Sara Owen

Critical realism: A philosophical framework for the study of gender and mental health

This paper explores gender and mental health with particular reference to the emerging philosophical field of critical realism. This philosophy suggests a shared ontology and epistemology for the natural and social sciences. Until recently, most of the debate surrounding gender and mental health has been guided either implicitly or explicitly within a positivist or constructivist philosophy. With this in mind, key areas of critical realism are explored in relation to gender and mental health, and contrasted with the positions of positivism and constructivism. It is argued that critical realism offers an alternative philosophical framework for the exploration of gender issues within mental health care.

A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing

BackgroundBenzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people.ObjectiveThe aim of this study was to identify and synthesise qualitative studies exploring patients’ experiences and perceptions of receiving benzodiazepines and Z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing.MethodsA systematic search of six databases for qualitative studies exploring patients’ experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis.ResultsNine papers were included and seven analytical themes were identified relating to patients’ experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and Z-drugs: (1) patients’ negative perceptions of insomnia and its impact, (2) failed self-care strategies, (3) triggers to medical help-seeking, (4) attitudes towards treatment options and service provision, (5) varying patterns of use, (6) withdrawal, (7) reasons for initial or ongoing use.ConclusionsInappropriate use and prescribing of benzodiazepines and Z-drugs is perpetuated by psychological dependence, absence of support and patients’ denial/lack of knowledge of side effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing.

Towards a gendered perspective for Irish mental health policy and service provision

Background: The Irish Government has adopted “Gender Mainstreaming” as a strategy to promote equal opportunities between women and men in its National Development Plan. While current mental health policy addresses the principle of partnership and social inclusiveness as a way forward for mental health service provision, it still does not explicitly deal with the notion of gender and gender sensitivity. Indeed, Irish mental health policy and service provision is criticised for being gender-neutral. Aim: This paper explores the relationship between gender, mental health policy and service provision. Method: The literature on theoretical perspectives on mental health policy, gender and mental health in relation to Irish mental health policy is reviewed. Results: The importance of gender for policy development and service provision is recognised, and the need to reformulate debate within a gendered context is discussed. Some key theoretical perspectives and their significance for mental health policy are considered with possible explanations for the absence of a gender perspective for Irish mental health policy presented. Conclusion: Arguably, a move towards developing gender-sensitive mental health policy and service provision requires a stronger awareness of and connections between the macro, meso and micro levels for policy development and analysis.

Gender awareness, symptom expressions and Irish mental health- care provision

Irish mental health policy and care provision is criticised for being gender-neutral despite gender being present in almost every aspect of illness; from risk to protection; symptom interpretation; diagnosing, ideology and knowledge of illnesses. The aim of this paper was to present the views of Irish service users and providers in relation to symptom expressions, gender awareness and care provision. A qualitative social realist design was used using Layders (1998) adaptive theory and social domains theory. In-depth interviews (n = 54) with 26 service users and 28 service providers were conducted within one mental health service in Ireland. Dominant societal expectations for men and women are described in response to symptom expressions that reflect ‘categorical’ and ‘performative’ understandings of gender. A return of interest to symptoms-based research and practice from a gendered perspective is argued for.

Prison reform in Serbia: a case for mental health

This article outlines the findings of the recent research in the field of prison mental health care in Serbia, in light of the recent developments in the Serbian criminal justice system and the development of community mental health care services. The article notes paucity of research in this area, which is a reflection of the unfavorable position of offender care on the Serbian prison agenda. The authors emphasize the need for dedicated mental health legislation as well as the development of mental health services in prisons, which would mirror the developments in the community. Other suggestions for the development of prison mental health care are discussed in the text.