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This chapter uses Goffman’s concept of total institutions in a comparative case study approach to explore the role of psychotropic drugs in the process of transinstitutionalization.

This chapter interprets psychotropic drug use across four institutionalized contexts in the United States: the active-duty U.S. military, nursing homes and long-term care facilities, state and federal prisons, and the child welfare system.

This chapter documents a major unintended consequence of transinstitutionalization – the questionable distribution of psychotropics among vulnerable populations. The patterns of psychotropic use we synthesize suggest that total institutions are engaging in ethically and medically questionable practices and that psychotropics are being used to serve the bureaucratic imperatives for social control in the era of transinstitutionalization.

Psychotropic prescribing practices require close surveillance and increased scrutiny in institutional settings in the United States. The flows of mentally ill people through a vast network of total institutions raises questions about the wisdom and unintended consequences of psychotropic distribution to vulnerable populations, despite health policy makers’ efforts regulating their distribution. Medical sociologists must examine trans-institutional power arrangements that converge around the mental health of vulnerable groups.

This is the first synthesis and interpretive review of psychotropic use patterns across institutional systems in the United States. This chapter will be of value to medical sociologists, mental health professionals and administrators, pharmacologists, health system pharmacists, and sociological theorists.

Old age is a complex and dynamic phenomenon. The relationship between old age and transport is also very complex due to the heterogeneity within this age group. Yet what is certain is that with age, a person’s functional abilities change. This chapter provides a summary of how older people can be vulnerable within the road environment. Using an established framework for understanding old-age vulnerabilities, this chapter explains the common exposure factors and threats that several older people face in the transport environment. These primarily deal with individual physical and cognitive characteristics, medical conditions as well as the appropriateness (or not) of infrastructure. Subsequently, common difficulties for older drivers, pedestrians and public transport users are discussed. The main vulnerabilities that result from such difficulties are related to an over-representation of older people in accidents and to a lower quality of life due to mobility inefficiencies. Yet, using the same framework, the compensation techniques that older people often adopt to minimise such limitations are also highlighted. Reference is also made to the issues related to the lack of awareness in old age and the corresponding inability to compensate. The review concludes by suggesting a way forward for further studies on transport vulnerability in later life.

According to The Ethics Centre (2018) ‘[T]he social license to operate (SLO) is made up of three components: legitimacy, credibility, and trust’. These three components serve to frame the relationship that has emerged and continues to evolve, its root arguably dating back to the Enlightenment and Post-industrial ages, between the worlds of capitalist commercial and industrial operations, and the liberal-democratic citizenry/consumers of society. The ‘SLO’, it will be shown, has historical grounding that indicate the SLO is a broader translatable concept not limited to the business realm. The SLO, the evidence will show, is a multifaceted concept not least, a unifying vehicle utilized for the purpose of acceptance, to advance normative concerns, and resistance, against questionable and harmful practices. Evidently, many domains of human services operate sub-optimally with less than favourable outcomes. In effect, this translates to structural injustices as characterized by poor understanding, insufficient standards of practice, ineffective safeguard, and governance institutions, perpetuated by entrenched practices, allowing the rise of mediocre service providers no less enabled by deficient regulation. Accordingly, the ethical focus of this paper is on the healthcare system, the evident and unnecessary deficiencies, and the failings of the central governance institutions involved. The underlying characteristics of what constitutes a SLO arguably, whether in name or not, have been engaged to expose, challenge, and repel, unethical conduct that gave rise to multiple health care-related Royal Commissions across Australia; predominantly, impacting the Disability, Aged Care, and Mental Health (DAM) sectors to name a few of recent times.

In recent years there have been increasing calls for the use of anabolic androgenic steroids (AAS) and associated drugs to be recognized as a public health issue. In the domain of the competitive athlete and professional bodybuilder, recent decades have seen the diffusion of AAS from the hardcore gyms of the 1980s and 1990s to the mainstream exercise and fitness environments of the twenty-first century. Alongside the apparent increases in the use of these drugs, there is a growing evidence base in relation to harms – physical, psychological and (to some extent) social. But is this form of drug use a public health issue? What criteria should we use to make this judgement? What is the available evidence and has our understanding of the issue improved? By drawing on the authors' research in the United Kingdom and the wider international literature this chapter will explore these issues and attempt to answer the fundamental question – is the use of anabolic steroids a public health issue?

Abuse and misuse of Substitute Decision-Making (SDMg) authority impacts the lives of children and adults with decision-making disabilities. The concerns raised in this paper amplify previous attention addressed by advocacy agencies and law reformists such as the Law Commission of Ontario. I analyse problems associated with Plenary Guardianship from both the lived experience of the non-guardian perspective and from the authority bestowed to the Guardian pursuant to the Guardianship and Administration Act 1990 of Western Australia legitimating the unintended capacity to abuse one’s substitute decision-making authority. Substitute decision-making arrangements enable decisions to be made on behalf of a person with a decision-making disability; usually made when such arrangements are necessary and subject to safeguards. Detrimentally, the substitute decision-maker (SDM) can assert broader powers beyond sensible measures that include thwarting investigations undertaken by family members; removing family members from the life of the person for whom an order is made; inappropriately applying a paternalistic or ‘best interest’ approach to decision-making where other approaches are required; failing to consider the individual’s wishes or making decisions contrary to those wishes; having insufficient contact with the individual; and, sharing insufficient or incorrect information. Moreover, they may subject the individual for whom an SDM order is made to experimental medical treatment in tandem with imposing or condoning severe and harmful restrictive-practices. Consequently, the second issue addressed in this paper concerns normalising both chemical and physical restrictive-practices that are both morally abhorrent and clinically highly questionable. Furthermore, often undertaken by service providers and their contracted psychiatrists and treating teams, endorsed under authority of a collaborating Guardian or SDM.

An overview of the impact of dementia that focuses on underdeveloped countries across the globe, and migrant and minority ethnic communities within the developed world. Increased longevity increases the risk of dementia and brings new challenges in terms of cultural perspectives and cultural obligations in the care of elders. The chapter examines these challenges in detail and their consequences in planning for support and care.