Civil commitment of the mentally ill: an overview

This article discusses historical themes that led to the civil commitment reforms of the sixties and seventies. The changes in the substantive criteria for commitment are analyzed and critiqued. The author believes that the present criteria tend to focus so specifically on various external indicia of mental illness that they render commitment difficult for many seriously ill patients. An alternative commitment scheme is discussed.     

Causes of death in hospitalized intravenous drug abusers

The authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital. There were 127 who died from diseases unrelated to intravenous drug abuse, and in 41% of these, chronic alcoholism was implicated. Deaths from overdose syndromes and drug-related organ pathology comprised only 11% of all cases. The mean age at death was 39 years. There was a male/female ratio of 3.6:1. Half of all patients died from infection--72 from acquired immunodeficiency syndrome (AIDS) alone. These findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that AIDS and chronic alcoholism are significant problems. Emphasis should be placed upon detecting "hidden" intravenous drug deaths to provide more accurate statistical information.     

Physician recruitment after Hermann Hospital

The state of physician recruitment changed after the Internal Revenue Service required Hermann Hospital to publish its closing agreement with the IRS. The closing agreement released the long-awaited IRS "Hospital Physician Recruitment Guidelines." The IRS' recently proposed revenue ruling provides additional insight on acceptable physician recruitment practices as well.     

Lies Matter

Law and Philosophy -     

Regionalism and the WTO: Opportunities and dangers for Africa

An examination of regionalism and its ramifications for the African region within the framework of the World Trade Organization and other economic partnership agreements being negotiated with this and other regions.     

Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.     

Knowledge and attitudes about AIDS: A comparison of public high school students,incarcerated delinquents,and emotionally disturbed adolescents

This study compared AIDS knowledge and attitudes in public high school students (N=167), incarcerated delinquents (N=166), and emotionally disturbed (SED) adolescents (N=151). The response measure was a 50-item Acquired Immunodeficiency Syndrome (AIDS) questionnaire that was previously used by Bell et al., in their 1991 study of learning disabled adolescents. Although AIDS knowledge was moderately high in all three groups, widespread misunderstandings about disease transmission and awareness of high-risk groups and practices were noted. Knowledge scores were significantly higher in the public school sample than in the SED adolescents; moreover, they tended to be slightly higher (p<0.10) than the delinquent group as well. Teenagers with the severest emotional problems were by far the least informed. Age and race were also predictive of AIDS knowledge. Other results showed that delinquents were more permissive in their attitudes about sex, more inclined to disdain safe sex practices, and more likely to feel threatened by high-risk groups as well as powerless to protect themselves against AIDS. Generally speaking, the findings extend the work of other investigators on the needs for AIDS education in adolescents. The need is especially urgent in delinquent and emotionally disturbed youth who may require a more comprehensive intervention because of their greater knowledge deficits, propensity for high-risk practices, and tendency to deny or underestimate their own vulnerability.Received Ph.D. in clinical psychology from the University of Utah in Salt Lake City. Research interests include health behavior change and the treatment of anxiety and habit disorders. To whom correspondence should be addressed.Received M.A. degree in psychology from the University of the Pacific. Research interests include health behavior change and medical epidemiology.Received Ph.D. in psychology from the University of Auckland, Auckland, New Zealand. Research interests are in child and adolescent psychiatry and the delivery of mental health services.Received Ph.D. in biostatistics from the Medical College of Virginia. Research interests are in general linear models.