It's been a while.

In my last post, I was saying that I had adopted the practice of Mindfulness. I used the Williams and Penman book "Finding peace in a frantic world", it was clear , easy to read and the audio material very helpful. However, I found I needed to really get to grips with this in a more structured way. I enrolled on an 8 week course here in sunny Bridgend for the bargain price of £120!
I think my motivation was to get more information but really I felt the need to be back in a group. I find I spend much of my time working alone and I missed the experience of learning in the company of others. So I enrolled and managed to clear seven out of eight evenings needed to attend.
No surprises in that it entailed practice of mindfulness, reflection on progress and homework. it was great to be back in a group and even nicer not to have to facilitate it but just enjoy it. My fellow students were a mixed bunch of people, many had health problems and real issues of stress and anxiety. I felt a bit of an interloper really as I was not in a similar place, but in the course of the programme I had a bereavement and a health scare that tested my practice.
The course ended and we were invited to attend a full day of practice at a local Friends House (Quakers). that was really enjoyable and required lots of attention. So what now?
I continue with a daily practice of meditation and find it remains beneficial. It seems preferable to be trying to be in a mindful place rather than a mindless one!
I have now offered to facilitate a Mindful Pause at the RCN HQ on world mental health day, and though I cannot teach the practice of Mindfulness I think a taster session will be fine.
I am now considering further training and possibly another formal course and perhaps a direction to consider is becoming a teacher of Mindfulness. there is a path here that could be taken and which I believe could be fruitful.
So sorry for the gap in postings, but I have been busy.

Slip , slop and slide!

Unusual title I know but kind of captures what's been happening over the last six months or so. Its been a long gap and of course I think I have eluded to my difficulty with consistency before. however, all is not lost and I have found my initial training in mindfulness very helpful. Since last I wrote I have been for a job interview (2nd place alas), and yesterday I sat in the car in the M6 for three hours going nowhere but watching my poor car get a bit low on fuel and also rather hot.
it was interesting to note how my anxiety levels were slowly rising as I considered all manner of potential outcomes and yet settled after some very brisk "noticing" to just be there and wait.
So a clear indication for me that mindfulness has everyday utility and also effective.
I will post more shortly about some more ideas (honest)

Week four of Mindfulness training 6/9/13

The observant among you will have seen there is a huge gap in the posting sequence. I am afraid that my annual leave and a return to a busy work schedule has knocked some of this off course. Now that shouldn't have happened and I guess if you value something (or indeed someone) then that's a pretty lame excuse.
However, all is not lost in the world of mindfulness training. I can sense that some learning has occurred and the practice of meditation is really a way or indeed a path to greater awareness of the moment.
I am using a audio recording to practice and it commences with a gentle sounding bell to denote the commencement and the closure of the session.
In the book you are urged to find "bells" in your everyday life that can signal brief moments of clarity and mindfulness. One that it suggests is that of the red man at road crossings when you are walking. It gives you approximately two minutes to note your current situation and root yourself in your breathing
So if you are in London and see a man calmly standing at a red signal despite every one else dashing across then that will probably be me!

Mindfulness Week 3 : 22/7/13

There's much to write about in mental health services at the moment , but with your patience I am going to continue to consider the issue of Mindfulness and my on going practice. It has been really hard to build a sense of discipline into this area of my life and I guess discipline is not a virtue I possess but am keen to develop. It really is striking what can get in the way when you have to find all of 8 minutes for a meditation exercise. I recall clearly when I have had the task of writing or even the dreaded marking when a lecturer.
It was surprising then how much time I could waste on walking from room to room , or tasks that needed doing suddenly seemed urgent. I found myself engaged in any distracting behaviour rather than get marking that pile of dissertations.
In many ways this is similar , there are lots of reasons why I should do other things rather than pay attention to the needs of practice. Yet I persist, and have found real moments of calm and quiet. If we wait for the world we live in to be like that , then we can wait a very long time!
I have found one of the most revealing issues to be the constant chatter of internal dialogue that demands attention but which can be really fruitless, at worst this seems to take the form of ruminating and can be tiring. Yet a simple attentive episode of "noticing" can be so restorative, it seems to have the capacity to introduce actual choice as to the significance of what we experience.
I have found the exercises related to listening quite revealing (although dominated by the local jackdaws) , as they clearly point towards the listening we can undertake to internal thought "chatter" and whether choose to do more than notice its presence.
So yes still persisting and even more importantly feeling a real sense of benefit.

Mindfulness: Week 1

So my first week of mindfulness practice ends today and only seven more weeks of the course to go. I must admit like most issues requiring discipline I have found this a challenge. So far I have enjoyed the delights of chocolate, examined the intricacies of a raisin and undertaken routine tasks in a mindful manner.As the week has progressed the two daily meditations on awareness of body and breath have been fairly easy to fit in my day as only eight minutes long. Somehow though they seem to be ending more quickly and leaving me wanting more.
So what are the tangible benefits of this approach to life, and what does the future hold on the programme?
Firstly there does seem to be a growing awareness of the "moment" and engaging with "now" rather than the past or future. A simple example being when a meeting started looking difficult as the IT was not present I found myself rushing down a corridor and getting in a real sweat about it. I found myself aware of this rushing and then just slowly returning to a sensible pace and feeling a lot better for it. I guess I intervened and prevented a situation escalating.
There also seem to be benfits in the awareness of the thoughts that can intrude and require attention (and therefore energy) when they are really rather pointless rehearsals or speculation about future events.So what is next on the course? I enter week two anticipating rather more lenghty meditation sessions, in fact I think they are about three times longer.
I will report back on the end of the second week.

Mindfulness, getting ready

This course of learning over 8 weeks starts with a taster (literally) event to prepare you for the future work. It all starts with a meditation exercise requiring chocolate. Now its not something I really ever buy so last night at Paddington following a long day I quickly purchased a bar . I settled into my seat on the 20:15 to Swansea and read some more of the Mindfulness book.
Now I am no stranger to commuter etiquette but I did feel a bit strange sniffing and admiring the chocolate before I ate it!
Fortunately I was ( I hope ) discreet and undertook the exercise.
All I will say is that the process of noticing the various flavours as it dissolved on my tongue made this the most enjoyable chocolate bar I have ever eaten.
I think I learnt the process of being in the moment and savouring an experience rather than rushing onto the next event or idea or even task allowing myself to truly engage with the experience.
I look forward to going forward and savouring not just a raisin (all will become clear) but also anticipating an ability to notice rather than engage (especially with those pesky intrusive thoughts)

Mindfulness : an Eight week programme

I have been discussing recently the issue with colleagues of levels of morbidity amongst the nursing proffession. The RCN provides a excellent welfare service and the level of demand is rising year on year. I couldn't help wondering if there was more that could be offered or even done in order to try and adopt a more healthy approach to the stresses of life than all the usual coping mechanisms we may all use at some time.
My attention was drawn by various events to the work of John Kabat-Zin who like Lord Layard before him has caught the eye of the top level of Goverment. The approach of Mindfulness whilst drawn from Buddist meditation practice has been integrated into approaches such as Cognitive Behavioural Therapy and also Stress reduction. Well Ok you may say but isn't it all a bit West Coast USA?
Not really , apparently endorsed by  NICE , MBCT is recommended for people who have endured repeated episodes of depression.
So armed with such endorsements I have purchased the book Mindfulness by Mark Williams and Danny Penman and I am embarking on a 8 week course in Mindfulness practice.
First exercise involves eating Chocolate so should improve my journey home tonight
I'll keep you posted
Ian

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

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?

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"?

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!

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?