August 2004: This Month's Highlights

A 1988 survey conducted by the Center for Mental Health Services was the first to investigate the national availability of mental health services for prisoners in the state correctional system. However, the data no longer present an accurate picture of services currently available to this population. Ronald W. Manderscheid, Ph.D., and his coauthors examined trends in the availability and use of mental health services in state correctional facilities by comparing the 1988 survey results with results from the 2000 Census of State and Federal Adult Correctional Facilities conducted by the Bureau of Justice Statistics. The study's hypothesis was that the growth in the number of state adult correctional facilities and in their prisoner populations would be matched by at least a proportionate growth in the availability and use of mental health services in these institutions. However, the results of the study suggest a somewhat bleaker situation (see page 869).

Although compliance with medications is often conceptualized as an all-or-nothing phenomenon, it is more realistic to think of compliance across a continuum of "partial compliance" behaviors. Commonly, a patient will take some—but not all—of his or her prescribed medication. Peter J. Weiden, M.D., and his coauthors assessed the partial compliance behaviors of 4,325 California Medicaid patients with schizophrenia and then estimated relationships between these behaviors and the patients' risk of hospitalization. Although the overall finding of the study is not surprising—an association between poorer compliance and hospitalization—results for individual partial compliance behaviors cast light on the undeniable risks associated with seemingly minor lapses in compliance, such as a medication gap as small as one to ten days (see page 886). In a related Taking Issue piece, Samuel J. Keith, M.D., discusses why such brief lapses can have serious consequences (see page 857).

Type 2 diabetes is an important comorbid medical condition associated with schizophrenia. In a study reported in this issue of the journal, Lisa B. Dixon, M.D., M.P.H., and her coauthors compared diabetes outcomes among three groups of patients with type 2 diabetes: patients with schizophrenia, patients with a major mood disorder, and patients with no identified major mental illness. Although all three of the patient groups had glycosylated hemoglobin (HbA_1c) values above recommended levels, some of the differences between the groups were surprising. Among the authors' conclusions was that there may be previously unrecognized benefits of diabetes management among persons with severe mental illness who are receiving regular mental health care (see page 892).

Just as racial and ethnic disparities in mental health care have been highlighted as a major area of concern, so have racial and ethnic disparities in the criminal justice system been widely reported. Debra A. Pinals, M.D., and her coauthors conducted a study to examine associations between race and ethnicity and predispositions for pretrial defendants in Massachusetts who were referred for forensic mental health evaluations of their competence to stand trial, their criminal responsibility, or both. These authors developed logistic regression models to assess the relationship between defendants' race and ethnicity and the likelihood that they would be evaluated in a strict-security facility. As could be expected, the study uncovered various disparities, the basis of which will require further attention from researchers (see page 873).

• In Personal Accounts, a consumer describes his successful efforts to educate high school students about schizophrenia in light of his own experiences as a youth (see page 863).

• The Books section opens with a review of three books about how society dictates what is physically and socially desirable (see page 947).