Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Thousands of restraint victims could seek compensation

Camilla Pemberton
Friday 13 January 2012 10:59
Royal Court Justice

Children who were unlawfully restrained in privately-run child prisons over a 10-year period could pursue compensation claims, according to a high court judge.

The number of potential claimants could reach thousands, experts have warned.

Passing judgement this week on a judicial review case brought by the Children’s Rights Alliance for England (CRAE), Mr Justice Foskett said the government was under no legal obligation to identify potential victims and notify them of their right to seek compensation – as CRAE had argued.

However, he pointed out that victims could come forward themselves.

“It probably requires just one former detainee, looking back at his or her experience in a [secure training centre] and having conducted the necessary preliminary inquiries, to pursue a well-publicised claim and others will be alerted to the potential of pursuing matters,” he said.

The judge said it was highly likely that large numbers of children were unlawfully restrained in privately-run secure training centres (STCs) for at least a decade between 1998 and 2008.

“I do not think that there is any true or realistic alternative to the conclusion that probably up until July 2008 (and possibly, though unlikely, for another two years thereafter) there was widespread unlawful use of restraint within the STC system and many children and young persons were subjected to such restraint,” he wrote in the judgement.

Restraint techniques involved included the controversial, and subsequently banned, nose distraction technique used on 14-year-old Adam Rickwood hours before his suicide in 2004.

Rickwood’s death at Hassockfield STC and the 2004 death, following restraint, of Gareth Myatt, 15, at Rainsbrook STC led to the discovery of information about unlawful restraint.

The judge said statutory agencies had failed to take appropriate action to stop the unlawful treatment, also criticising the Youth Justice Board (YJB) for its “apparent active promotion” of the methods, due to “confused thinking” until 2007.

He said the “fullest explanation” had not yet emerged as to why widespread unlawful restraint went unchecked for so long, and why there were apparently so few complaints from victims.

Mark Scott, a solicitor for CRAE, said he hoped the judgment would encourage children who were subject to unlawful restraints by STC staff to “come forward and seek redress”.

Carolyne Willow, CRAE’s national co-ordinator, said there could be “potentially thousands of former detainees of STCs being entitled to claim compensation for unlawful restraint. The violations went unchecked for at least a decade so the scale of claims could be enormous.”

But she warned victims would need to know they may have a claim. “Without action by the government we firmly believe former detainees will remain ignorant of their entitlement to seek justice. Unlawful restraint was so endemic that children detained at the time would have seen it as normal and legitimate. The professionals around them certainly did,” she said.

Filed under: Violence, , , , , ,

Fat-faced Men and Aggression

I am often amazed by the things that researchers get up to. The research below is, to me at least, both bizarre and intriguing.

What lies beneath the face of aggression?
Soc Cogn Affect Neurosci first published online December 23, 2011
Carré JM, Murphy KR, Hariri AR
Recent evidence indicates that a sexually dimorphic feature of humans, the facial width-to-height ratio (FWHR), is positively correlated with reactive aggression, particularly in men. Also, predictions about the aggressive tendencies of others faithfully map onto FWHR in the absence of explicit awareness of this metric. Here, we provide the first evidence that amygdala reactivity to social signals of interpersonal challenge may underlie the link between aggression and the FWHR. Specifically, amygdala reactivity to angry faces was positively correlated with aggression, but only among men with relatively large FWHRs. The patterns of association were specific to angry facial expressions and unique to men. These links may reflect the common influence of pubertal testosterone on craniofacial growth and development of neural circuitry underlying aggression. Amygdala reactivity may also represent a plausible pathway through which FWHR may have evolved to represent an honest indicator of conspecific threat, namely by reflecting the responsiveness of neural circuitry mediating aggressive behavior.
Affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA, 48202.

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How effective are Anti-depressants?

One of the problems in assessing the efficacy of drugs is that the assumption that patients don’t know in a double-blind study if they are taking the active medicine or a placebo. However, all medicines have side-effects and placebos have none, so in fact most trialists know if they are taking sugar pills because they don’t notice any physical changes. Consequently when trials show, for example, fluoxetine to be better than placebos, they may show nothing of the kind.

In this light, the study below is even more surprising in that it suggests that anti-depressants, placebo and a talk therapy are all equally (in)effective! It would be even more alarming if they had chosen fluoxetine as the antidepressant (although recent studies have suggested that even this is only more effective than placebos for the most severe forms of depression) and CBT in place of supportive-expressive therapy.

Antidepressant, Talk Therapy Fail to Beat Placebo

By Amy Norton

NEW YORK (Reuters Health) Dec 22 – Neither antidepressants nor “talk therapy” were able to outperform placebo pills in a new clinical trial on depression treatment — although there were hints that the effects varied by gender and race, researchers report.

The findings, published November 29 in the Journal of Clinical Psychiatry, add to evidence that people receiving “real” depression treatment in studies — from antidepressants to St. John’s wort — often do no better than people given a placebo.

A recent review found that a minority of antidepressant users even fared worse than placebo users.

In this latest study, researchers randomly assigned 156 patients with major depression to either take sertraline daily for 16 weeks; take a placebo for the same period, or undergo supportive-expressive therapy twice a week for four weeks and then weekly for 12 weeks.

The three groups did similarly overall.

In the antidepressant group, 31% responded (as judged by improvements on the Hamilton Rating Scale for Depression). The same was true of about 28% of patients in the talk-therapy group, and 24% in the placebo group.

“I was surprised by the results. They weren’t what I’d expected,” said lead researcher Dr. Jacques P. Barber, dean of the Institute of Advanced Psychological Studies at Adelphi University in Garden City, New York.

Still, he stressed in an interview, the lack of benefit over placebo does not mean that depression therapies are pointless.

For one, Dr. Barber said, receiving a placebo in a clinical trial “is not the same as getting no treatment.”

Study participants in placebo groups have contact with health professionals who are asking about their symptoms and well-being, he said. And for some people, that attention can make a difference — and may help explain the placebo response seen in studies.

In addition, at least some people in placebo groups believe they are getting the real treatment – and people’s beliefs about their therapy can play a key role in whether they get better.

But apart from that, different people may respond differently to a given type of depression therapy. Dr. Barber’s team found some evidence of that.

The study had an unusually large minority population for a clinical trial on depression: Forty-five percent of the patients were African American.

The researchers found that African-American men tended to improve more quickly with talk therapy than with medication or placebo. In contrast, white men fared best on placebo, while black women showed no differences in their responses to the three treatments.

Only white women, Dr. Barber said, showed the expected pattern: a quicker response to both medication and talk therapy than to the placebo.

But all of that is based on fairly small numbers of people, and more research is needed to see if the gender and racial differences are real, according to Dr. Barber.

A psychiatrist not involved in the study agreed. “Those findings are interesting, but need to be interpreted with a grain of salt,” said Dr. David Mischoulon from Harvard Medical School.

As for the overall lack of benefit from the real treatments over placebo — in this and other studies – Dr. Mischoulon cautioned against reading that as “nothing works for depression.”

“I think it’s the opposite,” he told Reuters Health, “It’s more that, everything seems to work to some degree.”

Like Dr. Barber, Dr. Mischoulon said that the placebo condition in clinical trials is not really “no treatment.”

Instead, he said, “I try to offer as broad a menu of options as possible, because all may potentially help.” Dr. Mischoulon has also studied alternative depression remedies, like fish oil and acupuncture.

Another caveat from the current study, he noted, is that it looked only at two types of medication. (Some patients were switched to venlafaxine if they did not respond to sertraline after eight weeks). And it tested just one type of talk therapy.

Supportive-expressive therapy is a short-term form of psychoanalysis that aims to help people understand how their personal relationships are related to their symptoms.

It’s different from cognitive behavioral therapy, the best-studied form of talk therapy for depression. Both Dr. Barber and Dr. Mischoulon said it’s not clear if the current findings would extend to psychotherapies other than supportive-expressive therapy.

“This is one type of psychotherapy, and it’s two antidepressants,” Dr. Mischoulon said. “It would be wrong to conclude that psychotherapy doesn’t work, and antidepressants don’t work.”

The study was funded by the National Institutes of Health. Some of Dr. Barber’s co-researchers have received funding from the pharmaceutical industry.

Filed under: Other Mental Health, ,

Are the Clinically Depressed Just More Realistic?

It is often reported that we all tend to delude ourselves and actively distort our assessments of the probability of events occurring about us, but only one group of people are able to predict the likelihood of those events occurring better than the rest of us, the clinically depressed! A recent study seems to bear this out (J Behav Ther Exp Psychiatry. 2011 Oct 5; vol. 43(2) pp. 699-704 Confidence judgment in depression and dysphoria: The depressive realism vs. negativity hypotheses. Zu-Ting Fu T, Koutstaal W, Poon L, Cleare AJ). See the abstract below (I have edited out the methodology as if you are interested in that you would need to examine the original and full text.

BACKGROUND AND OBJECTIVES: According to the negativity hypothesis, depressed individuals are over-pessimistic due to negative self-concepts. In contrast, depressive realism suggests that depressed persons are realistic compared to their nondepressed controls. However, evidence supporting depressive realism predominantly comes from judgment comparisons between controls and nonclinical dysphoric samples when the controls showed overconfident bias. This study aimed to test the validity of the two accounts in clinical depression and dysphoria. CONCLUSION: The present study confirms depressive realism in dysphoric individuals. However, toward a more severe depressive emotional state, the findings did not support depressive realism but are in line with the prediction of the negativity hypothesis. It is not possible to determine the validity of the two hypotheses when the controls are overconfident. Dissociation between item-by-item and retrospective confidence judgments is discussed.
Copyright © 2011 Elsevier Ltd. All rights reserved.
Affiliation: Institute of Biomedical Sciences, Academia Sinica, 6F, No. 16, Alley 10, Lane 437, Pa-The Rd Sec 2, Taipei 10552, Taiwan.

Filed under: Other Mental Health, ,