Tag Archives: psychology

Collaborating in coercion? A pivotal time for the psychotherapy profession

27 Jun

“Professional or collaborator” banner at demonstration in Streatham, 26 June 2015 (photo @CommsPsychUK)

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[Not a full blog post, but tweets saved here to possibly write up into a blog post later]

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My thoughts on professional ethics and psychotherapists’ professional bodies providing clear guidance to their members about how far they are prepared to be involved with coercive practices given job centres are inherently coercive environments, not therapeutic ones. Will psychotherapists wait for the governnment and DWP to define the scope of their profession? Or will they provide clear professional standards for members to follow? Professional ethics

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“He’s a psycho” – Professor Adrian Furnham on the importance of cleansing the workplace of undesirables

19 Jun
Harry Enfield as Kevin the Teenager (PA)

Harry Enfield as Kevin the Teenager (PA)

 

Have you seen this? Rachel Hobbs of mental health charity Rethink Mental Illness asked me this afternoon. She was referring to the charity’s response to a piece in the Sunday Times headed “I’m sorry, he’s not a differently gifted worker – he’s a psycho”. I’d just arrived home so hadn’t but, sadly, I had already seen the piece that prompted the rebuttal – and been shocked to the core.

The Sunday Times piece to which Rethink had issued a response advises employers of the necessity of screening job applicants and employees to weed out undesirable ones. The author writes:

“There are three important questions. The first is how you spot these people at selection so you can reject them … The second is, given that they have already been appointed, how to manage them … Sometimes it is a matter of damage limitation …  The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.”

Putting aside for one moment the reference to “maladaptive personalities” and the telltale use of “these people” (a clue that we’re about to experience a group of people being made “other”), this all seems fair enough. After all, what employer wants to end up lumbered with rogues or duffers, or people who are simply not suited to the post being filled?

In any recruitment process, whether to fill a new role or replace a departing employee, some sort of selection process is inevitable. Indeed it is welcome, since it will give both prospective employer and employee the opportunity to see whether post and candidate are a good fit. I’ve read plenty of books and done courses including interview techniques, networking, career development and workplace psychology. I’ve undertaken interviews and assessments. It’s an interesting field and one that can bear fruit for employers and employees.

So what’s the problem? The problem is that the premise of the piece is – regardless of the role to be filled – people fall into two categories: they are either desirable or undesirable in the workplace, and the “unemployables” are to be hunted down and excluded. “These people” are to be avoided at all costs. “These people” have “maladaptive personalities”.

“These people”, according to the piece, fall into 5 categories, namely people who exhibit what is classified as antagonism,  disinhibition (Harry Enfield’s Kevin the Teenager – pictured above – is the illustration the author provides for this category), detachment, negative affect or psychoticism (bear with me – this isn’t made up). Each, as described in the piece, has a clear link to mental health problems.

Reading the piece, I had several strong immediate reactions – to the extent I sat down and wrote out my thoughts (then, unhelpfully, lost the piece of paper; perhaps there should be a sixth category of “unemployables”, the abstent-minded).

First, I took away the message that (based on the characteristics of the people described in the 5 categories, some of which I share) I was most definitely not wanted in the workplace. I was not wanted in the workplace and there were armies of workplace psychologists devising tests designed to make jolly sure I wouldn’t be able to sneak in undetected.

It felt as if, when I finally feel able to re-enter the competitive employment market and, were I ever to make it through to a job selection process, there would be a head to head battle. On one side would be the selectors, trying to expose my “maladaptive personality”; and, on the other, me, desperately trying to keep my deficiencies and undesirable characteristics under wraps. Then, in the unlikely event I was able to pull the wool over their eyes and win on that occasion, I would always be at risk of exposure and therefore dismissal. And, even if I started a job mentally healthy but then (for whatever reason – even if it was because too much work was loaded onto me at work, causing unnecessary stress) I became unwell, my employer wouldn’t seek to support me, a valuable employee, through that illness – but instead try to get me out.

I was reminded of the recent disappointment of prospective cabin crew Megan Cox. Notoriously, her offer of a dream job with Emirates Air was withdrawn when she disclosed a past history of depressive illness. In Megan’s case, it was clear that the prospective employer had based their decision on generalisations about depressive illness rather than the individual under consideration. Perhaps they were administering a standardised workplace psychological assessment which sought to weed out the undesirables. Megan Cox was deemed undesirable by Emirates Air. Lucky escape for them that they were able to spot her during the recruitment process. The piece made clear that, similarly, I would be weeded out.

Second, the contents made me want to send the piece to all those people involved in making decisions about the social security support of people who, like me, are managing disabilities, to show them the high barriers we have in getting into employment. Only today, it was reported that Employment and Support Allowance and the Work Programme were costing more than the predecessor welfare benefit Income Support and were getting fewer disabled people back into work. Is it any wonder that a system based around the notion that disabled people are out of work because of a lack of motivation (and incentives – or, rather, penalties) to seek work will fail when the actual barrier is the attitudes of employers – fed by pieces such as these – towards people with disabilities?

Third, having assumed at first glance that the piece was written by a generalist journalist to meet a deadline, I was gobsmacked to find it was written by a professor of psychology. A renowned academic – Professor Adrian Furnham – of a renowned institution – University College London – was the author. It simply did not compute.

So then  I did a little reading around the subject on the internet. I discovered that Furnham hadn’t made up terms like “dark traits” or “psychoticism”. No: they were legitimate. These terms came from last year’s new version of the US psychiatric manual (DSM5) and from workplace psychology (for the past couple of years).  The meat of the piece seemed to be almost a cut and paste from ideas that would be familiar to people who’d studied the field: nothing new, surprising or out of the ordinary. This wasn’t some rogue piece by a lazy journalist in a hurry: it reflected current thinking in (US) workplace psychology. That was hard to swallow.

However, on reading the piece again, there were some flaws (whether of the author or in the editing) which meant it was skewed to paint a worse picture than US workplace psychology actually seems to do. Thank goodness. For instance, the professor conflates the DSM5’s “maladaptive personality traits” (undesirable characteristics) with “maladaptive personalities” (undesirable people). To confuse a trait with a person is a big leap – and a damaging one for the people on the receiving end of the “undesirables” label. Furnham also conflates mental illness (with references to “disorders” and “pathology”) with personality disorders (he lists the 3 DSM5 clusters) and personality traits. Thankfully, therefore, the piece isn’t an accurate representation of the current state of play. In fact, it’s a bit of a mess.

In addition – as is common with fear-mongering pieces – the particular damage “these people” could do in the workplace is left vague; but the fact that they will cause damage is made plain.

The trouble is, however, that anyone not familiar with the nuances in the field (and that might be your average Sunday Times reader) would easily be expected to come away with the very clear message that people with mental health problems – yes, people like me – should be excluded from the workplace at all costs. And that is a damaging message.

Which leads me to my fourth thought on the topic: I wonder (and I don’t know) whether the piece might breach disability discrimination laws.

Furnham argues for keeping “these people” – people with “maladaptive personalities”, people whose symptoms which, as described, fall within mental health diagnoses such as anxiety, depression and schizophrenia – out of the workplace. My understanding is that, where a condition impacts on someone’s health for 12 months or longer, that counts as a disability and is protected by law. In other words, discriminating against someone in these circumstances counts as disability discrimination.

I’m trying hard to see how advising employers on how to avoid employing or get rid of people with disabilities is any different to advising employers to not employ black people or gay people or women. Whether or not it amounts to disability discrimination, it’s clear it is not good to advocate discrimination in the workplace.

Rethink Mental Illness has been in contact with the author and are hoping to have a piece – written with other mental health charities – published in this weekend’s Sunday Times. Rethink reports that Furnham and colleagues were surprised at the reaction to the piece and believe it has been misinterpreted. It seems to me there is a clear opportunity for a dialogue, and for largely commercially-focused workplace psychologists to gain a greater understanding of the crossover between their work and mental illness and the role they can play in the negative stereotypes.

Until employers are willing to consider job candidates or existing employees as individuals rather than categories based on assumption, the prejudices and assumptions of employers will impact on people managing mental health problems like a form of modern straight jacket.

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Update smallThe Sunday Times published a letter from Rethink Mental Illness and others on Sunday 22nd; and the following day Furnham wrote to explain, apologise and request that the article be withdrawn. Constructive engagement and a willingness to engage produced a positive result.

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The Sunday Times story and rebuttal:

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Employment and Support Allowance

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Emirates Air and depression

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Here’s the full text of the piece written by Adrian Furnham and published in the Sunday Times on 17th June under the heading “I’m sorry, he’s not a differently gifted worker – he’s a psycho”:

Open quotesTWO things account for the success of a popular personality test: extensive marketing and the reassuring message you get with your results. Whatever profile you have, or type you are, “it’s OK”. We have different gifts. We can’t all be the same. Everyone is fine. Celebrate your quirkiness.

The message makes it easy for consultants and trainers. Researchers, however, know that one of the best predictors of success at work is (raw) intelligence, along with emotional stability and adjustment. But too many in the selection business are afraid of using well-proven tests to assess these factors for fear of having to deliver feedback such as: “Sorry you were unsuccessful in your application: the reason is that you are too dim and too neurotic.”

However, the message of “we are all OK” is not true. There are people with a distinctly unhealthy personality. There are many words for this. Some talk of “dark-side” traits, others of “abnormal” traits. And for more than 20 years, clinicians have talked about the maladaptive personality.

Researchers have recently tried to spell out traits that are most clearly manifest in the maladaptive personality. There are five of them.

Antagonism
This is defined as manifesting behaviours that put people at odds with others. It has components such as manipulativeness, deceitfulness, self-centredness, entitlement, superiority, attention-seeking and callousness.

Antagonistic people put everyone’s back up. They are selfish, self-centred and bad team players. The clever and attractive ones are the worst, because they use their skills and advantages to get what they want, come hell or high water.

Disinhibition
Defined as manifesting behaviours that lead to immediate gratification with no thought of the past or future. It has components such as irresponsibility (no honouring of obligations or commitments), impulsivity, sloppiness, distractability and risk-taking.

Think Kevin the Teenager. It can mean enjoying shocking others with unacceptable language, outlandish clothing or poor manners. This may be amusing in the playground but hardly acceptable in any form in the workplace.

Detachment
This is defined as showing behaviours associated with social avoidance and lack of emotion. It has various components, such as a preference for being alone, an inability to experience pleasure, depressivity and mild paranoia.

These are the cold fish of the commercial world. They seem uninterested in nearly everything and certainly the people around them. Some seem frightened by others, most just not interested in being part of a team.

Negative affect
This is defined as experiencing anxiety, depression, guilt, shame, anger and worry. It has components such as intense and unstable emotions, anxiety, constricted emotional expression, persistent anger and irritability, and submissiveness.

These are the neurotics of the world. They can be very tiring to engage with and highly unpredictable because of their mood swings. The glass is always empty, and they seem always on edge.

Psychoticism
This is about displaying odd, unusual and bizarre behaviours. It includes having many peculiar beliefs and experiences (telekinesis, hallucination-like events), eccentricity and odd thought processes. Some may see such people as creative, others as in need of therapy.

Psychiatrists have grouped those with personality disorders into three similar clusters: dramatic, emotional and erratic types; odd and eccentric types; and anxious and fearful types.

There are three important questions. The first is how you spot these people at selection so you can reject them. This is easier with some disorders than others. It is virtually impossible to spot the psychopath or the obsessive-compulsive person at an interview. Clearly, you need to question those who have worked with them in the past to get some sense of their pathology, which many are skilled at hiding.

The second is, given that they have already been appointed, how to manage them. There is, alas, no simple method that converts the antagonist into a warm, open, honest individual or the disinhibited worker into a careful, serious and dutiful employee. Sometimes it is a matter of damage limitation.

The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.

Adrian Furnham is professor of psychology at University College London and co-author of High Potential: How to Spot, Manage and Develop Talented People at Work (Bloomsbury) Close quotes

 

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South London and Maudsley on film: humanity and humour

28 Oct

Bedlam (4) OCT 2013Bedlam (1) OCT 2013

Looking at a newspaper story about the murder of drummer Lee Rigby earlier in the year, Lloyd, who has a diagnosis of paranoid schizophrenia, said that hearing about schizophrenics in the news made him feel worse. He worried that he didn’t know his own mind and wondered if he himself could turn into a murderer too, since that’s what he read in the papers. Dealing with the symptoms of psychosis can be difficult enough in itself. Having to deal with society’s perceptions that people with your diagnosis are violent and unpredictable adds another level of difficulty.

Earlier today, I attended an advance screening of Channel 4’s new series on the realities of modern mental health care at the South London and Maudsley (SLaM) mental health trust.  In the screening room in the basement of Channel 4′s headquarters in Horseferry Road, a select audience sat in red plush seats watching one of four programmes in the series on modern mental health care. The series is entitled Bedlam and the name choice has caused controversy. To an extent it can be argued that, when a respected NHS trust calls a television series after a medieval asylum, it dilutes the strength of the case against Thorpe Park’s “mental patient scary fun” horror maze Asylum. But what of the series itself?

The episode previewed profiled the work of Speedwell community mental health team (CMHT) in Deptford, south London, over the course of a year. The four-part series, which starts at 9pm this Thursday, also covers the Anxiety Disorders Residential Unit, Lambeth Triage (the front line for emergency cases) and the older adults unit (over 65s).

Without giving too much away, we followed patients Tamara, Lloyd and Rosemary, all of whom experience psychosis. We saw them trying to cope with periods of illness, voices, delusional beliefs about bed bugs and with children being taken into foster care.  We saw them using prescription drugs as well as speed and alcohol to help manage their troubling symptoms. We saw them at times chaotic and disturbed, and at other times funny and happy.

We saw social worker Jim Thurkle doing his best to hunt down and help patients, a third of whom refuse to engage with him. We saw Dr Tom Werner doing his best to confirm the stereotype of the psychiatrist in the bow tie. We saw the fine line between enabling someone to live the life they choose and intervening in the interests of their own health and safety.

Not once did we see someone who could be considered a danger to anyone else. Not once did any of the patients present as anywhere remotely near the stereotype of the paranoid schizophrenic mad axe murderer. What we saw was patients struggling to manage their lives in difficult circumstances, and the professionals who tried to help them.

It was particularly interesting to see the work of a CMHT  which, along with GPs, carry out the bulk of psychiatric care in this country. As the booklet handed out at the advance screening says:

“The lion’s share of SLaM’s work takes place in a community setting, looking after more than 35,000 people with mental health issues. SLaM treats 8,000 psychosis patients a year; 6,000 of whom are based and treated in the community. We touch on different treatments available and see intense and moving interaction with social workers and mental health teams.”

As Pete Beard, the producer of the episode, who answered questions after the screening, said:

“We wanted to reflect the realities of this challenging work, following the actual narratives of people walking a tightrope with their mental health as it happened and the teams who act as a safety net. I feel that these realities are rarely reflected accurately in the media and as a result it is important to demystify the work performed as community teams, especially taboo subjects such as being sectioned”.

It was profoundly moving to see someone taken away from their own home, against their will, and detained with no legal authority other than the personal opinions of a social worker and doctors. No police arrest, no court process, no judge, no jury. Just a simple form signed, and you have no choice about even the simplest things like what you eat, where you sleep or what shampoo you use to wash your hair. And, on a more intrusive level, you have no right to refuse medication.

This extended scene cannot help but make you reflect on the balance of power between the state and the individual, and on what society deems to be acceptable norms of behaviour. This is especially so when you’re dealing with someone you don’t really know, as can be the case when a mental health team is called out to consider sectioning someone. Britain has a proud tradition of eccentricity, but that is not tolerated if you are deemed to be mentally ill. Simply being a nuisance to others but in no way dangerous to yourself or others can, ultimately, mean three people decide on your behalf that your quality of life will be improved by a compulsory stay in a locked psychiatric ward.

The sectioning sequence made me think about the boundaries or free will and autonomy and to what extent people’s peculiarities are tolerated. I have been on the receiving end of such a process, and it changed my life irrevocably. As Dr Baggaley said, when he’s taken part in sectionings he does wonder whether this was what he trained for. Although he sees it as difficult, he does see it as necessary.

Dr Baggaley described the person in question as a “revolving door patient” who would face repeated hospitalisations, some under section (compulsion), for the rest of their life. And yet this is someone who will – under the current welfare benefits system – also face repeated Work Capability Assessments. It is hard to see the point of such assessments in this case particularly since, as Dr Sarah Wollaston MP wrote today, WCA’s are not geared towards helping people with mental health problems find and retain employment.

One of the things which struck me in this episode was the amount of humour. Despite their difficult circumstances and troubling symptoms, the patients followed could come across as affable, amenable and warm-hearted. Ripples of laughter would regularly rumble across the audience, and not just because viewers were looking for a little light relief in what was, after all, a serious topic. As with any other fly-on-the-wall documentary, the colourful charaters in this episode were full of humour. The seriousness of the subject matter made the flashes of levity even more welcome.

Overall, this preview episode was intimate, insightful and profound. It showed human beings in all our difficulties, complexities and ambiguities. It showed the realities of trying to combat the stigma around mental illness with humanity and humour. It showed that danger and fear are the least of the concerns of the CMHT.

On a final note, I will end with a criticism that was raised by audience members with personal experience of mental health services: namely that the episode was somewhat naive and unrealistic. Audience members had received far worse experiences of mental health care, or had been able to deliver a far worse service due to cutbacks. It was acknowledged by the film makers that Speedwell CMHT had a ring-fenced budget, so had not been under the same constraints and workload other CMHT’s they’d liaised with had.

It was also highlighted that a lot of the difficulties patients needed help with were practical, and that these needs were not being met. The patients were unable to deal with these matters themselves and therefore they were stuck in difficult circumstances. Examples were the bedbugs which did actually exist in Tamara’s flat. It was not a delusional belief (though its extent may have been) and dealing with that practical problem may have lessened her delusional symptoms. This and her use of amphetamines may also have been the way she managed the immense sorrow of losing her children. Lloyd appeared to be using alcohol to numb his pain.

With a series planned over two years and filmed over twelve months, much footage will have ended up on the cutting room floor. It’s a shame, however, that the close relationship between medical help and social support, and the parts played by talking therapies and thereapeutic activities, were overlooked completely in this preview episode.

Nor was the 9% reduction in inpatient beds in the past 2 years mentioned.  Nor were the terrible cuts to community mental health services mentioned.

On the other hand, as Madeliene Long, SLaM chair said:

“Despite it affecting so many people, mental illness is still poorly understood. The stigma and discrimination that people face can make their mental health even worse and can prevent them from seeking help. So it’s really important that we do everything we can to raise awareness, challenge stereotypes and promote the facts about mental health. I’m really pleased that we have been able to work with Channel 4 and The Garden Productions on such an ambitious project which sets out to do exactly that.”

As executive producer Amy Flanagan said,

“Many of these patients had lived long lives with no history of mental illness. It could happen to our parents, to us.”

And, if it does happen to us or someone we know, programmes such as these will mean it feels a little less alien and a little more a part of everyday life.

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Media coverage:

  • Channel 4 press release about Bedlam
    • Anxiety (Episode 1/4) – 9pm Thursday 31st October – “It’s a condition every one of us experiences from time to time, but imagine if one day you woke up and found your anxiety had spiralled completely out of control.”
    • Crisis (Episode 2/4) – 9pm Thursday 7th November – “At Lambeth Hospital in south London, the Trust has pioneered the use of short-stay emergency wards for patients in crisis. It’s effectively run like A&E but for those with mental illness.”
    • Psychosis (Episode 3/4) – 9pm Thursday 14th November – “In this episode we explore the world of the mentally ill who live in the community.”
    • Breakdown (Episode 4/4) – 9pm Thursday 21st November – “In the final episode of Bedlam, cameras gain access to a psychiatric ward for over 65s at the South London and Maudsley (SLaM).”

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South London & Maudsley NHS Trust:

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People involved:

  • Dan Charlton – Head off communications & media at SLaM (twitter @Dan_Charlton1)
  • Dr Tom Werner (twitter @TellDrTom) – psychiatrist & CBT therapist – website

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Help yourself! What are your favourite free online mental health resources?

9 Oct
My photo of Souzou: Outsider Art from Japan at Wellcome Collection

My photo of Souzou: Outsider Art from Japan at Wellcome Collection

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More links have been added below (scroll down) – please keep them coming!

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In the resources section of my website, I have a little page tucked away entitled self help. It’s where I’ve posted links to useful online resources to help you manage your mental health. It’s a random collection of what I happen to have stumbled across, mostly on twitter. I have to admit that I haven’t tried any of them personally – but they come highly recommended.

I’d like the page to be as helpful as possible – and I also know there will be things out there that I’d find useful myself, if only I knew about them! – so I’m inviting suggestions of free online resources that you have used and found helpful – or, alternatively, ones that you’d recommend people steer clear of! I’d like to mine the hive mind and see what we can come up with to help ourselves – so we can side-step those pesky waiting lists for treatment or do our best whilst waiting for treatment.

So far, my self help page includes links to three areas:

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Free online cognitive behaviour therapy (CBT)

What is CBT? As Living Life to the Full describes it, “CBT is a structured form of psychotherapy that aims to alter the unhelpful thinking (cognitions) & behaviour that commonly occur during times of distress.” The 4 resources I’ve come across so far are:

  • e-couch – An online programme for preventing and coping with depression, generalised anxiety disorder and social anxiety
  • Living Life to the Full (twitter @llttfnews) – This was recommended to me during a ward round. It’s a free life skills resource teaching practical skills using CBT. The strapline is, “Be happier, sleep better, do more, feel more confident” – which sounds pretty good to me!
  • MoodGYM – An Australian National University training programme that teaches CBT skills for preventing and coping with depression.
  • Moodjuice – A site developed by Choose Life Falkirk and the Adult Clinical Psychology Service, NHS Forth Valley. The site is designed to offer information, advice to those experiencing troublesome thoughts, feelings and actions.

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Free online mindfulness

What is mindfulness? It’s a method of mental training, a simple form of meditation that can be quite quick to do – and can be done any time, any place, anywhere. The resources below include guided mindfulness exercises you can listen to online or download for later.

  • Frantic WorldFree meditations from mindfulness, taken from the book ‘Mindfulness: Finding Peace in a Frantic World’. The book contains the complete 8 week mindfulness course developed at Oxford University.
  • Free Mindfulness – A collection of free-to-download mindfulness meditation exercises.“
  • MindfulFree online audio and video mindfulness instruction, online courses in mindfulness and other resources
  • UCLA Mindful Awareness Research CentreFree guided meditations

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Free online bipolar disorder resources:

  • Beating Bipolar“Beating Bipolar is an interactive internet based programme that aims to improve understanding of the condition. It includes video of professionals and people with lived experience of bipolar disorder and discuses various approaches that many have found to be beneficial.”

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Have you used a free online resource that’s helped (or hindered!) you to manage your mental health? If so, I’d really appreciate it if you could share that with me – so I can share that with the lovely twitter people and readers of this blog. I know you’ll have some great ones, so I’m really looking forward to being able to add them to this blog … and thank you in advance!

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UPDATE: Here are some of the fab links I’ve been sent already (they’ll be added to the self help page shortly):

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But we’re not all like that …

16 Aug

Blue Toyota toy car

“But we’re not all like that!” We’ve all said it, haven’t we? Read or heard something that seems to criticise a group we belong to or feel part of and said, “But we’re not all like that!” I know I have. It’s instinctive. Especially so for those working in social care or the NHS, perhaps even more so for those working in mental health which seems to get criticism from every angle. There are many committed, hard-working, professional, compassionate staff who do the best they can in difficult circumstances, make a  positive difference to people’s lives and do a really good job.

So when a dedicated  GP or mental health occupational therapist hears a story on the news about terrible care in a service elsewhere, he might say, “But not all of us are like that!” A compassionate doctor or psychiatric nurse will read a story about a patient abused in another hospital and say, “We don’t all do that!” A social worker will see a story on a soap about a child being taken from its mother and say, “Not all social workers!” A psychiatrist or mental health healthcare assistant will read a patient describing their experience of poor care and tweet back, “But we’re not all like that!” It’s true: we’re not. But … And there is a but.

What happens when someone – such as a patient who’s had a brutal experience of mental health care or been badly let down by the NHS when she needed help – describes their experience and gets the response, “But we’re not all like that!”? What happens? The conversation stops being about the person who’s describing their own difficult experience and becomes … all about the person who’s interrupted. It becomes all about the interrupter talking about me,  me, me.

Now that’s understandable … to an extent. We all have our own experiences and perspectives. We all have our own hot buttons or soft spots. Many working in the mental health field have, I’ve come to learn through twitter, their own personal experience of mental health problems – whether directly or through family members. It really isn’t them and us.

It’s always easiest to see our own perspective. But … there is a time and a place for raising it. When someone is describing their own experience of pain, abuse or neglect it may, I’d suggest, not be the time to butt in defensively and talk about yourself. Sometimes, a sense of perspective is needed. This is well illustrated, it seems to me, with this simple anecdote:

Me: Someone driving a blue Toyota just hit and killed my four year old child.

You: I drive a blue Toyota. Not everyone who drives a blue Toyota hits four year old children.

What does this do? I was talking about having been recently bereaved: you turn the conversation around to … you being a good driver. No doubt that’s true or, if not, you sincerely believe it to be the case, are a conscientious driver and are genuinely offended at any suggestion you might not be. Perhaps there have even recently been stories in the press about bad drivers. But … was I criticising drivers of blue Toyotas? No. Was I criticising drivers? No. Was I criticising you? No. I was talking about the painful personal experience of bereavement.

Or, as mental health researcher Dr Sarah Knowles tweeted:

“I broke my leg :(” “Okay, but not all legs are broken. Why do you generalise? For example my leg is intact.” “I … what?!”

Put like that, it should, I hope, be obvious why the response, “But we’re not like that!” is inappropriate. And how responding or butting in with, “But we’re not all like that!” derails the conversation and belittles the experience of the person describing it.

It’s not about you.

Why do I raise this now? Because the “But we’re not all like that!” argument was raised earlier this evening in a twitter conversation. The conversation did – as these sorts of things so often do on twitter – broaden out to include many other tweeps and move on to other debating gambits, such as victim blaming, “if you can’t stand the heat, stay out of the kitchen” and the “them and us” culture. Read on for some fascinating insights and well-made points.

As Charlotte Walker (twitter @BipolarBlogger) tweeted:

“If someone has a terrible experience, I am going to honour that experience. There is no point in saying to someone who’s waited 18 months for CBT, ‘Oh don’t be harsh, in other Trusts it’s better.’ No use at all.”

And as NHS doctor Elin Roddy (twitter: @elinlowri) tweeted:

“I always remember you saying – just because you don’t work in a bad service doesn’t mean they don’t exist … It stuck with me and stops me getting too defensive (I hope) when people criticise health care.”

Next time you’re tempted to butt in and say, “But we’re not all like that!”, take a breath, pause and think … Maybe it’s not the right time to interrupt and hijack the conversation. Maybe  it’s time, instead, to listen.  Maybe it’s not about you. And, next time someone tries to stop you in your tracks with a “But we’re not all like that!”, maybe send them a link to this blog!

Not all drivers

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Pill shaming, Giles Fraser and happy pills

10 Aug
Photo courtesy of medicalhumour.wordpress.com

Photo courtesy of medicalhumour.wordpress.com

What’s hot and what’s not in media land? Fashions ebb and flow. Mental health stories come in and out of the spotlight. Recently, the  supposed psychiatrist vs psychologist war has been stoked. This past week, we’ve had various pundits rehashing the old, old story that mental illness doesn’t really exist. Today, it was the turn of Giles Fraser to spin this line, having made the same case on BBC Radio 4’s debate show the Moral Maze.

Fr Giles has had what I hope will turn out to be an education by twitter’s expert’s by experience and experts by profession. I’ve been commenting on twitter today. Various writers have put it far better than I could, so I’ll let their words speak for me by picking what I consider to be three of the best rebuttals:

Many others have written excellent pieces and all the relevant links I’ve come across are also linked below. Enjoy.

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Mainstream media (pill shaming):

  • Psychiatrists: the drug pushers

    Guardian newspaperWill Self  – “Is the current epidemic of depression and hyperactivity the result of disease-mongering by the psychiatric profession and big pharma? Does psychiatry have any credibility left at all?” (3rd August)

  • The Moral Maze – The Pursuit of Happiness

    BBC Radio 4 – “As a nation we have a reputation for being phlegmatic, stiff upper-lipped types. The reality, it seems, could hardly be further from that caricature. When it comes to anxiety and depression, we’re a nation of pill poppers.” Debate chaired by Michael Buerk with Claire Fox, Anne McElvoy, Kenan Malik and Giles Fraser, and witnesses David Pearce (World Transhumanist Association / Humanity Plus), Alison Murdoch (Foundation for Developing Compassion and Wisdom) Oliver James (clinical psychologist and author) and Mark Williamson (Action for Happiness) (7th August)

  • Taking pills for unhappiness reinforces the idea that being sad is not human

    Guardian newspaper – Giles Fraser “If you have a terrible job or home life, being unhappy is hardly inappropriate. Pathologising it can only make everything worse.” (9th August) (twitter: @giles_fraser)

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Rebuttals – mainstream media:

  1. Letters – Psychiatry, drugs and the future of mental healthcare

    Guardian newspaper (rebuttals to the Will Self piece) (7th August)

  2. Depression is not the same as “being sad”, Giles Fraser

    New StatesmanGlosswitch (twitter: @glosswitch) – “Casual “let’s not pathologise sadness” musings don’t contribute much to the debate about medication for depression. I’m writing this post to dispel a few myths about depression and the use of medication. I should mention, however, that I’m none of the following: psychiatrist, psychologist, pharmacist, biologist, philosopher, renowned expert in happiness and the inner workings of every human soul. That said, neither is Giles Fraser, the Guardian’s Loose Canon, but he hasn’t let that stop him.” (10th August)

  3. Depression is more than simple unhappiness

    Guardian newspaper – Margaret McCartney (twitter: @mgtmccartney) – “Antidepressants may be overprescribed, but as a GP I know the solution is not to minimise the experience of this condition.” (12th August)

  4. We don’t know if antidepressants work, so stop bashing them 

    Guardian newspaper, SciencePete Etchells (twitter: @petetchells) – “It’s a difficult debate, because it is so often emotionally charged on both sides. The best thing that we can do is to look at the data for answers.” (15th August) – An examination of scientific studies into anti-depressant use, including the 2 main ones that say they do and do not work.

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Rebuttals – blogosphere:

  1. My tweets (Storify)
  2. Doctor, Doctor… Pt 2

    Tania Browne blog (twitter: @CherryMakes) –“I read an article today that shows the stigma of mental health that hinders people seeking help isn’t going to go away any time soon. Speaking in The Guardian’s Comment section, Giles Fraser suggested that we may be too happy just to pop to the doc and get some jolly old pills to cheer us up when sadness is a very normal side of the human condition.” (10th August)

  3. For Giles Fraser, ignorance truly is bliss

    The Dirty Ho blog (twitter: @the_dirty_ho) – “In his recent article Giles Fraser allows a valid underlying point to be undermined by his profound lack of understanding of depression.”) (10th August)

  4. In the interests of clarity, Giles Fraser should exercise the right to reply

    The Dirty Ho blog (twitter: @the_dirty_ho) (11th August)

  5. Response to Giles Fraser’s Latest Article on Depression

    Elliot Hollingsworth blog (twitter: @ElliotHollings) – “I have a lot of time for Giles Fraser. However his latest article in the Guardian’s Comment is Free seems fairly lax on the facts and also on the difference between normal sadness and the mental illness, depression.” (10th August)

  6. Giles Fraser and mental health: When the Church fails at being a church, when the spiritual let down spirituality

    by Heathen Hub blog (twitter: @gurdur) (10th August)

  7. Common Misconceptions About Depression

    A Hot Bath Won’t Cure It blog (twitter: @chloemiriam) -– BINGO! – “In rebuttal to Giles Fraser’s poorly argued piece on anti depressants and ADHD medication, which may have hit ‘common misconceptions about depression BINGO!”  I am inspired to reply in a somewhat tired and mixed up manner.” (10th August)

  8. Dear Giles Fraser, Depression and Unhappiness are NOT the Same

    Gibbs Gubbins blog (twitter: @msjenmac) (10th August)

  9. Depression, Anti-Psychiatry and Christianity

    Los the Skald blog (twitter: @lostheskald) – “In his Guardian column today, Fr. Giles Fraser presents an argument which, has, in various guises, been with us since at least the 1960s: that mental illness, and specifically depression, is the ‘pathologisation of sadness’, and that biochemical treatments for depression are an example of ‘the scientists [being] called in to reinforce generally conservative norms of appropriate behaviour’. This post responds to his article by assessing the ‘anti-psychiatry’ tradition within which it falls, discussing some differences between sadness and depression, examining this difference in the Old Testament, and suggesting a Christian response to mental illness based on the stories of healings and exorcisms performed by Jesus in the Gospels.” (10th August)

  10. The Continuum Concept – why your sadness is not my depression

    Mental Health Cop (twitter: @MentalHealthCop) – “I recently read the piece you are about to read – a service user’s reaction to a recent media piece – and was totally blown away …” Reblogged piece, plus introduction (11th August)

  11. My “peculiar reaction” to Giles Fraser’s thoughts on anti-depressants

    Nurture My Baby blog (twitter: @nurturemybaby) (10th August)

  12. The continuum concept: why your sadness is not my depression

    Purple Pursuasion blog (twitter: @bipolar blogger) – “Modern medicine is widely held to be A Good Thing. It is allowing us to live longer, healthier lives than at any other point in human history. The media loves the story of a scientific breakthrough and the promise of yet more astounding treatments in years to come, whether through improved surgical techniques, gene therapy or new, more effective drug treatments.Unless, that is, we’re talking about the modern medicine of psychiatry. Suddenly, the ground shifts and medication is viewed with suspicion, even disgust. Antidepressants become “happy pills”; using drugs as directed by a doctor is described as being “hooked” or “addicted.” (10th August)

  13. Depression is not Being a Bit Sad

    A Reflex Anglican blog by Eileen Fitzroy Russell (9th August)

  14. Sadness and Depression – NOT the same thing

    Ruby Wax‘s website (12th August)

  15. Plaster of paris on a broken leg reinforces the idea that having a broken limb is not human

    Ruth Stirton blog (twitter: @RuthStirton) – “Giles Fraser misses the point. His entire comment is premised on the idea that being sad, and having clinical depression are on the same spectrum. Of course clinical depression can be solved with diet and exercise, because we all know that those things make us feel better if we’re having a sad day. No. Wrong. Clinical depression is a different thing entirely.” (10th August)

  16. Forgive him father, for he knows not what he does

    The Dirty Ho blog (twitter: @thedirtyho) (14th August)

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Older pieces – mainstream media:

  • Britain – the Prozac Nation? Not So Fast

    Discover Magazine – by Neuroskeptic (twitter: @neuro_skeptic) – “The media coverage has been predictable with lots of scary, context-free statistics, and boilerplate quotes from the usual suspects. No doubt tomorrow we’ll see a selection of moralistic op-eds about this. But not one of the many nigh-identical articles provided a link to the original data, or even a useful description of where one might find it. After contacting one of the NHS organizations named as the source, I managed to track the numbers down.” (December 2011)

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Older pieces – blogosphere:

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Additional:

  • Depression

    Royal College of Psychiatrists

  • Resources for churches

    Time to Change – “We aim to encourage organisations from all sectors and communities to challenge stigma and discrimination. One example of this is work that the Church of England have done to get church congregations talking about mental health. The Revd Eva McIntyre has produced a web resource providing ideas and resources for churches to plan worship on the theme of mental health.”

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Using mental illness as an insult – Mick Philpott, Jon Snow & lunatics

4 Apr

Jon Snow twitter profile pic

We’ve all done it: casually thrown around as insults terms related to mental illness. This evening, Jon Snow, Channel 4’s lead news anchor, posted a blog in which he used the term “lunatic” as an insult in the tragic Philpott case. When picked up on it, Snow swiftly apologised and earned brownie points for doing so. At present, however, Snow’s blog post still contains the term.

The problem with calling someone convicted of manslaughter a lunatic is that lunacy is a synonym for insanity, a legal defence to murder; its use in relation to the Philpott case is sloppy and inaccurate. And the trouble with casually using terms related to mental illness to insult people is that it turns mental illness into an insult.

As background, Snow’s blog post was in reference to distasteful and misleading political posturing reported during the day. Various pundits and politicians (in particular the Chancellor, George Osborne, later endorsed by the Prime Minster, David Campbell) sought to capitalise on the sentencing of the Philpotts and their friend for the manslaughter of 6 children. (Take a look at the links at the foot of this page to explore the subject further.) To take one example of the coverage, the Telegraph newspaper said:

“The Chancellor has questioned why British taxpayers should be “subsidising lifestyles” such as those of Mick Philpott, who was today sentenced to life in prison for killing six children. Mr Osborne made the controversial comments during a visit to Derby shortly after Philpott and his wife Mairead were handed their sentences for intentionally setting fire to their home. Asked whether the Philpotts were a product of Britain’s benefit system, Mr Osborne said: “It’s right we ask questions as a Government, a society and as taxpayers, why we are subsidising lifestyles like these.”

Jon Snow has, in addition to his platform on a national broadcaster, nearly 300,000 twitter followers. He also introduced Channel 4’s 4 Goes Mad mental health season. He’s influential. Earlier this evening, I saw a tweet of his containing a link to a post on his Snow Blog about the tragic Philpott case. Snow’s post was titled: Can abnormal behaviour affect the welfare policy debate?

Snow, in a strongly worded rebuttal, asked whether there really was a case for regarding Mick Philpott’s behaviour as a valid ground for reforming welfare policy. He referenced, amongst others, statistics showing there were just 50 families in the UK with the same number of children as the Philpotts.

Philpott is not representative of people who are currently in need of the state safety net due to ill health, lack of private pension or inability to find paid work. And of course it is highly distasteful to use the tragedy of the deaths of 6 children for political purposes. Snow’s blog was robust and well-written, apart from this, which caught my eye:

“The idea that an entire system should be re-jigged to cope with a lunatic who burnt to death half the children he’d fathered seems questionable at the least.”

Here, Snow uses the word “lunatic” as an insult, in order very deliberately to convey the deepest disapproval. The trouble with using terms related to mental illness as insults – especially when it’s done by a figure as prominent as Snow – is that it’s just this sort of casual stigma that adds to the big fat stigma pie we’re being served extra helpings of at the moment.

As I then tweeted:

Disappointed @jonsnowC4 refers to Philpott as a “lunatic” when he was judged criminally responsible #casualstigma

Snow swiftly responded:

I apologise..that was sloppy of me.

And, in a response to another tweep, Snow tweeted:

I’m sorry the word ‘lunatic’ was very absuive [sic] usage..thoughtless..I should know better

I tweeted in response:

Credit to @jonsnowC4 for apologising so quickly for calling Philpott a lunatic. (Wish I was so good at apologising when I stuff up.)

Snow received plaudits for his quick apology, as my Storify of tweets shows. His fans hold him in even more affection now. For example, Rich Humphrey (@RichMHumphrey) tweeted:

“completely agree! Few in the media would hold their hands up like that. Even more respect for him now”

Finally, I also asked Snow:

Could you tweak the blog to remove the reference to lunatic? That’d be good.

At present, the blog has yet to be revised. Fingers crossed. There are so many expressive insults in the English language that there’s really no need to resort to using references to mental health as insults.

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web links 5Links related to the story above

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Links on the debate about what (if anything) the Philpott case tells us about welfare benefits, in light of the notorious Daily Mail headline (pictured below right) and George Osborne’s subsequent comments:

Firstly, coverage on 4th April:

Coverage from later dates (added to this blog subsequently):

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When I came out of hospital, I thought I’d be focussing on getting better …

23 Mar

Way out sign

Here are some tweets about the bumpy road I’ve been on since being discharged from hospital. I thought I’d be focussing on getting better.I thought I’d be resting my mind and doing things to nurture myself mentally and physically. Instead, I’ve had to focus on lots of other things.

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How much difference can Time to Change make to how print journalists report mental illness?

19 Mar

Newspapers rolled up

On Monday 18th March, Time to Change held the latest in its series of media education events. This one focussed on print journalists, both tabloid and broadsheet. How much difference can this make to the quality of press reporting where there is a mental health aspect? Take a look at the links below – including the live blog and tweets under the hashtag #TTCmeet media – to see what you think.

At the start of the evening, a film was shown with some valuable advice about reporting mental illness. It’s well worth watching the short (7 mins) film for more fascinating insights put in a straighforward manner. These included the following advice on reporting breaking news stories:

  1. Stick to the facts and don’t speculate that mental health is a factor unless you know it to be 100% true
  2. Interview someone with a mental health problem, to give your audience a realistic view of what it’s like to live with one
  3. Put as much of the subject’s voice in the piece as possible. Use quotes. Let them them tell the story.
  4. Include contextualising facts, since homicides by people with mental health problems are incredibly rare
  5. Seek comment and context by a mental health charity like Mind or Rethink Mental Illness, or a professional body like the Royal College of Psychiatrists
  6. Avoid stereotypes, clichés & sensationalism
  7. Mind your language: misusing mental health diagnoses in the media can be offensive, and can cause misunderstanding
Good advice which, if followed by print journalists, would make stories with a mental health aspect far more relateable to their readers – a quarter of whom, after all, experience mental health problems in any one year – as well as less sensationalist and alarmist. However, as Ian Mayes, Guardian associate editor and former readers’ editor, said in 2008:
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“We stand in relation to some aspects of mental health – particularly in the way we refer to mental illness, in the language that we use and misuse – roughly where we stood in relation to race 20 or 30 years ago. The least we can do is to accept that language used about mental illness is important and reflect this in the practice of our trade.”
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The current state of reporting means there are opportunities available for journalists. What do I mean?
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  • The fact there are so many misconceptions around mental illness means there’s an abundance of great stories waiting to be told.
  • There’s a revolution happening in mental health, which gives the best journalists the chance to make their names in an evolving subject.
The best journalists will break out of the old cliches and start reporting mental health in the new way. Hopefully some of the journalists present at the Time to Change event will be inspired to take on board at least some of the messages receive during the evening and put them into practice in their writing. Of course, the worst journalists will continue reporting mental illness in the same tired old way, using the three bog-standard storylines, namely:
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  1. When a heinous crime is committed, journalists speculate that the perpetrator must have a mental illness. This is sloppy journalism of course, based around an incorrect assumption that “normal” people can’t do terrible things. The opposite is born out by the facts.
  2. When a crime is committed by someone who in the past had a mental health diagnosis or contact with mental health services or treatment for a mental health problem, whether recent or in the far distant past, it’s assumed that mental illness caused that crime. Again, sloppy journalism which confuses correlation and cause.
  3. When a crime is committed by someone who’s been diagnosed or treated for mental illness, this is extrapolated to portray all people with mental illness as potentially dangerous. Again, sloppy journalism which is not born out by the facts.

If you’re not familiar with Time to Change or their event that night, here’s some information, followed by all the relevant links. As the Time to Change  website says:

“Time to Change is an anti-stigma campaign run by the leading mental health charities Mind and Rethink Mental Illness. These two charities decided to work together, combining their knowledge, skills and expertise, in the biggest attempt yet in England to end the discrimination that surrounds mental health.”

When I first started reading around mental health, I didn’t understand what the word “stigma” meant. And it gets repeated a lot. So I came up with the phrase “negative assumptions” instead, which is pretty straightforward. And discrimination is acting on those negative assumptions.

The Time to Change event aimed to provide:

“a space for journalists to learn more about mental health problems by meeting people with direct experience and hearing their stories, along with some top speakers from the industry.”

It was hosted by Time to Change ambassador Alistair Campbell (writer, communicator and formerly Tony Blair’s press secretary) with celebrity panelists including Denise Welch (presenter of ITV’s Loose Women and former Coronation Street actor), Fiona Phillips (TV presenter and Daily Mirror columnist) and Guardian journalist Mary O’Hara. Media volunteers included Helen Hutchings from Tea and Talking and mental health campaigners Jonathan Benjamin and Erica Camus.

It also aimed to enable journalists to:

  • challenge myths and misconceptions around mental health
  • find out the truth behind the headlines that link mental health with violence
  • join in the debate by asking the panel of experts a question
  • be inspired by the stories of people with experience of mental health problems
  • network with other industry professionals over a glass of wine (the main hook for some attendees no doubt!)

Real stories about mental illness are so much more fascinating than the standard speculation & hyperbole. Hopefully we’ll start to see a gradual improvement in the quality of reporting in Britain’s tabloids and broadsheets when the subject of mental illness comes up.

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Mental health nurse & patient tweet chat: what do newbies need to know?

11 Feb

Psychiatric Nurse - Garrison - Book cover

Update small..

The tweet chat took place on Thursday 20th February 2014 with We Nurses – catch up with the discussion by taking a look at the full transcript!

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I’m planning my first one hour tweet chat in a couple of weeks (date to be announced). (Check out my quick guide to tweet chats for more on what they are – this and other helpful links are below). Here’s what I have in mind, for an inpatient mental health nursing tweet chat:

  • Patients: Are you a patient who’s experienced inpatient mental health nursing? What would you like the newbies to know – the student nurses about to start a placement or the newly qualified mental health nurse. What things that nurses did – good or bad – made a difference to your experience on ward?
  • Students: Are you about to qualify as a mental health nurse? Are you a student nurse about to start your mental health placement?  What is the balance between fear and excitement? What would you like to know? What practical concerns do you have? What do you want help with to make your first days on ward a success?
  • Nurses: Are you a qualified mental health nurse? Are you a student nurse who has completed your mental health placement? What tips would you like to pass on to newbies about to qualify or about to undertake a placement? What are those little insider tips that really helped? What would you have liked to know when you were a newbie?

I’d like to be able to share some really useful tips to help new mental health nurses and nursing students make their best start on ward, because that benefits both staff and patients. Here are some example questions I’ve thought up that students might want to know the answer to:

“How can I prepare for my placement so I get the most from it?”

How can I put the knowledge I’ve learned at university into practice on the ward?”

“How can I settle in as quickly as possible so I fit in with my nursing team and ward life?”

“How can I switch off after a shift?”

“What should I do if I see another nurse doing treating a patient unkindly?”

Here are some examples of useful tips to pass on:

The Bic 4-colour pens are really useful for filling in your paperwork.”

“Remember to always respect the patient as an individual and see past the diagnosis.”

“Don’t make assumptions or have preconceived ideas based on what you’ve been told before. Remain open-minded and make your own judgments based on your own personal experiences.”

As I’m not a nurse and haven’t run a tweet chat before, I’ve invited @MHnursechat – associated with the awesome We Nurses website and tweet chats – to run a joint tweet chat with me. We’re going to be discussing how this will work and, hopefully, setting a date. Very exciting!

In preparation for the tweet chat, I’m asking you to please share your tips and questions. That will help set the agenda to be followed and the areas we’ll focus on in the tweet chat – so it covers the most burning questions and drills down to the most useful tips. It may be that there will be more than one tweet chat on this topic – perhaps one covering what nurses need to know in their first few days, and another for when they’ve been there a few weeks. We’ll see. A tweet chat needs to have enough of a focus to engage people without overwhelming them, but at the same time enough breadth so it doesn’t peter out prematurely! If there are other topics you think would be good for tweet chats then please let me know!

You can comment below or tweet me (please don’t try to pack more than one query or tip into each tweet ) @Sectioned_ (please remember the underscore). It’s helpful if you could say whether you’re offering your comment from your experience as a patient, nurse or student. Look forward to hearing from you!

Why a tweet chat? I’m often interested in discovering what other tweeps think about topics and then sharing those insights. So, quite a few times, I’ve tweeted questions then collated the responses into a Storify story which I’ve sometimes turned into a blog. (I was rather excited to learn that this is called “crowd sourcing” and “curating the chat”.) This time I thought I’d try making it a bit more organised & involve more people: I’m beginning to learn just how valuable Twitter is as a way to bring together groups of people to share views openly in a way they might not otherwise do. (I’m told this is called “disruption” – disrupting the natural order of things and mixing it up, like mental health peeps and staff learning together.) (Thanks to Victoria Betton for all the cool jargon!)

Why this topic? After all, I’m not a nurse. As a child, however, I remember being taken to one of the big long-stay psychiatric hospitals of the sort portrayed in the film One Flew Over the Cuckoo’s Nest. I remember the high ceilings, big windows and long corridors. Happily I wasn’t being booked in myself. I was visiting family friends who worked there as psychiatric nurses. Members of my family also worked on psychiatric wards and in nursing.  When I was sectioned a couple of years ago, my inpatient experience fell far short of the care I would hope all psychiatric nurses aim to deliver. You could say that everything that could go wrong did go wrong. But, as I’ve been around nurses my whole life, I know that the image and practice of mental health nursing has come a very long way since the fearsomely controlling figure portrayed by Nurse Ratched. For me, nurses are (or should be) an essential part of the team that helps get me well. So I’m all for sharing tips and best practice to help nurses be their best. I’m hoping this tweet chat will be one small way to do that.

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web links 5

  • Guide to tweet chats – all you need to know to join in your first tweet chat or get more from them
  • Mental health jargon buster and acronym buster – please send yours in! We’ll try to avoid jargon during the tweet chat itself, but if the jargon’s in the jargon buster, I can just tweet a copy of that by way of explanation

For the nurses and student nurses amongst you, here’s some nurse-focussed content:

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