Finding and Reading Research

The Mental Health Research Network (England) have produced a very useful user friendly guide to finding and reading a research paper for INVOLVE, a service user research organisation in the UK. This is something I would give to anyone new to research or just thinking about getting involved in research - and it is free to down load on-line!

Click here to go to download page

Collaborative Recovery Model

This Collaborative Recovery Model has been developed in Australia and has some interesting reviews on effectiveness. As a new 'model' I was wondering if it would fit with the fluidity of the recovery approach but it does appear to take into account that all recovery is personal.

The website is well worth a visit for the information about the recovery measurement tool STORi and how it might work for service users and staff.

Stories Make us Human

In this New Year we will all resolve to do some things better and to stop doing other things completely but how many of us will resolve to tell a good story? Yet it is the ability to tell a good story that separates us out from simply being animals or machines. Paul Ricour identifies the basic construct of narrative as story which includes a beginning, middle and end but we all know that stories are much more subtle than this. While the words narrative and story are used interchangeably I think there is a difference in that narrative is often a collection of stories but here I want to point out the meaning of story as a human construct.

We all see things as they are which may not be the same as each other. We use language to communicate what we see either in words, numbers, music or art. So far a machine could do all of these things and often does in health and social care. Then we use passion to transfer the emotional content of the story either in the writing or the telling. Try telling a child a story in monotone - they will soon lose interest if you are unable to engage them emotionally so that they can understand the characters of the story. A good film or book or piece of music or art will also reach out to us emotionally so that we can recognise or associate ourselves with the characters in the story or song.

In an age of technical rationality (and machines doing everything for us) we are at risk of losing the art of telling stories because they may be ignored as unreliable evidence or even untruths. Once we begin to call stories lies we have lost their essence or passion and fail to listen to what is really going on. They may of course be untrue but the story is what makes each and every one of us human beings trying to communicate our own interpretation of an event. If you ignore the story you ignore the person and what it is to be a member of the human race. We may all be what Arthur Frank terms wounded storytellers but that does not mean that we do not have a story to tell.

Lancashire Care Library

This is a great library for receiving updates by email on latest research in health care .Some of the publications are free  but all have links and can help keep you up to date - without even trying!

The economic argument for more mental health promotion

This report although only about Wales provides some interesting information on the cost of mental illness in Wales. For example the cost of mental health care amounts to 20% of the healthcare budget which is higher than cardiovascular disease (16%) and cancer (15%). It also provides advice on how we can reduce the "burden of disease" and improve the mental health promotion of children and adults in Wales. The report gives practical examples and reasons to improve mental health care in Wales, which can only be of benefit to the people who live there. 

T-E-A-C-H Resource

I am currently looking at recovery indicators so expect to see a few coming this way over the next few weeks. This one includes some measurement tools of hope and recovery so might be useful  now or in the future.  Will add to the list of resources too just for good measure;-)

The King's Fund

This is a useful website for free downloadable publications on the health service and how it is delivered. There is a section that specifically looks as  involvement practices and how they can be improved. I keep revisiting some of the documents which tells me that it is a useful resource. I am going to add it to my links section for this reason. In particular The Point of Care section  has useful information on improving dignity and compassion.  

No Health Without Mental Health Strategy 2011

The new government strategy for mental health care in the UK is  now available with all supporting evidence on their website.  There is a lot to read but also  an easy read document. Having skimmed through a lot of it (because we already know it)  it appears to be promoting the following ideas

• mental illness is costing the country a lot of money
• people need to be more resilient
• people need to be more in control of their health and recovery
• early intervention and health promotion may reduce the burden
• stigma should be addressed locally
• primary care should be more active 
• people need to be back in work to reduce isolation and improve resiliency/ social support

Much of the above service users and carers have been asking for for some time. there is little attention to involving service users and carers ( it is mentioned once or twice)  and there is little talk of emancipation. Although there is some reference to the Equality Act  2010. All in all this document does not say anything that we do not already know in mental health care but it does use some of the above as outcome indicators. This is a start in the right direction, let's hope that the principles and outcomes within this strategy have got some power to  improve mental health care provision.

Health is Social Blog

Just found this great blog about making health care - social care, mainly using micro blogging tools like Twitter. The very generous author (also a nurse)  provides us  us with 140 uses for micro blogging in health as well as lots more information and presentations. I am going to add this to my links because I think it will be useful to follow how micro blogging  can involve service users and carers in health and social care decision making in the future.

Quality or Safety or both?

I attended a really useful conference yesterday on inter professional  learning. There were some useful discussions on safety and quality not being the same thing. Perhaps we are now at the point in our health care system that we need to be talking about safety a lot more and with dwindling budgets, quality a lot less? Some of the main issues are identified below.

Human Factors - that can lead to mistakes are hardly recognised within  the quality literature - people make mistakes when they are tired, lack knowledge and support or are simply expected to do too much.

Team working - people  do not always learn how to work as a team  which involves collaboration and  communication at all times. Developing team working skills can therefore prevent mistakes from happening if people feel valued, supported and listened to within a team. This includes peer support workers and carers who are all trying to achieve the same goal- recovery and wellness.

Communication - even if people do not work as part of a team but are more specialised they still need to be able to communicate vital information that can reduce risk and improve safety. Saying it is not my job is not a good reason. Nor is confidentiality but it is important to gain consent before passing on  personal information. Signs and symptoms are not personal information but simply your observations of what is/could be happening. Tools can be used here to give exact measurements or an overview e.g. SBAR 

Knowledge & Skills - it is difficult to have skills without knowledge but by grouping them together does not mean that they are both the same thing. You need knowledge  to  decide which skills you should be using so they cannot be used in isolation of each other.  For example in order to give medication you must not only know how to give it ( route/dose etc) but also why you are giving it and how it might interact with other substances.  Some skills require more complex knowledge than others but all skills require some knowledge and  understanding that you must be able to demonstrate that you are competent in. Simply attending conferences or one-off study days will not achieve this and could be unsafe in practice if you do not fully understand the consequences of what you are doing. Most professional bodies require this as a minimum to
be considered safe practice.  Educational courses also give 'credit' that you are competent by assessing you at the right level for your knowledge needs. However all professionals are responsible for their own safe practice ( not their managers) and must make it known if they feel practice is becoming unsafe. It can also be useful to identify what you need to know to make it safe. This can be done through clinical supervision or peer evaluation.

Consistency - is perhaps a quality issue that can be related to safety. If practice is different from area to area people will not get consistent care which can lead to mistakes being made.  Consistency means following the most up to date guidelines and evidence-based practice and being able to consistently demonstrate that you have done this.  This could be used to audit  and improve current practice in teams and in our own continual professional / personal development (CPD).

Some useful links for  measuring safety in  practice where 'how-to'guides may have been created

Patient Safety First
National Patient Safety Agency
Scottish Patient Safety Alliance
1000 Lives Plus -Wales
HSC Safety Forum -Northern Ireland

Service User Voice

This is a blog by service users on the Community Care journal website.  There has been so much going on lately within health and social care it feels hard to keep up with it all. I was looking to see who was blogging about the government reforms and found this site, it looks pretty active so will add it to the links bar.
However following the march against the cuts yesterday I fear that it will be harder to make service user's voices heard. When the politicians are not listening the public cannot be heard. 

Whose Story is it Anyway?

A recent report published about making narratives effective  for changes in practice. This is an easy to read report and gives some ideas about how involvement can be improved - this is one to download and show to as many people as you can.
I have always felt uneasy about leadership and management courses that are supposed to effect change? This report  confirms  that in saying that it is front-line works who should be empowered to make the difference as they are the ones who have the most contact with patients/ clients - at last!

Can we guarantee compassionate care? - The King's Fund

Can we guarantee compassionate care? - The King's Fund
No but - this interesting blog provides some ideas for improving compassionate care and preventing compassion fatigue

Involving users in commissioning local services | Joseph Rowntree Foundation

Involving users in commissioning local services Joseph Rowntree Foundation
A new report but with similar findings to others.
it is about time this was taken more seriously

Mental health - RCN

Mental health - RCN

Social Inclusion Resource - free at the Royal College of Nursing Website. Provides some useful information and links to current thinking about recovery and personalisation in mental health care and other areas such as learning disabilities, homeless , and the traveling communities. I do wish they would not split groups up in this way, although I recognise that each group may have different needs. It does tend to lead people into thinking that only certain groups have social inclusion needs which can in effect exclude some people.
Social Inclusion is for everybody isn't it?

Emancipatory Practice and Lessons From Geese

This blog is adapted from the website above but includes their original text with my adaptation in italics

Lessons from Geese ( with some additional emancipatory lessons)

Fact 1


As each goose flaps its wings it creates an 'uplift' for the birds that follow. By flying in a 'V' formation, the whole flock adds 71% greater flying range than if each bird flew alone.

Lesson

People who share a common direction and sense of community can get where they are going quicker and easier because they are traveling on the thrust of one another.

Service user groups provide encouragement, support, care, and understanding in helping people cope with mental illness. For many years this was not encouraged but now some service users have developed groups of their own. However they are often controlled by the budgets of those in power. Any organisation that has particular goals or policies to follow must learn to fly in formation .

Fact 2

When a goose falls out of formation, it suddenly feels the drag and resistance of flying alone. It quickly moves back into formation to take advantage of the lifting power of the bird immediately in front of it.

Lesson

If we have as much sense as a goose we stay in formation with those headed where we want to go. We are willing to accept their help and give our help to others.

It is possible to go it alone in recovering from mental illness but this is more difficult and requires more inner strength and coping skills.  Finding people who can provide us with that uplift when we need it is important in beginning  and continuing our journey to recovery. Developing relationships with professionals and family/ friends will help us do this - so that we are not flying alone.

Fact 3

When the lead goose tires, it rotates back into the formation and another goose flies to the point position.

Lesson

It pays to take turns doing the hard tasks and sharing leadership. As with geese, people are interdependent on each other's skills, capabilities and unique arrangements of gifts, talents or resources.

Identifying and sharing our skills make coping and managing easier - this is true of any team approach to a task. This means that we need to get to know each other better and before a crisis occurs so that someone can quickly take our place when necessary.  Learning to let go and let others take the lead is a strength not a weakness and benefits the whole group. Encouraging people to talk about and identify their strengths and weakness should be encouraged so that they can be recognised an planned for in times of need. (but never used against them)


Fact 4
The geese flying in formation honk to encourage those up front to keep up their speed.

Lesson

We need to make sure our honking is encouraging. In groups where there is encouragement, the production is much greater. The power of encouragement (to stand by one's heart or core values and encourage the heart and core of others) is the quality of honking we seek.

Making is a noise is not just about making a noise but about demonstrating our support for each other. Making sure people are heard and developing a narrative of experiences will provide support for service users who are new to the service and will also develop a strong network of support from existing service users. Writing, talking, playing,  drawing and acting are all ways in which narratives can be heard.

Fact 5

When a goose gets sick, wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it dies or is able to fly again. Then, they launch out with another formation or catch up with the flock.

Lesson

If we have as much sense as geese, we will stand by each other in difficult times as well as when we are strong.

We all need support some of the time and in helping each other we can work towards recovery or our goals much more effectively and efficiently .
This includes helping people cope in a relapse / crisis and not blaming them or others for its cause. People get weak or ill and it is our duty to help them recover not abandon them when they are no longer useful to us. This could take some time and patience but is the minimum we can expect from each other if we are to develop emancipatory practice.


Lessons from Geese was transcribed from a speech given by Angeles Arrien at the 1991 Organizational Development Network and was based on the work of Milton Olson. It has since circulated in several organizations across the world.

National Empowerment Centre

I may have mentioned this site before. It is USA site with updated advice and information. I will add it to the links section so that it does not get lost.

The Triangle of Care

At last a good practice guide for involving carers in acute mental health care! This has been a long time coming  and is a useful resources for ideas in practice on how to involve carers .
It does however provide the dreaded tick list which can lead people into a false sense of security but the auditors love it. Likewise it does not really address the  issue of conflict which will inevitably arise around who knows what the best needs of the service user are?
It does not even  acknowledge the law  that has been around for the last decade on carers needs although there is a little bit about confidentiality.
 One recommendation is for training  but does not say what this should be and another is for carer champion posts which can sometimes be a dumping ground. A change in values and attitudes is what is needed ( I can hear some staff saying that they will not have the time)  and there is a lack of evidence for this within the document.

Oregon State Hospital Museum

This active blog provides interesting information on objects found at the hospital made famous in the film One flew over the Cuckoos Nest.  Records of costs appears to be familiar in many of the old asylums indicting that organisation of resources were a major function. Pity nursing and medical records were not so strictly kept up.

sociology research journal online

this journal is free online with some interesting if a little complex ideas discussed - not for the faint hearted