Recidivism: Reducing Non-Compliance or Victim Blaming?

Court-mandated outpatient treatment in New York State, known as Assisted Outpatient Treatment (AOT), is a program designed to compel outpatient treatment and medication for individuals with serious and persistent mental illness who refuse to comply with treatment and become hospitalized or violent as a result.  However, this program fails to acknowledge the impact of mental health treatment shortages.

forcedmentalhealthThis error arises because the AOT program, and others like it around the country, falsely associates repeat hospitalization with treatment non-compliance. In many cases, treatment shortages, particularly housing shortages, are a major source of risk for repeat hospitalization. As such, thousands of individuals who struggle or are unable to secure limited mental health services are mischaracterized as dangerous, stripped of their rights to choose their treatment options, and are forced to submit to a court mandated treatment and medication regiment.

Since the creation of AOT in 1995, nearly 12,000 people in New York State have been subjected to court-mandated outpatient. As of 2012, approximately 3,330 people were currently compelled to the program. There are also major racial and geographic discrepancies in the implementation of the AOT program.

According to New York Lawyers for the Public Interest (NYLPI) (2005), African Americans and Latinos are subject to AOTs at five and two and a half times the rate of their Caucasian counterparts, respectively. Furthermore, people living in New York City were four times as likely to receive an AOT compared to those living in the surrounding state (NYLPI, 2005). These disparities indicate a major bias in the implementation of AOTs and suggest that other factors are influencing the application of this severely restrictive program.

Current Policy and Background

Assisted Outpatient Treatment was introduced in New York through the 1999 legislation known as “Kendra’s Law.” This law was named in memory of Kendra Webdale, a 32-year-old journalist who was killed when Andrew Goldstein, a man with a severe and persistent mental illness, pushed her front of a subway (Hartocollis, 2006).

Kendra’s Law provides the AOT mandate for people over the age of 18 suffering from a mental illness who are unlikely to survive safely in the community without supervision. AOTs can only be authorized by a judge and a hearing must prove either, A) lack of treatment compliance led to hospitalization at least two times in the last three years, or B) lack of treatment compliance led to threats or acts of serious violence to self or others in the last four years. In addition, the court must prove that the person’s mental illness makes them unlikely to participate in community-based treatment and that such treatment would be beneficial to prevent relapse and deterioration. (New York State Office of Mental Health, 2014)

600_subwayOnce approved, AOTs require case management services or an assertive community treatment (ACT) team. The person is required to follow a detailed treatment plan, which typically includes both services and medication.

If a person chooses not to comply with the treatment plan, they will be arrested and locked in a psychiatric hospital for 72-hours. After such time, the standard civil commitment process begins where it is determined whether they should remain hospitalized or be released into the community. (New York State Office of Mental Health, 2014)

Critique of Assisted Outpatient Treatment

Some advocates for the mentally ill consider the AOT program a positive step because it mandates providers to ensure care for the mentally ill and prevents people from falling through the cracks (Van Dorm, 2010). There have also been many documented benefits from the AOT program including a decrease in homeless, hospitalization, incidences of harmful behavior (New York State Office of Mental Health).

While the positive outcomes should not be overlooked, we must ask ourselves, at what cost are we accomplishing such feats? What are the unintended consequences of compulsory treatment and are there hidden victims behind the data?

A major critique of the AOT program is that it is likely applied to a wider rang of individuals than the intended population. Specifically, it is applied to individuals for whom services are scare. Recall that the first requirement for AOT is at least two hospitalizations within the last three years. While courts must prove these hospitalizations were caused by treatment non-compliance, it is often difficult to identify non-compliance when voluntary services are limited or substandard.

In a tragic and ironic example, Andrew Goldstein, Kendra Webdale’s assailant, was determined treatment non-compliant because he was not taking his medication when he pushed Ms. Webdale onto the subway tracks. However, this ruling was made despite the fact that Mr. Goldstein’s family and social worker had been fighting desperately for years to obtain medication assistance and supervised housing for him (Wineripe, 1999). Mr. Goldstein was countlessly denied treatment due to shortages and was on a waiting list for housing at the time of Kendra’s death. Mr. Goldstein had been hospitalized fourteen times in the two years preceding Ms. Webdale’s death and was given no priority access to community-based services upon his release.

The assumption underlying the resulting legislation was that Mr. Goldstein was too ill to comply with treatment and should thus be striped of his rights in order to maintain public safety. This is an unfair and victim-blaming perspective. Mr. Goldstein was failed by the system.  He was denied services and then punished for not accessing them. This is not to say that people with mental illnesses never refuse treatment. Rather, it is to say that inadequate mental health services are a much greater cause of hospital recidivism than treatment refusal. Instead of addressing this problem by improving services, Kendra’s Law and the AOT program has focused on stripping the mentally ill of their rights.

Mr. Goldstein’s experience is not unique, as many mental health services in New York are limited. According to the National Alliance for Mental Health (NAMI, 2009), New York State is in “Urgent Need” of acute care facilities, mental health housing, and crisis intervention teams. According to a report by the U.S. Substance Abuse and Mental Health Services Administration (2013), only 38.5 percent of individuals with a mental illness in New York receive adequate treatment. The shortage of housing services for people with mental illnesses is particularly significance because, “Without appropriate housing in place, recidivism is especially high within this population” (NAMI, 2013). As of 2013, NAMI estimated that 21,000 additional housing units were required to adequately address the needs of the mentally ill.

Because of service shortages, two major distortions of the AOT program have occurred. First, hospital recidivism, rather than a history of violence, has become the dominant mechanism of AOT authorization. According to a comprehensive evaluation of the program commissioned by the state, 66 percent of all AOT cases were opened at hospital discharge to reduce recidivism (Swartz, 2009). They also found that the majority of AOTs were obtained before seeking an Enhanced Voluntary Service Agreement (EVS). Furthermore, only 15 percent of AOT participants were found to have any history of violence.

The second distortion of the AOT program due to treatment shortages is that court mandates have become the most reliable avenue for an individual in New York to obtain mental health services.  According to NYLPI (2005), because court mandates provide individuals with a “right to treatment” and priority access, AOTs are sometimes sought simply to get people treatment. This unfortunate and perverse distortion of the AOT program is of grave concern because it required the mentally ill to subject themselves to a subordinate legal status in order to be provided the care they need to live healthy, safe and productive lives.

Policy Recommendations

In order to improve the AOT system and ensure only those who are truly non-compliant are court-mandated treatment the following recommendations are provided. First, treatment shortages must be eliminated. This requires a significant increase in mental health financing and an increase in the number of supportive housing facilities, day program services, medication management, and intensive case management.

Second, individuals with a history of hospitalization should be provided priority access to community based services and a “right to treatment.” This includes creating Enhanced Voluntary Service Agreement (EVS) for all individuals who have been hospitalized at least two times in the last three years, rather an the current requirement that these individuals are prescribed AOTs. Third, AOT authorization for individuals with a history of hospitalization should be amended to include proof that non-compliance occurred in the presence of reasonably accessible services.

With these recommendations, the need for court-mandated outpatient treatment will be significantly diminished.  People with mental illness will have the resources that prevent hospitalization and those in critical conditions will have full-access to the services they need to get better.  Most importantly, mental health consumers will maintain their rights, dignity, and freedom to choose their providers, medications, and service-delivery methods. Treatment shortages should not be tolerated and neither should the further disenfranchisement of the mentally ill.

While there may be limited instances where court mandates are necessary, we should resist these mechanism whenever possible. Court-mandates are an oversimplified solution for a challenging program. Ultimately, the currently AOT system unfairly robs individuals of their liberties, dignity, and falsely blame the mentally ill for treatment shortages when the onus is on society.


Hartocollis, A. (October 11, 2006). Nearly 8 Years Later, Guilty Plea in Subway Killing. The New York Times. Retrieved from:

National Association of Mental Health. (2009). Grading the states 2009 report card: New York. Retrieved from:

National Association of Mental Health. (2013). Legislative agenda: the need for safe and affordable housing for people with mental illness. Retrieved from:

New York Lawyers for Public Interest. (2005). Implementation of Kendra’s Law is Severely Biased. Available at

New York State Office of Mental Health (NYOMH1): Summary of Kendra’s Law. Available at:

New York State Office of Mental Health (NYOMH2: Assisted Outpatient Treatment Reports: Outcomes. Available at:

Swartz, M.S., Swanson, J.W., Steadman, H.J., Robbins, P.C. & Monahan J. (2009). New York State assisted outpatient treatment program evaluation. Durham, NC: Duke University School of Medicine (June, 2009). DOI: 10.1176/

Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: New York, 2013. HHS Publication No. SMA-13-4796NY. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Van Dorn, R.A., Swanson, J.W., Swartz, M.S., Wilder, C.W., Moser, L.L., Gilbert, A.R., Cislo, A.M., & Robbins, C.P. (2010). Continuing involuntary outpatient treatment: medication and hospitalization outcomes in New York. Psychiatric Services, 61(10) 1-6.

Winerip, M. (Nov 1999). Report faults care of man who pushed women onto tracks. New York Times.

McCutcheon Decision: Anatomy of a Policy Distraction


It is not my intent to diminish the import or significance of the McCutcheon v FEC decision. Obviously, this court composition has shown itself to be happy to adjudicate cases erring on the side of pure Juris prudence even when in opposition to precedence. I have an opinion on that, but my current point is that THAT DISCUSSION about the make-up, activism, and bias of the court is not the story of democracy.

Let’s engage in an exercise where we actually break down the logic in the ways that we are taught as policy analyst rather than resorting to emotional reactions based on a basic mistrust of money. I am in favor of laws requiring full disclosure of donors and sources of sponsorship. Yet, I am not with those who lament that the latest Supreme Court decision on related to campaign finance spells doom to our democracy. My analysis pivots on two questions. First, what is the fundamental activity of our democracy? Second, how do we operationalize that fundamental activity?

Two Questions
These two questions are important because their answers demonstrate the perspective guiding those who answer. I am in favor of a perspective that recognizes how grassroots organizing carries the day beyond political ads and fundraising dinners. The bottom line is that if the candidates I support are upset because they are outmatched by the money, they have lost sight of the equation that 3.2 million dollars from one donor is matched with $1 from 3.2 million individuals. I will wait while you make the larger realization… 3.2 million individuals offer a greater voting block—the core of democracy—when compared to the money of one individual.

Content Analysis
What is the fundamental activity of our democracy? It is the right and responsibility of every citizen to vote. Universally across the country, the voting experience is a private, unencumbered activity between an individual citizen and a ballot. In some polling places, the action is still shrouded in a booth with a physical curtain separating the voter from the influences of the world outside.

We must not lose sight of this fundamental activity. As policy analysts, we see content analysis as our opportunity to examine McCutcheon v FEC for its literal content. The decision limits the ability of the government to set limits on the contributions of any one citizen to a political campaign. Any argument based on the content of the decision necessarily sets up agreement or disagreement with governmental powers. We can have that discussion, even that disagreement, but the content of the case must not be a proxy for other discussions. The content of this case was not about corruption–bribery of elected officials. As shown in other criminal cases, most recently the verdict concerning Ray Nagin, the former New Orleans mayor, money accepted by elected officials in order to provide unfair advantage to donors remains illegal.

Process Analysis
How do we operationalize that fundamental activity of democracy? We have to activate our abilities as citizens within our sphere of influence. Get involved at whatever level you are comfortable with. Then, challenge yourself to act beyond that level of comfort. Every phone call, every presentation, every door you knock on, every check you write counteracts the money spent. We have to educate ourselves, inform others, mobilize voters, and construct the narrative.

As policy analysts, we see process analysis a our chance to examine what the McCutcheon case will mean in practice. This is where every citizen has real opportunity. One characteristic that separates the wealthy from the middle and poor is their political activity. Wealthy folks, certainly for a number of reasons, are more politically active. Yet, as far back as Howard Dean fundraising and as recently as Obama 2008, we are witness to what well-organized, grassroots campaigns with dedicated volunteers can do.

This case is a good example. Keep in mind, according to the NY Times, 43 percent of the 1% are non-republican. Republican-leaning citizens making more than $500,000 per year are deficit over economy focused, comfortable with more non-government solutions, and active in politics. We cannot allow the faulty logic of money amplifying one opinion over another to mask the reality that we each have a way to provide alternatives to those highly financed voices. We can vote. What’s more, we can support the vote of others. Not just the right, but the actual activity. Realize what the NY Times revealed about those with money. They are politically active, and that activity is not confined only to making contributions. They support others to make contributions, but they also make phone calls, host dinners, message friends, and speak within their venues of influence. Do not fail to realize the reality that those venues have fewer people in attendance than the other 99% of venues.

Granted, the Citizens United decision allowed for contributions from corporations. Granted, this McCutcheon decision increases limits for individuals. Still, I would like to think that people make their decisions about who to elect based on merits and research rather than political ads and billboards. I am further willing to ensure that reality through informing others. I will reiterate my appeal that we support disclosure so that we know where the money comes from and who all the donors are.

Please do not acquiesce to the position that the people, all of us, are less powerful than the relatively few, extremely wealthy individuals. Once we give in to that view, it ceases to matter what the law is. At that point, we have relinquished our greatest power– to organize ourselves.

Photo Credit: Courtesy of the Constitution Center

Cancer Biologists Can’t Solve Cancer by Themselves

The Problem Behind the Problem

CancerBiologyCancer biologists cannot solve the cancer problem by themselves, nor can anyone else for that matter.  I’m a cancer biologist, so what do I mean when I say this?  Allow me to explain.  I’m not talking about understanding the staggering complexity of cancer, which requires many researchers ranging from engineers to physicians.  That’s another topic, for another (many other) article. What I want to talk about here is a higher order complexity at the societal level that prevents people from having access to cancer treatment, or to something as basic as a preventive measure.

The fact of the matter is, no matter how good our cancer treatments or preventive knowledge become, if people don’t have access to them or cannot implement them, then their effectiveness is not applicable.  This is why advocates in the fields of public health and social welfare are so important.  Simply teaching people in third world countries to wash their hands regularly can have a tremendous impact on decreasing mortality.  Washing hands isn’t “rocket science”—it’s “people science”; and, it’s quite effective against the spread of germs. While hand washing doesn’t prevent cancer, it’s a great example of how public health information can go a long way in dealing with healthcare issues.

Case Study: Effective Pesticides, More Crops, More Cancer

The plight of migrant farm workers is a great example of the societal complexity that is beyond the prowess of cancer biology.  Migrant farm workers are exposed to chemical pesticides at doses that cause cancer, among other ailments.  Let’s take a step back and look at the web of problems beyond what can be seen through the lens of a microscope.  In addition to the cancer problem, there is the public health issue of widespread chemical exposure, the lack of legal representation required get compensation and to secure future prevention, and the lack of access to health care, let alone the inability to afford health care. Thus, the problem is actually much bigger than just cancer. Having more effective chemotherapies only addresses one issue in this web.

Seeing the Whole Elephant, Not Just It’s Parts

During graduate school, I attended a commencement ceremony for graduate students from a biology department.  The commencement speaker was a biochemist whose career had spanned many decades, which gave him a front row seat to the intellectual explosion that occurred in the past 60 years of molecular biology.  Speaking to the dozens of graduate students on stage whom were about to be awarded their degrees, he gave them a charge.  He reflected upon the ways in which his generation had solved many societal problems, but acknowledged that in the wake of their success, they created new ones.  “This is why we need you,” he said, “to solve the problems that we have created.”

Indeed, this charge will remain true for any future generation. Science has produced many materials and chemicals for the purposes of human flourishing—with no sign of letting up—but these inventions can negatively impact human health in unintended ways.   As always, disadvantaged populations are the most vulnerable to these negative effects.  As people who are privileged with adequate information, it falls upon us to ensure that others are protected. It’s not just about inventing better treatments, which is part of the answer.  It’s about making sure that people are treated humanely, which can be done regardless of whether or not treatments improve.

Photo Credit: Wisconsin University

Hashtag #Molestation On Instagram Reveals Disturbing Trend

Recently, I went to the #fostercare hash-tag on Instagram to look at the most current foster-care related photos. At the top of the list of images, I saw a very inappropriate nude photo of an attractive young woman. Initially, I was very frustrated that someone would post nude photos in the #fostercare hashtag in which I use to inspire foster care youth and advocates.

Then, I read what she posted and noticed the other hash tags she used: # orphan# liar, and # molestation. This girl was molested most of her younger years and is deeply scarred. Posting nude photos appears to be her way of expressing and fighting back.

ChildMolestationIt is understandable she is trying to take control of what was taken from her for many years, and I can’t really blame her for no longer wanting to be silenced. However, do you know what was the most shocking? When I clicked on the hashtag #molestation, I found something even more disturbing. Almost every other photo that I saw was of someone joking and inappropriately touching someone else. A mockery of what is both a sad reality and the cause of a life-time of guilt, shame and a lack of self-esteem for many.

The 2003 National Institute of Justice report states that 3 out of 4 adolescents who have been sexually assaulted were victimized by someone they knew well (page 5). lists that 1 in 5 girls is a victim of child sexual abuse while reports that studies show 1 in 6 men have experienced sexual abuse before the age of 18.

It is no surprise that “as many as 75% of those in #fostercare have been sexually abused.” That makes them a prime target for repeat abuse and more horrendous statistics. According to the website 1 and 6, they report studies in two east coast states indicating that 21 and 28 percent of child sexual abuse cases, respectively, involved reports that originated in a foster home.

Although these statistics reference children, I would like to place emphasis on how one’s traumatic experiences impact adulthood. Anyone who experiences any type of trauma, regardless of socioeconomic status, lives with it forever. reports that “studies reveal staggering proof of the health, social, and economic risks that result from childhood trauma.”

The above stats are a harsh reality to swallow. Maybe that is why so many joke about it on social media, but never allow the subject to be talked about in public. In our society, it is so easy to joke about some pretty messed up things, yet when someone has something real to talk about people clam up and don’t know what to say.

Well, sometimes you don’t have to say anything. Sometimes you just need to not be scared of the truth, open your heart and ears, and listen. Allowing someone to hurt and express their hurt might be all they need to feel reassured and start to heal; even if it is something as taboo as molestation. We all need healing.

The Language of Effective Social Work

I find it fascinating that we, as social workers, proclaim we want to help people make better choices and choose healthier behaviors on their own, but then we speak to them as though they don’t have any power. In the past, I have noticed some of my colleagues experience trouble connecting with those we serve due to their language. The language portrayed two completely false ideas as if it was the honest truth such as our clients had no options/say-so in their own lives or we are psychic and know exactly what was going to happen to them at any given moment in the future.

We tell them that they have to do something or need to be somewhere. As Morgan Freeman/Joe Clark proclaimed in the movie Lean on Me, “I don’t have to do nothin’ but stay [insert your race here] and die!” Some of us may still talk to our clients in the exact same way. Whatever we choose to call this pattern of speech  ‘aggressive’, ‘controlling’, even ‘male’, I’ve found that I am much more successful and a more effective practitioner (and a healthier wife, sibling, child, friend, and co-worker) when I lean towards making a few simple changes in the way I talk to others.

Try to Avoid Telling People What They Can and Can’t Do

notlisteningDoes anyone have to go to treatment? No.  Do people need counseling? Not at all.

However, these things could be very helpful, may have some benefit, and could help people achieve their goals in life.Can you see the difference between “You have to go to treatment or you’ll never get better” and “You might want to consider entering treatment. I’ve seen it help a lot of people get their lives back on track.”?Let’s listen to ourselves, our clients, and our peers for the following phrases in bold, and see if we can start using (and encouraging others to use) the words and phrases in italics:

You have to   –   You might like to…, You might want to consider…

She should   –   It might have been more helpful to…, Maybe a better choice would have been…

You can’t   –   You might run into some problems if you…, I haven’t seen people be very successful when they…

I know   –   I get the impression that…, It seems as though…, I can understand if…

He always   –   I often see him…, I’ve noticed that he usually…, I can’t remember a time when he didn’t…

Addicts never   –   People suffering from an addiction often don’t…, Alcoholics generally don’t…

I’ve especially noticed a resistance to more aggressive language from people who have issues with authority figures, due to their past experiences with them. However, when we interact with them with an attitude that expresses the fact that they have all the power, and every right, in the world to get up and walk out our door, they seem to feel less of an urge to actually do that. They don’t have an overly controlling figure to “rebel” against. Think about how it takes two to tango, just like it takes two to argue. Let’s try to steer clear of being that opposing force that they use to push themselves away from us and, in many cases, a healthier lifestyle.

Being someone that is there to help, versus someone who is there to control someone else’s life, can be really helpful in building stronger, more effective helping relationships with the people we assist. As a bonus, speaking in a less controlling manner to our spouses, family members, and co-workers can often have a similar effect. The relationship becomes more open, more relaxed, and people feel more comfortable sharing their problems (and successes) with us.

Steer Clear of the Habit of Prophesizing

I’ve found it helpful to avoid telling people what is going to happen to them. Sharing what I have seen or experienced in the past, or even giving them and idea of my fears for them should they make a certain choice is one thing. However, I’ve seen many a practitioner guarantee (they sometimes even literally use that word) that something catastrophic or fantastic is going to happen to someone if they make a certain choice.

“If you don’t go to treatment, you’ll die.”

“If you try to live independently, you’ll fail. Schizophrenics need assisted living–it’s a fact!”

“If you stay in treatment for 30 days, you’ll live a happy, healthy rest of your life.”

“If you don’t go to the therapy group for help, your wife’s gonna leave you–plain and simple.”

“If you quit using heroin, you’re going to have so much more money!”

“You don’t stand a chance without Narcotics Anonymous.”

“If you start a business, you’ll just shoot all the profits up your arm.”

While I understand that most of us have been in the field long enough to have seen multiple examples of people struggling with addiction after leaving treatment or having a hard time living independently with a mental illness, there are (many) exceptions to those situations. So, if we decide to essentially promise someone that something will happen, when we really have no way of knowing, the second that terrible thing doesn’t happen to them, or it doesn’t happen to someone who our client knows, we become somebody who has no credibility. It’s hard to trust somebody without credibility, so we have just severely injured our relationship with that person. Try using phrases like “I’ve never seen,” “It’s not impossible, however,” and “Feel free to try, but I’ve never heard of” in order to express humility. We can still give the person the caring warning and advice that we want to offer without delivering it like Ms. Cleo.

Here are some tweaks to the above example sentences to make them more realistic:

“I’ve seen lots of people avoid going to treatment and it often leads to them living a really hard, chaotic life, or even dying. I’d hate to see that happen to you.”

“Trying to live independently can be hard for people who don’t have any mental health concerns. I’m worried about you wanting to live on your own, but let’s look at some ways we might be able to make that more feasible, such as hiring an aide to check in on you or getting you on some medications.”

“Though there are no guarantees, I’ve seen people do a lot better in their recovery when they have some form of formal treatment.”

“I know your wife threatened to leave if you didn’t get help, and I can’t predict what she’s going to do, but her and I both are encouraging you to attend a bipolar support group. Is not going really worth the possibility that she might actually divorce you?”

“Stopping your heroin use can really increase the amount of money you have left to save or spend as you please.”

“I’ve seen kicking a habit be a real struggle for some people, but they often seem to do a lot better when they have the support of the people at Narcotics Anonymous.”

“It’s not impossible, however, I have witnessed several incidences in which people suffering from addiction who do actually gain a profit from running a business slip back into using because they have large sums of money that they’re handling on a daily basis.”

Boys Don’t Cry: The Crisis of Masculinity

When we talk about sexism, we almost always automatically think of the victims as women. Tackling discriminating language, sexual harassment and domestic violence seems to be exclusively discussed as ‘women’s issues’. Much in the same way that these problems are not only ‘women’s issues’, sexism itself is not a ‘women’s issue’. There are other types of sexism which are equally pervasive in our society and potentially more corrosive due to the fact that they constantly go undiscussed or completely undetected.

boysdont‘Man up’, ‘be a man’, ‘men don’t cry’, ‘Lad culture’; these are all commonplace maxims in our daily lives. Our understanding of manhood and masculinity is that of men as tough, unemotional individuals who will not shy away from a fight and who have a duty to protect and provide. They can never be the vulnerable ones.

This image is everywhere for our young boys to aspire to. Popular culture feeds us the ultimate ‘men’s men’ such as Sylvester Stallone, Vin Diesel, 50 Cent, and even the fictional comic heroes, like Batman and Superman, are physically strong and violent individuals.

Manhood is so synonymous with violence that we never stop to ask ourselves what we are fed by the media. How often is the climatic, heroic moment in a film, the part in which one man fights and defeats another? And from being violently superior, that man consequently wins the affection of women and the admiration of his peers. We celebrate these moments rather than condemn the violence.

We have begun to openly acknowledge the damage that our narrow view of manhood has done to young men struggling with their sexuality. As a Social Worker I have worked with a young man whose greatest hurdle to admitting his homosexuality was how it would affect his identity as a male. “But I don’t like girly things” was his stock response for denying his feelings. Ignorant preconceptions state that in order to be a man, you must like women and in order to be gay, you must be camp. However the problem runs much deeper than this.

The conversation we are not having is why the majority of the world’s prison population is male or why the majority of all violent crimes, rapes and assaults are committed by men. We accept this as normal; as if this is what nature intended and there is no cure. Similarly, throughout the world, the number of men successfully committing suicide is dramatically higher than the number of women. In addition to this, a report from 2012 from the Office of National Statistics in the United Kingdom discovered that men were most likely to be homeless or suffer from substance misuse issues. There is something terrible plaguing our men and I do not believe we should simply stand by and claim ‘it is what it is’.

Some people are finally beginning the conversation about the crisis in masculinity. Jackson Katz, creator of Tough Guise, is a leading anti-violence educator in America. In the United Kingdom, the theatre production of Result, is using football to discuss mental health problems amongst young males. UK MP, Diane Abbot, also launched a campaign to tackle what she describes as the ‘Fight Club’ generation.

We need to stop allowing masculinity and feminity to be defined so rigidly. Siobhan Bligh succinctly stated: ‘What we must aim for is a healthy masculinity, in much the same way feminists would want women to have a healthy femininity. Whilst these ideals may be social constructions, they still guide people in the way they see themselves and others, and therefore it is imperative to promote a healthy gender culture for both men and women.’ )

If we as Social Workers are to claim to be defenders of social justice and equality then we cannot ignore this problem any longer. We must lobby nationally and internationally to tackle the media glorification of male violence, but also on an individual level, we should never allow boys to feel that power, aggression and stoicism are necessary parts of their development into manhood.


Poverty: Do You Think Beggars Are Comfortable With Handouts

Have you ever experienced someone who lives in deep poverty, I am talking about someone whom its obvious that they live in the margins of society. Someone very peripheral, who when you extend some form of empowerment focused assistance swears or curses at you because to him it seems you want to disrupt his form of livelihood? By empowerment focused approach I mean “a food for work initiative” instead of directly giving them money.

creative-beggarMost of the time these individuals exhibit a form of hostility towards those who are attempting to help them with some form of work. December 2013, I was in Addis Ababa, and I found a similar phenomenon. However, there they were more aggressive and used all forms of schemes to get money from tourists to the extent of using babies to trap “if these were their babies” and generate some form of sympathy. Don’t get me wrong there are certain pressures that lead people to poverty, they might not have chosen this path, but with handouts it gets a bit comfortable to be where they are.

From someone who has worked with poor communities in rural Swaziland, I noted the deliberate efforts made by rural women to develop themselves and their families through collaborative community based income generating activities. This was largely done through non governmental and community based organization funding through capacity and small grants.  These communities had a sense of self belief and motivation to make life just a little bit bearable even though they were not getting huge returns but enough to get by.

The difference between these rural folks and the beggars in Mbabane, Manzini, Addis Ababa, was that sense of pride when they succeeded in what they did whether a community project, income generating activity or food for work, they always had this glow and joy that they were doing work for themselves. These rural women were driven by the change they wanted to see, whilst tapping into community resilience that was surprising given their living conditions.

Looking at these two scenarios one wonders if our governments, bilateral institutions, religious institutions, training institutions, and civil society organizations really believe in change? Do we ever envisage an Africa continent or Swaziland free of poverty, lack and marginalization? If in a twinkle of an eye we didn’t have the poor with us, would we celebrate a success of poverty eradication? Many would be retrenched or would they find other jobs to sustain the change?

Though we display goals of vision 2020 or 2022 in plaques we seem to be too lethargic in the process of initiating change that will result in permanent change. The income distribution skew continues to be steep, the rich are getting richer, whilst the poor are getting poorer. It would seem to me the status quo creates a conducive environment for further entrenchment of the dependency syndrome. The receivers continue to receive handouts so that we keep them right where we want them, and the same receivers have found comfort in receiving such that change is not what they want to see. They do not want to see change because change will shake their nest and disturb their comfort. We are breeding a society of people who have gotten used to receiving that it has become their way of life to beg and to take, and we have it systematized even in our programming.

A generation that doesn’t seek after empowerment is a generation that will propagate the increase of discord that leads to escalation of crime. And crime will affect those who are empowering themselves now. In development, we say the function holder for development is always the government, and many ask what becomes the role of government when change is not what we want to see. Policy formulation is totally different from policy implementation.

Currently, Swaziland sits at 63% (SHIES, 2010) poverty rate and 40% (SDHS, 2007) unemployment rate, and a 26% HIV prevalence rate, these rates makes us vulnerable as a country and therefore a charity case. I have said in this very platform that dependency leads to vulnerability. Our state of vulnerability has placed us in a position where we literally cannot live or survive without external assistance. External assistance has helped in employing some of us to deal with developmental issues and pulling people out of their poverty situations.

Our vulnerability makes us dependent. The change we don’t want to see might just be eradication of poverty, marginalization and lack.  Maybe we still want to be dependent;

“[Dependency is]…an historical condition which shapes a certain structure of the world economy such that it favors some countries to the detriment of others and limits the development possibilities of the subordinate economics…a situation in which the economy of a certain group of countries is conditioned by the development and expansion of another economy, to which their own is subjected.”

(Theotonio Dos Santos, “The Structure of Dependence,” in K.T. Fann and Donald C. Hodges, eds., Readings in U.S. Imperialism. Boston: Porter Sargent, 1971, p. 226)


Swaziland Demographic Health Survey (SDHS, 2007)
Swaziland Household Income and Expenditure Survey (2010)
Manzini (Industrial City in Swaziland)
Mbabane (Capital City Swaziland)
Addis Ababa (Ethiopia capital city)

3 New Year Resolutions That You Should Actually Do

New Year’s resolutions are something a lot of us make, but very few of us ever actually stick with them. Nonetheless, these failures don’t stop us from continuing year after year to make resolutions. After all, who knows? This could finally be the year that you make those resolutions stick. For those looking for some ideas that can provide a  huge benefit and even be fun, here are three great suggestions.

Start Saving Money

savingmoneyThis really should be at the forefront of most people’s New Year’s resolutions, as most of us are simply not very good at saving. Considering the economic difficulties in the world, saving some of your hard earned cash is even more important now than ever before. No matter how young or old you are, you need to be putting money aside for your retirement.

You also need to consider what would happen if you were to suddenly lose your job or get sick and be unable to work. These things can become major problems, but by starting to save money, you can be prepared for any of these unfortunate events and ensure that they won’t ruin your life. Saving money doesn’t have to be difficult, but it does take some planning. One of the easiest ways is to make a monthly budget, limiting your expenses and ensuring you put aside a designated amount each month.

Start Learning a Language

Learning a new language can be both fun and incredibly rewarding. Also, it’s really not as hard as you think as long as you’re willing to put the time and effort into it. Whether you want to learn a new language to be able to better communicate while travelling or to help you get ahead in your job, there is truly no end to the benefits of learning a new language. So, if you’re looking for a New Year’s that will truly improve you as a person and is something you can really be proud of, why not sign up for language lessons or try one of the many language learning softwares on the market. If you manage to stick with it, it will be one of the most rewarding experiences of your life.

Learn Computer Code

Similar to learning a new language, learning computer coding can again have great benefits and makes a fantastic New Year’s resolution. If you’re sick of your current job, learning computer code can help you change careers and find a job you love. The field of IT is constantly growing and changing, meaning you’ll have no shortage of jobs available should you successfully undertake this resolution.

Still, even if you’re not looking to make a career change, learning coding can open up a whole new world of fun possibilities. You could try your hand at building and running your own website, making mobile apps or other programs. Either way, you’ll be focusing on learning new skills and bettering yourself which is really what New Year’s resolutions are all about.

Five Provocative Tips On How To Stop Your Addiction As Of Today


Are you sick and tired of your addiction? Smoking, adult content on the web, online gambling, alcohol, or others? If you tried to quit and didn’t succeed until now, you probably committed one of five typical mistakes. Here are five tips that you probably never thought about. Apply them as of today and you will get rid of your problem more quickly than you ever imagined.

1. Don’t stop overnight.

Did you try to stop your bad habit with New Year’s resolutions and similar approaches? ‘As of tomorrow I won’t … ‘? This won’t usually work. Your brain is used to your drug, whether it’s alcohol, chocolate, adult content, casinos, smoking or whatever. Your brain learned that it’s good for you. It won’t give up that behavior. Reduce your dose slowly instead. 10% every week. Allow your brain to get used to less. Set yourself a two-months-target. Then it won’t hurt. No cold turkey. 10% every week are small steps. You can take small steps. You will be successful. The more successful you are the more you will like it and the more you will keep on going.

2. Observe yourself.

Allow yourself to give in to your urges. Smoke, drink, watch, whatever it is that you want to give up. As you learned in step 1, you will slowly reduce your addiction. You won’t do it overnight. While you give in to your addictive behavior, watch yourself. Observe how you feel, what you do exactly, how it feels before and afterwards and while you do it. Make it become a more conscious behavior. It is harder to exaggerate in whatever you do when you have a sober mind. It will help you reduce your addiction further, by 10% every week.

3. Analyse your addiction.

A typical mistake most people make is that they only rely on their will power. There are reasons why you become an addict. Find the underlying reasons for your behavior. Go back to the times when you smoked, drank, watched adult content or gambled for the first time. Why did it you do it? Which pain did you want to heal? Why did it feel so good? Can you forgive people or forgive yourself for bad things that happened to you? Are there alternate sources of those feelings that you get when you take your drug? Can you define new goals in life for important areas such as partnership, job, hobbies, body and spirituality? Identify the triggers for your cravings. The more you analyze yourself, the more you release old pain and the more you strive for new horizons, the less often you will feel cravings.

4. Give up feelings of guilt and shame.

There are reasons why you did what you did. Stop feeling guilt and shame. The more you feel bad about yourself the more you want to kill those feelings with new addictive behavior. When you feel craving, tell yourself: I could do it now. Nobody said that it’s forbidden but do I really want to do this now? Don’t let it become compulsive. You have the choice whether to give in to the cravings or not. If you do, fine. You’ll be stronger next time. Be happy that you don’t give in every time now. Feel more positive about yourself. Be proud that you started a self-help approach. Get into a positive cycle.

5. Seek professional help.

You don’t need to lie on a couch and breaking your addiction may not always require a rehab center. However, there are good books, e-books, and audio programs to help you on the road to self-discovery as well as some excellent self-help programs. You may also want to connect with others struggling with your addiction, and there are some good forums on the internet for you to try. Just don’t do it all by yourself and try to benefit from the experience of others. Don’t forget, allow yourself two months to break free.

Is Your Spouse The Next Walter White?

By Deborah Nguyen

Walter White

Walter White, the fictional character of Breaking Bad fame, has quickly become the antihero that people couldn’t avoid loving. In reality, however, life isn’t always like it’s portrayed on television. While the difficulties that White faced were extreme, it’s often the family of a criminal who ends up hurt, both physically and emotionally.

While it’s hard to say just how many people have spouses who are drug dealers, the reality of the situation is that a drug arrest happens every 17 seconds in America. With these types of numbers, it’s imperative for those who suspect a spouse of criminal activity to know what they’re up against.

Domestic Violence

One of the most serious risks that a person faces when their partner is engaged in criminal activity is from the spouse themselves. This is especially the case when the person in question is not just trafficking drugs but using them. Drugs such as benzodiazepine (Valium), cocaine, crack, meth and anabolic steroids can all increase aggression in a person. Sadly, as was the case with wrestler Chris Benoit, this can lead to violent and sometimes deadly outcomes for a user’s spouse.

A person engaged in criminal activity, however, doesn’t have to be on drugs to be violent. Simply being involved in such a stressful atmosphere can lead to violent behavior. One of the main precursors for domestic violence, for instance, is displaced anger. This occurs when a person showcases anger or acts violently towards a subject who is not actually the cause of their anger. This displaced anger can lead to repeated physical abuse in a relationship.

Other Risk Factors

Even if a person has the most mild-mannered spouse in the world, his criminal activity puts his family’s safety at risk. His colleagues may not always be so concerned about the welfare of his family. As a matter of fact, families stand the risk of being used as a bargaining chip, or are seen as a liability, when complications occur in the illicit goings on. This was portrayed in the movie Alpha Dog which told the true story of 15-year-old Nick Markowitz being kidnapped and murdered over drug money that his half-brother owed.

There are a few options of recourse that a person has when their spouse has put them into danger. One option could be developing a safety plan in order to protect yourself and your family in advance. Contacting the national domestic violence hotline to obtain information and identify resources may help you process the chaos around you. Also, you may want to consult a divorce attorney to see what options are available to dissolve the relationship.

Getting Out Alive

The first step to getting out of these situations with your level head intact is recognizing that there is an issue. If you don’t know where the source of income springs from, this could be an immediate red flag that something suspicious is going on. Do your research and start collecting financial information and by performing a criminal history check.

If you find out the whole ugly truth to be real, be prepared to walk away. You have to ensure your and your children’s safety. But you probably don’t know the extent that his influence reached within his business colleagues. Your future could be wrought with danger. No level of criminal activity is safe, so getting out as quickly as possible is the only safe recourse.

While watching the character Walter White was undoubtedly enjoyable for millions of people, the realities of living a life that is funded by illegal drugs is undoubtedly accompanied by many risks.

What To Do With Those Unwanted Christmas Gifts

Whether it’s a book that you are never going to read or a jumper that just isn’t suited to your style, the chances are that many of us will have received unwanted Christmas gifts that we have no use for. This isn’t to say that these gifts were not appreciated, but they didn’t quite hit the mark when it comes to the type of gift you were hoping for.

However, there may be other reasons why a gift may be unwanted, though such as being damaged or it could even be a duplicate present. Whatever the reason, here are a few options that you can choose from to help you figure out what to do with them.

Problems with Unwanted Christmas Gifts
Problems with Unwanted Christmas Gifts

Talk To The Giver 

There is a need to tread carefully here. Whatever the gift was, it was given with love. The person giving it is likely to have been pleased with their purchase, so you need to consider their feelings. If you don’t know them too well, maybe they’re a work colleague or the spouse of a distant family member, you may want to avoid telling them.

For closer family members and friends, a bit of honesty can go a long way. Not only will this mean they know your preference for next time, you also have a chance to see if they have the receipt or ask where they got it from.

Refunds And Credit 

If you can get hold of the receipt or you know that the shop the gift was bought from has a more relaxed returns policy, then the best thing to do is attempt to take it back. If the issue is just with the size, then you can always exchange it for one that fits better.

Sadly, not all companies will be open to offering refunds. It is your right to a refund if the product is faulty. If you are returning an item for no other reason apart from the fact that you don’t like it, the shop may have no obligation to accept your return.

However, most places will have a goodwill policy in the period after Christmas and those that don’t offer money back should give store credit, which is still better than something you are never going to use.


Re-gifting may be frowned upon by some people, but it’s much better that someone gets to enjoy the gift than it sitting in a drawer for the foreseeable future. If you know someone who would love that jumper you didn’t really want or you know someone with a child that would love the unwanted toy your child was bought, then there is no harm in passing the parcel. Again, it is a good idea to be honest with whoever gave you the gift in case they also know the person you are re-gifting it to.

Selling Online 

Ebay has been a massive success since it was founded in 1995 and this site acts as a great platform for you to sell your unwanted presents. The fees for selling are scaled according to how much the gift costs, and it offers you the chance to give your gift to people who are actively searching it out.

Ebay is not the only site that’s available though. There are specialist websites all over the internet for various types of gifts. Got a new mobile that you don’t need or want or you want to get rid of your old one, try Got some clothes that don’t fit or aren’t in your style, try For everything else, there’s always Gumtree.


All this talk of unwanted gifts can make some of us feel a little spoilt and so if you really want your redundant gifts to make a difference, you could always drop them off at your local charity shop. Alternatively, you could give any unwanted toys to a children’s hospital or day care centre in your area.

If you want to avoid the embarrassment of giving an unwanted gift, then why not consider gift baskets for the next big occasion in your family. Gift hampers always go down well and can be filled with plenty of goodies, so the recipient is at least likely to enjoy one of them.

photo credit: MRHSfan

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