Outpatient commitment and coercion in New Zealand: a matched comparison study

BACKGROUND: It has been hypothesized that a degree of coercion is a necessary component in using outpatient commitment to attain therapeutic outcome for those people subject to mental health law. However, what degree of coercion is required and how it is sustained is poorly understood. There is speculation that patients' recognition of beneficial as well as unwanted aspects of outpatient commitment (ambivalence) maybe an indicator that the necessary level of coercion has been achieved to facilitate a therapeutic outcome. AIM: The aim of this study was to determine the level of coercion perceived by those under outpatient commitment in New Zealand. Emphasis was given to consideration of the presence of ambivalence and the role of interactive processes, including procedural justice, in influencing patients' perceptions of coercion. METHOD: A cross-sectional comparative study was undertaken to compare the perceptions of coercion of patients on outpatient commitment (n = 69) to a matched sample of voluntary outpatients (n = 69), using the Perceived Coercion Scale. The influence of a range of variables, including patients' knowledge of and beliefs concerning outpatient commitment, were considered. RESULTS: Although the level of coercion for involuntary outpatients was relatively low, it was significantly higher than that experienced by voluntary outpatients. Yet involuntary outpatients were more likely to espouse benefits of outpatient commitment. Although there was an inverse correlation between perceptions of procedural justice and perceived coercion, procedural justice did not feature in the linear regression analysis. DISCUSSION: In the New Zealand context, involuntary outpatients hold contrasting views to outpatient commitment. We suggest that this ambivalence is an indicator that the degree of coercion is suffice to achieve therapeutic outcome. Furthermore, this study suggests the impact of procedural justice on patients' perceptions of coercion may be more crucial during admission to hospital than in the context of on-going community care.     

Cognitive Heterogeneity and Economic Voting: A Comparative Analysis of Four Democratic Electorates

This article examines the cognitive foundations of economic voting in four diverse democratic electorates: Canada, Hungary, Mexico, and Taiwan. We present a theory of heterogeneous attribution, where an individual's level of political sophistication conditions his or her ability to attribute responsibility for economic conditions to governmental actors. In contrast to previous literature, we argue that higher, not lower, levels of political sophistication prompt citizens to "vote their pocketbook." Using data from surveys done in conjunction with recent elections in all of these countries, we find that more politically sophisticated respondents are more likely to make use of pocketbook evaluations in their decisions to support or oppose the incumbent government. These findings both present a significant challenge to the conventional wisdom on political sophistication and economic voting and shed light on the necessary cognitive preconditions for democratic accountability.     

Social rights,child rights,discrimination and devolution: untangling the web

Abstract

This article examines judicial reviews of two areas of social security policy and practice in the UK – the household benefit cap and the restriction of bereavement benefits to bereaved spouses and civil partners. While each case ostensibly concerned discrimination against claimants, in practice much of the legal argument centred on the impact on claimants’ children. The judiciary is revealed to be deeply divided on the lawfulness of the acknowledged discrimination. The article considers what lessons can be drawn about the relative weight that ought to be afforded to claimants’ property rights, the best interests of affected children, anti-discrimination provisions and the state’s stated policy imperatives of cost control and administrative convenience. Insights are also sought into whether devolutionary differences can be identified between the approaches of courts in London and Belfast.