Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.     

State-Sponsored Social Control of Illegitimate Social Movements: Strategies Used to Financially Damage Radical Islamic,Terrorist-Labeled Organizations

This article documents strategies and tactics of social control used by the U.S. government to detect and deter financing of radical Islamic, terrorist-labeled organizations. Through grounded theory, social control strategies were identified based on data from congressional committee hearings from 1999 to 2011. Findings revealed the presence of nine such strategies: (1) discover sources of funding, (2) deny or restrict access to money, (3) establish information networks and communication norms, (4) create derogatory labels, (5) influence the media, (6) impose legal sanctions, (7) offer financial incentives, (8) construct a shared collective identity, and (9) force terrorist-labeled organizations on the defensive.     

The Relational Dynamics of World Bank Survey Missions

This article demonstrates that World Bank internal learning has led to significant changes in how the organization interacts with government officials through survey missions. Reviewing evidence of institutional learning and associated changes in practice and focusing on the relational modes being manifest in technical assistance, the article identifies three main phases of World Bank survey missions: general survey missions (1940s–1960s), country assistance strategies (1990s–2000s), and country partnership frameworks (2010s). Overall, World Bank reviews have repeatedly highlighted the importance of non-hierarchical interactions between Bank staff and country officials. In recent years, practice has begun to catch up with these operational insights.     

From resistance to military institutionalisation: the case of the peshmerga versus the Islamic State

This study explores differing strategies and tactics employed by the peshmerga forces against the Islamic State (IS). This experience highlights a number of issues which are relevant to contemporary security debates. Firstly, the struggle highlights important aspects of the development of the peshmerga and their strategies as an organised non-state military force (defending as it does the Kurdistan Region in Iraq). Secondly, the peshmerga–IS conflict is an important case study of small wars. The strategy and tactics used here are therefore useful empirical references about the effectiveness of military force in counter-insurgency. Finally, the war against IS united the peshmerga forces, possibly for the first time, and effected a radical change in the Kurdish use of military tactics, including the shift from defensive to offensive strategies. The article examines the methods employed by the peshmerga forces against IS, explains why the cases of Makhmour and Shingal stand out as tipping points, and discusses the evolution of Kurdish defence capacity.     

Suicidal ideation and suicide attempts among Australian adults

Too little is known about suicidal thoughts and behaviors at a population level to recommend appropriate preventive strategies. Using data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), this study examined rates of, and risk factors for, suicidal ideation and suicide attempts. For 10,641 respondents, the 12-month and lifetime cumulative incidence rates of suicidal ideation were 3.4% and 16.0%, respectively; the 12-month and lifetime cumulative incidence rates of suicide attempts were 0.4% and 3.6%, respectively. 12-month ideation was associated with anxiety disorders (relative risk ratio [RRR] = 3.51; population attributable risk percent [PAR%] = 19.6%), affective disorders (RRR = 11.94; PAR% = 38.8%) and substance abuse disorders (RRR = 1.85; PAR% = 6.1%). Attempts in the past 12 months were also associated with anxiety disorders (RRR = 7.06; PAR% = 37.0%), affective disorders (RRR = 12.24; PAR% = 39.5%), and substance abuse disorders (RRR = 2.09; PAR% = 7.7%). Age, marital status, and disability were associated with ideation; marital status and employment status with attempts. Approximately 12% of ideators in the sample progressed to making an attempt; employment status was the only significant predictor. Reducing suicidal ideation and attempts requires a multi-faceted approach that targets those with mental illness but also adopts population-based strategies that address other factors, such as unemployment.     

How Did the Automotive Component Suppliers Cope with the Economic Crisis in Hungary?

This article studies the reaction of automotive component suppliers in Hungary to the 2008–2009 economic crisis. We find that the global suppliers viewed the crisis as an opportunity to reinforce the competitiveness of their Hungarian affiliates by engaging in product and process upgrading, and upgrading through research and development. The regional suppliers combined defensive strategies aimed at reducing costs with offensive measures in the form of product upgrading, production upgrading and expansion into new markets. The local suppliers reduced costs and reduced their workforce, but also reacted offensively by expanding into new markets, upgrading their activity and collaborating with other local suppliers.     

Confronting Coup Risk in the Latin American Left

Military coups d'état have become dramatically less frequent in Latin America over the past 20 years, leading many analysts to conclude that the risk of coups in the region today is negligible. Yet we observe that a particular subset of presidents in the region—namely, those commonly associated with the radical left—pursue a wide range of “coup-proofing” behaviors, primarily in the way that they manage relations with their militaries, but also in their political rhetoric. Our goal in this article is to explain why some Latin American presidents spend precious resources on coup-proofing. First, even as we demonstrate that coup activity is significantly diminished across the region as a whole, we offer evidence to suggest that coup risk is quite real in countries with radical left presidents. Second, we identify several specific strategies that these presidents have pursued to minimize coup risk. We explain the coup-proofing rationale behind each of these strategies and document their use in Venezuela, Bolivia, and Ecuador. Third, we show that no similar set of strategies or policies has been pursued by moderate leftist or more conservative presidents in the region. We infer from these empirical patterns that radical left presidents have undertaken substantial efforts to maintain military allegiance and to mitigate coup risk precisely because they recognize the possibility of military intervention. In our conclusion, we suggest that these strategies may confer a short-term benefit for the presidents who implement them, but they are likely to have negative consequences for the long-term stability of democratic institutions.     

Risk Avoidance Strategies After Sexual Assault: A Dyadic Study of Survivors and Informal Support Providers

Interview data from 45 matched pairs of survivors disclosing sexual assaults and their primary informal support provider (friend, family, significant other) were used to explore survivor-support provider perspectives on self-protective behaviors survivors and those close to them take to protect themselves from future assaults. Strategies for reducing risk taken by survivors included behavioral changes, security measures, self-defense strategies, avoiding alcohol or drugs, and protecting others. Support providers play critical roles by encouraging survivors to pursue risk avoidance strategies, and employing these strategies themselves. Counseling and prevention implications are drawn in the context of risks facing survivors trying to avoid further sexual victimization.     

DOCTORS AND DEFICITS: REGULATING THE MEDICAL PROFESSION IN FRANCE

This paper seeks to analyze the political factors involved in health care delivery in a modern industrial welfare state and to illustrate how the transformation of the French state has affected the policymaking environment surrounding this particular issue. Cultural traditions rooted in the nineteenth century seriously circumscribed the role of the state in de-the conditions of medical practice. Nonetheless, pressures emerging since 1945 for the provision of a wide array of social services have drawn the state into ever closer regulation of the health sector. The economic constraints of the past decade resulted in state-imposed cost-containment policies which accentuated the trend toward politicization of health care. In consequence, and despite the rear-guard defensive tactics of the medical profession, the French state has succeeded in firmly establishing its primacy in this major area of public policy.     

Self-reported suicidal behavior in juvenile offenders in custody: prevalence and associated factors

Suicide rates in prisons in England and Wales are high, including those in juvenile detention centers. Previous deliberate self-harm (DSH) is the strongest predictor of suicide in the general population. There is limited information on how many juvenile offenders (15 to 18 year-olds) have a history of DSH at the time of entering custody, or on factors associated with previous DSH. We aimed to determine the prevalence of previous DSH and suicidal ideation in a population of juvenile offenders in custody and to identify factors associated with DSH and suicidal ideation. Seven out of 45 subjects (15.6%) reported an act of DSH in the past. Twelve (26.6%) reported past suicidal ideation. Peer relationship difficulties and sexual abuse were significantly associated with DSH (p < 0.05). Other factors showed a trend toward being more common among those with DSH, but the premature ending of the project by the juvenile detention center prevented full investigation of the extent of DSH and associated factors. Nevertheless, the results indicated a much higher rate of DSH in this population than in young males in the community. A larger joint project with juvenile detention centers is required to confirm the extent of previous DSH at the time young offenders are admitted, and the associated risk factors, in order to assist prevention and intervention strategies.     

Therapeutic mechanisms of suicidal ideation: the influence of changes in automatic thoughts and immature defenses

The treatment processes associated with reduced suicidal ideation have received little research attention. This study evaluates the influence on suicidal ideation of theory-based intrapsychic processes: maladaptive cognition and defensive style. Thirty-three community mental health patients completed questionnaires at two time points. Decreases in automatic thoughts were a strong correlate of decreased suicidal ideation, and decreases in immature defenses were a moderate strength correlate. These relationships remained significant even when controlling for initial level of depression. The theorized mechanisms of cognitive-behavioral and psychodynamic therapy had the expected effects on suicidal ideation. The strong association of decreased maladaptive cognitions with decreased suicidal ideation supports further development of cognitive-behavioral suicide interventions and clinical use of cognitive interventions. Psychodynamic processes in suicidal ideation and behavior warrant further exploration.     

Resilience and disaster risk reduction: reclassifying diversity and national identity in post-earthquake Nepal

This paper discusses disaster resilience in the context of disaster risk reduction. It focuses on how the Nepali state, through disaster risk reduction and resilience strategies, is reinventing the ‘diversity’ question in Nepal. Disaster risk management and disaster risk reduction are being used to create a specific form of national identity that paradoxically both segregates and excludes ethnic and traditional communities through a variety of strategies of paternalism and inclusivity. The emerging state-led use of exploiting and capturing ethnic and indigenous ‘traditional knowledge’ is part of the government’s disaster risk strategy. This is sanctioned by multilateral bodies, which further legitimates subtle practices of exclusion through state-led monitoring. This has wider implications for contested narratives on Nepali democracy and federalism.     

COLLABORATIVE CAPACITY AND STRATEGIES IN AREA‐BASED INITIATIVES

Despite considerable evaluator investment in examining partnership activity in UK public policy initiatives, little attention has been paid to the role of strategy in supporting the generation and harnessing of the resources necessary to collaborate effectively. This paper focuses on one of the first New Labour initiatives – Health Action Zones (HAZ) – and draws on national evaluation findings to delineate local strategies, assess their application in practice and reflect on their contribution to collaborative action. The paper argues that even within nationally constrained policy initiatives there is sufficient flexibility for local actors to select strategies to steer collaborative effort, but these strategies are informed by their operating context and are liable to change in response to experience and changes in context. In addition, the evaluation findings suggest that effective strategies are those which harness collaborative capacity across a range of dimensions. The paper concludes by identifying implications for theory, policy and evaluation.     

In practice - Modernising the Council: A Personal Reflection

Joined up governance has emerged as one of the key policy discourses of the modernisation of local government under New Labour. Community strategies are one of the principal policy tools that are intended to deliver more joined up governance at the local level. This paper draws upon early findings from the national formative evaluation of community strategies to consider the extent to which community strategies are delivering more joined up governance in practice. The paper concludes by highlighting a number of tensions in the role of community strategies in delivering a more joined up local agenda.     

Long- and short-term risk factors in the prediction of inpatient suicide: review of the literature

The prediction of suicide remains a major challenge for health care professionals in inpatient settings. A clearer identification of factors specific to inpatient suicide is required to improve both practice and research within this area. This paper provides an overview of the inpatient suicide literature to date focusing on two particularly salient themes: Long term and short term prediction of suicide. Since the concept of short-term suicide risk dominates clinical practice, issues in relation to dynamic risk factors are emphasized.     

STRATEGY,STRUCTURE AND PROCESS IN THE PUBLIC SECTOR: A TEST OF THE MILES AND SNOW MODEL

We present a comprehensive empirical application of the Miles and Snow (1978) model of organizational strategy, structure and process to the public sector. We refine the model by distinguishing between strategy formulation and implementation, and applying it to 90 public service organizations. Although the empirical evidence shows that organizational strategies fit the Miles and Snow categories of prospector, defender and reactor, the relationship between these strategies and organizational structures (for example, centralization) and processes (for example, planning) is less consistent with their model. Conclusions are drawn for public management theory and practice.     

Critical peacebuilding and the dilemma of difference: the stigma of the ‘local’ and the quest for equality

Recent research has revealed the need to include and understand local actors in order to improve the effectiveness of peacebuilding. According to these analyses, peacebuilding could become more respectful of cultural differences thanks to a genuine engagement with the specificities of the local. Empirical studies of the ‘different’ local have thus flourished in the field with the ambition of countering the universalist tendency of traditional peacebuilding. Through the use of the concept of ‘dilemma of difference’, this article challenges this intuitive argument and argues that these approaches risk reproducing a stigma attached to the ‘different’ local. Indeed, emphasising difference in order to ensure its respect means separating and reifying ‘it’ as a deviation from the norm(al). As such, this analytical strategy is likely to recreate the stigma that contributed to the exclusion of local actors in previous peacebuilding practice and research. In contrast, I outline three strategies for studying difference differently in peacebuilding: focusing on the institutional arrangements that enabled specific differences to emerge and become visible; recognising that these differences are internal to peacebuilding (and thus an unlikely source of alternative and emancipation); and revealing the unstated and implicit Self for/from whom local difference is relevant.     

PARALLEL,TRANSFER OR COLLABORATION STRATEGY OF RELATING THEORY TO PRACTICE? A CASE STUDY OF PUBLIC MANAGEMENT DEBATE IN GERMANY

The relationship between theory and practice is essential to ‘applied sciences' such as public management. However, the current debate on this topic lacks empirical substantiation. Here I develop a methodology for the indication of how the theory‐practice gap is actually addressed in a given subfield of management enquiry. I distinguish three archetypal strategies of relating theory to practice and develop several bibliometric indicators for them. Subsequently, I apply this methodology in a case study on the German public management debate from 1989 to 2005, a study based on bibliometric data of some 900 articles on public management. As will be demonstrated, in Germany, the theory‐practice divide is predominantly framed as a problem of knowledge transfer between scholars and practitioners. Reflections on the institutional structures of public management in Germany make it clear why the transfer strategy is chosen, thus proving the validity of the suggested indicators.     

Are transformational and transactional types of leadership compatible? A two‐wave study of employee motivation

Transformational and transactional leadership strategies have become prominent in public administration research, but it is unclear whether they are compatible or whether they could undermine each other. We examine the combined and interactive effects of transformational and three types of transactional leadership (contingent verbal rewards, material rewards, and sanctions) on employee work motivation, conceptualized as work engagement and intrinsic motivation. Panel analyses using repeated measures of 385 leaders and 3,797 employees show that transformational leadership and contingent verbal rewards increased employee motivation. However, simultaneous use of contingent material rewards undermined the benefits of transformational leadership. Thus, the motivational potential of service‐ or community‐oriented visions was undercut when leaders also appealed to extrinsic material motives. This could help explain why financial incentives do not always have the expected benefits in public organizations. We therefore argue that research and practice should pay more attention to how different leadership strategies work in combination.     

Defensive Propaganda and IRA Political Control in Republican Communities

The IRA's training manual, the Green Book, stresses the importance of preparing their sympathetic audiences for impending attacks through propaganda campaigns that vilify the intended target and otherwise support the moral legitimacy of the action. Such “defensive propaganda” creates the conditions under which a population with normal moral values can either support or be apathetic toward terrorist actions. Or drawing on terminology introduced by Albert Bandura, the strategy facilitates the community's moral disengagement from an inherently immoral action and in doing so protects the popular support upon which the republican movement relies for its military and political existence. This article examines the IRA's use of defensive propaganda against members of their sympathetic community and introduces a conceptual overview of the structure of such campaigns.