Tarasoff in Missouri: The jurisprudence of a mental health provider's duty to warn and protect non-patients of potential risks from patients

In 1976, the Supreme Court of California issued its well-known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third-party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff-related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff-like third-party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof-like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment.     

Conclusion: Mental health and legal responses to the adolescent mental health crisis: Raising the bar on best interests and promoting family connectedness in divorcing families

We are currently facing an unprecedented increase in adolescent mental health problems resulting in alarmingly high levels of depression, anxiety, and suicidality. Significant mental health problems among youth pose unique challenges to families in the process of separation and divorce, as well as to family law professionals across all disciplines. The current adolescent mental health crisis calls for new ways of approaching our work with high conflict families to promote family connectedness and shift away from adversarial approaches that may exacerbate conflict and further destabilize families. As a conclusion to the special issue on adolescent mental health needs, the authors make multidisciplinary best practices recommendations and advocate for systems level changes in recognition of the needs of youth in crisis at this pivotal developmental stage.     

Development of an Index of Subsidized Housing Availability and its Relationship to Housing Insecurity

Housing insecurity is a known threat to child health understanding predictors of housing insecurity can help inform policies to protect the health of young children in low-income households. This study sheds light on the relationship between housing insecurity and availability of housing that is affordable to low-income households.

We developed a county-level index of availability of subsidized housing needed to meet the demand of low-income households. Our results estimate that if subsidized units are made available to an additional 5% of the eligible population, the odds of overcrowding decrease by 26% and the odds of families making multiple moves decrease by 31%. Both of these are known predictors of poor child health outcomes. Thus, these results suggest that state and federal investments in expanding the stock of subsidized housing could reduce housing insecurity and thereby also improve the health and well-being of young children, including their families' food security status.     

Realising the Right to Health for Young People in South Africa—Some Reflections

Abstract

The right to health is enshrined in the South African Constitution as well as a range of international and regional human rights treaties which South Africa accepts. Yet empirical data reveals some of the challenges faced by South African youth—childhood diseases, HIV/AIDS and such like. There are evidently challenges realising the right to health in practice. Nevertheless, South African courts have led the international field in recognising the justiciability of economic and social rights such as the right to health. Having reviewed the applicable laws and jurisprudence, the paper will conclude that a more holistic human rights-based approach offers perhaps the best way forward.     

Justifications for Non-Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. Yet it occasionally seems morally permissible to carry out non-consensual medical interventions on competent individuals for the purpose of infectious disease control (IDC). We describe two different moral frameworks that have been invoked in support of non-consensual IDC interventions and identify five desiderata that might be used to guide assessments of the moral permissibility of such interventions on either kind of fundamental justification. We then consider what these desiderata imply for the justifiability of carrying out non-consensual medical interventions that are designed to facilitate rehabilitation amongst serious criminal offenders. We argue that these desiderata suggest that a plausible case can be made in favor of such interventions.     

ICF脑卒中核心分类组合功能的图形建模研究

目的依据《国际功能、残疾和健康分类(ICF)》脑卒中核心组合,探讨脑卒中相关功能类目之间的关系,绘制ICF脑卒中核心分类组合的功能地形图,为脑卒中的伤残评定提供科学理论依据。方法收集106例脑卒中被鉴定人样本,采用"最小的绝对缩减和变量选择算子",研究脑卒中ICF核心组合功能的59项类目变量之间的条件依存关系,并用图形建模分析类目之间的内在联系,绘制功能地形图。结果 59项类目之间的相互联系构成了功能地形图,b340、b735、b175和b152因关联性较高而居于地形图的中心位置。结论脑卒中功能地形图可以揭示ICF功能类目之间复杂的关系结构及关联程度。可以为应用ICF进行脑卒中的伤残评定提供科学理论依据。     

'Your personality is the intervention': a grounded theory of mental health nurses’ beliefs about hope and experiences of fostering hope within a secure setting

Hope is an important factor in psychological resilience and change, and recovery from mental health difficulties. Recently, there has been an increased focus on recovery-oriented practice within forensic mental health settings. Several policies include calls for mental health practitioners to inspire hope for recovery in the individuals they work with. However, there is little suggestion of how to implement such recommendations in practice or research exploring how staff foster hope in forensic settings. This study used grounded theory to explore nurses’ perspectives and experiences of hope within a medium secure setting. A model was developed from the data that integrated nurses’ beliefs about hope, practices to develop service users’ hope and the emotional impact of this work. The nurses’ values played a significant role in their work to develop hope. Recommendations are made to help manage the emotional impact and address challenges unique to fostering hope within forensic settings.     

Therapeutic engagement in medium-secure care: an interpretative phenomenological analysis of service users’ experiences

Service users (SUs) detained in forensic hospitals are usually required to engage in psychological therapies aimed at reducing mental distress and/or for preventing further offending. Poor therapeutic engagement (TE) can lead to adverse clinical outcomes and reoffending, at a cost to the individual, staff, the service provider, and the public. To understand what factors influence TE from a SUs’ perspective, the experiences of 10 male residents of a medium-secure hospital were explored. Using a service-user informed design, interpretative phenomenological analysis of interview data was completed. Four superordinate themes emerged: different worlds; what the individual brings; what the therapy entails; and control. Consideration of how these factors may be of use to professionals working in secure care settings is discussed in relation to existing theory and research.     

“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.