World Mental Health Day 2014: or...

https://www.time-to-change.org.uk/WMHD

http://www.mentalhealth.org.uk/our-work/world-mental-health-day/world-mental-health-day-2014/

or - World Parity of Esteem Day 2014?

Mental health & Psychology resources
(Links I - Hodges' model)

Interviews: In the political melee don't forget the green corner...!

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

Therapeutic alliance

"Sir Robin cited research conducted by two psychologists on interviews during the 1987 general election campaign. Dr Peter Bull and Kate Mayer found that Kinnock and Thatcher avoided more than half the questions put to them. They concluded the party leaders used 31 different forms of evasion, among them ignoring the question, acknowledging the question without answering, questioning the question, attacking the question, attacking the interviewer, declining to answer, giving an incomplete answer, repeating a previous answer and claiming already to have answered the question." FT Weekend. p.1

Source:
Katz, Ian, (2014) The death of the political interview. FT Weekend, Life & Arts, September 6-7th. p.1.

Never give up on someone ...

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

group

Never give up on someone with Mental Illness – 

when 'I' is replaced with -
'We'  'illness' becomes 'Wellness'

Thanks to colleague Julie Draper - apparently this is doing the rounds on Facebook and elsewhere.

Rare Disease Day 28 February 2014

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

Source: http://www.rarediseaseday.org/

I am honored to stand, in her graceful place, and shine a light on a delicate group of individuals who, nevertheless, in sheer numbers are a force to be reckoned with. Thank you, Sean Hepburn Ferrer

A disease or disorder is defined as rare in Europe when it affects fewer than 1 in 2000. A disease or disorder is defined as rare in the USA when it affects fewer than 200,000 Americans at any given time. One rare disease may affect only a handful of patients in the EU (European Union), and another touch as many as 245,000. In the EU, as many as 30 million people alone may be affected by one of over 6000 rare diseases existing. 80% of rare diseases have identified genetic origins whilst others are the result of infections (bacterial or viral), allergies and environmental causes, or are degenerative and proliferative. 50% of rare diseases touch children.

In the words of Audrey Hepburn, “We cannot save everyone… but the knowledge that someone is coming to their rescue… that we care as a society is ultimately as important…”. It is in this spirit that we invite you, alongside Sean Hepburn Ferrer, to Join Together for Better Care.

group - population

Winwick Hospital remembered

Image source: Metro

Syria's Trojan women

The Syria Trojan Women project began by creating drama workshops in Amman, Jordan in autumn 2013, and put on a theatrical production of Euripides’ anti-war tragedy, 'The Trojan Women' in December with a cast and crew of Syrian refugees. The first performances were a great success, and we hope to stage further performances in and around Amman, and a tour of Jordan and the region. http://www.syriatrojanwomen.org/

My source: Charlotte Eagar, Syria's Trojan women. FT Weekend, Life&Arts, 4 - 5 January 2014. pp.1-2.

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

"personal	parallels" p.2.
drama therapy	conflict

group - population

http://hodges-model.blogspot.co.uk/search/label/Jordan

Held in equal esteem: Physical health and Mental health

As a mental health nurse you are familiar with concept of ‘esteem’. Self-esteem is central within assessments of clients, central to all care workers as safe and effective practitioners; and self esteem tests carers in those people for whom their condition means self-esteem is something attributed by proxy.

I noticed just recently use of the term esteem applied to the disparity between physical health and mental health. The two upper-most domains in Hodges' model (interpersonal and sciences) draw attention to the historical duality of mind and body. To integrate the two means acknowledging differences and this is acute in terms of finance, research and treatment plus many other measures.

The limitations of my emphasis in a series of previous posts on holism, holistic care, holistic approaches become apparent as long as the political domain is not addressed. You can be as holistic as you like, identifying, processing and integrating the full remit of health care concepts relevant in a case. If esteem is not achieved then the benefits of being holistic must be severely damaged. They may even be considered futile politically (speaking - just a whisper)?

Through the links below this post demonstrates that esteem is stirring in the political, policy and legislative domain and is being addressed, even if a solution will not arrive overnight.

My original sources: New Scientist, the HSJ and BBC.

Nick Craddock (2013) Opinion: Where's our Higgs? New Scientist, 27 April, 2914; pp.30-31.
Psychiatry needs the star quality of physics to help recruit top academics and fight the scourge of mental illness - this opinion piece concludes:

So, in 2013, psychiatry has powerful scientific tools and a developing narrative that already points to strong theoretical bases. Yet, in the UK research into mental illness is stalled at around 5 per cent of the annual medical research budget, and the picture is similar in other rich countries. That will have to change – and governments and funders are starting to see this. The door is open: all that is needed is for more of the best to come in and find out just how hot psychiatry really is.

‘Esteem gap’ between mental and physical health remains
10 October, 2013 | By Alastair McLellan
The government knows the challenges the facing mental health sector, but without radical solutions the goal of treating mental and physical health service users on an equal footing seems as far away as ever
http://www.hsj.co.uk/opinion/leader/esteem-gap-between-mental-and-physical-health-remains/5064120.article

Debate on 10 October: Parity of Esteem for Mental and Physical Health - Lords Library Note
http://www.parliament.uk/briefing-papers/lln-2013-024/debate-on-10-october-parity-of-esteem-for-mental-and-physical-health

Lords debate – Parliament TV:
http://www.parliamentlive.tv/Main/Player.aspx?meetingId=13879&st=11:51:20

Royal College of Psychiatrists: OP88. Whole-person Care: from rhetoric to reality (Achieving parity between mental and physical health)
http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/op/op88.aspx

TO: EU -omics research community; if you are seeking a holistic approach for personalised medicine...

The relevance of Hodges' model as a resource in 21st century health care and research can be found within personalised medicine.

This is in addition to the need to assure holistic bandwidth within existing health care delivery, when it is person centered care that is the concern. Personalised medicine brings with it further challenges as it emphasizes the scientific, the inevitable reductionist work can potentially increase the distance between the humanistic and the mechanistic. The working document from the European Commission -

Brussels, 25.10.2013 SWD(2013) 436 final COMMISSION STAFF WORKING DOCUMENT. Use of '-omics' technologies in the development of personalised medicine
http://ec.europa.eu/health/files/latest_news/2013-10_personalised_medicine_en.pdf

on page 7 we read:

The figure is instructive as it shows that a holistic approach is needed to fully appreciate the challenges and opportunities presented by personalised medicine. 

'Holistic' is a much maligned word, with its fuzzy, new age connotations. Especially when the word count = '1'. Another related document also picks up the holistic call:

IMI2 will deliver tools, methods and prevention and treatment options (directly or indirectly) that will progress the vision of personalised medicine and prevention. Through providing the framework required to support collaboration between scientists, regulators, HTAs, patients and healthcare providers, IMI2 will ensure that research is translated into implementable solutions to current healthcare challenges. Solutions that are not purely focussed on the development of new medicines, but that provide a holistic personalised healthcare package as well as maintain people healthy and productive through out their lifetime. Reclassification of diseases based on their root cause and not symptoms will help addressing unmet needs even in areas where a range of options exist but patients do not respond, because their symptoms are misleading therapy choices.
[ IMI - Innovative Medicines Initiative ]

Outline Strategic Research Agenda for a biomedical research public private partnership under Horizon 2020: (draft) The right prevention and treatment for the right patient at the right time. 08 July 2013http://www.efpia.eu/uploads/Modules/MCMedias/1373296554546/IMI2%20Strategic_Research_Agenda_v%208%20July%202013.pdf

On page 10:

A sustainable healthcare system is a holistic one in which the patients are responsible for their wellness and quality of life; physicians, therapists, nutritionists, community carers, and all other actors in the value chain are motivated to this goal; delivery of care takes into account patient beliefs, values and both rational and irrational behaviors; the care is affordable to both public and private payers and promotes health; sustainable businesses can thrive; and the education, prevention and management of chronic conditions are aligned to achieve this goal.

The focus of these documents is -omics and the development of new medicines. By its very nature this research, data and knowledge lies deep within many sciences: new sciences no less. This recognition of the need for holistic approaches and perspectives is still very encouraging. As the first document on personalised medicine notes, future treatments must be from "bench to bedside". We can equate this as "mechanistic to humanistic", but only as long as the patient in that bed is a person and not just viewed as a diagnosis with an associated -omic profile.

Have a look also at the figure on page 7, the medical innovation cycle. As discussed previously on W2tQ patient safety needs situated awareness and holistic perspectives.

My original (and seemingly incomplete) source:
http://www.researchresearch.com/index.php?option=com_news&template=rr_2col&view=article&articleId=1339313

Book review "Clinical Intuition in Psychotherapy: The Neurobiology of Embodied Response"

Clinical intuition is something that in formal learning terms is intangible, but in practice is earned and relied upon as a gift of experience. When I first received this book from the author Terry Marks-Tarlow, leafing through I thought the emphasis was on the neurobiology presaging a rather technical read. The references to brain structures, neocortex, brain waves ... seemed to suggest a reductive approach, remote from my conception of intuition in clinical practice. I need not have worried, the initial discussion on the brain and evolutionary development is not just a foundation for what follows but as the title suggests underpins and integrates the whole text. Despite the title and as the foreward advises you do not have to be a psychotherapist to read and appreciate this book. The stall is set from the outset in the introduction which explains that chapter one defines clinical intuition:

Clinical intuition is defined from a neurobiological perspective as a right-brain, fully embodied mode of perceiving, relating, and responding to the ongoing flows and changing dynamics of psychotherapy. (p.3)

The introductory material here is essential foundation reading for people starting a career in psychology and mental health related disciplines. The evolutionary development of the brain from reptile through to the mammalian brain is invaluable. Tying this to specific brain functions and circuits - care, fear, panic, play, lust, rage and seeking - helps integrate brain anatomy, perception, emotion, and behaviour. The advances in neurobiology to follow will no doubt demand that we all extend our understanding of this interdisciplinary fusion.

The book itself (hardback edition) is very well produced, the type face easy to read and the book well structured and with a well balanced mix of illustrations and photographs. The reference listing at the end runs over thirteen pages and is well grounded historically and in having regard to ongoing research. The index is comprehensive (fourteen pages) and a resource itself providing a look-up approach. The book's use of case studies, thirteen in total informs the text and provides some continuity through the book. Dialogue between therapist and client is easy to follow and illustrations are provided with ample explanation in situ. The references also utilize web-based resources.

I recall intuition coming up as a thread on several occasions on the psychiatric-nursing list especially between 1998 and 2004. Intuition is a central quality for all personnel working in health and social care. We must also recognise intuition as a human trait as when non-health professionals exercise the judgement that: "Wait a minute, we need a clinical opinion here." Self-care is also discussed. I had a Pythonesque moment - "Is this the right room for an argument?" - considering psychotherapy as a therapeutic modality within therapies as a whole. Here in the UK (and no doubt elsewhere) self, brief and solution based therapies rule economically. Even though the shortage of psychological intervention is recognised in the UK through IAPT improving access to psychological therapies, we need to ask: how does psychotherapy fare in the current (austerity) climate? To what extent can clinicians exercise intuition? Therapy relies on caseness, relationships and narrative, but to what extent can these be acknowledged and delivered within the economical time frames that frequently operate? 

Although there's no specific chapter on training for clinical intuition, Marks-Tarlow provides a list of how researchers have characterized clinical intuition (more recently in the 1980-1990s); five characteristics are proposed:

• Sudden recognition;
• Immediate knowledge;
• Emergent awareness;
• Non-verbal insight; and 
• Holistic integrative sensibilities. (pp.42-43).

 Of the first two sudden recognition and immediate knowledge, I thought of the intuitive sense that is applied upon receiving a referral. That is the assumptions (not always helpful) that arise from the information provided (and missing) and where this leads you? But of course, is this clinical intuition? Intuition as the author makes clear (p.3 and) throughout the book is in psychotherapy. Intuition here (and for me) depends on interpersonal - therapeutic - interaction. What precedes is something else (data integration, hypothesizing, reasoning...?). I can however still see explanatory avenues in the above that can help us travel from the conceptual (reduced) to a holistic whole. I did wonder about the role of intuition in suicidal ideation and risk management, but this is also a question of referral criteria and caseness.

I would very much like to write myself about information and complexity and these themes recur in the text, especially the latter. Several 'spaces' are discussed too: social, physical and spatial schemas. The work of Buzsáki on the hippocampus, navigation and maps - landmark navigation - is fascinating in chapter 7 Navigating the Seas. I have likened Hodges' model to a cognitive periplus - an ancient maritime map. Over the next few months I'll post some quotes from the book.

This is an excellent book that I heartily recommend. The discussion of what is implicit in the brain and so in therapy, what is embodied and wisdom in mentoring invites re-reading. Finally but vitally there is much humour and humanity here too.

Many thanks to Terry Marks-Tarlow for the review copy.

'Pictures to Share' book titles for people with later stage dementia

Hi

I am contacting you as one of our LinkedIn colleagues working in the field of dementia. One of our 'Pictures to Share' book titles for people with later stage dementia has been shortlisted for the UK 'People's Book Prize'

By winning this award we can help to to raise awareness of the needs of people with dementia, so it would be great if you could take a look at the People's Book Prize website, and consider voting for our book 'Proverbs and Sayings'.

The link is below:

http://www.peoplesbookprize.com/book.php?id=982

Many thanks for your help

Helen Bate and Michelle Forster
http://www.picturestoshare.co.uk/

[I will register and vote Michelle - good luck PJ ]

Papers in progress, book reviews and volcanoes

There are three papers currently in process. There is some good and bad news; plus some similarity with volcanoes. This is in the sense of active, dormant and extinct.

The papers are - with no prizes for guessing the common feature:

1. The Scope of Nursing and Hodges' model
2. Case Formulation (Conceptualization), Diagrams and Hodges' model
3. Recovery and Hodges' model

Two papers are active, that's Case Formulation and Recovery. On the stove is Recovery and it's cookin. I've two co-authors providing invaluable input.

I've just read Terry Marks-Tarlow's Clinical Intuition in Psychotherapy The Neurobiology of Embodied Response and a review will follow my recommending this book right now.

There's a review copy of another book in the post that I believe can inform the recovery paper:

Values-Based Commissioning of Health and Social Care (thanks CUP)

I'm sure the concept of values-based commissioning is a gift to Hodges' model and the recovery paper. A theme to return to on W2tQ. The paper includes the Recovery STAR and relates this to Hodges' model.

The case formulation effort is with my co-author, and after a meeting in Manchester one early evening may incorporate risk formulation too.

The good news is none of these projects are extinct. The first nursing scope paper was rejected. The nursing scope paper is dormant, but is stirring following the symposium on person centredness in nursing early in May 2013.

There are two other books to get to grips with and a project that is in danger of extinction. The sight of Vesuvius next month may help: shift matters.

Computer-based 'avatar' therapy promising for persecutory auditory hallucinations

A study in the British Journal of Psychiatry has reported symptom reductions among patients hearing voices, who developed computerised 'avatars' of the voices and then engaged in dialogue with them. When compared with treatment as usual during a randomised trial, the therapy group showed mean reductions in scores for auditory hallucinations and for the omnipotence and malevolence of the voices. The researchers conclude: 'Patients who are able to sustain a dialogue with their persecutor feel much more in control.'
BJP June 2013, 202:428-433

Source:
http://www.mental-health-forum.co.uk/news-blog.html

In addition see and listen to:

UCL news:  Avatar therapy helps silence voices in schizophrenia

BBC Radio 4: http://www.bbc.co.uk/news/health-23141916

Update on new papers: 1. Case formulation & 2. Scope of Nursing

At present, with the support of a co-author, I am editing a paper on Hodges' model and the scope of nursing. The text some 6000 words was submitted to a journal last April and rejected, but as ever feedback is golden and the comments are being used to revise. The referees have set a challenge as amongst several points I tease out where the inherent theoretical perspectives lie in Hodges' model and how their identification within h2cm helps to define the scope of nursing.

Another paper in final draft - 4400 words - concerns the model and case formulation. At last I've arrived at this topic. Hodges' model is basically a simple drawing with care concepts superimposed. Cognitive behavioural therapy [CBT] and cognitive analytical therapy [CAT] make use of case formulation and CAT utilizes what are called sequential diagrammatic formulations.

The old website pages were written rather on the fly. They almost comprise a 'to-do-list' of thoughts and findings to revisit and check. Of two old pages one dealt with possible ideas and sources that might inform the structure of Hodges' model; the other page theory.

On the latter page I learned of SDRs - the sequential diagrammatic reformulations used in CAT and related this to the care domains of h2cm -

It feels good to be able to address this theme at long last.

In just over a week I'm looking f/w to a three day break in the Lakes. Weather permitting some  walking and a few runs, a bike ride, writing and Drupal - which I have put down of late...

Case formulation and Reflection in Hodges' model

Case formulation is a process in which I believe Hodges’ model can be used. Johnstone and Dallos (2006) help conjoin case formulation with an original purpose of Hodges’ model, that of supporting reflective practice, as follows:

Formulation and reflective practice. The notion of reflective practice is becoming increasingly important in all therapeutic traditions; that is, the necessity of being aware of one’s own feelings and reactions as a therapist as well as one’s own position in terms of professional status, gender, class, ethnicity and so on, and how these impact upon the therapeutic process. How might these ideas be taken on board in formation? What kind of biases is formulation open to, and how can we minimise them? p.2.

There are of course many concepts mentioned above that are key in staging a therapeutic interaction. As a series of conjoined conceptual spaces Hodges’ model provides a stage were reflections can be made personally, professionally and therapeutically moving to the development of formulations that are shared with clients.

Johnstone, Dallos and contributors also describe the issue of integrative formulation an aspect also of relevance to further study of Hodges' model.

Johnstone L., Dallos, R., (Eds.) (2006). Formulation in Psychology and Psychotherapy: Making Sense of People's Problems, Routledge, Oxford.