Category: Mental health

NPNR 2013 conference review

Health and health services are political. I therefore applaud those who selected the ‘personal and the political’ as the theme for this year’s Network for Psychiatric Nursing Research conference.

A word on the keynotes:

Kate Pickett‘s Thursday morning opener pressed home how disastrous inequalities are, for all of us. For those not there to hear Kate speak there’s plenty of compelling evidence available via The Equality Trust website, and indeed in The Spirit Level (which I now realise I must read).

Simon Duffy, in his keynote yesterday, challenged mental health nurses to act collectively and assertively to improve welfare. I believe he was correct in pointing out that public services are often experienced as fragmented, bureaucratic and impersonal. Check out the Centre for Welfare Reform website for more in this area.

Charles Walker, Conservative MP for Broxbourne, has spoken openly about his personal experiences of obsessive compulsive disorder and until recently was Chair of the All Party Parliamentary Group for Mental Health. His Thursday afternoon conversation with the NPNR audience was stylishly done, and whilst I can’t bring myself to vote for his party (not now, not ever) I do appreciate what he has done to challenge discrimination.

Len Bowers used his Thursday keynote to share, for the first time anywhere, results from his Safewards trial. Len is a genuinely world leading researcher, and Safewards is a big and important study with seriously major implications for policy, services, education and practice. Take note, inpatient mental health nurses: the findings from this one are coming your way.

Rounding off the whole event yesterday afternoon was Fiona Nolan, sharing results from her pilot study of the use of protected engagement time (PET) by inpatient mental health nurses. Fiona’s was another great presentation, and her and her colleagues’ findings are important because (despite the push from policymakers) they suggest PET offers no additional benefits to service users.

Other items of news: warm congratulations to Joy Duxbury, who will be delivering the Eileen Skellern Lecture for 2014, and to Hugh McKenna, who will be receiving the Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award. Two fine people, and worthy winners both.

The concurrent sessions I had the chance to participate in were of uniformly high-quality, and there was plenty of discussion and debate to be had. I’d also like to think that this year’s event maintained the NPNR’s reputation for combining quality with informality and collegiality. For the record, my view is that nothing of great consequence was lost in moving the conference, for the first time ever, away from Oxford. Warwick worked well, and as others have said via their post-event tweets, it’s the people not the place which matter.

See you next year.

Reflections on a pre-conference week

Funding for Welsh students and Welsh universities is in tonight’s news, I see, and I’m beginning to wonder how long the Welsh Government’s current policy in this area will survive. More immediately, it’s been a varied enough week for me personally: and that’s without my two days at the NPNR conference in Warwick which begin with a frighteningly early start tomorrow morning. But at least I’ll have Gerwyn Jones and Mohammad Marie in the car for company, so all will be well.

Highlights so far include a meeting of (most of) the excellent RiSC team (which includes the newly-professored Steven Pryjmachuk), to make further progress on our evidence review of ‘risk’ for young people moving into, through and out of inpatient mental health services. This is a two-phase project, and we’re now in the second segment. This is involving searches for research and other materials across a number of databases, and putting out calls for evidence to local services and other organisations.

Data has continued to be generated in COCAPP, and this week a date has been set for a first planning meeting for an exciting new project I am involved in led by Michael Coffey. More to follow on this in the fullness of time, I expect. And yesterday took me to a second meeting of the Mental Health Research Network Cymru Service User and Carer Partnership Research Development Group, an event convened at Hafal‘s premises located in the grounds of the magnificent St Fagans: National History Museum. A good place, St Fagans: well worth a visit.

Elsewhere there have been comments to make on students’ draft assignments, research ethics committee work, undergraduate teaching to prepare (on roles in health and social care teams) and writing plans to be laid. I’ve also been reading a PhD ahead of a viva scheduled in the next few weeks. So this short post will do for tonight: time to knock off, iron some shirts, pack a bag and have an early night.

A final plug for this year’s NPNR conference

Having navigated to the website for this year’s NPNR conference I see a full (final?) schedule of presentations and discussions. The two day event takes place at Warwick University at the end of this very week, no less. It should be a good one, and if I can I’ll tweet some choice messages throughout. For those not in the know, here’s how the gathering is described by the organisers:

This international conference aims to examine the personal everyday experiences of living with mental health problems and delivering mental health nursing care and some of the political responses and implications of the events and forces that provide the context within which we live and work.

Mental health nurses regardless of setting are engaged in highly personal alliances with individuals with mental distress. In that light, we wish to hear about research that examines the therapeutic alliances, mental health nursing interventions and creative partnerships that form the focus of much mental health care.

But these personal and professional alliances can also be influenced by wider events that can shape and determine the culture of mental health nursing practice. National responses to global financial crises in the form of austerity measures, cutbacks in services and changes to roles within the workforce can dovetail with existing patterns of inequality, stigma and discrimination to the detriment of mental health service users and staff alike.

The personal and political can be seen to be played out too in the relationships between nurses and the people they seek to support and help through issues of involvement, partnership and collaboration – whether in practice, education or research.

This conference provides an opportunity for an informed and critical look at the therapeutic alliance and the therapeutic environment from the personal and political perspectives of service users, carers, mental health nurses and colleagues. Papers examining interactions and interventions in mental health settings and the wider community were welcomed and may include nurse/patient interactions dealing with resistance, challenge, compliance, containment, risk, sexuality and gender, employment and inequalities.

Successful papers will seek to measure mental health outcomes and critically examine the ways in which these findings work to advance the development of interventions better suited to the needs of individuals and society.

Improving physical health

A common refrain amongst mental health nurses is that our knowledge, skills and contributions are poorly understood and undervalued by our physical healthcare nurse colleagues. As a nurse trained in both mental and physical health care fields I have sympathy with this position. But I also wonder if our concern with meeting mental health need has caused us to lose sight of the importance of physical health? I am again reminded of Professor Graham Thornicroft’s recent editorial in the BMJ on the scandal of early death in people with mental illness. Mental health nurses have a real part to play in promoting physical wellbeing and facilitating access to services, in their capacity as direct providers and as coordinators of care. Locally, I see evidence that some are taking this part of their work seriously. I know of mental health nurses who, as part-time MSc students, are motivated to develop smoking cessation programmes in hospitals and to introduce wellbeing screening clinics in the community.

With all this in mind it was interesting to see the most recent issue of the International Journal of Mental Health Nursing carrying a series of papers on this topic. There are contributions on: the work of mental health nurses in primary care; promoting access; attitudes, knowledge and training needs; and the physical activity levels of people with mental ill-health. Worth a read, I think.

Unrelatedly, here in England and Wales we are midway through an extended (bank holiday) weekend. This is all pretty meaningless to those nurses for whom shiftwork goes on as usual. Occupying the privileged position that I do, this afternoon brings not a trip to the office but, instead, the first visit of the new season to the Cardiff City Stadium. There, the newly promoted Bluebirds play their inaugural home game in football’s Premier League. Against Manchester City, it’s going to be tough. But whatever the outcome I know we’ll enjoy the occasion.

Doing crisis work

Here’s a new paper just accepted for publication, and about to appear in early online publication form. Titled ‘There’s a lot of tasks that can be done by any’: findings from an ethnographic study into work and organisation in UK community crisis resolution and home treatment services this will be appearing in Health: an Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. Health is published by SAGE, and the copyright agreement I have signed allows me to deposit a post-peer review version of the accepted manuscript in my employing university’s digital repository. So, for a green open access version of this paper which is almost identical to the version which will appear in the journal, follow this link.

For a quick summary, here’s the abstract:

Across the United Kingdom (UK) large numbers of crisis resolution and home treatment (CRHT) services have been established with the aim of providing intensive, short-term, care to people who would otherwise be admitted to mental health hospital. Despite their widespread appearance little is known about how CRHT services are organised or how crisis work is done. This article arises from a larger ethnographic study (in which 34 interviews were conducted with practitioners, managers and service users) designed to generate data in these and related areas. Underpinned by systems thinking and sociological theories of the division of labour, the article examines the workplace contributions of mental health professionals and support staff. In a fast-moving environment the work which was done, how and by whom reflected wider professional jurisdictions and a recognisable patterning by organisational forces. System characteristics including variable shift-by-shift team composition and requirements to undertake assessments of new referrals whilst simultaneously providing home treatment shaped the work of some, but not all, professionals. Implications of these findings for larger systems of work are considered.

I’ll be adding this post, with its embedded link to the open access version of this article, to my ‘enduring posts’ page. I’ll group it with other posts and publications addressing the theme of ‘work and roles’.

All change in East London

How pleasing it was to discover, during a return trip this week to East London, that the site of the now-disused St Clement’s Hospital (this being where I trained as a mental health nurse) is becoming the UK’s first community land trust. This means that the space will be developed for permanently affordable housing for local people.

Having cast an eye through the windows of London estate agents during this trip away I can see why there’s a need. The capital has become a prohibitively expensive place to live and work, it seems.

As it happened, our visit on August 8th coincided with the opening of the Shuffle festival. Curated by Danny Boyle (who made an appearance) this is bringing film, music and other good stuff to the St Clement’s site ahead of its redevelopment.

Further west, in Whitechapel, we discovered that the Royal London Hospital has been built anew under a private finance initiative scheme. The front parts of the old hospital remain, but are unused and propped up from behind for purely ornamental purposes.

At the back, the original nurses’ homes and other notable venues (including the Oxford Arms pub) have been entirely demolished to make way for a tall, exceptionally shiny, new main building. For the time being the Princess Alexandra Building, this being the old School of Nursing site in Philpot Street, remains.

All in all It is – we had to conclude – looking very different.

Thoughts on the occasion of having written 100 posts

My first post was written and uploaded to this site on November 24th last year. I wrote about my interest in exploring the mental health system’s ‘wicked problems’, and drew attention to an article Michael Coffey and I had recently published in this area. In this, my 100th post, I want to think a little about what I have learned using a blog as a medium of communication.

As a mental health nurse academic my job involves researching and writing. I have wanted this site to be a vehicle for bringing some of this work to a wider audience. The main way I have gone about doing this has been to write posts to surround published articles, and where copyright makes this possible to add links to full-text green open access versions of papers stored on Cardiff University’s ORCA digital repository. The link above to Michael’s and my paper on wicked problems is an example. I’d like to think that this strategy has had some effect. As I wrote in this post last month, copies of papers I have deposited and then blogged about have been downloaded. By whom I cannot know. Nor can I be sure what use, if any, people have made of what they’ve read. If anyone wants to let me know, then that would be all to the good.

Over the last eight to nine months I have also learned that a blog needs looking after. So in addition to writing about research I have taken the opportunity to write generally about other things I do at work or am interested in, or about stuff which has simply caught my eye. My approach has been to write little, but to write often. I reflect that adding small pieces here and there has helped me in my teaching, as I noted earlier here. I also realise that in blogging beyond research I have blurred my boundaries somewhat, having added notes along the way about (for example) the simple pleasures of running. As an aside, I’ve been plagued by minor, but annoying, running-related injuries over the last few months and am missing my forest jaunts very much.

Just as a peer reviewed, published, article can be given a leg-up by a post on a blog, so too can a new blog be supported by a tweet. I have taken to using Twitter to draw attention to newly published posts, and indeed have started using this (sporadically, it has to be said) as another, independent, way of exchanging ideas.

That’ll do, for now. But I conclude that I’ll maintain this site in its small niche for a while longer yet.

COCAPP gets a blog

Time only this morning for a super-speedy post to draw readers’ attention to COCAPP’s new blog. COCAPP is funded by the NIHR Health Services and Delivery Research Programme, and is a cross-national study of care planning and care coordination in community mental health. I’ve written about COCAPP on my blog before, but now recommend interested people get over to the project’s dedicated site to meet the team and to find out the detail of what it’s all about.

Care work and health system complexity

Two interesting collections of papers have caught my eye in the last week or so. Davina Allen has edited an online volume of articles, all previously published in the journal Sociology of Health & Illness, addressing the sociology of care work. In her editorial Davina sets the scene with reference to the Francis Inquiries and concludes with this:

[…] in the wake of Francis the predominant response to raising the quality of care and compassion has been to focus on the attributes of individuals and wider regulatory arrangements. As we have seen, however, the kind of care that can be provided depends fundamentally on the social organisation of care work, which in turn hinges on what we (society) are prepared to pay for. Francis has called for national fundamental care standards, but this requires more careful attention to the models of care-giving practice that will sustain them, including care-giver roles, the inter-relationship of care work components and features of the organisational context. The papers in this collection reveal there are no easy answers to these questions, but the insights they yield make an important contribution to these debates. In bringing the papers together in this virtual special issue the aim is to both raise the profile of the individual contributions, but also their collective value to this critical issue of public and policy concern.

Meanwhile, Tim Tenbensel, Stephen Birch and Sarah Curtis have edited a special issue of Social Science & Medicine devoted to the study of complexity in health and health care systems. I have a personal interest here, as it is in this collection of new papers that my article Connections and consequences in complex systems: insights from a case study of the emergence and local impact of crisis resolution and home treatment services appears. Describing himself as ‘a sympathetic outsider to complexity theory’, Tim Tenbensel in his editorial closes with this:

[…] perhaps the most important conceptual issue for complexity theory seems to be the place of ‘top-down’ interventions in complex systems. Are they part of the landscape of complexity, or are they things that ‘impede’ the unfolding of self-organising, emergent phenomena? More sophisticated applications of complexity suggest the former answer, yet the will to control through linear, rational, prescriptive mechanisms remains an ever-present shadow – something that should be minimised – because it this a defining trope of complexity theory applied to the social sciences. This theoretical challenge is perhaps most pressing in contexts in which health services are directly funded from public sources.

My apologies to the doctoral students whose ‘complex systems’ module I taught a few weeks ago, who may erroneously have thought that I knew what I was talking about, but like Tim Tenbensel I regard myself as being a relative newcomer to this whole complexity approach. So I for one am looking forward to reading the other papers in this new collection, and to learning plenty that is new.