Lived experience conference

There is increasing recognition of the value of lived experience and the important contribution people with personal experience of mental health issues can make to mental health care.

Peer workers already exist in a number of different organisational work settings and roles. However, at the same time, many other professionals also have valuable lived experience, which could be an asset to services.

Navigating the boundaries between ‘the personal’ and ‘the professional’ is a complex task for mental health services. But Leeds and York Partnership NHS Foundation Trust are facing this challenge head on.

They have supported Jonny Lovell, a PhD student in the International Centre for Mental Health Social Research, to undertake research with practitioners and service users on sharing lived experience. And they are holding a day conference on this topic on Friday 6th November in Leeds.

Jonny will be presenting his research alongside others such as Rachel Perkins OBE and the TIme to Change team.

Some questions which the conference will address include:

  • How can we work towards acknowledging and embracing all of our lived experience in the most helpful, effective and appropriate ways?
  • How can we work together to challenge the stigma which continues to exist in many services and settings?
  • How can we capture the power and promise of the wealth and breadth of lived experience available to us?

It looks like a really interesting day and a great opportunity to hear some of the early findings of Jonny’s research.

More information about the conference can be found here.

Mental effectiveness training: findings of two pilot studies

Two new studies conducted by the International Centre for Mental Health Social Research have found that mental effectiveness training helps you to learn more about your mind and be more effective in your daily life.

Your Mind: A User’s Guide ‘Your Mind: A User’s Guide’ was developed by Mindapples, an innovative social enterprise which campaigns to increase public understanding of the mind and raise awareness of the importance of good mental health.

mindapples.bmp

The course consists of eight one-hour sessions:

  1. Love your mind
  2. Master your moods
  3. Get motivated
  4. Handle pressure
  5. Know yourself
  6. Make smarter decisions
  7. Influence people
  8. Think creatively

Evaluation

We evaluated pilots of the training with undergraduate nursing students in a London university and with people who have used mental health services in London.

We used a waiting-list controlled trial design for the pilots to allow us to assess outcomes in comparison with a similar group not undertaking the training. All the people in the control group received the training after we had collected their follow-up data. We evaluated three outcomes at the end of training and three months later:

  • Knowledge of mental effectiveness – measured using a multiple choice quiz based on the content of the training
  • Ability to self-manage stress – measured using a four-item self-efficacy and resilience scale
  • Mental wellbeing – measured using the Warwick-Edinburgh Mental Wellbeing scale

We also held focus groups with training participants to obtain their views on the training and its impact on their lives. All participants received shopping vouchers for completing questionnaires and attending focus groups.

Nursing students

Mindapples adapted the training for nursing students as they, just like social workers, experience high levels of stress in their roles. We hypothesised that training to help them to self-manage their stress and improve their mental agilities may help them in their training and subsequent careers.

Working with Professor Emeritus Alex Murdock from London South Bank University, we recruited 101 undergraduate nursing students to participate in the study. 57 were in the intervention group and 44 were in the control group and received training at the end of the study.

The students who received the Mindapples training improved their ability to self-manage stress and increased their knowledge about their own minds in contrast to the control group. In this modest sample, these improvements were statistically significant and maintained at three-month follow-up, and after differences between the intervention and control groups were considered. A statistically significant increase in mental wellbeing was also found for the intervention group post-training, though this difference did not persist at three-month follow-up.

The focus groups revealed that the students had readily engaged with the Mindapples training and were prepared to make the voluntary commitment to come to the sessions, often overcoming several barriers to doing so. The enthusiastic students also provided many examples of how it had benefitted both their academic work and clinical training. This evaluation was funded by Guy’s and St Thomas’ Charity and the full report can be downloaded here.

Mental health service users

Mindapples made further adaptations to the training to make it suitable for people who have experience of using mental health services. We hypothesised that its focus on mental health (rather than illness) may support their recovery.

The National Survivor User Network worked with us to recruit 82 participants for the pilot study. 39 were in the intervention group and 43 in the control group in two cohorts.

Participants receiving the Mindapples training increased their knowledge about their own minds in contrast to the control group. In this small sample, these improvements were statistically significant and maintained at three-month follow-up, and after controlling for socio-demographic variables. A statistically significant increase in participants’ ability to self-manage their stress was also found for the intervention group post-training and at three-month follow-up, though differences between the groups at baseline may largely account for this. No significant change in mental wellbeing was found.

Focus group participants appreciated the focus of the training on positive mental health which supported them in their daily lives. The lively and engaging style of the training, and user-friendly handouts, helped to secure a high attendance at the eight sessions. Many found the innovative training quite different to their experience of mental health services, and discussed how they have used it in their daily lives. They also provided many useful suggestions for future changes to make it more effective.

This evaluation was funded by Comic Relief and the full report can be downloaded here.

Final thoughts

These were relatively modest pilot studies, but they consistently found that the Mindapples training can be adapted for use with different groups with positive outcomes. Increased knowledge of mental effectiveness and improved ability to self-manage stress were maintained three months after the end of the training, suggesting that participants retained and made use of the new knowledge. Mental wellbeing did not significantly improve in both groups, but many studies have found this to be quite resistant to change.

Future research will need to randomise participants into intervention and control groups to minimise the potential impact of selection bias. However, these two studies provide good evidence that the Mindapples training can be adapted and produce positive outcomes in different groups of people.

This training may help to improve the mental effectiveness of social workers. But that’s for another study…

Acknowledgements

We are very grateful for all the participants who gave their time to participate in the training and the evaluation. We were ably assisted in this work by Charlotte Scott (who helped with the data entry and analysis, and the focus groups with students); Sarah Carr and Tina Coldham (who co-facilitated the focus groups with mental health service users and analysed the data); Alex Murdock (who co-ordinated the training with the students); Andy Gibson, Esther King and Amanda Walderman from Mindapples (who co-ordinated and delivered the training); staff at the National Survivor User Network; and staff and students at London South Bank University. A huge ‘thank you’ to you all, and to the two funders of these pilots. Full acknowledgements are provided in the two reports.

Latest news on our work in Sierra Leone

Meredith Fendt-Newlin has just returned from a visit to Sierra Leone where she met with the nurses we trained in April to see how the Sababu model and intervention has impacted their practice. Here are her reflections on her visit.

 “The training greatly helped me to know to connect myself and my clients to other people or organisations for support.” – Sierra Leone Mental Health Nurse

Developed over the past three years, Sababu is a culturally adapted mental health social intervention that we’re currently piloting with mental health nurses in Sierra Leone. Meaning “connections that may bring benefit” in one of the local languages, Sababu incorporates elements of enhancing a service user’s social capital such as building trusting relationships, communication skills with service users and families, assessing an individual’s assets in addition to their needs, and networking in the community.

Click here to read Martin Webber’s first impressions of mental health services in Sierra Leone, 2014.

sababu

Sababu Intervention model

In April we ran a five day training workshop with 20 mental health nurses, after which they returned to their posts in each of Sierra Leone’s 14 districts. Last week we brought the nurses back to Freetown for refresher training, supervision and a chance to hear how the Sababu model has impacted their practice.

Using case examples from the past three months we discussed ways in which the nurses have been using the Sababu model in their practice during a peer supervision activity. Splitting into small groups of three we asked one nurse to present a difficult case, one to play the role of the supervisor, and the third person to observe and provide feedback on what the nurse could do to improve.

PHOTO-2PHOTO-3

Sierra Leone Mental Health Nurses presenting cases during peer supervision

This activity illuminated some of the many challenges currently faced by the nurses. In Port Loko, still an Ebola “hot spot”, fifteen young people experiencing mental health problems were recently found in a camp held by a local traditional healer, chained to small huts and with little opportunity to move or interact. Health authorities removed the individuals and the nurse in Port Loko is now working to reintegrate them back into the community. She spoke of skills learned in the Sababu training that help her to draw upon the local networks and build relationships to support the recovery of these young people. Her peers made suggestions about which services in the community she might be able to access and offered to be available for peer support as she manages this influx of difficult cases.

PHOTO-4

Disused signs from the former Ebola Treatment Centre at Jui Hospital, Freetown

Read more here about how the EVD outbreak has impacted our work in Sierra Leone.

PHOTO-5

One of the Mental Health Nurses, an EVD survivor, describing her recent experience with the disease

The role of traditional healers is still very strong in most of Sierra Leone, especially in the rural districts where they have been the main source of treatment for many years. One nurse based in an Eastern province struggled to be trusted by the community when she first arrived as a mental health nurse. During role play she shared the process she needed to take in her district to build relationships with the District Medical Officer, the traditional healers, and families by working in collaboration to support service users in the community.  As we learned in April, giving the nurses an opportunity to practice new skills during role play is an effective way to translate theory into practice. And the nurses are brilliant actors!

PHOTO-6 PHOTO-7

Nurses during role play

With only 20 newly trained mental health nurses across the country the referral systems are yet to be fully established; in many areas more advocacy and promotion of services is needed. One of the nurses trained a small group of hospital-based general nurses in mhGAP and aspects of Sababu so they could recognise symptoms and refer to her as appropriate. The establishment of a skilled workforce through such ‘link nurses’ enables the mental health nurse to spend more time with service users and their families.

Click here to view a BBC video with Mental Health Nurse Jennifer Duncan, talking about ways to support people affected by Ebola

 People have known for thousands of years that the best way to understand a concept is to explain it to someone else. “While we teach, we learn,” said the Roman philosopher Seneca. Feedback from the April training indicated the nurses wanted to have more experience, skills and resources to train others in the District Mental Health units (DMHUs).

PHOTO-8

Visiting the DMHU at Connaught Hospital, Freetown

 With this in mind, we obtained funding from the University of York Learning and Teaching Forum to create a series of short training videos that will enable us, and the nurses, to teach others about Sababu and how to adapt evidence-based social interventions for use with service users from diverse cultural backgrounds. The training videos include interviews with the nurses and their supervisors role play and other training activities, and visits to DMHUs in Freetown.

PHOTO-9

Presenting nurses with Certificates of Attendance for the training; Researcher Meredith Fendt-Newlin wearing a dress that was a gift from the nurses for “Africana Friday”

The next stage of the research includes publishing the videos (check back on the ICMHSR blog for updates!), analysing and reporting findings from the evaluations, and looking at ways we can further adapt Sababu for use with social workers and Community Health Officers (CHOs) in Sierra Leone.

Piloting the Sababu Intervention in the wake of Ebola

By Meredith Newlin

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 toward 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.

Our research in Sierra Leone began in 2012 with a feasibility study and development of a culturally sensitive social intervention to mobilise community resources and connect individual service users to supportive networks. In light of the Ebola outbreak, iterations to the intervention were made to address the changing needs of communities. Funded by the Maudsley Charity and one of several projects undertaken by the International Centre for Mental Health Social Research (ICMHSR), Martin Webber and I travelled to Freetown last week to pilot the intervention and determine its application and effectiveness during a humanitarian crisis.

IMG_6754

It had been nearly one year since we had been in Sierra Leone, and two years since seeing most of the nurses we’d be training. We were starting the week establishing relationships and coming together to learn from the intervention and model of practice we’d co-produced during that time. During the introductions I was given a Krio name, Mame, and was told this is a sign of respect. But I knew that earning the respect and understanding of this group wouldn’t be as easy as a name; that it would come over time, throughout the week.

The Sababu Training Programme offers techniques for training mental health workers within a social intervention framework. In Krio, ‘sababu’ means connections with other people, in particular, benefiting from connections with other people. Suggested as a suitable name for the training programme by members of Sierra Leone’s Mental Health Coalition and one of our partners, sababu relates to the notion of social capital, describing the connections among people and the shared value that arises from such relationships.

Over the week our group dynamic shifted. Using Tuckman’s theory we could see how each stage was experienced: forming, storming, norming, and performing. The week was not without challenges but each day we left feeling more energised and connected than the previous day. This group of 20 nurses has worked together for several years. Though now placed in each of Sierra Leone’s 14 districts to lead mental health services across the country, they come together quarterly for supervision and possess a wide variety of experience. Coming in as outside trainers meant that we needed to learn the group dynamic and assert our place with it.

In Sierra Leone there is a culture around receiving that is most often viewed in terms of tangible items. Mental health practitioners experience this as a barrier to their credibility in the community because most Sierra Leoneans are accustomed to getting ill with a short-term disease, with malaria, for example, going to hospital and receiving a tablet or treatment with an immediate cure. Mental health, contrastingly, is often longer course and infrequently treated with medication as supply is drastically limited. The nurses are up against this belief in their day-to-day practice.

We observed this week how the idea of tangible incentives carries over into learning and what the nurses expect to obtain from training. Questions arose about what the incentive of our training would be when knowledge was not immediately seen as a take-away. International aid organisations have plagued the training culture with per diems and financial incentives taking precedence over knowledge gained. It took us time to develop mutual understanding around the purpose of the Sababu training and how it could be seen as an opportunity to enhance practice, to better support the work they’re doing.

In many of the UK trainings Martin and I have done together we use a great deal of experiential learning, sharing difficult cases and success stories to relate the model to practice, building upon that knowledge from peers. But what we encountered in Sierra Leone is that the nurses didn’t feel there was learning happening if it came from peers and their own experience: they wanted to see what knowledge and expertise we as trainers could impart on them.

IMG_6800

Like many African cultures, Sierra Leone teaching is often characterised as using a didactic style. The teacher or trainer is seen as an authority figure with expertise to pass down to participants who listen and observe (typically in lecture format, powerpoint as preference). Coming to training the nurses expected new knowledge to be given and that they could sit as passive recipients. Which, unfortunately, translates to the need for “no sleeping” to be listed in ground rules!

Although it wasn’t immediately welcomed, our style of interactive training, with a great deal of practice through role plays and encouraging the quiet nurses to be actively involved, was eventually appreciated by most members of the group. Understanding their preconceptions of what training should look like, we didn’t need to drastically change our plans but found activities that would meet their needs whilst offering dynamic interaction. It did also help us to think critically about the pitch. We needed to ensure the nurses would walk away with specific strategies and tools to use in their practice so they felt they had learnt something.

During introductions one day, most described themselves first and foremost caregivers, thinking often of how to support others but very little about how to address their own problems. Reflective practice was a new concept to them and we found it was necessary to provide a step-by-step process in how to analyse their own problems, reflect on what they could have done better in their past experiences, and begin to apply such learning to new situations.

IMG_6817

We also spent a full day on social network mapping, first getting the nurses to write down their own networks and support systems. When it came time to practice using this approach with service users, it was clear that writing is not always possible—stationery may be unavailable, service users may be illiterate—and thus an approach of using one’s hand to discuss social networks was deemed more appropriate. We asked them to list five supportive figures, one on each finger, on the palm to imagine enjoyable activities and the wrist as a place to imagine a comforting proverb. We then needed to break down the specific questions they could ask a service user to elicit information about their assets and resources to access in the community. By repeating these questions in role play we hope the nurses turn this new approach into tacit knowledge and make changes to their usual practice.

I noticed a pattern in each role play, it would start with the family member discussing why they had brought their son or daughter to see the nurse, the nurse addressing the family member first, sometimes speaking as if the service user wasn’t even present, and only after the family member had shared their story would the nurse turn to the service user. I could see that part of this approach was to show respect to an elder, but on the other hand it undermined the service user and inhibited trust building.

One of our local trainers, George, paused the role play to put a rule in place: speak only to the family if your relationship with the service user has broken down. We could see this was a major shift for some nurses. Changing the tacit knowledge in how they’ve always practiced is not an easy shift. But this is why role play seemed to be one of the best training methods we used, it’s necessary for them to practice the concepts we were teaching. And in a storytelling culture they are all brilliant actors, usually keen to be the difficult/unresponsive service user or the loud angry parent!

On the final day of training the nurses were asked to complete evaluation forms to assess their reaction and satisfaction with the training, the extent to which their knowledge has been enhanced, and to gain feedback about how to improve the training in future iterations. I will return to Sierra Leone in July and October to evaluate the extent to which the nurses have been able to put this new knowledge into practice. At that time we will also offer refresher training sessions and create videos to be used in teaching this approach of social intervention development to social work students and practitioners, funded by University of York’s Teaching and Learning Rapid Response Fund.

 

Visit from ICMHSR collaborator

This week we’re really pleased to welcome David Ansari to the University of York. David is a collaborator of the International Centre for Mental Health Social Research (ICMHSR) from the University of Chicago and he’s coming to discuss some research plans with us.

David worked on the development of the Connecting People Intervention with ICMHSR Director, Dr Martin Webber. A skilled ethnographer, David undertook ethnographic fieldwork with us in the UK to help us explore good practice in supporting people with their relationships with others.

International Centre for Mental Health Social Research lunchtime seminar

On Thursday 5th March there is an opportunity to meet David when he talks about his own work on migrant mental health. He will be presenting at the ICMHSR lunchtime seminar at 12pm in A/C/209 at the University of York. Further information can be found on the ICMHSR events page, but here are more details about his project:

Diagnosing disorder and recognising difference: Training in immigrant mental health and social services in Paris

In France, the Republican ideal of equality has led to the lack of official acknowledgement of cultural difference within the country’s multicultural population. In the context of mental health services, France’s policies of inclusion have precluded the establishment of specific state-sponsored services for migrant and minority groups. However, previous research describes how clinicians have developed approaches to address the mental health needs of France’s migrant groups with varying degrees of state recognition and acceptance by other clinicians.

My dissertation project explores how clinicians and front-line workers, such as psychiatrists, psychologists, social workers, interpreters, and medical secretaries, manage tensions between state discourses of providing universal care for all citizens, expertise regarding the cultural and structural factors impacting mental illness, and popular sentiments about immigration in France. I examine how knowledge of immigrants’ experiences of mental illness is taught, contested, and applied in mental health and social care settings. I focus on the ways in which actors in these service settings disentangle knowledge about structural barriers to mental health from perceptions regarding cultural factors that impact care.

My thesis involves an ethnographic project at a multilingual mental health centre in Paris. I will build on previous research by examining how clinicians are trained to recognize culturally complex cases of mental illness and how protocols are developed to address the mental health needs of migrants.

All are welcome!

PhD studentship on street triage

The International Centre for Mental Health Social Research is offering a PhD studentship on street triage to start in September 2015. With North Yorkshire Police and Tees, Esk & Wear Valleys NHS Foundation Trust we have obtained an ESRC studentship from the White Rose Social Science Doctoral Training Centre to conduct an evaluation of street triage in North Yorkshire.

images

The project

Police officers report that a disproportionate amount of their time (anecdotally reported to us as 50 per cent) is spent in responding to incidents involving people with mental health problems. This is common throughout England and Wales, and the Government recognises that the police are not always best placed to respond to mental health crises.

In February 2014 the Government published the Mental Health Crisis Care Concordat to improve the care provided to people in a mental health crisis. In York and North Yorkshire, many agencies including NHS Mental Health Trusts, North Yorkshire Police, and Clinical Commissioning Groups have declared their commitment to implement the Concordat.

One initiative which has been introduced to improve mental health crisis care is street triage. This involves mental health professionals advising police officers on, or accompanying them to, incidents where police believe people require immediate mental health care and support. The Government has invested £25m to pilot street triage in locations across the country and in North Yorkshire schemes are currently in operation in Scarborough, York and Selby. Street triage in Leeds, for example, is producing early evidence that the use of police powers under s.136 Mental Health Act 1983 to remove someone who appears to be suffering from a mental disorder to a place of safety has been reduced by 22 per cent.

Street triage is yet to be thoroughly evaluated, though pilot sites are collecting and reporting data to the Department of Health. This project builds upon our evaluation of the Scarborough street triage service to extend our knowledge of the process and outcomes of street triage to inform its development both locally and nationally. It has three specific objectives:

  1. To calculate the proportion of police time spent with people with mental health problems and to understand the nature of these incidents.
  2. To evaluate three, six and twelve month outcomes of people who have used street triage services in terms of their contact with police, criminal justice system and mental health services.
  3. To understand the processes and mechanisms of street triage which contribute to both short and long term outcomes.

Apply

If you are interested in making an application for this studentship, further information is available here. The deadline for applications is Friday 20th March.

Two new studies for 2015

The International Centre for Mental Health Social Research has been successful in obtaining funding for two new studies starting in February 2015. Both studies are evaluations of innovative mental health services to help build the evidence base for practice and to inform future commissioning decisions.

Peer support service

The peer support service provided by South London & Maudsley NHS Foundation Trust in the London Borough of Southwark matches people with psychosis with a peer to support their recovery.

The service started in June 2011 initially to help individuals who had accessed the crisis services and had opted for home treatment rather than a hospital admission. From September 2012 the service was extended to people in hospital. The aim was to match individuals just before their discharge, as this was the point that clinicians perceived them to be most at risk of relapse, anxiety and encountering other difficulties due to the sudden reduction in support. Individuals were entitled to six to nine months of peer support which was deemed to be sufficient time to support them through discharge and for any initial problems experienced post-discharge to be resolved.

The Southwark peer support scheme can be defined as a ‘peer delivered service’ whereby the frontline support is delivered by peers, and clinical and non clinical staff provide aid for the peer supporters.

The evidence for the effectiveness of peer suppport is not strong. A recent systematic review found little or no evidence that peer support helped to reduce hospitalisation,  reduce symptoms or improve satisfaction with services (Lloyd-Evans et al, 2014). However, there was some evidence that peer support was associated with improvements on measures of hope, recovery and empowerment.

In 2013 we published an interim evaluation of the Southwark peer support service. The initial evaluation examined routinely collected data, but there was insufficient to make any firm conclusions.

South London & Maudsley NHS Foundation Trust have now funded us to return and undertake a further analysis of outcome data which the service has collected. This will be supplemented by qualitative semi-structured interviews to explore individuals’ experiences of the service. It is a small evaluation and will be completed by late spring by our researcher Samantha Treacy.

Street triage evaluation

The Department of Health is funding pilots of street triage across England to help reduce use of s.136 Mental Health Act 1983. Street triage sees mental health professionals advise local police forces about their response to calls involving people with mental health problems. The aim is to divert people from police custody where this is not required and facilitate access to mental health treatment. In Leicestershire, for example, an early street triage pilot has seen a 33% reduction in s.136 detentions.

The Scarborough street triage pilot has been running for over 9 months and is a partnership between Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and North Yorkshire Police (NYP). We have been working with them to design an evaluation which will help both services understand if, and how, street triage works in the first year of its operation.

We have been successful in obtaining funding from the N8 partnership of eight northern universities co-production programme (which is funded by the Economic and Social Research Council). This research programme aims to learn how co-produced research between academics and non-academics might help to shape the future of social science research.

Embedding research findings into policy and practice is the ultimate aim of applied social science. While projects frequently include knowledge exchange as part of their funded activities to increase the impact of their findings, few have the opportunity to reflect on whether this process achieves its desired outcome. This small evaluation includes reflective learning on the co-produced process of embedding research findings in practice to investigate how jointly agreed and delivered messages are received and acted upon by mental health practitioners and police officers.

This project will utilise multiple methods including the analysis of routinely recorded information on police and NHS databases, qualitative interviews, participant observations and reflective diaries to achieve the following objectives:
1) To evaluate the impact of street triage on rates of s.136 Mental Health Act 1983 in Scarborough and district
2) To evaluate the short-term outcomes of people seen by street triage in terms of their
contact with the police and mental health services in Scarborough and district
3) To understand how the co-design and co-delivery of street triage contributes to its
outcomes
4) To co-design and co-deliver briefing sessions to police officers and street triage
practitioners to discuss research findings
5) To reflect on the immediate impact of the co-produced evaluation on policy and practice in the police and NHS

This evaluation will be conducted by Annie Irvine in the Social Policy Research Unit, supervised by ICMHSR Director Dr Martin Webber. Annie will work in partnership with data analysts in NYP and TEWV to undertake some aspects of the evaluation. We also look forward to working closely with NYP and TEWV to learn how co-produced research can produce insights lacking in traditional academic research. The evaluation will be completed by summer 2015.

International Symposium on Evidence in Global Mental Health

The International Centre for Mental Health Social Research (ICMHSR) brings together researchers from the University of York with those around the world to develop a programme of research which has the potential to influence mental health policy and practice both nationally and internationally. This week we have brought together four of our international collaborators for the first time.

DYUTI 15

20150107_165957

ICMHSR supported one of its partners, Rajagiri College of Social Sciences in Kerala, India, to organise an International Symposium on Evidence in Global Mental Health which was held from 7-9 January 2015. Led by ICMHSR collaborator Fr Saju Madavan, staff and students from the Rajagiri School of Social Work hosted an international meeting attended by about 250 people. This conference was part of their annual series of DYUTI (meaning ‘spark of life’) forums.

Rajagiri were superb hosts and attended to every detail to make both national and international delegates feel welcome. Every aspect of the visit including transportation, accommodation, food, visits, cultural and social activities were taken care of. Their hospitality was far superior to that provided by any international conference and made us feel part of the Rajagiri family in a very short space of time.

Scientific programme

The scientific programme included papers of a quality found at other international social work conferences. Its focus on the social work role in addressing the ‘effective treatment gap’ (the difference between the number of people with a mental health problem and the availability of effective interventions) in low and middle income countries was important and unique. It raised the profile of global mental health problems amongst social workers and reminded the community of researchers in global mental health that social workers have an important role to play. The conference featured presentations from India, USA, Australia and Belgium, but I only mention those here which involved ICMHSR collaborators for the sake of brevity.

Day 1

Inaugural session

Inaugural session

ICMHSR collaborators played a full role in plenaries and workshops during the conference. Dr Martin Webber (Director) gave a special address to open the conference. He explored the role of mental health social workers in the global mental health agenda and argued that there is untapped potential within the profession. He used evidence from ICMHSR research to argue that social workers have the potential to contribute to closing the treatment gap in low and middle income countries, but more work is required to develop, evaluate and implement culturally appropriate social interventions.

Adopting the mantra ‘Start Local, Think Global, Act Local’ he argued that international research evidence could inform the design of solutions to local problems. Warning against the wholesale adoption of social interventions from different countries which may not be culturally appropriate, action should be locally determined. Finally, he argued that research should be used strategically to develop and evaluate interventions in the local contexts in which they are to be used.

Day 2

On the second day ICMHSR collaborator Dr A.T. Jotheeswaran (Public Health Foundation India) gave a plenary paper on the mental health of the ageing population. He discussed his work in India where he has trained health workers to diagnose common difficulties associated with chronic mental and physical health problems in older people. He has also designed interventions which health workers deliver to address these difficulties and is in the process of evaluating these in a randomised controlled trial.

In the afternoon, Dr Martin Webber and Meredith Newlin (ICMHSR Researcher at University of York) led a workshop on scaling up mental health programmes. They presented the findings of the Connecting People studies and the feasibility of adapting the Connecting People Intervention for use in Sierra Leone (now as a response to the Ebola outbreak) to help alleviate psychosocial distress. They led a discussion with delegates about how intervention models can be transformed for use in different socio-economic and cultural contexts. They suggested that ‘scaling up’ should be viewed as the whole process of developing new ways of working, evaluating them and utilising them in different communities or countries, and not just the final part of this process.

Whilst this workshop was running, ICMHSR collaborator Dr A.T. Jotheeswaran held a workshop on mental health research. He discussed different research designs and their role in developing an evidence base for social work’s contribution to global mental health.

These workshops were followed by a plenary panel discussion featuring ICMHSR collaborators Dr Martin Webber and Dr A.T. Jotheeswaran and other colleagues who shared their thoughts on the research priorities in the field of global mental health, particularly of relevance to social work. There was general agreement amongst panel members that social workers have the potential to contribute to reducing the effective treatment gap. However, as a profession we need to improve the rigour of our research so that it can make a valuable contribution to the evidence base for global mental health.

Day 3

The ICMHSR contributions on the final day started with a plenary session chaired by Dr Martin Webber. This featured four papers, three of whom from ICMHSR collaborators. Professor Jacques Joubert (a research neurologist from Melbourne, Australia, who is a new ICMHSR collaborator working with us on grant applications straddling the boundaries of mental health and chronic disease such as hypertension) presented his work on the role of social isolation as a risk factor for post-stroke depression, which increases the risk of further strokes. Social work interventions which help to alleviate social isolation can improve mental wellbeing and prolong lives.

Meredith Newlin introduced the Sababu intervention model which has been developed with the Mental Health Coalition in Sierra Leone in readiness for training psychiatric nurses in the country (there are no mental health social workers there). She discussed how the model and training is being modified in response to the Ebola outbreak to help the nurses provide a response to the psychosocial distress caused by the humanitarian crisis.

Finally, ICMHSR collaborator Professor Lynette Joubert from the University of Melbourne, Australia, presented her research on brief social work interventions for people who present to hospital Emergency Departments with self-harm. She discussed the findings of her randomised controlled trial which found that good social work practice helped to reduce re-presentations to Emergency Departments and the severity of depression of participants. The intervention is currently being evaluated in Wales to investigate if it can be adopted in a different country.

In the afternoon, ICMHSR collaborators Dr Martin Webber and Professor Lynette Joubert contributed to a plenary panel discussion on global mental health policy. Each briefly presented the social work contribution to mental health care in the UK and Australia respectively, with colleagues from USA and India talking about their respective countries. While there is some diversity of roles, there is a consensus that social workers play an important role, but this is not always supported or made explicit in mental health policy.

Finally, Dr Martin Webber was invited to offer some take-home messages in the closing valedictory to the conference. He suggested that we must continue to learn together and from each other. Exemplified by starting each day of the conference with a demonstration of yoga, Western countries have much to learn from the natural mind-body wisdom of people in India. In turn, we have a duty to work with colleagues in India to support the development of social work and community mental health services. In so doing, we should strive for excellence in our social work practice and research, and challenge ourselves to move outside of our comfort zones. Finally, he emphasised that we need to look after our own mental health and that of people around us. We all have mental health and we need to take care of it.

Research collaboration

(l-r) Dr Rameela Shekhar, Ms Meredith Newlin, Prof Lynette Joubert, Fr Saju Madavan, Dr Martin Webber

(l-r) Dr Rameela Shekhar, Ms Meredith Newlin, Prof Lynette Joubert, Fr Saju Madavan, Dr Martin Webber

The conference also fulfilled its role in bringing ICMHSR collaborators together to discuss research proposals. It facilitated a meeting of our Indian collaborators, Dr A.T. Jotheeswaran and Fr Saju Madavan, with Professors Jacques and Lynette Joubert from Melbourne. Dr Martin Webber chaired a meeting with them, Meredith Newlin and two other collaborators from India, Dr Rameela Shekhar (Dean of the School of Social Work at Roshni Nilaya, Mangalore) and Professor Keith Gomez (formerly of Loyola College, Chennai).

The collaborators quickly identified common research interests and made an action plan to undertake some pilot work in preparation for grant applications later in the year. We will be focusing on finding ways for social workers to support people in Kerala to manage long-term mental and physical health problems more effectively. We will draw on our experience in the UK, Australia and India to collaborate on new research which has the potential to have a positive impact on social workers’ practice and the local communities in which they are working in Kerala.

Reflecting on his week in India, Dr Martin Webber said:

On behalf of the International Centre for Mental Health Social Research I wish to again extend my warm appreciation and heartfelt thanks to Fr Saju and the faculty and students of Rajagiri School of Social Work for their hospitality and excellent organisation of the conference. It has been an excellent week and I look forward to continuing our work together.

You can read a personal perspective on his visit to India in Martin’s blog.

 

The research behind the Connecting People Intervention

The first paper reporting findings from research which led to the creation of the Connecting People Intervention was published on 1st December 2014 online by the journal Health and Social Care in the Community.

‘Enhancing social networks: a qualitative study of health and social care practice in UK mental health services‘ explores how workers connect people with mental health problems to others in their various communities. It focuses on good practice which enables us to recommend to other agencies how best to train their workers to undertake this vital work.

Supporting people’s connectivity is important as it helps them to get on and get ahead with their lives. People who are better connected in society can find better jobs and more resources, which lead to wealth, power and status. Supporting people to enhance their networks helps them to stand a better chance when looking for work or other life opportunities which can enhance their well-being and recovery.

We worked with six agencies and teams who were a mixture of third sector and statutory agencies:

We spent a lot of time with workers in these teams, talking to them and the service users they were working with, shadowing them on visits and community activities, and sitting in on team meetings. We observed how they supported people to connect with others and how the agencies which employed them supported them with this task. In total we collected data from 73 workers and 51 people who used their services in this study.

We conducted our data analysis with some of the participants of the study to ensure our assumptions were correct. Focus groups helped us to refine our themes and develop the intervention model, which will be reported in a separate paper.

The prominent themes to emerge were the importance of worker skills; attitudes and roles; connecting people processes; the role of the agency; and barriers to network development. The sub-themes which were identified included worker attitudes; person-centred approach; equality of worker–individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on.

These themes are consistent with recovery models used within mental health services and were subsequently modelled into the Connecting People Intervention.

This study was important as it helped us to define the components of the Connecting People Intervention which has subsequently been shown to be effective in enhancing individuals’ access to social capital.

We would like to thank all the participants of the study, the participating agencies and the NIHR School for Social Care Research for funding the research.

Webber, M., Reidy, H., Ansari, D., Stevens, M. & Morris, D. (2014) Enhancing social networks: a qualitative study of health and social care practice in UK mental health services, Health and Social Care in the Community DOI: 10.1111/hsc.12135

Please do not hesitate to contact me if you would like a PDF copy of the paper and do not have access to this via the publisher’s website.

ICHMSR example used in new guidance from ‘Involve’

Involve is the organisation, funded by the NIHR, to support public involvement in NHS, Public health and social care research. On 24th November 2014 they launched new ‘Guidance on the use of social media to actively involve people in research’ . The guidance provides examples of ways in which different types of social media are currently being used to involve the public in research, the benefits, challenges, risks and ethics of using social media for involvement, and some top tips and things to think about.

ICMHSR has provided a case study for the guidance document: Using Twitter and a blog to identify and prioritise topics for research. It comes from the experiences of Martin Webber in using his established twitter account and blog to reach as diverse an audience as possible, but especially people with mental health experience – those using mental health services and those working in mental health.

In the case study Martin lists the challenges involved but also the power and impact of using this medium to directly contact people who were engaged in debates about mental health and its services. He sums up the piece by giving advice to other researchers about using social media to actively involve people in research:

“Think clearly about what you want to get out of it. Think about your target audience
and select the social media that this group is most likely to use. Use more than one
form of social media if possible.

“Make the requirements on people as minimal as possible – e.g. only ask one or two
questions.”

“Be warm and positive and engaging and enthusiastic. Don’t assume that just
because you’ve got a good title or a catchy tweet this will come across to people.”

“People get fed up with you if you are always self-promoting, so pick different things
to tweet about, tell people about interesting articles, resources etc.”

“In the current university landscape there’s a lot of emphasis on knowledge
exchange and on impact. But you need to communicate and share what you’re doing
at the beginning of a project and on an ongoing basis. That engages people so that
when you have the results they are already interested.”