DMU Research: Approaches to Mental Health Care

Today I was one of the speakers at DMU’s third ‘Be the Change’ event. Focusing on the research that takes places within the university, the event has speakers throughout the day talking about their work and their contributions to research. During my time I spoke about how mental health training can contribute to a public health approach to mental health care. This post is a summary of what I said.

Mental health is an increasingly prominent social issue. Partially this is because of the social and financial impact of mental health needs. People with mental health needs generally need more treatment for their physical health also. People with schizophrenia and bipolar disorder die up to 20 years earlier than then general population due to physical health conditions. Additionally untreated mental health needs also cause more people to turn to drugs or alcohol to self-medicate, which places further strain on our health service when this causes health problems, or requires emergency care. It is not only health care that struggles to address the extent of mental health needs within society. Up to 40% of police time is spent addressing incidents which are linked to mental health needs. This contributed to an over-representation of mental health needs within the criminal justice system, and an overuse or misuse of section powers by police.

For those who have sought help and been assessed as needing mental health support, accessing care is difficult, with waiting lists as long as a year or more for treatment in some areas. This all amounts to our support services for the whole community being overstretched, and professionals from a variety of areas being expected to understand or offer mental health support in some capacity, without necessarily being trained to do so. As 1 in 4 people will experience some form of mental health need at some point within their lifetime, it is clear that the approach we take to providing mental health care requires improvement.

Policy and funding allocations have a huge impact upon how mental health services and care can be delivered. The current Prime Minister has said that the inadequacy of mental health support is a “burning injustice”, but in speeches her views of mental health care focus on citizens supporting each other, rather than more formalised support. This echoes David Cameron’s ‘big society’, which was generally viewed to be unsuccessful. Additionally framing mental health care as a community based issue effectively minimises the responsibility of government to fund and support mental health services. The “no health without mental health” policy stated that more financial control would be given to local services and local authorities, to ensure that spending was used to meet needs within that area. Additional funding was released to support this also. But front-line services actually saw very little of these funds, and in many areas mental health services have been impacted by cuts.

To properly support the mental health needs of the population, a new approach is needed, which recognises the extent and prevalence of mental health need, and allows people to get support before they reach crisis. Public health models would be a good way to do this. Public health approaches look at problems and offer support on a number of levels. The primary level focuses on universal services, and how they could offer generalised support for a specific problem. This may be schools offering counselling services, or ensuring that police offers understand what a panic attack looks like to allow them to act appropriately. This isn’t a replacement for specialised services, but allows for less serious problems to be addressed in a non-clinical, accessible setting, or referrals to be made for more specialised support. The secondary level would be specialised support for low to mid-level needs. This may be ensuring that GPs can diagnose mental health needs correctly, and that treatments that are shown to be effective are accessible. Currently medication is a common treatment, whereas CBT or talking therapies are difficult to access, despite potentially being more effective for many people. The tertiary level of a public health approach is comprised of highly specialised services, for those with the greatest level of need, such as psychiatric units or long term systemic therapies.

The public health model doesn’t look too different from what we have now, except for the primary level. We don’t offer general mental health support and wait until people reach crisis to offer support, or all issues are addressed by what should be a more specialised service. Developing our primary level mental health care within universal services would be beneficial for everyone and would allow specialised mental health services to work more effectively. We’ve taken public health approaches to a number of issues within the UK, such as smoking, nutrition, heart disease; so why not mental health?

It isn’t necessary to wait for government to apply a public health approach to mental health care to develop and improve primary level services. Ensuring that staff within universal services are aware of mental health needs and have some skills to offer support would be a step towards this. Mental health training is becoming more commonplace, with Mental Health First Aid (MHFA) being a good example. Developed in Australia, MHFA is a two day course delivered to a group of mixed professionals. It covers basic information about common issues such as depression and anxiety, and more serious needs such as psychosis. MHFA also offered practical tips like how to calm someone who is having a panic attack, and how to have a conversation with someone experiencing a delusion. One of the main things MHFA courses deliver is knowledge of what support is available, and how to access it. The receptionist in social services shouldn’t be expected to deliver mental health care, but informing them of who they can call if someone is in distress is helpful.

In my research into MHFA courses, it seems one of the main benefits to people is that they are reassured about what they do in those situations, much of the fear or hesitation in supporting someone with mental health needs seems to stem from uncertainty and not knowing what the “right thing” to do is. The courses also humanise and demystify mental health. Emphasizing that someone experiencing mental health needs is simply unwell puts it in a similar context to someone who has a physical health need, which makes it easier to understand and allows people to feel more confident in offering support. Helping professionals to develop this confidence to offer support, even in a non-professional setting, is positive. It means that your colleague feels more able to listen to you and be there for you if you’re experiencing an episode of depression, it means that you won’t have to worry about being seen as weird if your anxiety is too much and you have to leave the office to calm down for a while, it means that we can help each other to access support when we need it.

Advertisements
Posted in Uncategorized | Leave a comment

The Demonisation of Average

I recently read this article from The Guardian, which talks about the culture of acceptance around poor mental health in academia. There’s a focus on PhD students here, but I think this could apply to all stages of the academic profession. There is an expectation that long hours will be worked, that stress is normal, that academia should come before all other things in life. The way we talk about academic life is also somewhat fatalistic; ‘publish or perish!’ we are told at every opportunity. I don’t particularly want to perish, so the other option is to publish. But by placing academic life into a ‘do or die’ context, we tend to overlook how hard it can be to ‘do’. Publishing work is difficult, requires a large amount of effort and time, and can be a really long winded process. I submitted an article 5 months ago, and it hasn’t yet been allocated a reviewer, does this mean it’s perishing?

When you fill a building with clever, hard-working people, there’s bound to be an expectation that the things that they do or create will be good. When these people have higher degrees and are technically ‘above average’, it might be reasonable to expect the results to be above average also. But within academia it seems that ‘average’ is being shunned entirely as unacceptable. The results of the TEF are due any time now (once we can agree on a functional government), and the discussions leading up to this shows a fear of average. Every institution wants to be ranked as ‘gold’, but not everyone can, otherwise the standard would become meaningless. Some will have to be silver, some bronze. This doesn’t necessarily mean that these are bad universities, being ranked as bronze is not the same as a school being placed in special measures following an Ofsted inspection. But the way they are talked about, it may as well be.

The requirement for everything in academia to be above average is at best statistically naive, and at worst, unhealthy. We all want REFable journal articles, but 5-star international journals can’t publish every piece of research, nor would they want to. The issue is that work published in ‘lesser’ journals is seen as not-worthy. We’re told to focus on international work that will develop the field, create impact, generate funding, and also be accessible to those outside of academia. Work that doesn’t tick all of these boxes is then looked down upon somewhat, whereas it might still be interesting, it might still be good work, it just doesn’t meet those very specific criteria. One of my concerns is the impact this has on those who carry out research and teach students.

Poor mental health is a pervasive problem within academia; a post on the Thesis Whisperer said that the process of a PhD takes bright, bookish, sensitive people and tries to break them. Academic posts don’t buck this trend either. Whether it’s requiring average pass rates for taught modules to be above 60%, or questioning people’s ability if their research work doesn’t set the world alight, we are essentially asking academics to be continually above average. This pressure isn’t good for mental health, whilst we can expect people to develop and improve, the stress of always having to be perfect can be very damaging.

The damage of this culture gets dismissed to an extent, because we’ve almost learned to expect it. ‘If you aren’t stressed, you clearly don’t have enough to do’ seems be a common viewpoint. Within academia we need to accept that whilst stress is normal, constant stress is not, constant pressure is unsustainable, and that average isn’t bad. I’m not sure how this can be achieved on a large scale, but for myself, I’ve started actually taking a lunch break rather than eating at my desk whilst checking emails. It’s only a small thing, but it helps me, and when I think about everyone I know working in different fields, it’s something they expect as standard. It’s normal, it’s average.

Posted in Uncategorized | Tagged , , | Leave a comment

Current Research: Benefits of Pokémon Go

Myself and Dr Catherine Flick are currently carrying out research into the mental health benefits of playing Pokémon Go! We’re interviewing players in the field, and also asking people to complete an online survey, which can be found at: https://www.surveymonkey.co.uk/r/PokemonMH

The below is detailed information about the research that you may want to consider before taking part. If you have any questions, please feel free to contact us!

What is the study about?

Pokémon Go took the world by storm following its launch in summer 2016. As well as being a fun game to play there have been some reports of it encouraging exercise, social interaction, and improving the mental health of players. This study is looking at what mental health benefits players receive from Pokémon Go, and to understand how the format of the game itself contributes to this (if at all).

What does the study involve?

We are asking individuals who play Pokémon Go to complete an online questionnaire. This will ask about your experiences of playing Pokémon Go, if you feel it has benefitted you in any way, and what form those benefits have taken. As the research is related to mental health, the questionnaires will touch on this subject. However, you do not have to disclose any personal information that you do not feel comfortable sharing, and do not have to answer the questions if you do not wish to.

Why have I been chosen?

We are approaching Pokémon Go players through various online communities to take part in the questionnaire.

Do I have to take part?

It is up to you to decide whether or not to take part.  If you do decide to take part you will be given this information sheet to read and be asked to sign a consent form.  If you decide to take part you are still free to withdraw at any time and without giving a reason.

What if I agree to take part and then change my mind?

You can withdraw from the study at any time, without giving a reason, through non-completion of the questionnaire. As survey data is anonymous, we will not be able to remove any of the information following the completion of the survey. But individuals will not be able to be identified by any of the data.

What are the possible disadvantages and risks of taking part?

As the work is discussing mental health, there is the possibility that some individuals may find this upsetting or triggering. We have ensured that all participants will be fully informed of the topic before deciding if they want to take part or not. Additionally the questions are phrased so that individuals do not have to disclose mental health needs if they do not wish to. Additionally, if participation is difficult or distressing, one of the research team is a mental health first aider, and can provide support if needed.

What are the possible benefits of taking part?

Aside from getting to talk about what you enjoy about playing Pokémon Go, the research hopes to identify specific aspects of this type of game that support individuals mental health. By improving understanding of these issues, there is the possibility of improving support regarding mental health.

What if something goes wrong? / Who can I complain to?

If you have a complaint regarding anything to do with this study, you can initially approach the lead investigator.  If this achieves no satisfactory outcome, you should then contact the Administrator for the Faculty Research Ethics Committee, Research & Commercial Office, Faculty of Health & Life Sciences, 1.25 Edith Murphy House, De Montfort University, The Gateway, Leicester, LE1 9BH or hlsfro@dmu.ac.uk

Will my taking part in this study be kept confidential?

All information which is collected about you during the course of the research will be kept on a password protected database and is strictly confidential. You will be given a pseudonym which will be used instead of your name. Any identifiable information you may give will be removed and anonymized, and all quoted materials will have all identifying information removed.

What will happen to the results of the research study?

It is hoped that a number of journal articles will be written from the findings of this work, which may be accessible to you. If you would like to be informed of the outcomes of the study and any writings that follow, please let a member of the research team know and we will keep you informed.

Who is organising and funding the research?

The research is being organised and funded by De Montfort University.

Who has reviewed the study?

This study has been reviewed and approved by De Montfort University, Faculty of Health and Life Sciences Research Ethics Committee.

Contact for Further Information

If you have further questions or would like to discuss any aspect of the research, please contact Catherine Flick: cflick@dmu.ac.uk or Jessica Urwin: Jessica.urwin3@dmu.ac.uk

Thank you!

Posted in Uncategorized | Tagged , , , | Leave a comment

World Mental Health Day 2016

Today is World Mental Health Day, and many people on my social media feeds are talking about it. Most of it is great! Some of it is not. I wanted to write a brief something to address some of the things I have seen today, to try and help people understand a little of what it is like to have mental health needs, and also to get some of the frustration at seeing these posts out of my own head. I am wiring this in the spur of the moment, so if there are holes, or it’s not fully thought out, please forgive.  This example is probably very UK-centric, if you know of something that is similar from other cultures/countries, please let me know.

Have you ever played a party game where a bar of chocolate was placed on a plate, a timer started, and you had a minute to eat as much as you could? Oh, and you’re wearing an oversized hat, scarf, gloves, and have to use a knife and fork. It’s a fun game, but also really frustrating! If you’ve ever played this (and I’m pretty sure that most children/people who grew up in Britain have played this at least once), you’ll know how difficult it actually is to try and cut up a cold bar of chocolate with a butter knife. If you’ve never played it, why not give it a go at your next party?

This game is a pretty good analogy for having mental health needs. You want to do a specific thing (whether it’s eating chocolate, or just getting on with your life), and there’s something that makes it heaps more difficult. Maybe you’re only wearing the gloves, maybe you have the full outfit plus a winter coat and your knife and fork are made of plastic. There are different difficulty settings. But the outcome is that it makes it harder to do the thing you wanted to.

Some people who haven’t played this game might be asking, why wouldn’t you just throw off the gloves, ignore the cutlery, and stuff your face with chocolate? Well, in the children’s party game, that would be cheating and you’d quickly find you weren’t invited to play any other games in the future. In terms of the analogy, maybe you’re not lucky enough to be able to “just” take off all that stuff. Those gloves are really stuck on, and sometimes wearing them is enough of a restriction that you can’t take them off yourself. You might come up with some strategies to manage with the gloves on, but it takes more effort on your part, and can be pretty tiring.

Imagine if this wasn’t just for a children’s party game, but for every meal you ate. You don’t get different cutlery, you have to keep all the winter accessories on all the time. Soup would become a distant luxury. Eating would be hard. Which would make everything else a bit harder too, because you’re tired. Having to use extra energy to manage the impediment caused by the gloves/hat/scarf etc. means you have less energy to do other stuff, like focus during conversations. Or you might start to plan your meals well in advance so that you know you’ll be able to take your time while eating, that takes energy too and restricts your time, so you can’t do other things.

Having a mental health need is not a choice, and if it could be easily overcome, people would definitely choose that option! If those gloves could be taken off, they would. So please, have a little consideration before you say to someone “just get over it! It’s not a big deal!” or proceeding to tell them how easily your own gloves came off. You wouldn’t do that to someone with a broken leg, so please don’t try to create hierarchies of illness.  Maybe you don’t realise that you might be wearing privilege earmuffs. Instead, on world mental health day (and on every day), ask, “can I help you with that?” and listen to the response.

Posted in Uncategorized | Leave a comment

The Joy of Ethics

I really enjoy completing ethics forms. Everyone I have told this to gives me a slightly bemused look and says “really?”, and then quickly changes the subject. But I do. I find completing ethics forms satisfying and exciting. It means the beginning of a new project, which is always the fun bit. I like deciding what questions I want to ask and reading the literature to find the gaps. I like considering what methods would be best, whilst not having got to the headaches that sometimes come with the practicalities of carrying them out. I like considering ethical quandaries, and as someone who shouts about social justice a lot, I like thinking about how to make the work I do stand up to those principles. I enjoy all of the preparatory work of research, and for me the ethics submission is the culmination of it all.

Considering what issues might come up in research projects and how we can either avoid them or overcome them is the heart of considering ethics applications. How can we ensure research does no harm? By thinking about how others will be affected by what we say and do. I enjoy this kind of work because it is the application of the principles that I claim as a gold standard. I might not always be able to do it perfectly, but I enjoy the challenge and find it a good way of planning out what I want out of my research and what the best way to do it is.

At the moment I’m doing some planning for a research project that requires a third party to distribute questionnaires at specific events, collect them and then returns copies to the research team, alongside contact details for the participants. How to do this in a way that is secure, confidential, maintains anonymity, and ensures that nothing gets lost or missed is my current quandary. It’s like a Professor Layton puzzle that counts as work! What’s not to love? it also means that I have to figure out the logistics of the research now rather than later, and as I am both a worrier and a planner, this suits me down to the ground.

One of the specific ethical issues I always try to consider when planning research is accessibility. Can I create the research materials in different formats so that people with disability or different levels of ability can be involved? Do I need to consider language barriers in the work? A past project involved some work in Wales, and so all the materials had to be translated into Welsh. No one asked for them in Welsh, but we were prepared if they did. Ensuring that research can be accessed by as many people as possible is positive, as it means samples are more inclusive, and new perspectives may be uncovered. Additionally, as much of my work focuses on social work and mental health, ensuring that researcher considers accessibility is consistent with these areas and the values they embody.

A lot of my research work (and teaching work) is very paper oriented; questionnaires, consent forms, information sheets, all are usually printed or online. In future I’d like to find other formats for these types of research tools to greater improve accessibility. If any of you have come across strategies for this or have experience of it, please let me know!

Posted in Uncategorized | Leave a comment

Mental Health Support, Communities, and Reddit

I’ve never really been a Reddit user; I don’t have an account, but I occasionally read some stuff there. In the past 2 weeks I’ve spent some time lurking at Reddit’s Radiohead sub. I’m a fan of Radiohead, and wanted to hear what other people were saying about the new album, and so on. Reddit is made up of sub-forums based on specific interests and topics, and the most popular/commented on/controversial posts may also get posted on the main page. Reddit often gets criticised for allowing specific subs to exist, particularly around hate groups, discriminatory views, or general unpleasantness (I’m not linking to any, if you’re interested, I’m sure you can find them), and generally Redditors have something of a bad-rep online.

All of this meant I was pleasantly surprised by r/Radiohead. In amongst the general fandom, the HYPE TRAIN, and speculation about when the album would come out, what songs would be on it and so on, was a really supportive community. Every so often would be a post where someone would allude to difficulties in their life, mental health needs, or occasionally, suicide, and the responses were all really supportive; expressing concern and understanding. One post in particular has stuck in my mind, where the poster suggested that they “wouldn’t make it” to the album release, and were essentially saying goodbye to the other fans in the sub. The responses were heartening to see, people offering to talk, suggesting support options, and asking the poster to not hurt themselves. This made me think about the value of online shared interest groups as support networks, and how this often gets overlooked.

Online mental health support resources are becoming more commonplace, with Mind’s Elefriends being a good example. But one of the issues that resources like this have to overcome is the stigma attached to accessing mental health support. Pretty much all of the resources I’ve come across had “mental health support” or variations of the phrase in big letters, which is useful in allowing people to find it, but may also put others off. So shared interest communities, like r/Radiohead, may seem like a safer place for individuals to open up and admit their struggles; as it’s not a mental health resource, and it can be anonymous, there’s no risk to individuals of being sectioned, or their friends/family in “real life” judging them.

In my work I have often come across people who view being online, and particularly talking to others online, as a “risk”. As someone who has pretty consistently used the internet since I was 13, this seems very strange to me. Yes, some people do use the internet for nefarious purposes, but more often than not, you will find people like those in r/Radiohead, who will respond to a distressed and potentially suicidal internet stranger with “I understand how you’re feeling, but please don’t do that. From one fan to another, I want you to stay here”, and I find that heartening. We need to view online shared interest communities in the way that we would “real world” shared interest communities. These are still social networks that individuals choose to spend time with and build connections with. Given all the evidence for support networks and communities as a benefit to individuals mental health, recognising the value that online communities can bring is important, and might be an effective way of allowing people to access support.

We’re more likely to be influenced by our peers than others groups, and often “peers” has meant people from similar social backgrounds that we have commonalities with. There is an argument that this could be changing due to the prevalence of online communities. The people I went to school with would generally be considered as my “peers”, but I didn’t have very much in common at all with a large number of them, and chose my friends based on shared interests. The internet allows us to find those shared interest groups much more easily, and somewhat negates the similar social background aspect of the definition of “peers”. The internet allows individuals from all over the world to create communities that aren’t impacted by class/race/age etc. and so can change who your peers may be.

I can see value in these shared communities as sources of support, and whilst the advice these individuals can offer may not go beyond giving out the number to the Samaritans, having a peer group that can act as a safe space may help individuals at risk of harm to access more formalised support.

Posted in Uncategorized | Tagged , , , , | Leave a comment

Five Years Time

My very good friend Ruth recently posted on her blog about the dreaded question “where do you want to be in five years?”, and wondered why “anywhere with good biscuits” was not an appropriate answer. She is an all round excellent person, and you should go and read her writing. When I saw her post I felt a little smug within myself that I don’t have to answer the “five years” question, or so I thought.

Academic planning is an important thing, otherwise we risk becoming stagnant, and not doing the things we want/need to. But as well, it means considering what we want to be doing in five years time. A form I recently had to fill in had exactly this question on it. Other than researching stuff, teaching stuff, and wearing snazzy jumpers, I had no idea of what to say. I’m currently an Early Career Researcher (ECR), and only 6 months in to my current job, which to me means I’m still figuring things out and trying to decide where I fit into the academic system as a whole.

But the form would not relent, and the question remained; what are my research plans for the next five years? So I had to think on it and work out some stuff that I wanted to do. I know that the big daydream style plans of winning a Nobel Prize probably aren’t going to happen (at least not in the next five years); I’m not even sure if there is a Nobel Prize for social science. So what else would I like to do? Write a book, present a BBC4 documentary about justice, spill things less. One of those seems possible, so onto the form it went. It was the book. I’m doomed to a life of spilled drinks.

In terms of specific research projects, I was a little stumped. I’d been so wrapped up in my thesis for a long time that I couldn’t really see other possible projects. But there were some questions that my thesis didn’t answer, so I wrote those down too. There were some other things that I’m interested in as well, but hadn’t really acted on either, which I realised I now could, even if they seemed a little silly. Yes, I’m shoehorning ways to shout about Superman into my job. It’s entirely fine and very grown-up.

The idea of planning out five years was daunting and seemed far too big at first. Now I’ve committed myself to doing a whole bunch of stuff within that time frame, I’m not sure it’s enough. But “where do you want to be in five years time” is definitely not a fun question still. I understanding the need to put time lines to things, but we might get a better response from people if instead we asked what their goals were, or what things they wanted to achieve overall in their work. I couldn’t answer the question without thinking about what I’m interested in, and how I could act on those things, so to me those are more useful approaches of helping people figure out what they want to do.

Posted in Uncategorized | Leave a comment