All posts by Andy

Who monitors the monitor?

who monitors the monitor?

(This post is by Kim Moore : BCU Mental Health Nurse Lecturer)

Current debates on health services are never far from headline news these days. In the wake of the Stafford Hospitals inquiry and the emerging issues of Morecambe Bay Hospital the role of the Care Quality Commission in monitoring and applying quality assurance standards to others seems somewhat hypocritical.

Public confidence in the work of the CQC has been seriously undermined by its own management team and the ability as an organisation to meet its own stated objectives (parliamentary business post can be found here).
What of CQC’s new role in policing “openness and transparency” in the NHS?  Recommendation 16 in the Francis enquiry (Vol 1, pp 415) clearly called for an independent examination of the commissioning, supervisory and monitoring bodies on learning to identify “failing hospitals” with a “level playing field for accountability” (Recommendation 82) with the clearly identified the consequences of “hiding information about poor care to become a criminal offence” (PM statement Feb 2013 ).

The breaking news of Morecambe Bay Hospital highlights the problems of who monitors the monitor, and to whom they are accountable for poor or misleading practice. The finding from the Parliamentary committee was to severely criticise the function and performance of the CQC, despite the criticism what remains unclear to me are those consequences that Francis outlined when such a clear management failure has been found.

Troubled to trouble maker? Misrepresenting the ‘120,000 troubled families’ in England

(This post is by Will Murcott Lecturer at BCU) With great interest I again see statistics being used to marginalise and foster unhelpful beliefs about the most vulnerable in society.

I welcome the injection of thought and funds into helping those in need, but as shown in a report by Ruth Levitas of the University of Bristol (full report is here, the figures being touted appear to be used in a misleading and misrepresentative fashion.

Thankfully, as a non-statistician, the More or Less programme on Radio 4 explains the case of the 120,000 very nicely (

Ruth Levitas found that the figure of 120,000 problem families originated from research in 2004 which surveyed disadvantaged families, not disruptive or criminal. This found 2% of the studied population had 5 or more out of 7 characteristics. These were:


  1. No parent in the family is in work
  2. Family lives in overcrowded housing
  3. Mother has mental health problems
  4. At least one parent has a long-standing limiting illness, disability or infirmity
  5. Family has low income
  6. Family cannot afford a number of food and clothing items
  7. No parent has any qualifications


The overall figure was adjusted (i.e. reduced) and made relevant for just England. Ruth Levitas argues that this could in fact be a vast underestimation of the actual number, as most families with these problems drop out of such lengthy studies. The ’120,000’ figure also stands alone quoted without it’s sample error. Which in this instance is +/- 3%. Meaning a figure ranging from minus families to 300,000!

Now, where things get a bit cloudy is in the shifting of focus from ‘troubles’ to ‘trouble maker’. A second government report (found here was then brought into the mix. Part of the definition for troubled families included families that are involved in crime and antisocial behaviour. The immediate effect of this was to then associate a family which has significant problems to one which is criminal, as David Cameron demonstrates in a 2011 speech:

That’s why today, I want to talk about troubled families. Let me be clear what I mean by this phrase. Officialdom might call them ‘families with multiple disadvantages’. Some in the press might call them ‘neighbours from hell’. Whatever you call them, we’ve known for years that a relatively small number of families are the source of a large proportion of the problems in society. Drug addiction. Alcohol abuse. Crime. A culture of disruption and irresponsibility that cascades through generations.

Recently the ‘troubled-families tsar’ Louise Casey interviewed ‘over a dozen’ of these families and found:

The prevalence of child sexual and physical abuse and sometimes child rape was striking and shocking. Some discussed it as if as it was almost expected and just a part of what they had experienced in life. Children often had not been protected by their parents. In many of the families the sexual abuse repeated itself in the next generation … There were also incidents where families talked about incest.

I welcome the raising of interfamilial abuse into the mainstream agenda and the potential cycle this has and its devastating impact on people’s lives. However, I fear that these associations will distort the necessary understanding of families in need of significant support from children’s mental health services, adult mental health services and social services. The associations made by linking poverty, crime and abuse and ‘identifying’ these families in way that gives the impression that there is a department somewhere with a list of families misrepresents this and those that we aim to work with.

We do need to be able focus and respond to families that are the most vulnerable, especially when it comes to early intervention of mental health services. But to do so under misleading evidence of whom and where these are will not help them or the understanding that the public has of these issues.

Courageous MPs speak of personal experience of mental illness in Parliamentary session

Houses of Parliament

(This post is by Will Murcott Lecturer at BCU) I was very pleased to see the issue of mental health and discrimination being raised in parliament the other week, and at the bravery of four ministers who stood up and spoke openly about their experiences of obsessive compulsive disorder, depression and postnatal depression. It’s not often I’m made to sit up and take notice when listening to recaps of parliamentary sessions, but this was something unique and special.

For those members of parliament to speak about their illnesses when their positions ultimately depend on the votes they receive from the general public was exceptionally brave.

The excellent article by Clare Allen outlines some of the discrimination from current legislation faced by members of the public, and also for MPs, an area I was not familiar with. In particular the rule where an MP automatically loses their seat if they are detained for more than 6 months under the Mental Health Act 1983. has a video extract of Kevin Jones MP, Charles Walker MP and Sarah Wollaston MP speaking in Parliament. Charles Walker’s very personal, eloquent and funny speech is here in full .

A private members bill introduced by Gavin Barwell MP proposes to change existing legislation which discriminates against those with mental health difficulties. This will hopefully continue to place much needed pressure for the continual revision and open debate of legislation in this sensitive area.

Learning Disability nurse vacancies?



This post is by Fiona Rich, senior Lecturer in Learning Disability Nursing at Birmingham City University.

I am disappointed to learn that our first year student nurses are yet again being told that there are no jobs available for learning disability nurses, because in fact there are many vacancies for learning disability nurses – just Google ‘Learning Disability Nursing Vacancies’ and see for yourself.

The NMC have recently re-written competencies for entry into Learning Disability Nursing… they would not have done so if the role was going to be obsolete.  In addition, this university alone was commissioned for 35 Learning Disability Degree students by the Strategic Health Authority for our next intake… again, they would not spend money training student nurses if they intended to make the role obsolete.  The Strategic Health Authority only commission student places for the jobs available within the NHS, but only 45% of learning disability nurses work in the NHS – the other 55% work in the private, voluntary and independent sector.  This means that there is actually a shortfall of 55% of learning disability nurses to meet the demands throughout the UK.

All of our students get jobs when they qualify – whether it is in the NHS or other sectors is irrelevant as they still provide the skills needed to support this vulnerable group of people which is growing in demand not decreasing.  Many people with learning disabilities are living to an older age and therefore have very specific needs.  In addition, people with LD tend to acquire the problems associated with older adults (eg Alzheimer’s, Dementia, physical disorders and diseases such as sensory defects, cancer, diabetes, respiratory and cardiovascular illnesses) at a much earlier age than the general population so there is a growing need for very specialist learning disability nurses.

Sadly, I have been hearing this misinformed argument about the future of learning disability nursing for decades but there is still a demand for such a role and it grieves me to see genuinely dedicated learning disability nurses dissuaded from qualifying in this branch.  I would urge all first year learning disability nursing students to think carefully about who will support this vulnerable group of people if there were no learning disability nurses in the future because the very specific needs of individuals with learning disabilities are not going away.

New Perinatal mental health care course

(This is a post by Pam Morley, Senior Lecturer at Birmingham City University)

Many people are aware of possible mental health problems associated with pregnancy but do people realise how destructive these can be?  Suicide in the perinatal period is the highest cause of maternal death in the UK.  Also, maternal depression prior to the baby’s birth can increase the risk of birth complications and poorer birth outcomes, including higher rates of spontaneous abortion, low birth weight babies and developmental delay.  Again, anxiety in the mother has been shown to be linked to poorer child health and behavioural difficulties at the age of four years.

National Perinatal Mental Health Project

The National Perinatal Mental Health Project Report, published by the Mental Health Development Unit on 8th March 2011 examines provision of mental health care for women who are planning to have a baby, are pregnant or who have had a baby in the past year or so.  In particular the report examines the current provision of care for women in the Black and Ethnic Minority groups.  (

Seamless care?

As I was reading this report one finding struck me as being very significant; namely that 27 different professional groups may be involved in the care of women with mental health difficulties who are in the perinatal period.   How can all these different groups work together to provide seamless, efficient care?   After all, many of them will have been trained in different ways and use various theories to underpin their practice.

So, how can care be co-ordinated and dove-tailed together?  The answer is fairly straightforward, I think.  It is the mental health nurse who is at the hub of the multidisciplinary ‘wheel’ together with the service user.  It is the mental health nurse who spends time with the service user, who is the conduit through which messages are passed and information carried.  Perhaps we should be highlighting this aspect of our role much more.  Forget superconductors; just get a mental health nurse involved!

Post-graduate certificate in perinatal mental health at Birmingham City University

Seriously though, we should be promoting this aspect of our role, and giving it the value that it deserves.  Without the nurse to ‘glue’ the team together, care would be a lot more fragmented.  The importance of communication is a strong aspect of a new post-graduate certificate in perinatal mental health being run at Birmingham City University.   This is a brand new course, designed b y academics and clinicians together and aimed at any health care professionals who work with women in the perinatal period.  If you would like more information about the course, please email

(Pictures from Flickr creative commons click photos for more details re authors)

Commercial clinical trials : How do we get health professionals interested?

(This is a guest post by Gemma Borland on behalf of the Heart of England Hub of the Mental Health Research Network)

drugs etc

Do your patient’s receive the best possible treatment? How do you know?

Every day in clinical practice medications are used, but do you know how these medications have been developed and would you want to be involved when the products of the future are being tested?
Pharmaceutical companies sponsor clinical trials to research new medications.  Potentially, these trials may lead to the  development of  more effective drugs.

The importance of this research cannot be underestimated, finding medications with fewer side effects, which are easier to take, impact less on someone’s life and manage someone’s condition better, can improve a service user’s quality of life dramatically. The need to continually strive towards the best treatments available in the NHS is paramount.

Equally important is the need for new medications to be tested in the NHS and on the UK’s patient populations.

Clinical research studies

Since I became involved in setting up clinical research studies 5 years ago, I have worked with dedicated clinicians and nurses, passionate about the importance of commercial research having seen the benefits that access to cutting edge treatments can bring to their patients. However, there is a real need to increase commercial trial activity within the NHS.

Industry trials are often seen as complex, with onerous Sponsor requirements and a lack of understanding as to what the work entails. For Health Professionals who have not yet been involved in commercial clinical trials, the work can seem a daunting avenue to pursue. This is the challenge facing the Mental Health Research Network, a national initiative to support mental health clinical research in the NHS.  We need to identify how we get individuals involved in commercial research and look at the issues which may prevent people working on commercial trials.

Mental Health research Network

The Heart of England Hub of the Mental Health Research Network is currently piloting a project to develop and run a mentoring programme, tailored at supporting nurses, clinicians and other professionals, working on commercial studies for the first time. The programme will provide an experienced mentor with whom study teams can access for advice and guidance whilst working on a commercial trial, as well as training and information to help people better understand commercial trial work.

With this additional support, we are hoping to expand the number of clinicians, nurses and other health professionals working on commercial studies in the Midlands, with the ultimate goal of increasing the number of commercial trials running across the region.

We want your comments, i.e. what are your opinions on commercial clinicial trials, would you get involved? If not, why not?
For further information on the mentoring programme contact :

NHS fails to care for elderly?

No doubt everyone has heard by now that the Health Service ombudsman has published a report which is critical of NHS care of the elderly (Report available here)

I have not had time to read the full report but what I have seen is a grim catalogue of neglect and incompetence.

It is apparently based on ten complaints – not a big sample but big enough to make a major impact in the news ( BBC , Daily Mail , Express , Guardian )

Would many people be prepared to argue that these cases are unrepresentative of care – and that we really do have good standards of care?

I know a lot of people in NHS health care and of course I get to speak to our students about care –  I am sure that people still want to do a good job and strive for high standards.

Rather than pontificate for ages about this I really wanted to ask you all – what do you think?

Uniforms in Mental Health Nursing…or not?

Andy Hamilton honoured
(Perhaps the last time our Mental Health Nursing graduates will wear a uniform?)

This post looks at some of the issues around the wearing of uniforms in mental health nursing, as usual we would welcome any comments that you may have.

Currently, although most mental health nurses do not have to wear uniforms this is under review at our local trust – (Birmingham and Solihull Mental Health NHS Foundation Trust ). According to Deputy Director of Nursing Martin Herriott, the Trust are looking at re-introducing uniforms in some areas such as acute in-patient and older peoples services.

Feedback from both service users and carers indicate that staff are often very hard to identify, uniforms might make this less of a problem as well as making staff appear more professional? Of course, there are ongoing concerns around infection control in areas where staff are likely to be exposed to bodily fluids of any sort.

In some areas it is likely that the Trust will avoid uniforms, such as for example long term residential areas where service users are likely to live for any length of time in home like environments. Also, staff going outside of care areas with clients (for instance escorting people to hospital appointments etc) will need to cover up uniforms.

Obviously, this is a potentially controversial idea – although some people are in favour of wearing uniforms, others are likely to be less keen. I found a recent survey amongst patients in a US mental health unit (Miller,T. Mann, N. Grim, R 2010). This study set out to examine patients attitudes about what nurses wore and whether their attire made nurses appear more approachable, competent and professional. Whilst most did have any particular preference what staff wore there was a lot of concern that nurses were difficult to identify. Interestingly, whilst over half of the respondents felt that attire made no difference to approachability, 29% felt that ordinary clothes made nurses seem less approachable!

Another, earlier study conducted in London (Tham, S & Ford, T 1995) concluded that it was other staff who had difficulty identifying nurses whilst 36% of patients felt that uniforms made staff less approachable. For some reason, patients in ‘old age wards’ were excluded from this study – (old age = ‘assume that everyone has dementia?) a shame as this is a client group most likey to encounter nurses wearing uniforms. This aside, it was generally agreed that identification of some sort was really important.

Across at Mental Nurse blog there was a discussion about uniform – most contributors were opposed although there was a contribution from a service user who flagged up the issue of nurses being identifiable (although in fairness, uniform/ identification might not have been at the top of my list of priorities to sort out in this example).

We did a quick (and totally unscientific survey) with a BCU student group and asked them what they thought about this issue.

(thanks to Kate Hopley, Oliver O’Connell & Kimberley Zilke for filming and BCU pre reg MH group Dip HE 0409 for appearing in the film)


Miller, T. Mann, N. Grim, D (2010) Clothes Encounter: Patient Perception of Nursing Attire in a Behavioral Health Unit. Journal of the American Psychiatric Nurses Association. 16(3):178-183, May/June 2010
Tham, S & Ford, TJ (1995) Staff dress on acute psychiatric wards Journal of Mental Health 4, 297-299

“Let “Her” Have it”!

(Post author Mark Jukes from BCU LD team*) 

Death row inmate Teresa Lewis is pictured in this undated photograph, September 23, 2010. Lewis, who is convicted in the October 2002 hired killings of her husband and stepson, is scheduled to die by lethal injection on Thursday, September 23, and would be the first woman executed in Virginia in nearly 100 years. UPI/ Photo via Newscom

Does this quote ring any bells?

Well, to some of us familiar will remember this was the famous alleged line (although it was “Let Him Have It”), from Derek Bentley which sealed his fate at the gallows in 1953 for shooting a policeman.

Teresa Lewis died early today after being given a lethal injection at the Greensville Correctional Centre.

The first woman to be executed in Virginia since 1912,and the first in the USA for 5 years,and a woman who had a borderline mental retardation (USA terminology),with an IQ of 72 and additionally diagnosed with Dependent Personality Disorder.

In the UK, the sentence handed down to Derek Bentley in 1953 produced outrage over his execution, although he was labelled as being illiterate and of low intelligence – he wasn’t deemed as being “Feeble-minded” under the then Mental Deficiency Act. He was granted a Royal Pardon in respect of the sentence of death,and in 1998,the Court of Appeal quashed Bentley’s conviction for murder.

1. In an EU protest,the ambassador to the US wrote: “We consider the execution of people with mental disorders of all types is contrary to minimum standards of human rights”.

2. Contemporary opinion does not seem to learn from cases such as Bentley where the issue of Capacity and Aquiesence to crime is particularly of note with people who have learning disabilities.

Instead we have politicians who refuse to budge on giving a reprieve to what the rest of us consider as “unsafe” convictions.

In my opinion this flies in the face of human rights and ignores this womans vulnerabilities in the cause of ‘justice’ – I deplore this.

JARRATT, VA - NOVEMBER 10:  A correctional officer directs a driver outside the Greensville Correctional Center November 10, 2009 near Jarratt, Virginia. Condemned DC sniper John Allen Muhammad is scheduled to be executed by lethal injection at 9 p.m. at the center for the shooting death of Dean Harold Meyers at a gas station in the Manassas area of Virginia on October 9, 2002.   (Photo by Alex Wong/Getty Images)




(* Sorry – ongoing tech problems prevent me labelling the post author correctly)

Personalisation: Where are we going?

This post is by Mark Jukes Reader in Learning Disabilities at BCU – (technical problems are getting in the way of my being able to credit him properly)

In mental health and learning disability nursing what does Personalisation mean and what impact does this new wave of ideology and policy have on nurses? 

In the context of mental health and learning disability services, Personalisation accommodates mental health promotion and maintenance: having choice and control over one’s life contributes to well-being. Personalisation is about meeting the needs of individuals in ways that work best for them,(Carr, 2008)

In specialist mental health and learning disability nursing there appears to be a number of competing paradigms in terms of how our clients are perceived.  For those nurses who suscribe to a psychodynamic/behavioural school of practice how does personalisation fit, when after all, Carl Rogers has influenced person-centred practice?

So if determinism is part of your frame of reference for therapeutic relationships, where does the concept of freedom of choice feature in the eyes of mental health and learning disability nurses, who are required to promote individualism,where a full range of psychosocial interventions can be delivered?

Skills need to be developed by professionals so that genuine person-centred assessments incorporating the person’s own view of their needs become the norm.


a father and son sit on the floor and talk

Supplementary prescribing is another area where in developing clinical management plans – concordance of medication is strongly advised from such prescribers, but where the client may see things differently in terms of personal choice and not wishing to endure adverse side effects!

Additionally, how can we apply the concept of person-centred practice across secure settings, in prisons and young offenders institutions? where a balance is required to be achieved between order and freewill. There are particular concerns about the management of risk in certain situations for people choosing to opt for a personal budget,(Spandler,2007).

In communities, individuals who attain either individual or shared tenancies and therefore become tenants not clients in residential care – how do we safeguard against vulnerabilities where the evidence clearly identifies hate crime on the increase for individuals who are vulnerable,yet perceived by society as having equal status and rights when living independently?

I suggest we need to take seriously the fact that personalisation is now in the mainstream and as mental health and learning disability nurses. As a Profession we need to decide how best to move forward with our clients whilst developing new ways of working  across agencies (such as housing consortias) whilst remaining responsive to possible negative effects on clients in a variety of situations and environments.


Carr S (2008) “Personalisation: a rough guide” SCIE,

Spandler H (2007) Individualised Funding,social inclusion & the politics of mental health.Journal of Critical Psychological Counselling,7 (1): 18-27.