Psychological Implications of Health Disparities

The psychological implications of health disparities are damaging as humans of different religions, genders, races, cultures, and socioeconomic backgrounds seek entry into healthcare systems and receive poor quality of treatment related to health care workers' and healthcare providers' conscious and unconscious biases. Linguistics, a cultural aspect of diversity, also impacts healthcare disparities, as language barriers affect health literacy. Psychologically impaired by both perceived and overt expressions of discrimination, affected persons can develop discomfort in seeking health care treatment secondary to a history of maltreatment by healthcare workers and providers. However, this pattern of maltreatment can be altered when healthcare workers are educated about unconscious biases and how, if not brought to awareness and removed from the daily interactions with others, they impact the physical and mental health of generations of people.

Police Interactions with Persons-in-Crisis

This chapter addresses the interaction of law enforcement officers and people who are psychologically impaired as a result of mental illness, emotional disturbance, or severe intoxication. The chapter consists of three major sections. Part One provides an overview of the larger legal and social factors that increasingly require law enforcement to develop specialized programmatic responses for responding to a Person-in-Crisis (PIC). Part Two provides an overview of different types of programmatic attempts to address the problems associated with these at-risk populations. Part Three offers recommendations to police psychologists on how to develop programmatic solutions to the challenges faced by law enforcement when dealing with PICs.

A Study of Outrage of Modesty Offenders in a Singapore Prison

Outrage of modesty (OOM) offenders cause considerable annoyance and distress to their victims. The offending behaviours include touching, grabbing or fondling of erogenous or non-erogenous parts of the victim's body. The purpose of this study is to examine a prison cohort of OOM offenders and to compare them with a group of OOM offenders who had been remanded in a state mental hospital. All prisoners serving sentence over a two-year study period were interviewed. They were of similar mean age to the hospital cohort but were better educated, more likely to be married and most were working. Victims tended to be young females with an average age of 19 years. Psychotic disorders were rarely present, although 15% had a dissocial personality disorder. Those with previous OOM convictions were likely to have had past psychiatric consultations and were more likely to be unmarried. However, there were no statistically significant differences between convicted first-time offenders and repeat offenders with respect to age, educational level, nature of offences and alcohol consumption. The prisoners were less inclined to commit their offences in the mornings. Breasts and genitalia were the favoured targets for molest action, irrespective of time or place or whether the offence was committed by a first or repeat offender. The offences were often committed along staircases, corridors and in crowded public places. CONCLUSION: Interesting differences emerged when a cohort of prisoners was compared with another cohort of molesters remanded in a psychiatric hospital. The prison cohort contained fewer individuals with psychiatric illness, whereas the converse was true for the hospital cohort. Although it is thought that sexual offences are typically committed by those with no psychiatric disorders, much depends on the type of study population being evaluated. If the study population is from a prison setting, fewer mentally ill individuals would be expected. In these situations the Dissocial Personality Disorders are expected to be more prevalent. The surprising finding that the prison group comprised those who were fairly well educated with high employment contrasted with an age-old concept of the criminal population as a whole. While mental illnesses tended to be found in a minority of the prisoners, there seemed to be an indication that those who had committed repeat offences were in some way more psychologically impaired than those who had molested for the first time. Such impairments were probably responsible for problems in forming intimate relationships leading up to marriage.

Impaired Interns and Residents

In 1981 a study was undertaken to determine intern and resident psychological well-being and identify those house staff who were psychologically impaired. Fourteen percent of house staff were found to be impaired. Single females and house staff who were chronically fatigued or socially isolated were at highest risk for impairment. Impairment arose out of the interaction between sleep and social deprivation and individual vulnerability. Minor tranquillizers, but not alcohol, were used as a coping response to impairment.

Children's Problems in Peer Relations and Severity of Behavior Disorders

From 150 clinical records those of 24 children and youths (range = 3 to 19 yr.) assessed as having difficulty with peer relations were compared with the records of referred children who did not present difficulties with peers. Children in the target group were judged to be more psychologically impaired at time of first assessment and to experience difficulties in more areas than the comparison group. They tended as well to require more counselling sessions. Also, for boys but not girls, results indicated that problems in the parent-child relationship may be a necessary but not sufficient condition for the emergence of difficulties with peers.

Medical and Social Factors Associated with Psychological Distress in a Sample of Community Aged

Two hundred persons over 80 in two urban communities were interviewed. Of those interviewed, 21% evidenced psychological impairment as defined by the presence of at least one of the following self-report symptoms: 1) depression; 2) periods of inability to function; 3) suicidal ideation; 4) alcohol problems and 5) use of psychotropic medication. A profile of the psychologically impaired group compared to the psychologically healthy showed that accidents (mostly falls), eye problems and few social contacts were significantly associated with impairment. Approximately 75% had some restrictions on activity due to physical health problems. Social isolation was marked: 54% either had no children or saw them less than once a month; 38% visited with close friends or relatives less than once a month; 19% were rated as having very little or no social support; and 23% socialized beyond the household less than once a week. Social interaction was the strongest predictor of psychological well-being (Affect Balance Scale) in a multiple regression analysis that included physical health and socioeconomic variables. Questions about service needs and utilization indicated unmet needs in the areas of transportation, house maintenance, medical services, and a regular visiting service.