a_AT1 Non-punitive_JJ Paradigm_NN1 of_IO Probation_NN1 Practice_NN1 :_: Some_DD Sobering_JJ Thoughts_NN2 L.R._NP1 SINGER_NP1 Lawrence_NP1 Singer_NP1 is_VBZ an_AT1 Assistant_JJ Chief_JJ Probation_NN1 Officer_NN1 with_IW Merseyside_NP1 Probation_NN1 Service_NN1 ._. 
Beforehand_RR he_PPHS1 worked_VVD as_II a_AT1 probation_NN1 officer_NN1 for_IF Berkshire_NP1 Probation_NN1 Service_NN1 and_CC later_RRR as_II a_AT1 research_NN1 officer_NN1 for_IF Somerset_NP1 Probation_NN1 Service_NN1 where_CS he_PPHS1 undertook_VVD the_AT research_NN1 reported_VVD here_RL ._. 
The_AT paradigm_NN1 which_DDQ is_VBZ described_VVN originates_VVZ from_II doctoral_JJ research_NN1 into_II generic_JJ probation_NN1 practice_NN1 and_CC has_VHZ been_VBN presented_VVN in_II a_AT1 book_NN1 Adult_NN1 Probation_NN1 and_CC Juvenile_JJ Supervision_NN1 :_: Beyond_II the_AT Care-Control_NP1 Dilemma_NN1 (_( 1989_MC ,_, Gower_NP1 )_) ._. 
SUMMARY_NN1 The_AT Government_NN1 White_JJ Paper_NN1 Crime_NN1 ,_, Justice_NN1 and_CC Protecting_VVG the_AT Public_NN1 proposes_VVZ a_AT1 radical_JJ change_NN1 for_IF probation_NN1 practice_NN1 ._. 
Henceforth_RT probation_NN1 work_NN1 will_VM no_RR longer_RRR be_VBI an_AT1 alternative_NN1 to_II punishment_NN1 but_CCB an_AT1 alternative_JJ form_NN1 of_IO punishment_NN1 ._. 
This_DD1 article_NN1 challenges_VVZ the_AT conceptual_JJ and_CC practical_JJ appropriateness_NN1 of_IO applying_VVG the_AT notion_NN1 of_IO punishment_NN1 to_II the_AT probation_NN1 context_NN1 ._. 
Probation_NN1 officers_NN2 ,_, it_PPH1 is_VBZ argued_VVN ,_, are_VBR concerned_JJ with_IW establishing_VVG rules_NN2 for_IF probationers_NN2 and_CC not_XX inflicting_VVG pain_NN1 on_II them_PPHO2 ._. 
An_AT1 alternative_JJ non-punitive_JJ paradigm_NN1 of_IO probation_NN1 practice_NN1 is_VBZ described_VVN ._. 
The_AT paradigm_NN1 is_VBZ based_VVN on_II the_AT joint_JJ supervisory_JJ aims_NN2 of_IO support_NN1 and_CC surveillance_NN1 which_DDQ are_VBR implemented_VVN through_II the_AT methods_NN2 of_IO counselling_NN1 ,_, assisting_VVG ,_, directing_VVG ,_, and_CC monitoring_NN1 ._. 
To_TO illustrate_VVI the_AT paradigm_NN1 ,_, reference_NN1 is_VBZ made_VVN to_II an_AT1 alcohol_NN1 education_NN1 course_NN1 developed_VVN for_IF offenders_NN2 in_II trouble_NN1 through_II drink_NN1 ._. 
The_AT efficacy_NN1 of_IO the_AT alcohol_NN1 project_NN1 and_CC the_AT non-punitive_JJ paradigm_NN1 is_VBZ demonstrated_VVN by_II the_AT results_NN2 reported_VVN from_II a_AT1 three_MC year_NNT1 evaluation_NN1 study_NN1 covering_VVG 152_MC offenders_NN2 ._. 
The_AT article_NN1 concludes_VVZ with_IW an_AT1 affirmation_NN1 of_IO the_AT disciplined_JJ but_CCB non-punitive_JJ character_NN1 of_IO current_JJ probation_NN1 work_NN1 and_CC argues_VVZ that_CST ,_, to_TO successfully_RR protect_VVI the_AT public_NN1 and_CC reintegrate_JJ offenders_NN2 into_II the_AT community_NN1 ,_, the_AT probation_NN1 officer_NN1 's_GE employment_NN1 of_IO established_JJ social_JJ work_NN1 knowledge_NN1 ,_, skills_NN2 ,_, and_CC values_NN2 is_VBZ a_AT1 strength_NN1 not_XX a_AT1 weakness_NN1 ._. 
The_AT aim_NN1 of_IO this_DD1 article_NN1 is_VBZ to_TO challenge_VVI the_AT assertion_NN1 contained_VVN in_II the_AT White_JJ Paper_NN1 Crime_NN1 ,_, Justice_NN1 and_CC Protecting_VVG the_AT Public_NN1 (_( Home_NN1 Office_NN1 ,_, 1990a_FO )_) that_DD1 probation_NN1 practice_NN1 can_VM be_VBI conceived_VVN of_IO as_II a_AT1 form_NN1 of_IO punishment_NN1 in_II the_AT community_NN1 ._. 
Issue_NN1 will_VM be_VBI taken_VVN with_IW the_AT appropriateness_NN1 of_IO applying_VVG the_AT concept_NN1 of_IO punishment_NN1 to_II the_AT probation_NN1 context_NN1 through_II reference_NN1 to_II a_AT1 demanding_JJ and_CC successful_JJ probation_NN1 project_NN1 concerned_JJ with_IW offenders_NN2 in_II trouble_NN1 through_II drink_NN1 ._. 
In_II describing_VVG the_AT project_NN1 ,_, a_AT1 non-punitive_JJ model_NN1 for_IF understanding_VVG probation_NN1 practice_NN1 will_VM be_VBI developed_VVN ._. 
This_DD1 non-punitive_JJ paradigm_NN1 will_VM provide_VVI a_AT1 framework_NN1 for_IF contrasting_VVG the_AT efficacy_NN1 of_IO current_JJ practice_NN1 with_IW future_JJ plans_NN2 inappropriately_RR to_TO transform_VVI probation_NN1 work_NN1 into_II '_GE a_AT1 new_JJ approach_NN1 to_II punishment_NN1 in_II the_AT community_NN1 '_GE (_( p._NNU 18_MC ,_, para_NN1 ._. 
4.3_MC )_) ._. 
The_AT punitive_JJ approach_NN1 anticipated_VVN for_IF the_AT Probation_NN1 Service_NN1 in_II the_AT White_JJ Paper_NN1 is_VBZ underpinned_VVN by_II a_AT1 definition_NN1 of_IO punishment_NN1 that_DD1 resides_58 '_GE in_II the_AT restrictions_NN2 on_II liberty_NN1 and_CC in_II the_AT enforcement_NN1 of_IO the_AT orders_NN2 '_GE ._. 
The_AT White_JJ Paper_NN1 goes_VVZ on_RP to_TO emphasize_VVI :_: '_" It_PPH1 is_VBZ the_AT loss_NN1 of_IO liberty_NN1 involved_JJ in_II carrying_VVG out_RP the_AT terms_NN2 of_IO the_AT order_NN1 rather_II21 than_II22 the_AT activities_NN2 carried_VVN out_RP during_II the_AT order_NN1 which_DDQ is_VBZ the_AT punishment_NN1 '_GE (_( p._NNU 18_MC ,_, para_NN1 ._. 
4.4_MC )_) ._. 
Notwithstanding_II the_AT popular_JJ appeal_NN1 and_CC political_JJ capital_NN1 to_TO be_VBI derived_VVN from_II such_DA a_AT1 humane-sounding_JJ statement_NN1 ,_, this_DD1 definition_NN1 is_VBZ nevertheless_RR at_II variance_NN1 with_IW the_AT traditional_JJ understanding_NN1 of_IO the_AT meaning_NN1 of_IO punishment_NN1 ._. 
Discourses_NN2 on_II punishment_NN1 and_CC dictionary_NN1 definitions_NN2 of_IO the_AT term_NN1 clearly_RR specify_VV0 the_AT central_JJ feature_NN1 of_IO punishment_NN1 as_CSA being_VBG the_AT infliction_NN1 of_IO pain_NN1 rather_II21 than_II22 the_AT loss_NN1 of_IO liberty_NN1 per_RR21 se_RR22 (_( Hudson_NP1 ,_, 1987_MC )_) ._. 
The_AT conceptual_JJ and_CC practical_JJ implications_NN2 of_IO this_DD1 discrepancy_NN1 will_VM be_VBI examined_VVN in_II the_AT third_MD and_CC final_JJ section_NN1 of_IO this_DD1 article_NN1 ._. 
Beforehand_RR ,_, however_RR ,_, consideration_NN1 will_VM be_VBI given_VVN first_MD to_II the_AT probation_NN1 project_NN1 and_CC second_NNT1 to_II its_APPGE evaluation_NN1 ._. 
In_II these_DD2 sections_NN2 punishment_NN1 will_VM be_VBI understood_VVN to_TO mean_VVI the_AT infliction_NN1 of_IO pain_NN1 and_CC the_AT review_NN1 of_IO the_AT project_NN1 will_VM seek_VVI to_TO demonstrate_VVI that_CST the_AT probation_NN1 practice_NN1 described_VVN is_VBZ not_XX only_RR more_RGR demanding_JJ but_CCB also_RR more_RGR effective_JJ than_CSN this_DD1 traditional_JJ understanding_NN1 of_IO punishment_NN1 ._. 
At_II a_AT1 time_NNT1 when_RRQ the_AT Home_NN1 Secretary_NN1 is_VBZ inviting_VVG the_AT Probation_NN1 Service_NN1 to_TO '_" move_VVI centre_NN1 stage_NN1 in_II the_AT Criminal_JJ Justice_NN1 System_NN1 '_GE (_( NACRO_NP1 ,_, 1990_MC ,_, p._NN1 17_MC )_) it_PPH1 may_VM seem_VVI misguided_JJ and_CC unnecessarily_RR pedantic_JJ to_TO take_VVI issue_NN1 with_IW the_AT White_JJ Paper_NN1 's_GE notion_NN1 of_IO punishment_NN1 ._. 
Punishment_NN1 is_VBZ just_RR a_AT1 word_NN1 after_II all_DB :_: nothing_PN1 more_DAR than_CSN convenient_JJ political_JJ rhetoric_NN1 meriting_VVG only_JJ lip-service_NN1 from_II probation_NN1 managers_NN2 and_CC practitioners_NN2 poised_VVN at_II the_AT '_GE window_NN1 of_IO opportunity_NN1 '_GE ._. 
However_RR ,_, this_DD1 fails_VVZ to_TO acknowledge_VVI a_AT1 fundamental_JJ axiom_NN1 of_IO social_JJ work_NN1 practice_NN1 ;_; namely_REX that_CST language_NN1 not_XX only_RR reflects_VVZ but_CCB also_RR shapes_VVZ social_JJ reality_NN1 ._. 
As_CSA Davies_NP1 (_( 1981_MC )_) has_VHZ pointed_VVN out_RP ,_, speech_NN1 is_VBZ the_AT basic_JJ tool_NN1 of_IO the_AT social_JJ worker_NN1 ._. 
What_DDQ we_PPIS2 say_VV0 influences_NN2 what_DDQ we_PPIS2 think_VV0 and_CC in_II turn_NN1 ,_, what_DDQ we_PPIS2 do_VD0 ._. 
If_CS punishment_NN1 is_VBZ assimilated_VVN into_II the_AT probation_NN1 glossary_NN1 it_PPH1 will_VM inevitably_RR influence_VVI the_AT sort_NN1 of_IO practice_NN1 the_AT Service_NN1 undertakes_VVZ ._. 
In_II the_AT sections_NN2 to_TO follow_VVI the_AT stark_JJ question_NN1 is_VBZ therefore_RR put_NN1 '_GE Is_VBZ the_AT Probation_NN1 Service_NN1 in_II the_AT business_NN1 of_IO inflicting_VVG pain_NN1 ?_? '_GE and_CC the_AT answer_NN1 which_DDQ unfolds_VVZ may_VM be_VBI summarized_VVN '_" No_UH ,_, because_CS it_PPH1 neither_RR aspires_VVZ nor_CC wishes_VVZ to_TO !_! 
'_GE THE_AT PROJECT_NN1 :_: MORE_DAR DEMANDING_JJ THAN_CSN PUNISHMENT_NN1 Government_NN1 concern_NN1 about_II the_AT problem_NN1 of_IO drink-related_JJ offending_NN1 is_VBZ as_RG old_JJ as_CSA the_AT Probation_NN1 Service_NN1 ._. 
Indeed_RR ,_, as_CSA Bochel_NP1 (_( 1976_MC )_) has_VHZ shown_VVN ,_, the_AT establishment_NN1 of_IO a_AT1 Probation_NN1 Service_NN1 in_II England_NP1 and_CC Wales_NP1 was_VBDZ inextricably_RR linked_VVN with_IW work_NN1 undertaken_VVN with_IW offenders_NN2 in_II trouble_NN1 through_II drink_NN1 ._. 
Almost_RR a_AT1 century_NNT1 later_RRR the_AT new_JJ approach_NN1 to_II punishment_NN1 in_II the_AT community_NN1 outlined_VVN by_II the_AT White_JJ Paper_NN1 once_RR21 again_RR22 presents_VVZ alcohol_NN1 misuse_NN1 as_II a_AT1 key_JJ problem_NN1 requiring_VVG community-based_JJ intervention_NN1 ._. 
'_GE Alcohol_NN1 '_GE ,_, the_AT White_JJ Paper_NN1 states_NN2 ,_, '_GE is_VBZ implicated_VVN in_II a_AT1 wide_JJ variety_NN1 of_IO crimes_NN2 ,_, drunken_JJ driving_JJ ,_, offences_NN2 of_IO public_JJ disorder_NN1 and_CC domestic_JJ violence_NN1 '_GE (_( p._NNU 21_MC ,_, para_NN1 ._. 
4._MC 14_MC )_) ._. 
In_II describing_VVG its_APPGE vision_NN1 of_IO effective_JJ supervision_NN1 the_AT White_JJ Paper_NN1 goes_VVZ on_RP to_TO note_VVI :_: offenders_NN2 take_VV0 part_NN1 in_II alcohol_NN1 education_NN1 programmes_NN2 so_CS21 that_CS22 they_PPHS2 can_VM learn_VVI to_TO drink_VVI sensibly_RR ._. 
They_PPHS2 learn_VV0 about_II the_AT relative_JJ strength_NN1 of_IO different_JJ drinks_NN2 ,_, the_AT amount_NN1 which_DDQ is_VBZ safe_JJ to_TO consume_VVI ,_, and_CC the_AT pitfalls_NN2 to_TO avoid_VVI (_( e.g._REX competitive_JJ drinking_NN1 and_CC buying_NN1 '_GE rounds_NN2 '_GE )_) (_( p._NNU 37_MC ,_, para_NN1 ._. 
7.11_MC )_) ._. 
As_II a_AT1 summary_NN1 of_IO alcohol_NN1 education_NN1 programmes_NN2 ,_, this_DD1 is_VBZ something_PN1 of_IO a_AT1 simplification_NN1 ._. 
However_RRQV it_PPH1 does_VDZ provide_VVI a_AT1 useful_JJ introduction_NN1 to_II the_AT origins_NN2 of_IO the_AT Alcohol_NN1 Education_NN1 Course_NN1 reported_VVD here_RL ._. 
Furthermore_RR ,_, it_PPH1 highlights_VVZ the_AT suitability_NN1 of_IO referring_VVG to_II this_DD1 type_NN1 of_IO project_NN1 for_IF testing_VVG out_RP the_AT appropriateness_NN1 of_IO applying_VVG the_AT notion_NN1 of_IO punishment_NN1 to_II probation_NN1 practice_NN1 ._. 
In_II 1985_MC the_AT management_NN1 of_IO Somerset_NP1 Probation_NN1 Service_NN1 was_VBDZ faced_VVN with_IW the_AT fact_NN1 that_CST nearly_RR one_MC1 in_II three_MC of_IO the_AT offenders_NN2 supervised_VVN in_II their_APPGE area_NN1 were_VBDR either_RR known_VVN to_TO be_VBI or_CC suspected_JJ of_IO misusing_VVG alcohol_NN1 (_( Singer_NP1 ,_, 1985_MC )_) ._. 
Aware_JJ of_IO practitioners_NN2 '_GE frustration_NN1 in_II not_XX being_VBG able_JK to_TO work_VVI effectively_RR with_IW these_DD2 problematic_JJ clients_NN2 ,_, Probation_NN1 management_NN1 ,_, in_II partnership_NN1 with_IW the_AT voluntary_JJ sector_NN1 ,_, determined_VVN to_TO develop_VVI an_AT1 Alcohol_NN1 Education_NN1 Course_NN1 (_( AEC_NP1 )_) ._. 
By_II 1986_MC ,_, when_CS social_JJ inquiry_NN1 report_NN1 monitoring_NN1 information_NN1 covering_VVG 1,257_MC offenders_NN2 indicated_VVD that_CST the_AT problem_NN1 of_IO drink-related_JJ offending_NN1 was_VBDZ virtually_RR as_CSA great_JJ for_IF pre-_JJ as_II21 for_II22 post-sentence_JJ clients_NN2 ,_, that_REX21 is_REX22 ,_, alcohol_NN1 was_VBDZ cited_VVN as_II a_AT1 pre-offence_JJ problem_NN1 in_II twenty-nine_MC per_NNU21 cent_NNU22 of_IO cases_NN2 ,_, a_AT1 specialist_NN1 project_NN1 worker_NN1 had_VHD been_VBN appointed_VVN ._. 
Towards_II the_AT end_NN1 of_IO 1986_MC an_AT1 AEC_NN1 was_VBDZ launched_VVN and_CC has_VHZ been_VBN running_VVG ever_RR since_RR ._. 
The_AT aim_NN1 of_IO the_AT course_NN1 is_VBZ to_TO educate_VVI offenders_NN2 about_II alcohol_NN1 to_TO facilitate_VVI a_AT1 lasting_JJ change_NN1 in_II their_APPGE subsequent_JJ use_NN1 of_IO this_DD1 drug_NN1 ._. 
This_DD1 aim_NN1 is_VBZ underpinned_VVN by_II three_MC interrelated_JJ objectives_NN2 and_CC it_PPH1 is_VBZ not_XX without_IW significance_NN1 how_RRQ they_PPHS2 complement_VV0 and_CC serve_VV0 to_TO implement_VVI the_AT White_JJ Paper_NN1 's_GE own_DA trinity_NN1 of_IO '_GE aims_NN2 of_IO supervision_NN1 '_GE ,_, that_REX21 is_REX22 ,_, protection_NN1 of_IO the_AT public_NN1 ,_, prevention_NN1 of_IO reoffending_VVG and_CC successful_JJ reintegration_NN1 of_IO the_AT offender_NN1 in_II the_AT community_NN1 (_( p._NNU 35_MC ,_, para_NN1 ._. 
7.3_MC )_) ._. 
These_DD2 were_VBDR :_: 1_MC1 ._. 
To_TO increase_VVI knowledge_NN1 about_II alcohol_NN1 so_CS21 that_CS22 future_JJ alcohol_NN1 use_NN1 can_VM be_VBI more_RRR informed_VVN and_CC therefore_RR more_RGR prudent._NNU 2_MC ._. 
To_TO instil_VVI or_CC reinforce_VVI responsible_JJ drinking_NN1 attitudes_NN2 and_CC behaviour._NNU 3_MC ._. 
To_TO encourage_VVI the_AT maintenance_NN1 of_IO ,_, or_CC ,_, where_CS appropriate_JJ ,_, a_AT1 reduction_NN1 to_II a_AT1 personally_RR and_CC socially_RR safe_JJ level_NN1 of_IO alcohol_NN1 unit_NN1 intake_NN1 ._. 
To_TO meet_VVI these_DD2 objectives_NN2 the_AT AEC_NN1 has_VHZ a_AT1 structured_JJ programme_NN1 involving_VVG group_NN1 and_CC individual_JJ contact_NN1 ,_, that_REX21 is_REX22 ,_, six_MC group_NN1 sessions_NNT2 sandwiched_VVN between_II one-to-one_JJ interviews_NN2 held_VVD immediately_RR before_CS and_CC after_CS the_AT group_NN1 con_NN1 act_NN1 ._. 
The_AT initial_JJ one-to-one_JJ meeting_NN1 ,_, held_VVN with_IW one_MC1 of_IO the_AT two_MC group_NN1 leaders_NN2 ,_, serves_VVZ to_TO clarify_VVI what_DDQ participants_NN2 can_VM expect_VVI from_II the_AT course_NN1 and_CC what_DDQ is_VBZ expected_VVN of_IO them_PPHO2 ._. 
A_AT1 standard_JJ contract_NN1 which_DDQ covers_VVZ conditions_NN2 of_IO attendance_NN1 and_CC an_AT1 agreement_NN1 to_TO complete_VVI various_JJ assignments_NN2 between_II group_NN1 sessions_NNT2 is_VBZ signed_VVN by_II each_DD1 participant_NN1 ._. 
The_AT final_JJ interview_NN1 entails_VVZ a_AT1 personalized_JJ review_NN1 of_IO the_AT course_NN1 ,_, as_II31 well_II32 as_II33 the_AT formulation_NN1 of_IO a_AT1 follow-up_JJ plan_NN1 to_TO be_VBI undertaken_VVN with_IW the_AT offender_NN1 's_GE supervising_NN1 officer_NN1 ._. 
The_AT course_NN1 employs_VVZ a_AT1 variety_NN1 of_IO materials_NN2 and_CC techniques_NN2 including_II the_AT use_NN1 of_IO checklists_NN2 ,_, magazine_NN1 and_CC newspaper_NN1 clippings_NN2 ,_, quizzes_NN2 ,_, videos_NN2 ,_, brainstorm_VV0 exercises_NN2 ,_, discussions_NN2 ,_, drink_VV0 diaries_NN2 ,_, and_CC role_NN1 plays_NN2 (_( Menary_NP1 ,_, 1986_MC )_) ._. 
The_AT AEC_NN1 is_VBZ primarily_RR intended_VVN for_IF young_JJ adults_NN2 subject_II21 to_II22 a_AT1 probation_NN1 order_NN1 with_IW a_AT1 special_JJ condition_NN1 of_IO attendance_NN1 (_( Schedule_NN1 11_MC 4A(II)_FO Criminal_JJ Justice_NN1 Act_NN1 1982_MC )_) and_CC reflects_VVZ the_AT fact_NN1 that_CST most_DAT Somerset_NP1 offenders_NN2 in_II trouble_NN1 through_II drink_NN1 commit_VV0 serious_JJ offences_NN2 and/or_CC possess_VV0 a_AT1 substantial_JJ number_NN1 of_IO previous_JJ convictions_NN2 ._. 
In_RR21 short_RR22 ,_, they_PPHS2 are_VBR seriously_RR at_II risk_NN1 of_IO committing_VVG further_JJR offences_NN2 and_CC becoming_VVG trapped_VVN in_II the_AT revolving_JJ door_NN1 of_IO custody_NN1 ._. 
The_AT development_NN1 of_IO the_AT Somerset_NP1 AEC_NP1 both_DB2 accords_NN2 with_IW and_CC constitutes_VVZ a_AT1 practical_JJ example_NN1 of_IO the_AT Home_NN1 Office_NN1 's_GE recent_JJ guidance_NN1 to_II sentencers_NN2 :_: In_II recent_JJ years_NNT2 the_AT probation_NN1 service_NN1 has_VHZ devoted_VVN increasing_JJ resources_NN2 to_II supervising_VVG the_AT more_RGR serious_JJ and_CC persistent_JJ offenders_NN2 ._. 
Probation_NN1 orders_NN2 which_DDQ are_VBR combined_VVN with_IW constructive_JJ ,_, disciplined_JJ and_CC effective_JJ programmes_NN2 of_IO supervision_NN1 are_VBR increasingly_RR being_VBG used_VVN for_IF offenders_NN2 who_PNQS stand_VV0 to_TO receive_VVI custodial_JJ sentences_NN2 (_( 1990b_FO ,_, p._NN1 35_MC )_) ._. 
From_II the_AT description_NN1 of_IO the_AT AEC_NN1 already_RR given_VVN the_AT demanding_JJ and_CC disciplined_JJ nature_NN1 of_IO the_AT course_NN1 can_VM be_VBI appreciated_VVN ._. 
However_RR ,_, the_AT course_NN1 is_VBZ not_XX punitive_JJ ;_; it_PPH1 is_VBZ not_XX concerned_JJ with_IW the_AT infliction_NN1 of_IO pain_NN1 ._. 
Instead_RR ,_, it_PPH1 is_VBZ concerned_JJ with_IW the_AT establishment_NN1 of_IO rules_NN2 ._. 
This_DD1 is_VBZ plainly_RR evident_JJ from_II the_AT section_NN1 of_IO the_AT contract_NN1 signed_VVN by_II each_DD1 participant_NN1 where_RRQ what_DDQ is_VBZ expected_VVN of_IO them_PPHO2 is_VBZ spelt_VVN out_RP :_: You_PPY will_VM be_VBI expected_VVN to_TO keep_VVI a_AT1 drink_NN1 diary_NN1 throughout_II the_AT course_NN1 ,_, and_CC make_VV0 attempts_NN2 at_II reducing_VVG the_AT amount_NN1 you_PPY drink_VV0 if_CSW it_PPH1 is_VBZ greater_JJR than_CSN accepted_JJ healthy_JJ drinking_NN1 levels_NN2 ._. 
You_PPY must_VM be_VBI willing_JJ to_TO be_VBI helped_VVN and_CC help_VV0 others_NN2 your_APPGE experiences_NN2 will_VM be_VBI useful_JJ to_II other_JJ group_NN1 members_NN2 ._. 
You_PPY must_VM attend_VVI 8_MC sessions_NNT2 (_( these_DD2 will_VM consist_VVI of_IO :_: an_AT1 introductory_JJ session_NNT1 ,_, six_MC group_NN1 sessions_NNT2 and_CC a_AT1 final_JJ assessment_NN1 interview_NN1 )_) ._. 
You_PPY must_VM not_XX drink_VVI before_II the_AT session_NNT1 ._. 
You_PPY must_VM be_VBI on_II time_NNT1 lateness_NN1 will_VM count_VVI as_II an_AT1 absence_NN1 ._. 
Unlike_II the_AT prison_NN1 inmate_NN1 ,_, AEC_NP1 participants_NN2 can_VM not_XX sit_VVI back_RP and_CC passively_RR do_VDI their_APPGE time_NNT1 ._. 
Probation_NN1 practice_NN1 is_VBZ not_XX ,_, however_RR ,_, solely_RR concerned_JJ with_IW the_AT establishment_NN1 of_IO rules_NN2 ._. 
As_CSA has_VHZ been_VBN demonstrated_VVN elsewhere_RL with_II31 regard_II32 to_II33 the_AT generic_JJ probation_NN1 setting_NN1 (_( Singer_NP1 ,_, 1989_MC )_) ,_, the_AT supervision_NN1 of_IO offenders_NN2 involves_VVZ two_MC overarching_JJ aims_NN2 :_: namely_REX support_NN1 and_CC surveillance_NN1 ._. 
Support_NN1 refers_VVZ to_II anything_PN1 which_DDQ is_VBZ said_VVN or_CC done_VDN to_TO help_VVI the_AT offender_NN1 solve_VV0 or_CC mitigate_VV0 their_APPGE personal_JJ or_CC social_JJ problems_NN2 :_: surveillance_NN1 to_II anything_PN1 which_DDQ is_VBZ said_VVN or_CC done_VDN to_TO induce_VVI the_AT offender_NN1 to_TO conform_VVI to_II socially_RR acceptable_JJ standards_NN2 of_IO behaviour_NN1 ._. 
These_DD2 aims_NN2 are_VBR implemented_VVN through_II the_AT practice_NN1 of_IO four_MC distinguishable_JJ but_CCB related_JJ methods_NN2 ._. 
In_II31 terms_II32 of_II33 support_NN1 ,_, there_EX is_VBZ counselling_NN1 and_CC assisting_VVG :_: in_II31 terms_II32 of_II33 surveillance_NN1 ,_, there_EX is_VBZ directing_VVG and_CC monitoring_NN1 ._. 
Each_DD1 of_IO these_DD2 four_MC methods_NN2 are_VBR employed_VVN during_II the_AT eight_MC sessions_NNT2 ._. 
Although_CS summarized_VVN as_II an_AT1 alcohol_NN1 education_NN1 course_NN1 ,_, the_AT sessions_NNT2 are_VBR not_XX just_RR concerned_JJ with_IW giving_VVG information_NN1 but_CCB also_RR with_IW enabling_VVG participants_NN2 to_TO make_VVI practical_JJ use_NN1 of_IO it_PPH1 ._. 
In_II the_AT first_MD group_NN1 session_NNT1 the_AT counselling_NN1 method_NN1 is_VBZ registered_VVN in_II the_AT course_NN1 tutor_NN1 's_GE notes_NN2 (_( Menary_NP1 ,_, 1986_MC )_) by_II the_AT explanation_NN1 :_: '_" This_DD1 session_NNT1 aims_VVZ to_TO get_VVI participants_NN2 to_TO consider_VVI the_AT subject_NN1 of_IO alcohol_NN1 in_II ways_NN2 they_PPHS2 had_VHD not_XX thought_VVN of_IO in_II the_AT past_NN1 '_GE (_( p._NNU 3_MC )_) ._. 
During_II this_DD1 session_NNT1 the_AT importance_NN1 of_IO monitoring_NN1 is_VBZ also_RR emphasized_VVN :_: Drinks_NN2 exercises_NN2 introduce_VV0 the_AT notion_NN1 of_IO measurement_NN1 ,_, concentration_NN1 of_IO alcohol_NN1 content_NN1 ;_; information_NN1 which_DDQ will_VM be_VBI necessary_JJ to_TO carry_VVI out_RP the_AT recording_NN1 of_IO alcohol_NN1 consumption_NN1 throughout_II the_AT duration_NN1 of_IO the_AT course_NN1 (_( p._NNU 3_MC )_) ._. 
In_II the_AT fifth_MD group_NN1 session_NNT1 entitled_VVN '_GE Focus_NN1 on_II the_AT Individual_NN1 '_GE ,_, the_AT counselling_NN1 and_CC the_AT monitoring_NN1 combine_VV0 with_IW the_AT directing_NN1 and_CC assisting_VVG methods_NN2 ._. 
At_II the_AT start_NN1 of_IO the_AT session_NNT1 the_AT tutor_NN1 's_GE notes_NN2 make_VV0 clear_JJ that_CST directing_VVG extends_VVZ beyond_II enforcing_VVG the_AT conditions_NN2 of_IO attendance_NN1 :_: This_DD1 session_NNT1 allows_VVZ for_IF an_AT1 in_II depth_NN1 examination_NN1 of_IO the_AT drinking_NN1 diaries_NN2 over_II the_AT last_MD five_MC weeks_NNT2 identifying_VVG the_AT risky_JJ circumstances_NN2 or_CC situations_NN2 ...._... 
The_AT aim_NN1 at_II the_AT end_NN1 of_IO the_AT session_NNT1 is_VBZ to_TO encourage_VVI participants_NN2 to_TO make_VVI rules_NN2 for_IF their_APPGE future_JJ drinking_NN1 which_DDQ will_VM lead_VVI to_II a_AT1 lessening_NN1 of_IO identified_JJ problems_NN2 (_( p._NNU 4_MC )_) ._. 
Similarly_RR ,_, the_AT assisting_NN1 extends_VVZ beyond_II simply_RR providing_VVG handouts_NN2 of_IO useful_JJ information_NN1 :_: It_PPH1 is_VBZ important_JJ that_CST participants_NN2 are_VBR provided_VVN with_IW the_AT skills_NN2 to_TO reduce_VVI their_APPGE drinking_NN1 levels_NN2 or_CC handle_VV0 more_RGR effectively_RR '_GE pub_NN1 centred_VVD '_GE problems_NN2 ._. 
The_AT use_NN1 of_IO role_NN1 play_NN1 ,_, incorporating_VVG previously_RR discussed_VVN difficulties_NN2 (_( i.e._REX homework_NN1 assignment_NN1 session_NNT1 4_MC )_) in_II '_GE real_JJ '_GE or_CC set_VVD up_RP situations_NN2 provides_VVZ an_AT1 opportunity_NN1 for_IF testing_VVG these_DD2 skills_NN2 ._. 
Probably_RR the_AT best_JJT illustration_NN1 of_IO the_AT assisting_JJ method_NN1 in_II action_NN1 during_II the_AT course_NN1 comes_VVZ in_II the_AT fifth_MD session_NNT1 when_RRQ Somerset_NP1 practitioners_NN2 take_VV0 the_AT logic_NN1 of_IO working_VVG with_IW the_AT problem_NN1 in_II the_AT community_NN1 to_II its_APPGE ultimate_JJ conclusion_NN1 ._. 
In_II the_AT second_MD half_NN1 of_IO the_AT session_NNT1 ,_, course_NN1 leaders_NN2 sponsor_VV0 participants_NN2 to_II an_AT1 evening_NNT1 at_II the_AT pub_NN1 for_IF the_AT purpose_NN1 of_IO practising_JJ drinking_NN1 skills_NN2 and_CC purchasing_VVG non-alcoholic_JJ drinks_NN2 ._. 
The_AT counselling_NN1 ,_, assisting_VVG ,_, directing_VVG ,_, and_CC monitoring_VVG on_II the_AT AEC_NN1 give_VV0 substance_NN1 to_II the_AT aims_NN2 of_IO support_NN1 and_CC surveillance_NN1 and_CC provide_VV0 the_AT basis_NN1 for_IF establishing_VVG a_AT1 model_NN1 of_IO probation_NN1 practice_NN1 ._. 
Punishment_NN1 has_VHZ no_AT place_NN1 in_II this_DD1 model_NN1 ._. 
Instead_RR the_AT AEC_NN1 can_VM best_RRT be_VBI understood_VVN as_II an_AT1 example_NN1 of_IO a_AT1 non-punitive_JJ paradigm_NN1 of_IO probation_NN1 practice_NN1 ._. 
Twenty_MC years_NNT2 ago_RA the_AT Advisory_JJ Council_NN1 on_II the_AT Penal_JJ System_NN1 observed_VVD that_CST notions_NN2 of_IO punitiveness_NN1 do_VD0 not_XX accord_VVI with_IW '_GE the_AT British_JJ concept_NN1 of_IO probation_NN1 as_II an_AT1 alternative_NN1 to_II ,_, rather_II21 than_II22 a_AT1 suspension_NN1 of_IO ,_, punishment_NN1 '_GE (_( quoted_VVN in_II Bochel_NP1 ,_, 1976_MC ,_, p._NN1 238_MC )_) ._. 
Twenty_MC years_NNT2 later_RRR the_AT AEC_NN1 demonstrates_VVZ that_CST this_DD1 remains_VVZ no_AT less_RGR true_JJ now_RT than_CSN it_PPH1 was_VBDZ then_RT ._. 
But_CCB does_VDZ the_AT AEC_NN1 work_VVI ?_? 
THE_AT EVALUATION_NN1 :_: MORE_DAR EFFECTIVE_JJ THAN_CSN PUNISHMENT_NN1 According_II21 to_II22 Home_NN1 Office_NN1 statistics_NN ,_, probation_NN1 practice_NN1 is_VBZ more_RGR efficient_JJ and_CC no_AT less_RGR effective_JJ than_CSN imprisonment_NN1 ._. 
At_II 1988/89_MC rates_NN2 (_( Home_NN1 Office_NN1 ,_, 1990b_FO ,_, p._NN1 110_MC )_) ,_, it_PPH1 cost_VVD on_II average_NN1 288_MC per_II week_NNT1 to_TO keep_VVI an_AT1 offender_NN1 in_II custody_NN1 ,_, compared_VVN with_IW 19_MC per_II week_NNT1 to_TO supervise_VVI an_AT1 offender_NN1 on_II probation_NN1 ;_; yet_RR the_AT Home_NN1 Office_NN1 acknowledge_VV0 :_: '_" It_PPH1 is_VBZ hard_JJ to_TO show_VVI any_DD effect_NN1 that_CST one_MC1 type_NN1 of_IO sentence_NN1 is_VBZ more_RGR likely_JJ than_CSN any_DD other_JJ to_TO reduce_VVI the_AT likelihood_NN1 of_IO reoffending_VVG ,_, which_DDQ is_VBZ high_JJ for_IF all_RR '_GE (_( p._NNU 7_MC )_) ._. 
If_CS anything_PN1 can_VM be_VBI shown_VVN ,_, it_PPH1 would_VM appear_VVI that_DD1 probation_NN1 is_VBZ more_RGR effective_JJ than_CSN prison_NN1 in_II reducing_VVG the_AT risk_NN1 of_IO further_JJR offending_NN1 ._. 
In_II a_AT1 review_NN1 of_IO reconviction_NN1 rates_NN2 ,_, for_REX21 example_REX22 ,_, a_AT1 Home_NN1 Office_NN1 report_NN1 concluded_VVD :_: '_" Those_DD2 given_JJ probation_NN1 orders_NN2 were_VBDR therefore_RR less_RGR likely_JJ to_TO be_VBI reconvicted_VVN within_II two_MC years_NNT2 of_IO being_VBG given_VVN probation_NN1 than_CSN those_DD2 released_VVN from_II custody_NN1 '_GE (_( Home_NN1 Office_NN1 ,_, 1986_MC ,_, p._NN1 5_MC )_) ._. 
Methodological_JJ objections_NN2 could_VM be_VBI made_VVN to_II comparing_VVG the_AT two_MC groups_NN2 because_II21 of_II22 the_AT different_JJ periods_NN2 of_IO time_NNT1 monitored_VVD ,_, that_REX21 is_REX22 ,_, for_IF prisoners_NN2 the_AT period_NN1 of_IO time_NNT1 refers_VVZ to_II after_II the_AT sentence_NN1 has_VHZ been_VBN served_VVN whereas_CS for_IF probationers_NN2 it_PPH1 is_VBZ after_II the_AT sentence_NN1 has_VHZ been_VBN imposed_VVN ._. 
Moreover_RR ,_, it_PPH1 could_VM be_VBI argued_VVN that_CST prisoners_NN2 are_VBR more_RRR at_II risk_NN1 of_IO further_JJR offences_NN2 than_CSN probationers_NN2 because_II21 of_II22 ,_, first_MD ,_, their_APPGE commission_NN1 of_IO relatively_RR more_RGR serious_JJ offences_NN2 ,_, and_CC second_NNT1 ,_, their_APPGE more_RGR extensive_JJ and_CC therefore_RR more_RGR entrenched_JJ criminal_JJ careers_NN2 ._. 
This_DD1 may_VM be_VBI so_RR for_IF the_AT population_NN1 of_IO probationers_NN2 generally_RR but_CCB does_VDZ not_XX apply_VVI to_II the_AT AEC_NN1 sample_NN1 ._. 
As_CSA noted_VVN earlier_RRR ,_, the_AT AEC_NN1 was_VBDZ designed_VVN for_IF offenders_NN2 at_II risk_NN1 of_IO further_JJR offending_NN1 and/or_CC custody_NN1 ._. 
Between_II 1986_MC and_CC 1988_MC 152_MC offenders_NN2 undertook_VVD the_AT AEC_NN1 while_CS simultaneously_RR being_VBG monitored_VVN to_TO assess_VVI the_AT impact_NN1 of_IO the_AT course_NN1 upon_II them_PPHO2 ._. 
As_II a_AT1 sample_NN1 of_IO offenders_NN2 ,_, the_AT course_NN1 participants_NN2 have_VH0 more_DAR in_II31 common_II32 with_II33 prisoners_NN2 than_CSN probationers_NN2 ._. 
In_II Table_NN1 1_MC1 below_II a_AT1 comparison_NN1 of_IO the_AT offences_NN2 committed_VVN by_II the_AT sample_NN1 and_CC those_DD2 committed_VVN by_II persons_NN2 commencing_VVG probation_NN1 or_CC entering_VVG custody_NN1 nationally_RR is_VBZ given_VVN ._. 
Whereas_CS for_IF theft_NN1 and_CC fraud_NN1 type_NN1 offences_NN2 there_EX were_VBDR almost_RR twice_RR as_RG many_DA2 commencing_VVG probation_NN1 nationally_RR as_CSA amongst_II the_AT AEC_NN1 participants_NN2 ,_, the_AT reverse_NN1 was_VBDZ true_JJ for_IF violence_NN1 ,_, burglary_NN1 and_CC criminal_JJ damage_NN1 type_NN1 offences_NN2 ._. 
The_AT similarity_NN1 between_II the_AT AEC_NN1 participants_NN2 and_CC offenders_NN2 entering_VVG custody_NN1 rather_II21 than_II22 persons_NN2 commencing_VVG probation_NN1 nationally_RR is_VBZ clearly_RR shown_VVN by_II the_AT identical_JJ proportions_NN2 each_DD1 group_NN1 recorded_VVN for_IF violent_JJ offences_NN2 ._. 
Furthermore_RR ,_, the_AT greater_JJR proportion_NN1 of_IO other_JJ indictable_JJ offences_NN2 for_IF the_AT AEC_NN1 sample_NN1 ,_, compared_VVN with_IW probationers_NN2 nationally_RR ,_, reflected_VVD the_AT large_JJ number_NN1 of_IO drink-driving_JJ offenders_NN2 ,_, that_REX21 is_REX22 ,_, 25_MC ._. 
Given_VVN this_DD1 array_NN1 of_IO serious_JJ offences_NN2 committed_VVN by_II the_AT AEC_NN1 sample_NN1 it_PPH1 is_VBZ not_XX surprising_JJ that_CST the_AT average_JJ number_NN1 of_IO previous_JJ convictions_NN2 was_VBDZ seven_MC ,_, with_IW only_RR 10_MC per_NNU21 cent_NNU22 having_VHG no_AT previous_JJ convictions_NN2 compared_VVN with_IW 28_MC per_NNU21 cent_NNU22 who_PNQS had_VHD ten_MC or_CC more_RRR ._. 
In_II this_DD1 connection_NN1 it_PPH1 is_VBZ relevant_JJ to_TO note_VVI that_CST 84_MC per_NNU21 cent_NNU22 of_IO the_AT sample_NN1 had_VHD consumed_VVN alcohol_NN1 prior_II21 to_II22 the_AT commission_NN1 of_IO their_APPGE current_JJ offences_NN2 and_CC three_MC out_II21 of_II22 four_MC of_IO the_AT convictions_NN2 for_IF previous_JJ offences_NN2 had_VHD been_VBN drink-related_JJ ._. 
The_AT possibility_NN1 that_CST the_AT sample_NN1 's_GE previous_JJ convictions_NN2 simply_RR reflected_VVN persistent_JJ petty_JJ offending_NN1 can_VM be_VBI discounted_VVN because_CS over_RG a_AT1 third_MD had_VHD already_RR received_VVN a_AT1 custodial_JJ sentence_NN1 (_( 37_MC per_NNU21 cent_NNU22 )_) ;_; a_AT1 further_JJR fifth_MD community_NN1 service_NN1 (_( 20_MC per_NNU21 cent_NNU22 )_) ;_; and_CC nearly_RR another_DD1 fifth_MD a_AT1 probation_NN1 or_CC supervision_NN1 order_NN1 (_( 17_MC per_NNU21 cent_NNU22 )_) ._. 
Most_DAT of_IO the_AT sample_NN1 were_VBDR male_JJ (_( 94_MC per_NNU21 cent_NNU22 )_) ,_, aged_VVN between_II seventeen_MC and_CC twenty-four_MC (_( 61_MC per_NNU21 cent_NNU22 )_) and_CC the_AT risk_NN1 of_IO further_JJR offending_NN1 and_CC custody_NN1 is_VBZ highlighted_VVN by_II the_AT fact_NN1 that_CST over_RG half_DB of_IO the_AT sample_NN1 had_VHD committed_VVN an_AT1 offence_NN1 within_II a_AT1 year_NNT1 of_IO the_AT current_JJ offence_NN1 ._. 
In_II Somerset_NP1 the_AT management_NN1 of_IO the_AT Probation_NN1 Service_NN1 has_VHZ reached_VVN an_AT1 agreement_NN1 with_IW the_AT local_JJ and_CC neighbouring_JJ courts_NN2 that_CST Schedule_NN1 11_MC probation_NN1 orders_NN2 ,_, that_REX21 is_REX22 ,_, orders_NN2 containing_VVG day_NNT1 centre_NN1 or_CC specified_JJ activity_NN1 requirements_NN2 ,_, are_VBR operated_VVN as_II a_AT1 direct_JJ alternative_NN1 to_II custody_NN1 ._. 
In_II this_DD1 light_NN1 the_AT at-risk_JJ status_NN1 of_IO the_AT sample_NN1 is_VBZ further_RRR indicated_VVN by_II the_AT fact_NN1 that_CST 91_MC per_NNU21 cent_NNU22 of_IO the_AT sample_NN1 were_VBDR subject_II21 to_II22 Schedule_NN1 11_MC ,_, with_IW only_RR six_MC per_NNU21 cent_NNU22 being_NN1 on_II ordinary_JJ probation_NN1 and_CC three_MC per_NNU21 cent_NNU22 on_II statutory_JJ licence_NN1 following_VVG release_NN1 from_II custody_NN1 ,_, that_REX21 is_REX22 ,_, parole_NN1 and_CC youth_NN1 custody_NN1 licence_NN1 ._. 
The_AT large_JJ proportion_NN1 of_IO schedule_NN1 11_MC cases_NN2 in_II the_AT AEC_NN1 sample_NN1 contrasts_VVZ dramatically_RR with_IW the_AT proportion_NN1 commencing_VVG probation_NN1 nationally_RR in_II 1988_MC ,_, that_REX21 is_REX22 ,_, 63_MC per_NNU21 cent_NNU22 of_IO the_AT AEC_NP1 's_GE probationers_NN2 were_VBDR subject_II21 to_II22 a_AT1 day_NNT1 centre_NN1 requirement_NN1 compared_VVN with_IW only_RR six_MC per_NNU21 cent_NNU22 nationally_RR ;_; similarly_RR ,_, 31_MC per_NNU21 cent_NNU22 of_IO the_AT AEC_NN1 probationers_NN2 were_VBDR subject_II21 to_II22 a_AT1 specified_JJ activity_NN1 requirement_NN1 compared_VVN with_IW only_RR six_MC per_NNU21 cent_NNU22 nationally_RR (_( Home_NN1 Office_NN1 ,_, 1990c_FO ,_, p._NN1 46_MC )_) ._. 
The_AT more_RGR highly_RR convicted_VVN and_CC at-risk_JJ profile_NN1 of_IO the_AT AEC_NN1 sample_NN1 was_VBDZ also_RR reflected_VVN by_II the_AT fact_NN1 that_CST whereas_CS nationally_RR as_RG many_DA2 as_CSA 80_MC per_NNU21 cent_NNU22 of_IO the_AT persons_NN2 commencing_VVG probation_NN1 in_II 1988_MC had_VHD no_AT additional_JJ requirements_NN2 made_VVN to_II their_APPGE probation_NN1 orders_NN2 ,_, only_RR six_MC per_NNU21 cent_NNU22 of_IO the_AT probationers_NN2 undertaking_VVG the_AT AEC_NP1 received_VVD this_DD1 traditional_JJ type_NN1 of_IO probation_NN1 order_NN1 from_II the_AT courts_NN2 ._. 
The_AT evaluation_NN1 of_IO the_AT AEC_NN1 was_VBDZ based_VVN upon_II a_AT1 comprehensive_JJ assessment_NN1 of_IO the_AT extent_NN1 to_II which_DDQ the_AT course_NN1 was_VBDZ able_JK to_TO achieve_VVI its_APPGE stated_JJ objectives_NN2 ._. 
This_DD1 involved_VVD the_AT collection_NN1 and_CC analysis_NN1 of_IO five_MC different_JJ types_NN2 of_IO information_NN1 :_: an_AT1 alcohol_NN1 knowledge_NN1 test_NN1 ,_, a_AT1 drink_NN1 profile_NN1 questionnaire_NN1 ,_, a_AT1 drink_NN1 diary_NN1 ,_, a_AT1 consumer_NN1 questionnaire_NN1 and_CC reconviction_NN1 rate_NN1 statistics_NN ._. 
The_AT nature_NN1 of_IO the_AT method_NN1 ,_, its_APPGE relation_NN1 to_II course_NN1 objectives_NN2 and_CC the_AT results_NN2 obtained_VVN are_VBR described_VVN below_RL ._. 
As_II will_NN1 gradually_RR become_VVI evident_JJ ,_, the_AT AEC_NN1 has_VHZ proven_VVN itself_PPX1 to_TO be_VBI an_AT1 unambiguous_JJ success_NN1 ._. 
ALCOHOL_NN1 KNOWLEDGE_NN1 TEST_VV0 The_AT alcohol_NN1 knowledge_NN1 test_NN1 (_( AKT_NP1 )_) is_VBZ a_AT1 twenty_MC item_NN1 multiple_NN1 choice_NN1 test_NN1 of_IO alcohol_NN1 knowledge_NN1 ._. 
Each_DD1 question_NN1 ,_, like_II the_AT course_NN1 overall_NN1 ,_, is_VBZ practical_JJ in_II focus_NN1 and_CC concerned_JJ with_IW information_NN1 about_II the_AT relative_JJ strength_NN1 of_IO different_JJ alcoholic_JJ drinks_NN2 ,_, detoxification_NN1 times_NNT2 ,_, legal_JJ limits_NN2 and_CC medical_JJ effects_NN2 ._. 
The_AT purpose_NN1 of_IO the_AT test_NN1 is_VBZ to_TO provide_VVI an_AT1 objective_JJ basis_NN1 for_IF assessing_VVG the_AT nature_NN1 and_CC extent_NN1 of_IO participants_NN2 '_GE alcohol_NN1 knowledge_NN1 before_II and_CC after_II doing_VDG the_AT course_NN1 ._. 
Accordingly_RR ,_, the_AT AKT_NN1 was_VBDZ administered_VVN during_II the_AT first_MD and_CC last_MD of_IO the_AT group_NN1 sessions_NNT2 and_CC constituted_VVD a_AT1 straightforward_JJ method_NN1 for_IF evaluating_VVG the_AT success_NN1 of_IO the_AT first_MD course_NN1 objective_NN1 :_: specifically_RR ,_, to_TO increase_VVI participants_NN2 '_GE alcohol_NN1 knowledge_NN1 so_CS21 that_CS22 future_JJ alcohol_NN1 use_NN1 can_VM be_VBI more_RRR informed_VVN and_CC therefore_RR more_RGR prudent_JJ ._. 
It_PPH1 will_VM probably_RR not_XX surprise_VVI the_AT reader_NN1 to_TO learn_VVI that_CST at_II the_AT outset_NN1 of_IO the_AT course_NN1 serious_JJ gaps_NN2 in_II participants_NN2 '_GE knowledge_NN1 were_VBDR identified_VVN ._. 
For_REX21 example_REX22 ,_, over_RG half_DB of_IO the_AT participants_NN2 (_( 56_MC per_NNU21 cent_NNU22 )_) did_VDD not_XX know_VVI how_RGQ many_DA2 beers_NN2 they_PPHS2 could_VM drink_VVI before_II reaching_VVG the_AT legal_JJ limit_NN1 for_IF driving_VVG and_CC well_RR over_II two-thirds_MF of_IO them_PPHO2 knew_VVD neither_RR how_RGQ long_RR it_PPH1 took_VVD for_IF alcohol_NN1 to_TO be_VBI burned_VVN up_RP by_II the_AT body_NN1 (_( 71_MC per_NNU21 cent_NNU22 )_) nor_CC what_DDQ ,_, if_CS anything_PN1 ,_, was_VBDZ an_AT1 effective_JJ way_NN1 of_IO sobering_VVG up_RP (_( 71_MC per_NNU21 cent_NNU22 )_) ._. 
However_RR ,_, by_II the_AT conclusion_NN1 of_IO the_AT course_NN1 over_II three-quarters_MF of_IO the_AT sample_NN1 knew_VVD the_AT beer_NN1 equivalent_NN1 to_II the_AT legal_JJ limit_NN1 (_( 77_MC per_NNU21 cent_NNU22 )_) ;_; the_AT correct_JJ detoxification_NN1 time_NNT1 (_( 78_MC per_NNU21 cent_NNU22 )_) ;_; and_CC the_AT fact_NN1 that_CST there_EX is_VBZ no_AT effective_JJ way_NN1 to_TO accelerate_VVI the_AT detoxification_NN1 process_NN1 (_( 79_MC per_NNU21 cent_NNU22 )_) including_II a_AT1 cold_JJ shower_NN1 or_CC a_AT1 cup_NN1 of_IO strong_JJ coffee_NN1 !_! 
When_CS the_AT sample_NN1 's_GE average_JJ score_NN1 out_II21 of_II22 twenty_MC was_VBDZ calculated_VVN ,_, it_PPH1 revealed_VVD an_AT1 increase_NN1 from_II 9.5_MC to_II 14.3_MC out_II21 of_II22 twenty_MC ._. 
This_DD1 means_VVZ that_CST there_EX was_VBDZ an_AT1 overall_JJ increase_NN1 in_II the_AT participants_NN2 '_GE alcohol_NN1 knowledge_NN1 between_II the_AT start_NN1 and_CC the_AT finish_NN1 of_IO the_AT course_NN1 of_IO 50.5_MC per_NNU21 cent_NNU22 :_: not_XX abstract_JJ knowledge_NN1 ,_, but_CCB knowledge_NN1 that_CST is_VBZ relevant_JJ to_II drinking_VVG with_IW associates_NN2 in_II the_AT pub_NN1 or_CC elsewhere_RL ._. 
To_TO test_VVI whether_CSW each_DD1 of_IO the_AT participants_NN2 '_GE before_CS and_CC after_CS scores_NN2 were_VBDR simply_RR a_AT1 fluke_NN occurrence_NN1 ,_, as_CSA distinct_JJ from_II a_AT1 genuine_JJ increase_NN1 in_II alcohol_NN1 knowledge_NN1 ,_, a_AT1 Wilcoxon_NP1 Matched_VVD Pairs_NN2 Test_NN1 was_VBDZ undertaken_VVN using_VVG SPSS_NP1 and_CC the_AT result_NN1 proved_VVD statistically_RR significant_JJ ,_, that_REX21 is_REX22 ,_, Z=_FO -_- 10._MC 1839_MC ,_, 2-tailed_JJ ,_, P=0.0000_FO ._. 
DRINK_VV0 PROFILE_NN1 QUESTIONNAIRE_NN1 It_PPH1 does_VDZ not_XX necessarily_RR follow_VVI that_CST knowing_VVG more_RRR about_II alcohol_NN1 will_VM automatically_RR result_VVI in_II more_RGR responsible_JJ drinking_NN1 attitudes_NN2 and_CC behaviour_NN1 ,_, that_REX21 is_REX22 ,_, the_AT second_MD course_NN1 objective_NN1 ._. 
Participants_NN2 could_VM ,_, for_REX21 example_REX22 ,_, attempt_VV0 to_TO make_VVI their_APPGE attitudes_NN2 consonant_NN1 with_IW their_APPGE recently_RR acquired_VVN knowledge_NN1 only_RR to_TO find_VVI themselves_PPX2 unable_JK to_TO break_VVI from_II their_APPGE established_JJ pattern_NN1 of_IO behaviour_NN1 (_( Festinger_NP1 ,_, 1957_MC )_) ._. 
To_TO measure_VVI the_AT extent_NN1 to_II which_DDQ the_AT AEC_NN1 was_VBDZ able_JK to_TO successfully_RR anticipate_VVI and_CC overcome_VVI this_DD1 potential_JJ problem_NN1 a_AT1 drink_NN1 profile_NN1 questionnaire_NN1 (_( DPQ_NP1 )_) was_VBDZ devised_VVN and_CC administered_VVN before_II and_CC after_CS the_AT course_NN1 ._. 
The_AT DPQ_NP1 is_VBZ a_AT1 Likert-style_JJ schedule_NN1 comprising_VVG five_MC possible_JJ answers_NN2 attracting_VVG a_AT1 score_NN1 of_IO between_II one_MC1 and_CC five_MC points_NN2 for_IF twenty-five_MC different_JJ questions_NN2 concerned_JJ with_IW key_JJ aspects_NN2 of_IO drinking_VVG attitudes_NN2 and_CC behaviour_NN1 ._. 
When_CS completing_VVG the_AT DPQ_NP1 participants_NN2 were_VBDR told_VVN that_CST ,_, unlike_II the_AT AKT_NN1 ,_, there_EX were_VBDR no_AT right_JJ answers_NN2 ._. 
Regarding_II attitudes_NN2 ,_, participants_NN2 were_VBDR invited_VVN to_TO rank_VVI from_II strongly_RR agree_VV0 (_( five_MC points_NN2 )_) to_TO strongly_RR disagree_VVI (_( one_MC1 point_NN1 )_) their_APPGE level_NN1 of_IO agreement_NN1 with_IW statements_NN2 such_II21 as_II22 '_GE To_TO enjoy_VVI yourself_PPX1 ,_, it_PPH1 is_VBZ necessary_JJ to_TO have_VHI something_PN1 to_TO drink_VVI '_GE and_CC '_" If_CSW you_PPY limit_VV0 the_AT amount_NN1 you_PPY drink_VV0 ,_, it_PPH1 spoils_VVZ your_APPGE enjoyment_NN1 '_GE ._. 
Regarding_II behaviour_NN1 ,_, participants_NN2 were_VBDR asked_VVN to_TO indicate_VVI from_II always_RR (_( five_MC points_NN2 )_) to_II never_RR (_( one_MC1 point_NN1 )_) the_AT frequency_NN1 of_IO instances_NN2 occurring_VVG where_RRQ ,_, for_REX21 example_REX22 ,_, they_PPHS2 got_VVD drunk_JJ even_CS21 when_CS22 they_PPHS2 did_VDD not_XX intend_VVI to_TO ;_; their_APPGE drinking_NN1 left_VVD them_PPHO2 short_JJ of_IO cash_NN1 ;_; they_PPHS2 drank_VVD to_TO help_VVI themselves_PPX2 deal_VV0 with_IW a_AT1 crisis_NN1 ;_; and_CC they_PPHS2 missed_VVD meals_NN2 because_CS they_PPHS2 wanted_VVD to_TO drink_VVI instead_RR ._. 
The_AT participants_NN2 '_GE answers_NN2 were_VBDR scored_VVN and_CC their_APPGE grand_JJ totals_NN2 then_RT checked_VVN against_II where_RRQ they_PPHS2 fell_VVD on_II a_AT1 continuum_NN1 of_IO five_MC risk_NN1 levels_NN2 ranging_VVG from_II very_RG low_JJ to_II very_RG high_JJ ._. 
Whereas_CS in_II the_AT AKT_NN1 an_AT1 upward_JJ trend_NN1 is_VBZ indicative_JJ of_IO success_NN1 ,_, the_AT reverse_NN1 is_VBZ true_JJ for_IF the_AT DPQ_NP1 ,_, that_REX21 is_REX22 ,_, the_AT lowering_NN1 of_IO risk_NN1 level_NN1 represents_VVZ a_AT1 shift_NN1 towards_II having_VHG instilled_VVN or_CC reinforced_VVD responsible_JJ drinking_NN1 attitudes_NN2 and_CC behaviour_NN1 ._. 
It_PPH1 was_VBDZ precisely_RR this_DD1 type_NN1 of_IO downward_JJ shift_NN1 that_CST was_VBDZ recorded_VVN ._. 
Between_II the_AT first_MD and_CC the_AT second_MD DPQ_NP1 over_II three-quarters_MF of_IO the_AT participants_NN2 either_RR reduced_VVN to_II (_( 72_MC per_NNU21 cent_NNU22 )_) or_CC remained_VVD at_II (_( six_MC per_NNU21 cent_NNU22 )_) a_AT1 medium_NN1 or_CC low_JJ level_NN1 of_IO risk_NN1 ._. 
To_TO assess_VVI whether_CSW this_DD1 before_RT after_II difference_NN1 was_VBDZ merely_RR a_AT1 fluke_NN occurrence_NN1 the_AT Wilcoxon_NP1 Test_NN1 was_VBDZ undertaken_VVN and_CC the_AT result_NN1 proved_VVD statistically_RR significant_JJ ,_, that_REX21 is_REX22 ,_, Z=-7.7565_FO ,_, 2-tailed_JJ ,_, P=0.0000_FO ._. 
Bearing_VVG in_II mind_NN1 the_AT course_NN1 leaders_NN2 '_GE concern_NN1 to_TO instil_VVI or_CC reinforce_VVI responsible_JJ drinking_NN1 attitudes_NN2 and_CC behaviour_NN1 ,_, it_PPH1 is_VBZ worth_II noting_VVG that_CST before_CS the_AT course_NN1 77_MC per_NNU21 cent_NNU22 of_IO the_AT participants_NN2 agreed_VVN with_IW the_AT statement_NN1 '_GE To_TO enjoy_VVI yourself_PPX1 ,_, it_PPH1 is_VBZ necessary_JJ to_TO have_VHI something_PN1 to_TO drink_VVI '_" ;_; yet_RR by_II the_AT end_NN1 of_IO the_AT course_NN1 88_MC per_NNU21 cent_NNU22 disagreed_VVD with_IW this_DD1 attitude_NN1 ._. 
Similarly_RR ,_, whereas_CS over_RG half_DB of_IO the_AT sample_NN1 (_( 57_MC per_NNU21 cent_NNU22 )_) admitted_VVD to_II always_RR or_CC mostly_RR continuing_VVG to_TO drink_VVI even_CS21 when_CS22 they_PPHS2 knew_VVD they_PPHS2 were_VBDR intoxicated_VVN ,_, at_II the_AT end_NN1 of_IO the_AT course_NN1 60_MC per_NNU21 cent_NNU22 said_VVD this_DD1 rarely_RR or_CC never_RR occurred_VVD ._. 
DRINK_VV0 DIARY_NN1 The_AT third_MD objective_NN1 of_IO the_AT AEC_NN1 is_VBZ to_TO encourage_VVI the_AT maintenance_NN1 of_IO ,_, or_CC ,_, where_CS appropriate_JJ ,_, a_AT1 reduction_NN1 to_II a_AT1 personally_RR and_CC socially_RR safe_JJ level_NN1 of_IO alcohol_NN1 unit_NN1 intake_NN1 ._. 
Determining_VVG how_RGQ much_DA1 is_VBZ too_RG much_DA1 is_VBZ debatable_JJ but_CCB authoritative_JJ (_( if_CS somewhat_RR tough_JJ )_) guidelines_NN2 have_VH0 been_VBN set_VVN by_II Alcohol_NN1 Concern_NN1 in_II31 consultation_II32 with_II33 the_AT Health_NN1 Education_NN1 Council_NN1 and_CC the_AT medical_JJ professions_NN2 (_( Alcohol_NN1 Concern_NN1 ,_, 1986_MC ,_, p._NN1 5_MC )_) ._. 
Three_MC levels_NN2 of_IO alcohol_NN1 consumption_NN1 are_VBR specified_VVN :_: low_JJ ,_, moderate_JJ ,_, and_CC high_JJ ._. 
Males_NN2 consuming_VVG over_RG 36_MC units_NN2 of_IO alcohol_NN1 a_AT1 week_NNT1 and_CC females_NN2 consuming_VVG more_DAR than_CSN 22_MC units_NN2 have_VH0 a_AT1 high_JJ level_NN1 and_CC are_VBR advised_VVN to_TO cut_VVI down_RP immediately_RR ._. 
AEC_NP1 participants_NN2 were_VBDR required_VVN to_TO keep_VVI a_AT1 weekly_JJ drink_NN1 diary_NN1 after_II each_DD1 of_IO the_AT group_NN1 sessions_NNT2 to_TO monitor_VVI their_APPGE drinking_NN1 levels_NN2 ._. 
Although_CS it_PPH1 must_VM be_VBI acknowledged_VVN that_CST there_EX is_VBZ a_AT1 danger_NN1 of_IO deliberate_JJ under-recording_NN1 ,_, the_AT emphasis_NN1 placed_VVN by_II the_AT course_NN1 on_II the_AT value_NN1 and_CC importance_NN1 of_IO being_VBG honest_JJ with_IW oneself_PNX1 appears_VVZ to_TO have_VHI resolved_VVN this_DD1 problem_NN1 ._. 
The_AT non-punitive_JJ approach_NN1 of_IO the_AT course_NN1 is_VBZ reflected_VVN in_II its_APPGE policy_NN1 neither_RR to_II reward_NN1 low_JJ scores_NN2 nor_CC to_TO punish_VVI underscoring_VVG ._. 
This_DD1 is_VBZ because_CS the_AT aim_NN1 of_IO the_AT exercise_NN1 is_VBZ to_TO provide_VVI the_AT participants_NN2 with_IW a_AT1 practical_JJ tool_NN1 for_IF monitoring_VVG their_APPGE drinking_NN1 :_: if_CS they_PPHS2 want_VV0 to_TO cheat_VVI ,_, they_PPHS2 will_VM only_RR be_VBI cheating_VVG themselves_PPX2 ._. 
In_II this_DD1 connection_NN1 the_AT comments_NN2 from_II two_MC of_IO the_AT participants_NN2 were_VBDR typical_JJ ._. 
The_AT first_MD time_NNT1 I_PPIS1 went_VVD he_PPHS1 got_VVD us_PPIO2 to_TO do_VDI a_AT1 drink_NN1 diary_NN1 and_CC I_PPIS1 know_VV0 I_PPIS1 did_VDD n't_XX tell_VVI the_AT truth_NN1 ._. 
I_PPIS1 put_VV0 down_RP a_RR21 bit_RR22 less_DAR than_CSN I_PPIS1 had_VHD been_VBN drinking_VVG ._. 
I_PPIS1 do_VD0 n't_XX know_VVI why_RRQ I_PPIS1 did_VDD that_DD1 ._. 
I_MC1 thought_NN1 '_GE What_DDQ 's_VBZ the_AT other_JJ person_NN1 going_VVGK to_TO put_VVI down_RP ,_, is_VBZ he_PPHS1 going_VVG to_TO do_VDI the_AT same_DA ?_? 
Well_RR I_PPIS1 do_VD0 n't_XX want_VVI to_TO be_VBI seen_VVN drinking_VVG more_DAR than_CSN he_PPHS1 is_VBZ !_! 
'_" As_CSA the_AT group_NN1 went_VVD on_RP I_PPIS1 was_VBDZ being_VBG truthful_JJ ,_, I_PPIS1 put_VV0 down_RP what_DDQ I_PPIS1 was_VBDZ drinking_VVG ._. 
The_AT two_MC lads_NN2 that_CST were_VBDR with_IW me_PPIO1 at_II the_AT end_NN1 ,_, they_PPHS2 were_VBDR being_VBG truthful_JJ ._. 
Theirs_PPGE went_VVD down_RP but_CCB mine_NN1 went_VVD up_RP ._. 
These_DD2 drink_VV0 diaries_NN2 are_VBR excellent_JJ ,_, brilliant_JJ way_NN1 as_CS31 long_CS32 as_CS33 nobody_PN1 cheats_VVZ ._. 
You_PPY 're_VBR only_RR cheating_VVG yourself_PPX1 when_CS you_PPY cheat_VV0 ._. 
They_PPHS2 were_VBDR easy_JJ to_TO do_VDI ._. 
Information_NN1 from_II the_AT drink_NN1 diaries_NN2 ,_, based_VVN on_II a_AT1 comparison_NN1 of_IO the_AT averages_NN2 for_IF the_AT first_MD and_CC the_AT last_MD three_MC weeks_NNT2 of_IO the_AT course_NN1 ,_, revealed_VVD a_AT1 shift_NN1 from_II high_JJ to_TO moderate_VVI drinking_VVG levels_NN2 for_IF males_NN2 ,_, that_REX21 is_REX22 ,_, from_II 40_MC to_II 32_MC units_NN2 per_II week_NNT1 ._. 
The_AT nine_MC females_NN2 who_PNQS undertook_VVD the_AT course_NN1 remained_VVD within_II the_AT high_JJ zone_NN1 but_CCB nevertheless_RR registered_VVN a_AT1 reduction_NN1 from_II an_AT1 average_NN1 of_IO 39_MC units_NN2 to_II 28_MC units_NN2 per_II week_NNT1 ._. 
Overall_RR ,_, almost_RR three-quarters_MF of_IO the_AT participants_NN2 either_RR reduced_VVD their_APPGE intake_NN1 (_( 61_MC per_NNU21 cent_NNU22 )_) or_CC remained_VVD at_II the_AT same_DA level_NN1 (_( 11_MC per_NNU21 cent_NNU22 )_) between_II the_AT first_MD and_CC the_AT last_MD three_MC weeks_NNT2 of_IO the_AT course_NN1 ._. 
Using_VVG the_AT Wilcoxon_NP1 test_VV0 this_DD1 downward_JJ trend_NN1 was_VBDZ again_RT found_VVN to_TO be_VBI statistically_RR significant_JJ ,_, that_REX21 is_REX22 ,_, Z=_FO 4.9595_MC ,_, 2_MC tailed_VVD ,_, P=_FO 00000_MC ._. 
CONSUMER_NN1 FEEDBACK_NN1 After_II completing_VVG the_AT AEC_NN1 ,_, participants_NN2 were_VBDR interviewed_VVN to_TO provide_VVI them_PPHO2 with_IW an_AT1 opportunity_NN1 to_TO reflect_VVI and_CC comment_VVI on_II the_AT course_NN1 ._. 
Interviews_NN2 were_VBDR conducted_VVN by_II the_AT research_NN1 officer_NN1 or_CC the_AT alcohol_NN1 project_NN1 worker_NN1 (_( instead_II21 of_II22 the_AT course_NN1 leaders_NN2 )_) to_TO ensure_VVI confidentiality_NN1 ;_; and_CC a_AT1 semi-structured_JJ interview_NN1 guide_NN1 was_VBDZ used_VVN ._. 
The_AT guide_NN1 covered_VVD questions_NN2 about_II the_AT participants_NN2 '_GE expectations_NN2 ,_, experience_NN1 and_CC evaluation_NN1 of_IO the_AT course_NN1 ._. 
The_AT interview_NN1 transcripts_NN2 run_VVN to_II some_DD 121_MC pages_NN2 and_CC can_VM only_RR be_VBI superficially_RR summarized_VVN here_RL ._. 
However_RR ,_, five_MC points_NN2 of_IO direct_JJ relevance_NN1 to_II the_AT success_NN1 of_IO the_AT course_NN1 and_CC the_AT applicability_NN1 of_IO the_AT non-punitive_JJ paradigm_NN1 warrant_VV0 a_AT1 brief_JJ mention_NN1 ._. 
First_MD ,_, out_II21 of_II22 all_DB the_AT responses_NN2 made_VVD ,_, only_RR two_MC participants_NN2 stated_VVD that_CST their_APPGE attendance_NN1 on_II the_AT course_NN1 had_VHD not_XX been_VBN worthwhile_JJ and_CC none_PN said_VVD that_CST the_AT course_NN1 should_VM be_VBI discontinued_VVN ._. 
Second_MD ,_, the_AT vast_JJ majority_NN1 of_IO participants_NN2 were_VBDR able_JK to_TO indicate_VVI the_AT practical_JJ ,_, as_CSA distinct_JJ from_II abstract_JJ ,_, usefulness_NN1 of_IO the_AT course_NN1 ._. 
With_II31 regard_II32 to_II33 drinking_NN1 and_CC driving_VVG for_REX21 example_REX22 :_: I_PPIS1 've_VH0 learnt_VVN a_RR21 lot_RR22 ,_, my_APPGE job_NN1 depends_VVZ on_II me_PPIO1 driving_VVG and_CC it_PPH1 's_VHZ made_VVN me_PPIO1 realise_VV0 how_RGQ much_DA1 I_PPIS1 can_VM drink_VVI ,_, how_RGQ much_DA1 I_PPIS1 ca_VM n't_XX drink_VVI ,_, what_DDQ I_PPIS1 can_VM drink_VVI and_CC realising_VVG about_II road_NN1 accidents_NN2 ._. 
The_AT amount_NN1 you_PPY drink_VV0 does_VDZ affect_VVI your_APPGE driving_VVG quite_RG considerably_RR Third_MD ,_, different_JJ aspects_NN2 of_IO the_AT course_NN1 appeared_VVD to_TO cater_VVI for_IF different_JJ needs_NN2 ._. 
For_IF some_DD the_AT counselling_NN1 was_VBDZ particularly_RR appreciated_VVN :_: A_RR21 lot_RR22 more_DAR knowledge_NN1 ,_, it_PPH1 made_VVD you_PPY think_VVI a_RR21 lot_RR22 more_RRR about_II what_DDQ you_PPY were_VBDR doing_VDG really_RR ._. 
For_IF others_NN2 it_PPH1 was_VBDZ the_AT assistance_NN1 that_CST was_VBDZ especially_RR useful_JJ :_: When_RRQ we_PPIS2 all_DB went_VVD to_II the_AT pub_NN1 and_CC some_DD of_IO them_PPHO2 went_VVD up_RP and_CC got_VVD non-alcoholic_JJ drinks_NN2 and_CC that_DD1 ,_, and_CC they_PPHS2 all_DB said_VVD they_PPHS2 could_VM n't_XX go_VVI into_II a_AT1 pub_NN1 and_CC do_VD0 that_DD1 and_CC they_PPHS2 done_VDN it_PPH1 ,_, no_AT problem_NN1 ._. 
I_PPIS1 think_VV0 it_PPH1 was_VBDZ useful_JJ going_VVG to_II the_AT pub_NN1 ._. 
Fourth_MD ,_, many_DA2 participants_NN2 frankly_RR admitted_VVN that_CST they_PPHS2 had_VHD very_RG low_JJ expectations_NN2 at_II the_AT outset_NN1 :_: specifically_RR that_CST the_AT course_NN1 was_VBDZ simply_RR designed_VVN to_TO punish_VVI them_PPHO2 ,_, in_II31 return_II32 for_II33 which_DDQ they_PPHS2 would_VM give_VVI the_AT minimum_JJ amount_NN1 of_IO attention_NN1 possible_JJ ._. 
All_DB agreed_VVD that_CST this_DD1 was_VBDZ not_XX Their_APPGE experience_NN1 as_II the_AT following_JJ comments_NN2 clearly_RR demonstrate_VV0 :_: I_PPIS1 thought_VVD they_PPHS2 were_VBDR out_RP to_TO get_VVI me_PPIO1 to_TO be_VBI honest_JJ with_IW you_PPY ._. 
I_PPIS1 thought_VVD they_PPHS2 were_VBDR out_RP to_TO get_VVI me_PPIO1 as_II a_AT1 punishment_NN1 ._. 
But_CCB I_PPIS1 do_VD0 n't_XX think_VVI so_RR now_RT ._. 
He_PPHS1 was_VBDZ just_RR telling_VVG us_PPIO2 and_CC you_PPY learn_VV0 ._. 
You_PPY 've_VH0 got_VVN ta_UH face_VV0 it_PPH1 have_VH0 n't_XX you_PPY ,_, you_PPY 've_VH0 got_VVN ta_UH face_VV0 it_PPH1 whatever_DDQV ._. 
If_CS you_PPY do_VD0 n't_XX face_VVI anything_PN1 ,_, you_PPY do_VD0 n't_XX get_VVI anywhere_RL ._. 
I_PPIS1 was_VBDZ frightened_JJ ._. 
I_PPIS1 thought_VVD it_PPH1 was_VBDZ going_VVGK to_TO be_VBI worse_JJR than_CSN it_PPH1 was_VBDZ ._. 
It_PPH1 was_VBDZ good_JJ once_CS it_PPH1 got_VVD going_VVG ._. 
I_PPIS1 did_VDD n't_XX think_VVI we_PPIS2 would_VM have_VHI the_AT opportunity_NN1 to_TO say_VVI things_NN2 we_PPIS2 all_DB got_VVD a_AT1 chance_NN1 to_TO speak_VVI ._. 
I_PPIS1 really_RR thought_VVD it_PPH1 was_VBDZ going_VVGK to_TO be_VBI sort_RR21 of_RR22 '_" You_PPY must_VM not_XX drink_VVI ever_RR again'_VVG and_CC '_" You_PPY naughty_JJ boy_NN1 ,_, you_PPY must_VM n't_XX do_VDI it_PPH1 ever_RR again'_VVG sort_NN1 of_IO thing_NN1 ._. 
I_PPIS1 had_VHD the_AT idea_NN1 that_CST it_PPH1 was_VBDZ going_VVGK to_TO be_VBI '_" Do_VD0 this_DD1 ,_, do_VD0 that_DD1 '_VBZ but_CCB it_PPH1 was_VBDZ n't_XX like_II that_DD1 ._. 
Finally_RR (_( and_CC in_II direct_JJ accord_NN1 with_IW the_AT non-punitive_JJ approach_NN1 of_IO the_AT course_NN1 )_) ,_, the_AT emphasis_NN1 upon_II participants_NN2 by_II the_AT end_NN1 of_IO the_AT course_NN1 making_VVG their_APPGE own_DA rules_NN2 as_II31 opposed_II32 to_II33 them_PPHO2 being_VBG made_VVN by_II others_NN2 was_VBDZ greatly_RR appreciated_VVN ._. 
My_APPGE rules_NN2 are_VBR to_TO cut_VVI down_RP drinking_VVG ,_, control_VV0 my_APPGE temper_NN1 if_CS I_PPIS1 am_VBM drinking_VVG ,_, not_XX to_TO drink_VVI in_II a_AT1 such_DA a_AT1 large_JJ group_NN1 and_CC not_XX to_TO waste_VVI much_DA1 money_NN1 ._. 
It_PPH1 's_VBZ a_AT1 good_JJ idea_NN1 ,_, you_PPY should_VM set_VVI yourself_PPX1 your_APPGE own_DA targets_NN2 so_CS you_PPY can_VM know_VVI ._. 
RECONVICTION_NP1 RATE_NN1 STATISTICS_NN Positive_JJ test_NN1 results_NN2 and_CC favourable_JJ feedback_NN1 might_VM be_VBI sufficient_JJ evaluation_NN1 criteria_NN2 outside_II21 of_II22 the_AT Criminal_JJ Justice_NN1 System_NN1 but_CCB reconviction_NN1 rates_NN2 for_IF probation_NN1 practice_NN1 must_VM remain_VVI the_AT acid_NN1 test_NN1 ._. 
Before_CS and_CC after_II course_NN1 results_NN2 are_VBR important_JJ indices_NN2 of_IO immediate_JJ impact_NN1 ,_, but_CCB did_VDD participants_NN2 manage_VVI to_TO keep_VVI out_II21 of_II22 trouble_NN1 with_IW the_AT law_NN1 twelve_MC months_NNT2 after_II completing_VVG the_AT course_NN1 ?_? 
Thanks_II21 to_II22 the_AT assistance_NN1 of_IO the_AT statistics_NN department_NN1 of_IO Avon_NP1 and_CC Somerset_NP1 Police_NN2 ,_, it_PPH1 was_VBDZ possible_JJ to_TO answer_VVI this_DD1 question_NN1 and_CC provide_VVI a_AT1 fifth_MD and_CC final_JJ indicator_NN1 of_IO success_NN1 ._. 
In_II31 spite_II32 of_II33 the_AT high_JJ risk_NN1 profile_NN1 of_IO the_AT participants_NN2 ,_, that_REX21 is_REX22 ,_, an_AT1 average_NN1 of_IO seven_MC previous_JJ and_CC often_RR recent_JJ convictions_NN2 (_( see_VV0 above_RL )_) ,_, 95_MC or_CC 63_MC per_NNU21 cent_NNU22 of_IO the_AT sample_NN1 were_VBDR not_XX recorded_VVN as_CSA having_VHG committed_VVN further_RRR offences_NN2 during_II the_AT twelve_MC month_NNT1 follow-up_NN1 ._. 
In_II other_JJ words_NN2 ,_, almost_RR two_MC out_II21 of_II22 three_MC of_IO the_AT participants_NN2 had_VHD kept_VVN away_II21 from_II22 further_JJR trouble_NN1 through_II drink_NN1 ._. 
As_CSA one_MC1 participant_NN1 observed_VVD :_: Yea_UH ,_, drinking_NN1 's_VHZ always_RR got_VVN me_PPIO1 into_II trouble_NN1 in_II the_AT past_NN1 ,_, I_PPIS1 mean_VV0 now_RT I_PPIS1 've_VH0 thought_VVN about_II it_PPH1 ,_, I_PPIS1 've_VH0 thought_VVN what_DDQ a_AT1 stupid_JJ idiot_NN1 I_PPIS1 'd_VM be_VBI ,_, so_CS you_PPY know_VV0 if_CSW it_PPH1 was_VBDZ n't_XX for_IF the_AT course_NN1 ,_, then_RT I_PPIS1 probably_RR would_VM have_VHI gone_VVN and_CC done_VDN it_PPH1 again_RT ,_, you_PPY know_VV0 ,_, without_IW a_AT1 second_MD thought_NN1 ._. 
Without_IW the_AT benefit_NN1 of_IO the_AT results_NN2 from_II a_AT1 random_JJ allocation_NN1 study_NN1 based_VVN on_II experimental_JJ and_CC control_NN1 groups_NN2 ,_, second_MD thoughts_NN2 about_II how_RGQ much_DA1 of_IO the_AT two_MC out_II21 of_II22 three_MC success_NN1 rate_NN1 can_VM be_VBI directly_RR attributed_VVN to_II the_AT AEC_NN1 are_VBR inevitable_JJ ._. 
However_RR ,_, Phillpotts_NP2 and_CC Lancucki_NP1 's_GE (_( 1979_MC )_) authoritative_JJ study_NN1 for_IF the_AT Home_NN1 Office_NN1 on_II reconviction_NN1 rates_NN2 offers_VVZ a_AT1 basis_NN1 for_IF provisional_JJ optimism_NN1 ._. 
In_II their_APPGE six_MC year_NNT1 follow-up_JJ study_NN1 of_IO 5,000_MC offenders_NN2 convicted_VVN of_IO standard_JJ list_NN1 offences_NN2 in_II January_NPM1 1971_MC ,_, they_PPHS2 reported_VVD that_CST :_: Offenders_NN2 who_PNQS were_VBDR reconvicted_VVN within_II the_AT follow-up_JJ period_NN1 were_VBDR likely_JJ to_TO have_VHI their_APPGE first_MD reconviction_NN1 fairly_RR soon_RR after_II sentence_NN1 (_( or_CC ,_, for_IF those_DD2 given_VVN custodial_JJ sentences_NN2 ,_, after_CS discharge_NN1 )_) ._. 
Offenders_NN2 with_IW a_AT1 large_JJ number_NN1 of_IO previous_JJ convictions_NN2 were_VBDR not_XX only_RR more_RGR likely_JJ to_TO be_VBI reconvicted_VVN but_CCB were_VBDR reconvicted_VVN sooner_RRR than_CSN those_DD2 with_IW few_DA2 previous_JJ convictions_NN2 (_( 1979_MC ,_, p._NN1 41_MC )_) ._. 
What_DDQ is_VBZ of_IO particular_JJ relevance_NN1 to_II the_AT AEC_NN1 sample_NN1 is_VBZ Phillpott_NP1 and_CC Lancucki_NP1 's_GE finding_NN1 that_CST 53_MC per_NNU21 cent_NNU22 of_IO all_DB male_JJ offenders_NN2 with_IW five_MC or_CC more_DAR preconvictions_NN2 were_VBDR reconvicted_VVN within_II a_AT1 year_NNT1 (_( 1979_MC ,_, p._NN1 24_MC )_) ._. 
If_CS the_AT AEC_NN1 had_VHD made_VVN no_AT difference_NN1 to_II the_AT male_JJ participants_NN2 with_IW five_MC or_CC more_DAR preconvictions_NN2 we_PPIS2 would_VM expect_VVI over_RG half_DB of_IO them_PPHO2 to_TO have_VHI been_VBN reconvicted_VVN ._. 
However_RR ,_, as_CSA might_VM be_VBI anticipated_VVN from_II the_AT progress_NN1 registered_VVD earlier_RRR in_II31 connection_II32 with_II33 improvements_NN2 regarding_II alcohol_NN1 knowledge_NN1 ,_, attitudes_NN2 and_CC behaviour_NN1 ,_, instead_II21 of_II22 53_MC per_NNU21 cent_NNU22 only_RR 42_MC per_NNU21 cent_NNU22 of_IO the_AT '_GE five_MC or_CC more_DAR '_GE male_JJ offenders_NN2 were_VBDR reconvicted_VVN ._. 
DISCIPLINE_NN1 :_: MORE_DAR APPROPRIATE_JJ THAN_CSN PUNISHMENT_NN1 The_AT idea_NN1 espoused_VVN in_II the_AT White_JJ Paper_NN1 that_CST restrictions_NN2 on_II liberty_NN1 will_VM become_VVI '_GE the_AT connecting_JJ thread_NN1 in_II a_AT1 range_NN1 of_IO community_NN1 penalties_NN2 as_II31 well_II32 as_II33 custody_NN1 '_GE (_( p._NNU 19_MC ,_, para_NN1 ._. 
4.5_MC )_) is_VBZ conceptually_RR flawed_JJ for_IF two_MC basic_JJ reasons_NN2 ._. 
First_MD ,_, if_CS restriction_NN1 on_II liberty_NN1 is_VBZ the_AT defining_JJ feature_NN1 of_IO punishment_NN1 ,_, what_DDQ are_VBR we_PPIS2 to_TO make_VVI of_IO the_AT experience_NN1 of_IO children_NN2 who_PNQS have_VH0 to_TO go_VVI to_II school_NN1 and_CC adults_NN2 who_PNQS have_VH0 to_TO work_VVI for_IF a_AT1 living_NN1 ?_? 
Is_VBZ their_APPGE liberty_NN1 not_XX being_VBG restricted_VVN in_II31 terms_II32 of_II33 both_RR intention_NN1 and_CC effect_NN1 ?_? 
For_REX21 example_REX22 ,_, employers_NN2 and_CC teachers_NN2 keep_VV0 registers_NN2 of_IO attendance_NN1 and_CC prescribe_VV0 as_II31 well_II32 as_II33 supervise_VV0 the_AT activities_NN2 of_IO their_APPGE employees/pupils_NN2 ,_, that_REX21 is_REX22 ,_, restriction_NN1 by_II intent_NN1 ._. 
Moreover_RR ,_, children_NN2 attending_VVG school_NN1 and_CC adults_NN2 turning_VVG up_RP for_IF work_NN1 inevitably_RR have_VH0 their_APPGE liberty_NN1 restricted_VVN :_: simply_RR because_CS the_AT engagement_NN1 in_II one_MC1 activity_NN1 necessarily_RR restricts_VVZ their_APPGE opportunity_NN1 to_TO participate_VVI in_II other_JJ activities_NN2 ,_, that_REX21 is_REX22 ,_, restriction_NN1 by_II effect_NN1 ._. 
It_PPH1 is_VBZ patently_RR absurd_JJ to_TO regard_VVI attendance_NN1 at_II school_NN1 or_CC work_VV0 per_RR21 se_RR22 as_II a_AT1 punishment_NN1 ._. 
Second_MD ,_, the_AT notion_NN1 of_IO a_AT1 continuum_NN1 of_IO restriction_NN1 ranging_VVG from_II community_NN1 penalties_NN2 to_II custody_NN1 neat_JJ as_CSA it_PPH1 sounds_VVZ fails_VVZ to_TO acknowledge_VVI the_AT unique_JJ and_CC painful_JJ experience_NN1 of_IO imprisonment_NN1 ._. 
As_CSA Sykes_NP1 (_( 1971_MC )_) has_VHZ shown_VVN ,_, confinement_NN1 to_II and_CC within_II a_AT1 prison_NN1 entails_VVZ a_AT1 number_NN1 of_IO pains_NN2 ._. 
These_DD2 involve_VV0 physical_JJ ,_, financial_JJ ,_, and_CC psychological_JJ hardships_NN2 including_II the_AT loss_NN1 of_IO liberty_NN1 ,_, goods_NN2 and_CC services_NN2 ,_, heterosexual_JJ relationships_NN2 ,_, autonomy_NN1 ,_, security_NN1 and_CC life_NN1 chances_NN2 post-custody_NN1 ._. 
Lest_CS anyone_PN1 doubt_VV0 the_AT validity_NN1 of_IO these_DD2 observations_NN2 in_II England_NP1 and_CC Wales_NP1 ,_, consider_VV0 the_AT following_JJ admission_NN1 about_II a_AT1 custodial_JJ sentence_NN1 from_II the_AT Home_NN1 Office_NN1 :_: It_PPH1 is_VBZ likely_JJ to_TO affect_VVI an_AT1 offender_NN1 's_GE personal_JJ or_CC financial_JJ prospects_NN2 ._. 
There_EX is_VBZ the_AT possibility_NN1 that_CST serious_JJ hardship_NN1 will_VM be_VBI inflicted_VVN on_II the_AT offender_NN1 's_GE family_NN1 ,_, particularly_RR those_DD2 responsible_JJ for_IF the_AT care_NN1 of_IO young_JJ children_NN2 ...._... 
On_II release_NN1 from_II custody_NN1 ,_, it_PPH1 can_VM be_VBI very_RG difficult_JJ for_IF the_AT offender_NN1 to_TO be_VBI reintegrated_VVN into_II the_AT community_NN1 ._. 
Furthermore_RR ,_, tor_NN1 the_AT young_JJ or_CC inexperienced_JJ offender_NN1 ,_, mixing_VVG with_IW more_RGR sophisticated_JJ inmates_NN2 may_VM deepen_VVI his_APPGE anti-social_JJ attitudes_NN2 and_CC increase_VVI his_APPGE criminal_JJ skills_NN2 (_( 1990b_FO ,_, pp._NNU2 89_MC )_) ._. 
Probation_NN1 practice_NN1 can_VM not_XX legitimately_RR be_VBI placed_VVN on_II this_DD1 sort_NN1 of_IO continuum_NN1 ._. 
The_AT description_NN1 and_CC evaluation_NN1 of_IO the_AT AEC_NN1 clearly_RR demonstrates_VVZ that_CST ,_, in_II their_APPGE particular_JJ sphere_NN1 of_IO constructive_JJ influence_NN1 ,_, probation_NN1 officers_NN2 ,_, like_II employers_NN2 and_CC teachers_NN2 ,_, are_VBR concerned_JJ in_RR21 part_RR22 with_IW the_AT establishment_NN1 of_IO rules_NN2 and_CC not_XX the_AT infliction_NN1 of_IO pain_NN1 ._. 
Put_VV0 another_DD1 way_NN1 ,_, it_PPH1 is_VBZ discipline_NN1 ,_, not_XX punishment_NN1 ,_, which_DDQ constitutes_VVZ the_AT connecting_JJ thread_NN1 running_VVG through_II the_AT diverse_JJ range_NN1 of_IO probation_NN1 practice_NN1 ._. 
This_DD1 point_NN1 was_VBDZ made_VVN by_II one_MC1 commentator_NN1 during_II the_AT first_MD review_NN1 of_IO the_AT '_GE Probation_NN1 System_NN1 '_GE at_II the_AT beginning_NN1 of_IO this_DD1 century_NNT1 :_: his_APPGE comments_NN2 remain_VV0 pertinent_JJ for_IF the_AT Home_NN1 Office_NN1 in_II their_APPGE current_JJ review_NN1 at_II the_AT end_NN1 of_IO the_AT century_NNT1 ._. 
Probation_NN1 ..._... is_VBZ a_AT1 test_NN1 or_CC trial_NN1 of_IO the_AT character_NN1 of_IO a_AT1 convicted_JJ offender_NN1 under_II suspension_NN1 of_IO judgment_NN1 ,_, in_BCL21 order_BCL22 that_CST the_AT court_NN1 may_VM determine_VVI if_CSW the_AT probationer_NN1 be_VBI fit_JJ to_TO retain_VVI his_APPGE or_CC her_APPGE place_NN1 as_II a_AT1 helpful_JJ member_NN1 of_IO society_NN1 ,_, or_CC being_VBG unfit_JJ ,_, must_VM be_VBI deprived_VVN of_IO his_APPGE or_CC her_APPGE liberty_NN1 as_II a_AT1 menace_NN1 to_II society_NN1 ._. 
It_PPH1 is_VBZ established_VVN for_IF the_AT purpose_NN1 of_IO correction_NN1 and_CC oversight_NN1 ._. 
It_PPH1 is_VBZ a_AT1 conditional_JJ freedom_NN1 ._. 
It_PPH1 recognises_VVZ that_CST the_AT newer_JJR and_CC better_JJR way_NN1 to_TO govern_VVI the_AT law-breaker_NN1 is_VBZ not_XX through_II the_AT expiring_JJ system_NN1 of_IO the_AT cell_NN1 and_CC the_AT lash_NN1 ,_, but_CCB rather_RR through_II the_AT mind_NN1 and_CC the_AT heart_NN1 (_( Bridgwater_NP1 ,_, 1909_MC ,_, p._NN1 9_MC )_) ._. 
The_AT punitive_JJ calculus_NN1 ,_, with_IW its_APPGE just_JJ deserts_NN2 gloss_VV0 ,_, may_VM have_VHI political_JJ appeal_NN1 and_CC offer_VV0 an_AT1 antidote_NN1 to_II the_AT soft_JJ image_NN1 that_CST has_VHZ beset_VVN the_AT Service_NN1 since_CS its_APPGE inception_NN1 ._. 
However_RR ,_, this_DD1 is_VBZ to_TO mistake_VVI not_XX only_RR the_AT demanding_JJ nature_NN1 of_IO current_JJ practice_NN1 but_CCB also_RR the_AT non-punitive_JJ knowledge_NN1 ,_, skills_NN2 ,_, and_CC values_NN2 which_DDQ provide_VV0 for_IF its_APPGE success_NN1 ._. 
The_AT AEC_NN1 is_VBZ but_CCB one_MC1 example_NN1 of_IO a_AT1 number_NN1 of_IO fruitful_JJ initiatives_NN2 undertaken_VVN by_II practitioners_NN2 in_II and_CC through_II the_AT medium_NN1 of_IO counselling_NN1 ,_, assisting_VVG ,_, directing_VVG and_CC monitoring_NN1 ._. 
The_AT non-punitive_JJ approach_NN1 of_IO probation_NN1 officers_NN2 is_VBZ a_AT1 strength_NN1 rather_II21 than_II22 a_AT1 weakness_NN1 ._. 
Some_DD years_NNT2 ago_RA the_AT '_" Nothing_PN1 Works_NN '_GE school_NN1 of_IO thought_NN1 dominated_VVD the_AT Probation_NN1 Service_NN1 ._. 
Now_RT it_PPH1 seems_VVZ that_CST some_DD things_NN2 work_VV0 ,_, especially_RR those_DD2 like_II the_AT AEC_NN1 that_CST are_VBR associated_VVN with_IW what_DDQ has_VHZ come_VVN to_TO be_VBI described_VVN as_II the_AT approach_NN1 (_( Roberts_NP1 ,_, 1990_MC )_) ._. 
These_DD2 new_JJ ways_NN2 of_IO working_VVG are_VBR simply_RR a_AT1 consolidation_NN1 of_IO the_AT established_JJ pattern_NN1 among_II officers_NN2 of_IO personalizing_VVG their_APPGE practice_NN1 ,_, that_REX21 is_REX22 ,_, carefully_RR matching_VVG their_APPGE particular_JJ social_JJ work_NN1 knowledge_NN1 and_CC skills_NN2 to_II the_AT unique_JJ needs_NN2 of_IO the_AT individual_JJ offender_NN1 (_( Singer_NP1 ,_, 1989_MC )_) ._. 
This_DD1 trend_NN1 reflects_VVZ a_AT1 developing_JJ and_CC successful_JJ specificity_NN1 of_IO probation_NN1 practice_NN1 :_: the_AT pity_NN1 is_VBZ that_CST this_DD1 specificity_NN1 of_IO practice_NN1 has_VHZ not_XX been_VBN complemented_VVN by_II a_AT1 more_RGR appropriate_JJ specificity_NN1 of_IO language_NN1 from_II the_AT authors_NN2 of_IO the_AT White_JJ Paper_NN1 ._. 
The_AT Role_NN1 of_IO Residential_JJ and_CC Nursing_JJ Homes_NN2 in_II the_AT Last_MD Year_NNT1 of_IO People_NN 's_GE Lives_NN2 ANN_NP1 CARTWRIGHT_NP1 Ann_NP1 Cartwright_NP1 ,_, B.Sc._NNA ,_, Ph.D._NP1 ,_, is_VBZ Director_NN1 of_IO the_AT Institute_NN1 for_IF Social_JJ Studies_NN2 in_II Medical_JJ Care_NN1 SUMMARY_NN1 Almost_RR a_AT1 quarter_NN1 of_IO a_AT1 random_JJ sample_NN1 of_IO adults_NN2 dying_VVG in_II 1987_MC had_VHD spent_VVN at_RR21 least_RR22 part_NN1 of_IO the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 in_II a_AT1 residential_JJ or_CC nursing_NN1 home_NN1 ;_; one_MC1 in_II eight_MC spent_VVD all_DB of_IO that_DD1 year_NNT1 in_II one_PN1 ._. 
The_AT old_JJ ,_, the_AT unmarried._NNU those_DD2 with_IW difficulty_NN1 looking_VVG after_II themselves_PPX2 ,_, the_AT confused_JJ ,_, the_AT incontinent_JJ ,_, the_AT blind_JJ ,_, the_AT deaf_JJ ,_, and_CC the_AT bad_JJ tempered_JJ were_VBDR more_RGR likely_JJ to_TO be_VBI in_II such_DA homes_NN2 than_CSN others_NN2 ._. 
With_IW their_APPGE greater_JJR dependency._NNU people_NN living_VVG in_II residential_JJ homes_NN2 received_VVD rather_RG more_DAR consultations_NN2 and_CC home_NN1 visits_NN2 although_CS not_XX night_NNT1 calls_VVZ from_II their_APPGE general_JJ practitioners_NN2 ._. 
But_CCB they_PPHS2 did_VDD not_XX get_VVI more_DAR help_NN1 from_II community_NN1 nurses_NN2 and_CC they_PPHS2 were_VBDR less_RGR likely_JJ to_TO be_VBI admitted_VVN to_II ,_, or_CC to_TO die_VVI in_RP ,_, a_AT1 hospital_NN1 or_CC hospice_NN1 ._. 
According_II21 to_II22 the_AT assessments_NN2 of_IO relatives_NN2 ,_, friends_NN2 ,_, and_CC neighbours_NN2 who_PNQS answered_VVD the_AT questions_NN2 ,_, the_AT quality_NN1 of_IO life_NN1 of_IO people_NN who_PNQS had_VHD been_VBN in_II a_AT1 residential_JJ home_NN1 for_IF a_AT1 year_NNT1 or_CC more_RRR before_II their_APPGE death_NN1 was_VBDZ similar_JJ to_II that_DD1 of_IO others_NN2 who_PNQS died_VVD but_CCB had_VHD never_RR been_VBN in_II such_DA a_AT1 home_NN1 ._. 
It_PPH1 was_VBDZ those_DD2 who_PNQS were_VBDR admitted_VVN in_II the_AT year_NNT1 before_CS they_PPHS2 died_VVD who_PNQS were_VBDR perceived_VVN as_CSA having_VHG a_AT1 relatively_RR poor_JJ quality_NN1 of_IO life_NN1 in_II that_DD1 year_NNT1 ._. 
Increasingly_RR ,_, the_AT quality_NN1 of_IO life_NN1 during_II the_AT year_NNT1 before_II death_NN1 is_VBZ going_VVGK to_TO depend_VVI on_II the_AT attributes_NN2 of_IO residential_JJ homes_NN2 and_CC their_APPGE staff_NN ._. 
The_AT marked_JJ rise_NN1 in_II the_AT number_NN1 of_IO residential_JJ homes_NN2 ,_, particularly_RR the_AT recent_JJ growth_NN1 in_II the_AT private_JJ sector_NN1 (_( DHSS_NP1 ,_, 1987_MC ;_; Bebbington_NP1 and_CC Tong_NP1 1986_MC ;_; Laing_NP1 ,_, 1985_MC )_) has_VHZ drawn_VVN attention_NN1 to_II the_AT somewhat_RR uncertain_JJ role_NN1 of_IO these_DD2 homes_NN2 (_( Judge_NN1 and_CC Sinclair_NP1 ,_, 1986_MC )_) ._. 
Two_MC areas_NN2 of_IO concern_NN1 are_VBR first_MD ,_, who_PNQS should_VM have_VHI residential_JJ care_NN1 and_CC second_NNT1 ,_, the_AT relationship_NN1 between_II residential_JJ and_CC community_NN1 care_NN1 ._. 
A_AT1 recent_JJ study_NN1 of_IO people_NN 's_GE lives_NN2 in_II the_AT year_NNT1 before_II their_APPGE death_NN1 makes_VVZ it_PPH1 possible_JJ to_TO examine_VVI the_AT part_NN1 residential_JJ and_CC nursing_JJ homes_NN2 play_VV0 in_II caring_VVG for_IF people_NN during_II the_AT twelve_MC months_NNT2 before_II their_APPGE death_NN1 ._. 
This_DD1 paper_NN1 then_RT looks_VVZ at_II the_AT characteristics_NN2 of_IO the_AT people_NN who_PNQS spent_VVD some_DD or_CC all_DB of_IO their_APPGE time_NNT1 in_II such_DA homes_NN2 and_CC at_II the_AT care_NN1 they_PPHS2 got_VVD from_II general_JJ practitioners_NN2 ,_, community_NN1 nurses_NN2 and_CC hospitals_NN2 ._. 
Care_VV0 and_CC conditions_NN2 in_II the_AT homes_NN2 and_CC the_AT extent_NN1 of_IO visiting_VVG are_VBR described_VVN and_CC a_AT1 final_JJ section_NN1 considers_VVZ the_AT quality_NN1 of_IO people_NN 's_GE lives_NN2 as_CSA perceived_VVN by_II their_APPGE relatives_NN2 and_CC others_NN2 ._. 
METHODS_NN2 The_AT data_NN come_VV0 from_II a_AT1 study_NN1 of_IO a_AT1 random_JJ sample_NN1 of_IO adult_NN1 (_( aged_II 15_MC and_CC over_RP )_) deaths_NN2 in_II ten_MC areas_NN2 of_IO England_NP1 in_II October_NPM1 and_CC November_NPM1 1987_MC ._. 
For_IF these_DD2 deaths_NN2 we_PPIS2 tried_VVD to_TO identify_VVI and_CC then_RT interview_VVI the_AT people_NN who_PNQS could_VM tell_VVI us_PPIO2 most_RRT about_II the_AT last_MD twelve_MC months_NNT2 of_IO the_AT lives_NN2 of_IO the_AT people_NN who_PNQS died_VVD ._. 
Someone_PN1 was_VBDZ interviewed_VVN about_RG 639_MC of_IO the_AT deaths_NN2 ,_, 80_MC per_NNU21 cent_NNU22 of_IO the_AT original_JJ sample_NN1 of_IO 800_MC ._. 
Husbands_NN2 or_CC wives_NN2 were_VBDR seen_VVN about_RG 36_MC per_NNU21 cent_NNU22 of_IO the_AT 639_MC ,_, other_JJ relatives_NN2 about_RG 43_MC per_NNU21 cent_NNU22 ,_, friends_NN2 or_CC neighbours_NN2 about_RG 10_MC per_NNU21 cent_NNU22 ,_, staff_NN of_IO institutions_NN2 about_RG 10_MC per_NNU21 cent_NNU22 and_CC other_JJ officials_NN2 about_II one_MC1 per_NNU21 cent_NNU22 ._. 
Staff_NN of_IO institutions_NN2 responded_VVN about_RG 18_MC per_NNU21 cent_NNU22 of_IO those_DD2 who_PNQS had_VHD been_VBN in_II residential_JJ homes_NN2 for_IF less_DAR than_CSN a_AT1 year_NNT1 ,_, 47_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II one_PN1 for_IF longer_JJR ._. 
In_RR21 general_RR22 ,_, the_AT answers_NN2 from_II different_JJ types_NN2 of_IO respondent_NN1 did_VDD not_XX differ_VVI all_DB that_DD1 widely_RR and_CC the_AT variations_NN2 that_CST emerged_VVD seemed_VVD ,_, for_RR41 the_RR42 most_RR43 part_RR44 ,_, understandable_JJ in_II31 terms_II32 of_II33 the_AT characteristics_NN2 and_CC circumstances_NN2 of_IO the_AT people_NN they_PPHS2 were_VBDR telling_VVG us_PPIO2 about_II ,_, although_CS there_EX did_VDD seem_VVI to_TO be_VBI a_AT1 tendency_NN1 for_IF the_AT staff_NN of_IO homes_NN2 to_TO put_VVI a_AT1 more_RGR rosy_JJ interpretation_NN1 on_II situations_NN2 ._. 
For_IF an_AT1 analysis_NN1 of_IO these_DD2 differences_NN2 ,_, and_CC for_IF further_JJR details_NN2 about_II the_AT study_NN1 ,_, see_VV0 Cartwright_NN1 and_CC Seale_NP1 (_( 1990_MC )_) ._. 
TYPES_NN2 OF_IO HOMES_NN2 AND_CC NUMBERS_NN2 RECEIVING_VVG CARE_VV0 The_AT '_GE homes_NN2 '_GE covered_JJ in_II this_DD1 study_NN1 include_VV0 residential_JJ homes_NN2 for_IF older_JJR people_NN ,_, nursing_VVG homes_NN2 and_CC other_JJ institutions_NN2 excluding_II hospitals_NN2 or_CC hospices_NN2 ._. 
For_IF convenience_NN1 they_PPHS2 are_VBR referred_VVN to_II here_RL as_CSA residential_JJ homes_NN2 ._. 
Fourteen_MC per_NNU21 cent_NNU22 of_IO the_AT sample_NN1 of_IO deaths_NN2 occurred_VVD in_II such_DA homes_NN2 ;_; this_DD1 compares_VVZ with_IW a_AT1 much_RR lower_JJR proportion_NN1 ,_, 5_MC per_NNU21 cent_NNU22 in_II 1969_MC (_( Cartwright_NP1 et_RA21 al._RA22 ,_, 1973_MC )_) ._. 
A_AT1 further_JJR 9_MC per_NNU21 cent_NNU22 of_IO the_AT people_NN who_PNQS died_VVD spent_VVN at_RR21 least_RR22 part_NN1 of_IO the_AT last_MD twelve_MC months_NNT2 of_IO their_APPGE lives_NN2 in_II such_DA homes_NN2 ;_; so_RG almost_RR a_AT1 quarter_NN1 ,_, 23_MC per_NNU21 cent_NNU22 ,_, were_VBDR in_II residential_JJ homes_NN2 at_II some_DD stage_NN1 in_II the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 ._. 
The_AT length_NN1 of_IO time_NNT1 they_PPHS2 spent_VVD there_RL and_CC the_AT types_NN2 of_IO homes_NN2 involved_VVN are_VBR shown_VVN in_II Table_NN1 1_MC1 ._. 
Those_DD2 classed_VVN as_58 '_GE other_JJ homes_NN2 '_GE included_JJ convalescent_JJ homes_NN2 ,_, a_AT1 rehabilitation_NN1 centre_NN1 ,_, an_AT1 assessment_NN1 centre_NN1 ,_, a_AT1 holiday_NN1 home_RL for_IF the_AT disabled_JJ and_CC rest_NN1 homes_NN2 which_DDQ may_VM in_II practice_NN1 have_VH0 been_VBN homes_NN2 for_IF older_JJR people_NN (_( the_AT classification_NN1 was_VBDZ made_VVN on_II the_AT basis_NN1 of_IO the_AT information_NN1 given_VVN by_II the_AT person_NN1 interviewed_VVN )_) ._. 
A_AT1 relatively_RR high_JJ proportion_NN1 of_IO those_DD2 in_II other_JJ types_NN2 of_IO home_NN1 were_VBDR there_RL for_IF less_DAR than_CSN a_AT1 month_NNT1 ._. 
Sixty-two_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II old_JJ people_NN 's_GE homes_NN2 had_VHD been_VBN there_RL for_IF a_AT1 year_NNT1 or_CC more_RRR compared_VVN with_IW 47_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II nursing_JJ homes_NN2 ,_, but_CCB this_DD1 difference_NN1 might_VM have_VHI occurred_VVN by_II chance_NN1 ._. 
Of_IO the_AT old_JJ people_NN 's_GE homes_NN2 ,_, 56_MC per_NNU21 cent_NNU22 were_VBDR said_VVN to_TO be_VBI run_VVN by_II the_AT Council_NN1 ,_, 6_MC per_NNU21 cent_NNU22 by_II a_AT1 charity_NN1 and_CC 39_MC per_NNU21 cent_NNU22 were_VBDR private_JJ ._. 
In_II contrast_NN1 the_AT great_JJ majority_NN1 of_IO nursing_JJ homes_NN2 ,_, 83_MC per_NNU21 cent_NNU22 ,_, were_VBDR privately_RR run_VVN ._. 
Nearly_RR a_AT1 quarter_NN1 of_IO those_DD2 in_II nursing_JJ homes_NN2 had_VHD not_XX had_VHN to_TO pay_VVI towards_II the_AT cost_NN1 of_IO living_VVG there_RL compared_VVN with_IW only_RR 7_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II old_JJ people_NN 's_GE homes_NN2 ._. 
The_AT reason_NN1 for_IF the_AT difference_NN1 seemed_VVD to_TO be_VBI that_CST the_AT DHSS_NP1 paid_VVD for_IF nursing_NN1 home_NN1 treatment_NN1 in_II a_AT1 number_NN1 of_IO instances_NN2 :_: '_" They_PPHS2 took_VVD the_AT pension_NN1 and_CC attendance_NN1 allowance_NN1 and_CC the_AT DHSS_NP1 paid_VVD the_AT rest_NN1 ._. 
'_GE Nevertheless_RR the_AT proportion_NN1 for_IF whom_PNQO payment_NN1 was_VBDZ thought_VVN to_TO have_VHI been_VBN something_PN1 of_IO a_AT1 problem_NN1 was_VBDZ 7_MC per_NNU21 cent_NNU22 of_IO all_DB those_DD2 in_II old_JJ people_NN 's_GE homes_NN2 (_( 15_MC per_NNU21 cent_NNU22 for_IF private_JJ ones_NN2 ,_, 6_MC per_NNU21 cent_NNU22 for_IF others_NN2 )_) and_CC 17_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II nursing_JJ homes_NN2 further_JJR differences_NN2 which_DDQ did_VDD not_XX reach_VVI statistical_JJ significance_NN1 ._. 
WHO_NP1 SPENDS_VVZ ALL_DB OR_CC ANY_DD PART_NN1 OF_IO THE_AT LAST_MD YEAR_NNT1 OF_IO THEIR_APPGE LIFE_NN1 IN_II A_AT1 RESIDENTIAL_JJ HOME_NN1 ?_? 
AGE_NN1 ,_, SEX_NN1 AND_CC FAMILY_NN1 ?_? 
People_NN who_PNQS lived_VVD longer_RRR were_VBDR more_RGR likely_JJ to_TO have_VHI spent_VVN some_DD or_CC all_DB of_IO the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 in_II residential_JJ homes_NN2 ._. 
People_NN have_VH0 been_VBN counted_VVN as_CSA spending_VVG all_DB of_IO the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 in_II residential_JJ homes_NN2 if_CS they_PPHS2 had_VHD lived_VVN in_II one_PN1 for_IF a_AT1 year_NNT1 or_CC more_RRR ._. 
(_( In_II fact_NN1 ,_, as_CSA will_VM be_VBI seen_VVN later_RRR ,_, a_AT1 number_NN1 of_IO them_PPHO2 were_VBDR admitted_VVN to_II hospital_NN1 during_II the_AT last_MD twelve_MC months_NNT2 of_IO their_APPGE lives_NN2 and_CC some_DD died_VVD in_II hospital_NN1 ._. )_) 
Few_DA2 under_RG 75_MC had_VHD spent_VVN any_DD time_NNT1 in_II such_DA homes_NN2 but_CCB more_DAR than_CSN half_DB those_DD2 dying_JJ when_CS they_PPHS2 were_VBDR aged_II 85_MC or_CC more_RRR had_VHD spent_VVN at_RR21 least_RR22 some_DD of_IO the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 in_II one_PN1 ._. 
The_AT figures_NN2 are_VBR in_II Table_NN1 2_MC which_DDQ also_RR shows_VVZ expected_JJ age_NN1 related_JJ differences_NN2 with_IW sex_NN1 and_CC marital_JJ status_NN1 ._. 
Further_JJR analyses_NN2 by_II age_NN1 and_CC marital_JJ status_NN1 showed_VVD that_CST married_JJ people_NN less_RGR often_RR spent_VVN any_DD time_NNT1 in_II residential_JJ homes_NN2 than_CSN single_JJ or_CC previously_RR married_JJ people_NN of_IO the_AT same_DA age_NN1 ._. 
The_AT proportions_NN2 among_II those_DD2 aged_II 75_MC 84_MC were_VBDR 8_MC per_NNU21 cent_NNU22 of_IO the_AT married_JJ ,_, 34_MC per_NNU21 cent_NNU22 of_IO the_AT others_NN2 ,_, and_CC for_IF those_DD2 aged_II 85_MC or_CC more_RRR 25_MC per_NNU21 cent_NNU22 compared_VVN with_IW 61_MC per_NNU21 cent_NNU22 ._. 
Neill_NP1 et_RA21 al._RA22 (_( 1988_MC )_) found_VVD that_CST few_DA2 married_JJ people_NN applied_VVN for_IF residential_JJ care_NN1 and_CC those_DD2 who_PNQS did_VDD so_RR were_VBDR less_RGR likely_JJ to_TO be_VBI admitted_VVN than_CSN applicants_NN2 who_PNQS were_VBDR single_JJ or_CC widowed_JJ ._. 
There_EX were_VBDR no_AT significant_JJ differences_NN2 in_II the_AT present_JJ study_NN1 between_II the_AT never_RR and_CC the_AT previously_RR married_JJ although_CS it_PPH1 might_VM be_VBI expected_VVN that_CST people_NN with_IW children_NN2 might_VM be_VBI less_RGR likely_JJ to_TO go_VVI into_II a_AT1 home_NN1 than_CSN those_DD2 without_IW any_DD and_CC the_AT widowed_JJ ,_, divorced_VVD ,_, or_CC separated_JJ are_VBR much_RR more_RGR likely_JJ to_TO have_VHI children_NN2 than_CSN the_AT single_JJ :_: 75_MC per_NNU21 cent_NNU22 compared_VVN with_IW 6_MC per_NNU21 cent_NNU22 ._. 
An_AT1 analysis_NN1 by_II marital_JJ status_NN1 and_CC number_NN1 of_IO children_NN2 showed_VVD that_CST for_IF the_AT married_JJ the_AT main_JJ difference_NN1 was_VBDZ between_II those_DD2 with_IW no_AT children_NN2 ,_, 17_MC per_NNU21 cent_NNU22 of_IO whom_PNQO had_VHD been_VBN in_II a_AT1 residential_JJ home_NN1 ,_, and_CC those_DD2 with_IW one_MC1 or_CC more_DAR ,_, for_IF whom_PNQO the_AT proportion_NN1 was_VBDZ 5_MC per_NNU21 cent_NNU22 ._. 
For_IF the_AT widowed_JJ or_CC divorced_VVD there_EX was_VBDZ no_AT difference_NN1 between_II those_DD2 with_IW and_CC without_IW children_NN2 nor_CC any_DD significant_JJ trend_NN1 with_IW the_AT number_NN1 of_IO children_NN2 ._. 
So_RR it_PPH1 would_VM seem_VVI that_CST children_NN2 may_VM assist_VVI one_MC1 parent_NN1 to_TO care_VVI for_IF the_AT other_NN1 who_PNQS might_VM otherwise_RR go_VVI into_II a_AT1 home_NN1 ,_, but_CCB apart_II21 from_II22 this_DD1 they_PPHS2 have_VH0 to_TO residential_JJ homes_NN2 for_IF some_DD while_NNT1 caring_VVG for_IF and_CC thus_RR avoiding_VVG the_AT admission_NN1 of_IO others_NN2 ,_, and_CC that_CST these_DD2 two_MC influences_NN2 cancel_VV0 each_PPX221 other_PPX222 out_RP in_II the_AT statistics_NN ._. 
An_AT1 analysis_NN1 by_II the_AT sex_NN1 of_IO children_NN2 showed_VVD no_AT significant_JJ differences_NN2 between_II those_DD2 with_IW a_AT1 son_NN1 or_CC sons_NN2 only_RR and_CC those_DD2 with_IW only_RR a_AT1 daughter_NN1 or_CC daughters_NN2 ._. 
An_AT1 earlier_JJR study_NN1 (_( Cartwright_NP1 et_RA21 al._RA22 ,_, 1973_MC )_) found_VVD that_CST those_DD2 with_IW a_AT1 daughter_NN1 or_CC daughters_NN2 were_VBDR more_RGR likely_JJ to_TO die_VVI in_II their_APPGE own_DA homes_NN2 than_CSN those_DD2 with_IW just_RR a_AT1 son_NN1 or_CC sons_NN2 ._. 
Data_NN in_II Table_NN1 2_MC suggest_VV0 that_CST those_DD2 with_IW living_JJ brothers_NN2 or_CC sisters_NN2 may_VM be_VBI less_RGR likely_JJ to_TO be_VBI admitted_VVN to_II a_AT1 home_NN1 ._. 
Part_NN1 of_IO this_DD1 is_VBZ an_AT1 age_NN1 effect_NN1 :_: the_AT proportion_NN1 with_IW such_DA relatives_NN2 falling_VVG from_II 86_MC per_NNU21 cent_NNU22 of_IO those_DD2 aged_II 45_MC 54_MC to_II 41_MC per_NNU21 cent_NNU22 of_IO those_DD2 aged_II 85_MC or_CC more_RRR ._. 
Among_II those_DD2 aged_II 85_MC or_CC more_RRR a_AT1 similar_JJ proportion_NN1 of_IO those_DD2 with_IW and_CC without_IW living_JJ siblings_NN2 had_VHD been_VBN admitted_VVN to_II a_AT1 home_NN1 at_II some_DD stage_NN1 but_CCB among_II those_DD2 aged_II 75_MC 84_MC more_DAR of_IO those_DD2 without_IW any_DD such_DA relatives_NN2 had_VHD been_VBN admitted_VVN :_: 30_MC per_NNU21 cent_NNU22 compared_VVN with_IW 17_MC per_NNU21 cent_NNU22 ._. 
These_DD2 variations_NN2 reflect_VV0 the_AT fact_NN1 that_CST siblings_NN2 themselves_PPX2 age_NN1 and_CC die_VV0 and_CC therefore_RR become_VV0 less_DAR of_IO a_AT1 source_NN1 of_IO support_NN1 as_CSA people_NN grow_VV0 older_JJR ._. 
CAUSE_NN1 OF_IO DEATH_NN1 People_NN who_PNQS died_VVD of_IO cancer_NN1 were_VBDR less_RGR likely_JJ than_CSN those_DD2 dying_VVG from_II other_JJ causes_NN2 to_TO have_VHI been_VBN in_II such_DA homes_NN2 ,_, 7_MC per_NNU21 cent_NNU22 against_II 29_MC per_NNU21 cent_NNU22 ._. 
The_AT difference_NN1 remains_VVZ when_RRQ the_AT age_NN1 at_II which_DDQ they_PPHS2 die_VV0 is_VBZ taken_VVN into_II account_NN1 ._. 
(_( Cause_NN1 of_IO death_NN1 was_VBDZ taken_VVN from_II the_AT death_NN1 registration_NN1 form_NN1 as_CSA coded_VVN by_II OPCS_NP1 ._. )_) 
When_CS the_AT type_NN1 of_IO home_NN1 was_VBDZ taken_VVN into_II account_NN1 ,_, those_DD2 dying_JJ of_IO respiratory_JJ disease_NN1 were_VBDR more_RGR likely_JJ to_TO have_VHI been_VBN in_II nursing_JJ homes_NN2 14_MC per_NNU21 cent_NNU22 compared_VVN with_IW 6_MC per_NNU21 cent_NNU22 for_IF those_DD2 dying_JJ of_IO other_JJ conditions_NN2 whereas_CS those_DD2 dying_JJ of_IO stroke_NN1 were_VBDR more_RGR likely_JJ to_TO have_VHI been_VBN in_II old_JJ people_NN 's_GE homes_NN2 :_: 27_MC per_NNU21 cent_NNU22 against_II 12_MC per_NNU21 cent_NNU22 ._. 
SELF_NN1 CARE_VV0 The_AT proportions_NN2 reported_VVN to_TO have_VHI had_VHN difficulty_NN1 with_IW various_JJ aspects_NN2 of_IO caring_VVG for_IF themselves_PPX2 (_( getting_VVG in_RP and_CC out_II21 of_II22 a_AT1 bath_NN1 or_CC shower_NN1 ,_, dressing_VVG and_CC undressing_VVG ,_, going_VVG to_II the_AT toilet_NN1 ,_, washing_VVG and_CC shaving_VVG ,_, feeding_VVG themselves_PPX2 ,_, making_VVG a_AT1 hot_JJ drink_NN1 ,_, or_CC needing_VVG help_NN1 at_II night_NNT1 )_) for_IF a_AT1 year_NNT1 or_CC more_RRR before_II death_NN1 was_VBDZ 87_MC per_NNU21 cent_NNU22 of_IO those_DD2 who_PNQS had_VHD been_VBN in_II a_AT1 residential_JJ home_NN1 for_IF a_AT1 year_NNT1 or_CC more_RRR ,_, 60_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_RP for_IF a_AT1 shorter_JJR time_NNT1 and_CC 25_MC per_NNU21 cent_NNU22 of_IO those_DD2 who_PNQS had_VHD not_XX been_VBN in_II such_DA a_AT1 home_NN1 at_RR21 all_RR22 ._. 
(_( People_NN who_PNQS had_VHD been_VBN in_II a_AT1 hospital_NN1 for_IF all_DB the_AT year_NNT1 before_CS they_PPHS2 died_VVD have_VH0 been_VBN excluded_VVN from_II these_DD2 comparisons_NN2 ._. )_) 
But_CCB many_DA2 of_IO the_AT symptoms_NN2 asked_VVD about_II were_VBDR reported_VVN for_IF similar_JJ proportions_NN2 of_IO those_DD2 who_PNQS had_VHD been_VBN in_II residential_JJ homes_NN2 and_CC those_DD2 who_PNQS had_VHD not_XX ;_; these_DD2 were_VBDR pain_NN1 ,_, trouble_NN1 with_IW breathing_NN1 ,_, vomiting_VVG or_CC feeling_VVG sick_JJ ,_, drowsiness_NN1 ,_, sleeplessness_NN1 ,_, dry_JJ mouth_NN1 or_CC thirst_NN1 ,_, depression_NN1 ,_, loss_NN1 of_IO appetite_NN1 ,_, difficulty_NN1 swallowing_VVG ,_, dizziness_NN1 ,_, bed_NN1 sores_NN2 ,_, an_AT1 unpleasant_JJ smell_NN1 ,_, and_CC backache_NN1 ._. 
However_RR ,_, for_IF a_AT1 number_NN1 of_IO these_DD2 symptoms_NN2 ,_, more_DAR people_NN in_II residential_JJ homes_NN2 had_VHD had_VHN them_PPHO2 for_IF a_AT1 year_NNT1 or_CC more_RRR :_: the_AT proportions_NN2 were_VBDR 31_MC per_NNU21 cent_NNU22 against_II 20_MC per_NNU21 cent_NNU22 for_IF drowsiness_NN1 ,_, 22_MC per_NNU21 cent_NNU22 against_II 14_MC per_NNU21 cent_NNU22 for_IF dizziness_NN1 ,_, 19_MC per_NNU21 cent_NNU22 against_II 11_MC per_NNU21 cent_NNU22 for_IF loss_NN1 of_IO appetite_NN1 and_CC 4_MC per_NNU21 cent_NNU22 against_II one_MC1 per_NNU21 cent_NNU22 for_IF bedsores_NN2 ._. 
Only_RR one_MC1 symptom_NN1 ,_, a_AT1 persistent_JJ cough_NN1 ,_, was_VBDZ reported_VVN more_RGR often_RR for_IF those_DD2 who_PNQS had_VHD not_XX been_VBN in_II a_AT1 residential_JJ home_NN1 24_MC per_NNU21 cent_NNU22 compared_VVN with_IW 10_MC per_NNU21 cent_NNU22 of_IO those_DD2 who_PNQS had_VHD spent_VVN some_DD time_NNT1 in_II such_DA a_AT1 home_NN1 ._. 
When_RRQ deaths_NN2 from_II cancer_NN1 were_VBDR excluded_VVN the_AT difference_NN1 remained_VVD :_: 22_MC per_NNU21 cent_NNU22 against_II 9_MC per_NNU21 cent_NNU22 ._. 
SYMPTOMS_NN2 The_AT symptoms_NN2 reported_VVN more_RGR frequently_RR for_IF those_DD2 in_II residential_JJ homes_NN2 are_VBR shown_VVN in_II Table_NN1 3_MC ._. 
Several_DA2 of_IO them_PPHO2 constipation_NN1 ,_, confusion_NN1 ,_, urinary_JJ incontinence_NN1 and_CC difficulty_NN1 seeing_VVG and_CC hearing_NN1 have_VH0 been_VBN shown_VVN elsewhere_RL to_TO increase_VVI with_IW age_NN1 (_( Cartwright_NP1 ,_, 1990a_FO )_) ._. 
Some_DD of_IO them_PPHO2 ,_, such_II21 as_II22 mental_JJ confusion_NN1 ,_, incontinence_NN1 and_CC difficulty_NN1 seeing_VVG and_CC hearing_NN1 ,_, may_VM have_VHI contributed_VVN to_II them_PPHO2 being_VBG admitted_VVN to_II such_DA homes_NN2 ._. 
They_PPHS2 can_VM certainly_RR make_VVI it_PPH1 more_RGR difficult_JJ for_IF people_NN to_TO look_VVI after_II themselves_PPX2 ._. 
And_CC among_II those_DD2 people_NN with_IW confusion_NN1 ,_, constipation_NN1 and_CC incontinence_NN1 ,_, those_DD2 in_II residential_JJ homes_NN2 were_VBDR more_RGR likely_JJ to_TO have_VHI had_VHN the_AT symptoms_NN2 for_IF a_AT1 year_NNT1 or_CC more_RRR ._. 
The_AT figures_NN2 were_VBDR 81_MC per_NNU21 cent_NNU22 compared_VVN with_IW 39_MC per_NNU21 cent_NNU22 for_IF confusion_NN1 ,_, 78_MC per_NNU21 cent_NNU22 and_CC 52_MC per_NNU21 cent_NNU22 for_IF constipation_NN1 ,_, and_CC 54_MC per_NNU21 cent_NNU22 against_II 36_MC per_NNU21 cent_NNU22 for_IF incontinence_NN1 ._. 
Bad_JJ temper_NN1 might_VM result_VVI from_II being_VBG in_II such_DA a_AT1 home_NN1 ._. 
Another_DD1 explanation_NN1 for_IF the_AT relatively_RR high_JJ proportion_NN1 of_IO those_DD2 in_II residential_JJ homes_NN2 reported_VVN to_TO be_VBI bad_RR tempered_VVN could_VM be_VBI that_CST relatives_NN2 ,_, friends_NN2 or_CC neighbours_NN2 were_VBDR less_RGR likely_JJ to_TO report_VVI or_CC perceive_VVI the_AT person_NN1 who_PNQS died_VVD as_CSA being_VBG bad_JJ tempered_JJ than_CSN staff_NN of_IO institutions_NN2 ._. 
Among_II those_DD2 in_II residential_JJ homes_NN2 the_AT frequency_NN1 with_IW which_DDQ bad_JJ temper_NN1 was_VBDZ reported_VVN was_VBDZ 31_MC per_NNU21 cent_NNU22 when_CS the_AT respondent_NN1 was_VBDZ a_AT1 relative_NN1 ,_, friend_NN1 or_CC neighbour_NN1 ,_, 45_MC per_NNU21 cent_NNU22 when_CS he_PPHS1 or_CC she_PPHS1 was_VBDZ a_AT1 staff_NN member_NN1 a_AT1 difference_NN1 which_DDQ did_VDD not_XX reach_VVI statistical_JJ significance_NN1 ._. 
But_CCB if_CS the_AT comparison_NN1 between_II those_DD2 who_PNQS had_VHD been_VBN in_II a_AT1 home_NN1 and_CC others_NN2 is_VBZ confined_VVN to_II those_DD2 for_IF whom_PNQO relatives_NN2 ,_, neighbours_NN2 or_CC friends_NN2 were_VBDR interviewed_VVN ,_, there_EX is_VBZ still_RR a_AT1 difference_NN1 :_: 31_MC per_NNU21 cent_NNU22 against_II 19_MC per_NNU21 cent_NNU22 ._. 
Bad_JJ temper_NN1 could_VM be_VBI either_RR a_AT1 cause_NN1 or_CC effect_NN1 of_IO being_VBG admitted_VVN to_II a_AT1 residential_JJ home_NN1 ._. 
Other_JJ studies_NN2 have_VH0 found_VVN that_CST caring_JJ relatives_NN2 are_VBR more_RGR likely_JJ to_TO favour_VVI residential_JJ care_NN1 as_II a_AT1 solution_NN1 for_IF the_AT elderly_JJ confused_JJ if_CS the_AT old_JJ person_NN1 exhibits_VVZ difficult_JJ behaviour_NN1 (_( Levin_NP1 et_RA21 al._RA22 ,_, 1989_MC )_) ._. 
So_RR the_AT evidence_NN1 suggests_VVZ that_CST because_II21 of_II22 their_APPGE age_NN1 and_CC frailty_NN1 those_DD2 living_VVG in_II residential_JJ homes_NN2 will_VM have_VHI needed_VVN more_DAR care_NN1 during_II the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 than_CSN other_JJ people_NN who_PNQS died_VVD ._. 
CARE_VV0 FROM_II GENERAL_JJ PRACTITIONERS_NN2 People_NN in_II residential_JJ homes_NN2 remain_VV0 under_II the_AT care_NN1 of_IO general_JJ practitioners_NN2 ._. 
The_AT numbers_NN2 of_IO consultations_NN2 ,_, home_NN1 visits_NN2 and_CC night_NNT1 calls_NN2 reported_VVN for_IF those_DD2 in_II such_DA homes_NN2 for_IF a_AT1 year_NNT1 or_CC more_RRR before_CS they_PPHS2 died_VVD are_VBR compared_VVN with_IW those_DD2 for_IF others_NN2 under_II the_AT care_NN1 of_IO a_AT1 general_JJ practitioner_NN1 in_II Table_NN1 4_MC ._. 
As_CSA expected_VVN ,_, those_DD2 in_II residential_JJ homes_NN2 had_VHD more_DAR consultations_NN2 and_CC more_DAR visits_NN2 from_II their_APPGE general_JJ practitioners_NN2 than_CSN others_NN2 ._. 
But_CCB ,_, if_CS anything_PN1 ,_, they_PPHS2 had_VHD rather_RG fewer_DAR night_NNT1 calls_NN2 ._. 
Of_RR21 course_RR22 night_NNT1 calls_NN2 are_VBR usually_RR made_VVN in_II a_AT1 crisis_NN1 and_CC the_AT help_NN1 normally_RR available_JJ in_II residential_JJ homes_NN2 may_VM make_VVI it_PPH1 easier_JJR to_TO cope_VVI with_IW a_AT1 minor_JJ one_PN1 without_IW calling_VVG out_RP a_AT1 doctor_NN1 ._. 
In_II the_AT minority_NN1 of_IO homes_NN2 (_( a_AT1 quarter_NN1 )_) where_CS all_DB the_AT residents_NN2 had_VHD the_AT same_DA doctor_NN1 ,_, visiting_VVG rates_NN2 were_VBDR higher_JJR (_( 16.8_MC a_AT1 year_NNT1 on_II average_NN1 )_) than_CSN in_II the_AT majority_NN1 (_( three-quarters_MF )_) where_RRQ the_AT residents_NN2 could_VM have_VHI different_JJ doctors_NN2 (_( 9.5_MC )_) ._. 
However_RR ,_, the_AT proportions_NN2 for_IF whom_PNQO the_AT general_JJ practitioner_NN1 was_VBDZ described_VVN as_CSA reluctant_JJ to_TO visit_VVI ,_, or_CC for_IF whom_PNQO it_PPH1 was_VBDZ felt_VVN it_PPH1 would_VM have_VHI been_VBN helpful_JJ if_CS the_AT doctor_NN1 had_VHD visited_VVN the_AT person_NN1 who_PNQS died_VVD more_RGR often_RR ,_, did_VDD not_XX vary_VVI significantly_RR between_II the_AT groups_NN2 ._. 
So_RR it_PPH1 would_VM seem_VVI that_CST people_NN in_II homes_NN2 where_CS they_PPHS2 were_VBDR free_JJ to_TO have_VHI a_AT1 doctor_NN1 of_IO their_APPGE own_DA choice_NN1 were_VBDR not_XX seen_VVN as_CSA being_VBG more_RGR deprived_JJ of_IO visits_NN2 in_II31 spite_II32 of_II33 having_VHG fewer_DAR of_IO them_PPHO2 than_CSN people_NN in_II homes_NN2 where_RRQ everyone_PN1 had_VHD the_AT same_DA doctor_NN1 ._. 
Those_DD2 in_II homes_NN2 where_RRQ everyone_PN1 had_VHD the_AT same_DA doctor_NN1 might_VM receive_VVI less_RGR individual_JJ attention_NN1 at_II visits_NN2 if_CS general_JJ practitioners_NN2 saw_VVD several_DA2 patients_NN2 on_II the_AT same_DA visit_NN1 ._. 
The_AT mixture_NN1 of_IO praise_NN1 and_CC criticism_NN1 for_IF general_JJ practitioners_NN2 '_GE care_NN1 of_IO people_NN in_II residential_JJ homes_NN2 was_VBDZ similar_JJ to_II comments_NN2 about_II their_APPGE care_NN1 of_IO others_NN2 during_II the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 ._. 
Although_CS most_DAT respondents_NN2 praised_VVD ,_, or_CC were_VBDR satisfied_VVN with_IW ,_, this_DD1 care_NN1 the_AT study_NN1 identified_VVN a_AT1 number_NN1 of_IO inadequacies_NN2 ._. 
Home_NN1 visits_NN2 were_VBDR much_RR appreciated_VVN when_CS they_PPHS2 happened_VVD but_CCB failure_NN1 to_TO visit_VVI was_VBDZ one_MC1 of_IO the_AT more_RGR common_JJ and_CC significant_JJ criticisms_NN2 (_( Cartwright_NP1 ,_, 1990b_FO )_) ._. 
The_AT matron_NN1 of_IO a_AT1 residential_JJ home_NN1 ,_, talking_VVG about_II a_AT1 doctor_NN1 who_PNQS she_PPHS1 felt_VVD was_VBDZ reluctant_JJ to_TO visit_VVI said_VVD it_PPH1 would_VM have_VHI been_VBN helpful_JJ if_CS the_AT person_NN1 who_PNQS died_VVD had_VHD been_VBN visited_VVN more_RGR often_RR :_: '_" It_PPH1 would_VM have_VHI given_VVN her_PPHO1 a_RR21 lot_RR22 more_DAR comfort_NN1 and_CC the_AT staff_NN a_RR21 lot_RR22 more_DAR confidence_NN1 ._. 
'_" When_RRQ asked_VVD why_RRQ she_PPHS1 thought_VVD the_AT doctor_NN1 had_VHD not_XX come_VVN more_RGR often_RR ,_, she_PPHS1 replied_VVD ,_, '_GE The_AT doctors_NN2 feel_VV0 the_AT residents_NN2 are_VBR in_II a_AT1 rest_NN1 home_RL to_TO save_VVI them_PPHO2 working_VVG ._. 
'_GE The_AT doctor_NN1 had_VHD not_XX been_VBN asked_VVN to_TO come_VVI more_RGR often_RR '_GE because_CS we_PPIS2 're_VBR resigned_VVN to_II the_AT fact_NN1 that_CST ,_, unless_CS it_PPH1 's_VBZ an_AT1 emergency_NN1 ,_, he_PPHS1 wo_VM n't_XX come_VVI out_RP ._. 
'_GE The_AT matron_NN1 also_RR told_VVD us_PPIO2 that_CST this_DD1 patient_NN1 had_VHD to_TO go_VVI into_II a_AT1 nursing_NN1 home_NN1 '_GE towards_II the_AT end_NN1 '_GE because_CS '_" she_PPHS1 needed_VVD morphine_NN1 injections_NN2 which_DDQ the_AT doctor_NN1 would_VM n't_XX give_VVI otherwise_RR she_PPHS1 would_VM n't_XX have_VHI had_VHN to_TO move_VVI to_II somewhere_RL strange_JJ ._. 
She_PPHS1 had_VHD to_TO leave_VVI her_APPGE room_NN1 ,_, her_APPGE furniture_NN1 :_: that_DD1 's_VBZ why_RRQ she_PPHS1 gave_VVD up_RP ._. 
'_GE CARE_NN1 IN_II HOSPITAL_NN1 People_NN who_PNQS had_VHD lived_VVN in_II old_JJ people_NN 's_GE homes_NN2 were_VBDR less_RGR likely_JJ than_CSN others_NN2 who_PNQS died_VVD to_TO have_VHI gone_VVN into_II a_AT1 hospital_NN1 or_CC hospice_NN1 during_II the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 or_CC to_TO die_VVI in_II one_PN1 ._. 
This_DD1 can_VM be_VBI seen_VVN from_II the_AT figures_NN2 in_II Table_NN1 5_MC which_DDQ also_RR suggest_VV0 that_CST the_AT longer_JJR the_AT time_NNT1 they_PPHS2 had_VHD lived_VVN in_II an_AT1 old_JJ people_NN 's_VBZ home_RL the_AT less_RGR likely_JJ they_PPHS2 were_VBDR to_TO go_VVI into_II hospital_NN1 ._. 
But_CCB those_DD2 least_RRT likely_JJ to_TO have_VHI spent_VVN time_NNT1 in_II a_AT1 hospital_NN1 or_CC hospice_NN1 or_CC to_TO die_VVI in_II one_PN1 were_VBDR those_DD2 who_PNQS had_VHD lived_VVN in_II a_AT1 nursing_NN1 home_NN1 for_IF a_AT1 year_NNT1 or_CC more_RRR ._. 
This_DD1 lower_JJR use_NN1 of_IO hospital_NN1 inpatient_NN1 facilities_NN2 was_VBDZ not_XX accounted_VVN for_IF by_II the_AT older_JJR age_NN1 of_IO the_AT people_NN in_II residential_JJ homes_NN2 although_CS fewer_DAR of_IO all_DB those_DD2 aged_II 85_MC or_CC more_RRR had_VHD spent_VVN time_NNT1 in_II hospital_NN1 64_MC per_NNU21 cent_NNU22 against_II 80_MC per_NNU21 cent_NNU22 of_IO those_DD2 under_RG 85_MC ._. 
Among_II this_DD1 older_JJR group_NN1 46_MC per_NNU21 cent_NNU22 of_IO those_DD2 who_PNQS had_VHD been_VBN in_II a_AT1 residential_JJ home_NN1 for_IF a_AT1 year_NNT1 or_CC more_DAR were_VBDR admitted_VVN ,_, 75_MC per_NNU21 cent_NNU22 of_IO the_AT others_NN2 ._. 
There_EX were_VBDR similar_JJ differences_NN2 when_RRQ people_NN dying_VVG of_IO respiratory_JJ disease_NN1 and_CC of_IO cerebrovascular_JJ accident_NN1 were_VBDR considered_VVN separately_RR :_: the_AT proportions_NN2 admitted_VVN to_II hospital_NN1 were_VBDR 25_MC per_NNU21 cent_NNU22 and_CC 47_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II a_AT1 residential_JJ home_NN1 for_IF a_AT1 year_NNT1 or_CC more_RRR ,_, 76_MC per_NNU21 cent_NNU22 and_CC 89_MC per_NNU21 cent_NNU22 of_IO others_NN2 among_II the_AT two_MC causes_NN2 of_IO death_NN1 groups_NN2 respectively_RR ._. 
The_AT numbers_NN2 dying_VVG of_IO other_JJ causes_NN2 were_VBDR too_RG small_JJ to_TO analyse_VVI separately_RR ._. 
The_AT only_JJ source_NN1 of_IO information_NN1 from_II this_DD1 study_NN1 of_IO any_DD possible_JJ reluctance_NN1 to_TO admit_VVI people_NN from_II residential_JJ homes_NN2 to_II hospital_NN1 relates_VVZ to_II those_DD2 who_PNQS were_VBDR admitted_VVN and_CC respondents_NN2 '_GE views_NN2 on_II whether_CSW they_PPHS2 should_VM have_VHI been_VBN admitted_VVN earlier_RRR ._. 
This_DD1 showed_VVD that_CST in_II practice_NN1 relatively_RR few_DA2 ,_, one_MC1 in_II ten_MC ,_, of_IO those_DD2 who_PNQS had_VHD spent_VVN any_DD time_NNT1 in_II residential_JJ homes_NN2 were_VBDR thought_VVN to_TO have_VHI been_VBN admitted_VVN '_GE too_RG late_JJ '_GE ;_; this_DD1 proportion_NN1 was_VBDZ a_AT1 quarter_NN1 for_IF those_DD2 who_PNQS had_VHD not_XX spent_VVN any_DD time_NNT1 in_II a_AT1 residential_JJ home_NN1 ._. 
Residential_JJ homes_NN2 ,_, and_CC long_RR stay_VV0 nursing_JJ homes_NN2 in_RR21 particular_RR22 ,_, appear_VV0 to_TO cut_VVI down_RP the_AT use_NN1 of_IO hospital_NN1 care_NN1 during_II the_AT last_MD year_NNT1 of_IO people_NN 's_GE lives_NN2 ._. 
What_DDQ of_IO the_AT nursing_JJ care_NN1 given_VVN by_II district_NN1 and_CC other_JJ nurses_NN2 to_II those_DD2 in_II old_JJ people_NN 's_GE homes_NN2 ?_? 
HELP_VV0 FROM_II VISITING_JJ NURSES_NN2 Just_RR over_RG a_AT1 third_MD ,_, 35_MC per_NNU21 cent_NNU22 ,_, of_IO those_DD2 who_PNQS had_VHD lived_VVN in_II an_AT1 old_JJ people_NN 's_VBZ home_RL for_IF a_AT1 year_NNT1 or_CC more_RRR had_VHD had_VHN help_NN1 from_II a_AT1 nurse_NN1 who_PNQS visited_VVD the_AT home_NN1 in_II the_AT year_NNT1 before_CS they_PPHS2 died_VVD ._. 
This_DD1 was_VBDZ similar_JJ to_II the_AT proportion_NN1 receiving_VVG help_NN1 from_II district_NN1 and_CC other_JJ nurses_NN2 among_II those_DD2 who_PNQS had_VHD not_XX spent_VVN any_DD time_NNT1 in_II such_DA homes_NN2 once_RR sudden_JJ deaths_NN2 and_CC those_DD2 who_PNQS had_VHD spent_VVN all_DB their_APPGE last_MD year_NNT1 in_II hospital_NN1 have_VH0 been_VBN excluded_VVN ._. 
They_PPHS2 also_RR received_VVD similar_JJ numbers_NN2 of_IO visits_NN2 ._. 
Given_VVN their_APPGE age_NN1 ,_, symptoms_NN2 and_CC frailty_NN1 ,_, it_PPH1 might_VM have_VHI been_VBN thought_VVN that_CST the_AT residents_NN2 of_IO old_JJ people_NN 's_GE homes_NN2 would_VM receive_VVI more_DAR care_NN1 from_II visiting_JJ nurses_NN2 than_CSN people_NN in_II the_AT community_NN1 ,_, as_CSA they_PPHS2 received_VVD more_DAR visits_NN2 from_II general_JJ practitioners_NN2 ._. 
But_CCB some_DD of_IO the_AT less_RGR skilled_JJ tasks_NN2 undertaken_VVN by_II district_NN1 and_CC other_JJ nurses_NN2 for_IF people_NN living_VVG in_II their_APPGE own_DA homes_NN2 were_VBDR probably_RR done_VDN by_II staff_NN in_II the_AT residential_JJ homes_NN2 ._. 
The_AT next_MD section_NN1 looks_VVZ at_II respondents_NN2 '_GE views_NN2 of_IO the_AT care_NN1 given_VVN to_II people_NN in_II residential_JJ and_CC nursing_JJ homes_NN2 and_CC the_AT conditions_NN2 there_RL ._. 
CARE_VV0 AND_CC CONDITIONS_NN2 IN_II THE_AT HOMES_NN2 Almost_RR nine_MC tenths_MF ,_, 88_MC per_NNU21 cent_NNU22 ,_, of_IO the_AT people_NN who_PNQS had_VHD spent_VVN some_DD time_NNT1 in_II a_AT1 residential_JJ home_NN1 were_VBDR said_VVN to_TO have_VHI had_VHN access_NN1 to_II a_AT1 telephone_NN1 where_RRQ they_PPHS2 could_VM make_VVI calls_NN2 and_CC people_NN could_VM telephone_VVI them_PPHO2 ._. 
Among_II those_DD2 who_PNQS did_VDD not_XX have_VHI this_DD1 facility_NN1 ,_, two-fifths_MF were_VBDR thought_VVN to_TO have_VHI wanted_VVN it_PPH1 ._. 
Ninety-two_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II old_JJ people_NN 's_GE homes_NN2 compared_VVN with_IW 82_MC per_NNU21 cent_NNU22 of_IO those_DD2 in_II other_JJ sorts_NN2 of_IO homes_NN2 had_VHD this_DD1 amenity_NN1 a_AT1 difference_NN1 which_DDQ fell_VVD short_JJ of_IO statistical_JJ significance_NN1 but_CCB more_DAR of_IO those_DD2 in_II old_JJ people_NN 's_GE homes_NN2 had_VHD a_AT1 room_NN1 of_IO their_APPGE own_DA ,_, two-thirds_MF against_II half_DB ._. 
Overall_RR the_AT proportion_NN1 with_IW a_AT1 room_NN1 of_IO their_APPGE own_DA was_VBDZ three-fifths_MF and_CC again_RT two-fifths_MF of_IO those_DD2 without_IW one_PN1 were_VBDR thought_VVN to_TO have_VHI wanted_VVN one_PN1 ._. 
If_CS the_AT respondent_NN1 was_VBDZ a_AT1 relative_NN1 ,_, friend_NN1 ,_, or_CC neighbour_NN1 ,_, they_PPHS2 were_VBDR asked_VVN to_TO say_VVI whether_CSW they_PPHS2 thought_VVD various_JJ aspects_NN2 of_IO the_AT home_NN1 were_VBDR good_JJ or_CC not_XX so_RG good_JJ ._. 
The_AT replies_NN2 of_IO those_DD2 who_PNQS felt_VVD able_JK to_TO make_VVI these_DD2 assessments_NN2 are_VBR shown_VVN in_II Table_NN1 6_MC ._. 
Clearly_RR their_APPGE views_NN2 may_VM have_VHI been_VBN different_JJ from_II those_DD2 of_IO the_AT people_NN who_PNQS died_VVD ,_, but_CCB respondents_NN2 are_VBR likely_JJ to_TO have_VHI taken_VVN into_II account_NN1 the_AT reactions_NN2 of_IO their_APPGE relatives_NN2 and_CC friends_NN2 ,_, and_CC how_RRQ these_DD2 respondents_NN2 felt_VVD about_II the_AT care_NN1 in_II the_AT homes_NN2 is_VBZ also_RR of_IO interest_NN1 and_CC concern_NN1 ._. 
The_AT most_RGT frequent_JJ criticism_NN1 was_VBDZ of_IO the_AT food_NN1 ,_, and_CC over_II this_DD1 there_EX was_VBDZ a_AT1 difference_NN1 between_II old_JJ people_NN 's_GE homes_NN2 for_IF which_DDQ 26_MC per_NNU21 cent_NNU22 thought_VVD the_AT food_NN1 '_GE not_XX so_RG good_JJ '_GE and_CC nursing_JJ homes_NN2 for_IF which_DDQ it_PPH1 was_VBDZ 7_MC per_NNU21 cent_NNU22 ._. 
There_EX were_VBDR no_AT differences_NN2 between_II Council_NN1 homes_NN2 and_CC private_JJ ones_NN2 on_II any_DD of_IO these_DD2 assessments_NN2 ,_, nor_CC in_II the_AT amenities_NN2 available_JJ ._. 
And_CC the_AT overall_JJ assessments_NN2 of_IO the_AT homes_NN2 were_VBDR similar_JJ in_II the_AT two_MC groups_NN2 and_CC between_II nursing_JJ homes_NN2 and_CC old_JJ people_NN 's_GE homes_NN2 ._. 
Altogether_RR 50_MC per_NNU21 cent_NNU22 were_VBDR described_VVN as_II '_GE excellent_JJ '_GE ,_, 31_MC per_NNU21 cent_NNU22 as_58 '_GE good_JJ '_GE ,_, 9_MC per_NNU21 cent_NNU22 as_58 '_GE fair_JJ '_GE ,_, 6_MC per_NNU21 cent_NNU22 as_58 '_GE poor_JJ '_GE and_CC one_MC1 per_NNU21 cent_NNU22 as_58 '_GE dreadful_JJ '_GE ,_, with_IW 3_MC per_NNU21 cent_NNU22 making_VVG other_JJ comments_NN2 ._. 
A_AT1 number_NN1 of_IO criticisms_NN2 were_VBDR exacerbated_VVN by_II feelings_NN2 that_CST people_NN were_VBDR in_II the_AT wrong_JJ type_NN1 of_IO institution_NN1 ._. 
A_AT1 son_NN1 whose_DDQGE father_NN1 had_VHD Parkinson_NP1 's_GE disease_NN1 and_CC had_VHD been_VBN in_II an_AT1 old_JJ people_NN 's_GE home_NN1 commented_VVD :_: They_PPHS2 were_VBDR not_XX equipped_VVN to_TO deal_VVI with_IW a_AT1 progressive_JJ condition_NN1 ,_, they_PPHS2 were_VBDR not_XX that_DD1 kind_NN1 of_IO establishment_NN1 ._. 
The_AT degree_NN1 of_IO mental_JJ stimulation_NN1 was_VBDZ absent_JJ ._. 
It_PPH1 was_VBDZ a_AT1 very_RG distressing_JJ time_NNT1 for_IF him_PPHO1 ._. 
The_AT whole_JJ point_NN1 of_IO his_APPGE being_VBG there_RL was_VBDZ because_II21 of_II22 his_APPGE condition_NN1 ._. 
He_PPHS1 could_VM have_VHI been_VBN in_II a_AT1 hotel_NN1 ,_, had_VHD he_PPHS1 not_XX needed_VVN care_NN1 and_CC supervision_NN1 which_DDQ he_PPHS1 blatantly_RR did_VDD not_XX get_VVI ._. 
The_AT daughter_NN1 of_IO a_AT1 woman_NN1 with_IW Huntingdon_NP1 's_GE chorea_NN1 who_PNQS had_VHD been_VBN in_II a_AT1 nursing_NN1 home_NN1 described_VVD the_AT care_NN1 she_PPHS1 got_VVD there_RL as_CSA Limited_VVN not_XX because_CS they_PPHS2 did_VDD n't_XX want_VVI to_TO care_VVI ,_, they_PPHS2 just_RR did_VDD n't_XX know_VVI how_RRQ to_TO care_VVI for_IF this_DD1 type_NN1 of_IO patient_NN1 ...._... 
It_PPH1 should_VM not_XX be_VBI registered_VVN as_II a_AT1 nursing_NN1 home_NN1 ._. 
The_AT one_PN1 '_GE dreadful_JJ '_GE home_NN1 was_VBDZ thought_VVN to_TO have_VHI contributed_VVN to_II the_AT death_NN1 of_IO the_AT man_NN1 admitted_VVD there_RL :_: It_PPH1 was_VBDZ an_AT1 awful_JJ place_NN1 :_: dreary_JJ ,_, badly_RR furnished_VVN and_CC he_PPHS1 was_VBDZ n't_XX as_RG clean_JJ as_CSA he_PPHS1 'd_VHD been_VBN in_II hospital_NN1 food_NN1 all_DB down_RP his_APPGE clothes_NN2 and_CC he_PPHS1 had_VHD n't_XX shaved_VVN ,_, he_PPHS1 really_RR looked_VVN unkempt_JJ ._. 
I_PPIS1 do_VD0 n't_XX think_VVI the_AT staff_NN cared_VVD ._. 
I_PPIS1 'm_VBM sure_JJ the_AT fact_NN1 of_IO moving_VVG to_II the_AT home_NN1 contributed_VVN to_II his_APPGE death_NN1 ._. 
He_PPHS1 was_VBDZ so_RG well_JJ when_CS he_PPHS1 left_VVD hospital_NN1 ..._... and_CC the_AT deterioration_NN1 within_II a_AT1 week_NNT1 was_VBDZ unbelievable_JJ ._. 
I_PPIS1 just_RR feel_VV0 he_PPHS1 gave_VVD up_RP when_CS he_PPHS1 got_VVD in_II that_DD1 home_NN1 ._. 
(_( Died_VVN of_IO Parkinson_NP1 's_GE disease_NN1 and_CC pneumonia_NN1 aged_II 73_MC within_II 24_MC hours_NNT2 of_IO being_VBG readmitted_VVN to_II hospital_NN1 after_II being_VBG in_II an_AT1 old_JJ people_NN 's_VBZ home_RL for_IF less_DAR than_CSN a_AT1 month_NNT1 ._. )_) 
A_AT1 number_NN1 of_IO respondents_NN2 commented_VVN on_II the_AT lack_NN1 of_IO stimulation_NN1 :_: '_" They_PPHS2 sat_VVD in_II the_AT front_JJ room_NN1 and_CC did_VDD n't_XX move_VVI ._. 
Just_RR sat_VVD there_RL ,_, no_AT t.v._NNU and_CC no-one_PN1 seemed_VVD to_TO talk_VVI to_II them_PPHO2 ._. 
'_GE When_CS asked_VVN about_II the_AT other_JJ residents_NN2 in_II the_AT homes_NN2 ,_, respondents_NN2 '_GE views_NN2 were_VBDR roughly_RR equally_RR divided_VVN about_II whether_CSW the_AT person_NN1 who_PNQS died_VVD had_VHD on_II balance_NN1 found_VVD them_PPHO2 helpful_JJ (_( 25_MC per_NNU21 cent_NNU22 )_) or_CC tiresome_JJ (_( 22_MC per_NNU21 cent_NNU22 )_) ._. 
Most_DAT of_IO them_PPHO2 ,_, however_RR ,_, 53_MC per_NNU21 cent_NNU22 ,_, made_VVD other_JJ comments_NN2 ,_, generally_RR to_II the_AT effect_NN1 that_CST the_AT person_NN1 had_VHD had_VHN little_DA1 to_TO do_VDI with_IW other_JJ residents_NN2 :_: '_" Her_APPGE mind_NN1 had_VHD gone_VVN so_CS she_PPHS1 was_VBDZ not_XX able_JK to_TO socialise._NNU ,_, Many_DA2 of_IO the_AT relatives_NN2 and_CC friends_NN2 who_PNQS rated_VVD the_AT homes_NN2 as_II an_AT1 excellent_JJ place_NN1 for_IF the_AT person_NN1 who_PNQS died_VVD to_TO live_VVI towards_II the_AT end_NN1 of_IO his_APPGE or_CC her_APPGE life_NN1 made_VVD rather_RG perfunctory_JJ comments_NN2 :_: '_" I_PPIS1 ca_VM n't_XX fault_VVI the_AT home_NN1 '_GE ;_; '_" It_PPH1 was_VBDZ very_RG nice_JJ ,_, no_AT qualms_NN2 about_II it_PPH1 ._. 
'_GE Others_NN2 were_VBDR rather_RG more_RGR forthcoming_JJ :_: I_PPIS1 would_VM say_VVI that_DD1 ,_, instead_II21 of_II22 '_GE spoon-feeding_NN1 '_GE the_AT residents_NN2 ,_, they_PPHS2 tried_VVD to_TO make_VVI them_PPHO2 independent_JJ ._. 
The_AT staff_NN were_VBDR always_RR there_RL to_TO help_VVI but_CCB did_VDD n't_XX impose_VVI themselves_PPX2 ._. 
This_DD1 was_VBDZ very_RG good_JJ ._. 
And_CC they_PPHS2 kept_VVD her_PPHO1 there_RL when_CS they_PPHS2 could_VM have_VHI sent_VVN her_PPHO1 to_II hospital_NN1 ._. 
(_( Friend_NN1 of_IO woman_NN1 who_PNQS had_VHD had_VHN a_AT1 number_NN1 of_IO strokes_NN2 ._. )_) 
A_AT1 wife_NN1 whose_DDQGE husband_NN1 had_VHD had_VHN multiple_JJ sclerosis_NN1 and_CC went_VVD to_II a_AT1 holiday_NN1 home_RL for_IF the_AT disabled_JJ for_IF two_MC weeks_NNT2 to_TO give_VVI her_PPHO1 a_AT1 rest_NN1 said_VVD :_: It_PPH1 's_VBZ a_AT1 good_JJ idea_NN1 ,_, gets_VVZ them_PPHO2 away_II21 from_II22 home_NN1 to_TO meet_VVI new_JJ people_NN ._. 
They_PPHS2 deserve_VV0 a_AT1 holiday_NN1 like_II everybody_PN1 else_RR ._. 
He_PPHS1 had_VHD a_AT1 good_JJ time_NNT1 ,_, said_VVD he_PPHS1 really_RR enjoyed_VVD it_PPH1 and_CC would_VM like_VVI to_TO go_VVI again_RT ,_, and_CC I_PPIS1 had_VHD all_DB the_AT washing_NN1 done_VDN for_IF me_PPIO1 he_PPHS1 did_VDD n't_XX bring_VVI anything_PN1 home_RL dirty_RR except_II the_AT previous_JJ day_NNT1 's_GE clothes_NN2 ._. 
Sometimes_RT relatives_NN2 and_CC patients_NN2 had_VHD obviously_RR had_VHN different_JJ views_NN2 of_IO the_AT home_NN1 ._. 
One_MC1 daughter-in-law_NN1 who_PNQS rated_VVD the_AT home_NN1 as_CSA excellent_JJ went_VVD on_RP to_TO explain_VVI that_CST her_APPGE mother-in-law_NN1 :_: hated_VVD everything_PN1 about_II everything_PN1 ._. 
We_PPIS2 thought_VVD they_PPHS2 were_VBDR angels_NN2 in_II the_AT home_NN1 and_CC that_CST everything_PN1 was_VBDZ marvellous_JJ ._. 
The_AT staff_NN told_VVD us_PPIO2 she_PPHS1 was_VBDZ the_AT most_RGT difficult_JJ lady_NN1 as_CS31 far_CS32 as_CS33 she_PPHS1 was_VBDZ concerned_JJ nothing_PN1 was_VBDZ right_JJ ._. 
She_PPHS1 had_VHD to_TO share_VVI (_( the_AT bathroom_NN1 and_CC lavatory_NN1 )_) much_RR to_II her_APPGE annoyance_NN1 ,_, but_CCB they_PPHS2 were_VBDR just_RR next_II21 to_II22 her_APPGE room_NN1 ._. 
You_PPY get_VV0 what_DDQ you_PPY pay_VV0 for_IF ._. 
The_AT views_NN2 of_IO people_NN who_PNQS had_VHD previously_RR looked_VVN after_II those_DD2 who_PNQS died_VVD sometimes_RT reflected_VVD their_APPGE gratitude_NN1 and_CC admiration_NN1 for_IF the_AT people_NN who_PNQS took_VVD on_RP this_DD1 task_NN1 ._. 
A_AT1 friend_NN1 of_IO 30_MC years_NNT2 standing_NN1 who_PNQS had_VHD previously_RR cared_VVN for_IF a_AT1 woman_NN1 with_IW senile_JJ dementia_NN1 described_VVD how_RRQ :_: I_PPIS1 thought_VVD she_PPHS1 was_VBDZ just_RR being_VBG awkward_JJ until_CS she_PPHS1 slowly_RR went_VVD downhill_RL and_CC became_VVD incontinent_JJ ._. 
I_PPIS1 got_VVD help_NN1 from_II the_AT social_JJ services_NN2 for_IF this_DD1 :_: they_PPHS2 brought_VVD sheets_NN2 and_CC pillowcases_NN2 from_II the_AT hospital_NN1 ._. 
The_AT crux_NN1 came_VVD when_RRQ she_PPHS1 became_VVD doubly_RR incontinent_JJ and_CC her_APPGE mind_NN1 had_VHD got_VVN to_II the_AT point_NN1 where_RRQ she_PPHS1 had_VHD forgotten_VVN how_RRQ her_APPGE body_NN1 functioned_VVD ._. 
It_PPH1 was_VBDZ winter_NNT1 and_CC I_PPIS1 was_VBDZ changing_VVG her_APPGE clothes_NN2 three_MC times_NNT2 a_AT1 day_NNT1 and_CC my_APPGE self-control_NN1 snapped_VVD and_CC I_PPIS1 shook_VVD her_PPHO1 very_RG hard_JJ to_TO stop_VVI her_PPHO1 sitting_VVG down_RP without_IW her_APPGE pants_NN2 and_CC was_VBDZ so_RR upset_VVN by_II my_APPGE behaviour_NN1 and_CC frightened_VVN by_II what_DDQ I_PPIS1 had_VHD done_VDN that_DD1 they_PPHS2 agreed_VVD to_TO put_VVI her_PPHO1 in_II a_AT1 home_NN1 ._. 
The_AT young_JJ nurses_NN2 were_VBDR very_RG kind_JJ and_CC would_VM kiss_VVI and_CC cuddle_VVI her_PPHO1 ._. 
VISITING_VVG How_RGQ much_DA1 contact_NN1 do_VD0 people_NN in_II residential_JJ homes_NN2 have_VH0 with_IW relatives_NN2 ,_, friends_NN2 ,_, and_CC neighbours_NN2 outside_RL ?_? 
This_DD1 question_NN1 is_VBZ considered_VVN for_IF people_NN who_PNQS had_VHD been_VBN in_II such_DA homes_NN2 for_IF a_AT1 year_NNT1 or_CC more_RRR ._. 
The_AT number_NN1 of_IO different_JJ visitors_NN2 they_PPHS2 were_VBDR reported_VVN to_TO have_VHI had_VHN during_II the_AT last_MD twelve_MC months_NNT2 averaged_VVD 5.0_MC ._. 
Seven_MC per_NNU21 cent_NNU22 had_VHD none_PN ,_, 52_MC per_NNU21 cent_NNU22 had_VHD one_MC1 to_II four_MC ,_, 33_MC per_NNU21 cent_NNU22 five_MC to_II nine_MC ,_, and_CC 8_MC per_NNU21 cent_NNU22 ten_MC or_CC more_RRR ._. 
The_AT number_NN1 of_IO visits_NN2 was_VBDZ much_RR greater_JJR :_: 11_MC per_NNU21 cent_NNU22 had_VHD 300_MC or_CC more_RGR almost_RR one_MC1 a_AT1 day_NNT1 ,_, 33_MC per_NNU21 cent_NNU22 between_II 100_MC and_CC 300_MC two_MC or_CC more_RRR a_AT1 week_NNT1 on_II average_NN1 ,_, 19_MC per_NNU21 cent_NNU22 50_MC 99_MC ,_, between_II one_MC1 and_CC two_MC a_AT1 week_NNT1 ,_, 4_MC per_NNU21 cent_NNU22 2049_MC between_II one_MC1 a_AT1 fortnight_NNT1 and_CC one_MC1 a_AT1 week_NNT1 ,_, 14_MC per_NNU21 cent_NNU22 1019_MC less_DAR than_CSN one_MC1 a_AT1 fortnight_NNT1 ,_, 12_MC per_NNU21 cent_NNU22 had_VHD less_DAR than_CSN 10_MC or_CC less_DAR than_CSN one_MC1 a_AT1 month_NNT1 ._. 
The_AT number_NN1 of_IO visits_NN2 was_VBDZ strongly_RR related_VVN to_II the_AT number_NN1 of_IO visitors_NN2 :_: of_IO those_DD2 with_IW less_DAR than_CSN five_MC visitors_NN2 ,_, a_AT1 quarter_NN1 had_VHD a_AT1 hundred_NNO or_CC more_DAR visits_NN2 ,_, but_CCB this_DD1 proportion_NN1 was_VBDZ three-quarters_MF for_IF those_DD2 with_IW five_MC or_CC more_DAR visitors_NN2 ._. 
Of_IO those_DD2 who_PNQS were_VBDR visited_VVN ,_, 44_MC per_NNU21 cent_NNU22 had_VHD only_JJ relatives_NN2 to_TO see_VVI them_PPHO2 ,_, 11_MC per_NNU21 cent_NNU22 were_VBDR visited_VVN just_RR by_II friends_NN2 or_CC neighbours_NN2 and_CC 45_MC per_NNU21 cent_NNU22 by_II both_RR relatives_NN2 and_CC friends_NN2 ;_; the_AT most_RGT frequent_JJ visitor_NN1 was_VBDZ a_AT1 relative_NN1 for_IF 78_MC per_NNU21 cent_NNU22 and_CC a_AT1 friend_NN1 or_CC neighbour_NN1 for_IF 22_MC per_NNU21 cent_NNU22 ._. 
Three_MC of_IO the_AT five_MC who_PNQS had_VHD no_AT visitors_NN2 were_VBDR said_VVN by_II the_AT people_NN we_PPIS2 interviewed_VVD to_TO have_VHI had_VHN no_AT relatives_NN2 ._. 
Neither_DD1 of_IO the_AT other_JJ two_MC who_PNQS had_VHD no_AT visitors_NN2 had_VHN any_DD children_NN2 ;_; one_PN1 had_VHD elderly_JJ relatives_NN2 abroad_RL ,_, the_AT other_JJ ,_, in_II the_AT opinion_NN1 of_IO the_AT deputy_NN1 officer_NN1 in_II31 charge_II32 of_II33 the_AT home_NN1 ,_, only_RR had_VHN herself_PPX1 to_TO thank_VVI :_: Because_II21 of_II22 her_APPGE awkward_JJ manipulative_JJ ways_NN2 she_PPHS1 just_RR did_VDD n't_XX get_VVI any_DD visitors_NN2 ._. 
She_PPHS1 did_VDD get_VVI visits_NN2 from_II other_JJ visitors_NN2 but_CCB they_PPHS2 wore_VVD off_RP because_II21 of_II22 her_APPGE awkwardness_NN1 ._. 
She_PPHS1 went_VVD out_II21 of_II22 her_APPGE way_NN1 to_TO be_VBI unpleasant_JJ to_II people_NN ._. 
Isaacs_NP1 and_CC his_APPGE colleagues_NN2 (_( 1972_MC )_) found_VVD that_CST relatives_NN2 '_GE failure_NN1 to_TO provide_VVI basic_JJ care_NN1 for_IF elderly_JJ people_NN was_VBDZ often_RR associated_VVN with_IW their_APPGE previous_JJ rejection_NN1 by_II the_AT elderly_JJ person_NN1 ._. 
However_RR ,_, for_IF one_MC1 in_II five_MC of_IO the_AT people_NN in_II residential_JJ homes_NN2 for_IF a_AT1 year_NNT1 or_CC more_RRR ,_, our_APPGE respondents_NN2 said_VVD that_CST there_EX were_VBDR relatives_NN2 who_PNQS they_PPHS2 felt_VVD might_VM have_VHI visited_VVN more_RGR often_RR ._. 
This_DD1 compares_VVZ with_IW one_MC1 in_II four_MC of_IO those_DD2 living_VVG in_II the_AT community_NN1 who_PNQS were_VBDR felt_VVN to_TO have_VHI relatives_NN2 who_PNQS might_VM have_VHI helped_VVN more_RRR a_AT1 difference_NN1 which_DDQ might_VM well_RR occur_VVI by_II chance_NN1 ._. 
QUALITY_NN1 OF_IO LIFE_NN1 Respondents_NN2 were_VBDR asked_VVN whether_CSW they_PPHS2 would_VM describe_VVI the_AT quality_NN1 of_IO life_NN1 of_IO the_AT person_NN1 in_II the_AT year_NNT1 before_CS they_PPHS2 died_VVD as_RG good_JJ ,_, fair_JJ ,_, or_CC poor_JJ ._. 
Two_MC things_NN2 appeared_VVD to_TO affect_VVI this_DD1 assessment_NN1 independently_RR ._. 
One_PN1 was_VBDZ whether_CSW the_AT respondent_NN1 was_VBDZ a_AT1 staff_NN member_NN1 or_CC a_AT1 relative_NN1 ._. 
Those_DD2 spending_VVG any_DD time_NNT1 in_II a_AT1 residential_JJ home_NN1 were_VBDR less_RGR often_RR described_VVN as_II having_VHG a_AT1 poor_JJ quality_NN1 of_IO life_NN1 if_CS the_AT respondent_NN1 was_VBDZ a_AT1 staff_NN member_NN1 than_CSN if_CS he_PPHS1 or_CC she_PPHS1 was_VBDZ a_AT1 relative_NN1 :_: 10_MC per_NNU21 cent_NNU22 compared_VVN with_IW 42_MC per_NNU21 cent_NNU22 ._. 
This_DD1 probably_RR reflects_VVZ the_AT perceptions_NN2 of_IO the_AT respondents_NN2 rather_II21 than_II22 a_AT1 real_JJ difference_NN1 in_II the_AT actual_JJ quality_NN1 of_IO life_NN1 of_IO the_AT people_NN who_PNQS died_VVD ,_, although_CS staff_NN members_NN2 may_VM have_VHI been_VBN more_RGR willing_JJ to_TO act_VVI as_CSA respondents_NN2 for_IF residents_NN2 they_PPHS2 had_VHD got_VVN on_II well_RR with_IW ,_, and_CC those_DD2 residents_NN2 may_VM have_VHI had_VHN a_AT1 better_JJR quality_NN1 of_IO life_NN1 because_II21 of_II22 their_APPGE relationship_NN1 with_IW the_AT staff_NN ._. 
The_AT other_JJ factor_NN1 that_CST was_VBDZ related_VVN to_II assessments_NN2 of_IO quality_NN1 of_IO life_NN1 was_VBDZ whether_CSW people_NN had_VHD been_VBN in_II a_AT1 residential_JJ home_NN1 for_IF a_AT1 year_NNT1 or_CC more_RRR or_CC for_IF a_AT1 shorter_JJR time_NNT1 ._. 
Taking_VVG all_DB types_NN2 of_IO respondents_NN2 together_RL their_APPGE ratings_NN2 were_VBDR similar_JJ for_IF people_NN who_PNQS had_VHD not_XX been_VBN in_II a_AT1 residential_JJ home_NN1 at_RR21 all_RR22 and_CC those_DD2 who_PNQS had_VHD been_VBN in_II one_PN1 for_IF a_AT1 year_NNT1 or_CC more_RRR ,_, while_CS those_DD2 who_PNQS had_VHD only_RR spent_VVN part_NN1 of_IO the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 in_II a_AT1 residential_JJ home_NN1 were_VBDR generally_RR felt_VVN to_TO have_VHI had_VHN a_AT1 worse_JJR quality_NN1 of_IO life_NN1 :_: for_IF 39_MC per_NNU21 cent_NNU22 of_IO them_PPHO2 it_PPH1 was_VBDZ rated_VVN as_CSA poor_JJ compared_VVN with_IW 27_MC per_NNU21 cent_NNU22 of_IO the_AT other_JJ two_MC groups_NN2 ._. 
The_AT difference_NN1 between_II those_DD2 spending_VVG all_DB and_CC those_DD2 spending_VVG some_DD of_IO the_AT last_MD twelve_MC months_NNT2 in_II a_AT1 home_NN1 persisted_VVN when_CS the_AT analysis_NN1 is_VBZ confined_VVN to_II those_DD2 for_IF whom_PNQO relatives_NN2 responded_VVD ._. 
This_DD1 can_VM be_VBI seen_VVN in_II Table_NN1 7_MC ._. 
In_RR21 addition_RR22 ,_, among_II those_DD2 for_IF whom_PNQO a_AT1 staff_NN member_NN1 responded_VVD only_RR one_MC1 in_II twelve_MC of_IO those_DD2 admitted_VVN during_II the_AT last_MD year_NNT1 of_IO the_AT life_NN1 was_VBDZ felt_VVN to_TO have_VHI had_VHN a_AT1 good_JJ quality_NN1 of_IO life_NN1 during_II that_DD1 time_NNT1 compared_VVN with_IW nearly_RR half_RR (_( 46_MC per_NNU21 cent_NNU22 )_) of_IO those_DD2 who_PNQS had_VHD been_VBN in_II a_AT1 home_NN1 for_IF a_AT1 year_NNT1 or_CC more_RRR ._. 
One_MC1 possible_JJ explanation_NN1 for_IF these_DD2 findings_NN2 is_VBZ that_CST people_NN take_VV0 time_NNT1 to_TO adjust_VVI to_II living_VVG in_II residential_JJ homes_NN2 ._. 
Another_DD1 possibility_NN1 is_VBZ that_CST those_DD2 going_VVG into_II residential_JJ homes_NN2 shortly_RR before_II their_APPGE death_NN1 do_VD0 so_RR in_II a_AT1 crisis_NN1 situation_NN1 ._. 
Weaver_NP1 and_CC his_APPGE colleagues_NN2 (_( 1985_MC )_) found_VVD that_CST residents_NN2 most_RRT able_JK to_TO come_VVI to_II terms_NN2 with_IW admission_NN1 were_VBDR those_DD2 who_PNQS had_VHD exercised_VVN some_DD degree_NN1 of_IO control_NN1 or_CC choice_NN1 in_II entering_VVG residential_JJ care_NN1 ._. 
Findings_NN2 from_II the_AT present_JJ study_NN1 suggest_VV0 that_CST once_CS people_NN had_VHD become_VVN established_VVN in_II the_AT homes_NN2 their_APPGE quality_NN1 of_IO life_NN1 ,_, in_II the_AT opinion_NN1 of_IO their_APPGE relatives_NN2 ,_, was_VBDZ similar_JJ to_II that_DD1 of_IO other_JJ people_NN who_PNQS died_VVD and_CC had_VHD never_RR been_VBN in_II such_DA homes_NN2 ._. 
DISCUSSION_NN1 Most_DAT of_IO the_AT people_NN ,_, just_RR over_RG two_MC thirds_MF ,_, who_PNQS spent_VVD all_DB the_AT last_MD year_NNT1 of_IO their_APPGE life_NN1 in_II a_AT1 residential_JJ or_CC nursing_NN1 home_NN1 were_VBDR 85_MC or_CC more_RRR ,_, and_CC it_PPH1 is_VBZ this_DD1 age_NN1 group_NN1 which_DDQ is_VBZ predicted_VVN to_TO increase_VVI most_RGT rapidly_RR in_II the_AT next_MD twenty_MC years_NNT2 (_( Central_JJ Statistical_JJ Office_NN1 (_( CSO_NP1 )_) ,_, 1989_MC )_) so_CS it_PPH1 is_VBZ likely_JJ that_CST increasing_JJ numbers_NN2 will_VM spend_VVI the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 in_II such_DA homes_NN2 ._. 
But_CCB this_DD1 increase_NN1 may_VM not_XX be_VBI as_RG great_JJ as_CSA the_AT rise_NN1 in_II the_AT numbers_NN2 of_IO older_JJR people_NN if_CS there_EX is_VBZ an_AT1 improvement_NN1 in_II their_APPGE state_NN1 of_IO fitness_NN1 as_CSA Jefferys_NP1 and_CC Thane_NP1 (_( 1989_MC )_) suggest_VV0 ._. 
The_AT symptoms_NN2 that_CST were_VBDR more_RGR common_JJ among_II those_DD2 in_II residential_JJ homes_NN2 ,_, particularly_RR confusion_NN1 ,_, incontinence_NN1 ,_, and_CC bad_JJ temper_NN1 ,_, indicate_VV0 some_DD of_IO the_AT problems_NN2 in_II making_VVG these_DD2 homes_NN2 attractive_JJ and_CC stimulating_JJ places_NN2 to_TO live_VVI ._. 
The_AT description_NN1 of_IO one_MC1 man_NN1 of_IO ninety-four_MC illustrates_VVZ many_DA2 of_IO the_AT difficulties_NN2 :_: He_PPHS1 was_VBDZ n't_XX ill_JJ ,_, it_PPH1 was_VBDZ just_RR general_JJ deterioration_NN1 ._. 
He_PPHS1 was_VBDZ still_RR quite_RG active_JJ for_IF his_APPGE age_NN1 ,_, but_CCB his_APPGE mental_JJ deterioration_NN1 was_VBDZ the_AT problem_NN1 he_PPHS1 'd_VHD lost_VVN his_APPGE sense_NN1 of_IO direction_NN1 ._. 
He_PPHS1 found_VVD it_PPH1 difficult_JJ to_TO accept_VVI his_APPGE own_DA failings_NN2 ._. 
Memory_NN1 loss_NN1 was_VBDZ the_AT worst_JJT aspect_NN1 ,_, the_AT fact_NN1 that_CST he_PPHS1 was_VBDZ unable_JK to_TO complete_VVI a_AT1 crossword_NN1 puzzle_NN1 in_II ten_MC minutes_NNT2 as_CSA he_PPHS1 once_RR could_VM troubled_VVD him_PPHO1 ._. 
He_PPHS1 was_VBDZ suffering_VVG from_II frustration_NN1 ._. 
He_PPHS1 was_VBDZ worried_VVN because_CS he_PPHS1 was_VBDZ deaf_JJ ,_, worried_VVN because_II21 of_II22 his_APPGE bowels_NN2 ._. 
He_PPHS1 worried_VVD a_AT1 lot_NN1 ._. 
He_PPHS1 was_VBDZ ,_, I_PPIS1 think_VV0 ,_, unhappy_JJ and_CC tired_JJ ._. 
He_PPHS1 often_RR said_VVD he_PPHS1 'd_VHD had_VHN enough_DD of_IO living_NN1 and_CC was_58 '_GE ready_JJ to_TO go_VVI '_GE was_VBDZ how_RRQ he_PPHS1 put_VVD it_PPH1 ._. 
(_( Died_VVN from_II falling_VVG down_RP a_AT1 flight_NN1 of_IO steps_NN2 and_CC fracturing_VVG his_APPGE skull_NN1 ._. )_) 
That_DD1 man_NN1 was_VBDZ admitted_VVN to_II hospital_NN1 after_II his_APPGE fall_NN1 and_CC died_VVD there_RL within_II a_AT1 week_NNT1 without_IW regaining_VVG consciousness_NN1 ._. 
But_CCB in_RR21 general_RR22 people_NN living_VVG in_II residential_JJ homes_NN2 were_VBDR less_RGR likely_JJ than_CSN others_NN2 either_RR to_TO die_VVI in_RP ,_, or_CC to_TO be_VBI admitted_VVN to_II ,_, hospital_NN1 during_II the_AT last_MD year_NNT1 of_IO their_APPGE lives_NN2 ._. 
Residential_JJ homes_NN2 seem_VV0 to_TO cut_VVI down_RP the_AT use_NN1 of_IO hospital_NN1 care_NN1 ;_; they_PPHS2 probably_RR also_RR reduce_VV0 the_AT need_NN1 for_IF it_PPH1 ,_, but_CCB this_DD1 is_VBZ less_RGR certain_JJ ._. 
They_PPHS2 may_VM also_RR reduce_VVI the_AT demand_NN1 and_CC need_VVI for_IF night_NNT1 calls_VVZ from_II general_JJ practitioners_NN2 and_CC ,_, taking_VVG into_II account_NN1 the_AT age_NN1 and_CC frailty_NN1 of_IO residents_NN2 ,_, the_AT pressures_NN2 on_II the_AT district_NN1 nursing_NN1 service_NN1 ._. 
Because_II21 of_II22 the_AT nature_NN1 of_IO the_AT sample_NN1 this_DD1 study_NN1 could_VM not_XX ascertain_VVI the_AT views_NN2 of_IO residents_NN2 themselves_PPX2 ._. 
Others_NN2 who_PNQS have_VH0 done_VDN so_RR have_VH0 argued_VVN that_CST elderly_JJ people_NN are_VBR often_RR faced_VVN with_IW a_AT1 choice_NN1 between_II an_AT1 unpleasant_JJ battle_NN1 to_TO survive_VVI in_II their_APPGE own_DA homes_NN2 and_CC an_AT1 equally_RR unpleasant_JJ enforced_JJ dependence_NN1 in_II the_AT institution_NN1 (_( Wilkin_NP1 and_CC Hughes_NP1 ,_, 1987_MC )_) ._. 
In_II this_DD1 study_NN1 relatives_NN2 and_CC friends_NN2 generally_RR thought_VVN conditions_NN2 in_II the_AT home_NN1 were_VBDR '_GE good_JJ '_GE rather_II21 than_II22 '_" not_XX so_RG good_JJ '_GE ,_, although_CS a_AT1 number_NN1 of_IO their_APPGE comments_NN2 and_CC descriptions_NN2 indicate_VV0 that_CST circumstances_NN2 were_VBDR sometimes_RT far_RG21 from_RG22 ideal_JJ and_CC analysis_NN1 of_IO respondents_NN2 '_GE views_NN2 of_IO the_AT quality_NN1 of_IO life_NN1 suggest_VV0 that_CST the_AT initial_JJ period_NN1 after_II admission_NN1 may_VM be_VBI particularly_RR stressful_JJ for_IF residents_NN2 ._. 
While_CS most_DAT residents_NN2 were_VBDR in_II fairly_RR frequent_JJ contact_NN1 with_IW relatives_NN2 and_CC friends_NN2 from_II outside_RL the_AT home_NN1 ,_, one_MC1 in_II five_MC of_IO those_DD2 who_PNQS spent_VVD all_DB the_AT last_MD twelve_MC months_NNT2 of_IO their_APPGE lives_NN2 in_II a_AT1 home_NN1 had_VHD either_RR no_AT visitors_NN2 at_RR21 all_RR22 or_CC less_DAR than_CSN one_MC1 visit_VV0 a_AT1 month_NNT1 ._. 
Becoming_VVG old_JJ and_CC frail_JJ can_VM be_VBI distressing_JJ ;_; to_TO be_VBI also_RR isolated_VVN from_II relatives_NN2 and_CC friends_NN2 seems_VVZ dire_JJ ._. 
The_AT task_NN1 of_IO relieving_JJ avoidable_JJ distress_NN1 and_CC creating_VVG a_AT1 caring_NN1 and_CC heartening_JJ environment_NN1 in_II residential_JJ and_CC nursing_JJ homes_NN2 is_VBZ going_VVGK to_TO be_VBI of_IO increasing_JJ importance_NN1 in_II determining_VVG the_AT quality_NN1 of_IO the_AT last_MD year_NNT1 of_IO people_NN 's_GE lives_NN2 ._. 
How_RRQ can_VM we_PPIS2 Measure_VV0 the_AT Effects_NN2 of_IO Client_NN1 Participation_NN1 on_II the_AT Effectiveness_NN1 of_IO Social_JJ Work_NN1 Intervention_NN1 ?_? 
ALAN_NP1 S._NP1 YORK_NP1 and_CC HAYA_NP1 ITZHAKY_NP1 Alan_NP1 York_NP1 was_VBDZ born_VVN in_II England_NP1 and_CC received_VVN his_APPGE BA_NN1 (_( in_II law_NN1 )_) from_II Trinity_NP1 College_NN1 ,_, Oxford_NP1 in_II 1962_MC ._. 
In_II 1963_MC he_PPHS1 emigrated_VVD to_II Israel_NP1 ,_, took_VVD a_AT1 certificate_NN1 in_II Community_NN1 Social_JJ Work_NN1 in_II Tel_NP1 Aviv_NP1 and_CC worked_VVD as_II a_AT1 community_NN1 worker_NN1 in_II an_AT1 immigrant_JJ development_NN1 town_NN1 ._. 
He_PPHS1 returned_VVD to_II England_NP1 in_II 1970_MC and_CC took_VVD his_APPGE MA_NN1 in_II Social_JJ Work_NN1 at_II Leicester_NP1 in_II 1972_MC ._. 
He_PPHS1 received_VVD his_APPGE doctorate_NN1 (_( in_II sociology_NN1 )_) at_II Bar-Ilan_JJ University_NN1 ,_, Ramat-Gan_NP1 ,_, Israel_NP1 in_II 1979_MC ._. 
Haya_NP1 Itzhaky_NP1 was_VBDZ born_VVN and_CC brought_VVN up_RP in_II Israel_NP1 and_CC graduated_VVN from_II the_AT School_NN1 of_IO Social_JJ Work_NN1 at_II Bar-Ilan_JJ University_NN1 in_II 1973_MC ._. 
She_PPHS1 worked_VVD as_II a_AT1 community_NN1 worker_NN1 in_II an_AT1 immigrant_JJ village_NN1 ,_, and_CC took_VVD her_APPGE MA_NN1 (_( in_II social_JJ work_NN1 )_) and_CC her_APPGE doctorate_NN1 (_( in_II sociology_NN1 )_) in_II Bar-Ilan_NN1 ._. 
Both_RR Dr_NNB York_NP1 and_CC Dr_NNB Itzhaky_NP1 teach_VV0 in_II the_AT School_NN1 of_IO Social_JJ Work_NN1 at_II Bar-Ilan_JJ University_NN1 ,_, where_CS they_PPHS2 are_VBR in_II31 charge_II32 of_II33 the_AT community_NN1 work_NN1 specialization_NN1 ._. 
SUMMARY_NN1 This_DD1 paper_NN1 examines_VVZ the_AT concepts_NN2 of_IO client_NN1 or_CC citizen_NN1 participation_NN1 in_II community_NN1 work_NN1 and_CC of_IO effectiveness_NN1 in_II social_JJ work_NN1 and_CC other_JJ related_JJ fields_NN2 ._. 
It_PPH1 surveys_VVZ and_CC summarizes_VVZ the_AT literature_NN1 in_II these_DD2 two_MC fields_NN2 ,_, focusing_VVG on_II how_RRQ the_AT two_MC key_JJ concepts_NN2 are_VBR empirically_RR measured_VVN ._. 
After_II examining_VVG the_AT literature_NN1 on_II the_AT effects_NN2 of_IO citizen_NN1 participation_NN1 on_II community_NN1 work_NN1 intervention_NN1 ,_, the_AT paper_NN1 puts_VVZ forward_RL an_AT1 operative_JJ model_NN1 for_IF both_RR researchers_NN2 and_CC practitioners_NN2 to_TO measure_VVI how_RRQ the_AT participation_NN1 of_IO clients_NN2 can_VM make_VVI community_NN1 work_NN1 more_RGR effective_JJ and_CC productive_JJ ._. 
The_AT underlying_JJ assumption_NN1 (_( or_CC ,_, more_RGR accurately_RR ,_, hypothesis_NN1 )_) of_IO this_DD1 paper_NN1 is_VBZ that_DD1 client_NN1 participation_NN1 makes_VVZ for_IF a_AT1 better_JJR social_JJ work_NN1 intervention_NN1 ,_, and_CC thus_RR the_AT higher_JJR the_AT degree_NN1 of_IO client_NN1 participation_NN1 the_AT more_RGR effective_JJ the_AT intervention_NN1 will_VM be_VBI (_( Kurzman_NP1 and_CC Solomon_NP1 ,_, 1970_MC ;_; Freedberg_NP1 ,_, 1989_MC ;_; York_NP1 ,_, 1989_MC )_) ._. 
In_II Bernstein_NP1 's_GE words_NN2 :_: we_PPIS2 find_VV0 that_CST imposing_JJ ,_, telling_VVG or_CC giving_VVG orders_NN2 do_VD0 not_XX work_VVI well_RR ._. 
Only_RR as_CSA the_AT client_NN1 is_VBZ thoroughly_RR involved_VVN and_CC comes_VVZ to_TO accept_VVI on_II deepening_JJ levels_NN2 the_AT process_NN1 of_IO change_NN1 can_VM our_APPGE methods_NN2 be_VBI effective_JJ in_II31 relation_II32 to_II33 our_APPGE goals_NN2 (_( Bernstein_NP1 ,_, 1960_MC ,_, p._NN1 8_MC )_) ._. 
Most_DAT of_IO the_AT debate_NN1 on_II the_AT validity_NN1 and_CC primacy_NN1 of_IO client_NN1 self-determination_NN1 has_VHZ taken_VVN place_NN1 within_II the_AT casework_NN1 context_NN1 (_( Bernstein_NP1 ,_, 1960_MC ;_; McDermott_NP1 ,_, 1975_MC ;_; Freedberg_NP1 ,_, 1989_MC )_) where_RRQ the_AT elements_NN2 of_IO eligibility_NN1 ,_, statutory_JJ rights_NN2 ,_, social_JJ control_NN1 and_CC professional_JJ authority_NN1 may_VM be_VBI of_IO central_JJ importance_NN1 (_( Rothman_NP1 ,_, 1989_MC ;_; Spicker_NP1 ,_, 1990_MC )_) ._. 
This_DD1 paper_NN1 will_VM consider_VVI the_AT issue_NN1 in_II the_AT context_NN1 of_IO community_NN1 work_NN1 ,_, in_II which_DDQ the_AT elements_NN2 accentuated_VVD by_II Rothman_NP1 are_VBR of_IO less_DAR consequence_NN1 and_CC client_NN1 participation_NN1 has_VHZ indisputably_RR remained_VVN a_AT1 primary_JJ value_NN1 ._. 
We_PPIS2 are_VBR currently_RR engaged_VVN on_II a_AT1 research_NN1 project_NN1 that_CST seeks_VVZ to_TO test_VVI empirically_RR whether_CSW client_NN1 participation_NN1 does_VDZ indeed_RR increase_VVI the_AT effectiveness_NN1 of_IO community_NN1 work_NN1 intervention_NN1 ._. 
We_PPIS2 found_VVD much_DA1 literature_NN1 on_II client_NN1 participation_NN1 and_CC even_RR more_RRR on_II effectiveness_NN1 ,_, but_CCB there_EX is_VBZ considerable_JJ controversy_NN1 on_II how_RRQ to_TO measure_VVI these_DD2 variables_NN2 ._. 
Thus_RR the_AT scarce_JJ research_NN1 work_NN1 on_II the_AT effects_NN2 of_IO participation_NN1 on_II effectiveness_NN1 is_VBZ further_RRR limited_VVN by_II its_APPGE inability_NN1 clearly_RR to_TO define_VVI (_( and_CC to_TO measure_VVI )_) what_DDQ it_PPH1 is_VBZ studying_VVG ._. 
In_II this_DD1 paper_NN1 ,_, we_PPIS2 shall_VM review_VVI the_AT relevant_JJ literature_NN1 ,_, including_II that_DD1 from_II other_JJ applied_JJ social_JJ sciences_NN2 ,_, and_CC show_VV0 the_AT operative_JJ implications_NN2 for_IF research_NN1 and_CC practice_NN1 ._. 
The_AT first_MD section_NN1 will_VM review_VVI the_AT literature_NN1 on_II client_NN1 participation_NN1 and_CC its_APPGE measurement_NN1 ,_, and_CC the_AT second_MD section_NN1 will_VM summarize_VVI the_AT '_GE state_NN1 of_IO the_AT art_NN1 '_GE in_II the_AT measurement_NN1 of_IO effectiveness_NN1 ,_, stressing_VVG evaluation_NN1 of_IO community_NN1 work_NN1 intervention_NN1 ._. 
The_AT third_MD section_NN1 will_VM review_VVI the_AT published_JJ research_NN1 linking_VVG participation_NN1 and_CC effectiveness_NN1 in_II social_JJ work_NN1 and_CC other_JJ human_JJ welfare_NN1 interventions_NN2 and_CC programmes_NN2 ._. 
If_CS these_DD2 researchers_NN2 had_VHD succeeded_VVN in_II measuring_VVG operatively_RR and_CC empirically_RR what_DDQ degree_NN1 of_IO participation_NN1 was_VBDZ achieved_VVN and_CC how_RRQ this_DD1 affected_VVD the_AT degree_NN1 of_IO effectiveness_NN1 ,_, then_RT our_APPGE search_NN1 would_VM have_VHI been_VBN finished_VVN ._. 
The_AT reader_NN1 will_VM have_VHI guessed_VVN ,_, no_RR21 doubt_RR22 ,_, that_CST the_AT quest_NN1 was_VBDZ unsuccessful_JJ ,_, and_CC so_RR the_AT final_JJ section_NN1 will_VM suggest_VVI an_AT1 operative_JJ model_NN1 with_IW practical_JJ implications_NN2 for_IF community_NN1 work_NN1 practitioners_NN2 and_CC researchers_NN2 ._. 
WHAT_DDQ IS_VBZ CLIENT_NN1 PARTICIPATION_NN1 AND_CC HOW_RRQ CAN_VM WE_PPIS2 MEASURE_VVI IT_PPH1 ?_? 
Traditionally_RR social_JJ workers_NN2 have_VH0 espoused_VVN client_NN1 self-determination_NN1 ,_, the_AT right_NN1 of_IO the_AT clients_NN2 to_TO participate_VVI in_II decisions_NN2 affecting_VVG their_APPGE lives_NN2 and_CC interests_NN2 (_( Kurzman_NP1 and_CC Solomon_NP1 ,_, 1970_MC ;_; Gilbert_NP1 and_CC Specht_NP1 ,_, 1976_MC )_) ._. 
Many_DA2 and_CC varied_JJ reasons_NN2 have_VH0 been_VBN put_VVN forward_RL for_IF this_DD1 basic_JJ element_NN1 of_IO practice_NN1 ,_, but_CCB they_PPHS2 can_VM be_VBI summarized_VVN under_RG three_MC headings_NN2 :_: ideological_JJ reasons_NN2 (_( the_AT right_NN1 of_IO a_AT1 person_NN1 to_TO decide_VVI for_IF himself_PPX1 or_CC the_AT recognition_NN1 of_IO this_DD1 as_II an_AT1 existential_JJ reality_NN1 )_) ,_, educational_JJ and_CC developmental_JJ reasons_NN2 (_( participation_NN1 as_II part_NN1 of_IO human_JJ growth_NN1 and_CC development_NN1 ,_, for_IF the_AT individual_NN1 ,_, the_AT family_NN1 ,_, the_AT group_NN1 ,_, the_AT organization_NN1 or_CC the_AT community_NN1 )_) ,_, and_CC political_JJ reasons_NN2 (_( participation_NN1 as_II a_AT1 means_NN to_II enfranchisement_NN1 and_CC empowerment_NN1 ,_, an_AT1 antidote_NN1 to_II alienation_NN1 )_) (_( Ross_NP1 ,_, 1960_MC ;_; Bernstein_NP1 ,_, 1960_MC ;_; Katan_NP1 ,_, 1980_MC ;_; Freedberg_NP1 ,_, 1989_MC ;_; Rothman_NP1 ,_, 1989_MC )_) ._. 
Freedberg_NP1 (_( 1989_MC )_) has_VHZ shown_VVN how_RGQ social_JJ workers_NN2 have_VH0 applied_VVN the_AT principle_NN1 in_II different_JJ ways_NN2 at_II different_JJ times_NNT2 ._. 
Bernstein_NP1 (_( 1960_MC )_) puts_VVZ forward_JJ limitations_NN2 on_II self-determination_NN1 ,_, and_CC shows_VVZ how_RRQ it_PPH1 stems_VVZ from_II '_GE the_AT supreme_JJ social_JJ work_NN1 value_NN1 ..._... human_JJ worth_NN1 '_GE (_( p._NNU 7_MC )_) ._. 
Thus_RR self-determination_NN1 is_VBZ not_XX an_AT1 absolute_JJ value_NN1 ,_, but_CCB it_PPH1 is_58 '_GE supremely_RR important_JJ ._. 
Only_RR through_II the_AT rich_JJ utilization_NN1 of_IO this_DD1 concept_NN1 can_VM we_PPIS2 fully_RR honor_VVI the_AT human-worth_JJ value_NN1 '_GE (_( p._NNU 8_MC )_) ._. 
Rothman_NP1 (_( 1989_MC )_) extends_VVZ Bernstein_NP1 's_GE critique_NN1 and_CC suggests_VVZ that_CST many_DA2 social_JJ workers_NN2 use_VV0 manipulative_JJ and_CC directive_NN1 techniques_NN2 under_II the_AT guise_NN1 of_IO self-determination_NN1 ._. 
He_PPHS1 suggests_VVZ the_AT construction_NN1 of_IO a_AT1 continuum_NN1 of_IO categories_NN2 ,_, each_DD1 with_IW its_APPGE set_NN1 of_IO conditional_JJ factors_NN2 ,_, in_II which_DDQ the_AT practitioner_NN1 could_VM decide_VVI upon_II the_AT degree_NN1 of_IO directiveness_NN1 or_CC non-directiveness_NN1 needed_VVN in_II a_AT1 specific_JJ situation_NN1 ._. 
Almost_RR all_DB the_AT examples_NN2 he_PPHS1 gives_VVZ for_IF a_AT1 restriction_NN1 of_IO client_NN1 participation_NN1 are_VBR atypical_JJ of_IO a_AT1 community_NN1 work_NN1 situation_NN1 ._. 
Defined_VVN simply_RR (_( even_RR simplistically_RR )_) client_NN1 participation_NN1 means_VVZ that_CST the_AT client_NN1 system_NN1 ,_, as_II a_AT1 whole_NN1 or_CC in_RR21 part_RR22 ,_, is_VBZ always_RR part_NN1 of_IO the_AT action_NN1 system_NN1 ._. 
How_RRQ can_VM we_PPIS2 measure_VVI client_NN1 participation_NN1 in_II community_NN1 work_NN1 ?_? 
What_DDQ are_VBR the_AT dimensions_NN2 that_CST can_VM be_VBI observed_VVN empirically_RR ?_? 
The_AT literature_NN1 is_VBZ well_RR developed_VVN and_CC offers_VVZ a_AT1 wealth_NN1 of_IO suggestions_NN2 ._. 
Arnstein_NP1 (_( 1969_MC )_) ,_, Hollnsteiner_NP1 (_( 1977_MC )_) and_CC Wandersman_NP1 (_( 1979a_FO )_) base_NN1 typologies_NN2 on_II the_AT distribution_NN1 of_IO power_NN1 between_II the_AT establishment_NN1 and_CC the_AT clients_NN2 ,_, drawing_VVG similar_JJ but_CCB slightly_RR different_JJ levels_NN2 between_II the_AT two_MC extremes_NN2 ,_, and_CC considering_VVG other_JJ relevant_JJ dimensions_NN2 such_II21 as_II22 roles_NN2 ,_, representation_NN1 ,_, influence_VV0 ,_, and_CC the_AT stages_NN2 of_IO the_AT process_NN1 ._. 
Mogulof_NP1 (_( 1974_MC )_) sees_VVZ a_AT1 dialectic_NN1 in_II which_DDQ the_AT establishment_NN1 and_CC the_AT change_NN1 agent_NN1 system_NN1 determine_VV0 how_RGQ much_DA1 participation_NN1 they_PPHS2 will_VM allow_VVI ,_, while_CS the_AT client_NN1 system_NN1 decides_VVZ how_RRQ strong_JJ is_VBZ its_APPGE desire_NN1 or_CC demand_VV0 for_IF participation_NN1 ._. 
The_AT level_NN1 of_IO participation_NN1 becomes_VVZ ,_, therefore_RR ,_, a_AT1 function_NN1 of_IO the_AT motivation_NN1 of_IO the_AT partners_NN2 ._. 
Susskind_VV0 and_CC Elliot_NP1 (_( 1981_MC )_) take_VV0 a_AT1 similar_JJ line_NN1 ,_, seeing_VVG the_AT relationship_NN1 between_II the_AT establishment_NN1 and_CC the_AT client_NN1 system_NN1 as_II an_AT1 evolution_NN1 from_II paternalism_NN1 to_II co-operation_NN1 via_II conflict_NN1 ._. 
Others_NN2 prefer_VV0 a_AT1 multiplicity_NN1 of_IO dimensions_NN2 ._. 
Cole_NP1 (_( 1974_MC )_) describes_VVZ two_MC major_JJ dimensions_NN2 :_: the_AT scale_NN1 of_IO participation_NN1 and_CC its_APPGE range_NN1 ._. 
The_AT former_DA delimits_VVZ the_AT activity_NN1 involved_VVD ,_, the_AT latter_DA the_AT number_NN1 of_IO participants_NN2 ._. 
Wandersman_NP1 (_( 1979b_FO )_) outlines_NN2 five_MC dimensions_NN2 :_: the_AT setting_NN1 and_CC the_AT scale_NN1 of_IO the_AT activity_NN1 ,_, the_AT stage_NN1 in_II the_AT process_NN1 at_II which_DDQ participation_NN1 takes_VVZ place_NN1 ,_, the_AT identity_NN1 and_CC the_AT representativeness_NN1 of_IO the_AT participants_NN2 ,_, the_AT level_NN1 of_IO participation_NN1 (_( as_CSA described_VVN above_RL in_II Wandersman_NP1 ,_, 1979a_FO )_) ,_, and_CC the_AT different_JJ techniques_NN2 used_VVN by_II the_AT change_NN1 agent_NN1 in_II achieving_VVG participation_NN1 ._. 
Finally_RR ,_, Liron_NP1 and_CC Spiro_NP1 (_( 1988_MC )_) choose_VV0 three_MC multi-faceted_JJ dimensions_NN2 to_TO examine_VVI the_AT participation_NN1 of_IO clients_NN2 in_II the_AT Israeli_JJ Urban_JJ Renewal_NN1 Project_NN1 :_: authority_NN1 (_( how_RGQ central_JJ ,_, final_JJ ,_, and_CC comprehensive_JJ are_VBR the_AT decisions_NN2 of_IO the_AT participatory_JJ steering_NN1 committees_NN2 ,_, and_CC how_RGQ complete_JJ is_VBZ their_APPGE domination_NN1 over_II resources_NN2 )_) ,_, the_AT influence_NN1 of_IO the_AT client_NN1 representatives_NN2 vis_MC2 vis_MC2 the_AT establishment_NN1 and_CC the_AT professionals_NN2 ,_, and_CC the_AT representativeness_NN1 of_IO these_DD2 representatives_NN2 ._. 
All_DB of_IO the_AT dimensions_NN2 from_II the_AT literature_NN1 are_VBR measurable_JJ ,_, and_CC many_DA2 of_IO the_AT authors_NN2 present_VV0 operative_JJ techniques_NN2 for_IF their_APPGE measurement_NN1 ._. 
Thus_RR we_PPIS2 shall_VM conclude_VVI this_DD1 first_MD section_NN1 by_II summarizing_VVG six_MC criteria_NN2 put_VVN forward_RL in_II the_AT literature_NN1 reviewed_VVD above_RL ,_, together_RL comprising_VVG a_AT1 multidimensional_JJ and_CC empirical_JJ test_NN1 of_IO the_AT extent_NN1 of_IO client_NN1 participation_NN1 at_II the_AT community_NN1 level._NNU 1_MC1 ._. 
LEVELS_NN2 OF_IO PARTICIPATION_NN1 The_AT levels_NN2 will_VM reflect_VVI the_AT influence_NN1 and_CC authority_NN1 of_IO the_AT different_JJ partners_NN2 ,_, and_CC the_AT distribution_NN1 of_IO power_NN1 among_II them._NNU 2_MC ._. 
TYPE_NN1 AND_CC SCALE_NN1 OF_IO ACTIVITIES_NN2 In_II what_DDQ types_NN2 of_IO activities_NN2 or_CC interventions_NN2 are_VBR the_AT levels_NN2 of_IO participation_NN1 applied_VVN ?_? 
The_AT scale_NN1 of_IO the_AT activities_NN2 can_VM be_VBI inferred_VVN both_RR from_II the_AT activity_NN1 type_NN1 and_CC the_AT level_NN1 of_IO participation_NN1 involved._NNU 3_MC ._. 
REPRESENTATIVENESS_NN1 OF_IO CLIENT_NN1 PARTICIPANTS_NN2 How_RRQ far_RR do_VD0 the_AT clients_NN2 involved_JJ in_II participation_NN1 represent_VV0 the_AT complete_JJ client_NN1 system_NN1 ?_? 
This_DD1 question_NN1 is_VBZ important_JJ whether_CSW the_AT client_NN1 system_NN1 be_VBI a_AT1 social_JJ group_NN1 ,_, a_AT1 committee_NN1 of_IO a_AT1 functional_JJ community_NN1 or_CC a_AT1 neighbourhood_NN1 activist_NN1 group_NN1 ._. 
In_II one_MC1 way_NN1 or_CC another_DD1 ,_, the_AT representatives_NN2 will_VM be_VBI compared_VVN with_IW the_AT total_JJ client_NN1 system_NN1 ._. 
THE_AT ORIGINS_NN2 OF_IO PARTICIPATION_NN1 Upon_II what_DDQ authority_NN1 do_VD0 the_AT clients_NN2 participate_VVI and_CC whose_DDQGE initiative_NN1 was_VBDZ it_PPH1 that_CST launched_VVD the_AT participation_NN1 ?_? 
Is_VBZ participation_NN1 voluntary_JJ and_CC welcomed_VVN by_II the_AT clients_NN2 ,_, or_CC is_VBZ it_PPH1 demanded_VVN of_IO them_PPHO2 by_II the_AT action_NN1 system_NN1 ,_, the_AT change_NN1 agent_NN1 or_CC even_RR by_II some_DD extraneous_JJ system_NN1 ,_, as_CSA in_II some_DD parent-teacher_NN1 associations_NN2 ?_? 
TECHNIQUES_NN2 OF_IO PARTICIPATION_NN1 What_DDQ methods_NN2 are_VBR used_VVN to_TO achieve_VVI client_NN1 participation_NN1 ?_? 
The_AT different_JJ methods_NN2 will_VM reflect_VVI different_JJ levels_NN2 of_IO participation_NN1 ,_, and_CC show_VV0 how_RGQ broad_JJ the_AT participatory_JJ front_NN1 is_VBZ ._. 
ATTITUDES_NN2 TO_II CLIENT_NN1 PARTICIPATION_NN1 It_PPH1 seems_VVZ clear_JJ to_II us_PPIO2 that_CST all_DB of_IO the_AT above_JJ criteria_NN2 will_VM be_VBI enhanced_VVN or_CC negated_VVD by_II the_AT way_NN1 in_II which_DDQ the_AT change_NN1 agent_NN1 or_CC the_AT action_NN1 system_NN1 reacts_VVZ to_II participation_NN1 :_: what_DDQ stereotypes_NN2 do_VD0 they_PPHS2 have_VHI of_IO client_NN1 representatives_NN2 ?_? do_VD0 they_PPHS2 believe_VVI in_II participation_NN1 ?_? what_DDQ expectations_NN2 do_VD0 they_PPHS2 have_VHI of_IO participation_NN1 and_CC client_NN1 representatives_NN2 ?_? 
Similarly_RR ,_, parallel_JJ questions_NN2 will_VM be_VBI asked_VVN of_IO the_AT participants_NN2 ,_, for_IF the_AT clients_NN2 also_RR bring_VV0 expectations_NN2 and_CC stereotypes_NN2 (_( of_IO the_AT workers_NN2 ,_, administration_NN1 ,_, etc._RA and_CC of_IO their_APPGE fellow_JJ clients_NN2 )_) to_II participation_NN1 ,_, as_II31 well_II32 as_II33 a_AT1 wide_JJ gamut_NN1 of_IO often_RR conflicting_JJ ideologies_NN2 ._. 
WHAT_DDQ IS_VBZ EFFECTIVENESS_NN1 AND_CC HOW_RRQ CAN_VM WE_PPIS2 MEASURE_VVI IT_PPH1 ?_? 
Social_JJ work_NN1 has_VHZ begun_VVN to_TO evaluate_VVI its_APPGE effectiveness_NN1 in_II the_AT last_MD fifty_MC years_NNT2 ,_, and_CC Sheldon_NP1 (_( 1986_MC )_) has_VHZ described_VVN two_MC separate_JJ waves_NN2 of_IO reviews_NN2 and_CC researches_NN2 ._. 
From_II the_AT 1940s_MC2 till_CS the_AT early_JJ 1970s_MC2 the_AT question_NN1 asked_VVD was_58 '_GE does_VDZ social_JJ work_NN1 work_NN1 ?_? '_GE ,_, and_CC the_AT answers_NN2 given_VVN ,_, for_REX21 example_REX22 by_II Mullen_NP1 and_CC Dumpson_NP1 (_( 1972_MC )_) ,_, Fischer_NP1 (_( 1973_MC and_CC 1976_MC )_) ,_, and_CC Wood_NP1 (_( 1978_MC )_) ,_, were_VBDR generally_RR negative_JJ :_: social_JJ work_NN1 intervention_NN1 was_VBDZ apparently_RR ineffective_JJ ._. 
The_AT second_MD wave_NN1 ,_, from_II the_AT 1970s_MC2 to_II the_AT present_JJ day_NNT1 ,_, have_VH0 limited_VVN their_APPGE attention_NN1 to_II the_AT question_NN1 '_GE how_RGQ effective_JJ is_VBZ a_AT1 particular_JJ program_NN1 with_IW a_AT1 particular_JJ type_NN1 of_IO client_NN1 ?_? 
'_GE (_( Reid_NP1 and_CC Hanrahan_NP1 ,_, 1982_MC ,_, p._NN1 328_MC )_) ,_, and_CC the_AT answers_NN2 appear_VV0 to_TO be_VBI positive_JJ ._. 
Reid_NP1 and_CC Hanrahan_NP1 (_( 1982_MC )_) ,_, in_II a_AT1 review_NN1 of_IO twenty-eight_MC studies_NN2 between_II the_AT years_NNT2 1973_MC and_CC 1981_MC ,_, find_VV0 that_CST the_AT objectives_NN2 of_IO the_AT interventions_NN2 were_VBDR generally_RR achieved_VVN ,_, and_CC so_CS they_PPHS2 conclude_VV0 that_DD1 '_VBZ intervention_NN1 carried_VVN out_RP by_II social_JJ workers_NN2 can_VM be_VBI effective_JJ '_GE (_( p._NNU 333_MC )_) ._. 
Of_IO particular_JJ importance_NN1 to_II the_AT subject_NN1 of_IO this_DD1 paper_NN1 ,_, they_PPHS2 emphasize_VV0 in_II their_APPGE summary_NN1 that_CST the_AT client_NN1 in_II the_AT studies_NN2 reviewed_VVD '_GE is_VBZ engaged_VVN as_II a_AT1 voluntary_JJ collaborator_NN1 '_GE ,_, and_CC his_58 '_GE motivations_NN2 were_VBDR directed_VVN toward_II what_DDQ the_AT social_JJ workers_NN2 were_VBDR attempting_VVG to_TO provide_VVI '_GE ._. 
This_DD1 kind_RR21 of_RR22 '_GE motivational_JJ congruence_NN1 between_II practitioners_NN2 and_CC clients_NN2 '_GE was_VBDZ generally_RR missing_VVG from_II the_AT studies_NN2 in_II the_AT first_MD wave_NN1 of_IO effectiveness_NN1 research_NN1 ,_, they_PPHS2 suggest_VV0 (_( p._NNU 338_MC )_) ._. 
This_DD1 implies_VVZ the_AT connection_NN1 between_II client_NN1 participation_NN1 and_CC effectiveness_NN1 that_CST Bernstein_NP1 (_( 1960_MC )_) (_( as_CSA quoted_VVN above_RL )_) seems_VVZ to_TO take_VVI almost_RR as_CSA axiomatic_JJ ,_, and_CC which_DDQ we_PPIS2 would_VM like_VVI to_TO demonstrate_VVI empirically_RR ._. 
Ruben_NP1 (_( 1985_MC )_) reviews_VVZ twelve_MC more_DAR research_NN1 studies_NN2 between_II 1978_MC and_CC 1983_MC ,_, and_CC generally_RR replicates_VVZ the_AT findings_NN2 of_IO Reid_NP1 and_CC Hanrahan_NP1 ._. 
(_( See_VV0 also_RR Brawley_NP1 and_CC Martinez-Brawley_NN1 ,_, 1988_MC ._. )_) 
How_RRQ is_VBZ effectiveness_NN1 defined_VVN and_CC measured_VVN in_II these_DD2 studies_NN2 ?_? 
Sheldon_NP1 (_( 1986_MC )_) points_VVZ out_RP that_DD1 '_VBZ effectiveness_NN1 '_GE is_VBZ not_XX absolute_JJ :_: for_IF whom_PNQO ?_? in_II31 relation_II32 to_II33 what_DDQ ?_? are_VBR some_DD of_IO the_AT limitations_NN2 ._. 
Thus_RR his_APPGE definition_NN1 is_58 '_GE a_AT1 much_RR less_RGR ambitious_JJ affair_NN1 '_GE :_: It_PPH1 implies_VVZ describing_VVG carefully_RR the_AT nature_NN1 ,_, extent_NN1 and_CC implications_NN2 of_IO any_DD problems_NN2 prior_II21 to_II22 intervention_NN1 ;_; saying_VVG what_DDQ it_PPH1 is_VBZ you_PPY might_VM do_VDI to_TO alter_VVI these_DD2 and_CC why_RRQ it_PPH1 would_VM be_VBI beneficial_JJ to_TO try_VVI ;_; describing_VVG how_RRQ best_RRT this_DD1 might_VM be_VBI brought_VVN about_RP ;_; saying_VVG in_II advance_NN1 what_DDQ kinds_NN2 of_IO public_JJ test_NN1 might_VM be_VBI applied_VVN to_TO support_VVI the_AT view_NN1 that_CST something_PN1 worthwhile_JJ has_VHZ been_VBN achieved_VVN ;_; pursuing_VVG a_AT1 solution_NN1 ,_, and_CC then_RT defending_VVG the_AT results_NN2 against_II criticism_NN1 from_II peers_NN2 (_( Sheldon_NP1 ,_, 1986_MC ,_, p._NN1 224_MC )_) ._. 
However_RR ,_, the_AT literature_NN1 so_RG far_RR described_VVN is_VBZ concerned_JJ almost_RR entirely_RR with_IW social_JJ work_NN1 at_II the_AT micro_NN1 level_NN1 :_: individuals_NN2 ,_, families_NN2 and_CC small_JJ groups_NN2 ,_, much_DA1 of_IO it_PPH1 using_VVG techniques_NN2 that_CST are_VBR of_IO little_JJ relevance_NN1 to_II community_NN1 work_NN1 ,_, for_REX21 example_REX22 behaviour_NN1 modification_NN1 ._. 
Sheldon_NP1 (_( 1986_MC )_) suggests_VVZ that_CST one_MC1 implication_NN1 of_IO the_AT research_NN1 findings_NN2 is_VBZ that_DD1 social_JJ workers_NN2 are_VBR more_RGR effective_JJ on_II '_GE smaller-scale_JJ problems_NN2 '_GE than_CSN '_GE large-scale_JJ experiments_NN2 on_II problems_NN2 of_IO genuine_JJ concern_NN1 to_II the_AT community_NN1 '_GE ._. 
Jenkins_NP1 (_( 1987_MC )_) describes_VVZ effectiveness_NN1 research_NN1 so_RG far_RR as_CSA a_AT1 '_GE limited_JJ concept_NN1 ,_, primarily_RR relating_VVG to_II the_AT intervention_NN1 process_NN1 '_GE and_CC with_IW little_DA1 validity_NN1 in_II the_AT '_GE macro_JJ area_NN1 '_GE ._. 
Rees_NP1 (_( 1987_MC )_) maintains_VVZ that_DD1 effectiveness_NN1 is_VBZ meaningless_JJ without_IW usefulness_NN1 ,_, and_CC this_DD1 implies_VVZ ,_, among_II other_JJ things_NN2 ,_, political_JJ constraints_NN2 ._. 
Thus_RR our_APPGE review_NN1 of_IO literature_NN1 must_VM now_RT address_VVI those_DD2 studies_NN2 specifically_RR concerned_JJ with_IW the_AT evaluation_NN1 of_IO effectiveness_NN1 in_II community_NN1 work_NN1 ._. 
Key_NN1 and_CC his_APPGE associates_NN2 (_( 1976_MC )_) ,_, in_II an_AT1 attempt_NN1 to_TO decide_VVI how_RRQ to_TO evaluate_VVI their_APPGE community_NN1 project_NN1 ,_, make_VV0 a_AT1 thorough_JJ review_NN1 of_IO evaluation_NN1 research_NN1 literature_NN1 ._. 
They_PPHS2 emphasize_VV0 qualitative_JJ and_CC quantitative_JJ approaches_NN2 ,_, methods_NN2 ranging_VVG from_II the_AT rational_JJ to_II the_AT intuitive_JJ ,_, and_CC the_AT role_NN1 of_IO the_AT clients_NN2 in_II the_AT evaluative_JJ process_NN1 ._. 
Hunt_NP1 (_( 1987_MC )_) states_VVZ the_AT dilemma_NN1 more_RGR briefly_RR :_: the_AT scientific_JJ approach_NN1 may_VM be_VBI quite_RG unrealistic_JJ ._. 
Control_VV0 groups_NN2 are_VBR not_XX relevant_JJ ,_, and_CC important_JJ variables_NN2 can_VM seldom_RR be_VBI specified_VVN in_II advance_NN1 owing_II21 to_II22 the_AT complexity_NN1 and_CC dynamic_JJ nature_NN1 of_IO the_AT processes_NN2 involved_VVD ._. 
Objectives_NN2 are_VBR usually_RR very_RG general_JJ to_TO begin_VVI with_IW ,_, and_CC the_AT non-directive_JJ nature_NN1 of_IO the_AT work_NN1 means_VVZ that_CST they_PPHS2 are_VBR defined_VVN as_II the_AT work_NN1 goes_VVZ on_RP ._. 
Finally_RR ,_, she_PPHS1 asks_VVZ ,_, '_" when_RRQ is_VBZ an_AT1 outcome_NN1 not_XX an_AT1 outcome_NN1 ?_? '_GE ,_, that_REX21 is_REX22 ,_, how_RRQ are_VBR outcomes_NN2 defined_VVN and_CC for_IF whom_PNQO :_: funders_NN2 ?_? community_NN1 workers_NN2 ?_? people/clients_FU ?_? researchers_NN2 ?_? 
These_DD2 studies_NN2 (_( and_CC earlier_JJR studies_NN2 by_II the_AT team_NN1 of_IO Epstein_NP1 ,_, Fellin_NP1 and_CC Tripodi_NP1 :_: Tripodi_NP1 et_RA21 al._RA22 ,_, 1971_MC ;_; Epstein_NP1 et_RA21 al._RA22 ,_, 1973_MC )_) lay_VVD a_AT1 basis_NN1 for_IF the_AT study_NN1 of_IO effectiveness_NN1 in_II community_NN1 work_NN1 ,_, but_CCB ,_, instead_II21 of_II22 giving_VVG clear_JJ ,_, operative_JJ and_CC replicable_JJ indications_NN2 of_IO how_RRQ to_TO measure_VVI it_PPH1 ,_, emphasize_VV0 the_AT problematical_JJ nature_NN1 of_IO the_AT task_NN1 ._. 
Thus_RR ,_, in_II the_AT spirit_NN1 of_IO the_AT culture_NN1 of_IO openness_NN1 and_CC coherence_NN1 proposed_VVN by_II Rees_NP1 (_( 1987_MC )_) ,_, let_VV0 us_PPIO2 consider_VVI what_DDQ might_VM be_VBI learned_VVN from_II other_JJ applied_JJ social_JJ sciences_NN2 ,_, particularly_RR management_NN1 science_NN1 ._. 
Lewin_NP1 and_CC Minton_NP1 (_( 1986_MC )_) in_II their_APPGE comprehensive_JJ survey_NN1 of_IO the_AT literature_NN1 find_VV0 no_AT less_DAR than_CSN thirteen_MC orientations_NN2 to_II management_NN1 from_II the_AT year_NNT1 1911_MC onwards_RL ,_, each_DD1 with_IW its_APPGE own_DA typical_JJ effectiveness_NN1 attributes_NN2 ._. 
Steers_NP2 (_( 1975_MC )_) ,_, summarizing_VVG seventeen_MC research_NN1 studies_NN2 ,_, finds_VVZ various_JJ criteria_NN2 of_IO effectiveness_NN1 ,_, but_CCB the_AT three_MC most_RGT frequent_JJ ones_NN2 are_VBR adaptiveness_NN1 ,_, productivity_NN1 ,_, and_CC participant_NN1 satisfaction_NN1 (_( meaning_NN1 ,_, of_RR21 course_RR22 ,_, worker_NN1 ,_, not_XX client_NN1 participation_NN1 )_) ._. 
He_PPHS1 concludes_VVZ that_CST the_AT effectiveness_NN1 of_IO a_AT1 given_JJ system_NN1 should_VM be_VBI based_VVN on_II its_APPGE ability_NN1 to_TO fit_VVI in_RP with_IW the_AT external_JJ systems_NN2 making_VVG up_RP its_APPGE environment_NN1 on_II the_AT one_MC1 hand_NN1 ,_, and_CC ,_, on_II the_AT other_JJ hand_NN1 ,_, on_II its_APPGE competence_NN1 in_II allowing_VVG its_APPGE own_DA sub-systems_NN2 to_TO fit_VVI in_RP with_IW each_PPX221 other_PPX222 ._. 
This_DD1 model_NN1 is_VBZ clearly_RR process_VV0 oriented_JJ ._. 
Pennings_NN2 and_CC Goodman_NP1 (_( 1977_MC )_) present_VV0 a_AT1 systems_NN2 model_VV0 that_CST also_RR stresses_VVZ internal_JJ processes_NN2 :_: they_PPHS2 see_VV0 effectiveness_NN1 as_II the_AT result_NN1 of_IO coalitions_NN2 and_CC arrangements_NN2 between_II dominant_JJ and_CC interest_NN1 groups_NN2 ,_, and_CC the_AT satisfaction_NN1 of_IO the_AT participants_NN2 from_II the_AT efficiency_NN1 of_IO these_DD2 inner_JJ processes_NN2 ._. 
Miles_NP1 (_( 1980_MC )_) presents_VVZ an_AT1 '_GE ecology_NN1 model_NN1 '_GE ,_, not_XX dissimilar_JJ to_II the_AT systems_NN2 models_NN2 ._. 
Dividing_VVG previous_JJ schools_NN2 of_IO thought_NN1 into_II goal_NN1 attainment_NN1 models_NN2 and_CC systems_NN2 models_NN2 (_( and_CC criticizing_VVG both_DB2 of_IO them_PPHO2 )_) ,_, Miles_NP1 defines_VVZ organizational_JJ effectiveness_NN1 as_58 '_GE the_AT ability_NN1 of_IO the_AT organization_NN1 to_TO minimally_RR satisfy_VVI the_AT expectations_NN2 of_IO its_APPGE strategic_JJ constituencies_NN2 '_GE (_( Miles_NP1 ,_, 1980_MC ,_, p._NN1 375_MC )_) ,_, thus_RR demanding_VVG both_DB2 sets_NN2 of_IO criteria_NN2 ._. 
However_RR ,_, the_AT criteria_NN2 of_IO effectiveness_NN1 will_VM change_VVI with_IW the_AT different_JJ constituencies_NN2 :_: different_JJ sub-systems_NN2 will_VM define_VVI effectiveness_NN1 differently_RR ,_, some_DD in_II31 terms_II32 of_II33 goal_NN1 attainment_NN1 (_( say_VV0 the_AT management_NN1 and_CC the_AT stock_NN1 holders_NN2 )_) and_CC some_DD in_II31 terms_II32 of_II33 process_NN1 (_( the_AT workers_NN2 ,_, for_REX21 example_REX22 )_) ._. 
This_DD1 means_VVZ that_DD1 '_VBZ organizational_JJ assessment_NN1 is_VBZ best_RRT conceived_VVN of_IO not_XX as_II a_AT1 one-shot_JJ affair_NN1 ,_, but_CCB as_II an_AT1 ongoing_JJ process_NN1 '_GE (_( Miles_NP1 ,_, 1980_MC ,_, p._NN1 380_MC )_) ._. 
Campbell_NP1 (_( 1977_MC )_) too_RR divides_VVZ organizational_JJ effectiveness_NN1 into_II two_MC categories_NN2 :_: '_GE goal-centred_NN1 '_GE and_CC '_GE natural_JJ system_NN1 '_GE ,_, and_CC he_PPHS1 lists_VVZ no_AT less_DAR than_CSN thirty_MC criteria_NN2 '_GE that_DD1 have_VH0 been_VBN proposed_VVN seriously_RR as_CSA indices_NN2 of_IO organizational_JJ effectiveness_NN1 '_GE (_( p._NNU 36_MC )_) ._. 
Probably_RR ,_, therefore_RR ,_, Cameron_NP1 (_( 1986_MC )_) is_VBZ right_RR when_RRQ ,_, after_II summarizing_VVG five_MC areas_NN2 of_IO agreement_NN1 on_II effectiveness_NN1 and_CC three_MC areas_NN2 of_IO conflict_NN1 ,_, he_PPHS1 concludes_VVZ that_DD1 '_VBZ agreement_NN1 about_II effectiveness_NN1 is_VBZ mainly_RR an_AT1 agreement_NN1 to_TO disagree_VVI '_GE (_( p._NNU 544_MC )_) ._. 
His_APPGE suggestion_NN1 is_VBZ to_TO see_VVI competing_JJ criteria_NN2 as_CSA both_RR compatible_JJ and_CC congruent_JJ and_CC to_TO accept_VVI that_DD1 '_VBZ organizational_JJ effectiveness_NN1 is_VBZ inherently_RR paradoxical_JJ ._. 
To_TO be_VBI effective_JJ ,_, an_AT1 organization_NN1 must_VM possess_VVI attributes_NN2 that_CST are_VBR simultaneously_RR contradictory_JJ ,_, even_RR mutually_RR exclusive_JJ ,_, (_( Cameron_NP1 ,_, 1986_MC ,_, pp._NNU2 5445_MC )_) ._. 
Thus_RR successful_JJ organizations_NN2 will_VM have_VHI a_AT1 high_JJ degree_NN1 of_IO role_NN1 specialization_NN1 (_( reinforcing_VVG expertise_NN1 and_CC efficiency_NN1 )_) together_RL with_IW a_AT1 high_JJ generality_NN1 of_IO roles_NN2 (_( encouraging_JJ flexibility_NN1 and_CC interdependency_NN1 )_) ,_, a_AT1 continuity_NN1 of_IO leadership_NN1 alongside_RL of_IO infusion_NN1 of_IO new_JJ leaders_NN2 ,_, and_RR31 so_RR32 on_RR33 ._. 
Our_APPGE conclusion_NN1 must_VM be_VBI that_CST there_EX are_VBR many_DA2 criteria_NN2 of_IO organizational_JJ effectiveness_NN1 ,_, some_DD of_IO which_DDQ are_VBR mutually_RR exclusive_JJ ,_, yet_RR ,_, paradoxically_RR ,_, these_DD2 seemingly_RR conflicting_JJ attributes_NN2 are_VBR able_JK to_TO co-exist_VVI and_CC to_TO work_VVI together_RL ._. 
Most_DAT of_IO these_DD2 criteria_NN2 are_VBR measurable_JJ and_CC have_VH0 been_VBN measured_VVN in_II management_NN1 research_NN1 in_II quantifiable_JJ terms_NN2 ._. 
It_PPH1 remains_VVZ to_TO be_VBI seen_VVN to_II what_DDQ extent_NN1 they_PPHS2 can_VM be_VBI applied_VVN to_II social_JJ work_NN1 ._. 
We_PPIS2 propose_VV0 two_MC composite_JJ criteria_NN2 for_IF the_AT measurement_NN1 of_IO effectiveness_NN1 ,_, both_DB2 using_VVG variables_NN2 used_VVN in_II previous_JJ research_NN1 ,_, in_II31 accordance_II32 with_II33 the_AT specific_JJ demands_NN2 and_CC context_NN1 of_IO the_AT researcher_NN1 or_CC practitioner._NNU 1_MC1 ._. 
CLASSIFICATION_NN1 OF_IO EFFECTIVENESS_NN1 Using_VVG the_AT terms_NN2 of_IO Miles_NP1 (_( 1980_MC )_) ,_, we_PPIS2 classify_VV0 effectiveness_NN1 by_II '_GE goal_NN1 attainment_NN1 '_GE (_( that_DD1 is_VBZ goal_NN1 achievement_NN1 ,_, productivity_NN1 ,_, etc._RA )_) and_CC '_GE systems_NN2 processes_NN2 '_GE (_( adaptiveness_NN1 ,_, participant_NN1 satisfaction_NN1 ,_, inner_JJ processes_NN2 ,_, systems_NN2 resources_NN2 ,_, etc_RA ._. )_) ._. 
The_AT assessor_NN1 may_VM use_VVI either_DD1 of_IO these_DD2 classifications_NN2 (_( with_IW whatever_DDQV sub-groups_NN2 he_PPHS1 or_CC she_PPHS1 prefers_VVZ )_) or_CC both_DB2 of_IO them_PPHO2 ._. 
Both_DB2 measurements_NN2 of_IO effectiveness_NN1 are_VBR valid_JJ ,_, and_CC the_AT one_PN1 used_VVN will_VM depend_VVI upon_II the_AT purpose_NN1 of_IO the_AT assessment_NN1 ,_, the_AT customer_NN1 ordering_VVG the_AT assessment_NN1 and_CC the_AT audience_NN1 at_II which_DDQ the_AT assessment_NN1 is_VBZ aimed_VVN ._. 
An_AT1 evaluation_NN1 of_IO effectiveness_NN1 of_IO a_AT1 community_NN1 economic_JJ enterprise_NN1 in_II31 terms_II32 of_II33 productivity_NN1 and_CC profit_NN1 is_VBZ legitimate_JJ in_II one_MC1 set_NN1 of_IO circumstances_NN2 ;_; the_AT same_DA evaluation_NN1 of_IO the_AT same_DA enterprise_NN1 in_II31 terms_II32 of_II33 citizen_NN1 satisfaction_NN1 and_CC decision-making_JJ processes_NN2 is_VBZ equally_RR legitimate_JJ in_II another_DD1 set_NN1 of_IO circumstances_NN2 ._. 
If_CS possible_JJ ,_, the_AT evaluation_NN1 will_VM include_VVI both_DB2 types_NN2 of_IO effectiveness_NN1 measurement._NNU 2_MC ._. 
EFFECTIVENESS_NN1 EVALUATED_VVN BY_II WHOM_PNQO ?_? 
Clearly_RR not_XX just_RR the_AT type_NN1 of_IO evaluation_NN1 of_IO effectiveness_NN1 but_CCB its_APPGE essence_NN1 will_VM be_VBI affected_VVN by_II who_PNQS evaluates_VVZ ._. 
In_II the_AT example_NN1 of_IO a_AT1 factory_NN1 ,_, completely_RR different_JJ assessments_NN2 may_VM be_VBI expected_VVN from_II the_AT board_NN1 of_IO directors_NN2 ,_, shareholders_NN2 ,_, management_NN1 ,_, workers_NN2 ,_, and_CC shop-stewards_NN2 ._. 
DOES_VDZ PARTICIPATION_NN1 LEAD_NN1 TO_II EFFECTIVENESS_NN1 ?_? 
A_AT1 REVIEW_NN1 OF_IO LITERATURE_NN1 The_AT amount_NN1 of_IO published_JJ research_NN1 on_II this_DD1 topic_NN1 is_VBZ not_XX extensive_JJ ._. 
The_AT management_NN1 research_NN1 field_NN1 includes_VVZ many_DA2 studies_NN2 on_II effectiveness_NN1 ,_, but_CCB the_AT only_JJ type_NN1 of_IO participation_NN1 to_TO be_VBI found_VVN in_II them_PPHO2 is_VBZ worker_NN1 participation_NN1 ,_, quite_RG different_JJ from_II our_APPGE topic_NN1 of_IO client_NN1 participation_NN1 ._. 
Some_DD of_IO the_AT conclusions_NN2 from_II this_DD1 literature_NN1 do_VD0 seem_VVI applicable_JJ to_II our_APPGE topic_NN1 ,_, and_CC they_PPHS2 will_VM be_VBI considered_VVN at_II the_AT end_NN1 of_IO this_DD1 section_NN1 ._. 
Research_NN1 on_II the_AT participation_NN1 of_IO the_AT public_NN1 in_RR21 general_RR22 or_CC clients_NN2 in_RR21 particular_RR22 tends_VVZ to_II centre_NN1 around_II the_AT form_NN1 of_IO participation_NN1 involved_VVN (_( inputs_NN2 )_) and_CC its_APPGE effect_NN1 on_II the_AT change_NN1 agent_NN1 and_CC action_NN1 systems_NN2 (_( processes_NN2 ,_, '_GE thruputs_NN2 '_GE )_) ,_, but_CCB little_DA1 attention_NN1 is_VBZ paid_VVN to_II the_AT results_NN2 of_IO participation_NN1 (_( outputs_VVZ )_) in_RR21 general_RR22 ,_, and_CC in_II achieving_VVG the_AT specific_JJ goals_NN2 of_IO the_AT activity_NN1 involved_VVD ._. 
Moreover_RR ,_, the_AT conclusions_NN2 of_IO the_AT studies_NN2 which_DDQ do_VD0 consider_VVI the_AT effectiveness_NN1 of_IO participation_NN1 are_VBR by_RR31 no_RR32 means_RR33 clear_JJ or_CC unanimous_JJ ._. 
Mazmanian_NP1 (_( 1976_MC )_) ,_, in_II his_APPGE evaluation_NN1 of_IO projects_NN2 carried_VVN out_RP by_II the_AT Corps_NN of_IO Engineers_NN2 ,_, and_CC Gilbert_NP1 and_CC Specht_NP1 (_( 1977_MC )_) ,_, in_II their_APPGE classic_JJ evaluation_NN1 of_IO the_AT Model_NN1 City_NN1 programme_NN1 between_II the_AT years_NNT2 1967_MC 71_MC ,_, appear_VV0 to_TO reach_VVI a_AT1 similar_JJ conclusion_NN1 :_: participation_NN1 helps_VVZ process_NN1 but_CCB not_XX goal_NN1 attainment_NN1 ._. 
Mazmanian_NN1 finds_VVZ participation_NN1 effective_JJ in_II such_DA process_NN1 goals_NN2 as_CSA leading_VVG to_II public_JJ appreciation_NN1 of_IO the_AT Engineers_NN2 '_GE work_NN1 ,_, but_CCB not_XX in_II what_DDQ he_PPHS1 calls_NN2 '_GE product_NN1 '_GE goals_NN2 ,_, such_II21 as_II22 increasing_VVG public_JJ support_NN1 for_IF the_AT projects_NN2 or_CC recommending_VVG courses_NN2 of_IO action_NN1 ._. 
Gilbert_NP1 and_CC Specht_NP1 show_VV0 that_DD1 project_NN1 workers_NN2 used_JJ client_NN1 participation_NN1 effectively_RR in_II the_AT planning_NN1 stage_NN1 ,_, where_CS the_AT process_NN1 was_VBDZ the_AT main_JJ consideration_NN1 ,_, work_NN1 was_VBDZ non-directive_JJ ,_, and_CC the_AT major_JJ skills_NN2 needed_VVN of_IO the_AT worker_NN1 were_VBDR interactional_JJ in_II nature_NN1 ._. 
But_CCB when_CS they_PPHS2 reached_VVD the_AT implementation_NN1 stage_NN1 ,_, in_II which_DDQ their_APPGE orientation_NN1 was_VBDZ to_II concrete_JJ tasks_NN2 and_CC the_AT skills_NN2 required_VVN of_IO them_PPHO2 were_VBDR chiefly_RR technical_JJ ,_, then_RT they_PPHS2 became_VVD more_DAR directive_NN1 and_CC used_JJ client_NN1 participation_NN1 less_RRR ._. 
These_DD2 conclusions_NN2 appear_VV0 to_TO have_VHI been_VBN replicated_VVN by_II York_NP1 (_( 1989_MC )_) ,_, who_PNQS finds_VVZ that_DD1 community_NN1 workers_NN2 express_VV0 more_DAR satisfaction_NN1 and_CC effectiveness_NN1 in_II their_APPGE short-term_JJ projects_NN2 ,_, which_DDQ are_VBR more_DAR directive_NN1 and_CC task-oriented_JJ ,_, than_CSN in_II their_APPGE long-term_JJ projects_NN2 ._. 
However_RR ,_, the_AT conclusions_NN2 of_IO Gilbert_NP1 and_CC Specht_NP1 are_VBR indirect_JJ and_CC do_VD0 not_XX necessarily_RR show_VVI that_DD1 client_NN1 participation_NN1 in_II implementation_NN1 stages_NN2 is_VBZ ineffective_JJ ._. 
As_CSA York_NP1 finds_VVZ ,_, workers_NN2 prefer_VV0 not_XX to_TO involve_VVI their_APPGE clients_NN2 in_II short-term_JJ task_NN1 processes_NN2 ,_, but_CCB this_DD1 may_VM be_VBI for_IF a_AT1 multitude_NN1 of_IO reasons_NN2 other_II21 than_II22 that_DD1 of_IO effectiveness_NN1 :_: lack_NN1 of_IO time_NNT1 (_( client_NN1 participation_NN1 is_VBZ generally_RR time_NNT1 consuming_VVG )_) ,_, agency_NN1 policy_NN1 and_CC pressure_NN1 (_( paternalism_NN1 )_) ,_, professional_JJ socialization_NN1 and_CC norms_NN2 ,_, and_RR31 so_RR32 on_RR33 ._. 
Only_RR Mazmanian_JJ ,_, so_RG far_RR ,_, clearly_RR states_VVZ that_DD1 client_NN1 participation_NN1 leads_VVZ to_II ineffectiveness_NN1 ,_, and_CC he_PPHS1 does_VDZ so_RR only_RR for_IF '_GE product_NN1 goals_NN2 '_GE ._. 
We_PPIS2 should_VM like_VVI to_TO know_VVI more_RRR about_II how_RRQ participation_NN1 was_VBDZ achieved_VVN in_II these_DD2 projects_NN2 and_CC what_DDQ was_VBDZ the_AT nature_NN1 of_IO the_AT tasks_NN2 involved_VVD ._. 
In_II any_DD case_NN1 ,_, it_PPH1 is_VBZ clear_JJ that_CST Mazmanian_JJ does_VDZ not_XX deal_VVI with_IW social_JJ work_NN1 programmes_NN2 ,_, and_CC the_AT change_NN1 agents_NN2 involved_VVD were_VBDR not_XX social_JJ workers_NN2 ._. 
Gittell_NP1 (_( 1980_MC )_) ,_, in_II a_AT1 research_NN1 study_NN1 of_IO school-related_JJ citizen_NN1 organizations_NN2 in_II three_MC American_JJ cities_NN2 ,_, finds_VVZ that_CST both_RR lower-_JJR and_CC middle-class_JJ parent_NN1 organizations_NN2 had_VHD little_DA1 effect_NN1 on_II educational_JJ decision-making_NN1 ,_, their_APPGE declared_JJ goal_NN1 ._. 
In_II our_APPGE terms_NN2 ,_, client_NN1 participation_NN1 was_VBDZ not_XX effective_JJ ._. 
However_RR ,_, she_PPHS1 shows_VVZ how_RRQ imperfect_NN1 was_VBDZ the_AT participation_NN1 ,_, particularly_RR in_II lower-class_JJ organizations_NN2 ,_, and_CC also_RR makes_VVZ clear_JJ that_CST some_DD of_IO the_AT objectives_NN2 were_VBDR achieved_VVN ._. 
Thus_RR Gittell_NP1 's_GE data_NN are_VBR not_XX conclusive_JJ ._. 
Rosener_NP1 (_( 1978_MC )_) finds_VVZ much_DA1 consideration_NN1 in_II the_AT literature_NN1 of_IO participation_NN1 as_II an_AT1 end_NN1 in_II itself_PPX1 ,_, and_CC this_DD1 is_VBZ relatively_RR easy_JJ to_TO evaluate_VVI :_: how_RGQ many_DA2 clients_NN2 participated_VVD ?_? what_DDQ kinds_NN2 of_IO people_NN ?_? how_RRQ frequently_RR ?_? how_RRQ much_DA1 time_NNT1 did_VDD they_PPHS2 invest_VVI ?_? what_DDQ were_VBDR their_APPGE attitudes_NN2 (_( and_CC those_DD2 of_IO the_AT workers_NN2 )_) to_II participation_NN1 ?_? 
However_RR ,_, participation_NN1 is_VBZ seldom_RR evaluated_VVN as_II a_AT1 means_NN to_II an_AT1 end_NN1 ,_, that_DD1 is_VBZ effectiveness_NN1 ,_, she_PPHS1 maintains_VVZ ._. 
To_TO do_VDI this_DD1 ,_, two_MC difficult_JJ questions_NN2 must_VM be_VBI answered_VVN :_: what_DDQ are_VBR the_AT criteria_NN2 of_IO effectiveness_NN1 (_( goals_NN2 and_CC objectives_NN2 )_) according_II21 to_II22 the_AT different_JJ participants_NN2 (_( citizens_NN2 ,_, officials_NN2 ,_, workers_NN2 )_) ?_? and_CC how_RGQ clear_JJ is_VBZ the_AT cause/effect_NN1 relationship_NN1 between_II these_DD2 goals_NN2 and_CC participation_NN1 ?_? 
Thus_RR Rosener_NP1 suggests_VVZ a_AT1 matrix_NN1 between_RL '_GE knowledge_NN1 of_IO a_AT1 cause/effect_NN1 relationship_NN1 between_II participation_NN1 program_NN1 and_CC achievement_NN1 of_IO specified_JJ goals_NN2 and_CC objectives_NN2 '_GE (_( complete_VV0 or_CC incomplete_JJ )_) and_CC '_GE agreement_NN1 on_II program_NN1 goals_NN2 and_CC objectives_NN2 ,_, whose_DDQGE they_PPHS2 are_VBR ,_, and_CC the_AT criteria_NN2 to_TO measure_VVI success_NN1 and_CC failure_NN1 '_GE (_( yes_UH or_CC no_UH )_) (_( 1978_MC ,_, p._NN1 459_MC )_) ._. 
But_CCB ,_, as_CSA Rosener_NP1 herself_PPX1 points_VVZ out_RP ,_, examples_NN2 of_IO complete_JJ knowledge_NN1 and_CC perfect_JJ agreement_NN1 are_VBR rare_JJ indeed_RR ._. 
We_PPIS2 learn_VV0 ,_, therefore_RR ,_, two_MC important_JJ lessons_NN2 :_: deciding_VVG before_II intervention_NN1 what_DDQ our_APPGE goals_NN2 and_CC objectives_NN2 are_VBR ,_, if_CS possible_JJ a_AT1 common_JJ decision_NN1 of_IO all_DB the_AT participants_NN2 (_( though_CS separate_JJ ,_, if_CS not_XX conflicting_JJ decisions_NN2 would_VM be_VBI legitimate_JJ )_) ;_; and_CC setting_VVG criteria_NN2 and_CC measurement_NN1 indicators_NN2 to_TO show_VVI the_AT relationship_NN1 between_II participation_NN1 and_CC effectiveness_NN1 ._. 
The_AT first_MD point_NN1 is_VBZ undeniable_JJ ,_, and_CC few_DA2 field_NN1 workers_NN2 and_CC even_RR fewer_DAR researchers_NN2 would_VM object_VVI to_II it_PPH1 a_JJ21 priori_JJ22 (_( though_CS its_APPGE applicability_NN1 may_VM be_VBI complicated_VVN by_II the_AT dynamic_JJ development_NN1 of_IO a_AT1 project_NN1 )_) ._. 
The_AT second_MD point_NN1 is_VBZ more_RGR difficult_JJ ,_, for_IF how_RGQ often_RR in_II the_AT social_JJ sciences_NN2 do_VD0 we_PPIS2 have_VHI '_GE complete_JJ knowledge_NN1 '_GE of_IO a_AT1 cause/effect_NN1 relationship_NN1 ?_? 
The_AT aspiration_NN1 towards_II some_DD sort_NN1 of_IO rational_JJ understanding_NN1 of_IO the_AT causal_JJ relationship_NN1 is_VBZ probably_RR the_AT best_JJT we_PPIS2 can_VM achieve_VVI ._. 
Although_CS management_NN1 science_NN1 literature_NN1 on_II worker_NN1 participation_NN1 is_VBZ of_IO limited_JJ relevance_NN1 to_II the_AT topic_NN1 of_IO client_NN1 participation_NN1 ,_, some_DD of_IO the_AT recent_JJ research_NN1 on_II the_AT relationship_NN1 between_II worker_NN1 participation_NN1 and_CC productivity_NN1 sheds_NN2 light_VV0 ,_, in_II our_APPGE opinion_NN1 ,_, on_II the_AT wider_JJR topic_NN1 of_IO how_RRQ participation_NN1 in_RR21 general_RR22 leads_VVZ to_II effectiveness_NN1 ._. 
Erez_VV0 et_RA21 al._RA22 (_( 1985_MC )_) suggest_VV0 that_DD1 participation_NN1 per_RR21 se_RR22 does_VDZ not_XX cause_VVI better_JJR performance_NN1 ;_; they_PPHS2 hypothesize_VV0 that_DD1 participation_NN1 in_II decision_NN1 making_NN1 strengthens_VVZ the_AT level_NN1 of_IO goal_NN1 acceptance_NN1 ,_, and_CC this_DD1 leads_VVZ to_II better_JJR performance_NN1 ._. 
Thus_RR the_AT causal_JJ model_NN1 is_VBZ a_AT1 two-step_JJ one_PN1 ._. 
Their_APPGE two_MC empirical_JJ studies_NN2 ,_, one_MC1 laboratory_NN1 and_CC one_PN1 in_II the_AT field_NN1 ,_, partially_RR support_VV0 their_APPGE hypotheses_NN2 :_: increased_JJ goal_NN1 acceptance_NN1 leads_VVZ to_II more_RGR effective_JJ performance_NN1 ,_, and_CC participation_NN1 is_VBZ an_AT1 effective_JJ strategy_NN1 to_TO enhance_VVI goal_NN1 acceptance_NN1 ._. 
They_PPHS2 suggest_VV0 that_CST this_DD1 may_VM be_VBI through_II the_AT perceived_JJ control_NN1 an_AT1 individual_NN1 has_VHZ over_II his_APPGE goals_NN2 ,_, as_CSA compared_VVN to_II that_DD1 when_CS goals_NN2 are_VBR externally_RR assigned_VVN ._. 
Miller_NP1 and_CC Monge_NP1 (_( 1986_MC )_) ,_, in_II their_APPGE '_GE meta-analytic_JJ review_NN1 '_GE of_IO participation_NN1 ,_, satisfaction_NN1 ,_, and_CC productivity_NN1 ,_, in_II forty-seven_MC articles_NN2 and_CC book_NN1 chapters_NN2 ,_, find_VV0 two_MC possible_JJ models_NN2 to_TO explain_VVI how_RRQ participation_NN1 and_CC productivity_NN1 are_VBR linked_VVN ._. 
The_AT cognitive_JJ model_NN1 proposes_VVZ a_AT1 direct_JJ causal_JJ link_NN1 :_: participation_NN1 brings_VVZ about_RP enhanced_JJ information_NN1 on_II goals_NN2 ,_, and_CC so_RR performance_NN1 is_VBZ improved_VVN ._. 
The_AT affective_JJ model_NN1 ,_, like_II that_DD1 of_IO Erez_NP1 and_CC her_APPGE associates_NN2 ,_, is_VBZ multi-stage_JJ :_: participation_NN1 fulfils_VVZ needs_NN2 ,_, these_DD2 lead_VV0 to_II satisfaction_NN1 which_DDQ strengthens_VVZ motivation_NN1 ,_, and_CC thus_RR workers_NN2 '_GE productivity_NN1 is_VBZ improved_VVN ._. 
Both_DB2 of_IO these_DD2 models_NN2 are_VBR supported_VVN by_II their_APPGE analysis_NN1 ._. 
They_PPHS2 suggest_VV0 that_CST the_AT models_NN2 may_VM be_VBI linked_VVN ,_, and_CC further_RRR suggest_VV0 that_CST the_AT direction_NN1 of_IO the_AT causal_JJ link_NN1 between_II participation_NN1 and_CC satisfaction_NN1 is_VBZ not_XX entirely_RR clear_JJ :_: possibly_RR satisfaction_NN1 leads_VVZ to_II participation_NN1 and_CC not_XX vice_RR21 versa_RR22 ._. 
Both_DB2 of_IO these_DD2 management_NN1 research_NN1 studies_NN2 stress_VV0 the_AT complexity_NN1 of_IO the_AT relationship_NN1 between_II participation_NN1 and_CC effectiveness_NN1 and_CC of_IO the_AT variables_NN2 involved_VVD ._. 
Thus_RR we_PPIS2 can_VM use_VVI the_AT existing_JJ research_NN1 to_TO help_VVI us_PPIO2 find_VVI our_APPGE empirical_JJ measures_NN2 for_IF the_AT effects_NN2 of_IO client_NN1 participation_NN1 on_II effectiveness_NN1 in_II social_JJ work_NN1 ,_, but_CCB we_PPIS2 have_VH0 not_XX yet_RR achieved_VVN our_APPGE aim_NN1 ._. 
None_PN of_IO the_AT studies_NN2 presents_VVZ an_AT1 operative_JJ model_NN1 (_( Rosener_NP1 ,_, in_II our_APPGE opinion_NN1 ,_, comes_VVZ closest_RRT ,_, but_CCB her_APPGE model_NN1 ,_, as_CSA she_PPHS1 shows_VVZ herself_PPX1 ,_, is_VBZ more_RGR heuristic_JJ than_CSN empirical_JJ )_) ,_, and_CC so_RR in_II the_AT next_MD section_NN1 a_AT1 model_NN1 will_VM be_VBI set_VVN out_RP and_CC explained_VVN in_II41 the_II42 light_II43 of_II44 the_AT evaluation_NN1 criteria_NN2 for_IF participation_NN1 and_CC effectiveness_NN1 put_VVN forward_RL in_II the_AT first_MD two_MC sections_NN2 of_IO this_DD1 paper_NN1 ._. 
We_PPIS2 believe_VV0 the_AT model_NN1 can_VM be_VBI used_VVN to_TO answer_VVI the_AT question_NN1 posed_VVN in_II the_AT title_NN1 of_IO this_DD1 paper_NN1 ._. 
PARTICIPATION_NN1 AND_CC EFFECTIVENESS_NN1 :_: AN_AT1 OPERATIVE_JJ MODEL_NN1 In_II the_AT evaluation_NN1 of_IO the_AT effectiveness_NN1 of_IO social_JJ services_NN2 and_CC interventions_NN2 ,_, we_PPIS2 have_VH0 shown_VVN the_AT importance_NN1 of_IO who_PNQS evaluates_VVZ ,_, and_CC our_APPGE model_NN1 identifies_VVZ three_MC different_JJ systems_NN2 (_( on_II the_AT basis_NN1 of_IO Gilbert_NP1 and_CC Specht_NP1 ,_, 1979_MC ,_, and_CC Pincus_NP1 and_CC Minahan_NP1 ,_, 1973_MC )_) that_CST could_VM be_VBI involved_JJ in_II the_AT process_NN1 :_: 1_MC1 ._. 
Change_VV0 Agents_NN2 professional_JJ and_CC para-professional_JJ workers_NN2 in_II the_AT change_NN1 agent_NN1 system_NN1 ;_; 2_MC ._. 
Administration_NN1 ,_, Political_JJ and_CC Administrative_JJ Establishment_NN1 within_II the_AT change_NN1 agent_NN1 system_NN1 and_CC in_II the_AT larger_JJR systems_NN2 of_IO which_DDQ the_AT change_NN1 agent_NN1 system_NN1 is_VBZ a_AT1 sub-system_NN1 ,_, for_REX21 example_REX22 politicians_NN2 and_CC bureaucrats_NN2 in_II local_JJ or_CC national_JJ government_NN1 within_II which_DDQ the_AT change_NN1 agent_NN1 system_NN1 is_VBZ located_VVN ;_; 3_MC ._. 
Clients_NN2 individuals_NN2 and_CC groups_NN2 within_II the_AT client_NN1 system_NN1 ,_, those_DD2 that_CST were_VBDR part_NN1 of_IO the_AT action_NN1 system_NN1 and_CC those_DD2 that_CST were_VBDR not_XX ._. 
These_DD2 ,_, then_RT ,_, are_VBR the_AT three_MC groups_NN2 that_CST will_VM evaluate_VVI the_AT effectiveness_NN1 of_IO client_NN1 participation_NN1 ,_, each_DD1 in_II its_APPGE own_DA way_NN1 and_CC using_VVG its_APPGE own_DA peculiar_JJ criteria_NN2 ._. 
Each_DD1 of_IO the_AT three_MC groups_NN2 will_VM use_VVI the_AT double_JJ classification_NN1 of_IO goal_NN1 attainment_NN1 (_( goal_NN1 achievement_NN1 ,_, productivity_NN1 ,_, etc._RA )_) and_CC systems_NN2 processes_NN2 (_( adaptiveness_NN1 ,_, participant_NN1 satisfaction_NN1 ,_, inner_JJ processes_NN2 ,_, systems_NN2 resources_NN2 ,_, etc._RA )_) ,_, as_CSA explained_VVN above_RL in_II the_AT summary_NN1 of_IO the_AT section_NN1 on_II effectiveness_NN1 ._. 
Thus_RR the_AT model_NN1 includes_VVZ six_MC categories_NN2 of_IO effectiveness_NN1 evaluation_NN1 ,_, two_MC each_DD1 for_IF all_DB three_MC groups_NN2 of_IO evaluators_NN2 ._. 
They_PPHS2 are_VBR summarized_VVN in_II Table_NN1 1_MC1 with_IW examples_NN2 given_VVN of_IO the_AT types_NN2 of_IO outputs_NN2 to_TO be_VBI expected_VVN in_II each_DD1 of_IO the_AT categories_NN2 ._. 
The_AT change_NN1 agents_NN2 ,_, in_II41 the_II42 light_II43 of_II44 their_APPGE professional_JJ values_NN2 ,_, get_VV0 satisfaction_NN1 out_II21 of_II22 client_NN1 participation_NN1 (_( Bernstein_NP1 ,_, 1960_MC ,_, although_CS the_AT findings_NN2 in_II York_NP1 ,_, 1989_MC ,_, referred_VVN to_II above_RL ,_, in_II the_AT third_MD section_NN1 ,_, may_VM throw_VVI some_DD doubt_NN1 on_II this_DD1 )_) ._. 
Goal_NN1 attainment_NN1 is_VBZ also_RR improved_VVN in_II the_AT long_JJ run_NN1 :_: leadership_NN1 development_NN1 among_II the_AT clients_NN2 is_VBZ a_AT1 goal_NN1 by_II itself_PPX1 ,_, and_CC the_AT strengthening_NN1 of_IO client_NN1 independence_NN1 will_VM lead_VVI to_II the_AT better_JJR preservation_NN1 of_IO any_DD other_JJ outputs_NN2 achieved_VVN ._. 
The_AT clients_NN2 get_VV0 satisfaction_NN1 from_II participation_NN1 (_( or_CC ,_, perhaps_RR ,_, participate_VV0 as_II a_AT1 result_NN1 of_IO their_APPGE satisfaction_NN1 )_) ,_, take_VV0 part_NN1 in_II a_AT1 learning_NN1 process_NN1 which_DDQ enriches_VVZ them_PPHO2 ,_, and_CC identify_VV0 with_IW a_AT1 process_NN1 in_II which_DDQ they_PPHS2 themselves_PPX2 are_VBR involved_VVN ._. 
They_PPHS2 achieve_VV0 declared_JJ or_CC undeclared_JJ goals_NN2 :_: involvement_NN1 ,_, legitimization_NN1 ,_, recognition_NN1 ,_, prestige_NN1 ,_, all_DB of_IO which_DDQ increase_VV0 their_APPGE influence_NN1 among_II the_AT others_NN2 in_II the_AT client_NN1 system_NN1 and_CC those_DD2 in_II external_JJ systems_NN2 ,_, thus_RR increasing_VVG the_AT chances_NN2 of_IO further_JJR and_CC better_JJR outputs_NN2 in_II the_AT future_NN1 ._. 
The_AT administration_NN1 and_CC the_AT external_JJ political_JJ and_CC administrative_JJ establishment_NN1 may_VM see_VVI participation_NN1 as_II a_AT1 political_JJ end_NN1 in_II itself_PPX1 ,_, as_II31 well_II32 as_II33 a_AT1 means_NN to_II building_NN1 coalitions_NN2 for_IF the_AT political_JJ good_JJ of_IO their_APPGE establishment_NN1 ._. 
If_CS participation_NN1 saves_VVZ resources_NN2 (_( jobs_NN2 carried_VVN out_RP by_II volunteers_NN2 ,_, for_REX21 example_REX22 ,_, instead_II21 of_II22 paid_JJ workers_NN2 )_) ,_, then_RT this_DD1 is_VBZ an_AT1 important_JJ output_NN1 ,_, along_II21 with_II22 the_AT public_JJ legitimization_NN1 and_CC support_VV0 which_DDQ are_VBR likely_JJ to_TO accompany_VVI client_NN1 participation_NN1 ._. 
This_DD1 ,_, then_RT ,_, is_VBZ the_AT model_NN1 which_DDQ seems_VVZ to_II us_PPIO2 most_RGT appropriate_JJ for_IF attempting_VVG empirically_RR to_TO answer_VVI our_APPGE question_NN1 :_: How_RRQ can_VM we_PPIS2 measure_VVI the_AT effects_NN2 of_IO client_NN1 participation_NN1 on_II the_AT effectiveness_NN1 of_IO social_JJ work_NN1 intervention_NN1 ?_? 
Using_VVG the_AT six_MC measurement_NN1 criteria_NN2 summarized_VVN at_II the_AT end_NN1 of_IO the_AT section_NN1 on_II client_NN1 participation_NN1 ,_, we_PPIS2 are_VBR able_JK to_TO measure_VVI the_AT extent_NN1 to_II which_DDQ our_APPGE clients_NN2 are_VBR participating_VVG in_II the_AT community_NN1 work_NN1 project_NN1 (_( the_AT independent_JJ variable_NN1 )_) ,_, and_CC the_AT model_NN1 presented_VVN in_II this_DD1 section_NN1 allows_VVZ us_PPIO2 to_TO evaluate_VVI the_AT effectiveness_NN1 of_IO the_AT project_NN1 (_( the_AT dependent_JJ variable_NN1 )_) in_II a_AT1 number_NN1 of_IO different_JJ ways_NN2 ._. 
CONCLUSION_NN1 In_II this_DD1 article_NN1 we_PPIS2 have_VH0 reviewed_VVN the_AT extensive_JJ literature_NN1 on_II client_NN1 participation_NN1 and_CC effectiveness_NN1 and_CC the_AT limited_JJ literature_NN1 in_II which_DDQ the_AT effect_NN1 of_IO the_AT former_DA on_II the_AT latter_DA was_VBDZ examined_VVN ._. 
With_IW the_AT help_NN1 of_IO this_DD1 previous_JJ research_NN1 ,_, we_PPIS2 propose_VV0 criteria_NN2 for_IF the_AT measurement_NN1 of_IO these_DD2 two_MC important_JJ variables_NN2 and_CC an_AT1 operative_JJ model_NN1 to_TO illustrate_VVI and_CC to_TO measure_VVI how_RRQ participation_NN1 can_VM lead_VVI to_II effectiveness_NN1 ._. 
We_PPIS2 hope_VV0 that_CST improved_JJ methodology_NN1 will_VM allow_VVI a_AT1 better_JJR evaluation_NN1 of_IO the_AT relationship_NN1 between_II two_MC extremely_RR important_JJ values_NN2 in_II the_AT social_JJ worker_NN1 's_GE day_NNT1 to_II day_NNT1 work_NN1 ,_, and_CC will_VM show_VVI that_CST the_AT participation_NN1 of_IO our_APPGE clients_NN2 is_VBZ not_XX just_RR ideologically_RR based_VVN but_CCB practically_RR worthwhile_JJ ._. 
General_JJ Practice_NN1 ,_, Social_JJ Work_NN1 ,_, and_CC Mental_JJ Health_NN1 Sections_NN2 :_: The_AT Social_JJ Control_NN1 of_IO Women_NN2 MICHAEL_NP1 SHEPPARD_NP1 Michael_NP1 Sheppard_NP1 trained_VVD in_II social_JJ work_NN1 at_II the_AT University_NN1 of_IO East_NP1 Anglia_NP1 and_CC was_VBDZ a_AT1 social_JJ worker_NN1 in_II Norfolk_NP1 Social_JJ Services_NN2 Department_NN1 ._. 
His_APPGE publications_NN2 include_VV0 Mental_JJ Health_NN1 :_: The_AT Role_NN1 of_IO the_AT Approved_JJ Social_JJ Worker_NN1 (_( University_NN1 of_IO Sheffield_NP1 Press_NN1 ,_, 1990_MC )_) and_CC Mental_JJ Health_NN1 Work_NN1 in_II the_AT Community_NN1 :_: Theory_NN1 and_CC Practice_NN1 in_II Social_JJ Work_NN1 and_CC Community_NN1 Psychiatric_JJ Nursing_NN1 (_( Falmer_NP1 ,_, 1991_MC )_) ._. 
SUMMARY_NN1 A_ZZ1 survey_NN1 was_VBDZ undertaken_VVN of_IO all_DB referrals_NN2 for_IF compulsory_JJ admission_NN1 received_VVN by_II a_AT1 city_NN1 mental_JJ health_NN1 centre_NN1 over_II a_AT1 one_MC1 year_NNT1 period_NN1 ._. 
The_AT centre_NN1 receives_VVZ the_AT overwhelming_JJ majority_NN1 of_IO all_DB these_DD2 referrals_NN2 in_II the_AT city_NN1 ._. 
Referrals_NN2 from_II GPs_NN2 were_VBDR compared_VVN with_IW other_JJ referrals_NN2 focusing_VVG particularly_RR on_II women_NN2 ._. 
The_AT results_NN2 indicate_VV0 GPs_NN2 discriminated_VVN against_II women_NN2 ,_, referring_VVG considerably_RR more_DAR women_NN2 than_CSN men_NN2 with_IW less_DAR emphasis_NN1 on_II major_JJ (_( psychotic_JJ )_) mental_JJ illness_NN1 ._. 
The_AT involvement_NN1 of_IO approved_JJ social_JJ workers_NN2 (_( ASWs_NP2 )_) in_II the_AT assessment_NN1 process_NN1 was_VBDZ associated_VVN with_IW diversion_NN1 of_IO many_DA2 of_IO the_AT women_NN2 away_II21 from_II22 compulsory_JJ admission_NN1 ,_, although_CS even_RR they_PPHS2 appeared_VVD affected_VVN by_II patriarchal_JJ assumptions_NN2 ._. 
GPs_NN2 behaviour_NN1 with_II31 regard_II32 to_II33 sections_NN2 is_VBZ consistent_JJ with_IW reports_NN2 about_II sexist_JJ practice_NN1 in_II other_JJ areas_NN2 of_IO work_NN1 ._. 
This_DD1 ,_, however_RR ,_, is_VBZ particularly_RR grave_JJ with_IW sections_NN2 because_II21 of_II22 civil_JJ liberties_NN2 implications_NN2 ._. 
The_AT article_NN1 concludes_VVZ that_CST ASWs_NN2 need_VM be_VBI aware_JJ of_IO potential_JJ sexist_JJ GP_NN1 practice_NN1 ,_, that_CST their_APPGE psychosocial_JJ perspective_NN1 is_VBZ critical_JJ to_II assessment_NN1 and_CC that_DD1 ASW_NN1 training_NN1 should_VM include_VVI gender_NN1 issues_NN2 ._. 
Researchers_NN2 are_VBR beginning_VVG to_TO unravel_VVI some_DD of_IO the_AT factors_NN2 significant_JJ in_II the_AT process_NN1 of_IO assessment_NN1 for_IF compulsory_JJ admission_NN1 (_( section_NN1 assessments_NN2 )_) under_II the_AT 1983_MC Mental_JJ Health_NN1 Act_NN1 ._. 
Studies_NN2 have_VH0 focused_VVN on_II Approved_JJ Social_JJ Workers_NN2 (_( ASWs_NP2 )_) (_( Sheppard_NP1 ,_, 1990_MC ;_; Barnes_NP1 et_RA21 al._RA22 ,_, 1990_MC )_) and_CC the_AT police_NN2 (_( Bean_NN1 et_RA21 al._RA22 ,_, 1989_MC ;_; Bean_NN1 ,_, 1990_MC ;_; Rogers_NP1 ,_, 1989_MC )_) ._. 
One_MC1 study_NN1 has_VHZ used_VVN theoretical_JJ and_CC empirical_JJ research_NN1 to_TO provide_VVI the_AT foundations_NN2 for_IF a_AT1 social_JJ work_NN1 knowledge_NN1 base_NN1 assessing_VVG social_JJ risk_NN1 (_( Sheppard_NP1 ,_, 1990_MC )_) ._. 
There_EX has_VHZ ,_, however_RR ,_, been_VBN no_AT focus_NN1 on_II the_AT position_NN1 of_IO GPs_NN2 and_CC their_APPGE interaction_NN1 with_IW ASWs_NN2 in_II the_AT assessment_NN1 process_NN1 ._. 
This_DD1 article_NN1 examines_VVZ general_JJ practitioners_NN2 (_( GPs_NN2 )_) as_CSA referrers_NN2 ,_, and_CC women_NN2 as_II the_AT subject_NN1 of_IO referral_NN1 for_IF section_NN1 under_II the_AT 1983_MC Act_NN1 ._. 
It_PPH1 does_VDZ so_RR by_II examining_VVG the_AT process_NN1 of_IO assessment_NN1 in_II which_DDQ the_AT ASW_NN1 plays_VVZ a_AT1 critical_JJ role_NN1 between_II the_AT initial_JJ referral_NN1 from_II the_AT GP_NN1 and_CC the_AT decision_NN1 whether_CSW31 or_CSW32 not_CSW33 to_II section_NN1 the_AT woman_NN1 ._. 
This_DD1 is_VBZ interesting_JJ ,_, both_RR because_II21 of_II22 the_AT serious_JJ consequences_NN2 of_IO a_AT1 mental_JJ health_NN1 section_NN1 ,_, and_CC because_II21 of_II22 concern_NN1 expressed_VVN about_II sexist_JJ practice_NN1 by_II GPs_NN2 in_II other_JJ areas_NN2 of_IO their_APPGE work_NN1 (_( Barrett_NP1 and_CC Roberts_NP1 ,_, 1978_MC ;_; Cooperstock_NP1 ,_, 1978_MC )_) ._. 
GPs_NN2 occupy_VV0 a_AT1 pivotal_JJ position_NN1 in_II31 relation_II32 to_II33 mental_JJ health_NN1 ._. 
Because_CS they_PPHS2 occupy_VV0 key_JJ positions_NN2 in_II primary_JJ care_NN1 ,_, they_PPHS2 are_VBR for_IF most_DAT people_NN the_AT most_RGT accessible_JJ caring_JJ profession_NN1 ,_, and_CC psychiatry_NN1 is_VBZ considered_VVN by_II doctors_NN2 to_TO be_VBI primarily_RR their_APPGE occupational_JJ territory_NN1 ._. 
Hence_RR they_PPHS2 deal_VV0 with_IW high_JJ levels_NN2 of_IO psychiatric_JJ morbidity_NN1 (_( Jenkins_NP1 et_RA21 al._RA22 ,_, 1988_MC ;_; Goldberg_NP1 and_CC Huxley_NP1 ,_, 1980_MC )_) ._. 
They_PPHS2 are_VBR likely_JJ ,_, therefore_RR ,_, to_TO be_VBI the_AT first_MD profession_NN1 approached_VVD by_RP ,_, for_REX21 example_REX22 ,_, relatives_NN2 ,_, for_IF assessment_NN1 ._. 
In_II many_DA2 circumstances_NN2 GPs_NN2 are_VBR likely_JJ to_TO be_VBI the_AT first_MD professional_JJ to_TO decide_VVI a_AT1 section_NN1 is_VBZ necessary_JJ and_CC initiate_VVI the_AT section_NN1 assessment_NN1 process_NN1 subsequently_RR involving_VVG ASWs_NN2 ._. 
It_PPH1 is_VBZ widely_RR recognized_VVN that_CST the_AT proportion_NN1 of_IO women_NN2 who_PNQS suffer_VV0 mental_JJ disorders_NN2 particularly_RR depression_NN1 exceeds_VVZ that_DD1 of_IO men_NN2 (_( Cochrane_NP1 ,_, 1983_MC )_) ._. 
A_AT1 variety_NN1 of_IO possible_JJ contributing_JJ factors_NN2 have_VH0 been_VBN put_VVN forward_RL :_: that_DD1 biological_JJ factors_NN2 make_VV0 women_NN2 more_RGR vulnerable_JJ than_CSN men_NN2 ;_; that_CST women_NN2 are_VBR socially_RR disadvantaged_JJ by_II the_AT roles_NN2 they_PPHS2 are_VBR expected_VVN to_TO perform_VVI ,_, and_CC psychologically_RR disadvantaged_JJ by_II socialization_NN1 preparing_VVG them_PPHO2 for_IF these_DD2 roles_NN2 ;_; that_CST women_NN2 express_VV0 their_APPGE emotions_NN2 more_RGR readily_RR ;_; and_CC that_DD1 health_NN1 professionals_NN2 are_VBR more_RGR likely_JJ to_TO equate_VVI feminine_JJ characteristics_NN2 with_IW ill_JJ health_NN1 (_( Weissman_NP1 and_CC Klerman_NP1 ,_, 1977_MC ;_; Penfold_NP1 and_CC Walker_NP1 ,_, 1984_MC ;_; Corob_NP1 ,_, 1987_MC )_) ._. 
Feminists_NN2 in_RR21 particular_RR22 make_VV0 much_DA1 of_IO the_AT social_JJ disadvantage_NN1 under_II which_DDQ women_NN2 suffer_VV0 ._. 
In_II31 view_II32 of_II33 this_DD1 disadvantage_NN1 ,_, and_CC possible_JJ GP_NN1 sexism_NN1 ,_, the_AT study_NN1 of_IO GP_NN1 section_NN1 referrals_NN2 and_CC the_AT influence_NN1 of_IO ASWs_NP2 in_II the_AT subsequent_JJ process_NN1 of_IO assessment_NN1 is_VBZ significant_JJ ._. 
Compulsory_JJ admission_NN1 in_II England_NP1 and_CC Wales_NP1 is_VBZ carried_VVN out_RP under_II the_AT Mental_JJ Health_NN1 Act_NN1 1983_MC ._. 
This_DD1 is_VBZ primarily_RR carried_VVN out_RP under_II sections_NN2 2_MC ,_, 3_MC ,_, and_CC 4_MC ,_, although_CS section_NN1 5_MC provides_VVZ for_IF doctor_NN1 and_CC nurse_NN1 holding_VVG powers_NN2 ,_, police_NN2 powers_NN2 exist_VV0 under_II section_NN1 136_MC and_CC courts_NN2 have_VH0 powers_NN2 to_TO direct_VVI individuals_NN2 into_II hospital_NN1 (_( for_REX21 example_REX22 ,_, section_NN1 37_MC )_) ._. 
Section_NN1 2_MC involves_VVZ admission_NN1 for_IF assessment_NN1 ,_, section_NN1 4_MC for_IF emergency_NN1 admission_NN1 for_IF assessment_NN1 and_CC section_NN1 3_MC for_IF admission_NN1 for_IF treatment_NN1 ._. 
Admission_NN1 under_II these_DD2 sections_NN2 ,_, in_RR21 brief_RR22 ,_, may_VM be_VBI made_VVN when_CS a_AT1 person_NN1 is_VBZ suffering_VVG from_II a_AT1 mental_JJ disorder_NN1 ,_, and_CC such_DA admission_NN1 is_VBZ in_II the_AT interests_NN2 of_IO the_AT person_NN1 's_GE (_( defined_VVN as_CSA patient_JJ )_) own_VV0 health_NN1 or_CC safety_NN1 or_CC for_IF the_AT protection_NN1 of_IO other_JJ persons_NN2 ._. 
The_AT duration_NN1 of_IO section_NN1 2_MC may_VM be_VBI up_RG21 to_RG22 28_MC days_NNT2 and_CC of_IO section_NN1 3_MC up_RG21 to_RG22 six_MC months_NNT2 ,_, although_CS it_PPH1 is_VBZ renewable_JJ ._. 
Section_NN1 4_MC may_VM last_VVI up_RG21 to_RG22 72_MC hours_NNT2 ,_, and_CC may_VM be_VBI made_VVN only_RR when_CS admission_NN1 is_VBZ of_IO urgent_JJ necessity_NN1 and_CC complying_VVG with_IW the_AT provisions_NN2 of_IO section_NN1 2_MC would_VM cause_VVI undesirable_JJ delay_NN1 ._. 
Application_NN1 may_VM be_VBI made_VVN by_II an_AT1 ASW_NN1 or_CC nearest_JJT relative_NN1 although_CS the_AT draft_NN1 code_NN1 of_IO practice_NN1 (_( Department_NN1 of_IO Health_NN1 ,_, 1989_MC )_) states_VVZ the_AT former_DA should_VM apply_VVI whenever_RRQV possible_JJ ._. 
Sections_NN2 2_MC and_CC 3_MC require_VV0 two_MC medical_JJ recommendations_NN2 ,_, one_MC1 by_II an_AT1 approved_JJ doctor_NN1 ,_, while_CS section_NN1 four_MC requires_VVZ only_RR one_MC1 ._. 
Individuals_NN2 may_VM also_RR be_VBI admitted_VVN informally_RR (_( section_NN1 131_MC )_) or_CC not_XX admitted_VVN at_RR21 all_RR22 ._. 
There_EX is_VBZ ,_, therefore_RR ,_, a_AT1 variety_NN1 of_IO possible_JJ outcomes_NN2 following_VVG a_AT1 referral_NN1 ._. 
METHOD_NN1 The_AT research_NN1 was_VBDZ undertaken_VVN on_II referrals_NN2 received_VVN by_II the_AT Psychiatric_JJ Advisory_JJ Service_NN1 (_( PAS_FW )_) at_II the_AT Nuffield_NP1 Mental_JJ Health_NN1 Centre_NN1 in_II a_AT1 medium_JJ sized_JJ city_NN1 of_IO about_RG 240,000_MC ,_, with_IW a_AT1 very_RG small_JJ ethnic_JJ minority_NN1 population_NN1 ._. 
The_AT Centre_NN1 is_VBZ situated_VVN in_II a_AT1 central_JJ location_NN1 with_IW good_JJ transport_NN1 links_VVZ to_II all_DB parts_NN2 of_IO the_AT city_NN1 ._. 
The_AT PAS_FW is_VBZ well_RR known_VVN in_II the_AT city_NN1 and_CC receives_VVZ the_AT overwhelming_JJ majority_NN1 of_IO the_AT section_NN1 assessment_NN1 requests_NN2 received_VVN during_II normal_JJ working_NN1 hours_NNT2 ._. 
It_PPH1 is_VBZ staffed_VVN by_II a_AT1 team_NN1 of_IO community_NN1 psychiatric_JJ nurses_NN2 and_CC a_AT1 team_NN1 of_IO social_JJ workers_NN2 together_RL with_IW psychiatrists_NN2 approved_VVN under_II the_AT Act_NN1 ._. 
It_PPH1 is_VBZ open_JJ from_II 9_MC a.m._RA to_II 5_MC p.m_RA ._. 
Referrals_NN2 at_II other_JJ times_NNT2 are_VBR received_VVN by_RP out_II21 of_II22 hours_NNT2 social_JJ workers_NN2 ._. 
Referrals_NN2 received_VVN from_II all_DB sources_NN2 requesting_VVG a_AT1 section_NN1 assessment_NN1 over_II a_AT1 one_MC1 year_NNT1 period_NN1 were_VBDR included_VVN in_II this_DD1 study_NN1 ._. 
When_CS the_AT ASWs_NP2 responded_VVD to_II a_AT1 section_NN1 referral_NN1 ,_, whatever_DDQV the_AT source_NN1 ,_, they_PPHS2 were_VBDR asked_VVN to_TO complete_VVI fully_RR structured_JJ questionnaires_NN2 ._. 
These_DD2 had_VHD been_VBN developed_VVN over_II a_AT1 one_MC1 year_NNT1 period_NN1 and_CC had_VHD been_VBN fully_RR piloted_VVN ._. 
Detailed_JJ analysis_NN1 both_RR of_IO the_AT questionnaires_NN2 and_CC piloting_VVG is_VBZ provided_VVN elsewhere_RL (_( Sheppard_NP1 ,_, 1990_MC ;_; 1991_MC )_) ._. 
The_AT research_NN1 instruments_NN2 involved_VVD questions_NN2 about_II the_AT source_NN1 of_IO referral_NN1 ,_, section_NN1 requested_VVN and_CC psychiatric_JJ state_NN1 suggested_VVD ,_, if_CS any_DD ,_, in_II the_AT referral_NN1 ._. 
They_PPHS2 involved_VVD demographic_JJ characteristics_NN2 such_II21 as_II22 age_NN1 ,_, sex_NN1 ,_, and_CC marital_JJ status_NN1 ;_; information_NN1 on_II psychiatric_JJ state_NN1 and_CC psychiatric_JJ disorder_NN1 ;_; and_CC social_JJ problems_NN2 ._. 
Finally_RR ,_, information_NN1 was_VBDZ provided_VVN on_II who_PNQS in_II the_AT patient_NN1 's_GE social_JJ circle_NN1 was_VBDZ interviewed_VVN as_II part_NN1 of_IO the_AT assessment_NN1 process_NN1 ,_, factors_NN2 considered_VVN in_II assessment_NN1 ,_, and_CC outcome_NN1 ._. 
These_DD2 data_NN ,_, it_PPH1 should_VM be_VBI remembered_VVN ,_, were_VBDR provided_VVN by_II the_AT ASW_NN1 ,_, and_CC in_II some_DD respects_NN2 ,_, such_II21 as_II22 the_AT presence_NN1 of_IO social_JJ problems_NN2 ,_, will_VM represent_VVI their_APPGE perspective_NN1 on_II the_AT patient_NN1 ._. 
In_II other_JJ respects_NN2 ,_, such_II21 as_II22 outcome_NN1 ,_, we_PPIS2 have_VH0 unambiguously_RR objective_JJ information_NN1 ._. 
These_DD2 questionnaires_NN2 were_VBDR completed_VVN within_II the_AT week_NNT1 following_VVG assessment_NN1 ._. 
Agency_NN1 records_NN2 ,_, which_DDQ recorded_VVD all_DB referrals_NN2 ,_, were_VBDR checked_VVN weekly_JJ to_TO confirm_VVI that_CST ASWs_NN2 had_VHD completed_VVN questionnaires_NN2 where_RRQ relevant_JJ ._. 
RESULTS_NN2 MALE_NN1 AND_CC FEMALE_JJ REFERRALS_NN2 Altogether_RR 120_MC referrals_NN2 were_VBDR made_VVN during_II the_AT study_NN1 year_NNT1 ._. 
Forty_MC (_( 33_MC per_NNU21 cent_NNU22 )_) were_VBDR by_II GPs_NN2 ._. 
Of_IO the_AT other_JJ 80_MC referrals_NN2 17_MC were_VBDR by_II the_AT family_NN1 ,_, 13_MC by_II psychiatrists_NN2 ,_, 17_MC other_JJ health_NN1 referrals_NN2 ,_, 15_MC police_NN2 ,_, nine_MC social_JJ workers_NN2 and_CC nine_MC other_JJ referrals_NN2 ._. 
The_AT overall_JJ rate_NN1 of_IO referral_NN1 was_VBDZ 49.9_MC per_II 100,000_MC population_NN1 ,_, and_CC for_IF GPs_NN2 ,_, 16.6_MC per_II 100,000_MC ._. 
These_DD2 figures_NN2 relate_VV0 to_II referrals_NN2 during_II working_NN1 hours_NNT2 only_RR ,_, and_CC compare_VV0 with_IW overall_JJ referral_NN1 rates_NN2 varying_VVG between_II 19.9_MC and_CC 102.7_MC per_II 100,000_MC in_II 42_MC social_JJ services_NN2 departments_NN2 studied_VVN by_II Barnes_NP1 et_RA21 al._RA22 (_( 1990_MC )_) ._. 
Although_CS ,_, therefore_RR ,_, quite_RG high_JJ ,_, the_AT rate_NN1 of_IO referral_NN1 in_II this_DD1 study_NN1 was_VBDZ well_JJ within_II the_AT range_NN1 for_IF different_JJ areas_NN2 ._. 
Seventy-five_MC referrals_NN2 (_( 62_MC per_NNU21 cent_NNU22 )_) were_VBDR women_NN2 ._. 
This_DD1 is_VBZ consistent_JJ with_IW trends_NN2 identified_VVN by_II Barnes_NP1 et_RA21 al._RA22 (_( 1990_MC )_) ,_, and_CC raises_VVZ issues_NN2 of_IO what_DDQ ,_, if_CS any_DD ,_, social_JJ processes_NN2 are_VBR occurring_VVG which_DDQ leave_VV0 women_NN2 more_RGR frequently_RR identified_VVN as_CSA candidates_NN2 for_IF sections_NN2 ._. 
The_AT social_JJ profile_NN1 of_IO the_AT women_NN2 differed_VVD markedly_RR from_II that_DD1 of_IO the_AT men_NN2 in_II a_AT1 number_NN1 of_IO respects_NN2 ._. 
Men_NN2 tended_VVD to_TO be_VBI younger_JJR than_CSN women_NN2 :_: 58_MC per_NNU21 cent_NNU22 of_IO men_NN2 compared_VVN with_IW 49_MC per_NNU21 cent_NNU22 of_IO women_NN2 were_VBDR aged_VVN under_RG 45_MC ._. 
A_AT1 number_NN1 of_IO differences_NN2 are_VBR significant_JJ ._. 
Table_NN1 1_MC1 shows_VVZ significant_JJ differences_NN2 in_II marital_JJ status_NN1 ._. 
Markedly_RR more_DAR men_NN2 than_CSN women_NN2 were_VBDR single_JJ ,_, while_CS considerably_RR more_DAR women_NN2 were_VBDR married_JJ or_CC cohabiting_VVG ._. 
More_DAR women_NN2 than_CSN men_NN2 had_VHD children_NN2 ,_, although_CS the_AT small_JJ proportion_NN1 of_IO men_NN2 with_IW children_NN2 confirms_VVZ their_APPGE limited_JJ involvement_NN1 in_II family_NN1 relationships_NN2 ._. 
Men_NN2 were_VBDR more_RGR disadvantaged_JJ in_II other_JJ ways_NN2 ._. 
Only_RR 43_MC per_NNU21 cent_NNU22 of_IO women_NN2 were_VBDR unemployed_JJ or_CC in_II families_NN2 where_RRQ no_AT member_NN1 was_VBDZ employed_VVN compared_VVN with_IW 56_MC per_NNU21 cent_NNU22 of_IO men_NN2 (_( p=0.024_FO )_) ._. 
Sixty-seven_MC per_NNU21 cent_NNU22 of_IO men_NN2 compared_VVN with_IW 42_MC per_NNU21 cent_NNU22 of_IO women_NN2 were_VBDR on_II state_NN1 benefit_NN1 excluding_II child_NN1 benefit_NN1 and_CC retirement_NN1 pension_NN1 (_( universal_JJ to_II parents_NN2 and_CC the_AT retired_JJ elderly_JJ )_) (_( p=0.013_FO )_) ._. 
Housing_VVG condition_NN1 also_RR showed_VVD greater_JJR ,_, but_CCB not_XX significant_JJ ,_, male_JJ disadvantage_NN1 ._. 
When_CS divided_VVN into_II two_MC stable_JJ residence_NN1 consisting_VVG of_IO council_NN1 and_CC owner_NN1 occupied_VVN housing_NN1 ,_, and_CC unstable_JJ consisting_VVG of_IO private_JJ rented_JJ ,_, lodging_VVG ,_, and_CC hostel_NN1 accommodation_NN1 and_CC no_AT fixed_JJ abode_NN1 76_MC per_NNU21 cent_NNU22 of_IO women_NN2 lived_VVN in_II stable_JJ accommodation_NN1 compared_VVN with_IW 63_MC per_NNU21 cent_NNU22 of_IO men_NN2 ._. 
Marked_JJ differences_NN2 ,_, however_RR ,_, are_VBR not_XX evident_JJ in_II the_AT '_GE processing_NN1 ,_, of_IO these_DD2 people_NN ._. 
Eighty-nine_MC per_NNU21 cent_NNU22 of_IO men_NN2 and_CC 84_MC per_NNU21 cent_NNU22 of_IO women_NN2 were_VBDR previously_RR known_VVN to_II the_AT psychiatric_JJ services_NN2 ,_, indicating_VVG longstanding_JJ problems_NN2 ._. 
In_II just_RR over_RG half_DB male_JJ and_CC female_JJ referrals_NN2 no_AT specific_JJ mental_JJ disorder_NN1 was_VBDZ identified_VVN ._. 
Following_VVG the_AT section_NN1 assessment_NN1 84_MC per_NNU21 cent_NNU22 of_IO males_NN2 and_CC 95_MC per_NNU21 cent_NNU22 of_IO females_NN2 were_VBDR considered_VVN to_TO suffer_VVI some_DD kind_NN1 of_IO mental_JJ disorder_NN1 ._. 
Over_RG 70_MC per_NNU21 cent_NNU22 of_IO both_DB2 groups_NN2 were_VBDR considered_VVN psychotic_JJ ,_, with_IW rather_RG more_DAR men_NN2 schizophrenic_NN1 and_CC rather_RG more_DAR women_NN2 suffering_VVG affective_JJ psychosis_NN1 ._. 
Frequently_RR ,_, then_RT ,_, an_AT1 unspecific_JJ referral_NN1 was_VBDZ subsequently_RR considered_VVN a_AT1 psychosis_NN1 ._. 
On_II average_NN1 the_AT ASWs_NN2 identified_VVN more_RGR social_JJ problems_NN2 for_IF women_NN2 (_( 2.12_MC per_II case_NN1 )_) than_CSN men_NN2 (_( 1.6_MC per_II case_NN1 )_) ._. 
Twenty_MC women_NN2 (_( 27_MC per_NNU21 cent_NNU22 )_) but_CCB only_RR five_MC men_NN2 (_( 11_MC per_NNU21 cent_NNU22 )_) had_VHD marital_JJ problems_NN2 ,_, while_CS only_RR one_MC1 man_NN1 (_( 2_MC per_NNU21 cent_NNU22 )_) compared_VVN with_IW ten_MC women_NN2 (_( 13_MC per_NNU21 cent_NNU22 )_) had_VHD child_NN1 care_NN1 problems_NN2 ,_, both_DB2 differences_NN2 show_VV0 just_RR below_II significance_NN1 (_( taken_VVN as_CSA p&lt;0.05_FO )_) ._. 
Women_NN2 ,_, then_RT ,_, had_VHD more_DAR social_JJ problems_NN2 ,_, particularly_RR connected_VVN with_IW familial_JJ responsibilities_NN2 ._. 
Outcome_NN1 (_( Table_NN1 2_MC )_) was_VBDZ generally_RR similar_JJ for_IF both_DB2 groups_NN2 ,_, although_CS considerably_RR more_DAR men_NN2 were_VBDR placed_VVN on_II section_NN1 3_MC and_CC rather_RG more_DAR women_NN2 on_II section_NN1 2_MC ._. 
The_AT former_DA ,_, which_DDQ is_VBZ more_RGR draconian_JJ ,_, may_VM reflect_VVI the_AT longer_JJR term_NN1 perceived_VVD treatment_NN1 needs_NN2 of_IO the_AT men_NN2 ._. 
This_DD1 may_VM be_VBI related_VVN to_II a_AT1 relative_JJ lack_NN1 of_IO social_JJ stability_NN1 :_: being_VBG more_RGR frequently_RR single_JJ and_CC in_II less_RGR permanent_JJ accommodation_NN1 ._. 
Overall_RR ,_, then_RT ,_, the_AT main_JJ differences_NN2 were_VBDR in_II the_AT social_JJ profile_NN1 ,_, and_CC a_AT1 greater_JJR number_NN1 of_IO social_JJ problems_NN2 in_II women_NN2 ._. 
Difference_NN1 in_II outcome_NN1 may_VM be_VBI related_VVN to_II different_JJ social_JJ profiles_NN2 ._. 
This_DD1 still_JJ leaves_NN2 the_AT issue_NN1 of_IO the_AT process_NN1 by_II which_DDQ more_DAR women_NN2 were_VBDR referred_VVN ._. 
WOMEN_NN2 AND_CC GP_NN1 REFERRALS_NN2 The_AT impact_NN1 of_IO GPs_NN2 on_II the_AT sex_NN1 composition_NN1 of_IO referrals_NN2 is_VBZ profound_JJ (_( Table_NN1 3_MC )_) ._. 
Exactly_RR a_AT1 third_MD of_IO referrals_NN2 were_VBDR made_VVN by_II GPs_NN2 ._. 
However_RR ,_, the_AT overwhelming_JJ majority_NN1 of_IO GP_NN1 referrals_NN2 were_VBDR women_NN2 ,_, compared_VVN with_IW only_RR just_RR over_RG half_DB the_AT other_JJ referrals_NN2 ._. 
Indeed_RR GP_NN1 referrals_NN2 account_VV0 for_IF nearly_RR all_DB the_AT excess_NN1 of_IO female_NN1 over_II male_JJ referrals_NN2 ._. 
Examination_NN1 of_IO outcome_NN1 ,_, furthermore_RR ,_, is_VBZ intriguing_JJ ._. 
The_AT difference_NN1 between_II male_NN1 and_CC female_JJ GP_NN1 referrals_NN2 was_VBDZ noticeable_JJ :_: five_MC of_IO the_AT eight_MC males_NN2 referred_VVN (_( 63_MC per_NNU21 cent_NNU22 )_) were_VBDR sectioned_VVN ,_, compared_VVN with_IW only_RR 12_MC (_( 38_MC per_NNU21 cent_NNU22 )_) of_IO female_JJ referrals_NN2 ._. 
However_RR ,_, compared_VVN with_IW the_AT 70_MC per_NNU21 cent_NNU22 of_IO women_NN2 referred_VVN from_II other_JJ sources_NN2 (_( 39_MC )_) who_PNQS were_VBDR sectioned_VVN ,_, the_AT number_NN1 of_IO female_JJ GP_NN1 referrals_NN2 sectioned_VVD was_VBDZ significantly_RR lower_JJR (_( p=0.011_FO )_) ._. 
This_DD1 indicates_VVZ a_AT1 significantly_RR greater_JJR diversion_NN1 of_IO women_NN2 ,_, following_VVG ASW_NN1 assessment_NN1 ,_, generally_RR with_IW a_AT1 psychiatrist_NN1 ,_, away_II21 from_II22 compulsory_JJ admission_NN1 when_CS referred_VVN by_II GPs_NN2 ._. 
An_AT1 excess_NN1 of_IO GP_NN1 referrals_NN2 over_II other_JJ referrals_NN2 of_IO women_NN2 informally_RR admitted_VVN was_VBDZ matched_VVN by_II an_AT1 excess_NN1 of_IO female_NN1 over_II male_JJ GP_NN1 referrals_NN2 who_PNQS were_VBDR informally_RR admitted_VVN ._. 
Two_MC initial_JJ observations_NN2 may_VM be_VBI made_VVN ._. 
This_DD1 combination_NN1 of_IO data_NN an_AT1 excess_NN1 of_IO GP_NN1 over_II other_JJ referrals_NN2 of_IO women_NN2 ,_, together_RL with_IW a_AT1 significantly_RR greater_JJR likelihood_NN1 of_IO diversion_NN1 of_IO women_NN2 referred_VVN by_II GPs_NN2 away_II21 from_II22 compulsory_JJ admission_NN1 compared_VVN with_IW other_JJ female_JJ referrals_NN2 suggests_VVZ apparent_JJ discrimination_NN1 on_II41 the_II42 part_II43 of_II44 GPs_NN2 against_II women_NN2 ._. 
Second_MD ,_, the_AT role_NN1 of_IO specialist_NN1 professionals_NN2 ASWs_NN2 and_CC psychiatrists_NN2 appears_VVZ significant_JJ in_II enabling_VVG women_NN2 referred_VVN by_II GPs_NN2 to_TO avoid_VVI compulsory_JJ admission_NN1 ._. 
Outcome_NN1 is_VBZ shown_VVN in_II more_DAR detail_NN1 in_II Table_NN1 4_MC ._. 
This_DD1 shows_VVZ a_AT1 noticeable_JJ excess_NN1 of_IO women_NN2 referred_VVN by_II GPs_NN2 over_II other_JJ female_JJ referrals_NN2 who_PNQS were_VBDR not_XX admitted_VVN at_RR21 all_RR22 ._. 
Informal_JJ admissions_NN2 are_VBR also_RR interesting_JJ ._. 
Noticeably_RR more_DAR women_NN2 referred_VVN by_II GPs_NN2 were_VBDR admitted_VVN informally_RR than_CSN either_RR male_JJ GP_NN1 referrals_NN2 or_CC other_JJ female_JJ referrals_NN2 ._. 
This_DD1 group_NN1 involves_VVZ women_NN2 who_PNQS were_VBDR considered_VVN to_TO need_VVI assessment_NN1 or_CC treatment_NN1 ,_, but_CCB where_RRQ compulsion_NN1 was_VBDZ not_XX considered_VVN necessary_JJ ._. 
This_DD1 suggests_VVZ the_AT significance_NN1 of_IO specialist_NN1 workers_NN2 in_II two_MC possible_JJ ways_NN2 :_: either_RR preventing_VVG compulsion_NN1 where_CS there_EX was_VBDZ insufficient_JJ risk_NN1 to_II the_AT patient_NN1 or_CC others_NN2 ,_, or_CC persuading_VVG those_DD2 who_PNQS would_VM otherwise_RR have_VHI been_VBN sectioned_VVN to_TO enter_VVI hospital_NN1 informally_RR ._. 
Bean_NN1 's_GE (_( 1980_MC )_) typology_NN1 of_IO doctor_NN1 patient_NN1 interaction_NN1 showed_VVD that_CST ,_, under_II the_AT 1959_MC Act_NN1 ,_, voluntary_JJ admission_NN1 occurred_VVD when_CS there_EX was_VBDZ agreement_NN1 between_II doctor_NN1 and_CC patient_NN1 on_II the_AT patient_NN1 's_GE sick_JJ role_NN1 or_CC where_RRQ ,_, although_CS agreement_NN1 did_VDD not_XX exist_VVI ,_, the_AT patient_NN1 acquiesced_VVN and_CC accepted_VVN this_DD1 role_NN1 ._. 
Compulsory_JJ admission_NN1 occurred_VVD where_RRQ the_AT doctor_NN1 ascribed_VVN the_AT sick_JJ role_NN1 but_CCB the_AT patient_NN1 did_VDD not_XX accept_VVI it_PPH1 or_CC did_VDD not_XX react_VVI at_RR21 all_RR22 ._. 
The_AT nature_NN1 of_IO the_AT ASW_NN1 involvement_NN1 suggests_VVZ that_CST they_PPHS2 too_RR would_VM be_VBI involved_JJ in_II this_DD1 process_NN1 (_( Sheppard_NP1 ,_, 1990_MC )_) ._. 
Referrals_NN2 by_II GPs_NN2 where_RRQ outcome_NN1 was_VBDZ informal_JJ admission_NN1 were_VBDR consistently_RR characterized_VVN by_II familial_JJ disruption_NN1 :_: indeed_RR only_RR two_MC of_IO these_DD2 cases_NN2 were_VBDR referred_VVN where_CS the_AT woman_NN1 's_GE behaviour_NN1 drew_VVD attention_NN1 to_II her_PPHO1 in_II the_AT wider_JJR social_JJ environment_NN1 outside_II the_AT family_NN1 ._. 
The_AT noticeable_JJ familial_JJ disruption_NN1 occurring_VVG in_II other_JJ cases_NN2 is_VBZ particularly_RR interesting_JJ because_CS it_PPH1 reflects_VVZ social_JJ role_NN1 expectations_NN2 of_IO women_NN2 ,_, where_CS the_AT primary_JJ role_NN1 traditionally_RR is_VBZ that_DD1 of_IO homemaker_NN1 ,_, family_NN1 manager_NN1 ,_, and_CC housewife_NN1 (_( Oakley_NP1 ,_, 1981_MC )_) ._. 
Thus_RR ,_, informal_JJ admissions_NN2 were_VBDR characterized_VVN by_II a_AT1 combination_NN1 of_IO mental_JJ ill_JJ health_NN1 and_CC transgression_NN1 of_IO traditional_JJ social_JJ role_NN1 expectations_NN2 ._. 
Three_MC examples_NN2 ,_, drawn_VVN from_II the_AT ASWs_NP2 '_GE account_NN1 ,_, indicate_VV0 the_AT different_JJ types_NN2 of_IO familial_JJ disruption_NN1 ._. 
The_AT first_MD type_NN1 active_JJ familial_JJ disruption_NN1 involved_VVD a_AT1 woman_NN1 in_II her_APPGE thirties_MC2 who_PNQS was_VBDZ considered_VVN to_TO be_VBI suffering_VVG from_II schizophrenia_NN1 ._. 
She_PPHS1 was_VBDZ very_RG overactive_JJ and_CC had_VHD not_XX slept_VVN for_IF three_MC nights_NNT2 ._. 
She_PPHS1 was_VBDZ pacing_VVG up_RP and_CC down_RP in_II the_AT house_NN1 ,_, was_VBDZ hostile_JJ to_II other_JJ family_NN1 members_NN2 and_CC was_VBDZ shouting_VVG at_II voices_NN2 that_CST she_PPHS1 (_( and_CC no-one_PN1 else_RR )_) heard_VVD ._. 
She_PPHS1 was_VBDZ paying_VVG little_JJ attention_NN1 to_II her_APPGE normal_JJ '_GE household_NN1 duties_NN2 '_GE such_II21 as_II22 child_NN1 care_NN1 ,_, shopping_VVG ,_, and_CC looking_VVG after_II the_AT house_NN1 ._. 
She_PPHS1 had_VHD two_MC young_JJ children_NN2 ,_, aged_II five_MC and_CC seven_MC ,_, and_CC the_AT ASW_NP1 expressed_VVD concern_NN1 for_IF their_APPGE welfare_NN1 ._. 
Her_APPGE husband_NN1 ,_, who_PNQS usually_RR worked_VVD 200_MC miles_NNU2 away_RL ,_, had_VHD been_VBN forced_VVN to_TO return_VVI to_TO look_VVI after_II the_AT children_NN2 ._. 
The_AT second_MD example_NN1 a_AT1 woman_NN1 considered_VVN to_TO be_VBI depressed_JJ involved_JJ passive_JJ withdrawal_NN1 from_II her_APPGE usual_JJ role_NN1 ._. 
In_II this_DD1 case_NN1 ,_, a_AT1 45_MC year_NNT1 old_JJ woman_NN1 with_IW a_AT1 large_JJ family_NN1 had_VHD recently_RR moved_VVN into_II the_AT area_NN1 ._. 
She_PPHS1 was_VBDZ described_VVN as_II having_VHG become_VVN '_" withdrawn_VVN and_CC introverted_JJ '_GE ._. 
She_PPHS1 was_VBDZ not_XX going_VVG out_RP at_RR21 all_RR22 and_CC was_VBDZ communicating_VVG very_RG little_DA1 with_IW her_APPGE immediate_JJ family_NN1 ._. 
She_PPHS1 had_VHD two_MC adult_JJ children_NN2 who_PNQS lived_VVD nearby_RL ,_, and_CC had_VHD stopped_VVN visiting_VVG them_PPHO2 as_CSA was_VBDZ her_APPGE usual_JJ custom_NN1 ._. 
She_PPHS1 had_VHD stopped_VVN undertaking_VVG her_APPGE usual_JJ tasks_NN2 within_II the_AT home_NN1 ,_, was_VBDZ eating_VVG very_RG little_DA1 and_CC had_VHD taken_VVN to_II her_APPGE bed_NN1 a_AT1 few_DA2 days_NNT2 previously_RR and_CC had_VHD not_XX re-emerged_VVN ._. 
The_AT third_MD example_NN1 involved_VVD escape_NN1 from_II familial_JJ circumstances_NN2 ._. 
This_DD1 was_VBDZ a_AT1 woman_NN1 in_II her_APPGE twenties_MC2 who_PNQS was_VBDZ considered_VVN to_TO be_VBI schizophrenic_JJ ._. 
There_EX was_VBDZ ,_, according_II21 to_II22 the_AT ASW_NN1 ,_, a_AT1 '_GE continuing_JJ crisis_NN1 at_II home_NN1 '_GE ._. 
She_PPHS1 had_VHD suffered_VVN paranoid_JJ delusions_NN2 for_IF a_AT1 number_NN1 of_IO months_NNT2 ,_, that_CST the_AT house_NN1 was_VBDZ electronically_RR '_GE bugged_VVD '_GE ,_, that_CST there_EX was_VBDZ a_AT1 camera_NN1 in_II the_AT television_NN1 watching_VVG her_PPHO1 and_CC that_CST she_PPHS1 was_VBDZ being_VBG followed_VVN ._. 
Her_APPGE husband_NN1 was_VBDZ described_VVN as_II having_VHG difficulty_NN1 coping_VVG with_IW her_PPHO1 ._. 
She_PPHS1 had_VHD left_VVN home_RL and_CC was_VBDZ refusing_VVG to_TO return_VVI because_II21 of_II22 the_AT '_GE weird_JJ things_NN2 '_GE that_DD1 were_VBDR going_VVG on_RP ._. 
When_CS her_APPGE husband_NN1 tried_VVD to_TO reason_VVI with_IW her_PPHO1 she_PPHS1 refused_VVD to_TO accept_VVI what_DDQ he_PPHS1 was_VBDZ saying_VVG ,_, and_CC had_VHD begun_VVN to_TO suspect_VVI that_CST he_PPHS1 was_VBDZ involved_JJ in_II some_DD way_NN1 (_( in_II the_AT bugging_NN1 )_) ._. 
The_AT lack_NN1 of_IO section_NN1 4_MC admissions_NN2 was_VBDZ due_II21 to_II22 the_AT availability_NN1 of_IO an_AT1 approved_JJ doctor_NN1 at_II the_AT Centre_NN1 :_: the_AT approved_JJ doctor_NN1 is_VBZ frequently_RR the_AT most_RGT difficult_JJ of_IO the_AT two_MC doctors_NN2 to_TO get_VVI hold_NN1 of_IO under_II sections_NN2 2_MC or_CC 3_MC ._. 
There_EX was_VBDZ ,_, amongst_II those_DD2 sectioned_VVD ,_, considerably_RR less_DAR use_NN1 of_IO section_NN1 3_MC among_II women_NN2 referred_VVN by_II GPs_NN2 than_CSN either_RR male_JJ GP_NN1 referrals_NN2 or_CC other_JJ referrals_NN2 of_IO women_NN2 ._. 
It_PPH1 is_VBZ not_XX immediately_RR obvious_JJ why_RRQ this_DD1 should_VM be_VBI the_AT case_NN1 ,_, but_CCB this_DD1 provides_VVZ evidence_NN1 of_IO a_AT1 less_RGR restrictive_JJ response_NN1 to_II GP_NN1 referrals_NN2 of_IO women_NN2 ,_, since_CS section_NN1 3_MC applies_VVZ for_IF six_MC months_NNT2 and_CC section_NN1 2_MC for_IF 28_MC days_NNT2 ._. 
Section_NN1 2_MC is_VBZ for_IF assessment_NN1 and_CC may_VM more_RGR frequently_RR be_VBI expected_VVN where_CS an_AT1 individual_NN1 had_VHD no_AT previous_JJ psychiatric_JJ history_NN1 ._. 
However_RR ,_, the_AT proportion_NN1 of_IO men_NN2 and_CC women_NN2 previously_RR known_VVN to_II the_AT psychiatric_JJ services_NN2 was_VBDZ exactly_RR the_AT same_DA (_( 84_MC per_NNU21 cent_NNU22 )_) for_IF both_RR GP_NN1 and_CC other_JJ referrals_NN2 ._. 
Overall_RR then_RT ,_, not_XX only_RR were_VBDR female_JJ GP_NN1 referrals_NN2 sectioned_VVD less_RGR frequently_RR than_CSN other_JJ female_JJ referrals_NN2 ,_, but_CCB when_RRQ sectioned_VVD they_PPHS2 were_VBDR less_RGR frequently_RR subject_II21 to_II22 the_AT lengthier_JJR section_NN1 3_MC ._. 
PROBLEMS_NN2 We_PPIS2 can_VM explore_VVI these_DD2 differences_NN2 further_RRR in_II31 relation_II32 to_II33 problems_NN2 ._. 
Individuals_NN2 '_GE psychiatric_JJ state_NN1 was_VBDZ divided_VVN into_II '_GE definite_JJ cases_NN2 '_GE ,_, '_GE borderline_NN1 or_CC threshold_NN1 cases_NN2 '_GE ,_, and_CC '_" not_XX cases_NN2 '_GE ,_, where_CS no_AT psychiatric_JJ disorder_NN1 was_VBDZ present_JJ ._. 
The_AT ASW_NN1 was_VBDZ asked_VVN which_DDQ of_IO these_DD2 were_VBDR considered_VVN applicable_JJ to_II the_AT assessed_JJ individual_NN1 ._. 
Few_DA2 differences_NN2 emerged_VVD between_II the_AT relevant_JJ groups_NN2 :_: 88_MC per_NNU21 cent_NNU22 of_IO male_NN1 and_CC 84_MC per_NNU21 cent_NNU22 of_IO female_JJ GP_NN1 referrals_NN2 plus_II 86_MC per_NNU21 cent_NNU22 of_IO other_JJ female_JJ referrals_NN2 were_VBDR considered_VVN definite_JJ ._. 
There_EX was_VBDZ a_AT1 tendency_NN1 ,_, however_RR ,_, for_IF female_JJ GP_NN1 referrals_NN2 to_TO involve_VVI less_RGR major_JJ mental_JJ illness_NN1 than_CSN others_NN2 ,_, although_CS differences_NN2 were_VBDR not_XX significant_JJ ._. 
The_AT individual_JJ diagnostic_JJ categories_NN2 were_VBDR broadly_RR divided_VVN into_II three_MC :_: neurotic_JJ ,_, psychotic_JJ ,_, and_CC alcohol_NN1 or_CC drug_NN1 problems_NN2 ,_, which_DDQ could_VM be_VBI neurotic_JJ or_CC psychotic_JJ ._. 
Of_IO those_DD2 considered_VVN mentally_RR ill_JJ rather_RG more_RGR female_JJ GP_NN1 referrals_NN2 (_( 23_MC per_NNU21 cent_NNU22 )_) than_CSN other_JJ female_JJ referrals_NN2 (_( 8_MC per_NNU21 cent_NNU22 )_) and_CC no_AT male_JJ GP_NN1 referrals_NN2 were_VBDR considered_VVN neurotic_JJ ._. 
All_DB male_JJ mentally_RR ill_JJ GP_NN1 referrals_NN2 were_VBDR psychotic_JJ ,_, as_CSA were_VBDR 82_MC per_NNU21 cent_NNU22 of_IO other_JJ female_JJ referrals_NN2 ,_, compared_VVN with_IW 77_MC per_NNU21 cent_NNU22 of_IO GP_NN1 female_NN1 referrals_NN2 ._. 
The_AT concept_NN1 of_IO primary_JJ problem_NN1 was_VBDZ used_VVN by_II the_AT ASW_NN1 to_TO identify_VVI ,_, from_II the_AT whole_JJ range_NN1 of_IO psychiatric_JJ and_CC social_JJ problems_NN2 noted_VVN in_II each_DD1 case_NN1 ,_, which_DDQ was_VBDZ considered_VVN to_TO be_VBI the_AT main_JJ or_CC primary_JJ problem_NN1 ._. 
There_EX was_VBDZ a_AT1 slight_JJ tendency_NN1 for_IF GPs_NN2 '_GE female_JJ referrals_NN2 to_TO have_VHI fewer_DAR psychiatric_JJ primary_JJ problems_NN2 :_: 78_MC per_NNU21 cent_NNU22 ,_, compared_VVN with_IW 86_MC per_NNU21 cent_NNU22 of_IO other_JJ women_NN2 and_CC 88_MC per_NNU21 cent_NNU22 of_IO male_JJ GP_NN1 referrals_NN2 ._. 
Psychotic_JJ primary_JJ problems_NN2 also_RR had_VHN a_AT1 slightly_RR lower_JJR profile_NN1 amongst_II female_JJ GP_NN1 referrals_NN2 :_: only_RR 60_MC per_NNU21 cent_NNU22 came_VVD into_II this_DD1 category_NN1 ,_, compared_VVN with_IW 74_MC per_NNU21 cent_NNU22 of_IO other_JJ females_NN2 although_CS similar_JJ to_II male_JJ GP_NN1 referrals_NN2 (_( 62.5_MC per_NNU21 cent_NNU22 )_) ._. 
Social_JJ problems_NN2 were_VBDR divided_VVN into_II thirteen_MC categories_NN2 ._. 
The_AT ASWs_NP2 were_VBDR asked_VVN to_TO indicate_VVI which_DDQ of_IO these_DD2 each_DD1 individual_NN1 suffered_VVN and_CC which_DDQ of_IO these_DD2 they_PPHS2 considered_VVD to_TO be_VBI severe_JJ ._. 
Female_JJ GP_NN1 referrals_NN2 averaged_VVD 2.28_MC social_JJ problems_NN2 compared_VVN with_IW 2_MC for_IF other_JJ women_NN2 and_CC 1.87_MC for_IF male_JJ GP_NN1 referrals_NN2 ._. 
While_CS ,_, however_RR ,_, female_JJ GP_NN1 referrals_NN2 averaged_VVD more_RGR severe_JJ social_JJ problems_NN2 per_II case_NN1 (_( 1.34_MC )_) than_CSN male_JJ GP_NN1 referrals_NN2 (_( 1.12_MC )_) ,_, this_DD1 was_VBDZ less_RRR than_CSN other_JJ female_JJ referrals_NN2 (_( 1.44_MC )_) ._. 
Nonetheless_RR ,_, there_EX appears_VVZ to_TO be_VBI a_AT1 different_JJ '_GE threshold_NN1 '_GE which_DDQ triggers_VVZ GP_NN1 female_NN1 referrals_NN2 compared_VVN with_IW other_JJ referrals_NN2 ,_, with_IW greater_JJR emphasis_NN1 on_II neurotic_JJ problems_NN2 ,_, fewer_DAR psychiatric_JJ primary_JJ problems_NN2 and_CC more_RGR social_JJ problems_NN2 than_CSN other_JJ referrals_NN2 ._. 
GPs_NN2 ,_, therefore_RR ,_, more_RGR frequently_RR resorted_VVN to_II section_NN1 referrals_NN2 for_IF women_NN2 with_IW neurotic_JJ and_CC social_JJ problems_NN2 than_CSN is_VBZ evident_JJ in_II other_JJ referrals_NN2 ._. 
The_AT pattern_NN1 of_IO social_JJ and_CC mental_JJ health_NN1 problems_NN2 indicates_VVZ GPs_NN2 were_VBDR more_RRR sensitized_VVN to_II mental_JJ health_NN1 and_CC illness_NN1 ,_, and_CC that_CST this_DD1 played_VVD a_AT1 significant_JJ part_NN1 in_II choice_NN1 of_IO referral_NN1 ._. 
The_AT more_RGR frequent_JJ presence_NN1 of_IO social_JJ problems_NN2 among_II female_JJ GP_NN1 referrals_NN2 is_VBZ interesting_JJ here_RL because_CS these_DD2 might_VM be_VBI expected_VVN to_TO raise_VVI the_AT possibility_NN1 of_IO alternative_JJ referral_NN1 (_( for_REX21 example_REX22 ,_, to_II a_AT1 social_JJ worker_NN1 )_) and_CC management_NN1 ._. 
However_RR ,_, these_DD2 GPs_NN2 seemed_VVD to_TO be_VBI seeking_VVG a_AT1 medical_JJ solution_NN1 to_II these_DD2 women_NN2 's_GE problems_NN2 ._. 
Second_MD ,_, the_AT solution_NN1 they_PPHS2 sought_VVD had_VHD serious_JJ implications_NN2 for_IF civil_JJ liberties_NN2 since_CS sections_NN2 would_VM effectively_RR deprive_VVI individuals_NN2 of_IO their_APPGE liberty_NN1 ._. 
This_DD1 search_NN1 for_IF a_AT1 medical_JJ solution_NN1 ,_, then_RT ,_, may_VM present_VVI a_AT1 serious_JJ threat_NN1 to_II civil_JJ liberties_NN2 ._. 
We_PPIS2 may_VM pursue_VVI this_DD1 through_II a_AT1 further_JJR examination_NN1 of_IO primary_JJ problem_NN1 ._. 
The_AT detailed_JJ classifications_NN2 of_IO mental_JJ health_NN1 and_CC social_JJ problems_NN2 were_VBDR divided_VVN into_II six_MC :_: neurotic_JJ ,_, psychotic_JJ ,_, alcohol_NN1 drugs_NN2 for_IF mental_JJ health_NN1 ;_; and_CC practical_JJ ,_, emotional_JJ and_CC relationship_NN1 ,_, and_CC physical_JJ ill_JJ health_NN1 for_IF social_JJ problems_NN2 (_( Fitzgerald_NP1 ,_, 1978_MC )_) ._. 
Amongst_II GP_NN1 referrals_NN2 ,_, seven_MC (_( 22_MC per_NNU21 cent_NNU22 )_) of_IO the_AT women_NN2 ,_, but_CCB no_AT men_NN2 had_VHD emotional_JJ or_CC relationship_NN1 problems_NN2 as_CSA primary_JJ ._. 
These_DD2 involved_VVN marital_JJ ,_, loss_NN1 or_CC separation_NN1 ,_, social_JJ relations_NN2 or_CC isolation_NN1 ,_, and_CC criminal_JJ behaviour_NN1 problems_NN2 ._. 
Although_CS not_XX significant_JJ ,_, only_JJ women_NN2 had_VHD relationship_NN1 primary_NN1 problems_NN2 ._. 
However_RR ,_, this_DD1 is_VBZ particularly_RR interesting_JJ when_CS related_VVN to_II outcome_NN1 ._. 
No_AT woman_NN1 with_IW emotional_JJ or_CC relationship_NN1 primary_NN1 problems_NN2 was_VBDZ sectioned_VVN ._. 
Indeed_RR ,_, six_MC of_IO the_AT seven_MC women_NN2 falling_VVG into_II this_DD1 category_NN1 were_VBDR not_XX admitted_VVN at_RR21 all_RR22 ,_, and_CC one_PN1 was_VBDZ admitted_VVN informally_RR ._. 
In_II contrast_NN1 only_RR 15_MC per_NNU21 cent_NNU22 of_IO all_DB other_JJ GP_NN1 referrals_NN2 (_( and_CC 12_MC per_NNU21 cent_NNU22 of_IO other_JJ female_JJ referrals_NN2 )_) were_VBDR not_XX admitted_VVN ,_, while_CS over_RG half_DB were_VBDR sectioned_VVN ._. 
This_DD1 suggests_VVZ GPs_NN2 were_VBDR attempting_VVG to_TO deal_VVI ,_, both_RR medically_RR and_CC compulsorily_RR ,_, and_CC only_RR in_II the_AT case_NN1 of_IO women_NN2 ,_, with_IW problems_NN2 which_DDQ at_II subsequent_JJ assessment_NN1 were_VBDR considered_VVN to_TO be_VBI primarily_RR about_II social_JJ relationships_NN2 ._. 
CONSULTING_JJ OTHERS_NN2 One_MC1 expectation_NN1 of_IO the_AT ASW_NN1 is_VBZ that_CST others_NN2 in_II the_AT patient_NN1 's_GE social_JJ network_NN1 relatives_NN2 ,_, friends_NN2 ,_, neighbours_NN2 and_RR31 so_RR32 on_RR33 should_VM be_VBI consulted_VVN to_TO help_VVI build_VVI a_AT1 picture_NN1 of_IO the_AT individual_NN1 and_CC their_APPGE behaviour_NN1 (_( DHSS_NP1 ,_, 1983_MC ;_; Department_NN1 of_IO Health_NN1 ,_, 1989_MC )_) ._. 
When_RRQ women_NN2 were_VBDR referred_VVN by_II GPs_NN2 ,_, others_NN2 were_VBDR consulted_VVN significantly_RR more_RGR frequently_RR (_( 88_MC per_NNU21 cent_NNU22 )_) than_CSN women_NN2 who_PNQS were_VBDR referred_VVN by_II other_JJ referrers_NN2 (_( 61_MC per_NNU21 cent_NNU22 )_) (_( p=0.02_FO )_) ._. 
This_DD1 may_VM be_VBI because_CS the_AT GP_NN1 's_GE previous_JJ contact_NN1 with_IW the_AT family_NN1 facilitated_VVN such_DA contact_NN1 or_CC that_CST a_AT1 balance_NN1 to_II the_AT GP_NN1 's_GE assessment_NN1 was_VBDZ sought_VVN ._. 
In_II relation_NN1 specifically_RR to_II GP_NN1 's_GE referrals_NN2 others_NN2 were_VBDR consulted_VVN with_IW exactly_RR the_AT same_DA frequency_NN1 whether_CSW male_JJ or_CC female_JJ referrals_NN2 ._. 
Consulting_JJ others_NN2 ,_, furthermore_RR ,_, had_VHD no_AT impact_NN1 on_II outcome_NN1 ,_, consultation_NN1 occurring_VVG in_II 88_MC per_NNU21 cent_NNU22 of_IO sectioned_JJ and_CC 87_MC per_NNU21 cent_NNU22 of_IO not_XX sectioned_JJ GP_NN1 referrals_NN2 ._. 
However_RR ,_, did_VDD the_AT person_NN1 consulted_VVN have_VH0 an_AT1 impact_NN1 on_II outcome_NN1 ?_? in_RR21 particular_RR22 ,_, what_DDQ was_VBDZ the_AT impact_NN1 of_IO male_JJ family_NN1 members_NN2 ?_? 
Table_NN1 5_MC shows_VVZ significant_JJ differences_NN2 in_II outcome_NN1 for_IF women_NN2 according_II21 to_II22 whether_CSW31 or_CSW32 not_CSW33 a_AT1 male_JJ family_NN1 member_NN1 was_VBDZ consulted_VVN by_II the_AT ASW_NN1 ._. 
Women_NN2 not_XX admitted_VVN were_VBDR markedly_RR more_RGR likely_JJ to_TO have_VHI a_AT1 male_JJ family_NN1 member_NN1 consulted_VVN ._. 
Where_RRQ sections_NN2 were_VBDR undertaken_VVN ,_, males_NN2 were_VBDR more_RGR frequently_RR consulted_VVN where_CS section_NN1 2_MC was_VBDZ undertaken_VVN than_CSN section_NN1 3_MC ._. 
The_AT picture_NN1 was_VBDZ similar_JJ in_II31 relation_II32 to_II33 sectioned_JJ women_NN2 where_RRQ female_JJ family_NN1 members_NN2 were_VBDR consulted_VVN ,_, but_CCB interestingly_RR females_NN2 were_VBDR not_XX generally_RR consulted_VVN where_CS women_NN2 were_VBDR not_XX admitted_VVN ._. 
Consulting_VVG both_RR male_JJ and_CC female_JJ family_NN1 members_NN2 was_VBDZ therefore_RR associated_VVN with_IW briefer_JJR section_NN1 periods_NN2 ,_, but_CCB only_JJ males_NN2 were_VBDR associated_VVN with_IW non_FU admission_NN1 ._. 
Indeed_RR ,_, in_II relation_NN1 specifically_RR to_II women_NN2 not_XX admitted_VVN ,_, the_AT difference_NN1 between_II male_NN1 and_CC female_JJ members_NN2 consulted_VVN was_VBDZ significant_JJ (_( p=0.034_FO )_) ._. 
There_EX were_VBDR also_RR significant_JJ differences_NN2 between_II GP_NN1 and_CC other_JJ referrals_NN2 ,_, specifically_RR with_II31 regard_II32 to_II33 women_NN2 not_XX admitted_VVN ._. 
Of_IO the_AT nine_MC women_NN2 referred_VVN by_II GPs_NN2 who_PNQS were_VBDR not_XX admitted_VVN ,_, eight_MC cases_NN2 (_( 89_MC per_NNU21 cent_NNU22 )_) involved_VVD consultation_NN1 with_IW a_AT1 male_JJ family_NN1 member_NN1 ._. 
Of_IO the_AT eight_MC other_JJ women_NN2 not_XX admitted_VVN only_RR two_MC cases_NN2 (_( 25_MC per_NNU21 cent_NNU22 )_) involved_VVD consulting_VVG a_AT1 male_JJ family_NN1 member_NN1 (_( Fisher_NP1 exact_JJ probability_NN1 test_NN1 :_: one_MC1 tail_NN1 0.013_MC ,_, two_MC tail_NN1 0.015_MC )_) ._. 
There_EX was_VBDZ little_JJ difference_NN1 ,_, however_RR ,_, between_II GP_NN1 and_CC other_JJ referrals_NN2 in_II the_AT rate_NN1 of_IO male_NN1 or_CC female_JJ consultation_NN1 in_II31 relation_II32 to_II33 section_NN1 2_MC and_CC in_II female_JJ consultation_NN1 with_II31 regard_II32 to_II33 non_FU admissions_NN2 ._. 
These_DD2 data_NN indicate_VV0 that_DD1 consultation_NN1 with_IW either_RR male_JJ or_CC female_JJ family_NN1 members_NN2 can_VM have_VHI the_AT effect_NN1 on_II women_NN2 sectioned_VVD ,_, of_IO producing_VVG less_RGR lengthy_JJ compulsory_JJ admission_NN1 ._. 
It_PPH1 indicates_VVZ also_RR ,_, however_RR ,_, that_DD1 male_JJ family_NN1 members_NN2 can_VM have_VHI an_AT1 impact_NN1 on_II non_FU admission_NN1 where_RRQ females_NN2 do_VD0 not_XX ,_, and_CC that_CST this_DD1 was_VBDZ significantly_RR greater_JJR with_IW GP_NN1 referrals_NN2 ._. 
This_DD1 suggests_VVZ ,_, perhaps_RR ,_, two_MC possibilities_NN2 ._. 
The_AT mere_JJ availability_NN1 of_IO a_AT1 family_NN1 male_NN1 is_VBZ reassuring_JJ ,_, giving_VVG the_AT ASWs_NP2 and_CC others_NN2 assessing_VVG greater_JJR confidence_NN1 that_CST the_AT woman_NN1 can_VM remain_VVI in_II the_AT community_NN1 ._. 
Second_MD ,_, the_AT male_JJ family_NN1 members_NN2 ,_, because_CS they_PPHS2 are_VBR male_JJ ,_, are_VBR given_VVN a_AT1 credibility_NN1 and_CC hence_RR power_VV0 to_TO influence_VVI non_FU admission_NN1 not_XX given_VVN to_II female_JJ members_NN2 ._. 
However_RR ,_, this_DD1 power_NN1 is_VBZ primarily_RR relevant_JJ to_II GP_NN1 referrals_NN2 ._. 
This_DD1 strongly_RR indicates_VVZ that_CST it_PPH1 is_VBZ only_JJ males_NN2 who_PNQS have_VH0 the_AT status_NN1 and_CC power_NN1 to_TO provide_VVI ,_, in_II the_AT eyes_NN2 of_IO the_AT relevant_JJ professionals_NN2 ,_, a_AT1 credible_JJ challenge_NN1 to_II the_AT GP_NN1 ._. 
The_AT Memorandum_NN1 to_II the_AT Act_NN1 (_( DHSS_NP1 ,_, 1983_MC )_) indicates_VVZ a_AT1 number_NN1 of_IO factors_NN2 to_TO be_VBI taken_VVN into_II account_NN1 by_II ASWs_NN2 ._. 
The_AT woman_NN1 's_GE past_JJ history_NN1 of_IO mental_JJ disorder_NN1 ,_, family_NN1 relations_NN2 and_CC support_NN1 and_CC medical_JJ opinion_NN1 were_VBDR all_DB considered_VVN both_RR with_IW GP_NN1 and_CC other_JJ referrals_NN2 in_II a_AT1 minimum_NN1 of_IO 93_MC per_NNU21 cent_NNU22 of_IO cases_NN2 ._. 
The_AT woman_NN1 's_GE financial_JJ and_CC material_NN1 circumstances_NN2 were_VBDR considered_VVN less_RGR frequently_RR with_IW GP_NN1 referrals_NN2 (_( 28_MC per_NNU21 cent_NNU22 )_) than_CSN other_JJ referrals_NN2 (_( 49_MC per_NNU21 cent_NNU22 )_) as_CSA was_VBDZ the_AT case_NN1 with_IW non_FU familial_JJ social_JJ supports_NN2 (_( GP_NN1 referrals_NN2 53_MC per_NNU21 cent_NNU22 ,_, other_JJ referrals_NN2 65_MC per_NNU21 cent_NNU22 )_) ._. 
The_AT referred_JJ woman_NN1 's_GE wishes_NN2 were_VBDR ,_, however_RR ,_, considered_VVN more_RGR frequently_RR in_II GP_NN1 (_( 78_MC per_NNU21 cent_NNU22 )_) than_CSN other_JJ referrals_NN2 (_( 63_MC per_NNU21 cent_NNU22 )_) ._. 
Although_CS these_DD2 differences_NN2 were_VBDR not_XX significant_JJ ,_, there_EX was_VBDZ less_DAR concentration_NN1 on_II social_JJ factors_NN2 relating_VVG to_II wider_JJR social_JJ supports_NN2 and_CC financial-material_NN1 circumstances_NN2 with_IW GP_NN1 referrals_NN2 ,_, suggesting_VVG ,_, in_II the_AT face_NN1 of_IO the_AT GP_NN1 's_GE referral_NN1 ,_, and_CC despite_II section_NN1 diversions_NN2 ,_, less_DAR preparedness_NN1 by_II ASWs_NN2 to_TO examine_VVI social_JJ factors_NN2 which_DDQ may_VM challenge_VVI the_AT GP_NN1 's_GE definition_NN1 ._. 
What_DDQ power_NN1 did_VDD the_AT woman_NN1 herself_PPX1 have_VH0 to_TO influence_VVI the_AT course_NN1 of_IO events_NN2 ?_? 
Table_NN1 6_MC shows_VVZ the_AT relationship_NN1 between_II outcome_NN1 and_CC the_AT extent_NN1 to_II which_DDQ their_APPGE wishes_NN2 were_VBDR considered_VVN ._. 
This_DD1 shows_VVZ significant_JJ differences_NN2 :_: women_NN2 's_GE wishes_NN2 were_VBDR taken_VVN into_II account_NN1 most_RGT frequently_RR when_CS they_PPHS2 were_VBDR informally_RR admitted_VVN or_CC not_XX admitted_VVN ._. 
Interestingly_RR ,_, women_NN2 's_GE wishes_NN2 were_VBDR more_RGR frequently_RR considered_VVN with_IW the_AT longer_JJR section_NN1 3_MC than_CSN section_NN1 2_MC admissions_NN2 (_( 15_MC of_IO 17_MC cases_NN2 compared_VVN with_IW 15_MC of_IO 23_MC cases_NN2 )_) ._. 
Taken_VVN together_RL with_IW consultation_NN1 with_IW family_NN1 members_NN2 ,_, this_DD1 suggests_VVZ that_CST ,_, when_CS sectioned_VVN ,_, family_NN1 members_NN2 had_VHD a_AT1 greater_JJR impact_NN1 on_II the_AT length_NN1 of_IO admission_NN1 ._. 
However_RR ,_, there_EX was_VBDZ little_JJ difference_NN1 between_II GP_NN1 and_CC other_JJ referrals_NN2 where_RRQ women_NN2 were_VBDR not_XX sectioned_VVN ._. 
Only_RR one_MC1 of_IO the_AT 20_MC women_NN2 referred_VVN by_II GPs_NN2 did_VDD not_XX have_VHI her_APPGE wishes_NN2 considered_VVN ._. 
The_AT wishes_NN2 of_IO not_XX admitted_VVN women_NN2 referred_VVN by_II others_NN2 were_VBDR in_II all_DB cases_NN2 considered_VVN ._. 
The_AT trend_NN1 was_VBDZ similar_JJ with_IW men_NN2 ._. 
These_DD2 data_NN suggest_VV0 that_CST ,_, for_IF both_RR men_NN2 and_CC women_NN2 ,_, outcome_NN1 significantly_RR depended_VVN on_II whether_CSW their_APPGE wishes_NN2 were_VBDR considered_VVN ,_, or_CC ,_, alternatively_RR ,_, that_CST their_APPGE wishes_NN2 were_VBDR taken_VVN more_RGR seriously_RR in_II less_RGR serious_JJ cases_NN2 ._. 
In_II either_DD1 situation_NN1 the_AT mental_JJ health_NN1 state_NN1 of_IO the_AT woman_NN1 may_VM be_VBI significant_JJ ._. 
PROFILE_NN1 OF_IO FEMALES_NN2 REFERRED_VVD What_DDQ of_IO the_AT social_JJ profile_NN1 of_IO women_NN2 referred_VVN ?_? 
Women_NN2 referred_VVN by_II GPs_NN2 were_VBDR generally_RR younger_JJR than_CSN other_JJ women_NN2 :_: 59_MC per_NNU21 cent_NNU22 of_IO GP_NN1 and_CC 42_MC per_NNU21 cent_NNU22 of_IO other_JJ referrals_NN2 were_VBDR aged_VVN between_II 16_MC and_CC 44_MC ._. 
More_DAR women_NN2 referred_VVN by_II GPs_NN2 were_VBDR married_JJ (_( 47_MC per_NNU21 cent_NNU22 )_) or_CC single_JJ (_( 28_MC per_NNU21 cent_NNU22 )_) than_CSN other_JJ referrals_NN2 (_( 35_MC per_NNU21 cent_NNU22 married_JJ and_CC 19_MC per_NNU21 cent_NNU22 single_JJ )_) ._. 
However_RR ,_, 22_MC per_NNU21 cent_NNU22 of_IO GP_NN1 referrals_NN2 and_CC 42_MC per_NNU21 cent_NNU22 of_IO other_JJ referrals_NN2 were_VBDR widowed_JJ ,_, divorced_VVD ,_, or_CC separated_JJ ,_, and_CC hence_RR had_VHD lost_VVN their_APPGE partner_NN1 ._. 
Rather_RG more_DAR (_( 28_MC per_NNU21 cent_NNU22 )_) women_NN2 referred_VVN by_II GPs_NN2 than_CSN other_JJ women_NN2 referred_VVN (_( 12_MC per_NNU21 cent_NNU22 )_) had_VHD children_NN2 ._. 
About_RG three_MC quarters_NN2 of_IO both_DB2 groups_NN2 lived_VVN in_II owner_NN1 occupied_VVN or_CC council_NN1 housing_NN1 ._. 
Rather_RG fewer_DAR GP_NN1 referrals_NN2 of_IO working_VVG age_NN1 (_( 54_MC per_NNU21 cent_NNU22 )_) lived_VVD in_II a_AT1 unit_NN1 with_IW no_AT employed_JJ members_NN2 than_CSN other_JJ referrals_NN2 (_( 65_MC per_NNU21 cent_NNU22 )_) ,_, while_CS fewer_DAR GP_NN1 (_( 33_MC per_NNU21 cent_NNU22 )_) than_CSN other_JJ women_NN2 referred_VVN (_( 48_MC per_NNU21 cent_NNU22 )_) received_VVD state_NN1 benefit_NN1 other_II21 than_II22 child_NN1 or_CC retirement_NN1 benefit_NN1 ._. 
In_II31 relation_II32 to_II33 GP_NN1 referrals_NN2 only_RR ,_, more_DAR women_NN2 (_( 59_MC per_NNU21 cent_NNU22 )_) than_CSN men_NN2 (_( 38_MC per_NNU21 cent_NNU22 )_) were_VBDR aged_II 16_MC to_II 44_MC and_CC more_DAR women_NN2 (_( 63_MC per_NNU21 cent_NNU22 )_) than_CSN men_NN2 (_( 43_MC per_NNU21 cent_NNU22 )_) were_VBDR in_II more_RGR stable_JJ council_NN1 or_CC owner_NN1 occupied_VVN housing_NN1 ._. 
More_DAR men_NN2 (_( 57_MC per_NNU21 cent_NNU22 )_) than_CSN women_NN2 (_( 28_MC per_NNU21 cent_NNU22 )_) were_VBDR single_JJ ,_, and_CC more_DAR women_NN2 (_( 47_MC per_NNU21 cent_NNU22 )_) than_CSN men_NN2 (_( 29_MC per_NNU21 cent_NNU22 )_) were_VBDR married_JJ ._. 
Only_RR one_MC1 man_NN1 (_( 13_MC per_NNU21 cent_NNU22 )_) had_VHD children_NN2 compared_VVN with_IW nine_MC women_NN2 (_( 28_MC per_NNU21 cent_NNU22 )_) ._. 
The_AT proportion_NN1 unemployed_JJ was_VBDZ similar_JJ ._. 
Although_CS differences_NN2 are_VBR not_XX significant_JJ the_AT overall_JJ profile_NN1 indicates_VVZ that_CST female_JJ GP_NN1 referrals_NN2 were_VBDR more_RGR frequently_RR married_JJ ,_, aged_VVN between_II 16_MC and_CC 44_MC ,_, had_VHD children_NN2 ,_, and_CC lived_VVD in_II more_RGR stable_JJ housing_NN1 ._. 
Insofar_CS21 as_CS22 GPs_NN2 were_VBDR using_VVG section_NN1 referrals_NN2 as_II a_AT1 method_NN1 of_IO social_JJ control_NN1 ,_, it_PPH1 was_VBDZ more_RGR frequently_RR upon_II these_DD2 women_NN2 ._. 
DISCUSSION_NN1 The_AT difficulty_NN1 of_IO research_NN1 in_II this_DD1 area_NN1 has_VHZ meant_VVN that_CST ,_, with_IW one_MC1 notable_JJ exception_NN1 (_( Barnes_NP1 et_RA21 al._RA22 ,_, 1990_MC )_) very_RG large_JJ scale_NN1 studies_NN2 have_VH0 not_XX been_VBN undertaken_VVN ,_, whether_CSW on_II the_AT 1959_MC or_CC 1983_MC Acts_NN2 ._. 
It_PPH1 is_VBZ also_RR relevant_JJ that_CST these_DD2 were_VBDR referrals_NN2 to_II one_MC1 mental_JJ health_NN1 centre_NN1 ,_, although_CS the_AT lack_NN1 of_IO ASWs_NP2 in_II district_NN1 teams_NN2 meant_VVD that_CST these_DD2 represented_VVN practically_RR all_DB the_AT daytime_NNT1 referrals_NN2 to_II ASWs_NN2 ._. 
Although_CS we_PPIS2 must_VM recognize_VVI the_AT limits_NN2 of_IO a_AT1 study_NN1 focusing_VVG on_II one_MC1 city_NN1 ,_, the_AT results_NN2 are_VBR ,_, perhaps_RR ,_, startling_VVG ,_, and_CC of_IO considerable_JJ interest_NN1 ._. 
The_AT pattern_NN1 of_IO results_NN2 raises_VVZ major_JJ concerns_NN2 about_II the_AT role_NN1 of_IO GPs_NN2 in_II using_VVG section_NN1 referrals_NN2 as_II a_AT1 method_NN1 of_IO social_JJ control_NN1 of_IO women_NN2 ._. 
Its_APPGE significance_NN1 lies_VVZ in_II the_AT seriousness_NN1 of_IO the_AT consequences_NN2 should_VM a_AT1 woman_NN1 be_VBI inappropriately_RR sectioned_VVN ._. 
Enforced_JJ hospital_NN1 entry_NN1 would_VM be_VBI accompanied_VVN by_II a_AT1 loss_NN1 of_IO normal_JJ civil_JJ liberties_NN2 ._. 
Under_II section_NN1 2_MC or_CC 3_MC this_DD1 involves_VVZ detention_NN1 respectively_RR up_RG21 to_RG22 28_MC days_NNT2 or_CC six_MC months_NNT2 ._. 
They_PPHS2 may_VM be_VBI forced_VVN to_TO take_VVI medication_NN1 (_( mind_VV0 altering_VVG drugs_NN2 )_) ,_, although_CS consent_NN1 or_CC a_AT1 second_MD opinion_NN1 is_VBZ required_VVN three_MC months_NNT2 after_II the_AT beginning_NN1 of_IO treatment_NN1 (_( section_NN1 58_MC )_) ._. 
Although_CS some_DD protection_NN1 is_VBZ provided_VVN by_II appeal_NN1 to_II the_AT Mental_JJ Health_NN1 Review_NN1 Tribunal_NN1 or_CC nearest_JJT relative_JJ right_NN1 to_TO discharge_VVI ,_, in_II practice_NN1 both_DB2 are_VBR rarely_RR undertaken_VVN or_CC successful_JJ ,_, relative_II21 to_II22 the_AT total_NN1 sectioned_VVD ._. 
Referral_NN1 for_IF compulsory_JJ admission_NN1 is_VBZ clearly_RR an_AT1 issue_NN1 of_IO power_NN1 ._. 
It_PPH1 involves_VVZ generally_RR male_JJ professionals_NN2 (_( GPs_NN2 )_) raising_VVG the_AT issue_NN1 of_IO deprivation_NN1 of_IO liberty_NN1 for_IF women_NN2 ,_, frequently_RR married_JJ and_CC aged_VVN under_RG 45_MC ,_, and_CC ,_, compared_VVN with_IW other_JJ referrals_NN2 ,_, likely_JJ to_TO have_VHI children_NN2 ._. 
The_AT excess_NN1 of_IO these_DD2 women_NN2 in_II GP_NN1 referrals_NN2 ,_, it_PPH1 might_VM be_VBI argued_VVN ,_, represents_VVZ the_AT excess_NN1 of_IO women_NN2 with_IW children_NN2 seen_VVN in_II general_JJ practice_NN1 (_( Shepherd_NP1 et_RA21 al._RA22 ,_, 1966_MC )_) ._. 
However_RR ,_, this_DD1 fails_VVZ to_TO account_VVI for_IF various_JJ other_JJ elements_NN2 in_II the_AT process_NN1 of_IO assessment_NN1 ._. 
Following_VVG assessment_NN1 ,_, involving_VVG ASWs_NN2 and_CC ,_, at_II times_NNT2 ,_, approved_JJ doctors_NN2 ,_, fewer_DAR women_NN2 then_RT men_NN2 referred_VVN by_II GPs_NN2 or_CC other_JJ women_NN2 referred_VVD were_VBDR actually_RR hospitalized_VVN ._. 
The_AT incidence_NN1 of_IO informal_JJ admission_NN1 was_VBDZ also_RR higher_JJR in_II GP_NN1 referred_VVD women_NN2 ._. 
Although_CS considered_VVN in_II31 need_II32 of_II33 assessment_NN1 or_CC treatment_NN1 ,_, these_DD2 women_NN2 did_VDD not_XX require_VVI compulsory_JJ admission_NN1 ,_, with_IW the_AT attendant_JJ limits_NN2 on_II civil_JJ liberties_NN2 ._. 
We_PPIS2 may_VM legitimately_RR ask_VVI why_RRQ ,_, given_JJ GPs_NN2 '_GE professional_JJ concern_NN1 with_IW mental_JJ health_NN1 ,_, this_DD1 should_VM be_VBI the_AT case_NN1 to_II a_AT1 greater_JJR extent_NN1 than_CSN with_IW other_JJ frequently_RR lay_VV0 referrals_NN2 ._. 
It_PPH1 strongly_RR suggests_VVZ that_CST GPs_NN2 '_GE concern_NN1 for_IF civil_JJ liberties_NN2 was_VBDZ considerably_RR outweighed_VVN by_II their_APPGE concern_NN1 for_IF treatment_NN1 :_: at_RR21 best_RR22 a_AT1 conceptual_JJ inability_NN1 to_TO distinguish_VVI between_II treatment_NN1 need_NN1 and_CC treatment_NN1 requirements_NN2 combined_VVN with_IW curtailment_NN1 of_IO civil_JJ liberties_NN2 ;_; at_RR21 worst_RR22 something_PN1 more_RGR sinister_JJ ._. 
The_AT data_NN indicate_VV0 a_AT1 connection_NN1 between_II adequate_JJ assessment_NN1 of_IO social_JJ factors_NN2 and_CC civil_JJ liberties_NN2 ,_, commented_VVN on_II elsewhere_RL (_( Sheppard_NP1 ,_, 1990_MC )_) ,_, and_CC considered_VVD further_JJR later_RRR ._. 
They_PPHS2 ascribe_VV0 a_AT1 significant_JJ role_NN1 in_II this_DD1 respect_NN1 to_II mental_JJ health_NN1 specialists_NN2 ,_, particularly_RR ASWs_VVZ ._. 
The_AT distribution_NN1 of_IO problems_NN2 is_VBZ also_RR revealing_VVG ._. 
Women_NN2 referred_VVN by_II GPs_NN2 were_VBDR more_RGR neurotic_JJ and_CC less_RGR psychotic_JJ than_CSN the_AT comparison_NN1 groups_NN2 ,_, and_CC had_VHD more_DAR social_JJ problems_NN2 ._. 
GPs_NN2 showed_VVD a_AT1 different_JJ threshold_NN1 triggering_VVG their_APPGE female_NN1 compared_VVN with_IW their_APPGE male_JJ referrals_NN2 ._. 
More_RRR telling_VVG still_RR is_VBZ that_CST where_CS ASWs_NN2 considered_VVN relationship_NN1 problems_NN2 primary_NN1 no_AT woman_NN1 referred_VVN by_II GPs_NN2 was_VBDZ sectioned_VVN ._. 
A_AT1 further_JJR important_JJ aspect_NN1 of_IO the_AT assessment_NN1 process_NN1 was_VBDZ the_AT significance_NN1 of_IO ASW_NP1 consultation_NN1 with_IW male_JJ family_NN1 members_NN2 ,_, associated_VVN with_IW section_NN1 2_MC more_DAR than_CSN section_NN1 3_MC and_CC to_II a_AT1 greater_JJR degree_NN1 with_IW GP_NN1 than_CSN other_JJ referrals_NN2 with_IW non_FU admission_NN1 ._. 
This_DD1 creates_VVZ a_AT1 strongly_RR patriarchal_JJ image_NN1 :_: of_IO women_NN2 as_II the_AT hapless_JJ subjects_NN2 where_RRQ ,_, in_II the_AT face_NN1 of_IO the_AT (_( professionally_RR powerful_JJ )_) GP_NN1 referral_NN1 ,_, it_PPH1 was_VBDZ through_II ASW_NP1 consultation_NN1 with_IW males_NN2 that_CST a_AT1 potential_JJ section_NN1 was_VBDZ averted_VVN ,_, or_CC the_AT duration_NN1 of_IO a_AT1 section_NN1 was_VBDZ shortened_VVN ._. 
A_AT1 possible_JJ (_( relatively_RR )_) benign_JJ explanation_NN1 might_VM be_VBI presented_VVN for_IF GPs_NN2 '_GE failure_NN1 to_TO pursue_VVI a_AT1 non_FU compulsory_JJ route_NN1 :_: that_CST women_NN2 ,_, whose_DDQGE conventional_JJ role_NN1 involves_VVZ running_VVG the_AT home_NN1 and_CC family_NN1 ,_, would_VM be_VBI less_RGR willing_JJ to_TO go_VVI into_II hospital_NN1 precisely_RR because_II21 of_II22 their_APPGE feelings_NN2 of_IO responsibility_NN1 for_IF others_NN2 in_II the_AT home_NN1 ._. 
However_RR ,_, the_AT evidence_NN1 contradicts_VVZ this_DD1 ._. 
First_MD ,_, of_IO those_DD2 not_XX sectioned_VVN ,_, a_AT1 considerable_JJ proportion_NN1 were_VBDR not_XX hospitalized_VVN at_RR21 all_RR22 :_: whether_CSW31 or_CSW32 not_CSW33 mentally_RR ill_JJ ,_, they_PPHS2 were_VBDR not_XX ,_, following_VVG assessment_NN1 ,_, seen_VVN to_TO fit_VVI the_AT criteria_NN2 for_IF compulsory_JJ admission_NN1 ._. 
Second_MD ,_, there_EX was_VBDZ a_AT1 marked_JJ trend_NN1 for_IF (_( female_NN1 )_) referrals_NN2 by_II GPs_NN2 subsequently_RR considered_VVN to_TO be_VBI primarily_RR about_II social_JJ relationships_NN2 not_XX to_TO be_VBI sectioned_VVN ._. 
Indeed_RR ,_, overall_JJ women_NN2 referred_VVN by_II GPs_NN2 showed_VVD greater_JJR evidence_NN1 of_IO neurotic_JJ ,_, rather_II21 than_II22 psychotic_JJ ,_, problems_NN2 and_CC a_AT1 greater_JJR predominance_NN1 of_IO social_JJ problems_NN2 ._. 
GPs_NN2 were_VBDR clearly_RR treating_VVG women_NN2 differently_RR and_CC utilizing_VVG a_AT1 different_JJ threshold_NN1 or_CC trigger_NN1 for_IF female_JJ referrals_NN2 ._. 
Finally_RR ,_, of_IO those_DD2 informally_RR admitted_VVN ,_, the_AT majority_NN1 of_IO women_NN2 were_VBDR no_RR21 longer_RR22 contributing_VVG to_II the_AT running_NN1 of_IO the_AT household_NN1 ._. 
They_PPHS2 were_VBDR either_RR disruptive_JJ ,_, or_CC withdrawn_VVN ,_, or_CC simply_RR not_XX around_RP to_TO be_VBI involved_JJ in_II familial_JJ or_CC household_NN1 responsibilities_NN2 ._. 
This_DD1 is_VBZ ,_, of_RR21 course_RR22 ,_, a_AT1 not_XX surprising_JJ by-product_NN1 of_IO some_DD forms_NN2 of_IO mental_JJ illness_NN1 and_CC some_DD women_NN2 ,_, despite_II this_DD1 ,_, might_VM still_RR argue_VVI that_CST they_PPHS2 were_VBDR needed_VVN at_II home_NN1 ._. 
However_RR ,_, a_AT1 sympathetic_JJ and_CC patient_JJ GP_NN1 would_VM not_XX have_VHI required_VVN great_JJ imagination_NN1 to_TO point_VVI out_RP the_AT disparity_NN1 between_II such_DA claims_NN2 by_II these_DD2 women_NN2 and_CC their_APPGE ability_NN1 to_TO perform_VVI family_NN1 and_CC household_NN1 tasks_NN2 based_VVN on_II the_AT evidence_NN1 of_IO their_APPGE behaviour_NN1 ._. 
Certainly_RR ,_, if_CS this_DD1 was_VBDZ what_DDQ was_VBDZ necessary_JJ ,_, it_PPH1 did_VDD not_XX subsequently_RR prove_VVI beyond_II the_AT wit_NN1 of_IO the_AT ASW_NN1 or_CC psychiatrist_NN1 to_TO point_VVI this_DD1 out_RP ._. 
As_CSA one_MC1 of_IO the_AT '_GE specialists_NN2 '_GE involved_JJ in_II assessment_NN1 subsequent_II21 to_II22 GP_NN1 referral_NN1 ,_, ASWs_VVZ clearly_RR played_VVD a_AT1 significant_JJ part_NN1 in_II diverting_VVG these_DD2 women_NN2 from_II possible_JJ compulsory_JJ admission_NN1 ._. 
To_II what_DDQ extent_NN1 ,_, however_RR ,_, does_VDZ this_DD1 reflect_VVI the_AT work_NN1 specifically_RR of_IO the_AT ASW_NN1 rather_II21 than_II22 the_AT psychiatrist_NN1 ?_? 
First_MD ,_, ASWs_NN2 took_VVD responsibility_NN1 for_IF decisions_NN2 diverting_VVG individuals_NN2 from_II compulsory_JJ admission_NN1 ._. 
Where_RRQ individuals_NN2 referred_VVN by_II GPs_NN2 were_VBDR subsequently_RR informally_RR admitted_VVN or_CC not_XX admitted_VVN at_RR21 all_RR22 ,_, in_II no_AT case_NN1 would_VM the_AT ASW_NN1 have_VHI preferred_VVN compulsory_JJ admission_NN1 ._. 
There_EX is_VBZ ,_, furthermore_RR ,_, considerable_JJ evidence_NN1 in_II this_DD1 study_NN1 of_IO social_JJ factors_NN2 being_VBG of_IO some_DD significance_NN1 ._. 
This_DD1 is_VBZ most_RGT clearly_RR the_AT case_NN1 in_II referrals_NN2 where_RRQ relationship_NN1 problems_NN2 were_VBDR considered_VVN primary_JJ and_CC where_CS no_AT compulsory_JJ admission_NN1 took_VVD place_NN1 ._. 
Although_CS we_PPIS2 can_VM not_XX be_VBI categorical_JJ in_II31 relation_II32 to_II33 the_AT cases_NN2 in_II this_DD1 study_NN1 ,_, other_JJ research_NN1 has_VHZ indicated_VVN that_CST psychiatrists_NN2 rarely_RR trouble_VV0 themselves_PPX2 with_IW the_AT social_JJ circumstances_NN2 of_IO individuals_NN2 referred_VVD ,_, and_CC are_VBR rather_RG preoccupied_JJ with_IW evidence_NN1 of_IO mental_JJ disorder_NN1 (_( Bean_NN1 ,_, 1980_MC )_) ._. 
In_II this_DD1 research_NN1 social_JJ information_NN1 ,_, as_II31 opposed_II32 to_II33 psychiatric_JJ diagnosis_NN1 ,_, was_VBDZ not_XX considered_VVN by_II psychiatrists_NN2 to_TO be_VBI central_JJ to_II their_APPGE task_NN1 ,_, although_CS they_PPHS2 were_VBDR aware_JJ of_IO the_AT influence_NN1 of_IO social_JJ factors_NN2 on_II psychiatric_JJ symptomatology_NN1 ._. 
They_PPHS2 therefore_RR made_VVD little_DA1 attempt_NN1 ,_, for_REX21 example_REX22 in_II31 relation_II32 to_II33 family_NN1 history_NN1 ,_, income_NN1 ,_, education_NN1 ,_, and_CC criminal_JJ history_NN1 ,_, to_TO collect_VVI information_NN1 on_II social_JJ circumstances_NN2 ._. 
Although_CS this_DD1 research_NN1 involved_VVD the_AT 1959_MC Act_NN1 ,_, unlike_JJ social_JJ workers_NN2 ,_, additional_JJ training_NN1 has_VHZ not_XX been_VBN required_VVN of_IO psychiatrists_NN2 under_II the_AT 1983_MC Act_NN1 ._. 
It_PPH1 is_VBZ reasonable_JJ to_TO suppose_VVI ,_, therefore_RR ,_, that_CST in_II31 relation_II32 to_II33 social_JJ factors_NN2 influencing_VVG decision_NN1 making_VVG ,_, the_AT ASW_NP1 played_VVD an_AT1 important_JJ part_NN1 ._. 
Third_MD ,_, a_AT1 number_NN1 of_IO significant_JJ dimensions_NN2 analysed_VVN reflect_VV0 ,_, specifically_RR ,_, the_AT ASW_NN1 rather_II21 than_II22 the_AT medical_JJ role_NN1 ._. 
This_DD1 is_VBZ particularly_RR the_AT case_NN1 in_II31 relation_II32 to_II33 social_JJ and_CC familial_JJ factors_NN2 considered_VVN ,_, and_CC the_AT members_NN2 of_IO the_AT individual_NN1 's_GE social_JJ network_NN1 interviewed_VVD ,_, as_II part_NN1 of_IO the_AT assessment_NN1 process_NN1 ._. 
Section_NN1 13_MC (_( 2_MC )_) of_IO the_AT Act_NN1 specifically_RR requires_VVZ the_AT ASW_NN1 to_TO consider_VVI '_" all_DB the_AT circumstances_NN2 of_IO the_AT case_NN1 '_GE and_CC these_DD2 factors_NN2 were_VBDR specifically_RR mentioned_VVN in_II the_AT Memorandum_NN1 (_( DHSS_NP1 ,_, 1983_MC )_) as_II a_AT1 guide_NN1 to_TO ASW_VVI assessment_NN1 ._. 
Where_RRQ ,_, for_REX21 example_REX22 ,_, members_NN2 of_IO the_AT patient_NN1 's_GE social_JJ network_NN1 were_VBDR interviewed_VVN as_II part_NN1 of_IO the_AT assessment_NN1 process_NN1 ,_, these_DD2 interviews_NN2 were_VBDR specifically_RR carried_VVN out_RP by_II the_AT ASWs_NP2 ._. 
Finally_RR the_AT research_NN1 is_VBZ based_VVN on_II information_NN1 collected_VVN from_II the_AT ASWs_NP2 themselves_PPX2 ._. 
Thus_RR ,_, for_REX21 example_REX22 ,_, the_AT definition_NN1 of_IO primary_JJ problem_NN1 in_II each_DD1 case_NN1 comes_VVZ from_II the_AT ASWs_NP2 ,_, reflecting_VVG their_APPGE perspectives_NN2 on_II individuals_NN2 assessed_VVN ._. 
To_II that_DD1 extent_NN1 the_AT results_NN2 reflect_VV0 the_AT basis_NN1 upon_II which_DDQ ASWs_VVZ made_VVN decisions_NN2 ,_, which_DDQ frequently_RR involved_VVN diversion_NN1 of_IO GP_NN1 referrals_NN2 from_II compulsory_JJ admission_NN1 ._. 
However_RR ,_, the_AT ASW_NN1 role_NN1 was_VBDZ not_XX wholly_RR positive_JJ :_: ASWs_NP2 were_VBDR significant_JJ in_II diverting_VVG women_NN2 from_II compulsory_JJ admission_NN1 ,_, and_CC injecting_VVG a_AT1 psychosocial_JJ perspective_NN1 which_DDQ appears_VVZ to_TO have_VHI contributed_VVN to_II this_DD1 diversion_NN1 ._. 
Nonetheless_RR ,_, the_AT significance_NN1 of_IO ASW_NP1 consultation_NN1 with_IW male_JJ relatives_NN2 ,_, and_CC a_AT1 tendency_NN1 to_TO examine_VVI social_JJ factors_NN2 which_DDQ may_VM have_VHI challenged_VVN GP_NN1 definitions_NN2 less_RRR than_CSN with_IW other_JJ referrals_NN2 are_VBR rather_RG less_RGR positive_JJ ._. 
These_DD2 serious_JJ findings_NN2 may_VM be_VBI linked_VVN with_IW other_JJ aspects_NN2 of_IO GP_NN1 behaviour_NN1 ._. 
The_AT first_MD may_VM be_VBI related_VVN specifically_RR to_II GPs_NN2 '_GE training_NN1 as_CSA medical_JJ practitioners_NN2 ._. 
Huntington_NP1 (_( 1981_MC )_) identifies_VVZ two_MC significant_JJ elements_NN2 of_IO GP_NN1 occupational_JJ culture_NN1 :_: a_AT1 biophysical_JJ (_( rather_II21 than_II22 psychosocial_JJ )_) frame_NN1 of_IO reference_NN1 ,_, and_CC an_AT1 action_NN1 (_( rather_II21 than_II22 holding_VVG )_) orientation_NN1 ._. 
Although_CS medical_JJ education_NN1 may_VM pay_VVI some_DD attention_NN1 to_II the_AT social_JJ sciences_NN2 in_II the_AT pre-clinical_JJ curriculum_NN1 ,_, the_AT highest_JJT priority_NN1 is_VBZ still_RR overwhelmingly_RR given_VVN to_II the_AT so_JJ21 called_JJ22 '_GE hard_JJ sciences_NN2 '_GE ._. 
This_DD1 bias_NN1 is_VBZ reflected_VVN in_II practice_NN1 ,_, where_CS medicine_NN1 's_GE primary_JJ concern_NN1 is_VBZ with_IW the_AT biophysical_JJ consequences_NN2 of_IO diagnosis_NN1 and_CC treatment_NN1 ,_, not_XX its_APPGE social_JJ causes_NN2 and_CC consequences_NN2 (_( Freidson_NP1 ,_, 1970_MC )_) ._. 
The_AT result_NN1 is_VBZ an_AT1 emphasis_NN1 on_II the_AT subject_NN1 matter_NN1 of_IO general_JJ practice_NN1 as_II a_AT1 biomedical_JJ phenomenon_NN1 ,_, concomitantly_RR ignoring_VVG or_CC minimizing_VVG the_AT need_NN1 for_IF psychosocial_JJ knowledge_NN1 or_CC skills_NN2 ._. 
This_DD1 ,_, Huntington_NP1 (_( 1981_MC )_) thinks_VVZ ,_, is_VBZ allied_VVN to_II an_AT1 action_NN1 orientation_NN1 :_: a_AT1 predilection_NN1 for_IF '_" doing_VDG '_GE traceable_JJ back_NN1 to_II teaching_VVG hospitals_NN2 ,_, where_CS the_AT dominant_JJ image_NN1 of_IO the_AT emergency_NN1 prevails_VVZ ._. 
The_AT legacy_NN1 in_II the_AT GP_NN1 is_VBZ a_AT1 tendency_NN1 to_TO take_VVI action_NN1 for_IF its_APPGE own_DA sake_NN1 doing_VDG something_PN1 is_VBZ better_JJR than_CSN doing_VDG nothing_PN1 (_( Freidson_NP1 ,_, 1970_MC )_) ._. 
The_AT potential_NN1 for_IF ill_JJ considered_JJ actions_NN2 is_VBZ great_JJ with_IW sections_NN2 ._. 
Viewed_VVN from_II the_AT subsequent_JJ assessment_NN1 ,_, GPs_NN2 mostly_RR correctly_RR identified_VVN individuals_NN2 with_IW mental_JJ illness_NN1 ._. 
However_RR ,_, many_DA2 were_VBDR referred_VVN for_IF compulsory_JJ admission_NN1 where_CS they_PPHS2 were_VBDR subsequently_RR not_XX admitted_VVN ,_, or_CC admitted_VVD informally_RR ._. 
In_II the_AT latter_DA case_NN1 ,_, could_VM the_AT GP_NN1 not_XX have_VHI discussed_VVN this_DD1 with_IW the_AT individual_JJ first_MD ?_? why_RRQ resort_NN1 to_II possible_JJ compulsory_JJ powers_NN2 ?_? 
Second_MD ,_, by_II resorting_VVG to_II a_AT1 medical_JJ route_NN1 (_( and_CC a_AT1 compulsory_JJ one_PN1 at_II that_DD1 )_) for_IF dealing_VVG with_IW problems_NN2 of_IO women_NN2 ,_, frequently_RR having_VHG a_AT1 major_JJ psychosocial_JJ element_NN1 ,_, their_APPGE behaviour_NN1 indicated_VVD a_AT1 limited_JJ frame_NN1 of_IO reference_NN1 for_IF viewing_VVG these_DD2 problems_NN2 a_AT1 predominantly_RR biophysical_JJ perspective_NN1 ._. 
Bean_NN1 (_( 1980_MC )_) ,_, in_II31 relation_II32 to_II33 the_AT 1959_MC Act_NN1 ,_, makes_VVZ some_DD points_NN2 about_II psychiatrists_NN2 which_DDQ may_VM be_VBI extended_VVN to_II GPs_NN2 ._. 
He_PPHS1 suggests_VVZ that_CST their_APPGE orientation_NN1 is_VBZ towards_II the_AT perceived_JJ therapeutic_JJ needs_NN2 of_IO the_AT patient_NN1 rather_II21 than_II22 their_APPGE legal_JJ rights_NN2 ._. 
This_DD1 does_VDZ not_XX mean_VVI that_DD1 legal_JJ rights_NN2 are_VBR entirely_RR ignored_VVN ,_, but_CCB it_PPH1 does_VDZ mean_VVI the_AT scope_NN1 for_IF making_VVG decisions_NN2 primarily_RR based_VVN on_II illness_NN1 is_VBZ increased_VVN ._. 
Sheppard_NP1 (_( 1990_MC )_) has_VHZ described_VVN a_AT1 '_GE mental_JJ health_NN1 orientation_NN1 '_GE in_II section_NN1 assessments_NN2 ,_, with_IW which_DDQ the_AT behaviour_NN1 of_IO these_DD2 GPs_NN2 is_VBZ consistent_JJ ._. 
This_DD1 involves_VVZ the_AT balance_NN1 of_IO emphasis_NN1 placed_VVN on_II the_AT mental_JJ health_NN1 status_NN1 of_IO the_AT patient_NN1 versus_II the_AT social_JJ risk_NN1 they_PPHS2 present_VV0 (_( to_II the_AT health_NN1 or_CC safety_NN1 of_IO the_AT patient_NN1 or_CC protection_NN1 of_IO others_NN2 )_) ._. 
A_AT1 mental_JJ health_NN1 orientation_NN1 places_VVZ greater_JJR emphasis_NN1 on_II the_AT former_DA to_II the_AT detriment_NN1 of_IO the_AT latter_DA ._. 
This_DD1 mental_JJ health_NN1 orientation_NN1 leads_VVZ to_II a_AT1 more_RGR pessimistic_JJ outlook_NN1 on_II patient_JJ needs_NN2 they_PPHS2 not_XX only_RR require_VV0 treatment_NN1 ,_, but_CCB it_PPH1 is_VBZ assumed_VVN that_CST it_PPH1 must_VM be_VBI compulsory_JJ and_CC there_EX is_VBZ a_AT1 tendency_NN1 towards_II a_AT1 '_GE presumption_NN1 of_IO risk_NN1 '_GE that_CST the_AT presence_NN1 of_IO mental_JJ illness_NN1 makes_VVZ the_AT situation_NN1 inherently_RR risky_JJ ._. 
This_DD1 is_VBZ consistent_JJ with_IW the_AT behaviour_NN1 of_IO these_DD2 GPs_NN2 :_: placing_VVG mental_JJ illness_NN1 to_II the_AT fore_NN1 when_CS the_AT problem_NN1 may_VM be_VBI primarily_RR social_JJ ,_, and_CC seeking_VVG a_AT1 compulsory_JJ rather_II21 than_II22 voluntary_JJ route_NN1 ._. 
When_RRQ ASWs_NN2 made_VVD assessments_NN2 ,_, social_JJ factors_NN2 frequently_RR took_VVD a_AT1 high_JJ profile_NN1 ,_, as_CSA social_JJ rather_II21 than_II22 mental_JJ health_NN1 problems_NN2 were_VBDR considered_VVN primary_NN1 ._. 
Where_CS relationship_NN1 problems_NN2 were_VBDR primary_JJ no_AT women_NN2 were_VBDR sectioned_VVN ,_, whether_CSW31 or_CSW32 not_CSW33 a_AT1 mental_JJ health_NN1 problem_NN1 was_VBDZ present_JJ ._. 
The_AT injection_NN1 of_IO a_AT1 more_RGR psychosocial_JJ perspective_NN1 ,_, therefore_RR ,_, diverted_VVD some_DD women_NN2 away_II21 from_II22 sections_NN2 ,_, and_CC even_RR informal_JJ hospitalization_NN1 ._. 
There_EX are_VBR also_RR characteristics_NN2 which_DDQ show_VV0 specific_JJ disadvantage_NN1 to_II women_NN2 ._. 
It_PPH1 is_VBZ the_AT involvement_NN1 of_IO the_AT ASW_NN1 ,_, and_CC possibly_RR the_AT approved_JJ doctor_NN1 ,_, which_DDQ rescues_VVZ some_DD women_NN2 from_II possible_JJ compulsion_NN1 ._. 
Why_RRQ should_VM GPs_NN2 show_VVI discrimination_NN1 against_II women_NN2 ?_? and_CC why_RRQ emphasize_VVI married_JJ women_NN2 with_IW children_NN2 ?_? 
There_EX is_VBZ evidence_NN1 of_IO sex_NN1 role_NN1 stereotyping_NN1 by_II mental_JJ health_NN1 professionals_NN2 ,_, and_CC GPs_NN2 in_RR21 particular_RR22 ._. 
Broverman_NP1 et_RA21 al._RA22 's_GE (_( 1970_MC )_) well_RR known_VVN study_NN1 showed_VVD that_DD1 sex_NN1 role_NN1 stereotyping_NN1 placed_VVN women_NN2 in_II a_AT1 disadvantageous_JJ position_NN1 ._. 
Characteristics_NN2 considered_VVD healthy_JJ for_IF an_AT1 adult_NN1 (_( sex_NN1 unspecified_JJ )_) were_VBDR primarily_RR those_DD2 considered_VVN healthy_JJ for_IF men_NN2 rather_II21 than_II22 those_DD2 considered_VVN healthy_JJ for_IF women_NN2 ._. 
The_AT healthy_JJ person_NN1 was_VBDZ also_RR the_AT healthy_JJ man_NN1 ._. 
This_DD1 leaves_VVZ women_NN2 in_II a_AT1 catch_NN1 22_MC '_GE whether_CSW to_TO exhibit_VVI those_DD2 positive_JJ characteristics_NN2 considered_VVD desirable_JJ for_IF men_NN2 and_CC adults_NN2 and_CC have_VH0 their_APPGE '_GE femininity'_NN1 '_GE questioned_JJ ..._... or_CC to_TO behave_VVI in_II the_AT prescribed_JJ feminine_JJ manner_NN1 &lsqb;_( and_CC &rsqb;_) accept_VV0 second_MD class_NN1 adult_NN1 status_NN1 '_GE (_( Broverman_NP1 et_RA21 al._RA22 ,_, 1970_MC ,_, p._NN1 6_MC )_) ._. 
By_II implication_NN1 ,_, the_AT healthy_JJ female_NN1 is_VBZ not_XX the_AT healthy_JJ adult_NN1 ._. 
Some_DD characteristics_NN2 Broverman_NP1 et_RA21 al._RA22 (_( 1970_MC )_) found_VVD identified_VVN by_II clinicians_NN2 as_CSA characteristic_NN1 of_IO healthy_JJ women_NN2 were_VBDR :_: being_VBG more_RGR submissive_JJ ,_, less_RGR adventurous_JJ ,_, less_RGR objective_JJ ,_, more_RGR emotional_JJ ,_, more_RGR excitable_JJ in_II minor_JJ crises_NN2 strange_JJ characteristics_NN2 for_IF a_AT1 so_JJ21 called_JJ22 healthy_JJ person_NN1 !_! 
Yet_RR these_DD2 are_VBR reflections_NN2 of_IO popular_JJ expectations_NN2 ._. 
Penfold_NP1 and_CC Walker_NP1 (_( 1984_MC )_) comment_VV0 that_CST a_AT1 girl_NN1 is_VBZ trained_VVN to_TO consider_VVI her_APPGE primary_JJ achievement_NN1 is_VBZ to_TO be_VBI a_AT1 wife_NN1 and_CC mother_NN1 ._. 
She_PPHS1 is_VBZ led_VVN to_TO believe_VVI that_CST she_PPHS1 will_VM be_VBI happy_JJ and_CC fulfilled_VVN if_CS she_PPHS1 serves_VVZ others_NN2 ,_, devoting_VVG herself_PPX1 to_II the_AT needs_NN2 of_IO her_APPGE husband_NN1 and_CC children_NN2 ._. 
She_PPHS1 provides_VVZ for_IF the_AT physical_JJ needs_NN2 of_IO the_AT family_NN1 ,_, she_PPHS1 is_VBZ its_APPGE emotional_JJ organizer_NN1 ,_, mediator_NN1 of_IO feelings_NN2 ,_, with_IW a_AT1 responsibility_NN1 to_TO dampen_VVI and_CC absorb_VVI confrontations_NN2 and_CC generally_RR keep_VV0 the_AT family_NN1 running_VVG smoothly_RR ._. 
The_AT GP_NN1 in_II this_DD1 social_JJ world_NN1 far_RR from_II being_VBG an_AT1 expert_NN1 is_VBZ no_AT more_DAR than_CSN a_AT1 layperson_NN1 ,_, with_IW the_AT same_DA prejudices_NN2 as_CSA others_NN2 ._. 
Barrett_NP1 and_CC Roberts_NP1 (_( 1978_MC )_) showed_VVD how_RRQ GPs_NN2 tended_VVD to_TO see_VVI middle_JJ aged_JJ women_NN2 patients_NN2 primarily_RR in_II31 terms_II32 of_II33 their_APPGE family_NN1 ,_, and_CC men_NN2 primarily_RR in_II31 terms_II32 of_II33 their_APPGE occupation_NN1 ._. 
Where_CS a_AT1 woman_NN1 fails_VVZ to_TO perform_VVI her_APPGE expected_JJ role_NN1 properly_RR the_AT GP_NN1 tends_VVZ to_TO see_VVI her_PPHO1 '_GE either_RR in_II31 terms_II32 of_II33 the_AT conventional_JJ models_NN2 of_IO their_APPGE own_DA social_JJ background_NN1 (_( she_PPHS1 must_VM adjust_VVI to_II her_APPGE situation_NN1 )_) ,_, or_CC in_II31 terms_II32 of_II33 individual_JJ personal_JJ inadequacy_NN1 (_( that_CST she_PPHS1 must_VM be_VBI referred_VVN to_II the_AT psychiatrist_NN1 )_) '_GE (_( Barrett_NP1 and_CC Roberts_NP1 ,_, 1978_MC ,_, p._NN1 46_MC )_) ._. 
However_RR ,_, extensive_JJ research_NN1 shows_VVZ that_CST the_AT stereotypically_RR female_JJ role_NN1 of_IO mother_NN1 ,_, as_II31 well_II32 as_II33 other_JJ social_JJ disadvantage_NN1 ,_, is_VBZ actually_RR associated_VVN with_IW vulnerability_NN1 to_II depression_NN1 and_CC broader_JJR distress_NN1 (_( Brown_NP1 and_CC Harris_NP1 ,_, 1978_MC ;_; Richman_NP1 ,_, 1974_MC ,_, 1976_MC ;_; Moss_NP1 and_CC Plavis_NP1 ,_, 1977_MC )_) ._. 
The_AT relative_JJ emphasis_NN1 on_II neuroses_NN2 in_II female_JJ GP_NN1 referrals_NN2 is_VBZ interesting_JJ in_II this_DD1 context_NN1 ._. 
The_AT problem_NN1 appears_VVZ in_II medicine_NN1 's_GE successful_JJ expansion_NN1 of_IO its_APPGE empire_NN1 ._. 
Doctors_NN2 are_VBR consulted_VVN on_II environmental_JJ ,_, technical_JJ ,_, religious_JJ ,_, or_CC psychiatric_JJ matters_NN2 ,_, which_DDQ are_VBR frequently_RR beyond_II the_AT scope_NN1 of_IO medical_JJ education_NN1 ._. 
Since_CS medical_JJ advice_NN1 has_VHZ the_AT force_NN1 of_IO moral_JJ imperative_NN1 ,_, health_NN1 and_CC illness_NN1 are_VBR concepts_NN2 expanding_VVG to_II ever_RR increasing_JJ parts_NN2 of_IO human_JJ existence_NN1 (_( Zola_NP1 ,_, 1975_MC )_) ._. 
The_AT effect_NN1 is_VBZ the_AT creation_NN1 of_IO doctors_NN2 as_CSA social_JJ control_NN1 agents_NN2 ._. 
Two_MC levels_NN2 may_VM be_VBI identified_VVN from_II previous_JJ discussions_NN2 ._. 
First_MD ,_, there_EX is_VBZ advice_NN1 maintaining_VVG an_AT1 unrewarding_JJ and_CC demoralizing_VVG existence_NN1 ._. 
Barrett_NP1 and_CC Roberts_NP1 (_( 1978_MC )_) found_VVD GPs_NN2 extensively_RR '_GE smoothed_JJ away_JJ surface_NN1 anxieties_NN2 '_GE (_( p._NNU 42_MC )_) and_CC adjusted_JJ women_NN2 to_II a_AT1 life_NN1 located_VVD totally_RR in_II the_AT home_NN1 ._. 
In_II so_RR doing_VDG they_PPHS2 legitimated_VVD and_CC endorsed_VVD the_AT status_NN121 quo_NN122 ,_, and_CC fulfilled_VVD an_AT1 ideological_JJ function_NN1 of_IO agent_NN1 of_IO disguised_JJ social_JJ control_NN1 ._. 
Doctors_NN2 frequently_RR used_VVD their_APPGE medical-moral_JJ language_NN1 to_TO offer_VVI a_AT1 set_NN1 of_IO prescriptions_NN2 based_VVN '_GE on_II the_AT conventional_JJ wisdom_NN1 of_IO their_APPGE own_DA social_JJ milieu_NN1 '_GE (_( p._NNU 42_MC )_) ._. 
The_AT second_MD level_NN1 of_IO social_JJ control_NN1 relates_VVZ to_II the_AT use_NN1 of_IO drugs_NN2 ._. 
The_AT use_NN1 of_IO psychotropic_JJ drugs_NN2 is_VBZ a_AT1 pervasive_JJ dimension_NN1 of_IO the_AT medicalization_NN1 of_IO problems_NN2 of_IO living_NN1 ._. 
These_DD2 drugs_NN2 are_VBR prescribed_VVN in_II vast_JJ quantities_NN2 ,_, and_CC far_RG more_RGR frequently_RR for_IF women_NN2 than_CSN men_NN2 (_( Cooperstock_NP1 ,_, 1978_MC )_) ._. 
Valium_NN1 is_VBZ a_AT1 case_NN1 in_II point_NN1 (_( Koumjian_JJ ,_, 1981_MC )_) :_: an_AT1 extensively_RR prescribed_JJ drug_NN1 to_TO deal_VVI with_IW anxiety_NN1 and_CC stress_NN1 ._. 
It_PPH1 can_VM ,_, however_RR ,_, have_VH0 severe_JJ withdrawal_NN1 symptoms_NN2 ,_, including_II dizziness_NN1 ,_, nausea_NN1 ,_, vomiting_VVG ,_, panic_NN1 ,_, anxiety_NN1 and_CC depression_NN1 ._. 
Valium_NN1 prescription_NN1 is_VBZ frequently_RR related_VVN to_II an_AT1 individual_NN1 's_GE social_JJ functioning_NN1 :_: the_AT person_NN1 's_GE ability_NN1 to_TO live_VVI up_II21 to_II22 social_JJ ideals_NN2 ,_, social_JJ expectations_NN2 and_CC the_AT physician_NN1 's_GE judgement_NN1 are_VBR factors_NN2 in_II a_AT1 pseudo_JJ objective_JJ diagnosis_NN1 ._. 
Valium_NN1 ,_, therefore_RR ,_, is_VBZ frequently_RR prescribed_VVN for_IF problems_NN2 such_II21 as_II22 loneliness_NN1 and_CC marital_JJ discord_NN1 ,_, the_AT latter_DA interestingly_RR considerably_RR more_RGR evident_JJ in_II female_JJ than_CSN male_JJ section_NN1 referrals_NN2 in_II our_APPGE study_NN1 ._. 
Valium_NN1 use_NN1 ,_, furthermore_RR ,_, focuses_VVZ on_II individual_JJ malfunctioning_NN1 :_: social_JJ and_CC economic_JJ problems_NN2 are_VBR dealt_VVN with_IW in_II a_AT1 framework_NN1 of_IO a_AT1 medical_JJ model_NN1 of_IO relief_NN1 of_IO individual_JJ distress_NN1 ,_, alleviating_VVG symptoms_NN2 rather_II21 than_II22 operating_VVG in_II a_AT1 social_JJ context_NN1 which_DDQ may_VM require_VVI familial_JJ or_CC wider_JJR social_JJ change_NN1 ._. 
Indeed_RR ,_, the_AT conditions_NN2 of_IO medical_JJ practice_NN1 support_VV0 these_DD2 approaches_NN2 ._. 
The_AT lack_NN1 of_IO emphasis_NN1 on_II psychosocial_JJ factors_NN2 in_II training_NN1 leaves_VVZ GPs_NN2 without_IW sensitivity_NN1 or_CC skills_NN2 in_II these_DD2 areas_NN2 ._. 
Second_MD ,_, lack_NN1 of_IO time_NNT1 is_VBZ a_AT1 factor_NN1 ._. 
There_EX is_VBZ clear_JJ advantage_NN1 in_II31 terms_II32 of_II33 time_NNT1 use_NN1 in_II prescribing_VVG drugs_NN2 rather_II21 than_II22 engaging_VVG in_II more_DAR time_NNT1 consuming_VVG counselling_NN1 ,_, or_CC confronting_VVG the_AT social_JJ origins_NN2 of_IO the_AT problems_NN2 ._. 
Anyway_RR ,_, GPs_NN2 are_VBR not_XX trained_VVN for_IF either_DD1 of_IO these_DD2 ._. 
Finally_RR ,_, advertising_NN1 of_IO tranquillizers_NN2 has_VHZ provided_VVN an_AT1 explicit_JJ message_NN1 :_: to_TO use_VVI drugs_NN2 in_II controlling_VVG conflict_NN1 ,_, for_REX21 example_REX22 producing_VVG a_AT1 less_RGR demanding_JJ and_CC more_RGR compliant_JJ patient_NN1 ,_, or_CC for_IF dealing_VVG with_IW life_NN1 crises_NN2 or_CC social_JJ problems_NN2 ._. 
A_AT1 third_MD ,_, and_CC more_RGR sinister_JJ ,_, level_NN1 of_IO social_JJ control_NN1 has_VHZ been_VBN identified_VVN here_RL :_: the_AT use_NN1 of_IO compulsory_JJ admission_NN1 ._. 
This_DD1 takes_VVZ medical_JJ ideology_NN1 to_II an_AT1 extreme_JJ point_NN1 ._. 
There_EX is_VBZ an_AT1 unequal_JJ knowledge_NN1 relationship_NN1 between_II GP_NN1 and_CC patient_NN1 the_AT GP_NN1 is_VBZ expert_JJ and_CC '_GE definer_NN1 '_GE of_IO the_AT patient_NN1 's_GE problem_NN1 ._. 
The_AT balance_NN1 of_IO power_NN1 is_VBZ also_RR unequal_JJ in_II that_DD1 GPs_NN2 exert_VV0 pressure_NN1 for_IF compulsory_JJ admission_NN1 of_IO women_NN2 who_PNQS could_VM otherwise_RR be_VBI admitted_VVN informally_RR ._. 
This_DD1 involves_VVZ a_AT1 medical_JJ solution_NN1 in_CS41 so_CS42 far_CS43 as_CS44 GPs_NN2 seek_VV0 medical_JJ care_NN1 in_II a_AT1 hospital_NN1 environment_NN1 ._. 
Finally_RR ,_, such_DA medical_JJ care_NN1 will_VM generally_RR involve_VVI invasive_JJ drug_NN1 therapy_NN1 ._. 
Our_APPGE evidence_NN1 suggests_VVZ section_NN1 referrals_NN2 may_VM be_VBI used_VVN by_II GPs_NN2 as_II an_AT1 extreme_JJ form_NN1 of_IO social_JJ control_NN1 of_IO women_NN2 ._. 
It_PPH1 also_RR indicates_VVZ that_CST specialists_NN2 ,_, particularly_RR ASWs_VVZ ,_, play_VV0 a_AT1 significant_JJ role_NN1 in_II preventing_VVG unnecessary_JJ sections_NN2 ,_, hence_RR guarding_VVG women_NN2 's_GE civil_JJ rights_NN2 ._. 
Even_RR they_PPHS2 ,_, however_RR ,_, were_VBDR not_XX unaffected_JJ by_II patriarchal_JJ assumptions_NN2 ._. 
We_PPIS2 have_VH0 here_RL further_VV0 evidence_NN1 of_IO the_AT need_NN1 for_IF ASWs_NN2 to_TO assume_VVI a_AT1 social_JJ risk_NN1 rather_II21 than_II22 mental_JJ health_NN1 orientation_NN1 (_( Sheppard_NP1 ,_, 1990_MC )_) ._. 
ASWs_NN2 are_VBR ,_, by_II their_APPGE training_NN1 ,_, the_AT best_RRT equipped_VVN to_TO examine_VVI social_JJ dimensions_NN2 of_IO section_NN1 assessments_NN2 ._. 
Given_VVN the_AT apparent_JJ pervasiveness_NN1 of_IO GPs_NN2 '_GE behaviour_NN1 ,_, it_PPH1 is_VBZ vital_JJ ,_, given_VVN their_APPGE primary_JJ training_NN1 in_II the_AT complexity_NN1 of_IO the_AT social_JJ world_NN1 ,_, that_DD1 ,_, first_MD ,_, ASWs_NN2 are_VBR aware_JJ of_IO issues_NN2 of_IO gender_NN1 and_CC sexism_NN1 ,_, and_CC second_NNT1 that_CST they_PPHS2 are_VBR prepared_VVN to_TO challenge_VVI medical_JJ power_NN1 threatening_VVG women_NN2 's_GE civil_JJ rights_NN2 ._. 
