Rearrests during mental health court supervision: Predicting rearrest and its association with final court disposition and post-court rearrests

Mental health courts are one means to address the involvement of persons with mental illness in the criminal justice system. Using a sample of 811 participants of a municipal mental health court, this study found that 23.2% of participants were rearrested during court supervision. This study also identified factors associated with these rearrests, as well as the effect of rearrests during supervision on program completion and rearrests in the 1-year period following program completion. This study concludes with implications for mental health court supervision

An Analysis of Readmissions to a Mental Health Court

Mental health courts (MHCs) have emerged as one option to address the needs of people with severe mental illness who enter the criminal justice system. Little is known about defendants having multiple referrals to MHCs or the outcomes of subsequent admissions. This study included a sample of 1,084 defendants referred to municipal MHC. During the 13-year study period, 14.3% of defendants had a second admission, with an estimated probability of readmission of 17.4%. Key factors associated with readmission included being eligible to participate in the court but choosing not to do so, being rearrested during court supervision, and having a negative termination from supervision. Defendants who had a second admission during the study period had poorer outcomes than those with one admission. When defendants are referred for readmission to MHCs, careful assessment is required to ensure that these courts are the best alternative for them

Visualizing the Hermit Kingdom Graphing, Mapping, and Analyzing the 2008 North Korean Census

Discussion rarely takes a dispassionate view of North Korea and its people, and ingrained aversion to the idea of promoting a better understanding of the state distracts from serious, empirical study of the population. This research makes use of the 2008 North Korean census, an extensive set of fifty-three tables, which received little attention and remained in PDF format. This research project first translates and publishes machine-readable formats of the census data and then employs R statistical programming to create visualizations of select tables and conduct simple data analysis, including p-tests and Mantel-Haenzel tests. Males and urban residents were found to be less likely to suffer physical impairment than females and rural residents, allowing us to reject the null hypothesis that there is no proportional variation. Maternal mortality ratios are found to differ across provinces and are lowest in Pyongyang. Governments and humanitarian aid organizations can use these findings to effectively target vulnerable populations. This study sets precedence for further analysis of the 2008 North Korean census

A Redefinition of the Problem of Homelessness Among Persons with a Chronic Mental Illness

Two definitions of the problem of homelessness among persons with a chronic mental illness are examined, along with their implied solutions and ramifications for policy. Homelessness among this group is first viewed as the result of deinstitutionalization, and secondly, as the outcome of a critical shortage of low-income housing. Solutions stemming from the deinstitutionalization definition of homelessness, reinstitutionalization or improvement in the mental health system, are seen as inadequate to deal with the problem of homelessness among the mentally ill. Instead, state departments of mental health are called upon to provide a leadership role in the development of affordable housing

Rearrests During Mental Health Court Supervision: Predicting Rearrest and its Association With Final Court Disposition and Post-court Rearrests

Mental health courts are one means to address the involvement of persons with mental illness in the criminal justice system. Using a sample of 811 participants of a municipal mental health court, this study found that 23.2% of participants were rearrested during court supervision. This study also identified factors associated with these rearrests, as well as the effects of rearrests during supervision on program completion and rearrests in the one-year period following program completion. This study concludes with implications for mental health court supervision

Prozessierung und Sortierung der lysosomalen Ntn-Hydrolase Plbd2 und Erzeugung von Plbd1- und Plbd2-defizienten Mausmodellen

Linhorst A. Prozessierung und Sortierung der lysosomalen Ntn-Hydrolase Plbd2 und Erzeugung von Plbd1- und Plbd2-defizienten Mausmodellen. Bielefeld: Universität Bielefeld; 2018.The lysosomal matrixprotein Plbd2 (phospholipase B-domain containing 2) was initially identified in the proteomic analyses of mannose-6-phosphate (M6P)-modified proteins (Kollmann *et al*., 2005; Sleat *et al*., 2005). The lysosomal localisation was confirmed by indirect immunfluorescence in cultured cells (Kollmann *et al*, 2005) and by cofractionation analyses of lysosome-enriched fraction from mouse liver (Deuschl *et al*., 2006). Moreover, Plbd2 was assigned to the superfamily of N-terminal nucleophile (Ntn)-hydrolases by X-ray crystallography due to structural homology (Lakomek *et al*., 2009). With the assignment to the Ntn-hydrolase family, we assume an amidase activity, while the physiological substrate is not yet identified. In this study, the cleavage of the Pro-Plbd2 into an α- and a β-fragment was shown to occur autocatalytically at acidic conditions. While a mutation of the catalytic cystein in the active site inhibited autocatalysis *in vitro*, cleavage still took place intracellularly due to endoprotease activity, most probably by Cathepsin L, cleaving a linker region between the α- and β-fragment of Plbd2. Whether removal of the linker peptide is necessary for enzymatic activity, remains to be elucidated after the identification of the physiological substrate. In contrast to other known Ntn-hydrolases, further processing of the β-fragment can be observed for Plbd2. This processing was shown to be related to the activities of Cathepsin B, Cathepsin L and AEP and most likely takes place at an asparaginyl-residue in position 394 of Plbd2. A direct activity of AEP at this position was ruled out, whereas an indirect effect of AEP by activation of Cathepsin B and Cathepsin L appears to be more likely. By incubation with cysteine protease inhibitors, the cleavage of the β-fragment was inhibited, which is consistent with the involvement of CtsB or CtsL. Further proteolytic truncations at the N- and C-termini of the recombinant Plbd2 were detected *in vitro*. Plbd2 is predominantly sorted in a mannose-6-phosphate (M6P)-dependent manner which was also confirmed in this work. Furthermore, in cells with defects of the M6P-receptors the existence of an M6P-independent pathway for Plbd2 was postulated. However, the correct processing of Plbd2 did not occur in these cells. In order to get access to the physiological role of Plbd2, knockout mouse models for Plbd2 and the homologous protein Plbd1 were generated using the CRISPR-Cas9 technology. In both mouse models strongly reduced transcript levels and virtually no residual protein could be detected for Plbd2 and Plbd1, respectively. In initial analyses the animals had no apparent phenotype that would suggest the function of the proteins. While Plbd2 was particularly detected in macrophages, Plbd1 appeared to be more present in dendritic cells and cells of the bone marrow. A function of the proteins in the hydrolysis of amid bonds to degrade pathogenic macromolecules or immunological relevant mediators of inflamation is postulated in this work

A Comparison of Defendants with Mental Illness Represented by Public Defenders and Private Attorneys: an Analysis of Court-Ordered Pretrial Psychiatric Evaluations

This study compared the characteristics and court-ordered evaluation questions and responses among 4,430 defendants to determine if differences existed between those represented by public defenders and private attorneys when receiving trial competency or responsibility psychiatric evaluations from a state department of mental health. Defendants represented by public defenders were more likely to be younger, to have less education, to have psychotic disorders, to have a history of inpatient psychiatric treatment, to live in urban or rural counties, and to be jailed at the time of the evaluation. In addition, defendants represented by public defenders were less likely to have a request for a criminal responsibility evaluation and more likely to be evaluated as having a mental illness, to be incompetent to stand trial, and to need hospitalization pending trial. Consideration of whether defendants with public defenders receiving less requests for responsibility evaluations was indicative of a therapeutic jurisprudence approach is discussed. Implications for research on types of legal representation of defendants with mental illness are discussed

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Background: Inpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies were undertaken. Objectives: To synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector. Design: Three linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2. Results: At stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains. Conclusions: Together, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted. Future work: This would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge. Study registration: This study is registered as PROSPERO CRD42015016941. Funding: The National Institute for Health Research Health Services and Delivery Research programme

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Background: The REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap. Methods: The programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses. Results: Most NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study. Conclusions: People who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery. Main limitation: Our programme included only NHS, non-secure, inpatient mental health rehabilitation services. Trial registration: Current Controlled Trials ISRCTN25898179. Funding: The NIHR Programme Grants for Applied Research programme

A need for “good eyes”: Experiences told by patients diagnosed with psychosis

This study highlights experiences of psychiatric care described by patients diagnosed with psychosis. The aim was to investigate how patients, based on earlier experiences, described their wishes and needs regarding the psychiatric care system. Data comprised material from four focus groups; analysis used an inductive thematic approach. Relationships with staff emerged as a recurring theme. During periods of psychosis, patients needed staff to act as “parental figures,” providing care, safety, and help in dealing with overwhelming stimulation from the outside word. In the ensuing struggle to devise a livable life, the need for relationships recurred. In this phase, staff needed to give their time, provide support through information, and mirror the patient's capacity and hope. The patient's trials were described as threatened by a lack of continuity and non-listening professionals. It was important for staff to listen and understand, and to see and respect the patients' viewpoints