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.
Meanwhile, 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.
A brief post whilst away for a week of walking, crowned by this photograph of the sculpture in New Quay marking the halfway point along the Wales Coast Path. A short search online reveals that it was recently made by David Appleyard. A very fine job he’s made of it, too.
Another quick search online finds evidence of walking as being good for mental health. No great surprises there, then, including the point made at the end of the abstract that outdoor walking confers greater benefit than walking indoors. Here, too, is a link to an excellent project run by colleagues in the School of Healthcare Sciences in Cardiff involving walking groups for people who are homeless.
Mental health nursing is important and fulfilling work, and offers a fine and rewarding career. More people also need to be doing it. By way of background, last month Mental Health Nurse Academics UK (MHNAUK) submitted a response to Health Education England (HEE)’s Facing the Facts, Shaping the Futuredraft health and care workforce strategy for England to 2027. Contained in this HEE draft are figures on trends in the numbers of nurses, by field of practice, employed in NHS England over the period 2012 to 2017.
Obvious at a glance from this figure is the decline in both mental health and learning disability nursing numbers over time. Elsewhere HEE also describes a 14% mental health nursing vacancy rate.
Now, the Nursing Times reports a reduction for the second year in a row (£) in the numbers of applications for nursing degrees received via the Universities and Colleges Admissions Service (UCAS). Declining applications need to be viewed in the context of the removal of bursaries for students of nursing enrolling at English universities. In MHNAUK we have said, more than once, that we fear the loss of bursary support poses a particular threat to our field of practice. The same applies to learning disability nursing, where at least one degree programme closed last year (£).
With all this in mind this may be a good time to remind people of this useful page, hosted on the MHNAUK website, on joining the profession. As this says:
Forget all the stereotypes about straitjackets and Victorian asylums; modern mental health nursing focuses on helping and supporting people from all walks of life with a variety of ‘common’ mental health disorders (such as anxiety and depression) as well as more serious disorders such as drug and alcohol problems, suicidal feelings, psychosis, bipolar disorder and dementia. They also play a key role in promoting mental health and well-being among the public and preventing mental health problems occurring in the first place.
On November 6th 2017 the School of Healthcare Sciences welcomed Alan Simpson from City, University of London to give a talk titled, Full-steam ahead or treading carefully? Reflections on public and patient involvement in health services research.
In warm and engaging style Alan drew on a whole programme of mental health research (including the City 128 study, Safewards, COCAPP, COCAPP-A and ENRICH) to share his experiences of involving service users at every step. Alan began with an exploration of the reasons for involving patients and the public in research, and drew on his case studies to provide examples of different methods and approaches in action. He closed with lessons learned, emphasising the importance of time, resources, flexibility, training and support, and having funds to pay people for their time and expertise.
Cardiff welcomed delegates to the 23rdInternational Mental Health Nursing Research Conference (#MHNR2017), which took place at City Hall on September 14th and 15th 2017. This was the conference’s first visit to Wales, with the theme for the year being Imagination, Invention and Inquiry. Papers were welcomed emphasising the need for new ideas, new research and new ways of providing services. As a curtain-raiser, with the involvement of André Tomlin (aka The Mental Elf), keynote speakers took part in a pre-conference streamed webinar which can still be viewed here.
#MHNR2017 (which, as readers of this blog will know, was until last year known as the Network for Psychiatric Nursing Research Conference), was again organised jointly by Mental Health Nurse Academics UK (MHNAUK) and the Royal College of Nursing. It remains the UK’s leading annual event of its kind. I was pleased to serve as chair of the conference steering committee for this year, and got to open proceedings with a short welcome address.
Across the two days keynote speakers (all of whom were live streamed: see below) were Professor Joy Duxbury, who drew on her programme of research into reducing restrictive practices; Dr Phil Cooper, Danny Sculthorpe and Jimmy Gittins who gave inspirational talks drawing on the personal experience of mental distress and their work with State of Mind; Dr Jay Watts, who challenged delegates to embrace the idea of trauma-informed care; Dr Michael Coffey, who spoke as one of two inaugural MHNAUK Lecturers about the problem of assessing risk; Professor Paul French, also an inaugural MHNAUK Lecturer, who talked about his programme of research into psychosis; and Professor Gary O’Reilly who introduced his research into the use of computer games as a vehicle for the provision of psychological therapies for young people with mental health difficulties.
Here are the saved live streams from our excellent keynotes for those who are interested. Eventually we’re hoping to upload higher quality recordings to our conference YouTube account:
Elsewhere I heard some outstanding presentations from colleagues elsewhere in the UK and around the world, and was particularly heartened to listen to and to meet student nurses. Thanks for coming, everyone.
Planning for #MHNR2018 will begin shortly, with updates available via the conference twitter account which can be found here.
The Nursing and Midwifery Council is consulting on its programme of change for education. Information can be found here, and there’s a lot of it. Mental Health Nurse Academics UK (MHNAUK) will be submitting a response, with Anne Felton from Nottingham University (who leads MHNAUK’s Education Standing Group) coordinating this work.
On July 11th, with mental health nurse academic colleagues in the School of Healthcare Sciences in Cardiff I spent part of our annual summer away day formulating a team response to the NMC’s proposals. Once we’re happy with the content we’ll be forwarding it to Anne, and simultaneously submitting directly to the NMC.
Individually and collectively, other mental health nurses will be formulating responses too. For now, the NMC confirms that the four nursing fields (mental health, adult, child and learning disability) will remain. For an explanation of the importance of preserving mental health nursing as a pre-registration speciality, follow this link for MHNAUK’s relevant position paper. But, as MHNAUK Chair Steven Pryjmachuk pointed out last month in this piece (£) for the Nursing Times, the list of nursing procedures contained in the NMC’s draft standards of proficiency is heavily skewed towards the adult field. This is the Cardiff University mental health team’s concern too, and we’ll be saying so (with specific examples) in our response. Another place for this (and any other) view to be given is at this forthcoming WeMHNurses chat:
Meanwhile, last week ended with two days of professional doctorate teaching. With Nicola Evans I lead a module which addresses working in, and examining, complex systems of health and social care. We’ve run this module before, and as always the student group was a lively and engaged one. Amongst the things we discussed together are the connections running within and between systems of different scale, and the sometimes unforeseen consequences of introducing change. These are matters about which both Nic and I have written (see here, here, here and here).
To link the two parts of this post together: the NMC is a big player, and for better or worse its programme of education reform will trigger significant disruption. A systems thinking perspective encourages us to consider the possible impact of the NMC’s proposals alongside other sources of change. These include the introduction of fees for student nurses in England, the arrival of nursing associates and reductions in the size of the UK’s registered nurse workforce. As cumulative shifts take place I’m hoping mental health nursing as a distinct profession emerges intact, with its current and future practitioners able to fulfil their places in a system which continues to very much need them.
Here in Wales, the duty to calculate nurse staffing levels is currently limited to adult acute medical and surgical inpatient wards. In each NHS organisation with responsibilities in these fields, the Government’s draft document refers to the appointment of a ‘designated person’ with the job of calculating nurse staffing levels using three elements:
use of an evidence-based workforce planning tool; and
a consideration of the extent to which patients’ wellbeing is sensitive to nursing care.
Making these calculations, I can only imagine, will be a mighty challenging task requiring in-depth understanding of individual wards, the characteristics of patients admitted, and use of a tool which has (so far as I understand it) yet to be finalised.
Meanwhile, via John Baker I learn today of this new publication by NHS Improvement on safe, sustainable and productive staffing in mental health services. This is not about safe nursing staffing, but is about interprofessional staffing in specialist mental health services. Here I read of expectations around right staff, right skills and right place, right time and also spot a rapid review of the relevant literature. This begins with the understated observation that, ‘the issue of safe and sustainable staffing in mental health is complex and research is lacking’. I should say so. The time is ripe, I think, for some serious independent studies in this area.
The closure of Whitchurch Hospital to inpatients in spring 2016 provided the backdrop for #AfterWhitchurch, a collaborative Economic and Social Research Council (ESRC)/Cardiff University Festival of Social Science event focusing on the changing system of mental health care hosted at Cardiff’s Chapter Arts on November 10th 2016.
Whitchurch Hospital opened as the Cardiff City Mental Hospital in 1908, the image below being the first entry on the first page of the hospital’s visitors book.
Members of the hospital’s Historical Society were on hand with objects, documents and photographs from their archive. Artist and director Elaine Paton presented and talked about her work with Moment(o)s of Leaving, a multimedia performance produced to mark the occasion of the hospital’s closure. Audiorecorded interviews, created for Momento(s) of Leaving by artist/curator and researcher Julia Thomas, recounted staff members’ reflections on leaving Whitchurch and their thoughts for the future.
Chaired by Norman Young from Cardiff and Vale University Health Board, School of Healthcare Sciences and service user researchers discussed how mental health care has shifted from hospital to the community, and shared reflections from research into the organisation of services, the work and experiences of service users and staff and the provision and evaluation of novel psychological interventions.
Ben Hannigan talked about using in-depth case methods to understand mental health services at different levels of organisation, and Nicola Evans discussed her research into the mental health of children and young people. Dean Whybrow drew on 18 years of experience in the Royal Navy to describe how mental health support and interventions is provided in the military. Alan Meudell shared his reflections on being a service user researcher, and Bethan Edwards spoke of her dual identity as an occupational therapy researcher investigating care for older people with dementia and as a service user researcher. Stimulating and informed questions from the floor challenged the panel to think about stigma, the impact of research on changing practice and services offering respite and asylum.
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.
Not for the first time, I’ve attempted to produce some cumulative insights from the past and present mental health research studies I’ve had the opportunity to work on. These include my PhD investigation into work and roles in community mental health care, my post-doctoral study of crisis services, and more recent projects which Alan Simpson, Michael Coffey or I have led on.
The prompt, on this occasion, has been the chance to give a presentation at a School of Healthcare Sciences research seminar taking place this afternoon. For anyone interested, here is the PowerPoint I used. I opened with some general comments on the need for mental health research, and on the funding landscape. I then had some things to say about theory, design and methods. Many of the individual slides have hyperlinks to green open access publications: