At the World Congress of Psychiatry, Berlin 2017

Gaia CetranoGaia Cetrano is a Research Associate at the Social Care Workforce Research Unit, King’s College London. (800 words)

From 8 to 11 October I joined the World Psychiatric Association XVII Congress in Berlin. This was my second WPA Congress; I also attended the previous one in Madrid in 2014. Berlin is a great city, which has developed at a tremendous pace in the last few decades. It perfectly represents how things can change, and thus offered the best context for a congress entitled ‘Psychiatry of the 21st Century’.

Remembering the Madrid Congress, I was expecting this to be a big event, but this one exceeded all my expectations. When I arrived at the venue, Messe Berlin, to join the opening ceremony on the first day, I suddenly felt overwhelmed, if not intimidated, by everything around me. The venue was enormous, there were stands, films, exhibitions, music, and hundreds and hundreds of disoriented-looking people around me (around 10,000 in fact). The programme, with its 900 sessions, was impressive but daunting. Continue reading

Who wants to be an Approved Mental Health Professional?

Stephen MartineauAs the Unit embarks on a new piece of Department of Health commissioned research examining the role of the Approved Mental Health Professional (AMHP), Stephen Martineau and colleagues report from the AMHP Leads Network conference, held in London last week (10 July), and map out some of the background to the study. (977 words)

AMHPs carry out a variety of tasks when it comes to the use of compulsion under the Mental Health Act 1983 (MHA). Chief among these is coordinating the assessment under the MHA of individuals whose mental disorder is such that it fulfils the statutory criteria; the application for a formal admission to a hospital must be ‘founded’ on medical recommendation, as the pink form for a detention under the MHA has it, but the AMHP takes the decision.[1]

Form A2 Section 2 appl by AMHP for admiss for assess-page-001

Form A2. Section 2 MHA: application by an approved mental health professional for admission for assessment (photo links to pdf)

Of course, this is only the very barest description of what is involved in the job: last week, someone who had been the subject of a MHA assessment by an AMHP wrote vividly of the experience in Community Care. Elsewhere, the Masked AMHP has asked, and answered, the question: What is an AMHP?

In making a MHA assessment of a person, AMHPs bring to bear a ‘social perspective’. And it is social workers—initially under the MHA, Approved Social Workers (ASWs)—who have been historically associated with the role. But in 2008 ASWs became AMHPs, and with the change in designation came a loosening of the ties to the social work profession: it was now also possible for certain kinds of nurses, occupational therapists and psychologists to take up the role. Continue reading

Mental Health Workers – We need your help for our research

Tasneem ClarkeTasneem Clarke, Research Officer at the Money and Mental Health Policy Institute, based at King’s College London, discusses the Institute’s latest research, which asks: what can mental health practitioners do to support people in financial difficulty? Please take this two minute quiz to register your interest and help her come up with pragmatic solutions to this difficult issue. (736 words)

Money and mental health – a toxic relationship

As practitioners in mental health services know, life can be messy. The people we work with are rarely only facing one issue; from relationship breakdown to past traumas, economic disadvantage or long-term physical and mental health problems – issues interweave and make each other worse. Continue reading

Mental Health Social Care 2016: Research findings informing policy and practice

Dr Joan RapaportJoan Rapaport reports from the annual event co-hosted by the Social Care Workforce Research Unit and Making Research Count. The day started with a presentation from a user-led study. (1,173 words)

‘The Girls Who Kicked the Hornet’s Nest’: Perspectives from a user-led study on service user experiences of mental health related violence and abuse in the context of adult safeguarding: Dr Sarah Carr, Associate Professor of Mental Health Research, Middlesex University and Alison Faulkner, Independent Survivor Researcher, Mental Health.

‘It’s rather like writing a dark thriller’ were Sarah Carr’s opening comments regarding the research into service user experiences into and concepts of targeted violence and hostility, and prevention and protection. This small-scale exploratory study, led and entirely conducted by mental health service users, fills a gap in safeguarding research. It further provides an embedded knowledge exchange approach between service users, practitioners and agencies throughout the research process. Continue reading

Four studies in mental health social care

Dr Joan RapaportOn Thursday 8 October the Social Care Workforce Research Unit held its second annual Mental Health Social Care conference, in conjunction with Making Research Count. Joan Rapaport, Visiting Research Fellow at the Unit, was there. (2,275 words)

In her opening comments, Jo Moriarty, Deputy Director of the Social Care Workforce Research Unit, highlighted that the seminar was taking place as part of Mental Health Awareness week and that 10 October is World Mental Health Day. She observed that as well as mental health social workers, delegates from a wide range of organizations, in particular housing, were represented in the audience. This confirmed that adult mental health was not specific to one area of practice. Continue reading

Piloting the Sababu Intervention in the wake of Ebola

Meredith NewlinMeredith Newlin, Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s, reports from Sierra Leone. Her post incorporates photographs of the Sababu Training Programme in action last month. (1,386 words)

The Ebola outbreak, which reached Sierra Leone in May 2014, quickly became a global health crisis and caused significant psychosocial distress and a disintegration of communities across West Africa. The case numbers are now dropping and Sierra Leoneans talk about the ‘aftermath’ and a shift towards a recovery phase. However, amid a resource-limited system there is still an urgent call to address the psychosocial needs of individuals and families by enhancing the skills and capacity of the existing workforce. Continue reading

The challenges of mental health for social science and policy

Guntars Ermansons, student in the Department of Social Science, Health and Medicine, introduces a report on a workshop held earlier this summer. See the full report of the workshop. (309 words)

On 19 June 2014, a workshop on “The Challenges of Mental Health for Social Science and Policy” was held at King’s College London, Waterloo Campus. Supported by the King’s Interdisciplinary Social Science Doctoral Training Centre’s Science & Society initiative and organized by the Department of Social Science, Health and Medicine, in collaboration with the Institute of Psychiatry and Social Care Workforce Research Unit, the workshop hosted a number of distinguished speakers and experts on mental health and involved postgraduate and early career researchers. Continue reading

A Mixed-up World

Suzanne has been involved in the work of the Social Care Workforce Research Unit at King’s College London for many years, as a researcher and now as an ‘expert by experience’. She reflects on the integration of the medical versus social models of disability and the sense of dis(ease) which can follow the realisation that this has yet to materialise as a coherent practice.

Over two years ago I joined the ranks of those diagnosed with bipolar mixed affective disorder. I didn’t understand what it meant then in real terms and I am not sure I am much the wiser now. I had assumed it meant what the older term, manic-depressive, conveys quite cogently. I would have highs (which sounded like they might well be fun) and lows (which would not be!). I didn’t realise the significance of the word ‘mixed.’ I have highs and lows all at once and they can cycle very rapidly: sometimes over a few days, sometimes every few hours and—if it’s really bad—fluxing every few minutes. The character of the ups and downs are not what I expected either. The highs are not fun, just periods of great mental agitation when I obsess and worry about things. My head gets busier and busier. The lows are what you might expect—only worse. I feel depressed, sometimes become very tearful and often get overwhelmed by angst. In short: no peace at all.

There is a certain irony here. I had studied mental disorder and Bi-Polar prior to my illness, and worked with many people who had similar mental health problems. I realise now that I had little insight into their ‘lived experience’. I now know too well how hard it is to capture in words and images what such realities feel like. Normal language isn’t designed to accommodate these shady extremes of intensity.

What’s more nothing prepared me for the differences between the medical and social models as regards the ‘lived experience’. I expected that my treatment would be an integrated programme of medication and therapy, but that is not what the NHS offers. I have a committed psychiatrist who is determined to find me the right mix of medication, but it is an inexact science and takes time. I am very fortunate to receive counselling from Mind. The counsellor’s person-centred approach and my Community Health Team care co-ordinator’s style of reflective therapy gives me hope for the future.

So, exactly what have I experienced? I have lived the past two years on a cocktail of drugs some of which are potentially toxic and none of which has solved the problem or enabled me to regain equilibrium in my home or working life. I moved from being a sociable, glass half-full person to one for whom life is half-empty and being told by the doctors that my agitation was the high. I long to have the high that gives great elation—but that doesn’t come my way. Instead I have felt in limbo, argumentative with my family, not living life but existing in a swamp of sorrow or anxiety most of the time.

The medication path is fraught with difficulties. Are my symptoms an expression of the illness or side effects of the drugs? It is not easy to tell. My current medication is not stable at present as I am going through another titration. My psychiatrist sees a lot of me but I have a nagging instinct that if an integrated approach was truly followed I would be able to come off the drugs. Medication alone cannot be the solution or the answer to the symptoms. It provides a platform that should stabilise effects—but a lot else is needed. Is my lived experience the same as others out there?

 

Is a Personal Budget right for you?

Sarah Hamilton, Research Manager at The McPin Foundation, introduces new guides available for practitioners, service users and families getting to grips with Personal Budgets and Direct Payments for people with severe mental illness.

The transformation of social care services and the shift towards personalisation over the last few years has presented many, well discussed challenges for local authorities, social care professionals and service users and their families. In mental health, however, there are specific challenges that need to be addressed. Take up of personal budgets in mental health lags behind other disability groups. In 2012-13, 8.6% of people with mental health problems received self-directed support compared to 27.3% of people with a physical disability and 28.4% of people with a learning disability (HSCIC, 2013).

Is a Personal Budget right for youOur three year research project explored the challenges of introducing personal budgets for severe mental illness in four local authorities. We identified barriers to implementing personalisation that meant that some areas were still struggling to offer personal budgets at all. Chief among these is the difficulty posed by the integration of health and social care, such that personal budgets became the responsibility of both – or sometimes seemingly of neither (Larsen et al, 2013).

Where personal budgets are available, however, other difficulties arise in practice. In the PEOPLE Study we interviewed over 50 people who received, or were applying for, a personal budget to support their mental health, as well as care co-ordinators and families. We found, even among these service users, that there was little awareness of personal budgets, what they are for and how they can be used. The shifting policies and budget cuts of local authorities made it hard for practitioners and service users to get to grips with what was possible. Among many practitioners, patience with these problems had already run out, and we heard how many no longer saw any value in starting a process that was liable to disappoint.

Despite the challenges, however, we also saw how personal budgets and direct payments, when used creatively, could transform lives and give people the determination and the control to manage their lives in the way they wanted. The learning from this research showed how the experience of getting and using personal budgets could be improved, and how practitioners, service users and families can, between them, secure the type of support that makes the biggest difference.

Reaching goals and moving onFrom this research we have produced a series of guides for people with a mental illness, their families, and mental health staff. The guides tell it as it was for the people who shared their stories with us. They point out challenges and offer solutions, and provide examples of what can change for people when it works. They include recorded stories using people’s own words to describe what getting a personal budget was like for them. The guides are freely available to download, use and distribute from Rethink Mental Illness.

 

The research project which led to the guides was delivered in a partnership between The McPin Foundation and Rethink Mental Illness, with support from Jill Manthorpe of the Social Care Workforce Research Unit (SCWRU), King’s College London, and Jerry Tew of the University of Birmingham. It was funded by the Big Lottery.

Sarah Hamilton is based at The McPin Foundation in London. You can contact her on sarahhamilton@mcpin.org, or visit the Foundation’s website to see more of its work.

@McPinFoundation | @Rethink_ | @scwru

References

Adult Social Care Statistics team, Health & Social Care Information Centre, Measures from the Adult Social Care Outcomes Framework, England 2012-13, Provisional Release, 10 July, 2013.

Larsen, J., Ainsworth, E., Harrop, C., Patterson, S., Hamilton, S., Szymczynska, P. Tew, J., Manthorpe, J. & Pinfold, V. (2013). Implementing personalisation for people with mental health problems: A comparative case study of four local authorities in England. Journal of Mental Health, 22(2): 174-182.

Evidence Based Interventions in Dementia: What have we found?

Caroline Norrie reports on the presentation of findings yesterday from the major research programme known as EVIDEM, Evidence Based Interventions in Dementia.

Yesterday was a great day for those of us at the Social Care Workforce Research Unit, King’s College London who worked, together with colleagues from other universities, on the EVIDEM programme on changing practice in dementia care in the community. We joined an invited audience gathered at Friends House, Euston Road, London, to hear a summary of the EVIDEM programme research findings.

Presentations of the findings of this five year research programme were delivered to representatives from the Department of Health, the charity sector, health and social care professions, service user groups and research colleagues. This was the culmination of a huge amount of work and a fantastic opportunity to celebrate the project outputs.

EVIDEM was funded from a National Institute for Health Research (NIHR) grant of £2 million which ran from 2008-2012 with the aim of developing and testing interventions for people with dementia living in the community, including care homes.

Research teams were involved from King’s College London, UCL, LSE, St George’s & Kingston, University of London, University of Hertfordshire and Central and North West London NHS Foundation Trust.

The opening address was given by Professor Alistair Burns, the National Clinical Director for Dementia at NHS England, who outlined key policy goals in dementia such as: timely diagnosis and support for people with dementia; reduction in hospital admissions of people with dementia; improving services in care homes; reduction in the prescribing of anti-psychotic drugs; and care and support for carers. Professor Burns noted, “We are on the threshold of getting the data to change practice in dementia care.” 

Chairs Peter Ashley and Dr. James Warner, then introduced the five speakers and Professor Steve Iliffe from UCL gave an overview of the EVIDEM Programme. This consisted of: EVIDEM ED (education), EVIDEM E (exercise) EVIDEM C (continence) and EVIDEM MCA (Mental Capacity Act), EVIDEM EoL (end of life).

Professor Steve Iliffe opened the presentations with a discussion of EVIDEM ED. The aim of this intervention study was to test a customized educational intervention developed for general practice, promoting earlier diagnosis with management guidelines. Five NHS providers and two overseas organisations have now rolled out this training.This randomized trial, however, showed that the intervention did not appear to change the practice of GPs, which led to discussion of what other levers could be used to encourage GPs to follow best practice guidelines for dementia care.

Dr. James Warner from Central and North West London NHS Foundation Trust introduced EVIDEM E. He discussed results from this randomized trial of exercise as therapy for behavioral and psychological symptoms of dementia (BPSD). Dr Warner described how this was a simple intervention – a person with BPSD and a their carer went on a walk five times a week for 12 weeks. This study found that regular simple exercise does not improve symptoms of BPSD, but it does decrease caregiver burden.

Professor Vari Drennan from Kingston and St. George’s, University of London, presented EVIDEM C. Work on dementia and incontinence is of huge significance because this is a key factor in why people with dementia move into care homes. This group of studies included 4 elements: i) scoping the evidence on prevalence, effective interventions, local clinical guidance on provision of NHS funded incontinent products; and a nested study of the THIN database reporting incidents rates for the first time, for urinary and faecal incontinence in community dwelling people with dementia; ii) a longitudinal study exploring the experiences and strategies of people with dementia, their family carers and health and social care professionals; iii) a feasibility study of the investigation of the effectiveness and acceptability of different designs of continence pads; and, iv) the design of a continence assessment tool tailored to the needs of people with dementia. Findings from Professor Drennan’s research team showed that the incidence of incontinence in community dwelling people with dementia is at least double that in a matched population. The use of indwelling urinary catheters, a management strategy discouraged by international and national clinical guidelines was in fact found to be double the rate in people with dementia compared to a matched population. The presence of faecal incontinence was found to significantly increase expenditure by almost two-thirds from both a health and social care perspective. “This study suggests that there are strategies and responses that primary care professionals and others can employ to encourage greater openness, thereby lessening the taboo of incontinence within the stigma of dementia.” added Prof Drennan.

Professor Jill Manthorpe, Director of the Social Care Workforce Research Unit, King’s College London outlined EVIDEM MCA. This project involved developing practice in and building evidence on the use of the Mental Capacity Act 2005 (MCA). Professor Manthorpe’s research showed that dementia care services and practitioners have traditionally not conceptualised their practice as being framed by legal rules. The MCA has proved a major challenge to this and dementia care. Key points from this presentation were that practitioners in dementia care need to be legally literate and aware of the new clauses making neglect and abuse criminal offences. There are messages also for thinking about how future changes to the legal framework of social care contained within the Care and Support Bill may be sustained. (Jill Manthorpe and Kritika Samsi’s presentation from the event.)

Professor Claire Goodman, from University of Hertfordshire presented on EVIDEM-EoL: Quality of Care at the End of Life. The project team has found the trajectories of end of life in people with dementia (PWD) are often unclear to care home staff, family and healthcare practitioners. They used Appreciative Inquiry (AI) as a way to enhance professional relationships around the care home. It fostered rapid and sustained engagement between care home staff and GPs, did not increase resource use, reduced use of emergency services and appeared to improve the management of unexpected events and unplanned hospital admissions.

Finally, the afternoon was brought to a close by Professor Steve Iliffe who gave a short presentation on how EVIDEM has worked with the government funded Dementia and Neurodegenerative Diseases Research Network (DeNDRoN) to help build systems to give people with dementia who are interested  in research more choice and opportunity to get involved.

Overall, from the point of view of someone who worked as a researcher on one of the studies, this was a fantastic day, as it was highly satisfying to view the whole, complex programme of studies coming together and the wide range of evidence and research outputs produced.

Caroline Norrie is Research Fellow at the Social Care Workforce Research Unit, King’s College London. She is working on a NIHR School for Social Care Research funded project comparing the costs and benefits of different models of adult safeguarding.