Brighton Journal of Research in Health Sciences

Supporting Research in the School of Health Sciences


Wednesday 17th June 2015

Aldro 113,Eastbourne 1pm-2pm

The Neater Uni-wheelchair: Developing Evidence through mixed methods

Dr Anne Mandy PhD, MSc, BSc(Hons) Reader, Director of Post Graduate Studies


This presentation will detail the stages and types of research and development that were undertaken to produce a viable, clinically acceptable wheelchair. Wheelchair provision for users with hemiplegia are inadequate. This research evolved from a clinical issue and involved users, clinicians and a manufacturing partner to solve the problem. The research commenced 10 years ago, with the production of a basic prototype. The different stages of research, the funding difficulties and political arena will be discussed.


Dr Anne Mandy is a Reader and Director of Doctoral Post Graduate Research Students. Her research is centred around assisting mobility. She works inter-professionally with users, research engineers,rehabilitation therapists and manufacturers to provide an evidence base for therapists and greater choice for users.


Wednesday 10th June 2015

Aldro 113, Eastbourne 1pm-2pm

Straight leg raise treatment for individuals with spinally referred leg pain: exploring characteristics that influence outcome: an quantitative experimental design

Colette Ridehalgh, Senior Lecturer


The presentation will discuss the findings of my PhD study which aimed to assess the differences in the immediate response to a Physiotherapeutic neural intervention (a straight leg raise treatment) between 3 sub-groups of individuals with spinally referred leg pain (somatic referred pain, radicular pain and radiculopathy). It has been proposed that individuals with spinally referred leg pain may have poorer prognosis than individuals with low back pain alone, and that one reason for this may be greater levels of disability or psychosocial factors such as fear avoidance beliefs or higher levels of emotional distress. In addition, individuals with chronic low back pain may complain of a complex pain presentation called central sensitisation. Such characteristics could impact on immediate changes to treatment. This presentation will discuss the rationale for the study, the preliminary studies that were carried out in preparation for the main clinical study, and the overall results and implications.


Dr Colette Ridehalgh is a senior lecturer in the Physiotherapy division of the School of Health Sciences. She has been lecturing in both undergraduate and postgraduate neuromusculoskeletal Physiotherapy since 2002. She gained her PhD in July 2014, and MSc in Manipulative Physiotherapy (leading to membership of the Musculoskeletal Association of Physiotherapists) in 2002. She has published work from her PhD and other collaborative work and presented her work on nerve excursion and neurodynamic treatment at several National and International conferences.


Wednesday 27th May 2015

Aldro 113, Eastbourne 1pm-2pm

A session on NVivo

Hubert Van Griensven, Research Fellow


Seeking Sense in Mental Health

Mission Statement

We are a group of mental health nursing students aiming to create a therapeutic network to support students and professionals in practice.

We intend to provide a forum for open discussion and debate over practical and ethical issues relating to mental health theory, practice and service delivery.

Our network is intended to be multi-disciplinary and is open to all who work, study or simply have an interest or experience in the mental health field.

We appear to be at a time of great changes in the medical profession (Beasley, 2011; Lee & Fawcett, 2012) and nursing needs to find its own professional identity to develop and embrace those changes (Beasley, 2011; Clarke, 2012; Lee & Fawcett, 2012). However there appear to be conflicts within the very role of nursing. Advocacy, considered to be fundamental to nursing practice (MacDonald, 2006), is included as an essential quality of nurses in the Nursing and Midwifery Council (NMC) code (NMC, 2008) yet policy, in the shape of mental health legislation focus on risk management (Department of Health (DH), 2005), demands that mental health nurses be complicit in the denial of liberty and enforced treatment of some of those in their care (Pilgrim, 2005; Szmuckler & Applebaum, 2001).

The Royal College of Nursing (RCN) and the King’s Fund both suggest that nursing morale is at an all-time low (Royal College of Nursing (RCN), 2015; Independent, 2015). Seeking Sense in Mental Health (SSiMH) aims to focus on auditing morale levels of students in placement and attempt to find ways to address issues arising from workplace stress, consider questions over ethical or practical aspects of treatment and raise awareness of alternative or complementary perspectives.

SSiMH has a practical and intellectual purpose that aims to support and inform professionals, students and service users alike. One focus within the network involves bringing the process of mindfulness to our groups, encouraging participants to use the practice to benefit both their personal and working lives whilst potentially also offering positive experiences for service users, their carers and families (Beddoe and Murphy, 2004). Our interactions with clients carry myriad layers of our own mental clutter and one way of developing a ‘clutter free’ communication is to have awareness of possible countertransference. Scheick (2010) suggests that this awareness can be achieved through mindfulness.

The aim of mindfulness is to slow the rapid and stressful stream of thoughts that constantly flow through our minds. Coming to a point of acceptance that we are in the present, not dwelling in the past or worrying about the future, and stilling the mind brings great calmness and an inner peace. When we are at our most relaxed and creative, we are in alpha brain wave mode. Stress is reported to deplete the alpha wave functionality of our brains while meditative practices such as yoga, Tai Chi and mindfulness enhance it (Miller, 2011).

Psychiatric drugs are associated with a variety of unpleasant and potentially life-threatening side-effects (Boseley, 2003; Boseley, 2005: Charatan, 2005) yet medication remains the dominant form of treatment for mental health problems (Moncrieff, 2009). The availability of alternative treatments such as psychological talking therapies is geographically inconsistent and access to them often involves long waiting times (DH, 2014).

We hope to encourage discussion and evaluation of the merits of complementary and alternative treatments. We have already started to develop links with service user groups and organisations such as the Hearing Voices Network who offer differing perspectives on mental health provision. We intend to invite speakers to share their visions of the future of psychiatric service provision and run workshops which will enable us to consider alternative perspectives on approaches to treatment and support. We recently held the first of these sessions, a well-attended Gestalt Art Therapy practical event which investigated emotional responses to visual imagery.

We have a facebook page, or follows us on twitter @SSiMH_Network and the SSiMH website is under construction. We welcome comments, questions and suggestions from students, service users, carers, professionals and anyone else who may also be seeking sense in the mental health field.

Nik Holland, Zoe Hughes, Robyn-Jayne Crofton, Laura Johnstone, Chantelle Maduemezia, Sasha Marshall, Imogen Sotos-Castello and Graeme Wetherill Mental Health Nursing BSc (Hons) students


Beasley, C. 2011. The heart of nursing: past, present and future, British Journal of Nursing 20(22) 1407.

Beddoe, A.E, S.O Murphy (2004) Does mindfulness decrease stress and foster empathy among nursing students? The Journal of Nursing Education 2004, 43[7] 305-312. Available at: Accessed 10/02/2015.

Boseley, S. 2003. Drugs for depressed children banned. The Guardian. Available at: Accessed 04/01/15.

Boseley, S. 2005. Drugs ‘can trigger suicide in adults’. The Guardian. Available at: accessed 04/01/15.

Charatan, F. (2005) Study finds that new antipsychotics offer few benefits over traditional drugs’ British Medical Journal volume 331 p. 717.

Clarke, P. N. 2012. Discipline-Specific Knowledge: Time for Clarity, Nursing Science Quarterly 25(2) 149-150.

Department of Health (2005) Government response to the Report of the Joint Committee on the Draft Mental Health Bill 2004. London: Department of Health.

Department of Health (2014) Closing the Gap: Priorities for essential change in mental health. London: Department of Health.

The Independent (2015) NHS hospitals flatlining: Staff morale falls to new low after Coalition ‘bashing’ Available at: Accessed 16/02/15.

Lee, R. C. and J. Fawcett. 2012. The influence of the Metaparadigm of Nursing on Professional Identity Development among RN-BSN Students, Nursing Science Quarterly 26(1) 96-98. Available at Accessed 16/02/15.

MacDonald, H. 2006. Relational ethics and advocacy in nursing: literature review, Journal of Advanced Nursing 57(2) 119-126.

Miller, A. (2011) ​Exercises to Achieve Alpha Brain Waves. Available at: Accessed 10/02/2015

Moncrieff, J. (2009) Deconstructing psychiatric drug treatment’. In: Mental Health Still Matters, edited by J. Reynolds, R. Muston, T. Heller, J. Leach, M. McCormick, J. Wallcraft, and M. Walsh. Milton Keynes, The Open University.

NMC (2008) The code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC.

Pilgrim, D. (2005) Key Concepts in Mental Health. London: Sage.

RCN (2015) ‘Nursing workforce morale at all-time low’ Available at: Accessed 16/02/15.

Scheick, D.M. (2010) Developing Self-Aware Mindfulness to Manage Countertransference in the Nurse-Client Relationship; An Evaluation and Developmental Study. The Journal of Professional Nursing 27[2] 114 – 123. Available at: Accessed 10/02/2015

Szmuckler, G. and Applebaum, P. (2001) ‘Treatment pressures, coercion and compulsion’. In: Textbook of Community Psychiatry, edited by G. Thornicroft and G. Szmuckler. Oxford: Oxford University Press.


The other woman

“I didn’t like your letter.” Norman said.
Rebecca, his daughter, had written to him on Father’s Day. It was formal and very unlike her usual style. She expressed her concerns, not so much at the marriage, but the secret way they had done the deed. She worried that he had kept something from her, perhaps about his health. She sensed something was not right, her intuition rehearsing all manner of tragic scenarios. He had phoned her that Father’s Day evening and told her about his cancer and the treatments he had undergone.
Some weeks later, Norman agreed to meet with his children for lunch for his 70th birthday, leaving his second wife, Esme, at home alone. Rebecca and Greg, his grown up children, insisted they wanted to meet and spend some time with him as a family.
They had lunch, but neither hungry nor enjoying the meal at the quiet bistro. After Greg left to go back to work, Rebecca and her father had some time alone together. He avoided her gaze, longing to get back to Esme. It was not the big welcome Rebecca had expected or hoped for.
“You seem to be living in another world, to have shut the door on me and Greg.” She said.
“Well, I have,” he replied. “I don’t understand why you can’t be happy for me. All our friends are.” His coldness shocked her, witnessing a side she had never experienced.
“You must know I found it so hard losing mum, and then all this… it was all so quick.” She said.
She blocked her tears, embarrassed to lose control in a public place. She longed for some indication of warmth and sympathy, a kind touch. He showed no empathy, not caring in the slightest that she had been so distraught and needed counselling to deal with the sudden death of her mother. It felt so brutal, not one iota of sensitivity to her pain. The impact of losing her mother, his wife of over 40 years, swept away, dismissed like the grubby plates in front of them from the half-finished meal.
“I can’t do this again.” Norman said sadly, as he fumbled for his coat.
“Ok, I understand.” She said. He had made his choice and he wanted her to be pleased for him, but she couldn’t, it was all so raw and his loving someone else felt so obscene and offensive to her mother, her memory violated.
She wondered why the need to be a part of her father’s life was so strong, why was her happy marriage, busy job, two children, not enough? What was it that had made their relationship so special? She had pondered, in her darkest moments, if there was something almost sexual, but this was ridiculous, she dismissed this. The umbilical cord to her past was pure and innocent and formed from her memories of childhood and adolescence: the unconditional love of a father to his daughter. He always made her feel she was so special.
Over the next ten years, Rebecca learned to be grateful that she kept some communication with her father. Christmas and birthdays, she used her boys as hostages to get through the threshold of her former parents’ house. Every visit .some subtle change had been made until nothing of her mother’s taste remained; her pictures were quickly relocated to the loft, Esme’s family taking precedence on the teak sideboard. All the detritus of the previous life removed, snuffed out so her memory was invisible.
At times, she found it hard to imagine where it would all end, if she would be allowed to see Norman if he became ill again or if she would be exiled. She rehearsed how she might respond. She dreamt of one bedside vigil, being called to see him, begging her forgiveness for all the hurt he had caused, content that the happy ending she longed for had come at last. But she knew that Esme would make her suffer in some evil way and she would hear after he had died, denied access to make their peace and forever living in pain and sorrow.
Sometimes she decided to sever all ties, protect herself, building her resilience to cope with the loss to come, but never quite having the guts to go through with it, always keeping some superficial reason to maintain contact, frightened of what she might lose and how she might feel afterwards, as there would be no going back.
Then Esme died suddenly, she could see Norman when she liked, no longer estranged, alienated from him after all those long years of separation. But it was a bitter-sweet victory, as dementia had crawled into his mind leaving an empty catacomb where memories of their happy times together once thrived.
The call came at 5.30am. “Get here soon as you can.” Greg said, exhausted from lack of sleep and the enormity of the situation. Rebecca drove through the night, oblivious to the driving rain and speed cameras. She ran to the Emergency Department the glaring white lights ablaze as she wove through the maze of curtains and rooms, searching for him.
He lay there attached to the ECG monitor, bleeping with life, taunting her with hope. She looked into his eyes but there was no response, just dark pools, fixed and dilated. He never wanted to be kept alive; his biggest fear dependence. The machine with its incessant alarm was switched off and he gasped his last breath. She left the room, letting out a primal scream, but no tears came. She didn’t care who heard her. It came from the very depths of her heart, so broken, mended and now ripped apart, and this time for good.
They moved him to a room, an oasis of calm in the madness of the busy department. He was laid out respectfully, his soft baby-like hair brushed neatly. Rebecca gently kissed his now cool forehead.
“I got you back.” She said.

Helen Stanley, Principal Lecturer School of Health Sciences


Message from Professor Ann Moore

apm21On behalf of the Centre for Health Research it is a pleasure to have been invited to write a small piece for the inaugural issue for our new journal. This is a very welcome development for the new School of Health Sciences and I would like to thank all the members of the editorial team for all their hard work and commitment in putting the first issue of this journal together. I wish the journal well for all its future developments. Writing about and reporting regularly on research and scholarly activities is an important component of all academic members of staff routine activity. Sometimes early on in your career this can be a challenging concept and your confidence may be lacking in terms of your ability to write and to publish in an academic journal. The Journal has been set up by the editors to nurture and support members of staff and students who wish to write for an academic journal. It is anticipated that the editors’ and reviewers’ comments on your work will help to strengthen your manuscript. Through this you will learn more about how to craft research and scholarly papers that sit within your field of practice.The Journal will also give all staff the opportunity to publish their research news and thereby share research activities across the school. The journal is therefore a very welcome development in this new school and I look forward to seeing this development over
the coming years.
Professor Ann Moore
Director of the Centre for Health Research
University of Brighton


Hundreds of recommendations adopted by the Department of Health, but have we seen it all before? The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: a socio-historical context


Following a Public Inquiry led by Robert Francis into the reasons why poor care at the Mid Staffordshire NHS Foundation Trust was not challenged by a wide range of National Health Service (NHS) regulatory bodies between 2005 and 2009, the Department of Health (DoH) has committed to the implementation of more than 200 recommendations for change in both primary and secondary care. Planned developments range from increasing the powers of government-sponsored health and social care regulator the Care Quality Commission, to promoting cultural change throughout the NHS (DoH, 2014). The stated aim of these changes is to protect patients from unacceptable and unsafe care in the future (Francis, 2013; DoH, 2014).

This review was written as background for research on ways in which the recommendations of the Francis Report may relate to the education of healthcare professionals. Its objective is to to identify the key themes underlying the 290 recommendations of the Francis Report, and to consider these themes in the context of recent NHS policy for England. Archived documents are used to trace the course of policy developments, from the New Labour reforms of the early noughties, through to the coalition governement’s Health and Social Care Act 2012, and the publication of the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry in 2013.

The relevance of key DoH policies to events occuring at the Mid Staffordshire NHS Trust will be explored, and reasons examined for the widely expressed view (Moore, 2013) that, in the current political climate, there is a serious risk that the recommendations of Francis will be implemented only where they coincide with pre-existing DoH policies.

Preliminary search of the literature relating to the Francis Report and the education of healthcare professionals

A preliminary search of the literature identified no published research relating to ways in which the Francis recommendations may be applied, either to the education and continuing professional development (CPD) of healthcare professionals in general, or of podiatrists in particular. The University of Brighton online library catalogue was searched using the terms: “Francis Report”; “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry”; “Francis Report education”; “Francis Report podiatry”; “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry education”; and “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry podiatry”. A summary of search strategy, search terms and number of results returned is presented in Table 1.

Table 1. Preliminary search of the literature relating to the Francis Report and the education of healthcare
professionals: search strategy, search terms and number of results returned



The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: a socio-historical context

The process of mapping recent NHS policy developments as a context for the recommendations of the Francis Report (Francis, 2013) began with Not the Francis Report: a National Voices Report on How to Ensure Safety & Quality (National Voices, 2012). (See also, Discussion, below.)
21 key documents were reviewed: five government-commissioned reports; six White Papers; four Acts of Parliament; five reports not commissioned by the government, and two pieces of comment and analysis. A classification of the literature reviewed is presented in Results, Table 2 (below).

Mechanism for review of archive material

Data extracted from each document

  • Title
  • Author
  • Author background
  • Date
  • Publisher
  • Summary

Data analysis is descriptive


A classification of the literature reviewed is presented in Table 2.

Table 2. Classification of the literature reviewed



Underpinning the 290 recommendations of his Report, Robert Francis identifies six core themes: culture; compassionate care; leadership; standards; information; and openness, transparency & candour (DoH, 2014, p.9).

With the purpose of developing these themes, the initial government response to the Francis Report (DoH, 2013) included the commissioning of a number of further reports, including one from Professor Don Berwick (National Advisory Group on the Safety of Patients in England, 2013) asking for ways to make “zero harm a reality in our NHS”. A summary of Berwick’s recommendations (see Figure 3, below) can be read as a summary of the themes underpinning the recommendations of the Francis Report.

Figure 3.Key themes underpinning the recommendations of the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (aka the Francis Report)
(Francis, 2013; National Advisory Group on the Safety of Patients in England, 2013)


Concepts of “patient-centred” care and “putting patients first”
As reflected in its title, Hard truths: the journey to putting patients first, the DoH response to the Francis Report places the allied concepts of “patient-centred” care and “putting patients first” at the centre of its stated ambitions for NHS change (DoH, 2014). “Patient-centred” care is characterised as the experience of being treated as a “person rather than a number” (DoH, 2014, p.38), while the related concept of “putting patients first” is defined as “placing the quality of patient care, especially patient safety, above all other aims” (National Advisory Group on the Safety of Patients in England, 2013, p.36). Both these ideas can be seen to reflect Minister for Health, Lord Ara Darzi’s 2008 definition of high-quality care, as care that is “clinically effective,  safe and  personal” (DoH, 2008, p.8).

Cultural change through lifelong learning
The key strategy proposed by Francis, both for the delivery of patient-centred care and also for the implementation of his recommendations generally, is the promotion of cultural change throughout the healthcare system (Francis, 2013) (see also Figure 1, below). Francis (2013) and many others, including the DoH (2014), the King’s Fund (2012), and the National Advisory Group on the Safety of Patients in England (2013), identify the professional training and CPD of clinicians and health service managers as a key tool for the achievement of this cultural change.

But what does it all add up to?
In Not the Francis Report: a National Voices Report on How to Ensure Safety & Quality (2012), Don Redding, director of the coalition of health and social care charities, National Voices, argues that there was no need for a report from Francis and his team, that “ample evidence and consensus already exists” (p.2) to support reforms that will improve the quality and safety of health and social care. Redding (2012) argues that the themes identified by both Berwick and Francis (above) are not new. He suggests, instead, that attempts to address these themes form a thread that weaves its way through the history of NHS policy. Exploring this idea, these themes will be traced through three recent NHS White Papers (3.3.1 to 3.3.3, below) and compared against the recommendations of the Francis Report (2013).

The NHS Plan: a plan for investment, a plan for reform (DoH, 2000)

In July 2000, Tony Blair’s Labour government published the NHS Plan: a plan for investment, a plan for reform. This White Paper is built on earlier ground-breaking policy documents including A first class service: quality in the new NHS (DoH, 1998) and Clinical governance: its origins and foundations (Nicholls, Cullen, O’Neill, & Halligan, 2000). Like Francis (2013) and others (DoH, 2014, National Advisory Group on the Safety of Patients in England, 2013), the authors of both these documents emphasise the need for system-wide cultural change that includes reflective learning, staff development and patient-centred care based on partnership between patients and professionals.

Through the first half of the noughties, one notable and generally well-reviewed strategy for the achievement of the desired cultural change was the delivery, to 40,000 NHS staff, of a three-day management skills course known as Leading an Empowered Organisation, or LEO (Jones, 2005).

Setting out plans for a “reformed and patient-centred NHS”, the NHS Plan: a plan for investment, a plan for reform became law as the Health and Social Care Act, 2001. A key policy strategy included the establishment of Primary Care Trusts (PCTs), designed to improve the integration of health and social care by commissioning both of these services together. Major investment in clinical staff aimed to reduce long waiting times for treatment and to abolish the ‘postcode lottery’ in standards of care (DoH, 2008).

Staffing levels
It is noted that, as at the turn of the century, NHS staffing levels remain a contentious issue today, with a policy of inadequate staffing identified as a significant contributory factor to failures in care at Stafford Hospital (Francis, 2013).

As recommended by Francis, all NHS Trusts are now required to publish monthly, ward-by-ward nursing and midwifery staff numbers (DoH, 2014). In addition, the National Institute for Care Excellence (NICE) has published guidelines for staffing levels in adult inpatient wards in England (NICE, 2014). In contrast to the generous financial provisions of the 2001 Health and Social Care Act however, present-day requirements for major financial savings (DoH, 2011) make it unclear how far these staffing guidelines are likely to be implemented in practice.

The development of NHS Foundation Trusts
With direct relevance to the events at Stafford Hospital between 2005 and 2009, under the Health and Social Care Act 2001 high-performing NHS Hospital Trusts were granted ‘Foundation Trust’ status and a degree of independence from DoH control (DoH, 2005). The aim of Foundation Trust status is identified as allowing health service managers freedom from centralised decision making, thereby increasing patient choice through the delivery of health services that are responsive to local needs (DoH, 2005).

Despite the disastrous standards of care reported by Robert Francis within the Mid Staffordshire NHS Foundation Trust (Francis, 2010), the Health and Socal Care Act 2012 states that all NHS Hospital Trusts should aim to become NHS Foundation Trusts by April 2014.

Under the Health and Social Care Act 2012 and in line with the recommendations of the Francis Report, the DoH has recently increased the powers of the independent regulator of Foundation Trusts, Monitor (DoH, 2012; DoH, 2014). This development is opposed by influential commentators including Don Redding (National Voices, 2012), and Dr Hamish Meldrum (British Medical Journal, 2011), who believe that while regulatory bodies such as Monitor and the Care Quality Commission need to work better together, increasing their regulatory powers is likely to have a negative effect on patient care.

High quality care for all: NHS next stage review final report (DoH, 2008)

Aiming to reflect the views of 60,000 NHS staff and patients, and led by surgeon and Minister for Health, Lord Ara Darzi, this document presents the Labour government’s 10-year plan for the NHS.

Building on the Health and Social Care Act 2001, the key policy aim of this White Paper is identified as improving the quality of NHS healthcare, with ‘quality’ defined as care that is clinically effective, personal and safe. As in the Health and Social Care Act, 2001, this definition of high-quality care echoes the concepts of “patient-centred” care and “putting the patient first” that are identified by Robert Francis (2013) as the foundation stone of his recommendations for change.

Evidence-based practice
Building on documents such as Cullen, O’Neill & Halligan’s Clinical governance: its origins and foundations (2000), Darzi’s 10-year plan identifies the continued development of NICE guidelines and NHS Evidence as an important strategy for the delivery of high-quality care through evidence-based clincal practice. This is a strategy that continues to play an important role in the delivery of NHS healthcare, with Equality and excellence: liberating the NHS (DoH 2010) promising a “relentless focus on clinical outcomes” p.4.

Valuing NHS staff
Like Francis, Darzi identifies staff wellbeing and CPD as key to the delivery of high-quality care. Pledges on these issues are laid down in the first NHS Consitution, developed as part of this White Paper (DoH, 2008, p.77). Strategies for enhancing staff wellbeing include investment in preceptorships and apprenticeships, and a commitment to ensuring opportunities for CPD. By specifically rejecting the setting of any further national targets, Darzi acknowledges, and aims to reduce, the heavy administrative burden on clinical staff.

This commitment to reducing target setting is reiterated both in Equality and excellence: liberating the NHS (DoH 2010) and in the DoH response to the Francis Report (2014). In addition, like Darzi, the DoH (2014) identifies CPD as a key area for development within the health service. Based on strong recommendations from both Francis (2013) and the National Advisory Group on the Safety of Patients in England (2013), The DoH (2014) states that “Education and training should be a running theme throughout a healthcare practitioner’s career” (DoH, 2014, p.93). Developing this theme the government response to Francis continues that, as supportive management that facilitates staff engagement is shown to deliver better patient outcomes (King’s Fund, 2012), it must be “implemented with the rigour of a new drug” (DoH, 2014, p.91). To date, these ideas are yet to be translated into significant policy. A summary of proposed or actual changes to healthcare education legislation in response to the recommendations of the Francis Report is presented in Table 3.

Table 3. Summary of proposed or actual changes to healthcare education legislation in response to the recommendations of the Francis Report


Empowering clinicians and increasing patient choice

With the aim of empowering clinical staff to “set the direction of the services they deliver” (DoH, 2008, p.64), Darzi’s 2008 White Paper gave high-performing GP practices the freedom to offer previously hospital-based services, such as diagnostic imaging, in a primary care setting. Expanding on this theme, GPs were enpowered to buy services not only from the NHS, but also from the private and charity sectors, so that all patients referred for hospital treatment were now able to choose from several NHS and private sector providers (British Medical Association, 2013). Under the Health and Social Care Act 2010 this idea has been developed further, to become the controversial Any Qualified Provider scheme, whereby services are delivered by any qualified private provider on a payment-by-patient basis (DoH, 2010).

Equality and excellence: liberating the NHS (DoH, 2010)

Published only two years after Darzi’s 10-year plan, Equality and excellence: liberating the NHS sets out the new coalition government’s vision for the NHS.

Like Darzi’s 10-year plan, the stated aims of this White Paper include putting patients first and improving healthcare outcomes, with the expansion of patient choice identified as a key strategy for the achievement of these goals. A more controversial proposition is the idea that increased competition, in the form of the Any Qualified Provider scheme, will bring about improvements in the performance of healthcare providers. Key policies include abolishing the PCTs established by the New Labour government in 2001,  and delegating their health-care-commissioning role to GPs overseen by an independent NHS Commissioning Board. In contrast to earlier policies designed to facilitate closer integration of health and social care services (DoH, 2001), social care is to be commissioned separately, by the Local Authority.

The policies of this White Paper were formally opposed by many professional bodies, including the British Medical Association, the Royal College of General Practitioners, the Royal College of Nursing and the Allied Health Professions Federation (Rogers, 2012). Two issues identified as key causes for concern are, firstly, that the fast pace of policy change poses an excessive risk to patient safety; and secondly, that by forcing GP commisioners to offer NHS contracts to private providers, the AQP scheme risks destabiising local health economies and making collaberative work in multi-disciplinary teams more difficult.
In a demonstration of misalignment between stated DoH aims and likely results of DoH policy, Hard Truths: the journey to putting patients first (DoH, 2014) makes frequent reference to the importance of supporting NHS staff to work effectively in multi-disciplinary teams, a well-evidenced strategy for the delivery of safer, more effective healthcare. Clinicians, including Dr Peter Carter of the Royal College of Nursing, and Dr Hamish Meldrum of the British Medical Association, argue that by fragmenting integrated care pathways, the AQP scheme will make services less efficient and put patient safety at risk (British Medical Journal, 2011). in March 2012, Equality and excellence: liberating the NHS was passed into law as the Health and Social Care Act, 2012.

Echoing the concerns of the professional bodies, Francis comments that insufficient risk assessment appears to have been undertaken by the DoH with regard to the implementation of system-wide change (2013 p.63). He goes on to note his impression that clinician advisors to the DoH are not at the heart of policy making on a number of issues, including the Foundation Trust agenda. He concludes that this lack of clinician involvement in policy making is likely to have negative implications for patient safety throughout the NHS.


Aiming to consider The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry in a socio-historical context, this review begins by identifying the key message of the Francis Report as an urgent need for widespread cultural change throughout the NHS. The overarching goal of this cultural change is to ensure that patients are protected from inadequate and unsafe care such as that provided at Stafford Hospital between 2005 and 2009.

Comparing the key themes underlying the recommendations of the Francis Report with the policy aims and strategies of three recent DoH White Papers, the hypothesis is supported that the themes identified by Francis are not new, but rather form a thread that weaves its way through recent NHS policy. A number of recurring themes are identified, including the key role of CPD in the delivery of high-quality healthcare, the need for partnership between patients and clinicians, and policy maker ambitions to increase patient choice.

Reflecting the concerns expressed by many professional bodies, Francis highlights the risk that, by demanding rapid organisational change (DoH, 2010) allied to tight financial control (DoH, 2011) , current DoH policies may compromise the ability of the NHS to deliver the identified goal of safe, patient-centred care. Healthcare commentators argue that, against the current poliitical background, many of the recommendations of the Francis Report may be more wishful thinking than a practical blueprint for change (Moore, 2013).

Nancy Jones, Podiatrist and Dr. Christopher Morriss-Roberts, Senior Lecturer, School of Health Sciences


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Arts and Health: Creative Writing as a Reflective Method in Healthcare


In this essay I shall explore how creative writing can aid practitioners in the formation of therapeutic nursing relationships. I will first discuss some of the benefits and barriers to the establishment of the therapeutic relationship in nursing. I then turn to the potential of the use of the arts within health care, to establish reflective and self-aware practitioners. Following this, working towards closure of the essay, I turn to the value of reflective practice, including the benefits of creative writing to aid my awareness of self, particularly within the nursing role. In this context, I focus on my creative attempt, a fairy tale entitled The Girl and the Well, which can be found as an appendix to this essay, below the reference list.

Therapeutic relationships in nursing: benefits and barriers

All nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication. They must take account of individual differences, capabilities and needs. (NMC 2010) To develop and inform our knowledge of patient health needs, nurses must build up a strong rapport with those in their care. They must establish a ‘therapeutic relationship’ (NMC 2010) in which patients feel able to express their needs, beliefs, social/cultural contexts and any pre-existing health knowledge. Good communication is essential in the negotiation of the therapeutic nurse and patient relationship. It has the potential to not only affect the actual care delivered but also how the patient perceives it. As Jootun and McGhee (2011, 41) state: ‘Poor communication can compromise care, which can lead to undue anxiety and frustration on the part of the patient’.

However, effective communication is a complex skill and can, particularly within nursing practice, prove problematic. Communication, as Balzer Riley states, ‘involves the reciprocal process in which messages are sent and received between two or more people’ (cited in Bach and Grant 2011, 11). These messages and delivered both consciously and subconsciously via body language, verbal discourse, eye contact, etc.

The communication process can become further distorted by the interpretation of these messages, which will inevitably be translated through individual schemas (Niven 1995). Schemas referred to an internal storage system informed by facts, experiences, beliefs and views, which we compare and contrast all new and incoming information to (Niven 1995). Processing this information allows us to make sense of our surroundings, to shape our social perception. However, the sense derived is not necessarily a universally accepted perception, as Niven and Robinson explain: ‘each individual’s different observations has been influenced by his or her background. The scene is constant, but the observations are different’ (1994, 40).

This highlights the fluidity of perceptions and their potential to become unconsciously prejudiced. In turn, this can lead to the individual selectively recalling information that can lead to the formation of what Oliver (1993) refers to as negativity bias. Individual prejudices and/or biases can form barriers to communication and therefore the successful formation of a therapeutic nursing relationship. Acknowledging that these barriers may be unconsciously constructed, how then do we as nurses overcome them and create ‘the right conditions for the development of mutual trust’? (Niven and Robinon 1994, 45).

The arts in health care

The nursing theorist Peplau (1952) proposed that is through the exploration of one’s ‘self’ that nurses may start to over come the barriers to therapeutic patient relationships. Peplau (1952, 12) argued that ‘Self insight operates as an essential tool and as a check in all nurse-patient relationships that are meant to be therapeutic’. This is a belief that remains popular in the twenty-first century and is supported by Freshwater (2002, 6): ‘Knowing and recognising self through self-awareness and self-consciousness … can be seen to be fundamental to the development of caring alliance which is to be therapeutic’. Wagner (2002, 121), further argues that the notion of self-awareness is fundamental to our understanding of what caring is:

Implicitly threaded throughout definitions of caring is the need to develop a sense of self, a sense of knowing ones beliefs and values, intention to help, moral commitment to be present, ability to respond competently to another’s need, and willingness to entre therapeutic relationships that encourage human connectedness.

So, how then does the nurse become more self-aware? Wagner (2002, 128) suggests ‘art therapy’ as a possible means, explaining that through the creative process one can unearth the ‘expressions of the unconscious psyche’. The use of artistic methods of expression in health is also promoted by Staricoff (2004, 24), who declared that the ‘relationship between the arts, particularly literature and medicine, stimulates insights into shared human experiences and individual difference, and increases the language and thoughts of the practitioner’.

Staricoff argues for the importance of literary works, which contemplate issues of illness and death, as a valuable resource for practitioners to aid reflection on clinical practice. Wagner (2002) extends on this argument in his assertion that, while the benefits of studying established artists’ work are clear, healthcare practitioners should personally participate in the creative process in order to develop greater awareness of self and personal knowing. However, the creative process and the encouraged confrontation of personal experience is not always an appealing or easy task particularly to those who have been encouraged to focus on the science of nursing and not its art.

The value of reflection

Reflection on and in practice is a process, which has long been encouraged in nursing and nursing education (NMC 2010). As a students nurse I have been encouraged to reflect on my experiences of nursing practice with placement mentors. Indeed, it is an NMC competency, which they have assessed my ability to engage in.

However, not until a recent meeting with my mentor did I fully appreciate the importance of self-refection and the impact it might have on my practice. During this meeting my mentor asked me to reflect on any personal barriers I might have which would prevent me from delivering care. My initial inclination was to reply in the negative; after all I came to nursing with the simple desire to care. However, I wanted to give her enquiry the reflection and attention it deserved and so I took my time to consider my personal values and beliefs.

This led to a consideration of how I have come to hold my personal values and beliefs, my experiences of life so far. In doing so, a somewhat contentious personal memory was re-surfaced, one that I was not aware still had to power to bother me. As with most unwanted/painful memories my initial response was to push it aware, ignore it and hope it goes away. However, through it surfacing I realised this memory/experiences was most likely the sort of potential issue my mentor wanted me to be aware of.

This was clearly an issue, that should I be reminded of it during practice, consciously or subconsciously, could effect my delivery of care. My unwanted memory was from my childhood experiences of living with a parent suffering from alcoholism. Alcohol addiction remains a predominant issue it the UK with ‘1.2 million alcohol-related hospital admissions in England in the year 2011/12, a 135% increase since 2002/03 (Alcohol Concern, 2014) It is inevitable that in my role as a student nurse (and a future registered nurse) I will be delivering care to patients effected by alcohol abuse. This is an issue I needed to reflect on more deeply on to ensure it did not ever bias my care.

I decided to use creative writing as a therapeutic technique to explore this issue. To gain a better understanding of my self in the hope that an increased self-awareness would deconstruct any barriers I may construct to in the attempted formation of therapeutic relationships with my patients. Creative narratives offer the writer permission to explore their own story (Grant et al. 2011) and thus use the art of storytelling therapeutically. Slater (2005,4) similarly argues that creative writing is therapeutic as ‘your own fears and short-comings will find expression in the process… the stories you generate will at once reveal to you your mind while offering up chances to change it.

However, while the reflective output from my creative endeavors promised to be beneficial to my future nursing practice, I found myself daunted by this personal and emotional task and sought some creative distance from it. I found my distance in the simplistic and symbolic style of the fairy tale. In the security of the traditional fairy tale third person narrative I reflected on my experiences of my mothers descent into alcohol addiction when I was a child. This narrative choice was not only elected to maintain fidelity to my genre’s structure but also for the theoretical therapeutic distance it provides. By writing in the third person, in a fantasy world of undefined time and place, using symbols and metaphors to represent emotionally painful issues and events, one can externalize one’s feelings and thoughts without having to explicitly confront them directly. I found this technique worked as a sort of mediator between my realistic memories and the feelings that arise from them. It is the symbolic nature of fairy tales, which have made them a useful and respected therapeutic device in the emotional treatment of children and adults (Brun et al. 1993).

In reflecting on my piece The Girl and the Well, I became aware of its somewhat typical representation of Freud’s theory of separation anxiety. This was expressed well by Bettelheim (1976, 145), who stated: ‘no greater threat in life than that we will be deserted, left all alone. Psychoanalysis has named this – man’s greatest fear – separation anxiety; and the younger we are, the more excruciating is our anxiety when we feel deserted’.

In acknowledging this Freudian interpretation I was able to accept and reflect and on potential feelings of anger at the neglect of myself as a child. In representing my mother I incorporated the formulaic fairy tale element of ‘splitting’ (Warner 1995, 212), a conscious writing strategy that divides the mother figure into two different characters, the ‘good’ mother and the ‘bad’ mother. The severing of the mother figure into these morally polarized beings allows me as the writer to ‘preserve an internal all-good mother when the real mother in not all-good … [and] permits anger at the bad mother’ (Warner 1995, 212). This strategy allowed me to really reflect on my more complex and conflicting feelings about my mother, a process that I found surprisingly cathartic.

Although I found creative writing for self-reflection an overall positive experience, it was a long process. I didn’t just write the entirety of my story in one sitting and feel suddenly healed and enlightened. It took time. It was a reflective period in which I felt completed to read and not just write. I remembered, sought out and re-read Sharon Olds (1987) poem ‘After 37 Years My Mother Apologizes for My Childhood’, which I feel aided my reflection and helped construct the image of my mother in the my tale. At this stage I feel ready to let my fairy tale go, it has served its purpose and provided ‘testimony’ (Grant 2011, 2) to my lived experiences.


I feel that my attempt at utilizing creative writing to explore my self, and therefore become a more self-aware caregiver, was successful. A nurse’s beliefs can be, as Ersser (2002, 56) argues, be ‘communicated to the patient with or without intention’, which highlights just how important it is for nurses to be self-aware in practice. Although I would never knowingly behave in a prejudiced way towards my patients, I feel this deeper reflection has made me more aware of a pre-existing potential issue, which I have had the proactive opportunity to work on. It has also made me more appreciative of the personal narratives patients have and that are always being constructed. As, Slater (2005, 11) argues, ‘Everyone, absolutely everyone had a tale to tell. And everyone, absolutely everyone will have to revise it, only to revise it again’. I believe the learning process has allowed me the freedom to really develop myself independently as a reflective writer and nursing practitioner, a progression I’m not sure I would have been able to succeed to in a more formally structured module.

Charlotte Pendlington, BSc (Hons) Nursing (Mental Health) student


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Bach, S. and A. Grant. 2011. Communication & Interpersonal Skills for Nurses. 2nd ed. Exeter: Learning Matters.

Bettelheim, B. 1976. The Uses of Enchantment: The Meaning and Importance of Fairy Tales. London: Thames and Hudson.

Brun, B., E. W. Pedersen and M. Runberg. 1993. Symbols of the Soul: Therapy and Guidance Through Fairy Tales. London: Jessica Kingsley Publishers Ltd.

Ersser, S.J. 2002. The presentation of the nurse: a neglected dimension of the therapeutic nurse-patient interaction? In: Nursing as Therapy. 2nd ed. edited by McMahon, R and A. Pearson. Cheltenham: Nelson Thornes Ltd.

Freshwater, D. 2002. The Therapeutic Use of Self in Nursing. [Online] London: Sage Publications. Available from: [Accessed 15 May 2014].

Grant, A., F. Bailey and H. Walker. 2011. Our encounters with madness. Ross-on-Wye: PCSS Books.

Grant, A. 2011. Introduction: Learning for narrative accounts of the experience of mental health challenges. In: Our encounters with madness, edited by Grant, A., F. Bailey and H. Walker. Ross-on-Wye: PCSS Books.

Jootun, D. and G. McGhee. 2011. Effective communication with people who have dementia. Nursing Standard. 25(25): 40-46.

Niven, N. 1995. Health Psychology: An Introduction for Nurses and Other Health Care Professionals. 2nd ed. Edinburgh: Churchill Livingstone: 25-42.

Niven. N and J. Robinson. 1994. The Psychology of Nursing Care. Leicester: BPS Books: 39-64.

Nursing and Midwifery Council. 2010. The code: Standards of conduct, performance and ethics for nurses and midwives. [Online] London: Nursing and Midwifery Council. Available from: [Accessed 20 May 2014].

Olds, S. 1987. The Gold Cell. New York: Knopf.

Oliver, R. W. 1993. Psychology & Health Care. London: Billlière Tindall: 159-176.

Peplau, H. E. 1952. Interpersonal Relations in Nursing. New York: Putnam.

Slater, L. 2005. Blue Beyond Blue: Extraordinary Tales for Ordinary Dilemmas. London: W. W. Norton & Company Ltd.

Staricoff, R.L. 2004. Arts in Health: a review of the medical literature. London: Arts Council England.

Wagner, A.L. 2002. Nursing Students Development in Caring Self Through Creative Reflective Practice. In: Therapeutic Nursing: Improving Nursing Care Through Self-Awareness and Reflection, edited by D. Freshwater. London: SAGE Publications Ltd.

Warner, M. 1995. From the Beast to the Blonde: On Fairy Tales and Their Tellers. London: Vintage.

The Girl and the Well

girl&woodOnce upon a time, there was a little girl who lived in the heart of a dark forest. Her name was Little Rose and once upon a time she had been happy. Little Rose had grown up in the comfort of a cosy cottage with her young and beautiful mother whom she loved dearly. Although she considered herself content, Little Rose’s mother was a curious woman with a longing to travel and know all there was to know about the world. One day, tiresome of their modest cottage, Little Rose’s mother announced that she was to journey alone into the forest in search of new and exciting delights to return home with. “Oh Mother,” sobbed Little Rose “please do not go! Or, if you must, take me with you. I won’t be any trouble.” Unaltered by her child’s pleas Little Rose’s mother kissed her daughter on the cheek, made her promise not to leave the cottage, and set out upon her expedition alone.

All alone Little Rose sat by the cottage window and awaited her mother’s return. Years past and yet Little Rose kept her little nose pressed against the pane of glass, willing her mother to walk through the clearing to their cottage; to return home. One day, to her great joy, Little Rose did see her mother emerge from out of the trees and towards their little cottage. “Oh Mother, you have returned to me! You are home. How I have missed you,” shrieked Little Rose as she ran to embrace her mother. However, as she got closer she froze and gasped. The woman in front of her, although with a likeness to her mother, was old and haggard. “You are not my Mother! My Mother is beautiful with a sweet face and fare skin. Your skin is sallow, your mouth is mean, your eyes are red. Oh where is my Mother? What have you done to her?” cried Little Rose. Irritated by the child’s wails, the changed mother pushed her daughter aside with a rough dirty hand, entered the cottage and closed the door behind her.

Left outside, on the other side of the door, Little Rose fell to the ground and sobbed. After a time, when she felt herself more steady, she picked herself up and crept to the window. Carefully peering through, she looked in horror at the sight which presented itself before her. There on the bed was her mother, she was not asleep but awake, breathing smoke, drinking a blood red potion and cackling a strange broken laugh. Her head was swaying an unnatural sway as she began to cough, sending forth hideous flecks of red and yellow slime from clenched cracked black teeth. “This monster is not Mother,” whispered Little Rose as she backed away from the door of her once happy home. “I shall find Mother and together we shall rid our home of this false creature,” vowed Little Rose.

All alone Little Rose set out for the first time into the woods in search of the loving mother she remembered. The woods were dark and unwelcoming and as Little Rose tried to make her way through the masses of unruly branches her hair and clothes were seized and shredded by sharp thorns. As night approached, and the little light that shone through the trees died, the woods became alive with the sound of wild and angry animals shrieking, hissing and growling their warning to those unfortunate enough to cross their path. Hungry and cold, Little Rose persisted on her desperate journey, wandering in circles and calling out for her lost loving mother. “Oh Mother, shall we ever find each other?” As she sobbed these words a worn old owl flew down and perched upon a branch close to where Little Rose lay. “Do not cry Rose, I can tell you where your mother is,” softy hooted the owl. “Where? Please tell me at once! I beg you!” implored Little Rose. Suddenly with a wide sweep of his wings the owl took flight and glided off in and out of the trees, “follow me,” he hooted as he disappeared into a mass of vines and leaves.

Pushing her way through the dense brier Little Rose came to a dry barren patch of earth upon which stood a rickety stone well. The owl perched itself upon the edge of the well hooting “here you are Rose, just as you asked.” Bewildered and overwhelmed with disappointment Rose began to yell “how could you? How could you be so cruel? My mother is not here! Oh, I am all alone and I will never see her again.” As her cries became whimpers the owl flew down and placed itself next to Little Rose sighing softly “you are not alone Rose, and you are not a little girl anymore, see how you have grown.” Rose looked down at her self and gasped, it was true she was no longer a child, indeed she was now a grown woman.

“Once upon a time,” continued the owl “a young woman entered these woods thirsty for adventure and exotic treasures, dissatisfied with the riches her life already held, she let her blind and selfish greed guide her on her journey and it led her to this very well. This is the ‘well of temptation’ and only those willing to forsake their souls to it may drink from it.” Rose slowly stepped toward the well and begrudgingly peered into its depths, “the blood red potion,” she exclaimed “oh mother, was I not enough for you?” The owl stared hard at Rose, “what do you wish to do now my dear? Perhaps you too would like to partake from the well? Or perhaps your heart yearns to return home?”, questioned the owl. Rose glanced again at the well, the thick red liquid was rich and velvety, its aroma strong and enticing. “I am so thirsty” murmured Rose, “maybe I should have just a little … I have no home now … even if I do wish to return there.”

She lowered the old pail into the well and once it was full carefully drew it back towards herself, she lifted it towards her lips and was about to take her first sip when she froze in horror. There staring back at her, reflected in the alluring liquid, was the haggard sallow face which had possessed her mother. “No” she cried, “No, this is not what I want! I want to go home! I want to go home!” As she declared her last words Rose threw the pail back into the well and ran as fast as she could out of the barren land and through the woods. She passed vines and brambles shouting to them “I want to go home!” and as she did they parted, clearing her way. She ran into the darkest part of the woods and shouted at the hidden sky “I want to go home!” and suddenly the trees swayed their branches aside letting the newly risen sun shine through. “I want to go home!” she yelled once again and as she did she ran out of the trees into a clearing leading to a lovely little cottage. Rose stopped in front of the cottage. Suddenly the cottage door flew open and out ran a beautiful little girl calling “Mother! Oh Mother you have returned! You have come back to your Little Rose!” Rose took the little girl in her arms, kissed her on the cheek and softly whispered “yes my little one, Mother is here, Mother is home.” Hand in hand they walked together back into the cottage where they lived together happily ever after.



The 15th Annual Mental Health Conference – 9th April 2014

The beautiful thing about learning is that no one can take it away from you (BB King)

The 15th Annual Mental Health Conference was marked by one of the first truly sunny days of the year and the feeling of warmth that this gave was carried into the conference itself. In the canteen, as everyone filled up on coffee, it was a delight to see quite a few of the usual suspects and a smattering of new faces
The proceedings started with a brief introduction from Sharon Davies who announced that the conference has now acquired charity status. This should help with raising funds, ensuring that it runs annually and is free to all who attend. As Sharon said, there are those who would not attend regularly if there were a cost attached, so this was important and positive news.
The Marion Beeforth memorial lecture this year was given jointly by Sara Meddings, Diana Byrne and Hazel Lambe. They have all been involved in setting up a pilot project to establish Recovery Colleges in the Sussex area. The two initial projects were in Brighton & Hove and Hastings and it looks like they have both been a great success. Recovery Colleges are a pioneering way of helping people with a mental health diagnosis (or their carers) to cope with their illness, to take charge of their own recovery process and to live a freer and more fulfilling life. Having been established in various parts of the country, Sara and the team are now planning to open colleges in various parts of Sussex.
Sara told us that the principles behind the college are that they bring together people with lived experience and clinical training and that the expertise of both these groups is acknowledged and given equal status. The colleges offer a range of courses to teach people coping strategies and applicants can choose from prospectuses courses that will suit them best and then, at the end of the course, they receive a certificate celebrating their success.
One of the great things about these colleges is that they ‘recycle’. Students can, if they wish, become teachers, thus bringing their own skills to the mix. Diana talked us through how this worked and how valuing it is to be able to bring one’s own experiences to the table to help others.
Finally we heard from Hazel who had graduated as a student from the Recovery College. She told us how rewarding she had found the process, how she felt that she had ‘re-engaged’ her brain and how she was now training to be one of the Peer Support Workers.
It was a truly inspiring presentation of an initiative that looks as though it may fill a huge gap for many people who have experience of mental illness. One of the overwhelming impressions was that the Recovery College provided some thing that had been missing for many people – hope.
After the presentation the conference divided into group work sessions that, on returning, fed back their thoughts on the Recovery College initiative. Feedback was, unsurprisingly, overwhelmingly positive. It really felt like the sunshine had followed us into the conference and stayed there.

Steve Smith Mental Health Nursing BSc(Hons) student


Trapeze: An Autoethography


The lights were so bright. So bright she could be a star. Stella Star, a Brighton burlesque dancer. She was so important and the people surrounding her were a higgle piggle of famous people or random relatives. The ultimate ending of it all was that Prince Andrew was going to collect her in his helicopter, free her from the Irish Police Station she was detained in, and take her to her star.

Six months later she was wading in the Thames, after ending up in a crack house in Lambeth, shiny sports car and art in the garage, stereo screwed to the walls, swanky apartment on the top floor. She only knew it was a crack house because her friend was a drug and alcohol worker; she’d never been in one before!

I write ‘she’, as the woman in the paragraphs above doesn’t feel like me. People ask if I remember my hallucinations and I do generally, once the booze had ebbed away. The crack den story, when I found a shotgun, and ended up in the Thames was a definite turning point. Not my usual New Years Eve that’s for sure. Not that I have ever been much of a wallflower, this turn of events was an all time low, even for me. My friends, frantic, had reported me missing. My 3 year old daughter was with her father for a few days. I didn’t have a clue what I was doing.

Before the crack den event, I had been psychotic two times in three years. This time I got some actual help and I actually listened. I had an amazing trainee social worker, who was on placement in mental health. He came every week for an hour, for two months. He listened to my worries and fears, of which there were many at the time and soothed me with the advice that things will feel different given time. It did. It does. He also advised I take up a sport. A hard sport. One which pushes you. A close friend also advised I gave up drinking. My standard coping mechanism of old. I had never learnt how to deal with life’s blows without it. Every time something bad happened I turned to it and when I was feeling high this was a very bad combination. It still puzzles me that this was never mentioned by any health professionals I came into contact with. It also puzzled me that, previously every time, I had an assessment my life history was taken. I never felt that this information was ever put to a therapeutic use. Time and time again I delved deep into the depths of my murky, tumultuous past, dredging up horrors, disappointments, trauma. As far as I can remember these were never used to help me forge a new path for my future. Each time I felt my utterances were a complete waste of time and why hadn’t someone documented it the first time so I didn’t have to keep repeating myself!

However, this time I did listen, for the first time. I began to accept there had been something wrong. My daughter was starting school and this freed up week days. I started to run, got addicted to that for a while. I ran by the sea. I became hypnotised by the changing scenery by the waters edge. How every time it was different, how many birds I saw, how many things I could ruminate about, in time to the gentle plodding of my feet hitting the concrete. Then the circus came to town.

The tag line for the show was ‘the circus you’ll want to run away with!’ I went to the show, only going out with close friends at the time, due to the shame my last bout of mania had brought upon me. My friend and I decided there and then that we would do this; we would become aerialists. A festival girl at heart, I’d always longed to be part of a show, on the stage, a performer. Puberty and a messed up childhood got in the way of those dreams. As a young girl I had longed to be in the Kids from Fame. Longed with a passionate young girl’s heart! As soon as I finished my A levels, I bought a £50 ticket to Glastonbury Festival, hitched a ride in a pink Fiat Panda and got lost in the mayhem of that world. I went back year upon year in various different guises, but always wondered how I could be a performer. I never believed in myself enough to be able to do it as an adult.

My first classes were a dream come true. The teacher was experienced and kind. I had my friend in tow too, my little security blanket. My daughter safely deposited at school, I would drop her off then don my leg warmers for my trapeze class once a week. I felt liberated. I felt like I was coming alive for the first time since perhaps puberty. I was discovering my body again, and also my mind. This time, the third round of recovery from mania, I was ready. I had more to lose. With the booze safely tucked up and away in the naughty corner, I could see more clearly I think. This last time I had pushed the boundaries way too far. I had a daughter now and she had to come first. Social services had become involved in our lives and it scared me that if I didn’t find a way back to wellness I might lose her. The threat felt very real. I had to find a way to make it work without medication. Trapeze was my way.

After a time I started to train very regularly. I soon met several local aerialists who trained around the city. I loved it. Not only was I becoming very, very strong, I was doing something exciting, bold and daring. I have never been a member of a gym, the idea itself sends me to sleep, but trapeze, well that’s more like it. I love its hardcore nature. The danger aspect. The fact you have to become very fit. I love the calloused hands you get, the bruises, the odd face plants (literally falling on my face). The skills I have learnt from the several teachers I have had, and from sharing my experiences with a lovely group of people has rewarded my mental health immensely.

I set up a children’s circus skills group, funded by the Scarman Trust, and we met weekly. I trained four times a week. I perform a little, work teaching at festivals and at an international aerial convention in Edinburgh. I worked hard. The training gave me hope. It built up a new version of myself, one in which I was proud. It was the closest I had come to fulfilling my dreams in my entire adult life. I have to concentrate. I have to be present in my body and mind. I get to express all those tumultuous whirling emotions in movement and a display of my strength. I spend a lot of time choosing the right music tracks, fitting my dance in. The enforced music searching, is therapy in itself. It took a long time to be able to play around with all the moves I had learnt. I learnt to dance up in the air, throw shapes, like on land. I feel like I can fly there.

There is all the rush and danger that I felt in my mania, but in a safe, methodical, creative outlet. When I work on a performance, I have to marry up a lot of different creative mediums: performance art, circus skills, music and I need to be brave. All the time I was training as an aerialist, my social situation didn’t change. I was still a single parent; I still had a very, very low income. I still suffered stigma and abuse on a regular basis, even from my close friends. I still lived in a small community that judged me as a mental health patient. Trapeze made me rise above it. Literally. That combined with the alcohol abstinence changed my life. I have found new friends. I discovered a route to a better, more stable me without medication, or contact with mental health services. I was still the woman coping with a life which had seen not only herself abused, but also her daughter. The pain of my reality was a lot to bear; my imagination leaking out was my escape. It needed to be contained but in a creative way. The thought of not being able to get out of bed, to do all the busy things a single mother has to do in a day to keep afloat, kept me off medication. I wanted to be healthy, not on route to a shortened, deadened life, where I had no way of navigating through my difficulties. I have always thought if the roots of a problem aren’t tackled, then the symptoms, psychologically will remain. Medication was just not an option. Besides, I was 33, I might want more children, and all the medication looked too toxic for that.

I began to think that I could share this gift I had been given. I kept meeting women who had had a troubled mental health history, but had discovered the healing properties of aerial circus. It might sound evangelical, but circus demands so much dedication and rewards you so utterly, so you want to sing it’s praises from the roof tops. More and more signs were pointing to me training to be a professional within mental health. I applied to be a mental health nurse. It was not an easy decision. Ever since I started I have been desperately trying to tailor it to my own interests and wonderings about the world. Whilst on the course I visited a project in London, a mental health trapeze project. It blew my mind and I swore I would replicate the amazingness of the London project in Brighton. I met people there who oozed happiness and pride. They all stated how much they enjoyed it, how proud they were of themselves, how fit they felt. All the participants were very vocal about how they had benefited from the trapeze experience and how it was transforming their lives. This is better than psychiatric drugs, I thought . This is something that I believe in, that I care about. Something I respected.

It validated my own experiences and was a way for people to work in a therapeutic, creative, possibly medication-free way. I applied to Southdown Housing, who now run Brighton and Hove’s day recovery services, for funding. The Women’s Only Mental Health Trapeze Project starts on June 4th 2014, with funding for an initial 6 weeks. I arranged it to be in the day time, so mothers can attend, and have ensured there is a creche space for their children also. I am so happy, as I truly believe this works for people.

My own experiences of trapeze and my journey to better mental health were my inspiration for the project and now my next challenge is how to bring my unique standpoint of ‘service user’ or ‘survivor’ and connect with my professional status as a mental health nurse. I am a very creative person, and hopefully my continuing work within creative performing arts will aid my transition into the profession of nursing. I am certain it will help. I hope my new venture with trapeze and mental health will inspire others and bring hope that a different future is possible for them, away from the constraints of the standard mental health system. ‘I would never have chosen to be taught this way but I like the changes in me. I guess I had to go to the edge to get there’ (Hobler Kahane 1995, 83).

Theoretical and methodological background

Writing this piece for me has been positive for my mental health in many of the ways that Taylor and her colleagues outline in their work on recovery writing and narrative restorying (Taylor, Leigh-Phippard & Grant 2014). Their idea that this process might challenge ‘social justice issues of disempowerment, isolation and diminished sense of self worth’ (Grant, Biley & Walker 2011; Grant, Biley & Leigh-Phippard 2012; Grant et al. 2012; Taylor, Leigh-Phippard & Grant 2014; Costa et al. 2012) resonates deeply for me. The act of writing about my mental health history in relation to art has made me consider things differently and the actual documenting of it has made me see my history in a slightly different light, a more positive one. This contrasts with the fact that as a person who had been given a psychiatric diagnosis I had for several years felt defined by this. As a student nurse I have used the technique of story telling and poetry on a psychiatric intensive care unit to great effect. I hope to use it as much as possible in the future.

My life story, which includes episodes of psychosis and hospitalization has been re-written as a positive one (Grant and Zeeman 2012). It is a hopeful story, not just for myself but others who may still be awash in the murky depths of their minds. Work such as Our Encounters with Madness (Grant, Biley & Walker 2011) and Our Encounters with Self Harm (Baker, Biley & Shaw 2014) are inspirational books which will hopefully help direct the world to a kinder place in regard to those, like myself, have suffered from mental distress.

Amy Barlow Mental Health Nursing BSc(Hons) student


Baker, C., F. Biley and C. Shaw (eds). 2013. Our Encounters with Self-Harm. Ross-on-Wye: PCCS Books.

Costa, L., J. Voronka, D. Landry, J. Reid, B. McFarlane, D. Reville and K. Church. 2012. Recovering our stories: a small act of resistance. Studies in Social Justice. 6(1) 85-101.

Grant, A., F. Biley and H. Walker (eds). 2011. Our Encounters with Madness. Ross-on-Wye: PCCS Books.

Grant, A., F.C. Biley and H. Leigh-Phippard. 2012. The Book, the stories, the people: an ongoing dialogic narrative inquiry study combining a practice development project. Part 1: the research context. Journal of Psychiatric and Mental Health Nursing. 19: 844-851.

Grant, A., F. Biley, H. Walker and H. Leigh-Phippard. 2012. The Book, the Stories, the People: An ongoing dialogic narrative inquiry study combining a practice development project. Part 2: The practice development context. Journal of Psychiatric and Mental Health Nursing. 19: 950-957.

Grant, A. and L. Zeeman. 2012. Whose Story Is It? An Autoethnography Concerning Narrative Identity. The Qualitative Report. 17(72) 1-12.

Hobler Kahane, D. 1995. No Less a Woman: Femininity, Sexuality and Breast Cancer. 2nd edition. California: Hunter House.

Taylor, S., H. Leigh-Phippard and A. Grant A. 2014. Writing for Recovery: A practice development project for mental health service users, carers and survivors. IJPD (International Journal of Practice Development). 14(1) 1-13.

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