The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness

OBJECTIVE: In recent decades debate has intensified over both the ethics and effectiveness of mandated mental health treatment for persons residing in the community. Perceived barriers to care among persons subjected to mandated community treatment, and the possibility that fear of involuntary treatment may actually create or strengthen such barriers rather than dissolve them, are key issues relevant to this debate but have been little studied. This article explores the link between receipt of mandated (or "leveraged") community treatment and reasons for avoiding or delaying treatment reported by persons with severe mental illness. It also examines the potential moderating effect of social support on the association between mandated treatment experiences and barriers attributable to fear of involuntary commitment or forced treatment. METHOD: Data are presented from a survey of 1011 persons with psychiatric disorders being treated in public-sector mental health service systems in five U.S. cities. Logistic and negative binomial regression analyses were used to examine the association between mandated community treatment and perceptions of barriers to care, controlling for demographic and clinical characteristics. RESULTS: Across sites, 32.4% to 46.3% of respondents reported barriers attributed to fear of forced treatment. Whereas 63.7% to 76.1% reported at least one non-mandate-related barrier to care; the mean number of non-mandated barriers to care ranged from 1.6 to 2.3 (range 0-7). Between 44.1% and 59.0% of participants had experienced at least one type of leveraged treatment. Persons experiencing multiple forms of mandated treatment were more likely to report barriers to care in comparison to those not reporting mandated treatment. Findings also indicated that social support moderates the relationship between multiple leverages (three or four forms) and mandate-related barriers to care. CONCLUSIONS: Perceived barriers to care associated with mandated treatment experience have the potential to adversely affect both treatment adherence and therapeutic alliance. Awareness of potential barriers to care and how they interact with patients' perceived social support may lead to improved outcomes associated with mandated treatment.     

Parenting,Peer Orientation,Drug Use,and Antisocial Behavior in Late Adolescence: A Cross-National Study

The objective of this study was to investigate the links between maternal and paternal bonding, parental practices, orientation toward peers, and the prevalence of drug use and antisocial behavior during late adolescence. A model was tested using structural equation modeling in order to verify the robustness of the investigated links across 3 countries: Canada, France, and Italy. A self-report questionnaire was given to a sample of 908 adolescents, with an equivalent number of girls and boys, in Grade 11. The questionnaire assessed the following variables: parental bonding, parental supervision, parental tolerance, orientation toward peers, involvement in physically aggressive antisocial behavior, non-physically aggressive antisocial behavior, and drug use. The model was robust across the 3 countries, thus confirming a path that identified quality of emotional bonds between adolescents and their parents as a distal variable acting upon deviant behaviors through the following mediators: parental supervision, parental tolerance, frequency of conflicts, and orientation toward peers. Michel Claes is full professor at the Université de Montréal, Canada. He received his Ph.D. in Education from Université Catholique de Louvain, Belgium. His major research interest is in social development in adolescence, with a special focus on intercultural studies.     

Psychological Distress Following Suicidality Among Gay,Lesbian, and Bisexual Youths: Role of Social Relationships

Longitudinal relations between past suicidality and subsequent changes in psychological distress at follow-up were examined among gay, lesbian, and bisexual (GLB) youths, as were psychosocial factors (e.g., self-esteem, social support, negative social relationships) that might mediate or moderate this relation. Past suicide attempters were found to have higher levels of depressive symptoms, anxious symptoms, and conduct problems at a later time than youths who neither attempted nor ideated. Psychosocial factors failed to mediate this relation. The interaction among past suicidality, social support, and negative relationships was associated with subsequent changes in all 3 psychological distress indicators 6 months later. Specifically, high levels of support (either from family or friends) or negative relationships were found to predict increased psychological distress among those with a history of suicide attempts, but not among youths without a history of suicidality. The findings suggest that GLB youths who attempt suicide continue to have elevated levels of psychological distress long after their attempt and they highlight the importance of social relationships in the youths psychological distress at follow-up.Earlier versions of this paper were presented at the biannual meeting of the European Association for Research on Adolescence, Oxford, UK, September 2002; and, at the annual meeting of the American Public Health Association, San Francisco, CA, November 2003.Associate Professor of Psychology, The City University of New York—The City College and Graduate Center. Received PhD in psychology from New York University. Research interests include the relation of identity to health, the intersection of multiple identities, and the relation of violence to health.Doctoral candidate in Social/Personality Psychology and Health Psychology, The City University of New York—Graduate Center. Research interests include the role of social relationships in the preservation of health and well-being.Research Scientist, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute; and Assistant Professor, Department of Psychiatry, Columbia University. Received doctorate in social welfare (DSW) from The City University of New York—Graduate Center. Research and clinical interests include the design and implementation of interventions for gay, lesbian, and bisexual adolescents.     

Personal transformation in multistakeholder environmental partnerships

This paper examines some of the secondary or indirect consequences of multistakeholder collaborative processes in the environmental arena. Its thesis is that such collaborative processes constitute fertile ground for participating actors to experience change in their subjective understandings of and relationships to each other, themselves, and environmental action. This exposition draws upon ethnographic research performed with a U.S.-based multistakeholder environmental partnership over a two year period in 1997–1998 as well as a theoretical perspective conceptualizing these personal transformations in terms of social learning, cultural production, and identity formation. Three main findings are explored that support the proposed thesis. The first concerns contributions toward personal transformation made by typical partnership structures and operations. The second pertains to the existence of a commonly shared belief among partnership participants demonstrating an expectation for such changes. The third involves evidence that such transformations actually do take place. Examples from the case study include changes to participants understandings of other environmental stakeholders, the development of new relationships among participating actors, the adoption of new ways of approaching environmental problem solving and decision making, and the formation of altered identities. The paper explores some of the implications, both positive and negative, that this transformative quality of multistakeholder environmental partnerships has for both environmental problem solving and some of the enduring conflicts that have impeded satisfying environmental action in the past. Finally, recommendations are made for how practitioners may organize, manage, and evaluate multistakeholder partnerships to promote such changes.     

The Historical Context of Small Claims Courts

The conception of simple, informal, lawyerless courts where ordinary people can settle their affairs amicably without expense, delay, technicality, or contentiousness has fascinated Americans since colonial times. This theme can be seen running through the movements to codify the law, simplify legal procedure, open the practice of law to Everyman, create conciliation courts; the creation of the small claims courts and administrative tribunals; and attempts in the 1960s and 1970s to divert small matters out of the courts altogether and into Neighborhood Justice Centers and other informal dispute resolution mechanisms. The long and complex history of reform has been characterized by cyclical shifts in emphasis between two principal modes of characterizing small claims. One mode characterizes small claims as petty private quarrels and has led to attempts to supply justice by aiding fair outcomes between the particular parties. Since no broader social impact of the dispute is seen, the most efficient possible individual level response is viewed as appropriate. The other mode perceives small claims as particular instances of important systematic injustices between social groups or classes and has led to attempts to use small claims processing as the forum for making important policy. Perceiving broad social impact of the resolution of small claims, one will see a mobilization of aggregate resources to deal with them as important social problems as appropriate. As a result, entire classes of cases and issues may be skimmed off and dealt with collectively as important social-legal problems. When this occurs the perception of the small claims that remain shifts to the other mode, and they are viewed as less important residual petty quarrels meriting less attention and resources. This periodic skimming off of certain claims and waning of collective attention to the remaining mass of claims has introduced a cyclical element into the development of small claims courts (and other legal reforms). Thus the mode of preceiving small claims itself conditions the mode of legal response which is advocated.