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Whether citizens are better represented by politicians ‘like them’ has been the subject of much debate and analysis. Yet, this scholarship has largely ignored the 1 in 5 people who are disabled and experience economic, social and political marginalization. Linking voter and candidate data from the 2015 British general election, this study examines whether disabled citizens are better represented by disabled elites. It analyses the effects of disability on both preferences and preference congruence. The findings reveal that disabled citizens and candidates are more supportive of healthcare and general public spending, even within parties. At the same time, the views of disabled citizens are rarely more congruent with the positions of disabled candidates than those of non-disabled candidates, except on healthcare spending. The study provides ground-breaking insights into the role of disability in policy preferences and political representation while also highlighting broader implications of how the descriptive–substantive representation link is analysed.
Persistent inequalities exist in how individuals from minority ethnic groups access mental health care. A failure to investigate how these inequalities are experienced and what they mean to people with psychosis has privileged professional narratives and hindered our understanding of how they are sustained and what could be done to reduce them. The aim of this study was to investigate the long-term experience of living with psychosis and navigating mental health services within different ethnic groups.
Our approach was informed by work on narrative analysis and prioritised the meaning that mental health services held for participants. In-depth interviews with 17 black Caribbean, 15 white British and 3 non-British white people with psychosis as part of AESOP-10, a 10-year follow-up of an ethnically diverse cohort of individuals with first-episode psychosis in the UK. Thematic narrative analysis was used to examine experiences at the personal level within and then across the individual accounts.
Service users shared many defining experiences and narratives frequently returned to individuals' first contact with mental health services, first hospital admission, the experience of impatient wards, and the meaning of medication and diagnosis in their lives. We found that experiences of powerlessness punctuated the journey through mental health services and this appeared to dominate the accounts of black Caribbean, and to a lesser extent, white British participants. The findings reveal how negative expectations and experiences of mental health services are compounded over time, creating a vicious cycle of disempowerment and mistrust that manifests for many in resistance to – or at the best passive acceptance of – intervention by mental health services. High levels of need, coupled with alienation from services, contributed to negative patterns of service use among black Caribbean participants. White participants recounted substantial, though fewer, experiences of disempowerment and more instances of shared decision making that for some helped protect positive aspects of their lives.
Against a background of entrenched social and economic disempowerment, services were experienced as disempowering by many black Caribbean people, compounding and perpetuating a sense of alienation. Concerted efforts by services to more systematically target social needs and to share power through partnership working may reduce the mistrust that many with psychosis feel when entering services and in turn reduce persistent inequalities across ethnic groups.
To investigate whether gender balance in academic psychiatry in the UK has improved since a 2005 initiative to encourage career progression for female academics in UK universities. We surveyed the gender of academic psychiatrists across the UK and compared our findings with our previous 2003 London-wide survey and with the Royal College of Psychiatrists’ 2001 workforce census.
The percentage of women in academic psychiatry posts in the UK more than doubled, from 20% in 2001 to 40% in 2019, with increases at senior lecturer (from 25 to 50%), reader/associate professor (from 29 to 48%) and professor level (from 11 to 21%). Outside London, men occupy 72% of all posts and 89% of professorial posts. Within London, men occupy 45% of all posts and 74% of professorial posts.
The representation of women in academic psychiatry has improved but men continue to dominate at professorial level. Gender equality appears worse outside London. The situation is exacerbated by the diminishing availability of posts across the UK.
This chapter address the rise of research performance measurement as an instrument of governance designed to steer the higher education sector in a specific direction. Performance measurement is always a political decision and it is about both accountability and control. Performance measurement is directed at many different entities, it serves multiple purposes, and it represents a variety of goals and values. In order to focus on the level of convergence between nations in the use of performance measurement of research in higher education institutions, this chapter examines the range of stated purposes behind the decision to measure performance. The chapter address research performance measurement in Australia, Canada, and the UK, and focuses on assessing convergence in ‘talk’ about performance measurement by senior administrators. It seeks to uncover how performance measurement is labelled and represented in these countries, and to examine the level of similarity across these nations. Hence, performance measurement is an example of a governance instrument which is utilized to shed light on how the higher education sector is being steered in various locations.
This chapter reports data from a comparative study of academic governance within England, the USA, and Australia showing that, overall, opportunities for academics to contribute to decision making about matters that affect teaching and research have declined. The chapter highlights the reduced opportunities for student participation in university decision making and substantial gaps between those who support students and staff, and those who make decisions about the provision of support services and their mode of delivery. The chapter address the current dimensions of university decision making within the context of institutional level academic governance before analyzing the ways in which university decision making has changed in recent years and the forces causing such changes. The chapter also highlights the potential impact of these changes on the effectiveness of university decision making, addressing four specific consequences and unanticipated risks. The final section briefly explores two alternative models of university decision making and considers the extent to which these models demonstrate some capacity to respond to consequences and unanticipated risks.
Sites of ancient woodland in the United Kingdom (UK) are diminishing rapidly and the multifunctional forest management system with its fragmented approach fails effectively to protect such woodland. In the face of reports on the destruction of ancient woodland, the HS2 High-Speed train project in the UK signifies the extent of trade-offs among the key stakeholders. Such large infrastructure projects typically come with high environmental and social costs, including deforestation, habitat fragmentation, biodiversity loss, and social disruption. This article examines the protection of ancient woodland in the UK and assesses the challenges in applying the ecosystem approach, an internationally recognized sustainability strategy, in the context of such protection. A better understanding of the ecosystem approach to manage ancient woodland is critical for promoting sustainable forestry practices in the UK and informs the discussion in this article of the importance of conserving ancient woodland globally. Lessons learned from UK woodland policies and certification schemes include the need to have in place strong regulatory frameworks, introduce clear indicators, and recognize pluralistic value systems alongside economic considerations. The article concludes that the protection of ancient woodland in the UK requires distinct and strong laws that reflect multiple values of this resource, acknowledge the trade-offs among stakeholders, and adopt an inclusive approach to reduce power asymmetries.
In turbulent environments and unstable political contexts, policy advisory systems have become more volatile. The policy advisory system in Anglophone countries is composed of different types of advisers who have input into government decision making. Government choices about who advises them varies widely as they demand contestability, greater partisan input and more external consultation. The professional advice of the public service may be disregarded. The consequences for public policy are immense depending on whether a plurality of advice works effectively or is derailed by narrow and partisan agendas that lack an evidence base and implementation plans. The book seeks to addresses these issues within a comparative country analysis of how policy advisory systems are constituted and how they operate in the age of instability in governance and major challenges with how the complexity policy issue can be handled.
Hugh Hale Leigh Bellot (1860–1928) was a key figure in the process of the transformation of international law in general and international criminal law in particular generated in the context of World War I. This chapter looks at the biography and the intellectual work of a man, who, being a Doctor of Civil Law called to the bar in 1890, in 1915 became a founding member and honorary secretary to the Grotius Society. The aim of this society was to promote impartial discussion on the Laws of War and Peace, and on their reform as a consequence of what those involved considered to be the “new conditions” in World War I. For the time after the war this chapter discusses the crucial contribution of Bellot in the discussions within the International Law Association on the creation of an international criminal court. In general the chapter aims to put Bellot’s contribution into a context that looks at the same time into the nineteenth as well as the early twentieth century and thereby clarifies the position of this important man at the crossroads of international criminal law
This chapter provides an historical analysis of the UK judiciary's limited role in central government public finance throughout the eighteenth and nineteenth centuries. Tax litigation represented the high point of judicial involvement in public finance, but judges' hostility to fiscal legislation did little to bolster Parliament's revenue-raising interests. Mid-nineteenth century explorations with judicial review of appropriation legislation never became a settled practice and the judiciary imposed no discernible constraints on the legal limits of public borrowing (by the Treasury) or lending (by the Bank of England). By the conclusion of the nineteenth century, it was clear that the common law judiciary would not have a prominent role in the model of parliamentary public finance which was exported throughout the common law world. Various celebrated and important cases are critiqued, including: Auckland Harbour Board v The King; Bowles v Bank of England; the Bankers' Case; and The Queen v The Lords Commissioners of the Treasury.
International criminal justice has by many accounts a long and chequered past. Histories of that past have tended to be dominated by narratives of the institutional development of international criminal justice. The great diplomatic conferences, jurisdictional initiatives and adoption of treaties that have accompanied its existence at regular intervals are emphasized. The historical-legal narrative that dominates the scholarship is that of linear evolution from custom to conventions, noble plans to concrete institutions, from ad hoc to permanent. The undertone often is that of celebration of the progress accomplished, but also perhaps more problematically one where the past is seen to merely foreshadow the present and thus read in that light. Much legal scholarship, perhaps understandably given its emphasis on legal and institutional form, errs closely to this genre.
Service integration is a global trend aiming to create partnerships, cost-effectiveness and joined-up working across public and third sector services to support an ageing population. However, social policy research suggests that the policy making process behind integration and implementation is complex, contradictory and full of tension. This paper explores social policy integration at the ground-level of services in the health and housing sector within a new integrated model for housing for older people. The paper applies a critical Lipskian approach to show that housing can promote integration for both users and wider stakeholders. Front-line workers were central to service integration, often working to integration principles despite policy changes and uncertainty. Challenges of social policy integration include the gaps between policy and practice and the developing nature of interaction at the ground-level – most notably, the role of technology. Technology and digital health platforms could enhance service user and practitioner interactions at the ground-level. The paper calls for renewed focus on policy processes in relation to service integration and consideration of new forms of service user, practitioner and policy maker interaction.
Post-war Germany has been seen as a model of 'transitional justice' in action, where the prosecution of Nazis, most prominently in the Nuremberg Trials, helped promote a transition to democracy. However, this view forgets that Nazis were also prosecuted in what became East Germany, and the story in West Germany is more complicated than has been assumed. Revising received understanding of how transitional justice works, Devin O. Pendas examines Nazi trials between 1945 and 1950 to challenge assumptions about the political outcomes of prosecuting mass atrocities. In East Germany, where there were more trials and stricter sentences, and where they grasped a broad German complicity in Nazi crimes, the trials also helped to consolidate the emerging Stalinist dictatorship by legitimating a new police state. Meanwhile, opponents of Nazi prosecutions in West Germany embraced the language of fairness and due process, which helped de-radicalise the West German judiciary and promote democracy.
This chapter studies the role of public opinion in the politics of education reforms in England from 2010 until early 2018. We find the influence of public opinion to vary depending on the salience and coherence of public opinion. When issues were highly salient and public opinion was coherent (loud politics), the government appealed to public opinion. It expanded free access to childcare and partly corrected its original attempts to cut public spending on schools and increase tuition fees for higher education. With high salience on the issue but conflicting preferences across partisan constituencies (loud but noisy politics), the government pushed through its reform agenda, which targeted the preferences of its core constituencies. It was able to continue to do this provided it possessed sufficient strength in parliament (in the case of its attempt to expand selective grammar schools) and as long as public opinion remained sufficiently split between supporters and opponents of the government (in the case of tuition fees). When salience was low, quiet politics predominated. Several reform issues related to the governance of the education system failed to capture much public attention, which gave interest groups an opportunity to insert their preferences into the decision-making process.
This chapter examines the proportionality test as applied in Hong Kong’s constitutional jurisprudence. In addition to tracing the evolution of proportionality doctrine from the British colonial era to the present day, the paper advances two broad claims. First, it argues that the Hong Kong judiciary, led by the Court of Final Appeal (CFA), has gradually inserted more structure to the proportionality test, but has also become more deferential to governmental authority and expertise in constitutional rights adjudication. The CFA’s landmark judgment in Hysan Development Co Ltd v Town Planning Board (2016) is most significant in this regard, as it enabled the use of a very deferential standard of review – “manifest” unreasonableness – in a wide range of fundamental rights cases. Second, Hysan’s introduction of a fourth step to the proportionality test has had little, if any effect on subsequent judgments. The fourth step calls for courts to balance the societal benefits of an impugned law against the harm it imposes on individual rights. Thus far, however, Hong Kong courts have refrained from taking this balancing exercise seriously, even when the burden on those whose rights are affected appears to be substantial or excessive.
ENT surgeons are likely to be at high risk of coronavirus disease 2019 exposure.
A national registry of UK ENT surgeons with suspected or confirmed coronavirus disease 2019 was created with the support of ENT UK. Voluntary entry was made by either the affected individual or a colleague, using a web-based platform.
A four-month data collection period is reported, comprising 73 individuals. Coronavirus disease 2019 was test-confirmed in 35 respondents (47.9 per cent). There was a need for hospitalisation in two cases (2.7 per cent) and tragically one individual died. Symptom onset peaked in March. The majority suspected their exposure to have been in the workplace, with a significant proportion attributing their disease to a lack of personal protective equipment at a time before formal guidance had been introduced.
The registry suggests that a significant number of ENT clinicians in the UK have contracted coronavirus disease 2019, and supports the need for tailored personal protective equipment guidance and service planning.
This chapter presents an overview of the history of humanitarian efforts as seen according to a new periodisation scheme, which identifies three main phases of engagement. These are the laissez-faire 'ad hoc humanitarianism' of the nineteenth century, the 'organised humanitarianism' associated with Taylorism and mass society (c. 1900–70), and the 'expressive humanitarianism' characterising the period since 1968. We combine this with background information on the context of the three case studies: relief efforts during the Great Irish Famine of the 1840s; the famine that ravaged Soviet Russia and the Ukraine in 1921–3; and the devastating famine in Ethiopia of the mid-1980s.
Why should we care about religious liberty? Leading commentators, United Kingdom courts, and the European Court of Human Rights have de-emphasised the special importance of religious liberty. They frequently contend it falls within a more general concern for personal autonomy. In this liberal egalitarian account, religious liberty claims are often rejected when faced with competing individual interests – the neutral secular state must protect us against the liberty-constraining acts of religions. Joel Harrison challenges this account. He argues that it is rooted in a theologically derived narrative of secularisation: rather than being neutral, it rests on a specific construction of 'secular' and 'religious' spheres. This challenge makes space for an alternative theological, political, and legal vision. Drawing from Christian thought, from St Augustine to John Milbank, Harrison develops a post-liberal focus on association. Religious liberty, he argues, facilitates creating communities seeking solidarity, fraternity, and charity – goals that are central to our common good.
The purpose of this study was to compare epidemiological trends in suicide for the three regions of the United Kingdom (England and Wales, Northern Ireland, and Scotland) and for Ireland from 1960 to 1990. The data on suicide rates were obtained from the World Health Organization statistical base, supplemented by data from the statistical offices of the four regions. While the suicide rates in Ireland, Northern Ireland and Scotland increased during the period under study, English/Welsh suicide rates first declined and then held steady. In Ireland, both male and female suicide rates increased, whereas in the other regions only male suicide rates rose. According to age, in England and Wales, suicide rates rose for male teenagers and young males, while for the other regions male suicide rates increased in general for all age groups. Social indicators (unemployment, marriage and birth rates) were quite successful in predicting male suicide rates in all four regions and in predicting female suicide rates in England and Wales and in Ireland. The results emphasize the importance of studying several regions in epidemiological studies in order to identify which trends are general and which are unique to one nation. In the present study, the epidemiological trends for suicide in England and Wales were quite different from those in the other three regions. In particular, the steady overall suicide rate in England and Wales and the rising suicide rate for young males alone differ from the trends observed in the other regions and raise importante questions about the causes of the social suicide rate in these four regions.
We examine cross-sectional and prospective associations between objectively measured SHS exposure and mental health using data from the Health and Lifestyle Survey (HALS), a large, UK-wide, general population-based, prospective cohort study with measurements of carbon monoxide or salivary cotinine levels.
Mental health was assessed using the 30-item version of the General Health Questionnaire (GHQ). Multivariate logistic regression models adjusting for age, sex, height, body mass index, alcohol intake, social status, and longstanding illness were used to analyze the association between exposure to SHS (exhaled CO and salivary cotinine categories) and psychological distress (≥ 5 GHQ).
Fully adjusted cross-sectional analysis revealed a positive relationship between exhaled carbon monoxide and psychological distress among smokers (OR 1.36; 95% CI 1.04-1.78) but not among non-smoking adults. In a similar cross-sectional analysis between cotinine level and psychological distress, non-significant associations were found among smokers and non-smokers. Prospective analyses of the cotinine-psychological distress relationship among participants without psychological distress at baseline showed no significant increased risk of psychological distress among both smokers and non-smokers. In a prospective analysis of poor mental health outcome with respect to self-report smoking and SHS status, smokers had an increased risk of psychological distress while SHS and non-smokers did not.
A non-significant association between objectively measured SHS exposure and poor mental health was found in this study. Our findings show discrepancies with recent studies suggesting the need for additional future research in this growing field of study.
This observational study examined return to duty (RTD) rates following receipt of early mental health interventions delivered by deployed mental health practitioners.
In-depth clinical interviews were conducted among 975 UK military personnel referred for mental health assessment whilst deployed in Afghanistan. Socio-demographic, military, operational, clinical and therapy outcomes were recorded in an electronic health record database. Rates and predictors of EVAC were the main outcomes examined using adjusted binary logistic regression analyses.
Overall 74.8% (n = 729) of personnel RTD on completion of care. Of those that underwent evacuation home (n = 246), 69.1% (n = 170) returned by aeromedical evacuation; the remainder returned home using routine air transport. Predictors of evacuation included; inability to adjust to the operational environment, family psychiatric history, previously experiencing trauma and thinking about or carrying out acts of deliberate self-harm.
Deployed mental health practitioners helped to facilitate RTD for three quarters of mental health casualties who consulted with them during deployment; psychological rather than combat-related factors predicted evacuation home.