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Since the mid-1970s, the mental health treatment system in the U.S. has faced budgetary famine. This is in stark contrast to the growing cornucopia of fiscal resources enjoyed by the overall health care system. This paper explores the complex reasons for this disproportionate allocation in health spending. On the one hand, mental health may suffer from the perception that its diagnoses are largely "subjective" and its treatments do not fit the traditional "medical model" that can be defined precisely and paid for by third-party insurers. But more importantly, the death of mental health resources can be attributed to the peculiar nature and characteristics inherent in American politics. This paper describes the American political environment, from both a historical and a contemporary perspective, to give some insight into the development of policies affecting the mental health system in the U.S. Given the current climate of fiscal conservatism in this country toward any increases in social spending, it is likely that the profound mismatch in need and spending for mental health programs will continue indefinitely. 相似文献
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Abstract: The use of deadly force during law enforcement is a matter that compels public scrutiny. There were 42 gunshot deaths caused by police over a 4-year period in New York City. The decedents' average age was 31 years and ranged from 17 to 64 years. There were 41 males and one female; and 26 Black, nine Hispanic, and seven White decedents. Ethanol and/or drugs of abuse were detected in 78% (31/40) of the decedents. The vast majority of shootings occurred with the police responding to a crime and 90% of the decedents were armed (26 handguns, six knives, one axe, one metal pipe, and one toy gun). Vehicles were used as weapons in two incidents. A total of 177 bullets struck the 42 decedents. Fourteen decedents sustained single gunshot wounds (GSWs), and the remainder had multiple GSWs ranging from 2 to 21. In the majority of the cases in this study, the number of GSWs of the body was three or fewer. Thirteen decedents had at least one GSW of the back or buttocks, accounting for 25 of the total 177 wounds, and four of the 13 had GSWs of only the back. With the exception of the upper extremities, GSWs of all locations were more likely to penetrate than perforate. Although these deaths may be high profile, the certification is typically straightforward and the cause (i.e., GSW) and manner of death (homicide) are readily apparent. Although police shootings in which the decedent was unarmed and/or sustained numerous GSWs are widely reported by the lay press, these types of shootings were not typical in our study. 相似文献
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Pseudo-Stab Wounds: Putrefactive Dehiscence of Remote Surgical Incisions Masquerading as Stab Wounds
James R. Gill M.D. ; Dennis P. Cavalli RPA-C M.P.H. ; Susan F. Ely M.D. M.P.H.T.M. 《Journal of forensic sciences》2009,54(5):1152-1154
Abstract: Artifacts due to decomposition can be mistaken for antemortem injury leading to an incorrect suspicion of foul play. We describe an instance of postmortem wound dehiscence that mimicked antemortem stab wounds. A man with a history of colon cancer and substance abuse was found dead. There were advanced putrefactive changes and multiple defects of the anterior torso that resembled stab wounds. Subsequent investigation revealed that 11 months earlier, he had a laparoscopic-assisted colon resection that involved surgical incisions corresponding in location and size to the above defects. Putrefactive gases may cause bloating of the body. This distension may cause recent and remote healed incisions to dehisce. Correlation of these "defects" at autopsy with the antemortem clinical history is crucial in determining their etiology. 相似文献
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Geoffrey C. Barnes Lindsay Ahlman Charlotte Gill Lawrence W. Sherman Ellen Kurtz Robert Malvestuto 《Journal of Experimental Criminology》2010,6(2):159-189
The Philadelphia Low-Intensity Community Supervision Experiment provides evidence on the effects of lowering the intensity
of community supervision with low-risk offenders in an urban, US county community corrections agency. Using a random forests
forecasting model for serious crime based on Berk et al. Journal of the Royal Statistical Society, Series A, 172(Part 1), 191–211, 2009, 1,559 low-risk offenders were identified and randomly assigned to either standard or reduced frequency of mandatory office
visits. Treatment as assigned was substantially delivered at 4.5 probation visits per year versus 2.4, for as long as offenders
remained on active probation or parole. In a one-year follow-up for all cases, outcomes examined were the prevalence, frequency,
seriousness and time-to-failure of arrests for new crimes committed after random assignment was implemented. No significant
differences (p = .05) in outcomes were found between standard and low-intensity groups. Non-significant differences for offense seriousness
favored the low-intensity group. We conclude that lower-intensity supervision at the tested level of dosage can allow fewer
officers to supervise low-risk offenders in the community without evidence of increased volume or seriousness of crime. 相似文献
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Charlotte Gill Alese Wooditch David Weisburd 《Journal of Quantitative Criminology》2017,33(3):519-545