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Mental health services are increasingly employing peer workers (PWs), individuals who have lived experiences with mental health problems, to support patients and be part of mental health care teams. While the employment of PWs continues to increase, little is known about how the function unfolds in practice. This paper explores the broader context in which the PWs navigate and the concrete outcomes and everyday issues that exist at the individual level. Methodologically, the paper draws on 22 interviews with PWs employed in the mental health services in Denmark. Theoretically, it combines Lipsky's (1980) theory on street-level bureaucrats with sociological discussions concerning the lay-expert divide. The analysis shows that PWs experience both role ambiguity and goal uncertainty and that they use substantial discretion in determining the nature, amount and quality of their peer practices. This – combined with the PWs' diverse lived experiences – calls for a heterogeneous understanding of peer work and therefore the analysis presents three categories of peer workers: PWs as (1) a representative of patients' lifeworld, (2) an interdisciplinary professional and (3) an 'expert by experience'. These categories display PWs different enactments of their lived experiences and reveal ambiguities tied to the lay-expert divide. [ABSTRACT FROM AUTHOR]

The concept of placebo has had a long history in medicine, and has evolved over time with the introduction of randomised controlled trials for testing health treatment, the increasing research done around the psychotherapies, the development of complementary and alternative medicine approaches to health, as well as the conceptual contributions from academic disciplines like psychology and anthropology. In recent years, discourses about placebo have pursued a number of key directions, and the current review paper explores these developments. For example, psychology has looked at placebo in terms of classical conditioning and the role of anxiety. Anthropology on the other hand has focused on the role of meaning and ritual in the placebo effect and psychotherapy research has encouraged an examination of the effects of the therapeutic relationship. Our review paper concludes by outlining directions ahead for future scholarship and research. [ABSTRACT FROM AUTHOR]

Objectives: This paper examines social inequality in children's health following the election of Evo Morales. Bolivia is marked by dramatic socioeconomic, ethnic and geographic inequality in children's health. The Morales government initiated several public health reforms designed to provide more equal access to public health services. Methods: Analysis was conducted using Bolivia Demographic and Health Survey data from 2003 to 2008. Results: The analysis shows some improvements in children's health. However, inequality in access to doctors, child mortality and child nutritional status did not diminish. In contrast, inequalities in immunization declined dramatically. Conclusions: Results suggest that aspects of health that are easier to implement such as immunization are more accessible to public policy than are more complex health problems like malnutrition and high child mortality. [ABSTRACT FROM AUTHOR]

New medicines represent exciting possibilities to individual patients for improved futures through reduced morbidity, as well as the potential for disappointment where promised outcomes are not forthcoming. For healthcare systems these technologies can enable enhanced effectiveness as well as spiralling costs, depending on value-for-money offered. Amidst uncertainty over efficacy and pricing, institutions such as the National Institute for Health and Clinical Excellence have been set up to regulate the cost-effectiveness of new products. The increased transparency of this new regulation, combined with inescapable uncertainties, leads to the heightened politicisation of decision-making and an insidious subjectivity beneath a veneer of rational-bureaucracy. This paper develops a theoretical framework for understanding the influence of hope within such contexts. Conceptualised here as ideological, affective and prone to lapsing into trust, hope is considered to shape the lifeworld-background of regulatory decisions and mask uncertainty around effectiveness. These processes challenge regulator legitimacy and effectiveness within polycentric regimes, through the distortion of communication and the manipulation of blame. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study of UK mental health practitioners' experiences of working with the contested condition, dangerous and severe personality disorder (DSPD). Our interviews focused on the issues of treatability, risk assessment and decision-making in multi-disciplinary teams. We discuss the approach of values-based medicine (VBM) as a useful framework for interpreting the data: respondents cited both explicit values (based on occupational training) and implicit values (based on personal beliefs and subjective perceptions). There was evidence of conflicting values -- within individuals, between occupational groups, and between individuals in occupational groups -- which led to widespread uncertainty and caution about whether and how those with 'dangerous' personality disorders could be treated. These disputes were resolved by a 'slide to pragmatism', whereby practitioners, reluctantly acknowledging their own empowerment in the process, sought to make whichever choice was least risky for their own professional reputation, and most pragmatic, given the resources available. [ABSTRACT FROM AUTHOR]

This manuscript outlines the multiple methods utilized in a long-term follow-up of a non-traditional population: Homeless substance abusers in New Orleans. This article addresses qualitative mental health research by outlining steps taken to explore both qualitative and quantitative data sources. By way of qualitative and quantitative methods, this research examines the life course of a sample of New Orleans homeless substance abusers from the time they entered into treatment (1991) until the present and observes the quality of their social bonds and their long-term outcomes. By making use of mixed methods, this research gives a more thorough understanding of mental health, specifically examined through homelessness and substance abuse. [ABSTRACT FROM AUTHOR]

Book prescription schemes and healthy reading schemes are public mental health initiatives that are inspired by the bibliotherapeutic principle of 'the guided use of reading, always with a therapeutic outcome in mind' (Katz & Watz, 1992). These initiatives were originally developed in the UK as an example of care in the community for the treatment of mild to moderate mental health problems. This involves the creation of a collection of self-help books in a local library which members of the public can access free of charge to help with their recovery from mental illness. Ireland's first Book Prescription Scheme was established in Dublin City in 2007. This article presents a critical assessment of the contribution that these reading schemes offer the treatment of mental illness in Ireland. While advocates commend this new service, a critical discourse analysis of Irish self-help reading schemes reveals that offering guided reading for the treatment of mental illness provides an individualistic and neo-liberal construction of mental illness and well-being. [ABSTRACT FROM AUTHOR]

Recent years have seen an international move towards home treatment of acute mental health difficulties. This has been based upon trial data which do little to develop understanding of how or why this approach is as effective as it seems to be. In order to explore this question the study interviewed patients who had recently used the services of a crisis resolution home treatment (CRHT) team in the English East Midlands. Triangulated parallel qualitative analyses of 33 semi-structured interviews conducted by service users trained in research techniques demonstrated that successful CRHT reflected practitioners' ability to provide clients with a sense of feeling safe, accepted and understood. Unhelpful outcomes followed when participants did not experience such unconditionally supportive relationships. These findings further endorse the primacy of relational factors in mental health practice. They are discussed in relation to the Dodo Bird verdict upon psychological therapies and systemic difficulties acknowledging an inconvenient truth. [ABSTRACT FROM AUTHOR]

Cognitive-behaviour therapy (CBT) has been a central plank in the mental health policies of many Anglophone countries in recent years. This emphasis reflects the triumph of modern rationalism in two senses. First, the appeal of CBT to policy makers rests largely on its claims of being evidenced-based and quickly effective. Second, it is committed to a view of eudemonia (the good life) in which rationality predominates over non-rationality to generate the greatest happiness for the greatest number. Both aspects, which appeal to policy makers, warrant sociological interrogation. This article provides a brief history of CBT to highlight the rhetoric of rationalism it has espoused successfully. Then, using the UK Depression Report as a point of departure, it compares this success of CBT with the criticisms it has encountered. Both positions of advocacy and critique are examined in relation to disciplinary knowledge and professional interest work. These orientations from poststructuralist accounts of the modern episteme, on the one hand, and neo-Weberian sociology of the professions, on the other, help us understand the current controversy surrounding CBT. [ABSTRACT FROM AUTHOR]