Self-help/mutual aid groups in mental health : ideology, helping mechanisms and empowerment

In the last quarter of the twentieth century, self-help/mutual aid groups for mental health issues started to emerge in growing numbers, mainly in Western societies, offering and/or advocating for alternative non-traditional forms of support, and attracted the attention of many researchers and clinicians for their unique characteristics. Among the subjects of interest are typologies of groups, helping mechanisms and benefits from participation. However, there is lack of systematic research in the area and existing studies have been largely confined to the therapeutic value of these groups instead of acknowledging their socio-political meaning and subsequent psychosocial benefits for their members like personal empowerment. The present study was conducted during the transitional years from a Conservative to a newly elected Labour Government (1996 -1998), with subsequent policy shifts taking place in the welfare sector. The purpose of the study was to explore the potential of self-help groups as part of a broader new social movement, the service user movement, focussing on the English scene. It addressed this issue examining the relevance of a group typology based on political ideology and focus of change. To test the validity of this classification for members, a set of individual characteristics and group mechanisms as well as their change through time were examined. The sample consisted of fourteen mental health selfhelp/mutual aid groups from London and South East England, with a variety of structural and organisational features. The methodology used was a combination of both quantitative (self-completion questionnaires) and qualitative techniques (analysis of written material, participant observation and interviews). Measurements were repeated after a one-year interval (Time 1N=67, Time 2 N=56). Findings showed that, indeed, political ideology of self-help/mutual aid groups provided the basis of a meaningful typology and constitutes a comprehensive way of categorising them. Group ideology was related to specific helping mechanisms and aspects of personal empowerment. Specifically, conservative and combined group members reported more expressive group processes like sharing of feelings and self-disclosure, while radical group members were more empowered and optimistic. Group identification was also associated with specific helping activities and aspects of empowerment in the three group categories. The psychosocial character of group types and the beneficial outcomes for members remained stable through time. In general, prolonged participation was reflected in greater member identification with the group and resulted in improved mental wellbeing, increased social support, companionship and optimism for the future

Older People Have Their Say! Survey of Older People’s Needs in Westgate Ward, Canterbury

Although a lot of effort in the last few years has been made to address the needs of people in old age, surprisingly not much is known about the views of this age group in the Canterbury City Council area. To address this lack of knowledge, the Canterbury and District Pensioners’ Forum was funded by the Canterbury City Council to explore the needs of older people living in this area. Our Forum decided to collaborate with the University of Kent to produce a survey on the needs of older people within the District of Canterbury. During the process of the project, we decided to base the survey on the Westgate Ward in Canterbury because we felt that older people living in this area represent a good example for highlighting needs that involve ‘ordinary’ older people. This ward is quite diverse in many ways; it spreads from a semi-rural area through to town dwelling. It is not seen as an area of deprivation, thereby has not generated any special money from the Government to help with social problems in the provision of social centres, community learning, social activities etc. Yet we know from our own experience that what may appear in many parts as fairly affluent is quite deprived of places for people to meet; and has large public housing areas with no amenities at all. The present Government put through legislation, which said that public services should be surveyed, and the part of that legislation that we are particularly interested in is “The National Service Framework for Older People”. That framework asks that older people are treated with dignity by NHS and Social Care organisations; and that Councils –County and District, examine existing services- housing, leisure and transport – to identify opportunities to promote health and well-being. We felt that Westgate Ward would be representative of many other areas within our District that had not received any special investment. The work that has been done in producing this survey has been done by members of the Canterbury & District Pensioners’ Forum with help from the University of Kent. It is a survey of older people, carried out by older people. It is our work. Information generated by this project will be assisting the Forum’s work to promote important issues related to older people’s quality of life and access to health and social care services. A comment from J.F. Kennedy we believe sums up the approach that we took at the start of this survey: “It is not enough for a nation to have added years of life. Our object must be to add new life to those years

Training Needs and Development of Online AT Training for Healthcare Professionals in UK and France

Background: Assistive Technology (AT) solutions for people with disabilities has become part of mainstream care provision. Despite advantages of AT on offer, abandonment and non-compliance are challenges for healthcare professionals (HCPs), introducing this technology to clients. Studies of abandonment reveal that 1/3 of all devices provided to service users end up stored unused. Key need is training to make informed decisions about AT tailored to individual needs and circumstances. In an online survey undertaken by the ADAPT project, HPCs identified AT training needs and barriers. Currently, a programme is being developed aimed at introducing AT concepts and enhancing practices to a wide range of HCPs. Method: Survey questions explored gaps, availability, qualifications and barriers to AT training in England and France. A series of consultation meetings with ADAPT partners took place. An advisory group consisting of longstanding AT users and their formal/informal carers and HCPs (occupational therapist, speech and language therapist, psychologist and biomedical engineer) contributed to the discussions on survey findings, development and evaluation of AT training for HCPs, key content areas and means of delivery. Key results: HCPs had no AT specific qualifications (UK 94.6%; FR 81.3%) nor in-service AT training (UK 65.1%; FR 66.4%). They either did not know of AT courses (UK 63.3%) or knew that none existed (FR 72.5%). Barriers to AT training were mainly local training (UK 62.7%, FR 50%) and funding (UK 62.7%, FR 55.7%). Some training priorities were clearer for French HCPs – overall knowledge of AT devices (82.1%, UK 45.8%), customization of AT (65.3%, UK 30.1%), assessing patient holistically (53.4%, UK 25.3%), educating patient/carers (56.5%, UK 28.3%) (p < 0.001). Variances may be due to differing country-specific HCP education approach. A third of both groups highlighted also abandonment, client follow-up, powered wheelchair training and prescribing AT. To bridge gaps in knowledge and identified training needs of HCPs, the online interactive training programme starts by introducing foundations of AT, including definitions, types/uses of AT, legislation/policies and AT in practice. More specialist units build and expand on specific areas, e.g. AT for mobility, communication, assessment and evidence-based practice. The biopsychosocial model of Health and World Health Organisation’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework underpin development of content. ICF shifts focus from disability to health and functioning, in line with a social model of rehabilitation. E-learning comprises existing videos, AT textbook material and bespoke animated presentations. Selfassessment and evaluation of training are embedded and learners receive certificate of completion. Training was piloted to a group of HCPs trainees and postregistration HCPs who commented on relevance of AT content, clarity, accessibility of presentation, and usefulness. Users found training very useful, especially legislation/policies and AT literature. Conclusion: Overall, survey results suggest that both UK and French HCPs’ training on AT solutions is limited and highly variable. There is need for crosschannel AT professional competencies, availability of work-based training and funding support. Development of online, interactive training aims to increase professional confidence and competence in this area as well as the evidence base for AT

A Literature Review of the Challenges Encountered in the Adoption of Assistive Technology (AT) and Training of Healthcare Professionals

Background: Long-term disabilities often result in loss of autonomy and social interaction. Accordingly, there is a demand for Assistive Technology (AT) devices to enable individuals to live independently for as long as possible. However, many people experience difficulties in obtaining and using AT. This paper presents findings from a narrative literature review undertaken as part of the development of AT training for healthcare professionals, one of the work areas of the ADAPT project (Assistive Devices for Empowering Disabled People through Robotic Technologies), funded by EU INTERREG France (Channel) England. The results of the review informed the design of a survey of healthcare professionals regarding their views and experiences of AT and the development of AT training. Method: The review sought to understand challenges encountered in the adoption and use of AT as well as how training of healthcare professionals in AT takes place. A narrative approach was adopted as the most appropriate way to synthesise published literature on this topic and describe its current state-of-art. Narrative reviews are considered an important educational tool in continuing professional development. An initial search was conducted via databases in the UK and France, including CINAHL, Academic Search Index, Social Sciences Citation Index, BDSP (Base de données en Santé Publique), Documentation EHESP/MSSH (Ecole des Hautes Etudes en Santé Publique/Maison des Sciences Sociales et Handicap), Cairn, Google Scholar and Pubmed. Inclusion criteria for the review included: covering issues relating to AT provision and training, English or French language, and published from 1990 onwards. Application of these criteria elicited 79 sources, including journal papers (48), reports (11), online sources (11), books (6) and conference papers (3). Sources were thematically analysed to draw out key themes. Key results: The majority of papers were from USA and Canada (27), then UK (20) and France (19). Others were from Europe (7), Australia (3), country unknown (2), and one joint UK/France publication. The main source of literature was journal papers (48), of which the most common types were practice reports (18), evaluation surveys (10) and qualitative studies (9). The review uncovered a number of key challenges related to the adoption of devices, including: difficulty defining AT across disciplines, lack of knowledge of healthcare professionals and users, obtrusiveness and stigmatisation AT users can experience when using devices, and shortfalls in communication amongst professional groups and between professionals and users. These issues can lead to abandonment of AT devices. Furthermore, substantial barriers to healthcare professionals exist, including inconsistent provision and quality of training, lack of evaluation of training, lack of resources and funding, shortage of qualified professionals to teach, and the increasingly rapid development of the technologies. Conclusion: Support, training and education for prescribers, distributors, users, and their carers is vital in the adoption and use of AT. Evidence indicates a need for comprehensive education in the AT field, as well as ongoing assessment, updates and evaluation which is embedded in programmes

A Survey of Assistive Technology (AT) Knowledge and Experiences of Healthcare Professionals in the UK and France: Challenges and Opportunities for Workforce Development

Background: Assistive Technologies (AT) in healthcare can increase independence and quality of life for users. Concurrently, new AT devices offer opportunities for individualised care solutions. Nonetheless, AT remains under-utilised and is poorly integrated in practice by healthcare professionals (HCPs). Although occupational therapists (OTs), physiotherapists and speech and language therapists (SLTs) consider that AT solutions can offer problem-solving approaches to personalised care, they have a lesser understanding of application of AT in their practice. In this paper, we report findings of a survey on AT knowledge and experiences of HCPs in UK and France. Training needs also explored in the survey are presented in a separate paper on development of online training for the ADAPT project. Method: A survey of 37 closed/open questions was developed in English and French by a team of healthcare researchers. Content was informed by published surveys and studies. Email invitations were circulated to contacts in Health Trusts in UK and France ADAPT regions and the survey was hosted on an online platform. Knowledge questions addressed AT understanding and views of impact on user’s lives. Experience questions focussed on current practices, prescription, follow-up, abandonment and practice standards. 429 HCPs completed the survey (UK = 167; FR = 262) between June and November 2018. Key results: Participants were mainly female (UK 89.2%; FR 82.8%) and qualified 10+ years (UK 66.5%; FR 62.2%). A key group in both countries were OTs (UK 34.1%; FR 46.6%), with more physiotherapists and SLTs in UK (16.8%, 16.8%; vs. FR 6.5%, 2.3%), and more nurses in France (22.1% Vs. UK 10.8%). More HCPs were qualified to degree level in France (75.2%; UK 48.5%, p < 0.001). In terms of knowledge, all HCPs agreed that AT helps people complete otherwise difficult or impossible tasks (UK 86.2%; FR 94.3%) and that successful AT adoption always depends on support from carers, family and professionals (UK 52.7%; FR 66.2%). There were some notable differences between countries that require further exploration. For example, more French HCPs thought that AT is provided by trial and error (84.7%, UK 45.5%, p < 0.001), while more UK HCPs believed that AT promotes autonomous living (93.4%; FR 42.8%, p < 0.001). Also, more French HCPs considered that AT refers exclusively to technologically advanced electronic devices (71.8%, UK 28.8%, p <0.001). In both countries, top AT prescribers were OTs, physiotherapists and SLTs. Respondents had little/no knowledge in comparing/choosing AT (UK 86.8%; FR 76.7%) and stated they would benefit from interdisciplinary clinical standards (UK 80.8%; FR 77.1%). A third of HCPs did not know if AT users had access to adequate resources/support (UK 34.1%; FR 27.5%) and rated themselves as capable to monitor continued effective use of AT (UK 38.9%; FR 34.8%). Conclusion: Knowledge and application of AT was varied between the two countries due to differences in health care provision and support mechanisms. Survey findings suggest that HCPs recognised the value of AT for users’ improved care, but had low confidence in their ability to choose appropriate AT solutions and monitor continued use, and would welcome AT interdisciplinary clinical standards

A qualitative analysis of migrant social workers’ work experiences and perceived prejudice from an empowering acculturative integration approach

An increasing number of migrant social workers are employed in the UK social work sector. This article explores the acculturative integration experiences of a small group of migrant social workers. We critically observe that research on migrant professionals’ trajectories should adopt theories that emphasise people’s empowerment and potential for agency. We use a framework drawing on liberation psychology for analysing the autobiographical narratives of a sample of migrant social workers employed in England. Findings indicate that the participants perceived prejudice on a number of occasions and circumstances. Even though in their narrative of survival they talked about activating several psychosocial resources, they were sceptical about their professional development and dissatisfied at work. The paper discusses the emerging findings while highlighting the framework’s relevance for understanding these experiences from an empowering acculturation perspective and suggesting ways of improving migrant social workers’ acculturative integration by addressing systemic barriers

Intimate partner violence: a study in men and women from six European countries

OBJECTIVES: We aimed to assess intimate partner violence (IPV) among men and women from six cities in six European countries. METHODS: Four IPV types were measured in a population-based multicentre study of adults (18-64 years; n = 3,496). Sex- and city-differences in past year prevalence were examined considering victims, perpetrators or both and considering violent acts' severity and repetition. RESULTS: Male victimization of psychological aggression ranged from 48.8 % (Porto) to 71.8 % (Athens) and female victimization from 46.4 % (Budapest) to 70.5 % (Athens). Male and female victimization of sexual coercion ranged from 5.4 and 8.9 %, respectively, in Budapest to 27.1 and 25.3 % in Stuttgart. Male and female victims of physical assault ranged from 9.7 and 8.5 %, respectively, in Porto, to 31.2 and 23.1 % in Athens. Male victims of injury were 2.7 % in Östersund and 6.3 % in London and female victims were 1.4 % in Östersund and 8.5 % in Stuttgart. IPV differed significantly across cities (p < 0.05). Men and women predominantly experienced IPV as both victims and perpetrators with few significant sex-differences within cities. CONCLUSIONS: Results support the need to consider men and women as both potential victims and perpetrators when approaching IPV

Cultural capital and professional development experiences of migrant health and social care professionals

In the last decade there has been a systematic growth in the population of skilled migrants entering the UK health and social care sector. In particular, the numbers of social workers possessing qualifications from overseas who come to work in the UK have been increasing annually (Hussein et al., 2010a). Previous research has examined the profile, motivations, experiences and expectations of ‘international’, ‘overseas’ or ‘migrant’ social workers in the UK. In some of these studies (e.g. McGregor, 2007) the participants were professionals from various fields who entered the care sector out of necessity after their arrival to the UK, while in other studies the participants were qualified social workers who trained in their home countries and then migrated to the UK to join the social care sector (Evans et al., 2006b; Hussein et al., 2010b; Moran et al., 2005; Sale, 2002). Much of this literature focuses on challenges these professionals face as they enter the social work workforce (e.g. difficulties in adapting to the English culture, insufficient induction, limited opportunities for career progression) as well as on adverse experiences at the workplace (e.g. experiences of racism and discrimination). While it is undeniably important to do further research on these challenges and difficulties and suggest effective ways of tackling them, it is also important to explore the resources these professionals activate when faced with such challenges. In particular, it is important to tap into the ways in which they actually utilise their cultural capital both in its formal/institutionalised form (i.e. educational credentials and professional qualifications) but also in its informal/incorporated form (i.e. their own work ethics). In this paper migrant social workers are not perceived as passive employees whose cultural capital is inevitably undermined by institutional and informal forms of exclusion, but as active agents who can shape to a large extent the specific context in which they work. The paper is based on part of a larger original research project, which explored the education and employment-related experiences of three groups of migrant health and social care professionals (doctors, social workers and nurses) before and after migrating to the UK. The presented findings emerged from five in-depth narrative interviews carried out with migrant social workers* who were qualified in their home countries and are currently working full-time as social workers in England. The narrative analysis illustrates certain institutional mechanisms which influence the participants’ experiences (e.g. their informal/incorporated cultural capital, that is, their own work ethics, is often undervalued in which case they feel they do ‘more managerial tasks and less actual work with people’). The analysis also reveals how certain social norms in the field of social work shape the participants’ experiences while interacting with colleagues, employers and service-users (e.g. experiences of bullying or mistreatment). However there are also particular accounts of how they actually utilize their cultural capital both for resolving dilemmas they face at the workplace but also for suggesting general improvements in the services they are employed in. Our analysis therefore highlights not only the employment-related difficulties migrant social workers face but also how individuals themselves effectively deal with professional challenges. *language in this area varies but we use the term ‘migrant’ to describe social workers who have qualified outside the UK -either from the EU or other countries- and have already significant work experience in the UK social work sector