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This study assesses newly qualified doctors’ confidence in practising clinical skills related to the assessment and management of mental health conditions and how this correlates with other areas of medicine. We conducted a national survey of 1311 Foundation Year 1 doctors in the UK. Survey items assessed confidence recognising mentally unwell patients, conducting a mental state examination, assessing cognition and mental capacity, formulating a psychiatric diagnosis and prescribing psychotropic medications.
A substantial proportion of surveyed doctors lacked confidence in their clinical skills related to mental health and prescribing psychotropic medications. Network analysis revealed that items corresponding to mental health were highly correlated, suggesting a potential generalised lack of confidence in mental healthcare.
We identify areas of lack of confidence in some newly qualified doctors’ ability to assess and manage mental health conditions. Future research might explore how greater exposure to psychiatry, integrated teaching and clinical simulation might better support medical students for future clinical work.
The World Health Organization (WHO) is tasked with the ‘attainment by all peoples of the highest possible level of health’, yet, it is widely struggling to meet this mandate, and COVID-19 has revealed significant limitations of the organisation. Despite clear guidance provided by the institution as to how best to respond to the pathogen, many governments departed from WHO's guidance in their response efforts. Is this a new crisis for WHO? Does WHO need to restore its legitimacy in the eyes of the global community? As renewed calls for changes to WHO emerge, in this perspective we lay out the obstacles WHO face to become the WHO ‘we’ need. The assumption is that UN member states need an empowered and well-funded organisation. Yet, many years of discussion of reform of WHO have failed to lead to meaningful change, and glaring challenges remain in its financing, governance and politics, which are considered in turn. The reality may be that we have the WHO that UN member states need – one that can provide guidance and advice, but also take criticism for health governance failures when states want to avoid blame or responsibility. We discuss this, by analysing three key areas of WHO'S challenges: mandate and scope; structure, governance and money and domestic vs international.
The concluding chapter sets out some of the key themes to emerge from the book. It recalls the influence of the various groups of actors who gave meaning to the Abortion Act, emphasising how the Act was shaped over time in a complex process of negotiation, dispute, revision and consolidation. We locate the Act within the shifting contours of a country undergoing a demographic revolution, exploring how it shaped and was shaped by processes of secularisation, the decline of discursive Christianity and an enhanced role for science in ordering understandings of the world, changing norms of gender, family and disability, shifting ideas of medical authority and changing technologies.
Chapter 3 explores a series of attempts to restrict the Abortion Act fought between 1974 and 1990. The early attacks were led by men, most of them Tories, and framed in terms of defending family values, personal responsibility and moral standards. We show how the Women’s Movement now claimed and defended the Act, itself being importantly shaped in the process. We describe how, over the course of two decades, the centre ground for debate would gradually shift, with attacks coming to be framed in a language of social justice, civil liberties and scientific advance. The chapter ends when Parliament is finally given the opportunity for a meaningful vote on the Act and uses it to endorse the Act’s broad framework.
Chapter 2 traces the Act’s early, formative years. We explain how its meaning was negotiated as women arrived in doctors’ surgeries seeking services that they now believed to be lawful and how doctors worked to understand and apply the new law. We explore how, over time, different interpretations of the Act coexisted, fell out of use or became entrenched in professional codes, internal policy and procedure documents, official guidance and medical curricula. The chapter ends in 1974 with the publication of two important texts discussing the workings of the Abortion Act in these early years: the sensationalist media expose Babies for Burning and the highly influential and authoritative Lane Report.
Chapter 4 explores how the Abortion Act became embedded in daily life: abortion for non-medical reasons became gradually more widely accepted, services were embedded and streamlined and abortion technologies became safer and less technically demanding. We consider how dispute would now come increasingly to turn on the ‘normalisation’ (or ’trivialisation’) of abortion. While these disputes would find focus in contestation regarding the meaning of the Abortion Act, they were always also about far more, lying along a fault line between competing visions of gender, family, religion, science and society.
This introdutory chapter describes events leading to the introduction of the Abortion Act. It explains the use of ’biography’ to frame the analysis, offers a brief synospsis of each chapter, discusses the sources used in the research and explains the choices made regarding terminology.
Chapter 6 focuses on that part of the UK that was omitted from the Abortion Act: Northern Ireland. We show that, notwithstanding this formal exclusion, the Abortion Act has played an important role in the region such that a biography of the Abortion Act necessarily offers the story of not just a British law but, rather, of a UK one. Over the past five decades, Northern Irish women have travelled in large numbers to access legal abortions in Britain, with the Act offering a ‘release valve’ that would limit the numbers of dangerous backstreet abortions and the mortality and morbidity that have driven reform elsewhere. Further, the Abortion Act would form a key focus of campaigns for and against abortion law reform within Northern Ireland; when reform eventually came, the Act would play a role in shaping it, and the reform of Northern Ireland’s abortion law has given significant momentum to the campaign for the decriminalisation of abortion.
Chapter 7 considers parliamentary debates regarding the reform of the Abortion Act from 1990 to 2021. Those leading the fight for restrictive reform would now be mainly Tory women who placed particular emphasis on Christian faith in driving parliamentary work and made the case for narrowly focused reform measures in a language of clinical advance, female empowerment and civil liberties. Pro-Choice MPs would move off the defensive and argue for further liberalisation of the law. Reflecting a significant shift in the centre ground of the debate, each side would now claim to be defending the interests of women, and each would claim to be supported by clinical science and medical opinion, with the gulf between them more than ever presented not as a moral but an empirical one. Above all, each would claim to be offering necessary modernisation of an outdated Abortion Act, whilst relying upon radically different visions of what such modernisation required.