Mental health policy in the liberal state: the example of the United States

Mental health policy arises out of the interaction of many different variables. These include (but are not limited to) the composition of the population of persons with severe mental illnesses; the means of dealing with disease and dependency; concepts of the etiology and nature of mental disorders; the organization and ideology of psychiatry; funding mechanisms; and existing popular, political, cultural, and professional values. But an often neglected but crucial factor in shaping policy is the very structure of the American political system, which played a crucial role in shaping mental health policy. Rather than emphasizing the neo-liberal theory and its accompanying hostility toward "unsuccessful" people and disdain of welfare, this article suggests that an understanding of mental health policy in the latter half of the twentieth century is better served by an examination of what actually happened. Theory, however attractive, rarely can encompass the messy data of reality.     

Using the state to change society: The example of ‘domestic violence’

North American research on the policing of ‘domestic violence’ has been very influential among policy makers in Great Britain. In particular, research which purports to verify the deterrence value of arrest has prompted the establishment of over thirty domestic violence units in London and similar initiatives elsewhere in Britain. The paper will outline the nature of the traditional police response to ‘family violence’ in London and the nature of the experimental innovations. Changes in police practice with regard to this type of violence will be put in the context of the organizational constraints and possibilities of policing. Finally, changing police responses to domestic violence will be evaluated in terms of the debate over the possibility of using the state or its organs to achieve social change.     

Paternity analysis when the putative father is missing: first case in Chile.

Genetic marker analysis is a powerful tool for solving paternity-related problems when the putative father is missing. This report describes the first time this approach was employed in Chile to solve such a problem. In the case presented, the alleged father was missing as a result of the political detentions that took place in Chile during 1973. It was not possible to obtain any biological sample from him because he was missing. Thus, the case was resolved by means of genetic marker analysis of the alleged father's close relatives.     

It is and it is not: the Importance of Context when Exploring Gender Differences in Perpetration of Physical Partner Violence

The literature on gender differences in perpetration of physical partner violence (PV) consists of two opposing camps: those who emphasize gender symmetry, and those who emphasize gender asymmetry. We propose a both/and approach to this controversy by suggesting that the issue of gender symmetry is complex and dependent upon context. Furthermore, we discuss how the role of personal investment in political agendas contributes to this divide in the literature. We argue that this both/and approach to inquiry will significantly contribute to the understanding of gender differences in perpetration of PV, as well inform the development of interventions for PV.     

Breaking up is hard to do: the economic impact of provisional funding contingent upon evidence development

Funding contingent upon evidence development (FED) has recently been the subject of some considerable debate in the literature but relatively little has been made of its economic impact. We argue that FED has the potential to shorten the lag between innovation and access but may also (i) crowd-out more valuable interventions in situations in which there is a fixed dedicated budget; or (ii) lead to a de facto increase in the funding threshold and increased expenditure growth in situations in which the programme budget is open-ended. Although FED would typically entail periodic review of provisional or interim listings, it may prove difficult to withdraw funding even at cost/QALY ratios well in excess of current listing thresholds. Further consideration of the design and implementation of FED processes is therefore required to ensure that its introduction yields net benefits over existing processes.     

Schiavo's lessons for health attorneys when good law is all you have: reflections of the special guardian ad litem to Theresa Marie Schiavo

Rarely have all the branches of federal and state government converged upon a single issue, a single person as they did in the tragic and acrimonious case of Theresa Maria Schiavo. In late 2003, the Florida Legislature passed what become known as "Terri's Law" and in Spring of 2005, Congress and the President of the United States sought to directly intervene in the care of the severely brain damaged woman. During that period, the state and federal court systems, through the highest courts in both venues, ruled on Ms. Schiavo's life, resulting in the removal of an artificial feeding tube and her death during Easter week. The legal and medical issues in this complex, politically and emotionally charged case continue to raise important questions for health attorneys. In this Article, Professor Wolfson, who served as the legislatively mandated, court appointed special guardian ad litem for Theresa Schiavo in late 2003, provides a distinctive first-person overview of the Schiavo case.