Little Feet pursues PALS- an update in the Mental Health Inpatients Blogging debate

As I wrote in an earlier post, blogger @ChaosandControl, or Little Feet, was recently prevented from blogging whilst an Inpatient in an Acute Mental Health Unit by staff who confiscated her phone to prevent her having access.

Without my knowledge, staff read through the archives of my blog and my twitter stream…

…During a subsequent meeting with staff, I was notified that the archives of my blog and twitter stream had been read. I was asked to stop blogging and my mobile phone was confiscated for 24 hours. I agreed to stop blogging for the duration of my admission. While I did not want to stop blogging, I agreed to because I felt to do otherwise might have been detrimental to the care I was receiving. I enquired as to whether it would be possible to retain my mobile phone but agree with staff not to blog. I was informed that this would not be possible because a team decision had been made to confiscate my mobile phone.

As a result, she has had to re-evaluate her existence as an award winning mental health blogger and may feel unable to continue to operate her Chaos and Control blog.

She has updated her blog readers with the news that she has emailed her Trust PALS (Patient Advice and Liaison Service) with a view to gaining clarity about the decisions made in this case, and to highlight what may be a misguided interpretation of current guidance from the Care Quality Commission about Inpatient’s rights to communication.

Little Feet also makes clear that she has no wish to apportion blame to the staff who made this decision, since they were not in possession with up to date training in the ethics and guidance in this area.

She also points out the potential risks faced commonly by whistleblowers and has (as we would expect from an accomplished blogger) a fair-minded assessment of the internet convention for right to reply, in this case by the Trust concerned.

I feel it important that I pursue this matter through local channels in the first instance. I do not want to cause detriment to my current or future care I may need by skipping straight to national media and social networking sites. I believe the Happyvillesire Mental Health Trust should have the opportunity to respond to my request for clarification of policies.

As was pointed out during the #nhssm Tweetchat this week:

The ‘Streisand effect‘ is the inverse relationship between the attempt to surpress information and the internet’s tendency to make the information freely available and easily searchable due to the interest such decisions provoke.

So, the Trust concerned is now decidedly on the back foot in terms of managing the message about their brand, and only Little Feet’s sensitivity in leaving them unnamed is holding back the opprobrium of the blogging community. I need hardly point out the irony of this, since confidentiality was cited as a justification for the Trust’s actions!

As we saw in my last post, the Trust’s reactions in this case were probably due to a lack of preparedness for the new networked reality. We saw how they are occupying the bottom layers of Maslow’s hierarchy, whilst Little Feet comfortably negotiates higher levels.

How could the Trust learn from this matter, and put in place measures to prevent this kind of publicity and negative brand association in future?

The organisation, or at least some individuals within the organisation need to make their journey up the levels of this pyramid to improve their business readiness for a future scenario.

Traditionally, the individuals within a Trust organisation concerned with the perception of their brand are located within the corporate Communications structure. We can see that in this instance, as in many other potential scenarios, this is a risky situation. Communications professionals are not embedded into practice areas, where these judgments will, increasingly, have to be made by clinical staff and managers. So, even if a Trust had a competent communications structure that was conversant with the conventions and corporate risks inherent in social media, they may not be available to consult with clinical staff in a timely manner.

It becomes clear that in fact it is the clinical, customer facing roles that must develop capacity and be sufficiently strategically resourced and trained in current corporate policy in this area. This flies in the face of the traditionally centralized business model for corporate communications within the NHS.

What is the solution?

Communications through social media are an organisational game-changer. We must move with the times and adopt a new way of doing business, where we empower clinical staff with the training and resources they need to support the efforts towards self-actualisation of people in recovery.

How do we do this? We must re-visit our centralised model of corporate communications, following on from the lead shown by notable public sector organisations such as Monmouthshire County Council, who recently allowed all employees to respond directly to customer enquiries. We should all prepare to move towards a “honeycomb” communications model, where all members of an organisation are empowered to understand the rules and conventions that govern response in the social space. Staff should be resourced such that they are able to identify which communications should be handled by communications professionals, and feel confident to handle the rest as the excellent brand ambassadors that NHS staff invariably are.

The Slideshare presentation linked to in the last post includes an excellent triage flowchart for staff using Social Media by Jeremiah Owyang. This could be used as a baseline for your policy.

Source:DavidArmano,Edelman  (http://www.flickr.com/photos/7855449@N02/5042953763)

@HelReynolds of Monmouthshire County Council and ReynoldsPR.com has some tips- I recommend the article.

What do you think?

If you would like me to help your business change the centralised communications culture, and train your staff in how to respond on the social web, please don’t hesitate to contact me tech4health(at)gmail(dot)com.

An experiment in Social Media in Clinical OT practice Growing Together 3- Growing shoots

I’ve posted a couple of blogs about my experimental use of Social Media in Clinical OT practice (see part1 and part2). Today’s post discusses the first foray into the use of Social Media.

As I discussed in the first blogs, I visited other groups both within the city and more widely. During these visits, I took photos to share with our group members when we talked about what we could learn from other groups. These photos were also included in reports I made about the visits, which were uploaded to the Staffnet site discussed in the previous post. They made the reports more interesting, and also made my service users more likely to connect with the reports, when I printed them out to share with them a little like magazine articles.

Service users wanted to be involved. They wanted reports like these relating to their project. In response to service users asking if we could take photos of our progress, and to enable the participants in the group to share this progress as they wished, I took photos with my smartphone.  Initially, we only shared the photographs during the tea break with each other, but then I considered the use of a photo sharing social networking site in order to share the photos more widely with family and friends of group members. We talked about how to do this, and settled on using FlickR, a free social media tool for sharing photographs. This would mean they could share their progress with others, all that was required was internet access.

As health service employees we have a duty of care for everybody that uses our services, including protecting their data. Mindful of our Information Governance issues, this was cleared by our IG department, and clear boundaries set for the use of cameras to record progress. Consent forms were developed to capture informed consent from service users before they were photographed. Part of  gaining the informed consent was to discuss what we could do with the pictures  and what kind of boundaries I was operating under in terms of what information would be photographed. We made sure that the majority of the photos we took didn’t have “patient identifiable information” on them (faces, distinctive tattoos) because this made the Information Governance issues much easier to handle, and it made our service users comfortable with the process. Of course, if people didn’t wish to be photographed, we would respect their wishes.

We started to take more pictures, uploading them to the FlickR site we had set up.

As we developed the project and they became more comfortable with what was happening, they did ask to be photographed on occasion. One particularly memorable photo was of a young man holding a crop of onions he was proud of harvesting! Because of our informed consent proceedure, the subjects of the photos (if identifiabe) got a second chance to decline their permission for publication on FlickR, but if they agreed, my clinical reasoning was that it was okay to publish.

Disabled people and people with mental health issues are often socially excluded, and I felt that including the photos within the larger social network was a way to combat some of that exclusion, in our own small way. We had set up a group that was non-stigmatising- it didn’t carry “health” branding, and our group members had as much right to occupy the virtual space as any other community group. Had we encountered any adverse comments or increase in social difficulty for the group members as a result of this, we could have taken alternative action. But we didn’t.

Sometimes, the things which matter in a therapeutic group are not the things we carefully plan for. Within this group, the wildlife that we saw around us became a real hot topic of conversation, and this was another great opportunity to take pictures to share.

We also had a regular visitor in the form of our Allotment cat.

Many people with disabilities and mental health issues don’t have pets because they fear they either cannot afford to look after them, or they have lifestyles which mean they wouldn’t be able to offer the care they feel the animals need. This was the case for several of our group participants. However, they all felt very affectionate about the Allotment cat, and he seemed to return their affection. He would visit during every group, and was inevitably fed and offered a saucer of milk by the group. He would then make his way from knee to knee, offering every group member the opportunity to give him a stroke or two. Who knows what effect this affection has on a person with limited social skills?

At this point, I felt I needed to learn more about Social Media, in order to really maximise how we used it within the group; so I attended a local Social Media Surgery. I am immensely grateful for the help I received there. I felt encouraged to venture further into the realms of social media.

What are your views about using photo sharing social media with mental health service users? Please share in the comments.

To find out our next steps, watch out for my next post.

Censorship, or Duty of Care? “Little Feet”, Blogging on an Acute Mental Health Inpatients Ward.

This blog is inspired by a post I have read today by @Chaosandcontrol, who blogs as Little Feet. Please do read the original post and comments in their entirety, and excuse me for quoting from it in addition.

Here, Little Feet describes her actions in  password protecting her entire blog:

I was readmitted to hospital on 28 December and discharged today (3 January). On 29 December, I was notified by staff that my blog had come to their attention. Staff read through the archives and my phone was confiscated for 24 hours. I made a verbal agreement with staff that I would not blog while I was in hospital.

She then posted about how because of this lack of privacy, she no longer felt safe to continue with her blog. She has currently stopped. I have so many things to say about this short statement. Im afraid they may come tumbling out helter skelter, so please bear with me.

Staff probably defend their actions by claiming they are acting to protect either the organisation (and staff), the patient, or the other patients. Each of these defences relies on slightly different clinical reasoning. Let me go through them.

First, let us consider Maslow’s famous hierarchy of needs.

An individual travels up this pyramid  from a baseline of meeting physiological needs, through safety, then social and emotional needs towards self expression and self actualization. By transferring the principles contained within this model, we can look at the organisation’s equivalent succession of needs within the social space, using a term coined by Jeremiah Owyang at the 2011 Leweb conference in Paris- the ‘Social Business Hierarchy of Needs’

If you haven’t got 20 minutes to watch the video, you could look at the Slideshare presentation.

climb-the-social-business-hierarchy-of-needs-leweb-keynote-2011?player=js

What we can learn from this is that the hospital in which Little Feet found herself was still concerned with the bottom layers of the pyramid- those regarding security and safety, whilst Little Feet had progressed past these layers in her digital interaction and was performing at a much higher level, concerned with self-exppression and self- actualisation.

We can see  that because of this disconnect in the digital literacy of the staff and organisation, and the population it is serving, the efforts by the staff to take control of the situation by using their power over their patients was (expectedly) experienced as oppressive by Little Feet, and also by the blogging community leaving comments on Twitter and on the blog itself. I am sure this was not the way they wished to be experienced, as I am sure they are good people who are just terrified by this new technology and way of communicating. But actively preventing someone from operating on the higher levels of Maslow’s pyramid is never going to be experienced as anything but oppressive, and services need to wake up to this fact and work out how to deal with their concerns about safety and move along in their own journey with social media.

Learning about patients from sources other than from within the clinical relationship and information from friends and family WITHOUT EXPRESS PERMISSION is not on. We are able to work that out from first principles, because one of the pre-eminent concerns of healthcare professionals is consent. Without consent, we must tread very carefully in what we do, using reflection, interdisciplinary learning, and close regard for the legal and policy framework for what we do (e.g. sectioning, deprivation of liberty). Little Feet did not consent for the staff to read her blog. They did not happen across it as a blog by an unknown individual, they had inside knowledge at the time of reading of Little Feet’s clinical presentation. That’s not cricket.

It’s unethical- In the same way that we would be justifiably angry if we found someone has read a secret diary, EVEN IF WE LEFT IT OPEN ON OUR INPATIENT BED we can have an expectation that clinical staff will form their clinical opinions based on presentation, symptoms, and medical history.

Discovering additional information about our clients is one of the cautionary tales warning clinical staff (and teachers for that matter) off from using SNS. The belief is that learning these insights will damage the therapeutic relationship, and cloud the (supposedly impartial) process of developing a diagnosis or formulation. That’s why your GP probably won’t friend you n Facebook.

It’s not that digital sources of information are irrelevant- but THIS SHOULD BE EXPRESSLY CONTRACTED WITH THE PATIENT.

What we present to the world is a series of faces, like the sides of a prism. None of them entirely explains our essential essence, each one is slightly different. How Little Feet appears in her blog is quite different from how she appears to her clinical team, I’m sure. After all, they are presented with a real life, flesh and blood version, perhaps with tears, anger, occasional incoherence, and frustration with the inherent power imbalance of mental health treatment- just like you or me in a mental health crisis.

The clinical team need to focus on the clinical presentation if they are to avoid bias, prejudice and all sorts of personal opinions from creeping unseen into the clinical situation. That’s why we have such developed conventions for clinical consultation. Contracting to source additional information pertinent to the clinical relationship could be appropriate, but it must be done with consent.

So, we can see that protecting the patient by removing her ability to express herself and self-actualize runs counter to the principles of recovery, which are about supporting progress up Maslow’s pyramid, not forcing someone down it. We have also seen how clinical treatments should not use information gleaned from  relationships outside the clinical arena without consent.

Protecting other patients is a little more difficult, in that we know that they will have a range of digital literacies and understanding of the consequences of being referred to within the blog. They will all occupy different levels of Maslow’s hierarchy. Confidentiality is a complicated issue, becase someone can be identified by a clinical picture (if unusual enough) just as easily as from a photograph. The difference here is that the staff hold the responsibility for protecting confidentiality, service users do not. That is why at the start of clinical group work, protecting confidentiality is generally introduced as a ground rule- to make sure it is in the mind of the participants.

However, what exactly are the patients here being protected from? In fact, there is no difference between Little Feet’s potential to discuss her descriptions and those of other patients. It is the medium of the descriptions that worries the staff.

Where conversations about services are confined to individuals, organisations feel happier because they are perceived as less threatening. What is frightening for the organisation about digital media is related to their lack of understanding of it, as discussed above. The old ‘command and control’ model of communications is so prevalent in health organisations dealing with digital media because they are operating in an unfamiliar medium and are just on the initial steps of Maslow’s pyramid.

There is excellent clinical practice out there, and there are both practitioners and organisations whoa re prepared for the journey they must take in understanding social media. But there are so many others who still haven’t framed the question, never mind worked out an answer.

Little Feet’s blog has served a critical purpose with the final post. It illustrates the difficulties that are facing health organisations who are treating individuals with much higher digital literacy than themselves. It’s time we woke up and started to play catch up in this arena.

What are your experiences of this?

If you would like to know how I can help your organisation or clinical staff move on in their understanding of digital and social media, get in touch at tech4health(at)gmail(dot)com.

An Experiment in the use of Social Media in Clinical OT Practice: Growing Together (2) Putting down roots

I reflected in my earlier post about my experience with a Gardening project run within my NHS Foundation Trust, in which we used digital tools including Social Media in an innovative way to further the aims of the group.

I considered the difference between the natural social networks of our service users, family and friends, and the support from various agencies- health, the voluntary sector, the local authority and education. The division we practitioners placed between the providers and agencies seemed quite unnatural to the group members. The solution to this seemed to be to improve the communication channels within and between the various groups operating.

This post is part 2 in the series giving the whole story, and today it deals with the Intranet. We wished to connect the services within our Trust, and it occurred to me that in order to facilitate conversations within the Trust related to our groups, the Staff Intranet was a good place to start.

Luckily, within our Trust we have a very approachable and helpful Information Governance lead. Without his help and support, I would never have got the sign off to even begin this project, and so to him my thanks.

After consulting with the Information Governance lead, and obtaining his consent and guidance I was able to develop an Intranet site for our project. The site was built using Sharepoint, along with the rest of our staff Intranet. It focussed on shared resources, evidence and news about gardening groups within the Trust.

Populating the site with interesting and relevant content was surprisingly easy.  I visited some local projects  that were using gardening as a therapeutic intervention, to build links and to swap ideas around social inclusion, and possible future plans for collaboration- even discussing developing social enterprises. I added reviews of these other gardening groups and developing projects within the city to the embryonic site.

I added recipes which we were using with the produce we were growing, to be used by staff, or within our “Cook and Eat” groups. These were recipes I was inspired to come up with in response to the seasonality of food were were starting to produce, and which I was assiduously storing in the freezer in the Therapy kitchen for future group work.

I added a calendar of events to the page, so that other groups around the Trust knew when similar groups were running, so that they could inform potential participants. We had a news stream, to discuss plans for planting schedules.

Our network was growing- with this resource, I was able to develop links between the different services around the Trust. I visited some other sites to make them aware of the work, and developed close links with some of the other projects working in similar ways. Each project was developed into a sub-site, so that they had their own area to show off content they produced- which I anticipated would be photographs, news, and calendar events.

I added in contact details for individuals prepared to take a lead on the gardening projects in each area of the Trust and geographical areas of the city, so that there was a clear path to follow if viewers wished to refer people onto a suitable project in their locality.

I was still concerned that we weren’t able to respond to the request from our service users to enable them to share their progress within their natural social networks. I was also aware that our partner organisations within the Voluntary sector had no access to the resource on the Intranet that had been created.

Please see my next post for details of how the project progressed, where I took the skills and confidence developed though the use of Sharepoint and applied them to Social Media.

An Experiment in the use of Social Media in Clinical OT Practice: Growing Together (1) Planting the seed

As a mental health OT, and an advocate for delivering services for people through multiple channels (including the use of Social Media), I am sometimes challenged as to how and why this is possible or indeed, desirable. The identified risks in service provision can be summarised thus:

1. Duty of Care
2. Learning information the patient didn’t disclose to you
3. Confidentiality
4. Privacy (of the practitioner)
5. Risk assessment
6. Vulnerability of the service users

I want to unwrap these issues, and to do so I want to tell you a story. It’s going to take a few posts, so do stick around if you want to find out more.

I developed a project, through my NHS Foundation Trust employer, which was my grounding in examining these issues and developing the innovative tools to address the needs of my service users encompassing the use of Social Media in Clinical Practice.

I worked in an Inpatient setting, where we had a greenhouse and regular gardening groups. An Allotment was being run by an OT who was based in a CMHT (Community Mental Health Team) and was employed as a Care Coordinator. I had previously worked with him, when we both had roles in a different, community based team, specifically for people with severe and enduring mental health issues.

When working on the Allotment previously, we had seen fantastic gains in the Recovery of the service users who were group members. It had been a real confirmation of the power of Occupation in mediating mental health issues. Some of “our” service users had progressed far enough in their Recovery journey that they were now attending other, community based or local authority funded gardening groups.

They had all developed skills, and had all improved their ability to communicate, to work as a team, and to enjoy social interaction, (we assumed) as a result of their participation in our supportive group.

My colleague found he was care co-ordinating for the same group of service users, as the old team had been integrated into the CMHT. He was able to do his Care Coordination during the group, which also facilitated peer support between group members.

This group of service users, beccause of the nature of their mental health needs, sometimes found themselves back in the hospital where I now worked. It occurred to me that it would be great if they had the opportunity to continue to participate in the Allotment group during Inpatient stays. Further, it occurred to me that the other people who were Inpatients could also benefit from attending a socially inclusive group based off-site. This is, after all, in line with principles of Recovery, and addressed risks associated with Inpatient sojourns such as institutionalisation.

I realised that during our Inpatient Gardening Groups, popular activities of planting and nurturing seeds and seedlings would lead naturally to the extension of the activity to include planting up in an Allotment to see the plants grow and develop. It struck me that there was a useful metaphor within the work: our service users, like our seedlings, would “grow” in their Recovery through initial nurturing in the safe and protected environment of the greenhouse/hospital, be “hardened off” by regular trips off site to the Allotment, and finally be “planted” back into the community they lived in, ready to continue to grow, “blossoming” on the Allotment at some later time.

My colleague and I decided to draft a proposal to pilot a scheme where we could attempt this. We decided to propose that I could bring a few identified service users off site each week to attend their regular gardening group, and when I had a keen gardener who became an Inpatient, they would be offered to join us on the Allotment (subject to risk assessment, leave status etc.) Meanwhile, he would continue to offer his Care Coordination through the medium of the group to his set of gardeners, and would pick up other suitaable referrals as we progressed.

Within the NHS it is important to put together a clear brief for any novel idea in order to get approval from the managers of the service. It is important to follow the process of full risk assessment, both of the activity and for the participants. One must consider how one will keep records, pay for resources, and evaluate the idea. But having done this, we were delighted to hear the pilot was approved and we could begin.

The pilot started slowly, in the Spring, as the soil was warming up. Seeds were planted, in the courtyard greenhouse at our Inpatient Unit gardening groups. They developed into seedlings, and were re-potted on to larger growing-on pots. Then, they were hardened off outside the greenhouse for a few weeks before they were transported over to the Allotment to be planted in the final position. Meanwhile, on the Allotment, the ground was cleared ready to accept the plants. We planned what to plant, where to plant it, and how to look after it.

An important element of the group was that the serice users and staff didn’t wear any identification on the Allotment. We were, therefore, treated like any other Allotment holders by the others on the site. They would offer us advice on the best times to plant different vegetables, and ensure we were aware of Allotment ettiquette and rules, such as path widths, and how to dispose of waste. We were, in essence, modelling social inclusion on a small scale, within the Allotment site.

We had a tea break halfway through each session. We brought, each week,  large thermoses full of hot water. We brought the items needed to make tea and coffee. We brought biscuits, and we tried to make them special biscuits, to reflect the value and esteem in which we held the workers on the project- and to keep our energy levels up for the second half of the group!

We didn’t occupy staff and service user roles within the Allotment. We took turns to make and serve the tea, for instance. For some service users, this was a huge challenge as they might generally avoid social discourse. We were so happy, as the group progressed, to see that all of the group members were able to increase their confidence in social interaction. The service users responded well to the responsibilities of taking tea and coffee “orders”, making the tea and handing out the biscuits. It encouraged turn taking, spoken communication, reinforcing of social mores, and offered an opportunity to informally assess them in a typical domestic activity so loved by the OT profession- making a cup of tea.

We shared our feelings and plans about what to grow, and what to do next on the site during our tea breaks. One day, a service user said to me

“I wish I could show people what I’m doing here.

This is really good.

My Mum would like to see this.”

I agreed, it would be great to share his success with his family and friends.

I couldn’t stop refelecting on this remark. It became a bit of a challenge to me.

Why, when we were modelling a socially inclusive group, did it exclude the natural social networks of support that these service users had, outside traditional services?

Was there any way to devleop the service in order to respond to the challenge?

Please join me in my next post, when I will talk about the next phase of the project, Social Network Seedlings

My #OTweek- Digital Strategy, Patient Opinion, Tweetchats, Blogs, and Baking

I thought that since it is OT week this week, I would post about the kinds of activities I have been up to in the world of OT.

picture by College of Occupational Therapy

Now, my practice is somewhat unusual these days- because of my disability my role as an OT has had to adapt to fit my changed circumstances. As a result, I am following my professional interest in the use of Social Media and digital technology to develop innovations in healthcare. In a way, I have been fortunate to have been given the “push”, which has resulted in my taking this leap of faith (necessity truly is the mother of invention).

I have an interest in developing new learning opportunities for Occupational Therapists through the use of digital media and Social Media. One of the ways I am keen to explore this is through a MOOC, which I have blogged about previously. Some of Monday was spent formulating plans about MOOC development, including an element suitable for an inter-professional audience about how to use Social Media for professional development, and how to capture the evidence of this use. This will form part of a MOOC that is in the planning stage, for launch in 2012. During the evening, a Tweetchat meeting with synchronus use of GoogleDocs to create a project plan was held, and I participated in this, adding to the knowledge and capacity of the group.

Additionally, I continued to work on some Digital Strategy development that I have been tasked with. I am really enjoying the process of thinking in mental “wide open spaces” to address strategic needs of large organisations. It helps me to embed learning, and as I wholeheartedly believe it is critical to the success of the organisation to develop this strategy, I am enjoying the opportunity to make positive changes to services and evaluate the impact of this. This is the subject of my initial project towards my MSc in Professional Health and Social Care Studies, which I commenced this Autumn.

On Tuesday, I had a meeting to discuss a new venture which I am developing in partnership with other organisations locally, and which we are attempting to get funding for in order to complete the project management plan. It was a great meeting, which I afterwards described as a mental “work-out” as we had truly pushed our thinking and collaboration along during it. Details will follow in due course.

Tuesday evening was the second ever #OTalk,  a lively discussion held on Twitter and free and open to anyone to join in. This week, I was the host for the chat, so I was tasked with promoting the event, with guiding the discussion, and with ReTweeting points of interest. After the discussion, it was my role to get a transcript of the discussion up on our group blog, and to follow up with a blog post about the talk. I also made sure to thank participants for joining in and sharing their knowledge, and responding to requests for information and offers of help and support for the project.

I always enjoy the Wednesday evening #nhssm Tweetchat. This week, we looked at ensuring digital inclusion of our service users, and when to appropriately deploy Social Media tools to accomplish the aims of our respective organisations and to uphold our professional and Trust values. We had a lively debate about how to develop practice in this area, and as usual, all the chat participants shared fantastic links and information.

I was asked to complete a piece of work for Patient Opinion this week. They were looking for a guest blog post in celebration of OT Week, and contacted me to ask if I would do it. I was happy to oblige, as I am a big supporter of the organisation and believe that the more opportunities and channels there are for the health service to receive feedback from people with experience of using services, the better. So, I offer this as my contribution to the challenge from BAOT/COT to do something to promote the role of the OT during OT Week.  It was published today, Thurday, and you can read the post here.

I have been moderating the on-going discussion about my post regarding Inpatient’s Smoking Rights, which has spilled over into other Social Networks, such as a Facebook Group I am a member of called MH4OT (Mental Health for OT). The comments have been fascinating- once more, showing the benefits for OTs and other HCPs in the use of Social Media for professional growth, reflection and for the recording of Continuing Professional Development (CPD). As a result, I have blended the social media I use and continued the conversation through a new post on this blog.

As we OTs know all too well, Occupational Balance is essential to health; so I have been happy to commit Thursday and Friday to childcare responsibilities. One of my children was a little unwell, and so hasn’t been able to go to the childminders.

I spent some time on Thursday in the company of some other Mums I know, who popped round for coffee and cake. I was interested to try a “friendship cake”, which is produced in a fermentation process. My share of the fermenting mixture is coming soon- and I’m looking forward to “feeding” it and watching it grow before making my own “friendship cake” to share. I couldn’t help but analyse the activity and concluded that this was something to put in my “bag of tricks” to use at some later date in a therapeutic group.

In addition, I have used my skills in baking to make flapjack for the family , and to create Christmas presents using crochet and knitting. I’ve played with blocks, with dominos, and with dollies with the kids. I’ve cooked meals, and I’ve both been independent in some, and assisted in other personal activities of daily living (PADL).

Phew! writing it down makes me realise how busy and full my life is- which I am very grateful for.

I hope you have enjoyed this glimpse into the life of an OT during OT week. What did you get up to?

http://www.patientopinion.org.uk/blog/post/2011/11/10/Occupational-Therapy-and-understanding-what-it-really-takes-to-recover.aspx

Inpatients Smoker’s Rights- the Debate Continues on the MH4OT Facebook Page

Here is the copy of the interesting thread that developed discussing the original post that I put on the MH4OT Facebook Page.

This is a Facebook group with 310 members (and counting!) of Occupational Therapists working in Mental Health worldwide. Looks like this debate will continue- please do leave a comment if you have a view.

Epic Women

There has been a debate online about misogyny experienced by women bloggers. I’m not going to write extensively about it, as I believe others have done it very well, already.

As a counterpoint to the debate, I would like to talk about all the fantastic things that women are doing so brilliantly online. Despite the misogyny, women have taken up residence all over the internet, and are changing the world for the better, one fantastic project at a time.

On Twitter, we use the #ff to offer suggestions to others of people who are worth following for their updates, which hold useful or interesting information for the benefit of the whole community.

What follows is a short list of women who I believe are worthy of a #ff, because of the great projects they have initiated or are contributing to. It’s not in any order, and it”s not going to be complete. Epic women are springing up all the time, and so I expect to revisit this theme again.

@LouLouK is one of the first women I came across online who made me take a step back and just enjoy seeing her expertise spilling out across her keyboard. She is a geek (well, from where I’m sitting) and is able to apply technological tools to devlop new ways of approaching her job in Local Government. She can haz maps, apps, and can work almost anything out if you give her the dataset- I’m quite sure of it. She writes for the Guardian and has developed the #lgovsm Tweetchat for people in local government to share good practice.

@HelReynolds Helen has been really inspirational, as she set about effecting huge change in Monmouthshire, where as a direct result of her efforts, the local government has now given all employees access to communicate with the residents through Social Media tools.

@ShirleyAyres is a remarkable individual who seems to know everyone, and be a part of every conversation I’m interested to join on Twitter! She has years of knowledge and experience of Social Care, Social Work and Local Government, and yet seems to have retained the ability to keep looking at situations with fresh eyes, in order to see fresh solutions.

@Ermintrude2 is a Social Worker who has recently started to blog at “The Not So Big Society“. She is reflective about her own practice and the national and local drivers that are impacting on it. She is sensitive to the power differentials within her relationships with the people she works with and has brilliant, strong opinions about politics and how it impacts on her practice. Especially interesting about personalisation, mental capacity and mental health.

@SalmaPatel has been engaged with her doctoral research at the University of Warwick which relates to digital tools in healthcare. She blogs about her ideas and opinions related to this area, and has a fabulous brain to examine the issues involved. Always questioning, and really helps me to develop my own ideas through discussing things with her.

@LoveArtsLeeds Victoria has recently developed the first festival in the UK to explicitly celebrate the links between mental health and wellness, and the arts. This festival has been a huge success story here in Leeds, and has really got our community talking about mental health and breaking down the stigma attached to such discussions.

@ChristineBurns is a specialist in equality issues, and she has been a critical source of information relating to diversity and best practice for me since I started Tweeting. She feels it is important to develop the business case as much as the human rights case in support of diversity in the workforce, and supports her arguments very persuasively. She has strong opinions, and is not afraid to voice them- a very refreshing characteristic!

@amcunningham is a GP who teaches Medical Students in Cardiff. She is a blogger, and raises interesting issues about online identity, medical ethics and social media opportunities consistently with the health and digital communities. Recently the centre of an online dispute with other medics about professional behaviour online that was termed #hcsmukgate and which I blogged about some time ago.

@Re_connection is an early Social Media friend, when we first started to discuss the possible links between health, wellness and digital technology, we were two islands in a whole sea of incomprehension! I am glad to say that we are no longer so isolated; Katie has gone on to win a fantastic tender to deliver the Innovation Labs to develop online and offline resources to support young people’s mental health and wellbeing- a fantastic acheivement.

@JanelWood is another @Leedsgirlgeek who I met some years ago. She has worked staeadily at her mission, to improve health and wellbeing outcomes for women who are experiencing breast cancer, for whom she has developed an online “virtual friend” in the form of MiHealth. MiHealth, is now being rolled out across hospital cancer departments. Check it out, it’s really something.

@Katie Bacon is a youth worker with an evident passion for online technology. Her company is called Online Youth Outreach. She works with education, health and the private sector internationally to develop the skills and confidence their staff need to be effective in online youth outreach. She is really great at what she does, and regularly vlogs about it, too, which I find to be a fantastic, accessible resource.

Lastly, a mention for the group of OTs who developed the #24OTvx the 24 hour Virtual Exchange for OT. @SJB2 (Sarah) and the other group members have managed to develop a fantastic online community for OT, which covers Facebook, Twitter, Blogs, Second Life, and the Virtual Classroom. This development has helped my confidence to grow as I navigate these spaces, and they continue to offer support and encouragement to a global community of OT.

So, please do feel free to get in touch with me if you feel that you know an epic woman who I didn’t include- maybe leave a comment and tell me a bit about them? Let’s big it up for the sisters!

Edit 07/11/11 Just to give context for this post, please read recent media coverage of the online harassment and misogyny many female bloggers encounter. I particularly recommend the original observer article, and the Sianandcrookedrib post giving the commonest justifications for misogynist abuse, and the response

http://www.guardian.co.uk/world/2011/nov/05/women-bloggers-hateful-trolling?newsfeed=true

http://sianandcrookedrib.blogspot.com/2011/11/my-guide-to-online-abuse-and-excuses.htmlhttp://www.theweek.co.uk/uk-news/42103/all-days-work-female-blogger-rape-threats

http://www.atheistrev.com/2011/11/misogyny-in-blogosphere.html

http://furiouspurpose.me/article-on-hateful-and-misogynist-attitudes-towards-women-bloggers/

http://www.womensviewsonnews.org/2011/11/female-bloggers-speak-out-about-misogynist-comments-rape-and-death-threats-2/

Inpatient’s Smoking Rights- Join the Debate #inpatientssmoking

Today I want to blog about the effect of reading this link, supplied by the excellent Marion Janner, founder of Star Wards. Star Wards is a scheme developed to address the simple changes that can be made in order to make Mental Health Services more responsive to the needs of our service users.

This relates to a story from Australia, where a ban on smoking inside an inpatient unit is to be lifted in order to ensure patients stop putting themselves and staff at increased risk as a result.

Apparently, they had been using paperclips in electrical sockets to get a spark to light their cigarettes from, and exchanging sex for cigarettes. Clearly, as a harm mimimisation policy, the smoking ban in this inpatient setting had unforeseen and unwanted consequences which urgently needed addressing. But, I wondered if simply lifting the ban was the correct response?

I ReTweeted the original Tweet, and followed up with some additional ideas, as I was wondering how others felt about this issue.

There were some really interesting responses. I’m going to roughly group them in themes.

1. The ban should be lifted

• Because it’s a good opportunity to give “head space”

• Because it’s an opportunity for therapeutic engagement

2. The ban should stay in place, but access to smoking should be improved

• Outdoor spaces should be more available

3. Smoking bans should be more restrictive than they are now

• How can places that promote health be allowed to promote such a dangerous habit?

It’s something I have been in constant debate with myself about.

As a worker on an inpatient ward, it can be hugely frustrating to have to go outside with someone who needs an escort to go and have a cigarette (particularly if it’s cold and rainy!) and I have sometimes felt that doing this has decreased the amount of time I have to do my job- provide opportunities for meaningful activity for inpatients.

As a sometime smoker, I have also felt that it didn’t support my own efforts to quit, to stay quit, or to reduce the number of cigarettes smoked (I work my way through these categories regularly).

In fact, I have never smoked a cigarette with an inpatient, as I believe it doesn’t support my efforts to role-model healthy behaviours (which are physical as well as mental) and because I think it would be easy for staff to get confused about who’s needs they were meeting by having a cigarette with an inaptient.

I also fervently believe in the human rights of inpatient, including their rights to make bad decisions (given they have capacity to make the decision), so I do not agree with forcing people to quit smoking.

I recognise that when people are admitted, they are in a mental health crisis. That’s surely not a good time to try to quit smoking? Or, in fact, to make any other kinds of changes such as a diet. And anecdotal evidence suggests that smoking may help people deal with psychiatric medications, as well as self-medicate for mental health symptoms.

On the other hand, in a hospital setting, with support from smoking cessation workers, a pharmacist on hand to advise about Nicotine Replacement Therapy (NRT) options, and a medic who can prescribe a suitable course of NRT, what better time to quit?

Ultimately, as with so much in mental health, it comes down to your attitude to risk management:

I did a quick search of the Star Wards site to look for information about smoking. Here is one of their suggestions:

Most people would argue that this is something that should be happening in inpatients, wouldn’t they?

I’m really interested to continue this debate.

Do you have a view about this? Perhaps you believe the cameraderie of smokers is more important than other considerations.

If you’re happy to identify yourself in terms of if you smoke, if you use services, and if you’re staff that would be great, but all contributions welcome. I’ve started the # #inpatientssmoking on Twitter, or @me, or leave a response below. Thanks, I’m really interested to hear what you think!

The Kawa Model and Kawa Creative (UK)

On the OT4OT pages, I have been talking with OTs committed to using an OT Model called Kawa. This is a great Model, and it’s one I haven’t considered in the context of this blog before because I tend to use the MOHO; so forgive me if I spend a few moments going over the principles of the Model.

One of the criticisms of OT comes from a cultural competence perspective. Other cultures find that our concept of client-centredness can be unhelpful to them. In other, less individualistic cultures, a person is seen as interdependent with their social and cultural environment to a much greater degree than in our culture, with the historic assertion that “there is no such thing as society“. In this way, focus on the needs and strengths of the individual in treatment, without reference to a much larger degree to the social milleau, is not considered useful.

Kawa Model, developed by Professor Michael Iwama, uses the metaphor of a River. I love the simplicity of this image, used as I am to the Systems Theory behind MOHO. Under Kawa, we can visualise the activity, the group, the individual, the family, or the society as flowing like a River. As all rivers do, as it flows, the nature of the flow changes. Sometimes a mere trickle, sometimes the awesome power of the waterfall, sometimes the slow, deep waters of the river.

In Kawa terms, what we are concerned with are aspects of the river course that are impeding the natural flow. That’s it. It’s so beautiful and simple as an image. We are called in because over time, debris may block up a river, silt may aggregate to reduce a river’s capacity. There may be a drought which is reducing the water in the flow. Debris could accumulate in the River, which could need our assistance to clear.  All of these metaphoric ways of understanding the purpose of OT, so easily circumnavigate the complex task (which OT students and many OTs in practice) find so difficult- articulating the benefits and modality of OT treatment.

It’s not only a lovely image, but it seems to be one which can be applicable in any practice environment. And importantly, it uses no jargon, no OT speak, which we can unconsciously slip into our chats with people we’re working with, and which undermine our efforts to create true partnerships in their care.

Whilst hoping to ensure cultural competence in our OT practice, it may be useful to remember this Model, the first Model to have been developed through clinical practice outside our Western perspective.

It is also being used in the UK, and I would encourage and challenge all of us to engage further with this fascinating and relevant way to conceptualise the OT that we deliver.

Please see Kawa Creative, for a great example of how this model is being applied in UK practice