Elder abuse has become increasingly relevant for intervention and study in the context of an aging population. One of the major barriers to progress in the field is underreporting of elder abuse by victims. This systematic literature review aimed to synthesize the available findings regarding victims’ help-seeking behavior to inform practice, understand the limits of the evidence, and identify research gaps. A comprehensive search of published and unpublished literature was undertaken, and studies were included if they addressed help-seeking behavior from the perspective of elder abuse victims aged 60 and older. A total of 19 studies met inclusion criteria for review. Findings are presented as a narrative synthesis organized according to help-seeking barriers, facilitators, sources of help, the responses of others, and the characteristics of victims more likely to seek help. Although barriers and sources of help received detailed attention across all studies, findings regarding victim characteristics and facilitators for and responses to help-seeking were limited. The results suggest that there are many barriers to help-seeking and that some victims only seek help when the abuse is perceived as unbearable or they fear for their safety. Results are discussed in relation to implications for intervention, including suggestions to enhance help-seeking behavior. Future research should identify facilitators of help-seeking among victims of elder abuse and victim characteristics associated with early disclosure. Research efforts should frame help-seeking as a continuing process and study ways in which the responses of others may impact future help-seeking or service engagement.
The prevalence of substance misuse in patients with severe mental disorders in a suburban area is about as high as that for similar patients in inner-city London. While DD patients are not admitted more often than patients with psychosis alone, they have double the length of in-patient stay, which may be attributable to higher levels of unmet need.
Establishing a model of sexual assault reflecting psychosocial and behavioral characteristics of perpetrators of sexual killing and rape is necessary for development in risk assessment and intervention. Methodological variations in defining sexual killing have amalgamated serial and non-serial offenders and perpetrators with direct and indirect associations between killing and sexual arousal. This study defined sexual killing specifying that killing should be directly linked to sexual arousal, and sampled 48 sexual killers, operationalized to include only those engaging in post-mortem sexual interference, with one or two known female victims (non-serial), from prison service national (England and Wales) databases. These sexual killers were compared with 48 non-homicide, life or indeterminately sentenced sexual aggressors on psychological and crime scene characteristics. Contrary to previous research, fatal outcomes were associated with neither stranger victims nor weapon presence; sexual killing was characterized by severity of violence less so than non-fatal assault. Sexual killers more often reported problems with emotional loneliness, empathic concern, and sexual entitlement than the sexual aggressors. Theoretical and applied implications are discussed.
There are financial and humanitarian consequences to unmet need amongst service users of high secure hospital care, not least in terms of length of stay. This paper presents two reviews of high secure service user needs. They provide support for the sequencing of interventions to meet service user needs and the utility of a structured framework for their review. Through analyses of these reviews, eight domains of need were identified: Therapeutic Engagement, Risk Reduction, Education, Occupational, Mental Health Recovery, Physical Health Restoration, Cultural and Spiritual Needs, Care Pathway Management. A model is presented, within which logically sequenced, timely and relevant interventions could be framed in order to provide a comprehensive and streamlined pathway through a high secure hospital. Domains of Need 3 Reducing Length of Stay in High Secure Hospital Settings: A Model for Streamlining CareThere are three high secure hospitals in England and Wales, the function of which are to provide a service to people who cannot be managed in conditions of lesser security, predominantly mentally disordered offenders (MDOs). More specifically, service users are detained under legislation which mandates assessment and treatment and emphasises public protection (Sarkar, 2010). Grounds for detention must include 'mental disorder' -any disorder or disability of mind -and a risk of harm to self or others (Mental Health Act 1983 as amended 2007. MDOs can be diverted into the Mental Health System from the Criminal Justice System at the point of contact with the police, during the pre-trial period of assessing fitness to plead, at trial, post-trial (advice on disposal prior to sentencing) and on disposal to a prison or psychiatric hospital (Wrench and Dolan, 2010). Some individuals will encounter the Criminal Justice System secondary to the Mental Health System and might find themselves transferring to facilities of increasing levels of security, through low, medium and high security. Under the Mental Health Act (1983 as amended 2007), provisions exist for MDOs to be admitted to hospital for assessment of mental disorder and risk, for offenders to be treated in hospital rather than serve a prison sentence and for prisoners to be transferred for 'urgent' treatment (for more complete descriptions of forensic mental health systems, services and concepts in England and Wales the reader is referred to Bartlett and McGauley, 2010).Broadmoor Hospital is one of three, publically-funded National Health Service (NHS), high secure hospitals in England and Wales which admit people with serious mental illness and severe personality disorders, often in combination (Adshead, 2010), who pose a serious risk of harm to themselves or others. Service users are most often referred from courts, prisons and Domains of Need 4 secure hospitals of lesser security (see Völlm, Daley and Silva, 2009 for further description) and most commonly have restrictions on their movement and liberty at the discretion of the Ministry of Justice (the gov...
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