NHS as an Anchor Institution (needs conceptual anchors?)

... and four harbours?

INDIVIDUAL

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INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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GROUP

CONCEPTUAL ANCHORS NHS - mindset: continuity consistency constancy future career development: Person - not in employment, education or training INDIVIDUAL level	size, scale, reach, solidity geography buildings - estate and places reduce carbon footprint working with local partners nano - SCALE - macro SYSTEMIC level
COLLECTIVE level COMMUNTIES for fleet of co-production and collaboration domestic, state, global - SOCIAL level NHS understanding - local demographics and residents NHS as an actor for social benefit Partner in a Place SOCIO-	NHS as ANCHOR INSTITUTION and [Good?] EMPLOYER Report: Building healthier communities  increase access to quality work procurement and commissioning purchasing locally policy -ECONOMICS

Stranger in a strange land: 'Adult' CMHT

I've started working in an 'adult' community mental health team. This is a change in character from older adults and in Hodges' model we can draw the discussion on this out in several directions.

The 'adult' - 'older adult' distinction on one hand may seem discriminatory. So, once you are aged 65 you move to another service? On the other hand there are many scholars / professionals who have over many decades fought to have older people's needs recognised, represented and funded as a distinct speciality. There are protocols accepted and practiced that should - must also take into account the patients (carers) wishes allied with needs and circumstances.

The 'character' is also different between adult - older adult, but both carry unique challenges*. This must always be the case if the patients and their situation are viewed as unique.

3.5 days in - I'm already aware of changes in community mental health provision. My previous experience 16-65 goes back to 1995, apart from having some patients during studies in psychosocial intervention in psychosis.

There seems to be more chronicity and I have a sense that suddenly 'nursing' has a welfare and benefits problem solving flavour to it.

The summit I've just posted about is invaluable learning, as I have inherited a caseload of people living with varying forms of diagnosed personality disorder. I'll expand on this experience over the next few weeks. This is timely as I have re-validation next year.

Over many years I have heard of Paris the clinical record system. Now I will be having training and become a 'user'. Looking forward ...

*With challenges also come rewards!

iv RCGP’s 7th Health and Justice Summit ...

I've been working through notes, photographs and the summit programme hence the flip-flopping between days.

So, back to day one:

Megan Georgiou, Jem Jethwa and Dave Banks, Programme Manager for Royal College of Psychiatrists, Project Officer at Royal College of Psychiatrists and Lead Nurse for the Intensive Support Unit at HMP Durham and Tees, Esk and Wear Valleys NHS Foundation Trust
“Transforming the Care Programme Approach in Prisons”

The Care Programme Approach (CPA) has a history of being poorly implemented within a prison setting. The Quality Network for Prison Mental Health Services and Tees, Esk and Wear Foundation Trust have teamed up to review the process and develop new tools and guidance. The purpose of the workstream is to improve service delivery and patient care. The workshop will summarise the findings from the consultation event and present our work to date.

Late again and frustrated since as a former CPA Lead this subject is close to my heart. It is not a sacred cow, although the learning and values that it helps carry must be carried forward.

I got the immediate impression of a methodology being presented and sure enough we practised too:

Go M.A.D. Thinking ® Results Framework

Part of the approach includes the 10 possibility thinking areas as per the photo.



[There's an additional exercise that reveals the ability of Hodges' model to help prioritise, contextualise (or decontextualise) and assign the 10 areas.]

Dr Alex Acosta-Armas & Ms Sarah Hill, Consultant Forensic Psychiatrist & Service Manager for  North London Forensic Service presented “Forensic Learning Disability Pathways, from prison to the community: Less restrictive practices in secure care and the development of a specialist community forensic LD service”.

Pathways of care for people with learning disabilities, from prison with the establishment of assessment and detection services, followed by secure inpatient care, focussed on introducing less restrictive practice interventions. Development of a community forensic learning disability service aimed to facilitate transition into the community and to support community services.

Brian E Hodges who created Hodges' model was a Learning Disability Nurse and Tutor and designed the model with this population in mind.

I was not ideally placed for photos, but would encourage readers interested in Forensic Learning Disability Pathway to seek out the slides. There was a local history from 1997, improving quality, stating the case for a Community Forensic LD Team, eligibility criteria (referrals), progress since April 2019 and training delivered to date. This was informative relating autistic spectrum disorder, training for staff, assessment within prison and in-patient settings, attention deficit hyperactivity disorder,risk concerns - sexual offending, arson, stalking and FTAC - Fixated Threat Assessment Centres.

Whenever I see a slide, paper ... titled "New Model of care" my heart skips a beat. This model was CHOICES. I will try and obtain more information. 

Robert McEntree - Defining trauma

A workshop was presented by Michelle Osborne & Robert McEntree, Ward Manger & Staff Nurse for Arnold Lodge on “Trauma Informed Care in Forensic Health Care: Male Mental Illness”

How the admission ward of a Medium Secure Forensic Mental Health Unit in Leicester is introducing a framework for Trauma Informed Care.

There is frequent use of 'lenses' as a metaphor and this workshop was helpful as to me it presented 'trauma' as another lens, a potentially constructive metaphor upon an emotional - lived reality (with varying degrees of recall). Robert defined trauma with references and some texts:

The Polyvagal Theory, Stephen W. Porges:
https://www.stephenporges.com/books

The Body Bears The Burden, Robert Scaer:
https://www.routledge.com/The-Body-Bears-the-Burden-Trauma-Dissociation-and-Disease-3rd-Edition/Scaer/p/book/9780415641524

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Book, Bessel van der Kolk:
https://www.penguin.co.uk/books/259/259420/the-body-keeps-the-score/9780141978611.html

Despite trauma's acuity (obviousness?) the slides were very informative:

What we talk about when we talk about "Trauma"

• Pervasive
• Impactful
• Effects the most vulnerable in society
• Self perpetuating
• Negates potentially supportive relationships

Five core values of Trauma Informed Care and Environments

Safety  Trust  Collaboration  Choice  Empowerment

Barnett Brown, V., Harris, M., and Fallot, R. (2013) Moving toward Trauma-Informed Practice in Addiction Treatment: A Collaborative Model of Agency Assessment, Journal of Psychoactive Drugs, 45:5, 386-393, DOI: 10.1080/02791072.2013.844381

Fallot, R.D. and Harris, M. 2009. Creating Cultures of Trauma-Informed Care: A Self-Assessment and Planning Protocol, Washington, DC: Community Connections. [Google Scholar]

See also:

Becoming Trauma Informed:
https://www.mappingthemaze.org.uk/wp/wp-content/uploads/2017/08/Covington-Trauma-toolkit.pdf

In post iii I made (rather) a lot of 'transitions' and two major examples include veterans returning to civilian life and prisoners on release. The frequency of 'transition' was even raised at the summit. For example, if prisoners are recruited to a health programme and are then released that will be 'lost' so interventions are kept short for that reason. Alternately, reflecting cold reality there is acceptance in being able to re-enrol should someone arrive in custody once again.

Before closing remarks and thanks the summit's sessions ended with news of a transition:

Kate Morrissey, National Programme Manager - Mental Health, Implementation Lead for RECONNECT on:

 “RECONNECT – Care After Custody” 

When I referred to the obviousness of trauma above, of course so often to the observer psychic trauma is not obvious. Is this why transition to stability, coping, staying well, recovery is so hard won? Is this why in housing, welfare and benefits so often the lens cycles through what is 'seen' resulting in doubt, denial and neglect?

These four posts reflect the main sessions and workshops I opted to attend. The summit's focus also included Women in prison, Transgender pathways and Children’s services.

Many thanks to Convenzis and other organisers, sponsors and supporters:
Great values, learning and job.

iii RCGP’s 7th Health and Justice Summit ...

Returning to Juliet Lyon CBE, Chair of the Independent Advisory Panel on Deaths in Custody, who presented ‘Keeping Safe – how consultation with women and men in prison and health and justice professionals informs our work and advice to ministers.’

In February this year the Independent Advisory Panel on Deaths in Custody (IAP) and the national newspaper for people in prison, Inside Time, began a ground-breaking collaboration - Keeping Safe - to help keep people in prison safe. Supported by the Samaritans and Prison Radio, the IAP called on Inside Time readers to say how best to prevent suicide and self-harm. Prisoners’ recommendations in this Inside Time special report reflect evidence from, and recommendations made repeatedly by, amongst others, the Prisons and Probation Ombudsman, HM Chief Inspector of Prisons, the Chief Coroner and the National Audit Office.

Ms Lyon spoke of the clinical context, hope and time:

What was done in the  ::   Being in Prison  ::    What might be done in the

Past                        Now                             Future

Mention was made of a 'Keeping Safe' event in February 2020. If I learn more, I will add details.

Mark Langridge took us through some technology developments in healthcare as Care UK National Lead Pharmacist:

Socrates (with reference to 5-domains of well-being)
PharmaSelf24
PrisonAssist
Turning-On

There was discussion of "Opt-out" in respect to population screening for antibody positive screening tests and how the question is framed:

"Want your bloods done, luv?"

"We test everyone because    ...

is that OK with you?"

On day 2 Suzy Diamond-White, Governor at HMP Eastwood Park shared management experiences and the quest for change in ‘Delivering Health and Wellbeing in a Women’s Prison’

A look at how health services are delivered within the operational demands of daily life at Eastwood Park given its complex population and wide geographical catchment area. How we keep wellbeing on the agenda to support our contracted health teams. What is so specific about a women’s prison? What needs to be overcome to ensure equivalent service to the community.

Gender was obviously fundamental here, the fit and appropriateness of P.E. kits, the procurement and supply of sanitary towels and incontinence pads. What is 'hygiene' being accounted for through a 'cleaning' budget and other historical legacies to be challenged. The geographical range of Eastwood Park across nine counties and all the consequences for family and children. Talk of prison as a punishment and the public's view was echoed a few times at the summit.

Elizabeth Moody, Deputy Ombudsman at Prisons and Probation Ombudsman provided more reflection on deaths in custody, stressing the families affected by and need for action and lessons to be learned. High profile cases were mentioned in several presentations. The talk gave me a sense on one hand of what families must go through, especially when circumstances suddenly engulfs an individual in the criminal justice system. The work that independent agencies do behind the headlines and sometimes in the midst of them

Chantal Edge, NIHR Clinical Doctoral Research Fellow for Department of Epidemiology and Public Health described research on “Systems barriers to telemedicine in prisons”.

Experiences of systems barriers (prison and hospital/community) encountered in England whilst attempting to operationalise a local prison-hospital telemedicine model, alongside broader evidence on prison telemedicine implementation barriers drawn from a systematic qualitative literature review of published prison telemedicine evidence.

I was late arriving to this session. As per my thoughts concerning Dr Matthew Langley's presentation the potential socio-technical studies might provide some insights?

Although it is also a commercial vehicle, Raconteur published with The Times had a special report on 5G in June. In a similar way to my references to the 5-Care-Domains of Hodges' model, many people talk of 5G and its speed, without fully understanding the change and opportunities this can bring. The report's summary:

"5G is so much more than faster 4G, but the extraordinary hype surrounding it has left many confused over what it will actually do for them. The 5G special report, published in The Times aims to shine light on this, exploring how 5G can transform healthcare and make smart roads a reality ahead of autonomous cars. It covers how to address public concerns over the health impacts of 5G and examines whether the rush to be first in the 5G race is a fool’s errand, with comment on how it might be better to deploy 5G best, rather than deploy it first. Also featured is an infographic measuring the true impact of 5G and looking at the sectors which stand to benefit the most ..."

Chantal provided some copies of an associated paper:

Edge, C., Black, G., King, E., George, J., Patel, S., & Hayward, A. (2019). Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X19869131

Rachel Gibbs "Equalizing Spaces"

Rachel Gibbs, Assistant Director for Prison Healthcare Services for Northern Ireland shared a travel fellowship “Equalising Spaces”.

Rachel Gibbs was awarded a Winston Churchill Memorial Trust Fellowship in 2019. She will share learning from her visits to Prison Healthcare services/Transitions clinics/Harm reduction rooms in California, North Dakota, New York, Barcelona, Geneva and Stockholm over an eight week period in order to being back innovative ideas to the UK. She will share some of the user involvement work happening in Northern Ireland.

Churchill Fellowship

The title of this session including 'spaces' had my immediate attention and did not disappoint. Rachel's Gibbs also provided help in making me feel a little less guilty in the future. Rachel highlighted and reminded me of the value of travel in the exchange, transfusion and diffusion of ideas, a difficult equation to resolve in these flight-shaming days.

Rachel Gibbs - findings

I do wonder what a global consensus would be on models of care, nursing theory and what other continents have to say (if anything?) on this topic that might inform my study of Hodges' model. Rachel recounted her travels and learning not just from her peers but from prisoners and ex-prisoners. Existing awareness of international health and justice provision was used to focus countries to visit.

Rachel shared her time with:

Transitions Clinic Network (TCN), USA.

and 

One Day at a time
Empowering youth to lead positive lives

Hodges' model repeatedly 'takes' me to spaces of all kinds and also transitions:

Life course - infant - child - teens - adult - older adult - end of life

Life course - infant - child - teens - adult - older adult - end of life :: Diagnosis X (Rare?)

Health - Social Care

Critical information giving :: Pre - Post

Adult service - Older Adult Services

Looked after Children - Adult

Younger Adult, Adult, Older Adult :: Early Onset Dementia

Home care - Day care - Respite care - Residential Care

Continuing Health Care

Justice and Health

Veteran - Civilian

Risk

Formative education - Lifelong learning

Health - Trauma - Intensive Treatment - Return Home

and other Transitions (Prevention!) ...

We often think of tools and the need for them to be ready to hand, as in organising your workspace. Increasingly as the list above suggests there is a need for tools to help keep things 'close to mind' also.

Professor Graeme Henderson (School of Physiology, Pharmacology and Neuroscience for The University of Bristol) gave a serious and yet entertaining talk on“Why are fentanyls so deadly?”

Fentanyls are highly potent opioid agonists. Only small quantities are required to produce their effects and this may make them attractive drugs for smuggling into prisons. fentanyls have pharmacological properties that make them more likely to lead to overdose than other opioids – in addition to their high potency and rapid onset of action these drugs induce respiratory muscle stiffness making it difficult to breath, are less sensitive than heroin to naloxone reversal and may show reduced cross tolerance to other opioids.

Prof Henderson provided statistics that had you paying notice, supporting the first answers to the title:

• High potency
• Faster rate of onset of respiratory depression
• Muscle stiffness (wooden chest) making it harder to breathe
• Lower cross tolerance between heroin and fentanyl
• Resistance to naloxone reversal

The Chairs for the summit had quite rightly drew delegates attention to the exhibitors, so I was a bit late again here. The photo is not very good, but brings home the potency of fentanyl. (That is Prof Henderson in the biohazard suit.)

... (still) to be completed - part iv to follow ...

ii RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Before moving to day 2 ...

- the keynote by Cllr Asher Craig Deputy Mayor (Communities, Equalities & Public Health) at St George West Ward and Bristol City Council provided a city-wide perspective on public health, public mental health, the lived experience of child poverty and with it adverse childhood experiences, the impact of institutional racism and deaths in custody. I've taken more notice locally of community initiatives and sadly note speaking to what was once a local authority day care centre is now a social enterprise with uncertainty about its future. Cllr Craig spoke of Bristol's One City Approach and Learning Circles.

I attended Dr James Matheson's workshop, a GP at Hill Top Surgery and three medical students at Manchester Medical School - “Resources for primary care support to people in contact with the criminal justice system and their equally-affected others”

"Whilst the GP workforce is short, never have we had so many GPs in training. Is general training enough without extra specialist skills training on top? How then do we create and deliver a curriculum to inspire and prepare the next generation adequately for the challenges they will face?"

With posts to follow reviewing Kinchin's book the care environment presented by prison health  seems to encourage a network approach to learning, not merely linear - procedural - chain like approaches. As air safety methods demonstrate (outside of recent design?) checklists have their vital place as a heuristic and decision-making algorithm, but prison immediately challenges a student's attitudes, their expectations of themselves and others. Meeting prisoners crystalises a focus on self-awareness, what is subjective, objective, verbal and non-verbal communication. As per the synopsis the enthusiasm and feedback of the students to their learning was great to hear.

In addition to the student's contributions Dr Matheson highlighted inequality and referenced the "Deaths of Despair" that we have reached.

Another by Dr Matthew Langley, Consultant Forensic Psychiatrist for Rampton Hospital addressed:
“Remote vital signs and activity monitoring”.

"Early experiences with remote vital signs monitoring technology in High Secure (Women’s) Coral Ward (NHSHSW) is trialling Lio Health (Oxehealth)’s remote vital signs and activity monitoring system. This is an innovative solution to support our staff but also presents challenges to integrate effectively. This presentation will discuss initial feedback from staff and patients and investigate our experience as a service with this new technology."

This project was already underway when Dr Langley returned to work at Rampton. Apparently the technology is very effective, Dr Langley trying it himself. Risk is a cost-rationaliser and here the risk is acute. Generally in health care professionals will need to weigh the ethical pressures in adopting technology. Technology will be a factor in making health care (and universal health care) sustainable, but as with electronic health records and their benefits the latter need to be assured. Does a technology 'solution' really free senior staff to focus on more 'complex' work?

I did not ask in session Dr Langley about his awareness of work on socio-technical approaches and Enid Mumford's work. At coffee we had a chat and will follow up with some information. I am very much an advocate for technology - students expect no less, the public look at what we do, the way we work and rightly wonder: wither the technology?

Another concern, however, is the word 'recognition'. Facial recognition is already politically and ethically loaded. States are deploying this technology with 'emotional recognition', so careful consideration and critique is needed (imho).

Sarah Bromley, National Medical Director Health in Justice at Care UK, covered:
“Patient Safety and Quality in Prisons”

"Deaths in Custody are still rising and the PPO have identified repeat recommendations that continue to contribute to deaths. How do we learn lessons and implement change and how do we know when we have been successful. Dr Sarah Bromley will discuss the challenges faced, the Care UK PROTECT programme and quality assurance measures in use."

Sarah appealed to my 'information-oriented' focus, as it was noted how teams can still reach a point with a new referral / patient ' client and question:

"Have we got more information"?

"No."

"Oh, right."

They then elect to carry on without this (acute - in contrast to the uncertainty it represents?) need being pursued and fulfilled. A useful distinction was made by Sarah between training for staff - Wellbeing approach, ASSIST training 2-days on self-harm and suicidality, TRIM training; and support for staff who experience extreme trauma, clinical supervision and clinical forums.

There are subjects that need regular update and so I was very grateful for:

Dr Iain Brew, Deputy National Medical Director of Health in Justice Medicines Safety and
“Hepatitis C – developments and outcomes”.

This was very helpful personally as a nurse, and in the national and global objectives that have been set. With Hodges' model incorporating an individual -- group (population) axis and a Political care domain two further talks were greatly appreciated:

Juliet Lyon CBE, Chair of the Independent Advisory Panel on Deaths in Custody, who presented ‘Keeping Safe – how consultation with women and men in prison and health and justice professionals informs our work and advice to ministers.’ Ms Lyon explained feedback from prisoners on how "... you get the odd officer who really takes care and really wants to do something but there should be an officer on every landing who spends at least twenty minutes with one prisoner at a time through the time he is there and understand him and get to know him rather him just being a number ...".

A comment Ms Lyon made concerned the training of prison officers. The time is limited. I spoke briefly to Ms Lyon as there is a resource that imho should be a part of all course 101's and again I will reach for the email. This resource might help many prisoners too. One of the needs identified was prevention, improving prisoner - officer relationships and preparation for release. It must surely help in all of these if prisoners themselves were better equipped to reflect and have a better relationship with themselves? Self-esteem counts for a great deal and whether inside or out it seems many prisoner's self-esteem is challenged, even if sufficiently coherent and emotionally mature?

A quote also struck a chord: "All my life just got the better of me since aged 13" and a self-harmer.

And, Dr Brad Hillier, Consultant Forensic Psychiatrist at Heathrow Immigration and Removal Centres on “Mental Health and Substance Misuse in the Immigration Estate”. A topic that is clinically remote to me and yet conceptually 'visible'. Visible through geopsychiatry, the impacts of conflict, enforced migration.

Dr Hillier outlined the history of immigration removal in the UK from "Immigration Act Prisoners"
1970 - small detention unit in Harmondsworth, similar units in Dover and Gatwick.
Most IAPs held in prisons (180 in 1982).
1993 - Campsfield House converted from prison to IRC
Current system dates from around 2001-6
Home Office Policy to detain and deport developed
Detention Centre Rules (2001 - statutory instrument)
Immigration Detainees

More background on 'Routes into Detention'; the impact of detention on mental health (Von Werthem et al. 2018; Adult at Risk and Rule 35 - consideration for release on medical/professional evidence that there is a history/evidence of

• Torture/trauma
• self-harm
• Health condition (mental and physical) ...;

and Issues on removal / release.

This insight was new for me.

Although the programme is primarily divided between plenary sessions and workshops, the workshops - at least those I attended are essentially presentations. The room layouts reflected this. A workshop for me should have an audience work.

More to follow ...

i RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Day one of my second Health & Justice Summit (with Convenzis) was very enjoyable and informative. The title even had me wondering whether I have inadvertantly referred online, or in conversation to the conference as 'Justice & Health'. This one, like January's in Liverpool demonstrates the balancing act that is: health (care) and justice.

Sometimes given the all-encompassing nature of Hodges' model you might think nothing stood out on day one. There is key learning here for me as on Monday I take on a ready-made caseload with an 'Adult' Community Mental Health Team. The team / service designations (Adult / Older Adult) are not mine (but, yes I am part of this 'system') and within teams due attention is given to ageism and 'where' patients are best suited whatever their age. While not specifically prison health, the new part-time role includes references to substance misuse, self-harm, history of violence, personality disorder and post-traumatic stress disorder. (The current political context was also acknowledged and applied on several occasions.)

As I start to write this (25th Nov) PM on BBC Radio 4 is deliberating on violent incidents and the need to toughen up on sentences, the glamourising of certain lifestyles and expectations for life chances, employment, police numbers, youth services, political manifestos, social media and understanding 'all this'. Amid what is a complex background the event's agenda was context packed, but for me several sessions stood out.

Suicide and Self-Harm across the Criminal Justice Pathway
with Dr Louise Robinson

Prison health is a challenging context. The prison health community are not just asking hard questions, they are clearly researching them, as in 'Suicide and Self-Harm across the Criminal Justice Pathway' with Dr Louise Robinson. The research pathway was outlined. Interventions discussed included 'skin camouflage' for self-harm; and Psychodynamic Interpersonal Therapy [PIT].

The development of the study from feasibility to WORSHIP I & "Women Offenders Self Harm Intervention Pilot I":

Walker, T., Shaw, J., Turpin, C., Reid, C., & Abel, K. (2017) The WORSHIP II study: a pilot of psychodynamic interpersonal therapy with women offenders who self-harm, The Journal of Forensic Psychiatry & Psychology, 28:2, 158-171, DOI: 10.1080/14789949.2017.1301529

- through to the latest WORSHIP III. It must be marvellous to be part of evidence-based thought and practice development and with future plans delineated: Complete WORSHIP III, COVER RCT; Cell-Soothe and PrisScope.

Miranda Davies of the Nuffield Trust reported work on "Prisoners' use of hospital services in 2017/18. Many were shocked hearing that 31% prisoners miss out-patient appointments, in contrast to a general did-not-attend - DNA rate of 8.6%. Was this due to the 'patient', or prison reasons? With frequent talk of the need for increased productivity and its neighbours of efficiency and effectiveness: this is painful. Miranda Davies also questioned the limits of hospital data: what (and how) healthcare is provided in prisons; wider aspects of the prison environment; whether researchers are capturing all the activity associated with prisoners from post code alone and coding quality.

Defining trauma

Emma Facer-Irwin explained “The role of trauma and PTSD on negative behaviours among male prisoners: Toward a model of Trauma-Informed Correctional Care in the UK”. When revising and updating - definitions are always welcome.









This definition is useful as on twitter and elsewhere you cannot fail to notice an addition to the debate, critique and vitriol on PTSD with the companion of Complex PTSD.

Differentiating between PTSD and Complex PTSD

This slide 'gave' me the lead for this blog post. It stresses the 'self' and interpersonal difficulties which can create humanistic chaos, by undermining relationships old and new 'in' the Sociological domain. The intra-personal and reflexive aspect is found in the re-experiencing centred on the inter-interpersonal domain as memory, emotional response, dreams (nightmares) and avoidance behaviours that can also affect other people.

In another session the bias, stigma and damage associated with the diagnosis of personality disorder as a 'bin' was noted. This was very positive to hear and later ('elsewhere') on twitter, negative responses in cases of self-harm in casualty by nurses were also called out. I remember this being highlighted in the late 1990s - early 2000s, a surprise that such negative attitudes from mental health professionals can still be expressed and felt.

Here in a tweet are organisers, supporters and sponsors who made the event possible:
https://twitter.com/h2cm/status/1199459402446712832?ref_src=twsrc%5Etfw


More to follow ...

G.D.P. Capitalism pp. A.M. Holistic ...

One pivot-point or several?

INDIVIDUAL

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INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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GROUP

"A more holistic approach to 'growth' needs to evolve ... Growth mania -	Demographics: Population Growth  GDP per capita - new measures? "nominal GDP growth, supported by population growth,
... looking to capture societal and environmental benefits and costs". "borrowing from the future while destroying the environment". socio -	[and profit] growth" Gross Domestic Product [GDP] Sustainability - economics

This week there has been a major focus on Self  Care Week.

Lars Münter brought to my attention the need for an 'Economy of Wellbeing'. 

Jenkins's item in the FT refers to Milton Friedman, shareholders and stakeholders. The latter seems to be an over-used term in healthcare and health services, but there is learning in comparing and contrasting the two.

The climate emergency will change capitalism. 

Perhaps, what we need is not just an:

'Economy of Wellbeing'

as 'Economies of Wellbeing'

The presiding orientation of which must be circular.

See also:
The Friedman Doctrine, or Shareholder Theory; and Stakeholder Theory. 

My source:
Patrick Jenkins, Fund chiefs call for shift in capitalism, FT Weekend, 16-17 November 2019, p.4.

World Philosophy Day: "Why do we need evidence of mechanisms?"

December 17th 2019, 14h30-16h00

Bordeaux Pellegrin Hospital, Rheumatology Service, 12th floor

Phyllis Illari (University College London, UK)

"Why do we need evidence of mechanisms?" A PhilInBioMed seminar

Open to all

Phyllis Illari is a Senior Lecturer at University College London (Dept of Science & Technology Studies; Faculty of Maths & Physical Sciences) in the UK. She works in the philosophy of science, with particular expertise in causality, mechanisms and information.

Abstract

I will present a view of evidence of mechanisms as evidence of the activities, entities, their organization, and the phenomena they explain, using the idea of ‘minimal mechanism’ (Glennan and Illari, 2018). I will argue that this view allows us to theoretically organize an incredibly diverse array of forms of evidence and empirical practices. I will then home in on a specific way in which evidence of mechanism is crucial, arguing that it is important even for solid evidence of correlation. Any clinical study, even a well-conducted RCT, which is still one of our best methods of establishing a reliable correlation, needs decent answers to two questions: (i) what are the variables for disease, treatment and outcome? and (ii) how and when are they measured and why?

I will use the case of ‘vitamin D deficiency’ to show how important these questions are, even when they are not explicitly addressed in published results, because they are regarded as sufficiently standardised to be unimportant. Until recently, vitamin D deficiency was regarded as well-understood, reliably measurable in standardised ways, and linked to diseases such as rickets by well understood mechanisms. However, recent research has linked vitamin D deficiency to other diseases, in ways that expose the fact that different measuring techniques measure slightly different forms of Vitamin D. Those differences are now relevant.

Considering the case shows how deeply integrative our evidential pluralism needs to be, and therefore how complex our practices of reasoning about evidence are. Philosophical accounts need to be responsive to this.

For more information click here.

Best regards,

Wiebke Bretting
--
Dr. Wiebke Bretting
Project Manager ERC IDEM
ImmunoConcEpT, UMR5164
Université de Bordeaux
146 rue Léo Saignat
33076 Bordeaux
https://www.immuconcept.org/erc-idem/

My source:
Philos-L "The Liverpool List" is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/

A key to Health & Art...?

INDIVIDUAL

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INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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GROUP

"When you have no power, no rights, no privacy, and no control - when your humanity is denied and your liberty revoked - creativity can still save you. That is the radical message message of The Pencil is a Key, a potent and timely exhibition at the Drawing Center in New York. ... As Milton declared, "the mind is its own place, and in itself / Can make a Heaven of Hell, a Hell of Heaven". The pencil can be a tool in this act of self-creation. Drawing unlocks the brain's shackles, empowering the passive prisoner with private forms of dignity and escape." p.15.

T h e P e n c i l

Chester Brost, Devon Daniels, Joseph Dole, Francisco “Paco” Estrada, Darrell W. Fair, R Dot Nandez,  Damon Locks, C. McLaurin, Flynard “Fly 1” Miller, Andrés Reyes, Sarah Ross,  B.R. Shaw, Bring, Johnny Taylor. The Long Term, 2017–2018. Video animation, 13:05 minutes. Courtesy of the artists. Image courtesy of C. McLaurin.

i s a K e y

My source:
Ariella Budick, The mind unlocked, Life&Arts, FT Weekend, 2-3 November 2019, p.15.


... and looking forward next week to:

RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation
Bristol, 25-26 November 2019

- on which more to follow ...

South Sudan Medical Journal - November 2019

South Sudan Medical Journal

The November 2019 issue is now online here and includes items on Diabetes management, FGM and perineal injuries, Nutrition surveys, Gestational choriocarcinoma, Laryngeal trauma, Tympanic membrane perforation, Acute malnutrition and Overuse of antibiotics.  See details below.


Please send us your feedback on this issue, submit your manuscripts (which we can help you prepare), encourage colleagues to join the mailing list here, follow us on twitter @SSMedJournal and our Facebook Group, and find previous SSMJ articles at African Journals Online (AJOL) and the Directory of Open Access Journals (DOAJ).



EDITORIAL

• Bringing diabetes mellitus into focus on World Diabetes Day Edward Eremugo Kenyi

ORIGINAL RESEARCH

• The effect of Female Genital Mutilation on perineal injuries among women in labour in Dodoma Region, Tanzania Janeth Dickson Sichone, Athanase Lilungulu, Secilia K. Ngwashemi and Agatha Ngowi
• Analysis of trends in SMART Nutrition Survey data from South Sudan between 2004 and 2016 Ciara Hogan, Kate Golden, Regine Kopplow and Elaine Ferguson
• Pattern and causes of tympanic membrane perforation at a private hospital in Dar es Salaam, Tanzania Zephania Saitabau Abraham, Aveline Aloyce Kahinga, Kassim Babu Mapondella, Enica Richard Massawe, Emmanuel Ole Lengine and Daudi Ntunaguzi
• Nurses’ knowledge of the management of diabetic patients at Juba Teaching Hospital Abuk Mayen Deng, Lucia Buyanza and Fekadu M. Alemu
• Abstracts from the Juba College of Nursing and Midwifery: Management of 3^rd stage of labour Deborah Akon Akech; Danger signs of obstetric complications Kiden Harriet Oliver

CASE REPORTS

• Gestational choriocarcinoma at Juba Medical Complex and Juba Teaching Hospital: five case reports Kizza Paul, Kuma Chuol Biel, Anthony Lupai, Changkel Banak, Mirghany Abdallah and Paula Nuer
• Laryngeal trauma at Juba Teaching Hospital, South Sudan Justin Rubena Lumaya, Jino David and Natali Tong

NEWS

• South Sudanese recipients of grants from the Gordon Memorial College Trust Fund (GMCTF) in 2019
• Continuum of care for acute malnutrition in South Sudan
• Public health resources

BACK COVER

• WHO Poster: Misusing and overusing antibiotics puts us all at risk

Kind regards
The SSMJ team

Copyright © 2019 Southern Sudan Medical Journal, All rights reserved.