Faculty Bibliography

Mental health courts (MHCs) were designed to address the high rates of incarcerated individuals with serious mental illness in the United States by providing mental health treatment and social supports to those facing criminal charges. In the setting of national uprisings and grassroots demands for abolition of the prison industrial complex (PIC), which is the broad construct of economic and sociopolitical drivers of imprisonment, we draw upon the scholarship of community activists to examine the role of MHCs within the PIC. Specifically, we explore whether MHCs exacerbate harms caused by the criminal justice system or work to reduce its oppressive power. In this analysis, we argue that MHCs can perpetuate harmful assumptions about mental illness and crime, can legitimize the harsh punishment of individuals unfairly deemed undeserving of policy intervention, and can preserve power differentials between courts and court participants. Our analysis underscores the need for a critical reassessment of the role of MHCs in communities and in the PIC. We advocate for an open discussion between community members and advocates, policymakers, and health professionals about how to address the need for mental health treatment and social support without expanding and entrenching the power of the PIC.

Purpose: To share the experience of AAPM Task Group 275 (TG275) in developing and delivering regional workshops to encourage the implementation of TG recommendations.
Method(s): A one-day workshop curriculum was developed by nine task group members to familiarize participants with the work and recommendations of TG275: Strategies for Effective Physics Plan and Chart Review in Radiation Therapy. In addition to a didactic component, at least 40% of each session's allotted time was devoted to active learning activities including individual exercises, small group activities, and full group discussions. Morning sessions included an overview of the work of TG275 along with education on the data collection phases. Afternoon sessions included education about the analysis phase, key recommendations, and suggestions for clinical incorporation of TG275 recommendations. The target audience included medical physicists with responsibility for plan review and chart checks. Each workshop was sponsored by an AAPM Chapter and feedback was gathered through program and speaker evaluations.
Result(s): To date, two workshops have been held. The first was in-person with seventeen attendees and facilitated by two TG275 members. The second was virtual with fifteen attendees and facilitated by four members. Minor adjustments were made to the curriculum after the first workshop based on attendee feedback. The curriculum proved adaptable to both in-person and virtual formats. Attendees were actively engaged throughout both workshops. CAMPEP credits were offered in both instances with SAMs credits offered for the second workshop. Average program evaluation scores were 4.75 and 4.82 out of 5 for the two workshops respectively.
Conclusion(s): A workshop curriculum was developed with the goal of familiarizing participants with the work and recommendations of AAPM TG275. To date, two workshops have been held. Workshops are a potentially useful mechanism to encourage the implementation of AAPM Task Group recommendations

OBJECTIVE/UNASSIGNED:New York City's (NYC) Correctional Health Services has introduced specialized treatment units for patients with serious mental illness in the NYC jail system. With multidisciplinary mental health staffing and a coordinated approach with NYC's Department of Correction, these units expand therapeutic options for patients vulnerable to clinical instability and physical harm, including those at high risk of psychiatric medication nonadherence and those returning to jail from psychiatric hospitalization. This study evaluated the extent to which these units improve clinical outcomes for this population. METHODS/UNASSIGNED:This retrospective, observational cohort study included adult males with serious mental illness with a length of jail stay of ≥14 days between January 1, 2016, and March 31, 2018. Patients on treatment units were matched with patients of similar characteristics (control group) by using propensity score matching (N=302 pairs). Rates of self-injury, injury due to violence, and psychiatric medication adherence were analyzed. RESULTS/UNASSIGNED:Most patients on treatment units had diagnoses of schizophrenia spectrum and other psychotic disorders (81%), and most had a violent felony as their most severe charge (68%). Compared with patients in a control group, those on the treatment units had lower rates per 100 person-days of injury due to violence at 30 and 60 days (0.04, 95% confidence interval [CI]=0.02-0.07, and 0.03, 95% CI=0.02-0.06, respectively) and higher mean medication adherence (77% versus 55%, p<0.001). They also experienced lower rates of self-injury, although the difference was not statistically significant. CONCLUSIONS/UNASSIGNED:Initial outcomes indicate substantial benefits to patients, demonstrating the value of a rehabilitative approach to psychiatric care in jail.

Individuals with serious mental illness detained in jail may require frequent psychiatric hospitalization due to the destabilizing nature of the jail environment. This study examined the impact of a pilot treatment program involving continuity of patient care across jail and hospital settings aimed at reducing hospitalizations and negative health outcomes for a population of high-risk, incarcerated individuals with mental illness. This study examined rate ratios of psychiatric hospitalizations, injuries, and suicide watches, comparing 15 patients in the treatment program to themselves pretreatment and to a control group of 15 frequently rehospitalized patients. Patients in treatment experienced significant decreases in overall hospitalizations ( p < .001), 15-day rehospitalizations ( p < .002), and suicide watches in jail ( p < .02), compared to themselves pretreatment. A boundary-spanning treatment program lowered hospitalization rates and need for suicide watch for a small, yet clinically complicated and challenging group of patients.

The practice of prescribing in jails and prisons is often different from that in the community. Serious mental illness is common among inmates, and so are co-morbidities such as substance use, impulse-control, attention-deficit/hyperactivity, and personality disorders. Operational requirements, staffing, and the physical plant of the institution may complicate the provision of treatment according to community standards. Problems related to medication nonadherence, as well as the pursuit of medications for nonmedical reasons, are often seen in these settings and may be managed differently than they are elsewhere. Existing practice resources rarely account for these challenges. Pursuant to a recommendation by the Correctional Committee of the American Academy of Psychiatry and the Law (AAPL), the AAPL Council in May 2015 approved the creation of a task force charged with producing a document on prescribing in correctional facilities.Full Document: Tamburello A, Metzner J, Ferguson E, et al: AAPL practice resource for prescribing in corrections. Journal of the American Academy of Psychiatry and the Law Online Supplement 2018, 46 (2). Available at: http://www.jaapl.org/content/46/2_Supplement.