Poppy's Promise: "What happened next would change our lives forever"

April 2021:

'After my due date passed, I was admitted to hospital to be induced. Labour began and everything appeared normal. As first-time parents, we trusted that our baby was safe and that if something was wrong, someone would tell us. We had no reason to think otherwise.

During labour, opportunities to recognise that Poppy was in distress were missed.

Monitoring that should have taken place did not happen.

By the time concerns were recognised, panic had replaced reassurance.

I was rushed to theatre frightened, confused and not fully understanding what was happening to my baby. ...'

Poppy's Promise read more ...

My source: BBC Radio 4 Today 0736 mins:

https://www.bbc.co.uk/sounds/play/m0032fq8

Gaps and Legacy Issues in Health and Education

 ... and across the Professions and Disciplines

I've just revised what may be table 1 of an exploratory paper. The table's role is to inform the motivation, scope and overall purpose within the introduction. The aim is to outline the gaps and legacies in health and education. Is this the combined inheritance of life chances, health and work career: gaps?

1. Theory-Practice gap

   A. Research in Practice – Translational Research;
    B. Education/Training: University – Apprenticeship (see 4.B);

2. There is no research-based conceptual framework taught and applied across health and social care systems and services.

3. Individual – Collective (Population) Health

4. Legacies of:
     A. Integrated care (global: funding / philosophy / location / disciplines / academic …);
     B. Parity of Esteem
          i   Mind - Body – Cartesian dualism;
          ii  Funding of Health Services [mental health - general];
          iii Research funding; Policy & Education);

C. Person-Centred Care – Service-Centred Care;

D. NHS - Social care;

5. (Ill-Health-Disease, see 4.B.ii) Treatment versus Prevention first 

6. Long-term policy Vs Short-termism

7. Personal, Local, Global: Developed – Developing Health Systems & Services 

8. Determinants of Health (Schrecker and Bambra, 2025)
   
   

Any thoughts, key sources ... are most welcome, e.g. should there be a place for sustainability, self-care, the literacies and the basis of funding public, private, or charitable (mixed)? h2cmng AT yahoo.co.uk
 

Schrecker, T., Bambra, C. (2025). ‘Lethal But Legal’: The Corporate Connections (Commercial Determinants of Health). In: How Politics Makes Us Sick. Palgrave Macmillan, London. 
https://doi.org/10.1057/978-1-349-96127-6_7

Dear Editorial Office,

Dear Dr. Jones,

My name is Editorial Office, and I am writing on behalf of the selected journal. I came across your article, "A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts". Its focus on deprivation of liberty safeguards, Hodges' model, older adults caught our attention. I would like to invite you to consider a new and unpublished contribution to the selected journal.

For this invited contribution, we are pleased to offer a Full APC Waiver. Invited manuscripts receive priority editorial handling, and we aim to provide an initial editorial decision within one week. This invitation does not imply acceptance, and editorial standards remain unchanged.

If you are interested, a working title or short abstract is enough for an initial discussion. If your current work is not closely aligned with this journal, you are also welcome to share your present research topic and we can check whether another journal in our portfolio may be more suitable.

I would be glad to answer any questions and look forward to hearing from you.

Best regards,
Editorial Office
the selected journal

Dear Editorial Office,

Re. 'the selected journal: Invited Contribution – Full APC Waiver'

Thank you for your communication and recognition of my recent paper.

Unfortunately you have not specified the 'selected journal'. Without this detail it is difficult to proceed at all, or ascertain what benefit is provided by the 'full APC waiver'. 

I am more troubled, however by your name. Is it really 'Editorial Office'?

Again the specific journal matters here. If it is materials science, chemistry, or quantum physics or related this is (slightly?) less of a problem. Otherwise, I do worry that with Hodges' model being person-centred your being de-personalised does not sit very well with the purposes and values of Hodges' model.

It is however reassuring to learn that I should not take your invitation to suggest acceptance, and that accordingly your editorial standards remain intact - especially in these times.

Again, even if I were interested, I am at a loss to provide either a working title, or abstract.

I do hope you understand my difficulty? 

Although perhaps I ask too much.

Can it be - this IS in fact the journal?

'The Selected Journal'?

Yours Faithfully,

Mr^ P Jones

^'Conceptual Surgeon' 4th class

(and not sent.) 

Brief introduction to Hodges' model

Hodges’ model is a conceptual framework of universal value in theoretical work, practice, policy and care management. While this model is a product of the health-education sector, it is global in scope, taking in the current situation, history and future as complicated by scientific, socio-political, technology and climate change. Practice-based, Hodges’ model is a tool simple in form and yet powerful in terms of how it can help users frame the problems and opportunities of the 21st century. The model was originally taught in studies for the post-registration certificate of care of the mentally ill in the community and other courses. Student assessment included the completion of a case study (vignette), demonstrating competence in application of the model and its embedded (implicit) values.

Access to education, especially early years, is emphasised as foundational for personal and community growth and development. For individuals this can set the course for lifelong learning and an ability to contribute to society and the economy. Given this primary challenge, global institutions and policy makers point to the need for curricula that are relevant. In turn employers and industry leaders need a (global) workforce who are: 

• reflective practitioners;
• critical thinkers;
• able to see the ‘big-picture’; and focus on detail and priorities when needed (risk and triage);
• decompose a problem, but also integrate (care);
• work as team-members;
• and extend across several literacies.

These challenges are ongoing for education (being health literate, so as to address personal, social, health and economic education, and the sustainable development goals), and increasingly climate impacts.

iii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

In reading this book and others on W2tQ, I must make the following points:

  * my need to remember the purely USA context (I have never worked there);
  * my healthcare, nursing, informatics experience is NHS-based;
  * this review (and others) is motivated by the project here - Hodges' model;
  * as a result, I will be quoting heavily, there is much to bring to your attention.

As noted in post (i) there is much to whet the appetite, a paradigm shift, 'comprehensive, collaborative, and integrated care' (p.11) certainly have become popular topics in the medical literature. Not only that but 'interpersonal and intersubjective treatment models' too (p.12).

The role of 'Case Managers' is highlighted, plus the Case Management Society of America, which is committed to:

•  Improved Consumer Health Outcomes
•  Professional Diversity, Equity, and Inclusion
•  Cultural Competency and Humility
•  Advocacy for the Health Consumer
•  Integrity and Ethical Principles
•  Promoting Health Equity
•  Educating Case Managers Across the Care Continuum
•  Evidence-based Quality Care
•  Holistic, Compassionate Care
•  Fostering Communication and Collaboration
•  Advancing Research, Innovation, and Use of Technology
•  Fiscal Accountability [ https://cmsa.org/about/ ]

Whether the USA influences global trends in the structure and form of healthcare is another post, but there is a UK Case Management Society too: https://www.cmsuk.org. I can see a fit here [UK] with the development in recent decades on social prescribing. A different role, of course but part of a complex jig-saw.

As expected definitions are provided: 

'Roger Kathol has eloquently defined "health complexity" as "the interference with the achievement of expected or desired health and cost outcomes, due to the interaction of biological, psychological, social and health systems factors when patients are exposed to standard care delivered by their doctors" [1].' p.10. 

Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel (2018) The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients. 2nd ed. Basel: Springer.

I can see where this definition comes from, but for me, it does not sit right. The problem when there is 'interference' is the assignment of responsibility and consequence that blame can follow. We've seen this, and in mental health too), with the recover model^. Some of the terms here may be completely innocuous politically speaking (which is the author's intent of course), but they can also be 'weighted'. Hence they can become concrete terms of judgement. Think about it: achievement, expected, desired, cost (and) outcomes, standard care, delivered (by doctors)? Or, am I over-thinking again.

In the margin I pencilled/drew:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Standard -	care
Other -	factors

As ever, the individual patient is our focus. The individual is supported (literally) by the social and political (infra-)structures that act as a scaffold, safety-net for most.

Time flies, I can't believe it was 2007 I posted 

Plush HQ foyer, shame about the mannequins!

I had this notion of life-size cardboard cutouts representing the average people who use a given health service provider (local, or not so local these days?). The data will be there in statistical annual reports. I'd noticed the displays - analogue and digital that greeted visitors at a local NHS Trust HQ. This would be the book's 'routine patients' who receive standard care. 

Chapter 3 introduces 'variables' which again is brief, but imporant as variables recur throughout the book. The 'Clinical Field' is first outlined, as in:

• Sources of clinically relevant factors;
• Dynamic factors;
• and: Variables representing contributions from practitioner(s).

Abstract variables are differentiated from those that are concrete. It's reassuring to read there is no true simplicity within the clinical field, and the author's goal is to 'unpack complexity so it remains as true to life as possible, not just manageable conceptually.' p.18.

Frankel et al. are primed to go beyond this. Maths, as in statistical procedures are one tool. Chapter 4 adds to this with a theoretical model to guide clinical understanding of patients with biopsychosocial complexities, the foundations of our paradigm shift. p.23.

If you have an understanding of Hodges' model you can picture my response to this. But, staying grounded, the whole book and paradigm shift represents a form of scientific "emergence". It is frustrating that literature searches fail to pick out Hodges' model. 

Frustrating too as reading of "awe", also on page 23, I have experienced this many times (over say 1977 - 2019 ...). So, I held on to my dummy (pacifier!?) and read on ...  

Chapter 4 Technical Considerations is one the longest and contributes all of Part III. Here you can read about science, measurement, statistics, empirical, operational definitions, intelligence, reliability. I often see a chapter, book section as a useful primer for students and the same applies here; with inter-judge realiability, validity, control, null hypothesis, statistical methods and much more. Reference to mathematics (axiomatic too) had me hoping for more. I picked out Structural Equation Modelling:

 'We would also like to suggest that following the steps involved in "structural equation modeling" (path analysis) is a good way of conceptualizing and reasoning about complex clinical variables altogether. For example, constructing a clinical model informally (intuitively, loosely from data) and thinking about (diagramming) how the variables involved may moderate and mediate each other can be a useful activity for clarifying the nature and requirements of a complicated clinica1 situation. 
 

 In simplest terms, an independent variable is the causal or influential variable that impacts and effects the dependent variable. A moderating variable is a dichotomy, and refers to two comparison groups (e.g., male/female; passed/fail; religious/nonreligious; tall/short; high versus low socioeconomic status) that display significantly different degrees of magnitude on a correlated relationship. For example, the relationship between a specific treatment for a medical disorder and treatment outcomes may be moderated by socioeconomic differences. The treatment outcome relationship may be stronger and more positive for individuals with elevated socioeconomic standing who therefore have better support systems and access to medical professionals, and fewer economic stressors.' p.36.

I think from this the authors might be sympathetic to giving 'life' to the POLITICAL domain and Hodges' model; after all it lives in people's daily experience - acknowledged or not. The book's structure works thus far: Chapter 5 Nature-Nurture (n.b. no escape!)  and the Epigenome. The structure - flow - works, as at just over four pages, it begs further reading (beyond the listed references). I still have my copy of:

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

 

With the epigenome being added to the 'patient complexity equation' in chapter 5, I wondered whether this was predictable, a promise, or a tease?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

nature?	NATURE?
NURTURE?	nurture?

 

Previously: 'complex' : 'nature' : 'mental health' : 'person(-centred)'

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

Tanzania Health Summit (THS)

Hello Peter Jones,

Warm greetings from the Tanzania Health Summit (THS).

As we prepare for the 13th Tanzania Health Summit, scheduled for 5th–7th October 2026 at Mlimani City Conference Center, Dar es Salaam, we are excited to share key opportunities and updates for your participation.

Abstracts Submission is underway, submit before 1st June.

We invite researchers, innovators, and professionals to submit abstracts aligned with this year’s theme:

“Building Health Sovereignty and Strengthening
Health Systems in a Changing Global Order.”

This is your opportunity to showcase impactful work and contribute to national and global health conversations.

Elizabeth & her Colleagues story about their wish to present at THS: 

SUBMIT YOUR ABSTRACT NOW!!!

Early Bird Registration is Still Open

Secure your spot at a discounted rate by registering early. Take advantage of this limited-time offer and be part of Tanzania’s largest healthcare gathering.

My source: Email - THS

iii Picking up sticks: when axes matter

It is one thing for us to break the stick, but quite another from a concept's perspective. They are accustomed to the dynamics at work, when as search terms they are exploded, or not. And, not just any concept but one that can be unique. Consider the concept, and how or where it finds itself [ in Hodges' or another model ]? Let us use the intra-INTERPERSONAL domain, as an example, and ask:

1. Is 'mood' fixed by the I-axis alone?
2. Does the humanistic axis have a role in where in the doomain the user of Hodges' model places 'mood'?
3. Acknowledging person-centredness, if the patient/client had a view, to what extent would this agree (with annonymity assured) with the professional's judgement, or a relatives / guardian?
4. What is as a result, 'mood' has become 'very low mood'? (To continue in this vein , invites complication, but we will continue.)
5. Introducing the 'Other' whatever their role and relationship, pushes us to the humanistic, but whether this is achieved in a person-centred manner (triage excluded) is a matter of opinion and judgement (evaluation).

If mood is fixed by the I-axis then if we determine the issue is 'low mood' are we introducing a combined quantitative and qualitative dimension, a continuum, at the selected point in the interpersonal domain? Writing previously about threshold concepts, I wondered, and proposed compound threshold concepts. There is a progression from the patient's subjective self-assessment, to in all likelihood of an objective measure being introduced, so spanning two domains. Definition of 'compound' aside; there is a compound structure at work.

What points 1-5 above reveal is triangulation. When it is argued that Hodges' model facilitates navigation as per my presentation on 21st April, this is a strategy from mixed-methods research in practice. Many years ago, Hodges' model was described as a 'cognitive periplus', reflecting the way ancient mariners initially charted the coastlines creating the first map, as per their culture and dispora. In the west more recently the value of social approaches and activities, especially in mental health. Care navigation is a role. Literally sign-posting to individually suited (which must be stressed) activities, resources, and agencies. So, in Hodges' model what are our three triangulation points? They are:

1. Axial;
2. Intra- InterDomain; 
3. Person-centred. 

Perhaps, we can describe 1-2 as conceptual anchors at least when dealing with a concept, while #3 is more about approach, values and philosophy. So, there is something of a 'cheat' going on, because each one is compound:

1. Axial: The axial is comprised of four points. The axes create a Cartesian plane (figure). And, as far as a patient is concerned, they mark off a point on the respective Individual and Humanistic-Sciences parts of the axes. This form of triangulation point can claim a general conceptual precision (language) in the applied terminal labels; but what happens in-between can be patently fuzzy. A mix of what may be objective and subjective.

2. Intra- Interdomain: This may be the most imprecise triangulation point. It appears the axes of Hodges' model are composite (figure). They have two-sides as a boundary. To be pedantic, in our example, one plays to the interpersonal domain, the other the sciences.

[The relationship between the axis and the domains in Hodges' model, is far from unique; but I wonder if there is something else here?]

2. Person-Centred: There is a paradoxical nature to person-centred(ness). It is also nebulous in nature, and yet in care it is definitive in practice (safety, purposes, values, professionalism, competency, ...).  It forms locus which can also be classed as a traingulation point, at the centre of the model. This is the point around which Hodges' model is built. This captures the individual's (life, care) context and situation, all influenced by their life chances as consequent health - and other - careers. Salience and our attention^ is key. Is it possible to frame our purpose(s)?

^A focus for [N] autumn.

Marrakech, Le Jardin Secret. 24th April. 1000-1830.

Global Experts call for Paradigm Shift in Medicine, Health and Education to Save Lives and Fight escalating Health Crisis

ACCESS NEWS WIRE – for PRESS RELEASE on Tuesday, 28. April 2026

A global consortium of 64 experts (72 entities, 5 continents) unveiled two coordinated consensus plus policy brief reports, outlining a science‑driven roadmap to confront escalating health crises and to tackle the growing burden of noncommunicable diseases (NCDs—including cardiovascular diseases, cancer, diabetes, etc.: 75% of global deaths; 82% in low-/middle income countries; 90% of all death in European region).

The centerpiece is HEAL—Healthy Eating & Active Living, ideally whole‑food plant‑predominant/vegetarian-vegan diets & daily exercise outdoors/active mobility—as the minimum, first‑line standard in health and care. The authors urge immediate action on Prevention-over-Treatment and reforming education and human‑relevant science (drug failure rate from animal studies is 90-95%, and as high as 99.6% for Alzheimer disease), with a rapid shift from disease‑centered reaction to person‑centered, lifestyle‑first cure and care.

Figure 1. HEAL means choosing a whole-food, plant-predominant (ideally vegan) diets coupled with daily exercise outdoors/in nature to kick-start better health. Credit: iStock/LightFieldStudios.

“Sustainable health is for free but cannot be downloaded or prescribed—it must be lived daily and earned across lifetime through informed lifestyle choices, with HEAL as starting point. As childhood-entrenched health literacy lasts a lifetime; embedding HEAL from primary to tertiary education is the policy priority of our generation.” —Lead author Katharina Wirnitzer | PHT, University of Innsbruck & CCCTIM

Foto 2. Katharina Wirnitzer/Keynote on Vegan Diet in Sports. Credit: ©Katharina Wirnitzer.

Why change is imperative.

• The paradox: Despite rising health spending and scientific advances, public health gains lag while ever-growing NCDs. The expert panel offers 101 consensus statements and a 10‑step policy roadmap to act across the lifespan—from individual behavior to population‑level change.

• Why HEAL, and why now: HEAL combines Healthy Eating (whole‑food, plant‑predominant; preferably vegetarian/vegan) with Active Living (regular, ideally daily, including outdoor activity and active mobility). Evidence shows synergistic benefits beyond either alone, reducing reliance on drugs and surgery while improving resilience and sustainability of health systems.

• Prevention-First (3:1): The reports recommend prioritizing prevention, health maintenance, and health promotion over treatment by 3:1 (Figure 3), making healthy choices the easy, first‑line intervention and reserving medicalized treatment for specific indications.

• Education and workforce: Embed HEAL from primary through tertiary education and continuously upskill healthcare and education professionals to deliver evidence‑based lifestyle counseling, routine assessment, and monitoring. Improve meal standards and support active mobility in schools and public spaces.

• Human‑relevant science: Accelerate the transition to non‑animal, human‑relevant methods for basic and preclinical research and for efficacy, safety and toxicity testing through funding priorities, validation, and regulatory adoption.

• Policy roadmap: Apply Health in All Policies (HiAP) to link individual choices with systemic supports (Figure 4); invest in supportive defaults (healthy public catering, active transport, public‑space design, community HEAL programs); embed HEAL in curricula; and track outcomes with robust evaluation to scale what works.

“Every dollar/euro invested in evidence-based prevention saves multiples in treatment. HEAL is the smartest first investment a health system can make.” —Bernd Haditsch | ÖGK – Austrian Health Insurance Fund, Prevention Unit
“Obesity is a disease with powerful drivers. HEAL gives every patient a proven, first-line foundation to reclaim their health.” —Fatima Cody Stanford | Harvard Medical School & MGH
“A doctor who cannot counsel patients on the Power of Lifestyle, especially on food and movement, is only half-equipped. Lifestyle education in medical school is the missing foundation of modern medicine. Helping our patients to eat a more plant-strong diet is the most powerful healing medicine we can prescribe.”
—Michael Klaper | Moving Medicine Forward
„Plant-forward diets provide a powerful opportunity to concurrently improve health and wellbeing for people, farmed animals and the environment.“ —Andrew Knight | Griffith University

Figure 3. Four areas-of-action, balanced 3:1, to achieve lifelong health. Credit: ©Katharina Wirnitzer.

“Given its cost-effectiveness, Traditional, Integrative, and Complementary Medicine will be the evidence-based mainstream of tomorrow’s global healthcare.” —Tomáš Pfeiffer | ITCIM & SANATOR
“Treatment alone will not sustain health systems. HEAL connects prevention, lifestyle medicine and integrative care to advance salutogenesis on a planetary scale. We must invest far more in creating health.” 
—Georg Seifert | WHO CC & CCCTIM, Charité Universitätsmedizin Berlin

“The science clearly shows that, when it comes to human health, animal protection is a win-win.
Given human health’s complexity, and since animal testing virtually fails to cure human diseases, human-relevant methods already outperform animal experimentation and must therefore be implemented with priority in science, with funds going to human-focused research.
Citizens in the EU and US have spoken clearly in favor of this transition.
HEAL can prevent many diseases, avoiding the need for animal studies altogether.“
—Merel Ritskes-Hoitinga | Universities Aarhus & Utrecht; Doris Wilflingseder | Vetmed Uni Vienna, Aysha Akhtar | Center for Contemporary Sciences, Corina Gericke & Gaby Neumann | Doctors Against Animal Experiments

 

Figure 4. Systemic application of HEAL to reach target groups and improve personal and public health across micro (individuals/families), meso (communities), and macro (state/government/federal policy) levels, ensuring optimal vertical and horizontal permeability and integration. Credit: ©Katharina Wirnitzer.

Key Actions at a Glance.

• Make HEAL the universal starting point and minimum, first‑line prevention standard.

• Implement lifestyle‑first counseling before routine prescriptions.

• Prioritize Prevention-over-Treatment with an 3:1 balance.

• Mandate lifestyle education in schools; embed HEAL across tertiary programs.

• Continuously upskill professionals for evidence‑based lifestyle counseling and monitoring.

• Accelerate adoption of human‑relevant methods to end animal experiments in research, education and regulatory testing.

  
  

Figure 5. The Power of Lifestyle: Start with the dual HEAL approach across 6 interconnected areas to improve health and well-being. Credit: ©ACLM. Graphic modification: ©Katharina Wirnitzer (permission: 24.11.2021).

Contact for further information

Katharina C. Wirnitzer—Professor for Sports Public Health with a special focus on Child Public Health

Email: katharina@wirnitzer.at | Cell: +43 (650) 5901794

University College of Teacher Education Tyrol (PHT), Innsbruck, Austria

Slingshot AI? Meet the Earthshot (Prize ...!)

Slingshot AI

Ash
"the first AI designed for therapy" 

'In January 2024, we set out to build a 
foundation model for psychology. 

The mental health crisis sweeping across 
our communities isn’t going anywhere, 
and what we’re doing clearly isn’t enough. 
Therapists have one of the hardest jobs in the world,
and there just aren't enough people 
or resources to help everyone in need.
And we all know in our hearts that everyone 
could use some help with their mental health. ...'

'We need a foundation model for psychology.'

 

🔷 

 

Plus a bit more ...? 

 

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

The four primary therapeutic approaches used by Ash are: Cognitive Behavioral Therapy (CBT): Focuses on identifying and modifying dysfunctional thoughts, emotions, and behaviors. Dialectical Behavior Therapy (DBT): Teaches skills for emotion regulation, distress tolerance, and interpersonal effectiveness. Acceptance and Commitment Therapy (ACT): Focuses on accepting difficult emotions while committing to actions that align with personal values. Psychodynamic Therapy: Explores unconscious patterns and early life experiences to understand current behaviors. [ Google AI Overview* ]

?

?

?

Our 'Intelligence' is embodied.
The whole of Hodges' model is / can be 
embodied - embedded within the SPIRITUAL.

My source: Electronic therapy - Machines of loving grace, The Economist, November 15th-21st, 2025. Vol. 457: #9474. pp.72-73.

 *"slingshot ai - what are the four therapeutic approaches used by ash?"

 

Previously: 'health' : 'ai' : 'parity of esteem' : 'foundation' : 'language' : 'embodied'

Person-centredness, Holistic approach, Prevention c/o Hippocrates

“It is more important to know what sort of person 
has a disease than to know 
what sort of disease a person has.” Hippocrates

 

Individual

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      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

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To say that Hippocrates was ahead of his time is a gross understatement. Hippocrates recognised the importance of person-centredness and prevention, and contributed to the emergence of several medical specialties. (Kostakopoulos, et al., 2024).

'Holistic Approach One of the most significant innovations of the founding father of clinical medicine was the holistic approach for the diagnosis and treatment of disease. This approach is based on the assumption that the human body is a sum of many parts that function in harmony and that if one part is ill, the balance will be affected and the whole person will suffer. Hippocrates considered that patients consisted of body, mind, and spirit and this is also the modern physicians' approach when treating a disease [2].'

Health and social care are still playing catch-up. The vitriolic 'debate' on X over psychiatry - anti-psychiatry and DSM-X. The total inability now to shift to preventive healthcare due to the perverse, entrenched economic incentives, which facilitate increasing inequity, inequality. Whichever Government does switch to preventive medicine, perhaps other governments had better take note?  I think Hippocrates would have approved - wholeheartedly - of Hodges' model.

'Prevention of Disease Another important aspect of Hippocrates' works that is widely applied in 21st-century medicine is the prevention of disease. The phrase “Κάλλιον το προλαμβάνειν του θεραπεύειν,” which means that it is better to prevent than to treat a disease, was the cornerstone of his teachings and is based on the observation that healthy Mediterranean diet and daily moderate physical activity can prevent disease. The ancient Greeks believed that all maladies started from the gut and that walking was the best available medicine [2].'

Kostakopoulos NA, Bellos TC, Katsimperis S, Tzelves L. Hippocrates of Kos (460-377 BC): The Founder and Pioneer of Clinical Medicine. Cureus. 2024 Oct 1;16(10):e70602. doi: 10.7759/cureus.70602. PMID: 39483540; PMCID: PMC11526839.

Gabbard, G. The Person with the Diagnosis. Psychiatric News. 49;6. 19 March 2014. 
https://doi.org/10.1176/appi.pn.2014.3b19.

Brigić, A., Hasanović, M., Pajević, I., Aljukić, N., Hamidović, J., & Jakovljević, M. (2021). Principles of Hippocratic Medicine from the Perspective of Modern Medicine. Psychiatria Danubina, 33(Suppl 4), 1210–1217. 

See also: 'medicine' : 'person' : 'diagnosis' : 'prevention'

Normansfield Theatre in Teddington

Normansfield Theatre in Teddington

'My favourite building is the amazing Normansfield Theatre in Teddington that John Langdon Down (1828-1896) built to provide positive and stimulating education for learning disabled people (Down syndrome is named after him). At a time when most disabled people would have been shut away in horrific asylums, Down adapted his own house as a residential home, and built a beautiful theatre for creative rehabilitation. It's one of the few surviving private theatres from the period, with original painted scenery and other ornate fixtures, recently remodelled. For me, it's also a reminder of how the wealthy often used their money for good causes, which feels less common now. Jos Boys, guest curator and co-director of The DisOrdinary Architecture Project'

My source: The pick of London Open House. House&Home, FTWeekend. 6/7 September 2025. p.8.

Image: Langdon Down Centre

Previously: 'learning disability' : 'theatre' : 'architecture'

ii 'Thinking outside the box ...' by Amber Javis

Second reply to a blog post by Amber Jarvis on The Mental Elf:

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/

Jarvis highlights concern within inpatient services of:

'use of coercive practices ... (Nyttingnes et al., 2018; Belayneh et al., 2024). These include physical restraint (physically holding a person), seclusion (holding a person in a locked room) and chemical restraint (the use of sedating medication to manage distress or behaviour, sometimes administered “as needed” rather than as part of any planned treatment). Poor relationships between staff and service users have also been noted, ...'

Reflecting since the previous post, I realise that I encountered efforts to prevent admission and treat in the community prior to going part-time. A short stay unit at a general hospital. Being a member of Intermediate Support for older adults; shifts ran 0800-2000 - early or late. Then working part-time, there were short-stay placements in the community that the recovery team would visit providing support.

Mental distress is distressing (a truism of course), both as lived experience (with or without self-awareness in-situ/crisis) and for others in the vicinity. Family, friends - who see a person they thought they knew, perhaps even thought they were a friend, a person who loved them; but now!? They present as distant, aggressive, subdued, agitated, unpredictable, inconsolable and possibly expressing thoughts of self-harm, threats to harm others, or totally bizarre, 'psychotic' ideas. This is not the person they thought they knew. For the person affected, familiars are strangers. A relational breakdown. We forget the severely mentally ill at our peril. A pervasive sense of helplessness is readily transferred: the reflex conclusion that help is needed - and fast.

To say we are creatures of habit, is to also acknowledge that change our environment results in a change in our behaviour. When relatives did arrive on the psychogeriatric ward I mentioned previously, they cried. Apologising for the environment, yes; efforts to reassure ensued and eventually family, friends were won over. They shouldn't have been. Unless we're in a game, play, or movie, who wants to find themselves in a Victorian era institution?

I've posted previously (or is it in draft?) on the importance of design in the design of care environments. It was a relative's visit to a care home, that resulted in a nursing home design business (Sunday Times). 

A person who is severely mentally ill needs service-centred care, not purely person-centred care. Person-centredness is key, but safety of self, and the public soon makes itself known. We also forget this at our peril. The problem is that control, and law literally take over. Plus, it's our place not yours. Loss of power the person struggling, ill, in crisis then follows. Amber continues:

'The concerns described above chime uncomfortably with modern mental health agendas of prioritising autonomy, compassion, trauma-informed and person-centred care. In light of these tensions, and the growing number of crisis alternatives – ranging from crisis cafes to intensive home treatment services – researchers  at the NIHR Policy Research Unit in Mental Health set out to map current alternatives to traditional inpatient care, both nationally and internationally. Griffiths and Baldwin’s findings raise important questions about how mental health services could evolve to better suit people’s needs, providing a valuable starting point for service planners considering developments in care.'

Hodges' model is ideal to help reflect and critique the relation-ship between 'a person' and 'the service'. I passed two gentlemen in London over the weekend. Clearly unkempt, standing but gesticulating, freely verbalising, incoherent on passing. Neither appeared intoxicated ( but I wasn't that close) or 'stoned'. That's the other question; passing-by what was I going to do? Does the 'community' care? On 'X' you encounter the extremes of debate. Anti-psychiatry, resort to and risks of dependence on medication - anti-depressants, anxiolytics; the damage from anti-psychotic drugs and atypical antipsychotics. The continuous debate about ECT. A dizzying stream of texts about mental health, over-diagnosis and wellbeing:

Medical prescribing has a partner. Social prescribing is well established, with organisations, events, publications and research emerging. People, have scoffed at the suggestion that gardening can help; or going for a run. Especially when you can't get out of bed. Chronic fatigue syndrome, long-COVID are seemingly monolithic in their resistance to change. A real challenge and so counter to the person's 'pre-morbid' personality and lifestyle.

For several years the state of mental health nursing as a specialty has been questioned. Is the mental health nursing curriculum being genericised? Enrollment of students nurses in learning disability has also dropped.

RCN questions separation of mental health nurse training (28 March 2025)

Medical prescribing has a partner. Social prescribing is well established, with organisations, events, publications and research emerging. People, have scoffed at the suggestion that gardening can help; or going for a run. Especially when they can't get out of bed. Chronic fatigue syndrome, long-COVID are seemingly monolithic in their resistance to change. A real challenge and so counter to the person's 'pre-morbid' personality and lifestyle. As a conceptual framework Hodges' model is ideal as a semantic net, to reflect and critique concepts that stretch and so disrupt (for a time) out norms. Concepts with a dual character. If social prescribing is one example, take crisis cafe mentioned by Jarvis above. If you think in physical - environmental terms where do you envisage a crisis occuring or playing out? What about a cafe? What is the ambience of these places?

I noticed a little visual game, an animation of characters running, jumping, climbing over an obstacle course. You focus on one figure and follow them for a time. This makes a difference, called distraction. In psychosocial intervention and managment of psychosis and anxiety audio - music, poetry, repetition has also bee used. The essence here must be when the intervention begins. Recognising relapse triggers, requires preparatory work. The Griffith reference is provided, but Jarvis begins to describe the results:

'Researchers identified 65 alternative service models to standard inpatient care. These were organised broadly organised according to the setting (e.g., community-based, hospital-based, or cross-setting) and the target population (e.g., adults versus children). Across these categories, ‘community-based alternatives’ were the most common category of alternative service models, followed by hospital-based and cross-setting approaches. We’ll explore each of these in more detail below.'

In post (i) and here I suppose I am advocating for mental health nursing as a distinct programme of study, practice and proven competence. For several years the state of mental health nursing as a specialty has been questioned. Is the mental health nursing curriculum being genericised? Enrollment of students nurses in learning disability has also dropped. 

RCN questions separation of mental health nurse training (28 March 2025)

There is a saying: 'You get what you pay for'. There is a sense that there are people who would like to ignore, deny, erase 'mental health'. After all, the truth really is that you can 'see' a broken leg. This isn't an issue if you can afford a private psychotherapist, or a psychoanalyst.

The elephant here (well, there always is one) is education and the literacies. For prevention: the ultimate change - this is where we must focus. But of course for the problem at hand - and mind it is too late.

(Post iii likely to follow.)

Individual

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      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

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Group

subjectivity          mental state - crisis - mind quality	objectivity hand - physical state - crisis quantity
Social prescribing Cafe	Housing - crisis Cost of living - crisis

See also: 'literacy' : 'prevention' : 'service' : 'severe' : 'change'

'Thinking outside the box ...' i

iii 'Thinking outside the box ...'