Voluntary and involuntary care: three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit

Individuals with mental disorders can, under specific circumstances, be detained and treated against their wishes. In 2009, there were 1633 involuntary admissions in Ireland, accounting for 8.1% of all psychiatric admissions. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in Dublin's north inner-city over a retrospective three-year period. The overall admission rate was 450.5 admissions per 100,000 population per year (deprivation-adjusted rate: 345.7), which is lower than the national rate (476.3). The involuntary admission rate was 67.7 (deprivation-adjusted rate: 51.9), which is higher than the national rate (38.5). Fifteen per cent of admissions were involuntary (for all or part of the admission), which is higher than the national proportion (8.1%) but the same as that reported in another inner-city psychiatry service (15.7%). The proportion of admissions that was involuntary was higher amongst individuals from outside Ireland (33.9%) compared to those from Ireland (12.0%) (p<0.001). Country of origin was, however, related to diagnosis: 53.2% of admissions of individuals from outside Ireland were with schizophrenia, compared to 18.5% of admissions of individuals from Ireland (p<0.001). Diagnosis was, in turn, related to admission status: 37.5% of admissions with schizophrenia were involuntary compared to 15% overall (p<0.001). On multi-variable testing, diagnosis was the only independent predictor of admission status (p=0.01) (R(2)=35.2%); country of origin was not an independent predictor of admission status. Deprivation accounts for part, but not all, of the high rate of involuntary admission in Dublin's inner-city. Diagnosis accounts for one third of the variance in admission status between individuals. Further study is required to determine what factors account for the remaining two thirds (e.g. symptoms, insight) and to clarify better the relationships between admission status, diagnosis and country of origin. There is a strong need for enhanced focus on the mental health needs of individuals from outside of Ireland, especially in Dublin's north inner-city.     

Book reviews

Bryan S. Turner, Orientalism, Postmodernism and Globalising (Routledge, London 1994). 208pp. ISBN 0–415–10861–6, 0–415–10862–4 (pb).

Mir Zohair Husain, Global Islamic Politics, (Harper Collins, London 1995). 282pp. ISBN 0–06501484–7 (pb).

Sondra Farganis, Situating Feminism: From Thought to Action, (Sage, London 1994). 195pp. ISBN 0–8039–4650–3

Tom Mayer, Analytical Marxism, (Sage, California 1994). 371pp. ISBN 0–8039–4681–3 (pb).

Ian Adams, Political Ideology Today, (Manchester University Press, Manchester 1995). 369pp. ISBN 0–7190–3347–0.

Geoffrey Pridham and Tatu Vanhanen, Democratization in Eastern Europe: Domestic and international perspectives, (Routledge, London 1994). 274pp. ISBN 0–415–11063–7(hb), 0–415–11064–5(pb).

Ash Amin (ed), Post‐Fordism: A Reader, (Basil Blackwell, Oxford 1994). 435pp. ISBN 0–631–18857–6 (pb).     

The use of Facebook in the recruitment of foster carers: A dialogic analysis

Social media is becoming increasingly important for communication and community building, yet research on the use of social media by non‐profit organisations is limited and largely restricted to content analysis of social media comments. This article contributes to addressing this research gap, through a survey‐based study of the perspectives of key informants in U.K. Local Authority fostering teams on their use of social media. Specifically, it examines the extent to which the Facebook activity of local authority fostering teams is aligned with the principles of successful social media engagement, as represented by dialogic strategies and outcomes. A questionnaire on the use of Facebook was circulated to all local authority fostering teams in England. Findings suggest that although there is progress, many teams are at an early stage in their social media journey and that there is considerable variation between agencies. The limited evidence of engagement in relation to dialogic principles suggests that there is some adoption of a strategic approach. In particular, of the three dialogic principles associated with successful online engagement, two (updating and community building) were applied by about half of local authority fostering teams and the third (engagement) by just over a quarter.     

The roles of information deficits and identity threat in the prevalence of misperceptions

Why do so many Americans hold misperceptions? We examine two factors that contribute to the prevalence of these beliefs. First, presenting correct information should reduce misperceptions, especially if provided in a clear and compelling format. We therefore test the effect of graphical information, which may be especially effective in facilitating belief updating about changes in quantities over time. In some cases, though, people may reject information because it threatens their worldview or self-concept – a mechanism that can be revealed by affirming individuals’ self-worth, which could make them more willing to acknowledge uncomfortable facts. We test both mechanisms jointly. In three experiments, we find that providing information in graphical form reduces misperceptions. A third study shows that this effect is greater than for equivalent textual information. Our findings for self-affirmation are more equivocal. We find limited evidence that self-affirmation can help diminish misperceptions when no other information is provided, but it does not consistently increase willingness to accept corrective information as previous research in social psychology would suggest. These results suggest that misperceptions are caused by a lack of information as well as psychological threat, but that these factors may interact in ways that are not yet well understood.     

Pitfalls in the Interpretation of Traumatic Socioethnic Practices

The purpose of this case study was to raise awareness among forensic pathologists and medicolegal death investigators regarding two unique socioethnic practices and regional customs that have significant forensic implications. We present two cases involving coining (gua sha) and bloodletting (sapi) that represent two forms of traditional customs that involve the use of blunt force and sharp force trauma, respectively. In coining, the skin lesions are produced as a result of dermabrasion with oils and oval objects such as coin. In sapi, multiple superficial linear scrapes are made in the skin as part of a bloodletting ceremony. The identification of these lesions will prevent the interpretation of them as non‐voluntary‐inflicted trauma.     

Dharmakīrti on the role of causation in inference as presented in Pramāṇavārttika Svopajñavṛtti 11–38

In the svārthānumāna chapter of his Pramāṇavārttika, the Buddhist philosopher Dharmakīrti presented a defense of his claim that legitimate inference must rest on a metaphysical basis if it is to be immune from the risks ordinarily involved in inducing general principles from a finite number of observations. Even if one repeatedly observes that x occurs with y and never observes y in the absence of x, there is no guarantee, on the basis of observation alone, that one will never observe y in the absence of x at some point in the future. To provide such a guarantee, claims Dharmakīrti, one must know that there is a causal connection between x and y such that there is no possibility of y occurring in the absence of x. In the course of defending this central claim, Dharmakīrti ponders how one can know that there is a causal relationship of the kind necessary to guarantee a proposition of the form “Every y occurs with an x.” He also dismisses an interpretation of his predecessor Dignāga whereby Dignāga would be claiming non-observation of y in the absence of x is sufficient to warrant to the claim that no y occurs without x. The present article consists of a translation of kārikās 11–38 of Pramānavārttikam, svārthānumānaparicchedaḥ along with Dharmakīrti’s own prose commentary. The translators have also provided an English commentary, which includes a detailed introduction to the central issues in the translated text and their history in the literature before Dharmakīrti.