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Police officers initiate psychiatric holds following determination of suicide risk. Such referrals constitute direct decriminalization of mental illness at the single most efficient criminal justice system diversion point. However, system-level problems with this process highlight a need to further understand and improve this service connection juncture. The goal of the present study was to inform the development of a smartphone application designed to enhance police referrals of individuals experiencing suicide crises into treatment via culturally responsive structured professional judgment.Given the developmental and qualitative nature of this study, there were no formal hypotheses tested. Research questions included the following: Would police officers broadly endorse concerns about the care referral process? Would officers support the use of technology to assist with those concerns? And would officers raise concerns about the demands on time and expertise that would be placed on them to conduct thorough risk assessments?Researchers used community-based participatory research (CBPR) methods to obtain police stakeholder-driven data through four focus groups with 47 police officers (76.6% male, 59.6% White, with a mean of 10.7 years of police employment) sampled from patrol and hostage negotiation units. Participants shared information about specific problems arising in the process through which police refer people to medical care, and they gave feedback on the beta version of a culturally responsive mobile app designed to streamline officers' evidence-based and culturally informed determinations of suicide risk.Results, qualitatively coded using grounded theory methodology, yielded key considerations for police use of culturally responsive apps to divert individuals in suicidal crisis into treatment, including the need to maintain a balance between risk assessment and communication, allow for variance in time constraints, allow for flexibility in response and report options, account for inaccurate reports of suicide risk factors, maximize utility of the app's risk report output, incorporate sensitivity around cultural questions, and consider officers' safety in their use of the app in the field.The results illustrate a theoretically based (CBPR) approach to cross-disciplinary technology development to facilitate evidence-based assessments by law enforcement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Law enforcement officers (LEOs) may play the most important role in directing people in mental health crises into treatment versus incarceration. While most military veterans will never experience a crisis interaction with LEOs, they represent an important at-risk target group for whom to enhance LEO response. The evidence supporting LEO crisis training models includes important limitations that stem from jurisdiction-limited studies, and emphasize LEOs who volunteer for mental health training. The current study reports the primary outcomes of a national (U.S.) large-scale mandated train-the-trainer program to enhance VA LEO response to military veterans with mental health issues. Multidisciplinary teams comprised of VA LEOs, Veterans Justice Outreach Specialists, and mental health professionals (n = 245) were trained in two nested waves. Both trainers and endpoint LEOs (n = 1,284) improved from pretest to posttest on knowledge and skills in identifying psychological services and related treatment referral resources and cross-discipline collaboration, the latter of which showed some retention at 3-month follow-up. The findings support the potential for LEOs mandated to training to improve in important prerequisites to diverting people with mental health issues into care, and away from the criminal justice system. Such results may require professional trainers of LEOs who have themselves received relevant specific training. Potential cautions of such an approach, including inter-team differences and potential for publication bias in extant literature, are also elucidated by the current methodology. The links to all of the collaboratively-developed curriculum materials from the current study are provided for use by qualified professionals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alcohol and marijuana are the most commonly used substances for college-attending young adults. This study evaluated differences in substance-specific consequence attribution by alcohol-marijuana use patterns (concurrent alcohol and marijuana [CAM; use of both substances, not at same time] and simultaneous [SAM; use of both, at same time]) as well as alcohol-only (AO). First-year college students with prior alcohol use (N = 610, 50.9% women, 71% White, Mage = 18) completed an online assessment of past-three-month substance use, including SAM, and related consequences. Results indicated that polydrug (SAM and CAM) users reported greater alcohol involvement and earlier alcohol initiation than AO, and polydrug use was associated with more alcohol-related problems, including sexual risk taking and alcohol-related blackouts. When restricted to SAM/CAM users, logistic regressions indicated that SAM users reported an increased incidence in two marijuana-related problems relative to CAM (driving after using and academic difficulties), but lower rates of social problems. SAM users were also less likely to attribute substance-related social problems to alcohol. Overall, findings highlight variations that exist within alcohol-marijuana polydrug users and show areas to consider for intervention development and future research.

We longitudinally investigated coping among male military veterans ( n =98) with posttraumatic stress disorder (PTSD) symptomatology and a co-occurring substance use disorder (SUD) who participated in a randomized controlled trial of seeking safety (SS). Participants were randomized to SS or intensive treatment-as-usual (TAU) for SUD. Coping (active, avoidant, emotional discharge), and PTSD and SUD symptomatology were measured prior to and at the end of treatment, and at 6- and 12-month follow-ups. Among the total sample, we found that: (a) avoidant and emotional discharge, but not active, coping tended to be positively associated with PTSD and SUD symptomatology at baseline; (b) active coping increased and avoidant and emotional discharge coping decreased during the 12-month time-period; and (c) avoidant and emotional discharge, but not active, coping longitudinally covaried with PTSD and SUD symptomatology. Results suggest the utility of targeting maladaptive coping in treatments for individuals with co-occurring PTSD and SUD.

This study evaluated the impact of structured training in evidence-based risk assessment for suicide.Forty-five psychiatry and psychology trainees participated in a workshop on evidence-based risk assessment. A comparison group of ten psychiatry trainees participated in a different workshop on the application of evidence-based medicine to psychiatry that was not focused specifically on risk assessment. Before and after each workshop, participants rated their skills in assessing patients' risk of suicide and wrote progress notes regarding clinical vignettes that included the assessment of and plan regarding suicide risk. Researchers systematically rated the progress notes.Participation in risk assessment training predicted improvement on specific indicators of documentation quality, ratings of the overall quality of documentation of suicide risk, and self-rated competence in suicide risk assessment.Structured clinical training in evidence-based risk assessment can improve documentation of assessment and management of patients' risk of suicide.

The debate surrounding the application of the psychopathy construct to juveniles polarizes mental health professionals and must be considered within the context of (1) larger societal problems of reification and general misuse of mental health diagnoses and (2) more specific problems caused by the “forensic culture.” In supporting the responsible application of the psychopathy construct to juveniles, I review how (1) psychopathy is fast becoming a reliable and empirically validated assessment for juveniles, already equaling or surpassing more subjective evaluation processes and even other diagnostic categories; (2) the state of the science in culturally competent juvenile psychopathy assessment is positive so far, and in need of immediate empirical attention; (3) concerns about the malleability of psychopathy in juveniles are rooted in problematic assumptions; and (4) the empirical evidence regarding the cost/benefit of stigma versus clinical gain currently supports careful responsible use. I clo...

ajp.psychiatryonline.org With this article, the Journal inaugurates a new feature for our readers. Education in Psychiatry, like Treatment in Psychiatry, begins with a case vignette to illustrate an important problem in clinical psychiatry. However, the goal of Education in Psychiatry is to present and evaluate methods to teach students, trainees, and other psychiatrists how to treat patients with these problems.

Psychobiological studies of posttraumatic stress disorder (PTSD) often challenge participants to assess the dynamics of systems evolved to organize responses to extreme events. Informed consent insures that volunteers have every opportunity to preevaluate the conditions of the research experience and decline if made uncomfortable by them. Notwithstanding their necessity, these protections set the stage for self-selection phenomena that may bias study outcomes. This study compared prospectively obtained psychometric data from 196 participants and 1229 nonparticipants in sleep and psychophysiological studies of PTSD. Lower subjective nightmare severity was endorsed by persons who later agreed to participate in a study of baseline sleep, an observation consistent with the low nightmare frequencies observed in most laboratories studies of sleep in PTSD.

The authors assessed base rates of firearm possession reported by hospitalized psychiatric patients.The study involved retrospective review of the charts of 100 patients consecutively admitted after a hospital had incorporated routine firearm screening in the workup done at admission and the charts of 100 patients who had been consecutively admitted during an earlier interval when firearm screening had been done on an as-needed basis.Whereas one patient (1%) acknowledged having access to a firearm when screening had been done on an as-needed basis, under conditions of routine screening, nine patients (9%) reported owning or having access to a firearm.A substantial proportion of hospitalized patients have access to firearms. Unless patients are directly asked about firearm access, this information may not come to the attention of health care providers. Strategies to manage the risk of suicide and violence by hospitalized patients may benefit from routine assessment of firearms possession.

Bose-Einstein condensates in crystals of light with honeycomb geometry give rise to nonlinear Dirac equations and relativistic linear stability equations supporting a zoo of long-lived relativistic vortices, skyrmions, and solitons.

This study evaluated the prevalence and types of criminal arrest among 99,512 male veterans in substance use disorder (SUD) treatment across 150 VA facilities from 1998 to 2001. Participants were assessed with the Addiction Severity Index (ASI), which includes detailed information about lifetime criminal activity. A majority of the patients (58.2%) had three or more previous arrests, with 46.0% reporting one or more criminal convictions. Criminal arrests were frequent and varied. A majority of patients (69.3%) had at least one arrest that was not due to drug possession, drug sale, or intoxication. Nearly 24% reported at least one arrest for a violent crime. Patterns of arrest for specific crimes varied across SUD diagnostic categories. Screening for specific types of offending is informative and viable. Existing VA SUD treatment is a potentially underrecognized point of intervention for justice involvement among veterans.

When crisis situations involving veterans occur, responding police officers find themselves playing an important role in the spectrum of health and mental health services for those veterans. Crisis response training can help officers respond in a manner that increases safety and optimizes outcomes for all people involved. Yet, current crisis response police training models are only accessible to select officers. Nor do they emphasize the unique challenges and strengths that impact veterans who experience acute symptoms of mental illness. In the current study, we report the results from the first generation of training, collaboratively designed to enhance officers' (a) knowledge of relevant topics, including posttraumatic stress disorder and traumatic brain injury, (b) attitudes about veterans, and (c) and skills helpful in identifying and deescalating veterans and referring them to treatment. Officers completed in-class evaluations (N = 314), and a subsample (n = 53) completed 3-month follow-up evaluations. Pre- versus posttest comparisons indicated significant improvements in total score, and individually in knowledge, attitudes, and skills. Consistent with previous literature, the specific in-class gains were not retained on follow-up. However, responding officers widely endorsed use of de-escalation techniques during, and a positive impact of the training on, their interactions with veterans in the 3 months following the training. Implications for future training and policy are discussed.

Older adults are among the highest at risk group for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental healthcare. However, providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of health care providers who may see older adults in their care settings. One hundred and thirty two participants from two VA Medical Centers participated in a 6.5 hour long workshop in the assessment and management of suicide risk among older adults. Participants were asked to complete pre- and- post workshop case notes and report on subjective changes in knowledge, attitude, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists coming from a variety of care settings including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, and home and community. Following the workshop, participants demonstrated improvement in the overall quality of case notes (p

The authors compared 2-, 3-, 4-factor, and 2-factor/4-facet Psychopathy Checklist-Revised (PCL-R) models in a previously unpublished sample of 1,566 adult male sex offenders assessed under applied clinical conditions as part of a comprehensive state-mandated community notification risk assessment procedure. “Testlets” significantly improved the performance of all models. The 3-factor model provided the best fit to the current data, followed by the 2-factor/4-facet model. The 2-factor model was not supported.