Anne Goodwin: Fictionalising the mentally disordered offender

As a former clinical psychologist who now writes fiction, I’m not particularly drawn to crUnderneath 3D Coverime on the page. So it was almost as much a surprise to me as to anyone that my forthcoming second novel, Underneath, is about a man who keeps a woman captive in a cellar. But, as you might expect from my mental health background, what attracts me to this topic is not the offence itself, but the character underneath it; less the what (although the novel certainly addresses that), but the how and why.

My character Steve’s emotionally neglectful childhood has left him with abandonment issues, which he’s managed to side-step for most of his life by a peripatetic lifestyle with no expectation of forming long-term bonds. Eventually, it’s time to settle down and, as his new girlfriend moves in with him, life seems to have turned out fine. But even then there are warning signs in his defensive cognitive style. In conversation with her friend and colleague – and Steve’s nemesis – Jules, Liesel refers to Steve’s reaction to an art exhibition they’d seen together (p30):

Liesel stroked my hand. “Steve found the exhibition rather disturbing.”

“No I didn’t. I found it boring.”

“Same difference,” said Jules. “When you’re overwhelmed by emotion your mind switches itself off.”

Later, when Liesel’s priorities change, Steve rejects her attempts to talk through their differences, preferring, instead, to locate all vulnerability in her. This isn’t too difficult given her own issues with loss stemming from her mother’s suicide (p153):

Jules knows a good psychotherapist, she’d said, as if it were my mind that needed to be fixed.

Liesel’s perspective on mental health is grounded in her work as an art therapist in a forensic mental health unit. Unfortunately, although he respects her professional status, Steve disregards her expertise (p151 -2):

I felt sorry for her in a way. I imagined her spouting this nonsense in her interview and the panel covering their smirking mouths with their hands. I imagined her being ridiculed by the prosecution for trying to convince the jury that some thug hadn’t meant to throttle his wife, he was acting out some pre-conscious childhood trauma … She seemed to have rather too much in common with her patients. Fortunately, there was no hint as yet of criminality.

On visiting her workplace one lunchtime, Liesel tries to explain her therapeutic approach (and apologies to the art psychotherapists I’ve worked with for Steve’s misrepresentation of the profession). But he shows little empathy for the patients, instead envying the attention she gives them (p91-92):

“If you’ve missed out on the basics, like my patients have, you live with a yearning, an absence, whether you remember where it comes from or not.”

She was going all Freudian again. I gazed at the brown stain at the bottom of my coffee mug as I stifled a yawn.

Liesel squeezed my shoulder. “Sorry, I’m lecturing you like you’re one of my students.” She scraped back her chair. “I’m afraid you’ll have to go. It’s time for my group.”

I covered her hand with mine, imagining fucking her across the mottled table. “Let them wait.” It seemed morally offensive for a bunch of hooligans and perverts to have a woman like Liesel at their beck and call.

Advice to writers on creating an immoral character suggests being nonjudgemental and empathic, and framing the character’s behaviour as the outcome of various unfortunate events rather than a random act. It would spoil the story to give much detail about how personality combines with happenstance to make Steve a jailer, but there are parallels between my task as a writer and that of health and social care professionals working with mentally disordered offenders. Despite the disapproval and distaste one may feel for the crime that has been committed, professionals are conscious of the perpetrator’s circumstances and underlying vulnerability that have led them to cross the boundary. In a society that is often lacking in empathy for offenders, it can be hard to juggle the conflicting feelings of compassion for the person and condemnation of the crime.

I hope that mental health professionals, service users and their families with direct experiences of such services, if they should read Underneath, will consider that I’ve approached these issues respectfully. I also hope that readers without this background knowledge might be nudged a little closer towards a more compassionate perspective on the mentally disordered offender which, as a society, we urgently require.

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Anne Goodwin is a former employee of Nottinghamshire Healthcare NHS trust. Her second novel, Underneath, is published internationally on 25th May 2017 in e-book and paperback and launched at Nottingham Writers’ Studio on 10th June.

She has contributed two previous articles to the Institute of Mental Health blog:

Three novelistic approaches to mental health issues that won’t set your teeth on edge From clinical and academic writing to fiction

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IMH Research day is coming!

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House for a Gordian Knot, Ekkehard Altenburger

 

Tomorrow (Tuesday, May 9th) the IMH will be hosting its Annual Research Day to highlight the work of the Institute’s doctoral candidates, Managed Innovation Networks (MINs), and all early-career researchers (including research assistants, research fellows, and research-active clinicians and service users).

There are some fantastic talks and poster presentations lined up including a Keynote discussion from Max Birchwood titled  “Translating the science of prevention to service reform in youth mental health: the emergence of 0-25 years services across the West Midlands of England”.

The event will start at 9am and finish just before 5pm and will take place in the Institute of Mental Health, Jubilee Campus. Attendance is open to everyone so please feel free to come by.

 

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Student minds committee opportunity

What is student minds? 
Student Minds is the UK’s student mental health charity. We empower students with the knowledge, confidence and skills to look after their own mental health and support others through our national network of university groups. One conversation at a time, we will transform the state of student mental health.

How can I get involved?

We are looking for a new committee for 2017-18! There are a range of roles on offer, from Co-ordinator to Events Team member. You don’t have to have any prior experience to apply but if mental health is something you are passionate about, or just helping people in general, one of these roles may be for you!

Check out the variety of roles we have on offer by clicking here. If one of these roles takes your fancy, please click here to apply.
Applications for committee close: Sunday 7th May 2017

We are also looking for student volunteers to help run our Positive Minds Course for University of Nottingham.We provide a fantastic opportunity for students who are interested in receiving training and on-going support in delivering these projects. Successful applicants will join us for a two-day training workshop, on the 16th and 17th September, covering all the basics of running a safe and effective support group, from listening skills to publicity and lots more. By creating a positive atmosphere for talking about mental health, we aim to give students the confidence to look after their own wellbeing. This is an opportunity not only to make a real difference to student life but also to develop your own skills and experience!

For more information on how to apply, go to http://www.studentminds.org.uk/peer-support-application-and-training.html
Applications for facilitators close: Sunday 30th April 2017

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New publication: Wellbeing, Recovery and Mental Health

We are delighted to announce the publication of a new book called Wellbeing, Recovery and Mental Health, edited by Mike Slade from IMH, Lindsay Oades from Australia and Aaron Jarden from New Zealand. The book brings together two bodies of knowledge – wellbeing and recovery. Wellbeing and ‘positive’ approaches are increasingly influencing many areas of society. Recovery in mental illness has a growing empirical evidence base. For the first time, overlaps and cross-fertilisation opportunities between the two bodies of knowledge are identified.

 Wellbeing, Recovery and Mental Health will be of interest to anyone connected with the mental health system, especially people using and working in services, and clinical and administrative leaders, and those interested in using research from the mental health system in the wider community.

 Mike Slade commented “It has been exciting to bring together expert contributions from around the world. I have learned a lot about enhancing wellbeing in schools (‘positive education’), workplaces, families (‘need-supportive parenting’) and cities (‘urban liveability’). Marshalling the very best evidence from recovery and wellbeing research raises important questions for us all. How much should policy-making be judged by its impact on population wellbeing? If employing peer workers in mental health systems is proving so beneficial, should we be employing people with a criminal history in police forces, or people with experience of homelessness as housing workers? Should wellbeing literacy be taught in schools, alongside traditional numeracy and literacy skills? What would be the impact on society if co-production became the norm?

 Prof Martin Seligman is often described as the ‘father of positive psychology’, and he wrote the foreword to the book. He states that “psychotherapy and drugs as they now are used are half-baked. At their very, very best they remove the internal disabling conditions of life. Removing the disabling conditions, however, is not remotely the same as building the enabling conditions of life. If we want to flourish and to have wellbeing, we must indeed minimize our misery, but in addition we must have positive emotion, meaning, accomplishment, and positive relationships. The skills of flourishing – of having positive emotion, meaning, good work, and positive relationships – are something over and above the skills of minimizing suffering. These skills are documented to build wellbeing and they also may act to relieve psychopathology itself. This volume tells their story.

 The book has been endorsed by international leaders. Prof Larry Davidson (Professor of Psychiatry, Yale University) wrote “This exciting collection of groundbreaking research from around the world shows how hope, recovery, and wellbeing are far better than suffering, misery, and illness as guiding concepts for policy and practice in mental health and beyond, to civil society”. Prof Ken Sheldon (Curators’ Professor of Psychological Sciences, University of Missouri) states “Slade, Oades, and Jarden have fostered a long-overdue conversation within this book – between clinicians focusing on recovery, and positive psychologists focusing on well-being.  Although the first group has traditionally focused on returning clients to baseline, the other group has tried to leave the baseline behind, for new heights of well-being. The upshot of the conversation is this:  That the processes bringing recovery and the processes bringing well-being are much the same, though they have been focused on in isolation. This book also stakes a claim for diversity, and the equal personhood of “victims” needing to “recover” from mental illness.  They are not different from us, it turns out:  they ARE us!”. A/Prof Acacia Parks (Hiram College) identifies that “research has been converging on the idea that positive psychological approaches have great utility for people at risk for and experiencing mental disorders. This book provides a much needed framework for synthesizing that literature and planning ahead for what is sure to be a vibrant and massively impactful field of study“.

 More information about the wellbeing research programme led by Prof Slade is at http://www.researchintorecovery.com/WELLFOCUS, and the publisher’s website is http://www.cambridge.org/gb/academic/subjects/medicine/mental-health-psychiatry-and-clinical-psychology/wellbeing-recovery-and-mental-health?format=PB&isbn=9781107543058.

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Clare Knighton – Fostering hope on an acute psychiatric ward through Peer Support

Hope. It’s a word often used in day to day conversation; I hope I win the lottery, I hope my partner has put the washing on when I get home. When we use the word hope in conversation, we are usually expecting something good or positive to happen but often it’s used without any action or thought to make the intended outcome a reality.

Well I’m going to talk about a different kind of hope. A hope that needs time, attention, nurturing and care. A hope that you can’t leave to fend for itself or ignore. I have blogged before, about the magic of peer support, of how transformative it has been for me and my personal journey. As I settle into this role, now well into my second year, other questions begin to surface, and I share them with you here.

I was a ‘frequent flyer’ to mental health wards before becoming a peer support worker. Now, somehow, magically I visit these places only as a staff member. Working side by side with the very people who have cared for me, seen me at my lowest, and seen me behave in a very distressed manner and now I’m part of the team. I really feel it. They check up on me, joke with me, and best of all, ask my opinion on how best to help someone. What more could anyone ask for? This integration into the team fosters my own hope and it grows daily.

I do spend some time helping people to understand what peer support is, but I’m happiest when I’m showing them what it is. How I can sit with someone in distress, and story share small bits to give them hope, that there is a way out of the darkness they find themselves in. How I can talk about my experiences of medication, when it worked well for me, when I resisted and how I got to a position to make my own choices. Or how I can suggest social activities that are going on outside of the ward, that can help give people other identities than that of’ mental health patient’.

Peer support on an acute psychiatric ward is all about growing hope. It’s fast paced; you never know how long you have to work with someone, how long they will be there, or even how ready they are for peer support. Even those who say they don’t want peer support, I can still help. Sitting with someone in silence is still a way to show them that you are there for them, and the hope sits there with me, waiting for them, being there for someone when they need it. Hope is also fostered in the language you use – positive affirmations, compliments and a genuine belief that someone is so much more than their diagnosis. Many people I see have lacked positive support in their lives, and who doesn’t want someone to believe in them? We all benefit from that and just because someone is detained under the mental health act doesn’t mean they can’t have hope; I am living proof!

An acute psychiatric ward may seem a place where there isn’t much hope that it’s all about control and dis-empowering people. I know different. Without being sectioned I wouldn’t have found peer support, I wouldn’t have been encouraged to apply to do the training, and ultimately change my life. All the staff want the same thing, for the person to recover and now with peer support on the team, I do all I can to prevent a ward becoming a revolving door, like it was for me for so many years.

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Clare is an accredited peer support worker based in Worcestershire, a passionate coach, mentor, cat owner and lover of kindness..NHS champion..survivor….expert by experience. You can follow her on Twitter @knightonstar for daily tweets about peer support.

You can also read more of her other fantastic posts here

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Note from editor:

If this post has sparked your interest in peer support, you might like to know about our specialist peer support training course which starts in London in June.  The Institute of Mental Health was the first nationally accredited education provider in the field of peer support training. A key element of the training is the model of co-production, co-learning and co-facilitation, whereby all training is delivered by two trainers who between them have clinical expertise and lived experience of distress. These experiences are grounded in an academic understanding of recovery and peer support. This authentic approach to training, enhances the learning experience and offers an opportunity to role model effective co-working of people with different backgrounds, demonstrating effective peer working. The training helps organisations to embrace the Recovery agenda and support the development of skilled Peer Supporters.
Closing date for applications: 5 May 2017

 

 

 

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First INDUCT School was a success!

INDUCT teamIn January 2017 the INDUCT (Interdisciplinary Network for Dementia Using Current Technology) team got together in Maastricht, a city in the south of the Netherlands, for the first INDUCT school. It was a great opportunity to finally meet, in person, all of our fellow PhDs on the programme. We were only able to meet each other virtually before, one of the wonders of technology, during an online course offered by INTERDEM (Early Detection and Timely Intervention in Dementia).

As the week progressed, our bond became stronger, not only because we could share and relate to each other’s challenges and struggles of starting a PhD, but also because we shared moments of joy and intellectual and personal growth. It was an intense week with multiple sessions providing us opportunities to learn new and exciting things. Have a look below for a brief overview of the week.

Monday: We kicked off the week with a session of elevator pitches in which every PhD student was required to explain his/her research in 90 seconds. It was an interesting moment for many, since it was just the beginning of the week and it was challenging to explain a huge amount of information in a short amount of time. The presence of 20 people you did not know very well contributed to the nerves. However, it was a safe environment which meant that people were given the space to think and take time. This feeling of safety set the tone for the rest of the week. The day continued with wonderful presentations on different methods to use technology in dementia research by Dr. Marco Blom and Rob Groot Zwaaftink from Alzheimer Nederland. Joris Wiersinga from Silverfit talk to us about the use of exergaming in dementia care to promote physical activity among people with dementia. We concluded the day with an interactive session by Phil Joddrell and Yvonne Kerkhof on making better use of touch-screen applications (apps) and how to make these more accessible for people with dementia.

Tuesday: The second day started with a session by Marc Wortmann from Alzheimer Disease International on global dementia policy which was followed by a talk by Professor Anne Margriet Pot on the World Health Organisation (WHO) dementia policy and an online, worldwide tool developed by the WHO for carers of people with dementia. We continued with a fun and enlightening role playing activities coordinated by our fellow ESRs, in which each of us took on the role of a different stakeholder when talking about ethics and the involvement of people with dementia. The last session about Patient and Public Involvement (PPI) with Dr. Nancy Preston informed us about PPI work in the UK and its importance for research.

Wednesday: On day three we enjoyed some workshops and were joined by members from the INTERDEM academy. The first workshop, led by Professor Rose-Marie Dröes from the VUmc in Amsterdam, covered the MRC (Medical Research Council) Framework and its application to piloting interventions. We had the opportunity to develop our own potential feasibility study in dementia care. In the afternoon we had a lecture and a workshop on the Theory of Change and the MRC framework led by Dr. Graham Moore, Professor Lieve Van der Block, Dr. Lara Pivodic and MSc. Joni Glissen.

Thursday: This day stood out as we had the participation of Alzheimer Europe, represented by Project Officer Ana Diaz, and the EWGPWD (European Working Group of People with Dementia), with Chris Roberts and Alv Orheim. After an inspiring talk Ms. Diaz and Mr. Roberts, we had the chance to ask Mr. Roberts and Mr. Orheim about how to involve people living with dementia in our PhDs. This session was great and provided us with a lot of useful and directed feedback.

Friday: The snow did not stop us from having a great last day. We started with a lecture given by Rosalie van Knippenberg and Dr. Lizzy Boots about the use of technology in their research. This was a relatable session because we could learn from their experience; the do’s and don’ts in dementia research while using technology. We also had the participation of second level partners (Betawerk and Eumedianet) who showed us their work and told us more about implementation of technology in health care settings (as well as dementia care).

On Friday it was also time to say goodbye. This was a great week for all of us, with a lot of learning and networking. The whole week was a fantastic experience and we just can’t wait for the next INDUCT school in September this year in Salamanca, Spain.

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Aline Cavalcanti Barroso and Harleen Rai are Marie Sklodowska-Curie Researcher Fellows for INDUCT and PhD candidates at the Institute of Mental Health, University of Nottingham.
Contact: Aline.CavalcantiBarroso@nottingham.ac.uk and Harleen.Rai@nottingham.ac.uk

 

 

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A day in the life of Joy Rooney, Peer Support Worker

blogI work for two days a week as an intentional peer support worker (PSW, 07:00 – 15:00, Worcestershire Health and Care NHS Trust) in a recovery unit offering:  facilitated training group work, along with spending time with people on a one to one basis (1:1s), practical and emotional support.  People with longer term stays can develop their interests in, and benefit from the hearing voices group, bite size psychology group, peer group using the PeerZone free materials (from Mary O’Hagan in New Zealand), and the early warning signs course (written by Prof Jo Smith and Dr Tom Barker).  There’s also the gardening project which I initiated – growing vegetables and flowers in dedicated beds.  Other types of groups are run by the second intentional PSW who works on the other three days.

The day starts with the nursing handover, moves on to preparation for the days’ groups and 1:1s and then really gets going with 1:1s recovery orientated conversations with people, practical and emotional support.  The groups of up to nine people run at 11:00 and 14:00 for up to 45 minutes and I write case notes and make diary entries after the groups and 1:1 conversations.  It’s a hectic two days a week and reflection, refinement and lesson planning are taken home but not dwelt overly on.  There is a group meeting/ supervision with the other seven peer support workers across the county for two hours once a month and line management supervision from the ward manager too.

I really enjoy relating little chunks of my relevant experiences of poor mental health and how I coped with being in hospital in an empathetic way to people when I hear their stories. I know that holding hope for them to recover will see them improve and be discharged to live a self-determined life away from the hospital ward with the tools they need to prevent re-admission or at least reduce its longevity.

Within Worcestershire PSWs have typically worked exclusively with people with mental distress, but I have also met families and friends during the evening so that they can understand the ethos of recovery from its beginnings. By doing so I am able to help and support them in applying recovery principles when visiting and living with their loved ones.

The peer support I offer is unique because it flows from my personal experience of 38 years in secondary mental health services (now discharged), all its ups and down across four acute inpatient wards including three of the old asylums around England with multiple admissions as a ‘revolving door patient’. These chunks of relevant personal experience come from more than half a lifetime of mental distress. I am seen as a role model, someone that’s been there and got the t-shirt. Not many other mental health practitioners have that sort of experience “from the other side” – to know what it feels like to recover a life, trying to cope alone with lots of systems.

Although I have worked in many fields (notably as an agricultural research scientist for 16 years) in a number of roles and organisations, none has matched what I feel I am giving back to others with mental health difficulties as a PSW. I feel it gives me a sense of achievement when these people have ‘light bulb’ moments around the recovery principles and what it means to them. It especially gives me great joy when they are discharged.

Along with my recent academic successes both within the Trust and the University of Worcester in the Institute of Health and Society as an associate lecturer and research stemming from the IMPACT group of service users and carers (SUAC), I feel I am making a contribution to the knowledge base around peer support and SUAC, student and staff perceptions of SUAC involvement in higher education through peer reviewed publications. I am also a student again, taking a part-time Diploma in Education and Training to benefit my practice around teaching recovery in group sessions and teaching research, recovery and mental health, advocacy and long term conditions within the University of Worcester.

Being an intentional peer support worker is really important to my own wellbeing.

Dr Joy M Rooney is a project leader and peer support worker with Worcestershire Health and Care NHS Trust and an associate lecturer and researcher at the University of Worcester. Contact: joy.rooney@nhs.net or j.rooney@worc.ac.uk

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Recent Publications/ conferences:

Rooney, J. M., Osborne, N. and Unwin, P. F. (2015). “The impact of IMPACT – reflections on the first seven years of a service user and carer (SUAC) group at the University of Worcester, UK”. Conference paper: Where’s The Patient’s Voice in Health Professional Education – 10 years on, 13/11/2015, Vancouver, Canada.

Rooney, J. M., Miles, N., and Barker, T. (2016a). “Patients’ Views: Peer Support Worker on Inpatient Wards.” Mental Health and Social Inclusion 20(3) 160-166. doi 10.1108/MHSI-02-2016-0007.

Rooney, J. M. and Unwin, P. (2016b). “Transformative or Tokenistic – Can involving service users and carers in the training of health and social care professionals promote social justice?” Social Justice Conference 26/06/2016 University of Worcester.

Rooney, J. M., Unwin, P. F. and Osborne, N. D. (2016c). “Gaining by Giving? Peer Research into Service User and Carer perceptions of Inclusivity in Higher Education.” Social Work Education. 35(8) 945-959. http://dx.doi.org/10.1080/02615479.2016.1227314

Rooney, J. M. (2017). “HQUIP Case Study. Patients value peer support worker in their recovery. ” http://www.hqip.org.uk/resources/case-study-patients-value-peer-support-worker-in-their-recovery/

Unwin, P., Rooney, J. M. and Cole, C. (2017, in press). “An evaluation of the impact of service user and carer involvement on students’ classroom learning in higher education.” Journal of Further and Higher Education. http://dx.doi.org/10.1080/0309877X.2017.1281886.

Unwin, P., Rooney, J. M., Osborne, N., and Cole, C. (201x, accepted). “Are perceptions of disability changed by the involvement of service users and carers in the qualifying training of health and social work professionals?” Disability and Society.

 

 

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