Thinking of Harm Reduction and Reducing Harm in a Chinese Therapeutic Community for Drug Users.

Harm is a concept that permeates behavioral and public health discourses on addiction. Examining addiction recovery services in settings beyond the OECD led me to the question: What does harm mean in an un-urban, un-Western, and un-democratic space? While some emphasize the human rights potential of reducing harm, others speak to the violence of cure. My ethnographic research in a Therapeutic Community (TC) for drug treatment in Southwest China pushed me to consider how the potential for reducing the harms of illegal substance use balance with the complex psychological demands of cure. The alliance linking Sunlight Therapeutic Community with the provincial drug abuse institute and a foreign NGO was fragile. At the TC, they had difficulty weaving the Western psychological construct of the singular self through the Chinese scaffolding of institutional and cultural practices around the group. In thinking with the concepts of harm and reducing harm, I move across time and space to consider how current tensions link to and reflect: 1) the historical harms of opium imperialism; 2) reducing harm in translation; and, 3) reducing harm in the recent psycho-boom.

Qualitative evaluation of a postgraduate course in mental health nursing.

This evaluation aimed to explore mental health nurses' experience of one postgraduate (PG) Mental Health Nursing course in Australia. It investigated students' recognition and acquisition of new skills to improve their clinical practice, thereby enhancing consumer and family outcomes. In addition, nurse educators were interviewed to ascertain their impression of the impact of course materials on nursing practice and nurses' confidence in the clinical field. An exploratory qualitative descriptive design was chosen, using semi structured in-depth interviews, to elicit participants' experience of the PG course at completion. Using thematic analysis, themes were extrapolated from the data through examination and reporting on the participant's reaction, learning, behaviour and result of behaviour. The main theme identified was a "new awareness of self" with a number of related sub-themes. The findings from the evaluation indicate that this course supports emerging practitioners to develop a strong professional mental health nursing identity, grounded in recovery oriented practice. The results of this evaluation will inform further development and improvement of postgraduate studies in mental health practice for practice development. Importantly, data indicate a high potential for graduates to lead by example in sharing new knowledge and optimising recovery oriented practice.

Beyond China's drug century: Yunnan's first therapeutic community and narratives of drug treatment and mental health care.

China is experiencing rapid cultural change and new forms of sociability that are accompanied by social problems and novel humanitarian interventions that have been formulated to address those problems. The pressure related to the rapid transformation of the countryside into mid-level cities has led to recreational drug-use as a means of escape. These illegal drugs have greased the wheels of what I call an affective biopolitics that has influenced Chinese citizens. Carlos Rojas argues that development in China results from the effects of discrete protocols, or practices that stem from tensions between capital and labor, governmentality and biopolitics, and nationalism and globalization. To tease out the particulars of Rojas' protocols and practices, in this article, I first review two historical periods: 1) the rise and fall of opium consumption in the early 19th century, and 2) the 21st-century psychology boom. I use these two literature reviews to set the stage to discuss my ethnographic study of Sunlight, China's first residential therapeutic community for drug users in Yunnan Province. Sunlight's residents and founders provide a unique window into local everyday drug use at a particular time in China's economic boom, from 2007 through 2015. We know much about China's opium century but very little about the contemporary context, new consumers who partake in pleasure-consuming drugs, or the reformers who address these 21st-century public health issues.

'Spending My Own Money, Harming My Own Body': Addiction Care in a Chinese Therapeutic Community.

In this article, I explore a Chinese residential therapeutic community I call Sunlight in order to understand its quotidian therapies, its fraught nature binding China's past with its future, and the to care for the self under postsocialism. Reviewing Sunlight ethnographically allows for broader theoretical exploration into how China's economic transition created tensions between capitalism, socialism, and communism; between individual and community, care and coercion, and discipline and freedom. Sunlight blended democratic, communal, and communist values that in several ways transition drug addicts into a market-socialist society. In focusing on the socialist transition to capitalism much work concentrates on the neoliberal transition as the only path out of communism rather than exploring its exceptions. In exploring China as an exception, I ask: What do the residents, peer-educators and administrators reveal in their stories and reactions to community-based therapeutics of care and what happens when their notions of care clash?

Global flows in drug treatment: heroin addiction and therapeutic community approaches in China.

This article focuses on one residential therapeutic community for the treatment of heroin and opiate addiction in contemporary China. It discusses 2 case vignettes and shows that although addictions are extremely difficult to treat, there are small successes being reached in China's southwest. Residential treatment communities follow mobile global practices that link Western models of 12-step Narcotics Anonymous, self-healing, to other Chinese practices like Maoist "speak bitterness." In China it is in the drug aid theaters where Sunlight-International traveled to do three things: (a) stave off the American drug market, (b ) reduce drug trafficking across national borders, and (c) address the psychosocial problems associated with global drug trafficking and consumption. Through the process of unraveling the on-the-ground practices of public health international humanitarian nongovernmental organizations and some of their therapeutic models, we begin to see new alliances formed across the globe around drug treatment and care that point toward important results.

A clinical improvement project to develop and implement a decision-making framework for the use of seclusion.

The use of seclusion within acute psychiatric settings is contentious. As evidenced by its use in practice, seclusion continues to be supported by mental health-care professionals. However, there is a growing evidence base that indicates that it is viewed negatively by patients and causes symptoms of severe distress. In Australia and several other countries, the use of restraint and seclusion is now being questioned, and there are now policy directives to reduce or abandon these practices. Despite mental health-care professionals' awareness of the potential detrimental effects of seclusion, the practice is strongly embedded in Australian mental health settings. This paper describes an improvement project to develop and implement a clinical decision-making framework around the use of seclusion. The setting was an acute mental health-care facility servicing a large health district in south east Queensland, Australia. The impetus for this project was driven by concerns expressed by consumers of the service and our own need to reduce the incidence of seclusion and the length of time of seclusion events to below 4 hours' duration. This improvement project employed practice development and action research principles to engage colleagues in the development of the framework. The project duration was 6 months, and resulted in two decision-making frameworks around the use of seclusion: the decision to seclude and the decision to release.