How women use and experience western herbal practice for distress: implications for health care and self-management approaches.

Introduction: In the UK, common mental health disorders account for one in five of all work days lost, and cost employers £25bn each year. Herbal medicine has been shown to potentially be of use for mental distress, including conditions like anxiety. In 2008, 35% of British adults surveyed claimed to have used herbal medicine at some stage, the majority of whom were women. However, there is little research into how the users of western herbal medicine (WHM) experience the practice of herbal medicine, or how these experiences may change over time. Our research is studying women in the south-east of the UK who are suffering from distress (either as a primary complaint, or associated with another condition) who are seeking the services of a herbalist who practices WHM. Aim: To investigate the experiences of western herbal practice by women who are suffering with distress. Methods: The study is using semi-structured interviews of around thirty women, to elicit patient narratives at two time points. Thematic analysis is being used to consider how distressed women perceive and experience their distress, their reasons for using WHM, what contribution the women perceive the consultation and treatment with WHM may or may not make to their wellbeing, and whether their experiences change over time. Currently, sixteen women have been interviewed, and a preliminary thematic analysis has commenced. Results: Preliminary finding suggest that not only do women internalise their distress, but that they are surprisingly isolated in how they deal with it, whilst some also express social embarrassment about their experiences. The women perceived that their distress is not always considered seriously from their medical practitioners’ point of view. These women are drawn to herbalists not only in a search for effective treatment, but also to be given time to have their story heard, to form a collaborative relationship, and to attempt to regain some control of their life. The herbal treatment is valued due to its perceived naturalness, and reduced risk of adverse side effects. Nevertheless, WHM is just one of a number of self-care strategies that women utilise to help manage their distress. Discussion: Effective treatment is not only dependent upon the herbs, but also upon an effective therapeutic relationship. Feeling that the herbalist hears their story, provides a treatment plan that is individually tailored to the patient, and is available (even outside of the consultation) are all important in helping to establish this relationship.

Governing through community? A comparative study of changing management practices in mixed tenure housing development

An important feature of UK housing policy has been the promotion of consortia between local authorities, private developers and housing associations in order to develop mixed tenure estates to meet a wide range of housing needs. Central to this approach has been a focus on the management of neighbourhoods, based on the assumption that high densities and the inter-mixing of tenure exacerbates the potential for incivility and anti-social behaviour and exerts a disproportionate impact on residents' quality of life. Landlord strategies are therefore based on a need to address such issues at an early stage in the development. In some cases community-based, third sector organisations are established in order to manage community assets and to provide a community development service to residents. In others, a common response is to appoint caretakers and wardens to tackle social and environmental problems before they escalate and undermine residents’ quality of life. A number of innovative developments have promoted such neighbourhood governance approaches to housing practice by applying community development methods to address potential management problems. In the process, there is an increasing trend towards strategies that shape behaviour, govern ethical conduct, promote aesthetic standards and determine resident and landlord expectations. These processes can be related to the wider concept of governmentality whereby residents are encouraged to become actively engaged in managing their own environments, based on the assumption that this produces more cohesive, integrated communities and projects positive images. Evidence is emerging from a number of countries that increasingly integrated and mutually supportive roles and relationships between public, private and third sector agencies are transforming neighbourhood governance in similar ways. This paper will review the evidence for this trend towards community governance in mixed housing developments by drawing on a series of UK case studies prepared for two national agencies in 2007. It will review in particular the contractual arrangements with different tenures, identify codes and guidelines promoting 'good neighbour' behaviour and discuss the role of community development trusts and other neighbourhood organisations in providing facilities and services, designed to generate a well integrated community. The second part of the paper will review evidence from the USA and Australia to see how far there is a convergence in this respect in advanced economies. The paper will conclude by discussing the extent to which housing management practice is changing, particularly in areas of mixed development, whether there is a convergence in practice between different countries and how far these trends are supported by theories of governmentality.