Competitive bidding and states' purchase of services: the case of mental health care in Massachusetts.

Over the past two decades states have significantly increased their use of competitive bidding to purchase health and social services from private agencies. Competitive contracting is thought to facilitate program administration, to reduce costs, and to increase the quality of delivered services. We evaluate these claims in light of Massachusetts' experience with competitive contracting for mental health care. We find that few of the expected benefits are achieved. In practice, supposedly competitive bidding systems often degenerate into administratively complicated negotiations between the state and private monopolies. This results in higher costs and lower quality of services. In light of this negative assessment, three strategies for reform are proposed and evaluated.     

The contract murderer: patterns, characteristics, and dynamics

A case of an independent professional contract murderer, who killed over 100 people, is reported. After eluding law enforcement for 30 years, the subject killed several associates who he believed could implicate him in various crimes. These homicides eventually led to his arrest, since the victims were individuals who could be linked to him. This hit man had a background of poverty and childhood abuse but, as an adult, had pursued a middle-class lifestyle and kept his family totally separate from his criminal career. In addition, he had a number of characteristics that helped him carry out his crimes in a highly planned, methodical, and organized manner: he had adept social judgment; personality traits of orderliness, control, and paranoid vigilance; useful defense mechanisms of rationalization and reframing; and an exceptional ability to encapsulate emotions. This case is discussed within the context of contract murder, a crime that occurs relatively frequently and is probably increasing; yet it often goes undetected, the arrest rate is low, and the offender is rarely studied.     

Adolescent sexual matricide following repetitive mother-son incest.

A case of a 16-year-old male who committed a sexual matricide following years of mother-son incest is reported. After murdering his mother by strangulation, which itself was sexually arousing, the youngster engaged in both vaginal and anal necrophilia. The homicide occurred while the perpetrator was in a dissociative state and experiencing what has been referred to as a catathymic crisis: the sudden release of emotionally charged psychic conflict and tension, resulting in extreme violence within an interpersonal bond. Discussion of maternal image and maternal sexual conduct in relationship to the psychosexual development of adolescent males offers insight into the motivation in this extremely rare case.     

Celebrity stalking, homicide, and suicide: a psychological autopsy

Despite the high-profile nature of many celebrity stalking cases, little is known about the offenders and even less is known about those who kill their celebrity victims. The case of an obsessed fan who attempted to kill a rock star and then committed suicide is presented. By analyzing his detailed diary, both insight into the motivational dynamics of this type of stalker and delineation of several warning signs, which help differentiate an enthusiastic fan from one who harbors a potentially dangerous obsession, is gained.     

Crime Scene Staging in Homicide

A nonrandom national U.S. sample of 946 homicide crime scenes--supplied by the FBI Behavioral Science Unit for purposes of research--was studied to delineate the prevalence, types, levels, and motives for staging in domestic, nonserial sexual, serial sexual, and general felony homicides. Stagers were found to be a relatively small group who employ a variety of methods to alter the crime scene in an attempt to redirect the investigation away from themselves as logical suspects. Results also suggest that different types of homicides have different staging rates based primarily on the relationship (or connection) between offender and victim. Implications for investigations and understanding this type of crime scene behavior are discussed.