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PubMed1998

Persons with severe mental illness in jails and prisons: a review.

OBJECTIVE: The presence of severely mentally ill persons in jails and prisons is an urgent problem. This review examines this problem and makes recommendations for preventing and alleviating it. METHODS: MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1970, and all pertinent references were obtained. RESULTS AND CONCLUSIONS: Clinical studies suggest that 6 to 15 percent of persons in city and county jails and 10 to 15 percent of persons in state prisons have severe mental illness. Offenders with severe mental illness generally have acute and chronic mental illness and poor functioning. A large proportion are homeless. It appears that a greater proportion of mentally ill persons are arrested compared with the general population. Factors cited as causes of mentally ill persons' being placed in the criminal justice system are deinstitutionalization, more rigid criteria for civil commitment, lack of adequate community support for persons with mental illness, mentally ill offenders' difficulty gaining access to community treatment, and the attitudes of police officers and society. Recommendations include mental health consultation to police in the field; formal training of police officers; careful screening of incoming jail detainees; diversion to the mental health system of mentally ill persons who have committed minor offenses; assertive case management and various social control interventions, such as outpatient commitment, court-ordered treatment, psychiatric conservatorship, and 24-hour structured care; involvement of and support for families; and provision of appropriate mental health treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed2003

The M-C-M' cycle and social capital.

Social capital has become a popular term over the past two decades amongst researchers, policy makers and practitioners from varied disciplines. This popularity, however, has resulted in a great deal of confusion over the nature and application of social capital in different contexts. This confusion has made it difficult to identify and measure social capital within the evaluation of specific social and health programmes, one of the aims of which may be to stimulate social capital. This paper identifies a theoretical model that seeks to capture the dynamic nature of social capital to assist in the development of research methods that will facilitate its measurement and exploration within such programmes. The model reported in the paper identifies the key components of social capital and expresses the relationship between those components in a dynamic system based on Marx's description of the process of capital (economic) exchanges expressed in the M-C-M' cycle. The M-C-M' cycle is the transformation of money (M) into commodities (C), and the change of commodities back again into money (M') of altered value. The emphasis within the paper is on the capital element of the concept and its transactional nature with the aim of avoiding the pitfall of attributing social capital in relation to social behaviours in isolation of context and interaction. Importantly, the paper seeks to distinguish the central elements of social capital from some of the antecedent factors and outcomes often attributed to and confused with social capital adding to the problem of providing valid measurement. The model is presented as the basis for the measurement of social capital within a transactional process involving the investment of social resources in a cyclical process, which may result in net gains or losses. This process is described as the R-C-R' cycle following Marx's model of economic capital, with the focus being on the transfer of social resources (R) rather than money (M). R represents an internal resource held by individuals, C the external resource or commodity they obtain from the network and the R' the internal resource of altered value. The possibilities of the model in assisting in the measurement of social capital specifically in assessing formal networks are explored.

Commerce↗
PubMed1990

Battered wives--measures by the social and medical services.

The social files and medical records of 98 acutely battered wives who attended a surgical emergency department were studied. Although all women had been hospitalized during the decade preceding the present incident, wife battering was documented in the records in only 18%. The majority of the women (73%) were also known to the social services, but battering was documented in less than half of the cases in the social service files. The measures taken by the social services to help the battered women consisted mainly of economic support and psychotherapy. The cooperation between the medical and social services and the police in cases of wife battering was very limited or non-existent. It is concluded that support given to battered women by the formal sources of aid is insufficient. The documentation of the cases is poor, there is a lack of practical measures and the cooperation between the authorities is limited. This study indicates that the social and medical services underestimate the importance of informal help sources like women's groups or shelters which often are the most valued resources by the battered women themselves. With improved cooperation between authorities and between formal and informal sources of aid the battered wives could be helped more effectively.

Adolescent↗
PubMed1995

Principlism and the ethical appraisal of clinical trials.

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as "principlism", has come under scrutiny. In this paper we argue that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be "specified" as described by De Grazia (1992), and (2) that the principle-based approach should be supplemented by formally incorporating "sensitivity to context" into the evaluation of clinical trials.

Altruism↗
PubMed1995

Drunkenness among police detainees.

All detainees at seven police stations within the Metropolitan Police Area were observed by the authors. Continuous 24-hour cover was provided at each station for periods of 3 weeks. The number of people arrested for offences of drunkenness was noted, as was the apparent degree of drunkenness of all detainees, irrespective of arrest offence. Arrest for drunkenness in London was strongly associated with being white and with having been born in Scotland or Ireland. Within the confines of the station, being drunk was associated with aggressiveness, with the need for medical examination and with delays in implementing interview procedures. The physical condition of many chronically drunk people was very poor and evidence of long-term self neglect was common. Formal cautioning of drunkenness offenders has effectively removed such people from the courts; in the present study only 5% of those arrested for drunkenness alone were subsequently charged. Despite this the police in London must continue to arrest and detain the drunk and incapable for want of suitable alternatives.

Adolescent↗
PubMed2001

[Human cloning in the activities of the European Union].

The European Union has been concerned with human cloning since the late 80. It resulted from inclusion of biotechnology into the sphere of European integration. The attitude of the European Union in the domain of human cloning was shaped, in principle in the second part of the 90. As the Community law stands at present, the European Union is not able to regulate all aspects of the cloning of human beings. It has no general power to decide in that sphere, especially, as far as bioethic aspects are concerned. The cloning of human beings in the European Union is understood as a process aiming at producing new human being, genetically identical with another live or dead human being. Thus the notion of human cloning is reduced to reproductive cloning. Three instruments are at the disposal of the European Union in the domain of human cloning. The first is prohibition of reproductive cloning as a general principle of Community law. However, that principle is not the result of judicial activity of the European Court of Justice (as general principles normally are), but the logical consequence of views formally expressed by the European Parliament, the Council of the Europe as well as the Commission. The principle was finally included in the Charter of fundamental rights of the European Union. The second instrument is an imperative prohibition of patent granting to biotechnological inventions on human reproductive cloning. Last, but not least, the Union applies a prohibition of financing scientific research connected with human cloning from the budget of the European Communities within the V Framework Programme in the field of research and technological development.

Bioethics↗
PubMed1975

Components of "authority" as determinants of compliance.

This study investigated factors affecting compliance, to orders from a formal authority. The design created a two-level status hierarchy in which subjects occupied identical low-status positions and responded to demands from a simulated high-status leader. Four components of authority-normativity,coervice power, collective justification, and success-failure-were manipulated as independent variables. Another component, the endorsement accorded the leader, was included in the design as a measured variable. Results indicated that compliance increased significantly when coervice power was high (rather than low), when justification was collective (rather than partisan), and when demands were normative (rather than counternormative). Contary ti the theoretical expectation, endorsement did not affect compliance by low-status members. The findings show that the normative aspect of legitimacy serves as a compliance-gaining base even when stripped of enforcing sanctions and under-lying goals and that the distinction between normativity and endorsement is valid for research on social power.

Achievement↗
PubMed1995

Galileo and the embryos: religion and science in parliamentary debate over research on human embryos.

Confrontation between science and religion was a significant feature of the lengthy public appraisal of research on human embryos in Britain during the 1880s. The series of formal debates over embryo research in the House of Lords is chosen as a particularly appropriate setting to study this confrontation. It is shown that religious opposition to embryo research was repeatedly attacked in these debates by means of a stereotyped contrast between religious and scientific styles of thought. Leading figures in the movement for embryo research attempted to discredit their opponents by claiming that, whereas their own case was built upon reasoned assessment of the facts, the other side relied on religious dogma, clerical authority and faith. It is shown that, although there were genuine differences between those critical of embryo research on religious grounds and those supporting such research on grounds furnished by scientists, this account of the differences is inaccurate: dogma, reliance on authority and faith were as characteristic of the discourse associated with science as they were of that associated with religion. It is argued that these features were not generated by the presence of religious or scientific beliefs as such, but by the struggle between advocates of science and religion for intellectual and moral dominance.

Beginning of Human Life↗
PubMed1998

Measuring quality of care at the end of life.

Caring for patients at the end of life presents a series of quality-of-care problems to the health care system. In the past, concern has focused on overaggressive treatment of dying patients. Given rapid changes in the financing and delivery of care, it is time to focus on a range of quality problems and address ways to improve care and achieve outcomes desired by patients and their families. We provide a framework for conceptualizing such a task. This article addresses the purposes of measurement, definition of the patient population, timing of measurement, use of surrogates in measurement, scope of services to be evaluated, and the choice of measures. It emphasizes the necessary links between quality measurement and quality improvement.

Continuity of Patient Care↗
PubMed1977

Decriminalization of public drunkenness: the response of suburban police.

In 1973, Massachusetts abolished the crime of public drunkenness, with the intent that many of the persons who formerly had been arrested on this charge would now be treated at detoxification centers. We studied the effects of this law in the Boston suburbs, with an emphasis on the police response. We found that there has been a paradoxical increase in drinking-related jail cell detentions, and that the police and detoxification centers are dealing with two essentially different and unrelated populations. Police and detoxification officials agree that the suburban detoxification system is irrelevant for dealing with most of the public intoxicants whom the police have always dealt with and whom they continue to deal with.

Alcoholic Intoxication↗