Sharing the excitement and rewards of becoming and being a mental health nurse

Sometimes the most challenging and interesting facts come from the most unlikely of places. I’m not sure if the Office for National Statistics (ONS) is on your reading list or email alerts, but it is on mine. I find their audits and research fascinating. Last week was a case in point; the ONS released a whole load of data about how the lives of young people today differed from the lives of their parents and grandparents. You can read the full report here. It was interesting to see that while young people today travel the world more, lead healthier lives and use new technology in ways never dreamed of by their grandparents, they are more likely to still be living with their parents, more likely to be in debt and more likely to feel lonely. 

The latter point made me stop and think. We usually associate loneliness with the older generation. The ONS report notes that 16-24-year olds were almost three times more likely to feel lonely than those aged 65 or older. Those young people living in cities are more likely to be lonely compared to those who live in towns or villages. Something's for young people haven’t really changed though. They can legally undertake part-time paid work from the age of 13, at 16 they can consent to sexual activity and at 17 they can hold a driving licence. One area that has changed over the last 35 years is the age of criminal responsibility. Currently, in England, the age of criminal responsibility is 10 years old – no child under this age can be found guilty of a criminal offence. Up until 1998 there was a presumption that a child aged under the age of 14 did not know the difference between right or wrong and therefore they could not be capable of committing a criminal offence – a highly contested assertion.

I remember well the dreadful murder of James Bulger (aged 2), by John Venables and Robert Thompson (both aged 10) in 1993. I was working at what was then called Mental Health Services of Salford (now Greater Manchester Mental Health NHS Foundation Trust) as a Director of Corporate Development. I had just moved from being a Service Manager for the Regional Specialist Mental Health Services, which included the Adolescent Forensic Service (the Gardener Unit). The main child forensic consultant psychiatrist was one Sue Bailey (now Dame Sue Bailey). I had worked with her for a number of years, both in commissioning the original inpatient service, and as the Service Manager responsible for the total forensic services. 

At the time of the James Bulger case, Sue Bailey was also a Home Office forensic psychiatrist. She interviewed John Venables before his trial and at his trial testified that he unequivocally knew the difference between right and wrong. Both boys were convicted of James Bulger’s murder and sentenced to life imprisonment. It was a time of high expressed emotion by many on both sides of the innocent child versus child criminal divide. It was also an early excursion for me into the nature of evil, something I was later to pursue as part of my supervisory session with my PhD supervisor, the late and great Professor Joel Richman, see here.

I mention these events and memories as last week also saw the first ever Mental Health Nurses Day. The day was organised by the RCN Mental Health Forum, partly in response to the drop in numbers of those entering and staying in the profession. The NMC reported a fall in mental health nurses from 90,693 in 2014 to 88,821 in 2018. The day was aimed at ‘myth busting’ those issues that might stop people from entering the profession.  Much of the approach was to use social media to give a voice to those whose positive experience of becoming and being a mental health nurses might counter some of the more negative and lurid stories still to be found in many parts of the wider media reports of mental health services. It was an opportunity to really raise the profile of mental health nursing. 

Judging by the activity of Twitter (I didn’t look at other SoMe services), the day was a success. I posted a couple of tweets using the #mhnursesday2019 hashtag and was both inspired and comforted by the many tweets I read during the day. Like many of those who posted their stories, I had enjoyed a similar range of experiences. Unlike today’s young people, who on average leave the family home aged 23, I left when I was 16, was married and had my first daughter when I was 20. I ‘fell’ into nursing when it was a better tax position to be student nurse than a nursing assistant. I never looked back. I have worked in therapeutic communities, acute and community mental health services, older people’s services and forensic mental health care. I have been a practitioner, a manager, and more latterly in my career a mental health academic. As a mental health nurse academic, I have travelled the world, published many peer reviewed papers and presented my research at conferences as far apart as Australia, China, US, UK and much of continental Europe. 

It’s not always been a rosy experience – I worked hard and often made decisions about maintaining a healthy work-life balance that I’m not proud of and which may have hurt some of those I dearly loved. That said, would I do anything different? I don’t know if I would. Whilst today’s young people have a very different journey into adulthood than the one I experienced, I would recommend nursing as a career worth considering for anyone, and, mental health nursing is a fantastic place to really make a difference to the lives of others. I can guarantee it will make a positive difference to your life as well.

Crafting jobs for the future – Johnny Depp is an optional extra

It’s funny how sometimes our brains take a moment to recognise and make sense of what we are seeing or reading. Last Friday, I saw a tweet that showed a poster entitled The Pie Rates of the Caribbean. My first thought was there were no cheese and onion or vegetable pies on offer. My second thought was to compare the prices and wonder why they were different. It probably took me at least 10-15 seconds before the penny dropped and my brain registered the clever and witty paronomasia (pun). And when it did, I laughed out loud.

Which was good, as there weren’t many laughs to be had last week. Even ignoring the ever increasingly depressing spectre of life after Brexit, there were other concerns that were just as sobering. For example, on Tuesday I attended a half-day workshop on how the NHS Trust, where I’m a Non-Executive Director, could take the NHS Long Term Plan forward. I’m sure most readers of this blog will have read the 136 pages, and probably like me, have a copy by their bedside for quick and easy reference. So, I don’t need to tell you that the long-term plan is committed to improving community and primary care services, mental health care and services for children and young people. New service models are to be the norm with much more integration, both of health and social care organisations coming together to provide more joined-up care closer to people’s homes.

It’s all good stuff, and ambitions that nobody, health professionals and patients alike would want to argue about, except there are more patients than there are health professionals to provide care for them. Conservatively, it’s thought that across England there are 100,000 vacancies, many of them nurses and doctors, and these shortages are chronic and not easily resolved in the short term. It would also take a great deal of money, and although there is some new money, realistically it wouldn’t buy many steak and kidney pies in the Caribbean.  The health think tank - the Health Foundation - published a comprehensive review of the situation – see here – the report’s title, ‘A Critical Moment’ says it all. If you are looking for something to read that will cheer you up, steer clear of this report.

However, having been asked to read this report and the NHS long-term plan prior to the workshop, I arrived feeling quite at a loss as to how we might tackle the plan’s ambitions, with very little new money and the constant difficulties in recruiting and retaining staff. After the scene was set, we were taken through some of the approaches already in use across the Trust to promote a healthy and engaged workforce. Whilst there had been some notable successes, it was also true that the recent ‘pulse’ staff surveys had shown a downward trend in terms of satisfaction and happiness in the workplace. Many colleagues were tired and there had been an increase in the number of older experienced colleagues taking their pensions early. 

When we moved on to new initiatives and approaches, there was one stand-out idea that captured my imagination. It was something called ‘job crafting’. I had not really heard much about this approach before, and it sounded both a simple idea and a difficult one to implement. The idea comes from the same stable as ‘flexible’ and ‘agile’ working. With senior management buy in and support, organisations can implement job crafting for little or no extra cost, something to be welcomed by all concerned. At its simplest, job crafting allows individuals to alter their jobs in ways that better suit their skills and interests.  Job crafting doesn’t mean that folk can change everything about their job or get rid of necessary tasks, but it is a powerful motivator for staff engagement. 

Job crafting is simply a brilliant idea. For the individual, it can mean stronger connections with others in the organisation (and beyond), improved well-being, a reduction in stress and greater happiness (and happy workers are on average 12% more productive than unhappy workers).  Equally, employers benefit from high levels of staff engagement, and emotional commitment from the workforce, employees who are more productive and keener to seek out opportunities to grow personally and professionally. 

There is a very famous example of job crafting in the US, which involves the empowerment (I so dislike that word, but that is a subject for a different blog) of hospital cleaners. Starting off as a way of reaching out to women living with breast cancer, it became a national phenomenon in changing the relationships people have in the work place – see here. For the cleaners themselves, the validation of their ability to speak with and support patients moved them from seeing themselves as cleaners, to being part of the hospital’s team of healers. In this case pink gloves were involved, and readers of this blog might be just as familiar with the pink socks approach, see here. Keen-eyed readers will notice the name Eric Topol mentioned, he used his formidable Twitter following to promote the ideas behind the pink socks’ movement (he is also the author behind the recently published Topol report looking at the need to prepare NHS staff for a digital future) – it’s a small world, albeit there might be no cheese and onion pies in the Caribbean. 

Bad habits, smoking tales of everyday sexism

It’s been a while since I mentioned smoking in one of my blogs. I’m a reformed smoker, haven’t smoked for many years and I’m now a passionate anti-smoking campaigner. Smoking is the single largest preventable cause of death in the world. The latest data available estimates that there were 115,000 deaths attributed to smoking in the UK in 2015. This is about a fifth of all deaths. Smoking (and being exposed to cigarette smoke) causes three out of 20 cancer cases in the UK. Against this backdrop, it is good to know that the number of people who still smoke has steadily decreased since the 1970s, as has the number of cigarettes people smoke each day.

Not that we should be complacent. There are still too many people smoking tobacco. In the UK, it’s some 9.4 million people, nearly 19% of the population who still smoke cigarettes. From a public health point of view much has been done to help people quit. There is a great deal of help, information and advice available these days. Some of this is rather simple and I suspect wouldn’t help many folk wishing to give up - see this NHS website for example. Other sources are so complicated and data-rich that many non-professionals would simply give up reading - see the NHS England Smoking Cessation site for example. There are some sites that are aimed primarily at healthcare professionals, but which contain a wealth of useful information - see the RCN site for example (and I wasn’t aware of third-hand smoking problems). I think this is a great site, but I imagine that few non-nurses would read it.

Some of the smoking cessation campaign approaches haven’t always worked. Younger readers of this blog probably won’t remember the NHS 2007 campaign that used fishhooks. Here is one of the adverts used. It caused a great deal of controversy and eventually the campaign was dropped here in the UK (although a similar one was still being shown in Australia three years later). I used one of the images from the campaign in a poster I created to celebrate the 60th birthday of the NHS. The poster had 60 images, each representing the achievements and challenges the NHS faced over its 60 years of existence. 

In terms of smoking cessation campaigns, the fight goes on, but I was disappointed last week to see the latest smoking cessation campaign from the ‘Stop Smoking London’ organisation. It is a great initiative by the 31 combined London boroughs to get people to stop smoking. However, the positive message of ‘amazing things happen when you quit smoking’ is entirely spoiled by the everyday sexism of the images and associated messages. The posters, sporting images of men and women, have very different consequences for each gender – as one commentator put it: ‘MEN, give up smoking and you’ll be fitter and have more money’ ‘WOMEN, give up smoking and you’ll be more attractive.’  Have a look at the posters here and see what you think. 

Whilst not wishing to defend the campaign, according to ‘Stop Smoking London’ it has already sparked a lot of enquiries from people wanting to give up smoking. When one thinks that possibly the hardest part of stopping smoking is taking the decision to stop, and with a success rate of 50% of those who decide to stop smoking, who actually stop, every encouragement to do so must be helpful. However, there should be no reason to condone sexism, regardless of however unintended it might be.   

That wasn’t the only blatant everyday sexism in the news last week. JD Sports, the sports-fashion company with shops across the UK and around the world, including the US, Singapore, South Korea and Australia started off in a small shop in Bury, Greater Manchester. The seemed to have lost their way last week, with the launch of its range of the official Scotland Football kit. In the advertisements the men and boys were presented as athletes and posed in traditional poses, whereas the female model was featured wearing jeans with rips to the thighs and sitting with her legs apart. There was a massive social media campaign against this approach, both because of the blatant sexism of the images but also because JD Sports only featured boys and not children in their advertisement. The offending image has been taken down, but if you must see it, it can be found here in the Independent news coverage.

And if you want to find out more about the perniciousness nature of sexism in our society, you need to look no further than the regular column by Laura Bates in the Guardian newspaper. Laura is the founder of the ‘Everyday Sexism Project’, which is a collection of over 80,000 women’s daily experiences of gender inequality. I regularly dip in and are both humbled and encouraged by the stories I read. Writing back in 2017, Laura talked about the solidarity, sense of resistance and resilience found in the stories she receives, but she recognised that the problem remains immense. So, she believes, the will to fight it is greater still. There is no reason for everyday sexism or smoking. We must find ways of helping people stop both.