Why we need to ask questions about the birth control conditions attached to treatment for women who use drugs

First paragraph: Dundee, the city with the highest rate of drug deaths in Europe, is the first place in Scotland to deliver the Pause intervention to 20 women from some of the city’s poorest areas. The programme, which started in England, offers support to women who use drugs on the condition that they receive long-acting reversible contraception (LARC), including implants, injections and intrauterine devices – the pill is not an option. These LARCs are administered by healthcare professionals and don’t require – or allow – the woman to do anything.https://theconversation.com/why-we-need-to-ask-questions-about-the-birth-control-conditions-attached-to-treatment-for-women-who-use-drugs-13170

Family solidarity in the face of stress: responses to drug use problems in Greece

Background: In the past, Greek drug-affected families had predominantly been conceptualized as one of the main causes of drug problems. This study explored the ways drug-affected families respond to, and cope with, a relative’s drug problem by examining the perceptions of both Greek drug users and drug-affected families.  Method: A qualitative study comprised of semi-structured in-depth interviews was conducted in two state drug agencies in Thessaloniki, Greece. A total of 40 adult problem drug-using men and women and eight parents of problem drug users were asked to reflect on the ways families respond to, and cope with, drug use. The method of data analysis involved a manual systematic identification of themes in participant narratives in line with analytic induction principles.  Results: After discovery of the drug problem, all families were reported as coping with their adult children’s drug problems in ways consistent with the stress-strain-coping-support model. The emergent high engagement and low withdrawal coping exhibited by study participants can be contextualized by situating these strategies within the Greek cultural milieu and the notion of familism. While the data illustrate the importance of family solidarity in the face of addiction, caution is invited in making generalizations as sample selection may provide an alternative explanation for study findings.  Conclusion: The paper advocates for a non-pathological view of drug-affected families and highlights the importance of cultural context. The stress-strain-coping-support model helps to depathologise and better understand family reactions to problem drug use. Implications for non-stigmatizing and culturally relevant policy and practice are outlined

'Discursive struggles' between criminal justice sanctions and health interventions for people who use drugs: a qualitative exploration of diversion policy and practice in Scotland

Amidst growing recognition that people who use drugs are often vulnerable and in need of health-focused support, international conventions and national priorities on personal drug use are changing with emphasis shifting from criminal justice to health narratives. In Scotland, there has been a move toward health-led drug policymaking, and yet little is known about how diversion operates in this context. An exploratory qualitative study was conducted utilizing semi-structured interviews with professionals holding lead, strategic-level roles in Scottish diversion policy and practice (n = 15). Interview transcripts were thematically analyzed using a structured framework technique. Findings show that the term ‘diversion’ is used to refer to criminal justice-initiated drug treatment routes, both pre- and post-conviction. Unlike many international examples, Scottish diversions tend to embed health-focused support within criminal sanctions, rather than acting as alternatives. Participants expressed the view that the term diversion implied a shift from criminal justice sanctions to health-led support that did not occur in reality. We, therefore, argue that the term diversion may function to mute a ‘discursive struggle’ between criminal justice sanctions and health interventions for people who use drugs, obscuring a growing gap between aspirational governance principles and institutional and lived realities

Feathers and Thorns: the politics of participation in mental health services

A key development in mental health service planning and delivery in the UK over the last fifteen years has been the introduction of user participation. Alongside this development has been the growth and expansion of the service user/survivor movement. Research in Canada and Australia has documented the 'unsettling relations' created by these demands for participation and power sharing. Research in the UK has also raised questions about the ability of user participation to create the cultural change some believe is required to prevent services from being disempowering. Feathers and Thorns explores the 'unsettling relations' and the conflict and power dynamics of user participation in mental health services, in a UK context, to address the lack of systematic research in this area. The study uses qualitative methods to investigate user participation in two statutory mental health settings in England, between 1997 and 1999. Feathers and Thorns found that the uncritical adoption of the consumerist approach has led to a 'business as usual' model of participation and a consequent lack of discernible organisational and cultural change. The influence of user groups within statutory mental health services rarely extends to setting agendas, with the 'rules of the game' of participation still firmly controlled by statutory partners. There was evidence of professional and organisational resistance, as user participation destabilised the roles of both users and professionals and boundaries became increasingly blurred. It is suggested that this destabilising of traditional roles provides evidence of a shift in power relations, despite continued organisational and professional resilience to change. Although user participation was considered to be an effective strategy to legitimate existing power relationships and give the illusion of change: there was evidence that user groups and individuals have also gained from these processes, particularly in terms of raised consciousness, increased activism and self-assurance

Ethical pathways to informed consent when collecting information from children in research

Background: Informed consent is an ethical practice that should be guaranteed before a child is involved in a research. The position of the child in research has also become a subject of debate with regards to ethics. Though many countries may have unique provisions for conducting research with children, it is the goal of every regulatory mechanism to guarantee the autonomy, rights and protection of children in research.  Discussion: The form in which the information about a research is presented to a child can either weaken or strengthen the capacity of child to provide informed consent. The Medical Research Council suggests that many children would be competent to give consent if the information about the study is provided in an appropriate form and they are helped through the process of decision-making. It is ethically unacceptable to exclude children with cognitive challenges or learning disabilities from research based on their condition. Any research with children should be designed to integrate children with these forms of condition, except it is vital to exclude them. Even when the capacity of a child to provide informed consent is apparent, it is good ethical practice to involve the parents of the child in the decision making process especially for a research that carries any form of risk or discomfort. Notwithstanding this position, researchers always face challenges with obtaining active parental consent. Parental consent waiver is one of the options for dealing with the challenges associated with obtaining active parental consent. Most times parental waiver is a decision reached at recruitment points where a child with capacity to give informed consent insists that his or her parents should not be informed if he or she would participate in the research. Summary: It is now clear that researchers must seek to position a child as one who can make informed choices. These emerging perspectives should support the selection of design, methodology and intervention for children with a goal to strengthen their capacity and autonomy to give informed consent

Coronavirus: why managed alcohol programmes are essential for problem drinkers who are homeless

People who are homeless are being particularly affected by the coronavirus pandemic. Common health problems such as respiratory disease put people who are homeless at more risk and self-isolation is impossible if you are living on the streets or in temporary accommodation. Those dependent on alcohol are at even greater risk as they need to continue using to prevent withdrawal, which can lead to serious health problems and sometimes death. But lockdown and self-isolation are challenging if you need to get a hold of alcohol.https://theconversation.com/coronavirus-why-managed-alcohol-programmes-are-essential-for-problem-drinkers-who-are-homeless-13665

Scotland’s drug death crisis needs a radical harm reduction response – now

First paragraph: The newly published figures of annual drug-related deaths (DRD) in Scotland are appalling. The National Records of Scotland figure of 867 represents the highest annual total recorded – a 23% increase on the previous year, and a 100% increase since 421 Scottish DRDs were reported in 2006

Greenspace interventions for mental health in clinical and non-clinical populations: What works, for whom, and in what circumstances?

With growing strain on mental health services, greenspace interventions could be a promising addition to current health and social care provisions as they have the potential to be widely accessible for people within their own communities and used alongside a variety of treatment plans. Despite promising progress in greenspace research, the underlying mechanisms and processes of greenspace interventions are still unclear. Without knowing these it is impossible to understand why programmes work and how best to replicate them. To address this gap this review uses realist methodology to synthesise the international evidence for greenspace interventions for mental health in both clinical and non-clinical populations. Forty-nine full text articles are included in the review and the underlying contexts, mechanisms, and outcomes of the interventions identified and refined into an original overriding theory under three themes of Nature, Individual Self, and Social Self. The interaction of these three factors represents a new conceptual framework for greenspace interventions for mental health and shows what works, for whom, and in what circumstances. The findings of this review are not only theoretically novel but they also have practical relevance for those designing such interventions including the provision of recommendations on how to optimise, tailor and implement existing interventions

Feasibility and acceptability of Managed Alcohol Programmes for people who are homeless with severe alcohol problems

In Scotland, rates of alcohol use and alcohol-related harm are high, with more than 1100 deaths attributable to alcohol in 2018. People who are experiencing homelessness are at a particularly high risk of alcohol use and associated harms, including experience of extreme social inequalities. Managed Alcohol Programmes (MAPs) are a harm reduction approach specifically for people experiencing homelessness, providing alcohol in measured, regular doses throughout the day, as well as a range of other supports including health and housing. This briefing paper summarise a study which aimed to scope the feasibility and acceptability of MAPs in Scotland

Military veterans with mental health problems: a protocol for a systematic review to identify whether they have an additional risk of contact with criminal justice systems compared with other veterans groups

BACKGROUND: There is concern that some veterans of armed forces, in particular those with mental health, drug or alcohol problems, experience difficulty returning to a civilian way of life and may subsequently come into contact with criminal justice services and imprisonment. The aim of this review is to examine whether military veterans with mental health problems, including substance use, have an additional risk of contact with criminal justice systems when compared with veterans who do not have such problems. The review will also seek to identify veterans' views and experiences on their contact with criminal justice services, what contributed to or influenced their contact and whether there are any differences, including international and temporal, in incidence, contact type, veteran type, their presenting health needs and reported experiences. METHODS/DESIGN: In this review we will adopt a methodological model similar to that previously used by other researchers when reviewing intervention studies. The model, which we will use as a framework for conducting a review of observational and qualitative studies, consists of two parallel synthesis stages within the review process; one for quantitative research and the other for qualitative research. The third stage involves a cross study synthesis, enabling a deeper understanding of the results of the quantitative synthesis. A range of electronic databases, including MEDLINE, PsychINFO, CINAHL, will be systematically searched, from 1939 to present day, using a broad range of search terms that cover four key concepts: mental health, military veterans, substance misuse, and criminal justice. Studies will be screened against topic specific inclusion/exclusion criteria and then against a smaller subset of design specific inclusion/exclusion criteria. Data will be extracted for those studies that meet the inclusion criteria, and all eligible studies will be critically appraised. Included studies, both quantitative and qualitative, will then undergo stage-specific analysis and synthesis. The final stage will combine the findings of both syntheses to enable new understandings of why, how, and by how much, military veterans with mental health problems, including problematic drug and alcohol use, come into contact with the criminal justice system