Category: Other

New year…

Cardiff University Colleges and SchoolsHappy new year. 2013 promises plenty. I’m committed to two externally funded research projects, collaborating with outstanding folk located both in, and out, of Cardiff University. In the fullness of time I’ll perhaps blog about these studies when there’s more to say. I’ll be supervising people working on their doctorates, and as always will be teaching and assessing across the range of academic levels. I’ll be working up grant applications (there’s one in the pot at the moment), writing papers (including the one I’ve mentioned before), and contributing to various types of ethics and scientific review processes. I also have a number of external examining roles to fulfil, at doctoral and pre-registration undergraduate level.

In the year ahead I suspect there will be some interesting organisational changes to adjust to as Cardiff University refashions itself, and as the new College and School structure (which I’ve reproduced to the left of this post, with an added oval to highlight where I work) takes shape. As it happens, the University is making headlines at the moment. Just before the Christmas and New Year break Cardiff’s collaboration with the Open University (and others) to develop ‘MOOCS’ (Massive Open Online Courses) was widely reported. As I understand it, MOOCS are free-to-access courses made available via the web to pretty much anyone with use of a computer and an internet connection. I’m not sure how, if at all, people are able to work towards achieving formal academic awards in this way but I very much like the idea of freely available knowledge. Meanwhile, in this week’s Times Higher Education there’s a report on the new Vice Chancellor’s plans to develop the University’s international presence.

REF 2014In 2013 there’s also the small matter of the Research Excellence Framework (REF). I think the REF (like its predecessor the Research Assessment Exercise, or the RAE) is a flawed process, but it remains a (very) big deal for the UK’s universities. In this cycle, formal submissions will be made at the end of the year. Panel members will then have their work cut out in 2014, reading and assessing the quality of outputs (typically, journal papers), judging the impact of completed research beyond the realms of academia (for example, on policy and practice), and reviewing the institutional environment for research activity. Universities will be ranked on the results, and money will flow (or not). For an ambitious, research-led, Russell Group university like Cardiff this is an exercise of great import. It’s also significant for the professions of nursing and midwifery, which have spent the last decades upping their evidence base. In the last RAE, the outcomes of which were made known at the end of 2008, nursing and midwifery research fared pretty well. Let’s hope this can be sustained.

Outside of work I’ll keep running, hoping to stay injury free. As a meticulous record keeper I track my miles. So far for 2013 it’s 22-and-a-bit, and the aim is to manage 1,000 in total. This I achieved in 2012, and more besides. There’s also an increasingly good chance that this year will see Cardiff City climb out of the Football League Championship. I’m liking this, and it’s something I follow (with season tickets) with one of my boys. And, for those interested in the health and well-being angle of all this, check out the work of Alan Pringle and his colleagues on using football as a means to promote mental health, particularly amongst young men. Alan gave a fantastic talk on this at last year’s Network for Psychiatric Nursing Research conference.

That’ll do for now, I think: enough of the rambling.

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.

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.

On not lying-in

I’m not very good at lying-in. Once I’m awake (which, on most mornings, is earlier rather than later) I’m up. It’s then a matter of creeping downstairs to do some soundless chores, before making my mandatory mug of strong coffee and grabbing breakfast. Whilst in the kitchen I’ll have the radio on, tuned (at low volume) to BBC R4, for company. Invariably I’ll then make my way to the computer: the very one I’m sitting in front of now.

This blog is about a week old, and a number of my posts have started life in this pre-dawn window of opportunity. Papers I’ve written for publication have often been chipped away at at a similar time. So far the relationship between my writing-for-this-blog and my writing-for-journal-submission has been one-way, in that I’ve used this space to share ideas rehearsed at greater length in already-published academic articles. Indeed, this was one of my purposes in setting this site up: I wanted to experiment with blogging as a way of promoting work, and as a means of engaging beyond the production of lengthy outputs for paid-for journals.

It now occurs to me that this blog might also become a working space for the development of new ideas, and that the relationship between writing-for-journals and writing-for-the-blog might sometimes run in the opposite direction. This forum will never be a substitute for my academic journal-writing, and I’m not proposing to dump heaps of unmanaged data here (even if I had it!) for some kind of public write-in. But I might bring fledging ideas which I’m in the process of working through in my head.

Which brings me to…

At this year’s Network for Psychiatric Nursing Research conference I gave a talk titled, ‘Past, present and possible future in the system of community mental health care’. I intended this to be a kind of reflective run-through, taking in a decade-and-a-half of research and writing in the field. I wanted to touch lightly over a string of studies and papers I’ve had the good fortune to be involved in, and to knit together something cumulative around the themes of system interrelatedness, complexity and change. I’m not sure I pulled this ambition off in that forum, and in the longer term I’d like to work this all up into a full-blown paper. This space might become a repository of some sort for this type of work-in-progress. We’ll have to see, though, and I’ll need to think through how this might happen.

Unrelatedly: I’ll be opening the Mental Health Nurse Academics UK Vice Chair elections on Monday. My congratulations, too, to Louise Poley (Consultant Nurse in Substance Misuse, Cardiff and Vale UHB) for becoming RCN Wales Nurse of the Year. Lou has done outstanding work improving the health of people who are homeless, collaborating with partners across the statutory and non-statutory sectors.

Now I’m off out for run. Thanks, again, for reading.

Blogging on the bus: floods, mental health and more wicked problems

A brief post as I make my way, by bus, to a meeting at the University Hospital of Wales.

What’s the connection between the prevention of floods (noting the terrible weather we’ve been having, again) and the promotion of mental health? Both are problems of the wicked variety. Here I’m using ‘wicked’ in the way I used it in my previous posts, with due acknowledgment of Rittel and Webber and their 1973 paper. Flood management and improving mental health and well-being are complex problems. Responsibilities are dispersed across different people, groups and organisations. There are no ‘stopping rules’, in that there is potentially no end to what could be done.

That’s it: bus journey over.