Download the Summary of all the PPN Mental Health Conversations by clicking HERE.
The mental health working group aims to promote and develop knowledge exchange and knowledge transfer in relation to mental health, based on the existing and potential research and teaching activities of the University. The group is drawn from both academic and research staff and research users, including policy makers, professionals and practitioners and service users.
The initial project, intended to evolve iteratively towards an 'unconference', is a set of 'conversations': open, innovative events inviting all who participate to contribute to thinking together about salient features of mental health and illness in Scotland. Indicative further projects may include:
- Mapping mental health research interests across the University, notably in the Humanities and Social Sciences;
- Contributing to internal discussion of mental health and related issues among both administrative and academic staff and students.
For further information, and to explore possibilities for knowledge exchange and transfer, contact Steve Tilley.
Notes from the PPN Conversation, 25 February, 2013:
Can we talk about resources for people experiencing mental health crisis in Edinburgh - past, present and future?
Approximately 25-30 people took part in the Conversation. Richard Freeman facilitated.
Neville Singh worked at the Young People’s Unit at the Royal Edinburgh Hospital during the period 1970-1978, then 1980-1987; when the YPU was a ‘modified therapeutic community’. He described working there at that time as ‘serious human relations work,’ requiring understanding of the suffering entailed by mental illness, and what mental suffering really means. In the 1960s psychiatry was a Cinderella service; today, that has not changed. The YPU aimed to be a therapeutic facilitating environment wherein the psychologically troubled adolescents could regain or repair their on-going maturational development towards adulthood. Paradoxically, a psychiatric unit aimed to a normalizing setting for growth. Crisis was seen as involving the whole family; the young person was never seen in isolation. Crisis was regarded as a ‘cry for help’; for example, ‘delinquency’ as a sign of hope: the adolescent as getting themselves admitted, and bringing their family to treatment.
Conversation participants’ comments included views that now, ‘crisis’ is an unpalatable term in work with homeless people; space for talk does not reflecting that ‘awful things happen’; cries were heard, but not many responses from local statutory health services; not finding a ‘place of care’.
Kathleen Stewart outlined the development of the Intensive Home Treatment Team (IHTT). It was set up in 2008 in the context of reduction of inpatient beds at the Royal Edinburgh Hospital (REH) (followed by reduction also in East Lothian). The IH TCT provides a service all hours, all days. Staff include medical staff who had worked in crisis teams, nurses predominantly from in patients wards, and Occupational Therapy and Psychology staff; there is no longer a Social Worker on the team, and social work involvement if via referral. The targeted caseload is people at risk to self or others, who are being considered for hospital treatment. People can be assessed at home. The team can visit up to 2-3 times a day (if more, the person would perhaps need to go to hospital); have access to carers; and remain involved till the crisis is resolved, on average 3 weeks (range 1-100 days). It's important that service users are willing to engage with the team; some are not and may feel safer in hospital. IHTT can also facilitate earlier discharge from hospital. Initial operation in the context of bed reduction created pressure of work, and pressure to be successful, for the Team.
Participants’ comments/questions included: why was the Social Worker lost to the team (issue of payment by Health of Social Care?). Earlier forms of crisis intervention services were noted: c. 1978/9 Ward 1A, REH (context: lots of beds, not reactive to lack of beds); Dingleton Hospital. Early 70s; composition of both latter teams included social workers, nurses, and doctors. Other current resources were noted: the Lothian Bi-polar Group, which offers peer support; there was a perception that with regard to supports, things have improved over time. It was noted that drop-ins that once provided support had been discontinued; views were expressed on their value (not healthy/not recovery focused v. some people need that amount of support; OK to close as long as other services are there to provide support). The role of Mental Health Officers s in identifying and advocating for alternatives to hospital was noted. Perceptions were voiced that hospitals are not always safe/secure places. With re-provisioning of the REH pending, there would be needs to make more contact with community groups: are the CC and IH TT linked in with re-provisioning and related funding decisions? Are the CC and IH TT filling the gap for people who have been left as changes have been made to the REH? There is a need for hospital, but who determines what is a crisis – the person or the NHS? It is important to ensure that the person’s subjective distress, and the person, are not objectified.
Steve Atkinson and Tamsin Kilgour provided perspectives on the Edinburgh Crisis Centre’s work, informed by views of people working there and people who have been users (single time, or repeat) of the service. The long campaign by service users to get a Crisis Centre established was noted. The aim was to have safe spaces in which the person could retain choice and; where the person could be seen when they said they were in crisis; where managing crisis was not just about managing symptoms but also about exploring the background and planning a way forward. The Service offers a self-referral system, in which they only have to tell their story once, at a time when repeating it (telling more people, and remembering who they’ve told what), would be a real barrier to going for help. Some use it to prevent stress getting worse, and to decrease stress. There are a variety of ways to access the service. Those working at the service do not define ‘crisis’ but explore with the person what the crisis means for them. They may offer support and information on ways to deal with and decrease distress, and ways to use the person’s strengths and develop coping strategies; and may give information on sources of ongoing support. The Partnership Group overseeing the work of the Centre includes users and carers, and representatives of NHS Lothian & Edinburgh Council (funders) and Penumbra (providers). Among other functions the Centre provides the person, and e.g. the police, with an alternative to hospital: people can stay for short periods. The Group is looking at offering users an option to come back to meet a peer support worker – to ‘bridge the gap’ with other services.
Participant comments/questions included a nurse’s ‘validating’ the benefits of the person not having to tell their story to more than one person. The link between Mental Health Officers (MHO) and the Crisis Centre was discussed: were the people seen at the Royal Edinburgh Hospital different from those seen at the Crisis centre? could the Crisis Centre make referral(s) to the Intensive Home Care Team and MHOs. Links with GPs were noted – the Crisis Centre going out to inform GPs about the service.
Edie Irwin described her commitment to do something about the suffering experienced by people in mental health crisis, based on her involvement with Kingsley Hall, Soteria House and the Samye-Ling monastery. Broadly these were in the therapeutic community tradition: places where the person was protected, those helping them drawing on their life experience; based on an ethos of service; with professional expertise brought to bear as needed, and integration and coordination of people dedicated to this approach. She described Lothlorien in South-West Scotland) as a current example of a therapeutic community with good relationships with the local mental health service. Looking to the future she described her vision of ‘a house on every corner’ where people can get the support they need in the place they are. She noted the need for a map that can be shared, of friendly and welcoming places where people can go and sit regardless of their states of mind; and for an economy of care based not on paying the highest rate, but on sharing human resources.
In discussion after, a person cited New Zealand’s greater (compared to Scotland) – ‘more colourful - variety and levels of services; offering e.g. immediate access for people in crisis, and respite. Other comments included: the current neo-liberal commissioning (of services) environment; belief in the value of good hospital services; Edinburgh as lacking in diversity (provision) for a city of its size; different views – that ‘it comes down to money’ v. no it does not, creativity and compassion are needed; hospitals are expensive, if hospital beds were reduced, the money freed would seed alternatives; but we are risk averse, NHS Lothian staff are risk averse; it is important not to lose sight of the past, and past achievements - the Crisis Centre was established after a long campaign by service users. A note to end on: “The big colourful thing!”
Participants were invited to leave notes suggesting questions / suggestions for future conversations. Nine notes were collected:
1. Diversity in support and provision. Better risk assessment and reduction in medication dependence. Put the ‘social’ back. Communities yes, Alienation and stigma NO!
2. Is it possible to provide nurturing therapy/treatment within the NHS? Good intentions turn to minimal interventions?!
3. How much risk is a good thing? How to manage risk? Is some risk a good thing? Can it help recovery?
4. Can we talk about where the money goes in mental health service provision? Get the commissioners in [for Conversation or related workshop]!
5. “If a hospital bed is £60k? how many beds’ worth would you need to offer something creative and community-focused with twice the Recovery impact for service users?” e.g. Dream Bids: mock business plan + a short and funny powerpoint.
6. How do we, because we must, retrieve creative ethics from being buried under defensive ethics?
7. What could come out of the Conversations? Edie mentioned a need for a ‘map’ of places that are friendly and welcoming to people regardless of their state of mind. A few years ago Edspace had an idea for some kind of symbol that could be displayed by premises (shops/cafes) to show that they are welcoming. Would be great to see this happen, with a map!
8. Therapeutic alternatives: Art Therapy and Containment in Crisis Situations.
9. Suicide Prevention – how to close the gaps in provision?
Steve Tilley's Summary
Ann Diment briefed on the University’s and the University’s signing of the ‘See Me’ Pledge, and on the initiative in which staff in the Hugh Robson Building have been trained to offer voluntary peer support for colleagues wanting to talk about mental health / mental illness matters. The latter indicates that, increasingly, we can talk about mental health and illness in the University; less clear is how much collective conversation there is across staff / student boundaries – mental health and illness can seem ‘always someone else’s problem’. Conversation: The lead on the NHS Lothian 12S programme (for higher and further education institutions in Lothian) said the programme’s focus was on whole institutions and the ‘healthy university’, in the context of national policy on mental health and well-being. There was discussion on how policy reflects categories of ‘mental health’ and ‘mental illness’ (and diagnoses in the latter), and conventional practices. Proliferation of categories of mental illness in the US diagnostic system was noted, and a related need to have a diagnosis to get recognised and get support you need a label to access resources. “Society is part of the problem”: categories are part of diversity e.g. mad / mad student may reflect the person’s point of view and experience of relationships with professionals; lithium may be considered a dietary supplement. There is interest, including among undergraduates, in expanding areas in the university for inclusive conversations. How can the University cater for international students who need support with adjustments to a different city, climate, etc.?
Sheila Williams described services and support provided by the Student Disability Service (SDS), including the Mental Health Mentor service (part of SDS) and the Student Counselling Service. There needs to be evidence of disability for students to access SD S via students disclosing their impairment. There may be under-disclosure on applications to the University. There has been a 44% increase in disclosures of mental health problems in the current academic year compared to last year, with a rise in disclosure from international students.
The Student Counselling Service has seen a 68% increase in referrals [note: at February 2012]. Student use of the Student Disability Service has increased by 40% since the move to the Main Library. Schools have concerns about demands on staff dealing with student mental health issues. The Disability Committee’s Mental Health Sub-Group considers policies and strategies regarding student mental health, and the University has a mental health policy for students (currently under review). Different policies for staff and students may lead to missing opportunities to address issues common to everybody.
Conversation: Language is an issue – 1) classes provided through SDS could provide a way to get help without have to self-identify as disabled; is it a mental health policy or a mental illness policy?; 2) do you need a diagnosis to be able to access not just services, but policy? Definition of mental illness is a difficult issue: a person may move through stages from coping with stresses to depressed; labels may produce dividing lines in the community, militating against seeing each member as a human being and looking out for each other, allowing for differences. There are conversations about mental health/illness at different levels in the University: organisational talk is important, it is important to know where conversations are taking place and to get involvement of the top person e.g. in committee structures; someone needs to be taking an overview. The Equality and Diversity Committee is seen as to key committee regarding staff mental health/illness policy; the SDS’s core function relates to student disability; what is the role for HR in addressing staff mental health? The ‘see me’ initiative can be a vehicle for getting areas of the University on board, but writing policy and practising policy are two different things. NHS Lothian 12S can provide an ‘outside perspective’ on mental health / illness issues e.g. by making contact with the Principal and work with EUSA. The value of different levels and systems to enable students to work with and look out for each other was noted e.g. EUSA is to approach the Rector as a possible mental health champion. Can we talk about mental health / illness? We can officially, but we can’t; we have policies, but no vision.
Sue Cowan addressed the lack of discourse around prevention of mental health problems / illness, and the universities as a cause of mental health problems for staff and students. Figures on Europe and UK indicate 10.8 million (staff) working days are lost per annum are due to anxiety/stress caused by the workplace; mental health difficulties are the largest category of work-related illness, with high costs of personal suffering, impact on families, and economic costs to society, and impact on organisational health as a whole (e.g. ‘presenteeism’ – people frightened to go off sick, trying to avoid loss of jobs in challenging times). Work-related mental health problems linked e.g. to excessive workload and problems of managing change) constitute a growing epidemic in post-16 education. What can be done to address these issues? Work organisation, design and management are major sources of stress for staff. Risk assessment every 12 to 18 m, maximum every 2 years is a standard of good practice. This, along with effective risk management means that sources of stress can be identified and addressed before they cause harm to staff. Stress on students may be seen e.g. in missing lectures, staying at home. Conversation: There is a lot going on to address these issues e.g. health and safety processes may enable accommodations, but it is not pulled together. Examples were given of classes at Cambridge University aimed at enhancing staff and students’ positive mental health and well-being. The evening’s Conversation was noted as a place where different sort of conversation and connections were made regarding matters of mental health and illness, and projects based on university-mental health work - Talbot Rice Gallery-Royal Edinburgh Bicentenary Project, and the Oor Mad History - noted.
Steve Tilley's Summary
In the second PPN Mental Health Conversation of 2011-12, Robert Whitaker, investigative journalist, former Director of Publications at Harvard Medical School, and author of Anatomy of an Epidemic, gave an overview of the argument in that book. He described his shift from accepting a narrative of a great leap forward in psychopharmalogical treatment of major mental illnesses, to finding facts that did not fit that narrative of progress. Instead he found another, duelling, narrative, based on studies showing increasing, not decreasing, rates and burden of illness and disability. He identified as elements responsible for the first narrative’s dominance the power of psychiatry as a guild with prescribing powers, and a merging of interests of the pharmaceutical industry and psychiatry to promote a story of improved diagnosis. He argued that science supports the counter-narrative.
Desmond Ryan, responding, accepted Bob’s analysis, and used the context of professionalisation theory explore how and why psychiatry has been successful in sustaining the dominant narrative in the US. Factors include: exclusion of psychiatries not centred on drugs e.g. psychodynamic psychiatry; creation of a single authoritative hymn sheet (the various Diagnostic and Statistical Manuals [DSMs]); America’s religious society is susceptible to authoritative statements; the therapeutic efficacy of medicine is not contested; increasing direct-to-public/patients advertising spurring patients’ self-referral to psychiatrists to get specific drugs; a risk discourse focused on threats to individual safety and ‘dangerous mentally ill’; legal privileges to control the market. He recalled former US President Eisenhower’s warning about the dangers of a ‘military-industrial complex’: Bob’s analysis points to the dangers of a ‘medical-industrial (pharmacological)’ complex, through the transformation of a functional specialism (psychiatry) to a successful business model industry. Bob agreed, saying the US wants to export the industrial-medical model to other countries, by rewarding those who get on with this model of care.
Topics raised in the discussion included:
You can now check the short video about the Edinburgh performance of the DEMENTIA DIARIES.
Contacted by Mark Hewitt, director of Dementia Diaries, PPN linked with University of
Edinburgh (i.e. Centre for Cognitive Ageing and Cognitive Epidemiology) and other partners (including the local Polish community) to promote knowledge exchange in the two Dementia Diaries events in Edinburgh.
This page was published on 16 December 2013