Psychiatry, subjectivity and emotion - deepening the medical model

Morale among psychiatrists continues to be seriously challenged in the face of recruitment difficulties, unfilled posts, diagnostic controversies, service reconfigurations and public criticism of psychiatric care, in addition to other difficulties. In this article, we argue that the positivist paradigm that continues to dominate British psychiatry has led to an undervaluing of subjectivity and of the role of emotions within psychiatric training and practice. Reintegrating the subjective perspective and promoting emotional awareness and reflection may go some way towards restoring faith in the psychiatric specialty

You can lead a horse to water . . . what Self-Determination Theory can contribute to our understanding of clinical policy implementation

There has been increasing reliance on policy directives as instruments for shaping clinical practice in health care, despite it being widely recognized that there is a significant translation gap between clinical policy and its implementation. Self- Determination Theory, a widely researched and empirically validated theory of human needs’ fulfilment and motivation, offers a potentially valuable theoretical framework for understanding not only why the current policy environment has not led to the anticipated improvement in the quality and safety of clinical care but, importantly, also provides guidance about how organizations can create an environment that can nurture behavioural change in the workforce. We describe an alternative approach to clinical policy-making underpinned by Self-Determination Theory, which we believe has broad application for the science of clinical implementation theory

A practice research study concerning homeless service user involvement with a programme of social support work delivered in a specialized psychological trauma service

Homeless people are a population known to be highly vulnerable to trauma, in triggering events to becoming homeless and the considerable social isolation, discrimination, and adversity suffered when homeless. Currently, there is a paucity of research into mental health service delivery to homeless persons and the influence it imparts in individual lives. This article presents a qualitative ‘practice research’ study into a pilot programme of social support work delivered in a specialized psychological trauma service to homeless service users. The programme was grounded in a non-directive, person-centred approach and staffed by student social workers. The study aim was to explore the support work programme as it was received by service users domiciled in supported housing for homeless persons, encompassing experiencing the programme, worker-service user engagement and contextual influences bearing upon positive outcomes. Narrative interviews gathered the impressions of service users and support workers and the data arising from these interviews was analysed thematically. Service user participants valued support work that combined practical and relational elements, but would have preferred a longer-term involvement. They also spoke of feelings of disconnection and estrangement from their peers in the supported accommodation and their families. The worker participants valued the flexibility of person-centred work tailored to service users' individual needs and echoed service user concerns around the short-term nature of their involvement. Psychiatric nurses carrying out, or supervising, mental health support work with homeless service users should be mindful of the potential impact of temporary staffing arrangements on continuity of care. They should also consider how working from a person-centred perspective and addressing client's practical needs may aid in developing rapport and trust with homeless service users

The design of compassionate care

Aims and objectives To investigate the tension between individual and organisational responses to contemporary demands for compassionate interactions in health care. Background Health care is often said to need more compassion among its practitioners. However, this represents a rather simplistic view of the issue, situating the problem with individual practitioners rather than focusing on the overall design of care and healthcare organisations, which have often adopted a production-line approach. Design This is a position paper informed by a narrative literature review. Methods A search of the PubMed, Science Direct and CINAHL databases for the terms compassion, care and design was conducted in the research literature published from 2000 through to mid-2013. Results There is a relatively large literature on compassion in health care, where authors discuss the value of imbuing a variety of aspects of health services with compassion including nurses, other practitioners and, ultimately, among patients. This contrasts with the rather limited attention that compassionate practice has received in healthcare curricula and the lack of attention to how compassion is informed by organisational structures and processes. We discuss how making the clinic more welcoming for patients and promoting bidirectional compassion and compassion formation in nursing education can be part of an overall approach to the design of compassionate care. Conclusions We discuss a number of ways in which compassion can be enhanced through training, educational and organisational design, through exploiting the potential of brief opportunities for communication and through initiatives involving patients and service users, as well as practitioners and service leaders. Relevance to clinical practice The development of contemporary healthcare systems could usefully address the overall design of compassionate care rather than blame individual practitioners for a lack of compassion

Caught between compassion and control: exploring the challenges associated with inpatient adolescent mental healthcare in an independent hospital

Aim. To extend our understanding of how healthcare assistants construct and managedemanding situations in a secure mental health setting and to explore the effects ontheir health and well-being, to provide recommendations for enhanced support.Background. Contemporary literature acknowledges high rates of occupationalstress and burnout among healthcare assistants, suggesting the context in whichthey work places them at elevated risk of physical harm and psychologicaldistress. Yet, there is a deficit of qualitative research exploring the experiences ofhealthcare assistants in adolescent inpatient facilities.Design. An exploratory multi-method qualitative approach was used to collectdata about the challenges faced by healthcare assistants working on secureadolescent mental health wards in an independent hospital during 2014.Method. Fifteen sets of data were collected. Ten participants completed diaryentries and five participants were also interviewed allowing for triangulation.Data were analysed using Interpretive Phenomenological Analysis.Findings. The findings illustrated how inpatient mental healthcare is a unique anddistinctive area of nursing, where disturbing behaviour is often normalized anddetached from the outside world. Healthcare assistants often experienced tensionbetween their personal moral code which orientate them towards empathy andsupport and the emotional detachment and control expected by the organization,contributing to burnout and moral distress.Conclusions. This study yielded insights into mental health nursing andspecifically the phenomenon of moral distress. Given the ever-increasing demandfor healthcare professionals, the effects of moral distress on both the lives ofhealthcare assistants and patient care, merits further study

It's not just What you do, it's also the Way that you do it: Patient and Public Involvement in the Development of Health Research

This is a pre-copyedited, author-produced version of an article accepted for publication in International Journal for Quality in Health Care following peer review. The version of record will be available online at: https://academic.oup.com/intqhc/issue, DOI: 10.1093/INTQHC/MZX177.Purpose: This paper presents a reflective account of Patient and Public Involvement (PPI) in the development of obesity and binge eating research. Method: We established Patient Advisory Groups (PAGs) at two English regional National Health Service (NHS) weight management services. PPI was evaluated as follows; (1) PAG members completed a PPEQ, (2) PAG meetings captured group discussion on PPI involvement, (3) practitioner and researchers produced written reflections on PPI, (4) sources one to three were consolidated during reflections that took place via e-mail and telephone correspondence between researchers and practitioners, culminating in a summary SKYPE meeting between one practitioner and one researcher involved in the PAGs. Results: Results in the form of reflections suggest guidelines on undertaking PPI were helpful with regards what to do, but less helpful on how. For example, suggestions for the management of interpersonal factors such as eliciting self-disclosure and managing power differentials are insufficiently addressed in existing guidelines. Conclusions: The present case study illustrated how interpersonal considerations can help or hinder the optimal use of PPI. Recommendations for practitioners and researchers planning PPI are offered

Practical compassions: repertoires of practice and compassion talk in acute mental healthcare

This article reports an exploratory study of the concept of compassion in the work of 20 mental health practitioners in a UK Midlands facility. Using notions of practice derived from phenomenology and Bourdieusian sociology and notions of emotional labour we identify two contrasting interpretive repertoires in discussions of compassion. The first, the practical compassion repertoire, evokes the practical, physical and bodily aspects of compassion. It involves organising being with patients, playing games, anticipating disruption and taking them outside for cigarettes. Practitioners described being aware that these practical, bodily activities could lead to patients ‘opening up’, disclosing their interior concerns and enabling practical, compassionate mental health work to take place. In contrast, the second, organisational repertoire, concerns organisational constraints on compassionate practice. The shortage of staff, the record-keeping and internal processes of quality control were seen as time-greedy and apt to detract from contact with patients. The findings are discussed in relation to Bourdieu and Merleau-Ponty's phenomenological accounts of practice and habit and set in context in the growing interest in placing compassion centrally in healthcare. We also explore how the exercise of compassion in the way our participants describe it can afford the more effective exercise of medical power

Differences in the semantics of prosocial words: an exploration of compassion and kindness

The study of prosocial behaviour has accelerated greatly in the last 20 years. Researchers are exploring different domains of prosocial behaviour such as compassion, kindness, caring, cooperation, empathy, sympathy, love, altruism and morality. While these constructs can overlap, and are sometimes used interchangeably, they also have distinctive features that require careful elucidation. This paper discusses some of the controversies and complexities of describing different (prosocial) mental states, followed by a study investigating the differences between two related prosocial concepts: compassion and kindness. For the study, a scenario-based questionnaire was developed to assess the degree to which a student (N = 222) and a community (N = 112) sample judged scenarios in terms of compassion or kindness. Subsequently, participants rated emotions (e.g. sadness, anxiety, anger, disgust, joy) associated with each scenario. Both groups clearly distinguished kindness from compassion in the scenarios on the basis of suffering. In addition, participants rated compassion-based scenarios as significantly higher on sadness, anger, anxiety and disgust, whereas kindness-based scenarios had higher levels of joy. As a follow-up, a further sample (29 male, 63 female) also rated compassionate scenarios as involving significantly more suffering compared to the kindness scenarios. Although overlapping concepts, compassion and kindness are clearly understood as different processes with different foci, competencies and emotion textures. This has implications for research in prosocial behaviour, and the cultivation of kindness and compassion for psychotherapy and in general.N/