From positive screen to engagement in treatment: A preliminary study of the impact of a new model of care for prisoners with serious mental illness

Background: The high prevalence of serious mental illness (SMI) in prisons remains a challenge for mental health services. Many prisoners with SMI do not receive care. Screening tools have been developed but better detection has not translated to higher rates of treatment. In New Zealand a Prison Model of Care (PMOC) was developed by forensic mental health and correctional services to address this challenge. The PMOC broadened triggers for referrals to mental health teams. Referrals were triaged by mental health nurses leading to multidisciplinary team assessment within specified timeframes. This pathway for screening, referral and assessment was introduced within existing resources. Method: The PMOC was implemented across four prisons. An AB research design was used to explore the extent to which mentally ill prisoners were referred to and accepted by prison in-reach mental health teams and to determine the proportion of prison population receiving specialist mental health care. Results: The number of prisoners in the study in the year before the PMOC (n = 19,349) was similar to the year after (n = 19,421). 24.6 % of prisoners were screened as per the PMOC in the post period. Referrals increased from 491 to 734 in the post period (Z = −7.23, p < 0.0001). A greater number of triage assessments occurred after the introduction of the PMOC (pre = 458; post = 613, Z = 4.74, p < 0.0001) leading to a significant increase in the numbers accepted onto in-reach caseloads (pre = 338; post = 426, Z = 3.16, p < 0.01). Numbers of triage assessments completed within specified time frames showed no statistically significant difference before or after implementation. The proportion of prison population on in-reach caseloads increased from 5.6 % in the pre period to 7.0 % in the year post implementation while diagnostic patterns did not change, indicating more prisoners with SMI were identified and engaged in treatment. Conclusions: The PMOC led to increased prisoner numbers across screening, referral, treatment and engagement. Gains were achieved without extra resources by consistent processes and improved clarity of professional roles and tasks. The PMOC described a more effective pathway to specialist care for people with SMI entering prison

Rosanna Raymond’s SaVAge K’lub at the eighth Asia Pacific Triennial of Contemporary Art

This visual essay is based on a conversation in June 2016 between artist Rosanna Raymond and academic Karen Jacobs on Raymond’s art work, The SaVAge K’lub, with which she contributed to the eighth Asia Pacific Triennial of Contemporary Art. While this artwork challenges a variety of stereotypical misrepresentations of Pacific people and their arts, it unexpectedly appeared to reinforce certain perceptions too

Long-term effects of flooding on mortality in England and Wales, 1994-2005: controlled interrupted time-series analysis

BACKGROUND: Limited evidence suggests that being flooded may increase mortality and morbidity among affected householders not just at the time of the flood but for months afterwards. The objective of this study is to explore the methods for quantifying such long-term health effects of flooding by analysis of routine mortality registrations in England and Wales. METHODS: Mortality data, geo-referenced by postcode of residence, were linked to a national database of flood events for 1994 to 2005. The ratio of mortality in the post-flood year to that in the pre-flood year within flooded postcodes was compared with that in non-flooded boundary areas (within 5 km of a flood). Further analyses compared the observed number of flood-area deaths in the year after flooding with the number expected from analysis of mortality trends stratified by region, age-group, sex, deprivation group and urban-rural status. RESULTS: Among the 319 recorded floods, there were 771 deaths in the year before flooding and 693 deaths in the year after (post-/pre-flood ratio of 0.90, 95% CI 0.82, 1.00). This ratio did not vary substantially by age, sex, population density or deprivation. A similar post-flood 'deficit' of deaths was suggested by the analyses based on observed/expected deaths. CONCLUSIONS: The observed post-flood 'deficit' of deaths is counter-intuitive and difficult to interpret because of the possible influence of population displacement caused by flooding. The bias that might arise from such displacement remains unquantified but has important implications for future studies that use place of residence as a marker of exposure

Flood vulnerability, risk and social disadvantage: current and future patterns in the UK

Present day and future social vulnerability, flood risk and disadvantage across the UK are explored using the UK Future Flood Explorer. In doing so, new indices of neighbourhood flood vulnerability and social flood risk are introduced and used to provide a quantitative comparison of the flood risks faced by more and less socially vulnerable neighbourhoods. The results show the concentrated nature of geographic flood disadvantage. For example, ten local authorities account for fifty percent of the most socially vulnerable people that live in flood prone areas. The results also highlight the systematic nature of flood disadvantage. For example, flood risks are higher in socially vulnerable communities than elsewhere; this is shown to be particularly the case in coastal areas, economically struggling cities and dispersed rural communities. Results from a re-analysis of the Environment Agency’s Long-Term Investment Scenarios (for England) suggests a long-term economic case for improving the protection afforded to the most socially vulnerable communities; a finding that reinforces the need to develop a better understanding of flood risk in socially vulnerable communities if flood risk management efforts are to deliver fair outcomes. In response to these findings the paper advocates an approach to flood risk management that emphasizes Rawlsian principles of preferentially targeting risk reduction for the most socially vulnerable and avoids a process of prioritisation based upon strict utilitarian or purely egalitarian principles

Beyond ‘just’ flood risk management: the potential for—and limits to—alleviating flood disadvantage

The threat of flooding poses a considerable challenge for justice. Not only are more citizens becoming exposed to risk, but they are expected to play increasingly active roles in flood risk management. However, until recently, few efforts have charted broader understandings of disadvantage relating to flood risk exposure. Drawing upon social science scholarship that has long been sensitive to concerns related to justice, we deploy and develop the notion of flood disadvantage as a means to assess the challenges to more ‘just’ flood risk management. We contend that the concept of flood disadvantage offers a useful lens to appreciate the constraints of technical approaches to flood risk management, in particular, its limited ability to incorporate complex social elements such as how individuals have differing vulnerabilities and sensitivities to flooding and uneven abilities to engage with risk agendas. The notion highlights the compounding interactions between flooding and other social disadvantages across multiple public policy areas and scales. We argue a fuller acknowledgement of the socio-spatial-temporal dimensions of intersecting disadvantages can help sensitise technical risk analyses that tend to see people and communities as homogeneous entities in a given spatiality. In doing so we can better reveal why some individuals or communities are more vulnerable to disasters or are slower to recover than others. Finally, we outline the challenges in turning more ‘just’ flood risk management from an abstract notion into one that could inform future practice

Applying whakapapa research methodology in Māori kin communities in Aotearoa New Zealand

ABSTRACTIndigenous research methods centralises the importance of Indigenous ways of researching, validating and interpreting knowledge. In Māori kin-community (kāinga) contexts this methodology is called whakapapa. It is an ethical approach to research. Through three kāinga case studies, our article explores whakapapa methodology as an expression of Kaupapa Māori research. We explore the importance of co-productive relationships or whanaungatanga; co-design and co-development, or kotahitanga; ethics procedures or tikanga; accountability to community or utu; and kin narratives or kōrero as a genealogically-ordered methodology of engaging kāinga and hearing their stories or views, compared to formal interviews. In relation to the research teams and kāinga, we also discuss two intersecting values, which we call the mana/manaakitanga dynamic. It is a widely accepted dualism in Māori society. Mana concerns ancestrally-framed authority based on descent, providing specialist views and perspectives, while manaakitanga concerns service through kinship, not least respect and consideration of others’ interests. Given their centrality to shaping genealogically-prescribed behaviours, we show how they apply in research contexts amongst researchers, who are not just ‘included’, but who also become engaged participants in overall kāinga-led and kāinga-owned outcomes. We conclude by discussing how whakapapa methodology can help shape institutional ethics and help address grand challenges