What is evidence as evidence is used? A case of dualism?

How ‘evidence’ is conceptualised, generated and deployed in meso-level policy implementation on the ground is critical to health delivery. Using the case of a large-scale health service reconfiguration in northwest England, this study began as a narrative investigation into how different data types and sources are prioritised as NHS administrative structures change over time. During the research, one unpopular reconfiguration decision, the downgrading of a hospital, was challenged using judicial review. Suddenly, a key decision was being based not upon ‘facts and data’ type evidence but upon evidence of adherence to administrative procedure. This transferred focus away from the ever-shifting categories and hierarchies of data ‘types’ towards an emphasis on process. By comparing two deliberative contexts—committee and judicial review—this article proposes that evidence can be understood as simultaneously entity and process. As health service reconfigurations continue in response to austerity, integration agendas, evolving organisational landscapes, and demographic and political change, it is increasingly important to recognise the different meanings and uses of evidence.

Strength- and recovery-based approaches in forensic mental health in late modernity: Increasingly incorporating a human rights angle?

Forensic mental health care is situated across both criminal justice and healthcare systems and is subject to political, cultural, legal and economic shifts in these contexts. The implementation of strength- and recovery-based models of care should be understood in light of these social and structural processes. Drawing on novel empirical fieldwork and the extant literature, we argue that full realisation of strength- and recovery-based principles is at odds with aspects of late modern social control. Not wholly compatible, we highlight how concepts of empowerment, autonomy, identity and connectedness can unhelpfully rub-up against the concepts of punitiveness, otherness and risk management. Conceptually this is problematic, but in frontline forensic psychiatry settings, this has real lived-experience detrimental effects for patients – as our data demonstrate. To address this, a human rights approach might be fruitful. Grounding arguments for strength- and recovery-based principles in the heuristic framework of human rights can offer a set of common values to stimulate reform in forensic mental healthcare. The right to respect for private and family life, home and correspondence under Article 8 of the European Convention on Human Rights and Fundamental Freedoms offers a particularly promising, robust and well-defined framework for these future changes – as we outline.

The psychosocial implications of social distancing for people with COPD: some exploratory issues facing a uniquely marginalised group during the COVID-19 pandemic

Chronic obstructive pulmonary disease (COPD) is an illness associated with intersectional poverty and stigma in old age; people with COPD are susceptible to anxiety, loneliness and isolation. People with COPD who contract COVID-19 are at high risk of serious complications, intensive medical needs and death and are, therefore, required to socially distance particularly assiduously. This paper offers an embodied phenomenological analysis of the emerging theoretical literature exploring the impact of social distancing upon people with COPD. Firstly, people with COPD are aware of how respiratory illness feels, are anxious about COVID-19 and afraid of being denied care. Future research might consider how people with COPD may be susceptible to “coronaphobia” and mental health consequences of the pandemic. Secondly, COPD tends to affect older people within the most intersectionally marginalised socioeconomic groups. Future research should remain mindful that people with COPD may be among the most lonely and least able to access health and social care services online than others. Thirdly, pandemics are known to intensify pre-existing social stigmas. Researchers and practitioners alike should be conscious that people with COPD may become increasingly stigmatised, especially those from intersectionally disadvantaged minorities.