Lesbian and bisexual women's experiences of aversion therapy in England.

This article presents the findings of a study about the history of aversion therapy as a treatment technique in the English mental health system to convert lesbians and bisexual women into heterosexual women. We explored published psychiatric and psychological literature, as well as lesbian, gay, and bisexual archives and anthologies. We identified 10 examples of young women receiving aversion therapy in England in the 1960s and 1970s. We situate our discussion within the context of post-war British and transnational medical history. As a contribution to a significantly under-researched area, this article adds to a broader transnational history of the psychological treatment of marginalised sexualities and genders. As a consequence, it also contributes to LGBTQIA+ history, the history of medicine, and psychiatric survivor history. We also reflect on the ethical implications of the research for current mental health practice.

The Recovery Narrative: Politics and Possibilities of a Genre.

Recovery is now widely acknowledged as the dominant approach to the management of mental distress and illness in government, third-sector and some peer-support contexts across the United Kingdom and elsewhere in the Anglophone Global North. Although narrative has long been recognised in practice and in policy as a key "technology of recovery," there has been little critical investigation of how recovery narratives are constituted and mobilised, and with what consequences. This paper offers an interdisciplinary, critical medical humanities analysis of the politics and possibilities of Recovery Narrative, drawing literary theoretical concepts of genre and philosophical approaches to the narrative self into conversation with the critiques of recovery advanced by survivor-researchers, sociologists and mad studies scholars. Our focus is not on the specific stories of individuals, but on the form, function and effects of Recovery Narrative as a highly circumscribed kind of storytelling. We identify the assumptions, lacunae and areas of tension which compel a more critical approach to the way this genre is operationalised in and beyond mental health services, and conclude by reflecting on the possibilities offered by other communicative formats, spaces and practices.

A history of lesbian politics and the psy professions.

This article explores the relationship between lesbian activists and the "psy professions" (especially psychology and psychiatry) in England from the 1960s to the 1980s. We draw on UK-based LGBTQIA+ archive sources and specifically magazines produced by, and for, lesbians. We use this material to identify three key strategies used within the lesbian movement to contest psycho-pathologisation during this 30-year period: from respectable collaborationist forms of activism during the 1960s; to more liberationist oppositional politics during the early 1970s; to radical feminist separatist activism in the 1980s. Whilst these strategies broadly map onto activist strategies deployed within the wider lesbian and gay movement during this time, this article explores how these politics manifested in particular ways, specifically in relation to the psy disciplines in the UK. We describe these strategies, illustrating them with examples of activism from the archives. We then use this history to problematise a linear, overly reductionist or binary history of liberation from psycho-pathologisation. Finally, we explore some complexities in the relationship between sexuality, activism and the psy professions.

Conducting sexualities research: an outline of emergent issues and case studies from ten Wellcome-funded projects.

This letter seeks to synthesise methodological challenges encountered in a cohort of Wellcome Trust-funded research projects focusing on sexualities and health. The ten Wellcome Trust projects span a diversity of gender and sexual orientations and identities, settings; institutional and non-institutional contexts, lifecourse stages, and explore a range of health-related interventions.  As researchers, we originate from a breadth of disciplinary traditions, use a variety of research methods and data sources. Despite this breadth, four common themes are found across the projects: (i) inclusivity, representations and representativeness, (ii) lumping together of diverse groups, (iii) institutions and closed settings (iv) ethical and governance barriers.

Materialities of mundane care and the art of holding one's own.

The focus of this special issue is on how everyday or mundane materialities actively mediate health and care practices. This article extends this concern with the mundane to care itself and explores how specific materialities, such as shared spaces and everyday objects, not only mediate mundane care but enable it to happen. Our focus is on mundane help in the context of ill health, between people who are not immediate family, such as neighbours, acquaintances and others with whom we interact in our daily lives. Drawing on recent empirical studies of low-level support in two different parts of the UK, we show how the materialities of care can mediate the affective risks associated with receiving such help. Specifically, we investigate how materialities help people to balance the expression of their vulnerability with a need to retain their dignity, a practice referred to as 'holding one's own'. In doing so, we argue that materialities are not just the conduits for care - what care passes through - or things that mediate care. We suggest instead that materialities are part of how relationships of mundane care are constituted and maintained.

It's the talk: a study of involvement initiatives in secure mental health settings.

BACKGROUND: A study of involvement initiatives within secure mental health services across one UK region, where these have been organized to reflect alliances between staff and service users. There is little previous relevant international research, but constraints upon effective involvement have been noted. OBJECTIVE: To explore and evaluate involvement initiatives in secure mental health settings. DESIGN: A case study design with thematic analysis of qualitative interviews and focus groups. SETTING AND PARTICIPANTS: Data collection was carried out between October 2011 and February 2012 with 139 staff and service users drawn from a variety of secure mental health settings. FINDINGS: Our analysis offers four broad themes, titled: safety and security first?; bringing it all back home; it picks you up; it's the talk. The quality of dialogue between staff and services users was deemed of prime importance. Features of secure environments could constrain communication, and the best examples of empowerment took place in non-secure settings. DISCUSSION: Key aspects of communication and setting sustain involvement. These features are discussed with reference to Jurgen Habermas's work on communicative action and deliberative democracy. CONCLUSIONS: Involvement initiatives with service users resident in secure hospitals can be organized to good effect and the active role of commissioners is crucial. Positive outcomes are optimized when care is taken over the social space where involvement takes place and the process of involvement is appreciated by participants. Concerns over risk management are influential in staff support. This is germane to innovative thinking about practice and policy in this field.

'You'll never walk alone': Supportive social relations in a football and mental health project.

Football can bring people together in acts of solidarity and togetherness. This spirit is most evocatively illustrated in the world renowned football anthem 'You'll Never Walk Alone' (YNWA). In this paper, we argue that this spirit can be effectively harnessed in nursing and mental health care. We draw on data from qualitative interviews undertaken as part of evaluating a football and mental health project to explore the nature of supportive social relations therein. We use some of the lyrics from YNWA as a metaphor to frame our thematic analysis. We are especially interested in the interactions between the group facilitators and group members, but also address aspects of peer support within the groups. A contrast is drawn between the flexible interpersonal boundaries and self-disclosure evident in the football initiative, and the reported, more-distant relations with practitioners in mainstream mental health services. The findings suggest scope for utilizing more collective, solidarity-enhancing initiatives and attention to alliances and boundaries to maximize engagement and therapeutic benefits within routine practice.

Football metaphor and mental well-being: an evaluation of the It's a Goal! programme.

BACKGROUND: The It's a Goal! programme utilises football metaphor and football venues as a means to frame and deliver a non-clinical, group-based therapeutic intervention, targeting men with mental health needs. A pilot in the North West of England was hosted by seven professional football clubs in partnership with local Primary Care Trusts. AIMS: To evaluate the impact of the intervention and to identify the benefits and key components of the approach from the perspective of participants. METHOD: Analysis of impact utilised before and after well-being scores measured on a modified version of the Warwick-Edinburgh Mental Well-being Scale. Focus groups provided additional qualitative data that were analysed thematically. RESULTS: Findings suggest that It's a Goal! had a significant impact upon participant's well-being. In addition, participants reported a range of positive benefits especially in relation to confidence, self-esteem and developing better coping mechanisms. Participants related these benefits to a number of key components, not least the therapeutic value of football metaphor, the focus on goal-setting and the mutual support developed within the groups. CONCLUSIONS: Using football metaphor to deliver a group therapeutic programme aimed at men appears to be an effective means of facilitating mental health benefits.

No hope without compassion: the importance of compassion in recovery-focused mental health services.

BACKGROUND: Whilst current policy is replete with recovery language and references to the need for services to create a sense of hope and optimism, there is less understanding about how such hope may be engendered within services. We propose that an understanding of compassion is necessary to appreciate what actually stimulates hope-inspiring practices. AIMS: An examination of the continuing relevance of compassion to mental health care and an exploration of its place within modern mental health policy and practice. METHODS: A review of the compassion deficit in mental health care and a critical examination of whether the direction of current mental health policy in the UK is likely to facilitate compassionate care. RESULTS: Compassion needs to be viewed not merely as an individual expression or property but something which must be nurtured in context, through relationships, cultures and healing environments. However, current mental health policy and practice does not appear to prioritise the development of such contexts. CONCLUSION: Attention to fostering compassion would help to shift the language of "recovery" (or "well-being") beyond the twin dangers of rhetoric and/or imposing preconceived definitions, models or expectations of what recovery "should" be. Therefore, the development of compassionate contexts should have a stronger place in modern mental health practice and policy.

Spaces of psychiatric contention: a case study of a therapeutic community.

This article uses a historical case study of a day hospital therapeutic community (TC) to explore the emergence of particular spaces of psychiatric contention. Using ideas from critical social geography, it employs the notion of 'convergent spaces' to understand how particular sites become important in the development of innovative practice and new social movements. It argues that these spaces of convergence enabled innovation to occur through a collectivised social setting where commonalities were expressed, new resistant identities forged and charismatic figures such as 'tricksters' emerge to challenge and subvert psychiatric authority. In discussing some of the problems which beset the day hospital, it is proposed that the notion of 'paradoxical spaces' might also be helpful to understand how contested spaces can avoid imposing new forms of totalisation. It concludes by reflecting on the conditions of possibility for new spaces of contention.

Evaluating the impact of participatory art projects for people with mental health needs.

Participatory art projects for people with mental health needs typically claim outcomes such as improvements in confidence, self-esteem, social participation and mental health. However, such claims have rarely been subjected to robust outcome research. This paper reports outcomes from a survey of 44 female and 18 male new art project participants attending 22 art projects in England, carried out as part of a national evaluation. Outcomes were quantified through self-completed questionnaires on first entry to the project, during January to March of 2006, and 6 months later. The questionnaires included three measures: empowerment, mental health [Clinical Outcomes in Routine Evaluation (CORE)] and social inclusion. Paired t-tests were used to compare overall change, and mixed model repeated measures analysis of variance to compare subgroups, including age, gender, educational level, mental health and level of participation. Results showed significant improvements in empowerment (P = 0.01), mental health (P = 0.03) and social inclusion (P = 0.01). Participants with higher CORE scores, no new stress in their lives and positive impressions of the impact of arts on their life benefited most over all three measures. Positive impressions of the impact of arts were significantly associated with improvement on all three measures, but the largest effect was for empowerment (P = 0.002) rather than mental health or social inclusion. This study suggests that arts participation positively benefits people with mental health difficulties. Arts participation increased levels of empowerment and had potential to impact on mental health and social inclusion.

A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia.

BACKGROUND: The "Soteria paradigm" attempts to support people diagnosed with schizophrenia spectrum disorders using a minimal medication approach. Interest in this approach is growing in the United Kingdom, several European countries, North America, and Australasia. AIMS: To summarize the findings from all controlled trials that have assessed the efficacy of the Soteria paradigm for the treatment of people diagnosed with schizophrenia spectrum disorders. METHODS: A systematic search strategy was used to identify controlled studies (randomized, pseudorandomized, and nonrandomized) employing the Soteria paradigm to treat adults and adolescents meeting the criteria for schizophrenia spectrum disorders according to International Classification of Diseases and Diagnostic and Statistical Manual for Mental Disorders criteria. RESULTS: We identified 3 controlled trials involving a total of 223 participants diagnosed with first- or second-episode schizophrenia spectrum disorders. There were few major significant differences between the experimental and control groups in any of the trials across a range of outcome measures at 2-year follow-up, though there were some benefits in specific areas. CONCLUSIONS: The studies included in this review suggest that the Soteria paradigm yields equal, and in certain specific areas, better results in the treatment of people diagnosed with first- or second-episode schizophrenia spectrum disorders (achieving this with considerably lower use of medication) when compared with conventional, medication-based approaches. Further research is urgently required to evaluate this approach more rigorously because it may offer an alternative treatment for people diagnosed with schizophrenia spectrum disorders.

Mental health and arts participation: the state of the art in England.

Although participation in arts activity is believed to have important mental health and social benefits for people with mental health needs, the evidence base is currently weak. This article reports the first phase of a study intended to support the development of stronger evidence. Objectives for the first phase were to map current participatory arts activity, to identify appropriate indicators and to develop measures for use in the second phase of the research. A survey of participatory arts projects for people with mental health needs aged 16 to 65 in England, identified via the Internet and relevant organizations, was carried out to map the scale and scope of activity and to establish the nature of current approaches to evaluation. The results indicate that the scope of activity, in terms of projects' settings, referral sources, art forms and participation is impressively wide. In terms of scale, however, projects reported low funding and staffing levels that may have implications for the feasibility of routine evaluation in this field. Current approaches to evaluation were limited, but entailed considerable effort and ingenuity, suggesting that projects are keen to demonstrate their benefits. The survey has enabled us to build on the best evaluation practice identified to develop a measure for assessing the mental health, social inclusion and empowerment outcomes of arts participation for people with mental health needs. For the second phase of the study we will work with arts and mental health projects, using the measure alongside qualitative work in a realistic evaluation design, in order to identify the characteristics of effective projects.

Opportunities for independent living using direct payments in mental health.

Mental health service users have yet to reap the benefits of greater choice, control and independent living, which direct payments have facilitated in other groups of community care users, particularly people with physical disabilities. To redress this imbalance a national pilot to promote direct payments to people with mental health needs in five local authority sites across England was set up and evaluated. The evaluation used a multi-method approach incorporating both qualitative and quantitative data, including individual semi-structured interviews and group discussions with key stakeholders across the pilot sites. This article draws on findings from the pilot evaluation to provide a preliminary understanding of how applicable the independent living philosophy is to mental health and what opportunities direct payments offer for service users. When given the opportunity, service users were able to use direct payments creatively to meet a range of needs in ways which increased their choice, control and independence. This suggests that the benefits of greater independent living through direct payments may be realisable in mental health. However, a number of ways in which the principles of direct payments in mental health could be 'downgraded' were identified. The evaluation results indicate that a thorough understanding of the independent living philosophy needs to be developed in the context of mental health.