6 results
Citizens Under Compulsory Voting: A Three-Country Study
- Ruth Dassonneville, Thiago Barbosa, André Blais, Ian McAllister, Mathieu Turgeon
-
- Published online:
- 19 September 2023
- Print publication:
- 12 October 2023
-
- Element
- Export citation
-
A burgeoning literature studies compulsory voting and its effects on turnout, but we know very little about how compulsory voting works in practice. In this Element, the authors fill this gap by providing an in-depth discussion of compulsory voting rules and their enforcement in Australia, Belgium, and Brazil. By analysing comparable public opinion data from these three countries, they shed light on citizens' attitudes toward compulsory voting. The Element examines citizens' perceptions, their knowledge of the system, and whether they support it. The authors connect this with information on citizens' reported turnout and vote choice to assess who is affected by mandatory voting and why. The work clarifies that there is no single system of compulsory voting. Each country has its own set of rules, and most voters are unaware of how they are enforced.
4 - Risk prevention and non-pharmacological management of violence in acute settings
-
- By Sachin Patel, Imperial College London, Douglas MacInnes, Canterbury Christ Church University, Kent, John Olumoroti, Springfield University Hospital, London, Ruth McAllister
- Edited by Masum Khwaja, Dominic Beer
-
- Book:
- Prevention and Management of Violence
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 18-34
-
- Chapter
- Export citation
-
Summary
When the Zero Tolerance campaign against violence in the NHS was launched in 1999, very few people thought it would relate to mental health services. However, the campaign was timely and coincided in a movement towards not accepting violence as an everyday, unavoidable reality of mental health services. This change in values has seen an increase in the belief that more can and should be done to reduce the rates of violence and aggression. Although services may not be able to stop or anticipate all incidents of violence, they certainly should not tolerate violent behaviour.
In addition, we would reiterate that effective risk assessment and management prior to imminent violence is vital in prevention. Evidence from randomised controlled trials is emerging, showing that aggressive incidents can be reduced significantly through structured risk assessment (van de Sande et al, 2011; Abderhalden et al, 2008).
Prevention of violence
Containment v. Engagement
Traditional thinking has often included the notion that increasing containment interventions by staff and restrictive regimes produces safer environments and decreases disturbance. In contrast to this logic, Bowers et al (2006) in a multicentre study in several European cities found that the delivery of ‘containment’ interventions by staff did not produce a proportional reduction in disturbance. Positive engagement over observation and activity over boredom are being increasingly recognised as highly effective concepts in producing dramatically reduced levels of aggression.
Any successful method of engagement over containment needs to include a strong emphasis on a programme of structured activity in conjunction with an appropriate risk assessment. This should be delivered in a consistent fashion and facilitated both on and away from the ward environment. Successful interaction and positive engagement within a framework and in a setting that allows for safe observation are key characteristics central to reducing violent incidents. Ward regimes
In 1999, the Standing Nursing and Midwifery Advisory Committee produced a report in response to published and damming accounts of boredom and inactivity in mental health in-patient hospitals, and gave persuasive accounts of how this is related to disturbance. Subsequent guidance from NICE, the Royal College of Psychiatrists, the Department of Health and Star Wards has recommended the provision of recovery-focused meaningful activity in mental health in-patient settings (Department of Health, 2001; National Institute for Health and Clinical Excellence, 2005; Janner, 2006; Cresswell & Beavon, 2010).
3 - Risk assessment and management
-
- By Ruth McAllister, Elmleigh Hospital, Hampshire, Sachin Patel, Imperial College London
- Edited by Masum Khwaja, Dominic Beer
-
- Book:
- Prevention and Management of Violence
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 13-17
-
- Chapter
- Export citation
-
Summary
Risk assessment forms an integral part of psychiatric practice. It covers a wide range of potential harms to which patients may be exposed, or which they may pose to themselves or others. Risk assessment may be defined as the systematic collection of information from all available sources to estimate the degree to which harm (to self or others) is likely at some point in time (O'Rourke & Bird, 2001). It begins at first contact with a patient and needs to be reviewed regularly in light of changing circumstances and new information; it is a dynamic process. Risk assessment is meaningless, however, unless it is linked with a management plan which aims to reduce the likelihood that harm will occur, or to reduce its severity if it does occur. Risk assessment and management should be an integrated process.
In the past 20 years the concept of ‘dangerousness’ has been left behind as it is increasingly recognised that risk to others is not a trait inherent in a patient, but the product of a range of interacting factors. Some of these factors are patient-related; some are related to the people around the patient, some to the environment and some to chance. When a mental health professional recognises a significant risk of violence, they are under a professional obligation to take steps to manage and reduce it by all practicable means (Department of Health, 2008).
There is, however, a danger in adopting an overly risk-oriented and risk-averse approach to mental healthcare. The association between certain mental disorders and violent behaviour is established; however, the spectrum of risk and the relative rarity of the most serious violence must also be considered (National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, 2011). A Royal College of Psychiatrists’ briefing document offers a helpful commentary on moving beyond a ‘culture of blame’ (Morgan, 2007).
In this chapter, we outline current views on the principles of assessing and managing the risk of violence, as well as some of the practical implications. This is not intended to be exhaustive and readers are encouraged to refer to the publications cited for further guidance.
11 - Liaison with the police, Crown Prosecution Service and MAPPA
-
- By Ruth McAllister, Elmleigh Hospital, Hampshire
- Edited by Masum Khwaja, Dominic Beer
-
- Book:
- Prevention and Management of Violence
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 103-111
-
- Chapter
- Export citation
-
Summary
Offences committed by mental health patients
Police are regularly called to hospitals and community mental health sites when someone with a mental health problem commits a crime. In the past many offences, including violent offences, committed by mental health patients were neither investigated nor prosecuted. This was due to a perception that patients could not be held responsible for their actions, that the likelihood of conviction was unacceptably low or that prosecution was not necessary to protect the public if the patient was already in hospital. Modern police policy is that the criminal law has an equal application inside and outside mental health units and there should be a presumption that patients have the capacity in law to take responsibility for their actions. Mental health professionals should be prepared to liaise with the police and help them to make better-informed decisions about investigations. Positive action against the offender by the police may assist in future management of the patient.
The police should seek the views of the consultant in charge before deciding how best to deal with the matter. They may ask the consultant to assess whether the patient is fit to be interviewed and detained at a police station. This should be done as promptly as possible and the assessment forwarded in writing to the police custody officer, for the attention of the forensic medical examiner (police doctor) or custody nurse. The mental health trust should provide an appropriate adult to accompany the patient at police interview and ensure that they are legally represented.
If the patient is charged, the court may ask the consultant for a report on the patient's fitness to plead and stand trial. National Health Service staff should be prompt in responding to such requests and avoid passing them on to different teams and departments. Similarly, staff should cooperate with the police in arranging to provide witness statements and medical reports relating to the victim's injuries. Those who give statements should add their contact details and the dates when they know they will be unavailable to attend court, in order to avoid delay and additional court costs.
Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France
- Christine Bergeron, Nathalie Largeron, Ruth McAllister, Patrice Mathevet, Vanessa Remy
-
- Journal:
- International Journal of Technology Assessment in Health Care / Volume 24 / Issue 1 / January 2008
- Published online by Cambridge University Press:
- 24 January 2008, pp. 10-19
-
- Article
- Export citation
-
Objectives: A vaccine to prevent diseases due to human papillomavirus (HPV) types 6, 11, 16, and 18 is now available in France. The objective of this study was to assess the health and economic impact in France of implementing a quadrivalent HPV vaccine alongside existing screening practices versus screening alone.
Methods: A Markov model of the natural history of HPV infection incorporating screening and vaccination, was adapted to the French context. A vaccine that would prevent 100 percent of HPV 6, 11, 16, and 18-associated diseases, with lifetime duration and 80 percent coverage, given to girls at age 14 in conjunction with current screening was compared with screening alone. Results were analyzed from both a direct healthcare cost perspective (DCP) and a third-party payer perspective (TPP). Indirect costs such as productivity loss were not taken into account in this analysis.
Results: The incremental cost per life-year gained from vaccination was €12,429 (TPP) and €20,455 (DCP). The incremental cost per quality-adjusted life-year (QALY) for the introduction of HPV vaccination alongside the French cervical cancer screening program was €8,408 (TPP) and €13,809 (DCP). Sensitivity analyses demonstrated that cost-effectiveness was stable, but was most sensitive to the discount rate used for costs and benefits.
Conclusions: Considering the commonly accepted threshold of €50,000 per QALY, these analyses support the fact that adding a quadrivalent HPV vaccine to the current screening program in France is a cost-effective strategy for reducing the burden of cervical cancer, precancerous lesions, and genital warts caused by HPV types 6, 11, 16, and 18.
Mood and Psychiatric Disturbance in HIV and AIDS: Changes Over Time
- Mary Fell, Stanton Newman, Mary Herns, Pauline Durrance, Hadi Manji, Sean Connolly, Ruth McAllister, Ian Weller, Michael Harrison
-
- Journal:
- The British Journal of Psychiatry / Volume 162 / Issue 5 / May 1993
- Published online by Cambridge University Press:
- 02 January 2018, pp. 604-610
- Print publication:
- May 1993
-
- Article
- Export citation
-
A sample of 26 HIV seronegative, 59 HIV seropositive asymptomatic and 7 HIV seropositive symptomatic homosexual and bisexual men were assessed over two visits, a mean of 11 months apart, using the BDI, STAI, and CIS. Significant differences emerged between the symptomatic group and the other two groups. Past psychiatric history and the somatic items in the assessments accounted for some of these differences. The seropositive asymptomatic and the seronegative groups did not differ on any of the mood or psychiatric assessments, suggesting minimal effect on psychological well-being of seroconversion in the absence of symptoms.