RESEARCH WEEKLY: August Research Roundup
By Elizabeth Hancq
Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about severe mental illness and summarizes recently published research reports or developments.
DATAPOINT of the month
824,000 individuals with serious mental illness received inpatient psychiatric care in 2018
According to results from the National Survey of Drug Use and Health, an annual national household survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), 824,00 individuals with serious mental illness received inpatient mental health services in 2018. Almost half of those individuals (46%) were insured by Medicaid or CHIP, an increase from the previous year.
RESEARCH of the month
COVID-19 and forensic psychiatric hospitals
State hospitals are increasingly being utilized mainly for forensic patients, such as those in need of competency restoration services prior to trial or those found not guilty by reason of insanity. Forensic hospitals are a unique type of institution, having much longer lengths of stay than acute psychiatric hospitals and discharge being dependent on court or criminal justice agencies rather than clinical readiness. Therefore, mitigating the COVID-19 pandemic in these settings requires unique considerations.
In an article published this month in Psychiatric Services, Dr. Tobias Wasser and his colleagues provide an overview of specific challenges of protecting patients in forensic hospitals during the COVID-19 pandemic and innovative strategies for others to consider adopting. The authors suggest utilizing videoconferencing for family visits with patients, in addition for meetings with attorneys, conservators and advocates. Communicating and coordinating with all parties is key to address challenges, especially around addressing the external pressures to discharge patients without a careful plan in place. “In addition, providing patients with ongoing education about the public health risks and recommended mitigation strategies is crucial,” the authors write.
Services in permanent supported housing programs
Permanent supportive housing has become the central housing model to address chronic homelessness in the United States in recent years. Founded on the same principles as the Housing First approach, this model provides longer-term housing assistance in addition to support services with aims to keep people housed for longer. The Department of Housing and Urban Development created a coordinated entry system to manage the insufficient supply of housing options and prioritize housing to those most in need. Because of the dominance of these models in federal policy and funding, careful analysis of the effectiveness of these programs on improving outcomes for people with severe mental illness is crucial.
A recently published cross-sectional analysis of more than 800 residents in different types of permanent supporting housing programs was conducted to understand how these programs impacts may differ depending on individual characteristics or type of services provided. The authors found that those with a serious mental illness or serious mental illness and co-occurring substance use disorder were not more likely to be housed using the coordinated entry system. However, these individuals were more likely to be housed if placed in high-intensity service programs. The results suggest a need for additional research into how to identify not only who is best served by housing programs, but also what kinds of housing programs.
Suicide behind bars
Suicide behind bars is a significant public health problem and is the leading cause of death in jails and significant cause of preventable deaths in prison. In a recently published study in The Lancet Psychiatry, researchers conducted a systematic review and meta-analysis of published research to identify risk factors for self-harm behind bars. Including more than 30 studies in the final analysis, the researchers found that a psychotic disorder increased the risk of self-harm in prison by more than four times. Other implicated factors were previous self-harm or suicidal ideation and time spent in solitary confinement. Although this method does not allow a determination of causality, the results highlight the important need to identify at-risk people and offer comprehensive treatment to prevent suicide among inmates with severe mental illness behind bars.
