Playing our Part

A short post this morning to draw attention to Professor Tony Butterworth’s Playing our Part review, this being something which occupied me towards the start of last week. With the support of the Foundation of Nursing Studies Tony is conducting a review of mental health nursing, by mental health nurses. I made the trip to the (very plush) King’s Fund headquarters in London’s Cavendish Square on Monday, where FoNs is currently in residence, to join an educators’ group discussing responses to a series of questions Tony had set for us in advance. The questions were of a type always easier to ask than to answer (‘how do you prepare students to uniquely become mental health nurses?’, and ‘do you think that students should be exposed to some form of basic psychosocial education skills at undergraduate level?’ being two examples). We talked lots about the interpersonal aspects of nursing, and the enduring importance of relational work, but also about the roles that mental health nurses fulfil in managing the system and coordinating care. I’ll be keeping an eye on the Playing our Part blog over the coming weeks as Tony continues his tour through the UK, meeting groups of nurses to draw out their views and experiences. The final report, as I understand it, is due to appear towards the end of the year. 

Elsewhere I’ve been working with co-conspirators to fine-tune next week’s #AfterWhitchurch ESRC Festival of Social Science event at Chapter in Cardiff. I’ll have to post something uniquely about that once we’re done. 

COCAPP Knowledge Transfer

Last week I joined the rest of the COCAPP team at an all-day event at City University London, designed to help NHS staff, service users and carers make use of what we found. I was pleased to meet Donna Kemp, who has since written about her experiences of the day. I thought it would be a nice idea to reblog this.

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Last week I was fortunate enough to be invited to the COCAPP Knowledge Transfer event held at City University London on 21st July 2016. You can read more about this here.

It was great to meet people face to face, beyond Twitter – particularly Alan Simpson (PI) Ben Hannigan, and Michael Coffey who are leading this important NIHR funded research, #COCAPPimpact.

Whats really good about this piece of research is that it is within my area of interest and that the method used aimed to address care planning on 3 levels – macro (national), meso (organisation) and micro (care delivery, face to face). To achieve this they used a mixed methods approach . The fabulousness of this is that it answered the research question on the 3 levels, perhaps anticipating that tackling one level in isolation would give rise to questions in the other levels. Adding to the credibility is…

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Mental health across the life course

NPNR twitter logoThe theme for this year’s Network for Psychiatric Nursing Research conference is Mental health across the life course. We’re convening in Nottingham on September 15th and 16th, and I’m very much looking forward. With help from André Tomlin (of the Mental Elf Service) we’re aiming to organise some pre-conference social media events: watch out for more on this, including via the new @npnrconf Twitter account. We’re also hoping to add some social media to the conference itself, including streaming. Very exciting.

Best of all, of course, is to come along to the conference as a delegate. This is an event which prides itself on its friendliness. Here are the keynote speakers:

  • Luciana Berger MP – Former Shadow Minister (Mental Health)
  • Elaine Hanzak, Inspirational speaker and author on perinatal mental health
  • Professor John Keady – Professor of Older People’s Mental Health Nursing, University of Manchester
  • Professor Steven Pryjmachuk – Professor of Mental Health Nursing Education, University of Manchester
  • Dr Bryn Lloyd-Evans – Lecturer in Mental Health and Social Care/ CORE Programme Manager, University College London

 

Research impact

Yesterday’s Health and Care Research Wales conference, held at the SWALEC stadium in Cardiff (more about that later), was all about closing the gaps between research, policy and practice.

There were some excellent keynote speakers. Jenny Kitzinger spoke of her research involving families of people who are minimally conscious, sharing her experiences of working with policymakers to influence at a national level. Jenny argued that impact is helped when research (1) has strong foundations, (2) is collaborative, and (3) is communicated through diverse outputs. ‘Diverse outputs’ means doing a whole lot more than simply writing journal articles (particularly those which end up behind publisher paywalls). For a direct example of how Jenny’s work influences, follow this link for a Parliamentary Office of Science and Technology POSTnote which cites a number of her and her collaborators’ publications.

André Tomlin, aka The Mental Elf, drew on his work with the National Elf Service to make the case for getting evidence into practice. This means communicating research findings in ways which are both understandable and accessible to practitioners. This, of course, is exactly what the Mental Elf Service does, using blog posts and other social media to share key research messages.

Steve Jones is a biologist known to many for his efforts to improve the public understanding of science. In his afternoon address he gave a fascinating account of working with government and the BBC. I liked his upbeat take on the past and present strength of UK science, but also noted his examples of scientific advice being flatly ignored or misused.

The day’s final keynote speaker was Malcolm Mason, whose talk emphasised the time it can take to generate research findings which have the potential to change care and treatment. Malcolm is an oncologist, specialising in prostate cancer, and his message for researchers wanting to make a difference is that they must ask questions which are important and not only interesting.

Worth mentioning, too, are yesterday’s workshops. Three were on offer, from which delegates had the chance to participate in two. As I have some experience in public involvement in research I elected to join the ‘impact on practice’ and ‘impact on policy’ options.

I enjoyed the day, and along the way also appreciated the chance to catch up with colleagues. Overwhelmingly, though, I am left thinking that the work of getting research into policy, services and everyday practice is something which needs to be planned for, and resourced. I also think most researchers (myself included) have some learning to do on this front, and perhaps need to develop some new skills and to make some new friends. In the past I’ve come across the Economic and Social Research Council’s impact toolkit, and yesterday was alerted to the existence of a study titled, A systematic review of barriers to, and facilitators of, the use of evidence by policymakers. Worth a read, perhaps.

Anyway…

I’ve now been to the SWALEC stadium five or six times for meetings, conferences and the like. I’ve never been there, though, to watch sport: the stadium being the home of Glamorgan Cricket. Perhaps I should rectify this at some point, as the idea of watching a match which might last days, involve beer (for spectators, if not players) and then end in a draw rather appeals.

 

 

#AfterWhitchurch

On the evening of Thursday November 10th at Chapter in Cardiff, as part of Cardiff University‘s contribution to this year’s ESRC Festival of Social Science, I’ll be joining friends from the School of Healthcare Sciences, the Whitchurch Hospital Historical Society, the service user community, the National Centre for Mental Health and the world of community arts for an evening reflecting on the changing mental health system. The event is free to members of the public, and further details (and a link for ordering tickets) can be found on our #AfterWhitchurch page.

For a snippet, here’s what we’re planning:

Whitchurch Hospital opened as the Cardiff City Mental Hospital in 1908. The transfer of its last inpatients to new purpose-built facilities in April 2016 provides a backdrop for an event reflecting on the changing shape of mental health care. In conjunction with the Whitchurch Hospital Historical Society and the National Centre for Mental Health, we will invite our public audience to review care as it used to be and care as it is now. We will draw on current Cardiff University mental health services research and use a range of historical and artistic media to maximise participation and provide variety.

Spread the word!

#NPNR2016 review 

I’m back from my annual trip to the International Network for Psychiatric Nursing Research conference, held this year in Nottingham and once again presented as a collaboration between MHNAUK and the RCN. 

This, the 22nd NPNR gathering, is the second for which I have served as a member of the conference organising and scientific committee. Our theme – trailed well in advance via our dedicated conference twitter account – was mental health across the lifecourse. We had some super keynote speakers: Elaine Hanzak, who spoke with openness about her recovery from postnatal mental illness; Luciana Berger MP, former Shadow Minister for Mental Health and President of the Labour Campaign for Mental Health, who demonstrated knowledge of, and commitment to, the field; John Keady, who spoke with passion about creative, biographical, approaches to researching the needs and experiences of people with dementia, including in his ongoing Neighbourhoods and Dementia programme; Steven Pryjmachuk, who made the case for nursing leadership in children and young people’s mental health research, and along the way gave a mention to the RiSC study; and Bryn Lloyd-Evans, who summarised the state of play in crisis resolution research, drawing (amongst other things) on the CORE programme. Our plenary sessions were expertly chaired by Wendy Cross and Geoff Dickens, and – as a first – this year’s event also included a partnership with André Tomlin from the Mental Elf Service and Mark Brown and Vanessa Garrity from the WeMHNurses community. This meant we had lots of social media and online discussion throughout the conference, recording of plenary sessions and a live-streamed pre-event round table evening discussion chaired by Alan Simpson. Here is a link to the recording, for those who missed it as it happened:

Once I have a link to the recordings of #NPNR2016’s keynote talks I’ll update this post with these, too. 

A note, too, on the conference’s workshops and concurrent sessions. I enjoyed participating in André Tomlin’s critical appraisal workshop, and with Elaine Hanzak writing a contribution during this to the blog post published on The Mental Elf website here. I also enjoyed our follow-up discussion on using social media, convened by André and Vanessa Garrity. I heard Nicky Lambert give two presentations (no less), and listened to talks from Karen Wright, Paula Libberton, Andrew Grundy and Ashlee Charles. There’s some great work going on out there, let it be said. That includes in COCAPP-A, Plan4Recovery and RiSC, all of which were presented in Nottingham.

As soon as we’re able, the conference organising committee will announce details of both dates and venue for #NPNR2017. Watch this space for an update. 

Recovery Colleges

Last month I had the opportunity to visit Gellinudd, the soon-to-be-opened recovery centre in Pontardawe run by the Welsh mental health charity Hafal. I was there with my Cardiff colleague Aled Jones, but also with Shu-Jen Chen (a former PhD student of mine: as an aside, follow this link for a copy of her thesis, which is on self awareness and the therapeutic use of self in Taiwanese community mental health nurses), four of her students from the College of Nursing at the Central Taiwan University of Science and Technology and one of our Cardiff mental health nursing students, Alys Jones.

Following this link takes you to the report of our visit published on the Hafal website, complete with photos. The Gellinudd Recovery Centre is opening at the beginning of 2017, and will be Wales’ first recovery college. Recovery colleges are a relatively new arrival within the mental health system; a useful introduction to them is this Centre for Mental Health briefing. The Gellinudd Recovery Centre buildings used to be an NHS hospital, and the whole is located in very pleasant woodland. Right now, Hafal is recruiting for registered nurses (and others) to work there.

Recovery, it has to be said, can mean different things to different people. This is one of the things we found in COCAPP, as we reported in our main findings paper. No shared understanding was revealed amongst people taking part in our interviews. Hafal write about what they believe ‘recovery’ means in their booklet, Recovery: the way ahead for people with severe mental illness. This is referenced in the job descriptions currently on the Hafal website as part of their current Gellinudd recruitment campaign. They place particular emphasis on empowerment, a whole person approach and progress. The term which will be used in the recovery centre to refer to people in residence is ‘guests’, and plans are in place to make the most of the centre’s green environment.

Elsewhere, #NPNR2016 is now only a few weeks away. We meet in Nottingham, and the conference promises to be an excellent one. I’ll aim to post some more about this at a later point.

Mental health and Europe

I am all for interdependence and collaboration, and take no pleasure in the prospect of the UK casting itself adrift from the European Union. With MSc students I have sometimes discussed global mental health, and policy in this area. This has included talking about work led by the EU. Derived from my teaching, here for information are some of the initiatives member states have taken together.

First is 2005’s Green Paper, Improving the mental health of the population: towards a strategy on mental health for the European Union. Green Papers stimulate discussion, and this one made its case for action with reference to the extent of mental health need across Europe, the cost to economies and the problem of social exclusion.

Next up is the European pact for mental health and wellbeing, which in 2008 presented five priorities against a background of rising rates of mental illness:

  • Prevention of depression and suicide
  • Mental health in youth and education
  • Mental health in workplace settings
  • Mental health of older people
  • Combating stigma and social exclusion

The Joint action mental health and wellbeing from 2013 uses its funds to address these five areas:

  • Depression, suicide and e-health
  • Community-based approaches
  • Mental health at workplaces
  • Mental health and schools
  • Mental health in all policies [which recognises how policy in non-health areas can have an effect on mental health]

The European Union also supports mental health research. Take, for example, the work of the ROAMER consortium which has agreed a series of research priorities. Here they are:

  • Preventing mental disorders, promoting mental health and focusing on young people
  • Focusing on causal mechanisms of mental disorders
  • Setting up international collaborations and networks for mental health research
  • Developing and implementing new and better interventions for mental health and well-being
  • Reducing stigma and empowering service users and carer
  • Research into health and social systems

For a comprehensive list of Horizon 2020 and FP7 projects in the field of mental health, try following this link.

Leaving the EU will greatly diminish opportunities for people in the UK to cooperate with people in Europe to tackle our shared problems, of which mental ill-health and its associated stigma is most definitely one. On the research front, post-EU referendum some in UK universities are already reporting that their collaborations with academics in other EU member states are under threat. Suffice to say I wish the vote on June 23rd had gone the other way.

Ordinary risks and accepted fictions

Ordinary risksThis new paper you need to read. You also can, because it is published in gold open access form and is therefore free to download to anyone with an internet connection. Lead authored by Michael Coffey, and arising from the larger COCAPP study (see also here, here and here), it draws on qualitative data to examine in detail what staff, service users and carers say about risk assessment and management. Here’s the abstract:

Background

Communication and information sharing are considered crucial to recovery-focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety.

Objective

Using data from our cross-national mixed-method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans.

Design

Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template.

Findings

Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment.

Conclusions

Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.

Reported here is one of the most important sets of findings arising from the COCAPP study. Diana Rose has written a post on the article, which is scheduled to appear on the inestimable Mental Elf site next week. I’m very much looking forward to reading that.

Resilience of community mental health nurses in Palestine

Earlier this week a new article lead authored by Mohammad Marie, and co-authored by Aled Jones and me, was published in the International Journal of Mental Health Nursing. The title of the article is Resilience of nurses who work in community mental
health workplaces in Palestine, and is the second paper arising from Mohammad’s completed PhD. As the article appears in gold open access form copies can be directly downloaded from the journal’s website for free: or indeed, by clicking either the hyperlinked title or image above.

The larger part of Mohammad’s qualitative dataset is interviews conducted with CMHNs working in the West Bank. Fifteen practitioners took part, from a total population of 17. For the record, that’s 17 community mental health nurses for a population of some three million people. That’s an astonishingly low number by UK standards; for more on mental health needs and services in Palestine, the place to go is Mohammad’s first paper (Mental health needs and services in the West Bank, Palestine) about which I previously blogged here.

Here is the abstract from this latest paper:

People in Palestine live and work in a significantly challenging environment. As a result of these challenges they have developed resilient responses which are embedded in their cultural context. ‘Sumud’, in particular, is a socio-political concept which refers to ways of surviving in the context of occupation, chronic adversity, lack of resources and limited infrastructure. Nurses’ work in Palestine is an under-researched subject and very little is known about how nurses adjust to such challenging environments. To address this gap in the literature this study aimed to explore the resilience of community mental health nurses (CMHNs) who work in Palestine. An interpretive qualitative design was chosen. Fifteen face-to-face interviews were completed with participants. Thirty-two hours of observations of the day-to-day working environment and workplace routines were conducted in two communities’ mental health centres. Written documents relating to practical job-related policies were also collected from various workplaces. Thematic analysis was used across all data sources resulting in four main themes, which describe the sources of resilience among CMHNs. These sources are ‘Sumud and Islamic cultures’, ‘Supportive relationships’, ‘Making use of the available resources’, and ‘Personal capacity’. The study concludes with a better understanding of resilience in nursing, which draws on wider cultural contexts and social ecological responses. The outcomes from this study will be used to develop the resilience of CMHNs in Palestine.

The idea of ‘Samud’ which is referred to above is an important one in Mohammad’s work, and (as I have learned) for Palestinian people. Drawing on the work of Toine Van Teeffelen, here is what Mohammad says about it in his thesis:

[Samud] is the art of living to survive and thrive on their homeland in spite of hardship and under occupation practices. These skills of how to live are used in different aspects of life such as economic, political and social. They can also be used at many levels: individual, family and within the Palestinian community. Moreover, Sumud has been divided into two types: tangible resources such as the infrastructure supporting basic needs (for example, schools and hospitals) which enable the existence of the Palestinians on their land and help them to be more resilient. In addition intangible sources of Sumud also exist, which include: belief systems, religion and social and family support which help the Palestinians to cope with their chronic daily collective suffering.

For Mohammad, Samud is closely related to the more familiar (to me, at any rate) idea of resilience. Or, more properly put, Samud connects to social ecological variants of resilience which place as much emphasis on the social and cultural as they do on the individual.

I’ll stop here and leave people to download and read this new paper for themselves. For those interested, Mohammad, Aled and I are working on further publications from this doctorate: so more will follow in due course.