A case-linkage study of crime victimisation in schizophrenia-spectrum disorders over a period of deinstitutionalisation

Abstract Background: Despite high rates of self-reported crime victimisation, no study to date has compared official victimisation records of people with severe mental illness with a random community sample. Accordingly, this study sought to determine whether persons with schizophrenia-spectrum disorders have higher rates of recorded victimisation than the general population, and to explore whether there have been changes in rates of recorded victimisation over a period of deinstitutionalisation. Methods: The schizophrenia-spectrum cases were drawn from a state-wide public mental health register, comprising all persons first diagnosed with a schizophrenic illness in five year cohorts between 1975 - 2005. The criminal histories of 4,168 persons diagnosed with schizophrenic-spectrum disorders were compared to those of a randomly selected community sample of 4,641 individuals. Results: Compared to community controls, patients with schizophrenia-spectrum disorders were significantly more likely to have a record of violent (10.1% vs. 6.6%, odds ratio 1.4) and sexually violent victimisation (1.7% vs. 0.3%, odds ratio 2.77), but less likely to have an official record of victimisation overall (28.7% vs. 39.1%, odds ratio 0.5). Over the approximate period of deinstitutionalisation, the rate of recorded victimisation has more than doubled in schizophrenia-spectrum patients, but stayed relatively constant in the general community. Conclusions: People with schizophrenic-spectrum disorders are particularly vulnerable to violent crime victimisation; although co-morbid substance misuse and criminality both heighten the chances of victimisation, they cannot fully account for the increased rates. Deinstitutionalisation may have, in part, contributed to an unintended consequence of increasing rates of victimisation amongst the seriously mentally ill

First radial velocity results from the MINiature Exoplanet Radial Velocity Array (MINERVA)

The MINiature Exoplanet Radial Velocity Array (MINERVA) is a dedicated observatory of four 0.7m robotic telescopes fiber-fed to a KiwiSpec spectrograph. The MINERVA mission is to discover super-Earths in the habitable zones of nearby stars. This can be accomplished with MINERVA's unique combination of high precision and high cadence over long time periods. In this work, we detail changes to the MINERVA facility that have occurred since our previous paper. We then describe MINERVA's robotic control software, the process by which we perform 1D spectral extraction, and our forward modeling Doppler pipeline. In the process of improving our forward modeling procedure, we found that our spectrograph's intrinsic instrumental profile is stable for at least nine months. Because of that, we characterized our instrumental profile with a time-independent, cubic spline function based on the profile in the cross dispersion direction, with which we achieved a radial velocity precision similar to using a conventional "sum-of-Gaussians" instrumental profile: 1.8 m s$^{-1}$ over 1.5 months on the RV standard star HD 122064. Therefore, we conclude that the instrumental profile need not be perfectly accurate as long as it is stable. In addition, we observed 51 Peg and our results are consistent with the literature, confirming our spectrograph and Doppler pipeline are producing accurate and precise radial velocities.Comment: 22 pages, 9 figures, submitted to PASP, Peer-Reviewed and Accepte

The nature of police involvement in mental health transfers

During the course of their duties, police regularly have contact with mentally ill persons who are experiencing psychiatric crisis and require some form of mental health transfer. This study examined 2611 unique mental health transfers completed by police in the Australian state of Victoria over an eight-month period in 2009-2010. The overwhelming majority of mental health transfers performed by police during this period were the result of unplanned calls for assistance. Although police frequently requested assistance from other services, these were often not available. The study findings support a substantial body of anecdotal evidence from police citing lengthy involvement with people experiencing mentally illness, with the average mental health transfer consuming 2.5 h of police time. The frontline responses of police to people in psychiatric crisis need to be more formally acknowledged and creative solutions need to be sought with health and welfare services to better meet the needs of those who are falling between the cracks of community mental health care services

Police perceptions of their encounters with individuals experiencing mental illness: A Victorian survey

Objectives: Police have long played a central role in the management of people experiencing mental illness. This study explored: (1) the frequency of contact between the police and people experiencing mental illness; (2) the way in which police officers' knowledge and the sources of information used relates to various dispositions; (3) the signs, symptoms and behaviours that police officers consider are associated with mental illness; and (4) the challenges police face in this respect when performing their duties.Method: A survey was completed by 3,534 police officers in Victoria, Australia. Canonical correlations were used to explore the 'approach styles' of police when responding to people with a mental illness. Thematic analyses, based on grounded theory, were utilized to examine and code open-ended responses.Results/conclusions: Police reported that a considerable amount of their time each week was spent dealing with people they believed to be mentally ill. These encounters were reportedly associated with considerable practical difficulties for police, both in terms of knowing how to deal with people experiencing mental illness and how to best find appropriate supports for them. The most common results of their encounters were instigating a mental health apprehension, followed by arrest, but decision-making was influenced by the differential weight police placed on different sources of information received at the scene. Recommendations for police training, while based on practical wisdom, need to be multi-modal and should engage mental health experts in design and delivery

Utilization of public mental health services in a random community sample

Objective: The aim of this study was to examine patterns of service utilization in the public mental health service in the Australian state of Victoria. Lifetime contact with the public mental health system will be used to approximate lifetime prevalence for schizophrenia in the community. Method: A case-linkage design joined a statewide psychiatric register with a random sample of community members drawn from a statewide electoral roll (n = 4830). In cases where individuals had been in contact with public mental health services, their full contact history was extracted. Results: Members of the community come into contact with public mental health services for a variety of reasons, including those beyond the scope of psychiatric diagnosis and treatment, with 23% of those who made contact not receiving a psychiatric diagnosis and/or ongoing treatment. Although only 0.7% of the sample had a lifetime diagnosis of schizophrenia, these persons accounted for a significant proportion of public mental health service use. Schizophrenia-spectrum disorders were particularly prevalent among psychiatric crisis and extended care and supervision services. Conclusions: The Australian public mental health system has undergone significant reform in recent years. As a result, there has been a shift towards community-based care and a marked reduction in inpatient facilities. The public mental health system is a service that primarily serves those with a psychotic illness, thereby dictating that persons with so-called high-prevalence disorders, including affective and/or substance use disorders, seek psychiatric treatment elsewhere

Police perceptions of their encounters with individuals experiencing mental illness: a Victorian survey

Objectives: Police have long played a central role in the management of people experiencing mental illness. This study explored: (1) the frequency of contact between the police and people experiencing mental illness; (2) the way in which police officers\u27 knowledge and the sources of information used relates to various dispositions; (3) the signs, symptoms and behaviours that police officers consider are associated with mental illness; and (4) the challenges police face in this respect when performing their duties. Method: A survey was completed by 3,534 police officers in Victoria, Australia. Canonical correlations were used to explore the \u27approach styles\u27 of police when responding to people with a mental illness. Thematic analyses, based on grounded theory, were utilized to examine and code open-ended responses. Results/conclusions: Police reported that a considerable amount of their time each week was spent dealing with people they believed to be mentally ill. These encounters were reportedly associated with considerable practical difficulties for police, both in terms of knowing how to deal with people experiencing mental illness and how to best find appropriate supports for them. The most common results of their encounters were instigating a mental health apprehension, followed by arrest, but decision-making was influenced by the differential weight police placed on different sources of information received at the scene. Recommendations for police training, while based on practical wisdom, need to be multi-modal and should engage mental health experts in design and delivery

Influence of histopathologic factors on pattern of metastasis in squamous cell carcinoma of the head and neck

OBJECTIVES/HYPOTHESIS: Knowledge of histopathological factors, such as perineural invasion (PNI), extracapsular spread (ECS), angiolymphatic vessel invasion, and conglomerate lymph nodes, in patients with head and neck squamous cell carcinoma is important for appropriate treatment decisions. Given the availability of aggressive therapeutic options with known side effects and burdens for the patient, choosing the correct treatment option is vital. STUDY DESIGN: Retrospective patient database. METHODS: Using a retrospective database of patients treated over a 10-year period, independent prognostic factors for disease-free survival and overall survival were assessed. Univariate analysis was used to identify significant variables, and multivariate Cox regression analysis was used to determine independent prognostic factors. RESULTS: Between January 1, 1999 and December 31, 2009, 291 patients with head and neck squamous cell carcinoma were analyzed to identify influence of histopathological factors on pattern of metastasis. PNI tends to set metastasis locoregional, both in ipsilateral and contralateral lymph nodes. Lymphangiosis eases the way toward ipsilateral lymph node metastasis. ECS spread and hemangiosis demonstrated a significantly higher risk of distant metastasis. With the occurrence of conglomerate lymph nodes, patient data demonstrated a highly significant accumulation of distant metastasis. CONCLUSIONS: Patients with PNI and lymph vessel invasion tend toward locoregional lymph node metastasis on the ipsilateral side of the neck. In cases of PNI, the patient is at risk for a contralateral neck recurrence of the tumor. In patients with ECS, blood vessel invasion, or conglomerate disease, disseminated spread of the disease to distant locations is more likely and has a high negative impact on survival of the patient. LEVEL OF EVIDENCE: 4 Laryngoscope, 2013

Police discretion and encounters with people experiencing mental illness: the significant factors

Police discretion as it applies to encounters with people experiencing mental illness has far-reaching implications. In this study, some of the factors that are related to police officers' decisions following encounters with people experiencing mental illness were explored. Officers in Australia were presented with one of three videos depicting a police encounter with an individual who was either mentally ill, not mentally ill, or with an ambiguous mental state. Participants were asked how they would "likely" and "ideally" resolve the encounter. Discriminant function analysis revealed that officers' responses were related to (a) the severity of symptoms presented and (b) the officers' attitudes toward people experiencing mental illness, as measured by an attitudes questionnaire. There was a discrepancy between participants' likely and ideal outcomes to the scenarios, which supported the well-known fact that police officers face considerable obstacles when attempting to resolve encounters with people experiencing mental illness

Police perceptions of their encounters with individuals experiencing mental illness: a Victorian survey

Objectives: Police have long played a central role in the management of people experiencing mental illness. This study explored: (1) the frequency of contact between the police and people experiencing mental illness; (2) the way in which police officers' knowledge and the sources of information used relates to various dispositions; (3) the signs, symptoms and behaviours that police officers consider are associated with mental illness; and (4) the challenges police face in this respect when performing their duties.Method: A survey was completed by 3,534 police officers in Victoria, Australia. Canonical correlations were used to explore the 'approach styles' of police when responding to people with a mental illness. Thematic analyses, based on grounded theory, were utilized to examine and code open-ended responses.Results/conclusions: Police reported that a considerable amount of their time each week was spent dealing with people they believed to be mentally ill. These encounters were reportedly associated with considerable practical difficulties for police, both in terms of knowing how to deal with people experiencing mental illness and how to best find appropriate supports for them. The most common results of their encounters were instigating a mental health apprehension, followed by arrest, but decision-making was influenced by the differential weight police placed on different sources of information received at the scene. Recommendations for police training, while based on practical wisdom, need to be multi-modal and should engage mental health experts in design and delivery