How are employees at different levels affected by privatization? A longitudinal study of two Swedish hospitals

Despite the amount of privatizations around the world in recent decades, only limited research attention has been paid to how privatization affects the employees. The effects are likely to vary depending on the individual's position in the organization. The aim of this study was to investigate how employees' work‐related attitudes and strain changed after privatization of a Swedish acute care hospital, and to analyze whether the effects of privatization differed between employees at various hierarchic levels. Questionnaire data collected at a hospital 1 year before and 2 years after privatization, as well as at a hospital which remained a public administration unit, suggest only limited effects of privatization on a general level, but that employees at various hierarchic levels may be affected differently. While employees at a high level (physicians) and low level (assistant nurses) reported only marginal differences over time in work attitudes and strain, also in comparison with their colleagues at the comparison hospital, work attitudes of employees at the intermediate level (registered nurses) decreased after privatization. These results emphasize the importance of taking hierarchic level into account when a privatization is implemented and analyzed.     

Editorial

Market‐oriented changes within the NHS in the last 15 years have increasingly created difficulties with funding of referrals to tertiary psychotherapy health providers. The often‐cumbersome, time‐consuming and expensive bureaucratic procedures now required by the Primary Care Trusts to fund patients referred to tertiary care services leads to lengthy delays in the pathway from assessment to treatment. This paper describes a systematic survey of funding and administrative delays endured by the 23 patients referred on a cost‐per‐case basis to the Outreach Personality Disorder service at the Cassel Hospital over a 1‐year period. The results of the survey found that the median administrative delay patients endured between referral to treatment funding decision was 141 days. Two cases are presented to illustrate the difficulties encountered by patients who have to go through several obstacles before they can obtain the treatment they need. The implications of NHS reforms for the future of socialized healthcare in general and for psychotherapy tertiary care service provision in particular are highlighted in the discussion.     

Public and private responsibility for mental health services. A report on the Tennessee Task Force

The "privatization" of mental health services during the last decade has literally reshaped the way state and county departments of mental health go about fulfilling their statutory responsibilities. In Tennessee, a conference and later a task force examined the implications of this trend for the future. Two issues came to the forefront: Is it appropriate or possible for the private sector to take over the delivery of all mental health services, and if so, who will ensure that the poor receive adequate care? The Tennessee task force concluded that the privatization trend is appropriate and should be encouraged by government. It further concluded that government is ultimately responsible for ensuring access to care for the poor and uninsured although private facilities should provide some free care. Government best serves the poor by providing them the financial means to purchase care from private providers.     

A PILOT STUDY OF NATURALLY OCCURRING HIGH‐PROBABILITY REQUEST SEQUENCES IN HOSTAGE NEGOTIATIONS

In the current study, the audiotapes from three hostage‐taking situations were analyzed. Hostage negotiator requests to the hostage taker were characterized as either high or low probability. The results suggested that hostage‐taker compliance to a hostage negotiator's low‐probability request was more likely when a series of complied‐with high‐probability requests preceded the low‐probability request. However, two of the three hostage‐taking situations ended violently; therefore, the implications of the high‐probability request sequence for hostage‐taking situations should be assessed in future research.     

Subjective well‐being and valuation of future health states: Discrepancies between anticipated and experienced life satisfaction

One way of informing health policy decisions is to ask people about the impact that different health states would have on their future subjective well‐being. The present research explored the relation between anticipated and experienced changes in health‐related subjective well‐being, and examined whether affective forecasting errors could be reduced by psychological distancing manipulations. Using survey methodology, we tested whether people can accurately estimate the impact of different possible health states on their subjective well‐being. We also manipulated psychological distance: Forecasts were made about present self, future self, or others. Based on construal level theory and past work on affective forecasting errors, our prediction was that increasing psychological distance may reduce the mismatch between anticipated and experienced impact of health states on subjective well‐being. We found that the impact of ill health on subjective well‐being was greatly overpredicted and that this overprediction was not eliminated when participants were asked to make predictions about themselves in the future or about other people. Consistent with past work, we found that our participants correctly expected that their subjective well‐being would deteriorate more if they experienced the highest levels of mental illness as compared to the highest intensities of pain or most severe limitations to physical functioning.     

Self‐absorption paradox is not a paradox: Illuminating the dark side of self‐reflection

Although considered an important component of a healthy personality, self‐reflection has not so far been shown to have any specific benefits for mental health. This research addresses this issue by taking into consideration two important suppressor variables, self‐rumination and the need for absolute truth. The latter is an innovative variable, defined and presented in this research. The first two studies aimed to validate a new measure that acts as an operational definition of the need for absolute truth. The first study was conducted with two group of participants; the first group consisted of 129 females and 67 males, mean age = 20 years, and the second 182 females and 104 males, mean age = 27. In the second study, participants were 22 females and 18 males, mean age = 20.5. In the final study, conducted with 296 female, 163 male participants (mean age = 37), suppressor effects were tested using structural equation modeling. The results showed that by taking account of these two suppressor variables, particularly the need for absolute truth, the expected relationship between self‐reflection and mental health was revealed. The need for absolute truth was shown to be crucial for understanding the effects of self‐reflection on mental health, therefore it should be considered in all processes of psychotherapy.     

The role of computer‐aided psychotherapy within an NHS CBT specialist service

To date, the feasibility of computer‐aided psychotherapy as an intervention has only been recognised in primary care practice. The present study sought to evaluate the impact of ‘Beating the Blues’ (BtB), an established computerised cognitive behaviour therapy (CCBT) self‐help programme for the management of anxiety and depression, within an NHS CBT specialist healthcare centre. Of the 555 service users who used BtB as part of routine care, with follow‐up assessment at six to eight weeks, 71% completed all eight sessions. Statistically significant differences on the Beck Depression Inventory‐II (BDI‐II) and Beck Anxiety Inventory (BAI) were found in completer and intention‐to‐treat analyses; 50% of completers achieved reliable change on the BDI‐II and approximately 25% of completers achieved reliable and clinically significant change on both measures. Outcomes were benchmarked against outcomes in studies of routine face‐to‐face CBT. These findings provide evidence that BtB may be of value to service users in secondary mental healthcare centres, alleviating current burdens on public health and therapeutic resources. Future research directions should include examining which factors influence individuals’ decisions to try computer‐aided psychotherapy, which individuals are best suited to using these interventions, and why some users drop out prior to programme completion.     

Investing in our future: unrealized opportunities for funding graduate psychology training

PURPOSE: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.     

The Legitimacy of Pseudo‐Expert Discourse in the Public Sphere

This article examines the role of expertise in public debate, specifically the ways in which expertise can be mimicked and deployed as “pseudo‐expert discourse” to generate legitimacy for views that have otherwise been discredited. The article argues that pseudo‐expert discourse having a clear public health or safety impact should be regulated. There have been some attempts to legally regulate this speech through various means; however, these attempts at regulation have been met with fierce resistance, because of free‐speech concerns. The article suggests that these appeals to free speech in the context of pseudo‐expert discourse are both misguided and misplaced. Moreover, because speakers with the relevant expertise or perceived expertise are able to secure uptake of their views, they have a moral responsibility to not deceive or mislead audiences, and may also have various legal responsibilities.     

The Long Arm of Religion: Childhood Adversity,Religion, and Self‐perception Among Black Americans

Significant associations between childhood adversity and adult mental health have been documented in epidemiological and social science research. However, there is a dearth of research examining this relationship among black Americans, as well as into what cultural institutions and practices may help individuals in dealing with childhood adversity. This study suggests that religion may be an important resource for black Americans in the face of early‐life socioeconomic and health disadvantage. Using data from the National Survey of American Life, a nationally representative sample of both African Americans and black Caribbeans (n = 5,191), this study outlines a series of arguments linking childhood adversity, religiosity, and self‐perception among black Americans. The results suggest some support for religious involvement in moderating—or buffering—the harmful effects of childhood adversity on the self‐esteem and mastery among black Americans, specifically religious service attendance and religious coping. In addition, the results reveal that religion may also amplify the deleterious effects of childhood disadvantage on adult mental health. Study limitations are identified and several promising directions for future research are discussed.     

Interventions to Promote Sun Protection Behaviors: What Do We Know About the Efficacy of Health‐ and Appearance‐based Messages and the Role of Cognitions and Emotions?

Human behavior has been implicated as a critical component in the development of a number of diseases, including skin cancer. More than 85% of all skin cancers are attributed to over‐exposure to the sun, and two primary types of interventions have been utilized to motivate sun protection practices – those that focus on the health consequences (i.e., skin cancer) and those that highlight the negative appearance consequences (i.e., wrinkles and age spots) of sun exposure. Both health‐based and appearance‐based interventions have been demonstrated to increase awareness of sun exposure dangers and of recommended risk reduction behaviors. Much of the literature examining the efficacy of appearance‐based interventions also contains evidence of behavior change in response to such interventions. The role of consciously accessible attitudes and perceptions as mechanisms of behavior change has been extensively examined, and there is evidence that sun protection interventions may promote behavior change in part by altering various health‐related cognitions (e.g., perceived susceptibility to skin damage). However, the role of nonconscious mechanisms in the efficacy of sun protection interventions has received little empirical attention. A growing body of literature, primarily in other health contexts, has demonstrated that behavior is sometimes more strongly predicted by emotions than cognitions, and that processes outside of conscious awareness may affect behavior change. It is suggested that both future sun protection interventions, and health promotion theories in general, could benefit from a thorough examination of the role that emotions and autonomic reactions may play in intervention efficacy.     

A Social Neuroscience Perspective on Stress and Health

Psychological stress is a major risk factor for the development and progression of a number of diseases, including cardiovascular disease, cancer, arthritis, and major depression. A growing body of research suggests that long term, stress‐induced activation of the sympathetic nervous system (SNS) and the hypothalamic‐pituitary‐adrenal (HPA) axis may lead to increases in inflammation, which is known to play a key role in the pathophysiology of a variety of diseases. Furthermore, the burgeoning fields of social neuroscience and health neuroscience have begun to identify the neurocognitive mechanisms by which stress may lead to these physiological changes. Here we review the literature examining the neurocognitive correlates of stress‐induced SNS, HPA, and inflammatory responses. Specifically, we summarize the results of neuroimaging studies that have examined the neural correlates of stress‐related increases in SNS, HPA, and inflammatory activity. A set of neural systems involved in threat processing, safety processing, and social cognition are suggested as key contributors to stress‐related changes in physiology. We conclude by offering suggestions for future research in the exciting new field of health neuroscience.     

Social interaction and cognitive growth: An examination through the role‐taking skills of deaf and hearing children

Recent research using theory‐of‐mind tasks has rekindled interest in the possibility that social interaction makes a significant contribution to cognitive development. It is proposed here that this contribution may be most pronounced with phenomena that, like belief or affective states, are internal and abstract. A more modest contribution is envisaged with phenomena that are overt and perceptible. The proposal is explored via comparison of deaf and hearing children's ability to engage in affective and perceptual role‐taking, since the aspects of social interaction that have been implicated in cognitive development are known to be problematic for deaf children. Therefore, the proposal of more marked consequences for internal and abstract phenomena leads to the hypothesis that deaf children should lag behind hearing children on affective role‐taking, while showing little or no difference on perceptual role‐taking. The hypothesis was tested in two studies, one involving 10 deaf children and 10 hearing children aged 6.94– 8.93 years and the other involving 25 deaf children and 20 hearing children aged 5.08– 11.58 years. In both studies, affective role‐taking was examined using a task developed from Chandler (1973), while perceptual role‐taking was examined via an extension of Hughes and Donaldson's (1979) hiding task. The results provide consistent support for the hypothesis, and patterns of correlation between age, affective performance and perceptual performance give clues to the relevant developmental mechanisms.     

The role of randomised controlled trials in developing an evidence‐base for counselling and psychotherapy

Background: Representatives of counselling and person‐centred organisations indicate many of their members feel their profession and orientation is under threat, with counselling services being decommissioned in NHS settings. Aims: To understand the views of key figures in the psychological therapies field (policy makers, researchers and representatives of the counselling community) towards randomised controlled trials (RCTs), and their present and future role in developing the evidence‐base for counselling and psychotherapy. Method: Interviews (phone, Skype or face‐to‐face) were conducted with 24 authorities in the field. Relevant practitioner and academic networks were also contacted and key documents in the field were reviewed. Results: Key figures believe that RCTs will continue to play a decisive role in determining which psychological interventions are recommended and commissioned within the NHS for the foreseeable future. Other methods are seen as having some validity, but are generally considered supplementary to RCTs and not a replacement for them. Discussion: Although many members of the counselling community are critical of RCTs, they are likely to remain the mainstay of commissioning policy for some years to come. This means, in the coming years, members of the counselling community may face difficult choices in how to promote their work, while maintaining their core principles and values.     

HOLOCAUST COMMEMORATIONS IN LONDON AND ANGLO‐JEWISH (DIS‐)UNITY

This study of selected episodes of Holocaust commemorations in London (UK) sheds light on the tense and ambiguous relationship between commemoration of the Holocaust and Anglo‐Jewish unity. Many have shared the aspiration for Anglo‐Jewish unity at Holocaust commemorations, but a narrow definition of “unity”, as taken to mean centralization, uniformity and consensus, has been restrictive and has not served the desired end. As these case studies demonstrate, despite the high level of cohesion achieved by the rituals of the ceremony and the collective mourning, Holocaust commemorations have also been occasions of conflict and disunity. It is the recent proliferation of commemorations in the 1990s, taking place in a diverse range of Jewish organizations and institutions rather than one combined memorial gathering, that has led to Anglo‐Jewry’s uniting in common moments of remembrance. These differing approaches to the nature, form and content of Holocaust commemorations should be perceived not only as a positive development for the future of Holocaust remembrance in Britain but also an indication of an increasingly healthy Anglo‐Jewry.     

Implicit self-esteem is associated with higher levels of trait gratitude in women but not men

ABSTRACT

Higher levels of trait gratitude have been associated with measures of greater self-reported self-esteem. However, such self-report measures may be influenced by self-report biases. In this study we investigated for the first time whether implicit measures of self-esteem would be associated with greater trait gratitude in a sample of 88 undergraduate students (41 female). We observed that, in women (but not men), higher levels of trait gratitude were associated with higher implicit self-esteem (r = .26, p = .05), even when accounting for depressive symptoms. This finding may be of particular importance, as implicit measures of self-esteem have been more strongly associated with psychological health than explicit measures. Future research should further investigate whether the experience of gratitude affects self-esteem differently in men and women, as this knowledge may be important in informing the design of future gratitude interventions aimed at improving psychological health in men and women.     

Adoption: some clinical features of adults who have been adopted and the difficulties of helping them in NHS psychotherapy

This paper explores issues of adoption and specifically what happens when adults who have been adopted as babies present for psychological help in the NHS. Two clinical examples of women patients are given, and it is suggested that there is a re‐enactment of earlier adoption experiences within the approach to and engagement in psychotherapy. The tendency for splitting and projection between biological and adoptive mothers, good and bad mothers and the patient's body and mind are discussed, as are the implications for the transference and countertransference. The combination of the patients' problems and the restrictions imposed on treatment in the NHS due to scarce resources is explored.     

RESCUING RELIGIOUS NON‐REALISM FROM CUPITT

Don Cupitt's version of religious non‐realism based as it is on linguistic constructivism, radical relativism and the view that culture forms human nature has been attacked with devastating effect by realists in the last few years. I argue that there is another strand in Cupitt's thinking, his biological naturalism, that supports a different version of religious non‐realism and that he failed to see this possibility because of his global non‐realism and commitment to the strong programme in the sociology of scientific knowledge. Cupitt's biological naturalism should have led smoothly into evolutionary psychology, which has an account of religious belief that supports a non‐realist interpretation. Evolutionary psychology shows that religious beliefs are natural, normal and about matters of the deepest significance to humans. They gain their character from the operation of evolved structures of the mind and cannot be reduced to other sorts of belief. I argue that the form of religious non‐realism that emerges from taking biological naturalism seriously has a future because it respects the nature of religious belief and seeks to build on its capacity as a unique source of meaning in people's lives. There is also enough common ground with religious realism for there to be genuine dialogue between the two.     

Ethical social justice: Do the ends justify the means?

This article offers an ethical decision‐making model, informed by community psychology values, as a means for guiding psychologists when engaging in social justice‐oriented work. The applicability of this model is demonstrated through a case analysis elucidating how America's psychologists individually and collectively arrived at the decision to endorse torture—ostensibly as a means for preventing terrorism. Critics have wondered how the American Psychological Association succumbed to these involvements, and how to prevent such ethical lapses in the future. Unfortunately, the American Psychological Association's ethical codes fail to provide explicit guidance for psychologists' involvement in social justice work that impacts communities and systems. To address this gap, we present a values‐driven, ethical decision‐making framework that may be used to guide psychologists' future practices. This framework infuses fundamental community psychology values (i.e., caring and compassion; health; self‐determination and participation, human diversity, social justice; and critical reflexivity) into a 9‐step model.     

The future of genetics in public health

During the 1980s, we have witnessed an erosion in federal and state funding for the coordination of genetic services in state health departments. As this decade begins, the federal budget for the support of the national genetics program is less than half of the total available in 1980. In addition, priorities in state maternal and child health programs have changed, and genetic services have often received lower rankings aside of programs to improve prenatal care and to address problems such as teenage pregnancy. Clearly we are at a critical point for the future of genetics programs in the public health arena. Fortunately, despite the problems with funding and priority setting, important coalitions have been built during the past decade and continued advances in medical genetics have made it difficult for public health officials to ignore the potential impact of genetic services. Council of Regional Networks for Genetic Services (CORN) and the regional genetic services networks have provided opportunities for interaction and coordination between genetic services providers and public health officials that had not been available to any significant extent. The full potential of these coalitions has yet to be realized, but efforts in data collection, development of national guidelines and standards, and information sharing and networking have already had an influence on state genetic services programs. Continuing research on the genetics of chronic diseases and the influence of discoveries in molecular genetics will undoubtedly broaden the current scope of state public health programs in genetics, which all too often have been limited to newborn screening and administration of grants for genetic services. The regional and national genetic services programs should be strengthened and appropriate training programs should be developed in Schools of Public Health to provide the expertise and leadership that will be needed to guide the future of genetics in public health.