Psychiatric services (Washington, D.C.)最新文献

{"title":"Fifty Years On: The Enduring Relevance of General Systems Theory to Community Psychiatry.","authors":"Benjamin Druss","doi":"10.1176/appi.ps.20250346","DOIUrl":"https://doi.org/10.1176/appi.ps.20250346","url":null,"abstract":"<p><p>An important but largely forgotten influence on the early development of community psychiatry is general systems theory, a framework that seeks to replace reductionistic, mechanistic models in science with a theory that better reflects the holistic and dynamic nature of open living systems. In his keynote address at the 1975 Institute on Hospital and Community Psychiatry, Judd Marmor, M.D., described the nexus between general systems theory and community psychiatry. To commemorate the 50th anniversary of that address, the author provides a brief historical overview of general systems theory and how it influenced the development of community psychiatry. The theory holds particular relevance in an era when the ecology of the public mental health system, which was already strained, is facing widespread threats from cuts to federal health insurance and social safety-net programs.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20250346"},"PeriodicalIF":3.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting Youth Mental Health Through Equity-Centered Trauma-Informed Educational Initiatives in Schools.","authors":"Ruth S Shim, Alex Shevrin Venet","doi":"10.1176/appi.ps.20250126","DOIUrl":"https://doi.org/10.1176/appi.ps.20250126","url":null,"abstract":"<p><p>The youth mental health crisis is reaching epidemic proportions, stemming from both single and complex traumatic experiences. Because children and adolescents spend a considerable amount of time in schools, educational settings present both opportunities for and threats to youth mental health. This article outlines how the principles of equity-centered trauma-informed education can be applied in educational environments to enhance the mental health of students. The authors discuss policy recommendations aimed at prioritizing predictability, flexibility, empowerment, connection, and unconditional positive regard. Effectively implementing these policies can help protect young people from structural sources of trauma in the educational system and ensure that schools do not become additional sources of trauma for youths in the United States.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20250126"},"PeriodicalIF":3.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the Unmeasured: U.S. Civil Commitment Rates.","authors":"Samuel Dotson, Robert O Cotes, Joseph Stoklosa","doi":"10.1176/appi.ps.20250431","DOIUrl":"https://doi.org/10.1176/appi.ps.20250431","url":null,"abstract":"","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":"76 10","pages":"860"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Apps and Crisis Support: Exploring the Impact of 988.","authors":"Bridget Dwyer, Jane Mikkelson, James Burns, Valeria Diaz-Pacheco, John Torous","doi":"10.1176/appi.ps.20240485","DOIUrl":"10.1176/appi.ps.20240485","url":null,"abstract":"<p><strong>Objective: </strong>Mental health apps continue to grow in popularity. However, although these apps offer many benefits, they are not equipped to manage mental health crises alone, and they often refer users to external resources. In 2022, the 988 Suicide and Crisis Lifeline was officially recognized as the U.S. national standard suicide hotline. This naturalistic experimental study aimed to assess the crisis resources offered within these apps as well as their responsiveness to implementation of national guidelines.</p><p><strong>Methods: </strong>The authors conducted a thorough search of the mental health app marketplace in January 2024 and collected a representative sample of mental health apps (N=302) available to download. A team of raters assessed each app with a modified version of the American Psychiatric Association's app evaluation model and specifically examined the presence and functionality of crisis resources.</p><p><strong>Results: </strong>Findings indicated that 15% of the apps referred users to 988, and 24% offered an alternative hotline. Of note, 14 apps that had collectively been downloaded >3.5 million times provided incorrect or nonfunctional alternative crisis hotlines.</p><p><strong>Conclusions: </strong>To avoid the harmful effects of a nonfunctional hotline, within-app crisis resources require thorough screening and regular developer updates.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"867-871"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Virtual Versus Physical Psychiatric Admissions: A Retrospective Cohort Study.","authors":"Cathal McCaffrey, Ana Jelovac, Aoife Gordon, Basil Matti, Sarah Thompson, Declan M McLoughlin","doi":"10.1176/appi.ps.20250120","DOIUrl":"10.1176/appi.ps.20250120","url":null,"abstract":"<p><strong>Objective: </strong>Telepsychiatry is an effective alternative to in-person care in many settings. However, evidence is lacking on clinical outcomes when telepsychiatry is used to deliver virtual inpatient psychiatric care. This study compared clinical outcomes of patients virtually admitted with outcomes of those physically admitted to a psychiatric hospital in Ireland during the COVID-19 pandemic. Factors associated with transfer from virtual to physical admission were also investigated.</p><p><strong>Methods: </strong>Data for this retrospective cohort study (N=1,579 patients) were extracted from electronic health records. Admissions were coded as physical or virtual. Outcome measures were treatment response, length of stay, and time to readmission or death within 6 months of discharge. Inverse probability of treatment weighting was used to control for confounding. Outcomes were analyzed by using logistic and Cox regressions.</p><p><strong>Results: </strong>In 2021, a total of 214 patients were virtually admitted and 1,365 were physically admitted. The virtual admission group had significantly lower odds of treatment response (OR=0.58, 95% CI=0.41-0.81), longer lengths of stay (hazard ratio [HR]=0.83, 95% CI=0.71-0.97), and faster times to readmission or death (HR=2.11, 95% CI=1.52-2.93). Lower socioeconomic status, personality disorder or personality difficulties, history of suicide attempt or deliberate self-harm, and lack of insight into need for treatment were associated with a greater likelihood of transfer from virtual to physical admission.</p><p><strong>Conclusions: </strong>Patients virtually admitted during the COVID-19 pandemic had worse outcomes than patients who were physically admitted. Postpandemic research should further evaluate the effectiveness of virtual psychiatric wards and identify patient characteristics associated with outcomes of such novel services.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"891-897"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Self-Induced Symptoms\" and the Insanity Defense.","authors":"Paul S Appelbaum","doi":"10.1176/appi.ps.20250438","DOIUrl":"10.1176/appi.ps.20250438","url":null,"abstract":"<p><p>The insanity defense is intended to negate the culpability of defendants who cannot fairly be held responsible for behavior that was due to their mental illness. Does the calculus change when the defendant may have self-induced an impaired mental state by failing to take prescribed medication? That question was considered by the Georgia courts in the case of a woman with bipolar disorder whose reckless driving led to the death of a 5-year-old child. One of the few states to have addressed this issue, Georgia looked to the terms of its insanity defense statutes to come up with an answer.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"930-932"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Encounters and Expenditures Among Children With Diagnosed Tic Disorders and Co-Occurring Disorders, 2022.","authors":"Valentine Wanga, Melissa L Danielson, Kai Hong, Helena J Hutchins, Carol A Mathews, Jonathan W Mink, Maria Gonzalez, Scott D Grosse, Rebecca H Bitsko","doi":"10.1176/appi.ps.20240615","DOIUrl":"10.1176/appi.ps.20240615","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to use claims data to calculate incremental 2022 health care expenditure estimates for children with tic disorders relative to children without tic disorders.</p><p><strong>Methods: </strong>Children ages 6-17 years with tic disorders were identified in the Merative MarketScan Multi-State Medicaid (N=6,277) and MarketScan Commercial (employer-sponsored insurance [ESI]; N=6,955) databases via inpatient and outpatient claims and were compared with children without tic disorders, matched at a 1:8 ratio on age, sex, and coverage type. Presence of 12 types of co-occurring disorders was identified. Analyses were stratified by insurance type. Individual-level total expenditures and total inpatient, total outpatient, outpatient psychological services, and filled prescription medication expenditures were calculated and compared by tic disorder status. Two-part regression models for Medicaid and generalized linear regression models for ESI were fit to estimate the difference in expenditures for children with versus without tic disorders, with sex, age, and presence of individual co-occurring disorders as covariates.</p><p><strong>Results: </strong>In 2022, mean per-person expenditures for children with tic disorders were $4,549 in the Medicaid sample and $9,870 in the ESI sample-more than twice as high as totals for children without tic disorders. The adjusted mean difference in expenditures between children with and children without tic disorders was -$15 (nonsignificant) in the Medicaid sample and $1,641 in the ESI sample (p<0.001).</p><p><strong>Conclusions: </strong>This study documents substantial health care utilization and expenditures for children with tic disorders, although higher mean expenditures relative to children without tic disorders largely reflect differences in the prevalence of co-occurring disorders.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"881-890"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simulation-Based Approach to Understanding Social Determinants of Mental Health and Criminal Legal Involvement.","authors":"Lauren E Kois, Cassidy White, Haylie Stewart, Stacy Moak, Jeremy Scherer","doi":"10.1176/appi.ps.20240383","DOIUrl":"https://doi.org/10.1176/appi.ps.20240383","url":null,"abstract":"<p><p>Social determinants of mental health and criminal legal involvement have substantial overlap and bidirectional influence. However, these elements are not yet fundamental components of mental health practitioner training, and practitioners are prone to stigmatize individuals with criminal legal histories. This case study describes a reentry simulation as a possible practitioner training tool. Participants indicated that the simulation was an effective training experience that increased their understanding of social determinants and empathy for individuals affected by the criminal legal system. Experiential learning activities such as simulations appear to be a promising but underutilized training tool that could be leveraged to promote more equitable mental health services.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":"76 10","pages":"933-936"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involuntary Inpatient Civil Commitment: Trends From 2010 to 2022.","authors":"Mustafa Karakus, Victoria Nelson, Emma Scott, Sushmita Shoma Ghose, Tina Marshall, John Cosgrove, N Phil Masiakowski, David Cohen","doi":"10.1176/appi.ps.20250024","DOIUrl":"10.1176/appi.ps.20250024","url":null,"abstract":"<p><strong>Objective: </strong>Involuntary inpatient civil commitment occurs across all U.S. states and territories. However, individual state laws define states' procedures for implementing civil commitment, including data collection requirements and the entities responsible for collecting and managing these data. This study aimed to build on previous efforts by collecting and analyzing the available state-level data to capture trends in civil commitment over time.</p><p><strong>Methods: </strong>Through systematic website searches and direct outreach to state mental health authorities and court systems, data on civil commitment (2010-2022) were obtained for 32 states and the District of Columbia.</p><p><strong>Results: </strong>From 2010 to 2022, the rates of civil commitment were found to have significantly increased in nine states and the District of Columbia and to have remained relatively stable in 23 states; no states showed significant decreases in civil commitment rates. The rates reported by state mental health authorities were significantly higher than those found through state court system data.</p><p><strong>Conclusions: </strong>To the authors' knowledge, the data set compiled represents the most current and comprehensive resource on involuntary inpatient civil commitment in the United States. However, the lack of standardized processes, definitions, and data across states hinders the ability to examine the contributing and explanatory factors that may guide policy decisions.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"861-866"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Federal Demonstration Project of Money Management Services for Veterans at Risk of Homelessness.","authors":"Jack Tsai, Taiki Matsuura, Annie Harper, Robert Rosenheck","doi":"10.1176/appi.ps.20250016","DOIUrl":"10.1176/appi.ps.20250016","url":null,"abstract":"<p><p>With funding provided by the American Rescue Plan Act and support from the U.S. Department of Veterans Affairs (VA), in 2023 more than $2.1 million was distributed to 13 community grantees to create or expand money management (MM) services for homeless veterans and those at risk of homelessness. Technical assistance was provided, and data about MM services and participating veterans were collected across the 13 sites. Sites reported a mean±SD increase of 2.08 ± 1.50 in the types of MM services provided and that the most common new MM service offered was related to financial technology. MM services related to advance directives and financial monitoring were not implemented by any sites. A total of 348 veterans enrolled in MM services, and those who were followed over time reported benefits in financial well-being and mental health. The findings from this demonstration project indicate that with funding support, community organizations can expand the diversity and technology of the MM services they provide.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"921-925"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}