I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan-A qualitative study

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi-structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person-centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person-centred care approach are provided. Alternative support options for this group of people need to be explored.

Striking the Right Balance and Supporting Social Aspirations: How Agency and Choice Play out in a Recovery-Oriented Mental Health Service

INTRODUCTION

There has been an increasing drive for a transformation of the mental health system towards recovery orientation, with research identifying a series of key recovery principles. It has been argued that these principles remain rhetoric rather than routine practice, and it remains unclear how these are operationalised and promoted within inpatient settings.

AIM

To address the knowledge gap of how staff and service-users enact recovery principles during the daily workings of an inpatient mental health service.

METHOD

Twenty-one interviews were conducted with staff and service-users at a recovery-oriented inpatient service in the United Kingdom. Data was analysed using framework analysis.

FINDINGS

Analysis of research interview data identified three subcategories grouped under the category of choice. These categories were: a delicate balancing act, acceptability of choices, and social issues impacting choice.

DISCUSSION

Staff were uncertain of their role in promoting choice, resulting in service-users feeling unsupported in their recovery. Staff had to adopt a titrated approach to social inclusion, to protect service-users from discrimination and rejection.

IMPLICATIONS

Mental health professionals need to take a more proactive role in enabling service-users to realise their social aspirations, as well as managing any adverse impacts of stigma and discrimination.

Individualizing the burnout problem: Health professionals' discourses of burnout and recovery in the context of rehabilitation

This discourse analytical study explores how health professionals (HPs) construct burnout as a form of mental distress in the context of Finnish burnout rehabilitation framed with a particular rehabilitation ethos. Burnout is a fuzzy concept and lacks a disease status. Therefore, it calls for context-specific definition and justification. By highlighting the socially and interactionally produced character of categories of mental distress, the study investigates the kinds of discourses HPs use to formulate "the problem" and its solutions, and how people dealing with burnout are categorized in these discourses. The data consists of field notes from the observation of group discussion sessions in two 1-year burnout rehabilitation courses. As a result of the analysis, five partly overlapping discourses were identified: psychological, evolutionary, healthy lifestyle, biomedical, and welfare. Within these discourses, people who experience burnout were categorized as over-conscientious employees, "good girls," "primitive people," self-responsible rehabilitees, patients, and (aging) employees with social and legal rights. Burnout rehabilitation and HPs' views reproduce a cultural and clinical discourse around burnout in which work-related problems are treated as individual-level problems and individuals are responsibilized for the management of mental distress. Based on the results, it is concluded that the hybrid type of interventions that attempt to influence both individual- and work-related problems behind burnout would help to prevent people dealing with burnout from being over-responsibilized for solving problems at the workplace.

Commodification and healthcare in the third sector in England: from gift to commodity-and back?

IMPACT

This article suggests why a different approach may be required for commissioning services from third sector providers than from, say, corporate or public providers. English systems for commissioning third sector providers contain both commodified elements (for example formal procurement, provider competition, commissioner-provider separation) and collaborative, relational elements (for example long-term collaboration, reliance on inter-organizational networks). When the two elements conflicted, commissioners and third sector organizations tended to try to work around the commodified elements in order to preserve and develop the collaborative aspects, which suggests that, in practice, they find de-commodified, collaborative methods better adapted to the commissioning of third sector organizations.

ABSTRACT

When publicly-funded services are outsourced, governments still use multiple governance structures to retain some control over the services provided. Using realist methods the authors systematically compared this aspect of community health activities provided by third sector organizations in six English localities during 2020-2022. Two modes of commissioning coexisted. Commodified commissioning largely embodied Washington consensus models of formal, competitive procurement. A contrasting, collaborative mode of commissioning relied more upon relational, long-term co-operation and networking among organizations. When the two modes conflicted, commissioners often favoured the collaborative mode and sought to adjust their commissioning to make it less commodified.

A Market of Lived Experience-User Involvement and the Commodification of Personal Experiences of Mental Illness

Working actively to engage service users in participatory practices is both a policy expectation and a moral imperative for mental health social workers in contemporary Western mental health care. Recent research suggests that such practices of service user involvement are becoming increasingly individualised and driven by market logic. Based on an ethnographic study within a Swedish public psychiatric organisation, this article applies the concept of commodification to examine this trend. By showing how the practice of user involvement takes the form of a market where personal narratives and experiences of mental health problems are bought and sold as commodities, the analysis illuminates how market logic permeates the everyday practice of user involvement. One consequence of this commodification is that user organisations, as well as individual service users, are restricted in their role as independent actors pursuing their own agenda, and instead increasingly act on behalf of the public and as providers of personal experiences. While it is vital that service user perspectives are heard and recognised within mental health services, mental health social workers need to be aware of the risks of commodifying lived experience. When attention is directed to individual experiences and narratives, there is a risk that opportunities to advocate on behalf of the user collective as a whole and speak from a more principled and socio-political standpoint are lost. In addition, the commodification of personal experience tends to rationalise and privilege user narratives that conform to the dominant institutional logic of the mental health organisation, while excluding more uncomfortable and challenging voices, thereby undermining the ability of service users to raise critical issues that do not align with the interests of the mental health organisation.

Mental health outcome measures in the Australian context: what is the problem represented to be?

BACKGROUND

There is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes.

METHODS

An in-depth policy and document analysis was conducted using Carol Bacchi's 'What is the problem represented to be?' approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves.

RESULTS

Two dominant representations of the 'problem' were identified: 1) the 'problem' of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the 'problem' of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the 'problem' of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision.

CONCLUSIONS

This critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.

The use of recovery model in forensic psychiatric settings: A Foucauldian critique

Recovery, a model of care aimed at patient-led nursing practice emphasizing autonomy, hope and self-determination, has in recent years been adapted for the secure forensic psychiatric setting. Often referred to as 'secure recovery', this model suggests the aims of recovery are achievable even in highly restrictive settings. This paper will adopt a Foucauldian perspective to offer a critical analysis of recovery in forensic settings. In providing recovery-oriented care, nurses utilize pastoral power in guiding patients to institutionally preferred outcomes. Akin to Christian religious conversion, nurses engage in a neo-religious conversion of patients to a neoliberal subjectivity of homo-economicus. This path of recovery is grounded in an ethos of personal responsibility and self-government, inseparable from the greater context of neoliberal governmentality. Despite attempts at transforming forensic nursing practice into more egalitarian directions, recovery remains a coercive practice, and fails to meet the overall goals of this paradigm in secure settings.

Challenging the Constraints of Neoliberalism and Biomedicalism: Repositioning Social Work in Mental Health

This article explores the impact of neoliberalism and biomedicalism on social work mental health care practice through presenting the results of a Canadian provincial study which illustrates the experiences of social work service users, providers, and supervisors. While Canada has a universal health care program, the intensification of the free-market approach is evident in the shifts from public sector support to growing rationalization and marked cutbacks to the provision of social welfare services. The specific impact of neoliberal economic restraint on social justice in mental health services has pressured practitioners to adopt medicalized, short-term strategies, under efficiency-based models. The participants in this study reported significant co-occurring concerns with the state of mental health service delivery, and results suggest social work is increasingly co-opted by the conservative individualizing, pathologizing, and contextualizing dominant biomedical framework in the provision of mental health social services and lack of professional practice autonomy.

Mental Health Challenges Related to Neoliberal Capitalism in the United States

Rates of mental illness have increased dramatically over the past 15 years in the United States [Products-Data Briefs-Number 283-August 2017. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db283.htm . Published August 15, 2017]. Additionally, life expectancy has fallen over the past several years due to increases in death from suicide, opioid overdose, and alcoholic liver cirrhosis as reported by Case and Deaton [Deaths of despair and the future of capitalism. Princeton University Press, 2020]. Over the last decade some have questioned whether these changes are due to neoliberal capitalist policies and ideologies. Neoliberal capitalism incorporates theories of eliminating all restrictions on the market and decreasing government assistance programs as reported by Harvey [A brief history of neoliberalism, Oxford University Press, 2005]. Since then these policies have led to income inequality, disempowerment of workers, outsourcing of manufacturing jobs, inadequate social services, mass incarceration and an expensive and ineffective healthcare system as reported by Case and Deaton [Deaths of despair and the future of capitalism. Princeton University Press, 2020] and Nkansah-Amankra et al. [International Journal of Health Services 43(2):217-240, 2013]. Studies have shown that the consequences of these policies and ideologies likely have a role in increasing rates of mental illness. This paper will discuss how these factors increase mental distress and postulate ways that mental health professionals can advocate for change.

Mental Health Challenges Related to Neoliberal Capitalism in the United States

Rates of mental illness have increased dramatically over the past 15 years in the United States [Products-Data Briefs-Number 283-August 2017. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db283.htm . Published August 15, 2017]. Additionally, life expectancy has fallen over the past several years due to increases in death from suicide, opioid overdose, and alcoholic liver cirrhosis as reported by Case and Deaton [Deaths of despair and the future of capitalism. Princeton University Press, 2020]. Over the last decade some have questioned whether these changes are due to neoliberal capitalist policies and ideologies. Neoliberal capitalism incorporates theories of eliminating all restrictions on the market and decreasing government assistance programs as reported by Harvey [A brief history of neoliberalism, Oxford University Press, 2005]. Since then these policies have led to income inequality, disempowerment of workers, outsourcing of manufacturing jobs, inadequate social services, mass incarceration and an expensive and ineffective healthcare system as reported by Case and Deaton [Deaths of despair and the future of capitalism. Princeton University Press, 2020] and Nkansah-Amankra et al. [International Journal of Health Services 43(2):217-240, 2013]. Studies have shown that the consequences of these policies and ideologies likely have a role in increasing rates of mental illness. This paper will discuss how these factors increase mental distress and postulate ways that mental health professionals can advocate for change.

Espiritualidad y neoliberalismo: Self en participantes chilenos de la Nueva Era

Resumen Hace algunas décadas se observa la masificación en Latinoamérica de las así llamadas “espiritualidades alternativas”, como la Nueva Era (New Age). Esta investigación tuvo por propósito explorar el self de los participantes de la Nueva Era en un contexto neoliberal de transformación subjetiva. Para esto, se realizaron entrevistas semiestructuradas de historia de vida a seis practicantes de la Nueva Era del sur de Chile. El análisis de contenido de los relatos de los entrevistados reveló dimensiones en el self de los participantes, tales como: empoderamiento, búsqueda de plenitud, renuencia de las instituciones formales, redención, un terapeuta en las relaciones, las cuales pueden ser conceptuadas desde elementos del neoliberalismo, resultados compatibles con la idea de un emprendedor y consumidor espirituales presentes en esta espiritualidad de culto al self.

The Recovery Narrative: Politics and Possibilities of a Genre

Recovery is now widely acknowledged as the dominant approach to the management of mental distress and illness in government, third-sector and some peer-support contexts across the United Kingdom and elsewhere in the Anglophone Global North. Although narrative has long been recognised in practice and in policy as a key "technology of recovery," there has been little critical investigation of how recovery narratives are constituted and mobilised, and with what consequences. This paper offers an interdisciplinary, critical medical humanities analysis of the politics and possibilities of Recovery Narrative, drawing literary theoretical concepts of genre and philosophical approaches to the narrative self into conversation with the critiques of recovery advanced by survivor-researchers, sociologists and mad studies scholars. Our focus is not on the specific stories of individuals, but on the form, function and effects of Recovery Narrative as a highly circumscribed kind of storytelling. We identify the assumptions, lacunae and areas of tension which compel a more critical approach to the way this genre is operationalised in and beyond mental health services, and conclude by reflecting on the possibilities offered by other communicative formats, spaces and practices.

"We Should Be at the Back of the Line": A Frame Analysis of Old Age Within the Distribution Order of the COVID-19 Vaccine

BACKGROUND AND OBJECTIVES

In the fall of 2020, it became clear that the initial doses of the coronavirus disease 2019 (COVID-19) vaccine would be limited, and a priority order would be necessary. This article examines the perceptions of old age in the context of establishing a priority order for the COVID-19 vaccine from the perspective of online newspaper commenters. Two research questions are investigated: (a) How do commenters place older people in line for the COVID-19 vaccine? and (b) What frames and factors do commenters use as reasoning for their proposed position of older adults?

RESEARCH DESIGN AND METHODS

This study involves a frame analysis of 440 online comments on an article published by The New York Times on December 1, 2020 about the U.S. recommendations for distributing the coronavirus vaccine.

RESULTS

Older adults were referenced as belonging to one of the 3 groups: older long-term care residents, older workers, and older adults retired and/or isolating at home. Two frames emerged from the data as criteria for prioritization: social contribution and vulnerability. Older commenters themselves frequently stated that they should be deprioritized so that others can be inoculated earlier.

DISCUSSION AND IMPLICATIONS

The findings may be interpreted as demonstrative of pervasive ageism throughout the pandemic; older commenters' sacrificial remarks may reflect generativity, internalized ageism, social pressure from online forums, or some combination thereof.

Building back better: Imagining an occupational therapy for a post-COVID-19 world

INTRODUCTION

The COVID-19 pandemic, which has disrupted occupations and lives of people around the world, has simultaneously exposed deeply rooted social inequities and structural injustices that have negated the facile claim that "we're all in this together." But the pandemic has also opened up opportunities to imagine other ways of living and doing in the future. This paper imagines some possibilities for shaping occupational therapy's future practices and seeks to illustrate why it is both timely and necessary to re-imagine occupational therapy in 2021.

METHODS

Drawing from epidemiological research, the paper explores the inequitable impacts of COVID-19, environmental degradation, and multiple social determinants on people's real opportunities for health, wellbeing, and occupational engagement.

FINDINGS

Evidence presented in this paper challenges occupational therapy's individualised approach towards wellbeing and contests the limited parameters of occupations "that matter" that are prioritised and promoted within the profession. In response, the paper seeks to expose the specific, political, economic, and ableist ideology that has effectively shaped the occupational therapy profession's assumptions, models, theories, and the practices these inform.

CONCLUSION

Drawing from the "Build back better" approach to post-disaster recovery-with its dual attentions to wellbeing, equity, and inclusivity and to physical, social, cultural, economic, and environmental vulnerabilities-this paper imagines an occupational therapy for a post-COVID-19 world; an occupational therapy that takes seriously the premise that occupations and people are inseparable from their environments; a profession that no longer colludes in individualising problems that are inherently social or in depoliticising the systemic social and economic inequalities that create stress and illness; an occupational therapy that no longer promotes the values of neoliberal ableism; and an occupational therapy dedicated to expanding people's just and equitable opportunities to engage in meaningful occupations that contribute positively to their own wellbeing and the wellbeing of their communities.

Social Injustice in the Neoliberal Pandemic Era for Homeless Persons With Mental Illness: A Qualitative Inquiry From India

The Corona Virus Disease 2019 (COVID-19) pandemic has presented an unprecedented challenge globally. It is much bigger than a bio-medical concern now with the multitudes of socio-economic, socio-political, socio-cultural, and psycho-social impact, which are likely to outlast the pandemic itself by far and long. The pandemic and the resulting challenges across societies highlighted the existing social injustices in a neoliberal world for historically marginalized populations like homeless persons with mental illness (HPMI). The nationwide lockdown in India to resist the spread of the virus posed a unique challenge to this vulnerable population. The present study thus attempts to understand the experience of HPMI during the COVID-19 induced lockdown through the theoretical framework of social justice vis-à-vis injustice. Semi-structured interviews have been conducted on seven HPMI rehabilitated in the community through an NGO situated in Kolkata, India. Seven stakeholders have also been interviewed to understand their experience in providing services to the HPMI during the COVID-19 induced lockdown. Analyses of the narratives have been done using initial coding, focused coding and axial coding through the process of constant comparison of constructivist grounded theory (CGT) methodology. Critical insights from the study bring out experiences of HPMI during COVID-19 as a victim of structural violence, highlighting their exclusion and victimization due to the existing marginalized status, living closer to the edge as a consequence of the lockdown, lack of awareness of the gravity of the pandemic situation. The experiences of the stakeholders, on the other hand, pointed out the role of community members and social workers in partially mitigating the challenges. This study indicates that to mitigate the aftermaths, stakeholders, including community members, need to work together for rebuilding and enhancing the strength and resilience of the marginalized populations like HPMI, who are historically victims of social injustice in the neoliberal pandemic era.

Contingent Relations: Migrant Wellbeing and Economic Development in Rural Manitoba

Drawing on ethnographic fieldwork conducted in rural Manitoba and the Philippines, this paper uses the example of the small town of Douglas, which since 2009 has been home to a small Filipino community, as a tenuous counter-point to the accounts of exclusion that dominate the scholarship on Temporary Foreign Labour in Canada. This paper draws on ethnographic research conducted in Manitoba with the region's newest immigrants-those recruited to ensure the viability of the new, diversified rural regional economy, and more specifically, the tourism and hospitality sector, established in the 1970s. In 2009, unable to meet its labour needs regionally, a local hotel began recruiting temporary foreign labour. By 2014, the Hotel had recruited 71 workers from the Philippines, most of whom arrived through Canada's Temporary Foreign Worker Program; others having arrived through the province's immigration scheme, the Manitoba Provincial Nominee Program (MPNP). A reflection of the ubiquity of globalized Filipino migration, the well-being of these workers had long been informed by economic development in the Philippines and the centrality of international labour mobility to that state project. What emerges from the data is a simultaneous acceptance and contestation of the conditions of transnational family life, and moreover-reflecting the focus of this special issue-the extent to which migrant well-being shifts in accordance to labour mobility regimes responsive to development. Migrant workers and their families are implicated in these connected, yet differently motivated, state projects. And while particular narratives concerning their contributions come to be valorized and even celebrated, their mental, physical, affective, and relational well-being is often over-looked by those who benefit from their labour and mobility. Of equal importance is the provincial state's participation in this process through the provision of permanent residency to existing and in-coming migrants. While this benefits individual families, it does not inherently challenge the logics of neoliberalism; rather, drawing on its nuances, it create new possibilities for capital accumulation and exploitation, while offering some protection for select families who are willing and able to abide by the terms established by their employer and the Manitoba state.

"You have to fight to legitimize your existence all the time": The social context of depression in men with physical disabilities

Little is known about the common experience of depression in men with physical disabilities. To help address this gap, we present findings from a qualitative study situated in the social determinants of health (SDH). Findings describe the detrimental effects of marginalization, economic precarity, restrictive masculine norms, stigma, and the need to resist ableist messages on men's health and well-being. It is our intention to raise awareness of the impact of the SDH on depression in men with physical disabilities and encourage clinicians and policy makers to address the social domain as they seek to improve mental health in this population.

Health(care) in the Crisis: Reflections in Science and Society on Opioid Addiction

Opioid abuse and misuse have led to an epidemic which is currently spreading worldwide. Since the number of opioid overdoses is still increasing, it is becoming obvious that current rather unsystematic approaches to tackle this health problem are not effective. This review suggests that fighting the opioid epidemic requires a structured public health approach. Therefore, it is important to consider not only scientific and biomedical perspectives, but societal implications and the lived experience of groups at risk as well. Hence, this review evaluates the risk factors associated with opioid overdoses and investigates the rates of chronic opioid misuse, particularly in the context of chronic pain as well as post-surgery treatments, as the entrance of opioids in people's lives. Linking pharmaceutical biology to narrative analysis is essential to understand the modulations of the usual themes of addiction and abuse present in the opioid crisis. This paper shows that patient narratives can be an important resource in understanding the complexity of opioid abuse and addiction. In particular, the relationship between chronic pain and social inequality must be considered. The main goal of this review is to demonstrate how a deeper transdisciplinary-enriched understanding can lead to more precise strategies of prevention or treatment of opioid abuse.

A Critical Perspective on Mental Health News in Six European Countries: How Are "Mental Health/Illness" and "Mental Health Literacy" Rhetorically Constructed?

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as "dangerous," "a matter of lifestyle," "a unique story and experience," and "socially situated." We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts.

'Every single minute and hour is scrutinised': neoliberalism and Australian private mental health care

There is little understanding of how recovery-oriented approaches fit within contemporary mental healthcare systems, which emphasise biomedical approaches to care, increased efficiency and cost-cutting. This article examines the established models of service delivery in a private, youth, mental health service and the impacts of the current system on staff. It explores whether the service is prepared or capable of adopting recovery-oriented approaches to care. Qualitative interviews were undertaken with staff and thematically analysed to understand the everyday practices on the unit. Data suggest that economic efficiencies and biomedical dominance largely shaped how health care was organised and delivered, which was perceived by staff as inflexible to change. Additionally, findings suggest that market-oriented principles associated with neoliberalism restricted the capacity of individuals to transform services in line with alternative models of care and lowered staff morale. These finding suggest that, while neoliberal ideologies and biomedical approaches remain dominant in organisations, there will be challenges to adopting alternative recovery-oriented models of care and promoting healthcare systems that understand mental health issues in broader socio-political contexts and can flexibly respond to the needs of service users.

Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision

In this study, we undertook a narrative analysis of participants' long-term lived experience of eating disorders and specialist service provision. Eight participants were recruited with service experience across five National Health Service (NHS) Trusts in the United Kingdom. All participants had a minimum of 10 years self-reported experience living with an eating disorder. The data are presented across different temporal stages that demonstrate the development of participants' self-construct in relation to their first contact with specialist services, what had happened in their lives for this to become necessary, and their current relationships with services, before exploring what participants need from services to help them feel heard going forward. Findings suggest that current methods of service delivery result in delayed and inappropriate supports and a consequent "battling" against professionals, which can provide an obstacle to compassionate and collaborative working and promote "revolving door" experiences.

Who cares for academics? We need to talk about emotional well-being including what we avoid and intellectualise through macro-discourses

This article explores academics’ well-being through analysing published sensitive disclosures, bringing to journal space the pain, rawness and emotional suffering of individuals’ experiences. We confront the taboos of speaking openly about mental health and emotional well-being in academic institutions, with masculine structures and encroaching neoliberal discourses that create hostile atmospheres unsupportive of vulnerability and uncertainty. We also challenge existing discourses about academics’ well-being, implicitly burdening individuals as responsible for their pain and creating walls of shame, rather than building new healthy structures. By spotlighting the voices of academics’ emotional disclosures, intensified by embodied social inequalities, we plead for openness in formal academic outlets for sharing pre-existing emotional struggles and new wounds created by cruelly competitive, winner-takes-all structures, fortified by neoliberal ideals. Led by individuals’ voices and experiences, we make recommendations for supporting academics as an attempt to extract academia from its current perverse state and commit to repair and transformation.

The poison in the cure: Neoliberalism and contemporary movements in mental health

Neoliberalism reaches beyond economic policy and material conditions and reformulates the subject and psychological life and therefore is best understood as an attitude toward science, knowledge making, and subjectivity. In a neoliberal climate, markets give us truth and individuals are encouraged to be self-concerned agents rather than members of a polis. Thus, at the very moment that neoliberal policies transfer responsibility to individuals, there is a simultaneous increase in surveillance in order to reinstall certain patterns of human behavior. Mental health research and practice risk becoming commodities dedicated to enforcing this logic. In this article, we explore medical neoliberalism in some of its recent manifestations: global mental health interventions, routine depression screening, and the monitoring of social media to assess mental health. We also consider the ways in which popular reforms in the mental health field are founded on neoliberal assumptions and may be abetting these ideological aims.

Decolonizing culture: Euro-American psychology and the shaping of neoliberal selves in India

Adopting a decolonizing framework, this article examines the role of mainstream Euro-American psychology in shaping neoliberal conceptions of self in many postcolonial nations such as India. We specifically draw on our respective ethnographic research to analyze identity formation in Indian cultural contexts. Our article is organized around three goals. First, we show how Indian outsourcing industries have become heavily reliant on Euro-American “personality tests” and are used for recruitment, screening, promotion, cross-cultural communication, and to motivate employees to become happy and positive workers. Second, we examine the tensions around identity or values that Indian youth face while embracing the ideology of Western corporate culture and acquiring new transnational identities. Third, we analyze how mental health in India is being shaped by neoliberalism by investigating the villagers’ narratives in Nandigram, who encountered brutal acts of political violence by the state of West Bengal in India.

Narrative approaches in mental health: Preserving the emancipatory tradition

Narrative approaches have exercised an emancipatory influence within mental health. In this article, it is suggested that there is a risk that the emancipatory tradition associated with narrative may be co-opted through contemporary mental health strategy by a narrow agenda which promotes a particular Western and neoliberal form of citizenship. This may limit the way recovery can be imagined by equating it solely with the future-orientated individual who strives, above all, to be economically independent. To resist this, it is suggested that narrative in mental health should be approached with recourse to therapeutic thinking which promotes a relational ethos of ‘recovery together’. The ‘recovery together’ model is subsequently considered in relation to narrative research on temporal understandings which have been conducted in disability studies and in the area of chronic illness. These studies point towards the value of a relational orientation towards well-being in the present, rather than fixating on future goals. It is suggested that a relational philosophy of the present might be usefully incorporated into narrative approaches when working therapeutically with people suffering from mental distress. It is argued that this might enable users and practitioners to extend the available narrative templates and to imagine recovery in diverse ways which support personal transformation and, ultimately, contribute to social change.

(Dys) Functional Diagnosing

This article contributes to the burgeoning literatures on the sociology of diagnosis and transgender studies by examining the relationship between diagnostic processes and the legitimation of gender identity—the medicalization of transgender people. In order for trans-identified people to access medical and surgical services, they must submit to a complex mental health diagnostic process that relies on criteria set by the American Psychiatric Association and the World Professional Association of Transgender Health (WPATH). By focusing on provider experiences of using the Gender Identity Disorder (GID) diagnosis in the Diagnostic Statistical Manual of Mental Health Disorders, Fourth edition, text revision (DSM-IV-TR) to meet the requirements of WPATH’s Standards of Care (SOC-6), we show that diagnostic processes can both support and inhibit a transpatient’s abilities to access services. Participants reveal how deeply held cultural views pertaining to gender, mental health, and patient competency are entrenched in diagnostic categories. While the new DSM-5 has relabeled GID as Gender Dysphoria and the SOC-7 has somewhat lessened the requirements for accessing hormone treatments, our data suggest that these changes will not be enough to alter the underlying structure of social control and power that diagnostic categories have over transpeople and their providers.

Research protocol: a realist synthesis of contestability in community-based mental health markets

BACKGROUND

In most developed nations, there has been a shift from public services to a marketisation of public goods and services - representing a significant reform process aiming to transform the way in which community-based human services, such as health, are delivered and consumed. For services, this means developing the capacity to adapt and innovate in response to changing circumstances to achieve quality. The availability of rigorous research to demonstrate whether a market approach and contestability, in particular, is a coherent reform process is largely absent. Contestability operates on the premise that better procurement processes allow more providers to enter the market and compete for contracts. This is expected to create stimulus for greater efficiencies, innovation and improved service delivery to consumers. There is limited understanding, however, about how community-based providers morph and re-configure in response to the opportunities posed by contestability. This study focuses on the effect of a contestability policy on the community-managed mental health sector.

METHODS/DESIGN

A realist review will be undertaken to understand how and why the introduction of contestability into a previously incontestable market influences the ways in which community-based mental health providers respond to contestability. The review will investigate those circumstances that shape organisational response and generate outcomes through activating mechanisms. An early scoping has helped to formulate the initial program theory. A realist synthesis will be undertaken to identify relevant journal articles and grey literature. Data will be extracted in relation to the emerging contextual factors, mechanisms and outcomes and their configurations. The analysis will seek patterns and regularities in these configurations across the extracted data and will focus on addressing our theory-based questions.

DISCUSSION

Increasingly, community-based mental health markets are moving to contestability models. Rigorous research is needed to understand how such markets work and in what contexts. The knowledge gained from this study in community-based mental health will provide valuable lessons in how contestability works, in what circumstances and who benefits when. The results of the proposed research will be useful to policy-makers and may be applicable in other contexts beyond the community-based mental health sector.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015016808.