Sense Of Hopelessness Research Articles

COVID-19 and HIV testing: different viruses but similar prejudices and psychosocial impacts

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) high infectivity and perceived substantial fatality rates are causing negative psychosocial effects, including the increased psychiatric and economic burden. Research has demonstrated that a severe diagnosis triggers various responses in a person, including depression, sense of hopelessness, shame, and self-destructive behaviours. This manuscript explores the reasons why people did not follow the recommendations to be tested for SARS-CoV-2. Methods A mixed study design, sequential explanatory study was carried out from March-Dec 2020, based on an online COVID-19 symptom checker. Quantitative and qualitative data were collected. Video interviews were held with Key Informants (n=19), who were selected purposefully from the online tool users’ group that consented to the study. Results Among 176 users of the online triage tool, 150 (85%) followed the recommendations and 26 (15%) did not. The reasons people did not test for SARS-CoV-2 emerged as fivefold: i) improved symptoms, ii) the cost of test, iii) fear of a painful test procedure, iv) test kit shortages, and v) fear of a positive SARS-CoV-2 test result. Conclusions Of the reasons why people did not test, fear of a positive SARS-CoV-2 result remains unaddressed in our view. Integrating pre- and post-test counselling into SARS-CoV-2 testing strategies, similarly as done for HIV-testing, seems warranted to address this problem.

Ameliorative Effects of Enriched Environment and Chronic Administration of Aqueous-methanol Extract of Garlic (Allium sativum) on Mice Models of Depression

Depression is a state of mood or energy level that includes lack of motivation, a sense of hopelessness and a loss of physical energy. The World Health Organization revealed that depression is one of the leading causes of ill health and disability worldwide. More than 300 million people are living with depression. Many of the currently available antidepressant drugs have proven to be effective but they are burdened with some disadvantages such as various adverse effects, problematic interactions and relatively low response. Therefore the need to utilize a natural agent in the management of depression is paramount. The aim of this study was to investigate the effects of chronic administration of extract of Allium sativum and Enriched environment in depression. 42 albino mice were used and divided into seven groups of five mice each. Group 1 was given distilled water; groups 2 and 3 received 200 mg/kg and 400 mg/kg of aqueous extract of Allium sativum respectively; while groups 4 and 5 were in addition to receiving 200 mg/kg and 400 mg/kg of the extract, housed in an enriched cage. Group 6 was only housed in an enriched cage and group 7 receives 10 mg/kg of imipramine. The experiment lasted for six weeks after which Force Swimming Test, Tail Suspension Test and Sucrose Preference test were conducted. The mice were sacrificed and their brain isolated, homogenized and centrifuged. The supernatant was used for biochemical assays (MDA, SOD, GPx, BDNF & TNF-α). The results showed that Allium sativum and Enriched Environment helped in mitigating depressive disorders. Therefore, conducive environment and garlic extract could be used in the management of depression.

Decolonizing Indigenous health: Generating a productive dialogue to eliminate Rheumatic Heart Disease in Australia

In common with colonized Indigenous people worldwide, many Australian Aboriginal people experience inequitable health outcomes. While the commitment and advocacy of researchers and health practitioners has resulted in many notable improvements in policy and practice, systemic and structural impediments continue to restrain widespread gains in addressing Indigenous health injustices. We take Rheumatic Heart Disease (RHD), a potent marker of extreme health inequity, as a case study, and critically examine RHD practitioners' perspectives regarding the factors that need to be addressed to improve RHD prevention and care. This study is an important explanatory component of a broader study to inform new clinical practices, and health system strategies and policies to reduce RHD. A decolonising, critical medical anthropology (CMA) analysis of findings from 22 RHD practitioner in-depth interviews conducted in May 2016 revealed both practitioners' perceptions of health system shortcomings and a sense of hopelessness and powerlessness to transform existing health system inequities, the negative impacts of which were subsequently confirmed in a separate study of RHD patients' lived realities. We reveal how biomedical dominance, normalized deficit discourses and systemic racism influence the current policy and practice landscape, narrowing the intercultural space for productive dialogue and reinforcing the conditions that cause disease. To counter biomedical approaches that contribute to existing health inequities in health care, we recommend localized, strength-based, community-led research projects focused on actions that use critical decolonizing social science approaches to achieve system change. We demonstrate the importance of integrating biological and social sciences approaches in research, education/training, and practice to: 1) be guided by Indigenous strengths, knowledges and worldview, and 2) adopt a critical reflexive stance to examine systems, structures and practices. Such an approach facilitates productive cross-cultural dialogue and social transformation; providing direction and hope to practitioners, enhancing their knowledge, skills and capacity and improving Aboriginal health outcomes.

Bonsai as a group art therapy intervention among traumatized youth in KwaZulu-Natal.

Bonsai can be used as an art therapy tool during psychodynamic therapeutic interventions maintenance of good mental health. Bonsai is generally considered to be relaxing and is practiced by many to relieve stress and as an expression of art. The aim was to establish bonsai as an art therapy tool to overcome trauma. Fifteen isiZulu‐speaking traumatized youths in a remote area in KwaZulu‐Natal, South Africa participated in a qualitative study that investigated their narratives around experienced trauma and sense of hopelessness. Materials in the form of bonsai, tools, wire, and pots were supplied, and six sessions were held. Results indicated that the participants experienced an improvement in their mental state, which was attributed by them to the practice of the art of bonsai. Bonsai can be beneficial as a healing medium mental health tool when employed as art therapy and can be promoted in a group setting in potential rehabilitation situations.

The lived experience of people who require prostheses or orthoses in the Kingdom of Cambodia: A qualitative study

BackgroundThere is an assumption that provision of assistive technologies, such as prostheses and orthoses, will improve the life situation of people with disabilities; however, this issue has been poorly addressed in low- and middle-income country settings. ObjectiveThe objective of this qualitative study was to explore the life experience of people who use lower-limb prosthetic or orthotic devices in Cambodia, with a view to identifying areas in which developments can be made to improve the life experiences for prosthesis and orthosis users. MethodsParticipants were recruited from 1/urban and 2/rural prosthetic and orthotic clinics, run by the same non-governmental organisation. Individual interviews were conducted in 2019 with 15 users of prosthetic or orthotic devices. Interviews were transcribed and analysed using a thematic analysis approach. ResultsThree themes were identified: 1) A more positive outlook with an assistive device; 2) assistive devices reduce barriers but do not eliminate them and 3) disability creates social exclusion while assistive devices facilitate inclusion. For participants in this study, life without a prosthesis or orthosis was characterised by financial insecurity and a sense of hopelessness. After receiving an assistive device, participants experienced a greater sense of self-worth and empowerment as well as improved functional performance and social interactions. ConclusionsDisability was found to affect multiple facets of participants’ lives including physical and psychosocial factors. Prosthetic and orthotic devices were experienced as being enablers of social inclusion and generally improved the life situation for individuals with disabilities in The Kingdom of Cambodia. Attention should be directed towards improving knowledge of, and access to prosthetic and orthotic services, securing a stable income for users and addressing device related problems.

The features of the formation of a value attitude towards another person among pupils of specialized schools

This article is devoted to the study of the features of the formation of a value attitude towards another person among pupils of boarding schools. Without taking into account factors, namely: the sensitivity of primary school and older adolescence in forming a value attitude towards another person; the peculiarities of organizing the life activities of pupils of boarding schools of the specifics of the contingent of pupils of general education boarding schools of the potential of out-of-hours activities of the above-mentioned educational institutions - it is impossible to determine the effectiveness of certain pedagogical means, to design educational strategies for the formation of a value attitude towards another person among pupils of boarding schools. According to graduates of boarding schools, the greatest difficulties at the end of school are unprepared for relations with members of the opposite sex, the search for friends, the inability to civilize resolve conflicts, fear of new people, inability and unwillingness to build relations with “normal people” and contrast their interests to others, as well as the lack of opportunity to get separate advice. The barrier to the independent life of graduates of boarding schools is the lack of positive examples of life experience in solving various problems; negatively affect the attit ude towards other people, misunderstandings, and conflicts. Often the inability to establish relations with people and show a value attitude to them causes panic, a sense of hopelessness, misunderstanding, isolation. That is why teachers propose to educate pupils of boarding schools based on correspondence with the real needs of children, communication with life, activation of feedback, motivation.

Ethical Implications of COVID-19: Palliative Care, Public Health, and Long-Term Care Facilities.

Outbreaks of COVID-19 among nursing homes, assisted living facilities, and other long-term care facilities in the United States have had devastating effects on residents. Restrictions such as banning visitors, sequestering residents, and testing health care staff have been implemented to mitigate the spread of the virus. However, consequences include a decline in mental and physical health, decompensation, and a sense of hopelessness among residents. We present and explore a case study at an assisted living facility addressing the ethical issues in balancing the management of the community versus the resident's right to autonomy and self-determination. A team of palliative care experts was brought into assisted living facilities to manage patients, care for well residents, and provide input in advance care planning and symptom management. The principles of self-determination and autonomy, stewardship, and distributive justice were explored. The use of nursing skills in triage and assessment, principles in public health, and the 8 domains of palliative care provided a comprehensive framework for structuring emergency operations. Palliative interventions and the role of palliative care nurses played an integral part in addressing ethical challenges in the containment of the virus and the deleterious effects of social isolation among the elderly.

Holes in the wall: Examining gaps in knowledge in child and adolescent mental health in Tanzania - Scoping review.

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

Dentists in India feel hopeless as a fulltime academician: A national survey

Assess the relationship between job satisfaction and feeling of hopelessness among dental academicians.Cross sectional study was conducted among dental academicians across India through email and social media using a pretested questionnaire.An Internet-based cross-sectional survey was conducted among dental academicians via social media and electronic mail (e-mail) throughout India. Demographics, credentials and job satisfaction across five dimensions (working conditions, pay and promotional potential, work relationships, use of skills and abilities and work activities) were rated on a 5-point Likert scale and a sense of hopelessness was assessed using Brief-H-Neg scale. The results were collected using self-reported Google forms. Bivariate and multivariate analysis were performed to identify the risk towards hopelessness, and the relationship between job satisfaction and hopelessness was assessed using student's t-test.The mean hopelessness score among dissatisfied faculty was 8.5 and among satisfied was 5.6 (P < 0.05). Tutors, assistants and associate professors with salary of INR <50000/month were highly dissatisfied (P < 0.05), and those willing to quit reported significantly lesser hopelessness compared to no/maybe. Regarding job satisfaction, greater hopelessness was reported with poor work relationships, poor working conditions and poor pay and promotional opportunities (P < 0.05). Dental academicians in India are highly dissatisfied with their career as a full-time teaching faculty. Willingness to quit has a positive effect on hopelessness, depicting the stress faculties experience in institutions. Job satisfaction among academicians plays a vital role in the student's dental learning experience and dissatisfaction will have huge ramifications on the quality of dental education and future graduates in India.

Understanding the Pathways of Neighborhood Environmental Influences on Health Among U.S. Chinese Older Immigrants

Neighborhood environment has proven to be consequential for older Americans’ physical, mental and cognitive health. However, this topic is much less studied among older Asian immigrants, a fast growing immigrant group who embrace values of collectivism and community connections. The current study used the first wave data (N=2920) of the Population Study of Chinese Elderly (PINE), the largest population-based sample of Chinese older adults in the U.S., 1) to examine the direct associations between neighborhood environment (social cohesion, physical disorder) and health outcomes (self-rated health, depression, and cognitive health); and 2) to identify possible mediators at intrapersonal (sense of hopelessness, sense of mastery) and interpersonal levels (social engagement, cognitive engagement) through which neighborhood environment influences health. The results of Sobel tests from path analysis showed that neighborhood social cohesion was associated with better health outcomes on all the domains: self-rated health (b= 0.050, p<.01), depression (b= -0.202 p<.001), and cognitive health (b=0.092, p<.001), whereas neighborhood physical disorder was associated with poorer self-rated health (b= -0.069, p<.01) and more depressive symptoms (b=0.174, p<.001). Full and partial mediations were detected. For example, neighborhood physical disorder influences depression completely through intrapersonal traits, higher sense of hopelessness (b=1.879, p<0.001) and reduced sense of mastery (b= -2.656, p<0.001). Neighborhood social cohesion contributes to better cognitive health partially through increased social engagement (b=1.696, p<0.001) as well as cognitive activities (b=1.392, p<0.001). The findings identified the ecological component in resilience building processes, and provide evidence for mezzo-level intervention to improve health among aging U.S. Chinese immigrants.

Psychological Strain and Suicidal Ideation in Athletes: The Multiple Mediating Effects of Hopelessness and Depression.

The present study aims to examine the relationship between psychological strain, suicidal ideation, hopelessness, and depression among Chinese athletes. Participants were 774 Chinese athletes (454 men and 320 women), with a range of ages from 12 to 35 (M = 18.47, SD = 3.39). The structural equation modeling method was used to examine the multiple mediating effects of hopelessness and depression between psychological strain and suicidal ideation. As expected, a positive correlation between psychological strain, suicidal ideation, hopelessness, and depression was found. Additionally, results seem to indicate that psychological strain directly and positively influenced suicidal ideation, and that hopelessness and depression played a serial mediating role in the relationship between psychological strain and suicidal ideation. To conclude, the psychological strain theory is applicable for explaining suicidal ideation in athletes. In athletes, psychological strain is sequentially associated first with a sense of hopelessness and then depression, which is in turn related to suicidal ideation. The present study makes a significant contribution to the literature because we provide a new theoretical basis and new methods for preventing mental disorder and suicidality in athletes.

Experience of hope: An exploratory research with bereaved mothers following perinatal death

ProblemThe negative implications of perinatal death on mothers’ mental health are documented, however little is known about their experience of hope. BackgroundWithin the broader literature, hope has contributed to better mental health and bereavement adjustment and often bereaved mothers report the importance of hope for the grieving process. AimThis study aims to explore bereaved mothers’ experience of hope following perinatal death. MethodsIndividual interviews were conducted with 33 mothers having experienced the death of an infant in the perinatal period. Data from the interviews were analysed using thematic analysis. FindingsThe mothers’ experience of hope following perinatal loss is organized into three themes: Hope disrupted by perinatal loss; Transformed hope: a new pregnancy challenged by the sense of foreboding of another loss; and Ways to restore and foster hope in life. DiscussionAlthough hope has been a motivating force for mothers to reconnect with their life plan and move on after a loss, it is also negatively affected by the experience of perinatal bereavement, social support, and health professionals’ clinical practice. ConclusionBereaved mothers have reported a disruption in their experience of hope. While some experience a loss of hope or a sense of hopelessness, others experience a transformation and restoration of hope, which is reinvested in the grieving process. Mothers’ experience of hope highlights the need for the support of a healthcare professional and may contribute to enhanced clinical practice through the promotion of bereavement care, considering the aspects that instil, maintain, and interfere with hope.

Review: Convicted and Condemned: The Politics and Policies of Prisoner Reentry, by Keesha M. Middlemass

Review: Convicted and Condemned: The Politics and Policies of Prisoner Reentry, by Keesha M. Middlemass

Exhausted: Education and the Response to the Planetary Crisis

The climate crisis is of a severity that fills many with a sense of hopelessness. The modest steps that ordinary citizens can take to reduce energy consumption and waste seem futile in relation to the massive changes that are needed from governments and industry, and inertia often results. The responses of philosophy and education have been conscientious and constructive in many respects, but again these endeavours are overwhelmed by the intransigence of economic interests. Perhaps because of this, such responses are in danger of becoming self-referential expressions of right-mindedness or nostalgic appeals for a simpler, more natural world. The discourse betrays signs of exhaustion—an exhaustion that seems to match the exhausted condition of the planet. The present discussion offers no easy solutions but asks what might be the best way to live in relation to such circumstances and how education might contribute to this.

Suicidal ideation, hopelessness, and affective temperament in patients with blepharospasm

Objective The aim of this study was to investigate the relationship between suicidal ideation and neurological, psychological, and psychiatric features in patients with blepharospasm (BSP). Methods We enrolled 70 BSP patients and 80 control subjects. All participants underwent a psychiatric and psychometric evaluation: Structured Clinical Interview, Clinical Global Impression, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Columbia-Suicide Severity Rating Scale, Beck Hopelessness Scale, Temperament Evaluation of Memphis, Pisa, San Diego Auto-questionnaire. BSP severity was assessed using the Blepharospasm Severity Rating Scale. Results Suicidal ideation was reported in 18% of BSP patients and 6% had current suicidal ideation. 83% of BSP patients had severe hopelessness. BSP patients presented an increased sense of hopelessness (OR= 1.39, 95% CI = 1.13/1.70) and a pronounced depressive temperament (OR= 1.36, 95% CI = 1.12/1.65). Suicidal ideation in BSP patients correlated with psychiatric disorders (OR = 3.96, 95% CI = 1.23/12.74) and higher scores on the HAM-A (OR = 1.11, 95% CI = 1.02/1.20), HAM-D (OR = 1.18, 95% CI = 1.05/1.32), CGI (OR = 1.85, 95% CI = 1.18/2.90), TEMPS-A Cyclothymia (OR = 1.16, 95% CI = 1.02/1.31). Conclusion Our findings suggest the presence of suicidal ideation and severe hopelessness in BSP patients. KEY POINTS BSP patients as compared to controls more frequently reported the presence of a psychiatric disorder and more severe anxiety and depressive symptoms, psychopathology on the CGI, suicidal ideation, and hopelessness. BSP patients with prevalent cyclothymic temperament had more severe suicidal ideation, suggesting an increased suicide risk most likely due to difficulties in psychological adaptation to changing environments, including the neurological disease. A psychiatric assessment is recommended for patients with this condition, with possible referral to a suicide prevention centre.

Evaluation of Suicide Risk in Chronic Schizophrenic Hospitalized Patients

Schizophrenic patients have a high risk for suicide. Research indicates that suicide is the cause of death in 5–13% of schizophrenic patients. Many factors are known to be involved in the suicidal process, some of which are different from those in the general population. The aim of the study was to evaluate the suicidal intent in schizophrenic hospitalized patients. In this descriptive cross sectional study, the numbers of patients who participated and continued all the psychometrics were 94 patients, 58 males and 36 females. Psychiatric sheet of General Secretariat of Mental Health, Structured interview using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) and Arabic version of Beck Scale for Suicide Ideation (BSS) were done for all patients. According to BBS, 44.7% of the studied patients had no suicide ideation, 34.0% had passive suicide ideation, 11.7% had active suicide ideation and 9.6% had both passive and active suicidal ideation at the time of study. It was concluded that suicidal risk is high among schizophrenic patients. Marital status, onset and duration of schizophrenia, history of undergoing ECT, depressed mood and sense of hopelessness were found to have a strong association with suicide ideation.

Older Adult Suicides: What You Should Know and What You Can Do.

Suicide among most age groups has been on the rise in the United States for the past 20 years. Suicide is currently the 10th leading cause of death in the United States, but suicide completion and suicide attempts may be underreported. Suicide is a very personal act often predicated on a sense of hopelessness and despair, but often prompted by very addressable factors such as pain and social isolation. This article will use a case narrative to illustrate life circumstances that may influence suicidal thinking. In addition, risk factors are addressed. Lastly, the article addresses some useful assessment tools to gauge suicide risk among older adult clients and provides resources for home care clinicians.

Perceived parental sacrifice, filial piety and hopelessness among Chinese adolescents: A cross-lagged panel study

IntroductionThere is a dearth of research on examining the longitudinal effects of cultural family processes on adolescent hopelessness, and the mechanisms through which the effects happen. Hence, the present study examined the relationship among parental (paternal and maternal) sacrifices, filial piety and adolescent hopelessness in the Chinese context. MethodsThe study was based on a three-wave longitudinal data from a sample of 1569 Chinese adolescents (Time 1: mean age = 13.15 ± .92 years; 50.8% girls). The adolescents were invited to fill out a questionnaire containing measurements of studied variables thrice, at an interval of one year. ResultsThe results of cross-lagged panel analysis indicated that maternal sacrifice was associated with filial piety, which in turn was linked with hopelessness among Chinese adolescents. Moreover, there was bidirectional effects of adolescent hopelessness at earlier time point on paternal and maternal sacrifice at later time point via filial piety. ConclusionsThe study showed that maternal sacrifice serves as a protective factor that reduces adolescents’ sense of hopelessness via the development of filial piety. At the same time, the bidirectional indirect effects of filial piety on the relationship between parental sacrifice and adolescent hopelessness also alert family researchers and youth practitioners on the child effects on parental behavior in Chinese families. Theoretical and practical implications of the findings are discussed.

Climate of Anxiety in the Sahel: Emigration in Xenophobic Times

Young Sahelian farmers are crossing the Sahara toward Europe. They are sold as slave labor, held ransom for money from their families, beaten and spit on. Many die in the desert or drown at sea. Yet, knowing the dangers, they go. The media depicts them as “climate refugees”—running from climate stress. These emigrants and their families, however, rarely mention the weather as a cause of their plight at home or their decisions to leave. They are fleeing abusive policies, exposure to markets, debt peonage, failures of social security systems and a sense of hopelessness in a world where they never expect to have a dignified role in their families or communities. Casting them as climate refugees occludes the multiple forces that lead them to emigrate and diverts attention from potential responses. This casting mobilizes, thus validating, European xenophobia to motivate Europeans to fight climate change. While climate investments appear responsible and progressive, the climate focus denies the colonial and postcolonial histories of emigrants’ plights, thereby threatening to deepen the crisis.

Violence in Schools: Rare and Preventable With a ‘Culture of Safety’

Back to table of contents Previous article Next article ProfessionalFull AccessViolence in Schools: Rare and Preventable With a ‘Culture of Safety’Mark MoranMark MoranSearch for more papers by this authorPublished Online:5 Dec 2019https://doi.org/10.1176/appi.pn.2019.12a15Abstract“See Something, Say Something” programs that encourage young people to come forward with concerns about someone who may exhibit signs of being potentially violent are part of a “safe school culture.”Twenty years after the mass shooting at Columbine High School, some American schools have become high-security zones with elaborate procedures for entry into the property, active-shooter lockdown drills, and zero-tolerance policies that allow students to be suspended for minor infractions. But schools are safer than the public has been led to believe by media attention to high-profile mass shootings, and at least some of these policies and practices that schools are employing may be counterproductive, according to the report “Mass Violence in America: Causes, Impacts, and Solutions” by the National Council on Behavioral Health (NCBH).“Your child is safer in school than she is driving with you in your car,” said Joseph Parks, M.D., medical director of the NCBH, at a session on mass violence at the IPS: The Mental Health Services Conference in October in New York. He was joined by John Rozel, M.D., an expert in threat assessment and president of the American Association for Emergency Psychiatry (see story).They summarized the findings and conclusions of the National Council report, emphasizing the need for a public health—rather than a punitive or fear-based—approach to prevention of mass violence. The report addresses mass violence in general, but Parks and Rozel highlighted some special recommendations for schools.A priority of a public health approach to violence in schools is creating a positive climate for students to come forward because of mental health problems or concerns about other students who may be troubled.“See Something, Say Something” programs that encourage students to approach authorities with information about a possible threat are essential in the creation of a culture and climate of safety, allowing timely, nonpunitive identification of students displaying mental distress.A culture of safety also includes adequate teacher-student ratios and resources to provide in-school mental health and substance use evaluation and treatment or means for referral. And schools should make information about mental health widely available; the council recommendations specifically cite “Typical or Troubled?,” the APA Foundation program designed to help school personnel and others distinguish young people who are at risk or in need of treatment for mental or substance use disorders.At the IPS presentation, Rozel and Parks underscored several practices and policies that schools should not employ. Among them:Zero tolerance suspension policies. Many schools have adopted policies prohibiting not only guns or knives but all manner of objects or utensils that might be regarded as potentially dangerous, with suspensions or expulsions for violations. But suspensions and expulsions may increase a student’s isolation, alienation, and feelings of injustice and sense of hopelessness, which increase risk.High-cost hard security measures. Schools should avoid measures that create a correctional facility–like atmosphere such as bulletproof glass, armed security guards, and metal detectors. These are costly and, as physical reminders of potential danger, can create a threatening atmosphere and an environment not conducive to education. Less heavy-handed measures such as limited entry points into the school and surveillance cameras can be just as effective and less intrusive.Extremely realistic and dramatic active shooter drills. Some schools have employed surprise enactments with drawn guns and injury makeup. These can be traumatizing. “Shooter drills should be no more stressful or realistic than fire drills,” according to the council report. ■ ISSUES NewArchived