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.

Dignity. Period.

You may have seen a lot of news items about period poverty, where lack of money precludes some women from purchasing pads and/or tampons. You may have been shocked to hear that some girls were unable to attend school because they could not afford – or were too worried about their parents’ financial circumstances to ask them – to buy sanitary products. While Foodbanks request donations of pads and tampons, other campaigns, such as Bloody Good Period and Gift Wellness Foundation have been collecting and distributing sanitary products to homeless women, refugees and other vulnerable women. Today, on Menstrual Hygiene Day, The Body Shop have launched an initiative to collect products for Bloody Good Period at some of their stores. A scheme began in 2018 in Scotland to provide sanitary products in schools and Wales and England have recently followed. Unite the Union launched a campaign in 2018 for period dignity, urging employers to make sanitary products freely available in the workplace.

You may be surprised to learn that, at the time of writing, the NHS does not provide free sanitary products for patients, although the government has made a commitment to begin providing them as from July 2019. There is more to period poverty than money, however, as the organisers of Menstrual Hygiene Day hope to convey.

The cost of period poverty

Increased awareness of the potentially prohibitive cost of feminine hygiene products has brought the related costs of not having access to these products into sharp focus. GPs have reported increased rates of urinary tract infections resulting from the use of toilet roll or other makeshift solutions and/or prolonged use of specially designed products (increasing the risk of toxic shock syndrome). As well as health implications, lacking access to these products can disrupt education and employment. And then there is the negative impact on women’s dignity. The World Health Organisation defines dignity (in mental health) as:

Dignity refers to an individual’s inherent value and worth and is strongly linked to respect, recognition, self-worth and the possibility to make choices. Being able to live a life with dignity stems from the respect of basic human rights including: >Freedom from violence and abuse;
>Freedom from discrimination;
>Autonomy and self-determination;
>Inclusion in community life; and
>Participation in policy-making

Earlier this year, we blogged about how Liz Hughes, along with other members of MHNAUK and the Twitter community, issued a call for period dignity in “Seeing Red!”: Why We need Menstruation Awareness in Mental Health Services. The report highlights the challenges of managing menstruation in an unfamiliar setting, where you may not have the resources (or access to them), and documents some of the distressing and degrading experiences recounted by service users. Liz and her fellow authors call for the provision of sanitary products – which has been addressed – but also for more open discussion around menstruation in mental health settings and how mental health nurses can support this.

Mental Health Research in Leeds: Promoting safe, effective and therapeutic mental health care

Liz’ commitment to raising awareness of period poverty and stigma in mental health is just one example of how dignity is at the heart of our research endeavours in the Mental Health Research Group. For us, dignity and safety are intertwined: to protect and promote service user safety and reduce physical and mental harm is to actively demonstrate an individual’s worth. Through our research, whether our focus is on identifying ways to reduce restrictive practices (COMPARE & CONTRAST) or inequality and discrimination (asking about sexual identity), or examining how effective sexual assault referral centres are for people with mental health problems (Mimos Study, blog coming soon) or what happens when service users raise concerns about quality and safety (Mary Smith’s PhD research), our ultimate goal is dignity. Period.

How comfortable are NHS staff with asking about sexual identity?

As of April 2019, sexual identity monitoring became mandatory across the NHS. Health disparities – inequalities in the provision of or access to healthcare – are faced by many different minority groups. Collecting monitoring information such as age, race and socioeconomic group makes healthcare providers aware of these disparities and therefore better able to take action to address them. The existence of disparities in accessing health care has been the subject of increased empirical study in recent years, yet without accurate and suitable monitoring data on patients’ sexual orientation it is difficult to know the true extent of these disparities. In 2013 the Lesbian, Gay, Bisexual and Trans (LGBT) Public Health Outcomes Framework Companion Document (Williams et al., 2013) recommended that sexual orientation and gender identity should be routinely monitored in health and social care to allow for a better understanding of disparities facing the LGBT community when accessing health care.

Research in the US suggests staff and patient perceptions of collecting sexual orientation monitoring information differ drastically, with staff greatly over-estimating how much discomfort collecting this information would cause patients. While 80% of healthcare staff thought that asking patients about their sexuality or gender identity would cause offence, only 11% of patients reported they would be offended when asked (Maragh-Bass et al. 2017).

“80% of healthcare staff thought that asking patients about their sexuality or gender identity would cause offence.” (Maragh-Bass et al. 2017)

Kate Ward – in association with The Rainbow Alliance – conducted a service audit at Leeds and York Partnership Foundation Trust. Her findings mirrored those of previous research: a disconnect between UK staff and patients perceptions of recording information about sexual orientation. In the absence of any UK studies on this topic we have devised a survey to try to gain some insight into NHS staff’ views about collecting mandatory sexual orientation monitoring data.

“How comfortable do NHS staff feel about collecting information about patient sexuality?”

We will invite NHS staff who collect sexual orientation data during their day-to-day interactions with patients to share their opinions and behaviours . A 5 minute online survey will be used to collect information about how staff currently collect information about sexual orientation within their trust. As a result of this survey, we hope to gain a better understanding of how staff feel about collecting sexual orientation data from patients and what support staff would like to be put into place. In addition, each trust involved in the study will receive a document showing the how their trust is collecting sexual orientation information and the opinions of their staff, this document will help trusts understand how they are conforming to the sexual orientation monitoring information standard.

“What support would staff like?”

We will send out an online questionnaire to a sample of acute care and mental health NHS Trusts for completion by any employee that collects patient information as part of their role. The questionnaire will ask a series of questions about that individual staff member’s opinions and behaviours surrounding sexual orientation monitoring. We will also ask staff to volunteer information about their own sexual orientation, LGBTQ+ training and job role. All questionnaires will be anonymous. We will use this information to investigate any potential connections between comfort and willingness to collect information about sexual orientation and staff members own sexual orientation, job role and LGBTQ+ awareness.

Do you have to record sexual orientation as part of your role? How do you feel about that? We’d love to hear your thoughts.

For further information please contact us or Emily Pattinson directly e.m.pattinson@leeds.ac.uk. Follow Emily (@EmilyPatPsyc) and Liz (@LizHughesDD) on Twitter.

References

Maragh-Bass, A.C. and colleagues (2017) Risks, benefits, and importance of collecting sexual orientation and gender identity data in healthcare settings: a multi-method analysis of patient and provider perspectives. LGBT Health, 4(2), 141-152.

Williams, H. and colleagues (2013) The lesbian, gay, bisexual and trans public health outcomes framework companion document. The Lesbian and Gay Foundation.