Category: Research

Education for community mental health work

This week brought a COCAPP meet-up in Bristol, where we had the chance to plan our work for the immediate period ahead. The RiSC team also met, albeit in teleconference rather than face-to-face fashion. I’ve had pre-registration student nurses’ assignment work to begin marking, and this afternoon will be taking part in a joint Cardiff University/Local Health Board discussion on the future provision of post-qualification modules for community mental health practitioners.

This afternoon’s meeting has given me pause for thought, and a chance to reflect a little on my long involvement in post-registration mental health education. It was explicitly to lead a full-time, one-year, programme for actual or intending community mental health nurses (CMHNs) that I was recruited into what was then the University of Wales College of Medicine in 1997. Education, and my role, have changed considerably in the period following. In Wales there is no longer a fully funded, full-time, course of this type. Like pretty much everywhere else, here education for health care workers beyond registration has increasingly become part-time, and modularised.

I once wrote about the CMHN course we ran in Cardiff in the journal Nurse Education Today. The article was titled ‘Specialist practice in community mental health nursing‘, and had an abstract which went like this:

Community mental health nurses (CMHNs) work in an increasingly complex health and social care environment. Over recent years, the evolving direction of general health service and specific mental health policy has directed CMHNs towards: the provision of clinically-effective interventions; a closer attention to meeting the needs of people experiencing severe and long-term mental health problems; the simultaneous provision of services to meet the needs of people experiencing a wide range of mental health problems presenting in primary care settings; greater collaboration with workers representing other disciplines and agencies; and the development of active partnerships with mental health service users. This paper explores the context within which CMHNs practise, and within which education programmes preparing specialist practitioners in community mental health nursing have been developed. One recently-validated specialist practice course for CMHNs is described in detail, with the intention of stimulating discussion and debate surrounding the practice of, and the educational preparation for, community mental health nursing.

I can’t claim that this paper did actually trigger any particular debate, but at least I tried.

I also had the chance, during the time that I ran Cardiff’s full-time CMHN course, to survey the leaders of other programmes of this type offered elsewhere in the UK. A paper called, ‘Specialist practice for UK community mental health nurses: the 1998-99 survey of course leaders‘ appeared in the International Journal of Nursing Studies. This was co-written with Philip Burnard, Debs Edwards (who, I am delighted to say, is now project manager for the RiSC study already mentioned in this post) and Jackie Turnbull. In the paper’s abstract we said:

Surveys of the leaders of the UK’s post-qualifying education courses for community mental health nurses have taken place, on an annual basis, for over 10 years. In this paper, findings from the survey undertaken in the 1998–99 academic year are reported. These findings include: that most course leaders do not personally engage in clinical practice; that interprofessional education takes place at a minority of course centres, and that course philosophies and aims are characterised by an emphasis on both outcomes (in terms of, for example, skills acquisition, knowledge development and the ability to engage in reflective practice), and process (adult learning).

And then there was a paper called, ‘Education for community mental health nurses: a summary of the key debates‘ which Steve Trenchard, Philip Burnard, Michael Coffey and I wrote for Nurse Education Today. Here we said:

A wide range of post-qualifying education courses exist for community mental health nurses (CMHNs) working in the UK. ‘Specialist practitioner’ courses emphasize shared learning between CMHNs and members of other community nursing branches. These programmes typically include course content drawing on the social and behavioural sciences, as well as on material more tailored to the clinical needs of practitioners. Such courses and their predecessors have been subject to criticism, however. Courses have been described as anachronistic, and failing to take account of recent advances in treatment modalities. In addition concerns about the generic focus of some programmes have also been raised. Educational alternatives, such as programmes preparing nurses and other mental health workers to provide ‘psycho-social interventions’ have, correspondingly, become increasingly popular. In this paper we explore some of the debates surrounding the education of CMHNs, and explore the context in which CMHNs work and in which educational programmes are devised. We consider the multidisciplinary environment in which CMHNs practise, the differing client groups with which CMHNs work, the developing policy framework in which mental health care is provided, demands for more user-responsive education, and the relationship between higher educational institutions and health care providers. We conclude the paper with a series of questions for CMHN educators and education commissioners.

And there are other papers and book chapters, too, which I won’t refer to now. But I am reminded that I once spent large parts of my working life running programmes for community mental health workers, and managed to research and write a fair bit about the same. Perhaps today’s meeting will lead to a modest rekindling.

Research priorities for mental health nursing

Last week’s arrival in my email inbox of the notes taken at Mental Health Nurse Academics UK‘s most recent meeting, held on October 8th at Teesside University, reminds me that MHNAUK is still conducting a research priorities exercise. These minutes, taken by Joy Duxbury and circulated by Michael Coffey, note that Len Bowers led our discussions on the day and has offered to collate responses:

The group discussed the scope of future research for the profession of mental health nursing. The idea is to develop research priorities to influence what research gets funded and funders will be interested to hear about this. The priority setting exercise included discussions on the following:

  • The role of the mental health nurse – What works and what doesn’t? What we are good at and what we aren’t so good at.
  • The role of theory as well as empirical research – how does this influence funders and how research might still be theory driven?
  • What do mental health nurses contribute that aids recovery?
  • Transitions
  • Care co-ordination
  • Does it have to be unique to mental health nursing? Maybe not
  • Underpinning values
  • Public Health

As there seemed to be problems with consensus e.g. defining what counts as mental health nursing research as opposed to mental health research of relevance to nursing it was felt that we need first to feedback top ten priorities for research to Len before Christmas. He will then collate to discuss at a future meeting. It might also help if we report what research we are currently doing too.

Meanwhile, over on MHNAUK’s blog there’s this post from Alan Simpson to kick-start this exercise off, and room for people to add their thoughts beneath via the comments function. In his ‘starter for 26’ Alan writes:

Inspired by last week’s MHNAUK meeting, today staff at our mental health research team meeting were asked to identify their research priorities for mental health nursing research. The meeting consists of various academic research staff and clinical academics discussing on-going and forthcoming research studies and various research-related issues. Today, I simply asked each person to write a short list of priorities, which we then shared and discussed. Here’s our Top 30 in no particular order with repeats removed. Most frequent repeat was physical healthcare. Second was recovery. Third – racism and culture. What’s your Top 10?

  1. Generic vs Specialist MHN training
  2. Measures of Compassion
  3. Effects of selection procedures for MHN students and staff
  4. Nursing and PTSD
  5. Tool development
  6. Risk assessment and MHN
  7. The 6 Cs and MHN
  8. Mental capacity and issues of consent
  9. Racism and stigma in MHN
  10. Values and beliefs and how they impact on practice
  11. Mental health and the performing arts
  12. MHN training and learning disabilities
  13. MHN views on developments that may threaten MHN, e.g. peer support, self-care
  14. Physical healthcare in secondary mental health care settings
  15. Philosophy and MHN: The Art of Living
  16. Identity and body image in people with MI
  17. Community and third sector organisations and how they link with mental health teams/services
  18. Communication, especially information giving and the first contact
  19. Culture and ‘cultural safety’ as a useful model
  20. Fear – underpinning MHN and service user behaviours
  21. Brokerage roles, self-care and MHN
  22. Workforce planning and nurse education/training and physical/mental health divide
  23. Evaluation of education/training and preparation of MHNs for the job
  24. Recovery and MHN interventions
  25. MHN interventions to maximise engagement
  26. Liaison mental health care

We’re looking to conduct an informal exercise of this type amongst Cardiff University’s mental health nurse academics, with a view to forwarding our collective ideas to Michael Coffey for wider incorporation. Ahead of this, here are some initial suggestions of my own, which I’ll also add to the MHNAUK blog:

  1. What do mental health nurses do?
  2. What do/can mental health nurses do which promotes recovery and individually tailored care?
  3. What do/can mental health nurses do to better promote physical health and well-being in people with severe and enduring mental health difficulties?
  4. What do/can nurses do to help people in their journeys into, through and out of the mental health system?
  5. What are mental health nursing values, and what difference do/can they make?
  6. How are/should students of mental health nursing be prepared for practice?
  7. How can nurses use new technologies to improve care and its organisation?
  8. What are the intended and unintended consequences of organisational and therapeutic innovation on the experiences of people both using, and providing, mental health services?

These are all ideas occurring this evening, though it’s also true to say most reflect lines of inquiry I’m fortunate enough to already be associated with. More to follow, perhaps.

Mental health R&D 2013

Yesterday I made it to the SWALEC Stadium for the annual Cardiff and Vale UHB Mental Health R&D meeting. I was pleased to again be invited, and appreciated the opportunity to talk about mental health research activity across the new School of Healthcare Sciences.

I was also reminded of the work of the National Centre for Mental Health (NCMH). Funded as Wales’ only Biomedical Research Centre by the National Institute for Social Care and Health Research (NISCHR), and led by Professor Nick Craddock, the NCMH supports mental health research, undertakes mental health research and communicates and engages. Newly housed in Cardiff University’s Hadyn Ellis Building, members of the NCMH do all three elements extremely well. The Centre’s website has recently been revamped, and is well worth a visit. Here, too, is an NCMH call for volunteers video:

Catching up post

Plenty going on in the last week or so. I had the chance to join pre-registration mental health nurses and occupational therapists for a second day as they made preparations for an interprofessional event scheduled for early December. Some of these students have also been giving me drafts of assessed work to comment on, but as the deadline for receipt of these is first thing next week I expect a deluge then. ’twas ever thus.

Elsewhere there has been RiSC reviewing to crack on with, assignment marking, and peer review reports to both consider and write. I’ve also put myself in the frame to act as a reviewer for another university’s proposed new MSc mental health programme, this being the kind of curriculum work I haven’t had the chance to do for a while.

I’m not normally one for formal, suit-and-boot, events, but made an exception last Wednesday (November 27th) to join a posse of colleagues from the School of Healthcare Sciences at the RCN Wales Nurse of the Year awards. These took place at Cardiff City Hall, and the overall winner was Cardiff and Vale UHB ward sister Ruth Owens. Congratulations, Ruth. Congratulations, too, to the individual category winners: including Andy Lodwick (also from Cardiff and Vale) for picking up the Mental Health and Learning Disabilities award and Dr Carolyn Middleton, doctoral graduate from what was the Cardiff School of Nursing and Midwifery Studies, for winning the Research in Nursing award.

This week also brought me to a meeting of the MHRNC Service User and Carer Partnership Research Development Group and, yesterday morning, to the Cardiff City Stadium for an open meeting to discuss NISCHR’s infrastructure and programme funding review. Both were lively events, and on the NISCHR front I see big changes ahead from 2015.

And to close this summary post: via the twitter grapevine I see that the RCN is now giving early notification of the Network for Psychiatric Nursing Research 2014 conference. This will take place at Warwick University on the 18th and 19th of September. I’ll post a link to the call for abstracts once this appears, but for now will reproduce this extract from the event website:

This year [2014] is the 20th international NPNR conference and it’s going to be a celebration.

We wish to celebrate and promote some of the outstanding mental health nursing research that shapes mental health policy and nursing practice across the world. We will also acknowledge some of the best psychiatric and mental health nursing research that helped create the strong foundation for our work today. And we will invite delegates to look ahead to map out the future for mental health nursing research, education and practice.

One year retrospective

The appearance of a new icon in my WordPress dashboard reminds me that this site has now been registered for a year. My first post was uploaded on 24 November 2012. The title of this piece, revealing a shocking lack of inspiration on my part, was Some opening thoughts (1). In this I wrote about policy and service challenges in health and social care.

In my first full 12 months of blogging I published 127 posts. I categorised each with one or more of the words appearing beneath the site’s title, and now reproduce here. The size of each word reflects the number of times the category has been used. ‘Research’ is my most-applied category, closely followed by ‘Mental health’. So no surprises there.

Looking at my viewer statistics I see that the Enduring posts page has been popular. This is pleasing, as I deliberately set this up as a way of keeping together my more substantial, often research-related, pieces. Individual posts attracting most views have included those relating to this year’s NPNR conference, nursing and the approved mental health professional (AMHP) role, and the research excellence framework.

The WordPress software I am using also allows me to track clicks, which are the links to other sites I have embedded in posts and pages that readers choose to follow. I see that, over the year, the onwards site which has been visited the most is the Cardiff University digital repository (ORCA). Again, this is pleasing, as this tells me that some people have been sufficiently interested to visit the place from where green open access versions of papers I have provided links to can be obtained. Most popular amongst downloaded articles has been Michael Coffey‘s and my paper on the mental health system’s wicked problems, which was also the first document I made available in this way. Next up are Michael’s and my paper on AMHPs and Davina Allen‘s and my paper on complex caring trajectories in community mental health.

Doughnut meetings

My esteemed colleague Professor Jane Hopkinson facilitates a Wednesday lunchtime research drop-in, to which people in the School of Healthcare Sciences at Cardiff University are invited. Affectionately known as doughnut meetings (see photo of today’s goodies attached), these provide a loosely-structured, supportive, space for the sharing of ideas and experiences. The gatherings are really very good: informal, but always informed. I make a point of getting along when I can.

Typically those who meet up get to propose themes for future meetings. This afternoon’s topic was ‘research and evaluation’, and more particularly the distinctions between the two. People involved in health services research (or indeed, health services evaluation) will know how important this differentiation is for NHS governance and approval purposes. Projects classified as ‘research’ require independent NHS research ethics committee (REC) approval. Projects classified as ‘evaluation’ do not. The NHS Health Research Authority provides guidance to help people work out what type of project it is that they are proposing, but in my experience making these determinations remains a wholly inexact science.

I have also learned that a project can be ‘evaluation’ in one context (e.g., for NHS research governance and ethics review) and ‘research’ in another (e.g., for academic progression and award purposes). My own PhD was designed, part-funded through open competition, completed and examined as ‘research’: what else could it possibly have been, as a research degree? But it was also categorised as something else when I offered it up for NHS REC approval, as I’ve written about here and (at length) in this paper.

So there we have it. Potentially all rather confusing, and certainly enough to make me want to eat a doughnut.

Postgraduate symposium

Tomorrow I’m off to the School of Healthcare Sciences’ first-ever Postgraduate Research Student symposium, taking place in the grand surroundings of Cardiff University’s Glamorgan Building.

This has given me the perfect excuse to find out, once and for all, the particular meaning of the word ‘symposium’ (as opposed to ‘colloquium’, for example). So for those interested (which won’t be many of you, I’m sure), the Collins English Dictionary defines ‘symposium’ thus:

  1. a conference or meeting for the discussion of some subject, esp an academic topic or social problem
  2. a collection of scholarly contributions, usually published together, on a given subject
  3. (in classical Greece) a drinking party with intellectual conversation, music, etc

A ‘colloquium’, on the other hand, is:

  1. an informal gathering for discussion
  2. an academic seminar

I’m glad that’s sorted. Looking at the third definition of ‘symposium’ above, and then at the organising committee’s Socratic quotation reproduced in the flyer at the top, I now realise I ought to prepare for an event in the ancient Greek style. I may bring my guitar, all the better to join in with.

Returning to the REF

Photo by Antony Theobald (ant.photos) Creative Commons 2.0 (CC BY-NC-ND 2.0) licence

This is the month that universities in the UK make their submissions to the Research Excellence Framework (REF) 2014. The REF is a big deal, as I’ve written about before. It is also continuing to attract plenty of commentary, much of it critical. For some time Dorothy Bishop, Professor of Developmental Neuropsychology at Oxford University, has been using her personal blog to critique exercises in research rating. Her objections include their poor cost-effectiveness and the dangers of using journal impact factors as a proxy for the quality of individual papers. In his blog Peter Coles, Professor of Theoretical Astrophysics at Sussex University, has attacked the REF for becoming self-serving. Quoting from a Times Higher Education (THE) story he also writes of the practice in some universities of research-active academics not selected for REF return being shifted onto teaching-only contracts. This week, Professor Peter Scott from the Institute of Education writes in The Guardian that research assessment is now ‘out of control’ whilst the THE has recently reported on the case of Lancaster University historian Professor Derek Sayer who has appealed against the decision to include him in the REF on the grounds that the procedures used to exclude some of his colleagues have been discriminatory.

And so it goes on. In the REF proper, outputs (typically articles in journals) will be graded by experts as ‘world leading’ (4*), ‘internationally excellent’ (3*), ‘internationally recognised’ (2*), ‘nationally recognised’ (1*) or as either ‘sub-national’ or ‘not research’. These gradings will be made using the criteria of originality, significance and rigour. Universities get to select which of their staff will be included in their returns, drawing on their preparatory assessments of the quality of eligible outputs and underpinned by strategic ambitions of where they want to be in the HE firmament once the official REF results are published and institutions ranked. My guess is that, for most researchers and their employers, the most important distinction needing to be made will have been between outputs which are internationally excellent (3*) and outputs which are ‘only’ internationally recognised (2*). For reasons of reputation and likely future funding an article assessed as being at least the former is much more likely to be included in a REF submission than one which is not.

Quality assessments informing imminent REF returns will have been made by busy people with varying degrees of expertise in the (sub)areas in which the papers they have been reading lie. I’m going to speculate that there will be many hundreds (thousands?) of academics with outputs which will have attracted inconsistent scores from internal and external reviewers. Who knows, perhaps there are even some with individual outputs assessed by different people as simultaneously being ‘world leading’ and ‘unclassified’. Many will certainly have papers differentially judged as being 2* or 3*, leaving all sorts of tricky decisions to be made on submission or non-submission with all manner of possible consequences for both individuals and universities.

Back in the world of actually doing research, as opposed to the world of assessing research outputs and fretting over returns to assessment exercises, I am pleased to say COCAPP is now receiving questionnaires from service users and RISC is deep into phase 2. If you head over to this NISCHR page you’ll also find news of the Plan4Recovery project, led by Michael Coffey. This is a collaboration involving Hafal, and I’m very pleased to be a co-applicant along with Sherrill Evans and Alan Meudell. Plan4Recovery is advertising for a research officer, and is about to have its first advisory group meetings. Exciting times.

Reviewing health and social care research in Wales

Here in Wales, a month or so ago the National Institute for Social Care and Health Research (NISCHR) published a document outlining ideas for its restructuring, and opened a discussion on how research should be prioritised, organised and supported in the future. NISCHR says that it:

[…] proposes to engage its stakeholders, including patients, the public, the NHS, social care organisations, universities, industry, the third sector and other government departments to review the infrastructure and programmes it currently funds and help determine what changes should be made.

Now, details of a series of open meetings have appeared. I’ve registered for the November 29th meeting taking place at the Cardiff City Stadium. I will also be offering up some ideas for the School of Healthcare Sciences’ collective response.

A number of things are currently brought together under the NISCHR umbrella. Funding is provided for national-level registered research groups (RRGs), regionally based academic health science collaborations (or partnerships) and a biomedical research centre and series of biomedical research units. Social care research is assisted through capacity-building funding. Support is also provided for Involving People, and for all-Wales training in research governance and related matters. Studies on the NISCHR portfolio are eligible for funded, in-the-field, help via a network of clinical studies officers and research nurses. NISCHR also oversees approval processes for NHS research, funds a number of trials units and has (this year) launched a faculty. There is also the small matter of NISCHR’s competitive funding schemes, which provide project-by-project support for high-quality studies of importance to health and social care in Wales.

Given all of this, NISCHR’s review is, I think, an important process to be contributing to. One of the NISCHR schemes mentioned in the review document is the Research Capacity Building Collaboration for Nursing and Allied Health Professionals (RCBC Wales). This has been an excellent initiative, entirely delivering (so far as I can tell) on its ambitions to develop capacity. As such, it deserves to be continued (and better still, expanded). I have to declare an interest here, of course, being an alumni of the RCBC Wales scheme having secured a postdoctoral fellowship in 2006. This was the funding which allowed me to investigate the establishment, work and wider system impact of crisis resolution and home treatment services, as I’ve variously blogged about in the past here, here and here.

The NISCHR document also draws attention to the use of Welsh health and social care research funds to support NIHR NETSCC Programmes. This paves the way for researchers in Wales to apply, on an equal footing to colleagues in England, for support from the HS&DR Programme, the HTA Programme and others. This mechanism facilitates cross-UK collaboration, which has to be a good thing. It is only through this support that Wales-based colleagues and I have been able to work on the COCAPP and RiSC projects.

I also see mention by NISCHR of an ongoing review of the operation of R&D offices, and in this regard I hope that a way is found to further rationalise approval and governance processes. The NHS research passport system could be better (it’s not really much of a ‘passport’ at all), and there are variations still in the ways different R&D offices process applications.

It is also clear that NISCHR is considering the level and type of support it offers to its all-Wales RRGs, and the connections these might have with biomedical research centres and biomedical research units working in overlapping areas. NISCHR is, if I understand this correctly, thinking through how organisations like the Mental Health Research Network Cymru and the National Centre for Mental Health might relate.

So, there we have it: evidence that changes to health and social care research organisation and funding in Wales are on the cards, with plenty of time remaining for people with an interest to get involved in shaping future arrangements.

More unwanted invitations

In a post I wrote in May I complained about academic spam, and particularly the endless receipt in my email inbox of unwanted invitations to write papers for unknown journals specialising in areas I know absolutely nothing about. Emails of this type keep on coming, and I thought I’d share one directly with readers who may be interested. Remember, the additional sting in the tail is that if I ever do take one of these offers up I’ll probably then be asked to pay an author processing charge.

Today, the OMICS publishing group sent me this:

Dear Dr.Ben Hannigan,

Greetings from OMICS!
We are really happy to connect with an expert like you in the field of Journal of Civil and Legal Sciences which is a very important area of publication in our Journal of Civil and Legal Sciences.
We believe your potential in submitting a manuscript towards our journal and please let us know your response regarding this.
In the context of your busy timings or other professional commitments if you cannot agree to this, we expect you to suggest any other expert like you for this.
Hope to hear from you soon.

Nice to know that civil and legal sciences are an important area for OMICS to publish in their Journal of Civil and Legal Sciences. Who’d have thought it? I’ve actually hidden my personal expertise in this area very well, pretending instead to be an academic mental health nurse who knows something about systems, services, work and roles.

OMICS, you won’t be hearing from me.