In this section, we describe psychiatric disorders in the perinatal period, with a focus on understanding the triggering of mood and psychotic disorders by childbirth (postpartum psychosis and postnatal depression). We define perinatal disorders and the perinatal period, and the issues around how these episodes of illness are dealt with in the current diagnostic classification systems – the World Health Organization’s International Classification of Diseases, 11th edition (ICD-11) and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [1, 2].

Within the UK, and further afield, the spatial delineations of the ‘city region’ have seen a renaissance as the de facto spatial political units of governance for economic development (Clarke and Cochrane 2013, Sykes et al 2021). In the UK, successive governments have sought to reshape the ways in which economic development takes place, and although this shift in governmental delivery began under New Labour, it has been much vaunted by the UK coalition government (Deas 2013), and subsequently by the continuing Conservative administrations (Conservative Party 2015) and the Welsh Labour Party (Bristow and Healy 2015). This chapter, therefore, addresses the (re-)positioning of civil society within these new structures of city region governance. Based on stakeholder mapping and semi-structured interviews with key actors operating across each city region, the chapter illustrates how this has created several significant tensions as well as opportunities for civil society actors.

The chapter draws from four UK case study city regions (two in Wales and two in England from 2015 to 2019) and specifically looks at the ways city and devolution deals have impacted upon the positioning of civil society actors. It was funded by the Economic and Social Research Council under grant No: ES/L009099/1; part of WISERD’s ongoing civil society research programme. This methodology takes the form of thematically grouping stakeholder responses to look across the four differing city regions for points of convergence and divergence. This allows the chapter to consider the ways in which civil society organisations and individuals have sought to interpret, rationalise and respond to the challenges of the city region agenda. In doing this, we draw out three thematic tensions that straddle the development of each city region; the purpose being to highlight how the ongoing processes of restructuring sub-national economic space has significant impacts upon the ways in which civil society actors think and mobilise. This is important when much of the city region agenda has been primarily focused upon economic development, often to the detriment of more social concerns. In turn, this has significant implications for civil society autonomy and criticality.

The chapters in this edited collection have examined how the uncertainties of the age present diverse challenges to civil society at the beginning of the twenty-first century. We have drawn on a wide range of studies from WISERD’s Civil Society research programme. The first part of this concluding chapter summarises the different existential challenges with reference to the principal findings of each study and how they link to civic stratification. The second part outlines the common themes emerging from this volume and the associated prospects and perils for civil society organisations.

Principal findings, existential challenges and civic Stratification

Drawing upon David Lockwood’s (1996) conceptualisation, the present volume underlines how the existential challenges and the uncertainties facing civil society impact on civic stratification in the form of civic deficit and exclusion as well as civic expansion and gain. Lockwood posits that ‘the institutional unity of citizenship, market and bureaucratic relations is central to social cohesion’ (1996: 531). However, in a specific and qualified sense, the studies presented here point to the demise of institutional unity of citizenship. This is because of the global trend of state decentralisation and the rise of meso – or ‘regional’ – governance. Lockwood cannot be blamed for not foreseeing the full impact of this. He did, however, view demands for constitutional reform as a mode of civic expansion (p 535). His seminal work was formed in an era largely characterised by what Wimmer and Glick Schiller (2002: 301) term ‘methodological nationalism’, or the assumption that the state-wide practices are the natural social and political form of the modern world. As this volume’s findings illustrate, devolution in the UK is leading to the territorialisation of welfare citizenship, trust, identity and rights (see Chaney 2013, 2015, 2021c). For so-called ‘sub-state’ nations such as Wales and Scotland, the present may be a stepping-off point, a transitional stage on the way to independent statehood. What we do know from the studies in this volume is that the rise of territorial electoral politics and meso-government is significant because prevailing policy approaches in each UK nation are grounded in the different ideological orientations of the dominant parties.

This volume explores a range of existential challenges facing civil society organisations in the early twenty-first century, a period that has been dubbed ‘the age of uncertainty’ (Bauman 2007; Gagnon 2018; Obeng-Odoom 2021). Such a focus is grounded in existential humanist studies of social welfare. As originally propounded by Mohan (1979, 1985a, b), these highlight how a concern for the well-being of others underpins associative life and impacts on people in diverse ways, including the way they think about themselves, behave and interact. It links to deeper questions about meaning and the values that shape associative life, welfare, culture and democracy. As Dixon (2010: 180) explains,

In contrast to the North American tradition where ‘welfare’ is often defined narrowly ‘to mean income transfers or direct services which support the poor and give a minimum standard of living’ (Gamble 2016: 3), this volume follows the European approach, defining it as associative action and services designed to improve the general well-being of citizens. In other words, service provision and interventions to promote well-being involving voluntarism and collective action ‘to pool collective risks and to provide investment in the human capital of all citizens’ (Gamble 2016: 3; see also Beveridge 1943; Titmuss 1958; Greve 2013). Beresford (2016: 2) puts it simply: ‘[I]t is essentially concerned with how we take care of each other as human beings.’

To better understand the notion of existential threats facing civil society we need to briefly remind ourselves of the underpinnings of existentialist thought. As Dixon (2010: 178) explains, ‘first-person subjective experiences are dominated by the self’s awareness of individuality, temporality and nothingness, which means people are left only to contemplate the absurdity of living a life without reason or purpose, where self is just a contingent fact engulfed by the infinite’.

This volume explores a range of contemporary challenges facing civil society organisations in the early twenty-first century. As the following chapters reveal, each may arrest or subvert the beneficial effects of associative life and negatively impact upon governance, culture and welfare. The overall argument of this volume is the importance of civil society to individual and collective well-being, as well as the health of democracy. On the one hand, the following chapters note the resilience of civil society and its adaptability to meet uncertainties, yet on the other, we argue that civil society’s ability to prevail in the face of the existential challenges is far from assured. Rather, it is contingent in nature and requires ongoing vigilance, social self-organisation and criticality. A further strand of our argument underlines the point that while the contemporary ‘project’ to reconfigure the state might be normatively sound, its execution can be subverted by dogma, and the failure of political elites to listen and engage exogenous interests, as well as civil society organisations’ mistrust and lack of capacity to participate. Accordingly, this is the first of two short introductory chapters to this volume. Here we summarise core aspects of the history and theory associated with the concept of civil society. This is followed by a discussion of the key features of civil society in the nations of the UK. In the next chapter we summarise contemporary political and social changes and how these contribute to the existential challenges facing civil society today.

The concept of civil society has been variously advanced as: a corrective to the negative effects of neo-liberal, market-driven policies; an answer to the challenges of state down-sizing and declining welfare capacity; and a bedrock of democracy and good governance through which citizens can hold political elites to account. Moreover, it has been styled as a space where culture, identity and norms can be transmitted and valued. However, the reality is that, far from being a panacea, civil society is itself intimately wrapped up in the uncertainties of the age.