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Appendix A: Workshop-Related Discussion Papers
Pages 75-128

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From page 75...
... Blair 77 A.2 Violence and Mental Health: Opportunities for Prevention and Early Intervention, A Workshop of the National Academies of Sciences, Engineering, and Medicine's Forum on Global Violence Prevention, February 26, 2014, Daniel Fisher 84 A.3 Interface with the Justice Community: The Police, Sheldon Greenberg 90 A.4 Mental Health in Latin America and the Caribbean, Dévora Kestel 98 A.5 Heavy Episodic Alcohol Use and Intimate Partner Violence: A Cross-Cultural Public Health Issue, Cory A Crane and Kenneth E
From page 76...
... 76 VIOLENCE AND MENTAL HEALTH FIGURES AND TABLES Figures A-1 Mental health expenditures, 101 A-2 The impact of being bullied on functioning in adulthood, 121 A-3 Adjusted mean young adult CRP levels (mg/L) based on childhood/ adolescent bullying status, 123 Tables A-1 Mental Health Professionals in LAC, 102 A-2 Number of Users Attending Mental Health Facilities, 103
From page 77...
... . Reactive aggression is unplanned and can be characterized as impulsive.
From page 78...
... In contrast, individuals with the personality disorder psychopathy, who show reduced guilt and empathy, show an increased risk for instrumental aggression coupled with an increased risk for reactive aggression (Frick et al., 2005)
From page 79...
... . In short, it can be argued that these stressors increase the risk for reactive aggression because they increase the responsiveness of systems mediating the acute threat response.
From page 80...
... . The presence of psychopathic traits, particularly reduced guilt and empathy, are associated with an increased risk for instrumental aggression (Cornell et al., 1996)
From page 81...
... the acute threat response implicating the amygdala, hypothalamus, and p ­ eriaqueductal gray; (2) empathic responding (instrumental)
From page 82...
... . Reduced amygdala response to fearful expressions in children and adolescents with callous-unemotional traits and disruptive behavior disorders.
From page 83...
... . Reduced amygdala responding in youth with disruptive behavior disorder and psychopathic traits reflects a reduced emotional response not increased top-down attention to non-emotional features.
From page 84...
... Thomas Insel of NIMH stated that NIMH will not use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] because its diagnostic categories are not based on biological markers.)
From page 85...
... . This evidence fits closely with the findings of the MacArthur Violence Risk Assessment Study, considered one of the most definitive published studies of mental health issues and violence.
From page 86...
... 2. Persons with a substance abuse disorder carry a substantial risk of increased violence.
From page 87...
... This is a preventative public health program, enabling anyone to help another person through an emotional crisis. eCPR, therefore, represents the type of primary prevention that would reach a much greater proportion of persons than present programs that focus on persons labeled with mental health disorders (see www.­ motional e cpr.org)
From page 88...
... He said that the problem of gun violence is not guns but people with mental illness, whom he described as "deranged mongrels." The NRA called for ensuring that persons labeled with mental illness be placed on the National Instant Criminal Background Check System (NICS)
From page 89...
... 2012. Mental disorder and violence: Is there a relationship beyond substance abuse?
From page 90...
... For decades, mental health professionals, advocacy organizations, family members, political leaders, and others have sought to have the criminal justice system or criminal justice community (generally perceived as consisting of the police, courts, and corrections) end the unnecessary "criminalization" of mental illness.
From page 91...
... that began in the mid-1950s and increased continually through the 1980s, criminal justice agencies have altered policies, procedures, training, and relationships with mental health providers and advocates to overcome difficulties stemming from critical and routine interaction with people who have severe mental illness ( ­Lurigio and Swartz, 2000)
From page 92...
... Research shows consistently that police officers do not want to criminalize events involving people with mental illness unless significant violation of the law has occurred (assault, theft, arson, weapons violation) and cannot be ignored or handled less formally.
From page 93...
... in the late 1980s, which brought together well-trained police officers and mental health professionals to respond immediately to calls for service involving people who have mental illness. Although recognized primarily for intervention in serious or critical situations, CITs responded to any call (crisis and non-critical)
From page 94...
... As such, the initial information a police officer receives may make no reference to mental illness or contain any details about risk, existing injury or illness, medication use, illicit substance abuse, presence of weapons, or precise location. Officers need, but often lack, information on the individual's medical or criminal history, cause of the crisis or hostility, prior suicide or self-injury attempts, and attending physicians, among other information (James, 1990)
From page 95...
... Yet, little is known about the nature and quality of the initial face-to-face interaction of police officers called into situations involving people who have mental illness. Conclusions and assumptions about the early one-on-one interaction that occur are drawn from police incident report narratives, interviews, anecdotal information, and, to a lesser degree, statistical reports, policies and procedures, and training curricula.
From page 96...
... Due to space limitation, the following recommendations are noted in brief: • Improved methods for conveying research to frontline practitioners • Research on point-of-contact communication and other character istics of initial interaction that influence outcomes • Orientation/training for mental health professionals on public safety and, particularly, the police (culture, fragmentation, train ing, policy, safety mandates, discretion, liability) • Research on the curricula being used to teach the police, with atten tion to awareness, interaction, use of community-based resources, and law • Model curricula for police, designed to accommodate the various time limitations imposed by police academy schedules • Model curricula for police on how to manage concurrent issues (mental illness, mobility or communication disability, criminal be havior, homelessness, substance abuse, injury)
From page 97...
... knowledge and skills into the daily work of police officers: A focus group study. Community Mental Health Journal, 44(6)
From page 98...
... . Greek police officers' attitudes towards the mentally ill.
From page 99...
... A treatment gap represents the percentage of people with severe mental disorders that do not receive treatment (3)
From page 100...
... Specifically, in the English-speaking Caribbean countries, the mental health budget is 3.5 percent of the health budget, and 84 percent of that budget goes to mental hospitals. In Central America, the mental health budget is even lower, at 1.5 percent of the health budget, with 75 percent of it spent in mental hospitals.
From page 101...
... Reprinted with the permission of the Pan American Health Organization.
From page 102...
... . TABLE A-1  Mental Health Professionals in LAC Social Occupational Subregion Psychiatrists Nurses Psychologists Workers Therapists Others Central 1.5 2.3 2 0.7 0.2 2.3 America, Mexico and Latin Caribbean Non-Latin 1.9 14.3*
From page 103...
... (7) The rest of the patients are seen by ambulatory services, in general hospitals, or in any other service available at the community level, developed with only 12 percent of the budget available for mental health (as mentioned above, 88 percent of the budget dedicated to mental health goes to traditional mental hospitals)
From page 104...
... In parallel, several countries in the region are at different stages of serious reforms to their mental health systems, in some cases at the national level, and in others at the regional or even local level. In October 2013, the World Health Assembly approved a Comprehensive Mental Health Plan of Action that emphasized the need to move ahead in this path that was initiated several years or decades ago (8)
From page 105...
... Countries in the region will be ready to answer to these situations when an appropriate range of mental health services, from promotion and prevention to rehabilitation and recovery, based in the community will be available and when mental health will fully be integrated with general health services. When discussing violence and mental health, mental health professionals should be aware that most LACs' mental health systems create and direct violence toward individuals with mental disorders and their families.
From page 106...
... Research Institute on Addictions University at Buffalo Intimate partner violence (IPV) involves the perpetration of physically aggressive acts against a spouse or dating partner and has been identified as a serious social concern with considerable health and financial costs at the individual, family, and societal levels (Lawrence et al., 2012)
From page 107...
... and provided further empirical impetus to extend this work into the field of partner violence, resulting in multiple meta-analytic investigations examining the relationship between indices of heavy alcohol use and IPV within cross-sectional and case control studies, inclusive of considerable diversity in sample characteristics. These reviews find high heterogeneity across studies and significant overall effect sizes in the small to medium range.
From page 108...
... There have been fewer longitudinal investigations addressing the asso­ ciation between heavy alcohol use and IPV. However, the available evidence suggests that heavy alcohol use is longitudinally predictive of IPV perpetration over short follow-up periods, but the evidence is less supportive over long follow-up periods.
From page 109...
... than nonfatal partner violence perpetrators (30.9 percent) and that the majority of intimate partner homicides (59.5 percent)
From page 110...
... and general (for a review, see Exum, 2006) aggression literatures are replete with examples of experimental evidence supporting the effects of heavy alcohol consumption on aggressive and violent responding, such as setting more frequent or intense shocks for an opponent after having received alcohol in a competitive reaction time task (Bushman, 1997)
From page 111...
... seem to be at high risk of IPV perpetration following heavy alcohol consumption. Similarly, longitudinal data suggest that alcohol problems are associated with increased IPV perpetration the following year only among husbands high in both hostility and avoidance coping strategies (Schumacher et al., 2008)
From page 112...
... . Heavy alcohol use may also impact the poor outcomes of IPV treatment inasmuch as IPV perpetrators with alcohol problems attend fewer sessions and drop out of treatment at a greater rate than perpetrators without drinking problems (for a review, see Daly and Pelowski, 2000; Olver et al., 2011)
From page 113...
... Problematic alcohol use is associated with IPV treatment dropout, and successful substance abuse treatment reduces the risk of future IPV perpetration beyond violence interventions alone. Even still, integrated programs for clients with special treatment needs are routinely met with resistance and remain more the exception than the norm.
From page 114...
... . What factors are associated with recent intimate partner violence?
From page 115...
... . The occurrence of male-to-female intimate partner violence on days of men's drinking: The moderating effects of antisocial personality disorder.
From page 116...
... . Incidence and prevalence of intimate partner violence by and against women with severe mental illness.
From page 117...
... . Alcohol consumption and intimate partner violence by alcoholic men: Comparing violent and nonviolent conflicts.
From page 118...
... . Prevalence and consequences of male-to-female and female-to-male intimate partner violence as measured by the National Violence Against Women Survey.
From page 119...
... Evidence is provided that bullying by peers either at school or at home by siblings has been mostly ignored by health pro­ fessionals but should be considered as a significant risk factor and safeguarding issue. Policy suggestions are made to more effectively recognize ­ and manage affected children.
From page 120...
... However, recent longitudinal studies into adolescence,24,25,26 early adulthood8,9,27,28 and even into late adulthood29 indicate that being the victim of bullying is associated with often severe mental health problems, including anxiety disorders, depression, self-harm and suicide, personality disorder,30 and psychotic symptoms that are long lasting and persist up to 40 years later! The use of genetically sensitive designs where mono-zygotic twins (genetically identical living in the same households)
From page 121...
... . The carefully controlled longitudinal studies paint a converging picture of the long-term effects of being bullied in childhood.
From page 122...
... or the epigenome.39 Altered HPA-axis activity and altered cortisol responses may not only increase the risk for developing mental health problems40 but also increase susceptibility to illness by interfering with immune responses.41 A recent study found that bullied children may experience higher than normal chronic inflammation and associated health problems that can persist into adulthood.42 Blood tests for C-reactive protein (CRP) , a marker of low-grade systemic inflammation in the body often associated with cardiovascular disease, metabolic syndrome, and psychological disorders, revealed that CRP levels in the blood of bullied children increased with the number of times they were bullied.
From page 123...
... SOURCE: Reprinted with permission from Copeland et al., 2014. with poor concurrent academic achievement.48 In the UK alone, more than 16,000 young people aged 11–15 are estimated to be absent from state school with bullying as the main reason, and 78,000 are absent where bullying is one of the reasons given for absence.49 The risk of failure to complete high school or college in chronic victims or bully/victims increases the risk of poorer income and job performance.32 Summary and Implications Childhood bullying has serious effects on health, leading to substantial costs for individuals, their families and society at large.
From page 124...
... and reduce mental health problems, it is imperative to address bullying! Key Messages • Childhood bullying is a significant risk factor leading to harmful physical, psychological, and social effects that can last a lifetime.
From page 125...
... Socioeconomic Status and Bullying: A Meta-Analysis. American Journal of Public Health.
From page 126...
... Adult Health outcomes of childhood bullying victimization: Evidence from a five-decade longitudinal british birth cohort. American Journal of Psychiatry.
From page 127...
... 2014. Intervening in primary care against childhood bullying: An increasingly pressing public health need.


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