A comparative examination of policy and models of disability in Korea and the UK

Over the last three decades, the understanding of disability has changed substantially, changes in theoretical debates and policy on disability now encourage society to understand and treat disabled people as ordinary citizens. However, arguably the dominance of Western theory on disability has resulted in the marginalisation of disabled people’s experiences in non Western cultures. This paper compares disability in relation to the culture of South Korea and the UK, by attempting to articulate some of the implicit values of disability and development of the relevant disability polic

Mental distress and 'self-stigma' in the context of support provision: exploring attributions of self-stigma as sanism

Purpose – The purpose of this paper is to discuss the findings from a detailed qualitative PhD study exploring experiences of stigma and discrimination in the lives of people in receipt of “mental health support” at two voluntary sector organisations in the North East of England. Design/methodology/approach – Empirical material was collected during two periods of three-month long ethnographic periods of fieldwork from July to December of 2013 at two organisations providing support to their members who experience or have experienced mental distress. Along with field notes taken during and after periods of participant observation, the empirical material also included 30 interviews with staff (n ¼ 10) and members (n ¼ 20) across both organisations, along with a series of three focus groups at each organisation. Findings – Staff at the organisations did not demonstrate obvious stigmatising or discriminatory attitudes or behaviours. However, they did attribute “self-stigma” to particular attitudes and behaviours of some of the members they support, referring to how they “made excuses”, “did not try” and/or “avoided situations”. Originality/value – This paper argues that these attributions resulted from the misrecognition of members’ reactions to experiences of discrimination. The empirical material also suggests that these attributions of self-stigma may be indicative of the material limitations of the support environment, the consequent frustrations of well-intentioned staff, and, overall, as symptoms of neoliberalism. Drawing upon a Mad Studies approach and focussing on self-stigma and its attribution in contemporary mental health support, this paper provides a new perspective, which considers how stigma is linked to discrimination by rethinking what is thought of as “self-stigma”

Power and disabled people: A comparative case study of three community care services in London.

The main research question addressed is how the perceptions and experiences of people with disabilities around what is termed 'quality of life' are enhanced or modified by differing service delivery systems. This approach is based on the assumption that people with disabilities have unique knowledge about services, providing a core understanding of the power around decision making and its effects on their lives. The perspectives and methodology used are underlined by concepts of user autonomy, social control, independence, interdependence, advocacy, respect and citizenship. The case study methodology provides an in-depth focus on both 'positive' and 'negative' ethics in social science. The research area was examined within a multi-professional framework and aimed at a triangulation of perspectives from participant observation, user and professional interviews, tailored vignettes and organisational documentation from services formally designed to empower their users following the latest government policy. The research, following the principles of grounded theory, examined to what extent care management and advocacy, residential support and service brokerage and a more traditional day centre system were achieving these primary aims. The qualitative data generated by the research gives rise to a socio-organisational power analysis of 'service forums'. The service forums are constructed from 'service postures' and 'service cultures'. Service posture refers to the set of formal values and beliefs owned by an organisation. The service posture for the residential consortium is summarised as 'normality', the day centre's as 'respect' and the care management organisation's as 'advocacy'. The organisations' service cultures are the unofficial presentation of the service, shown to come from the service posture, either being complementary, its antitheses, or quite separate. It is clear that the behaviour of the workers and the structure of the three organisations studied have both distinct and profound effects on their users' senses and experiences of power. The conclusion explores the elements of disability, choice and decision making which make up the socio-organisational power structures with respect to each organisation. Finally ways in which a participatory service delivery system could be constructed are considered in the context of training, policy and organisational structure

The Development of a Prison Mental Health Unit in England: Understanding Realist Context(s).

A pragmatic solution for the provision of care for prisoners with serious mental illness, who are often subject to delays in hospital transfer, is the creation of specialist prison units. This paper analyses the development of a prison unit in England for prisoners with ‘serious mental illness’. The unit was developed within over-lapping health and justice contexts, including expectations, pressures and priorities, which impacted on the outcomes expected and achieved. The methodology included attendance at Steering group meetings, analysis of a minimum dataset, and interviews with key stakeholders. A number of key sites of contestation are analyzed including: admission criteria; aims; activities; staffing; the physical environment; and discharge

Responsibility as professional leadership and decision making: Interviews with non-medical Responsible Clinicians

Background Responsible Clinicians are professionals who are primarily accountable for the care and treatment of patients detained under the Mental Health Act, 1983 in England and Wales. The role has only been taken up by under 100 nurses and psychologists since 2007. The aim of this study was to explore the experiences of non-medical Responsible Clinicians, to inform our understanding of interprofessional dynamics and professional identity in contemporary mental healthcare. Methods A qualitative study comprising thematic analysis of interviews with twelve non-medical Responsible Clinicians. Results A major theme of ‘Interpretations of responsibility’ emerged, with two sub themes: ‘Responsibility as leadership ‘and ‘Responsibility as decision making’. Taking on the role had implications beyond the care of specific patients. Participants saw themselves as having the power to shape their team and service whilst exercising their authority to make difficult decisions about risk and restrictions. Conclusions More widespread adoption of the non-medical Responsible Clinician role should not be seen solely as a solution to workforce shortages or lack of opportunities for professional advancement. Consultant nurses and psychologists who take on this role are seising the opportunity to steer service developments more widely, influencing team dynamics and perceptions of accountability

Making space for mental health care within the penal estate

In this paper we explore the enfolding spatialities of control and care within the penal estate through analysis of the creation of a unit for prisoners with serious mental illnesses (SMIs). Prisons have increasingly become the key institutions for mental health care provision, yet serious mental illness disrupts the self-government upon which contemporary prison regimes are based. Our analysis highlights the ‘trouble’ institutions face in making space for mental health care; in trying to fit different control-care regimes into existing carceral environments. We argue that the different actors that have made space for this control-care have been open to potentiality. Developments have been experimental, emergent and incomplete; often not officially challenging wider institutional processes, but eluding them. What emerges is an institution within an institution with a certain level of spatial autonomy but constrained in its transformative potential

The introduction and development of a mental health integrated support unit within an English Prison: clinical, care staff and Operational Officer perspectives

Purpose: There is clear evidence that prison can be detrimental to mental health and that wider society has tended to assume ‘out of sight, out of mind’ for prisoners in mental distress. The lack of access to effective mental health care in prisons along with increasingly lower numbers of prison officers, or Operational Officers (OO) has created a negative culture that requires the development of specialist services. With this comes a need to conduct evaluations, and investigations, into the roles of Operational Officers and mental healthcare staff. This work reports on a commissioned evaluation around the introduction and development of a HMP Mental Health Unit, named the Integrated Support Unit (ISU), in the North of England. Our section of the wider evaluation focuses on the early team building, working practice and development of mental health registered nurses, other care staff and Operational Officers within the ISU. Design/methodology/approach: Three focus groups incorporating two professional groups took place on the Integrated Support Unit (ISU). The first of six Mental Health Workers (MHW) including Registered Mental Health Nurses and support workers; the second of two sets of two ISU dedicated Operational Officers (OO). The areas addressed within each of the groups concerned why staff wanted to work in the ISU, as well as how they would measure its potential success, and the necessary skills competencies and training they thought were required to prepare them to work in the area. Findings: Overall, the participants expressed an interest or enthusiasm for their work having actively chosen to work in the ISU. There was a strong sense of a wish for the unit to succeed; in fact, success was a motivating drive for all. Both Operational Officers and mental health workers emphasised the importance of teamworking, autonomy and freedom as well as information sharing. Analysis also revealed many areas of practice which were challenging. The findings are optimistic for the development of such special units as evaluated here. The drivers for different professions along with their measures of success in the field are discussed in detail. The relationship, expectations, hopes and needs of both mental health workers and prison officers working in a multidisciplinary unit provide useful information to support both policy and practice in the field. We make recommendations around training regimes and how they can effectively coordinate the different symbiotic professional roles. The integrated Support Unit is a new initiative in offender management within prisons and is reviewed as a model of mental health practice in prison settings. Practical implications: • The value in recruiting to the ISU dedicated OOs, with committed interests in mental health. • A continued emphasis on the ongoing development of team working, focusing on issues of risk, trust, and treatment. • The development (by nurses) of a formal/mandatory period of training for new OO’s prior to taking up a role on the ISU. • For mental health nurses to embrace team leadership/educator roles in the areas of mental health awareness, team building and conflict resolution. • To capture and formulate and develop the specific range of mental health interventions offered within the ISU. Originality/value: • The presented research explores and evaluates the introduction of a new mental health wing (ISU) for 11 patients in a northern UK prison. • It does this through the consideration of group discussions with both mental health workers and operational officers on this wing. • This work is part of a larger study

Use of a targeted, computer/web-based guided self-help psychoeducation toolkit for distressing hallucinations (MUSE) in people with an at-risk mental state for psychosis: protocol for a randomised controlled feasibility trial

Individuals who access at-risk mental state (ARMS) services often have unusual sensory experiences and levels of distress that lead them to seek help. The Managing Unusual Sensory Experiences (MUSE) treatment is a brief symptom targeted intervention that draws on psychological explanations to help account for unusual experiences. Practitioners use formulation and behavioural experiments to support individuals to make sense of their experiences and enhance coping strategies. The primary objective of this feasibility trial is to resolve key uncertainties before a definitive trial and inform parameters of a future fully powered trial

Efficacy and Safety of Admilparant, an LPA₁ Antagonist, in Pulmonary Fibrosis A Phase 2 Randomized Clinical Trial

Rationale: Idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) have high morbidity and mortality; thus, novel treatments are needed. Objectives: Assess efficacy and safety of admilparant (BMS-986278), an oral lysophosphatidic acid receptor 1 antagonist, in patients with IPF and PPF. Methods: This phase 2, randomized, double-blind, placebo-controlled trial included parallel cohorts of patients with IPF (n = 278 randomized, n = 276 treated) or PPF (n = 125 randomized, n = 123 treated) who received 30 mg of admilparant, 60 mg of admilparant, or placebo (1:1:1) twice daily for 26 weeks. Background antifibrotics (both cohorts) and immunosuppressants (PPF only) were permitted. Measurements and Main Results: Rates of change in percentage of predicted FVC over 26 weeks for IPF were 22.7% (placebo), 22.8% (30 mg), and 21.2% (60 mg) and for PPF were 24.3% (placebo), 22.9% (30 mg), and 21.1% (60 mg). Treatment differences between 60-mg admilparant and placebo were 1.4% (95% confidence interval, 20.1 to 3.0) for IPF and 3.2% (95% confidence interval, 0.7 to 5.7) for PPF. Treatment effect was observed with or without background antifibrotics in both cohorts. Diarrhea occurred at similar frequencies in admilparant arms versus placebo. Transient Day 1 postdose blood pressure reductions were observed in all arms in both cohorts but were greater with admilparant. Treatment discontinuations because of adverse events were similar across IPF arms and lower with admilparant (2.5% [30 mg]; 0% [60 mg]) versus placebo (17.1%) for PPF. Conclusions: In this first phase 2 study to evaluate antifibrotic treatment in parallel IPF and PPF cohorts, 60-mg admilparant slowed lung function decline and was safe and well tolerated, supporting further evaluation in phase 3 trials. Clinical trial registered with clinicaltrials.gov identifier (NCT04308681).</p