The Pain of Parity of Esteem

"Chronic pain is defined as pain that lasts more than 12 weeks or persists beyond the usual healing time (Treed et al., 2015)."

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"Functional magnetic resonance imaging studies of the brain have shown that emotional pain stimulates the somatic pain system, and the somatic pain system activates the nuclear accumbens and ventral tegmental areas, which are the seats of emotion and reward pathways (O'Connor et al., 2008). This biological evidence underscores the complex and bidirectional association between physical and emotional pain." (p.14).

12 weeks "the mesocortico-limbic dopaminergic pathway and endogenous opioid system"

 

Majeed MH, Naveed S. Chronic Pain in Youth: Can Mental Health Services Provide Relief?. J Psychosoc Nurs Ment Health Serv. 2018;56(11):13-16. doi:10.3928/02793695-20181012-03

See also:

Morton, J., & O’Reilly, M. (2019). Mental health, big data and research ethics: Parity of esteem in mental health research from a UK perspective. Clinical Ethics, 14(4), 165–172.

https://doi.org/10.1177/1477750919876243
 

RCN: Parity of Esteem – Delivering Physical Health Equality for those with Serious Mental Health Needs

https://www.rcn.org.uk/professional-development/publications/pub-007618

The dimensions and directions of self-care

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Mental capacity Personal autonomy My choice Subjective (lived-) experience Quality of (my) life Mood - mental state (assessment) Psychic pain - trauma Expectations - 'desired outcome' Can't keep a job "If it's all in my head - that's what one of the doctors said - I said, if it's an imaginary pain, how is the swelling there?" Nick	Physical pain - cause not identified Injury - trauma: history - playing football Goalpost collision - snapped - posterior cruciate ligament 28 years ago On feet leg swells Leg amputation 'best' option Twelve operations to date - Still in constant pain Clinical experience specialists, advice Guidance Evidence base Aggregated outcomes
Brown Housebound for days Feels guilty - holding family back Living pain-free ... would be a "New lease of life" Experience & expectations of family, friends .. Holiday, spoke to a veteran four years ago ..	Fundraising Mental Capacity Act Medical accountability Professional opinion - general outcomes NHS - "no" - 'Cosmetic'? Pain management (clinics)? Private operation £18,000 'desired outcome'

Chappell, P. Injured man fundraises for own leg amputation, The Times, August 10, 2022, p.19.

https://thetimes.pressreader.com/article/282080575609624

RCN Congress 2026 & RCN North West Multicultural Group (NWMG)

England's North West is certainly in the news at present, on two counts:

1. The current Labour party machinations in the Makerfield ward;
2. and RCN Congress in Liverpool.

 As I attend Congress a key focus is the debates and how I can relate these to Hodges'model - (with some links to previous posts):

1. Nursing as a STEM profession
Matter for discussion submitted by the Eastern Board
That this meeting of RCN Congress discusses the recognition of nursing as a STEM (Science, Technology, Engineering, and Mathematics) profession, valuing the scientific, technical and analytical expertise of nurses.

STEM - science : technology : engineering : mathematics

2. Safe, ethical, person‑centred nursing
Resolution submitted by the Cheshire Branch
That this meeting of RCN Congress calls on RCN Council to urgently develop and implement a UK‑wide framework for realistic person‑centred care, ensuring that nursing practice is safe and ethical.

safe : ethics : person-centred 

3. Regular redeployment
Matter for discussion submitted by the Wiltshire Branch
That this meeting of RCN Congress discusses the impact of the daily redeployment of nursing staff on morale, team work and patient safety.

re- deployment

4. Unpaid hours
Matter for discussion submitted by the North East London Inner Branch
That this meeting of RCN Congress discusses the culture of nursing staff missing breaks and working beyond their contracted hours.

work

5. National safety standards for lone working
Resolution submitted by the Health and Safety Reps Committee
That this meeting of RCN Congress calls on RCN Council to lobby for the implementation of national safety standards for lone working, ensuring access to appropriate safety equipment, technology and protocols to protect staff across all care settings.

lone working

6. Accountable, compassionate and psychologically safe leadership
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses how the RCN can help create a culture where accountability, compassion, and psychological safety coexist, enabling managers to lead effectively while ensuring all staff feel respected and protected.

accountability : compassion : leadership 

7. Misinformation in health care
Matter for discussion submitted by the Women's Health Forum
That this meeting of RCN Congress discusses misinformation in health care and the impact this has on the nursing workforce.

misinformation : information disorder

8. Confidence to address racism
Matter for discussion submitted by the South West London Outer Branch
That this meeting of RCN Congress discusses how to build the confidence of nursing staff in addressing racism.

confidence : racism

Once again the North West Multicultural Group will have a stand:

The RCN North West Multicultural Group (NWMG) creates a community for members across the region from multicultural ethnic backgrounds to connect with each other, share their lived experience, knowledge and diverse ideas that help drive change around racism to ensure that their various organisations is the best place to work.

Membership is open to RCN members of Royal College of Nursing from multicultural backgrounds and their allies.

Mission statement: 

The aim of the North West Multicultural Group is to stand against racism and discrimination by using members lived experiences, encouraging organisations to be anti-racist and with the support of allies.  

Aims and objectives: 

• To raise the issues around race, discrimination and equality in the workplace and to find potential solutions. 
• To challenge misconceptions about people from different ethnic backgrounds.
• To recognise the skills and contribution to care for people from all backgrounds make.
• To acknowledge that racism is a social construct that needs to be eradicated together.  Together we are stronger.
• To be a platform for black, Asian and minority ethnic staff and allies to work collaboratively to address racism in practice.
• To help amplify the voice black, Asian and minority ethnic staff.
• To be role models, set examples as allies and develop confidence.
• To provide training and support about anti-racist practice.
• To work with the RCN to support campaigns to make sure communication is fit for purpose and acknowledges any cultural differences. 

Your executive team:

Chair: Olanike Babalola
Vice Chair: Susan Owen-Naz
Communications Officer: Mark Anthony

9. Advanced nursing practice
Resolution submitted by RCN Council
That this meeting of RCN Congress agrees that the RCN will act upon attempts to undermine advanced nursing practice.

advanced : practice : theory

10. Protecting nurse education
Resolution submitted by the Education Forum
That this meeting of RCN Congress asks RCN Council to lobby UK governments to protect nurse education from university sector economic pressures.

protect

11. Quality of clinical placements
Matter for discussion submitted by the Students Committee
That this meeting of RCN Congress discusses ways in which the quality of clinical placements can be ensured and consistent across all 4 countries.

quality : placement

12. Bank rates
Resolution submitted by the South Yorkshire Branch
That this meeting of RCN Congress demands that employers pay nursing staff bank shifts at their substantive rate.

pay

13. Are external reviews meaningful?
Matter for discussion submitted by the Midwifery Forum
That this meeting of RCN Congress discusses whether external reviews and inquiries are genuinely driving meaningful improvements in safety across health and social care.

inquiry : review

14. Improving acute mental health crisis services for children and young people
Resolution submitted by the London Board
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to improve the provision of services to children and young people presenting in acute mental health crisis.

children : mental health

15. Access to specialist pain services
Matter for discussion submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress discusses access to specialist pain services and the role of the registered nurse in caring for those in pain.

pain

16. Palliative and end-of-life care
Resolution submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to ensure everyone living across all 4 nations has access to specialist palliative and end-of-life care.

palliative

17. Accessible and affordable travel
Matter for discussion submitted by the North Central London Inner Branch
That this meeting of RCN Congress discusses what accessible and affordable travel means for the nursing workforce.

18. Uptake of physical health checks
Resolution submitted by the Public Health Forum
That this meeting of RCN Congress requests RCN Council to lobby UK governments to improve the uptake of physical health checks for people with learning disabilities and serious mental illnesses (SMI).

serious mental illness (SMI)

19. Eye donation
Matter for discussion submitted by the Greater Glasgow Branch
That this meeting of RCN Congress discusses the role nursing has in eye donation in end-of-life care planning.

eye : vision

20. 35-hour week
Resolution submitted by the Lothian and Borders Branch
That this meeting of RCN Congress calls on RCN Council to instigate a campaign for a maximum 35 hour working week for the nursing workforce.

21. Inappropriate delegation
Matter for discussion submitted by the Berkshire Branch
That this meeting of RCN Congress discusses the delegation of health care tasks to school staff and non-health care professionals.

22. Access to medicinal cannabis
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses the impact of current NHS prescribing practice on access to medicinal cannabis.

medicinal cannabis

23. SPA time
Resolution submitted by the Wiltshire Branch
That this meeting of RCN Congress calls on RCN Council to lobby for the inclusion of Supporting Professional Activities (SPA) time in all nursing job-plans.

See: https://www.rcn.org.uk/Congress/Agenda 

Are there any lessons from this exercise? Well, I have no posts tagged 'donor', or 'medicinal cannabis' - to make an important distinction. Something to correct and try to follow this week. 

See you there ...?

(I may need to reduce the link-count here.) 

Ibrahim El-Salahi: Pain Relief Drawings c/o Ashmolean Museum

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

meditation ...

"Suffering from physical pain, El-Salahi began this new and ongoing series of drawings on medicine packets and envelopes in summer 2017. The artist has emphasised how the concentrated creative process is a major part of the works. Focussing on the small drawings, he is able to forget the pain: to concentrate on it is like a form of meditation and I don't feel the pain at all. It is a kind of medicine itself." Ashmolean Museum, 22 June 2018

Pain Relief Drawings, 2017 : Ibrahim El-Salahi

Nurses ... console, console, yes; but don't become one ...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

subjective	console noun ​ a surface on which you find the controls for a piece of electrical equipment or a machine: a gaming console
console verb ​ to make someone who is sad or disappointed feel better by giving them comfort or sympathy: He tried to console her, but she kept saying it was all her own fault. I tried to console her with a box of chocolates. I was consoling Liz on having broken up with her boyfriend.	objective [ political objectives? ]

My source:
Whiston Hospital: Accident & Emergency & Resus, Laminated FLACC.
Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children

See also:
Crellin D.J., Harrison, D., Santamaria, N, & Babl, F.E. (2015). Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain. Nov;156(11):2132-51. doi: 10.1097/j.pain.0000000000000305.

Dictionary entries:
http://dictionary.cambridge.org/dictionary/english/console

The Public, Patients and Carers in Hodges' model

The table below indicates some of the main concepts and concerns that
surround the PUBLIC, PATIENTS and CARERS agenda presented using the four care domains of Hodges' model:

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

Well-being, mental (subjective) health, mood, hope, human spirit. Knowledge and understanding of condition. Literacies: 3Rs, ICT, social, visual, spiritual, health.... Diagnosis - prognosis. Psychological impact. Aware of info sources tolerance, personal choices & autonomy. Response to trauma, threat, loss. Belief systems. Coping strategies. Emotional memory Perception. 'Individual pain' Motivation. Responsibility Ability to work, disability, gender Individual engagement, personhood, dignity. Self-care, Purpose Personal Health Record Attitudes, beliefs

Physical (objective) health. Chronological - Pathological Age (of care subject, carers). 'Fitness'. Activity. Systems. SAFETY PROCESSES, structural flexibility. Pain thresholds. Measures (Pain genetics, scorecards). Systems, feedback, redesign, improvement. Complexity. Change. Research: Evidence-based care. NICE. Quantitative, Quality of Life, assessment, screening. Process redundancy. Decision making Referral, care pathways, plans, time. Self-admin drugs. Expert patient. Health, care, eng. model(s) Ill-health - Health promotion Time for data collection. Curricula design, Courses, qualification. Standards vs Innovation Computer supported engagement*

Carer - family understanding of condition, diagnosis-prognosis. Genetic implications (if any). Familial genetics pain. Sense making. Meaning. Social articulation of individual +ve & -ve experiences. Generational (role) inversion. Engagement and Social inclusion: work, social mobility, homelessness, stigma, poverty. Access to info and comms technology Medical Sociology. Sick-role. PRACTICE Effects of culture 'meanings'. Dependency. Religion, fatalism. Leisure. Volunteering. Social capital / capacity. Collaborative care, concordance. Socio-cultural reach. Communications. Media. Dialogue. Qualitative research. Social change attitudes. Shared definitions and meanings: 'engagement', 'health', 'wellness'...

POLICY, Nat. - U.N., FUNDING, GLOBAL ECONOMICS. Legislation: Section 11 of the Health and Social Care Act 2001. Nat. programs: Health For All. Health & Local Social Service Auths, 3rd & Independent sectors. Choice, Equity, Equality, Access, Advocacy Services. Consultation, engagement. Patient Advice and Liaison Service (PALS). Definitions: engagement continua, datasets, intelligence / reporting. Service planning and development. 'Localisation' - Center. NHS Constitution Scalability of concept: Grp - Ind. Organisational empathy (public, patient rapport, involvement'). Economic cost of prolonged 'patiency'. 'Patient Lead'. Compliance. Political priorities, strategy, continuity. Policy half-life. Consolidation. Governance. Expenses. Specificity of roles, social exclusion. Wellness. Disability. Human Rights. Invalidity. Re-training. Health outcomes, assessment. (Lay) Representation. Champions. Black, Minority, Ethinic groups. 'Citizen-Patient'? INVOLVE1 Involve2 Retirees. NHS: 'Open All Hours' Dedicated centres

The focus above is UK, but can be readily revised to reflect other countries.

1. INVOLVE: Promoting public involvement in NHS, public health and social care research.
2. Involve: Promoting public and patient involvement in policy making and service design.

*Several informatics schools: community, urban, social, health, nursing, gender, e-gov...

Book: Empire of Pain

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

PSYCHOLOGICAL PAIN	Empire of Pain
How do governments recognise individual pain? How do governments recognise individual trauma?	A protest sculpture of a bent heroin spoon is placed outside the Purdue Pharma headquarters in Connecticut in 2018 © New York Times / Redux / eyevine c/o FT.

Gapper, J., Deadly Painkillers, Life&Arts, FTWeekend, 1-2 May, 2021. p.8.

Online: https://www.ft.com/content/1db7800f-78d5-474e-9b1e-744b1c1a837c

Book cover: https://www.foyles.co.uk/

BBC Radio 4: Start the Week, The opioid crisis and erosion of trust

Book: "Rethinking Causality, Complexity and Evidence for the Unique Patient"

Rethinking Causality, Complexity and Evidence for the Unique Patient

Questions arising:

Where would you place whole person care in the model below?

Similarly, what about evidence, complexity,

person-centred care, the unique patient?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

mind (soul - personhood) subjective (inc. PAIN) quality subject Psychotherapy & others psycho- philosophy Diagnosis: classification DSM.. dispositions, cognition, bias, beliefs mental health PURPOSE(S) 2. -PSYCHO- Intrapersonal Interpersonal (skills) Reflection - Reflexive (individual) psychology

(em-)body (machine) objective (inc. PAIN) quantity object Physiotherapy & others -somatic scientific method Bayesian formula, analgesia biomedical model, treatment Diagnosis: classification ICD SNOMED.. 1. Yes. The BIO- Thresholds, intensity, prediction cause, causality, explanation, reductionism dispositional causality, relation - flow PROCESS(ES) TIME events, clinical 'content', [Sciences(Physics,Chemistry,Biology..)]

(group) psychology relationships, support 3. SOCIAL model sociology (of PAIN, disease) Medical Sociology phenomenological - lived experience PRACTICE CLINICAL ENCOUNTER

political - power - autonomy Where is the individual | within the collective? 4. ... is incomplete (p.83) POLICY CLINICAL ENCOUNTER

See also:

https://hodges-model.blogspot.com/2009/08/combining-h2cm-informing-science-and.html

https://hodges-model.blogspot.com/search/label/4-fold%20care

The Care Campaign

The Care campaign is a joint drive by the Patients Association and Nursing Standard magazine to improve fundamental patient care across the UK.



CARE stands for:

C – communicate with compassion
A – assist with toileting, ensuring dignity
R – relieve pain effectively
E – encourage adequate nutrition


The campaign recognises that everyone who goes into a care setting is entitled to these four fundamental aspects of care – they are a human right.

We hope patients, relatives and nurses will use this Care slogan as a care checklist. Patients and relatives can use it to pinpoint shortcomings in care; nurses can use it to articulate a case to their managers for more support, for example, more staff.

The Care campaign asks all nurses, nursing directors, chief executives and non-executive directors of NHS trusts to sign up to the Care Challenge so that ‘Care’ becomes a universal expectation for patients.

The campaign’s aims are:

• For nursing staff to adopt the Care Challenge, based on our four-point tool.
• To highlight obstacles nurses face in delivering the Care Challenge.
• For organisations to sign up to the Care Challenge.
• For patients to recognise the Care checklist and to use it to challenge poor care.
• To support nurses who expose failures to deliver the fundamentals of care.

Contact The Care Campaign: carecampaign AT rcnpublishing.co.uk

===========
Some thoughts:
What is crucial of course is what the above C. A. R. E. depends upon - and this has been considered within the campaign:

C: Attitude, self-awareness, professionalism and training in theory and practice.
A: Time and adequate staff assignment to enable patient - person-centred care not task allocation.
R: Time to observe and interact with patients and relatives - acknowledging patient reports and training in the recognition of pain and management. Pain management should not be incidental - neither should dignity and respect.
E: Too posh to wash - Too senior to help feed a patient, ensure they have a drink?

"Values in Advanced Directives" mapped to Hodges' model

Hechter, et al. (1999) consider values in respect of advanced directives and medical treatment. The authors discuss an old debate in social science that still divides objectivists and subjectivists. Below, with my emphasis the four designated values are mapped to Hodge' model:

individual
|
INTERPERSONAL : SCIENCES
humanistic ---------------------------------------  mechanistic
SOCIOLOGY : POLITICAL
|
group

(ii) self-concept values involving feelings of dignity, self-control, and/or physical capacity (designated as function);	(i) hedonic values about pain, aversive physical states, chances for recovery to some minimally satisfactory level, and so forth (designated hereafter as pain);
(iii) allocentric values referring to concerns with creating an emotional burden for family and/or loved ones (designated as burden)	(iv) financial considerations (designated as cost) (p.409).

Since 1999 and considering the above I have added the following additions to reflect elements of change and a more generic view:

identity, self-expression (of needs), consistency in expressed wishes, intentionality, mood, alternative-adaptive forms of communication, time - active listening	distance, logistics (family, friends), what telecare might offer in terms of communication, evidence-based interventions, measures, assessment
independent advocacy, standards of social care, 'appropriate' placement for ongoing care, social - life history;	legislation - mental capacity, advocacy, evidence-based care - policy, pension, safeguarding;

While the focus of Hechter, et al. is specific these values also apply in a more generic sense. As students and lifelong learners engage with patients, carers and public they must learn to have due regard for the totality of values that might be encountered.

Hechter, M., Ranger-Moore, J., Jasso, G., & Horne, C. (1999). Do Values Matter? An Analysis of Advance Directives for Medical Treatment. European Sociological Review, 15(4), 405-430. 
 

Tongues: The Edinburgh Companion to the Global Medical Humanities

Editors: Benjamin Dalton (Lancaster University), Steven Wilson (Queen’s University Belfast), Alex Wragge-Morley (Lancaster) and Stephanie Wright (Lancaster)

NEW Deadline for abstracts: 30 January 2026

The deadline for proposals to participate in a new Edinburgh Companion to the Global Medical Humanities has been extended. Following on from the landmark Edinburgh Companion to the Critical Medical Humanities, this handbook aims to catalyse the emerging field of global, multilingual work in the medical humanities. In its earliest form, the medical humanities sought to recognize the importance of literature and the arts to medical education and communication. In the following decades, scholars have recognized the entanglements that have existed between mind, body and environment – entanglements that call into question still prevalent distinctions between the sciences and the humanities, or between biology and culture (Whitehead et. al., 2016). Now, scholars and practitioners are increasingly bringing global cultures, epistemologies, and languages to bear on the medical humanities. At the same time, new approaches that both challenge and extend the concerns of the medical humanities are emerging in non-Anglophone and non-Western contexts.

This volume will give students and scholars a comprehensive guide to the dynamic and emerging field of global medical humanities – identified as such in recent editorials in Medical Humanities, The Polyphony and The Routledge Handbook of the Medical Humanities. This is a field that engages critically with the notion of global studies, recognizing that some of its iterations simply perpetuate the cultural, epistemic, and cultural hierarchies that have so long dominated the fields of health and the humanities. At once synthesizing and developing the insights of the field, this Edinburgh Companion will deploy the metaphor of the tongue to bring together, without homogenizing, a globally diverse range of contexts and interconnections. The tongue is at once an instrument of speech and a bodily organ that connects people to their cultures and environments. Indeed, through its communicative function and the pleasures and pains of taste, the tongue relates people to the language and foodways frequently taken to define cultures and societies. Moreover, the tongue is an interface for pleasure, intimacy and connection between bodies. And, of course, the tongue quite literally brings the world into the body through acts of taste and eating (Mol, 2021).

On the one hand, therefore, this Companion will deal with language, exploring the manifold ways in which translation between cultural and linguistic contexts can change our understandings and experiences of health. But at the same time, taking its cue from the corporeality of the tongue, it will explore how thought, perception and bodily reality may alter or be altered by movement in and between cultural and linguistic settings. This new handbook will thus serve as a crucial resource for anybody engaging with the trans-cultural and trans-linguistic aspects of health and wellbeing, from scholars and students to medical practitioners and carers.

The handbook will include a foreword by Angela Woods (Durham University), and the editors invite proposals for chapters on any topic relating to the global medical humanities, including but not restricted to:

• Translating the medical humanities across cultures (broadly conceived)
• Vernaculars of healthcare
• Non-verbal languages
• Global conceptions or expressions of pleasure, sexuality, taste, and/or pain
• Bodies, senses and environments
• Failures of language to communicate pain and/or bodily resistance to translation

Abstracts of between 200-300 words should be sent along with a short (50-word max) bio to a.wragge-morley AT lancaster.ac.uk, b.dalton AT lancaster.ac.uk, s.wright9 AT lancaster.ac.uk and steven.wilson AT qub.ac.uk by 30 January 2026. Informal enquiries can be directed the same addresses.

My source: NNMHR list www.jiscmail.ac.uk/NNMHR

Money and Mental Health [i] Impact of Mass Unemployment Events (MUEs)

This post was prompted by an infographic on twitter and an associated report that includes the infographics:

Davies AR, Homolova L, Grey C, Bellis MA (2017). Mass Unemployment Events (MUEs) – Prevention and Response from a Public Health Perspective. Public Health Wales, Cardiff ISBN 978-1-910768-42-6.

The report is very interesting, not just in it demonstrating the conceptual scope and application of Hodges' model, but in the real-world examples of people who have experienced this socioeconomic phenomena which impacts so heavily on the individual, spouses (partners) and communities. In addition the research is global across countries and industries. It is sobering to reflect also on the dynamic that is the workforce. Paradoxically, at present UK employment is at a high:

"The employment rate (the proportion of people aged from 16 to 64 who were in work) was 74.8%, the joint highest since comparable records began in 1971." (ONS June 2017).

The report does not mention the 'gig economy', but the rise of 'zero hours' a feature of the new economy is found on page 48. With demographers, forward thinking policy makers and media seers predicting the future of work as the robots not only find their feet, but walk, run and jump - you wonder where we are headed. Children will need to be educated in such a way that they are prepared to retrain, possibly several times in their working lives. Other avenues to ease the human pain are a basic universal income, and a reduced working week. You do wonder if another hidden and subtle MUE is underway? It is not so much massive, as yet, but it is happening in not so slow - slow motion ...?

What follows is drawn from section 4.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Effect on mental health and well-being loss of self-esteem, increased stress, anxiety, changes to perceived control, shame and loss of status, withdrawal experiencing a grieving process insomnia, depression, self-harm, attempted and completed suicide loneliness financial strain  Effect on pre-existing poor health behaviours -  helplessness, hopelessness loss of individual and collective* identity

physical health reduced freedom from disability back-pain mortality reduced life expectancy stroke, myocardial infarction weight gain relapse to smoking ... again - such as, increased alcohol consumption, tobacco smoking, illegal and prescription drug misuse, and being overweight "job for life" hidden morbidity

spousal mental health reduced household income change in family dynamics emasculation increased conflict and domestic violence, increased unplanned pregnancy, and reduced infant growth - child educational attainment Community impact: loss of cohesion and identity* the already unemployed social inequalities women seeking community mental health support as their (male) partners will not seek help having to work away from home intergenerational impact culture of worklessness, unemployability "job for life of a family"

hidden unemployed accumulation of debt jobs offered not local labour market competition housing market - affordability commuting costs reliance on food banks  increased expenditure on antidepressants  and related drugs financial hardship increased hospitalisation, out-patient attendance Community impact: labour market and economy Loss of industries youth move away -  no workers for new initiatives/industries loss to local economy of MUE reliance on welfare benefits

A future post will conduct a similar treatment of a publication by The Money and Mental Health Policy Institute.

Care with a Smile: For a Smile in Care Homes

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Self-esteem, self-image anxiety, worry, depression Able to express needs communication Ability to ask, remind, argue - self-advocate Challenging behaviours, agitation, aggression Irritability, poor sleep reduced attention and concentration Observation of staff - pain? Loss of dentures, memory

Changes in gums, gum disease, weight loss cleaning teeth, false dentures, fit, marking dentures, care plans Access to toothbrush, toothpaste, mouth wash, Oral hygiene Sugar – sweets (one of few pleasures?) Risk of thrush and other infections (cardiac?) Mobility of the resident Appearance and sense of well-being Pain of toothache, analgesia – tiredness Avoiding eating and drinking properly Access to dental surgery Changes with speech Equipment challenges of remote care, technology changes Mobile clinics

Responding to expressed distress - whether explicit or implicit (listening - caring) Confidence. Isolation Avoiding other people. Having friends and family to advocate for dental care Impatience with others, argumentative, shouting Family expectations

Guidelines Commissioning of dental care in the residential / nursing home sectors Local authorities, Health, CQC Asessment - Evaluation Referral process Staff  awareness and knowledge The nursing home make the referral? The family must make the referral? Payment National standards Domiciliary visits paid in advance. Dental service packs packs circulated to residential and nursing homes across a Region. Global access to Dental care?

Depression Worskhop: c/o and with thanks to AffecTech

As posted last September I enjoyed an evening at the launch of AffecTech at Lancaster. This post is prompted by a tweet:

AffecTech Design Workshop: Discussion on Cross-disciplinary Methods for Depression Treatment: https://t.co/7xVinrvmWf #wearables #tech #innovation #research #digitalhealth #mentalhealth #depression

— AffecTech (@Affec_Tech) February 16, 2018

I should add that this post is not intended to represent an endorsement by AffecTech but there is an opportunity to reflect and show how Hodges' model can be used.  I contacted the researchers who - in the spirit just mentioned - kindly forwarded higher resolution images. Of course, not being present at the workshop a lot of information is lost. The reference to art is interesting in itself. It is difficult to capture the context of the whole workshop but - as per the tweet - a short article sets the scene:

AffecTech Design Workshop: Discussion on Cross-disciplinary Methods for Depression Treatment

I have provided two examples of Hodges' model mapping the contents of the workshop. The first,  covers Figure 1: Concept maps of depression causes and symptoms. I don't have a key so there may be the thoughts of several individuals - as per the colours and codes on the flipcharts. Some terms are immediately not only cross-disciplinary but multicontextual in terms of their everyday meaning, for example, darkness, falling, stuck-ness, negative spiral (thoughts, actions), imprisonment mentally, physically, and politically due to dependency, financial constraints.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Unreachable hope                                     Pain                                           Weight - burdened        Immobility - motivation                   DEPRESSION    Anxiety DESPERATION                                          Stuck                 Darkness    Grief             Falling Insomnia       Negative filter         No hope Nowhere   Negative spiral                             Lack of interest and motivation Internalising rage   Suppressed emotions Anger Not being listened to                  Darkness

Pain Im-mobility  Physical decline Weight Stuck Chained/Locked to go energy imprisonment Darkness

Imprisonment – Social Isolation No support Hiding Loneliness

Imprisonment – Powerlessness? Loss of control

Next, I have examined the text immediately following and mapped this [my emphasis] to the model.

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------- THE SYSTEM --------------- mechanistic

SOCIOLOGY : POLITICAL

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group

Identified, general state of lack of interest as a main symptom of depression (lack of energy, negative spiral), and as one of the obstacles for technology-based treatment of it. Therapist input: the emotion regulation component of the system should be suggestion-based (promoting novelty in the patient daily routine). system should be able to continuously monitor* (and predict) the user mood should have an appealing and trust-worthy interface from which it can communicate with the user and modifying his/her immediate context. If depressed - the agent engages the user in a discussion in which a range of emotion regulation techniques is proposed to him/her. Includes: (i) modifying environment (light changes, playing music); (ii) recommending activities; (iii) proposing mindfulness exercises; (iv) engaging the user in a discussion; or (v) recommending the user to look for the support of a friend. Further, at the end of each day the user and the agent discuss progress made over recent days, and define small steps that could be taken in the near future.

Requirement for a pro-active intervention system, and engage the user as soon as (or better just a bit before) a critical situation is detected. System should: *real time - 'always on'? provide daily feed-back to the user (giving a sense of incrementally overcoming problems). Low-fidelity prototype of a system that meet these requirements. Composed of two components: (i) wrist-band device worn by the user that monitors the user mood; and (ii) an assistive agent that is responsible for the emotion regulation system component. Working principle of system - wrist-band devices communicates to the agent when the user is in a depressed mood (- use of biosensors)

Should strive to connect the user with his/her close friends.  Emotion regulation techniques - (v) recommending the user to look for the support of a friend (see above).

The above is provided as a 'pause for thought'. I'm no expert on NLP, but I am acutely aware of the power of the words we use. And how what is said to patients, carers can be returned as a sizzling hot potato that may reveal: great foresight in what you have missed; a major lack of understanding of a situation and treatment plan; and (then) as follows a need for urgent educational intervention. In applications such as this - care needs to be taken in when and were particular words are used. 'Treatment' is in the title, but can be a loaded term as understood by the patient, client, carer, or user. People will say, "No it isn't - this is a 'balanced' approach." but herein risks lie.

Services should be non-ageist and yet culturally if you survey treatment and related terms - from a decennial perspective I wonder what you would find? I have patients who refer to Dr Google and will challenge and ask about their care and if not satified seek further opinions - a fresh pair of eyes; and others who are quite institutionalized in respect of passively accepting what is 'prescribed'. This may be reflected in the length of their mental 'health career' and their previous mental health history.

Please note the inclusion of THE SYSTEM above in the axes and domains of Hodges' model. This is non-trivial. 

At the end of the day (and the start of the night - for someone with depression?) what is the system? I'm not being awkward, but the 'system' in research can become a lay-by. As a compound term it is shorthand, but obviously we need to focus on the elements, constituents and what glues the system together: coherence. As an example, how often in IT project are 'Requirements' the sought after token that signifies "We are on the right track!"? The focus from the above is laudable being clearly person- patient-centred. Is there more that can be said about the system and requirements in the social and political domains? Is there a way also for the agent to figure higher up the design ecosystem (hierarchy)? This is no doubt were the hard work matters - theory, practice - the thesis!

Given the complexity of the (design, care, technical, global...) problems we face I do believe that Hodges' model may serve a purpose in helping to sustain, or ‘recover’ the context – of a situation. This is the purpose of stories of course. The aim of AffecTech's project here is no less than detecting a critical situation. Perhaps this is the truth of 'integrated health records' from wrist device, to agent, patient's record and health services'? It is brilliant to see such initiatives getting underway they are the future....

 (I may add to this post in coming days - weeks.)

With thanks to Alan Cole and Andrea Patane of AffecTech at Lancaster University.