Effects of National Culture on Accounting Rule Application Essay

Effects of National Culture on Accounting Rule Application - Essay Example The study will randomly select Certified Public Accountants from eight states to measure contingent liabilities and contingent assets recognition and disclosure decisions. The study will use an analysis of variance to compare the group average to determine if there are any statistically significant differences between the variables. The proposed study has both a theoretical and practical implication. The study will attempt to validate Tsakumis’ survey that applied Gray’s accounting theory with respect to conservatism and secrecy. From a practical application, the study may identify variables that influence an accountant’s disclosure decisions that could lead to improving information reporting between manager and other stakeholders. The cross-border dynamics of the global economy has consistently required businesses to conduct trade across international lines in order to remain or become competitive. In each host country, the authorities require multinational firm s to submit financial statements that adhere to the host nation’s Generally Accepted Accounting Principles (GAAP). However, cultural differences have resulted in accountants exercising a degree of caution relative to adopting new accounting GAAP. The International Accounting Standards Board (IASB) has developed International Accounting Standards (IAS) and, in particular, International Financial Reporting Standards (IFRS). These standards are intended to produce uniformity in financial information reports for all multinational firms globally. In the U.S., the Security and Exchange Commission (SEC) has mandated that all publicly traded firms in the U. S. adopt the IAS by 2016.

To what extent can global geopolitics in the period since 1989 be Essay

To what extent can global geopolitics in the period since 1989 be described as a 'clash of civilisations' - Essay Example Between the 1940s and 1989, global citizens were held hostage to recurring conflict between the world’s two largest superpowers which never reached a full militaristic situation as a result of both superpower’s capability to impose mass destruction against the other (Gaddis 56). However, since 1989, many states have developed more technological capacity and economic strength, making powers other than the Western Bloc and the Eastern Bloc more influential in geopolitics. Since 1989, more geopolitical power spread throughout emerging militaristic and economically-sound states has changed the dynamics of political relationships throughout the world. This essay explores the Gulf War, theory regarding global capitalism and U.S. unipolarity to describe how geopolitics, today, has led to a clash of civilisations. Between 1980 and 1988, Iraq had been engaged in a lengthy war against Iran, sparked by unsettled border disputes between the two nations. Iraq, a once-wealthy and prosperous nation, was witnessing its economic strength diminishing as a result of continuously funding a costly military effort against its rival. During this war, Saudi Arabia, one of the world’s largest oil producers, began to fear that if Iran won this conflict, it would create an Iran hegemony that would ultimately threaten national security of Saudi Arabia and its oil-related revenues. Saudi Arabia had loans $26 billion USD to Iraq as a dual effort to ensure that the Shia in Iran would not gain substantial political power. Kuwait, another oil rich nation, had also loaned Iraq $14 billion USD to assist Iraq in its military objectives against Iran. By 1990, Kuwait refused to simply forgive this $14 billion dollar loan even though Iraq was convinced that the eight year-long war had achieved an oppression of Iran’s growing strength (Watson, George, Tsouras and Cyr 61). The Saudis, additionally, placed considerable pressure on Iraq to begin loan

Study Guide Hitler Essay Example for Free

Study Guide Hitler Essay -Half Austrian and half German. Serves with distinction, wounded returns to Bavaria after war (served in a Bavarian regiment). -German nationalist+supporter of authoritarianism+ opposed to democracy and socialism + racially motivated (anti-Semitism v German Volk) -Pseudo spy for Bavarian govt and runs into the DAP (German Workers Party). Likes their anti-capitalist, anti-Semitic and nationalist message. Anton Drexler is founder/head; Hitler has energy, oratory and propaganda skills. -1920 – 25 Points authored by Hitler/Drexler. DAPNSDAP. Hirtler in charge of propaganda: salute, uniforms,swastika. Also creates armed squads. -Drexler alarmed – power play but loses as Hitler offers to resign and instead becomes chairman and Fuehrer. -1921-23 party reorganization. A) Armed squads reorganized into SA headed by Ernst Roehm: intimidation and violence. B) 1921 Newspaper – People’s Observer  C) Julius Streicher gives Hitler support (rival right wing group in Bavaria) D) Hermann Goering joins party in 1922. Aristocracy/high society makes party â€Å"more respectable† 1923 – 20,000 members – powerful mainly in one part of Bavaria. 1923 – Beer Hall Putsch: successful example of Mussolini and weaknesses of Weimar: a) hostility of elites (top army brass, aristocracy, industry); b) limited popular support, and economic problems. c) Nostalgia for Kaiser and Imperial Germany, not used to democracy d) Economic problems: costs of WWI and debts, reparations, new welfare benefits provided by State (health insurance, housing), hyperinflation because of Ruhr crisis. e) Association with defeat in war – Treaty of Versailles, November criminals and stab in the back myth. Hitler plots â€Å"March on Berlin† with Gustav von Kahr (ultra-conservative leader of Bavarian govt) and General von Lossow (local head of army). However, poor planning, not enough public support, too much reliance on General Ludendorff, Kahr and Lossow back out at last minute. Nov 8, Hitler announces a â€Å"national revolution† and next day marches into Muncih with 2000 SA. Easily crushed by police and 14 Nazis killed, Hitler arrested for treason. Consequences: Nazi party banned. Hitler gets onto national stage and attracts attention of other right wingers; B) Muellers Grand Coalition (SDP, Center and Stresemann’s party). C) United Opposition: formed by media magnate Hugenberg – has DNVP, Pan-german league, Nazis, leading industrialists. Draft a â€Å"Law against the Enslavement of German People†. Referendum in 1929, but lose. D) Oct. 1929 Wall Street Crash and Great Depression – 32% unemployment (6 million) – industrial workers lose jobs for extended time, middle class and small businesses affected. 42% fall in GNP. World trade collapses (protectionism and tariffs). Peasants hit by collapse of agr prices; industrial workers are unemployed. 50,000 businesses collapse and banks fail. Loss of confidence and despair. Nazi  organization: use of modern propaganda techniques (Goebbels); exploitation of scapegoats; strong party structure and organization After 1930 –Presidential Government – and rule by Emergency Decree (art 48): every govt rules by emergency decree. Bruning (1930-32) Center Party; von Papen (May-Dec 1932) also Center but more right wing; General Kurt von Schleicher (Dec 1932-Jan 1933) no party affil. E) Muellers coalition collapses March 1930. Meissner, Gen. von Schleicher and Hindenburg are all conservative nationalists and get Bruning in. When Reichstag rejects his austerity budget, he invokes Art. 48. Calls for elections F) Reichstag elections 1930 on yield no mandates: 1930 Election – Nazis get 18.3% (2nd after Socialists)†¦800,000 to 6.4 m votes. Nationalists lose half votes to Nazis, middle class democratic parties lose the most and extremes gain, socialists lose ground to KPD. G) Bruning continues as Chancellor – Presidential Govt. May 1932 dismissed. A monarchist, against democracy, anti- Socialist. Failed economic policy of balancing the budget, over-relied on Hindenburg and Art 48. Successes include Allies evacuate Rhineland; Hoover memo suspends debts and reparations; abolished by Lausanne Conference. H) 1932 Reichstag election – brutal street violence; Bavarian left-center govt removed by Papen. Nazis win 37.3% and are largest party; center parties collapse and only KPD gains (14.3%). Dec 1932, von Papen humiliated after no-confidence vote; fails to dissolve Reichstag. Schleicher now has doubts. Hitler, Hindenburg and Papen try to resolve impasse – Hitler wants Chancellorship and rebuffed. Nov 1932 new elections called and Nazis only get 33.1%. Schleicher insists von Papen be replaced; 2 month rule by Gen. von Schleicher. Wants to have left/trade unions join and to split Strassers from Hitler. Fails because trade unions doubt him, landowners and businessmen have no trust. Hindenburg agrees to a Nazi-Nationalist coalition = Hitler appointed Chancellor. Papen, Hindenburg’s son oskar, landowners, industrialists and army support him. Why did Nazis succeed? 13 m voters; appeal to middle class and Protestants; high in north and east; peasants and farmers, Mittelstand (shopkeepers) and white collar workers; appeal to youth, â€Å"politics of anxiety†, becomes genuine people’s party by 1932 Political methods: propaganda, canvassing (posters and leaflets), technology, mass suggestion, scapegoats and unifying theme, violence. The Legal Revolution: 2/12 Nazis in Cabinet; no majority in Reichstag although  the NSDAP is largest party; President can dismiss Chancellors at will. Plus side: has largest party; conservatives must choose between him and possibly Communists or civil war; he can use resources of the state. Calls for new Reichstag elections for March 1933 within 24 hours. Violence, intimidation, 69 people die Hitler’s â€Å"A ppeal to the German people† blames everything on communists and democrats, idea of a â€Å"national uprising† Promised 3 million reichsmarks from key industrialists. Feb 27 – Reichstag Fire – a communist accused therefore play up fears of a communist led coup. Next day, Hindenburg signs â€Å"Decree for the Protection of the People and the State† – most civil and political liberties suspended (hundreds are arrested). Election results 5 March: Nazis win 44% but needs 52 seats won by nationalists. Changes in laws need 2/3 majority to pass. March 1933 – the Enabling Act – to give him and cabinet full powers for 4 years – a â€Å"legal dictatorship†. At vote, communists denied entry – Hitler promises to respect rights of catholics and gets ZP support; only SPD vote against and bill passes. Policy of Gleichschaltung: Nazification, a merging with German society during 1933-34. Revolution from below (the SA) and Revolution from above (leadership). Main focus on Federal States, political parties and indpt trade unions. A.Federal States: violence and intimidation threaten to spin things out of control. 31 March 1933 law to dissolve regional parliaments, reformed with acceptable majorities and to be controlled by Nazis. 7 April – Governors posts created usually run by Gauleiters (regional party leaders). Jan 1934, regional parliaments are abolished. No more federalism. B.Trade unions: connects to socialism and Catholicism. May Day declared national holiday, SA/SS occupy offices, seize funds and leaders are sent off to camps. DAF (German Labor Front) set up and run by Robert Ley with 22 m. members. C.Political parties : need for a one-party state. Communists outlawed after Fire; Social Dems assets seized in June and they are banned; in late June most parties agree to self dissolve; July Catholic Center Party disbands. Chancellor to Fuehrer: 6 months in – Hitler is stronger position. Calls for end of revolution 6 July 1933. Needs to stop free-for-all and violence. SA and Roehm call for a â€Å"Second Revolution† – SA more made up of unemployed youth.Had made the street revolution earlier but hadn’t benefitted. Roehm calls for National Socialist Revolution – SA has 3 m men in 1934, much larger than army. But army could do a coup, and has the  military expertise to fulfiull foreign policy of Hitler. June 29-30, 1934 – Night of the Long Knives Hitler before comes to agreement with Generals Fritsch and Blomberg. 200 murdered by SS, old scores settled (Schleicher and Strasser) Results: SA leaderless and powerless now. Army behind Hitler. Emergence of the SS. Hitler has firmed up own position August 2 – Hindenburg dies: Hitler merges two offices and takes title of Fuehrer. RULE OF HITLER Great Depression: Conditions in 1933 1)Collapse of trade and especially exports 2) Although an industrial powerhouse, many firms go bust in GD 3)Mass long-term unemployment. 4)In agriculture, food prices fall and farmers get poorer 5)In finance, collapse of banking sector Economic Policies Given the huge problems – 3 choices A.Anti-capitalist, socialist program embodied in 25 Points (profit-sharing, social security, nationalization) B.Deficit financing (Keynesian economics) C.Defense economy Concept of Autarky = self-sufficiency Focus on: Public works projects, Jobs for unemployed. 1) Schacht and the New Plan President of Reichsbank and later Minister of Economy held a leading role in 1923 crisis and creation of new currency under Stresemann. Note: the economic low was reached in end 1932, early 1933 (but no one knew) Solutions: A.Banking- government moves to control capital and to set low rates B.Financial benefits given to groups such as farmers and small businesses also tariffs, subsidies, reduced debts, tax concessions, allowances, and grants C.Public works: reforestation, land reclamation, new roads, housing By 1936, emphasis shifts to rearmament D.Bilateral trade agreements with focus on barter E.New Reichsmark policy as only currency to be used F.Mefo Bills – like t-bills 2 Problems remain: Fear of inflation, Balance of trade deficit. 2) The 4 Year Plan (1936) â€Å"Guns or Butter?† Deficit financing has been hidden by financial tricks Schacht proposes reduction in arms spending Hitler sides with the army: Military+Economymust be ready in 4 years. Goering made Czar of the 4 year plan Goals: Autarky and rearmament, Nazi control of economy becomes much tighter. 3) War Time Economy Goering replaced by Speer in 1942 Germany is on a total war footing Social Policies Ideology: 4 main tenets A) Race : Aryanism, racial purity, Social Darwinism, anti-Semitism, euthanisa, eugenics B) Authoritarianism – the Fuehrer principle C) All Germans together : Lebensraum D) Volksgemeinschaft One Volk, harmony, no social class divisions or distinctions Social Groups Industrial workers (very left): Trade unions closed down DAF established: Beauty of Labor (beautify working conditions) Strength through Joy (vacations, sports, excursions, etc) But – shortage of workers and real wages stay low as war starts, more women work and Labor camps set up. Peasants and small farmers: Nazi sympathy for their plight. They are the Volk. Initiatives include: write-offs, cheap loans, land. But – after initial benefits, resentment and lower standard of living Landowners: initially suspicious of low-born Hitler and his socialists; then buy in and support Middle class: low rate loans and encouragement for their businesses Upper Class and Big Business: prefer Hitler and Fascists to communism Education and Youth Centralized: Indoctrinate, brainwash: no more individual choice One curriculum and one textbook Teachers trained the right way: Nazi Teachers League Understand what it means to be German Pride and nationalism Obedience and loyalty Emphasis on physical fitness and education Hitler Youth compulsory in 1939 League of German Maidens: Teamwork and group work is a big feature But – teacher shortages, anti-academic curriculum focus Religion: Most Germans are Christian: 2/3 Protestant. Church is a powerful institution. A) Conciliation; policy of coordination Concordat July 1933: Features non-interference. B) Aggressivenes 1935-45: Nazis become more anti-Christian. German Faith Movement: Never gathers strength.Teutonic paganism – a made-up religion. Anti-religious measures: Close churches, arrests, taking away funds, closing youth groups. → Pope speaks out against Nazis in 1937 Women and Family Population growth falling, female employment expands, too many unmarried women. Nazis oppose emancipation and feminism. Goals: Kinder, Kuche, Kirche More children Care for husbands and kids Stop employment of women Between 1933-36, married women debarred from work. Loans to young women to stop working and many need to get married. Some Nazi women’s organizations are used as covers. Economic necessity in 1937: Despite discrimination – need for more cheap labor Marriage loans, family allowances, taxes reduced, maternity benefits, anti-abortion laws, contraception restricted. Lebensborn Racial purity, SS brothels. Result: Births increase, divorces increase, marriages flat Culture Reich Chamber of Culture headed by Goebbels who is also Minister of Propaganda Burning of the books Modern music, jazz, etc are degenerate 2500 writers leave Germany Modern schools of art held in contempt Degenerate Art v Great German Art Outsiders a)Ideological opponents (Communists, religious, military leaders) b)Biologically inferior (sub-humans) sterilization – 350,000 euthanasia – 70,000 c) Asocials (Homosexuals) Political Gleichschaltung – Policy of Coordination All political parties banned July 1933 State parliaments abolished 1934 Civil Service purged Gestapo established SS headed by Himmler established 1925 – elite bodyguards first , then run all police actions (incl. camps) First camps established in 1933 for regime’s opponents: Labor Concentration Death camps after 1939 Emigration for Jews and others encouraged/preferred up to 1939 Steps against the Jews: Nuremberg Laws, Kristallnacht (Night of Broken Glass), Poland, Final Solution decided on at Wannsee Conference.

Psychosocial Interventions for Psychosis Evaluation

Psychosocial Interventions for Psychosis Evaluation Introduction This report aims to critically appraise psychosocial interventions (PSI) that are utilised when working with complex cases. In order to do this the term complex is explored with reference to people with psychosis. Different types of complexity are discussed with a more detailed examination of a specific complexity; the relationship between substance misuse and psychosis (dual diagnosis). The effects that substance misuse and psychosis have upon the service user and their care givers are outlined. An overview of the use of psychosocial interventions when working with complex cases is given. This discussion is then focused on particular interventions for dual diagnosis that show promise for enhancing service user and carer experience, namely a integrated treatment approach of cognitive-behavioural therapy, motivational interviewing and family therapy. These interventions are critically appraised with reference to evidence base, policy and guidelines. Examples from clinical practice are given to illustrate potential barriers, and outcomes when implementing such interventions with service users with complex needs and their caregivers. Strategies to overcome such barriers are generated and recommendations are made. Aliases are used within the scenarios of this report in order to maintain anonymity of the service users and carers described to illustrate points and examples. Complexity The term complex case is referred to frequently within mental health literature, policies and guidelines but there are very few definitive explanations of what the term actually means. Griffiths Allan (2007) discuss how the term complex case is ill defined within mental health literature summarising how the term is often used to denote circumstances where people appear to have many interrelated needs that require several, coordinated responses from multiple services. The term complex case is often used to denote needs that services do not fully understand or provide for effectively. This report aims to explore the term complexity in relation to individual cases of those with serious mental illness. Complex: ‘Made of many different things or parts that are connected; difficult to understand (Soanes Stevenson 2005) Interpreting the above definition of complex within the Oxford Dictionary of English one could describe a complex case as a service user with more than one problem or need that are connected making the case more difficult to work with. For example having a diagnosis of schizophrenia and being detained within a medium secure unit. A person fitting this example would potentially present the mental health professional with more challenges than a person with moderate depression living with their supportive family. Wilson, Holt and Greenhalgh (2001) discuss the term complexity in relation to human health and illness. They suggest there are a number of factors (outlined in Table 1) that we all posses that makes us all complex. They go on to suggest that human illness and behaviour are not predicable and neither can be thought of as a simple cause and effect system. Again, adding to the complexity of individuals that because one individual responds one way to an event does not mean all will. Although this list of human complexities was written with medical practice in mind it applies to all and provides the baseline of those service users we work with in mental health services. Table 1 (Wilson, Holt, Greenhalgh 2001 p685) Factors that add the human complexity The human body is made up of multiple interacting and self regulating physiological systems including biochemical and neuroendocrine feedback loops. An individuals behaviour is determined partly by an internal set of rules based on past experiences and partly by unique and adaptive reaction to external stimuli. The web of relationships in which individuals exist contained varied and powerful determinants of their beliefs expectations and behaviour. Individuals and their immediate social relationships are embedded within wider social political and cultural systems which can influence outcomes in entirely novel and unpredictable ways. All of these interacting systems are dynamic and fluid. A small change in one part of the web of interacting systems may lead to a much larger changes in another part through amplification of effects. If we bear this in mind, that all humans are complex, then maybe the term complexity needs to be described as a continuum (Figure 1). That the more problems a person has or the more difficulties they face the further they move up a complexity continuum. People with a diagnosis of serious mental illness (as with all people) can face a large number of problems and difficulties through the course of their lives for example, positive symptoms, negative symptoms, anxiety, depression, mania. When adding this to the complexity of an individual this produces more challenges for the health care professional, the individual and their carers/families. However, these experiences also produce problems and difficulties for the service user making their case even more complex. For example the impact of experiencing voices does not end here but effects other areas of a persons life (see Table 2). Table 2. Laura Case study Laura first started to hear voices at the age of 9 and at first these did not bother her. As she got a bit older and discovered that this wasnt ‘normal her voices started to become critical of and derogatory towards her. To cope with this Laura started to experiment with Illicit drugs and alcohol as this blocked out the voices for a short time. However, this also made Laura lose her inhibitions and she would participate in sexual acts with men in her local area. This fuelled the voices and they became much more negative. So to cope Laura would take more drugs. Eventually Laura would run out of money and so would shoplift and resorted to prostitution. Her life became very chaotic and at 16 her mother kicked her out. Laura was now sleeping in neighbours gardens, sheds, anywhere she could. Laura lost touch with all her family and friends, her physical health suffered and she ended up very underweight and her voices became worse. Eventually Laura was found by the police sleeping se mi-clothed in a car park under the influence of drugs and alcohol. It was at this point she was admitted to an acute mental health unit. From the case of Laura it can be seen how not even having a diagnosis of schizophrenia, but experiencing positive symptoms can result in stigma, social exclusion and have a huge impact on a persons life. Lauras case was exacerbated by the use of illicit substances and alcohol demonstrating how substance misuse can add greatly to the complexity of an individual. Within the literature it can be seen that there are many factors that add to the complexity of a person with mental health needs including: medication resistant symptoms (Tarrier et al 1993), receiving care within secure forensic units (DOH 2005), psychological reactance (Moore, Sellwood, Stirling 2000), poor social functioning (Cather 2005, Couture et al 2006), , learning disabilities (DOH 2001a), insight (David 1990 and Buckley et al 2001), physical health (Marder et al 2003) homelessness (Randall et al 2006), and dual diagnosis (DOH 2002). These complexities have been recognised by the government and national drivers have been produced to guide mental health professionals and services to enable delivery and provision of the best services. For example ‘The National Service Framework for Mental Health (1999a) outlines a number of interventions for several complex groups including some of those mentioned above. Rankin Regan (2004) discuss how the term complexity means that there is no generic complex needs case. This therefore suggests each individual has a unique interaction between their own health and social care needs, therefore, requiring personalised responses from mental health services. Adopting an approach that incorporates psychosocial interventions could help to achieve a personalised response and provide individualised, tailored care for the service user and their care givers. Psychosocial Interventions The use of psychosocial interventions (PSI) is advocated in national drivers such as ‘Schizophrenia: Core intervention is the treatment and management of schizophrenia in adults in primary and secondary care (NICE 2009). This guidance recommends that all service users and their families are offered psychosocial interventions as a treatment of schizophrenia. Also, documents such as ‘From values to action: The chief nursing officers review of mental health nursing (DOH 2006) recommends the use of psychological therapies to improve outcomes for service users and ‘The mental health policy implementation guide (DOH 2001b) advocates the use of psychosocial interventions through a variety of service delivery modes. Demonstrating the emphasis that is placed upon such interventions in the treatment of serious mental illness. Mairs and Bradshaw (2005 page 28) suggest PSI is â€Å" a range of evidence-based interventions for people with psychosis and their care givers. The term is generally used to include both models of service delivery such as assertive outreach and specific interventions, for example Family Intervention and Cognitive Behavioural Therapy (CBT). PSIs aim is to reduce stress experienced by an individual with psychosis or help him or her to cope with stress more effectively.† As a result of adopting a PSI approach an individualised service is offered to the service user to help meet their needs utilising a variety of interventions and services with great emphasis being placed upon collaboration. Psychosocial interventions assume a complex link between biological, environmental, and sociological factors which suggests that ambient stress, together with life events may trigger onset or relapse of, mental health in some people (Gamble Curthoys 2004). A model which displays this link is the Stress Vulnerability Model by Zubin and Spring (1977 cited in Norman, Ryrie 2004). This model helps explain the aetiology, course and outcome of mental illness, demonstrating how stress has different effects on individuals. The Stress Vulnerability Model (See figure 2) suggests that some people are more vulnerable to stress than others and that when an individuals stress threshold is passed they can become unwell i.e. experience positive symptoms. In terms of a complex case it could be proposed that an individuals complexities cause stress in themselves and/or increase a persons vulnerability to stress. An example of how ‘The Stress Vulnerability Model can be illustrated to enable it to be shared with a service user with complex needs, using an easy to understand analogy can be seen in Appendix 1. As previously mentioned the aim of PSI is to reduce stress or to help cope with stress better; therefore, it can be seen how the Stress Vulnerability Model plays a central role in providing psychosocial interventions. Substance Misuse and Psychosis Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels (Cleary et al 2009) and even low levels of substance misuse can have detrimental effects and cause serious complications (Barrowclough et al 2001). The combination of substance misuse and mental health problems (dual diagnosis) is associated with a range of social, behavioural, physical and psychological problems (see table 3) providing challenges for mental health services and adding to the complexity of an individual (Hussein 2002). In addition to this complexity ‘The national service framework of mental health (DOH 1999a) identifies patients whom misuse substances and have a diagnosis of serious mental illness as a population of greater risk of stigmatisation and exclusion from existing service provision. Demonstrating some of the factors that add to an individuals complexity. Table 3 Complications posed by dual diagnosis (Cleary 2009, Drake Mueser 2000, Clark 1996, Dixon, McNarey Lehman 1995, Griffiths Allen 2007 and Gibbins Kipping 2006) Increased risk of Suicide, Self Neglect, Violence, Poor compliance with treatment, More inpatient stays worsening psychiatric symptoms Relapse, Homelessness, HIV and Hepatitis, Contact with criminal justice system Prejudice and Stigma. Negative impacts on Social relationships Financial resources (of individual and/or family/friends) Family Relationships i.e. increased burden, increased expressed emotion Within literature the most commonly reported reason that people with serious mental illness use illicit drugs is to self medicate, for example, to relieve negative symptoms of schizophrenia (Littlejohn 2005). However, as Conley Benishek (2003) report there is the additional complexity of trauma that has lead to the use of substances for various reasons including dissociation, and modelling from parents. They continue recommending that nurses working within the substance misuse field should be trained in picking up such information. If an approach adopting psychosocial interventions was utilised and therapies such a cognitive behavioural therapy were delivered then this historical information may be identified and dealt with appropriately. Therefore, leading to a different delivery of services compared to someone who uses substances to self medicate. However, the mental health professional must also bear in mind that service users also use substances for the same reasons as others (L ittlejohn 2005). Even though the NICE (2007) Guidelines, ‘Drug Misuse: Psychosocial Interventions recommends that CBT be offered to those with anxiety and depression who are stabilised with their drug use, but does not discuss its use with those with psychosis. There is growing literature examining the use of CBT for those with a dual diagnosis (Cleary et al 2009, Barrowclough et al 2001, Baker et al 2006, Weiss et al 2007 and Haddock et al 2003) although, as mentioned earlier the amount of literature in this area is limited. Also the CBT that is delivered to the participants within the studies has been adapted to suit the needs of those with dual diagnosis. This integrated treatment, namely C-BIT (Cognitive-Behavioural Integrated Treatment), has a number of components; Cognitive Behavioural Therapy, Motivational Interviewing and Family Interventions. C-BIT is not only about adapting psychosocial interventions to suit those with dual diagnosis but it is also about service provision and developm ent (Thylstrup Johansen 2009, Graham et al 2006, Graham et al 2003). Such interventions are used as part of an individualised treatment plan that incorporates the key principles of working with dual diagnosis (see table4). Table 4 (Drake et al 1993 cited in Abou-Saleh 2004) Principles of treatment of substance misuse in people with severe mental illness Assertive outreach to facilitate engagement †¢ Close monitoring to provide structure and social reinforcement †¢ Integrated concurrent service †¢ Comprehensive, wide range of interventions †¢ Stable living situation †¢ Flexibility and specialisation (modified approaches) †¢ Stages of treatment: engagement, persuasion, active treatment and relapse prevention †¢ Longitudinal perspective for relapsing and chronic disorder †¢ Optimism instilling hope in patients and carers Motivational Interviewing (MI) The aim of this intervention is to increase a persons ability to recognise and do something about any problems they have (Gamble Curthoys 2004) and that change would be desirable (Kipping 2004 and Miller Rollnick 2002). This approach conveys hope and is non-confrontational in it style (Kemp et al 1996) and is largely used within substance misuse services (DOH 1999b). This intervention is used alongside Prochaska DiClemente (1986 Cited in Kipping 2004) Model of Change (see Figure 3) to provide a framework of which interventions should be used at which stage of change a service user is at. Motivational Interviewing is mainly used as a persuasion tool to move people from precontemplation/ contemplation to decision and active change. Four General principles are followed as outlined by Miller Rollnick (2002); expressing empathy, developing discrepancy, rolling with resistance, and supporting self efficacy in order to facilitate this change. When a service user demonstrates that they have arrived at the decision or action stage of the cycle of change cognitive behavioural interventions are then commenced. Cognitive Behavioural Therapy (CBT) The aim of CBT is to lessen distress caused by negative feelings; it attempts to do this by changing the thoughts (cognitive) and beliefs that underpin them. It can also alter actions (behavioural) and circumstances that are affecting these thoughts and feelings (Nelson 2005). This approach has been written about for many years and has arguably evolved from the work of Aaron Beck, a psychiatrist whose work dates back to the 1950s. There is a vast amount of literature examining the use of CBT with psychosis (Jones et al 2004). Generally the research and literature supporting the use of CBT for Those with serious mental illness often excludes people who misuse illicit drugs and/or alcohol for example Garety et al (2008), and Jackson et al (2008). The topics covered within CBT sessions for those with dual diagnosis differs from that of someone who does not use substances. For example Baker et al (2006) outlines components of CBT sessions used within their trial. They include, presenting the model of problematic substance use and psychotic symptoms (Graham et al 2004), specific techniques for managing substance use, and identification of triggers and beliefs that could lead to substance use and increase psychotic symptoms. Finally a large component of CBT for dual diagnosis is around relapse prevention, identifying unhelpful thinking patterns and managing cravings. Family Interventions (FI) A relative of a person with a diagnosis of schizophrenia may experience negative consequences in many areas including: emotionally, socially, psychologically and economically, as they adjust to their new role as a care giver (Reader 2002). How the care giver attempts to cope with these consequences can have an effect on their relative. Research has shown that expressed emotion within families could lead to relapse in schizophrenia (Brown et al 1962, Kavanagh 1992). Often a person with dual diagnosis is only marginally engaged with services but may have regular contact with their families who provide financial and psychological support (Thylstrup Johansen 2009). Putting them under immense strain; but also in prime position to work with mental health services to promote engagement and treatment adherence. There is a vast evidence base to support FI for promoting recovery from psychosis (Pharoah et al 2006, Pilling et al 2002). The family dynamics of a person with a dual diagnosis is often impacted greatly due to the complexities discussed earlier and there is growing evidence to suggest how family involvement can have positive impacts on outcomes for both the service user and their families (Fischer et al 2008; Dixon, McNarey and Lehman 1995). Within integrated treatment Barrowclough et al (2001) use family interventions as a means of encouraging care givers to adopt motivational interviewing styles to improve motivation, and treatment adherence amongst other interventions. See Table 5 to illustrate how minimal family work in the form of psycho-education enhances the experience of service users and their care givers, even when staff have had no formal training. Unfortunately, family relationships of those with dual diagnosis can often be put under vast amounts of strain that cause the family dynamics to breakdown. Leading to people losing contact with their friends and families. This therefore makes family interventions very difficult as often one or both parties (care giver(s) and service user) do not wish to accept family work. In addition to this there are service users who do not wish their care givers be informed of their illicit drug use as they are worried of the consequences this may bring, for example: negative appraisal due to the stigma surrounding substance misuse. From experience this can be overcome in some cases through normalisation and psycho-education. Providing a good rationale of why care givers should be informed and how doing this can help the situation. Although, this often takes a lot of guidance and motivational interviewing techniques. Table 5 Psycho-education with Laura and her Father. Once Laura was admitted to the rehabilitation unit where she is currently residing her father got in touch. Laura was keen to build on the relationship between her and her father and started to visit him once a week. Staff at the unit (whom are not trained in family interventions) thought it would be a good idea to spend some time with Laura and her father to help them both gain an understanding of each others situation, thoughts, feelings and behaviours. After explaining the benefits of this to Laura she consented and her dad was offered to come and have a few informal sessions with Laura and her named nurse. Lauras dad explained how he had never been given any information about schizophrenia or substance misuse and how he knew very little of how these effected his daughter. This information was shared with both Laura and her dad. The stress vulnerability model was explained to Lauras dad with a view to building on his understanding of why his daughter experiences psychotic symptoms and providing a reason why she uses drugs. Leading on to state how this only causes more problems (all of this was discussed with Laura at an earlier date). Lauras Dad was given the opportunity to voice any concerns he had about regaining contact with Laura i.e. financial drain, crime, and ‘picking up the peices. These problems were discussed and brainstormed with both Laura and her dad to identify ways to prevent these happening, and produce a contingency plan if either person felt they needed support. Lauras Dad reported that these sessions made it easier for him to build on lost relationships with his daughter and reduced his fears that he would have to ‘deal with it all if things went wrong. Laura also felt much more positive as now she was starting to rebuild relationships providing more motiviation to change and sustain change. Her mood improved slightly and she had more hope for the future. Arguably the benefits Laura experienced may have inevitably occurred with out staff intervention. Literature Review A small number of studies examining interventions for use with people with dual diagnosis will now be appraised.Two of the Studies are Randomised Controlled Trials (RCTs) and are considered the gold standard method for evaluating treatment efficiency (Greenhalgh 2006). They are said to produce the least biased results as random samples are used to minimise the possibility of error in design and conduct (Roberts, 1999). Barrowclough et al (2001) and Haddock et al (2003) Barrowclough et al (2001) produced one of the first robust RCTs to examine the impact an integrated intervention programme consisting of CBT,MI and FI had upon service users. The design of the trail was robust in that it was a RCT, ensured as far as possible good treatment fidelity (making certain that the treatment being delivered is the one intended (Leeuw 2009)) and the assessors in the trial were blind to group allocation (reducing the risk of bias). However there were some limitations of this study such as small numbers of participants, short follow up period, and treatment was delivered by cognitive behavioural therapists. In reality it is not possible for all service users with dual diagnosis to receive interventions from a cognitive behavioural therapist. All of these limitations question the generalisibility of the results. Although care givers were in receipt of interventions their outcomes were not reported in this study. It would have been interesting to see these results; even those whom were in the control group received more interventions than the majority of families of substance misusers get (based on experience). One could hypothesise that the results of the two groups were not too dissimilar due to the fact that both sets of care givers were being supported. The Haddock et al (2003) study is a follow on from the Barrowclough et al (2001) study reporting further service user outcomes, cost effectiveness and carer outcomes over an 18month period. The robustness of the study was discussed above. This study found quite significant positive outcomes of those whom received the integrated intervention programme. Results demonstrated improved outcomes for the service users general and social functioning, and reduced number of negative symptoms to a significant degree. When examining this result with experience from practice it could be hypothesised that when a service users level of functioning increases they rely less upon their care givers. Thereupon improved functioning has a positive indirect effect upon carers. There was also a small difference in the percentage of days of abstinence between the two groups with the treatment group proving more favourable. However, the clinical significance of this is questionable. Although carer outcomes we re reported within the Haddock et al (2001) paper they are only briefly examined with more of an emphasis based on cost effectiveness. However, the results do show promise for care givers within the treatment programme, showing some trends towards better personal outcomes. At the 12 month follow up the treatment group demonstrated a reduction in needs and objective and subjective burden. However, these results were not statistically clinically significant. Haddock et al (2003) suggest more intensive work should be done with families due to the high rates of expressed emotion. Baker et al (2006) Baker et al (2006) also produced a RCT to examine the impact a series of sessions of CBT and MI has upon service users with a dual diagnosis. This study was not as robust as the Barrowclough et al (2001) study in relation to randomisation and assessor blindness. Within this study participants were paid for their expenses and time attending assessments. Although the authors suggest this was not enough to influence responses, this procedure was not carried out in similar studies such as the one by Barrowclough and colleagues (Barrowclough et al 2001 and Haddock et al 2003) which should be considered when comparing results. Another negative to this study as with that of Barrowclough et al(2001) was that the interventions were carried out by highly trained psychologists; Echoing the argument of generalisability. On a positive note this study did have a larger number of participants almost double that of Barrowclough et al (2001). Baker et al (2006) suggest both this trial and the one car ried out by Barrowclough and colleagues suggest improvements in substance misuse. However from the results these improvements appear minimal. Baker et al (2006) also report that there was no significant difference in improvement of functioning or positive symptoms; providing opposite and contrast results of the Barrowclough et al (2001) study. Baker et al (2006) conclude that this study demonstrates that this challenging case group (service users with dual diagnosis) is able to engage in CBT and demonstrate positive results. Although this ‘excellent therapy-attendance could be questioned due to the use of payment for time and travel. Graham et al 2006 This study carried out by Graham et al (2006) differs from those discussed above in that it is not a RCT, it is a preliminary evaluation of the impact of C-BIT training on 3 assertive outreach teams and service user outcomes and is not an RCT. Care co-ordinators from 5 assertive outreach teams were allocated to two groups. One of which received immediate C-BIT training and the other groups training was delayed. Results of the training demonstrated increased confidence of care co-ordinators in working with substance misuse and mental illness. Graham et al (2006) suggest these findings illustrate the effectiveness of such training and highlights the extent to which implementation actually occurs. They suggest their findings add evidence to the recommendations made for implementation of interventions for this client group presented in Mental Health Implementation Guide: Dual Diagnosis Good Practice (DOH 2002). Graham et al (2006) also discuss the impact of such training upon service user outcomes. The results highlighted an improvement in engagement, reduction in alcohol use and a reduction in positive alcohol related beliefs. Demonstrating that this team approach to C-BIT shows promise. This report does not measure impact on care giver outcomes. All of the reports mentioned here suggest further research is needed to establish a firm evidence base for integrated treatment programmes that use interventions such as CBT, MI and FI. Nonetheless, they do provide a good grounding for recommending that such interventions show promise for enhancing service user and carer experience. In order to do this there may need to be a change in service provision. For example for a change within treatment philosophy of a team may mean that all staff must be trained preferably at the same time (Graham 2004). This causes barriers on numerous levels such as cost implications of all staff receiving training, back fill of their hours, cost of trainer and venue etc.. Potential barriers may occur when implementing these newly acquired skills and knowledge due to feelings of diminished confidence as part of the learning process (Atherton 2008). Discussion Substance misuse services separated for mental health services some time ago (Conley Benishek 2003) and as a result mental health professionals have limited training and experience in working with people who misuse substances. In addition, many drug and alcohol workers have only had minimal education in mental health issues (Frankel 1996). This could result in mental health professionals and substance misuse workers feeling unequipped in working with people with a dual diagnosis; resulting in them receiving inadequate care. A way to overcome this is for more health professionals to acknowledge their deficits in knowledge and attend training. Perhaps as a result of having minimal education in the field of substance misuse, negative attitudes towards those who misuse substances is still present (Howard Chung 2000 and Richmond Foster 2003). This can take the form of moralistic and stereotypical attitudes leading to mistrust, suspicion and avoidance on both sides. Evidence indicates that when such attitudes are held problems of substance misuse are often overlooked and not dealt with or referred on (Howard Chung 2000). Table 6: Luke Case Study Luke was brought up in a deprived area of a large city and often experimented with illicit substances with his friends. He had a very poor relationship with his mother and siblings (although he did reside with them) and never saw his father. Luke started to hear voices at the age of 18 and was soon admitted to an acute unit where he commenced anti-psychotic medication. Luke was discharged from hospital back to his home. Lukes motivation was draining and he was experiencing little enjoyment in life. it wasnt long before he stopped taking his anti-psychotic medication because it was making him put on weight and causing side effects. L

Homosexual Indifference :: Free Essays Online

Homosexual Indifference The times seem to be changing in acceptance of homosexual relationships for the better, but many laws as well as society still prohibit gay marriage and adoption. There are two sources which I will use to show different view points on gay marriage and adoption. The first is an article written by Andrew Sullivan, titled â€Å"Let Gays Marry.† This is written as an informal piece to argue that gay people should be allowed to marry one another. The next is also on gay marriage, but in this article, â€Å"Leave Marriage Alone,† author William Bennett writes that it is wrong for gays to marry. These two authors show separate feelings on the issue of gay marriage, while attempting to persuade the readers to agree with them. Each of these articles have valuable arguments, but will they be enough to change people’s views, to benefit their beliefs? Beginning with the topic on gay marriage and the controversial battle between authors, Andrew Sullivan and William Bennett, Sullivan is the gay supporter. In Sullivan’s piece, â€Å"Let Gays Marry,† he opens with a statement by the Supreme Court, â€Å"A state cannot deem a class of persons a stranger to its laws.† He feels that this simple sentence has so much meaning, saying that whatever type of person, male or female, black or white, everyone deserves the same legal protection and equal rights. Therefore, gay marriage should not be excluded from the legal system. He tells that some churches practice different beliefs and may oppose gay marriage but religion has nothing to do with the state appeals. Sullivan explains how the definition of marriage has changed in the past and that it can be done again. Sullivan ends his piece by saying that changing the law would not affect straight couples, so why are they against gay marriage? He believes t he change would allow gay couples to experience what straight couples already have. On the other hand, William Bennett, author of â€Å"Leave Marriage Alone,† feels that the right for gays to marry should not come into effect. He begins by asking if gay marriage will benefit the institution. He fears that if this law was passed the true meaning of marriage would be altered and destroyed.

Pressures Of Society :: essays research papers

Pressures of Society Our behavior usually is controlled and decided by us, but that is not always the case. As we saw in the play Marty's behavior was not always his own decision. The behavior of any person can be greatly manipulated by society. There are a few points in the play and in normal life that can prove this statement is true. Marty's actions were greatly influenced by the views of his family and friends. Marty was forced into many actions by the people around him. A person will consider what other tells them as much as what they believe in themselves. Marty was always a quiet man that didn't like going out, it was his family and friends that told him to do so. It was his decision, but it wasn't his choice. Marty did not want to go anywhere yet he did just because his friends and family told him so. It is not always easy to refuse such thing, Marty had to make a decision and decided he should go out. By analyzing the pros and cons he made a decision, basing it on knowledge and commonsense, after all going out is not a bad thing. But what if there is no decision? What if the person is forced to do something that he does not agree with? This can be blamed on the pressure of society as well, sometimes you do something that you know you don't want just because someone is forcing you. Marty showed such behavior many times throughout the play. It was not always a conscious decision every time that Marty did what he did, he based many of his decisions just on what his friends and family told him. It is this play that made me think, that our decisions and choices are based on what we think just as much as what others think. It is not always your choice and it is not always what you want that you do. For example I am writing this essay because someone told me so, and it is not my choice either to do it or not, I can decide if to do so but that doesn't leave with other options. Some actions people do are subconsciously inputted by society, that means that there was no specific someone that told you what to do, yet you still do it because society has set this standard. This type of action can be seen in anyone at every given day. It can range from the simpler things like dressing up, and looking good all

Function of Storytelling Essay

The novel Atonement by Ian MCewan and the short story â€Å"The Things They Carried† by Tom O’Brien both employ storytelling as a form of redemption. This is achieved in each text through the narrator’s freedom to manipulate the content and truth of the narrative in order to amend past wrongs and to imagine a more comforting, alternate reality. In Atonement, the narrator , Briony uses her literal imagination to alter the story of her life in hope to seek redemption for past actions with great consequence, while the narrator in Tim O’Brien’s â€Å"The Things They Carried† tells and retells his version of the memory to help it become real. Both narratives show storytelling to be a possible healing process. P1-First step to redemption is to admit the reason for your deception. A novels allows narrator to confess the motive behind his/her sin. Briony initial stage towards redemption is by confessing the dangers of interpretation. quote- To herâ€Å"reading a sentence and understanding it were the same thing; as with the crooking of a finger, nothing between them. There was no gap during which symbols were unravelled†(37) -quote shows Briony’s belief in the ease of interpretation which leads her to jump to conclusions she can never change. The blame for the tragedy is not only due to Briony’s misinterpretation of events , but the misguided nature of interperation provided by books. â€Å"The Things They Carried† -The narrator describes the difficult conditions of war by describing the emotional and physical baggage they carry. Lieutenant Jimmy Cross carried the love letters from Martha. These horrible conditions forced Lieutenant cross to day dream about Martha which lead to Ted Lavender’s death. -quote:told they carry â€Å"pocket knives, heat tabs, wristwatches†¦and two or three canteens of water† which weigh â€Å" between 15 and 20 pounds†(241). -quote allows the reader to feel the overwhelming weight of being a soldier, which words can’t simply explain. The narrator demonstrates the reasoning for Lieutenant cross’s daydreaming as a way to escape from chaos of Vietnam war. P2-Using storytelling another step towards redemption is taken by character’s revealing repentance by punishing themselves for their wrong doing (reveal repentance/remorse) -briony becomes a nurse and turns away Cambridge. She writes about the hard work she does as a nurse. quote: â€Å"Whatever skivvying or humble nursing she did and however well or hard she did it, whatever illumination in tutorial she had relinquished ,or lifetime moment on a college lawn, she would never undo the damage. She was unforgivable† -Lieutenant Jimmy burns Martha’s letter and pictures, thus destroying his distracting fantasy in order to become a true soldier -quote: â€Å"Lavender was dead. You couldn’t burn the blame† -Something is missing in explanation. How can I tie in that acts of remorse both did not make amends. P3-Novel is attempt by narrators to erase the wrong he/she did. The outcome of redemption differs for each narrator. -Briony alters the ending of the ending of the story in hope to seek redemption but does not achieve it because quote: â€Å"The problem of these fifty-nine years has been this:how can a novelist achieve atonement when, with her absolute power of deciding outcomes, she is also God? There is no one , no entity of higher form that she can appeal to, or be reconciled with, or that can forgive her† -No matter how many times she rewrites the story she will never receive Robbie and Cecile’s forgiveness. She can†t achieve self forgiveness because no alternate ending that she imagines will replace the true ending. -The only way Briony will end her guilt is when her memory fails and she dies. (disease) -Narrator for â€Å"The Things They Carried† achieves redemption for Ted Lavender’s death because storytelling allows the memories of Ted Lavender to stay alive. -Storytelling enables the narrator’s memories to be shaped and rearranged in order to make sense of past events and make them real -The narrator achieves redemption for Ted Lavender’s death by storytelling because each time the story is told or retold the soldier’s in the Alpha Company are being given a new life each time by the reader. -quote:At first, we learn â€Å"he was shot and killed outside Than Khe† (O’Brien 241) and gradually learn â€Å"Ted Lavender was shot in the head on his way back from peeing† (O’Brien 246).