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Psychiatric and Mental Health

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2012

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Articles 1 - 29 of 29

Full-Text Articles in Medicine and Health Sciences

Research Brief: "Impact Of The Seeking Safety Program On Clinical Outcomes Among Homeless Female Veterans With Psychiatric Disorders", Institute For Veterans And Military Families At Syracuse University Oct 2012

Research Brief: "Impact Of The Seeking Safety Program On Clinical Outcomes Among Homeless Female Veterans With Psychiatric Disorders", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief is about the effect of the Seeking Safety program's services on improvement in PTSD, psychiatric symptoms, and social support among homeless female veterans. In policy and practice, clinicians should be trained on how to use the program to better serve homeless female veterans, and policymakers should push for clinician training for those who work with homeless veterans. Suggestions for future research include applying this study and the Seeking Safety program to non-VA healthcare systems, assessing substance use within the program, and assessing the long-term effects of the Seeking Safety program.


Family Aided Community Treatment As An Intervention For The Treatment Of Early Psychosis: A Proof Of Concept Study, Ryan P. Melton Oct 2012

Family Aided Community Treatment As An Intervention For The Treatment Of Early Psychosis: A Proof Of Concept Study, Ryan P. Melton

Regional Research Institute for Human Services

Major psychotic disorders are one of the leading causes of disability worldwide, having severe impacts on the people who suffer from the conditions, their families and society. There is evidence that if these conditions are identified and treated early, the prognosis is improved. The purpose of this study is to produce findings related to the use of year long trial of family aided community treatment (FACT) with individuals who are experiencing a first episode psychosis as defined by the SIPS. Using a proof of concept design with multiple repeated measure t tests, this study focused on first-episode psychotic disorder participants …


Art As A Cure: Analyzing Healthcare Treatment For The Mentally Ill Through The Lens Of Art Therapy Programs In Dakar, Senegal, Sofia Porter-Castro Oct 2012

Art As A Cure: Analyzing Healthcare Treatment For The Mentally Ill Through The Lens Of Art Therapy Programs In Dakar, Senegal, Sofia Porter-Castro

Independent Study Project (ISP) Collection

Mental illness is a malady that affects roughly 2.3 million people in Senegal ("Statistics by Country” 2012), but the wide and sometimes opposing range of healing practices suggests that the attitudes surrounding mental illness are still largely contested. This is especially true in Senegal’s capital, where advances in medicine in big city hospitals are growing while ties to traditional beliefs and practices remain strong. Alternative therapies, such as art therapy, provide an opportunity for practitioners to explore different techniques for treating the mentally ill while still integrating elements of the local culture. It is precisely this integration that this paper …


Impact Of Sunlight On The Age Of Onset Of Bipolar Disorder, Michael Bauer, Tasha Glenn, Martin Alda, Ole A. Andreassen, Raffaella Ardau, Frank Bellivier, Michael Berk, Thomas D. Bjella, Letizia Bossini, Maria Del Zompo, Seetal Dodd, Andrea Fagiolini, Mark A. Frye, Ana Gonzalez-Pinto, Chantal Henry, Flávio Kapczinkski, Sebastian Kliwicki, Barbara König, Mauricio Kunz, Beny Lafer, Carlos Lopez-Jaramillo, Mirko Manchia, Wendy Marsh, Monica Martinez-Cengotitabengoa, Ingrid Melle, Gunnar Morken, Rodrigo Munoz, Fabiano G. Nery, Claire O'Donovan, Andrea Pfennig, Danilo Quiroz, Natalie Rasgon, Andreas Reif, Janusz Rybakowski, Kemal Sagduyu, Christian Simhandi, Carla Torrent, Eduard Vieta, Mark Zetin, Peter C. Whybrow Sep 2012

Impact Of Sunlight On The Age Of Onset Of Bipolar Disorder, Michael Bauer, Tasha Glenn, Martin Alda, Ole A. Andreassen, Raffaella Ardau, Frank Bellivier, Michael Berk, Thomas D. Bjella, Letizia Bossini, Maria Del Zompo, Seetal Dodd, Andrea Fagiolini, Mark A. Frye, Ana Gonzalez-Pinto, Chantal Henry, Flávio Kapczinkski, Sebastian Kliwicki, Barbara König, Mauricio Kunz, Beny Lafer, Carlos Lopez-Jaramillo, Mirko Manchia, Wendy Marsh, Monica Martinez-Cengotitabengoa, Ingrid Melle, Gunnar Morken, Rodrigo Munoz, Fabiano G. Nery, Claire O'Donovan, Andrea Pfennig, Danilo Quiroz, Natalie Rasgon, Andreas Reif, Janusz Rybakowski, Kemal Sagduyu, Christian Simhandi, Carla Torrent, Eduard Vieta, Mark Zetin, Peter C. Whybrow

Marriage and Family Therapy Faculty Articles and Research

Objective: Although bipolar disorder has high heritability, the onset occurs during several decades of life, suggesting that social and environmental factors may have considerable influence on disease onset. This study examined the association between the age of onset and sunlight at the location of onset.

Method: Data were obtained from 2414 patients with a diagnosis of bipolar I disorder, according to DSM-IV criteria. Data were collected at 24 sites in 13 countries spanning latitudes 6.3 to 63.4 degrees from the equator, including data from both hemispheres. The age of onset and location of onset were obtained retrospectively, from …


Taking The Perspective That A Depressive State Reflects Inflammation: Implications For The Use Of Antidepressants, Jill Littrell Aug 2012

Taking The Perspective That A Depressive State Reflects Inflammation: Implications For The Use Of Antidepressants, Jill Littrell

SW Publications

This paper reviews both the evidence that supports the characterization of depression as an inflammatory disorder and the different biochemical mechanisms that have been postulated for the connection between inflammation and depression. This association offers credible explanation for the short term efficacy of antidepressants, which have short term anti-inflammatory effects. Evidence for those anti-inflammatory effects is discussed. Evidence of the contrary long-term effects of antidepressants, which increase rather than decrease inflammation, is also reviewed. It is argued that this increase in inflammation would predict an increase in chronicity among depressed patients that have been treated with antidepressants drugs, which has …


From Portland To Paris: Clinical Perspectives On Supporting Young People Suffering From Early Psychosis, Craigan Usher, Ryan P. Melton, Sarah Lynch Jul 2012

From Portland To Paris: Clinical Perspectives On Supporting Young People Suffering From Early Psychosis, Craigan Usher, Ryan P. Melton, Sarah Lynch

Regional Research Institute for Human Services

This workshop examines the Early Detection and Prevention of Psychosis Program (EDIPPP) that focuses on reducing the incidence of major psychotic disorders in a defined population, by early detection and treatment.


Research Brief: "Psychiatric Status And Work Performance Of Veterans Of Operations Enduring Freedom And Iraqi Freedom", Institute For Veterans And Military Families At Syracuse University Jun 2012

Research Brief: "Psychiatric Status And Work Performance Of Veterans Of Operations Enduring Freedom And Iraqi Freedom", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This study examines the relationship between psychiatric status and work impairment among OEF/OIF veterans enrolled in VA healthcare. In practice, mental health services are a high priority for the Veterans Administration, which is now focused on integrating behavioral health services into primary care so OEF/OIF veterans face fewer obstacles in obtaining and sustaining psychiatric care. In policy, policymakers should integrate veterans’ health programs with systematic assessment functioning, and develop treatment geared towards addressing impaired job performance. Suggestions for future study include focusing on whether workers with depression and other psychiatric conditions participate fully in the labor market and function effectively …


Suicide In Young Men, Alexandra Pitman, Karolina Krysinska, Michael King Jun 2012

Suicide In Young Men, Alexandra Pitman, Karolina Krysinska, Michael King

Aboriginal Policy Research Consortium International (APRCi)

No abstract provided.


Stress, Coping And Suicide Ideation In Chinese College Students, Xiaoyun Zhang, Haiping Wang, Yan Ruth Xia, Xiaohong Liu, Eunju Jung Jun 2012

Stress, Coping And Suicide Ideation In Chinese College Students, Xiaoyun Zhang, Haiping Wang, Yan Ruth Xia, Xiaohong Liu, Eunju Jung

Department of Child, Youth, and Family Studies: Faculty Publications

The study was to examine 1) whether stress and coping styles could significantly predict the probability of suicide ideation; 2) and whether coping styles were mediators or moderators on the association between life stress and suicide ideation. The survey was conducted in a sample of 671 Chinese college students. Approximately twenty percent students reported having suicide ideation. Life stress, active coping styles, and passive coping styles all had independent effect on the probability of suicide ideation. Passive coping styles, especially fantasizing, mediated the relation between life stress and suicide ideation. Moderation hypotheses were not supported. Implications of the findings and …


Evaluating Effectiveness Of A Public Mental Health Re-Entry Program: Strategic Statewide Partnerships, Stephanie Hartwell Apr 2012

Evaluating Effectiveness Of A Public Mental Health Re-Entry Program: Strategic Statewide Partnerships, Stephanie Hartwell

Office of Community Partnerships Posters

This study is the first ever initiative to merge administrative data base in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcome of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The Program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007 - 2011, comparing FTT clients to …


Mental Disorders And Communication Of Intent To Die In Indigenous Suicide Cases, Queensland, Australia, Diego De Leo, Allison Milner, Jerneja Sveticic Apr 2012

Mental Disorders And Communication Of Intent To Die In Indigenous Suicide Cases, Queensland, Australia, Diego De Leo, Allison Milner, Jerneja Sveticic

Aboriginal Policy Research Consortium International (APRCi)

In comparing Indigenous to non-Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non-Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non-Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent …


Guidelines For Peer Support In High‐Risk Organizations: An International Consensus Study Using The Delphi Method, Mark C. Creamer, Tracy Varker, Jonathan Visson, Kathy Darte, Neil Greenberg, Winnie Lau, Gill Moreton, Meaghan O'Donnell, Don Richardson, Joe Ruzek, Patricia Watson, David Forbes Apr 2012

Guidelines For Peer Support In High‐Risk Organizations: An International Consensus Study Using The Delphi Method, Mark C. Creamer, Tracy Varker, Jonathan Visson, Kathy Darte, Neil Greenberg, Winnie Lau, Gill Moreton, Meaghan O'Donnell, Don Richardson, Joe Ruzek, Patricia Watson, David Forbes

MacDonald Franklin OSI Research Centre

Despite widespread adoption of peer‐support programs in organizations around the world whose employees are at high risk of exposure to potentially traumatic incidents, little consensus exists regarding even the most basic concepts and procedures for these programs. In this article, consensus refers to a group decision‐making process that seeks not only agreement from most participants, but also resolution of minority objections. The aim of the current study was to develop evidence‐informed peer‐support guidelines for use in high‐risk organizations, designed to enhance consistency around goals and procedures and provide the foundation for a systematic approach to evaluation. From 17 countries, 92 …


Readers Are Leaders In Publishing, Kiran Ejaz, Haider Naqvi Mar 2012

Readers Are Leaders In Publishing, Kiran Ejaz, Haider Naqvi

Department of Psychiatry

No abstract provided.


Risk Factors For Depression Among Married Women Belonging To Higher And Lower Socioeconomic Status In Karachi, Pakistan, Saima Zainab, Zafar Fatmi, Ambreen Kazi Mar 2012

Risk Factors For Depression Among Married Women Belonging To Higher And Lower Socioeconomic Status In Karachi, Pakistan, Saima Zainab, Zafar Fatmi, Ambreen Kazi

Community Health Sciences

OBJECTIVES: To determine the risk factors for depression among married women belonging to low and high socioeconomic status in Karachi.METHODS: The study design was cross-sectional. The data was collected from 128 adult married women during July to September 2005. The women were selected from different socioeconomic classes from five hospitals/institutes in Karachi. The Centre for Epidemiology Studies-Depression (CES-D) scale was used to screen the subjects for depression and a structured questionnaire was used to identify the factors for depression.RESULT: According to the CES-D scale, 65% of the study population was found to be depressed. Among the women from high socioeconomic …


Mental Health Of Indigenous Australians: A Review Of Findings From Community Surveys, Anthony F. Jorm, Sarah J. Bourchier, Stefan Cvetkovski, Gavin Stewart Feb 2012

Mental Health Of Indigenous Australians: A Review Of Findings From Community Surveys, Anthony F. Jorm, Sarah J. Bourchier, Stefan Cvetkovski, Gavin Stewart

Aboriginal Policy Research Consortium International (APRCi)

Objective: To assemble what is known about the mental health of Indigenous Australians from community surveys. Data sources: A systematic search was carried out of publications and data sources since 2000 using PubMed, PsycINFO, Australian Medical Index, the National Library of Australia and datasets known to the authors.

Study selection: Surveys had to involve representative sampling of a population, identify Aboriginal and Torres Strait Islander people and include a measure of mental health.

Data extraction: 11 surveys were found. Data were extracted on prevalence rates for Indigenous people by age and sex, along with comparison data from the general population, …


Psychosis In Indigenous Populations Of Cape York And The Torres Strait, Ernest M. Hunter, Bruce D. Gynther, Carrick J. Anderson, Leigh-Ann L. Onnis, Jeffrey R. Nelson, Wayne Hall, Bernhard T. Baune, Aaron R. Groves Feb 2012

Psychosis In Indigenous Populations Of Cape York And The Torres Strait, Ernest M. Hunter, Bruce D. Gynther, Carrick J. Anderson, Leigh-Ann L. Onnis, Jeffrey R. Nelson, Wayne Hall, Bernhard T. Baune, Aaron R. Groves

Aboriginal Policy Research Consortium International (APRCi)

Objective: To describe and characterise treated psychotic disorders in the Indigenous populations of Cape York and the Torres Strait.

Design: Cross-sectional analysis of patients with a psychotic disorder identified by treating psychiatrists.

Setting and participants: Indigenous patients aged 􏰀 15 years in Cape York and Torres Strait communities receiving treatment for a psychotic disorder over 3 months in 2010.

Main outcome measures: Prevalence of psychosis diagnoses, intellectual disability, and substance use comorbidities.

Results: 171 patients were included. The prevalence rate in this population was 1.68%, higher for males (2.60%) than females (0.89%), and twice as high in the Aboriginal (2.05%) …


Constructivism Applied To Psychiatric–Mental Health Nursing: An Alternative To Supplement Traditional Clinical Education, Michelle Hampton Feb 2012

Constructivism Applied To Psychiatric–Mental Health Nursing: An Alternative To Supplement Traditional Clinical Education, Michelle Hampton

Faculty Publications

With the popularity of accelerated pre‐licensure nursing programmes and the growth in nursing student enrolments, traditional clinical education continues to be a challenge to deliver. Nursing faculty members are required to develop and implement educational innovations that achieve effective learning outcomes, while using fewer resources. The purpose of this qualitative study was to explore the effectiveness of a constructivism‐based learning project to achieve specific learning outcomes and to supplement approximately 30 clinical hours in a psychiatric–mental health nursing course. Students participated in a 10‐week, multistage project that examined life histories, treatment resources, and evidence‐based practice, as applied to a single …


Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani Feb 2012

Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani

Department of Psychiatry

No abstract provided.


A Comparative Review Of “How To” Books For Parents Of Adhd Children And “How To” Books For Parents Of Typical Children, Bora Pajo, Paul H. Stuart Dr. Jan 2012

A Comparative Review Of “How To” Books For Parents Of Adhd Children And “How To” Books For Parents Of Typical Children, Bora Pajo, Paul H. Stuart Dr.

All Faculty and Staff Scholarship

Although an increasing number of children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and take medications to control their behaviors, a well-publicized controversy persists about whether ADHD refers to a common neurobehavioral disorder of childhood or to various medicalized temperamental, educational, and cultural differences and difficulties of children. Moreover, behaviors indicative of ADHD are commonly found among all children—although with different frequencies. This paper aims to identify and compare the type of information provided to parents of ADHD and non-ADHD diagnosed children through readily available self-help books. Searches using popular online bookstores were conducted to rank and select the …


Is There Evidence For The Bipolar Spectrum And The Safety Of Pharmaceutical Interventions?, Jill Littrell Jan 2012

Is There Evidence For The Bipolar Spectrum And The Safety Of Pharmaceutical Interventions?, Jill Littrell

SW Publications

Social workers constitute a high proportion of mental health professionals and a high percentage of social workers provide mental health care. Thus, psychiatric diagnoses and pharmaceutical interventions are relevant for many social workers. This paper reviews the rise in the diagnoses of Bipolar spectrum disorders for both children and adults. It considers the safety of antipsychotic medications, a mainstay of treatment for children and adults, which, in addition to other well-documented negative side effects, have recently been shown to decrease brain volume by a significant percent. These issues are particularly relevant for children in the foster care system.


Children In Foster Care And Excessive Medications, Jill L. Littrell Jan 2012

Children In Foster Care And Excessive Medications, Jill L. Littrell

SW Publications

Children in foster care system are more likely to receive diagnoses of major mental illness and to be medicated with powerful medications such as antipsychotic drugs. Reasons for the increased risk of the actual mental illnesses and for the diagnoses of illness among children in foster care are reviewed. The reliabilities of various diagnoses are considered. The legitimacy of the rationale for early medications to prevent later disability is discussed. The very real hazards of medicating with antipsychotics, anticonvulsants, stimulants, mood stabilizers and antidepressants are reviewed. A discussion of advocacy efforts occurring around the United States on behalf of medicated …


Preliminary Development And Content Validity Of A Measure Of Australian Aboriginal Cultural Engagement, Stacey L. Berry, Trevor P. Crowe, Frank P. Deane Jan 2012

Preliminary Development And Content Validity Of A Measure Of Australian Aboriginal Cultural Engagement, Stacey L. Berry, Trevor P. Crowe, Frank P. Deane

Aboriginal Policy Research Consortium International (APRCi)

Objectives. Aboriginal people form one of the populations most in need of mental health and substance abuse services within Australia, although many services are not adequately sensitive to, or inclusive of, relevant aspects of Aboriginal culture in their programmes. The Aboriginal Cultural Engagement Survey (ACES) was developed with the objective of assessing the level of cultural engagement of Aboriginal clients. A measure of cultural engagement is an important step in establishing an association between culture and health benefits, so that future interventions may be designed which better meet the cultural needs of Aboriginal Australians within health services.

Design. The process …


Culture Ontogeny: Lifespan Development Of Religion And The Ethics Of Spiritual Counselling, Glen Milstein, Amy Manierre Jan 2012

Culture Ontogeny: Lifespan Development Of Religion And The Ethics Of Spiritual Counselling, Glen Milstein, Amy Manierre

Publications and Research

The counsellor has an ethical obligation to treat the whole person. Humans are cultural beings and the foundation of most cultures is religion. Religion and culture are received from our early relation~ ships and modified through later relationships across the lifespan. The paper introduces the term "culture ontogeny" to emphasize that this is a biological process wherein abstract ideas of culture and religion become material in the developing neurophysiology of each brain. A framework and methods are offered to examine the changing roles of religion in clients' emotional self~ structure, inclusive of those who describe themselves as spiritual, not religious. …


Addressing The Physical Health Challenges Impacting Young Individuals With Major Mental Illness, Ryan P. Melton Jan 2012

Addressing The Physical Health Challenges Impacting Young Individuals With Major Mental Illness, Ryan P. Melton

Regional Research Institute for Human Services

Research has found that individuals who suffer from major mental illness, such as schizophrenia, are dying on average 15-25 years earlier than those who do not suffer from schizophrenia.1 Many causes for this shortened lifespan are suspected. Those causes include: lack of access to health care, suicide, poverty, substance use and side effects from anti-psychotic medications. The Substance Abuse and Mental Health Services Administration (SAMHSA) has challenged mental health providers treating major mental illness to address this disturbing trend by promoting their “10x10” campaign. The goal of the campaign is to increase the lifespan of individuals who suffer from major …


Psychotherapy As Cultivating Character, Mike W. Martin Jan 2012

Psychotherapy As Cultivating Character, Mike W. Martin

Philosophy Faculty Articles and Research

Duff R. Waring argues that, in some instances, psychotherapy should be viewed as healing (or alleviating) mental disorders and also as cultivating good character in patients (Waring 2012). In these instances, psychotherapists should understand their patients as having character faults that are manifested as mental disorders, as having nascent virtues they can build on during therapy, and as moving toward goals that can be specified in terms of both improved mental health and greater moral virtue. Waring’s discussion is deeply illuminating, but it suffers from a major difficulty: the failure to take adequate account of the differences between the perspectives …


New Therapies, Old Problems, Or, A Plea For Neuromodesty, Stephen J. Morse Jan 2012

New Therapies, Old Problems, Or, A Plea For Neuromodesty, Stephen J. Morse

All Faculty Scholarship

This article suggests that investigational deep brain stimulation (DBS) for mental disorders raises few new bioethical issues. Although the scientific basis of the procedure may be both complex and largely unknown, addressing informed consent in such situations is a familiar problem. After reviewing the legal and moral background for investigating DBS and the scientific difficulties DBS faces as a potential treatment for mental disorders, the article focuses on informed consent and makes two primary suggestions. The study of DBS may proceed, but "hyper-disclosure" of the complexities should be required for competent subjects or proper surrogates if the candidate is not …


Significant Race Differences In Factors Related To The Detention Recidivism Of Youthful Offenders, Christopher A. Mallett, Miyuki Fukushima, Patricia A. Stoddard Dare, Linda M. Quinn Jan 2012

Significant Race Differences In Factors Related To The Detention Recidivism Of Youthful Offenders, Christopher A. Mallett, Miyuki Fukushima, Patricia A. Stoddard Dare, Linda M. Quinn

Social Work Faculty Publications

A significant number of youthful offenders in the United States are held in juvenile court detention centers. Of broad concern is the disproportionate impact these placements have on minority youth, with African American and Hispanic youth much more frequently detained in these facilities compared to Caucasian youth. This U.S. study of a 2-county youthful offender population in the Midwest (1 urban, 1 rural) investigated racial differences in both extralegal (demographic, educational, mental health, and history of abuse or neglect) and court-related legal variables that predict detention placement upon recidivism—in other words, a second detention placement. Findings from logistic regression analysis …


Bracing For Idiopathic Scoliosis: Improving Adherence Through Psychological Intervention, Shoshana J. Fagen Jan 2012

Bracing For Idiopathic Scoliosis: Improving Adherence Through Psychological Intervention, Shoshana J. Fagen

Antioch University Full-Text Dissertations & Theses

Poor treatment adherence is increasingly being recognized as a significant problem in pediatric medicine. For the condition Adolescent Idiopathic Scoliosis, poor adherence rates to the most non-surgical intervention, orthotic bracing, have become a well-established fact. This treatment modality has been correlated with multiple psychosocial areas of difficulty, including low self image, suicidal ideation, feelings of isolation, social discomfort, depression, an external locus of control, increasing risk taking behavior, high levels of stress, anger, fear, shame, and eating disorders. Since the orthotic bracing has been linked to both poor adherence and to psychosocial problems, an intervention is created to increase adherence …


Theorizing Mental Health Courts, E. Lea Johnston Jan 2012

Theorizing Mental Health Courts, E. Lea Johnston

UF Law Faculty Publications

To date, no scholarly article has analyzed the theoretical basis of mental health courts, which currently exist in forty-three states. This Article examines the two utilitarian justifications proposed by mental health court advocates—therapeutic jurisprudence and therapeutic rehabilitation—and finds both insufficient. Therapeutic jurisprudence is inadequate to justify mental health courts because of its inability, by definition, to resolve significant normative conflict. In essence, mental health courts express values fundamentally at odds with those underlying the traditional criminal justice system. Furthermore, the sufficiency of rehabilitation, as this concept appears to be defined by mental health court advocates, depends on the validity of …