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OBJECTIVE: Mental health care reform has brought an increasing emphasis on community care, with concomitant reductions in inpatient psychiatric resources. Hospitalization remains a necessary and integral component of the mental health care system, but it is taking on a more specialized role. Examining the circumstances in which hospitalization is indicated can help clarify emergency psychiatric practices and determine whether patients' needs are being met within this changing environment. This pilot study examined the impact of selected patient and contextual characteristics on the decision to admit patients to inpatient psychiatric units and assessed the utility of the Severity of Psychiatric Illness (SPI) scale for monitoring clinical practice in emergency psychiatric services. METHODS: Crisis workers in two emergency psychiatric services crisis teams in Toronto, Canada, used the SPI in the assessment of 205 visitors to the services during the winter of 1998-1999. Contextual characteristics, including bed availability, service site, and the admitting physician's level of training, were recorded. Multivariate logistic regression was used to assess the relative contribution of patient and contextual variables in the admission decision. RESULTS: The severity of axis I symptoms and difficulties with self-care were significantly associated with the decision to admit. Site, bed availability, and the admitting physician's level of training did not appear to be associated with clinical decisions. CONCLUSIONS: Patients with the most need are being admitted to inpatient units despite significant systemic pressures on inpatient services. The SPI is a useful and discriminating tool for evaluating clinical practice in emergency services.

The Pathways Into Homelessness project in Toronto interviewed 300 unaccompanied adult users of homeless shelters to identify characteristics of individuals who are homeless for the first time. The sample reflected the total population of homeless shelter users in terms of age, sex, level of use, and type of shelter. Two fifths of the sample were homeless for the first time. There were more similarities than differences between those who were homeless for the first time and those who had been homeless previously. The prevalence of psychiatric and substance use disorders and the rate of previous hospitalization did not differ between first-time homeless persons and those who had been homeless before. The two groups were distinguished by some childhood experiences related to housing. Both groups had multiple indicators of serious problems, suggesting that the need for intervention is as pressing for persons who are homeless for the first time as it is for the larger population of homeless persons.

This Article identifies and explores the justifications or rationales offered by national court judges in support of their references to international human rights law. It does not analyze the extent to which judges invoke international law; rather, it examines the reasons offered by judges to explain their references to international law. The focus is on leading decisions rendered by higher courts in the United States and Commonwealth jurisdictions where the international norms do not bind decision-makers because they have not been made part of domestic law through an act of incorporation, the relevant treaty has not been ratified, or the ratifying state has filed a reservation limiting a treaty's domestic effect.

Women’s pain and death blurs the distinction between war and peace. Women are disproportionately starved, attacked physically, emotionally and psychologically, and killed during both war and peace. This paper focuses on the sanctions imposed against Iraq by the United Nations Security Council (“Se- curity Council”) in response to Saddam Hussein’s invasion of Kuwait in 1990 and the on-going purported threat posed to international peace and security by the Iraqi regime. Intended as a humane alternative to war, the sanctions have nonetheless lead to such high levels of death and suffering, particularly among women and children, that commentators have labeled them “genocide,” a “medieval military siege,” and “a humanitarian disaster comparable to the worst catastrophes of the past decades.”

This paper presents a particular reading of Truth and Method, Hans-Georg Gadamer's landmark text, as a lens through which to consider the meaning of international texts in domestic contexts. Gadamer's thoughts have been the subject of inquiry and controversy across legal lines; yet, they remain virtually unknown within international human rights law. His absence within this circle is unfortunate because Gadamer takes up questions concerning culture, perspective, difference, and authority - issues that no international human rights scholar can hope to ignore. More importantly, however, Gadamer addresses these issues within a theory of language that proves relevant to the very structure of international human rights law itself, given that it lacks a third party arbitrator authorized to pronounce on meaning. The judicial use of international law within domestic courts brings this feature of the international regime into stark relief because the rising judicial reliance on international law has the potential to generate as many meanings of international texts as there are courts willing to engage those texts. Truth and Method expounds a theory of language that recognizes the authority of international texts and international law's governance ambitions while still accommodating variations in interpretation between national jurisdictions.

This paper presents a particular reading of Truth and Method, Hans-Georg Gadamer’s landmark text, as a lens through which to consider the meaning of international texts in domestic contexts. His thoughts have remained virtually unknown within international human rights law but is highly relevant to accommodating variations in interpretation between national jurisdiction.

The author argues that the apparent collapse or erosion of the Oakes test reflects the problem of fitting a right such as freedom of expression, which is social and relational in character, into a structure of constitutional adjudication, which is built on an individualist conception of rights. In the leading Canadian freedom of expression cases, the task for the courts under section 1 is not simply to strike the proper balance between competing interests, but rather to resolve the single but complex question of whether the expression contributes to, or undermines, human agency or autonomous judgment. In these cases, the “value” of expression and the “harm” of expression are not distinct issues, but rather two sides of the same basic issue. Whether expression is more likely to contribute to insight and judgment or to manipulate and lead to an unreflective response is a relative judgment that will depend significantly on the social and economic circumstances in which it occurs. This issue fits awkwardly within an adjudicative structure that is based on an individual liberty model of rights. The author argues that this awkwardness accounts for the “erosion” of the Oakes test in freedom of expression cases and more specifically for the court's increasing, and inadequately justified, deference to legislative judgment under section 1.