Place, mobility and social support in refugee mental health

Purpose This review and theoretical analysis paper aims to bring together literatures of place, mobility, refugees and mental health to problematise the ways in which social support is practised on the ground and to rethink its possibilities. Design/methodology/approach This paper draws on an interdisciplinary understanding of social support that focusses on the social networks and significant and intimate relationships that mitigate negative mental health and well-being outcomes. The authors explore the dialectic relationship between place and mobility in refugee experiences of social support. Findings The authors argue that, in an Euro-American context, practices of social support have historically been predicated on the idea of people-in-place. The figure of the refugee challenges the notion of a settled person in need of support and suggests that people are both in place and in motion at the same time. Conversely, attending to refugees’ biographies, lived experiences and everyday lives suggests that places and encounters of social support are varied and go beyond institutional spaces. Research limitations/implications The authors explore this dialectic of personhood as both in place and in motion and its implications for the theorisation, research and design of systems of social support for refugees. Originality/value This paper surfaces the dialectics of place and mobility for supporting refugee mental health from an interdisciplinary perspective

Power in Big Local Partnerships

This report is about the practice of decision-making in a resident-led, place-based programme. It explores the operation of power within decision-making: how decisions are made, by and with whom and in what contexts. It considers how particular ideas gather appeal, how some voices are heard more than others, and how beliefs in ‘the right way’ to make decisions matter, and can have unintended consequences of limiting agendas and imagination. It identifies ways to strengthen decision-making in a community-led programme, by developing new forms of participation and sharing power among all sections of the community. The research is based on Big Local. Big Local is a resident-led funding programme providing groups of people in 150 areas in England with £1.15m each to spend across 10–15 years in order to create lasting change in their neighbourhoods. A key goal of the Big Local programme is for communities to build confidence and capacity for the longer term (Local Trust, 2019). In Big Local areas, resident-led partnerships play a key role in decision-making and guide the overall direction of Big Local in their area. The research was conducted by the Centre for Ethnographic Research at the University of Kent, through interviews and online observation (virtual ethnography). Our findings are presented in five main areas: culture, power and processes; partnership rules and agendas; membership, recruitment and diversity; voice, power and inequality; and spaces of communication and decision-making. Our research revealed how power resides in different phases of the processes involved in decision-making as well as in the final outcome. We also found that although most Big Local partnerships aim to include all members of the community, barriers remain based on protected characteristics such as race and gender that affect individuals’ participation in Big Local partnerships. The research was carried out during the Covid-19 pandemic, and the move to online decision-making has disrupted partnerships’ internal working cultures and created new opportunities for inclusivity. We conclude that power operates in different ways across decision-making processes and that this is influenced by the space decisions take place in, whose voice is heard and why, and how rules are made and interpreted

The Contribution of Anthropology to the Study of Open Dialogue: Ethnographic Research Methods and Opportunities

When Open Dialogue diversifies internationally as an approach to mental healthcare, so too do the research methodologies used to describe, explain and evaluate this alternative to existing psychiatric services. This article considers the contribution of anthropology and its core method of ethnography among these approaches. It reviews the methodological opportunities in mental health research opened up by anthropology, and specifically the detailed knowledge about clinical processes and institutional contexts. Such knowledge is important in order to generalize innovations in practice by identifying contextual factors necessary to implementation that are unknowable in advance. The article explains the ethnographic mode of investigation, exploring this in more detail with an account of the method of one anthropological study under way in the UK focused on Peer-Supported Open Dialogue (POD) in the National Health Service (NHS). It sets out the objectives, design and scope of this research study, the varied roles of researchers, the sites of field research and the specific interaction between ethnography and Open Dialogue. This study is original in its design, context, conduct and the kind of data produced, and presents both opportunities and challenges. These are explained in order to raise issues of method that are of wider relevance to Open Dialogue research and anthropology

Patient and public involvement (PPI) in UK surgical trials: a survey and focus groups with stakeholders to identify practices, views, and experiences

Background and aims Historically, patient and public involvement (PPI) in the design and conduct of surgical trials has been absent or minimal, but it is now routinely recommended and even required by some research funders. We aimed to identify and describe current PPI practice in surgical trials in the United Kingdom, and to explore the views and experiences of surgical trial staff and patient or public contributors in relation to these practices. This was part of a larger study to inform development of a robust PPI intervention aimed at improving recruitment and retention in surgical trials. Methods Our study had two stages: 1) an online survey to identify current PPI practice in active UK-led, adult surgical trials; and 2) focus groups and interviews with key stakeholders (surgical trial investigators, administrators, and patient or public contributors) to explore their views and experiences of PPI. Results Of 129 eligible surgical trial teams identified, 71 (55%) took part in the survey. In addition, 54 stakeholders subsequently took part in focus groups or interviews. Sixty-five (92%) survey respondents reported some kind of PPI, most commonly at the design and dissemination stages and in oversight or advisory roles. The single most common PPI activity was developing participant information sheets (72%). Participants reported mixed practice and views on a variety of issues including the involvement of patients versus lay members of the public, recruitment methods, use of role descriptions and payment for the time of PPI contributors. They suggested some solutions, including the use of written role descriptions and databases of potential PPI contributors to aid recruitment. Conclusions UK surgical trials involve patients and members of the public in a variety of different ways, most commonly at the beginning and end of the trial lifecycle and in oversight or advisory roles. These are not without challenges and there remain uncertainties about who best to involve, why, and how. Future research should aim to address these issues

"Power makes us sick": How Mental Health Activists in London Heal through Indeterminate Worlds

This thesis is based on 13 months of ethnographic fieldwork with groups of mental-health activists in London. As past or current patients of the National Health Service, activists self-identify as 'survivors', 'evaders' and/or 'ex-users' of formal mental healthcare. These terms express how engagement with services has left activists with a profound sense of grievance and disquiet. In accounting for their views, activists decry the dominance of the biomedical model, the invasive managerial systems, and the insensitivity of clinical encounters, some of which involve force. They also protest that access to welfare benefits is determined by mental-health assessments. I explain the lingering affective and phenomenological presence of biomedicine in activists' lives by describing it as a 'shadow'. This shadow manifests in activists' histories and narratives and also informs and unsettles their present. Reliant on a system of mental healthcare whose tenets they reject, activists are caught between conflicting subjectivities. While activists strive to assert their autonomy and competence and call out epistemic violence and injustice, the biomedical system positions them as incapacitated and vulnerably dependent, in turn discounting their concerns and corroding their sense of independence. This is the context in which activists come together to forge their own modes of healing by building indeterminate worlds. Worldbuilding is the everyday relational and spatial practices and ways of being, which in the case of mental-health activism are founded on mutuality and indeterminacy. Building healing worlds around these attributes allows activists to enact alternative social and political imaginaries, or live 'the change they wish to see'. In the process, activists seek to re-frame their lives and relationships by making spaces to 'be' and 'become', and to 'go through madness' together. Thus, activists resist the drive toward coherence or consistency in mental health services; this allowing them to prefigure a more subjective, inclusive and adaptive approach to mental distress that permits plurality, alterity and autonomy. In other words, activists heal according to their own terms. This is not to imply that activists' relational practices are invariably consensual and cooperative, since mutuality, and indeterminacy entail much complexity, contradiction and much uncertainty. Moreover, when activists experience the suffering of others, this can become enmeshed, and even indistinguishable from their own distress. Nevertheless, I conclude that conflict and mutual hurt are not simply sources of suffering, since they also generate a sense of safety and connection and as such, are constitutive of the kind of mutuality activists enact. In making this case, my thesis contributes to debates in medical and political anthropology as well as mental health and Mad studies

Power in Big Local Partnerships Graphic Report

A graphic comic of the Power in Big Local Partnerships project findings. This report considers power in Big Local partnerships and Big Local, a resident-led, place-based programme. It explores how decisions are made, by and with whom and in what contexts. It considers how particular ideas gather appeal, how some voices are heard more than others and importantly, identifies ways to strengthen decision making. An online comic has been designed alongside this report to visually demonstrate inclusivity and invisibility in decision making and how power and knowledge operate in community meetings