Telehealth forensic mental health assessment clinic
Principal investigator: Jennifer Piel, MD, JD
Project period: July 2023–July 2024
Funder: Association of American Medical Colleges (AAMC)
Washington is currently experiencing unprecedented wait times for people in jails pending their forensic mental health evaluations. There is a backlog of criminal prosecutions that were suspended during the first two years of the COVID-19 public health emergency, resulting in a surge in demand for competency-related services. This is particularly true in rural and underserved areas where there are fewer community-based forensic mental health evaluators.
The study will evaluate the feasibility of an academic-state partnership to provide competence to stand trial and other forensic mental health evaluations through a university-based telehealth forensic assessment clinic. The study results will inform policy and programming to better serve people with mental health conditions involved in the criminal legal system.
Role of criminal defense attorneys in suicide prevention following defendant arrest
Principal Investigator: Jennifer Piel, MD, JD
Project Period: July 2022–December 2023
Funders: Mary. E Nelson Charitable Remainder Trust, Heidi Combs Trustee
This study will explore the role that criminal defense attorneys could play in reducing risk of suicide amongst recently arrested criminal defendants. Suicide is the leading cause of death in jails and the period after recent arrest may be a particularly vulnerable time for suicide. For many persons with recent arrest, their attorney is one of only a small number of persons that they encounter in the days following arrest. This proposal aims to better understand the experience of the criminal defense attorney in working with clients who have suicidal thinking or behavior; training they have received in the past; desired training (such as suicide risk identification, trauma-informed care, resources); and challenges in disclosures in light of their professional responsibility to preserve client confidences.
Update: Jennifer Piel, MD, JD, and Joellyn Sheehy, MD, contributed an entry, Criminal defense attorneys and suicide prevention (pages 8–9), to the Winter 2023 edition of the International Association of Forensic Mental Health Services Newsletter.
Deliberate indifference to suicide in corrections facilities
Principal investigators: Carol Barnes, MD and Jennifer Piel, MD, JD
Project period: January 2022–March 2023
Funder: Unfunded
Suicide is a leading cause of death in corrections facilities. In corrections facilities, legal actions against mental health professionals after a patient suicide may arise under a theory of deliberate indifference to the detainee’s risk of suicide in violation of the Eighth Amendment’s ban against cruel and unusual punishment. This is a different than standard medical malpractice, which alleges that the clinician failed below the standard of care in assessment or management of the patient’s suicide risk and that failure caused the alleged harm.
For this study, Drs. Carol Barnes and Jennifer Piel reviewed legal cases related to deliberate indifference to suicide in corrections facilities. Understanding the law of deliberate indifference is informative for suicide screening, assessment, risk management planning, and institutional policies in corrections facilities, and may shape practice to reduce the incidence of suicide.
Read “Understanding deliberate indifference to suicide in corrections facilities: A review of recent legal cases” in The Journal of Forensic Sciences.
Forensic training for general psychiatry residents
Principal investigators: Katherine Michaelsen, MD, MASc and Tobias Wasser, MD
Project period: October 2021–October 2023
Funder: AAPL Institute for Education and Research
Dr. Katherine Michaelsen, CMHPL core faculty member, together with Dr. Tobias Wasser at Yale University, is working with members of the Residency Training in Forensic Committee in the American Academy of Psychiatry and the Law (AAPL) to develop peer-reviewed online training modules on core forensic topics for general psychiatry residents. The new modules will address civil competence and informed consent, civil commitment and the right to refuse treatment, and suicide risk assessment.
The modules will be hosted on the AAPL website, though the previously-created modules, Confidentiality and Duties to Third Parties, are currently available on the Yale website. These modules are also included as part of a model curriculum through the American Association of Directors of Psychiatric Residency Training.
Workforce innovation and leadership in forensic mental health
Principal investigator: Jennifer Piel, MD, JD
Project period: July 2022–July 2023
Funder: Sozosei Foundation
The Center for Mental Health, Policy, and the Law, through an operations grant, is developing programming in Workforce Innovation and Leadership in Forensic Mental Health to address the forensic mental health workforce shortage.
The CMHPL anticipates the programming will have a direct impact on recruitment and retention of mental health professionals who work in forensic settings, as well as other public sector and psychiatric leadership roles. Through development of high-quality training, mentorship, consultation, and leadership development programming, the CMHPL is growing the number of clinicians with knowledge and aptitude to work with persons involved in the criminal justice system. In turn, this will engender high-quality patient services to improve access and care delivery to persons involved with the justice system and reduce the risk of prolonged or repeated cycles through the system.