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- Published: 18.03.10
- Updated: 16.08.11
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Current Awareness
The effectiveness of the service user consultant role in specialist personality disorder services.
By D'Sa, Amy . 2011 PURPOSE: This qualitative study considers the roles of service user consultants (SUCs) in six of the original 11 Department of Health (DH) Community Personality Disorder (PD) pilot services; how these roles differ from the active participation traditionally encouraged in therapeutic communities (TCs) around responsibility for self and others; how a service user (SU) becomes a SUC; what responsibilities they hold; the views of both staff members and SUCs on the role and the benefits and difficulties it creates; and how the role could be developed in a service-specific and general way. It is of particular interest to consider the amount of time for which the SUC role is seen to be beneficial, and what support a SUC would need to leave the role. DESIGN/METHODOLOGY/APPROACH: Two qualitative interview schedules were developed to investigate issues highlighted in previous literature, one designed to be answered by staff members, another developed with a SUC from Cumbria for SUCs and administered by telephone. The research questions were designed to look at four main themes: How SUs become SUCs; SUC responsibilities within the service; views on the benefits and difficulties of the SUC role; and developing the role and moving forward. The context of each service was explored to reflect the uniqueness of each SUC role and service philosophy. FINDINGS: The SUC role continues to develop and is seen as having value, particularly as a "bridge" between SUs and staff members, and as a transitional stage in which the work of therapy can be consolidated. Problems remain in respect to: optimal levels of disclosure between other staff members and SUCs; the level and type of support needed to carry out the work and to remain well; acceptance of the role by professionals in other teams; and the extent to which SUCs are felt able to engage, or not, in direct clinical work. RESEARCH LIMITATIONS/IMPLICATIONS: This is a qualitative study in which only just over half of the pilot services agreed to take part and in which fewer SUCs were put forward to take part as compared to other staff members. There are therefore potential problems in generalising these findings to other services which employ SUCs. PRACTICAL IMPLICATIONS: Within personality disorder services there is a perceived optimal level of disclosure and information sharing between other staff members and SUCs, and between SUCs and SUs, but this remains undefined. SUC responsibilities do not always include direct clinical work because of concerns to maintain their well being. There is evidence from a number of services that SUCs can safely and creatively engage in direct clinical work given suitable support and supervision. Staff members from other teams without experience of employing SUCs may not always understand the SUC role, may denigrate the experience of SUCs, or feel threatened by their incursion into training and clinical work. SUCs seem enthusiastic to work in other areas within their wider service to promote understanding of mental health and personality difficulties. In-service supervision/mentoring can help to monitor and alleviate SUC distress. ORIGINALITY/VALUE: The paper extends knowledge about the SUC role, as it has developed and diversified during the development of the DH Community PD Pilot Sites. Novel semi-structured interview schedules have been developed. [Abstract]
Mental health service user involvement in policy development : social inclusion or disempowerment?
By Cowan, Sue . 2011 PURPOSE: The paper's purpose is to reopen a debate around the potential impact of narrow conceptualisations of inclusion, or participation, of service users in current mental health policy development and implementation. DESIGN/METHODOLOGY/APPROACH: The approach here is a conceptual analysis of the continuity of "‘New Labour’ thinking" and its connection to Putnam on social capital and citizenship, whilst also offering counter critiques drawing on Bourdieu, Rose, and Arnstein. FINDINGS: The findings show the potential for disempowerment and argue for alternative service user action, either contracting on "their own rules of engagement" or specifically taking up an oppositional stance to disempowering forms of involvement. The authors also draw attention to the influence of differing English and Scottish policy drivers which appear to offer potentially different forms of engagement. ORIGINALITY/VALUE: The paper offers a fresh analysis that particularly points to the potential value of service user groups considering alternative forms of involvement, rather than those prescribed by "Third Way" or "Big Society" thinking. [Abstract]
The relationship between personal debt and mental health : a systematic review.
By Fitch, Chris . 2011 PURPOSE: The purpose of this paper is to evaluate the evidence on the extent to which personal debt impacts on mental health, and mental health on personal debt. DESIGN/METHODOLOGY/APPROACH: The paper systematically reviews the English-language, peer-reviewed literature, 1980-2009, drawing on 14 databases across the medical, business, legal, and social science fields. FINDINGS: From 39,333 potential papers identified, 39,283 were excluded, and 50 were reviewed using a narrative analysis approach. Among nine longitudinal studies, three controlled for psychiatric morbidity or psychological wellbeing at baseline, income/wealth, and other socio-economic variables. From these, two reported indebtedness or an increase in debt levels associated with subsequently poorer mental health, while one study found no such relationship. While methodological limitations make it difficult to definitively demonstrate whether indebtedness causes poorer mental health, plausible data exist which indicate that indebtedness may contribute to the development of mental health problems, and mediate accepted relationships between poverty, low income, and mental disorder. RESEARCH LIMITATIONS/IMPLICATIONS: Existing research either uses definitions of "debt" which lack specificity, or definitions of "mental health" which are too broad-brushed. A more sensitive set of core questions is needed. Further longitudinal research is also a key priority. PRACTICAL IMPLICATIONS: Those working with people with debt problems need to be aware of the potential risk of reduced mental wellbeing or mental disorder. ORIGINALITY/VALUE: The mental health of individuals living with indebtedness has become a recent concern for the health and financial services sectors. However, no systematic reviews have so far been conducted. [Abstract]
Beyond rhetorical differences : a cohesive account of post-devolution developments in UK health policy.
By Smith, Katherine . 2012 Health is perhaps the most significant policy area to be devolved to decision-makers in Northern Ireland, Scotland and Wales. Consequently, there has been a great deal of interest in assessing the extent to which health policies (which already differed somewhat prior to devolution) have diverged since 1999. To date, analyses have tended to focus either on health care policies or on specific public health issues (e.g. health inequalities or tobacco control). The story that emerges from this body of work suggests health care policies have diverged significantly, whilst public health policies have remained remarkably similar. This article is one of the first to consider health care and public health policy alongside each other. It reassesses and updates previous analyses, incorporating developments relating to the 2010 general election and the 2007 and 2011 devolved administration elections. Drawing on a variety of textual sources (policy documents, research evidence and corporate literature), our findings differ from existing analyses in suggesting that, despite some noticeable differences in policy rhetoric, approaches to both health care provision and tackling public health problems remain similar. Looking to the future, the article concludes that the common economic challenges, combined with a tight fiscal policy (that remains excepted from devolution), means the similarities in health care provision across the UK are likely to remain more pronounced than the differences. However, current debate about the constitutional settlement, and in particular the prospect of greater fiscal freedoms for the devolved administrations, may provide opportunities for more meaningful divergence in health policy than has been possible hitherto. [Abstract]
Making best interests decisions : people and processes.
By Williams, Val . 2012 . 156p.
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