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okay, thank you very much, Jeremy. Yes. give you

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in that way. It is much on the social

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we are using. When we

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investigator. the conversation was people severe mental illness, or in particular. actually going to focus on.

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So generally

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it comes to

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the issue of violence in the context of

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psychiatry. the

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and start coming through to see

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no, but just continue, for now.

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So

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it comes to compliance in the context of the kind

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the public perception is drawn.

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Why.

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supported by your report to scandalize violent crimes with a strong focus on mental illness as it

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irrespective of

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that most while caused by people without for his borders. And so perceptions are in contrast to.

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But for a long time. This also the academic. the academic

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interest in this issue. This review is from 2,008, and it focused on bottles of violence and also on victimization, and it captured 31,

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and it captured

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and 31 in studies on perpetration. But

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10 studies on victimization.

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And these findings are in line with conceptions.

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Our that there is an increase  about people with to be a Mentalist borders

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population, but at the same time far more increases the rate of ritualization.

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while 3% of the

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experience victimization, 25% of we are mental supporters to so and so, while the discourse of violence is dominated by a focus. This review show that

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victimization and not is the problem

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on the

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optimization. Brains have been widely confirmed.

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and also more recently, by this study from the University of South Wales in Sydney. based on 25 studies. This review provided further evidence for the higher rates of victimization than perpetration

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for individuals with

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and mental illness, but also for higher rate of both victimization and perpetration. For those with mental illness compared to those in the.

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it is important to know, however, that victimization and violence perpetration can over.

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In this early standing more than 400 participants were asked about their involvement in 30 days. and as a result of 41,

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341 percent of the respondents reported the to

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of

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180 incidents. And again it was far and far more easy

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involved.

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and a number of was that most incident

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as violation. And

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as the

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however, at 26

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question.

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So let's have a quick look at the numbers, at the prevalence rates, and, according to a systematic review, the odds ratio, so the likelihood for so victimization were found between 2 and almost 12, compared to the general population.

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and meta-analysis found a pooled odds ratio over 6 studies of 5.6 for any physical and sexual violence for people with severe mental disorders.

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So what can be said about the impact of gender? The prevalence for sexual victimization is almost 10% for female service users and around 3% for male service users. So when comparing females to male-service users, we found that women have a three-fold risk of being victimized

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in the sexual victim sexually victimized. And this gender gap is not really surprising, because it is in line with the general trends regarding the higher, significantly higher prevalence rate for sexual violence among women.

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But what is really surprising is that is the fact that there is no gender difference for physical victimization.

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and this is in in sharp contrast to data from the general population that is constantly show a greater risk for mayors to be physical or victimized.

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and this reverse gender gap seems to be explained by a profoundly higher percentage of female service users compared to the general population.

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While men have a five-fold increased risk for physical victimization. Female service users have a nine-fold increased risk.

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So against this background we identified several research gaps and developed the following research questions. what is the victimization prevalence among people with severe mental illness in Germany? What are forms and context, and under what conditions are these experiences disclosed?

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What are prevalence and forms of the overlap of victimization and perpetration.

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What is the subjective meaning of violence, experiences, and what is the impact of gender on prevalence? Nature, and the context of violence, experiences, and finally, in what ways the mental health professionals respond to experiences of violence among their clients?

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What are barriers for addressing violence? And what needs can be identified for mental health professionals themselves when they deal with their clients experiences of violence.

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And just a few weeks ago we started with a 3 year. mixed method research Project, funded by the German Research Association, and the aim is to investigate the prevalence of violent incidents among people with severe mental disorders and to develop a comprehensive understanding of the social, biographical and the institutional context factors.

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Also, we will identify barriers and mental health professionals needs regarding, addressing violence, experiences within mental health, treatment, and care.

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and the first step is a survey, including 500 individuals, with severe mental disorders from different settings on their violence, experience, experience of. So for both victimization and also perpetration for comparison with the general population, we also use a representative online, for example, including 1,000 participants.

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Based on this. The second step includes qualitative biographic narrative interviews with a subsample of those who screened positively for victimization. above specific cut off.

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And finally, we use qualitative and quantitative measures to investigate mental health professionals, perspectives and experiences.

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So what are the sensitizing concepts of our study.

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our starting point for investigating is a sociological understanding of violence as an expression of power. Here we follow Heinrich puppets, which is a German sociologist, who, in his book Phenomena of Power, extensively sorry, extensively studied the the various experiences

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of violence and power in societies. This book was published in 86 in Germany, and it was translated 2,017 to English. He described a violence as as as a power of action, proposing that violence is a form of power which enables individuals or groups to exert their will or achieve their goal through force or coercion.

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Power is assessed as a relational concept, and it's deeply grounded in every human's vulnerability.

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And this vulnerability provides the option to exert power as a part of day to day interactions. social relations and power. Dynamics are not fixed, but subject to change and rearrangements over time

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and power and violence are thus inherent or integral parts of societal structures and interactions.

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And following this idea of power relations as inherent elements of any societies, we will investigate forms of power that enable the exploitation, discrimination, or abuse among the group of people with severe mental illness.

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And here we draw mainly on symbolic power which was conceptualized by Pierre Bourgu. According to this symbolic power, is necessary for maintaining social hierarchies, and thus for individual displacement in a social field.

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This power is maintained through symbols, language, or culture, and in regard with severe mental disorders. Stigma of people with vehicle disorder is a form of symbolic power, as we assess it.

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In addition, this is very much in line with the stigma power. We also refer to stigma power, which is a concept introduced by link and feeling. Proposing stigma can only exert its impact when the stigmatizers occupy a privileged social position, and a specific stigma finds rather social acceptance. As it is the case with mental health stigma.

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In line with this we refer to structural power as well as relevant for the, for our understanding of victimization

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and structural power includes power which is embedded within social, economic, and political structures in regard with people with severe mental illness. This is obvious in regard with the evidence of the risk factors for victimization, including low so socio-economic status, low education, but also, for example, homelessness

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and structural power can manifest in institutional power in regard with severe mental disorders, the Mental Health Institution, but also the legal system apply and shape the stigma power and the symbolic power through practice norms and well use.

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And there is strong evidence that the response to the victimization of mental health you service users is inappropriate.

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And this does not only Prevent adequate responses in terms of ser reported responses, but also increases the risk for re-ritimization in psychiatric settings through coercive or violent treatment, particularly with insecure psychiatric settings

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and the severe effects of this inadequate responses of mental health services were shown in an earlier Us. Study. The authors found that service users with lifetime history of sexual assaults as adults were more likely to report levels of concerns for personal safety and feelings of helplessness, fear, and distress in psychiatric settings.

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Service users with a post-traumatic stress disorder, reported feeling less safe, more feeble and more distressed in psychiatric settings. This means that if mental health professionals are unaware of violence, experience

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such ineffective responses to trauma can lead to further re-traumatize the Mental Health Service users

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regarding gender, we will apply concepts of gender-based violence both in heterosexual heterosexual and homosexual dimensions

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here we draw on feminine theories that interprete male violence against women as the enforcement of a dominant male power position. We follow Carol Hagermann Wide, which describes physical or sexual violence as an assault of the physical and mental integrity of a person through exploitation of a socially predetermined relative power position.

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Furthermore, we apply the concept of hegemonic masculinity structures introduced by Roy and Canal. Within this concept the gender logic of Mayo, violent acts entails in regard with heterosexual violence, the differentiation and exclusion of women in regard with homosexual violence the marginalized or subordinate of certain masculinities not in line with traditional norms of masculinity.

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How many minutes do I have? For

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in our study, we aim to gain insight into violence beyond rigged attributions of male perpetrator versus male victim status.

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which is often the case, and we move beyond understanding that follows like Beyond an understanding which follows a dichotomous categorization of individuals with mental illness as either victims or either perpetration. And here the biographical approach will allow for analyzing the overlap over time in a biographical perspective, and also with this, the processuality of violence within a biographical context.

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And finally, we advert to both context centered and situation-centered approaches for the understanding of violence.

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Context-centered approaches refer to the macro sociological investigation into the social, structural or social cultural conditions, for instance, poverty or but also normative prescriptions of violent actions.

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Situation-centered approaches, on the other hand, refer to the situational interaction and the interpretation and and the interpretations of the individuals involved. And here we try to achieve a meaningful understanding of subjective constructions of violence. So what people basically do to to mean by violence. So we have different definitions.

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and considering that both perspectives are mutually complementary, we will apply an integrative perspective.

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and this is based on the assumption that victimization is embedded in social authors that provide social interpretation and rules, and these interpretations are contextually structured by the actors involved.

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So the aims of our study. is to get a comprehensive investigation or a comprehensive understanding of violence in the context of mental health, illness, and we hope in doing so that we will make a fundamental contribution to a better understanding, and this.

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we hope, will provide us an empirical basis for the development of targeted and tailored interventions to improve the management of violence, experience in a particular vulnerable group, and for the development of preventive and interventive services.

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And thank you. And also and thanks to my colleagues, we in both teams, we are working on that. And yeah, I can't wait to introduce to the results next time.

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Thank you.

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So thanks very much, Sylvia. Well, as I've mentioned before, we'll take questions for all presenters at the end. So our next presenter

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and should be online.

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Piyush Pushkar: Yeah, Hi, that's me.

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William, thank you.

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Great. So we'll just stir it.

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Are you able to share your screen at the moment.

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Piyush Pushkar: yeah, I'm just pulling it up.

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Piyush Pushkar: Hey, Kay, can you see that?

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Yeah, we can. It's It says, today's talk. So I think you just need to go to the beginning of your slides.

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Piyush Pushkar: Yeah.

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okay.

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brilliant. Thank you very much. So I'd like to introduce Piosh Pushkar, who's speaking about guilt and shame amongst mentally unwell offenders. So over to you.

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Piyush Pushkar: thanks. Yeah. So yeah, I'm quish

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Piyush Pushkar: just to tell you who I am. Yeah. So I'm a doctor training in forensic psychiatry in Manchester. which is where I am right now.

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Piyush Pushkar: And my Phd. And most of my published work, was actually on on health care activism.

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Piyush Pushkar: I did ethnographic field work with people campaigning against custom privatization in the Nhs.

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Piyush Pushkar: that's not what I'm going to talk about today. If you would like to hear about that, I'll be presenting tomorrow in the social movements and state panel.

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Piyush Pushkar: But today's presentation is about a new project. I've been designing and working on more recently.

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Piyush Pushkar: And so the new projects on guilt and shame amongst people who are mentally unwell

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Piyush Pushkar: and people who have also committed crimes. And so we're in some kind of forensic setting. whether that's a prison or a secure hospital

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Piyush Pushkar: just quickly on on the kind of the words that I'm using the terminology of using just for brevity. From now on I'm going to call this group of people the kind of population of interest for this study mentally on well offenders.

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Piyush Pushkar: and so realize that they more than just offenders, that people and you know the turn offender deserve some unpacking, and to who gets to say what an offences, and how and what are the systems by which that happens? etc., etc. And similarly, there's debate around, you know, the use of the words mentally unwell, and rather than something less medicalizing, like people suffering mental distress, or something

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Piyush Pushkar: so acknowledged all of that debate. But around these kind of potentially stigmatizing terms, just for gravity. And he's today I'm going to refer to mentally unwell offenders. it's also relevant that that is is how

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Piyush Pushkar: this group of people is referred to within the psychological and the psychiatric literature.

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Piyush Pushkar:  when I submitted this abstract I had hoped to have actually done some interviews by now, and so I was going to be presenting when the preliminary results

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Piyush Pushkar: I understand that actually got I haven't got past ethics as yet, so instead, I'm going to present a bit of what I'm trying to do what my questions are, what? My! A bit of my literature review and my current plans in terms of methods. And so I'd love any kind of feedback from yourselves on methodology, any pointers in terms of literature, etc.

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Piyush Pushkar: So What I'm trying to do is you're going to explore the role of the guilt and shame play in psychiatric assessment and management. for mentally on world offenders. the background is the, you know feelings of guilt and shame play a very important role in the assessment of mentally under offenders and doctors, psychologists, nurses

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Piyush Pushkar: ask about patients, feelings of guilt, shame, remorse in relation to their offenses, and also in relation to other traumatic experiences in their lives. patients may also be consumed by such feelings in relation to other issues. such as the stigma of mental illness itself?

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Piyush Pushkar: questions use these answers the answers to these questions to form clinical judgments regarding diagnosis, personality.

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Piyush Pushkar: fire cycle by a second social formulation and and and collisions, then make decisions based on these assessments. not just for treatment plans, but also for medical legal reports. and these reports influence court processes.

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Piyush Pushkar: and I have a profound influence on the lives of offenders.

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Piyush Pushkar: so within

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Piyush Pushkar: so there's extensive literature within psychiatry and psychology on the role of guilt and shame in sector, pathology, personality and risk assessment.

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Piyush Pushkar: And, for example.

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Piyush Pushkar: the IC D Icd 10. Diagnostic criteria for this social personality. Disorder include. This is a quote an incapacity to experience guilt.

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Piyush Pushkar: On the other hand, excessive feelings of guilt are also a symptom of major depressive disorder. So it's relevant that diagnosis and formulation. But it's also relevant for risk assessment

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Piyush Pushkar: and so promise to experiencing guilt is considered a protective factor, and with respect to future recidivism.

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Piyush Pushkar: whereas, on the other hand, shame!

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Piyush Pushkar: I I I can talk about the differences between gilt and shame. According to the literature, Shame is considered a risk factor for going on to commit future crimes.

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Piyush Pushkar: So such find this kind of push towards particular treatment recommendations, such as psychological interventions, that foster feelings of guilt in relation to the past offense without incurring shame.

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Piyush Pushkar: So that's why kind of question is discuss guilt and shame in medical legal reports.

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Piyush Pushkar:  just quickly question to medical legal reports and what they did write this kind of long explain of it. And there's longer than the rest of the presentation. So just to give a very quick and there to explain that psychiatrists.

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Piyush Pushkar: right medical legal reports. This is, you know, I'm talking about within the Uk. Here. so I just write medical legal reports. The Criminal Court as expert witnesses, and also write reports for tribunals.

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Piyush Pushkar: So anyone who's detained in hospital under the Mental Health Act so detained against their will.

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Piyush Pushkar: has regular tribunals to protect their rights, and so that they're not being unfairly detained. and tribunals have the power to discharge people, even if the doctor is not recommending this judge.

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Piyush Pushkar: and

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Piyush Pushkar: but a lot of the people that I'm interested in. who's committed crimes are not just detained under the civil, but actually detained under specific criminal sections of Mental Health Act.

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Piyush Pushkar: where it's not just that the patient can't discharge themselves, but also the doctors can't discharge them. and yes, the discharge has to come from either a tribunal or directly from the Secretary of State for Justice.

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Piyush Pushkar: and

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Piyush Pushkar: and those decisions the to decisions of the tribunal is are based on medical legal reports.

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Piyush Pushkar: So you can see how these medical reports are incredibly important

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Piyush Pushkar: deeply consequential for patients, particularly in terms of how permissions are conceptualizing risk in their reports. So that's where kind of my interest in guilt and shame starts

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Piyush Pushkar: as soon as a clinician begins to argue that guilt and shame are relevant to risks. You can see the wave condition is thinking about it, the way that

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Piyush Pushkar: the way they sold describing it in their reports, the way they conceptualize it in their management plans all become incredibly important to the patient. I'll have a bearing on whether they go to prison or hospital.

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Piyush Pushkar: What happens with that care in hospital, how long they spend in hospital, what kind of restrictions they might be subject to. you know, when they leave hospital.

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Piyush Pushkar: and

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Piyush Pushkar: so shame is also been explored by sociologists. like Graham, Scambler, imaging Tyler philosophers like Danza, Harvey, and Luna Dol as well.

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Piyush Pushkar: and these scholars have drawn links, not just with trauma, adverse childhood experiences and offenses.

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Piyush Pushkar: but also with class gender ethnicity. and not many people attempt to to draw links between these 2 different streams of scholarship.

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Piyush Pushkar: you know, between the psychological and psychiatric literature on one side and the kind of more sociological if we are on the other side  to to learn lessons that can be applied to clinical practice, although there are some exceptions.

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Piyush Pushkar: for example, that there's a shame in medicine project in in exit, and they've recently done a recently released a book on Covid and shame. And they also do really interesting things like collaborate with

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Piyush Pushkar: medical educators, produce graphics and resources to be used to stimulate kind of conversation, reflection amongst health care students and professionals.

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Piyush Pushkar:  that's an example of one of the things they produce to kind of stimulate conversation. But drawing links across these literature is partly what I would like to do. So, for example.

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Piyush Pushkar: Caroline's suffering. who, like me, is a doctor and an and and an anthropologist writes about providing health care for pregnant people in American jails.

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Piyush Pushkar: and so she noticed how the paradigm of Castle Risk management interacts with and shapes the ways in which care is provided and experienced by the women that she's looking after. when they're in jail

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Piyush Pushkar: and the tragedy in her writing is that care is shaped by this castle logic, but

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Piyush Pushkar: but it is at least provided for people who are in prison. whereas outside jail they there's no health care for these people at all. her studies based in the U.S.A.

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Piyush Pushkar: So these people. When they need care, they find a way to get rested and put in jail.

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Piyush Pushkar: And so the social structures and institutions, class race gender inequality that dictate access to care profoundly affect how people seek, understand, and experience care and deserving this, which is to get negotiated relationally where those relationships are with prison offices.

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Piyush Pushkar: And so it's deserving this, and shame a lot deeply into related Tollis, all A philosopher who, I mentioned before describes shame as the key emotion of neoliberalism.

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Piyush Pushkar: as people take on responsibility for their own individual failures and feel that they deserve it. Coming back to different different rights of people who commit minor crimes.

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Piyush Pushkar: and it may

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Piyush Pushkar: normally been dealt with with a community sentence. But actually they get sent to jail because they're pregnant. And that's because

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Piyush Pushkar: jail and health care in jail becomes a way of managing the risk to the pregnancy.

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Piyush Pushkar: so yeah, because they are less likely to use drugs, not sleeping rough, less likely to acquire sexually transmitted infections, etc. So this jail sentence kind of serves a double purpose of punishing the mother for whatever crime it was, and she, is supposed to have done as well as protecting the unborn child from the quite dangerous mother.

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Piyush Pushkar: and we see how the custodial approach to risk management and the organization of health care focuses all the blame on the individual.

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Piyush Pushkar:  literally gets the woman jail jail for her own good and the good of the unborn child, rather than considering the kind of structural factors that might have led to reducing those risks while living in the community. The structural factors that make drug use sleeping rough

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Piyush Pushkar: getting essentially transmitted, in fact, is more likely for some people, you know, than others.

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Piyush Pushkar: So if we consider this in conjunction with the psychological literature that says more guilt.

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Piyush Pushkar: feeling, more guilt, means, you know, less risk. We see that puts a different flav on the ways that the systems are themselves shaping and perpetuating

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Piyush Pushkar: particular negative emotions. The doctors unquestionally, then use those emotions to make assessments that may lead to those people spending more time in prison.

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Piyush Pushkar: so we can see how guilt and a shame, a deeply kind of politicized emotions. particularly when we're using to configure whether or how a patient is taking responsibility for his or her crimes.

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Piyush Pushkar: while aiding which other people or social groups may be equally responsible, or more responsible for creating the societal conditions which made those crimes more likely.

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Piyush Pushkar: So what does this mean for the ways in which we think about the work that medical illegal reports are doing, or that doctors are doing when asking about guilt and shame.

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Piyush Pushkar: Why, the doctors are so keen to us. He's already already marginalized people who've ended up committing crimes about whether they feel remorse

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Piyush Pushkar: as a rather than going and asking the people who have much greater influence and power to change the structural conditions that contributed to mentally on well offenders, criminal behavior. In the first place.

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Piyush Pushkar: I this is part. My motivation for doing this project came from noticing. The architects of austerity in the Uk, ostensibly feel no guilt nor shame for creating the conditions which more people are becoming unwell.

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Piyush Pushkar: and more people are ending up in prison.

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Piyush Pushkar: And

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Piyush Pushkar: so Graham, Scambler says, the shame And blame do work in society that facilitates the ongoing stability of regimes of extraction and unequal accumulation. So he got. He points the gaze and and purpose of sociology

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Piyush Pushkar: at highlighting and changing this order. So then, if I apply that kind of insight to my work I would be interrogating. Is that correct?

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Piyush Pushkar: What nuances are? There is psychiatry contributing to that facilitating extraction, exploitation, oppression. Here's a medical legal report writing just the technology of neoliberal individual responsibilities.

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Piyush Pushkar: If it is, is that all it is. And

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Piyush Pushkar: so, in terms of what my building towards you know what my actual research questions we saw from what I said about the psychological literature that clinicians have an understanding of the role, guilt and shame play in psychopathology, diagnosis, personality, development, formulation, risk assessment. What's missing

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Piyush Pushkar: is an empirical investigation of how conditions use that knowledge in different situations? With what kind of proximal consequences for diagnosis, formulation, and management our distal consequences for patients are the health care workers institutions. So how are kind of the pearls of over this based medicine, combined with other forms of knowledge in dynamic situations, and which conditions must also reckon with their own affect subjectivity, and how the patients kind of experience that clinical practice?

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Piyush Pushkar: What effect does it have in terms of how I actually

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Piyush Pushkar:  want to go about doing that? And investigating these questions.

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Piyush Pushkar: So phase one is kind of what you know, what I'm still going through ethics for. So what what I'm going to do is do semi-structured interviews with psychiatrists and psychologists. So the people who actually write reports

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Piyush Pushkar: and also the people who use reports to argue for particular legal outcomes. They solicitors and barristers, and and then the people who actually make decisions on the basis of reports and legal arguments as judges.

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Piyush Pushkar: And so I'll recruit by snowball sampling, and then kind of ask these people about about

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whether they ask about guilt and shame, how they ask about it, what its significance is, how they write about it, how they've seen other people write about it, etc. No, too. You've got about 5 min left.

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Piyush Pushkar: Okay, yeah, that's fine. thanks.

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Piyush Pushkar: And the idea is that I'll get some preliminary day to do some analysis and then have to think about what that means, and kind of use that to to plan what to do next. which means that I kind of you know I don't really have a proper plan for what? What the next stage will be my background, as I said in anthropology so would be keen to bring an ethnographic perspective to this project. so that's one option. I think that would probably mean looking at

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Piyush Pushkar: how Gil and shame are considered mobilized and made use of, addressed in psychological therapies in a secure setting. so that would mean doing field work in, in, in A, in a secure setting which would obviously require addressing

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Piyush Pushkar: practical issues, ethical issues, and not to mention issues with kind of access. another option is looking at court documents and decisions themselves, looking at the actual reports rather than

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Piyush Pushkar: in an interview.

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Piyush Pushkar:  with someone writing reports actually looking at, I mean, actually looking at the documents themselves.  so that's kind of where I'm up to.

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Piyush Pushkar: any questions. Feedback suggestions. Very welcome.

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Piyush Pushkar: Thanks.

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Thank you very much for your presentation. That's great.

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So we'll take questions at the end. So if people can hang on to those for the time being. I think our next presentation is recorded. So this is conceptual investigation

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of the social acceptability of drug use disorder services

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in the primary health care system

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from the Iranian client's perspective by mayhem

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Mehrabi.

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Mari Mehrabi: Hello!

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Hi! There!

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Mari Mehrabi: And I am my! I'm Ms. Rabi from Iran. And now I Right before presentation.

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Mari Mehrabi: She.

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okay, he's just a minute. Okay, we've got down on our program. It's pre recorded. So you're going to present in person online.

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Mari Mehrabi: Yes, online.

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Great. so yeah. off you go when you've got when you're ready, and I'll give you about 5 min warning with

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me. That's okay.

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We've we've just got that. We can see your. You might want to share the whole screen if you if you're able to do that, I think you I can see you're doing that great

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Mari, just to let you know that you're currently on mute. So we cannot hear you.

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Mari Mehrabi: Do you have my boss.

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Yeah, we can hear you now. Thank you.

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Mari Mehrabi: It's okay. Thank you. And

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Mari Mehrabi: my work is about conceptual investigation of social assembly, acceptability of service and uses all the services in the Iranian payment.

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Mari Mehrabi: Health care system.

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Mari Mehrabi: mit Ctl. And mental health disorder imposed a considerable burden on public health system. The high prevalence of substance use problems led to a significant challenge to societies and countries. Health care system, one

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Mari Mehrabi: based on the area and mental health survey.

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Mari Mehrabi: the prevalence of 12 months. Yes, this order for any parent city, right? 14 to this, and 5 and the same

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Mari Mehrabi: this, and for and this, and quite criteria, over 2.44% of it. Use this order and open in particular, where the most

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Mari Mehrabi: come, and a common disorder, approximately half of those withdraw this order, and for 40% with dependence had it. The 12 unmet need for treatment. Self-help groups who are the most common type of service use follow

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Mari Mehrabi: obtaining medication from pharmacies directly in an outpatient track.

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Mari Mehrabi: Sorry

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Mari Mehrabi: trick, and followed by obtaining medication for pharmacies directly, and of outpatient treatment services

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Mari Mehrabi: erez Agmoni, according to the strategy of the World Health Organization. The heirs of the people of the Society is affected by the change of social prices.

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Mari Mehrabi: crisis and the ongoing of the characteristics of prevention and treatment services in premier health care

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Mari Mehrabi: mit Ctl. And the effective responses of the Ministry of Hearts of Iran. To this issue was the implementation and development of national preventive policies and programs, including the integration of health services, and specifically 100 and

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Mari Mehrabi: Mit. Ctl. And some some use these orders in their premier health care system, with the approach of justice in her, and promotion of public health, with the aim of prevention and early addiction of paper, at least was applied 150

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Mari Mehrabi: health policies. Iran has both manuscript and expand the public health care services for increasing access and coverage for the general population, maintaining and promoting mental Health service, provision for mental health and management of substance use disorders.

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Mari Mehrabi: The first step in this regard was the integration of mental health into primary health care. In the second half of 1,980, and which has been shown to

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Mari Mehrabi: we have many, has benefits, especially in rural areas. The revolution next step started. Since 2,015 services for the

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Mari Mehrabi: and initial treatment of substance use disorders in Iran integrated into the Phc. System.

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Mari Mehrabi: His program there are. He has a Walker mental health care.

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Mari Mehrabi: general practitioner, provide a complete package of fair services, including screening early detection, education

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Mari Mehrabi: Mit, Ctl, and a psychological brief integration for lawyer. So it is all there, and site treatment for tool that we use is all there's a referral for our their treatment and follow up of other person use disorder. These packages still with covers to work with alcohol and drug use disorder

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Mari Mehrabi: upon tooretical background. I can't say Percy system. Second studies for who some people they they at my password models and follow sick person step by, say, from their explanation of symptoms through different type of health, seeking until they will help all capable of living with their condition.

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Mari Mehrabi: I'm sticking

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Mari Mehrabi: mit Ctl. And the studies provide a deeper understand of why, when and how individuals, social groups and communities seek access to healthcare services 250

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Mari Mehrabi: and investigate instruction interactions between the lay persons and professional.

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Mari Mehrabi: In this perspective social actors are the potential driving force for improving access to effective and affordable healthcare, but they are often constrained by politics and the economy on national and international level.

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Mari Mehrabi: Another

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Mari Mehrabi: cockroach is health services, study, concentrate on factors employing thing access to health care which they commonly define as utilization utilization rates. They have, like the determinants, model and consider access as a general concept, summarizing the set of more specific dimension.

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Mari Mehrabi: and such as availability, affordability, accessibility, and requesting and access, accept ability

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Mari Mehrabi: mit Ctl and research for policy intervention to reduce supply, body and improve the delivery of services, including availability of health facilities, equipment, and a qualified staff.

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Mari Mehrabi: It's good

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Mari Mehrabi: protocols of diagnosis, treatment, and quality of care. Moreover, they are less

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Mari Mehrabi: oriented toward her seeking process. Intervention on the Dms side are commonly limited

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Mari Mehrabi: to information, education, and communication.

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Mari Mehrabi: The the valuable concept of social acceptability is reflected as a multifaceted construction that shows the day of acceptance of people to receive high school intervention based on anticipated or experience cognitive and emotional response in the tooretical concept of conceptual of social acceptability proposed by 2

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Mari Mehrabi: sorry.

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Mari Mehrabi: the cons of fire, and by so so on, consists of 5 concept, effective.

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Mari Mehrabi: active burden, perive effectiveness, ethically, intervention, coherence, opportunity, cost, and self. If Casey.

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Mari Mehrabi: According to the related comprehensive of the operational conceptualization of Sahan and his colleagues, and we got an idea from this historical model in order to evaluate the social acceptability of the prevention and treatment of citizen uses all there in er 101,

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Mari Mehrabi: the acceptability of social service plays over. And this is this issue role in the attraction and retention of clients in their treatment

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Mari Mehrabi: and the process of identifying and treat and treating a psychiatric disease, including substance, use disorder

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Mari Mehrabi: about the method, I say.

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Mari Mehrabi: and I can say this study aims to analyze the conceptual structure of the social acceptability of science, and uses all their services in their premier health care system by adopting the interpretative political paradigm. The method of this research is they qualitative

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Mari Mehrabi: mit ctl and qualitative study. It is conducted, using the phenomena. Physical approach always open and in depth. Nerve you the tools and based on the proposed for qualitative sampling methods

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Mari Mehrabi: mit Ctl, and this study data obtained from nineteen-depth interview with the clients of the health care services in the Pierc centers of Tehran as the capital city of Iran. In for you the offline? 2

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Mari Mehrabi: 2,022 early, 2,021 year, when at least 2 in 2 times a follow up of care recipients.

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Mari Mehrabi: I am into one of 3 months.

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Mari Mehrabi: Fine

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Mari Mehrabi: the transfer central structure of social acceptance, and use this, all the services in that we run Spacec, which is represented by the automatic analyzes of the live, live experience of the participants of our study, conceive of 5 main teams.

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Mari Mehrabi: expected emotionality to

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Mari Mehrabi: perceive emotional attitude.

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Mari Mehrabi: expected

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Mari Mehrabi: effectiveness, per sleep, effectiveness, and finally cause opportunity.

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Mari Mehrabi: Can you see in this day I from at this Thames.

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Mari Mehrabi: this don't you stop

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Mari Mehrabi: at times are affected by each other in a complex model, as it is difficult to distinguish their independence, or in the in some case, as in our study, the overlapping of some concept has cost to review their number of I

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Mari Mehrabi: and expanded the subjects in new concept rather than the second models.

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Mari Mehrabi: Comparing this concept to

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Mari Mehrabi: conceptual structure, common and different aspects of this and a studio framework can be seen.

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Mari Mehrabi: Hey?

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Mari Mehrabi: The conceptual model and perceive related studies to quality service that explore the attitude, dinner gap between the service provider and the

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Mari Mehrabi: their service, the emotional attitude as an effective mind, 10 affected by the time dimension.

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Mari Mehrabi: Let's

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Mari Mehrabi: what sub concept of respect being understood, capacity and trust, custom, oriented communication have been used.

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The distinguishing

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Mari Mehrabi: point of conceptual model of the present study is the integration of the ethical dimension.

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Mari Mehrabi: I. Of the work of Sahan and his colleague in the maintenance of emotional active ethics in this society, is defined in the concept of degree of

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Mari Mehrabi: appropriate fit of the intervention with the

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Mari Mehrabi: individual also value a system.

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Mari Mehrabi: the maintenance of structure, because opportunity in this study was understood in the form of it the old concept

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Mari Mehrabi: it. It includes the programme dimension of access, including time and place, and also educate the.

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Mari Mehrabi: as you can see, off

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Mari Mehrabi: services. On the other hand, opportunities and advantages that are offered at the health centers, and, on the other hand, all the cost of a client, including time, financial resources, physical and mental cost. During the long time interval between diagnosis and treatment.

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Mari Mehrabi: Therefore, in this study another main theme, called Burden, has been merged because of opportunity town with

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Mari Mehrabi: which refer to how we non-economic us

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Mari Mehrabi: in the second model is used as a separate dimension, right from has

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Mari Mehrabi: the economy sources and is defined as the amount of benefits, profits for merit or values that the client must spend to engage in an intervention

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Mari Mehrabi: the medical problem of health, and that diseases can be related to how the must 3 stage one. It's analyzed.

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Mari Mehrabi: This in each statement is related to

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Mari Mehrabi: through the claims regarding the objective. Both brightness claims regarding the common world or the crime of truthfulness. Looking at the

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Mari Mehrabi: mental rules are justified and proven.

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Mari Mehrabi: based on the.

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Mari Mehrabi: we extracted some from the

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Mari Mehrabi: participants, and then the reason and suggestion are for post has decision. Making is not a network can be in

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Mari Mehrabi: independent of value. Orientation is

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Mari Mehrabi: mit ctl, and this matter in itself and by nature is for the interest of the owners of power sources. Therefore, one of the consequence of her's policy is not one side press 101

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Mari Mehrabi: clinical. This decision making is not to the result and product of the mind of

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Mari Mehrabi: an individual who acts in a social vacuum, and, like any other knowledge is.

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Mari Mehrabi: it is

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Mari Mehrabi: suspect, Tibel, to being shape under the influence of social influences. These issues, related to have a mass conceptualization in

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Mari Mehrabi: in cognitive 80 at different level.

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Mari Mehrabi: First, if I expected.

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Mari Mehrabi: and emotional attitude.

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Mari Mehrabi: this, as some of main finding it includes ethic, gender and professional

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fine

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Mari Mehrabi: ere

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Mari Mehrabi: the patient puts the aspect of ethics, gender and professional ability of the service providers under the emotional magnifier in the making decision process 3.

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Mari Mehrabi: Making decision process for entrance, a intervention, and, more importantly.

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Mari Mehrabi: the permanent permanence in their treatment process.

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Mari Mehrabi: Erez agmoni evidence shows that the sensitivity sensitivity of psychiatric patients, including those white substances, or there is higher than other patients. On the other hand, 150,

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Mari Mehrabi: the existence and extension

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Mari Mehrabi: expansion off

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Mari Mehrabi: positive emotional attitudes act as a desirable tool.

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Mari Mehrabi: The for for Canada to improve social acceptability and increase the quantitative and qualitative coverage of health service. One.

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Mari Mehrabi: The nature of

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okay.

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Mari Mehrabi: Erez agmoni. The this is of drug use. Disorder is such that, due to reasons such as the purity of the sense of pleasure over them, suffering resulting from the the fruition or secession, one

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Mari Mehrabi: of drug use as well as the self-dependent of

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4 min left. Yes, okay.

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Mari Mehrabi: Mit Ctl. And therefore it seems that the social acceptability of these services were low until the balance of the patient's emotional benefits and loans most to work a serious design to stop using the tropic properties 250

333
00:53:46.500 --> 00:54:02.890
Mari Mehrabi: erez agmoni taxes. Right for effective intervention is low. Therefore, paying attention to perspective interventions before the thought of drug use and dependence is more cost-effective than an investigation after the period of dependence, higher level.

334
00:54:03.740 --> 00:54:32.210
Mari Mehrabi: the emotional, the emotional act to do it does not only depend on the health provided by has so on the motion to do, and fast beliefs of clients and participants regarding the nature of substance use is all they based on these. Some software from off this. This is, do not consider something, use this order to be preventable, and reach ever. Like other des. Therefore this problem is considered a big obstacle to extradition and traffic to

335
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Mari Mehrabi: the intervention and to pay attention to receiving preventive care of the health system. Another past belief that exists as a serious obstacle to entering psychiatric services is the signal of using psychiatry. 2.

336
00:54:46.630 --> 00:55:04.760
Mari Mehrabi: The drives which cost the lack of timely referral, and they decide to receive tracking, to watch an impatient with psychiatric disorder that led to their views, which automatically result in it's often lead to the warning of the underlying. This is Anthony to track. Thanks.

337
00:55:11.140 --> 00:55:18.619
Great, thank you ever so much. and as with the other presenters, we'll take the questions at the end.

338
00:55:20.720 --> 00:55:24.189
So we now have our final presenter.

339
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Sorry, Mary, do you mind stopping the sharing of your screen?

340
00:55:42.220 --> 00:55:43.170
Thank you.

341
00:56:01.810 --> 00:56:15.849
Okay, so Finally, we have an Analina Aldmisks to speak about out of home care of young people with complex needs a parental perspective on risk management. So over to you, Anna.

342
00:56:17.630 --> 00:56:23.960
well. first of all, how does the sound, the sound? It's okay.

343
00:56:24.360 --> 00:56:25.940
Okay. Thank you.

344
00:56:40.520 --> 00:56:41.500
This is

345
00:56:43.320 --> 00:56:47.529
some fuss the other day.

346
00:56:49.070 --> 00:56:53.339
And how it seems. Yeah. you just to ask him.

347
00:56:58.070 --> 00:56:58.850
okay.

348
00:57:05.170 --> 00:57:06.520
okay.

349
00:57:06.970 --> 00:57:24.340
so it's precisely when the child is violent. Every one is afraid of it shines. A psychiatric care, is afraid with the social services, are afraid of it, and the homes, too, because it's so difficult to handle, so that his well, his behaviors escalated, and only got worse when he actually moved.

350
00:57:34.940 --> 00:57:37.810
Well, we warmly welcome

351
00:57:37.940 --> 00:57:40.370
to this session that you come here.

352
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and

353
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despite that you have come, or despite all other activities going on here, and my name is Amalian alchist, and I will present this study made by myself and my colleague, Kitty Lassid.

354
00:57:55.160 --> 00:58:02.659
Well, we have many countries presented here, so here you can see Sweden as Sweden's position on the globe.

355
00:58:02.820 --> 00:58:14.370
and also our university in the middle of Sweden, Maladora University. and the study that I will present here is a part of

356
00:58:14.620 --> 00:58:18.470
actually 3 studies already made.

357
00:58:18.730 --> 00:58:27.560
It's a Literature Review, and also we have in done interviews with professionals, in social services and psychiatric care.

358
00:58:27.900 --> 00:58:32.259
and we have also made interviews with young persons

359
00:58:32.270 --> 00:58:41.789
which is also published. And now this study relates to parents and guardians, and it's they are all ethically approved of.

360
00:58:42.930 --> 00:58:47.939
So they take. We start off with a take home message

361
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that increase young people's participation in decisions regarding placements and treatment, and see the whole person obeyed their complexity.

362
00:58:58.610 --> 00:59:12.329
and some of the conclusions we have the preliminary findings. So these are also preliminary conclusions. But there is certainly a lack of risk management from from the

363
00:59:12.660 --> 00:59:34.389
from organizations, and from the sort of power structures in terms of the in terms of the care of these young persons, and when when talking about risk management, it's more, and the responsibilities on the young person, the parents siblings, and also in the aim of physical distancing

364
00:59:36.870 --> 00:59:37.870
and

365
00:59:38.280 --> 00:59:57.089
the aim and the research questions are done to examine the process leading to the placement of a shine from a parental perspective? And how can different actions taken by different actors before, during and after the child was placed in outer home care, we understood in terms of management of risks.

366
00:59:58.310 --> 00:59:59.720
and

367
01:00:00.510 --> 01:00:09.130
we have made semi-structured interviews in 2,021 during the pandemic, as many of many others of us.

368
01:00:09.180 --> 01:00:13.340
and they were recruited through an online support group

369
01:00:13.460 --> 01:00:24.400
9 persons, and through the social services and with 3 persons. And that was also the gender distribution of the sample, and they were. They were nationwide.

370
01:00:24.460 --> 01:00:43.440
From where they come from, and they were either guardians or parents to children and young people who were in placement, in voluntary or compulsory care, and they were in residential care or foster homes during childhood or and or adolescents.

371
01:00:53.650 --> 01:01:02.690
and also we, as an analysis, we have used both a trial and Ringspan primarily with a thematic analysis.

372
01:01:02.970 --> 01:01:03.750
Yeah.

373
01:01:03.910 --> 01:01:12.389
yes. And our study is informed by several theoretical perspectives.

374
01:01:12.550 --> 01:01:20.839
as you probably those who of you are here. You are sort of aware of them, or involved in the risk society.

375
01:01:20.950 --> 01:01:30.840
and also kamshell argues for that. More risk, assessment and safety, promoting services delivery in terms of in terms of social watch

376
01:01:31.180 --> 01:01:38.390
and Scarlett argues about service users expected to be responsible for their own care.

377
01:01:39.030 --> 01:01:46.460
Turnbull and Spence. inform us about youth at risk versus use as risk.

378
01:01:46.690 --> 01:01:50.450
and Dixon elaborates on risk and the recovery.

379
01:01:52.090 --> 01:01:56.680
And this down. Well, I will sort of illuminate

380
01:01:56.800 --> 01:02:02.449
this by exemplifying some of the voices of the parents.

381
01:02:03.270 --> 01:02:04.360
and

382
01:02:05.450 --> 01:02:10.389
this is a kind of a quite extensive problem in.

383
01:02:10.680 --> 01:02:21.019
and this in Sweden, in terms of a care of people, with the combination of substance, abuse, and mountain illness.

384
01:02:21.170 --> 01:02:30.650
because you have to be kind of you should not. In terms of getting a counselor, you need to. Sort of. You shouldn't have a drug problem.

385
01:02:31.170 --> 01:02:43.190
So this mother, she talks about her daughter having them using cannabis, and she says, so you get absolutely no help in psychiatry when you have substance substances in your body

386
01:02:43.670 --> 01:02:55.279
and like Like another young person I interviewed, she said. Well, I need actually to have a counselling not to to start using Dyks again, so it becomes like a vicious circle.

387
01:02:57.580 --> 01:03:06.310
So here we can also see it's really a lack of risk management. Yeah, it's kind of left

388
01:03:06.760 --> 01:03:10.560
left falling between the cracks and

389
01:03:10.980 --> 01:03:13.570
and another. My mother says

390
01:03:20.760 --> 01:03:23.520
before placement, that

391
01:03:23.800 --> 01:03:45.000
we think we have never been against the placement, but we did have considerations that this was like located in Ecstown. Primarily for logistic reason. Sweden is a long country, and it's cumbersome. If you have to travel by public transport, it is 1,000 kilometers by car from this family's home, Tom, to Ecstown, and this was also quite common

392
01:03:45.130 --> 01:03:54.679
that either because of that social services thought that the young person should be needed because of maybe problematic friends, and

393
01:03:55.010 --> 01:03:58.520
should be distanced from the from the family.

394
01:03:58.570 --> 01:03:59.900
or

395
01:04:00.410 --> 01:04:04.900
that there there were actually a lack of lack of placement.

396
01:04:06.020 --> 01:04:11.990
So this is like one way of handling the one way of risk management then.

397
01:04:13.360 --> 01:04:17.449
and as then another parent says.

398
01:04:18.020 --> 01:04:33.279
and she she's referring them to the to the social services. They say that. Okay, we can't help the son Peter, but we can help and support the siblings, and that then the idea was to place

399
01:04:33.390 --> 01:04:37.170
plays. Peter. The siblings in other families

400
01:04:37.540 --> 01:04:44.969
than because they thought they to to protect them from being exposed to violence. But there, so that but how? She sort of

401
01:04:45.030 --> 01:04:55.670
the the suggestion from the social services. But what happened in the end? What? Actually that they found another solution, that the Peter was was in placement?

402
01:04:56.230 --> 01:04:59.919
Yes, so that them to put the responsibility on there

403
01:05:00.250 --> 01:05:02.220
on the other family members.

404
01:05:03.680 --> 01:05:06.689
and

405
01:05:08.110 --> 01:05:14.429
another voice here, and talking or more about the individualization of risk management.

406
01:05:15.470 --> 01:05:23.169
And this relates to a situation where the young person she

407
01:05:23.300 --> 01:05:30.049
she calls this gets up, and then doesn't want to go to the doctor

408
01:05:30.930 --> 01:05:32.279
and says.

409
01:05:32.320 --> 01:05:34.580
Well, no, this won't work.

410
01:05:34.920 --> 01:06:00.189
And then she calls on counsels, and I think that in a situation like that the doctor, or the person from the social services, or whoever it is. They say the psychiatrist should call an Orc. Hey, your council. But what made you counsel so? This is becomes like well, it was argued in other interviews, that well, then, nothing is done, and they assume that the person doesn't need or want the support.

411
01:06:00.730 --> 01:06:09.690
So then, also the management of the risk is, it's put on the individual in this case the young person.

412
01:06:10.690 --> 01:06:17.610
and also another voice talking about in the situation. Well.

413
01:06:17.810 --> 01:06:23.550
the child in this case the sound said, Well.

414
01:06:24.060 --> 01:06:25.879
take me away from here.

415
01:06:25.920 --> 01:06:41.369
And then his mother says I phoned her the social worker, and she said, Well, picking up directly, and the mother then said. Well, since I did so, I did, since he was placed voluntarily. Then it's me as a mother who takes the decisions.

416
01:06:41.450 --> 01:06:45.489
But then she says, we drove him to his big brother.

417
01:06:45.960 --> 01:06:47.580
so

418
01:06:47.740 --> 01:06:58.379
one could here argue, this is kind of some kind of it's a lack of risk management which is disguised as empowerment in this case.

419
01:06:58.570 --> 01:07:02.950
that you have some kind of decision, but instead it is

420
01:07:03.420 --> 01:07:05.080
sold within the family.

421
01:07:07.420 --> 01:07:09.170
and also

422
01:07:09.330 --> 01:07:13.409
during the placement, there is a risks in residential care homes.

423
01:07:13.550 --> 01:07:17.450
It's a lack of the right knowledge and competence among stuff.

424
01:07:17.500 --> 01:07:27.019
And it's also risk that. So that that socializing with other young people, with problems, creates incentives for drug abuse and criminality to escalate.

425
01:07:27.090 --> 01:07:30.019
And this is examples for also for

426
01:07:30.050 --> 01:07:31.330
about

427
01:07:31.510 --> 01:07:38.910
a lack of risk management. It just goes on. And this was also what was said when we interviewed the professionals

428
01:07:41.950 --> 01:07:44.240
and the final

429
01:07:44.390 --> 01:07:49.770
 so the voice, the final parent, and this relates to

430
01:07:50.390 --> 01:07:57.850
also their responsibilities put on parents, but actually afterwards, after the placement.

431
01:07:58.070 --> 01:08:10.100
it is actually here that the parent looks for in this case, Job, so that we are the ones who have always tried to find the best for for for eggs for them.

432
01:08:10.230 --> 01:08:12.009
In this case the daughter

433
01:08:12.020 --> 01:08:15.439
but the social services done, signed the papers.

434
01:08:16.030 --> 01:08:18.929
So these are them

435
01:08:19.030 --> 01:08:24.980
examples of but to illuminate the findings. And

436
01:08:25.050 --> 01:08:33.729
now we will continue and relate back to the the title referring to complex needs. Because this is

437
01:08:33.740 --> 01:08:36.860
kind of a

438
01:08:36.970 --> 01:08:41.530
a bit, one could say contested

439
01:08:41.660 --> 01:08:57.189
concept. It's used by Katya Malvas and colleagues. the Australian Australian researcher, talking about the labor for people with multiple interconnected needs that span medical and social issues.

440
01:08:57.900 --> 01:09:02.470
And we also talk about social problems like poverty and employment.

441
01:09:02.510 --> 01:09:12.909
abuse and mental ill health or disability that occurred simultaneously. and its needs extensive and of long durability as a spat or use

442
01:09:12.930 --> 01:09:16.680
and anger talks about multiple service users

443
01:09:17.020 --> 01:09:18.639
and Valentine.

444
01:09:18.900 --> 01:09:28.040
He also has in his research of talks about people with complex needs. They are often presented as a challenge to services.

445
01:09:29.290 --> 01:09:30.640
and and

446
01:09:31.010 --> 01:09:33.580
since we are.

447
01:09:33.770 --> 01:09:41.719
And in the international Conferences I wanted to give you just a brief overview of out of our car in Sweden.

448
01:09:42.370 --> 01:09:48.120
in 2,021 there were 24,700 children, and young people were placed.

449
01:09:48.150 --> 01:09:56.529
and of them 18,700 in foster homes and 6,000 in residential homes. So this and this is quite

450
01:09:56.860 --> 01:10:02.880
also, yeah. The more general around two-thirds

451
01:10:03.210 --> 01:10:10.839
of the young people are placed in in foster care and around one third, and in residential care.

452
01:10:11.270 --> 01:10:23.490
and also about half of them, were about 15 years of age. And it's also kind of. And before earlier, more boys than girls were placed.

453
01:10:24.100 --> 01:10:31.399
But then this is kind of narrowing down and getting more more an even than the distribution.

454
01:10:33.120 --> 01:10:47.570
and also in in talking about support in Sweden with 4 young persons with complex needs. It's the social needs they are primarily taken care of by the social services on the municipal level

455
01:10:47.810 --> 01:10:54.340
and needs concerning mental health. It's the psychiatric on the County Council or the regional level.

456
01:10:54.780 --> 01:11:03.989
And both these organizations, actors, or structures whatever prefer to say, provide voluntary as well as compulsory compulsory measures.

457
01:11:04.110 --> 01:11:10.270
and the Municipal and County Council there will have a statutory obligation to collaborate.

458
01:11:10.730 --> 01:11:17.720
Yeah, through various meetings. And there is actually, what is happening is that they are doing.

459
01:11:18.000 --> 01:11:21.940
They are actually talking about maybe

460
01:11:22.190 --> 01:11:39.809
changing the responsibility also for for substance abuse more to the the more in in terms of of the health care sector to not not having these 2 kind of silos that are really creating problems for this person

461
01:11:39.820 --> 01:11:43.800
that are have the support from multiple actors.

462
01:11:44.380 --> 01:11:47.829
So these are some references and

463
01:11:48.170 --> 01:11:48.970
the

464
01:11:49.180 --> 01:11:50.030
Yes

465
01:11:50.550 --> 01:11:52.640
about the finance.

466
01:11:52.740 --> 01:11:55.650
But it's trying to think. Just thank you.

467
01:11:58.510 --> 01:12:03.480
And it just it ended up, disappear to finally one. But

468
01:12:05.610 --> 01:12:16.729
okay, so thank you. To all our presenters. Do we have any questions or comments from the audience? Would you mind just coming up to 6 of the people on line can see you as well.

469
01:12:17.440 --> 01:12:19.190
That is fine. Actually, it doesn't matter

470
01:12:20.650 --> 01:12:29.600
if you can just introduce yourself. So people know who you are that'd be great. Hi, everyone. Can you hear me? Okay, I think you can. Amory Sawyer from La Trobeuny in Melbourne.

471
01:12:29.830 --> 01:12:32.119
I've got a question for.

472
01:12:32.710 --> 01:12:44.790
And I I think your paper's fabulous, and the research is really interesting. And I'm interested in what you're going to be doing with the analysis of documentation in files.

473
01:12:45.160 --> 01:12:56.040
And because I don't know how the yeah Uk system works with mentally unwell offenders. It sounds like you'll be looking at psychiatric and psychologist reports.

474
01:12:56.440 --> 01:13:02.859
I'm wondering if social workers are also asked to write reports in that context, because

475
01:13:02.910 --> 01:13:11.339
I'm thinking that they may have a different kind of interpretation of the person, a more holistic contextual interpretation.

476
01:13:13.720 --> 01:13:16.569
So that, did you get my question?

477
01:13:17.240 --> 01:13:24.050
Piyush Pushkar: Yes, I did. Yeah. Thanks. Yeah. yeah. yes.

478
01:13:26.570 --> 01:13:40.380
Piyush Pushkar: So the the first bit is the first bit that I'm just going through ethics, for at the moment is actually interviewing people who write reports rather than looking at the reports themselves.

479
01:13:40.600 --> 01:13:46.779
Piyush Pushkar: I do. I do want to look at reports themselves, but that will require a separate ethical

480
01:13:47.000 --> 01:14:05.129
Piyush Pushkar: well, actually just tackling some different ethical questions, I suppose. I suppose speaking to social workers would be relevant for, or could be relevant for for both of those, and I agree. that it could give a different perspective. That would also be useful.

481
01:14:07.700 --> 01:14:10.960
Piyush Pushkar: the in terms of

482
01:14:11.270 --> 01:14:22.110
Piyush Pushkar: So for tribunal, certainly social workers do do contribute reports as well as the psychiatrists. and actually,

483
01:14:22.310 --> 01:14:34.750
Piyush Pushkar: probably more than psychologists. So I'm not sure why I hadn't thought of that before. I suppose it was just slightly focusing on what's and more proximate to me. So I think that's a that's a great

484
01:14:35.220 --> 01:14:39.980
Piyush Pushkar: thing for me to consider. Actually, so yeah, thanks for that.

485
01:14:40.080 --> 01:14:41.850
Piyush Pushkar: in terms of

486
01:14:43.600 --> 01:14:50.849
Piyush Pushkar: yeah, that that that that's my answer. Actually, that that's just a great a great the advice, so I'll take that as a as a

487
01:14:50.900 --> 01:14:52.870
Piyush Pushkar: as a comment. So thanks.

488
01:14:53.160 --> 01:14:54.320
Thank you.

489
01:14:54.860 --> 01:15:14.170
I've got a follow up question as well. Actually, while you're on the screen. it was really interesting to see that you were focusing on the sociology of Shane. in your study. I just wondered if you had thought about how you would might apply the sociology of risk and uncertainty to the study as well.

490
01:15:16.940 --> 01:15:21.720
Piyush Pushkar:  yeah, I mean, I suppose.

491
01:15:22.630 --> 01:15:31.080
Piyush Pushkar: my reading around the sociology of risk is perhaps I haven't done as much. so like I'm aware of, so we'll r it back. And

492
01:15:31.090 --> 01:15:44.329
Piyush Pushkar: Nicholas rose in particular. and in in in terms of sort of responsibilities more than risk, I suppose. so I think.

493
01:15:46.700 --> 01:15:49.490
Piyush Pushkar: yeah, I haven't.

494
01:15:49.500 --> 01:15:57.859
that's one of the things I'll I'll need to do a bit more reading on, I think.

495
01:15:58.070 --> 01:16:02.820
Okay. are there any other questions or comments. for from people.

496
01:16:04.410 --> 01:16:07.120
perhaps to some of the other presenters. Yep, go for it.

497
01:16:12.750 --> 01:16:34.109
Hi, I'm Peter! From turning point in Melbourne. I just had a question in regards to Sylvia's study. If that's okay. I was curious about the research methods for the study, and was wondering if you could clarify your definition of severe mental illness, explain how you're planning to assess eligibility and what your recruitment methods will be.

498
01:16:37.870 --> 01:16:48.000
Yeah. Thank you. The first question regarding definition of severe mental disorders, we follow basically the 3 criteria for what is.

499
01:16:48.370 --> 01:16:57.040
of course, it's a very. I'm aware of the critical view to that term, but there are some definitions, and we follow them roughly in terms of

500
01:16:57.070 --> 01:17:12.529
having a diagnosis of mental disorder, like psychosis or depression or bipolar disorder. So the second is the duration of the treatment, since it should be at least 2 years in treatment.

501
01:17:12.640 --> 01:17:16.680
And the third definition is of having a

502
01:17:16.690 --> 01:17:19.720
yeah, a kind of a

503
01:17:19.840 --> 01:17:22.689
Yeah. What do you say?

504
01:17:22.930 --> 01:17:39.250
in everyday life a kind of effect on your social life? So this is roughly the definition. And we will follow this definition and in inclusion or the methods. But what the methods? It's a.

505
01:17:41.600 --> 01:17:42.600
I see.

506
01:17:44.810 --> 01:17:45.990
Yeah.

507
01:17:53.330 --> 01:18:02.600
yeah, we are basically recruiting at mental health settings in patient settings, and also our patient settings. And

508
01:18:02.720 --> 01:18:04.550
yeah,

509
01:18:04.860 --> 01:18:09.650
what was the question? Exactly. Yeah.

510
01:18:10.010 --> 01:18:10.740
Hey?

511
01:18:15.790 --> 01:18:18.170
You can. I?

512
01:18:18.190 --> 01:18:24.590
Thanks for very interesting presentations, and I have a question to Anna Lena.

513
01:18:24.750 --> 01:18:35.870
just. It's for clarification, because I'm not sure if I understood correctly one that excerpt from the interview were a mother of a adolescent.

514
01:18:36.720 --> 01:18:39.179
She told that

515
01:18:39.240 --> 01:18:48.599
since her child had behavioral problems, other siblings were moved to foster

516
01:18:48.660 --> 01:18:49.760
here

517
01:18:49.890 --> 01:18:53.640
who didn't have any problems. So we were

518
01:18:53.670 --> 01:18:58.899
placed out of the family, and that I'm not sure if I understood correctly.

519
01:18:58.910 --> 01:19:21.990
Yes, you're perfectly right, and that was she was kind of bewildered by this suggestion, by the social services, that the kind of that the siblings who didn't have any problems should be sort of placed elsewhere because they? They thought that the the child was so problematic they didn't really know where to sort of put this child. So that was kind of the first

520
01:19:22.010 --> 01:19:24.369
planned a sort of speech.

521
01:19:24.380 --> 01:19:34.259
but in the end they really tried to find another, because the the the Paris seems what disrupt the family. So they they found the placement for this

522
01:19:34.300 --> 01:19:37.159
sort of problematic shine in the end.

523
01:19:37.310 --> 01:19:41.070
So yeah, so that's you're right. That was the suggestion.

524
01:19:41.490 --> 01:19:42.210
Yes.

525
01:19:43.220 --> 01:19:44.010
yes.

526
01:19:45.350 --> 01:19:47.800
great. Yeah. Go for it to please.

527
01:19:47.880 --> 01:19:50.370
I also had a question for Annailina.

528
01:19:50.750 --> 01:19:56.299
So you're saying that they they're not integrating the health services

529
01:19:56.560 --> 01:19:59.850
for all of the problems that go on

530
01:19:59.940 --> 01:20:04.469
with somebody who has got severe depression, or whatever else it might be, with.

531
01:20:04.480 --> 01:20:14.140
with the, with the care, out of care services and the psychiatric. It's not. They're not coordinating the the

532
01:20:14.210 --> 01:20:15.450
services.

533
01:20:17.430 --> 01:20:20.710
It's been done a bit differently.

534
01:20:22.130 --> 01:20:35.999
It's done a bit differently in different regions. But this is kind of an ongoing work in Sweden to try to make this work, because it has really been like under 2 separate laws. Also that makes it

535
01:20:36.000 --> 01:20:52.779
a bit more complicated. But they try to sort of increase the collaboration. But it's more like that that if you have like substance abuse, and it's more like there's a responsibility for the social services to try to solve this. So then the psychiatric carries one.

536
01:20:52.900 --> 01:20:55.450
Well, it's kind of put back to the

537
01:20:55.670 --> 01:21:03.630
in a municipality. So this this. That's the problem how these young people sort of go. Yeah, sell back and forth.

538
01:21:03.810 --> 01:21:06.070
We've all received. Oh.

539
01:21:07.610 --> 01:21:09.710
yes.

540
01:21:10.050 --> 01:21:11.680
yes, yes.

541
01:21:12.070 --> 01:21:12.940
Yeah.

542
01:21:13.220 --> 01:21:19.240
So it becomes like, yeah. The company catch 22 in one way. Yes.

543
01:21:24.910 --> 01:21:36.440
thank you. Yeah. Appreciate it all the talks as well. It was. Very lovely, thank you, everybody. Bruce Cohen, from the University of Auckland, in New Zealand.

544
01:21:36.730 --> 01:21:45.009
I had a question for all 4 of you. Actually, if you wanted to speak a little bit to this issue

545
01:21:45.640 --> 01:21:47.140
about

546
01:21:47.150 --> 01:21:54.470
medicalization and particularly given the mental health topic. We're on the the potential, I suppose.

547
01:21:54.550 --> 01:22:01.560
psychiatrization within your projects. If you actually see.

548
01:22:01.570 --> 01:22:26.130
any aspects or issues here in terms of potentially the increasing medicalization, psychiatrization of everyday life in your projects. Or you'll be kind of like looking at in your research in terms of maybe psychiatric violence, or the extension of a psychiatric discourse into other parts of our world. And so for underdef

549
01:22:26.350 --> 01:22:52.429
you had something to say about that. Okay, so I'll give all speakers. There's that's a question to everybody, so I'll maybe just take it in the order of speakers that we've had. So if I'll start with Sylvia and going to P. And and then, Miriam. So, Sylvia, you go first. Thank you. That's a good question. And I think what we are aware of is that maybe in terms of

550
01:22:52.620 --> 01:22:58.940
asking for the risk. Factors for being victimized

551
01:22:59.320 --> 01:23:23.369
are, of course, I mean, there is a literature on risk factors and psychopathology is one of the huge risk factors. So and there I see a risk of medicalization. So to put the the risk of being victimized to the psychopathology in, irrespective of the social context where victim

552
01:23:38.570 --> 01:23:39.670
this group.

553
01:23:39.680 --> 01:23:58.020
So there is a risk that this is put on on. Yes, of course he or she has a mental illness, and this is why he behaves in a specific way, and so on. This. This would be for me, for me. Expression of medicalization. To put it to the mental illness and not to put it on the social context.

554
01:23:59.350 --> 01:24:02.670
Okay, we move to our second speaker. A peers.

555
01:24:06.000 --> 01:24:07.779
Piyush Pushkar: Oh, yeah, thanks. And

556
01:24:08.280 --> 01:24:19.870
Piyush Pushkar: yeah, I wouldn't say, that's An explicit one of the main things that I'm sort of thinking about, or investigating the

557
01:24:19.970 --> 01:24:22.770
Piyush Pushkar: in terms of the sort of relevance to my

558
01:24:22.920 --> 01:24:29.930
Piyush Pushkar: project. I suppose the the people that I'm working with are

559
01:24:31.250 --> 01:24:32.690
Piyush Pushkar: mostly

560
01:24:33.090 --> 01:24:40.929
Piyush Pushkar: people with kind of severe mental illnesses. you know, you who are going through the court process?

561
01:24:41.410 --> 01:24:52.610
Piyush Pushkar: so this sort of psychiatrization, or the medicalization of everyday life? these are generally people who are in quite extreme situations. so

562
01:24:53.740 --> 01:24:56.860
Piyush Pushkar: let's not say that medicalization in psychiatrization

563
01:24:57.550 --> 01:25:04.199
Piyush Pushkar: isn't relevant, but it's not exactly the the medicalization of everyday life. for them.

564
01:25:04.510 --> 01:25:07.490
Piyush Pushkar: the one thing that that is

565
01:25:07.590 --> 01:25:12.020
Piyush Pushkar: certainly one of them is the the and

566
01:25:13.620 --> 01:25:24.849
Piyush Pushkar: the way that we conceptualize medical mental illnesses is not is is kind of codified in in law, in the mental health fact. So in writing reports.

567
01:25:24.910 --> 01:25:31.909
Piyush Pushkar: you doctors and other people writing reports

568
01:25:32.330 --> 01:25:37.959
Piyush Pushkar: you know. trying to provide evidence to show that

569
01:25:38.830 --> 01:25:51.100
Piyush Pushkar: a a person has a mental disorder according to the Mental Health Act, according to what the Mental Health Act says mental disorder is, and so there's no kind of questioning of what the law is.

570
01:25:51.730 --> 01:25:56.750
Piyush Pushkar: and what a mental disorder is is defined in in the law. And so

571
01:25:56.980 --> 01:26:07.509
Piyush Pushkar: there, there's a sort of lack of questioning that is built into the system there. The other thing is that it's

572
01:26:07.920 --> 01:26:11.119
Piyush Pushkar: almost always There's a sort of

573
01:26:12.090 --> 01:26:28.580
Piyush Pushkar: you you're explaining behavior on the basis of illness in these reports that that's kind of the general structure of them. so the illness becomes an explanation, you know, as if the illness

574
01:26:30.510 --> 01:26:44.559
Piyush Pushkar: is the causation rather than you know, it becomes an explanation in and of itself, rather than sort of thinking about how exactly that's that's going about. So you know, this person has done whatever because of this schizophrenia.

575
01:26:44.590 --> 01:26:52.950
Piyush Pushkar: and you know this is these are my reasons for believing that. so that's the kind of structure of these things. So I think there is certainly relevance.

576
01:26:53.090 --> 01:26:54.220
Piyush Pushkar: And

577
01:26:54.350 --> 01:27:08.579
Piyush Pushkar: for the kind of discourses that related to the kind of things that I think you're thinking about. But it's not exactly to do with the medicalization of everyday life. Because, you know, the research I'm doing. This group of people are in kind of relatively extreme situations.

578
01:27:09.480 --> 01:27:12.629
Thank you very much, Mary. If I can come up to you.

579
01:27:22.890 --> 01:27:24.629
I think you're muted at the moment.

580
01:27:34.470 --> 01:27:35.680
Okay, try now.

581
01:27:44.730 --> 01:27:45.630
the

582
01:27:46.880 --> 01:27:50.179
Murray. We can't he? For some reason I'm not quite sure why

583
01:27:50.640 --> 01:28:02.680
I can hear you. I didn't understand. what is your question? Sorry we still want to repeat the question. And then, yeah,

584
01:28:06.400 --> 01:28:07.380
okay.

585
01:28:07.800 --> 01:28:09.030
excuse me.

586
01:28:11.100 --> 01:28:20.800
We're just getting the the person asking the question to the microphone. So sorry. Yes, it was just If there was a if there is an element of

587
01:28:20.930 --> 01:28:26.969
any part of your research presentation that could speak to the issue of

588
01:28:27.000 --> 01:28:31.010
what seems to be the increase in psychiatrization.

589
01:28:31.030 --> 01:28:45.050
Of everyday life with your presentation, Mari, you were looking at drug use disorders. For instance, in using a hard mash, so forth, there might be points of reference there, particularly when

590
01:28:45.100 --> 01:28:46.640
is the irony of

591
01:28:46.690 --> 01:29:01.260
people with drug use disorders at the same time as. of course, one of the solutions by psychiatry is very much to drug people. So anyway, medicalization or psychiatrization or everyday life.

592
01:29:03.250 --> 01:29:04.340
Mari Mehrabi: And

593
01:29:05.800 --> 01:29:07.949
Mari Mehrabi: hey, Hi! And

594
01:29:10.530 --> 01:29:14.650
Mari Mehrabi: it's about medicalization of, I guess.

595
01:29:14.920 --> 01:29:17.969
Mari Mehrabi: in your

596
01:29:18.310 --> 01:29:20.549
Mari Mehrabi: I you can explain about this.

597
01:29:22.450 --> 01:29:28.229
Yeah. So do you did. You feel in your own research that there was

598
01:29:28.240 --> 01:29:41.309
a focus on seeing it all the sort of problems of the service users that you were working with as being medical problems. And did did you think that there was? Maybe other explanations

599
01:29:41.350 --> 01:29:44.379
were considered less? I think that's a question.

600
01:29:50.260 --> 01:29:52.480
Oh, yeah, I don't have any explain.

601
01:29:54.320 --> 01:30:03.969
Okay, that that's that's fine. Yeah, it's it's maybe something to think about. So if we move on to Annelina, if if you'd like to, maybe answer the same question.

602
01:30:06.370 --> 01:30:16.859
Yes, that's true. Some of the children these parents guardians, had a diagnosed with Adhd, for instance.

603
01:30:16.920 --> 01:30:30.430
But maybe it says in many other countries. It's a racing, rising problem in Sweden, but it could be a cue for maybe one year or one and a half or 2 years to get this diagnosis.

604
01:30:30.470 --> 01:30:56.830
And it's and what has actually occurred lately. If there are actually also clinics for maybe more adults who want to sort of get rid of the diagnosis also. But that's another. I mean that I mean, because it's a problem also to get maybe your driving licence or loans, or whatever. Yeah, yes, so so. But and these parents in my study.

605
01:30:56.950 --> 01:31:12.709
they sort of expressed a kind of something. It was almost a relief that the child got to the diagnosis, because then there was like a road for support. So I guess it's not something special for Sweden. But that was the case actually, in this.

606
01:31:13.270 --> 01:31:16.869
Yeah, I don't know. Would you like to add something to say that?

607
01:31:23.390 --> 01:31:25.840
So on. Yes.

608
01:31:26.540 --> 01:31:46.279
I was just going to add, from the Australian point of view, we've had a big rise in people being diagnosed with autism as well as a the attention deficit and the attention deficit hyperactivity. And there's a lot of people who are in their forties and fifties now. Oh, at last I know what's wrong with me.

609
01:31:46.300 --> 01:31:54.890
Oh, you know it's great! I'm so relieved to get a diagnosis. And you think, Well, yeah, but it's your. It's dealing with your everyday life

610
01:31:55.050 --> 01:32:06.440
and getting through. And, as you say, maybe getting some support, you know. And and there is a whole. As you know, there's a whole theory labelling theory in sociology and the medicalisation of

611
01:32:06.490 --> 01:32:22.249
of people's lives. It's it's all it's interactive with labelling. And so I think we're doing too much labelling now, you know. And and as I and and and Elaine said before, we need more integration of just services, of how to just help people at points when they need it.

612
01:32:22.410 --> 01:32:26.160
They probably won't need it through their whole life, but just at points

613
01:32:29.480 --> 01:32:44.719
great. I had a quick question for Marie. So In your presentation. You said that! The the patients that you were speaking to considered the gender of professionals and their ability.

614
01:32:44.780 --> 01:32:51.899
can you just say a bit more about that? So how is gender? How was gender relevant to the people you were talking to. What were they concerned about?

615
01:32:59.460 --> 01:33:00.350
Mari Mehrabi: And

616
01:33:02.670 --> 01:33:04.269
Mari Mehrabi: of course, the people.

617
01:33:04.920 --> 01:33:07.889
Mari Mehrabi: Yeah, we the the same ginger

618
01:33:07.970 --> 01:33:20.600
Mari Mehrabi: accent the psychiatric as of this this same gender, for example, the woman has

619
01:33:20.900 --> 01:33:38.720
Mari Mehrabi: the moment at the moment client has accepted a woman psychiatric and has for care. they say, we are easy for asking the problem, and

620
01:33:39.520 --> 01:33:44.060
Mari Mehrabi: hmm explain about the difficult.

621
01:33:44.080 --> 01:33:49.070
Mari Mehrabi: They they think they have it

622
01:33:51.030 --> 01:34:01.690
Mari Mehrabi: correctly guidance from the same gender of providers in healthcare

623
01:34:03.330 --> 01:34:19.759
Mari Mehrabi: in part of this fact. some people think the demand providers especially. psychiatric is a man and a physician man

624
01:34:19.760 --> 01:34:34.849
Mari Mehrabi: can have a better professional ability for providing the help to patients.

625
01:34:37.230 --> 01:34:39.429
Okay, thank you very much. Thank you.

626
01:34:39.470 --> 01:34:42.870
Is there any other questions or or comments from people.

627
01:34:44.980 --> 01:34:46.279
By the

628
01:34:47.180 --> 01:35:06.880
because I was curious about the informed consent for the because I think someone you asked about, I think the recruitment of the your participants in your study. So I wonder about in terms of they are institutional. They were in an institution

629
01:35:07.010 --> 01:35:23.929
for patients, or if they are a lot of in-house patients and regarding or about their diagnosis. I wonder about yeah, the possibility to have to have say yes to the study sort of voluntarily. So could you maybe elaborate on?

630
01:35:25.200 --> 01:35:48.590
Yeah, sure. For as for any study and and always, we wouldn't have to get an ethical approval, of course we did not start yet with a recruiting process, but the plan is to go into the institution, which is, as I said, inpatient. but also outpatient services. And we have several clinics and settings. We would like to. yeah, recruit

631
01:35:48.590 --> 01:35:57.520
the participants. And regarding if persons are involuntarily.

632
01:35:59.350 --> 01:36:00.240
Hmm.

633
01:36:03.470 --> 01:36:09.280
yeah, no, that's not a plan. So

634
01:36:09.550 --> 01:36:12.820
actually, I don't know if a person

635
01:36:12.950 --> 01:36:14.000
and

636
01:36:14.690 --> 01:36:17.610
is involuntarily

637
01:36:19.480 --> 01:36:22.450
3, yeah.

638
01:36:27.910 --> 01:36:32.380
you need to just use the mic again. I'm afraid to. So people online can hear

639
01:36:32.830 --> 01:36:45.189
so that you can feel a pressure to participate in the study if you are, maybe an in patient. That's yeah to sort of that. Well, maybe I should. Yes, say yes to this, because, yeah, like that.

640
01:36:45.750 --> 01:36:55.379
Yeah. Now I see, of course. Yes, we try to avoid it. Of course. Yeah. And how to do that.

641
01:36:57.450 --> 01:37:25.870
This is part of the approach. If you are doing research in psychiatric institutions to have a way to ask people if they are willing to explain the study, and to get sure that they understood that they are not in any kind pressured or not. So this is part of the way we are approaching and asking people so to make sure that they feel no pressure, of course, and

642
01:37:26.020 --> 01:37:50.030
also we make sure, just at a level of information about the study that we are not in contact with the mental health treatment team, so that the study has nothing to do with the treatment. It's absolutely yeah, independent. So all those measures we normally use when we are doing research in natural health settings.

643
01:37:50.750 --> 01:37:53.029
Is that sufficient? Yeah.

644
01:37:53.820 --> 01:37:57.720
okay, any final comments or questions from our audience.

645
01:37:59.520 --> 01:38:16.000
No, okay, great. Well, thank you to everybody for their participation. Thank you to all the speakers for for great presentations. And yeah, hopefully, see you all later at other sessions.