Introduction: The Covid-19 restrictions of 2020-2021 are known to have undermined the UK population's mental health. Working alongside staff, peer trainers and students at Recovery in Mind (RiM), a Recovery College (RC) in West Berkshire, England, this mixed-methods study is amongst the first to investigate how an RC has responded to the pandemic. Methods: Working in co-production with RiM staff and peer-trainers, this study employed a mixed-methods design, gathering Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) well-being outcome measures by questionnaire and student experience, learning and co-production by interviews.Findings: This research found that RiM continued to produce demonstrable improvements in student mental health. Students welcomed the way that RiM adapted to offering online and socially distanced provisions. Students valued the skills that RiM taught and the way that RiM courses reinforced prior learning; above this, however, they valued the mutual support and sense of community that participation provided. Conclusion:This study underlines the value of RCs maintaining 'hidden curriculums' of peer support and community involvement. This research emphasizes co-production as not only a tool for empowerment or service improvement but as a valuable skill for personal mental health recovery. Even when operating under the most unforeseen or challenging of conditions, RCs should always endeavour to prioritize and maintain co-production.

Chronic obstructive pulmonary disease (COPD) is an illness associated with intersectional poverty and stigma in old age; people with COPD are susceptible to anxiety, loneliness and isolation. People with COPD who contract COVID-19 are at high risk of serious complications, intensive medical needs and death and are, therefore, required to socially distance particularly assiduously. This paper offers an embodied phenomenological analysis of the emerging theoretical literature exploring the impact of social distancing upon people with COPD. Firstly, people with COPD are aware of how respiratory illness feels, are anxious about COVID-19 and afraid of being denied care. Future research might consider how people with COPD may be susceptible to “coronaphobia” and mental health consequences of the pandemic. Secondly, COPD tends to affect older people within the most intersectionally marginalised socioeconomic groups. Future research should remain mindful that people with COPD may be among the most lonely and least able to access health and social care services online than others. Thirdly, pandemics are known to intensify pre-existing social stigmas. Researchers and practitioners alike should be conscious that people with COPD may become increasingly stigmatised, especially those from intersectionally disadvantaged minorities.

Governments, employers, and trade unions are increasingly developing “menopause at work” policies for female staff. Many of the world’s most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.

Purpose: For years, the Arts and Health (AaH) movement has been guided by values of art for art's sake, practitioner as Artist and artist as Outsider. These values are instrumental to the effectiveness of AaH as a relational and processdriven tool for individual empowerment, collective health activism and social change. This paper explores how the AaH movement, together with the artists operating as AaH practitioners, has responded to the political and economic and policy transitions of recent years. Methodology: This paper critically analyses and updates the frequently-cited Diamond model of Smith (2003) and Macnaughton, White and Stacy (2005) exploring how and why, within a UK context of neoliberalism, austerity and evidence-based practice, AaH is being increasingly drawn into the methods and governance of medical and rehabilitative services. Findings: Whenever AaH in the UK is governed by health services, it becomes reconceptualised as therapy or treatment. It risks relinquishing its artistic and philosophical identity and distinctive effectiveness. Originality: This paper builds upon the Diamond model to present two new models, the Stalactite and the Helictite. These new models conceptualise the current situation and the potential future fragmentation of the AaH movement, highlighting how AaH might remain faithful to its core values. Keywords Arts and health, arts as treatment, participatory arts, artists in health settings, social prescribing Arts and Health (AaH) and the AaH 'movement' "Ah, music," he said, wiping his eyes. "A magic beyond all we do here!" (Rowling, 1997, p. 95

Purpose The landscape of adult social care, and in particular of adult safeguarding, has shifted considerably over the last decade. Alongside policy changes in the responses to adult abuse, there have been shifts in professional and public understanding of what falls within the remit of this area of work. This results, arguably, in differing understandings of how adult safeguarding is constructed and understood. Given the increasing emphasis on multi-agency inter-professional collaboration, service user involvement and lay advocacy, it is important to consider and reflect on how both professionals and lay people understand this area of work. The paper aims to discuss these issues. Design/methodology/approach This study employed Augusto Boal’s model of Forum Theatre to explore how a variety of professional and lay groups understood, related to and engaged with how the Care Act 2014 defines and describes “adult safeguarding”. Findings Lay participants responded to the scenario in a variety of ways, upholding the construct validity of “adult safeguarding” and the authority of the social worker. Social care and health practitioners sought orderly, professionalised and sometimes ritualistic solutions to the “adult safeguarding” scenario presented, seeking carefully to structure and to manage lay involvement. Inter-professional collaboration was often problematic. The role of lay advocates was regarded ambiguously and ambivalently. Originality/value This paper offers a number of practice and research recommendations. Safeguarding practitioners could benefit from more effective and reflexive inter-professional collaboration. Both practitioners and service users could benefit from the more thoughtful deployment of the lay advocates encouraged within the Care Act 2014 and associated guidance.

Anecdotal experience and qualitative accounts suggest that singing groups, classes or choirs specifically for people with COPD (henceforth referred to as COPD-SGs) are effective in improving health. However, this is not reflected in the quantitative evidence. This meta-ethnography deployed phenomenological methods to explore this discrepancy. Analysis identified the phenomena of being together, being uplifted and being involved as central benefits of COPD-SGs. When viewed through the phenomenological lens of body-social as distinct from body-subject and body-object, findings demonstrated that the qualitative effectiveness of COPD-SGs is greatest on a collective basis. Qualitative research into the effectiveness of COPD-SGs offers more favourable results because phenomenological approaches can identify collective benefits that quantitative methods cannot. COPD-SGs should seek to maximise these collective benefits by rediscovering their cultural and artistic heritage within the national and global Arts in Health (AiH) movement, which has long emphasised the radical creative and healing power of group activity.

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Aims: To scope the breadth of existing cultural and community assets and how alcohol drinkers and community health workers perceived them in relation to reducing alcohol-related harm. Methods: The study was conducted in Chitwan, south-central Nepal, which has considerable alcohol problems. Participatory asset mapping was conducted using field notes, photography, and through engaging with communities to explore how community assets affect alcohol consumption. Semi-structured photovoice interviews were conducted with harmful/hazardous drinkers (AUDIT score 8 to 19) and community health workers. Purposive and snowball sampling were used to recruit participants. During interviews, participants used their photographs to reflect on how community assets influenced alcohol use. Thematic framework analysis was used to analyse the data. Results: We recruited 12 harmful/hazardous drinkers (3 females) and 6 health workers (2 females). The mean AUDIT score of the former was 12.17 (SD ±2.86). Thematic analysis of the photovoice interviews produced three themes: ‘influences and impact of families and communities’; ‘culture and spirituality’; and ‘nature and the environment’. The community mapping produced five assets that promoted alcohol consumption: (1) availability; (2) advertising; (3) negative attitudes towards users; (4) festivals/gatherings; and (5) illiteracy/poverty. Six assets that discouraged consumption were: (1) legislation restricting use; (2) community organisations; (3) cultural/spiritual sites; (4) healthcare facilities; (5) family and communities; and (6) women’s community groups. Those from certain ethnic groups consumed more alcohol, experienced more family discord, or felt stigmatised due to their drinking. Assets ‘festivals/gatherings’ and ‘negative attitudes toward users’ and the theme ‘family and communities’ concerned with relationships and community activities were perceived to both promote and reduce alcohol use. Conclusions: This study provides new insight into a variety of cultural and community assets that promote and reduce alcohol use. The study identifies new possibilities to build on visual participatory and arts-based methods that have potential to be effectively implemented at scale.