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This concluding paper draws together the dominant themes across the papers published in this issue. The majority of the papers clearly point to disparities between the aims of policy-makers and mental health workers. Using a variety of perspectives and methods, the authors of these insightful papers argue that modernist, rational approaches to structuring and evaluating services are at odds with the professional needs of mental health workers. At one level this critique is self-evident given the messiness and uncertainties inherent in working with service users whose individual problems require flexible approaches tailored from a broad and evolving practice-base. For some authors, the focus is epistemological and methodological; they offer much needed examples of analysing policy construction, interpreting statistics and the concurrent application of the widely used concepts of medicalisation and structural inequality. Together, the papers indicate that the progress of mental health reform in many western countries remains inconsistent and, in some cases, obstructive to effective professional practice. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore how the avoidance of death preoccupies the focus of most health professionals, including policy makers, in the western world, and the implications of this for the lives of people with chronic diseases. Avoiding death has become the ultimate challenge in the provision of contemporary healthcare. An implication of this way of thinking for people with chronic diseases is that their chronic disease is then positioned as something which will produce a death which could have been avoided. Such a death is then viewed as failure, not only biological, but also social. However, such failure is also position [ABSTRACT FROM AUTHOR]

Our aim is to examine a series of systems-level challenges to the continuity of care of a newborn (i.e. a particular case) in the rural–urban context. These challenges include the state-wide system whereby inadequate bed numbers relative to demand are monitored on a daily basis (bed management), specialist medical expertise as a resource, and the flow of information between hospitals in a rural–urban divide. Whether quality of care is maintained in light of these challenges is dependent on the relationships and ‘invisible’ work of a number of clinicians. Of critical importance are issues involving affective or invisible work and the solidary networks and relationships of clinicians. Ethnographic participant-observations were made of clinical teams and their networks in an Australian rural–urban health care service involving the multiple hospital admissions of a seriously-ill infant. The findings demonstrate that the system works because of clinicians' willingness to enact their practice knowledge, the networking they undertake, their resilience and the affective labour they perform to attend to patients' and families' needs. Ultimately the continuity of care is embedded in the quality of relationships as much as in specialist knowledge or professional expertise. [ABSTRACT FROM AUTHOR]

Many countries, including Australia, are currently experiencing severe shortages of professional, para-professional, and semi-professional workers in their health care systems. This is generally conceived as a problem stemming from rising demand in health care services or the production of inadequate numbers of health related graduates. A qualitative study of health care workers in the Australian context challenges the adequacy of this supply-demand approach to the health care system; and demonstrates that solutions lie in the conceptualisation of the health sector as a socio-cultural system. Findings indicate the extent to which policies independently formulated for the health, education, finance, and industry sectors have, in combination, inadvertently impacted on the functioning of the health care system, and some policy mechanisms, such as privatisation and marketisation, have fundamentally eroded its structural framework. Conclusions can therefore be drawn about the relationship between workforce shortages and the neo-liberal orientation of recent governments. [ABSTRACT FROM AUTHOR]