To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This chapter describes some of the key responses by the Omagh community and its agencies to the crisis of the bombing and its anticipated long-term implications. Within minutes of the bombing, the local hospital in Omagh, The Tyrone County Hospital, which was located less than a kilometre away from the scene, began to receive casualties. To convey where the bombing registered as a community tragedy, reference was made to a framework developed some years earlier to reflect upon the impact of the Enniskillen bombing of 1987. As a result of the highly charged political context of the tragedy, additional expectations became apparent, with politicians and community leaders being concerned that services should be provided for those affected by the bombing. It was clear that the bombing posed a serious mental health risk for those who had been involved in the care, treatment and support of casualties and the bereaved.
This chapter outlines four major needs-assessments undertaken to better understand the impact of the bombing and the way in which the findings helped in the development of services for psychological and mental health needs. It includes Omagh needs-assessments, adult needs-assessment, children's and adolescents' needs-assessments, and health and social care services staff needs-assessment. In the history of the Troubles in Northern Ireland there had not been an incident with a combination of so many deaths, so many injuries and so many exposed to highly traumatic experiences. The chapter describes the Sperrin Lakeland Trust under the leadership of its occupational health consultant in collaboration with the University of Northumbria. The adult study was undertaken by the Trust with the support of Professor David Clark and his colleagues, based then at Oxford University.
Large grant-making philanthropic foundations in the UK and the EU can have a significant influence over environmental law and as such are worthy of more attention from environmental law scholars. Through analysis of publicly available documents, we identify in this paper an absence of consistent transparency by these foundations. This makes their influence hard to understand, hard to research, hard even to see at work in the world. Transparency is complex and challenging, however. And so, rather than berating problematic approaches, we explore through interviews with actors in the field, as well as the academic literature, both the difficulties that foundations experience in pursuing transparent practices and the benefits of transparency. We conclude by identifying some principles for improved visibility of foundation work.
This chapter describes the Northern Ireland Centre for Trauma and Transformation (NICTT)'s training development and delivery programmes over ten years, focusing in particular on vocational training. It aims to build the skills base of existing practitioners by providing a number of cognitive behavioural therapy (CBT) and trauma-related skills courses. Through a research-based explanatory model of trauma and how it could be addressed in the life of the individual a trauma-focused approach offered a way of understanding the experience and needs of the individual. The experience of the Centre suggests that commissioning for conflict-affected communities needs to be informed by evidence-based models of trauma and related needs. In terms of services, there would be sufficient appropriately trained and skilled practitioners, with commissioning and funding of services, and training, intelligently reflecting the changing needs of the post-conflict community.
There is a widespread perception among academics, doctors and patients that the common law can effectively drive the development and incorporation of patients’ autonomy-based rights into medical practice. However, there is reason to doubt that this is correct.
We present a critical analysis of this view, prompted by themes that emerged from interviews with n=31 lawyers and n=24 doctors as part of a larger interdisciplinary study. We focus on the limitations of case law in driving autonomy-respecting clinical practice. Part I examines how the development and impact of decided cases is dominated by practical and economic considerations. It also considers the lack of understanding of case law among clinicians and the extent to which this limits its ability to drive change. Part II sets out our reasons for treating these limitations as a cause for concern. In Part III, we conclude by considering different levers for supporting case law in creating or confirming autonomy-respecting norms in medical practice, suggesting ways in which these might be developed further.
We argue that clinical negligence litigation is important as a guide to clinical practice and a means of enforcing autonomy-based patient rights but that it cannot be relied upon to drive changes in practice. Both professional guidance and legislation can augment case law but, for them to be effective, proper communication between doctors and legislators, courts, lawyers and insurance organizations is essential.
The ‘Digital Economy and Society Index’ (DESI) Dashboard for the Digital Decade is a set of indicators created by the European Union in the early 2010s to monitor Member States’ progress in pursuing the EU’s Digital Agenda, as well as many of the goals of the UN’s 2030 Agenda for Sustainability. The figures provided by the Dashboard are perceived by academics, the media and the general public as objective neutral data on the progress of Member States towards digitalisation, and on the promotion of sustainable development. This short contribution unpacks the Dashboard, examining the variables it considers and the methodology it employs, and finds out a very different picture. The Dashboard mainly assesses how easily people can access products and services online. It thus promotes a pro-market digitalisation agenda that excludes any other possible alternative and has little to do (if any) with the idea of sustainability. As is often the case with quantitative measurements of social phenomena, behind its seemingly scientific numerical veil the Dashboard conveys a policy vision that is hardly compatible with the objectives the Dashboard allegedly promotes. The essay thus raises broader questions as to the legitimacy of governing through indicators and as to the role of EU in shaping Member States’ digital future.
This article develops an evaluative framework for community-rooted justice systems through comparative analysis of South Africa’s Community Advice Offices (CAOs) and Bolivia’s constitutionally recognised Indigenous jurisdictions. Departing from courtroom-centric approaches that have dominated access-to-justice scholarship, the study employs socio-legal methodology synthesising ethnographic research, constitutional texts and institutional analyses. The examination reveals that both systems derive legitimacy from relational embeddedness rather than formal legal authority, resolve disputes holistically within social networks and navigate ongoing tensions between community autonomy and state regulation. From these practices, five evaluative dimensions emerge inductively: accessibility, responsiveness, legitimacy, empowerment and sustainability. The framework offers conceptual tools for assessing alternative justice mechanisms on their own terms, contributing to a shift from descriptive legal pluralism toward evaluative pluralism attentive to how communities themselves produce and experience justice.
This chapter considers the benefits of, and an approach to, undertaking research as part of the task of a trauma centre. Ongoing research into the changing needs of communities affected by emergency or conflict is fundamental to informing policy, advocating for service development, supporting the needs-directed commissioning of services and training, and to developing practice. Once the Northern Ireland Centre for Trauma and Transformation (NICTT) therapy team was established, a research working group was formed to guide the development of the research programme. As the work of the Omagh Community Trauma and Recovery Team was drawing to a close, the proposals for what became the NICTT were being developed, and from an early stage included research and development as one of the key programmes. Some practitioners and agencies had expressed anxieties about the use of such tools for those who sought help with trauma-related needs.
This chapter charts a pathway from the early days of the Troubles and the efforts to understand the mental health impact of the violence. D. O'Reilly and Des Browne reported upon the Northern Ireland Health and Social Wellbeing Survey of 1997 focusing on health service use. In 2002, P. McConnell reported upon their epidemiological study of mental health disorders and needs for treatment of the general population in the city of Derry/Londonderry. Between 2008 and 2012 a partnership of the Northern Ireland Centre for Trauma and Transformation and the Psychology Research Institute at Ulster University published a series of studies that examined the mental and associated physical health impact of the Troubles. The Commission for Victims and Survivors for Northern Ireland (CVSNI) was established in 2008, following the passing of legislation by the Northern Ireland Assembly in 2006.
In recent decades, theorists of disability rights have made the moral and legal case for supported decision-making. Whereas surrogate decision-making, the long upheld legal standard, looks to a third party to make a decision for a person deemed to lack the capacity to make that decision for themselves, support in decision-making empowers that person to make their own decisions. In this article, we argue for a significant shift in the norms governing enrollment in clinical trials. Rather than assume that support is only appropriate for individuals who cannot independently make sufficiently informed enrollment decisions, we propose “support in decision-making for all” when research protocols are beyond a certain risk threshold. Drawing inspiration from the universal design movement and feminist insights about autonomy, we argue that making support in decision-making the presumption has substantial expressive and practical benefits, and better empowers all potential research participants to make more informed, autonomous decisions.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book describes the outcome of needs-assessments undertaken following the Omagh bombing. It explains that the mental health and wider needs arising from loss and trauma must be incorporated as early as possible into the peace-making and peace-building project. The book looks in some detail at the efforts to understand the mental health and related impact of the violence associated with the Troubles in Northern Ireland over the period 1969 to 2015. It considers the Northern Ireland Centre for Trauma and Transformation (NICTT) and also describes developments in therapy, in training and education, and in research and advocacy. The book draws key conclusions about the approaches that could be taken to address mental health and well-being as an essential component of a peace-building project.
On July 25, 2025, the French Court of Cassation handed down an important decision concerning the existence in international law of possible exceptions to the functional immunity of agents of a foreign state. The Court of Cassation reached the conclusion that the “principle of functional immunity from jurisdiction in criminal matters” recognized for foreign agents acting in the exercise of their functions cannot be invoked in cases of prosecutions for genocide, crimes against humanity, and war crimes. However, the Court’s internationalist approach, which sought to identify the evolution of custom on the issue by examining relevant state practice, remains exclusively Eurocentric, by examining the practice of only five states, all from the same region of the world.
The study is one of the first in its field to be grounded in extensive, original qualitative data on the lived experiences of senior managers in financial firms. Its principal aim is to construct a comprehensive, empirically-based typology of culture in finance, drawing on findings from 29 semi-structured interviews with current and former senior managers in UK financial firms and regulatory personnel. The study employs a rigorous participant selection and thematic analysis process that reflects the diverse array of financial firms, sectors, roles and perspectives on culture. It does so by applying appropriate theoretical frameworks on organisational culture to unearth the nuances and typology of culture in the UK finance industry. Our findings indicate that financial firms are in a state of transition between two distinct types of culture, from an old and heavily criticised archetype (which still holds sway) towards a not yet fully realised vision of a new transformed culture. Beyond its theoretical interest, our analysis reveals ways to improve culture in finance and provides recommendations for the development of financial regulation and broader policymaking, aiming for a whole-hearted shift from principles-based regulation to outcomes-based regulation.
This chapter provides an overview of the unfolding understanding of the psychological impact of the violence, with reference to key studies, research reviews and other key reports published between 1969 and 1999. One of the earliest studies to investigate the mental health impact of communal violence in Northern Ireland was reported upon shortly after the large-scale violence began. The study focused on three family doctor practices in west Belfast, one of the areas most affected by the early violence. The parties to the Belfast Agreement looked forward to the results of the work of the Northern Ireland Victims' Commission. In 1999, Lost Lives, a chronicle of the deaths associated with the Troubles in Northern Ireland, was published. The form and approach of studies that have investigated the mental health impact of the Troubles varies considerably.
Experiences of tragic loss and overwhelming trauma divide our lives into what went before and what came thereafter. The paradigm of loss and trauma, of altered views of oneself, others and the world, of the crisis of adjustment, can be found in the struggles of Northern Ireland in the wake of the Troubles. To tragic loss and the distress of traumatic events is coupled the crisis of how to cope with or survive this deeply unfamiliar landscape, where friendship, faith and other consolations fail us. Entering into the existential crisis and its intolerable consequences is the erosion of well-being and mental health presented in psychological problems, mental health disorders, substance misuse, addictions and wider family and social problems. The capacity of individuals, families and communities to adjust and recover, to regain well-being and build resilience to face future stressors, can be significantly impaired.
This chapter describes the establishment of a trauma-focused approach to the needs of those seeking help with emotional, psychological and mental health problems linked to traumatic experiences of the civil conflict in Northern Ireland. It outlines the development of a therapy service based upon trauma-focused cognitive behavioural therapy (CBT). The chapter describes and discusses key issues relating to the origins, principles, aims and challenges of this development. The new Centre's programmes were to deliver trauma therapies, undertake research, train practitioners in trauma-related skills, and support other communities affected by war and conflict. The Centre continually documented its therapy protocols, which had been developed initially in the original Omagh Community Trauma and Recovery Team. In the early years, the therapy programme was managed by the Centre's therapy team leader who coordinated the allocation of the referrals.
While supported decision-making for persons with dynamic cognitive impairment has been considered in the context of medical treatment, there has been little attention to its application in the context of enrolling cognitively impaired subjects in clinical research. The Common Rule allows enrollment permission from a Legally Authorized Representative, one empowered under institutional policy to provide consent for subjects lacking decision-making capacity, but many Legally Authorized Representatives lack knowledge of the person’s values and preferences adequate to an ethically valid judgement about research enrollment. Supported decision-making and surrogate decision-making can be complementary as subjects transition between impairment stages, providing an opportunity to address ethical problems with the current practice of reliance on uninformed surrogates. Through designation of a supporter who is willing to serve through the progression of impairment, dementia patients choose their supporter and ultimate surrogate, engage with them on the issues that later give rise to requests to enroll the subject in research, and ensure that the surrogate will have knowledge of the values and preferences of the subject necessary to an ethically defensible substituted judgement. Legal frameworks can be adapted to provide recognition of research enrollment as an area of valid decision by supporters on behalf of beneficiaries.
Federal disability anti-discrimination laws expect clinical trials to render study processes and sites accessible to potential participants, including through the provision of reasonable accommodations. Nonetheless, people with disabilities, and particularly people with mental illness, are often excluded from clinical trials. Supported decision-making, a strategy that allows people to select trusted others to help them understand and communicate decisions, is an important accommodation to further inclusion. However, because mental illness can be dynamic and vary widely in nature (e.g., diagnosis, symptom severity, functional impairment) and duration (e.g., short-term, intermittent, progressive, permanent), supported decision-making is neither a one-size-fits-all strategy nor one that can serve as a reasonable accommodation in every situation. While prior work on supported decision-making has focused predominantly on adults with intellectual and developmental disabilities or dementias, people with mental illness may also benefit from supported decision-making, although the variability in decision-making capacity in mental illness presents nuanced challenges. Here, we explore supported decision-making in the case of people with intermittent or episodic mental illness that may impact decision-making capacity to varying degrees at different times.