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

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

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 ...'

Jayasinghe (2025) 'People‑centred care: a systems view of a new paradigm'

C/o HIFA

Dear friends,

It is my pleasure to share the link to my article "People-centred care: a systems view of a new paradigm". It is published online in Discover Health Systems and Open Access. Please see full-text access to your paper by using the following link:

https://rdcu.be/ejNUq

Kind regards Saroj

ABSTRACT People-Centred Care (PCC) is an emergent property in an “open” system. Policies aiming at promoting PCC can be categorized under four nested levels: Micro-level; Meso-level; Macro-level; and Mega-level and used to draw systems diagrams. We develop a single composite diagram which demonstrates interactions and feedback, within and across subsystems, resembling panarchy.

Jayasinghe, S. People-centred care: a systems view of a new paradigm. Discov Health Systems 4, 43 (2025). https://doi.org/10.1007/s44250-025-00215-9.

Saroj Jayasinghe MBBS (Col), MD (Col), MRCP (UK), MD (Bristol), PhD (Col), FRCP (Lond), FCCP, FNASSL Fellow of the International Science Council, Emeritus Professor, University of Colombo, Former Head, Department of Medical Humanities, University of Colombo, Sri Lanka Consultant Physician sarojoffice AT yahoo.com, saroj AT clinmed.cmb.ac.lk

Professor Jayasinghe's paper provides several informative figures on centredness, scale and levels, micro-mega; and affords a way to use Hodges' model to help define person, patient, people and service-centred care. These definitions could be developed, refined and validated using a relational formulation.

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

PERSON-  PATIENT-CENTRED psycho-

PERSON- PATIENT-CENTRED location bio-

social PEOPLE-CENTRED 'Health systems and services designed ‘for and with people’ are captured by the concept of People-Centred Care (PCC) defined as an approach “to care that consciously adopts individuals’, carers’, families’, and communities’ perspectives as participants in, and beneficiaries of, trusted health systems that are organised around the comprehensive needs of people rather than individual disease, and respects social preferences.' Duong, et al. (2024).

political policy - engagement - design SERVICE-CENTRED panarchy 'Let us together forge a new way of knowing and practicing health care in the post-Sustainable Development Goal era, using people-centred care as our guide to achieve Universal Health Coverage.' Duong, et al. (2024).

Duong DB, Holt B, Munoz C, Pollack TM. For and with people: announcing the Lancet Global Health Commission on people-centred carefor universal health coverage and a call for commissioner nominations. Lancet Glob Health. 2024:S2214-109X(24)00216-X.
https://doi.org/10.1016/S2214-109X(24)00216-X.

Previously: 'design' : 'patient' : 'person' : 'system' : 'people'

Variety really is the spice of Hodges' model

In the previous post - RCN Congress iii 2025 Accountability for patients in ambulances I wrote of how corridor care has become variegated, as it is bound to, in a system(?).

Variegation means difference, and yet in organisational accountability, there should be reliance upon a procedure, if not a standard operating procedure. The experience of individual patients should be nuanced, standardised and yet catering for individual differences.^ The resolution at congress was questioning the need for guidance amid legal ambiguities.

This is also helpful in two senses. 

1. In exploring ways that Hodges' model might help encompass and explain the dual character category*, [or other, or not] as may apply to person-centredness and service-centredness?
2. Plus, (and potentially confusing for me) in seeking a basic understanding of dual categories in a mathematical sense.

* Book review iii: 'Categories we live by'

from the above post:
Knobe J, Prasada S, Newman GE. Dual character concepts and the normative dimension of conceptual representation. Cognition. 2013 May;127(2):242-57. doi: 10.1016/j.cognition.2013.01.005. Epub 2013 Mar 1. PMID: 23454798.

^This highlights a quality of what it is to care/and caring. It relies upon relationship building, the nurse getting to know the patient, person and vice-versa (to a degree) as befits the emergence of empathy, rapport, generation of trust; and the nurse's ability to anticipate not only care needs (that arise from direct observation), but those that are unique to the patient as an individual. In the previous post which mentioned corridor care, the physical, emotional, social and political environment is not established. Noise, on several levels stymies care, disrupting communication and interpersonal skills - even presence and touch - amid the chaos of the corridor. 

'Best Interests' - Audio Drama by Sasha Hails

by Sasha Hails

Peter Polycarpou (Read by), Gerard McDermott (Read by), Jonathan Forbes (Read by), James Lailey (Read by), Alex Tregear (Read by), Susie Riddell (Read by), Elaine Caxton (Read by)


A BBC Radio 4 dramatisation

'Two new dramas which get inside the emotional realities of dealing with ethical dilemmas. When a confused young man with no I.D. and a Doctor Who fixation is brought into hospital, the staff have clear rules about how decisions can be made on his behalf. But when he starts to make his own wishes clear, are they right to listen?

Starring Gunnar Cauthery, Clare Perkins, Simon Bubb, and Carl Prekopp. With Peter Polycarpou, Gerard McDermott, Jonathan Forbes, James Lailey, Alex Tregear, Susie Riddell and Elaine Claxton. Script Consultant: Jim Blair, St George's Healthcare NHS Trust. Produced and directed by Jonquil Panting.'

My source: 

Jim Blair @jimgblair - https://x.com/jimgblair/status/1906993515038429252

Consultation: CHANGE NHS

 
Our NHS is broken, but not beaten. Together we can fix it.    [ c/o https://change.nhs.uk/en-GB/ ]

The NHS has been there for us for over 76 years. But to make sure the NHS is here for the next 76 years, doing all it can to support the health of everyone, we need your help.

We want to have the biggest ever conversation about the future of the NHS.

It doesn’t matter whether you have a lot or a little to say. Your views, experiences and ideas will shape a new 10 Year Health Plan for England. 

This is open to everyone. If you are a member of the public or someone who works in health and care in England, 'Start Here', to tell us how the NHS needs to change.

If you are contributing as a representative of an organisation, complete the organisation questionnaire. This is an early opportunity to share your insights as we begin an extensive programme of engagement to develop the 10 Year Health Plan. 

If you register your email address, we will stay in touch to seek your views as the 10 Year Health Plan develops.

[video no longer available]

'change' in Hodges' model

The NHS and people's health is more than 

a machine, more than a mechanistic thing 

that if broken can be fixed.

By definition you cannot be 'inclusive'
if you do not achieve balance
with the humanistic; and the
values of humanity and
 the spiritual as per context.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

purposes person-centredness personalised care experiences continuity mental state; mental health attitudes - mindset expectations (public education) my health literacy (all of them: education)	processes (care inc. 'writing' records, 'gates' access) demographically-driven care  define 'success' - metrics - data utilise evidence peak CO2 peak obesity physical health: chronological age - pathological age encourage self-care to support sustainability
social care social attitudes child support - support for families proven practices that delivers community as resource community: homes for living in - not profiting from Public involvement:  #NHSCHANGE #CHANGENHS Protect / Create green spaces for outdoor play	funding, finance, budgets, economics POLICY: FROM: National ill-Health Service TO: National Health Service  long-termism E3^ for all the literacies address: food quality,  air, water, noise, litter SOCIO-tech approach to applied technology Teach Hodges' model to teens, and prisoners as part of PSHE and rehab programmes

E3^ education, education, education - by literacies we include: information, emotional, media, finance, spiritual, cultural, scientific, religious, climate...

'delivers' includes: improved care experiences, integrated care (related to all the domains), patient, carer, public safety, cost effectiveness, research questions, accurate - valid reporting.

All health disciplines / professionals, social care, and APPGs ... share a common model - a conceptual framework for critical thinking and reflective practice.

The paradox of Service Vs Person-Centred Care

Looking at Hodges' model and its basic structure of axes and care (knowledge) domains, I wrote a note to the effect that:

- the INTERPERSONAL (INTRA-) and SCIENCES domains are fundamental to individual care. 

This follows, of course, from the vertical axis.

Then I added, that the SOCIOLOGICAL and POLITICAL domains are fundamental to person-centred care.

 

Person-centredness is vested, is realised in and by the care domains that involve concepts mediated and related by the group, the collective.

 

There seems a (strong?) recognition of social justice and justice at work.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

individualised	individualised
person-centred	person-centred

Perhaps this is the implicit origin of the call to new learners and professionals alike to 'Make a Difference', 'Be the Difference'?

Then I thought of the perennial duality of service-centred and person-centred care.

 

Accepting the idealised nature of these thoughts, when 'presented' with a case, health services - through their practitioners, focus on the individual. The individual may express personal choices, hopes, but the extent to which these garner a response, are acted upon, also depends on the SOCIOLOGICAL and POLITICAL domains. 

In terms of the ideals (that apply, and what I will call upon) there are two extremes - I have mentioned previously, consider:

In the triage situation, apart from establishing consciousness - communication and interpersonal are collapsed into seconds, and response to stimuli / pain, communication is not key. Task orientation, practice, procedure, events, rehearsal, stock and equipment checks are to the fore.

 

Alternately, there is the level of interpersonal skills that are exercised to communication with the patient, to learn of, recognise, and respond to their personal choices.

 

All of a sudden things seem to be reversed.

 

Short of being plain wrong (?) -

THIS seems powerful, essential and required medicine for the 21st century.

service	SERVICE
person	PERSON

It is even more nuanced, however, and I'm not trying to clever (mathematics and logic are definitely not my subject), but making the above easier to describe:

s	S
p	P

Above, I'm trying to suggest and represent:

1. A lack of regard and relative neglect of the humanistic domains [ s AND p ];
2. This is then reflected in the ongoing issues of parity of esteem for mental health, illness and psychological interventions [ s OR S ].

In #1, we can add the UK decade long, debacle of funding for social care and the status and recognition of the workforce; the legacy (lessons) of medical sociology and the potential of attention to the social determinants of health and the sustainable development goals (paper to follow mapping the SDGs to h2cm).

The [ S AND P] in the SCIENCES and POLITICAL domains - might (also) be indicative of the continuously espoused benefits of technology as part of health care delivery. While accessibility and improvements in this are emphasized, often Politically people are isolated due to lack of technology, or funds. There remains a SOCIO-technical divide.

The years to follow, will no doubt see the microscope from the SCIENCES placed in the humanistic domains and technology's impact - benefits examined there. Who knows: maybe a new instrument, simultaneously (transdisciplinary) qualified will be found?

Conclusion that might be drawn:

The bio-psycho-social model is insufficient for person-centred care (having an opportunity, then yes - I would say this).

The overall aim and objective of Hodges' model when applied, is not to tick boxes but to diffuse the disciplinary boundaries, to assure, and integrate.

More to follow... (a paradox?)

Scratching the surface: Optimization algorithms

... In healthcare ..? 

Well - yes,

we've definitely scratched the surface,

but not a sufficient number of surfaces,

and not necessarily the right ones 

in the right order...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

My source:

An overview of #GradientDescent optimization #algorithms | @DataScienceCtrl https://t.co/bHrOnW03tk #AI #DataScience #DeepLearning #NeuralNetworks #abdsc pic.twitter.com/qKOMwNrF4l

— Duane Baker (@DBaker007) January 7, 2018

Mental Health Act 1983: Code of Conduct 2015 Revision

“Everyone including carers and families needs to know about the Code
and all communication channels 
— 
from bottom to top 
and vice versa
including sideways
— 
should remain open for the benefit of all.”

Expert Reference Group carer, p.5.

individual

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

Mental Disorder Patient, Person Individual, Safety Individual practitioner Assessment Autonomy, Decision Concordance Learning, Recovery Wishes, Choice - Advanced Plans	Process, Procedure Care Planning Contingency Records Treatment Place of Safety Time, Duration
Community of Practice Families, Nearest Relatives Communication Carers Care Co-ordination Integrated Services Relapse Prevention Relapse signatures Public safety	Human Rights, Mental Capacity Equality, Health Inequality Mental Health Act 1983 Code of Practice Tribunals, Appeals, Attorneys, Hospital, Police, Criminality

Image source:
http://www.tsoshop.co.uk/bookstore.asp?FO=1160007&DI=642031

Heat maps and hotbeds in Hodges' model

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

	out of area
family contact	"Out of area placements are a good indicator of heat within the system and how over-stretched it is." p.5 Prof. Paul McCrone, Lintern (2014).

Sources:
Image: http://www.usability.gov/sites/default/files/images/eye-tracking-full-option1.jpg

Lintern, S. (2014) Analysis reveals mental health trust funding cuts, Health Service Journal. 124, 6411, 4-5.

End of Life Care: Gold Standards Framework (Heaven's door)

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

individual

PRIMARY CARE	ACUTE CARE
CARE HOMES	DEMENTIA (CARE)

group - population

Looking at a table 'GOLD STANDARDS SET BY BENCHMARK PROGRAMME' (p.23) in Prof. Thomas's HSJ article, I could see an instant fit between the four listed care contexts and the domains of Hodges' model.

There are also many overlaps and of course Hodges' model is an idealised resource. For example,  governance applies across all the above and in that way all can be placed in the POLITICAL domain.

Further points explaining the above includes:

• The GP and primary care seeing the person first not the diagnosis. Again in this sense - respect and dignity we can place all these care specialisms in the INTERPERSONAL. You would hope that primary care 'know' the patient as a person, an individual; or at least through recourse to the primary care record.
• If a care home 'works' it will be able to deliver care almost transparently, it is not a process but a social gathering. It is not the person's home (their home is not something to be forgotten, replaced like their past), but it seeks to emulate this as far as possible. Care is a routine that is also personalised and even at the end of life there is peace, calm and dignity.
• Dementia care is a political challenge, a priority and challenge across all the domains. As in the previous post - what training is provided to Health Care Assistants and other staff? How is the strategy for dementia progressing across all these care environments?

The National Gold Standards Framework Centre in End of Life Care

Thomas, K. (2014) 'End of life care is a litmus test for the whole of the NHS'.  HSJ, 31 January, 124, 6384, 21-23.

Reprise: Hodges' model introduction

Developed in the UK during the early 1980s, Hodges’ model (h2cm) is a conceptual framework that is person-centered and situation based. In structure it combines two axes to create four care (knowledge) domains (as illustrated on the website). Academics and practitioners in many fields create models that help support theory and practice (Wilber, 2000). Models act as a memory jogger and guide. In health care generic models can encourage holistic practice directing the user to consider the patient as a whole person and not merely as a diagnosis derived from physical investigations? Exposure of h2cm is limited to a small (yet growing) cadre of practitioners; several published articles (Hinchcliffe, 1989; Adams, 1987; please see the bibliography on this blog). In addition to a website (Jones, 1998) there is a blog and an audio presentation both first published in 2006.

The best way to explain h2cm is to review the questions Hodges originally posed....

To begin, who are the recipients of care?

Well, first and foremost individuals of all ages, races and creed, but also groups of people, families, communities and populations. In this way the potential scope of Hodges' model is personal and global.

Then Brian Hodges asked: what types of activities - tasks, duties, and treatments - do nurses carry out?

They must always act professionally, but frequently according to strict rules and policies, their actions often dictated by specific treatments including drugs, investigations, and minor surgery. Users who adopt Hodges' model find that the model transcends the purely task-based perspectives of care and intervention. Hodges' model also encompasses beliefs, attitudes, motivation, self-awareness, and values. Nurses do many things by routine according to precise procedures, the stereotypical matron - machine-like efficiency? If these are classed as mechanistic, they contrast with times when healthcare workers give of themselves to reassure, comfort, develop rapport and engage therapeutically. This is opposite to mechanistic tasks and is described as humanistic; what the public usually think of as the caring nurse. In use this framework prompts the user to consider four major subject headings or care domains of knowledge. Namely, what knowledge is needed to care for individuals - groups and undertake humanistic - mechanistic activities?

Through these questions Hodges’ derived the model depicted on the website.

Initial study of h2cm on the website has related Hodges’ model to the multicontextual nature of health, informatics, consilience (Wilson, 1998), interdisciplinarity, and visualization. H2cm says nothing about the study of knowledge, but a great deal about the nature of knowledge is implied in the models structure and knowledge domains. This prompted two web pages devoted to the structural and theoretical assumptions of h2cm. Although the axes of h2cm are dichotomous, they also represent continua. This duality is important as for example an individual’s mental health status is situated on a continuum spanning excellent to extremely unwell. There are various states in-between affected by an individual’s beliefs, response to stress, coping strategies, epigenetic and other influences. H2cm was created to meet four educational objectives:

1. To produce a curriculum development tool.
2. Help ensure holistic assessment and evaluation.
3. To support reflective practice.
4. To reduce the theory-practice gap.

Since h2cm’s formulation these objectives have grown in relevance. The 1980s may seem remote, but these problems are far from archaic as expansion of points 1-4 reveals. Education is now preparation for life-long learning. Curricula are under constant pressure. Despite decades of policy declarations, truly holistic care (combining physical, mental and pastoral care) remains elusive. The concept and practice of reflection swings like a metronome, one second seemingly de rigour, the next moment the subject of web based polls. H2cm can be used in interviews, outlining discussion and actions to pursue, an agenda - agreed and shared at the end of a session. The model is equally at home on paper, blackboard, flipchart and interactive whiteboard. Finally, technology is often seen as a way to make knowledge available to all; the means to bridge theory-practice gap through activities such as e-learning, governance and knowledge management. The digital divide cannot be bridged by idealism alone.

The axes within h2cm create a cognitive space; a third axis projecting through the page can represent history; be that an educational, health or other ‘career’. It is ironic, that an act of partition can simultaneously represent reductionism and holism. Reductionism has a pivotal role to play, which h2cm acknowledges in the sciences domain. What h2cm can do is prompt the user that there are three other pages to reflect and write upon.

Should you be interested I can f/w two papers on Hodges' model published 2008 and 2009: please contact me at h2cmng at yahoo.co.uk. Much of the material on the website is in need of update, or removal - if you would like to help please let me know. The time for partnership in spreading Hodges' model is now....

REFERENCES:

Adams, T. (1987). Dementia is a Family Affair. Community Outlook, Feb, pp. 7-8.Hodges E. Brian (1989). Hodges health Career Model, IN, Hinchcliffe, S.M. (Ed.). Nursing Practice and Health Care, [1st Edition only], London, Edward Arnold.
Wilber, K. (2000). Integral Psychology: Consciousness, Spirit, Psychology, Therapy. Shambhala Publications.
Wilson, E.O. (1998). Consilience: The Unity of Knowledge, Abacus.

See this blog's bibliography for references and the blog labels (tags) for additional resources.

Person-centred care: "Right! Down! Down! Riiggghhht again! Spot On!"

-|- Person-centred care is one of the Grails of health and social care. It is up there with holistic care, which it precedes since holistic care needs a subject (discuss?).

In terms of Hodges' model the 'person' (for me) is to the upper-left-of-centre. Why there? Well, you really understand why when helping people cope through dementia.

It is no surprise that the development of person centred care and personhood have been especially concentrated and emphasised in the care of people living with dementia.

They need to be and constantly refreshed too - everyone forgets - some of us more than others.

Physically of course 'person' translates to the upper-right quadrant. So there you have it - in the INDIVIDUAL-group axis the classic dichotomy-debate: MIND-BODY.

I have no argument with the need for person-centred care, but faced with a Grail and the bright light that can encompass it, safety and respect dictates we step back. From a distance we can then see that person-centred care is only part of a much bigger picture.

At the end of the day (and night!) we need to be centred full-stop.

If not then saying the words that count such as dignity, respect, choice, privacy will echo in the intra-INTERPERSONAL domain and make everyone feel good in the SOCIOLOGICAL domain. All very worthy but possibly without making an impact where it counts - in the POLITICAL domain.

By placing the person at the centre of Hodges' model ALL the
domains are ready to hand and mind.