2020 Skellern Lecture Short List Synopses (in alphabetical order)
The Fall of Icarus: the Trials and Tribulations of the ‘Informal Patient’ in the 21st Century. Dr. Russell Ashmore - Senior Lecturer, Sheffield Hallam University.
The recent Independent Review of the Mental Health Act (DH, 2018) has suggested that there has been a “…steady decline of informality in mental health settings despite the provisions of section 131, which explicitly protects the status of informal patients” (DH, 2018). Whilst the review recognised there has been little commentary on this, it seems to dismiss its significance with a figurative shrugging of the shoulders with the statement, “…it is inescapable now that we live in a society where trust in professionalism is a steadily decreasing commodity, and we prefer regulation and the law as safeguards and protections” (DH, 2018). However, this “decline” may have been overstated. Recent statistics from England and Wales suggest that individuals admitted to hospital informally, remain informal for the duration of their stay or become informal prior to discharge, represent a significant group (approximately 48 per cent). A further concern is whether the laws, safeguards and protections referred to in the review actually mean that the legal rights of informal patients are “no more than a legal fiction” (Houlihan, 2000). This lecture will draw on ongoing research to argue that (at least) some mental health trusts and health boards in England and Wales are producing policies stating that informal patients should be “managed as if detained”, thus creating a de facto two-tier system of detention. Others state that practitioners should consider anyone who does not meet the criteria for detention for discharge if they do not comply with treatment. In relation to leave, organisations appear to be operating de facto section 17 leave policies for informal patients enforced through ‘leave prescriptions’ or ‘contracts of leave’. A final concern is that less than half of mental health healthcare providers in England and Wales give informal patients written information about their legal rights on admission. In this lecture, using a socio-legal historical approach, I will explore the history, current position and potential future of informal inpatient care. Drawing on historical documents, national and internal legislation, statistics pertaining to the use of the Mental Health Act, personal narratives, research and the human rights agenda to offer a personal and hopefully coherent argument that informal inpatient care is as important now as it was when first introduced in 1959. In addition, that it must be preserved at all cost to prevent a return to the worst excesses of admission to hospital under the 1890 Lunacy Act. Finally, I will draw on over 25 years of experience in nurse education to offer a view on how we equip mental health nurses of the future to take lessons learnt from history back into practice.
The Case for Welcoming Service Users/Survivors as Academic Partners in Mental Health Nursing Curriculum and Research: Speaking from 10 years of Experience. Bridget Hamilton - Associate Professor, Director: Centre for Psychiatric Nursing, University of Melbourne.
Service user academics are shaping mental health nursing education and programs of research. Across healthcare broadly, the perspectives of patients and service users are informing evaluation and design. In the field of mental health, the contribution of service users is more critical and potentially more potent, since many patients experience treatment without their consent. In my university, we have been learning to welcome a full range of service user expertise. This lecture is built around the review of a decade of partnerships between academics from consumer/service user/survivor, nursing, and other disciplines. As we reflect on many examples of co-designed curriculum, research projects and co-authored publications, we see the depth of service user influence, across the research questions posed and answered, the language nurses use, the focus of everyday work. Service user insights are recasting bread-and-butter issues of: therapeutic relationships, assessment, safety, and supporting recovery. A program of health services research is targeting consumer priorities, including recognising and redressing breaches of human rights. Inherent difference in nursing and service user understandings presents challenges and opportunities for teamwork. We reflect on ingredients that are sustaining solid partnerships to this day. Allies in government and the university commit to academic capacity-building among service users who bring reforming passion to this field. Casual teaching, special grants and scholarships are buttressed by the continuing appointment of a Senior Consumer Academic. Sustaining co-productive teams depends as much on our capacity to listen, sit with discomfit and cede power. Early work shows how partnering has stretched nurses and other clinicians; what was considered good collaborative process in a previous decade is now questioned and our capability must continually grow. Despite challenges, we can see how these partnerships are setting an exciting agenda for mental health nursing future that is more widely valued by the people we serve.
Good Enough Care, What Does That Mean? My Journey in Acute Mental Health Inpatient Care. Ellie Walsh – Assistant Director Acute Mental Health Services, NAViGO CIC.
Good enough care, what does that mean? The last 20 years has seen inpatient services evolve dramatically with many internal and external influencing factors. Often we only hear about poor care (the Care Quality Commission placing a trust in special measures or a scandal in the press). Positive life changing work by acute inpatient services are seldom reported. How have services evolved over the years and what has happened to bring about that change? Qualifying as a mental health nurse in September 2000, due to the hostile environment with no drive to support people to recovery and discharge, I decided not to work in acute inpatients. Significant changes in the locality allowed me to develop my career and bring about changes. These brought me back into the acute setting with an expectation at that time that people would receive “good enough care”. But what is good enough care and is it good enough. I believe that services that we deliver in NAViGO go beyond what people perceive as good enough care and deliver outstanding care. My talk will focus on how we measure good enough care, what does it actually look and feel like for people using mental health services and how do we ensure it’s delivered? This lecture will present the following: i) share my journey through adult acute inpatient services; ii) explore what is good enough care - what makes it good? iii) what are the barriers to good enough care? iv) what drives standards forward? v) what does NAViGO do that is different and how do we deliver outstanding care and services we would be happy for our families to use?
JPMHN LIFETIME ACHIEVEMENT AWARD SHORT LIST (in alphabetical order):
Professor Sean Duggan - Chief Executive, Mental Health Network. Sean Duggan has been Chief Executive of the NHS Confederation’s Mental Health Network for the past three years. Sean is passionate about raising standards of care and treatment of mental health services and improving lives of those who use services and their carers. His focus is on influencing politicians, policy makers and heads of public sector organisations and other key stakeholders to deliver evidence-based intervention with a sound economic basis. Training as a registered mental health nurse in 1979 set the scene for a career motivated by passion for the profession and for the professionals within it. Sean ensures that mental health nursing is promoted at all opportunities, with the Mental Health Network and Nurse Directors Network’s Aspiring Nurse Director Programme being his most recent project. To ensure the continued improvement of mental health services, Sean has influenced health policy on a national level; through his membership of the Five Year Forward View oversight group, chairing of the Mental Health Act Review’s Addressing Rising Detention Rates Topic Group and NHS Long Term Plan Steering Group. Whilst at the Sainsbury’s Centre for Mental Health, Sean led on several health economic studies, many of which were eventually included in the NHS Long Term Plan and widely accepted by the Treasury. Criminal justice and prison mental health have been priorities for Sean over the past 30 years; in 2006 he joined the Sainsbury’s Centre for Mental Health as director of Criminal Justice Programme, before becoming Chief Executive. Immediately before this, Sean was Director of Health and Social Care for Criminal Justice at the London Development Centre and offender health consultant for the Department of Health. Sean is a Professorial Fellow at the Institute of Mental Health and in 2013 was awarded the President’s Medal by the Royal College of Psychiatrists.
Professor Karina Lovell - Professor of Mental Health and Director of Research for the School of Health Sciences at the University of Manchester. Professor Lovell is a mental health nurse, CBT therapist and Health Services Research whose work has addressed common mental health problems such as depression and anxiety and the extent to which low intensity psychological interventions (CBT based guided self-help) can be employed effectively. Her work with telephone delivered intervention has shown that remotely delivered therapy is effective and established the clinical, cost effectiveness and acceptability of telephone-delivered cognitive behaviour therapy (T-CBT) in young people and adults with OCD, anxiety and depression and chronic widespread pain. Importantly she demonstrated that T-CBT is as effective as face-to-face CBT. The cumulative success of this work was submitted as an impact case study for the 2014 REF. This case study was selected as one of 17 showcased at the All Party Parliamentary Group for Medical Research. Her work is cited in NICE guidelines for post-traumatic stress disorder, depression, OCD and generalised anxiety disorder. Karina is committed to service user and carer involvement and has developed and implemented research methods courses for service users and carers, published in the NICE shared learning database. She was awarded the 2014 Mental Health Research Network (MHRN) prize for outstanding carer involvement, the 2015 CRN award for public engagement, the NIHR Let’s Get Digital video in 2017 and the 2018 McPin/NIHR Service User and Care Involvement Research Award. She is an Expert Adviser for the NICE Centre for Guidelines, a member of the DH/NIHR Translational Research Working Group for the ‘Framework for mental health research over the next decade’ (DH 2016), a member of the Forward Thinking - NIHR research on support for people with severe mental illness (DH 2018), and has been a NICE guideline member for OCD and Generalised Anxiety Disorder. Karina has published in excess of 200 academic papers and secured external grant income from funders, including the NIHR, MRC, and ARUK of more than £4.5m as Chief Investigator and £40m as co- investigator. In recognition of her work she was awarded NIHR Senior Investigator in 2012, one of only a few nurses to hold this award, which was renewed in 2016 for a further 5 year term.
Professor Eimear Muir-Cochrane - Chair of Nursing (Mental Health) at Flinders Uni University in Adelaide, South Australia and a Visiting Professor at City, London University, UK. Eimear was elected as President to the Australian College of Mental Health Nursing in 2017 for a three year term. She undertook a BSc Hons in Nursing at the then Chelsea College, University of London, commencing in 1979 and had the privilege of being taught by luminaries such as Professor Jenny-Wilson-Barnett. Her Honours thesis was supervised by the late Dr Julia Brooking and was published in the first text in the UK on psychiatric nursing research, edited by Dr Brooking in 1986. Eimear worked at St Georges Hospital, London as a Staff Nurse in medicine and then undertook her mental health nurse training at the Maudsley and Bethlem Hospitals in London in the early 1980’s. Eimear was a student on the interview panel of Ben Thomas at the Maudsley when he was interviewed for a Nurse Educator position! Eimear worked at the Bethlem post her training until 1987 and then travelled in Asia and Australia where she settled, married and had a daughter, Caitlin who is now an intensive care nurse. Eimear is a career academic teaching and researching in mental health nursing for the last three decades. Eimear’s first publication was in the Nursing Mirror in 1984 on the nurse as a change agent and has since published multiple books, chapters, monographs and papers in mental health with funded research on seclusion, aggression and violence, physical restraint, youth homelessness, absconding chemical restraint and the use of community treatment orders. Eimear also acts a mentor to nurses and mental health nurses and attempts to improve care practices through applied research in mental health nursing. It is de rigeur in academia to cite metrics to show how significant your research is, how many people reference your wok and to state how much money you have won in research grant funding. However, Eimear’s passion is in making a difference to service users experiences of psychiatric hospitalisation, to reduce the use of restrictive practices used in hospitals and to contribute to the practice and education of mental health and mental health nursing