Palliative care in UK prisons: practical and emotional challenges for staff and fellow prisoners

Despite falling crime rates in England and Wales over the past 20 years, the number of prisoners has doubled. People over the age of 50 constitute the fastest growing section of the prison population, and increasing numbers of older prisoners are dying in custody. This article discusses some of the issues raised by these changing demographics and draws on preliminary findings from a study underway in North West England. It describes the context behind the rise in the numbers of older prisoners; explores the particular needs of this growing population; and discusses some of the practical and emotional challenges for prison officers, health care staff, and fellow prisoners who are involved in caring for dying prisoners in a custodial environment

Time is not enough : promoting strategic engagement with writing for publication

Research, scholarship and publication are central to the work of higher education. However, even academics with the necessary research and writing skills can struggle to publish as often as they would like. Research suggests that a writing retreat is one solution; there is a process going on there that addresses the problem, but how it does so has not been fully explained. We used a novel approach, containment theory, to explain why the functions of a structured retreat work. We argue that a retreat does more than simply provide time to write; it is a model for academics to meet the demands of research assessment. Finally, we conceptualise this as strategic engagement - a model for producing regular writing for publication while continuing to meet other professional demands

Introducing compassion into the education of health care professionals; can Schwartz Rounds help?

Whilst health care professionals embark on their careers with high ideals these can be eroded by the pressures and stress of the system. This paper explores the problems, which may lead both students and professionals, working in health care, to feel isolated and stressed. It considers the value of Schwartz Rounds as an initiative that can be used to enhance student well-being and ultimately enable students to treat each other, colleagues and patients with more compassion

‘Stumbling through’? Relationship-based social work practice in austere times

In recent times relationship-based practice has become a familiar term in social work practice and education. Despite its widespread adoption, how relationship-based practice is understood varies widely. Drawing on contemporary conceptualisations of the child and family and individuals as psychosocial subjects experiencing social suffering, this paper explores how current social work practice can be understood in the context of neoliberalism and austerity. Setting these ideas in an historical context helps to inform our understanding as to why social work seems to be the focus of sustained political discontent and scrutiny, making it difficult to retain a balanced relationship-based professional stance. Contemporary responses to the current challenges of everyday practice are outlined and the contribution of psychodynamic and systemic ideas to promoting relationship-based practice is explored. The paper concludes by considering how the concept of social systems as defences against anxiety can inform our understanding of the resistance amongst practitioners to relationship-based practice and emphasises the importance of reflective spaces and places for developing and maintaining integrated, mature relational approaches to practice which impact on practice at both the individual casework and social structural level

Conflict, compromise and collusion: dilemmas for psychosocially-oriented practitioners in the mental health system

The nature and causes of mental health problems are contested. The dominant approach in services views them as ‘illnesses like any other’. The structure, legislative base and practices of mainstream mental health services are largely predicated on this idea, known variously as the medical, illness, disease or diagnostic model. By contrast, psychosocial theories highlight the role of the events and circumstances of peoples’ lives. The tension between these two approaches can lead to challenges and dilemmas for psychosocially oriented practitioners. Clinical psychologists participated in interviews and a focus group about these challenges and how they managed them. A grounded theory was constructed which suggested that their responses took three forms: openly ‘dissenting’ (conflict), strategically ‘stepping into’ the medical model (compromise), or inadvertently ‘slipping’ into it (colluding). Strategies for managing the challenges included focusing on clients; foregrounding clients’ contexts and understandings; holding the tension between ‘expert’ and ‘not-knowing’ approaches; using ordinary language; forging robust working relationships; being mindful of difference and of constraints on colleagues; recognising one’s power and ability to influence; self-care and work/life balance; taking encouragement from small changes; consolidating a personal philosophy; mutual support and solidarity; drawing on scholarship and finally engaging in activism outside work

Institutional creativity and pathologies of potential space: The modern university

This paper proposes the applicability of object relations psychoanalytic conceptions of dialogue (Ogden, 1986, 1993) to thinking about relationships and relational structures and their governance in universities. It proposes that: the qualities of dialogic relations in creative institutions are the proper index of creative productivity; that is of, as examples, ’thinking’ (Evans, 2004), ’emotional learning’ (Salzberger-Wittenburg et al., 1983) or ’criticality’ (Barnett, 1997); contemporary institutions’ explicit preoccupation in assuring, monitoring and managing creative ’dialogue’ can, in practice, pervert creative processes and thoughtful symbolic productivity, thus inhibiting students’ development and the quality of ’thinking space’ for teaching and research. In this context the paper examines uncanny and perverse connections between Paulo Freire’s (1972) account of educational empowerment and dialogics (from his Pedagogy of the oppressed) to the consumerist (see, for example, Clarke & Vidler, 2005) rhetoric of student empowerment, as mediated by some strands of managerialism in contemporary higher education. The paper grounds its critique of current models of dialogue, feedback loops, audit and other mechanisms of accountability (Power, 1997; Strathern, 2000), in a close analysis of how creative thinking emerges. The paper discusses the failure to maintain a dialogic space in humanities and social science areas in particular, exploring psychoanalytic conceptions from Donald Winnicott (1971), Milner (1979), Thomas Ogden (1986) and Csikszentmihalyi (1997). Coleridge’s ideas about imagination as the movement of thought between subjective and objective modes are discussed in terms of both intra- and inter-subjective relational modes of ’dialogue’, which are seen as subject to pathology in the pathologically structured psychosocial environment. Current patterns of institutional governance, by micromanaging dialogic spaces, curtail the ’natural’ rhythms and temporalities of imagination by giving an over-emphasis to the moment of outcome, at the expense of holding the necessary vagaries of process in the institutional ’mind’. On the contrary, as this paper argues, creative thinking lies in sporadic emergences at the conjunction of object/(ive) outcome and through (thought) processes