Economic issues in access to medications: schizophrenia treatment in England

Mental health problems and the services to address them are currently receiving more attention in the UK than ever. Mental health care in England--indeed, across the UK--is experiencing a much needed transformation. It is therefore highly pertinent to examine the patterns of psychotropic medication use, given their intended links to recovery, rehabilitation, and reintegration, as well as to explore the economic and other factors that appear to influence those patterns. These are the aims of this paper. Our attention will be primarily focused on England. What this analysis shows is that given a higher profile by government, including additional funding (although not really benefiting differentially compared to other parts of the health service) and the first national service framework, it is possible to see changes in service patterns, access and (to a degree) outcomes. These changes are occurring at a time when new classes of psychotropic medication are being introduced in a range of therapeutic areas, contributing to the relatively rapid growth of take-up but also raising questions about appropriateness, effectiveness, cost-effectiveness and equity.     

The regulation of cognitive enhancement devices: refining Maslen et?al.'s model

Our (2014) model for the regulation of cognitive enhancement devices (CEDs) received a great deal of interest from those involved in European device regulation and from academic commentators. Further, since the publication of our recommendations, the number of manufacturers of brain stimulation devices for non-medical purposes has increased, underscoring the need for a regulatory response. In this paper, we clarify aspects of our original proposal and address additional regulatory issues beyond our original focus on the sale of devices. We begin with theoretical points pertaining to the definition of a CED and the distinction between treatment and enhancement. We then respond to practical challenges raised by the prospect of implementing our regulatory framework. Next, we address some wider societal considerations relating to users and other stakeholders. Finally, we revisit the broader regulatory context within which the various discussions are situated.     

Self-Defense,Retaliation, and Gender: Clarifying Motivations for Physical Partner Violence

The motivations behind intimate partner violence (IPV) have been a controversial topic. It has been suggested that women’s use of IPV mainly occurs in the context of self-defense (Saunders 1986). However, men also report perpetrating IPV in self-defense (Harned 2001; Makepeace 1986). This article differentiates self-defense from retaliation and reviews findings regarding these motives for perpetrators of IPV. Self-defense motives are common among battered women; however, undergraduates and arrested perpetrators often report other motives. Women do not consistently report using violence in self-defense more than men do. Clinical and research implications are discussed and existing self-defense measures are critiqued.     

Assessing effective participation in vulnerable juvenile defendants

Effective participation in trial is outlined under article 6 of the European Convention on Human Rights and refers to the ability to understand and engage in trial. Juvenile defendants are often referred to psychologists or psychiatrists by their solicitors to establish ‘effective participation’ capacity. In the USA, key components to participate effectively are defined and standardised assessments available. In the UK, no formal measures exist. A consecutive series of 20 adolescents aged 12–20 years, referred by their solicitors to our service, were assessed using a standardised battery and a semi-structured interview designed to assess effective participation. Fifty-five per cent had at least one neurodevelopmental disorder. Low IQ was common and 50% had age-equivalent language scores below 10 years. Rates of depression, anxiety and PTSD were high. Knowledge about trial was poor. These findings have implications for Criminal Justice System professionals and to ensure fair trials for young defendants.     

Changes in staff confidence and attributions for challenging behaviour after training in positive behavioural support,within a forensic mental health setting: a replication study with follow-up

Positive behavioural support (PBS) is a proactive approach to managing challenging behaviour. Staff in a forensic mental health service were provided training in PBS. The study aimed to assess the effectiveness of training by measuring changes to staff confidence and attributions for challenging behaviour before training, post training and at six-month follow-up. Qualified and unqualified staff were compared, as were male and female staff. Confidence was measured using an adapted version of the Confidence in Coping with Patient Aggression Instrument. The Challenging Behaviour Attributions Scale and the Causal Dimension Scale II assessed staff attributions. Staff confidence levels in working with challenging behaviour increased following PBS training, and this increase was maintained at six-month follow-up, for unqualified, qualified, male and female staff. Changes in attributions for challenging behaviour were observed post training; however changes were not maintained at follow-up. Limitations and clinical implications were outlined.     

The impact of an intensive inpatient violent offender treatment programme on intermediary treatment targets,violence risk and aggressive behaviour in a sample of mentally disordered offenders*

This study examined the impact of an intensive inpatient violent offender treatment programme, Life Minus Violence-Enhanced (LMV-E), on intermediary treatment targets, risk for violence, and aggressive behaviour during treatment in a sample of male mentally disordered offenders. Using quasi-experimental design, offenders who completed LMV-E and a comparison group showed reduced problems with impulsivity and anger regulation and improvements in social problem solving. Aggregate risk for future violence lessened in both treatment and comparison groups, although by a significantly greater degree for the comparison group. The aggressive behaviour of both groups reduced. Completion of the LMV-E conferred additional improvements in some facets of social problem solving and anger regulation. Neither group showed improvements in empathic responses, coping skills or problematic interpersonal style. Overall, these results suggest anger regulation, impulsivity and social problem solving are most amenable to change, that reductions in certain facets of these dynamic risk factors transpires with nonspecific psychiatric inpatient treatment, but that the LMV-E, a cognitive behavioural violence specific psychological treatment, confers greater change in some facets of social problem solving and anger regulation.