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

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.

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!