“Parity of Esteem, No Health Without Mental Health” : Political Sloganism

I found myself tweeting this the other day, in amongst tweeting about book writing and the excitement of new Dr Who episodes and Great British Bake Off:

— Stephen Williams (@MHNurseLecturer) September 10, 2014

Looking at governmental interventions that have affected mental health we have had years of NHS staffing cuts, resource cuts, bed losses, ‘back door’ privatisation and rhetoric and tokenism. Take Nick Clegg’s  recent pledge (not a good word to associate with Mr Clegg – notorious as he is for reneging on promises) of a £50M ‘boost’ into mental health research. What does this actually do for the much vaunted ‘parity of esteem’? Well firstly from a research perspective it could help maybe fund a few randomised control trials worth of studies. This may improve understanding or enable a new therapy to be trialled. As for what this would do for the experience of the service – next to nothing I would imagine. So this kind of pledge strikes me as nothing more than a misguided and empty political piece of misdirection. Sort of – don’t look at what a terrible dangerous mess this is all in, look at the offer of shiny-shiny money – aren’t we caring and doing something about it after-all?

Remember this one? Liberal Democrats 2010 Electioneering Slogan.


Let’s also consider this idea of ‘parity of esteem’ – that mental health which has pretty much from its inception within medical and health care practice always played second-fiddle to physical health services in terms of image, funding and priority. Perhaps it seems, at first glance, laudable to call for a parity? When I first heard the phrase it immediately seemed to me that this was going to be another bit of ‘rhetoric’ that would never translate into meaningful action – i.e. raising resources and funding for mental health services. The disproportionate cuts between acute services and mental health services seems to bear this assumption of mine out. (See  http://www.bbc.co.uk/news/uk-england-sussex-26530733, http://www.bbc.co.uk/news/health-25777429, and http://www.bbc.co.uk/news/health-27942416 for examples of how cuts demonstrate that ‘parity of esteem’ is a hollow political promise).

Given the potentially devastating impact that mental health difficulties can have on a person’s well-being, life circumstances, relationships, emotional state, livelihood, physical health, citizenship, personal security, status, longevity and employability is it reasonable to suggest that ‘mental health’ should just be ‘on a par’ with physical health? I’m bound to argue that in some respects addressing mental health difficulties should be given priority according to its own needs and impacts, in its own right. This might mean that it needs funding above and beyond acute and physical care and that calling for a ‘parity of esteem’ is doing mental health and healthcare in general a disservice. Is acute and physical care necessarily getting the attention, funding and resourcing it needs and deserves? Somehow I doubt it given the shear depth and breadth of the services encompassed. Equality is not necessarily about “treating everybody equally”, it’s more about making adjustments that enable those persons needs to be met – tailored to obstacles that are present within that person’s life circumstances.

Ok, extended grumbling over – as you were!

Why the Mental Health Act needs a review of Community Treatment Orders #ChallengeCTOs

Community Treatment Orders: What’s the Evidence for Legally Enforced Treatment?

In my upcoming book on Recovering from Psychosis (Williams, In Press) I have a chapter that critically reflects on the potential abuses of the widely discussed ‘recovery’ movement. Within this reflection a point I make is  that an organisational requirement to developing clinical practice founded upon partnership in decision-making necessitates a shift in terms of power and authority within professional roles and practices (Slade et al., 2014). This is particularly problematic in the case of treatment under section within the Mental Health Act (1983; 2007) and it is hard to see how services can maintain a recovery approach when this legal enforcement of aspects of treatment are in place. What follows now are my reflections on CTO’s excerpted from my current book draft.

Community Treatment Orders (CTO’s) were introduced as a means of reducing the need for admission and detention in inpatient settings. The data on rates of admission and implementation of CTO’s does not support these ideas, and neither do early randomized trials evaluating the efficacy of CTO’s. According to the Health and Social Care Information Centre (2009; 2013) rates of detention to inpatient facilities in the U.K. increased from 47,600 in 2007/2008 – 2008 being the year in which CTO’s were introduced – to 50,408 in 2012/2013.

Within the limitations of designing and implementing randomized control trials those conducted to investigate the efficacy of CTO’s in reducing the need for admission to hospital each unequivocally indicate that CTO’s do not have an impact statistically on such outcomes (Burns and Molodynski, 2014). There is in counter-balance to this some evidence that the use of CTO’s can reduce the length of hospital stay for certain groups of people (Light, 2014).

As Light (2014) points out in discussing the whys and wherefores of the legitimacy of CTO’s in the face of unfolding contradictory and in places unequivocally negative evidence is that the process of study design, choice of ‘outcomes measures’ and what kinds of evidence inform evidence-based care are philosophical matters. An implication of such studies thus far on CTO’s is that inpatient treatment in some sense is the result of a failure of the CTO. That is there is an assumption that the function of community care is to prevent the need for inpatient treatment. In a clinical context this does not always make particularly good sense – sometimes the purpose of community mental health care is to facilitate access to inpatient care. It has also been argued that CTO’s, like recovery, amounts to a process – wherein what benefit is entailed within the treatment order is in the improved access and availability of clinical resources to the person (Kisely et al., 2013).

These studies also fail to speak as to the qualitative nature of experiencing a CTO – the most recent studies of which in Australia (Light, 2014) paint a consistent picture of distress and ambivalence about the use of CTO’s there. Strangely, whilst studies of lived experience or qualitative data tend to have a reduced regard in terms of health-economic decision-making where randomised trials are seen as the gold-standard for research, a rebuttal of the OCTET trial evidence by Mustafa (2013) argues against the withdrawal of CTO’s based largely on evidence from a fictitious case of anecdotal evidence of its efficacy! It’s a perversely inconsistent world where on one hand we have arguments against the narrow use of existent psychological therapies for psychosis based stoutly and solely on hard-won expensive scientific empirical evidence (via RCT’s) that has limited room for the complexity of user-experience outside of often researcher originated numerical scales of symptom intensity. Yet again we have arguments for the persistence of a typically unpopular form of legally enforceable intervention in the face of the same kind of evidence that draws on a putative case of user-experience to justify this. We are well overdue embracing mixed-methodologies in psychological health ‘science’ and finding ways to draw upon user-experiences so that we can provide interventions that are both empirically valid and experientially attentive.

Given that mental health services is under-pinned by professional mandate to be ‘evidenced-based’ (Goodman and Ley, 2012) and so far CTO’s fail to meet the much prized and costly gold-standard of evidence – how can we be justified in their persistent mandatory usage in the Mental Health Act as is?

This, amongst other arguments, is the basis for the #ChallengeCTOs campaign. We are calling for a review of the relevant legislation that governs the usage of CTO’s. If you agree that a review is warranted you can help get this heard in Parliament by signing up to our e-petition: http://epetitions.direct.gov.uk/petitions/67906.


Burns, T. and Molodynski, A.(2014), Community treatment orders: background and implications of OCTET trial. Psychiatric Bulletin, 38, pp3-5.

Goodman, B. and Ley, T.(2012), Psychology and Sociology in Nursing, London: Sage Publications.

Great Britain. Mental Health Act 2007. London: The Stationary Office. Available at: http://www.legislation.gov.uk/ukpga/2007/12/contents (accessed 30/06/14)

Health and Social Care Information Centre (2009), Inpatients Formally Detained in Hospitals Under the Mental Health Act, 1983 and Patients Subject to Supervised Community Treatment – 1998-1999 to 2008-2009, http://www.hscic.gov.uk/article/2021/Website-Search?productid=13209&q=rates+of+CTO%27s+2007&sort=Relevance&size=10&page=1&area=both#top[Accessed: on 30/06/2014].

Health and Social Care Information Centre (2013), Inpatients Formally Detained in Hospitals Under the Mental Health Act, 1983 and Patients Subject to Supervised Community Treatment, England – 2012-2013, http://www.hscic.gov.uk/article/2021/Website-Search?productid=13209&q=rates+of+CTO%27s+2007&sort=Relevance&size=10&page=1&area=both#top[Accessed: on 30/06/2014].

Kisely S, Preston N, Xiao J, Lawrence D, Louise S, Crowe E, et al. (2014), An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use. J Psychiatr Res,47,pp 650-6.

Light, E. (2014), The epistemic challenges of CTOs: Commentary on Community treatment orders. Psychiatric Bulletin, 38, pp6-8.

Mustafa F., (2013) On the OCTET and supervised community treatment orders. Med Sci Law doi:10.1177/0025802413506898

Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S. and Whitley, R. (2014), Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems, World Psychiatry, 13(1), pp12-20.

Williams, S. (In Press), Recovering from Psychosis: Empirical Evidence and Lived Experience, Routledge Press.

Against ‘Involvement’ and Towards ‘Co-Production’.

Several weeks ago whilst taking part in some discussions on service-user involvement on Twitter that were, in fact, generally positive about this idea I had to profess that lately I have become ‘against involvement’. It’s tricky when you are limited to 140 characters to express nuanced ideas without oversimplifying what it is that you are endeavouring to express. I don’t wish to sound as if I am against ‘inclusion’ or embracing the ideas of service users. As an ex-service user myself that would be somewhat strange – I would have to censor and exclude myself!  So I’ve resorted to expressing these ideas at more length here in this blog post. It’s particularly pertinent I think to reflect on this now given the recent thought provoking Guardian article by Peter Beresford in the wake of the DOH’s (Department of Health’s, 2014) project to extend user involvement and live up to the policy pledge (rhetoric?) of “nothing about me without me”.

My problems with ‘involvement’ are that it is an ill-considered idea in the first place. It seems like something initially that is highly laudible and worthwhile. However my difficulties with it stem from what is implicit in setting up programmes with an ‘involvement’ agenda and from having being ‘involved’ in the running of such programmes in organisations in the past.  My experience as a professional in educational, healthcare and research organisations is that when ‘involvement’ is raised it’s at the point when most of the work in developing the educational, service or research project has already been done within the organisation itself.  “Involvement” can all too typically devolve down to inviting a service-user or outsider of the host organisation to participate in some pre-determined aspect or element of the service or programme that has already been committed to. They might have their expenses provided or receive some form of token payment for their activity. They might participate in the evaluation of a project as participants in a focus-group. My point here is that this is very much a form of “involvement” that stands to maintain the status-quo of the user as an “outsider” to the programme, project and host organisation. To put it in a nutshell “involvement” as has initially been developed is at risk of being “othering”.

If not “involvement” then, because of this “othering” risk, what instead? I would like to see the development of projects that aim instead from the outset to be collaborative and co-productive. Seek out and employ service users on an equal footing as participants in developing, designing, implementing and evaluating programmes across organisational settings as co-producers. Developing from this co-production I would then envisage programmes that head towards service-users leading and developing services/programmes in their own right.

The potential advantages of co-production and service-user leadership are, amongst other things, in the expressed values and diversity of the project. This is reflected in the Writing for Recovery research project of Taylor et al. (2014) who employed a service-user/writer to lead their project group.  Group members in this project reflected on the difference this made, and one reflected that:

‘Undertaking a service user led group gave me the courage to speak out, as I knew we had all faced major life challenges at some stage’ (WfR member). (Taylor et al., 2014, p 6).


Beresford, P. (2014), How Can Social Care Providers Involve Service-Users?, http://www.theguardian.com/social-care-network/2014/may/22/social-care-providers-involve-service-users [Accessed 28/05/2014].

Taylor, S. , Leigh-Pippard, H. and Grant, A. (2014), Writing for recovery: a practice development project for mental health service users, carers and survivors, International Practice Development Journal, 4(1) , pp. 1-13.

Further Reading and Watching

Check out the SCIE’s (Social Care’s Institute for Excellence) guide to co-production: http://www.scie.org.uk/publications/guides/guide51/

And a great little explanatory video: http://www.scie.org.uk/publications/guides/guide51/resources.asp

An @WeNurses Twitter Chat on NICE Guidelines and Evidence in Nursing

Are NICE Guidelines Enabling Our Caring Professionals to Meet NMC Standards of Evidence-Based Practice?

By Stephen Williams, Sian Jackson and Sarah O’Donnell (2013)

15042014wenursesThis is a proposed @WeNurses chat co-written by Steve Williams aka @MHNurseLecturer, Sian Jackson aka @firecracker1305 and Sarah O’Donnell aka @sarah_searz. This proposed twitter chat came about as a result of a pre-registration nursing @BradfordUni debate on evidence-based practice in healthcare. This represents a strand of ‘SoMe’ (Social Media) integration and dissemination of student-nursing practice as explored in Williams (2013).

The NMC (Nursing and Midwifery Council) (2008) code states we must: “deliver care based on the best available evidence” (p.6) and keep our “knowledge and skills up to date” (p.6). NICE (National Institute of Health and Care Excellence) guidelines have assisted practice since 2001. With a variety of treatment options/pathways it seeks to enable professionals to provide evidence-based advice and care. However is the evidence assessed by NICE sufficiently contextually relevant for our patients’ clinical needs?

Research evidence can become rapidly out dated and some academics and practitioners might argue it’s not always sufficiently well developed for practice. Nurses establish their practice in a variety of ways and their ability to critically evaluate research varies (Funk et al., 1991; Kirkevold, 2008). NICE guidelines take two years to be developed prior to publication. This suggests that upon publication they are already out of date and indeed may not be updated for a further three to four years.

An example of such issues with NICE guidance can be seen in the development of guidelines for self-harm (Pitman and Tyrer, 2008). Pitman and Tyrer (2008) point out that this was developed on research evidence with only one recommendation based on a RCT (randomised controlled trial) quality of evidence. Most of the research at the time was on the physical impact of self-harm and the guidelines received criticism for amalgamating self-poisoning and self-laceration as a single kind of problem (Barker and Buchanan-Barker, 2004). Is it pertinent to argue then that a culture of ‘following NICE guidelines’ perhaps disables nurses obligation to critically review nursing research and related evidence themselves?

NICE guidelines set out to reduce inequalities in treatment provision. Whilst this is a laudable ideal the reality of treatment provision is considerably murkier. Take the provision of IVF (in vitro fertilization): NICE guidelines in 2004 recommended three full cycles of treatment for those who met agreed clinical criteria. By mid-2005 PCTs (primary care trusts) were being asked to make at least one cycle available by the secretary of state. There was no mandate or mechanism for ensuring the recommendations were implemented (House of Commons Health Committee, 2008). A further critical point is that PCT’s in England were able to set the eligibility criteria for access to NHS funding above and beyond clinical criteria set out in the guideline (House of Commons Health Committee, 2008). This being the case – are they really addressing health inequalities and are we confident the advice they prompt us to give is sufficiently empirically robust?

A twitter chat in conjunction with @WeNurses is scheduled for Tuesday 15th April 2014 at 8pm online.


Barker, P. Buchanan-Barker, P., (2004), NICE and self-harm: Blinkered and exclusive,Mental Health Nursing, 24,6,pp. 46.

Funk, S.G., Thornquist, E.M., Wiese, R.A. and Champagne, M. T. (1991), Barriers to using research findings in practice: The clinicians perspective. Applied Nursing Research. 4, pp 90-95.

House of Commons Health Committee (2008), Health Inequalities: Written Evidence, Session 2007-08, Volume II, Her Majesty’s Stationery Office.

Kirkevold M. (1997), Integrative Nursing Research – An Important Strategy to Further The Development of Nursing Science and Nursing Practice, Journal of Advanced Nursing, 25, pp 977-984.

Nursing and Midwifery Council (2008), The Code: Standards of conduct, performance and ethics for nurses and midwives, NMC.

Pitman, A. and Tyrer, P. (2008), Implementing clinical guidelines for self-harm – highlighting key issues arising from the NICE guidelines for self-harm, Psychology and Psychotherapy: Theory, Research and Practice, 81, 4, pp. 377-397.

Williams, S. (2013), Embracing Digital Education for Nursing (An @WeNurses Web-blog Article), The Inside Skinny Latte Blog, September 9th 2013, Available from: http://mhnurselecturer.co.uk/?p=8, [accessed 19th November 2013].

An @WeNurses WebBlog Article on Digital Education in Nursing


Embracing Digital Education for Nursing (An @WeNurses WebBlog Article).

Originally Posted on Sept 9, 2013 by mhnurse

This is the original article text for my @WeNurses WebBlog Article on Embracing Digital Education for Nursing. Teresa Chinn (@AgencyNurse) invited me to write this blog article for @WeNurses over at WeNurses.co.uk as she became aware of how we are developing the integration of social media use, and twitter chats in particular, in our pre-registration nursing curriculum at Bradford University (@BradfordUni). I chose to take a somewhat personal perspective and incorporate the story of my development as a ‘twittering’ nurse for want of a better phrase and how the project ensued.

Embracing Digital Education for Nursing

Earlier this year I did something quite major in terms of my twitter identity. Having reviewed the NMC’s SoMe (Social Media) guidelines (NMC, 2012) I changed my identity to a professional one on twitter. I’m now @MHNurseLecturer. From this moment on I shifted the emphasis  to largely tweeting about the needs of people with mental illness and how we can learn from their struggles. I wanted to get serious about helping liberate us from what I largely see as something of a mess that our society’s fear and lack of understanding has created. Twitter is a way of communicating and connecting with others who share your interests and also challenging the views of others who maybe don’t.

I became aware of other professionals, groups, service users and nurses in particular. I can’t recall how I stumbled upon @WeNurses initially as an organization. I honestly didn’t like the sound of it at first –“How could it include all of us?” I remember thinking. However, I resolved to give it a try and joined in on a few twitter chats. So I eventually found myself rather late at night in the University hunched over my computer as my colleague was giving a seminar on Diversity in the office via Skype. I was helping co-lead a nursing twitter chat! I had connected with some organizational development professionals I met over twitter in a previous @WeNurses chat when it became apparent that we shared the same kind of interest in resiliency and mindfulness. We led a twitter chat together having collaborated to put in our proposal and you can read the write up I put together for that here, and also here at WeNurses.co.uk (Williams, 2013).

At this time I was in the throes as a module leader  of putting together the first run of our Year Three, Semester One module for nurses. At this point of their training they are ‘developing proficiency’ and consolidating their skills. I’d also been charged with threading cognitive based talking therapies and their derivatives throughout the curriculum to bring our nursing training up to and beyond scratch in terms of delivering evidence-based interventions for serious mental illnesses. That’s my area of expertise from my own experience and on-going clinical practice since 2002. I’m currently a nurse-therapist part-time, so I just started weaving in what I do into the curriculum and developed the delivery of teaching sessions that focus on skills coaching, recovery and talking therapy interventions by nurses. I’ve also engaged nurse turned psychotherapist professionals in practice to come into education and co-teach sessions with us.

It occurred to me to join some of these things up. Why not, I thought, get the students to run a twitter chat? First let’s get twitter streamed in our school. I quickly got my learning resource team colleagues to stream @WeNurses chats on one of the displays as a trial. I say ‘quickly’ that was several months of e-mails and effort! Students could have their lunch and watch the tweets of professionals, carers, service-users and others on the current topics as they arose. This trial run quickly showed me that we need a dedicated display so that the screen can be rapidly controlled directly by an academic and not have to compete for space with other necessary university information. So my learning resource team colleagues figured out how to have a dedicated display page that we could switch from #hashtag to #hashtag according to what was topical and also control the time-parameters of the twitter stream so that it could be displayed retrospectively.

At present we have a business case for the screen being processed to have this dedicated display create a permanent social media presence in the school. The vision is that Academic Twitter Champions (ATC’s) will form a multi-disciplinary academic team that can seek out interesting SoMe users, dialogues and #hashtag streams. The ATC will then be responsible for ensuring  that they are of relevant interest and are suitable for student consumption so we can respond rapidly and safely to emerging debates. Naturally we are wanting as an organization to safeguard the quality of the content and minimise the risk of deleterious twitter activity from being displayed. Another knock on benefit we forsee from this is being able to role model the use of SoMe and NMC SoMe guidelines for nurses in training.

I took things a step further by making a twitter chat a vehicle for student learning.  So for example something we examine really closely at this stage of the nurses education is what they understand of ‘evidence’. As  a whole collection of nursing fields they come to grips with the nature of research informed evidence, evidence based practice and evidence informed practice. These are perhaps, to some, relatively subtle distinctions and are further complicated when you consider how these kinds of practice and evidence differ from say practice-based evidence! It may sound as if I’m merely shuffling the same words about but these are distinct relationships between kinds of evidence and types of practice.

I’d already planned on a whole field in class structured debate for the module. That is: there will be a student-led debate after a key lecture on the nature of evidence. This trigger lecture refreshes what they’ve already learned and sets out some of the pro’s and con’s of different kinds of evidence, efficacy vs effectiveness, mixed methods vs single methods and so on. They then have a whole field debate that we facilitate on whether NICE (National Institute of Health and Care Evidence) standards of evidence are sufficient for nursing practice.

From this the students will put together a small working party and use their initial debate to put together a @WeNurses twitter chat on what they found interesting about being ‘evidence based practitioners in nursing’. Everybody in the fields will be able to contribute to the discussion on twitter though and therefore the learning that comes from it. The elected group will make a full submission and lead a twitter chat and see what it is like to disseminate and discuss knowledge creation and sharing in this digital medium. This hopefully will help them draw upon a wider range of critical views, improve their own constructive critical thinking and show them the value of knowledge transfer in the digital age. It will hopefully also show them some of the pitfalls too.

The first run of this module is coming up in September. Part of the evaluation of learning will be the twitter chat transcripts and bits of work following on from the dissemination fed back into the module. I hope they put together a good submission for @WeNurses so that we end up with some healthy sharing of student nurse and professional perspectives on the nature of what we call evidence, and how we put it into our practice. If this would be of interest to the @WeNurses blog-o-sphere, I’ll come back with what we learned and ask some of my student nurse colleagues to give you their account of the process of getting involved in this kind of digital literacy in their nurse education and training. You can then be instrumental in the educational development of your upcoming colleagues who are getting ready to join you in improving and maintaining the delivery of high-quality, compassionate nursing care in our unfolding post-Francis world.


Nursing and Midwifery Council (2012), Practical guidance for students, nurses and midwives using social networking sites [online], London:  Nursing and Midwifery Council. Available from: http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/Regulation-in-Practice-Topics/Social-networking-sites/ [accessed 21st August 2013].

Williams, S. (2013), A Twitter Chat for @WeNurses on Resilience (Hosted 7th March 2013), The Inside Skinny Latte Blog, 8th March 2013, Available From: http://mhnurselecturer.co.uk/wp/?p=10, [accessed 21st August 2013].

An @WeNurses Twitter Chat On Resilience


A Twitter Chat for @WeNurses on Resilience (Hosted 7th March 2013)

Originally Posted on April 8, 2013 by mhnurse

Following a recent twitter chat I  joined forces with Maxine Craig (@maxine_craig) and Andrew Moore (@steesimprove), two Organisational Development NHS professionals from South Tees, to co-host a twitter chat on the #WeNurses hashtag. We found that we shared a common interest in the idea of ‘resiliency’ and elected to collaborate and develop a twitter chat on this topic. You can find the archive of this twitter chat via WeNurses.co.uk. Here’s my covering blurb from that twitter chat, that I have subsequently edited a little.

“Resilience” is a topic of particular interest to a growing variety of stakeholders in health and social care and beyond. This is evident in the relatively recent call for science to adopt a more positive mind-set (Luthar and Zelazo, 2003: cited in Mohaupt, 2009) and the rise of ‘positive psychology’. You can find resiliency research present in fields as diverse as ecology, physics, medicine, social psychology, and psychiatry as far back as the 1940’s (Mohaupt, 2009).

Coming from the Latin ‘resilio’ meaning ‘spring back’ (Oxford Dictionary, 2010) in a therapeutic context it describes how people can get through adversity by drawing upon their various strengths (Kyuken, Padesky and Dudley, 2009). Definitions and the usage of resilience have changed over time, but the bottom line is that resilience is currently conceptualised as “a dynamic concept referring to a person’s ability to maintain or regain health after exposure to adversity” (Herrman and Jane-LLopis, 2012, p.1).

Our question, and topic for our nursing twitter chat, is – how do we build personal resilience as nurses? The idea of nursing (and indeed we could argue any kind of person-focused work) as a kind of “emotional labour” with a concomitant risk of “burnout” is well established in the literature and across the fields of nursing (Henderson, 2001; Brotheridge and Grandey, 2002, Mann and Cowburn, 2005). It would seem to make sense then to join these things up and consider carefully how nurses can apply the developing expertise from well-being and positive-psychology research (e.g. Seligman and Csikszentmihalyi, 2000) to themselves, colleagues and those they care for.

Positive-psychology interventions (PPI) are not primarily about treating people with significant emotional and psychological health difficulties (SEPHD), although there is considerable interest and research into this (see Sin and Lyubomirsky, 2009). PPI strategies run the gamut of: writing thank-you letters, practicing optimistic thinking, re-living/rehearsing positive experiences, to practicing mindfulness skills. These interventions have been shown to increase well-being in people without SEPHD (e.g. Lyubomirsky et al. 2011). The need for national and local NHS strategies to develop staff health and well-being was recognised on the back of the Boorman report (Boorman, 2009) and led to the development of the Department of Health (DH) “Healthy Staff, Better Care for Patients” National guidance for the NHS (DH, 2011). Your NHS trust should have a health and well-being strategy and policy.

That’s the rhetoric – what of the reality? The national guidelines places staff at the top of the chain of responsibility in their illustrative diagram of how we should go about “embedding improvements to the health and well-being of staff in the NHS” (DH, 2011, p.6). There is, naturally, the predictable raft of guidelines for managers, the organisation, the wider health system and the community beyond that. So, in the light of all this how do we build personal resilience as nurses?


Boorman, S. (2009), NHS Health and Well-being: Final Report, DoH.

Brotheridge C.M. and Grandey A.A. (2002), Emotional Labor and Burnout: compating Two Perspectives of “Perople Work”, Journal of Vocational Behaviour, 60: pp.17-39.

Department of Health (2011), Healthy Staff, Better Care for Patients: Realignment of Occupational Health Services to the NHS in England, DoH.

Henderson A. (2001), Emotional Labor and nursing: an under-appreciated aspect of caring work, Nursing Inquiry, 8(2); p130-8.

Herrman H. and Jane-Llopis E., (2012), The status of mental health promotion. Public Health Reviews, 34(2).

Kuyken W., Padesky C.A. & Dudley R., 2009, Collaborative Case Conceptualization: Working Effectively with Clients in Cognitive Behavioural Therapy, New York: Guildford Press.

Lyubormirsky, S.,  Dickerhoof, R.,  Boehm, J.K.,  and Sheldon, K.M. (2011). Becoming happier takes both a will and a proper way: an experimental longitudinal interventions to boost well-being. Emotion. 11(2): pp 391-402.

Mann S. and Cowburn J. (2005), Emotional labour and stress within mental health nursing, Journal of Psychiatric and Mental Health Nursing, 12 (2), pp154-162.

Mohaupt, S. (2009), Review Article: Resilience and Social Exclusion, Social Policy and Society, 8 (1), pp 63-71.

Oxford Dictionaries. (2010) Oxford Dictionaries Oxford University Press.http://oxforddictionaries.com/definition/english/resilience (accessed February 18, 2013).

Seligman, M.E.P. and Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55, p5-14.

Sin N.L. and Lyubomirsky S. (2009), Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis., Journal of Clinical Psychology, 65(5): pp.467-487.