Josh Cameron

Uniting Resilience Research and Practice With an Inequalities Approach

The concept of resilience has evolved, from an individual-level characteristic to a wider ecological notion that takes into account broader person–environment interactions, generating an increased interest in health and well-being research, practice and policy. At the same time, the research and policy-based attempts to build resilience are increasingly under attack for responsibilizing individuals and maintaining, rather than challenging, the inequitable structure of society. When adversities faced by children and young people result from embedded inequality and social disadvantage, resilience-based knowledge has the potential to influence the wider adversity context. Therefore, it is vital that conceptualizations of resilience encompass this potential for marginalized people to challenge and transform aspects of their adversity, without holding them responsible for the barriers they face. This article outlines and provides examples from an approach that we are taking in our research and practice, which we have called Boingboing resilience. We argue that it is possible to bring resilience research and practice together with a social justice approach, giving equal and simultaneous attention to individuals and to the wider system. To achieve this goal, we suggest future research should have a co-produced and inclusive research design that overcomes the dilemma of agency and responsibility, contains a socially transformative element, and has the potential to empower children, young people, and families.

Return-to-work support for employees with mental health problems: Identifying and responding to key challenges of sick leave

Introduction This research explored return-to-work and sick leave experiences of workers with mental health issues in contact with acute or community mental health services. Method Using a critical realist methodology with a comparative case study and collaborative design, 21 employed participants recovering from mental health problems participated in semi-structured interviews. Data were analysed using inductive and deductive thematic and constant comparative analysis. Findings While on sick leave, despite a range of challenges, participants treasured their work identities. They were sustained by positive and troubled by negative memories of work. People missed the routine of work and felt isolated. To varying degrees of success, they searched for alternative activities to fill this gap and promote recovery. Conclusion The need for sick leave was not disputed, but an important discovery was its iatrogenic (‘side-’) effects, whereby isolation and reduced activity levels could exacerbate mental health problems. Negative impacts of sick leave need to be mitigated by support to maintain worker identity and orientation and by opportunities and encouragement to sustain routine, activities and social contacts. A new concept of ‘occupational capital’ emerged, comprising accessible external opportunities and supports for occupational participation, and internal capacities and skills required to access these.

Comparison of activities of daily living in two different one arm drive wheelchairs: a controlled trial

Aims. This pilot study measured activities of daily living (ADLs) in users propelling both a standard dual handrim Action 3 wheelchair and a standard Action 3 wheelchair with a Neater Uni-Wheelchair (NUW) kit attachment. The kit consists of a steerable front castor and a single pushrim propelling both rear wheels via a differential. Hypothesis. There would be a difference in the efficiency of ADL skill performance, speed and heart rate. Methods. Twenty non-disabled participants simulating hemiplegia were used in a cross over, repeated measures trial. Assessment of Motor and Process Skills (AMPS) of users undertaking making a bed and laying a table ‘Swedish style’, tasks, were measured. Heart rate at rest and post-task and time taken to complete each task were recorded. Results. Heart rate when laying the table was lower in the NUW (p < 0.005) and task completion time was quicker (p < 0.0001). There was no difference in motor and process ability skills. Conclusion. ADL tasks in the NUW were completed more efficiently with no loss in quality of motor and process skills performance. This suggests that the NUW is a viable alternative to current one arm drive provision.

Ethical Issues in Obtaining Informed Consent for Research from Those Recovering from Acute Mental Health Problems: A Commentary

This study appeared in full in the last issue of Research Ethics Review (2007; 3 (3): 91). It concerned the ethical review of a qualitative research study in which the participants are recovering from acute mental health problems. Debate focussed on the issue of how informed consent was to be obtained.

NHS job shortage: challenges for government, practice and education

Over the past 2 years, educators, practitioners, managers and students have expressed concern because, ‘for the first time in a generation’, there are more health professionals, including occupational therapists, seeking employment in the National Health Service (NHS) than there are vacancies. In response, NHS employers and trade unions have produced an action plan (Social Partnership Forum 2007). This notes the long-term need for newly qualified health professionals despite the impact of financial pressures, which has led to the reduction in available posts. The College of Occupational Therapists has expressed concern to the Health Select Committee about reducing training places: ‘Training people to join the health professions is like turning a tap on and off. The problem with turning it off is that it takes three years to turn it on again’ (Scott 2007). Discussion about how this situation has arisen continues. The action plan from the Social Partnership Forum (2007) makes short-term and long-term recommendations for employers, strategic health authorities and higher education. Potential headline grabbers include the possibility of ‘managed migration’, given that the NHS has historically been an importer of health professionals. Less seemingly controversial recommendations include actions to maximise job opportunities in the NHS; find alternative employment in the wider health and social care sector; and preserve the skills of qualifiers awaiting their first professional post. A potential arena for alternative employment outside the NHS is what has been termed the ‘third sector’. This includes small community and voluntary groups, registered charities, foundations, and the growing number of social enterprises and cooperatives. They are independent from government, have value-driven objectives and reinvest their surplus to further these. The Government considers that a greater role for such organisations in health and social care provision will increase flexibility, innovation and responsiveness (Department of Health 2006). Despite criticisms raised by some unions and professional bodies about the lack of evidence and debate of this strategy and the potential for a negative impact on the quality of care (Limb 2006), the policy is being taken forward. Alsop (2006) suggested that student placements in these nontraditional or role-emerging settings can demonstrate how our profession may help service users and possibly lead to increased job opportunities. A survey of practice placement tutors reported that nearly all provided such placements, although the allocation depended on criteria such as personal attributes and academic profile (Wood 2005). These placements helped the development of a strong professional identity, independent thinking, problem solving, and creativity in therapy planning. These attributes are also valued by employers, in new and traditional settings, as managers call for high levels of autonomy and initiative from new practitioners (Barnitt and Salmond 2000). Such skills may assist students’ transition into the workplace and ameliorate the reality shock described by Kramer (1974) and others. As well as engaging in the political process to debate funding, perhaps it is also time to recommend that all pre-registration occupational therapy students should cross the internal border and do a placement in the ‘third sector’ to equip them for the changing world of work.

The occupation of looking for work: an interpretative phenomenological analysis of an individual job-seeking experience

ABSTRACT This qualitative study explored the meaning of job-seeking, as a human experience and occupation, as it is understood by an individual job-seeker within the United Kingdom. Interpretative phenomenological analysis was used to understand the meaning of job-seeking as a lived experience. A series of three, in-depth interviews were conducted with a single participant at various stages of the job-seeking experience. After individual and cross analyses of interview transcripts, three master themes were developed that demonstrated how the job-seeking experience was understood. These were: (1) understanding the self and identity, (2) understanding relationships, (3) understanding job-seeking as a journey. These results are discussed in the context of previous studies of job-seeking and occupational perspectives that focus on meaning in human occupation. The authors conclude that job-seeking is a rich human occupation in which the form, function and meaning are influenced by internal and external factors related to the person, their occupations and environment. Future research could build on these insights by considering the efficacy of these internal and external supports and how job-seeking varies across different cultural and social contexts.

Collaboration in the design and delivery of a mental health recovery college course: experiences of students and tutors

Abstract Background: Recovery Colleges address mental health challenges using an educative approach underpinned by a collaborative recovery orientated philosophy. Research has been limited with no studies identified reporting research on the design and delivery of a specific course. Aims: To understand how Recovery College students and tutors experience the design and delivery of a mental health Recovery College course, specifically the “‘Building Resilience” course. Method: Thematic analysis of qualitative data related to the experience and process of collaboration in recovery college course design and delivery. Data included 13 qualitative individual interviews with course students and tutors and “naturally occurring” data generated through course preparation and delivery. Results: Findings drew attention to the centrality of: prior experience and design related to students, tutors and the course structure; co-delivery related to tutors and co-learner impacts; and to the course methods and environment. Conclusions: Commitment to collaboration in design and delivery of Recovery College courses can mobilise the diverse experiences and expertise of tutors and students. The environment and methods of learning have a significant impact and should be considered alongside content. Boundaries between people and areas of knowledge and experience that arise can be viewed as sources of creativity that can enrich courses.

Boundaries and Boundary Objects: An Evaluation Framework for Mixed Methods Research

While mixed methods research is increasingly established as a methodological approach, researchers still struggle with boundaries arising from commitments to different methods and paradigms, and from attention to social justice. Combining two lines of work—social learning theory and the Imagine Program at the University of Brighton—we present an evaluation framework that was used to integrate the perspectives of multiple stakeholders in the program’s social interventions. We explore how this “value-creation framework” acts as a boundary object across “boundaries of practice,” specifically across quantitative and qualitative methods, philosophical paradigms, and participant perspectives. We argue that the framework’s focus on cycles of value creation provided the Imagine Program with a shared language for negotiating interpretation and action across those boundaries.

Work-related experiences of people who hear voices: An occupational perspective

Introduction Hearing distressing voices can be a significant mental health challenge, potentially disrupting working lives. Yet few studies have explored voice-hearing in relation to employment. This study aimed to understand the work-related experiences of voice-hearers, including the impacts on their working lives and their corresponding self-management strategies. Method A phenomenological approach gathered data from the electronic diaries of five voice-hearers with experience of working. Data were analysed using thematic analysis. Findings Critical and distressing voices that demanded full attention were most disruptive of people’s working lives, particularly affecting concentration, communication and task completion. At times voices were experienced as neutral and, for some, as supportive of work. Meaningful experiences of work could diminish the negative impact of voice-hearing. A range of resilience strategies were used to manage voices, notably attempts to interact with voices and using activities (including work) to engage or distract them. The diary method of writing about one’s experiences emerged as an unanticipated positive occupational coping strategy. Conclusion Practitioners should pay close attention to the diversity of individual voice-hearing experiences and self-management strategies (including occupational ones) and draw on these to support their clients’ participation in work.