Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries

People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness. The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South East Asia and Eastern Asia.     

Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

The way service seekers interact with the staff at emergency services has been shown to influence the standard of care, especially in the case of certain psychiatric manifestations. Staff reactions to psychiatric complaints have been linked to their comfort dealing with these types of service users as well as their competencies understanding the illness. It is therefore vital to understand which skills increase confidence in treating psychiatric emergencies. Twenty‐six open‐ended convergent interviews were conducted with staff working in a psychiatric emergency department. Thematic analysis was used to analyze the data. Participants reported several non‐technical skills which developed from exclusively serving people with psychiatric emergencies: 1) Vigilance allowed staff to be sensitive to minor changes in behavior which precede psychiatric emergencies. 2) The ability to negotiate and find tangible solutions was particularly important when dealing with psychiatric complaints which may not have tangible resolutions. 3) The ability to appraise social support networks allowed staff to plan follow‐up actions and ensure continuity of care when support was available. 4) The ability to self‐reflect allowed participants to learn from their experience and avoid burnout, frustration, and fatigue. Participants also reported several other clinical skills which they gained during training, including teamwork, de‐escalating techniques and risk assessment. Tentatively speaking, these skills improve staff's confidence when treating psychiatric emergencies. Certain skills may be generalized to staff working in medical emergency departments who frequently encounter psychiatric complaints.     

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.     

A laboratory method for testing the volatility from aqueous solution: First results and comparison with theory

The mobility of a chemical in the environment is often determined by its volatilization from aqueous solution, especially if it shows poor water solubility and/or high vapor pressure. A small laboratory apparatus is described which allows the simulation of the volatilization process from a stirred water body with well-defined wind velocities and water temperatures. In experiments with naphthalene, pentachlorophenol, trichloroethene, and di(2-ethylhexyl)phthalate, substance concentrations in the water body decrease exponentially, in accordance with theory. Half-residence times are found to be independent of wind velocity (v < 1 m sec⁻¹) or air humidity, but are strongly dependent on temperature. The measured substance fluxes through the water surface are comparable with theoretical values. In the case of pentachlorophenol, which partly dissociates in aqueous solution, the volatility is controlled by the pH value of the solution.     

Selection and prioritisation procedure of hazardous substances for the marine environment within OSPAR/DYNAMEC. Oslo and Paris Convention for the Protection of the Marine Environment of the North East Atlantic

In 1998, the contracting parties to the OSPAR Convention agreed on a Strategy with regard to Hazardous Substances: [...] the prevention of pollution of the maritime area by continuously reducing discharges, emissions and losses of hazardous substances thereby moving towards the target of their cessation within one generation (25 years, year 2020) [...]. In OSPAR, an ad-hoc working group on the development of a dynamic selection and prioritisation mechanism for hazardous substances (called DYNAMEC) has developed a dynamic selection and prioritisation scheme for the marine environment. The approach taken within OSPAR and DYNAMEC to implement the political agreement into practical instruments is summarised in the following.