This Month's Highlights

Seven reports in this issue focus on services provided to young people and their treatment needs. The lead article presents findings of a randomized trial that examined whether youths aged 11 to 18 who were receiving home-based treatment would have better outcomes when their clinicians received weekly feedback from assessments of the youths' symptoms and functioning. As in previous research involving adult patients, youths improved faster when routine measurement and feedback were employed (page 1423). Using court records, the authors of the second article found high rates of childhood maltreatment among male and female youths in a juvenile detention center. Combining these data with information from current clinical interviews with the youths, the authors were able to show strong links between past abuse and current mental disorders—the strength of which increased with the severity of the abuse (page 1430). Three years after the 2007 shootings at Virginia Tech, researchers surveyed 63 colleges in Virginia about academic policies governing responses to apparent mental health crises of students. The researchers found that few students are affected by such policies, and their chief value may be to motivate students to seek treatment voluntarily (page 1439). Analyses of three years of claims data from privately insured children with bipolar I disorder found that only a fifth received guideline-concordant pharmacotherapy within three months of the index diagnosis and that nearly three-quarters received nonrecommended medications, such as antidepressant monotherapy (page 1443). How prevalent is psychotropic polypharmacy among children, and how best to define it? Researchers studied Medicaid claims data from three large states and learned that polypharmacy prevalence rates fell from 27% to 18% when the overlap period used to define polypharmacy was raised from 30 to 90 days (page 1450). Interviews with a sample of more than 150 college students who had a lifetime history of suicidal ideation revealed that 44% who had experienced such ideation since the start of college did not seek treatment for the problem (page 1510). The Best Practices column describes how the State of Utah, concerned about suicide rates among young people, established an early-intervention program within the juvenile court system for high-risk youths (page 1416).

Two reports in this issue focus on people with mental illness in jails and prisons. A study by Nancy Wolff, Ph.D., and colleagues explored the thinking styles and emotional states of prison inmates to shed light on a key question: is mental illness or criminality the first-order cause of the criminal behavior that results in incarceration of persons with mental illness? Analyzing data from interviews with more than 4,200 prison inmates, Dr. Wolff and her colleagues found that criminal thinking patterns of inmates with mental disorders were consistent with those of inmates without disorders; however, males with mental illness displayed higher levels of antisocial attitudes than their counterparts. Both male and female inmates with disorders scored higher on aggression and hopelessness than those without disorders. The authors note that rhetoric should give way to evidence in the development of interventions to respond to the co-occurring nature of mental disorders and criminogenic factors in this population (page 1485). Diversion from the criminal justice system of “nonviolent misdemeanants” with serious mental illness has become a mainstay of public policy. Analysis of arrest records over ten years from a large cohort of adults with serious mental illness in Massachusetts showed that 28% were arrested at least once and that 72% of the arrestees committed felony offenses. Because 13% of the cohort committed violent crimes against persons, the authors note that “significant numbers of offenders with mental illness will continue to find their way into local jails” and that multiple systems should converge to serve this population (page 1503).