Monthly Archives: June 2009

From mental health nurse to nurse lecturer.

This post is from Samantha Chapman, who has just started work as a Mental Health Nurse Lecturer at BCU. We are delighted to welcome her to BCU & hope that you will give her a warm welcome too!

Having spent the last 6 years working with people who experience severe and enduring mental health needs I am now into my third week as a mental health nurse lecturer at Birmingham City University. Frequently having to pull myself down from cloud nine, I shake my own shoulders and remind myself ‘this is the honeymoon period’. Soon I will be committed to my own workload and responsibilities. The transition from nursing in an Assertive Outreach Team to nurse lecturer so far has been very different but enjoyable. I loved nursing; in fact it’s the longest I have ever stayed in the same job. I loved the variety, the experience, the presentation of symptoms, patient’s strengths and advocating, caring and the ongoing learning process as I became more experienced. People I worked with predicted the world of lecturing for me before I chose the path myself. In response I would tell them I’m not ready to leave clinical practice, equally I loved presenting and sharing information to teams, staff, patients and students within my nurse role.

Now I have entered a world where the language and terms used are strange and new. Three weeks into the job I have met with Moodle, Eyelit, Talislist and Uceel, tools I am to become familiar with as they become part of my daily teaching. There is plenty to keep any lecturer busy, with moderation, invigilation, interviews, marking, quality meetings, boards of study and Rolex. There are students to visit on placement, tutorial meetings and personal students to support. There are pathways to co-ordinate, modules to run and classes to teach. In addition, lecturers will want to commit some of their time and interests in research, publication of work, design and creation of new teaching systems. For me, effective time and diary management is essential if I want to contribute fully to my role.

Considering the amount of work expected of the lecturer is it also important to allow time for ongoing involvement in clinical practice. How much time can I realistically commit? Is clinical practice the only way to stay fresh and ahead with clinical issues and skills? Is it essential and do students notice a difference to the quality of their learning experience? Having recently come from clinical practice, I am more concerned with the long term effects if clinical experience is not maintained. Is there cause for concern?

With all that I have highlighted, the University is a buzzing place to work, this week there were delicious homemade cakes, strawberries and cream and fruit punch to tempt us all and raise money for charity, the lemon slice with homemade lemon curd was particularly tasty! When the sun is shining the grounds are perfect for a sunny lunch break.

I would be interested in any comments.

Samantha.

Unconditional positive regard?

I would like to think a little bit about the use of language within mental health. I have struggled for a couple of years with the kind of language that we use on a regular basis, but don’t really give it much more thought. I know we all have words or phrases that when heard, make your hackles rise. Here is a small selection of mine!  How about “therapeutic relationships” for a start, hands up if you can give a definition? I’m sure we all can, but it will mean something different to everyone. Yet we use it often, how many times do we hear people say, “well, first of all I’d build a therapeutic relationship with the person” No! No! No!

Conversation (click to see photographer)

I noticed that even Jim Chapman and Cheryl Chessum struggled with this concept in their chapter in “The fundamentals of mental health nursing”. Their research shows that Aldridge (2006) states that brief definitions of the therapeutic relationships are scarce, giving only one which is, “Building a genuine human alliance that might begin to address the person’s problems with living.” (Barker & Buchanan-Barker, 2005). Jim and Cheryl say that engagement with the client starts the therapeutic relationship. But does it ever get underway? And if it does, where to then?

Maybe it’s on to “Unconditional positive regard”. The good old statement that says I’m not really troubled that you have been violent and aggressive to people in the past, that you beat up your girlfriend so badly she lost her baby, or that you threw your 9 week old puppy down the waste disposal chute, I’ll accept you as you are now because I believe you were lacking “insight” at the time. But what it really means is that I will try and disguise the disgust I feel for your actions because I’m only human and because I’m told you have a mental health problem – but I’m not promising anything.

Speaking of insight…….The Collins English dictionary defines insight as;

“The ability to perceive clearly or deeply”

 And “a penetrating and often sudden understanding, as of a complex situation or problem. There is also, “3. psychol; The capacity for understanding one’s own or another’s mental processes”

“4. Psychia; the ability to understand one’s own problems, sometimes used to distinguish between psychotic and neurotic disorders”.

Now I consider myself to be a fairly rational, responsible and capable human being, but am I always insightful according to the definitions? I don’t think so! So why do we often hear, “Mr Jones, suffering from schizophrenia, lacks insight”. How dare we? A double whammy there – who says that everyone suffers from or with schizophrenia? I know of many people who have and still do enjoy their experiences.

I’m not so stupid as to think we can, or should get rid of this type of language, but I think we need to consider the implications of using it. Are we really being honest in our use of it? Does it exclude people because we as mental health professionals have a shared, common understanding of its meaning and others don’t? Is it a cunningly disguised way of stigmatising and discriminating against “service users/patients/clients” (there’s another area that we should really get sorted!)

What do you think?

 

(NB Click images to see photographers)

A Question of Suicide?

Henry Wallis (1856-58) Reproduced with the kind permission of Birmingham Museums & Art Gallery
The Death of Chatterton: Henry Wallis (1856-58) Reproduced with permission and ©Birmingham Museums & Art Gallery  (click image for more details)

 

On a recent visit to Birmingham City Art museum I had a look at the painting above ‘The death of Chatterton’ by Henry Wallis (1856). This painting shows the dead body of Thomas Chatterton, an 18th century poet who killed himself by taking arsenic rather than live in poverty.

I suspect that if you weren’t familiar with this picture you wouldn’t guess that it shows an impoverished young man who has died of self administered arsenic poisoning. Although relatively unknown during his life, Chatterton’s death became a well known event because of the romanticised reaction it provoked. As well as this painting, there were poetic responses from the likes of Shelley, Wordsworth, Coleridge and Keats.

When Want and cold Neglect had chill’d thy soul,
Athirst for Death I see thee drench the bowl!
Thy corpse of many a livid hue
On the bare ground I view,
Whilst various passions all my mind engage;
Now is my breast distended with a sigh,
And now a flash of Rage
Darts through the tear, that glistens in my eye

(Monody on the death of Chatterton by Samuel Taylor Coleridge See link)

Arguably, this type of response served to glorify the act of suicide. Certainly, there is evidence of concern about how suicide was portrayed in the media. This essay on the Victorian web looks at attitudes to suicide and fears that media portrayals, especially in the ‘cheap press’ might increase suicide rates. How would we feel if a modern day suicide was to receive a response like this? The National Suicide Prevention Strategy is quite clear that it is necessary to promote “responsible representation of suicidal behaviour in the media”.

I was wondering though about how we as professionals really feel about suicide?

Personally, I do feel some uncertainty. I believe that somehow we need to sort out how we as a country are going to work with people who want to end their lives with dignity. There are large numbers of people who suffer from incurable illness and chronic physical and emotional pain who wish to have some control over when their lives will end. I don’t think that this should be left up to families to travel abroad (risking prosecution) with loved ones to assisted suicide clinics. I also think we would be better off if we didn’t have to rely on the likes of this ‘Euthanasia Doctor’ who recently visited the UK.

On the other hand, I spent many years working in in-patient mental health settings where I often cared for people who were considered at risk of suicide. Although we talk about the importance of ‘person centered care’ and working in collaboration with people –  lets be blunt. This involved helping to detain people against their will. There was often (not always) a feeling that the person receiving the care was trying to outwit us. If they succeeded in doing so then a likely result would be the death of that person. Were we right to try and prevent this? – I believe that we were. Is this an ideal way to be treating people? – certainly not – does anyone have any better ideas?

Take a look at this debate (transcript here) with Thomas Szasz, filmed  at Birmingham University. Having read the work of Szasz it seems clear to me that much of his critique of psychiatry and it’s contradictions makes sense. However, it seems quite clear that he wouldn’t approve of working with potentially suicidal people in the manner described above, i.e. “Compulsion is a bad thing”.

Trouble is though, where does this leave all of the people considered at risk of suicide who are currently detained in the UK? What about the people who are doing the detaining? How do we square this with an attempt to treat people with terminal illness’ with compassion and dignity. Lets be clear, I absolutely don’t pretend to have the answers to any of the issues raised above. I am pretty sure that there are no clear answers and certainly no answers that would please everyone. It will be interesting to see what the recent RCN consultation (see also) on the subject of assisted suicide will conclude. How  this will affect people involved in mental health services remains to be seen, I hope it will lead to wider discussion about this subject.

What do you think? – I would be interested to see any comments.

Update 10th June – See comments re an interesting debate on Mental Nurse Blog re Szasz link here & here