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This article describes the processes undertaken to implement change in East Lancashire adult mental health services through New Ways of Working. The views of users, carers and staff of the services at the start of the project are described, and an overview offered of the development work that took place to support the change. Barriers to change are also described.

With this number the Library Review enters on its ninth year, and we send greetings to readers at home and abroad. Though the magazine was started just about the time when the depression struck the world, its success was immediate, and we are glad to say that its circulation has increased steadily every year. This is an eminently satisfactory claim to be able to make considering the times through which we have passed.

The purpose of this paper is to improve the quality of monitoring of risk factors that predict the likelihood of people with severe mental illness (SMI) developing cardiovascular disease (CVD), diabetes and obesity, major contributors to poor physical health and risk of premature mortality.

The first phase of the AQuA “Don’t just screen-intervene” initiative supported five specialised community-based Early Intervention for Psychosis services in North West England to assess the effectiveness of monitoring of cardiometabolic risk in their patients using standards derived from the Lester Positive Cardiometabolic Health Resource, a nationally acknowledged framework for people with psychosis receiving antipsychotic medication. The initial findings formed the basis for a quality improvement programme which ran from November 2012 until May 2013.

By the end of a six month quality improvement programme the likelihood of a patient receiving a comprehensive cardiometabolic risk screening (evidenced by recorded measurement of body mass index or waist circumference, blood pressure, blood glucose and lipid profile, assessment of smoking status and enquiry of relevant family history) had increased from 10 to between 63 and 80 per cent.

Cardiometabolic risk monitoring from the onset of psychosis and its treatment can be improved utilising quality improvement methodology in real-world specialist mental health services. Earlier identification and treatment of risk factors that predict higher rates of obesity, diabetes and SMI may help people with SMI avoid life-restricting and life-shortening physical disorders.

Given the National Audit of Schizophrenia findings of inadequate screening in those with established SMI alongside evidence that CVD risk can emerge early in the course of psychosis, a group of early intervention in psychosis services in North West England decided to examine this aspect of their routine clinical practice. This service evaluation describes the effectiveness of a quality improvement programme based on the Lester Positive Cardiometabolic Health Resource (referred to as Lester resource henceforth) to improve the effectiveness of monitoring of risk factors that predict the likelihood of people experiencing psychosis and schizophrenia developing CVD diabetes and obesity.

A combination of social disadvantage and unhealthy lifestyles, adverse cardiometabolic impacts of antipsychotic medication and inequitable access to physical healthcare combine to put people with SMI at particular risk from CVD, the single biggest cause of premature death, and much more common than suicide (Brown et al., 2010). Despite higher rates of potentially modifiable CVD risk factors (De Hert et al., 2009) people with SMI appear to be missing out on opportunities to actively prevent conditions like CVD and diabetes compared to the general population.

People with SMI such as schizophrenia die 15-20 years earlier on average than the general population. Around 20 per cent of premature deaths can be explained by suicide and injury, but the remainder arise from a variety of natural causes such as CVD, chronic obstructive pulmonary disorder and certain cancers and infections (Nordentoft et al., 2013). The authors worked with five mental health trusts in the North West of England covering a sample of over 500 cases within early intervention services.

My intent in this chapter is not to review this ever-expanding body of work, which now encompasses all sorts of “new” institutionalisms applied to micro-, meso-, and macro-levels of social analysis in a wide variety of fields. Rather, I propose to stay a narrower course, focusing on the “new” organizational institutionalism that emerged at Stanford in the 1970s. To a considerable extent, this focus excludes from sustained attention the growth of world polity theory, a body of work that is closely aligned to organizational institutionalism, but that was developed somewhat independently of Scott by Meyer and his associates (for an excellent, short overview of this line of work, see Jepperson, 2002; otherwise, see Meyer et al., 1997 or Meyer, 2000). In focusing on organizational institutionalism, I will add only marginally to what has already been written. My first task will be to describe the earliest developments of this form of analysis in the 1970s and early 1980s at Stanford, since describing how research programs in organizational studies got founded at Stanford is a major theme of the present volume. After that, I will advance some ideas about how and why this research program became so influential, in so many fields of study.

Purpose: We review theory and research to suggest how research on sexual and gender minority (SGM) population health could more completely account for social class.

Approach: First, we review theory on social class, gender, and sexuality, especially pertaining to health. Next, we review research on social class among SGM populations. Then, we review 42 studies of SGM population health that accounted for one or more components of social class. Finally, we suggest future directions for investigating social class as a fundamental driver of SGM health.

Findings: Social class and SGM stigma are both theorized as “fundamental causes” of health, yet most studies of SGM health do not rigorously theorize social class. A few studies control socioeconomic characteristics as mediators of SGM health disparities, but that approach obscures class disparities within SGM populations. Only two of 42 studies we reviewed examined SGM population health at the intersections of social class, gender, and sexuality.

Research implications: Researchers interested in SGM population health would benefit from explicitly stating their chosen theory and operationalization of social class. Techniques such as splitting samples by social class and statistical interactions can help illuminate how social class and SGM status intertwine to influence health.

Originality: We synthesize theory and research on social class, sexuality, and gender pertaining to health. In doing so, we hope to help future research more thoroughly account for social class as a factor shaping the lives and health of SGM people.

The rise of East Asia to most dynamic center of processes of capital accumulation on a world scale is a phenomenon of the 1970s and 1980s. As a first approximation, the extent of this rise can be gauged from the trends depicted in figure 1. The figure shows the most conspicuous instances of “catching‐up” with the level of per capita income of the “organic core” of the capitalist world‐economy since the Second World War. As defined elsewhere, the organic core consists of all the countries that over the last half‐century or so have consistently occupied the top positions of the ranking of GNPs per capita and, in virtue of that position, have set (individually and collectively) the standards of wealth which all their governments have sought to maintain and all other governments have sought to attain. Broadly speaking, three regions have constituted the organic core since the Second World War: North America, Western Europe and Australasia (Arrighi, 1991: 41–2; Arrighi, 1990).