Anticipatory Processing in a Verb-Initial Mayan Language: Eye-Tracking Evidence During Sentence Comprehension in Tseltal.

We present a visual world eye-tracking study on Tseltal (a Mayan language) and investigate whether verbal information can be used to anticipate an upcoming referent. Basic word order in transitive sentences in Tseltal is Verb-Object-Subject (VOS). The verb is usually encountered first, making argument structure and syntactic information available at the outset, which should facilitate anticipation of the post-verbal arguments. Tseltal speakers listened to verb-initial sentences with either an object-predictive verb (e.g., "eat") or a general verb (e.g., "look for") (e.g., "Ya slo'/sle ta stukel on te kereme," Is eating/is looking (for) by himself the avocado the boy/ "The boy is eating/is looking (for) an avocado by himself") while seeing a visual display showing one potential referent (e.g., avocado) and three distractors (e.g., bag, toy car, coffee grinder). We manipulated verb type (predictive vs. general) and recorded participants' eye movements while they listened and inspected the visual scene. Participants' fixations to the target referent were analyzed using multilevel logistic regression models. Shortly after hearing the predictive verb, participants fixated the target object before it was mentioned. In contrast, when the verb was general, fixations to the target only started to increase once the object was heard. Our results suggest that Tseltal hearers pre-activate semantic features of the grammatical object prior to its linguistic expression. This provides evidence from a verb-initial language for online incremental semantic interpretation and anticipatory processing during language comprehension. These processes are comparable to the ones identified in subject-initial languages, which is consistent with the notion that different languages follow similar universal processing principles.

Prevalence of mental disorders in defendants at criminal court.

BACKGROUND: Psychiatric morbidity in prisons and police custody is well established, but little is known about individuals attending criminal court. There is international concern that vulnerable defendants are not identified, undermining their right to a fair trial. AIMS: To explore the prevalence of a wide range of mental disorders in criminal defendants and estimate the proportion likely to be unfit to plead. METHOD: We employed two-stage screening methodology to estimate the prevalence of mental illness, neurodevelopmental disorders and unfitness to plead, in 3322 criminal defendants in South London. Sampling was stratified according to whether defendants attended court from the community or custody. Face-to-face interviews, using diagnostic instruments and assessments of fitness to plead, were administered (n = 503). Post-stratification probability weighting provided estimates of the overall prevalence of mental disorders and unfitness to plead. RESULTS: Mental disorder was more common in those attending court from custody, with 48.5% having at least one psychiatric diagnosis compared with 20.3% from the community. Suicidality was frequently reported (weighted prevalence 71.2%; 95% CI 64.2-77.3). Only 16.7% of participants from custody and 4.6% from the community were referred to the liaison and diversion team; 2.1% (1.1-4.0) of defendants were estimated to be unfit to plead, with a further 3.2% (1.9-5.3) deemed 'borderline unfit'. CONCLUSIONS: The prevalence of mental illness and neurodevelopmental disorders in defendants is high. Many are at risk of being unfit to plead and require additional support at court, yet are not identified by existing services. Our evidence challenges policy makers and healthcare providers to ensure that vulnerable defendants are adequately supported at court.

COVID-19 Vaccination in those with mental health difficulties: A guide to assist decision-making in England, Scotland, and Wales.

There is currently no specific guidance addressing vaccine hesitancy in those with mental health difficulties in the United Kingdom. This is particularly problematic when one considers that individuals with serious mental illnesses are at greater risk of infection and have poorer health outcomes for a range of reasons. There are also many individual and system level barriers to vaccination in this group. When an affected adult lacks the capacity to make a decision for themselves, it often falls to healthcare professionals to make a decision on that person's behalf and in their best interests. This article explores this matter with regard to the law in practice in the English and Welsh, and Scottish, jurisdictions and consider this with relevance to the safest approach that doctors and other healthcare professionals should take in working with patients for whom mental disorder may impact on decision-making capacity. The article focuses on psychiatric inpatients, including those who are detained involuntarily, to consider whether, and in what circumstances, COVID-19 vaccination should be given to individuals who cannot or do not consent.

Adverse childhood experiences and adult self-harm in a female forensic population.

AIMS AND METHOD: This study aimed to investigate the prevalence of adverse childhood experiences (ACEs) among patients in a female forensic psychiatric in-patient medium-secure unit, and to analyse the link between ACEs, adulthood self-harm and associated comorbidities and risk factors. The study used a cross-sectional design, with data gathered from the anonymised electronic health records of patients. RESULTS: It was found that there was a high prevalence of both ACEs and self-harm among this patient group, and that there was a relationship between the two; those with more ACEs were more likely to have self-harmed during adulthood. Of the individual ACE categories, it was also demonstrated that emotional abuse had a significant association with adulthood self-harm. CLINICAL IMPLICATIONS: In medium-secure settings for women, implementation of trauma-informed care will be beneficial because of the high number of those with mental disorders who have experienced adversity during their childhood.

Managing restricted patients in acute, non-secure in-patient services: clinical, ethical and resource implications of long waits for a response from the Ministry of Justice.

AIMS AND METHOD: In-patients subject to Section 37/41 of the Mental Health Act 1983 (MHA) require permission from the Ministry of Justice (MoJ) for leave, transfer and discharge. This study aimed to quantify the time spent waiting for the MoJ to respond to requests, using data on restricted patients recalled to a non-forensic unit over 8 years. RESULTS: Eleven admissions were identified. The mean total time waiting for response was 95 days per admission, with an estimated cost of £40 922 per admission. CLINICAL IMPLICATIONS: Current procedures may contribute to considerable increases in length of stay. This goes against the principles of the MHA, as non-secure services rarely provide the range of interventions which justify prolonged admission. We suggest several ways to resolve this issue, including broadening the guidance for the use of voluntary admissions and civil sections, and allowing clinicians to make decisions on leave and transfer where there is little risk.

The prevalence of mental illness and unmet needs of police custody detainees.

BACKGROUND: Internationally, there is evidence of high rates of mental disorders amongst police custody detainees but this literature is limited, and there has been little research into the unmet needs of police detainees in the UK, or elsewhere. Such research could support better focussed interventions for improving health and recidivism outcomes. AIM: To examine psychiatric and developmental morbidity amongst police detainees, and ascertain differences in need between morbidity categories. METHOD: We used a cross-sectional study design and interviewed a 40% sample of people entering police custody in one South London police station over a 2-week period. A series of standardised measures was administered to screen for the presence of mental illness, general health and social care needs. RESULTS: A cohort of 134 people was generated, of whom nearly one-third (39, 29%) had current mental illness (major depression and/or psychosis); more had a lifetime diagnosis (54, 40%). Just under a fifth met the threshold for post-traumatic stress disorder (11, 8%). Clinically relevant alcohol or daily cannabis use affected about one quarter of the sample. Twenty-one percent (or 28) screened positive for personality disorder, 11% (or 15) for attention deficit hyperactivity disorder and 4% (6) for intellectual disability. Nearly one-fifth (24, 18%) were at risk for suicide. Those with psychosis, and those deemed at risk for suicide, had the highest levels of unmet need and, indeed, overall need. The most frequent unmet need was for accommodation. CONCLUSION: Our findings not only confirm high rates of mental health problems amongst police detainees but also demonstrate their high risk of suicide and high levels of unmet need, especially as regards accommodation. This underscores the need to provide mental health services in police stations, to help identify and resolve these issues at this early stage in the criminal justice system. Extending accommodation capacity to help some arrestees may help to save lives and interrupt cycling through the criminal justice system.

Early language experience in a Papuan community.

The rate at which young children are directly spoken to varies due to many factors, including (a) caregiver ideas about children as conversational partners and (b) the organization of everyday life. Prior work suggests cross-cultural variation in rates of child-directed speech is due to the former factor, but has been fraught with confounds in comparing postindustrial and subsistence farming communities. We investigate the daylong language environments of children (0;0-3;0) on Rossel Island, Papua New Guinea, a small-scale traditional community where prior ethnographic study demonstrated contingency-seeking child interaction styles. In fact, children were infrequently directly addressed and linguistic input rate was primarily affected by situational factors, though children's vocalization maturity showed no developmental delay. We compare the input characteristics between this community and a Tseltal Mayan one in which near-parallel methods produced comparable results, then briefly discuss the models and mechanisms for learning best supported by our findings.

Early Language Experience in a Tseltal Mayan Village.

Daylong at-home audio recordings from 10 Tseltal Mayan children (0;2-3;0; Southern Mexico) were analyzed for how often children engaged in verbal interaction with others and whether their speech environment changed with age, time of day, household size, and number of speakers present. Children were infrequently directly spoken to, with most directed speech coming from adults, and no increase with age. Most directed speech came in the mornings, and interactional peaks contained nearly four times the baseline rate of directed speech. Coarse indicators of children's language development (babbling, first words, first word combinations) suggest that Tseltal children manage to extract the linguistic information they need despite minimal directed speech. Multiple proposals for how they might do so are discussed.

Differential coding of perception in the world's languages.

Is there a universal hierarchy of the senses, such that some senses (e.g., vision) are more accessible to consciousness and linguistic description than others (e.g., smell)? The long-standing presumption in Western thought has been that vision and audition are more objective than the other senses, serving as the basis of knowledge and understanding, whereas touch, taste, and smell are crude and of little value. This predicts that humans ought to be better at communicating about sight and hearing than the other senses, and decades of work based on English and related languages certainly suggests this is true. However, how well does this reflect the diversity of languages and communities worldwide? To test whether there is a universal hierarchy of the senses, stimuli from the five basic senses were used to elicit descriptions in 20 diverse languages, including 3 unrelated sign languages. We found that languages differ fundamentally in which sensory domains they linguistically code systematically, and how they do so. The tendency for better coding in some domains can be explained in part by cultural preoccupations. Although languages seem free to elaborate specific sensory domains, some general tendencies emerge: for example, with some exceptions, smell is poorly coded. The surprise is that, despite the gradual phylogenetic accumulation of the senses, and the imbalances in the neural tissue dedicated to them, no single hierarchy of the senses imposes itself upon language.

Fitness to plead: Development and validation of a standardised assessment instrument.

The ability of an individual to participate in courtroom proceedings is assessed by clinicians using legal 'fitness to plead' criteria. Findings of 'unfitness' are so rare that there is considerable professional unease concerning the utility of the current subjective assessment process. As a result, mentally disordered defendants may be subjected unfairly to criminal trials. The Law Commission in England and Wales has proposed legal reform, as well as the utilisation of a defined psychiatric instrument to assist in fitness to plead assessments. Similar legal reforms are occurring in other jurisdictions. Our objective was to produce and validate a standardised assessment instrument of fitness to plead employing a filmed vignette of criminal proceedings. The instrument was developed in consultation with legal and clinical professionals, and was refined using standard item reduction methods in two initial rounds of testing (n = 212). The factorial structure, test-retest reliability and convergent validity of the resultant instrument were assessed in a further round (n = 160). As a result of this iterative process a 25-item scale was produced, with an underlying two-factor structure representing the foundational and decision-making abilities underpinning fitness to plead. The sub-scales demonstrate good internal consistency (factor 1: 0·76; factor 2: 0·65) and test-retest stability (0·7) as well as excellent convergent validity with scores of intelligence, executive function and mentalising abilities (p≤0·01 in all domains). Overall the standardised Fitness to Plead Assessment instrument has good psychometric properties. It has the potential to ensure that the significant numbers of mentally ill and cognitively impaired individuals who face trial are objectively assessed, and the courtroom process critically informed.

Making sense of (exceptional) causal relations. A cross-cultural and cross-linguistic study.

In order to make sense of the world, humans tend to see causation almost everywhere. Although most causal relations may seem straightforward, they are not always construed in the same way cross-culturally. In this study, we investigate concepts of "chance," "coincidence," or "randomness" that refer to assumed relations between intention, action, and outcome in situations, and we ask how people from different cultures make sense of such non-law-like connections. Based on a framework proposed by Alicke (2000), we administered a task that aims to be a neutral tool for investigating causal construals cross-culturally and cross-linguistically. Members of four different cultural groups, rural Mayan Yucatec and Tseltal speakers from Mexico and urban students from Mexico and Germany, were presented with a set of scenarios involving various types of causal and non-causal relations and were asked to explain the described events. Three links varied as to whether they were present or not in the scenarios: Intention-to-Action, Action-to-Outcome, and Intention-to-Outcome. Our results show that causality is recognized in all four cultural groups. However, how causality and especially non-law-like relations are interpreted depends on the type of links, the cultural background and the language used. In all three groups, Action-to-Outcome is the decisive link for recognizing causality. Despite the fact that the two Mayan groups share similar cultural backgrounds, they display different ideologies regarding concepts of non-law-like relations. The data suggests that the concept of "chance" is not universal, but seems to be an explanation that only some cultural groups draw on to make sense of specific situations. Of particular importance is the existence of linguistic concepts in each language that trigger ideas of causality in the responses from each cultural group.

Assessments of mental capacity in psychiatric inpatients: a retrospective cohort study.

BACKGROUND: The Mental Capacity Act 2005 (MCA) was introduced in 2007 to protect vulnerable individuals who lack capacity to make decisions for themselves and to provide a legal framework for professionals to assess incapacity. The impact of the MCA on clinical practice is not known. This study aims to evaluate how frequently mental capacity is assessed in psychiatric inpatients, whether the criteria for determining capacity set out in the MCA are used in practice, and whether this has increased with the introduction of the MCA. METHOD: A retrospective cohort study was carried out using a case register of South East London mental health service users. The Case Register Interactive Search (CRIS) system enabled searching and retrieval of anonymised information on patients admitted to the South London and Maudsley NHS Foundation Trust since 2006. The presence and outcomes of documented mental capacity assessments in psychiatric admissions between May 2006 and February 2010 were identified and demographic information on all admissions was retrieved. RESULTS: Capacity assessments were documented in 1,732/17,744 admissions (9.8%). There was a significant increase in the frequency of capacity assessments carried out over the study period of 0.3 percentage points per month (95% CI 0.26-0.36, p < 0.00001). In only 14.7% of capacity assessments were the MCA criteria for assessing capacity explicitly used. CONCLUSIONS: Over the period of the introduction of the MCA there has been a significant increase in the number of mental capacity assessments carried out on psychiatric inpatients. Although mental health services are considering the issue of capacity more frequently, mental capacity assessments are inconsistently applied and do not make adequate use of MCA criteria.

Time and space in tzeltal: is the future uphill?

Linguistic expressions of time often draw on spatial language, which raises the question of whether cultural specificity in spatial language and cognition is reflected in thinking about time. In the Mayan language Tzeltal, spatial language relies heavily on an absolute frame of reference utilizing the overall slope of the land, distinguishing an "uphill/downhill" axis oriented from south to north, and an orthogonal "crossways" axis (sunrise-set) on the basis of which objects at all scales are located. Does this absolute system for calculating spatial relations carry over into construals of temporal relations? This question was explored in a study where Tzeltal consultants produced temporal expressions and performed two different non-linguistic temporal ordering tasks. The results show that at least five distinct schemata for conceptualizing time underlie Tzeltal linguistic expressions: (i) deictic ego-centered time, (ii) time as an ordered sequence (e.g., "first"/"later"), (iii) cyclic time (times of the day, seasons), (iv) time as spatial extension or location (e.g., "entering/exiting July"), and (v) a time vector extending uphillwards into the future. The non-linguistic task results showed that the "time moves uphillwards" metaphor, based on the absolute frame of reference prevalent in Tzeltal spatial language and thinking and important as well in the linguistic expressions for time, is not strongly reflected in responses on these tasks. It is argued that systematic and consistent use of spatial language in an absolute frame of reference does not necessarily transfer to consistent absolute time conceptualization in non-linguistic tasks; time appears to be more open to alternative construals.

Mired in confusion: making sense of the Deprivation of Liberty Safeguards.

INTRODUCTION: There is uncertainty about how to identify deprivation of liberty and the interface of the Mental Health Act and Mental Capacity Act Safeguards. OBJECTIVE To increase current understanding by exploring how an expert legal panel interpret existing case law relating to deprivation of liberty in the clinical setting. Design Clinical vignettes of real patients were used to explore lawyers' thinking about important factors that: (1) distinguish lawful restriction from deprivation of liberty and (2) govern the choice between safeguard regimes when there is deprivation of liberty. The relative importance of such factors was discussed in a consensus meeting using a modified nominal group approach. Participants and setting Six eminent barristers and solicitors with expertise in mental health law attended a consensus meeting after making individual judgements about vignettes describing the situations of 28 incapacitated patients who had been admitted informally to a range of psychiatric inpatient units in South East London. RESULTS: Lawyers attributed key importance to a patient's 'freedom to leave' and suggested that patients' subjective experiences should be considered when identifying deprivation of liberty. CONCLUSIONS Clarification of deprivation of liberty and its safeguards will develop with future case law. Based on current available case law, the lawyers' expert views represented a divergence from Code of Practice guidance. We suggest that clinicians give consideration to this.