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.
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.
The National Centre for Mental Health (NCMH), a NISCHR-funded research centre, has opened a consultation on future mental health research priorities for Wales. For more information, and instructions on how to make a contribution, follow this link. I see the NCMH is also planning a live Twitter discussion on Thursday August 21st 2014, between 7pm and 8pm. The hashtag pulling all of this together is #TellNCMH.
Here are my priorities, as submitted this morning:
How do we make mental health services more person-centred and collaborative, particularly at a time of financial constraint and cuts to public services?
What do service users need to promote recovery, and how can services be organised and provided in ways which reflect this?
What is shared decision-making in mental health, what are its effects, and what can be done to improve it?
New roles in mental health, including peer support: what is the impact on users, workers and organisations?
Understanding and improving the experiences of organising, providing and receiving mental health care across system interfaces (eg, transitions from home to community crisis services, or community crisis services to inpatient care, or from hospital to home, or from community CAMHS to inpatient CAMHS, or from 18-65 to older people’s services, or across interprofessional interfaces, etc).
In my response I made the additional point that parity of esteem means investing in mental health services and also in mental health research (see my recent post here). More generally, I suggested we need research into the causes of mental ill-health and distress and into actions and interventions (physical, psychological, social) which help, and research into the experiences of people receiving and working in services, and research into the organisation and delivery of services.
Time this morning, before I head off for a second day of MMI-ing, to draw attention to revised restructuring proposals from (and for) the National Institute for Social Care and Health Research here in Wales. I’ve written about the NISCHR review in this earlier post, and this latest document is the version which has gone out for external peer review.
I’m pleased to see that NISCHR proposes a continuation of its support for research capacity building in nursing and the allied health professions. Here’s a snip from the new document:
Research Capacity Building Collaboration (RCBC) – RCBC was established in 2006 as a collaboration between six universities in Wales to increase research capacity in nursing/midwifery and the allied health professions in Wales. It does this through a number of funding schemes including PhD Studentships and Post-doctoral Fellowships.
v. It is proposed that a new specification is developed for an application for renewal of RCBC/ a new initiative to increase research capacity in nursing/midwifery and the allied health professions in Wales.
For those not familiar with the RCBC scheme I recommend a visit to this website.
Elsewhere, I see that NISCHR proposes pressing ahead with its plans to close the gap between its funded Registered Research Groups, Biomedical Research Centres and Biomedical Research Units. It says:
There is a need to further integrate the functions of the BRC, BRUs and RRGs into the NISCHR infrastructure and to provide clear objectives and indicators to ensure NISCHR funding makes a real difference and contributes to future outcomes. There is also a need to avoid duplication and address the perception of NISCHR’s infrastructure being unnecessarily complicated.
b. It is proposed to create new entities known as NISCHR Centres and Units. These will replace BRCs, BRUs and RRGs and become central pillars of the NISCHR infrastructure to create a more streamlined and integrated structure, improve cost-effectiveness and foster collaboration across sectors to facilitate translation.
c. It is proposed that NISCHR Centres will have responsibility for portfolio development and delivery in their areas across the translational spectrum, in collaboration with other elements of the infrastructure. In some instances they may also provide elements of infrastructure support themselves.
d. It is proposed that NISCHR Units will be smaller entities than NISCHR Centres and focus on specific points of the translational spectrum, specific activities, or represent emerging areas of research strength with aspirations to become NISCHR Centres in the future.
e. It is proposed that a competition is held for NISCHR Centres and Units; the existing BRC, BRUs and RRGs will be able to apply and be encouraged to consider how best to augment existing functions and strengths to become more integrated entities in the future. They may also incorporate the functions of other elements of the existing infrastructure. The NISCHR Centres and Units will have a Director, Operational Manager and Leads for specific specialties/areas. They will be multi-professional and multidisciplinary, including Public and Patient, NHS, HEI, Industry and Social Care representation as appropriate.
This is a significant, if not unexpected, proposal. As future arrangements begin to become clearer I’ll be looking for ways to make sure that research into mental health systems and services continues to be supported. Plenty to think about, then, as I head for the train.
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?
Generic vs Specialist MHN training
Measures of Compassion
Effects of selection procedures for MHN students and staff
Nursing and PTSD
Tool development
Risk assessment and MHN
The 6 Cs and MHN
Mental capacity and issues of consent
Racism and stigma in MHN
Values and beliefs and how they impact on practice
Mental health and the performing arts
MHN training and learning disabilities
MHN views on developments that may threaten MHN, e.g. peer support, self-care
Physical healthcare in secondary mental health care settings
Philosophy and MHN: The Art of Living
Identity and body image in people with MI
Community and third sector organisations and how they link with mental health teams/services
Communication, especially information giving and the first contact
Culture and ‘cultural safety’ as a useful model
Fear – underpinning MHN and service user behaviours
Brokerage roles, self-care and MHN
Workforce planning and nurse education/training and physical/mental health divide
Evaluation of education/training and preparation of MHNs for the job
Recovery and MHN interventions
MHN interventions to maximise engagement
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:
What do mental health nurses do?
What do/can mental health nurses do which promotes recovery and individually tailored care?
What do/can mental health nurses do to better promote physical health and well-being in people with severe and enduring mental health difficulties?
What do/can nurses do to help people in their journeys into, through and out of the mental health system?
What are mental health nursing values, and what difference do/can they make?
How are/should students of mental health nursing be prepared for practice?
How can nurses use new technologies to improve care and its organisation?
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.
[…] 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.
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.
The day has been an interesting one. Len Bowers reprised findings from his Safewards trial (and very important they are, too). Ian Hulatt and Joy Duxbury led a discussion on positive behavioural support. PBS? Not something I know much about, I have to confess. The possibility of establishing research priorities for mental health nursing was also explored. I now realise, as I type, that a discussion on Twitter is taking place on what these priorities might be. A similar round is taking place on themes for future MHNAUK meetings. Time to dive in, perhaps?
Here’s what will probably be a final Hay Festival-related post. Last Thursday the Nobel Laureate Professor Sir John Sulston chaired a discussion titled The Next Big Thing. This began with four researchers talking about what they do: Alison Rust, a volcanologist; Zita Martins, an astrobiologist; Nicole Grobert, a nanotechnologist; and Jenny Nelson, a physicist working on materials for solar cells.
All gave fascinating talks, and exemplified the art of conveying complex ideas to the interested but non-specialist listener. And who doesn’t want to hear about supervolcanoes (for the record, they’re bad news, and are definitely best avoided)? Or amino acids from space, the practical applications of graphene or comparing different ways of capturing energy from the sun?
This discussion has since got me thinking about the Next Big Things in nursing and midwifery research (and mental health nursing research in particular). Generally nurses do not do fundamental or basic science, and are not in the business of discovering how bits of the natural world work. So, no volcanoes or extraterrestrial chemicals for us. But practical applications of health-related technologies, and exploring and comparing different ways of doing health work? That’s more up our street, I think, even if graphene and solar power are unlikely to immediately feature.
River Wye, Builth Wells
To the applications-of-technology and exploring-and-comparing questions which might be asked within mental health nursing I would personally add some others related to the examination of health and health care experiences. We know that mental health nurses do ‘people work’ in a big way, spend much of their time coordinating (or ‘articulating’) complex trajectories of care and are often present during service users’ critical junctures. There are applications of skill and technology in this, and how nurses do their work and the effects this has are wide-open areas for study. COCAPP, as I’ve mentioned on this site before, is aiming to distil the components of care planning and care coordination associated with recovery-oriented and personalised mental health services, and is a great example of applied research in this broad field. I’d like to think that its findings will, in some way, be directly useful to practitioners and others in the fullness of time.
Thinking of Graham Thornicroft’s recent editorial on the poor physical health of people using mental health services, referred to on this blog here, if asked to give their research priorities now perhaps some would make a case for researchers and practitioners to combine their efforts to seriously improve this situation. I know there are people working in this area already, but given the magnitude of the problem it seems to deserve some serious new investment. And how about extending research into the mental health nursing contribution to the vital care of older and vulnerable people, including those with dementia? Again, there are people, such as John Keady, doing this already, but possibly not in sufficient numbers. Or research in the area of quality improvement and safety? And what about workforce research, including studies into factors sustaining nurses’ resilience to provide care in conditions of adversity?
However they might be identified and emerge I suspect that any Next Big Thing candidates for nursing research will be the products of sustained collaborations. To return to last Thursday’s four discussants at Hay: all were explicit about interdisciplinarity, and the importance of crossing boundaries to do high quality research aimed at answering ‘big questions’. There are established academic mental health nurses doing this already (I’m thinking of people like Len Bowers, Karina Lovell, Patrick Callaghan and Alan Simpson), but more of us need to make friends with colleagues possessing specific substantive and methodological expertise relevant to our intended studies. Depending on the questions at hand this might mean finding collaborators with disciplinary backgrounds in various of the social and physical sciences and in the humanities, and if necessary with experience in the practical conduct of clinical trials, qualitative investigation and so on. Crucially, and arguably most importantly, it also means forging meaningful collaborations with people with experience of using services, whose priorities are the ones which really matter.
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.
Ben Hannigan's blog 