The nearest relative in the Mental Health Act 2007: still an illusionary and inconsistent safeguard?

Abstract

The role of nearest relative (NR) is intended as a safeguard in the Mental Health Act 1983 (as amended in 2007) to curb the excesses of professional discretion and protect patients from unwarranted compulsory hospitalisation. It is unique to the mental health compulsory detention process in England and Wales. There are, however, evident tensions in the role and a lack of clarity surrounding the precise functions of the NR. There is also some uncertainty and confusion among practitioners about the scope of the NR involvement, and government plans announced recently to review mental health legislation will include a focus on the role of family and carers in the care of detained patients. Despite long-standing concerns about the role, there is remarkably little published research available to date on its use and effectiveness, in so far as evaluating the extent to which it provides an adequate safeguard for patients, as intended by the legislation. This article will briefly explore the background to the role, highlight some of the difficulties and tensions within it and conclude with some observations about where further research and reform may be needed to provide greater protection and clarity for patients, relatives and health and social care practitioners.     

Economic Burden of Child Exposure to Intimate Partner Violence in the United States

Because the effects of children’s exposure to intimate partner violence (IPV) carry long lasting consequences for the affected children, IPV exposure may impose a significant economic burden to localities, states, and society at large, made explicit over the victim’s lifetime and over a wide range of behaviors and outcomes, including use of social services, health and healthcare utilization, educational outcomes, workforce productivity, and criminal behavior. While much research has been conducted on the effect of IPV exposure on multiple short- and long-term outcomes, no research to date has examined the economic burden associated with IPV exposure. Using an incidence-based approach, we estimated the aggregate discounted costs associated with healthcare spending, criminal behavior, and labor market productivity accrued by a 20-year-old victim in 2016 projected to the age of 65, applying a 3% discount rate. The average lifetime costs derived from childhood IPV exposure are estimated to be over $50,000 per victim (2016 U.S. dollars) due to increased healthcare costs ($11,000), increased crime costs ($14,000), and productivity losses ($26,000). Over an annual birth cohort of young adults, these costs amount to over $55 billion nationwide. IPV exposure imposes a substantial economic burden to society at large in the form of increased healthcare costs, increased crime costs, and reduced productivity. This study offers an explicit quantification of substantial lifetime costs, which should encourage policy makers to redouble efforts to reduce the incidence of IPV and successfully ameliorate its effects on IPV-exposed children.     

Shoot/No-Shoot Decisions in the Context of IED-Detection Training and Eyewitness Memory for Persons

Cognitive approaches to training for the detection of improvised explosive devices (IED’s) are of increasing importance. However, there is a question as to the degree to which such training might interfere with other important law enforcement (LE) functions in the field, and the degree to which such training might enhance other important cognitive/perceptual functions. A promising cognitive approach to IED training, the SMOKE system, was provided to respondents, who then responded to shoot/no-shoot decisions, important LE situations of increasing relevance. It was shown that SMOKE training did not interfere with shoot/no-shoot decisions. However, those with SMOKE training performed better than control respondents on eyewitness memory for the perpetrator of a given crime in field-valid scenes. This indicates that cognitively based training may enhance vigilance and resultant memory in field situations.     

Criminal Records and Employment: A Survey of Experiences and Attitudes in the United States

Ban-the-Box (BTB) legislation, which bans employers from asking about criminal history records on the initial job application, is arguably the most prominent policy arising from the prisoner reentry movement. BTB policies assume: 1) most employers ask about criminal records, and 2) inquiries occur at the application stage. However, we lack reliable information about the validity of these assumptions or about public attitudes towards criminal background checks, which limits our understanding of the potential scope of this innovative policy. Using survey data from a national probability sample, we estimate that in the past year, over 31 million U.S. adults were asked about a criminal record on a job application. According to our survey, virtually all of the criminal record inquiries occurred at the application stage, highlighting the potential of BTB. However, we also found that the public is sharply divided on whether to prevent employers from asking on applications, as per BTB.     

Deficits in Emotional Clarity and Vulnerability to Peer Victimization and Internalizing Symptoms Among Early Adolescents

Peer victimization is a significant risk factor for a range of negative outcomes during adolescence, including depression and anxiety. Recent research has evaluated individual characteristics that heighten the risk of experiencing peer victimization. However, the role of emotional clarity, or the ability to understand one’s emotions, in being the target of peer victimization remains unclear. Thus, the present study evaluated whether deficits in emotional clarity increased the risk of experiencing peer victimization, particularly among adolescent girls, which, in turn, contributed to prospective levels of depressive and anxiety symptoms. In the present study, 355 early adolescents (ages 12–13; 53 % female; 51 % African American) who were part of the Adolescent Cognition and Emotion project completed measures of emotional clarity, depressive symptoms, and anxiety symptoms at baseline, and measures of peer victimization, depressive symptoms, and anxiety symptoms at follow-up. Moderation analyses indicated that deficits in emotional clarity predicted greater peer victimization among adolescent girls, but not adolescent boys. Moderated mediation analyses revealed that deficits in emotional clarity contributed to relational peer victimization, which, in turn, predicted prospective levels of depressive and anxiety symptoms among adolescent girls, but not boys. These findings indicate that deficits in emotional clarity represent a significant risk factor for adolescent girls to experience relational peer victimization, which, in turn, contributed to prospective levels of internalizing symptoms. Thus, prevention programs should target deficits in emotional clarity to prevent peer victimization and subsequent internalizing symptoms among adolescent girls.     

Material Feminism and Epigenetics: A ‘Critical Window’ for Engagement?

ABSTRACT

While there is increasing interest in gender and sex issues in the medical field, most research in medicine can still be defined as operating with a binary of sex/gender. Epigenetics presents a marked challenge to such binaries as it operates across many tightly held boundaries, blurring the lines between the biological and social. Feminist scholars are paying attention to this new field and reconsidering relationships between the politics of matter, biologies and the social in new ways. The aim of this article is to investigate how theoretical insights from material feminism might enhance epigenetic research. Rather than repeat important critical arguments that point to the dangers of reductionism and biological essentialism, we make a case for examining the ways that material feminism can engage with epigenetic research by broadening ideas of reproduction (beyond in-utero effects) to relational and political views of gender and sex within a materialist framework. In conclusion, we suggest that a focus on material-discursive co-formations has the potential to contribute to an established body of feminist theory and science work; increasing awareness of the intra-action of gender and sex in relation to exposures, and increasing political leverage in supporting health-enhancing environments.