Policy networks and the implementation of community care policy for people with mental handicaps

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, 'in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this 'implementation gap' in respect of services for people with mental handicaps--a consistent priority group for national policymakers. We examine centre-periphery relations in the health and personal social services in the light of Rhodes' power-dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.     

The Power of Stories: Using Narrative for Interdisciplinary Learning in Health and Social Care

This paper discusses the aims, process and outcomes of an interdisciplinary workshop day held for undergraduate students from Social Work, Mental Health Nursing, Adult Nursing, Midwifery and Occupational Therapy courses. The day's activities focused on mental health and were based on the use of service user narrative within three different workshops. The feedback from the students showed that the day was relevant to the curriculum that they were engaged in; allowed them to interact with and explore the perspectives of different professional groups; assisted them in understanding the lived experience of mental health difficulties; offered them the opportunity to consider implications for practice; was enjoyable and added ‘value’.     

Economic metaphors and working knowledge: enter the 'cogito-economic' subject

This paper probes the effects upon people of defining knowledge primarily in economic terms. It asserts that the language of commerce increasingly appropriates 'knowledge' by defining it in such terms. Theoretically, the analysis draws on the work of Jacques Derrida to explore the effects of metaphors in human resource management and development environments. The paper explores the ways that metaphors can become powerful signifiers of knowledge at work. As critical technologies of representation, the metaphors that have emerged out of recent theorizations of knowledge at work have contributed to a powerful discourse that defines people as 'knowledge workers'. It is argued here that dominant views of 'what constitutes a knowledge worker' imply that subjects are both 'knowledge workers' (cogito) and 'human resources' (economic) - thus the title 'cogito-economic subjects'. By defining people in this way, it is argued that there are potential dangers of metaphors becoming reified with knowledge becoming describable only in economic terms, and people describable only in cogito-economic terms.     

The Maudsley Model of Family Therapy for Children and Adolescents with Anorexia Nervosa: Theory,Clinical Practice,and Empirical Support

The aim of this paper is to present the Maudsley model of family therapy for children and adolescents with anorexia nervosa, one that integrates principles and skills from a variety of models. The Maudsley model is of prime importance because of its non‐pathologising approach to families, because its techniques have been published in sufficient detail for standardised application by clinicians, and because of its strong history of empirical support. It is also a model that integrates both modernist and constructivist influences from the history of family therapy.     

Systemic Consultation in Intellectual Disability Case Management

Systemic consultation is a form of tertiary case supervision derived from the principles of systemic family therapy. The present study defines the process and outcomes of systemic consultation through the experiences of case managers (CMs) working with people who have an intellectual disability. CMs were invited to present and discuss one of their complex cases with a team of consultants and attend a follow up session 4 to 6 weeks later. Measures of levels of stress, perception of workplace functioning, and workflow information were completed pre and post‐intervention and compared to measures completed by a second group of CMs receiving regular supervision only. After participation in systemic consultation, the networks of people CMs consulted about the case were significantly smaller and they scored significantly higher on a network measure of efficiency of information flow. The CMs experienced lower levels of stress and higher perception of workplace functioning, these differences approached significance. After attending the consultation outcome, themes included a reduced sense of being stuck and stressed, becoming an agent of change and taking perspective. The approach allows CMs space for reflection on practice and new perspectives to be heard. Case management has been under‐represented in documented research and evidence‐based training and supervision models, and is an area in which professional theory appears to be lacking.     

Intention to Change Careers: Determinants and Process

Based on reasearch involving a sample of 180 school teachers, the determinants and process associated with the intention to change careers was examined using path analysis on data from public school teachers. Overall, the empirical analysis provided support for the model and its causal ordering. However, lack-of-fit components suggested that a more complex model with additional paths might be more appropriate. Implications of the findings for research are discussed.