Rather than love, than money, than fame, give me truth : Thoreau


Consider these examples:

  • One of my personal students told me that when on placement some staff told their patients that they would do things for them and then never bothered. The student was upset by the fact that staff would systematically and routinely lie to their patients.
  • I did an exam with a group of students, I told them about the assessment criteria and then used something else to work out who passed or failed, ok, I lied but who cares?

The above examples are completely untrue but what would you think about health care staff or University lecturers who routinely lied to people?

Lies: Everyone’s at it?

“It is that truth that guides our action in Libya……………………………………… …………………………………….That is why we stopped a massacre in Libya. And we will not relent until the people of Libya are protected, and the shadow of tyranny is lifted.
(Barack Obama speaking in London’s Westminster Hall)

Is it just me or did the West court Gaddafi for his oil money? Are we now supporting the insurgents so we can now court them for the same?

Then I came back to the NHS. I watched a daughter talking about the death of her mother on the news. Her story reflected the lack of care given to the elderly in the NHS according to the Care Quality Commission report. Yet when we visit websites belonging to these same hospitals we are bombarded with mission statements and philosophies about “putting the patient first”
Is it possible that the public does not need to know the truth? Or is it that we don’t want to? If people in power told us the truth could we handle it? If people in power told the truth could they remain in power?
We live in a world that claims to put transparency above all else but uses smoke and lies to blind us.

What could I say to this student or the daughter? I suppose I’ll just have to say that’s the way things are?

(BBC News 26th May 2011)

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.  (http://www.nmhdu.org.uk/silo/files/national-perinatal-mental-health-project-report-.pdf)

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 pam.morley@bcu.ac.uk.

(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 : gemmaborland@nhs.net

A confusion of words?

The tower of Babel (engraving by Gustav Dore)

I am fascinated by the use of words. Well, I should say that I am fascinated by how people use certain words to present a desirable image of themselves. An everyday example is the obvious one of politicians – you can see them deliberatel pausing several times in an interview to think carefully about what words utter from their mouths.
Rightly so. We all know how easily people can be insulted over a few words (ask Mr Clarkson from Top Gear about this) and so choosing our words is vital.

Using the wrong word can spell doom. I recently marked an assignment where a student ‘psycho-educated a patient on holidays abroad’. Yes this could be psycho education before someone comments but in the context of the essay it clearly was not. Put simply, if you do not know what a word means, then don’t use it as incorrect use sends a very clear signal of the level of your knowledge on the subject!

One phrase that irritates the hell out of me is ‘1:1 intervention’. I saw a football match the other week where the result was 1:1 so if a nurse says they had a 1:1, does this mean they played football? What is so wrong with saying ‘I spoke with…’ or heaven forbid whats wrong with saying ‘I chatted with…’? I am extremely proud that I have never conducted a 1:1 intervention with a patient but I am equally as proud that I have chatted with many over the years. I think that the meaning of ‘1:1 intervention’ has been lost/warped over time, this is evidenced by a student seeing me and explaining how they had a 1:1 with a patient and their family. I explained that one to one means a private chat between two people but this was lost on the poor soul because his mentor (a nurse in practice) had informed him that this work was indeed classed as a’1:1’.

We also ‘ob’ patients. The phrase ‘observe’ has been lost or to be precise the meaning has been lost. To ‘ob’ someone is simply to aimlessly follow someone around with the bizarre belief that this helps. What is wrong with chatting anyhow? Chatting with someone allows for the assessment of memory, orientation, delusional ideas, concentration, anxiety, paranoia – well the list goes on. It is the skilful nurse who uses these informal opportunities to gather information and to develop the greatest tool in a nurse’s armoury – the therapeutic relationship.

So why do we use these words? Well, I believe it comes to us as nurses losing our sense of self pride. What is wrong with saying I chatted with Fred? Answer – it simply doesn’t sound professionally credible. Are we scared that other health professionals may say ‘but talking isn’t really work that a professional does’ and so we disguise it by saying we conducted a 1:1 intervention? Perhaps those who are familiar with a previous post “Registered Nurse Plumber” may already know the direction that I am going.

Who do you want caring for you and your loved ones – the nurse who conducts 1:1 interventions with patients or the nurse who chats with you?

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?

Public Spending? stop moaning


Like many others, there was a time in my life that I was skint. Didn’t have two ha’pennies to rub together (to use a colloquium of my mother’s). I’m sure many of you are nodding your head in agreement, with a sorrowful sigh of remembrance.

But I wanted my ha’pennies – to be precise I wanted thousands of the little blighters and more. I wanted a new car, new suite and I wanted to decorate the front room. I wanted to go out and party and spend obscene amounts of money, still leaving a handsome amount in the bank. I wanted the high life and then some. I wanted my cake, yours and still have the cakes sat in the kitchen.

Unfortunately as everyone knows, what you want and what you can have are two distinct ideas that are rarely, if ever compatible.

Not good enough I thought. I wanted this life and so I planned to get it with precision that would make Machiavelli proud. I stopped my subscription to several magazines/newspapers and acknowledged that I don’t have to eat out several times a week. Walking rather than the car became the norm and perhaps I didn’t really need another CD.
I’m sure you get the picture.

Still not good enough though. I took on a part-time job and also worked from home on a rather unwholesome project. If I could have, I would have sold my grandmother for one of the sacred ha’pennies.

And the result?…

Well, I’m sure you can work this out. Put simply, I slashed my expenditure and increased my income. There is nothing amazing with this though as this is an obvious thing to do so I am amazed that the Governments spending cuts have been met with such outcry and derision. The country is skint and doesn’t have two ha’pennies to rub together. We are in a major financial problem that requires a major financial solution. This is not rocket science – if you don’t have the money, then you need to cut back on your expenditure and increase your income.

So if you are one of those people moaning at the harsh financial decisions that the Government has made, just open your eyes. Despite its many problems we still have the NHS. We still have a police force. And roads. And armies. And society. Etc etc.

We are living in harsh times and a harsh solution is needed. Stop moaning please.

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/Saveteresalewis.org 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)


1. www.ccrc.gov.uk/CCRC_Uploads/Bentley_Derek_-30_7_98.pdf

2. www.mirror.co.uk/news/top-stories/2010/09/24/us-state-ignores-outrage-with-execution-of-retarded-woman-115875-22583855/

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

Universities, the new motorists?

woman in car

Everyone knows that successive governments have plundered the pockets of motorists to swell the National coffers. They know that we will not give up our cars to use overpriced, dirty and unreliable public transport.

It now seems that if something becomes a priority to people and high on their wish list then that too can become a valuable source of income. Higher education has become something which all people are beginning to realise will improve not only the lives of the individual but of society as a whole.

What was once considered the province of the upper and middle classes has become widely available to all. This importance placed on education by the people has opened it up to charges. Not only has public funding for Universities been plundered but now Vince Cable, the Business secretary, has come up with an even better cash cow. Let’s tax Graduates forever. Well, maybe not but it could seem like it. We can also means test them to ensure we get the most out of the process. Not only will this force higher education facilities to increase their bureaucracy to manage tax collection but will also increase the number of civil servants required.

Isn’t it about time that the value of higher education to the country was realised and the country properly funded it?

LONDON - OCTOBER 29:  A student takes part in a demonstration to protest over higher tuition fees on October 29, 2006 in London, England. Students are calling on the British government to reform the new student finance policy. Students who started degree courses in September 2006 will have to pay up to GBP3,000 a year towards their tuition costs.  (Photo by Scott Barbour/Getty Images)

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, www.scie.org.uk/publications

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