Future of Mental Health Nursing Conference 2019

When the Future of Mental Health Nursing Conference asked people to submit a quote that sums up Mental Health Nursing, I sent my favourite quote: “When you can’t look on the bright side, we’ll sit with you in the dark”. I was extremely lucky to win the competition to attend the conference in Edinburgh. The quote and my name was also printed on all the bags, which was fantastic to see. 

“When you can’t look on the bright side, we’ll sit with you in the dark”

Lewis Carroll, Alice in Wonderland

Greeting us at the event was a therapy dog called Phoebe. She brought a smile to everyone’s face (especially to mine, as I absolutely love dogs). This was such a lovely way to begin the conference. The main hall had an incredible atmosphere.  In one corner was Lynn (@AlongBorderline) who raises awareness of Borderline Personality Disorder through dance and theatre. In another was Angie Strachan (@AngieStrachan75), who attends Spoken Word events to raise awareness for mental health problems.

“To the world you might be one person, but to one person you might be the world”

Ben Thomas opened the event, telling the story of how he wanted to create a conference just for students after witnessing the number of mental health nurses drop when he worked at the Department of Health. This is how the Future of Mental Health Nursing Conference was formed! Although Ben is involved in planning each event, the majority of the conference is organised by groups of students – just like us. This made the event even more special.

The Chief Nursing Officer for Scotland, Fiona McQueen (@FionaCMcQueen) spoke first. She shared Scotland’s plans for funding, their hope to increase mental health nurses and how they are ensuring safe staffing. It was incredibly interesting to hear their plans. When Fiona said: “To the world you might be one person, but to one person you might be the world”, her words really reminded me of the impact I could have throughout my career. 

“What matters to you?”

This was followed by Tommy Whitelaw (@TommyNtour), who moved me (and most of the room) to tears. Tommy was a carer to his late mother, Joan, who sadly passed away after a battle with dementia. He told us how the encouragement he received from one nurse when he was struggling had helped him to carry on. He explained that she had no idea of the impact she had made that day, as she was simply being “a great nurse”. He now campaigns to spread awareness of dementia and emphasise the importance of asking: “What matters to you?” instead of: “What’s the matter with you?” ‘What Matters To You Day’ is now an annual event. It’s a fantastic idea and is absolutely worth taking a look at online to see if you can help to spread the message. Tommy told us he believed the room to be filled with the “greatest profession ever created” and finished by getting the room up for some karaoke. We ended by clapping and singing together which was a brilliant moment. 

Between speakers, there were workshops available to attend. Jennifer Young delivered the a trauma workshop, then James King and Lin Anderson led another on crime and prison education. In the afternoon, there was a mindfulness workshop led by James Kennedy. Followed by a writing talk by Elliot Lawrie. There was even a room to join in with some yoga!

Another incredibly inspiring speaker to was a man with first hand experience of addiction and mental health problems. David McCollom spoke in depth and gave us a real and raw depiction of his journey to recovery. He proudly shared with us the success of his business and his achievements. It was amazing to hear his story.

Playlist for Life

Next, Andy Lowndes, the music detective (@AndyDetective), introduced us to Playlist for Life and explained the impact that music can have on the brain. He told us how he and Sally Magnusson (@SallyMag1) formed Playlist For Life (@PlaylistForLife) after Sally found music helped when she was caring for her mother. Andy prompted everyone to think about what song they would include in their own playlist and why. He shared clips of people with dementia who displayed a marked and touching improvement when listening to their playlist.

Closing the event was comedian, Luisa Omielan (@LuisaOmielan). She gave a frank, yet funny talk about the issues faced within mental health care. She spoke about important topics and had us all clapping at her honesty. All the while, somehow managing to make us laugh!

“We have the ability to change so many people’s lives and providing this care can also really change ours for the better too”

The whole event was utterly inspiring and I left feeling prouder than ever before to have chosen this career. It reminded me that Mental Health Nursing is so much more than a career. We have the ability to change so many people’s lives and providing this care can also really change ours for the better too. I’m in such a privileged position to share incredible moments with people throughout their journey. The Future of MHN Conference has given me the boost I needed to finish my dissertation, prepare for my final placement and look forward to being qualified!

What song would you include in your playlist for life? Let us know in the comments below or via @mhresearchleeds

Dakota Scollen is a third year mental health nursing student at the University of Leeds. You can follow her @DakotaScollen

Reducing Restrictive Practices: Understanding Key Intervention Components

On Wednesday 5 June we held a dissemination event for the COMPARE study. COMPARE is an evidence review of interventions designed to reduce restrictive practices with adults in mental health inpatient settings. The aim of the event was to share preliminary findings from our evidence review with stakeholders (including frontline staff and service users) and provide an opportunity for discussion and feedback before we complete the study.

For anyone who was unable to attend in person, The Mental Elf took the event #BeyondTheRoom on Twitter. This was particularly important as it enabled people to follow along and participate in the discussion using the hashtag #BCTCompare.

In this blog we’ve tried to summarise the highlights from both within and beyond the room. You can also learn more about our motivation for the study, our preliminary findings, and why reducing restrictive practices matters by listening to the podcasts that we recorded before the event.

(1) John Baker sets the scene for the COMPARE study; (2) Krysia Canvin, Ian Kellar and Kathryn Berzins provide an overview of our preliminary findings; (3) Iris Benson describes her lived experience of restrictive practices and why it is important to reduce their use (NB trigger warning)

Setting the scene

John Baker opened the event by outlining why we need to reduce restrictive practices. As John explained, restrictive practices are harmful to everyone involved, so it’s vitally important to identify the most effective ways of reducing their use.

With the backdrop set, John introduced the first speaker, Iris Benson. Iris has lived experienced of restraint and uses her experiences to educate others. As part of this endeavour she has worked with us on COMPARE as an Expert By Experience. Iris spoke passionately about the need to address the use of restrictive practices.

Iris’ talk really set the tone for the rest of the afternoon, acting as a stark reminder of why we are doing this research, but also prompting us to look at the issue from a different perspective. This is why Iris’ involvement in our study has been utterly invaluable. As Iris pointed out, no-one behaves badly when they have experienced the kind of abuse that she has lived with. She asked how would you expect someone who has experienced trauma to behave when frightened? And how would you expect them to respond to being physically restrained?

In her typical fair-minded style, Iris went on to emphasise that she is not interested in blaming individual staff. Instead, she asked us to acknowledge that using restrictive practices can harm staff too and urged researchers, service users and staff to work together in this crucial area.

Following Iris was Tim Kendall who shared some reflections from his early days practicing psychiatry in the asylums. Tim is a co-applicant on the COMPARE study and a Consultant Psychiatrist for homeless people in Sheffield. Equally dedicated to improving reducing restrictive practices, Tim outlined the work he’s leading as National Clinical Director for Mental Health @NHSEngland @NHSImprovement and Director @NCCMentalHealth. It’s a powerful message when people traditionally divided into “them and us” make the same argument for change.

This really summed up the purpose of the afternoon, to bring different stakeholders together to consider how we can move forward in an effective manner. But what does the evidence say?

The intervention landscape

The initial goal of COMPARE was to systematically map all interventions designed to reduce restrictive practices with adults in inpatient mental health settings. Krysia Canvin introduced us to the intervention landscape.

Having sifted through 17,000 records, the team identified 150 unique interventions to reduce restrictive practices.

These interventions comprised all manner of procedures intended to reduce the use of restrictive practices, injuries and “challenging” behaviour or improve staff and service user experiences and safety. These procedures ranged from staff training, debriefing, data review, to introducing sensory rooms and changing staffing levels. Most interventions had multiple procedures.

Krysia explained how most interventions were one-off endeavours, but that we also identified 29 ‘intervention families’ where the same intervention had been used multiple times.

Unfortunately, despite all these good intentions, Krysia said that many of the interventions were poorly described, and few had been subject to high quality evaluation.

Krysia then drew our attention to two further issues. First, that few studies involved service users in the design or delivery of the interventions (and even fewer in their evaluation); and second, that many studies aimed to reduce harm or injury to staff – and subsequently measured the impact on these of their interventions – but only a handful were similarly focused on harm or injury to patients.

Consequently, she suggested, we are left with a disparate, complicated and low-quality evidence base: we simply do not know what the (most) effective way to reduce restrictive practices is. Geoff Brennan (#InTheRoom), founder of Starwards, suggested that rather see this as ‘a problem’ we should be heartened by the fact that there are so many initiatives. Krysia concluded by highlighting the difficulties of making comparisons between so many diverse interventions and how looking at their Behaviour Change Techniques could help.

What are behaviour change techniques?

The next speaker, Ian Kellar, brought a dual perspective. Ian shared his expertise on Behaviour Change Techniques, but also has a son with autism who experiences threats of restraint.

Ian explained what Behaviour Change Techniques (BCTs) are, that is, the very basic components that are used in interventions to change behaviour. Examples include ‘goal setting’ or ‘instruction on how to perform a behaviour’. The idea is that we can use these components to design interventions that target the behaviour we want to change using proven mechanisms. Ian described it as cracking open the ‘black box’ of interventions to see what exactly it is that leads to the change.

Can we use BCTs to avoid reinventing the wheel?

The final part of the COMPARE study involved looking closely at the interventions we found to see which (if any) Behaviour Change Techniques they used. Kathryn Berzins presented these findings, describing how we identified just under half of the available 93 BCTs in the interventions. Most of these BCTs were in the categories of ‘Goals and Planning’, ‘Shaping knowledge’ and ‘Antecedents’ (where the social or physical environment is altered to try to prevent incidents arising).

Kathryn reminded everyone that just because we didn’t detect a BCT in an intervention doesn’t mean it isn’t used, just that it’s not described anywhere. Kathryn explained that even thought lots of these interventions have been shown to reduce different restrictive practices, we don’t know which of their ‘ingredients’ are the active ones. If, however, we can test BCTs (or categories of BCTs) separately we will be able to work out which ones have the most effect and drop some of the others. Equally, there are also a lot of BCTs that don’t seem to have been tested for their potential to reduce restrictive practices that are certainly worth considering.

Kathryn concluded that we need to take a step back and try some more simple interventions (informed by service users themselves) otherwise we risk constantly reinventing the wheel.

The discussion

We asked everyone attending the event as well as those following #BeyondTheRoom to provide us with some feedback on four points.

We’re really grateful to everyone who attended and/or contributed to discussion on Twitter. Some really important points were made that we will think about very carefully.

The event generated much discussion (even the day before!) and we were really pleased to receive some positive feedback.

Most importantly, we hope this is the beginning of an ongoing conversation (and action) between all of us who are working towards reducing restrictive practices. You can join the conversation by tweeting using the hashtag #BCTCompare, commenting below or you can contact us.

April/May Update

Since our last update, we’ve published three blogs, won 2 prizes and published another paper. In April, Emily Pattinson wrote about the new study led by Liz Hughes that will explore NHS staff views about collecting sexual identity data from patients. Then, Susan Guthrie blogged about embarking on her PhD as one of the new CArDiNAL Fellows. Finally, Krysia Canvin marked Menstrual Hygiene Day 2019 by revisiting the issue of period poverty and its impact on service users’ dignity in mental health settings. She concluded by reflecting on how, ultimately service users’ dignity is at the centre of all our research endeavours.

Out and About

Leila Sharda, final year PhD student, attended the Faculty of Liaison Psychiatry Annual Conference, 15th May – 17th May. The conference was held at the Royal College of Psychiatrists in London and focused on long term conditions. Leila’s research examines how general hospitals respond to patients diagnosed with a personality disorder who are distressed. She presented a poster and gave a talk about the adverse responses these patients receive. Leila’s work was very well received: she was awarded joint first prize for her oral presentation by the panel of expert judges.

Leila’s poster of her PhD findings

Dakota Scollen (@DakotaScollen), third year mental health nursing student, attended the Future of Mental Health Nursing Conference in Edinburgh after winning a competition. Entrants were invited to submit a quote that captures the essence of Mental Health Nursing. Dakota won with her entry, a favourite quote from Alice in Wonderland:

“When you can’t look on the bright side, we’ll sit with you in the dark”

The Mad Hatter, Alice in Wonderland by Lewis Carroll

Look out for Dakota’s blog about the conference, coming soon.

Latest Publications

The contribution of mental health services to a new strategic direction for sexual assault and abuse services

Liz Hughes contributed to a paper published recently in the Journal of Forensic and Legal Medicine led by Professor Charlie Brooker. The paper reports a freedom of information request to NHS mental health care providers to ask whether they had a clear pathway to sexual assault referral centres following disclosure of sexual assaults by people using their services. Very few trusts reported that they had such a pathway. Given that sexual violence is not uncommon in people who use mental health services, and that sexual assault has a significant impact on mental health, there is a need for better joined up services.

Look out for a blog about Liz’ related study about the effectiveness of sexual assault referral centres with regard to mental health and substance use, coming soon.

March Update

This month we published two blogs written by PhD students affiliated to the Mental Health Research Group. Both Susan and Angela are engaged in important work that focuses on areas of which the public – including many of us working in mental health – are unaware. On Delusion Awareness Day, Angela gave us an insight into the occurrence of delusions in intensive care. Susan then brought our attention to the difficulties eating, drinking and swallowing that may be experienced by people with mental health conditions on Swallowing Awareness Day.

Out and About

Liz was invited to speak at a joint mental health and HIV cross party group at the Scottish Government on 20th March. Liz described her systematic review (available free from The Lancet) of blood borne viruses in people with serious mental illness and how there is limited data in BBV prevalence in this group in the UK. She then introduced her new feasibility study of sexual health promotion for people with severe mental illness: the Respect study (details coming soon).

Nicola held a very successful World Café event on 14th March in collaboration with staff from Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH). Thirty-five carers and carer champions attended the event and their contributions (pictured) – and some very large slices of cake – made the day a great success. We learned a lot about what carers want from health research and how they would like to be involved. The project is funded by the School of Healthcare Pump Priming Fund and supported by the RDaSH Patient and Public Engagement Team.

John attended the two-day Educational Meeting on the Multidisciplinary Management of Acute Disturbance hosted by the British Association for Psychopharmacology (BAP) and the National Association of Psychiatric Intensive Care & Low Secure Units (NAPICU). The event made it clear just how little research has been conducted into the use of rapid tranquilisation (particularly how to reduce its use), and services users’ views of this practice. Evidence-based guidance on the clinical management of acute disturbance (de-escalation and rapid tranquilisation) produced jointly by BAP and NAPICU in 2018 is available online from BAP.

Latest Publications

Sexual Violence and Mental Health Services: A Call to Action

Liz published an editorial in which she issues a call for action on sexual violence in mental health services. In the absence of routine enquiry about experiences of sexual violence, the editorial explores the evidence and makes some recommendations about how staff can discuss sexual issues.

Provision of Care for Women in the Postpartum Period (STUDY Protocol)

Rebekah Shallcross, who recently joined us here in Leeds, has published the protocol for the ESMI study, a collaboration with University of Manchester and Kings College London. The study will compare the effectiveness and cost-effectiveness of mother and baby units with general psychiatric inpatient wards and crisis resolution team services.

Staff Experiences and Understandings of the REsTRAIN Yourself Initiative

Finally, John has published the first in a series of papers coming out this year that present findings from REsTRAIN Yourself. REsTRAIN Yourself is the UK adaptation of “6 Core Strategies”, an intervention designed to reduce the use of restrictive practices. The study was led by Professor Joy Duxbury, now at Manchester Metropolitan University, and the toolkit is free to download.

Swallowing Awareness Day: What Does Eating & Drinking Mean To You?

Eating, drinking and swallowing difficulties (dysphagia) are experienced by at least a third of adults with mental health conditions, dementia and acquired neurological diagnoses. Dysphagia often goes unrecognised until severe, however, and fatal choking incidents or aspiration pneumonia are leading causes of premature death in people with mental health conditions. The impact of any level of dysphagia can be considerable, affecting not just physical health but also quality of life issues such as socialising and relationships. My PhD research brings together communication and swallowing difficulty – the two roles of Speech and Language Therapy. As a Specialist Speech and Language Therapist the extent of my role is often misunderstood; so my work has involved raising awareness of the impact of dysphagia in this population (Guthrie et al., 2015; Guthrie & Stansfield, 2017).

“What would it be like if you couldn’t share a meal or a drink with family or friends?”

This year’s Dysphagia Awareness Day (#swallowaware2019) takes place on Wednesday 13th March as part of Nutrition and Hydration week. Speech and Language Therapists, Healthy Living Practitioners, Dietitians and other clinicians across the Leeds and York Partnership Foundation Trust are offering staff and service users with mental health conditions the chance to try some different smoothies and to think about how they swallow and cope with different consistencies.

As you eat, drink and swallow on Wednesday, take a moment to think about how important food and drink is in your everyday life. How would you feel if every swallow was painful or you were at risk of choking or aspirating (when food or drink ‘goes down the wrong way’)? What would it be like if you couldn’t share a meal or a drink with family or friends?

Susan Guthrie is a Highly Specialist Speech and Language Therapist and CArDINAL Clinical Academic Research Fellow. You can follow Susan on Twitter @SusanGuthrieSLT and on Researchgate. To find out more about the events taking place across the Leeds and York Partnership Foundation Trust please contact Susan via our contact page or directly (hcsg@leeds.ac.uk). If you have any concerns about swallowing please seek a referral to Speech and Language Therapy for assessment and advice.

References

Guthrie, S., Lecko, C. and Roddam, H. (2015) Care staff perceptions of choking incidents: what details are reported? Journal of Applied Research in Intellectual Disabilities, 28(2), pp.121-132.

Guthrie, S. and Stansfield, J. (2017) Teatime Threats. Choking Incidents at the Evening Meal. Journal of Applied Research in Intellectual Disabilities: JARID, 30(1), pp.47-60.

February Update

February may be a short month, but we have been no less busy…

John has been out and about. He attended a meeting of NHS England’s Expert Reference Group: Restrictive Practices where he presented evidence for the current use of rapid tranquilisation in inpatient settings. The talk was based on work conducted jointly with Peter Pratt, NHS England & NHS Improvement Head of MH & LD Medicines Strategy (follow Peter @jppharm). John also attended a conference promoting nursing research in Greater Manchester Mental Health NHS Foundation Trust where he had been invited to talk about the need to develop research into safe, effective and therapeutic staffing in inpatient units.

Nicola and John joined fellow academic mental health nurses to discuss various matters at their meeting at the University of Birmingham. An overview of the meeting can be found on the MHNAUK website.

Forthcoming Events

7 March

We are delighted to announce that Richard Gray, Professor of Clinical Nursing Practice will be delivering a School of Healthcare Education and Debate lecture on 7th March. Professor Gray, who is visiting from La Trobe University, Melbourne, Australia, will speak about ‘How to Enhance the Physical Activity of People with Severe Mental Illness?’ For further details and to register please visit Eventbrite.

14 March

Nicola blogged earlier this month about her Carers World Café event on 14th March where she hopes to find out more about the research priorities of carers of people with mental illness. Spaces are still available and if you would like to attend please contact us or Nicola for further information and to reserve a place.

5 June

We continue to make progress with our NIHR-funded studies and we are preparing a range of reports and resources in different formats. Some of these will be made available via this website, so watch this space. We are also pleased that half of the available places have already been reserved for our @BCTcompare free dissemination event in June. We are very keen to ensure that service users and carers attend and contribute to the discussion and can cover travel expenses. If you would like to attend or to enquire about travel expenses, please contact us or reserve a ticket via Eventbrite.

New Project Starting Soon

Liz and her team are about to embark on a new study in April examining NHS staff views about collecting sexual orientation data. More information to follow!

World Café: What do carers want from mental health research?

Nicola, Kathryn and John are excited to be working in partnership with Doug MacInnes at Canterbury and Christchurch University and Cheryl Watkinson at Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) to understand the best ways to involve and recruit informal carers in mental health research.

We’re doing this because we know that, in the UK, there are around 1.5 million carers (mostly family members) providing unpaid mental health care. Last year, RDaSH supported us to interview carers about their experiences of transitions between mental health services. The carers we spoke to told us that they don’t always feel listened to or supported, but despite feeling stressed, they said that providing care can be rewarding. By listening to carers in these interviews, we realised that carers provide essential care and have important caring skills that we know little about. We plan to do more research with carers but…

“Carers are rarely asked for their priorities for research.”

We want to ask carers in mental health about research they want to see, what topics are important to them, how researchers should involve them as partners and recruit them as research participants. Carers are not often asked what mental health research they would like to see carried out and are rarely involved as co-producers or partners in research projects. We plan to share what we find with other researchers and carers to make sure that carers’ voices are louder in mental health research in the future.

“What research do carers want to see?

What topics are important are important to carers?

How can researchers involve carers as partners in research?

How can researcher recruit carers to participate in research?”

What is World Café?

…it’s a way to meet with a large group of different people to answer questions that are important to the guests – in this case, about carer involvement in research. The event will look and feel like a café and cake and hot drinks will be served.

Guests move from table to table to join in conversations about participation in research, supported by a table host. The table hosts will be carers, NHS staff or researchers. We will provide coloured pens and invite guests to write or draw their ideas on the paper tablecloths. We will take the tablecloths away and use these to help us understand carers’ views.

Example of World Café Tablecloth

The School of Healthcare at University of Leeds has provided funding for this event so that we can ask these questions by holding a World Café on the 14th March 2019 at The Doncaster DomeIf you would like to attend this World Café, you can book using the information in the link above or by contacting us or Nicola Clibbens directly.

Follow Nicola on Twitter @UniLeedsMH

Have you attended a World Café before? Do you have questions we should ask at the World Café? We would be delighted to receive comments or ideas.

Tickets Available – Reducing Restrictive Practices: Understanding Key Intervention Components

As we move into the final stages of COMPARE: Establishing components of programmes to reduce restrictive practices: an evidence synthesis, we are pleased to announce that we will share our findings at a dedicated event:

Reducing Restrictive Practices: Understanding Key Intervention Components

12.30-15.30 5 June 2019
Horizon Conference Centre, Leeds

We have identified and mapped over 100 interventions that have been implemented in various adult mental health settings across the world. A free, interactive directory will be made available following this event. Using a specially designed taxonomy, we were able to discern between the active components of a substantial proportion of these interventions. Consequently, for the first time, we will be able to indicate which intervention components have the most (or least) potential to reduce restrictive practices.

We will also introduce a new study that builds on and extends this work: CONTRAST: Establishing components of interventions to reduce restrictive practices with children and young people: an evidence synthesis. Here, we will seek to identify interventions to reduce restrictive practices with children in a range of residential settings.

“We particularly encourage service users and carers to come along and join in the discussion.”

A draft programme for the event can be found below. Please join us for a complimentary lunch from 12.30 onwards. We hope that we will be joined by a wide range of stakeholders with an interest in the reduction of restrictive practices for plenty of networking and discussion. We particularly encourage service users and carers to come along and join in the discussion and we can cover travel expenses for those who wish to do so. Please contact us to make arrangements.

If you have any questions about the event, please do not hesitate to contact us. For travel and parking information visit Horizon, Leeds

Tickets are available via Eventbrite.

January 2019 – Welcome!

In the month that we launch our new website we’ve been busy. The start of the month saw Liz Hughes publish a joint position paper with other members of Mental Health Nurse Academics UK and people with lived experience: “Seeing Red” raises the issue of period dignity in inpatient mental health settings. Liz engaged in a streamed video chat about this issue with UNITE Mental Health.

In addition, Liz is a co-investigator on a new study Identifying and evaluating mental health early intervention services and self-care support for lesbian, gay, bisexual and transgender young people: a mixed methods study led by Lancaster University and funded by the Health Services and Delivery Research stream of the NIHR. The study will examine and evaluate access to mental health support for young people who identify as lesbian, gay bisexual, or transsexual (LGBT). LGBT young people report significantly higher rates of depression, self-harm, suicidality and poor mental health than heterosexual youth. We are pleased to welcome Dr Emily Pattinson, who will be working with Liz on this three year study, to the Mental Health Research Group. 

John Baker and Kathryn Berzins have been busy blogging for the National Elf Service (@mentalelf on Twitter). Kathryn’s blog examined a review which focused on the role of carers under the Mental Health Act, and John’s discussed a recently published systematic review on Community Treatment Orders.

A journal accepted our first paper to explore some of the work led by Joy Duxbury’s team to reduce the use of restrictive interventions in acute mental health settings informed by the 6 Core Strategies approach (more on this in a future blog).

Nicola Clibbens‘ upcoming World Café will focus on carers’ views about their participation in mental health research featured on the radio (Hallam FM). The World Café event will be held in Doncaster at The Dome in Doncaster on 14th March 1-3.30pm as a partnership between Rotherham, Doncaster and South Humber NHS Trust and The University of Leeds.