'Mad, bad and dangerous to know': exploring the everyday spaces of older, mental health service users

The area of mental health distress is one that crosses many disciplines including; psychiatry, critical psychiatry, psychology, critical psychology, history, politics, economics, philosophy, sociology, culture and human geographies (Thrift, 2006). Consequently, there are a complex set of issues to consider when discussing the experiences of being a mental health service user. Notwithstanding this diversity, such representations of mental health have a tendency to position service users as a fairly homogenous and static group of bodies – in other words, they are the stable ‘other’ (Conradson, 2005; Parr, 2000). As a way of exploring the complexity, this thesis sets out to explore the multiplex constituents and heterogeneous ways in which daily service user life is played out within everyday mental health spatial contexts. These spaces incorporate the psychiatric institution, the mental health day centre and the home. Using interviews, ethnography, poetry and visual ethnographies, service users’ experiences are analysed by exploring the relational aspects of the discursive and the non-discursive, such as receiving a diagnostic label and subsequent treatments and the ways in which these practices permeate the embodied and spatial experiences of every day service user life. This corpus of research data suggests that rather than the experiences of mental health distress operating as a stratified set of factors awaiting analysis, there were divergent accounts incorporating positivity, negativity and ambivalence in the ways which service users made meanings of their daily lives (Brown & Tucker, 2010). Consequently, this thesis is framed around the ontological realms of creativity, potentiality and of becoming within and through space (Deleuze & Guattari, 2004; Massumi, 2002). Finally, some implications of the current political changes and how these may impact upon daily service user life are discussed to highlight that mental health service users’ are always on the move

The online multi-agency support barometer

This report presents the findings of a small feasibility study which sought to investigate the use of an online risk management Barometer. The barometer was developed with a view to helping multiple agencies communicate about vulnerable and 'at risk' patients within mental health settings.The Barometer is an online tool which allows staff from multiple agencies to access and share information with other staff if a patient is at risk.The key aims and objectives of this small research project were i) to evaluating how professionals felt about their current risk assessment tools, ii) to assess the ease of use and the relevance of questions within the Barometer tool and iii) to discuss some potential modifications/problem areas of incorporating the Barometer tool within mental health services and across a multi-disciplinary perspective.The research was conducted in three mental services within the South Essex Partnership Trust (2 x CAMHS and 2 x Adult Services) using a mixed-methods approach

“It’s like shrooms times a million, plus aliens”: an interpretative phenomenological analysis of experiential accounts from recreational Ayahuasca users

DMT the ‘spirit molecule’, is one of the active ingredients in the botanical brew ‘Ayahuasca’. Shanon’s (2002) cartography of Ayahuasca reports of users entering a ‘fourth-dimensional realm’ characterised as enchanted and magical. Users also commonly report increased empathy towards other humans. We are beginning to see Ayahuasca communities set up across Europe where the plant medicine is not only used for religious purposes but or ‘recreation’ too (Prayag, Mura, Hall & Fontaine, 2015). Although there is emerging research on the use of Ayahuasca in western civilisation, the literature is scarce and imbued with epistemological shortfalls (Tupper, 2009). In particular, there is minimal consensus on the social aspects of taking Ayahuasca, particularly within the social sciences. Society has neatly constructed people who take psychedelics as having particular characteristics such as ‘deviance’, ‘loss of control’ and being ‘socially and psychologically unstable’ (Johansen & Krebs, 2015). These kinds of negative social positions have conjured up a ‘moral panic’ around the use of psychedelics. With limited data surrounding recreational usage of Ayahuasca in private settings, there is a growing need to understand the social consequences of these activities. We argue that the ingestion of Ayahuasca (whether taken alone or within a group setting) is far more complex and multi-layered than dominant frameworks would suggest. Drawing from the premise of Process Philosophy, this research paper will explore the multiplicity and fluctuation of people who ingest Ayahuasca; to provide a more factual narrative of recreational Ayahuasca users in Britain. We aim to explore identities around ‘anti-establishment’ group identities and the ‘spiritual and/or psychedelic’ identity

Topology and mental distress: Self-care in the life spaces of home

This article develops a topological approach derived from Kurt Lewin to analyse the psychological life space/s produced in a mental health service user’s home. Drawing on arguments that space plays an important part in the organisation and management of mental distress, photographs of a service user’s home are analysed as topological spaces. The article argues that topological theory can contribute to community health psychology through framing psychological distress as spatially distributed, meaning individual bodies, environments and action are conceptualised as equally contributing to the organisation and management of health-related experience and activity

BARRIERS AND ENABLERS RELATED TO THE IMPLEMENTATION OF THE NURSING PROCESS AMONG NURSES IN TWO PRIVATE HOSPITALS IN THE CAPE METROPOLE AREA

Nursing and Midwifer

Secondary use of data recorded in primary care: insights from human computer interaction field studies

Introduction: Electronic health records from primary care, are now aggregated in a number of large datasets from primary care settings, containing both coded data and free-text. Secondary users can easily undertake analyses using coded data. However although the balance of information between these codes and free text is variable, they rarely use the information contained in doctors’ free-text notes - because of their ‘messy’ nature and the costs of ensuring anonymity. Our epidemiological studies within the Patient Records Enhancement Project has demonstrated that free text contains important information, that is often ignored. Method: Human computer interaction (HCI) studies, using qualitative approaches, can help us understand the reasons for variability in the balance of coded and free text data. We undertook field studies in six GP surgeries which included observations of record use across the surgery, video analysis of real patient consultations and interviews with a range of surgery staff. We also undertook ‘simulated’ consultations, with two medical actors playing the part of the patient, allowing us to standarise the patient across doctors and software systems. Results: Preliminary results suggest several reasons for variation in data recording. Doctors create notes in order to best manage patients with little consideration for use by others, and reported limited awareness of secondary uses of the information. Doctors often record and “read” a picture painted by the overall record of a consultation or record symptoms and signs in free text notes, and choose not to code a definite diagnosis. If coding, they often choose a more general non specific code, even when they have inferred and acted on a clear diagnosis. These approaches reflect processes of progressing from differential to definite diagnosis, and the surgery’s administrative and consultation processes. Conclusion: Our findings may explain apparent delays in diagnosis often observed in epidemiological analyses. The picture portrayed within records may not be at all clear to researchers relying on coded data. Our results have implications for secondary users of data and assessment of data for quality of care. Follow on work might result in typologies of diseases liable to coded data deficits and support software development

Recovering fraudulent claims for Australian federal expenditure on pharmaceuticals and medical devices

The Australian Federal Government expends increasingly large amounts of money on pharmaceuticals and medical devices. It is likely, given government experience in other jurisdictions, that a significant proportion of this expenditure is paid as a result of fraudulent claims presented by corporations. In the United States, legislation such as the False Claims Act 1986 (US), the Fraud Enforcement and Recovery Act 2009 (US), the Stark (Physician Self-Referral) Statute 1995 (US), the Anti-Kickback Statute 1972 (US), the Food, Drug and Cosmetic Act 1938 (US), the Social Security Act 1965 (US), and the Patient Protection and Affordable Care Act 2010 (US) has created systematic processes allowing the United States Federal Government to recover billions of dollars in fraudulently made claims in the health and procurement areas. The crucial component involves the creation of financial incentives for information about fraud to be revealed from within the corporate sector to the appropriate state officials. This article explores the opportunities for creating a similar system in Australia in the health care setting