Showing papers on "Mental health published in 1998"

Excess mortality of mental disorder.

Abstract: BACKGROUND We describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders. METHOD With a Medline search (1966-1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes. RESULTS Highest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy. CONCLUSION All mental disorders have an increased risk of premature death.

The MOS 36-Item Short Form Health Survey: reliability, validity, and preliminary findings in schizophrenic outpatients.

Abstract: Objectives The authors test the reliability and validity of the Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) as a written, self-administered survey in outpatients with chronic schizophrenia. Methods Thirty-six schizophrenic outpatients completed a written and oral form of the SF-36. A psychiatrist rated the patients using the Brief Psychiatric Rating Scale to determine severity of psychopathology. Cognitive functioning and academic achievement were also assessed. Internal consistency, test-retest reliability, concurrent and discriminative validity of the oral and written versions were determined. Results The SF-36 in both forms was shown to have good internal consistency, stability, and concurrent validity. The mental health SF-36 subscales had poor discriminant validity, compared with the physical functioning scale that demonstrated good discriminant validity. Conclusions The validity of using the written form of the SF-36 on a sample of patients with chronic mental illness was demonstrated. The SF-36 appears to be an appropriate outcome measure for changes in physical and role functioning in consumers of outpatient mental health programs.

Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods.

Abstract: Background The public perception that mental disorder is strongly associated with violence drives both legal policy (eg, civil commitment) and social practice (eg, stigma) toward people with mental disorders. This study describes and characterizes the prevalence of community violence in a sample of people discharged from acute psychiatric facilities at 3 sites. At one site, a comparison group of other residents in the same neighborhoods was also assessed. Methods We enrolled 1136 male and female patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence to others every 10 weeks during their first year after discharge from the hospital. Patient self-reports were augmented by reports from collateral informants and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks. Results There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home. Conclusions "Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.

The Religion-Health Connection: Evidence, Theory, and Future Directions

Abstract: The volume and quality of research on what we term the religion-health connection have increased markedly in recent years. This interest in the complex relationships between religion and mental and physical health is being fueled by energetic and innovative research programs in several fields, including sociology, psychology, health behavior and health education, psychiatry, gerontology, and social epidemiology. This article has three main objectives: (1) to briefly review the medical and epidemiologic research on religious factors and both physical health and mental health; (2) to identify the most promising explanatory mechanisms for religious effects on health, giving particular attention to the relationships between religious factors and the central constructs of the life stress paradigm, which guides most current social and behavioral research on health outcomes; and (3) to critique previous work on religion and health, pointing out limitations and promising new research directions.

Written emotional expression : Effect sizes, outcome types, and moderating variables

Abstract: A research synthesis was conducted to examine the relationship between a written emotional expression task and subsequent health. This writing task was found to lead to significantly improved health outcomes in healthy participants. Health was enhanced in 4 outcome types--reported physical health, psychological well-being, physiological functioning, and general functioning--but health behaviors were not influenced. Writing also increased immediate (pre- to postwriting) distress, which was unrelated to health outcomes. The relation between written emotional expression and health was moderated by a number of variables, including the use of college students as participants, gender, duration of the manipulation, publication status of the study, and specific writing content instructions.

Antisocial Behavior and Mental Health Problems: Explanatory Factors in Childhood and Adolescence

Abstract: Epidemiological surveys have provided key information about the prevalence and degree of seriousness at different ages of a wide array of problem behaviors such as delinquency, substance use, early sexual involvement, and mental health disorders. Knowledge of the extent of these problems and changes in their course over time is important. In its absence, interventions and health planning in general can be difficult. Understanding which risk and protective factors are relevant to which problem behaviors is also essential for the formulation of theories that constitute the basis of intervention. This book draws on the results of the major Pittsburgh Youth Study complemented by follow-up tracking of juvenile court records for more than six years, to address the following questions: *What is the prevalence and age of onset of delinquency, substance use, and early sexual behavior for three samples of boys age 8, 11, and 14? What are the average mental health problems for these ages? How strong are the relationships among these problem behaviors in each of the samples? *Which variables best explain individual differences among the boys in their manifestations of delinquency, substance use, early sexual behavior, and mental health problems? To what extent do explanatory factors vary with age? How accurately can boys with different outcomes be identified by risk scores based on hierarchical multiple regressions? *To what extent are explanatory factors associated with one outcome that are also associated with other outcomes? Are explanatory factors that are especially characteristic of a multiproblem group of boys--who display many different problem behaviors--different from explanatory factors associated with boys with few problems? *Do the results fit a general theory of juvenile problem behaviors, or is a differentiated theory more applicable?

Physical exercise and psychological well being: a critical review.

Abstract: The relation between physical exercise and psychological health has increasingly come under the spotlight over recent years. While the message emanating from physiological research has extolled the general advantages of exercise in terms of physical health, the equivalent psychological literature has revealed a more complex relation. The paper outlines the research evidence, focusing on the relation between physical exercise and depression, anxiety, stress responsivity, mood state, self esteem, premenstrual syndrome, and body image. Consideration is also given to the phenomena of exercise addiction and withdrawal, and implications for exercise prescription are discussed.

Persons with severe mental illness in jails and prisons: a review.

Abstract: OBJECTIVE: The presence of severely mentally ill persons in jails and prisons is an urgent problem. This review examines this problem and makes recommendations for preventing and alleviating it. METHODS: MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1970, and all pertinent references were obtained. Results and CONCLUSIONS: Clinical studies suggest that 6 to 15 percent of persons in city and county jails and 10 to 15 percent of persons in state prisons have severe mental illness. Offenders with severe mental illness generally have acute and chronic mental illness and poor functioning. A large proportion are homeless. It appears that a greater proportion of mentally ill persons are arrested compared with the general population. Factors cited as causes of mentally ill persons' being placed in the criminal justice system are deinstitutionalization, more rigid criteria for civil commitment, lack of adequate community support for persons with mental illness, m...

The structure and stability of common mental disorders (DSM-III-R): A longitudinal-epidemiological study

Abstract: The latent structure and stability of 10 common mental disorders were examined in a birth cohort at ages 18 and 21. A 2-factor model, in which some disorders were presumed to reflect internalizing problems and others were presumed to reflect externalizing problems, provided a more optimal fit to the data than either a 1- or a 4-factor model. To a significant extent, persons in the sample retained their relative positions on the latent factors across the 3-year period from age 18 to age 21. Results offer potential clarification of the meaning of comorbidity in psychopathology research by suggesting that comorbidity may results from common mental disorders being reliable, covariant indicators of stable, underlying "core psychopathological processes."

Trauma and posttraumatic stress disorder in severe mental illness.

Abstract: This research assessed the lifetime prevalence of traumatic events and current posttraumatic stress disorder (PTSD) in 275 patients with severe mental illness (e.g., schizophrenia and bipolar disorder) receiving public mental health services in Concord and Manchester, New Hampshire, and Baltimore, Maryland. Lifetime exposure to traumatic events was high, with 98% of the sample reporting exposure to at least 1 traumatic event. The rate of PTSD in our sample was 43%, but only 3 of 119 patients with PTSD (2%) had this diagnosis in their charts. PTSD was predicted most strongly by the number of different types of trauma, followed by childhood sexual abuse. The findings suggest that PTSD is a common comorbid disorder in severe mental illness that is frequently overlooked in mental health settings. Language: en

Religious coping and health status in medically ill hospitalized older adults.

Abstract: Associations between specific religious coping (RC) behaviors and health status in medically ill hospitalized older patients were examined and compared with associations between nonreligious coping (NRC) behaviors and health status. The sample consisted of 577 patients age 55 or over consecutively admitted to the general medical inpatient services of Duke University Medical Center (78%) or the Durham VA Medical Center (22%). Information was gathered on 21 types of RC, 11 types of NRC, and 3 global indicators of religious activity (GIRA). Health measures included multiple domains of physical health, depressive symptoms, quality of life, stress-related growth, cooperativeness, and spiritual growth. Demographic factors, education, and admitting hospital were control variables. "Negative" and "positive" types of religious coping were identified. Negative RC behaviors related to poorer physical health, worse quality of life, and greater depression were reappraisals of God as punishing, reappraisals involving demonic forces, pleading for direct intercession, and expression of spiritual discontent. Coping that was self-directed (excluding God's help) or involved expressions reflecting negative attitudes toward God, clergy, or church members were also related to greater depression and poorer quality of life. Positive RC behaviors related to better mental health were reappraisal of God as benevolent, collaboration with God, seeking a connection with God, seeking support from clergy/church members, and giving religious help to others. Of 21 RC behaviors, 16 were positively related to stress-related growth, 15 were related to greater cooperativeness, and 16 were related to greater spiritual growth. These relationships were both more frequent and stronger than those found for NRC behaviors. Certain types of RC are more strongly related to better health status than other RC types. Associations between RC behaviors and mental health status are at least as strong, if not stronger, than those observed with NRC behaviors.

Handbook of religion and mental health

Abstract: H.A. Pincus, Preface. H.G. Koenig, Introduction. Historical Background: S.B. Thielman, Reflections on the Role of Religion in the History of Psychiatry. S.G. Post, Ethics, Religion, and Mental Health. A New Research Frontier: J.S. Levin and L.M. Chatters, Research on Religion and Mental Health: An Overview of Empirical Findings and Theoretical Issues. E.L. Idler and L.K. George, What Sociology Can Help Us Understand About Religion and Mental Health. R.A. Emmons, Religion and Personality. A.B. Newberg and E.G. d'Aquili, The Neuropsychology of Spiritual Experience. M.E. McCullough and D.B. Larson, Future Directions in Research. Religion and Mental Functioning: K.I. Pargament and C.R. Brant, Religion and Coping. G.J. Kennedy, Religion and Depression. J.A. Thorson, Religion and Anxiety: Which Anxiety? Which Religion? W.P. Wilson, Religion and Psychoses. J. Booth and J.E. Martin, Spiritual and Religious Factors in Substance Use, Dependence, and Recovery. Religious Perspectives on Mental Health: H.N. Malony, Religion and Mental Health from the Protestant Perspective. N.C. Kehoe, Religion and Mental Health from the Catholic Perspective. S.H. Barlow and A.E. Bergin Religion and Mental Health from the Mormon Perspective. G.R. Mosley, Religion and Mental Health from the Unity Perspective. M.R. Zedek, Religion and Mental Health from the Jewish Perspective. B.W. Scotton, Treating Buddhist Patients. N.V. Juthani, Understanding and Treating Hindu Patients. S.A. Husain, Religion and Mental Health from the Muslim Perspective. A.D. Gaines, Religion and Culture in Psychiatry: Christian and Secular Psychiatric Theory and Practice in the United States. Clinical Applications: H.G. Koenig and J. Pritchett, Religion and Psychotherapy. L. VandeCreek, D. Carl, and D. Parker, The Role of Nonparish Clergy in the Mental Health System. A.J. Weaver, Mental Health Professionals Working with Religious Leaders. Education of Mental Health Professionals: E.S. Bowman, Integrating Religion into the Education of Mental Health Professionals. D.G. Blazer, Religion and Academia in Mental Health. H.G. Koenig, Summary and Conclusions. Index.

Natural Course of Schizophrenic Disorders: A 15-Year Followup of a Dutch Incidence Cohort

Abstract: Data are presented on the 15-year natural course of schizophrenia and other nonaffective functional psychoses in a cohort of 82 first-contact cases from a circumscribed area in the Netherlands. The subjects were suffering from functional psychosis with International Classification of Diseases-Ninth Revision (ICD-9) diagnoses 295, 297, or 298.3-9 (broad definition of schizophrenia) on entry. Standardized assessments of psychopathology, psychological impairments, negative symptomatology, social disability, and use of mental healthcare were used. The study reveals a pattern of chronicity and relapses with a high risk of suicide: Two-thirds of the subjects had at least one relapse and after each relapse 1 of 6 subjects did not remit from the episode; 1 of 10 committed suicide; and 1 of 7 had at least one episode with affective psychotic symptoms that started on average 6 years after the onset of the schizophrenic disorder. Diagnoses were reclassified in five patients, according to DSM-III-R criteria for a bipolar disorder. The predictive power--in terms of time in psychosis and in partial or full remission--of demographic, illness, and treatment variables at onset of the illness was very limited. Insidious onset and delays in mental health treatment are risk factors that predict a longer duration of first or subsequent episodes. The importance of mental health treatment in regard to outcome is probably subject to change because an early warning and intervention strategy could prevent further damage and deterioration. Our data support the need for an adequate relapse prevention program as a priority for our mental health services.

Review of Integrated Mental Health and Substance Abuse Treatment for Patients With Dual Disorders

Abstract: Patients with severe mental disorders such as schizophrenia and co-occurring substance use disorders traditionally received treatments for their two disorders from two different sets of clinicians in parallel treatment systems. Dissatisfaction with this clinical tradition led to the development of integrated treatment models in which the same clinicians or teams of clinicians provide substance abuse treatment and mental health treatment in a coordinated fashion. We reviewed 36 research studies on the effectiveness of integrated treatment for dually diagnosed patients. Studies of adding dual-disorders groups to traditional services, studies of intensive integrated treatments in controlled settings, and studies of demonstration projects have thus far yielded disappointing results. On the other hand, 10 recent studies of comprehensive, integrated outpatient treatment programs provide encouraging evidence of the programs' potential to engage dually diagnosed patients in services and to help them reduce substance abuse and attain remission. Outcomes related to hospital use, psychiatric symptoms, and other domains are less consistent. Several program features appear to be associated with effectiveness: assertive outreach, case management, and a longitudinal, stage-wise, motivational approach to substance abuse treatment. Given the magnitude and severity of the problem of dual disorders, more controlled research on integrated treatment is needed.

Encyclopedia of mental health

Abstract: Encyclopedia of Mental Health, Second Edition, tackles the subject of mental health, arguably one of the biggest issues facing modern society. The book presents a comprehensive overview of the many genetic, neurological, social, and psychological factors that affect mental health, also describing the impact of mental health on the individual and society, and illustrating the factors that aid positive mental health. The book contains 245 peer-reviewed articles written by more than 250 expert authors and provides essential material on assessment, theories of personality, specific disorders, therapies, forensic issues, ethics, and cross-cultural and sociological aspects. Both professionals and libraries will find this timely work indispensable. * Provides fully up-to-date descriptions of the neurological, social, genetic, and psychological factors that affect the individual and society* Contains more than 240 articles written by domain experts in the field* Written in an accessible style using terms that an educated layperson can understand* Of interest to public as well as research libraries with coverage of many important topics, including marital health, divorce, couples therapy, fathers, child custody, day care and day care providers, extended families, and family therapy

Short form 36 (SF-36) health survey: normative data from the general Norwegian population.

Abstract: Anchoring health-related quality of life (HRQOL) measures in population norms makes clinical interpretations more meaningful and is in accordance with practice in other fields of medicine. In this paper norms for the Short Form 36 (SF-36) are presented in a random sample, representative of the general Norwegian population. In addition, sociodemographic variables affecting the scale scores are explored and discussed. The response rate was 67%, being lowest among subjects aged 70 years or over. Data-completeness strongly declined with increasing age. Physical health scales were also strongly affected by age. In all scales, with the exception of general health perceptions, women reported having poorer health than men. Marital status affected the four mental health scales. Educational status affected all the scales, but the effect was smallest in the mental scales. These norms can be employed for comparison in case-control studies, or to interpret HRQOL changes in prospective studies. Differences in social status should be given special attention. Caution should be exercised when assessing subjective health or employing the norms among subjects aged 70 years or over.

Empirically Supported Couple and Family Interventions for Marital Distress and Adult Mental Health Problems

Abstract: This article evaluates the efficacy, effectiveness, and clinical significance of empirically supported couple and family interventions for treating marital distress and individual adult disorders, including anxiety disorders, depression, sexual dysfunctions, alcoholism and problem drinking, and schizophrenia. In addition to consideration of different theoretical approaches to treating these disorders, different ways of including a partner or family in treatment are highlighted: (a) partner-family-assisted interventions, (b) disorder-specific partner-family interventions, and (c) more general couple-family therapy. Findings across diagnostic groups and issues involved in applying efficacy criteria to these populations are discussed.

Health-Related Quality of Life in Patients Served by the Department of Veterans Affairs Results From the Veterans Health Study

Abstract: Background The Department of Veterans Affairs Health Care System (VA) is the largest integrated single payer system in the United States. To date, there has been no systematic measurement of health status in the VA. The Veterans Health Study has developed methods to assess patient-based health status in ambulatory populations. Objectives To describe the health status of veterans and examine the relationships between their health-related quality of life, age, comorbidity, and socioeconomic and service-connected disability status. Methods Participants in the Veterans Health Study, a 2-year longitudinal study, were recruited from a representative sample of patients receiving ambulatory care at 4 VA facilities in the New England region. The Veterans Health Study patients received questionnaires of health status, including the Medical Outcomes Study Short Form 36-Item Health Survey; and a health examination, clinical assessments, and medical history taking. Sixteen hundred sixty-seven patients for whom we conducted baseline assessments are described. Results The VA outpatients had poor health status scores across all measures of the Medical Outcomes Study Short Form 36-Item Health Survey compared with scores in non-VA populations (at least 50% of 1 SD worse). Striking differences also were found with the sample stratified by age group (20-49 years, 50-64 years, and 65-90 years). For 7 of the 8 scales (role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health), scores were considerably lower among the younger patients; for the eighth scale (physical function), scores of the young veterans (aged 20-49 years) were almost comparable with the levels in the old veterans (>65 years). The mental health scores of young veterans were substantially worse than all other age groups (P Conclusions The VA outpatients have substantially worse health status than non-VA populations. Mental health differences between the young and old veterans who use the VA health care system are sharply contrasting; the young veterans are sicker, suggesting substantially higher resource needs. Mental health differences may explain much of the worse health-related quality of life in young veterans. As health care systems continue to undergo a radical transformation, the Department of Veterans Affairs should focus on the provision of mental health services for its younger veteran.

Perceived parental burden and service use for child and adolescent psychiatric disorders.

Abstract: OBJECTIVES: Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. METHODS: A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. RESULTS: Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. CONCLUSIONS: Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.

Effects of parental divorce on mental health throughout the life course

Abstract: The long-term effects of parental divorce on individuals' mental health after the transition to adulthood are examined using data from a British birth cohort that has been followed from birth to age 33. Growth-curve models and fixed-effects models are estimated. The results suggest that part of the negative effect of parental divorce on adults is a result of factors that were present before the parents 'marriages dissolved. The results also suggest, however, a negative effect of divorce and its aftermath on adult mental health. Moreover, a parental divorce during childhood or adolescence continues to have a negative effect when a person is in his or her twenties and early thirties

Treating Major Depression in Primary Care Practice: An Update of the Agency for Health Care Policy and Research Practice Guidelines

Abstract: The Depression Guideline Panel of the Agency for Health Care Policy and Research in 1993 published recommendations for treating major depression in primary care practice that were often based on studies of tertiary care psychiatric patients. We reviewed reports of randomized controlled trials in primary care settings published between 1992 and 1998. This evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings. In most cases, the choice between these treatments should depend on patient preference. Studies to date suggest that improving treatment of depression in primary care requires properly organized treatment programs, regular patient follow-up, monitoring of treatment adherence, and a prominent role for the mental health specialist as educator, consultant, and clinician for the more severely ill. Future research should focus on how guidelines are best implemented in routine practice, since conventional dissemination strategies have little impact.

Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile.

Abstract: BACKGROUND Refugees who have suffered traumatic events present complex therapeutic challenges to health professionals. There is little research into post-exile factors that may be amenable to change, and therefore reduce morbidity. We examined the importance of social factors in exile and of trauma factors in producing the different elements of psychological sequelae of severe trauma. METHOD Eighty-four male Iraqi refugees were interviewed. Adverse events and level of social support were measured. Various measures of psychological morbidity were applied, all of which have been used in previous trauma research. RESULTS Social factors in exile, particularly the level of "affective" social support, proved important in determining the severity of both post-traumatic stress disorder and depressive reactions, particularly when combined with a severe level of trauma/torture. Poor social support is a stronger predictor of depressive morbidity than trauma factors. CONCLUSIONS Some of the most important factors in producing psychological morbidity in refugees may be alleviated by planned, integrated rehabilitation programmes and attention to social support and family reunion.

Antecedents of Frailty Over Three Decades in an Older Cohort

Abstract: Studies of disability in old age have focused on gross measures of physical functioning. More useful results for prevention might be gleaned from examining risk factors associated with frailty, a concept implying a broader range of more subtle problems in multiple domains. This study conceptualized frailty as involving problems or difficulties in two or more functional domains (physical, nutritive, cognitive, and sensory) and analyzed prospective predictors. Subjects were 574 Alameda County Study respondents age 65-102. One-fourth scored as frail; there was no gender difference. Frail persons reported reduced activities, poorer mental health, and lower life satisfaction. Cumulative predictors over the previous three decades included heavy drinking, cigarette smoking, physical inactivity, depression, social isolation, fair or poor perceived health, prevalence of chronic symptoms, and prevalence of chronic conditions. By modifying these risk factors, it may be possible to postpone the onset of frailty or ameliorate its further development.

Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data.

Abstract: This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988-1995) and Philadelphia (1991-1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.

Serious criminal offending and mental disorder. Case linkage study.

Abstract: BACKGROUND A relationship exists between mental disorder and offending behaviours but the nature and extent of the association remains in doubt. METHOD Those convicted in the higher courts of Victoria between 1993 and 1995 had their psychiatric history explored by case linkage to a register listing virtually all contacts with the public psychiatric services. RESULTS Prior psychiatric contact was found in 25% of offenders, but the personality disorder and substance misuse accounted for much of this relationship. Schizophrenia and affective disorders were also over-represented, particularly those with coexisting substance misuse. CONCLUSIONS The increased offending in schizophrenia and affective illness is modest and may often be mediated by coexisting substance misuse. The risk of a serious crime being committed by someone with a major mental illness is small and does not justify subjecting them, as a group, to either increased institutional containment or greater coercion.