Endorsement of personal benefit of outpatient commitment among persons with severe mental illness.

This study examines whether individuals who experienced involuntary outpatient commitment (OPC) attribute benefit to this intervention. It was found that the majority of experimental subjects who underwent a period of OPC did not personally endorse OPC's benefits at the end of the study, either because they did not think it improved treatment adherence or because they rejected their own need for continued treatment. However, at the end of the study, a positive appraisal of benefit was roughly twice as likely among subjects who actually experienced positive treatment outcomes. These data provide little support for acceptance and "gratitude" as a rationale to support decision making about OPC continuation. Rather, clinicians need to rely on other clinical and empirical data for such decision making.     

A Quarter Century of Participation in School-Based Extracurricular Activities: Inequalities by Race,Class, Gender and Age?

Extracurricular activity participation is linked to positive development, but it is also a setting for inequality. Using a quarter century of data from Monitoring the Future (N?=?593,979; 51% female; 65% non-Hispanic white; 13% non-Hispanic black; 12% Hispanic; 4% non-Hispanic Asian/Pacific Islander; 7% other race), this article documents patterns and trends in school-based extracurricular participation by race, social class, gender, and age, and their links to academic and substance use outcomes. Findings reveal differences by race and confirm a division by social class that has worsened over time. Further, girls are gaining on boys and surpass them in some types of school-based activities. Participation is linked to better academic outcomes and less substance use, affirming the importance of redressing the inequalities revealed.     

Why requiring employers to provide health insurance is a bad idea

There is mounting pressure at the federal (and state) level to require employers to provide health insurance to their employees. However, two quite different groups of workers could be affected by such a mandate. In addition, there are at least five major problems with requiring employers to provide health insurance. Chief among these is the further fracturing of the insurance market, so that the spreading of risk will be reduced, and only the young and healthy will be offered insurance at relatively low premiums. We should be designing a health insurance system that has both universal coverage and a cost-containment structure. Toward this end, we need to tackle issues that transcend alternative methods of financing health care in the U.S.     

Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N=469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid.     

Is thin a feminist issue?

Anorexia nervosa and similar disorders preponderate in women and therefore seem particularly suited to feminist models of understanding. Boskind-Lodahl (1976) and Orbach (1979, 1982) have put forward similar views on the subject, and their work is well known.This article explores the assumptions behind the Boskind-Lodahl/Orbach hypothesis, and argues that the most fundamental of these lies in a problematic distinction between the concepts of nature and culture. Some implications of the hypothesis are discussed with emphasis on the extent to which these authors normalize anorectic behaviour. The question is raised as to whether this normalizing approach may be read as legitimating symptoms. Feminist, anthropological, and other writing is used to examine the potential for alternative models of understanding anorexia nervosa which do not rely on a nature/culture split and which address the issue of the social function of anorectic symptoms. These models point towards a more general concern in feminist theory with the relationship between culture and psychological disorder.