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The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

The purpose of this paper is to explore how a study of a practice can lay the foundation to describe this very practice whilst transformations of it were taken place. Descriptions of changes to the practice of social work which was observed empirically serve as a starting point for experimenting with how social scientists, though often exploring transformative study objects, can remain focused on describing the object, under study.

The study was done through circa one year of fieldwork conducted with participant observation in two Danish municipal units offering services to socially marginalized people and interviews with social workers and employees in drug/alcohol treatment and psychiatric units.

The object of study within social sciences, though changing, is able to be described. Through the theories of “Social Navigation” (Vigh) and “Strategy and Tactics” (de Certeau), the practice of social work can be described as one concrete bounded practice but one which is performed within a transformative/changeable environment that are capable of influencing it. In this case, the experience of a changeable seascape might serve as a metaphor for how study objects change within an environment of change; how they can be viewed as “motion within motion” (Vigh).

Even though fields such as anthropology and organizational studies seem to rid themselves from their objects of study (culture and organization, respectively) and dissociate themselves from descriptions thereof these objects might still be of value to us. Even though the objects of study in postmodern anthropology and organizational studies are defined as unbounded, anti-essential, ephemeral, ever-changing non-objects, this might not be the entire picture. Despite their ever-changing shape, we might still be able to study and describe them if we take their changeable form and environment into account.

This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with material-discursive practices and accounting representations. It seeks to explore the political and ethical implications of constructing the valuable through a shared consensus over the “facts” when addressing complex, multi-agency problems with long time horizons and outcomes that are not always easily quantifiable.

The theorisation, drawing on science and technology studies (STS) scholars and Karen Barad's (2007) agential realism, opens up the analysis to the performativity of both material and discursive practices in the period following a major re-organisation of activity. The study investigates two case authorities in England and the national regulator through interviews, observations and documentary analysis.

The paper demonstrates the deeply ethical and political entanglements of accounting representations as objectivity, consensus and collective action are constructed and resisted in practice. It goes on to demonstrate the practical challenges of constructing “alternative accounts” and “intelligent accountabilities” through times of austerity towards a shared sense of public value and suggests austerity measures make such aims both more challenging and all the more essential.

Few studies in the accounting literature have explored the full complexity of valuation practices in non-market settings, particularly in a public sector context; this paper, therefore, extends familiar conceptual vocabulary of STS inspired research to further explore how value(s), ethics and identity all play a crucial role in making things valuable.

In this study, the authors report visitors' and personnel's safety experiences and concerns in order to understand the safety conditions of a library.

The analysis is based on answers from a small sample survey of library visitors, interviews with the personnel and incidents recorded in a library in Stockholm the capital of Sweden.

Dealing with visitors under influence of drugs/alcohol or feeling intimidated by groups of young individuals are examples of situations in which the staff feel most unsafe. Visitors declare witnessing problems of public disturbance and disorderly conduct, fights and other types of aggression. Although the vast majority of visitors declare feeling safe in the library, their perceptions vary according to the library's environment and their individual characteristics, including their previous victimization.

The study is novel because it indicates the importance of the environment to ensure the safety conditions of the library for both visitors and staff. Finally, research on safety in libraries is often from North America and Western European contexts, while this study contributes to the international literature by illustrating libraries in a Nordic European context.

The study indicates that more social control, both formal and informal, is at the top of the list of recommendations for visitors. Among personnel, recommendations include the need for cooperation with other local actors to solve problems in surrounding areas as well as better education for librarians in dealing with the current safety challenges of libraries as multifunctional public facilities.

Combine visitors' and personnel's safety experiences to better understand the safety conditions of a public library.

Episodic mood disorders are often associated with alcohol dependence. Few studies have explored the contribution of episodic mood disorders to length of stay among those hospitalized with alcohol dependence syndrome. Filling this research gap could improve care for patients while minimizing hospital utilization costs. This study was a cross-sectional analysis of the National Hospital Discharge Survey. ICD-9-CM diagnosis codes were used to identify those admitted to a private or non-profit hospital with alcohol dependence syndrome, and a co-morbid diagnosis of an episodic mood disorder (n=358). Descriptive statistics were used to highlight differences in key demographic and hospital variables between those with and without episodic mood disorders. Negative binomial regression was used to associate episodic mood disorders with hospital length of stay. Incidence rate ratios were calculated. Co-morbid episodic mood disorders ([.beta]=0.31, P=0.001), referral to a hospital by a physician ([.beta]=0.35, P=0.014), and increasing age ([.beta]= 0.01, P=0.001) were associated with longer hospital stays. Hospital patients with an admitting diagnosis of alcohol dependence syndrome were 36% more likely to have a longer hospital stay if they also had a co-morbid diagnosis of an episodic mood disorder (IRR=1.36, CI=1.14-1.62). Patients admitted to a hospital with alcohol dependence syndrome should be routinely screened for episodic mood disorders. Opportunities exist for enhanced transitional care between acute, ambulatory, and community-based care settings to lower hospital utilization.

This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges.

This qualitative study was comprised of 26 1:1 interviews (16 men and 10 women), conducted between February and May 2021 with people who experienced homelessness in North East England during the COVID-19 pandemic. An inductive reflexive thematic analysis was undertaken, with input from individuals with lived experience who were involved throughout the study.

Four themes were developed. The first theme, lack of support and exacerbation of mental health and substance use difficulties, highlighted how the lack of in-person support and increased isolation and loneliness led to relapses or new challenges for many people’s mental health and substance use. The second theme, uncertainty and fear during the pandemic, explored how the “surreal” experience of the pandemic led to many people feeling uncertain about the future and when things would return to normal. The third theme, isolation and impacts on social networks, discussed how isolation and changes to relationships also played a role in mental health and substance use. Finally, opportunity for reflection and self-improvement for mental health and substance use, explored how some people used the isolated time to re-evaluate their recovery journey and focus on self-improvement.

The experiences shared within this study have important implications for planning the future delivery and commissioning of health and social care services for people facing homelessness, such as sharing information accessibly through clear, consistent and simple language.

As one of the few papers to involve people with lived experience as part of the research, the findings reflect the unique narratives of this population with a focus on improving services.

People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.

The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals’ perceptions of their contribution to improvement.

In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.

Recovery processes were dependent of the persons’ access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one’s self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person’s life. Trusting a professional might be a basis for trusting one’s self as an agent in one’s recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).

Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.

Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.

Young incarcerated male offenders are at risk of poorer sexual health, adolescent parenthood and lack opportunities for formative relationship and sexuality education (RSE) as well as positive male role models. The purpose of this paper is to report the process of co-production and feasibility testing of a novel, gender-transformative RSE programme with young male offenders to encourage positive healthy relationships, gender equality, and future positive fatherhood.

Using a rights-based participatory approach, the authors co-produced an RSE programme with young offenders and service providers at two UK prison sites using a sequential research design of: needs analysis, co-production and a feasibility pilot. Core components of the programme are grounded in evidence-based RSE, gender-transformative and behaviour change theory.

A needs analysis highlighted the men’s interest in RSE along with the appeal of film drama and peer-group-based activities. In the co-production stage, scripts were developed with the young men to generate tailored film dramas and associated activities. This co-production led to “If I Were a Dad”, an eight-week programme comprising short films and activities addressing masculinities, relationships, sexual health and future fatherhood. A feasibility pilot of the programme demonstrated acceptability and feasibility of delivery in two prison sites. The programme warrants further implementation and evaluation studies.

The contribution of this paper is the generation of an evidence-based, user-informed, gender-transformative programme designed to promote SRHR of young male offenders to foster positive sexual and reproductive health and well-being in their own lives and that of their partners and (future) children.

This paper aims to explore how the Celtic Tiger economic boom and Great Recession influenced drug and alcohol use in one Irish city.

Semi-structured interviews were conducted with 48 people, living in Cork City, who had previously used drugs and/or alcohol problematically. All participants had engaged with services for their problematic use and had at least one year of abstinence at time of interview.

Some participants reported that their drug and/or alcohol consumption increased during the economic boom; others, who were already in (self-defined) active addiction, reported how full employment lessened some of the harms of their problematic use. For others, problematic use struck once the economy entered a downturn and, heavy drink and drug use became a means of soothing the strains of economic recession.

The paper provides two key contributions. Methodologically, it demonstrates how large-scale national quantitative data can mask local idiosyncratic tendencies, suggesting the need for mixed-method approaches for understanding drug market trends. The paper also provides insights into the impact of global and local economic conditions on drug and alcohol consumption in Ireland.