Quality-of-life measurement in depression trials: A consumerist relic

Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and 'choice' a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the 'affective fallacy' (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare.

Lessons learnt while integrating services for children: qualitative interviews with professional stakeholders

BACKGROUND

In the English NHS, integrated care is seen as an opportunity to deliver joined-up care for children and families. This paper examines the lessons learnt by professional stakeholders in the process of developing different examples of integrated models of care/frameworks for children's services.

METHODS

Initial desk research was undertaken to identify different examples of integrated care models and systems/frameworks for children's services. This identified forty-three examples in England. Of these, twelve examples were shortlisted after consultation with the senior managers within the Health and Care Partnership that had commissioned the research, and a more detailed online search for published documents was undertaken. Semi-structured qualitative interviews were then conducted with sixteen professional stakeholders in eight of these examples, ranging from one to four interviewees per example. Interviews focused on the lessons learnt from integrating and transforming services. Data were analysed using framework analysis.

RESULTS

The eight examples vary in their design but have several broad commonalities. A number of common themes and learning have emerged, of which two were identified within all eight examples: the first is about focusing on children and young people; the second is about focusing on partner engagement and collaboration and the importance of building trust and relationships between partners. A number of other important themes also emerged together with several challenges.

CONCLUSIONS

A number of common factors were identified that are essential to success in integrating health and care systems. Common across all localities were being child-centric and focusing on child outcomes plus the importance of building trust, engagement and relationships with partners. The findings can help health and care system leaders transform services to ensure efficiency, improvement in services and integration.

NICE rapid guidelines: exploring political influence on guidelines

The National Institute for Health and Care Excellence (NICE) has been presented as politically independent, asserting it is free from industry influence and conflicts of interest so that its decisions may be led by evidence and science. We consider the ways in which soft political factors operate in guideline development processes at NICE such that guidelines are not truly led by science. We suggest that while NICE procedures explicitly incorporate scientific principles and mechanisms, including independent committees and quality assurance, these fail to operate as scientific practices because, for example, decisions may only be challenged through the courts, which regard NICE as a scientific authority. We then examine what the NICE rapid guideline procedure for COVID-19 reveals about the practical reality of claims about the scientific integrity of NICE guidelines. Changes to guideline development processes during the COVID-19 emergency demonstrated how easy it is to undermine the scientific integrity of NICE's decision-making. The cancellation of the guideline programme and the publication of a rapid guideline process specifically to address the COVID-19 pandemic removed scientific checks and balances, including independent committees, stakeholder consultation and quality assurance, demonstrating that the relationship between NICE and the UK government is more complex than a scientific principle truism. We suggest that NICE is not (and indeed cannot be) truly independent of government in practice, nor can it be truly led by science, in part because of its relationship to the state, which it is simultaneously constituted by and constitutive of.

Levelling the playing field: Exploring inequalities and exclusions with a community‐based football league for people with experience of mental distress

Introduction

Sport workforce strategy in the United Kingdom (UK) has identified the occupational therapy profession as being ideally positioned to contribute to public health agendas relating to tackling physical inactivity amongst marginalised populations, such as disabled people and people with experience of mental distress. However, a robust understanding of the enablers, restrictions, and exclusions such groups encounter when seeking to participate in sport and physical activity is currently lacking.

Methods

This study aimed to gain an in‐depth understanding of the different ways people with experience of mental distress talked about their participation in a community‐based football league in England, in the UK. Nine people took part in this strand of a larger participatory action research (PAR) study, which used go‐along interviews as the method of data collection. In alignment with PAR seeking to address power imbalances, the data from the go‐along interviews were analysed through a Foucauldian lens using a collaboratively produced analytic framework.

Findings

Participants constructed the community‐based football league as fostering feelings of purpose and belonging, against a backdrop of them describing experiencing stigma and exclusion when seeking to be active in their wider communities. They used the concept of occupational marginalisation to further interpret their situation.

Conclusion

Understanding why and how people participate in football extends beyond seeing it as an individual exercise to shared social lives and occupations. With this perspective, occupational therapists could address occupational marginalisation in partnership with community sports organisations, collaborating for wider social change beyond specialist services.

Populism, pestilence and plague in the time of coronavirus

Purpose

This paper aims to explore right wing populist government responses to the coronavirus pandemic.

Design/methodology/approach

This paper is a narrative overview of right-wing populist policies and strategies, which is loosely structured around fascistic themes set out in Albert Camus’ allegorical novel, The Plague.

Findings

Although individual responses to the coronavirus pandemic among right-wing populists differ, they appear to coalesce around four central themes: initial denial and then mismanagement of the pandemic; the disease being framed as primarily an economic rather than a public health crisis; a contempt for scientific and professional expertise; and the “othering” of marginal groups for political ends. Populist responses to the pandemic have given rise to increased levels of xenophobia, the violation of human rights and the denigration of scientific expertise.

Research limitations/implications

This is a narrative overview from a personal viewpoint.

Originality/value

Drawing on themes in Camus' novel The Plague, this is a personal perspective on right wing populist government responses to the coronavirus pandemic. Populist responses to the pandemic have given rise to increased levels of intolerance and xenophobia and the violation of human rights and civil liberties.

Populism and health policy: three international case studies of right-wing populist policy frames

Over the past decade, some of the world's most stable parliamentary democracies have witnessed a revival in right-wing populist political parties, movements and leaders. Although there is a growing body of theoretical and empirical literature documenting the rise of populism, there has been very little exploration of the implications for health policy of this important political development. In this article, we draw from three illustrative international cases, originating from the USA, the UK and Italy, to explore the ways in which right-wing populism influences health policy: the election of President Trump in the United States (and subsequent healthcare reforms), the United Kingdom's vote to withdraw from the European Union (Brexit), and how this has played out in the context of the UK National Health Service, and the rise of a politically aligned anti-vaccination movement in Italy. Drawing on the work of the influential socio-political theorist Ernesto Laclau, we interpret populism as a performative political act, predicated on drawing logics of equivalence (and difference) between different actors. We use this theoretical framing to explore the ways in which the recent upsurge in right-wing populism creates a specific set of barriers and challenges for access to healthcare and the health of populations.

Comparative optimism about infection and recovery from COVID-19; Implications for adherence with lockdown advice

Background

Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people’s health expectations and potentially behaviour during the COVID‐19 pandemic.

Objectives

Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself.

Methods

Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile.

Findings

Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P < .001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year.

Discussion

This is one of the first ever studies to report compelling comparative biases in UK adults’ thinking about COVID‐19.

Getting the Problem Definition Right: The Radical Right, Populism, Nativism and Public Health Comment on "A Scoping Review of Populist Radical Right Parties' Influence on Welfare Policy and its Implications for Population Health in Europe"

Building on Rinaldi and Bekker’s scoping review of articles on the impact of populist radical right (PRR) politics on welfare and population health, this short article formulates three pointers towards a framework that might help structure future research into PRR, populist politics more generally, and coronavirus disease 2019 (COVID-19) and other health issues. First, we discuss the centrality of welfare chauvinism to the PRR’s impact on health, taking this as a cue for a broader reflection on the importance on distinguishing between the nativist and populist dimensions of PRR politics. Secondly, we turn our attention to the potential moderating effect of the PRR’s welfare chauvinism on the welfare cuts proposed by their right-wing coalition partners, comments we see as pointing to the need to focus on nativist, populist, neoliberal and other threats to welfare policy more generally, rather than on the PRR only. Thirdly, we reflect on the paradoxical nature of welfare chauvinism – its negative consequences for the health of the ‘own people’ it proclaims to defend – as a starting point for a brief discussion of the need to consider carefully the not-so-straightforward relation between the PRR’s political rhetoric, its (impact on) policy and institutions, and the outcomes of such policy.

Building spaces for controversial public engagement – Exploring and challenging democratic deficits in NHS marketization

The Brighton Citizen's Health Services Survey (BCHSS) was developed to explore and potentially challenge how knowledge is used and by whom in the production of local health commissioning institutions and relations. Through the creation of an ‘animating set of questions’, it sought to open up spaces through which to make visible some of the ways of knowing and valuing the NHS and health services that had been minimised through the commensuration practices of post-2012 public engagement. In this way there was a clear agenda to facilitate a form of knowledge democratisation which opened up and validated different 'health publics’, in order to explore and broaden participative engagement opportunities. The paper provides an account of the project. It considers the theoretical and methodological underpinnings of this example of ‘evidence-based activism’, reflects on the impact of the project on local commissioning and considers the range of controversies that arose as a result of the work. It explores the way that research straddling the boundary between academic inquiry and political activism speaks to the many issues that are prevalent in the changing HE sector as well as NHS privatisation, health commissioning and public sector cuts.

Risk assessment practice within primary mental health care: A logics perspective

From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.

The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy

Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism.

The anonymity paradox in patient engagement: reputation, risk and web-based public feedback

The UK National Health Service (NHS) has long espoused patient and public engagement. Recent years have seen increasing use of internet-based methods of collecting feedback about patient experience and public and staff views about NHS services and priorities. Often hailed as a means of facilitating participative democratic patient engagement, these processes raise a number of complex issues. A key aspect of it is the opportunity for comment to be made anonymously. Our research reveals an anonymity paradox whereby patients clearly demonstrate a perception that anonymity is a prerequisite for effective use of these feedback processes, whereas professionals demonstrate a perception that patient anonymity is a barrier to effective use. The risks of anonymity are constructed very differently by patients and professionals. Patient concerns around anonymity were not motivated by a general concern about a loss of privacy, but more that a positive identification might compromise future care. For professionals, concerns were voiced more around risks of reputational damage for specific practitioners or practices (in that anyone could say anything) and also that this anonymous feedback was available publicly and that it might go against the medical opinion of the professional. These concerns pointed to important differences in perceptions of patient and professional vulnerability. In the qualitative analysis that follows the key finding was that while anonymity makes service users feel less vulnerable, it can have the opposite effect on managers and clinical staff. This raises important implications for the use and utility of internet-based methods of collecting patient feedback.

Mental health and houses in multiple occupation

Purpose

– Previous research has established that there is a relationship between housing and mental health, however, understanding about how and why housing affects mental health is still limited. The purpose of this paper is to address this deficit by focusing on the experiences of residents of houses in multiple occupation (HMOs).

Design/methodology/approach

– Semi-structured interviews were carried out with 20 HMO residents who were asked about their housing career and experience of living in a HMO. Participants were recruited with assistance from community organisations and landlords.

Findings

– The physical properties and social environment of the property, as well as personal circumstances experienced prior to the move into the property, all influenced how mental health was affected. The authors identify and discuss in detail three key meditating factors: safety, control and identity which may affect how living in the property impacts the mental health of tenants.

Practical implications

– Good property management can lessen the potential harmful effects of living in a HMO. However, poorly run properties which house numerous vulnerable people may increase the risk of poor mental health due to attendant high levels of stress and possible risk of abuse.

Originality/value

– Based on the reports of HMO residents, the authors outline the key mediating processes through which living in HMOs may affect mental wellbeing, as well as illuminating the potential risks and benefits of HMOs, an overlooked tenure in housing research.

Civil society and the Health and Social Care Act in England and Wales: theory and praxis for the twenty-first century

In this paper we revisit the notion of civil society in the light of recent attempts to privatize health care in England via the passing of the Health and Social Care Act of 2013. This legislation promises a re-commodification of the National Health Service (NHS) in England. The Bill was bitterly contested during its passage through parliament, most vigorously in 2011. Much of the opposition occurred at a time of widespread, global rebellion, most notably in the 'Arab uprisings' and through the 'occupy movement'. Despite a plethora of protests, we argue, a non-porous boundary between what we call the 'protest sector' of civil society and the wider public sphere of the lifeworld has become apparent in England. A good deal of collective action, whether campaign-focused (like opposition to the Health and Social Care Bill) or more generalized (like rejections of corporate greed), has so far proved ineffective, at least in the short-term; no crisis of legitimation is apparent. We highlight a new 'class/command dynamic', leading to oligarchic rule, in the present era of financial capitalism. We use this health care case-study to re-examine the notion of civil society and its changing properties in what Castells calls a 'networked society'. The contribution ends with a discussion of the role of the sociologist re-civil society and the advocacy of both 'action' and 'foresight sociologies'.

Patients, consumers and survivors: a case study of mental health service user discourses

This paper is an exploratory study of ways of talking about mental health. Drawing upon data collected from mental health service users in the Republic of Ireland, it employs discourse analysis within a case study approach to embellish three 'types' of service user identified in the sociology literature. Rather than being seen as specific types it is proposed that patient, consumer and survivor be regarded as a discursive typology which function as discursive resources for service users. The re-conceptualisation of these types, as discourses, allows the researcher to gain thicker descriptions of the ways in which service users socially construct their own perspectives on mental illness. Through a process of discourse analysis, discourses of patients, consumers and survivors are extrapolated out from interview talk with members of mental health social movement organisations or groups. The identified discourses contain intrinsically different ways of talking about mental illness and allude to different conceptions of agency on the part of the service user. It is argued that they offer an insight into bottom-up social constructions of mental illness. It is proposed that these discourses suggest that notions of patients, consumers and survivors have entered the service users' discursive canon and that they are actively utilised by service users to socially construct their perspectives on mental health.