Elders in the justice system: how the system treats elders in trials, during imprisonment, and on death row

As the average lifespan increases, it becomes increasingly likely that elders will be involved in the justice system. Elders may be witnesses, victims, plaintiffs, or defendants in a trial. They are also prisoners and, in some cases, death row inmates. Because there are special needs and costs associated with elders, it is important to consider how they are treated in each of these areas of the justice system. For instance, jurors may have age biases; some prisons are unable to address elders' health problems; and critics have questioned the constitutionality of executing frail elders. In order to determine whether the court system is treating elders fairly, this analysis reviews current policies, research, and anecdotal evidence from recent high-profile cases. Recommendations for future research and policy changes are offered to ensure that elders are treated fairly in the justice system.     

Reproductive justice for incarcerated mothers and advocacy for their infants and young children

The United States has seen unprecedented growth in the number of incarcerated women, most of whom are mothers with minor children. Major public health concerns relate to the reproductive health of women in prisons and jails and the well-being of their infants and young children. In the current article, we use a reproductive justice framework to examine the intersection of incarceration and maternal and child health. We review (a) current research on the reproductive health of incarcerated women, (b) characteristics and experiences of pregnant incarcerated women, (c) outcomes of infants and young children with incarcerated parents, (d) implications of research findings for policy and practice, and (e) the need for increased research, public education, and advocacy. We strongly recommend that correctional policies and practices be updated to address the common misconceptions and biases as well as the unique vulnerabilities and health needs of incarcerated women and their young children.     

Central New York Psychiatric Center: an approach to the treatment of co-occurring disorders in the New York State correctional mental health system

Central New York Psychiatric Center operates a maximum security inpatient treatment hospital and outpatient mental health services for all of the 72 New York State prisons. In this article prevalence data, patient characteristics, and interventions offered to inmates diagnosed with co-occurring mental illness and substance abuse disorders in the New York State prison system are reviewed and discussed. Available interventions have resulted from the close collaboration of the State Department of Correctional Services and State Office of Mental Health. Aspects of current programs and plans for future service developments are discussed along with implications for the treatment of an offender population diagnosed with a co-occurring disorder.     

Exploring Gender Bias Against Women: Ethics for Marriage and Family Therapy

During the past 15 years, the negative implications of the female gender role, as demonstrated by marital dissatisfaction and mental health problems, have been documented extensively in the social science, psychology, and feminist literatures. In this article, developmental and psychological assumptions about women that are fundamental to current marriage and family therapy practice are explored. The authors call attention to the absence of substantive knowledge about women's development and to the ethical risks associated with reliance on traditional gender role notions in work with female clients. Ethical guidelines for reducing bias in therapy, especially with couples and families, are offered to counselors and therapists for evaluation and refinement of professional gender role sensitivity.     

Female sexual offenders: Five Italian case studies

Women who sexually abuse children are rare and case histories are scarce; even less is known about sexually abusive mothers. Due to the number of cases in which women sexually abuse minors, more in-depth studies on this subject are needed. This article examines the clinical files of five women who are currently serving time in Italian prisons for the sexual abuse of children. Records of the abuse cases and other records were utilized. The cases involved varying degrees of participation in the abuse by the mothers, and ranged from active sexual engagement to allowing others to abuse their children. Female perpetrators are likely to be experiencing problems in many areas of their life, including relationship dysfunction and psychological impairment. In three cases women revealed an antisocial personality disorder (ASPD), while in two cases a borderline personality disorder (BPD) was diagnosed according with DSM-IV criteria. Possible motivations for women who molest their children are explored and discussed. The current review shows that most female sex offenders fall into several suggested typology models. Therefore, the existing typologies used to classify female child sex offenders may be insufficient, and more comprehensive exploration of this offender population is needed.     

The issue of drugs and crime among a sample of incarcerated women

Based on a sample of incarcerated women in Quebec prisons in 1989, this study focuses on drug use and abuse and its relation to crime with a special concern for age of onset, nature of conviction, previous involvement in criminal activities, motivation, and other related variables. The emerging profile of these subjects is one of drug‐related problems rather than a deep involvement in criminality. Within this population of women prisoners a strong link between drugs and crime is still difficult to establish. In conclusion, it is suggested that future research rely more on qualitative analyses to gather a better understanding of the operating processes.     

Proposing Abolition Theory for Carceral Medical Education

Medical schools, like all institutions, are conservative since they seek to maintain and expand on their accomplishments. Stakes are high in carceral medicine given the risks of replicating the inhumane social conditions that exist within prisons and allow prisons to exist. Given the increasing number of partnerships between state and municipal carceral systems with academic medical centers, medical schools must consider which guiding theory they will use to teach carceral medicine. The interdisciplinary theory of prison abolition is best fit for the task of training medical students to think about the long term goals of societal change and public health.

     

Mental health measurement among women veterans receiving co-located,collaborative care services

Routine use of measurement to identify patient concerns and track treatment progress is critical to high quality patient care. This is particularly relevant to the Primary Care Behavioral Health model, where rapid symptom assessment and effective referral management are critical to sustaining population-based care. However, research suggests that women who receive treatment in co-located collaborative care settings utilizing the PCBH model are less likely to be assessed with standard measures than men in these settings. The current study utilized regional retrospective data obtained from the Veterans Health Administration’s electronic medical record system to: (1) explore rates of mental health measurement for women receiving co-located collaborative care services (N = 1008); and (2) to identify predictors of mental health measurement in women veterans in these settings. Overall, only 8% of women had documentation of standard mental health measures. Measurement was predicted by diagnosis, facility size, length of care episode and care setting. Specifically, women diagnosed with depression were less likely than those with anxiety disorders to have standard mental health measurement documented. Several suggestions are offered to increase the quality of mental health care for women through regular use of measurement in integrated care settings.     

Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the "gay-friendly" Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed.     

Interpersonal Conflicts of Women in Nursing Homes: An Administrative Perspective

Older women may respond to conflicts by suppressing anger. Suppressed anger is associated with depression and hypertension. Research on the everyday conflicts of community-dwelling older women has begun to emerge. Such information is not available for women in nursing homes, and is necessary for developing interventions that can help protect women in nursing homes against anger-related illness. Nursing home administrators were surveyed to evaluate women's health promotion programming in general, and the incidence of and institutional response to conflicts of women residents. About 74% of residents were women; yet, women's health promotion programs were rare (offered in 1 out of 25 facilities, or 4%). Ninety percent of administrators identified depression as the most significant women's health problem, but tended to see it as warranting medical rather than programmatic attention. Eighty percent identified strained interpersonal relationships as a significant health problem for women, requiring programmatic attention. In particular, administrators identified the need for programming to help women residents resolve conflicts with roommates and family members. Formal mechanisms for managing conflicts of residents did not exist in sample nursing homes.     

Recommendations for research on the effects of organizational diversity on women

This paper discusses some of the possible effects of increasing organizational diversity on four areas of concern to women: 1) hiring discrimination; 2) appraisal, promotion, and advancement problems; 3) problems related to managing and leading; and 4) sexual harassment. Recommendations for research are offered for each of these areas.     

Counselling in areas of armed conflict: the case of Jaffna, Sri Lanka

In this article counselling is discussed in relation to the traditional resources of the Tamil community for dealing with psycho-social and mental health problems. It describes some of the problems of clients affected by the armed conflict, the approaches of the local counsellors and mental health professionals, and the training offered to future Sri Lankan counsellors who want to work with people affected by the armed conflict on the island.     

Medical Liberty: Drugless Healers Confront Allopathic Doctors, 1910–1931

Education, medicine and psychotherapeutics offer exemplary sites through which liberty and its dreams are realized. This article explores the social history of medical freedom and liberty in North America during the late nineteenth and early twentieth centuries. The National League for Medical Freedom (NLMF) and the American Medical Liberty League (AMLL) offered fierce resistance to allopathic power. Allopatic liberties and rights to medical practice in asylums, clinics, courts, hospitals, prisons and schools were never certain. The politics of these liberties and rights represents a fascinating story that neither intellectual nor social historians have fully appreciated.     

Feminism and Health in the Decade of Behavior

National health data are presented to demonstrate that important issues of women's health are linked to inequality and to the generalized oppression of women. Health issues of violence, reproductive health, coronary health, and mental health are reviewed as they relate to women of color and diverse ethnicity as well as to women in general. Feminist principles are applied to these issues, pointing out inequalities in assessment, treatment and access to care, bias in research and lack of research on topics particularly relevant to women and minorities, and limitations in the education and training of health care providers. It is imperative that these problems, which are not solely biological, be addressed in light of systems-level analysis that includes a feminist lens. Guided by feminist principles and sensibilities, the relevance of behavioral and social science is outlined for research, training, assessment, intervention, evaluation, and overall social change.     

Sexual Minority Stress and Social Support Explain the Association between Sexual Identity with Physical and Mental Health Problems among Young Lesbian and Bisexual Women

Bisexual women report more physical and psychological health problems than lesbian women do, which may be attributed to greater sexual minority stress and less social support. However, many studies combine lesbian and bisexual women into a single group. The current study examined if sexual minority stress and social support mediated the association between women’s sexual identity (lesbian or bisexual) and health-related outcomes. A total of 650 U.S. young adult lesbian (n?=?227) and bisexual (n?=?423) women completed an online survey about sexual minority stress, social support, and physical and mental health problems. Bisexual women reported more physical and mental health problems. A sequential mediation model showed that bisexual women reported greater sexual minority stress than lesbian women, which in turn was associated with less social support, which was associated with more physical and mental health problems. Greater sexual minority stress and lower social support may help explain why bisexual women report more health-related problems than lesbian women. The results of the present study support the importance of examining risk and protective factors for health problems separately for lesbian and bisexual women. Health-related intervention programs that target sexual minority women may need to be tailored differently for lesbian and bisexual women.

     

Women,Ethnicity, and AIDS: What's Love Got to Do with It?

This paper examines the usefulness of relationships as the critical factor in preventing AIDS for women of color. An analysis is offered of the conceptualization of issues, as well as the prevention measures and safe-sex strategies developed for gay men versus women's HIV/AIDS incidence rates. The discussion of similarities demonstrates that gender and culture play a role in the disproportionate negative impact affecting the health status of women of color. The compounding factor of poverty is considered essential to the complex situation in the ethnic minority community, resulting in a lack of public concern and a lack of community responsiveness to these women. Finally, several challenges for health researchers are presented including the need to adopt cultural sensitivity in research efforts, include researchers with an understanding of the ethnic community's perspective, and develop clearer guidelines for risk assessment.     

The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study

The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.     

Gay,Lesbian, and Bisexual Adolescents: A Critical Challenge to Counselors

Meeting the health care needs of gay, lesbian, and bisexual teenagers has become a public health imperative, and mental health professionals should be prepared for the challenge. The stigma of homosexuality often gives rise to psychosocial problems for adolescents, who are in the process of sexual identity development. The stigma also may complicate delivery of appropriate, ethical, and sound mental health treatment. Suggestions are offered to support healthy development, to assist recovery from stigma, and to avert the disastrous consequences of suicide and AIDS.     

Women's Sexual Health: The Need for Feminist Analyses in Public Health in the Decade of Behavior

Women's sexual health is directly affected by women's low status in society. This low status, and subsequent lack of sexual autonomy, not only increases risk for sexual health problems, it also decreases ability to obtain treatment and support when a sexual health concern arises. This has clearly been demonstrated in the HIV epidemic within the U.S.. Earlier in the epidemic, women were simply ignored by public health research and practice. Once they could no longer be ignored, they were blamed and viewed as vectors. Current seroprevalence rates among men reveal that women are not significant vectors. In contrast, rates among women indicate that infection from men is the primary mechanism by which women are contracting HIV, and male-controlled sexual decision-making, male partner violence against women, and histories of sexual assault all contribute to increased HIV risk for women. Once infected, women are not given the support and resources they need as mothers and caretakers of HIV-positive partners and/or children. These findings are especially true for marginalized women such as women of color, poor women, women addicted to alcohol or drugs, and women who exchange sex for drugs or money. Findings from this review demonstrate the need for feminist approaches in understanding and addressing this issue in the Decade of Behavior. Such approaches must include an understanding of the needs of diverse women. An empowerment approach is needed to better contend with the sexual health needs of women; this must include the goal of ensuring women's control of their own bodies.