The Impact of Insanity Acquittees on Missouri's Public Mental Health System

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouri's insanity acquittees on the state's public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems.     

Compulsory psychiatric care in Sweden: development 1979-2002 and area variation

As in many other countries, the Swedish legislation on compulsory psychiatric care has been revised several times during the last four decades. Great regional differences within the country in the use of compulsory psychiatric care have been reported. The aims of this study were to describe the development of compulsory psychiatric care in Sweden 1979-2002, and to analyse differences between two groups of counties, one group with high and one with low civil commitment rates, in terms of psychiatric care structure, resources and processes. Data on civil commitments and forensic psychiatric care in Sweden 1979-2002 were collected from public statistics. At least one responsible person in leading position (administrative manager or chief psychiatrist) in each of the included counties was interviewed. The total number of involuntarily hospitalised patients decreased about 80% between censuses in 1979 and 2002, but the rates of forensic patients were unchanged. No clear-cut differences were found in the analyses of structure, resources and processes of psychiatric services between counties with high and counties with low levels of compulsory care. The equality before the law may be questioned. The importance of leadership is emphasised for future analyses.     

The Swedish mental health system. Past, present, and future

In sum, the evolution, strengths, and weaknesses of the Swedish mental health system are quite similar to mental health systems in other Western countries; early reliance on stand-alone, state psychiatric hospitals, followed by deinstitutionalization and development of largely ambulatory, community mental health care. This evolution has been complicated in Sweden by the multiple levels and system components, the state, the county councils and the municipalities. Unlike the United States, but similar to Britain, community mental health care in Sweden is provided by two systems; treatment (and forensic services) by the county councils' mental health providers, and generic services by the municipalities' social welfare system. The resulting division of roles and responsibilities creates a strong need for collaboration and coordination of activities on behalf of consumers. It can also have the unintended disincentives to serving more difficult consumers. All these difficulties not withstanding, the Swedish mental health system has made major stride in providing quality, appropriate care.     

PSYCHIATRIC HOSPITAL CAPACITY,HOMELESSNESS, AND CRIME AND ARREST RATES*

As a result of developments in pharmacology, stricter standards for involuntary commitment, and changes in public expenditures, there has been a dramatic decline in the capacity of public psychiatric hospitals to maintain America's most severely mentally ill. Psychiatric deinstitutionalization has led to an increased presence of persons with mental illness in urban areas, many “falling through the cracks” of community‐based services. This is hypothesized to have contributed to homelessness, crime, and arrests. Individual‐level research has documented disproportionate and increasing numbers of mentally ill persons in jails and prisons. It has also found higher rates of violence and arrest among persons with mental illness compared to the general population. This study takes a macro‐level social control approach and examines the relationships between psychiatric hospital capacity, homelessness, and crime and arrest rates using a sample of eighty‐one U.S. cities. I find that public psychiatric hospital capacity has a statistically significant negative effect on crime and arrest rates, and that hospital capacity affects crime and arrest rates in part, through its impact on homelessness. In addition, I find no crime‐reducing effect of private and general psychiatric hospital capacity.     

Prisoners with psychosis in England and Wales: diversion to psychiatric inpatient services?

The prevalence of psychosis among prisoners in England and Wales is ten times that in the household population and UK government policy is that prisoners should receive equivalent care to those in the community. This study investigated the implications of policy to divert more from the criminal justice system for psychiatric treatment. Psychotic prisoners were compared with psychotic persons in households and with other prisoners in two surveys of psychiatric morbidity in representative samples of the UK population. Psychotic prisoners were younger, more from ethnic minorities, with comorbid anxiety, substance misuse, ASPD, and childhood behavioural problems compared to psychotic persons in households. Less than a third had received previous inpatient treatment. Psychotic prisoners had similar criminal histories and higher psychopathy scores than non-psychopathic prisoners. Diversion is unfeasible without improved screening for psychosis and increasing bed numbers at higher levels of security to accommodate more patients who would pose high risk to the public. Future research should investigate why UK psychiatric services fail to identify psychotic prisoners and provide aftercare.     

中国经济法的改革与创新——一种制度变迁的视角

经济法是我国改革开放的产物。中国经济法的改革与创新,是在改革开放、社会转轨的大背景下完成的。经济法的发展一直是＂摸着石头过河＂。一方面,＂渐进式改革＂注定了经济法在发展初期以国家本位为主导、以经济行政法规、法律＂双轨制＂立法为特征,在稳定的前提下,以较小的社会成本获得了中国经济的高速增长（政治的科斯定理）。早期我国经济法属于典型的＂由上而下＂的＂强制性制度变迁＂。随着经济改革的不断推进、意识形态的转变、以及国内外法制环境的变迁,特别是中国加入WTO,经济法完成了从国家干预法到国家协调法、从国家本位到社会本位、从国内法到国际转轨、从实体法到程序法、从硬法到软法、从公法到公私融合的六大转变。＂周虽旧邦,其命维新。＂新时代下,＂以人为本＂,以科学发展观为理念,经济法正迎接新的发展契机。     

中国的法治进程与公众参与——以网民参与法律事件对法治建设的影响为例

中国走的是一条政府主导型的法治化发展道路,即在政府主导下强制性地完成社会制度变迁。在这一过程中,中国社会的法治发展条件也发生了根本性的变化。社会自身的发展、经济和社会生活的需要、公众的参与正在成为法治发展的动力。本文以时间为序,把中国的法治进程划分为初始起步阶段、加速发展阶段和平稳发展阶段,并以公众中极具代表性的网民群体作为分析范本,以当前网民参与法律事件为例,结合目前我国所处的法治阶段,分析了网民参与法律事件的性质和特征,以期进一步探讨中国法治进程和公众参与之间的互动意义。     

论第三部门兴起下的公共政策

第三部门的兴起带来了公共政策过程的变革。它使公共政策成为社会治理体系中新的调节工具,并使公 共政策具有了新地位和新作用。第三部门的兴起展示了社会治理环境对公共政策的创新要求。     

Medical school forensic psychiatry units in health care delivery facilities rather than criminal justice institutions: an alternative model

We have presented a model for developing forensic psychiatric treatment and teaching services of a medical school Department of Psychiatry, but where these services are the basic comprehensive health care delivery system for the entire community. These offer consultative and treatment services for adult and family court clinic, psychiatric forensic services, of forensic psychiatry open bed and medium security-type bed, as well as day hospital and outpatient services. All of these are sited in the normal health care delivery system of the university teaching hospitals and its patient treatment, teaching, and research facilities. Consultative services are offered on request to the criminal justice system, but the basic health care delivery system is controlled administratively by the ordinary university teaching hospital authorities and exists as a one of a kind unit at the Royal Ottawa Hospital. The Royal Ottawa Hospital is a private nonprofit hospital, with its own Board of Trustees, and is affiliated with the medical school, as part of a major university network. We believe it important to present this model for an overall forensic psychiatric service, in contradistinction to the more commonly established forensic psychiatric facilities in state mental hospitals, in a special facility for the criminally insane, or in a criminal justice system institution such as a penitentiary. We believe that our model for forensic psychiatric facilities has great advantages for the patient. Here the patient is treated in a specialized facility (as all psychiatric patients with specialized problems should be); but one which is a specialized forensic facility, within the range of specialized psychiatric facilities that are needed by an urban community.(ABSTRACT TRUNCATED AT 250 WORDS)     

论地方政府在关注弱势群体中的责任

随着社会主义市场经济体系的不断完善和改革的深入推进,弱势群体问题已经成为影响我国社会稳定和制约经济可持续发展的因素之一,备受社会各界的广泛关注.因此,各级地方政府应在关注并切实解决弱势群体问题的实践中勇于承担责任,履行职责,为实现经济社会平稳较快发展保驾护航.     

Medicare reform: social and ethical perspectives

Despite Medicare's success as a social program, its future is in question because of the program's enormous costs. Because the issue of Medicare reform has been forced upon us at this juncture by a crisis of finance rather than by the long-standing inequities in the present system of paying for the health care of the elderly, questions about how best to secure its fiscal integrity have seized the attention of the public. Yet, such questions are hard to contain; they force an examination of broader and more fundamental issues. In this article, we examine the validity of the ultimate moral and social rationales for continuing Medicare in something approximating its present form; the legitimacy of a social entitlement program that is age- rather than means-based; the implications for the future of health care reform if significant changes were to be made in the Medicare program and its underlying rationale; and the possibility that changes in that program may jeopardize the chances for a more rational, just, and systematic approach to the provision of health care to all Americans.     

Obligation to medical treatment as a possibility of medical and social supervision (author's transl)]

In lectures of forensic medicine and in jurisdiction the patient's decision to release his secret records of medical examinations and treatment is considered to be an intangible right. Actually this privilege is only existing for the rich patient who can afford it to resign economic help in daily life and in case of illness, disablement and of incapability of earning his living. The population of our social state is largely subjected to obligations to disclose, tolerate and cooperate. In Civil Right, Social Right and in Labour Law theoretically this cannot be enforced, but it is forced in fact by refusing social and insurance accomplishment. If a young person refuses medical tests, a veto of employment will result. An employee will not get a position in an industrial firm where a medical department had to be established according to the law, or in the public service, if he refuses medical tests. In the attempt to extend the social insurance system to the whole population and to extent medical service in industry to all employees within certain time, there is no longer space for avoiding the social pressure for medical good conduct. Wanting to live a civil life one has to obey those directions. The postulation of lecturers and of High Courts concerning the patients decision on medical examination and treatment has only explanatory value and does not consider medical insurance and labour aspects. Further legal restrictions of this fundamental rights exist in Criminal Law.     

Rationing psychosocial treatments in the United States

This paper briefly reviews the recent history of psychosocial treatment for adults with severe mental illnesses in the United States. It examines the current sources and financing of such care, revealing the planned and unplanned reclassification of entitled beneficiaries and eligible patients, appropriate treatment, acceptable outcomes, and levels and sources of payment. One illustration of this phenomenon is seen in current efforts to identify and deliver only those public services that are covered by Medicaid, so as to allocate state resources only when they can be matched by federal monies. Another is the reliance on private health insurance, tied in the U.S. almost exclusively to employment, for medical care delivered under an acute, rather than a chronic care model. These analyses conclude with a discussion of the implicit and explicit mechanisms used to ration access to psychosocial treatment in the United States. The implications for individuals with serious mental illnesses, their families, and the general public are placed in historical and current policy contexts, recognizing the economic, social, and clinical variables that can moderate outcomes.     

论强制医疗启动程序决定主体

强制医疗制度是国家医疗保健制度的有机组成部分,强制医疗有广义与狭义之分。狭义的强制医疗,如实施危害行为的精神病患者、甲类传染病患者等;广义的强制医疗,包括预防接种、指定医保单位就医等。强制医疗程序启动的决定主体必须是国家赋予相应权力的机关,其他任何单位不具有这样的权力,因而无权决定强制医疗程序启动。强制医疗主体的确定取决于强制医疗对象的危害程度、广度及时间等因素。     

Legal Aid in the Eye of a Storm: Rationing, Contracting, and a New Institutionalism

This article discusses possible rationales underlying a legal aid system through an articulation of theories of distribution in the legal services market, considers the idea of prioritization and planning or, in the political vernacular, rationing of public funding, and addresses the impact of economic and social theories of the professions on legal aid structures. Finally, the emerging concepts of 'new-institutionalism' and 'new public management' are introduced to indicate the organizational and sociological complexity of reforming the legal services market. Each of these threads illustrate competing values and institutional influence on publicly funded legal services. Bureaucratic rules mix with professional and economic incentives to articulate entitlement to public money in a predominantly private forum. Drawing on research in the field of rationing health care, sociological and economic work on legal services, and organizational theories, it will be demonstrated that conceptual, policy, and research tools need to play closer attention to this competition of values.     

The evolution of China’s social policies

The movement of the Chinese economy towards a market-based system brought about a profound change in the nature of the social protection system in China and in the relative incomes of different groups in society. The collectively-provided health care systems failed to adapt to the new economic system, pension provision in urban ceased to be provided for all workers and rewards in the labour market became linked to the market-value of a skills. The result was a significant increase in inequality driven, especially by differences between urban and rural incomes. Since the middle of the last decade, though, inequality has stopped rising and shows signs of declining as increased labour mobility has tended to raise incomes in rural areas. At the same time, a range of new social policies have been introduced. While the level of spending on these policies remains low, they offer a framework for future expansion. There are still some areas where only limited progress has been made, notably concerning the access of migrants to public services in urban areas.     

论商法

本文按照历史和逻辑的统一,对诸多涵义和意义迥异的“商”法概念做了澄清,认为社会经济发展造成“商”与工以至农、金融。教科文卫间的行业壁垒消失,法对于泛商化社会条件的反应就是民商合一,同时由国家保障公共产品供应、维护经济协调运行和发展的需要所决定,“商”还冲出民或私的领域,成为经济法的有机组成部分。文章指出,由于英美法向来不拘公私、民商之分,有包容行政、“民、行（政）”不分的真正的“大民事”,所以其“经济法”实在很发达,没有“经济法”而不需要经济法,Ｂｕｓｉｎｅｓｓ ｌａｗ也不是什么商法。大陆法系的商法则已在公、私冲突和交融之中寿终正寝,需要由“经济法”来协调和融合公与私,以免公、私理念和制度在对立冲突中两败俱伤。因此,商法并非实际的法部门和法现象,但不妨在一般私法或不严格的意义上使用“民商法”或“商法”的提法。     

国家与社会关系变迁的公法回应

法律根植于社会,社会变迁与公法的发展紧密相连,社会变迁在制度、观念和应用等层面影响着公法的发展,公法对社会变迁具有推动作用。中国正在经历从政治国家一元社会向政治国家与市民社会并存的二元社会的变迁,这种变迁需具备建立市场经济和确立正确的政府理念两大要素,对中国经济社会发展具有积极意义。与之相适应,中国公法应当在制度层面、观念层面和方法层面对这种变迁作出回应。     

经济法与公益诉讼的契合性分析

实体法与程序法作为矛盾的对立双方相互依赖、互为前提。没有实体法就没有程序法;没有程序法,实体法也没有存在的必要。经济法是在生产高度社会化的历史条件下,为适应国家广泛调节社会经济的需要而逐渐形成为以社会公共利益为本位的部门法;与之相适应,经济法程序始终贯穿着对社会公益的关注,以有效保护社会公共利益不受侵害为主线。公益诉讼是有关组织和个人依据法律的规定,对由于违反法律而给国家、社会公共利益造成事实上损害或潜在损害的行为向法院起诉,由法院追究违法者的法律责任的诉讼活动。所以,公益诉讼作为经济法的内部生命的表现有效地维护了经济法的切实实施,经济法与公益诉讼之间具有天然的契合性。     

复仇与法律--以《赵氏孤儿》为例

复仇是一种高度分散执行的社会制裁制度或控制机制,其诸多核心要素至今仍然是实践中的传统法律必须具有的。复仇制度的衰落最主要应归功于社会经济、政治条件的结构性变迁。在一个存在集中化公权力的社会,如果公权力不能有效地以公道的方式解决其内部成员的纠纷和冲突,或者受到不公甚或冤屈的人们无法诉求这种公权力获得公道,那么复仇现象就仍然会出现。