IMH research day 2019 is coming!

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Call for papers!

If you are a IMH doctoral candidate, part of IMH Managed Innovation Networks (MINs), or an early-career researcher (including research assistants, research fellows, research-active clinicians and service users) please consider submitting an abstract for the event to showcase your work. Oral and poster presentations accepted. Send completed abstract submission form found here to Amna Al Shamsi: Amna.Alshamsi1@nottingham.ac.uk by no later than 25 March 2019.

You need to be connected to the IMH to submit and abstract but attendance is open to all. 

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

Date: Tuesday 21 May 2019, 9.00am – 5.10pm

Plenary Speaker: Plenary Speaker: Kate King BSc BA, lived experience adviser on mental health inpatient care, Fellow of the Mental Health Collective

Title of talk:  Self determination: representing lived experience in the MHA review

IMH

Dear All,

The IMH will be hosting its 7TH IMH Annual Research Day to highlight the work of the Institute of Mental Health’s doctoral candidates, IMH Managed Innovation Networks (MINs), and IMH early-career researchers (including IMH research assistants, research fellows, and research-active clinicians and service users). Further information, flyer and abstract submission form can be found here.

We are delighted to announce that the plenary speaker this year will be Kate King BSc BA, lived experience adviser on mental health inpatient care, Fellow of the Mental Health Collective. Kate’s biography and abstract details are below.

Biography: Kate King is a member of the core working group of the Independent Review of the Mental Health Act 2018, working group lead for Patient dignity and safety topic group. Kate is also a member of Nice guideline development committees on Managing Violence and Aggression (2015) and Transitions between Inpatient mental health settings and the Community (2016). Currently service user representative with the Royal College of Psychiatry on their General Adult and Eastern Division committees. She has experience of repeated detention and inpatient life on acute, rehab and secure rehab wards. She is a published poet under her maiden name, Kate Bass, and one of her poems, The Albatross, which explores post-natal depression, is regularly studied by US schoolchildren as a set work for a national competition.

Abstract: Human rights legislation was an overarching theme of the 2018 Mental Health Act Review and people with lived experience were involved in decision making at all levels. What was it like to work within such a project as a patient representative and what insights can be drawn from a year of such intense collaboration.

If you would like to attend please email IMH.Events@nottshc.nhs.uk giving your name, job title and organisation details by no later than 15 May 2018.

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Good practice when researching people with mental health conditions- a snapshot of the first CMHHR seminar!

Have you ever felt a gap in knowledge on best practice when researching people with mental health conditions (MHCs)? As a junior researcher in this area- I certainly have! And I know many of my colleagues have as well. It’s a gap which hasn’t been filled thus far by other, more general skills courses- as after all, there are some more unique factors involved in researching people with MHCs which not everyone has knowledge or experience of.  But fear not- the Centre for Mental Health and Human Rights (CMHHR) have answers! After the festive period of excessive eating and celebrations, they hosted the first of their seminars on this very topic, where we heard from three researcher with first-hand experience- there to offer help in a Q&A. I know what you’re thinking- I can’t believe my Christmas wish came true! How did you know!?! Well if you missed it, not to worry, I’m here to provide a run-down of key points to take away.

First, to introduce the panel members. They included Amanda Keeling from the University of Leeds who did an ethnographic study of social workers- which incidentally involved ethnography of people with MHCs; Jack Tomlin- a fellow PhD researcher here at Nottingham whose research involved interviewing people in a secure mental health facility; and Ben Clubbs-Coldron, also a fellow PhD researcher at Notts- who interviewed people with MHCs in rehabilitative mental health facilities.

Some of their key points of advice I know I’ll be taking away! And broadly they include questions around informed consent, our duty to participants, preparation and more practical advice.

Informed Consent

Amanda expressed how informed consent isn’t always as straight forward as we’d like to think. When working in a busy field- as she was with social work, she often gathered it quickly, opportunistically in some quite stressful situations and at the behest of the social workers. She explains how some people hear and agree to the information needed for informed consent, but don’t truly hear it. If she had her time again, Amanda said she’d be more assertive in the conditions needed for the informed consent and reminisced about how in one notable instance, she removed information on a participant whom she felt wasn’t truly consenting when she went on the client visit with the social worker. All researchers emphasized the importance of researcher intuition and discretion when gathering consent from people with MHCs. After all, part of our job is being trusted to do the right thing!

Duty to Participants

For people with MHCs in mental health facilities who have routinized daily activities and may have been living there for many years- having a researcher enter their lives is a big deal! Over the course of Jack and Ben’s interviews they built relations with their participants, and Jack noted how residents’ faces would light up when he visited the facility! Exiting an environment like that when people have begun to like having you around, should be just as carefully thought out as how you go about entering. Keeping participants up to date with your research, sending them your transcripts and initial analysis, and respecting that they give you an insight into their experiences- their life, was recommended.

With regards to balances in power relations, it’s important to remind participants that you’re not a member of staff and work independently- therefore they won’t be punished for anything they tell you.

Prep and Practical Advise!

One of the first things Ben flagged up in his advice was to take the preparatory classical literature on interviewing people with MHCs with a pinch of salt! In some ways it alienates this group and he urges us to remember that they’re fellow human beings. Jack advised that people wanting to work within secured facilities should factor in the extensive safety training needed before you’ll be allowed access-and to factor that into your time scale. He also reflected on how some interviewees tended to go on long and sometimes delusional (although revealing) tangents, whereas others gave little more than one word answers. He recommended having two sets of question sheets to hand. One for bringing tangents back on track- grouped my main themes or with a significantly reduced number of questions; and the other with more detailed questions for those who don’t give much response.

Some of the topics researched were sensitive and caused participants to become upset. This is something predictable in most interviews but may be more likely/severe for people with MHCs or those living in secured facilities. All researchers remind us to remain human and sensitive to the feelings of participants, whilst not breeching professional boundaries. A tip on how to do this came from Jacks first-hand experience of a participant getting upset in an interview. He gave the interviewee time to experience those emotions, asked if he would like to take a break or end the interview for the time being or altogether. This allowed the interviewee the time they needed, and provided them with time to collect their thoughts before carrying on the interview (if they so wished.)

Of course this was just a snapshot of what was discussed but hopefully it has helped give some ideas to researchers either get getting into, or hoping to get into, this area of research!

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If you’re interested in this content and would like to see what else the CMHHR has to offer, click the link to view upcoming events or follow us on Twitter at @CMHHR1!

This post was written by Grace Carter. Grace is a PhD student whose research focuses on a reformulation of advance planning for people with mental health conditions under the Convention on the Rights of Persons with Disabilities

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Clare Knighton: The challenges of co-production- A Peer Support Workers Perspective

It’s really important that we as service users and patients can talk about service experiences, share common ground and negotiate service improvements together. This, to me, is the essence of co-production: making meaningful change together. However, to do this well takes time and effort all round.

Co-production isn’t, or at least shouldn’t be, a tick box exercise and whilst it may add more time onto a project, the outcome of a better fit-for-purpose service is worth the effort.Often there is a lack of time for people implementing new changes to circulate information about involvement opportunities. True co-production takes time, detailed conversations, time to ‘think’ (often left out of NHS change projects) and just general involvement and communication.

I believe that many people do want to involve patients and service users, however, it can sometimes appear tokenistic – usually due to lack of time. For my own experiences I feel fortunate to have been involved fully in several changes that have taken place in my Trust, however, I know there is always more to do.

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I sit on the community engagement panel and have seen first-hand how our involvement has given fresh thinking and ideas to upcoming projects. Our ‘fresh pair of eyes’ often uncover things that haven’t been thought about which clearly help bring about more robust, patient focused changes.

Co-production will be on the NHS’s agenda more and more and will eventually become ‘business as usual’, but until then, we need to think clearly about involving those whom the service directly affects – ‘no decision about me, without me.’

perspective

Clare Knighton

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

@knightonstar

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The cost of persuasive design: digital media use and ADHD

This longitudinal study of American teenagers by Ra and colleagues, sought to explore the association between digital media use and symptoms of Attention Deficit Hyperactivity Disorder (ADHD), as well as explore the relationship between high frequency digital media use and ADHD symptom severity.

The study is topical as all parents worry about the relative amount of screen time versus green time that their children engage in, however on the basis of this study should we be concerned about the relationship between digital media use and an enhanced risk of later ADHD?

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All parents worry about the relative amount of screen time versus green time.

Ra and colleagues study highlights the urgent need to ensure that the design of digital services and products is appropriate for children and young people. Their longitudinal study shows a significant (but modest) association between higher frequency of digital media use and subsequent symptoms of ADHD when measured with Self-Report Form DSM-IV.

The study seems to indicate that the likelihood of developing ADHD symptoms among a longitudinal (24 months) cohort of 15 and 16 years olds (that showed no significant ADHD symptoms at baseline) can increase as a result of high frequency social media activities. While more evidence is needed to understand the impact of persuasive design strategies on children and young peoples’ social, mental and physical development, studies such as this illustrate the potential negative outcomes of excessive use.

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This longitudinal study shows a significant (but modest) association between higher frequency of digital media use and subsequent symptoms of ADHD.

Pervasive design

Pervasive design, a term coined by psychologist BJ Fogg, combines the theory of behavioural design with computer technology (Fogg, 2002). Behavioural design uses a system of rewards and punishments to determine human behaviour patterns. Both persuasive and behavioural designs can be used to manipulate human behaviour so that users act in the commercial interest of others (Kidron et al, 2018). Persuasive design strategies are deployed for commercial purposes to keep users online.

It is neither ethical or reasonable to design services to be compulsive and then worry about the impact that persuasive design may have on children and young people’s mental health due to smart device overuse. Internet Matters (2015) revealed that in the UK, 40% of secondary school-aged children and 34% primary school-aged children “feel worried that they are addicted to the internet” (Clark et al, 2015).

Often British children and young people display absolute devotion to their devices, on the one hand saying they “could not do without their mobile phone for a day” (Murgia, 2017), that they are “best friends” with their phone or don’t feel “right without it”. At the same time, they report being “addicted”, “attached”, “distracted”, “obliged”, “always consuming”, having “no control” and feeling “panicked” (Coleman et al, 2017).

Common Sense Media (2016) found that one third of American children aged between 12 and 18-year-old struggled to cut down time spent on devices; half said they felt “addicted to their mobile devices”.

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Persuasive design strategies are deployed for commercial purposes to keep users online.

Persuasive strategies

The tension between being governed by and devoted to their devices is, in part, a result of the persuasive strategies baked into the digital services that children and young people use. These include:

  • Excessive notifications such as buzzes, pings and all other non-specific alerts
  • Lack of save buttons (so users are forced to stay online to complete a task)
  • Software upgrades that automatically enhance or switch persuasive design features back on
  • Personalised services design to extend use among many others
  • Reward features that release dopamine
  • The need to use social media in order to be social or popular
  • Highly emotive content

All of the above create a digital environment that does not meet the needs of children and young people.

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Digital technology is designed to persuade young people to use it as much as possible.

Monitoring and addressing problems with digital media

Whilst acknowledging the great potential of the digital world, and recognising the value of responsive usage, the technology sector should monitor and address the effects of their products on children and young people and recognise that the options provided to parents and teachers to address digital media overuse are inadequate an ineffective. These include:

  • Over simplistic rules
  • Misconceptions
  • Exaggerated claims
  • Widespread uncertainty that may limit opportunities and creativity.
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We need better ways to monitor and address overuse of digital technology.

Digital media use in young people with ADHD

Digital media use for children with ADHD presents a unique threat that non-ADHD children do not face to the same extent. It is clear that sustained attention is poorer in children with ADHD compared to typically developing children and reinforcement improves sustained attention (Bubnik et al, 2015).

Taken together these findings suggest that children with ADHD may be even more likely to seek out the immediate and intense reinforcement opportunities available via digital media, because they are less likely to find the reinforcement opportunities in their offline life.

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Young people with ADHD are likely to be more susceptible to the intense reinforcement opportunities available via digital media.

Limitations

In addition to the three study limitations already identified by the Ra and colleagues (i.e., ADHD symptom scale, media use measure validity, and sampling), other issues need addressing:

  • The authors do not reflect on the high attrition rate (almost 50%) or the large proportion of participants (48.2%) eligible for subsidised lunch, its impact on sample representativeness and overall results
  • In addition, the authors do not display data regarding the 13th digital media use index score (i.e., Online shopping or browsing).

While we welcome longitudinal studies that explore the impact of digital social media use on children and young people’s mental health and wellbeing, we need to remain vigilant as to the complexity of multiple confounding influences that may be contributing to the Ra and colleagues’ study results.

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Longitudinal studies suffer from problems with confounding, so better evidence is needed before we can be sure of the links between digital media and ADHD.

Links

Primary paper

Ra CK, Cho J, Stone MD, et al. (2018) Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among AdolescentsJAMA. 2018;320(3):255–263. doi:10.1001/jama.2018.8931

Other references

Fogg BJ (2002). Persuasive Technology: Using Computers to Change What We Think and DoUbiquity, Volume 2002 December, Article 5.

Kidron B, Evans A, Afia J (2018) Disrupted Childhood. The Cost of Persuasive Design (PDF).

Clarke B, Atkinson R, Svanaes S (2015) How Children Use Mobile Devices at School and at Home (PDF). London: Techknowledge for Schools. September 2015, p4.

Murgia M. (2017) Secret lives of children and their phonesFinancial Times, 6 October 2017.

Coleman S, Pothong K, Perez Vallejos E, Koene, A (2017). The Internet on Our Own Terms: How Children and Young People Deliberate about their Digital Rights (PDF).

Technology Addiction: Concern, Controversy and Finding a Balance. Common Sense Media. Research Brief, May 2016.

Bubnik, M.G., Hawk, L.W., Pelham, W.E., Waxmonsky, J.G.Rosch, K.S. (2015) Reinforcment enhances vigilant among children with ADHD: Comparisons to typically developing children and to the effects of Methylphenidate. Journal of Abnormal Child Psychology, 43, 149 – 161.

Photo credits

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This post first appeared on the National elf service.

It was written by:

Dr Elvira Perez Vallejos is an Associate Professor of Digital Technology for Mental Health and Digital Technologies at Nottingham Biomedical Research Centre (Division of Psychiatry and Applied Psychology, Faculty of Medicine).

Dr David Daley is Professor of Psychological Intervention and Behaviour Change in the Faculty of Medicine & Health Sciences at the University of Nottingham.

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Happy Holidays

Dear reader,

As 2018 draws to a close we would like to take this opportunity to thank you for your support.  We’ve had some great content this year and as always it’s been a privilege to be able to host the research, experience and opinions of our wonderful collaborators & contributors. We hope you have a brilliant festive season and look forward to sharing new content with you in January.

 

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Remember: if you end up with a little time to spare over the holiday season and you would like to write something, please get in touch as we would love to hear from you.

Happy holidays!

IMH blog team

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Elvira Perez Vallejos: Digital technology will transform the role of NHS clinical staff

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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.

This review is being led by Dr Eric Topol, an American cardiologist, geneticist, and digital medicine researcher, author of ‘The patient will see you now’ and ‘The creative destruction of medicine’ among other more clinical textbooks.

During the workshop, attendees were distributed into heterogeneous groups. My table included several mental health practitioners (three psychiatrists and a mental health nurse), a policy maker and a machine learning expert. We were asked to reflect on these questions:

1. How will digital technologies change roles and functions of clinical staff?
2. What are the implications for the skills required?
3. What will this mean for the selection, education and training of staff?

To my surprise, I did not have to defend or argue about the need to promote a basic understanding of how the digital economy works and its implications for users’ data privacy and security, the dangers of secondary data being sold in data markets, harm related to self-diagnosis and self-treatment. Nor did we discuss the use of unreliable smartphone apps (see Bauer 2017 for more details), the risks of persuasive design, or the need for human-centred design and co-production of new tech for mental health engaging and involving clinicians, service users and developers.

We all agreed about the need for a cultural shift in which data ethics and responsible research innovation (RRI) drives tech advances. One of the barriers that kept appearing during our discussions on the effective adoption of digital tech was the software licence issue.

I was not aware that NHS Trusts have to pay a substantial amount of money in order to be able to offer specific treatments to service users or analyse health data. If software were instead developed in-house or with taxpayer money, this should be open access and freely available within the NHS.

We also discussed the lack of research evidence to help us understand current and future relationships developed towards machines (i.e. avatars, robots, virtual human therapists and chatbots) designed to support or monitor peoples’ mental health. These new attitudes and human-machine relationships have a generational effect and younger people may place more or less trust on tech outcomes than older people.

This is an aspect that needs more research, specifically understanding the implications of these new attitudes on mental healthcare.

It was agreed that technology advances are moving fast; too fast for health services to cope with. And tech innovation cannot be slowed down and NHS services cannot speed up. This is a problem that will influence how training is delivered and medical curricula is updated.

Digital technology will force a rapid transformation of the roles and functions of clinical staff who will be expected to adapt quickly and cope with a constant flow of new solutions.

Bringing the digital into the NHS will require the training of staff on digital literacy, basic maths and statistics (e.g. to understand mental health algorithm-mediated outputs), and to become more multidisciplinary than ever before. The data analyst or natural language processing developer working alongside clinicians may become the expected norm.

I really enjoyed the whole discussion but what struck me the most was the realisation that ‘the digital’ can actually revolutionise psychiatric diagnosis. It was argued that mental health distress and difference is more fluid and dynamic than the DSM (Diagnostic and Statistical Manual of Mental Disorders) codes, a product influenced by the pharmaceutical industry.

Digital tech for mental health seems to highlight the issues embedded within the current diagnostic system and may offer an alternative perspective that can influence the future of psychiatry.

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This post was originally hosted on the Nottingham Biomedical Research Center pages.

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Why celebrate World Mental Health Day?

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.

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Not many people know that I’ve been working in collaboration with the Institute of Mental Health (IMH) curating temporary exhibitions since 2014. My first contact with the IMH was after they invited artist Rachel Oxley to show a retrospective of her work. At the time Rachel was finishing her MFA at Nottingham Trent University and I was also finishing my MA in Curation at the same university. I had grown very close to Rachel during our studies while supporting each other through the rollercoaster of emotions that a postgrad can become. We were there for each other, at our best and at our worst. Rachel is a Nottingham based artist who deals with mental health subjects in her work, drawing most of her inspiration from her own experience living with dissociative identity disorder (DID). DID is a complex psychological condition caused by many factors, including severe trauma during early childhood. Due to the nature of my studies and our friendship, Rachel approached me for support while putting on her exhibition at the IMH.

Since then I have worked with artists that use all sorts of media; photography, painting, sculpture, ceramics and many other, in artistic ways to share and explore their experiences with mental health. From conditions as common as depression or anxiety to more complex medical conditions like DID or schizoaffective disorder, I have learned that each of us have our own way to overcome and move forward. I have learned that artistic practices help us channel emotions and thoughts, and that helps a great deal in the process of recovery.

This year’s World Mental Health Day fell on the 10th October. To commemorate this we celebrated the launch of the exhibition The Twisted Rose and Other Lives by artist Andy Farr, which will run until the 1st March 2019. I worked with Andy to curate a thought-provoking exhibition focused on post-traumatic stress disorder (PTSD). Post-traumatic stress is more common than we think. Andy claims that his own traumatic experiences were much less severe than those who have suffered abuse or been involved in war conflicts, nevertheless they had a profound impact on his life, leaving his career in marketing research and advertising to become a full-time artist. With help from the IMH Andy has been meeting with other people who have experience post-traumatic stress to create a series of paintings that brings their experiences to life.

Andy says: “My hope with this exhibition is to show what it is like to suffer and recover from mental health problems, to raise awareness and consciousness of the issues surrounding trauma, and to provide positive therapeutic outcomes for those directly involved.”

It’s important to give visibility to artists like Rachel or Andy, and to support the work that organisations like the IMH and many others do in the city, to appreciate the space they provide, because it’s priceless.

While World Mental Health Day is a great opportunity for global mental health education, awareness and advocacy,  we should be listening to those voices every day, in order to break down the social stigma around mental health. Let’s make every day World Mental Health Day.

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If you or someone you know is struggling with mental health, please call the NHS on 111 or visit NHS Every Mind Matters.

 This piece has been reposted with consent after first appearing here

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