# Praxeological analysis (PA/CPA) for stigma, health inequalities, and coercion in women’s services

## TL;DR

This paper introduces a new method to study stigma and inequalities in women's mental health and disability services using real-world data.

## Contribution

A novel interview-free protocol using praxeological analysis to study stigma and restrictive practices in institutional women's services.

## Key findings

- The protocol uses naturally occurring clinical and institutional documents to analyze stigma and inequalities.
- It shifts focus from individual attitudes to the practices and situations where discrimination occurs.
- The method supports trauma-informed and culturally competent care aligned with NHS standards.

## Abstract

This paper sets out a practical, interview-free protocol for studying how stigma, inequalities, and restrictive practices are done in women’s mental health, learning-disability, and autism services, with a particular focus on women detained in inpatient and other institutional settings. Building on Praxeological Analysis (PA) and Critical Praxeological Analysis (CPA), we specify data pathways for naturally occurring materials (clinical letters, triage logs, ward round notes, safeguarding records, complaint correspondence, public hearings/transcripts, and, where ethically approved, audio/video recordings of clinical interactions between people who use services and healthcare professionals), and a replicable analytic procedure keyed to linguistic/praxeological Gestalts. Rather than treating “stigma” as an attitude, attribute or variable, we investigate stigma in its sites of production, the situations in which discrimination, discreditation, degradation etc are done, experienced and witnessable. The protocol operationalizes what we call a praxeological respecification: a shift from traits to scenes and from beliefs and attitudes to practices, enabling research and quality improvement that directly addresses the levers through which inequalities are produced and maintained and which supports least-restrictive, trauma-informed, autism-informed and culturally competent inpatient care in line with current NHS culture-of-care standards.