'An aid to mental health': natural history, alienists and therapeutics in Victorian Scotland

In the nineteenth century natural history was widely regarded as a rational and ‘distracting’ pursuit that countered the ill-effects, physical and mental, of urban life. This familiar argument was not only made by members of naturalists’ societies but was also borrowed and adapted by alienists concerned with the moral treatment of the insane. This paper examines the work of five long-serving superintendents in Victorian Scotland and uncovers the connections made between an interest in natural history and the management of mental disease. In addition to recovering a significant influence on the conduct of several alienists the paper explores arguments made outside the asylum walls in favour of natural history as an aid to mental health. Investigating the promotion of natural history as a therapeutic recreation in Scotland and elsewhere reveals more fully the moral and cultural significance attached to natural history pursuits in the nineteenth century.

Oesophageal cancer: caregiver mental health and strain

Objective: To investigate strain and mental health among family caregivers of oesophageal cancer patients and possible factors associated with caregiver mental health and strain.

Methods: Patients with oesophageal adenocarcinoma in Ireland were recruited into the FINBAR study (the main aim of which was to investigate factors influencing the Barrett's adenocarcinoma relationship). Carers completed the 13-item Caregiver Strain Index and the General Health Questionnaire-30 (GHQ) in the context of a brief interview with trained research staff that was undertaken separately from the interview with each cancer patient.

Results: Two hundred and twenty-seven patients participated in the FINBAR study. A total of 39 patients did not have a family carer or the carer could not be identified. Fifty percent (94/188) of carers completed the questionnaires. Mean (SD) scores for strain (6.65, SD=3.63) and mental health status (10.21, SD=7.30) were high and 71% of carers scored >5 on the GHQ indicating psychological distress. There was a statistically significant positive relationship between level of strain experienced by caregivers and the severity of their mental health status and whether or not carers scored >5 on the GHQ. Relatives were 1.70 (95% CI 1.34-2.15) times more likely to be defined as high scorers with each unit increase in the CSI score.

Conclusions: A significant proportion of caregivers experienced high levels of strain and psychological distress. There is a need to provide appropriate support and services targeted specifically at reducing the considerable strain of caring for patients with oesophageal cancer, particularly for carers of patients from lower socioeconomic groups.

‘Care just changes your life’: Factors impacting on the mental health of children and young people in care in Northern Ireland.

This paper represents one element of a research project carried out into the mental health needs of children and young people with experiences of care in Northern Ireland. Focusing exclusively on qualitative data collected from 51 young people in care and aftercare, it discusses in the first instance how the challenges and difficulties faced by young people can manifest themselves in feelings and behaviours that may exemplify poor mental well-being. In doing so it provides an understanding of mental health in the context of these young people’s lives. Through offering a more detailed account of some of the specific issues that put these young people at increased risk, it highlights areas for further work and consideration as a means of protecting them against these risks. These include: dealing with experiences prior to care; easing and ‘‘normalising’’ the experience of living in care; and enhancing ‘‘safety nets’’ after care. A key objective of the research is to inform policy and practice through the accounts of children and young people. It is argued that more work needs to be done to find creative ways of enhancing the day-to-day experiences of young people while in care and when leaving care.

National and Provincial Influences on Public Sector Pay: Northern Ireland after 1945

This article examines the national and regional pressures in Northern Ireland in the post-war period for parity in public sector pay with the rest of the UK. Northern Ireland had a devolved legislature and government within the UK from 192 1 and was constitutionality in all essentially federal relationship with the rest of the UK. However, the Stormont Government chose to use legislative devolution to minimize policy differences with the rest of the UK. The article highlights the national industrial relations environment as the backdrop for provincial developments in pay setting. It establishes the important role Played by the Social Services Agreement negotiated with the Labour Government at Westminster in triggering the principle of parity in public sector pay in the early post-war years. The principle of pay parity subsequently became a benchmark for regional trade union coercive comparisons in collective bargaining across the devolved public sector. The article highlights the Policy relevance of these developments both to the UK Treasury and to devolved Governments in the UK, as they address the issue of regional public sector pay.

A Longitudinal Study of the Effects of Childhood Trauma on Symptoms and Functioning of People with Severe Mental Health Problems

This study examines the relationship between childhood trauma and the psychiatric symptoms and psychosocial functioning of adults with severe mental health problems. Participants (n = 31) were recruited from the caseloads of community mental health services in Northern Ireland and assessed at baseline, 9 months, and 18 months. More than half had a history of childhood trauma (n = 17). There were no differences between the no childhood trauma (n = 14) and childhood trauma groups on psychiatric symptoms, but a significant relationship was found between trauma history and all aspects of social functioning. Those with no history of trauma showed improved psychosocial functioning over time, whereas those with a history of trauma deteriorated. These findings have implications for current service provision.

Coercion in the Community: A Situated Approach to the Examination of Ethical Challenges for Mental Health Social Workers

Increasingly, mental health social workers in the United Kingdom and elsewhere in the world are employing coercive interventions with clients. This paper explores this trend in the context of community-based settings, using national and international research literature on this subject. It begins with a discussion about the complex, contested nature of ideas on coercion. The authors then explore debates about how coercion is perceived and applied in practice. They choose two forms of coercion*/informal types of leverage, and the legally mandated use of Community Treatment Orders*/to highlight the range of ethical problems and dilemmas that confront practitioners in this field. The authors conclude by developing a tentative, explanatory model to explain how and why mental health social workers should consider a more holistic, situated approach to help deal with ethical concerns about the use of coercion.