They also found that the rate of violent criminal victimization in their sample was two and a half times greater than in the general population. In general, these studies of victimization among individuals with serious mental illness have focused on diagnostically mixed samples that are at high risk as a result of being homeless or seriously disabled because of their illness. The studies we have discussed on community risk among persons who have severe mental illness reveal several trends.
First, most of the studies used samples of individuals who were at high risk because of homelessness, dual diagnosis, or compromised clinical status. Thus these studies provide only a partial picture of community risk for the total population of individuals with schizophrenia who reside in the community. Second, few studies examined police contact or victimization, and those that did used samples with a mix of psychiatric diagnoses.
Third, only one study used a prospective design. The absence of prospective designs limits the kinds of predictors of community risk that can be used as well as the significance of the models that are developed to predict community risk. Fourth, few studies used a full range of clinical, functional, and demographic variables as predictors of community risk. Our study addressed a number of these issues by examining, over a three-year period, a sample of individuals with diagnoses of schizophrenia who were living in an urban environment.
Compared with samples used in previous studies, our sample must be considered a lower-risk sample because of an absence of comorbid substance abuse or dependence at the time of study entry and because the participants were housed in the community at baseline. As such, this was a sample of individuals for whom community risk would not generally be considered a focal issue.
Second, because of the low occurrence of two other major risk factors—homelessness and substance use—this sample provides a more accurate representation of the contribution of schizophrenia to community risk. We addressed two sets of questions. First, what were the rates and types of police contact, criminal charges, and victimization over a three-year period in this sample of individuals with schizophrenia?
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Second, considering clinical status, current psychosocial functioning, demographic variables, and functional history, what were the predictors of police contact, criminal charges, and victimization over the three years? This was a follow-along study of individuals who had diagnoses of schizophrenia or schizoaffective disorder. All of the participants had been admitted to one of three community-based programs in urban Los Angeles between and and were monitored over a three-year period The three programs have been described in detail elsewhere 29 , 30 , Nearly all of the participants had received treatment in the publicly funded mental health system and were receiving public assistance.
To be eligible for the study, in addition to having a diagnosis of schizophrenia or schizoaffective disorder, participants had to have lived in Los Angeles for at least three months and to be 18 to 60 years of age, and they could not have a diagnosis of mental retardation or organic brain syndrome or a current diagnosis of substance dependence. All subjects consented to participate in the study under procedures that had received approval from the institutional review board of the University of California.
Measures of psychosocial functioning were administered during face-to-face interviews at baseline and every six months during the three-year study period. A life history interview was conducted at baseline. Diagnoses were established through a two-step process. First, an initial diagnostic screening for schizophrenia based on chart and interview data was conducted by an admitting clinician at the program sites. All participants who passed the first screening subsequently received diagnoses in a face-to-face interview by a licensed doctorate-level clinician trained in the use of the Schedule for Affective Disorders and Schizophrenia SADS Structured interview data and clinical records were used to determine the SADS diagnosis, which included the assessment for current substance dependence.
Interviewer training and reliability protocols have been described in detail elsewhere During the first six months of the study, any participant who dropped out was replaced and was excluded from the analyses. The study sample was recruited over an month period. Functional measures.
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The Community Adjustment Form CAF 34 is a semistructured interview in which the subject reports objective behaviors or events that have occurred during a six-month period. This measure contains 17 domains of psychosocial functioning and community adjustment and is designed to minimize the subjective ratings of interviewers. After extensive training of the interviewers, intraclass correlation coefficients ICCs obtained from 22 interviews indicated excellent interrater reliability range,. Both scales use single items with multiple descriptive anchors to assess a functional domain.
The scales each assess outcome in four distinct domains. The variables used in this study were the work item from the SCOS and the independent living, family functioning, and social functioning items from the RFS. The scale ratings were derived from the CAF according to procedures that have been outlined elsewhere Interrater reliability was established on the basis of the ICCs during intensive rater training and during booster rating assessments throughout the study.
The ICCs on the four outcome items ranged from. Clinical measures.
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The measure of symptoms was the overall score on the item version of the Brief Psychiatric Rating Scale 40 , After intensive rater training, ICCs on the items ranged from. The intrapsychic-deficits measure was the intrapsychic-foundations subscale of the Quality of Life Scale ICCs on the items ranged from. Life history measure. We used the Demographic Interview Form 34 , a life history interview, at baseline only.
It captures social demographic data and functional history data in several psychosocial areas and targets an individual's life history up to the point of study entry. Four domains of predictors were used: baseline functional status, baseline clinical status, demographic variables, and history of problems.
The demographic variables were sex, age, and race. The clinical-status variables were number of days of psychiatric hospitalization in the six months before study entry, number of days of taking psychiatric medications in the six months before study entry, overall severity of symptoms at study entry, and intrapsychic deficits at study entry. Psychosocial functioning included baseline housing stability, substance use, and three items from the RFS that measured family relations, social skills, independent living skills, and the work item from the SCOS.
Finally, the four problem-history variables were lifetime history of suicide attempt, arrest, assault, and substance use before study entry. Criterion variables. The dependent variables had three domains: police contact, criminal charges, and victimization. The police-contact data consisted of the number of police contacts in the previous six months that were not related to being victimized and the nature of each contact. The criminal-charge data consisted of the number of charges in the previous six months and the nature of each charge. The victimization data consisted of the number of times the subject was victimized in the previous six months and the nature of the victimization.
The nature of the community-risk events—police contact, criminal charges, and victimization—were coded into categories from written interview data by three research assistants using a consensus method. For some variables these data were collapsed over the three-year study period to yield data on whether an individual had had contact with the police during the three years, whether criminal charges had been filed against the individual during the period, and whether the individual had been victimized during the period.
Studies on the reliability and validity of self-report data on criminal and violent behavior among individuals with serious mental illness have been published 3 , 4. These studies found that self-reports of criminal behavior provided higher incidence rates than official arrest records or information from collateral informants. To determine predictors of the three dichotomous variables—police contact, criminal charges, and victimization—we performed logistic regression. A total of 17 predictor variables were grouped into four conceptual categories: demographic variables, baseline clinical status, baseline psychosocial functioning, and history of problems.
On the basis of this conceptual framework, we used the same two-step procedure for each dependent variable. In step one, we performed four separate logistic regression analyses by using each conceptual group of predictor variables forced into the equation as a block.
This approach avoided the inflation of the type I error rate associated with stepwise entry procedures. In the second step, we combined the significant variables from the first step and entered them all as a block to derive the final models for predicting each dependent variable. Ninety-eight percent of the sample were housed at baseline; in aggregate, the sample had symptoms in the moderate range, which is similar to other outpatient samples of individuals with schizophrenia, and had low levels of current substance use.
As shown in Table 1 , less than 3 percent of the sample received a score of 11 or higher on the positive-symptom subscale of the Brief Psychiatric Rating Scale, which reflects the severity of psychotic symptoms possible scores range from 3 to 21, with higher scores reflecting greater severity. This finding suggests that the vast majority of this sample was not experiencing severe psychotic symptoms at baseline.
During their adult life until study entry, 78 subjects 49 percent of the sample had been arrested, 44 25 percent had committed assault, and 45 26 percent had attempted suicide. A total of individuals 83 percent of the sample had been taking antipsychotic medication every day during the six months before study entry, and the sample generally maintained this high level of medication use throughout the study period. Most of the sample was male individuals, or 74 percent ; the number of subjects from racial minorities—50 African American 29 percent of the sample , 27 Hispanic 16 percent , and 8 4 percent other—was almost equal to the number of nonminority Caucasians 87 individuals, or 51 percent.
At 12 and 18 months, 88 percent of the original sample had been retained. The retention rate dropped to 83 percent at 24 months, 80 percent at 30 months, and 72 percent at 36 months. We compared the individuals who completed the study at 36 months with the 49 who dropped out of the study in sex, race, prognosis, age, duration of illness, severity of symptoms at baseline, baseline role functioning, and baseline substance use. None of the differences were statistically significant.
Police contact. The descriptive data on the community risk variables during the three-year study period are shown in Table 2. Eighty-three participants 48 percent of the sample had contact with the police during the three years, for a total of separate contacts. The vast majority of the contacts incidents, or 87 percent were initiated by someone other than the study participant, such as the police or other individuals.
Twenty-five 18 percent of the contacts involved aggressive behavior against property or persons. The single largest category of contacts involved traffic-related offenses, such as jaywalking and traffic violations; most other contacts were related to status offenses, such as vagrancy, or illness or were general police-assistance calls. Criminal charges. Thirty-seven individuals 22 percent of the sample reported that charges had been filed against them during the three years, for a total of 62 separate charges. Only 20 of the charges 32 percent were for behavior against property or persons; most of the charges were associated with status or traffic-related offenses.
Only 6. Sixty-five individuals 38 percent of the sample reported having been the victim of a crime during the three years. A total of separate victimization incidents were reported, 70 59 percent of which had not been reported to the police; 91 percent of the victimization incidents involved robbery, rape, or assault, which are considered violent crimes. Fifty-nine subjects 34 percent of the sample reported having been the victim of a violent crime during the three-year period.
Annual incidence rates. Annual incidence rates can be useful for comparison with other population data. In this study we provided an upper and lower value for each annual incidence rate. The lower value was the three-year rate for that category divided by three.
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The upper value was the average of the three separate yearly rates. It must be emphasized that because this was not a random sample, these incidence rates are sample estimates only. The annual incidence of police contact was 16 to All other annual rates presented below reflect the same procedure. The results of the logistic regression analyses are shown in Table 3.
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Younger age, more address changes at baseline, and a history of arrest and assault were associated with a higher probability of police contact. The Wald test statistic for history of assaults was not significant when the other predictors were in the equation. The results for predicting the probability of police contact initiated by individuals other than the study participant, which reflects the most serious risk to the community, are shown in Table 3. Criminal charges filed. Poorer social functioning, more address changes, fewer days of taking medication, and a history of arrests and assaults were associated with a higher probability of criminal charges being filed against an individual during the three-year study period.
As with police contact, history of assault was not a significant predictor when the other variables were in the equation. A greater severity of clinical symptoms and more substance use at baseline were associated with a higher probability of victimization during the three years. Severity of symptoms was a stronger predictor than substance abuse. This study examined the self-reported rates of police contact, criminal charges, and victimization over a three-year period among individuals with diagnoses of schizophrenia who were living in a major urban community in the United States.
At baseline these individuals were housed in their community, did not have co-occurring substance use disorders, and were in a nonacute phase of their disorder. With these baseline characteristics, this sample could be considered to be more stable and at a lower risk than samples in most previous studies of community risk among individuals with severe and persistent mental illness. The politics has perpetuated fear when it comes to people living with a mental illness, and has allowed it to trump evidence.
As professionals and law makers in Canada, we have a responsibility to ensure Canada's laws effectively look after their welfare and well-being. Therefore, again, I ask you to study and debate the issue on the evidence and facts, and not the politics. The mental health community has been told that Bill C will not negatively impact people with a mental illness. If this were true, we would not be here today.
This Bill will negatively impact people living with a mental illness, even if they have never come into contact with the law. I think of Canadians out there who start to realize that something is not right with their mind, perhaps even hearing voices, and not wanting to seek help, knowing what society and their government may think and do to them. It's frightening and saddening.
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We would like to emphasize, as we have said from the introduction of the Bill, that we wholeheartedly support changes that create greater involvement for victims in the process. It's heartbreaking to see the issue turn into one of "us against them". When debating this issue and the bill, many often discuss striking a balance between the needs and rights of both victims of crime and those found not criminally responsible on account of a mental disorder.
Thank you for this most important article. By Celeste Henery June 28, 1. Attendees listen during a march and rally in honor of Charleena Lyles. Photo: Hamburg, Harry. Share with a friend:. Share on Facebook Share. Share on Twitter Tweet. Share on Google Plus Share. Share on LinkedIn Share. Send email Mail.