"step inside" TO "think outside"

  

individual

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INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

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             c/o Somerset House, 6th June 2016.

'Thinking outside the box: alternatives to standard inpatient mental health care' by Amber Jarvis

c/o The Mental Elf on 'X' I came across a blog post by Amber Jarvis:

Thinking outside the box: alternatives to standard inpatient mental health care

Amber's post considers a study by:

Griffiths, J. L., Baldwin, H., Vasikaran, J., Jarvis, R., Pillutla, R., Saunders, K. R., … & Johnson, S. (2025). Alternative approaches to standard inpatient mental health care: development of a typology of service models. International Journal of Mental Health Systems, 19(1), 1-13: https://pubmed.ncbi.nlm.nih.gov/40247283/

At an online meeting this evening, near the close the discussion loosened and alighted on AI. The ability of AI to summarise a large text file, a *.pdf and create discrete web HTML pages. The racial bias 'built-in' by human coders, reflected in outputs; that point to structural racism. 

Finding this paper on X, boxes are the bread and butter of Hodges' model. Not just thinking outside a box, or inside one, but several and with a final twist - to follow. Amber begins:

'Inpatient mental health care involves staying in a hospital or specialised facility to receive intensive, round-the-clock support for serious mental health needs (Staniszewska et al., 2019). Whereas acute inpatient services typically respond to immediate crises, longer-term wards support individuals with more complex needs and a higher level of ongoing risk.

Inpatient services are a core component of our mental health system — whether someone stays for a night, weeks, or even several years. However, inpatient care has recently come under growing scrutiny – and for good reason.'

A Community Mental Health Nurse since 1985, my in-patient experience is a tad misty, but not misty-eyed. As the wards: psychogeriatrics, long-stay, female acute admission were simultaneously challenging, rewarding - in the sense of being able to make a positive difference, changing what were institutionalised practices, no personal clothes, lockers, tea urn, no banking, few visitors (admission wards excepted). It was all very quotidian: check the bath book. Then tell, confirm, assure the patient, 'yes!'. It is your bath day. I've posted previously about critical mental health. You do (should?) quickly learn you are part of a system, a machine; and the distinction between person- patient-centred and service-centred care. The need to do my 'general' quickly emerged too. 

As ever, two words, across Amber's post and Griffith et al's title, stand out; 'map' and 'typology'. I must revisit and post about:

Macduff C. (2007). Typologies in nursing: a review of the literature. Nurse researcher, 14(2), 40–50. https://doi.org/10.7748/nr2007.01.14.2.40.c6020

Part-time work since 2020, in two adult CMHTs and a recovery team, has provided an update. The first as COVID emerged, was a bit of a shock in terms of diagnoses, caseness, the proximity to the law and forensic psychiatry, thresholds for referral, changes to mental health law (that were now more practical) and the management of patient's finances. 

So, to return to last night's brief online discussion, the observation of how racism is ongoing, brought up the fact of racism being structural and institutional (Dean & Thorpe, 2022). The change needed is an intergenerational break, which doesn't bear thinking about. The National HEALTH Service faces the same challenges in the shift to prevention, and addressing racism. Where is the workforce, going to come from, to help recovery, health and related literacies (media, emotional, financial)?

It is easy in boxes like Hodges' model (and others) to be idealistic. Ideally as I learned of Community Psychiatric Nurses being recruited, six of us, we all should have asked:

What is the plan?

What is the model of care?

What characterises 'care in the community'?

How do we prevent relapse, readmission?

Is there a 'halfway house'*?

We did, to an extent. There was great enthusiasm, motivation, idealism, co-ordination, collaboration  (Tyrer & Gelder, 1990) and leadership. 'We' had an association,^ and a journal. Back then the Royal College of Psychiatry produced a report on CPNs. Is there a message in this? Progress was and has been made, but the promise has not been delivered. With care in the community having regressed, an incomplete 'project'.

I will read more and revise this post, or more likely add another: with less 'history' ...

Individual

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HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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Model of Care	Model of care
Model of Care Care in Community Children - Schools - Education	Model of care 'Care Leavers'

*'Cross-settings' in Griffith et al.

^https://www.unitetheunion.org/what-we-do/unite-in-your-sector/health-sector/mental-health-nurses-association

Lorraine T Dean, Roland J Thorpe, What Structural Racism Is (or Is Not) and How to Measure It: Clarity for Public Health and Medical Researchers, American Journal of Epidemiology, Volume 191, Issue 9, September 2022, Pages 1521–1526, https://doi.org/10.1093/aje/kwac112

Tyrer P, Gelder M. The future of community psychiatric nursing: some research findings. Psychiatric Bulletin. 1990;14(9):550-551. doi:10.1192/pb.14.9.550

ii 'Thinking outside the box ...'

iii 'Thinking outside the box ...'

See also: 'institution' : 'racism' : 'typology' : 'map' : 'Forensic'

Progress in Transdisciplinary Times

For about a decade I think ... hold on please! ...

Since October 2011 in fact, and an issue of -

Journal of Evaluation in Clinical Practice, Volume 17, Issue 5

Special Issue: Philosophy of Evidence Based Medicine

- I've carried the concept of 'progress' in my head. I think I picked up this issue somewhere and still have some of its key papers. 

 

Progress is always there in the media, in its obvious forms, technical, education, scientific, social, political, economic, medical; whether or not we agree on the pace, realisation, ethics, extent and contribution to overall well-being. Now, we can also add Earth as the foundational element.

Simon Kuper's 'Opening Shot' in the FT Magazine, 11-12 December 2021 wrote about 'progress' and Thomas Midgley Jr; "often described as the most disastrous peaceable human who ever lived." Responsible for the progressive, at the time, innovations of lead in petrol (to reduce "knocking" in petrol engines), and chlorofluorocarbons - you'll understand that one I think. Kuper notes how:

"Midgley's story illustrates the damage that one brilliant, ambitious, out-of-the-box thinker can do."

Since the early 20th century, we have nuclear fission, biolabs, genetic technology, artificial intelligence, climate change and other 'inventions'. The 'progress' of climate change is catching up with us. Ironic, how the question, after all those millennia remains - can I/We outrun this threat? The problems we face now, we are told, call for transdisciplinary solutions - adding yet more complexity.

Clearly, we need to equip people with the cognitive, conceptual tools to work alternately, in-and-out of the boxes. And, whatever our belief system consider progress in spiritual terms too.

 INDIVIDUAL

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HUMANISTIC --------------------------------------  MECHANISTIC      

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progress	progress
progress	PROGRESS

Another thing to return to!

Simon Kuper, Opening Shot, When too much progress is a bad thing. FT Weekend, Magazine, December 11-12, 2021, p.8.

Previously on W2tQ: progress

What is your 'Best' domain ...?

There are times we need to think outside the box.

 

But, when necessary are there 'boxes' you tend not to think in?

 

If so, what is stopping you?

 

 individual 

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INTERPERSONAL : SCIENCES

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SOCIOLOGY : POLITICAL

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Best Notch (closed) showroom, 1975	Best Notch (open) showroom, 1975
?	?

 

My sources:

Images:

Architecture + Branding: The utilitarian box store and design fodder known Best

(source: siteenvirodesign.com)

Wines, J., Heathcote, E. Designing outside the box, Arts, FTWeekend, 21-22 November, 2020. p.15.

Butt up against the Boxes...?

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myth

Hodges' model may seem to suggest (as above) that its purpose is to help categorise and put things - concepts - into boxes. While this is true, the model's primary purpose is to support users (and especially learners) to 'see' and reflect upon the (disciplinary) scope of what is being paid attention to and what is not. Ultimately, as we organise our thinking, we can collapse this series of boxes into what will hopefully be a meaningful whole. If this scoping is also conceptual, then the model's two axes also serve to denote implicitly the many oppositions - dichotomies that must also be negotiated (one way or another). This does not represent an appeal to, or for conceptual or information overload. Quite the contrary. We may acknowledge that uncertainties remain, information is missing. It is meaning that counts. What is salient. Meaningful as pertains to the specific context or situation at the time and the sharing of this meaning.

Image: Sisifo rassegnato/Sisyphus Resigned (1983) Copper engraving, 109 x 161 mm

My source: Cuttings, Obituary Jürgen Czaschka (1943-2018), Printmaking Today, Autumn 2018, p.19.

Anti-Dwelling Box (or Boxes?)

individual

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INTERPERSONAL : SCIENCES

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HOUSING	HOUSING
HOUSING	Anti-Dwelling Box (1972) by Kiko Mozuna

"There are postmodernist houses and sci-fi houses - I particularly like Kiko Mozuna's bright yellow Anti-Dwelling Box (1972), in which nests of boxes sit inside each other like a surreal puzzle." p.13.

The Japanese House: Architecture and Life after 1945: Barbican, March 23-June 25 2017.

My source:
Heathcote, E. (2017) The home reinvented, FT Weekend, House&Home, 18-19 March, pp.12-13.

Photo c/o: http://erinwilliamsondesign.com/design-crisis/the-antidwelling-box

Box (-es) [ 1 ] [ 0 ] [ 1 ] [ 0 ]

One mind, many minds - ONE PLANET. One need, many needs - ONE PLANET: what price stability?

Hodges' model
a gyro for the
Mind and Planet

One mind or many more than ever we need to think OUT of the box and IN it.

Gyroscopes.org
The Incredible Genius Of Eric Laithwaite

Images - source: Photobucket
Thanks to David McKendrick for the inspiration.

Little boxes, little boxes ....

We are obsessed with 'boxes' - many of us especially so - at this time of year.

We cut and dice Nature into categories - boxes for things and concepts. Leaving the car and aircraft aside, being somewhere else - means thinking out of the box. Materialism? Well that is thinking out of the box taken to the extreme since materialism has us:

• filling boxes
• shipping boxes
• and the populous buying the latest and greatest of them.

(What would I like for Christmas? Well, I could really put a MacBook to good use - please!)

It used to be you shook the box - something rattled. These days silence prevails. The contents are virtual. The only rattle is from the dosette boxes. Count them out - M:T:W:T:F:S:S....

Science and medicine in particular has a thing about boxes. Of course, I have to put my hand up here as Hodges' model is not exactly quadratically challenged. It's rather ironic that in order to think out of the box, Hodges' model encourages us to think in four or five (spiritual) of them!

The business community is equally obsessed. The box clichés abound loud and clear in group, consultancy and change exercises. Of course the problem is when we only think in one box then things can come unstuck. They are often blinkered and this makes sense at times. As mentioned previously, medicine very frequently has to deal with life saving interventions that need snap decisions. I don't think it would go down very well in a crisis that someone pipes up "Now hold-on everyone we need to reflect on this, let's proceed in an holistic manner." At other times though critics point the finger, when people are treated purely in a box called 'SCIENCES' and the person becomes a mere adjunct to the box: a sticky label with a diagnosis (or two) written on it.

Nurses pride themselves and their person-centred caring approach on seeing the individual, not just the diagnosis.

Health professionals spend several years getting to know their box(es). The SCIENCES anatomy, biochemistry, physiology... Now in medical training doctors spend more time on communication skills. All health and social care professionals are prepared to 'travel', i.e. to put themselves in the patient's (carer's) shoes and see the world through their eyes. Increasingly in all human activities one discipline depends on the combined contributions of many others. Maybe that's why there's so much emphasis on words and disciplines like - integrated, transdisciplinary, socio-economics, interdisciplinary, psychosocial and geopolitical. New disciplines like neuromarketing emerge which we can expand in the respective boxes - e.g.

• INTRAPERSONAL box: behaviour, experiments, priming, freewill, ethics, personal choice, memetics
• POLITICAL box: consent, advertising, legislation, neuroeconomics, public health, governance-control, measures
• SCIENCES box: functional-MRI, bioinformatics, research programmes
• SOCIAL box: media, language, mental pollution, social nets, cultural acceptance, public perception

Using the model and 'travelling' you don't have to think of it as being 'in' or 'out' of boxes. Draw Hodges' model on A4 paper:

[Archived]:
https://web.archive.org/web/20060705190702/http://www.p-jones.demon.co.uk/index.htm

OK, now mentally fold it - one way - then another.

Suddenly disparate ideas, issues, techniques are thrown together. As physicists show (in theory only alas) as our learning grows, our previous journeys (new experiences - role plays, placements, secondments...) mean we don't have to travel the full distance. You too can warp space. In addition you are better equipped to take the patient and carer (student, whoever) with you and (try) to get their engagement.

It's true that many of these combined horizons may not work, but that's the nature of risk and creativity for you. Boxes! Do take care how you handle yours. Look out for those edges too - the leading edges change constantly....

Image source: Copyright © 2007 Apple Inc.