Interaction during mental health floating support home visits: managing host–guest and professional–client identities in home-spaces

Mental health work has been transformed by ‘shifting geographies of care’ from institutions to care in communities, in particular by the emergence of support located within home-spaces. This article studies a floating support service targeted at people with mental health problems and contributes to research on post-institution and home care geographies. The data contain 17 audio-recorded home visits conducted by professional care workers. An ethnomethodological analysis informed by geographies of care in home-spaces shows how the home as a material space has consequences for conversations and the relations between the service users and workers. The parties orient to two relational and shifting identity pairs in their ‘home-space talk’: a host–guest pair (social call talk) and a professional–client pair (targeted intervention talk). Professional–client pair dominates, and in this sense floating support produces institutionalization of home-spaces. However, social call talk that enables service users to act as hosts governing their home-spaces has important functions. Orientations to hosts and guests create symmetry and trust among the parties that encourages recovery promoting interaction. The article also demonstrates the applicability of the methods developed in the geographies of mental health and home in the ethnomethodological interaction analysis, and the other way round.     

Farmwomen's emotional geographies of care: a view from rural Ontario

This article contributes to geographies of rural women's health by investigating farmwomen's perceptions of their caring roles and responsibilities, which are crucial to the wellbeing and sustainability of rural people and their communities. Featuring a thematic analysis of interviews and a focus group with farmwomen from Ontario, Canada, the research examines farms and farming as unique places and spaces of care. Informed by the literature on emotional geographies, the article examines how care is situated and performed through farmwomen's negotiation of multiple, overlapping identities and how these are embodied and affective in emotional work. The findings not only confirm the paramount role of women in rural care, they demonstrate the interdependence of family, community and work as central to the challenges of rural women's health. The article argues that the link between health and productivity on the farm is crucial to understanding farmwomen's caring, and highlights the paradox that their emotional work is as much about opportunities for power and resistance as it is about obligation and subordination.     

‘It’s a very isolating world’: the journey to HIV care for women living with HIV in British Columbia,Canada

HIV health services research conventionally defines place in terms of proximity to care. However, understandings of place must also include the social spaces that women living with HIV (WLWH) occupy which shape their experience of health and access to care. Drawing on focus group data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study, we explored how 28 WLWH navigate geographic place and social space in attempting to access HIV-related healthcare within and across a range of urban to rural localities in British Columbia (BC), Canada. We describe how existing services, even if physically close, can be socially marginalizing as women confront HIV stigma, racism, and classism, which operate to exclude women from the places and spaces they must access for care. We also emphasize how women enact ‘geographies of resistance’ and succeed in carving out their own safe options for care and support. Finally, we share recommendations identified by women themselves towards developing local and community-driven ‘geographies of change’ that support the health and healing of diverse communities of WLWH. Our findings stress the urgent need to acknowledge and redress socio-spatial barriers to care and to work with WLWH to co-create a therapeutic landscape that reflects women’s diverse identities, localities, emotions, and experiences.     

Masculinities and geography,moving forward: men’s bodies,emotions and spiritualities

Geographical work on men and masculinities has expanded and diversified since the 1990s. Gender, Place and Culture has been, and continues to be, a significant outlet for this research. Geographies of masculinities now range across diverse sub-fields – social, cultural, economic, health, post-colonial, urban and rural geographies. We provide a brief overview of this scope, including the expansion of geographies of masculinities beyond the Anglo-American sphere. We then focus on two vibrant fields of research on geographies of men and masculinities, which cut across the various sub-fields of the discipline: men’s embodied and emotional geographies, and their experiences in relation to religion, faith and spirituality. We discuss these fields, suggesting further productive developments for geographies of masculinities, which include work on the body and wellbeing, body size, male care giving, men’s experiences in diverse faith communities, and men and alternative spiritualities. Ongoing development of geographical work on men and masculinities is important for helping to contest patriarchal structures and knowledge production.     

Caregiving as mobility constraint and opportunity: married daughters providing end of life care in northern Ghana

In the global south where care services are sparse and familial care remains practically and socially important, end of life care often occurs within families. Furthermore, in health care related policy development, care is often assumed to be ensured by ‘traditional’ norms of extended family relationships. In this context, the demands of providing care may require care providers to relocate, as well as reorganize their everyday responsibilities. This article contributes to geographies of care by offering an examination of the mobility constraints experienced by married and externally-resident daughters seeking to provide end of life care to a parent in northern Ghana. Drawing on ethnographic research, I examine how particular familial relationships are embedded with socially constructed labour obligations, leading to conflicting responsibilities at a parent’s end of life. I then consider how a woman as a daughter works to overcome these constraints to provide end of life care. I conclude that understanding the mobility of care providers can contribute to avoiding potentially damaging assumptions of ‘traditional’ norms of care and is an important consideration towards understanding the geographies of care in the rural global south.     

British voluntary hospitals, 1871-1938: the geography of provision and utilization

This article examines the distribution of beds, staff and in-patients in voluntary hospitals in England, Wales and Scotland between 1871 and 1938. The findings bear upon two theoretical debates; first, the concern of historians of social policy with the extent to which charity and mutual insurance delivered a satisfactory level of institutional care before the NHS, and second, the broader issue of whether the localism of voluntary sector provision tends to produce a geographically uneven service. We survey the chronology of voluntary hospital growth pointing to reasons for foundations. We then analyse the levels of beds, staff and in-patients per head of population in counties, county boroughs and large burghs. This evidence suggests that despite the expansion of the sector and the narrowing of differences between places, considerable variations in provision and utilization remained. We argue that these variations were likely to have had an impact on the health of individuals. We conclude by tracing the emergence in political and public discourse of the perception that geographical unevenness was a failing of the voluntary system.     

Rural mental health and social geographies of caring

This paper contributes to an emerging geographical literature on the social geographies of caring. Drawing on recently undertaken empirical work in the Scottish Highlands, personal accounts about the provision of both formal and informal care for people with mental health problems are evaluated. The notion of ‘community care’ is critiqued, as too are claims about how rural and remote rural locations engender particular configurations of caring roles, practices and relations. It is shown that geographical distance, social proximity, stoic cultures and rural gossip networks all have a part to play in how caring occurs in such places. The paper concludes by suggesting areas of future research.     

Social Service Delivery and the Voluntary Sector in Contemporary Australia

Continuing poverty, deprivation and unemployment in rich English-speaking countries have led governments to reconsider existing methods of delivering social services. In Australia, the Minister for Employment Services, Tony Abbott, has developed a doctrine of 'constructive compassion' to justify human service delivery through private firms and voluntary organisations. The McClure Report has also argued for 'social partnerships' involving governments, the business community and the voluntary sector. The limited purpose of this research note is to evaluate these arguments using the conceptual tools of market failure, government failure and voluntary failure and drawing on some of the theoretical literature on the voluntary sector, especially Billis and Glennerster (1998). We contend that considerable scope does indeed exist for social service delivery by voluntary organisations, subject to at least one important caveat.     

Examining social isolation by gender and geography: conceptual and operational challenges using population health data in Canada

In 2003, the Canadian Federal/Provincial/Territorial Task Force on Seniors identified social isolation as an important issue for further study and policy development given that socially isolated persons are considered to be more vulnerable to both inappropriate use of the health care system and poorer health outcomes. In order to provide adequate support to this vulnerable population, it is critical to untangle the complex web of relationships that influence the need for care, and the health status and service utilization patterns of socially isolated older adults. Using data from the 2000–01 Canadian Community Health Survey (CCHS), this article explores social isolation as a multidimensional social construct examining in particular the axes of gender and geography to try to tease out some of this complexity and its relationship to health status and service utilization. When individual characteristics like gender are considered together with broader contextual variables like place of residence, a more comprehensive and layered portrait of vulnerability among socially isolated persons begins to emerge with insights into their unique patterns of health and service use. For example, home care may be an extremely critical resource for keeping older women in their homes and out of hospital. On the other hand, among socially isolated older men, those living in rural communities may be particularly ‘invisible’, neither benefiting from home care nor having strong social supports. It seems plausible then that both men and women may be in need of special interventions or targeted programmes to help them to remain, or to become, more socially integrated in their communities as they age in place. In addition, this article addresses some of the limitations of using both a quantitative analytic approach and the CCHS dataset itself in grappling with such complexity.     

Mining sick: Creatively unsettling normative narratives about industry,environment, extraction,and the health geographies of rural,remote, northern,and Indigenous communities in British Columbia

Rural, remote, northern, and Indigenous communities on Turtle Island are routinely—as Cree Elder Willie Ermine says—pathologized. Social science and health scholarship, including scholarship by geographers, often constructs Indigenous human and physical geographies as unhealthy, diseased, vulnerable, and undergoing extraction. These constructions are not inaccurate: peoples and places beyond urban metropoles on Turtle Island live with higher burdens of poor health; Indigenous peoples face systemic violence and racism in colonial landscapes; rural, remote, northern, and Indigenous geographies are sites of industrial incursions; and many rural and remote geographies remain challenging for diverse Indigenous peoples. What, however, are the consequences of imagining and constructing people and places as “sick”? Constructions of “sick” geographies fulfill and extend settler (often European white) colonial narratives about othered geographies. Rural, remote, northern, and Indigenous geographies are discursively “mined” for narratives of sickness. This mining upholds a sense of health and wellness in southern, urban, Euro‐white‐settler imaginations. Drawing from multi‐year, relationship‐based, cross‐disciplinary qualitative community‐informed experiences, and anchored in feminist, anti‐colonial, and anti‐racist methodologies that guided creative and humanities‐informed stories, this paper concludes with different stories. It unsettles settler‐colonial powers reliant on constructing narratives about sickness in others and consequently reframes conversations about Indigenous well‐being and the environment.     

Forging Creative Partnerships

While much public attention focuses on the impact of immigration policy at the national level or in major metropolitan areas, the realities of political policy regarding refugees and immigrant populations are also felt in smaller, more rural communities as well. Local decisionmakers increasingly face new community needs at a time when mandated programs are being shifted as federal responsibility changes. This article recounts the work of a unique, ongoing collaborative effort that began in 1996 establishing a partnership between health care and public safety services in support of low-income and immigrant populations in the city of Portland, Maine. The project seeks to address two of the most pressing problems associated with immigrant populations: preventive medical care and the reduction of neighborhood violence. The project is predicated on the belief that community building works best when all residents are stakeholders in a vision that includes strong schools, safe neighborhoods, and healthy families. The elements of the Portland experience in service provision are recounted for other state and local policymakers in forging new and collaborative working relationships among service providers and government agencies     

The greying of resource communities in northern British Columbia: implications for health care delivery in already-underserviced communities

The delivery of 'rural' health care services has long confronted the geographic problems of distance, low user densities, low-order facilities and caregiver shortages. As a result, rural and remote communities across Canada have struggled with health care delivery. For rural and remote communities in resource hinterlands, population ageing driven by industrial restructuring presents a significant departure from past experience. Drawing on examples from northern British Columbia (BC), this paper examines this context of ageing in rural and remote locations with the purpose of highlighting impending challenges for health care service provision. In the first part of this paper, we provide a demographic overview of population change and ageing in northern BC. In the second part, we present data on the availability of services throughout the region to support seniors who age-in-place. Population ageing, in areas that have never dealt with this issue before, highlights not only important servicing questions but also important policy questions about how to provide for needs that the policy and community context are not presently equipped to meet.     

Social and Spiritual Capital: Building ‘Emotional Resilience’ In Communities and Individuals

Abstract

The article examines the relationship between mental health, mental health promotion, religious communities and general issues of public health. It begins with an exploration of what is meant by mental health drawing a distinction between it, mental illness and mental health promotion, and argues that mental health can have a profound impact on physical health. The relationship between religious communities and the mentally ill is analysed next. Despite the attitudes of many in mental health provision, religious communities can offer a supportive environment for the mentally ill. The article avoids a ‘faith communities—good’, ‘mental health services—bad’ dichotomy, recognizing that religious communities can be excluding and discriminatory. The ambiguity of some experiences is recognized: are they forms of religious experience or symptoms of psychosis? The article highlights the inceasing advocacy of the user/survivor movement. In the final section, the relationship between mental health and public health is explored. It is suggested that religious communities can be places for the promotion of mental health. Mental health promotion is understood as aiming to strengthen both individuals and communities; its value is explored in relation to public health issues. It is suggested that those who are socially excluded are at a greater risk of some form of mental illness and that this may well impact on their physical health. Related to this are the beneficial effects of opportunities for participation in decision making, be it in the workplace or the local community. The article ends by arguing that service providers and service users need to be involved in decisions and planning. Further, some elements of mental health promotion will need to involve those outside the statutory sector.     

Common Counsel,Common Policy: Healthcare,Missions and the Rise of the ‘Voluntary Sector’ in Colonial Tanzania

Analysis of the voluntary sector in sub‐Saharan Africa has tended to focus on the role of the NGO, and the types of relationships this institution establishes and maintains with donors, national governments and the communities with which they work. The voluntary sector in Africa is therefore usually defined through, and often treated as synonymous with, the institution of the NGO. As a result, the boundaries of understandings of the ‘third sector’ space occupied by the vast number of NGOs — its origins, the nature of the relationship of voluntary sector actors to the state, the types of organizations that characterize the sector — have tended to reflect a narrow concern with the NGO type and its experiences. This article suggests that this view is too narrow in its gaze. The voluntary sector was not a creation of a post‐colonial (and especially post‐1970s) development crisis. It emerged from an evolving relationship between colonial‐era non‐state (voluntary) actors and governments determined to demonstrate that they were meeting their commitments to the welfare of Africans under their charge. Missions and mission welfare services, expanding across much of rural sub‐Saharan Africa by the beginnings of the twentieth century, and increasingly coordinated from the late 1920s and early 1930s, created the foundations for the emergence of sub‐Saharan Africa's formal voluntary sector as it exists today. This matters for more than just historical accuracy. To understand the constraints, challenges and opportunities faced by NGOs, we need to move beyond a narrow focus on the institution of the NGO itself, and look in addition to the environment in which it operates: its history, its evolution and the shifts that created those conditions.     

Discipline and Devolution: Constructions of Poverty, Race, and Criminality in the Politics of Rural Prison Development

Abstract:  The soaring expansion of the US prison population is transforming the geographies of both urban and rural landscapes. As the trend in mass incarceration persists, depressed rural spaces are increasingly associated with rising prison development and the increasing criminalization of rural communities of disadvantage. Drawing on in-depth archival and interview research in rural communities in the Northwestern states of Idaho and Montana, this paper explores how cultural productions of poverty and exclusion intersect with rural prison development. I examine how representations of poverty and criminality are entangled with processes of economic restructuring and the localization of economic development and social welfare. I explore the ways in which the rural prison geography of the Northwest is linked to the material and discursive construction of those in poverty and how these narratives are produced through local relations of race, ethnicity, and class. I suggest that the mobilization of these constructions legitimates rural prison expansion, increasingly punitive social and criminal justice policies, and the retrenchment of racialized and classed inequality. Further, I argue that these discursive imaginations of the poor work to obscure the central dynamics producing poverty under the neoliberal restructuring of rural economies and governance.     

The space between: using ‘relational ethics’ and ‘relational space’ to explore relationship-building between care providers and care recipients in the home space

Geographers and other social scientists have a longstanding interest in ‘geographies of aging’ focused on the provision of care to vulnerable older populations and the challenges and experiences of caregivers [Skinner, M. W., Cloutier, D., & Andrews, G. J. (2014). Geographies of ageing: Progress and possibilities after two decades of change. Progress in Human Geography, 1–24]. This qualitative research project explores strategies for relationship-building used by home support workers and older residents according to a ‘relational ethics’ framework, enacted in the ‘relational space’ of the home environment. This framework rests on four principles: engagement, embodiment, mutual respect and environment, and argues that ‘relationships’ between care providers and care recipients must be preserved as the real essence or heart of the health care experience. Two linked conclusions are drawn from the research: that the treatment of the environment can be expanded using a social geographic lens to capture the more active influence of ‘homes’ on relationship-building and second, the relational ethics framework is useful in the home care context to characterize and ground the importance of relationships in the home care domain and the importance of home care to foster aging in place for vulnerable older persons.     

Shopping,social inclusion and the urban geographies of people with intellectual disability

In this paper, we examine the social geographies of people with intellectual disabilities. We focus particular attention on the significance of shopping and spaces of consumption as they relate to questions social inclusion and belonging in the lives of PWID. The focus on consumption offers a useful counterpoint to a prevailing policy emphasis on social inclusion through productive activities. The paper also contributes to the literature on intellectual disability within social and health geography, shedding light on the varied socio-spatial experiences of people beyond the confines of community-care facilities and other separate spaces. Our analysis draws on data collected from a participatory research project in Toronto (Canada). The project involved a small but diverse group of people with intellectual disabilities, who led academic researchers on a series of excursions designed to explore those places and routes that make up their everyday social geographies. Shopping emerged as a significant but often ambivalent theme in the context of these geographies, and the analysis demonstrates the complex interplay of autonomy and control, pleasure and restraint, care and support that shape people’s experiences of consumption. We conclude by discussing the significance of these findings for notions of social inclusion and belonging.     

MULTIPLE DIMENSIONS OF URBAN WELL-BEING

This paper examines the trends and changes in medical assistance at birth among poor and non-poor mothers in the state of Uttar Pradesh, India. It also investigates the relative role of public and private health care providers, and social and economic correlates on the non-use of natal care, as well as reasons for this non-use. Data from three rounds of the National Family Health Survey (NFHS) conducted over the period 1992–2006 were used. The wealth indices are estimated separately for rural and urban areas, and state-specific poverty line cut-off points are used to demarcate the poor and non-poor. Results show that birth assistance by skilled health professionals remained at an abysmal level, particularly for the poor. There had been no significant increase in the use of natal care among poor mothers during the period 1992–2006. Moreover, the increase in birth assistance by medical professionals came largely from private health care providers, and the use of natal care from public health centres had stagnated over the years.     

Voluntarism, municipalism and welfare: the geography of hospital utilization in England in 1938

This paper provides a comprehensive analysis of the pattern of hospital utilization (rather than provision) in England prior to the establishment of the NHS, showing the extent to which the probability of obtaining hospital treatment was a function of residence. Access to hospital care depended on the vigour of voluntarism and the political priorities of local governments. The pattern of voluntary hospital utilization is shown to have been markedly unequal, but the effect of municipal provision was to reduce disparities in access to services. The paper demonstrates variations in hospital utilization and discusses contemporary assessments of the situation. This work contributes to debates about the efficacy of non-profit forms of welfare delivery; it provides a novel British study to complement American work in this field. It also raises questions about the contemporary vogue for partnerships in health care delivery between the public and private sectors, arguing that such proposals rest on an optimistic view of history.     

The Diverging Geographies of Social and Business Interaction Patterns: a Case Study of Rural South Australia

Major changes in personal mobility and in country town service provision have taken place in rural South Australia in the period 1968–69 to 1992–93. The later part of this period was one of major rural recession across Australia as a whole. The impact of this recession is considered by investigating changes in three different geographies of rural South Australians. These are their affective identification with place, their local social interaction and their commercial service consumption. There has been a shift of both commercial and social activity up through the hierarchy of settlement, but this is much more pronounced in the case of commercial activity. These differential rates of change are weakening the once mutually reinforcing links between community self‐identification, social interaction and trading patterns. The full impact of the rural crisis commencing in 1982–83 on social and commercial spatial patterns is unlikely to have been achieved by 1992–93, and adjustment is likely to continue.