Managing madness: mental health and complexity in public policy

Abstract This paper explores the concept of collaborative care, particularly in relation to a range of new models of organisation and service that are emerging in response to one of the most problematic areas of public policy – mental health. These emerging models of coordinated mental health care are testing the limits of the evidence supporting coordinated care, and require critical evaluation. Myriad concepts of collaborative or coordinated care in health, including mental health, have created multiple definitions. Once definitional issues have been surmounted, however, the evidence for coordination of health care is reasonably strong. There is considerable research about which treatments and programs are best for people with a mental illness. There are few areas seemingly as complex as mental health, given that responsibility for policy and service lies across all three tiers of Australian government and across multiple jurisdictions. It also engages public, private and non-government sectors. Co-morbidities are commonplace, particularly drug and alcohol problems among younger people. Governments in Australia have traditionally taken responsibility for policy, programs and services, either as direct service providers or through contracting outputs from others. Yet the evidence indicates that for people with a mental illness, the best solutions are often not found in government but in the community and in organisations outside of government. New organisations and new structures are attempting more holistic management approaches, combining clinical care, community support, housing, employment and other services. This paper considers some of these new models in the light of existing evidence. The key challenge facing continued reform in mental health is not uncertainty regarding programs or services, but rather how to drive coordinated care for consumers across departments, governments and providers. This review will highlight the key changes that must be made for the benefit of the millions of Australians with a mental illness. Such changes need to empower users of care systems to choose options that actively support coordinated and efficient care delivery systems

What is the Red Plaster in the Mastodon Tusk?

During the first visit to the tusk, Dr. Sebree found the crack that had been filled with a strange plaster that was not known at the time. After seeing the plaster glow from the small flashlight Dr. Sebree had with him, identifying this material seemed like an interesting project. Due to the fact that the plaster’s makeup is unknown, but identifying the material it was made of, future attempts to restore and preserve the fossil can be done more safely in the event that the material is harmful Initial x-ray analysis of the mastodon tusk revealed many unexpected surprises. In section 4 of the tusk, a series of cracks had been packed with a red-ish plaster that was opaque to x-rays indicating a high concentration of possible heavy metals. If the material is a heavy metal, extra precautions would need to be taken to stay safe while working with the tusk. • Popular methods of preserving fossils in the past use harmful materials.[2] • Lead oxides blood affect bone marrow , central nervous system , peripheral nervous system and kidneys and may be a carcinogen. • This includes plasters that use heavy metals such as lead. • The tusk has also never been tested for a radiation, so there is a chance of the material being radioactive. The sample was unable to be tested for radioactivity, however.https://scholarworks.uni.edu/mastodon_posters/1003/thumbnail.jp

A study of human capital development in young entrepreneurs

In recent years young entrepreneurs have attracted considerable attention from policy makers and the media, and there is evidence that increasingly many young people aspire to start their own business. However, there has been little research into how young entrepreneurs actually build their businesses, and the limited existing research about young entrepreneurs has tended to focus on participants who have struggled to achieve business survival and growth. By contrast, this thesis investigates how young entrepreneurs are able to build high performing businesses. All participants have built a business with a turnover between £1 million and £90 million or otherwise raised at least £1 million in external investment. It takes a qualitative approach, based primarily on semi-structured interviewing, to understanding the knowledge and skills 21 young entrepreneurs used to build their businesses. It uses a human capital theory framework to analyse how the young entrepreneurs developed relevant knowledge and skills prior to start-up in order to build a business. It then considers what additional human and social capital the young entrepreneurs acquired during the venture creation process itself. The findings identify three different pathways, each of which typifies the human capital used by particular young entrepreneurs, according to their educational background and the precise age at which they started their business. The study also establishes the necessary human capital which all of the young entrepreneurs developed prior to start-up or during the early stages of starting their ventures, which was important to their success in growing a business. The study finally contributes to the debate about whether general human capital or venture-specific human capital is most important to entrepreneurs, finding that for young entrepreneurs developing pre-start-up general human capital is particularly significant

An Examination of Student Performance in Reading/Language and Mathematics after Two Years of Thinking Maps® Implementation in Three Tennessee Schools.

The purpose of this study was to determine what, if any, association exists between Thinking Maps® instruction and student achievement in fifth grade students in Reading/Language and Mathematics as reported by the State NCE scores of the criterion referenced portion of the Tennessee Comprehensive Assessment Program (TCAP) Achievement Test in 3 Title I elementary schools in northeast Tennessee. The association was examined after 2 years of Thinking Maps® implementation and instruction. Using a quantitative design, the quasiexperimental study included fifth grade students\u27 State NCE scores from 2005 and the same students\u27 State NCE scores from 2003. Scores obtained by fifth grade students who received Thinking Maps® instruction were examined for differences in Reading/Language and Mathematics and were also compared with scores obtained by fifth grade students who did not receive Thinking Maps® instruction for the same 2-year period. Paired t-tests and a 3-factor repeated measures design, repeated on 1 factor, were used to investigate differences in achievement as categorized by Thinking Maps® instruction or no Thinking Maps®instruction for 2 years. The results of the study indicated that there was a significant difference for the Reading/Language means for students after 2 years of Thinking Maps implementation but not a significant difference for Mathematics. There was not a significant difference between the two treatment schools in either Reading/Language or Mathematics. The 2 treatment schools had different percentages economically disadvantaged students. The results of the study also indicated that there was a significant 2-way interaction for Year by School in Reading/Language between 1 treatment school and the control school, the 2 schools with similar percentages of economically disadvantaged students. The findings of the tests of simple effect for the differences between the 2003 and 2005 Reading/Language means for the treatment school showed the 2005 Reading/Language mean was over 7 points higher than the 2003 Reading/Language mean. The findings of the tests of simple effect for the differences between the 2003 and 2005 Reading/Language means for the control school were also significant with the 2005 Reading/Language mean being 6 points lower than the 2003 Reading/Language mean

Scenography as process in British devised and postdramatic theatre

The term scenography is an increasingly popular one within the worldwide theatre making community, becoming the term of choice to refer to the visual, spatial and aural aspects of theatre production. In her book What is Scenography? (2002) Pamela Howard suggests that we should consider the term scenography as referring not only to those aspects of the theatre product, but also to the collaborative process through which the product is created. In the context of her study, Howard refers to scenography as process within her own work, grounded in the production of literary texts. But what are the implications of scenography as process within non text-based and postdramatic theatre? This thesis will consider the place and process of design within devised and postdramatic theatre, and how this fits with Howard's conception of scenography as process. The change and development in all aspects of the theatre making process that occurred through the twentieth century, with the growth of devising methodologies and collective-based companies, necessitated the emergence of a different type of theatre designer. Howard cites an emphasis in collaboration and the scenographer's presence in the rehearsal room as distinguishing factors between a scenographic and more orthodox design process, and as such this need for a collaborative design methodology can be seen as having arisen from the development of collective and devising working processes. Considering the historical importance of figures such as Appia, Craig, Meyerhold, Brecht and Svoboda in the revolution and development of stage design and scenography through the twentieth century, this thesis documents the scenic practice of Complicite, Improbable, Forced Entertainment, Fevered Sleep and two recent productions by Katie Mitchell at the National Theatre, considering scenography as an integral part of the process of writing the performance text. Out of the work of these practitioners various models of scenographic practice are drawn, offering a variety of methodologies that can be used individually or in combination as a starting point for developing scenography in a devised or postdramatic context

The prevalence of overweight and obesity in indigenous kindergarten children: A cross sectional population based study

Background This study investigated the prevalence of overweight and obese Indigenous kindergarten children in the Australian Capital Territory. Methods A retrospective analysis was performed on data collected as part of the Kindergarten Health Check, a c

Using new and innovative technologies to assess clinical stage in early intervention youth mental health services: Evaluation study

Background: Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. Objective: The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). Methods: The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. Results: Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P\u3c.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. Conclusions: The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right tim

Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study

Functional disability is the lead contributor to burden of mental illness. Cognitive deficits frequently limit functional recovery, although whether changes in cognition and disability are longitudinally associated in recent-onset individuals remains unclear. Using a prospective, cohort design, 311 patients were recruited and assessed at baseline. One hundred and sixty-seven patients met eligibility criteria (M = 21.5 years old, s.d. = 4.8) and returned for follow-up (M = 20.6 months later, s.d. = 7.8). Two-hundred and thirty participants were included in the final analysis, comprising clinically stable patients with major depression (n = 71), bipolar disorder (BD; n = 61), schizophrenia-spectrum disorders (n = 35) and 63 healthy controls. Neuropsychological functioning and self-rated functional disability were examined using mixed-design, repeated-measures analysis, across diagnoses and cognitive clusters, covarying for relevant confounds. Clinical, neuropsychological and functional changes did not differ between diagnoses (all P40.05). Three reliable neuropsychological subgroups emerged through cluster analysis, characterized by psychomotor slowing, improved sustained attention, and improved verbal memory. Controlling for diagnosis and changes in residual symptoms, clusters with improved neuropsychological functioning observed greater reductions in functional disability than the psychomotor slowing cluster, which instead demonstrated a worsening in disability (Po0.01). Improved sustained attention was independently associated with greater likelihood of follow-up employment (Po0.01). Diagnosis of BD uniquely predicted both follow-up employment and independent living. Neuropsychological course appears to be independently predictive of subjective and objective functional outcomes. Importantly, cognitive phenotypes may reflect distinct pathophysiologies shared across major psychiatric conditions, and be ideal targets for personalized early intervention