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: http://www.sciencedirect.com/science/article/pii/S0165032714000573,) . Hence the ethnographic/autoethnographic approaches mentioned above.

Topics

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 https://kar.kent.ac.uk/59731/1/insights-32.pdf.,  Perkins et al. 2017 http://www.emeraldinsight.com/doi/pdfplus/10.1108/MHSI-12-2016-0039).

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: http://www.yearoftheduck.com/trojan-duck/

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. https://www.youtube.com/watch?v=AyzOUbkUf3M

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.