Can ministries of health support primary health care? Some suggestions for structural reorganization and planning

Patrick Vaughan is Reader in health care epidemiology, Gill Walt is Lecturer in health policy and Anne Mills is Lecturer in health economics, at the Evaluation and Planning Centre for Health Care, London School of Hygiene and Tropical Medicine, Gower Street, London WC1, United Kingdom. A previous version of this paper was prepared for the Commonwealth Secretariat, London, for the Conference of Commonwealth Health Ministers held in Ottawa, Canada, in October 1983.     

Treating offenders with mental illness: a research synthesis

The purpose of this research synthesis was to examine treatment effects across studies of the service providers to offenders with mental illness. Meta-analytic techniques were applied to 26 empirical studies obtained from a review of 12,154 research documents. Outcomes of interest in this review included measures of both psychiatric and criminal functioning. Although meta-analytic results are based on a small sample of available studies, results suggest interventions with offenders with mental illness effectively reduced symptoms of distress, improving offender's ability to cope with their problems, and resulted in improved behavioral markers including institutional adjustment and behavioral functioning. Furthermore, interventions specifically designed to meet the psychiatric and criminal justice needs of offenders with mental illness have shown to produce significant reductions in psychiatric and criminal recidivism. Finally, this review highlighted admission policies and treatment strategies (e.g., use of homework), which produced the most positive benefits. Results of this research synthesis are directly relevant for service providers in both criminal justice and mental health systems (e.g., psychiatric hospitals) as well as community settings by informing treatment strategies for the first time, which are based on empirical evidence. In addition, the implications of these results to policy makers tasked with the responsibility of designating services for this special needs population are highlighted.     

Dialogic reverberations: police, domestic abuse, and the discontinuance of cases

This study investigated the social construction of domestic abuse by police officers, specifically in the context of arguments presented to the prosecutor for a decision on whether to proceed with or discontinue the case. Nineteen police files were examined with a particular focus on the MG3, the "Report to Crown Prosecutors for Charging Decision." Access to such sensitive material is usually denied to researchers; therefore, this study offers unusual insights into the treatment of victims and perpetrators of interpersonal violence by the police. Discourse analysis revealed three dominant speech genres: impartiality, credibility, and the "real" victim. These genres separately and in interaction served to construct domestic abuse cases in ways that did not support the victim's account. The "dialogic reverberations" of these findings are discussed and the implications of the work for research and practice are considered.     

“Knowledge and Death Penalty Opinion: The Marshall Hypotheses Revisited.”

This study tests the three hypotheses derived from the written opinion of Justice Thurgood Marshall in Furman v Georgia in 1972. Subjects completed questionnaires at the beginning and the end of the fall a semester. Experimental group subjects were enrolled in a death penalty class, while control group subjects were enrolled in another criminal justice class. The death penalty class was the experimental stimulus. Findings provided strong support for the first and third hypotheses, i.e., subjects were generally lacking in death penalty knowledge before the experimental stimulus, and death penalty proponents who scored “high” on a retribution index did not change their death penalty opinions despite exposure to death penalty knowledge. Marshall’s second hypothesis--that death penalty knowledge and death penalty support were inversely related--was not supported by the data. Two unexpected findings were that death penalty proponents who scored “low” on a retribution index also did not change their death penalty opinions after becoming more informed about the subject, and that death penalty knowledge did not alter subjects’ initial retributive positions. Suggestions for future research are provided.     

Correctional outcomes of offenders with mental disorders

While there is now a considerable literature on the extent of mental disorder (MD) within correctional settings, there is much less research on the correctional outcomes of offenders with a mental disorder (OMDs). This study contributes to that knowledge base by comparing the profiles and institutional and community outcomes of federally-sentenced Canadian offenders with, and without, a MD and examines the correctional response to their management. Results showed that OMDs had higher risk and need ratings and were more likely to be serving their current sentence for a violent offense. Outcomes for OMDs were poorer as reflected by higher rates of institutional charges and transfers to segregation, and higher rates of recidivism on release. This difference holds for the recidivism analysis, even when variables related to risk are controlled. The results demonstrate the complex needs of OMDs and points to the requirement for correctional agencies to provide specialized interventions that address both their mental health and criminogenic needs. Future research is required to examine whether type of diagnosis, particularly the degree of antisocial orientation, contribute to these poorer outcomes.     

Morality analysis: Reducing moral backlash to public policy

Widely used policy development processes rarely systematically consider differing moral values, which can lead to overlooked risks, ineffective communications and suboptimal policy design. This article introduces morality analysis, a policy tool that draws on moral foundations theory to optimize policy and program design, build public support for policies and present key advice to decision-makers. Morality analysis is used to examine the case of a controversial vaccination incentive program introduced by the Government of Alberta in late 2021 and identify policy options that would likely have prompted less public backlash. This article suggests that morality analysis should supplement the policy analysis toolkit.     

Changing the Domestic Violence Narrative: Aligning Definitions and Standards

Many states use a broad legal definition of domestic violence that includes intimate partner violence along with family violence, and it is from this broader conceptualization that the criminal justice system intervenes and often treats all types of offenders in the same way. This judicial response can include a mandate to attend a Batterer Intervention Program-type group, which does little to address violence that occurs outside of the “traditional” partner violence paradigm. In order to advance interventions for physical partner violence that adequately address both male and female perpetration, as well as the broader conceptualization of domestic violence, we must align definitions and standards among researchers, service providers, advocates, policymakers, and the public health and criminal justice systems. Examples of how this misalignment has stalled progress in offender treatment are discussed and a plan for enabling continued innovation in the field is presented.     

Economic,trade and development relations between South Africa and the European Union: The end of a strategic partnership? A South African perspective

ABSTRACT

The relationship between democratic South Africa and the European Union (EU) has been in existence for over 20 years, with its roots tracing back to anti-apartheid support measures. In its earlier form, it was anchored in the Reconstruction and Development Programme. Currently, it is guided by the National Development Plan of the National Planning Commission. This relationship has been tested over time, especially as a result of negotiations over the Economic Partnership Agreement with the EU. In the meantime, the euphoria that marked new South Africa's participation in the global system, with trade and development cooperation with the EU as one of the cornerstones, has waned considerably. The cancellation of several bilateral investment treaties with EU member states has further strained the relationship. While there are notable successes in the EU–South Africa Strategic Partnership, these may not be reflective of the actual strategic value of the partnership in the context of global shifts and the rising influence of emerging powers with which South Africa is integrating.