#MindTech- Thoughts and Reflections

March 31, 2012 1 Comment


This post discusses the recent Mind Tech Unconference, a transcript of the back channel discussing the day can be found in my previous post http://claireot.wordpress.com/2012/03/31/mindtech-the-unconference-grabchat/

There are several issues that I immediately wished to comment on, namely, commissioning criteria in the new health economy, how this is impacted on by the ides of  #mentalhealthpound, the scope of using Apps to support mental health, social prescribing, and the place of the social enterprise in poulation based mental health promotion activity.

Commissioning

This point in time is fairly unique, in terms of the transitions happening in healthcare commissioning I was reliably informed at the #AHPNorth Conference this week by very senior members of the Department of Health just how the new commissioning environment is likely to work. Currently, the system of tariffs for work done has contributed to the “Cinderella” nature of mental health services, as well as thorny issues in attempts to implement Payment by Results etc. One of the salient points is that rather than rely on these historic tariffs as a system for commissioning care, we are more likely to see population based commissioning coming to the fore. Now, one of the advantages of this is that (in theory) it then becomes possible for a successful mental health promotion service to be commissioned, if they can show an effect at  population level for reducing the incidence of mental illness, and a reduction on other areas of the service such as inpatient admissions. This has huge implications for the work of organisations working to promote good mental health such as Moodscope and Mindapples, who both presented information at the Mind Tech event. I’m not clear about the outlined ideas of the #mentalhealthpound presented at the event, but look forward to exploring these and looking at how this in combination with the commissioning environment means we can address funding issues relating to many fantastic projects that many people like myself wish to engage with.

Apps

We all know that the recent MapsandApps project run by the Department of Health was a huge success, and that it really shifted some thinking about how to use crowdsourcing and technology to help to address health inequalities, and to promote good health. In my opinion, this benefit has hardly been touched on in health services, and particularly in mental health services. There are concerns with the Informatics agenda related to this. Who owns the information uploaded by the patient? What are the ethics of allowing the app development company to be selling this (anonymised) information on as another income stream? If these issues are worked out, how do they impact on how our statutory services are funded-will they be expected to pursue similar revenue streams using their valuable data?

It is also worth noting that apps and devices that can take advantage of gaming theory could have an impact on adherence to treatment regimens, perhaps even medications compliance. We know that there is a cost impact to this- as people adhering to treatment regimes and medications schedules are cheaper to engage in health services. If we see the wholesale adoption of gamification in tech applications in health and mental health, how will this affect the bottom line of organisations delivering care?

We know the future is co-morbidity. In the same way that we are now comfortable with APIs that mash up data from several social networks, could we see implications in Telecare and Telemedicine as APIs are developed that mash up data gathered by different specialists, different healthcare providers, that bring personalised, granulated information down to the point of care delivery by doctors and healthcare providers? What does it mean for the de-professionalisation of medical and therapeutic services when these APIs become available to the general public? Will they result in greater self-care, or will they result in people choosing to treat themselves rather than engage in formal healthcare provision?

Social Prescribing- or Occupational Therapy?

I was interested to read one of the first blogs produced upon reflection of the Mind Tech event, by Puffles (working, as ever, with his Bestest Buddy). To read the blog, please see here http://adragonsbestfriend.wordpress.com/2012/03/30/mind-tech-unconference-30-march-2012/

I can’t resist adding one of my favourite photos from Mind Tech: here is @Puffles
lovely to meet @Puffles2010 and his charming handler at #mind... on Twitpic

Picture from @Gandy’s FlickR site, used with thanks.

Bestest Buddy has frankly documented his own difficulties with managing his menetal health, and gives us a great insight into tunderstanding of the nature of mental illness. He describes:

one of the big challenges I faced was getting away from the idea that a short course of medication was going to solve things. It didn’t and it hasn’t. If anything, it’s made me realise that medication in my case has only suppressed the worst of the symptoms and that a longer term recovery is only going to be achieved through a tailored/personalised combination of other things.

Bestest Buddy relates his idea

Conditions such as moderate to mild depression and anxiety by their nature affect and are affected by the lifestyles that we lead. Every time I’ve been through an acute period of anxiety, depression or generally being ‘a mess’ I’ve tried to pick myself up by trying new actions and activities to deal with it.

When I read this sentence, I was struck by the notion that if I had been asked to define what mental health occupational therapy does, my definition would have been very close to that of Bestest Buddy’s idea of social prescribing.

giving patients and GPs the option of looking at what activities might be beneficial for patients I think would be brilliant. Rather than a course of medication and a few sessions of counselling alone, what about things that can complement such treatments? And how about making them on the NHS? This could include things like exercise classes, cooking classes covering things such as foods that help and hinder conditions such as anxiety. It’s one thing saying ‘avoid X,Y & Z’ but quite another to build it into a lifestyle.

It is clear that despite the wish of the public for activity based intervention to mediate mental health difficulty, this is not associated with Occupational Therapy treatment We have to ask ourselves as a profession, why is this? Despite our rich and growing evidence base within the profession and the related dicipline of occupational science, why is the message not getting through to the general public about what we do? How can it be that people who are engaged in mental  health treatment, and who are in attendance at events with other members of clinical staff are not being informed that what they are talking about is occupational therapy?

This is a topic we may cover on the #OTalk #occhat hashtags on Tuesday nights as part of our regular weekly peer-supervision Tweetchats. I think its an issue that deserves some of our attention. The analysis, prescription, and grading of activity to facilitate health really is the bread and butter of what we as OTs can offer. In the new health ecology, we need as a profession to start to stand up and define ourselves in terms that the public can understand- perhaps social prescribing should be added to our list of core competencies? I certainly believe that this is in line with advice I have taken on board from Karen Middleton, the Chief Health Professions Officer at DH after listening to her rousing speech at the AHP North conference.

Social Enterprises in Population Based Commissioning

Taking on board the Section above looking at commissioning, it becomes clear that this is a real opportunity for ex-NHS staff, service uers, mental health activists, and social entrepreneurs who want to make a shift into promoting mental health rather than waiting for mental illness to develop. It’s my belief that this commissioning environment will start to have an impact on the number of Social Enterprises, and the reach that they will have- moving out from community development activities into health promotion, and hopefully into peer-support networks commissioned to mediate mental illness.

I’m working on an interesting Social Enterprise idea which uses peer-support, in combination with appropriate APIs and my Occuaptional Therapy background to both promote good mental health and to catch the early warning signs of mental illness developing. Although it is a worrying time for people who care about healthcare in our Country, I am beginning to think that if we do get this sea-change in the nature of commissioning decisions, then we can see the stage opening up for players like myself and many others, who find their innovative ideas are very difficult to develop within traditional statutory services, and within the big voluntary sector organisations. We are nimble and agile in our peer-to-peer solutions to these issues, perhaps our time has come?

Filed under AHP, Anxiety, Commons, Conference, CPD, Depression, Evidence based practice, Inpatient Services, Recovery, Reflection, Social Media Tagged with , , , , , , , , , , , ,

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

January 4, 2012 1 Comment


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.

Filed under Digital Inclusion, FlickR, Occupational Therapy, Recovery, Social Inclusion, Social Isolation, Social Media Surgery, Stigma Tagged with , , , , , , , ,

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

December 12, 2011 4 Comments


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

Filed under Evidence based practice, Inpatient Services, Occupational Therapy, Recovery, Risk, Social Inclusion, Social Media Tagged with , , , , , ,

Using Facebook to foster social interaction in older people after acquired brain injury. Anita Hamilton 2011

July 24, 2011 1 Comment


I have found a great example of how we can use Social Media (in this case, Facebook) to foster social engagement in older adults after acquired brain injury.

A.hamilton festival of teaching 2011

View more documents from Anita Hamilton

As can be seen, as Occupational Therapists we need to look at Social Media such as Facebook and adapt and grade the activity of engaging with them in the same way we would with any offline activity. By instilling another layer of support, of educating in digital literacy, in enabling our clients to use motivational activity such as computer gaming; by these mechanisms we may enable recovery through Social Media as we would through any other OT activity.

Anita Hamilton can be found on Twitter as @VirtualOT

Filed under Acquired brain injury, Digital Inclusion, Evidence based practice, Facebook, Occupational Therapy, Recovery, Social Isolation, Social Media Tagged with , , , , , , , , , , , , ,

Have a look at this guidance

November 5, 2009 Leave a comment


A working group has already been developing the guidance for nhs professionals using social networking sites in their professional practice.

Link available here: http://www.library.nhs.uk/KNOWLEDGEMANAGEMENT/ViewResource.aspx?resID=289920

edit: sorry, this link no longer seems to work 24/07/2011

Link provided by Sarah Bodell, who is running an excellent entirely online MSc programme in Occupational Therapy at Salford.

The conference was reported in the informaticopia blog:

http://www.rodspace.co.uk/blog/2008/05/masterclass-event-social-networking-in.html

This link to a blog shows how the simplest social networking tools such as Flickr can be used in order to get people “switched on” to social networking- which I find pleasing to hear since this is my tactic!

http://www.bcs.org/server.php?show=conBlogPost.436

Another interesting link, although this research is not systematically carried out and therefore the results are not reliable. This is a view of some of the staff I have worked with, who are concerned for the social implications of the people we work with on social networking sites.

http://www.nhs.uk/news/2009/02February/Pages/Facebookhealthstudy.aspx

So much food for thought…will digest some of this and try to formulate my thoughts more coherently.

Filed under Recovery, Reflection, Second Life, Social Media, Web 2.0 Tagged with , , , , , , , ,

Web 2.0 applications for OTs

October 30, 2009 Leave a comment


Well, during my usual mooching around online I happened across this blog http://frederickroad.blogspot.com/2009/09/education-in-changing-environment.html

As you can see, the fab OTs at Salford are way ahead of me in terms of looking into the use fo web 2.0 for developing their practice- they have developed an entirely online MSc in OT (Wow!) as well as exploiting Facebook, Twitter etc in the way I have been thinking we should….

On the one hand, it is always reassuring when one comes across someone with similar ideas- it confirms that there’s some mileage in the idea. On the other hand, when I saw the presentation that had been done, it was a bit of a blow because it looks so similar to the one I did at work last month….although I have to admit theirs looks better.

http://2.bp.blogspot.com/_eW5X-qfrCs4/SruTtu-ebWI/AAAAAAAAAWw/gOeq-hhpLo4/s1600-h/P1020351.JPG

Filed under Blogging, Facebook, Occupational Therapy, Reflection, Second Life, Social Media, Twitter, Web 2.0 Tagged with , , , , ,

Working as an Occupational Therapist in Mental Health in the UK.

October 29, 2009 Leave a comment


This is my new blog, where I discuss working as an Occupational Therapist in mental health in the UK. I am interested in using new media opportunities to enhance my practice, and using this space to muse on how these new opportunities impact on me. I am also interested in gardening which I use as a therapeutic medium at work, and in social enterprises, which I am investigating in order to provide more vocational opportunities for people I work with.

Filed under Occupational Therapy, Reflection, Social Media Tagged with , , , , , ,

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