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This thesis explores how the “hierarchy of impairments” —a collection of prejudices that results in levels of preference for certain types of disabled people over others, while maintaining a general societal preference for non-disabled people—impacted the design, development, management and experience of life in Het Dorp, an accessible urban community for people with physical disabilities in Arnhem, the Netherlands, during its first two decades (1962-1982).Materials analysed included architectural design documents, weekly meeting notes of the Het Dorp management board, media produced for internal and external consumption, contemporary news coverage, contemporary published accounts of residents and researchers, and interviews.Het Dorp arose in the context of the burgeoning Dutch welfare state. Justification of these costs to the public was built through careful selection of early residents, as well as the construction of disabled people as worthy of citizenship via creation of governance structures that gave the appearance of a separate, self-governing community of disabled people. Understanding the hierarchy of impairments provides context for how Het Dorp positioned physically disabled people as a normalisable “model minority.” Resulting displays of normalcy via employment, social participation and self-governance at times differed significantly from the reality of life in Het Dorp. The hierarchy of impairments was embedded at societal and project level, and also internalised by residents.Despite attempts of Het Dorp’s founders to carefully stage-manage the community, residents and some staff recognised the limits of technological solutionism and normalisation to address problems rooted in long-standing attitudes, laws, societal practices and benefits policies. These conflicts were experienced on a personal level, but also gave rise to communal responses and attempts to secure societal change.In sum, the hierarchy of impairments was a key factor in shaping Het Dorp, but Het Dorp also embodied emancipatory possibilities that challenged such constructions.

People with mental illness can experience mental health crises (MHCs) that manifest in behaviours risky for the affected persons and for others, often resulting in unwanted police encounters and detention. Mobile crisis teams employing the psychiatric ambulance model (PAM) have shown positive effects when responding to MHCs, including diverting patients from police custody. However, the literature contains few reports about PAM. The emerging model of street triage (ST) is more frequently used and better researched. This study explored and compared facilitators and barriers of PAM and ST from the perspective of professionals from different countries. We conducted 12 semi-structured interviews with key PAM stakeholders in Sweden and the Netherlands and ST stakeholders in England, then performed comparative thematic analysis. Participants believed that PAM and ST led to better care for persons in MHC, reducing stigma and use of force. The main facilitators for Swedish participants were that PAM is a specialty with highly experienced and autonomousstaff. For Dutch participants, the more generalized medium-care ambulance led to success. Street triage enhanced overall safety and interagency collaboration. A common barrier was the lack of (emergency) treatment options and funding to meet the high demand for mental health care. Future research should explore collaboration between mobile crisis teams and community care to improve MHC response, and the perspectives of persons with mental illness on mental health emergency response models. Careful assessment is recommended to determine which mental health emergency response model best suits a specific local or national context.

De afgelopen jaren is duidelijk geworden dat mensen met autisme onevenredig zwaar worden getroffen door ongelijkheiden op het gebied van gezondheid en gezondheidszorg (Krahn, Hammond en Turner, 2006; Emerson et al., 2011). Bestaande literatuur heeft aangetoond dat er verschillen bestaan tussen mannen en vrouwen met autisme met betrekking tot zowel hun diagnose, als hun toegang tot, duur en succes van therapieën. Wat ontbreektis onderzoek naar de mate waarin geslacht, gender, en dynamieken met betrekking tot de ontwikkeling van genderidentiteit van personen met autisme van invloed zijn op deze verschillen, en hoe laatstgenoemde variabelen kunnen samenhangen met andere dynamieken.

The creation of autism as a diagnostic category, and the societal responses to it recommended currently and, in the past, has a specific historical and sociological context. This chapter examines how the autism category arose in concert with developments in educational psychology, industrial psychology, and the child guidance movement. It further discusses the impact of eugenic discourses, the concept of the child as ‘product’, and increased medicalisation of behaviour on production of discourses of regulated normalcy in childhood and beyond, and the consequences of these on the category of autism. The goal of this socioeconomic project, which goes far beyond autism per se, is shown to be production of financial advantage for employers; it has also involved successful commodification of deviance, producing financial gains for companies providing putative solutions or care. Negative impacts on families and on children who do not fit the norm (including those identified as autistic) are discussed.

The creation of autism as a diagnostic category, and the societal responses to it recommended currently and, in the past, has a specific historical and sociological context. This chapter examines how the autism category arose in concert with developments in educational psychology, industrial psychology, and the child guidance movement. It further discusses the impact of eugenic discourses, the concept of the child as ‘product’, and increased medicalisation of behaviour on production of discourses of regulated normalcy in childhood and beyond, and the consequences of these on the category of autism. The goal of this socioeconomic project, which goes far beyond autism per se, is shown to be production of financial advantage for employers; it has also involved successful commodification of deviance, producing financial gains for companies providing putative solutions or care. Negative impacts on families and on children who do not fit the norm (including those identified as autistic) are discussed.

Background: Leprosy, cutaneous leishmaniasis (CL) and Chagas disease (CD) are neglected tropical diseases with a high psychosocial burden (PSB). These conditions are endemic in Norte de Santander and Arauca in Colombia, but data on the related PSB are scarce. Therefore, we assessed mental distress, participation restriction and stigma among CD, CL and leprosy patients. Methods: In 2018, 305 leprosy, CD or CL patients were interviewed using a self-report questionnaire to assess mental distress, participation scale for participation restriction and explanatory model interview catalogue (EMIC) for stigma. Descriptive statistics and the significance of median score differences were compared. Results: Fifty percent of CD patients and 49% of leprosy patients exhibited mental distress, percentages which were significantly higher than that of CL (26%). Twenty-seven percent of leprosy patients experienced participation restriction, which was lower for CL (6%) and CD (12%). Median EMIC scores were significantly higher for leprosy patients than for CD (27%) and CL (17%) patients. Conclusions: We found high levels of PSB among leprosy, CD and CL patients. Mental distress was highest among CD patients. Participation restriction and stigma were more prevalent in leprosy patients. Rural residence or lower educational status may impact PSB. Further investigation is needed to formulate evidence-based, holistic interventions. © The Author(s) 2019. Published by Oxford University Press.

Objective: To collect baseline data on community stigma against leprosy and leprosy-related knowledge and ideas, with a view to develop contextualised community education and stigma reduction interventions. The data will also be used to evaluate subsequent stigma-reducing interventions. Methods: Community members (n ¼ 371) in Chandauli District, India, were interviewed, using a knowledge questionnaire, the EMIC Community Stigma Scale (EMIC-CSS) and Social Distance Scale (SDS). In the latter two scales, a higher sum score indicates a higher level of stigmatizing and negative attitudes of community members towards leprosy-affected people. Linear and quantile regression analyses were applied to explore the relation between (sociodemographic) covariates and the level of negative attitudes. Results: Community members indicated that avoidance of people affected by leprosy, problems with (prospective) marital life, concealment, and shame and embarrassment are present. Linear regression showed that knowing people affected by leprosy and being a government employee significantly increased one’s mean EMIC-CSS score, whereas a higher level of education significantly decreased this. Additionally, community members reported a desire to create social distance between people affected by leprosy and their children. Quantile regression showed that increased leprosy-specific knowledge and religion were associated with significantly decreased SDS scores, whilst housewives had significantly increased SDS scores. Knowledge was poorest regarding the transmission and cause of leprosy: only 8·1% and 10·5% knew the correct route of transmission and cause of leprosy. Conclusion: The level of negative attitudes of the community towards leprosy is high in Chandauli District, which may affect many aspects of the lives of people affected by leprosy. Community members knew least about the transmission and cause of leprosy and these domains should, therefore, be considered when designing stigma-decreasing interventions.

How can service providers help young adults on the autism spectrum find their way towards successful independent living? What factors need to be taken into account, what promotes independence and a good quality of life, and what might barriers might there be? The researchers decided to gain views directly from six young men under the age of 30 who were living in different types of residential settings in different locations.