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Although human trafficking is recognized as a public health issue, research on the health effects of human trafficking and best intervention practices is limited. We describe 2 citywide collaborative victim services models, the THRIVE (Trafficking, Healthcare, Resources, and Interdisciplinary Victim Services and Education) Clinic at the University of Miami and Jackson Health System in Miami, Florida, and the Greater Houston Area Pathways for Advocacy-based, Trauma-Informed Healthcare (PATH) Collaborative at Baylor College of Medicine, CommonSpirit Health, and San Jose Clinic in Houston, Texas, funded in part by the Office for Victims of Crime, which focus on trauma-informed health care delivery for victims of human trafficking. From June 2015 through September 2021, the THRIVE Clinic served 214 patients with an average age of 28.7 years at the time of their first visit. From October 2017 through September 2021, the PATH Collaborative received 560 suspected trafficking referrals, 400 of which screened positive for labor or sex trafficking. These models serve as a framework for replication of interdisciplinary practices to provide health care for this unique population and preliminary information about the strategies put in place to assist victims during their recovery. Key lessons include the importance of a citywide needs assessment, patient navigators, interdisciplinary care, and building community partnerships to ensure safe housing, transportation, identification, health insurance, vocation services, input from survivors, peer-to-peer mentorship, and medical–legal services. Further research is needed to understand the detrimental health effects of trafficking and the health care needs of victims. In addition, a need exists to develop optimal models of care for recovery and reintegration for this patient population and to address public health, legal, and medical policies to ensure access to and sustainability of comprehensive, trauma-informed, interdisciplinary victim services.

Foreign-born individuals immigrating to or residing in the United States are especially vulnerable to exploitation by traffickers. Being trafficked elevates the risk for a variety of physical and mental health problems; thus, victims will often come into contact with health professionals. Because there is a dearth of literature concerning the treatment of human trafficking victims, and especially foreign-born victims, we set out to describe the practical applications of a model that we use for the mental health treatment of victimization in this population. As has been suggested by leaders in the anti-human trafficking community, we employed a culturally sensitive version of Bronfrenbrenner’s Ecological Systems Model to provide recommendations and educational resources for treatment at the individual, interpersonal, community, and societal levels. Our recommendations should serve to inform and improve the provision of care for foreign-born victims of human trafficking.

There are few studies of the manner in which media portray the mental state of mass killers. There are also no formally tested frameworks or models for understanding how such portrayals contribute to the stigma of mental illness. In this article we analyzed the initial depictions of a high-profile mass killer applying discourse analytic methods to representations of the Tucson shooter, Jared Loughner, in the New York Times. We identified fourteen items that focused on Loughner and his actions that were published over the 1st week after the shooting prior to any authoritative assessment of his mental state. This study sought to deconstruct this portrayal of the killer as “mad”, and to show how the four cultural mechanisms of language in use, culture, social practices, and institutions contributed to that construction. Those cultural mechanisms underpinned links observed in the items between Loughner’s behavior, his putative mental illness, and the mass murders. This seamless interplay between the cultural mechanisms as related intertextually enabled the differing representations of Loughner as mad, dangerous, and fearsome. We argue that such a portrayal is a significant contributor to stigmatizing understandings of mental illness and people’s fear of mental disorders.

Objectives: We surveyed the prevalence of various types of threats or assaults by patients against psychiatrists and determined the impact of the most distressing event. Method: An anonymous questionnaire was mailed to all 308 vocationally registered psychiatrists practicing in New Zealand. Results: A response rate of 63.9% ( n = 197) was obtained. In the preceding 12 months, as many as 46% ( n = 89) of respondents had been verbally threatened and 39% ( n = 76) had been physically intimidated by patients. In addition 16% ( n = 32) had been assaulted without requiring medical attention, 14% ( n = 27) had been harassed through formal complaint mechanisms, 10% ( n = 20) had been sexually harassed, and 5% ( n = 9) had been stalked. As indicated by responses on the Impact of Event Scale, only one-third of the psychiatrists had any symptoms related to the most distressing event and only two had symptoms that might be associated with clinically significant levels of distress. Conclusions: The prevalence of these events suggest a need for the development and evaluation of preventive interventions.

Objective: Having found no discussions of self-depictions offered by psychiatric patients in the mass media we sought such items in a prospective national sample of print media and analysed how those speakers portrayed themselves. Method: As part of a larger study of media depictions of mental illnesses in print media all items with any mental health or illness aspect that appeared in a New Zealand publication over a four-week period were collected. The resulting collection of 600 items ranged from news briefs to full-page newspaper articles. From that set we selected and analysed items in which a person identified as having been a psychiatric patient or as having a mental disorder was either quoted by the reporter who had interviewed them, or personally described their experiences. Employing both propositional analyses and discourse analysis we explored how the speakers were positioned and identified patterns or themes in their construction of living with a mental illness. Results: Only five articles (0.8%) met our criteria for a person with a mental disorder being reported directly. In those items the journalists had positioned the speakers as credible, expert sources who, in representing their lives and experiences, drew on five clusters of resources, that we titled: Ordinariness/Living Well; Vulnerability; Stigma; Crisis; and Disorder/ Treatment. Ordinariness/Living Well foregrounded the role of personal strengths in living well and in overcoming adversity, particularly that associated with being stigmatized. We identified that theme as central to the ways in which these speakers depicted themselves as recognizably human and understandable. Conclusion: The findings are preliminary but these depictions are different from those reported by most researchers. Unlike those depictions, these speakers provided accessible and recognizably human self-portrayals. That finding intensifies our concern that most researchers appear to be unaware that these consumer voices are largely absent from mass media depictions of mental illnesses.

Objective: Because there are no published reports of depictions of mental illness in print media based on national samples, we set out to prospectively collect and analyse a near complete New Zealand sample of print media. Methods: A commercial clipping bureau was contracted to provide cuttings of all items with any mental health or illness aspect over a four week period. These items were analysed for potentially positive and negative depictions and how mental illness was represented within each item. An independent search for additional newspaper items concerning one prominently featured topic indicated that the rate of identification of relevant stories was at least 91%. Result: The collection consisted of six hundred print items which were most commonly news or editorial pieces (n = 562, 93.7%). Negative depictions predominated, with dangerousness to others (n = 368, 61.3%) and criminality (n = 284, 47.3%) being the most common. Positive depictions, including human rights themes, leadership and educational accomplishments occurred in 27% (n = 164) of all items. Generic mental illness terminology without reference to specific diagnostic categories was present in 47% of all items (n = 284). Conclusions: Negative depictions that predominate confirm the stereotypic understanding of mental illness that is stigmatizing. These findings underscore the challenge facing us as mental health professionals attempting to change attitudes towards mental disorders when the stereotypes are so regularly reinforced.

Objective: Expected standards for student performance in psychiatry can vary between supervisors and institutions. Recently, the University of Auckland required its academic departments to have an objective standard assessment or test for each student on a clinical attachment. We aimed to compare an objective structured clinical examination of final year medical students training in psychiatry and their supervisors' appraisals. Method: Assessment in psychiatry initially consisted of a two-hour written test. Subsequently, the test in psychiatry changed to a standardised, modified, objective, structured, clinical examination (OSCE) using simulated patients. The clinical supervisor rated each student on a set of clinical parameters using a scale of 1-6. In addition, members of the academic department of psychiatry separately tested the students with a modified OSCE on the last day of their clinical attachment. The results of the OSCE are compared with clinical attachment assessments and the previous method of evaluation, the written test. Results: There was no correlation between the written test and the supervisor's assessment for the clinical attachment indicating that the written test was not a good method of evaluating student performance. The correlation between the clinical attachment grading and the OSCE for year 1 was 0.4 (p=0.002) and for year 2 was 0.5 (p=0.001). However, marks for the OSCE were consistently lower than those given for the clinical attachment. Conclusions: The introduction of the modified OSCE had the desired outcome of changing students' focus from the pursuit of theoretical knowledge to the attainment of practical skills.

Objective: To determine to what extent research skills are taught and how they are taught to psychiatrists-in-training across Australasia.Method: Anonymous mail-out survey of training directors and trainee representatives on local training committees.Results: The questionnaire was completed by 20 of 23 directors (response rate = 87%) who reported on 522 trainee psychiatrists. Formal seminars or lectures and journal clubs were the most commonly adopted methods of teaching (90% and 70% of programs respectively) while only two programs formally required trainees' participation in research. Epidemiologi-cal research methods, critical appraisal skills, ethical issues, and research design were the topics most commonly taught formally, and these were taught in 80% of programs or less. Only 33 (6.3%) trainees were involved in a research project that involved data collection.Conclusions: Research skills were rather uniformly taught. The results are discussed in relation to identified areas for improvement.

Violence by patients against psychiatry registrars in training has received little published attention in Australasia. For example, as far as we are aware, there is no information on what psychiatr...

Objective: To determine best practice management strategies in the clinical application of civil commitment. Method: All relevant literature on the topics of ‘civil commitment', ‘coercion’ and ‘procedural justice’ were located on MEDLINE and PsychUT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. Results: Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. Conclusions: Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.

Objective: There is a dearth of studies examining how dangerousness is constructed in media depictions of mentally ill individuals who are frequently portrayed as acting violently. The aim of the present study was to identify the contribution of diverse technical, semiotic and discursive resources utilised in portraying a character with a mental illness in a prime-time drama as dangerous. Method: Discourse analytic techniques, involving systematic, repeated, critical viewings, were applied to a single program drawn from a sample of prime-time television drama episodes touching on mental illness. Results: Nine devices (appearance, music and sound effects, lighting, language, intercutting, jump-cutting, point of view shots, horror conventions and intertextuality) were identified as contributing to the signified dangerousness of person receiving care in the community for a mental illness. Conclusions: These techniques combine in signifying mental illness and a person suffering from it as dangerous. The findings suggest that mental health professionals working to reduce the stigma of mental illness need to have a reasonably sophisticated understanding of the practices and priorities of television production if they are to collaborate effectively with producers to create dramas that convey more human and sympathetic understandings of mental illness or to combat the negative effects of such portrayals.

Objective: The aim of this paper is to examine the base for integrating biomedical, psychological and social strategies in the management of schizophrenia. Method: A review of the literature on schizophrenia with particular emphasis in management considerations.Results: Effective treatment components include psychoeducation, medication strategies, carer-based stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioural strategies for residual symptoms.Conclusions: Treatment for schizophrenia is best provided by integrating the various and specific psychosocial intervention strategies in addition to the optimal use of medication. Methods for implementing these strategies in outpatient settings include the use of a comprehensive assessment and treatment plan, the training of mental health professionals, and periodic review with assessment packages.

We aimed to determine the attitudes and behaviours of mental health professionals (MHPs) including psychiatrists towards identifying and reducing their own patients' risk for sexually transmitted diseases and unwanted pregnancies.102 of all of the 162 mental health professionals serving predominantly chronically psychiatrically ill adult outpatients and inpatients in Waitemata district responded to an anonymous questionnaire (response rate = 63%), concerning their own attitudes and behaviours towards identifying and counselling patients on their risk for sexually transmitted diseases and unwanted pregnancies.Mental health professionals reported that, on average, they had counselled 14% of their own male patients and 21% of their own female patients on sexually transmitted diseases, including AIDS prevention, and that more of their own patients were at risk than were counselled. They also reported that they had counselled 5% of their own male patients and 17% of their own female patients about family planing. Forty-two per cent of mental health professionals indicated that they had insufficient knowledge about sexually transmitted diseases to educate patients, 72% indicated that when it came to risky sexual behaviours chronic psychiatric patients were much the same as other people, and 33% or more felt uncomfortable discussing topics of condom use and patients' sexual preferences.These results suggest that family planning and sexually transmitted diseases risk preventive interventions for psychiatric patients need to overcome mental health professionals' own barriers to risk prevention.The authors aimed to determine the attitudes and behaviors of mental health professionals (MHPs), including psychiatrists, towards identifying and reducing their own patients' risk for sexually transmitted diseases (STDs) and unwanted pregnancies. 102 of all of the 162 MHPs serving predominantly chronically psychiatrically ill adult outpatients and inpatients in Waitemata district responded to an anonymous questionnaire (response rate = 63%) concerning their own attitudes and behaviors towards identifying and counseling patients on their risk for STDs and unwanted pregnancies. MHPs reported that, on average, they had counseled 14% of their male patients and 21% of their female patients on STDs, including AIDS prevention, and that more of their patients were at risk than were counseled. They also reported that they had counseled 5% of their male patients and 17% of their female patients about family planning. 42% of MHPs indicated that they had insufficient knowledge about STDs to educate patients, 72% indicated that when it came to risky sexual behaviors chronic psychiatric patients were much the same as other people, and 33% or more felt uncomfortable discussing topics of condom use and patients' sexual preferences. These results suggest that family planning and STD preventive interventions for psychiatric patients need to overcome MHPs' own barriers to risk prevention.

Objective: Because there are few controlled studies, we aimed to determine the prevalence of sexual and physical abuse reported by psychiatric outpatients compared to matched controls.Method: The sample consisted of 158 outpatients with major mental disorders including schizophrenia and bipolar disorder, who responded to a semi-structured interview (response rate = 64.8%) and who were individually matched for gender, age and ethnicity with 158 outpatients who had never been treated for psychiatric illness. They answered questions about whether and when they had ever been sexually or physically abused, and about the type and circumstances of abuse.Results: Abuse was more common during adulthood (16 years or older); 45 psychiatric patients (28.5%) were sexually abused and 43 (27.3%) were physically abused. Compared to the controls, patients were significantly more likely to report a history of sexual or physical abuse during adulthood (χ2 = 5.15, d.f. = 1, p = 0.02; χ2 = 4.09, d.f. = 1, p = 0.04 respectivel...

Goals: The participant will learn about the prevalence and circumstances of violent acts against registrars and about possible methods of response.Summary: The literature on violence against psychiatry trainees will be reviewed with an emphasis on data from Australasia and the psychological impact of incidents. Models for both preventing and responding to incidents of violence by patients against trainees will be discussed, and case examples will illustrate the principles at stake. Workshop participants will be invited to discuss any relevant experiences within their own training programmes.

Objective: Because of the paucity of controlled studies, we aimed to determine the STD Risk Behaviours of male chronically ill psychiatric outpatients compared to controls.Method: Ninety-two male outpatients with major psychiatric disorders, including schizophrenia, bipolar disorder and mood disorders, were individually matched for age and ethnicity with 92 men who had never been treated for psychiatric illness. The patients completed a semi-structured interview (response rate = 66%) on specific STD Risk Behaviours.Results: Sexually active psychiatric patients were significantly more likely than controls to have known their sexual partner for less than one day, and to report having been pressured into unwanted sexual intercourse over the preceding year (χ2 = 7.45, d.f. = 1, p < 0.01; Fisher's Exact Test two-tailed p < 0.05 respectively). There was also a strong but not significant trend for sexually active patients to have had sex with a male partner and sexual intercourse with a drug user over the preced...

Objective: Because there is a dearth of studies, we examined how intertextuality expressed through relationships between news media storylines contributes to the stigmatization of the mentally ill.Methods: A nearly complete national sample of newsprint materials was collected over one month. This featured two extensively covered events of acts of violence by mentally ill individuals against members of the public. Discourse analytic techniques involving systematic, repeated, critical viewings were used to examine the relationships between the printed articles about the two stories or events.Results: Five intertextual themes were identified (patients' rights versus public safety, individuals as victims or heroes, agency, grieving and sense of community). These together with illustrations and layout were indentified as contributing to the stigmatization of the mentally ill as dangerous.Conclusions: Intertextuality is a central element in the stigmatization of the mentally ill. The findings suggest that menta...