ABSTRACT Background Reconviction after imprisonment is common. Findings on its association with mental health problems are mixed and need further exploration. Unmet social needs and a pattern of aggressive behaviour may explain part of the association but have rarely been examined alongside mental health. Aims To test for associations between mental health problems, unmet social needs and aggressive behaviour recognised while in prison and postrelease criminal convictions. Methods We prospectively followed 188 men consecutively received into prison on pretrial remand for up to 10 years after release from this imprisonment. Mental health problems (MINI‐Plus and BPRS), unmet needs (CANFOR) and in‐prison aggression (SDAS) were all assessed during the index remand. Kaplan–Meier and Cox regression analyses tested for independent associations between scale scores and postrelease convictions. A final survival analysis with a four‐group comparison based on the presence of mental disorder and unmet need risk factors was conducted. Results Most participants (155, 82%) sustained at least one new conviction within 10 years of the index release, including 78 (42%) within the first year after release. Indicators of mental disorder with substance use disorders (dual diagnosis) and preimprisonment unmet needs regarding food and/or company had the highest risk of new conviction. By contrast, dual diagnosis alone was not associated with an increased risk compared with prisoners without either risk factor. Conclusions This study suggests that the link between mental disorder and postrelease conviction is largely concentrated among prisoners with unmet social needs. Future prevention strategies should address social and mental health vulnerabilities.
Background Homelessness is a pervasive societal problem for large numbers of people, leading to numerous negative outcomes. Research has shown that the prevalence of mental disorders among individuals experiencing homelessness is consistently higher than in the general population, in turn, being associated with a higher likelihood of incarceration. In California, this may relate to the rapidly increasing numbers of individuals found incompetent to stand trial since 2010.Aims We sought to explore relationships between homelessness, mental disorders and community mental health treatment in the 6 months before an index offence in a cohort of individuals found incompetent to stand trial. Our primary research questions were as follows: Among those found incompetent to stand trial, (1) are data collected at one state hospital representative of the entire system? and (2) how, if at all, are living situation, mental disorders and prior treatment related?Methods We gathered information from interviews and inpatient records about individuals found incompetent to stand trial and committed to at least one of four of the five hospitals operated by the California Department of State Hospitals over a 2-5-month period in 2016/2017. We also obtained data from the California state Medicaid system to access data on treatment in the community in the 6 months prior to the index charge. These datasets were then combined.Results Data were available on 396 individuals, approximately 60% of those found incompetent to stand trial and ordered to inpatient treatment in the study period; 333 of them were matched in the mental health treatment dataset. Almost half were homeless and unsheltered at the time of their arrest; a similar proportion had received no Medicaid-funded mental health community treatment in the 6 months prior to their arrest. Analyses revealed a relationship between housing status and receiving emergency treatment, with men particularly disadvantaged in regard to receiving any mental health treatment.Conclusions Our data are consistent with many other studies to the extent that we found high rates of both psychosis and homelessness among individuals found incompetent to stand trial. Men are particularly disadvantaged in accessing necessary mental health treatment in these circumstances. Our study adds detail that may help recognise those in special need, on public safety and on personal grounds. California's fairly new Community Assistance, Recovery, and Empowerment Act 2024 may be a useful vehicle for improvement, but work may have to begin with building a clinically appropriate, integrated community mental health infrastructure that meets the complex needs of this population.
ABSTRACT Background Stalking has a multifaceted impact on victims and is of considerable importance from a public policing perspective. In England and Wales, there has been criticism of the police's response to stalking and investment in multi‐agency working to tackle this. The extent of actual multi‐agency working is currently unknown. Aims To establish the nature and extent of operational developments within Police Forces across England and Wales to support management of stalking. Methods A set of questions were posed to each Police Force in England and Wales under the Freedom of Information Act 2000, which provides individuals with a legal right to access information held by public authorities, thus promoting transparency and accountability in public services. Results Forty‐one of the 43 Police Forces approached provided relevant data under this Freedom of Information request. Of these, 34 reported having a strategy to manage stalking cases and 35 a dedicated stalking prevention coordinator. Twenty held multi‐agency stalking prevention panels, of which seven offered direct assessments of interventions with the alleged perpetrator. Stalking Protection Order applications were rarely made. Stalking Protection Orders are civil preventative orders introduced by the Stalking Protection Act 2019, enabling police and courts to impose restrictions and requirements on individuals who pose a stalking risk, thereby enhancing victim protection and facilitating early intervention. Conclusions Police Forces across England and Wales are at least trying to respond more effectively to the problem of alleged stalking; even the two Forces that did not participate hold stalking prevention panels, according to their official websites. The considerable variation in practice in how Forces are responding, and in particular in how dedicated stalking prevention panels are constructed and working, offers a milieu that is ripe for research on what works best, under what circumstances for whom.
Background Adolescents involved in the juvenile justice system have high rates of psychiatric disorder and social vulnerability. Those in custodial or semi-custodial detention may be particularly vulnerable to psychiatric emergencies, but the clinical factors associated with these crises remain insufficiently understood.Objective To characterise the sociodemographic and clinical profiles of detained adolescents attending a psychiatric emergency service and compare them with those of community-living adolescents.Methods In this retrospective cross-sectional study, we reviewed the medical records of all patients presenting to a public child and adolescent psychiatry emergency service in Brazil over 1 year. Detained adolescents aged 12-17 years were compared with community-living adolescents regarding sociodemographic characteristics, psychiatric diagnoses and presenting complaints.Results Of 1206 adolescents, 160 (13%) were detained. Compared with community-living adolescents, detained adolescents were more likely to be male (86%: 53%), older (mean [SD] 15.9 [1.1]: 14.9 [1.6] years) and to identify as Black (13%: 8%). Stress-related/adjustment disorders (30%:10%), conduct disorder (27%:10%) and substance use disorders (26%:20%), were more frequent among detained adolescents, whereas depression was less frequent (26%:35%). Emergency consultations involving detained adolescents were more likely to include insomnia (43%: 19%) and suicide attempts (26%: 18%), whereas behavioural presentations such as agitation, aggressiveness, irritability, disobedience and attention difficulties were comparatively less frequent.Conclusion Emergency psychiatric presentations among detained adolescents were more strongly associated with stress-related disorders, suicidal behaviour, sleep disturbance and substance-related problems than with behavioural disturbance alone. These findings have implications for emergency psychiatric assessment within juvenile justice settings.
