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At a time of increased demand for specialist mental health services, a more nuanced understanding of how adolescents navigate systems of care and support is essential. We mapped ‘networks of care’ to explore patterns of mental health help-seeking alongside the perceived helpfulness of support accessed.
Methods
We examined data from 23 927 adolescents aged 11–18 years who participated in the 2023 OxWell Student Survey, an English school-based, repeated cross-sectional survey of mental health and wellbeing. Students self-reported past-year access to 18 types of support across informal (e.g. friends and family), semi-formal (e.g. school and charities), and formal (e.g. health and social care) domains, alongside how helpful they found the support. We used a network approach to explore interconnections between sources of support accessed and perceived helpfulness.
Results
One in four (27.0%, 6449/23927) adolescents reported past-year access to mental health support, of which 56.7% (3658/6449) reported accessing multiple types. Informal networks were the most commonly accessed (23.1%, 5523/23927), followed by semi-formal (9.7%, 2317/23927) and formal (6.8%, 1623/23927) supports. Informal sources had high acceptability, with around 80–90% reporting them as helpful, whereas child and adolescent mental health services (CAMHS), helplines, and online supports were perceived to be the least helpful. The networks also identified groups who might not be optimally served by current systems, including gender diverse adolescents and adolescents who found mental health support from their parents unhelpful.
Conclusions
Adolescents are accessing mental health support across informal, semi-formal, and formal sources of care. Services can no longer be developed, delivered, or evaluated in isolation from these networks.
Edited by
Allan Young, Institute of Psychiatry, King's College London,Marsal Sanches, Baylor College of Medicine, Texas,Jair C. Soares, McGovern Medical School, The University of Texas,Mario Juruena, King's College London
Cultural background influences multiple aspects of human experience, including perceptions of mental illness and symptom expression. Incidence and prevalence of mood disorders appear to differ between cultures, with higher rates reported for developing compared to developed areas, although this is limited by differences diagnostic classification, as well as methodological inconsistencies in epidemiological studies. Social constructs about the self and others, beliefs, norms, and customs may affect not only the occurrence but also shape the profile of mood disorders and the extent of help seeking. The impact of culture on illness presentation may even extend to treatment selection and service use. Culture plays an important role in treatment outcomes, with racial disparities in antidepressant efficacy and fewer talking therapy referrals for minorities being prominent examples. Access to health services may also vary between cultural groups, even within regions and countries. A personalised approach matching patients with clinicians may provide a framework for shared understanding and experiences of illness to improve provided care.
The differences between AI software and normal software are important as these have implications for how a transaction of AI software will be treated under sales law. Next, what it means to own an AI system – whether it is a chattel, merely a software, or something more than a software – is explored. If AI is merely a software, it will be protected by copyright, but there will be problems with licensing. But if AI is encapsulated in a physical medium, the transaction may be treated as one of the sale of goods, or a sui generis position may be taken. A detailed analysis of the Court of Justice of the European Union’s decision in Computer Associates v The Software Incubator is provided. An AI transaction can be regarded as a sale of goods. Because the sale of goods regime is insufficient, a transaction regime for AI systems has to be developed, which includes ownership and fair use (assuming AI is regarded as merely a software) and the right to repair (whether AI is treated as goods or software).
AI will greatly challenge product liability since it is based on assumptions as to physical objects distributed through organised linear value chains which do not necessarily apply in the AI context. AI systems further challenge both liability compartmentalisation based on separate risk spheres and the notion of defectiveness. The European Product Liability Regime is based on a linear value chain, whereas with AI, systems may be distributed differently. The realities of new value chains call for a number of adjustments to central product liability concepts, which will widen the scope of product liability rules. Further, AI may in fact have the potential to ultimately dissolve the very notion of product liability itself.
The chapter begins by looking at social inequality, particularly in relation to health and wellbeing. Despite huge improvements in the available resources (think for a moment about the early childhood experiences of your grandparents or parents, who may have grown up before antibiotics were available), internationally we are seeing significant declines in population health and wellbeing, and increasingly larger gaps between the rich and the poor in countries all around the world. The chapter explores how governments are attempting to address social inequality. While early childhood educators are rarely involved at the level of policy, and although it is very important that we advocate at this level, it is necessary to understand how the policy context influences our work. The chapter concludes with practical suggestions for how early childhood educators can contribute to addressing the problem of social inequality.
The economies in the 1970s were characterized by high inflation and low growth. Labor acquired great power that was used to increase wages and to reduce effort and labor efficiency. This was the beginning of a trend toward opening global markets and globalization. There was an assumption that opening of markets would increase global efficiency and standards of living. Enterprises with “global reach” become important. China joined the global economy at this time. There was significant change in favor of market-based policies and against high taxes and public spending, and the role of the market came to be seen more favorably and that of governments less favorably. There was a view that a free market can do almost anything. Pro-market theories become popular. Political elections were affected in several countries. Globalization left some industrial workers without work and without income and conservative governments were reluctant to assist them. In dealing with this problem, domestic markets work less well than expected from theory, while global financial markets grow significantly. There was the collapse of the Bretton Woods Agreements and the growing use of flexible exchange rates.
Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development.
Aims
To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.
Method
A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire.
Results
Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score.
Conclusions
Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.
The first article written about psychiatric services in Qatar was published in BJPsych International in 2006. Since then, the health system in Qatar has undergone significant transformation in the areas of service delivery, research and education. International accreditations are sought in all these fields to emphasise the standard achieved. In this article, we follow up on the mental health services currently available in Qatar, their strengths and the associated challenges.
The chapter provides an introduction to neurodevelopmental disorders and summarises recent advances in published research, focusing on the very early development and function of the human brain. The main influences on the current delivery and development of forensic healthcare services is set within the context of available policy and guidance, which is limited in part by the available research evidence to inform it. The book is divided into three sections. The first provides an overview with an introduction to individual disorders and covers aetiology, prevalence, comorbid mental disorder and relevant policy to date. The second section focuses on the clinical aspects of the range of disorders including screening, assessment, diagnosis, risk assessments and therapeutic approaches. The final section examines the pathways through the criminal justice system from police to court to disposal and addresses the specific aspect of fitness to plead or stand trial for those with neurodevelopmental disorders. This section also describes current relevant legislation within the UK as well as forensic services for those with such disorders from a national and international perspective.
Edited by
Bruce Campbell, Clim-Eat, Global Center on Adaptation, University of Copenhagen,Philip Thornton, Clim-Eat, International Livestock Research Institute,Ana Maria Loboguerrero, CGIAR Research Program on Climate Change, Agriculture and Food Security and Bioversity International,Dhanush Dinesh, Clim-Eat,Andreea Nowak, Bioversity International
Climate services (CS) and agricultural advisory services (AAS) have the potential to play synergistic roles in helping farmers manage climate-related risk, providing they are integrated. For information and communication technology (ICT)-enabled, climate-informed AAS to contribute towards transformation, the focus must shift from scaling access to scaling impact. With expanding rural ICT capacity and mobile phone penetration, digital innovation brings significant opportunities to improve access to services. Achieving impact requires the following actions: building farmers’ capacity and voice; employing a diverse delivery strategy for CS that exploits digital innovation; bundling CS, agri-advisories, and other services; investing in institutional capacity; and embedding services in a sustainable and enabling environment in terms of policy, governance, and resourcing. Recent experiences in several countries demonstrate how well targeted investments can alleviate constraints and enhance the impact of climate-informed AAS.
A large and increasing share of economic activity in modern rich economies can be shown to lie outside what mainstream neoclassical economics itself says it can be applied to: according to neoclassical economics, such activities are unsuited to markets. Since World War II rich economies have de-industrialised, shifted to services. Since the 1970s neoclassical economics has come to dominate policy advice. This worldview justifies state interventions when there is remediable market failure, but it ignores irremediable market failure, where its theory says that markets cannot work efficiently (such as where there is joint production or own consumption). Servicisation, this article argues, has increased and is increasing the extent to which neoclassical economics is, in its own terms, ‘knowably ignorant’. This is because, where service provision is subject to irremediable market failure, neoclassical economics, in its own terms, is inapplicable. The GDP [Gross Domestic Product] share of sub-sectors serving diverse human needs, such as aged care and education, is large and rising. Such sub-sectors are dominated by joint production, manifest as diverse outputs (complex and inter-related changes in the welfare of their diverse clients). Setting aside questions of the wider ‘scientific’ validity of neoclassical theory, the article focuses on its assertion that markets cannot generate economically efficient outcomes in such activities. Arguing that the constrained optimisation of its conceptual world cannot happen in the case of joint production and own consumption of service outputs, neoclassical theory reports itself as unable to determine optimal resource allocation, and so by implication cannot fulfil its role as the foundational basis of state economic policy. Yet the literature shows that the coverage of this theoretical result is not publicised – it is ‘knowable’ but not widely known. The article concludes that, as neoclassical economics is foundational to contemporary state policy, both GDP data and neoclassical theory show that it, and markets, are knowably and increasingly inapplicable. Therefore, mainstream policy thinking continues to face an increasing ‘state of ignorance’, and the cognitive foundations of state policy are correspondingly weak.
Natural disasters are becoming more common and destructive. There is a critical need to build accessible legal services for vulnerable populations that suffer disproportionately from natural disasters. Law schools, legal clinics, and law professors are well-positioned to serve vulnerable and marginalized communities and can address the issues of poverty and race that exacerbate the harm caused by natural disasters. Access to justice and civil legal aid after natural disasters should be rooted in preparedness and planning before the disaster. Understanding the nature of natural disasters, the ecosystem of response systems, existing networks, common legal issues, and the typical arc of recovery will help law schools, legal clinics, and lawyers prepare and plan for response. The models and lessons discussed in this chapter may help provide increased post disaster legal services to vulnerable people to empower them with confidence and tools to serve their communities. This chapter builds on lessons learned from previous natural disasters and offers information and insights on responsive program design, professionalism, and disaster response systems. Building a framework for institutional responses in the legal academy can advance and improve access to justice for vulnerable communities recovering after a disaster so that they can survive, rebuild and return home.
The regulation of services pursues both economic (market failure, protection and promotion of competition) and non-economic objectives. The regulation has to accommodate different ‘modes’ – the World Trade Organization identifies four ‘modes’ of trade in commercial services. The modes will be used as themes to explore the concepts used by the Court to create a single internal market in services. Cases arising from broadcasting rules and gambling will demonstrate the deference to national autonomy in issues of ‘cross-border supply’. However, cases concerning ‘consumption abroad’, in particular of healthcare services, demonstrate a less deferential approach. The strongest defence of free movement of services and establishment appears in cases dealing with ‘commercial presence’ and ‘presence of natural persons’. It will be seen that the CJ tries to defend the rights of natural and legal persons under these provisions. Before plunging into the case law, the primary and secondary rules will be laid out.
With an increasing global ageing population, the psychiatry of old age has become increasingly important. This revised second edition remains a succinct manual on the practice of psychiatry of old age, providing an up-to-date summary of existing knowledge, best practice and future challenges for the specialty, from a global perspective. Written by four leading clinicians, teachers and researchers, the book offers a much-needed international focus and is designed for use in a wide variety of countries and settings. Chapters are presented in a clear and practical way, enhanced by current and comprehensive further reading sections as well as tables and diagrams for quick assimilation and reference. The new edition is updated to incorporate new developments in assessment, investigation, classification, treatment and care since the publication of the first edition, including the ICD-11 and DSM-5. Essential reading for practising psychiatrists and geriatricians, as well as trainees, nurses and medical students.
The prevalence and effects of delirium in very old individuals aged ≥80 years have not yet been systematically evaluated. Therefore, this large single-center study of the one-year prevalence of delirium in 3,076 patients in 27 medical departments of the University Hospital of Zurich was conducted.
Methods
Patient scores on the Delirium Observation Screening scale, Intensive Care Delirium Screening Checklist, Diagnostic and Statistical Manual, 5th edition, and electronic Patient Assessment–Acute Care (nursing tool) resulted in the inclusion of 3,076 individuals in 27 departments. The prevalence rates were determined by simple logistic regressions, odds ratios (ORs), and confidence intervals.
Results
Of the 3,076 patients, 1,285 (41.8%) developed delirium. The prevalence rates in the 27 departments ranged from 15% in rheumatology (OR = 0.30) to 73% in intensive care (OR = 5.25). Delirious patients were more likely to have been admitted from long-term care facilities (OR = 2.26) or because of emergencies (OR = 2.24). The length of their hospital stay was twice as long as that for other patients. Some died before discharge (OR = 24.88), and others were discharged to nursing homes (OR = 2.96) or assisted living facilities (OR = 2.2).
Conclusion
This is the largest study to date regarding the prevalence of delirium in patients aged ≥80 years and the medical characteristics of these patients. Almost two out of five patients developed delirium, with a high risk of loss of independence and mortality.
This chapter compares the Trans-Pacific Partnership Agreement (TPP) with the Australia -- United States Free Trade Agreement (AUSFTA), reflecting on relevant developments in the Australia -- United States relationship, including with respect to agriculture and biologic medicines. The chapter focuses on the Chapters on services and investment, addressing areas such as electronic commerce, investor--state dispute settlement (ISDS), and the "carve-out" of tobacco control measures from ISDS in the TPP. The comparison of investment in the two treaties is particularly of interest given the exclusion of ISDS in the AUSFTA and its inclusion (except as between Australia and New Zealand) in the TPP. We conclude that the TPP is a more modern agreement than the AUSFTA with several improvements that provide greater regulatory policy space. However, the inclusion of ISDS as between Australia and the United States in the TPP is questionable.
It was early in the morning of October 5, 2015 when the trade ministers of twelve countries announced in Atlanta, Georgia, the successful conclusion of a seven-year, extremely complex negotiating effort known as the Trans-Pacific Partnership Agreement (TPP). The TPP was formally signed four months after its conclusion, on February 4, 2016, in Auckland, New Zealand, apparently heralding a new momentum for international trade and investment liberalization.
The global economy is in the midst of the Services Revolution, which is having as dramatic an effect on our work life and daily life as the Industrial Revolution 100–150 years ago. Services make the world go around, for consumers, businesses, and governments.
Just think of your daily routine. First thing in the morning, you wake up knowing that your family was safe because of the electronic security service that was monitoring everything while you slept, from the locks on your doors to the carbon monoxide in the garage. Then you probably check your e-mail, the football or cricket results, and the headlines from the Financial Times on your smartphone service. If you drive to work, you require car insurance; if you take the subway or bus, life insurance. On the way to the office, you stop at your favorite coffee bar for your breakfast. At the office, you put the box of that birthday tie return in the express delivery pick-up box. A quick check online of your bank balance. Then you place calls to everyone who left you voicemails overnight, using one of the international telecommunications services.