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.     

McTear v Imperial Tobacco: understanding the role and limitations of expert epidemiological evidence in scientific litigation

The use of epidemiological evidence in litigation presents a range of challenges for both litigants and the courts. Given the complex statistical basis of epidemiology itself, it is possible that the technical and factual constraints associated with such evidence may fail to be properly considered by a trier of fact. The recent Scottish decision in McTear v Imperial Tobacco Ltd [2005] Scots CSOH 69 sets a high standard for the future use of epidemiological evidence and thoroughly evaluates the strengths and weaknesses of epidemiology generally. While epidemiological evidence remains controversial, and cannot in itself prove direct causation (nor causation in the individual), it is likely it will continue to be adduced as indirect evidence of general causation. It is also likely, however, that both the subjective and objective processes involved in epidemiological study design and reporting will be questioned by courts more thoroughly than has historically been the case. Further, failure by a party to adduce primary evidence (ie original data sets and interpretation thereof) of an epidemiological study which it seeks to rely on at trial will most likely undermine the value of adducing such evidence in the first place.     

American Indians and sentencing disparity: An Arizona test

Although a proliferation of research exists examining the extent to which African American criminal defendants receive more harsh sentences relative to Caucasians, comparatively little research has examined the issue of discrimination in relation to other minority groups. This article examines disparities in sentence length received between American Indian and Caucasian inmates incarcerated in Arizona state correctional facilities. Regression analyses were used to predict the sentences received by American Indian and Caucasian inmates convicted of six crimes (homicide, sexual assault, robbery, assault, burglary, and larceny). After prior felony record and other demographic variables were controlled in these crime-specific models, the crimes of robbery and burglary were the only crimes in which American Indians received longer sentences than Caucasians convicted of the same offense. Caucasian defendants received significantly longer sentences than American Indians for cases of homicide. A defendant's prior felony record was the only variable that consistently increased the length of sentence received by defendants across all types of crime. These findings are discussed and interpreted using various theoretical arguments.     

Rent-seeking with asymmetric valuations: Addition or deletion of a player

We consider an extension of Tullock's (1980) N-player contest under which prize valuations may vary across players. We show that the pure-strategy equilibrium of this contest is unique. We also establish the following results: rent dissipation increases, individual winning probabilities decrease, and individual spending either increases or decreases with the addition of a player.     

The Cultural and Developmental Significance of Parenting Processes in Adolescent Anxiety and Depression Symptoms

This study examined the cultural and developmental significance of maternal and paternal parenting processes (closeness, support, monitoring, communication, conflict, and peer approval) for measures of anxiety and depression symptoms in adolescents from Hungary, the Netherlands, Switzerland, and the United States (N=6,935). Across all cultural contexts, measures of maternal and paternal support and conflict were most consistently associated with measures of internalizing behaviors. Few differences were observed in the importance of individual parenting processes for anxiety or depression symptoms across cultures. Additionally, with the exception of maternal conflict for anxiety and depression symptoms and paternal closeness for depression symptoms, none of the parenting process dimensions differed in importance for internalizing behaviors across developmental periods (middle versus late adolescence). The investigation provides evidence of great similarity in developmental processes, both across cultural contexts and developmental periods.

Evaluating partnerships for community health improvement: tracking the footprints

Private-public partnerships are increasingly seen as an important mechanism for improving community health. Despite their popularity, traditional evaluations of these efforts have produced negative or mixed results. This is often attributed to weak interventions or an insufficient period of time to observe an impact. This study examines two additional possibilities--the need for a well-articulated shared vision and the governance and management capabilities of the partnership itself. We conducted a midstream process evaluation of twenty-five community partnerships associated with the Community Care Network (CCN) Demonstration Program. We examined how the roles of a common shared vision, strong governance, and effective management influence a partnership's ability to achieve its objectives. The findings, based on both qualitative and quantitative analyses, underscore the importance of membership organizations' perceived benefits and costs of participation and management capabilities to the partnership's progress toward a vision. Based on the qualitative data, six key governance and management characteristics are identified that separate the top performing partnerships from the lowest performing ones. We explore the implications of this research for future evaluations of public-private community health partnerships.