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Michel Foucault's concept of governmentality has been hugely influential in sociology and other disciplinary fields. However, its application has been criticised by those who suggest it neglects agency, and gives overwhelming power to governmental discourses in constituting subjectivities, determining behaviour and reproducing social reality. Drawing on posthumously translated lecture transcripts, in this article the authors suggest that Foucault's nascent concept of pastoral power offers a route to a better conceptualisation of the relationship between discourse, subjectivity and agency, and a means of understanding the (contested, non-determinate, social) process through which governmental discourses are shaped, disseminated and translated into action. The authors offer empirical examples from their work in healthcare of how this process takes place, present a model of the key mechanisms through which contemporary pastoral power operates, and suggest future research avenues for refining, developing or contesting this model. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples. Methods: A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models. Results: Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury. Conclusion: Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources. [ABSTRACT FROM AUTHOR]

Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a "new" professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, potential, and limitations of professionalism as a means of engaging clinicians in efforts to improve service quality. We found that appeals to notions of professionalism had strong support among practitioners, but converting enthusiasm for the principle of professionalism into motivation to change practice was not straightforward. Some tactics used in pursuit of this deviated sharply from traditional models of collegial social control. In systems characterized by fissures between professional groups and powerful market and managerial influences, we suggest that professionalism must interact creatively but carefully with other logics. [ABSTRACT FROM AUTHOR]

Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a “new” professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, potential, and limitations of professionalism as a means of engaging clinicians in efforts to improve service quality. We found that appeals to notions of professionalism had strong support among practitioners, but converting enthusiasm for the principle of professionalism into motivation to change practice was not straightforward. Some tactics used in pursuit of this deviated sharply from traditional models of collegial social control. In systems characterized by fissures between professional groups and powerful market and managerial influences, we suggest that professionalism must interact creatively but carefully with other logics. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop and pilot an instrument for the assessment of self-injury in adolescent inpatients. Methods: The Self-Injury Motivation Scale was modified for use in adolescents. Thirty-eight consenting adolescent inpatients with a history of self-injury completed the Self-Injury Motivation Scale - Adolescent version (SIMS-A) and the Self-Injury Interview (SII) to collect information about a range of factors associated with self-injury, other clinical variables and demographic details. Results: The SIMS-A was acceptable to this adolescent sample and motivations for self-injury were similar to those of adults using the original SIMS scale. Adolescents were, however, more likely to use self-injury for communicating to/influencing others compared to adults. The participants most frequently reported self-injury by hitting, cutting and burning. The clinical diagnosis most frequently associated with self-injury was major depression. Females reported earlier onset, higher frequency and multiple methods of self-injury compared to males. Distraction from emotional pain was the most common motivation for self-injury in both males and females. Conclusions: This pilot study suggests the SIMS-A is a useful self-report measure to assist clinicians and adolescent patients to understand a behaviour that may be associated with shame, guilt or other difficult emotions for the adolescent. Results also support the contention that there are often multiple and conflicting motivations for self-injury. Self-injury in this population was more common and severe in female adolescents compared to males, while clinical depression was a risk factor for self-injury in both males and females. The small sample size of adolescent inpatients is an important limitation of this pilot study, and research using the SIMS-A in larger samples is warranted. [ABSTRACT FROM AUTHOR]

To examine new strategies which may be implemented to address the significant mental health and substance abuse problems of young people within the juvenile justice system. Wide-ranging literature review of mental health problems within the juvenile justice population is given, illustrating the high prevalence of mental health problems within this cohort of young people. Reference is made to the differing demographics and agendas of the American justice system compared to that found in Australia. It is suggested that new initiatives stemming from quality Australian studies are required in order to facilitate reform within adolescent forensic mental health. Psychiatrists need to be at the forefront of innovative policy delivery within the juvenile justice system. A transdisciplinary approach is required to meet the changing needs of young people within the juvenile justice system. Such a system of care recognizes that these young people and their families have multiple needs that cross traditional boundaries and a collaborative approach across agencies is essential at both the policy and practical level. Psychiatrists have an important role to play in the development of these services. A systemic process to address such needs is offered. [ABSTRACT FROM AUTHOR]

To investigate relationships between firesetting, antisocial behaviour, individual, family and parenting factors in a large community sample of adolescents. A cross-sectional study of students (n = 2596) aged 13 years on average, from 27 schools in South Australia with a questionnaire on firesetting, antisocial behaviour (adapted 21-item Self Report Delinquency Scale), risk-taking, drug use, suicidality, physical and sexual abuse, depressive symptomatology, hopelessness, anxiety, locus of control, self-esteem, family functioning (McMaster Family Assessment Device) and parenting style (Influential Relationships Questionnaire). Data analysis included χ2, anova and logistic regression. Large significant differences are found between firesetters and non-firesetters on all measures. Among adolescents with serious levels of antisocial behaviour (7+ acts included in diagnostic guidelines for DSM-IV conduct disorder), firesetters differ from non-firesetters in reporting more extreme antisocial behaviour (10+ acts), extreme drug use, suicidal behaviour, and perceived failure at school. Gender differences are apparent. A study limitation is the single item assessment of firesetting. Self-report firesetting is strongly associated with extreme antisocial behaviour in young community adolescents, in support of existing evidence from incarcerated delinquent and psychiatric populations. Early detection of community firesetters demands further assessment and intervention. Clinicians should consider its coexistence with serious drug use and high risk-taking (especially in girls), and suicidality, sexual and physical abuse (in boys). [ABSTRACT FROM AUTHOR]

To investigate gender-specific relationships between self-reported sexual abuse, antisocial behaviour and substance use in a large community sample of adolescents. A cross-sectional study of students aged, on average, 13 (n = 2596), 14 (n = 2475) and 15 years (n = 2290), from 27 schools in South Australia with a questionnaire including sexual abuse, frequency and severity of substance use, depressive symptomatology (CES-D), family functioning (McMaster Family Assessment Device), and antisocial behaviour (an adapted 22-item Self-Report Delinquency Scale). Logistic regression analyses using HLM V5.05 with a population-average model were conducted. In the model considered, reported sexual abuse is significantly independently associated with antisocial behaviour, controlling for confounding factors of depressive symptomatology and family dysfunction, with increased risks of three- to eightfold for sexually abused boys, and two- to threefold for sexually abused girls, compared to nonabused. Increased risks of extreme substance use in sexually abused girls (age 13) and boys (ages 13−15) are more than fourfold, compared to nonabused. Age differences were not statistically significant. Childhood sexual abuse is a risk factor for the development of antisocial behaviour and substance use in young adolescents. Clinicians should be aware of gender differences. [ABSTRACT FROM AUTHOR]

The poem "Turning Point" by Graham Martin is presented. First Line: We sit in silence; Last Line: I seek more training.

Non-suicidal self-injury (NSSI) is of increasing concern, yet many adolescents who self-injure are reluctant to seek professional help. Instead, they turn to friends for support, although it is unclear what these friends can offer. This study aimed to identify adolescents’ views of how peers and online friends can help young people who self-injure, and examine differences according to age, gender, and exposure to NSSI. Students (n = 2,637; aged 12-18 years) from 41 schools completed questions asking them to describe what peers and online friends could do to help young people who self-injure. Thematic analysis identified seven strategies, including communication about NSSI with peers and online friends, referral to adults and health professionals, greater public awareness of NSSI, and reduced peer stigma and bullying. Endorsement of themes varied by age, gender, and experience with NSSI. Findings have implications for school prevention of NSSI. [ABSTRACT FROM AUTHOR]

The present study investigates the association of parenting and family factors with nonsuicidal self-injury (NSSI) in preadolescents. A sample of 1,439 preadolescents and their parents were assessed by means of (a) adolescent-reported parenting behaviors (support and behavioral/psychological control), (b) parent-reported parenting behaviors (support and behavioral/psychological control) and parenting stress, and (c) parent-reported family structure, socioeconomic status (SES) of the family, family functioning, and family stressful life-events. The prevalence of NSSI was 4.82%. Preadolescents engaging in NSSI perceived more psychological and behavioral control from their parents. Logistic regression using parent-reported parenting behaviors as covariates showed a significant interaction between parent-reported support and behavioral control in relation to NSSI behaviors. No significant differences in parent-reported parenting stress and family structure emerged. Significant differences in parent-reported SES of families with and without self-injurious preadolescents were found. Finally, no significant associations appeared between the presence of NSSI and parent-reported family functioning and stressful life-events. [ABSTRACT FROM AUTHOR]

Food supplementation can potentially provide additional energy and/or liberate time usually devoted to foraging, enabling birds to invest more in activities, such as nest construction, that provide long-term fitness benefits. Although nest construction can represent large temporal and energetic investments in a breeding attempt, few studies have investigated how it is influenced by food supplementation. We studied the effects of food supplementation on nest construction by Blue Tits (Cyanistes caeruleus) and Great Tits (Parus major). We found that food supplementation advanced nest construction and egg laying in both species. Food supplementation also resulted in truncation of the nest construction period of Blue Tits, but not Great Tits. The duration of the nest-lining period was not influenced by food supplementation in either species. Unexpectedly, food supplementation resulted in significantly shallower nests in Blue Tits but not in Great Tits. We conclude that food availability can constrain nest construction behaviour and that these constraints can be released by the provision of supplementary foods prior to and throughout nest construction. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to clarify the extent to which the recorded marked decline in young male suicide (20–34 years) in Australia since 1998 is attributable to misclassification of cause of death information. Methods: Secular trends in young male suicide rates were investigated for the period 1976–2005. Suicide rates in the period after the peak of the epidemic in this age group (1998) were re-calculated based on published estimates of under-enumeration of suicide data, and misclassification of likely suicide cases to other unintentional and undetermined external causes. Two misclassification scenarios were used to revise young male suicide rates from 1998: previously reported estimates of 9% under-enumeration due to misclassification of unintentional causes of death, and 17% under-enumeration due to misclassification of open cases in addition to unintentional causes of death. All-cause mortality was also examined. Results: Recorded male suicide in the 20–34 year age group increased over the study period, peaking in 1998 at 39 per 100 000, before declining sharply in the period 1999–2005 by 44% to 22 per 100 000 in 2005. Following adjustment for misallocation under the first scenario, suicide rates declined 38% to 24 per 100 000, and under the second scenario declined 33% to 26 per 100 000. Revised suicide rates were not materially different from recorded suicide rates based on 95% confidence intervals over this period. All-cause mortality declined from 1999 due to reductions in suicide and other causes. Conclusion: The recent marked decline in young male suicide in Australia is real. The effects of misallocation of likely suicide cases to other causes did not substantially affect population trends in suicide rates in the period after 1998. There is still a need to account in detail for why young male suicide has declined so substantially during the period after 1998. [ABSTRACT FROM AUTHOR]

Objective: This study examined the risk relationship between depressive symptomatology and suicidal ideation for young adolescent males and females. Method: A large cohort of students in their first year of high school completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Adolescent Suicide Questionnaire. The risk relationship between depressive symptomatology and suicidal ideation was modelled using non-parametric kernel-smoothing techniques. Results: Suicidal ideation was more frequently reported by females compared with males which was partly explained by females having higher mean depression scores. At moderate levels of depression females also had a significantly higher risk of suicidal ideation compared with males and this increased risk contributed to the overall higher levels of female ideation. Conclusions: The risk relationship between depressive symptomatology and suicidal ideation is different for young adolescent males and females. The results indicate that moderate levels of depressive symptomatology can be associated with suicidal ideation (especially among young females) and that for these young people a suicide risk assessment is required. [ABSTRACT FROM AUTHOR]

Objective: To describe the evolution, structure and outcomes of Gundhu Adolescent Wing, Toowoomba, Queensland, which comprises six dedicated beds set aside during development of a new rural acute mental health unit.Methods: All adolescents discharged from Gundhu in its first 7 months were included in the study. Data pertaining to patient characteristics, model of service delivery, length of inpatient stay and outcome at 7 months were obtained.Results: Thirty-three adolescents with mental illness living in the rural area were discharged from Gundhu in the first 7 months. For the 23 adolescents who stayed on the unit <14 days, outcome at 7 months after discharge was generally favourable. Six adolescents with length of stay of >or=30 days did less well, but made similar progress to patients in tertiary units.Conclusions: From the authors' experience, designating a small number of beds as adolescent within a rural acute mental health unit is an effective intervention for short-stay patients and is valued by adolescents and their families. Keeping the adolescent unit separate is beneficial even at the expense of foregoing access to space and facilities enjoyed by adult patients. Involving families early to provide off-ward fun, exercise and socialization with peers is important. Rural services tend to have high staff turnover. Involving rural general practitioners in follow-up plans may ensure better continuity of care after discharge. [ABSTRACT FROM AUTHOR]

Focuses on a study which explored the child assessment model of the Initial Consultations initiative of the South Australian Child and Adolescent Mental Health Services Program Committee. Background on Initial Consultations; Methodology of the study; Results and discussion.