CArDiNAL: A New Clinical Academic Research Fellowship

The beginning…

I am delighted to be starting my PhD journey with the University of Leeds in tandem with Leeds and York Partnership Foundation Trust. The new CArDiNAL (ClinicAl Doctoral Nurses and ALlied Health Professionals) Clinical Academic Research Fellowship embeds and promotes my research role within my clinical (Speech and Language Therapist) Specialist post. A strength of this new post is the support of a cohort of clinical academic fellows – including different Allied Health Professionals and Nursing Specialists – together, we form a community of research active clinicians across the Yorkshire and Humber footprint.

“The service users on my clinical caseload, their caregivers and the multidisciplinary team have directly influenced my research topic.”

Without this important initiative by Yorkshire and Humber NIHR CLAHRC I would not have been able to embark on this research journey whilst continuing to practice as a Speech and Language Therapist. As well as adding to the wider evidence-base for dysphagia in mental health, my research and ongoing clinical practice will inform each other. The service users on my clinical caseload, their caregivers and the multidisciplinary team have directly influenced my research topic and I will use my specialist skills to support involvement from other service users with communication difficulties in co-production.

“How can service users, caregivers and clinicians be supported to recognise the early warning signs of eating, drinking and swallowing problems?”

My PhD research will consider everyday quality of life around mealtimes and I will continue to identify and unpack good practice. My pilot work progressed from an initial case study (highlighting the different perspectives of an inpatient and members of his staff team; see Guthrie et al. 2012) to projects considering the risks associated with swallowing difficulties, communication and choking incidents in adults with mental health conditions (Guthrie and Stansfield 2017; Guthrie and Roddam 2011), leading me to ask: how can service users, caregivers and clinicians be supported to recognise the early warning signs of eating, drinking and swallowing problems? I developed a free booklet to support service user, carer and staff discussions about mealtimes (Guthrie 2013). The pictures, text and checklist suggest conversation topics, including aspects of swallowing difficulty that may have gone unrecognised or been overlooked. Any concerns about swallowing should always be referred to Speech and Language Therapy for assessment and advice.

I am keen to hear any patient or caregiver “stories” of the experience of living with mental health conditions and dysphagia.

Susan Guthrie is a Highly Specialist Speech and Language Therapist and CArDINAL Clinical Academic Research Fellow. For more information about her PhD research you can contact her here or directly via hcsg@leeds.ac.uk. You can also follow Susan on Twitter @SusanGuthrieSLT and on Researchgate.

References

Guthrie, S. and Roddam, H. (2011) Reporting and learning from choking incidents in adults with learning disabilities. Speech and Language Therapy in Practice.

Guthrie, S., Roddam, H., Panna, S. and Fairburn, G. (2012) Capacity to choose and refuse? A case study. Advances in Mental Health and Intellectual Disabilities, 6(6), pp.293-300.

Guthrie, S. (2013) Me at Mealtimes [Free online booklet]

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

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!

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.