Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.     

Understanding Change in Political Science: On the Need to Bring Space into Theoretical Positions and Empirical Analyses

In recent times, issues surrounding change have become increasingly important in the study of political analysis. This is especially true within strains of new institutionalism such as historical institutionalism and the 'Varieties of Capitalism' approach. However, although this has led to a sensitising towards the temporal dimension, the spatial dimension has been relatively ignored. This is arguably problematic, as a fuller understanding of space and the spatiality of social and political relations would lead to more coherent and accurate analyses of political phenomena that currently characterise historical institutionalism. Indeed at an ontological level, drawing on work within the natural sciences and geography, it is impossible to talk of time without reference to spatiality and of space without reference to temporality. This short article reviews some of the more prominent historical institutionalist literature that deals with change and renders explicit the problematic conceptualisation of space, and consequently time, which underpins their analyses. Drawing on Massey and Sayer, it proceeds to outline briefly a relational conception of space and the difference that space makes to political analyses.     

Earth Day and Its Precursors: Continuity and Change in the Evolution of Midtwentieth‐Century U.S. Environmental Policy

Earth Day 1970's legacy overshadows two earlier events resulting in popular misconceptions about U.S. environmental politics: that environmental policy began with Earth Day and that Congress and the president were not concerned with the environment until public opinion and interest groups pressured them. These misconceptions increase public opinion ambivalence and frustrate environmental leaders. This paper describes Earth Day 1970, the congressionally established Outdoor Recreation Resources Review Commission established in 1958, and President Kennedy's Natural Resources Tour of September 1963, arguing the latter two prepared for the convergence of multiple streams of policy change that resulted in the first Earth Day.     

Special Edition on Performance Management

This edition of Policing: A Journal of Policy and Practice isdevoted to police performance management. Several of the articlesherein trace the origins of this style of police managementand the influences that have brought it about. Others appraiseits effects on matters as diverse as domestic violence, criminalinvestigation and the closure of police stations. They do so,not only from the perspective of the UK, but also from thoseof France, the United States and elsewhere; police performancemanagement is widespread and so are the issues that it raises. In this editorial     

The struggle for power and control: shifting policy‐making models and the Harris agenda for education in Ontario

Abstract: This article describes the evolution of three different models in educational policy‐making in Ontario. In the late 1960s, education policy moved away from reliance on a traditional, centralized, administrative‐agency approach and gravitated towards a decentralized, asymmetrical policy interdependence that dominated until the mid‐1990s. The ndp government erected a more centralized scaffolding, with the centre undertaking a greater tutelary role vis à vis local authorities. The aim was to make more transparent the rules and standards by which local authorities, trustees and educators would operate and be held accountable. The education minister also sought to bolster local democracy by widening local parental participation in decision‐making, Since 1995, the Conservative government has erected a politicized administrative agency that has adopted a confrontational stance towards stakeholders, reduced the powers of school board trustees, decimated middle‐level professional staffing, and muffled teacher union executives. Decision‐making now seems to reside with Harris advisers and key cabinet ministers, whose stance is driven by an amalgam of neo‐liberal and neo‐conservative ideology and by voter opinion. This neo‐conservative approach differs in its embrace of a social conservatism ‐ that government maintain social order and that excessive concern for individual choice and liberty not be allowed to undermine it. Harris' social conservatism, in its K‐12 reforms, includes an embrace of regulation, hierarchy, monopoly and uniformity in the design of public policy. Sommaire: Cet article décrit l'évolution de trois modèles différents d'élaboration de politiques en matière d'éducation en Ontario. Vers la fin des anébes 1960, ces politiques d'éducation ne suivaient plus l'approche classique et centralisée caractéristique d'un organisme administratif; elles tendaient plutôt vers une interdépendance décentralisée et asymétrique, qui prédomina jusqu'au milieu des années 1990. Le gouvemement néo‐démocrate érigea une structure plus centralisée qui accordait au centre un plus grand rôle tutelaire par rapport aux autorités locales. Ceci, aux fins d'une plus grande transparence des règles et normes de fonctionnement et de redev‐abilité pour les autorités locales, les conseillers scolaires et les enseignants. Le minis‐tre de l'Éducation s'est efforcé aussi de favoriser la démocratic locale en amplifiant la participation parentale dans la prise de décisions. Depuis 1995, le gouvemement conservateur a éigé un organisme administratif politicisé qui a adopté des positions conflictuelles envers les intervenants, qui a réduit les pouvoirs des conseillers scolaires et qui a sabré dans les rangs du personnel professionnel de niveau intermédi‐aire tout en muselant les dirigeants syndicaux des enseignants. II semblerait que les décisions sont maintenant prises par les conseillers de Harris et par certains de ses ministres ‐ clé, poussés par l'opinion des électeurs et une idélogie à la fois néo‐libérale et néo‐conservatrice. Cette approche néo‐conservatrice embrasse un certain conservatisme social: le gouvemement doit maintenir l'ordre social qui ne doit pas être sapé par une trop grande préocupation concemant la liberté et les choix personnels. Le conservatisme social de Harris dans le cadre des réformes scolaires fait appel à la réglementation, à la hiérarchie, au monopole et à l'uniformité dans l'élaboration des politiques gouvemementales.     

A Survey of Perspectives on Intergovernmental Relations: A Comparative Analysis of the Czech and Slovak Republics

The results of a survey of local government officials from the Slovak and Czech Republics taken in December of 2005 are presented and analysed. Attitudes about and perspectives on intergovernmental fiscal relations in the two republics are probed. Differences and similarities in Czech and Slovak views are established regarding some of the perceptions of local autonomy and the sufficiency of available funds; whether or not public services are supplied by the appropriate levels of government; the potential benefits of adopting a serious rather than a nominal property tax; and the flexibility of local budget planning in Czech and Slovak cities and towns.     

Resistance and Creativity in Social Interaction: For and Against Memory in Poland, Israel–Palestine, and the United States

In this paper, I present an analysis of Adam Michnik’s notion of “Amnesty without Amnesia”. His was a wise political judgment presented at a critical moment in the struggle to constitute a democratic polity in Poland. Mine is an appreciation of his political position, along with a sociological analysis that highlights the empirical difficulties of its realization in practical action. I will show how at critical moments of social change creative political action works to erase memories of the relevant past, which act as a repressive force, while “re-remembering” (to use Toni Morrison’s formulation). Three cases will be compared, Michnik’s, after the fall of the communist regime in east central Europe, and cases drawn from the Palestinian–Israeli conflict and the American presidential campaign. A paper prepared for presentation at Cerisy, France, Summer, 2008.     

A retrospective study of drugged driving in Norway

The National Institute of Forensic Toxicology, Oslo, receives blood and urine samples from all Norwegian drivers apprehended on suspicion of driving under the influence of alcohol or drugs. In 1983 we received samples from 1446 drug-suspected drivers, out of which 445 underwent toxicological analysis. The drugs found most frequently were tetrahydrocannabinol (THC) (n = 199), diazepam (n = 166) and amphetamine (n = 102). A cautious interpretation of the data indicate that about 200 of the 445 subjects selected for toxicological analysis drove under severe influence of drugs. Because of the high percentage of submitted cases not analysed for drugs, this figure represents a minimum estimate. Compared with the results from 1978, we found a several-fold increase in detections of THC and amphetamine in 1983. The number of diazepam detections did not increase in a similar way, but we estimated that the diazepam detections would have increased 3-fold if we had analysed as frequent for this drug in 1983 as in 1978.