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The concept of user participation is well accepted internationally. Nevertheless, studies show that both patients and health professionals find it challenging to maintain patient-centred ideals in the context of severe mental illness. The purpose of this paper is to explore how professionals deal with the ideals in light of patients’ right to participate in planning and decision making regarding milieu therapeutic measures and activities.

This is a qualitative study with an interactionist approach based on fieldwork at three district psychiatric centres in Norway during 2011-2012. The observations focused on patient-staff interaction in milieu therapeutic activities. Interviews were based on observed situations.

Adherence to treatment, rules and routines restricted patient autonomy. The professionals’ practical orientation towards routines overrode the ideals of patients’ rights. The staff regarded user participation primarily as participation in organised and mandatory activities. Refusal to comply was met with different sanctions, e.g. the prospect of being discharged.

Although user participation calls for patient-centred approaches, there is some debate about the challenges and premises for cooperation with persons suffering from severe mental conditions. This study adds insight into the everyday organisational context that facilitates or impedes user participation. It helps to explain why the user perspective can be overlooked, thus providing important information to both clinicians and policy makers who aim to fulfil the patient’s right to participate in planning and decision making regarding treatment and care.

The purpose of this paper is to understand the impact of participation in sustainable agricultural intensification practices (SAIPs) on household food security status in Northwestern Ghana.

The study utilised the Household Food Insecurity Access Scale (HFIAS) indicator for the measurement of food access data from 168 households in ten communities from the Northwestern region of Ghana for the analyses. Households were categorised into participating households (treatment) and non-participating households (control). The endogenous treatment effects model was employed to evaluate the impact of participation in SAIPs training on food insecurity access scale.

The results show that participation in SAIPs training lowers, on average, the household food insecurity access by 2.95 points, approximately an 11 per cent reduction in HFIAS score. Other significant factors found to influence household food insecurity access scale are age of household head, experience in farming, total acres owned by household, income level of the household and occupation of the head of the household.

The training programme of participation in SAIPs has massive implications for food security, rural economy and farmers’ livelihoods. However, due to the unique conditions prevailing in Northwestern Ghana, the findings of this research are limited in terms of their generalisability. Future research direction in the area of SAIPs trainings and impact study replications in all qualifying rural food production areas in Ghana, which are susceptible to household food insecurity, will provide a national picture of the efficacy of SAIPs trainings on household food insecurity.

A proven means to decrease natural resource degradation, increase crops yields, and increase subsistence farmers’ income, and food security is an important intervention to resolve the seasonal food shortage, which last for five months in a typical year for agro-food-dependent farming communities in Northwestern Ghana.

Ensuring household food security improvement and environmental sustainability will help improve living standards of food producers and reduce the adverse social challenges associated with food insecure communities such as health problems due to food deficiencies, social inequalities, environmental pollution and natural resource degradation in Northwestern Ghana.

The contribution of this paper is the novel thought and approach to examine the impact of the SAIPs trainings on household food security in Northwestern Ghana using the household food insecurity access scale indicator. The study also examined the factors that affect household food security using the endogenous treatment model, which also evaluates the impact of the training programme on the outcome variable.

The aims of this paper are to measure the impacts of subsidy, work experience and training programmes on New Zealand male registered unemployed, and to examine the sensitivity of these estimates to the amount of time that participants are followed after an intervention.

The impact of an intervention on those who participate in an active labour market programme is the key question addressed in this paper. A New Zealand panel data set is used, which includes both intervention and individual characteristics of the unemployed. Both a potential outcomes and single nearest‐neighbour difference‐in‐differences matching approach are used to estimate the impact of participation.

The key findings are that work experience programmes are the most effective in the short‐term. Training programmes are the least effective. Programmes are more effective for the long‐term unemployed than for short‐term unemployed. The results are sensitive to the point of time examined in the post‐intervention period, with short‐term benefits disappearing completely three years after the intervention.

This paper examines the relative effect of active labour market programmes in New Zealand using a consistent evaluation framework. The sensitivity of the results to different time periods, and matching estimator specifications are examined.

Despite the importance of increasing engagement and minimising attrition and drop‐out in parenting interventions, there is a paucity of empirical evidence examining factors related to engagement and participation. The range of factors examined in relation to engagement is generally limited in scope and variety, focusing on variables of convenience rather than utilising a theoretically‐driven approach.The aim of this article is to review the factors related to parental engagement with interventions and to describe strategies and implications for improving engagement with parenting interventions. Several policy and practice implications are identified: (1) Poor parental engagement may threaten or compromise the capacity of parenting programmes to deliver valued outcomes. Viable engagement strategies need to be a core part of prevention and early intervention parenting programmes; (2) Agencies delivering parenting services need a proactive engagement strategy, which includes strategies to prevent drop‐out, as well as strategies to actively respond to parental disengagement; (3) Research is needed to test the efficacy and robustness of different engagement enhancement strategies. Empirical tests are needed to test the effectiveness of different engagement strategies in order to ensure that the most efficient, cost‐effective and efficacious approach is used in order to engage parents. Investment of research effort to improve parental engagement is likely to have a high yield in terms of programme efficiency, utility and cost effectiveness. We conclude that research examining how to improve engagement and decrease non‐completion is needed to strengthen the population level value of parenting programmes as preventive interventions.

Effective substance use treatment is a viable way to reduce criminal justice contact among drug-involved offenders, but there is still a lot to learn about which indicators have the greatest impact on treatment outcomes. The purpose of this paper is to determine which clinical indicators influenced the likelihood of rearrest among male drug-involved offenders.

This prospective longitudinal study examined indicators of 12-month post-treatment rearrest for male criminal justice-involved substance use treatment patients. Multinomial logistic regression results drawn from a sample of 1,531 adult male patients who were mandated to substance use treatment indicated that there were different factors related to the likelihood of one as well as multiple post-treatment arrests.

Demographic risk factors, such as age and unemployment, were associated with significant increases in the probability of experiencing an arrest within 12-months of treatment discharge. Substance use relapse was also a significant indicator of the likelihood of rearrest and contributed to an increase in the odds of one post-treatment rearrest as well as multiple rearrests. A drug dependence diagnosis, relative to a diagnosis for alcohol dependence, was associated with an increased likelihood of rearrest. Participation in outpatient treatment was associated with a lower likelihood of rearrest.

These findings emphasize the need for treatment providers to concentrate heavily on demographic risk reduction to minimize the chance that male patients are rearrested after treatment. Relapse prevention, on the other hand, is critical in the effort to minimize the number of post-treatment rearrests in this population.

The results from this study provide evidence to empirically support the refinement of substance treatment programs for male patients involved in the criminal justice system.

Purpose – This study tracks the legal control of the problem of substance abuse.

Methodology/Approach – The chapter explores the “natural history” of the evolution of the social construction of drug use and our collective response to it. Over the past 100 years, our understanding of drug use/abuse and the system for handling drug problems have gone through a series of changes. In the past 20 years or so, provision of treatment for drug offenders within the criminal justice system has rapidly expanded. California's recently enacted Proposition 36 (Prop 36) initiates for the first time on a mass basis the court-supervised drug treatment that began a decade earlier on a much smaller scale with the original drug courts. This chapter compares the Prop 36 program for diverting nonviolent drug offenders into court-supervised treatment with the original drug courts.

Findings – The research shows how court-supervised drug treatment has evolved from a personalized care program in the original drug courts to a mass processing operation under Prop 36. The research finds that the social problem solution of offering treatment to more drug defendants created its own unanticipated consequences and problems, including significant standardization in the operations of the court and a dilution of many useful features that defined the early drug courts.

Practical implications – “Farming out” drug defendants to probation and treatment makes case-processing and treatment potentially less effective therapeutically. The chapter raises questions about how social control can extend its domain without “breaking the bank” and what the consequences are for how social problems are handled.

Dual diagnosis is a term that describes the co-occurrence of mental health disorders or illness and substance use or abuse disorders. Because this co-occurrence results in multiple diseases, layers of treatment are often needed to successfully create positive change in the individual. The purpose of this study is to explore factors of treatment that could facilitate improvements in functionality and quality of life for those with a dual diagnosis.

A secondary data analysis, using both quantitative and qualitative data, was completed. Secondary analysis is an empirical exercise that applies the same basic research principles as studies using primary data and has steps to be followed, including the evaluative and procedural steps commonly associated with secondary data analysis. Documentation data from the intensive mobile psychosocial assertive community treatment program was gathered for this analysis; this program was used because of the intensive and community-based services provided to patients with a dual diagnosis.

The major findings from this secondary analysis suggested that significant barriers included “denial” (e.g. evasion, suspension or avoidance of internal awareness) of diagnoses, complicated treatment and other barriers related to housing. Ultimately, these findings provided greater insight into potential effective treatment interventions for people living with a dual diagnosis.

This study adds to the growing body of literature showing that patient-centered care allows for more effective treatment and ultimately, improved health outcomes.

The Millfields unit is one of three medium secure hospital services on the Offender Personality Disorder (OPD) pathway, for the assessment and treatment of high-risk offenders who are likely to meet criteria for this diagnosis. This study has designed an audit to examine influencers of patient engagement within Millfields, whose treatment approach is that of an adapted therapeutic community (TC). The purpose of this study was to explore themes raised by patients in relation to engagement, drivers for and barriers to engagement and to make recommendations for improvement.

The first author engaged in ward and group observations, a review of each patient’s medical records, unstructured discussions with staff and semi-structured interviews with each patient exploring their experiences of therapy, relationships with staff, understanding of and engagement with the treatment model, attitudes towards peers and aspirations for the future. Themes were generated from the transcription of interviews and subsequent mind mapping.

In total, 12 of the 13 patients engaged in the semi-structured interviews. Six main themes were identified as being important influencers of engagement: the ward atmosphere, authenticity of engagement, perception of staff investment in the treatment, preferential treatment of senior residents, responses to boundary crosses and violations and the level of understanding a patient had of his treatment.

Research into engagement with psychosocial therapies in patients who have personality disorders has recently been published by Tetley et al. (2012) and Jinks et al. (2012). This study specifically focusses on TC engagement and male offenders with personality disorders.

Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context.

The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included.

The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce.

The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care.

The authors highlight several limitations and challenges for the measurement of SDM in mental health care.