Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between service user and professional social work discourses and provides a critical commentary on their respective contributions to the recent review of mental health policy and legislation in Northern Ireland. The analysis indicates that dominant trends in mental health care, as mediated through service structures and institutional identities, have tended to prioritize the more coercive aspects of the social work role and reinforce existing power inequalities with service users. It is argued that such developments underline the need for a ‘refocusing’ debate in mental health social work to consider how a more appropriate balance can be achieved between its participatory/empowering and regulatory/coercive functions. Whilst highlighting both congruence and dissonance between respective discourses, the paper concludes that opportunities exist within the current change process for service users and social workers to build closer alliances in working together to reconstruct practice, safeguard human rights and develop innovative alternatives to a traditional bio-medical model of treatment.

After Housing Policy: Housing and the UK General Election 2001

This paper describes the results of a review of the housing content of UK General Election 2001 manifestos. Housing policy was of little importance during the election campaign. The main British political parties had, essentially, a shared housing agenda - to promote and facilitate home ownership, support area and community regeneration, tackle homelessness, improve the private rented sector, and prevent building on greenfield sites. Many issues of importance to housing specialists received little or no attention, most notably that of low demand. Some policy variations within the UK were evident, for example in attitudes towards greenfield development, home ownership and stock transfer. The paper concludes that differences in housing policy are emerging within the UK as part of a new politics of devolution and that the days of a single housing policy approach for the UK are over.

Devolving Housing Policy and Practice in Northern Ireland 1998 - 2002

This paper reviews the effect of devolution on housing policy and practice in Northern Ireland. It outlines the history and context of devolution and housing policy in Northern Ireland, including the legacy and persistence of intense social conflict. Current devolution arrangements are reviewed, including the implications of enforced coalition for policy governance. The paper focuses on three dimensions of housing and housing-related policy development and implementation: social housing, especially the distinctive history and changing organisation of social housing provision; policies affecting the housing market, including the changing regime for spatial planning; and, regeneration and tenant participation. The paper argues that housing policy has tended to converge with policies in England, rather than moving towards a distinctively local agenda. Local political agendas remain dominated by disagreements over constitutional status, thus policy formulation is determined more by officials than by elected politicians.

Fiddling for Outcomes: Traditional Music, Social Capital, and Arts Policy in Northern Ireland

Arts development policies increasingly tie funding to the potential of arts organisations to effectively deliver an array of extra-artistic social outcomes. This paper reports on the difficulties of this work in Northern Ireland, where the arts sector, and in particular the so-called 'traditional arts', have been drawn into a politically ambiguous discourse centered on the concepts of 'mutual understanding' and, more recently, 'social capital.' The paper traces the recent history of these policies and the difficulties in evaluating the social outcomes of arts programs. The use of the term 'social capital' in the work of Putnam and Bourdieu is considered. The paper argues, through a rereading of Bourdieu's articulation of the 'forms' of capital and Eagleton's 'ideology of the aesthetic,' the concept of social capital can be released from its current neoliberal trappings by imagining a reconnection of the concepts of 'capital' and 'the aesthetic.'

A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes

Objectives: to evaluate the effectiveness of a policy of making hip protectors available to residents of nursing homes. Design: a cluster randomised controlled trial of the policy in nursing and residential homes, with the home as the unit of randomisation. Setting: 127 nursing and residential homes in the greater Belfast area of Northern Ireland. Participants: 40 homes in the intervention group (representing 1,366 occupied beds) and 87 homes in the control group (representing 2,751 occupied beds). Interventions: a policy of making hip protectors available free of charge to residents of nursing homes and supporting the implementation process by employing a nurse facilitator to encourage staff in the homes to promote their use, over a 72-week period. Main outcome measures: the rate of hip fractures in intervention and control homes, and the level of adherence to use of hip protectors. Results: there were 85 hip fractures in the intervention homes and 163 in the control homes. The mean fracture rate per 100 residents was 6.22 in the intervention homes and 5.92 in the control homes, giving an adjusted rate ratio for the intervention group compared to the control group of 1.05 (95% CI 0.77, 1.43, P = 0.76). Initial acceptance of the hip protectors was 37.2% (508/1,366) with adherence falling to 19.9% (272/1,366) at 72 weeks. Conclusions: making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture.

Theorising European Integration: Revisiting Neo-Functionalism and Testing its Suitability for Explaining the Development of EC Competition Policy?

This paper was published in the highly respected, peer reviewed and ISI ranked journal - 'European Integration on-line paper series

Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study

Objective : To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design : Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. Setting : Acute district hospital, Northern Ireland. Participants : Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. Results : Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in `real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. Conclusions : The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. Palliative Medicine 2007; 21 : 305—312 Key Words: do not attempt resuscitation (DNAR) • end stage illness • inter-professional • policy • resuscitation decisions