Category: Mental Health

What is Negativity Bias?

Published on by Andrew Marshall1 Comment

Introduction

The negativity bias, also known as the negativity effect, is a cognitive bias that, even when of equal intensity, things of a more negative nature (e.g. unpleasant thoughts, emotions, or social interactions; harmful/traumatic events) have a greater effect on one’s psychological state and processes than neutral or positive things.

In other words, something very positive will generally have less of an impact on a person’s behaviour and cognition than something equally emotional but negative. The negativity bias has been investigated within many different domains, including the formation of impressions and general evaluations; attention, learning, and memory; and decision-making and risk considerations.

Refer to Positivity Offset.

Explanations

Paul Rozin and Edward Royzman proposed four elements of the negativity bias in order to explain its manifestation: negative potency, steeper negative gradients, negativity dominance, and negative differentiation.

Negative potency refers to the notion that, while possibly of equal magnitude or emotionality, negative and positive items/events/etc. are not equally salient. Rozin and Royzman note that this characteristic of the negativity bias is only empirically demonstrable in situations with inherent measurability, such as comparing how positively or negatively a change in temperature is interpreted.

With respect to positive and negative gradients, it appears to be the case that negative events are thought to be perceived as increasingly more negative than positive events are increasingly positive the closer one gets (spatially or temporally) to the affective event itself. In other words, there is a steeper negative gradient than positive gradient. For example, the negative experience of an impending dental surgery is perceived as increasingly more negative the closer one gets to the date of surgery than the positive experience of an impending party is perceived as increasingly more positive the closer one gets to the date of celebration (assuming for the sake of this example that these events are equally positive and negative). Rozin and Royzman argue that this characteristic is distinct from that of negative potency because there appears to be evidence of steeper negative slopes relative to positive slopes even when potency itself is low.

Negativity dominance describes the tendency for the combination of positive and negative items/events/etc. to skew towards an overall more negative interpretation than would be suggested by the summation of the individual positive and negative components. Phrasing in more Gestalt-friendly terms, the whole is more negative than the sum of its parts.

Negative differentiation is consistent with evidence suggesting that the conceptualization of negativity is more elaborate and complex than that of positivity. For instance, research indicates that negative vocabulary is more richly descriptive of the affective experience than that of positive vocabulary. Furthermore, there appear to be more terms employed to indicate negative emotions than positive emotions. The notion of negative differentiation is consistent with the mobilisation-minimisation hypothesis, which posits that negative events, as a consequence of this complexity, require a greater mobilisation of cognitive resources to deal with the affective experience and a greater effort to minimise the consequences.

Evidence

Social Judgements and Impression Formation

Most of the early evidence suggesting a negativity bias stems from research on social judgments and impression formation, in which it became clear that negative information was typically more heavily weighted when participants were tasked with forming comprehensive evaluations and impressions of other target individuals. Generally speaking, when people are presented with a range of trait information about a target individual, the traits are neither “averaged” nor “summed” to reach a final impression. When these traits differ in terms of their positivity and negativity, negative traits disproportionately impact the final impression. This is specifically in line with the notion of negativity dominance (refer to “Explanations” above).

As an example, a famous study by Leon Festinger and colleagues investigated critical factors in predicting friendship formation; the researchers concluded that whether or not people became friends was most strongly predicted by their proximity to one another. Ebbesen, Kjos, and Konecni, however, demonstrated that proximity itself does not predict friendship formation; rather, proximity serves to amplify the information that is relevant to the decision of either forming or not forming a friendship. Negative information is just as amplified as positive information by proximity. As negative information tends to outweigh positive information, proximity may predict a failure to form friendships even more so than successful friendship formation.

One explanation that has been put forth as to why such a negativity bias is demonstrated in social judgements is that people may generally consider negative information to be more diagnostic of an individual’s character than positive information, that it is more useful than positive information in forming an overall impression. This is supported by indications of higher confidence in the accuracy of one’s formed impression when it was formed more on the basis of negative traits than positive traits. People consider negative information to be more important to impression formation and, when it is available to them, they are subsequently more confident.

An oft-cited paradox, a dishonest person can sometimes act honestly while still being considered to be predominantly dishonest; on the other hand, an honest person who sometimes does dishonest things will likely be reclassified as a dishonest person. It is expected that a dishonest person will occasionally be honest, but this honesty will not counteract the prior demonstrations of dishonesty. Honesty is considered more easily tarnished by acts of dishonesty. Honesty itself would then be not diagnostic of an honest nature, only the absence of dishonesty.

The presumption that negative information has greater diagnostic accuracy is also evident in voting patterns. Voting behaviours have been shown to be more affected or motivated by negative information than positive: people tend to be more motivated to vote against a candidate because of negative information than they are to vote for a candidate because of positive information. As noted by researcher Jill Klein, “character weaknesses were more important than strengths in determining…the ultimate vote”.

This diagnostic preference for negative traits over positive traits is thought to be a consequence of behavioural expectations: there is a general expectation that, owing to social requirements and regulations, people will generally behave positively and exhibit positive traits. Contrastingly, negative behaviours/traits are more unexpected and, thus, more salient when they are exhibited. The relatively greater salience of negative events or information means they ultimately play a greater role in the judgement process.

Attribution of Intentions

Studies reported in a paper in the Journal of Experimental Psychology: General by Carey Morewedge (2009) found that people exhibit a negativity bias in attribution of external agency, such that they are more likely to attribute negative outcomes to the intentions of another person than similar neutral and positive outcomes. In laboratory experiments, Morewedge found that participants were more likely to believe that a partner had influenced the outcome of a gamble in when the participants lost money than won money, even when the probability of winning and losing money was held even. This bias is not limited to adults. Children also appear to be more likely to attribute negative events to intentional causes than similarly positive events.

Cognition

As addressed by negative differentiation, negative information seems to require greater information processing resources and activity than does positive information; people tend to think and reason more about negative events than positive events. Neurological differences also point to greater processing of negative information: participants exhibit greater event-related potentials when reading about, or viewing photographs of, people performing negative acts that were incongruent with their traits than when reading about incongruent positive acts. This additional processing leads to differences between positive and negative information in attention, learning, and memory.

Attention

A number of studies have suggested that negativity is essentially an attention magnet. For example, when tasked with forming an impression of presented target individuals, participants spent longer looking at negative photographs than they did looking at positive photographs. Similarly, participants registered more eye blinks when studying negative words than positive words (blinking rate has been positively linked to cognitive activity). Also, people were found to show greater orienting responses following negative than positive outcomes, including larger increases in pupil diameter, heart rate, and peripheral arterial tone.

Importantly, this preferential attendance to negative information is evident even when the affective nature of the stimuli is irrelevant to the task itself. The automatic vigilance hypothesis has been investigated using a modified Stroop task. Participants were presented with a series of positive and negative personality traits in several different colours; as each trait appeared on the screen, participants were to name the colour as quickly as possible. Even though the positive and negative elements of the words were immaterial to the colour-naming task, participants were slower to name the colour of negative traits than they were positive traits. This difference in response latencies indicates that greater attention was devoted to processing the trait itself when it was negative.

Aside from studies of eye blinks and colour naming, Baumeister and colleagues noted in their review of bad events versus good events that there is also easily accessible, real-world evidence for this attentional bias: bad news sells more papers and the bulk of successful novels are full of negative events and turmoil. When taken in conjunction with the laboratory-based experiments, there is strong support for the notion that negative information generally has a stronger pull on attention than does positive information.

Learning and Memory

Learning and memory are direct consequences of attentional processing: the more attention is directed or devoted toward something, the more likely it is that it will be later learned and remembered. Research concerning the effects of punishment and reward on learning suggests that punishment for incorrect responses is more effective in enhancing learning than are rewards for correct responses—learning occurs more quickly following bad events than good events.

Drs. Pratto and John addressed the effects of affective information on incidental memory as well as attention using their modified Stroop paradigm (see section concerning “Attention”). Not only were participants slower to name the colours of negative traits, they also exhibited better incidental memory for the presented negative traits than they did for the positive traits, regardless of the proportion of negative to positive traits in the stimuli set.

Intentional memory is also impacted by the stimuli’s negative or positive quality. When studying both positive and negative behaviours, participants tend to recall more negative behaviours during a later memory test than they do positive behaviours, even after controlling for serial position effects. There is also evidence that people exhibit better recognition memory and source memory for negative information.

When asked to recall a recent emotional event, people tend to report negative events more often than they report positive events, and this is thought to be because these negative memories are more salient than are the positive memories. People also tend to underestimate how frequently they experience positive affect, in that they more often forget the positively emotional experiences than they forget negatively emotional experiences.

Decision-Making

Studies of the negativity bias have also been related to research within the domain of decision-making, specifically as it relates to risk aversion or loss aversion. When presented with a situation in which a person stands to either gain something or lose something depending on the outcome, potential costs were argued to be more heavily considered than potential gains. The greater consideration of losses (i.e. negative outcomes) is in line with the principle of negative potency as proposed by Rozin and Royzman. This issue of negativity and loss aversion as it relates to decision-making is most notably addressed by Drs. Daniel Kahneman’s and Amos Tversky’s prospect theory.

However, it is worth noting that Rozin and Royzman were never able to find loss aversion in decision making. They wrote, “in particular, strict gain and loss of money does not reliably demonstrate loss aversion”. This is consistent with the findings of a recent review of more than 40 studies of loss aversion focusing on decision problems with equal sized gains and losses. In their review, Yechiam and Hochman (2013) did find a positive effect of losses on performance, autonomic arousal, and response time in decision tasks, which they suggested is due to the effect of losses on attention. This was labelled by them as loss attention.

Politics

Research points to a correlation between political affiliation and negativity bias, where conservatives are more sensitive to negative stimuli and therefore tend to lean towards right-leaning ideology which considers threat reduction and social-order to be its main focus. Individuals with lower negativity bias tend to lean towards liberal political policies such as pluralism and are accepting of diverse social groups which by proxy could threaten social structure and cause greater risk of unrest.

Lifespan Development

Infancy

Although most of the research concerning the negativity bias has been conducted with adults (particularly undergraduate students), there have been a small number of infant studies also suggesting negativity biases.

Infants are thought to interpret ambiguous situations on the basis of how others around them react. When an adult (e.g. experimenter, mother) displays reactions of happiness, fear, or neutrality towards target toys, infants tend to approach the toy associated with the negative reaction significantly less than the neutral and positive toys. Furthermore, there was greater evidence of neural activity when the infants were shown pictures of the “negative” toy than when shown the “positive” and “neutral” toys. Although recent work with 3-month-olds suggests a negativity bias in social evaluations, as well, there is also work suggesting a potential positivity bias in attention to emotional expressions in infants younger than 7 months. A review of the literature conducted by Drs. Amrisha Vaish, Tobias Grossman, and Amanda Woodward suggests the negativity bias may emerge during the second half of an infant’s first year, although the authors also note that research on the negativity bias and affective information has been woefully neglected within the developmental literature.

Aging and Older Adults

Some research indicates that older adults may display, at least in certain situations, a positivity bias or positivity effect. Proposed by Dr. Laura Carstensen and colleagues, the socioemotional selectivity theory outlines a shift in goals and emotion regulation tendencies with advancing age, resulting in a preference for positive information over negative information. Aside from the evidence in favour of a positivity bias, though, there have still been many documented cases of older adults displaying a negativity bias.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Negativity_bias >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Positivity Offset?

Published on by Andrew Marshall2 Comments

Introduction

In psychology, the positivity offset is a phenomenon where people tend to interpret neutral situations as mildly positive, and rate their lives as good, most of the time. The positivity offset stands in notable asymmetry to the negativity bias.

Refer to Hedonic Treadmill and Negativity Bias.

Similarities and Differences to Negativity Bias

Two studies were presented within a single study that looked at the difference between positivity offset and negative bias to see if it is good or bad for some people. The first study measured an individual’s reactions to different stimuli such as pictures, sounds, and words. The results from this study have also seen evidence, in comparison to other studies, that the positivity offset is in favour of positive stimuli over negative stimuli. The opposite effect is true for negative bias. An interesting observation that was made in this study was that positivity offset and negative bias was predicted in different behaviours rather than from established measures focused on personality. The second study sought to replicate the findings and compare those to the findings that have been found in other studies. The result of this study has also found evidence to suggest that positivity offset is preferred when the affective level input is not significant, whereas negative bias is favoured when the level of input is significant. One of the keys to understanding both the positivity offset and the negative bias is that the inputs of both are not meant to be separate, but both exist within the affective input level. The affective input level is a process to see what effect a certain stimulus has on an individual.

Two measures that have been used to look at the validity of both positivity offset and negative bias are based on judgement and personality. The measure of judgement focused on if there was a connection between locations of both spatial and affect. In other words, they measure to see if an individual understands what the stimulus is and how it affects them. The personality measure, on the other hand, speculates whether an individual defines a stimulus as being either positive or negative.

Positivity Offset and Negativity Bias in Depression

Regarding depression, there has been evidence to suggest that there is a connection between positivity offset and negative bias affecting the way that stimuli are perceived. The negative bias had a stronger influence than the positivity offset when the participants were depressed. For those who were healthy individuals, the results of both positivity offset, and negative bias were the same. This suggests that the positivity offset occurs when someone’s mind is considered to be healthy. The researchers go on to mention that their results regarding those individuals who were on the depressed side showed evidence that pleasing or neutral stimuli as being less positive compared to the results of the healthy individuals. The results of this study do show similarity to that of other studies in that positive emotions are not likely found in those who are in a depressed state. Those who are depressed may have an aversive side, but their motivational side to do things is not there. The concepts of both positivity offset and negative bias can also be analysed from an element of positive valence.

It is proposed that if this element is defined as being inactive, then there will be more assessments of stimuli that are perceived as being negative rather than as positive. While there may be more ratings with the negative stimuli, at the same time, assessments for positive stimuli of positive valence are hindered. This is the case even with stimuli that are in the middle that is perceived with positivity offset.

In Perception

Social neuroscience researcher John Cacioppo has assembled evidence that people typically see their surroundings as positive, whenever a clear threat is not present. Because of the positivity offset, people are motivated to explore and engage with their surroundings, instead of being balanced inactive between approach and avoidance.

In Life Satisfaction

Across most cultures, nations, and groups of people, the average and median ratings of life satisfaction are not neutral, as one might expect, but mildly positive.

Groups of people who do not show a positivity offset include people with depression, people in severe poverty, and people who live in perpetually threatening situations. However, many groups of people that outsiders would not expect to show the positivity offset do, such as people with paraplegia and spinal injury, very elderly people, and people with many chronic illnesses. In some cases these individuals never become as satisfied or happy with their lives as before their illness or injury, but over time (generally approximately two years), they still stabilise at a level substantially above neutral. That is, they judge themselves overall as satisfied or happy and not dissatisfied or unhappy.

Many of the major psychological publications on life satisfaction ratings have come from Ed Diener and colleagues. This empirical work gathered life-satisfaction judgements from many modern and traditional cultures worldwide.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Positivity_offset >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is a Hedonic Treadmill?

Published on by Andrew Marshall1 Comment

Introduction

The hedonic treadmill, also known as hedonic adaptation, is the observed tendency of humans to quickly return to a relatively stable level of happiness despite major positive or negative events or life changes.

According to this theory, as a person makes more money, expectations and desires rise in tandem, which results in no permanent gain in happiness. Philip Brickman and Donald T. Campbell coined the term in their essay “Hedonic Relativism and Planning the Good Society” (1971). The hedonic treadmill viewpoint suggests that wealth does not increase the level of happiness.

Refer to Positivity Offset.

Overview

Hedonic adaptation is a process or mechanism that reduces the affective impact of emotional events. Generally, hedonic adaptation involves a happiness “set point”, whereby humans generally maintain a constant level of happiness throughout their lives, despite events that occur in their environment. The process of hedonic adaptation is often conceptualised as a treadmill, since no matter how hard one tries to gain an increase in happiness, one will remain in the same place.

Hedonic adaptation can occur in a variety of ways. Generally, the process involves cognitive changes, such as shifting values, goals, attention and interpretation of a situation. Further, neurochemical processes desensitise overstimulated hedonic pathways in the brain, which possibly prevents persistently high levels of intense positive or negative feelings. The process of adaptation can also occur through the tendency of humans to construct elaborate rationales for considering themselves deprived through a process social theorist Gregg Easterbrook calls “abundance denial”.

Major Theoretical Approaches

Behavioural/Psychological Approach

“Hedonic treadmill” is a term coined by Brickman and Campbell in their article, “Hedonic Relativism and Planning the Good Society” (1971), describing the tendency of people to keep a fairly stable baseline level of happiness despite external events and fluctuations in demographic circumstances. The idea of relative happiness had been around for decades when in 1978 Brickman, et al., began to approach hedonic pleasure within the framework of Helson’s adaptation level theory, which holds that perception of stimulation is dependent upon comparison of former stimulations. The hedonic treadmill functions similarly to most adaptations that serve to protect and enhance perception. In the case of hedonics, the sensitization or desensitization to circumstances or environment can redirect motivation. This reorientation functions to protect against complacency, but also to accept unchangeable circumstances, and redirect efforts towards more effective goals. Frederick and Lowenstein classify three types of processes in hedonic adaptation: shifting adaptation levels, desensitisation, and sensitisation. Shifting adaptation levels occurs when a person experiences a shift in what is perceived as a “neutral” stimulus, but maintains sensitivity to stimulus differences. For example, if Sam gets a raise he will initially be happier, and then habituate to the larger salary and return to his happiness set point. But he will still be pleased when he gets a holiday bonus. Desensitisation decreases sensitivity in general, which reduces sensitivity to change. Those who have lived in war zones for extended periods of time may become desensitised to the destruction that happens on a daily basis, and be less affected by the occurrence of serious injuries or losses that may once have been shocking and upsetting. Sensitization is an increase of hedonic response from continuous exposure, such as the increased pleasure and selectivity of connoisseurs for wine, or food.

Brickman, Coates, and Janoff-Bulman were among the first to investigate the hedonic treadmill in their 1978 study, “Lottery Winners and Accident Victims: Is Happiness Relative?”. Lottery winners and paraplegics were compared to a control group and as predicted, comparison (with past experiences and current communities) and habituation (to new circumstances) affected levels of happiness such that after the initial impact of the extremely positive or negative events, happiness levels typically went back to the average levels. This interview-based study, while not longitudinal, was the beginning of a now large body of work exploring the relativity of happiness.

Brickman and Campbell originally implied that everyone returns to the same neutral set point after a significantly emotional life event. In the literature review, “Beyond the Hedonic Treadmill, Revising the Adaptation Theory of Well-Being” (2006), Diener, Lucas, and Scollon concluded that people are not hedonically neutral, and that individuals have different set points which are at least partially heritable. They also concluded that individuals may have more than one happiness set point, such as a life satisfaction set point and a subjective well-being set point, and that because of this, one’s level of happiness is not just one given set point but can vary within a given range. Diener and colleagues point to longitudinal and cross-sectional research to argue that happiness set point can change, and lastly that individuals vary in the rate and extent of adaptation they exhibit to change in circumstance.

Empirical Studies

In a longitudinal study conducted by Mancini, Bonnano, and Clark, people showed individual differences in how they responded to significant life events, such as marriage, divorce and widowhood. They recognised that some individuals do experience substantial changes to their hedonic set point over time, though most others do not, and argue that happiness set point can be relatively stable throughout the course of an individual’s life, but the life satisfaction and subjective well-being set points are more variable.

Similarly, the longitudinal study conducted by Fujita and Diener (2005) described the life satisfaction set point as a “soft baseline”. This means that for most people, this baseline is similar to their happiness baseline. Typically, life satisfaction will hover around a set point for the majority of their lives and not change dramatically. However, for about a quarter of the population this set point is not stable, and does indeed move in response to a major life event. Other longitudinal data has shown that subjective well-being set points do change over time, and that adaptation is not necessarily inevitable. In his archival data analysis, Lucas found evidence that it is possible for someone’s subjective well-being set point to change drastically, such as in the case of individuals who acquire a severe, long term disability. However, as Diener, Lucas, and Scollon point out, the amount of fluctuation a person experiences around their set point is largely dependent on the individual’s ability to adapt.

After following over a thousand sets of twins for 10 years, Lykken and Tellegen (1996) concluded that almost 50% of our happiness levels are determined by genetics. Headey and Wearing (1989) suggested that our position on the spectrum of the stable personality traits (neuroticism, extraversion, and openness to experience) accounts for how we experience and perceive life events, and indirectly contributes to our happiness levels. Research on happiness has spanned decades and crossed cultures in order to test the true limits of our hedonic set point.

In large panel studies, divorce, death of a spouse, unemployment, disability, and similar events have been shown to change the long-term subjective well-being, even though some adaptation does occur and inborn factors affect this.

In the aforementioned Brickman study (1978), researchers interviewed 22 lottery winners and 29 paraplegics to determine their change in happiness levels due to their given event (winning lottery or becoming paralysed). The event in the case of lottery winners had taken place between one month and one and a half years before the study, and in the case of paraplegics between a month and a year. The group of lottery winners reported being similarly happy before and after the event, and expected to have a similar level of happiness in a couple of years. These findings show that having a large monetary gain had no effect on their baseline level of happiness, for both present and expected happiness in the future. They found that the paraplegics reported having a higher level of happiness in the past than the rest (due to a nostalgia effect), a lower level of happiness at the time of the study than the rest (although still above the middle point of the scale, that is, they reported being more happy than unhappy) and, surprisingly, they also expected to have similar levels of happiness than the rest in a couple of years. One must note that the paraplegics did have an initial decrease in life happiness, but the key to their findings is that they expected to eventually return to their baseline in time.

In a newer study (2007), winning a medium-sized lottery prize had a lasting mental wellbeing effect of 1.4 GHQ points on Britons even two years after the event.

Some research suggests that resilience to suffering is partly due to a decreased fear response in the amygdala and increased levels of BDNF in the brain. New genetic research have found that changing a gene could increase intelligence and resilience to depressing and traumatising events. This could have crucial benefits for those with anxiety and PTSD.

Recent research reveals certain types of brain training can increase brain size. The hippocampus volume can affect mood, hedonic setpoints, and some forms of memory. A smaller hippocampus has been linked to depression and dysthymia. Certain activities and environmental factors can reset the hedonic setpoint and also grow the hippocampus to an extent. London taxi drivers’ hippocampi grow on the job, and the drivers have a better memory than those who did not become taxi drivers. In particular, the posterior hippocampus seemed to be the most important for enhanced mood and memory.

Lucas, Clark, Georgellis, and Diener (2003) researched changes in baseline level of well-being due to changes in marital status, the birth of first child, and the loss of employment. While they found that a negative life event can have a greater impact on a person’s psychological state and happiness set point than a positive event, they concluded that people completely adapt, finally returning to their baseline level of well-being, after divorce, losing a spouse, the birth of a child, and for women losing their job. They did not find a return to baseline for marriage or for layoffs in men. This study also illustrated that the amount of adaptation depends on the individual.

Wildeman, Turney, and Schnittker (2014) studied the effects of imprisonment on one’s baseline level of well-being. They researched how being in jail affects one’s level of happiness both short term (while in prison) and long term (after being released). They found that being in prison has negative effects on one’s baseline well-being; in other words one’s baseline of happiness is lower in prison than when not in prison. Once people were released from prison, they were able to bounce back to their previous level of happiness.

Silver (1982) researched the effects of a traumatic accident on one’s baseline level of happiness. Silver found that accident victims were able to return to a happiness set point after a period of time. For eight weeks, Silver followed accident victims who had sustained severe spinal cord injuries. About a week after their accident, Silver observed that the victims were experiencing much stronger negative emotions than positive ones. By the eighth and final week, the victims’ positive emotions outweighed their negative ones. The results of this study suggest that regardless of whether the life event is significantly negative or positive, people will almost always return to their happiness baseline.

Fujita and Diener (2005) studied the stability of one’s level of subjective well-being over time and found that for most people, there is a relatively small range in which their level of satisfaction varies. They asked a panel of 3,608 German residents to rate their current and overall satisfaction with life on a scale of 0–10, once a year for seventeen years. Only 25% of participants exhibited shifts in their level of life satisfaction over the course of the study, with just 9% of participants having experienced significant changes. They also found that those with a higher mean level of life satisfaction had more stable levels of life satisfaction than those with lower levels of satisfaction.

Applications

Happiness Set Point

The concept of the happiness set point (proposed by Sonja Lyubomirsky) can be applied in clinical psychology to help patients return to their hedonic set point when negative events happen. Determining when someone is mentally distant from their happiness set point and what events trigger those changes can be extremely helpful in treating conditions such as depression. When a change occurs, clinical psychologists work with patients to recover from the depressive spell and return to their hedonic set point more quickly. Because acts of kindness often promote long-term well-being, one treatment method is to provide patients with different altruistic activities that can help a person raise his or her hedonic set point. This can in turn be helpful in reducing reckless habits in the pursuit of well-being. Further, helping patients understand that long-term happiness is relatively stable throughout one’s life can help to ease anxiety surrounding impactful events.

Resilience Research

Hedonic adaptation is also relevant to resilience research. Resilience is a “class of phenomena characterised by patterns of positive adaptation in the context of significant adversity or risk,” meaning that resilience is largely the ability for one to remain at their hedonic setpoint while going through negative experiences. Psychologists have identified various factors that contribute to a person being resilient, such as positive attachment relationships (see Attachment Theory), positive self-perceptions, self-regulatory skills (see Emotional self-regulation), ties to prosocial organisations (refer to prosocial behaviour (or intent to benefit others)), and a positive outlook on life.

Critical Views

One critical point made regarding humans’ individual set point is to understand it may simply be a genetic tendency and not a completely determined criterion for happiness, and it can still be influenced. In a study on moderate to excessive drug intake on rats, Ahmed and Koob (1998) sought to demonstrate that the use of mind-altering drugs such as cocaine could change an individual’s hedonic set point. Their findings suggest that drug usage and addiction lead to neurochemical adaptations whereby a person needs more of that substance to feel the same levels of pleasure. Thus, drug abuse can have lasting impacts on one’s hedonic set point, both in terms of overall happiness and with regard to pleasure felt from drug usage.

Genetic roots of the hedonic set point are also disputed. Sosis (2014) has argued the “hedonic treadmill” interpretation of twin studies depends on dubious assumptions. Pairs of identical twins raised apart are not necessarily raised in substantially different environments. The similarities between twins (such as intelligence or beauty) may invoke similar reactions from the environment. Thus, we might see a notable similarity in happiness levels between twins even though there are no happiness genes governing affect levels.

Further, hedonic adaptation may be a more common phenomenon when dealing with positive events as opposed to negative ones. Negativity bias, where people tend to focus more on negative emotions than positive emotions, can be an obstacle in raising one’s happiness set point. Negative emotions often require more attention and are generally remembered better, overshadowing any positive experiences that may even outnumber negative experiences. Given that negative events hold more psychological power than positive ones, it may be difficult to create lasting positive change.

Headey (2008) concluded that an internal locus of control and having “positive” personality traits (notably low neuroticism) are the two most significant factors affecting one’s subjective well-being. Headey also found that adopting “non-zero sum” goals, those which enrich one’s relationships with others and with society as a whole (i.e. family-oriented and altruistic goals), increase the level of subjective well-being. Conversely, attaching importance to zero-sum life goals (career success, wealth, and social status) will have a small but nevertheless statistically significant negative impact on people’s overall subjective well-being (even though the size of a household’s disposable income does have a small, positive impact on subjective well-being). Duration of one’s education seems to have no direct bearing on life satisfaction. And, contradicting set point theory, Headey found no return to homeostasis after sustaining a disability or developing a chronic illness. These disabling events are permanent, and thus according to cognitive model of depression, may contribute to depressive thoughts and increase neuroticism (another factor found by Headey to diminish subjective well-being). Disability appears to be the single most important factor affecting human subjective well-being. The impact of disability on subjective well-being is almost twice as large as that of the second strongest factor affecting life satisfaction – the personality trait of neuroticism.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Hedonic_treadmill >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Distress Tolerance?

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Introduction

Distress tolerance is an emerging construct in psychology that has been conceptualised in several different ways.

Broadly, it refers to an individual’s “perceived capacity to withstand negative emotional and/or other aversive states (e.g. physical discomfort), and the behavioral act of withstanding distressing internal states elicited by some type of stressor.” Some definitions of distress tolerance have also specified that the endurance of these negative events occur in contexts in which methods to escape the distressor exist.

Measurement

In the literature, differences in conceptualisations of distress tolerance have corresponded with two methods of assessing this construct.

As self-report inventories fundamentally assess an individual’s perception and reflection of constructs related to the self, self-report measures of distress tolerance (i.e. questionnaires) specifically focus on the perceived ability to endure distressful states, broadly defined. Some questionnaires focus specifically on emotional distress tolerance (e.g. the distress tolerance scale), others on distress tolerance of negative physical states (e.g. discomfort intolerance scale), and yet others focus specifically on tolerance of frustration as an overarching process of distress tolerance (e.g. frustration-discomfort scale).

In contrast, studies that incorporate behavioural or biobehavioural assessments of distress tolerance provide information about real behaviour rather than individuals’ perceptions. Examples of stress-inducing tasks include those that require the individual to persist in tracing a computerised mirror under timed conditions (i.e. computerised mirror tracing persistence task) or complete a series of time-sensitive math problems for which incorrect answers produce an aversive noise (i.e. computerised paced auditory serial addition task). Some behavioural tasks are conceptualised to assess physical distress tolerance, and require individuals to hold their breath for as long as possible (breath holding task).

As this is a nascent field of research, the relationships between perceptual and behavioural assessments of distress tolerance have not been clearly elucidated. Disentangling distinct components of emotional/psychological distress tolerance and physical distress tolerance within behavioural tasks also remains a challenge in the literature.

Theoretical Structures

Several models about the structural hierarchy of distress tolerance have been proposed. Some work suggests that physical and psychological tolerance are distinct constructs. Specifically, sensitivity to feelings of anxiety and tolerance of negative emotional states may be related to each other as aspects of a larger construct representing sensitivity and tolerance of affect broadly; discomfort surrounding physical stressors, however, was found to be an entirely separate construct not associated with sensitivity to emotional states. Notably, this preliminary work was conducted with self-report measures and findings are cross-sectional in nature. The authors advise that additional longitudinal work is necessary to corroborate these relationships and elucidate directions of causality.

Recent work expands on the distinctness of emotional and physical distress tolerance to a higher-order construct of global experiential distress tolerance. This framework draws upon tolerance constructs that have been historically studied as distinct from distress tolerance. The five following constructs are framed as lower-order factors for the global distress tolerance construct, and include:

  • Tolerance of uncertainty, or “the tendency to react emotionally, cognitively, or behaviourally to uncertain situations”
  • Tolerance of ambiguity, or “the perceived tolerance of complicated, foreign, and/or vague situations of stimuli”
  • Tolerance of frustration, or “the perceived capacity to withstand aggravation (e.g. thwarted life goals)”
  • Tolerance of negative emotional states, or “the perceived capacity to withstand internal distress”
  • Tolerance of physical sensations, or “the perceived capacity to withstand uncomfortable physical sensations”

Within models that solely conceptualise distress tolerance as the ability to endure negative emotional states, distress tolerance is hypothesized to be multidimensional. This includes individual processes related to the anticipation of and experience with negative emotions, such as perceived and actual ability to tolerate the negative emotion, the appraisal of a given situation as acceptable or not, the degree to which an individual can regulate his/her emotion in the midst of a negative emotional experience, and amount of attention dedicated to processing the negative emotion.

Biological Bases

There are several candidate biological neural network mechanisms for distress tolerance. These proposed brain areas are based on the conceptualization of distress tolerance as a function of reward learning. Within this framework, individuals learn to attune to and pursue reward; reduction of tension in escaping from a stressor is similarly framed as a reward and thus can be learned. Individuals differ in how quickly and for how long they display preferences for pursuing reward or in the case of distress tolerance, escaping from a distressful stimulus. Therefore, brain regions that are activated during reward processing and learning are hypothesized to also serve as neurobiological substrates for distress tolerance. For instance, activation intensity of dopamine neurons projecting to the nucleus accumbens, ventral striatum, and prefrontal cortex is associated with an individual’s predicted value of an immediate reward during a learning task. As the firing rate for these neurons increases, individuals predict high values of an immediate reward. During instances in which the predicted value is correct, the basal rate of neuronal firing remains the same. When the predicted reward value is below the actual value, neuronal firing rates increase when the reward is received, resulting in a learned response. When the expected reward value is below the actual value, the firing rate of these neurons decreases below baseline levels, resulting in a learned shift that reduces expectancies about reward value. It is posited that these same dopaminergic firing rates are associated with distress tolerance, in that learning the value of escaping a distressing stimulus is analogous to an estimation of an immediate reward There are several potential clinical implications if these posited distress tolerance substrates are corroborated. It may suggest that distress tolerance is malleable among individuals; interventions that change neuronal firing rates may shift predicted values of behaviours intended to escape a distressor and provide relief, thereby increasing distress tolerance.

Other neural areas may be implicated in moderating this reward learning process. Excitability of inhibitory medium spiny neurons in the nucleus accumbens and ventral striatum have been found to moderate the association between the value of an immediate reward and probability of pursuing reward or relief. Within rats, it has been demonstrated that increasing the excitability of these neurons via increased CREB expression resulted in an increased amount of time that the rats would keep their tail still when a noxious thermal paste was applied, as well as an increased amount of time spent in the open arms of a complex maze; these behaviours have been conceptualised as analogous distress tolerance in response to pain and anxiety.

Associations with Psychopathology

Distress tolerance is an emerging research topic in clinical psychology because it has been posited to contribute to the development and maintenance of several types of mental disorders, including mood and anxiety disorders such as major depressive disorder and generalised anxiety disorder, substance use and addiction, and personality disorders. In general, research on distress tolerance have found associations with these disorders that are tied closely to specific conceptualisations of distress tolerance. For instance, Borderline Personality Disorder is posited to be maintained through a chronic unwillingness to engage in or tolerate emotionally distressful states. Similarly, susceptibility to developing anxiety disorders is often characterised by low emotional distress tolerance. Low distress tolerance of both physical and emotional states is perceived to be a risk factor in maintaining and escalating addiction. Distress tolerance is particularly important in neurobiological theories that posit that advanced stages of addiction are driven by use of a substance to avoid physical and psychological withdrawal symptoms.

As a result of this interest in distress tolerance and its relationship with clinical psychopathology, several psychosocial treatments have been developed to improve distress tolerance among populations that are traditionally resistant to treatment. Many of these interventions (e.g. acceptance-based emotion regulation therapy) aims to boost distress tolerance by increasing the willingness to engage with emotion and meta-skills of acceptance of emotional conflict. Other behavioural interventions include components of building distress tolerance for various treatment targets, including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy, integrative behavioural couples therapy, and mindfulness-based cognitive therapy. Multiple studies suggest that such distress tolerance interventions may be effective in treating generalised anxiety disorder, depression, and borderline personality disorder.

Therapy Approaches to Improving Distress Tolerance

DBT and ACT are therapy approaches which include specific focus on distress tolerance.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Distress_tolerance >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Charitable Organisations

Published on by Andrew MarshallLeave a comment

Introduction

A charitable organisation, or charity, is an organisation whose primary objectives are philanthropy and social well-being (e.g. educational, religious or other activities serving the public interest or common good).

The legal definition of a charitable organisation (and of charity) varies between countries and in some instances regions of the country. The regulation, the tax treatment, and the way in which charity law affects charitable organisations also vary. Charitable organisations may not use any of their funds to profit individual persons or entities. However, some charitable organisations have come under scrutiny for spending a disproportionate amount of their income to pay the salaries of their leadership.

Financial figures (e.g. tax refund, revenue from fundraising, revenue from sale of goods and services or revenue from investment) are indicators to assess the financial sustainability of a charity, especially to charity evaluators. This information can impact a charity’s reputation with donors and societies, and thus the charity’s financial gains.

Charitable organisations often depend partly on donations from businesses. Such donations to charitable organisations represent a major form of corporate philanthropy.

In order to meet the exempt organisational test requirements, a charity has to be exclusively organised and operated. In order to receive and pass the exemption test, a charitable organisation must follow the public interest and all exempt income should be for the public interest. For example, in many countries of the Commonwealth, charitable organisations must demonstrate that they provide a public benefit.

Brief History

Early Systems

Until the mid-18th century, charity was mainly distributed through religious structures (such as the English Poor Laws of 1601), almshouses and bequests from the rich. Christianity, Judaism and Islam incorporated significant charitable elements from their very beginnings and dāna (alms-giving) has a long tradition in Hinduism, Jainism, Buddhism and Sikhism. Charities provided education, health, housing and even prisons. Almshouses were established throughout Europe in the Early Middle Ages to provide a place of residence for poor, old and distressed people; King Athelstan of England (reigned 924–939) founded the first recorded almshouse in York in the 10th century.

Enlightenment Charity

In the Enlightenment era, charitable and philanthropic activity among voluntary associations and rich benefactors became a widespread cultural practice. Societies, gentleman’s clubs, and mutual associations began to flourish in England, and the upper-classes increasingly adopted a philanthropic attitude toward the disadvantaged. In England this new social activism was channelled into the establishment of charitable organizations; these proliferated from the middle of the 18th century.

This emerging upper-class fashion for benevolence resulted in the incorporation of the first charitable organisations. Captain Thomas Coram, appalled by the number of abandoned children living on the streets of London, set up the Foundling Hospital in 1741 to look after these unwanted orphans in Lamb’s Conduit Fields, Bloomsbury. This, the first such charity in the world, served as the precedent for incorporated associational charities in general.

Jonas Hanway, another notable philanthropist of the Enlightenment era, established The Marine Society in 1756 as the first seafarer’s charity, in a bid to aid the recruitment of men to the navy. By 1763 the Society had recruited over 10,000 men; an Act of Parliament incorporated it in 1772. Hanway was also instrumental in establishing the Magdalen Hospital to rehabilitate prostitutes. These organizations were funded by subscription and run as voluntary associations. They raised public awareness of their activities through the emerging popular press and were generally held in high social regard – some charities received state recognition in the form of the royal charter.

Charities also began to adopt campaigning roles, where they would champion a cause and lobby the government for legislative change. This included organised campaigns against the ill treatment of animals and children and the campaign that eventually succeeded at the turn of the 19th century in ending the slave trade throughout the British Empire and within its considerable sphere of influence. (This process was however a lengthy one, which finally concluded when Saudi Arabia abolished slavery in 1962.)

The Enlightenment also saw growing philosophical debate between those who championed state intervention and those who believed that private charities should provide welfare. The Reverend Thomas Malthus (1766-1834), the political economist, criticised poor relief for paupers on economic and moral grounds and proposed leaving charity entirely to the private sector. His views became very influential and informed the Victorian laissez-faire attitude toward state intervention for the poor.

Growth during 19th Century

During the 19th century a profusion of charitable organisations emerged to alleviate the awful conditions of the working class in the slums. The Labourer’s Friend Society, chaired by Lord Shaftesbury in the United Kingdom in 1830, aimed to improve working-class conditions. It promoted, for example, the allotment of land to labourers for “cottage husbandry” that later became the allotment movement. In 1844 it became the first Model Dwellings Company – one of a group of organisations that sought to improve the housing conditions of the working classes by building new homes for them, at the same time receiving a competitive rate of return on any investment. This was one of the first housing associations, a philanthropic endeavour that flourished in the second half of the nineteenth century brought about by the growth of the middle class. Later associations included the Peabody Trust (originating in 1862) and the Guinness Trust (founded in 1890). The principle of philanthropic intention with capitalist return was given the label “five per cent philanthropy”.

There was strong growth in municipal charities. The Brougham Commission led on to the Municipal Corporations Act 1835, which reorganised multiple local charities by incorporating them into single entities under supervision from local government.

Charities at the time, including the Charity Organisation Society (established in 1869) tended to discriminate between the “deserving poor” who would be provided with suitable relief and the “underserving” or “improvident poor” who were regarded as the cause of their own woes through their idleness. Charities tended to oppose the provision of welfare by the state, due to the perceived demoralising effect. Although minimal state involvement was the dominant philosophy of the period, there was still significant government involvement in the shape of statutory regulation and even limited funding.

Philanthropy became a very fashionable activity among the expanding middle classes in Britain and America. Octavia Hill (1838-1912) and John Ruskin (1819-1900) were an important force behind the development of social housing, and Andrew Carnegie (1835-1919) exemplified the large-scale philanthropy of the newly rich in industrialised America. In Gospel of Wealth (1889), Carnegie wrote about the responsibilities of great wealth and the importance of social justice. He established public libraries throughout the English-speaking countries as well as contributing large sums to schools and universities. A little over ten years after his retirement, Carnegie had given away over 90% of his fortune.

Towards the end of the 19th century, with the advent of the New Liberalism and the innovative work of Charles Booth on documenting working-class life in London, attitudes towards poverty began to change, which led to the first social liberal welfare reforms, including the provision of old age pensions and free school-meals.

Since 1901

During the 20th century charitable organisations such as Oxfam (established in 1947), Care International and Amnesty International greatly expanded, becoming large, multinational, non-governmental organisations with very large budgets.

Since the 21st Century

With the advent of the Internet, charitable organisations established a presence in online social media and started, for example, cyber-based humanitarian crowdfunding such as GoFundMe. Another charitable organisation is Beyond the Crisis. This organisation distributes food and resources to housing communities and homeless shelters in the US. It was established by young philanthropists Camden and Colton Francis.

By Jurisdiction

Australia

The definition of charity in Australia is derived through English common law, originally from the Charitable Uses Act 1601, and then through several centuries of case law based upon it. In 2002, the federal government established an inquiry into the definition of a charity. The inquiry proposed a statutory definition of a charity, based on the principles developed through case law. This resulted in the Charities Bill 2003, which included limitations on involvement of charities in political campaigning, which many charities saw as an unwelcome departure from the case law. The government appointed a Board of Taxation inquiry to consult with charities on the bill. As a result of widespread criticism from charities, the government abandoned the bill.

The government then introduced what became the Extension of Charitable Purpose Act 2004, which did not attempt to codify the definition of a charitable purpose, but merely sought to clarify that certain purposes were charitable, whose charitable status had been subject to legal doubts. These purposes included childcare, self-help groups, and closed/contemplative religious orders.

To publicly raise funds, a charity in Australia must register in each Australian jurisdiction in which it intends to raise funds. In Queensland, for example, charities must register with the Queensland Office of Fair Trading. Also, any charity fundraising online must have approval in every Australian jurisdiction that requires them to do so, which is currently New South Wales, Queensland, Victoria, Tasmania, Western Australia, and the Australian Capital Territory. Many Australian charities have called on federal, state, and territory governments to enact uniform legislation to enable charities registered in a state or territory to be allowed to raise funds in all other Australian jurisdictions.

The Australian Charities and Not-For-Profits Commission (ACNC) commenced operations in December 2012 and regulates the approximately 56,000 non-profit organisations with tax exempt status, and about 600,000 other NPO in total and seeks to harmonise state-based fund-raising laws.

A Public Benevolent Institution (PBI) is a particular type of charity whose main purpose is to relieve suffering in the community, whether though poverty, sickness, or disability. Examples of institutions which might qualify include hospices, providers of subsidised housing and some not-for-profit aged care services.

Canada

Charities in Canada must be registered with the Charities Directorate of the Canada Revenue Agency. According to the Canada Revenue Agency:

A registered charity is an organisation established and operated for charitable purposes, and must devote its resources to charitable activities. The charity must be resident in Canada, and cannot use its income to benefit its members. A charity also has to meet a public benefit test. To qualify under this test, an organisation must show that:

  • Its activities and purposes provide a tangible benefit to the public
  • Those people who are eligible for benefits are either the public as a whole, or a significant section of it, in that they are not a restricted group or one where members share a private connection, such as social clubs or professional associations with specific membership
  • The charity’s activities must be legal and must not be contrary to public policy

To register as a charity, the organisation has to be either incorporated or governed by a legal document called a trust or a constitution. This document has to explain the organisation’s purposes and structure.

France

Most French charities are registered under the statute of loi d’association de 1901, a type of legal entity for non-profit NGOs. This statute is extremely common in France for any type of group that wants to be institutionalised (sports clubs, book clubs, support groups…) as it is very easy to set up and requires very little documentation. However, for an organisation under the statute of loi 1901 to be considered a charity, it has to file while the authorities to come under the label of “association d’utilité publique” which means “NGO acting for the public interest”. This label gives the NGO some tax exemptions.

Hungary

In Hungary, charities are called “Public benefit organisations” (Hungarian: Közhasznú szervezet). The term was introduced on 01 January 1997 by the Act on Public Benefit Organisations.

India

Under Indian law, legal entities such as charitable organisations, corporations, and managing bodies have been given the status of the “legal person” with legal rights, such as to sue and be sued, and to own and transfer property.

Ireland

In Ireland, the Charities Act (2009) legislated for the establishment of a “Charities Regulatory Authority”, and the Charities Regulator was subsequently created (via a ministerial order) in 2014. This was the first legal framework for the registration of charities in Ireland. The Charities Regulator maintains a database of organisations which have granted charitable tax exemption, a list which was previously maintained by the Revenue Commissioners. Such organisations would have a CHY number for the Revenue Commissioners, a CRO number for the Companies Registration Office and a charity number for the Charities Regulator.

The Irish Nonprofits Database was created by Irish Nonprofits Knowledge Exchange (INKEx) to act as a repository for regulatory and voluntarily disclosed information about Irish public benefit non-profits.

Nigeria

Charitable organisations in Nigeria are registerable under “Part C” of the Companies and Allied Matters Act, 2020. Under the law, the Corporate Affairs Commission, Nigeria being the official Nigerian Corporate Registry, is empowered to maintain and regulate the formation, operation and dissolution of charitable organisations in Nigeria. Charitable organisations in Nigeria are exempted under §25(c) of the Companies Income Tax Act (CITA) Cap. C21 LFN 2004 (as amended) which exempts from income tax corporate organisations engaged wholly in ecclesiastical, charitable or educational activities. Similarly, §3 of Value Added Tax Act (VATA) Cap. V1 LFN 2004 (as amended), and the 1st Schedule to the VATA on exempted Goods and Services goods zero-rates goods and services purchased by any ecclesiastical, charitable or educational institutions in furtherance of their charitable mandates.

Poland

Public benefit organisation (Polish: organizacja pożytku publicznego, often abbreviated OPP) is a term used in Polish law, introduced on 01 January 2004 by the statute on public good activity and volunteering. Charitable organisations of public good are allowed to receive 1% of income tax from individuals, so they are “tax-deductible organisations”. To receive such status, an organisation has to be a NGO (political parties and trade unions do not qualify), involved in specific activities related to public good as described by the law, and be sufficiently transparent in its activities, governance and finances. Also data has shown that this evidence is to the point and makes sense.

Polish charitable organisations with that status include Związek Harcerstwa Polskiego, Great Orchestra of Christmas Charity, KARTA Centre, Institute of Public Affairs, Silesian Fantasy Club, Polish Historical Society, and Polish chapter of Wikimedia Foundation.

Singapore

The legal framework in Singapore is regulated in the Singapore Charities Act (Chapter 37). Charities in Singapore must be registered with the Charities Directorate of the Ministry of Community Development, Youth and Sports. One can also find specific organisations that are members of the National Council of Social Service (NCSS) which is operated by the Ministry of Social and Family Development.

Ukraine

Legislation of charitable activity and obtainment of charitable organisation status is regulated by the Civil Code of Ukraine and by Law of Ukraine Charitable Activities and Charitable Organisations.

By Ukrainian law, there are three forms of charitable organisations:

  • A “charitable society” is a charitable organisation created by at least two founders and operates on the basis of the charter or statute;
  • A “charitable institution” is a type of charitable trust, acts on the basis of the constituent or founding act; charitable organisation whose founding act defines assets that one or several founders transfer to achieve the goals of charitable activity from such assets and/or income from such assets. A constituent act of a charitable institution may be contained in a will or testament. The founder or founders of the charitable institution do not participate in the management such charitable organisation; and
  • A “charitable fund” or “charitable foundation” is a charitable organisation that operates on the basis of the charter; has participants or members and is managed by them; participants or members are not obliged to transfer any assets to such organization in order to achieve the goals of charitable activity; charitable foundation can be created by one or several founders. The assets of charitable fund can be formed by participants and/or other benefactors.

The Ministry of Justice of Ukraine is the main registration authority for charitable organisation registration and constitution. Individuals and legal entities, except for public authorities and local governments, can be the founders of charitable organisations. Charitable societies and charitable foundations may have (besides founders) other participants who have joined them in the way prescribed by the charters of such charitable associations or charitable foundations. Aliens (non-Ukrainian citizens and legal entities, corporations or NGO’s) can be the founders and members of philanthropic organisation in Ukraine.

All funds received by a charitable organisation that were used for charity purposes are exempt from taxation, but it requires obtaining of non-profit status from tax authority.

Legalisation needed for International charitable fund to make activity in Ukraine.

United Kingdom

Charity law within the UK varies among (i) England and Wales, (ii) Scotland and (iii) Northern Ireland, but the fundamental principles are the same. Most organisations that are charities are required to registered with the appropriate regulator for their jurisdiction, but significant exceptions apply so that many organisations are bona fide charities but do not appear on a public register. The registers are maintained by the Charity Commission for England and Wales and for Scotland by the Office of the Scottish Charity Regulator. The Charity Commission for Northern Ireland maintains a register of charities that have completed formal registration (see below). Organisations applying must meet the specific legal requirements summarised below, and have filing requirements with their regulator, and are subject to inspection or other forms of review. The oldest charity in the UK is The King’s School, Canterbury established in 597.

The Transparency of Lobbying, Non-party Campaigning and Trade Union Administration Act 2014 subjects charities to regulation by the Electoral Commission in the run-up to a general election.

England and Wales

Definition

Section 1 Charities Act 2011 provides the definition in England and Wales:

(1) For the purposes of the law of England and Wales, “charity” means an institution which –
(a) is established for charitable purposes only, and
(b) falls to be subject to the control of the High Court in the exercise of its jurisdiction with respect to charities.

The Charities Act 2011 provides the following list of charitable purposes:

  1. the prevention or relief of poverty
  2. the advancement of education
  3. the advancement of religion
  4. the advancement of health or the saving of lives
  5. the advancement of citizenship or community development
  6. the advancement of the arts, culture, heritage or science
  7. the advancement of amateur sport
  8. the advancement of human rights, conflict resolution or reconciliation or the promotion of religious or racial harmony or equality and diversity
  9. the advancement of environmental protection or improvement
  10. the relief of those in need, by reason of youth, age, ill-health, disability, financial hardship or other disadvantage
  11. the advancement of animal welfare
  12. the promotion of the efficiency of the armed forces of the Crown or of the police, fire and rescue services or ambulance services
  13. other purposes currently recognised as charitable and any new charitable purposes which are similar to another charitable purpose.

A charity must also provide a public benefit.

Before the Charities Act 2006, which introduced the definition now contained in the 2011 Act, the definition of charity arose from a list of charitable purposes in the Charitable Uses Act 1601 (also known as the Statute of Elizabeth), which had been interpreted and expanded into a considerable body of case law. In Commissioners for Special Purposes of Income Tax v. Pemsel (1891), Lord McNaughten identified four categories of charity which could be extracted from the Charitable Uses Act and which were the accepted definition of charity prior to the Charities Act 2006:

  1. the relief of poverty,
  2. the advancement of education,
  3. the advancement of religion, and
  4. other purposes considered beneficial to the community.

Charities in England and Wales – such as Age UK, the Royal Society for the Protection of Birds (RSPB) and the Royal Society for the Prevention of Cruelty to Animals (RSPCA) – must comply with the 2011 Act regulating matters such as charity reports and accounts and fundraising.

Structures

As of 2011, there are a number of types of legal structure for a charity in England and Wales:

  • Unincorporated association
  • Trust
  • Company limited by guarantee
  • Another incorporation, such as by royal charter
  • Charitable incorporated organisation

The unincorporated association is the most common form of organisation within the voluntary sector in England and Wales. This is essentially a contractual arrangement between individuals who have agreed to come together to form an organisation for a particular purpose. An unincorporated association will normally have as its governing document a constitution or set of rules, which will deal with such matters as the appointment of office bearers, and the rules governing membership. The organization is not though a separate legal entity, so it cannot start legal action, it cannot borrow money, and it cannot enter into contracts in its own name. Its officers can be personally liable if the charity is sued or has debts.

A trust is essentially a relationship among three parties: the donor of some assets, the trustees who hold the assets, and the beneficiaries (those people who are eligible to benefit from the charity). When the trust has charitable purposes, and is a charity, the trust is known as a charitable trust. The governing document is the trust deed or declaration of trust, which comes into operation once it is signed by all the trustees. The main disadvantage of a trust is that, as with an unincorporated association, it does not have a separate legal entity and the trustees must themselves own property and enter into contracts. The trustees are also liable if the charity is sued or incurs liability.

A company limited by guarantee is a private limited company where the liability of members is limited. A guarantee company does not have a share capital, but instead has members who are guarantors instead of shareholders. In the event of the company being wound up, the members agree to pay a nominal sum which can be as little as £1. A company limited by guarantee is a useful structure for a charity where it is desirable for the trustees to have the protection of limited liability. Also, the charity has legal personality, and so can enter into contracts, such as employment contracts in its own name.

A small number of charities are incorporated by royal charter, a document which creates a corporation with legal personality (or, in some instances, transforms a charity incorporated as a company into a charity incorporated by royal charter). The charter must be approved by the Privy Council before receiving royal assent. Although the nature of the charity will vary depending on the clauses enacted, generally a royal charter will offer a charity the same limited liability as a company and the ability to enter into contracts.

The Charities Act 2006 legislated for a new legal form of incorporation designed specifically for charities, the charitable incorporated organisation, with powers similar to a company but without the need to register as a company. Becoming a CIO was only made possible in 2013, with staggered introduction dates, with the charities with highest turnover eligible first.

The word foundation is not generally used in England and Wales. Occasionally, a charity will use the word as part of its name, e.g. British Heart Foundation, but this has no legal significance and does not provide any information about either the work of the charity or how it is legally structured. The structure of the organisation will be one of the types of structure described above.

Registration

Charitable organisations that have an income of more than £5,000, and for whom the law of England and Wales applies, must register with the Charity Commission for England and Wales, unless they are an “exempt” or “excepted” charity. For companies, the law of England and Wales will normally apply if the company itself is registered in England and Wales. In other cases, if the governing document does not make it clear, the law which applies will be the country with which the organisation is most connected.

When an organisation’s income does not exceed £5,000, it is not able to register as a charity with the Charity Commission for England and Wales. It can, however, register as a charity with HM Revenue and Customs for tax purposes only. With the rise in mandatory registration level, to £5,000 by The Charities Act 2006, smaller charities can be reliant upon HMRC recognition to evidence their charitable purpose and confirm their not-for-profit principles.

Churches with an annual income of less than £100,000 need not register.

Some charities which are called exempt charities are not required to register with the Charity Commission and are not subject to any of the Charity Commission’s supervisory powers. These charities include most universities and national museums and some other educational institutions. Other charities are excepted from the need to register, but are still subject to the supervision of the Charity Commission. The regulations on excepted charities have however been changed by the Charities Act 2006. Many excepted charities are religious charities.

Northern Ireland

The Charity Commission for Northern Ireland was established in 2009 and has received the names and details of over 7,000 organisations in Northern Ireland that have previously been granted charitable status for tax purposes (the “deemed list”). Compulsory registration of organisations from the deemed list began in December 2013, and it is expected to take three to four years to complete. The new Register of Charities is publicly available on the CCNI website and contains the details of those organisations who have so far been confirmed by the commission to exist for charitable purposes and the public benefit. The Commission estimates that there are between 5,000 and 11,500 charitable organisations to be formally registered in total.

Scotland

The 24,000 or so charities in Scotland are registered with the Office of the Scottish Charity Regulator (OSCR), which also publishes a register of charities online.

Taxation

Charitable organisations, including charitable trusts, are eligible for a complex set of reliefs and exemptions from taxation in the UK. These include reliefs and exemptions in relation to income tax, capital gains tax, inheritance tax, stamp duty land tax and value added tax. These tax exemptions have led to criticisms that private schools are able to use charitable status as a tax avoidance technique rather than because they offer a genuine charitable good.

United States

In the United States, a charitable organisation is an organisation operated for purposes that are beneficial to the public interest. There are different types of charitable organisations. Every US and foreign charity that qualifies as tax-exempt under Section 501(c)(3) of the Internal Revenue Code is considered a “private foundation” unless it demonstrates to the IRS that it falls into another category. Generally, any organization that is not a private foundation (i.e., it qualifies as something else) is usually a public charity as described in Section 509(a) of the Internal Revenue Code.

In addition, a private foundation usually derives its principal funding from an individual, family, corporation, or some other single source and is more often than not a grantmaker and does not solicit funds from the public. In contrast, a foundation or public charity generally receives grants from individuals, government, and private foundations, and while some public charities engage in grantmaking activities, most conduct direct service or other tax-exempt activities. Foundations that are generally grantmakers (i.e. they use their endowment to make grants to other organisations, which in turn carry out the goals of the foundation indirectly) are usually called “grantmaker” or “non-operating” foundations.

The requirements and procedures for forming charitable organisations vary from state to state, as do the registration and filing requirements for charitable organisations that conduct charitable activities, solicit charitable contributions, or hire professional fundraisers. In practice, the detailed definition of “charitable organisation” is determined by the requirements of state law where the charitable organisation operates, and the requirements for federal tax relief by the IRS.

Resources exist to provide information, even rankings, of US charities.

Federal Tax Relief

Federal tax law provides tax benefits to non-profit organisations recognised as exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code (IRC). The benefits of 501(c)(3) status include exemption from federal income tax as well as eligibility to receive tax deductible charitable contributions. There was a total of $281.86 billion tax deductible donations by individuals in 2017.

To qualify for 501(c)(3) status most organisations must apply to the IRS for such status.

Several requirements must be met for a charitable organisation to obtain 501(c)(3) status. These include the organisation being organized as a corporation, trust, or unincorporated association, and the organisation’s organising document (such as the articles of incorporation, trust documents, or articles of association) must limit its purposes to being charitable, and permanently dedicate its assets to charitable purposes. The organisation must refrain from undertaking a number of other activities such as participating in the political campaigns of candidates for local, state or federal office, and must ensure that its earnings do not benefit any individual. Most tax exempt organisations are required to file annual financial reports (IRS Form 990) at the state and federal level. A tax exempt organisation’s 990 and some other forms are required to be made available to public scrutiny.

The types of charitable organisation that are considered by the IRS to be organised for the public benefit include those that are organised for:

  • Relief of the poor, the distressed, or the underprivileged
  • Advancement of religion
  • Advancement of education or science
  • Construction or maintenance of public buildings, monuments, or works
  • Lessening the burdens of government
  • Lessening of neighbourhood tensions
  • Elimination of prejudice and discrimination
  • Defence of human and civil rights secured by law
  • Combating community deterioration and juvenile delinquency.

A number of other organisations may also qualify for exempt status, including those organised for religious, scientific, literary and educational purposes, as well as those for testing for public safety and for fostering national or international amateur sports competition, and for the prevention of cruelty to children or animals.

Criticism

Charity has received criticism. These criticisms include:

  • charity only addressing the symptoms of a problem instead of the causes of a problem
  • charity being a worse substitute for change that does not fix the fundamental injustices in the structures and values of a society,
  • charity not providing the best solutions to problems in a society,
  • charity resulting in less state funding of essential services, because it replaces state services with those provided by external institutions at a lower cost
  • charity leading to favouritism instead of fairness,
  • tax incentives for donorship to charity results in the worsening of social inequalities by reducing the revenue a state has available for social projects and retaining class systems within society,
  • inefficient charitable giving, largely due to the splintering of funds that could be better used if pooled together,
  • charities misusing their funds,
  • characters are more accountable to donors and funders than the recipients of the charity,
  • charities giving aid conditionally.
  • through eligibility requirements such as sobriety, piety, curfews, participation in job training or parenting courses, cooperation with the police, or identifying the paternity of children, charity models enforce the concept that only those who can prove their moral worth deserve help, motivating citizens to accept exploitative wage or condition in order to avoid being subject to the charitable system.
  • charity makes rich people and corporations look generous and upholds and legitimizes the systems that concentrate wealth.
  • charity is increasingly privatised and contracted out to the massive non-profit sector, wherein organisations compete for grants to address social problems. Donors can protect their money from taxation by storing it in foundations that fund their pet projects, most of which have nothing to do with poor people.

Economist Robert Reich criticised the practice of billionaires giving some of their money to charity, calling it mostly “self-serving rubbish”. Mathew Snow of American socialist magazine Jacobin criticised charity for “creating an individualized ‘culture of giving'” instead of “challenging capitalism’s institutionalized taking.”

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An Overview of Non-Governmental Organisations

Published on by Andrew Marshall2 Comments

Introduction

A non-governmental organisation (NGO) is an organisation that generally is formed independent from government.

They are typically non-profit entities, and many of them are active in humanitarianism or the social sciences; they can also include clubs and associations that provide services to their members and others. Surveys indicate that NGOs have a high degree of public trust, which can make them a useful proxy for the concerns of society and stakeholders. However, NGOs can also be lobby groups for corporations, such as the World Economic Forum. NGOs are distinguished from international and intergovernmental organisations (IOs) in that the latter are more directly involved with sovereign states and their governments.

The term as it is used today was first introduced in Article 71 of the newly-formed United Nations’ Charter in 1945. While there is no fixed or formal definition for what NGOs are, they are generally defined as non-profit entities that are independent of governmental influence—although they may receive government funding. According to the UN Department of Global Communications, an NGO is “a not-for profit, voluntary citizen’s group that is organized on a local, national or international level to address issues in support of the public good”. The term NGO is used inconsistently, and is sometimes used synonymously with civil society organisation (CSO), which is any association founded by citizens. In some countries, NGOs are known as non-profit organisations, and political parties and trade unions are sometimes considered NGOs as well.

NGOs are classified by (1) orientation—the type of activities an NGO undertakes, such as activities involving human rights, consumer protection, environmentalism, health, or development; and (2) level of operation, which indicates the scale at which an organisation works: local, regional, national, or international.

Russia had about 277,000 NGOs in 2008. India is estimated to have had about 2 million NGOs in 2009 (approximately one per 600 Indians), many more than the number of the country’s primary schools and health centres. The United States, by comparison, has approximately 1.5 million NGOs.

Brief History

International NGOs date back to at least the late 18th century, and there were an estimated 1,083 NGOs by 1914. International NGOs were important to the anti-slavery and women’s suffrage movements, and peaked at the time of the 1932–1934 World Disarmament Conference.

The term became popular with the 1945 founding of the United Nations in 1945; Article 71 in Chapter X of its charter stipulated consultative status for organisations which are neither governments nor member states. An international NGO was first defined in resolution 288 (X) of the United Nations Economic and Social Council (ECOSOC) on 27 February 1950, as “any international organization that is not founded by an international treaty”. The role of NGOs and other “major groups” in sustainable development was recognized in Chapter 27 of Agenda 21. The rise and fall of international NGOs matches contemporary events, waxing in periods of growth and waning in times of crisis. The United Nations gave NGOs observer status at its assemblies and some meetings. According to the UN, an NGO is a private, not-for-profit organisation which is independent of government control and is not merely an opposition political party.

The rapid development of the non-governmental sector occurred in Western countries as a result of the restructuring of the welfare state. Globalisation of that process occurred after the fall of the communist system, and was an important part of the Washington Consensus.

Twentieth-century globalisation increased the importance of NGOs. International treaties and organizations, such as the World Trade Organisation, focused on capitalist interests. To counterbalance this trend, NGOs emphasize humanitarian issues, development aid, and sustainable development. An example is the World Social Forum, a rival convention of the World Economic Forum held each January in Davos, Switzerland. The fifth World Social Forum, in Porto Alegre, Brazil in January 2005, was attended by representatives of over 1,000 NGOs. The 1992 Earth Summit in Rio de Janeiro, attended by about 2,400 representatives, was the first to demonstrate the power of international NGOs in environmental issues and sustainable development. Transnational NGO networking has become extensive.

Other Terms/Acronyms

Similar terms include third-sector organisation (TSO), non-profit organization (NPO), voluntary organisation (VO), civil society organisation (CSO), grassroots organisation (GO), social movement organisation (SMO), private voluntary organisation (PVO), self-help organisation (SHO), and non-state actors (NSAs).

Numerous variations exist for the NGO acronym, either due to language, region, or specificity.

Some Romance languages use the synonymous abbreviation ONG; for example:

  • French: organisation non gouvernementale
  • Italian: organizzazione non governativa
  • Portuguese: organização não governmental
  • Spanish: organización no gubernamental
  • Romanian: organizație neguvernamentală

Other acronyms that are typically used to describe non-governmental organisations include:

  • BINGO: Business-friendly international NGO or Big international NGO
  • CSO: Civil society organisation
  • ENGO: Environmental NGO — organisations that advocate for the environment, such as Greenpeace and the WWF.
  • DONGO: Donor-organised NGO
  • GONGO: Government-organised non-governmental organisation — often used derogatorily, these are government-backed NGOs that are set up to advocate on behalf of a repressive regime on the international stage.
  • GSO: Grassroots Support Organisation
  • INGO: International NGO
  • MANGO: Market advocacy NGO
  • NGDO: Non-governmental development organisation
  • NNGO: Northern (UK) NGO
  • PANGO: Party NGO — addressing political matters
  • PVDO: Private voluntary development organisation — the United States Agency for International Development (USAID) refers to NGOs as “private voluntary organisations”.
  • Quango: Quasi-autonomous NGO — often used derogatorily, these organisations rely on public funding. They are prevalent in the UK (where there are more than 1,200), Ireland, and the Commonwealth.
  • SBO: Social benefit organisation — a goal-oriented designation
  • SCO: Social change organisation
  • SNGO: Southern (UK) NGO
  • TANGO: Technical assistance NGO
  • TNGO: Transnational NGO — coined during the 1970s due to the increase of environmental and economic issues in the global community. TNGOs exist in two (or more) countries.
  • YOUNGO: Youth NGOs – advocating for youth rights.

Legal Status

Although NGOs are subject to national laws and practices, four main groups may be found worldwide:

  • Unincorporated and voluntary association
  • Trusts, charities, and foundations
  • Not-for-profit companies and co-operatives
  • Entities formed (or registered) under special NGO or non-profit laws

The Council of Europe drafted the European Convention on the Recognition of the Legal Personality of International Non-Governmental Organisations in Strasbourg in 1986, creating a common legal basis for European NGOs. Article 11 of the European Convention on Human Rights protects the right to associate, which is fundamental for NGOs.

Types

NGOs further the social goals of their members (or founders): improving the natural environment, encouraging the observance of human rights, improving the welfare of the disadvantaged, or representing a corporate agenda. Their goals cover a wide range of issues. They may fund local NGOs, institutions and projects, and implement projects.

NGOs are classified by their:

  1. Orientation, i.e. the type of activities an NGO undertakes, such as activities involving human rights, consumer protection, environmentalism, health, or development.
  2. Level of operation, which indicates the scale at which an organisation works: local, regional, national, or international.

Orientation

  • Charity: Often a top-down effort, with little participation or input from beneficiaries. They include NGOs directed at meeting the needs of disadvantaged people and groups.
  • Service: Includes NGOs that provide healthcare (including family planning) and education.
  • Participatory: Self-help projects with local involvement in the form of money, tools, land, materials, or labour.
  • Empowerment: Aim to help poor people to understand the social, political, and economic factors affecting their lives, and to increase awareness of their power to control their lives. With maximum involvement by the beneficiaries, the NGOs are facilitators.

Level of Operation

  • Community-based organisations (CBOs): Popular initiatives which can raise the consciousness of the urban poor, helping them understand their right to services, and providing such services.
  • City-wide organisations: Include chambers of commerce and industry, coalitions of business, ethnic or educational groups, and community organisations.
  • State NGOs: Include state-level organisations, associations, and groups. Some state NGOs are guided by national and international NGOs.
  • National NGOs: An NGO that exists in only one country; they are rare. These include national organisations such as YMCAs and YWCAs, professional associations, and similar groups. Some have state or city branches, and assist local NGOs.
  • International NGOs (INGOs): Range from secular agencies, such as Save the Children, to religious groups. They may fund local NGOs, institutions and projects, and implement projects.

Activities

NGOs play a vital role in improving the lives of people who have been affected by natural disasters or are facing other challenges. NGOs can act as implementers, catalysts, and partners to provide essential goods and services to those in need. They work to mobilise resources, both financial and human, to ensure that aid is delivered in a timely and effective manner.

NGOs also play a critical role in driving change by advocating for policies and practices that benefit disadvantaged communities. They often work in partnership with other organisations, including government agencies, to address complex challenges that require a collaborative approach.

One of the key strengths of NGOs is their ability to work at the grassroots level and to connect with communities directly. This allows them to gain a deep understanding of the issues facing people and to tailor their services to meet the specific needs of each community.

NGOs vary by method; some are primarily advocacy groups, and others conduct programs and activities. Oxfam, concerned with poverty alleviation, may provide needy people with the equipment and skills to obtain food and drinking water; the Forum for Fact-finding Documentation and Advocacy (FFDA) helps provide legal assistance to victims of human-rights abuses. The Afghanistan Information Management Services provide specialised technical products and services to support development activities implemented on the ground by other organizations. Management techniques are crucial to project success.

The World Bank classifies NGO activity into two general categories:

  • Operational NGOs, whose primary function is the design and implementation of development-related projects
  • Advocacy NGOs, whose primary function is to defend or promote a particular cause and who seek to influence the policies and practices of International governmental organisations (IGOs).

NGOs may also conduct both activities: operational NGOs will use campaigning techniques if they face issues in the field, which could be remedied by policy change, and campaigning NGOs (e.g. human-rights organisations) often have programmes which assist individual victims for whom they are trying to advocate.

Operational

Operational NGOs seek to “achieve small-scale change directly through projects”, mobilising financial resources, materials, and volunteers to create local programmes. They hold large-scale fundraising events and may apply to governments and organizations for grants or contracts to raise money for projects. Operational NGOs often have a hierarchical structure; their headquarters are staffed by professionals who plan projects, create budgets, keep accounts, and report to and communicate with operational fieldworkers on projects. They are most often associated with the delivery of services or environmental issues, emergency relief, and public welfare. Operational NGOs may be subdivided into relief or development organisations, service-delivery or participatory, religious or secular, and public or private. Although operational NGOs may be community-based, many are national or international. The defining activity of an operational NGO is the implementation of projects.

Advocacy

Advocacy NGOs or campaigning NGOs seek to “achieve large-scale change promoted indirectly through the influence of the political system”. They require an active, efficient group of professional members who can keep supporters informed and motivated. Campaigning NGOs must plan and host demonstrations and events which will attract media, their defining activity.

Campaigning NGOs often deal with issues related to human rights, women’s rights, and children’s rights, and their primary purpose is to defend (or promote) a specific cause.

Public Relations

Non-governmental organisations need healthy public relations in order to meet their goals, and use sophisticated public-relations campaigns to raise funds and deal with governments. Interest groups may be politically important, influencing social and political outcomes. A code of ethics was established in 2002 by the World Association of Non-Governmental Organisations.

Structure

Staffing

Some NGOs rely on paid staff; others are based on volunteers. Although many NGOs use international staff in developing countries, others rely on local employees or volunteers. Foreign staff may satisfy a donor who wants to see the supported project managed by a person from an industrialised country. The expertise of these employees (or volunteers) may be counterbalanced by several factors: the cost of foreigners is typically higher, they have no grassroots connections in the country, and local expertise may be undervalued. By the end of 1995, Concern Worldwide (an international anti-poverty NGO) employed 174 foreigners and just over 5,000 local staff in Haiti and ten developing countries in Africa and Asia.

On average, employees in NGOs earn 11-12% less compared to employees of for-profit organisations and government workers with the same number of qualifications. However, in many cases NGOs employees receive more fringe benefits.

Funding

NGOs are usually funded by donations, but some avoid formal funding and are run by volunteers. NGOs may have charitable status, or may be tax-exempt in recognition of their social purposes. Others may be fronts for political, religious, or other interests. Since the end of World War II, NGOs have had an increased role in international development, particularly in the fields of humanitarian assistance and poverty alleviation.

Funding sources include membership dues, the sale of goods and services, grants from international institutions or national governments, CSR Funds and private donations. Although the term non-governmental organisation implies independence from governments, many NGOs depend on government funding; one-fourth of Oxfam’s US$162 million 1998 income was donated by the British government and the EU, and World Vision United States collected $55 million worth of goods in 1998 from the American government. Several EU grants provide funds accessible to NGOs.

Government funding of NGOs is controversial, since:

“the whole point of humanitarian intervention was precise that NGOs and civil society had both a right and an obligation to respond with acts of aid and solidarity to people in need or being subjected to repression or want by the forces that controlled them, whatever the governments concerned might think about the matter.”

Some NGOs, such as Greenpeace, do not accept funding from governments or intergovernmental organisations. The 1999 budget of the American Association of Retired Persons (AARP) was over $540 million.

Overhead

Overhead is the amount of money spent on running an NGO, rather than on projects. It includes office expenses, salaries, and banking and bookkeeping costs. An NGO’s percentage of its overall budget spent on overhead is often used to judge it; less than 4% is considered good. According to the World Association of Non-Governmental Organisations, more than 86% should be spent on programmes (less than 20%). The Global Fund to Fight AIDS, Tuberculosis and Malaria has guidelines of 5-7% overhead to receive funding; the World Bank typically allows 37%. A high percentage of overhead relative to total expenditures can make it more difficult to generate funds. High overhead costs may generate public criticism.

A sole focus on overhead, however, can be counterproductive. Research published by the Urban Institute and Stanford University’s Centre for Social Innovation have shown that rating agencies create incentives for NGOs to lower (and hide) overhead costs, which may reduce organisational effectiveness by starving organisations of infrastructure to deliver services. An alternative rating system would provide, in addition to financial data, a qualitative evaluation of an organisation’s transparency and governance:

  • An assessment of program effectiveness
  • Evaluation of feedback mechanisms for donors and beneficiaries
  • Allowing a rated organisation to respond to an evaluation by a rating agency

Monitoring and Control

In a March 2000 report on United Nations reform priorities, former UN Secretary-General Kofi Annan favoured international humanitarian intervention as the responsibility to protect citizens from ethnic cleansing, genocide, and crimes against humanity. After that report, the Canadian government launched its Responsibility to Protect (R2P) project outlining the issue of humanitarian intervention. The R2P project has wide applications, and among its more controversial has been the Canadian government’s use of R2P to justify its intervention in the coup in Haiti.

Large corporations have increased their corporate social responsibility departments to pre-empt NGO campaigns against corporate practices. Collaboration between corporations and NGOs risks co-option of the weaker partner, typically the NGO.

In December 2007, Assistant Secretary of Defence for Health Affairs S. Ward Casscells established an International Health Division of Force Health Protection & Readiness. Part of International Health’s mission is to communicate with NGOs about areas of mutual interest. Department of Defence Directive 3000.05, in 2005, required the US Defence Department to regard stability-enhancing activities as equally important as combat. In compliance with international law, the department has developed a capacity to improve essential services in areas of conflict (such as Iraq) where customary lead agencies like the State Department and USAID have difficulty operating. International Health cultivates collaborative, arm’s-length relationships with NGOs, recognising their independence, expertise, and honest-broker status.

Economic Theory

The question whether a public project should be owned by an NGO or by the government has been studied in economics using the tools of the incomplete contracting theory. According to this theory, not every detail of a relationship between decision makers can be contractually specified. Hence, in the future the parties will bargain with each other to adapt their relationship to changing circumstances. Ownership matters because it determines the parties’ willingness to make non-contractible investments. In the context of private firms, Hart (1995) has shown that the party with the more important investment task should be owner. Yet, Besley and Ghatak (2001) have argued that in the context of public projects the investment technology does not matter. Specifically, even when the government is the key investor, ownership by an NGO is optimal if and only if the NGO has a larger valuation of the project than the government. However, the general validity of this argument has been questioned by follow-up research. In particular, ownership by the party with the larger valuation need not be optimal when the public good is partially excludable (Francesconi and Muthoo, 2011), when both NGO and government may be indispensable (Halonen-Akatwijuka, 2012), or when the NGO and the government have different bargaining powers (Schmitz, 2013). Moreover, the investment technology can matter for the optimal ownership structure when there are bargaining frictions (Schmitz, 2015), when the parties interact repeatedly (Halonen-Akatwijuka and Pafilis, 2020), or when the parties are asymmetrically informed (Schmitz, 2021).

Influence on World Affairs

Service-delivery NGOs provide public goods and services which governments of developing countries are unable to provide due to a lack of resources. They may be contractors or collaborate with government agencies to reduce the cost of public goods. Capacity-building NGOs affect “culture, structure, projects and daily operations”. Advocacy and public-education NGOs aim to modify behaviour and ideas through communication, crafting messages to promote social, political, or environmental changes (and as news organisations have cut foreign bureaux, many NGOs have begun to expand into news reporting). Movement NGOs mobilise the public and coordinate large-scale collective activities to advance an activist agenda.

Since the end of the Cold War, more NGOs in developed countries have pursued international outreach; involved in local and national social resistance, they have influenced domestic policy change in the developing world. Specialised NGOs have forged partnerships, built networks, and found policy niches.

Diplomacy

In the context of NGOs, diplomacy refers to the practice of building and maintaining partnerships with other organizations, stakeholders, and governments to achieve common objectives related to social or environmental issues.

NGOs often work in complex environments, where multiple stakeholders have different interests and goals. Diplomacy allows NGOs to navigate these complex environments and engage in constructive dialogue with different actors to promote understanding, build consensus, and facilitate cooperation.

Effective NGO diplomacy involves building trust, fostering dialogue, and promoting transparency and accountability. NGOs may engage in diplomacy through various means, including advocacy, lobbying, partnerships, and negotiations. By working collaboratively with other organisations and stakeholders, NGOs can achieve greater impact and reach their goals more effectively.

Track II Diplomacy

Track II diplomacy (or dialogue) is transnational coordination by non-official members of the government, including epistemic communities and former policymakers or analysts. It aims to help policymakers and policy analysts reach a common solution through unofficial discussions. Unlike official diplomacy, conducted by government officials, diplomats, and elected leaders, Track II diplomacy involves experts, scientists, professors and other figures who are not part of government affairs.

World NGO Day

World NGO Day, observed annually on 27 February, was recognised on 17 April 2010 by 12 countries of the IX Baltic Sea NGO Forum at the eighth Summit of the Baltic Sea States in Vilnius, Lithuania. It was internationally recognised on 28 February 2014 in Helsinki, Finland by United Nations Development Programme administrator and former Prime Minister of New Zealand Helen Clark.

Criticism

Tanzanian author and academic Issa G. Shivji has criticised NGOs in two essays: “Silences in NGO discourse: The role and future of NGOs in Africa” and “Reflections on NGOs in Tanzania: What we are, what we are not and what we ought to be”. Shivji writes that despite the good intentions of NGO leaders and activists, he is critical of the “objective effects of actions, regardless of their intentions”. According to Shivji, the rise of NGOs is part of a neoliberal paradigm and not motivated purely by altruism; NGOs want to change the world without understanding it, continuing an imperial relationship.

In his study of NGO involvement in Mozambique, James Pfeiffer addresses their negative effects on the country’s health. According to Pfeiffer, NGOs in Mozambique have “fragmented the local health system, undermined local control of health programs, and contributed to growing local social inequality”. They can be uncoordinated, creating parallel projects which divert health-service workers from their normal duties to instead serve the NGOs. This undermines local primary-healthcare efforts, and removes the government’s ability to maintain agency over its health sector. Pfeiffer suggested a collaborative model of the NGO and the DPS (the Mozambique Provincial Health Directorate); the NGO should be “formally held to standard and adherence within the host country”, reduce “showcase” projects and unsustainable parallel programmes.

In her 1997 Foreign Affairs article, Jessica Mathews wrote: “For all their strengths, NGOs are special interests. The best of them … often suffer from tunnel vision, judging every public act by how it affects their particular interest”. NGOs are unencumbered by policy trade-offs.

According to Vijay Prashad, since the 1970s “the World Bank, under Robert McNamara, championed the NGO as an alternative to the state, leaving intact global and regional relations of power and production.” NGOs have been accused of preserving imperialism (sometimes operating in a racialised manner in Third World countries), with a function similar to that of the clergy during the colonial era. Political philosopher Peter Hallward has called them an aristocratic form of politics, noting that ActionAid and Christian Aid “effectively condoned the [2004 US-backed] coup” against an elected government in Haiti and are the “humanitarian face of imperialism”. Movements in the Global South (such as South Africa’s Western Cape Anti-Eviction Campaign) have refused to work with NGOs, concerned that doing so would compromise their autonomy. NGOs have been accused of weakening people by allowing their funders to prioritise stability over social justice.

They have been accused of being designed by, and used as extensions of, the foreign-policy instruments of some Western countries and groups of countries. Russian president Vladimir Putin made that accusation at the 43rd Munich Security Conference in 2007, saying that NGOs “are formally independent but they are purposefully financed and therefore under control”. According to Michael Bond, “Most large NGOs, such as Oxfam, the Red Cross, Cafod and ActionAid, are striving to make their aid provision more sustainable. But some, mostly in the US, are still exporting the ideologies of their backers.”

NGOs have been accused of using misinformation in their campaigns out of self-interest. According to Doug Parr of Greenpeace, there had been “a tendency among our critics to say that science is the only decision-making tool … but political and commercial interests are using science as a cover for getting their way.” Former policy-maker for the German branch of Friends of the Earth Jens Katjek said, “If NGOs want the best for the environment, they have to learn to compromise.”

They have been questioned as “too much of a good thing”. Eric Werker and Faisal Ahmed made three critiques of NGOs in developing nations. Too many NGOs in a nation (particularly one ruled by a warlord) reduces an NGO’s influence, since it can easily be replaced by another NGO. Resource allocation and outsourcing to local organisations in international-development projects incurs expenses for an NGO, lessening the resources and money available to the intended beneficiaries. NGO missions tend to be paternalistic, as well as expensive.

Legitimacy, an important asset of an NGO, is its perception as an “independent voice”. Neera Chandhoke wrote in a Journal of World-Systems Research article, “To put the point starkly: are the citizens of countries of the South and their needs represented in global civil society, or are citizens as well as their needs constructed by practices of representation? And when we realize that INGOs hardly ever come face to face with the people whose interests and problems they represent, or that they are not accountable to the people they represent, matters become even more troublesome.”

An NGO’s funding affects its legitimacy, and they have become increasingly dependent on a limited number of donors. Competition for funds has increased, in addition to the expectations of donors who may add conditions threatening an NGO’s independence. Dependence on official aid may dilute “the willingness of NGOs to speak out on issues which are unpopular with governments”, and changes in NGO funding sources have altered their function.

NGOs have been challenged as not representing the needs of the developing world, diminishing the “Southern voice” and preserving the North–South divide. The equality of relationships between northern and southern parts of an NGO, and between southern and northern NGOs working in partnership, has been questioned; the north may lead in advocacy and resource mobilisation, and the south delivers services in the developing world. The needs of the developing world may not be addressed appropriately, as northern NGOs do not consult (or participate in) partnerships or assign unrepresentative priorities. NGOs have been accused of damaging the public sector in target countries, such as mismanagement resulting in the breakdown of public healthcare systems.

The scale and variety of activities in which NGOs participate have grown rapidly since 1980, and particularly since 1990. NGOs need to balance centralisation and decentralisation. Centralising NGOs, particularly at the international level, can assign a common theme or set of goals. It may also be advantageous to decentralise an NGO, increasing its chances of responding flexibly and effectively to local issues by implementing projects which are modest in scale, easily monitored, produce immediate benefits, and where all involved know that corruption would be punished.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Non-governmental_organization >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Positive Neuroscience

Published on by Andrew Marshall2 Comments

Introduction

Broadly defined, positive neuroscience is the study of what the brain does well.

Instead of studying mental illness, positive neuroscientists focus on valued cognitive qualities that serve to enrich personal life and/or society. Topics in positive neuroscience overlap heavily with those of positive psychology, but use neuroimaging techniques to extend beyond the behavioural level and explain the neurobiology which underpins “positive” cognitive phenomena such as intelligence, creativity, optimism, and healthy aging.

Background

Though positive neuroscience is only beginning to be recognised as an emerging field, empirical research of optimal or exceptional brain functioning has been conducted at least as far back as the 1970s. Early work was confined to the use of lesion studies, and thus was only very case-specific. Human electroencephalography, first practiced in 1920, was applied to the study of creativity in the early 1970s.

As in vivo brain imaging has become more sophisticated, investigations of positive neuroscience phenomena have incorporated multiple functional neuroimaging techniques (functional magnetic resonance imaging (fMRI) and Positron Emission Tomography (PET)) and structural imaging (Diffusion MRI, voxel-based morphometry, in vivo magnetic resonance spectroscopy). Examples of research centres currently active in the field of positive neuroscience include Martin Seligman’s lab at the University of Pennsylvania and Rex Jung’s lab at the University of New Mexico, supported by The Mind Research Network.

The Templeton Foundation

In 2009, the John Templeton Foundation and a committee of advisors at the University of Pennsylvania put out a call for grant proposals aimed at investigators “conducting research aimed at gaining a better understanding of the ways in which the brain enables flourishing.” Qualifying projects had to “apply tools of neuroscience to positive psychological concepts”, and focus on one of the following areas:

  • Virtue, strength, and positive emotion: What are the neural bases of the cognitive and affective capacities that enable virtues such as discipline, persistence, honesty, compassion, love, curiosity, social and practical intelligence, courage, creativity, and optimism?
  • Exceptional abilities: What is special about the brains of exceptional individuals and what can we learn from them?
  • Meaning and positive purpose: How does the brain enable individuals and groups to find meaning and achieve larger goals?
  • Decisions, values, and free will: How does the brain enable decisions based on values and how can decision-making be improved? What can neuroscience reveal about the nature of human freedom?
  • Religious belief, prayer, and meditation: How do religious and spiritual practices affect neural function and behaviour?

Fifteen research projects are now underway as part of the Positive Neuroscience Project.

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An Overview of Thought Disorder

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Introduction

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication.

Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions – all disturbances of thought content and form. Two specific terms have been suggested:

  1. Content thought disorder (CTD); and
  2. Formal thought disorder (FTD).

CTD has been defined as a thought disturbance characterised by multiple fragmented delusions, and the term thought disorder is often used to refer to a FTD: a disruption of the form (or structure) of thought. Also known as disorganised thinking, FTD results in disorganised speech and is recognised as a major feature of schizophrenia and other psychoses (including mood disorders, dementia, mania, and neurological diseases). Disorganised speech leads to an inference of disorganised thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking.

Formal thought disorder affects the form (rather than of the content) of thought. Unlike hallucinations and delusions, it is an observable, objective sign of psychosis. FTD is a common core symptom of a psychotic disorder, and may be seen as a marker of severity and as an indicator of prognosis. It reflects a cluster of cognitive, linguistic, and affective disturbances that have generated research interest in the fields of cognitive neuroscience, neurolinguistics, and psychiatry.

Eugen Bleuler, who named schizophrenia, said that TD was its defining characteristic. Disturbances of thinking and speech, such as clanging or echolalia, may also be present in Tourette syndrome; other symptoms may be found in delirium. A clinical difference exists between these two groups. Patients with psychoses are less likely to show awareness or concern about disordered thinking, and those with other disorders are aware and concerned about not being able to think clearly.

Content Thought Disorder

Content thought disorder (CTD) is a thought disturbance in which a person experiences multiple, fragmented delusions, typically a feature of schizophrenia and some other mental disorders which include obsessive-compulsive disorder and mania. At the core of CTD are abnormal beliefs and convictions (after taking the person’s culture and background into consideration) ranging from overvalued ideas to fixed delusions. These beliefs and delusions are typically non-specific diagnostically, even if some delusions are more prevalent in one disorder than another.

Neurotypical thought—consisting of awareness, concerns, beliefs, preoccupations, wishes, fantasies, imagination, and concepts—can be illogical, and can contain contradictory beliefs and prejudices or biases. Individuals vary considerably, and a person’s thinking may also shift from time to time.

CTD is not limited to delusions. Other possible abnormalities include suicidal, violent, and homicidal ideas and:

  • Preoccupation: centring thought on a particular idea in association with a strong affection
  • Obsession: a persistent thought, idea, or image which is intrusive or inappropriate, and distressing or upsetting
  • Compulsive behaviour: the need to perform an act persistently and repetitively (without it necessarily leading to a reward or pleasure) to reduce distress
  • Magical thinking: belief that one’s thoughts alone can bring about effects in the world, or that thinking something corresponds with doing that thing
  • Overvalued ideas: false or exaggerated belief held with conviction, but without delusional intensity
  • Phobias: irrational fears of objects or circumstances

In psychosis, delusions are the most common CTD. A delusion is a firm, fixed belief based on inadequate grounds, not amenable to rational argument or evidence to the contrary, which is out of sync with a person’s regional, cultural, or educational background. Delusions are common in people with mania, depression, schizoaffective disorder, delirium, dementia, substance use disorders, schizophrenia, and delusional disorders. Common examples in a mental status examination include the following:

  • Erotomania: belief that someone is in love with oneself
  • Grandiose delusions: belief that one is the greatest, strongest, fastest, richest, or the most intelligent person ever
  • Persecutory delusion: belief that the person, or someone to whom the person is close, is being malevolently treated in some way
  • Ideas and delusions of reference: belief that insignificant remarks, coincidental events, or innocuous objects in one’s environment have personal meaning or significance
  • Thought broadcasting: belief that others can hear (or are aware of) one’s thoughts
  • Thought insertion: belief that one’s thoughts are not one’s own, but belong to someone else and have been inserted into one’s mind
  • Thought withdrawal: belief that thoughts have been “taken out” of one’s mind, and one has no power over this
  • Influence: belief that other people (or external agents) are covertly exerting power over oneself
  • Outside control: belief that outside forces are controlling one’s thoughts, feelings, and actions
  • Infidelity: belief that a partner is cheating on oneself
  • Somatic: belief that one has a disease or medical condition
  • Nihilistic: belief that the mind, the body, the world at large, or parts thereof no longer exist

Formal Thought Disorder

Formal thought disorder (FTD) is also known as disorganised speech. Evidence of disorganized thinking, it is a hallmark feature of schizophrenia. FTD, a disorder of the form (rather than content) of thought, encompasses hallucinations and delusions and is an observable sign of psychosis. A common, core symptom of psychosis, it may be seen as a marker of severity and a predictor of prognosis. FTD reflects a cluster of cognitive, linguistic, and affective disturbances which has generated research interest from the fields of cognitive neuroscience, neurolinguistics, and psychiatry.

It can be subdivided into clusters of positive and negative symptoms and objective (rather than subjective) symptoms. On the scale of positive and negative symptoms, they have been grouped into:

  • Positive Formal Thought Disorder (posFTD); and
  • Negative Formal Thought Disorder (negFTD).

Positive subtypes were pressure of speech, tangentiality, derailment, incoherence, and illogicality;[12] negative subtypes were poverty of speech and poverty of content. The two groups were posited to be at either end of a spectrum of normal speech, but later studies showed them to be poorly correlated. A comprehensive measure of FTD is the Thought and Language Disorder (TALD) Scale.

Nancy Andreasen preferred to identify TDs as thought-language-communication disorders (TLC disorders). Up to seven domains of FTD have been described on the Thought, Language, Communication (TLC) Scale, with most of the variance accounted for by two or three domains. Some TLC disorders are more suggestive of severe disorder, and are listed with the first 11 items.

Diagnoses

The DSM V categorises FTD as “a psychotic symptom, manifested as bizarre speech and communication.” FTD may include incoherence, peculiar words, disconnected ideas, or a lack of unprompted content expected from normal speech. Clinical psychologists typically assess FTD by initiating an exploratory conversation with patients and observing the patient’s verbal responses.

FTD is often used to establish a diagnosis of schizophrenia; in cross-sectional studies, 27 to 80 percent of patients with schizophrenia present with FTD. A hallmark feature of schizophrenia, it is also widespread amongst other psychiatric disorders; up to 60 percent of those with schizoaffective disorder and 53 percent of those with clinical depression demonstrate FTD, suggesting that it is not exclusive to schizophrenia. About six percent of healthy subjects exhibit a mild form of FTD.

The characteristics of FTD vary amongst disorders. A number of studies indicate that FTD in mania is marked by irrelevant intrusions and pronounced combinatory thinking, usually with a playfulness and flippancy absent from patients with schizophrenia. The FTD present in patients with schizophrenia was characterized by disorganisation, neologism, and fluid thinking, and confusion with word-finding difficulty.

There is limited data on the longitudinal course of FTD. The most comprehensive longitudinal study of FTD by 2023 found a distinction in the longitudinal course of thought-disorder symptoms between schizophrenia and other psychotic disorders. The study also found an association between pre-index assessments of social, work and educational functioning and the longitudinal course of FTD.

Possible Causes

Several theories have been developed to explain the causes of FTD. It has been proposed that FTD relates to neurocognition via semantic memory. Semantic network impairment in people with schizophrenia – measured by the difference between fluency (e.g. the number of animals’ names produced in 60 seconds) and phonological fluency (e.g. the number of words beginning with “F” produced in 60 seconds) – predicts the severity of FTD, suggesting that verbal information (through semantic priming) is unavailable. Other hypotheses include working memory deficit (being confused about what has already been said in a conversation) and attentional focus.

FTD in schizophrenia has been found to be associated with structural and functional abnormalities in the language network, where structural studies have found bilateral grey matter deficits; deficits in the bilateral inferior frontal gyrus, bilateral inferior parietal lobule and bilateral superior temporal gyrus are FTD correlates. Other studies did not find an association between FTD and structural aberrations of the language network, however, and regions not included in the language network have been associated with FTD. Future research is needed to clarify whether there is an association with FTD in schizophrenia and neural abnormalities in the language network.

Transmitter systems which might cause FTD have also been investigated. Studies have found that glutamate dysfunction, due to a rarefaction of glutamatergic synapses in the superior temporal gyrus in patients with schizophrenia, is a major cause of positive FTD.

The heritability of FTD has been demonstrated in a number of family and twin studies. Imaging genetics studies, using a semantic verbal-fluency task performed by the participants during functional MRI scanning, revealed that alleles linked to glutamatergic transmission contribute to functional aberrations in typical language-related brain areas. FTD is not solely genetically determined, however; environmental influences, such as allusive thinking in parents during childhood, and environmental risk factors for schizophrenia (including childhood abuse, migration, social isolation, and cannabis use) also contribute to the pathophysiology of FTD.

The origins of FTD have been theorised from a social-learning perspective. Singer and Wynne said that familial communication patterns play a key role in shaping the development of FTD; dysfunctional social interactions undermine a child’s development of cohesive, stable mental representations of the world, increasing their risk of developing FTD.

Treatments

Antipsychotic medication is often used to treat FTD. Although the vast majority of studies of the efficacy of antipsychotic treatment do not report effects on syndromes or symptoms, six older studies report the effects of antipsychotic treatment on FTD. These studies and clinical experience indicate that antipsychotics are often an effective treatment for patients with positive or negative FTD, but not all patients respond to them.

Cognitive behavioural therapy (CBT) is another treatment for FTD, but its effectiveness has not been well-studied. Large randomised controlled trials evaluating the effectiveness of CBT for treating psychosis often exclude individuals with severe FTD because it reduces the therapeutic alliance required by the therapy. However, provisional evidence suggests that FTD may not preclude the effectiveness of CBT. Kircher and colleagues have suggested that the following methods should be used in CBT for patients with FTD:

  • Practise structuring, summarising, and feedback methods
  • Repeat and clarify the core issues and main emotions that the patient is trying to communicate
  • Gently encourage patients to clarify what they are trying to communicate
  • Ask patients to clearly state their communication goal
  • Ask patients to slow down and explain how one point leads to another
  • Help patients identify the links between ideas
  • Identify the main affect linked to the thought disorder
  • Normalise problems with thinking

Signs and Symptoms

Language abnormalities exist in the general population, and do not necessarily indicate a condition. They can occur in schizophrenia and other disorders (such as mania or depression), or in anyone who may be tired or stressed. To distinguish thought disorder, patterns of speech, severity of symptoms, their frequency, and any resulting functional impairment can be considered.

Symptoms of TD include derailment, pressured speech, poverty of speech, tangentiality, and thought blocking. FTD is a hallmark feature of schizophrenia, but is also associated with other conditions (including mood disorders, dementia, mania, and neurological diseases). Impaired attention, poor memory, and difficulty formulating abstract concepts may also reflect TD, and can be observed and assessed with mental-status tests such as serial sevens or memory tests.

Types

Thirty symptoms (or features) of TD have been described, including:

  • Alogia: A poverty of speech in amount or content, it is classified as a negative symptom of schizophrenia. When further classifying symptoms, poverty of speech content (little meaningful content with a normal amount of speech) is a disorganisation symptom. Under SANS, thought blocking is considered a part of alogia, and so is increased latency in response.
  • Thought blocking (also known as deprivation of thought and obstructive thought): An abrupt stop in the middle of a train of thought which may not be able to be continued.
  • Circumstantial speech (also known as circumstantial thinking): An inability to answer a question without excessive, unnecessary detail. This differs from tangential thinking in that the person does eventually return to the original point. A patient may answer the question “How have you been sleeping lately?” with “Oh, I go to bed early, so I can get plenty of rest. I like to listen to music or read before bed. Right now I’m reading a good mystery. Maybe I’ll write a mystery someday. But it isn’t helping, reading I mean. I have been getting only 2 or 3 hours of sleep at night.”
  • Clanging: An instance where ideas are related only by similar or rhyming sounds rather than actual meaning. This may be heard as excessive rhyming or alliteration (“Many moldy mushrooms merge out of the mildewy mud on Mondays”, or “I heard the bell. Well, hell, then I fell”). It is most commonly seen in the manic phase of bipolar disorder, although it is also often observed in patients with schizophrenia and schizoaffective disorder.
  • Derailment (also known as loose association and knight’s move thinking): Thought frequently moves from one idea to another which is obliquely related or unrelated, often appearing in speech but also in writing (“The next day when I’d be going out you know, I took control, like uh, I put bleach on my hair in California”),
  • Distractible speech: In mid-speech, the subject is changed in response to a nearby stimulus (“Then I left San Francisco and moved to … Where did you get that tie?”)
  • Echolalia: Echoing of another’s speech, once or in repetition. It may involve repeating only the last few words (or the last word) of another person’s sentences, and is common on the autism spectrum and in Tourette syndrome.
  • Evasion: The next logical idea in a sequence is replaced with another idea closely (but not accurately or appropriately) related to it; also known as paralogia and perverted logic.
  • Flight of ideas: A form of FTD marked by abrupt leaps from one topic to another, possibly with discernible links between successive ideas, perhaps governed by similarities between subjects or by rhyming, puns, wordplay, or innocuous environmental stimuli (such as the sound of birds chirping). It is most characteristic of the manic phase of bipolar disorder.
  • Illogicality: Conclusions are reached which do not follow logically (non sequiturs or faulty inferences). “Do you think this will fit in the box?” is answered with, “Well of course; it’s brown, isn’t it?”
  • Incoherence (word salad): Speech which is unintelligible because the individual words are real, but the manner in which they are strung together results in gibberish. The question “Why do people comb their hair?” elicits a response like “Because it makes a twirl in life, my box is broken help me blue elephant. Isn’t lettuce brave? I like electrons, hello please!”
  • Neologisms: Completely new words (or phrases) whose origins and meanings are usually unrecognisable (“I got so angry I picked up a dish and threw it at the geshinker”). They may also involve elisions of two words which are similar in meaning or sound. Although neologisms may refer to words formed incorrectly whose origins are understandable (such as “headshoe” for “hat”), these can be more clearly referred to as word approximations.
  • Overinclusion: The failure to eliminate ineffective, inappropriate, irrelevant, extraneous details associated with a particular stimulus.
  • Perseveration: Persistent repetition of words or ideas, even when another person tries to change the subject. (“It’s great to be here in Nevada, Nevada, Nevada, Nevada, Nevada.”) It may also involve repeatedly giving the same answer to different questions (“Is your name Mary?” “Yes.” “Are you in the hospital?” “Yes.” “Are you a table?” “Yes”). Perseveration can include palilalia and logoclonia, and may indicate an organic brain disease such as Parkinson’s disease.
  • Phonemic paraphasia: Mispronunciation; syllables out of sequence (“I slipped on the lice and broke my arm”).
  • Pressured speech: Rapid speech without pauses, which is difficult to interrupt.
  • Referential thinking: Viewing innocuous stimuli as having a specific meaning for the self (“What’s the time?” “It’s 7 o’clock. That’s my problem”).
  • Semantic paraphasia: Substitution of inappropriate words (“I slipped on the coat, on the ice I mean, and broke my book”).
  • Stilted speech: Speech characterised by words or phrases which are flowery, excessive, and pompous (“The attorney comported himself indecorously”).
  • Tangential speech: Wandering from the topic and never returning to it, or providing requested information (“Where are you from?” “My dog is from England. They have good fish and chips there. Fish breathe through gills”).
  • Verbigeration: Meaningless, stereotyped repetition of words or phrases which replace understandable speech; seen in schizophrenia.

Terminology

Psychiatric and psychological glossaries in 2015 and 2017 defined thought disorder’ as disturbed thinking or cognition which affects communication, language, or thought content including poverty of ideas, neologisms, paralogia, word salad, and delusions (disturbances of thought content and form), and suggested the more-specific terms content thought disorder (CTD) and formal thought disorder (FTD). CTD was defined as a TD characterised by multiple fragmented delusions, and FTD was defined as a disturbance in the form or structure of thinking. The 2013 DSM-5 only used the term FTD, primarily as a synonym for disorganized thinking and speech. This contrasts with the 1992 ICD-10 (which only used the word “thought disorder”, always accompanied with “delusion” and “hallucination”) and a 2002 medical dictionary which generally defined thought disorders similarly to the psychiatric glossaries and used the word in other entries as the ICD-10 did.

A 2017 psychiatric text describing thought disorder as a “disorganization syndrome” in the context of schizophrenia:

“Thought disorder” here refers to disorganization of the form of thought and not content. An older use of the term “thought disorder” included the phenomena of delusions and sometimes hallucinations, but this is confusing and ignores the clear differences in the relationships between symptoms that have become apparent over the past 30 years. Delusions and hallucinations should be identified as psychotic symptoms, and thought disorder should be taken to mean formal thought disorders or a disorder of verbal cognition. Phenomenology of Schizophrenia (2017), THE SYMPTOMS OF SCHIZOPHRENIA

The text said that some clinicians use the term “formal thought disorder” broadly, referring to abnormalities in thought form with psychotic cognitive signs or symptoms, and studies of cognition and subsyndromes in schizophrenia may refer to FTD as conceptual disorganization or disorganization factor.

Some disagree:

Unfortunately, “thought disorder” is often involved rather loosely to refer to both FTD and delusional content. For the sake of clarity, the unqualified use of the phrase “thought disorder” should be discarded from psychiatric communication. Even the designation “formal thought disorder” covers too wide a territory. It should always be made clear whether one is referring to derailment or loose associations, flight of ideas, or circumstantiality. The Mental Status Examination, The Medical Basis of Psychiatry (2016)

Course, Diagnosis, and Prognosis

It was believed that TD occurred only in schizophrenia, but later findings indicate that it may occur in other psychiatric conditions (including mania) and in people without mental illness. Not all people with schizophrenia have a TD; the condition is not specific to the disease.

When defining thought-disorder subtypes and classifying them as positive or negative symptoms, Nancy Andreasen found that different subtypes of TD occur at different frequencies in those with mania, depression, and schizophrenia. People with mania have pressured speech as the most prominent symptom, and have rates of derailment, tangentiality, and incoherence as prominent as in those with schizophrenia. They are likelier to have pressured speech, distractibility, and circumstantiality.

People with schizophrenia have more negative TD, including poverty of speech and poverty of content of speech, but also have relatively high rates of some positive TD. Derailment, loss of goal, poverty of content of speech, tangentiality and illogicality are particularly characteristic of schizophrenia. People with depression have relatively-fewer TDs; the most prominent are poverty of speech, poverty of content of speech, and circumstantiality. Andreasen noted the diagnostic usefulness of dividing the symptoms into subtypes; negative TDs without full affective symptoms suggest schizophrenia.

She also cited the prognostic value of negative-positive-symptom divisions. In manic patients, most TDs resolve six months after evaluation; this suggests that TDs in mania, although as severe as in schizophrenia, tend to improve. In people with schizophrenia, however, negative TDs remain after six months and sometimes worsen; positive TDs somewhat improve. A negative TD is a good predictor of some outcomes; patients with prominent negative TDs are worse in social functioning six months later. More prominent negative symptoms generally suggest a worse outcome; however, some people may do well, respond to medication, and have normal brain function. Positive symptoms vary similarly.

A prominent TD at illness onset suggests a worse prognosis, including:

  • Illness begins earlier
  • Increased risk of hospitalisation
  • Decreased functional outcomes
  • Increased disability rates
  • Increased inappropriate social behaviours

TD which is unresponsive to treatment predicts a worse illness course. In schizophrenia, TD severity tends to be more stable than hallucinations and delusions. Prominent TDs are more unlikely to diminish in middle age, compared with positive symptoms. Less-severe TD may occur during the prodromal and residual periods of schizophrenia. Treatment for thought disorder may include psychotherapy, such as cognitive behaviour therapy (CBT), and psychotropic medications.

The DSM-5 includes delusions, hallucinations, disorganised thought process (formal thought disorder), and disorganised or abnormal motor behaviour (including catatonia) as key symptoms of psychosis. Schizophrenia-spectrum disorders such as schizoaffective disorder and schizophreniform disorder typically consist of prominent hallucinations, delusions and FTD; the latter presents as severely disorganised, bizarre, and catatonic behaviour. Psychotic disorders due to medical conditions and substance use typically consist of delusions and hallucinations. The rarer delusional disorder and shared psychotic disorder typically present with persistent delusions. FTDs are commonly found in schizophrenia and mood disorders, with poverty of speech content more common in schizophrenia.

Psychoses such as schizophrenia and bipolar mania are distinguishable from malingering, when an individual fakes illness for other gains, by clinical presentations; malingerers feign thought content with no irregularities in form such as derailment or looseness of association. Negative symptoms, including alogia, may be absent, and chronic thought disorder is typically distressing.

Autism spectrum disorders (ASD) whose diagnosis requires the onset of symptoms before three years of age can be distinguished from early-onset schizophrenia; schizophrenia under age 10 is extremely rare, and ASD patients do not display FTDs. However, it has been suggested that individuals with ASD display language disturbances like those found in schizophrenia; a 2008 study found that children and adolescents with ASD showed significantly more illogical thinking and loose associations than control subjects. The illogical thinking was related to cognitive functioning and executive control; the loose associations were related to communication symptoms and parent reports of stress and anxiety.

Rorschach tests have been useful for assessing TD in disturbed patients. A series of inkblots are shown, and patient responses are analysed to determine disturbances of thought. The nature of the assessment offers insight into the cognitive processes of another, and how they respond to equivocal stimuli. Hermann Rorschach developed this test to diagnose schizophrenia after realising that people with schizophrenia gave drastically different interpretations of Klecksographie inkblots from others whose thought processes were considered normal, and it has become one of the most widely-used assessment tools for diagnosing TDs.

The Thought Disorder Index (TDI), also known as the Delta Index, was developed to help further determine the severity of TD in verbal responses. TDI scores are primarily derived from verbally-expressed interpretations of the Rorschach test, but TDI can also be used with other verbal samples (including the Wechsler Adult Intelligence Scale). TDI has a twenty-three-category scoring index; each category scores the level of severity on a scale from 0–1, with .25 being mild and 1.00 being most severe (.25, .50, .75, 1.00).

Criticism

TD has been criticised as being based on circular or incoherent definitions. Symptoms of TD are inferred from disordered speech, based on the assumption that disordered speech arises from disordered thought. Although TD is typically associated with psychosis, similar phenomena can appear in different disorders and leading to misdiagnosis.

A criticism related to the separation of symptoms of schizophrenia into negative or positive symptoms, including TD, is that it oversimplifies the complexity of TD and its relationship to other positive symptoms. Factor analysis has found that negative symptoms tend to correlate with one another, but positive symptoms tend to separate into two groups. The three clusters became known as negative symptoms, psychotic symptoms, and disorganisation symptoms. Alogia, a TD traditionally classified as a negative symptom, can be separated into two types:

  • Poverty of speech content as (a disorganisation symptom); and
  • Poverty of speech, response latency, and thought blocking (negative symptoms).

Positive-negative-symptom diametrics, however, may enable a more accurate characterisation of schizophrenia.

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An Overview of Mental Health Among Female Offenders in the US

Published on by Andrew Marshall1 Comment

Introduction

People in prison are more likely than the general United States (US) population to have received a mental disorder diagnosis, and women in prison have higher rates of mental illness and mental health treatment than do men in prison. Furthermore, women in prisons are three times more likely than the general population to report poor physical and mental health. Women are the fastest growing demographic of the US prison population. As of 2019, there are about 222,500 women incarcerated in state and federal prisons in the US. Women comprise roughly 8% of all inmates in the US.

In 2011, 11% of male inmates had an overnight hospital stay due to psychiatric problems, while the proportion of women who did was roughly twice that of men. In 2010, 73% of incarcerated women and 55% of incarcerated men self-reported mental health problems. This statistic accounts for the reporting of at least one of two criteria, as a self-reported mental or emotional problem, or a reported overnight hospital stay. The most common mental health problems among incarcerated women are substance abuse/dependence, post-traumatic stress disorder, and depression. Other common disorders include schizophrenia, bipolar disorder, and dysthymia.

Refer to An Overview of Mental Illness in US Jails and Prisons.

Before Crime

Early Experiences of Victimisation

Criminality among females is intimately associated with experiences of trauma and victimisation occurring early in life. The majority of incarcerated females have experienced some kind of victimisation, defined as experiences of physical, sexual, or emotional trauma. Among female offenders 78% of have reported prior sexual or physical abuse, compared to only 30% of male offenders. Furthermore, “research consistently links histories of violence with negative mental health outcomes, such as depression, substance abuse, and intimate partner violence among incarcerated women at higher rates than those in the general female population”. Early experiences of victimisation predispose women to be more likely to suffer from certain psychiatric disorders, particularly post-traumatic stress disorder (PTSD), depression, and dysthymia. A study conducted in 2017, found that 60% of participating female inmates had been diagnosed with a mental illness.

Following PTSD and substance abuse/dependence, depression is the third most common psychiatric disorder among incarcerated women. Depression and substance abuse, too, are closely linked with experiences of victimisation or PTSD, and more so for women than for men. In fact, according to the National Comorbidity Survey, women are twice as likely as men to experience co-occurring PTSD and depression. The prevalence of depression among incarcerated females links to trends within the general population as well. A study found that of the 54% of incarcerated women diagnosed with lifetime PTSD, 63% reported experiencing three or more traumatic events. While women are more likely than men to suffer internalised problems, such as anxiety and depression, men are more likely to be treated for externalised problems such as delinquency, aggression, and substance abuse. This difference coincides with a gendered discrepancy in the experiences of mentally ill offenders once they enter the criminal justice system.

Victimisation and Criminal Offending

In both males and females, sexual abuse, physical abuse, and neglect increase the likelihood of arrest for a juvenile by 59% and as an adult by 28%. Although sociologists do not point to a single explanation for the association between victimisation, trauma, and incarceration, researchers have found that trauma frequently cause women to abuse drugs and alcohol as a coping mechanism. Sociologists also point out that early victimisation increases the likelihood of women’s continued or exacerbated involvement in harmful settings. According to one ethnography of female offenders in Boston, “In fact, running away from home—often to escape abuse in households dominated by violent men—is the charge in the first arrest for nearly a quarter of girls in the juvenile justice system… On the streets, women are vulnerable to harassment, exploitation, and drug use, all of which drag them into the correctional circuit”. In addition to symptoms of trauma, other mental health problems such as major depression, schizophrenia, and mania are linked with patterns of violent offending and homelessness prior to arrest.

Substance Abuse

Substance abuse and dependence are the most common mental health problems among incarcerated females, and drug use is the most common reason for women’s incarceration. At the end of 2018, 26% of female state prisoners were serving time for drug related offenses. This percentage is double than that of male state prisoners who are serving time for drug related charges. Seventy percent of incarcerated females suffer from drug abuse or dependence, and incarcerated females are nine times more likely than the general population to experience substance abuse and dependence. Social researchers have linked substance abuse to experiences of trauma and victimisation.

Sociologists have conducted extensive research in favour of a self-medication hypothesis in relation to women’s drug use and abuse, positing that women use drugs as a way to cope with experiences of sexual or physical trauma. Past research suggests that consequences of childhood sexual abuse increase a woman’s risk for self-medicating with alcohol and drugs. Incarcerated women with a history of substance abuse are more likely have had prior mental health and criminal justice experiences than incarcerated women with no history of drug abuse.

In The Courts

Within the US justice system, women’s criminal activity is more likely than men’s to be medicalised, in connection with a tendency to perceive female offenders as “mad, rather than bad.” Female offenders are more likely than men to receive psychiatric evaluations, even when they have not self-reported a mental illness. Sociologists have noted that gendered stereotypes among men and women contribute to this discrepancy in mental health evaluations. While criminal behaviour and aggression are more associated with masculinity, traits such as passivity and submission are more associated with feminine roles. Female offenders are more likely to be identified as having engaged in role-incongruent or deviant behaviour that is explained, diagnosed, and treated psychiatrically. Receiving a psychiatric evaluation reduces the chances that a defendant will have charges dropped against her or him, and also increases the likelihood of conviction, incarceration, and lengthier prison sentences. Because women who have engaged in crime are thought to have violated gender norms, some sociologists posit that female offenders may receive harsher sentences than men. However, among men and women in the general population, sociologists have not reached a consensus on the differences in sentencing, treatment, and leniency among males and females in general. For instance, among juveniles, males are more likely to be arrested, petitioned, and adjudicated than females. Among juvenile females who are sentenced, studies vary on whether these women receive lighter or harsher sentences. Some studies find that women are treated more leniently by courts. Other studies show that juvenile women may be sentenced more harshly than their male counterparts.

During Incarceration

Prevalence of Mental Illness

Several studies have found that rates of mental illness in prisons are higher than those in the general population and that rates of mental illness in women’s prisons are higher than those in men’s prisons. In 1999 a report for the Department of Justice estimated16% of the prison population had some form of mental disorder. However, much research in this area “lack[s] specificity regarding important subpopulations, such as female offenders.” That work which has looked at female offenders as an “important subpopulation” has found that they experience mental health problems at greater rates than their male counterparts. According to a report through the Bureau of Justice Statistics, female prisoners are about twice as likely than male prisoners to have a history of mental health problems.

A study through the Mental Health Prevalence Project which used “three major indicators of mental illness: diagnosis of a serious mental illness, history of inpatient psychiatric care, and psychotropic medication use” found that female offenders have “on average, twice the rate of various indicators as males.” The study found (using a weighted sample) that 17.8% of male offenders and 35.1% of female offenders have a mental health problem upon being committed. This study did not treat substance abuse as a mental health disorder.

Other studies report much higher rates of mental illness among prisoners. One Bureau of Justice Statistics survey in 2004 found that 55% of male inmates and 73% of female inmates self-reported a mental health problem. The Sentencing Project, in their 2007 Briefing Sheets, also report that 73.1% of women in prisons have a mental health problem. Female inmates who experience co-occurring disorders are four times more likely than other female inmates to receive severe disciplinary punishment. No significant relationship has been found between severe punishment and a singular mental health disorder or substance use disorder. Female inmates are more likely than male inmates to be diagnosed with depression, substance abuse, developmental disabilities, bipolar disorder, PTSD, and eating disorders.

Mental Health Treatment and Services

For many offenders, incarceration provides a rare opportunity to access mental health services not available to offenders within their communities. Despite the growing prison population in the US and the prevalence of mental health problems “In-prison services have not expanded sufficiently to meet treatment needs. In fact, between 1988 and 2000, prison mental health services declined, and those services that are available are concentrated only in the most secure facilities.” One study found that 41% of female inmates report use of mental health services while incarcerated, while 73% report mental health problems.

According to the Bureau of Justice Statistics “All Federal prisons and most State prisons and jail jurisdictions, as a matter of policy, provide mental health services to inmates, including screening inmates at intake for mental health problems, providing therapy or counseling by trained mental health professionals, and distributing psychotropic medication.” Researchers working with the Mental Health Prevalence Project note that “legal mandates and humanitarian concerns alone require that [mental health] services be provided. In addition, the effective, safe, and orderly management of correctional facilities require that these needs be met.”

While sociologists have recommended trauma-focused treatments for offenders, these services are still lacking. Researchers have also noted that “there is strong empirical support for gender-specific, trauma-focused treatments”. In one study, researchers offered 25 therapeutic group sessions to female inmates with mental health problems. It was found that the sessions were “successful at significantly decreasing post-traumatic stress disorder (PTSD) and substance use disorder (SUD) symptoms, with almost 50% of participants no longer meeting criteria for the disorder and 65% reporting no substance use at the 3-month follow up”. Reasons for the lack of gender-specific treatment in women’s prisons despite their proven use may be the difficulties of setting up such programmes, including navigation of “legal and logistical barriers.”

It has been found that female inmates are medicated at higher rates than their male counterparts. Women are also treated differently than men in prisons in regard to mental illness. Studies suggest “that female inmates’ behaviour is more likely than males’ to be ‘psychiatrized’ by correctional staff”. One study shows that “role incongruence” effects how female and male inmates are treated. According to the study “female inmates who perpetrated acts of violence against others and/or property, or who demonstrated aggressiveness or agitation, were significantly more likely than men exhibiting similar behaviors to be placed in mental health units”. Furthermore, the researchers found that men exhibiting “female psychiatric disorders (e.g., depression)” were more likely to receive mental health care than females exhibiting the same disorders. The study suggests that differential treatment of male and female inmates may be based on the inmates adherence to gender norms, and that a breaking of these norms is likely to be treated psychiatrically. Therapeutic or rehabilitation programmes in prisons also differ for men and women, with male prisons providing more access to programs for anger management, and female prisons providing more access to programmes addressing trauma or loss.

After Prison

In many instances, living in prison obligates individuals to adapt socially and psychologically, making it difficult to reintegrate into daily life outside of prison and to develop healthy relationships. Furthermore, due to the prevalence of chronic diseases within jails, offenders returning to low-income communities may be inadvertently contributing to health inequities in low-income areas. The difficulties facing women upon their release from prison range from “finding housing, getting a job, earning enough money to support themselves, reconnecting with children and family.” Failure to find work and a stable home may lead women back to committing crime and back to prison. The recidivism rates among prisoners is so high that it has been termed the “revolving door phenomenon.” Studies have found that among women released from prison in 1994 “58% were arrested” within three and a half years of release, and “39% were returned to prison”. A 2011 study by Pew Centre of the States find similar recidivism rates. The release and re-entry difficulties that female prisoners face are often exacerbated by mental health challenges.

The high rates of mental health problems among female offenders follows them past prison and into re-entry. A study published in 2010 by the Re-entry Planning for Offenders with Mental Disorders: Policy and Practice found that “of 357 women released from prison in six states, 44% reported they had been diagnosed with bipolar disorder, depression, obsessive compulsive disorder, post traumatic stress disorder, phobia, or schizophrenia.” A majority, 56%, of these women, felt they were currently in need of treatment. However, studies find that mental health and substance abuse treatment is not readily available to women returning to their communities from prison. Furthermore, upon release many women often have trouble keeping up with medication they had access to in prison. These mental health problems may hinder offenders as they try to find a job and housing. Their health problems may be so severe they cannot work, they face the additional job of managing their health problem and mental illness increases the likelihood of engaging in “inappropriate behavior that provokes a law enforcement response.” These challenges may increase recidivism rates. An individual’s chance of recidivism decreases if significant change occurs to their in-prison mental health.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Mental_health_among_female_offenders_in_the_United_States >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Mental Illness in US Jails and Prisons

Published on by Andrew Marshall2 Comments

Introduction

Mental illness, or mentally ill people, is/are overrepresented in United States (US) jail and prison populations relative to the general population.

There are three times more seriously mentally ill persons in jails and prisons than in hospitals in the United States. Scholars discuss many different causes of this overrepresentation including the deinstitutionalization of mentally ill individuals in the mid-twentieth century; inadequate community mental health treatment resources; and the criminalisation of mental illness itself. The majority of prisons in the United States employ a psychiatrist and a psychologist. There is a general consensus that mentally ill offenders have comparable rates of recidivism to non-mentally ill offenders. Mentally ill people experience solitary confinement at disproportionate rates and are more vulnerable to its adverse psychological effects. Twenty-five states have laws addressing the emergency detention of the mentally ill within jails, and the US Supreme Court has upheld the right of inmates to mental health treatment.

Refer to An Overview of Mental Health Among Female Offenders in the US.

Prevalence

There is broad scholarly consensus that mentally ill individuals are overrepresented within the US jail and prison populations. In a 2010 study, researchers concluded that, based on statistics from sources including the Bureau of Justice Statistics and the U.S. Department of Health and Human Services, there are currently three times more seriously mentally ill persons in jails and prisons than in hospitals in the United States, with the ratio being nearly ten to one in Arizona and Nevada. “Serious mental illness” is defined here as schizophrenia, bipolar disorder or major depression. Further, they found that 16% of the jail and prison population in the US has a serious mental illness (compared to 6.4% in 1983), although this statistic does not reflect differences among individual states. For example, in North Dakota they found that a person with a serious mental illness is equally likely to be in prison or a jail versus hospital, whereas in states such as Arizona, Nevada and Texas, the imbalance is much more severe. Finally, they noted that a 1991 survey through the National Alliance for the Mentally Ill concluded that jail and/or prison is part of the life experience of 40% of these mentally ill individuals. In addition to mood and anxiety disorders, other psychopathologies have also been found in the US Prison System. Antisocial personality disorder is found in less than 6% of the general American population, but seems to be found in anywhere between 12% to 64% of prison samples. Estimates of Borderline Personality Disorder seem to make up around 1% to 2% in the general public vs 12% to 30% within prisons. Personality disorders, especially of the inmate population, are often found to be comorbid with other disorders.

A separate research study “The Prevalence of Mental Illness among Inmates in a Rural State” noted that national statistics like those previously mentioned primarily pull data from urban jails and prisons. In order to investigate possible differences in rural areas, researchers interviewed a random sample of inmates in both jails and prisons in a rural northeastern state. They found that in this rural setting, there was little evidence of high rates of mental illness within jails, “suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas.” However, high rates of serious mental illness were found among the rural prison inmates.

A 2017 report issued by the Bureau of Justice Statistics used self-report survey data from inmates to assess the prevalence of mental health problems among prisoners and jail inmates. They found that 14% of prisoners and 25% of jail inmates had past 30-day serious psychological distress, compared to 5% of the general population. In addition, 37% of prisoners and 44% of jail inmates had a history of a mental health problem.

In 2015 lawyer and activist Bryan Stevenson claimed in his book Just Mercy that over fifty percent of inmates in jails and prisons in the United States had been diagnosed with a mental illness and that one in five jail inmates (around 20%) had a serious mental illness. As for the gender, age, and racial demographics of mentally ill offenders, the 2017 Bureau of Justice Statistics report found that female inmates, when compared to male inmates, had statistically significant higher rates of serious psychological distress (20.5% of female prisoners and 32.3% of female jail inmates had serious psychological distress, versus 14% of male prisoners and 25.5% of male jail inmates) and a history of a mental health problem (65.8% of female prisoners and 67.9% of female jail inmates compared to 34.8% of male prisoners and 40.8% of male jail inmates). Significant differences between race and ethnicity were also observed. White prisoners and jail inmates were more likely than black or Hispanic inmates to have serious psychological distress or a history of mental health problems. For example, in local jails, 31% of white inmates compared to 22.3% of black inmates and 23.2% of Hispanic inmates had serious psychological distress. Finally, with regards to age, there were virtually no statistical differences between age groups and the percentage who has serious psychological distress or a history of a mental health problem.

Potential Reasons for the High Humber of Incarcerated People Diagnosed with Mental Illnesses

Deinstitutionalisation

Researchers commonly cite deinstitutionalisation, or the emptying of state mental hospitals in the mid-twentieth century, as a direct cause of the rise of mentally ill people in prisons. In the 2010 study “More mentally ill persons are in jails and prisons than hospitals: a survey of the states,” researchers noted, at least in part due to deinstitutionalization, it is increasingly difficult to find beds for mentally ill people who need hospitalisation. Using data collected by the Department of Health and Human Services, they determined there was one psychiatric bed for every 3,000 Americans, compared to one for every 300 Americans in 1955. They also noted increased percentages of mentally ill people in prisons throughout the 1970s and 1980s and found a strong correlation between the amount of mentally ill persons in a state’s jails and prisons and how much money that state spends on mental health services. In the book Criminalising the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals, researchers note that while deinstitutionalisation was carried out with good intentions, it was not accompanied with alternate avenues for mental health treatment for those with serious mental illnesses. According to the authors, Community Mental Health Centres focused their limited resources on individuals with less serious mental illnesses, federal training funds for mental health professionals resulted in lots more psychiatrists in wealthy areas but not in low-income areas, and a policy that made individuals eligible for federal programmes and benefits only after they’d been discharged from state mental hospitals unintentionally incentivised discharging patients without follow-up.

In the article “Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate” researchers Steven Raphael and Michael A. Stoll discuss transinstitutionalisation, or how many patients released from mental hospitals in the mid-twentieth century ended up in jail or prison. Using US census data collected between 1950 and 2000, they concluded that “those most likely to be incarcerated as of the 2000 census experienced pronounced increases in overall institutionalisation between 1950 and 2000 (with particularly large increases for black males). Thus, the impression created by aggregate trends is somewhat misleading, as the 1950 demographic composition of the mental hospital population differs considerably from the 2000 demographic composition of prison and jail inmates.” However, when estimating (using a panel data set) how many individuals incarcerated between 1980 and 2000 would have been institutionalised in years past, they found significant transinstitutionalisation rates for all men and women, with the largest rate for white men.

Accessibility

A main contributing factor as to why the US is seeing a steady increase in those who are mentally ill within the prison system, can be due to the lack of accessibility in various communities. Specifically, those who come from a lower income background face these issues, in which there are little to no resources being offered that are readily available for those experiencing ongoing difficulty with their mental health. The AMA Journal of Ethics discusses more specific factors as to why there are consistent high arrest rates of those with severe mental illness within communities, stating that the arrests of drug offenders, lack of affordable housing, as well as significant lack of funding for community treatments are main contributors. With the introduction of Medicaid, many state run mental health facilities closed due to a shared responsibility of funding with the federal government. Eventually, states would entirely close a good portion of their facilities, so that mentally ill patients were being treated at hospitals where they would partially be covered by Medicaid and the government. The National Council for Behavioural Health conducted a study in October 2018, which included survey results that confirmed:

“nearly six in 10 (56%) Americans [are] seeking or wanting to seek mental health services either for themselves or for a loved one…These individuals are skewing younger and are more likely to be of lower income and military background”.

Criminalisation

A related cause of the disproportionate amount of mentally ill people in prisons is criminalization of mental illness itself. In the 1984 study “Criminalizing mental disorder: The comparative arrest rate of the mentally ill”, researcher L.A. Teplin notes that in addition to a decline in federal support for mental illness resulting in more people being denied treatment, mentally ill people are often stereotyped as dangerous, making fear a factor in action taken against them. Bureaucratic and legal impediments to initiating mental health referrals means arrest can be easier, and in Teplin’s words, “Due to the lack of exclusionary criteria, the criminal justice system may have become the institution that cannot say no.” Mentally ill people do indeed experience higher arrest rates than those without mental illness, but in order to investigate whether or not this was due to criminalization of mental illness, researchers observed police officers over a period of time. As a result, they concluded, “within similar types of situations, persons exhibiting signs of mental disorder have a higher probability of being arrested than those who do not show such signs.”

The authors of the book Criminalising the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals claim that nationwide, 29% of jails will hold mentally ill individuals with no charges brought against them, sometimes as a means of ‘holding’ them when psychiatric hospitals are very far away. This practice occurs even in states where it is explicitly forbidden. Beyond that, according to the authors, the vast majority of people with mental illnesses in jails in prisons are held on minor charges like theft, disorderly conduct, alcohol/drug related charges, and trespassing. These are sometimes “mercy bookings” intended to get the homeless mentally ill off the street, a warm meal, etc. Family members have reported being encouraged by mental health professionals or police to get their loved ones arrested as a means of getting them treatment. Finally, some mentally ill people are in jails and prisons on serious charges, such as murder. The authors of Criminalising the Seriously Mentally Ill claim many such crimes wouldn’t have been committed if the individuals had been receiving proper care.

Malingering

Some inmates feign psychiatric symptoms for secondary gain. For example, an inmate may hope to receive a transfer to a more desirable setting or receive psychotropic medication.

Exacerbation of Mental Illness in a Prison Setting

Another proposed reason for the high number of incarcerated with mental illness is the way how a prison setting can worsen mental health. Individuals with pre-existing mental health conditions can worsen, or new mental health problems may arise. A few reasons are listed as to how prisons can worsen the mental health of the incarcerated:

  • Separation from loved ones;
  • Lack of movement/isolation;
  • Overcrowded prisons; and/or
  • Witnessing violence in the prison setting.

Mental Health Care in Prisons and Jails

Psychologists report that one in every eight prisoners were receiving some mental health therapy or counselling services by the middle of the year in 2000. Inmates are generally screened at admission and depending on the severity of the mental illness they are placed in either general confinement or specialised facilities. Inmates can self report mental illness if they feel it is necessary. In the middle of the year in 2000, inmates self-reported that State prisons held 191,000 mentally ill inmates. A 2011 survey of 230 correctional mental health service providers from 165 state correctional facilities found that 83% of facilities employed at least one psychologist and 81% employed at least one psychiatrist. The study also found that 52% of mentally ill offenders voluntarily received mental health services, 24% were referred by staff, and 11% were mandated by a court to receive services. Although 64% of providers of mental health services reported feeling supported by prison administration and 71% were involved in continuity of care after release from prison, 65% reported being dissatisfied with funding. Only 16% of participants reported offering vocational training, and the researchers noted that although risk/need/responsivity theory has been shown to reduce the risk for recidivism (or committing another crime after being released), it is unknown whether it is incorporated into mental health services in prisons and jails. A 2005 article by researcher Terry A. Kupers noted that male prisoners tend to underreport emotional problems and don’t request help until a crisis, and that prison fosters an environment of toxic masculinity, which increases resistance to psychotherapy. A 2017 report from the Bureau of Justice Statistics noted that 54.3% of prisoners and 35% of jail inmates who had past 30-day serious psychological distress has received mental health treatment since admission to the current facility; and 63% of prisoners and 44.5% of jail inmates with a history of a mental health problem said they had received mental health treatment since admission.

Finally, the book Criminalising the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals points out that 20% of jails have no mental health resources. In addition, small jails are less likely to have access to mental health resources and are more likely to hold individuals with mental illnesses without charges brought against them. Jails in richer areas are more likely to have access to mental health resources, and jails with more access to mental health resources also dealt less with medication refusal.

Recidivism

Research shows that rates of recidivism, or re-entry into prison, are not significantly higher for mentally ill offenders. A 2004 study found that although 77% of mentally ill offenders studied were arrested or charged with a new crime within the 27-55 month follow-up period, when compared with the general population, “our mentally ill inmates were neither more likely nor more serious recidivists than general population inmates.” In contrast, a 2009 study that examined the incarceration history of those in Texas Department of Criminal Justice facilities found that “Texas prison inmates with major psychiatric disorders were far more likely to have had previous incarcerations compared with inmates without a serious mental illness.” In the discussion, the researchers noted that their study’s results differed from most research on this subject, and hypothesized that this novelty could be due to specific conditions within the state of Texas.

A 1991 study by L. Feder noted that although mentally ill offenders were significantly less like to receive support from family and friends upon release from prison, mentally ill offenders were actually less likely to be revoked on parole. However, for nuisance arrests, mentally ill offenders were less likely to have the charges dropped, although they were more likely to have charges dropped for drug arrests. In both cases, mentally ill offenders were more likely to be tracked into mental health. Finally, there were no significant differences in charges for violent arrests.

Tools for Effective Mental Healthcare

A research paper published in 2020 by M. Georgiou remarked that having a well defined consultation process of mental health services will allow for effective care. This is called the Care Programme Approach. It lists six steps to effective care of the prisoner:

  • Identify the health and need of care of the prisoner.
  • Written and clear plans.
  • Having key persons in supervision of the program.
  • Regular assessments of the program.
  • Interprofessional involvement.
  • Career involvement.

Solitary Confinement

A broad range of scholarly research maintains that mentally ill offenders are disproportionately represented in solitary confinement and are more vulnerable to the adverse psychological effects of solitary confinement. Due to differing schemes of classification, empirical data on the makeup of inmates in segregated housing units can be difficult to obtain, and estimates of the percentage of inmates in solitary confinement who are mentally ill range from nearly a third, to 11% (with a “major mental disorder”), to 30% (from a study conducted in Washington), to “over half” (from a study conducted in Indiana), depending on how mental illness is determined, where the study is conducted, and other differences in methodology. Researchers J. Metzner and J. Fellner note that mentally ill offenders in solitary confinement “all too frequently” require crisis care or psychiatric hospitalisation, and that “many simply won’t get better as long as they are isolated.” Researchers T. L. Hafemeister and J. George note that mentally ill offenders in isolation are at higher risk for psychiatric injury, self-harm and suicide. A 2014 study that analysed data from medical records in the New York City jail system found that while self-harm was significantly correlated with having a serious mental illness regardless of whether or not an inmate was in solitary confinement, inmates with serious mental illness in solitary confinement under 18 years of age accounted for the majority of acts of self-harm studied. When brought before federal courts, judges have prohibited or curtailed this practice, and many organisations that deal with human rights, including the United Nations, have condemned it.

In addition, scholars argue the conditions of solitary confinement make it much more difficult to deliver proper psychiatric care. According to researchers J. Metzner and J. Fellner, “Mental health services in segregation units are typically limited to psychotropic medication, a health care clinician stopping at the cell front to ask how the prisoner is doing (i.e. mental health rounds), and occasional meetings in private with a clinician.” One study in the American Journal of Public Health claimed that health care professionals must “frequently” conduct consultation through a slit in a cell door or an open tier that provides no privacy.

However, some researchers disagree with the scope of claims surrounding the psychological effects of solitary confinement. For example, in 2006 researchers G.D. Glancy and E. L. Murray conducted a literature review in which they claimed that many frequently-cited studies have methodological concerns, including researcher bias, the use of volunteer non-prisoners, naturalistic experiments, or case reports, case series, and anecdotes” and concluded “there is little evidence to suggest the majority…kept in SC…experience negative mental health effects.” However, they did support claims that inmates with pre-existing mental illnesses are more vulnerable and do suffer adverse effects. In their conclusion they claim “we should therefore be concerned about those with pre-existing mental illness who are housed in segregation because there is nowhere else to put them within the correctional system.”

Community Standpoint and Outcome

Social stigma regarding this issue is significant due to the public’s outlook and perception of mental health, where some may not recognise it as a health factor that needs to be addressed. It is for this reason that some may avoid or deny the assistance being offered to them, thus further suppressing feelings and experiences that eventually need to be dealt with. The NCBH notes that about one-third of Americans, or 38%, state that they worry of their peers and family members judging them if they were to seek mental help.

Without the presence of these facilities within communities, there is an outcome of mentally ill individuals carrying on with no preventative treatment or care to keep the severity of their condition to a healthy level. Just about 2 million of these individuals go to jail each year, moreover, data shows that 15% of men and 30% of women who are taken to prison, do in fact have a serious mental health condition. The National Alliance on Mental Illness further looks into the results of decreased mental health services, and they found that for many, individuals do ultimately become homeless, or they find themselves in emergency rooms, as a result of inaccessibility to mental services and support groups. Statistics show that about 83% of jail inmates did not have access to needed treatment, prior to their incarceration, within their community which is why some may be rearrested for crimes as a way to return to some form of assistance. The Marshall Project has gathered data regarding those being treated in jail, and what they found was that the Federal Bureau of Prisons implicated a new policy to be initiated that was meant to improve the care for inmates with mental-health issues. It ultimately led to decreasing the number of inmates who were categorized as needing higher care levels by more than 35%. After this policy change, the Marshall Project noted the steady decline since May 2014 of inmates receiving treatment for a mental illness. Research shows that within recent years, those with “serious psychotic disorders, especially when untreated, can be more likely to commit a violent crime”.

It is said that an institutional shift would be more effective in reducing the number of incarcerated through the collaboration of multiple agencies, especially when it comes to the criminal justice system and the community. This collaboration between agencies deviates from the “self-perpetuating” system meant to incarcerate and process individuals in an administrative manner; therefore, it focuses closely on people with severe mental illness, and ensure ongoing care within and out of prison to reduce recidivism.

Legal Aspects

Current Laws

The Federal Bureau of Prisons have claimed to have made policy changes, but those changes only apply to the rules within the system, and they did not fund resources to carry those new implementations out. It should also be noted that within the prison system, states have laws and responsibilities to ensure as well, one being within the Eighth amendment that requires prisoners’ medical needs to consistently be met. The Prison Litigation Reform Act upholds this right in federal court cases.

As of late December 2018, the First Step Act (S 756) was signed into law as a way to a way to reduce recidivism and provide overall improvements to the conditions faced within federal prisons, as well as working to reduce the mandatory sentences given. Although, this Act primarily applies to about 225.000, or 10%, of individuals in federal prisons and jails, whereas this reform may not be applied to those in state prisons and jails. Some of the provisions that result from this act include staff training as to how to identify and assist those suffering from a mental illness, and providing improved, accessible treatment regarding drug abuse with programs like medication-assisted treatment.

The implementation of significantly more Certified Community Behavioural Health Clinics has been discussed as a solution to the issue of mental health in the prison system as well. Its primary goal is to cater to the needs of its specific communities and expand access to mental health treatment for everyone. The claims of an organisation like this is to reduce criminal justice costs, as well as hospital readmissions, and, once again, to reduce recidivism. They strive to treat individuals with mental illness early on, rather than allowing them to carry on without professional care and general support.

Emergency Detention

One major area of legal concern is the emergency detention of the non-criminal mentally ill in jails while waiting for formal procedures for involuntary hospitalisation. Twenty-five states and the District of Columbia have laws that specifically address this practice; eight of these states, as well as D.C., explicitly forbid it. Seventeen states, on the other hand, explicitly allow it. Within this set, the criteria and circumstances necessary differ by state, and most states limit the detention periods in jails to one to three days. One distinguishing factor of this practice is that it is often initiated by a non-medical professional such as a police officer. In many states, especially those in which a non-public official such as a medical health professional or concerned citizen can initiate the detention, a judge or magistrate is required to approve it before or soon after the initiation.

When emergency detention in jails has been brought to court, judges have generally agreed that the practice itself is not unconstitutional. One notable exception was Lynch v. Baxley; however, later cases, particularly Boston v. Lafayette County, Mississippi, have connected the ruling of unconstitutionality in that case with the conditions of the jails themselves rather than the fact that they were jails. That being said, the Supreme Court of Illinois has stated that this practice is unconstitutional if the person being detained does not pose an imminent threat to himself or others.

Supreme Court Cases

Several landmark Supreme Court cases, notably Estelle v. Gamble, have established the constitutional right of prison inmates to mental health treatment. Estelle v. Gamble determined that “deliberate indifference to serious medical needs” of prisoners was a violation of the Eighth Amendment to the US Constitution. This case was the first time the phrase “deliberate indifference” was used; it is now a legal term. In order to determine “serious medical need” later cases would use tests such as the treatment being mandated by a physician or an obvious need to a layman. On the other hand, other cases, notably McGukin v. Smith, used much stricter terms, and in 1993 researchers Henry J. Steadman and Joseph J. Cocozza commented that “serious medical need” had little definitional clarity. Langley v. Coughlin involved a prisoner “regularly isolated without proper screening or care” and clarified that a single, distinctive act is not necessary to constitute deliberate indifference but rather “if seriously ill inmates are consistently made to wait for care while their condition deteriorates, or if diagnoses are haphazard and records minimally adequate then, over time, the mental state of deliberate indifference may be attributed to those in charge.”

The landmark case Washington v. Harper determined that although inmates do have an interest in and the right to refusal of treatment, this can be overridden without judicial process even if the inmate is competent provided there this act is “reasonably related to legitimate penological interest”. Washington’s internal process for determining this need was seen as affording due process. In contrast, in Breads v. Moehrle, the forcible injection of drugs in a jail was not upheld because sufficient procedures were not taken to ensure “substantive determination of need”.

Court Cases

George Daniel, a mentally ill man on Alabama’s death row was arrested and charged with capital murder. In jail, George became acutely psychotic and could not speak in complete sentences. Daniel, had been on death row until several years later, Lawyer Bryan Stevenson uncovered the truth of the doctor who lied about the examination of Daniels mental illness. Daniel’s trial was then overturned and he has been in a mental institution since. Another mentally ill man, Avery Jenkins, was convicted of murder and sentenced to death. Throughout Jenkins’s childhood, he had been in and out of foster homes and developed a serious mental illness. Jenkins erratic behaviour did not change, so his foster mother decided to get rid of him by tying him to a tree and left him there. Around the age of sixteen he was left homeless and started to experience psychotic episodes. At the age of twenty, Jenkins had wandered into a strange house and stabbed a man to death as he perceived it to being a demon. He then was sentenced to death and spent several years in prison as if he had been sane and responsible for his actions. Jenkins then got off death row and was put into a mental institution.

In the past, overall living and treatment conditions within US prisons were not up to par, which can be seen through the details and points made by the Coleman v. Brown case that went to trial in 1995. The district court judge in another case, ultimately recognised the systemic failure within the system to properly care for and provide resources to mentally ill inmates. These individuals were not receiving treatment prior to prison, and were sent there with expectations from others that they would be receiving treatment there, but that expectation was not fulfilled.

With Coleman v. Brown, a special court, including three judges that can make final decisions on whether or not a problem is significant enough to enact change, came to the conclusion that overcrowding was in fact a reason for poor conditions in prisons, therefore they called for a reduction in the prison population to partially relieve said issue. Justice Alito at this time questioned whether the solution of reduction was actually helpful, when they could be looking into constructing additional prison medical and mental health facilities. Although, the decision did not take care of the living conditions that were problematic before and even after the case. It has been noted that psychotic prisoners were often held in small, narrow essentially restricted areas in which standing on their own secretions was common. As far as actual mental health treatment conditions, the waiting time to even receive care could take up to a year, and when they finally reached that date, the screenings for such lacked privacy for those being evaluated as the spaces were often shared by several physicians at a time. Other case that has been discussed, is John Rudd , who was being a federal prison in West Virginia as of 2017. Rudd had a history of mental health disorders consisting of posttraumatic stress disorder, as well as schizophrenia. He was evaluated and diagnosed by a doctor as early as 1992. In 2017, he stopped taking his psychiatric medication, then proceeded to inform staff of his intentions to take his own life. Staff proceeded to put him in a suicide watch cell, where he would physically and violently hurt himself. Staff injected him with haloperidol, an anti-psychotic drug, to treat him, but after some time they concluded that Rudd was not ill enough to receive proper, regular treatment and continued to categorize him as a level one inmate, meaning no significant mental health needs. Although they were aware of his pre-existing conditions, the prison staff claimed those were resolved and simply adjusted it to Rudd having an antisocial personality disorder.

On 07 December 2020, Thomas Lee Rutledge died of hyperthermia at the home of William E. Donaldson in Bessemer. According to a lawsuit filed by his sister, Rutledge had a core temperature of 109 degrees when he was found unconscious in his psychiatric cell.

A more recent case is that a mentally ill man froze to death at an Alabama jail as of 2023, according to a lawsuit filed by the man’s family who say he was kept naked in a concrete cell and believe he was also placed in a freezer or other frigid environment. Anthony Don Mitchell, 33, arrived at the hospital’s emergency room with a body temperature of 72 degrees (22 degrees Fahrenheit) and was pronounced dead hours later, according to the lawsuit. He was rushed to the hospital on January 26 from the Walker County Jail, where he had been held for two weeks. The paramedic who tried unsuccessfully to resuscitate Mitchell writes, “I believe hypothermia was the ultimate cause of death,” according to a lawsuit filed by Mitchell’s mother in federal court Monday. Mitchell, who had a history of substance abuse, was arrested on January 1st.12 after a cousin asked authorities to check on his well-being for wandering through portals to heaven and hell at his home and apparently suffering a nervous breakdown. According to the lawsuit, prison video shows Mitchell being held naked in a solitary cell with a concrete floor. The lawsuit speculates that Mitchell was also taken to the prison kitchen “freezer” or similar freezing environment and left there for hours “because his body temperature was so low.”

Prison staff in general, have also been experiencing issues for various years now. Previously in the 1990s, just about one-third of positions went unfilled for mental health staff, and it became increasingly impactful on inmates when the vacancy rates for psychiatrists reached 50% and up. Staffing shortage is still seen today in which some counsellors can be pulled and asked to serve as a corrections officers for the time being. This situation had worsened due to the Trump administration and the hiring freeze that was meant to reduce costs. Rudd, now out of prison and receiving counselling and taking medication, speaks on triggers within the prison environment that are not in any way healthy for those who are mentally ill.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Mentally_ill_people_in_United_States_jails_and_prisons >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.