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To evaluate whether and how drafting psychiatric advance directives (PADs) with the support of a peer worker improves recovery outcomes for individuals with severe mental illness.
Methods:
A mixed-methods design was employed, combining quantitative data from a randomized trial with qualitative interviews. The trial included adults with schizophrenia, bipolar I disorder, or schizoaffective disorder who had experienced involuntary hospitalization in the past year. Participants either completed PADs with peer worker support or without specific facilitation. Recovery was assessed longitudinally using the Recovery Assessment Scale. Thematic analysis of interviews explored mechanisms underpinning the effectiveness of peer facilitation.
Results:
A total of 118 participants completed PADs, 84 with peer support. Mixed-effects regression analysis revealed significantly higher recovery scores for those supported by peer workers (coefficient = 4.77, p = 0.03). Qualitative findings highlighted two key mechanisms: peer workers’ boundary role fostering trust and relational symmetry and their facilitation practices promoting critical reflexivity and addressing past psychiatric trauma. Participants emphasized the flexibility and empathy of peer workers, which enabled deeper reflection and empowerment.
Conclusions:
Peer facilitation enhances the drafting of PADs, significantly contributing to recovery through trust, critical reflection, and trauma-informed approaches. These findings support the integration of peer workers into PAD frameworks and emphasize the need for tailored training and systemic reforms to maximize their impact.
Comparative measures of educational achievement (e.g. PISA, TIMSS, NAPLAN) demonstrate that although Australia is broadly understood to offer quality education, this masks stark and persistent inequalities. Wider disparities are evident between students from advantaged and disadvantaged backgrounds than in many other OECD countries. These inequities start before children enter schools. Children experiencing economic and social adversity are underrepresented in preschool and overrepresented in population level measures of ‘developmental vulnerability’ prior to school commencement. Young people from Indigenous backgrounds, rural/remote areas, and lower socio-economic backgrounds suffer significant achievement gaps across all measures, and the gap widens as they progress through their education. Some young people are being left behind as their more advantaged peers outpace them, with life-long consequences. Although public discourse encourages us to see educational failure as the fault of individuals, there is wide agreement that these inequities result from policy failures in Australian education.
The failure of democratic regimes to identify and confront the climate crisis is the outcome of the protracted yet incomplete defeat of critical reflexivity by instrumental reasoning. Historically, this is evident in the institutional and practical consequences of colonialism, militarism, and commodification. Political elites’ objectification of nature, of uncertainty, and of oppressed groups delimits normative scope of the climate crisis. By ignoring salient differences between the epistemic and ontological limits of these acts of objectification, elites place misguided faith in their capacity to control nature, exploit others, and convert uncertainty into risk. Lawrence first historicizes the inadequacies of collective responses to the climate crisis, then encapsulates salient differences between mainstream and critical approaches to this question. He subsequently details how a dependence upon militarism and GDP correlates with quantifying uncertainty and objectifying risk, while underplaying the ecological risks of both. He concludes by reflecting upon how strategies for seeing and knowing both democratic and ecological fragility and robustness can mutually inform each other.
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