“I'm a police officer not a social worker or mental health nurse”: Online discourses of exclusion and resistance regarding mental health related police work

Despite estimates suggesting that around 15% of UK police incidents involve people with a mental health concern, officers receive very little mental health training. The police have faced high‐profile criticisms over their handling of mental health‐related incidents, whereas the underfunding and fragmentation of UK mental health services has led to concerns that police officers are being forced to undertake a primary role in mental health care. At a time of austerity and widespread cuts to public services, it is important to explore how particular groups work to justify the parameters of their professional duties. This article therefore explores the discourses surrounding mental health problems on an online police discussion forum, highlighting two distinct ways in which mental health‐related work is represented as being incompatible with policing. First, mental health problems are delegitimised and conflated with “scrounging,” positioning individuals as undeserving of police time; second, mental health problems are reified and associated with violence and extreme behaviour, justifying the use of force by police officers and deflecting responsibility onto mental health services. Findings are consistent with previous research suggesting that mental health work is not perceived to be a valid part of the police role

Diagnostic identity and the legitimisation of mental health problems: An ethnographic study with a focus on bipolar disorder

Psychiatric diagnosis has become a pervasive aspect of modern culture, exerting an increasing influence on forms of personhood, identity practices, and modes of self-governing. Debates surrounding the classification of psychiatric disorders are also prevalent, with particular disputes surrounding the relative merits of ‘biomedical’ vs ‘psychosocial’ understandings of mental health difficulties. There is arguably a need for further empirical exploration into the social and cultural implications of psychiatric classification and categorising practices within mental health service interactions. Drawing on ethnographic research conducted within several UK mental health settings, this thesis considers the role of diagnosis in constituting patient identities and in shaping professional categorisation practices, with a particular focus on bipolar disorder. Observations were conducted within sites where diagnostic identities are particularly salient: Psychiatric diagnostic and screening assessments, and a psychoeducation programme for bipolar disorder. Focusing on the formal and informal categorisation practices of service users and professionals, this study highlights the way in which psychiatric classifications can be negotiated, ascribed, and withheld in order to legitimate and contest particular kinds of suffering; in particular, it explores the way in which diagnostic categories – in particular bipolar disorder - can be used to interpret and medicalise morally problematic forms of experience and behaviour. Whilst diagnosis itself can function to medicalise aspects of moral life, its ability to perform this function is also shown to depend upon its conceptualisation as a biomedical disease entity. Findings suggest that bipolar disorder gives rise to particularly somatic concepts of personhood; its conceptualisation as an essentialised and reified illness category, with its cause located within the brain, enables a legitimisation of psychiatric ‘symptoms’ for both patients and professionals. In seeking access to more specialised mental health services with limited resources, potential patients can face trivialisation and deligitimisation of their problems by professionals, which at times manifests in the withholding of diagnosis. This is particularly the case within a mental health policy context which has increasingly moved towards the prioritisation of those with ‘severe mental illness’. As such, the study shows how the legitimising function of diagnoses such as bipolar disorder, can lead to a tendency for it to be both sought after by patients, but contested by professionals and amongst patients. In light of the apparent advantages conferred by this diagnosis, the moral and personal consequences of diagnostic membership, exclusion, and uncertainty are considered; in particular, the potential for this essentialised category to create divides between those considered to ‘have’ the disorder and those who are not, is contemplated

Training school teachers in Malawi about substance misuse and trauma: the need for a sustainable strategy

Purpose The World Health Organisation found depression to be the fourth leading cause of disability in Malawi (Bowie, 2006) with the prevalence of mental health need in children and young people in Malawi estimated between 10 and 30% (Kutcher et al., 2019). One option to address this was to provide schoolteachers with skills and knowledge related to mental health so they can better support children. There is generally a lack of evidence of the utility or feasibility of school-based mental health literacy programmes in low to medium income countries (LMIC). This paper aims to report on a project to train schoolteachers in Malawi on aspects of mental health. Design/methodology/approach The aim of this project was to determine the acceptability and feasibility of delivering a training initiative in Malawi to teachers to better enable them to recognise and cope with school children who had been exposed to trauma and substance misuse. Findings Feedback was generated through the use of a specifically designed pre and post measure, focus groups, interviews and observations of the teaching delivery. Practical implications Teachers found the training built on their existing knowledge and they requested further opportunities for training and consultation about how to manage difficult presentations. It was evident that teachers did not know how to access mental health care or support for children whose needs could not be met by schoolteachers alone. Originality/value For a sustainable improvement for children’s mental health care in this context, further training becomes valuable when located as part of a network of joined up health and educational services