Deliberate self-harm patients who discharge themselves from the general hospital without adequate psychosocial assessment

Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.     

Parallels Between Crime and Terrorism: A Social Psychological Perspective

Although the psychology of terrorism is far from a neglected subject, there is still much to learn. “Ordinary” criminals remain enigmatic but have proved a far more accessible population for research purposes. This article bridges the gap between the study of crime and contemporary terrorism by examining the parallels between the two. Significant similarities are shown to exist between terrorists and organized as well as low-level criminals, including activities performed and systems of social influence and organization. Processes of social identification are universally important to varying degrees; however, specific differences in identity may represent key distinguishing features between groups. Although further comparisons utilizing more restrictive samples are necessary, attention is drawn to the sometimes underutilized potential that criminological research holds to act as a point of reference for the investigation of terrorism.     

Predicting suicidal risk in a cohort of depressed children and adolescents

Background: In children and adolescents with a depressive disorder, predicting who will also go on to exhibit suicide-related behaviors (SRBs), including suicide attempt or self-harm, is a key challenge facing clinicians. Aims: To investigate the relative contributions of depressive disorder severity, hopelessness, family dysfunction, and perceived social support to the risk of suicide-related behaviors. Methods: This was a cross-sectional study of a group of 10-16-year-olds with major depressive disorders and dysthymic disorder. Results: Child-rated depressive disorder symptom severity emerged as the greatest predictor of risk. Hopelessness and family dysfunction were also significant predictors of SRBs. In combination these variables were strong predictors, accounting for 66% of the variance. This is a cross-sectional study design, rather than longitudinal, therefore risk prediction over time was not possible. Conclusions: Understanding the child and adolescents depressive disorder symptom severity from their perspective, their level of hopelessness, as well as their family context is critical in understanding the risk of SRBs. These findings may help to provide direction for targeted interventions to address these clinical risk factors.     

Income Inequality and Redistributive Spending: Evidence from Panel Data of Texas Counties

Abstract

The relationship between redistributive spending and income inequality has been of interest to researchers for several decades. Existing literature has largely focused on country-level studies and may be broadly divided into two groups: studies that find a positive relationship between the two and studies that find a negative relationship. The positive association is usually explained through the median voter theory and the negative association through the social insurance theory.

This study offers a test of the median voter and social insurance hypotheses by examining the relationship between economic inequality, voter turnout and redistributive spending at the sub-national level among the 50 largest counties in Texas over years 2006 to 2012. One of the advantages of using a regional sample is that counties are relatively more homogeneous and allow for the collection of better records across time. Random effects models suggest that income inequality is positively associated with redistributive spending. The study improves our understanding of the patterns of redistribution at the sub-national level and highlights the importance of careful inter-temporal modelling of relationships between redistributive spending and inequality.     

Understanding self-harm and suicide websites: a qualitative interview study of young adult website users

Self-harm and suicide websites have been heavily criticized both in the literature and the wider media, despite the fact that very little is known about them. To date, no study has interviewed users of these sites about them. This qualitative study aims to explore the accounts of young adults who engage in self-harming and suicidal behaviors and use websites dedicated to these issues, in order to develop a broader understanding of these websites and to identify potential implications for future research. In-depth interviews were conducted via e-mail with 10 participants, who were recruited directly from self-harm and suicide websites. Using discourse analysis, we identified three main ways in which participants wrote about the sites. They constructed them as sources of empathy and understanding, as communities, and as a way of coping with social and psychological distress. These discourses gave users access to important, socially valued identities, such as being understood, belonging to a community and coping with their problems. If health professionals and researchers hope to understand people who use self-harm and suicide websites, and engage them in their services, they must take a more balanced view and not focus solely on the possible risks associated with using such sites.     

Sense of control: potentials for intervention.

A substantial amount of research has demonstrated that the sense of control is associated with numerous positive outcomes, including good health. Many aspects of the personal and social conditions of old age influence the control-health relationship. Environmental events associated with old age often place limits on the range of outcomes that are attainable by older people. Moreover, the association between control and indicators of health status may be altered by old age. Finally, old age may influence the relationship between control and various health maintenance behaviors. Aspects of the sense of control can be altered with small interventions that can enhance health specifically and the quality of aging in general. Given the relationship between control and health in old age, several possible factors may help explain or mediate this relationship including mechanisms of behavioral and cognitive change, and physiological adaptations. Despite the largely positive outcomes associated with increased sense of control, negative outcomes are also possible, especially when control is not desired or entails too much responsibility or other demands.     

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.     

The role of perfectionism and autobiographical memory in a sample of parasuicide patients: an exploratory study

The main objective of this study was to investigate the relationship between social perfectionism, overgeneral autobiographical memory recall, and psychological distress (hopelessness, depression/anxiety, and suicidal ideation) in a sample of parasuicide patients. Forty patients who had been admitted to a Scottish hospital following an episode of deliberate self-harm participated in the study. The participants completed the autobiographical memory task and a battery of self-report measures (multidimensional perfectionism, hopelessness, depression/anxiety, and suicidal ideation). The results showed that repetitive self-harmers were more overgeneral in their recall of positive autobiographical memories than were first-time self-harmers. Hierarchical regression analyses showed that socially prescribed perfectionism interacted with overgeneral recall of both positive and negative memories to predict suicidal ideation/depression. The findings are discussed in relation to previous research.     

The IMF and the mobilisation of foreign aid

Particularly in the context of the Millennium Development Goals, there has been much discussion of the association between the International Monetary Fund and bilateral aid flows. What role should the Fund be playing in helping to achieve the MDGs? Some observers have suggested that the Fund should seek to reduce its role in poor countries and should be minimising its own lending. They see aid donors taking on a larger role and present the IMF and aid donors as substitutes. Others envisage a much bigger lending role for the Fund. This may hint at complementarities. Although this discussion raises important policy issues there are very few studies that examine the relationship empirically. This paper attempts to help fill this gap. It explores the extent to which the IMF has had a catalytic effect on Official Development Assistance and the potential channels through which catalysis might work. It finds strong evidence of a positive association and suggests that this may have more to do with conditionality than with the provision of IMF resources. But it may not represent catalysis in the conventional sense. There is a synergy between the IMF and bilateral aid that may yet be more fully developed and exploited.     

Social modeling in the transmission of suicidality

Evidence from twin, adoption, and family studies suggests that there is strong aggregation of suicidal behaviors in some families. By comparison, the role of social modeling through peers has yet to be convincingly established. This paper uses data from four large studies (the WHO/EURO Multicentre Study on Suicidal Behaviour, the WHO/SUPRE-MISS, the CASE study, and the Queensland Suicide Register) to compare the effects of exposure to fatal and nonfatal suicidal behavior in family members and nonfamilial associates on the subsequent suicidal behavior of male and female respondents of different ages. Across all studies, we found that prior suicidal behaviors among respondents' social groups were more important predictors of suicidal behavior in the respondents themselves than previous research had indicated. Community-based suicide attempters in the WHO SUPRE-MISS had higher rates of exposure to prior suicide in nonfamilial associates than in family members. In an adolescent population, exposure to prior fatal suicidal behavior did not predict deliberate self-harm when exposure to nonfatal suicidal behavior (both familial and social) were controlled for, but exposure to nonfatal suicidal behaviors in family and friends was predictive of deliberate self-harm and suicide ideation, even after controlling for exposure to fatal suicidal behavior. The potential impact of "containment" of information regarding suicidal behaviors as a prevention initiative is discussed, in light of information behavior principles of social marketing.     

How Neopatrimonialism Affects Tax Administration: a comparative study of three world regions

Neopatrimonialism is a concept that has predominately been applied to describe governance in sub-Saharan Africa. Recently, however, it has also been used to describe governance in states from other world regions. However, scholars have rarely attempted systematically to compare neopatrimonial rule in different regional settings. This paper aims to narrow this gap by examining the effect of neopatrimonialism on the tax administration as a core state function in six countries from three different world regions: Argentina, Venezuela, Indonesia, the Philippines, Kenya and Zambia. We conclude that neopatrimonialism is a valuable concept for comparative area studies with the potential to foster dialogue on the ‘state in operation’ across the regional divide. Nevertheless, several indicators are more valid for some world regions than for others. We find that there is no systematic relationship between neopatrimonial trajectories and the strength of tax administration. Individual actor decisions influence the outcomes of neopatrimonialism substantially.     

Suicidal behavior in South Asians in the UK

Rates of deliberate self-harm have been reported to be higher among South Asians, especially women, in the UK. Two studies collected information on inception rates of deliberate self-harm in the UK and reported that rates of attempted suicide are much higher among South Asian women especially those aged 18-24. These rates are associated with high rates of cultural alienation and previous attempts. The implications of cultural conflict are discussed in this context. In addition, a hypothetical model of interrelationship of factors for both adults and adolescents is described.     

Under their “control”: Perceptions of Traffickers’ Power and Coercion Among International Female Trafficking Survivors During Exploitation

Despite an increase in knowledge about human trafficking, little is understood about interpersonal power dynamics between traffickers and their victims; particularly in relation to coercion. Understanding victims’ perceptions of power is critical to developing trauma informed, targeted services for prevention, intervention, and aftercare services for survivors. This paper explores human trafficking victims’ (n = 31; adult, female, international) perceptions of traffickers’ interpersonal social power as influenced by prior entrapment factors and traffickers’ characteristics during the controlling period of the exploitation, the “maintenance phase”. Findings from this study reveal that entrapment factors and shared characteristics between victims and traffickers influenced perceptions of specific kinds of power. Moreover, findings suggest that more investigation is need to explore how much influence dynamics outside of the trafficking relationship (i.e., social and environmental factors) have on victims’ perceptions of traffickers’ power. Further, results suggest a need for anti-trafficking professionals to be particularly cognizant that victims may perceive individuals in positions of power such as social service providers and law enforcement, as similar to their traffickers.     

Reforms to enhance accountability and citizen involvement: a case study of the hong kong hospital authority

The article begins by examining current issues in thinking about accountability, citizen involvement and empowerment. The discussion then moves to the particular context of Hong Kong. Recent reforms to public hospital services are reviewed in the light of the territory's traditional values of paternalistic bureaucracy and minimal citizen involvement. It is shown that despite good intentions to enhance public accountability and cgitizen involvement, in practice there has been little substantive change in the distribution of power between the ruling elite, health care professionals, and the actual service users. Whilst more information about service performance may now be available, opportunities for citizen involvement and representation continue to be carefully managed by the administration. The net result is that only a very few members of the lay public have been appointed to the new bodies that are now responsible for the governance of the public hospitals. Nearly all of those appointed to such bodies are unrepresentative of the normal service users being drawn, instead, from members of the mostly non-public hospital users - namely Hong Kong's very wealthy professional and business elites. For most of the general public, therefore, the reforms have been less about empowerment and involvement and more about informing them of the changes that have been introduced or of educating them so that abuses of the system can be reduced, or their help enlisted in locally organized fund-raising functions. The article concludes that however well-meaning the reformers might have been in terms of endeavouring to enhance accountability and citizen involvement, the impact of such efforts are likely to be seriously limited whenever underlying administrative or social values conflict with those that ostensibly guide the reforms.     

Capitalist Philanthropy and Hegemonic Partnerships

Over the past 10 years individual capitalists have become increasingly involved in philanthropy, setting up charitable foundations targeted at helping to reduce social problems such as poverty, disease and food security. This form of neoliberal capitalist philanthropy is both politically and ideologically committed to market-based social investment through partnerships, to make the market work or work better for capital. The new structures of philanthropy have received much praise in the media for imbuing capitalist business principles into the non-profit sector and for their potential for social transformation. While philanthropic activities may be considered worthy in themselves, this article examines the relationship between giving and business interest and the agency associated with neoliberal capitalist philanthropy. It questions partnerships between philanthropists and private corporations and their motivations for engaging in poverty-related philanthropy. The discussion focuses on capitalist philanthropic foundations' involvement in the process of agricultural commodification in sub-Saharan Africa through the New Green Revolution and genetically modified (gm) technologies.     

PERFORMANCE, EVALUATION AND THE NHS: A CASE STUDY IN CONCEPTUAL PERPLEXITY AND ORGANIZATIONAL COMPLEXITY

This paper adopts a comparative perspective towards the analysis of performance evaluation in the National Health Service. The NHS, it is argued, is best seen as an organization which is not unique but which ranks high on a number of dimensions: uncertainty about the relationship between inputs and outputs; heterogeneity of activities and aims; the ambiguity of the available information. These factors help to explain why performance evaluation in the NHS is both conceptually and organizationally problematic, and fragmented and professionalized in practice. By looking at the same factors in other organizations, it may be possible to start constructing a framework for examining the problems of performance evaluation in different settings.     

Health and Local Government Partnerships: The Local Government Policy Context

This article explores partnerships between health and local government from the local government perspective; placing developments between the two sectors within the wider context of the Local Government Modernisation agenda. A number of commentators have argued that developments since 1997 – in particular the emphasis on community leadership and the new power of well-being – have provided local authorities with an exciting opportunity to reclaim a more pivotal role in shaping the health agenda at the local level. Such a role would be based on promoting well-being and a good quality of life, in keeping with the social model of health. In the longer run this reclaimed role could produce a shift in what has become the main boundary between health and local government: the health–social care boundary. The article reviews developments in three key areas: the health–social care boundary; the core components of the Local Government Modernisation Agenda; and the relationship between regeneration and health. The paper concludes that although progress has been made in regeneration and health and there is potential in elements of the Modernisation Agenda that these do not equate to a paradigm shift in local government's perspective on health. Instead, the social care boundary continues to dominate local government's vision of health. Central to this picture of modest progress is the substantial barrier to more radical change provided by the performance management frameworks governing both sectors.     

Degrees of Separation: Informal Social Protection,Relatedness and Migration in Biswanath,Bangladesh

This paper argues for a more precise and context specific understanding of mechanisms of ‘informal social protection’ in Bangladesh. The context is a ‘Londoni’ village in Sylhet which has high levels of internal and overseas migration. The economic boom caused by the latter provides important employment opportunities for people from much poorer areas of Bangladesh, who have moved into the area. Yet, as our findings show, the extent to which the poor can call upon the help and protection of rich overseas migrants depends upon the degree of closeness to, or separation from, them. This is marked both through real and fictive kinship as well as geography: those that come from nearby become ‘our own poor’, whereas those from further away are treated as ‘outsiders', not qualifying for significant ‘help’. As the paper argues, access to hierarchically ordered places is vital for the sustainability of precarious livelihoods. Yet whilst geographical movement is an important survival strategy for the poor, it is only when social relations are established with wealthy patrons that it can be said to contribute to informal social protection.     

The state of the 'state' in globalization: Social order and economic restructuring in Malaysia

This article asserts that, instead of anticipating or searching for indications of the 'end of the state' in an era of neoliberal globalization, it is more fruitful to examine the relationship between the state and social order, because of the potential to discern the conditions and consequences in which occur the ruling elite's and social forces' resistance to and/or alliance with, transnational capital. A case study of Malaysia is presented to demonstrate the complex and even contradictory ways in which social order is regulated that allows the state to manage demands emanating within and beyond the country. Specifically, the analysis focuses on the different historical junctures in which changing bases of state power, paths of development, and official manipulation of social identities converge in the regulation of social order that facilitates capital accumulation while maintaining state legitimacy in a multi-ethnic context.