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Expanding on an interdisciplinary event that was part of the Tavistock Centenary celebrations, this paper explores experiences of leadership and followership in the orchestral context. Drawing on a sample of literature from a range of sources exploring organisational life in the orchestra including organisational psychology, music education, social semiotics and sociology, and with reference to psychoanalytic and systems psychodynamics frameworks, the paper makes links between experiences of leadership and followership in the orchestra and work in the NHS. [ABSTRACT FROM AUTHOR]

Background: Art therapy in perinatal parent-infant work is a developing area of practice in the UK. One in five mothers experience a mental illness during the perinatal period or during the early years following birth. It is likely that more than half of perinatal illness remains untreated. Parental stress and relational adversity are known to influence infant neurodevelopment. Context: This paper describes the introduction of art therapy in an NHS perinatal parent-infant mental health outpatient facility. The department concerned authorised an art therapy service evaluation during 2017. Views and experiences of nine mothers with mental health issues, who attended the service with their babies, were collected and are included here. Approach: The approach to perinatal parent-infant art therapy described is systemic in that it is underpinned by the concept of ecosystem and psychodynamic because it is informed by transgenerational relational effects that a parent's mind has on an infant's developing personality. Outcomes: The mothers who attended this perinatal parent-infant art therapy service felt their views and worries were considered and they perceived art therapy as helpful. Positive changes perceived by mothers include better self-understanding, comprehension of problems, positive mood changes, and improved interrelations with their babies. Conclusions: The mothers who experienced this innovative approach perceived the sessions as helpful in relation to their perinatal parent-infant mental health. Art therapy was well supported within the interdisciplinary perinatal parent-infant service. Implications for research: Further research is now needed to test clinical effectiveness and the potential for intergenerational repair. Plain-language summary This paper describes the introduction of art therapy in an NHS perinatal parent-infant mental health outpatient service. This facility is one of only a few in the UK which provides both a perinatal and a parent-infant service for parents with mental health and bonding issues. The perinatal period lasts from around twenty-weeks before to twenty-weeks after birth. One in five mothers suffer a mental illness during this time or during the early years of their infant's development. It is likely that more than half of perinatal illnesses remains untreated. Here we outline the underlying theoretical framework of this approach to perinatal parent-infant art therapy before describing the experiences and views of nine mothers who attended the service with their babies and agreed to take part in a service review authorised by the department. We asked one mother to talk about how difficult memories sometimes got in the way of the relationship she had with her new baby. She told us how art therapy and art making helped her express her thoughts and feelings outwardly. This gave her more 'head space' to think about what her baby needed to develop healthily. All mothers who attended this service felt their views and worries were considered and they perceived art therapy as helpful. Positive changes perceived by mothers include better self-understanding, comprehension of problems, positive mood changes and improved interrelations with their babies. In conclusion, the paper describes the ways in which art therapy within perinatal parent-infant work, using the approach described in this paper, may have provided a small window of opportunity for influencing change and intergenerational repair for the nine parent-infants who participated in the review. Future research is however needed to gain a better understanding of the mechanisms of change and to test clinical effectiveness. [ABSTRACT FROM AUTHOR]

In April 2013 the local public health function in England was returned from the National Health Service (NHS) to local government, reversing the transfer to the NHS made in 1974 with the abolition of the medical officer of health. Although many in the field had long felt that local government was the appropriate home for public health given its wide-ranging responsibilities for the social determinants of health, the timing was poor. Local government was in the third year of what continued to be an unprecedented ten-year period of austerity imposed by central government with cumulative cuts of the order of 40% for many local authorities. And despite an initial commitment to a ring-fenced public health grant, this grant has been cut each year since 2015–2016 in addition to the wider local authority funding cuts which have had inevitable knock-on effects on the public health function. Crucial public health services such as early years, smoking cessation and sexual health services have all been cut. Despite these cuts the UK government continues to claim a commitment to improving public health and tackling inequalities in health. This study examines the government's discourse on funding local public health services, and the ways in which it has responded to critics through a detailed documentary analysis of key government white papers, ministerial statements and its responses to criticisms, particularly from parliamentary select committees and professional bodies. The paper concludes by considering the implications for effective local public health action in a national regime of austerity. [ABSTRACT FROM AUTHOR]

A theoretical paper which considers the previous multiple attempts by nursing to engage with and usefully apply the theories of psychoanalysis to varying aspects of the nursing role. References to psychoanalysis within the nursing literature of the last century are reviewed and the legitimacy of the use of psychoanalytic theory 'outside the clinic' explored with reference to general hospital nursing in the UK's National Health Service. Themes explored include unconscious motivation behind nursing as a career choice, with associated risks of stress and burnout when the unconscious drive to heal is thwarted. Psychoanalytic consideration of nurse-patient relationships provides insight into the patient experience on hospital wards, whilst exploration of other aspects of the nursing role was found to be limited. From a wider perspective, psychoanalysis offers nursing an insight into societal changes impacting the profession. The systems and processes of the healthcare institution have also been explored, particularly in relation to containment of anxiety, though limited practical impact has resulted from the psychoanalytic insight encountered in the literature. The limited engagement between psychoanalysis and general nursing is considered from both a psychoanalytic and nursing perspective; ongoing potentiality for enriching dialogue between the disciplines is established and potential barriers explored. [ABSTRACT FROM AUTHOR]

With the Institute of Health Promotion and Education turning 60, it is timely to reflect on health promotion's journey. While health promotion can celebrate many advances, much remains to be done. This paper considers the enormous challenges we face and how we might move forward by working not only within, but beyond, the five action areas of the Ottawa Charter: engaging creatively with the opportunities offered by the changing contexts in which we operate, for example in relation to integrated care systems and place-based partnerships; learning from our experience of COVID-19 to ensure joined-up whole system responses that nurture the transformative change necessary to 'build back better' for a sustainable and healthy future; and advocating a new economic vision and model that rejects economic growth as an end in itself and refutes the assumption that such growth will automatically result in improved population and planetary health. Health promotion is inherently political. Reflecting on the UK's current situation – with spiralling child, food and fuel poverty, flatlined/reduced life expectancy, increased inequalities, and the ongoing failure of government to take on powerful vested interests through legislative, regulatory and fiscal measures – we face a crisis. However, a crisis represents not only danger, but also a potential turning point. This should motivate the health promotion workforce to harness and channel its righteous anger; and give space for active hope that we – as citizens, professionals and members of families and communities – can envision, advocate and fight to secure the wellbeing of people, places and the planet. [ABSTRACT FROM AUTHOR]

Many migrant groups, particularly those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care as well as poorer physical and mental health outcomes. The role of post-arrival experiences in contributing to these inequities is increasingly being explored, and it is suggested that being a migrant is itself a determinant of health outcomes. Drawing on the theoretical concept of structural vulnerability, this paper explores ASRs' experiences of health, wellbeing, and health practices in the context of their lived realities in Scotland. 24 semi-structured interviews were conducted with ASRs from Sub-Saharan Africa between January and December 2015. Data were explored using thematic analysis. Experience of the UK asylum system, both alone and in conjunction with other sources of vulnerability including racism, poverty, and language barriers had a negative and ongoing impact on the physical and mental health of ASRs. These impacts continued, even once refugee status was obtained. Efforts to engage ASRs in preventive health programmes and practices must take into account the ways in which the asylum system acts as a determinant of health, affecting both what it means to be healthy and what capacity individuals have to engage with their health. Political choices in how the asylum process is enacted have far-reaching implications for individual and population health. [ABSTRACT FROM AUTHOR]

Delivering Art Psychotherapy online has become a necessary part of practice for many in 2020 due to the Covid-19 Pandemic. Art Psychotherapy practice and theory needs to be considered in light of this new way of working in addition to the impact on clients themselves. This paper considers an experience of delivering online group Art Psychotherapy to adolescents attending an NHS day service programme for Anorexia Nervosa. A case vignette of three group sessions is provided to illustrate the process. The experiences and reflections of three clients are reported. The approach to the art therapy described is psychoanalytical as it focuses on importance of the relationship between the internal and external world and mentalization based as it aims to increase capacity to perceive and understand self and others. It is argued that there are additional considerations for this client group when working online including body image concerns and experience of gaze. Consideration of the unique requirements of this client group are important when devising protocol for ways of delivering art therapy online. Further research could consider, on a larger scale, the perspectives of clients with eating disorders on having art therapy delivered online. This paper describes the set up and delivery of an online Art Psychotherapy group for adolescents with Anorexia Nervosa as part of an NHS day service. The group ran for seven weeks and was attended by three clients. I outline the theoretical framework of my approach to delivering this intervention. Theories of containment, gaze and joint attention are highlighted as being particularly relevant for working with this client group online. I describe the experiences of the clients who attended as well as my process as the art therapist. I note the main themes arising from this group as an intensified experience of gaze, body image concerns and a desire for control over what might be seen or shown. I reflect on my experience of feeling deskilled and having to alter my process to adjust to working online. I conclude that when working with this client group online these are important considerations to bear in mind. Future research is needed to gather perspectives from clients with eating disorders regarding their experience of art therapy being delivered online. [ABSTRACT FROM AUTHOR]

Objectives: Persons with disabilities (PWD) often experience risks associated with HIV/AIDS including unmet needs and overlooked stigmatization. This could be attributed to certain misconceptions such as PWDs are asexual, and cannot enjoy sexual pleasure, among others. Therefore, this paper sought to investigate the extent of disability inclusion in recent National Strategic Plans (NSPs) for HIV/AIDS in West African countries. Methods: This study was a policy review of NSPs in 13 African countries. Relevant indicators in the UN Convention on the Rights of Persons with Disabilities and the UNAIDS International Guidelines on HIV and Human Rights were used. Six indicators (identification of people living with disability (PLWD) as a key population, the inclusion of principles related to PWD within the NSPs on HIV/AIDS, protecting the rights of PWD, recognition of PWD as a vulnerable population at higher risk of HIV and in need of special protection, providing HIV-related support services for PWD and monitoring and evaluating the impact of HIV on PWD). Results: Findings from this study revealed that only 30% of West African countries recognized disability as an issue of concern. Also, 38.5% of these countries recognize the vulnerability of people with disabilities to HIV. However, only a few (7.6%) provided support in the context of special needs, monitoring, and surveillance specifically for persons with disabilities. Conclusion: Most of the West African NSPs are outdated and due for renewal. Therefore, it is necessary to integrate the needs of persons with disabilities within the context of HIV/AIDS in the NSPs. More importantly, support and services should also be prioritized among the vulnerable groups to optimize inclusion. [ABSTRACT FROM AUTHOR]

Parent and therapist engagement and partnership are critical in early intervention physiotherapy and occupational therapy for infants with cerebral palsy to improve outcomes. The main aim of this study was to understand how parents perceive their engagement experience in early intervention over time. Grounded theory methodology was used. Twenty parents of diverse backgrounds participated in 22 interviews (including some repeated longitudinally) to reflect on their engagement experience within the context of early intervention community services provided in the UK NHS. The findings highlight how parents' perspectives of their engagement in EI change according to critical circumstances, including their preceding neonatal trauma, the at-risk CP label, firmer diagnosis of CP and their child's response to intervention. We theorise that this disrupted transition experience to parenthood becomes part of parental framing (or sense-making) of their engagement in EI. Overlapping frames of uncertainty, pursuit and transformation capture and explain nuances in parents' engagement patterns within EI over time. This theorising has implications for early intervention therapists in how they engage in the lives of families and partner with parents to support healthier parental transition, wellbeing and subsequent improved infant outcomes. New insights are provided into how recent advances to prognostic practices for infants with cerebral palsy affect parental perspectives and their engagement experience in early intervention The paper's organising concepts support a clearer understanding for early intervention practitioners of this complex parent experience Early intervention practitioners are encouraged to reflect upon their practice as they engage in families' lives and partner with parents during this challenging period to optimise outcomes [ABSTRACT FROM AUTHOR]

Controlled Organ Donation after Circulatory Death (DCD) was re-introduced in the UK in 2008, in efforts to increase rates of organs for transplant. Following reintroduction there were debates about the ethics of DCD, leading to production of legal and ethical guidelines. Today, DCD makes up 40% of deceased organ donors, leading to claims that the UK has 'overcome' its ethical challenges. However, there is little understanding of how DCD works in practice and the ethical implications of making DCD routine in the context of the NHS. This paper draws on data from an ethnographic study examining the practices of DCD in two acute NHS Trusts in England. Interviews with Intensive Care staff and Specialist Nurses in organ donation, observations of organ donation committee meetings and analysis of Trust documents were conducted. Findings reveal that the routinisation of DCD has created new ethical issues relating to interactions between organisational timeframes for DCD and (under)resourcing for, and de-prioritisation of, donation within an NHS subject to austerity. They include: the perceived burden on families and implications for consent when there are delays in the donation process, due to theatre space and retrieval team shortages; family and staff distress when death does not happen 'on time'; and the problem of where to take patients who do not die in time to donate. I argue these temporal-ethical issues are likely to become heightened as potential donor rates increase with the new opt-out legislation, unless the resourcing required to deal with these problems are also addressed. [ABSTRACT FROM AUTHOR]

Cognitive Behavioural Therapy for Psychosis (CBTp) is recommended in National Institute for Health and Care Excellence (NICE) Guidelines (2014) and Scottish Intercollegiate Guidelines Network (SIGN) Guidelines (2013) and is widely accepted as a helpful approach for people with lived experience of psychosis or schizophrenia. Despite this, research suggests that implementation rates across the UK remain extremely low and people with a psychotic spectrum disorder struggle to gain access to CBTp. Objective: To review current research evidence on the barriers to the implementation of CBTp in the UK. Design: Narrative review of the literature. Method: Using narrative synthesis the data from 18 relevant articles were extracted concerning the barriers to the implementation of CBTp. Conclusions: Key barriers identified in the literature include organisational, staff and service user barriers. [ABSTRACT FROM AUTHOR]

Using examples from the National Health Service in England, this paper illustrates key features of contemporary healthcare governance: the way decisions are hidden in places that are 'in between' and 'out of reach'; the enrolment of doctors in governing; and the important role played by 'boring things', such as power point slides, flow charts, and forms. The essay shows how anthropological proximity and perspectives can extend and deepen understanding of contemporary political power. It does this firstly by showing the importance of agency in the operation of governmentality, and secondly by illuminating the limits of governmentality. The different elements of governing assemblages, such as global management experts, medical leaders, forms of knowledge and analytical technologies, are brought together through the strategic act of framing. Frames are contested and resisted, requiring more visible forms of control. [ABSTRACT FROM AUTHOR]

Psychoanalysis has been around in India for over a century now, beginning with the works of G.S. Bose in 1910s. However, the popularity, acceptability and accessibility of Psychoanalytic Psychotherapy has had a fluctuating course in the mental health arena of the country. The initial enthusiasm seems to have been circumscribed within the academic community and appears to have taken objections with its 'foreign origin and roots'. This approach to psychotherapy was seen as alien to the Indian culture and was not welcome warmly as a treatment strategy. However, there have been some recent attempts in making this style of thought and school popular and accessible in clinical settings and there seems to be a slow but gradual increase in the usage of Psychoanalytic thinking in both clinical and non-clinical settings. The paper reviews the history and describes the current state of Psychoanalytic Psychotherapy in India and highlights the difficulties in accessing the therapy within the national health schemes. [ABSTRACT FROM AUTHOR]

Building synergies is seen as an effective strategy to address and decrease existing fragmentation in health systems of low-and middle-income countries (LMICs). To that end, different programmes, such as the Sector Wide Approach, have been adopted to increase health system synergies. Despite these efforts, fragmentation remains an enduring problem, hampering health system performance in LMICs. This study is part of the Lancet Commission on synergies between Universal Health Coverage, Health Security, and Health Promotion; we aimed to document synergising strategies adopted by Rwanda. Data for this paper came from a qualitative study including in-depth interviews of 15 key informants and a document review. A thematic analysis embracing deductive and inductive approaches was used to analyse the data. We found that Rwanda adopted three main strategies to increase health system synergies: (1) alignment of health programmes with national health policies and strategies, (2) increased coordination across national health institutions, and (3) effective monitoring and evaluation frameworks. Achieving synergies in a low-resource country is challenging but not impossible. To meet the target of global health agendas such as the Sustainable Development Goals and the prevention of future global pandemics, efforts to increase health system synergies in LMICs need to be strengthened. [ABSTRACT FROM AUTHOR]

Global health has become fashionable and an important topic on the international policy agenda. Even before the COVID-19 pandemic, cross-border infectious diseases had provoked a great deal of media and public interest, academic research and foreign-policy agendas. This paper analyses the relevance of health security in global health. It stresses global health as an explicitly political concept taking into consideration existing inequalities and power asymmetries. Global health represents the necessary evolution of public health in the face of ubiquitous global challenges and the growing number of international players. Some of them tend to divert global health towards technification, marketisation and privatisation, promoting biomedical reductionism and predominantly technological solutions. Overall, the current global health concept fails to adequately consider the global burden of disease, which is largely determined by non-communicable conditions. Global health goes beyond preventing infectious diseases and health security and must first and foremost focus on the social, economic, ecologic and political determination of health, which interacts with non-communicable and communicable diseases, turning them into syndemics. Health-in-all policies in a global perspective are required for sustainably reducing health inequalities within and between countries, instead of primarily focusing on security and safeguarding the status quo in a changing world. [ABSTRACT FROM AUTHOR]

Since the outbreak of the global financial crisis that started in 2007/8, austerity measures have been promoted in many European countries. Frequently justified as a form of crisis-management, these measures have been used to further privatise and deregulate welfare systems, as well as to reinforce the isolation of certain decision-making arenas from democratic processes. At the same time, they have also generated new strategic opportunities for resistance to different forms of anti-austerity disruptive agency. The paper analyses the rescaling strategies implemented in public health services in Spain and the UK during the current economic crisis, and contributes to the understanding of the scalar dynamics and strategies of two social struggles against the privatisation of hospitals and health centres in these two contexts: Marea Blanca (White Tide) in Madrid and Keep Our NHS Public in Greater Manchester. It argues that social movements are more successful when they exploit scale shifts to transform institutions into centres of resistance. [ABSTRACT FROM AUTHOR]

This article explores art therapy and EMDR for the treatment of complex PTSD caused by childhood sexual abuse, from the point of view of both client and therapist. It was co-written with a former client who wishes to remain anonymous. The therapeutic work took place in an NHS community setting. The idea of writing together – emerged organically as therapy came to an end, with both client and therapist feeling they have learnt from the process and that sharing these ideas could be beneficial for other practitioners. While psychodynamically informed, much of the intervention followed the main principles of a trauma-focused approach with an emphasis on embodied processes – both in art therapy and EMDR. The client made a great deal of progress during therapy and both writers explore the changes and insights that were gained as part of the article, with a particular emphasis on using interoceptive skills to enhance emotional processing. When working with clients who have complex PTSD it is important to be aware of trauma-informed approaches and the role of grounding, stabilisation, embodied experiences and trauma processing. At times, this might be essential in order to help clients manage high levels of emotional arousal in the room, learn to contain their distress and improve their symptoms. More research is required to establish ways in which trauma-informed thinking can be incorporated into art therapy, the link between visual and emotional processing, and whether art therapy can improve interoceptive ability. Plain-language summary This article contains the summary of three years of art therapy and Eye Movement Desensitisation and Reprocessing (EMDR). It was co-written with 'Rob' (pseudonym), a male client in his mid-thirties who has a history of childhood sexual abuse and who wishes to remain anonymous. In the paper, Rob provides his account of the intervention while I explain my process as a therapist. I had limited experience of complex trauma work before I met him, and in many ways the journey was transformative for both of us. In my writing, I briefly outline the theoretical basis of my thoughts and choices within our art therapy sessions. I reflect on the way my practice has expanded and changed, in order to incorporate an understanding of the way trauma affects the body and how we can work with the body in art therapy. As an EMDR therapist, I often combine EMDR and art therapy with clients who have complex trauma and believe that these two approaches can complement each other. Therapy with Rob was often difficult to contain and there were times where his risk – of self-harm, substance misuse and suicidal urges – had to be carefully considered and managed. The principles of trauma-informed interventions were crucial for our work together. This includes explaining the current research about trauma to the client, so that the client understands his/her experiences better. It also involves helping clients to feel as calm and safe in the room and in their own bodies as possible, and maintaining an emphasis on body sensations in the here-and-now. The article considers the idea of 'interoceptive imagery' as a way of working with the body in art therapy with traumatised clients. Some of Rob's images are explored and a link is provided for a video we co-produced, where he discusses more of his journey and his artwork. [ABSTRACT FROM AUTHOR]

Vietnam's health system continues to make great progress in improving its capacities and performance. However, despite the many significant achievements that have been made, this paper summaries 11 health system research papers from different perspectives with the aim of providing scientific evidence for policy actions in Vietnam. Health system research is ultimately concerned with improving the health of people and communities, by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development, with full involvement of all actors. We hope the findings from this cluster of papers provide some insights into issues of importance for the continued advancement and strengthening of the health system in Vietnam and can be considered a valid and reliable resource to inform planning, management and policy-making decisions. [ABSTRACT FROM AUTHOR]

India’s experience with the National Rural Health Mission (NRHM) is notable on account of nationally formalising – at scale – community action in service delivery,monitoring, and planning of health services. A study was undertaken to document and create a historical record of NRHM’s ‘communitization’ processes. The oral history method of the Witness Seminar was adopted and two virtual seminars with five and nine participants, respectively, were conducted, and supplemented with 4 in depth interviews. Analysis of transcripts was done using ATLAS.ti 22 with the broad themes of emergence, evolution, and evaluation and impact of ‘communitization’ under NRHM. This paper engages with the theme of ‘emergence’ and adopts the Multiple Streams Framework (MSF) conceptualised by John Kingdon for analysis. Key findings include the pioneering role of boundary spanning decision makers and the Jan Swasthya Abhiyan (JSA) in advocacy and design of ‘communitization’ structures, and the legacy of rights based social mobilizations and state-civil society partnerships in health during the 1990s influencing the ethos underlying ‘communitization’. Democracy, leadership from the civil society in policy design and implementation, and state-civil society partnerships are linked to the positive results witnessed as part of ‘communitization’ in NRHM. [ABSTRACT FROM AUTHOR]

Since the introduction of the Improving Access to Psychological Therapies (IAPT) programme in NHS England, psychological therapy has gained traction as 'evidence-based' and 'effective' in both clinical and economic terms. In the process, psychotherapeutic care has been reconstituted as highly manualised, standardised, and quantifiable. Drawing on anthropological fieldwork with mental health practitioners, this paper examines some common tensions that practitioners experience in their daily work where psychotherapy is sought within the framework of evidence-based medicine (EBM). For therapists working within IAPT, extensive monitoring and practices of accountability have come to undermine psychotherapeutic efforts to care for patients as 'people'. As a result, many practitioners now feel that they are working in a 'factory of therapy' whereby psychological treatment is recast in the service of outcome measures, and by which critique of the IAPT service, as well as caring relations within it, have been precluded. [ABSTRACT FROM AUTHOR]

This article provides a description of the development and work of The Fitzjohn's Unit a specialist service, housed within the Adult Department of the Tavistock and Portman NHS Foundation Trust, providing psychoanalytic psychotherapy for patients suffering from the more complex/serious disorders many of them having been unwell for many decades. The paper describes the patients treated, the model of care and also aims to show how this work can illuminate more general consideration such as the nature of the psychoanalytic attitude and the relation of psychiatry to psychoanalysis [ABSTRACT FROM AUTHOR]

As part of a planned series from Global Public Health aimed at exploring both the epistemological and political differences in diverse public health approaches across different geographic and cultural regions, this special issue assembles papers that consider the legacy of the Latin American Social Medicine and Collective Health (LASM-CH) movements, as well as additional examples of contemporary social action for collective health from the region. In this introduction, we review the historical roots of LASM-CH and the movement's primary contributions to research, activism and policy-making over the latter-half of the twentieth century. We also introduce the special issue's contents. Spanning 19 papers, the articles in this special issue offer critical insight into efforts to create more equitable, participatory health regimes in the context of significant social and political change that many of the countries in the region have experienced in recent decades. We argue that as global health worldwide has been pushed to adopt increasingly conservative agendas, recognition of and attention to the legacies of Latin America's epistemological innovations and social movement action in the domain of public health are especially warranted. [ABSTRACT FROM AUTHOR]

This paper examines the international networks that influenced ideas and policy in social medicine in the 1930s and 1940s in Latin America, focusing on institutional networks organised by the League of Nations Health Organization, the International Labour Organization, and the Pan-American Sanitary Bureau. After examining the architecture of these networks, this paper traces their influence on social and health policy in two policy domains: social security and nutrition. Closer scrutiny of a series of international conferences and local media accounts of them reveals that international networks were not just 'conveyor belts' for policy ideas from the industrialised countries of the US and Europe into Latin America; rather, there was often contentious debate over the relevance and appropriateness of health and social policy models in the Latin American context. Recognition of difference between Latin America and the global economic core regions was a key impetus for seeking 'national solutions to national problems' in countries like Argentina and Chile, even as integration into these networks provided progressive doctors, scientists, and other intellectuals important international support for local political reforms. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue including one on the experiences of being a family member affected by a relative's alcohol or drug misuse, one on the different modes for delivery of the intervention, and one on the opportunity for reflection on the program of work .

Background: This paper examines the introduction and operation of a number of support roles in mental health services. This is done in the context of concerns about the effectiveness of CMHTs. Aims: Three questions are addressed: the degree to which concern for the work of consultant psychiatrists informed the introduction of the new roles; what the reforms implied for the work of the psychiatrist and those in new roles; and the impact of any changes on the operation of CMHTs. Method: Data were collected as part of a national-level evaluation. The main means of collection was the semi-structured interview. Results: The study shows: that reform was underpinned by concerns about the workload of psychiatrists; and that while in principle the responsibilities of the psychiatrist were to be distributed across other team members, those in new roles felt themselves to be isolated. Conclusions: Despite the intentions of policy, the creation of the new roles did little to extend the idea of distributed responsibility in CMHTs. [ABSTRACT FROM AUTHOR]

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The City and Hackney Primary Care Psychotherapy Consultation Service is an innovative, public sector service designed to support GPs in meeting the needs of patients with complex psychological/physical health issues throughout the London Boroughs of Hackney and the City. This paper provides an account of how this new model for the National Health Service (NHS) developed in the context of psychotherapy provision within the NHS, within the national and local context in the UK and gives an overview of some the service's key features and how it differs from other services operating in primary and secondary care. A linked paper, in this journal, explores the reality within which the service functions and describes clinical outcomes, health economic data, the modifications to the original model and prospects for the future. [ABSTRACT FROM PUBLISHER]

Music is universal; it can provide a common language that speaks from the heart enabling others to connect with the private felt experiences of others regardless of differences within or between people. This ability to empathise with, and understand, the position of others from differing backgrounds is an important competency within the therapeutic work of Clinical Psychologists. There are many facets to diversity just as there are many facets to music. Diversity in music genres can reflect diversity in people. Indeed, there is music to cater for all tastes, cultural/ethnic backgrounds, gender, age and generations with listening often being guided by individual preferences. In the United Kingdom training to become a Clinical Psychologist consists of a university-based 3-year full time professional research doctorate funded through the National Health Service. Trainees work on placements 3 days a week and attend university for academic and research teaching 2 days a week. As part of the academic programme, Trainees undertake experiential learning through workshops and methods such as Problem-Based Learning (PBL). One of the PBL exercises is based on a typical referral within an Adult Mental Health (AMH) service. For the AMH PBL exercise music is used to enhance trainees’ ability to connect emotionally with the personhood of referrals, consider associated complexities, and to reflect on personal and professional boundaries and reflective practice during training and beyond. This paper reflects on the utility of music and songs to enhance the learning experience. [ABSTRACT FROM AUTHOR]

Background/purpose: This paper presents the findings of an action research (AR) project to improve a health information system (HIS) at the Operating Theater Department (OTD) of a National Health Service (NHS) hospital in South East England, the UK.Methods: Informed by socio-technical systems (STS) theory, AR was used to design an intervention to enhance an existing patient administration system (PAS) to enable data entries in real time while contributing to the literature. The study analyzed qualitative data collected through interviews, participant observations, and document reviews.Results: The study found that the design of the PAS was unsuitable to the work of the three units of the OTD. Based on the diagnoses and STS theory, the project developed and implemented a successful intervention to enhance the legacy system for data entries in real time.Conclusions: The study demonstrates the value of AR from a socio-technical perspective for improving existing systems in healthcare settings. The steps adopted in this study could be applied to improve similar systems. A follow-up study will be essential to assess the sustainability of the improved system. [ABSTRACT FROM AUTHOR]

National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues, however, federal health financing regimes differ in ways that are shaping the agenda for post-pandemic reforms. The analysis, which focuses on health care financing in three federal countries (Canada, the United States, and Mexico), explores the current and potential future impact of COVID-19 on existing policy legacies. [ABSTRACT FROM AUTHOR]

Delivering optimal and equitable palliative care is an international challenge. There are few cross-national comparisons examining challenges in expanding palliative care along public health lines. This paper presents a critical review of palliative care in the USA and England, which share similar challenges but have different contexts of healthcare. Beyond some obvious differences in the organisation of palliative care, a set of underlying common issues can be identified. A key tension in both is balancing attention ‘downstream’ in the dying phase, as well as ‘upstream’ earlier in the course of serious illness. In both, the dominant models of palliative care provision have resulted in excellent care towards the end of life for some patients, but there remain major deficiencies in care for the majority. England has a National Strategy for End-of-life care; the US has no equivalent, although a number of influential agencies have published statements. Achieving a public health approach in palliative care requires international consensus on the meaning and target population of palliative care, replacement of prognosis based understandings of entitlement to palliative care with a needs-based approach and development of an evidence base for cost-effective partnerships between providers across the specialist–generalist divide. [ABSTRACT FROM AUTHOR]

This paper explores why leadership, especially senior leadership in British organizations, is persistently nearly always white. The paper contends that beneath the veneer of our apparent commitment to equal opportunities, primitive often unconscious factors operate to ensure that leadership remains white, thus reproducing a racial hierarchy in the workplace. It argues that the barriers to black and minority ethnic people getting appointed to leadership positions in organizations today are largely invisible and are hidden within the psyches of decision makers, the cultures of white organizations, and their combined impact on the confidence of black and minority ethnic staff. [ABSTRACT FROM PUBLISHER]

This article examines how an expanding Mexican state sought the insights of ethnographic theory and practice between the 1940s and 1950s. Focusing on the Instituto Nacional Indigenista Coordinating Center in los Altos de Chiapas and its relationship with national and foreign researchers active in the same area, I show how ideas about gender affected the organization of health services, the hiring of indigenous promotores, and the differential treatment of women and men traditional medicine healers as well as anthropology graduate students and researchers. The article is organized around two conceptually distinct though, in reality, overlapping spaces: (1) the anthropologist's fieldwork site and relations between informants, professors, and students and (2) the Mexican state's provision of health services. Even if gender was not an automatic category of exclusion or inclusion of the researcher into a local community, ethnographic insights were formed through fieldwork practices that were determined in part by gender difference and relations among researchers and their subjects. Ultimately, both anthropologists and the Mexican state indigenous agency grew to rely informally on gender as a category of expertise for gaining access to indigenous women in particular, even if the "gender intermediaries" who helped achieve this access were frequently unpaid and received little formal recognition or reward. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Neil Thompson and Mary Walsh on understanding existential philosophy, one by Carolus Van Nijnatten and Marianne Heestermans on the impact of sexual abuse and one by Julie Morton on the role of emotions.

Given the challenges of climate change and population growth, it is essential for planners to think about the health of people and the planet in an integrated way. Until recently the profession has focused on environmental sustainability without necessarily making the link to human health. This is despite mounting evidence for the critical role urban planning plays in supporting human health and wellbeing. Walkable and mixed use urban areas, active and public transport modes, open space and locally sourced fresh food, together with safe and well-designed neighbourhoods, are the foundations of both environmental and human health. Regional plans set the framework within which these outcomes can be realised. This paper examines how the South East Queensland Regional Plan 2009-2031 proposes to manage human health in relation to environmental sustainability. Using a detailed textual analysis of the Plan, the paper investigates how well the Plan incorporates a comprehensive suite of inter-sectoral provisions that will build the strategic policy foundation for supporting human health and environmental sustainability in a high growth scenario. Further, consideration is given to how the specific provisions will translate into future actions and development requirements for the Region. [ABSTRACT FROM AUTHOR]

This paper challenges the elite position given to randomised controlled trials (RCTs) in assessing the viability of psychological therapies in the National Health Service. The debate into the significance of the 'allegiance effect' in dictating the outcomes of comparative studies into psychological therapies, particularly research that supports behavioural and cognitive behavioural therapies, reconfirms existing methodological arguments that challenge the claims made by traditional scientific methods of research. The underlying epistemological assumptions of RCTs are identified and critiqued with reference to the work of Husserl, Heidegger and Polanyi. An alternative to a scientific approach to research is explored based on Heidegger's theory of Daisen and Polanyi's work on tacit knowledge. The term 'influence' is presented as an alternative to the pursuit of causality and the discovery of definitive truth, seen as the underlying motives for a scientific approach to research. From this perspective, the determination of a researcher to persuade others of the value of their particular allegiance to a point of view or orientation could be seen as a potential quality of a study rather than a reason to dismiss the findings. Freud's classic case studies are used to illustrate the epistemological concept of 'influence', which represents an understanding of the pursuit of knowledge that is grounded on human experience. The paper concludes by arguing that RCTs should be considered as one of a range of approaches to research that might influence decisions on public funding, seen as part of a more pragmatic approach to research and evidence. [ABSTRACT FROM AUTHOR]

In this brief paper, I argue that the coronavirus pandemic is functioning like an ethnomethodological 'breaching experiment'. In short, it is putting a gigantic spanner in the works of neoliberal governance, in the process exposing the widening cracks and fissures of what I have called the 'fractured society'. I begin by recalling Garfinkel's notion of the breaching experiment and by listing the principal attributes of the fractured society. I then explore the response to the coronavirus in the UK, from the government's initial commitment to 'herd immunity' to its present policy of 'muddling through'. The bulk of the remainder of this contribution addresses precisely how this global health crisis shines a harsh and unforgiving searchlight on the strategies and policies pursued by governments in the UK since 2010, and most especially after the passing of the Health and Social Care Act of 2012. In the closing paragraphs, I examine possible scenarios for a post-fractured society, making particular use of Fraser's concepts on 'reactionary' versus 'progressive populism', and conclude with a comment on sociology and engagement. [ABSTRACT FROM AUTHOR]

Overall, adult men are less likely to seek and receive health care than women, but male circumcision for HIV prevention has been successful in engaging men in health services. The purpose of this paper is to examine the relationship between masculine norms and health care-seeking among men participating in a voluntary male medical circumcision (VMMC) programme in the Dominican Republic (DR). We employed a mixed methods approach integrating survey data collected 6–12 months post-circumcision (n = 293) and in-depth interviews with a sub-sample of these men (n = 30). In our qualitative analysis, we found that health care-seeking is connected to masculine norms among men in the DR, including the perceptions of medical facilities as feminine spaces. Participants' narratives demonstrate that male circumcision programmes may facilitate men overcoming masculinity-related barriers to health care engagement. In quantitative analysis, we found that being concerned about being perceived as masculine was associated with health care-seeking behaviour in the past five years, though this association was not retained in multivariable analyses. Findings indicate that male circumcision programmes can familiarise men with the healthcare system and masculinise health care-seeking and utilisation, easing associated discomfort. [ABSTRACT FROM AUTHOR]

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Adolescents in Tanzania are at risk of many health problems attributed to limited access to quality sexual and reproductive health services. Health professionals are a crucial part of service delivery, and their perspective on providing care is important in understanding the barriers that hamper access to sexual and reproductive health services for adolescents. Better understanding these barriers will support the development of more effective interventions. This paper explores these perspectives in view of the health-policy context that surrounds them. This study has aimed to explore and understand health professionals' perceptions and attitudes regarding the provision of adolescent sexual and reproductive health care in a selected national sexual and reproductive health programme in the Arusha region and Kilimanjaro region, Tanzania. A qualitative cross-sectional interview design was applied. Sixteen in-depth interviews were conducted with health professionals and community health workers. Data was analysed following inductive thematic analysis. Four main themes are identified in the data: concern about the stigma directed towards adolescents; over-medicalisation of services; difficulty involving adolescent males; and ambiguous policies and contradictory messages. The findings suggest that health professionals providing care in the current adolescent sexual and reproductive health programme must navigate the legacy of vertical health programmes as well as contradicting views and messages that are influenced by social norms, by uncertainties about current laws and by statements from political leaders. The findings suggest that future research, policies and health programmes should consider the perspectives of health professionals and their challenges in delivering care for adolescents to help improve the understanding of how to effectively and sensitively implement sexual and reproductive health programmes for adolescents. [ABSTRACT FROM AUTHOR]

This paper offers a theoretical perspective on pharmaceutical policy-making in the European Union, and shows the lack of a single European market in medicines to be the result of a clash between the supranational free movement rules and national healthcare policy competencies. The paper considers the roles of the European Commission, the member states, the industry and consumer interests (patients) as the main stakeholders, and frames the discussion within an integrated macro- and meso-level approach. Here we draw on Wilson's ‘politics of (regulatory) politics’ typology, tying it to Scharpf's ‘constitutional asymmetry’ perspective on EU policy. This enables the development of a broad sphere of analysis, allowing us to make observations on the EU regulatory arrangement for medicines as a whole. Specifically, the paper shows the extent to which industrial rather than health(care) policy interests have driven the development of regulatory policy in the sector, and seeks to understand the political dynamics shaping the on-going evolution of the regulatory framework. [ABSTRACT FROM AUTHOR]

Understanding consumer value is imperative in health care, as the receipt of value drives the demand for health care services. While there is increasing research into health care that adopts an economic approach to value, this paper investigates a non-financial exchange context using an experiential approach to value, guided by social marketing thinking on behaviour change. An experiential approach is deemed more appropriate for government health care services that are free and preventative rather than for treatment purposes. Thus, instead of using an illness paradigm to view health-services outcomes, the researchers applied a wellness paradigm. Data from 25 depth interviews have been analysed by the authors to demonstrate how social marketing thinking has guided the identification of six themes that represent four dimensions of value (functional, emotional, social, and altruistic) evident during the health care consumption process of a free government service. [ABSTRACT FROM AUTHOR]

The recent case of Dr Myles Bradbury, a paediatrician at Addenbrookes Hospital in the UK, has again brought the use and relevance of chaperones back into the minds of healthcare organisations. This paper outlines the recommendations of the report into the actions of Dr Bradbury along with previous reports concerning chaperones and that of professional guidelines on this subject. The use of chaperones specifically is also examined in relation to the historical recommendations and if any new practices should be included in revised policies and processes. [ABSTRACT FROM AUTHOR]

Objective: The aim of the article is to describe the process of implementing the Estonian national second generation electronic prescription service (e-prescription) and determine if the objectives set by the Estonian government were fulfilled.Materials and Methods: The study presents an analysis of both retrospective and current data in the evaluation phase of a design research project. Sources include, among others, publicly available documents and previous evaluation studies.Results: According to all of the major stakeholders, the Estonian e-prescription service has very high usability and user satisfaction scores have been high. There is only little empirical evidence available to confirm if the benefits aimed for in the creation of the service were achieved. From a public administration viewpoint, the implementation of e-prescription has led to potential efficiency gains.Conclusion: The Estonian second-generation e-prescription system is widely used by citizens, healthcare providers and administrators alike. However, there are gaps in measuring the impact of the service, especially with respect to time savings and enhanced healthcare quality. Additional functionalities will be key drivers in creating benefits for all stakeholders. Future nationwide e-health services should have a more rigorous evaluation process carried out during the design and implementation stages. [ABSTRACT FROM AUTHOR]

The Caribbean, accessed significant external funding over the first three decades of the epidemic, which provided local authorities the opportunity to defer their responsibility in leading or matching the support provided from the external agencies. The reduction in external support has placed increased pressure on the response to the epidemic, with some countries more likely to be affected than others. This paper undertakes a review of the expenditure and funding landscape for HIV programs in the Caribbean. The findings confirm that despite the dwindling number of funding sources, some countries continue to display a significant degree of dependency on external funding sources. It is noteworthy that Treatment and Care accounted for the largest share of HIV expenditure in those countries, which displayed the highest degree of dependency on external funding. While, HIV spending was a relatively small percentage of both total health expenditure and gross domestic product, expenditure levels were noticeably higher in Haiti. These averages however conceal significant differences across countries, which should inform the magnitude and direction of any spending expansion by these countries if they are to achieve financial sustainability. Some recommendations are provided on the way forward to facilitate building a sustainable response to the epidemic. [ABSTRACT FROM AUTHOR]

Much of the practice leadership literature is focused on people and their roles — the who and what of leading, thus neglecting the organisational environment and wider socio-economic and political influences. Taking an ethnographic and sociological approach, we argue for a reimagining of practice leadership as a series of verbs to explore the why and the how of great leadership. Moreover, humane social work practice driven by leaders is best supported by leadership frameworks that support, guide and reinforce the ethical and professional value base of social work. Housed within the West Midlands Social Work Teaching Partnership, and drawing on the sociological imagination, we offer a rationale for a shared organisational and professional leadership vision, congruent with social work values, presented as a leadership framework. This paper offers a leadership framework that brings together, in a logical design, the roles, ethos and responsibilities for every level of the organisation, to strengthen social work practice that is operating within a harsh neo-liberalist backdrop. It offers a methodology to enact the Chief Social Workers' knowledge and skills statements while connecting these to the professional principles of social justice and human rights. Challenges and opportunities in developing and trialling our approach to practice leadership are discussed. [ABSTRACT FROM AUTHOR]

Gender equity can be a neglected issue in health system reforms. This paper explores the multiple layered gender dynamics of the Afghan Community Health Worker (CHW) Program within broader health system reforms in Afghanistan using a qualitative research design. We interviewed policy makers, health managers, CHWs and community members in 16 sites in 2013 and 2014. We found that gendered societal norms interact and influence the Afghan CHW program in a dynamic way. Gendered social norms around the division of labour tend to privilege women in terms of access to resources at the community level, but it is men who hold leadership positions that ultimately decide how the resources are to be distributed. The Afghan Ministry of Public Health expresses a commitment to gender equity, but policies on gender are restricted to reproductive health, thus constraining a gender-equity approach as focused on maternal and child health. Our explicit gender analysis not only reveals gender inequities in the Afghan CHW Program and the broader health system, it also uncovers how a highly gendered division of health labour provides some opportunities for women’s empowerment that can disrupt patriarchal role constraints and broader gender inequities. [ABSTRACT FROM AUTHOR]

Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs. [ABSTRACT FROM AUTHOR]