New ways of working: COVID-19 as a catalyst for change in acute mental health services

BackgroundA need arose to divert patients with psychiatric complaints from the emergency department to alternative settings for psychiatric consultations to reduce footfall during COVID-19. We assessed the effectiveness of alternative referral pathway in reducing COVID-19 infection in our service and its effect on service quality: response time and number of patients leaving before the review. We evaluated the satisfaction of patients, general practitioners (GPs) and mental health service staff with the pathway.MethodsAll patients referred to the mental health service over a 2-month period following the introduction of the pathway were included. Findings were compared against the cohort referred for emergency assessment during the same period in 2019. Feedback surveys were distributed to patients, staff and GPs. χ2 and independent sample t-test were used to compare the variables.ResultsOver 2 months, 255 patients received an emergency assessment via the pathway, representing a 22.3% decrease in the volume of presentations from the same period in 2019. There were no COVID-19 cases among our patients or staff on the roster for assessing patients. In comparison to 2019, response times were improved (p<0.001), and the numbers of patients who left the hospital before the review were reduced by 3.2% during the study period (p<0.001). Patients and GPs were highly satisfied with the referral pathway and believed that the pathway should be retained post-COVID-19. Mental health service staff were divided in their opinions about its sustainability.ConclusionThe pathway was successful in reducing the spread of infection, improving response times and reducing the numbers of patients who left without an assessment. Given the improved outcomes and acceptability, this is a preferable pathway for emergency referrals into the future.

Do Country-level Creditor Protections Affect Firm-level Debt Structure Concentration?

We study the effects of country-level creditor protections on the firm-level choice of debt structure concentration. Using data from 46 countries, we show that firms form more concentrated debt structures in countries with stronger creditor protection. We propose a trade-off framework of optimal debt structure and show that in strong creditor rights regimes, the benefit of forming concentrated structures outweighs its cost. Because strong creditor protections increase liquidation bias, firms choose concentrated debt structures to improve the probability of successful distressed debt renegotiations. Firms with ex-ante higher bankruptcy costs, including those with higher intangibility, cash flow volatility, R&D expenses, and leverage exhibit stronger effects. Firms with restricted access to capital are also affected more. A difference-in-differences analysis of firms’ debt structure responses to creditor rights reforms confirms the cross-country results. Our findings are robust to alternative settings and a battery of robustness checks.

Time for ‘Green’ during COVID-19? Inequities in Green and Blue Space Access, Visitation and Felt Benefits

We hypothesized that visits to green and blue spaces may have enabled respite, connection and exercise during the COVID-19 pandemic, but such benefits might have been inequitably distributed due to differences in financial difficulties, opportunities to work from home, and localized restrictions in spatial mobility generated by ‘lockdowns’. A nationally representative online and telephone survey conducted in 12–26 October on the Social Research Centre’s Life in AustraliaTM panel (aged ≥ 18 y, 78.8% response, N = 3043) asked about access, visitation, and felt benefits from green and/or blue spaces. Increasing financial difficulty was associated with less time in and fewer visits to green and/or blue spaces, as well as fewer different types visited. Financial difficulty was also associated with feelings that visits to green and/or blue space had less benefit for maintaining social connection. Working from home was associated with more frequent and longer visitation to green and/or blue spaces, as well as discovery of ones previously unvisited. Working from home was also associated with increased levels of exercise and respite resulting from visits to green and/or blue spaces. Residents of Melbourne, a city of 4.9 million who were in ‘lockdown’ at the time of the survey, appeared more likely to benefit from visits to green and/or blue spaces than residents of Sydney, Australia’s largest city at 5.2 million, who were not in lockdown. Residents of Melbourne compared with Sydney reported consistently increased visitation of, discovery of, and greater levels of various felt benefits derived from green and/or blue spaces, including more respite, connection, and exercise. Comparatively shorter distances to preferred green and/or blue spaces and closure of alternative settings at the time of the survey completion in Melbourne compared with Sydney may provide partial explanation, though more acute responses to experiencing green and/or blue spaces within highly cognitively demanding antecedent conditions posed by lockdown are also plausible and warrant further investigation with other health indicators. These results were robust to adjustment for a range of covariates including preferences for natural settings, which were consistently associated with greater levels of green and/or blue space visitation and felt benefits. Collectively, these results indicate that parallel efforts to generate (or renew) felt connection to natural settings, to increase working from home opportunities, and to mitigate financial difficulties may be important to help maximize the population health benefits of urban planning strategies intended to improve the availability of, and to reduce inequities in access to, green and blue spaces. Benefits felt more commonly by people living through lockdown underlines the role previous investments in green and blue space have played in enabling coping during the COVID-19 pandemic.

Tourism and the Social Reintegration of Colombian Ex-Combatants

Research on the role of tourism in post-conflict scenarios has suggested that it contributes to peace and reconciliation by providing common ground for antagonists to meet. However, not enough attention has hitherto been given to cases where one of the opposing parties consist of former combatants. This chapter draws on academic literature on disarmament, demobilization, and reintegration (DDR) to discuss how Colombian demobilised guerrillas are currently using tourism to assist their reintegration process. Based on document analysis, semi-structured interviews, and non-participant observation, it is argued that tourism can contribute to the social reintegration of ex-combatants by making them visible and active agents in the process and supporting alternative settings where reintegration can take place. Ultimately, the chapter posits that tourism can assist non-conventional approaches to reintegration, which might increase the likelihood of ensuring a successful transition from war to peace.

The Nature and Extent of Component Analyses for Improving or Mitigating Behavior: A Systematic Review

A component analysis is an approach where two or more independent variables are evaluated as a package and independently. The approach is used to assess and identify which component of a treatment package is the most effective. The purpose of this review is to document the application of component analyses to improve or mitigate non-academic behaviors with individuals with disabilities. We identified 21 research articles that used a component analysis to evaluate treatment packages with students who were identified as having or at-risk for a disability in classroom and/or alternative settings. Results from reviewing 21 articles (22 cases) indicate that 11 intervention packages had a single component that was critical for successful behavior change. Two articles suggested the entire intervention package was necessary while nine articles did not report a critical component or had variable results pertaining to critical components. The benefits and drawbacks of using component analyses for single case research are discussed. Implications for future research are also presented.

Different settings for cardiac rehabilitation

Cardiac rehabilitation (CR) has traditionally been viewed as a hospital-based intervention consisting of a multidisciplinary exercise-based programme, aimed at improving exercise capacity after an acute CV event or surgery and optimizing the CV risk profile. Because of various limitations on attendance at these programmes, in particular lack of availability or difficulties in accessibility, alternative settings for providing secondary preventive measures have been developed. Amongst them, home-based rehabilitation with or without telemonitoring has the potential to increase patient participation and support behavioural changes. This may be a reasonable option for selected clinically stable patients at low to moderate risk who are eligible for CR but cannot attend a traditional hospital- or centre-based CR programme. Although short-term improvements in functional capacity, health-related quality of life (HRQoL), and CV risk factor control are comparable in home-based and hospital- or centre-based CR, long-term studies of the impact of home-based CR on clinical events are still needed.

Discrimination and Deterrence with Enforcer Liability

Taste-based discrimination (i.e. discrimination due to racist preferences) receives more attention than statistical discrimination in the enforcement literature, because the latter allows enforcers to increase their “success rates.” I show here that when enforcers’ incentives can be altered via liabilities and rewards, all types of discrimination reduce deterrence. Moreover, adverse effects of statistical discrimination on deterrence are more persistent than similar effects due to taste-based discrimination. I identify crime minimizing liabilities and rewards when enforcers engage in racial discrimination and consider the robustness of the analysis in alternative settings.