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The present paper reports an investigation of the self-reported needs of South Asian women suffering distress and mental health problems which may lead to self-harm and suicide, and uses the data to define indicators of good practice for primary care. The design was a qualitative study using focus group discussion. Four focus groups of South Asian women (using existing women's groups in Manchester, UK) formed the setting for this study. Each focus group was facilitated by one of the authors, and the discussions occurred in Urdu, English and Punjabi. An interview guide was used, although the direction of the discussions followed the women's agenda. Notes were taken during the focus group discussions. Analysis of notes to define themes and emergence of framework was carried out. The data were analysed according to the principles of framework analysis. A range of systemic issues were described by respondents including: social, political and economic pressures; domestic violence; poverty; language problems; family and children's issues; and health. These experiences were reinforced by an extremely efficient community grapevine and were evident in described experiences such as: racism and stereotyping of Asian women; Asian communities and Islam; and the concept of izzat (honour) in Asian family life, which was seen as a major influence in the lives of Asian women. These experiences were thought to result in mental distress, which was described in a variety of ways by the women. The women saw self-harm as a usable coping strategy to deal with their distress. Perceived barriers to services were described by the women. Services tended to be accessed only at a point of desperation, rather than prior to crisis points. This indicated the need for services to be able to respond rapidly when Asian women did ask for help. Whilst the present paper describes a local study, thus limiting its generalisability, the use of such work in commissioning local health and social services is outlined. A number of indicators for good practice were drawn up in relation to addressing systemic issues in service provision using these findings. Such indicators will be of use by primary care trusts in developing, commissioning and monitoring services for this patient group.

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Culture' as a barrier to service provision and delivery: domestic violence services for minoritized women Abstract This paper addresses how domestic violence services to women of African, African-Caribbean, South Asian, Jewish and Irish backgrounds are structured by assumptions about 'culture' which produce barriers to the delivery of domestic violence services. Phoenix's (1987, 'Theories of Gender and Black Families', pp. 50-61 in G. Weiner and M. Arnot (eds) Gender Under Scrutiny. London: Hutchinson) discussion of the representation of black women is applied more generally to analyse how discourses of gender and racialization function within accounts of domestic violence service provision. Discourses of both cultural specificity and generality/commonality are shown to intersect to effectively exclude minority ethnic women from such services. Domestic violence emerges as something that can be overlooked or even excused for 'cultural reasons', as a homogenized absence; or alternatively as a pathologized presence, producing heightened visibility of minoritized women both within and outside their communities -since domestic violence brings them and their communities under particular scrutiny. Such configurations also inform discourses of service provision to minoritized women. Finally key implications are identified for service design, delivery and development, including the need for both culturally specific and mainstream provision around domestic violence, and the need to challenge notions of 'cultural privacy' and 'race anxiety' in work with minoritized communities.

In this paper I explore the emotional interests maintained by the imagery of children used in Third World emergencies. Boundaries between adult and child are reproduced through relations of paternalism between North and South, such that the infantilisation of the South exemplified in imagery of children works to secure the competence and maturity of the Northern donor. Drawing on both analyses of the cultural origins and meanings of concepts of childhood and psychoanalytic perspectives, I suggest that media coverage of disasters arouses both identification and strategies to ward off and protect from the anxiety this brings. The gendered as well as geographical distribution of qualities of children's innocence and experience are discussed, drawing on both general imagery of children and recent coverage of children and child-saving, particularly in the former Yugoslavia. Developing analyses of 'disaster pornography', the paper explores how children appear as the principal focal objects onto which attention is pinned and as the signifiers of distress. This is at the cost of dehumanizing both children, their families and their cultures, and rendering them passive objects of a western gaze which seeks to confirm its own agency and omnipotence to ward off its own insecurities. While aid organisations and campaigns necessarily engage with, and sometimes collude with, these reactions, the paper ends by suggesting that there may be strategies whereby images of children can function to comment on rather than maintain prevailing colonial and paternalistic relations.

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In this paper I take up the theme of enabling difference in terms of the challenges and resources posed by taking the intersectional character of differences seriously. Drawing in particular on feminist debates, current discourses that address questions of structural, especially racialized, inequalities through notions of difference are critically evaluated as limited in their analysis of power relations and practices around the transformation of power inequalities. Applying this to questions of service design and delivery, I introduce the concept of intersectionality -in particular the intersection of 'race' and gender -to illustrate four key problems that this framework allows to come into focus: discourses of cultural autonomy as reflecting those of liberal individualism; 'race anxiety' as a form of obsessional undoing of the effort to challenge racism; how attending to 'race' and culture typically works to privilege 'race' over gender; and how discourses of specialization (whether around diagnosis or cultural background) can paradoxically work to exclude women from, rather than to extend, service provision. It is suggested that, rather than difference, intersectionality could be a more promising starting point for critical thinking and practice.Beyond enabling difference 'Enabling difference' is an interesting theme -indicative of a current central challenge for counselling and psychotherapy, and an outcome of a longstanding discussion among its practitioners over the past decade (which is a discussion as old as psychoanalysis): how to acknowledge and work with structural axes of difference as creative and valuable resources? But, beyond this, how to work with such differences, rather than Eur.

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