Monthly Archives: May 2012

A new IMH building and a new IMH blog opportunity!

The IMH’s editorial blog team had the opportunity to attend today’s unveiling of the new IMH building on the University of Nottingham’s Jubilee Campus/University of Nottingham Innovation Park. Today’s ceremony represents the official opening of the recently completed 4-storey building.

The IMH is a partnership between The University of Nottingham and Nottinghamshire Healthcare NHS Trust. Situated on Triumph Road, the innovative building brings together in one location the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire (NIHR CLAHRC-NDL), the NIHR Mental Health Research Network East Midlands Hub in partnership with South Yorkshire Comprehensive Local Research Network, the NHS East Midlands Leadership Academy, etc. The Institute embraces numerous research pursuits, for example, the newly created Centre for Health and Justice. Today’s opening ceremony takes place a year to the day since the official ground-breaking ceremony and was attended by representatives of the Institute, the University and Nottinghamshire Healthcare, partner organisations, and those involved in its construction.

A variety of speakers and presentations were arranged to celebrate the £7 million purpose-built space. Speakers included Professor Mike Cooke CBE, Chief Executive of Nottinghamshire Healthcare NHS Trust; Professor Nick Manning, Director of the Institute of Mental Health; Professor Dame Sally C. Davies, Chief Medical Officer and Chief Scientific Adviser at the Department of Health. All of the speakers spoke highly of the interdisciplinary approach to mental health embraced at the IMH, the exciting innovations occurring in applied research, and the opportunity to fuse clinical practice and research to provide original yet applicable mental health developments.

As cited in the IMH Press Release, Professor Dame Sally C. Davies said: “I am delighted to open this new research facility in Nottingham. Different forms of mental illness affect a significant proportion of people, and the research undertaken by the Institute of Mental Health will provide more evidence to improve the care and services for NHS patients and the wellbeing of the public.”

To that end, the editorial team for the IMH Blog is looking to recruit new post writers! You can write just one post, or many. It’s up to you. The IMH Blog is a forum to encourage dialog about issues related to mental health broadly defined. Our aim is to capture the variety of interest and expertise that is reflected in the Institute’s diverse membership body. All interested parties are very welcome to contribute. We encourage posts from carers, service users, clinicians, academics, allied health professionals, commissioners, etc. We look forward to hearing from you!

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IMH Blog Team

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Dr John Milton – Always walk on the grass

A short way down from the Department of Health building on Whitehall stands the statue of Field Marshall William ‘Bill’ Slim. Much beloved by his troops from the Burmese conflict in World War Two, there are stories that Slim was unusual in getting things done. One tale about setting up a new camp was that he would insist that sappers delayed laying paths and roads until it had become clear which directions had attracted the most use, usually the paths of most convenience or efficiency.

In a way this tale expounds both a ‘custom and practice’ approach as well as exhibiting innovation. After all how often have we seen organisations or systems insisting on doing things in a way that seems long-winded or inefficient? Human nature sometimes overtakes procedure and staff adapt an approach to save time or effort. Of course, one person’s short-cut is another’s health and safety nightmare. Knowing when it is safe to take a short-cut to improve a pathway is the key.

On my way to my office I get the chance to alight from the tarmac path onto the spongy turf. It isn’t far from the path but that briefest of periods puts the spring back in my step, changing my mindset and for a split second I feel and think differently about things. In his new book ‘Imagine: How Creativity Works’[1] Jonah Lehrer notes how new ideas and solutions to problems often arise from such a change of context, particularly when we are relaxed or off-guard.

So, what am I saying? That we should all stroll randomly about the lawns of our organisations? The gardeners would hate it; our shoes would get muddy too. But there is something about pathways that is fundamental to integrated healthcare in the twenty first century, both in terms of utilising existing flows between hospitals and community care but also allowing ourselves to think differently about going metaphorically off-piste. Now is the time to use a Slim (or should that be ‘lean’ – to adopt the management term) approach to examine what works well and strengthen those pathways as well as looking for other paths across networks that cut off the corners. The trick of course, as with all new ideas, is to get the right meld of innovation, pragmatism and efficiency. Easy to say….

Posted by:
Dr John Milton
Consultant Forensic Psychiatrist & Forensic Research Lead
Rampton Hospital Nottinghamshire Healthcare NHS Trust
E: John.Milton@nottshc.nhs.uk

Reference:

[1] http://www.jonahlehrer.com/


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Melanie Jordan ~ Care and custody for those with mental health needs in prison

Care and Custody

Recently, the Prison Reform Trust published an article entitled: Ministers outline steps to keeping ‘care not custody’ promise (http://www.prisonreformtrust.org.uk/PressPolicy/News/vw/1/ItemID/153). This article commences:

‘The Health Secretary, Andrew Lansley, and the Justice Minister, Crispin Blunt, have outlined the progress made towards diverting people with mental health needs from the justice system into treatment and care, at a Westminster reception on April 23rd – hosted jointly by the Prison Reform Trust and the National Federation of Women’s Institutes on behalf of the Care not Custody coalition’.

Accordingly, Prison Reform Trust director, Juliet Lyon, argues ‘a bleak cell in a dark, noisy prison is the worst place for someone with mental health needs’. Furthermore, Lord Bradley highlights ‘while public protection remains the priority, there is a growing consensus that prison may not always be an appropriate environment for those with severe mental illness and that custody can exacerbate mental ill health, heighten vulnerability and increase the risk of self-harm and suicide’ (DH 2009:7)(http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098698.pdf).

Thus, discussions regarding the prison environment, the care of offenders, and the nature of custody have contemporary worth.

This care not custody debate is also currently discussed in the National Newspaper for Prisoners InsideTime (http://www.insidetime.org/articleview.asp?a=1200&c=care_not_custody_promise).

In January of this year a BBC Radio 4 three-part series, The Bishop & The Prisoner, from the Bishop Rt Rev. James Jones aired prisoners’ voices and narratives verbatim on radio (http://www.bbc.co.uk/programmes/b0194p7v). Bishop Jones debates the purpose of imprisonment and the transformation from offender to useful citizen. Overall, the series focuses on reducing reoffending via the central argument that containment alone is neither effective nor sufficient. Here, the care versus custody debate also arises, yet is extended to the whole prisoner population.

This discussion could be further extended to include prison staff. Tait (2008) suggests that a reassessment of the role of the prison officer is required (http://www.hmprisonservice.gov.uk/resourcecentre/prisonservicejournal/index.asp). For example, the idea of prison officers as mere ‘turnkeys’ (p. 3) could be supplanted. Instead, ‘the care of and contact with the inmates in his or her charge’ (p. 3, emphasis added) are important. Empathetic care and contact are arguably crucial in the prison environment. Poignantly, Tait (2008) suggests that developing caring inmate–officer relationships often helps inmates manage their period of imprisonment, increases prison officer job satisfaction, and develops prison officer career aspirations. Such relations require prison officers to listen, understand, and respond to inmates’ needs. Tait’s (2008) caring interactions are ‘founded on relationships characterised by respect, fairness and sociability’ (p. 5). Beneficial ramifications for both prisoners and staff appear possible here. For those in prison with mental health needs, care alongside custody is arguably necessary. Factors associated with imprisonment itself appear to predispose prisoners to mental health problems and these mental health determinants in the prison setting require further research.

Regarding a whole prison approach to mental healthcare, the WHO’s healthy prison concept is a recognition that the health of prisoners is not the responsibility of healthcare clinicians alone. Rather, it is also dependent on the ethos and regime created in the penal setting. The WHO’s Health in Prisons Project acknowledges that prisoners’ individual healthcare needs are essential; however, the promotion of a whole prison approach to health is considered vital for apt development of healthy prisons that provide appropriate care for those in custody. Importantly, Ramluggun et al. (2010) report ‘the conflation of knowledge and experience of staff working in prison places them in a favourable position to contribute to the current reform of offender health’ (p. 70) (http://nurseresearcher.rcnpublishing.co.uk/archive/article-research-in-prison-a-researcher-practitioner-s-view). Certainly, the experiential knowledge of wing staff is remarkably valuable. Indeed, the involvement of HM Prison Service staff in the development of both prison mental health policy/practice and HM Prison Service’s overall approach to prison mental health is to be supported.

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Dr Nicola Wright – The Politics of Recovery in Mental Health: A Left Libertarian Policy Analysis

Turner (2002) identifies that recovery has been described as an idea, a movement, a philosophy, a set of values, a policy mantra and also a doctrine for change.  It splits opinion between those who view it as simplistic and obvious and others who see its revolutionary and transformatory potential.  Although increasingly fashionable within current mental health policy and practice, there are precedents for recovery as far back as the seventeenth and eighteenth centuries.  For example Phillippe Pinel appointed ex-service users in a bid for a humane regime at Biceptre in Paris and William Tuke developed moral therapy and self management approaches at the York retreat (Scull, 1981).  However, the roots of recovery are most firmly established in movements of protest intended to improve conditions in asylums and to give equal rights to citizens with disabilities.  Judy Chamberlin articulates these rights based approach when she appeals for recognition of the skills and abilities of people with mental health problems to make their own decisions, run their own lives and provide support for one another (1990, 1978).  While the normative claims of recovery have been adopted within English policy, its implementation in mainstream services is heavily critiqued by service users; the main point being that recovery has come to mean all things to all people (MIND, 2008).  Indeed there is a risk that its increasingly popular status and dominance as a paradigm within policy discourses will lead to it being co-opted and distorted by policy makers and experts in the field.

With colleagues in the School of Nursing we used Noam Chomsky’s critical methodology, as an exemplar of a left libertarian position, (Edgley, 2000; 2005; 2009) to provide a theoretical analysis and test of the coherence of the recovery model (Edgley et al., 2012).  We also used it as a critical mechanism to judge manifestations of recovery in practice settings.  In Chomsky’s political philosophy we find that hope is both a pre-requisite and a pre-condition for a trusting and supportive environment.  Everyone, whether or not they have mental health problems, need these conditions to be able to access and utilise their creativity in dealing with their current reality.  For Chomsky, hope, our innate creativity and a supportive community are the necessary conditions of freedom.  In Chomsky’s view, if our society nurtured our creative potentials, then our human nature would not confine itself to searching for autonomy and independence but would instead generate interdependent arrangements.  This could have direct implications for the implementation of recovery; it suggests that those experiencing mental ill health need to be the co-creators of policy and practice, rather than its passive recipients and they need to be able to build and use their own theoretical structure such as that offered by Chomsky.  This would protect recovery from being ideologically driven and open to political interpretation and potentially more importantly provide the basis to evaluate and present evidence on its own terms.  As we conclude in the article:

“The recovery paradigm has the essential elements in place, but control over its application – and lives- needs to be reclaimed from the state and experts alike before adoption turns to assimilation or perhaps co-option turns to emasculation.”

Posted by:
Dr Nicola Wright
Research Fellow: Research Delivery and Support Unit
Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Nottinghamshire, Derbyshire and Lincolnshire

References
Edgley, A (2000) The Social and Political Thought of Noam Chomsky.  London: Routledge.

Edgley A (2005) Chomsky’s political critique: Essentialism and political theory.  Contemporary Political Theory 4: 129-153.

Edgley A (2009) Manufacturing consistency: Social science, rhetoric and Chomsky’s critique special issue: The Herman-Chomsky propaganda model twenty years on.  Westminster Papers in Communication and Culture 6(2): 23-42.

Edgley A, Stickley T, Wright N and Repper J (2012) The politics of recovery in mental health: A left libertarian policy analysis.  Social Theory and Health 10(2): 121-140.

MIND (2008) Life and Times of a Supermodel.  The Recovery Paradigm for Mental Health.  MindThink Report 3.  London: MIND.

Scull A (1981) Madhouses, Mad-Doctors and Mad-Men: The Social History of Psychiatry in the Victorian Era.  Philadelphia: University of Pennsylvania Press.

 

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