1,721,405 research outputs found
Survival and its discontents: the case of British psychiatry
No full textSub-divisions of labour in health settings are common and medical dominance and encroachment from competitors are well known. This article considers this general picture but in specific relation to mental health work in Britain and its particular features of recent contestation. British psychiatric orthodoxy has faced challenges to its legitimacy for over a century. However, since the 1980s, in the wake of de-institutionalisation and a new shared service commitment to ‘recovery’, these challenges have taken new shape. They are explored by considering: the current ambit of mental health care; the sub-division of labour in specialist mental services; recent governmental expectations of the mental health workforce; and the contested legacy of theory and practice in mental health work. The conclusion is that the profession is not under immediate threat of collapse but that its fate may now rest on whether a biomedical or a biopsychosocial model of practice predominates in routine service deliver
Knowing as practice: self-care in the case of chronic multi-morbidities
No full textPatient expertise in self-care is recognised as a cornerstone of disease management in advanced welfare capitalist societies. When conceptualised within a broader agenda of ‘engaged and active patients’ such expertise is expected to relieve UK NHS resources significantly. However, although self-care is first and foremost an embodied practice, grounded in the context of everyday life, state sponsored self-care support initiatives such as the Expert Patients Programme operate a dualistic framework separating cognitive and corporeal elements. Moreover, chronic disease management operates through a framework that is increasingly biomedical, specialised and reductionist. Patients with multiple morbidities in particular are not served well by this epistemological approach. Utilising a ‘lived body’ conceptual paradigm and drawing upon qualitative data gathered from interviews with patients with multi-morbidities, we explore embodied self-awareness in health and illness and the everyday practices of chronic illness work. We examine how patients integrate the different types of knowledge and practices resulting from interaction with primary care professionals and highlight the implications for primary care practice, for medical epistemology and for the democratic potentiality of the NHS.<br/
The needs of others: the norms of self-management skills training and the differing priorities of asylum seekers with HIV
No full textThis paper challenges the notion of a shared social identity resulting from a self care skills training programme through exploring the engagement, experience and outcomes of participants from different social groups: sub-Saharan asylum seekers and gay men. In the former group norms and values about priorities and management of HIV differed significantly from the programme's underlying philosophy of individualism. Some needs were similar, but learning self-management skills was not the priority it was for gay men as pressing needs arising from their asylum status (to address social problems, access welfare and achieve marginal residential status) overwhelmed self care attempts.A focus on self-efficacy and individual behaviour change is likely to leave unaddressed social and material needs, inadvertently adding insult to injury. However, alternative benefits included sharing 'experience' and the perceived 'problem' that being an asylum seeker posed to other people. The contexts of location, needs, identities and social position are important in understanding self care support innovations.<br/
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