David Yeomans

Do guidelines for severe mental illness promote physical health and well-being?:

The effective management of individuals with severe mental illnesses (SMIs) requires an holistic approach that offers reliable symptom control, but also addresses other clinical, emotional and social needs. The physical health of individuals with an SMI is often poor, with many being overweight or obese, having hypertension, diabetes or dyslipidaemia, and at significant risk of developing cardiovascular disease or other comorbidities. We have recently reviewed current UK and US guidelines for the management of individuals with schizophrenia and bipolar disorder, and found very different approaches to the holistic care of people with SMIs, especially in relation to the management of physical health and cardiovascular risk. UK guidelines acknowledge the high risk of physical morbidity and mortality in individuals with an SMI, but fail to address in detail the specifics of physical health monitoring and lifestyle management. US guidelines are more descriptive in terms of the type and extent of monitoring recommended, but there are inconsistencies between the guidelines produced by different organizations, and studies in the field suggest that none of them is being adequately implemented. Clear and consistent recommendations on how and when to monitor weight, cardiovascular function, and metabolic parameters and, importantly, what to do with the results, would support clinicians wishing to integrate physical and mental healthcare. Publication of specific recommendations on evidence-based physical health interventions that can work for people with SMIs would also help primary care and mental health services improve general well-being in their patients with severe mental illnesses.

Critical Ethnography: problems in contemporary theory and practice

Abstract This paper reviews and critiques significant developments within contemporary ethnography. The first part of the paper traces the antecedents of ethnography in an anthropology which was itself closely identified and entwined with colonialism and imperialism. The paper then goes on to review contemporary developments within ethnography, particularly those associated with postmodernism. Attempts to establish a critical ethnography are reviewed and critiqued in the following section. The paper then goes on to suggest ways in which the concepts of ‘really useful knowledge’ and the processes of action research might be combined in order to assist in the construction of critical ethnography. The paper concludes by acknowledging the difficulties which exist for educational researchers and practitioners who wish to practice critical ethnography in the current educational climate in both Britain and North America.

Categorical prevalence and severity of hyperprolactinaemia in two UK cohorts of patients with severe mental illness during treatment with antipsychotics

Hyperprolactinaemia may be associated with hidden longer-term consequences, such as osteoporosis, bone fractures, pituitary tumours and breast cancer. Prolactin data from clinical trials is not always reported in a categorical manner and does not always allow the risk of hyperprolactinaemia to be evaluated for specific patient cohorts. Patients participating in a physical health management programme in the UK for severe mental illness patients — the Well-being Support Programme — had prolactin measurements made regardless of symptoms. Prolactin data from the complete cohort of 178 patients receiving antipsychotics in Leeds and London are reported. Hyperprolactinaemia was measured in 33.1% but more commonly in females than males (47.3% and 17.6%) and was associated with all antipsychotics except clozapine. The highest prevalence rates were found in amisulpride (n=20) 89%, risperidone long-acting intramuscular injection (LAIM) 67% (n=6) and risperidone (n=30) 55% used as antipsychotic monotherapy. Clinically Significant hyperprolactinaemia (>1000 mIU/L ~47 ng/ml) was measured in 15.8% of patients, predominantly in females. Levels >2000 mIU/L ~95 ng/ml in 6.2% of the complete cohort. Clinicians may wish to add prolactin measurement to the routine laboratory parameters currently measured for some antipsychotics and should be advised of the potential longer-term consequences of hidden hyperprolactinaemia.

Working together? Partnership approaches to 14–19 education in England

Partnership working between institutions and organisations is currently commonly seen as providing solutions to meeting multiple, interrelated needs in areas of social policy including health, social welfare and education. This article examines and discusses the policy and practice of such collaboration in an educational context. Drawing on studies of state‐funded interventions into 14–19 provision in England it offers insights into why and how schools, colleges and other organisations involved in education and training collaborate. It concludes that partnership is highly locally contingent. National policy on partnership working, which is itself not consistent, is strongly mediated by local contextual factors, institutional values and interests, personal missions and careers, pragmatic opportunism, ad‐hocery and happenstance. The interplay of these factors is highly dynamic and changes over time.

Constructing Vocational Education: From TVEI to GNVQ.

Abstract∗ This article compares and contrasts two programmes‐‐TVEI and GNVQ‐‐ostensibly introduced in the 1980s and 1990s to remedy defects in vocational education for 14‐ to 19‐year‐olds in England and Wales. The comparison illuminates continuities and discontinuities between the two programmes and illustrates shifts in curriculum and assessment policy over the period of study. ∗A glossary of the acronyms used can be found on p. 149.

Progressivism and the GNVQ: context, ideology and practice

Abstract In England, the new General National Vocational Qualification (GNVQ) has had a troubled and turbulent introduction. However, while it has generated a rapidly growing literature, the relationship with a progressive ideology has been relatively underex‐plored. In setting the scene for this special issue, this article explores the complex and multidimensional relationships between progressivism, vocationalism, of various types, and the GNVQ. It concludes that GNVQs cannot be seen as unequivocally progressive. Rather, somewhat emasculated ghosts of progressivism live on, competing with alternative educational ideologies and practices in a largely hostile environment of ‘controlled vocationalism’.

The New Vocationalism Enacted? The Transformation of the Business Studies Curriculum

ABSTRACT This paper, which is based on ESRC‐funded research, draws on quantitative and qualitative data to examine the transformation of the business studies curriculum in secondary schools. It links this transformation to the emergence of the ‘new vocationalism’ and to alleged changes in the nature of work, work organisation and the labour market. The paper argues that the changes which have taken place in the business studies curriculum are the result of interplay between the rhetoric of the new vocationalism, the resources mobilised to support this rhetoric, the activities of various mediating agencies, the characteristics and environments of schools and the professional and career concerns of teachers. The paper ends by considering the place of business studies within the curriculum in the aftermath of the 1988 Education Act.

The Fate of the Technical and Vocational Education Initiative in a Pilot School: a longitudinal case study

Abstract This paper arises out of wider Economic and Social Research Council funded research on the legacy of the Technical and Vocational Education Initiative (TVEI) in a national sample of original pilot schools. It describes and analyses the development of TVEI in one school over the period 1983‐91 and draws on field‐work at the school in 1986 and 1991. The development and demise of a radical cross‐curricular course are explained. It is argued that the particular fate of the innovation was the result of the interplay between a range of system level, local ‘market’ and in‐school factors.

Vocationalising the Design and Technology Curriculum: A Case Study from Post-Compulsory Education.

This paper analyses the General National Vocational Qualification (GNVQ) in Manufacturing, a course recently introduced in England and Wales to provide a broad, vocational introduction to manufacturing industry for students in post-compulsory education. The paper opens with a brief introduction to the main characteristics of the GNVQ curriculum and assessment model. This is followed by a detailed analysis of the prescribed GNVQ Manufacturing course with particular emphasis on its outcome-based character. The paper then proceeds to a description of the enactment of GNVQ Manufacturing in three schools and colleges and seeks to account for the very considerable differences which are revealed between the three courses. The paper concludes by considering the implications of the analysis for the development of broadly vocational courses in technology and design and for the processes of curriculum construction more generally.

From Vertical To Horizontal? A Longitudinal Study of Information Technology in Ten Schools

ABSTRACT This paper, which arises out of wider Economic and Social Research Council (ESRC) funded research, examines the provision of information technology in ten British secondary schools. The longitudinal nature of the research allows us to test a model proposed by Wellington, which describes the evolution of information technology in secondary schools from a vertical to a horizontal approach, against the data from the ten schools. We explore tensions between vertical and horizontal approaches and show that the evolutionary process is more complex than suggested by the model. We focus on the role of the information technology co‐ordinator in promoting horizontal approaches to information technology and explore the conditions under which the role is carried out.