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Internationally, rates of suicide and lifetime self-harm are higher in prisoners compared to the general population. This study aims to identify specific characteristics of self-harming behaviour and to establish a profile of prisoners who engage in self-harm.

Data from the Self-Harm Assessment and Data Analysis Project (SADA) on self-harm episodes in prisons in the Republic of Ireland during 2017–2019 was used. Annual rates per 1,000 were calculated by age and gender.

The rate of self-harm between 2017 and 2019 was 31 per 1,000 prisoners for men and six times higher at 184 per 1,000 prisoners for women. The rate of self-harm was twice as high among prisoners on remand than sentenced prisoners (60.5 versus 31.3 per 1,000). The highest rates of self-harm among sentenced prisoners were observed among 18–29-year-old men (45 per 1,000) and women (125 per 1,000). The rate of self-harm was higher among women prisoners in all age groups. Contributory factors associated with self-harm were mainly related to mental health but also linked to a prisoner’s environment and relationships.

There is a need to ensure access to timely and suitable mental health services, including both appropriate referral and provision of evidence-based mental health interventions to address the needs of these cohorts.

To the best of the authors’ knowledge, this is the first national study to systematically examine incidence and patterns of self-harm among the prison population in Ireland. The recording of severity/intent of each episode is novel when assessing self-harm among the prison population.

Managers must make numerous strategic decisions in order to initiate and implement a business model innovation (BMI). This paper examines how managers perceive the management team interacts when making BMI decisions. The paper also investigates how group biases and board members’ risk willingness affect this process.

Empirical data were collected through 26 in-depth interviews with German managing directors from 13 companies in four industries (mobility, manufacturing, healthcare and energy) to explore three research questions: (1) What group effects are prevalent in BMI group decision-making? (2) What are the key characteristics of BMI group decisions? And (3) what are the potential relationships between BMI group decision-making and managers' risk willingness? A thematic analysis based on Gioia's guidelines was conducted to identify themes in the comprehensive dataset.

First, the results show four typical group biases in BMI group decisions: Groupthink, social influence, hidden profile and group polarization. Findings show that the hidden profile paradigm and groupthink theory are essential in the context of BMI decisions. Second, we developed a BMI decision matrix, including the following key characteristics of BMI group decision-making managerial cohesion, conflict readiness and information- and emotion-based decision behavior. Third, in contrast to previous literature, we found that individual risk aversion can improve the quality of BMI decisions.

This paper provides managers with an opportunity to become aware of group biases that may impede their strategic BMI decisions. Specifically, it points out that managers should consider the key cognitive constraints due to their interactions when making BMI decisions. This work also highlights the importance of risk-averse decision-makers on boards.

This qualitative study contributes to the literature on decision-making by revealing key cognitive group biases in strategic decision-making. This study also enriches the behavioral science research stream of the BMI literature by attributing a critical influence on the quality of BMI decisions to managers' group interactions. In addition, this article provides new perspectives on managers' risk aversion in strategic decision-making.

Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs deliver the human right to health for all? This study addresses this question through qualitative research into access to health care for vulnerable communities, using Malawi as a case study. This study shows that there are significant accountability gaps and perceptions of weak service provision in Malawi’s EHP in relation to some particularly marginalised (and stigmatised) groups that limit the right to health and the promise of “health for all”.

This study extends the body of qualitative work on EHPs in general and on Malawi in particular by exploring the perceptions of key stakeholders in relation to inclusivity and the delivery of health policies to particularly vulnerable groups. To do so, this study adopted an approach based on interpretive epistemologies (Scott, 2014). This study conducted largely unstructured interviews with a range of health stakeholders, speaking to stakeholders individually, rather than through focus groups due to the potentially sensitive nature of the topic.

The findings of this study are as follows: limited inclusion of civil society actors and local communities; local communities and local policymakers feel frustration with the gap between the promises of consultation in the EHP and the reality, and the difficulties of not having effective channels of communication; and exclusionary health practices for particularly vulnerable groups.

There are limitations based on the qualitative methodology, and in terms of the particularly vulnerable groups – the authors studied two such groups (people with disabilities and those who identify as LBTQ) but a wider survey of vulnerable groups is needed to extend and confirm the findings.

Greater attention to the health rights of vulnerable groups would improve access and services, even in the context of resource restrictions. This study suggests that a deeper engagement with human rights-based approaches would pay dividends in terms of increasing access to health in Malawi, even within the constraints of the EHP process. Furthermore, without this, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.

Without addressing these issues, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.

This paper makes an important contribution to the growing literatures on EHP in sub-Saharan Africa and Malawi in particular and to the importance of listening to stakeholder perceptions. It provides original data on stakeholder perspectives of the challenges associated with universalising health care in resource-constrained countries. To the best of the authors’ knowledge, it is one of the first papers to focus on the rights of disabled and LBTQ people in relation to EHPs.

Individual Placement and Support (IPS) is an evidence-based employment model, effective in supporting individuals with severe mental health difficulties to gain competitive employment. Irish mental health policy recognises its value and IPS is being rolled out in a national programme. Employment is recognised an important contributor to mental health recovery and social inclusion. However, research on IPS has tended to focus on competitive job outcomes. The purpose of this study was to explore the non-vocational outcomes of IPS in an Irish context.

A qualitative research approach was used to interview participants taking part in IPS within community mental health teams. Twelve interviews were included in the data analysis process which was informed by a thematic analysis approach.

Participants experienced increased confidence and positivity, both within a work context and whilst job seeking. More purposeful time use, participation in activities and engagement with society were also experienced by those employed and those at the job search stage of IPS.

This study contributes to the literature about the non-vocational benefits of IPS within an Irish context, highlights the mental health recovery benefits of taking part in IPS and supports the need for ongoing development of IPS throughout mental health services in Ireland.

In this viewpoint article, the authors recognize the increased focus in health systems on co-design for innovation and change. This article explores the role of leaders and mangers in developing and enhancing a culture of trust in their organizations to enable co-design, with the potential to drive innovation and change in healthcare.

Using social science analyses, the authors argue that current co-design literature has limited focus on interactions between senior leaders and managers, and healthcare staff and service users in supporting co-designed innovation and change. The authors draw on social and health science studies of trust to highlight how the value-based co-design process needs to be supported and enhanced. We outline what co-design innovation and change involve in a health system, conceptualize trust and reflect on its importance within the health system, and finally note the role of senior leaders and managers in supporting trust and responsiveness for co-designed innovation and change.

Healthcare needs leaders and managers to embrace co-design that drives innovation now and in the future through people – leading to better healthcare for society at large. As authors we argue that it is now the time to shift our focus on the role of senior managers and leaders to embed co-design into health and social care structures, through creating and nurturing a culture of trust.

Building public trust in the health system and interpersonal trust within the health system is an ongoing process that relies upon personal behavior of managers and senior leaders, organizational practices within the system, as well as political processes that underpin these practices. By implementing managerial, leadership and individual practices on all levels, senior managers and leaders provide a mechanism to increase both trust and responsiveness for co-design that supports innovation and change in the health system.

The research analyzes the influence of three environmental triggers, i.e. awareness, concern and knowledge on environmental attachment and green motivation that affect tourists' pro-environmental behavior in the Pakistan’s tourism industry. Furthermore, this study has analyzed the moderating role of moral obligation concerning environmental attachment and green motivation on tourists' pro-environmental behavior.

Data were gathered via a structured questionnaire by 237 local (domestic) tourists of Pakistan. Furthermore, the data were examined by employing SmartPLS.

Findings demonstrate that all three environmental triggers have a positive and significant relationship with environmental attachment and green motivation. Accordingly, environmental attachment and green motivation promote tourists' pro-environmental behavior. Furthermore, the moderating role of moral obligations has also been incorporated in the study. The finding reveals a strong and positive relationship among environmental attachment and tourists' pro-environmental behaviors during high moral obligations. In contrast, moral obligations do not moderate association between green motivation and tourists' pro-environmental behavior. Therefore, competent authorities should facilitate tourists to adopt environmentally friendly practices; which will ultimately promote pro-environmental behavior.

This study provides useful insights regarding the role of tourism in fostering environmental attachment and green motivation that sequentially influence tourist pro-environmental behavior. Secondly, this research has employed moral obligations as a moderator to identify the changes in tourists’ pro-environmental behavior based on individuals' ethical considerations. Hence, the study provides an in-depth insight into tourists' behavior. Lastly, the present research offers effective strategies for the tourism sector and other competent authorities to increase green activities that can embed the importance of the environment among individuals.