'The Trip' - learning about Kay Parley RIP

Five prompts drew me to BBC Radio's 'The Trip':

1. the ongoing tenor of 'discussion' on twitter;
2. the ongoing history and future development and evolution of psychoactive, psychedelic medicines as treatments, running concurrently, or not with psychotherapy and psychosocial interventions (PSI);
3. being mindful of keeping up-to-date;
4. what is the temperature within critical psychiatry / mental heath / mental illness / well-being?
5. and how does all this 'sit' within Hodges' model?

As a student registered mental heath nurse, we learned about the historical introduction of chlorpromazine and other drugs, the difference they made to 'care' and the side-effects.

Pharmacology is dynamic. Atypical antipsychotics are now available. But this series, as the title confirms is about psychedelics and history from 08:30.

The episode highlights the importance of how sessions are delivered. Key points, given the additional pressures (UK) upon intakes for student nurse places for learning disability and mental health, plus questions about the status of these courses within university-based nurse education. If not already aware, the episode concludes with the role of a mental health nurse who died in May. Have a listen about Kay Parley.

THE TRIP - BBC Radio

https://www.bbc.co.uk/sounds/play/m002gqxs

It would have been marvellous to meet, speak to Nurse Parley. The episode has it's objectives of course, but there are values here. We are all test pilots, researchers.

"The American Journal of Nursing February 1964:

No role, is so welcomed on our psychiatric unit, as that of sitting with a patient during LSD therapy. This indicates that the treatment has value." ...

"Kate Parley passed away in May, so our last words will be hers. Words she would say to her patients at Weyburn, all those years ago.

'You are off on a trip with no baggage, no destination and no compass. That's why I'm here. I can't go with you, but I can be your anchor.

Wherever you go, you'll always be able to see me. I'll be the nurse who sits beside your bed. Taking notes and playing your records.

You'll never lose touch with me. Seeing me, you'll know, you are really in hospital and that you'll be back to Earth about 4 o'clock. I will send you signals too, to encourage your explorations.

I will remind you of places you longed to revisit and events you hope to scan.'"

PARLEY, KAY. Supporting the Patient. AJN, American Journal of Nursing 64(2):p 80-82, February 1964. 

https://www.openurses.org/_files/ugd/52de8b_870deaa149e842d286e76131b1321285.pdf

https://andrewpenn.substack.com/p/in-memoriam-kay-parley-rpn-registered

Todd, Betsy MPH, RN. Supporting the Patient on LSD Day. AJN, American Journal of Nursing 121(6):p 42-44, June 2021. | DOI: 10.1097/01.NAJ.0000753656.16844.a9 

"How much empathy should doctors have?" c/o BBC Radio 4 'All In The Mind'

In ongoing reading and writing, I'm developing examples of care situations and contexts that extend across the domains of Hodges' model, candidates include:

1. Eating Disorder
2. Sense-Making in light of information disorder
3. Public Understanding of Science
4. Empathy and Rapport in healthcare disciplines

#4 has loomed large for quite a while. The contrast between being humanistic and mechanistic: warmth, engaged, attending, person-centred  and subjective; set apart from being objective, logical, cold, precise, mechanical, efficient, and accurate. These terms and more also indicate the scope (vertical and horizontal) of Hodges' model. In my nurse training, I remember that first intramuscular injection, and how my mentor - supervisor explained how, as a prescribed treatment - remember the patient needs it. The 'political' dimensions of this - informed consent, capacity, personal - professional ethics, mental health, and mental health act, add obvious complexity and critique to this example. 

 

In #4 I've the more general medical example of the surgeon and empathy. Then, this past week 'All In the Mind' devoted an informative feature on the topic (available for 12 months):

"A good bedside manner is a wanted quality in healthcare professionals. But as is performing procedures that can be painful or uncomfortable. As medical students train to become doctors, they can experience changes in their levels of empathy; the ability to resonate with how others feel. Learning long lists of diagnoses and pathologies, the human body starts to resemble more of a machine. But how detrimental is this? Claudia Hammond asks Jeremy Howick, director of the Stoneygate Centre for empathic healthcare at the University of Leicester, who is training healthcare professionals to express more patient empathy to improve health outcomes and reduce burnout. Lasana Harris, professor of social neuroscience at UCL, describes how too much empathy might be a cause of burnout, and medics should toggle empathy on and off depending on context. Medical students from the University of Bristol express how they feel empathy should come into their future roles. "

'Welcome to the QUAD' includes many previous posts on empathy, rapport.

Below, I have mapped key concepts and programme content to Hodges' model:

INDIVIDUAL
|
INTERPERSONAL    :     SCIENCES              
HUMANISTIC --------------------------------------  MECHANISTIC
SOCIOLOGY :   POLITICAL
|
GROUP

Empathy (regulation) and Rapport Therapeutic alliance Risk of burnout Emotional curiosity	Research - BioMedical Model [machine] First injection - 'invasive' procedure . . . Doing Surgery - cutting a person Body posture - Sitting down with person - patient
Social Neuroscience Language, presence Pre-op contact with nurses Restore 'humanity' Reassure	Lived experience - Staying in hospital a night. 'Being a patient?' Accountability - Responsibility Time and Resources to do the job. [PJ]

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

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

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

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


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

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

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

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

Thanks to PCCS Books for my review copy.

Part ii

Part iii

Part iv

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

Book: In Therapy - Intra- Interpersonal

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

In Therapy, Susie Orbach

In Therapy, Susie Orbach BBC Radio 4 (My source)

Book review: In Therapy - The Guardian & The Observer

Book cover: Google

Hodges' model - draft paper on case formulation informed by Rainforth and Laurenson (2014)

The following is from a literature review by Rainforth, M., & Laurenson, M. (2014) for a draft paper on Hodges' model and case formulation [CF]. They do not refer to diagrams, but two models are included and the role of modelling. The paper is supportive for Hodges' model within mental health, forensic care and supervision more generally.

Crowe et al. (2008) suggest an advantage of CF is its ability to create understanding of service user needs regardless of their diagnostic classification. Thus an emphasis on the link between training provision, training outcomes and treatment plans is needed so practitioners understand the frameworks for conceptualizing mental distress whilst also being able to recognize the expertise of the service user in CF development.
...
A goal of the person-specific evaluation of CF is the development of an intra-individual statistical prediction model for actuarial prediction tailored to the specific issues and life circumstances. The essence of CF is its ability to provide shared understanding of a person’s presenting problems through theoretical explanation of assumed causes and maintaining factors, so appropriate interventions can be utilized (p.208).

Rainforth, M., & Laurenson, M. (2014). A literature review of Case Formulation to inform Mental Health practice: Case formulation in mental health practice. Journal of Psychiatric and Mental Health Nursing, 21(3), 206–213. http://doi.org/10.1111/jpm.12069