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Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.
Methods
This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.
Results
Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.
Conclusions
This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.
This introductory chapter discusses the focus of this monograph, and places it in its theoretical, contextual and methodological context. Working from the premise that while gender shapes violence, violence also shapes gender, I introduce the central line of enquiry of this book: the gendered politics of settler colonialism, with a specific focus on masculinities across the sharply hierarchical divide of Israeli militarism and occupied Palestine.
The empirical research is placed within its historical context, serving to contextualise the settler colonial present – the application of which is explicated within this section. My own positionality, research methodology and the structure of the book is discussed after articulation of the conceptual framework of the book. The latter explores theory and literature surrounding gender, masculinities, violence, and their intersections – affirming Demetriou’s (2001, 342–48) argument that “when the conditions for the reproduction of patriarchy change”, “exemplary masculinities […] adapt accordingly.”
The concluding chapter highlights the fluidity and interconnected nature of masculinities within specific interactional settings across Israel and Palestine, indicating that what is hailed as ‘the ideal’ is ever subject to change amid complex webs of power, patriarchy, and militarised colonisation. Each telling components of much broader and complex stories, I summarise each chapter as indicative of the contingency and mutual adaptability of gendered dynamics across manufactured, militarised, and sharply hierarchical colonial divides. I argue that gendered identities in this context are connected by that which simultaneously separates them – the militarised violence of the colonial regime. In so doing, the intertwined nature of identities across and enmeshed within complex webs of power, violence and resistance are explored, revealing a plurality of scripts and codes that variously constitute the complex gendered politics of settler colonialism.
Chapter III delves into the discursive mechanisms through which former Israeli conscripts in this study understood, justified and/or distanced themselves from the violent regime in which they serve(d) – relating this to the broader context of ‘moralised militarism’ so frequently attributed to the Israeli military. Through analysis of the speech acts, moralisations and emotive articulations by former and current soldiers, I argue that traits of emotional expression, reflection and critique – far from being anomalies of militarised masculinity in this context – are central to its legitimation and idealisation, enabling the soldier, and society more broadly, to retain their sense of humanity amidst enduring violence. Rather than performances of stoicism and emotional control with which ‘traditional’ forms of militarised masculinity are normatively associated, a more philosophical, emotive, and cerebral approach to violence appears to be celebrated and encouraged within Israeli militarism – consolidating the supposed relation between militarism, masculinity, and moralism in the settler-colonial state.
Specifically analysing the experiences of Palestinian youth in a West Bank refugee camp, Chapter IV analyses the navigation of emotions inevitably precipitated by the grinding realities of colonisation and military occupation, in a setting in which normative conceptions of masculinity assert that ‘men don’t cry’. Using Palestinian rap music as a case study to explore young refugee men’s navigation and subversion of these dynamics, I argue that emotional expression in this particular musical culture both functions to reconfigure binary gendered norms in a context of invasive settler colonialism, while simultaneously masculinising emotionality through a dialogic performance of emotion, nationalism, resistance, and paternalism. I illustrate, therefore, that in some ways gendered binaries are challenged in and through the performance of Palestinian rap as a form of resistance and release, while in other ways, these are reconfigured so that men’s emotional expression can be subsumed within them.
Chapter II examines shifting notions of masculinised strength as they adapt in occupied Palestine, contesting notions of ‘masculinity in crisis’ so frequently applied to this context. Where it is nigh impossible to enact physical strength in the face of the military might of Israel, I explore the fluidity of emblems of masculine strength and prowess – arguing that hegemonic masculinities and patriarchies in Palestine are not fixed, but move in dynamic relation to the conditions of coloniality with which they intersect. Through the examination of sumud, mental strength and moral strength, this chapter therefore charts emergent narratives of strength and resistance in a setting in which bodily invasion by the occupying forces is an ever-present reality. As such, where the violence of militarised colonisation routinely undermines normative conceptions of ‘masculine excellence’, I examine masculinised ideals as negotiated, maintaining binary gendered categorisations that (re)establish the masculine as strength.
Chapter VI explores the means through which imperial impositions and military occupation deliberately narrate, interact with, and affect internal dynamics of patriarchy in colonised Palestine – relating this to both articulations and expressions of violence against women within this context. Moving beyond the “essentialising cultural logics” that render patriarchal violence as a ‘static’ and ‘fixed’ component of ‘Palestinian culture’, this chapter thus joins with the pursuit of many Palestinian feminists to examine the complex “interplay between a colonial politics of exclusion and a localised culture of control” as it is narrated and deployed in relation to violence against Palestinian women (Shalhoub-Kervorkian and Daher-Nashif 2013, 298). Yet, I caution against centralising Israel’s military occupation as causal or ‘explanatory’ of internal dynamics of violence, arguing that making this link uncritically risks positioning Palestinian women’s bodies as discursive and material sites upon which an internal patriarchal order ‘in crisis’ can be normatively reclaimed.
Chapter I explores traditionally ‘non-hegemonic’ attributes as inherent to militarised masculinities in contemporary Israel, examining embodied compliance and submission to a higher order as a normalised means of ascending the ‘hierarchy of bodies’ that bolsters and undergirds the Zionist project from its outset. Exploring basic training, punishments, military hierarchy, friendship, camaraderie and death, I argue that the conscious performance of embodied submission (with enthusiastic consent) is as much valued within conscripted military masculinities as militarised domination in this context. Indeed, I suggest that the conscripted combat soldier – the archetypal national and masculine hero – must be both visibly dominant over the indigenous Palestinian ‘Other’, while simultaneously malleable and submissive to the goals of the Israeli state. As such, I explore both polarities of domination and submission as demanded within the parameters of idealised military masculinity – illustrating the gendered tensions that punctuate normative binaries in this militarised setting.
Chapters V explores the sexual politics of Israel’s colonial regime, serving to undo the all-too-common misconception that sexual violence is “extremely limited” in this context. Emphasising the obfuscation of dynamics of race and coloniality, I start with exploration of hegemonic analyses of conflict-related sexual violence, and the related depiction of Israeli militarism as devoid of sexual violence. I then analyse the eroticisation of the Israeli military and colonial ‘conquest’, and the fetishization of the bodies that undertake it – entangling colonial domination with notions and physiological sensations of erotic pleasure. Finally, I discuss the policing of militarised hierarchies through the logic of sexual violence, trickling from those ‘on top’ to inferior soldiers – by age, gender, and class – to the occupied Palestinian body. I thus argue that sexualised violence pervades the entire structure of Israeli settler colonialism, fusing military activity and colonisation with hetero-masculinised notions of domination, virility, pleasure, and control.
Patients who transition from one environment of care to another may experience an intersection of information given but not understood; a crossroads of directions for care provided but not acted upon or the facilitation of a destination for care that does not meet the needs or desires of the patient. When a patient moves from outpatient observational services to the next level of care, the plan for that transition may be impacted by time mandates that might not consistently support the development and full implementation of a transitional care plan. Gaps in affecting appropriate transitional processes often lead to potentially preventable hospitalizations or emergency department visits. It is, therefore, necessary for each member of the transitional team to consider the key elements of a care transition that support the patient’s movement through and across the health care continuum.
Working from the premise that gender and violence are cyclically related, masculinities' connection to power and violence are frequently simplistically assumed. Yet, amid ongoing colonisation and military occupation, there are other more complex dynamics simultaneously at play across Israel and Palestine. In this book, Chloe Skinner explores these dynamics, untangling the gendered politics of settler colonialism to shed specific light on the ways in which masculinities shift and morph in this context of colonial violence. Oscillating between analysis of Israeli militarism, colonisation, and military occupation in Palestine, each chapter examines the constitutive performance and negotiation of masculinised ideals across these colonial hierarchies. Masculinities are thus analysed across these settings in connection, rather than in isolation, as gendered hierarchies, performances, and identities intertwine and intersect with the racialised violence of settler colonialism.
Objectives/Goals: The UCLA Clinical and Translational Science Institute (CTSI) training programs have been optimized by clinical research experts since 2013. They inculcate an interest in clinical and translational research careers. The acquisition of new skillsets and early exposure to potential career opportunities often influence lifetime decision-making. Methods/Study Population: The first program, in 2013, was the CTSI Research Associates Program (CTSI-RAP), which exposes undergraduate students to clinical research opportunities. RAP students are now mentoring high school students in the Mentoring and Advocacy in Teaching Clinical and Health-Related Research (MATCH) program. The Fiat Lux seminar is a research course designed to allow freshman students to explore diverse interests. The Leveraging Amazing Undergraduates in Clinical Research at UCLA Health (LAUNCH) program continues the workforce development pipeline by recruiting and training recent graduates to enter clinical research study coordinator careers. Each of these programs has their own stellar track records in terms of high interest and satisfaction and are assessed by annual evaluations from stakeholders. Results/Anticipated Results: CTSI-RAP is in its 11th year and a recent 10-year impact survey demonstrated the value of the program to students and their career decision-making especially those who are underserved and/or disadvantaged. The MATCH program arose from the interest of RAP students to mentor STEM high school students from local disadvantaged schools and is now in its 4th year across the state. The Fiat Lux freshman seminar began with a clinical research essentials emphasis, followed by an FDA/regulatory focus, and is now evolving to highlighting specific innovative areas of research with this year’s course spotlighting Cellular & Gene Therapy/Regenerative Medicine. LAUNCH is now in its third year, having been inspired by graduating RAP students wishing to continue in clinical research and feedback from their own focus groups. Discussion/Significance of Impact: The UCLA CTSI has supported these highly successful workforce development pipeline programs, which have had a demonstrated impact on students and the overall institutional clinical research infrastructure. Their stellar reputations generate high interest at UCLA and serve as model programs for implementation at other academic medical centers.