Category: Education

#ACMHN2018

Big thanks to the Board of Directors of the Australian College of Mental Health Nurses (ACMHN) for inviting me to speak at the 44th International Mental Health Nursing Conference, or #ACMHN2018, which took place in Cairns between 24th-26th October 2018. Never having been to Australia before, and indeed having never before left Europe, this was a big deal and I was grateful for the opportunity.

The theme for the conference was ‘mental health as a human right’, and the three days opened with a memorable welcome to country given by Yidinji tribal elder Henrietta Marrie followed by music and dance. Keynote speakers reflected well the conference theme in their talks, variously focusing on tackling health inequalities (including amongst Aboriginal people), suicide prevention in LGBQTI communities, rural mental health, human rights progress in Ireland (and more). Concurrent presentations were also very high-quality. Worth noting, too, is how the ACMHN used its conference to raise awareness of its campaign, being run in concert with other health care organisations, to demand that children and families seeking asylum and currently being held on the island of Nauru be brought to Australia.

In my keynote I elected to speak about mental health policy, services and nursing in Wales and made the point that the Welsh approach to health care is different from that found elsewhere in the UK, or in other parts of the world. To illustrate this I spoke about the Mental Health (Wales) Measure, the introduction of both future generations and safe staffing legislation and the imminent appearance of a Framework for Mental Health Nursing prepared through the All Wales Senior Nurse Advisory Group for Mental Health.

I realise that in the UK we have nothing quite like the ACMHN: a professional organisation comprised of subscribing members, which represents its field, acts as a credentialing body (nursing education in Australia being a generalist one) and which lobbies for better services and higher standards. The College has a Board and an elected president, the current incumbent being Eimear Muir-Cochrane, and employs a team including Kim Ryan as salaried chief executive officer. The ACMHN performs no trade union function (like the RCN, Unite the Union, and Unison in the UK), and does not register or regulate nurses (as the NMC does). Australia looks to have a number of colleges and associations organised along the same lines as the ACMHN, and I’ve found this site which lists bodies advancing practice and representing members in the fields of critical care, midwifery, children and young people’s nursing, and more.

#ACMHN2018 was an excellent experience, and I was pleased to meet roomfuls of fine and interesting people. For the record, #ACMHN2019 takes place in Sydney between 8th-10th October 2019, with the theme of ‘integrated care’.

Skellern Lecture, JPMHN Lifetime Achievement Award and MHNAUK meeting

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Geoff Brennan begins his lecture

Earlier this month I made the trip to the University of Greenwich to celebrate this year’s Skellern Lecture and Journal of Psychiatric and Mental Health Nursing (JPMHN) Lifetime Achievement Award. First up was Geoff Brennan, whose lecture was titled The dark art of influencing inpatient mental health nurses. Over his career Geoff has worked as a consultant nurse, and has edited (with Cath Gamble) the textbook Working with serious mental illness. He now serves as Executive Director of Star Wards, and in his talk gave an energetic account of hospital mental health nursing now and in the past, and the skills and qualities which underpin this work. Geoff has long been a champion for inpatient nursing, but in his talk he was generous, too, in acknowledging the contribution made by others in this field. Special mention went to Len Bowers, who led the Safewards trial and who (until his retirement) oversaw the dissemination of findings and the work of promoting the uptake of these around the world.

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Michael Coffey presents the JPMHN Award to Philip Burnard

This year’s JPMHN Lifetime Achievement Award went to Philip Burnard, Emeritus Professor in the School of Healthcare Sciences at Cardiff University, and I was very pleased to have the opportunity to introduce Phil to those present. Phil’s oeuvre is a remarkable one, comprising books and papers on interpersonal and communication skills, research methods, ethics, culture, stress and burnout, and much more. The Scopus database lists 181 articles which Phil has authored, including one (A method of analysing interview transcripts in qualitative research) which has been cited well over 1,000 times. Phil gave a frank, and drily humorous, account of his early life, his career in nursing practice and academia, and his experiences of depression. I enjoyed hearing Phil speak, too, of his attachments to shoes and hats (as the photo in this post confirms).

Big congratulations indeed to Geoff and Phil, and worth noting that information on nominations for future Skellern Lecturers and JPMHN Achievement Awards can be found here. The day following this year’s event involved a return to the University of Greenwich, hosted by Deborah Watkins, John Crowley and colleagues, for the summer meeting of Mental Health Nurse Academics UK. Our surroundings were, surely, the grandest in which we’ve ever gathered as a group, being within the Maritime Greenwich World Heritage Site. Our meeting was particularly well-attended, with people making the journey from all four countries of the UK. Guest speaker was Dave Munday from Unite the Union, who gave an update on the #MHnursingFuture campaign. Also discussed were the new NMC standards and the assessment of mental health nursing students’ practice, MHNAUK’s recent responses to consultations and position papers, and (via a presentation from Mary Chambers) research impact. We meet again at the University of Essex in the Autumn.

Joining mental health nursing

Mental health nursing is important and fulfilling work, and offers a fine and rewarding career. More people also need to be doing it. By way of background, last month Mental Health Nurse Academics UK (MHNAUK) submitted a response to Health Education England (HEE)’s Facing the Facts, Shaping the Future draft health and care workforce strategy for England to 2027. Contained in this HEE draft are figures on trends in the numbers of nurses, by field of practice, employed in NHS England over the period 2012 to 2017.

Growth/reduction in NHS employed nurses and midwives by field, 2012 to 2017 (extracted from Facing the Facts, Shaping the Future)

Obvious at a glance from this figure is the decline in both mental health and learning disability nursing numbers over time. Elsewhere HEE also describes a 14% mental health nursing vacancy rate.

Now, the Nursing Times reports a reduction for the second year in a row (£) in the numbers of applications for nursing degrees received via the Universities and Colleges Admissions Service (UCAS). Declining applications need to be viewed in the context of the removal of bursaries for students of nursing enrolling at English universities. In MHNAUK we have said, more than once, that we fear the loss of bursary support poses a particular threat to our field of practice. The same applies to learning disability nursing, where at least one degree programme closed last year (£).

Evidence like this is why initiatives like #MHnursingFuture (see also here, for the Twitter account) are important. Initiated by Dave Munday from Unite the Union, this is all about celebrating the work of mental health nurses and encouraging others to join us. As an occupational group we haven’t always been good at describing what we do, and why what we do is valuable (£). This needs to change, now more than ever.

With all this in mind this may be a good time to remind people of this useful page, hosted on the MHNAUK website, on joining the profession. As this says:

Forget all the stereotypes about straitjackets and Victorian asylums; modern mental health nursing focuses on helping and supporting people from all walks of life with a variety of ‘common’ mental health disorders (such as anxiety and depression) as well as more serious disorders such as drug and alcohol problems, suicidal feelings, psychosis, bipolar disorder and dementia. They also play a key role in promoting mental health and well-being among the public and preventing mental health problems occurring in the first place.

This helpful MHNAUK resource also includes suggestions for further reading, included in which are texts describing in detail many of the skills that mental health nurses routinely use and the context in which they go about their work. And, for any reader contemplating applying to any of the 60+ mental health nursing degree courses offered throughout the UK, do give some thought to our undergraduate nursing programmes here in the School of Healthcare Sciences at Cardiff University.

Why I’m on strike

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Paul Brown, me, Graeme Paul-Taylor: thanks to Kerry Hood for the photo.

I have a fantastic job, which I enjoy very much. But today I haven’t been doing it. I came into it in 1997, leaving a post as a community mental health nurse in East London to relocate to South Wales as a Lecturer in Community Nursing at what was then the University of Wales College of Medicine (UWCM). As a family we made this move even though my initial contract was fixed for a two year term. It was renewed for a further two years, and only then did I become a permanent member of staff. As part of making my transition from the NHS into higher education I transferred my health service pension into the Universities Superannuation Scheme (USS).

I was recruited into UWCM with the chief responsibility of leading a full-time, post-registration, course preparing nurses to work in community mental health settings. I led that programme for 14 years, and over that time taught many hundreds of registered nurses and helped them on their way towards specialist, regulatory body-approved, qualifications. I have continued to contribute to, and to lead, modules involving many other groups of health care professional students, all the way from pre-registration undergraduate through to post-registration postgraduate. I have supervised and assessed umpteen student dissertations, and have supervised and examined many postgraduate researchers. I very much value my work with students, and think that I’m reasonably good at it.

Then there are the other bits of my job, which nowadays occupy as much, or more, of my time as teaching and teaching-related activities. Over the years I have become a researcher, working with excellent colleagues here and elsewhere on projects examining features of the mental health system. I help with the running of the School of Healthcare Sciences as a manager and mentor of valued colleagues, and contribute to the work of a large number of committees and groups. I do work external to Cardiff University, including with Mental Health Nurse Academics UK, at other higher education institutions as an external examiner, and for journals and funding bodies as a reviewer of manuscripts and grants.

Like all the academics I know I work long hours, and accept that my job comes with high expectations. These include securing research income and publishing excellent research papers. For me, 10 to 12 hour working days are exceptionally usual, with far fewer (but certainly not non-existent) hours spent working at weekends. It is easy to become absorbed in what I do. I respond quickly to requests for help and feedback from students and colleagues, and if I’m chipping away at a grant application or a paper for publication can soon become engrossed in the task at hand. Oddly, whilst the hours are long it doesn’t always feel that way, and I appreciate the benefits of being able to work away from the office and to have control over my diary. All in all, I do my best across the full range of activities associated with being an academic. And, as I wrote at the outset of this post I enjoy what I do, and enjoy doing it in Cardiff.

Having committed myself to university life for over two decades I conclude that it suits me well, and find it hard to imagine doing anything else until I retire. Which brings me to today. I’m far from being the most active of Union members, and from time-to-time have had my gripes about the University and College Union (UCU). But today I downed tools to join colleagues up and down the country on strike, as a protest against threats to dismantle our pensions. At the heart of the dispute is a highly contested valuation of the USS fund, and a proposal to move from a defined benefits to a defined contribution scheme. This means a potential loss in retirement of up to £10,000 per year for USS members. Here’s a useful leaflet explaining this in a little more detail:

And for those wanting more on the technical front, there’s this blogpost which I personally found very informative.

Academics are paid modestly considering the qualifications and transferable skills they have, and as I have demonstrated here put the hours in to get the job done. Many, as I did, put up with time-limited contracts in the earlier parts of their careers. We care about our students and our research. We take additional satisfaction when our work makes a contribution to society. In my field this is through the preparation of future health care professionals, and via generating an evidence base for the improvement of practice and services. In return, having a decent pension – of the kind I and others signed up for when we first came into the university sector – does not seem like much of an ask.

I also remain acutely aware of how much more precarious the position is of younger academics. If proposed pension changes go through, people in the future will enter university employment with only defined contribution USS pension arrangements as preparation for their eventual retirements. First saddled with student debt, these are talented individuals who will be employed in their early working years on fixed-term contracts, ahead of settling into careers characterised by working weeks of 60 hours or more for salaries falling far short of a king’s ransom. A working life over, they (and not their employers) will have carried all the risk to secure pensions the value of which will reflect, quite terrifyingly, the fluctuations of the stock market. It isn’t right.

New year

Happy new year. In December 2017, I was pleased to see Values in Health and Social Care: an Introductory Workbook published, co-written with Ray Samuriwo, Stephen Pattison and Andrew Todd. It is a product of the Cardiff Values group, which began life over 15 years ago, and is the third book of its type that I’ve been involved in. The first was Values in Professional Practice: Lessons for Health, Social Care and other Professionals and the second was Emerging Values in Health Care: the Challenge for Professionals. This latest outing is very hands-on, and is packed with exercises for students and their teachers. I hope people find it stimulating and useful.

SamudIn previous posts (see here and here) I’ve written about Mohammad Marie’s PhD, which investigated resilience in Palestinian community mental health nurses. A fourth paper derived from this study has just been assigned to the January 2018 issue of the journal Health. This is a review of literature, and addresses (amongst other things) the connections between resilience and the idea of ‘Samud’. By following this link a gold open access version of the paper can be downloaded for free.

Elsewhere, I realise I have neglected to add any recent updates on this site about the work of Mental Health Nurse Academics UK. Last year was an active one. In addition to our usual three meetings we exercised our responsibilities as a Research Excellence Framework nominating body, and responded to a variety of consultations and calls for evidence: a nursing workforce inquiry initiated by the House of Commons Health Select Committee; the Nursing and Midwifery Council‘s proposed standards for education; both NHS Improvement and Centre for Mental Health reports on the mental health workforce; and more besides. Our meetings for this year are all scheduled, and it will be good to catch up in Birmingham in February, Greenwich in June and Essex in October.

 

 

Conferences and meetings catch-up

October has been a month of external events. These began with the inaugural All Wales Mental Health Nursing and the #FutureMHN conferences, in Cardiff and Birmingham respectively. The former was organised through the All Wales Senior Nurse Advisory Group for Mental Health with support from Public Health Wales. The latter was the third such event of its kind, ably organised by a student-committee led. I’ve since been to Derry for the Autumn term meeting of Mental Health Nurse Academics UK and for Ulster University’s 14th annual mental health conference, the latter organised under the theme of Quality and Compassion: Challenges and Opportunities for Mental Health

At the MHNAUK meeting Professor Hugh McKenna, who chaired the #REF2014 Allied Health Professions, Dentistry, Nursing and Pharmacy Panel, gave a talk on #REF2021. We livestreamed this, and have embedded a link in the MHNAUK website. Scrolling to the bottom of this page takes you there.

Recruiting to mental health nursing degrees

Huge congratulations to all who, earlier this month, secured the necessary qualifications to begin their mental health nurse education in the coming academic year. Welcome to the profession, and to the start of a rewarding career.

Following the publication of A level results on August 17th, as John Baker was first to point out, over 50 UK higher education institutions (HEIs) went to clearing to recruit new mental health nursing students:

That, as John suggested, seemed a large number by any measure: worth noting is that Mental Health Nurse Academics UK counts representatives from just over 60 HEIs. Also worth noting is that this is the first year of recruitment to nursing degrees to follow bursary reform in England: a policy the Department of Health explicitly linked to an expansion in student places. So have universities been to clearing to recruit increased numbers of students – assuming they wanted, and were able, to accept more? Shaun Lintern from the Health Service Journal has been tweeting extracts from the Universities and Colleges Admissions Service (UCAS) data analysis service, comparing the numbers of students placed with previous years. Here’s an example from three days ago:

Between now and September 1st 2017 UCAS is publishing daily updates, and as it happens is paying particular attention to nursing: these are in the separate files marked as ‘B7 reporting’. The most recent report, published on August 24th, still shows a fall in the number of people placed on nursing courses compared to 2016:

Source: UCAS, https://www.ucas.com/file/122081/download?token=7aEZplYE
This is important, but what UCAS is not displaying is data on the numbers of applicants placed to nursing degrees broken down by field (mental health, learning disability, child and adult). Data on the age of placed applicants is available, and as Steven Pryjmachuk points out shows a reduction (compared to 2016) amongst mature students:

Mental health nursing courses attract older applicants, and so may have experienced a disproportionate reduction in the number of new students compared to other fields. But we can’t know for sure, in the absence of having the data. What we do know, though, is that the evidence so far on overall placements to nursing degrees commencing in the 2017-18 academic year suggests that recruitment will be doing little to plug the hole in nursing vacancies.

Educating nurses

The Nursing and Midwifery Council is consulting on its programme of change for education. Information can be found here, and there’s a lot of it. Mental Health Nurse Academics UK (MHNAUK) will be submitting a response, with Anne Felton from Nottingham University (who leads MHNAUK’s Education Standing Group) coordinating this work.

On July 11th, with mental health nurse academic colleagues in the School of Healthcare Sciences in Cardiff I spent part of our annual summer away day formulating a team response to the NMC’s proposals. Once we’re happy with the content we’ll be forwarding it to Anne, and simultaneously submitting directly to the NMC.

Individually and collectively, other mental health nurses will be formulating responses too. For now, the NMC confirms that the four nursing fields (mental health, adult, child and learning disability) will remain. For an explanation of the importance of preserving mental health nursing as a pre-registration speciality, follow this link for MHNAUK’s relevant position paper. But, as MHNAUK Chair Steven Pryjmachuk pointed out last month in this piece (£) for the Nursing Times, the list of nursing procedures contained in the NMC’s draft standards of proficiency is heavily skewed towards the adult field. This is the Cardiff University mental health team’s concern too, and we’ll be saying so (with specific examples) in our response. Another place for this (and any other) view to be given is at this forthcoming WeMHNurses chat:

Meanwhile, last week ended with two days of professional doctorate teaching. With Nicola Evans I lead a module which addresses working in, and examining, complex systems of health and social care. We’ve run this module before, and as always the student group was a lively and engaged one. Amongst the things we discussed together are the connections running within and between systems of different scale, and the sometimes unforeseen consequences of introducing change. These are matters about which both Nic and I have written (see here, here, here and here). 

To link the two parts of this post together: the NMC is a big player, and for better or worse its programme of education reform will trigger significant disruption. A systems thinking perspective encourages us to consider the possible impact of the NMC’s proposals alongside other sources of change. These include the introduction of fees for student nurses in England, the arrival of nursing associates and reductions in the size of the UK’s registered nurse workforce. As cumulative shifts take place I’m hoping mental health nursing as a distinct profession emerges intact, with its current and future practitioners able to fulfil their places in a system which continues to very much need them. 

Skellern Award and MHNAUK meet-up

My general election postal vote cast, June 8th began with a PhD examination at City University London moving as the day progressed to London South Bank University for this year’s Eileen Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award.

As Skellern Lecturer Mary Chambers gave a fine, interactive, presentation emphasising the importance of making visible the invisible work of mental health nurses. Here’s Mary with Ben Thomas and Isaac Marks, no less. Amongst other things Mary talked about her work developing the Therapeutic Engagement Questionnaire, a tool designed to establish the value of mental health nursing.

Len Bowers was recipient of the Lifetime Achievement Award. He gave a deeply personal, altogether humorous, account of his career in mental health nursing, highlighting in particular the curious accidents which helped propel him to the forefront of the profession. Len’s Safewards programme, of course, was no accident and his contribution to improving mental health nursing practice through research of this type continues to be sorely missed in the months following his retirement. Here he is receiving his award from Alan Simpson.

Friday was a meeting of Mental Health Nurse Academics UK, hosted by Sally Hardy at London South Bank University. Detailed notes from the meeting will appear in due course on the group’s website. In the morning Katie Evans from the Money and Mental Health Policy Institute talked about the associations between mental health problems and money difficulties, making the point that debt advice (which is a regulated activity) needs to be incorporated into care pathways where necessary.

MHNAUK is in the process of setting up permanent standing groups, covering the areas of: research; education; policy and practice; and communication. Each group now has a lead person, and each group has plenty to do. The education group, led by Anne Felton, will be coordinating MHNAUK’s response to the NMC’s consultation on proposed new standards for pre-registration nurses. At this last week’s meeting, under the education group agenda item, members heard about plans for this autumn’s #FutureMHN conference. The research group, led by Mary Chambers, will be coordinating MHNAUK’s work in the context of the future Research Excellence Framework. On Friday, as part of the research group update I gave a progress review for this year’s #MHNR2017 conference. The policy and practice group is led by John Baker, and members (John included) have been working on (amongst other things) safe staffing. The final group is communications, led by Steven Pryjmachuk and me.

#MHNAUK Lecturer wanted

The clock is winding down on the call for abstracts for the 23rd International Mental Health Nursing Research conference, taking place in Cardiff on September 14th-15th. As readers of the relaunched website of Mental Health Nurse Academics UK will know, nominations are currently being sought for the inaugural MHNAUK Lecturer. Reflecting the work of MHNAUK the Lecture will:

[…] be delivered by a mental health nurse in, or out of, the UK who in the opinion of the MHNR committee, the Chair and the Vice Chair of MHNAUK has made a significant contribution to the promotion and enhancement of mental health nursing education, research, policy and/or practice.

Perhaps, over the coming bank holiday weekend, readers of this blog might give some thought about possible nominees? We’re welcoming self-nominations, and nominations coming from others.

As always, spread the word!