Paper: "How can we mainstream mental health in research engaging SDGs? -

A theory of change." i

This paper caught my eye on twitter, quite a while ago - the combination of mental health and SDGs:

Madill A, Bhola P, Colucci E, Croucher K, Evans A, et al. (2022) How can we mainstream mental health in research engaging the range of Sustainable Development Goals? A theory of change. PLOS Global Public Health 2(8): e0000837. https://doi.org/10.1371/journal.pgph.0000837

"The recently updated WHO Comprehensive Mental Health Action Plan 2013–2030 [1] concurs with this vision in that two of its six cross-cutting principles are: (i) a multi-sectoral approach, and (ii) action on social determinants. This acknowledges that “integrating mental health across wider sectors such as education, employment and social welfare helps address social determinants of mental health and ensures a comprehensive and holistic approach” [7 p12]. Shen, Eaton and Snowden [8] investigated mental health mainstreaming in 42 countries in terms of a shift towards providing mental health care from institutional to community settings. They concluded that “different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs” [7 p313] and that more needs to be done with regard to management and implementation strategies. While the keyword for Shen, Eaton and Snowden [8] is ‘deinstitutionalisation’, for Gómez-Dantés and Frenk [9] it is ‘integration,’ and they provide a dimensional approach with regard to what is involved in mainstreaming mental health: “(i) incorporating mental disorders to the global and local agendas related to NCDs [non-communicable diseases]; ii) moving away both from the biological and sociological reductionisms around mental health prevalent in the past century; iii) addressing the whole range of conditions related to mental health; iv) migrating from the idea that mental diseases have to be treated in secluded clinical spaces; and v) expanding the use of a comprehensive approach in the treatment of these disorders, which includes medication, psychotherapy and other types of therapies” [9 p214]." p.2/23

Selected concepts are related to Hodges' model below. In addition to the 2x2 table below, it may be useful for visitors to consider the paper's figures against the model? There is no doubt an overlap across the care / knowledge domains of Hodges' model, but hopefully the 'holistic bandwidth' of the model and its potential as a generic conceptual framework will also be highlighted. 

Note for example the way mention of 'clinical' tends to attract care (understandably) to clinics, hospitals, institutions, controlled (mechanistic) spaces where resources can be controlled and concentrated. Additionally, to find appropriate concepts, we must appreciate how 'local' is applied not only geographically, regionally, but culturally also - within and across a community, or several.

Hodges' model provides several disciplinary bridges of relevance here:

• psycho-political
• psycho-social
• socio-economic
• socio-political
• bio-social

I will revisit the paper again soon ii.

INDIVIDUAL

|

INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

intra-personal - mental health  (contribution to individual's overall health status) self advocacy qualitative evidence mental health practitioners psychotherapy, counselling individual health literacy/education "Implications for researchers include: recognising the potential of their projects to have psycho-	quantitative evidence time, environment, geography - locale treatment resources (time and physical - space) digital technologies 'clinical' seclusion spaces multiple locally-appropriate concepts 'clinical spaces' seclusion/isolation
-social wellbeing impact"* "collaborating with local communities, researchers, and service providers to effect change." "developing a more inclusive and flexible language around mental health that bridges cultures and disciplines ..." multiple locally-appropriate concepts resources  - social, family, community	LMICs - 'workforce gap' shift from institutionalised to community settings security - conflict advocacy resources $$$ income/welfare/micro-finances/ banking/digital access legislation, policies, strategies and services

*The paper also refers to "psychosocial disabilities".

My source (twitter):

https://twitter.com/PLOSGPH/status/1565066449798205440?s=20

Madill A, Bhola P, Colucci E, Croucher K, Evans A, et al. (2022) How can we mainstream mental health in research engaging the range of Sustainable Development Goals? A theory of change. PLOS Global Public Health 2(8): e0000837. https://doi.org/10.1371/journal.pgph.0000837

Future of Mental Health Nurse Training - Generic Course

It is an old debate: the generalist versus specialist. In nursing it's the divide in the tree of knowledge that gives us the branches of adult - general  and mental health nursing. Never unique this physical-mental, mind-body divide is repeated. A fractal feature of being human.

Without checking these two camps have been mentioned on W2tQ previously. Ever defensive I have probably been responding to the critique so readily aimed at Hodges' model:

Well, it is plain to see and read from the model that it is reinforcing the Cartesian division. The model is putting the patient in a box, not only that but using the medical model's reductionist practice by having four boxes. The model acts as an elaborated checklist.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

MENTAL HEALTH CARE	PHYSICAL CARE

On the 15th I am 39. Yes, I wish I was. On the 15th it is 39 years since I started as a Nursing Assistant at Winwick Hospital, Warrington, UK. The change in mental health since then has been phenomenal. Winwick is gone as the local, or one of several regional asylums.

There is a proposal for students to specialise in the last year of training, to ensure there is an adequate grounding in physical care. The concern is that mental health skills will be diluted. There is some progress to be gained, ironically, in that suddenly the training will mirror what is experienced by the public and mental health services in terms of parity and spending.

MENTAL HEALTH CARE	PHYSICAL CARE

If we want to demonstrate nursing as a science and art let's mix the blue and green:

MENTAL HEALTH CARE and PHYSICAL CARE

SOCIOLOGY domain

POLITICAL domain

Voila! 50% of the work of the model is done. You wanted integrated care; you got integrated care: everything is all 70s Hunky Dory.

Of course, it is never that simple.

I've picked this issue up after it featured in Nursing Times (Stephenson, 2016) last month. Among the points raised:

• Mental health risks being sidelined. 
• Dilution of the mental health specialty could have a "devastating" impact.
• Some mental health courses have already be revised to incorporate more generic content. This can leave students with the "the worst of both worlds". There is a risk of a bias to adult nursing. 
• Recruitment and differences in the appeal of courses is also noted, mental health candidates may already have related qualifications and more life experience.
• There is a need for a responsive and flexible workforce who can work pretty much anywhere (pp.2-3).

It seems as if there is climate for merger and acquisitions activity. In truth it has been there for a long time.

Mental health has changed. From my limited perspective I have not needed a work-issued briefcase for a decade. There was one case for us to use as needed. This one facet of a service-defined stepped care model that reflects change. From institution issue 3-piece suit plus white coats to smart-casual on the community. It is several years since I last needed to give an i.m. injection. I do feel I could tomorrow if needed, but if it is Risperidone - Consta I would once again need to read about the client and digest the info leaflet before doing the visit. Questions about competence are the constant. Believe me I'm not wishing for a return for the old-days: I remember it very well.

As a sign-off mentor there has been a panic to find a student the necessary experience. Now it seems there is less urgency in this respect. This is a positive sign in terms of mental health nursing and social change and yet a loss of a clinical skill being learned and exercised.

The emphasis over the past 1-2 decades is on nursing assessment. The nurse as therapist in the formal - psychological sense is no longer emphasised. A further diminution of mental health nursing. This may be a bias on my part, as a new community psychiatric nurse in the 1980s.

Where I mention merger and acquisitions above, what of interest rates? What difference will the loss of the student bursary make? Workforce planners may benefit from more certainty and an increase in numbers, but what of the quality of the future workforce? This is a crucial factor in retention. I came to mental health nursing first then did two years for the SRN - RGN. Currently, some courses are structured such that in the first 6 months the student is already committed to the pathway. Change is not possible even if desired.

At the very least this suggests the need for a four year course?

The locus of my nursing career has been the community and begs the question: Is the project complete? The media and countless promises on mental health funding (ongoing) show that this is far from the case. Where would this place children's mental health, women's services and forensic? Has the reduction in beds been compensated for by community resources?

But ALL the above misses another agenda; one that is now: 21st century nursing; (this is also represented in the third rendering of Hodges' model above).

Policy makers must address the social and political foundations upon which all nurses, social workers and allied health professions (theorize and) practice.

Where is the workforce that will help the public to self-care? Where is the focus on prevention? How are those 'troubled families' doing?

There is a prospective dividend to follow from big-data, that can extend this debate to the real questions of - society, policy, and life-styles - and provide evidence for real change. Finally:

Where is the generic conceptual framework to help integrate physical - general nursing and mental health?

Stephenson, J. (2016). Rift over move to 'generic' courses. Nursing Times, 20.07.16. 112:29, 2-3.

c/o HIFA2015 - Meeting Information needs for Mental Health Care

Dear all.

I've been reading the messages about mental health and information needs in low resource settings. I agree that it's still such a disappointment that certain publishers refuse to make these core documents / books (like Where there is no Psychiatrist and Where there is no Child Psychiatrist) open access. Hope 2013 will bring changes......

I know a few free online/download alternatives for the mental health field:

In the Hesperian.org bookstore you find free downloads of a couple of health care guides in different languages including 'Where Women have No Doctor'. This book contains a brief mental health care chapter. Other helpful Hesperian books like 'Disabled Village Children', and the 'famous one' 'Where there is no Doctor'.
Link: http://hesperian.org/books-and-resources

Another is the WHO 'mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings'. Free download in English, French and Spanish. This is a 109 pages decision tree manual for depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints. It contains also  a chapter on 'general principles of care' and a brief chapter on 'advanced psychological interventions'.
Link: http://www.who.int/mental_health/publications/mhGAP_intervention_guide/en/index.html

The international NGO Basic Needs offers downloads of manuals and reports like 'Community Mental Health Practice, Seven Essential Features for Scaling Up in Low and Middle Income Countries', 'Essential Skills for mental health care',  'Mental Health Care, An Introductory Manual for Training General Health Personnel' amongst others.
Link for books: http://www.basicneeds.org/html/Publications_BasicNeeds_Books.htm
Link for manuals: http://www.basicneeds.org/html/Publications_BasicNeeds_Manuals.htm

For mental health and psychosocial support in humanitarian settings the WHO/World Vision/War Trauma Foundation publication is very helpful: 'Psychological First Aid: Guide for field workers', 60 pages and lots of illustrations.
Link for the PDF:
http://whqlibdoc.who.int/publications/2011/9789241548205_eng.pdf

Or the WHO/IASC 'Guidelines for Mental Health and Psychosocial Support in Emergency Settings', 205 pages and free downloads available in 7 languages. The manual is distributed on CDrom as well.
Link: http://www.who.int/mental_health/emergencies/9781424334445/en/index.html

For psychosocial support of children the NGO HealthNetTPO offers free downloads of their 'Psychosocial Care Package Children' with Modules, Tools and Publications sections. It contains information that describes the rationale, content and step-by-step implementation of the separate components of a comprehensive psychosocial care package (such as a Classroom Based Intervention, Counseling, Clinical Supervision, Screening and Psycho-education).
Link: http://www.healthnettpo.org/en/1311/psychosocial-care-package-children.html

In the field of psychosocial support for children and adults after emergencies or in HIV projects, the IFRC Psychosocial Centre offers free downloads of their manual like 'Psychosocial interventions - A
handbook', 'Community-based psychosocial support - A training kit', 'Children's Resilience Programme' and more.
Link: ...
This is where I stumbled on in the last few years. Hope it is helpful. Maybe I should write a blog post about it on the in2mentalhealth website, in order to make a comprehensive list which is available on
the internet for a longer period of time. So, if you have any additions please reply in this discussion or mail me with the link!

'Together we know more'.

Roos Korste
psychologist, trainer, blogger and founder of in2mentalhealth:

http://facebook.com/in2mentalhealth

http://www.linkedin.com/in/rooskorste

Plus:
Thanks for the comprehensive list Roos. Handicap International developed a Policy Paper on : "Mental health in post-crisis and development contexts" which can be found here [PDF, 1.1Mb]:

http://www.handicap-international.us/fileadmin/files/documents/PP03_Mental_health_01.pdf

Do feel free to add this to your list of materials. [ *see note below ]

Kind regards

Antony
Antony Duttine
Rehabilitation Technical Advisor in Global Health

[ *Note from HIFA2015 moderator: Neil Pakenham-Walsh

I would also like to mention the Essential Health Links (EHL) gateway. EHL was set up by myself and Lenny Rhine while I was working at INASP in the late 90s and early 00s. It is now hosted by AED Satellife and Lenny continues to maintain it on a voluntary basis. The Mental Health and Psychiatry section is available here:
http://www.healthnet.org/essential-links/mental-health-and-psychiatry

Essential Health Links has more than 750 websites selected according to criteria such as appropriateness for low-resource settings and free access. "Essential Health Links is offered freely for use as a template by others (e.g. medical school libraries, ministries of health, publishers, libraries, NGOs) to develop customised gateways on their own websites. This approach should reduce the risk of duplication of effort while maximising the usefulness of the gateway for specific target groups."

With thanks, Neil PW ]

Money and Mental Health [ii] OVERSTRETCHED, OVERDRAWN, UNDERSERVED

Following on from - Money and Mental Health [i] Impact of Mass Unemployment Events (MUEs)

I have been familiar with the relationship between mental health and finance since student days in the late 1970s. Debt was and remains a profound and common problem. This can exacerbate existing mental health problems or it be the trigger - the straw that breaks the camel's back. From the report:

One in four people with a mental health problem is also in problem debt, and half of people in financial difficulties have a mental health problem (p. 13).

Finance still has this impact whether it is a lack of basic financial skills (literacy), life chances and opportunity or attributed to bad luck. Speaking of 'luck': I have frequently felt angry and frustrated with government policy. It is common sense and statistically inevitable that within the population there will be people who are vulnerable to addiction of many sorts. Why make it easier for those who are vulnerable to potentially loose everything? Not only that but money impacts all those in vulnerable groups, not just people in work. When we talk of health inequality what is the biggest factor? I've come across instances of elderly people receiving scam mail and not just the 'odd' post. While within Hodges' model below I have family as a resource, sadly this can also be part of a problem.

'Productivity' looms large in the report and draws a rueful smile here. In the NHS productivity and its increase is a constant requirement. In the general economy UK productivity is low and seemingly stuck. Successive governments have failed and now with Brexit productivity is still on life-support.

In the report 'financial fragility' is a very useful construct (as with circumstantial, rather than careless overspending). The public sector is also highlighted in this regard:

Forecasts suggest that 5.4 million public sector workers, one in six of the UK workforce, will be worse off in 2020 than they were in 2010 (p.16).

Before you view the report itself and the small conceptual sampling in Hodges' model, the report refers to the hidden epidemic that this report seeks to highlight and represent. This government and successive, nationally and globally need to get to grips - somehow - with the hidden economy - parts of which are blatantly obvious in the subterfuge around tax avoidance. This is another relationship that operates upon us all - employed, unemployed, young and aged - and which Hodges' model can also help illuminate.


Evans, K., Holkar, M., Murray, N. (2017) OVERSTRETCHED,OVERDRAWN, UNDERSERVED: financial difficulty and mental health at work, The Money and Mental Health Policy Institute, May 2017.

What follows is drawn from the report above - with a couple of additions:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

[May THE KNOWLEDGE ECONOMY]  (including nursing) MENTAL HEALTH hidden epidemic ... over two thirds (67%) of employees who are struggling financially report at least one sign of poor mental health that could affect their ability to function at work loss of sleep, poor concentration, reduced motivation, preoccupation Increased risk taking (impact - occupation...?) Guilt/shame Anxiety Low self-esteem Anger Frustration Fear Low mood Self-harm Suicidal ideation Insomnia Panic attacks Depression, Lethargy/apathy Substance misuse [... starts here!]

PRODUCTIVITY Physical effects of anxiety, stress, alcohol, smoking (increase, relapse), other substance misuse physical fragility (lack of resilience) Nearly half (45%) of all working days lost to ill health were a result of stress in 2015/16 – adding up to 11.7 million days across the economy. work access to:   "on-site exercise facilities, healthy  food and rest spaces" hidden morbidity

Influence of individual mental health on colleagues, team morale and cohesiveness fear of bailiffs - seen by others at my door pressure on relationships conflict at work family breakdown shame, guilt, stigma social support, friends, family, colleagues

WORK THE ECONOMY "Money and Mental Health will set out the case for employers to provide practical support to employees experiencing financial difficulty, and how this could boost the mental health, wellbeing and resilience of their workforce." "financial fragility" Creditor action poor performance, punctuality, reliability disciplinary action OCCUPATION HEALTH services - counselling / advice Individual's awareness of Rights the hidden economy

Thanks and Acknowledgement to The Money and Mental Health Policy Institute

Nurses - Ask 5 complimentary questions

I received an email from RCNi subject heading - 'Q. What questions are nurses asking?'

An invitation to sign-up and ask five free questions: https://rcni.com/ask 

Question 1

Is there a model of care, or nursing that encompasses the sciences, mental health, sociology and political domains of care?

Several models of care and nursing frameworks integrate diverse domains beyond purely biological aspects, encompassing scientific, mental health, sociological, and even political dimensions. These models emphasise a holistic approach to patient well-being, recognising the complex interplay of various factors in health outcomes.

• Social Model of Health: This model focuses on salutogenesis, examining what contributes to health rather than just illness, by considering broad social, economic, environmental, and cultural influences on an individual's well-being .
• Person-Centred Nursing Framework: This framework extends beyond individual biological health to include the person's intricate cultural context, family, spirituality, and life experiences, defining health as encompassing intellectual, social, and spiritual dimensions .
• Biopsychosocial Model of Care: This approach integrates biological, psychological, and social factors to address a patient's holistic needs, moving beyond the biomedical model's sole focus on physical illness .
• Dual Registration Degrees: Educational programmes for nurses and social workers combine life sciences with social work principles, law, and policy, preparing professionals to understand factors influencing health, social justice, structural inequalities, and anti-discriminatory practises .
• Multidisciplinary Team (MDT) Care Model: While not a nursing model itself, the MDT approach enhances patient care by integrating expertise from various professionals, including specialist doctors, nurses, psychology counsellors, dietitians, and pharmacists, to deliver individualised treatment plans and coordinate care .

Modern healthcare increasingly recognises the necessity of comprehensive care models that extend beyond traditional medical approaches. These integrated frameworks, including the social model of health, person-centred nursing, and the biopsychosocial model, provide a foundation for understanding and addressing the multifaceted nature of health, incorporating scientific, mental health, sociological, and policy-related aspects to improve patient outcomes. [Five references provided - hence poor formatting in transfer.]

Question 2

What model of care has the conceptual scope to critique parity of esteem in mental health nursing?

Critiquing the concept of parity of esteem in mental health nursing requires models that move beyond a purely biomedical focus to embrace holistic, person-centred, and culturally sensitive approaches. These models emphasise equality, social justice, and comprehensive care, addressing the historical imbalance between physical and mental health provision.

• Biopsychosocial Model: This model offers a conceptual framework to critique parity of esteem by considering biological, psychological, and social factors in a patient's health, aiming for holistic needs rather than just biological ones . It contrasts with the biomedical model, which has historically led to paternalistic decision-making in healthcare .
• Culturally Sensitive and Competent Care: Essential for critiquing parity of esteem, culturally sensitive care requires nurses to appreciate diverse cultures and adopt personalised, flexible approaches to mental health support . Culturally competent care, underpinned by equality and diversity principles, involves behaviours and attitudes that value patients' diverse backgrounds, improving satisfaction and outcomes .
• Person Centred Care: This approach is crucial for addressing the historical paternalism in healthcare, ensuring patients participate in decisions about their care and re viewed as individuals with unique experiences rather than just labels or symptoms . Recent mental health reforms, such as the Mental Health Bill 2025, aim to embed person-centred and equitable care further .
• Holistic Care: The Nursing and Midwifery Council (2024) emphasises assessing spiritual needs to provide effective holistic care, recognising that "seeing the whole person supports better care" . This aligns with the biopsychosocial model's aim to meet holistic needs and challenges the organisational and practice divisions between mental and physical healthcare .

Effective critique of parity of esteem in mental health nursing necessitates a shift towards models that integrate biopsychosocial, culturally sensitive, and person-centred approaches. These frameworks are vital for fostering equality, social justice, and comprehensive care, moving beyond traditional biomedical limitations to address the full spectrum of patient needs. [Eight references.]

I'll leave it there. I think. PJ

<>

My emphasis: In the spring I tried to engage and see if I could write a short article about Hodges' model for RCNi. After an online chat and following up by email, Hodges' model isn't for them apparently. It was kindly suggested that I try another journal.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

Nurse, you must improve your prompt writing ...

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

Presentation: King's College London 17 May Mental Health SIG

Can you join us at the Higher Education Academy Health Sciences & Practice Subject Centre - Mental Health SIG in London
17th May 1000 - 1600?

I am really looking forward to presenting at the Mental Health Special Interest Group next month. It looks a great prospect as I have an hour on the programme. The draft title does not really represent what I intend, paradoxically I will re-introduce Hodges' model and explain why the model is so relevant in theory and practice.

I will outline my presentation here in a future post and the programme overall. For my sins I am now also a sign-off nursing mentor, so being able to network is another great plus. More to follow ....

Here are some details about the SIG from their website:

Welcome

To date, there has been no UK wide, cross disciplinary special interest group providing a regular opportunity for educators to meet face to face - with a view to exploring common issues and challenges, sharing resources and influencing policy and practice in the field of mental health. Arguably, this has hampered educators’ capacity to shape and respond to new developments.
In February 2005 the ‘Common Ground’ event organised by the Mental Health in Higher Education project in partnership with the Health Sciences and Practice subject centre met to identify key issues facing mental health educators in nursing and the Allied Health Professions. Subsequently, the special interest group has broadened out to encompass all colleagues with an interest in sharing approaches and engaging in debate about educational practice and the implications of policy developments for learning and teaching about mental health.

Who is the Mental Health SIG for?

Anyone involved in higher education with an interest in mental health.
We are keen to bring together people from across all disciplines and perspectives (including lecturers, practice educators and user educators and carers with involvement in education) – those who are mental health specialists and those for whom mental health may be one aspect of a broader subject area.
Health Sciences and Practice Subject Centre
Room: 1.17 Franklin Wilkins Building (1st floor)
Franklin-Wilkins buildings,
King's College London,
150 Stamford Street,
London SE1 9NH

a Paper: Hodges' model and mental health nursing in bushfire-affected communities

An email from ResearchGate informed me that a co-authored paper:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

- had been cited in another publication. A check was rewarded. It always feels good to be able to add a  study to the bibliography listing (please see the sidebar). This is an early view, by Brent Hayward in Australia:

Hayward, B.A. (2020), Mental health nursing in bushfire‐affected communities: An autoethnographic insight. Int J Mental Health Nurs. DOI: 10.1111/inm.12765

What stands out to me are Hayward's profession of mental health nursing within a public educational service and disaster response. I'm not sure how many times I have referred to the generic nature of Hodges' model, but this shift from reading a forensic paper to applying h2cm in disaster response is encouraging. While the immediacy of today's media brings home the catastrophic scale and tragedy of bushfires - work like this also reveals the humanistic side.

The research method of autoethnography has definite currency. Since the MRES at Lancaster, I have wondered if there is any autoethnographic merit in this blog? Hayward has clearly seen the value of the model with regard to reflection and self-reflection. Over the past few years - Brexit, climate change, the bushfires (and California) the importance and relevance of the political domain within Hodges' model continues to increase. (The content of many posts should provide evidence of this.)

It also appears that Hodges' model can draw out the distinction between intrapersonal and interpersonal relations and reflexivity. It could be argued that the humanistic-mechanistic axis also demarcates what is intrapersonal and what interpersonal. The latter standing for the (overt) skills so essential to effective mental health nurses. Hence, what are labelled the interpersonal and sociological domains. The combination of autoethnography, gestalt and use of a visual prompt for reflection is also informative and as Hayward notes could provide an avenue for the work of others. ...

"My unsuccessful attempt to locate literature about mental health nursing in bushfire-affected communities caused me to look towards nursing models more broadly. I was drawn to Doyle and Jones’ (2013) paper on the application of Hodges’ Health Career Model in forensic mental health nursing because of its deliberate consideration of political issues. This resonated with me as a public sector employee. Hodges’ model was originally developed in 1983 but has received little attention in the literature. Doyle and Jones’ paper was in response to this deficit, and in this frame, the present study continues this legacy. Hodges’ model is appealing here because of its attention to reflective practice and the theory-practice gap–two purposes which are of particular relevance in the present study." pp.2-3.

"Second is the use of a nursing theory or model to interpret findings. Only Gardner and Lane (2010) used a model, and this was one for clinical supervision rather than mental health nursing practice per se. Mental health nurses who are considering autoethnographic approaches should consider these methodological elements for both rigour and practical purposes. This study has also contributed the second published clinical application of Hodges’ model and its effectiveness here suggests that further exploration of its application would be useful." p.6.

I would like to express my sincere thanks to Brent for not only recognising the potential of Hodges' model, but actually applying it in research* and in such a vital context.

Hopefully I can reflect more on what is clearly for Hodges model and the concepts of health career, life chances and global health - a very significant paper.

*See also:

https://hodges-model.blogspot.com/2013/12/papers-actual-post-grad-studies-and.html

Book: "Outcome Measurement in Mental Health" Cambridge University Press

Outcome Measurement in Mental Health
Theory and Practice
Edited by Tom Trauer
Hardback
Published June 2010

In order to operate in an evidence-based fashion, mental health services rely on accurate, relevant, and systematic information. One important type of information is the nature of the problems experienced by recipients of mental health care, and how these problems change over the course of time. Outcome measurement involves the systematic, repeated assessment of aspects of health and illness, either by service providers, service recipients, or both. From outcome measurement clinicians and service recipients achieve a common language whereby they can plan treatment and track progress, team leaders and managers secure a basis to compare their services with others and to promote quality, while policy makers and funders derive evidence of effectiveness. This book will be an essential and practical resource for all members of the mental health clinical team as well as those responsible for establishing or managing services, and directing policy.

• Presents a global perspective on outcome measurement enabling readers to compare and contrast practices around the world
• Enables readers to identify the specific challenges presented in different groups and settings, the instruments to use, and how to use the results
• Emphasizes the relevance and use of outcome data to clinicians, to help them improve their effectiveness

Contents

Preface; 1. Introduction Tom Trauer; Part I. Outcome Measurement Around the World: 2. Mental health outcome measurement in Australia Jane Pirkis and Tom Callaly; 3. Outcome measures in New Zealand Graham Mellsop and Mark Smith; 4. Outcome measurement in England Mike Slade; 5. Outcome measurement in Ohio and the United States James Healy and Dee Roth; 6. The outcome questionnaire system: a practical application for mental health care settings Michael J. Lambert; 7. Outcome measurement in Italy Mirella Ruggeri; 8. Outcome measurement in Germany Sylke Andreas, Thomas Becker, Holger Schulz and Bernd Puschner; 9. Outcome measurement in mental health services in Norway Torleif Ruud; 10. Outcome measurement in Canada: one province's experience with implementation in community mental health David Smith; Part II. Outcome Measurement in Specific Groups and Settings: 11. Routine outcome measurement in child and adolescent mental health Peter Brann; 12. Outcome measurement in adult mental health services Tom Trauer; 13. Outcome measurement in older persons Rod McKay and Regina McDonald; 14. Outcome measurement with indigenous consumers Tricia Nagel and Tom Trauer; 15. Routine measurement of outcomes by Australian private hospital-based psychiatric services Allen Morris-Yates and Andrew Page; 16. Mental health outcome measurement in Non-Governmental Organizations (NGOs) Glen Tobias; 17. Outcome measurement in drug and alcohol services Maree Teesson and Mark Deady; Part III. Current Issues in Outcome Measurement: 18. Outcome measurement - applications and utility Tom Trauer; 19. Stakeholder perspectives in outcome measurement Tom Trauer; 20. Assessment of change in outcome measurement Tom Trauer; 21. Routine outcome measurement: perspectives on skills and training Tom Trauer and Tim Coombs; 22. A review of instruments in outcome measurement Tom Trauer; 23. Some economic and policy considerations for outcome measurement Rowena Jacobs; 24. Future directions Tom Trauer; Index.

My source:
UK Routine Clinical Outcomes Network Forum

Mental Health at NWHealthHack Knutsford - Prof. Lewis (thank you)

NWHealthHack began with several briefings. These were all excellent in providing both technical and health care insights before projects were pitched in 60 seconds.

Prof. Shôn Lewis set the health agenda in the context of mental health. I'm really grateful to Prof. Lewis to be able to share two slides here. The first speaks volumes not only in the research spend across health care domains but the disability-adjusted life year (DALY):

Over the past 25+ years I'm aware of the change within community mental health nursing. I can summarise this as follows:

• 1985 one of six new community psychiatric nurses - CPNs
• Early 1990s newly built community mental health resource centers
• Mid-late 1990s CPNs criticised for not meeting the needs of the enduring mentally ill
• Early 2000s early intervention services, role of psychosocial interventions
• Mid-late 2000s reduction and closure of mental health day hospitals
• Early 2010s former community mental health resource centers turned to primary care (mental health)

I have mentioned here previously about the need to put the 'mental'' into public - health and the need to put mental health literacy on the map. It will be interesting to watch what happens now that this has landed in a very 'local' way within Local Authorities. Prof. Lewis reviewed the situation in mental health conjoining serious mental illness, services and self-care, making a critical point for those readers working in community mental health teams. This should also give pause for thought for those (like me) working in related services:

Prof. Lewis also shared an app - ClinTouch and reflections on the professional's response to the apps potential and the findings in practice. It's never easy being open to what is new and being ready as a consequence to re-invent yourself. If that's a problem for individuals then for professional groups and multidisciplinary teams it's an even greater challenge. ...

C/o FT 'Inside the rise of the mental-health volunteer movement'

INDIVIDUAL

|

   INTERPERSONAL : SCIENCES              

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

 SOCIOLOGY : POLITICAL   

|

GROUP

'Amid a surge in demand for psychological support that has been exacerbated by the Covid-19 pandemic, Blue is one of many people without formal psychiatric qualifications — including volunteers and health workers — who are stepping in to deliver interventions.' 'Sangath became one of the first projects to run a randomised control trial (RCT) of task-sharing in mental health in 2007. “It’s not a compromise,” said Nadkarni, “it’s an idea backed by solid research evidence.”' [FT]

'Known as task-shifting or task-sharing, the trend has grown across healthcare as services grapple with a stark mismatch between resources and demand. The World Health Organization estimates that there is a global average of 13 mental health workers per 100,000 people, but in low-income countries this can fall to fewer than two. But a number of studies suggest that simple interventions, such as benches where people can sit with a sympathetic listener, can be at least as powerful as expensive clinical approaches, easing the burden on specialist workers.' [FT]

'About us - Sangath: Our vision is a world where every person has access to quality and affordable mental health care. Our signature principles are to leverage community and health system resources to deliver psychosocial interventions for the prevention and care of mental health problems. We address a wide range of mental health concerns across the life course, from cognitive development in childhood to self-harm and depression in youth, to drinking problems, psychoses and dementia in adults.  ... Our name: ‘Sangath’ (सांगात) means togetherness and consensus. It signals our mission – to take an integrated and participatory approach to addressing mental health challenges.'

'Health policymakers are increasingly seeking to replicate projects pioneered in the developing world, a process that has been dubbed “frugal innovation”.' '“Every $1 invested in a service like this gives you about $9 in return — both for the individual and the society combined,” he added.' 'Initiatives such as the Friendship Bench and the Common Elements Treatment Approach devised by Johns Hopkins University, a mental health intervention that can be delivered by trained and supervised lay providers in low and middle-income countries, are collectively reaching millions of people and have proved their worth in multiple studies. But funders still tended to focus on setting up clinical projects rather than bringing about systemic change in resource allocation or medical payment models that would drive widespread adoption.' [FT]

My source:

Sarah Neville, India inspires project saving lives in Texas. FTWeekend, 21-22 December 2024. p.4.
https://ft.com/content/a187719c-ccbb-4af9-8d22-8e70b65098cf

n.b. While these efforts are ongoing, there is a crisis and a crisis of confidence in student mental health nursing as a specialty: 

Beyond the Student Mental Health Crisis: A Collaborative Transatlantic Symposium

Virtual 1200-1830 25th March 2025. (Too expensive for me.)

Publication list - Peter Jones

Previously, I used to maintain a publications list, one that runs from the year 'dot' (ego eh!). The bibliography in the blog's sidebar serves this purpose, also being (much) enriched by other papers that use/cite Hodges' model. 

I decided to revisit the exercise. Successful at interview late in 2019, for a part-time (variable hours) tutoring role, no teaching opportunities followed as COVID intervened.

Invited now to f/w an updated CV and covering letter, I realise that apart from several recent papers I did not include a 'comprehensive' list - as I'm sure is the custom in academe; no doubt listings with many more entries. Here's the list:

Publications by Peter Jones (#1-4 software; #37 website; #40 this blog)

1. 1982 CAPA: COMPUTER AIDED PATIENT ASSESSMENT, Sinclair ZX81, advertised in Nursing Mirror (see below) provided on audio cassette tape.
2. 1983 THE NURSING PROCESS – Computer Aided Learning program, BBC Micro, published by Open Software Limited (OSL)
3. 1984 HAEM. Blood Groups Computer Aided Learning program, BBC Micro – (OSL). (see below)
4. c.1989 SHADES OF GREY, Computer Aided Learning program, BBC Micro. Simulation of nuclear weapons, Based on Fanchi, J. Local effects of nuclear weapons, BYTE, Volume 11. Issue 13. Dec., pp. 143–155. Computer Aided Learning program, BBC Micro, published by Open Software Limited. (see below).
5. Jones, P. (1986) Computing in Nursing NEWS. Computerised Patient Assessment. Nursing Times. 85: 5. Sep 3-9;82(36):63-5. PMID: 3532039 (Describes 'CAPA', a BBC microcomputer program for student nurses.)
6. Jones P. 1988 Thunderbirds are Go? (Impact of technology in society, disasters, macro-engineering). Popular Computing Weekly.
7. Jones, P. 1989 Modems are Cheap, it's the phone bills that hurt. Popular Computing Weekly.
8. Jones, P. (1989) Computers in Nursing NEWS. Creating a Program. Nursing Times. Feb 1-7;85(5):66-8. PMID: 2648342 (Describes 'HAEM', a BBC microcomputer program for student nurses on blood and blood groups.)
9. Jones, P. (1989) Information Technology is Good For You! (Effects of information technology) IT in Nursing, BCS-Nurs. Specialist Group. 1,1
10. Jones, P. (1990) Creating a Community Mental Health IS (Creation of a community mental health resource centre - a multidisciplinary research project). IT in Nursing and Paper at BCS NSG Conference. 2,4
11. Jones, P., Beckingham, D. (1991) The Ins and Outs of a small mental health Information System. Healthcare Computing 91 Conference Paper.
12. Jones, P. (1992) Nursing: All in the mind and machine? (Models of nursing and computing). British Computer Society -Nursing Specialist Group Conference Paper
13. Jones, P., Beckingham, D. (1992) Community Mental Health: IT in the Buffer Zone. Healthcare Computing 92 Conference (Poster).
14. Jones, P. (1993) Computerised Models of Nursing. (Data types in nursing - opportunities and problems). Healthcare Computing 93 Conference Paper.
15. Jones, P. (1993) Using a Semantic Network to Represent Nursing Terminology (project for B.A. (Joint Hons. Computing / Philosophy). Supervisor J Kirby - Medical Informatics Group. University of Manchester). BCS-NSG Conference Paper.
16. Jones, P. (1993) Nursing: All in the mind (and machine?). IT in Nursing, 5,4.
17. Jones, P. (1994) An Enthusiast's View of CAL. (Problems in production of CAL - Simulation effects of Nuclear Weapons - conversion of GWBASIC to BBC BASIC from BYTE - with original author's permission - J Fanchi). IT in Nursing. 6,2.
18. Jones, P. (1994) IT with Records in Mind (Mental Health CPA and Record types - idealised, cognitive, CBR, Distributed), IT in Nursing. 6,4.
19. Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.
20. Jones, P. (1996) An overarching theory of health communication? Health Informatics Journal,2,1,28-34.
21. Jones, P. (1996) Nursing Technology and Elephants - Part 1: Technology as a beast of burden. IT in Nursing. 8,1,4-6.
22. Jones, P. (1996) Nursing Technology and Elephants - Part 2: Technology as a serpent. IT in Nursing. 8,2,5-7.
23. Jones, P. (1996) Nursing Technology and Elephants - Part 3: Technology rope to save humanity and health care, IT in Nursing. 8,3,5-7.
24. Jones, P. (1997) Providing Mental Health Care: Getting A Purchase On Information. IT in Nursing. 9,3.
25. Jones, P. (1997) IT: The ubiquitous Research Tool (The use of IT in research - to access; transform; transcribe and disseminate information). IT in Nursing. 9,4.
26. Jones, P. (1999) Visualization in Nursing: Workshop report, IT in Nursing, 11.1.
27. Jones, P. (1999) It's time to master the latest tools and Hodges' Health Career Model, IT in Nursing, 11.2.
28. Jones, P. (2004) Viewpoint: Can informatics and holistic multidisciplinary care be harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.
29. Jones, P. (2004) The Four Care Domains: Situations Worthy of Research. Conference: Building & Bridging Community Networks: Knowledge, Innovation & Diversity through Communication, Brighton, UK.
30. 2005. Bursary Award Poster: Introduction and Scope of H2CM. HC2005: Harrogate. With thanks to the BCS Health Informatics Forum and my manager(s).
31. 2005. Mental health and geography: questions and issues for a mental health trust organised using Hodges' four care domains GEOMED 2005. Cambridge – Poster.
32. Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.
33. Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.
34. Jones, P. (2012). Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model. The Journal Of Community Informatics. 8(3). Retrieved from https://openjournals.uwaterloo.ca/index.php/JoCI/article/view/3034
35. Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract
36. 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.
37. 1998-2015 Website devoted to Hodges' model p-jones.demon.co.uk Now on web.archive.org:  https://web.archive.org/web/19990501185433/http://www.p-jones.demon.co.uk/index.htm
38. Jones P. Exploring the relationship of threshold concepts and Hodges’ model of care from the individual to populations and global health. Rev Cuid. 2017; 8(3): 1697-720. http://dx.doi.org/10.15649/cuidarte.v8i3.464
39. Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;0:e000254. doi:10.1136/bmjnph-2021-000254
40. 2006- Ongoing This blog - Welcome to the QUAD.

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

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

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

Amber's post considers a study by:

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

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

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

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

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

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

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

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

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

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

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

What is the plan?

What is the model of care?

What characterises 'care in the community'?

How do we prevent relapse, readmission?

Is there a 'halfway house'*?

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

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

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

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

*'Cross-settings' in Griffith et al.

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

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

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

ii 'Thinking outside the box ...'

iii 'Thinking outside the box ...'

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