Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

Regression Analysis of Count Data: Preface

庸言 = The justice

Men and women experience different kinds of mental health problems. While women exceed men in internalizing disorders such as depression and anxiety, men exhibit more externalizing disorders such as substance abuse and antisocial behavior, which are problematic for others. These differences also vary by race and social class: for example, African Americans possess better mental health and, thus, a smaller gender gap in psychiatric problems. What explains these differences? We concentrate on conceptions of gender and gender practices. Research on gender and mental health suggests that conceptions of masculinity and femininity affect major risk factors for internalizing and externalizing problems, including the stressors men and women are exposed to, the coping strategies they use, the social relationships they engage in, and the personal resources and vulnerabilities they develop. This chapter investigates explanations in these areas for gender differences both in general and by race and class.

Gender and mental health.

This study tests the hypothesis that seriously violent offenders pleading not guilty by reason of insanity or incompetent to stand trial are characterized by prefrontal dysfunction. This hypothesis was tested in a group of 22 subjects accused of murder and 22 age-matched and gender-matched controls by measuring local cerebral uptake of glucose using positron emission tomography during the continuous performance task. Murderers had significantly lower glucose metabolism in both lateral and medial prefrontal cortex relative to controls. No group differences were observed for posterior frontal, temporal, and parietal glucose metabolism, indicating regional specificity for the prefrontal deficit. Group differences were not found to be a function of raised levels of left-handedness, schizophrenia, ethnic minority status, head injury, or motivation deficits in the murder group. These preliminary results suggest that deficits localized to the prefrontal cortex may be related to violence in a selected group of offenders, although further studies are needed to establish the generalizability of these findings to violent offenders in the community.

selective Reductions in Prefrontal Glucose Metabolism in Murderers

Procedural justice and the mental health court judge's role in reducing recidivism

Objective: Relatively few studies have evaluated whether mental health courts reduce criminal recidivism. This study evaluated an established court and followed for two years defendants who exited the program in the court’s fifth year of operation. Methods: Court administrative data and state arrest records for 99 defendants who exited a mental health court in 2005 were used to determine whether the proportion arrested and number of arrests were lower in the two years after court exit than in the two years before court entry and whether the reduction was greater for those who completed the court process. Logistic regression was used to examine completion’s effect on recidivism with controls for other predictors. Survival analysis was used to discern how long court effects were sustained after exit. Results: Defendants had significantly reduced recidivism from precourt entry to postcourt exit. Completers (N=60) and those ejected from the program (N=31) had fewer rearrests, but completers were much less likely to be rearrested (odds ratio=.12), even with confounds controlled for, and they had a much longer period before rearrest. Conclusions: This study adds to the evidence that mental health courts can reduce criminal recidivism among offenders with mental illness and shows that this effect was sustained for two years, even though defendants were no longer being monitored by the court or receiving court-mandated treatment. The results show that the mental health court program studied had a greater impact on defendants who completed the program than on defendants who did not. (Psychiatric Services 61:463–468, 2010)

https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2010.61.5.463

Arrests two years after exiting a well-established mental health court.

There are now more than 300 mental health courts in the United States; yet studies on their effectiveness in reducing criminal recidivism are relatively few, and most follow defendants after entry into the court, during their participation, and sometimes, for a short period following exit. Using a preenrollment-postexit design that follows participants of one mental health court for 2 years after exit, this article examines criminal recidivism of participants after they no longer receive the court's services, supervision, and support. It investigates participant demographic, clinical, and criminal history and key arrest characteristics as well as process measures and graduation as predictors of two measures of recidivism, arrests, and postexit jail days. Its findings support the hypothesis that mental health courts can reduce criminal recidivism postexit and point to criminal history, time in mental health court, and graduation as the main influences on recidivism. Language: en

Effectiveness 2 Years Postexit of a Recently Established Mental Health Court

This article investigated criminal recidivism 1 year postexit from a mental health court (MHC), which has, unlike prior MHCs studied, relatively short periods of court supervision. It benefits from a federal pretrial services agency that screens all arrestees for mental illness and dedicates a specialized supervision unit (SSU) to provide supervision and services while on pretrial release to all screened positive, including MHC participants. We compared criminal activity prior to key arrest with criminal activity post court disposition in MHC participants (N 408) and MHC-eligible mentally ill arrestees in SSU (N 687) receiving the same supervision and services while controlling for possible confounders. The proportion of MHC participants arrested was significantly lower in the year after MHC exit and significantly lower than that of the comparison group. They also averaged fewer rearrests and had a longer time to rearrest. MHC graduates made the greatest gains and accounted for the recidivism differences between MHC participants and the comparison group. This study adds to the accumulating evidence of the effectiveness of MHCs in reducing recidivism among offenders with severe mental illness.

Bradley Ray

Papers

Procedural justice and the mental health court judge's role in reducing recidivism

Arrests two years after exiting a well-established mental health court.

Effectiveness 2 Years Postexit of a Recently Established Mental Health Court

Effectiveness of a short-term mental health court: criminal recidivism one year postexit.

Long-term recidivism of mental health court defendants