Nicola Burns

Rural madness: a geographical reading and critique of the rural mental health literature

This paper provides a geographical reading and critique of existing literature on rural mental health. It investigates what this literature has to say about how different dimensions of rural space physical, demographic, economic, social and cultural impact upon both the mental health of rural dwellers and the provision of mental health services to rural populations. It is argued that there is much to be learned from the existing literature, although caution is expressed about slipping into stereotypical notions regarding the constitution of rural space. Questions are raised about a common tendency to lean upon more or less examined rural urban contrasts, although useful reflections can be found on the tangled representational politics of rural mental health embedded within differing characterisations of the countryside as opposed to the city

Risk, responsibility and reconfiguration: penal adaptation and misadaptation

This article draws on the findings of an ethnographic study of social enquiry and sentencing in the Scottish courts. It explores the nature of the practice of social enquiry (that is, of social workers preparing reports to assist sentencers) and explores the extent to which this practice is being reconfigured in line with the recent accounts of penal transformation. In so doing, we problematize and explore what we term the ‘governmentality gap’; meaning, a lacuna in the existing penological scholarship which concerns the contingent relationships between changing governmental rationalities and technologies on the one hand and the construction of penality-in-practice on the other. The findings suggest that although policy discourses have, in many respects, changed in the way that these accounts elucidate and anticipate, evidence of changes in penal discourses and practices is much more partial. Drawing on Bourdieu, we suggest that this may be best understood not as a counter-example to accounts of penal transformation but as evidence of an incompleteness in their analyses which reflects the ‘governmentality gap’ and requires the development of more fully cultural penology drawing on ethnographies of penality.

'That awful place was home': reflections on the contested meanings of Craig Dunain Asylum

Abstract The paper explores a particular Scottish asylum geography (Craig Dunain Hospital near Inverness) as a meaningful social space. Drawing on archival evidence and combined with contemporary patient and staff voices, the contested meanings of this institution are discussed. In particular, patient narratives reveal both positive and negative assessments of internal and external asylum spaces. Changing feelings about the asylum are argued to be related to matters of geography, and are conceived in terms of distance from and proximity to the institution.

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions.

Assisting and Advising The Sentencing Decision Process: The Pursuit of 'Quality' in Pre-Sentence Reports

Pre-sentence reports are an increasingly prevalent feature of the sentencing process. Yet, although judges have been surveyed about their general views, we know relatively little about how such reports are read and interpreted by judges considering sentence in specific cases, and, in particular, how these judicial interpretations compare with the intentions of the writers of those same reports. This article summarizes some of the main findings of a four-year qualitative study in Scotland examining: how reports are constructed by report writers; what the writers aim to convey to the sentencing judge; and how those same reports are then interpreted and used in deciding sentence. Policy development has been predicated on the view that higher-quality reports will help to ‘sell’ community penalties to the principal consumers of such reports (judges). This research suggests that, in the daily use and interpretation of reports, this quality-led policy agenda is defeated by a discourse of judicial ‘ownership’ of sentencing.

Health-care access for migrants in Europe

Migration is a reality of today’s world, with over one billion migrants worldwide. While many choose to move voluntarily, others are forced to migrate due to economic reasons or to flee war, conflict, or persecution. Such migrants often find themselves in precarious and marginalized situations—particularly asylum seekers, refugees, and undocumented or irregular migrants. While often viewed as a single group, the legal status and entitlements of these three groups are different. This has implications for their ability to access health care; in addition, rights and entitlements vary across the 28 countries of the European Union and across different parts of national health systems. The lack of entitlement to receive care, including primary and secondary care, is a significant barrier for many asylum seekers and refugees and an even greater barrier for undocumented migrants. Other barriers include different health profiles and awareness of chronic disease risk amongst migrants; awareness of the organization of health systems in host countries; and language and communication. The use of professional interpreters can help to overcome communication barriers, but entitlement to free interpreting services is highly variable. Host countries need to consider how to ensure their health systems are “migrant-friendly”: solutions include provision of professional interpreters; ensuring that health care staff are aware of migrants’ rights to access health care; and increasing knowledge of migrants in relation to the organization of the health care system in their host country and how to access care, for example through the use of patient navigators. However, perhaps one of the greatest facilitators for migrants will be a more favorable political situation, which stops demonizing people who are forced to migrate due to situations out of their control.

REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE): study protocol

BackgroundThe implementation of guidelines and training initiatives to support communication in cross-cultural primary care consultations is ad hoc across a range of international settings with negative consequences particularly for migrants. This situation reflects a well-documented translational gap between evidence and practice and is part of the wider problem of implementing guidelines and the broader range of professional educational and quality interventions in routine practice. In this paper, we describe our use of a contemporary social theory, Normalization Process Theory and participatory research methodology—Participatory Learning and Action—to investigate and support implementation of such guidelines and training initiatives in routine practice.MethodsThis is a qualitative case study, using multiple primary care sites across Europe. Purposive and maximum variation sampling approaches will be used to identify and recruit stakeholders—migrant service users, general practitioners, primary care nurses, practice managers and administrative staff, interpreters, cultural mediators, service planners, and policy makers. We are conducting a mapping exercise to identify relevant guidelines and training initiatives. We will then initiate a PLA-brokered dialogue with stakeholders around Normalization Process Theory’s four constructs—coherence, cognitive participation, collective action, and reflexive monitoring. Through this, we will enable stakeholders in each setting to select a single guideline or training initiative for implementation in their local setting. We will prospectively investigate and support the implementation journeys for the five selected interventions. Data will be generated using a Participatory Learning and Action approach to interviews and focus groups. Data analysis will follow the principles of thematic analysis, will occur in iterative cycles throughout the project and will involve participatory co-analysis with key stakeholders to enhance the authenticity and veracity of findings.DiscussionThis research employs a unique combination of Normalization Process Theory and Participatory Learning and Action, which will provide a novel approach to the analysis of implementation journeys. The findings will advance knowledge in the field of implementation science because we are using and testing theoretical and methodological approaches so that we can critically appraise their scope to mediate barriers and improve the implementation processes.

An inclusive outdoors? Disabled people’s experiences of countryside leisure services

In recent years, disabled people’s access to the outdoors has been the subject of renewed interest. This has in part been driven by legislative developments coupled with an increasing recognition that disabled people are under‐represented as users of the countryside. However, very little is actually known about disabled people’s views and experiences of the outdoors. Drawing on the concept of affordances and combining this with a social barrier’s approach to disability, we explore disabled people’s attitudes towards and experiences of woodland and countryside leisure. We argue that disabled people’s reasons for being outdoors are more complex than simply seeking ‘rehabilitation’; and, like their non‐disabled counterparts, access to the outdoors is perceived for some as an integral aspect of wellbeing and revitalisation. Through engagement with the outdoors, disabled people are challenging normative constructions of who they are and their purpose in being in the countryside. The paper concludes by arguing that providers of outdoor leisure services need to go beyond barrier removal and understand disabled people’s uses and views of the outdoors in planning the provision of services.

Reducing the health care burden for marginalised migrants: The potential role for primary care in Europe

There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed.

Negotiating difference: disabled people's experiences of housebuilders

Recent changes in the building regulations have arguably signalled a growing awareness and recognition of the needs of different ‘bodies’ in the housing system. However, little is known of the ways in which housebuilders conceptualise the needs of those who do not conform to ‘able‐bodied’ norms and how this impacts on their dealing with such groups. Drawing on the experiences of disabled people accessing the private housing market, this paper explores the processes of negotiation which take place between disabled house buyers and housebuilders during the purchase of new‐build property. It is argued that underlying practical discussions around the (re)design of properties are negotiations around the concepts of disability and difference. These are played out and become apparent through the various roles assumed by each group. For example, lacking an institutional awareness of the needs of different bodies in domestic space, housebuilders are faced with the challenge of (re)viewing the needs and capacities of these ‘Other’ bodies. At such times, house buyers become the experts as they hold knowledge of their design needs which housebuilders clearly lack. The paper concludes by discussing the possibilities and challenges facing the housebuilding industry in engaging with the needs of disabled people and the role disabled people themselves can play in this.