Dr Maria Stuttaford

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Rights to Healthin Transitory Spaces of Care

• Dr Maria Stuttaford
• Associate Research Fellow
• Institute of Health
• Maria.Stuttaford_at_warwick.ac.uk

2
Acknowledgements

• The primary data quoted here was collected as
  part of a research project conducted with Helen
  Taylor, Bob Broad and Panos Vostanis. It was
  funded by the Gatsby Foundation.
• Paper also based on research conducted with
  Gillian Lewando Hundt and Lynnette Kelly on ESRC
  funded project (RES-000-22-0618-A).

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Outline of Presentation

• Rights to health
• Sites for health rights structures and agency
• Transitory spaces of care
• Voices of young people who are homeless

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Rights to Health

• Right to health
• the highest attainable standard of health (ICESCR
  1966)
• the underlying determinants of health, as well as
  health services (UN 2000 General Comment 14)

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Sites for Health Rights

• Where rights to health are invoked is as
  important
• Especially for people who seek health care and
  safeguard their health in transitory spaces of
  care
• Physical and metaphorical places where rights to
  health invoked and thwarted, individually and
  collectively
• Referred to as sites for health rights

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Sites for Health RightsStructures

• International level focus on judicial aspects
  of health
• Regional and national level focus on policy
• Local implementation e.g. National Service
  Framework (NSF) Standard on the Mental Health and
  Psychological well-being of Children and Young
  People

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Sites for Health RightsIndividual and Collective
Agency

• Actions to fulfil, defend and advocate for health
  rights are taken in the context of the
  individual, but also as collectives
• Individual bodies are sites of resistance, but so
  are collectives
• Challenges existing views of individual rights

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Sites for Health RightsStructure and Agency

• Rights have to be exercised somewhere, and
  sometimes that where has itself to be actively
  produced by taking, by wrestling, some space and
  transforming both its meaning and its use by
  producing a space in which rights can exist and
  be exercised. (Mitchell 2003, p, 81).

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Sites for Health Rights

• Levels of the structures of rights to health
  international, regional, national, local
  judicial and non-judicial
• Power is reflected in physical space landscape
  of power
• Individual and collective agency
• Interacts with structures and can create new
  sites for invoking rights to health

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Factors Tempering Rights to Health

• Acceptance of substantive rights
• Existence of procedural rights
• Attainable within resources of country
• Progressive realisation of rights
• Skills and resources of individuals and groups to
  invoke
• So, cannot rely solely on legal means for
  invoking and protecting rights

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Transitory Spaces of Care

• spaces of health and social care that are in
  transition, rather than in a geographically fixed
  location, e.g. soup kitchens (Johnsen, Cloke and
  May 2005), mobile clinics and assertive outreach
  services
• also defined by the experience of the people who
  use fixed spaces of care e.g. mental health
  drop-in service attached to a hostel

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Transitory Spaces of Care

• Increasing regulation of public space
• Street drinking bans, civil injunctions on
  begging and ASBOs may fail to acknowledge complex
  health and social care needs
• What might constitute sites for health rights for
  people in transition?

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Transitory Spaces of CareTherapeutic Landscapes

• So far talked about rights in positive sense
• But, sites for health rights places where
  rights are thwarted and abused e.g. Agambens
  state of exception
• Therapeutic landscapes or landscapes of despair
• Young people living in transitory space of hostels

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Right to Health for Children

• States parties should provide a safe and
  supportive environment for adolescents, that
  ensures the opportunity to participate in
  decisions affecting their health, to build
  life-skills, to acquire appropriate information,
  to receive counselling and to negotiate the
  health-behaviour choices they make. (UN 2000,
  Point 23 of General Comment 14).

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Who is a young person or a child?

• Rights to health are universally set out, but not
  always universally accepted
• Concept of childhood not universally accepted
• Convention of the Rights of the Child (1989), a
  child is below age 18
• Age-based definitions do not recognise the
  cultural dimension of childhood
• For children who are mobile, such definitions are
  important

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National Service Framework Standard on the
Mental Health and Psychological well-being of
Children and Young People

• All children and young people, from birth to
  their eighteenth birthday, who have mental health
  problems and disorders have access to timely,
  integrated, high quality, multi-disciplinary
  mental health services to ensure effective
  assessment, treatment and support, for them and
  their families (DoH 2004).
• Recognises need to improve equity and develop
  services for particular groups e.g. young people
  who are homeless.

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Local Level Implementation

• Local implementation of national policy
• Local authorities commission services
• Mutli-agency
• Requires multi-agency working to work
• Requires person to be in one place e.g. referrals
• Alternative sites for rights need to be considered

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Voices of Young People

• A lady called N come and done basic skills with
  me, and I went and seen her a few weeks for about
  two hours, and I can read like books now, and
  remember when I couldnt do that like two years
  ago . . . and this place has made me very
  confident, I think, cos I stand up for myself
  now, I didnt used to. Im very quiet, I wont,
  Im not a sociable person, I wont socialise in
  like a group of 19-year-olds, but Ill stand up
  to it and I, I connect more with like older
  people, so. But I have a lot more confidence and
  Ill stand up for myself.
• (19 year old female)

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Voices of Young People

• It was just, I dont know, it felt weird. I
  wasnt used to having the security guards and the
  gate and having to share with people that Ive
  never met before, um, it was just like, I dont
  know. I felt really small, just kind of get lost
  in this place when you first move in but after
  about a week or so, all the residents started to
  be really cool with us and showing us around and
  talking to us, so thats cool, and the staff were
  quite good about helping me settle in, so.
• (17 year old female)

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Voices of Young People

• Its this building, its making everybody worse,
  I swear it is. Youve got people coming in here,
  I was fine, I was normal before I moved in this
  building, and then like six months down the line
  and Im a nervous wreck, I cant even go out of
  this building and thats because of the staff. .
  . . And theres other people in there, S, he was
  all right until he moved in this building. Six
  months down the line, hes exactly the same. You
  know, and I swear, if you stay here for longer
  than six months, you get cursed or something.
  (21 year old female)

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Voices of Young People

• So, and I kicked up a bit of a stink, cos like
  me and my flatmate got on absolutely brilliantly,
  we moved from a three-bedroom to a two-bedroom,
  we got on absolutely brilliantly and then they
  just split us up and were like but why? You
  know, we do things together, we do our shopping
  together, we pay for things together so that we
  can eat in this building, and theyve just split
  us up, ruining everything. Which means we have
  to buy our own food, buy our own drinks, if were
  short one week, weve got nobody else to fall
  back on. (21 year old female)

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Voices of Young People

• Uh, theres always loads of arguments and that.
  With people graffiti-ing all over the walls and
  that, banging on your doors at like three oclock
  in the morning and that, and just people who
  literally want to cause trouble. Like last week
  the building got smashed off, doors got put
  through, lights got put through and it was just
  like not nice to be here at the time. The police
  came. There was a couple of weeks ago when about
  eight police come charging in the building and
  they searched peoples rooms and that for armed
  robbery, I was like crying me eyes out and that,
  and I had to phone a key worker because like cos
  there was two members of staff on that were new
  and they werent, like, they werent that
  experienced, like, they were just learning. So
  they had to phone the key worker and E, so I
  could talk to him on the phone and I was in a
  right state. Its just examples like that. (21
  year old female)

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Voices of Young People

• Illustrate how young people view transitory
  spaces of care, such as a hostel, in different
  ways
• For some is a safe place to gain confidence and
  skills
• For others it is a place of surveillance and
  anxiety
• Invoking rights to mental health vary, depending
  on the individual and collective experience of
  the place
• Need to understand how sites for rights can be
  nurtured, especially for people in transitory
  spaces of care

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Conclusions

• People living in transitory spaces of care need
  to have knowledge of their rights and how to
  invoke them
• Individual and collective agency to transform
  space into sites for health rights
• Non-judicial structures of rights to health can
  be advanced in these sites
• Provides a conceptual framework that takes
  account of where rights to health are invoked

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Next Steps

• Part of paper about to be submitted for
  publication
• Part of paper appearing as chapter in edited book
• Conducting deeper analysis of data for paper to
  be presented in summer and then submitted for
  publication
• Continue to develop research on sites for health
  rights in transitory spaces of care

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Forthcoming Events

• ESRC Seminar Series
• Global Health and Human Rights Theory, Process
  and Substance
• Liverpool 19-20 April 2007
• http//www2.warwick.ac.uk/fac/cross_fac/healthatwa
  rwick/research/currentfundedres/healthandhumanrigh
  ts/
• Public Health and Human Rights
• Monash University Prato Centre, Italy, 7-10 June
  2007
• www.conorg.com.au