Mental Health Nurse Academics UK meets in Nottingham

I was unable to make Thursday evening’s Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement event hosted by Patrick Callaghan at Nottingham University. My congratulations to Ian Norman and to Marion Janner, this year’s very worthy award winners. As it happens, Ian was one of my PhD examiners. My following of Thursday’s proceedings from afar, via Twitter, tells me I missed a treat.

I was, however, able to make the trip to Nottingham for Friday’s summer term meeting of Mental Health Nurse Academics UK (MHNAUK). This was held in the new, and rather impressive, Institute of Mental Health building:

Here’s a picture I took of the sculpture, titled House for a Gordian Knot, displayed at the entrance to the Institute’s main building:

We had three local presentations. First up was  Paul Crawford, who gave a broad overview of the Creative Practice as Mutual Recovery research programme which he leads, followed by Andrew Grundy giving an account of qualitative findings from the Enhancing the Quality of User Involved Care Planning in Mental Health Services (EQUIP) study. EQUIP is an important, NIHR-funded, programme of work which (along with COCAPP and COCAPP-A) is producing evidence of how care planning is being done and how it might be improved. Here’s a photo, taken and shared by Karen Wright, of one of Andrew’s final slides outlining steps to successful user involvement in this process:

Tim Carter talked us through his freshly-minted mixed methods PhD, in which he investigated the use of a preferred-intensity exercise programme for young people with depression. I thought this to be a very well-designed study, which generated considerable discussion around the active ingredients of the intervention and plans for a future follow-up.

Elsewhere Lawrie Elliott, editor of the Journal of Psychiatric and Mental Health Nursing, was welcomed by the group to give an update on developments at the journal in his first year at the helm. I really liked what I heard, and said as much in our discussion. Quality of papers, and relevance to mental health nursing, are being prioritised. Word limits have been increased to allow for more in-depth analysis in accepted articles. To extend its reach the journal now has a Twitter account, which can be followed by clicking the following link:

Ben Thomas from the Department of Health opened a discussion on the future of the Student Mental Health Nursing Conference, the inaugural event having taken place at the O2 Arena in London in February this year. As I understand it, much of the organising was done by staff and students at Greenwich University: well done, them. A group of MHNAUK members representing different universities has agreed to collaborate to keep this initiative going, and with a view to turning it into a cross-UK, rather than an England-only, opportunity.

Following David Sallah’s meeting with MHNAUK in York in March 2015, Joy Duxbury and Steven Pryjmachuk chaired a discussion on the current status of the Shape of Caring review. Since returning from Nottingham I have found that Health Education England is planning to sound out opinion through a series of events running into the autumn. Details are to follow.

Thanks particularly to John Baker, in the weeks leading up to this latest meeting MHNAUK published a response strongly criticising the announcement that the National Institute for Health and Care Excellence (NICE) was ending its work in the area of safe staffing. This decision, defended two days ago by Jane Cummings (Chief Nursing Officer at NHS England), has also been challenged by others including Sir Robert Francis and now the Council of Deans of Health. The Safe Staffing Alliance campaigns in this area, and MHNAUK will continue to make a contribution via a further response the outline of which was agreed in Nottingham. As a reminder of some of the key evidence supporting the importance of registered, graduate, nurses for quality and safety follow this link to an earlier post on this site and this link to a recording of Linda Aiken delivering the Winifred Raphael Memorial Lecture at the University of South Wales on October 1st 2014. And, for those interested in how #safestaffing is shaping up differently across the countries of the UK, follow this link for a record of the progress of the Safe Nurse Staffing Levels (Wales) Bill through the National Assembly for Wales. Following this link brings you to a report reviewing the evidence, commissioned by the Welsh Government and produced by a team led by Aled Jones in the Cardiff School of Healthcare Sciences.

Fiona Nolan shared progress on her survey of mental health nursing research interests and expertise in UK higher education institutions. And, finally, on behalf of the organising and scientific committee Russell Ashmore, Laoise Renwick and I took the chance to update MHNAUK members on progress for the 21st International Network for Psychiatric Nursing Research conference.

#NPNR2015 takes place at the Manchester Conference Centre on Thursday 17th and Friday 18th September 2015. We think the programme is shaping up perfectly, with keynote speakers including England’s National Clinical Director for Mental Health Dr Geraldine Strathdee, Prof Shôn Lewis from the University of Manchester, Mark Brown who ran One in Four magazine and is now involved with The New Mental Health, and André Tomlin who runs The Mental Elf service. We have symposia, workshops and concurrent sessions with papers accepted from presenters around the world, a walking poster tour and the opportunity for fringe events. Make your booking now!

Spring election, and the politics of mental health

It hasn’t always been like this, but mental health is something which politicians now talk about. In the run-up to next week’s general election mental health has even featured in public appeals to voters. The Liberal Democrats have particularly campaigned in this area, and in their manifesto promise £500 million per year for better mental health, and specifically make a case for investing in research. Labour talk about giving mental health the same priority as physical health, and the Conservatives say pretty much the same. Reviewing all the main parties’ manifesto promises for evidence of concrete plans for post-election improvements to mental health care, over on his blogsite the Psychodiagnosticator observes ‘that many of them were so vague as to amount to no promise at all‘. I think he has a point.

Possibly the broad manifestos produced in the run-up to a general election are not the places to look for fully worked-up blueprints of what future mental health policy across the UK might look like. Perhaps, more accurately, we should not think about ‘UK policy’ in this context at all. Members of Parliament elected to Westminster next week, from amongst whom a new government will be formed, will have authority to directly shape services in England only. Health and social care remain areas over which devolved authorities have jurisdiction, and for a ballot delivering a government with the power to pronounce on mental health care here in Wales we must look to the National Assembly elections to be held in 2016. I’ve indicated before that mental health policy here is different from that in England, and indeed from other countries in the UK. Consider again the case of the Mental Health (Wales) Measure. This is a piece of legislation for Wales alone, mandating for care and treatment plans, care coordinators, access to advocates in hospital and the right of reassessment within secondary mental health services following discharge. It was introduced in the face of some strong, pre-legislative, criticism from at least one senior law academic (Phil Fennell) who in 2010 began his submission to the National Assembly by saying,

The gist of my submission to the Committee is that this measure, although well-intentioned, is cumbersome, unduly complex, and will lead to a delay in providing services which ought to have been available already to service users and their families in Wales under the National Service Framework for Adult Mental Health and the Care Programme Approach.

Five years on the Measure has not only passed into law, but been subjected to a round of post-legislative scrutiny by the National Assembly’s Health and Social Care Committee (see my post here), to which the Welsh Government has now responded. With data from across both England and Wales, COCAPP (and in the future, COCAPP-A) will have something to say about how care planning and care coordination are actually being done, and readers will be able to draw their own conclusions on the extent to which changes in the law trigger changes to everyday practice. And, whilst we’re in policy comparison mode, for a view from Scotland try Paul Cairney. He argues that divergence in mental health policy across the UK, exemplified by contrasting English and Scottish experiences of reforming the law, reflect differences in both the substance of policy and in policymaking style.

In all of this I am, again, reminded of the wicked problems facing all policymakers who seek to intervene in the mental health field. Whatever direction it takes, future policy will be open to contest and will surely trigger waves of consequences.


FieldworkToday brought some interesting discussions on qualitative fieldwork, including on researcher roles and relations during data generation. First up was a COCAPP-A project meeting which included a conversation about observational methods in inpatient mental health settings. Second was a seminar led by Michael Coffey‘s PhD student Brian Mfula, drawing on his ongoing PhD experiences of ethnographic fieldwork centring on care planning and care coordination in forensic mental health care.

Brian shared his experiences of negotiating access, and of his reading and thinking about insider and outsider roles. This led to a wide-ranging talk amongst those present on fieldnotes and approaches to qualitative research (Grounded theory, anyone? Phenomenology? Or perhaps thematic analysis is more your thing?). We talked, too, about reflexivity, and knowing when (and how) to leave the field. Along the way this took us to the National Centre for Research Methods’ excellent Review Paper, How many qualitative interviews is enough?

Around ten years ago I contributed a chapter covering some of this territory to Davina Allen and Patricia Lyne’s edited book, The Reality of Nursing Research: Politics, Practices and Processes. Titled Data generation, this contrasted survey principles and practices in The All Wales Community Mental Health Nursing Stress Study with the ideas and methods in my (then-ongoing) ethnographic PhD, Health and Social Care for People with Severe Mental Health Problems. I wrote about decision-making, and the extent to which data are interactionally produced by researchers and participants together:

Whilst different strategies place different expectations and demands on nurse researchers, this chapter has also shown that – whatever approach is followed – data generation is always a purposeful activity demanding a reflexive stance. The principle of reflexivity underpins the idea that research always takes place in contexts, shaped to significant degree through an interaction between researcher and researched. The character of data produced in a study is moderated by aspects of the researcher’s personal biography and their interaction with research participants. This is a well-established principle in the social sciences. In nursing research, however, reflexive investigators have to give consideration not only to general biographical aspects such as age and gender, but also to their specific occupational backgrounds and practitioner experiences. A self-conscious, reflexive approach includes acknowledgement of the utility and the limitations of practitioner knowledge, and the implications of this for data production.

I’m now thinking that today’s seminar and discussions show how live these issues remain, and will ever remain so.

REF results out, COCAPP in

The publication of results from the Research Excellence Framework 2014 (#REF2014) has made this a big week for universities. REF is important for lots of reasons. First, it is assumed that recurring, quality-related (QR), research funding from the UK’s four higher education funding councils will be weighted to the REF results (I say ‘assumed’ here in the light of reports, today, on possible changes to the dual support system: see below for more). Second, universities and the departments within them are ranked based on REF outcomes, making the exercise a crucial one for relative reputations. Third, for governments the REF (like the various research assessment exercises (RAEs) before it) is a way of showcasing the value of research investment and the wider benefits this brings.

Universities will have followed different strategies in managing their REF submissions. In Cardiff a selective return produced a result comfortably better than had been aimed for with the University now ranked in the top five based on research quality. Check out this short video for an overview:

As I hinted above there are, already, questions being asked of how the REF results will (or will not?) be converted into future funding. A report in today’s Observer suggests that changes may be afoot to the dual support (QR and programme/project-related) system. Here’s an early morning tweet from Phil Baty at the Times Higher Education:

So that’s an evolving story which deserves to be closely watched.


…moving from research in the round to research projects specifically, this has also been the week that our draft final report from COCAPP has been submitted for peer review to the NIHR Health Services and Delivery Research Programme:

COCAPP has been an investigation into care planning and care coordination in mental health services, and has already been partnered by COCAPP-A. This related study is asking questions in the hospital setting similar to those asked by COCAPP in the community. The coming year sees COCAPP-A getting into full swing, with qualitative and quantitative data being generated across multiple NHS sites in England and Wales.

Summer research catch-up

Some time away and pressure of work explain the absence of recent posts on this site. So here’s a catch-up. In COCAPP, data generation and analysis are pressing ahead, whilst COCAPP-A (which is asking questions about care planning in acute mental health hospitals) has officially commenced. Plan4Recovery (which is concerned with shared decision-making and social connections for people using mental health services) is generating data. The draft final report from the RiSC study has now been peer reviewed and is back with us, the research team, for revisions. Methods and findings from this project (an evidence synthesis in the area of risk for young people moving into, through and out of inpatient mental health hospital) were also presented last month at the CAMHS conference at the University of Northampton. Many thanks to Steven Pryjmachuk for doing this.

Further conference presentations, from all but COCAPP-A, will also be delivered at this year’s NPNR conference. And, for the first time, I’m off to an event organised by Horatio: European Psychiatric Nurses. Horatio is a member of ESNO: European Specialist Nurses Organisations, and the event I’m speaking at in November is the 3rd European Festival of Psychiatric Nursing. One of the papers I’m delivering is titled, ‘Mental health nursing, complexity and change’. Here’s my abstract:

In this presentation I principally draw on two studies conducted in the UK to share some cumulative insights into the interconnected worlds of mental health policy, services, work (including that of nurses) and the experiences of users. I first set the scene with a brief review of the historic system-wide shift away from hospitals in favour of care being increasingly provided to people in their own homes. I emphasise the importance of this development for the mental health professions, and show how community care opened up new jurisdictional opportunities for nurses, social workers and others. I then draw on data from a project using a comparative case study design and ethnographic methods to show how the everyday work of mental health nurses (and others) is shaped both by larger jurisdictional claims and the contextual peculiarities of the workplace. From this same project I also show how the detailed, prospective, study of unfolding service user trajectories can lay bare true divisions of labour, including the contributions made by people other than mental health professionals (including support staff without professional accreditation, community pharmacists and lay carers) and by users themselves. I then introduce the second study, an investigation into crisis resolution and home treatment (CRHT) services, with an opening account of the unprecedented policymaking interest shown in the mental health system from the end of the 1990s. CRHT services appeared in this context, alongside other new types of community team, and I draw on detailed ethnographic case study data to examine crisis work, the wider system impact of setting up new CRHT services and the experiences of users. I close the presentation overall with some reflections on the cumulative lessons learned from these linked studies, and with some speculative ideas (on which I invite discussion) on the continued reshaping of the mental health system at a time of economic constraint, health policy contestation and political devolution.

I’ve given myself something of a challenge in attempting all this in a single concurrent session, but I’ll do my best and can signpost interested participants to papers I have published in these areas. One of my reasons for heading off to the Horatio event (in Malta, as it happens) is to make connections with international colleagues, with whom I might usefully share my projects, interests and ideas and perhaps find common ground.