The journal of the American Academy of Psychiatry and the Law
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J. Am. Acad. Psychiatry Law · Jan 2011
Assessing the risk of violent behavior before issuing a license to carry a handgun.
Handguns are intended to be used for protection, but they can also be used as weapons of assault that may endanger others or inflict self-harm and facilitate suicide. Research has revealed a direct correlation between firearm availability and suicide risk. ⋯ How can we ensure that firearms will not reach the hands of individuals who may pose a danger to themselves or to others, without infringing on the rights of other citizens to carry guns for protection, which is in the public interest? The potential to commit a crime will materialize, depending on dynamic interactions among personality factors, environmental factors, and the individual's history of offending. We present illustrative cases involving various aspects of gun control and a description of instruments for the assessment of dangerousness that can facilitate the licensing process for carrying and using firearms.
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J. Am. Acad. Psychiatry Law · Jan 2006
Competency for creation, use, and revocation of psychiatric advance directives.
Psychiatric advance directives help promote patient involvement in treatment and expedite psychiatric care. However, clinicians are unsure of how to use directives, partly due to poor clarity regarding standards for capacity to create, use, and revoke them. This article recommends possible capacity standards. ⋯ In many states, revocation of a psychiatric advance directive requires adequate decision-making capacity. Setting a capacity standard for revocation presents challenges, however, in light of obstacles to providing treatment when revocation is attempted and the fact that many patients prefer revocable directives. As more directives are created and used, additional research and statutory refinements are warranted.
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J. Am. Acad. Psychiatry Law · Jan 2008
National Instant Criminal Background Check Improvement Act: implications for persons with mental illness.
The National Instant Criminal Background Check Improvement Act has serious implications for persons with mental illness with regard to the ability to purchase firearms. Federally prohibited persons include those who have been adjudicated as mentally defective, or have been committed to a mental institution, or are unlawful users of or are addicted to a controlled substance. ⋯ As of April 2007, only 22 states were voluntarily submitting records from mental health databases to the NICS. The legislation was introduced following the Virginia Tech tragedy, when public opinion favored tightening control over access to firearms of persons with mental illness.
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J. Am. Acad. Psychiatry Law · Jan 2005
The use of the insanity defense as a jail diversion mechanism for mentally ill persons charged with misdemeanors.
Heightened awareness and concern regarding the large number of mentally ill misdemeanants in jails has led to a search for alternatives to jail and to the development nationwide of jail diversion programs for offenders with mental illness. Two such mechanisms-diversion to civil commitment and the use of mental health courts-are briefly reviewed. ⋯ Statistics regarding such use from 1978 to 2001 are provided. The authors compare and contrast this jail alternative with both mental health courts and diversion to civil commitment, and discuss questions related to the feasibility of larger-scale use of this mechanism.
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Although the epidemiology of mental disorders in the prison system has been investigated in the past, delivery of health services to prison inmates has not received similar scrutiny. Members of a state prison commission describe the process by which they developed their assessment of health care delivery. A model is offered for defining such a mission, selecting standards against which to test prison health services, choosing a testable focus, refining a valid and reliable methodology, and piloting the result.