Category: People

Mental health policy, services and nursing in Wales

The COVID-19 pandemic has drawn attention to the existence of devolved government in the UK. Here in Wales we’re used to hearing from Mark Drakeford, but my guess is that it’s only in recent months that most people in other parts of the UK will have become actively aware of his role as First Minister, and indeed the authority held by the Welsh Government to create policy and to legislate. For a helpful discussion on all things Wales and COVID-related, here’s a link to an episode of The Bunker podcast on the same.

In a Wales-themed episode of #mhTV held in October 2020 I joined a discussion panel alongside Hazel Powell (Nursing Officer for Mental Health and Learning Disability in the Chief Nursing Officer’s team) and Michelle Forkings (Associate Director of Nursing/Divisional Nurse for Mental Health and Learning Disability in Aneurin Bevan University Health Board) to talk about policy, power and mental health health nursing. Here’s a link:

International Mental Health Nursing Research Conference 2020

This year’s International Mental Health Nursing Research Conference (#MHNR2020) happened over two weeks in September, as planned through #mhTV and with a whole lot of help from Dave Munday, Nicky Lambert and Vanessa Gilmartin. Along with everyone else who values this annual event I’m indebted to all three for the work they’ve put in over the months to make #mhTV happen, and to do so as an entirely free offering open to anyone with use of an internet connection.

I enjoyed my chance to join Mick McKeown as a co-host of #MHNR2020’s evening panel discussions, and the format of inviting guests to pre-record and upload their presentations ahead of bringing them together in themed groups worked well. Every pre-recorded presentation and panel conflab can be viewed on the conference webpage, and will remain there as a resource for the future. As it happens, I pitched up as a panel member on the evening of September 25th, speaking about findings from the MENLOC evidence synthesis in the area of end of life care for people severe mental illness.  As a shortcut, here’s a link to my pre-recorded presentation summarising our main findings:

Papers update

Papers July 2020Back in summer 2019 (which seems, for pandemic-related reasons, to be much longer than a year ago) I wrote a short post introducing the 3MDR study. Here, now, is the main findings paper in early view in the journal Acta Psychiatrica Scandinavica. Working on a clinical trial has been an interesting, learning, experience for me and this feels like an important project to have made a contribution to.

I realise, too, that I’ve neglected to draw attention on this site to two papers co-written with Ray Samuriwo, both drawing on systems perspectives, wounds and mental health: see here and here. Ray is an original thinker, and makes interesting connections across different fields: check out, too, Values in health and social care for which Ray was lead author.

#MHNR2020 joins #mhTV

Back in pre-pandemic January 2020, the idea that a couple of hundred curious mental health nurses and their friends might gather together to share their research, practice development, educational and related projects seemed quite unremarkable. At that time, with the aim of enouraging a gathering of this sort, I published a short post on this site promoting the call for abstracts for the 2020 edition of the International Mental Health Nursing Research Conference.

#mhTVHow much has changed since then. As an organising committee we made a relatively early decision to call off the face-to-face conference originally scheduled for June 11th at Middlesex University. Now, in May 2020, #MHNR2020 is being brought into a new initiative called #mhTV.

#mhTV owes its existence in no small degree to the energy of Dave Munday from Unite/MHNA and Nicky Lambert from Middlesex University and the first episode launched on May 21st 2020 as a collaboration between Unite/MHNA, the WeMHNurses Community, Mental Health Nurse Academics UK and the Centre for Coproduction in Mental Health and Social Care:

 

The #MHNR2020 scientific committee will be reviewing all abstracts submitted for the intended June 11th conference, and once this work is done we’ll be in touch with invitations for authors to consider turning their presentations into a format suitable for #mhTV. We’ll identify episodes selected in this way as part of #MHNR2020 and publish details on the MHNAUK website. In the meantime, more on #mhTV and on how to submit new ideas can be found here.

Catch-up post 3: research under lockdown

One of the consequences of NHS resources being mobilised so decisively towards meeting the threat of the novel coronavirus has been the cessation of much face-to-face nursing and health services research other than that connected with COVID-19. A response in March 2020 from the NIHR included the instruction to delay the setting-up of new non-COVID projects, and to pause ongoing studies, in order that the infrastructure supporting NHS research be brought to bear almost exclusively on efforts to tackle the pandemic.

In this context, I have also observed how the online survey has become the method of choice for researchers wanting to immediately understand the effects of the COVID crisis on wellbeing and work. In April 2020, a team led by Chris Bundy from the School of Healthcare Sciences in Cardiff University launched a coping during coronavirus survey, whilst a team including Healthcare Sciences’ Danny Kelly invited nurses to take part in the first of three planned surveys reporting experiences during the crisis. The Mental Health Policy Research Unit, meanwhile, has opened its programme of COVID-related research with a survey for people working in mental health services.

WCEBCMeanwhile, one type of research relatively unaffected by the coronavirus outbreak is the evidence synthesis. In Cardiff we have the Wales Centre for Evidence Based Care and, in the early months of 2020, I joined a team led by Nicola Evans and Wales Centre colleagues to start work on a synthesis of the evidence in the areas of service organisation, effectiveness and experiences for children and young people in mental health crisis. Our plans include database searching plus online searching for grey literature, policies and guidance. More to follow as the project unfolds, which in April saw us deep in title and abstract screening.

#MHNR2020 call for abstracts

NPNR 1The first Network for Psychiatric Nursing Research (NPNR) Conference took place in 1996, and the picture at the left is the front cover of the delegate’s handbook. My first visit to the NPNR conference, as a non-presenting delegate,  was not until a few year’s later and I’m grateful to Russell Ashmore (the conference’s unofficial historian) for sharing this scanned document. The first presentation I gave at the event was during its seventh running, in 2001 (there having been one year previously in which two events took place); this went with the title Tales from the field: using ethnographic methods to investigate the provision of community mental health care. A glance at my records suggests that, to date, I’ve been involved in 27 papers delivered at the event over the years, as presenter, co-presenter and/or co-author. It’s the single conference I always aim to be at.

The NPNR became the International Mental Health Nursing Research (MHNR) Conference for 2017, and this year’s 26th running takes place over one day, June 11th 2020, at Middlesex University. A call for abstracts has been published on the Mental Health Nurse Academics UK website, and is reproduced here:

MHNR2020

Celebrating Mental Health Nursing

Past, Present and Future

26th International Mental Health Nursing Research Conference

11th June 2020

Middlesex University

The Burroughs, London NW4 4BT

Call for Abstracts

Follow us on Twitter: @MHNRconf and join in using the hashtag: #MHNR2020

This event represents a collaboration between Mental Health Nurse Academics UK (MHNAUK) and Middlesex University School of Health and Education.

Diversity of presenters, participants and topics will be a priority therefore all presenters will be offered one free place in addition to their own paid attendance which should be used to invite a student, service user researcher, carer, newly qualified nurse or a colleague who hasn’t previously attended a conference.

Abstracts are invited for work based in clinical practice, teaching, activism or research.  Those looking at mental health more generally are also welcome, and options for presenting will be in the form of concurrent papers, symposia, workshops or posters under the following topics:

  1. Advanced practice: To include examples of expanded roles, skills and responsibilities for nurses in healthcare services.
  2. Celebrating mental health: To include any activities addressing the history of mental health work or professional identity.
  3. Building communities: To include examples of work to promote community resilience, mental health and diversity and to reduce stigma and discrimination
  4. Creative approaches: To include any examples of creative approaches to promoting wellbeing and mental health.
  5. Activism and social justice: To include examples of rights-based approaches such as addressing restrictive practices, upholding human rights and achieving equality of access and resource allocation for mental and physical health services.
  6. Working across professions and disciplines: To include examples of inter-professional and cross-organisational projects or services
  7. General mental health: Those which do not fall into any of the above can be grouped here

Key dates and registration information

  • Call for abstracts opens: 28th January 2020
  • Deadline for receipt of abstracts: 28th February 2020
  • Confirmation of acceptance: 20th March 2020
  • Programme announced: 6th April 2020
  • Registration fees: £130 (for attenders, where this fee includes a place for an attender’s guest)/£70 for students and mental health service users
  • Please register early as places are limited

Guidance for preparing abstracts

  • Title: Should be clear, with appropriate use of capital letters that is, at the start of the title and when using abbreviations (RCN not Rcn).
  • Theme: Abstracts will be considered for one theme only, so please select the one most suitable for your submission (see above).
  • Word limit: Please adhere to the word limit given below.
  • Abstracts for concurrent sessions and posters should be no more than 350 words.
  • Concurrent sessions will be 15 minutes in length, with a further 5 minutes for questions.
  • Posters should be visually stimulating. Presenters will be expected to make themselves available to speak with delegates during identified poster viewing times.
  • Abstracts for concurrent and poster presentations MUST adhere to the following criteria:
  • Abstracts reporting on the results of quantitative research studies must be structured: background, aim(s), method(s), results, discussion and conclusions.
  • Statistics including sample size and sampling method used must be supplied.
  • Relevant contextual information must be given (e.g. research setting).
  • For qualitative studies the abstract must be structured: background, aim(s), sampling method, method(s), specific analytical approach or approaches, main findings, discussion and conclusions.
  • Theoretical/methodological abstracts and practice and/or education developments must be structured: background, aim(s) of the paper, discussion and conclusions.
  • For all abstracts authors must specify how the paper contributes to mental health nursing research, education, policy or practice.
  • All abstracts must be written in English. NB All accepted abstracts will be published ‘as submitted’. It is therefore incumbent upon the author to ensure that the spelling, grammar and syntax are of an academic publishing standard.
  • Workshop (350 words) will be 70 minutes in length. The abstract should include the aim(s) and proposed outcome(s), content, rationale for delivering the session in this format, how it relates to the conference themes, and description of any activities in which delegates will be invited to participate.
  • Recommended reading lists: Provide up to five references relevant to your abstract. These should be cited in full using the Harvard referencing system, that: Author, I. (year) ‘ Article title’. Journal name in full, vol #, no #, pp 101-107.
  • Biography: Maximum of 100 words, written in the third person.
  • Presenter details and authorship: Please include author details as you would like them to appear in a conference abstract book: forename, surname, qualifications, job title, and place of work. Please put an asterisk (*) next to the presenting author(s).

All abstracts should be submitted using this form:

https://forms.office.com/Pages/ResponsePage.aspx?id=iHvjOKGjz0ifBWU3Qn_tJCry0moWADJGn573rM2pLp5UM1JPQzNHQkg5QkJITTI3RzNLT1FCQkNTWi4u

With this being the Year of the Nurse and Midwife #MHNR2020 is aiming to be the place for mental health nurses to share what they do, and to say why it’s important. I’ll be there, as always, and am looking forward.

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.

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):

Annotation 2019-06-06 120912
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.

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.