Psychiatric wards: places of safety?

Aim. This paper is a report of a study to explore the experiences of service users on acute inpatient psychiatric wards in England regarding their feelings of safety and security whilst in hospital. Background. In recent years the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that whilst some psychiatric inpatients feel safe and cared for, others see their time there as neither safe nor therapeutic. Method. Sixty semi-structured interviews were conducted with psychiatric inpatients randomly selected from sixty psychiatric wards in England. The interviews were conducted over an 18 month period in 2004–2005. The interviews were analysed thematically. Findings. A third of the respondents felt safe in hospital and felt supported by staff and other patients in times of need. However, anything that threatened their sense of security, such as fighting between patients, intimidation, bullying, theft, racism, and illegal substances such as alcohol or cannabis being smuggled onto the ward, made many of them feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. Conclusion. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their in-patient experience

HIV and incarceration: prisons and detention

The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overcrowding and sub-standard living conditions sometimes amounting to inhuman or degrading treatment in violation of international law, make prisons and other detention centres a high risk environment for the transmission of HIV. Ultimately, this contributes to HIV epidemics in the communities to which prisoners return upon their release

The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in Southern Sudan

BACKGROUND: There remains limited evidence on how armed conflict affects overall physical and mental well-being rather than specific physical or mental health conditions. The aim of this study was to investigate the influence of demographic characteristics, living conditions, and violent and traumatic events on general physical and mental health in Southern Sudan which is emerging from 20 years of armed conflict. METHODS: A cross-sectional survey of 1228 adults was conducted in November 2007 in the town of Juba, the capital of Southern Sudan. Multivariate linear regression analysis was used to investigate the associations and relative influence of variables in three models of demographic characteristics, living conditions, and trauma exposure, on general physical and mental health status. These models were run separately and also as a combined model. Data quality and the internal consistency of the health status instrument (SF-8) were assessed. RESULTS: The variables in the multivariate analysis (combined model) with negative coefficients of association with general physical health and mental health (i.e. worse health), respectively, were being female (coef. -2.47; -2.63), higher age (coef.-0.16; -0.17), absence of soap in the household (physical health coef. -2.24), and experiencing within the past 12 months a lack of food and/or water (coef. -1.46; -2.27) and lack of medical care (coef.-3.51; -3.17). A number of trauma variables and cumulative exposure to trauma showed an association with physical and mental health (see main text for data). There was limited variance in results when each of the three models were run separately and when they were combined, suggesting the pervasive influence of these variables. The SF-8 showed good data quality and internal consistency. CONCLUSIONS: This study provides evidence on the pervasive influence of demographic characteristics, living conditions, and violent and traumatic events on the general physical and mental health of a conflict-affected population in Southern Sudan, and highlights the importance of addressing all these influences on overall health

The terror that underpins the ‘peace’: The political economy of Colombia’s paramilitary demobilisation process

Studies on terrorism have traditionally focused on non-state actors who direct violence against liberal states. Such studies have also tended to focus on political motivations and, therefore, have neglected the economic functions of terrorism. This article challenges the divorce of the political and economic spheres by highlighting how states can use terrorism to realise interconnected political and economic goals. To demonstrate this, we take the case of the paramilitary demobilisation process in Colombia and show how it relates to the US-Colombian free trade agreement (FTA). We argue that the demobilisation process fulfils a dual role. Firstly, the process aims to improve the image of the Colombian government required to pass the controversial FTA through US Congress in order to protect large amounts of US investment in the country. Secondly, the demobilisation process serves to mask clear continuities in paramilitary terror which serve mutually supportive political and economic functions for US investment in Colombia