Podcast: Catching up with Dr Josh Cameron
In the latest podcast, Dr Cameron discusses his extensive work in mental health and why building resilience is a societal issue.
The School of Health Sciences Principal Lecturer also explains the background behind the Blackpool-based ‘Resilience Revolution‘ project he co-leads on, and how ‘problem-based learning’ is implemented into his teaching.
To listen to the podcast, click ‘play’ in the link below. Alternatively, most of the interview is transcribed on this page.
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Enjoy the podcast.
I wanted to start with a significant shift in your younger years, which has led you to where you are now. You studied History with French and History at BA and MA level respectively. But then you changed lanes to become an occupational therapy technical instructor in psychiatric hospitals in London. What prompted that change exactly?
I was too scared to become a schoolteacher! I had a place to do that, and then I thought, no, it’s not for me. And I wasn’t sure what was for me. And I worked in the NHS, in IT and information processing and something called medical audit, looking at results of ear surgery and training staff in very basic computer skills. It was in the early days of Windows and using a mouse and I didn’t find that that rewarding. But from that I then moved up to London and found a very similar job in a psychiatric hospital, training patients in using computers and it was much worse paid, but much more challenging and a much broader range of skills. So I suppose that was what happened. I mean, I did history not for a career, but because I think history is important. It is all about understanding the world. And in some ways for me, what I’ve done subsequently has been about understanding the world and seeking to make an impact upon it.
Okay. We’ll get into that a bit later. But what do you remember from those early days working in a psychiatric hospital?
Well, although I’d worked in the health service prior to that for at least a couple of years, I’d never worked in mental health services. And to be honest, the first time I went up on the ward, I was scared. And then subsequently I reflected that I was quite embarrassed to be scared, as it was a much more scary place for people to be who were on the wards, particularly in those days and still unfortunately today in open dorms with limited privacy. But that was one of my first feelings. But then I started enjoying the work, enjoying the people and learning a lot myself from people who’d been through some very tough times and were finding ways to overcome it.
I know a lot of your work, even to this day, has that kind of community focus. Has that direct link to society been important to you in your academic life?
Yes. For me, everything is about applying things, about taking, learning, whether that was in terms of history or whether that’s in terms of mental health recovery and doing things to help people feel that they can make a difference to their lives and positively impact on the world around them. So, yes, that has been important. And actually also what’s been important is not always thinking that the solution lies inside the person themselves, sometimes it’s the situation they’re in that needs to be changed. The word we use is responsibilising individuals for their own recovery, and certainly individual efforts and determination can make a difference. But actually, that’s often nurtured from outside. And we need opportunities and supports and systems and services and resources to enable people to recover, to enable people to make a difference to their communities.
I know mental health and employment has always been a big interest of yours, and it was the focus of your PhD, which you carried out here at the University of Brighton. Can you trace the roots of that interest, that connection between mental health and employment?
Yes. Well, it was when I started my doctoral studies, actually, and I was working part time as a lecturer and part time as an occupational therapist with the mental health services. I was working on an inpatient unit. And at the time there was a lot of attention to work in relation to people who were using community mental health services. But there didn’t appear to be any attention or hardly any attention to work for those people who were admitted to inpatient units, despite the fact that about 20 percent of people had jobs and it was a high risk time for people to lose jobs as people lost touch with employers.
I was particularly struck by one encounter with somebody who worked for transport services, who experienced severe depression, had attempted suicide, was admitted, was discharged and then was readmitted after attempting to go back to work. And actually, his employer had been, you know, attempted to be quite understanding. They thought, well, we’ll leave him to it. We’ll set him up to do routine tasks. We’ll put him on shifts where it’s very quiet with no one else around. And they did this with all good intention, but it actually was the opposite of what was needed. When I spoke to him, he said he wanted absorbing tasks and he wanted people around him. So actually, his employer wanted to be understanding, but there needed to be some kind of conversation with this man or we might call it an assessment and understanding of what supports would help him and what wouldn’t. And very often that’s the case. It’s not always a case of sort of good people, bad people. It’s about understanding and thinking about what things are going to help in terms of changing somebody’s work routine environment, either temporarily or permanently.
And there’s no ‘one size fits all’ approach to that, is there? How do you go about assessing what an individual needs in the workplace?
Speak to them. Speak to them and listen to them. Sometimes people start off with a thought that ‘oh well this condition means that somebody needs to come back in four weeks with half time working for the first two weeks’. And that is a one size fits all. We need to listen to people and we need to understand their situation and actually work out whether it’s, you know, things that the person needs to do, whether there’s things in the work environment. And that might be the physical environment or might be people around them in terms of understanding.
We hear this word ‘resilience’ used a lot in conversations about mental health now, particularly in relation to young people. How do you approach that term in your work? Is there a particular interpretation of resilience that you have explored?
Yes, actually. And it was in the process of doing my PhD that I first encountered the term. It’s a contested term. And initially, actually, I was quite sceptical of the term because perhaps one of the most common understandings of it is a kind of ‘pull up your socks’, ‘stiff upper lip’ approach to things. But I was encouraged by colleagues such as Professor Angie Hart to actually engage in some of the literature of people who have done serious work around resilience theory and practice, to actually see that that people who are doing serious resilience-building work don’t see resilience as an internal trait, but rather in a systemic way. That resilience can involve internal resources. But an awful lot depends on the environment around people. And actually to ask for help is a resilient move.
A lot of your work on resilience has focused on that contextual side rather than the on the individual…
Yes. Although actually one of the things that helps us feel strong and able to cope is support around us. So I’m not denying the role of important things like hope and determination, but it’s good to recognize that those aren’t things that somebody is born with but things which can be nurtured and fostered by environments around people. I did some research work with the Sussex Recovery College, a mental health recovery college. And we actually co-developed a building resilience course along the lines of this approach to resilience. I was struck by one of the research interviews we did. Somebody said at the end, ‘well, at the beginning, I used to think resilience was all about coping with it on myself, by myself. And to ask for help was a sign of weakness. Whereas now I see it as a sign of strength using the tools and the people around me’. And that really touched me – she really helped to crystallize rather than abandon the word resilience. We should reclaim it from those who would try and responsibilise individuals to be resilient, looking at how we can develop resilience through our communities, our collectives and through society.
And you think that definition is changing then, in terms of how the public view it, from that ‘pull up your socks’ idea towards a wider contextual perspective?
In some places, yes. I think it’s a constant engaged debate. At the University of Brighton’s Centre of Resilience for Social Justice, we deliberately put those two words together, very much emphasising that resilience and social justice are aren’t opposites, but rather that social justice involves social resilience. And vice versa.
When you hear a term like snowflake bandied around by certain people, would you say that was a case of responsibilising mental health issues?
Absolutely. Some models of resilience and academic thought talk about resilience, quite rightly, in relation to something, in relation to an adversity. Now, in some models of resilience, that adversity is taken as a constant and as a given. Whereas in our model of resilience, actually sometimes it’s the adversity that needs to be changed. And the example I like to use partly for my mental health work and the collaborative work in the recovery college is the example of mental health discrimination and stigma. I don’t think it’s ethical or even that it works to say to somebody, well, you need to learn how to cope with stigma or discrimination. Actually, what people need who face stigma or discrimination at work is support in order to challenge it and to change it, not to be told, okay, you need to change how you think, so you can put up with it. That’s an example of something of an adversity that needs to be challenged or transformed.
Does this ‘responsibilising’ make you angry?
I suppose so, yes. I mean, I suppose my interest in history was always in terms of trying to understand the world, how it’s got to where it’s got, why it’s got there. And actually, I was always interested in in movements when people were seeking more justice, more rights, against all different forms of oppression. I’ve been interested in how people can affect change and make an impact.
This talk about resilience leads us onto the Blackpool Resilience Revolution, which you’ve worked on. Could you please give us a summary of what that project entails?
Yes. Again, the word resilience has been used quite a lot in schools and sometimes it’s been used in that way that I was criticising, getting school students to be resilient to the pressures of exams, stress and so on, whereas what we’re doing in Blackpool is actually trying to build resilience in schools. So we’re not seeking to just work on individuals to cope with pressures, but rather to try and transform the ways in which schools work and to support collaborative attempts to respond to things like bullying, to self-harm, to promote mutual understanding, to bring students, young people, parents, carers and teachers together to consider how they can change systems and to go along to schools and to look at social service systems and to look at the whole town. One of the striking things now is that there is a resilience pathway to the centre of Blackpool with messages from our ‘resilience framework’ which is really inspiring to see.
I was going to ask, have you kind of seen any palpable signs of progress? Well, I guess that is a big one, isn’t it?
Yeah, that’s a big one. I mean, there are still another couple of years to go in terms of seeing the results and what we’re looking for in terms of some sort of quantitative measures. And it’s hard to measure things like resilience. But there are some measures that you can look for.
What are the concrete ways that you can you can try and measure the results of the project?
I mean, it’s a complex intervention to use jargon. There is not a randomized control trial and it’s funded by the national lottery. So, what we will come up with is plausible explanation for the impacts that we observe. We’re using something called the value creation framework, and we’re doing a mixed methods analysis to try and link the outcomes that we observe to some of the data that we collect in terms of some of the measurement scales about wellbeing, in terms of incidences of self-harm, in terms of issues of school exclusions and people being supported in the schools and then trying to find comparative data in other areas and historical data. We will be cautious in what we claim. But we think by bringing together some rich and deep case studies and qualitative data to accounts that we can see what works, why it works and how it works, and also what doesn’t work.
Sure. And why Blackpool?
The Blackpool council were greatly taken by our ‘resilience framework’, and submitted an application to the National Lottery Head-Start program for funding to carry out a test. They wanted to use the resilience framework. So it’s actually more they chose this approach. And that’s why we’re evaluating it. Blackpool does have particular challenges. It’s one of the poorest local authorities in England. It has challenges around school exclusions, but also has a lot of assets and a lot of strength. And the resilience is about mobilising strengths and assets. There is a very strong community feel there. And that’s what’s incredibly inspiring about going up to these events where young people themselves are making presentations, are teaching teachers, teaching other professionals, are teaching us as researchers and are being co researchers, too.
Okay. Let’s go back to that word ‘snowflake’. I suppose it has become such a ubiquitous term now. I guess it does come from some area of analysis, regardless of whether you think that’s a sound analysis or not. Can that kind of terminology be damaging to people who it is levelled at? Or is there a degree of truth in it?
To be honest, I don’t think there is truth in it. I think too often some people in older generations have tended to criticize younger generations for not being able to cope. And I think if you look back in history, there’s always been a tendency for some people to do that, but only for some people to do that. There’s always been people who’ve been inspired by the efforts of young people. And if anything, actually today, some of the pressures on young people are greater than they ever have been. Pressures to grow up younger than actually they need to. Pressures from social media and the pressures of an exam system that that is really very stressful, much more stressful than it was in our day. Actually, far from snowflake, I have every admiration for young people. But I also think we have a responsibility to try and work with them to reduce some of those pressures, because actually it’s creating a crisis in young people’s mental health. And that’ll just roll on to adult mental health.
So what in particular do you think is creating the crisis – that that blame on them?
I don’t think it’s just the blame on them. I think the blame on them actually gets in the way of solutions being found. I think there’s pressures. I think there are pressures around schooling. There’s pressures around work. There’s pressures around all the time. Having an education system which puts an emphasis on achievement in an academic or exam terms and actually an insufficient valuing of the learning and the personal growth aspects.
Climate change and environmental breakdown is obviously a massive pressure on young people. And we’re seeing thousands of young people take to the streets to protest about government in action. Is that a case of mass resilience, too, in response to that issue?
Yes, and actually, resilience is the word that’s been used in relation to the environment. And when you think about the environment, actually, it makes no sense to think about resilience in terms of one system or people developing resilience to climate change, rather we need to do something about it. And the resilient move is to try and change that. And again, I think people like Greta Thunberg and the school strikes are absolutely inspirational. I think some of us older people have been a bit shamed by our inaction on such issues. I think that is a great example of collective resilience and the people saying, well, actually, we have to do something about it.
And that’s an issue that should bridge generations as well, I suppose. Well, we hope so…
Well, there are some people like those in oil companies who don’t have such a long term interest, and think only about the interests of the profits of those companies. That’s my view.
How does your work in this field impact your own mental health and how has it impacted your mental health over the years, would you say?
I suppose at times it’s been something that has helped me notice and be aware of issues in my own life with my own work. But there’s also been other times when only subsequently have I realized when I thought I was getting repeated bouts of flu-like systems, that I was experiencing some form of stress. And I was feeling it so physically that it’s strange when you’re in the middle of it, you perhaps sometimes don’t know what’s going on. And I didn’t at the time label it that way, and maybe that shows a problem with labels. But something I’ve always found inspirational and that was very helpful is when you realize you’re not alone. And when you’re doing things collaboratively and that includes collaborative research. Actually, one of the things that got me through my PhD, which was a challenging time, was collaborating with people who had lived experience and expertise. And now I know that that has helped.
PhD students have a potential mental health burden because it can be quite independent and isolating. I mean, was that your experience in some way?
It can be. Yes. And although taking a more collaborative approach to research does present extra logistical challenges, it actually makes you a little bit less alone. And in all areas of our life, if we find ways to be a bit less alone, that’s helpful.
Moving on to your teaching, I think you’ve said it’s one of your favourite aspects of your job. What do you find most rewarding about it?
I love talking about ideas and practice, hearing people’s examples from their life, students examples from when they’ve been on placement and they’re coming back and challenging ideas, because it is enlivening. I mean, we use something called a problem-based learning approach. So that involves an active learning where we have a scenario, an issue, and we invite people to explore it, identify questions and work out where best to go and look for those questions. It’s exciting.
What kind of placements do students undertake?
A lot of my teaching is on occupational therapy courses. We have a two year maste’s course and our spend about a third of time in a range of various health and social care placements, which might be the NHS or local authority, could be mental health, but also physical health services. But also we we’ve actually been one of the pioneers in developing a whole range of diverse placements, which can be in homelessness services, drug and alcohol services, prisons and so on. So it’s always wonderful, the experiences students bring back into our teaching. So, you know, they’ll go on a placement and then they’ll have a university-based module and we’ll deliberately draw on some of their learning experiences and support them to see the connections between what they’ve experienced in placement and what they’re learning at the university.
Would that entail students reflecting on their own mental health experiences?
We encourage people to recognize all those different forms of expertise which can include recognizing and should include recognizing your own lived experience. But we also say it’s about when, you know, we don’t expect people to share things if they don’t feel comfortable or able to. I think we’ve all experienced things in our lives. Sometimes we’re in the middle of something. Actually, it could feel a bit too close to home sometimes to share with people who we may or may not know that well. Whereas other times, maybe once we’ve done, there’s been some distance and so on, we feel that we can reflect on it and we can share that. So we never force people to do that. But we do encourage people to develop an awareness of what’s impacting upon them so they can perhaps understand the stuff that’s happening around them.
Do you want to try some lifestyle questions? The first one is what advice would you give to your 16 year old self? So what were you actually doing at 16 years old?
What I was doing was things like going on CND marches really and feeling very worried about what was going to happen with the world and whether the Cold War was going to lead to a nuclear war. I was trying to act a bit too much of like a father to my brother, which was of course disastrous in terms of the relationship, although actually this solved itself subsequently. Advice to myself… well, actually, although I don’t regret doing things like CND campaigning and so on, I think perhaps I felt I had to grow up younger than I needed to, so I would say to focus on and perhaps to allow myself to remain not an adult for a bit longer.
What about your favourite place in Sussex?
Anywhere on the downs. I love Mount Caburn, high up where you can see the sea. You can see the shapes of the hills and the wind’s blowing and the sun is shining.
Your perfect weekend?
I quite like rowing on a rowboat at sea, if I can get a hold of a rowboat anywhere, or perhaps a bit of kayaking. So yes, somewhere out in a bit more wilderness than the downs. I liked the downs, but I’d like something that’s a bit wild out there in Ireland or Wales maybe. And then, with people close to me, some nice food and drink, maybe a bit of music. Yeah, that would be a good weekend.
What are you currently reading, listening to or watching?
I’m currently reading Jung’s autobiography, but the only reason I’m currently reading it to take me so long to read it. I’ve been reading it for months and I’m not progressing very quickly. I’m watching Spiral, the French detective program. And I was reminded of a song I heard on the radio the other day. John Martin and the song May You Never. That’s a wonderful song.
And lastly, which three people would you invite to your fantasy dinner party?
I used to think this was a fun question, but I once went to a team day. Not at this university. And so since I’m not talking about this university, I won’t say where it was. I went to a team day where this came up as this sort of exercise and people in the team suggested arrange a range of pop stars, film stars, campaigners for human justice. And then in all seriousness, the actual team manager said he would invite Hitler and Stalin. I was shocked, and there was a silence. And in some ways, it didn’t surprise me, but he was sort of saying that he wanted learn about leadership from then. So I suppose my worthy answer would be perhaps some of the people who’ve campaigned against people like that. But I suppose my honest answer would be… I’m attempting at the moment to get in touch and see more friends from a long time ago who have lost touch with me. So I’d pick some of them.