Political and economic determinants of expenditure on day services for persons with intellectual disabilities or autism

This study investigates whether the Swedish national entitlement legislation, which is known to be one of the most developed in Europe for persons with intellectual disabilities or autism, accomplishes its aim to provide equal quality of day services independent of location. We estimated a reduced-form model of demand and supply-side determinants of a latent quality variable for day-service programmes using panel data on expenditure per attendee for the 290 Swedish municipalities 2004–2012. We found that expenditure per attendee is among others affected by changes of the local tax base and outcome in elections to the local assemblies. These results imply that rights of persons with intellectual disabilities with regard to equal quality of day services independent of where they live are not fully honoured in budget allocation decisions made by local governments.     

Perceptions of transition-related health and mental health services among transgender adults

The opportunity to live authentically is critical for the well-being of transgender individuals. For many this requires accessing transition-related services. Current knowledge of transition-related care is limited. This study aims to elucidate experiences and needs of transgender individuals (N = 65) related to (a) therapeutic support, (b) medical care, and (c) aspects of living authentically in order to inform the development and delivery of trans-affirmative services. Findings reveal challenges accessing health care providers with trans-specific competency; gaps between critical aspects of transition-related care and receipt of services; and heterogeneity of experiences and needs. Recommendations for improving transgender-affirmative services are provided.     

‘Unfit for reform or punishment’: mental disorder and discipline in Liverpool Borough Prison in the late nineteenth century

This article examines how Liverpool Borough Prison, opened in 1855 as one of the largest local prisons in England to adopt the separate system, categorized and dealt with mental distress and disorder amongst its prison population in the late nineteenth century. High prison committal rates in Liverpool, alongside high levels of recidivism, especially among female prisoners, led to severe overcrowding and encouraged a harsh disciplinary regime. Exacerbated by the poor physical and mental condition of the prisoners, this produced a challenging environment for maintaining the separate system of confinement and prisoners’ mental well-being. While official figures for the rates of mental disorder in local prisons are not readily available, Liverpool Prison’s diverse and under-exploited archives and official reports indicate that insanity caused prison officials and visiting justices great concern, and many prisoners were declared unfit for the rigours of prison discipline. Our article explores the implications of the ever more punitive, deterrent and physically taxing penal policy implemented in the late nineteenth century on the minds of prisoners. Despite the heavy toll on prisoners’ mental well-being, such cases were often retained by prison medical officers reluctant to acknowledge the failure of the prison to deter, reform and redeem.     

Anti-N-methyl-D-aspartate receptor antibody encephalitis: An important cause of encephalitis in young adults. A report of two cases

Encephalitis is a clinical syndrome which can include altered mental status, motor and sensory deficits, altered behavior including personality changes, speech and movement disorders and seizures. While the overall incidence of encephalitis is not known, it is common enough that most pediatric and adolescent medicine physicians will have seen at least one case. Peak times of risk include the newborn period and middle-to-late adolescence.¹ Dalmau J, Tüzün E, Wu HY, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007 Jan;61(1):25–36. doi:10.1002/ana.21050. PMID: 17262855.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar] It is important for clinicians to have a working knowledge of the broad range of encephalitis etiologies: viral, post-viral, toxic, auto-immune, and paraneoplastic. We discuss two cases of encephalitis in young adult women with ovarian teratoma and production of anti-N-methyl-D-aspartate receptor (NMDAR) antibodies.     

Implementing a college mental health program – an overview of the first twelve months

Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.     

Deaths of people with serious mental disorder: An exploration of deaths in custody and fatal police contacts

People with serious mental disorders (PSMDs) are overrepresented both in prison deaths and during fatal encounters with the police in the community (deaths after police contact, DAPC). To identify common factors present across cases of who died during contact with the criminal justice system in Queensland, publicly available coroners reports were analysed (N = 38). The findings of the study indicated psychosis and mood disorders were the most common diagnosis in incarcerated PSMD deaths, and suicide was the most common cause of death for incarcerated PSMDs. Within incarcerated settings, access to healthcare records, medication compliance, risk assessment and monitoring, and safe housing of at‐risk prisoners may be potential areas to explore with regard to prevention. Similarly, PSMD DAPCs were more likely to be experiencing mood or psychosis disorders than other forms of mental disorder, and suicide and police shootings were the most common causes of death. In PSMD DAPC, inadequate mental health access, treatment noncompliance and comorbid substance use were included as potential areas that could direct research efforts toward prevention.     

Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual,Family, Community,and Socio‐Political Contexts

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.     

Storifying routines and routinising stories: A dualistic subject positioning analysis of controversies about constraints on patient autonomy

This paper uses subject positioning theory to explore how conflicts between autonomy and protection are managed in the justification of controversial care arrangements for patients with mental/neurological illness. Its basic argument is twofold: firstly, to justify or propose care arrangements at strategic or contentious moments, actors position illness as an actant and make it present in talk‐in‐interaction, exploiting alignments and misalignments between the there and then of reported events and the above and beyond of shared societal discourses to say what matters and what's to be done here and now; secondly, the introduction of authoritative voices from elsewhere involves imbricating narrative and routine sequences in order to prioritise different subjectivities. Dilemmas opposing autonomy and protection may seem less intractable if we adopt a corresponding perspective interplay between narrative and routine situational readings.     

The relations between maternal mental state talk and preschoolers’ behavioral adaptation and school readiness: moderation by emotion situation knowledge

This study investigated the extent to which associations between mothers' elaborated talk about mental states and preschoolers’ behavioral adaptation (i.e., social competence and internalizing and externalizing behavior) and school readiness were moderated by emotion situation knowledge. Families (N = 120) were mostly middle‐income and White and 70 of the preschoolers (M = 50.65 months, SD = 6.19) were boys. Results revealed a positive association between elaborated maternal mental state talk and social competence, but only for children average and high in emotion situation knowledge. For children low in emotion situation knowledge, there was a positive association between elaborated maternal mental state talk and internalizing behavior. There also was a negative relation between elaborated maternal mental state talk and school readiness for preschoolers low in emotion situation knowledge. Findings highlight the importance of considering emotion situation knowledge when examining associations between elaborated maternal mental state talk and young children’s social behavioral adaptation and readiness for school.     

Supporting foster and kinship carers to promote the mental health of children

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care.