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This paper seeks to outline the nature of early intervention (EI) services in psychosis and to discuss substance use in clients in this setting. It considers ways of working with EI clients where substance use is an issue.

The paper begins by outlining the nature of EI services and early psychosis, then goes on to discuss the impact and management of substance use in this setting.

The authors argue that the El approach may be very appropriate for this subset of clients.

This paper focuses on the issues of treatment of dual diagnosis within a specialised area of mental service provision. EI services for psychosis aim to provide early detection and treatment of psychosis, particularly through increased emphasis on psychosocial interventions.

The aim of the paper is to assess the commissioning systems in place for the commissioning of local dual diagnosis interventions and to make recommendations for the establishment of innovative practice beacon sites. This involves focussing on five areas in the North West: Cumbria, Warrington, Manchester, Lancashire and Bolton.

A diagnostic process was undertaken to determine the characteristics of each area via the filling in of diagnostic tools by local commissioners; interviews; and a consultation event.

The review found that despite the lack of updated policy and guidance around the commissioning of dual diagnosis interventions, there are good examples of innovative practice in the North West. However, it must be noted that these interventions have not been the subject of formal evaluation and this is a recommendation of this review.

This is the first review of its kind into the commissioning of dual diagnosis in this region with the added legacy value of the establishment of the beacon sites, designed to develop and disseminate examples of innovative practice in commissioning dual diagnosis interventions.

The North of England characteristically has higher levels of alcohol‐related harm and higher levels of mental illness compared with the South. The purpose of this paper is to present observations on the use of services by people who have both alcohol and mental health problems to explore the equality and economic impact of services.

Inpatient hospital datasets as well as other NHS service datasets were examined to gather intelligence on alcohol and co‐occurring mental and behavioural disorders.

The study finds that there are high levels of dual diagnosis (DD) of alcohol and mental health in the North West with significantly higher rates in the more socially deprived areas and gap in access to services.

These health inequalities in relation to DD can only be demonstrated robustly for hospital inpatient admissions because other datasets currently provide intelligence only at larger geographies – such as Primary Care Trust – or by service provider.

Population surveys are useful to generate estimates of the prevalence of mental health issues in alcohol users which then reveal that there are greater inequalities in access to services in more deprived populations. Such valuable intelligence should be generated at the local level so that the most appropriate and the most cost effective services can be commissioned for the local population.

This is the first time that the economic cost of DD in the various services has been estimated.

The purpose of this paper is to obtain an insight into how mental health and alcohol services are responding to people presenting with alcohol and mental health problems, as a part of a wider North West Alcohol and Mental Health Project commissioned by Drink Wise North West and Alcohol Improvement Programme (Department of Health).

An electronic survey was sent to managers and clinical leads in mental health and alcohol services across the North West region of England.

The paper found a variation in definitions of dual diagnosis and that not all areas had a strategy in place. NHS mental health and alcohol services seemed to offer a wider range of treatment options; but, this reflects the more complex nature of the service users. Workforce issues were identified as an important issue. Barriers to accessing effective care included lack of agreements between local agencies, and solutions included greater partnership working.

This was a small sample of respondents, accessed opportunistically and, therefore, unlikely to be a true representation of all services in the North West of England.

Whilst limited in scope, this survey highlights that even after ten years of service development related to alcohol and mental health, there are still significant barriers to effective care and that more workforce development and multi‐agency collaboration is required.

The hospital industry is again experiencing a wave of consolidation as formerly independent hospitals are acquired by multihospital systems. The effects of these consolidations on operating costs and care quality have been researched extensively. However, in addition to these benefits, many hospitals also hope that joining a multihospital system will improve their access to capital. Improved access to capital could be a particularly important benefit for independent, not-for-profit (NFP) hospitals because these hospitals face capital constraints since they lack access to publicly issued equity. Despite being an often-cited benefit of system membership, access to capital has received little attention from researchers. We draw on financial theory to identify several mechanisms through which system membership might improve access to capital for acquired NFP hospitals. We develop and test hypotheses using data from an earlier period of hospital consolidation during which hospitals were even more financially constrained than they are at present. Using propensity score matched control hospitals, we examine changes in leverage that occurred after independent hospitals joined multihospital systems. We find evidence that system membership allows under-leveraged hospitals to increase their debt holdings, suggesting that system membership may help NFP hospitals attain an optimal capital structure.

Multidimensional fit (MDF) has been coined as “elusive” and relevant to an individual’s social identity and self-concept, unfolding over time as individuals assess their fit relative to Person-Organization, Person-Vocation, Person-Job, and Person-Team Fit. In this chapter, the literature as it relates to the refugee employment journey, MDF, and HRM practices that facilitate or inhibit MDF is reviewed. Furthermore, in this study, the process-oriented view of the refuge path highlights the complexity of their experience, noting an array of antecedents as they relate to country, host country and individual differences, interventions through NGOs, refugee resettlement agencies, and organizations, as well as the less explored entrepreneurial path. These diverse paths and the process of finding fit, and the obstacles refugees face, are viewed through the lens of shocks and reassessment of MDF throughout their journey. Finally, the study’s outcomes illustrate individual wellbeing factors, organizational level benefits, as well as community level benefits to MDF.

The global call to ‘leave-no-one behind’ cannot be achieved without tacking the intractable social issues faced by the most excluded people. There is increasing interest in using visual methodologies for participatory research in contexts of marginalisation, because they offer the potential to generate knowledge from people’s lived experience, which can reveal subjective, emotional, and contextual aspects missed by other methods; alongside the means for action through showing outputs to external audiences. The challenge is that the perspectives of those in highly inequitable and unaccountable contexts are – by definition – rarely articulated and often neglected. The author thus begins by assuming that there are unavoidable tensions in using visual methods; between perpetuating marginalisation by inaction, which is ethically questionable; and the necessary risks in bringing unheard views to public attention. Many experienced practitioners have called for a situated approach to visual methods ethics (Clark, Prosser, & Wiles, 2010; Gubrium, Hill, & Flicker 2014; Shaw, 2016). What is less clear is what this means for those wanting to apply this practically. In this chapter, the author addresses this gap through the exemplar of participatory video with marginalised groups. Drawing on cases from Kenya, India, Egypt, and South Africa, the author contributes a range of tried-and-tested strategies for navigating the biggest concerns such as informing consent; and the tensions between respecting autonomy and building inclusion, and between anonymity and supporting participant’s expressive agency. Through this, the author provides a resource for researchers, including prompts for critical reflection about how to generate solutions to visual ethical dilemmas in context.

This study is a queer autoethnography which deconstructs assumptions about a queer musical perspective and the associated heteronormative power and privilege. Using the lens of a Heideggerian interpretive phenomenology, it examines the request for and subsequent actualising or unfolding of musical compositions that respond to works of art. The request, being for a ‘queer compositional response’ to artworks occurred as personal; it touched my experience of being occurring as a kind of existential threat. As such, the personal is clearly political, positioning the experience of the request for queer compositions as a cultural experience which I am examining as socially unjust, or discriminatory. Furthermore, examining the intersectionalities of oppressive heteronormative and sexist attitudes and actions as queer in the world is an authentic mode of being in Heidegger's analytic of Dasein.