A cause for celebration?

Today (Monday 21st August 2017) marks the start of the third Health Visitor Week (#HVweek). When, previously I led on supporting Unite/Community Practitioners’ & Health Visitors’ Association (CPHVA) health visitor members in England, I reintroduced the celebration with it running, in 2016, between the 26th-30th September. The original event occurred in 1990.

For me it was a very enjoyable, if exceptionally hectic, culmination of over 9 months of planning and preparation, and brought together 82 organisations, who each supported the aims of the week.

As well as events in Cardiff, Glasgow and Belfast, I developed a virtual event for English members with 38 e-conference sessions which you can still watch today, and I hope stands the test of time.

I also developed the #whatisaHV memes which saw over 50 participants, both parents and professionals, tell us what a health visitor was to them.

With the 2017 #HVweek, I wanted to have a think about some of the changes in the 325 days since last years event.

Today I’m focusing on the numbers.

A few numbers

The Health Visitor Implementation Plan was never just about the numbers, but for me the numbers were the most important element. I believed that without a commitment to a final number, none of the other intended benefits would ever follow. But what has happened in the last 325 days?

The first problem? It’s difficult to answer. NHS Digital has a very comprehensive website which updates the number of health visitors in NHS employment, but that has a delay inherent in collecting this type of data. So, at the time of writing, you can only get figures up to April 2017.

This tells us that there were 8,830 whole time equivalent health visitors in the NHS. Since last years #HVweek, when there was 9,521 health visitors, this means a cut of 691 or 7.3%.

Even more worryingly than this is the cut that has happened since the end of the HV Implementation Plan. In March 2015 there was 10,257. Therefore, in just 25 months, there has been a cut of 1,427 (or 13.9%).

DM HVweek Memes 01.jpg

That equates to one health visitor being cut from the NHS every 12 hours. (So we’ll lose another 8 during this years #HVweek).

DM HVweek Memes 02.jpg

 

I’ve recently been blogging about the number of mental health nurses and for this I looked at the number of people in England per mental health nurses. There were two reasons for this:

  • I was looking at the change in mental health nurses since 2010. Over that period the population in England has increased by 5%.
  • Jeremy Hunt and Theresa May repeatedly talk about the increase in (all) nurses since 2010, most recently Hunt repeated this claim over the weekend in his spat with Stephen Hawking. However when you correct for the above increase in population the number of people per nurses has gone up (so got worse) by 3.2%.

For #HVweek, I’ve looked at a similar approach for health visitors. Again, the figures don’t make this too easy as the stats for the population of England are released once per year, and the most recent is mid-2016. I hope you don’t mind but I’ve used the 2016 population figure for the 2017 calculation:

Screen Shot 2017-08-20 at 23.52.59.png

 

 

This shows that this year, we’re in a better position than we were in 2010, by 5.9%, but the benefit gained during the Health Visitor Implementation Plan is rapidly disappearing.

You might be thinking at this point, as most health visitors caseloads will focus on the under 5’s (accepting that’s not a given, and certainly not these days!), it’s not really useful to use this statistic. I’ve thought of that, and here’s the figures for the number of under-5’s per health visitor:

Screen Shot 2017-08-20 at 23.59.27.png

Again, the position in 2017 is better than in 2010, by 6.3%. However, again, this is a markedly different figure from 2015, at the end of the Health Visitor Implementation Plan, when the improvement in caseload sizes was 18.6%.

If you prefer graphs, here it is:

DM HVweek Memes 03.jpg

During the life of the Health Visitor Implementation Plan, I met with about 1,000 student health visitors, and one of the things that I impressed upon them was that if you just looked at the time period of the HV plan, you would have a significantly skewed view. After all, the whole point of the plan was to correct the historic decline that was happening in the 2000’s. I’ve therefore followed my own advice and looked back to the situation in 2000.

In 2000, there were 10,046 whole time equivalent health visitors looking after 2.98 million under-5’s. That meant an average of 297 under-5’s per health visitor. I’ve crunched the data and this is the resultant graph of number of under-5’s per health visitor:

DM HVweek Memes 04.jpg

I’m going to finish with a prediction on the numbers. If the government continues on it’s current path in resect of health visiting, by 2019, we will be in the same position as we were on the 7th February 2011. For those that don’t know, that was the day before the HV Implementation Plan was launched.

I really hope I don’t have the opportunity to test my prediction out!

And to answer my initial question… #HVweek, a cause for celebration? Too right it is!! Health visitors are totally amazing!

 

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Is it me, or you Jeremy? Mental health nursing numbers in 2017

On 5th July, at Prime Ministers Questions, Theresa May (MP) answered a question from Jeremy Corbyn (MP); “Of course we now have more nurses in our hospitals than we had in 2010“.

First off, that statement is true. In May 2010 we had 280,950 nurses in England and in March 2017 (the most up to date stats we have from NHS Digital) we had 285,893. This is an increase of 4,943 or 1.6%.

But first…

Before heading off on the point of this blog however, I want to highlight that this isn’t as ‘good’ as it sounds as during a similar time, the population of England has increased by 2.6 million people, or 5%.

If you changed the governments reporting system so we looked at number of population per nurse, it’s increased (so got ‘worse’) by 3.2% (187 people per nurse in 2010 to 193 people in 2017).

What about mental health nurses?

George Coxon, the chair of Unite/Mental Health Nurses Association, and I, wrote to May to highlight that at the time of her making this statement the MHNA national committee was meeting in Salford with one of the agenda items, to discuss the cut in mental health nurses (MHNs).

Between 2010 and 2017, the number of MHNs has been cut by 4,942 (from 40,630 to 35,688) or 12.2%. Using the number of people per nurse reporting system I’ve used above, it means a change from 1,296 people/mental health nurse to 1,549 or a 19.5% increase.

I’ve produced a few iterations of a graph that shows the situation for MHNs and I updated it with these latest stats.


Alongside this data from NHS Digital, I’d had a conversation with Rachael Maskell (MP) to ask whether she could help to uncover some more detail. She submitted 4 questions to parliament which uncovered some more information regarding MHN education commissions. The answers from Philip Dunne (MP) shows that between 2009/10 and 2016/17 there has been an 11% cut in the number of MHN commissions (or 3,755 to 3,343).


Maskell also asked for the commissions for next year. You’ll see from the answer that the system is changing in 2017/18. There’s much to worry about in this new approach, and just a few news stories from this week highlight some of the possible impending problems ahead:

Another area that I wanted to investigate was the rate of graduation versus the number of students that took up the commission. Parliament wasn’t up for answering this one. They did point us towards HESA’s website. The page they pointed to, or any other I could find, didn’t seem to help. However Twitter came to my partial aid. When I asked for numbers of students enrolled and completed B760, they sent me the following:


This answer hasn’t helped fully as I’m guessing they’re not England specific and I don’t know the numbers who enrolled to result in the 2,890/595 qualifiers in 2015/16. I’ve asked but not reply so I’ll need to follow this up!

A reply from Jeremy

The next part to this story started with a tweet from Dr Rachel Clarke. She was asking Jeremy Hunt (MP) how much it would take before he acted on the dangers of NHS understaffing. He replied by arguing that he was acting because he was ‘dramatically increasing‘ the numbers of doctors that are being trained. He had his own graph (more of this later!):

I took the opportunity to ask for his thoughts on my (MHN) graph and unusually he replied to me:


I was intrigued by his response. I’d heard second hand before that he’d stated that MHN was the fastest growing nurse speciality, at this years CNO Summit. I hadn’t seen or heard it direct however. Now I had, I wanted to know more! I asked what his reference period was for this claim, but I must have used up my Twitter replies as I’ve not heard back.


Without a reply, I thought I’d do a bit more data crunching. I found out the following:


If you’re interested in the overall graph for the 6 groups between May 2010 and March 2017 here it is:

Jeremy, I’m not sure whether there is a reference period that does show MHNs being the ‘fastest growing’ but if there is I think you’ve got to be pretty selective to find it. I’m happy to be proven wrong however!

On the other point that Hunt raised, that ‘120,000 more people are treated every year’. I’m not surprised by this. Unite/MHNA asked its members last year about how things were going, and the results were pretty shocking, showing the effect that this increase in work, on top of the cuts that I have outlined above, has had on them.

What about the doctors?

Before hanging up my scientific calculator, I did a bit more number crunching as I was interested in Hunt’s point re. doctors. I found out that:

  • The ‘psychiatry’ doctor grouping showed an increase of 32 (8,699 to 8,732) or 0.4% between 2010 and 2017. Using a new people per psychiatry doctor stat this means a change of 6,052 people per psychiatry doctor to 6,329 people per psychiatry doctor (an ‘worsening’ of 4.6%).

  • There’s a real variety in the increase and decrease in the different doctor specialities, but when you take them as a whole, in 2010 there was 556 people per doctor vs. 519 people per doctor in 2017 (an improvement of 6.7%).

England population:

Briefing Westminster on mental health in the workplace

It was a change of pace today, I was still ‘conferencing’ but instead of tackling the politics of mental health nursing (which I covered at Horatio and Middlesex Uni over the last two weeks) I joined a Westminster Briefing event in London. 

My session was in the afternoon but unlike lots of speakers I come across, if possible I like to join in full events. There’s a few reasons for that:

  • As a speaker at most (sadly not all) events, you get to join in the conference for free. I have never been to a conference where I haven’t learnt something so I try not to miss out. 
  • I like to share information from conferences that I attend with members via Twitter. I appreciate that for most of our members, they find it difficult to either get paid release to attend events or get funding to pay conference fees. Twitter doesn’t replace this but hopefully it helps a little bit. 
  • It’s a great way to meet people that have things to say. Often I’ll invite them to write for one of the Unite in Health professional journals and therefore it’s another way to make sure Unite members get to learn something new. 

Back to today’s event!

It started with an intro from Sally Lawson (Head of Consultancy & Training Development, Heritage Care), who I felt did a great job chairing the day. Lots of quick reflections both after each speaker and at the days end. She also could throw in the odd reference backing up a resource suggested or statement made by speakers and delegates. 


The first speaker was Chris van Stolk (Vice President, RAND Europe) who spoke about ‘Learning from latest research‘. 


Much of his quoted research came from ‘Britains Healthiest Workplace‘ scheme, which although currently collating information for the 2017 results, he could talk about last years results. He reported that this identified particular problems for public sector workers and the low paid (with income between £10-20k being identified as a ‘problem range’) and that ‘financial concerns were prevalent‘. 

Credit: @Eric_Barratt

van Stolk raised an interesting point in stating that employers in the U.K. were less likely to invest in support for their staff because of the nature of the NHS, providing universal support. He felt that there could be ‘fiscal incentives‘ introduced for employers that would support them to do more. 


Next up was Madeline McGivern (Head of Workplace Wellbeing Programmes, Mind). She spoke about ‘Changing working cultures to promote mental wellbeing‘. 

McGivern had lots to cover as she rattled off a number of resources that Mind makes available for employers. She spoke about tools and resources like; The Time To Change employer pledge; Mind’s Blue Light campaign; and, their workplace resources. She also highlighted rather nicely the importance of HR professionals looking their wellbeing too with ‘put on your own mask first before helping others‘. I spend a fair bit of my life on planes and I wondered whether this advice would be listened to in the same way that it often appears on flights. The first time you’re all ears but after a short while, you’ve got your tablet device on, with headphones in, even if they ask you not to. 


Next, it was Louise Aston’s turn (Wellbeing Director, Business In The Community) speaking about ‘Leading on mental wellbeing: Transforming the role of line managers‘. 


Aston’s talk included discussion about a model that they had developed with their partners, the ‘Workwell Model‘ which was described as a ‘whole person approach’. In developing the model they uncovered a disconnect between what managers thought they were doing and what employees thought. They also uncovered ‘disappointing responses‘ to employees when they raised issues. 

Aston finished with 3 elements of BITC call to action:

  • Talk
  • Train
  • Take action

The final pre-lunch session was delivered by Eric Barratt (Senior Project Manager, Health Innovation Network). 


Barratt spoke about the 1.3 million staff in the NHS and reminded everyone about the link between staff wellbeing and patient outcomes. An example of an NHS employer response that would warrant some more looking in to is at Guy’s & St. Thomas’ where they’ve developed #HALT for their staff. 

I couldn’t help but think back to my old days as a staff side rep in the NHS. At that point we had the national ‘Improving Working Lives’ programme. I wonder how much we’ve had to reinvent the wheel because initiatives we’re undermined by the change of government in 2010? 


After lunch, we returned to the first afternoon speaker, Helen Davies (Research & Evaluation Lead, City Mental Health Alliance). Her session included looking at ‘How mental health problems can present in the workplace‘. 

Next up was me. Throughout the morning it had felt like I was playing PowerPoint bingo. As different speakers took to the lecturn I kept hearing segments from the talk that I would be delivering. Part of me thought, ‘wow this is great’, it means that what I want to say is agreed with. On the other hand I didn’t want delegates to get bored hearing the same thing twice. I started with a notice of how some bits of my presentation would be glossed over so people didn’t get déjà vu. 


I was asked to cover three topics:

  • Identifying problems and offering support;
  • Referring employees to professional help; and,
  • Developing effective policies and procedures for when problems arise.

First however I started with the questions ‘are trade unions important?‘ You’ll be unsurprised to hear that I believe that they are. The TUC gives 3 reasons for this, related to mental health:

  • Ensuring they can negotiate effective policies with the employer;
  • Ensuring they can represent members with mental health problems effectively; and,
  • Helping inform and educate their members and representatives to understand the issue.

As a side note, I had thought it interesting that up until this time, no one had mentioned trade unions in either earlier presentations, questions or answers, even when a few of the questions would have benefited from the reply of, ‘get your local trade union involved’. Looking at the delegate attendance list, I did wonder whether this could have been because of the industries and jobs represented. Hopefully my session readdressed this missing balance.

I covered the first point, ‘identifying problems and offering support’ by highlighting the resources that Mind have on their website. There’s lots of detail about mental health and workplaces on their website. I also encouraged organisations to sign up personally to the Time To Change pledge. Again there’s lots of information on their website about this.

This all fits in with Mind’s 3 step strategy:

  • Promote wellbeing for all staff;
  • Tackle the causes of work-related mental health problems; and,
  • Support staff who are experiencing mental health problems.

I also spoke about the Health and Safety Executive management standards for stress. Again interestingly, I don’t think anyone else had mentioned HSE up till this point.

When I moved on to discuss referring employees to professional help, I highlighted resources like the Samaritans helpline, including stating how this is both a freephone number and doesn’t appear on peoples phone bills. I also shared Rethink Mental Illness’s advice on when to get help and support.

I finished the session by giving some important starting places for designing effective policies locally, finishing by highlighting how all this will be much more successful if its done with local trade union colleagues involved. If you’re interested in looking at my slides from the day, you can find them here: 1 / 2 / 3.

Now that I could relax, there were two final sessions of the day. The first was Prof Diana Kloss (Chair, Council for Work & Health). She gave an interesting talk which included lots of examples of cases that had either been won or lost at employment tribunal. 


And then finally, Rosie Clark (Senior Inclusion & Diversity Consultant, Inclusive Employers) finished off by giving a ‘Practise based workshop‘. 


This session included us breaking in to groups to look at clinical diagnosis, descriptions of conditions and their signs and symptoms and us matching them all up. My group got 7 out of 9 which we were pretty proud of!

Proud to be different – #MHProud17

Watching my twitter feed over the past 7 days, you’d be forgiven for thinking that all I do at work is attend conferences. Still coming down from the buzz, and exhaustion, from the 4th Horatio Festival on Monday, today I’ve been at another excellent event. This time it was the ‘Proud to be Different Mental Health Conference‘ organised by Nicky Lambert, associate professor at Middlesex University, but much more importantly an excellent member of the MHNA Mental Health Nursing journal Editorial Board. I knew I was in for a great day as Nicky had kindly invited me to the inaugural event last year, and this year she’d done me the honour of asking me to speak. 

For a change after the last few days of torrential rain, I turned up to the Middlesex University campus in glorious sunshine. That made the decision to give our new MHNA teeshirts their first official outing an even better choice. It was a good opportunity to give people a social media plug that I had pens and journals to give out and everyone had a useful term of reference. 


It was then in to the first session of the day with welcomes from Jan Williams and Oliver Shanley (Regional Chief Nurse for London). He asked that we start with a quick ice-breaker where we discussed our own inspirations. Under pressure I spoke about my family and the families that I met as a health visitor, sometimes doing much with very little. Shanley gave two references that he encouraged everyone to look at once away: Maya Angelou’s reading at Bill Clinton’s inauguration; and, the NHS England, Molly Case composed poem 1,000 days. 


Credit @HeidelKarl

It was then the turn of Mary Sexton (Executive director of Nursig, Quality and Governance, Barnet, Enfield and Haringey) and Caroline Harris-Birtles (Acting Director of Nursing, Camden and Islington) to give their welcome. They included a mention of the CNO and NMCEnabling Professionalism‘ document from last week. They asked for a show of hands of those who had read it. It didn’t look like many apart from I put their hands up. Harris-Birtles also set 3 goals for today which we were set to return to later.

The next session saw Dr. Cecilia Amin (RCN President) speak. Her focus was on leadership and covered information as to the different foci that the RCN is taking on the issue. She had mentioned in her speech that she had just come from #RCN17 where there had been a number of debates about mental health. In the brief Q&A session at the end, I took the opportunity to ask about the debate around mental health ‘places of safety’, raising concern that what had come out of the conference hall was being perceived by mental health professionals, and more importantly service users, as a negative debate and resolution. Amin reassured me that there would be clarification coming from RCN Council and the Policy Unit and apologised for any confusion created


It was then time for the first round (of 4) concurrent sessions. I decided on joining in with ‘Nursing in prison‘ with Sue Bell and Maddie Ryan. 

In the second round of concurrent session, I joined Michael Traynor whilst he spoke about ‘What’s wrong with resilience?‘ As I said on Twitter, this felt like a really good evidenced-based warm-up for my session later. 


Instead of swapping rooms, I stayed to listen to Michelle Simmons-Safo and Marvin Nicholls speak about ‘Spiritual and religious beliefs‘. As well as lots of information about the subject, they also gave examples of their responses to service users who had wanted to discuss and/or practice their religion whilst receiving care. 


After an excellent lunch, it was then back to a session from Prof. Carmel Clancyon drugs‘. It included a quick quiz (Q1, Q2, Q3 & Q4) which explored our own preconceptions on drugs and resulted in the only injury of the day where a delegate was hit in the head by the microphone that could be tossed about. I had to leave this session early so I could get set up for mine. 

My session ‘The politics of mental health and mental health nursing: Why it matters‘ was in the next group of concurrent. I was happy with my turn-out of about 10-15 delegates but then when the main session kicked out, I was really pleased to be joined by lots more, meaning a full house, with people being turned away at the door. Although it would have been easier to repeat the session that I did last week at Horatio, I changed this a little, especially as the #GE17 manifestos had been launched by the majority of the main political parties (By the way, if you’ve not read the, yet, I’d encourage that you do. You can see the mental health pledges here). If you’re interested to look at the slides I used, you can have a look here 1/2 & 2/2.

Credit @AsterDaniel1

After my session, I could relax back in to delegate mode where I listened to Suzanne Traynor & Fiona Cameron speak about the ‘Digital Care Academy‘. I’m hoping this will feature in a future #MHNjournal as it was a pretty interesting proposition. 


After #CakeBreak (if that’s not already a thing, it should be and me and Nicky are copywriting it!) I listened to Alfonzo Pezzella speak about ‘Out and Proud: Responding to LGB&T needs in mental health services‘. Listening to Pezzella speak at last years event was one of the contributing factors as to why I encouraged a #MHNjournal special edition on protected characteristics and mental health. It feels a nice symmetry that Pezzella has authored an article in the journal which will be published in a few weeks time. 

In the session we got a history of how homosexuality was, until recently, considered to be a mental health condition and a few case studies as to how abhorently society has, and in some cases, still does treat people badly because of differences. As Laura Foley tweeted, it felt right that we finished the ‘proud to be different’ conference with these messages


With all the sessions completed all that was left was to hear closing speeches. It was checked that we had fulfilled our goals for the day, and rather nicely delegates were asked to give their highlights. I would have said Traynor’s session but my day was made when someone said my session had been really inspirational, and was their highlight. That is going right in my NMC revalidation file!

Well done to Nicky and the team at Middlesex University and I hope you’ll invite me back next year!

Horatio recap

Between 11th and 14th May 2017, a delegation of Unite/MHNA representatives attended the 4th Horatio European Festival of Psychiatric Nursing in Malta. The title of the festival was ‘Working in Partnership’.


We generated a large amount of material at the event and this blog collates it altogether in one place so members and other interested parties can feel like they were there.

Daily blogs

Links to Storify

Unite/MHNA delegates on Twitter

Presentations delivered by Unite/MHNA delegates

  • Building the bridge between theory and practice – Athia Manawar & Evridiki Anagnostara (United Kingdom)
  • Exploring the transition journeys of newly qualified mental health nurses – Hollie Roblin (United Kingdom)
  • Politically Engaged Nursing Practice – Nicky Lambert, Jonathon Slater & David Munday (United Kingdom)
  • Black Magic, Jinn and Evil Eye versus Mental Health – Athia Manawar & Evridiki Anagnostar (United Kingdom)
  • Chief Complaint Orientated Cognitive Behavioural Therapy for Psychosis (C-Co) in Conditions of High Security (HS): An Organisational Case Analysis – Jonathon Slater (United Kingdom)
  • Exploring Best Practice in Co-Producing Qualitative Mental Health Research – Nicky Lambert & Sarah Carr (United Kingdon)
  • How the physical health needs of mental health patients can be met in psychiatric inpatient settings – Evridiki Anagnostara & Athia Manawar (United Kingdom)
  • On being assessed…An auto-ethnographic exploration of a recovery journey from psychotic patient to award winning nurse psychotherapist – Jonathon Slater (United Kingdom)
  • Being a radical mental health nurse – George Coxon (United Kingdom)

Poster presentations produced by Unite/MHNA delegates

Reflections from George Coxon (Unite/MHNA Organising Professional Committee chair)

Some of the highlights and enduring themes from the 4th Horatio European Festival of Psychiatric nursing

Taking time out of ones often hectic schedule, a change of scene, and immersion into the wide varying perspectives of fellow Mental Health Nurses (MHNs) is a rare treat.  I have had the good fortune of travels to meet fellow MHNs as far away as China, USA, Helsinki, Stockholm, Istanbul, and most recently Iceland and this gathering in Malta again proved a really validating and inspiring experience.

In setting out what were for me some impactful highlights I must firstly apologies for the sizable range of other moments in this rich 4 day festival.  The mere fact that our MHNA supported contingent of activists were able to get to know one another better had huge value for me. This included having a personal share of Editorial Board member, Jonathan Slater’s very powerful auto-ethnographic narrative (due to its timing clashing with my own workshop). This being one of the examples of the strengthened insights gained into our respective career and personal journeys bringing us to our work within the MHNA.

I will however now share my key messages and prominent headlines from the festival:

  • The emerging themes in discussions with European MHN colleagues led to a realisation for me that work on a ‘Reimagining of MHN Roles and Work’ is much needed – this may be constructed around another perhaps emerging epiphany of the 8R’s of MHN work
  1. Resilience
  2. Robustness
  3. Receptive
  4. Reflective
  5. Responsive
  6. Resourceful
  7. Resourced
  8. Rewarded
  • Of the many plenary presentations the most memorable and pertinent included that from fellow UK presenter Jon Allen who like myself has crossed the lexicon from pure NHS work to work across social care – owning care homes, linking in a plural and collective portfolio like way to support MHN work at the highest level and advocate always for strong mental health values and prominence
  • I attended many of the workshops and stand out sessions included the one on ‘Black Magic, Jinn, and Evil Spirits & Mental Health’ led by fellow MHNA colleagues Athia and Evri – a packed session attracted by the very enticing title but not let down by the manner and content of the workshop itself
  • Another stimulating subject in one of the workshops led by Sharon Picot was titled ‘Dancing with Ravens’ and asked the question – how are we addressing end of life care for those people with life-long or long term mental health conditions – we know about the life expectancy gap related to a person living with an enduring mental illness but rarely address the themes about ensuring good palliative care for those needing it. My commissioning history in a senior NHS role had looked at this concluding much more needs to be done to address the often horrendous neglect in this important area – I have already shared the issue as a project plan with local hospice colleagues and will keep in touch with Sharon too – perhaps a short feature in our MHNJ way be required
  • Another conversation had during some downtime (not that there was much of that in such intense and stirring company) was the question of INSPIRATION and where our MHN leading voices are currently – who is shaping and influencing policy and practice?, who is offering a vision for MHN sustainability in the future? How can we be more dynamic, energised and as per my workshop focus ‘irresistible’? – work in development on this and an area we must address in a determined and progressive way
  • There were several other triggers from not only the presentations and workshops but also the passing thoughts and ideas that were prompted by being challenged by much of the content of the event – the value of attending this type of gathering has so many facets too – validation, mutual ‘seed planting’ of topics and themes, point to takeaway and test out with home based colleagues, vindication of current approaches used in our work, much new data and comparisons and an appreciation of how well our services stack up in many areas against those of our European counterparts and how MHN roles are seen and provided in a Europe wide context too. Networking with colleagues is always stimulating and has immense benefit in how best practice and exchanging innovation achievements create improved care and the working life of MHNs.

I would most certainly like to thank Unite in Health for supporting my attendance – particularly Dave Munday, Leona Sanders, and Colenzo Jarrett-Thorpe for all they have done to ensure we were able to have a high profile involvement in the Festival and receive great benefit from the experience too.

Horatio day 4 – Is this really the end?

3 days down and we’d arrived at the last day of the 4th Horatio Festival in Malta. If you haven’t read the reports from previous days, you can click on the links to find out what you missed out on! (Day 1, Day 2 and Day 3).


Jon Allen (UK 🇬🇧) was the last keynote speaker who took, what he described as the ‘grave yard slot’. In it he looked at ‘Until death we do part: Learning from catastrophe‘. This concerned exploring catastrophic events leading to the preventable death of service users or other persons. Allen stated that in 2015 in the UK there were ‘on average 70 to 80 hoimicides by people in receipt of mental health services’. This number was not reducing whilst the overall number of homicides was. 


A preventable death was defined as, if professionals had;

  • the knowledge;
  • the legal means; and,
  • the opportunity to stop the incident from occurring but did not take steps to do so.

Allen then spoke about 2 case studies. Ms A and Connor Sparowhawk. He then spoke about consequences following the case studies,  ‘what could have been done differently‘ and then spoke about ‘human factors’ and ‘checklists’ arguing that there should be research done to see if a change in approach would help


We then had the last concurrent, workshop and symposium sessions. Again MHNA was well represented with Jonathon Slater delivering his third session and George Coxon delivering his first. I joined George where he delivered a workshop on ‘Being a radical mental health nurse‘. For those that have heard George speak, you’ll know that he likes a mind-map.  


If you want to read his thoughts on this subject, which he penned before the last UK general election, you can read the Mental Health Nursing journal article which I shared. There was a few ideas that I’ll be following up on, including my favourite, the 7 ‘R’s’ of mental health nursing.


Jonathon’s concurrent ‘On being assessed… An auto-ethnographic exploration of a recovery journey from psychotic patient to award winning nurse psychotherapist‘ received excellent reviews and also appeared to generate lots of discussion and debate which wasn’t confined to the room


It was then time for closing speeches and the closing ceremony. Juxtaposed with the opening, which you’ll remember was entertained by a rock band, the closing was a totally different pace with a wind quartet providing a few songs to help with some thoughtful reflection. For our group its was done via our WhatsApp conference group, which was a great way to reflect amongst ourselves whilst listening along. 


All that was left was to say goodbye to friends old and new from across the world and wishe each one of them a safer and enjoyable journey home. It was also a chance for me to thank our MHNA reps who had been such excellent advocates for both MHNA and the mental health nursing profession in the UK.

Horatio day 3 – Over half way

It’s Saturday and my normal routine has been disrupted. Normally at 9am I’d be on a start line, ready to run my weekly 5km run at one of the ParkRun events in England. As it’s day 3 of the 4th Horatio Fesitval however I’m in Malta and sadly they haven’t taken up the #ParkRun challenge yet. Not to be dettered however, Jonathon and I still got a 5km run in, running along the coast at St. Paul’s Bay.


Once back, and after a quick swim, a shower and breakfast, we were ready for the 3rd day of the festival to start. 

The first speaker was Michel Probst (Belgium 🇧🇪) who was talking about ‘Physiotherapy in mental health: A puzzle piece in the transdisciplinary mental health care?‘ He started by saying that he often ‘hears surprise‘ that physiotherapy is involved in mental health services. To make sure we weren’t one of these people in future, he showed us what physiotherapy can offer people with mental health problems. He also highlighted IOPTMH and shared their objectives.


We then split into the concurrent, workshop and symposium sessions. Again, MHNA had an interest in these, where Evri and Athia we’re once again doing a double act. This time they were speaking about ‘How physical health needs of mental health patients can be met in psychiatric inpatient settings‘.

Before that though, Liesbet Van Bos (Belgium 🇧🇪) spoke about her project ‘pArticipation: Art-project throughout the social map of a city in Belgium‘.


In her presentation, she asked us to think about citizenship:

‘Citizenship at this moment is rather a policy concept than an instrument’

A main point of Evri and Athia’s session was the unacceptable fact that people with mental health problems can die 20 years before their peers. Evri encouraged delegates to look at the Department of Health, and MHNA supported, resource ‘Impriving the physical health of people with mental health problems: Actions for mental health nurses‘. 


The concurrent session finished with Herbert Mwebe (UK 🇬🇧) who kept the theme going with ‘Physical health care monitoring in mental health settings‘. 


Mwebe asked nurses to consider their answers to a number of questions in their own inpatient and community settings. 


Back in the main hall, Martin Ward (Horatio President) presented the inaugural Horatio Fellowship to Des Kavanagh. Des was the previous president and had been involved with Horatio since its inception. Aisling Culhane also spoke about Des’s achievements for members of the (Irish) Psychiatric Nurses’ Association.


It was the concurrent time again. I joined in the session delivered by student mental health nurses from Malta (🇲🇹). As part of their 3rd year studies, they had developed a poster campaign under the #EndTheStigma hashtag. 
When we had been shown all the posters they asked for our advice in terms of any changes or next steps. I suggested that the students look at Time To Change (🇬🇧) and look at how they had surveyed service users to see what they wanted. I highlighted their research that suggested that it was important to provide some positive messages. 

Other MHNA reps were spread out across other concurrent tweeting feverishly (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11)!


Back together, we had a keynote from occupational therapist, and COTEC Pesident, Stephanie Saenger. Her session ‘How do you do? Best practices of collaboration, partnerships and integrated care in occupational therapy and mental health‘ included a quick chance to speak to the other delegates around us. I spoke to nurses from Australia (🇦🇺) and Germany (🇩🇪), again highlighting the international nature of the event. Saenger took time to highlight the skills that OTs bring to mental health and also asked what ‘shape’ professional are you?

I then had to brush off my chairing skills as I’d been asked by the conference organisers to chair a session the next next round of concurrent, symposium and workshop sessions. I was assigned a concurrent which included 2 speakers, Áine Kelly (Ireland 🇮🇪) and Berno van Meijel (Netherlands 🇱🇺). 


Kelly spoke about a leaflet for service users and relatives in her session ‘Mental Health nurses supporting carers during acute admissions using Quality Improvement Methodology‘.


van Meijel spoke about ‘Somatic screening and lifestyle interventions in patients with severe mental illness: Opportunities and challenges for mental health nurses and clinical nurse specialists‘. 

With the festival sessions over for the day, we had a short break in proceedings before the ‘Horatio Expert Panel meeting‘. The meeting was led by the joint chairs, Roland Van de Sande (Netherlands 🇱🇺) and Michael Löhr (Germany 🇩🇪). At present Horatio has this expert panel which should be called on to provide advice to the board, however it was acknowledged that it wasn’t very active. As Van de Sande stated, he wanted to create version 2.0. 


The discussion included consideration as to what the group should be called. I also asked for clarity as to the structure that the group sits under and how it can be made sure that this (and the Horatio Board) ensures it secures a mandate from the 26 European organisations. I gave the example of the European Consensus Statement referenced the day before which had been developed in partnership with Horatio, but had not been shared in advance with the member organisations (and hadn’t been sent to the expert grou). The outcome was that the co-chairs would write to previous and prospective members and ask for their feedback on next steps.

The day was then capped off by the Festival party. We had been promised a BBQ which I was looking forward to, especially after the great setting of the networking session on Thursday. I’m guessing that this was being used for a wedding as we were told that due to concerns of rain, it would be an indoor BBQ. Other MHNA reps were much more resilient than I, as I gave relatively early excuse and headed to bed.