‘Monsters don’t bother me anymore’ forensic mental health service users’ experiences of acceptance and commitment therapy for psychosis

Acceptance and Commitment Therapy for psychosis (ACTp) is an approach that aims to change the relationship an individual with psychosis has with difficult thoughts, emotions and experiences. It promotes the use of acceptance, defusion, mindfulness and focussing on valued outcomes as opposed to struggling with psychotic experiences. This service evaluation project explored service users’ experiences and meanings of ACTp within a medium secure mental health service. Thematic analysis was used to analyse interviews with 10 male service users. Four main themes emerged from the data: ‘Recovery’, ‘Insight’, ‘Developing Skills’ and ‘Accessibility’. Overall, service users viewed their experience of ACTp positively and identified encouraging therapeutic outcomes. These findings suggest that ACTp is an approach that should be considered a therapeutic option within forensic mental health contexts. These outcomes were compared with previous research findings. Limitations of the study, clinical implications and ideas for future research have been discussed.     

Alexis de Tocqueville on the Covenantal Tradition of American Federal Democracy

Perhaps no analyst of democracy's potentials for despotism andself-government understood better than Alexis de Tocquevillethe importance of the "favorable circumstances" of America'srepublican and religious origins. America's covenantal heritageinspired the public philosophy of federal liberty and the federalprinciple used to establish governments and political associationsin colonial New England. The Puritans, Tocqueville explained,created the bonds and the liberties of citizenship by theirassent to eternal, transcendent principles, as well as by theirconsent to government. The principles of covenant ultimatelyprovided the institutional and conceptual foundation of constitutionalgovernment, making America's federal democracy less vulnerableto possessive individualism and democratic despotism. Federalprinciples fostered an important indirect role for religionin American politics. Tocqueville not only analyzed the tensionbetween the requirements of faith and democratic norms, butalso distinguished covenantal ways of negotiating these concernsfrom the approach taken by later advocates of religious freedom,fames Madison and Thomas Jefferson. He argued that federalism'smoral foundations will be difficult to preserve if this tensionis resolved in ways that promote individual autonomy by underminingcovenantal thinking.     

Skin Lesions and Other Associated Findings in Children with Abusive Head Trauma

When Abusive Head Trauma (AHT) is suspected, the presence of extracranial lesions can be a decisive factor in confirming the diagnosis. In this article, we briefly review and illustrate some of the skin lesions and other extracranial injuries frequently associated with AHT.     

Optimal liability for optimistic tortfeasors

As Alicke and Govorun (The self in social judgment, Psychology Press, New York, 2005, p. 85) observed, “most people are average, but few people believe it.” Optimism and other forms of inflated perception of the self lead parties to exercise suboptimal precautions when undertaking risky activities and often undermine the incentive effects of tort rules. In this paper, we show that the presence of optimism undermines several critical assumptions, upon which law and economics scholars have relied when modeling the incentive effects of tort law. We construct a model representing the incentives of “optimistic” tortfeasors and victims, and consider mechanisms for mitigating the effects of biased decision-making. We show that in the presence of optimism, comparative negligence rules are preferable to contributory negligence rules (i.e., the traditional equivalence between contributory and comparative negligence does not hold). Further, we discover the surprising conclusion that the most effective way to correct optimism may often simply be to “forgive” it, shielding optimistic individuals from liability, rather than holding them liable for the harms they cause.     

“Supporting me through emotional times,all different kinds of behaviour.” Forensic mental health service users understanding of positive behavioural support

This service evaluation project explored service users’ experiences of positive behavioural support (PBS) within a medium secure mental health service. Interpretative phenomenological analysis (IPA) was used to analyse interviews with ten service users. Four main themes emerged from the data: My plan; How I understand PBS; How PBS has helped me, the benefits; and Making the plan work. Overall, service users viewed their experience of having a PBS plan positively. They reflected that the plans offered staff greater understanding of their behaviours and needs, enabling them to receive appropriate support. Service users valued the experience of being involved in the process, offering important insights into their experiences. They also expressed frustrations about staff not following the plan and not understanding why they had a plan whilst others did not. Limitations of the study, clinical implications and ideas for future research have been discussed.     

DIVORCING FAMILIES WITH YOUNG CHILDREN IN THE COURT'S FAMILY SERVICES UNIT Profiles and Impact of Services

Little is known about the families being served by court support services, or the effectiveness of the services provided. This study investigates 137 higher conflict, divorcing families with young children, who received services from the Family Services division. The study utilizes questionnaire data filled out by family services clinicians. The families presented with multiple mental health needs, including allegations of substance use and physical, emotional and sexual abuses of spouses and, to a lesser extent, children. Results detailed evaluation outcomes pertaining to joint legal and physical custody, showing an increase in joint legal custody, with little difference in physical custody arrangements. Evaluators did encourage less parental dropout. The data also profiled parents least likely to attend mandatory parenting education, accept evaluators' recommendations, and settle their case with mediation assistance. Identifying these families early can help family services clinicians track families into individualized service plans as needed.     

Transferring Health Technology to South Africa: The Importance of Traditional African Culture

The transfer of new health technology to South Africa is occurring despite the fact that North American and European health care planners and entrepreneurs have a very limited understanding of traditional Black South African cultures which condition the health-related behaviors of the majority of the population. Consequently, relatively few people of African descent in this very diverse nation are, at least initially, benefiting from the new imported medical technology. This study gives an overview of traditional Black medicine in South Africa and, through the presentation of several case studies, discusses its implications for the societal adoption of new health technology received from the United States and other industrialized nations. The example of the successful application of cervical cancer exams in rural and urban clinics of the Eastern Cape is analyzed and institutional mechanisms that support successful transfer are identified.