Intellectual disability and mental illness in the NSW criminal justice system

There has been increasing international, national and local recognition of the need for more appropriate responses and services for individuals who come in contact with the criminal justice system and who have an intellectual disability and mental health issues. This article provides an overview of prevalence data that indicates a significant over representation of people with intellectual disabilities in correctional facilities and reviews the problems facing this population. Findings from two specific evaluation studies undertaken by the Centre for Developmental Disability Studies are presented, along with recommendations for future provision based on these results. One of these projects trialled a case management approach to supporting offenders with an intellectual disability upon their release from prison. The 20-month follow-up found that a number of serious barriers were encountered within the overall system of provision for this population; the most serious of which related to lack of adequate accommodation upon release. The second project involved a two-stage evaluation of one model of provision for individuals with intellectual disabilities who are sex offenders, only some of whom were on parole. This service provided both residential and therapy services in a small group home located in the community. Residents were found to have high levels of emotional and behavioural difficulties, in addition to offending behaviour, that continue to require support and supervision. Critical issues, including guardianship involvement, restrictive practices and retrieval, therapy provision, and risk management issues are discussed in relation to overall clinical and lifestyle outcomes.     

Does Medicare Coverage Improve Cancer Detection and Mortality Outcomes?

Medicare is a large government health insurance program in the United States that covers about 60 million people. This paper analyzes the effects of Medicare insurance on health for a group of people in urgent need of medical care: people with cancer. We used a regression discontinuity design to assess impacts of near-universal Medicare insurance at age 65 on cancer detection and outcomes, using population-based cancer registries and vital statistics data. Our analysis focused on the three tumor sites for which screening is recommended both before and after age 65: breast, colorectal, and lung cancer. At age 65, cancer detection increased by 72 per 100,000 population among women and 33 per 100,000 population among men; cancer mortality also decreased by nine per 100,000 population for women but did not significantly change for men. In a placebo check, we found no comparable changes at age 65 in Canada. This study provides the first evidence to our knowledge that near-universal access to Medicare at age 65 is associated with improvements in population-level cancer mortality.     

Blazing a trail while lazing around: knowledge processes and wood-fuel paradoxes?

Using autobiographical experience with reference to wood-fuel research in two locations in West Africa, this article illustrates how knowledge processes influence what can be produced as knowledge; how such knowledge is actually produced; and what is eventually produced as knowledge. However, although it explores the various roles that knowledge plays in the social relations at particular historical moments in the personal and professional development of a single individual, the questions that this subjective experience raises are of wider import: whose knowledge matters? How do certain knowledges get suppressed or denied, while others are privileged? In turn, this raises additional questions concerning the ways in which research and practice are mediated through local research, policy, and development prisms. In a general sense, the article is about the way in which wood-fuel philosophies, methodologies, and practices are constructed, modified, and maintained in existence as knowledge; and a reminder that such knowledge processes cannot truly be understood in isolation, but need to be situated within complex, diversified contexts of individual agendas, and group strategies, as well as in multiple sites of production.