Category: Mental health

Learning how to see: industrial action in universities and the nursing workforce

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Photo by @sarawhittam

I take the view that ‘everything is connected to everything else’, to use a phrase I recently learn is attributed to Leonardo da Vinci. More on him later.

Over the past week I’ve been involved in industrial action as part of #UCUStrikesBack. What I’m not going to do in this post is to explain why university staff are currently on strike, largely because this has already been adequately covered elsewhere (for example, see here and here). Instead, I want to share some picket-line reflections linking what happens in universities with what happens in the health service. These are connections which are not being made frequently enough, including by some who should know better.

As a mental health nurse academic I am acutely aware of the perilous position occupied by my profession in the NHS, with reports from earlier in 2019 pointing to a loss of 6,000 mental health nurses in NHS England since 2009. Below is a graph, created using NHS Digital data, which starkly reveals the current situation:

MHN numbers 2019As an aside, data of this type are not published here in Wales. They should be. In any event, quite correctly much concern has been expressed about this startling decline in the workforce, with mental health nursing now singled out as a group needing particular help to improve both recruitment and retention.

Reflecting my position as a health professional academic I hold joint membership of the University and College Union (UCU) and the Royal College of Nursing (RCN). The RCN, along with other health service unions like Unite and Unison, is trying to reverse the crisis facing the nursing workforce. It is campaigning on safe staffing, has published a manifesto to assist nurses wanting to interrogate prospective parliamentary candidates ahead of the December 2019 general election, and through its Fund our Future campaign is lobbying government to reverse the removal of tuition fee and living cost support for students of nursing in England.

These campaigns are important. So far, however, in its public pronouncements the RCN has failed to make the necessary connections between working conditions in universities and the present and future education of student nurses. Put simply, an adequate supply of educated, evidence-minded, person-centred nurses demands an adequate supply of secure, well-supported, fairly paid nurse educators and researchers. Nurse academics typically have career trajectories which are significantly different from those in other fields, with implications for their recruitment, retention and development. The modern norm for historians, physicists and sociologists seems to involve years of precarious, post-doctoral, employment characterised by repeated short-term contracts before landing (if ever) much sought-after full-time academic posts. In contrast, with some exceptions nurses are generally recruited into higher education by dint of their practitioner expertise, their posts linked to the servicing of courses of professional study. This was certainly how it was for me: my academic career commenced with an initial series of short-term employment contracts associated with the leading of a post-qualification course for community mental health nurses. In all universities, nurse academics can soon find themselves carrying major teaching and course management responsibilities, often for programmes and modules of study which run more than once across a single year. Demanding education and education-related workloads can squeeze out time for research, scholarship and wider engagement, in workplaces which traditionally value productivity in these areas for the purposes of career progression.

Expanding the number of nurses to fill the gaps which now exist, for which the RCN and others are rightly campaigning, requires thought and careful planning. In the run-up to the general election both are in short supply as nursing numbers become reduced to political soundbites. More student nurses must mean more nurse academics, but in any future rounds of staff recruitment potential entrants will have their eyes wide open. The erosion of university pensions relative to pensions in the NHS does nothing to encourage those contemplating the leap from health care into higher education (or, at least, into that part of the sector in which the Universities Superannuation Scheme predominates). Very reasonably, those considering future careers as nurse academics will also want to weigh up the appeal of doing work which is undoubtedly creative and rewarding with what they will hear about workloads, developmental opportunities and work/life balance.

I also learn, this week, that Leonardo da Vinci saw the making of connections as necessary in order that we might see the world as it truly is. In my working world, education, research and practice are intimately intertwined. It is disappointing that these connections are being missed by organisations which campaign on the state of nursing and the NHS, but which do not (as a minimum) also openly acknowledge the concerns that nursing and other academics have regarding the state of universities. Right now, some words of solidarity and support would not go amiss.

October review

Over on the website of Mental Health Nurse Academics UK (MHNAUK) I’ve written this brief review of MHNAUK’s last meeting, which took place at Unite the Union’s offices in Glasgow on October 11th 2019. This was a good meeting, with two guest speakers: Lawrie Elliott, Editor of the Journal of Psychiatric and Mental Health Nursing and David Thomson, Chair of the Mental Health Nursing Forum Scotland. I learned lots from both, and amongst other things ended up thinking how organised mental health nurses in Scotland look to be.

As it happens, MHNAUK is also about to embark on something new: next week we’re inviting nominations for people to lead our Education, Research, and Policy and Practice Standing Groups. Standing Groups are the engines of MHNAUK, and have been led thus far by Anne Felton, Mary Chambers and Neil Brimblecombe (and previously, John Baker) respectively. Big thanks to them for their work: the more that members become involved, the better.

Back in Cardiff, with esteemed co-investigators I’ve again (as I mentioned last month) been pressing on with the NIHR HS&DR-funded MENLOC evidence synthesis into end of life care for people with severe mental illnesses. This is proving to be a big piece of work, but we’re on track to submit our report in spring next year. As a team we’re also thinking carefully about future lines of enquiry, as there is lots still to do in this field.

A final thing to note in this catch-up: I’ve been thinking about what to say at next month’s Making a difference in Wales conference, which is all about taking the Framework for Mental Health Nursing forward. I think there is lots which is distinct about health policy and services in this part of the world, but also recognise the existence of gaps between policy and strategy aspirations, and workplace realities. One to mull over.

Summer research summary

Si3mdrnce returning from a week of walking August has included making final preparations for #MHNR2019, which is looking very exciting. Elsewhere, a big part of my work this month has been writing an analysis of qualitative interview data generated as part of a phase 2 trial of 3MDR for military veterans with treatment-resistant post-traumatic stress disorder. 3MDR, or Modular motion-assisted memory desensitisation and reconsolidation, is a novel psychological intervention involving walking on a treadmill towards personally selected images of trauma whilst in the company of a skilled therapist. The study is led by Jon Bisson, and here are Neil Kitchiner and John Skipper talking about what it involves:

Working on a trial has been an interesting, and new, experience for me, and I’ve been learning lots. My qualitative write-up is destined for inclusion in a final report for the trial’s funding body, Forces in Mind Trust, but during this work as a team we’ve also been planning papers for publication.

menloc logo 5MENLOC, our ongoing evidence synthesis into end of life care for people with severe mental illnesses (about which I have written on this blog before), is in full swing. We’ve reached the stage where we’re writing up syntheses of the research papers and other outputs we’ve included, organised via a series of themes. More on this to follow in due course.

Finally, it’s been good to work in support of colleagues who have led new papers for publications. Here’s Jane Davies‘ latest paper on the experiences of partners of young people living with cancer, and a paper led by Ray Samuriwo on wound care and mental health.

Walking for mental health

A brief post whilst away for a week of walking, crowned by this photograph of the sculpture in New Quay marking the halfway point along the Wales Coast Path. A short search online reveals that it was recently made by David Appleyard. A very fine job he’s made of it, too.

Another quick search online finds evidence of walking as being good for mental health. No great surprises there, then, including the point made at the end of the abstract that outdoor walking confers greater benefit than walking indoors. Here, too, is a link to an excellent project run by colleagues in the School of Healthcare Sciences in Cardiff involving walking groups for people who are homeless.

Time to get my boots on…

Nursing numbers

Next week I’ll be in London for this year’s Eileen Skellern and JPMHN Award evening, hearing Mick McKeown give his Making the most of militant and maverick tendencies for mental health nursing Skellern lecture and Patrick Callaghan deliver his Lifetime Achievement Award address. The day following, June 14th, I’ll be at Kingston/St George’s chairing the summer meeting of Mental Health Nurse Academics UK. One of the things we’ll we talking about is NHS England’s Interim People Plan, which looks to be prioritising mental health nursing as an occupational group in need of support. Here’s a short piece I wrote yesterday for the MHNAUK website, complete with a toxic-looking figure showing the decline in applications for nursing degrees:

The NHS needs more mental health nurses. The most recently available data on the size and composition of the workforce in NHS England, for February 2019, records a total of 36,290 mental health nurses. This compares to an NHS England mental health nursing workforce in September 2009 of 40,602.

Published on June 3rd 2019, the Interim NHS People Plan is about supporting the people needed to deliver NHS England’s Long Term Plan. Chapter 3 addresses nursing, this being the profession where the greatest shortages are found and where the most urgent and immediate action must be taken. Mental Health Nurse Academics UK welcomes the identification of mental health nursing as a priority group, and notes the Interim People Plan’s statement that what must now happen is:

[…] a detailed review across all branches of pre-registration nursing, including a strong focus on the steps needed in mental health and learning disability nursing to support growth in these areas.

The Plan echos Mental Health Nurse Academics UK’s view that undergraduate degree courses offer the best way to secure a future supply of nurses. It also reproduces a figure pointing to a sharp decline in applications for nursing and midwifery courses in England since the removal of bursary support (specifically, a 31% decrease between 2016 and 2018):

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Extracted from Interim People Plan, p24

The Interim People Plan places an emphasis on what it refers to as ‘the offer’ made by the NHS to its staff. Mental health nursing needs a better offer if it is to improve the recruitment, retention and support of its current and future members. Mental Health Nurse Academics UK will be looking for concerted action in these areas.

My view is that this decline in applications was entirely foreseeable in the context of the removal of bursaries in England. As it happens, students of nursing and other health professions commencing their programmes of study in Welsh universities in Autumn 2019 can expect to be supported through the award of a bursary, in return for working for two years post-qualification in NHS Wales. That’s a good deal, in my book, and is something presented as part of the country’s wider #TrainWorkLive initiative. I’m not entirely sure how far this ‘Welsh offer’ (to borrow the language of the People Plan) is known throughout other parts of the UK: so I’m happy to give it a nudge here.

May review

2019-05-20 18.41.32.jpgEarlier this month I joined colleagues at the main meeting of the #MHNR2019 scientific committee, held (as the conference itself will be) at the RCN in London. We had a good number of abstracts to work through, submitted by people from the UK, the US, Australia and elsewhere. The programme is being worked on now, and people will not have long to wait before learning the outcomes of the panel’s deliberations. As an aside, whilst the conference committee always welcomes proposals for workshops as well as for concurrent sessions, posters and symposia we were reminded, when we met, of the importance of workshops promising to make delegates work. This is doubly important given that a workshop typically occupies the same amount of time on the conference programme as do three concurrent talks: so they have to sound engaging, and interactive, and not read like a plan for a 90 minute lecture.

For me this month also included a trip to St Angela’s College in Sligo for a stint of external examining for the College’s Postgraduate Diploma in Community Mental Health Nursing. It’s a good course, attracting applicants from all around Ireland, in which students learn about recovery-focused practice, therapeutic relationships, formal therapies, the context for care and care coordination, and more besides. It’s complex work being a registered nurse, and that’s why in all parts of the world the profession is (or is becoming) a graduate one for new registrants, with specialist courses like this one in Sligo being offered at post-registration level. I mention this as, tediously, nurses (and their friends) are once again having to defend the value of an education which involves time in practice but also, crucially, study for a degree.

Finally, this is my 16th unbroken annual trip to the Hay Festival. When I was first here the event was a relatively small-scale affair, held in the town’s primary school. It’s a much bigger enterprise now, located on a site some half a mile out of town to which many thousands of visitors arrive each day. This year I’ve listened to talks and round table discussions on the interminable horror that is Brexit, the making of (and the intentions behind) Our Planet, the invasions first of the Vikings and then on D-Day, and more.

COCAPP-A main findings paper

COCAPP-ACOCAPP-A, funded by the NIHR Health Services and Delivery Research Programme, investigated care planning and coordination in inpatient mental health services. It was led by Alan Simpson, and I was mighty pleased to have been part of the research team. The full, 270 page, report appeared in 2017. Now, a derived paper reporting main findings has appeared in the journal BMC Psychiatry. Lead authored by Michael Coffey this article amounts to a more modest 18 pages, which means it stands a chance of actually being read by people able to make use of it.

As a gold open access article the paper is free to download to anyone with an internet connection. As a taster, here’s the abstract:

Background: Involving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care.
Methods: A cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method.
Results: For service users, when recovery-oriented focus was high, the quality of care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.
Conclusions: There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning.

#MHNR2019

#MHNR2019With just under one month to go before the deadline for submission of abstracts for the 2019 running of the International Mental Health Nursing Research Conference I thought it an idea to draw attention to this top tips post from two years ago. As I suggested then, conference guidelines are there to be followed. For the past couple of years we’ve published criteria for abstract selection, including information on the structured presentation of quantitative, qualititative and non-empirical abstracts.

And, whilst I’m writing about #MHNR2019, now is a good time to link to this MHNAUK post announcing Sue McAndrew as Mental Health Nurse Academics UK Lecturer for 2019. Sue works at the University of Salford, and will be drawing on her work in children’s and young people’s mental health.

#MHNR2019, A Framework for Mental Health Nursing, and MHNAUK meets in Birmingham

MHNR2019The call for abstracts for the 25th International Mental Health Nursing Research Conference is now live, with this year’s conference organised under the theme of From Global to Local: Mental Health in a Connected World. We’ll be meeting, for the first time, in London: specifically, in the RCN HQ in Cavendish Square. This is also the year that we’re working with the International Society of Psychiatric/Mental Health Nurses, and we’re hoping the event has a truly international feel. The deadline for receipt of nominations for people to deliver the Annual MHNAUK Lecture at #MHNR2019 has passed, and the commitee will be deliberating over the coming weeks before an announcement is made.

MHN FrameworkMeanwhile, on Mental Health Nurses’ Day, February 21st, here in Wales a new ten year Framework for Mental Health Nursing was launched at Cardiff University’s Hadyn Ellis Building. The Framework contains 13 pledges organised through four key themes: Professionalism, Voice and Leadership; Workforce and Education; Promoting Population Health and Wellbeing; and Quality and Safety of Care. It is also replete with exemplars of good practice.

One day after the Framework launch I was in the fine surroundings of the University of Birmingham for 2019’s first meeting of Mental Health Nurse Academics UK. A note of the event, which was attended by almost 50 people, can be found here. The meeting was a full one, with updates on both the REF and the TEF, experiences of course validation reflecting new NMC standards and more besides.