Mental Health Disorder Week 2 Assignment

Week 2 – Crime and Mental Health Paper: Goals & standards

Mental health nurses should demonstrate cultural competence in practice to be able to provide patient-centered care to their clients. They are required to use best-practice interventions supported by published evidence to promote cultural safety in psychiatric units (Milroy et al., 2023). This paper will utilize the nursing process to describe how the nurse would use cultural awareness to design a culturally-competent care for a patient diagnosed with a mental illness. Choosing and implementing interventions that are supported by evidence-based research will enable the mental health professional to provide quality care that promotes cultural safety.

Assessment

The journey towards providing culturally-competent care begins by understanding the cultural beliefs and values of patients. Therefore, it is important to assess the ethnic and racial backgrounds of the client focusing on the language, religious beliefs, and beliefs related to treatment by a healthcare provider. Parents act as the spokespersons of the family. Other issues to assess include sexual orientation, companionship, and social histories such as drug abuse and current employment status (Milroy et al., 2023). The success of the assessment process largely depends on the ability of the provider to communicate effectively with the patient and the provider’s capacity to develop a positive therapeutic relationship with him or her.

Diagnosis

A culturally competent mental health nurse should be able to identify both mental health and cultural diagnoses for their patients. The mental health nursing diagnosis for the client is generalized anxiety disorder evidenced by excessive worry about work and family issues. The patient’s worry has persisted for seven months and is characterized by several other symptoms including restlessness, sleep disturbance, difficulty concentrating, and excessive fatigue. These symptoms match the fifth version of the Diagnostic and Statistical Manual for mental disorders (DSM-5) criteria for generalized anxiety disorder (Goodwin & Stein, 2021). The cultural diagnoses that the mental health professional should address include language barrier and tight religious beliefs that people can only get healed when they pray and believe in God. The patient and her family members only understand and speak the Latino language. Additionally, the family does not believe in the effectiveness of medical interventions in treating diseases.

Planning

Planning is a crucial phase of the nursing process as it entails the development of a nursing care plan that the nurse will implement to solve the patient’s problems. The client’s cultural care plan should entail the development of goals to help address the identified mental health and cultural diagnoses (Maguire et al., 2022). The specific goals that the mental health professional should aim to attain are; to completely address symptoms of generalized anxiety disorder within a period of four weeks; to ensure effective communication between the client and the healthcare provider; and to help the patient accept that combining prayer with medical treatment promotes speedy healing and recovery (Maguire et al., 2022). These are SMART goals that the provider selected based on the client’s mental health and cultural needs.

Implementation

The mental health nurse needs to implement evidence-based interventions in order to achieve the goals identified in the care plan and address both the mental health and cultural needs of the client. In order to promote cultural safety and meet the client’s cultural needs, the mental health provider should use an interpreter to help with communication. Research evidence outlines the positive benefits of using interpreters to address language barrier when handling patients with communication challenges (Gerchow et al., 2021). Additionally, the provider should educate the patient about the health benefits of combining medical treatment with prayer. Divine intervention is considered an alternative and complementary intervention that when combined with medical interventions, can generate positive health outcomes in patients (Zhao et al., 2022). It is advisable that the mental health provider obtains the patient’s consent before implementing the recommended interventions.

Evaluation

The best way to determine whether the interventions were effective is by assessing whether they have produced the desired impacts. The mental health provider will evaluate whether the implementation was effective by using measures that are aligned with the set goals. The specific measures that will be observed include; a reduction in symptoms of generalized anxiety disorder; the ability to communicate effectively without challenges; and the patient’s acceptance to use medical treatment in addition to prayer (Maguire et al., 2022). For the interventions to be considered effective, the client’s anxiety symptoms should disappear completely within a period of four weeks, the client and the healthcare provider should be able to communicate effectively, and the patient should accept to combine prayer with medical treatment offered by the mental health professional.

Summary

Evidence-based culturally appropriate interventions are linked with positive health outcomes among treated patients. The proposed interventions, when successfully implemented, will improve the quality of care and health outcomes of mentally ill patients from diverse cultural backgrounds. The best way to ensure cultural safety for all clients in the setting is to offer training on cultural competence to all healthcare providers. Such training will increase their cultural awareness and guide them on how to implement evidence-based interventions that promote cultural safety.

References

Gerchow, L., Burka, L. R., Miner, S., & Squires, A. (2021). Language barriers between nurses and patients: A scoping review. Patient Education and Counseling, 104(3), 534–553. https://doi.org/10.1016/j.pec.2020.09.017.

Goodwin, G. M., & Stein, D. J. (2021). Generalised anxiety disorder and depression: Contemporary treatment approaches. Advances in Therapy, 38(2), 45–51. https://doi.org/10.1007/s12325-021-01859-8.

Maguire, T., Garvey, L., Ryan, J., Willetts, G., & Olasoji, M. (2022). Exploration of the utility of the Nursing Process and the Clinical Reasoning Cycle as a framework for forensic mental health nurses: A qualitative study. International Journal of Mental Health Nursing, 31(2), 358–368. https://doi.org/10.1111/inm.12963.

Milroy, H., Kashyap, S., Collova, J. R., Platell, M., Gee, G., & Ohan, J. L. (2023). Identifying the key characteristics of a culturally safe mental health service for Aboriginal and Torres Strait Islander peoples: A qualitative systematic review protocol. PloS one, 18(1), e0280213. https://doi.org/10.1371/journal.pone.0280213.

Zhao, F. Y., Kennedy, G. A., Cleary, S., Conduit, R., Zhang, W. J., Fu, Q. Q., & Zheng, Z. (2022). Knowledge about, attitude toward, and practice of complementary and alternative medicine among nursing students: A systematic review of cross-sectional studies. Frontiers in Public Health, 10, 946874. https://doi.org/10.3389/fpubh.2022.946874.

Make sure assignment aligns with the below questions as well as the assignment content. THANK YOU!
· Describe possible causes of mental health issues in the criminal justice system.

· Identify the behavioral criteria of common mental health disorders seen in the criminal justice system.

· Describe possible causes for common mental health disorders seen in the criminal justice system.

· https://medlineplus.gov/mentaldisorders.html

Week 2 – Crime and Mental Health Paper

Assignment Content

Write a 550- to 700-word paper on the connection between crime and mental health. Include the following:

o Describe the prevalence and causes of mental health issues in the criminal justice system.

o Describe the behavioral symptoms for three of the most common mental health disorders present in the criminal justice system.

o Describe the relationship between these mental health issues and crime.

Include a minimum of three sources.

Format your paper consistent with APA guidelines.

Submit your assignment.

Resources

o Center for Writing Excellence

o Reference and Citation Generator

o Grammar and Writing Guides

o Learning Team Toolkit

CPSS410 Overview of Mental Health in Criminal Justice

Week 2 Mental Health Issues in the Criminal Justice System

Readings:

Ringhoff, D., Rapp, L., & Robst, J. (2012). The criminalization hypothesis: Practice and policy implications for persons with serious mental illness in the criminal justice system. Best Practice in Mental Health, 8(2), 1-19.

Searches:

mental health disorders AND behavioral criteria

mental health disorders AND criminal justice system

Videos

Week 2 – Crime and Mental Health Paper Readings:

Films Media Group (1998). Criminal Justice and Brain Impairment (06:03) From Title: Mind Talk: The Brain’s New Story.

The term criminalization has been used to describe the overrepresentation of persons with serious mental illness in the criminal justice system. Public policy responses have focused on simply linking individuals with treatment. Although treatment is important to minimizing symptoms, evidence indicates that nonclinical variables are greater pre- dictors of arrest than clinical variables and that risk factors for arrest are similar for persons with and without mental illness. This article reviews the literature on the link between severe mental illness (SMI) and criminal behavior; considers whether treat- ment has been effective at reducing criminal behavior among individuals with SMI; and discusses practice, policy, and crime prevention implications.

Keywords: criminal justice system; criminalization; risk factors; serious mental illness

Introduction

The disproportionate number of persons with severe mental illness (SMI) involved in the criminal justice system is widely recognized as a significant social problem (Lamberti, Weisman, & Faden, 2004; More & Hiday, 2006; Steadman, Osher, Robbins, Case, & Samuels, 2009; Torrey, 1995). Research estimates that 8 percent of the nation’s 13 million annual arrests involve persons with SMI (McNeil & Binder, 2007; Morrissey, Cuddeback, Cuellar, & Steadman, 2007; Steadman & Naples, 2005), although others have argued that this may represent a significant underestimation (Steadman et al., 2009). Although people with diagnosable mental illnesses often spend brief periods of time in jail (Morrissey et al., 2006), rearrest is common and poses safety risks for both law enforcement

The Criminalization Hypothesis: Practice and Policy Implications for Persons with Serious Mental Illness in the Criminal Justice System

Daniel Ringhoff, Lisa Rapp, and John Robst

Daniel Ringhoff, LCWS, is a doctoral student in the School of Social Work at the University of South Florida. Lisa Rapp, PhD, is associate professor in the School of Social Work at the Univer- sity of South Florida. John Robst, PhD, is research assistant professor in the Department of Men- tal Health Law and Policy at the University of South Florida.

© 2013 Lyceum Books, Inc., Best Practices in Mental Health, Vol. 8, No. 2, December 2012

and arrestees (Cox, Morschauser, Banks, & Stone, 2001; Hartwell, 2003; Lamb & Weinberger, 2001; Lamb, Weinberger, & Gross, 2004). Inmates with SMI may cause considerable management and financial problems for state and local correctional authorities (Clark, Ricketts, & McHugo, 1999; Domino, Norton, Morrissey, & Thakur, 2004). They also generally receive inadequate mental health treatment while incarcerated (Veysey, Steadman, Morrissey, & Johnsen, 1997). Additionally, persons with SMI are more likely to be arrested (McNeil & Binder, 2007; Teplin, 1983, 1984, 1990; Teplin, Abram, & McClelland, 1996), and to have their community supervision revoked as the result of a technical vio- lation or new offense (Skeem & Louden, 2006).

Consequently, many policy makers and practitioners have labeled this phe- nomenon as the criminalization of mental illness or the criminalization of the mentally ill, and point to inadequacies in the mental health treatment system as its primary cause (Engel & Silver, 2001; Fisher, Silver, & Wolff, 2006; Lamb et al., 2004; Teplin, 1983). Mental health advocacy groups (National Alliance for the Mentally Ill, 2001), research institutes (Soros Foundation, 1996), government related entities and committees (Council of State Government’s Criminal Justice/ Mental Health Consensus Project, 2002; Florida Supreme Court, 2007; New Free- dom Commission on Mental Health, 2003), and lawmakers (Fisher et al., 2006) have all used such terms to describe the extent of the problem. Because of the widespread influence of perceived criminalization on public policy, it is important to assess the construct’s ability to explain the current problem so that researchers, policy makers, and practitioners can have confidence they are formulating and implementing the most effective policies and interventions. The purpose of this review, therefore, is to examine the construct of criminalization and the assump- tion that it is a significant cause of the overrepresentation of persons with SMI in the criminal justice system. In addition, this article will discuss the concept of mental illness as a cause of crime and criminogenic risk factors. Finally, promising models in the criminal justice literature that policy makers and practitioners may consider when planning and implementing interventions for individuals with mental illness and criminal justice histories will be reviewed.

Deinstitutionalization and the Criminalization Construct

Criminalization has long been viewed as an unanticipated side effect of deinsti- tutionalization (Aderibigbe, 1997; Fisher et al., 2006). Rather than referring to one event or policy decision, deinstitutionalization describes a confluence of events that closed many state hospitals and indelibly changed the mental health system between the 1950s and 1990s. Salient factors that caused these changes included statutory reforms, the advent of revolutionary psychotropic drugs such as Thora- zine, state budget constraints, and exposés of deplorable conditions in state hospi- tals, as well as the Community Mental Health Centers Act of 1964, which provided an avenue for community treatment (Fisher et al., 2006; Steadman, Monahan, Duffee, Hartsone, & Robbins, 1984; Teplin, 1983, 1984; Torrey, 2008). During this time, psychiatric beds in state mental and general hospitals were significantly

2 Best Practices in Mental Health

reduced—from 559,000 in 1955 to 68,000 in 1990—as patients were released to families and facilities in the community (Aderibigbe, 1997).

To provide for these persons, funding for community mental health services increased through the creation and expansion of Medicaid and Supplemental Security Income (SSI). Funding, however, remained inadequate (Frank, Goldman, & Hogan, 2003; Petrila, 2001). Increased funding also had the unintended effect of speeding up deinstitutionalization and creating what has been called the corol- lary phenomenon of transinstitutionalization, whereby psychiatric patients are transferred back and forth between community inpatient facilities and jails (Fisher et al., 2006; Frank et al., 2003; Steadman et al., 1984; Teplin, 1983, 1984; Torrey, 2008). As a result, many persons with mental illness entered the community with inadequate housing and community supports (Torrey, 1988). Statutory reforms and more stringent civil commitment criteria further limited psychiatric disposi- tions, making it more difficult to hold and treat persons in the mental health sys- tem, and presumably shifting persons with mental illness to the criminal justice system, as communities grappled with how to manage persons exhibiting undesir- able behavior (Fisher et al., 2006). In addition, as homelessness and incarceration increased among persons with mental illness, so did the perception that the men- tal health system was failing in its mission to provide adequate services for persons with mental illness (Fisher et al., 2006; McNeil, Binder, & Robinson, 2005).

In 1972, as these events were unfolding, one California psychiatrist (Abram- son, 1972) described the disproportionate number of persons with mental illness in the criminal justice system as “the ‘criminalization’ of mentally disordered behavior” (Fisher et al., 2006, p. 545). Although many use the term criminaliza- tion to refer simply to the prevalence of persons with SMI in the criminal justice system, in particular to their overrepresentation and increased likelihood of arrest, the term has specific connotations. Most broadly, it implies that jails became substitutes for state mental hospitals, presumably because persons who were previously state hospital patients were refusing treatment in the community or unable to access treatment in the community (Fisher et al., 2006). Fisher et al. (2006) provides more detail, describing criminalization as:

a process whereby behaviors that in one era had been managed by involun- tary transport and psychiatric hospitalization became less easily managed in that way as a result of the new restrictions placed on civil commitment. With the mental health disposition less available, but still faced with a need to man- age situations involving undesirable behaviors, agents of social control— police and judges—would impose a criminal, rather than psychiatric, defini- tion of an individual’s deviant behavior. The individual would then be arrested, often on a trivial charge such as trespassing or disorderly conduct, rather than civilly committed, and in some cases detained in jail. (p. 546)

In other words, judicial professionals, such as police and judges, began using crim- inal sanctions to manage persons with SMI in the community because other men- tal health options were unavailable (Engel & Silver, 2001; Fisher et al., 2006; Teplin, 1983).

The Criminalization Hypothesis 3

Junginger, Claypoole, Ranilo, and Crisanti (2006) provided more clarification regarding criminalization and the role that symptoms might play in the arrest of people with mental illness:

Why persons with serious mental illness are more likely to be arrested and incarcerated is unclear, but a literal and popular interpretation of the crimi- nalization hypothesis implies two possibilities. First, symptoms of serious mental illness have become de facto criminal offenses; that is, person with serious mental illness are arrested and incarcerated for displaying psychiatric symptoms. Second, symptoms of serious mental illness motivate or otherwise cause actual criminal offenses. (p. 879)

This nuanced definition is important because it helps clarify how mental health symptoms have become criminalized and distinguishes between arrests resulting from the display of mental health symptoms, and those resulting from criminal behaviors that are directly or indirectly caused by mental health symptoms. Crim- inalization therefore occurs when persons with mental illness are arrested, either for displaying symptoms of mental illness or for committing minor crimes that are a direct or indirect result of mental illness, instead of being treated in the mental health system.

Assessing the Validity of Criminalization

Although there is a great deal of anecdotal evidence supporting the criminal- ization hypothesis, it is a widely understood principle that policy should be driven by rigorous research (Morrissey et al., 2006). Criminalization therefore must be found to be an important cause of the problem before policy makers rely on it to inform decisions, even though there are a disproportionate number of persons with SMI in jails and prisons. Specifically, research must show that deinstitution- alization and inadequate community resources have caused individuals with SMI to have greater involvement with the criminal justice system. However, if other nonclinical factors are found to be important to the high rates of arrest, then pub- lic policy can address the problem only through a more comprehensive treatment plan that addresses both clinical and nonclinical factors.

Are Individuals with SMI Targeted for Arrest?

Junginger et al. (2006) stated that the criminalization hypothesis implies that legal professionals, such as police and judges, treat mental illness as a crime and target mentally ill persons in the community with criminal sanctions. Several studies have examined this question using: (1) prevalence data of persons with mental illness in jails and prisons, (2) arrest rates of discharged hospitalized men- tal health patients, and (3) comparisons of arrest rates for person with and with- out mental illness (Engel & Silver, 2001; Lamb & Weinberger, 1998; Rabkin, 1979; Teplin, 1984).

4 Best Practices in Mental Health

Some researchers have suggested that mental illness may be associated with an increased risk of arrest. For example, Teplin’s (1983) literature review focus- ing on (1) archival studies, (2) police decision making, and (3) prevalence data, found mixed evidence that persons with mental illness were being targeted for arrest. Arrest rates were higher among offenders with previous hospitalizations than for persons with no prior arrests, but persons previously admitted to psy- chiatric hospitals had arrest rates that were higher than those of the general pop- ulation. Furthermore, persons with mental illness and no prior arrests had arrest rates similar to those of the general population. Teplin (1984) analyzed arrest rates between persons with and without mental illness. Although there was an increased probability of arrest for those showing symptoms of mental illness as compared to those who did not, the findings were based on cross-tabulation analysis absent of statistical controls for legal factors and other important vari- ables known to affect police decision making (Engel & Silver, 2001). In support of criminalization, Teplin (1983) found a majority of studies investigating police decision making provided some evidence that persons with mental illness may be targeted for arrest.

Other studies investigating police decision making, however, appear to contra- dict Teplin’s findings. When the problem of the increasing incarceration rates of persons with mental illness was first becoming evident, Bittner (1967) found that police were “reluctant to take any official action (including arrest) ‘on the basis of the assumption or allegation of mental illness’ and that officers often chose to resolve such encounters informally” (Engel & Silver, 2001, p. 229). In addition, police were not found to arrest noncommittable persons with mental illness involved in nondangerous incidents simply out of expediency (Bonovitz & Bonovitz, 1981), nor were they more likely to arrest persons with SMI or to use arrest to manage persons with mental illness (Engel & Silver, 2001). In summary, there is no conclusive answer to the question of whether persons with SMI are tar- geted for arrest.

Does Mental Illness Cause Crime?

The second interpretation of the criminalization hypothesis by Junginger et al. (2006) is that symptoms of SMI indirectly or directly cause crime. Assessing the causal link between mental illness and crime is difficult for two reasons. First, mental illness is correlated with factors that cause crime, such as criminal think- ing; and second, mental illness elevates risk factors that lead to crime, such as sub- stance abuse (Frank & McGuire, 2010). A full review of the causal link between mental illness and crime is beyond the scope of this article. However, research thus far has found convincing evidence that there is a small connection between men- tal illness and crime, although the connection is specific for certain subsets of per- sons with mental illness (Frank & McGuire, 2010). Given the link, albeit a small one, between mental illness and crime, access to community resources and treat- ment is often seen as important to reducing criminal activity. The question of the

The Criminalization Hypothesis 5

extent to which improved access and use of mental health treatment would sig- nificantly reduce crime will be addressed below.

Does Access to Mental Health Treatment Reduce Crime?

Medicaid is the principal funding source for persons with SMI and accounts for 24 percent of total revenues for the community mental health centers that pro- vide many of the specialized programs for persons with SMI (Domino et al., 2004; Frank et al., 2003; Koyanagi & Stine, 2009; McAlpine & Mechanic, 2000; Morrissey et al., 2006; National Alliance for the Mentally Ill, 2001; Petrila, 1992, 2001). Morrissey et al. (2007) examined the association between Medicaid enroll- ment upon release from jail and time in the community (i.e., time until rearrest). The study compared two groups of individuals with SMI who had been enrolled in Medicaid prior to entering jail. One group remained enrolled in Medicaid at the time of release from jail whereas the other had been disenrolled due to incarcera- tion. Morrissey and colleagues found a small association between a combination of enrollment in Medicaid benefits and service utilization and reduction in arrests in a twelve-month period following release.

While Morrissey et al. (2007) focused on disenrollment of Medicaid recipients, Domino et al. (2004) examined whether reductions in mental health services due to managed mental health care led to indirect cost shifting from insurance plans to jails and state hospitals. By analyzing pre- and postmanaged care periods and comparing the difference in jail costs, state hospital costs, and county outpatient mental health costs between these periods, they found that managed care led to indirect cost shifting, most likely through poorer access to services, resulting from a greater probability of arrest. This study highlights the importance of cross- system outcomes. By seeking to control Medicaid costs, the implementation of managed care had the unintended consequence of increasing criminal justice expenditures.

The relationship between access to treatment and arrests has also been exam- ined by following a sample of people with SMI over time and by comparing arrest rates in communities with different levels of available care. Constantine et al. (2011) followed a sample of individuals with SMI and criminal justice contacts over a four-year period. Inpatient and emergency room contacts were positively related to the number of arrests, whereas outpatient treatment was negatively associated with arrests. Outpatient visits were associated with a reduced number of felony and misdemeanor arrests, whereas inpatient/emergency room contacts were associated with felony arrests. Fisher, Packer, Simon, and Smith (2000) com- pared incarceration rates of two regional communities in Massachusetts with sig- nificantly different levels of community mental health services and found no sig- nificant difference in arrest rates. The differing service levels were the result of a federal lawsuit, which doubled the per capita mental health funding in one county as compared to other counties in the state. This resulted in greater per capita fund- ing of residential programs and case management services as well as the creation of new services such as a mobile crisis team.

6 Best Practices in Mental Health

Current Responses and Risk Factors for Crime

The mixed findings discussed above do not provide strong support for the crim- inalization hypothesis. Such inconsistent findings have also caused several to sug- gest that criminal justice outcomes are not strongly related to clinical factors (Case, Steadman, Dupis, & Morris, 2009; Erickson et al., 2009; Fisher et al., 2006; Frank & McGuire, 2010; Lamberti et al., 20