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A blog by Elvira Perez Vallejos, Associate Professor of Digital Mental Health, Mental Health and Technology theme. I recently attended a workshop at the Royal College of Psychiatrists to discuss and reflect on the impact of digital technology on the future of mental healthcare. This workshop was part of the Topol review which is aiming at preparing the NHS healthcare workforce to embrace current and future digital developments for mental healthcare.

Interview and commentary from Mercè Santos Mir.
Every year #MentalHealthAwareness day steps into the limelight for its annual day of recognition, but has  it ever truly left? Mental health awareness is increasingly becoming a daily conversation between friends, family, colleagues and health service providers across the country and abroad – breaking down a little piece of the taboo topic each and every time we discuss anxiety, depression, schizophrenia and all the other conditions that fall under the mental health umbrella.
We caught up with our Exhibitions Curator at the Institute of Mental Health , Mercè Santos Mir, who has worked closely with artists who deal with issues of mental health within their practice, who put theirs and others' inner-experiences on canvas for all to see, to raise awareness and break down the barriers we face in the introverted dark of battling against a mental health condition.

Commentary written by professor Peter Bartlett
Sec State (Justice) v MM; Welsh Ministers v PJ, [2017] EWCA Civ 194
This was the conjoined appeal of two cases, concerning ostensibly similar programmes regarding release from hospital of people with mental health problems who require continued care in the community.
MM concerned conditional discharge under section 73.[1]  This mechanism affects people detained through the criminal provisions of the MHA (‘Part III patients’) who are subject to a ‘restriction order’ (s 41) – that is, they can only be released by the Secretary of State or, as in this case, a review tribunal.  A conditional discharge may be made when the tribunal considers that the criteria for ongoing psychiatric detention are no longer met, but where it considers that appropriate that should remain liable to be recalled for further treatment.  As the name suggests, the order allows conditions to be placed on discharge – typically determining where the individual will live, that he or she will comply with prescribed treatment, what medical supervision he or she will receive, that he or she will refrain from use of alcohol or drugs, and sometimes that he or she will not meet with former associates, or not go into particular geographic areas (eg., not near the home of a former victim, or not to go near schools, if the index offences involved children).

Integrating Care: Finding Commonality Between Organisations to Implement Best Practise

Neil Chadborn, Zvezdan Bozinovski Photography.

Neil Chadborn’s research focuses on inter-professional and inter-organisational aspects of integrated care for older people. He is currently involved in the PEACH project, to understand how a Quality Improvement Collaborative (QIC) can help organise healthcare services in care homes – and has an Alzheimer’s Society Knowledge Exchange Fellowship, exploring how services within a community can work together and with people living with dementia. We talked to him about the challenges of providing truly integrated care and why networks may provide a more inclusive way to enable people to access support according to their needs.

Someone close to me asked me which psychiatric tablet that I take helps me the best. I thought for a few seconds and then replied that actually it wasn’t a pill that helped me the best, but a ‘thing’ - validation. They replied quite honestly that they didn’t know what validation was. So I told them...........

I have blogged before about my journey of mental health distress, about how I found peer support and became an accredited peer support worker. I have blogged about relapse and how that has shaped my journey - I have talked about some of the challenges I have encountered on my recovery road, but now it’s time to talk about things that really matter to me. The things that are forming the concrete foundations that I am building, tools that I can use in my own recovery but also tools I can use to help those I have the privilege of working with.

So, to validation, I could easily give you many a dictionary definition to peruse but in short, validation is making someone’s experience ‘valid’, ‘real’ and ‘true’. If you can do this for someone then you have the power to help them in greater ways than any medication, I believe. Let me give you some examples. I have recently experienced a rapid relapse, that was scary, full of visual and auditory disturbances and scary shadows that were everywhere. For those of you that have experienced such things you will know that telling someone who works in mental health services what you can see and hear is very hard - you worry what they will say, you worry they will call a mental health act assessment - you worry that they will take away your choices - but above all, for me anyway, you worry they won’t believe you! To share something so scary, to ask for help is something I find really hard, and sadly in the past, people have said things like ‘pull yourself together’, or they try to minimise your experience by saying ‘oh it’s all in your mind’ or ‘other people have it worse’.

How wonderful and powerful it is then, to be with someone who will truly validate what is happening to you - they will say things like ‘that must feel so scary Clare’ or ‘I can’t imagine what that must feel like Clare’. Or even ‘I believe you, and I believe in you’. Thus acknowledging that they can’t take those experiences away but they can sit with you in your distress and help you find fresh avenues to reduce the intensity of your emotions. Validation, when truly experienced can help to safely minimise your distress and for me it creates strong bonds of trust that allow you to walk bravely in the darkness of your experience. How powerful is that?!

I love this quote by Danielle Bernock which says:

 “Trauma is not personal, it does not disappear if it is not validated. When it is ignored or invalidated the silent screams continue internally, heard only by the one held captive. When someone enters the pain and hears the screams, healing can begin.” Validation is so important, so crucial to healing and recovery, yet many people jump to fix or dismiss the suffering being felt. This can be equally frustrating for both parties.

When I think of my own relapses, I can recall occasions where I felt unheard, yet was desperately screaming inside for help. I can also think of times more recently where someone has said ‘I hear you’ and the difference it makes is truly amazing.

Being a peer support worker, the reciprocity of sharing feelings and experiences is so powerful and I feel honoured to sit with someone in their distress - but as a person who has experienced trauma, I KNOW the wonderful feeling when I have really been heard.

Validation, it’s priceless.

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Clare Knighton is an accredited peer support worker based in Worcestershire.

@knightonstar

   

The 6^th IMH Research Day was held on 22^nd May 2018. The event highlighted the work of the Institute’s doctoral candidates, Managed Innovation Networks (MINs), and all early-career researchers (including research assistants, research fellows, and research-active clinicians). Topics included Dementia care, Autism, ADHD, ASD, student and workplace mental health, experiences of breast cancer survivors, co-production of well-being tools, Forensic Mental Health, mental health and recovery narratives, just to name a few! All of which contributed to current debates within mental health care.

The Plenary Speaker at this year’s event was Professor Anne Rogers (Professor of Health Systems Implementation, University of Southampton) who’s presentation was titled ‘‘Plus ça change plus c’est la même chose’?: reflections on past and future research in mental health’. Professor Rogers reminded us of our responsibility as researchers to think critically about mental healthcare by looking beyond the medical model and focusing on what is valuable to individuals.

Katherine Dyke presented on the IMH blog and reminded researchers to develop their online profile through the blog. Kat reminded us of the importance of communicating our research through a range of mediums. Contributing to the IMH blog also valuably contributes to ‘Engagement, influence and impact’ section of the Research Excellence Framework. You can write a blog for the IMH – see the ‘contribute’ tab for more details.

Dave Waldram hosted a talk on the Public & Patient Involvement (PPI) support available to PhD students. Dave is willing to support students in the following ways:

• Review of documentation such as (draft) study proposal, lay (plain English) summary, patient Information. For best results it requires more than one (PP) person
• Having a conversation with them about the project & applying my prospective & experiences
• Expanding their networking capabilities, especially in the Patient & Public Involvement (PPI) domain
• Help with other areas of the research process if required

Please contact Dave Waldram if you would like to discuss PPI support for your project: This email address is being protected from spambots. You need JavaScript enabled to view it.
We hosted a spectacular range of 27 oral presentations and 15 poster presentations. The winners of our ‘best oral presentation’ prizes were Melanie Narayanasamy, Anni Bailey, and Katie Turner. The ‘best poster presentation prize’ was awarded to Reem Aldabbagh. Congratulations to our prize winners.

[caption id="attachment_3044" align="alignright" width="318"] Artwork by Fred Higton


With special thanks to Professor Mike Slade, Fred Higton, Dr Elena Nixon, Professor David Daley, Dr Melanie Jordan, and Professor Peter Bartlett who sat on the expert judging panel. Professor Peter Bartlett commended the high quality of all the presentations which featured at this year’s event, which made the task of judging ever more challenging. Finally, a warm thank you to Karen Sugars who works extremely hard behind the scenes ensuring the day runs smoothly.

Thank you to all those who presented and attended. It was great to see so many of you there.

The 7^th IMH Research Day planning is currently underway and will be held on Tuesday 21st May 2019. Call for abstracts will be circulated later in the year.

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Venue: A floor seminar rooms, Institute of Mental Health, Triumph Road, Nottingham NG7 2TU

Date: Tuesday 22 May 2018, 9.00am – 5.10pm

Plenary Speaker: Professor Anne Rogers

Title of talk: ‘Plus ça change plus c'est la même chose’ ?: reflections on past and future research in mental health

Dear All,

The IMH would like to invite you to attend the 6th Annual Research Day which is taking place on Tuesday 22 May 2018.

The event will highlight the work of the Institute’s doctoral candidates, Managed Innovation Networks (MINs), and all early-career researchers (including research assistants, research fellows, and research-active clinicians).

There will be 27 oral and 15 poster presentations throughout the day. Please visit the IMH website for full programme, further details and the flyer.

We are delighted to announce that the plenary speaker at this year’s research day will be Professor Anne Rogers, Professor of Health Systems Implementation, University of Southampton. Please see IMH website for Professor Anne Rogers’ biography.

If you would like to attend please email This email address is being protected from spambots. You need JavaScript enabled to view it. giving your name, job title and organisation details by no later than 15 May 2018

The purpose of this exhibition was to share my art work and inspire others to try art as a means of helping them through difficult times by finding ways to express their emotions and be in the “here and now”.

People have expressly stated how inspired they have been by the art and staff at IMH have stopped and thanked me stating that the light and life the artwork has brought into the building has been inspiring. Many people have stated that they have felt emotional connections to the artworks.

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Contributions to others and the community
I provided a talk with a group of MA students of Trauma and used the displayed artwork as a talking point for growth and resilience through trauma.

I followed up with an individual student interview to assist with dissertation studies.

I held live discussion with BBC Radio Nottingham (Alan Clifford show).

Developed links with the Nottingham Peace Project and planned provision of and gained council funding to lead “expression through art” workshops for young people in Basford (2018).

Roots Exhibition Book - my story of Trauma, Resilience and Growth with accompanying paintings.

Charitable financial benefits
Sales of paintings have raised £500 to provide a Remembrance Bench for Joel Cooke and £400 for Young Minds Trust. A total of £900 in sales was realised between the 10th October 2017 and 5th of January 2018.

New friendships and new opportunities
I have had a number of people ask me to show them how I paint different styles and I am starting small workshops in January 2018.

I am contributing to Prof Stephen Regel’s Stories and Narratives Project (2018).

I am working with Su Ansell (De Montfort University) on producing a short film about resilience, change and growth (2018).

Personal Growth, empowerment, health and wellbeing
The exhibition has encouraged me to get out and about, meet new people, socialise and converse. Exposure to the environment, particularly travelling on buses was my goal for my trauma treatment. I now have no fear of travelling on buses or passing through Nottingham. My confidence and communication skills are much improved. When I began planning g the exhibition with Elvira I had to take my daughter with me as I struggled with conversation skills. That is no longer the case. I am sure Elvira has noted the differences since we first met. My family and friends often comment on the progress I have made in overcoming my fear of public places and people.

I intend to continue to raise funds for charity, raise awareness of how we can rebuild our resilience and growth through art expression. I will continue to inspire others by sharing my story and art.

Thank you for this wonderful opportunity. I hope the IMH has many successful exhibitions in the future.

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Angie is a qualified teacher with a degree in Psychology and a Masters in Inclusive Education. She worked in New Zealand as an Inclusion Adviser to the Ministry of Education for 7 yrs. She was studying for a second Masters when she developed serious health difficulties resulting from trauma.  Angie was no longer able to follow her academic career. She retired in 2016 and returned to England (her roots). She now has a different and better life as an artist with a love of mother nature.  "There is always hope and It is never too late to try and experience something new in your life"

On Friday 17th November 2017, Professor Birgit Völlm hosted a forensic psychiatry research seminar “Interventions for Sex Offenders post-SOTP” at the Institute of Mental Health. The seminar was organised by the charity Crime in Mind and chaired by Professor Pamela Taylor. Professor John Gunn introduced the aims and objectives of Crime in Mind outlining the need for investment in research in forensic psychiatry. Crime in Mind aims to fundraise and commission relevant studies and put the scientific study of mentally disordered offenders on to a much firmer financial and political base. For further information see www.crimeinmind.org.

Speakers included a range of experts talking about a range of interventions fo sex offenders. Professor Conor Duggan reflected on the evidence base for the treatment for sex offenders referring to a recent report on the prison based Core Sex Offender Treatment Programme (SOTP) which failed to provide evidence of therapeutic effect and showed that in some outcomes treated sex offenders fair worse than untreated controls. Professor Duggan called for further analysis to be done on identifying who is likely or not to benefit from treatment. Fiona Williams and Rosie Travers from evaluation team of the SOTP outlined the design factors of the replacement approaches, notably the Horizon (for medium risk offenders) and Kaizen (for high risk, high need, high priority offenders) programmes.

Professor Belinda Winder and Dr Kerensa Hocken from HMP Whatton outlined the UK Prevention Project. The project, similar to the German Dunkelfeld project, provides a signposting, support and treatment service for individuals who are distressed about unhealthy sexual thoughts and feelings, and are concerned that they will sexually offend but are outside of the Criminal Justice System.

Professor Birgit Völlm described the development of Circles of Support and Accountability. Here the sex offender, known as the core member, is supported by a group of volunteers from the local community and helped to reintegrate into society. Professor Völlm presented findings on the characteristics of core members in England and Wales and a review of the evidence base.

Dr Jackie Craissati described her work in London on the Challenge Project which supports sex offenders with personality disorder. She found that alcohol use was more problematic than drug use in people who failed (i.e. were charged, convicted or recalled) and that housing difficulties are often a trigger point.

Professor Don Grubin outlined the use of pharmacological approaches to sexual offending such as the use of anti-androgens and selective serotonin reuptake inhibitors (SSRIs). SSRIs have fewer side effects than anti-androgens which require close monitoring. Professor Grubin argued that medication is not a substitute for psychological treatment but can produce improvements which help an offender participate in other treatment programmes.

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You can find out more about crime in the mind here: http://www.crimeinmind.org/

It is practically 12 months ago since I last wrote a blog entitled relapse. I spoke about how I was afraid that it would happen; “A lot of the time, the monster is small and I’m hardly aware it’s there. I can get on with my life, with no worries or dark thoughts, the monster stays quiet. At work, I can be extremely productive, full of ideas and positive energy and life is good.”

And then it happened. At first I felt ashamed and embarrassed, I worried what people would think – but then if peer support has taught me anything, it has taught me that by being brave and honest about my experiences, my honesty may give others the courage to do the same.

I don’t just want to blog about the fact I have relapsed, I want to share with you, deep dark parts that I can remember, the part of relapse that nobody sees, and very few bear witness to.

Being a peer support worker can make relapse feel terrible as to me, my role is about so many positive things, and when I don’t feel positive, I feel like I am losing part of my identity, part of who I am.

So let’s look at my relapse together. Despite the fact I run groups about recognising early warning signs, noticing the exact moment it begins is often hard, and it’s only when you look back on the experience, you can pinpoint where it began.

It began by me coming to work, keeping as busy as I could, avoiding taking breaks, not eating, and then going straight to bed when I got home. I was determined to keep the’ monster under the bed,’ and felt this was the only way. Trouble with monsters is, if you ignore them, they just get bigger and more demanding.

They get to a point where everything else comes second as all you can hear and see is the monster. So I took some time off work, with a little ‘encouragement’ from my work colleagues. All the time, I was saying to myself, this isn’t peer support, this isn’t hope, this isn’t recovery. Then I began to hear whispers, first very quiet, and this escalated to a point where I could hear nothing else. The voice I could hear was dark and repetitive and I stopped all my medication,  I had to shut out all sounds, no tv, and just sit in absolute silence. I couldn’t eat, as everything tasted bitter and poisonous, even coffee that I love tasted unbearable. Meanwhile, outside of my house, the world was going as normal, except that I was no longer a participant.

I’m not sure how long this went on for, but shortly, the home treatment team began to come and see me daily. There’s much I can’t recall about the early weeks they were with me, just that they came, gave me medication, and talked to me and listened to me. I remember feeling so frightened – convinced that something bad would happen if I took any medication, so it really took some convincing and the home treatment team had great patience with me, every day.

As things progressed, I then began to feel that I would lose everything, that the dark monsters that were swirling around would never go – I would lose the job of peer support worker that I loved, that I would lose my house, and end up homeless with nothing; which the voices told me would happen.

So early one morning, I made a bad choice and started to drink alcohol. My old friend addiction had come knocking, and I had answered, willing to go astray to oblivion, to failure, what |I deserved. I drank all day, and remember waking up the next morning, the first thing I did was go to the fridge for another drink. Something stopped me,I could see the disappointment on so many people’s faces, so I closed the fridge and walked away from that fake friend, alcohol.

Time passed by, days rolled into each other, and the home treatment team kept coming, no matter what I said or how hopeless I felt, they came and slowly supported me to a point where I could push the monster back under the bed! They held onto hope when it seemed I had none. I chastised myself for letting go of hope, the cornerstone of peer support.

Peer support colleagues that I had trained with text me regularly, offering support, coffees and validation of just how rotten I was feeling. So with home treatment, peer support colleagues and friends, I began to feel better. The hope that I felt I had lost, came back to me and I could return to the peer support job that I love. Once back at work, my work colleagues welcomed me back to the team and as usual offered their unconditional support, coffee and good humour.

The terrible thing for me, about relapse is that I feel that it will take everything away – leave me with nothing, no purpose, no hope, no life. So now, back at work, I can smile and say – I made it. I’m back and functioning well. All thanks to those around me who had such patience, expertise and belief in me in my darkest hour.

So to finish this blog on a positive, what have I learnt from this relapse? I have learnt that I am strong, and feel sure that knowing my job was sitting there waiting for me was a key factor in pushing my monsters back under the bed. I have learnt to trust people more, allowing them in to understand the nature of my distress, and of course I have added to the breadth of my lived experience which can only help me in my peer support role, and ultimately improve patient experience.

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Clare is an accredited peer support worker based in Worcestershire, a passionate coach, mentor, cat owner and lover of kindness..NHS champion..survivor….expert by experience. You can follow her on Twitter @knightonstar for daily tweets about peer support.

Dear readers, contributors and casual blog browsers,

As we come to the end of another fantastic year for the blog I would like to thank you for all your support. The blog has received some fantastic content throughout 2017 and as always it's been great to have so many people sharing their experiences, research, views and opinions. Have a brilliant festive season and I look forward to sharing some great new content with you in January.

 

  Happy holidays!

Katherine Dyke

(IMH blog editor)   PS- if you fancy writing a piece for the IMH blog it would be great to hear from you! Find out more here

In February 2017, a group of academics, researchers and “Lived experience” volunteers came together to explore the character, dynamic and outcomes of recovery colleges. The volunteers came from Leicester, London and Brighton, and were made up of people who had experienced mental health illness and attended a college, a carer of a person using the college and someone of mental ill health who had chosen to currently not attend a college. The group endeavoured through literature review, energetic discussion and challenge, to understand what a recovery college was, what and how it delivered learning experiences for those people experiencing mental ill health, and the longer term outcomes for all those involved in the recovery college community.

We agreed to meet 4 times in the year, and in the true spirit of co-leadership, thrashed out a meaningful and descriptive concept of recovery colleges that could reflect both academically relevant information and valuable real life experience. Our group fostered active listening, respectful argument and an openness and honesty that gave an authentic voice to our subsequent papers. The uniqueness of all the participants - academic and not, made a truly kaleidoscopic experience which we all hope will encourage you to learn more and get involved in recovery colleges yourself.

Written by Emma Munday – Bipolar, slightly old, human.

 

We jelled from the start

The group together

Our experience we pooled

Lived experience

Lived experience

Our knowledge coalesced

Thoughts and feelings

Merged

Used for research

Lived experience

Lived

Lived

Empowered

Confident

Confident

Giving inner strength

Sense of self worth

Worth

Common goals

Coalescing thought

Together with

Lived experience

Lived

Lived.

Poem written by Jane, who said, ‘I have been a mental health service user for most of my life and have suffered with bipolar disorder. I have found that being involved in the RECOLLECT project has been informative, useful and empowering to me.  I have enjoyed meeting with people with a common goal and talking and working together has been a lovely experience.

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The RECOLLECT study has been based at the Institute of Mental Health, funded by a Programme Development Grant from the National Institute for Health Research and led by Professor Mike Slade. Emma and Jane wrote their respective contributions to this blog after participating in all four meetings of the Lived Experience Advisory Group to support the delivery of RECOLLECT. You can find out more by contacting Peter Bates, PPI lead at the Institute of Mental Health or emailing This email address is being protected from spambots. You need JavaScript enabled to view it..

It sounds much too simple doesn’t it?  Making small talk could save a life.  But the truth is, it really could.  Today SHRG is supporting the campaign launched by the Samaritans. They are asking us all to be courageous and strike up a conversation with someone if we are worried about them at a railway station. MAKE SMALL TALK AND YOU COULD SAVE A LIFE is a new campaign that encourages public to intervene to help prevent railway suicides.  The Samaritans note that for each life lost on the railways, 6 are saved by life saving interventions.  You can find out more about the campaign here: https://www.samaritans.org/media-centre/our-campaigns/small-talk-saves-lives and here http://www.bbc.co.uk/news/uk-41992967
You can hear me speak to Andy and Sarah on BBC Radio Nottingham about the campaign here http://www.bbc.co.uk/programmes/p05lnxxs (The piece starts at 2:08:00 with my bit at 2:10:17)

The myth that work like this will help to dispel is that suicide is not preventable – it is and right up until the last moment.  Johnny Benjamin was brought back from the brink of a suicide attempt by a caring stranger (Neil Laybourn) who he managed to track down through the incredible ‘Find Mike’ campaign so he could thank him for saving his life http://www.telegraph.co.uk/news/health/10604805/I-finally-got-to-thank-the-man-who-saved-my-life.html
Kevin Hines, who survived a serious suicide attempt, maintains that he felt he could have been diverted from his attempt if just one person had asked him ‘Hey kid, are you OK?’ http://www.kevinhinesstory.com/
Dr Christabel Owens from the University of Exeter has produced a great leaflet to help get people talking about suicide if you are worried about someone, which you can access here: https://www.exeter.ac.uk/media/universityofexeter/ref2014/documents/UoA2_leaflet.pdf
So let’s all be courageous.  You won’t make things worse.  Start a conversation and save a life.

This post first appeared on the Self Harm Research Page .

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Ellen Townsend is a Professor of Psychology at the University of Nottingham, a fellow of the Institute of Mental Health and a visiting fellow of the University of Melbourne. Ellen is the director leading the Self-Harm Research Group.  
You can follow updates about Professor Ellen Townsends work on Twitter:  @SelfHarmNotts 

Funded by the Institute of Mental Health (IMH), the Nottingham People’s Choir was formed in 2013 as an initiative to promote mental health. It is not a condition of Choir membership that people have used mental health services, yet recruitment of members takes place within a local NHS mental health trust. The group, located in Nottingham, is facilitated by a professional choir leader who is experienced in working with people with mental health problems with the support of a mental health nurse.

The Choir meets weekly during school term-times; it meets during the day time as there are a number of community choirs meeting locally in the evenings. It was thought that meeting during the day, would enable people who do not work to attend and during school term-time to enable parents to attend. The venue is provided pro bono by the Nottingham Royal Concert Hall in the city centre by an arrangement with the local authority. The Choir has a steering group that comprises mainly Choir members with representatives from the local authority, the venue, the IMH, and the local NHS trust.

Participation in arts-based community activities has been reported to improve health and well-being for the past 30 years. There is a growing body of evidence to support community singing for health and well-being outcomes. In an international study, researchers report that from a sample of 1,124 choral singers, the majority claimed positive psychological benefits.

We conducted a qualitative study of 10 choir members and it became clear that participation in the Choir has a significant effect on the health and well-being of the individuals. Each participant described many positive experiences from their attendance. These were classified into five themes which are: social benefits, health benefits, accomplishments, personal benefits, and enjoyment.



Participants reported improvements in social experiences, health benefits, accomplishments, personal benefits and increased joy in their lives.

• ‘There’s honesty and openness I think because you’re all in the same boat in a way. We’re quite supportive of each other and share difficulties.’ – Maria 
• ‘It’s a big distraction because you can be focused…Improving your concentration and your memory about what you’ve learned.’ – Violet
• ‘In some ways I treat the choir, even though its not part of recovery college, I would treat it as another class because it does give you hope and opportunity.’ – Duncan
• ‘We’ve sung in different venues and they’re probably places that I couldn’t have ventured out into before that. I suppose in an evening as well, so that’ gave me more confidence to push myself.’ –Isaac
• ‘It’s a bit like taking medicine I suppose. Yeah, it’s definitely got that feel good factor. You just feel uplifted. It doesn’t matter what you’ve sung. It’s just that process of singing.’ – Isaac
• I think it’s been really beneficial for me in so many ways. I mean I’ve been here and I’ve felt quite ill, I’ve had occasions where I’ve not been too well but I still keep coming but it always lifts me.’ –Maria
• ‘Well it’s been a total joy, it’s a fun thing and friendly. Very, very friendly. I just enjoy it immensely…It’s just what I needed’ – Paula
• ‘I moved heaven and earth to get here with my Mum because it’s such a life-enhancing experience, especially for her. To be honest if it was at two o’clock in the morning I’ll make an effort to come.’ – Sadie

Participants reported improvements in social experiences, health benefits, accomplishments, personal benefits and increased joy in their lives. Participants have expressed how the Choir has had significant improvements in their mental health, physical health, and well-being and has helped some members recover from being in ‘dark places’. Given the extremely low cost of running a choir such as this, it makes the potential to set up such an enterprise easily achievable within either statutory health or social care, or in the voluntary sector.

For the full research report, please see:
Plumb, L., & Stickley, T. (2017). Singing to promote mental health and well-being. Mental Health Practice, 20(8), 31–36.

This post first appeared on PsychReg
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Associate Professor Theodore Stickley is the Academic Lead for Public Engagement and Associate Professor of Mental Health at the Faculty of Medicine & Health Sciences at the University of Nottingham. He led on the ESRC-funded seminar series for arts, health and well-being. This development has led to the formation of the Special Interest Group at the Royal Society for Public Health.

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The hula-hoop, the shimmy and the fiddle 10 October was World Mental Health Day and on Saturday 14 October Carnival MAD enlivened the IMH as part of a Nottingham-wide programme of events: see http://www.mhaw.org.uk/ The inimitable Julie Gosling chaired the day and many brave people took to the stage to demonstrate their personal strategies for wellbeing. I was struck by how many of these were non-verbal. Hula-hooping, belly-dancing and a jaunty tune on the fiddle resonated more for me than words or pictures. And it’s impossible to hula-hoop and not smile. It’s impossible to shimmy and not giggle. It’s impossible to listen to a tune that dances and to stay slouched and crouched in your mind.

I drove home refreshed, revitalised and with some questions for us all:

• What research question(s) might explore non-verbal ways of recovery and wellbeing in a health-service environment where talking therapies (and medication) are primary options?
• As adults in offices at desks and keyboards should we hula-hoop now and again (the theme of this year’s World Mental Health Day was ‘mental health in the workplace’)?
• What more can we do, together, to involve the IMH and its work in World Mental Health Day – sharing and celebrating our work and taking the opportunity to meet people who may wish to participate in a study or collaborate in its progress?

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Rebecca Toney is a Research Assistant based at the Institute of Mental Health. Rebecca works on the RECOLLECT Study – a study of Recovery Colleges in England which is led by Professor Mike Slade, Mental Health Recovery and Social Inclusion. Rebecca is a current user of secondary care mental health services and worked previously as a NHS counsellor in Staffordshire, Greater Manchester and Derbyshire over 13 years. Rebecca is keen to see the IMH ‘live and breathe’ its work and was delighted to attend Carnival MAD.

For more information on RECOLLECT: see http://www.researchintorecovery.com/recollect or email: This email address is being protected from spambots. You need JavaScript enabled to view it..

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A really insightful piece from Trevor Clower. Trevor organises the Carers Road Shows every year. You can follow his posts and activities through his blog.

To listen to doctors and nurses describe their everyday experience, is to realize how visceral, how raw, the interaction between them and their patients really is. We dress our doctors in white coats, our nurses in colour-coded uniforms, and dress our health policy in jargon but essentially the business of ‘healing’ is a series of ancient rituals, full of hope (Webb 2013) and at times, soaked in disappointment, fear and resentment.

But in the 21^st century, the daily work of the ‘healer’ has been changing in a profound way. The increasing role of technology in medicine can be seen in this dramatic image of begowned figures circling around a prone patient in the robot run operating theatre at Hamad, Qatar. This is the very leading edge of medicine in the 21^st century and the attention of the practitioners is intensely focused on the data led information coming from the machine above them.

Figure 1 Robotic surgery in Hamad, Qatar

The patient is only visible as a tiny scrap of vulnerable flesh, he is almost completely hidden by the robotic arms which will cut into him with an accuracy much greater than that offered by the human hand of a surgeon.

If all goes well, the patient will wake up and the journey he is on, which began with a conversation with a doctor or a nurse, will continue with conversations with doctors and nurses. This interrelational core of his treatment and recovery, while not as measurable as the success rate of robotic surgery, will be essential to its outcome. As a Medical Director from a Midlands trust explained to me, ‘the NHS measures what is easily measurable, like surgical outcomes but there are many other measurements of success’ (Medicine participant 21).  As this patient lies in recovery, data will stream from him into monitors around his bed. The practitioners who come to talk to him will first check these monitors, with the same intense gaze of the theatre staff in the image above. They cannot afford to make a mistake, and so our new practitioners have become adept at reading data, at searching for electronically produced statistical anomalies. Another of my participants, a gastro-enterologist, told me that ‘the patient comes to me now with the data in front of him’. She commented that she feels ‘sad’ for new doctors because ‘although they have much more accurate instrumentation, they don’t have the same pleasure in talking to patients. In touching a hand to a belly to make a diagnosis, a decision. The machines do a lot of it for them’ (Medicine, participant 12). However, the machines have to be monitored. Even machines make mistakes. And this means that the attention of these practitioners is not focused on the person in the bed in front of them. The patient is no longer the first resource for information about himself. And, crucially, neither the patient or the doctor is seen as the most accurate source of information about the patient’s condition. The tremendous advancement of medical technology is in danger of deskilling the expert practitioner and devaluing the relationship between the expert practitioner and the client.

A third participant in my research, a consultant cardiologist,  summed up this problem. ‘It (the relationship between the practitioner and the client) is a human interaction, in the end. As a doctor, I am altered by an interaction with a patient and, if it is a good interaction, I am rewarded. Data should facilitate that interaction, not replace it.  A machine doesn’t give me positive feedback’ (Medicine, participant 18).

Shoshana Zuboff (Zuboff 1988), refers to the ‘reflexivity’ that comes from working with ICT, an ‘informating’ process she believes generates ‘intellective skill’. The effective analysis by doctors and nurses of complex data requires practical training in the handling of data and the ‘reflexivity’ described by Zuboff (1988) to allow a useful interpretation of the material. And so ‘health’ workers have also become ‘informative’ workers, as this report for the Australian Health Review by Stephen Duckett, (2005:201-210) shows

In addition to the epidemiological and demographic transition, the environment for the health workforce is also changing because of wider social trends, in particular the impact of changes in information and communication technologies. (Duckett 2005: 201-210)

He describes the use of ‘multidisciplinary care plans which systematize the treatment and care processes’ and goes on to explain how these systemized care pathways are facilitated by tailor made software packages which are changing the work practice of health care professionals.

However, one practitioner educator told me that using software packages to aid diagnosis is barely better than ‘a stab in the dark’. ‘What they (junior doctors) want,’ she went on to say, ‘is didactic teaching and hands on experience. They should be with patients, talking to patients, examining patients, not in a classroom, taking part in yet another role play.’ She concluded by saying, ‘Where’s the fun in that?’ (Medical participant 24).

I thought the use of the word ‘fun’ was intriguing, and I asked other practitioners what they thought of her comment. Yes, absolutely, they said, she’s right, it should be ‘fun’ – working face to face with patients is exciting, challenging, ever changing. I realized that no one enters a people based profession unless they get real satisfaction from interacting with people. It should be ‘fun’, it should be rewarding; instead, practising medicine has become a kind of terrifying drudgery, with endless data-led tests to interpret, where failure brings litigation.

Solomon (2004) describes how one GP interviewee explained to her that the once dyadic relationship between GP and patient has now become a threesome; the Department of Health sits in the consulting room in the shape of a demanding, data crunching computer.

And maybe this lies at the core of the dissatisfaction junior doctors feel with their training and their roles, a dissatisfaction that led to the bitter dispute between these practitioners and their employers in 2016. They want to work with people, to have the time and the resources to interact with patients, that is why they decided to be doctors, but they are working with data.

Where’s the fun in that?

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Fiona Birkbeck  is a PhD researcher at the University of Nottingham. Fiona’s interest in the systemic issues faced by expert practitioners in Health and Education in the UK today grew from her experience of delivering workshops on resilience to education and NHS staff at venues such as North Staffordshire Trust, the BPS Annual Conference and The Science Learning Centre, University of York. She currently delivers an Education and Education Assessment module on the Medical Leadership, Education and Research MSc at De Montfort University, Leicester.

This email address is being protected from spambots. You need JavaScript enabled to view it.

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References Duckett , S. J., 2005. ‘Health workforce design for the 21^st century’. Australian Health Review, 29 (2), 201-210

Gerada, C.,  ‘Something is profoundly wrong with the NHS today’. British Medical Journal  16^th June  2014  Available from: http://php.nhs.uk/something-profoundly-wrong-nhs-today/ [accessed 14 June 2017]

Solomon J., 2009 ‘An Exploration the relationship between prescribing Guidelines and Partnership in Medicine Taking’, University of Leeds, PhD Thesis

Solomon, J., Raynor, D.K., Knapp, P. and Atkin, K., 2012. ‘The compatibility of prescribing guidelines and the doctor-patient partnership: a primary care mixed methods study.’ British Journal of General Practice. 62 (597), pp.275-81., 10.3399/bjgp12X636119

Webb, D., 2013 Pedagogies of hope. Studies in Philosophy and Education. 32;4:397-414

Zuboff, S., 1988. In the Age of the Smart Machine: The Future of Work and Power. Oxford: Heinemann.

When people consider dementia research, they often think of trials of drugs to treat or slow the disease. However, understanding and combating the many and varied negative effects of dementia requires more than just drug trials. In my research at the Centre for Dementia at the University of Nottingham’s Institute of Mental Health, we’re looking at an important topic within dementia care where no drug is likely to be available: hearing loss in care home residents.

Dementia is common: there are about three-quarters of a million people with dementia in the UK. Hearing loss is common too: almost half of people in their 70s have some degree of hearing loss, and this rises to 80% in people aged over 80. The two conditions often occur together, especially among residents of care homes, where around 75% of residents have dementia and at least that proportion have hearing loss. Probably about 300,000 care home residents have both.

This convergence of dementia and hearing loss in care home residents matters for several reasons:

• care homes are noisy environments
• care staff may lack knowledge and skills to support hearing aids and to communicate effectively
• the presence of other conditions, such as dementia, can affect staff attitudes and approach to hearing loss
• care staff may not have English as their first language
• hearing aids may be supplied but are often not used, get mislaid or broken, or batteries go flat
• losing expensive hearing aids can upset families and residents
• the resident may not be able to use or may not tolerate hearing aids, or even understand their purpose.

Clearly, dementia and hearing loss are big problems among residents in care homes. Indeed, if you mention ‘hearing aids’ and ‘care homes’ in the same sentence, most people just shake their heads or grin wryly, because this is recognised as a difficult area of care home work.

At the moment, there is no obvious intervention to use in a clinical trial in this area. It is not just a matter of giving everyone a hearing aid, because there is no good evidence that this improves outcomes for residents with dementia. Also, because there are very few, if any controlled trials of any intervention to improve hearing or communication in care homes, there is little point in attempting a conventional systematic review.

I had been interested in this clinical area for many years, having visited hundreds of people with dementia in care homes and finding that so many of them had hearing loss. When I came across realist methodology, I thought that this looked like a promising approach. Realist synthesis (or in this case, realist review) is a method that uses multiple sources of data to examine questions of what works for whom, when, and under what circumstances. Data can be obtained from the published literature, including the so-called grey literature as well as journal publications, but also from people who are expert in the area either from personal or professional experience (context experts).

Our team has received a funding award from the NIHR Research for Patient Benefit programme to run a realist evaluation called ORCHARD: Optimising hearing-Related Communication in care Home Residents with Dementia. We have been gratified that everybody whose help we have sought has been enthusiastic and interested to know what we will find out. However, of all the things that make this a strong proposal, I think the most important is that the research has arisen from everyday clinical practice.

Professor Tom Dening (third right) and the ORCHARD team Our approach is very different to a drug trial for dementia - there will be no drugs, but instead we’ll look at what approaches, aids and adaptations work best for people in care homes with dementia and hearing loss. We won’t be generating data by testing a drug or intervention on participants either, but rather synthesising and evaluating existing data from many sources.

Our evaluation will identify best practice and research priorities, including which interventions to use and how to measure them. In this way, we hope our research will have as big an impact for people with dementia as any drug trial.

Note: This content was first published here on the National Institute for Health Research (NIHR) blog and has been redistributed with permission. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Professor Tom Dening is Professor of Dementia Research and head of the Centre for Dementia in the Institute of Mental Health at the University of Nottingham School of Medicine. He is LCRN dementia speciality lead for East Midlands.

NIHR is running a campaign to mark World Alzheimer’s Month. Find out more on the NIHR website.

   

 

Narratives of recovery from mental illness: The role of peer supportMike Watts and Agnes HigginsRoutledge (2017)ISBN: 978-1-13-884799-6158 pages

It’s not often that I come across a book that has resonated with me on such a profound scale but this is one of them. Narratives of recovery from mental illness: The role of peer support is part of a growing body of evidence-based research that is challenging the prevailing bio-medical approach that currently dominates the mental health system especially within the field of psychiatry. Using a narrative based approach the authors, Mike Watts and Agnes Higgins, interviewed 26 people with lived experience of mental distress about their recovery journey to illustrate the transformative power of peer support. Those interviewed were all members of GROW, a mutual support group, that advocates the importance of social interaction that encourages people to become active agents in taking back control of their lives, through peer support, rather than just leaving it to health care professionals with their reliance on medication.   Those interviewed included people with a wide-range of diagnosis, including schizophrenia, bi-polar disorder and depression.

Mike Watts, Research Fellow at Trinity College Dublin, and Agnes Higgins, Professor in Mental Health at the School of Nursing and Midwifery at Trinity College Dublin, facilitated the research by giving those interviewed the opportunity to tell their stories from a personal perspective demonstrating the power of co-production thus reflecting the growing call for a more person-centred social approach to recovery. Their findings suggest there’s too much emphasis on the clinical approach to recovery and not enough focus on personal recovery and the importance of social inclusion. Adding that social factors are too important to be over-looked and ignored.

Relying solely on the medical model in the mental health system ignores the many social factors and adverse life experiences, such as bullying, sexual and physical abuse, divorce and bereavement, that can have a negative impact on people’s mental health but with social intervention through peer support and mutual empowerment the authors were able to demonstrate that people who had experienced mental distress were able to recover and build the emotional resilience needed to cope with adversity and other challenges that life throws at us.

While the researchers suggest that the traditional approach through the use of medication may be necessary in the early stages of some people’s recovery their finding illustrated that recovery can also be resolved through every day social interactions primarily through the use of peer support and social inclusion and with much better results.  The authors have provided us with an alternative way of looking at the prevailing medical framework of mental health therefore demonstrating the need to consider other avenues and pathways towards recovery and wellbeing.

Many of those interviewed in the study explained how they found their experiences with the medical profession a very debilitating and disempowering experience. For example ‘Tom’ described an encounter with his doctor when he was nineteen and had just questioned why the medication had failed to alleviate his symptoms when the doctor looked at him very gloomily and said:  Well you’ll be on medication for life. I don’t think you’ll ever hold down full time work. Friendships will be difficult but you’ll make friendships within the hospital’. Adding he’d never drive or have a girlfriend (p65).  It was only when ‘Tom’ came across GROW with its emphasis on mutual support and social interaction did ‘Tom’ become empowered to take control and take that path towards recovery and wellbeing thus proving his doctor wrong.

The emerging recovery story is taking hold across the western world and it is one that is ‘illuminating some of the limitations of the prevailing medical story and one which commentators such as UK clinical psychologist Mike Slade et al. (2012) believe has “come of age”, (p18).

In a chapter entitled: Recovery through mutual help, the authors discuss the eight processes identified in the study which testified to the value of peer support for those recovering from mental illness. These included an empathetic and compassionate social network, becoming hopeful, reconnecting with the self and others, positive risk-taking, and a re-authoring of a more positive identity which eventually led to a re-enchantment with life.

As someone who is undergoing the recovery process with many years lived experience of mental distress I have no doubt that this book demonstrates a profound and deep understanding of the person-centred recovery process and will in my opinion become a seminal read that puts forth evidenced-based research about the transformative power of peer support that challenges the medical model. The authors, Agnes Higgins and Mike Watts, along with the 26 co-authors, have produced a piece of work that will be a source of hope and inspiration for people with lived experience of mental illness and emotional distress, as it was for me.

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Eugene Egan (This email address is being protected from spambots. You need JavaScript enabled to view it.is a peer worker and recovery college facilitator for Birmingham and Solihull Mental Health Foundation Trust.

So far this year the blog has had over 5,850 views from 69 countries and we have you to thank! We would also like to thank our wonderful contributors who have allowed us to cover diverse topics such as prejudice in mental health, mental health & disclosure, social care since the mental health act,  brain stimulation,  academic/creative writing, peer support, schizophrenia and the media and many others.

We have no new content this week, but there’s plenty of fantastic posts from the last few years which we would invite you to browse through. As always we would love to hear from you and welcome new material so please do get in touch!