Month: December 2012

Moving and mental health

Craig yr Allt 23.12.12Yesterday’s torrential rain meant I skipped a run, which I’ve instead done this morning. Both the Taff Trail and Fforest Fawr are full of impromptu rivulets and debris. None of this has put off the walkers or mountain cyclists, or indeed the other runners. There were plenty of all types out there today.

Here’s the view from the top of Craig yr Allt, looking east. On this part of my journey I saw not a single other person. Remarkable, really, when you consider this is only a few miles from Cardiff.

I enjoy getting out and about, and that’s reason enough for me. For readers interested in the relationships between exercise and mental health, check out this blog and this blog, written by The Mental Elf (who also tweets via @Mental_Elf). Both posts have good links to individual research papers and systematic reviews. All very interesting, and by the looks of it an area where (not a phrase so often heard these days) more research is needed.

Thoughts on a first month, and a photo of a fallen tree

Officially I’ve knocked off for the Christmas and New Year holidays. I’m still awake earlier than I need to be, but the rotten weather this morning is (so far) putting me off a Saturday morning run. For today’s forecast, check out the clip to the left – which for the record I’ve extracted (in what I think is a permitted way) from the Met Office website.The weather! So for now it’s just me, my porridge, a mug of strong coffee and my computer. I reckon I have about 30 minutes before I’m joined by others, by then also awake and up for the day.

So I have a precious window in which to reflect on a first month of blogging. First up is to state how much I’ve enjoyed it. I began with the idea of writing about my research, drawing on my work as an academic mental health nurse at Cardiff University. I had the plan of blogging about papers and projects, and providing links wherever possible to articles available for public download via the University’s ORCA open access repository. I’ve certainly done some of this (as examples, check out my earlier posts on wicked problems here, here and here, my post on research ethics and governance and my post on the measurement of blood pressure and what this tells us about health care tasks).

But having gone to the bother of setting it up I’ve also found myself drawn to using this site as a place to record more general observations: on mental health care, nursing, policy, people and so on. That wasn’t completely planned, but I’m pleased to have used my blog for this purpose. It wasn’t a long post, but the short point I made in defence of student nurses earlier this week felt worth saying. I expect, as I head into what promises to be a very busy but exciting 2013, that I’ll continue to use this space in this additional way.

Fallen tree, Ridegeway, 15.01.12Others are now awake, and I should go. So without further ado, here at the right is the picture of the tree that’s mentioned in this post’s title. South Wales is full of trails, mountains and woodland. I enjoy this variety very much, as both a born-again runner and as a walker of longer standing. In January this year, heading out on a favourite route along the top of Craig yr Allt, I happened upon this enormous, fallen, monster. It had come down in high winds during the previous week, presumably missing by a whisker the telegraph wires you can see towards the top of the photo.

The tree rests, still, where it fell. For those using the path the way through is either over or under the branches to the right. Goodness knows how the horses are managing it.

The Mayan apocalypse and The King’s Fund

According to some interpretations of the Mayan long count calendar, tomorrow – December 21st 2012 – will see the end of the world. If the apocalypse does happen then none of us, I’m afraid, will get to know how accurate the predictions contained in Future Trends might otherwise have been.

I came across this report earlier today via a link tweeted by @TheKingsFund. It’s part of the organisation’s new Time to Think Differently programme, and sets out ‘the significant trends and drivers that we [The King’s Fund] believe will affect health and social care services over the next 20 years’. Properly speaking this is all about the outlook for England, though I think Future Trends offers plenty of food for thought for those of us in other parts of the UK, too.

The document addresses issues across a number of areas: demographic change, health-related behaviours, disease and disability, the workforce, attitudes and expectations, determinants of health, medical advances, information technology, sustainability and economic pressures. Future Trends also has some important, specific, things to say about mental health and illness and about services in this area. One is to restate the connections between mental and physical health. As The King’s Fund says, poor physical health is associated with poor mental health and vice versa. Future Trends also points to the existence of significant unmet mental health need, and to the fact that demand for services can be expected to rise at times (like now) of economic downturn. Elsewhere there are sections dealing with the workforce, and the risk of a growing ‘care gap’ as sources of informal care diminish. Changing patterns of disease are likely to increase demand for home (rather than hospital) care, and for new types of worker able to cross traditional professional boundaries.

To my mind the broad picture Future Trends paints is an entirely plausible, and simultaneously challenging, one. More plausible, certainly, than predictions of an imminent end to the world. I think we might want to start thinking, sooner rather than later, about how we improve the physical well-being of people using mental health services. We should consider what the rise of chronic conditions means for education and training, and how to better meet need.

In praise of…student nurses

Student nurses (and their teachers) have come in for some criticism lately, as I’ve observed on this blog before. I won’t say anything about nursing academics in this briefest of posts, but I will say something about students. Which is this: the vast majority of them are really rather good. In my view this simple truth is not stated sufficiently often. Again and again I come across hard-working, inquisitive, students who are (and here’s the thing) motivated to care. They put the shifts in, come home, and read about how to do it better. They arrive in class ready and willing to learn, share their experiences and improve. They don’t get paid much, and as their careers progress they probably never will. So, students, take the applause: you deserve it.

University of South Wales

A quick post before I head off for the train. Interesting to see that the merger of universities in this part of the world has taken a step forward. Yesterday it was reported that the name of the institution which will bring together the University of Glamorgan and the University of Wales Newport next year is to be the University of South Wales. Some of this has been quite fraught, what with Cardiff Met strongly resisting pressure from Welsh Government to join the party.

I’ve worked through an institutional merger of this type, having first been employed in the University of Wales College of Medicine before moving across to Cardiff University in 2004 when the two joined. In a day-to-day sense I’m not sure I ‘felt’ the significance of this move initially. Sometimes the impact of a change of this type takes time to work its way through the system, but I’m sure the limbering up for merger which has been taking place across other local universities has been anxiety-provoking for some. In the fullness of time it will be interesting to catch up with colleagues in Glamorgan’s Department of Care Sciences to hear how things are progressing. I wish them all well.

The train calls.

Mental Health Nurse Academics UK: hot off the press

For the last couple of weeks I’ve been acting as a returning officer of sorts, as members of Mental Health Nurse Academics UK (MHNAUK) have been voting for a new Vice Chair. This is a position held for two years, after which the incumbent becomes Chair for a further two years.

This morning I’ve emailed members of MHNAUK with news of the outcome. Well done to Professor Joy Duxbury, from UCLan, who is duly elected. Joy knows lots about risk, safety, aggression and coercion in mental health services (see, for example, this paper and this paper). She takes up her position in the new year, picking up from Dr Michael Coffey (Swansea University) who now becomes Chair. That’s a great combination of people, let it be said: MHNAUK remains in very capable hands. By the way, I’m not sure if Joy tweets, but for the Twitter-users out there Michael does as @D10Coff.

Taking a well-earned breather having done an excellent job chairing MHNAUK for the last two years is Professor Alan Simpson from City University, or @cityalan as he’s known in Twitter-land. Good work, Alan. Now go and prepare that talk you have to give as Skellern Lecturer for 2013!

On writing a paper about mental health systems, and running in mud

A fortnight ago I blogged about a paper I gave at this year’s Network for Psychiatric Nursing Research conference. My aim in this presentation was to move lightly through a series of completed studies I’ve previously been involved in, with a view to saying something cumulative about the mental health system. I mentioned my ambition of working this talk up into something a little more substantial and enduring, and sending this to a journal for peer review and (hopefully) eventual publication.

Progress has been slow, largely because of competing priorities. But I have at least made  a start, of sorts. One of the points I’m going to make is that, taking the long view, the story of how mental health care in the UK has evolved remains a quite remarkable one. A quarter of a century ago, which is when I first began working in mental health care, untold numbers of people remained resident in outdated institutions. Community services certainly existed, but were relatively under-developed. Many teams were uni-professional, and lacked a clear focus. Ideas of recovery, personalised care and collaborative working with service users were in their infancy.

It’s all very different now. I suspect it’s possible to qualify as a mental health nurse without having many hospital placements at all, and to spend the greater portion of practice time in varieties of community setting. There are locality community mental health teams (still the bedrock of specialist services for working age adults), and similar teams serving older people, and children and adolescents. There are crisis resolution and home treatment teams, assertive outreach teams, primary mental health teams, and more besides. I also think that the values which underpin care have changed. So, whilst it may not be a perfect system, it is much improved.

How much the investment in mental health systems which took place over the late 1990s and throughout the first decade of the new century can be sustained, in the face of crushing public services cuts, I do not know. In Wales, which is far more public services oriented than England, a strong case was made a few years ago for the importance of investing in mental health. Mental ill-health affects individuals, families, communities and the economy. I hope that the Welsh Government’s emphasis on public mental health in its new cross-cutting strategy ‘works’, without pulling vital resources away from dedicated services for people with long-term and disabling mental illnesses.

On the non-work front, this morning’s run entirely lacked the clear, hard, frostiness of recent Saturdays. It was wet, and muddy. Clinging, in fact, and thoroughly energy-sapping. It will take a few days for my (tired-looking) shoes to dry out, so I’m glad to have my second pair to hand (to foot?) should the need arise. Now it’s Christmas tree purchase time.

Mental health R&D

Following an afternoon interviewing potential new mental health nursing students, today it’s all about research and development. I’m off to Cardiff and Vale University Health Board’s annual mental health R&D meet-up, which on this occasion is titled ‘Updates, Opportunities and Overcoming Challenges’. The agenda is pretty packed, and includes (in the morning) an overview of, and progress report on, the National Centre for Mental Health. There’s also a session scheduled on research funding schemes managed by the National Institute for Social Care and Health Research (NISCHR). NISCHR is supported by the Welsh Government, and develops policy and priorities for health and social care research. It also directly supports research activity through its registered research groups and via its various competitive funding schemes.

New nurses

This afternoon I’ll be joining colleagues to interview potential students of mental health nursing. I imagine I’ll meet a variety of candidates: young people who are still at (or have just left) school, others who are looking for a second (or third) career, and others again who have considerable experience in caring work gained through employment as health care assistants or similar. The range of educational backgrounds people have is likely to be varied. Some may have A levels, or undergraduate degrees (often in the humanities or social sciences). Others may have (or be studying for) Access qualifications via their enrolment at colleges of further education.

From my accumulated experiences of interviewing in this context I expect that most, if not all, of the candidates I meet today will have thought very carefully about their applications. I expect them to be enthused about the prospect of learning and practising, and informed about what this involves. I expect people to demonstrate an interest in others, to be inquisitive and engaged, and to be motivated by a desire to help.

I also imagine that candidates will be aware of today’s proceedings taking place in a context of heightened scrutiny: of nurses, their roles, and their preparation. Cynon Valley MP Ann Clwyd, for example, has had strong things to say about nurses and nursing following the death of her husband at the University Hospital of Wales in Cardiff. To repeat what I’ve said before on this blog: the fact that nurses now qualify with undergraduate degrees does not make them any less compassionate than those without. To me, the idea that there might be some kind of automatic, inverse, relationship between education and capacity to care makes no sense whatsoever. For those interested, here’s a very thoughtful piece touching on some of this on the notsobigsociety blog.

Learning together, and more on peer review

Along with spending time with students rehearsing research ethics, this week I have also had the chance to be part of a small interprofessional education initiative. This involved pre-registration mental health nurses and pre-registration occupational therapists. Two linked sessions, the last of which was a few days ago, were facilitated by a teaching team led by my excellent colleague Gerwyn Jones, and Ruth Squire (who I hadn’t met before, but was pleased to meet in this context). Also taking part was the fine Teena Clouston, an occupational therapy academic who I have enjoyed working with, on and off, over a period of many years. As an aside, meeting up again with Teena gave me the opportunity to congratulate her on her freshly minted doctorate. That was nice.

Interprofessional education in health and social care is hardly a new idea. It’s also good to do. In the workplace nurses, occupational therapists, doctors, social workers, physiotherapists and all the rest have to rub along together. So why not create opportunities for students from across these fields to learn together first, in the classroom as well as in practice placements?

It’s worth reflecting on the extent to which we still recruit and teach students in uniprofessional isolation. There’s work involved in making connections across different university departments, in creating materials and in planning what will take place. Timetables need to be aligned, and facilities booked. Only then does cross-disciplinary, university-based, learning occur. Having brokered interprofessional education initiatives of this type in the past I appreciate the time and organisation required. But I think we have to collectively put this effort in, and more.

On this occasion, this mental health-focused two days of joint learning culminated in students participating in a role played care planning meeting. I have to say that I was impressed – very impressed – by the way students managed the process. Interactions between professionals, the service user, his carer and an advocate were respectful and productive. I’ve seen a whole lot worse in real life. I left feeling optimistic.

Unrelatedly: yesterday a journal I haven’t reviewed for before got in touch and asked if I would comment on a paper submitted for publication. Last weekend I blogged about peer review, and wrote about having graciously declined an invitation. Yesterday afternoon’s request was different: I know the area being written about, and was happy to give a view.

Changing the subject again, South Wales once more is spectacularly beautiful this morning. Frosty, and dry: perfect for my run.