And, In the End, what counts is the difference we make

Well the countdown is nearing its end.  Next Tuesday I start my retirement, something that fills me with mixed feelings. My first proper job was with Sainsbury's, the supermarket chain. That feels like a long time ago. I ‘fell’ into nursing in the mid 1970’s, and equally, I ‘fell’ into university life in the mid 1990’s. Both of these major chunks of my adult employment, nursing practice and nurse education, have been immensely fulfilling and very rewarding. So I'm going to be a little self-indulgent with this week’s blog and reminisce for a while.

Qualifying to become a nurse was hard work, but also great fun. My student cohort numbered just 14 students, and we were pioneers of self-directed learning using rudimentary computer based learning materials. I remember my Ward Management assessment involved me taking a mini bus full of service users with complex mental health problems to the Builth Wells Agricultural Show. It was a great day out and I passed my assessment. Once I qualified, I worked in Wales during a time when hospital care for people with learning disabilities was being replaced by community provision. I had a wonderful job as a rehabilitation and resettlement Charge Nurse. One of the ‘skills’ I acquired was to be able to teach others how to use a ‘twin tub’ washing machine to do the laundry – younger readers ask your parents what this means.

I moved to Manchester as the commissioning nurse for an adolescent forensic secure unit in the mid 1980’s and have never really moved out of the North West since that time. Whilst ‘going where no RMN has gone before’ was exciting, after a while the forensic service didn’t provide the challenge I wanted.  I became the Nursing Officer for acute and community mental health nursing services just as we were developing some of the first community mental health centres in the country – it was my first real taste of what can be achieved through effective multi-disciplinary working. It was a brilliant time and absolutely prepared me for next role, as Director of Regional Specialist mental health services, most of which were provided across the entire North West Region, whereas others were national specialist services.

If I wanted challenges I certainly got them with this role. The first was beating my boss to securing the job, a real challenge the day after I started! However, he was a good man, and became a great colleague and friend. He even taught me to play golf, and yes, way back then, a group of us health service managers and clinicians would occasionally spend Friday afternoon playing a round of golf. Definitely a different era…

And then 22 years ago I moved from the NHS to HEI, and started a second career as a University Lecturer. It took me 10 years to become a professor. The path was a tough one at times, but I did benefit from having a couple of mentors and colleagues who provided me with many opportunities, something that I have tried to do throughout my university career. In 2007, I became the first Executive Dean at my university, head up a School of Nursing. It was a dream come true and a dream job bringing together my love of nursing and my passion for education and research! 

Looking back over this time I am very grateful to have been provided with so many opportunities; opportunities to travel the world; opportunities to gain a voice in presenting papers at conferences, and publishing in journals and books. I’ve been fortunate to meet so many people, some famous, many not, but each one has added something to my view of the world and helped make me the person I am today. Of course I am remembering the good bits, and there were many, but I along the way, I have made mistakes and some of my decisions haven’t been that clever. Thankfully, I have always had family, friends and some wonderful colleagues to help me through those times.

It was one of my colleagues who inspired me to use social media as way to share what it was I was interested in and what I was doing. I started writing this blog, in the summer of 2009, and every Sunday since then I have posted a blog. It has been a great opportunity to talk about my thoughts on the world I find myself in, the one I contribute to and the world I would still like to see. And thank you dear reader for allowing me this indulgence. Whether this is your first experience or you have been reading them since the start, your support has been brilliant. Thank you.

As for the future? Well subject to the University Senate approving my application, I will gain my Professor Emeritus status. This will allow me to still use my voice in pursuit of my ambition to improve the care and opportunities for those who experience a mental health problem. As a society we have come a long way since the mid 1970’s and the start of my journey, but there is still a long way to go if we are to truly stamp out the self and societal stigma still associated with those who experience mental health problems.  

The last line, of the last song (The End), on the last album the Beatles ever made, has been described as 'this is how you finish a career'. Despite my retirement, I am not finished yet, and I guess many readers of this blog will be in the same position. So taking the liberty of a couple of small changes I leave you with almost Paul McCartney’s lyrics:

And, in the end

What really counts

Is the difference we make

And yes, I will be here, same place, same time next Sunday…

Professors, Publishers and Dinosaurs: Jurassic Park Revisited

My six year old grandson Jack is currently into dinosaurs. He seems fascinated by them, can pronounce all their different names and can tell you if they flew, swam, were big or small, what colour they were and what they ate. So last Tuesday it was such a shame he wasn’t with me at the launch of the Economic and Social Research Council (ESRC) Manchester Social Science Festival. The launch took place at the Manchester Museum, in a room totally dominated by the skeleton of Stan the T Rex. I was pretty thrilled, Jack would have been in seventh heaven!

The 3 big Universities of Greater Manchester (Manchester Metropolitan University, University of Salford, and the University of Manchester) jointly facilitate the festival, which runs between 4-11 November. If you happen to be in this part of the world and want to see what’s on, you can find out right here. Through the Festival of Social Science the ESRC aims to facilitate opportunities for social science researchers to share their work with non-academic audiences, and usually this is done through very creative events and approaches. The festival is aimed at all, but is particularly aimed at young people in an attempt to raise awareness of the contribution the social sciences can make to the UK society’s wellbeing and economy.

Impressively, a large number of my colleagues were making a contribution to this years festival. I was at the event in the company of the School of Health and Society professoriate. This group make a huge contribution to ensuring that the various curricula in the School remains evidence based and contemporary. They undertake research in a variety of fields, and my own contribution to this research portfolio has been in the areas of mental health, child abuse, and service user involvement.  Much of this research has been undertaken with my long term colleague and friend Sue McAndrew. It was great to learn last Tuesday that Sue had gained her own chair as Professor in Mental Health and Young People at the University – well done Sue!

Sue and I have edited a couple of books in our time and contributed chapters to many others. However, it seems that the desire by professors and other academics to write books is on the wane. The value and viability of the book publishing enterprise has been called into question in recently published research ‘Academic Books and Their Future’. The study was funded by the Arts and Humanities Research Council (AHRC) and the British Library. There are strong career incentives for academics to write and publish books – not least because it’s a critical criteria for those wanting to become a professor. It was reported that with library budgets for buying new books remaining static, and with traditional book retail sales falling over the last decade, these days the business case for the publication of new titles is often now based upon just 200 copies.

Such a low number is not going to inspire many publishers to back a new book! In the new digital age, people are gaining access to much more information and materials on-line, often in some form of open access publication or website. Arguably, journal papers are much easier and quicker to write and get published than books. Although in some subject areas, like the arts and humanities, even this can be difficult. Free and unrestricted accessibility to academic papers is set to continue to develop.  Sci-Hub, set up in 2011 by Alexandra Elbakyan, a software developer and neurotechnology researcher from Kazakhstan, aims to spread knowledge by allowing people free access to what would often be 'paid for' content

Apart from open access journals (where the author pays the publisher for their paper to be published in the journal) most academic publishers (of journals and books) will charge individuals or their institutions for access to their content. Such access charges rise every year. Even great universities like Harvard have reportedly cut down on the number of subscriptions they hold each year. Powerful academic publishers such as Elsevier, have taken Sci-Hub to court for copyright infringements. Some brave academics have responded by calling publishers parasites benefiting on the back of their labour. As a consequence of these legal battles, the original site is now suspended. However, it is still possible to gain access to the papers it holds, which in March 2017 numbered some 62 million. It’s worth noting that Sci-Hub receives over 200,000 requests a day for papers. In 2013, Sci-Hub started a partnership with LibGen (Library Genesis) which is a huge online repository of academic books and documents, hosted in Russia. Since that time Sci-Hub has downloaded approximately 60 million different articles from the LibGen database - perhaps a case of From Russia with love. 

Changing such well established business models will always be challenging – we only have to look at what happened to the music industry with file sharing services such as Napster – a service that arguably permanently changed the music industry. However, such changes also come with a degree of risk. For old and new professors alike, the publishers who publish their research and scholarly thinking, and the likes of Alexandra Elbakyan, there are probably lessons to be learnt from a rereading of the conceptual story dramatized in Jurassic Park. 

This Weeks Home Work: carry on talking, but let’s have more doing!

I wonder what you did last Tuesday. I spent the day working at home doing various things. My day started by exploring and contributing to what was being said on social media; walking 7.5k (my everyday prescription for promoting my own mental health and well-being – something Maureen Watts is also a fan of – more later); writing a slightly overdue report; spent a little time continuing with restoring the Horwich garden; having tea with 2 of my grandchildren, before watching catch up TV in the evening. An ordinary day I guess, minus the morning and evening commute. Last Tuesday was the 10th Oct 2017 and it was also World Mental Health Day 2017 (WMHD17).

WMHD17 is the day the World Health Organisation focus on spreading awareness and understanding about mental health. Every year a different theme is chosen and this year’s theme was mental health in the work place. It’s estimated that some 15% of the working population will experience mental health problems and 13% of all sickness absence days in the UK are due to a mental health problem. Women in full time employment are twice as likely to experience a mental health problem than men. However, recent research by the Mental Health Foundation, Oxford Economics and Unum found, almost counterintuitively, that employed people living with mental problems contribute £226 billion to the UK GDP, which is nearly 9 times the estimated cost to economic output due to mental health problems.

Interestingly, 86% of the study’s respondents felt that their job and being employed was important to protecting and maintaining their mental health and wellbeing. I say interestingly as in the 11 years I was a Dean of a very large health school, many conversations with Trade Union representatives revolved around responding to claims that decisions taken by myself or changes introduced by the wider University management team resulted in many, many (always never more precise than many, many) colleagues experiencing mental health and wellbeing problems. It’s also interesting to note that the report suggested that ensuring there is better mental health support in the workplace could actually save £8 billion a year for UK business.

It’s the organisations culture that can provide the real catalyst for change and ensure there is better support available. The Hoxby Collective, who provide a refreshing new approach to how people work, recently reported that 33% of workers said they experienced mental health problems as a direct result of the explicit and implicit expectations of their employers. For example, 61% of those surveyed reported that they felt pressure to work late, because their manager works late or they were keen to be noticed in order to enhance their promotion prospects. In some organisations this can be more noticeable than others. At the university, academic staff have a great deal more flexibility over how and where they work than say the professional support staff, who are often expected to work a fairly rigid 9-5 day.

Managers need to lead by example. For many years my working day would start at 06.00 and finish any time around 18.00, with there often being evening meetings or events to attend as well. I was very conscious that others might see this model of working the norm and I am very grateful that so many people didn’t! Eventually, this pattern of working contributed to my own experience of mental health problems, and yet for a very long time nobody in my organisation ever commented on the risks I might be running in adopting this approach to work.

Ironically perhaps, ensuring the good mental health and wellbeing of my colleagues was an important element of what I believed I was there to do. I also believed (believe still) that I was open, supportive and facilitative when colleagues shared their problems and concerns with me. I sincerely worked to ensure that colleagues achieved a healthy work life balance while completely ignoring my own advice! And whilst I have been well rewarded in many ways over the years, such success has come at a cost, mainly in broken and fractured family and personal relationships.

I fully support initiatives such as WMHD17, and the impact raising awareness of mental health issues has on society’s views of mental illness is welcomed. Conversations and discussions about mental health are growing more common, but sadly, social and self-stigma is still evident in many areas of our lives. The Royal College of Psychiatrists recently published survey showed the public’s understanding of what is mental health and what a mental illness might be is still very limited, particularly when it comes to understanding how severe some mental illnesses can be. 

It seems to me that there is a gap here – between talking, knowing and doing! Something I guess Maureen Watts knew all about last week. Maureen is the Minster for Mental Health in the Scottish Parliament. Her personal welcome on her web site is ‘Aye, Aye Fit Like!’, which to some I guess sounds parliamentarian. Maureen’s 15 minutes of fame last week was to claim £4.68 for a taxi ride of less than a mile to deliver a speech on the benefits of physical activity on one's mental health and wellbeing. Possibly a case of carry on talking, but let’s have more doing! 

Stopping the Abuse of FGM: tearing down the barriers

For much of last week I was in the city of Berlin attending the 6^th European Conference on Mental Health. I have been to all of the conferences since they started, and the conference has grown in terms of quality and popularity year on year. With my long term collaborator and writer Sue, I presented 2 papers on research that we had undertaken into Female Genital Mutilation (FGM) and into service user anomie and the role they take on as they come volunteers and or mentors to others. Both papers were well received but now comes the task to get them published - a much harder task!

There was an opportunity to see some of Berlin during the conference, and what a lovely city it is too. The autumn colours were vibrant and apart from one day where a near tropical storm tore through the city, the sky remained blue, and warm sunshine made being outside a wonderful experience. One afternoon after the conference had finished I took the 100 bus that runs from one side of Berlin to the other. It’s a cheap way to see the major attractions. I then retraced the route on foot to see all the famous and historical sights. It was a 17k walk.

The most poignant sight visited was the memorial of the Berlin Wall. Lengths of the former wall could be found in different parts of the city, and sometimes these were covered with hugely creative and political graffiti and images. However I went to the official memorial and museum. In the quietness of the afternoon I spent some time reading the fragments of history, and soaking in what was a very sad place to be. One section, now hidden unless you climb the 200 steps to an observation platform, had been kept in its original state, complete with watch tower. It was a bleak and frightening sight.

The pain, hurt and segregation could be seen in the various narratives of people who had been caught up in the building of the wall, and its continued barrier to free travel, families and opportunity. Given it was a mental health conference I was attending, the Berlin wall, and its impact on people’s lives, seemed symbolic of the self and social stigma many people living with a mental health problem experience. That one group of human beings can inflict such cruelty, pain and discrimination to another group and believe this to be OK, defies all sense of humanity and compassion.

This was an issue that the conference audience struggled with in listening to the paper we presented on FGM. Like the Berlin Wall did, FGM violates a number of human rights and principles. It reinforces notions of women having a political, economic, social and cultural subordinate role in society. FGM is often carried out on girls up to the age of 15. Adult women can also be subjected to FGM, for example re-infibulation following childbirth. FGM is commonly performed by traditional practitioners, including grandparents, who have no formal medical training, and often the procedures are carried out without anaesthetics.  The girl is often pinned down by a number of adults complicit in the FGM being performed. It is a form of child abuse.

Terre des Femmes (which translates from the French as Women’s Earth), is a non-profit women’s rights organisation. Founded in 1981, its head office is based in Berlin. According to Terre des Femmes there are at least 58,000 victims of FGM living in Germany, with a further 13,000 girls vulnerable to becoming mutilated. In England and Wales it’s estimated that 137,000 women and girls aged 15-49 are affected by FGM. 

In the UK some 79 FGM Protection Orders have been made since 2015, and although some 9000 FGM cases were treated by the NHS last year, there has so far not been a single conviction of anyone for carrying out, or allowing this practice to be carried out. Unfortunately there is no reliable data on the overall prevalence of FGM across Europe, but it thought there are many hundreds of thousands of women living in Europe who have been subjected to FGM. The largest groups of these women and girls originating from countries in which the practice of FGM is widespread live in Austria, Belgium, Denmark, Germany, Spain, Finland, Ireland, Italy, Portugal Sweden, the Netherlands and the UK. 

There are no easy solutions to stopping this abuse. Education is important and of course support for women affected by FGM is crucial in terms of restoring good mental health and wellbeing – our paper looked at how this could be done through peer mentorship and breaking down long established cultural and social barriers. It took 28 years before the Berlin Wall came down. This barrier was removed because of a thaw in the so called 'Cold War' and a cultural shift in relationships between the East and the West. I’m hoping we don’t have to wait for nearly 30 years before the barriers that prevent us from stopping the abuse of FGM can be torn down. 

Whilst we Plough the Field and Scatter, the NHS still Belongs to the People

Yesterday I had lunch with my youngest son, along with his wife Louise and their gorgeous daughter Carys. The food was superb, and hugely authentic – we ate at the Hispi (Didsbury) restaurant. If you are in Manchester for any reason, give it a go. Food has been on my mind this past week. Last Sunday I went to a Harvest Festival service in a small church known as ‘Ashworth Chapel’. It’s a church with a long history, originally built in 1514, and it stands on top of a hill amid the rolling moors surrounding Rochdale. I like it, partly for the history each stone represents, but also for the quiet and calm feeling sitting inside brings. The services are mainly from the Book of Common Prayer, which, in an age of digital everything, may not be to every ones taste. The church was decorated with flowers and symbols of the harvest, very much as I remember from my childhood. Some wag had even hung a bunch of grapes from the eagle lectern. 

I think it must have been in my childhood that I last sang the rousing hymn ‘We Plough the Fields and Scatter’. Apparently, it is one of the most performed hymns in the UK. One week later, and I am still singing the first verse and chorus. It’s a very infectious tune and I dare you to click on this link and see if the music and words don’t also stay with you for a while. The Harvest Festival service is primarily about taking the opportunity to say ‘thank you’, for the food we enjoy, for those that farm, produce, prepare and make available the results of their labour to the rest of us.

The service is also an opportunity to remember and respond to those who don’t have enough food or other basic necessities. Gifts of food were brought to the chapel and then distributed to those in need during the week. For me seeing the children and families bring their boxes and carry bags of food to the front of the church was a poignant glimpse back to my childhood when my parents encouraged my brothers and sisters and I to do the same thing. And last week I was privileged to enjoy a glimpse back to the work of my friend and colleague Professor Maxine Power. Maxine is currently the CEO of the fabulous innovation and improvement science centre known as HAELO – an organisation that the University of Salford has been proud to be a partner with. Last week, I joined many others who have been part of Maxine’s journey of discovery and achievement, to say thank you and to wish her well in her new role.

Maxine is leaving HAELO to join the North West Ambulance Service as their Director of Quality Improvement. Although she will be greatly missed by many working in health and social care services across Greater Manchester, this is an opportunity for her talents to be brought to bear across the whole of the North West of England. The emergency services in the UK, including the ambulance service, are having to change to meet the increasingly complex world of health and social care. They need to do so in a way that uses the advantages new technologies, might bring to improving the services individuals receive when they most need them. Maxine reminded us all of the opening words of the NHS Constitution:

The NHS belongs to the people

It is there to improve our health and wellbeing, supporting us to keep mentally and physical well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most. 

Regular readers of this blog will know that I am a big fan of the NHS and of what collectively, we have been able to achieve in tackling disease, treating illness and responding to trauma. It was great to read last week that the UK has joined other countries within the European Region in eliminating Measles. Measles is a highly contagious, serious disease caused by a virus. The disease remains one of the leading causes of death among young children globally, despite there being a safe and cost-effective vaccine available. It’s estimated that during 2000 – 2015, measles vacation prevented up to 20.3 million deaths. That the UK has eliminated this disease demonstrates the effectiveness of such a vaccination programme. I have grown to like and appreciate the value of tradition, but increasingly I also see the need to embrace change where this is appropriate to do so. And Joe, think about this for the next time we go to Hisbis for a meal and the bill comes.