Inclusion as Assimilation, Integration, or Co-optation? A Post-Structural Analysis of Inclusion as Produced Through Mental Health Research on Peer Support.

In the last 20 years, research on the inclusion of peer support within mental health settings has burgeoned, paralleling the broad adoption of service user inclusion within policy as a moral imperative and universally beneficial. Despite the seemingly progressive impetus behind inclusion, increasingly peer support workers talk of exhaustion working within mental health systems, the slow rate of change to oppressive values and practices, and ongoing experiences of workplace exclusion. Such experiences suggest differences in the way in which inclusion is produced across different stakeholder groups and contexts. In this article, we adopt Bacchi's 'what's the problem represented to be?' approach to identify how mental health research, often understood as an a-political activity, produces versions of inclusion. We argue current research predominantly produces inclusion as 'assimilation' and 'integration'. We use critical inclusion, mental health, and survivor scholarship to evaluate the effects these productions have for peer support and peer support workers, finding that both problematise peer support workers and those seeking support. We consider possibilities for more liberatory productions of inclusion, building on the notion of inclusion as 'co-optation'. Our analysis points to the need for researchers to engage with an uncomfortable reflexivity to enable more emancipatory possibilities regarding inclusion and peer support.

A snapshot of intellectual disabilities in Lao PDR: Challenges for the development of services.

Lao People's Democratic Republic (PDR) has experienced significant economic growth in the last two decades. While access to education, health, and employment for people with disabilities has also improved markedly, people with intellectual disabilities are still among the most vulnerable in society. This article presents findings from a screening survey of 2469 participants, a focus group discussion with key stakeholders in intellectual disabilities, and a case study of the Association for Autism. The screening survey suggests 1.9% of working age participants (18-59) and 0.7% of children (6-17) have intellectual disabilities. The qualitative data illustrate poor understanding and stigmatization of people with intellectual disabilities, lack of services, and development of a parent association to improve the life prospects for children with autism and intellectual disabilities. People with intellectual disabilities in Lao PDR remain particularly vulnerable. Parents and other disability advocates are raising awareness and demonstrating the effectiveness of specialized services.

Evaluation of an inter-professional training program for student clinical supervision in Australia.

BACKGROUND: As a response to an Australian shortage of clinical health, nursing, and medical placements, Commonwealth Government funding has been directed to expand student training opportunities and increase the competence and number of available clinical supervisors. This paper evaluates the application of a particular supervision training model for this purpose. It considers the model's suitability and relevance across professions and its impact on supervisory knowledge, skills, and values as well as the intention to supervise students. METHODS: The design, delivery, and evaluation of a series of one-day introductory student clinical supervision training workshops for allied health disciplines, nursing, and medicine are considered. Participants evaluated Proctor's model of clinical supervision, which was expanded by the trainers to incorporate diversity and power relations in student supervision. RESULTS: Evaluation results suggest that adapting Proctor's model for student clinical supervision is relevant across a broad range of health disciplines and clinical areas. Participants from 11 health professions reported that the training improved their knowledge, skills, and values and expanded their willingness to accept student clinical placements. The outcomes are suggestive of enhanced clinical supervision intent, capacity, and capability. CONCLUSIONS: The student supervision training improved participants' confidence in their clinical supervision skills. The findings suggest that the training has the potential to extend capacity and capability for student supervision across health professions and in Health Workforce Australia's identified priority areas of mental health, community health, rehabilitation, private practice, and non-government organisations. Findings also indicate that these gains are reliant on health organizations developing and sustaining cultures of learning.

Evaluation of a West Australian residential mental health respite service.

Family members continue to be the predominant providers of support, care and accommodation for loved ones with mental health issues, and empirical studies suggest that accessing mental health respite can be helpful for both carers and consumers. However, the availability of, and access to, this respite in Australia is far from optimal. Major issues have also been identified such as low utilisation, the inappropriate and inflexible nature of services and the inability of services to respond to situations where multiple needs exist. This article presents findings from a small evaluation of a pilot residential respite service. Semi-structured interviews were conducted with eight family members/carers and four consumers using the service, and five service providers. In addition, anonymised sociodemographic information about all users of the service in the first 9 months of its operation were analysed. Reflecting the current limitations around respite options, the majority of family members/carers and consumers were appreciative of, and satisfied with, the service. The research highlighted issues such as availability and suitability of respite, particularly when consumers had multiple and unmet needs. Mental health residential respite is often a stopgap in crisis situations and intersects with the difficulty of planning respite and shortages in affordable supported accommodation. Furthermore, the ramifications of individualised funding for people with "psychosocial disability" in the new Australian National Disability Insurance Scheme (NDIS) remain unclear. While family members and carers may benefit indirectly from NDIS funding, it is especially important at this time that the need for more suitable, recovery-oriented respite services is highlighted.

An evaluability assessment of a nutrition promotion project for newly arrived refugees.

ISSUE ADDRESSED: This paper reports on the benefits of conducting an evaluability assessment for a nutrition promotion project for newly arrived refugees to Perth, Western Australia. The assessment was the first step in a planned outcome evaluation. It was undertaken to contribute to the body of knowledge regarding nutritional health and promotion for newly arrived refugees to Australia. METHODS: Using semi-structured interviews with stakeholders, observation, presentations of early drafts of the program logic to key stakeholders and a review of the documentation, the analysis of qualitative data was used to make the project logic explicit and to better understand the project's underlying cause and effect relationships. RESULTS: The analysis alongside a review of contemporary health promotion literature revealed that the original underlying project logic needed refinement. A more complex and relevant project logic was developed which confirmed that the project had the potential to achieve its goals of improving the nutritional status of refugees. CONCLUSIONS: The evaluability assessment gave stakeholders the opportunity to reflect on the project and its implementation issues. Importantly, it made more explicit the complexity of the context of the project and the need for a diverse range of strategies to improve nutrition. Finally, the diagrammatic representation of the reconstructed project logic provided a powerful advocacy tool for a multi-sectoral approach.

Family inclusion in mental health services: Reality or rhetoric?

BACKGROUND: Contemporary mental health policies require family inclusion in the design, implementation and evaluation of services. MATERIALS: This scoping review considers the factors in mental health practice which either mediate or promote family inclusion. A wide range of factors are reported to obstruct family inclusion, while a smaller number of studies report that meaningful family inclusion rests on a partnership approach which values the input of families and services users. DISCUSSION: When it comes to family inclusion, there is a gap between policy and service delivery practice. Changes in service delivery attitudes, values and culture are necessary to meaningfully and systematically include families and service users.

Antenatal care in Goroka: issues and perceptions.

The high maternal mortality rate in Papua New Guinea indicates an urgent need for action. One area for examination is antenatal care. From April 2002 to August 2002 a qualitative study was undertaken in order to identify perceptions, beliefs, barriers and strengths relevant to the utilization of antenatal care by women in the urban, periurban and rural communities of Goroka, Papua New Guinea. Interview data about antenatal care utilization were collected from 20 pregnant or parous women and 4 antenatal health care workers and relevant statistics were reviewed. This information was analyzed in order to identify the constraints faced by the users of antenatal care and health care workers providing such services and to make recommendations aimed to improve the utilization and delivery of antenatal care in Goroka. Multiple encouragers and barriers to using antenatal care were identified within the three categories of physical barriers/encouragers, cultural issues and health care system characteristics. The attitude of health care workers and their perceived ill-mannered treatment of women was one of the most significant concerns raised by the women. Nevertheless, all of the women expressed overall satisfaction with the care given. All of the health care workers stated that antenatal care is very important for the health of both the baby and the mother and expressed a desire to improve the level of care. The major constraints faced were staff shortages, limited supplies and broken equipment. There were four key areas of strength: the broad level of coverage, the high regularity of attendance, the women's commitment to antenatal care and the willingness of health care workers to overcome resource difficulties in the provision of care. Recommendations to improve the delivery of antenatal care services and their utilization by women addressed the situation of women and the interactions between women and health care providers, and proposed innovations in the health care system.

Female sex work in Yangon, Myanmar.

BACKGROUND: Myanmar (Burma), with an upper estimate of 400,000 people living with HIV/AIDS, faces a dangerous and potentially devastating epidemic. Female sex workers in the country are one of the most affected populations, with high prevalence rates of both HIV and sexually transmitted infections (STIs). METHODS: A qualitative study was undertaken in Yangon at the end of 2002 to investigate the social and demographic features contributing to the transmission of HIV among female sex workers in urban Myanmar. Twenty-seven key informants from the government, non-government organisations (NGOs), international non-government organisations (INGOs), private sector and the United Nations system agencies and 25 women currently working in the sex trade were interviewed. RESULTS: The sex trade in Yangon is rapidly growing and is characterised by a high degree of complexity. The number of female sex workers is estimated to be between 5,000 and 10,000 and there are approximately 100 brothels operating in various townships around the city. Nearly one-third of the women in the study reported previous imprisonment for offences related to sex work as well as fear of harassment, sexual exploitation, violence and gang rape. Almost half reported using condoms with clients at all times. Contradicting views exist as to the level of awareness about STIs and HIV among Yangon sex workers, with the majority never having been tested for HIV. Only one-quarter of women were regular patients of the limited number of STI clinics operated by INGOs. CONCLUSIONS: Female sex workers in Myanmar remain a highly marginalised group almost inaccessible due to a variety of legal, political, cultural and social factors and are particularly vulnerable to HIV and STIs. It is important to encourage partnerships between INGOs by promoting service coordination and information sharing to increase the availability of services for sex workers and to build political support for an unpopular cause.

Effective mine risk education in war-zone areas--a shared responsibility.

The focus of this paper is effective health education and promotion in the field of mine awareness, or what has more recently been re-titled 'mine risk education'. According to the United Nations, mine risk education comprises educational activities that aim to reduce the risk of injury from landmine/unexploded ordnance (UXO) through raising awareness and promoting behavioural change and includes public information dissemination, education and training, and community mine action liaison. Specifically, this paper is an empirical study of mine risk education practices using data collected during the implementation of a mine risk education programme that commenced in Lao PDR in 1996 and is ongoing. In particular, it considers lessons learned from the programme's monitoring and evaluation process. The authors argue that in a country such as Lao PDR, where communities have lived with UXO infestation for over 25 years, more mine risk education is not necessarily needed. This paper concludes that common programmes of mine risk education using top-down educational methods, based on the assumption that ignorance of landmine/UXO risk is the key factor in mine accidents, are inadequate. Evidence from the literature on health promotion and the experience of the programme indicate that there is a need to supplement or replace existing common mine risk education practices with techniques that incorporate an understanding of the economic, social and political circumstances faced by communities at risk.