Dilemmas for clinicians in use of Community Treatment Orders

Clinicians who treat patients using Community Treatment Orders (CTOs) face many potential dilemmas in their relations with involuntary outpatients and the exercise of their powers. We compare the dilemmas identified in the literature with those reported by responsible clinicians in New Zealand (NZ). These clinicians experienced a number of well-known dilemmas, such as determining the right moment for a person's discharge from a CTO, but they seemed less troubled by some other difficulties than might be expected, usually because they considered involuntary outpatient treatment the best option for the patient or the best way to manage the risks involved. Further dilemmas were identified by the NZ clinicians that have not been widely discussed, concerning the proper scope of clinical authority over patients under CTOs and the decision to revoke involuntary outpatient status. In conclusion, some suggestions are made as to how clinicians might best manage the dilemmas involved.     

The Changing Role of Government in Community Services: Issues of Access and Equity to Administrative Review

Governments are increasingly moving to privatise, or contract out many community services and functions previously the responsibility of the public sector. Consumers of community services stand to benefit from this trend toward contracting out. However, it is also apparent that there is a need to ensure that improved avenues of review, redress and safeguards accompany these changes in delivery and decision making.     

CHILDREN'S ALIGNMENT WITH PARENTS IN HIGHLY CONFLICTED CUSTODY CASES

In one of two samples discussed in this article, 41% of 24 consecutively referred latency-age children were aligned with one parent in a divorce. In a separate sample of 20 families, both parents of aligned children were more rigid, naively defended, and less emotive than were parents of nonaligned children. Aligned children preferred the more emotive, problem solving, and outgoing of the two parents. Aligned children were less adept at conceptualizing complex problems than were nonaligned children, but they were more self-confident.     

Policymaking by Referendum in Presidential Systems: Evidence from the Bolivian and Colombian Cases

Government‐initiated referendums (GIRs) have so far been neglected by the debate on the effects of institutions on policymaking in presidential systems. The literature on Latin American politics has focused on isolated cases of GIRs, which are largely interpreted as epiphenomenal to a regional trend toward personalistic neopopulism. This article provides a conceptual framework for the systematic comparative study of GIRs. It argues that presidents' propensity to promote legal changes through referendums and their concomitant capacity to dominate policymaking are subject to the interaction of two institutional variables (constitutional rules regulating the competences of elected officials in GIR processes and minimum turnout requirements) and two political variables (preference distribution in the legislature and the position of the median voter). These propositions are tested through a comparative analysis of referendum experiences in Colombia and Bolivia, two cases with similar political settings and significant variation in each of the institutional variables.     

Early adopters of the magical thinking cap: a study on do-it-yourself (DIY) transcranial direct current stimulation (tDCS) user community

Among currently available technologies, transcranial direct current stimulation (tDCS) is one of the most promising neuroenhancements because it is relatively effective, safe, and affordable. Recently, lay people have begun to build—or purchase—the tDCS device to use it at home for treatment or as a cognitive enhancer. The tDCS device is currently not covered by the existing regulatory framework, but there are still significant potential risks of misusing this device, and its long-term effects on the brain have not been fully explored. Thus, researchers have argued the need for regulations or official guidelines for the personal use of tDCS. However, until now, no systematic research on the do-it-yourself (DIY) tDCS user community has been done. The present study explores the basic demographic characteristics of DIY tDCS users as well as why and how they are using this device through a questionnaire survey, in-depth interviews, and a content analysis of web postings on the use of tDCS. This preliminary but valuable picture of the DIY tDCS user community will shed light on future studies and policy analysis to craft sound regulations and official guidelines for the use of tDCS.     

Participation in Micro-Finance Programmes and Women’s Mental Health in South Asia: A Modified Systematic Review

Micro-finance provides financial services to poor women from developing countries where cultural and social constraints limit their opportunities for economic advancement. Using Forbes’s process of conducting systematic review, 12 quantitative studies from South Asia reporting on the impact of micro-finance on women’s mental health outcomes were analysed. Overall, studies revealed that the duration and depth of involvement in micro-finance activities would make a difference in women’s mental health and not just receiving loans; however, rigorous programme evaluation is needed. Collaborative actions by micro-finance and health care practitioners to recognise women’s mental health needs and to strengthen measures to optimise the beneficial effects of micro-finance must be considered.     

Review article

Janusz Bugajski and Maxine Pollock, East European Fault Lines: Dissent, Opposition, and Social Activism. Boulder: Westview Press, 1989. 332 pp., index, paper: $42.50.

H. Stuart Hughes, Sophisticated Rebels: the Political Culture of European Dissent, 1968–1987. Cambridge: Harvard University Press, 1988. 171 pp., index, cloth: $20.00.

H. Gordon Skilling, Samizdat and an Independent Society in Central and Eastern Europe Columbus: Ohio State University Press, 1989. 293 pp., index, cloth.