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2.3 Community care, fear and the ‘high-risk’ service user

So far in this course you have seen how the concept of risk has come to suggest danger. This section explores in greater depth how the changes that have led to this situation have impacted on mental health policies and practice. The next activity involves reading an article to help you consider risk in the context of mental health services.


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1.3 Ways of viewing mental distress

The first point to note is that there are two key competing ways of viewing mental illness or distress: physical and social. One of the functions of this course is to draw together aspects of these accounts in order to cross the boundaries that they create and maintain. Our aim in this respect is to devise a third way, a more rounded and holistic approach that brings together the best of both worlds. In the meantime, though, the physical and social explanations predominate. Physical explanati
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1.2.2 Boundaries of difference

One of the things that language does is define and give a name to differences between people – to delineate the boundaries that separate them. In the mental health field, the ‘mad’ are at one end of the social divide that separates the ‘normal’ from the ‘abnormal’. They are ‘the other’, a point made in the article by Perkins (above): ‘To be mad is to be defined as “other”’.

This is a recurring theme in the mental health field. In the following passage Abina Par
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1.1 Introduction

This extract looks at what we are calling ‘boundaries of explanation’. It tackles key issues such as:

  • What are mental health and distress – and who decides?

  • What are the views of people who have acquired a label of ‘mental illness’?

  • What are the views of those who determine – and patrol – the boundary between mental distress and ‘normality’?

The extract looks at language and terminology an
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Learning outcomes

After studying this course, you should be able to:

  • understand the complexity and dilemmas of diverse perspectives in the field of mental health and distress

  • undestand the importance of service users/'survivors' experiences and perspectives

  • understand how mental health issues affect everyone

  • understand the range of risks faced by service users/'survivors' in their everyday lives.


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Keep on learning

Study another free course

There are more than 800 courses on OpenLearn for you t
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3.17 Key ethical issues for CAM practitioners: respect confidentiality

During their professional practice, practitioners will be told a lot of personal information about their clients. This information is imparted in the context of a trusting relationship in which users trust that the information they have conveyed will be used only in their best interests and divulged only with their consent. The duty to respect users' confidentiality flows from the duty to respect their autonomy. People cannot make their own choices and control their lives if they cannot contr
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2.2 Users' experiences of the therapeutic relationship

CAM users may seek a very different type of therapeutic relationship from those they experience with orthodox practitioners. Some people may want to spend more time with a CAM practitioner than they do with their GP, to have more say in determining the frequency of access to practitioners, to have more control over what happens in the consultation room, and to have more choice about the treatments they are given.

In any therapeutic encounter, people want to be treated with respect, to b
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1.9 Models of health care delivery: alternative or holistic models

Many CAM modalities have grown from a wide range of concepts of the body and health and healing that differ from the models discussed so far. As Fulder notes:

The body, in Chinese medicine, is energetic. In yoga and healing, the body is spiritual. In modern (conventional) medicine, the body is physicochemical. In homeopathy, it is phenomenological. In naturopathy it is vital, etc. All of these conceptions do not necess
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1.8 Models of health care delivery: the salutogenic model

Whereas pathogenesis (the way disease processes develop) underpins the biomedical model, the concept of positive health, or salutogenesis, focuses on how and why people stay well. Salutogenesis can be seen either as a model in its own right or as an example of the biopsychosocial approach (Antonovsky, 1979, 1987). Antonovsky's salutogenic model was designed to advance understanding of the relationship between stressors, coping and health, with the aim of explaining how some indi
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6.3 (b) Switching to renewable energy sources

The use of renewable energy usually involves environmental impacts of some kind, but these are normally lower than those of fossil or nuclear sources.

Approaches (a) and (b) are essentially 'supply-side' measures – applied at the supply end of the long chain that leads from primary energy production to useful energy consumption.


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6.1 Introduction

So far, we have briefly introduced three key approaches to improving the sustainability of human energy use in the future. These are:

  • (a) 'cleaning-up' fossil and nuclear technologies;

  • (b) switching to renewable energy sources;

  • (c) using energy more efficiently.


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3.3 Nuclear energy

Nuclear energy is based on harnessing the very large quantities of energy that are released when the nuclei of certain atoms, notably uranium-235 and plutonium-239, are induced to split or 'fission'. The complete fission of a kilogram of uranium-235 should produce, in principle, as much energy as the combustion of over 3000 tonnes of coal. In practice, the fission is incomplete and there are other losses, but nevertheless nuclear fuels are more highly concentrated sources of energy than fossi
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3.2 Fossil fuels

So what are the principle energy systems used by humanity at present, and how sustainable are they?

Until quite recently, human energy requirements were modest and our supplies came either from harnessing natural processes such as the growth of plants, which provided wood for heating and food to energise human or animal muscles, or from the power of water and wind, used to drive simple machinery.

But the nineteenth and twentieth centuries saw a massive increase in global energy us
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6.1 The path to prevention

So far in this Introduction I have concentrated on some specific environmental issues, which has inevitably meant I have spent time looking at problems and their possible causes. A balanced account would look in similar detail at possible responses and solutions. The Greenfreeze example in Case Study 1 was one attempt at a solution. At the local scale, in the factory, scientists and engineers have always provided society with solutions to the problems of pollution and threats to public
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5.4 Discussion

We seem to have travelled a long way from the Industrial Revolution in Europe, but many of the impacts on New Zealand's ecosystems described here can be traced, in part at least, to reverberations from these developments.

What lessons can be drawn from this example? Perhaps I should start by emphasising this is not meant to be a complete account of the environmental history of New Zealand. For example, I have not discussed any responses from the population once they realised that harm w
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5.2 New Zealand's changing environment

In this study I want to explore some possible effects of this new trade on the environment of one of the countries involved. I've chosen New Zealand, partly because the developments we have just been discussing happened only a few decades after the first large-scale settlements of Europeans, and had a strong influence on the direction of its economy. Some background information will help to set the scene.

New Zealand consists of two mountainous islands with a total area similar to that
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4.4 Discussion

In this second case study, I have described two different trends in energy use by cold appliances over the last few decades. On the one hand the efficiency with which appliances use electrical energy has improved but, in spite of this, their consumption of electricity has increased significantly in recent decades. Since 2000 consumption has started to decline, probably as a result of the introduction of minimum energy standards. The trend will only continue if we demand and use the most energ
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4.2 The US experience: wasteful innovation?

In the 1950s and 1960s many industrialised countries experienced a prolonged period of economic expansion which, together with the rise of consumerism, created an increased demand for domestic appliances. With ready access to cheap supplies of fuel, there was little or no incentive for manufacturers or consumers to worry about energy conservation. Nowhere was this more evident than in the US, as the following extract from the influential book Factor Four of the design developments in d
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2.3 The Industrial Revolution and its environmental impacts

The environmental issues you have identified in your answer to the first exercise are likely to be complex and difficult to unravel, yet alone resolve. Rather than attempt that at this stage I'd like to start this section with another question. Where does our material prosperity come from? To which one short answer would be 'The Industrial Revolution'. In the space of less than 100 years between the eighteenth and nineteenth centuries, first Britain, then several other countries
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