• Mental health, social inclusion and the green agenda: an evaluation of a land based rehabilitation project designed to promote occupational access and inclusion of service users in North Somerset, UK.

      Stepney, Paul M.; Davis, Paul (Haworth Press, 2004)
      The current debate about social inclusion in the field of mental health reveals a tension between the political and economic objectives of social policy. The former utilises the language of citizen empowerment and rights, whilst the latter is concerned with reducing welfare dependency through labour market activation. A central question here is whether a suitable programme of therapeutic work, training and support will produce better outcomes than those predicted by either a clinical diagnostic assessment or indeed open employment in the labour market. This article evaluates a research project with mental health users designed to develop pathways towards inclusion. The principal means for achieving this was a programme of 'green' land-based activities, training and social support. The researchers employed a mixed method approach, utilising a quasi-experimental design with a hypothetical control and standardised testing. This was followed by interviews with users, staff and focus group discussion. The evaluation produced some unexpected findings; for example, it was found that no strong correlation existed between diagnosis and performance. Many users performed better than had been predicted by their diagnostic assessment. However, the reasons for this remained unclear until the qualitative interviews enabled users to give accounts of the problems they faced, explain what inclusion meant for them, and outline how the project had brought gains in confidence, motivation and self belief. The data gathered during the research derived from different epistemological positions. This can be seen as representing two ways of 'slicing the reality cake' rather than producing one complete view of mental health users reality. One construction related to how 'the system' diagnosed, processed, and 'objectively' managed them. The other was about how users' responded to their situation, utilised the opportunities available, and made 'subjective' sense of their experience.
    • Mental Health, Social inclusion and the green agenda: an evaluation of a land based rehabilitation project designed to promote occupational access and inclusion of service users in North Somerset, UK.

      Stepney, Paul M.; Davis, Paul (New York: Haworth Press, 2005)
      The current debate about social inclusion in the field of mental health reveals a tension between the political and economic objectives of social policy. The former utilises the language of citizen empowerment and rights, whilst the latter is concerned with reducing welfare dependency through labour market activation. A central question here is whether a suitable programme of therapeutic work, training and support will produce better outcomes than those predicted by either a clinical diagnostic assessment or indeed open employment in the labour market. This article evaluates a research project with mental health users designed to develop pathways towards inclusion. The principal means for achieving this was a programme of 'green' land-based activities, training and social support. The researchers employed a mixed method approach, utilising a quasi-experimental design with a hypothetical control and standardised testing. This was followed by interviews with users, staff and focus group discussion. The evaluation produced some unexpected findings; for example, it was found that no strong correlation existed between diagnosis and performance. Many users performed better than had been predicted by their diagnostic assessment. However, the reasons for this remained unclear until the qualitative interviews enabled users to give accounts of the problems they faced, explain what inclusion meant for them, and outline how the project had brought gains in confidence, motivation and self belief. The data gathered during the research derived from different epistemological positions. This can be seen as representing two ways of 'slicing the reality cake' rather than producing one complete view of mental health users reality. One construction related to how 'the system' diagnosed, processed, and 'objectively' managed them. The other was about how users' responded to their situation, utilised the opportunities available, and made 'subjective' sense of their experience.
    • The Isle of Wight Suicide Study: a case study of suicide in a limited geographic area

      Shahpesandy, H; Oakes, Michael; Heeswijck, Ad van (Cambridge University Press, 2014-06-30)
      Suicide is a major public health problem, with mental disorders being one of its major risk factors. The high incidence of suicide on the Isle of Wight has motivated this study, the first of its kind on suicide in this small geographic area. The aim of the study was to identify socio-demographic and clinical risk factors for suicide in the population of service users and non-service users, and gender-related characteristics of suicidal behaviour in a limited geographic region. Data were collected on 68 cases of suicide (ICD-10×60-X84) from residents of the Isle of Wight District between January 2006 and December 2009. All data were statistically analysed using Pearson’s χ2 test and Yates’ correction for continuity. The mean annual suicide rates over the period were 5.65 per 100 000 for women and 19.28 for men. Significantly (p=0.0006), more men than women (male/female ratio 3:1) died as a result of suicide. Relatively (p=0.07) more women (56.2%) than men (32.7%), and significantly more (p=0.05) service users (45.3%) than non-service users (13.3%) were unemployed. Significantly, more (p=0.0006) service users (64%) than non-service users (20%) had a history of suicide attempts and relatively (p=0.06) more (50.9%) service users than non-service users (20%) had attended the accident and emergency department before their death; 69% had an adverse life event within a year before their suicide. Depression as the most common Axis-I illness was diagnosed in 36% of all; but significantly (p=0.008) more in women (66.6%) than men (17.3%). Relatively (p=0.07) more women (56.2%) than men (32.7%) have contacted services before their death. Suicide by hanging was the most common cause, accounting for the death of 71% of men and 50% of women. The study found that 80% of all suicides occurred in people suffering from mental disorder. Men are at a significant risk of suicide. Depressive disorders in women and stress-related disorders in men were the most common mental disorders. Treating mental disorders and co-morbid conditions seems to be one of the key elements in suicide prevention strategies.