Effective Communication

The organisational model for United Health Group as a healthcare organisation is the traditional hierarchical structure that involves the managers at the top of the model, middle level managers and the other general staffs at the bottom of the hierarchy. The organisation is a multinational and the communication model focuses on the inter-personal interaction, aimed at sharing of knowledge from the managers to the subordinates, among the subordinates.  This model is quite flatter in terms of sharing of the information, such that it seeks the removal of layers in the organisation so as to open up the communication lines and collaboration. The model aims at reducing the hierarchy structures so that to focus communication, improving the experience of the employees, challenging the annoying status quo around the most traditional appearance of the model (Barker & Angelopulo, 2006).

Since UnitedHealth Group work as a public company, it sticks to the requirements of basic security laws that involve public disclosure of information of any company. The sharing of information among the employees is more liberal since the aim is to have them access the knowledge that is necessary to attain maximum performance in decision making. The organisation fosters overall employee social learning and collaboration, following the corporate philosophy which is based on being better together than alone in the work environment so that to share knowledge and thus provide good service to the customers. Social learning is the main technique that the organisation use in order to exchange idea among various teams. The technique help in providing a way of ingraining corporate values like relationships, innovation and general performance in the employees and the organisational culture. Give the size and complexity of the organisation, the employees interact with many stakeholders who include the government officials, the press, analysts and all other groups that come into contact with the company (UnitedHealth Group, 2015). The employees must therefore present any information in a truthful, clear and professional way since the business environment is really dynamic and thus their communication techniques must positively reflect to the commitment of making healthcare provision work for everybody. Any expectation for employees to embrace decision making must be based on an appropriate information sharing mechanisms and pass on necessary knowledge. In social learning employees can reach out to one another and in order to influence the others based on job functions, skills or just for the purpose of sharing information. This technique encourages those with great experiences to be giving advice to others and keep the process of learning ongoing and continue the spread of knowledge (UnitedHealth Group, 2015). This technique works to a great extent in the sharing of knowledge among the employees since one is able to learn while interacting or just by mere observation.

Apart from publications, the company’s employees use social media for communication and knowledge sharing among themselves and outside parties. The use of these communication tools by employees provide them with an opportunity to share information with customers and stakeholders while still taking responsibilities for any inaccurate information. They are able to make up decisions on how to share information effectively and which such information should be disclosed to outsiders. The company has guidelines that control the social media use which apply to taking social media as part of employees work on behalf of the company (UnitedHealth Group, 2014). This means that whenever someone need to share information through such techniques, they should do so while considering the set guidelines. This technique of sharing information however does not provide informed data since most of the information is inaccurate and can lead to poor guidance while information is being shared between the managers and the employees or among the employees themselves UnitedHealth Group (2014). Inaccurate information does not add up to sharing of knowledge.

The use of social media in healthcare environments has increased with time. It has various benefits to the healthcare professionals, the patients and other stakeholders. Regardless of the shortcomings, the tool is necessary in sharing information with patients that regard to their health while at the same helping employees to share relevant up-to-date information. Social learning on the other hand allow the health professionals to share information and knowledge through building personal relations  so that the ones who are more experience can impart knowledge to learners.

References

Barker, R., & Angelopulo, G. (2006). Integrated organisational communication. Cape Town: Juta Academic.242

UnitedHealth Group (2014). Code of Conduct Our Principles of Ethics & Integrity. Retrieved from: http://www.unitedhealthgroup.com/~/media/UHG/PDF/About/UNH-Code-of-Conduct.ashx?la=en

UnitedHealth Group (2015).UnitedHealth Group Provides Social Learning for its 114,000 Global Employees. Retrieved from:

 http://www.riversoftware.com/resources/River-Success-Story-UnitedHealth.pdf

Healthcare groups in U.S

  Individuals

            This refers to the current or the prospected patient who receives or will receive health based service such as cures and medicines from the health care system.  This player may be either a lone person such as a patient seeing a health attendant or a group of persons such as family or a communal in case of any rashes. The individual customer is the main factor of the healthcare choice and services and the individual has to settle and accomplish his or her, and the numerous of the other individuals’ anticipations. The player is the ultimate payer for the healthcare systems service (Andersen & Newman, 2005). 

Enterprise

            The enterprise is the player who gives specific services to the individual.  That player can be a good supplier of health based services such as giving medicals services such as medical provider of emergency services a short stay in hospital or a long period nursing in homes.  The player can be a support and a supply device such as lab, a drug company, an allocating drug store or a supplier of defensive services and teaching. The player can be a financing and a handling unit which cares for the health care arena such as an Insurance company or a public or private donor.  The player may also be a stockholder in goods that influence the health outcomes such as education and communal devices.  The player is a profit based though not profit for companies but is also included (Andersen & Newman, 2005).

The Government

            The player represents people whose main aim is to use the available public and private resources well and to raise the population health condition and results. The player acts as a policy maker and the legislator that makes the boundaries and the playing sections for the individuals and the enterprises.  Thus the government struggles to gratify the prospects of individuals and maintains equality towards the enterprises while making new prospects (Andersen & Newman, 2005). 

            The government also fulfills the role of a governor and auditor which makes sure that the other players act according to its rules. It gives licenses, creates the boundaries for the actions and the review them to make sure that they follow the legislations and the rules.  The player is best for providing a long choice apparition of the public health and the healthcare systems.  It also has the authority to direct and assess the communal health and assess a wide range of activities that may improve the health condition of the community (Andersen & Newman, 2005).

            All these players influence the healthcare system due to their corrupt inequity in their services which include the excess use of unimportant services and the underuse of valued services. These are said to be the effects of the imbalance between the enterprise and the government and the weaknesses of the individual and the community. The overuse of services that do not impact in better patient outcome can happen when the inducements and the construction are not associated with gaining the impartial of the improved population health. The overuse and the misuse of the services from these players has negative impacts such as that the overuse of the services increases the costs of the healthcare systems. The overuse of the unimportant health services such as treatments and reviews and the medications used for reasons not directly connected to advancing health leads to the increased healthcare costs to the whole community (Ferlie & Shortell, 2001). 

Reference

            Andersen, R., & Newman, J. F. (2005). Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly, 83(4), Online-only.

            Ferlie, E. B., & Shortell, S. M. (2001). Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Quarterly, 79(2), 281-315.

Medical Withdrawal Personal Statement

Q.1. describe the medical circumstances you have been dealing with?

            I have been diagnosed with the following conditions according to the doctor’s examination; chronic recurrent reactive airways disease, Insomnia, irritable bowel syndrome, generalized anxiety disorder, severe Vit.D deficiency VIT D LEVEL 10, weight loss from 261LB to 211LBS, stress disorder with depression , and VIT, B-12 and folic acid deficiency. The health and emotional problems became severe since July 2015.  I had various out-patient visits for consultation for the past 12 months due to the condition I was in. I visited the consultation office a number of times and this was recorded; 02/ 18/2015, 03/06/2015, 06/29/2015, 09/21/2015, 10/19/2015, and lastly 11/17/2015. In this very year, I also went to be seen by a psychiatrist. I was advised to take rest at home and return to school when I get well. This is due to the multiple medications am being treated on and uncontrolled illness symptom, depression and insomnia. The condition impacted my life in various ways for instance the impact of depression created a bad mood that I could not have interest to pursue daily life, with a feeling of fatigue throughout the day, and without any interest to socialize and hence I was in a state of isolation.

2. 2. Describe how those circumstances impacted your cores work?

            These circumstances affected greatly both my social life and life in class. I missed many classes and assignments since most of the times I would be away for a bed rest. I could not concentrate or be able to focus on any class work and this has left me lag behind so much. I was in a very bad psychological condition which was characterized by mental slowness, a state of confusion, decreased contact with people and in a cranky state where I could avoid people and other could also avoid me due to that state of hostility. Even my closest friends had to create a gap between me and them just because I was not easily approached. This affected my social life because I did not go out of my house for a number of weeks.

3. 3. What interactions have you had with your instructors regarding these circumstances?

            I did not talk to any of my instructors, one of the reasons being that I had a low mental capacity to express myself before the instructors and because I had not yet obtained medical form from the doctor, I could not convince them without it. Secondly, I hardly attended class and therefore could not have ample time to meet with any of them. Additionally, I was not able to do anything regarding class work for instance homework, quizzes, or exams and this made me feel that the instructors would not accept my excuses hence contributing to my failure to inform any of them.

4. 4. The university has established deadlines for pursuing courses withdrawals or dropping courses. You can view those on the academic calendar section. Did you utilize any of those options?

            I was not in position to follow those dates simply because I have to consult it with my sponsor to let him know before I drop any class or else I might be risking losing my scholarship. When I contacted the social affairs at my sponsor to provide them with my medical report, I did not receive any response before the due date that was established for pursuing courses withdrawals. I decided to drop my classes before deadline for semester withdrawal because I did not want to fail all my classes and drop GAP

Assignment , summaries of sources cse style. Which drugs are the best for adjuvant chemotherapy and why

In adjuvant or neoadjuvant treatment, chemo drugs are the most helpful drug that works best when it is combined with other drugs such as Taxanes, 5-fluorouracil and carboplatin. Among the many drugs that can treat adjuvant chemotherapy, the three are the best (Summerhayes, 2002). There are several cancer complications that include breast cancer and ESCC that are addressed in various articles that detail these drugs. This paper will provide a summary of why Taxanes, 5-fluorouracil and carboplatin are the best drugs in treating the adjuvant chemotherapy (Summerhayes, 2002).

5-Fluorouracil drug is the best in curing esophageal squamous cell carcinoma (ESCC).  ESCC is a very deadly disease that is best handled through the chemotherapy strategy. 5-Fluorouracil is a key and first line drug against ESCC. It is very efficient considering is content of anabolic and catabolic that exert cytotoxicity. The drug enters the process of anabolic that triggers the normal function of the nuclei enzymes and acids that work as the healing process. The 5-FU drug is best because it is resistant to ESCC cells. The resistance fastens the healing process and enhances its effectiveness.

Carboplatin is another chemotherapy drug that is best in curing testicular cancer. It has proven to be a cure to many other malignancies among them being testicular cancer. The efficiency of carboplatin is the total drug exposure (Osamue et al, 2015). This is a function that determines the dose as well as clearance. The carboplatin has a narrow range of exposure as well as therapeutic range which remain to the stronghold of the drug efficiency (Osamue et al, 2015). The drug has very minimal toxic which is an advantage that maintains a patient in a toxic free condition hence affecting the efficiency of the healing process. A statistical summary shows that 9.6% of the carboplatin done was used to treat 50% of cancer patients hence proving its efficiency (Osamue et al, 2015).

Taxanes are the best in curing breast cancer with significant recovery of cancer patients. Breast cancer has raised concern in most women in the United States which calls for an efficient drug to intervene (Murray, Bates & Buie, 2012). Taxane-based adjuvant chemotherapy has proven its significant benefit across the two stands of the chemotherapy, DFS and OS. A significant effect was observed during the phase III trials that involved a sample of 15, 598 patients. Taxanes were seen in DFS in large proportions with their benefits ranging from 3.3 to 4.6% on both the DFS and OS. From the various trials that were done in Phase III of the research, it was found that Taxanes provide a survival benefit more efficient compared to the standard chemotherapy (Murray, Bates & Buie, 2012).

References

Summerhayes, M. (2002). Capecitabine: a novel, orally administered, tumour-activated treatment for breast cancer. Journal Of Oncology Pharmacy Practice, 8(1), 1-17. doi:10.1191/1078155202jp086oa

Osamu, K., Shinya, O., Yukie, N., Shunsaku, N., Kazuaki, M., Takashi, K., & ... Manabu, M. (2015). Novel 5-fluorouracil-resistant human esophageal squamous cell carcinoma cells with dihydropyrimidine dehydrogenase overexpression. American Journal Of Cancer Research, 5(8), 2431-2440.

Murray, B., Bates, J., & Buie, L. (2012). Impact of a new assay for measuring serum creatinine levels on carboplatin dosing. American Journal Of Health-System Pharmacy, 69(13), 1136-1141. doi:10.2146/ajhp110560

Social Security and Medicare

Some changes that are expected within the next 20 years based on the Medicare and the Social security include;

            These two benefits will have insufficient trust funds to maintain their payment of the full benefits.  This will create a change in the cost of living.  These programs are there to help the elderly in their retreat and medical funds where they provide increased accustomed income. This change will create a big issue in that the elderly always spend their money on different services than the other individuals.  For instance they have been spending money on health services which is an issue that have experience higher than the average rates of increase over the past few years.  This shows that the elderly due to their spending manners will experience different price increase than what they are used to (Matthews, 2016). 

            There will be also a change in the increased tax of Social Security rate.  When there will be the increased amounts for the taxation of social security benefits which will be increased to the retirees.  In order to eradicate some of these benefits increase and to assist to fix the funding issue on the Social Security, it was proposed that there will be an increase in the Social Security tax rate (Matthews, 2016). 

            The main policy that the American Government will implement in order to make sure that there is positive changes for the Social security and Medicare benefits would be increasing the individual’s retirement age which would create American’s longer life span which would be a fair and a beneficial approach to improving the financial programs. Thus the earliest age of claiming the benefits would be at the age of 62 meaning that at that age for claiming would be increased along with the whole retirement age (Baker, 2001). 

Reference

Baker, D. (2001). Social security: The phony crisis. Chicago: Univ of Chicago Press.

Matthews, J. L. (2016). Social Security, Medicare & government pensions: Get the most out of your retirement & medical benefits.

Interpreting physical behavior and body language between male and females

Introduction

            Human beings have learnt to co-exist and live peacefully with each other despite their various differences. Even when conflicts arise, they have managed to come up with solutions that enable them to lead their lives in the best way possible. This co-existence is based on various factors but the most essential being communication. People interact on their daily basis an use various tools of communication such as talking, emails, messages and letters to mention a few. While each tool has its importance, talking is the most effective since it involve interaction at a much more personal level. While most people have mastered the skill of talking, few are aware of how their physical behavior and body language affect the communication process.

Part 1: Different types of body language.

            While most of the message being communicated is delivered through words, its reception may be affected by the different types of body language displayed by the individual delivering it. The body language may either be positive or negative depending on the body gesture of an individual. A gesture such as a firm grip while shaking hands confidently or walking upright may be seen as a sign of security and confidence (Osenga 8). Such gestures show that the person is actively participating and is sure of what he or she is saying and creates a lasting impression on the audience. Regardless of the message being communicated, people will view the person communicating differently depending on how they behave. Positive gestures ensure that an audience has more confidence on the communicator and cements their faith in them. Even without talking, a person can communicate and gain the confidence of others simply by displaying positive body gestures.

Being up tied or biting nails on the other hand gives off a negative body gesture (Stalter 141). These are seen as signs of being insecure or a lack of confidence on the part of the individual displaying such a body language. It communicates to anyone who sees this negative body language that the individual is not sure or does not believe in whatever he is saying. Even without talking, the individual ends up losing the attention of the people he or she may be trying to communicate to (bo).

            While some types of body language apply to both men and women, there are those that may be interpreted differently depending on the gender of the individual portraying them. If a woman stands with her feet crossed, it may be interpreted that she is not willing to communicate with others. The same conclusion is drawn when a man stands with his feet close together which comes out as being closed minded. A man is also said to display a hostile attitude which could be a defense mechanism if he is standing up tied and may even be considered to be aggressive if he stands with his arms crossed. In the case of women, standing with one arm crossed and the other holding the chin may be described as a sign that the woman is lying. Holding her waist on the other hand is seen as a defense mechanism. It is therefore important to learn what messages different types of body language send so as to avoid miscommunication (bo).

Part 2: Emotional output.

            Other than body language, people also communicate non-verbally using their emotional output and facial expressions. A smile for instance is seen as a sign of joy or happiness. Though this may be the case, smiling can be interpreted differently depending on the facial expression of the person smiling. The way the smile is curved on the face of an individual will therefore determine if it is a genuine or fake smile (Stalter 40). Tears on the other hand are seen as an expression of sadness or pain. It is however possible to shed tears without experiencing this emotions. A person can shed tears if they think of something that is sad even though they themselves are not sad (out2). Therefore, displaying such emotional outputs does not necessarily mean that the individual is experiencing what is being communicated by their appearance.

            However, when the emotional output is genuine, men tend to express themselves differently from women. Men tend to conceal their emotions and maintain their masculinity while women tend to be more open when it comes to displaying their emotions (Stalter 189). In the case of cheating for example, men will opt to ignore what happened and keep the issue to himself. A woman on the other hand will openly display her emotions and cry. While the woman will result to sharing with her friends for comfort, a man will prefer to go out on a drinking spree with his friends rather than asking them to help him deal with the issue. Another example is the type of reaction that the two will have if they see a baby. A woman’s emotional output will involve raising the pitch of her voice when talking to the baby and want to pick the baby. A man on the other hand will be confused, not sure what to do and end up just staring at the baby.

            Men are more reserved when it comes to displaying outward emotions compared to women (Stalter 189). The behavior is so common that men feel as if their masculinity is in question if they display too much outward emotions like women. To reassure their status as men, they tend to be more secretive and often prefer dealing with issues on their own. However, this does not mean that they do not experience as much emotion as their women counterparts. Finding out that a partner is cheating may hurt a man as much as it will hurt a woman. A baby may also excite a man the same way it would a woman. Women just find it easier to display their emotional output while men try to keep it in check for as long as they can. Understanding this is essential because it plays an important role in determining when a man may need help or support even if his emotional output does not suggest so. Since women are more open, it is easy to understand when they need help or when they are existed. This helps one to differentiate the different reactions between male and females. It also helps to have a better understanding for both genders so that women are not seen to be overreacting to an exact scenario that a man is witnessing or experiencing.

Work cited

 Osenga J, “How to Read Body Language: How to Read Anyone’s Body Language like an Open Book” Bull City Publishing, 2014

Stalter, Harmony. Employee Body Language Revealed: How to Predict Behavior in the    Workplace by Reading and Understanding Body Language. Ocala, Fla: Atlantic Pub.       Group, 2011. Print.

Psychological Disorder

Antisocial personality disorder’s history/background

            Antisocial personality disorder refers to a form of personality disorder where a person is characterized by traits of impulsivity, low conscientiousness and negative emotionality. The person is normally consists of irresponsible behavior, deceitfulness recklessness and with no empathy. People with antisocial personality disorder have always grown up in a conflicting parenting (Rotgers & Maniacci, 2006). Philippe Pinel noted that most of his patients had a character of damaging and impulsive behavior. In addition to their destructive inclinations, the patients had unimpaired intelligence and were fully aware of their wrongful behavior. Pinel described these patients insane without delirium. It was also believed that dispositional factors were the causes of wrong morals. The fundamental idea here was about the four body fluids which included; blood, phlegm, black bile and yellow bile. Therefore any variations in their levels were referred to cause changes in people’s moods (Rotgers & Maniacci, 2006). Later in the 18^th century, it was observed that patients behaved irrationally though they seemed in touch with reality and were aware of their irrationality.

            . In 1835, J.C. Pritchard a British senior Physician published a seminal work that was entitled “Treatise on Insanity and other Disorders of the mind” (Rotgers & Maniacci, 2006). According to him, moral insanity comprised of a morose distortion of one’s natural feelings, inclinations, habits, temper, morals and impulses without defect of the intellect faculties. The European diagnostic systems started describing various temperaments and personality types in the early 1900s (Rotgers & Maniacci, 2006). Due to infancy in the scientific profession of psychiatry during that period, mental conditions and disorders could not be well defined. Between 1920s and 1930s, Sigmund Freud and his team were the first to initiate the categorization of mental disorders. Freud theorized the causes of emotional and behavioral problems (Rotgers & Maniacci, 2006). However, there is advancement in the modern understanding of personality disorders beyond Freud’s theories.

Causes of antisocial personality disorders

            Despite in the past, when people believed that those with personality disorders were lazy and evil, the new research suggests the potential causes of personality disorders. One of the causes is genetics; researchers have identified possible genetic factors responsible of personality disorder (McCallum, 2001). According to this research, there is a possibility of inheriting a particular personality trait from parents. Personality disorders may also be caused as a result of environmental factors for instance by being exposed to chronic fear in childhood stage, being a victim of physical, emotional and sexual abuse at an early stage, being neglected by parents at an early stage, or growing up with a family member who had a mental disorder.

             Attachment theories may also contribute to the cause of personality disorder; this is the relationship between the child and their caregivers.  Sensitive care giving will result into a secure attachment which enables the child to grow in a flexible and a confident relationship with others (McCallum, 2001). However, an insecure attachment as a result of abandonment, being ignored, harmful threats will most likely lead to personality disorder. Personality disorder may also be caused by high reactivity; this is characterized by sensitivity to light, texture, noise, and other stimuli. Children who are overly sensitive are more likely to develop timid, shy or anxious personalities.

Treatment of antisocial personality disorders

            Treating personality disorder involves a course of psychological therapy which lasts for a period of six months or more depending on the severity of the condition. Psychotherapy refers to a treatment that involves discussion of emotions, thoughts and behaviors with a professional (McCallum, 2001). This is aimed at improving one’s ability to regulate emotions and thoughts. There are therapies that focus on dysfunctional thoughts and others that focus on self awareness of how one’s mind works. There are also social therapies that help understand how to socially relate with others. These psychological therapies are usually effective for many personality disorders. They are always conditioned to only be delivered by a professional trained to work with personality disorders. This is because of the dangers associated with personality disorders for example self harm (McCallum, 2001). Psychotherapist are trained to have all the experience to deal with personality disorders for example listening and discussing with the patient, strategies to deal with the problem. A range of psychotherapies are used in treating personality disorders.

            Psychodynamic psychotherapy is based on the view that personality disorder is related to negative childhood experience. In this case, metallization-based therapy is recommended in borderline personality disorder. There is cognitive behavioral therapy which is based on the view that our thinking about a situation affects our actions towards that particular situation and this need to change right from the how we think. This condition is being reduced using Dialectical Behavior Therapy (DBT) (McCallum, 2001). We also have interpersonal therapy which is based on the view that our relationship with people around us has a powerful impact to our mental health. There is no licensed medication currently being used in treating personality disorder, however, medications are always prescribed to treat a specific problem like anxiety, depression, etc.

Diagnostic criteria for antisocial personality disorders

            The following are the diagnostic criteria for a person antisocial personality disorder. There is a pattern of disregard for and defiance of the rights of others that occurs from the age of 15 years as shown by the following; failure to abide with the social norms in relation to lawful behaviors as shown by performing acts that are ground for arrest (Kantor, 2006). Deceitfulness as shown by repeated lies, conning others, use of aliases, failure to plan ahead,  recklessly disregarding self safety and others’ safety, lack of remorse which may be signified by being unresponsive to or rationalizing having harmed, mistreated and stolen from another. The other diagnostic criterion is that the individual is at least 18 years of age. There should also be an evidence of conduct disorder previously before 15 years of age (Kantor, 2006). Lastly, the occurrence of antisocial behavior should be excluded in the course of schizophrenia.

A person’s ability to live with antisocial personality disorder

            One is able to live with antisocial personality disorder as long as their condition is understood by those around them and they are not threatened because of their state. People with antisocial personality disorder are known not to be empathetic at all and hence e cannot understand others feelings. Therefore to help him or her live with the condition, let them be taken the way they are (Kantor, 2006). They can also be helped by taking them for medications if their conditions worsen. For healthcare professionals, they are recommended to set boundaries for themselves, enforce consequences in case boundaries are violated, debrief after enforcing consequences and when the person is calm, never to engage in arguments with the person and monitoring their communications both verbal and nonverbal.

Origin of antisocial personality disorder, first documented cases, types of treatment, how they work and the most effective ones

            This disorder originated from the view that there are people who exploit others and violate society rules for their personal gains as a result of their personality traits. One of the famous cases of antisocial personality disorders is that of David Garry a known criminal from Australia who spent his life in institutions since his adolescence (Kantor, 2006). He is known of mutilating himself as many times as seventy which includes swallowing razor blades, slicing off his nipples, nailing his feet and damaging his penis. He was also imprisoned for 14 years for attempting to murder three people. For all these crimes, he did not express remorse hence diagnosed of borderline antisocial personality disorder. This disorder is known to be the most difficult one to treat. However, antidepressants and antipsychotics are normally used in treating the associated problems and symptoms (Kantor, 2006). Additionally, psychotherapies are used to help patients deal with the disorder.

References

Rotgers, F., & Maniacci, M. P. (2006). Antisocial personality disorder: A practitioner's guide to comparative treatments. New York: Springer Pub.

McCallum, D. (2001). Personality and dangerousness: Genealogies of antisocial personality disorder. New York: Cambridge Univ. Press.

Kantor, M. (2006). The psychopathy of everyday life: How antisocial personality disorder affects all of us. Westport, Conn: Praeger.

Possible events or complications when investigating a crime scene using DNA as a primary source of evidence

Every person has a unique DNA and therefore it is a very accurate and primary evidence to investigate crimes for law enforcement assistance. It is used to investigate suspects by identifying the criminals who took part in the incidence (Shoester, 2006). DNA is used as primary source evidence in solving cold cases, murder, violence and robbery among other cases. Forensic, homicide, sexual assault cases and property complications are also investigated using DNA. These kinds of cases are investigated using DNA as their primary source in various ways (Bulman, 2014).

The quantity and the quality of DNA samples collected makes also affect the accuracy of the case and complication investigation. When the samples of DNA are not contaminated, they can provide enough information about the suspects. There are other complications that are solved using DNA as the primary source(Bulman, 2014). One of the complications is when violence is committed and there is no physical evidence such as damages. Samples of fingerprints and footsteps can help to investigate.

A study done in Florida shows that 52% of murder and sexual harassment cases were put in the database for break-in convictions. When the DNA is used, a hit of the DNA profile is able to match with those profiles in its database. This investigation helps in identifying suspects which becomes the primary source of investigation (Bulman, 2014).

Forensic cases are also best investigated using DNA. This is done through DNA profiling that was developed by Sir Alec Jeffreys in 1880s (Shoester, 2006). DNA for these cases is done by extracting samples cells of the people who were involved at the place of the incidence. Other body fluids such as blood, semen, saliva and urine are also used to ease the process (Shoester, 2006). DNA therefore plays an important role in getting hold of criminals who would not have been captured through other means of investigation.

References

Bulman P., (2014) Solving Cold Cases with DNA: The Boston Strangler Case. Retrieved from:  http://www.nij.gov/journals/273/pages/boston-strangler.aspx

Shoester, M. V. (2006). Forensics in law enforcement. New York: Nova Science Publishers.

HOSPITALITY INDUSTRY, LEADERSHIP SKILLS AND MANAGEMENT SYTLES

• What leadership skills did you talk about in your interview?

Leadership skills are the capability of a person to lead in an excellent manner. It is based on several key skills that an individual must possess in order to be a great leader. These skills are highly sought by an employer’s as they are involved in dealing with people in a way that it motivates, enthusing and building respect among individuals. We discussed skills such as being a good listener than can listen actively and is good in questioning to elicit information. A good leader must also know how to build rapport quickly and ensure that it is effective. This creates a good and strong relationship with others. The art of being good at public speaking either at informal or formal corridors is a leadership skill. Another skill we discussed was the ability to have good and strong negotiation skills that will broaden the sense of reaching a bottom line with a win-win situation.

• How did the interviewers demonstrate their leadership skills in their daily operations with evidence?

The interviewer demonstrated the leadership skills such a communication skill and attentive listening to the staff in the daily operation of the business. He showed by an action of how they have been conduction daily briefing every morning before business commences.

• How did the interviewers identify a) an effective leader, and 2) an ethical leader?

An effective leader is the one who knows how to communicate with his people and listening to them as well. A leader who can also solve any problems that emerges during the normal operations. An ethical leader is the one who observes moral behaviors. He lives up to the required standards and performs his duties without favor.

Q1.  How would you describe your management style?

 Management styles are the ways that are involved in decision making and it relates to the subordinates. They include autocratic and permissive styles as well as paternalistic and democratic styles. These styles help the management in making a daily decision to enhance smooth running of the business. Any style that is used has to be effective in order to make the very best decision of the business.

Q2. What are some mistakes that you think hospitality managers commonly make?

Being the head of a hospitality company is not an easy task. Just like any other business there are challenges. It is true that we can make mistakes the common one being able to make time for the employees and listen to their problem or little is done to their concerns. Another common mistake is not being able to recognize their achievements and reward them accordingly.

Q2 (a). How do you “fix” any mistakes or make sure that they do not happen again?

In order to be an effective manager then one should have the ability to command hearing and respect. A manager should also be able to communicate well and be able to make a wining decision.

Q3.  What do you think are some key qualities/characteristics and skills that a manager at your level should have?

The most valuable skill is to be a leader of strong character with charisma that can create a great impression to all staff.

Q4. Which skills to you believe has been most valuable in assisting you in your management role?

Being a manager is not easy at all. It is challenging because everybody else is looking up to you. As a manager, you are also expected to be a role model to the rest.

Q5. What is the most challenging aspect of being a manager?

There are problems in every business and these problems have to solve for business to continue with the operation. We use strategies such as problem definition, problem study, launch goals, make possible answers, examine the solution and implement it.

Q6. What problem solving strategies do you use?

I have experienced a big challenge of declining sale I the company. This place my jeopardized my work as a manager in the hospitality industry.

Q7. What is the most difficult challenge that you have faced as a hospitality manager?

I love my work for a reason it is my area of profession. Secondly, I love interacting with people from different area and regions. I enjoy it.

Q8. What do you enjoy least about your job as a hospitality manager?

I enjoy the flexibility that comes with my work since they are different shifts. I also do enjoy every single allowance that is given.

Q9. What do you enjoy most about your job as a hospitality manager?

On a normal working day depending on the shift I wake up four hours before the reporting time. I jog for thirty minutes and then I check my schedule of the day work. After that, I have my breakfast/meal and I proceed to work. I am always there an hour earlier.

Q10. How would you describe a typical work day for you?

In order to ensure that the employees maintain morale I always try to reward their work especially to those who go beyond a normal call of duty to see customer satisfied (Owen, 2012).

Q11. What strategies do you use to motivate employees and maintain morale?

To measure the employee’s success we mostly use the customers complement and the view of lines manager and how well an employee executes his or her duty.

Q12. How do you measure employees’ success?

In order to promote an employee to the management level, I consider the performance when little or no supervision is done and how well they conduct themselves (Owen, 2012).

Q13. What traits do you look for when hiring management employees?

When we hire employees we put them under training for a period of not less than three months.

Q14.   How long does it take for employees to complete the training program you offer?

For my range as a manager and to maintain a high degree of motivation to any manager, a competitive salary will be a six figure.

Q15. What is a competitive salary range for your position?

There are many reasons why I prefer working here compared to my previous employer is because the current company is in a more competitive range and this gives me a great chance to learn and gives me personal satisfaction.

Q16. Why do you like working for the company compared to your previous employer?

When I was looking for this job they required someone who has worked for a hospitality industry of a minimum of three years. I had worked for my previous employer for four years that landed me a place in this company.

Q17. What experiences have you had that helped you to get to your current position?

When I was growing up I loved and admired the industry especially when my parents used to take out to have some lunch or dinner in a hotel. I liked the way we were served and this created some interest in.

Q18. Why did you decide to get into the hospitality industry?

I decided to work for the company because there offered me a better pay package benefits. This was together with my own self-satisfaction.

Q19. Why did you decide to work for this company?

Almost everything is great but I would like to change people’s mind about how they view employees especially the waitress. They should treat them better.

Q20.  Is there anything that you would do differently in your career as a hospitality manager?

As much as practical experience is necessary, it is even better to have a university degree that will broad anyone knowledge about the hospitality industry.

Q21. How important is it to a management career to have a university degree in hospitality management?

I would like you to focus on how to increase customer satisfaction and also learn the best ways to solve problems when they arise.

Q22.  As a manager, what would you recommend that I focus on learning that will benefit me in my career?

This is greatly contributed to the low staff motivation programs and low salaries in the area.

Q23. Why do you think there is so much turn-over in hospitality management?

As a result of inadequate responsibilities given to the employees in hospitals and also the poor supervision of these employees and the repetitive work in the hospital there is the chances of high turnover.

Q24. Do you have any recommendations/suggestions for me in my hospitality management job search?

I would recommend you to first do it if it is your area of passion. Do not be afraid to start at the lower level. Embrace the challenge as a junior employee and you will see yourself place even better than mine.

Medicare Tax Revenue

Medicare programme refers to a health insurance programme that is meant for the people who are aged 65 years and above, people who have various disabilities and others of all ages who have renal disease that has reached the end-stage. It is a national programme that is usually administered by the federal government since the year 1966 and is usually provided using private insurance companies across the nation. The payment for this programme is done through two accounts of trust funds which are held by the treasury and such funds can only be used for the purpose of Medicare (Bryan and Percy, 2035). The funds for Medicare are obtained from the taxes paid by the employers, most employees and those people who are self- employed. These funds are also obtained from the general revenues like income from taxes which are paid on social security benefits, interest that is gotten from investments of trust monies and premiums for Part A of Medicare from those people who are ineligible for Part A that is premium free. This method assist in payment of visits to the hospital and physician, the prescription drugs and many other services which are either acute or semi-acute (Bryan and Percy, 2054). This programme sets an example of how the federal government should allocate revenue whose amount is substantially huge in terms of collection. In relation to this, the program should be expanded since its benefits are more than the expenses paid through it. The value of this programme will be exploited fully when it is expanded and through this the scope of its benefits will be wider. This will remove the limitation and inflexibility that this programme is experiencing currently.

In each year, Medicare uses billions of dollars from the federal budget that is usually over and above the taxes for Medicare that are usually paid through the employees’ payrolls. The payroll taxes are normally deducted from the pay checks and are paid by the employer on behalf of the employees.  Taxes from the OASDI benefits are paid by some recipients of social security on the benefits they receive from social security since they have other incomes that are more than a certain set threshold. These taxes are considered for purpose of funding Medicare (Bryan and Percy, 2054). Premiums are paid by those people who have subscribed for Medicare Part B that pays for services offered by the physicians or for Part D of Medicare that pays for the drugs prescribed.  Premiums are not contained in the Part A which pays for hospital stays. This is the portion of Medicare whose financing is mostly done through payroll taxes that are paid by employees. The Parts B and D of Medicare are not usually financed by taxes on payroll. Rather, the premiums paid by the people who enrol for this programs are calculated yearly such that they cover around a quarter of all the costs of the program. The remaining three quarters of these costs are paid for by the revenues from the general tax. In future, the transfers of general revenue are expected to be more than payroll taxes. This can be attributed to assumption made by Medicare trustees while they are projecting the future that the laws will not be changed from what they are currently. The current laws specifies what Medicare taxes on payroll should have 1.45 percent payment by the employee and the employer each , including some additional taxes by those people who have income that is above a certain set threshold. However, the law sets no limit on the amount transferred from general revenue for the purpose of funding Parts B and D of Medicare. Currently, the law provides that transfers from general revenue should amount to three quarters of the program’s cost regardless of how high such costs are (Lee and Sabiha, 3).

The issue arising concerning this programme is whether it should be expanded or not a matter that is largely determined by whether it will remain solvent and sustainable. Solvency can be referred to as a measure of determining whether the two funds of Medicare are able to meet the entire cost of benefits that are provided by the law on time. Sustainability can be identified as a concept that can be used to mirror the societal values or political viability of Medicare as it is structured currently. Considering that this programmes aims at benefiting the public, it is essential that sustainability is sort with the assist of the all stakeholders (Lee and Sabiha, 2). The stakeholders include the general public, doctors, other medical staffs and more importantly the politicians who pass laws to put in place such a programme. The stakeholders have had to influence how the funds to finance the program should be collected, how the payments for Medicare cost should be paid and participating in any reforms that are aimed at changing the current law on the program. Groups such as American Medical Association, RUC, and other medical profession groups give their perception regarding the Medicare program to the federal government before major change is made on this program. Beginning in the early 1980s, the stakeholders have been raising many concerns about the viability of this program as a hospital insurance policy, about the protection offered to the beneficiaries and the overall quality of care reimbursement through Medicare (Brown, 3). This has resulted to a lot of changes in system of quality assurance and the structure for reimbursement related to this program. For instance the, the congress as a major stakeholder in this program passed the 1984 act on deficit reduction that  ensured the development and implementation of Medicare payment system, which was designed to curb the spiralling cost of healthcare by having reimbursement made to providers at a fixed rate. This was centred on diagnosis-related groups which reflected the groups and amount of resources normally used for each diagnosis, thus replacing a system of reimbursement that was based on prevailing or reasonable charges (Brown, 5). This is an example of how the stakeholders have influenced any process that is aimed at altering the manner in which the funding of the program and the allocation of this healthcare funds to various costs.  

However, for this program to attain its maximum benefit there is a need to expand it so as it can cover more groups of people. This expansion will ensure that the program covers everyone for all the necessary medical services and this would include the visits to doctors, prevention programs, hospital care, long-term care, and care for reproductive health, vision, dental, mental health, prescription drugs and costs of medical supply. While it may appear like the cost of such expansion can be prohibitive, the savings on administrative costs that would be realised from having an efficient and non-profit program to pay all medical bills would make it possible to eliminate all deductibles and co-pays (Gerald 6). Moreover, the expanded system would allow for reduction and control of medication costs and the cost of any other supplies. This would also make it possible to prevent chronic conditions or provide treatment for such conditions that would require more cost and medical care that is complex if left untreated. This would make it possible for the public to understand and appreciate how the federal government raises its revenue and how such revenues are allocated to the various programs that are aimed at providing public services. This improved system is not to be seen as socialism. Similar to the current situation the government would not have ownership for any clinics or hospitals. Patients would have an opportunity to visit the doctor they prefer and the only change would concern the means of payment. The revenues for this program would be obtained through maintaining the present health care federal revenues and introducing new tax increases that are modest on those people with very high income. The revenues would also be obtained through increasing employee’s payroll taxes, since they would no longer be required to pay health premiums and a small taxation on bond and stock transactions (Gerald, 6).

In conclusion, Medicare is a program that can assist the taxpayers to understand how the federal government spends it revenue and the various means through which such revenues are collected. The policy on Medicare taxes ensures that the program is sustainable and ensure that health care services are accessible to those who are most in need.

Works cited

Lee Goldberg, Sabiha ZainulbhaIs. Medicare Solvent and Sustainable? The National Academy of Social Insurance. 5.1 (2012). 1-3

Lawrence, Brown. The Politics of Medicare and Health Reform, Then and Now. HEALTH CARE FINANCING REVIEW.Vol.18.2 (1996)1-6. Accessed from: https://www.ssa.gov/history/pdf/PoliticsMedicareReform.pdf

Gerald, Friedman. Funding HR 676:  The Expanded and Improved Medicare for All Act .How we can afford a national single-payer health plan. (2013)1-12. Accessed from: http://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf

Bryan, Percy W. Medicare and Medicaid Fee-for-Service Payments. New York: Novinka Books, 2004. Print.2035-2057

Human intelligence activities

Red Cells have recently collected and disseminated information concerning a terrorist group named Al-Sham. This is a specialized military body with unique customs, beliefs and language and also contracted DOD specialists (Byman, 2016). The analysis done by the Red Cells digs deep into the origin of Al-Sham , how it is funded, the current state they are in, the kind of weapons they use and their future. This detailed analysis will help in exposing the enemy for the strategies of stopping terrorists’ acts to be done beforehand. Red cell analysis has coordinated the human intelligence program and the specialists to gather and has analyzed the information about the Al-Sham terror group from various perspectives that shall be detailed (Byman, 2016).

 Al-Sham which is referred as ISIS by the U.S government was formed in 2004 as a division of Al-Qaeda which is located in Iraq. It is part of the overall ISI organization. Al-Sham is known to be quite and this gives a suspicion that they might be collaborating with other groups in committing the terrorist’s attacks. From the research done by the Red Cells, Al-Sham is grounded in the Muslim faith in the denomination of TQJBR which follow the Muslim traditions to the latter. The other strong hold of this group is their funding. Their funding really sustaining which is comes from various illegal activities which include oil smuggling, counterfeiting and getting donations from the most corrupt charity bodies of the Islamic and also kidnapping for ransom. The study also has shown that France and Italy have paid approximately $30 million as a ransom kidnap demands from the Al-Qaeda. This was just an annual payment in 2005. They also earned over 200 million dollars through other corrupt means still in 2005 and their sustenance is hence assured (Byman, 2016).

ISI generally has been gaining momentum since 2013 with very significant expansion of its power into Syria. With the already existing ISI groups in Somalia, Pakistan, Arabian Peninsula and Syria, the terrorists have gained full control over the Islamic community. Still under the systematic leadership of Abu Bakr Baghdadi, the groups have made an expansion of their goals with the main target being the attack of United States of America.

It was wise also for the Red Cells to have an assessment of the current state of the ISI groups which Al-Sham. The recent studies have shown that the year 2014 has be a year of terrorism revolution by being the most unstable year politically over the last decade. Various countries such as Egypt, Syria and Arab Springs have had a drastic fall in their political stability. Cases of rape, kidnap, murder and other forms of harassment have been reported (Byman, 2016). There have been more than 6000 women and children who have been kidnapped and sold in several sex slavery bodies. Muslims also who do not follow the exact beliefs that are followed traditionally are also killed. These terrorist groups have proven ruthless from the step they have recently taken of making a “cultural cleansing”. This is an attempt to erode the cultural heritage of Iraq. This is a movement driven by the Muslim extremists who want to erase the identity of the true Muslim religion (Byman, 2016).

The main weapon used by the ISI terrorist groups is the psychology of terror. They have ensured their omnipresence by setting small cell terror groups majorly in the United States. The members of the cells are actually citizens of U.S. who may not be easily noticed because they are born and brought out here. ISI has become unpredictable in the recent years than in the past because they are thinking and planning globally but act and implement locally. From a recent analysis done, 44% of the terrorists         are more than 30 miles away from their target (Byman, 2016). There have been small but organized groups that have spread across the globe with an aim of spreading the psychology of fear. This is majorly done with suicide bombs, random shooting and taking captives.

The Red Cells also evaluated about the future of the ISI and the Islamic state. It has been found that they don’t have a particular reason why they carry out the terror attacks. The extremists have used a very powerful weapon of fuel sympathizers just as the Al-Qaeda has been doing (Pollack, 2016). The 2013 bombing at Boston Marathon it is evidence that the target of the ISI groups is to cause deaths and suffering of important people. The ISIS has recently walked in the street of Brisbane with an aim of beheading the civilians on camera. Though the plan was foiled, it has worried the government and gatherings have been regarded as dangerous zones for the ISIS attacks (Pollack, 2016).

Red Cells have identified that the human intelligence programs are the best in monitoring the Al-Sham group by having a clear view on surprise attacks beforehand. It would work in identifying the lone-wolf sympathizers and other small cell groups that have been the great weapon for the terrorists. This intelligence body is able to collect a quality his profile information which can best help the arms forces in fighting against the ISIS terrorists (Harman, 2015). The human intelligence program has an important role to play in fighting the Al-Sham terrorists in the following ways. First, they are able to make a connection with the small cells and the sympathetic groups. They are also able obtain primary information that is reliable. It is also able to used specialized methodologies which are developed through sociology, anthropology and psychology (Pollack, 2016). This can best assist the government in understanding the conditions of the terrorists, their plans and any other agenda they might be discussing.

The red cell also has recommended the best IC members in using the human intelligence program. Military occupational specialists, private intelligence specialists and other special a agents. There is also an important docket for Arabic and cryptologist and linguistics (Pollack, 2016). These can work best in reaching the terrorists and through the human program intelligence. There are also other special group o communication signals intelligence specialists who can work in collaboration with the other specialists in operating an undercover in the territory of the enemies (Pollack, 2016).

The human intelligence program operators should be the frontline of the intelligence operations. This is because they are able to collect sensitive information about the Al-Sham. The information is gotten from the Islam refugees, the active members of the Al-Sham and various detainees (Pollack, 2016).

The coordination of the human intelligence programs, the right members to conduct the move and all the other aspects of the undercover needs to be run under the right strategy (Harman, 2015). The proposed strategy involves cross translation of the information by various linguistics, processing of the translated information, after which the analysis can follow. Red cell analysis has provides a strategy that coordinated all these operations so as to ensure that the bodies involved work in harmony. Red cell analysis is an approach that ensures the understanding of the Al-Sham in various ways (Harman, 2015).

First, it makes an attempt to think the way adversaries would think (Harman, 2015). The approach is based on assimilation whereby the members of the IC specialists are required to evaluate the social surroundings, their upbringing, their financial and other economic status religion and their beliefs. This approach also demands that the analysts should study the state of the Islam in an intent way and actually apparently becoming part of them. The Red Cell approach requires the members also to be open minded such that they are able to let go any pre-convinced notions about the Al-Sham (Pollack, 2016). With the procedures that the Red Cells analysis has put in place, misunderstanding, misleading of the information and inaccuracy are no longer a threat to the operations.

The intelligence activities against Al-Sham have to embrace the various recommendations that have been proposed. First, the proposed Homeland Security budget for 2015 should be revised by the concerned agencies to ensure that all the resources that are needed are in place. Secondly, they issue of recruiting more military should be done which should be accompanied by a military training in various occupational specialties. The graduates of the MOS school should also be awarded as a motivation for the new recruits (Harman, 2015). The last recommendation was for the Department of Defense policy to make a consideration on the use of country nationals and the recommendation of its abolishment should be considered. This should seize until the Al-Sham militant groups are totally eradicated to prevent the issue of counter spies of the terrorists from extracting information that would cause the exposure of the state against its enemy (Harman, 2015).

References

Byman, D. (2016). ISIS Goes Global. Foreign Affairs, 95(2), 76-85.

Harman, J. (2015). Disrupting the Intelligence Community. Foreign Affairs, 94(2), 99-107.

Pollack, K. M. (2016). Fight or Flight. Foreign Affairs, 95(2), 62-75.

Substance Misuse in Forensic Practice in the UK

It is palpably factual that people with the severe mental health problem exhibit higher rates of co-morbidity particularly in the substance misuse (Chiringa, Robinson & Clancy, 2014). Citing from studies conducted in the UK, it is proved that there are higher rates of substance misuse within the UK population. Precisely, rates of co-morbid misuse of substance among the patients being admitted in hospitals/forensic departments range between 50 to 90 percent (Humber, Hayes, Wright, Fahy, & Shaw, 2011). Further, it has been recorded that there is continuous substance misuse even after admission which marks the major challenge endured by the forensic units. Thus, adhering to this case of a 24 years old man who exhibited aggressive disorderly behavior and substance misuse, there are several conclusions that can be drawn with regard to the association of mental health disorder and substance misuse. Some of the attributing factors include homelessness, inconsistent adherence to medication, severe psychiatric conditions, high treatment costs, and persistent contact with the law enforcement/ criminal justice system (Chiringa, Robinson & Clancy, 2014). Precisely, persistent contact with the justice system can be attributed by continued misuse of substance while in admission in forensic units thereby resulting to reconviction after the victim is discharged from the hospital. As a result, it can be asserted that the cause of aggressive disorderly behavior exhibited by the victim is strictly resulted by severe co-morbid substance misuse. It is worthwhile to state that there is a need for addressing the issue of substance misuse which can be conducted through clinical and law intervention as a control measure (Durand, Lelliott & Coyle, 2006). Therefore, this paper will offer an applicable forensic intervention of the substance misuse together with the law enforcement in order to mitigate the predicament to lower the heightening rates of co-morbid misuse of substance.

To start with, it is perceptible that the victim can be suffering from mental health problem that directed him to substance misuse and later to aggressive disorderly behavior in the public. As a result, the problem can be mitigated through clinical treatment particularly through psychosocial interventions (STEWART & BOWERS, 2015). Thus, one of the psychosocial interventions that can be employed includes inspirational interrogation with the aim of persuading the victim to change from the addictive behavior, counseling, and social skills acquirement through training. However, it is factual that using these psychosocial interventions to a person with co-morbid misuse of substance as the result of psychiatric conditions can be challenging. Consequently, addressing the problem on a healthcare perspective demands for extended interventions which include parallel, serial and integrated care (STEWART & BOWERS, 2015). Precisely, for parallel care, the problem is addressed by a group of specialists from different fields in order to determine the major cause of the problem to the patient and the applicable remedy. On the other hand, serial care encompasses addressing both psychological illness and misuse of substance by the patient consecutively in order to derive an appropriate judgment regarding the primary problem and its cause (STEWART & BOWERS, 2015). Lastly, integrated care encompasses the concurrent treatment given to the patient both on substance misuse and mental illness by specialists from a single field (healthcare). Therefore, according to the provisions of the national policy, the victim of substance misuse ought to be treated mental health services through the integrated care model (STEWART & BOWERS, 2015). The reason why integrated treatment is proposed by the national policy is based on the fact that it is regarded as the most effective treatment method for the co-existing misuse of substance associated with mental illness (STEWART & BOWERS, 2015). Thus, it is recommendable that the mental health staff included in the treatment of the victim has competencies particularly in recognizing the treatment of the problem with regard to the mental status of the patient. For the patient/victim using mental health service, their use of alcohol and drugs should be examined as part of Care Programme Approach (CPA) which should adhere to a single care plan in order to evade interfering with the criminal justice system to be enforced to the victim (STEWART & BOWERS, 2015). Generally, it is noteworthy that interventions for addressing the problem with the healthcare perspective should be staged with regards to the motivational and engagement stage correspondent to the level of need.  

Mental Disorder of Substance Misuse

Assessment of the mental condition of the detainee is vital prior to determining the general care to be offered to him/her. Examining the mental condition of the detainee will help the forensic physician to determine whether misuse of substance is the determining factor of the psychotic condition or the other way round. This is based on the fact that mental disorder and substance misuse co-morbidity has been very common in many cases that exhibit aggressive disorderly behavior of an individual (Carrà & Johnson, 2009). As a result, this can be regarded as the reason why diagnosis of drug addiction and diagnosis of schizophrenia coexist. Incessant drug use can result to deterioration of the mental condition of an individual even in stabilized psychotic disorder. Misuse of the substance is typically linked with psychosis with regard to several mechanisms. Precisely, intoxication determines the psychotic state which may be caused by stimulants and sometimes cannabis (Cullen, Jewell, Tully, Coghlan, Dean & Fahy, 2015). Therefore, it is noteworthy that a psychotic condition may persist to a level of being hard to eliminate the drug. On the other hand, withdrawal such as that resulted by alcohol might cause vivid hallucinations and loss of consciousness (Isherwood & Brooke, 2001).     

Treatment

There are four stages of treatment that are typically engaged in the diagnosis of the patient with mental disorder and co-morbid substance misuse. The first stage is the Engagement where the staff and the patient develop a therapeutic relationship together with the appropriate interactional style (Price & Wibberley, 2012). This is achieved by addressing the immediate problems of the patient rather than basically focusing on how to lessen the substance misuse. The second stage is Motivation which encompasses deep assessment of the substance misuse behavior exhibited by the patient citing from the theoretical perspective (Price & Wibberley, 2012). Therefore, the team involved in this treatment stage use different principles of motivational interrogation in order to encourage and persuade the patient to respond effectively. The third phase of the treatment is Active Therapy (Clark, 2009).  In this stage, the team offering treatment focuses solely on minimizing the substance use by the patient (Price & Wibberley, 2012). The last stage of treatment is identified as Relapse Prevention which is vital in a condition that exhibits chronic relapse of the disorder. According to the contemporary policy and guidelines offered with regard to the successful treatment for the patients with mental disorder and misuse of substance (Clark, 2009), the following are the elements that reflect treatment success.

• Long term support
• Enhancing a collaborative relationship with the patient and the staff
• Creating hope and trust in the patient/victim through inspirational interventions (Price & Wibberley, 2012)
• Substance consciousness work    
• Conducted a staged therapy in order to enhance patient’s motivation and willingness to change
• Comprehensive consideration of other needs of the patient such as finances, physical health and social status
• Prevention of the relapsing condition and other high risk conditions (Isherwood & Brooke, 2001)

 These elements are regarded as the qualities to which psychiatrics can be able to effectively offer therapeutic services to a patient with both mental disorder and substance misuse behavior (Moore & Drennan, 2013). Thus, citing from the fact that treatment of the two disorders is associated with co-morbidity and motivational interventions, integrated treatment is regarded as the most appropriate type of treatment for the patient exhibiting these dual disorders (Moore & Drennan, 2013).

Legal Framework

With regards to the considerations that the individual is a suspect at the police custody, there are several factors to consider in the delivery of humane response during provision of treatment and care (Durand, Lelliott & Coyle, 2006). It is exhibited that most of the detainees do not receive appropriate care if not treatment while at the police custody particularly because police tend to overlook the fact that the suspect is suffering from co-morbid misuse of substance. Therefore, one of the considerations that police fail to make for the suspects in detention includes the level of substance dependence.  As a result, one of the ethical principles in this case is precise assessment of the level and severity of addiction exhibited by the suspect (Durand, Lelliott & Coyle, 2006). Assessing the level of dependence is vital for the execution of medical intervention as it minimizes chances of risks based on psychiatric, medical and legal complications which are basically associated with intoxication and withdrawal (Durand, Lelliott & Coyle, 2006). Consequently, the reason why most detainees of substance misuse do not receive proper treatment and care is due to the fact that it is difficult to take accurate assessment together with an effective response to the problem endured by the victims.

Therefore, one of the considerations to be made while detaining the victim of substance misuse is based on their rights. It is factual that individuals under detention are entitled to the same standard of healthcare as other citizens (GREAT BRITAIN, 2013). This means that forensic physicians and police officers hosting the detainee ought to be cautious to the issue of detainee’s rights during examination.  According to Police and Criminal Evidence Act 1984 (PACE) Code H 2014, one of the rights of a detainee is to have a prescribed medication while at detention provided that it is clinically safe (GREAT BRITAIN, 2013). Additionally, it is the right of the detainee to have informed consent regarding the assessment and its results together with consequential clinical decisions.   

The other consideration that ought to be made with regard to the codes of practice to the detained individual is clinical safety of the suspect (Durand, Lelliott & Coyle, 2006). It is noteworthy that the attendance of the forensic physician is based on the health safety and welfare of the detainee. Therefore, it is vital for the detainee to be diagnosed for intoxication and withdrawal signs as one of the ethical principles of treatment and care to the detainee (Durand, Lelliott & Coyle, 2006). Thus, the forensic physician ought to consider that inception signs of overdose with the misused substance might not be immediately observed but they exhibit future possibility. In consideration of this, the custody staff ought to be given instructions regarding regular visit of the intoxicated detainee(s) for at least every half an hour to assess their conditions. Precisely, the detainees should be roused after every visit in order to record their response while trying to rouse them and if any change is noted on their level of consciousness, a medical treatment is arranged promptly (Durand, Lelliott & Coyle, 2006).

The third consideration to be made is based on the expectations of the detainee (Durand, Lelliott & Coyle, 2006). It is factual that the suitable medical treatment may not solely involve drugs prescription although most of the cases it is necessary. As a matter of fact, detainees ought to be helped to gain consciousness and comprehension on the usefulness of the prescription. Additionally, this is significant in realizing the preferences of the detaining and the reason behind the preferences (Durand, Lelliott & Coyle, 2006). This can be used to assess the level of addiction exhibited by the detainee. Assessing the level of addiction is based on the fact that dependence brings about confusion between medical care and supply of drugs.     

Conclusion

Generally, individuals with mental illness exhibit higher rates of co-morbidity especially on substance misuse. The rate of co-morbidity for these patients ranges between 50 – 90% of the mental illness patients. Thus, some of the attributing factors associated with mental disorder and substance use include homelessness, inconsistent adherence to medication, severe psychiatric conditions, high treatment costs, and persistent contact with the law enforcement/ criminal justice system. In the treatment of the man who was suspected to have been misusing the substance, there are several considerations to make with regard to clinical and legal concerns. These concerns include the rights of the detainee, the severity of dependence, possibility of relapsing state, clinical safety and expectations of the detainee. These are some of the things that custody staff ought to make while detaining the suspect.

References

Carrà, G, & Johnson, S 2009, 'Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK', Social Psychiatry & Psychiatric Epidemiology, 44, 6, pp. 429-447

Chiringa, J, Robinson, J, & Clancy, C 2014, 'Reasons for recall following conditional discharge: explanations given by male patients suffering from dual diagnosis in a London Forensic Unit', Journal Of Psychiatric & Mental Health Nursing, 21, 4, pp. 336-344,

Clark, JJ 2009, 'Contemporary Psychotherapy Research: Implications for Substance Misuse Treatment and Research', Substance Use & Misuse, 44, 1, pp. 42-61

Cullen, A, Jewell, A, Tully, J, Coghlan, S, Dean, K, & Fahy, T 2015, 'A Prospective Cohort Study of Absconsion Incidents in Forensic Psychiatric Settings: Can We Identify Those at High-Risk?', Plos ONE, 10, 9, pp. 1-16

Durand, M, Lelliott, P, & Coyle, N 2006, 'Availability of treatment for substance misuse in medium secure psychiatric care in England: A national survey', Journal Of Forensic Psychiatry & Psychology, 17, 4, pp. 611-625

GREAT BRITAIN. (2013). Police and Criminal Evidence Act 1984 (PACE) 67(7B) - Code C: revised code of practice for the detention, treatment and questioning of persons by police officers.

Humber, N, Hayes, A, Wright, S, Fahy, T, & Shaw, J 2011, 'A comparative study of forensic and general community psychiatric patients with integrated and parallel models of care in the UK', Journal Of Forensic Psychiatry & Psychology, 22, 2, pp. 183-202,

Isherwood, S, & Brooke, D 2001, 'Prevalence and severity of substance misuse among referrals to a local forensic service', Journal Of Forensic Psychiatry, 12, 2, pp. 446-454

Moore, E, & Drennan, G 2013, 'Complex forensic case formulation in recovery-oriented services: Some implications for routine practice', Criminal Behaviour & Mental Health, 23, 4, pp. 230-240

Price, O, & Wibberley, C 2012, 'An exploratory study investigating the impact of the procedures used to manage patient substance misuse on nurse-patient relationships in a medium secure forensic unit', Journal Of Psychiatric & Mental Health Nursing, 19, 8, pp. 672-680

STEWART, D, & BOWERS, L 2015, 'Substance use and violence among psychiatric inpatients', Journal Of Psychiatric & Mental Health Nursing, 22, 2, pp. 116-124