Sunday, 17 September 2017

CSE and CSA and the need to create portfolios of prevention

Like many of my fellow bloggers, I am intrigued by words and how words are used. I touched upon the relative importance of words in communicating emotions and attitudes in my blog post last week. I'm also interested in the etymology of words. Etymologies are not definitions of particular words, but can provide explanations of what our words meant and how they might have sounded from as far back as 2000 years ago.

Last week I was looking for the origins of the word ‘portfolio’ (it was a temporary distraction from actually constructing my research portfolio) – and the word ‘portfolio’ comes from the Italian portafogli, as in portare ‘carry’ and foglio ‘leaf’. What I didn’t know until I searched was that ‘portfolio’ was one of 60 words introduced into the English language in 1713. Here are a couple of sentences containing some of the others – Dr T was a self-devoted sparkler of a man, with a horselaugh and a fuzzy beard. He had built a machinelike clothespress thinking he was creating an orrery, which although a great piece of work would not be going into his portfolio!

However, I did come across 2 news items last week that absolutely sat within my research portfolio. The first of which was the research published by the Centre for Mental Health. This showed that mental health problems experienced by the UK workforce had cost employers some £35Bn last year. This equates to £1300 for every employee in the UK economy. At any one time 1 in 5 working people will have a mental health difficulty, but the issues are not straightforward as they might first seem. A large proportion of the £35Bn cost comes from the reduced productivity caused by people continuing to go to work when they are mentally unwell. Such behaviour costs businesses’ twice as much as paying for sickness absence arising from mental health problems.

Sadly some people will never get any help and some will lose their job because of mental health problems. For others, being at work can be an important part of their recovery journey. The good news is that many organisations are now taking the mental health and wellbeing of their employees seriously. In my University, we have long had in place support for our students who may be experiencing mental health problems, and over time have extended this focus to staff as well. From my own recent experience of mental health problems. I know the current approach is on prevention, promoting a healthy workplace as well as being appropriately supportive when such measures are not quite enough. However, whilst mental health issues are increasingly talked about more generally, there is still a degree of stigma attached to those experiencing a mental health problem. The result can be some individuals being reluctant to ask for help or speak about their experiences. The sound of silence can be very damaging.

Shattering the silence really encapsulates the issues in the 2nd portfolio item to capture my attention last week. Last Friday was #PurpleFriday, a day to raise awareness of both Child Sexual Exploitation (CSE) and Child Sexual Abuse (CSA). Although closely entwined, there is a difference. CSE involves exploitative situations, contexts and relationship where young people (or a 3rd person) receives something (money, alcohol, gifts, affection) as a consequence of them performing and/or another or others performing in them, sexual activities. CSA involves forcing or enticing a child to take part in sexual activities, whether or not the child is aware of what is happening. Sexual abuse is not always perpetrated only by males, women can also commit acts of sexual abuse, as can other children and young people. 

The NSPCC recently reported a contemporaneous (and somewhat disturbing) evidence base of the prevalence of cases of CSE and CSA in the UK. Although comprehensive, it is an evidence base likely to be incomplete in terms of capturing and understating the prevalence of the both issues, because for example, the way in which cases get reported and the hidden nature of the abuse. Despite this lack of incomplete data, we do know that number of recorded sexual offences against under 16 years olds in 2015/16 was 37,778, a figure that has doubled over the last 10 years. It is not just sexual abuse or exploitation that should concern us. The impact on a child of emotional abuse or neglect is also likely to be significant. 

In the UK, there has been a rise of the number of children being on a child protection plan or register for emotional abuse, a rise from 23% in 2006 to 35% in 2016. As devastating as these statistics are, the increased number of children on such plans and register’s might also reflect an increased awareness of the importance of ‘breaking the silence’ and reporting concerns to professionals. The NSPCC report provides evidence that the wider public have a growing understanding of the ways in which abuse can be prevented. Their research showed that 56% of those asked believed that abuse and neglect could be prevented. The belief that abuse can be prevented is likely to be the critical first step to all of us taking action and saving a child from experiencing and living with abuse in any of its forms.

Sunday, 10 September 2017

The Zika virus: an organism at the edge of life

Although now retired, the psychologist, Professor Emeritus Albert Mehrabian still works as a researcher at the University of California, Los Angeles. He is probably best known for his research into body language and non-verbal communication. His book ‘Silent Messages’ (first published in 1971) can still be found on Amazon, and is absolutely worth a read. Ironically for someone whose work is so well known and is still hugely influential, it is often misunderstood and misused.  In particular, it is the work arising from a 1967 experiment, which has come to be the most misused over time – most people will know the outcomes of this research as the ‘so called’ 55%, 38%, 7% rule in communication.

That is: 7% of meaning is in the actual words that are spoken, 38% of meaning is in the way those words are said and 55% of meaning is in the accompanying facial expression. If one stops and thinks about this for a moment it is obvious that this cannot be so!  If it were, wouldn’t we be able to understand 90% of what is said in a foreign language just by seeing the person talk, or understand most of what is said on TV with the sound turned off? Mehrabian has long been at pains to say that his work was only about the way feelings and attitudes are being communicated; outside of this specific use, the 55, 38, 7 equation doesn’t hold true!

I recalled Mehrabian’s work as I was thinking about the way some research outcomes become completely embedded into our collective thinking, even, when as in Mehrabian’s example, it is for the wrong reasons. Many researchers are to blame in this regard. Last week I had an interesting discussion with a colleague whose role at the University involves communicating research outcomes and tracking the impact of the research as it gets translated into practice. He had a constant battle with the words used by many academics in describing the research undertaken, methodology used and the results. His complaint was that often the language used is not accessible to non-academics and what was often missing was the answer to the ‘so what’ question – you have done the research, but what difference or benefit will it have for me?

It was a valid observation. However, most academics write for a specific audience. Sometimes this will be for peer reviewed journals where methodological, epistemological and scientific narratives are standard and expected, or they are writing for commissioners of research and will be required to conform to a widely accepted way of communicating information and ideas in order that the bid can stand being scrutinised and judged against other similar bids. Such conventions can, at times, result in information content that is impenetrable to all but a limited group of other academics, and/or the message becomes over simplified and misunderstood.

As always, a middle ground can be found. Last week I thought the on-line BBC News site did a good job reporting on the outcomes of research into the Zika virus. Zika is a virus that people get through being bitten by an infected mosquito. Most people have very few symptoms, but the disease poses a serious threat to babies in the womb. I guess most of us will have seen pictures of affected babies - their abnormally small heads are the outward sign of the disease. Zika-based infections have been linked to severe birth defects in almost 30 countries. Although not now seen as an international medical emergency, the World Health Organisation (WHO) is closely monitoring its spread.

The BBC story focused on new research published in the Journal of Experimental Medicine that reported the Zika virus can selectively infect and kill ‘hard-to-treat’ cancerous cells in adult brains. Whilst human trials are not likely for at least another 18 months, the laboratory-based research shows the potential of injecting the virus into the brain at the same time surgery is performed to remove brain tumours. There are many types of brain cancer, but the most common tumours are Glioblastomas. These account for 12-15% of all brain tumours and they are very difficult to treat. Glioblastoma is most common in adults aged 45-75, and affects more men than women.

The tumours are fast growing, spreading through the brain very quickly, making it difficult to see where the tumour ends and the healthy tissue begins. So surgery, radiotherapy and chemotherapy may not be enough to remove these invasive tumours. Glioblastoma stem cells continue to grow and divide, creating new tumour cells. It is healthy stem cells that the Zika virus attacks in babies, whereas adult brains have very few stem cells. This means in the case of adults, Zika treatment should only destroy the cancer-causing brain stem cells without causing damage to other healthy brain cells. 

When I first read the story, I wondered who had first thought of doing the research. The science is clear, the connections obvious when pointed out, but I suspect beyond most of us. So perhaps my colleague was right – we need to find greater opportunities to talk, listen and share ideas in order to grow our shared understanding of the possible. Its sounds like a great starting point for everyone in the research community! For me, as today is World Suicide Prevention Day, I hope there are lots of researchers working on how we reduce the numbers of those who want to end their lives in this way.

Sunday, 3 September 2017

Flights of Fancy - the Challenges of Creating an Appropriate Workforce

25 years before I was born, Amy Johnson started her solo flight from England to Australia. It was a journey of over 10,000 miles. She finally landed some 19 days after leaving the UK. It was a fantastic achievement. She became the first women to fly solo over that distance. Today Emirates (there are other airlines), will do the same journey in 23 hours, and a business class ticket will cost you just £3160. These days it would probably be impossible to replicate exactly Amy’s journey. She put down in places that have now become very troubled and dangerous – Turkey, Iraq, Iran, Pakistan and Syria. Indeed, I am not sure if Aleppo in Syria still has a functioning airport. 

Amy Johnson was an inspirational women – not only did she undertake what must have been fantastically difficult journeys during the 1930s, but she was also an engineer of great repute. She was twice President of the Women’s Engineering Society (WES). WES is both a charity and a professional network of women engineers, scientists and technologists. They have a vision of the UK becoming a country where women are as likely as men to choose to study and work in engineering. To this end WES works collaboratively with educators, employers and influencers in creating a diverse engineering community. However, achieving this vision is a challenge.

At my University, we have many examples of the kind of outreach work that can introduce girls to study engineering and think about science, engineering and technology as a career choice. Someone who is as inspirational as Amy Johnson, is our Professor Haifa Takruri-Rizk. For over 20 years she has being researching and teaching in the fields of electronics, mobile networking, and the organisational cultures and workplace practices that support women in science, technology and engineering fields of practice. Her outreach work is very successful and applications by young women to study in these areas have held steady and begun to grow. But there is more that needs to be done.

Encouraging more women to study and work in these areas is critical for the UK's future economic prosperity. In the UK, the proportion of young women studying engineering and related subjects has remained more or less at 16% compared to places like India where around 30% of students are female, and these subjects represent over 30 of all university programmes taught. WES notes that less than 10% of the UK engineering workforce is female compared to countries like Latvia, Bulgaria, Cyprus where 30% of the workforce is female. The shortage of engineers in the UK is now becoming critical and it is estimated that we need to double the number of students and increase the current workforce by 60,000 people with engineering skills. It’s a challenge.

Of course it’s not just in the engineering workforce where gender inequality and representation is to be found. In my professional field of health care, gender balance has been a long standing issue. In medicine, there are some signs of change but it is slight. There are 281,440 doctors registered to practice in the UK. Of these 128,137 are female, but they are outnumbered by men in every field of practice other than General Practice, where there are slightly more females practising as GPs than men. The number of women entering medical school is still slightly higher than men (52%) but there has been a steady decline in overall numbers of women in training over the past 10 years.

In nursing the problem is reversed. The number of men in nursing remains stubbornly low. Only 12% of registered nurses in the UK were male – and this figure has remained constant over the past 5 years. Likewise for those considering nurse education and training, there are just under 12% male student nurses; a figure that has remained constant over the past decade. Just like in the case of engineers, encouraging children to think about nursing as a career and identifying strong role models is key to addressing the issues. And there’s the rub. Try and generate a list of famous and iconic nurses and you almost inevitably go back a long way in time – Florence Nightingale, Mary Seacole, Edith Cavell and so on, even my favourite, Virginia Henderson, whose legacy in terms of influencing contemporary nurse education and practice, is unlikely to be known outside of the profession. If one tries to identify male role models it becomes even harder. My 2 favourites are Walt Whitman and Phil Barker – but again, with the exception of poetry lovers, these are names that are unlikely to be  known outside the profession. 

Whilst social media is helping, the emergent nurse leaders of today, (and there are many to be found in the world of Twitter, Facebook and so on), don’t have the wider recognition that someone like Amy Johnson did all that time ago. It’s a challenge, and one that all members of the workforce, men and women need to rise to if we are ever going to change things. 

Sunday, 27 August 2017

Little things can make the world a brighter and better place

I had 24 hour power outage last week. The trip switch at the main fuse box would not reset, even with all the appliances unplugged. It was immensely frustrating. For me it was the little things that were the most frustrating, like not being able to flick a switch to boil the kettle for a cup of coffee, or washing in cold water as the boiler was out. I managed to find an electrician. He was very busy but he gave me a guaranteed time of arrival of 18.00. Thankfully he turned up and with just one small screwdriver (and I expect many years of experience and knowledge) found the problem. It was a trapped wire in the ceiling rose of the kitchen light, disturbed when I had changed a bulb. 

It was hard to believe that such a little thing could result in such a frustrating problem. There was an upside to the day though. As my lap top, iPad, and phone all needed charging, and the electrician wasn't arriving until 18.00, I decided to go for a walk – the sun was shining and I managed a 21km walk across some beautiful Lancashire countryside. Regular readers of this blog will know that I #WalkEveryDay, and for 99% of the time achieve the World Health Organisation recommended 150 hours of physical activity a week (for me, 10,000 steps a day). I find walking suits me better than running, but its good to know an increasing number of people have taken up jogging, park runs and so on. 

However, as Public Health England (PHE) reported last week, many middle aged people are becoming less active. Overall the population is 20% less active now than in the 1960s. PHE estimated that 4 out of every 10 people aged 40 – 60 do not even manage to have 1 brisk walk each month. The evidence now strongly supports the link between exercise such as walking and the impact on our health. Just a 10 minute brisk walk a day can reduce the risk of an early death by 15% - 1 in 6 deaths can be linked to inactivity. A brisk walk is generally accepted as being just under 5kph, which most people can easily achieve.

In encouraging more people to take this small step in improving their health PHE launched a new free app – Active 10 – which can both monitor the amount of brisk walking someone does and provides lots of tips on how such activity can be ‘incorporated’ into our daily routines. In this way the 10 mins walking doesn’t become an additional thing to do. Of course 10 mins brisk walking won’t on its own enable people to achieve the WHO target of 150 hours of physical activity a week, but it will be enough to start to make a difference to those with high blood pressure, diabetes, weight issues, depression and anxiety. For men and women of my age, walking also reduces the risk of hip fractures! Whilst I tend to mainly walk with Cello (my dog), all the grandchildren love walking as well – so when they get to join in their health and wellbeing benefits as well.

Exercise such as walking has also been shown to increase the level of BDNF, (brain-derived neurotrophic factor). BDNF is a key neurotrophin protein which helps to preserve the health of existing neurons and synapses, and create new ones. In the brain, BDNF is most active in the hippocampus, cortex and forebrain, all of which are areas crucial to learning, memory and higher thinking. So last week I was hoping that my walking had increased my BDNF levels as I wanted to participate in the Narrative magazines 6 word story challenge. 

Also launched last week, the challenge reflects Ernest Hemingway’s creation of the six-word story. These combine poetry and drama into a short form, which has grown in popularity despite it being difficult to achieve. Hemingway’s most famous 6-word story is possibly: Baby shoes for sale, never worn – I also liked the Booker Prize winner, Margaret Atwood’s 6-word story: Longed for him. Got him. S**t. Anyway, despite all my walking, I don’t think my BDNF level was increased sufficiently to match Hemingway and Atwood’s efforts. 

Given the black place I have found myself in over the past couple of months, I thought this 6-word story might be apt: I’ve low serotonin levels; very depressing – interestingly, the medication I have been taking for my depression comes in the form of tiny white tablets, but my goodness they have made a difference. If you are interested in the 6-word story challenge, please free to send your suggestions to me, and/or to the Narrative magazine challenge, which can be found here.

Sunday, 20 August 2017

Dressing down in a dressing gown – the naked truth

Early one morning last week I was out walking with Cello. The sun hadn’t yet got round to warming things up and it felt like winter had arrived. I was in a world of my own thinking about the day ahead. Out of the corner of my eye I saw someone coming out of their cottage, cross the road and root around in their car boot. As I got closer I could see it was a female and she was still wearing her pyjamas. She didn’t seem the least embarrassed to see me and even said good morning as she went back inside her house. I on the other hand, felt like some kind of inadvertent voyeur, and did feel strangely embarrassed.

I don’t know why, but then again I'm not alone. I recalled the public debate on social media last year when a chap called Chris Cooke posted a picture of two women shopping in the Salford Tesco’s and complained loudly that Tesco should ban anyone dressed as such in their pyjamas and dressing gowns. As far as I know Tesco have not actively enforced the ban that it introduced in 2010. They were later than the UAE, who banned the wearing of bed wear to work in 2006. Back in the UK, the Daily Mail, a paper dedicated to protecting our morality and our human rights, sent out two of their female reporters in their pyjamas to see where they could get into and where they might be barred. The Houses of Parliament were no problem, nor Harrods, The Ritz, the National Gallery or even Pret a Manger – all of which let them come in and go about their business.

The issue divided the UK into two groups - with one group seeing the dressing down in pyjamas as indicative of people’s slovenliness, laziness and disrespect for others, whilst the other side saw the fun side, talked about free choice and welcomed the new fashion fad. Nigella Lawson admitted to enjoying all-day pyjama parties and former Conservative Prime Minister, David Cameron admitted he liked to lounge around in his pyjamas, if working from home. I think I side with the fun loving group as do two of my grandsons who like nothing more than to get changed into ‘onesies’ and playing outside in them, and yes, going shopping in them to Tesco’s.

However, whilst increasingly pyjamas might be our favourite item of clothing, perversely actually sleeping in pyjamas (the reason we have pyjamas) is actually bad for our health. Now I have, in fairness at this point, to declare a personal interest – I haven’t worn pyjamas since I was 11 years old, and the last time was when I was admitted to hospital to have my appendix removed. I feel somewhat alone in my naked sleep mode. According to the American Academy of Sleep 92% of people globally go to bed wearing pyjamas.

Thankfully the science is with me. Research suggests that our bodies are designed to cool down while we sleep – wearing pyjamas can actually keep us to warm, which for many people will disrupt their sleep cycle. Those who sleep naked have better diets and increased happiness levels – and also due to released hormones naked sleepers can wake up feeling sexier. Feeling sexier aside, there are a number of surprisingly important public health issues to think about when it comes to deciding what you might wear in bed.

Generally, it is better to let what my Mother might call the ‘nether regions’ or ‘down there’ to breathe in order to prevent bacteria from gathering. Men who have liberated themselves from wearing pyjamas, but still want to wear something (underwear) are more at risk than women, (but for different reasons). Whilst a cool body at night helps keep blood pressure regulated, the prevailing perception is that men who wear tightly fitting pyjamas and/or underwear at night have a heightened risk of their fertility being affected. For women, the potential problems of wearing pyjamas to bed are more to do with the possibilities of yeast-borne infections – but it has to be said the risk to most women is very low.

I think that given the word pyjama has been around since 1800 (taken from the Urdu pay-jama) as a fashion statement, public health issue, and/or a way of expressing our sexual being, we might still have some way to go!  

Sunday, 13 August 2017

In my dream world there would be no if’s or butts!

Where do ideas for writing come from. I've read some really good blogs in the last few months from my friends in the #earlyrisersclub – often taking an idea or a thought and using these to explore their own sense of self and place in the world. My approach to both my blog writing and paper writing also tends to be a result of something I've read, or a conversation I've been part of (or overheard), or I have seen something that sets off a train of thought. I often don’t know what it is I'm going to write or how I want to try and say something until I put fingers to the keyboard. This week it was different. This week I had a dream.

In his most significant work, The Interpretation of Dreams, Freud described dreams as being ‘the Royal Road to the Unconscious’ - a way to unlock the information held there. Information in the unconscious is often disturbing, and it is held in check by the preconscious so that it cannot be passed into the conscious mind without being first of all altered. Although at originally Freud described dreams as being a form of ‘wish fulfilment’ in his later work he moved away from this position.

I am not sure how my dream would have been interpreted by Freud, but he was into the detail of peoples dreams and would often ask them to describe such detail in his analysis. It was one of the details that sparked the stream of consciousness that is this blog. My dream saw me attending a play (in New York) that started off in a ‘Smokey Joe’ type cafĂ©, and which as the play progressed was slowly transformed into a modern chic wine bar. As the audience applauded the end of the play, the whole wine bar rose into the air, and in a moment we were all flying across the New York skyline. 

In my dream I was delighted and poured another glass of red, reaching into my jacket pocket to pull out a cigar, which upon lighting up, brought a sense of contentment and happiness. At this point I awoke from the dream to find myself still in bed with an almost full moon shining in the night sky.  

I have no idea what the dream might have meant – (and vivid dreams are a possible side effect of the medication I am taking) – but it was the smoking of the cigar that held my attention. I once was a smoker, and smoked French cigarettes and French cigars, the latter much more habitually. One day I decided enough was enough and stopped smoking overnight. That was a long time ago now and whilst I no longer hanker after a cigarette, I do sometimes fancy having a cigar. But I have resisted the temptation now for some 12 years.

As regular readers of this blog know, I am very much opposed to smoking in any form. In the UK, over 100,000 people a year die from a preventable illness that is attributable to smoking. Yet there are still nearly 8 million people in the UK who continue to smoke. Men on average, smoke 12 cigarettes a day (compared to 11 for women) which shows a continuing and welcome decline in the rate of smoking. However there has been a corresponding rise in the number of people using e-cigarettes. Often it is smokers trying to give up. However, and perhaps more worryingly, is that information that people aged 16 -24 years of age are among those most likely to have taken up e-cigarette smoking, and 20% will progress to smoking tobacco. 

To put this into perspective, way back in 1974 almost 50% of all adults in the UK smoked, with one in two smokers dying from a smoking related disease. However, smoking is still the biggest cause of early preventable death. So maybe some readers might find it surprising to have included Freud in a blog that talks about not smoking. He regularly smoked at least 20 cigars a day – and said ‘that smoking was one of the greatest and cheapest enjoyments in life’ - we now know that is not true. For me I dream of a day when tobacco is no longer available because we recognise it kills. Now that would be an enjoyable thought! 

Sunday, 6 August 2017

It’s a dickens of a story: A Tale of Two Christies

One of the things I have on my to do list is to visit the Edinburgh Festival. Despite spending half my time in the North West of England and the other half in Scotland, I have yet to get to the festival. I was reminded of this last week as the festival started on Friday (4th August). Although it runs through until the 28th of August, for much of that time I am back in the North West of England - I have, however, been to the Glyndebourne Festival, and strangely there is a connection.

John Christie, was an English landowner and founder of the Glyndebourne festival which was held at his house in Sussex. If you not been and have the opportunity to go, I can recommend it – it’s a chance to dress up (evening wear is the dress code) and picnic in wonderful surroundings and listen to fabulous music and opera. John Christie fell in love with one Audrey Mildmay, a Canadian soprano. He was smitten. When Audrey went down with appendicitis and had her appendix out, he declared his was troubling him too and had his removed at the same time. Despite their age difference, she was some 8 years younger than he was, they eventually married. Together they set up a wonderful musical legacy that from its inception in 1934, still receives international acclaim.

In 1947, the very first Edinburgh Festival was held. The idea was conceived by one Rudolf Bing, who at the time was the manager of the Glyndebourne Opera Festival. With the help of both John Christie and in particular, his wife Audrey, and Harvey Wood, Head of the British Council in Scotland, the idea was brought to life. Ever since for 3 weeks in August the festival brings top class performers of music, theatre opera and dance from around the world to show their talent. The Fringe Festival has been going just as long and this allows aspiring performers to have a stage and create a new audience. Both national institutions Glyndebourne, and the Edinburgh Festival, are recognised the world over for the high quality performances they showcase.

Back in Manchester there is another national institution that also has an international reputation for excellence. This is The Christie, a hospital specialising in treating and researching cancer. The hospital was originally supported by a wealthy industrialist by the name of Joseph Whitworth (engineer, inventor and philanthropist). He died in 1887, and left large sums of (£500,000 equivalent to £60,000,000 today) to 3 trustees, one of whom was Richard Christie. Who as far as I can find out, was no relation to the John Christie above.

In 1892 some of this money was used to build a Cancer Pavilion and Home for Incurables. It was the only hospital outside of London that specialised in cancer treatment only. In 1901 it was renamed the Christie Hospital in honour of Richard Christie and his wife Mary who had done so much to establish the hospital. Richard Christie was an interesting person in his own right. A professor of history and then political economy, he used some £50000 (equivalent to £5,900,000 in today’s money) to build the beautiful Whitworth Hall (now part of the University of Manchester campus). He also left some 15,000 books, many of which were first editions, to what is now the John Ryland’s Library.

The Christie is the largest single site hospital in Europe for the treatment of cancer. It sees some 44,000 patients a year. The hospital employs 2500 members of staff, who are supported by over 300 volunteers. It is one of the largest hospital charities in the UK. Like Glyndebourne and Edinburgh festivals the work of Christie is excellent and world renowned. The hospital I have a connection with proudly entered into a partnership with The Christie and Macmillan to establish a chemotherapy and treatment centre at the Wrightinton, Wigan and Leigh NHS Trust. It opened its doors to patients in 2015. For the patients of Wigan needing chemotherapy, the centre means they avoid a 60 mile round trip to the Christie for their treatment, which in terms of improving patient care, is absolutely music to my ears!  

Sunday, 30 July 2017

Planting 'idea seeds' for improving mental health care

Once upon a time I would read every one of Roy Lilley’s blog postings. He is a very insightful commentator on health and social care in the UK. He is a very successful leader, educationalist and a great public speaker, and he is much in demand. I think over the past few months, as the Black Dog of depression began to be my companion I got out of the habit of regularly reading his work. I began to find the somewhat acerbic and negative narrative, often aimed at politicians and health service managers, wearying. However, I am sure my decision was influenced by where I found myself in the world, not really a consequence of Roy’s writing, which is much admired by many.

One of whom is Warren Heppolette. He is the Executive Lead for Strategy and System Development at the Greater Manchester Health and Social Care Partnership (GMHSC). It is the GMHSC Partnership, made up of NHS Organisations and Councils, that is leading the £6 billion devolution of health and social care budgets in making a difference to health and wellbeing in the city and region. They are doing a great job and are moving at a pace – and are starting to provide some excellent examples of what integrated care and population health could look like.

So when someone like Warren tweets that he thought one of Roy’s blogs last week was one of the best he’s read, I was compelled to have a look, and I am glad I did! The blog dealt with a mental health service in Grimsby. It was something Roy had experienced through visiting a garden centre run by the mental health service. Without wishing to sound disrespectful, I don’t think I would ever have associated Grimsby with innovation, but what Roy described was the hugely innovative and creative work of a social enterprise called NAViGO:

They own apartments, create communities, and piece by piece, carefully reassemble the components of shattered lives and glue them together with skills, care, attention and tuff-love… …the acute team is the community team, is the crisis team. I couldn’t tell who was health and who was social care, who were staff, clients, partners and people working towards recovery… …services entwined with people’s lives, families, hopes and futures. And it works.’

Like Warren, I was also impressed with the description of how this service has developed. Many years ago, we had some folks from the precursor to the NAViGO service visit the University and it was possible even then to see what an exciting journey the service providers, carers and service users were on. That Warren recognised the importance of this work was also good to see, particularly as on Friday he published the GMHSC plans for the Transformation of Mental Health Service: Next Steps.

This document sets out the plans to make a £134 million pound investment in not only meeting the national mental health care targets, but in so doing, also look at new and innovative ways of improving the mental wellbeing and resilience of the GM communities. There are plans to ensure that physical and mental health programmes and approaches are to be more closely integrated – and with Olympic Gold Medalist Chris Boardman being appointed as the GM Cycling and Walking tsar (Commissioner), I have great hopes that we can do something differently.

Effective 24 hour access to help and support for children, young people and adults requiring immediate care and treatment are planned, as are improvements to the early intervention service provision. All of which will ensure that every £1 spent in prevention and early intervention will save £15 in the provision of ongoing health service costs for people experiencing mental health problems. Likewise, improvements to mental health care in the criminal justice system, particularly for those in prisons are outlined. 

It is a great document, full of hope and determination. Although the report doesn’t specifically mention gardens, or horticultural therapy, care farms or anything remotely similar I am confident that my colleagues at the University will ensure these approaches are included in taking forward the GM mental health transformational plans for the future. So thank you Roy, thank you Warren for show-casing what (if we want it), could be a bright new future for mental health care in the UK.   

Sunday, 23 July 2017

Missing in Action; and Missing the Action

Last week there were a number of places I should have been at, people I should have seen, conversations I should have had, and hands I should have held. It wasn’t a good week for me, and possibly, for others too. It was a week of poignancy and pain as well as some goodness. Last week was graduation week at the University of Salford. As long standing readers of this blog will know, when I was Head of School and then latterly a Dean, Graduation Day was both my nemesis and one of my greatest pleasures each year. It was always great to celebrate the success of our students, meet their family’s and wish them well on the next stage of their life journey.

This was me some 39 years ago (ringed in yellow) ‘graduating’ as a qualified nurse in Swansea. I was so proud to have survived the course, which unlike today, was not a graduate level programme. The ceremony back then was a very different affair from the graduation ceremonies that I have been part of over the last 11 years. I love being on the stage and the little boy in me likes dressing up. The pomp and tradition, the seriousness and celebration were tangible acknowledgements of the achievement every person gaining their degree has made. What I dreaded about the day was trying to pronounce the names of some of our students. I just found it so difficult to get my tongue around some of the pronunciations, despite hours of practice.

However, despite my tendency to mangle some people’s names, it always felt like a real honour to present the names of the students as they each received their award. My current role in the University has taken me away from this, and it is something I have really missed. Last year I had a kind of ‘walk on part’. As a member of the University Council I was asked to talk about the work of the Council and the Councils contribution to the future development of the University. It wasn’t quite the same. And this year I didn’t get to be part of any of the ceremonies at all.

Being part of celebration of the students success was a wonderful experience to share. But I guess inevitably, it was those students who I had the closest and most sustained relationship with that made my heart beat with pride for them at graduation. Most often these were my PhD students. This year 2 students, Duaa and Seham, both from Saudi Arabia, completed and were able to graduate. They had their struggles over their time with the University, but both eventually did very well. Seham, whose work looked at the stigmatising views and attitudes of mental health professionals held against the very people they should be caring for, was both courageous and powerful. She has already gained an influential position back in Saudi, and I am very confident that she will make a difference to their future mental health care services.

Due to poor timing, another of my students Ibrahim, also from Saudi, had his PhD viva last week, and got through with just minor corrections to attend to. I missed the viva and being there with him, a role carried out so well by my co-supervisor Celia. Ibrahim's work looked at the impact of total quality management approaches to the improvement of health services in Saudi. Again it was a very interesting piece of work that revealed the difficulties that many health service systems have in both measuring and improving the quality of care provided.

In the UK it is the Care Quality Commission (CQC) who are charged with both measuring the quality of care provided and recognising where services are outstanding or simply unacceptable. To me, the CQC have an almost impossible task, and arguably whilst some poor practices are picked up and addressed, the approach remains imprecise and challenged by the human element of the assessors. They are not my favourite group of people, and I say that from the qualified position of being on both sides of the quality assurance table.

I was reminded of this last week as my brother-in-law David became a patient at a local hospital – North Manchester General Hospital. In 2016, the CQC judged this hospital overall to be ‘inadequate’. This was a damming judgement of the services provided, see here for the full report. The reports ‘inadequate’ outcome prompted a neighbouring and ‘outstanding’ NHS Trust to take responsibility for bringing about improvement. The work is ongoing. One of the things I think the CQC often gets wrong, is that they miss the individual experience of patients. David’s care was exemplary. It was provided by knowledgeable health care professionals, who demonstrated their care in the most compassionate of ways. Yes there were issues (noise at night; ward transfers and so on) but overall he was treated as I would want to be treated. 

Sadly, after just a week of receiving treatment, David died in the early hours of Friday morning. I wasn’t there, but his wife and son were. They were treated with respect and dignity and when W got there shortly after his death, the nurses made the time to support and comfort the family. David was a larger than life man – in all senses of the word. He looked after his 2 sisters (Glenda and W) all his life, and his son and 2 grandchildren were the apple of his eye. The love of his life was his wife Jenny, someone he would have done anything for. David will be very much missed, and although his sudden and unexpected death is a great shock, I am glad at the end of his life he didn’t suffer, and proud that that the care he received from the NHS was absolutely outstanding. 

Sunday, 16 July 2017

Depression and Duvet Days

Last week I finally managed to meet up with friend and long term collaborator Sue. We has been trying (somewhat unsuccessfully) to meet for the best part of 6 weeks, and it was so good to finally find a space to spend some quality time together. We have been writing and publishing for some 17 years, and we have relished getting our thoughts and ideas out there, editing books, writing papers, and of course presenting at conferences. It’s been great fun and I think together we have made a difference – I also like to think that we have also helped many others start their academic journey.

For some people, presenting their research, or their thoughts to a conference audience is a somewhat daunting experience. This is particularly the case for early career academics and practitioners, many of who, often feeling that nobody will be interested in hearing what it is they do in their day job. As Roy Lilly has so successfully demonstrated, so often what might be felt as being ordinary in the provision of health care can, and very often is, quite extraordinary. Whilst getting your words in print can be very satisfying, these days with more opportunities to put your thoughts out there and sometimes to a larger readership, my publication rate has slowed right down. However, I have always enjoyed the conference presentations, and Sue and I have presented over 90 conference papers between us over the last 17 years.

We both share a love of surreal images, and often our presentations contain very little words, just thought provoking images we use as cues to the paper being presented. It’s been our experience that people appear to become more engaged in what is being said, and tend to remember more of the paper than when the ubiquitous PowerPoint is used. I have never been nervous or anxious about presenting and very much enjoy being on the stage whatever the number of people in the audience, or the venue.

So I have been very surprised to have recently started to experience anxiety or panic attacks on fairly regular basis. It took me a while to recognise what these were and what was happening. I had described the feeling as being faced with utter desolation to my doctor, a feeling that happened mostly in the morning. I would wake up and everything would feel fine, I might even send out a few tweets, particularly to the #earlyrisersclub but then very soon I would be consumed a combination of physical sensations: hot flushes, sweating, pounding heart, pins and needles and psychological sensations: racing thoughts and thinking about the same situation over and over again, a sense of dread, feeling restless, and tense. In the UK 1 in 10 people will experience a panic attack, and  5% of the UK population experience anxiety attacks, and it affects twice as many women as men.

My response to these feelings and sensations was to pull the duvet over my head in an attempt to block everything out. Which of course didn’t work at all. Usually after about 10 minutes these sensations would begin to ease leaving me feeling very down and uneasy for a couple of hours. Eventually my mood would lift somewhat. It was only when I wrote the feelings and sensations down after one of these episodes that I realised it was an anxiety attack I was experiencing. There are a number of powerful stresses in my life currently, resulting as some readers might know, in a current state of depression.   

Thankfully, just as when I confirmed that diagnosis with my GP and could start to receive treatment, realising I was experiencing anxiety attacks has allowed me to start to deal with them, and begin to address the stress that lies at the root cause of the anxiety. Not bad for a Professor of mental health care. And I think there must be a paper to be written here and a conference to find where it could be presented!

Sunday, 9 July 2017

For some it will never be the ‘Darling Buds of May’

In 1892 the High Rid Reservoir was constructed as part of the need to supply water to the cotton industry and the local population. It lies just some 3 miles outside of Bolton, which in 1838 was the second town to be incorporated under the Municipal Corporations Act, and did so 12 days before Manchester, that other somewhat famous North West place did… ...just saying. High Rid is some 7500 steps (5.3Km) from my Bolton House front door and back, and it is one of my favourite walks. Last week on my walks I saw new generations of ducklings in abundance, the Sun had Her hat on most mornings, and as Cello and I walked, we were accompanied by dancing damsel flies weaving their intricate patterns along our pathway.

Walks around High Rid last week were also punctuated by the shrieks, screams, shouts and laughter of children having fun on the water. The owners of High Rid, United Utilities, allow Bolton Council to run a range of activities for children and young people – including canoeing, kayaking, raft building, sailing, in fact all water sports other than swimming. It was great to see the children having fun, doing something physical, outside and being in the company of other children, all of which is good for the physical development and emotional well-being. One of my neighbour’s sons attended such a session last week and he was so excited to have the opportunity, and he loved it.

However, there were a number of stories last week which didn’t paint such a rosy picture. The one that stayed upper most in my mind was a series of reports from the Children’s Commissionerfor England. The reports draw on data and information held by a range of government departments, agencies and third sector organisations. The reports make for a very hard read and present some very shocking statistics about the number of children in England living in vulnerable situations. The reports contain a huge amount of granular detail, too much for this blog. However, some of this information I found staggering, and I regularly read up on the research in these areas.

What I was aware of was that children and young people make up nearly 25% of the population. 40% of all primary care activity relates to this group. Nearly 3 million children aged between 0-17 are in contact with tier 1–3 child and adolescent mental health services each year. Such services include GP (primary care), services in schools and some specialised services. Of these 15% have a long term condition, 6% have a disability, and that 50% of all mental health problems in adulthood start by the age of 14. 50,000 children experience child abuse each year. Over 500,000 children are so vulnerable that the State has to step in with nearly a 1000 children being cared for within the criminal justice system and in secure accommodation of some sort. Some 60,000 children go missing each year and nearly 50,000 children aged 10-17 are involved in gang related activity. And there are 700,000 young people who are carers. All of which is what has been reported. The real statistics might be much higher of course as much of this activity happens ‘under the radar’.

What I didn’t know was nearly a third of children aged up to 5 years of age have significant tooth decay problems, or that there were some 46.000 emergency admissions for children with lower respiratory tract infections,  or that  some 130,000 young people between  ages of 15–24  were tested positive for Chlamydia  - and generally for children 15 and above, they seemed to be in a high risk group, with some 20% of those engaging with risky behaviours including smoking, drinking, poor diet and poor physical activity. There were over a 100,000 hospital admission due to unintentional and deliberate injuries in children aged 0–14, nearly 50% of which were aged 0–4. In addition there were some 50,000 admissions following self-harm in children and young people aged 10-24. Nearly 12,000 children had parents receiving drug treatment, and 15,400, children where parents were receiving treatment for alcohol abuse.   

The disturbing statistics go on and on – sadly. As a Father of 5 children, and now 10 grandchildren I felt humbled and ashamed in reading these reports. More so as I come from a generation that openly declared we would not bring our children up as our parents did. I love my parents, but in many ways I think I am very different to them. But they loved, cared for me and they did so unconditionally throughout my childhood, and continue to do so now albeit some 60 years later. And if asked, I hope my children will say the same about me.

Sunday, 2 July 2017

A stroll down a Welsh memory lane

In June 1984 I left Wales to start a new life in the North West of England, Manchester to be precise. I have been here ever since. I had trained as a nurse in Swansea, but lived in a little village called Pumpsaint, some 40 miles away. In those days the hour long journey was through the Welsh hills and valleys almost until you got to Swansea. Most of the time this was a journey that helped prepare me for the day, or provided time and space at the end of the day when coming home.

I had a little small holding in Pumpsaint, keeping a herd of milking goats, a small flock of Jacob sheep, chickens, ducks, geese, and even peafowl. I grew all the family vegetables, made goats cheese, brewed beer and wine and baked homemade bread. I fattened turkeys to sell at Christmas, and worked in the forest cutting down Christmas trees to sell. Four of my 5 children were born there, learning Welsh in a small village School. For a short period after gaining my qualification as a nurse and starting to practice I worked in a local agricultural blacksmiths, a place where the work included shoeing horses to repairing huge bulldozer blades and everything in between.

I eventually went back to work as a nurse in the local hospital, Allt-Y-Mynydd. This was a small hospital for people with learning disabilities, and it was a great time to be working in this area. At a policy level, the all Wales community care initiative was being enacted and this was aimed at moving all of the people receiving care for learning disabilities into assisted independent, community based care environments.

Allt-Y-Mynydd hospital was an old sanatorium, perched on top of a hill in the midst of the Brechfa forest. The hospital was just outside a village called Llanbydder, famous for its horse fairs, and where once there was a connection to the Manchester and Milford Railway! I joined as a staff nurse, but quickly gained promotion as Charge Nurse, an achievement marked by my not having the Learning Disability qualification, and only being on the register as Mental Health Nurse. However, I had an absolute conviction that we could carry out the policy and make a difference to the lives of the residents. 

Allt-Y-Mnynydd Hopsital is still there, now a tastefully modernised care home, and almost unrecognisable in terms of the facilities and the care provided. During my time in the hospital we very successfully prepared, moved and supported most of the residents out in to local community based homes. I was reminded of these memories as last week was Learning Disability week, 2017. There are some 1.4 million people with a learning disability in the UK, nearly 200,000 of whom, are children of school age.

Whilst it was great to hear so many very positive stories about learning disability services and in particular social care services, last week also saw the publication of a report on research undertaken by researchers at the University of Lancaster. It has a snappy title ‘A Trade in People: The inpatient healthcare economy for people with learning disabilities and/or Autism Spectrum Disorder’, but the findings were rather grim. It found that many people with learning disabilities had become commodities in a health care industry driven by profits. It seems the UK government spent some £477m last year on keeping just 2500 people in hospital with more than 50% of these beds being provided by the private sector. It is a trend that is growing. 

The consequence of this approach is that often individuals can be placed in geographical locations many miles away from their family home with families facing long and expensive journeys in order to maintain contact with their son or daughter. Sadly, those detained in private care services are also more likely to experience an assault and be restrained compared to those receiving care in a NHS unit. The report also found that that the cost of a care package (similar to those we put in place all those years ago in Wales) to move people back into their community could be prohibitively expensive for local authorities to contemplate – thus perpetuating the problem. It is such a sad indictment that some 33 years after my time in Wales we are still treating people in this way. 

Sunday, 25 June 2017

A pervasive persuasion: the need to protect our children in a digital age

Last Sunday was Father’s Day here in the UK. It is day used to celebrate Fathers that has its origins in the Middle Ages, when it was then celebrated in March. About 100 years ago many countries, including the UK adopted the current June date, made popular in the US.  For the first time in many years I celebrated the day with just W and myself at the House in Scotland. However, the children had sent gifts and cards, one of which was a rather splendid cockerel. Carved out of wood, with bicycle cogs for tail feathers and comb and bicycle chains for wings. These were all parts from my son-in-law Stewart’s bike, a bike that had travelled some 2500 miles in the last 12 months. The cockerel is a thing of beauty, and Stewart was the surprising artist!

Of course these days geographical distance is not a problem for staying in touch with others, and on Father’s Day I was able to Skype, Facetime and speak over the phone with family. I could also do all of this on my new phone, an iPhone, the first one I had ever owned. It was a great to discover that I could replicate everything I had been doing on my iPad on this phone. So I got it set up with emails, Twitter, Skype and so on and all was well. That is until one of my friends persuaded me to down load WhatsApp – an encrypted messaging service. I had never used it before and didn’t know that I would use it – but I was persuaded to get the app.

What I also discovered was that apart from using the phone as set up in the shop everything else, including downloading apps required an Apple ID and Password. Whilst I had one of these from years ago when I invested a great deal of time uploading my entire CD collection onto iTunes, I hadn’t used it for years. And as soon as I did I realised why. Suddenly I was up in the cloud, with demands for access codes to all my devices and generally getting twisted into knots of security and instructions and all for something I didn’t really want in the first place. Eventually it was installed and I sent out a WhatsApp message to my WhatsApp contacts – but I’ve heard nothing since.

I think I must be missing something as whilst Facebook (WhatsApp’s parent company) remains the most widely used social media service, WhatsApp is said to be becoming one of the most popular ways people both discover and discuss news. I’m from that generation that still goes to the BBC for my news, albeit more often than not, to BBC on-line. It’s amazing to note that it was only 50 years ago, in the June of 1967, that the Beatles performed ‘All you need is Love’ live on the BBC’s first live global broadcast! Many young people today shun the BBC (as being untrustworthy and biased in their reporting), preferring to use other services like WhatsApp to hear the news.

It’s perhaps easy to understand why. WhatsApp uses an end-to-end encryption approach which means messages can only be seen by the senders and recipients – crucial in countries where the political regimes monitor social media and where critical voices are often dealt with harshly. Social media increasingly gives those without a voice an opportunity to be heard, to articulate a point of view in ways unthinkable just a few years ago. We only have to look at the way the Labour Party very successfully harnessed social media in the recent general election to see how large numbers of the population can be reached, and given an opportunity to have their voice heard.

There are risks of course. In the UK, freedom of expression and the protection of our privacy over the internet is guaranteed by law. Some social media users abuse these rights and ‘troll’ others (sending menacing and or upsetting messages) and sometimes to such an extent that it can cause mental health problems and in some extreme cases, people ending their life through suicide. Children and young people are particularly vulnerable. The NSPCC reported that one in five 8 to 11 year olds and seven in ten 12 to 15 year olds has a social media profile. 1 in 4 children have reported experiencing something upsetting on a social networking site, and 1 in 3 children have been a victim of cyberbullying.

There were some 5653 child sex crimes committed against children in 2016/17 that had an on-line element. 13 was the most common age of the targeted children, and nearly 100 offences were committed against children 10 years and under. The Internet Watch Foundation, established in 1996, and now an independent international organisation which receives, assesses, and traces public complaints about on-line child sexual abuse content found over 57000 web sites containing child sexual abuse images. They access a webpage every 5 minutes, every 9 mins that webpage shows a child being sexually abused. In 1996, the UK hosted 18% of the world’s known online child sexual abuse material. Thanks to their work, and the commitment of major internet service providers, today the UK hosts just 0.2%. 

So I worry about encrypted services such as WhatsApp. It has some 1 billion users worldwide, and WhatsApp does have an image sharing facility. It is to be remembered that the Westminster bridge terror attacker, Khalid Masood, sent a WhatsApp message minutes before he attacked, an encrypted message that to this day cannot be accessed by the police and intelligence services. I’ve removed the WhatsApp application from my phone, a slightly puny protest I know, but I am from the generation that still goes to the BBC to learn about what’s happening and what’s up, not WhatsApp. 

Sunday, 18 June 2017

A quiet contemplation of the importance of hopes and dreams

Two of my favourite drinks couldn’t be more different. Lagavulin is a fine malt whisky from the Islay region of Scotland. It has an intense peaty smokey rich taste that is mellow and powerful on the nose and tongue. I’ve yet to taste the 37 year old, but the 16 year old and double matured malts are very, very good. My other favourite drink is the ‘widow champagne’, Veuve Clicquot, a champagne that dances on the tongue. Barbe-Nicole Clicquot Ponsardin, to give her full name, became a widow at the age of just 27. She took over her husband’s winemaking business and turned the ‘widow champagne’ into one of the worlds most successful ‘maisons de champagne’.

These are not drinks to be hurried in their drinking. If you want a flirty, quick fun drink, then maybe stick to pouring a glass or 2 of blended whisky or prosecco. Lagavulin and Veuve Clicquot need time, the right place and the right frame of mind to appreciate their flavours and the feelings that are evoked as each is sipped. They are drinks to contemplate with. They are drinks that can be shared with others in silence. No words needed, the quiet is welcomed, and it’s where dreams and thoughts can be shared in togetherness.

Difficult to do in our busy lives – which I guess is why we have blended whisky and prosecco. As regular readers of this blog will know, my life recently has not been quite as busy as it once was. I have lots more time in my waking day at present. Indeed, last week at my therapy session I was offered and accepted an acupuncture session. Laying on the couch, I’m sure that as every needle was inserted my mind and body slowed down a little further. When I was finally left alone, I felt so relaxed and at peace, and it was a feeling difficult to describe in words. It was a different type of contemplation time.

This experience was in absolute and total contrast to my feelings on waking up on Thursday morning to the news of the Grenfell fire in London. Again my feelings were also difficult to put into words. The absolute devastating impact of the fire on all those involved was and remains almost too much to comprehend. The loss of life, the injuries, all those who have now lost their homes, histories, and way of life, and their dreams of a future. Each of their personal and shared experiences I find so hard to understand and can’t even begin to know what such a loss must feel like. I watched with shame and hurt the accusations and recriminations so loudly being made, but I think I understood those who expressed their anger, hopelessness and frustration at what had happened. 

I watched with pride the magnificent response being made by communities around the tower block, and I am sure the authorities will do all that they can to find people new homes and provide financial support. Clearly many people, victims, professionals, and the communities they come from will need help in coming to terms with what has happened. And last week, as I sat on my mindfulness beach, I felt both impotent and sad that there was so little I could do to help those impacted by this tragedy. 

I have reached out in my thoughts and prayers, and instead of buying more Veuve Clicquot this week, I have sent the money to the Grenfell Fire relief fund – but this didn’t feel like much of a response to me. It felt very inadequate compared to the massive support I have received from friends and family over my recent mental health problems. Maybe there isn’t more I can do right now. I can keep those affected in my thoughts and prayers, and hope that in the future they will find the strength and have the opportunities to rebuild their dreams and lives. 

Sunday, 11 June 2017

Authenticity, passion and a ‘thing about chickens’

My fellow blogger Lynn reminded us in one of her recent tweets of Erving Goffman’s dramaturgical sociology and the way we choose to present our self – that is a sense of who one might be, often shaped by the time, place, and audience. In Goffman’s world, where the actor succeeds, the audience will view the actor as they might want to be viewed. Usually, such performances are carefully constructed, practiced and used with self-confidence. It is an approach, that in my professional life, I am very familiar and comfortable with.

I was reminded of this last week when a young man called Daniel, bounded up to me and smiling broadly said ‘Professor, good to see you’. He said I probably wouldn’t remember him, but he was one of my former students and that he had graduated in 2013 and was now working as a Charge Nurse in a local emergency care service. Now over the 10 years I was Dean of the School at the University, some 7000 nursing students passed through the School. Remembering individuals tended to happen only where someone had done something outstanding, or the reverse, they did something unprofessional that brought them to my attention.

However, Daniel had a very clear memory of me during his time at the University. He recalled that I always wore black, nobody had ever seen me in anything else, I had clogs of different colours which created urban myths amongst the students as to whether specific colours related to my mood or had some other significance, and that I had a ‘thing about chickens’. However the memory that struck a chord with me was his recollection of his very first day at University. On that first day I would always meet all the students to welcome them to the University and to their taking the first steps on their chosen professional journey.

Essentially I was performing on my stage. I talked about the possibilities and opportunities that lay in front of them; I talked about a number of people who had shaped my view of the world (Carl Rogers, unconditional positive regard for others; Virginia Henderson, understanding the nature of intrapersonal and interpersonal relationships – self, and self in relation to others; and Michel Foucault, the importance of both revealing and understanding the silenced voice). I had delivered various versions of this welcome speech many times, but for Daniel it was the first time. He told me how his memory was one shaped by feeling inspired, motivated, and reassured that he had made the right decision in coming to the School. He told me that his group thought I was authentic and passionate about enabling others to create a future for themselves. After 7 years of study and practice it was warming that he still retained such a positive memory of his first day at the University.

I met Daniel at a husting event leading up to the recent the general election. I had been supporting my friend and colleague Jane who was standing for the first time as a parliamentary candidate for the Conservatives. In the main my support and help involved undertaking policy analysis, trying to make what was a dreadful election manifesto more accessible, palatable and applicable to members of her community, developing daily messages and so on. All this work was undertaken in the context of Jane’s strong belief in being authentic and true to herself, even where this might give rise to challenges and tensions between her beliefs and what was set out in the Conservative manifesto – the official line! Although difficult at times to negotiate these tensions, it was relatively easy for me, from a distance to provide advice, possible comments and responses. 

The husting event was clearly different, and my friend would be very much on the stage. It was a bruising and hostile audience, largely made up of vocal and challenging Labour supporters. My friend did well in the face of much hostility. As a a performance it wasn’t one that was carefully constructed, practiced and used with self-confidence, but it was truly authentic and every response delivered with passion, and for me that what was important. Unfortunately, Jane did not get elected as the MP, but then the area hadn’t elected a Conservative MP for some 62 years – and against the national picture, she did double the votes, gaining nearly 30% of the vote and came a very respectful second. Staying true to one's self was and is important. Despite the disappointment I hope that with time, like Daniel, she holds some good memories of the opportunity she created. It was one she can be proud of and build authentically on, for the future.  

Sunday, 4 June 2017

Time for Bed, Zebedee said: asleep on the Magic Roundabout

Now my new car is full of digital marvels. It parks itself, it maintains a safe distance from cars around it, displays incoming emails, texts and even telephone message. Everything is voice activated and at night it lights up like a space ship. One of the things it does is to warn you when you stray over the white line in the middle of the road. The steering wheel tugs you back into lane, a series of warning beeps are sounded and it is both irritating and reassuring. If you happen to wander over the white line more than half a dozen times in quick succession – something difficult to avoid on the narrow country lanes up here in Scotland, the car tells me to pull over and take some rest!

Being told to take a nap by a car is one thing, when your body tells you it needs to sleep that is a different thing altogether. Some 15 days into my antidepressant therapy course, most of the early side effects (dizziness, nausea and so on) have faded. The one side effect that has remained has been an almost overwhelming need to lay down and sleep. I have never slept so much in any one day as I have over the past 15 days. It is strange, as I don’t feel constantly tired, but still find myself closing my eyes and drifting off. I am becoming like Cello, who can doze all day if not out running on the beach or in the woods.

Although my excess sleeping is a side effect of the medication, deep sleep therapy was once a very popular treatment for mental health problems, particularly during the 1930s and 1940s and then again during the 1950s and 1960s when in the UK it was used alongside ECT and medication. At that time ECT was a rather crude intervention and often terrified those being given it.  Using sleep therapy ECT could be administered and the patients seldom remembered this. Thankfully the practice largely fell into disuse as other more effective treatments were developed.

Imposed sleep is not without its risks. My PhD supervisor, the late and great Professor Joel Richman developed sepsis resulting in a 5 month stay in hospital, 7 weeks of which were spent in an induced coma in ICU. When he eventually ‘awoke’ he was for some time extremely paranoid, delusional, depressed and angry, often lashing out at those he loved and cherished. Being the great medial sociologist he was, Joel wrote up his experiences in a wonderful paper called Coming out of ICU Crazy: Dreams of Affliction – worth a read if you can gain access to it.

Anyway, and in a lighter vein, in-between naps, I did look at what was being said about sleep last week. It seems that many people are ‘under-sleeping’ by 60 mins every night, which is the equivalent of whole night’s sleep over a week (the average healthy sleep period is 7.7 hours a night). The Royal Society for Public Health found that people believed getting enough sleep was the 2nd most important activity for keeping themselves healthy – something that was behind not smoking, but in front of getting their 5-a-day, exercise and not drinking too much alcohol. They noted that a lack of sleep has resulted in 30% of people becoming depressed or stressed. The cause of not getting enough sleep can be complex and will often reflect life choices such as long commutes, parenting and socialising (late nights out). 

Somewhat ironically I guess, good sleep can be the result of people engaging in other healthy behaviours – those who eat healthily and get plenty of physical exercise often sleep better – and getting better sleep will often mean people are more likely to stick to those healthy behaviours. I’m sure my excess sleeping will begin to fade just as the other side effects have done – but as my friend and fellow blogger June told me last week, ‘keep taking the tablets’, which I fully intend to do. And finally if Cello could speak, I am sure he would say, ‘sleeping doesn’t make your dreams come true, waking up does’. So now this weeks blog has been posted, he and I are off out to explore the early morning sights and sounds of our beach.