6th Health and Justice Summit: safety with continuity i

Whilst I am using Hodges' model (h2cm) to 

reflect on the 1st day of this event no 

endorsement should be inferred...

My exposure to forensic - prison nursing is trivial in contrast to the emotions, policy, issues, contention and hence importance that just the word 'prison' provokes. This statement can can be summarised in one point that was made this afternoon. That is, how any duty of care to prisoners must be balanced with the public's perception* of what should and should not be done. The word important is a moot one when the the aim is to stress the risk of being forgotten. Prison health is surely in danger of being lost within the Russian doll of mental health. Mental health that was (still is?) also the Cinderella service of health care? I refer to history in celebration since while there was mention of pressure of staff, long shifts, not feeling valued, heightened risk there was no shroud waving. Attending today was refreshing in the expressed passion, pride and enthusiasm that I heard; even while some of slides showing older and newer prison interiors and rooms - cells - were sobering (as they are supposed to be*).

My forensic experience is limited to time as a student nurse, making numbers up, on Ward 17 at Winwick. Visiting a medium secure unit to liaise and 'communicate' about the National Programme for IT and co-writing a paper on the Hodges' model in forensic settings. I have long wondered about the model being used educationally with groups in primary care, looking at stress and vulnerability, resilience, staying well ... and perhaps more selectively with this population. A strength here is the model's use: explicit - explained and shared or used implicitly guiding the 'teacher' or (more properly?) facilitator. We invest in 'life story' interventions for people with dementia. What about the 'life stories' of prisoners? It not the matter of their life story, but their lack of understanding of that story? What tools are there to help make sense of their 'health career' the life chances encountered and experienced in their lives?

The keynotes this morning emphasised the facts and figures of the physical health of prisoners with severe mental illnesses [SMI] and the work of Equally Well. Amid many health problems the focus is upon obesity and smoking cessation.

Dr Alan Cohen from Equally Well, reported on surveys and analysis of national QOF data comparing the prevalence of people with SMI in ten long-term conditions. As per the summit website: “The physical health of those with a severe mental illness is held up as one of the last significant health inequalities. This presentation will explore some of the data that underpins that inequality. This will describe how it can be used to enhance services, through the development of a national learning network. Equally Well.”

There are plans for an evaluation phase of the work and other audits. Dr Cohen almost had me ask a question, with regards to some people having three health problems across least and most deprived populations. How can this be explained?

The second keynote c/o Stephen Watkins confirmed (for me) the history of mental health beds (below) and how ongoing studies and graphs can illustrate processes across prisons. How long do prisoners have to wait for mental health transfer and remission? Diagnoses, across gender, ethnicity and outcomes were also presented.

Today @NHSBenchmarking presented results from our national review of prison mental health transfers and remission. Findings include delays in the pathway in some areas, over representation of BAME groups, variations in prisoner location, & low remission rates

— Stephen Watkins (@SteveWatkinsNHS) January 31, 2019

Stephen Watkins NHS Benchmarking

Stephen Watkins NHS Benchmarking

I will post soon on the workshops I attended. As is often found with satellite sessions the choice is difficult at times.

Tomorrow I must ask someone about 'social care' input. I have had cause to liaise with palliative care and local hospices recently, dementia and cancers. A question concerning a very literal form of 'in-reach' was asked for me. With four people to follow up with tomorrow, great organisation and day 2 to follow it will be a 'breeze' getting out of bed - even if that breeze is chilly...

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	primary care
::: Society: SOCIAL (care): Family interface :::::: :::	Prison Health --------------  INTERFACE ------------- Prison Service

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personal autonomy	OPEN door CLOSED door Mechanistic: 'Lock' 'Up' Ability to step on the grass
Family involement (What do they know?)	prison experience in-validates the 'person' narrows - restrains - autonomy

Reflective exercises: define 'continuity' as per Hodges' model?

What is the bandwidth of autonomy across the domains of Hodges' model?

Contrast the return to society of prisoners and service veterans?

"Study in blue" Dictyota dichotoma

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	Anna Atkins (1799-1871) Dictyota dichotoma, in the young state & in fruit,  from Part XI of Photographs of British Algae: Cyanotype Impressions 1849-1850 Cyanotype
family tree

Chuang, J. (2019) Study in blue, FT Weekend Magazine, January 5-6th, pp.32-35.

Book review: i Critical Mental Health Nursing: observations from the inside

If the book's title does not suggest the challenge to come then perhaps the editor's "Our apology" just might.

The editors declare the limitations of their apology as mental health nurses (mhn) given the precariousness of life, the environmental situation, the power of global corporations and how the industrial-military complex can also affect and define the role and work of mental health nurses. It is clear, that for example, the past decade (at least) of mental health service provision and development has been impacted by political and socioeconomic trends. The reduced number of mental health beds; the subsequent phenomena of out of area referrals (that also redefine 'area'). This past month, commentators have pointed to the lack of a work-force plan that should precede NHS Long Term Plan.

From the start the vocabulary here is rings of 'anti-psychiatry' and seeks, if not redress, then redesign of formal mental health services. Anyone putting the book down at this stage would be doing themselves, patients, carers, health and social care and their own learning a great disservice. Clearly, it is not only that existing services are reductionist, invalidating, self-serving, drug-pushing and re-traumatising; but the editors stress it is how they are all too often experienced.


As a mental health nurse the introduction and apology gets to heart of the matter, if not the mind. All of what mhn's do is tinged with coercion; whether with people on locked wards or those in their own home. The list of what mental health nurses are party to is a long one and makes difficult reading: the detention and restraint of people and administration of antipsychotic depot medications. The profession hides behind the ethics of acting in a person's 'best interests'. The negative impact of this experience is not just limited to a vulnerable minority who are in most marked emotional distress, but others as the book attests. If this suggests a caveat, there are several, as I hope this review across several posts will reveal. That custard cream shared with a patient (person, householder, tenant, citizen...) in their home will never taste the same. So, more on that to follow and not just to address any sense of trivialisation, but the many caveats that apply.

The editor's frame their apology outlining the basis for mhn: as a profession, a university degree, codes of conduct and accountability. p.viii As a 'profession in our own right' the critical thinking we espouse (yes - here too) and are supposed to exercise has failed to question and counter the increase in detention and the assault on mental health services themselves. At one stage I believed there was some coherence to mental health policy development, but if it is there now - it is intangible in its quality. MHS have not developed progressively as might have been anticipated if not exactly predicted. As a new Community Psychiatric Nurse in 1985 I am now a 'Community Mental Health Nurse', what else might my colleagues and I have become? At the end of the day we may longer return to the hospital (Winwick, Eaves Lane, Ribbleton - all gone), but what are we returning to when we go back to the office, the base? There is an office move in this book; and the final chapter considers the profession's very title.

The editor's apology does not just set the scene, it places mhn and all practitioners on the stage - front and center. This RMN (SRN) (to be ageist for a moment) is all too aware that despite all the talk about the need for integrated, holistic, person-centred care they are, more often than not, still lacking. I've come to see these as 'legacy issues', but that is another 'book'?

The book itself has 260 pages in total. The cover of my (softback - as above) is a pleasing contemporary design. The mainly white cover is already a suffering grey as it's been on numerous trips. Thirteen chapters follow the apology and an introduction. There are notes on the editors and contributors. The print is an excellent size and the overall format easy on the eye. Even if lightly edited, the editors have done a good job as the chapters cohere. Two indices cover names and subjects and are sufficient. So with chapter 1 beckoning I was all-eyes and ready page turning...

Thanks to PCCS Books for my review copy.

Part ii

Part iii

Part iv

Bull, P., Gadsby, J., Williams, S. (Eds.) (2018) Critical Mental Health Nursing: observations from the inside, Monmouth: PCCS Books. ISBN 9781910919408

RCGP’s 6th Health & Justice Summit: Safety through Continuity

Perhaps I will see you in Liverpool, UK later this week? 
I will be taking notes and look forward to reporting here.

A 2-day summit organised by the RCGP Secure Environments Group in partnership with, Broadmoor, Ashworth, and Rampton high secure hospitals, Spectrum, Care UK, NHS England, Martindale Pharma, Nottinghamshire Healthcare NHS Foundation Trust, Betsi Cadwaladr University Health Board, HMP Berwyn, West London NHS Trust, Mersey Care NHS Trust.

Following on from our successful event in Glasgow in 2017, we are now focusing on ‘Continuity of Care – safety through continuity’ as this year’s theme. We recognise the need to embolden the links between primary and secondary care for people resident in secure settings and are looking to showcase examples of good practice on how we can improve on care transition to the community.

The first day will broadly address physical health in secure mental health environments, and the second day will address the health needs of people in other custodial environments such as prisons, immigration removal centres and YOI’s.

If you are registered as a delegate for the event, please register which workshop you would like to attend via the link below:

www.convenzis.co.uk/6th-health-justice-summit-safety-through-continuity-registration/

<>

n.b. There are two papers listed in the bibliography (please see the sidebar) that show how h2cm is applicable to this specialist field.

"Bounded epistemology, language and context of disciplinary thought ..."

"Effective learning does not happen in a content vacuum. John McPeck (2000) and other critical thinking theorists argue that teaching general thinking skills and techniques is useless outside of a particular knowledge domain in which they can be grounded. Similarly, Bransford et al. (1999) argue that effective learning is both defined and bounded by the epistemology, language, and context of disciplinary thought. Each discipline or field of study contains a world view that provides unique ways of understanding and talking about knowledge. Students need opportunities to experience this discourse and the knowledge structures that undergird discipline thinking. They also need opportunities to reflect upon their own thinking; automacy is a useful and necessary skill for expert thinking, but automacy without reflective capacity greatly limits learners’ capacity to transfer their knowledge to unfamiliar contexts or to develop new knowledge structures." pp.48-49.

Anderson, T. (2008) Towards a Theory of Online Learning, (Chapter 2). In, The Theory and Practice of Online Learning, second edition, Edited by Terry Anderson. AU Press, pp.45-74.

Learning often challenges the values we hold. When we experience new roles and must attain and maintain professional standards we may need to inculcate (tread upon) what we already know. A degree of unlearning may be needed, entailing a suspension of content as new understanding, insight and awareness is demonstrated. In the health and social care context, Anderson helps us appreciate the level of complexity in the number of disciplinary domains that must be negotiated and integrated conceptually and the requirements for person-centredness. It might be argued that this is a contributing factor for effective lifelong learning? That is, having the ability from early in our educational careers that we are capable and willing to 'refresh the conceptual slate'?

[Even as I cling on to the four-five care or knowledge domains.]

[Thank you: Centre for TEL]
https://www.lancaster.ac.uk/educational-research/research/centre-for-technology-enhanced-learning/

ERCIM News No. 116 Special theme "Transparency in Algorithmic Decision Making"

Dear ERCIM News Reader,

ERCIM News No. 116 has just been published at https://ercim-news.ercim.eu/

This issue includes:

- a Keynote by Sabine Theresia Köszegi, presenting the EU High-Level Expert Group on Artificial Intelligence.

- a Special Theme "Transparency in Algorithmic Decision Making", coordinated by the guest editors Andreas Rauber (TU Wien and SBA), Roberto Trasarti and Fosca Giannotti (ISTI-CNR), providing an overview of the range of activities in this domain.

- the section Research and Society about Ethics in Research, jointly coordinated by ERCIM (Claude Kirchner, Inria) and Informatics Europe (James Larrus, EPFL)

- the section "Research and Innovation" with news about research activities and innovative developments from European research institutes.

This issue is also available for download in pdf and ePub.

Thank you for your interest in ERCIM News. Feel free to forward this message to anyone who might be interested.

Next issue:
No. 117,  April 2019
Special Theme: "5G"

Peter Kunz                       
ERCIM Office
2004, Route des Lucioles
BP93
F-06902 Sophia Antipolis Cedex

Paper: Geopolitical factors and mental health I [mapped to h2cm]

" ... we propose that mental health must be seen as a key strategic goal of foreign policy and be used as a measure of success of the foreign aid to ensure that individual people with mental illness are guaranteed a role and support in the civil society and their needs – clinical or social – do not get swept under the carpet. To this end, we examine some key statistics and to address the mental health needs of those worst placed, we propose an index – the Compassion, Action, Pragmatism and Evidence (CAPE) Vulnerability Index – that identifies the most vulnerable communities so that international aid may be more appropriately targeted, possibly ‘ring fenced’ making mental health a strategic building block of foreign policy." p.779.

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wither mental health in relief, shorter life compared with general population,  poverty including  As a child As an adult Vicious cycle 1: Disaster experiences - mental health Traumatic Stress Disorder**

Natural & man-made disasters, health crises, e.g. Ebola, Conflict, War Climate warming Humanitarian intervention: Emphasis on physical survival and physical health Statistics: globally Proposed index: the Compassion, Action, Pragmatism and Evidence (CAPE) Vulnerability Index – that identifies the most vulnerable communities

Vicious cycle 1: [**Intergenerational transmission of stress and trauma - Epigenetics, social memory]  Social upheaval, migration and displacement mental illnesses assoc with social failures such as poor parenting, school failure, domestic violence and toxic stress, impacted prospects on earning a living, stigma social exclusion Social Determinants of Health Displacement refugees, poverty, women, children,  trafficking, rape

Foreign Policy Relief: mental illness = denial of - human rights, vote, marriage, inheritance, make a will Vicious cycle 2: corruption - inequality sequestration of assets crime, law & order Disaster ('declaration') Mental health problems cost the world some US$2.5 trillion per year  (US$16.1 trillion by 2030) Foreign aid & assistance Foreign policy Populism

Persaud, A. et al. (2018) Geopolitical factors and mental health I. International Journal of Social Psychiatry, 64(8) 778–785. DOI: 10.1177/0020764018808548
https://journals.sagepub.com/doi/abs/10.1177/0020764018808548?journalCode=ispa&

n.b. I have added epigenetics and the intergenerational transmission of stress and trauma.

Hospicing social policy and Identifying the seams..?

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Green - paper ([Very] Long - grass)	Recommended read on @Medium: “Hospicing The Old” https://t.co/aAM6i6hHVG — stephanie cole (@eseesea) January 18, 2019
'Future of care for older people & the adult care system is one of greatest unresolved public policy issues of our time' @CareQualityComm https://t.co/efm5JV0tUF — Prof Catherine Needham (@DrCNeedham) October 11, 2017	White - paper

"Four Colours Make a Forest" c/o Donna Ong

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	Donna Ong “Four Colours Make a Forest” UV Printed on Aluminium Plates, Wires, Concrete

"Singaporean artist Donna Ong sources tropical imagery from 18th-century lithographs for her work, Four Colours Make a Forest, which looks at interpretations of the tropics as alluring paradise or places of threat. She will present two perceptions of jungle on a billboard: on one side a collaged layout of tropical landscape prints (a colonial view), on the other a digital camouflage pattern (a militarized view).".p.24.

My source: Kiggell, R. Hot Printing, Preview, Printmaking Today, Winter 2018, 27,4, p.24.

Book: Making of Byrne’s Euclid

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	Scans of first eight propositions from Byrne’s Euclid

My source: Twitter @dr_tj @defilippovale @rougeux

https://twitter.com/defilippovale/status/1074436950663278592

"The Ball and the Box"

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coming to terms with loss - bereavement pain awareness insight understanding communication
After what has been a surprisingly okayish Christmas, I had a moment today in SuperStore. Saw a lady who reminded me of my 92yo grandma, who even in the early stages of dementia, completely understood that my mom died. I thought I’d share the Ball in the Box analogy my Dr told me pic.twitter.com/YfFT26ffU8 — Lauren Herschel (@LaurenHerschel) December 29, 2017

See also:

Colin Murray Parkes, Brenda Bridgeman, Annie Flower, Margaret Foster, Peter Speck & Colin Murray Parkes (1995) REVIEWS, Bereavement Care, 14:2, 22-23,  

DOI: 10.1080/02682629508657361

https://www.tandfonline.com/doi/abs/10.1080/02682629508657361?journalCode=rber20

The Art & Science of Health: [conceptual scraps ii]

The contrast here within health care is quite stark, we can distinguish between scraps of paper in two ways ...

1. Whatever we do with care needs; confirm them from the referral and possibly (usually) identify additional care needs (and educational opportunities also..?), assess, plan, intervene, and evaluate - that scrap of paper (or its digital analogue) should initially be blank, untainted by judgements, bias and assumptions.
2. As soon as the scrap of paper is populated - scribed-upon then its value and the responsibility of those who access it subsequently is suddenly weighed and measured by law and accountability.

In the first case, ownership is not relevant, in that there is nothing, as yet, to 'own'. Values however can still be represented, if the staff's attitude towards the new patient, client, service user or administration terms referral, contact, triage case is similarly 'neutral'.*

In the second case, when the print hits the page by whatever means the stakes are suddenly raised. The law has a say in what is expected, permissible and reasonable conduct by those gathering data, creating a record, holding, copying and transferring the record in part, or whole and its accuracy, destruction and disposal.

*Of course, even when blank, forms - templates can have proprietary value and may well be protected, copyrighted and trademarked.

to be continued ...

Related post - Part 1:
The Art & Science of Health: [conceptual scraps i]

An individual speaks to Power: Climate Change

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An individual speaks to power
	Greta Thunberg: "You are not mature enough to tell it like it is. Even that burden you leave to us children" #FridaysForFuture #ClimateStrike #ClimateChallenge #ClimateLeader #cop24 #schoolstrike4climate pic.twitter.com/9XQblo3N6Q — Paul Giesberg (@mamaloe66) December 13, 2018