Can ministries of health support primary health care? Some suggestions for structural reorganization and planning

Patrick Vaughan is Reader in health care epidemiology, Gill Walt is Lecturer in health policy and Anne Mills is Lecturer in health economics, at the Evaluation and Planning Centre for Health Care, London School of Hygiene and Tropical Medicine, Gower Street, London WC1, United Kingdom. A previous version of this paper was prepared for the Commonwealth Secretariat, London, for the Conference of Commonwealth Health Ministers held in Ottawa, Canada, in October 1983.     

Treating offenders with mental illness: a research synthesis

The purpose of this research synthesis was to examine treatment effects across studies of the service providers to offenders with mental illness. Meta-analytic techniques were applied to 26 empirical studies obtained from a review of 12,154 research documents. Outcomes of interest in this review included measures of both psychiatric and criminal functioning. Although meta-analytic results are based on a small sample of available studies, results suggest interventions with offenders with mental illness effectively reduced symptoms of distress, improving offender's ability to cope with their problems, and resulted in improved behavioral markers including institutional adjustment and behavioral functioning. Furthermore, interventions specifically designed to meet the psychiatric and criminal justice needs of offenders with mental illness have shown to produce significant reductions in psychiatric and criminal recidivism. Finally, this review highlighted admission policies and treatment strategies (e.g., use of homework), which produced the most positive benefits. Results of this research synthesis are directly relevant for service providers in both criminal justice and mental health systems (e.g., psychiatric hospitals) as well as community settings by informing treatment strategies for the first time, which are based on empirical evidence. In addition, the implications of these results to policy makers tasked with the responsibility of designating services for this special needs population are highlighted.     

Comparing the Recognition Memory Test and the Word Choice Test in a Mixed Clinical Sample: Are They Equivalent?

The Recognition Memory Test (RMT) was compared to the Word Choice Test (WCT) within the same fixed neuropsychological battery administered to a mixed clinical sample of 237 adults to empirically evaluate the psychometric equivalence of these two instruments. On average, there was a 3-point difference in raw scores between the two instruments (M _RMT?=?44.3, SD _RMT?=?6.8; M _WCT?=?47.1, SD _WCT?=?4.6; p?d?=?.48). The probability density functions differ substantially at the two ends of the scale but are similarly ≤42. Cross-validation analyses suggest that the RMT cutoff of ≤42 is functionally equivalent to a WCT score of ≤45.     

Morality analysis: Reducing moral backlash to public policy

Widely used policy development processes rarely systematically consider differing moral values, which can lead to overlooked risks, ineffective communications and suboptimal policy design. This article introduces morality analysis, a policy tool that draws on moral foundations theory to optimize policy and program design, build public support for policies and present key advice to decision-makers. Morality analysis is used to examine the case of a controversial vaccination incentive program introduced by the Government of Alberta in late 2021 and identify policy options that would likely have prompted less public backlash. This article suggests that morality analysis should supplement the policy analysis toolkit.     

The Recurring Victimization of Individuals with Mental Illness: A Comparison of Trajectories for Two Racial Groups

Objective

This study explores whether the trajectories of recurring victimization of Black persons diagnosed with major mental illnesses vary from the trajectories of their White counterparts. Further, the study examines whether the risk factors for recurring victimization among persons with major mental illness vary by race.

Methods

Using data from the MacArthur Violence Risk Assessment Study (MacRisk), two separate hierarchical binomial regression models were estimated to compare the recurring victimization trajectories of Black and White MacRisk participants. Cross-level interaction terms were also estimated to determine if the coefficients for each of the time-varying covariates included in the analyses were significantly different across race.

Results

The findings indicate that the trajectories of recurring victimization for Black persons with serious mental illness are significantly different from those of White persons with serious mental illness. Specifically, Black persons’ trajectories remain relatively stable over time, while the risk of recurring victimization declines for Whites as time since release from the hospital increases. Further, the effects of alcohol abuse on revictimization risk vary by race.

Conclusion

The findings suggest that the life experiences of Black persons with mental illness may be different from their White counterparts, which is likely to contribute to distinct patterns of recurring victimization over time. Future research should continue to explore recurring victimization among diverse samples to identify potential sources of the variation in revictimization trajectories across race.

     

Changing the Domestic Violence Narrative: Aligning Definitions and Standards

Many states use a broad legal definition of domestic violence that includes intimate partner violence along with family violence, and it is from this broader conceptualization that the criminal justice system intervenes and often treats all types of offenders in the same way. This judicial response can include a mandate to attend a Batterer Intervention Program-type group, which does little to address violence that occurs outside of the “traditional” partner violence paradigm. In order to advance interventions for physical partner violence that adequately address both male and female perpetration, as well as the broader conceptualization of domestic violence, we must align definitions and standards among researchers, service providers, advocates, policymakers, and the public health and criminal justice systems. Examples of how this misalignment has stalled progress in offender treatment are discussed and a plan for enabling continued innovation in the field is presented.     

Economic,trade and development relations between South Africa and the European Union: The end of a strategic partnership? A South African perspective

ABSTRACT

The relationship between democratic South Africa and the European Union (EU) has been in existence for over 20 years, with its roots tracing back to anti-apartheid support measures. In its earlier form, it was anchored in the Reconstruction and Development Programme. Currently, it is guided by the National Development Plan of the National Planning Commission. This relationship has been tested over time, especially as a result of negotiations over the Economic Partnership Agreement with the EU. In the meantime, the euphoria that marked new South Africa's participation in the global system, with trade and development cooperation with the EU as one of the cornerstones, has waned considerably. The cancellation of several bilateral investment treaties with EU member states has further strained the relationship. While there are notable successes in the EU–South Africa Strategic Partnership, these may not be reflective of the actual strategic value of the partnership in the context of global shifts and the rising influence of emerging powers with which South Africa is integrating.     

A field study of adult witness interviewing practices in a Canadian police organization

Purpose. The current study examined witness interviewing practices in a Canadian police organization. The effect of interviewer, interviewee, and interview characteristics on those practices was also examined. Method. Ninety witness interviews from a Canadian police organization were coded for the following interviewing practices: types of questions asked (i.e. open‐ended, probing, closed‐ended, clarification, multiple, leading, opinion/statement, and re‐asked), the number of interruptions, percentage of words spoken by interviewer, type of pre‐interview instructions (consequential vs. generic), and whether or not a free narrative was requested (and when requested during the interview). Characteristics pertaining to the interviewer (e.g. primary interviewer's age), interviewee (e.g. witness gender), and interview (e.g. crime type) were also coded. Results. Results showed that closed‐ended and probing questions were the most widely asked questions, and that open‐ended questions were asked relatively infrequently. It was also found that the 80–20 talking rule was violated in 89% of the interviews, interviewers rarely interrupted the witnesses, and free narratives were requested often. Overall, the effect of interviewer, interview, or interviewee characteristics on interviewing practices was minimal. Conclusions. The finding that scientifically prescribed interviewing practices are employed rarely by Canadian police officers highlights a need for increased professional interviewing training. The finding that practices are largely unaffected by personal and situational factors suggests that such training would be equally beneficial for all types of interviewers, interviewees, and contexts.