How has the idea of prevention been conceptualised and progressed in adult social care in England?

The authors would like to thank the Department of Health and Social Care Policy Research Programme for funding the research on which this article is based.Over recent years, a preventative approach has been promoted within adult social care policy and practice in England. However, progress has been somewhat inconsistent, in part due to issues around conceptualising what exactly prevention means within this context. Particularly since the financial crisis, there have emerged tensions between seeing prevention as a positive strategy to build assets and capability; as part of a neo-liberal project to roll back expectations for state support; or simply as a technocratic strategy to increase efficiency by deploying resources ‘upstream’ where they might have greater impact. This paper provides a critical perspective on how policy has unfolded over the last 15 years, which provides the context for an analysis of findings from a national survey of English local authorities and interviews with key stakeholders. These findings demonstrate a substantial commitment to preventative activity, but also some serious confusions and contradictions in how this agenda may be taken forward in the current policy environment.Publisher PDFPeer reviewe

The politics of the family and family therapy : a critical analysis of theory and practice

This thesis aims to develop a new theoretical framework by which to understand family organisation and the processes of family therapy from a political perspective - a framework that will highlight (changing) power relationships rather than assume some notion of functional order. In constructing and evaluating such a theoretical framework, I will draw upon the traditions of critical theory and qualitative research. My starting points are an overview of existing critical understandings of 'the family', and an examination of how 'power' itself may be theorised in a rigorous manner. I will review how such perspectives may expose specific relations of oppression or recognition that underpin particular forms of organisation, from the scale of the social formation as a whole to that of 'the individual'. Psychoanalysis and discourse theory have provided concepts whereby to deconstruct the dynamics of 'the individual' - in particular the concept of 'subjectivity' - which I will develop further so as to encompass participation, not just in discursive structures, but also in structures of emotional and material relations. In a critical appraisal of the various theoretical and practice traditions within family therapy, I will look at how the hegemony of systems theory has begun to be questioned and alternative metaphors for familial organisation proposed. However, as I will argue, none of these provide a satisfactory basis for understanding power relations in the family. I will therefore go on to apply a new conceptualisation of family organisation - that of 'subjectivity' - which is developed out of the theoretical traditions discussed earlier. I will theorise 'the family', not just as the context in which individual subjectivity may be constructed, but as an entity that may be seen to participate in the social formation as a subjectivity in its own right. Instead of understanding familial organisation as a natural outcome of self-regulating processes (as in systems theory), it may thus be seen to reflect the ways in which a family may have been constructed as a subjectivity in and by an oppressive social formation - its coherence only being maintained by a degree of internal violence and repression. Building on this, I will develop a theoretical framework by which to analyse, from a political perspective, the breakdown of family functioning and the specific ways in which the organisation of family life may be reconstructed through the processes of family therapy. Following on from this, I will test out the value of the theoretical framework in an analysis of three examples of family therapy practice. My source material is transcripts taken from videotapes of actual family sessions, and these are analysed in terms of the evidence they provide of minute-by-minute changes in power relations within family organisation (often in response to particular interventions by the therapist). Out of this in-depth study of a small number of case examples, my primary aim will be to assess the practical value of the various elements of the theoretical framework in exposing how familial power relations have been structured and how (and whether) they may be modified during the course of family therapy. In turn, this may enable me to reach some preliminary conclusions as to how specific family therapy interventions may affect family organisation in ways that are either oppressive or empowering

Conceptualizing the peer contribution in Open Dialogue practice

In English mental health services, people with their own experience of mental distress have trained as Open Dialogue practitioners and have been employed as peer practitioners, co-working as equals alongside workers with professional backgrounds in Network Meetings. The conceptual underpinnings of the peer practitioner role have been drawn from the principles and relational approach of Intentional Peer Support. These have significant similarities with Open Dialogue, in terms of philosophical and theoretical orientations, with a particular focus on what happens in the “between” of a relational encounter. However, there are also significant differences in how practice principles are conceptualized, particularly around areas such as mutuality and self-disclosure. This article offers an analysis of this conceptual territory drawing on the relevant literature. This is then taken forward with the teasing out of specific practice principles that capture the unique contribution that peer practitioners can bring to Open Dialogue practice. These are derived through discussions that took place in an Action Learning Set for peer practitioners who have been involved in delivering Open Dialogue services in mainstream mental health service settings. This was part of a wider research study entitled Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness (ODDESSI). The principles address how peer practitioners may be particularly well-placed to offer attunement, validation, connection and mutuality, and self-disclosure – and hence how they may be able to contribute an additional dimension to dialogical practice

Family-inclusive approaches to reablement in mental health:models, mechanisms and outcomes

This paper reports on a national study of ‘whole-family’ models of practice—and how these may (or may not) contribute to the reablement of people with mental health difficulties. Using a capabilities-based perspective, it is argued that, within the context of mental health, reablement may best be defined in terms of empowerment and social participation. Framed within a realist evaluation methodology, the study employs a comparative case study design to explore the relationships between contexts of intervention, mechanisms of change and the achievement (or otherwise) of reablement outcomes. Four distinct practice approaches in current use were examined: Systemic Family Therapy, Behavioural Family Therapy, Family Group Conferencing and an Integrated Systemic/Behavioural approach. Using a sample of twenty-two families, separate interviews were undertaken with service users, family members and practitioners, and narrative accounts were triangulated with scaled responses to scorecard questions. From an analysis of these data, heuristic models of change are derived for each approach. From this, a composite schema is developed that charts how, with different starting points and routes, engaging with whole families may lead to the construction of a secure and empowering base from which service users may reconnect with wider social worlds

Investing in a resilient generation: Keys to a mentally prosperous nation

Closing the mental health treatment gap is an impossible dream if we fail to stem the tide of people living with mental ill-health. While there remains an urgent need to significantly improve access to support and treatment, this alone is not sufficient. We must look ‘upstream’ and shift the focus towards maximising young people’s resilience and minimising the risks to their mental health. It is by closing the prevention gap that we can close the treatment gap too. As this report demonstrates, there is sufficient evidence to act now to begin the systematic shift of paradigm envisaged by the Commission. Such a decisive step would position the UK as a global leader in addressing the single largest global health challenge. To delay is to countenance avoidable harm. The costs of failing to marshal the necessary resources and implement large-scale programmes are huge. The time for small-scale pilots is over. It is time to change the paradigm and close the prevention ga

Joining Chain–Expressing and–Nonexpressing B Cell Populations in the Mouse

The diphtheria toxin A chain (DTA) was gene targeted into the Joining chain (J chain) locus to create a mouse strain selecting against J chain–expressing cells, JDTA mice. Serum immunoglobulin (Ig)M and serum IgG were reduced six to eightfold, while serum IgA was elevated 14-fold in these mice. JDTA mice were immune competent although the serum Ig response compared with wild-type mice was reduced sixfold at day 14 but only fourfold at day 45 after immunization. Exchanging the DTA gene with a cDNA for c-myc resulted in mice with a distinct phenotype with increased Ig production and enhanced humoral immune responses. Analysis of single B cells stimulated by lipopolysaccharide in vitro using reverse transcription–polymerase chain reaction showed that J chain–nonexpressing B cells could be detected that had a secretory phenotype as determined by an abundance of transcript for secretory IgM. Finally, limiting dilution analysis of peripheral B cells showed that J chain expression was a clonal property already established in naive, peripheral B lymphocytes