Disasters test civil administrations' and health services' capacity to act in a flexible but well-coordinated manner because each disaster is unique and poses unusual challenges. The health services required differ markedly according to the nature of the disaster and the geographical spread of those affected. Epidemiology has shown that services need to be equipped to deal with major depressive disorder and grief, not just posttraumatic stress disorder, and not only for victims of the disaster itself but also the emergency service workers. The challenge is for specialist advisers to respect and understand the existing health care and support networks of those affected while also recognizing their limitations. In the initial aftermath of these events, a great deal of effort goes into the development of early support systems but the longer term needs of these populations are often underestimated. These services need to be structured, taking into account the pre-existing psychiatric morbidity within the community. Disasters are an opportunity for improving services for patients with posttraumatic psychopathology in general but can later be utilized for improving services for victims of more common traumas in modern society, such as accidents and interpersonal violence.
The aim of this chapter is to provide a conceptual overview for emergency planners and responders of the different patterns of emergencies, incidents, disasters, and disease outbreaks (EIDD) and the challenges that they pose for mounting a mental health response. Issues covered include anticipating who is affected, where they are located, and how they can be identified and contacted, as well as other implications for public health and clinical services.
While there is great optimism for healthcare to be gained from developments in neuroscience, genetics and epigenetics, the social contexts and social approaches revealed by research, including much that we cover in this book, are also very powerful contributors to our health and recovery from ill health. As Nestler et al. say, ‘Psychiatric disorders are complex multifactorial illnesses … While genetic factors are important in the etiology of most mental disorders, the relatively high rates of discordance among identical twins … clearly indicate the importance of additional mechanisms’ (Nestler et al., 2016, p. 447).
An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.
Caring for people who are ill or injured in pre-hospital environments is emotionally draining and physically demanding. This article focuses on the Psychosocial and Mental Health Programme commissioned by the Faculty of Pre-Hospital Care (FPHC) at the Royal College of Surgeons of Edinburgh (RCSEd) in 2018 to investigate the experiences and needs of responders to pre-hospital emergencies and make recommendations. It summarises the report to FPHC published in 2022, and adds material from research published subsequently.
Introduction: Parental child `neglect’ is usually linked to parents but can apply to nations using the criteria explicit in UNICEF statement “in the last analysis Child-Mortality-Rates (CMR) indicates how well a nation meets the needs of its children”. Hence under-five (0-4) CMR rates of Japan and twenty Other Developed Countries (ODC) are compared within the context of relative poverty. Method: WHO data yields CMR rates per million (pm), analysed between 1989-91 and 2012-14 to compare Japan against ODC. World Bank Income Inequality data used as a measure of relative poverty. Excess deaths calculated by matching the most unequal Income Inequality country’s CMR with the most equal nation. Results: All countries reduced CMR substantially. The highest CMR was in USA 1383pm, followed by three English-speaking countries. Japan at 597pm was 19th of 21. USA and New Zealand were double Japan’s CMR, whilst twelve ODC had rates 25% higher than Japan. Most unequal Income Inequality USA at 15.9 times, Japan the most equal at 4.5 times. Income Inequality and CMR were strongly correlated (+0.6188 p<0.005). The countries with the lowest Income Inequality, had lowest CMR namely Finland Japan, Norway and Sweden. America not matching Japan’s CMR, meant an average excess of 16,838 US children’s deaths annually. Discussion: The strong statistical association between higher CMR and Income Inequality, suggests that one factor in Japan’s results is the lower social inequality, unlike Canada, New Zealand, the UK and USA. Does Japan’s results indicate cultural factors suggesting Japan is more child orientated than English-speaking countries?
The major concern for social work, namely child abuse‐related deaths (CARD), involves parental neglect. Societal neglect, when measured by child mortality rates (CMR), is considered by bodies such as UNICEF to be indicative of how a nation meets the needs of its children. This population‐based study analyses CARD and CMR for children aged from newborn to four years old between 1989–91 and 2013–15 to identify any relative child neglect in the USA and 20 other developed nations (ODN).
World Health Organization data were used for CARD, CMR and undetermined deaths (UnD), a possible source of unreported CARD, juxtaposed against World Bank income inequality data.
The USA had the highest number of CARD, the highest CMR and the worst income inequality. Five countries reduced their CARD significantly more than the USA, and 14 countries reduced their CMR more than the USA. Income inequality and CMR were correlated.
Had the USA matched the CMR of Japan, where income inequality was narrowest, there would have been on average 16 745 fewer child deaths annually.
CARD and UnD correlated, suggesting that UnD may contain unreported CARD. US CMR data indicate that services in the USA are less effective than those in ODN, possibly due to income inequality. These results will be unwelcome but child protection services must dare to speak truth to power.
‘This population‐based study analyses CARD and CMR for children aged from newborn to four years old between 1989–91 and 2013–15 to identify any relative child neglect in the USA and 20 other developed nations’
Key Practitioner Messages
The richest country in the world, the USA, has the highest rates of child abuse and total child mortality in the Western world.
The USA has the highest income inequality in the West, highlighting the statistical link between child mortality and poverty.
Children's services should lead the call for the necessary changes and ‘speak truth to power’.
Specialist CAMHS provide skilled assessment and interventions for children, young people and their families who have mental health disorders. The training needs of the staff who work in specialist CAMHS are not always clear or prioritised, due to the complexities and differing contexts in which specialist CAMHS are provided. The aim of this paper was to establish stakeholders' experiences of service complexities and challenges that affect training within specialist CAMHS. The project employed interviews to gain wide‐ranging consultation with key stakeholder groups. The sample consisted of 45 participants recruited from policy departments, professional bodies, higher education providers, commissioners, service managers, and practitioners. The participants identified a number of themes that limit training, and put forward solutions on how these could be facilitated in the future. Emerging themes related to leadership and the role of service managers, strategic management of training, commissioning, levels of staff training, resources, impact of training on service users, and availability of training programmes. The findings emphasise the need for the strategic workforce planning of training to meet service delivery goals. Policy, commissioning, workforce training strategies, service needs, and delivery of training should be integrated and closely linked.
The disqualification of company directors for unfitness to be concerned in the management of companies is offered by UK policy makers as a desirable form of regulation that effectively protects the public from so-called “abuse of limited liability”. However, placing disqualification in its proper context as an attempt by the state to reduce agency costs from conflicts of interest between corporate constituencies because of a perceived failure of private bargaining, this article argues that there is little, if any, evidence to suggest that disqualification under section 6 of the Company Directors Disqualification Act is an effective form of regulation. In so doing it asserts that public interest regulation, such as disqualification, can be seen as desirable only if it brings about a real improvement on outcomes that would result from market transactions alone and considers evidence from various sources in concluding that disqualification is unlikely to do so. It suggests that reform of the existing disqualification regime is pressing if meaningful protection is to be offered to the public, but argues that the prospects for useful reform are limited. By way of conclusion the article states that the failure of disqualification poses an urgent and profound challenge for policy makers, and suggests that as things stand little would be lost by the abolition of the disqualification regime altogether.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)