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.

The chapter addresses the stigma associated with mental illnesses. It begins by summarizing the development of thinking about labeling and stigma over the past half century within the field of the sociology of mental health. This background leads to our consideration of recent advances in the conceptualization of stigma as we ask: What is stigma? How do different stigmatizing circumstances (mental illness, obesity, facial disfigurement) resemble and differ from one another? We also ask: Why do people stigmatize? In keeping with the Handbook’s emphasis on social class and socioeconomic status (SES), we introduce the concept of “stigma power” and apply this new concept to the questions of “What do people gain by stigmatizing others?” and “How is stigma power exercised?” Finally, we consider the steps people take to avoid, mitigate, or overcome stigma, drawing in particular on Thoits’ (Soc Psychol Q 74:6–28, 2011) theoretical statements about this issue. The conceptual growth that has taken place over time opens enormous possibilities for advancing the sociological understanding of mental illness stigma and by doing so helps to illuminate ways in which the effects of stigma might be mitigated.

Labeling and Stigma

Although it is widely believed that risk assessment tools can help manage risk of violence and offending, it is unclear what evidence exists to support this view. As such, we conducted a systematic review and narrative synthesis. To identify studies, we searched 13 databases, reviewed reference lists, and contacted experts. Through this review, we identified 73 published and unpublished studies (N = 31,551 psychiatric patients and offenders, N = 10,002 professionals) that examined either professionals' risk management efforts following the use of a tool, or rates of violence or offending following the implementation of a tool. These studies included a variety of populations (e.g., adults, adolescents), tools, and study designs. The primary findings were as follows: (a) despite some promising findings, professionals do not consistently adhere to tools or apply them to guide their risk management efforts; (b) following the use of a tool, match to the risk principle is moderate and match to the needs principle is limited, as many needs remained unaddressed; (c) there is insufficient evidence to conclude that tools directly reduce violence or reoffending, as findings are mixed; and (d) tools appear to have a more beneficial impact on risk management when agencies use careful implementation procedures and provide staff with training and guidelines related to risk management. In sum, although risk assessment tools may be an important starting point, they do not guarantee effective treatment or risk management. However, certain strategies may bolster their utility. (PsycINFO Database Record

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Do risk assessment tools help manage and reduce risk of violence and reoffending? A systematic review.

A systematic review on the effectiveness of sex offender risk assessment tools in predicting sexual recidivism of adult male sex offenders.

The current study presents a quantitative review of the discriminative and convergent validity of Implicit Association Test (IAT) measures adapted to assess sexual interest in children. IAT measures were able to distinguish sex offenders against children (SOC) from non-SOC (M weighted d from random-effects = 0.63, 95 % CI [0.42-0.83], N = 707, k = 12). The largest group differences were found between SOC and non-offenders, followed by non-sex offenders and rapists. IAT measures using sex versus not sex (and similar attribute categories, such as sex vs. neutral) provided superior discrimination compared to IAT measures using sexy versus not sexy (and similar attribute categories, such as erotic vs. non-erotic). The IAT measures had a moderate relationship to self-report (r = .27, 95 % CI [.13-.40], N = 182), sexual offense history variables (r = .27, 95 % CI [.08-.43], N = 145), and viewing time (r = .30, 95 % CI [.16-.43], N = 180) measures of sexual interest in children. Although these IAT measures can discriminate between groups and show convergence with other measures of sexual interest, a better understanding of the construct validity of these tools is required before their use in the assessment, treatment, and supervision of sex offenders.

The Validity of Implicit Association Test (IAT) Measures of Sexual Attraction to Children: A Meta-Analysis

The current study examined the impact of a mental health court (MHC) on mental health recovery, criminogenic needs, and recidivism in a sample of 196 community-based offenders with mental illness. Using a pre-post design, mental health recovery and criminogenic needs were assessed at the time of MHC referral and discharge. File records were reviewed to score the Level of Service/Risk-Need-Responsivity instrument (Andrews, Bonta, & Wormith, 2008) to capture criminogenic needs, and a coding guide was used to extract mental health recovery information at each time point. Only mental health recovery data were available at 12 months post-MHC involvement. Recidivism (i.e., charges) was recorded from police records over an average follow-up period of 40.67 months post-MHC discharge. Case management adherence to the Risk-Need-Responsivity (RNR) model of offender case management was also examined. Small but significant improvements were found for criminogenic needs and some indicators of mental health recovery for MHC completers relative to participants who were prematurely discharged or referred but not admitted to the program. MHC completers had a similar rate of general recidivism (28.6%) to cases not admitted to MHC and managed by the traditional criminal justice system (32.6%). However, MHC case plans only moderately adhered to the RNR model. Implications of these results suggest that the RNR model may be an effective case management approach for MHCs to assist with decision-making regarding admission, supervision intensity, and intervention targets, and that interventions in MHC contexts should attend to both criminogenic and mental health needs.

Multidimensional Evaluation of a Mental Health Court: Adherence to the Risk-Need-Responsivity Model

The present investigation examined the predictive validity of the Level of Service/Risk–Need–Responsivity (LS/RNR) instrument for general and violent recidivism in a sample of 138 community-supervised adult mentally disordered offenders. The General Risk/Need section was strongly predictive of general recidivism, whereas the Specific Risk/Need section most strongly predicted violent recidivism. Among males, the General Risk/Need section produced a large effect size for general recidivism, whereas general and violent outcomes for females were best predicted by the Specific Risk/Need section. Across diagnostic subgroups, the General and Specific Risk/Need sections predicted general but not violent recidivism; however, many subgroups were small, highlighting a need for replication research with larger samples. The Other Client Issues and Special Responsivity Considerations sections did not significantly inform recidivism prediction. Broadly interpreted, the overall pattern supports the LS/RNR instrument as v...

Prediction of General and Violent Recidivism Among Mentally Disordered Adult Offenders Test of the Level of Service/Risk–Need–Responsivity (LS/RNR) Instrument

Previous studies have identified sexual deviance as a particularly strong predictor of sexual recidivism in sex offenders. The present study examined the construct validity (i.e., convergent and discriminant validity) of the three dynamic factor domains (Sexual Deviance, Criminality, Treatment Responsivity) of the Violence Risk Scale— Sexual Offender version (VRS-SO) as well as the Screening Scale for Pedophilic Interests (SSPI; for comparison purposes) with respect to phallometric measures of sexual deviance. VRS-SO and phallometric data were collected from 124 federally incarcerated sex offenders from a maximum security forensic psychiatric facility. The Sexual Deviance factor and SSPI were positively correlated to varying degrees with computed arousal indexes (Percent Full Erection, difference scores) for child stimuli but were not significantly correlated with nondeviant arousal, supporting the convergent and discriminant validity of these measures, respectively. Convergent validity also appeared stro...

Construct Validity of the Violence Risk Scale—Sexual Offender Version for Measuring Sexual Deviance

Prediction of General and Violent Recidivism Among Mentally Disordered Adult Offenders

Background:The Fountain of Health (FoH) initiative is a knowledge transfer (KT) project on the science of brain health and resilience promotion, in alignment with positive psychiatry. Objectives Assess the effectiveness of FoH KT delivered in individual and group-based formats. Design Pre- and post-intervention quality assurance survey of FoH KT. Setting Interventions occurred in Nova Scotia, Canada. Participants Adults over age 50 years without pre-existing dementia were targeted. A total of 92 participants received FoH KT in individualized (n = 41) and group-based (n = 51) formats. Intervention FoH KT (e.g. sharing evidence, lifestyle coaching, and goal setting) using a range of KT supports (e.g. FoH website, paper materials) was delivered to (1) individual patients by primary care clinicians and (2) community-based groups by lay leaders. Measurements The main outcome measure was participant pre- and post-quality assurance self-reports. Results Improvements were found in participant awareness of FoH, knowledge of evidence-based mental health promotion initiatives, and in application of this information in daily life in both individual and group-based settings. Improvements in participant knowledge about epigenetic factors that impact health and confidence with health behavior goal setting were reported in both contexts. Changes in self-perceptions of aging scores reached significance in the group intervention. Conclusions FoH KT produced short-term positive self-reported changes in participants in both individual and group formats. Larger control studies with long-term follow up are needed to better assess effects of both individual and group formats of FoH KT and longer term impacts on health behaviors and outcomes.

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Donaldo D. Canales

Papers

Multidimensional Evaluation of a Mental Health Court: Adherence to the Risk-Need-Responsivity Model

Prediction of General and Violent Recidivism Among Mentally Disordered Adult Offenders Test of the Level of Service/Risk–Need–Responsivity (LS/RNR) Instrument

Construct Validity of the Violence Risk Scale—Sexual Offender Version for Measuring Sexual Deviance

Prediction of General and Violent Recidivism Among Mentally Disordered Adult Offenders

The Fountain of Health: effective health promotion knowledge transfer in individual primary care and group community-based formats.