The harm chain : a public policy development and stakeholder perspective

This paper introduces the concept of a ‘harm chain’ as a mechanism to further broaden the way in which firms and public policy makers consider potential negative outcomes from marketing activities. The purpose of conceptualizing a ‘harm chain’ is to examine specifically the creation of harm within networks of marketing exchanges that might occur throughout preproduction, production, consumption and post-consumption activities. The authors suggest that addressing issues where harm occurs allows both firms and policy makers to identify whether exchanges bring about harm, how relevant parties can address the core cause of harm, as well as how those who are harmed can be protected.

Professional attitudes towards deliberate self-harm in patients with borderline personality disorder

Objective: The aim of the present study was to assess the attitudes of mental health and emergency medicine clinicians towards patients diagnosed with borderline personality disorder. The clinician gender, primary occupation and service setting, level of university training and years of experience, frequency of clinical contact, and completion of specific training in borderline personality disorder were expected to influence the attitudes of health professionals towards working with borderline patients that engage in self-harm.

Method: A purpose-designed questionnaire and an assessment tool to quantify attitudinal levels were used to collect demographic information and assess the attitudes of 140 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service.

Results: Statistically and clinically significant differences were found between emergency medical staff and mental health clinicians in their attitudes towards working with borderline personality disorder. The strongest predictor of attitudes was whether the clinician worked in emergency medicine or mental health. This was followed by years of experience and specific training in personality disorders as significant predictors of attitudes to self-harm.

Conclusions: The implications of these findings for the professional training of clinicians in the management and treatment of borderline personality disorder patients are discussed.

Targeted clinical education for staff attitudes towards deliberate self-harm in borderline personality disorder : randomized controlled trial

Objective: The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made.

Method: A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance.

Results: Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=−3.45, p=0.002, d=0.43 and t(65)=−5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings.

Conclusions: Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.

Is groin injecting an ethical boundary for harm reduction?

Background
Femoral vein (or groin) injecting by street drug users is an emerging public health issue in the UK. It has been proposed that groin injecting is becoming normalised among UK injecting drug users (IDUs), yet harm reduction strategies are currently piecemeal and some may be crossing the boundary of responsible provision of information. This paper discusses the interventions available to service providers dealing with groin injecting and explores the utility of ethical frameworks for informing service provider decisions.

Methods
Methods analysis of possible service provider responses using White and Popovits’ ethical decision-making framework.

Results
The use of ethical frameworks suggest that different types of groin injectors should receive different interventions. Injectors for whom the groin is a site of ‘last resort’ should be given information about how to inject there less dangerously, whereas ‘convenience’ groin injectors should be actively encouraged to inject elsewhere.

Conclusion
Groin injecting is a behaviour which represents a boundary for some harm reduction practices (such as providing ‘how to’ booklets to all injectors) as well as being an argument for more complex and environmentally appropriate harm reduction responses such as drug consumption rooms and training IDUs to maintain healthier injecting sites.

The fine line between harm reduction and harm production - development of a clinical policy on femoral (groin) injecting

The femoral region ('groin') appears to be increasingly commonly used by injecting drug users in the UK. With the advent of Britain's first supervised prescribed injectable opioid treatment clinic, unprecedented decisions and judgements were required about the safe supervision of this practice, or whether to permit this behaviour on site at all. This paper reports the reasons for, and outcome of, development of a clinical policy on injecting into the deep femoral vein (groin injecting)

Prison officer's beliefs regarding self-harm in prisoners : an empirical investigation

The prevention of self-harm and suicide in prisoners depends on good interaction between the individual prisoner and prison staff. Staff perceptions of prisoner self-harm are likely to be a crucial factor influencing this interaction. The aim of the present study was to determine correctional officers' perception of the causes and functions of self-harm, and the effects of incident severity and repetitiveness on perceptions. A sample of 76 correctional officers was presented with a vignette depicting a self-harm in which the severity and repetitiveness of the incident was systematically altered. Officers' rated both the causes and functions of the behaviour. Four attributional dimensions were identified by factor analysis. These factors related primarily to personal factors about the individual prisoner. Staff perceived the functions of self-harm to be communicative rather than to commit suicide. Perceptions were not affected by severity or repetitiveness information, except for high severity leading to a greater perception of suicidal intent. Initiatives to help staff work more effectively and therapeutically with distressed prisoners are therefore likely to impact positively upon rates of self-harm.

Defendants' liability for pure mental harm to third parties in Australia : still a work in progress

In Australia, both common and statutory law allows compensation for negligently occasioned recognised psychiatric injury, but distinguishes between pure mental harm and consequential mental harm. This column briefly discusses the concept of pure "mental harm" and the major Australian cases relating to defendants' liability to third parties for causing them pure mental harm (Jaensch v Coffey (1984) 155 CLR 549 [PDF]; Tame v New South Wales; Annetts v Australian Stations Pty Ltd (2002) 211 CLR 317 [PDF]; Sullivan v Moody (2001) 207 CLR 562 [PDF]; and Gifford v Strang Patrick Stevedoring Pty Ltd (2003) 214 CLR 269 [PDF]). The analysis focuses on judicial approaches to determining liability in these cases, especially causation. Lack of guiding principles and precise tests for attribution of liability are illustrated by Kemp v Lyell McEwin Health Service (2006) 96 SASR 192 [PDF]. This case is analysed first in the context of common law, and then in the light of the reform legislation contained in the Civil Liability Act 1936 (SA) and similar provisions in other jurisdictions.

Moving beyond resistance to restraint minimization : a case study of change management in aged care

Aim: This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility.

Approach: The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted.

Implications: Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

Protecting legal rights when things go wrong : legal recourse if mandatory fortification of a food were to harm human health

Food laws can encompass considerations that extend beyond food safety. The recent food standard mandating the fortification of flour with folic acid in Australia illustrates the legal problems and legal risks when governments introduce food standards that aim to medicinalise the population through the food supply despite a lack of scientific consensus. Legal analysis of the process by which the folic acid fortification was introduced into flour in Australia demonstrates legal inadequacies, administrative and policy failures, as well as flaws in safety assumptions. An analysis of the restrictions on legal rights and remedies for any adversely affected consumers seeking legal redress, and the existence of statutory immunities for governments, demonstrates a need for legal reform and changes in policy development processes.

Risk and harm reduction among recreational ecstasy users

Ecstasy users' perceptions of risk, harm reduction and decision making practices were examined in 153 adults. Identified were a range of positive and negative effects attributed to using ecstasy. There was only a weak association between risk perception, other risk taking behaviours and high ecstasy use. However, the role of the peer group was found to be an important factor in the reducation of harm, and in particular, the decision making process.