Beyond Community Care

An innovative, multi-perspective and international approach to the issues which normalisation entails. Carrying on from the concept of community care, normalisation or integration is about creating the conditions in the individual and society for leading as autonomous and acceptable a life as possible. Based on the right of people with disabilities to an ordinary life, it has extensive implications not just for professionals in the mental health field but for all of us.

Provides eyewitness accounts and personal stories demonstrating how nurses turn the awesome into the routine. Chambliss shows how patients-- many weak and helpless--too often become objects of the bureaucratic machinery of the health care system, and how ethics decisions--once the dilemmas of troubled individuals--become the setting for political turf battles between occupational interest groups. The result is a combination of realism with a theoretical argument about moral life in large organizations. --From publisher description.

Health care spending in the United States today is approaching 20 percent of GDP, yet levels of U.S. population health have been declining for decades relative to other wealthy and even some developing nations. How is it possible that the United States, which spends more than any other nation on health care and insurance, now has a population markedly less healthy than those of many other nations? Sociologist and public health expert James S. House analyzes this paradoxical crisis, offering surprising new explanations for how and why the United States has fallen into this trap. In Beyond Obamacare, House shows that health care reforms, including the Affordable Care Act, cannot resolve this crisis because they do not focus on the underlying causes for the nation’s poor health outcomes, which are largely social, economic, environmental, psychological, and behavioral. House demonstrates that the problems of our broken health care and insurance system are interconnected with our large and growing social disparities in education, income, and other conditions of life and work, and calls for a complete reorientation of how we think about health. He concludes that we need to move away from our misguided and almost exclusive focus on biomedical determinants of health, and to place more emphasis on addressing social, economic, and other inequalities. House’s review of the evidence suggests that the landmark Affordable Care Act of 2010, and even universal access to health care, are likely to yield only marginal improvements in population health or in reducing health care expenditures. In order to rein in spending and improve population health, we need to refocus health policy from the supply side—which makes more and presumably better health care available to more citizens—to the demand side—which would improve population health though means other than health care and insurance, thereby reducing need and spending for health care. House shows how policies that provide expanded educational opportunities, more and better jobs and income, reduced racial-ethnic discrimination and segregation, and improved neighborhood quality enhance population health and quality of life as well as help curb health spending. He recommends redirecting funds from inefficient supply-side health care measures toward broader social initiatives focused on education, income support, civil rights, housing and neighborhoods, and other reforms, which can be paid for from savings in expenditures for health care and insurance. A provocative reconceptualization of health in America, Beyond Obamacare looks past partisan debates to show how cost-efficient and effective health policies begin with more comprehensive social policy reforms.

Disobedience : doctor workers unite! / Howard Waitzkin -- Becoming employees : the deprofessionalization and emerging social class position of health professionals / Matt Anderson -- The degradation of medical labor and the meaning of quality in health care / Gordon Schiff and Sarah Winch -- The political economy of health reform / David Himmelstein and Steffie Woolhandler -- The transformation of the medical industrial complex : financialization, the corporate sector, and monopoly capital / Matt Anderson and Robb Burlage -- The pharmaceutical industry in the context of contemporary capitalism / Joel Lexchin -- Obamacare : the neoliberal model comes home to roost in the United States, if we let it / Howard Waitzkin and Ida Hellander -- Austerity and health / Adam Gaffney and Carles Muntaner -- Imperialism's health component / Howard Waitzkin and Rebeca Jasso-Aguilar -- U.S. philanthrocapitalism and the global health agenda : the Rockefeller and Gates foundations, past and present / Anne-Emanuelle Birn and Judith Richter -- Resisting the imperial order and building an alternative future in medicine and public health / Rebeca Jasso-Aguilar and Howard Waitzkin -- The failure of Obamacare and a revision of the single payer proposal after a quarter century of struggle / Adam Gaffney, David Himmelstein, and Steffie Woolhandler -- Overcoming pathological normalcy : mental health challenges in the coming transformation / Carl Ratner -- Confronting the social and environmental determinants of health / Carles Muntaner and Rob Wallace -- Conclusion : moving beyond capitalism for our health / Adam Gaffney and Howard Waitzkin

In answer to popular demand from students and practitioners alike, Braye and Preston-Shoot have produced a guide to understanding the complex area of community care. What are the core components of the Government's community care policy? What do terms like partnership, anti-discriminatory and anti-oppressive practice mean? This book provides a simple exposition of the concepts and value-base underpinning community care policy and practice. Written in a jargon-free style, it goes beyond the how-to approach of much of the existing social care literature and examines the principles and values on which professionals involved in welfare provision base their work. It addresses issues of power and partnership in professional practice and identifies dilemmas arising from the relationship between Needs, Rights and Resources, between Autonomy, Paternalism and Empowerment. It tackles the choices and uncertainties faced by those making decisions about service provision, and offers survival strategies to professionals under stress.

Beyond Clinical Dehumanisation Toward the Other in Community Mental Health Care offers a rare and intimate portrayal of the moral process of a mental health clinician that interrogates the intractable problem of systemic dehumanisation in community mental health care and looks to the notion of "wonder" and the visionary relational ethics of Emmanuel Levinas for a possible cure. An interdisciplinary study with transdisciplinary aspirations, this book contributes an original and compelling voice to the emerging therapeutic conversation attempting to re-imagine and transcend the objectifying constraints of the dominant discourse and the reductive world view that drives it. Chapters bring into dialogue the fields of community mental health care, psychology, psychology and the Other, the philosophy of wonder, Levinasian ethics, clinical ethics, the moral research of autoethnography and the medical humanities, to consider the defilement of the vulnerable help seeker, the moral injury of the clinician and look for answers beyond. This book is an ethical primer for mental health professionals, researchers, educators, advocates and service users working to re-imagine and heal a broken system by challenging the underpinnings of entrenched dehumanisation and standing with those they "serve".