Monthly Archives: October 2012

Chloe Hill ~ An internship at the Institute of Mental Health

Chloe Hill ~ An internship at the Institute of Mental Health

I wrote a post for this blog a couple of weeks ago based on ‘Society’s perception of “perfection”’, so as I’m now coming to the end of my Internship here at the Institute of Mental Health I thought I’d write a little bit about my experience here and how influential it has been on my decisions for the future.

When I left Ecclesbourne Sixth Form (Derbyshire) in July, I really didn’t have much of an idea what I wanted to do with my gap year, let alone my whole future career. I thought I wanted to do something related to Psychology and perhaps Criminology, but wasn’t exactly sure what. I wrote to the IMH hoping for a little work experience to give me an insight into the world of psychologists and psychiatrists, so I was extremely pleased when I was invited for an interview and offered an Internship.

Whilst here as an Intern, I’ve had the opportunity to gain an insight into the Institute and its work via attending seminars, workshops, and hearing the stories of some really fascinating people. The experience that has affected me the most has to be a workshop I attended entitled “Understanding Personality Disorder” with the Mental Health Research Network. We were first addressed by a therapist, who explained personality disorders in a way which I particularly found useful having had little previous experience in this field of healthcare. However, it was meeting the service users themselves that influenced my decision to consider Clinical Psychology as my future. Their stories of how their lives had been turned upside down by their personality disorders were quite poignant and moving, but it was the gratitude they expressed for people who actually listened and understood them that influenced me – particularly the benefits and outcomes created with help from these understanding relationships. I have also attended meetings with Learning Disability Paediatricians regarding current studies with autistic children, and the PPI (Patient and Public Involvement) Forum which consists of relevant individuals, including service users, who wish to be involved in the research process.

So what have I learnt from it all? Aside from the fact that I don’t think I’m ready to be getting up at 6 am for a job for the rest of my life yet!, I’ve decided to apply for a Psychology degree at University with the intention of studying a Masters in Development Psychology afterwards, which will hopefully help me on my way to undertaking a Doctorate in Clinical Psychology. For the rest of my gap year I’ve organised a voluntary placement at a local Special Needs School, and work experience in a clinical environment. Ideally, I’d love to be a Clinical Psychologist with children and adolescents, working with them during and after difficult times and events.

So a final thank you and goodbye to the Institute of Mental Health; I don’t know what I’d have done without you! My time here has been truly inspirational.

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Neil Chadborn ~ How might community organising relate to health or social research?

How might community organising relate to health or social research? #nottinghamcitizens

Neil Chadborn, Collaboration for Leadership and Applied Health Research and Care @nchadborn

On 17th October I joined a delegation from School of Sociology Social Policy to attend the first major public meeting of Nottingham Citizens.

170 people, representing 34 organisations, met at Nottingham Trent University to discuss how an alliance of organisations from ‘civil society’ might lobby the candidates for the first elected Police Commissioner, to improve the safety of the city.

We heard from the Rector of St. Nicks Church, Steve Silvester, about how the project has developed in Nottingham over the previous two years. During this time the group has raised £100k of community funds, held 1000 meetings and trained over 120 community leaders. The idea is to build a network of faith communities, schools, unions and charities to act on common concerns for the city.

Nottingham Citizens see the election of the new Police Commissioner as an opportunity to get the voices and concerns of the people of Nottingham heard in a powerful way. Four key concerns of Nottingham residents were described by personal testimonies of horrific incidents in the city. These issues have been researched, for example by mapping and surveying. Based on the personal stories and the research, action plans have been drafted to put to the Police Commissioner as the ‘Asks’ of Nottingham Citizens. Our objective for the evening was to vote on priorities (or veto) these concerns. We decided within our organisations our priorities, and the overall result was as follows:

1)      Safer Young People – following the story from a young girl who had been traumatised by a man approaching her on her way to school. This is a too frequent occurrence across the city and Nottingham Citizens have mapped routes to school and are asking for a greater police presence on these routes.

2)      Sensible Stop and Search – a young black man gave an account of being racially abused and physically assaulted during a police stop and search, being put in a van without being charged and without being read his rights at arrest. Nottingham Citizens are asking the Police Commissioner to ensure that receipts are given for every stop and search (and also stop and account), to ensure greater accountability.

3)      Safer City Centre – we heard an account, read by a friend, of a female student who, because she didn’t have enough money for a bus fare, had difficulty getting home after a night out and was attacked and raped in Forest Recreation Ground. Nottingham Citizens are asking for the police to move their operations centre to within the Rec itself. We are also asking that more support is given to Police Community Support Officers who are now on patrol until 1am.

4)      CitySafe Cabs – an Asian taxi driver told us about an incident when he was held at knifepoint within his taxi and forced to drive around the city, whilst also being racially abused. He managed to escape and fled his taxi (his livelihood) in fear of his life. His family have lived in fear during the investigation and conviction of the man, and continue to live in fear as he has been seen on their home estate after being released from prison. Nottingham Citizens are asking for match-funding to enable installation of CCTV in taxis.

How does Nottingham Citizens relate to the University? Firstly they are asking for our support on a personal level – if you feel strongly about any of these stories, please come with us to an Accountability Assembly with the future Police Commissioners (Mon 12th November, 18:15) where we will ask for action on these issues (email for more details: neil.chadborn@nottingham.ac.uk). In future we could raise concerns from within the university community.

From my public health perspective, action on all of the above has benefits for health and wellbeing for the people of the city. Obviously, if the number of violent attacks can be reduced, that can have huge impacts in avoiding the physical injury as well as mental trauma to individuals and families. Furthermore improving city safety can have an important impact on resident’s perception of risks. For people who may have been leaving in fear of these risks (sometimes emphasised by the press) knowing that the city is taking action could alleviate stress and hence benefit mental wellbeing. However actually taking part in Nottingham Citizens could be beneficial; Prof Sir Michael Marmot (and colleagues at University College London) has shown, in a series of studies on stress and health, that having a sense of control in day-to-day life can improve health and wellbeing.

The second question we are considering, is how departments and centres within the University may relate to Nottingham Citizens. Could Sociology, or various research centres including my own (Collaboration for Leadership and Applied Research in Health and Care) offer support or research for particular projects? In turn this could be an effective way for us to disseminate findings from relevant research to a local audience.

Thirdly can we ‘open up’ our departments to the city communities, whether from a student perspective – widening participation, or from engaging the public in our research processes and outputs, seminars for example.

Fourthly can we learn from their approach of ‘community organising’ to inform our engagement processes. Several of our members are engaging with Nottingham Citizens in order to learn more about the approach. We are also considering inviting their organisers to hold training sessions for our research staff. Maybe this could also be useful for students and teaching staff. This is an ongoing debate within our departments and centre – please feel free to join the debate (possibly on twitter: @nchadborn or @clahrc_ndl or @uniofnottingham or search for #nottinghamcitizens).

http://www.citizensuk.org/chapters/nottingham-citizens/

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Amanda Keeling – Emergency Services as the ‘Safety Net’ in Mental Health

There is a programme running on Channel 4 at the moment called 999: What’s your emergency?   The programme follows calls through from when they are received at the call centre, to their resolution by one of the three (or a combination of all three) emergency services.  The programmes are themed around different issues, and this week’s episode focused on the use of 999 and the emergency services by people with mental health issues.

It was mentioned by several of the emergency services staff on the programme that they often felt that it was not really within their job description to attend to such issues related to mental health, and moreover that they were not the ‘right person’ for the job, and had neither the expertise or the training required to properly help the person who was asking for it, or needed it.  The programme itself showed that this was certainly the case in some situations, with police officers becoming increasingly frustrated with a ‘repeat caller’ who took overdoses ‘with no intention of killing himself’  (although, there were counters to this position, with a wonderful example of good practice from the paramedic who attended Alan Abbott when he relapsed into alcoholism and called 999 in fear of taking his own life).  Yet despite feeling that it was not strictly within their remit, and feeling inexperienced, they were concerned that there was no one else to do it.  They are, said one police constable, the ‘sticking plaster’ on society, trying to fill the gaps and provide one last safety net for people.

The police officers in particular clearly felt under equipped, under resourced, and lacking in the appropriate experience to perform the work that they felt was more within the brief of social services, but that there was simply no one else to do it and they did not feel they could just sit back and watch someone they perceived to be vulnerable harm themselves.  The programme only serves to highlight some of the issues the Chief Inspector of Prisons raised in his annual report published last week, concerning overuse of police cells as a place of safety under s.136 of the Mental Health Act.  Debate about section 136, and the appropriate place for people with a mental disorder found in a public place, has been on-going for many years, and concern over the excessive use of s. 136 in police stations is not new.  However, despite the academic research, and the opinions of officers themselves, use of the police force as a ‘stop gap’ does not seem to be diminishing.

It was suggested in the programme that the cause of the rise in this type of call to 999 was due to the diminishing number of psychiatric inpatient facilities, which is of course a deliberate scaling down with a view towards greater levels of community care, whether you believe the motivation for this to be an idealistic move towards community inclusion, or a more cynical cost cutting exercise.  However, reducing the inpatient facilities does not diminish the number of people with mental disorders who want or need help.  As one of the paramedics interviewed noted, the emergency services can provide short-term help – a police cell doubling as a place of safety, or a bed in A&E for the night – but this is no long-term solution.  One of the police constables noted that with the increasing cuts on the police force and their reducing numbers on the streets, there is going to be a growing need to define more clearly the parameters of ‘police work’, and they may have to start refusing to attend many of the types of incidents shown in the Channel 4 documentary.

This is not my particular area of expertise, but I was really struck by the issues this programme raised between the lines.  The police may not be the appropriate people to be dealing with mental health  issues, but the fact that they are doing so must raise the question ‘who should be?’.  As public sector cuts only look set to continue, we must start asking this question more pressingly, because if the emergency services ‘safety net’ is taken away, what will replace it?  I know there are those of you out there reading this blog for whom this is your area of research, and I would welcome discussion of the issue in the comments section below.

Amanda Keeling
PhD Student
School of Law, University of Nottingham

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Dr John Milton ~ Any port(al) in a (information) storm

Any port(al) in a (information) storm

“Don’t read newspapers for the news (just for the gossip and, of course, profiles of authors). The best filter to know if the news matters is if you hear it in cafes, restaurants… or (again) parties”. Nassim Nicholas Taleb, Professor of Risk Engineering at New York University.

I like Taleb’s writing. ‘Maddeningly wise’ is how one reviewer proclaimed the Black Swan author’s recent short book The Bed of Procrustes. I therefore thought I would put his quip about news to the test. I used to be a news junkie; twenty four hour rolling news was made for me. But it is both so time-consuming, especially when so much isn’t actual ‘news’ (facts, whatever they are) but speculation and analysis, and so subject to editorial control in terms of what is deemed ‘newsworthy’. I decided that what I needed was another editorial filter, someone or something to cut out all the rubbish to allow me to peruse only the need-to-know (as Taleb says, assessing what news “matters”). Don’t worry, I’m not going all Chomsky ‘propaganda model’ on you at this point; read on.

And then I alighted on Twitter, something I had previously dismissed as a vanity project for media darlings. Using Twitter I now let the news ‘find’ me; if it is big enough I will hear about it through other users (the ‘cloud’ or ‘crowd’ sourcing approach as some see it). Of course this depends on using the right filters ie trustworthy sources as a kind of editorial control. It works though. I think I have saved myself at least an hour a day.

As a clinician I could be similarly overwhelmed with new information such as academic updates and clinical developments from journals. Having filters to control the information flow (other than a ‘head in the sand’ approach) has become a facet of professional development but who has the time to set these up and maintain them? In addition many clinicians now work in a portfolio style, across systems and sites with limited opportunities to meet up in the traditional lunchtime academic update format. To counter these problems there is a burgeoning industry of companies as well as some in-house health organisations promising and sometime providing knowledge management, access to the best evidence and ‘what your colleagues are reading’ type indicators. The holy grail is the provision of filtered ‘best’ knowledge (such as NICE guidelines, systematic reviews or even your local Trust’s policies) to the fingertips of both clinicians and patients, either as for example integrated clinical decision support tools in electronic patient records or at least having clinical knowledge resources in one easily accessible place, not dispersed across random intranet sites.

One idea we have thought about at the Institute of Mental Health in Nottingham is to have a ‘one stop’ website[1] capturing the ‘need-to-know’ information for our local mental health clinicians. It acts partly as a portal (read ‘filter’) to other sources, a quick way of on-line browsing of your usual sources (such as journals), as well as informing clinicians about other areas of indirect interest such as research or recent local talks or seminars. Ideally it offers macro and micro level learning, major updates but with local significance. Twitter increasingly has a role in this, often as re-tweets ie re-directed messages for rapid access to clinical and academic updates. What will make this initiative work though is the clinicians themselves, helping to identify the right filters, trustworthy sources to determine what matters to them and their patients. The clothes horse has been assembled; it just needs dressing. Over to you…..


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Chloe Hill – Society’s perception of “perfection”

“Teenagers have it so easy nowadays”– I’ve heard this quote used frequently by adults to their stressed teenagers, telling them to make the most of the youth they have before life gets difficult, but there are becoming more and more reasons for me to disagree with this statement. The expectations that come with a 17 year old adolescent are growing rapidly from their parents, schools, friends and society itself.  The pressure to be “perfect” can be too much for some people, leading to depressionwhich can bring on further difficulties such as eating disorders and self-harm. A Healthline report states, “Treatment is important because teens with untreated depression are more likely to have social and school problems, abuse drugs and alcohol, become parents at a young age, and go on to experience adult depression and possibly suicide.”  But with the all-too obvious stigma that comes with a diagnosis of depression, can we really judge their reluctance?

So, as an 18 year old myself, what do I class as perfection? Perfect grades, a perfectly set out future, perfect hair and the perfect body? These are all pressures that young adults have to face every day, in debatably the hardest time in their life as it isBut is the pressure any worse now that it was 30 years ago, or is it just much more publicised?

Personally, I think a lot of the pressure is to be placed with social networking and blogging sites such as Facebook, Twitter, Tumblr and many more, which have only become widely available in recent years. A study by Cyber Sentinel and published in The Daily Telegraph shows that the average teenagers spends 31 hours per week on the internet, spending a large proportion of these hours trawling through these social networking websites and looking up topics brought about by current pressures, such as cosmetic surgery, diet planning and weight loss methods. The models shown on such websites represent a figure and lifestyle that makes young adults believe that is what they must look like in order to be successful, and when so much time is being spent looking at them, it’s not surprising that image becomes transfixed in their mind. In a study by Stirling University in 2009, one in five school children said the internet, including social networking sites, influenced their decision to self-harm, a figure I find very believable.

But what can be done to help? Should parents be limiting internet access to their children, or is it up to someone else to notice the pressure piling up before it become too much? In my opinion, teenagers are the most unlikely age group to admit they think there’s something wrong with them, for fears of being judged further. So what can be done to stop them going to drastic measures to become “perfect”?

Chloe Hill
Intern, Institute of Mental Health

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