Literature and Aspects of the Human Experience Essay

Literature offers a unique view into the human experience. Writers share their ideas about life through language, literary devices, and imagery. The human experience of love is one that every person can relate to. Three examples of literature that share this theme of love are: â€Å"A Rose for Emily†, â€Å"Love Song†, and â€Å"A Doll’s House†. Although some of the stories deal with family and parental love, this paper will focus on the aspect of romantic love. In the story â€Å"A Rose for Emily† by William Faulkner romantic love was between Emily and the doomed Homer Barron; the poem â€Å"Love Song† by Joseph Brodsky gives the declarations of a man in love; and finally in the drama â€Å"A Doll’s House† Nora is fighting for the romantic love of her husband Torvald Helmer. Love is a shared theme in these stories, and the literature portrays this human experience in ways that allow the reader to better understand the mystery of romantic love. Romantic Love The story of â€Å"A Rose for Emily† by William Faulkner tells the sad tale of Emily Grierson. The story opens with Emily’s death. Her mortality sets the mood for this story of loss and sorrow. Although Emily has issues with parental and family love in this story the theme of romantic love is one that is truly tragic. Emily is the protagonist of the story. Her desire for love leads her to Homer Barron. Mr. Barron has come to Emily’s southern town to help in paving sidewalks. The ladies of town who still perceive Emily as part of a high society southern family do not believe that Emily could consider Homer Barron, â€Å"of course a Grierson would not think seriously of a Northerner, a day laborer† (Barnet, Cain, & Burto, 2011, p. 241, para. 2). Emily does fall in love with Homer. Unfortunately the story leads us to believe that Homer was not seriously interested in Emily. â€Å"Homer himself had remarked – he liked men, and †¦he was not a marrying man† (Barnet, Cain, & Burto, 2011, p. 42, para. 1). Emily is found buying poison around this time. Homer Barron disappears. With the close of the story Emily dies. The house is opened and it is revealed that the dead body of Homer Barron is laid out in an upstairs bedroom â€Å"this room decked†¦as for a bridal†¦the man’s toilet things back with tarnished silver†¦the man himself lay in the bed†¦we noticed†¦the second pillow was the indentation of a head†¦a long strand of iron-gray hair† (Barnet, Cain, & Burto, 2011, pps. 243 & 244, paras. 8, 1, & 3). Emily had been in love with Homer, but he did not return this love. Emily did not want to lose her love so she killed Homer and kept him with her. â€Å"Love Song† is a poem by Joseph Brodsky that is one man’s declaration of romantic love to a woman. The poem uses multiple metaphors of how much the man loves the woman. The wording reveals that the author has very conflicting views of romantic love which are often conflicting (Shippon, 2006). He offers to save her from drowning, yet then states he would arrest her and keep her imprisoned. Brodsky declares that he would try to make the woman happy when he says â€Å"if you were a bird, I’d cut a record and listen all night long to your high-pitched trill†¦if you were Chinese, I’d learn the language, burn a lot of incense, wear funny clothes, if you were a mirror, I’d storm the Ladies, give you my red lipstick and puff your nose† (Barnet, Cain, & Burto, 2011, p. 734). These declarations appear to show how the man would do things to impress the woman. Then Brodsky goes on to refer to love as a duty, obligation, and trap when he writes â€Å"if you were a sheriff, I’d arrest you†¦if I were a sergeant, you’d be my recruit†¦if you were my wife, I’d be your lover because the church is firmly against divorce† (Barnet, Cain, & Burto, 2011, p. 734). Brodsky’s ideas of romantic love give readers a picture of how complex love can be. â€Å"A Doll’s House† by Henrik Ibsen gives another sad account of the complexities of romantic love. â€Å"A Doll’s House† is a drama play that centers on the character of Nora Helmer. Nora goes through tremendous change in the course of the play as her ideas about love transform. Nora starts Act 1 as a childish girl trying to please her husband, Torvald; in Act 2 Nora acts out of desperation to save her marriage; then in Act 3 Nora comes to the realization that her husband never truly loved her at all (Bradford, 2012). Nora’s ideas of love are clouded by her relationship with her father. She carries on this relationship with her husband living as a source of entertainment and possession rather than a loving partner. Nora explains this when she says â€Å"I have existed to perform tricks for you, Torvald†¦I have been your doll-wife, just as at home I was papa’s doll-child†¦I thought it great fun when you played with me†¦that is what our marriage has been† (Barnet, Cain, & Burto, 2011, p. 838). Ibsen portrays the romantic love between Nora and Torvald as being childish and confused. When the character of Nora realizes that she does not really love Torvald she leaves to find someone who loves her for who she is. The connection between these three examples of literature is the hopes and ideals of romantic love. Romantic love is a human experience that all people desire. Different authors may portray the complexities of love in different ways, but the truth remains that people will do almost anything for love, such as kill the love who threatens to leave them as in â€Å"A Rose for Emily†; fight for love, try to impress someone for love, and do things they do not want to for love as in the poem â€Å"Love Song†; and try to be something that they are not to make the person they love happy as in â€Å"A Doll’s House†. The use of specific literary devices A literary technique or device is any element or the entirety of elements a writer intentionally uses in the structure of their work. An author will use a literary device in short stories, plays, poems, and novels. There are several types of literary devices that can be used such as imagery, symbolism, and descriptive words to build the theme of a story. We will discuss the different literary devices that are used in â€Å"A Rose for Emily† by William Faulker, â€Å"Love Song† by Joseph Brodsky and â€Å"A Doll’s House† by Henrick Isben. In William Faulker’s short story â€Å"A Rose for Emily, a series of literary devices were used to create the theme of the story, which was about Emily searching for love and acceptance. Faulker used foreshadowing throughout the story. He stated in the first line of the story â€Å"when Emily died, our whole town went to her funeral; he explains that the men go out of respect and the women go out of curiosity† (Barnet, Cain, & Burto, 2011, p. 241). Symbolism was also used throughout the story and was a main factor in getting the reader to understand the theme of the short story. The title â€Å"A Rose for Emily’ is an example of the symbolism used. The rose represents the absence of love that Emily feels. Also, one of the most effective elements that the author used in his development of the theme is the use of imagery. He portrays Homer Barron and Emily’s father as sort of villains who are preventing love. A reader can also see the symbolism used in â€Å"Love Song† by Joseph Brodsky. Brodsky describes multiple metaphors within the poem declaring that he would do anything for his love. He uses descriptive words, such as â€Å"If you were Chinese, I’d learn the languages, burn a lot of incense, wear funny clothes† and â€Å"If you loved volcanoes, I’d be lava relentlessly erupting from my hidden source† (Barnet, Cain, & Burto, 2011, p. 734). These descriptive words were used to express to the reader the way that Brodsky felt about this girl who he was in love with. In â€Å"A Doll’s House† by Henrick Isben the use of animal imagery are used mainly over the other literary devices. The animal imagery was used in the description of the main character in the play, Nora. This allows the reader to form a development of the character Nora. Isben uses words in the conversations between Nora and her Torvald. Torvald states in the beginning of the play â€Å"Is it my little lark tweeting out here? †(Barnet, Cain, & Burto, 2011, p. 838). This tells the reader that Torvald considers Nora a possession, instead of an equal. Torvald also refers to Nora as a squirrel on different occasions, to indicate that Nora is sneaky or negative. The use of the animal imagery helps to build the characters of Nora and Torvald and the relationship of husband and wife. Symbolism was also used in this play. The symbol of the Christmas tree was used in the play in order to help set up the theme that everything may seem perfect, but as the play comes to an end, Nora breaks away from her marriage to go find herself.

Tough Guise

Tough Guise What does it mean to be a man in society? Jackson Katz in the documentary â€Å"Tough Guise† argues that social media puts a lot of pressure on how men should look and act. For example, Arnold Schwarzenegger is possibly one of the most popular role models for young boys and men today. Therefore when our society thinks of the ultimate â€Å"many man† the first thing that comes to mind is strong, aggressive, tall, handsome, courageous, rough, tough, emotionless, insensitive, fearless and practical. Men should not be soft, submissive or weak. If a man would show weakness in any way, there would be much criticism to follow.People fail to realize how their cultural expectations can be harmful to boys, men, women, and society as a whole. Our culture needs to be more excepting of what it â€Å"truly† means to be a man. Gender roles are taught to boys from the very day they are born. Parents treat sons and daughters differently. Little boys are taught to be t ough. When little boy’s cry their parents might respond by telling him to grow up, and be a tough. However if a little girl did the same thing she would most likely receive more sympathy from her parents. A good example of this is in athletics. It is acceptable for a female athlete to cry when an injury takes place.But male athletes are usually made fun of for being â€Å"weak† or â€Å"sissies. † These expectations can be harmful to boys and men. According to Dennis Thompson, some studies show men and women share more emotional similarities than differences. When men are forced to hold in their emotions, they are more likely to suffer from high blood pressure, and participate in riskier behaviors such as smoking or drinking. (â€Å"Gender Differences in Emotional Health. †Ã‚  EverydayHealth. com. N. p. , n. d. Web. ) Boys and men should be allowed to grow up with non-stereotypical responses to their true emotional needs.Due to this tough guise persona, w omen suffer too. In the documentary â€Å"Tough Guise† Jackson Katz talks about the modern multicultural women’s movement. Katz explains how this movement in history has given men new intakes about relationships, work, and parenting. There are now many young men today who are very open minded about relationships between men and women, and sexual equality. But there has also been a â€Å"backlash. † This means some men are not adjusting to these cultural changes. For example Howard Stern plays the role of a â€Å"bad boy† who is only famous for demeaning women.Stern shows women as objects by airing them on television half naked and uses degrading names. Howard Stern makes young male viewers feel good about themselves by degrading women and regressing back to traditional sexist ways. Not only are young men seeing people like Howard Stern as the â€Å"social norm,† they are also being influenced by sexual violence films. Many slasher films show women in sexually explicit ways right before they are being assaulted. Jackson Kratz seems to think this might be why so many men are sexually assaulting women. Violence is rapid among boys and men, which is affecting our whole society.Men and boys are being bullied in their schools. This is resulting in mass murders. In order to show dominance boys and men are relying on guns. In fact, the boys interviewed felt they needed to seek revenge on those who bullied them to assert their manhood. Luke Woodham, who carried out the Pearl, Mississippi, quoted â€Å"people called me gay, stupid, fat, and lazy. Murder is not weak and slow-witted, murder is gutsy and daring. † I am not insane; I did this to show society that people like me are mistreated every day. † ( â€Å"The Day Luke Woodham Killed All Those People. †Ã‚  YouTube. YouTube, 15 Apr. 008. )   Luke Woodham was did not fit into societies cultural norm; therefore felt the need to show his dominance by taking lifeâ⠂¬â„¢s. These are things society needs to think about. Unfortunately Men are putting up a front for society. With this being said men go through a lot in order to fit the stereotypical â€Å"manly man. † Our culture needs to see all of the negative outcomes of putting this kind of pressure on men. Men should be allowed to be true to themselves without being judged. When men are expected to fit a certain stereotype, this sometimes results in violence against women, and society.

Associated Business Risks Of An Organization

An organization involved in a business has certain specific characteristics which makes it different from other organizations. Each and every organization has to work in different environment which makes the job of the management of an organization challenging as the conditions changes so are the challenges to an organization. Accordingly, the associated risks of doing business also change with even little change in environment and other conditions. In this document a detailed discussion shall be made on how to assess the associated business risks of an organization working under a particular environment and how to use analytical procedures for such an organization to conduct an effective audit in such circumstances. There are numerous countries across the globe which have specific domestic auditing standard on understanding and assessing the risks of material misstatement through understanding the entity and its environment is auditing standard. In order to conduct an audit efficiently the very first thing that the auditors need to know is the environment in which a particular organization operates. The environment and the attributes of the environment of an organization will determine the nature of risks that such an organization will experience in conducting its operations (Arens et al. 2016). In this document a detailed discussion shall be made to understand the risks of business associated with the operations of Aristocrat Leisure Limited and accordingly, the analytical procedures that shall be used to deal with these risks and provide an appropriate opinion on the financial statements of the company. Manufacturer of gambling machines Aristocrat Leisure Limited is an Australian company; with the administrative center of the company in Sydney the company conducts most of its research and development activities at its North Ryde site. Apart from Australia the company also has its marketing and brand development offices in countries like United States of America, South Africa and Russia. The management of the company takes product in its achievement of being the largest gambling machine manufacturer in the country and also at being one of the largest in manufacturing slot machines on the planet. In fact when it comes to manufacturing of slot machines the company is only second to International Game Technology (Byrnes et al. 2015).   Ã‚  Ã‚  Ã‚  Ã‚   The company is involved in manufacturing of gambling machines and slot machines and is one of the largest company in the globe in manufacturing these machines, certainly the largest in whole of Australia. The business operations of the company includes manufacturing of spinning reel slot machines and computerized gambling systems, development of computerized card games. The company has license to distribute computerized card game simulations, gambling machines and slot machines in more than 200 jurisdictions in and out of Australia (Cao et al. 2015). The company is a constituent of Australian Stock Exchange ASX and was first listed in way back 1996. It first manufactured a machine in the year 1953 and since then have invested in number of new initiatives and projects to manufacture innovative gambling and slot machine. Investment activities of the company include huge amount of investment on research and development process to find new and better ways to manufacture and develop slot machines as well as other gambling machines. Investment in research and development processes has also helped the company to come up with innovative new products of its own. The company has made substantial amount of investment on developing computerized gambling systems and automatic spinning slot machines. Apart from these the investment activities of the company includes investment in computerized card games simulations and advances computerized gambling systems. Over the years the management has used its funds very sensibly as it clear from the fa ct that most of the investment initiatives take by the management in the past has helped the company to enhance its market growth substantially. Thus, at present the company stands as a market leaders in Australian manufacturing gambling machines the second market leader in manufacturing slot machines across the globe (Fayol 2016).   Financing of the projects of the company has been done mainly by using the funds generated from the issuance of ordinary shares in the market and from loans taken from banks and other financial institutions. Thus, the financing of the company is a combination of own funds and borrowed funds. Apart from these two sources the company has also earned substantial amount of profit during the course of its existence and thus has substantial amount of retained earnings. The company has made efficient use of its retained earnings by financing profitable projects. The company follows the international financial reporting standards to prepare and present the financial statements of the company. The company has followed the going concern concept in preparing the financial statements. In recording the transactions that the company enters into, double entry system of accounting and accrual basis of accounting prince have been used. The company prepares Balance sheet, income statement, cash flow statement, statement of changes in equity and notes to accounts. All these statements include corresponding figures of previous year to allow the users of these statement to compare the current year’s figures instantly with the corresponding figures of previous year. The company has also followed the guidelines of AASB 8, Segment Reporting, and has provided necessary information for different operating and geographical segments of the company in its financial statements (Jans et al. 2014). Understanding of the industry of which the organization is part of us an important part of assessing the environment within which the organization performs to understand the associated risks and possible material misstatements in the financial statements. The industry of production of gambling machinery and development of computerized gambling system and computerized card games simulations is a huge industry with numerous companies vying to capture bugger market share than they have at the present. Slot Machine Manufactures, International Game Technology etc. are well-known organizations that are in the business of manufacturing gambling and slot machines for number of years now. These are only few companies mentioned since these are the only two companies that are in the same league as that of the Aristocrat Leisure Limited. However, there are numerous other companies that are looking to capture the market with production and development of innovative gambling machineries and computerized card simulation games. Apart from that there are other companies which are trying to get in the industry in the future. The industry growth has been phenomenal to say the least. According to the data provided by a leading magazine the gambling activities have showed an increase of 200% only over the last 5 years and if the trend continues then the gambling society believes that the revenue from gambling will increase to 5 times within next 10 years. Obviously as the gambling activity going to increase so will the requirement and need of gambling machines and system. The increase in use of computerized card games simulations have increased to 3 times in recent years and so has the business of the developers of such game. The potential of growth of the industry is huge and in fact with this rate of growth it can be said that the industry is in high growth trajectory. The industry has an effective supply chain and it has contributed immensely to the growth of the industry and will continue to do even in the future. Slot Machine Manufacturers, International Game Technology, Developers Limited are the major players in the market and have dominated the market for number of years now. The major portion of the market share are of International Game Technology, Slot Machine Manufactures and Aristocrat Leisure Limited. These three combined provides more than 50% of the machines used for gambling. Also in card game simulations these three companies are the top market share holder in the industry. All the other companies combined have a market share of less than 50% when it comes to manufacturing and production of gambling machines are concerned. The critical success factors are the following: The legal environment within which an organization works and operates is a huge factor that contributes to the overall development of an organization. Neither too much nor too less regulations is good for an organization and business hence, there should be proper balance between too much and too less regulations. Aristocrat Leisure Limited has to follow the relevant guidelines and provisions of competition act, Income Tax Assessment Act, 1997 and others to continue its business operation. The political environment of the company is stable and has never been a roadblock to the progress of the company and there is nothing to believe that this going to change in the immediate future. The economic environment within which the organization operates is also progressive and helpful for the development of business. Socially the country is a developed and opened society which have helped the gambling business to grow and so the business of the company. Technologically the country is well developed and been a leader around the globe in that aspect hence, technological progress has also helped the company to grow further (Trevino and Nelson 2016). Strength of the company is its ability to innovate. Over the years the company has provided new and invocative products in the market. The company has an efficient management and workforce which have helped the company to be the largest gambling manufacturing company in Australia and second largest computerized card game simulation developer in the whole wide world. Weakness of the company is the fact that often it has been unable to make optimum use of its idle funds and most of the times these funds have remained idle without any use. The ever increasing regulations and rules for the business of the company is another aspect to be looked at in the future as an area of possible concern. The company has the opportunity to be a huge player in the manufacturing and development of gambling machines in the whole world. The card game simulations also provide the company an opportunity to take over the reins of the market from International Game Technology. Threats are the ever increasing pressure of the existing players in the market to provide better quality products at relatively low prices in the market to keep the existing market share intact. Apart from that the threats of new entrants to the market is also a justifiable threat. Constant innovation and up-gradation of technology makes it imperative on the part of the management to keep modifying its machines and card game simulations to keep up with the requirements of the customers. However, the work force of the company is not fully capable of handling the ever changing needs and requirements of the customers. Thus, the management needs to recruit better equipped personnel to deal with this problem (Sierra?Garcà ­a et al. 2015).  Ã‚     Ã‚  Ã‚  Ã‚   The customers’ needs and expectations are always on the rise and the competitors in the market are always on the look out to provide the customers there desirable products to capture the market. Continuous up-gradation of technology and subsequently the machines and computerized card game simulations is essential for the company to hold on its market share.   The main risks in business expansion strategy of the company is the lack of innovative ideas on the operational aspects of the business. For years now the company has not been able to give a break-through computerized gambling machine or card game simulations of highest quality. In order to expand the business the management needs a break-through product which shall be liked universally by the customers. Apart from that the funds to expand the operations is another issue that the organization has faced in the past. Implementation of the guidelines provided in Australian Accounting Standards issued by the Australian Accounting Standards Board is the primary objective of the management and executive of the organization (Sekaran and Bougie 2016). The company is required to adhere to the Competition Act guidelines by not getting involved in any unlawful practices to hamper the competition in the market. Apart from that the company should disclose its earnings according to the provisions and guidelines provided in the Income Tax Assessment Act, 1936 and the relevant guidelines of Environment Laws of the country should also be followed to avoid penalty or other punishments. The company needs to fulfill its commitments to the banks and financial institutions in order to get financial assistance in expansion of business. Any failure on the part of the company in fulfilling its commitments to financial institutions and banks would hamper the chance of the company in getting financial assistance from these organizations (Sadgrove 2016). The use of information technology is crucial for the development of the company especially since the company is involved in the business of manufacturing computerized gambling machines, slot machines and simulation card games. Proper and effective use of information technology would help the company to achieve its desired objectives in the future. Effects of implementation of a new strategy: As soon as a new strategy is implemented there bound to be some changes in the organization. Accounting requirement might change with the implementation of a new strategy. The accounting professional must have the necessary knowledge to deal with changes and its impact on accounting environment.   An auditor is responsible to express a clear opinion on the financial statements of an organization as to whether the financial statements portray the true and correct picture of the organization. In order to discharge his responsibility efficiently and to express a valid opinion on the financial statements an auditor needs to corroborate evidence by using analytical and substantive procedure. The extent of use of substantive procedures would be dependent on the results of the analytical procedures used by the auditor. Thus, use of analytical procedures has to be done effectively and efficiently by the auditor (Louwers et al. 2015). Use of analytical procedures such as assessing the gross profit margin , net profit margin of the company in the current year and comparing the same with the previous years’ figures along with the standard industry parameters would help the auditor to check for any unnecessary fluctuations in these metrics. Apart from the percentage of interest expense to overall expenses, the growth in sales, the increase in operating expenses all these will help the management to identify any unwarranted fluctuations and possible area of misstatements and frauds. The mission and vision statement of the company has made it amply clear for all the stakeholders to understand how serious the management is to run the operations within the organization in accordance with the ethical values and norms of highest standards. The management has made sure that the importance of following ethical guidelines is conveyed to the employees, labor and other stakeholders in clear terms. The company has a separate unit that looks into this aspect of the organization and is responsible for design and administration of ethical values within the organization. In order to ensure that the manufacturing process as well as other important aspects of business are effectively managed the management has a standard skill and knowledge development program which includes providing training to the employees and educating them with new and improved technologies to equip them to deal with the challenges at the work place.   Ã‚  Ã‚   The governance of the company can be segregated into two main pillars, these are the shareholders of the company and the management of the company. The management of the company is separate from its shareholders. The decisions taken by the management of Aristocrat Leisure Limited are pure to achieve its desirable business objectives and for the benefit of the company. The company has a standard internal audit program which is completely independent of the management (Krahel and Titera 2015).   Ã‚  Ã‚   The management of the company has a very clear style when it comes to running the operations of the company. Managing the business risks by taking important decisions keeping in mind the interests of the company is the backbone of decision making process within the organization. Huge importance is given to the financial reporting process and the management never interfere with the accountants in financial reporting process. The organizational structure of the company is such that it allows the management to take important business decisions only after consulting with the other stakeholders of the company such as shareholders, banks and financial institutions who have provided the company with financial assistance. The management segregates duties and responsibilities of different departments within the organization. The employees have their duties and responsibilities clearly curved out thus, there is generally no overlapping of roles and responsibilities within the organization. The company has a standard recruitment policy which is regularly up-top-dated by the management to ensure that employees and staffs recruited by the company is capable of discharging their duties and responsibilities efficiently. Also in order to develop the skill and knowledge in the work force the company has a standard training program to ensure that the work force gets to know about the new development in their field of work to be able to give their best while working for the company (Knechel and Salterio 2016).     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Arens, A.A., Elder, R.J., Beasley, M.S. and Hogan, C.E., 2016.  Auditing and assurance services. Pearson. Byrnes, P.E., Al-Awadhi, C.A., Gullvist, B., Brown-Liburd, H., Teeter, C.R., Warren Jr, J.D. and Vasarhelyi, M., 2015. Evolution of auditing: from the traditional approach to the future audit.  Audit Analytics,  71. Cao, M., Chychyla, R. and Stewart, T., 2015. Big Data analytics in financial statement audits.  Accounting Horizons,  29(2), pp.423-429. Fayol, H., 2016.  General and industrial management. Ravenio Books. Jans, M., Alles, M.G. and Vasarhelyi, M.A., 2014. A field study on the use of process mining of event logs as an analytical procedure in auditing.  The Accounting Review,  89(5), pp.1751-1773. Knechel, W.R. and Salterio, S.E., 2016.  Auditing: Assurance and risk. Taylor & Francis. Krahel, J.P. and Titera, W.R., 2015. Consequences of big data and formalization on accounting and auditing standards.  Accounting Horizons,  29(2), pp.409-422. Louwers, T.J., Ramsay, R.J., Sinason, D.H., Strawser, J.R. and Thibodeau, J.C., 2015.  Auditing & assurance services. McGraw-Hill Education. Sadgrove, K., 2016.  The complete guide to business risk management. Routledge. Sekaran, U. and Bougie, R., 2016.  Research methods for business: A skill building approach. John Wiley & Sons. Sierra?Garcà ­a, L., Zorio?Grima, A. and Garcà ­a?Benau, M.A., 2015. Stakeholder engagement, corporate social responsibility and integrated reporting: an exploratory study.  Corporate Social Responsibility and Environmental Management,  22(5), pp.286-304. Trevino, L.K. and Nelson, K.A., 2016.  Managing business ethics: Straight talk about how to do it right. John Wiley & Sons.

Conference and Event Evaluation Report Essay Example | Topics and Well Written Essays - 2500 words

Conference and Event Evaluation Report - Essay Example The motto of the agency is to provide better information and data to the public to enhance the health and living standards of the public. AIHW is a statutory authority and is answerable to the Parliament and works under the provision of Australian Institute of Health and Welfare Act 1987. The AIHW makes an elaborate national health report every two years which contains a wide range of information about health services, injury, diseases and health work force. This time the AIHW’s report release and conference fell on the same day which is 23rd of June 2010. According to AIHW(2010)â€Å"At the pre-conference dinner, 2010 Australian of the Year, Professor Patrick McGorry described his work in the field of mental health and in particular the prevalence of mental illness among young people†. The focus point of the conference was that the AIHW should create a transparency within the healthcare system to make the policy more comprehensive for the public Literature Review: Aust ralia Health Conference 2010 Australia is rated as one the healthiest nations in the world and their health awareness is of high quality when compared to other developed nation. The country was rated at third position for the life expectancy rate and health quotient among the developed countries. At the conference were present various health experts, high ranked officials of the nation and media persons to overview the health and welfare agenda of the body. According to AIHW (2010)â€Å"Launching the report, Minister Roxon said Australia’s Health 2010 was ‘a very valuable analysis of where we are as a nation, what we're doing well, where we need to pick up our game and the trends showing us the risks on the horizons that of course any smart government will plan for†. During the conference, it was understood that the death rate and major health problems such as cardiovascular disease, lung disease, asthma, cancer and injuries were decreasing .The report of the AIH W showed that the health of the citizens of Australia was really improving and there is more space for the country to develop in health sector. However, the conference also highlighted on the fact that the country needs to focus on certain areas of concern like obesity and diabetes.As per AGDHA(2010)â€Å"For the first time since 1995 the 2007-08 National Health Survey (NHS) has measured the height, weight, hip and waist circumference of respondents aged 5 years or more. Results from this survey reveal that in 2007-08, 61.4% of the Australian population are either overweight or obese† The health report of the AIHW shows that there can bring about considerable change in the obesity and overweight issues by bringing about change in the lifestyle of Australian citizen. The life style of a person includes their food habits, physical activity, alcohol consumption and smoking habits. According to the AIHW, the diabetes is one of the main issues prevalent among Australians which nee ds dire attention. Another important issue which was highlight in the conference was the prevalence of mental disorder among young generation of Australia. AIHW(2010)states thatâ€Å"An estimated 1 in 4 young people had experienced a mental health disorder in the 12 months before the survey—a higher proportion than any other age group. And in the estimates of disease burden for 2010, mental disorders

Selecting Patient Escorts Assignment Example | Topics and Well Written Essays - 1250 words

Selecting Patient Escorts - Assignment Example The idea from the supervisor of patient escorts on using questioners to judge personality would also be limited in the sense that interaction between the patients and escorts would be verbal. He would rather suggest to the department conducting the interview to incorporate oral interview. Considering advice from the assistant human resource director that, the hospital should modify the typical interview through asking four or five stress producing questions. This would be very helpful because It would give the hospital better candidates that are competent enough to manage and cope with stress situations well (K. Kolcaba, Comfort theory and practice: a vision for holistic health care and research). Each applicant should submit three letters of recommendation from people that know them really well. This was the second suggestion made by the supervisor of patient escorts to curb the prevailing issues faced in the hospital. It is a good suggestion unlike the first criteria used where only one recommendation letter was required in recruiting escorts. It gives the impression that the individual applying for the job opportunity is interactive and has previously interacted with people. It also portrays the degree of socialization and other personal principles of an individual which is a crucial and relevant trait to look for in an individual. The previous system that the hospital used to recruit escorts is that, the hospital used to make a call within the hospital during a reference check because, those interviewed knew some other employees in the hospital. It is a good criterion for interviewing individuals and acts as assurance in the sense that, the hospital has experience working with the person writing the recommendation and their conduct at work reflected. This would be better compared to having recommendation given by people outside the institution. Suggestion by the head of the staffing section that, an attitude test be developed to measure applicants’ predisposition towards being friendly, helpful and sensitive is another step to tackle the problems facing the hospital. Test questions would also be a component of the attitude test package and would be a key role in the interview for competent escort. Recommend a procedure for recruiting and hiring patient escorts. Recruitment of patient escorts involves a series of steps in the choosing the right individuals for the job. The process involves; 1. Going through policies and procedures Policies and proced

E-procurement and diffusion of innovation theory and Rogerss model Thesis

E-procurement and diffusion of innovation theory and Rogerss model - Thesis Example This research will begin with the statement that procurement is one of the most crucial aspects of any organization. In general term, it is defined as the process of purchasing goods and materials at a proper time at the best affordable price. E-procurement involves using the internet and other web-based technologies as a tool for procurement. The success of this technique in the private sector has also aroused considerable interests among the public sector organizations with regards to adopting and implementing e-Procurement in their business process. In a typical e-Procurement process, an organization purchases goods and materials from suppliers by using the internet as a medium. E-procurement processes are characterized by the presence of e-marketplaces which is a platform that brings suppliers and buyers together. E-marketplaces also have the option of a reverse auction where competitive bidding can be undertaken for procuring a particular material. The process of e-Procurement i nvolves the following steps namely: Review of various suppliers Compiling documents related to ‘Request for Quotations’ Â  Sending out ‘Request for Quotations’ Revisions and resending related to ‘Request for Quotations’ Receiving proposals of RFQ’s Compiling and evaluating response Review of bids Narrowing down on the list of bidders Negotiations Selecting the winning bid.

European Single Market Essay Example | Topics and Well Written Essays - 3500 words

European Single Market - Essay Example The Treaty on the Functioning of the European Union is an international treaty between the European Union member states that forms the basis of the EU’s constitutional base. This treaty describes at length the policies, role and functioning of the EU. Chapter 3 of the Treaty on the Functioning of the European Union enumerates the â€Å"Prohibition of Quantitative Restrictions between Member States†. The Article 34 under this chapter states that â€Å"Quantitative restrictions on imports and all measures having equivalent effect shall be prohibited between the Member States.† (Similarly Article 35 prevents the member states from placing similar quantitative restrictions on export of goods). According to the rules of this Article, the member states Ultra and Media were not entitled to place any sort of restriction on Infran’s production of tomatoes and cucumbers. In a counter argument, the authorities of Ultra and Media could have declared that both of them were justified in prohibiting Infran’s products into their markets, under Article 36 of the Treaty. Article 36 states that â€Å"The provisions of Article 34 and Article 35 (regarding quantitative restrictions on export) shall not preclude prohibitions or restrictions on imports, exports or goods in transit justified on grounds of public morality, public policy or public security; the protection of health and life of humans, animals or plants;†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Such Prohibition or restriction shall not, however constitute a means of arbitrary discrimination or a disguised restriction on trade between Member States†. (The Treaty on the Functioning of the European Union

U.S.A. PATRIOT Act, Foreign Intelligence Surveillance Act, and the Essay

U.S.A. PATRIOT Act, Foreign Intelligence Surveillance Act, and the Future of Domestic Intelligence - Essay Example The attacks demolished the world trade center, which was regarded as a unique nucleus of international trade established in New York City, and took away 2,749 innocent lives. The attacks shook the pillars of the national security of United States of America and questioned the operation and functioning of the intelligence of the country. Following the day of attack, President George Bush immediately declared war on terrorism with his speech, â€Å"The United States of America will use all our resources to conquer this enemy† (Kam & Wong, 2006, p. 380). Later, on investigation it was revealed that two of the terrorist pilots gained flying training at the Huffman Aviation International in Venice, Florida, in September 2000. These men entered the United States of America on a visitor’s visa. It was further analyzed that the applications of these men were changed from the visitor to those of vocational students which were processed by the Immigration and Naturalization Servi ce (INS). Another pilot infiltrated the country on October 9, 2000 with an F-1 student visa for the purpose of studying English at English as a second language (ESL) center in California, USA. In this case it was also revealed that the student never attended the institute and the institute never reported about the missing student. With this background information it could be said that the country was suffering from inefficient intelligence operation and management. In fact legitimate questions arose regarding the intelligence operation of the nation. In the aftermath of the 9/11 disaster, America witnessed the tightening of the trajectories of homeland security and enforcement of amended and new laws with stricter policies towards immigration and emigration. But it has been also questioned as to what extent the laws were feasible in the context of the protection of the civil

The Issue of Abortion Essay Example | Topics and Well Written Essays - 1000 words - 1

The Issue of Abortion - Essay Example Clinical research has proved that despite the anesthesia, 90 percent of women having abortions reported having physiological pain during the procedure.   30 percent of these women reported having severe and intense pain which is more painful than the bone fracture and is of the same severity as the cancer pain. Moreover, the scientific evidence supports the notion that abortions cause psychological harm to women. Society has divided in its opinion over the right of women to have the abortion. The pro-life movement was initiated with the aim to persuade women in preserving human life. The pro-life thinking is based on three foundations: people (even criminals) have the right to live and it is morally wrong to kill, the fetus is the distinct human being from the very moment of conceptions, and women have the duty to preserve the life even if the pregnancy is not wanted. Science tells that the pregnant woman has a new life inside which is completely a new human being. Notably, when most abortions take place, the baby has already beating heart and brain waves. The unborn baby, fetus, is the unique human being, just as his mother and father, and he deserve being protected by law and granted the right to live. According to statistics, most of the abortions are performed after nine weeks of pregnancy and the potential mother becomes the murder of the fetus who already has an active brain and beating heart. It can be argued that fetus is a human being and is not a person. However, medicine points out that the fetus is the living organism, he is alive from the moment of conception (Klusendorf 12). Of course, it is possible to say that the living organism is not yet a person, but a fetus is nothing other than the human creature. At the moment the sperm and egg are united, 23 chromosomes from the father and 23 chromosomes from the mother are brought together. The fetus has unique DNA from this very moment. The fetus is not the potential life, he is the human being who is growing and getting older.

Impact of the Risk on Tiger Golfs Efficiency and Product Quality Case Study

Impact of the Risk on Tiger Golfs Efficiency and Product Quality - Case Study Example This paper illustrates that in addition to the probability and impact of each risk, Magness should determine the risk proximity for each identified risk. This approach would enable Magness and his team to avoid certain risks whose timing may be predicted or anticipated with a reasonable degree of accuracy. Supplier 1 poses some unique risks for Tiger Golf. These risks relate to both product quality and timeliness. The new product line represents the proprietary and intellectual capital of the company. However, as Supplier 1 produces successful knock-offs of golf clubs, there is a risk of lost revenue if the supplier produces replicas of the Tiger Golf line of golf clubs. Secondly, delivery is made FOB Origin and Port Kelang after which the cost and risk during transit would be borne by Tiger Golf. This would expose the company to the risk of damage in transit and delay. Risk of delay further increases because of the transit through the congested Malacca Straits. Moreover, there is a moderate risk of piracy in waters near Indonesia. Supplier 2 presents the risk of product loss and damage because of the lengthy overland distribution route. Disruption at any point in the distribution chain could lead to delays in product delivery causing the company to fail to launch the product at the PGA merchandise show due in six months. Trucks and rails transporting the goods could break down resulting in equipment malfunction and further delays. Supplier 3 poses the risk of supply chain interruption due to a capacity shortage. A delivery delay may also arise due to port congestion. Nonetheless, they promise to meet deadlines.

Creoles & language evolution process Essay Example for Free

Creoles language evolution process Essay Creoles have generally been considered to have more complex formation processes than pidgins, which lie at an earlier stage in the language evolution process (Culpeper, 1997). The processes that drive the development of creoles and pidgins have been the subject of interest and debate to linguists for many decades. Some have hypothesized that the development of these forms has been driven by variables similar to those that drive the creation of languages. Some of these hypotheses have included biological approaches to creole and pidgin evolution, while others have posited synchronic methods (Adone Vainikka, 1999; Bickerton, 1999). Many of these synchronic and biological ideas are compelling highly challenging in their plausibility, employing ideas related to Universal Grammar as a means of illuminating creole and pidgin development. The development of pidgins has been considered to be less difficult to understand than that of creoles, mainly because of the precise phenomenon that pidgins describe. As a language form that develops from the mixing of two distinct languages, many have simply considered it to occur as a result of the mixing of two (or more) people groups that possess distinct languages. Yet, some complexity exists in the different scales to which pidgins might develop (Adone Vainikka, 1999). Furthermore, it is interesting to note that when the languages of a bilingual child develop, even at an early age, that child generally distinguishes between the two perfectly without mixing them (Culpeper, 1997). When languages exist together on larger scales could be when pidgins are more likely to develop, and this appears to stem from the likelihood that the multiplicity of languages is intelligible by a wider range of persons. When this is the case, it creates no real need for any one speaker to make the effort distinguish between them for purposes of being understood. Despite the fact that pidgins and creoles are distinct language forms, many consider pidgins as a form that occurs on the way to the formation of a creole. In fact, the definition of creolization given by Adone and Vainikka is â€Å"the process by which pidgins develop into creole languages† (1999, p. 76). Discussions regarding the relationship that creolization bears to language acquisition processes and language development have led to two distinct schools of thought. One has viewed creolizaiton as being an extended process that takes several generations to mature. Indeed, this process never ends but continues to develop alongside the development of the particular culture in which it occurs. The other school of thought has viewed the process of creolization as on that has the potential to occur suddenly, within only one generation (1999). The gradual development of creoles appears to be more consistent with the prevailing theories of language development. If creoles are viewed according to the definition above (as a product of pidgin development) then it would appear that such a fast development of the language would be very difficult. Such speedy development would afford little time for the creation of the pidgin itself before its further evolution into a fully developed creole. The mixing of more than one language appears to be a phenomenon that would take quite some time, as this would involve a certain degree of standardization concerning which parts of each language should be included in this pidgin. In addition, it would appear that more than one generation would be needed to allow the general spread of this understanding among the population. However, it would also seem that geographical and population-density concerns would have a bearing on the ability of the creole to develop and suffuse an entire region. It may also depend on the demographic of the individuals who act as the agents of this development. Those theorists who believe that creolization has the potential to develop within one generation have cited young children as being the agents of such change (Bickerton, 1991, cited in Adone Vainikka, 1999). This researcher argues that this form of â€Å"radical creole† develops through a Bioprogram that operates very closely with the theory of Universal Grammar. Such a development, therefore, is based on humans’ innate understanding of language, which is to some degree distinct from the language that is learned in any given cultural context. Because this theory posits humans as having a relationship to grammar that transcends the grammar rules of any given language, the development of a particular radical creole would be based on the similarity of the language variation put forth by each child despite the fact that they may not grow up in close proximity to each other (1991; 1999). This particular view of creolization is based on language evolution theories that take a biological or even genetic approach to language change (Mufwene, 2001; 2006). In the creole form used in Mauritius, for instance, the children have been found to make fewer â€Å"mistakes† that represent a non-conformity to the language than those found in many standardized, non-creole language (Adone Vainikka, 1999; Bickerton, 1999). Bickerton writes, â€Å"Children acquiring English and other noncreole languages make a number of â€Å"mistakes,† a very high percentage of which would be fully grammatical utterances if the children were acquiring a creole language† (1999, p. 66). The opposite of this does not appear to be true—children acquiring creole languages do not make as many mistakes that would be considered grammatical in a noncreole language such as English or French (1999). It would seem therefore that creole might be considered a more naturally occurring form of a given language as distilled through the human’s biological propensity toward language expression. However, while this supports the idea of Universal Grammar, it does not appear to offer much support of radical creolization, as the Mauritian Creole has been evolving for many generations. Creoles and pidgins are interesting in that they offer insight into the earlier stages of language development. Many ideas exist concerning the classification of these language forms. Theories also exist concerning how such forms are developed, as well as the relationship they have to each other and to the languages on which they are based. Biological and synchronic approaches have both pointed toward the idea of Universal Grammar as having a bearing on the development of these forms of language, and intriguing (yet inconclusive) discussions have come about as a result of research done in that direction. . References Adone, D. A. Vainikka. (1999). â€Å"Acquisition of Wh-questions in Mauritian creole. † Language creation and language change: creolization, diachrony, and development. Boston: MIT Press. p. 75-95. Bickerton, D. (1999). â€Å"How to acquire language without positive evidence: what acquisitionists can learn from creoles. Language creation and language change: creolization, diachrony, and development. Boston: MIT Press. p. 49-75. Bickerton, D. (1991). â€Å"Haunted by the specter of creole genesis. † Behavioral and Brain Sciences. 14: 364-366. Culpeper, J. (1997). History of English. Oxford: Routledge. Mufwene, S. S. (2001). The Ecology of Language Evolution. Cambridge: Cambridge UP. Mufwene, S. S. (2006). Language evolution : the population genetics way. Marges linguistiques, 11, 243-260.

Ukraine in The World Bank Group Essay Example for Free

Ukraine in The World Bank Group Essay There have been major changes that have been experienced across the world and in many countries, Ukraine being one of them. Ukraine has experienced several changes in terms of population, labour, income distribution, education, social mobility as well as the living conditions of the citizens over the year 2008 to 2015. Over the year 2008 to the year 2015, the population of Ukraine have been observed to decline due to the large number of older people. In the year 2013, the population stood at about 45.59 million people as compared to the year 2010 where the population stood at 46. 01 million people (The World Bank Group, 2015). The decline in the population of Ukraine have in turn affected the labour market of the country whereby the country has over the years experienced lack of labour in addition to higher rates of unemployment. The labour market experienced an increase in the rate of unemployment at 8.90% compared to the previous year 8.60%. As of the year 2015, about 524.4 (thousands) of Ukraine citizens were unemployed compared to the year 2014 on April when the figure stood at about 474.7 (thousands) unemployed persons. The high rate of unemployment in the country has also contributed towards the poor living conditions (The World Bank Group, 2015). It was also observed between the year 2008 and 2015 that the level of poverty in the country increased from 7.1% in the year 2008 to about 9.1% by the year 2012. The increase in the level of poverty can be attributed to the increase in inflation which rose from about 24.90% in the year 2014 to about 28.50% in the year 2015. The increase inflation also caused an increase in the core consumer prices, which increased from 122.80 in 2014 to 126.10 in 2015 (The World Bank Group, 2015). This meant that the affordability of food became an issue resulting in poor living standards and the consumers have to pay more prices for basic needs such as food. Furthermore, there has been change in the education system of the country. The number of people attending schools in Ukraine has been observed to increase over the years whereby in the year 2012, the percentage of the population seeking for education reached about 106%. This indicates that the Ukraine society have embraced education in large numbers to gain skills which can allow them to get employment in other regions across the world (Trading economics.com, 2015). On the issue of income distribution, majority of the population in Ukraine falls under the category of lower and middle income earners. The wages paid to employed persons in the country per month experienced a decline from the year 2014 to the year 2015. In 2014, the average monthly wage stood at about 4,012.00 while in the year 2015 the wages stood at 3,455.00, a clear indication that there was a decrease in the wages (Trading economics.com, 2015). Finally, the social mobility of Ukraine population has increased over the years as they seek for more opportunities outside of Ukraine. It is to be noted that most have migrated to the United States and other countries for job opportunities and to try have better lives than they did in Ukraine. References The World Bank Group (2015) Ukraine, Accessed from http://data.worldbank.org/country/ukraine on 4th March 2015 Trading economics.com (2015) Ukraine, Accessed from http://www.tradingeconomics.com/ukraine on 4th March 2015 Source document

Personality Disorder Carer and Family Support Impact

Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p Personality Disorder Carer and Family Support Impact Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p