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".

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!

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?

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