Telling a Different Story Theory evidencebase and critical

Telling a Different Story Theory, evidence-base and critical reflection with social inclusion and mental health Helen Barnes Combining the strengths of UMIST and The Victoria University of Manchester

Why tell a different story? ‘Our view of the world will shape our responses to it (Thomas & Thomas 1928, Kuhn 1975) Evidence-base in policy - natural science approaches *Statistical basis for causal inferences - epidemiology *Experimental evidence-base - RCT’s User-led, professional perspectives - pluralistic methods ARE THESE ENOUGH FOR EFFECTIVE PRACTICE? Critical and emancipatory perspectives DIS-EASE questions underlying story New story - different use of evidence-base TO NEW PRACTICE, EVIDENCE-BASE Combining the strengths of UMIST and The Victoria University of Manchester

Social Inclusion in Modernisation Policy Evidence Social exclusion statistical links to mental health (Putnam 2000) Being in work and having social contacts is strongly associated with improvement in health and wellbeing’ (OPDM 2004) HENCE ‘ACTIVE AGENT’ THE ROUTE TO SOCIAL INCLUSION Combining the strengths of UMIST and The Victoria University of Manchester

Social Inclusion in Modernisation Policy ‘Active agent’ route to social inclusion Policy - employment, social capital, ordinary supports ‘From a welfare state that provides passive support to one that provides active support (Blair 2000) Interventions - coping, behaviour, minimum care - ‘to be avoided at all costs’ (Pembroke 1998) ‘Many of the professional groups accepted a psychological interpretation of the problems…interpret and assess them in behavioural terms’ (Keene 2001) Combining the strengths of UMIST and The Victoria University of Manchester

Social Inclusion in Modernisation Policy ‘Active agent’ route to social inclusion *Few welfare services *Exclusion SSD eligibility criteria • Generic social care - ethics? knowledge-base? • Reduced hospital admissions • Reliance on informal networks *Punishment as deterrence • Interventions ‘active agent’ – e. g. CBT Combining the strengths of UMIST and The Victoria University of Manchester

Is this what users, workers want? Some user, professional dis-ease • Aggregate v individualised • Not the full picture • ‘Staff find themselves responding to more than behaviour’ *‘When we attempt to rebuild our lives we stand to lose the health and social service we may need. Moving back into society is a risky business’ (Swinkels 2002, Jones 2001, Do. H 2003, Service User 2006) Combining the strengths of UMIST and The Victoria University of Manchester

Critical reflection - why dis-ease? Emancipatory approach What makes for dis-ease? What is the underlying theory? Individual story - motivation to participate ‘Self-absorbed, bizarre behaviour, incoherent violent outbursts’ (Cleaver 1999) ‘Not really ill’ (Keene 2001) ‘Weak populations’ (Tonen 1997) ‘She never meant to give up’ (Keene 2001) Combining the strengths of UMIST and The Victoria University of Manchester

Are there alternatives? Person in situation story • Person-centred theory • Emancipatory and socio-ecological theories • Critical realist theory ‘People are shaped by the world around them but are also creative beings’ - sociological imagination (Wright Mills 1970). Hard to participate ‘There is a choice. But I don’t feel able or ready to take part in what’s on offer I suppose’ (Carpenter et al 2004). Combining the strengths of UMIST and The Victoria University of Manchester

Alternative evidence-base Individual Story Statistical correlates - protective factors *Sense of control *Social participation What influences these responses? Person in situation • Symptoms - reduce problem-solving ( Paykel 1992) • Poverty – child care barriers to employment (SPAN 2001) • Childhood abuse - PTSS reduces coping (Walker 1992) • Disadvantage – poor access to services (Mold 2003) *Domestic violence - substance misuse (Humphries 2005) Combining the strengths of UMIST and The Victoria University of Manchester

Evidence-base for another story 1 Evidence to understand person in situation process: public issues, private pain • Qualitative: experiences, processes • Quantitative: antecedents, associated factors, multiple regression • Triangulation (Melrose 2000, Fitzpatrick 2000) Combining the strengths of UMIST and The Victoria University of Manchester

Evidence-base for another story 2 Example of evidence for person-in-situation route to social exclusion - substance misuse *30% CMD, 60% SMHP substance misuse *Abuse, poverty, domestic violence correlates • Abuse – I’ve had bad experiences in my life and drugs help me forget’ • Domestic violence - ‘Heroin…making me feel safe and that I’d handle anything’ • Poverty, unemployment – escape boredom, poverty. • 70% motivated to become drug free but cannot. (Do. H 1999, Penhale 1999, Keene 2001, Elliott 1999, Test 1989, Jones 1998) Combining the strengths of UMIST and The Victoria University of Manchester

Evidence-base for another story 3 Evidence to test the story – process-outcome research • Symptom relief - problem solving • Person-centred relationships - service use , recovery • Specialist social support - recovery motivation Services - outcomes (Paykel 1992, Secker 2002, NTA 2003, Quilgars 1998, Elward 1992, Ryan et al 1999) Combining the strengths of UMIST and The Victoria University of Manchester

Where does this story take us? Implications for research Underlying processes of protective factors Triangulation - Antecedents, Associations Experiences, Multiple regression. Areas of research • Social, Psychological, Medical • Interactions between and within these systems. Evaluation research • Triangulation and pluralistic evaluation Combining the strengths of UMIST and The Victoria University of Manchester

Where does this story take us? Implications for Practice Interprofessional Working Biomedical, psychological, social interventions: professional work with processes Partnership with service user creative social actor Interventions with social, psychological and biological conditions besides behaviour. Combining the strengths of UMIST and The Victoria University of Manchester

Helen Barnes Lecturer in Social Work Helen. Barnes@manchester. ac. uk Combining the strengths of UMIST and The Victoria University of Manchester