Mick McKeown

The value of involvement from the perspective of service users and carers engaged in practitioner education: Not just a cash nexus

This paper presents qualitative findings emergent from a participatory action research (PAR) study focused on developing service user and carer involvement in a university setting. The involvement of these experts by experience in practitioner education for health and social care, and nursing in particular, is now an international phenomenon. Adhering to the philosophy and practices of PAR, the project and the writing of this paper have been collectively produced. Data has been organised using simple thematic analysis into three broad themes accounting for different ways in which participating service users and carers obtain a sense of value from their involvement. We have titled these themes: a more positive sense of self; social and relational benefits; altruism in activism. Drawing on these participant narratives we develop an understanding of the relationship between involvement and reward that does not simply reflect value in payment.

A critical exploration of using football in health and welfare programs: Gender, masculinities and social relations

This article offers a theoretical exploration of the growing trend in the United Kingdom to utilize football (soccer) practices and ideas in various health and welfare programs, primarily as a means of engaging men. Drawing on critical men’s health studies, profeminist critiques of sport, and the notion of hegemonic masculinities, we survey the “field of play” to elucidate the perils and possibilities of using football in health and welfare programs. We theorize gender as a social relation, inseparable from the way that football operates as a contested and gendered space. We outline the way that football acts as a means not only to reassert, but also to reconfigure, dominant gender relationships and hegemonic masculinity. If health and welfare initiatives are to use football to address welfare issues, then the paradoxes of football, masculinity, and health need to be taken seriously when these initiatives are developed and theorized. We propose the idea of football welfare programs as potential “paradoxical spaces” where participants might be able to consciously reflect on the conflicts and possibilities of using football as a vehicle to improve welfare.

The UCLan community engagement and service user support (Comensus) project: valuing authenticity, making space for emergence

Objective  To develop and evaluate service user, carer and community involvement in health and social care education.

Q methodology, risk training and quality management

The results of a Q methodological study of professional understandings of the notion of risk in mental health services within the UK are discussed in relation to the relevance for staff training and quality assurance. The study attempted to access the diversity of understandings of risk issues amongst a multi-professional group of staff (n = 60) attending inter-agency risk training workshops in 1998. Q methodology is presented as both an appropriate means for such inquiry and as a novel experiential technique for training purposes. A tentative argument is advanced that the qualitative accounts generated by Q research could assist in systematic reviews of quality, complementing the singularly quantitative approaches typically represented in the audit process.

Service User and Carer Involvement in Education for Health and Social Care: McKeown/Service User and Carer Involvement in Education for Health and Social Care

Promoting Partnership for Health. The Comensus Writing Collective: Notes on Authorship. Notes on Language. Introduction. Part I: The Context. 1 Service User and Carer Involvement in Higher Education. 2 The Social and Political Context. 3 Beyond the Campus: Universities, Community Engagement andSocial Enterprise. 4 Research and Evaluation of Service Users andCarers Involvement in Health Professional Education. 5 What Counts Cannot be Counted: Community Engagement as aCatalyst for Emotional Intelligence. Part II: Personal Experiences: The Case of Comensus. 6 Setting up a Service User and Carer Engagement Project:Comensus. 7 Climbing the Ladder of Involvement: A Manager sPerspective. 8 Stories of Engagement. 9 Making Sense of Involvement in Comensus. 10 Shedding Masks: Transitions in Mental Health and Education, aPersonal View. Conclusions. References. Appendices. Appendix 1: Research and Evaluation Planning Worksheet. Appendix 2: Terms of Reference for Comensus Advisory Group. Appendix 3: Year One Issues and Solutions. Appendix 4: Terms of Reference for CIT. Appendix 5: COMENSUS: Action Plan 2009. Appendix 6: Year Three Sub-Groups of The Community InvolvementTeam. Appendix 7: Year 3 Issues and Solutions. Appendix 8: Protocol for the Development of Learning ResourcesInvolving Service Users and/or Carers. Appendix 9: Service User/Carer/Public Consent Form. Index.

The future of mental health nursing: are we barking up the wrong tree?

This commentary has been prompted by a degree of disquiet among the UK mental health nursing community in response to the Shape of Caring Review on the future of nurse education in England (Willis 2015). Proposals for the structure of nurse education have been interpreted as emphasizing generic at the expense of field-specific (e.g. mental health) education, with much specialist training beyond the scope of pre-registration courses (Lintern 2014, Middleton 2015). Specifically, there is a suggestion that student nurses will not enter their specialized field until completing two years of more generalist learning; reminiscent of the previous Project 2000 approach, criticized for supposed inadequate preparation of mental health students because general adult nursing dominated curriculum and teaching (UKCC 1999).

Editorial: Failure to care: nursing in a state of liquid modernity?

There has been significant public interest recently concerning perceived inadequacies in the quality of nursing care. Across a number of settings, there has been a litany of neglect and abuse leading to both accusations of a compassion deficit and counterclaims from nurses and nursing scholars. While some of what we are seeing in the media are moral panic and reporting exceptional cases, there has been an increase in complaints made about nurses in several countries (e.g. UK Government 2013). The number of media stories on the systematic failure of nurses to provide care would seem to indicate at least some level of a problem over and above media hyperattention. We know what makes good nursing and good nurses: nursing is perhaps one of the most highly regulated professions with national and internationally stated criteria for practice and education. Even children know what makes a good nurse (Randall & Hill 2012). We have had countless leadership programmes and health improvement programmes, and yet, we see now the failure of nurses, their leaders and of organizations to put in place safeguards that provide patients and nurses with cultures that consistently deliver safe human care. Why? What we want to argue is that this failure of caring systems is directly related to the liquidification of nursing. Bauman (2000) describes a state of liquid modernity, a phase in the development of capitalism where uncertainty reigns and stability are forever undermined. Without wishing to idealise a supposed ‘golden age’, arguably, in the 1950’s nursing was more ‘solid’. The matron ruled, nurses were educated in hospitals to which they were expected to owe a debt of gratitude and to work in the same hospital upon qualification. There was a sense that one worked one’s way up through a perhaps rigid somewhat militaristic structure of staff nurse, junior sister, sister, senior sister, matron. This solid system had certainty about it, but also nurses were encouraged and rewarded for staying in one place, working for the hospital in which they had trained. Patients too were expected to be in hospital for longer periods. Bauman argues that this solidity and sense of location allows systems to be human. It is worth investing in relationships if you can anticipate a certain longevity within which social ties may strengthen and deepen or if you think you are going to be around if people come back to complain! For nurses, it is worth investing time and effort in getting to know patients and their families as people if you are going to be working in a community over time. Compare this with the more recent liquidification, routinisation and mechanising of nursing. Now, nurses are educated by universities in various hospitals, they are encouraged to seek employment on the ‘open market’. Despite attempts to structure nursing careers (Department of Health 2006), it remains unclear what is required of nurses to progress to clinical nurse specialist or nurse consultant levels. Patterns of promotion, even at the initial clinical levels, vary between employers. There is a much faster turnover of staff and of patients too. Many of the important functions of the nurse are being mechanised often in a bid for alleged quality improvement. The nurses’ role is atomised and restructured as a set of competencies or colour-coded tick-box forms which arguably could be completed by any suitably trained person. Thus, the liquid state is one of fast-moving uncertainty and ambivalence, where it is difficult to establish and maintain relationships. Fear stalks the workforce, the liquid-state fear of being replaced, moved or removed. In the UK, it is claimed that the NHS lost over 6000 nursing posts between 2010–2012 (Campbell 2012). Although the actual number of nurses who are reorganised or made redundant may be relatively small, that is not the point; it is the fear of being reorganised or replaced which dominates and pervades nurses’ thinking. This leads nurses to disinvestment in caring for people as fellow human beings. For Bauman, contemporary society finds itself in a perpetual condition of uncertainty. Attempts to design order into systems, such as healthcare systems, are actually doomed to precipitate unanticipated obstacles and problems, ultimately leading to disorder. In some sense, Bauman is concerned with the potential for realising forms of human autonomy and solidarity, but sees this frustrated by the advancement of a consumerist culture as a characteristic of late capitalism. As such, there is a degree of resonance with earlier writing which explored the alienating effects of workplace technologies or the emotional labour of public service jobs (Hochschild 1983), and these ideas have been applied to better understand nursing roles and experiences (Theodosius 2008). Alienation in nursing work is both similar to that experienced by other workers, stemming from lack of control over ones work and how it is organised, but may also involve some factors fairly unique to nursing, such as dealing intimately with the body in illness which may be beyond the control of the nurse or health care more

Mental health advocacy with black and minority ethnic communities: conceptual and ethical implications.

Purpose of review Recent policy and legislative developments confirm the right to advocacy for people experiencing mental health problems. Provision of mental health advocacy for black and minority ethnic communities is particularly identified as a key objective for Primary Care Trusts. This review considers the implications for commissioners and practitioners of ensuring access to appropriate advocacy for service users from black and minority ethnic community. Recent findings There is a dearth of literature on mental health advocacy with black and minority ethnic communities. The available research suggests that mainstream conceptualizations of advocacy are not meaningful to these communities and this adversely affects access. Advocacy provided by black community and voluntary sector organizations begins with understanding racism and social disadvantage. It is therefore concerned with addressing these inequalities and resonates strongly with current concepts of recovery. Summary People from black and minority ethnic communities are not well served by current provision of mental health advocacy, and there is a risk that this will be replicated in the development of independent mental health advocacy, under the amendments to the UK Mental Health Act of 1983. This largely reflects the conceptualization of advocacy and its purpose. The implications for both commissioning and provision of advocacy are explored.

Service user involvement in practitioner education: Movement politics and transformative change

This paper will attempt to celebrate both key developments and best practice involving the users of health and social care services in programmes of practitioner education in a UK context, and offer a critical appraisal of the extent to which such initiatives meet some of the more transformative objectives sought by service user activists for change. The approach is largely that of a discussion paper but we will illustrate some of the themes relating to movement activism with selected data. These data relate to earlier research and two specially convened focus groups within the Comensus initiative at the University of Central Lancashire; itself constituted as a piece of participatory action research. We conclude that universities represent paradoxical sites for the facilitation of debate and learning relevant to key issues of social justice and change. As such, they are places that can impede or support movement aims. Particular strategic responses might be more likely to engender progressive outcomes. These ought to include the presence of critically engaged academic staff operating within a scholarly culture that fosters forms of deliberative democratic decision making.

Locating Mental Health in Black and White Men A Q-methodological Study

‘Race’ as identified by skin colour has been traditionally associated with the notion of the Other. In western culture the black man as Other has acted as a type of repository into which white men have projected anxieties about, for example, their sexuality. In psychologized, post-colonial culture such projections have taken on a different form and in this study we utilize Q-analysis to explore how this manifests itself into a representation of the white man as a type of ideal, contained, thinking subject set in opposition to a representation of the black man as someone who is constituted from without, by his relationship to the external world. We conclude by considering the evaluative and practical implications of this duality for our understanding of the mental health of black and white men.