In Canada, individuals accused of a criminal offence can raise a defence of Not Criminally Responsible on Account of Mental Disorder (NCRMD), stating they were suffering from a mental disorder that rendered them incapable of appreciating the nature or quality of the act, or of appreciating that it was wrong. Individuals found NCRMD are then rendered under the jurisdiction of a provincial mental health review board tasked with evaluating whether or not the individual represents a significant risk to the safety of the public. This study adopted a methodological approach using qualitative content analysis to investigate the construction of risk in the decision-making process of the Ontario Mental Health Review Board (ORB). Results from the analysis of 30 printed rationales for decision, the justificatory document for any disposition made by a review board, indicate some ambiguity in conceptualizing risk and justifying the dispositions made by the ORB. In an effort to open the black-box of these justificatory documents, this study notes the objectivity effect of a medicalized language that obfuscates understanding of terms used by the ORB to justify risk assessments. Ultimately, the complexity of the notion of risk is reduced to a function of medical-biological psychiatric diagnostics and intervention, community or social normativity, and secondary risk management (defensive decision-making by professionals involved in the review process). These interpretations are then discussed in terms of policy implications under a new politics of uncertainty (Power, 2004).

Background: Homicide-suicides are rare events in which an individual commits a homicide and then takes his or her own life. Despite extensive media coverage and a recent increase in research in this field, our understanding of these events is limited as most studies are descriptive. There is little reliable evidence regarding mental illness in individuals who commit homicide-suicide. Aims: The central aim of this study was to examine the role of mental illness in cases of homicide-suicide. The objectives were to: (1) determine the prevalence of mental illness; (2) describe the characteristics of perpetrators and victims, and the circumstances of the offence; (3) examine the psychopathology of perpetrators prior to the offence. Method: The research design was a mixed methods study of homicide-suicide. Quantitative and qualitative techniques were used to examine a national consecutive case series, in England and Wales, between 1st January 2006 and 31st December 2008. The sample contained 60 cases. Descriptive statistical analysis and a thematic framework analysis were undertaken on documents obtained from coroners, the police, GP medical records, records of mental health services contact and newspaper articles. The social, behavioural, offence and clinical characteristics of these incidents were reported. Results: Most of these offences were committed by men (53, 88%). The average age of perpetrators was 44 years (range 18-85). The overwhelming majority of these incidents involved close family members, mainly current or former intimate partners and/or the children of the perpetrator. Over half of the perpetrators had previously been diagnosed with mental health problems by a GP, most commonly depression. The incident was, in most cases, preceded by an actual separation from an intimate partner, or the perpetrator perceived separation to be imminent. The emotional responses to the loss of the relationship included: anger; frustration; humiliation; jealousy; desire for revenge; hopelessness, guilt and remorse. Poor coping strategies were observed, with many having a history of previous self-harm or suicide attempts, and difficulty controlling their aggression. Despite the high proportion of lifetime mental illness, few had been in recent contact with their GP for psychological problems prior to the incident. In the majority of cases, incidents involving mentally ill perpetrators were reported responsibly in newspapers. However, there were instances in which journalists sensationalised the incidents and provided stereotypical portrayals of the perpetrator. Conclusion: The findings from this study add valuable empirical qualitative data to the literature. These incidents occur in the context of existing and challenging common social issues, such as intimate partner violence, child custody disputes, an ageing population, and mental disorder. The evidence from this study shows that these perpetrators had an extreme reaction to an interpersonal crisis resulting in severe emotional distress. Perpetrators from vulnerable groups had complex needs and exhibited previous poor coping strategies that may put them at increased risk. However, prevention is difficult as these are rare events and though under distress, these individuals were less likely to seek help from services. More research is required to identify risk factors in targeted sub-groups of homicide-suicide, such as intimate partner, filicide-suicide and elderly homicide-suicide, in the context of social, economic and clinical problems.

INTRODUCTION: Mental illness is a major public health problem, and has been observed as early as infancy and persists throughout childhood into adulthood. Mental illness among children can severely impair a development, academic achievement, and the ability to live a productive life. Emotional dysregulation among parents may be a risk factor for mental illness among their children. The aim of this study was to evaluate aspects of poor emotional health of parents and mental health problems among children, aged 6-17 years old in the state of Georgia and nationally. METHODS: Data on 66,920 children between the ages of 6-17 years from the 2011-2012 National Survey of Children’s Health (NSCH) were utilized. Poor emotional health in parents was defined as self-reported health status and stress levels. Adverse childhood experiences (ACEs) and substance abuse exposure were reported by parents, who served as proxy respondents for their children. Children’s mental health problems were defined as parents reporting that their child had depression, behavioral/conduct problems, and anxiety. State level weighted estimates of the prevalence of mental health problems among children from Georgia were compared to national estimates from the NSCH. Multiple logistic regression models were used to determine the weighted adjusted odds ratio (AOR) for the association between parents’ emotional health status with select mental disorders in children (using alpha level =0.05). RESULTS: Estimates of mental health conditions of depression, anxiety, and behavioral problems among children 6 to 17 years in Georgia were 5.2%( 95% CI: 3.0-7.4) for males and 6.5 %( 95% CI: 3.5-9.5) for females; national estimates among children were (8.5%, 95% CI: 7.9-9.2) for males and 6.1% (95% CI: 5.5-6.7) for females. Results from the multiple logistic regression indicated that parents’ emotional dysfunction was significantly associated with mental health problems among children at the state and national levels. AORs at the state level for mental health conditions in children were 2.5 (95% CII: 0.6-10.1) for fathers who reported poor overall health and 0.2 (95% CI: 0.1-1.6) mothers who reported their poor overall health. At the national level there was an increased AOR for mental health conditions in children with reports of poor overall health from their mothers (AOR: 4.72 95% CI: 3.6-6.2) and fathers (AOR: 3.8 95% CII: 2.9-4.9). Parental stress also increased the likelihood of mental health problems among children at the states level, (AOR: 4.7 95% CII: 1.5-14.1); acknowledgment of substance abuse (AOR: 3.795% CII: 1.4-9.8); and reports of adverse childhood experiences (AOR: 1.8 95% CI 0.7-4.5). Similar findings were observed at the national level. CONCLUSION: Given the results of this study, parental emotional health appears to be a factor that is strongly associated with mental health problems among children. Understanding that parental emotional health is a predictor of mental health problems in children can inform current parenting interventions and increase awareness of the need for family mental health services.

En analysant trois romans des écrivains américains, l'auteur de cette thèse examine courantes attitudes envers la notion de paranoïa et théorie de conspiration. L'auteur envisage comment cela permet de constituer une manière de dépasser le type de pouvoir centrée sur la capacité d’agir compris comme exclusivement humaine, ou plus spécifiquement, de deprivilégier la position humain dominante ce qui ouvre la possibilité pour les approches posthumaines de causalité d'émerger. Le première étape est d'établir au début que les deux conceptions (paranoïa et conspiration) provoquent la peur intrinsèque des origines de cause et de pouvoir d’agir. La croyance que ce n'est pas moi-même qui est responsable de mes propres actions, ou que c'est quelqu'un d'autre qui décide et provoque les évènements et mes actions implique le problème et l’inquiétude sur l’origine d’un action. / On the basis of a detailed and thorough study of three novels of American writers,the author of the present thesis questions the current attitudes towards paranoia andconspiracy theory and claims that challenging these, constitutes a way of going beyondhuman-centered types of agency ; or more specifically, of de-privileging human agency andallowing for post-humanist approaches of causality to emerge. The first step is to state thatboth concepts bring about the inherent fear about the origin of cause and agency. The beliefthat it is not myself who is responsible for my own actions, or that there is someone else whois pulling the strings, necessarily involves the problem of agency.

Bakgrund: Psykisk ohälsa ökar globalt och även inom den somatiska vården har det skett en ökning av denna patientgrupp. Patienter med psykisk ohälsa kan ofta ha svårt att uttrycka sig och symtomen kan vara svåra att tolka för sjuksköterskorna. Det kan vara en utmaning för sjuksköterskor inom den somatiska vården att vårda de patienterna vilket ofta grundar sig i okunskap, rädsla och fördomar.Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelse i mötet med patienter som har en psykiska ohälsa när de söker somatisk vård.Metod: En litteraturstudie med beskrivande design för att få en fördjupad förståelse av sjuksköterskors upplevelser. Litteraturstudien innehåller 10 vetenskapliga artiklar.Huvudresultat: I resultatet framkom det att sjuksköterskor upplevde osäkerhet och rädsla när de vårdar patienter med psykisk ohälsa inom den somatiska vården. Det visade sig bottna i de fördomar och den stigmatisering som finns i samhället. Sjuksköterskor upplevde att de patienterna var svåra att bemöta och att dem inte hade de rätta förutsättningarna för att kunna ge den bästa vården.Slutsats: Sjuksköterskorna upplevde att det var svårt att vårda patienter med psykisk ohälsa inom den somatiska vården. De upplevde rädsla och brist på hur de skulle möta dem. Sjuksköterskorna upplevde att dem behövde mer utbildning inom området för att kunna möta och vårda de patienterna. Därav är det av vikt att vidare åtgärder vidtas för att ge de bästa förutsättningarna både för sjuksköterskor och patienter.Nyckelord: Allmän vård, Psykisk ohälsa, Sjuksköterskor, Upp

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We usually view a family as small social group, with its basic characteristics to be mutual co-operation of all of its individual members. They are inter-connected by a variety of relations. As each member of a family is an individual and original personality, even the created family makes an individual, original and unrepeatable social organism. This applies to each different family {--} even to families with a handicapped child. This is to say, coexistence in one or another family has the same basic characteristics. When talking of life quality of people, we may have in mind different extent of perception of a man. It is possible to talk about life quality of an individual man as well as life quality of several people, e.g. life quality in a family. The aim of the graduation thesis was to find out the life quality of families living with an individual with slight mental disorder (IQ 50-60). To find out their difference from families without any mentally handicapped individual. All of that using the PedsQL questionnaire, which is a sufficient criterion for the problems fixation. Information needed for the graduation thesis processing was obtained on the basis of specialised material studies. Quantity research was performed to map the families life quality. Data collection was performed using the questioning method {--} the questionnaire method. The questionnaire designed by James Walter Varni Ph.D. was distributed to two groups {--} families with a slightly mentally handicapped individual (IQ 50-69) and families with children, without any mentally handicapped individual. The questionnaire contained 8 areas, in which the individual families could encounter any problem. The aim of the graduation thesis was fulfilled and the research confirmed the hypothesis that life quality of a family with slightly mentally handicapped individual with his/her intelligence quotient in the range of 50-60 points, differs from life quality of a family without any mentally handicapped individual. Some questions of the questionnaire provably demonstrated lower quality of life in families living with a slightly mentally handicapped individual.

The term “mental health” is everywhere, from government agendas, to educational reforms, to daily discourse. This is for good reason—hundreds of millions of people suffer from significant mental health concerns with a diagnosable mental disorder, let alone the fact that nearly all individuals have struggled with their mental health. The importance of mental health is uncontroversial, but the same cannot be said about its nature. Every practice related to mental health—which involves some of the most vulnerable people in the world—is committed to a conceptualization of mental health regardless of whether that practice is cognizant of this fact. Therefore, it is imperative to develop better answers to the questions of “what is mental health and why?” because conceptualizations of mental health systematically guide research, intervention, policy, and even how individuals strive to live their lives. I argue that the answer to the question of “what is mental health?” is that mental health is a causal nexus of positive facts. That is, mental health is to be identified with a cluster of positive facts that regularly co-occur such as resilience, hedonistic mental states like joy, high cognitive functioning like concentration, and productivity. The answer to the question “why is mental health what it is?” is that the positive facts regularly appear together due to the causal relations between them, rather than arbitrarily. For instance, resilience causes high cognitive functioning, which in turn causes resilience, which causes productivity, which causes high cognitive functioning and joy, and so forth. This explains why mental health is what it is because the causal relations between positive facts “glue” them together, causing them to regularly co-occur, thereby making them a stable category of existence that factors into epistemic practices such as induction and prediction. However, given the state of our knowledge, further empirical evidence is needed to elucidate the exact positive facts that constitute the mental health causal nexus and thus answer what mental health is. I provide a novel methodology—the anchoring analysis—that involves studying the mechanisms of causal interactions between potential positive facts to determine which are the most causally important and thus should be considered constitutive facts of mental health. Elucidating the homeostatic mechanism of the kind mental health is a daunting task; however, we only complicate matters for ourselves if we simplify the complexity of mental health. / Thesis / Candidate in Philosophy

Introduction The aims of this thesis were twofold. The first was to systematically review the literature, on the influence of childhood trauma on psychopathology, across a range of forensic settings. The second was to complete an empirical study that examined the relationship between childhood trauma and insecure attachment patterns and psychopathology, risk, and engagement in therapy, in a forensic population. Method For the first aim database searches and hand searches of journals assessed against predefined criteria, identified 13 papers that were eligible for review. For the research study, 64 participants from three forensic secure hospitals completed three self-report questionnaires as part of a retrospective cross-sectional design. Data was also obtained from hospital records and clinical staff. Results The systematic review identified ten studies that were rated to be of good quality, two that were rated to be of fair quality and one that was rated as weak. Results identified a relationship between childhood trauma and psychopathology, but it is difficult to generalise findings due to the heterogeneity of this population. The research study found both childhood trauma and insecure attachment significantly predicted psychopathology and risk. No associations with engagement in therapy were found, but methodological reasons for this outcome were considered. Conclusion The systematic review highlighted that research in the area of childhood trauma and psychopathology in forensic settings is at an early stage, as most studies are small and cross-sectional. It discussed the need to develop further research to improve psychological treatment and reduce recidivism. Recommendations were made in the research study to routinely assess for childhood trauma and consider attachment patterns. Limitations in the design of the study were also acknowledged.