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The Original 643??? 6 0 2009 May 2009 10.1111/j.1751-9020.2009.00224.x 224 Sociology Journal Article 30??? Compilation 1751-9020 Sociology Compass SOCO The of Mental Health Oxford, UK Author Ltd Blackwell Publishing 2009 Blackwell Publishing Ltd

The Sociology of Mental Health: A Brief Review of Major Approaches

Joanne Warner*
University of Kent

Abstract

The article emphasises the importance of making sense of the theoretical debate in the sociology of mental health in order to position the wide range of studies that have contributed to this field within three main approaches. The article indicates ways in which various studies have proved highly influential and continue to form the basis for research, policy and practice. Sociological concepts such as stigma continue to resonate as they highlight the sense in which negative social attitudes often make life harder for those who are already experiencing distress. The politics of risk in mental health, which has become a particularly powerful force in recent years, has made the prevailing climate more and not less stigmatising for those identified with mental illness. The article concludes by arguing that the sociology of mental health continues to offer the conceptual and theoretical foundation from which negative associations can be challenged and overturned.

Introduction Sociological interest in mental health can be traced back to the classical theorists, most notably to Durkheim and his seminal work on the normal and pathological (1964 [1895]) and on suicide (1951 [1897]). Whilst sociology as a discipline increasingly encompasses a vast array of intellectual developments with new and distinctive specialist areas (Urry 2005), so too the sub-discipline of the sociology of health and illness now incorporates a wide and growing range of topics and theoretical developments, including what might be regarded as the sub-sub-discipline of mental health. Intellectual developments within the sociology of mental health differ from one another in profoundly important ways, not least because they reflect very contrasting ways of conceptualising mental and emotional distress; of understanding what it is, what it means and therefore how others should respond to those who experience it. One of the main differences is between those who regard mental and emotional distress as socially constructed to some degree or other, and those who (provisionally at least) accept the medical classification system of diagnosis and emphasise the role
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of social structures in causing different types of mental illness (including psychiatric epidemiology, as outlined later). What all perspectives have in common is the attempt to generate explanations for, and a deeper understanding of, experiences of mental health and distress. Sociological inquiry in this area remains vital, particularly given the emergence in recent years of a policy paradigm which is preoccupied with the concept of risk (Kemshall 2002; Warner 2007). Since the implementation of community care policies in the early 1990s, the focus in the media and in policy developments has been on a perceived increase in the risk of violence to others by people who have been in contact with mental health services. In terms of the probabilities of harm, the risk of harm to others by the mentally ill has received disproportionate attention compared to the multiple risks of suicide and violence faced by mental health service users. Care in the community has been socially constructed so that ... the mentally ill represent a lurking menace ... [in] ... the perilous inner-city streets (Wilkinson 1998). The effective conflation of violence with mental illness (Rogers and Pilgrim 2005, p. 209) necessitates a sophisticated understanding of the processes involved in contemporary constructions of mental illness which sociology is best placed to offer. The problematic nature of sociological inquiry in mental health can be demonstrated almost immediately, given that even the term mental health is a misnomer. Whilst we refer to the general field of study as mental health, our real interest lies in mental illness, mental disorder, mental health problems, and emotional distress; in fact anything and everything which is not considered mental health. Indeed a central preoccupation in this field of sociology is with where the dividing line should be drawn between mental health and anything else. The range of different ideas about where, how, and even if this line can be drawn is concerned with fundamental questions about the nature of social reality and how we might know it. What comes to be seen as mental disorder? Who are the mad? What constitutes an appropriate response? The range of terminology used in discussing mental health reflects this complexity and can therefore be confusing. However, the choice of terminology is crucial because it suggests an allegiance to a particular set of perspectives. Use of the term mental illness, for example, implies commitment to the idea that distress can be identified, diagnosed, and treated through medical intervention, and the problematic and contested nature of diagnostic categories such as schizophrenia tend to be downplayed. Use of broader terms such as distress and mental and emotional distress as used throughout this article implies a more problematised stance in relation to the issues under discussion. Alternative terms are used in the article where they reflect the terminology used in specific studies, in order to ensure that the contributions of others are accurately represented. The main aim of this article is to assist readers who are new to the field or those who feel lost in it to make sense of the wide range of ideas that
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are associated with the sociology of mental health. It provides a state of the field evaluation which incorporates references to the contribution the sociology of mental health continues to make to research, policy and practice. To do this, the article first provides an account of some of the basic theoretical questions that underpin sociological enquiry in mental health and, indeed any social issue. These theoretical questions are concerned with ontological claims about the nature of social reality, and with epistemologies, or theories of knowledge, about that reality. Blaikie (1993) supplies concise and simple definitions of ontology and epistemology that are sufficient for our purpose:
... ontology refers to the claims or assumptions that a particular approach to social enquiry makes about the nature of social reality claims about what exists, what it looks like, what units make it up and how these units interact with one another. (Blaikie 1993, p. 6; my emphasis) An epistemology is a theory of knowledge; it presents a view and a justification for what can be regarded as knowledge what can be known, and what criteria such knowledge must satisfy in order to be called knowledge rather than beliefs. (Blaikie 1993, p. 7; my emphasis)

Broadly speaking, epistemological positions can be divided into two camps: social constructionist or realist (Blaikie 1993). Social constructionism ranges from weak to strong perspectives. In its weaker form, it emphasises the way cultural and social processes shape the way in which mental health is understood. Mental illness such as schizophrenia cannot be understood except by reference to these processes. In its most extreme form, most closely associated with the work of Foucault and Derrida, strong social constructionism (Lupton 1999) suggests that there is no direct access to reality because all versions of reality are mediated through discourse or text. There is nothing more than the discourse or the text and all knowledge is indeed relative, or perspectival (Houston 2001). According to this perspective, there is literally no such thing as schizophrenia. In much of the relevant literature, the notion of social construction is compared with a realist view of the social world as though they are in binary opposition to one another. Questions that hinge upon ontological beliefs are often framed in an either/or way, that is to say, the world is presented as either socially constructed or real. This article engages in some depth with the debates that surround these theoretical questions because detailed discussion about them is often neglected. A wide spectrum of approaches can be discerned in the sociology of mental health, ranging from approaches based on a realist ontological position to those based on a strong or radical constructionist one. Of increasing importance in the literature is the impulse to adopt a position between constructionism and realism by regarding emotional and mental distress as both socially constructed and real. This is exemplified by the critical realist approach as
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discussed later in the article. Identifying where a particular work lies along the spectrum between the three main approaches of realism, critical realism, and constructionism is crucial when attempting to critically evaluate the contribution it makes to the production of understanding (Link 2003) in the sociology of mental health. Who contributes to the sociology of mental health? Broadly speaking, the major contributions to the sociology of mental health come from two groups: first, sociologists who have mental health as their focus, and second, those from a diverse range of other disciplines and backgrounds who are interested in mental health and who make use of sociological ideas and theories in their work, either explicitly or implicitly. Amongst the new and exciting contributions from non-sociologists relevant to the field is work by human geographers, such as Hester Parrs Mental Health and Social Space (2008). A major contribution to theoretical understandings in the sociology of mental health has come from people who have first-hand experience of mental and emotional distress and involvement in mental health services (e.g. Beresford 2005; Campbell 1999; Wallcraft and Bryant 2003). The service user/survivor movements have provided powerful critiques of the medical model in mental health and have questioned many of the core concepts that underpin it in order that new understandings of distress might develop (Campbell 1999, p. 201). Some of the most important work that is routinely cited in the sociology of mental health originates from non-sociologists, including professionals such as psychiatrists, social workers and nurses who work in mental health services. The anti-psychiatry movement, for example, was spear-headed by psychiatrists such as Szasz (1972), whose work I will be referring to later. The relationship between psychiatry and sociology has traditionally been volatile in that, Close and mutual working relationships with psychiatry at one point in time have been replaced by hostility and rejection at others (Rogers et al. 2007, p. 289). The relationship can be charted from its heyday in the 1950s to its disintegration in the 1970s as the antipsychiatry of psychiatrists such as Szasz (1972) came to dominate and the contribution of medical sociology realigned itself from that of handmaiden to medicine to that of observer providing a sociology of medicine (Pilgrim and Rogers 2005). In recent decades, it is collaboration with the neurosciences and genetics rather than sociology that has characterised psychiatric research. A major contribution to the literature has come from the long tradition of feminist work relating to mental health. These have consistently highlighted the gendered nature of mental health and distress and thus demonstrate the importance of recognising processes of social construction. Seminal studies in the 1970s, such as by Chesler (1972) and Broverman et al. (1970),
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were followed in the 1990s by work that has highlighted the complexity of the relationship between misogyny and mental illness (Ussher 1991), and the different ways gender is salient to mental disorder (Busfield 1996). More recently, there has been work that has emphasised the impact of social inequality on womens mental health (e.g. Williams 2005). In terms of key texts that offer a comprehensive account of contributions in the field, successive editions of A Sociology of Mental Health (Pilgrim and Rogers 2005) have been particularly influential. Beyond this work, there have been other contributions that offer insight into the most recent debates, including those that rethink the field (Busfield 2001) and those that seek to re-locate it (Rogers et al. 2007). This article does not attempt to reproduce the ideas already on offer in these accounts but would instead recommend them as essential further reading. The article provides a basic account of the ideas within three of the main perspectives from within sociology: those that emphasise the way mental and emotional distress has been socially constructed, those that have focused on the social causes of mental illness, and those that are based on critical realism. Social causation perspectives The focus of studies that adopt a social causation perspective is on social structures and the differential impact they have on the mental health of specific populations. Social class, race and ethnicity, gender, and age are all of interest because of the important differences that have been identified within and between populations in terms of the nature and degree of mental illness and the link with social disadvantage. Central to this perspective is the use of data drawn from psychiatric epidemiological studies, which focus on mental disorder at the level of population. Numerous studies have provided evidence for relationships between various diagnostic categories and social locations such as ethnicity and gender. Establishing the nature and direction of these relationships is however problematic. Evidence from such studies of a strong relationship between low social class and a diagnosis of schizophrenia, for example, appears to be robust. Further details of the nature of the evidence in this area will help to demonstrate the utility of social causation perspectives. For a comprehensive and well-organised introduction to the complexities of the evidence for other well-known relationships, I would direct the reader to Pilgrim and Rogers (2005). Evidence based on large-scale epidemiological studies has repeatedly demonstrated a close relationship between low social class, social deprivation and the likelihood of being diagnosed with schizophrenia. However, the precise nature of the relationship between social deprivation and mental illness and the direction of cause and effect have been hotly debated. Two main theories have been proposed to explain why people with a diagnosis of schizophrenia are found in greater numbers in socially and
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economically deprived urban areas: the opportunity and stress hypothesis and the drift hypothesis (Pilgrim and Rogers 2005). The opportunity and stress hypothesis suggests that people in lower socioeconomic groups suffer greater levels of stressful life events and have fewer buffers against adverse experiences, exposing them to an increased risk of developing schizophrenia in the first place. The drift hypothesis takes two forms; first, that people with a diagnosis of psychotic illness literally drift into poorer areas and, second, that they drift in class terms to the lower end of the social scale, largely due to compromised employment opportunities. The implications of such evidence for specific types of intervention are important as they translate into political action with real consequence for service users and others, as currently expressed through the language of social exclusion/inclusion in government policy (ODPM 2004). Although studies have to assume to a greater or lesser extent that categories such as schizophrenia are (provisionally at least) real, the difficulties in defining these categories and the variability between studies in the definitions used are widely acknowledged. The fact that other categories such as class and race have also been increasingly problematised in sociology means that it can be difficult to draw any meaningful conclusions. One of the problems with drawing conclusions on issues such as the over-representation of some groups compared with others is their very dependence on epidemiological data. Such data are constructspecific and are themselves social products (Busfield 1996, p. 97). Whilst this means there are substantial problems with establishing the true incidence or prevalence of a mental disorder, it can be argued that it is still possible to draw conclusions with some degree of confidence. This is when findings are supported by a sufficient range of studies so that they can be regarded as having secure foundations (Busfield 1996), such as the findings on social class and schizophrenia. It is also important to note that epidemiological studies have often provided the groundwork that is crucial for demonstrating the significance of social factors in mental health (Busfield 2001). The article now turns to consider the contribution made by studies that have focused on the role of social processes in producing or exacerbating the negative experiences of mental and emotional distress. Whilst major contributions date back to the 1960s, recent years have seen a revitalisation of work from within social constructionist perspectives, particularly those that focus on key concepts such as stigma, and labelling theory. The power of labels and the impact of stigma Labelling theory as applied to mental health was at its most popular in the 1960s, following the publication of Scheff s seminal work Being Mentally Ill: A Sociological Theory (1966), which followed Beckers work on the sociology of deviance (1963). Scheff s central argument is that concepts
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of mental illness in general and schizophrenia in particular are not neutral, value-free, scientifically precise terms but are, for the most part, the leading edge of an ideology embedded in the historical and cultural present of the white middle class of Western societies (Scheff 1966, p. 65). Mental illness is a category that represents the lumping together of offences against a particular set of social norms referred to by Scheff as residual rules. These rules are the unnamed understandings of everyday interactions, such as the manner in which someone makes eye contact when in conversation. If no other explanation (such as drunkenness) can be found when these unnamed understandings are transgressed, then mental illness is the catchall alternative explanation. It is this that accounts for the fact that a diagnosis such as schizophrenia is vague, imprecise and inconsistent, and why two people with that same diagnosis may not have a single symptom in common. For Scheff, schizophrenia is the residue of residues; the breadth of the category schizophrenia lending itself particularly well to its role in relation to normative social boundaries. It is important to note, however, that Scheff does not deny the reality of the suffering of someone who experiences the symptoms associated with schizophrenia, such as hearing voices. Labelling theory has not been easy to demonstrate in empirical terms, and in fact, some studies appeared to refute Scheff s main argument. Goves work in particular appeared to demonstrate that the negative experiences of mental health service users began with symptoms rather than with the responses of others to their behaviour (Gove 1970, 1975). However, in recent years, labelling theory has been revitalised in a modified form and various studies have highlighted the significance of labelling in the social processes involved in stigmatising experiences in the community (Link and Phelan 1999). In his classic 1960s sociological account of the processes involved, Goffman defines stigma as existing when:
... an individual who we might have received easily in ordinary social intercourse possesses a trait that can obtrude itself upon attention and turn those of us whom he [sic.] meets away from him, breaking the claim that his other attributes have on us. He possesses a stigma, an undesired differentness from what we had anticipated. ... (Goffman 1990 [1963], pp. 1118)

In their third edition of A Sociology of Mental Health and Illness, Pilgrim and Rogers (2005) incorporate a new dedicated chapter to stigma and social exclusion in acknowledgement of the rekindled sociological interest in these areas (p. xviii). Stigma is indeed currently a core concept in mental health research and policy partly because, in the years following the implementation of community care policies in the 1990s, it has been recognised that negative attitudes towards people experiencing mental distress compound whatever difficulties they may face. Stigma has been identified as a major factor in relapse and as an obstacle to recovery
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(Thornicroft 2006). In survey research, negative opinions towards those with mental distress have been found to be prevalent, with belief in a strong association between violence, unpredictability and mental illness most notable (Crisp et al. 2000). Discriminatory employment practices towards those with mental illness diagnoses have also been found to be widespread (Thomas et al. 2002). Along with others identified with the anti-psychiatrist movement, Szasz adopts perhaps the most extreme social constructionist ontological position arguing that, mental illness is a myth, psychiatric intervention is a type of social action, and involuntary psychiatric therapy is not treatment but torture (Szasz 1972 [1962], p. 12). Accordingly, the proper response to mental illness is not to treat it as if it were a physical illness, but to decode the behaviour involved. Schizophrenia cannot be regarded as an illness in the way that physical illnesses can be regarded because it does not conform to the basic requirements of being observable and measurable scientifically. The concept of mental illness is vague, capricious, and generally unsatisfactory (Szasz 1972 [1962], p. 13). Szasz argues that psychiatry is therefore a pseudoscience that has mimicked other fields of medicine and created disease categories based on nothing more than supposition and invention. The main role of psychiatry is to socially control those who do not conform to social norms. He uses examples such as homosexuality, which was categorised as a mental disorder by the American Psychiatric Association up until 1973 (and by the World Health Organisation until as recently as 1992), to illustrate his case. To some extent, we can see Szaszian elements in contemporary responses to phenomena in mental health, such as hearing voices. In contrast to treatment regimes where medication is used to suppress symptoms, service user movements such as the Hearing Voices Network (2008) emphasise the limited but growing inclination to engage with the meaning of voices, particularly through the use of talking therapies such as counselling. Although this is not yet the norm, this practice is increasing. While it has been argued that the reliability of diagnoses of schizophrenia has improved (in that clinicians are apparently more likely to reach agreement about a diagnosis), problems regarding reliability have persisted (Bentall 2006). The extent of the problems with reliability means that the case for the abandonment of schizophrenia as a disease category is more powerful than ever (Bentall 2006). Whilst the radical changes hoped for by the anti-psychiatrists such as Szasz and R. D. Laing have not taken place, it is still hard to overstate the importance of these major theoretical contributions to modern thinking about mental health. The post-psychiatry and critical psychiatry movements continue to challenge the power of psychiatry from within (see Critical Psychiatry Network 2008). However, there have been significant critiques of the strong social constructionism associated with Szaszian ideas.
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Problems with social constructionism Serious shortcomings have been identified with the application of the language of social constructionism in the sociology of mental health. While Busfield (2001) gives due credit to the ideas for identifying the way social processes have shaped ideas about categories of mental disorder, she also argues that the terminology is imprecise and that this has helped to generate hostility towards sociological ideas about mental and emotional distress. This is because the phrase social construct, can be taken to incorporate an ontological claim that mental disorder is only a category and does not refer to any objective reality (Busfield 2001, p. 5). Another of the problems with the strong constructionist standpoint concerns what it implicitly assumes about the nature of illness in a general sense. Some of the assertions imply that so-called physical illnesses are by nature unproblematic, easily defined and relatively straightforward to treat in ways that are invariably ethically sound. The emphasis in the sociology of mental health on social constructionist approaches tends, implicitly at least, to render physical health as unproblematic. Indeed, in arguing the case for a social constructionist approach to mental health, a comparison is often made with the relatively unproblematic categories used in physical health, encapsulated in a claim such as: schizophrenia is not like diabetes. Whilst this is true up to a point (one can measure insulin levels; one cannot measure a delusion in a meaningful sense or indeed verify that it exists at all), it creates an unhelpful dichotomy which seriously neglects the importance of the many complex social and cultural processes that are involved in the diagnosis and management of a condition such as diabetes (see, e.g., Sajaram 2008). Whilst many of the categories of physical illness may not, on the face of it, be so readily contested and open to interpretation, there is sufficient debate about them to argue that the sociology of mental health belongs within the wider framework of study that is the sociology of health and illness. A further problem with a strong social constructionist position in mental health lies in the tendency towards relativism in which all experiences of mental and emotional distress are understood as lying along a continuum of normal experience. Whilst this is a position advocated and seen as helpful by many, it has been criticised by some within the psychiatric survivor movement for whom it is at odds with their experience and who have reclaimed alternative language:
Political correctness drains most of the meaning from what we once called mental illness. No one can lay claim to full mental health, so we all must have some kind of mental health difficulty. It is not surprising that activists and consumer groups have reclaimed expressions like crazy and madness as a defiant act of subversion - hence the success of Crazy Folks in the US and Mad Pride in the UK. (Barker and Buchanan-Barker 2005)
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There is therefore a pressing problem with social constructionism, and that is its tendency to neutralise meaning. Houston (2001) argues that the inherent relativism of social constructionism is incompatible with prescribed courses of action, and others have described the ultimate effect of such an approach as paralysis (Munro 1998, p. 180). In essence, it becomes impossible to talk about anything, as everything is contingent. As Brown and Harris (1978) put it in their seminal work on the social origins of depression in women, even strong social constructionists have to face this problem:
R. D. Laing, in spite of his acerbic strictures, still uses the term schizophrenia albeit with ill-grace. He does so, because like everyone else, he needs to communicate. Clinical work as well as research is impossible without a means of reducing the variety of psychiatric phenomena to a provisional order. This can only be done by classification. (p. 19)

How is it possible, then, to use the language of social constructionism whilst being sure to avoid neutralising meaning through such an analysis? The article now turns to summarise how these issues have been addressed within the field, and describes a third approach, critical realism, which represents an alternative to realism and social constructionism. Critical realism an alternative approach Given the problems with strong social constructionist perspectives, some commentators explicitly advocate a less extreme form of social constructionism and emphasise that they are not seeking to minimise the suffering involved in experiences of mental and emotional distress. For Symonds (1998), arguing from a social constructionist perspective does not entail negating the reality of peoples experience. It is about placing these experiences in their social context. Symonds therefore maintains that mental illness is a social construct but very much a reality (Symonds 1998, p. 59). In his book aptly titled The Social Construction of What?, Hacking (1999) emphasises that, the tension between the real and the constructed results from interaction between the two, between, say, child abuse, which is real enough, and the idea of child abuse, which is constructed (p. 101). It has been argued that much of the misunderstanding about social constructionism derives from the failure to distinguish between reality and theories of reality in terms of what is being understood as socially constructed (Pilgrim and Rogers 2005). In order to clarify the epistemological position in relation to mental disorder, Busfield (2001) has advocated the use of alternative terms to social construction, such as social framing (after Rosenberg 1992) or social structuring (after Figert 1996). These retain the emphasis on social processes in shaping how mental and emotional distress is understood, whilst not denying the material reality of phenomena associated with it.
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As Pilgrim and Benthall (1999) have succinctly put it: The map is never the territory (p. 267). Essentially, such approaches could be said to derive from a critical realist approach. Critical realism is associated with the work of the British philosopher Roy Bhaskar (1998) and it has been advocated as a highly relevant approach for the sociology of mental health (Busfield 2001; Pilgrim and Benthall 1999; Pilgrim and Rogers 2005). Critical realism is regarded as offering an antidote to the problems which have been identified with strong social constructionist perspectives, specifically their inherent relativism, whilst not discarding the insights that are offered by an emphasis on social processes. Pilgrim and Rogers (2005) provide a useful summary of the relevance of a critical realist approach to mental health as follows:
Because critical realism is a materialist, rather than idealist, basis for social science (cf. the Kantian idealism underlying the work of Weber and Foucault and their followers) it can accommodate material causation (e.g. temporal lobe epilepsy) alongside a critical analysis of the interests being served by the way mental health problems are described and conceptualised in a society at a point in time (e.g. a critique of the interests served by psychiatric knowledge). Such a critical reading comes near to the deconstruction emphasis of post-structuralism and the critiques of interest work found in critical studies of the production of scientific knowledge, but differs in its position during the exercise about the factual status of reality. (p. 17)

In simple terms, critical realism suggests that it is possible to avoid denying the reality of the experience of mental and emotional distress whilst continuing the argument about what it means and how to respond. Conclusion The article has emphasised the importance of making sense of the theoretical debate in the sociology of mental health in order to position each of the wide range of studies that have contributed to the production of understanding (Link 2003) in this field. It is generally anticipated that one of three broad approaches will be adopted; either one that emphasises a social constructionist perspective, one that emphasises a realist approach to mental health issues, or, alternatively, an approach based on a critical realist view of social reality. This article has shown, albeit through a brief review, that studies from each of the first two of these perspectives have made a substantial contribution to the diverse field that is now the sociology of mental health. Whilst each have inherent weaknesses that need to be taken into account in any evaluation of their worth, the range of types of study that has contributed to policy, theory and practice in the mental health field is wide and diverse. To discount the value of studies from one set of perspectives outright would be the equivalent to dismissing observations from particle physics on the basis that the laws of gravity do not apply in the way they do for the study of planetary movements. The
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reality is that each dimension of the sociological universe requires the logic of the other. Studies which overvalue categories that are clearly deeply problematic, such as schizophrenia, and treat them as though they are real (thus mistaking the map for the territory, or theories of reality for reality) are flawed, just as those that attempt to argue schizophrenia out of existence as nothing more than a category are flawed. As I have already stated, some of the most influential contributors to the field have identified critical realism as a potentially useful route out of this theoretical conundrum (e.g. Pilgrim and Rogers 2005). This article has also indicated ways in which various studies from within the field have proved highly influential and continue to form the basis for research, policy and practice. Erving Goffmans 1960s work on stigma is a case in point. The concept of stigma continues to resonate, particularly with many service users, as it highlights the sense in which negative social attitudes often make life harder for those who are already experiencing distress. The politics of risk in mental health and the way the mentally ill have been newly constructed as representing a threat to others has made the prevailing climate more and not less stigmatising for those who experience mental and emotional distress. Mental and emotional distress in the 21st century is all too readily associated with uncertainty and unpredictability, specifically relating to the perceived risk of violence. The sociology of mental health offers the conceptual and theoretical foundation from which such associations can be challenged and overturned. Short Biography Joanne Warners main research interests are in risk, mental health and social work. Her work has focused on the intersections of risk and mental health with race and ethnicity, gender and place. She is particularly interested in the application of sociocultural approaches to understanding the way risk is constructed and the meanings attributed to social work in contemporary society. She has also explored the way social work practice is constituted in relation to risk work and the impact of cultures of inquiry, fear and blame on professional practice in general. Her research interests have reflected and built upon her professional background as a community development worker and social worker. She is currently guest editor of a 2010 special issue of the British Journal of Social Work on Risk and Social Work: Critical Perspectives (with Dr Elaine Sharland, Sussex). Recent publications include the following: Warner, J. (2008). Community care, risk and the shifting locus of danger and vulnerability in mental health, in A. Peterson and I. Wilkinson (eds) Health, Risk and Vulnerability. Oxford, UK: Routledge; Warner, J. (2006) Inquiry reports as active texts and their function in relation to professional practice in mental health. Health, Risk and Society. Vol. 8, No. 3, pp. 223237.
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Note
* Correspondence address: School of Social Policy, Sociology and Social Research, University of Kent, Chatham Maritime, Chatham, Kent ME4 4AG, UK. E-mail: j.warner@kent.ac.uk

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