Putting affected people at the centre of humanitarian action: an argument for the principle of humanitarian subsidiarity.

The humanitarian system has grown organically over the course of a generation to become a complex system bound by a common primary mandate. Its guiding principles provide it with a unique identity and separate humanitarian actors from other aid-related stakeholders. However, all of the evidence suggests that humanitarian actors will extend their reach and engage in new and unprecedented ways with an expanded mandate in years to come. Now, more than ever, they are challenged to retain the moral high ground and to put disaster-affected people at the centre of humanitarian action. Consequently, this paper proposes that the humanitarian system introduce a new principle: humanitarian subsidiarity. It moves the conception of subsidiarity beyond meanings ascribed by the Catholic Church and the European Union and links it instead to the attributes of agency, accountability, and trust to find accommodation with the core humanitarian principles of humanity, impartiality, neutrality, and independence.

Human rights and proactive displacement: determining the appropriate balance between the duty to protect and the right to remain.

The proactive displacement by public authorities of populations from areas perceived to be exposed to a high risk of disaster presents complex human rights challenges. Provided that no ulterior motive is at play, the use of compulsory evacuations and relocations as policy responses to such risk is mandated by the duty to protect the right to life. However, proactive displacement in the interest of saving lives can be problematic as such measures can lead to the limitation of other human rights, resulting in an intricate assessment of whether compulsory evacuation or permanent relocation is proportional in any given circumstance. Such an analysis demands critical attention by public authorities to the perception of the disaster risk in question and problematises claims to objectivity of official risk assessments. Furthermore, it poses the question as to whether measures designed to address the disaster risk in question that are less intrusive than relocation may be available to public authorities.

Service user experience of adapted dialectical behaviour therapy in a community adult mental health setting.

BACKGROUND: Dialectical behaviour therapy (DBT), a skill-based cognitive behavioural treatment, is increasingly used in the treatment of borderline personality disorder (BPD). AIMS: The study examined service users' perspective on the effectiveness of an adapted DBT programme, delivered within a community adult mental health setting. METHODS: Semi-structured interviews and focus groups were conducted with eight participants with a diagnosis of BPD about their experience of the programme. RESULTS: Thematic analysis focused on two key themes: evaluation of therapy and treatment impact. Therapy-specific factors and personal challenges emerged as important themes. Treatment impact raised issues relating to a renewed sense of identity and changes in daily life. CONCLUSIONS: The study describes the positive and negative experiences of service users with BPD attending an adapted DBT programme.

Naturalistic study of crisis referrals to an Irish community adult mental health service.

There is no agreed definition of a mental health crisis; however, a useful one is 'a situation where mental health has deteriorated to an extent that the user is likely to be at risk of harm to self or others and is in need of urgent intensive specialist support and treatment' (Minghella et al, 1998). Community-based care is the primary model of specialist mental healthcare in Ireland (Government of Ireland, 2006a). When clinically indicated, a patient with mental health crisis is referred to the community mental health team (CMHT) for an urgent assessment.

Patterns of denial in sex offenders: a replication study.

To assess whether a robust typology of sex offenders could be established based on the patterns of denial displayed, a previously developed semistructured interview method was used to assess denial in a mixed group of convicted rapists and child molesters. Cluster analysis was used to establish homogeneous groups of sex offenders based on the pattern of denial in each case, with a three-cluster solution emerging as the most appropriate, confirming previous research. The denial groups were compared in relation to objective offense characteristics to assess whether a consistent typology of offenders emerged. Each of the four groups of offenders identified (three groups emerging from the cluster analysis and an "absolute denier" group) corresponded closely with the previously identified typology. However, the authors failed to replicate previously identified differences between the denial groups in relation to independent variables such as offense type. Each group contained both rapists and child molesters and was found to differ quantitatively rather than qualitatively in the pattern of the denial expressed, with attributional style being the most consistent form of denial present in all groups. The authors conclude that denial consists of at least two continuous dimensions, rather than being a dichotomous phenomenon. Differences in the patterns of denial displayed by rapists and child molesters were found to be primarily quantitative rather than qualitative.

Infanticide and child murder - admissions to the Central Mental Hospital 1850-2000.

Infanticide and child murders have been known to all civilisations throughout time. This study looks at the problem from an Irish perspective, particularly with regard to the forensic psychiatry service. The case notes and legal files of 64 women admitted to the Central Mental Hospital (CMH), Dublin, between May 1850 and 2000 were examined. This group represents a complete sample of female inpatients charged with these offenses over the 150 year history of the institution. Sociodemographic and clinical data were analysed to provide psychiatric and social backgrounds to the cases. There has been a considerable decrease in the number of women admitted to the CMH on charges or conviction for infanticide and child murder in recent years. It appears that the attitude of the judiciary to these women has altered. The cases are discussed in the context of the prevailing attitudes of the era.