Social exclusion in clients with comorbid mental health and substance misuse problems

Todd, Jennie; Green, Gill; Harrison, Michele; Ikuesan, B. A.; Self, C.; Pevalin, David J.; Baldacchino, Alex

doi:10.1007/s00127-004-0790-0

Cited by 50 publications

(43 citation statements)

References 6 publications

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“…Speciality outpatient programs and community mental health services look to models of community mental health intended to support this population, for example, outpatient commitment, 64 jail diversion, 65 forensic case management or ACT teams, 66,67 and other models of practice that build bridges across mental health, substance abuse, and the criminal justice system, including housing supports. 6 8 From a life course perspective, this subpopulation has a high probability of cycling in and out of the substance abuse, mental health, and criminal justice systems. 69 Therefore, attention to justice-related issues across the mental health system would seem to be an essential element in addressing this trajectory for people with co-occurring disorders and reducing associated costs.…”

Section: -14mentioning

confidence: 99%

“…1 Although casual mechanisms are far from clear, negative outcomes such as relapse and rehospitalization are associated primarily with impaired adaptive functioning, higher psychiatric severity, poorer medication compliance, unstable housing, and diminished social capital, such as relationships and employment required for good quality of life. [2][3][4][5][6] Most, but not all studies, show an association between substance use disorders and suicide among clients of mental health services. 2,7 Behavioural challenges, such as aggressiveness, anger management, disruptive behaviour, impulsivity, and problems with affective regulation, are clearly the norm rather than exception, as is criminal justice system involvement.…”

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confidence: 99%

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Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Rush

Koegl

2008

Can J Psychiatry

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Objective: To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.Method: Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.Results: Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm. Conclusion:The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems. Can J Psychiatry 2008;53(12):810-821Clinical Implications · Clinicians can use sociodemographic characteristics, such as male sex, younger age, and being unemployed, and clinical indicators, such as overall mental health severity and behavioural challenges, to help identify and support people with substance use disorders. · Treatment and support models for co-occurring mental and substance use disorders must include risk management strategies, given the higher prevalence of challenging behaviours within this population. · There is a need for system-wide planning regarding co-occurring mental and substance use disorders. Limitations· Although findings were based on a comprehensive mental health system, the results may not be applicable to every jurisdiction. · Study findings should not necessarily be generalized to acute care, consumer, or peer support programs because they were not included in our study. · Clinical diagnostic interviews were not feasible to validate study criteria for defining co-occurring disorders.

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confidence: 99%

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confidence: 99%

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Rush

Koegl

2008

Can J Psychiatry

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“…As Anderson (1997) explains, the symbiotic relationship between mental illness and criminal behavior is complex. Comorbidity of mental illness with other behaviors is well documented across the literature and include substance abuse (Todd et al, 2004) and violent and criminal convictions (Anderson, 1997).…”

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confidence: 99%

A false dichotomy? Mental illness and lone-actor terrorism.

Corner¹,

Gill²

2015

Law and Human Behavior

239

183

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We test whether significant differences in mental illness exist in a matched sample of lone-and group-based terrorists. We then test whether there are distinct behavioral differences between lone-actor terrorists with and without mental illness. We then stratify our sample across a range of diagnoses and again test whether significant differences exist. We conduct a series of bivariate, multivariate, and multinomial statistical tests using a unique dataset of 119 lone-actor terrorists and a matched sample of group-based terrorists. The odds of a lone-actor terrorist having a mental illness is 13.49 times higher than the odds of a group actor having a mental illness. Lone actors who were mentally ill were 18.07 times more likely to have a spouse or partner who was involved in a wider movement than those without a history of mental illness. Those with a mental illness were more likely to have a proximate upcoming life change, more likely to have been a recent victim of prejudice, and experienced proximate and chronic stress. The results identify behaviors and traits that security agencies can utilize to monitor and prevent lone-actor terrorism events. The correlated behaviors provide an image of how risk can crystalize within the individual offender and that our understanding of lone-actor terrorism should be multivariate in nature.

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“…Mixed method approaches might be used to enrich or populate data in order to find a way to triangulate findings or to conduct a pilot study in order to inform a largescale quantitatively orientated project (Todd et al, 2004). Several developments in approaches to research have arisen from the application of mixed method approaches.…”

Section: Towards a Pluralistic Paradigm In Qualitative Researches mentioning

confidence: 99%

Pluralism as Multi-Method Scholarship in Qualitative Social Science Research: A Panacea for Methodological Tribalism

Musthafa¹

2014

IOSR-JRME

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Social exclusion in clients with comorbid mental health and substance misuse problems

Abstract: Recent Government policy advocates treating comorbid clients within mainstream mental health services. Health care workers need to recognise the likelihood of high levels of social exclusion among clients with comorbid problems.

Cited by 50 publications

References 6 publications

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

A false dichotomy? Mental illness and lone-actor terrorism.

Pluralism as Multi-Method Scholarship in Qualitative Social Science Research: A Panacea for Methodological Tribalism

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