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3. The camouflaging of austerity : institutional geographies of mental health in contemporary England

Author

Kiely, Edward and Nally, David

Subjects
Geography, Mental health, Austerity, Participant observation, Semi-structured interviews, Feminist geography, Institutional geography, Mental health geography
Abstract

This thesis examines the landscapes of mental health service provision which have emerged under austerity, and the institutional geographies which work to reproduce these. While austerity is sometimes portrayed as a relatively uniform process of retrenchment, I begin by offering a forensic cultural geography of austerity, a granular survey of the uneven geographies of mental health services and spending which emerged between 2010 and 2020. I situate these in a conjunctural analysis of English politics, economics and culture. To conceptualise how these national patterns are rescaled into the everyday, I then turn to the question of austerity's institutionalisation. How is the process of fiscal cutting made ethically and affectively tenable for those who must enact it? These empirical sections build on nine on participant observation with two groups of participants in a county in the south of England: clients and staff at a mental health day centre threatened with closure; and county council commissioners who allocate funding for services. While bureaucrats are typically depicted as meting out austerity with indifference, the commissioners I worked with were deeply invested in the notion that they provided care. Consequently, they reimagined austerity in optimistic terms, as a hopeful process of optimisation. I map the institutional geographies within the council which enabled this austerity optimism to be embodied and felt, and the discourses and knowledge-making practices which underpinned this interpretation. I argue that these practices inculcated an anaesthetic ignorance among the commissioners - a placatory unseeing of austerity's harms which allowed them to continue with the work of cutting. I conclude by foregrounding the voices and experiences of clients at the mental day centre, offering a countertopography which challenges claims of austerity optimism. Here, I theorise austerity and care temporally arguing that budget shortfalls were undermining expansive temporalities of care, intensifying distress and destabilising hopes for the future. In turn, they deepened commodification, tying staff and clients ever more tightly into the logics and time-spaces of the market. This thesis makes four significant contributions to geographical literature. In response to approaches which occlude the complexity of state retrenchment, it develops a comprehensive account of mental health services and expenditure under austerity, relating these patterns to a political and economic conjuncture emergent in Britain since 2010. It furthers geographical research on 'everyday austerity' through a relational account of the institutional geographies which rescale austerity from fiscal policy to quotidian phenomenon, drawing on feminist theories of affective economies. It advances mental health geography by mapping landscapes of service provision under austerity and conceptualising the role of institutional actors in enacting these. And finally, it develops the concept of camouflaging, as a process integral to reproduction and legitimation of austerity. Rather than focussing on moments when austerity materialises and is felt, the thesis charts the practices through which austerity is made to disappear from everyday life.

Published
2022
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5. Neuroblastoma

Author

Kiely, Edward, Höllwarth, Michael E., Lumley, J.S.P., Series Editor, Howe, James R., Series Editor, Puri, Prem, editor, and Höllwarth, Michael E., editor

Published
2019
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8. Conjoined Twins

Author

Spitz, Lewis, Kiely, Edward, Pierro, Agostino, Losty, Paul D., editor, Flake, Alan W., editor, Rintala, Risto J., editor, Hutson, John M., editor, and lwai, Naomi, editor

Published
2018
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10. The Camouflaging of Austerity: Institutional geographies of mental health in contemporary England

Author

Kiely, Edward

Subjects
Feminist geography, Geography, Austerity, Mental health, Institutional geography, Semi-structured interviews, Participant observation, Mental health geography
Abstract

This thesis examines the landscapes of mental health service provision which have emerged under austerity, and the institutional geographies which work to reproduce these. While austerity is sometimes portrayed as a relatively uniform process of retrenchment, I begin by offering a forensic cultural geography of austerity, a granular survey of the uneven geographies of mental health services and spending which emerged between 2010 and 2020. I situate these in a conjunctural analysis of English politics, economics and culture. To conceptualise how these national patterns are rescaled into the everyday, I then turn to the question of austerity’s institutionalisation. How is the process of fiscal cutting made ethically and affectively tenable for those who must enact it? These empirical sections build on nine on participant observation with two groups of participants in a county in the south of England: clients and staff at a mental health day centre threatened with closure; and county council commissioners who allocate funding for services. While bureaucrats are typically depicted as meting out austerity with indifference, the commissioners I worked with were deeply invested in the notion that they provided care. Consequently, they reimagined austerity in optimistic terms, as a hopeful process of optimisation. I map the institutional geographies within the council which enabled this austerity optimism to be embodied and felt, and the discourses and knowledge-making practices which underpinned this interpretation. I argue that these practices inculcated an anaesthetic ignorance among the commissioners – a placatory unseeing of austerity’s harms which allowed them to continue with the work of cutting. I conclude by foregrounding the voices and experiences of clients at the mental day centre, offering a countertopography which challenges claims of austerity optimism. Here, I theorise austerity and care temporally arguing that budget shortfalls were undermining expansive temporalities of care, intensifying distress and destabilising hopes for the future. In turn, they deepened commodification, tying staff and clients ever more tightly into the logics and time-spaces of the market. This thesis makes four significant contributions to geographical literature. In response to approaches which occlude the complexity of state retrenchment, it develops a comprehensive account of mental health services and expenditure under austerity, relating these patterns to a political and economic conjuncture emergent in Britain since 2010. It furthers geographical research on ‘everyday austerity’ through a relational account of the institutional geographies which rescale austerity from fiscal policy to quotidian phenomenon, drawing on feminist theories of affective economies. It advances mental health geography by mapping landscapes of service provision under austerity and conceptualising the role of institutional actors in enacting these. And finally, it develops the concept of camouflaging, as a process integral to reproduction and legitimation of austerity. Rather than focussing on moments when austerity materialises and is felt, the thesis charts the practices through which austerity is made to disappear from everyday life., Economic and Social Research Council [Grant number: ES/J50003/1]

Published
2023
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15. Neuroblastoma

Author

Kiely, Edward, Lumley, J. S. P., editor, Siewert, J. R., editor, Puri, Prem, editor, and Höllwarth, Michael E., editor

Published
2006
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31. Antenatal corticosteroids and outcomes in gastroschisis: A multicenter retrospective cohort study

Author

Carnaghan, Helen, James, Catherine P, Charlesworth, Paul B, Ghionzoli, Marco, Pereira, Susana, Elkhouli, Mohamed, Baud, David, De Coppi, Paolo, Ryan, Greg, Shah, Prakesh S, Davenport, Mark, David, Anna L, Pierro, Agostino, Eaton, Simon, Lapidus-Krol, Eveline, Cross, Kate MK, Kiely, Edward, Patel, Shailesh, Desai, Ashish, Nicolaides, Kypros, Curry, Joseph, and Ade-Ajayi, Niyi

Subjects
0301 basic medicine, Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, PRETERM BIRTH, Gestational Age, 030105 genetics & heredity, Antenatal steroid, Cohort Studies, DELIVERY, 03 medical and health sciences, AGE, 0302 clinical medicine, Enteral Nutrition, Adrenal Cortex Hormones, Pregnancy, MANAGEMENT, Medicine, Humans, MULTIPLE COURSES, Genetics (clinical), Retrospective Studies, Genetics & Heredity, Gastroschisis, Fetus, Science & Technology, 030219 obstetrics & reproductive medicine, business.industry, Proportional hazards model, Hazard ratio, Infant, Newborn, Pregnancy Outcome, Obstetrics & Gynecology, Obstetrics and Gynecology, Retrospective cohort study, Prenatal Care, Length of Stay, medicine.disease, Delivery, Obstetric, Prognosis, Treatment Outcome, Secondary Outcome Measure, Female, business, Life Sciences & Biomedicine, Cohort study
Abstract

OBJECTIVE: In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants. METHODS: A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression. RESULTS: Of 500 patients included in the study, 69 (GA at birth 34 [25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 [31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 [95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 [95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA [95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds. CONCLUSION: Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay. ispartof: PRENATAL DIAGNOSIS vol:40 issue:8 pages:991-997 ispartof: location:England status: published

Published
2019

34. Contributors

Author

Adams, Mark C., primary, Adibe, Obinna O., additional, Adler, Jeremy, additional, Adzick, N. Scott, additional, Albanese, Craig T., additional, Andrews, Walter S., additional, Applebaum, Harry, additional, Arca, Marjorie J., additional, Aronson, Daniel C., additional, Azizkhan, Richard G., additional, Baird, Robert, additional, Barnett, Sean, additional, Barnhart, Douglas C., additional, Barsness, Katherine A., additional, Bartlett, Robert H., additional, Baskin, Laurence S., additional, Beasley, Spencer W., additional, Bentz, Michael L., additional, Billmire, Deborah F., additional, Boulanger, Scott C., additional, Brandt, Mary L., additional, Brock, John W., additional, Brown, Rebeccah L., additional, Btaiche, Imad F., additional, Busuttil, Ronald W., additional, Caldamone, Anthony A., additional, Caniano, Donna A., additional, Caty, Michael G., additional, Chardot, Christophe, additional, Chung, Dai H., additional, Cilley, Robert E., additional, Colon, Nadja C., additional, Columbani, Paul M., additional, Coran, Arnold G., additional, Cotton, Robin T., additional, Cowles, Robert A., additional, Cox,, Charles S., additional, Dassinger, Melvin S., additional, Davidoff, Andrew M., additional, Davidson, Richard S., additional, Coppi, Paolo De, additional, Dicken, Bryan J., additional, Didelot, William, additional, DiFiore, John W., additional, Dillon, Patrick A., additional, Dillon, Peter W., additional, Donahoe, Patricia K., additional, Duchossois, Gina P., additional, Dunn, James C.Y., additional, Dutta, Sanjeev, additional, Eaton, Simon, additional, Ehrlich, Peter F., additional, Eichelberger, Martin R., additional, Elden, Lisa M., additional, Eliason, Jonathan L., additional, Emil, Sherif, additional, Escobar, Mauricio A., additional, Falcone,, Richard A., additional, Fallat, Mary E., additional, Farmer, Diana L., additional, Farmer, Douglas G., additional, Faro, Albert, additional, Fisher, Michael J., additional, Fishman, Steven J., additional, Fitzgerald, Tamara N., additional, Flake, Alan W., additional, Foglia, Robert P., additional, Ford, Henri R., additional, Franklin, Andrew, additional, Frischer, Jason S., additional, Fuller, Stephanie M.P., additional, Gandhi, Sanjiv K., additional, Garcia, Victor F., additional, Gatti, John M., additional, Gauderer, Michael W.L., additional, Geiger, James D., additional, Georgeson, Keith E., additional, Gingalewski, Cynthia A., additional, Glassberg, Kenneth I., additional, Glick, Philip L., additional, Gonzales, Kelly D., additional, Grikscheit, Tracy C., additional, Grosfeld, Jay L., additional, Groth, Travis W., additional, Gruessner, Angelika C., additional, Gruessner, Rainer W.G., additional, Gutierrez, Ivan M., additional, Guzzetta,, Philip C., additional, J. Hall, Jason, additional, Hamilton, Thomas E., additional, Harmon, Carroll M., additional, Harrison, Michael R., additional, Hayes-Jordan, Andrea, additional, Hays, Stephen R., additional, Healey, John H., additional, Hendren, W. Hardy, additional, Hering, Bernhard J., additional, Herndon, David N., additional, Hirose, Shinjiro, additional, Hirsch, Jennifer C., additional, Hirschl, Ronald B., additional, Hoganson, David M., additional, Holcomb, George W., additional, Höllwarth, Michael E., additional, Horn, B. David, additional, Huddleston, Charles B., additional, Hutchinson, Raymond J., additional, Hutson, John M., additional, Hyun, Grace, additional, Inge, Thomas H., additional, Jaksic, Tom, additional, Jea, Andrew, additional, Kaefer, Martin, additional, Kang, Kuang Horng, additional, Karsanac, Christopher J., additional, Kayes, Kosmas, additional, Kelly, Robert E., additional, Kiely, Edward M., additional, Klein, Michael D., additional, Krasin, Matthew J., additional, Krummel, Thomas M., additional, Kulungowski, Ann M., additional, Laberge, Jean-Martin, additional, Landsman, Ira S., additional, Langer, Jacob C., additional, La Quaglia, Michael P., additional, Laufer, Marc R., additional, Lee, Hanmin, additional, Lelli, Joseph L., additional, Levitt, Marc A., additional, Liau, James Y., additional, Lillehei, Craig, additional, Lindahl, Harry, additional, Liu, Gigi Y., additional, Lorenz, H. Peter, additional, Luerssen, Thomas G., additional, Lukish, Jeffrey R., additional, Lund, Dennis P., additional, Magee, John C., additional, McGahren, Eugene D., additional, McLaughlin, Eamon J., additional, McQuiston, Leslie T., additional, Meyers, Rebecka L., additional, Millar, Alastair J.W., additional, Minevich, Eugene, additional, Miranda, Edward P., additional, Mitchell, Michael E., additional, Mollen, Kevin P., additional, Moss, R. Lawrence, additional, Mouriquand, Pierre, additional, Murase, Noriko, additional, Murphy, J. Patrick, additional, Murphy, Joseph T., additional, Nance, Michael L., additional, Nathan, Saminathan S., additional, Newman, Kurt D., additional, Numanoglu, Alp, additional, Nwomeh, Benedict C., additional, Ohye, Richard G., additional, Oldham, Keith T., additional, O'Neill, James A., additional, Pakarinen, Mikko P., additional, Panait, Nicoleta, additional, Pearl, Richard H., additional, Peña, Alberto, additional, Pieretti, Rafael V., additional, Pierro, Agostino, additional, Piper, Hannah G., additional, Potsic, William P., additional, Pryor, Howard I., additional, Puligandla, Pramod S., additional, Puri, Prem, additional, Qureshi, Faisal G., additional, Rescorla, Frederick J., additional, Révillon, Yann, additional, Reyes, Jorge, additional, Reynolds, Marleta, additional, Rhee, Audrey C., additional, Rich, Barrie S., additional, Ricketts, Richard R., additional, Rink, Richard C., additional, Rintala, Risto J., additional, Rocchini, Albert P., additional, Rodeberg, David A., additional, Sadove, A. Michael, additional, Saggi, Bob H., additional, Scherer, L.R., additional, Schmid, Daniel B., additional, Scholz, Stefan, additional, Schwartz, Marshall Z., additional, Shamberger, Robert C., additional, Shapiro, Nina L., additional, Sheldon, Curtis A., additional, Shochat, Stephen J., additional, Sidell, Douglas, additional, Skinner, Michael A., additional, Smith, Jodi L., additional, Smith, Samuel D., additional, Snyder, Charles L., additional, Speer, Allison L., additional, Spitz, Lewis, additional, Spray, Thomas L., additional, Stanley, James C., additional, Starzl, Thomas E., additional, Stehr, Wolfgang, additional, Stolar, Charles J.H., additional, Storm, Phillip B., additional, Stylianos, Steven, additional, Subramaniam, Ramnath, additional, Superina, Riccardo, additional, Sutherland, David E.R., additional, Sutton, Leslie N., additional, Sydorak, Roman, additional, Sylvester, Karl G., additional, Teitelbaum, Daniel H., additional, Tepas, Joseph J., additional, Thomas, John C., additional, Thompson, Dana Mara, additional, Tovar, Juan A., additional, Upperman, Jeffrey S., additional, Vacanti, Joseph P., additional, van Aalst, John A., additional, Vane, Dennis W., additional, Allmen, Daniel Von, additional, Walkovich, Kelly, additional, Walsh, Danielle S., additional, Warner, Brad W., additional, Weber, Thomas R., additional, Weldon, Christopher B., additional, Wesson, David E., additional, Wetmore, Ralph F., additional, Willging, J. Paul, additional, Wilson, Jay M., additional, Woo, Lynn L., additional, Woo, Russell K., additional, Yerkes, Elizabeth B., additional, Ziegler, Moritz M., additional, and Zimmermann, Arthur, additional

Published
2012
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36. Conjoined twins

Author

Spitz, Lewis and Kiely, Edward M.

Subjects
Conjoined twins -- Diagnosis, Conjoined twins -- Care and treatment
Abstract

The diagnosis and treatment of conjoined twins are reviewed. Conjoined twins are commonly known as Siamese twins. This means that the bodies of both twins are joined, and they usually share some organs.

Published
2003

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