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There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness.
This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK.
We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages.
The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years.
The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
Shows that secularism is a dividing line between the parties, thus suggesting that the United States is moving toward a confessional party system, in which religiosity–secularity is a dividing line between the parties. The religious–secular divide between Republicans and Democrats is illustrated through the use of data from party convention delegates, as well as from the mass public.
Considers the likely future of secularism as a fault line in American politics. Secularism is gaining ground, which suggests that it will feed further political polarization, and perhaps even lead to a confessional party system based on religious–secular differences. We also speculate that the conditions may be right for the creation of a new political movement – a Secular Left to parallel the Religious Right. Such a movement is not a certainty, however. Will the strategic candidates seek to mobilize the growing secular population? The chapter, and thus the book, concludes by suggesting that growing secularism need not mean more polarization, as politicians could seek common ground between religionists and secularists.
Uses a set of experiments to explore how voters react to political candidates who describe themselves with varying degrees of secularity, from a hard-edged version such as “atheist” to a softer statement like “I’m not particularly religious.” The results show that while voters are averse to candidates who express disbelief in God, they are open to candidates who describe their secularity in other ways.
Establishes the political origins of the secular surge by demonstrating that the recent rise in nonreligiosity has been caused, at least in part, by a political backlash against the Religious Right, and the infusion of religion into conservative politics more generally. Using a series of experiments, we show that exposure to religion-infused politics causes people to drop their religious identity.
Examines how personal secularism shapes public opinion where we would expect it to matter: the line between church and state, or public secularism. We explore the nuances in Americans' attitudes on church–state separation, including how both personal secularism and nonreligiosity shape attitudes toward the twin religious protections guaranteed by the First Amendment, protection of religious free exercise and protection from government establishment of religion. Our analysis speaks directly to the current debate over the meaning of religious liberty.
Describes the rising tide of secularism within the United States, including but not limited to the growth of the “Nones” – people without a religious affiliation. Also introduces a key concept in the book: the difference between nonreligiosity and secularism. The former is defined by the absence of religion (what you are not) while the latter refers to an affirmative embrace of a secular worldview (what you are).
American society is rapidly secularizing–a radical departure from its historically high level of religiosity–and politics is a big part of the reason. Just as, forty years ago, the Religious Right arose as a new political movement, today secularism is gaining traction as a distinct and politically energized identity. This book examines the political causes and political consequences of this secular surge, drawing on a wealth of original data. The authors show that secular identity is in part a reaction to the Religious Right. However, while the political impact of secularism is profound, there may not yet be a Secular Left to counterbalance the Religious Right. Secularism has introduced new tensions within the Democratic Party while adding oxygen to political polarization between Democrats and Republicans. Still there may be opportunities to reach common ground if politicians seek to forge coalitions that encompass both secular and religious Americans.
Demonstrates, with original data, that Americans are more secular than they appear. We do so by contrasting conventional measures of nonreligiosity (the absence of religion) with our new and novel measures of personal secularism – or a secular worldview. We use a variety of methods, quantitative and qualitative, to validate these measures, which are then employed throughout the book.
Illustrates how secularism is a potent predictor of public opinion that has, heretofore, been undetected. The chapter then digs deeper into the relationship between secularism, nonreligiosity, and politics. By employing the panel version of the Secular America Study that ran from 2010 to 2012 we test whether political views are more likely to lead to secular orientations or the other way around. The results show a backlash: politics drives people away from religion. But they also show that secularism drives political views, even on issues far removed from questions related to church and state. Secularists are firmly planted in the progressive wing of the Democratic Party.
Examines how secularism affects the civic landscape. To what extent are Secularists civically engaged, including in nonpolitical activity such as community voluntarism and explicitly political action like working on a political campaign? When it comes to engagement outside of politics, Secularists pale in comparison to Religionists but shine next to Non-Religionists. Secularism, however, is a powerful predictor of political activity, and so Secularists are highly engaged in politics.
Demonstrates that secularism can also lead to intraparty tension among Democrats. While many grassroots activists within the Democratic Party are highly secular (and predominantly white and upper status), the party also has a large contingent of Religionist activists (who are predominantly African American, Latino, and working class). Not only do these two groups of activists have different worldviews, they often disagree on both policy and strategy. Secularists are farther to the left, and more interested in ideological purity than compromise. In short, there is potentially a secular storm brewing within the Democratic coalition.