Jeff Dennis

County budget priorities shape how local criminal justice systems manage individuals with mental illness when community treatment capacity is limited. Using data from one Texas rural hub county, a 2-year observational analysis paired county budget allocations with hospital emergency department encounters and jail bookings of individuals with serious mental illness. Results showed stable budget priorities favoring correctional and judicial operations over community mental health services. During the same period, jail bookings were concentrated among a small subset of individuals with serious mental illness. They were dominated by low-level, nonviolent, and administrative charges rather than charges involving violence. Detention length of stay varied widely and did not increase systematically with booking frequency, although repeated bookings led to greater incarceration exposure. Emergency department encounters involving serious mental illness did not show higher clinical severity, longer hospitalizations, or greater costs than encounters without serious mental illness. Most encounters involved medical diagnoses rather than psychiatric. Findings indicate local governments relied on jails and emergency departments as default crisis responders to unmet community mental health needs. The study contributes a framework linking budget composition, justice system contact, and emergency care in a rural hub setting, and highlights institutional substitution as a product of local governance and fiscal priorities.

Violence remains a central criminal justice and public health concern, yet policy discussions often narrow analysis to crime, punishment, and individual behavior. A broader framework is needed. Manuscripts in the special issue examine violence as a product of upstream political choices, institutional design, fiscal priorities, fragmented governance, unequal exposure to injury, access to health care, government services availability, and political representation. Across varied settings, authors show how local political monopoly, structural inequality, weak reintegration systems, unstable interagency coordination, and contested policy choices shape exposure to injury, death, coercion, victimization, and chronic harm. A second contribution concerns definition and measurement. Categories of violence, rules of reporting, agency jurisdiction, and available data are never neutral. Decisions about what counts, who counts, and which harms become visible influence criminal justice practice, research findings, public narratives, and policy agendas. Public health offers a useful framework because measurable harms, exposures, and institutional contact across health, justice, and social service systems can anchor analysis while still recognizing power, politics, and administrative discretion. Together, the manuscripts move beyond event-based and offender-centered explanations. Violence emerges as politically organized harm, patterned by governance and reproduced through institutions.

Violence remains a long-standing wicked problem because political, institutional, and fiscal choices shape how violence is defined, measured, and addressed. This special issue synthesizes contributions and uses public health framing to reposition violence as a measurable outcome. We draw together work on deaths of despair, structural violence, firearm homicide, restorative justice, recidivism, institutional cycling, and interagency response to identify patterns across settings and outcomes. Violence emerges as a downstream product of political monopoly, fragmented governance, weak accountability, fiscal choices, and unstable institutional support. Violence is also a contested object of definition, measurement, and response, with political actors shaping visible, credible, punishable, or preventable harms. Public health framing does not remove politics; rather, it makes room for partisan reframing, anchoring policy discussion in measurable injury, exposure, and preventable risk. Symbolic policies become the safe political option without reducing underlying harm. Partisan politics rewards symbolic action, creating short policy horizons and selective policy attention, which then makes evolving violence difficult to resolve. Violence reduction requires more than episodic solutions; it requires better measurement of acute and chronic harms, and governance capable of sustaining prevention beyond a single election cycle. Future violence research should bridge public health, criminal justice, political science, jurisprudence, and administrative practices to identify who can act, under what conditions, and with what governing tools so violence problems can be resolved as they emerge.

This study describes the development and evaluation of Better Together, a coalition between law enforcement, first responders, and health care organizations to develop an interagency training for managing justice-involved individuals with mental health issues. In the United States, calls to 9-1-1 and other crisis lines frequently dispatch law enforcement, first responders, and sometimes crisis intervention teams. As these individuals are assessed and managed during the response, they are taken into custody by law enforcement, transported for medical care, or released. A Department of Justice grant led to the facilitation of a collaborative to discuss how training in the various involved organizations aligns with complexities of these cases on the ground. An interagency training program was developed to clarify agency roles and improve cross-sector collaboration. Pretest, posttest, and 2-week follow-up assessments measured participant knowledge and understanding of agency roles. Overall scores improved significantly from pretest (63%) to posttest (76%, p < .001) and remained high in the 2-week follow-up (75%, p = .021). However, changes in leadership since the completion of the training have demonstrated the tenuous nature of keeping a collaboration of this nature sustainable.

Objective: Hospital and obstetric unit closures in U.S. counties often lead to expansion of maternal healthcare deserts, defined as counties without a birth center offering obstetric care. This study describes the maternal demographic profile and geographic scarcity of obstetric care across the large and sparsely populated west Texas region.Materials and Methods: Aggregate population data are obtained from the U.S. Census and American Community Survey. Maternal healthcare centers for 107 counties across west Texas, defined here as public health regions 1, 2, 9, and 10, are identified using data from the Texas Collaborative for Healthy Mothers and Babies.Results: Across west Texas, 76 of 107 counties are maternal healthcare deserts, with no available obstetric care. Approximately 82,000 women of childbearing age live in these counties, with about 5,000 reporting having given birth in the past 12 months. Level II or higher obstetric care is available in just 12 (about 11%) of west Texas counties.Conclusion: A majority of rural counties across the large geographic area of west Texas lack labor and delivery services, leading expectant mothers to travel to neighboring counties for obstetric care, or further for high-risk care. Greater coordination between higher level maternal care centers and rural hospitals and providers, as well as telehealth and community health worker outreach, may provide some level of connection to obstetric services for women in rural areas.

Colleagues conducting local or regional research frequently ask how to find county level or zip code-specific population data such as population size, mean income, or other demographic measures. In studies using patient data, where household income is typically not available, researchers may approximate socioeconomic status using median income for the county, zip code, or Census tract where the patient resides. 1,2,3 A variety of data aggregation websites may provide certain estimates of these data points, although for accuracy, it is far preferable to obtain these data from an original source such as the United States (U.S.) Census Bureau, where documentation about data collection methodology is provided along with the data.

Justice-involved veterans are a unique subpopulation with different mental health needs in pre-trial diversion than civilians. Veteran diversion can be challenging, creating evaluation issues at the program (i.e., development, implementation, outcomes), and individual (i.e., positive outcomes) levels. A case study of VetStar, a unified approach diversion for veterans spanning both the criminal justice and healthcare systems, is presented as a model for diversion of justice-involved veterans. The researchers obtained data from five publicly available sources: recorded radio interviews, VetStar published stakeholder reports, the VetStar Texas Veterans & Family Alliance 2018 grant submission, a photovoice project from the Lubbock Art Walk November 2019, and the Texas Veterans Commission Quarterly Reports and JMHCP Data Review. This case study found 10 major themes. VetStar is a non-profit organization using a modified version of assertive community treatment serving justice-involved veterans with mental health issues. We describe the progression of justice-involved veterans in the VetStar diversion program; 92% of the 571 veterans completing the VetStar program in five years did not re-offend for the same crime. VetStar’s approach could be performed in other subpopulations with distinct cultural identities. Modifications can be constructed and aligned within the construct of the subpopulation identity. Further research is needed to investigate VetStar’s FASTRR model, to help document a more detailed theory of the approach.

Introduction: Homeless individuals lack resources for primary healthcare and as a result use the emergency department (ED) as a social safety net. Our primary objective in this study was to identify the differences between features of visits to United States (US) EDs made by patients without a home and patients who live in a private residence presenting with mental health symptoms or no mental health symptoms at triage. Methods: Data for this study come from the 2009-2017 National Health and Ambulatory Medical Care Survey, a nationally representative cross-sectional survey of ED visits in the US. We examined differences in waiting time, length of visit, and triage score among homeless patients, and privately housed and nursing home residents. We used logistic regression to determine the odds of receiving a mental health diagnosis. Residence, age, gender, race, urgency, and whether the person was seen in the ED in the previous 72 hours were controlled. Results: Homeless individuals made up less than 1% of all ED visits during this period. Of these visits, 47.2% resulted in a mental health diagnosis compared to those who live in a private residence. Adjusting for age, race, gender, triage score, and whether the person had been seen in the prior 72 hours, homeless individuals were still six times more likely to receive a mental health diagnosis despite reporting no mental health symptoms compared to individuals who lived in a private residence. Homeless individuals reporting mental health symptoms were two times more likely to receive a mental health diagnosis compared to privately housed and nursing home residents. Conclusions: Homeless individuals are more likely to receive a mental health diagnosis in the ED whether or not they present with mental health symptoms at triage. This study suggests that homelessness as a status impacts how these individuals receive care in the ED. Community coordination is needed to expand treatment options for individuals experiencing emergent mental health symptoms.

Introduction: Benefits, risks, and the increasing popularity of yoga use warrant assessing yoga practice prevalence and users' profiles. This study describes trends in yoga practice exclusively among American adults from 2002 to 2017, compares the profile of yoga users, and identifies factors related to yoga use over time. Materials and Methods: This study is a secondary analysis done in 2019 and 2020 using the National Health Interview Survey (NHIS) 2002, 2007, 2012, and 2017 data. Population weights were used to obtain statistically accurate estimates of yoga use prevalence for the U.S. population. Descriptive statistics were used to profile the sociodemographic and health-related characteristics of yoga users. Multivariable logistic regression was used to identify factors associated with yoga use in each cohort defined by the NHIS year. Results: Yoga practice prevalence nearly tripled from 5.1% in 2002 to 13.7% in 2017 (weighted estimate 10,386,456 and 32,761,194 American adults, respectively). Typical yoga users were young non-Hispanic single white female adults with bachelor or higher education and health insurance, and resided in the west region of the United States. Yoga use pattern change over time was significantly related to only younger age (p < 0.001) but not to other sociodemographic or health-related factors. Conclusions: Yoga has gained increasing popularity in the past two decades among American adults, with younger adults being the driving force. Yoga appears to be adopted for general well-being or prevention more than for specific disease treatment. Future research should evaluate how yoga can be effectively and safely integrated into preventive medicine strategies.