Developing Technologically Enabled Remote Access to Recovery Colleges: A Co-Production Workshop.

On Thursday 16th of March at the Digital Exchange in Little Germany, Bradford, the  Digital Health Exterprise Zone (@DHEZ) hosted a workshop that brought together clinicians, recovery college students, users of services and technology innovators to consider the challenges of making recovery college sessions available for ‘remote participation’.

Professor Allan Kellehear, Academic Director @DHEZ, welcomes the delegates and introduces them to the challenge in hand.

Recovery colleges are meant to be health education communities where people can learn together, from each other and with educators developing personalised ways of improving their mental health, well-being and ability to work with distress. They should also offer opportunities to reforge identity, gain purpose and hope, hone life-skills and as desired work-skills without the latter being the necessary main focus of attention.

Steve Williams (@mhnurselecturer) and the lead for the @UoBRecoveryColl introduces what Recovery Colleges are and what the simulated college workshop will entail.

So why ‘remote participation’? The idea here is to consider developing technologies that enable people attending recovery education or psychological health sessions to join in from home if on that day they simply can’t get into college because they haven’t got enough money for travel, or they feel too distressed mentally or physically or for whatever reason that comes along with what health services typically refer to as ‘drop-out’ or reasons for non-attendance. Lots of advantages and lots of problems come along with this idea of remote participation. We feel it’s worth addressing these to help tackle, amongst other things, the ‘drop-out’ issue.

Drop-out is a massive problem in all forms of psychological health care, whether that’s situated in health or education. For example the most recent IAPT (Improving Access to Psychological Therapies) figures for 2015-2016 (from April 2015 to March 2016)  indicate that 33.9% of referrals end before entering treatment and of those referrals 92.1% did not attend any type of appointment. IAPT is the service aimed at providing psychological therapies for people with anxiety and depression. There were in total 1,399,088 referrals which equates to 1, 179, 328 people because there are sometimes multiple referrals, people being referred from one IAPT service to another and also people being stepped up from a lower intensity to a higher intensity service. 58.7% of referrals did not complete the course of treatment and ended participation for a variety of reasons and what ‘ending the referral’ means in IAPT terms  includes- declining to start, being deemed not suitable for IAPT or starting but not continuing. Given that IAPT aims to reach as an initial goal only 15% of those with anxiety and depression who need ‘evidence-based treatment’ and has a target of 50% reaching ‘recovery’ multiple approaches to addressing the reasons why treatment ends or is patchy are clearly urgently required. Using technology is one possible approach that we are exploring at Bradford.

Our delegates view, in another room, what is going on in the College Simulation and grasp the difficulties of current technology in providing ‘remote participation’ first hand.

Having run the workshop on the day our delegates left having worked together to form the skeleton framework of potential solutions. Problems were identified and discussed and ways to overcome them from an operational and technical perspective were raised. We now have potential partners who encompass user-experience, clinical and educator experience and technology expertise. We are looking forward to them joining with us on the next step to exploring how feasible, safe, and effective remote participation can be as a strand of delivering mental health care and to those struggling to find it and attend in our current education and care provision.

And here’s an interesting 360 degree image from one of our technology colleagues (David Renton) who participated on the day:

Interesting workshop in Bradford on Innovative tech to support Mental Health #MVPBuzz #MIEExpert #theta360 – Spherical Image – RICOH THETA

The Five Year Forward View Mental Health Taskforce

The FYFV for MH: The Independant MH Taskforce Report.

Following the NHS Five Year Forward View (5YFV) published in October 2014 work has been under-way to implement this. We are told from the foreword of the original document that this Forward View represents the:

“…shared view of the NHS’ national leadership, and reflects an emerging consensus amongst patient groups, clinicians, local communities and frontline NHS leaders. It sets out a vision of a better NHS, the steps we should now take to get us there, and the actions we need from others.” (p.2).

Bold words. In some places putting my critical hat on highly improbable words I’d say. However putting all that aside I stepped forward to be part of the recent consultation for how the 5YFV might look for Mental Health in particular following the Mental Health Taskforce public engagement findings. This was held in Cambridge last week but for one reason or another I couldn’t make it on the day. So I added my tuppence via email having scrutinised the Taskforce documents and commentary from the other consultants. This is what I said. It speaks more to what was missing then what was present in the current plan for mental health. (I’ve lightly edited this for grammatical clarity. Some would say I should edit this more heavily in this regard!).

I have been able to review the slides and the strategy workshop documents. I largely agree with much of my colleagues comments I have to say – I would like to add the following points:

Models of research – the need for more ethnographic and autoethnographic approaches as a research methodology is clear as a means of both challenging and complementing the more biological models of research. A strand of funding then and a significant one at that is needed, e.g. from within a respected research funder such as the NIHR that is dedicated to funding qualitative research would serve to (a) legitimise these chronically disregarded and marginalised forms of research (b) foster parity between the disciplines rather than division.

This would also speak to the liberal sprinkling of comments around social determinants. Social determinants are well established – now we need interventions based on our understanding of social determinants – e.g. Haslam et al.’s work as well as continuing to explore the specific social determinants and factors in place for people with mental health difficulties that are geographically and contextually relevant (see:,) . Hence the ethnographic/autoethnographic approaches mentioned above.


There has been some research into the impact of the current welfare system on the mental health and lives of people with disabilities and mental health problems. The direction of travel of the current research is clear.

More research is needed on:

  • income inequality and mental health
  • workfare/psychocompulsion
  • in work and out of work benefits,  sanctions and the process of assessment and mental health
  • housing and mental health
  • the efficacy, effectiveness and safety of recovery colleges

Policies and processes of benefit assessments should be subject to evidence-based scrutiny/direction. They are not. It seems that evidence is rarely the meaningful guide to policy direction and development in spite of the money spent on the civil service, evidence reviews, consultations and strategies. There is rising media, lived experience and scientific evidence of the distress and deaths (people killing themselves) due to the assessment and sanctioning processes. (see e.g. White 2016,  Perkins et al. 2017

I would strongly suggest that a specific theme of social determinants and social interventions is merited to give due regard and credence to all of the above.

As part of the upcoming Critical Mental Health Nursing volume I am developing the argument that compliments my approach to mental health nursing education, namely that MHN’s  must shift towards political-psycho-social activism. This represents in some small way a bit of that on my part. The bullet points with the exception of the final point on Recovery Colleges were raised by MH activist colleagues Recovery in the Bin.

Courtesy of and with kind permission granted from:

Critical Mental Health Nursing

I published Recovering from Psychosis: Empirical Evidence and Lived Experience in 2016 and having done that you would think that was enough and I should get on with business as usual. But no. I had already started working on a second book idea which was originally going to be a book on Recovery Oriented Nursing – a sort of how-to guide combined with a critical perspective on it. And then everything went pear-shaped. Well, no not really. I started approaching people and talking about the book looking for contributors because another solo effort seemed to be a bridge too far and one that I’ll revisit later (yes there is a Book III idea wanting to get out). Instead surely editing a book and having others write the chapters was easier? The astonishing naivete.

Now we are some 3 months into the writing process for book two. It’s not a Recovery Oriented Nursing book as you may have gathered as the conversations with contributors and gathering co-editors took shape. That and the fact that another book exactly on that topic turned out to already be in press. Instead we have a completely different animal – Critical Mental Health Nursing. Offered up in conjunction with the Critical Mental Health Nursing Network.

CMHN is a vehicle. For multiple perspectives from nurses being critical of nursing, from people who have had experience of being cared for by mental health nurses, from professionals of other disciplines working alongside nursing to be heard. It will have a strong applied to practice focus, an ethnographic and autoethnographic flavour along with empirical evidence, multiple-theoretical-analytical approaches, and is driven by the authors and not the editors. At least that’s the plan! More to come as I have it. We are looking to see it published in 2018 by PCCS.

Autoethnography, cognitive psychology, folk-psychology: Thoughts on connectionist approaches to mind.

So, a long time ago I made a casual promise on twitter to write a blog about connectionist implications of approaches to theories of mind and consciousness. Foolish. However, that idea has bubbled away and recently re-emerged in discussing some aspects on the inter-relationship between language, mind, and truth. I’ve edited this and reproduced it here. Make of it what you will.

Connectionist approaches to mind, particularly Smolensky’s sub-symbolic approach, would say in my interpretation of it that words are something like socioculturally negotiated categorical descriptors and are connected associatively to world-events by dint of learning-training experiences. Our experience of language/words/thoughts/beliefs in a computational-philosophical framework is of a virtual machine underpinned by Connectionist mechanisms that are highly attenuated informationally-primed sensitive pattern matching machines – amongst other things. Indeed the best connectionism networks we have to date ‘deep belief networks’ which are forms of boltzmann machines are able to make categorical distinctions of written numers for example – you can show them lots of example ‘1’s’ and it can recognise that it is a ‘1’ even when highly ambiguous or the mechanism is damaged. The learning process that does this is never specifically tutored on what is a ‘1’ or told the desired output it learns to discriminate without such labels. What I take from this is that language is arbitrary and negotiated and built on top of lower-level sub-symbolic cognitive consciousness supporting mechanisms that are primarily concerned with finding statistical regularities – reducing surprisal and anticipating and reducing information-error. Language itself is a virtual machine on top that enables us to express and converse but is subject to sociocultural influences and is in of itself not a necessary prerequisite of conscious experience. On this basis whilst I consider words to be necessarily useful and meaning rich vehicles for experience they can only ever be at best to ourselves partial approximate descriptors of ‘raw experience’ (or qualia) and are always thus potentially subject to revision, oppression and the imposition of others mediated ‘truth’.

This is a talk by Geoff Hinton on deep-belief nets recognising numbers, without instruction. The video starts at 21 minutes – his demonstration of brain states and mind states is cool.

With autoethnography I’m with Ellis and am not so concerned with ‘truth’ more with stories that impact emotionally upon the reader and stimulate empathy compassion. ‘Evocative’ autoethnography if you will to my mind has as much value – if not potentially more than ‘Analytical’ strands. I get different things from both. We are tasked in the nursing-education world, courtesy of the Francis report and our CNO, via the 6C’s, with imbuing nursing with requisite care and compassion – (amongst other empirically opaque ‘C’s’) and are forced to leave aside the political injustice of the government’s reduction of the myriad of recommendations to holding our profession accountable for these failings as we do so. I would argue that these, along with the Courage C, are sound reasons to promote the autoethnographic movement within mental health nursing in particular, and nursing in general.

In applying a connectionist approach I’m seeking to undermine the ‘psychological truth’ of psychological models by exposing what I consider to be the shaky foundations they rest on.

Geoff Hinton’s talk I linked you to is a classic example – he seriously talks about models of brain state and models of mental state. They are linked but not the same. As I’ve expressed before elsewhere in various talks about more philosophical-existential aspects of mind, based on my understanding and previous work on connectionist theory and models I see the mind as a ‘virtual machine’ or ‘extra-dimensional property’ – they are inherently hypothetical. Minds themselves and the associated language labels – beliefs, thoughts etc employed in cognitive and clinical psychology are a construct. I may behave and have experiences that can be described as ‘having a belief’ and that is a convenient way of talking about that experience and associated behaviour, but I’m quite convinced that what ‘really’ underlies this is nothing like either the folk-psychological account of mind and mental behaviour nor the clinical psychological version – they are both kinds of approximation. This is evident to me from how classical-AI systems can be built out of sub-symbolic AI systems. The former has rules, categorical labels and so forth much like a lingua franca of the mind. The latter is the machinery underneath that scaffolds all this and has no clue or interest in the above.  Thus I would argue that connectionist approaches are potentially quite liberating for this reason, and that it allows us to hold these folk-psychological, cognitive-psychological and clinical psychological models lightly as mere approximations, not by necessity truth.

The Politics of Nursing and Nurse Education

I’ve recently participated in two review consultations to present a commentary on the recent proposals by Health Education England to introduce a new support role on the back of the Shape of Caring review. In both of these review meetings the context of the proposals and potential implications of the wider context of recent changes to nursing and nurse education, in particular, was a common focus. I’m going to outline these here and voice the kinds of predictions that have been made by both groups about what the future of nurse education looks like.

So if we review the changes that have been happening across both the current Conservative government and the previous Coalition government we can see a number of interventions happening. Firstly in relation to nursing education, we have the establishment of £9,000 tuition fees amongst many Universities wherein the Liberal Democrats ditched their election pledge to not raise student’s fees. The impact of this has been a decline in undergraduate student numbers as quoted verbatim here from the Universities UK 2014 report in conjunction with the HESA (Higher Education Statistics Agency) on the Patterns and Trends in UK Higher Education.

“In 2012–13 there were 140,000 more students studying at UK higher education institutions than in 2003–04, an increase of 6.4%. However, the rate of change fluctuated across the period: 2009–10 saw the largest year-on-year increase, of 4.1%; between 2009–10 and 2011–12 numbers remained stable at around 2.5 million, and then in 2012–13 numbers decreased by 6.3% (156,000 students). First-year undergraduate student numbers increased by 13.7% from 2003–04 to 2009–10, followed by a 22% decrease between 2009–10 and 2012–13.” (Universities UK, 2014; p6). The devil is in the contextual details when it comes to monitoring student numbers – depending on which year we start measuring from and which subset of students get included in the counting.
This should be considered also in light of the upcoming proposals to move away from a student bursary for nursing students to a student loan arrangement. This led to a considerable outcry, protest, a professional and parliamentary debate about the relative merits and potential harms of such a move. It is worth considering that research indicates that in over 40% of such existing loan schemes in HEI institutions in 44 different countries the recovery of such loan monies is  40% or less (Shem and Ziderman, 2009). It’s also worth mentioning that bursaries for Social Workers are being mooted as next on the government’s agenda.

Nurse revalidation “to strengthen the … registration renewal process and increase professionalism” (NHS Employers, 2016) was introduced as one of the measures following the Francis Report (2013). I would argue that whilst this has been ‘spun’ as a way to strengthen nursing and validate our professionalism what has actually been taken away and implemented from the 290 recommendations is in places far removed from this. Whilst the report indicates a number of individualized failings and also managerial shortcomings amongst others the whole of the nursing profession has been made effectively, tacitly to accept as a professional group the responsibility for these failures.

For example, the Francis Report made recommendations regarding ‘safe-staffing’ that the government promised to implement by commissioning NICE to review this independently. They’ve already back-peddled on this and now it is in internal NHS/DOH hands and is only now at the time of writing starting this work picking up from NICE’s previous analysis.

We also now have the government led work-force development plan to create a ‘nursing associate‘ role that Health Education England (HEE) says is intended to sit between care-assistants and qualified nurses . Several issues spring out of this – if the intention is to improve the quality of care (as is alluded to in the HEE documentation and subsequent discussions) then what is the evidence that such a role would do so? (It’s worth noting that when looking at patient mortality rates from acute myocardial infarction in the States studies have shown lower mortality rates when the nursing staff ratio had higher proportions of RN’s and higher mortality rates when nursing staff ratios had higher proportions of LPN’s (Licensed Practitioner Nurses) – a role very similar to that proposed as the nursing associate Person et al. 2004).

HEE also intends that ‘nursing associates’ would form another career-pathway towards nursing qualification then the existing graduate-pathway. Exactly how this would work, and how we could be certain that this more apprenticeship style route would have equivalency in terms of the education delivered is highly contentious. What we would have in the interim however is a new tier of work-force that registered nurses would have to take responsibility for – more management and less hands-on nursing from qualified staff then – that decreases patient safety. Nursing associates will not for instance be putting together care-plans, so that’s a job left to the RN. Another consequence I see of this workforce change is that we have cheaper care and less of it directly in the hands of RN’s.  I would argue further that we also get less consistency in terms of how nursing education is delivered through the introduction of a new career pathway.

There is also the matter of the use of the word nursing in the job-title. Registered Nurse is a protected term, whereas ‘Nurse’ is not. Nursing associate implies the practitioner is of the nursing persuasion, and yet clearly they are a new tier of health-care support worker – not regulated by the NMC. I wonder if the average patient receiving care is going to appreciate what and who this new level of practitioner is and what their expectations will be of what nursing associates can and can’t do?

Once more we have poor work-force planning, not backed by evidence of improved quality of care, that is politically-led and austerity driven. This is coupled with the hanging of responsibility on nursing and education for the complex systemic and individual failings highlighted in the Francis Report. Alongside this we have changes pushed through to student nursing bursaries and graduate fees that will undoubtedly change the landscape of recruitment into the profession.

So, bottom line predictions: the move to a nursing associate will create a new pathway to a nursing qualification. This cheaper for employers option with an ‘earn as you learn’ sales pitch will compete and even become the dominant route into the profession. Regulate nursing associates in the NMC and we have a new two-tier nursing with employers recruiting for more nursing associates into their rotas because, well it’s cheaper. RNs will have an increased clinical-supervisory/managerial role as a result and decreased hands on care. Care quality will be threatened as a result. Nursing isn’t teaching with its attractive golden hello, TV marketing campaign and decent starting salary. Without a bursary a proportion of nurses that would train by the graduate route will go elsewhere or into the NA route instead. We will have less diversity in our workforce as a result. Having axed bursaries the government will turn to social work and claw back funds from there to shore up some other aspect of the incessant goal towards nullifying our countries deficit. To the cost of an already beleaguered health and social care system.

Some Thoughts on ‘Public Professionals’ on Social Media.

You can see the thoughts of other attendees to #WGT16 at the Live Blog.

I attended the fabulously well-organised #WGT16 (We Get Together 2016) event developed by the We Communities social media group. I’m not sure if ‘group’ is the right word – ‘network’ maybe? Anyway there was an Open Technologies discussion section towards the end where we were asked to think about “How Can We Improve the Lives and Services for Our Patients Through Social Media?”. This question prompted a range of strong reactions in me on the day, and still does. I blogged about it over at the We Communities site, and I’ve reproduced it here with some additional formatting.

Some thoughts from #WGT16. It was so nice to see lots of ‘tweeting’ nurses together in one place and spot people I knew in the community. I even got the chance to talk to some of them IRL and meet some new folk along the way. So the social aspect was good. Our table had an interesting discussion when it came to looking at how social media might be used to improve the lives of people we work with. I have some reservations about this and we acknowledged these within our group.

We discussed how we ‘curate’ our follows – that is our use of twitter depends on to a substantial degree (but not totally), on whom we choose to follow. So with my @mhnurselecturer account I naturally tend to follow a lot of folks who tweet about mental health and related issues. Therefore I think we are sometimes at risk of creating ‘networks of the likeminded’ to some degree and perhaps we need to think strategically about how we diversify our twitter network. Much was made of in the day about how diversity in our networks can be fruitful. We therefore thought that we don’t want to replace one sort of silo with another and that reaching out and following people in other walks of life, professions, with other interests and passions could be a helpful way of improving the diversity of what we experience through social media.

I work with people and work to improve the services that deliver care to people who are marginalised in many ways, stigmatised and also structurally disadvantaged in our society. They are also subject to damaging terrible experiences of abuse, coercion and control – socially and organisationally. They may well not wish to interact with me as I may well represent to them exactly the kind of thing they want to stay away from. So I find myself thinking that we must be attentive to the needs of people who for many good reasons may not wish to interact with professionals on social media. They could do without another form of imposition on top of what they have already experienced or are experiencing. Just as we would in other avenues of communication we must be attentive to the space and territory that we occupy in these virtual spaces. Not all will welcome the idea of professionals seeking to ‘improve their lives’ through social media, and may find this threatening and invasive.

Troubling Definitions of ‘Mental Health’

Troubling Definitions of ‘Mental Health’

Image result for mental health

Lately thinking over dialogues I have been observing and participating on twitter, online and in practice has led me to the conclusion that there is a significant socio-political problem at the heart of ‘mental health’ practice. This comes from an assumed idealism of what constitutes ‘mental health’ itself. Mental health is defined as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (World Health Organisation, 2013).

Perhaps on the face of it this positive spin on what constitutes good ‘mental health’ may seem benign and aspiringly inclusive. I find it question-begging. Shouldn’t we all wish to ‘work productively and fruitfully’ and ‘contribute to our community’? Shouldn’t we all wish to realize our potential? And it’s in reflecting upon the superficially desirous goals that I strike upon some potentially stony ground. If mental health is about realizing potential, getting on with life and being a contributing citizen – to paraphrase the definition – then what if my circumstances are such that I am obstructed from attaining any or perhaps all of these? Am I thus devoid of a state of mental well-being as a result? Are these truly necessary conditions for flourishing mental-well-being? If so then what of those who are for whatever reason unable to deal with the stresses and strains of day-to-day living and contribute to their national insurance contributions?

I had a troubled phase of my life (in the mid-latter part of my 20’s) where I was deemed unfit to work and signed off sick. This was because of my ‘mental health’. Already we are in some a kind of tautological trap before we’ve even got started. What sense does it make that I can be deemed ‘unfit for employment’ by virtue of my mental health that is defined as partly as a capacity to contribute to working life? Excluding me from work on these grounds is excluding me from a component of activity that constitutes my mental health! How do I regain this part of my mental health and be seen as ‘fit for employment’ despite my mental health if being in employment is considered to be a necessary feature?

Let’s look at this from a slightly different angle. Looking at research into retirement indicates that we are treading some very swampy ground here. On one hand some research recently published by the Institute of Economic Affairs demonstrates that retirement increases the chances of suffering from clinical depression by 40% and the chances appear to increase the longer you spend in retirement (Sahlgren, 2013). This research isn’t the last word on the matter. A cohort study of people working for Electricite de France (EDF) looked at the annual trend in reported mental fatigue, depression or physical fatigue over the seven years before and the seven years after retirement. It found reductions in depressive symptoms and mental and physical fatigue comparing the year before with the year after retirement. This led to the conclusion that retirement is related to improvements in well-being (Westerlund et al., 2010). So we have conflicting evidence – some suggesting that being out of work contributes to a healthier lifestyle and better mental health and another, equally credible that it leads to a deterioration.

This suggests to me that a serious danger to guard against are adopting ways of working that map goals and outcomes that perhaps generalise well to larger populations (and are the output of research) without care and attention, unthinkingly, to the individuals with whom we are working. Whatever ‘mental health‘ is will differ significantly from person to person and will vary through time – what affords my mental health now is not the same as 20-odd years ago. So for example with a client I worked with in a community service as a CMHN (community mental health nurse) her physical disabilities precluded her from paid employment (as deemed by her and the health and social care organisations). Thus for her mental health defined as necessarily being constituted out of working contributions was pretty toxic and irrelevant. Instead her mental health was living well and having control of her life within the infrastructure of services that provided her with care. She thrived from having support that she could flex around her – being more supportive at certain times, and stepping back with confidence when she was feeling more capable of self-support. For her skills of being able to differentiate between the two and communicating this level of support need accurately – and for that to be heard – scaffolded good ‘mental health’. She felt a sense of mastery and satisfaction from being able to direct her own care as it fluctuated over time.


Sahlgren, Gabriel, (2013), Working Longer, Live Healthier: The relationship between exonomic activity, health and government policy, [Accessed on 17/03/2014].

Westerlund H, Vahtera J, Ferrie JE et alEffect of retirement on major chronic conditions and fatigue: French GAZEL occupational cohort study. British Medical Journal 2010; 341:c6149

World Health Organisation, 2013, Mental health: a state of well-being, [Accessed on 17/03/2014].

Writing “Recovering from Psychosis: Empirical Evidence and Lived Experience”: Some Reflections

I started writing my soon to be published book (eek!) “Recovering from Psychosis: Empirical Evidence and Lived Experience” way back in the summer of 2012, and today handed my completed manuscript over to my critical readers for their commentary. So I am in the last throes of this piece of work – a little bit over 2 years of work.

I’m excited and nervous to get their feedback. It’s challenging to think that others are going to read and reflect on what I have written and proffer their expert opinions on the material. Writing this book has been a long undertaking – emotional at times, grueling in places when it felt like it was never going to end, and an education in terms of understanding first-hand what’s involved in publishing an academic book. Certainly its not something to be taken lightly – and there all kinds of hoops to jump through in the process that I had no inkling of when I sent my proposal off to Routledge 2 years ago.

I’d completed a survey for the publishers on pre-registration mental health nursing textbooks and noticed in the email that they were open to proposals of new books. I realized I did have something in mind to write and completed their initial form outlining what I had in mind. Then a sample chapter (the introductory chapter that is now Chapter 2 of Recovering from Psychosis) was put together and reviewed anonymously. I was really pleased to get such positive comments back from the anonymous review – my writing is not devoid of merit after all! This then led to the negotiation of the contract and setting a deadline (which moved several times as the enormity of the task set in).

Recovering from Psychosis isn’t just a review of the state of empirical evidence, although it does do that, it also explores my own lived experience of overcoming this devastatingly potent condition that tore my life into bits in my early 20’s. I was aiming to write something that synthesized the more ‘objective’ academic review of our understanding of psychosis with a testimony of my experience as it relates to this. So when I reviewed the range of treatments I included relevant aspects of my own experience of these. When I wrote about recovery and research into it, I reflected upon my own battle and growth from the experience of psychosis. What I hadn’t really anticipated was how powerfully emotional that would be. Indeed I had some sleepless nights and some reliving of those darker days, and this has made me even more grateful for where and who I am now 20 years after the episodes I reflect on in the book.

This is far from the ‘definitive account’ of psychosis because of the individual nature of the personal experience. There are certain commonalities and themes in the experience of psychosis that are present in my account that will undoubtedly resonate with others who have had the challenge or are living through the enormous challenge of psychosis. In terms of the review, already portions of it are losing their contextual edge because research continues into refining our understanding and capabilities to work meaningfully and productively with it. It also presents, I hope, a robust critique of the limitations and disadvantages, if not dangers, of the ‘recovery’ approach as well as summarizing what we can gain from this perspective. I expect that later editions will be able to address advances and changes to our knowledge about psychosis, although I’m hoping I won’t have to write a second edition too soon!

If you are considering writing, or are just embarking on writing a book something I’ve learned about the process is this. You’ll pretty much always think what you’ve written is rubbish, and first drafts tend to be raw in the first instance. Be prepared to revisit stuff, rewrite stuff and detach yourself from the process as much as you can. Getting into a disciplined routine of writing really helps – so if you can join a writing group that meets regularly, and sets up a space where everybody gets their heads down and hammers some words out – this is a ‘must’ do. Looking now at what I’ve written with some distance almost feels like an ‘out of body’ experience – did I really write this? It’s not too shoddy after all. Others will be the best judge of what you have written and you may be surprised what they think of your stuff. Certainly they are never going to know unless you commit some words onto the page and see what happens!