How do psychiatric patients on prison healthcare centres differ from inpatients in secure psychiatric inpatient units?

Abstract

Mentally ill prisoners have consistently been highlighted as a group with complex needs. However, it is not clear what these needs are, how effective prison health services are in meeting the needs of this vulnerable group, and whether there would be any benefit to transferring them to psychiatric facilities. This study compared the characteristics and needs of mentally ill patients in prison healthcare centres (HCC prisoners) with patients in forensic medium secure psychiatric units (MSU inpatients) in the UK. HCC prisoners and MSU inpatients were in fact very similar. Where they did differ, though, was that MSU inpatients were significantly more likely to be of non-white ethnicity, diagnosed with psychotic or substance use disorders, and have recorded histories of drug misuse. HCC prisoners and MSU inpatients reported the same number of needs overall, according to the CANFOR-S (Camberwell Assessment of Need Forensic Short Version), but HCC prisoners reported significantly higher levels of unmet need. The need for transfer to alternative services was common in both groups, with bottlenecks evident at all levels. The high level of unmet need reported in the HCC prison sample is of particular clinical concern and highlights the need for improved assessment and treatment services in this setting.     

Free and unfree labor in Qing China

Though internal migration in China during the Qing era (1644–1911) was mostly unrestricted, the government tightly controlled the movement of peasants who worked state lands in frontier regions and certain other locations. Such peasants accounted for 5–10% of China's population. In the state farms of northeast China, households could move legally only from one place to another within the system. Departure from the system was illegal. In this article, one of the first quantitative studies of migration in late imperial China, we apply discrete-time event-history methods to longitudinal, nominative household register data from six northeast Chinese state farm systems to compare how characteristics of the farm system, village, and household influenced the chances of legal moves and illegal departures. We show that among these state peasants, who were supposedly “unfree,” migration was not uncommon. We also show that the determinants of legal and illegal migration differed substantially. We conclude with a discussion of the implications of these findings for our understanding of migration processes in late imperial China.     

External Validity in Policy Evaluations That Choose Sites Purposively

Evaluations of the impact of social programs are often carried out in multiple sites, such as school districts, housing authorities, local TANF offices, or One‐Stop Career Centers. Most evaluations select sites purposively following a process that is nonrandom. Unfortunately, purposive site selection can produce a sample of sites that is not representative of the population of interest for the program. In this paper, we propose a conceptual model of purposive site selection. We begin with the proposition that a purposive sample of sites can usefully be conceptualized as a random sample of sites from some well‐defined population, for which the sampling probabilities are unknown and vary across sites. This proposition allows us to derive a formal, yet intuitive, mathematical expression for the bias in the pooled impact estimate when sites are selected purposively. This formula helps us to better understand the consequences of selecting sites purposively, and the factors that contribute to the bias. Additional research is needed to obtain evidence on how large the bias tends to be in actual studies that select sites purposively, and to develop methods to increase the external validity of these studies. © 2012 by the Association for Public Policy Analysis and Management.     

Psychological autopsies: the current Department of Defense effort to standardize training and quality assurance

Psychological autopsies have been gathered by the US military for a long time, both for lessons learned after a known suicide and to investigate an equivocal death. The term "psychological autopsies" is now being restricted to define an investigation by mental health to help determine, in an equivocal death, if the manner of death is a homicide, suicide, an accident, or from natural causes. The Department of Defense has developed policy, and is now implementing training and peer review. A sample model curriculum, report format and quality assurance standards are included.     

Global access to treatment: achievements and challenges

As mentioned in the previous issue, this section of the Review addresses issues related to improving access to adequate and affordable care, treatment, and support everywhere. It replaces the section previously called "Patents and Prices." In this issue, we feature a review of achievements and challenges in recent years in opening global access to HIV/AIDS treatments. The article - one of a series commissioned to mark the tenth anniversary of the Canadian HIV/AIDS Legal Network, discussing past developments and future directions in areas of policy and law related to HIV/AIDS - describes the developments that recast the debate about access to treatment from one focused on patent entitlements to one focused on the right to health and treatment. It analyzes the role of national and international activism, strategically constructed alliances, and principled leadership in achieving this change. And it discusses continuing obstacles to equitable access to HIV/AIDS treatments for the world's population.     

Nursing home quality-of-care cases after Mikes v. Straus

The quality of care rendered to residents of nursing facilities continues to gain attention from legislators, regulators, and the courts. Advocates for improvements in the quality of care by government-funded healthcare providers have identified the False Claims Act (FCA) as a potent tool. The Second Circuit decision in Mikes v. Straus might be viewed as a barrier to FCA claims against nursing facilities. Any impediment imposed by this decision, however, is limited by the facts of the case; the authors believe that carefully-crafted pleadings can enable litigants to rely upon the FCA in pursuing quality-of-care claims against nursing facilities.