Search

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]

Genital fashioning practices, such as Brazilian waxing and female genital cosmetic surgery, have become increasingly prevalent within contemporary western societies. This paper explores the role of genital fashioning in the construction of contemporary femininity. It uses in-depth interviews and focus groups with Australian women aged 18–30 to investigate female genitalia as a site of alteration. Drawing on broader understandings of the body as socially mediated, this paper contends that multiple modification practices are employed to produce genital appearance. It departs from previous investigations which consider genital fashioning practices in isolation. In identifying the scope of genital fashioning, this research reveals a continuum of genital fashioning practices, both physically and discursively mobilised by women to negotiate their identity, sexuality, and femininity. [ABSTRACT FROM AUTHOR]

The advent of post-industrialism in western societies saw social theorists pay greater attention to the blurring of traditional work and life conceptual categories and the growing role of service professions. Further, much of the theorisation around the human service professions has focussed on occupational stress and professional burnout. This focus on the challenges to worker health has limited considerations of how human service professionals can thrive, and not just survive, in demanding employment contexts. In response, the paper considers the 'lifeworld' as a conceptual resource that can encourage new ways of thinking about the work of human service professionals, as well as reworks this resource using the concept of affect to expand consideration of the interconnected, inter-subjective, bodily and emotive nature of human service work. The paper concludes by presenting a heuristic tool that can make these concepts more accessible to professional discourses and can facilitate their use within collaborative research with the human service professions. [ABSTRACT FROM AUTHOR]

This paper explores the intersection of gender and class concerning welfare clients with medically unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper's focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists of individuals that are defined by their lack of a bio-medical diagnosis. Their 'lack' of identity accentuates how gender and class become central in the categorisation practices, constructing the ill person as either bio-medically sick or as a person who may be suffering but only from diffuse psychological problems. The paper shows that it is predominantly poorly educated women without a bio-medical diagnosis that welfare officers describe as suffering from psychological problems despite the fact that the women themselves focus on physical ailments in their illness stories. Men and better-educated women are described by the welfare officers as tired and exhausted or truly stressed after a long working life. [ABSTRACT FROM AUTHOR]

Health promotion, as one tool of hospital managers to reorient hospitals towards more client-oriented healthcare services, has been emphasized for almost three decades. Yet, it is recognized that change in hospitals is challenging and is more desired than substantially enacted. To overcome organizational challenges, health promotion has, so far, adapted organizational change strategies primarily applied in business organizations. However, in this paper, it is argued that such strategies do not adequately reflect the nature of hospitals as 'professional organizations'. To gain a better understanding of the challenges for health promotion reorientation, this paper combines well-established theories from the sociology of professions and organizational science. These theories provide a useful framework that advances the role of professionals as powerful agents within any reorientation efforts in hospitals. This framework guided the narrative review of empirical literature on critical dimensions along which professionals engage with reorientation efforts in hospitals. Accordingly, specific managerial strategies to facilitate health promotion reorientation are formulated. With its theoretical underpinnings and related empirical studies, the paper offers a new perspective on the challenges of implementing health promotion and proposes strategies that may help hospital managers to push forward health promotion reorientation in their organizations. [ABSTRACT FROM AUTHOR]

Once exceptional, a long life is now an everyday expectation for many citizens of the prosperous nations. The consequence of this transformation in life expectancy however has led to a set of contradictory responses, representing threats as much as opportunities. Old age is no longer a stable coherent part of the life course; its future is fragmented by the competing narratives of the third age (opportunity) and the fourth age (threat). While there is a tendency to frame this distinction primarily through the lens of socio-demography and/or 'stages of life,' this paper proposes an alternative model. This model argues that later life is now represented through two different, though not unrelated, paradigms. The first frames the third age as a network of cultural fields dominated by rising consumerism and changing social relationships, while the second frames the fourth age as a negatively developed social imaginary of 'real old age.' The central features of this imaginary, we suggest, are frailty, abjection and the 'othering' of the self. This paper elaborates this theorising of the fourth age, briefly outlining each of these three features before considering in more detail the nature of othering and its consequences for those affected by this particular imaginary. [ABSTRACT FROM AUTHOR]

Following Howarth (2007), this paper examines the relationship between class culture and social distinction in the empirical area of death and dying. For Howarth (2007), the sociological neglect of the end-of-life cultural practices of working-class people carries the danger 'of privileging middle-class agendas for change, … [t]here is an urgent need for further studies … and a refinement of existing research to draw out social class distinctions' (p. 433). Drawing on Howarth (2007), and Bourdieu (1984), it is argued below that the connexion between death and class reflects and helps to reproduce class-based identities, advantages and conflicts. Whilst class culture can be a supportive resource for working-class people, for example, in ways which reflect solidarity, more typically the classed nature of death brings acute suffering. Relatedly, it is proposed that stereotypes of declining respectability are reflected in some middle-class conceptions of working-class practices and identity connected to death. Such thinking socially positions working-class tastes as objects of disgust, and working-class people as disgusting subjects. It is concluded that, whilst Howarth's call is much warranted, the debate also needs to problematise the normalisation of middle-class ways to die and grieve. [ABSTRACT FROM AUTHOR]

This paper sets out to explore the Australian instance of a significant international problem: Intergenerational solidarity and the willingness of younger generations to support the future care of older people. It draws on Bengston's intergenerational solidarity theory, in particular his conception of normative solidarity relative to filial obligations, to analyse data from the Australian Survey of Social Attitudes. This data demonstrates evidence of intergenerational solidarity at the policy level and a need for a continued role for government in the provision of residential care, insurance schemes, and the payment of income to full time and occasional carers. At the family level there is less support for the role of adult children in the payment of formal care or the provision of informal care. There is also a significant difference between men and women concerning the direct provision of informal care to ageing parents. Suggestions for future research are highlighted. [ABSTRACT FROM AUTHOR]

Dementia education and management is a major challenge nationally. However in the remote Aboriginal context, where the prevalence of dementia is five times greater than the national rate, the challenge is made more complex by cultural and linguistic differences between providers and consumers. Tins paper presents findings from the evaluation of a targeted dementia awareness resource piloted in three Aboriginal languages as well as English. It focuses on the intercultural communication aspects of the evaluation adding to the limited body of knowledge about communications with speakers of Australian Aboriginal languages. It identifies elements of effective intercultural communication in dementia education, implications for health literacy and considers the difference that culturally safe intercultural communication can make to a single issue such as dementia awareness. [ABSTRACT FROM AUTHOR]

This paper explores how the structuring of places and time influence Aboriginal and Torres Strait Islander patient and carer experiences of health services. Face-to-face in-depth interviews were conducted with urban Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease as well as family carers (N = 19). Content analysis was undertaken. Participants report that each element of the time spent in Aboriginal Medical Services is seen as more valuable and worthwhile than in mainstream health services, from social and health sharing experiences in the waiting room to health care in clinical places; and that users feel they can rely on sufficient time and respectful care in their clinical consultation. Purposeful design of both physical and temporal aspects of health services is called for. We suggest re-introducing opportunities for spatiotemporal design in health care that have been limited by the segmented 'person as illness' design features of Australia's current mainstream health system. [ABSTRACT FROM AUTHOR]

Despite almost two decades of reform under Australia's National Mental Health Strategy, the life circumstances of many people with mental illness seem little improved. While lack of rehabilitation, housing and community support services have been blamed for policy shortfalls, there is also concern that mental health services may impede rather than facilitate recovery from mental illness. To explore this particular concern, this paper reports data from a project which evaluated a group mentorship programme for new graduate nurses working in an Australian public mental health service. Prominent among the problems raised in mentorship group discussions were: the arduous nature of mental health work; the uncaring attitudes and practices of many veteran nursing staff; and the maltreatment and neglect of service users. These participants characterised mental health facilities as tough security-minded places, where staff act more as risk-managers rather than therapists, and all service users are treated as if they might be dangerous. They also perceived a connection between the dismissive ways in which they were often treated by veteran colleagues and the widespread mistreatment of service users. [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]

Understandings of culture and multiculture are broad and deeply embedded in every day talk and practices. In an increasingly globalised world, how we understand and work with these terms affects how parents and their families experience health care services and the support intended by health care professionals. This is particularly important for parents who are new to Australia. In this paper we report on findings from an ethnographic study undertaken across two community child and family health nursing sites in South Australia. Using examples, we explore how child and family health nurses appear to understand and use constructs of culture and multiculture during everyday, intercultural communication with parents who are new to Australia and Australian health services. By analysing these understandings through postcolonial and feminist theories we found pervading evidence that neo-colonial constructs of a white western monoculture shaped intercultural communication practice. We conclude by reflecting on how these constructs might be addressed to improve intercultural communication in child and family health settings. [ABSTRACT FROM AUTHOR]

The emphasis on a sexualised muscular body ideal in gay social and cultural settings has been described as facilitating body image dissatisfaction among gay men. Drawing on a concept of reflexive embodiment, this paper uses qualitative interviews to analyse gay men's embodiment practices in relation to discourses and norms that can be found across and beyond any coherent notion of 'gay subculture'. The findings reveal body image to be more complex than a limited focus on subculture or dissatisfaction can account for. In particular, gay men negotiate a gay pride discourse in which the muscular male body generates both social status and self-esteem, and deploy notions of everyday masculinity that imply rationality and control to resist gendered assumptions about gay men's body image relationships. [ABSTRACT FROM AUTHOR]

[ABSTRACT FROM AUTHOR]

The Complementary and Alternative medicine sector has grown enormously since 1980. Western Herbal Medicine (WHM), located within this domain, is a traditional therapeutic system that has enjoyed this recent public acceptance. Scientific evidence supporting therapeutic actions of plants employed in WHM has inspired public confidence. Today the herbal product industry is big business, employing sophisticated pharmaceutical manufacturing processes and competitive marketing strategies for phytomedicines with little resemblance to living plants. The literature reports a divergence of views among practitioners seeking to identify central tenets of contemporary WHM and cites herbalists who are resisting the commodification of herbal medicine. This study employs qualitative research methods to examine the blogosphere for evidence of this group using a combined purposive sampling approach and thematic analysis of blogs meeting predetermined inclusion criteria. The search revealed a group of bloggers who voice concerns about the direction WHM is taking and are ethically responsive to global environmental pressures. They share the common value that WHM should remain a healthcare option that empowers and supports the community and suggest this is best achieved by maintaining and sharing fundamental skills of plant identification, simple herbal product manufacturing and incorporating both science and tradition in their herbal practice. [ABSTRACT FROM AUTHOR]

This article draws upon research involving in-depth interviews with 60 mothers of young children about the home healthcare in which they engage when promoting their children's health and dealing with their illnesses, allergies or developmental problems. The study found that a series of often interconnected discourses were evident in the women's accounts. These included the discourses of health states as controllable, good health as an outcome of good management and the child's body as vulnerable. Other discourses were related to the concept of the 'good mother'. The interviewees also employed the discourses of home healthcare as emotionally distressing and as hard work and of children's illness as a mother's loss of control. As this suggests, such caring was often an intensely embodied and negative emotional experience for the mothers, particularly if they felt as if they had lost control over their children's bodies. [ABSTRACT FROM AUTHOR]

The implementation of interprofessional practice (IPP) within healthcare appears to be fraught with difficulties, despite the attention it has received in the literature. Although there are examples where IPP has reaped significant benefits, it has also been shown to impede team performance. We demonstrate that a key cause of failure in IPP can be attributed to interprofessional conflicts based on threats to professional identity, and provide insight into how professional identity faultlines have the potential to be activated and conflict induced when there is differential treatment of professional groups, different values between professions, assimilation, insult or humiliating action and simple contact within the team. This has significant implications for the management of interprofessional healthcare teams and provides information for team leaders and health managers. [ABSTRACT FROM AUTHOR]

This study explored the strategies for reinventing the disrupted biography of 20 people with HIV in Nepal. The study used a descriptive thematic analysis approach. The desire to strengthen the body's defense mechanisms evolved as a theme, which encouraged the participants to enroll in anti retro viral (ARV) treatment. However, none of the participants were able to afford ARV. Some enrolled in donor funded ARV therapy. Due to inadequate assistance in managing ARV-related side effects, many of the participants experienced the additional burden of illnesses associated with side effects, and they discontinued the treatment, leaving their biography at risk of further disruption. Natural therapies or ethno-medicines, such as Ayurvedic, homeopathic and home remedies appear to be the last resort to reinvent their biography, and change the trajectory of their illness. The acceptance of ethno-medicines is high, as they are rooted in Nepalese culture. However, the competency of the practitioners providing the treatment and efficacy of the treatment itself is untested empirically. Efforts should be made to engage qualified Ayurvedic and homeopathic practitioners to provide symptomatic treatment to people with HIV, as well as to foster collaboration between modern and alternative treatments. [ABSTRACT FROM AUTHOR]

Australia leads the world in the mass adoption of Human Papillomavirus (HPV) vaccines, a new frontier in mass vaccination programmes. This article reports on participatory workshops with the first generation of young Australian women to participate in the HPV mass vaccination programme. In particular, it addresses the themes of trust and confidence. A substantial literature highlights the growing realm of active trust at the expense of habitual confidence in 'risk society'. Another line of inquiry highlights the preference of governments for policies designed to enhance confidence rather than trust. This study finds that participants were guided by confidence in their adoption of the HPV vaccine, at the expense of trust. Participants readily transferred their confidence in the existing vaccination regime to the HPV mass vaccination programme, notwithstanding its novel features. Yet participants expressed growing misgivings about their informed consent and the 'marketing' of the vaccine in the course of workshops, reflecting failure to achieve their active trust. [ABSTRACT FROM AUTHOR]

Interviewing about death and loss can bring up unexpected emotions for respondents and interviewers. Positivist social scientific research methods often either ignore the emotions of the researcher, or argue that emotional expressions are to be avoided in research, even when the topic is thought to inspire intense feelings - like death and dying. This article argues for taking an alternative position toward emotions in death and dying research. Using data from over two years of participant observation and 34 semi-structured interviews with hospice workers, I illustrate one potential way to productively and ethically share emotions during a research interview. This approach includes learning and being open to the 'moderated cry', which involves minimal tears, the absence of sobbing and an overt acknowledgment of the emotional reaction. This article illustrates the ways respondents in this research used the moderated cry as well as the value of reconsidering prohibitions on emotions in research. [ABSTRACT FROM AUTHOR]

Health and wellbeing is defined internationally as a multi-dimensional and holistic concept, particularly within Indigenous worldviews. However, in Australia there is a lack of detailed frameworks supporting such definitions that are founded on Aboriginal knowledges. Tins study aimed to explore Aboriginal perspectives of child health and wellbeing in an urban setting. Qualitative interviews with 25 care-givers of Aboriginal children living in Melbourne, Australia were conducted. Aboriginal people and community controlled organisations were collaborative partners in all stages of the research. A conceptual fiamework of Aboriginal child health and wellbeing in an urban setting was developed comprising four main themes: Strong Culture; Strong Child; Strong Environment; and Strengths and Challenges. Aboriginal conceptions of culture are considered central to Aboriginal child health and wellbeing in an urban context. A holistic framework that privileges Aboriginal knowledge of child health and wellbeing has not previously been available. Further exploration of socio-ecological models within Aboriginal child health and wellbeing contexts is needed. This study identifies dimensions for further exploration in research, policy and practice. [ABSTRACT FROM AUTHOR]

This study explored Aboriginal perspectives of child health and wellbeing in an urban area in partnership with Aboriginal people and organisations. In depth interviews were conducted with 25 grandparents, parents, aunties or uncles of Aboriginal children. Interviews were transcribed and thematically analysed. A major conceptual theme was related to social, historical, and political factors seen by participants as influencing urban Aboriginal child health and wellbeing. This theme was called 'Strengths and Challenges: Harder for Koori Kids/Koori Kids Doing Well'. Increased challenges to achieving good health and wellbeing faced by Aboriginal children due to factors in their social, historical and political environment were emphasised. Many of these factors can be related back to historical and contemporary forms of racism. On the other hand, there was also a clear call to recognise and celebrate that many Aboriginal children were doing well in the context of these added challenges. [ABSTRACT FROM AUTHOR]

Age and ill-health have long been identified as being intrinsically intertwined, however the boundary between the discourses of ageing and chronic illness is not easy to demarcate. It is possible, however, to shed some light on the interplay between the ageing body and chronic illness by considering how differing cultures of ageing play a key role in articulating a dichotomy between seeing chronic illness as an aspect of health or of ill-health and age-related decline. Using knee pain as an example we argue that to understand how the interplay between ageing and chronic illness influences the interpretation of knee pain as 'ageing well' or as a sign of impending decline and physical dependency, then we need to employ a discursive methodological approach which explores talk as a form of action designed for its local interactional context and pays attention to what statements mean in the context in which they occur. [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]

Indigenous cultural training for health workers is an increasingly popular intervention designed to improve the health services provided to Indigenous peoples in Australia. The provision of this training is based on the recognition that the measured discrepancy between Indigenous and non-Indigenous health outcomes is in part influenced by cultural difference and a history of racism in Australian society. Indigenous cultural training in Australia predominantly draws on a 'cultural awareness' framework which seeks to educate health workers about 'Indigenous culture'. To date, evaluations of Indigenous cultural training programs have found them to have questionable efficacy, although most of these evaluations have been methodologically inadequate. This article draws on postcolonial theory to explore the limitations of Indigenous cultural training as it is commonly conceptualised. Issues of essentialising 'Indigenous culture', 'otherness' and the absence of systemic responsibility for culturally appropriate health service provision are discussed. Finally, we consider future directions for Indigenous cultural training that are useful to both Indigenous service users and the health workers charged with 'closing the gap' between Indigenous and non-Indigenous health outcomes. [ABSTRACT FROM AUTHOR]

This qualitative study into Australian manhood featured 63 men discussing 'acceptable' masculinity. Homophobic humour emerged as central to the formation of Australian male identity, but it had the potential to induce violence and emotional damage when the 'humour' moved along a malleable continuum from good-natured banter to abuse. Significantly, it was men of all sexualities who were targeted, indicating that it was non-conformity to gender norms as well as sexuality being policed, as boys and men used humour to control and humiliate each other. Recollections of these instances ranged from 'it was just a joke' for some perpetrators, to 'orchestrated cruelty' for men who had been victimised. Some of the latter group reported depression extending into their adult lives based on their youthful experiences. Understanding the impact when humour goes 'beyond a joke' is important for policy makers, educators and healthcare workers, as a potential for emotional damage and physical violence is highlighted. The study highlights the importance of understanding masculinity as an influence on men's health and wellness. [ABSTRACT FROM AUTHOR]

The down low has recently emerged as phenomenon where men have sex with men (MSM), but identify as 'heterosexual' or 'straight'. Although the down low has received considerable attention in United States media, little empirical research has sought to investigate this phenomenon beyond anecdotal evidence. Utilising data from the Urban Men's Health Study (UMHS) (n = 2881), this research offers a unique opportunity to investigate empirically claims of the down low beyond small opportunistic samples. We find significant support for the down low among Blacks and Latinos and its association with high-risk sexual behaviour. These findings highlight the need for future research that better understands the impact of the phenomenon within a cultural and community context [ABSTRACT FROM AUTHOR]