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Bias in Mental Health Assessment and Intervention: Theory and Evidence

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Abstract

A recent surgeon general’s report and various studies document racial and ethnic disparities in mental health care, including gaps in access, questionable diagnostic practices, and limited provision of optimum treatments. Bias is a little studied but viable explanation for these disparities.

It is important to isolate bias from other barriers to high-quality mental health care and to understand bias at several levels (practitioner, practice network or program, and community). More research is needed that directly evaluates the contribution of particular forms of bias to disparities in the area of mental health care. RACIAL AND ETHNIC DISPARITIES are as widespread in the diagnosis and treatment of mental illness as they are in other areas of health. In 2001, then–Surgeon General David Satcher issued the report Race, Culture, and Ethnicity and Mental Health,1 in which he convincingly documented disparities in access and treatment that leave too many minority individuals...

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Substance-Induced Disorders

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The toxic effects of substances can mimic mental illness in ways that can be difficult to distinguish from mental illness. This chapter focuses on symptoms of mental illness that are the result of substance abuse—a condition referred to as “substance-induced mental disorders.”

Overview Description Alcohol Caffeine Cocaine and Amphetamines Hallucinogens Nicotine Opioids Sedatives Diagnostic Considerations Case Studies: Identifying Disorders

Description As defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (American Psychiatric Association [APA] 2000) (DSM-IV-TR), substance-induced disorders include:

Substance-induced delirium Substance-induced persisting dementia Substance-induced persisting amnestic disorder Substance-induced psychotic disorder Substance-induced mood disorder Substance-induced anxiety disorder Hallucinogen persisting perceptual disorder Substance-induced sexual dysfunction Substance-induced sleep disorder

Substance-induced disorders are distinct from independent cooccurring mental disorders in that all or most of the psychiatric symptoms are the direct result of substance use. This is not to state that substance-induced disorders preclude co-occurring mental disorders, only that...

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Intellectual Disability

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Intellectua Disability

Email this page to a friend Print Facebook Twitter Intellectual disability is a condition diagnosed before age 18 that includes below-average intellectual function and a lack of skills necessary for daily living.

In the past, the term mental retardation was used to describe this condition. This term is no longer used.

Causes Intellectual disability affects about 1% to 3% of the population. There are many causes of intellectual disability, but doctors find a specific reason in only 25% of cases.

Risk factors are related to the causes. Causes of intellectual disability can include:

• Infections (present at birth or occurring after birth) • Chromosomal abnormalities (such as Down syndrome) • Environmental • Metabolic (such as hyperbilirubinemia, or very high bilirubin levels in babies) • Nutritional (such as malnutrition) • Toxic (intrauterine exposure to alcohol, cocaine, amphetamines, and other drugs) •Trauma (before and after birth) • Unexplained (doctors do not know the reason for the person's intellectual disability)

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Reviewing and Comprehending Autopsy Reports

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Understanding the value of the autopsy report and the information accompanying it is a valuable asset to all investigators.

DEEPER INSIGHTS

Advances, Benefits and Challenges of Oral Fluid Testing in Forensic Toxicology

Voltaire said “To the living we owe respect, but to the dead we owe only the truth.” This is the definitive task of the medicolegal death investigator and forensic pathologist. The course of the death investigation has multiple phases including: scene investigation, body assessment, medical records, and the forensic autopsy. This is finalized in three documents: the death certificate, the investigator’s report, and the autopsy report. In order to understand the importance of the autopsy report, and how to interpret it, you should understand how all the other factors influence the report and why you cannot rely on the autopsy report alone.

An Overview of Death Investigation...

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Suicide And Psychiatric Diagnosis: A Worldwide Perspective

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The World Health Organization (WHO) compiles and disseminates data on mortality and morbidity reported by its Member States, according to one of its mandates. Since the WHO's inception in 1948, the number of Member States has grown continually and so has the WHO mortality data bank. From 11 countries reporting data on mortality in 1950, the number of countries involved increased to 74 in the year 1985. More than 100 Member States reported on mortality at some point in time.

Data from developed countries (mostly in the North of Europe and of America, and a few countries of the Western Pacific Region) are received on a mostly regular basis. Most developing countries (in Latin America, Asia and in the Eastern Mediterranean Region) report on an irregular basis; very few countries in Africa regularly report on mortality to WHO.

Deaths associated with suicide are an integral part of the WHO mortality data bank...

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What’s the Difference Between a Delusion and a Hallucination?

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Delusions are a symptom of some mental disorder, such as schizophrenia, delusional disorder, schizoaffective disorder, and schizophreniform disorder. Hallucinations, on the other hand, tend to only appear in people with schizophrenia or a psychotic disorder.

Delusions

Delusions are false or erroneous beliefs that usually involve a misinterpretation of perceptions or experiences. Their content may include a variety of themes (e.g., persecutory, referential, somatic, religious, or grandiose).

Persecutory delusions are most common; the person believes he or she is being tormented, followed, tricked, spied on, or ridiculed. Referential delusions are also common; the person believes that certain gestures, comments, passages from books, newspapers, song lyrics, or other environmental cues are specifically directed at him or her.

The distinction between a delusion and a strongly held idea is sometimes difficult to make and depends in part on the degree of conviction with which the belief is held despite clear contradictory evidence regarding its veracity....

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Bullet Trajectories at Crime Scenes

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Recommended Procedures for Documenting Bullet Trajectory

Crime scenes involving the use of firearms present unique challenges for the crime scene investigator, but using relatively simple techniques it is often possible to reconstruct the events that give some indication as to what occurred during the actual discharge of the weapon. By this I mean it is possible to determine the actual path or trajectory of the bullets, and using this information, determine the location of the shooter.

A number of factors must be taken into account including the position of cartridge cases ejected from automatic and semi-automatic weapons. It is therefore essential that the exact position of spent casings be marked and documented before any other investigative procedures are followed.

Document (Photograph & Sketch) Positions of Spent Cartridge Casings

Photography is the first necessity so it is imperative that the crime scene be afforded absolute security. Until spent cartridges are properly recorde...

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Because the investigation of cold cases is usually an arduous and time-consuming task, most law enforcement agencies in the United States are not able to dedicate the resources necessary to I u iu u IIsupport the cold case investigation process. However, when those cases are fully pursued and prosecuted, they often result in convictions and lengthy prison terms. Cold Cases: Evaluation Models with Follow-up Strategies for Investigators, Second Edition saves law enforcement time by providing detailed guidelines for determining if a cold case is solvable, and if so, how to organize, manage, and evaluate the investigation. It also provides techniques for developing investigative strategies to complement the evaluation process and resolve the crime.

This second edition features a new revised model and methodology for investigating cold cases suitable for all police and public safety agencies—large or small, domestic or international. This new model is more expeditious and convenient for departments that have less...

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Forensics With Sceneworks

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INTRODUCTION TO THE CONCEPT

We all have experienced the immense power of a text driven search in the internet via search engines: once we know the right keyword, the search-engines will "find it all", BUT if we don't ...., the screen stays empty.

On a smaller scale: is part of your job description to be a shareholder in the process of crime scene investigation? If so, did you ever have to communicate results via "clever named" folders or file names?

Here's our background: as a manufacturer of high-end (full spherical) cameras, some of our customers in the past were indeed police-photographers. They used the camera to document crime scenes. They figured: "... see the glas of water there. I actually do know that we have found a fingerprint on it. Wouldn't it be great to allow everyone in our team to immediately access the PDF with the fingerprint analysis by a simple mouse-click on the glass?...

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The Self and the Psychology of Domestic Homicide-Suicide

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Abstract

Men commit the vast majority of domestic homicide-suicides (H-Ss) wherein a person kills their intimate partner (and/or other family members) before taking their own life. Studies of men who commit H-S have looked at the act from psychopathology and evolutionary psychology viewpoints. To complement those approaches, this article presents additional views of domestic H-S. Applications of theories from social (escape from self), developmental (evolution of self and continuity of self), gender role (power and the male role), and family violence psychology (abusive personality and proximal antecedents of abuse) are outlined. These conceptualizations are offered because they pertain to instability and deconstruction of the self amidst the life changes and intimate distress that precede many cases of domestic H-S....

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Multiple Murder And Criminal Careers: A Latent Class Analysis Of Multiple Homicide Offenders.

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Abstract

PURPOSE: To construct an empirically rigorous typology of multiple homicide offenders (MHOs).

METHOD: The current study conducted latent class analysis of the official records of 160 MHOs sampled from eight states to evaluate their criminal careers.

RESULTS: A 3-class solution best fit the data (-2LL=-1123.61, Bayesian Information Criterion (BIC)=2648.15, df=81, L(2)=1179.77). Class 1 (n=64, class assignment probability=.999) was the low-offending group marked by little criminal record and delayed arrest onset. Class 2 (n=51, class assignment probability=.957) was the severe group that represents the most violent and habitual criminals. Class 3 (n=45, class assignment probability=.959) was the moderate group whose offending careers were similar to Class 2.

CONCLUSION: A sustained criminal career with involvement in versatile forms of crime was observed for two of three classes of MHOs. Linkages to extant typologies and recommendations for additional research that incorporates clinical constructs are proffered.

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Organized/Disorganized Continuum Phase 3 Individual Project Forensic Psychology

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Physical and Behavioral Evidence Based Crime Scene Analysis

The crime scene analysis approach that is taken in profiling works under the assumption that the crime scene will reflect the personality of the perpetrator. FBI profilers have been able to identify the characteristics of the organized and disorganized rapists and murderers. (Thorton, 2002) The profiler’s will use information that they gather from the crime scene and reflect on the nature of the crime in order to produce a psychological profile that would be consistent with the offender in question. The offender can be classified as organized or disorganized based on the information they were able to obtain from the crime scene and other aspects of the crime itself.

“An organized offender is thought to be very intelligent, socially competent and very charismatic.” (Curt Bartol, 2012) The disorganized offender is described as being of average intelligence, immature socially and a loner by default....

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Homicide in Black and White

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Abstract

African-Americans are six times as likely as white Americans to die at the hands of a murderer, and roughly seven times as likely to murder someone. Young black men are Öften times as likely to be murdered as young white men. This disparity is historic and pervasive, and cannot be accounted for by individual characteristics. Culture-of-violence and tail-of-the-distribution theories are also inadequate to explain the geographic and demographic pattern of the disparity. We argue that any satisfactory explanation must take into account the fact that murder can have a preemptive motive: people sometimes kill simply to avoid being killed. As a result, disputes can escalate dramatically in environments (endogenously) perceived to be dangerous, resulting in self-fulflling expectations of violence for particular dyadic interactions, and significant racial disparities in rates of murder and victimization. Because of strategic complementarity, small differences in fundamentals can cause large differences in murder rates..

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Shootings: What EMS Providers Need to Know

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  Firearm-related injuries continue to be a significant public health problem, accounting for almost 20% of injury-related deaths in the United States.

   From January 1993 to December 1998, an estimated 115,000 firearm-related injuries occurred annually in the U.S. Males were seven times more likely to die or be treated in emergency departments for gunshot wounds than females. In 2006 more than 30,000 persons died from firearm injuries in the United States.

   Gunshot wounds to the head are the most lethal of all firearm injuries. It is estimated they have a fatality rate greater than 90%. Those to the myocardium have fatality rates reaching 80%. Intra-abdominal injuries from gunshot wounds tend to involve the small bowel (50%), colon (40%), liver (30%) and abdominal vascular structures (25%).

PENETRATING MOI

   Gunshot wounds involve the transfer of energy to a target. The damage that occurs is directly related to the amount of energy exchanged between the penetrating...

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Drug-Related Deaths With Evidence Of Intracorporeal Drug Concealment At Autopsy: Five Case Reports.

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Abstract

Intracorporeal concealment of illicit drugs is a rare observation at coronial autopsy examinations. The article reports 5 cases of accidental drug overdoses at the Westmead Coronial Morgue, Sydney New South Wales, over a 6-year period with evidence of intracorporeal drug concealment known as body packing or body stuffing. Three different forms of anatomic concealment of drugs are illustrated, Case 2 involving therapeutic medication in the form of glass ampoules for parenteral injection not previously reported. Three deaths were the result of acute toxicity due to polydrug abuse rather than as a consequence of the body packing behavior and rupture of the drug packaging, with the intracorporeal drug concealments an adjunct finding at the autopsy examinations. The cause of death in Case 3 was the direct result of acute cocaine intoxication due to rupture of drug packages in the rectum and mucosal absorption. The article details forensic sociological aspects of drug concealment...

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Sexual Homicide A Motivational Model

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Abstract

Reports findings from an exploratory study of the background characteristics of 36 male sexual murderers, their behaviors and experiences in connection with their developmental stages, and the central role of sadistic fantasy and critical cognitive structures that support the act of sexual murder. All Ss were born in the 1940s and 1950s; 33 were White, and 80% were of average to superior intelligence. A 5-phase motivational model is presented: (1) ineffective social environment, (2) formative events, (3) critical personal traits and cognitive mapping process, (4) action toward others and self, and (5) feedback filter. Clinical implications are noted. (PsycINFO Database Record (c) 2016 APA, all rights reserved)...

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