News

Whilst attending the World Psychiatric Association International Congress 2012 Conference (held 17-21 October), Rex Haigh, an NHS consultant psychiatrist, wrote a blog post for every day of the conference.   With a packed conference schedule of activities from 6:30am to 11pm, Rex reported on the variety of presentations, themes and discussions that emerged over the five days.   To highlight the conference, we have selected one post to reblog in full, covering the presentation from Rex's team and a variety of poster and speaker presentations from Day 2: More than 17 (just).

We would highly recommend checking out the rest of his posts as it appears to be an excellent conference with thought provoking themes arising.  To access all of the conference daily posts, please see the following on Rex’s blog:

The Yerkes-Dodson Test (Day 1)
(Day 2 is posted below)

Ulysses or Lithium? (Day 3)
Wheeling, Dealing and Scheming (Day 4)
The Kindergarten of Democracy (Day 5)
 
Featured Post by Dr Rex Haigh: More than 17 (just) 
Arriving for breakfast at 0632, I was surprised (and very pleased) to see I was
the last one there. We ate rather silently and nervously, and got the metro to
arrive in our presentation room just after 7am. We put up our display posters
either side of the stage, and leaflets on all the seats; we adjusted Yousuf’s
powerpoints a few more times,and finally handed it over to the technicians.
Then we waited…


Although there were only 3 attendees there on the dot of 0800 (our official starting time), somebody did say that lots more were outside the congress centre, just arriving – so we waited a few minutes before starting.

Soon there were 17 and by the end we had about 30, though there was some coming and going. The talks went pretty well exactly to time and to plan, and are available on the LLE website www.livinglearningexperience.com.  Afterwards, we breathed a sigh of relief and had the freedom to enjoy the rest of the congress.

[caption id="attachment_581" align="alignnone" width="300"] Nearly 17 by now


C B Nemeroff (USA) gave the first plenary lecture – on Neurobiology of Child Abuse and Neglect – and gave a dazzling exposition of the genetic, neuroimaging and pharmacological bases of adult consequences of childhood trauma and abuse, and how the people with histories of maltreatment had different brains. Although he seemed to deliberately avoid the PD label, it was almost a return to the days of ‘endogenous v reactive’ depression – except over a life course, rather than weeks or months. Quite reassuring to those of us who fear being eclipsed by the biomedical juggernaut driven by the economics of the pharmaceutical industry.

Then to the posters – hundred of them from all over the world; interestingly all of those from latin countries bearing a prominent ‘no conflict of interest’ declaration, none of which would have suggested any such suspicions. Is this an international version of the UK ‘health and safety’ culture, used to destroy trust and spread persecutory anxiety? And next to the poster, a display of restraint cages through the years, and straitjackets exhibited like a fashion display. Was this deliberate irony?

[caption id="attachment_582" align="alignnone" width="300"] Bed shortage?


[caption id="attachment_583" align="alignnone" width="300"] C&R?


[caption id="attachment_584" align="alignnone" width="300"] PICU?


[caption id="attachment_585" align="alignnone" width="300"] Straitjacket couture?


Next to a heart-warmingly reassuring session by Czech psychiatrists and therapists from The International Centre for Integrated Psychotherapy (Knobloch). Heart-warming because it was human-scale and clinical, reassuring because it is a TC by any other name. Although they only briefly referred to TCs, I asked if they recognised the British TC tradition, with Maxwell Jones and all, as their work seemed so familiar: and indeed they did. Somehow, we should be making friends with groups like this.

Towards the end of the afternoon, were workshops. The title of ‘Innovation in Psychotherapy Education’ was catchy enough to attract me, but for some reason, my heckles were soon raised once there. It was a sharply commercial presentation of an elegant and well constructed Moodle website for training in basic psychotherapy – not unlike KUF in its design, but lacking the radical ‘relational’ edge that I think is essential in any therapeutic engagement. A sales pitch, I suppose, when I was looking for realttitude change, I suppose – tackling ‘us & them-ness’ – ever seeking that dear old ‘quality of relationship’ again.  After an initial altercation which Yousuf and I had with the presenter – about the viability of hard evidence-based rules for all psychotherapies – I meekly shut up and watched nigh on a dozen video clips of very self-assured therapists teaching how to do CBT…

The final session was much more cheering, though. Professor R S Murthy was being presented with a special prize. The purpose, structure and committee for this prize was explained at great length before the ceremonial exchange of gifts and flowers and the lecture could begin. Professor Murthy is recently retired Dean of the NIMHANS – ‘the Maudsley of the Subcontinent’ in Bangalore – and I explained to him before the talk about our link with ASV and the intention to do an LLE there in the next year or two. Maybe we should do a second one for NIMANHS residents! But he was great – talking our language like few others did here.
Here’s the points from two of my favourite slides of his. This one gave seven criticisms of the current ways of psychiatric thinking and practice:

1.       Medicalisation of suffering
2.       Vague diagnosis
3.       Mainly pharmacological interventions
4.       Doubtful outcomes
5.       Insensitivity to local customs and practices
6.       Loss of personal context
7.       Psychiatric imperialism

• Recognition of the central role of people and families
• Information and interventions for them
• Professional development to share this

Dr Hugh Middleton (Consultant Psychiatrist Nottinghamshire Healthcare NHS Trust and the University of Nottingham’s School of Sociology and Social Policy) writes on how research is identifying success stories and offering new strategies for collaboration: To précis, mental health professionals need to work together if they are to fulfil their potential and deliver the best possible patient care, a new report has revealed (ref. below).

Hospital soap operas, everyday experience and what we hear about the “state of the NHS” all draw attention to strife between those who “do” health care and those who manage them, so it is good to see publication of some fresh research that tries to rise above this. October 10^th saw publication of the final report from a three-year investigation of multi-disciplinary team working in mental health. Numerous investigators were involved, including Dr Hugh Middleton and other participating organisations (e.g. Nottinghamshire Healthcare NHS Trust).

Healthcare professionals must work together as effective teams if they are to provide the best possible patient care. This is important for mental health services where quality includes consistency and a reassuring sense of being known and understood. Providing these and at the same time working in shifts, so that the service is available beyond office hours, is difficult without great team processes.

Previous research shows that many multi-professional teams fail to perform to their full potential, as they are not clear about their objectives, disagree about goals, their leadership and how to work together; or they find themselves trying unsuccessfully to meet the conflicting demands of senior managers from different disciplines. The Healthcare Commission has discovered that as many as half of all NHS staff may work in dysfunctional teams, which can jeopardise patient care and undermine staff well-being.

The overall aim of this research was to explore such issues in more focused detail amongst teams providing NHS mental health services. A variety of settings were investigated. Service users, their families and friends, a range of mental health practitioners and service managers were all consulted in the course of developing a novel measure of community mental health team effectiveness. Some 1500 practitioners from 120 teams took part in a survey which estimated how effective such teams were, and reported upon what it was like to work in them.

There were strong associations between team effectiveness, measured on a scale which reflects service users’ views of good and bad practice, and the quality of team working. This was assessed using the Aston Team Performance Inventory, a well-established measure of team working. Particular success in providing good quality mental healthcare was found amongst teams that had a clear sense of purpose, welcomed participation in creative problem solving and were well led in a style that encouraged reflective practice.

Alongside this survey the investigators also observed a number of team meetings and interviewed 114 service staff, 31 service users and 13 users’ informal carers. This qualitative research enabled enquiry into the interactions that lie behind numbers derived from the survey. In terms of what matters to service users it revealed disparities between what they find important, such as relationship, flexibility, availability, consistency and understanding, and requirements of the organisational settings from which care is provided.

Of service users, in the words of one community mental health team manager:

“… they don’t really want to see the paperwork and they don’t really want to see the risk assessment, don’t really want to see the care plan, sometimes they’ll talk to us about the care plan but they don’t want copies of it … a care plan doesn’t mean anything to them in that sort of sense but I think we do keep trying to engage with them … “ In relation to creativity, in the words of a support worker:

“So there may be some patients who would really, really benefit from you say taking them for a day at the seaside, because that was what they remembered their parents doing for them when they were little and that would mean so much for them to do that. We obviously can’t do that, and time is probably our most valuable resource really” These are readily dismissed as intuitive and predictable findings. Perhaps unsurprisingly they relate good clinical mental health outcomes to team creativity, task focus, participation, supportive leadership and interest in true relationship. On the other hand they are also timely and novel. They identify clear relationships between organisational determinants of the practitioner’s context and well-being, and the outcome of their clinical activities. It will require further studies to establish whether such interactions are also present in healthcare settings that are possibly less dependent upon practitioners carrying out “emotional work”, but an element of that is present in all health care settings. What this research demonstrates is that the success with which “emotional work” is conducted, in part reflects the practitioner’s emotional well-being and that is in the hands of those who manage and commission health care. There are connections between the management of health services and the service user’s experience which are not simply reflections of business efficiency, but provide the creative commissioner or manager with more sophisticated opportunities to influence real outcomes.

Reference:  West M, Alimo-Metcalfe B, Dawson J, El Ansari W, Glasby J, Hardy G, et al. Effectiveness of Multi-Professional Team Working (MPTW) in Mental Health Care. Final report. NIHR Service Delivery and Organisation programme; 2012.