Said Shahtahmasebi

Homicides and Suicides by Mentally Ill People

In 1992, following consultations with the Royal College of Psychiatrists, the confidential inquiry into homicides and suicides by mentally ill people was set up by the United Kingdom Department of Health. The inquiry collects detailed information on contact with secondary mental health services by means of a questionnaire from clinical audit or information departments from these organisations. In Leeds, however, a wider range of available records including Coroner Reports, police, social, educational, and all health records were consulted. This resulted in a series of health/life event histories of suicide cases that had been in contact with psychiatric services. This paper presents an exploratory analysis of these data. The Leeds suicide cases formed less than one-third of all suicide cases in Leeds; the remainder had not come into contact with psychiatric services. This proportion is consistent with the U.K. national figures. Records show that 46% of the samples first contact with the psychiatric services was through a first failed attempted suicide. Other results include the role of prescribed drugs in repeat suicide attempts, education levels, and employment stability. It is concluded that the link between mental illness and suicide is questionable. Life event history type data on all suicide cases is desperately required to study suicide as a social process.

Suicide in New Zealand.

This paper explores and questions some of the notions associated with suicide including mental illness. On average, about two-thirds of suicide cases do not come into contact with mental health services, therefore, we have no objective assessment of their mental status or their life events. One method of improving our objective understanding of suicide would be to use data mining techniques in order to build life event histories on all deaths due to suicide. Although such an exercise would require major funding, partial case histories became publicly available from a coroners inquest on cases of suicide during a period of three months in Christchurch, New Zealand. The case histories were accompanied by a newspaper article reporting comments from some of the families involved. A straightforward contextual analysis of this information suggests that (i) only five cases had contact with mental health services, in two of the cases this was due to a previous suicide attempt and in the other three it was due to drug and alcohol dependency; (ii) mental illness as the cause of suicide is fixed in the public mindset, (iii) this in turn makes psychological autopsy type studies that seek information from families and friends questionable; (iv) proportionally more females attempt, but more men tend to complete suicide; and (v) not only is the mental health-suicide relationship tenuous, but suicide also appears to be a process outcome. It is hoped that this will stimulate debate and the collaboration of international experts regardless of their school of thought.

The Good Life: A Holistic Approach to the Health of the Population

The idea of a holistic approach towards public health planning presented itself through a food-related and trivial curiosity. It is, however, emphasized that food and nutrition are only one aspect of public health. The aim is to reintroduce a holistic approach to achieve sustainable public health with emphasis on the interpretation of the term “holistic”. Holistic decision making is not a new phenomenon and has historical basis. In line with shifts in social norms, decision making has evolved. In particular, various complex models for public health have been proposed to respond to ever-increasing health issues. The advancement in mathematical sciences and technology has led to the quantification of health models. However, mathematical representations pose a major limitation on the holistic approach. Due to its evolutionary nature, human health is dynamically related to social, environmental, and other processes. With the current knowledge, it is difficult to quantify the evolution and feedback effects in holistic models. In this paper, the individuals and publics health is viewed as a dynamic process, but not independent of other dynamic processes (e.g., agriculture, economy, politics) that are all part of a much bigger process. Furthermore, it is argued that it is not merely sufficient to account for all known factors to be holistic. In this paper, the holistic conceptual model is illustrated, using public health as the central issue. The application of the conceptual model is also discussed using two practical examples.

Quality of Life: Information and Learning Resources in Supporting People with Severe Life-Changing Injuries to Return to Independence

This paper reports the first stages of the development of an integrated care model for people with massive sudden change in their lives with special reference to spinal cord injuries. The model aims to be holistic by placing the patient at the centre of the service. In addition to providing medical care for physical injuries, the model emphasises at the outset that regaining a good quality of life postinjury is expected. There is quality of life after change if individuals and their support network are provided with access to quality information and evidence for them to make informed choices. In New Zealand, this has been referred to as “life beyond bugger”!

Quality of Life: A Longitudinal Analysis of Correlates of Morale in Old Age

This paper examines recurrent continuous morale in old age within a statistical modelling paradigm. The Anglicised Philadelphia Geriatric Centre Morale Scale was used as a small component of a major longitudinal study of old age in rural North Wales, U.K. The literature review and cross-sectional analysis of morale in old age is published elsewhere. This paper deals with the aspect of the longitudinal analysis of morale in old age. The proposed statistical modelling relates recurrent morale to a set of explanatory variables that includes subjective as well as objective measures. In order to assess the degree to which explanatory variables influence morale, an adequate statistical model must handle the possibility that substantial variation between respondents will be due to unmeasured and potentially unmeasurable variables (residual heterogeneity), multicollinearity, and past behaviour effect. These applications are illustrated using morale in old age from the North Wales Longitudinal Study Old Age. The results suggested a strong presence of heterogeneity effect, i.e., current levels of morale appear to be individual specific and independent of its previous levels.

Suicide Research and Adolescent Suicide Trends in New Zealand

In recent years, there have been a number of claims and counterclaims from suicide research using time series and longitudinal data; in particular, the linkage of increased antidepressant prescriptions to a decrease in suicide rates. Suicide time series appear to have a memory compounded with seasonal and cyclic effects. Failure to take into account these properties may lead to misleading conclusions, e.g., a downward blip is interpreted as the result of current knowledge and public health policies, while an upward blip is explained as suicide being complex depending on many variables requiring further research. In previous publications, I argued that this misuse of time series data is the result of an uncritical acceptance of a medical model that links mental ill-health to suicide. The consequences of such research behaviour are further increases in antidepressant prescriptions and medications to those who should not be prescribed them, with adverse effects showing across the population, e.g., the prescription of antidepressants to very young children (some under 1 year of age) in New Zealand. Moreover, the New Zealand Evidence-based Health Care Bulletin recommends an authoritarian approach for every interaction with a young person to check their psychosocial well-being. When viewed holistically, this kind of human behaviour makes researchers, policy makers (politicians), treatment, and practitioners, and society in general part of the problem rather than the solution. This paper explores some dynamic aspects of suicide, using only official data with particular reference to youth suicide, and suggests that the medical model of suicide is only an attempt to treat depression without addressing suicide, and recommends the creation of a unified database through understanding the society that individuals live in. It is hoped that this paper will stimulate debate and the collaboration of international experts regardless of their school of thought.

Quality of Life: A Case Report of Bullying in the Workplace

The literature on bullying in the workplace describes the mental and physical ill health suffered by the victims and their families as the consequences of the bullying. The literature also discusses methods of bullying such as overt and covert physical and psychological abuse. The implications are that the consequences of abuse go far beyond the intended target; from impact on the working environment to individuals health to economic and financial loss. The literature suggests various recommendations to employers and managers to combat bullying at work. However, the common assumption within the literature has been that the bullying is done by a colleague, a line manager, or middle manager. Furthermore, it is often assumed that the executive/vice-chancellor, human resources, the trustees, or the governing board are unaware of bullying in their workplace. In this article, it is argued that cases of bullying (whether due to isolated individuals, competition, rivalry, power, or pure meanness as is reported in the literature) can only thrive in a bullying management culture. Therefore, debate and policy formulation must be directed at government level in the first instance. The case report is intended to raise some relevant issues to stimulate a debate and more research in this area.

A Case Follow-Up Report: Possible Health Benefits of Extra Virgin Olive Oil

In the course of a case study, a number of issues regarding the dynamics of blood cholesterol levels were identified. In this follow-up report, these issues are addressed. For example, issues of past behaviour and seasonality, intraindividual variation, and nonstationarity appear important over and above controllable variables such as diet and exercise. In this report, we conceptualise an alternative protective role for the dynamic blood cholesterol levels in a healthy population. Furthermore, regular consumption of extra virgin olive oil as produced in this case study may interact with the dynamics of cholesterol naturally. We recommend that future studies of this kind ought to include a time series of blood cholesterol based on daily measurements or intervals much shorter than the bimonthly measurements and to include measures of overall well being as covariates.

A Case Report of Possible Health Benefits of Extra Virgin Olive Oil

The literature on the chemical analysis of cooking oils suggests that the cholesterol-reducing effect may well be due to the antioxidant agents rather than unsaturated fats. Furthermore, antioxidant agents are present in extra virgin olive oil and not in olive oil. There is some evidence, based on studies using patients, to support such a supposition. In this paper, we present a case report on the possible health effects of changing from olive oil to extra virgin olive oil. The case report is intended to raise some relevant issues to stimulate a debate and more research in this area.

The impact of modern library services on the rehabilitation of people with disabilities

Abstract Information is the main currency in the provision of health and social care. Information plays an even more important role in the rehabilitation process for people who have suffered a major life changing event such as a spinal cord injury or brain injury. For patients/consumers to be able to make decisions about their rehabilitation they require access to information and knowledge, whether it is information about their injury/condition, pain management, returning to work and their community. There is some evidence to suggest that improved health outcomes can be achieved in patients with appropriate knowledge and information about their condition. However, this knowledge should be evidence-based and relevant for the patient. In addition, knowledge must enable patients to assume an important role in their treatment. In this paper, we present a holistic working model of rehabilitation care through the role of information resources. We will report on a number of case stories whose rehabilitation plans were benefited by using the information service. The paper concludes that a holistic rehabilitation model that considers the patient as a whole (the patient along with his/her formal and informal support networks) has a better chance of success.