Social representations and professional knowledge: The representation of mental illness among mental health practitioners

Creating communities that care: social representation of mental health in two urban poor communities in Ghana

Building caring communities is fundamental to achieving a community-based approach to mental health. Understanding how communities perceive mental illness provides critical insight into fostering mental health awareness and care. We explored the perceptions of mental illness among members of two urban poor communities in Accra, Ghana. Qualitative data were collected from 77 participants through key informant interviews, focus group discussions, and situated conversations. Using theory-driven thematic analysis based on social representations theory, findings revealed cognitive-emotional representations of mental illness. The communities demonstrated high awareness of the multilevel factors contributing to mental illness risk and experiences, drawing on five sources of knowledge: embodied, common sense, medical, cultural, and religious. Mental illness representations informed the classification and legitimization of mental illness based on the severity of conditions and the identity of sufferers. These findings provide valuable insights for planning community mental health interventions that address both social and institutional care needs.

Regulating liminality: Making sense of the vegetative state and defining the limits of end-of-life action

Persistently alive but unaware, vegetative state patients are stuck in the transition between life and death - that is, in a liminal hotspot. This condition raises complex ethical and legal dilemmas concerning end-of-life action. Drawing on social representations (SRs) and the liminality framework, our research investigated how the vegetative state was constructed within the Italian parliamentary debates discussing end-of-life bills (2009-2017). We aimed to understand (1) how political groups represented the vegetative state, (2) how they legitimised different end-of-life bills and (3) came to terms with the issue of liminal hotspots. By dialogically analysing three debates (No. of interventions = 98), we identified six themes and discursive aims allowing parliamentarians to differently represent the vegetative state and support different courses of action. In turn, we identified new features of the psycho-social processes generating SRs: the dialogical tensions between anchoring and de-anchoring. Results corroborated the idea that de-paradoxifying liminality relies on group sense-making and, thus, different political leanings differently addressed the liminality of the vegetative state. We also reveal a novel feature of dealing with liminal hotspots informing the psycho-social literature that applies when a decision needs to be taken, such as in the case of crafting a law: moving from the paradox.

Social Representation of Pain and Suffering in Cancer Patients: A Mixed Methods Study

Most patients report physical pain and psychosocial problems (suffering, depression, anxiety) during and after cancer treatment. This mixed methods study, based on the Theory of Social Representations, examines if pain and suffering are taboo subjects for oncologists and patients, and if they share the same representations. The data collected included 33 in-depth interviews with patients in chemotherapy/radiotherapy treatment (n = 20) and their oncologists (n = 13). We measured the number of spontaneous mentions of the words "pain" and "suffering" and their synonyms. We then examined semantic networks related to these two terms. The results show that for patients, suffering refers to bodily degradation and vulnerability while pain confirms the presence of the disease. In the interviews conducted with oncologists, suffering is absent. Pain is perceived as a sign of disease progression and an indicator of tolerance to treatment. These results may help in increasing the mutual understanding between oncologists and patients and facilitating the detection of depression and anxiety.

Professional Representations of Collaboration in the Response to Intimate Partner Violence

Purpose

Due to the complexity of intimate partner violence (IPV) and the many actors involved in its social and legal responses, there is a broad consensus that collaboration is essential if IPV is to be overcome. Few studies, however, have provided details as to how these collaborations occur. Rather, research on collaboration in IPV has typically focused on a series of factors facilitating and hindering it. However, these factors are rarely articulated in a systemic, comprehensive, and integrated way.

Method

To gain a better understanding of the socio-judicial response to IPV, we conducted a case study in an administrative region in the Province of Quebec, Canada. We conducted individual interviews with 37 key informants who work with people experiencing IPV. The data were subjected to deductive thematic coding as well as to intra- and inter-role matrices that cross-referenced the themes.

Result

According to our findings, interagency referrals and information sharing were the most common collaborative practices reported by participants which leading us to characterize the region studied in this article as poorly integrated. Factors facilitating and hindering collaboration are discussed in relation to previous studies.

Conclusion

Recommendations for cross-sectoral training, organizational policy development, and opportunities to leverage the expertise of specialized actors in IPV response systems are made.

Mental Health Nurses' Social Representations of People Who Experience Mental Illness: A Story of Paradoxes

Public representations of people who experience mental illness (PEMI) have been well documented within the stigma literature. However, studies about mental health nurses' representations of PEMI are still scarce and characterized by contradictions. Using the theoretical concept of social representation instead of stigma, the current study aims to explore and understand mental health nurses' social representations of PEMI. Qualitative research was conducted based on 13 semi-structured interviews with nurses from two psychiatric units in general hospitals. Data were analyzed using interpretative phenomenological analysis. Results showed that nurses' social representations were characterized by paradoxes. They explicitly displayed positive social representations, while nuancing them from an implicit point of view. The nurses wanted to work toward a destigmatizing voice for PEMI while nuancing their assertions to sound honest and accurate, which led them to a state of cognitive dissonance.

Organizational Context and Healthcare Reforms: What Effect on the Professional Distress of Canadian Social Workers and Social Service Provision?

This study examined the lived experience of Canadian clinical social workers in light of the organizational context in which they work. The literature indicates an alarming rise of occupational psychological distress in social workers, which aligns with the rise of the neoliberal ideology within the Canadian healthcare sector. While we know that organizational constraints and structural reforms affect social worker's workplace well-being, it remains unclear how these changes are represented by front-line practitioners and how they affect the provision of social services in healthcare settings. To deepen our understanding of this issue, we conducted a thematic analysis of thirty semi-directed interviews with social workers currently practicing in three Canadian cities (Ottawa, Moncton and Winnipeg). Discussions of daily work life, responsibilities, autonomy and subjective understandings of the social worker's role revealed which organizational constraints were the most significant in everyday practice and how they relate to their professional identity and mandate. Provincial healthcare reforms were generally found to have negative effects on clinical social workers, whose struggles for recognition were impaired by the fundamentally neoliberal ideologies behind the large-scale restructuring of service provision, themselves at odds with the humanistic principles of social work. Our findings further suggest that structural changes under the New Public Management frame could be detrimental to both the quality of services provided by clinical social workers and their well-being. Overall, this investigation highlights the importance of organizational improvements in the workplace through systemic changes that would concurrently target managerial expectations, resources allocation, autonomy, work-life balance and respect for professional values.

"A woman's life is tension": A gendered analysis of women's distress in poor urban India

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women's perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression "tension" to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women's distress and the need for scholarship on women's mental health in low-income settings to be more attuned to gendered forms of marginalization.

Health professional's social representation about ederly subject with mental health disorders: a pilot study on 790 health professionals

OBJECTIVES

The objective of the present study was to identify the structure and content of the Social Representation (SR) of health professionals regarding elderly subjects with mental health disorders and compare the latter to the lay Social Representation identified in the literature.

METHOD

The structure and content of the SR of health professionals was examined in 790 careproviders from the 'Grand Est' region of France through the use of the free and hierarchical associations methodology of Abric and Vergés. A prototypical and categorical analysis as well as a similarity analysis and factorial correspondence analysis were applied to the results.

RESULTS

Analysis of the collated data revealed that the items 'chronic', 'dependent', 'behavior disorders', 'memory disorders', 'solitude' and 'social isolation' were the characteristic components of the central core of the social representation.

DISCUSSION

Only the peripheral elements were more sensitive to the field of practice of each profession. These findings thus highlight that the SR of health professionals is substantially identical to that of the all-comer SR on several dimensions.

A Call to Action. A Critical Review of Mental Health Related Anti-stigma Campaigns

Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between "us" and "them." In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.

Determinants of mental health professionals' attitudes towards recovery: A review

OBJECTIVE

The attitudes of mental health professionals towards consumers' recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals.

METHODS

A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included.

RESULTS

From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals' pessimistic attitudes towards recovery.

CONCLUSIONS

This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers.

Young Adults' Knowledge and Attitudes Regarding "Music" and "Loud Music" Across Countries: Applications of Social Representations Theory

Exposure to loud music, especially by young people, has significantly increased in recent years as a result of (a) advancements in technology in terms of personal music players and smart mobile phones, and (b) streaming of music through these devices. The World Health Organization (WHO) estimates that some 1.1 billion teenagers and young adults are at risk of developing hearing loss due to exposure to recreational noise such as music. It is suggested that knowledge and attitude of young adults toward music has bearing upon their music listening habits and thereby influences who is at risk of developing music induced hearing loss. Hence, researchers from various fields have tried to understand the knowledge and attitude of young adults regarding loud music. However, there is some criticism of attitude studies as there is little relation between expressed attitude and behavior. Some recent studies have explored the social representations of music and loud music using the Social Representations Theory (SRT). It has been suggested that social representation is more fundamental than attitude (or in other words social representation informs attitude), hence, it has a better relation to behavior. The current paper: (1) provides an overview of studies on knowledge and attitude of young adults toward loud music, (2) discusses the limitations of attitude theories and introduces SRT, and (3) provides a summary of social representation studies on “music” and “loud music” in young adults from different countries.

Between medicalisation and normalisation: Antithetical representations of depression in the Greek-Cypriot press in times of financial crisis

Media offer people ways of understanding mental health and illness, shaping their attitudes and behaviour towards it. Yet, the literature on media representations of depression is limited and fails to illuminate sufficiently the content of representations. In times of financial crisis, the prevalence of depression is increased and the particular meanings associated with depression are widely diffused. To unpack these meanings, we focused on the Greek-Cypriot press during the financial crisis of 2013. Two-hundred and three articles from seven widely circulating newspapers were thematically analysed. Two antithetical themes of representations of depression were identified: Biomedical Depression, which constructed depression as a biologically grounded illness treated through medical/pharmaceutical means, and Everyday Depression, which portrayed depression as something normal, encountered in anyone, attributed to psychosocial factors (e.g. the financial crisis), and treated through self-management. Biomedical Depression reflects a widespread medical and deterministic understanding of depression. Nevertheless, this understanding has not overridden, as the literature suggests, references to individual agency, which are present in the Everyday Depression and the more normalising understanding of depression it expresses. We argue, however, that both themes promote an individualistic understanding of depression, placing individuals in a tense position of being responsible for a condition perceived to be outside their control.

Impact of economic crisis on the social representation of mental health: Analysis of a decade of newspaper coverage

BACKGROUND

Mass media plays a fundamental role in how communities understand mental health and its treatment. However, the effect of major events such as economic crises on the depiction of mental health is still unclear.

AIMS

This study aimed at analyzing representations of mental health and its treatment and the impact of the 2008 economic crisis.

METHODS

In total, 1,000 articles were randomly selected from two newspapers from a period before and after the economic crisis. These articles were analyzed with a closed coding system that classified the news as good or bad news according to the presence of themes associated with positive or stigmatizing representations.

RESULTS

The results show a positive representation of mental health and a negative representation of treatment. Furthermore, the economic crisis had a negative impact on the representation of mental health, but not on treatment.

CONCLUSION

These findings suggest that the representation of mental health is multifaceted and may be affected differently in its dimensions. There is a need for stigma-reducing interventions that both account for this complexity and are sensitive to context and period.

"How I Floated on Gentle Webs of Being": Psychiatrists Stories About the Mental Health Treatment Gap in Africa

A strong movement has emerged recently which is highlighting the high levels of untreated mental illness in Africa and making proposals for reducing this 'gap' in mental health care. This movement has been criticised for insufficiently attending to the epistemologies embedded in its recommendations, and inadequately considering the views of practitioners 'on the ground'. Employing a narrative-based approach, I accessed the stories about the mental health 'treatment gap' of 28 psychiatrists all working clinically in public mental health care settings in South Africa, Uganda, Nigeria or Ethiopia. Rather than focusing on the content of these stories, I was more interested in their underpinning meaning-codes and epistemological politics. Dominant thinking about the 'treatment gap' was heavily informed by a biomedical paradigm, and associated epistemological order of European Colonial Modernity. There were, however, cracks in this master narrative, which crystalised in the stories that were told by three particular psychiatrists. Their narratives operated within an alternative paradigm, one which appears to be informed by the tradition of phenomenology, and in particular the ideas associated with French philosopher Merleau-Ponty. This more marginalised thinking may offer important insights into reducing the mental health 'treatment gap' in Africa in ways very different from those created by current seats of power.

Social representations, ageing and memory: a holistic approach to cognitive assessment

This paper examines how contextual (conversational) aspects and socially shared meanings might affect the participants' performance on a standardised memory test using the theoretical framework of social representations. A total of 97 members of centres for older adults located in Rome, Italy participated in a screening using the Montreal Cognitive Assessment test. Prior to testing, a group of volunteers had organised a performance focused on events from the distant past, stimulating intergenerational reminiscence. The participants were randomly assigned to one of two conditions. In the first case, prior to administering the test, a psychotherapist talked to each participant about the performance, focusing on ageing and stressing the neutral aspects of its social representations, such as change and time. In the second case, performance was used to concentrate on positive aspects of the social representations of ageing, namely wisdom and experience. In line with the hypothesis, focusing on positive aspects of social representations of ageing (wisdom and experience) versus their neutral aspects (change and time) has resulted in improved performance on a standardised memory test. Practitioners (psychotherapists – experts in psycho-diagnostics) who administered the tests have been involved in the co-construction of the meaning of ageing, discussing a real-life situation: the common experience of intergenerational activity that involved the participants' memories of their urban environment.

Social representation of hearing aids: cross-cultural study in India, Iran, Portugal, and the United Kingdom

BACKGROUND

The current study was aimed at understanding the social representation of hearing aids in India, Iran, Portugal, and the United Kingdom. We also compared these results to explore the cross-cultural differences and similarities among these countries.

METHODS

The study involved a cross-sectional design, and the data were collected from four different countries using the snowball sampling method. Data were analyzed using a content analysis to identify the most-similar categories of responses reported, a co-occurrences analysis to see which of these categories are reported commonly, and a chi-square analysis to study if there was any association between positive, neutral, and negative connotations among participants in different countries.

RESULTS

The current study revealed four different social representations of hearing aids from India, Iran, Portugal, and the United Kingdom, and also a global index.

CONCLUSION

The study results provide very useful insights into how hearing aids are represented in the society. These findings may have important implications for public education and also for manufacturers from the viewpoint of designing and marketing hearing aids in different countries.

Impact of Community Interventions on the Social Representation of Depression in Rural Gujarat

There is a pressing need to develop community interventions that will address stigma against mental illness in rural India. This cross-sectional study will compare social representations of depression in villages where educational programs have targeted mental illness and stigma versus control villages. Participants from the villages exposed to the educational interventions (n = 146) will be compared with a sample from six control villages (n = 187) in the same geographic region, using a structured questionnaire. The impact of the intervention as a predictor for questionnaire score will be assessed along with socio-demographic variables. The intervention villages showed higher levels of literacy regarding depression and lower levels of stigma, after adjusting for all other socio-demographic variables. While some demographic factors associated with the knowledge and attitudes towards depression are not modifiable, our research provides evidence in favor of the positive influence a community grassroots intervention can have on mental health literacy in rural settings.

Mental ill health in the elderly: medical students' social representations in the United Kingdom

Objective This study aims to explore medical students' social representations of mental ill health in older adults. Method It comprises an exploratory and qualitative investigation based on the theory of social representations. Two focus groups with pre-clinical medics (group 1, N=4; group 2, N=4) and 10 individual interviews with clinical medical students were conducted. Thematic analysis at a latent level explored meanings and differences between groups. Results Three overarching themes reflect participants' representations of mental health problems in later life - mental ill health in old age, polarisation of care, and challenges to care. Primary health care appears as an important strategy to overcome barriers to mental health care in the community. Nevertheless, disqualifying representations, stigma and organization of services constitute the main challenges to quality mental health care in later life. Conclusion This paper highlights the need to address cultural and organizational barriers to promote quality care.

Descriptions of euthanasia as social representations: comparing the views of Finnish physicians and religious professionals

In many western societies health professionals play a powerful role in people's experiences of dying. Religious professionals, such as pastors, are also confronted with the issues surrounding death and dying in their work. It is therefore reasonable to assume that the ways in which death-related topics, such as euthanasia, are constructed in a given culture are affected by the views of these professionals. This qualitative study addresses the ways in which Finnish physicians and religious professionals perceive and describe euthanasia and conceptualises these descriptions and views as social representations. Almost all the physicians interviewed saw that euthanasia does not fit the role of a physician and anchored it to different kinds of risks such as the slippery slope. Most of the religious and world-view professionals also rejected euthanasia. In this group, euthanasia was rejected on the basis of a religious moral code that forbids killing. Only one of the religious professionals - the freethinker with an atheist world-view - accepted euthanasia and described it as a personal choice, as did the one physician interviewed who accepted it. The article shows how the social representations of euthanasia are used to protect professional identities and to justify their expert knowledge of death and dying.

Common sense of experts: Social representations of justice amongst professionals

The dialectics between different modes of knowledge is at the very core of social sciences. In particular, the theory of social representations looks at expert and lay modes as they were not peculiar of specific domains but rather as they were mutually interdependent. Based on the conceptual distinction between reified and consensual universes, this article explores the interplay between these two sources of knowledge through the analysis of the social representations of justice produced by justice professionals. In particular, the exploration of the social representations of justice amongst experts offers intriguing clues to overtake the idea that the lay understanding of justice is somehow opposed to the expert viewpoint and to accept the polyphasic understanding of this complex object. The article reports the findings of a qualitative investigation of the social representations of justice amongst professionals. The staff members of the Youth Social Services (YSS) and the Juvenile Classification Home and Residential Community (JCHRC) were interviewed, and transcriptions were content analysed. The findings indicated that professionals generate multiple theories of justice with each presenting a particular articulation of the basic interplay between expert and lay viewpoints. Most important, findings indicate that the context of everyday working practice has a significant symbolic valence that goes beyond the boundaries of the reified context of institutional justice system.

Models of care delivery in mental health nursing practice: a mixed method study

The aim of this study was to identify the conceptual models that underpin mental health nursing care in clinical settings. This study is a modification of a previous study which evaluated the influence of implicit models of mental disorder on processes of decision making within community-based teams. Participants completed questionnaires in response to a scenario. A range of explanatory conceptual models were identified in respect to aetiology, treatment and recovery. In a forced choice the participants ranked a medical model of care above other models as underpinning care delivery. The content analysis found that the participants used a psychodynamic framework for understanding the causes of mental distress but described the nursing interventions in terms of supporting a medical model of care. Nursing care is dominated by a medical model which constrains mental health nursing. This potentially creates tension between what nurses believe to be the problem and the responses available for nurses in their clinical setting. A range of psychosocial approaches to mental health care delivery have been developed, but there seems to be problems with their implementation in practice. Further research is required to explore how broader therapeutic interventions can be implemented by nurses within multidisciplinary systems of mental health care delivery.

Psycho-social processes in dealing with legal innovation in the community: insights from biodiversity conservation

Mitigation measures for tackling the consequences of a changing climate will involve efforts of various types including the conservation of affected ecosystems. For this, communities throughout the world will be called on to change habits of land and water use. Many of these changes will emerge from the multilevel governance tools now commonly used for environmental protection. In this article, some tenets of a social psychology of legal innovation are proposed for approaching the psycho-social processes involved in how individuals, groups and communities respond to multilevel governance. Next, how this approach can improve our understanding of community-based conservation driven by legal innovation is highlighted. For this, the macro and micro level processes involved in the implementation of the European Natura 2000 Network of Protected Sites are examined. Finally, some insights gained from this example of multilevel governance through legal innovation will be enumerated as a contribution for future policy making aimed at dealing with climate change consequences.

Emotional anchoring and objectification in the media reporting on climate change

Using the framework of social representations theory--more precisely the concepts of anchoring and objectification--this article analyses the emotions on which the media reporting on climate change draws. Emotions are thereby regarded as discursive phenomena. A qualitative analysis of two series in Swedish media on climate change, one in a tabloid newspaper and one in public service television news, is presented showing how the verbal and visual representations are attached to emotions of fear, hope, guilt, compassion and nostalgia. It is further argued that emotional representations of climate change may on the one hand enhance public engagement in the issue, but on the other hand may draw attention away from climate change as the abstract, long-term phenomenon of a statistical character that it is.

'Post antibiotic apocalypse': discourses of mutation in narratives of MRSA

In this paper we will consider the question of mutation as it is manifested in press coverage of MRSA in UK hospitals. This represents a fertile field of discourse which brings into focus issues relating to microbes, people and working practices as well as the concepts of risk and vulnerability. A regular feature of reporting has been the presence of explanations for drug resistance involving repeated random mutations of the microbe to achieve progressively greater resistance and versatility, largely through a Darwinian process which is 'clever' at overcoming human attempts at elimination. More recently a discourse has emerged which foregrounds also the vulnerability of patients who are very young, old or otherwise immunocompromised, or whose own genetic makeup might put them at risk from the microbe. The hospital is decentred as a source of infection, and attention is turned instead to nursing homes and gymnasia as sources of infection in the community. This latter development mitigates the responsibilities of hospitals and statutory healthcare providers and turns the risk back towards the individual as a responsible actor in an ecology of mutation.

Social Representation, Change and Resistance: On the Difficulties of Generalizing New Norms

This article addresses the difficulties of generalizing new norms and practices, focusing on the role of the legal system for proposing change and innovation to society. It first presents some contributions offered by the social representational approach for understanding these issues, based on the assumptions of the interdependence both of change and stability, and of the social and the individual. Afterwards it is argued that for advancing the study of change the approach needs to offer more attention to: (1) the role of expert mediating systems regarding the translation of new norms to concrete contexts and their articulation with practices; (2) the arguments and discursive strategies employed in everyday communication to resist change with normative force; and (3) the consequences for the relations between representations and practices of the distinction between 'transcendent' and 'immanent' representations. In the empirical part of the paper, and with the goal of better understanding the difficulties linked to the generalization of new norms and practices, these notions are used for analysing a controversy which, in a context of changed norms regarding public participation, involved the expert and lay spheres in a debate about the built heritage of a community.

Clinical formulation for mental health nursing practice

There are problems for mental health nurses in using psychiatric diagnoses as outcomes of their nursing assessments and nursing diagnoses present similar issues. However, there is a need in practice to link the assessment to nursing interventions in a meaningful way. This paper proposes that the clinical formulation can be regarded as central to providing this cohesion. The formulation does not merely organize the assessment findings but is also an interpretation or explanation, made in consultation with the client, of what meaning can be attributed to the issues explored in the assessment process. Because this interpretation is dependent on both the client's and the nurse's explanatory frameworks, there are multiple ways of developing the formulation. It is also an evolving and dynamic statement of understanding. A case example is provided in the paper to illustrate how the same case can be interpreted in different ways and the implications this has for the nursing interventions provided.