s), based on file review. Command hallucinations (OR  =  2.35, 95% CI  =  1.05 - 5.24), Threat/control-override symptoms (OR  =  3.10, 95% CI  =  1.51 - 6.35) and Capgras syndrome (OR  =  3.58, 95% CI  =  1.06 - 12.15) were identified as independent significant risk factors associated with acute severe or fatal violence. First degree relatives and intimate partners were significantly associated with being a victim of acute severe or fatal violence. Gender, recent alcohol use and recent drug use were not significantly associated with acute severe or fatal violence. Clinical utilities of the results and future directions for research are discussed., (Copyright © 2019 Elsevier B.V. All rights reserved.)

WHAT IS KNOWN ON THE SUBJECT?: Physical appearance, as in the case of individuals with physical disabilities who use a cane, walker or wheelchair, also influence others' reactions and as a result, may lead to one's negative or positive feelings and thoughts. A disability that is not observable by others, as in the case of individuals with psychiatric disabilities (mental illnesses), may also have a negative impact on one's feelings and thoughts, due to stigma associated with psychiatric disabilities. To date, research has mainly focused on the way persons with a noticeable type of disability think about themselves. It is also important to evaluate the impact of disability type on ones' feelings and thoughts, and compare persons with visible and invisible disabilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We asked 119 adults (over the age of 18 years) with different types of disabilities to complete a set of questionnaires and found that those who had a disability that was not observable by others (a psychiatric disability) felt more negative about themselves and their body than those who had a disability that was observable by others (a physical disability). The study extends the current knowledge on the impact of disability type and its visibility on the way persons with disabilities think about themselves. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that healthcare services should be modified to address the psychological needs of people with different types of disability. Mental health nurses should identify practices in the community that will improve the feelings and thoughts of consumers with disabilities, and especially those who cope with a psychiatric disability. Abstract Introduction Individuals with disabilities often face stigma and discrimination, which may negatively affect their self-concept. To date, research has mainly focused on the psychological implications of living with a noticeable physical disability. Less attention has been given to individuals with invisible psychiatric disabilities as a stigmatized subgroup in the disability community. Aim To evaluate the impact of disability type and its visibility on the self-concept and body image. Method A cross-sectional quantitative study design was implemented to compare the self-concept and body image of individuals with visible physical disabilities and individuals with invisible psychiatric disabilities (n = 119). Pearson correlations, ANOVA and multiple linear regression models were performed. Results Individuals with invisible psychiatric disabilities reported lower levels of self-concept and body image compared to individuals with visible physical disabilities. Gender, family status and the severity level of the disability were found to be associated with self-concept and body image. Discussion The study extends the current knowledge by showing that disability visibility might play a protective role for persons with physical disabilities compared to persons with psychiatric disabilities. Implications for Practice Mental health nurses should apply practices to enhance the self-concept and body image of consumers with invisible psychiatric disabilities., (© 2019 John Wiley & Sons Ltd.)

Background: Whereas from a professional point of view, a medical treatment might seem necessary, this treatment might be refused by the patient. In such cases, the patient's ability to determine his will is the key. Any substitutive medical decision is justified by a specific normative framework., Objective: The dialectic between a patient's inability to determine his will and the conviction of physicians about the necessity of a medical intervention is reformulated from a medical-anthropological point of view. This dialectic leads to a substitutive decision-making on the basis of a presumed will beyond the elemental will due to the breakdown of mental capacity/legal competence., Method: After bracketing out legal concepts, assumptions mirroring canonical conceptions of individual autonomy are carved out. Then the medical encounter involving medically necessary treatments rejected by the patients is analyzed from an anthropological point of view. Hereby, both i) the asymmetry in the understanding and implementation of necessary medical measures, and ii) the emotional resonance capability between physician and patient are discussed. Based on these observations, a criticism of a solely individualistic conception of the mentally ill without any consideration of social interconnections will be developed. Finally, criteria for the assessment of mental capacity as well as for a pragmatic and prudent decision-making under uncertainty are proposed., Results: Mental capacity and legal competence as normative concepts mean the autonomy to act towards sustainable self-care. It can be understood as the competence of judging one's own intentions; this competence includes the balanced interpretation of contingencies and forecasting the scope of consequences. The canonical dialectic between self-sufficiency (corresponding to mental capacity) and subsidiarity (according to substitutive decisions) is based, within the framework proposed here, on treatment asymmetry and personal resonance. When considering substitutive decisions, the relevant social micro systems the patient is embedded in should be taken into account., Discussion: The anthropological examination of the dialectic between autonomy (based on mental capacity) and substitutive decisions leads to a reflection on individual decision-making with uncertain denouement rather than unequivocal, categorical solutions. All stakeholders and relevant others should be taken into account in the decision-making process., Competing Interests: Der Autor erklärt, dass kein Interessenskonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Peer specialists are frequently employed in mental health settings, with growing evidence for positive impact on subjective aspects of recovery. As more individuals within the mental health system have criminal justice involvement, peer specialists with incarceration histories are increasingly important, yet little is known about how their experiences with the criminal justice system factor into their work. This study sought to understand the experiences of peer specialists with criminal justice histories and how they incorporate these experiences into their work., Methods: Purposive and snowball sampling was employed to recruit graduates from a peer training program. Three in-depth interviews were conducted each with 15 peer specialists who had incarceration experiences., Results: Thematic analysis revealed that Having and Sharing Lived Experiences formed the basis of their work as peer specialists. On this foundation, participants expounded on their specialized contributions in their work as peer specialists: Engagement, Priority of Relationship, Instilling Hope, and Providing an Alternative Service. Participants' criminal justice histories influenced how they approached their work, especially around using disclosure, developing relationships, and instilling hope., Conclusions and Implications for Practice: Peer specialists with incarceration histories may be a critical component toward recovery for consumers with criminal justice involvement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: Children of mentally ill parents are exposed to a multitude of burdens due to the diseases of their parents. Age-related preventive measures and interventions are needed to minimize the risk for the development of psychiatric disorders by the children themselves., Objective: The aim of the study was the documentation of preventive options on a national and international level for children of different age groups between 3 and 14 years with parents with depressive or anxiety disorders., Material and Methods: A systematic literature search was conducted to identify current evidence-based preventive interventions measures for these target groups and analyzed with respect to age-specific aspects and evidence., Results: From screening 107,573 publications 43 interventions could be found. After examining the evidence of the interventions 25 projects could be included in the analysis For each of the different age groups the intervention with the best evidence is presented in this article., Conclusion: Many interventions were found but most of them were not sufficiently evaluated or psychometrically defined; however, the few well-evaluated evidence-based projects for children mostly addressed the age-specific needs. Projects for preschool age children mostly worked with the parents and referred to elements of parental training. For schoolchildren there were various preventive projects that especially worked with increasing the self-esteem and the development of coping strategies. Projects for adolescents worked with psychoeducation and increasing social connectedness. Across all age groups there was no comprehensive and cross-system networking between the interventions.

Objective: Social effectiveness continues to play a critical role in recovery of people with serious mental illness (SMI), with greater social effectiveness predicting many positive life outcomes. Despite the abundance of literature supporting the relationship between perceptions and behavior, little is known about predictors of perceived social effectiveness of individuals with SMI., Methods: The purpose of this study is to examine the predictors of perceived social effectiveness of individuals with SMI. Cross-sectional data of 192 participants with SMI recruited from four psychiatric rehabilitation clubhouses in 2 states in the South and Midwest regions of the United States were used for this study. Self-report data on category of psychiatric disabilities, psychiatric symptoms, cognition, insight, educational attainment, empathy, interpersonal interactions and relationships, self-stigma, disability acceptance, and perceived social effectiveness were collected and analyzed using multiple regression analysis (MRA)., Results: MRA yielded a regression model that accounted for 56% of the variance in perceived social effectiveness, which is considered a large effect size. Controlling for all other factors, mood disorder, educational attainment, empathy, interpersonal interactions and relationships, and disability acceptance were found to be significant predictors of perceived social effectiveness of persons with SMI., Conclusions and Implications for Practice: Practitioners should consider determining points of intervention and targeting specific elements that enhance perceived social effectiveness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objectives: This cross-sectional study aimed to assess the prevalence, factors, and consequences of physical violence by mentally ill patients against mental health professionals., Methods: 124 of 145 mental health professionals at a Nigerian neuropsychiatric hospital satisfactorily completed a questionnaire on their experiences with physical assault., Results: 77 (62.1%) staff had been assaulted during their whole career; 38 (30.6%) of them were assaulted in the past 12 months. The most common type of assault was pushing (32.9%). The most common antecedent event to assault was calming an aggressive patient (44.1%). In their whole career, 22.1% of assaulted staff sustained injuries that required medical attention; 42.4% of assaulted staff sometimes or frequently/always experienced posttraumatic stress disorder symptoms. Physical assault in the whole career was associated with older age (p = 0.04), longer years of practice (p = 0.01), and job dissatisfaction (p = 0.05)., Conclusions: Physical violence encountered by mental health professionals at a Nigerian neuropsychiatric hospital is substantial. Policy review of staff safety, training, and support is recommended.

Objective: To understand the ways that mental health symptoms interfere with achieving health goals., Methods: Individuals with mental illness diagnoses and varying levels of preventive service use were recruited from federally qualified health centers and an integrated health care delivery system and interviewed. Thematic analysis was used to characterize descriptions of how mental illness experiences influenced lifestyle change efforts., Results: Three themes described patients' (n = 163) perspectives on barriers to making healthy lifestyle changes: 1) Thinking about making lifestyle changes is overwhelming for individuals already managing the burdens of mental illnesses; 2) Depression makes it difficult to care about a healthy future; and 3) When mental illness symptoms are not adequately treated unhealthy behaviors that provide relief are unlikely to be discontinued. Participants also made suggestions for improving health care delivery to facilitate positive behavior change., Conclusion: Patients with mental illnesses need their clinicians to be empathic, help them envision a healthier future, address unmet mental health needs, and provide resources., Practice Implications: Primary care clinicians should encourage their patients with mental illnesses to make healthy lifestyle changes within the context of a supportive relationship. Lifestyle change can be overwhelming; clinicians should acknowledge progress and provide ongoing tangible support., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The future of assertive community treatment is uncertain, and studies have questioned whether it continues to provide a more effective treatment model for severely mentally ill patients in a modern mental health context. Studies conducted in new settings can contribute to the debate., Methods: This Danish study compares treatment from assertive community treatment with treatment by standard community mental health teams, using a non-blinded quasi-experimental multi-center trial. Outcomes included contact with mental health services, days of admission, days of involuntary admission, number of outpatient contacts, adherence to antipsychotic medication, social functioning, user satisfaction, and psychopathology., Results: A total of 366 patients receiving treatment from assertive community treatment (n = 213) or continuation of care from community mental health teams (n = 153) were included in the trial. Assertive community treatment was significantly better in sustaining contact with patients. At 2-year follow-up, 16 (8%) of patients receiving assertive community treatment versus 22(14%) receiving care from standard treatment had lost contact with treatment. Patients who received assertive community treatment had a larger reduction in inpatient service-use, increased adherence to antipsychotic medication, improved social functioning, and higher user satisfaction. No differences in days of involuntary admission and psychopathology were found., Conclusions: The results suggest that a high fidelity assertive community treatment may be a valuable tool to strengthen contact between severely mentally ill patients and the treatment staff and may contribute to improving outcomes in a modern Danish mental health context.

Relational Evidence in Preventive Child Protection: Evaluation of a Manual Based Group Intervention "Strengthening Resources of Mentally Ill and Addicted Parents" This article describes results of the evaluation of the manual-based group intervention programme "Strengthening Resources of mentally ill and addicted Parents". This intervention's objective is to encourage parents in mentalization, emotional regulation, coping with stress and social support competencies. Strengthening these reflexive competencies aims at promoting parents' recourses and minimizing risks for child abuse. Therefore, the evaluation design is based on data triangulation: combining standardised instruments and qualitative interviews of participants and professional providers. Besides intervention effects, this design aims to analyse aspects by parents' and professionals' subjective perspectives, which promote the interventions in it's effect. 160 parents participated. The results show, that parents feel statistical significant less overwhelmed by the responsibility of being a parent, recognise more capacity to act and support in everyday. Qualitative data analysis reinforces these results and shows how the manual's concept supports parents' benefit from the intervention in their every day life.

Epistemic injustice occurs when therapists implicitly and explicitly impose professional and institutional power onto clients. When clients have a diagnosis of schizophrenia, this very fact further complicates and highlights the power disparity within the helping relationship. Inspired by the work of critical philosopher Miranda Fricker on epistemic injustice, and using critical theories of language and knowledge, this article analyzes audiotaped session transcripts between a client with a history of psychosis and a social worker in an outpatient mental health agency. Findings illustrate two main discursive interactional patterns in everyday clinical social work encounters: (1) how the therapist's utterances claim disciplinary power and construct the client's testimony in alignment with an institutional agenda, while pre-empting the client's lived experience; and (2) how the client, though actively resisting, is managed to perform the identity of being a mentally ill person. The authors close with suggestions of how to avoid these mishaps and work toward epistemic justice in mental health practice.

Background: Beginning in late 2010, private health insurance plans were required to allow dependents up to age 26 to remain on a parent's plan. Known as the dependent coverage or young adult mandate, this provision increased coverage substantially within the group of 19-25 year-olds affected by the policy change. Subsequent work evaluating whether increased coverage had a positive effect on mental health found mild improvements in self-reported mental health. This work focused exclusively on average effects among young adults in the years after the policy change, leaving open the question of how young adults fared depending on where they reside in terms of the distribution of risk for mental health issues., Aims of the Study: We assess the effects of the dependent coverage mandate on young adult mental well-being focusing on the distribution of mental health issues. We seek to understand how potential improvements (or degradations) differ across the entire risk profile. Gains among individuals who are at low risk for severe mental health issues may send a far different signal than gains among those with higher risks., Methods: Using MEPS data from 2006 through 2013, we use quantile regression within a difference-in-differences design to compare pre/post outcomes across the distribution of risk for young adults ages 23-25 affected by the mandate to 27-29 year-olds not affected by the mandate. Further, we evaluate differences in the effect of the mandate by sex, given well-known disparities in incidence and prevalence of mental illness between men and women. To gauge the effects of the mandate on mental health, we use the Mental Component Score measure within the MEPS, ideal for our quantile regression given the broad range of scores. The key premise in our evaluation is that individuals with higher risks for mental health problems due to biological or socioeconomics factors are more likely to rank at locations of the mental health score distribution indicating worse outcomes., Results: We find significant improvements in self-reported mental health in the 23-25 year-old group following the mandate. However, the gains were not equal across the risk distribution. For individuals at the 0.1 quantile (worse self-reported mental health), the improvement in MCS scores was significant, a 6.1% increase compared to the pre-mandate baseline at that quantile. Effects were smaller but still significant at the median but there was no apparent effect for those that were at higher levels of self-reported mental health. Our results also suggest improvements for women (+9% relative to baseline at the 0.1 quantile, e.g.) but limited evidence of an effect for men., Implications for Future Research: The finding that increased insurance coverage led to improved self-reported mental health foremost for young adults with the highest risk of mental health problems is encouraging. However, the mechanism for this effect is unclear and in need of further study. Whether improvements in the mental health status of the population depend more on increased access to services or derive primarily from improved financial security is an important research area.

Purpose: Quality of life (QoL) is a broad outcome that is often used to assess the impact of treatment and care interventions in mental health services. QoL, however, is known to be influenced by individual values and preferences. To investigate this heterogeneity on the individual level, this study aimed to distinguish classes with distinct QoL profiles in a broad group of people with severe mental health problems and to identify the QoL domains that are most strongly related to the classes., Methods: QoL data of seven studies that used the Lancashire quality of life profile (LQoLP) were used in a latent class analysis. Sociodemographic variables, health-related variables, and measures of well-being were used to characterise the classes. Additionally, univariate entropy scores were used to assess the strength of the association between the ten LQoLP domains and the latent classes., Results: Two of the three indices of fit pointed towards a three-class model. The three classes differed significantly on all of the LQoLP domains, on well-being, and on 'being in an intimate relationship'. No differences were found for the majority of the health-related and sociodemographic variables. The LQoLP domains 'family relations', 'positive self-esteem', and 'negative self-esteem' were most strongly related to the latent classes., Conclusions: The identification of three distinct classes of QoL scores re-emphasises the heterogenic nature of QoL. The lack of differences in sociodemographic or health-related characteristics between the three classes suggests that QoL is primarily determined by subjective, personal evaluations, rather than by objective characteristics and circumstances.

Purpose: This study validated the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire with 3400 respondents living in Singapore., Methods: The ethnic composition was 76.1% Chinese, 12.3% Malay, 9.6% Indian, and 2% Others. The sample included adults with disabilities (28.9%), adults recovering from mental health issues (14%), and adults from the general population (57.1%). Questionnaires about health-related conditions, the effects of disability on everyday functioning (WHODAS 2.0), the WHOQOL-BREF, and add-on modules of QOL of people with disabilities (WHOQOL-DIS) and QOL of elders (WHOQOL-OLD) were administrated., Results: Confirmatory factor analysis supported a construct of QOL made of four domains, revealing good construct validity. The four domains predicted overall QOL and health satisfaction. Good internal consistency was evidenced by high alpha coefficients for the physical (.79), psychological (.82), social relationships (.81), and environment (.83) domains. Convergent validity was shown by moderate correlations between the different questionnaires measuring QOL (WHOQOL-BREF, WHOQOL-DIS, and WHOQOL-OLD), and discriminant validity by a lower correlation between the WHOQOL-BREF and disability. Convergent and divergent validity were also indicated by higher correlations between similar constructs across the different measures, and lower correlations between dissimilar constructs across measures, respectively. Concurrent validity was supported by showing that individuals with chronic medical conditions had lower QOL than individuals without chronic medical conditions., Conclusions: The results showed that the WHOQOL-BREF has sound psychometric properties and can be used to measure QOL in Singapore.

Family Support Groups (FSGs) are developed for family members of mentally ill offenders. This study investigates family treatment expectations and experiences of an FSG. Family members were interviewed before ( n = 20) and after ( n = 17) attending an FSG. Results show that family members hesitated or were curious about the FSG, expected to receive peer support and universality of problems, to receive information and advice and thought about the safety and respect of the group. Family members experienced the treatment as helpful because it was supportive, they gained new insights and they felt relieved and satisfied. Many family members see the guidance of the therapists and the differences in family and gender roles as an added value of attending an FSG. However, considering the limitations of the study, future studies should gain insight in and stress the importance of the meaning of therapeutic processes for family members confronted with different psychiatric disorders and/or situations.

Purpose: The Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) is a recovery-oriented, self-report measure with an uncertain underlying factor structure, variously reported in the literature to consist of either one or two domains. We examined the possible factor structures of the English version in an enrolled mental health population who were not necessarily actively engaged in care., Methods: As part of an implementation trial in the U.S. Department of Veterans Affairs mental health clinics, we administered the Q-LES-Q-SF and Veterans RAND 12-Item Health Survey (VR-12) over the phone to 576 patients across nine medical centers. We used a split-sample approach and conducted an exploratory factor analysis (EFA) and multi-trait analysis (MTA). Comparison with VR-12 assessed construct validity., Results: Based on 568 surveys after excluding the work satisfaction item due to high unemployment rate, the EFA indicated a unidimensional structure. The MTA showed a single factor: ten items loaded on one strong psychosocial factor (α = 0.87). Only three items loaded on a physical factor (α = 0.63). Item discriminant validity was strong at 92.3%. Correlations with the VR-12 were consistent with the existence of two factors., Conclusions: The English version of the Q-LES-Q-SF is a valid, reliable self-report instrument for assessing quality of life. Its factor structure can be best described as one strong psychosocial factor. Differences in underlying factor structure across studies may be due to limitations in using EFA on Likert scales, language, culture, locus of participant recruitment, disease burden, and mode of administration.

Should psychiatrists be able to speculate in the press or social media about their theories? John Gartner argues the risk to warn the public of concerns about public figures overrides the duty of confidentiality; whereas Alex Langford suggests this is beyond the ethical remit of psychiatric practice.Declaration of interestA.O'B is joint debates and analysis Editor of the British Journal of Psychiatry. J.G. is the founder of Duty To Warn, an association of mental health professionals who advocate the president's removal under the 25th Amendment on the grounds that he is psychologically unfit and dangerous.

Background: The concept of recovery is contested throughout the existing literature and in mental health services. Little research exists that gives voice to service user perspectives of recovery., Aim: This paper explores how service users in two recovery oriented services run by the National Health Service in North West England talked about recovery and what it meant to them., Method: 14 service users accessing these services took part in semi-structured qualitative interviews focusing on the concept of recovery. Data were analysed using an interpretive phenomenological analysis approach., Results: Service users talked about recovery as a dynamic, day to day process as well as an outcome; specifically related to being discharged from inpatient settings. A number of factors including relationships and medication were cited to have the potential to make or break recovery., Conclusions: The study highlights the continued dominance of the biomedical model in mental health services. Service users appear to have internalised staff and services' understanding of recovery perhaps unsurprisingly given the power differential in these relationships. Implications for clinical practice are explored.

The art of the confined began to be studied by psychiatrists in the late 19th century for diagnostic purposes, while the first studies of aesthetic interest were found in the first decades of the 20th century, when psychiatrists as the Swiss W. Morgenthaler and the Austrian H. Prinzhorn published studies on mentally ill artworks, having mainly aesthetic approach. The artworks of the mentally ill belong to the field of Art found in the international literature by the term of Art Brut. The term "Brut" was introduced in 1945 by J. Dubuffet to describe the production of art by authors who were not taught academic art, did not belong to any artistic movement and were indifferent to a potential identification with the viewer or the collector. This French painter and sculptor named Art Brut the founded movement, whose main field was the works of mental patients. Dubuffet was particularly affected, in terms of artistic expression, like so many other creators of expressionism and surrealism, by the art of the mentally ill. Regarding the Greek scene, the relationship between our country and this category of Art began in 1950, at the Psychiatric Hospital of Attica "Dromokaitio", when Professor G. Pampoukis and Dr N. Drakoulidis sent patients' works to the Exposition Internationale d' Art Psychopathologique ( International Exhibition of Psychopathological Art) held in Paris that year. By the late 1980's, only occupational therapy projects existed. The first major artist appearance with a mental disorder is that of O.K. with his participation in the 2nd Biennale of Young Artists of the Mediterranean, in 1987. The year 1994 was a very important one in terms of art production of the mentally ill, as the Cultural Communication Unit (CCU) of the Psychiatric Hospital of Thessaloniki (P.H.T.) was founded, which aim was to produce original works that recorded the psychic reality of the patients and did not recreate other artists' projects. Regarding the promotion of this art, of great significance are the three Panhellenic Exhibitions held in 1996, 1997 and 2001, the last under the auspices of the Greek Psychiatric Association, which brought together the patient-artists' projects of various institutions of our country with the general public, receiving very positive feedback from both the press and the critics. Worth mentioning is also the honorary discrimination of two patient-artists who cooperated with the CCU, D.Z. and A.V., in EUWARD 2004 and 2007 of the German Foundation Augustinum, and also of G.M., who was awarded the first prize at the competition of "Very Special Art" in USA. Two other important moments of the effort of projecting the relationship between Art and Psychiatry were first in 2004 with the exhibition On The Other Bank, as part of the Cultural Olympiad, and the other in 2005 at the Christian and Byzantine Museum of Athens, where the exhibition Art against Stigma, organized by the World Psychiatric Association, the Greek Psychiatric Association and a privately held pharmaceutical company took place. Finally in 2011, again under the auspices of the Greek Psychiatric Association, works of the famous Prinzhorn Collection were exhibited both in Athens and Thessaloniki. In this way the public, once again, came into contact with works in which fears, insecurities and demons within the soul of every patientartist were imprinted, these projects serving not only as clinical evidence but also as creations of unquestionable artistic value.

This research describes the development of a targeted service delivery approach that tailors the delivery of interventions that target criminogenic needs to the specific learning and treatment needs of justice-involved people with serious mental illnesses (SMI). This targeted service delivery approach includes five service delivery strategies: repetition and summarizing, amplification, coaching, low-demand practice, and maximizing participation. Examples of how to apply each strategy in session are provided, as well as recommendations on when to use each strategy during the delivery of interventions that target criminogenic needs. This targeted service delivery approach makes an important contribution to the development of interventions for justice-involved people with SMI by increasing the chances that people with SMI can participate fully in and benefit from these interventions that target criminogenic needs. These developments come at a critical time in the field as the next generation of services for justice-involved people with SMI are being developed.

Background: Interactions between individuals experiencing mental health (MH) problems and the police are complex, and effectiveness of innovative support and diversion models in England and Wales not yet fully evaluated., Aims/hypotheses: Our aims were to examine police interactions with suspects and to measure the immediate effectiveness of police/NHS MH interventions, including liaison and diversion and embedded staff in police contact and control rooms. We hypothesised that those with an MH flag would have significantly greater benefit from such interventions than those without in terms of how far they are taken down the criminal justice pathway and how long they spend in police custody., Methods: We examined police interactions with suspects with and without flagged MH problems in relation to key outcome measures over a 15-month period, overall or when flagged by nurses alone. 'MH flagging' is defined as the presence of a marker on police systems, including both historical and current information, that alerts control room staff and response officers that the call may involve an individual/s with MH problems. Serial cross-sectional analysis of material from a database of individual cases integrating information from three police sources (N = 13,472) was used to test for associations between 'mental health flagging' and outcomes., Results: Individuals with an MH flag have almost identical police dispatch response profiles to those without; they were arrested for and charged with similar offences. Those with an MH flag were significantly more likely to be charged with a criminal offence, less likely to receive a caution and spent longer periods in police custody than people under similar accusations but no MH flag., Conclusions: MH flagging appeared to disadvantage the people flagged, despite the presence of theoretically appropriate interventions. Further research is needed to understand this. It may be that indicating this form of vulnerability if the person is not judged to qualify for a MH service is discriminatory and may even account for excessive rates of mental disorder among prisoners., (Copyright © 2018 John Wiley & Sons, Ltd.)

Background: Although there is a substantial body of research on the stigma associated with mental illness, much of the extant research has not explicitly focused on the concept of prejudice, which drives discriminatory behaviour. Further, research that has investigated prejudice towards people with mental illness has conceptual, theoretical and psychometric limitations. To address these shortcomings, we sought to develop a new measure, the Prejudice towards People with Mental Illness (PPMI) scale, based on an improved conceptualisation and integration of the stigma and prejudice areas of research., Methods: In developing the new scale, we undertook a thematic analysis of existing conceptualisations and measures to identify a pool of potential items for the scale which were subsequently assessed for fidelity and content validity by expert raters. We tested the structure, reliability, and validity of the scale across three studies (Study 1 N = 301; Study 2 N = 164; Study 3 N = 495) using exploratory factor, confirmatory factor, correlational, multiple regression, and ordinal logistic regression analyses using both select and general community samples., Results: Study 1 identified four factors underlying prejudice towards people with mental illness: fear/avoidance, malevolence, authoritarianism, and unpredictability. It also confirmed the nomological network, that is, the links of these attitudes with the proposed theoretical antecedents and consequences. Studies 2 and 3 further supported the factor structure of the measure, and provided additional evidence for the nomological network., Conclusions: We argue that research into prejudice towards people with mental illness will benefit from the new measure and theoretical framework.

Despite the improving mental health literacy of the public over recent years, people's attitudes towards people with the diagnosis of mental illness do not appeared to have changed. Long-term studies are scarce and mainly limited to Northwestern Europe. Given that no study has ever been carried out in Hungary, the present study examined attitudinal trends towards mentally ill people in the country, and evaluated its determinants using one item of the Social Distance Scale to assess social rejection towards others. National representative surveys of Hungarian adults were conducted in 2001, 2003, 2007 and 2015 (n = 7605). By means of interview and a self-administered questionnaire, socio-demographic information, preferences for social distance, and familiarity with mental illnesses were assessed. Trend analysis demonstrated that no meaningful change had occurred in the desire for social distance over a period of 15 years. Being a woman, having low education level, and lower familiarity with mental illnesses were all related to higher preferences for social distance. However, the explanatory power of these factors was very small (4.2%). As found in other countries, attitudes towards mentally ill people have not changed in Hungary. More effort is needed to understand better and overcome social rejection concerning mental illness., (Copyright © 2018. Published by Elsevier B.V.)

In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision-making in CCC. Also, the medico-legal framework underlying CCC use sometimes appears to foster the use of reductionist clinical evaluation. Layered on top of these issues is how stakeholders view coercion. There is a discrepancy between clinicians' and patients' perception of coercion, which leads to clinician-patient differences on whether CCC is necessary. Moreover, the way in which the evaluation is typically carried out influences patients' perception of coercion and subsequently their motivation for participating fully in treatment. In this article, we explore the value of care ethics, often applied to care practices such as nursing, when applied to more procedural medical practices, such as decision-making regarding CCC. The care-ethical approach views decision-making as part of a dynamic care process, within which the lived experience, interpretative dialogue and promotion of dignity are core features. Embracing this new framework means a paradigm shift in when the therapeutic relationship begins, namely, investing in it occurs while conducting an evaluation for a possible CCC procedure. Unlike in current typical evaluations, early cultivation of the therapeutic relationship enables the patient to participate in the definition of his needs, reduces perceived coercion and negative emotions and enhances treatment motivation. Finally, implications of this novel approach for clinical practice are formulated and discussed., (© 2017 Nordic College of Caring Science.)

Aims: The aim of the current study was to carry out a national population-based survey to assess the proportion of people disclosing mental health problems in a variety of settings. A further aim was to explore respondent characteristics associated with disclosure., Methods: In 2014, telephone interviews were carried out with 5220 Australians aged 18+, 1381 of whom reported a mental health problem or scored highly on a symptom screening questionnaire. Questions covered disclosure of mental health problems to friends, intimate partners, other family members, supervisors or other colleagues in the workplace, teachers, lecturers or other students in the educational institution, health professionals and others in the community. Other than for intimate partners or supervisors, participants were asked whether or not they told everybody, some people or no one. Multinomial logistic regression was used to model the correlates of disclosure in each setting., Results: For friends and family, respondents were more likely to disclose to some people than to everyone or to no one. In most other domains, non-disclosure was most common, including in the workplace, where non-disclosure to supervisors was more likely than disclosure. Disclosure was associated with having received treatment or with support in all settings except healthcare, while it was only associated with discrimination in two settings (healthcare and education)., Conclusions: Disclosure of mental health problems does not appear to be linked to discrimination in most settings, and is typically associated with receiving support. Selective or non-disclosure may be particularly critical in workplaces, education and healthcare settings.

Clinical research is predicated ethically on the authentic voluntarism of individuals who choose to enroll in human studies. Existing literature has focused on aspects of informed consent for clinical research other than voluntarism. The objective of this study was to compare the perspectives of clinical research participants who are in good health and who are ill regarding voluntarism-related aspects of informed consent and to assess situational influences that enable voluntarism in the process of obtaining clinical research consent. A 23-item written survey, the Informed Consent Questionnaire (ICQ), was administered in a "piggyback" semi-structured interview study of ill and healthy volunteers enrolled in IRB-approved clinical research studies. A total of 150 (60 mentally ill, 43 physically ill, and 47 healthy) clinical research participants participated. Respondents expressed positive views of their experiences with the informed consent processes for their respective clinical research protocols and respondents strongly endorsed items related to voluntarism irrespective of their illness type (range of means = [3.9, 4.8]). Ill participants more highly endorsed items relating to informed consent conditions (mentally ill vs healthy: 0.54 on a 5-point scale, P value = 0.01) (physically ill vs. healthy: 0.47 on a 5-point scale, P value = 0.01). The favorable views of clinical research participants regarding their experience of giving informed consent to enroll in a study were not surprising. Contrary to our a priori hypothesis, healthy individuals did not feel as positively as their ill counterparts., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Individuals forensically committed to a state hospital are at an increased risk of suicide; however, there is extremely limited research examining suicide risk estimates and risk factors among inpatients deemed not guilty by reason of insanity (NGRI). This study aimed to determine (a) rates of suicidal ideation history, suicide attempt history, and current distress due to suicidal ideation, and (b) the associations between psychiatric symptom severity, criminal risk factors, and suicide risk. NGRI inpatients (n = 207) from 2 state hospitals were administered assessments of psychiatric symptom severity and criminal risk factors (i.e., criminal tendencies and antisocial personality traits). Results indicated 46.4% of participants reported at least 1 previous suicide attempt, 58% reported previous suicidal ideation, and 10.1% reported some level of current distress due to suicidal ideation. Binary logistic regression results indicated psychiatric symptom severity, not criminal tendencies or antisocial personality traits, was associated with a greater likelihood of current distress due to suicidal ideation. There was a significant interaction between criminal tendencies and antisocial personality, which indicated that individuals higher in criminal tendencies and lower in antisocial personality traits are predicted to have the greatest probability of reporting current distress due to suicidal ideation. Additionally, psychiatric symptom severity and antisocial personality traits were associated with a greater likelihood of a suicide attempt history, whereas criminal tendencies were associated with a decreased likelihood. Clinical implications are discussed, particularly the need for suicide risk assessments and management to consider both psychiatric symptoms and criminal risk factors. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objective: To explore the differences, causes and countermeasures for mental patients' life quality between developed and developing regions.
 Methods: Based on the Quality of Life Questionnaire for Psychiatric Patients (QOL-P) and adopting convenient random sampling method, a total of 340 mental patients in Shanghai and Guangxi were investigated, and the data were analyzed by methods of Paired Design Crosstabulation Data hypothesis test, multivariate logistic regression, and independent sample Kruskal-Wallis test. The differences in patients' life quality in the 2 regions and the influential factors were evaluated.
 Results: There were high consistency and correlation in the total scores of self-evaluation items G (self overall evaluation of life quality by patient) between the 2 regions. Region and gender significantly affected mental patients' life quality in the basic demography characteristics in the 2 regions. The differences between total scores of 4 independent samples grouped by region and sex were significant (P<0.01). The male and femal patients in Guangxi in the dimensions of physiology, psychology, society and symptom were better than those in Shanghai (P<0.01). There was certain homoplasy between the patients from Shanghai and those from Guangxi in terms of the most prominent matters that affect the mental patients' life quality, with the former being affected more seriously than the latter.
 Conclusion: To a certain extent, the mental patients' life quality in the developing region (Guangxi) is better than that in the developed region (Shanghai).

The title's mode "in spite of" suggests that being mentally ill is an obstacle to happiness. Indeed, mental disorders usually tend to preclude happiness. This is at least partly due to the psycho-social consequences of such a disease. There are many hurdles for people with mental illness that exclude them from the sources of happiness. However, on the one hand we have to realize that happiness may not be the most important thing in life, and on the other hand, one may still become happy not only in spite of but even because of being mentally ill. The article closes with an illustrative tale about an unexpected visit by happiness., Competing Interests: Die Autorin ist Mitglied in Selbsthilfeverbänden für Psychiatrieerfahrene., (© Georg Thieme Verlag KG Stuttgart · New York.)

Ethical aspects towards the parenthood of mentally ill patients will be discussed in the German health care system. The "concept of an ethical therapist" offers new perspectives for solutions concerning the individual level. Structural and systemic problems require institutional and political configurations. The "ethical compass of psychiatric parenthood" points the dimensions of autonomy, heteronomy, egoism, and public spirit. Reductions of psycho-social burden, an age-dependent differentiated prevention und early external assessment contribute to successful parenthood of mentally ill patients., Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: The aim of the presented study was to analyse associations between drug-resistant depression and the way the illness is described by patients and members of their families. In particular, a hypothesis to be verified was that being ill may be a factor stabilising the family system, and consequently treatment of this kind of depression may encounter additional difficulties and enforce "drug-resistance" by "sustaining depression" by the family., Methods: The study included 20 patients and their families. The consultations that were conducted with each of the families constituted data for the presented research. Initial results indicate an explicit association between the way the patient and his or her family define circumstances of the illness and treatment and the type of interactions between them that are manifested verbally and nonverbally., Results: Results of qualitative analysis indicate that if a patient during consultation reflects on how to describe his or her situation and precipitating factors of the illness, it usually takes place in opposition to other members of the family of origin. On the other hand, if a patient manifests depressive symptoms, he or she assumes a dependent role, while the rest of the family express an attitude of warmth towards him or her., Conclusions: Drug resistance depression should be considered, also with the context of the patient's family.

Background and Aims: In recent years, there has been a growing awareness of the need to protect human rights in psychiatry. Within the last years, considerable effort has been made to reduce restrictive measures in mental health settings. Reducing restrictive measures within mental health care has also moved increasingly into the focus of public debate. This study aims, for the first time in a Southeast Asian sample, to explore whether socio-demographic factors affect public attitudes toward restrictions on mentally ill people in Hanoi, Vietnam., Methods: A general population-based survey (self-report questionnaire) was carried out in 2013 in the greater Hanoi area. The survey sample ( N = 813) was recruited according to the latest published census (2009) and micro-census (2013) in Vietnam and Hanoi with regard to the socio-demographic factors gender, age, urbanity, household size and marital status. Multinomial logistic regressions for odds ratios with 95% confidence intervals were calculated to examine the influence of epidemiological variables, like gender and age, on the public attitude toward restrictions imposed on mentally ill people in Vietnam., Results: This study found, for the first time in a large Vietnamese sample, that gender and age were associated with public attitudes toward restrictions on mentally ill people. In detail, significantly fewer men endorsed compulsory admission to a hospital and abortion than Vietnamese women. In addition, endorsement of abortion was significantly higher in older people., Conclusion: The results offer some insight into roles of women in the Vietnamese society and might reflect the traditional gender expectations in Vietnamese families. Moreover, the results emphasize the need for supporting female psychiatric patients and their families within their communities and in the Vietnamese society.

Background: Self-reported psychosis-like experiences (PEs) may be common in patients with mood disorders, but their clinical correlates are not well known. We investigated their prevalence and relationships with self-reported symptoms of depression, mania, anxiety, borderline (BPD) and schizotypal (SPD) personality disorders among psychiatric patients with mood disorders., Methods: The Community Assessment of Psychic Experiences (CAPE-42), Mood Disorder Questionnaire (MDQ), McLean Screening Instrument (MSI), The Beck Depressive Inventory (BDI), Overall Anxiety Severity and Impairment Scale (OASIS) and Schizotypal Personality Questionnaire-Brief form (SPQ-B) were filled in by patients with mood disorders (n=282) from specialized care. Correlation coefficients between total scores and individual items of CAPE-42 and BDI, SPQ-B, MSI and MDQ were estimated. Hierarchical multivariate regression analysis was conducted to examine factors influencing the frequency of self-reported PE., Results: PEs are common in patients with mood disorders. The "frequency of positive symptoms" score of CAPE-42 correlated strongly with total score of SPQ-B (rho=0.63; P<0.001) and moderately with total scores of BDI, MDQ, OASIS and MSI (rho varied from 0.37 to 0.56; P<0.001). Individual items of CAPE-42 correlated moderately with specific items of BDI, MDQ, SPQ-B and MSI (r φ varied from 0.2 to 0.5; P<0.001). Symptoms of anxiety, mania or hypomania and BPD were significant predictors of the "frequency of positive symptoms" score of CAPE-42., Conclusions: Several, state- and trait-related factors may underlie self-reported PEs among mood disorder patients. These include cognitive-perceptual distortions of SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD; and cognitive biases related to depressive or manic symptoms., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Despite the estimated 15% likelihood that a psychiatrist will become the victim of stalking, there is little formal recognition of its prevalence or its impact on well-being. Through narrative accounts, ten psychiatrists with psychodynamic orientations speak of their experiences including how each managed the anxieties consequent to stalking. These include a variety of adaptive psychic operations as well as concrete actions to curtail stalking.

Individuals with serious mental illness, prisoners, and ex-offenders needing skilled nursing facility (SNF)-level care are difficult to place in traditional SNFs. SNFs accepting these historically marginalized individuals may offer them a more appropriate level of care. We compared health services use (emergency room (ER) visits, acute hospitalizations), total number of antipsychotic medications prescribed, and quality-of-life indicators (depressive symptoms, cognition, resident behaviors), before and after admission, among 86 individuals admitted to a Connecticut SNF for persons difficult to place. Residents were racially diverse, primarily male (89%), and 58.4 (±12.5) years of age; 56 percent were transferred from state psychiatric facilities. Twelve-month hospitalization rates decreased from 36.5 to 10.6 percent, 27 percent of those taking an antipsychotic medication at admission experienced a reduction in total number of antipsychotics prescribed by six months, and 13 residents transitioned into the community. Quality-of-life indicators did not change between admission and first quarterly assessment. A SNF for persons difficult to place may help prevent hospitalizations, optimize antipsychotic medication use, and serve as an intermediate step into the community. These findings may inform development of an evidence-based model for establishing SNFs in other states for persons who are difficult to place., (© 2018 American Academy of Psychiatry and the Law.)

Background: Workplace violence is worrisome in the mental health sector. Little is understood about it in sub-Saharan Africa. Consequently, we decided to investigate the prevalence, related factors, and the available sources of support for the victims of workplace violence in a mental referral hospital in Botswana., Methods: We conducted a cross-sectional retrospective survey of 201 mental health staff (MHS) of Sbrana Psychiatric Hospital, Botswana. We used a self-administered questionnaire to obtain information on socio-demographics and various aspects of work-related violence and available source of supports. We also used Andrew and Withey Job Satisfaction Questionnaire to assess the workers' level of job satisfaction., Results: One hundred and seventy-nine questionnaires out of the two hundred and one returned were analyzed. One hundred and twenty-five (69.8%) of the respondents reported a lifetime experience of physical violence, while 44.1% experienced the same during the previous 12 months. Nursing services (χ2 = 29.95, p < 0.01) and long duration of service (χ2 = 29.95, p < 0.01) were associated with lifetime encounter of physical violence. Those who reported a physical assault had a higher level of job dissatisfaction than staff who never experienced violence (t = - 3.07, p = 0.02)., Conclusions: The rate of physical violence among mental health workers in Botswana is comparably high, and nurses are the most exposed members of staff. Protocol development and periodic training on violence prevention are hence recommended, especially for the most exposed members of staff.

Background: People who have observed or are aware that a consumer has been restrained may experience distress, confusion, concern, anger or fear and perceive as punishment. However, studies that examine the perspective of patient's family are limited. This study has explored the knowledge and attitude of family member of mentally ill patient., Method: A descriptive cross-sectional study was carried out among family member of mentally ill patient at Punarjeevan Hospital, Balkumari, Lalitpur to assess the knowledge and attitude of family member of mentally ill patient regarding restraint. Interview schedule was used to collect data related to knowledge and attitude regarding restraint along with demographic features., Result: The average score of knowledge regarding physical restraint was 30.66 (72.99%) and average attitude score was 4.17 (83.31%). In the study 40% relationship was found between knowledge and attitude. Regarding the association between knowledge and selected socio-demographic variables, knowledge was found to be associated with age, educational level and relation with patient of respondents. In terms of association between attitude and selected socio-demographic variables, attitude was found to be associated with relation with patient of respondents., Conclusion: This study concludes that family member has relevant knowledge regarding physical restraint but the knowledge regarding risk and consequences of physical restraint was lacking. In terms of attitudes about physical restraint over all attitude was found to be positive among family members but attitude regarding feeling of patient towards physical restraint was contrast., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The refugee health screener-15 (RHS-15) is utilized as a diagnostic proxy for common mental disorders in refugees. Studies are needed to determine its clinical and social utility. A retrospective chart analysis of adult refugees compared RHS-15 scores to utilization of medical services and presence of disability claims. Refugees with negative, positive, and highly positive RHS-15 scores attended 3.1, 4.4, and 5.7 mean primary care visits and 1.6, 2.8, and 4.4 mean non-primary care visits, respectively (p < .000). The 11% (43/392) claiming disability were 5.1 times more likely to have a positive RHS-15 (OR 4.3, 95% CI 2.1-8.8). A positive RHS-15 was not predictive of a disability claim (19% PPV), and those with a negative RHS-15 were unlikely to claim disability (96% NPV). The RHS-15 score correlates with visit utilization. A positive score is not predictive of a subsequent disability claim.

Integrative review about self-stigma among people with mental illness and its relationship with health services. A total of 149 articles were found in four databases. After screening, 9 articles were selected for complete reading and data extraction. The studies identified that higher levels of self-stigma result in lower levels of adherence to treatment and that lower levels of self-stigma result in greater adherence to treatment. Active participation and engagement in the aspects of care facilitate the empowerment of people with mental illness for better adherence to treatment, reduction of self-stigma and increase of recovery possibilities., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aims and Objectives: To examine professional stigma and attitudes of parenthood towards postpartum women with severe mental illness and the association between postpartum nurses' attitudes and nursing interventions that promote motherhood., Background: Stigma and attitudes towards parenthood of women with severe mental illness may influence nurses' clinical practices., Design: Cross-sectional, mixed methods., Methods: The Stigma among Health Professionals towards People with Severe Mental Illness, Attitudes towards Parenthood among People with Severe Mental Illness and Nursing Interventions that Promote Becoming a Mother Questionnaires were used in the study, as well as qualitative analysis., Results: Sixty-one postpartum nurses participated in the study. Increased stigma was associated with an increase in negative attitudes towards parenthood among people with severe mental illness, in general, and towards their parenthood skills, in particular. Postpartum nurses reported a decrease in nursing interventions and a therapeutic nurse-client relationship that fosters mother's empowerment. Themes that emerged from the qualitative analysis were postpartum nurse's perceptions of inadequacy, difficulty of postpartum nurses taking responsibility for managing women with severe mental illness and a paternalistic approach to these women, rather than empowerment, regarding infant care., Conclusion: Nurses providing care to postpartum women with severe mental illness and their infants may provide fewer routine postpartum interventions due to professional stigma and negative attitudes concerning parenting skills. Nurses should provide individualised, tailored care that allows women with severe mental illness to become a mother to the best of her ability., Relevance to Clinical Practice: Not all women with severe mental illness are capable of caring for themselves and/or their baby. Nurses should provide individualised, tailored care that allows the women with severe mental illness to become a mother to the best of her ability., (© 2017 John Wiley & Sons Ltd.)

The practice of mechanically restraining psychiatric patients is constantly under debate, and staff attitudes are considered a central factor influencing restraining practices. The aim of this study was to explore associations between psychiatric staff members' presence and participation in incidences of restraint and attitudes towards mechanical restraints., Methods: Staff members (psychiatrists, nurses, paramedical staff; N = 143 working in a government psychiatric hospital in Israel) completed a questionnaire including personal information, participation in incidents of restraint and attitudes towards mechanical restraints. Items were categorized into the following categories: security and care; humiliation and offending; control; order; education and punishment., Results: Compared to those who were not present during restraint, staff members who were present agreed significantly less with statements indicating that restraints are humiliating and offending and agreed more with statements indicating that restraints are used primarily for security and care (p < .05). Among those present in incidences of restraint, staff members who physically participated in restraint agreed significantly more with statements indicating that restraints are a means for security, care and order, and less with statements indicating restraints are humiliating and offending, compared to those present but not physically participating in restraint (p < .05)., Conclusions: These findings highlight the importance of proximity of staff members to incidences of restraints. This may have implications in understanding the professional and social discourse concerning mechanical restraints.

Introduction: Stigmatisation of mental illness constitutes a major problem in the development of mental healthcare programs, especially when it originates from health professionals themselves. The aim of this research is to investigate possible attitudes of stigmatisation among first and final year medical students registered at the University of Conakry faculty of medicine in Guinea-Conakry (West Africa)., Methods: Focus group discussions identified students' attitudes and perceptions in relation to mental illness, their explanatory models, their opinions concerning traditional and modern therapeutic practices with regard to mental illness, and their interest to possibly incorporate psychiatry in their future medical practice., Results: Many students explicitly regret the stigmatisation of mental health patients, but nevertheless share the general population's prevailing attitudes of discrimination. The dominant stereotype of mental illness is that of madness, although final year medical students describe a more diverse spectrum of mental health problems. There is strong adherence to secular occult explanations of mental illness and advocacy for traditional medicine in addressing these illnesses, including among final year medical students., Discussion: No student would opt for psychiatry as a specialisation, although some expressed interest in integrating psychiatry into their future medical practice. However, this research indicates that stigmatising attitudes are not cut in stone. Under the impetus of specific teaching programmes, attitudes can evolve to create room for tolerance and compassion.

Mental health courts (MHCs) have been in existence for more than 20 years, but little is known about the demographics, clinical features, and court outcomes of MHC defendants court-ordered for competence to stand trial (CST) evaluations. We examined these items in defendants who underwent CST evaluations for the Marion County, IN, MHC. The MHC defendants were significantly more likely than defendants referred from other courts to be male, black, unemployed, and on disability, and have a history of prior arrests and psychiatric treatment. MHC defendants found incompetent to stand trial (ICST) were significantly more likely to have a psychotic disorder and a high school education than MHC defendants found CST, and they were significantly less likely to have a mood disorder, to be on psychiatric medication, or to cooperate in forensic interviews. Evaluator concordance of primary diagnoses was linked to concordance of CST opinion. There were no significant differences in the outcome of charges between CST and ICST MHC defendants. This study highlights several important findings. First, evaluator concordance of diagnoses is linked to evaluator concordance of opinion. Second, the Marion County MHC functioned in a non-adversarial manner by not discriminating against defendants who were found ICST at the time of final judgment., (© 2018 American Academy of Psychiatry and the Law.)

Identification with Christ among psychiatric patients is an example of a complex and multifaceted phenomenon. As a delusion it includes a misidentification (change of identity) in the layer of content and, usually, grandiosity and/or paranoid traits in the formal aspect. What is more, it fits in the category of religious delusions, which are perhaps the most controversial type of delusions and as such require special sensitivity as well as knowledge beyond psychology or psychiatry. The aim of the articleis to show the phenomenon of identification with Christ among psychiatric patients, taking into account different ways of its explaining and understanding. Papers relating to the topic, both theoretical considerations and case studies, found in the EBSCO database were analyzed. Searching for the articles the following key words were used: identity, identification, delusion, Jesus/Christ/Messiah, psychosis, schizophrenia. The analysis included all (actually not numerous) articles except for the one linked to cognitive approach which did not significantly contribute to the issue. Given the multiplicity of ways of explaining and understanding the experience of identification with the figure of the Messiah, it seems to be a mistake to hold both objectivist and one-sided, based on one theory, attitude towards it. Such an experience should be recognized in the context of the history of patient's life and the all possible mechanisms leading to its occurrence, as well as the meanings hidden beneath the symptom, should be take into account. It is also important to be well-oriented in the system of religious beliefs and spiritual needs of the patient.