Sunday, 31 July 2016

All aboard the Ogoerk Bus for Tales of G&T and the Big C

Back in the 1970s, Poland’s buses were nicknamed ogorek (cucumber) buses, as their shape was said to resemble the vegetable. Last week in London, the gin makers Hendricks launched HERBERT (Hendricks Extraordinary Roving Bus for Exceptionally Refined Travel). It's a bus that was cunningly disguised as a cucumber (see here). A soothing G&T with a slice of cucumber to counter travel frustrations (40% of commuters believe that summer is the worst time to travel on public transport) was part of the offer. I say was as the bus only ran last week, the short lived service finished last Friday.

I mention this story for a number of reasons. I have recently taken up drinking Gin. After a lifetime of drinking whisky I have suddenly developed a taste for Gin. Having missed the HERBERT experience, I am pleased to share with you dear reader, the announcement that the UK's biggest Gin festival will be moving out of its current location, the Victoria Baths in central Manchester, to the glorious surroundings of Rochdale Town Hall. It is anticipated there will be more than 100 different varieties of Gin to taste and buy from craft distilleries located across the whole of Great Britain. The event takes place in October this year and tickets are going fast. I've got mine.

Anyway, I'm getting distracted. The main reason for mentioning all things Gin was the report published last week in the journal Addiction by Professor Jennie Connor from the University of Otago (New Zealand's oldest university). Her review of the evidence to date noted there is now overwhelming evidence that alcohol causes 7 types of cancer, and probably others as well. Science has not yet established why this might be, but alcohol is estimated to have caused about 500,000 deaths from cancer a year. This is nearly 6% of cancer deaths worldwide.  

Whilst the highest risks are for those who are heavy drinkers, the evidence suggests that even those who have the odd glass are at risk. Alcohol is already linked to cancer of the mouth, throat, larynx, oesophagus, liver, colon, bowel and breast (female). The really bad news is that Connor believes the evidence suggests there is no safe level of drinking. Any claims that a glass of red wine might be good for your heart is completely disingenuous in terms of the cancer risks. Indeed this January, our own UK Chief Medical Officer, Dame Sally Davies, who herself likes a glass of wine or 2, issued the first governmental advice in 20 years, as to what safe alcohol consumption might be for men and women.

Whilst acknowledging that there were no safe levels of alcohol consumption, the guidance recommended a weekly limit of 14 units of alcohol. This somewhat contradictory message has of course, been challenged by others. Professor Sir David Spiegelhalter, who is the Winton Professor of the Public Understanding of Risk at Cambridge University (2nd oldest university in the English speaking world, and the world’s 4th oldest surviving university) revealed that drinking the maximum allowance is no more dangerous than watching TV for an hour a day or a eating bacon sandwich a couple of times a weeks.

Since 2008, alcohol related deaths have continued to fall across the UK. In 2014, there were just under 9000 alcohol deaths, 65% of which were among males. 55 – 64 year olds form the largest group of those dying from alcohol related deaths. Whilst Scotland has the highest rate of alcohol related deaths, Scotland has also seen the fastest decrease in rates since these peaked in 2000. So let me pause here and review where we have got to. I have a ticket for the UKs biggest gin festival, a House in Scotland, I'm re-watching the first 32 episodes of Cold Feet, and I'm aged 61. On the plus side, I don't eat bacon sandwiches. With such contradictory advice and various interpretations of the evidence it’s difficult to know where I stand. 

I can't help but think that way back in 1871, when the University of Otago opened, coming to a consensus might have been much easier. There were just 3 professors: (1) Classics and English Language and Literature (2) Mathematics and Natural Philosophy (3) Mental and Moral Philosophy Economy – it was a somewhat lean professoriate, but I can imagine them sitting in the Senior Common Room, putting the world to rights over a glass or two of sherry.  It wouldn't happen today, but then, I guess the designers of Poland's buses would never have imagined the affectionate name given to their buses being used in London to provide commuters with a glass of G&T on their way home.  

Sunday, 24 July 2016

Seeking inspiration from and through others; is it habit or a habitus?

My Father has often asked the question, why do I write this blog? The answer is invariably the same, first and foremost, I write because I want to and have an almost compulsive urge to do so. Although writing primarily for me, I feel very privileged that other people choose to read the words. I also know that writing the blog takes time, and it could be time that I might use to do other things. Unlike my colleague Allan Walker (Dean of our School or Arts and Media) who taught himself to touch type in adult life, I am more or less a 2 finger typist. Even so I reckon I can pump out 1000 words every 20 mins, which in some kind of applied logical progression should mean that I ought to be able to churn out a 90,000 word thesis in just under 3 days.

As I am already living with arthritis in both hands, I am pretty sure that a 3 day stint at typing a 90,000 word thesis would be physically impossible. It would be also fairly impossible given that writing is a processes of creation. And the act of creating requires one overriding element, inspiration. How people become inspired will always be different. I don't know where the sense of being inspired comes from. It’s a form of cognitive magic. I do know that for me, inspiration can be triggered by a word read, something seen, a conversation heard or initiated, or a picture viewed. It is one of the reasons I like Twitter, and the rapid access to news and ideas such social media provides.

Social media of all kinds is for many people, an increasingly important part in our lives. For some it is a vital way of communicating with others, particularly 'in the moment'. Such instant live communication was something seen during and after the chaos of the recent Munich attack. It appears local people used the Twitter hashtag #offenetur (#opendoor), to offer shelter in their homes to people trapped in Munich as the city was locked down.

For others it's about sharing good ideas. Last week I became aware of great little project involving children putting forward their solutions to the health problems of the future – and these were some brilliantly simple ideas generated through the innocence of childhood, and facilitated through the Eastern Academic Health Science Network's Health and Wellbeing Village at the Cambridge Big Weekend (see here).  

For me sometimes the inspiration comes from something I feel I should know, but don't (it's really impossible to have read everything one should read in a life time). For example I came across this quote from Plato last week - We can easily forgive a child who is afraid of the dark; the real tragedy of life is when men are afraid of the light – a thought that for me felt both simple and profound, and when reflected upon against the context of our political, economic and cultural turbulence, deeply important.

And that’s the thing about writing and publishing it has the power to change beliefs, lives and ways of thinking. I have a Twitter colleague who lives in Melbourne, Australia. I've never met him (but hope one day to do so) – you can find him on @JermeyScrivens – he writes about how organisations can change, what a healthy organisation culture might look like and what it can achieve – I am inspired by both his thinking and academic writing, but equally I like it that he tells me there are 14 kangaroos in his back garden and that his ruby red roses are on the turn. 

Jeremy describes old media, (what I grew up with) as being a single event-consumption (a letter, phone call and so on), whereas social media is a triathlon: people are able to consume, make and share. In so doing they create and feed an ever changing world, what the French sociologist Pierre Bourdieu called 'habitus' – a 'somewhere' (virtual and physical) that is created through collective social rather than individual processes. It's why, every week,  I write my blog, and every day, I tweet on social media. so maybe when my Dad next asks I can say well its habit or even its a habitus. Once again, thank you for reading these words.

Sunday, 17 July 2016

Reflections on near death experiences and celebrating the joy of the innocent

I was coming back from London last Friday when the train I was on slowed, and then stopped in the early evening sunshine. Eventually the Train Manager announced that due to someone being hit by a train on our line, we were facing delays of up to 90 mins. The incident had a number of different consequences. Most importantly would be for the man involved in the accident. Although as I write this blog he has survived, and remains in a serious condition, the accident will have a life changing legacy. Less importantly, the delay had a knock on impact for my evening’s arrangements. I was already very tired from what had been an extraordinary day of concentration at the NMC, so the delay probably increased my irritability 10 fold. As for the train company, they would face many claims as all delays over 30 mins would incur a compensation payment.

The train eventually was given the all clear to move and after a few minutes, we slowly passed the scene of the accident. An air ambulance helicopter, police cars and other emergency vehicles were visible around the stationary train involved. It was sobering to think of how many lives the accident would touch. The sad incident came less than 24 hours after the news broke of the terrorist attack and the deaths and injuries of so many people in Nice, France. Like many others, I was affected once again by the senseless killings. It was yet another attack on innocent people that follows a number of such barbaric and cowardly acts in recent months.

I think both events brought into sharp focus the finality of death, and of a life (lives) ending, often prematurely or suddenly without any warning. I am not sure why I was dwelling on these thoughts right now. Dealing with death in one form or the other has been part of my professional life for as long as I can remember. One of the memories I still cherish was the humbling privilege it felt, when for the first I was asked to perform the last offices for a patient I had cared for. I have sat with countless people who have expressed a desire to end their life, and I am proud to work with colleagues who are doing much to improve the quality of care provided to people at the end of their life. This year there have also been what  has felt like a high number of deaths of famous people, some from my youth, and some who were of a similar age to myself.

Quite strangely I had only last week been talking about my younger brother Christopher, who died way before his time. I was telling someone of his 'seize the moment' approach to life. In telling the story I also recalled the time I picked him up from a HDU, as he wanted to discharge himself. I remember sitting at his bed watching him peacefully sleeping, and his comment on awakening and seeing me there – 'Oh God I thought it was the Grim Reaper coming to get me'.

Christopher was a kind and generous person, often hedonistic in outlook, and someone who possessed an acerbic sense of humour. He would always have a comment about most things in life. Thinking about him reminded me of Brian Sewells great piece about growing old disgracefully, written just a couple of years before he died. I looked it up last week and read it again - it is worth a read, even if it’s just for his explanation of what he calls the therapeutic use of the word f**k (see here). Possibly not for you Mother.  

And dear reader, just to allay any concern you might have about my state of mind, let me reassure you, that rather than feeling morbid or despairing, thoughts of death and what gets left behind spur me on to enjoy life. Perhaps not in quite the same manner as Christopher or Brian sometimes did, but maybe somewhere in-between. I am very fortunate to be part a large and extended family. This weekend has been devoted to being immersed in the lives of those who really know how to enjoy every second of life, 5 of my 9 grandchildren. Yesterday it was sleep overs, jumping in puddles, feeding ducks, walking Cello, haircuts (not mine), cooking meals for the freezer (or rather for busy Mums). Today, it will be similar (minus the haircuts) and enjoyed with an 8 year old fun loving girl and her younger twin siblings. Oh, and there will be ladder climbing, playing with big boys toys and tongue twisting conversations thrown in for good measure too. 

Sunday, 10 July 2016

Taking a deep breath, and dipping my toe in the sea, allows me to keep my head!

Antoine Lavoisier died by the guillotine. He had been found guilty of crimes against the state. These included adulterating the nation’s tobacco with water, supplying the enemies of France with large donations of tax payers cash and generally plundering the people and treasury of France. Unhelpfully (for him and his wife) his convictions were overturned a year after he died. I mention this story for 2 reasons. The first reason arises from the fact that at his trial the presiding Judge would not allow Antoine to mount a defence or actually speak at all. He noted that the emergent Republic had no need of scientists or chemists (Antoine was widely considered to be the Father of Modern Chemistry). As such his contribution to society had little value, and so there was no requirement for leniency when deciding to pass the death penalty. He was tried, convicted and guillotined on the same day.

All of this was going on during a time of great uncertainty, the French Revolution was at its height and there was enormous political and economic turbulence and much social change. In the UK today, as the post Brexit turmoil continues, particularly for vulnerable and innocent people, shades of what it must have been like in that Spring of 1794 Paris, can be glimpsed. And just like then, there are views held as to what and who might be considered critical and/or trustworthy in the making of their contribution to society. Last week YouGov published a survey on who people in the UK trusted to guide them through the current political and economic turbulence. 49% said the people they most trust were academics, followed by 28% family, and 23% friends. Only 10% trusted our political leaders.

Returning to our hero for a moment, the second reason for mentioning Antoines story was his discoveries. In 1778 he recognised and named 'oxygen' and went on to discover the role oxygen plays in combustion. His discovery also gave rise to a number of popular theories about the benefits of sea air, which back then was thought to be better and purer than that found anywhere else. This was the time of the Industrial Revolution and rapid industrialisation was starting to result in air pollution. Going to the beach for a holiday started to become a very popular choice during the late 18th century.

There were perceived health benefits associated with the sea, and sea air. I can remember from my nurse training, being introduced to the ancient theory of the 4 humors, substances which when in a state of balance, will keep a person healthy. Of course once medical research and our understanding of the human body reached an advanced stage, such theories fell into disuse. However, at the time, one of these so called humors, black bile (and there is no modern equivalent really) was said to cause melancholy (depression), and a quick dip in the cold sea was seen to be the best cure!

Indeed, in 1621, Robert Burton (author of the Anatomy of Melancholy) described depression as one of mankind's 'chief maladies', and his recommended 'cure' involved travelling and taking holidays, including holidays by the seaside. Today, depression remains the second leading cause of disability worldwide, and a major contributor to the levels of suicide and ischemic heart disease. Currently the 'cures' available in mental health care feature sophisticated anti-depressant medication as well as very effective talking therapies. 

As a Professor of mental health care I am no more insulated from feelings of stress, anxiety and sometimes depressive thoughts than anyone else. My approach to dealing with such feelings reflects the concept of mindfulness. I have an image I draw upon in focusing my thoughts in times of stress, anxiety and or despair. The image is of me sitting on favourite bench, a bench that looks out over a local beach. I often sit there for a while when taking Cello for a walk. I find it totally relaxing and up-lifting to just stop for a while and appreciate the world around me. It is this experience that I bring to mind when dealing with my own negative thoughts. 

Yesterday I found myself having to deal with such thoughts. It was the annual Village Boules Championships, and the only major sporting event of any real interest this weekend. We all get to dress up in traditional French outfits, mutter vague French phrases and drink lots of red wine, Oh and throw a few boules around. Last year I was the champion, this year I didn’t win. Some may say it was the red wine, some might say I was complacent and perhaps ill-prepared, or just distracted.  Well done to Caroline and David - worthy winners both, but I can say, without reservation, I will be back. I didn’t lose my head, just my crown. I will take a deep breath, and carry on...

Sunday, 3 July 2016

I’ve heard the question, but there’re no easy answers from this Professor

I belong to a group called the Mental Health Nurse Academics UK (MHNAUK). Its a group that meets periodically to discuss the state of mental health nursing practice, research and education. Every University with a mental health nurse education programme is entitled to have a representative. All Professors of mental health are automatically ex-officio members. Recently the group have been looking at the threatened erosion of the professional identity of mental health nursing. Those responsible for the regulation and commissioning of nurse education are considering the adoption of a more generic approach to the preparation and practice of all nurses including those in mental health practice.

Given the changing nature of health and social care provision, and in particular the move towards integrated services, I have mixed views about whether this is the battle we should be engaged in. Up until 2 weeks ago I would have probably written that time will tell how successful MHNAUK are in the efforts to protect the mental health nurse professional identity. The uncertainty of the UK’s political landscape and what is likely to be a governmental  'brain drain' of effort in working through the consequences of the UK withdrawal from the EU, will mean that many issues are likely to remain un-addressed for the foreseeable future.

Mental health care in the UK is one of these areas. The recently published tough, open and evidence based publication, The Five Year Forward View for Mental Health, presented a critical analysis of the current state of mental health care in the UK. It was a report that was welcomed by many concerned with improving mental health care. The report recognised the scale of mental health problems being experienced by people and the cost of mental ill health to the economy, some £105bn a year. Mental health ill health represents 23% of the disease burden in the UK.

The report made some big promises as to how these services would be improved. It recommended that an additional £1bn a year in funding was required. This was a sum in addition to the £1.4bn over the next 5 years to improve access to children and young people's mental health services announced last year by the Prime Minister (see here). And these services need improving. It’s thought that 1 in 10 children experience a mental health problem, yet children can wait over 5 months to get a routine appointment with a mental health practitioner, 7-8 months if you want to see someone from a community team. Some 258,000 children were referred to child and adolescent mental health service in 2015. This lack of care provision has an impact on other parts of the health and social care system.

The number of children attending A+E departments with mental health problems rose to 20,000 in 2014-15, doubling where it was 4 years ago. ChildLine (the free 24/7 counselling service for children and 30 years old this year) has helped 4 million children since it started. A child contacts ChildLine every 25 seconds, every day.

Last week, the Guardian newspaper reported on research undertaken by YouGov which revealed the concerns many parents have about their children and mental health problems. 67% believed their child would never recover from a diagnosis of a mental illness; 49% felt their child would never get married or have children of their own; and 44% of parents thought their child might be removed from them. When I first read the article I was disappointed by what I thought was the degree of ignorance and stigma these statistics revealed. However, there is no doubt that whether it's you or your loved one who is experiencing a mental health problem, it can be a difficult place to be. For parents of children who might be experiencing mental health problems this is often more so. Sometimes a combination of the emotional burden of care, the corrosiveness of guilt, and the lack of timely and appropriate help result in a crushing sense of despair and impotence for many people, feelings that can be almost overwhelming. 

From someone who has been there, to that sometimes dark place, and as mental health professional of many, many years I can say there are no easy answers. Being there, and being there for others, whatever the difficulties is the approach I have found the most helpful. And actually, I don’t think I ever needed to be a mental health nurse to understand that or to try and ensure I was that person.