Scholars@Duke
Michele Easter

Michele Easter

Associate Professor in Psychiatry and Behavioral Sciences
Psychiatry, Child & Family Mental Health & Community Psychiatry
michele.easter@duke.edu
DUMC 102505, Durham, NC 27705
6th Floor Box #11 DUMC Box 102505, Durham, NC 27705

Scholarly Works - Journal articles

Do Children's Mental Health Symptoms Impact Their Access to Unlocked Guns at Home?

Journal article J Am Acad Child Adolesc Psychiatry · February 2026 OBJECTIVE: To test whether changes in children's and adolescents' mental health symptoms predict changes in their access to unlocked guns at home. METHOD: This study used data from a longitudinal cohort study of 1,420 youth and their parents in the southea ... Full text Link to item Cite

Juvenile Records and Adult Gun Violence: Evidence From Three States With Divergent Firearm Age Policies.

Journal article J Interpers Violence · January 31, 2026 Young adults with a history of juvenile justice involvement are more likely than their peers to be arrested for a violent gun crime, but unlike felony convictions, juvenile adjudications are typically expunged and do not convey a federal firearm prohibitio ... Full text Link to item Cite

Firearm Disqualification and Rights Restoration Among Adults with Mental Illness in Virginia.

Journal article J Am Acad Psychiatry Law · September 3, 2025 This study evaluated legal prohibitions on firearm possession in a population of 128,090 adults in Virginia with a serious mental illness and record of at least one psychiatric hospitalization between 1998 and 2015. Approximately half the study population ... Full text Link to item Cite

Patching holes and bridging gaps: Implementing Law Enforcement-Assisted Diversion (LEAD) in resource-scarce environments.

Journal article J Subst Use Addict Treat · September 2025 INTRODUCTION: Law Enforcement Assisted Diversion (LEAD) is a pre-arrest diversion program that allows police officers to refer individuals to LEAD's harm reduction case management services in lieu of arrest for most low-level, non-violent criminalized beha ... Full text Link to item Cite

Extreme risk protection order use in six US states: a descriptive study.

Journal article Inj Epidemiol · June 3, 2025 OBJECTIVES: Extreme Risk Protection Orders (ERPOs) are civil court orders that temporarily prohibit firearm purchase and possession by someone ("respondent") at imminent risk of harming themselves or others. Despite ERPOs being currently available in 21 st ... Full text Link to item Cite

Mental disorders and criminal legal involvement: Evidence from a national diagnostic epidemiological survey.

Journal article PLOS Ment Health · April 2025 Large numbers of adults with mental disorders in the United States are incarcerated or otherwise involved with the criminal legal system. Evidence is lacking on prevalence of specific psychiatric diagnoses in this population. This article presents results ... Full text Link to item Cite

Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States.

Journal article J Am Acad Psychiatry Law · September 3, 2024 More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil cou ... Full text Link to item Cite

Extreme Risk Protection Orders in Connecticut, 2013-2020.

Journal article J Am Acad Psychiatry Law · June 4, 2024 Twenty-one states and the District of Columbia have enacted Extreme Risk Protection Order (ERPO) statutes, which allow temporary removal of firearms from individuals who pose an imminent risk of harm to themselves or others. Connecticut was the first state ... Full text Link to item Cite

Diversion to Treatment when Treatment is Scarce: Bioethical Implications of the U.S. Resource Gap for Criminal Diversion Programs.

Journal article J Law Med Ethics · 2024 Despite significant scholarship, research, and funding dedicated to implementing criminal diversion programs over the past two decades, persons with serious mental illness and substance use disorders remain substantially overrepresented in United States ja ... Full text Link to item Cite

Primary care need and engagement by people with criminal legal involvement: Descriptive and associational analysis using retrospective data on the entire population ever detained in one southeastern U.S. county jail 2014-2020.

Journal article PLoS One · 2024 More than 7 million people are released each year from U.S. jails or prisons, many with chronic diseases that would benefit from primary care in their returning communities. The objective of this study was to provide an in-depth, payer-agnostic description ... Full text Link to item Cite

Violent Experiences and Patterns of Firearm Ownership From Childhood to Young Adulthood.

Journal article JAMA Netw Open · October 2, 2023 IMPORTANCE: Young adults in their 20s are at high relative risk for self- and other-directed firearm injury, but little is known about gun access patterns for this group. OBJECTIVE: To describe the longitudinal patterns of firearm access from childhood to ... Full text Link to item Cite

Reliance on Community Emergency Departments by People Ever Detained in Jail: Retrospective Cross-Sectional Study.

Journal article J Correct Health Care · August 2023 Millions are confined in U.S. jails each year, often with unmet health and social needs. After release, many will visit the emergency department (ED). To illuminate their patterns of ED use, this study linked records from all individuals detained at a Sout ... Full text Link to item Cite

Adult criminal outcomes of juvenile justice involvement.

Journal article Psychol Med · June 2023 BACKGROUND: The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes. METHO ... Full text Link to item Cite

Relationships between substance use disorders, 'severe mental illness' and re-arrest in a county detention facility: A 4-year follow-up cohort study.

Journal article Crim Behav Ment Health · June 2023 BACKGROUND: A growing body of literature demonstrates strong association between poor mental health and criminal recidivism, but research from county jails is limited. AIMS: Our aim was to examine the relationship between re-arrest and severe mental illnes ... Full text Link to item Cite

NORTH CAROLINA LAW ENFORCEMENT ASSISTED DIVERSION (LEAD): CONSIDERATIONS FOR OPTIMIZING ELIGIBILITY AND REFERRAL

Journal article Law and Contemporary Problems · January 1, 2023 In 2011, a diverse group of stakeholders in Seattle, Washington, developed an alternative to repeated arrests and incarceration of people whose low-level unlawful conduct stemmed from unmet behavioral health needs, launching a new model called Law Enforcem ... Cite

Gun violence among young adults with a juvenile crime record in North Carolina: Implications for firearm restrictions based on age and risk.

Journal article Prev Med · December 2022 Youth who acquire a juvenile crime record may be at increased risk of perpetrating gun violence as adults. North Carolina and 22 other states permit young adults who were adjudicated by a juvenile court - even for some felony-equivalent offenses - to legal ... Full text Link to item Cite

Extreme risk protection orders in response to threats of multiple victim/mass shooting in six U.S. states: A descriptive study.

Journal article Prev Med · December 2022 Extreme risk protection orders (ERPOs), also known as red flag laws, are a potential tool to prevent firearm violence, including mass shootings, but little is currently known about the extent of their use in cases of mass shooting threats or about the thre ... Full text Link to item Cite

Appropriateness of psychiatric advance directives facilitated by peer support specialists and clinicians on Assertive Community Treatment teams.

Journal article J Ment Health · April 2022 BACKGROUND: Psychiatric advance directives (PADs) are used to document a person's treatment preferences for a future mental health crisis. Peer support specialists have been proposed to facilitate PADs, but little is known about the quality of peer versus ... Full text Link to item Cite

North Carolina Specialty Courts, Treatment Access, and the Substance Use Crisis: A Promising but Underfunded Model.

Journal article Psychiatr Serv · December 1, 2021 Treatment courts aim to reduce criminal recidivism by addressing the behavioral health care needs of persons with psychiatric or substance use disorders that contribute to their offending. Stable funding and access to behavioral health providers are crucia ... Full text Link to item Cite

Impact of psychiatric advance directive facilitation on mental health consumers: empowerment, treatment attitudes and the role of peer support specialists.

Journal article J Ment Health · October 2021 BACKGROUND: A psychiatric advance directive (PAD) is designed to prevent involuntary mental health interventions by enabling people with serious mental illnesses to plan ahead for their own treatment during a future incapacitating crisis. This study implem ... Full text Link to item Cite

Childhood Gun Access, Adult Suicidality, and Crime.

Journal article Pediatrics · August 2021 OBJECTIVES: To test the associations of childhood domestic gun access with adult criminality and suicidality. METHODS: Analyses were based on a 20+ year prospective, community-representative study of 1420 children, who were assessed up to 8 times during ch ... Full text Link to item Cite

Implementing Psychiatric Advance Directives: The Transmitter and Receiver Problem and the Neglected Right to Be Deemed Incapable.

Journal article Psychiatr Serv · February 1, 2021 Psychiatric advance directives (PADs) can help adults with serious mental illnesses preserve their autonomy and avoid involuntary interventions during an incapacitating mental health crisis. A PAD is a legal document prepared while mentally competent and s ... Full text Open Access Link to item Cite

Gender-specific participation and outcomes among jail diversion clients with co-occurring substance use and mental health disorders.

Journal article J Subst Abuse Treat · August 2020 Men and women with co-occurring substance use disorders and mental illness are at relatively high risk for becoming involved in the criminal justice system. Programs, such as post-booking jail diversion, aim to connect these individuals to community-based ... Full text Link to item Cite

Criminal Justice and Suicide Outcomes with Indiana's Risk-Based Gun Seizure Law.

Journal article J Am Acad Psychiatry Law · June 2019 This article examines the application and effectiveness of a 2006 Indiana law designed to prevent gun violence by authorizing police officers to separate firearms from persons who present imminent or future risk of injury to self or others, or display a pr ... Full text Link to item Cite

Informing Federal Policy on Firearm Restrictions for Veterans with Fiduciaries: Risk Indicators in the Post-Deployment Mental Health Study.

Journal article Adm Policy Ment Health · July 2018 Featured Publication This article examines the public safety rationale for a federal policy of prohibiting gun sales to veterans with psychiatric disabilities who are assigned a fiduciary to manage their benefits from the Department of Veterans Affairs. The policy was evaluate ... Full text Link to item Cite

Medication-Assisted Treatment for Alcohol-Dependent Adults With Serious Mental Illness and Criminal Justice Involvement: Effects on Treatment Utilization and Outcomes.

Journal article Am J Psychiatry · July 1, 2018 Featured Publication OBJECTIVE: Adults with serious mental illness and comorbid alcohol dependence are at high risk for both high utilization of crisis-driven health care services and criminal justice involvement. Evidence-based medication-assisted treatment (MAT) for alcohol ... Full text Link to item Cite

Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness.

Journal article J Subst Abuse Treat · March 2018 Featured Publication Adults suffering from a serious mental illness (SMI) and a substance use disorder are at especially high risk for poor clinical outcomes and also arrest and incarceration. Pharmacotherapies for treating opioid dependence could be a particularly important m ... Full text Link to item Cite

Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.

Journal article Psychiatr Serv · July 1, 2017 Featured Publication OBJECTIVE: Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facili ... Full text Open Access Link to item Cite

Implementation and effectiveness of connecticut's risk-based gun removal law: Does it prevent suicides?

Journal article Law and Contemporary Problems · January 1, 2017 Featured Publication Cite

Gun Violence, Mental Illness, And Laws That Prohibit Gun Possession: Evidence From Two Florida Counties.

Journal article Health Aff (Millwood) · June 1, 2016 Featured Publication Gun violence kills about ninety people every day in the United States, a toll measured in wasted and ruined lives and with an annual economic price tag exceeding $200 billion. Some policy makers suggest that reforming mental health care systems and improvi ... Full text Link to item Cite

Influence of Criminal Justice Involvement and Psychiatric Diagnoses on Treatment Costs Among Adults With Serious Mental Illness.

Journal article Psychiatr Serv · September 2015 The impact of criminal justice involvement and clinical characteristics on the cost of public treatment services for adults with serious mental illnesses is unknown. The authors examined differential effects of justice involvement on behavioral health trea ... Full text Link to item Cite

Interpreting genetics in the context of eating disorders: evidence of disease, not diversity.

Journal article Sociol Health Illn · July 2014 How is genetic involvement interpreted for disorders whose medicalisation is contested? Framing psychiatric and behavioural disorders in terms of genetics is expected to make them seem more medical. Yet a genetic aetiology can also be used to frame behavio ... Full text Link to item Cite

"Not all my fault": genetics, stigma, and personal responsibility for women with eating disorders.

Journal article Soc Sci Med · October 2012 Featured Publication Medical researchers and clinicians increasingly understand and present eating disorders (anorexia and bulimia nervosa) as biologically-based psychiatric disorders, with genetic risk factors established by high heritability estimates in twin studies. But th ... Full text Link to item Cite

"That's a good question": university researchers' views on ownership and retention of human genetic specimens.

Journal article Genet Med · June 2011 PURPOSE: To explore the views of university-based investigators conducting genetic research with human specimens regarding ownership and retention of specimens, and knowledge of related institutional review board and university policies. METHODS: Data were ... Full text Link to item Cite

Clinical trials and medical care: defining the therapeutic misconception.

Journal article PLoS Med · November 27, 2007 A key component of informed consent to participate in medical research includes understanding that research is not the same as treatment. ... Full text Link to item Cite

"Una mujer trabaja doble aqui": Vignette-based focus groups on stress and work for Latina blue-collar women in eastern North Carolina.

Journal article Health Promot Pract · January 2007 Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exp ... Full text Link to item Cite

The many meanings of care in clinical research.

Journal article Sociol Health Illn · September 2006 The conduct of clinical research often involves two distinguishable sets of relationships: the researcher-subject relationship, and the clinician-patient relationship. Some scholars argue that being a patient in a clinical care setting and a subject in a r ... Full text Link to item Cite

Therapeutic misconception in early phase gene transfer trials.

Journal article Soc Sci Med · January 2006 Many subjects in early phase clinical trials expect to benefit in some way from the research intervention. It is understandable that people hope for improvement in their condition, no matter what the evidence. Yet unreasonable expectation of medical benefi ... Full text Link to item Cite

Uncertain benefit: investigators' views and communications in early phase gene transfer trials.

Journal article Mol Ther · August 2004 We report on a study of potential sources of therapeutic misconception in early phase gene transfer research, examining how investigators and their consent forms represent the prospect for direct benefit. Our analysis demonstrates that even though half of ... Full text Link to item Cite