So what?

"So what"?
Apart from being the title of a superb piece recorded by the Miles Davis Quintet it is the acid test of many a critical reader of research papers. Nowhere is that more true than in the world of mental health nursing research. Now I know many people can discuss research methods in a passionate and frankly frighteningly intensity, but to many readers of a more casual (or practical ) ilk it's the findings they care about.
Many will wonder about how long until this finding will drizzle down to the realities of practice, or indeed find it's way into policy.
There will of course be those who just evoke the "so what" response and move on..
This question of relevance became all the clearer at the Network for Psychiatric Nursing Research conference in Oxford in September. It was a rousing success and well attended . Delegates were present from over 20 countries, and more PhD's present than you could shake a stick at.
The opening adress was in the form of a conversation between Professor Alan Simpson and that venerable sage Professor Peter Nolan. Now Peter is a raconteur that always manages to leave you wanting more, he has a wealth of stories, views and perspectives that have come from a long (sorry Peter) and thoughtful life.He was fascinating to listen to but possibly kept his final and most challenging thought until last.
I am paraphrasing rather badly here, but essentially he asked when will researchers in the field of mental health start utilising thier skills to ask questions that really matter. Projects , he mused, may be fascinating and personally rewarding ; but where was their relevance to the users of the services provided.
An eloquent "So what" , that challenged those present and perhaps the wider community to consider how they could use their knowledge to achieve outcomes that would hold real meaning and relevance to those living lives challenged by poor mental health.
Perhaps a challenge for research agendas that are challenging and  radical.
Perhpas an era of findings that cannot be dismissed with a cynical "so what".

The Crying Game(s)

Well its over, and we will all have our memories of what made the London Olympics memorable. For some it will be simply that they were there  either as a volunteer, a spectator or even a participant. For most of us I guess we will have consumed the Olympics by watching the television coverage.
The need for immediacy has seen athletes asked that favourite question of pundits "How do you feel" when they were barely able to speak for exhaustion, and on occasion we have seen levels of self blame and doubt that were hard to watch as they apologised to all who had supported them. The sense of failure was almost palpable.
There were of course the triumphant moments on the finishing line and the podium when the medals were awarded. which brings me to my main observation. How many times over the past two weeks have we seen the outpouring of emotion accompanied with tears? It doeesn't seem to matter what gender the athlete was; they just let the tears flow.
If the London Olympics has been a chance to bust myths such as the Tube won't run, it will rain all the time or even it will all grind to an inept halt ; then surely the one myth that has gone is that we (the British) are a repressed race of individuals who cannot show emotion. It  becomes all the more  paradoxical when you recall that just about a year ago a great deal of emotion was being expressed in parts of the capital but mainly of anger and perhaps frustration.
So are we now more comfortable with showing how we feel?
As we enter the Post-Olympic period and others will try and harness all this good feeling for various ends perhaps we can remember that summer of 2012 when Britain found it was OK to show how you feel and even share that moment with strangers.

Wardipedia has arrived!!

·         Wardipedia (www.wardipedia.org)  is a project of Star Wards..... which is the one and only project of the social justice charity Bright. Star Wards provides practical ideas and inspiring examples from and for mental health ward staff. About 600 wards are members and enjoying introducing small changes which make a massive difference to patients.

·           There are over 1,000 examples of imaginative approaches by wards eg:

             ‘Virtual pets corner ‘ i.e. developing a pet photo display of patients’ and staffs’ pets and wards sponsoring an animal e.g. a retired donkey or a guide dog 

             At the weekly Prepare and Share cooking group, the modern matron not only makes the coffee and washes up, but also does decorative serviette folding. The group is led by a ward manager who is a trained chef – including the skill of decorative pineapple carving!

             Football leagues, visits, stadium tours etc. The tour was to promote interest in local sport, active lifestyles and the importance of physical fitness.

             Podcast and music studio

             Remote control car races, and spacehopper races. Spontaneous paper plate Frisbee games.

             Repositioning a bed to give better view of outside

             Self-harm project run by a specialist nurse, including a camouflage clinic, support group, staff and training.

             The Catering Department have ‘Just for You’ where the patients are invited to design a meal themselves and the catering department will cook it for them.

             A  four week poetry workshop (also for community clients) in conjunction with Radio Stoke.

·         Wardipedia includes 77 ideas for enhancing inpatients’ experiences, with 11 in each of seven domains, structured around the concept of IMAGINE:

Imagination – what’s it like for the patient?

Mindfulness – chilling out

Activities – social, recreational, physical

Generosity - sharing, kindness, giving

Involvement –influence, information, independence

Neighbours – friends, family, fellow patients

Empathy – for self and others

For example:

7.        Mentalising

17.      Music

24.      Wii

33.      Men’s stuff

35.     Bring yourself to work day

44.     Gay patients

45.     Patient involvement

47.     Minority languages

53.     Bank staff

55.     Brain

59.     Social media

70.     Comfort objects

What would you say?

To a new resource of over 1,000 items that can energise the day for people receiving in patient care?
Wait a few more days and I will direct you to a fabulous , cost effective veritable treasury of things to do. Tried and tested means of making in patient care more stimulating for all concerned
What will you say?

One in four

I'm sure I have used the "one in four" statement many times. I have argued like many others before me that one in four people will have an episode of mental ill health/distress in their lifetime. The figure has been used by many to make people realise how we need to recognise and indeed de-stigmatise the number of people who need help but above all compassion for their situation.
But now we seem to have a new one in four. This new figure (actually based on a 2007 paper) argues that of those who have a mental health problem only one in four will actually be receiving treatment/help/assistance/support.So of that quarter of the population that need help only a quarter will be receiving it.
Quite an astonishing figure. Especially as the cost of this failure to treat /help is dwarfed by the savings to be accrued by returning people to a better place. As you can tell the argument is being underpinned by financial arguments (not surprising considering the London School of economics are involved) but isn't this really a moral issue?
Imagine if you will a quarter of diabetics only receiving treatment and a situation where retinopathy or gangrenous extremeties or indeed blindness were casually accepted. You can't really can you. Or even where a failure to treat for up to a year was accepted as a consequence of "how services are organised"
We do seem to be dogged by low expectations, fatalism and even a sense of nihlism when it comes to mental health.

"Homeland" and the issue of memory.

Quality drama, well thats the title afforded certain types of drama, along with the term "high production values" its meant to convey something extraordinary about what we choose to watch.
I guess the "Killing" seemd to be dominated by jumpers, "Borgen" by lamps and now the "Bridge" seems to focus on architecture and beautifully shot  enigmatic locations in Sweden  and Denmark.
But what of "Homeland" what will be your enduring memory of it? Theres no doubt it was a tense and gripping drama and not since "Twin Peaks" have I felt not only compelled to watch but also came to actually care about some of the characters. I suppose its nicely contemporary and also had that hard "real politik" with just an suggestion of dark and menacing forces (on both sides).
For me the really memorable episode was the penultimate one when Carrie became manic and distraught at the failure by others to understand and agree with her view of what was going on. I have never seen a more accurate depiction of the features of mania as she worked relentlessly to solve the problem of Abu Nasir. At the scene where her work was torn down off the wall the sound was faded and we saw her complete distress at not being believed. It seemd to me that could be the lived experience of many who we consider "unwell" or "ill". I found it sobering to see that so accurately depicted and for me will remain as an enduring memory.
Which is kind of neat as the series ended with Carrie hoping her memory would endure the ECT she was having. We wait to see if it does.

I may have to retire

Well apparently I may have to because I am over 50 (hard to believe I know). An article I read today suggested that all us over 50's should move over and allow younger people to take our jobs. Simples.
Bit of an economic "Solent Green" really. Initially it kind of seems attractive, lots of time for all manner of activities , but hang on.......how will Ipay for it? Epecially as I may (hopefully) have along retirement. I guess Icould take one of the part time jopbs that are being vacated by all the graduates looking for work. Of course it doesn't really stack up does it (though I may end up doing that). All that experience, knowldge and networks just lost in a moment.
But it does raise a couple of interesting ideas.
Could retirement begin earlier, in a sort of staged way with a partial pull down of pension? Could people like me be offered a person to succeed  us in our roles? Could I be actively preparing the next person for my job, and really enabling them to undertake it?
I guess its probably to radical an idea and it certainly made me feel old and just a little bit unwanted. But could a double dip and an enduring austerity provoke the serious consideration of such ideas?

Hospital car parks

Contentious things aren't they? we have all visitted someone and resented the scrabble for change, or even how much we have to pay for visiiting someone frequently and how much it costs. Some people find hospital car parks a very useful metaphor for many issues. Here's one i really like. Hospitals are just like car parks because .......as soon as you build one it fills up.Well I guess that does hold up as an illustration. We are often told there is an over provision of beds in some sectors, yet the beds are all full.I suppose if you restrict parking then people find other means of getting to places, and the belief is that if you close beds and transfer the funds to community services then lo and behold the beds just aren't needed. I suppose as occured in the massive down sizing of psychiatric provision in the 80's.
Hospital car parks are another useful indicator of activity. If you go to your average District General Hospital at the weekend , what do you find? The consultants car park with its designated spaces will of course be largely empty, likewise the admin peoples. Yet the nurses car park (if there was such a thing) will be full as usual. Why so? Probably because patient need doesn't keep office hours and acutiy doesn't drop off at 5pm on a friday. In fact we are now told that mortality rates rise by up to 10% at the weekends due to the non availablity of senior medical staff to advise their junior colleagues (although available on a phone). It has been suggested that this needs to change.
Perhaps we will see all the car parks starting to be as full as the nurses' one?

Keep Calm and Carry On

The slogan that has probably been most read for years, and the product of a campaign that thankfully never was. I like many people I am sure have seen it on T shirts, posters, television presenters and even on on a coffee mug! Perhaps we will never know who penned this amazing instruction to the British people in the event of a German invasion, but it seems to sum up an approach to life that is pretty timeless. You can actually imagine for most people this would not have been to difficult to do as it's so close to the national mind set. I can actually envisage that life would have gone on as it was and that people would have adjusted to the awful circumstances that would have arisen following an invasion. The new rules, the sense of helplessness and the real hope that all would have been over ridden by a positive force that was awaited.
Pretty much like the staff in the NHS at present really, stoically carrying on quietly with their duty. Remaining calm and carrying on in the hope that the present invasion of cold political imperatives will pass them by.Of course they remain calm as its essential for the people they care for that they feel safe in a situation where they are vulnerable,
I  really hope that they and indeed all of us who care about the NHS do not feel they are being told as in my other rather more up to date alternative coffee mug slogan to "Shut up and deal with it".

My "London face"

I was introduced to a fascinating idea the other day from a colleague who was visiting London for the day. He had at one time worked in London and then had moved to the West Country. Whilst we waited for the meeting to commence he told me that he hadn't been in London very long that day and he had found himself re-adopting his "London face". I was intrigued by this and asked what such a face looked like. He told me it was essentially a blank stare and he proceeded to demonstrate it to me.
It was as he said blank. In some ways similar to the blank expressionless stare that some people with Parkinson's disease have. Devoid of expression and at the same time a bit threatening.
We discussed what the purpose of such a stare was. He considered it was to avoid contact, in particular to avoid interactions with people who are trying to sell or beg. I was familiar with the tricky issue of eye contact on the Tube and how that took some managing on a busy trip, but this really interested me. Was it a way of keeping to oneself, or a means of keeping people away.
A look that says "don't bother me".
As I was making my way to the Tube at Oxford Circus I noticed that all three Big Issue sellers I had passed didn't offer me their magazine.
I became worried, was I wearing my very own "London face"?

Jack Nicholsons finest moment?

Well was it in Easy Rider, or in "The Shining" (who will forget his cry of Here's Johnny)? I think for many people his most exciting or indeed mercurial performance was in the movie adaption of "One flew over the Cuckoo's nest". He plays the part of one Randle McMurphy sent to an institution for evaluation. The rest is well known and I won't repeat it here. Suffice to say the adaption of Ken Keseys book (also a top read) won many plaudits and awards.
Its influence has been vast and for many that depiction of 1950's institutional care has become synonymous with mental health care "full stop". I was once interviewed for a place on a Masters Degree in mental health and the first question to me (as a nurse in particular) was "Why do you think Nurse Rachet behaved as she did"?
I watched the film (and enjoyed it) and I guess filtered it through a nurses values and culture. I saw clear brutality of a subtle and insiduous nature on behalf of Nurse Rachet. and also the actions of the male orderlies (am I right in remembering one using a cosh?), were really grim. They seemed to be not only institutionalised but also willing to engage in pretty forceful and dehumanising actions.
The patients themselves, well again pure drama and a good drama to, but a more sensationalist collection of stereotypes you couldn't hope to find. Does it have merits though? I guess it does, its pretty realistic in some senses, Its critique of psycho-surgery to ameliorate difficult behaviour is pretty accurate and the numbing routine of a neat and tidy ward is captured well. Perhaps this was because it was filmed in an actual hospital location.
There's much to commend the film as drama, my problem comes when its the main point of reference for peoples understanding of mental health services today.
Don't get me started on the infamous "Titicut follies" whatever you do. Well perhaps another time!

Form an orderly queue

I was intrigued to see a book review recently that referred to the author (British) as an "orderly" in a mental health secure unit. It is an account of his time in a service in the 1980's and is apparently a cracking read. My curiosity was aroused so I read the review a little closer to see who he was. As I read further I found he is also referred to as someone who had been "nursing" and doing so in his capacity as a "nursing assistant"! So now this poor fellow has had three tiltles foisted upon him and quite possibly only one he would have chosen for himself.
I guess its pretty obvious that the strap line containing the term "orderly" was considered more attention seeking and indeed a better fit for the tone of the book. Yet its so very unhelpful and to those in the "trade" an absolute howler of a mistake.But what effect was the copy write of the advert trying to gain?
When I hear the term I think of films such as "One flew over the cuckoos nest" (OFOTCN) and orderlies in white uniforms with bow ties and a penchant for coercive approaches. It leaves me cold and at the same time cross. I consider it a real distortion of what we do.The topic of OFOTCN will be a blog subject later on as i consider it a really damaging movie.
So the effect sought? Probably that of a spectre of locked rooms, secrets and howls of anguish.
Sorry to dissapoint the advertiser but the only howl of anguish was mine!

NHS in shock evidence based revelation!!!

I guess like most people you have been told about the "wasteful and unproductive" NHS. Indeed the current "reforms" (like stripping out £20Billion over the next 4 years) are predicated on this kind of rhetoric. How unfortunate then that a paper profiled in todays press that has been published in that organ of leftist dissent The Lancet by Prof Nick Black  (I jest about the political leanings of that august journal) gives the lie to that assertion. In fact it produces evidence quite to the contrary. I quote from todays Guardian online.
" Black produces a slew of evidence that questions the analysis of the Office of National Statistics used to work out the productivity of the health service. The ONS looked at the return for taxpayers by comparing public expenditure with how much patients used the health service and what the outcomes were.
Black's work, the first of its kind, argues that the measures the ONS used do not reflect the substantial improvements in NHS care. It points out that between 2000 and 2009, such were the advances that a baby born in 2009 could expect to live three years longer than one born in 2000.
Black says far fewer people were dying in specialist procedures in the NHS. He notes declines occurred in adult critical care (2.4% a year), dialysis (3.3% a year), and coronary artery bypass surgery (4.9% a year).
Patients' experience of how they were treated also improved. There were annual relative increases in the proportion of patients treated within four hours in accident and emergency departments (2.5% a year) and in the numbers operated on within 28 days of their operation having been cancelled for non-clinical reasons (10.4% a year).
Such was the NHS's popularity that in the annual British Social Attitudes survey, 70% of respondents reported they were overall satisfied with the NHS. This was the highest figure ever recorded by the long-running survey – the lowest was 34% in 1997, at the end of the Conservatives' 18-year tenure in office."
An impressive record is it not? 
If all that seems a bit technical then cast your mind back to how long people waited for a hip replacement in the 80's. it seemed quite the norm then to wait 2-3 years.Now we seem content with a wait of 18 weeks.
Could this paper herald  the advent of evidence based policy? Now that would be a breakthrough!!

Orgone accumulator

"I've got an Orgone accumulator
and it makes me feel greater
its a one man isolator
made out of orgone"
So sang Robert Calvert on probably Hawkwind's greatest album "Space ritual" , and if you haven't heard it I thoroughly recommend it (in particular the original  fold out sleeve is an exercise in 70's excess)
But this was a song based on an actual device that you were supposed to sit inside and somehow it would not only isolate you but capture Orgones and do you good (sorry about the lack of precision here). I came to think about this song (which I really must place on my I Pod) when I was on one of my usual long commutes to London to do RCN business. I am always impressed how we as humans choose to not engage with each other. In fact I would argue we seem to live in fear of the "other". Opprtunities to isolate the self in a public and indeed crowded place are now more numerous than ever. I like most commuters/travellers on the long haul to London have in my possession an I Pod and a Kindle (and probably a Guardian as well), and like a lot of others I probably use my IPod to erase or exclude the sound of the "others" around me. There is something really strange about being party to private conversations in public places facilitated by mobile phones.
We travel forced by circumstance to be with strangers and isolate ourselves by means of technology.
I wonder is this isolation healthy?

Can someone explain this to me?

Interesting piece in the propoganda war that now surrounds the NHS Bill, you know what I mean , all of a sudden research and reports are produced that support a certain view. All published under the guise of  news. I was really fascinated by this piece in the online Guardian today. It reports that a collection of NHS directors are arguing the elevation of the private commercial earning ceiling to 49% will benefit NHS patients. they say......
"Examples of these benefits include developing treatment innovations and specialisms - such as complex paediatric treatment, robotic surgery, and employer-funded mental health treatment - and mean that trusts will be able to provide services on the NHS that can no longer be commissioned or are now rationed, including IVF."
Now my eye was drawn to the term "employer funded mental health treatment". What could that treatment be I wonder. I assume its psychological therapies that are currently delivered by Employer Assistance Programmes and which engage with independent contractors. Now this could be an absolute fillip to the psychology services couldn't it? They could recruit more and more psychologists and their assistants and  deliver an IAPT style programme for the employers who would pay well for such a service.
But hang on Clin Psychs are a very small group and the low and high intensity workers are being trained to provide IAPT, and in particualr we are now working on a plans to develop that service into greater provision to people with a label of Serious Mental Illness, and indeed Young people.
Could there be a potential diversion of resources here? Could we see a client group neglected because there is more revenue (and less hassle maybe) in treating those employee clinets stressed out as they struggle with the impending recession
I think we need to keep a very careful eye on this one, it would be a real tragedy if a client group that has consistently called for such services sees the promise of delivery lost.
But hey thats the "Market" for you!!!

We've only just begun

Now I am pretty sure that was the first line of a Carpenters song in the 70's, and was probably about the commencement of a new relationship or something equally slushy (as I am sure I thought at the time). It also is true if the Guardian can be believed true of another relationship. According to an article last week by Polly Toynbee (who still gets ribbed by her call for readers to vote Lib Dem in the Election of 2010), we are also at the start of something else, another less welcome relationship. A relationship with Austerity. According to her article only 6% of actual public sector cuts planned have yet occurred. thats right readers, only 6%. Now there was no citing of sources, no references (Geneva or Harvard), so maybe she got it wrong. Say for arguments sake she's out by 300%, so  approximately 20% of projected cuts have occurred.
With a public sector payfreeze and an expensive reorganisation (marketisation) of the NHS occurring then what does this hold out for us? I wager its a bit more serious than the chatterati camping outside their Libraries in North London or indeed twice weekly bin collections.What will it actually look like? How we can envisage a rolling back of services at such a scale? How will it look in the sleepy hamlet where I live. Well mabe the libary is at risk, maybe the local schools will miss out on maintenance, day services for the vulnerable, or possibly a lessening presence  of police. Could be rubbish collection, street cleaning, or public amenities will start charging like parking at the beach . Small stuff maybe, but an eroding feeling, public morale can be vulnerable to such an approach.
To push through this we all need a belief that it can be endured, that we can tolerate the hardships (bit like winter really), and that maybe its in some way tolerable because its inevitable or even fair (just like winter).
So is this approach fair , tolerable or even something that the ordinanry citizen has caused and should pay for? If the answer is no then where will the feeling of injustice go? Here in the UK the usual pattern is to internalise distress , that could mean calls for help to  services that no longer exist. It really has only just begun.

Powerless victims?

Sometimes I catch a persons name, and especially one I haven't heard for a while and I think "I wonder what happened to them". Of course now with Google and other sourcers of information they can be tracked down if you wish. So it was with real pleasure I read an article online in Mental Health Practice by Prof Michael Traynor. It is called "Constrained by impossible ideals" and it offers (wait for it) a psycho-dynamic perspective on nursings apparent inability to resolve some of its more bedevilling contradictions. Indeed an old friends name (not Michaels...but a reference to Freud) is duly mentioned.
One of his four points to illuminate his argument he refers to is nursings apparent pleasure in "a stance of powerlessness and victimhood". This is evidenced by behaviours that are self defeatting and exhibited in that familiar process we often refer to as "wingeing".He supports this by reference to the Death Drive that Freud saw as part of his Pleasure Principle (not to be confused with the Gary Numan album of the same name), and further more this behaviour provides a degree of pleasure and relief from the conflict and tension that the role possesses.
The author really does have a valid point in his argument that nursing faces in many ways an impossible ideal, and as we know today an ideal that is the benchmark against which all nurses are judged, and publically so. Also it sems quite plausible that a powerless workforce that engages in such behaviour is of course more malleable and convenient to direct (guide, bully,influence.....take your pick)
Sigmund Freud certainly a name from the past in many ways but an interesting theoretical insight none the less
Oh just in case you think this is mere psychobabble then remember the work of Isobel Menzies in the 1960's ,quoted by many in reference to task allocation but predicated on the same underpinnings.

Five a day for mental health

Five a day seems a lot when we talk about vegtables and fruit, indeed if you are out and about like me (or indeed a CPN colleague) how can you carry it all. Some say crisps count but I am not to sure. Yet the principle of five a day is possibly equally applicable to our mental health. So what would they be for you? Indeed have you thought of that at all? How do you enhance your sense of well being and increase your resiliance(or even maintain it).
Well for me this is an interesting challenge. I guess my blog gives a clue. so here goes.
1 doing a day in work that feels worthwhile
2 getting outside at some point in the day and stopping and enjoying the fresh air (it can even be done in London)
3 completing a task or role well
4 enjoying time with others (preferably that involves laughing)
5 spending some time on my own (but not to much)
Simples!!!
What about you?

Redesign!!!

Well you have to admit it was a bit boring and needed a bit of visual sorting out, I have to thank my talented daughter for her help.If you are curious as to the location, its Ogmore By Sea here in the county of Bridgend, So thats the tourism bit over with, back to business.

Collective grieving and the NHS reforms

A while ago I read an analysis of the public reaction in Greece to the austerity measures where it was argued that the nation was grieving. It wasn't an outburst of sadness or anger but a progression through the stages proposed by Kubler -Ross all those years ago. you probably remember how it goes (Denial Anger Bargainning Depression Acceptance). The commentator was asking whether the reaction of the Greek public was more than attributable to a mediterranean temprament but in fact the Anger phase of the Kubler -Ross model. Since then publication of the suicide figures for Greece would indicate that collectively they are in a state of malaise.
Could the application of that model be applied here in the UK as we face a momentous change to a nationally cherished system of health care from which we all have probably benefitted? Its hard not to see the events of the last few weeks as not a hardening of self interested stances but a real move to a phase of Anger.As any student of Kubler -Ross's model will tell you , it's not necessary to progress through the stages in a ordered sequence. So just perhaps the preceived failure of Bargainning may take us back to Anger in a way never experienced before in the history of the NHS.

Intentional rounding in mental health settings?

Well you know how it is, you admit to something and it dates you. I guess things like the advent of colour TV, the recollection of steam trains (engines to be more precise) and oh yes Supercar. But nothing has made me feel more old than the notion of rounds. I remeber the tyranny of back rounds, obs rounds, comfort rounds, tidy rounds. Oh yes and then being told they were "task oriented" and then we had to pretend we weren't doing them any more. That was because we had become "patient centred".Now however thanks to the insights of the Prime Minister we are to be engaged in them once again. Now I can see the virtue of regular patient contact, and I can also see how they will be welcomed by patients who really do want to have "nurse time". I just am trying really hard to imagine what they would look like in a mental health setting.
Now we do know that if we take "anytown" acute psychitric admission ward, there will be patients who say that they do not see enough of the nurses.We know that they will be frustrated occasionally by what they see as a lack of interest. We also know that there are wards that have engaged in the process of rigorous 1:1 sessions, all duly documented and scrutinised by clinical supervision. Yet will that meet the "intentional rounding" that the PM has? Or is that limited to where the machines go "beep" and the nurses all wear uniforms?

Diabetes led the way

Interesting day today, discussing and considering how primary care services could and probably will care for people we consider labelled as having "serious mental illness"(SMI). In other words the psychoses such as Schizophrenia and Bi-Polar disorder. Why Diabetes in the header to this entry? Well not so long ago people with diabetes would attend diabetic clinics in hospitals, spend times in waiting areas and have their blood sugars measured and their insulin levels titrated. Something that a GP or Practice nurse was not considered competent to do. Then a change occurred and the staff in Primary care were trained up (or developed competencies if you prefer) and the ongoing care of people with diabetes was transferred to primary care. No more trips to hospitals, and only probably going there at all if matters became outwith the scope of primary care.
Now could the same occur for people with  SMI? Could their routine care be in the primary care setting, could this be achieved with the presence of existing secondary mental health staff located in primary care for support of their colleagues? Consider the gains. no more attending out patient clinics in possibly stigmatising settings, no more six monthly appointments where you see a different person each time, and possibly the chance to address the issue of poor physical health which still blights the lives of these clients.
Could it happen?

Here we go!

Hello and welcome to my blog! This will be my musings or indeed "mental notes", as I go about my business as Mental Health Adviser for the Royal College of Nursing. It's not intended to be a replacement for stuff in the professional press, but rather a useful and more immediate adjunct. I hope here to place ideas, impressions and thoughts that occur to me. As the tiltle suggests its going to very much be about whats going on in the world of mental health , and I hope it will be interesting for you to read.
Ian