| A grounded theory study of recovering from recurrent mental health problems |
Ms Yulia Kartalova-O'Doherty
Researcher at the Mental Health Research Unit
Ms Donna Tedstone Doherty | Presentation |
| The purpose of this presentation is to inform the audience about an on-going study undertaken by the Mental Health Research Unit of the HRB. The aim of this study is to analyse individual processes and desired outcomes of recovering from recurrent mental health problems. Recurrent mental health problems are described as having occurred more than once over a period of two or more years. Eligible participants will include those who have experienced recurrent mental health problems for two or more years, consider themselves in improvement and feel reasonably well to participate in individual interviews. A modified grounded theory approach will be used for the purposes of this study. Semi-structured individual interviews will be employed to collect information on individual experiences and views on recovering. To facilitate maximum variation sampling, the project will be carried out in suburban and rural areas and will include users of various mental health services and participants of peer support groups. It is estimated that 40-50 in-depth interviews will be sufficient for theoretical saturation. The study findings will inform service providers, researchers and other stakeholders in the area of mental health on concepts, processes and desired outcomes of recovery in an Irish context. It is also hoped that the findings will help in shaping recovery-oriented programmes for persons with mental health problems and their families. An MHRU researcher Yulia Kartalova-O’Doherty is leading the project. |
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| A relational-recovery oriented perspective of the psychotic experience: tuning into and making meaning out of "madness": A virtual reality workshop |
Dr David Cameron
Head of Research
Mr Paddy McGowan | Workshop |
| Working from the premise that schizophrenia is best viewed as an essentially contested concept the workshop argues that the causal attributions made and search for meaning of impending "madness" by someone labelled the “patient” and someone called the practitioner are important factors which mediate recovery. The work-shop is informed (led) by the unique blend-synthesis of the lived learned experiences and meeting of minds of (i) an individual whose voice hearing experiences were synonymous with being diagnosed with schizophrenia from which he recovered with the help of professionals and survivors and (ii) a psychologist who worked for some ten-years in residential therapeutic communities with people whose voice hearing experiences and associated internal and external distress were synonymous with a diagnosis of schizophrenia. The workshop draws on, integrates and assigns equal weight and validity to these overlapping yet different perspectives giving foremost authority to the subjective experience of the person who owns the experience, as well as their attempts to make sense of them. The workshop has three inter-related dimensions. The first virtual reality component uses special audio-visual effects alongside interactive exercises to replicate-authenticate and in some instances activate or reactivate the internal and external trauma and distress of a "voice hearing" experience. The second component outlines and examines the theoretical and clinical implications of the robust relationship between childhood sexual abuse and or childhood physical abuse and psychotic experiences. Finally, the third component uses case material to outline an alternative framework for accepting, thinking about and working with so-called psychotic experiences. |
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| Accounting for MRSA: Organisational change and hospital-acquired infections in the Irish health care system |
The Organisational Process Research Group
School of Nursing, DCU
Siobhan MacDermott, Colleen O’Neil, Mary Clynes, Nora Kilkullen, Stephanie Lawrence, Sara Raftery & Sabina Stan | Discussion |
MRSA is a significant challenge for hospitals and other healthcare institutions in Ireland. While the Celtic Tiger was taking off at the turn of the millennium, Irish hospitals were experiencing one of the highest rates of MRSA infections in Europe. This has had significant implications for patients’ physiological, psychological and social health, as well as for the functioning and finances of the health care system.
Owing to a recent increase in media and political attention, public awareness of MRSA has heightened. As one of the most pressing social problems of the day, MRSA has become more than a simple bug - a window into the contradictions of Ireland’s new prosperity. This goes with efforts to make MRSA visible by rendering rates of infection public and establishing causal links between the infection and subsequent deaths in hospitals.
Many researches dedicated to the MRSA infection approached it from a bio-technical perspective, which decomposed factors influencing the infection in discrete individual items such as sterilisation, compliance, surveillance or hand-washing. Our project investigates MRSA infection as a matter of larger organisational processes in hospitals, such as power relations between different healthcare professions or government and health agency policies. While some critiques of the government’s focus on hand washing pointed towards the importance of prevention, our project shows that prevention is to be understood not only in terms of individual action, but also in those of the collective action demanded from governments and management. |
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| An analysis of the need for counselling and prison based addiction treatment in one Irish Prison |
Mr Gerard Moore
Lecturer - School of Nursing, Dublin City University
Ms Rita Glover | Presentation |
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There is a growing trend in the consumption of psychoactive substances, and an increase in the associated health problems and crime. Scope exists for health and social gain amongst drug users. Significant numbers of drug users continue use during imprisonment. Health care in prison is an area of increasing international concern. The Prison Health Care Services endorses the equivalence of health care between the community and the prison population. This research investigate the needs of Prisoners for prison based addiction treatment in the context of planning the development of a high-quality, coherent, effective service. Information regarding, the extent of addiction treatment required, the size of the affected population and the form of counselling that might support and integrate well within the prison was required. Best practice in national and international prison based counselling and addiction treatment were explored. Information was generated from a literature review, focus groups and a self report form. Focus group material was audio taped, transcribed and analysed. Fifteen focus groups with prisoners, their families, prison staff, voluntary services, probation and welfare and health care staff were conducted. Drug use was reported as endemic, attitudes of prisoners and staff indicated there was a deficiency in the quality and availability of services. Incentives to change drug use behaviour were unapparent. Attitudes included the belief that cannabis use was relatively harmless in comparison to opiate use. Staff, service providers and prisoners unlike prisoners’ families and voluntary agencies had difficulty identifying the variety and value of available services. Services were un-coordinated with limited communication between prison and community. Data analysis identified short and long term recommendations indicting that service providers and prisoners believed they are inadequately resourced in comparison to other prisons. Findings indicated that a significant number of resources in education and health care could be utilised more effectively
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| An investigation of the potential psychosocial implications of genetic testing for breastovarian cancer outside the customary clinical setting |
Ms Ann Buckmaster
MSc Student, School of Nursing, DCU
| Presentation |
| To date, genetic testing has been carried out mostly through mainstream medical establishments such as clinics and hospitals, however this is changing with the arrival of direct-to-consumer (DTC) genetic testing,. Genetic testing has drifted from the customary clinical setting (with restrictive entry criteria) into the offices of GPs and the homes of consumers (Williams-Jones, 2003). The aim of this research is to look at experiences and opinions of genetic testing for breastovarian cancer in a clinical setting and ascertain any potential psychosocial issues which may emerge as a result of genetic testing away from the customary clinical setting. Semi-structured interviews were conducted with eight female participants from seven families (age range: 42-61 years) who had undergone genetic testing within a clinical setting. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA). In general, participants had a positive experience of genetic testing for breastovarian cancer within a clinical setting. An overlying theme in those that had suffered from cancer previously was that the testing process was considered insignificant in comparison to other experiences related to the disease. Overall participants expressed concern surrounding genetic testing outside the clinical setting, in particular with regard to the seriousness of the result and lack of assessment of recipient characteristics prior to testing. The implications of the findings are discussed in light of future policy relating to new technologies in this area. |
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| Another Way |
Mrs Joan Hamilton
Executive Director- Slí Eile
| Presentation |
| This is a presentation to highlight the uphill struggle to start anything that is "new" or "different" . Itr is not an accademic paper but the story of a personal journey: Slí Eile was set up by a small group of parents who all, like myself, had a son or daughter caught up in the revolving door of the psychiatric system. We all felt that whilst teh drug treatment they received on admission to hospital appeared to help at the time, when they were discharged back home, without any support or without having addressed the cause of their distress, inevitable they became isolaled and distressed once more and ended up back in hospital. As time went by, the length of stay in hospital became longer and the time at home became shorter. As parents we all shared the same feelings of helplessness and hopelessness and felt there had to be " another way". Slí Eile - Another Way - was set up to explore ways of helping people caught up in teh revolving door of the psychiatric system to break that cycle and to recover within a supported, transitional housing environment. After two failed attempts due to oppostion and stigma, our first project opened in September of last year. We have five tenants and plan to extend the house to accommodate a further two or three. Negotiations are under way to develop another two similar projects within the next three years. |
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| Applying a mindfulness-based approach to understanding obesity and enabling positive behaviour change. |
Mr Michael Daly
School of Psychology, Trinity College
Prof Malcolm MacLachlan (supervisor) | Presentation |
| Obesity has been partially attributed to ‘mindless’ or automatic behaviours brought about by environmental causes (e.g. the ready availability of cheap high-calorie food). A relationship has also been proposed between obesity and a form of emotional dysregulation involving functional binge eating which acts to direct attention away from negative thoughts and emotions. Recent research suggests that an individual’s current level of expendable self-regulatory resources mediates the relationship between (i) automatic attitudes and eating (ii) negative thoughts and affect, and eating. Excessive efforts to monitor behaviour or suppress thoughts and emotions deplete such regulatory resources thus increasing the likelihood of overeating. Mindfulness describes the practice of self-regulating attention in an accepting and non-judgemental way in order to bring about an enhanced awareness of present experience. Mindfulness training can help interrupt an existing connection between an environmental trigger and an impulsive reaction (e.g. snacking) and can prevent the conversion of internal experiences (e.g. negative emotions and thoughts) to overt behaviour (e.g. binge eating). Mindfulness approaches mould self-monitoring into a non-judgemental journaling process which does not rely on deliberate self-control. A mindfulness approach should therefore not bring about the negative depletion effects associated with ‘willpower’ based techniques. Discussion relates the similarities and differences between mindfulness approaches and other techniques which also off-set effortful top-down control permitting novel unconscious processes to function from the bottom up (e.g. implementation intentions). The ways in which a mindfulness approach considers and enables the person in a broader sense than other such techniques are then detailed. |
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| Clubhouse: Recovery, Innovation & Change |
Ms Carmel Doyle,
Mr Patrick Fitzpatrick,
Ms Anne
O’Loughlin,
&
Ms
Mary Kelly
| Presentation |
| This workshop will give an overview of the basic tenets of the clubhouse model. A clubhouse is a community of people with mental health difficulties who work together towards the common goal of recovery. Insight into the personal experience of members in the EVE clubhouses will be provided. The workshop will outline how the clubhouse work-ordered day functions, and the role this plays in confidence building, employment preparation, and recovery. The clubhouse performs various functions with members such as providing access to employment and education opportunities, running a social programme, and creating a vibrant community of members. How these operate, and the success we have met with at the EVE clubhouses, will be outlined. The member-led nature of the clubhouse will be discussed as cited in 'A Vision for Change' (2005)." |
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| Colouring in the landscape of emotionality: Painting clinical reflection |
Prof Tony Warne
Professor in Mental Health Care - Institute of Health and Social Care Research, University of Salford
Ms Sue McAndrew (University of Leeds) | Creative Presentation |
| This presentation symbolically draws on the film the Wizard of Oz in terms of its delivery. It invites the audience to travel along a yellow brick road, and at the end of this road to peer through a curtained aperture to reveal the ‘truth’. The presentation utilises 13 yellow stepping stones, each containing a segment of the story. At the end of this yellow brick road will be a small tube, that each audience member will be invited to peer through in order to obtain the final message of the presentation. The presentation can be laid out on a floor or along a wall. If on the floor, we would prefer there to be a normal step space between each stepping stone. Each stepping stone will also be entitled with a single four letter word that takes the traveller from a place called BODY to one called SOUL by simply changing just one letter in each word on each stepping stone. |
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| Disability and Power: Locus of control for the selective use of prosthetics for people with limited mobility |
Dr Kerry Greer
Lecturer in Psychology
| Presentation |
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Wheelchair users are typically perceived as ‘needy’ and treated by others, including health professionals as ‘sick’ people. These dependencies (wheelchair and medicine) coincide with many images that depict wheelchair users with health professionals or aids. Wheelchair users are seen as Patients who are subject to expert assessment and prescription Oliver (1993) argued that the rehabilitation industry is geared to force ‘non walkers’, or ‘nearly non walkers’ to walk! This paper argues that long term mobility is usually not a medical issue: it’s an imposition due to physical limitations or a choice between nearly walking (often painful, slow and tedious) and acceptable pain free mobility. This choice should not be made by medical professionals but by the individuals themselves Many wheelchair users’ immobility is a result of chronic illnesses or an injury for which there is no cure . e.g. chronic rheumatoid arthritis. These individuals need no contact with health professionals with regard to their mobility. A large number of ‘nearly walkers’ would benefit from the selective use of a range of prosthetic devices, from walking sticks to powered wheelchairs as a function of environmental constraints. This paper uses statistical and anecdotal evidence to argue that wheelchair users be regarded as individuals with preferences and rights to choose their prosthetic devices (e.g. crutches vs chair; or powered wheelchair vs self driven wheelchairs) as a function of current situations. The criteria should be no different to those that govern whether an able-bodied person CHOOSES to walk to the library or take the car!
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| Discovering intra cultural meanings and mutual understandings in a hostile place |
Mr Liam MacGabhann
Lecturer in Practice - Dublin City University
| Presentation |
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Acute inpatient psychiatric care perhaps epitomises an institutional asylum culture that policy, rhetoric and innovative approaches to care have had little impact on. The postmodern promises with partnership approaches to values and ethics based care in a ‘postpsychiatric’ world (Bracken and Thomas 2001) seem somewhat out of place. With consistent reports of meaningless days, lack of therapy, overmedication and custodial care, to name but a few misdemeanours (Sainsbury Centre for Mental Health 1998, Department of Health and Children 2002, Irish Advocacy Network 2004), one wonders at the capacity of such hostile badlands to withstand the onslaught of ‘better approaches to care’. The culture of acute inpatient care remains one of social control, coercion and segregation from society. Where meanings for distress can be found in psychiatric diagnosis, alleviated by the panacea of medication and state sponsored medical dominance (Hall 2004). Other professions such as nursing perpetuate this culture through disempowerment by medical authority or embracing bio-power as an empowering strategy (Roberts 2005). Against this backdrop it is difficult for service users to explore, alleviate or articulate their distress without assimilation. As it is difficult for nurses and psychiatrists to step outside their cultural comfort zone and to join them in their quest. This paper reports on part of a participatory action research inquiry in acute inpatient care. The process of inquiry led inpatients and psychiatric nurses as co-participants to a ‘communicative space’ away from the gaze of the Panopticon. Here they discovered a dialogue that enabled co-creation of meanings for distress and common understandings on how to alleviate this in therapeutic interactions. |
Bracken, P. and Thomas, P. (2001) Postpsychiatry: a new direction for mental health. British Medical Journal, 322(7288), 724-732.
Department of Health and Children (2002) Report of The Inspector of Mental Hospitals. Stationery Office, Dublin.
Hall, J. E. (2004) Restriction and Control: Perceptions of Mental Health Nurses in a UK Acute Inpatient Setting. Issues in Mental Health Nursing, 25, 239-252.
Irish Advocacy Network (2004) What We Heard: Report prepared on behalf of expert group on mental health policy. Department of Health and Children, Dublin.
Roberts, M. (2005) The production of the psychiatric subject: power, knowledge and Michel Foucault. Nursing Philosophy, 6, 33-42.
Sainsbury Centre for Mental Health (1998) Acute Problems. The Sainsbury Centre for Mental Health, London.
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| Don't ask me how I cope, but don't tell them how I do: Humorous reflections of a palliative care bereavement counsellor. |
Mr Mark Gibney
Palliative Care-Bereavement Counsellor - Murwillumbah Community Health Centre (NSW, Australia)
| Presentation |
| This presentation is a light hearted anecdotal narrative insight into how I cope in my role as a Palliative Care Bereavement Counsellor. In my professional role I am challenged daily by my client’s emotional profiles, as they confront their naked desperation of human frailty and loss. The inconvenient visitor of death and dying enters and distempers their peaceful lives. The role of a Counsellor listening to their shattered lives is not an easy task. The vicarious nature of bereavement counselling can project one to walk up to the edge of their own issues of grief and loss. I recognise that my true professional self is what animates me to take myself lightly and my work seriously. The value of humour in my life is a powerful and effective antidote to my work stress, it procures a dynamic shift from emotional fatigue of “Grim and Bear it” to a coping strategy of “Grin and Share it” with my professional colleagues. As a professional, I can allow myself to be authentic when I engage in subjective truths. I believe it promotes a recalibration of my professional boundaries. The central theme to this presentation is to promote and reflect the value and beliefs that suggest when laughter is humble, when it is not based on self esteem; it protects the emotional milieu of my daily relationship with bereavement. |
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| Embodiment, illness and medical treatment: a phenomenological study |
Ms Grainne Ni Mhaille
School of Psychology, Trinity College, Dublin
| Presentation |
| Despite approaches in health psychology aiming to challenge the mind-body split the general conception of the body derives from dualism. Therefore, the body is reduced to the status of an object or as entirely discursively produced. According to Merleau-Ponty, human beings are embodied. We do not just have a body; we experience the body and experience the world through the medium of the body. An empirical study was carried out to assess how the idea of embodiment can be included in discursive approaches to illness and health care by critically examining the relationship between the person’s conceptualization of the body and the experience of medical situations. 13 semi-structured interviews were carried out with participants who had undergone radiation therapy or are undergoing haemodialysis. A phenomenological analysis was performed in which embodiment is seen as the ground for self identity and culture. Emergent themes illustrate that embodied experiences can foster changes in self identity and alter experiences of the social world. Narratives concerning loss of self and changed social relationships are elaborated. Embodiment was also found to be important in emotional experiences of medical treatment and recovery from illness. Theoretical inferences regarding the role of the body in the experience of health and illness are made. Embodied existence is meaning and purposeful. Therein, the body is an important actor in the experience of illness and healthcare and must be theorised in discursive research. |
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| Escaping from Babel - Hosting Therapeutic Conversations With Children and Adolescents. |
Mr Andrew Duggan
Senior Lecturer - University of Huddersfield
| Workshop |
| Traditional psychiatry and psychotherapy with children has involved trying to understand the cause of their problems. This has often led to a focus on the deficiency and lack or resources of the child or their family. The result of this paradigm is that problems are identified, interpretations, assumptions and hypothesis are given, and children, adolescents and their parents become dependant on the expertise of the psychiatrist or therapist. The consequence of this has been a rise in diagnosis and the use of medication to control children’s behaviour. It has created a culture of ‘mother blame’ and has restricted the voice of the child to define their own problems and their preferred futures. This gathering will explore how we can move beyond the traditional comfort, fit and hierarchy of psychiatric and psychotherapeutic language, towards language and conversations that emphasise the expertise of children and adolescents to define and solve their own difficulties, and become case consultants in their own lives. It will illustrate how we can ‘give voice’ to children and their parents, in order that they can that challenge the unhelpful beliefs and myths that professionals hold about the nature, cause and solutions to their difficulties. |
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| Facilitating expressions of the self: Being a children’s nurse |
Dr Imelda Coyne
Senior Lecturer, DCU
Ms Emer Ward | Presentation |
This paper presents data from a reflective exercise completed by student nurses (N=37) on a one year Higher Diploma in Children’s Nursing course. The reflections arose from the students’ first clinical placement on a children’s ward and focused on a significant communication incident for each student. All of the students were qualified in another nursing discipline (registered general, mental health, and intellectutal disability) and were undertaking this course to gain a qualification as a children’s nurse. The students are non super-numerary full time paid employees of the children’s hospital for the duration of their programme.
The reflections provided rich insights into the students experiences of adaptating to a different clinical environment, of sick children and their families. The students encountered may unfamiliar and uncertain situations wherin they felt sometimes out of their depth. They described a range of emotions that were: feeling inadequate, sad, overwhelmed, guilty, nervous, awkward, shocked, anxious, frightened and embarassed. Although the incidents revealed many strong emotions, and frequent feelings of inadequacy, the students appeared to cope by drawing upon their own resources, observing qualified children’s nurses communicating with children and asking for assistance from nurses, doctors and parents. Preceptors played significant role in supporting these students. Likewise students were not afraid to seek help and guidance from more expert parents on how to proceed when encountering communication difficulties with a child. The students approached the children and families in a sensitive and empathic manner that was commendable considering that they had only 3 weeks of theory before this placement. Eliciting children and parents feelings and responding accordingly was a central theme in the students accounts. This data challenges some of the existingresearch on role transition from staff nurse to student children’s nurse in that it reveals the stengths rather than the deficits of student nurses. These findings illustrate the importance of being there as a caring presence for hospitalised children and families. |
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| Facilitating the process of recovery and choice within a social housing mental health project in Ireland |
Ms Teresa Tuohy
Strategic Development Coordinator - Sli Eile Housing Association
| Poster |
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The way in which you are and I am, the manner in which we humans are on earth is….dwelling (Heidegger, 1971:147) The Irish mental health policy document, A Vision for Change, (Department of Health and Children, 2006), recommends that recovery should inform every aspect of service delivery. Findings from a recent study of community residential mental health services in Ireland (Health Research Board, 2007) indicate that the goal of a recovery oriented service remains, as yet, an aspiration. To provide an innovative approach to community residential care, and to break the cycle of readmissions, Sli Eile Housing Association was set up, opening its first social housing project, Villa Maria, in September 2006. The creative assimilation and integration of Rapoport’s (1960) therapeutic community principles, Glasser’s (1998) Choice theory, and Copeland’s (2002) recovery model (WRAP) provide staff and tenants with a recovery framework in a supportive therapeutic environment. This innovative approach, the sli eile (another way) approach to supporting people with mental health problems in their recovery, is being facilitated by an experienced mental health nurse, employed as a strategic development worker. The presentation will focus on the development and implementation of this approach, drawing on the experiences of both the staff and the tenants. The presentation will be shared between the strategic development worker, who will provide an overview of the project and share some of the recent developments, and one of the tenants, who will share her experiences of living in this therapeutic community.
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| Forum Theatre Presentation. Schizophreinia Ireland, Women Together Network. |
Ms Marie McNamara
Theatre Practitioner - Drama Facilitator - Forum Theatre
The Women Together Network | Workshop |
The work of Augusto Boal and Theatre of the Oppressed has been well documented as a way of using theatre to make sense of life and as a means of giving people the strenghth and confidence to overcome their oppressions. Forum Theatre provids an ensemble of techniques and approaches in which the common element is to seek to make the power of drama a force for change. It is available and accessable to everyone by actively addressing the external and internal oppressions in any given situation. Forum works through the process of anger, provocation and liberation by moving the Protagonist from the monologue of oppression to the dialogue of empowerment, from the individual to the general. This is not formal therapy, but the therapeutic effect of the process of such work is transforming, empowering and life enhancing.
The Women Together Network was formed through Scizophrenia Ireland in response to an identified need to collectively adress specific mental health issues in the lives of women, particularly through the Arts and creativity. The oppressed become the disspossessed. The creative process of working towards this presentation enables the disspossessed to become the rehabilitated and recover that indefinable 'something' that has been lost through oppression and disempowerment. Through active participation in body and image work, the women have discovered the powerful expression of emotion and tragedy allowed in Forum, discovering and stimulating the desire for change within and without, whilst at the same time experiencing the fun and hilarity of working together in the face of adversity. Self expression, creativity and imaginations are stimulated, individual and group dynamics, issues and stories are shared, skills and strategies are explored in an atmosphere of solidarity and confidence. The audience can actively share in all of this. The presentation by its very nature includes the audience as 'Spect-Actors' - this is not passive theatre. Debate, discussion and participation are encouraged and actvely facilitated.
The play presents the protagonist experiencing a series of crises which she fails to overcome, she fights but does not win. The question is always ' What could the protagonist have done in order to win?' This is a group of actors telling a significant story of oppression, but the game of Forum is to invite alternatives. Many different solutions can be enacted in the course of a single Forum, there may not be a happy ending but in the process of engagement and participation there will inevitably be a pooling of knowledge, ideas and experience from what ideally is an audience of the similarly oppressed andor those in solidarity. In the context of the themes of the Health4Life Conference, and in the antcipated atmosphere of innovation, emotional engagement and awareness, this presentation gives delegates a unique opportunity to actively engage, and in the words of Boal himself..
"For the love of humanity; let us all be artists, let us all be madmen.. Let us be mad artists, let us be artists...mad!" |
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| Foucauldian interpretations of risk, power and gender in mental health nurses’ descriptions of managing aggression and violence in their practice. |
Dr Anne Matthews
Lecturer - School of Nursing - Dublin City University
Dr Anne Matthews (DCU), Angela Cocoman (DCU), Prof Anne Scott (DCU), Prof Maritta Välimäki (University of Turku, Finland) | Presentation |
| Ideas on risk and power permeated the writings of the social philosopher Michel Foucault. Within the postmodern tradition of multiple and fluid interpretations of phenomena and events, Foucault was interested in the dispersal of power and the “micro-politics” of everyday life. This presentation reports on secondary analysis undertaken from a Foucauldian perspective of data on mental health nurses’ descriptions of their everyday practices in the management of aggression and violence. The data were collected for a European study funded under the European Union Leonardo da Vinci Education and Culture programme. Within this study practising mental health 23 nurses (8 male and 15 female) from one service took part in four focus groups which were held between January and March 2007. The areas which were discussed included: practices in the management of violence and aggression, the use of restraint and seclusion, nurses’ thoughts and feelings about this area of practice and current and desirable levels of education and support for nurses related to this area of practice. The themes of risk and power and their intersection with gender appeared to be an interwoven within the findings being provisionally ananlysed. The key components of Foucault’s ideas of risk and power (including surveillance, the “clinical gaze”, confinement, the fallacy of super-structural power, the exercise of dispersed power) will be outlined and the research findings related to these. How nurses spoke about risk and power will also be linked to gender, in terms of gendered perceptions of risks of violence, physical male strength and male and female approaches and interactions in situations of violence or aggression. Based on this analysis, the key implications for mental health care and nursing practice will be outlined. |
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| FRED - Rehabilitation: A New Zealand Perspective |
Mrs Jennie Synnott
Staff Nurse
| Presentation |
I would like to deliver a presentation and discussion on a Functional Rehabilitation Education and development package (FRED). A programme that I believe shows advanced rehabilitative practice and significant service user involvement. It is a comprehensive three phase package that has been implemented and delivered in New Zealand. The presentation would begin with the history of FRED and is application in NZ to both adult and forensic psychiatry, including adaption of FRED to include Maori and pacific Island culture. There are three definitive features of FRED:
(1) Assessment and entry level,
(2) Skill aquisition,
(3) Auditable review and outcome with resetting.
The initial level had a rateable assessment tool which identifies rehabilitation need and will be explained in the presentation. This stage also includes a risk assessment and a self assessment that is completed by the service user. Following this stage we progress to the skill aqusition level and rehbilitation planning that provides for the supported shift of power from the service to the person. This is achieved by task dissemination, assisted achievement, education and empowerment. Finally I will present the review assessment in detail. The presentation will end with an exploration of FREDs limitations, the changes that would need to be made to adapt to peoples needs in Ireland. Time allowing I will also highlight the regional and national awards that are credited to FRED and our team. I beleve that this presentation would cover several themes the conference is centered around, service user involvement, familysociety and an example of international best practice. |
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| Grieving for myself: A phenomenological hermeneutical study of women’s lived experience of postnatal depression |
Ms Denise Lawler
Lecturer in Midwifery - Trinity College Dublin
| Presentation |
| This presentation sets out to provide the audience with a deeper insight into the lifeworld of women who have lived through an episode of postnatal depression. A phenomenological hermeneutic approach was used to describe the women’s experiences and a purposeful sample of seven women agreed to participate in the study. In-depth interviews were audio- taped and transcribed verbatim with consent. Transcriptions were processed using the hermeneutic circle: dialogue, fusions of horizons and metaphors to understand the meaning of the experience and the transcript interpretations were confirmed by the participants. Findings are presented under four existential life worlds - lived space, lived body, lived relations and lived time. All of the women in the study experienced a loss of their former self as they embarked on their transition to motherhood. The women vividly described their brokeness and sorrow as they struggled to come to terms with their new body image and their new role as mother. It was after they had experienced a cycle of grief that they were able to accept their new self and motherhood. These women accepted their experience as being 'normal'. They felt they had to experience death of their former self before giving birth to the new woman. This perception of 'normal experience' challenges midwives and mental health workers to redefine the meaning of normal and to review the consequences of labelling women as suffering from postnatal depression. The study calls for a review of current antenatal preparation for parenthood and challenges midwives to review commonly accepted beliefs that almost every woman naturally adjusts to the role of mother when their baby is born. New approaches to education are required to prepare women for the possible event of experiencing this sometimes 'natural' metamorphic state after the birth of their baby. |
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| HRB National Psycholoigcal Wellbeing and Distress Survey |
Dr Donna Doherty
Senior Researcher, Mental Health Reserach Unit
| Poster |
There is little information available on the level of psychological distress in the Irish population or the use of health care services and professionals for mental health problems. The HRB Psychological Wellbeing and Distress Survey (NPWDS) aimed to address this gap in information. The NPWDS was a telephone survey of a nationally representative random sample of 2,711 adults aged 18 years and over and living in private households. The data was collected between the period December 2005 and April 2006 over three two-week intervals. The main aims of the survey were to:
• Produce data of a representative sample of the population in relation to mental health issues.
• To determine the proportion of the Irish population who were experiencing psychological distress or had experienced psychological distress in the previous year.
• To describe the help-seeking behaviour of the Irish population for mental health problems including primary care, mental health services and the use of other professionals support persons in the previous year.
The findings showed that 12% of the population are experiencing psychological distress at a given point in time, while 14% have experienced mental health problems in the last year. Approximately 9% of respondents reported that they had attended a general practitioner in the previous year specifically for mental health problems. Those who had spoken to the general practitioner about mental health problems had, on average, done more often than those with physical health problems. The proportions of respondents reporting attending mental health services were much less than the proportion reporting attending general practice for mental health problems. The survey provides an indication on the extent of psychological distress in the Irish population and the extent of service use for mental health problems. |
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| I had a dream (but got committee membership): authority, representativeness, collusion and protest in the service user movement |
Mr Jim Walsh
Lecturer - Dublin City University
Mr Paddy McGowan & Mr Richard Lakeman | Discussion |
| The user movement is commonly understood to have been formed during the 1960s. At the heart of the movement was human rights and the deinstitutionalisation of the so called ‘mentally ill’. Like all social movements the mental health user movement has experienced various transformations over time. User involvement is now a relatively common occurrence in the drawing up of policy and legislative documents, in the planning and development of mental health services and research projects. These advances are primarily attributable to the user movement. Indeed, we now have service users asked to present at major mental health conferences, carrying out their own research projects and running their own services with some individuals reaching the dizzy heights of becoming authors of academic papers and books. The audience will be encouraged to reflect on the user movement, its legacy and transformative processes. The three presenters will be challenging participants to think critically about the current state of the user movement and ‘what it has become’. For example, has user involvement become a means by which services control the social agenda originally set out by the user movement? Has a hierarchy of service users developed mirroring that which exists within mental health services? Consequently, has the social status and levels of freedom for those deemed mentally ill improved since the 1960s? The presenters will address these controversial issues. Debate and dialogue with the audience to critically examine this will follow.
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| If I am not me who am I?: Working with a person after a brain injury. |
Mr Keith Oulton
Clinical Manager - Peer Counselling Service - Irish Wheelchair Association
| Presentation |
Disability gets constructed by society in a specific way. A discourse becomes dominant, is assigned truth status. These “truths” are even more evident when talking about brain injury. Every person is different and much depends on the extent of the injury but frequently people with brain injury are told:
• The old personality and self are gone due to the damage
• They have to reinvent or retrain a new self which will never be the same as the old self.
• Anger is a symptom of this grief and loss or a failure to go through the process
• There is a similar process that all people go through
This presentation shows a twenty seven minute taped interview with a couple who talk about their experience of life after a brain injury. It is not a therapy session but a review of the work done over a year and a half. This couple were keen to make the tape for others to see it as it shows another story of brain injury, a story that allowed this woman to discover things about herself that she thought were lost. Throughout the sessions the focus was on:
• Identifying their skills to respond to a dramatic change in their lives
• Recognising what of the self or old personality was the same and what was different
• Developing a range of responses to difficult situations
• Identifying what works and does not work in stressful situations. |
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| Innovations in Educational Evaluation |
Dr Margaret Webb
Ms Eileen Courtney (DCU), Ms Therese Leufer (DCU) and Mr Gerard Clinton (DCU) | Presentation |
This paper presents an innovative evaluation process whereby students were asked to evaluate an “Introduction to Recovery in Mental Health” module, undertaken as part of a FETAC level 5 award. The evaluation process required students to reflect upon what they had gained from participating in the module, and to represent their learning and achievements in terms of a personal journey. Thirteen students, incorporating both service users and service providers, participated in the evaluation process. Working in groups of 4-5 they used drawing or other artwork to represent their own personal learning journeys.
Journeys through the module were metaphorically represented in various ways. These included landscapes, various recreational and competitive activities, and representations of the concept of metamorphosis. All essentially involved the personal turbulence involved in moving from a place of darkness (represented in colour / shading) to a place of light (represented in shading / sunshine).
This novel and innovative process of evaluation is significant in its ability to explicate areas of personal development not easily illuminated through conventional evaluation methodologies. The evaluation process provided participants with an opportunity to uncover the deep learning that occurs as result of participation in the Recovery Module. |
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| Integrated approach to trauma and phobia |
Mr Findlay Collins
Lecturer - University of Paisley
| Workshop |
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After several years of academic work and research within the field of evidenced based practice the University of Paisley have researched various models of intervention and devised a model that incorporates a client-centred and a cognitive behavioural approach, that is firmly grounded in a paradigm embracing the work of among others Rogers, Bandura, Rotter, Gendlin and Seligman. The University of Paisley have incorporated this model into a named pathway degree course. Elements of the model have also been incorporated into the Higher Diploma of Education for Mental Health Nurses. Several organizations have also integrated this approach into their clinical practice. The organizations include:
• P.E.T.A.L. (People Experiencing Trauma and Loss, an organization that support individuals who have lost a loved one through suicide or murder.
• RAMH (Renfrewshire Association for Mental Health) who have used our methods to train their counsellors.
• Lanarkshire Mental Health Trust in the acute and older adult sectors.
This unique approach can be adapted for most clinical settings that provide support for mental health interventions, including trauma, phobias, substance abuse, severe and enduring mental illnesses. The facilitators are also accredited in Neurolinguistic Programming and Emotional freedom technique which had been incorporated in their delivery. We would welcome the opportunity to share our approach with the delegates of your conference within a workshop setting
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| International Festival: A Means of Promoting Inter-Culturalism & Parental Involvement in the Primary School |
Ms Marie Reidy
Language Support Teacher
| Presentation |
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The Language Support teachers at Scoil Naomh Brid in Celbridge have noticed, over the years, a reluctance on the part of International Parents to become involved in school activities and Parents’ Groups. This reluctance continues the isolation felt by International parents and their children. Goals and Objectives The teachers decided to hold an International Festival which would promote inter-culturalism within the school community. They hoped to foster understanding and participation amongst the Staff, parents and children of both Irish and International Students.
The Festival took place in March during the European Week against Racism to coincide with national activities in the media. Each class prepared a project on the home country of International students in that class. A project on Ireland was also presented. During the school day, parents were invited to come in and share one part of their culture with a few classes. The entire school community and local school representatives were invited to attend an evening of music, dance and food from around the world. The result was overwhelming-an indication of how anxious International parents are to share their cultures. The response was also indicative of the interest Irish parents have in newcomer cultures. Unfortunately, not many parents have the necessary platform to share their culture or to participate in Irish life. Qualitative research was performed post-Festival to see if attitudes had been changed. The results were shared within the school community.
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| Irish Internet users searching for health information online: An analysis of key demographic and self-reported mental health characteristics |
Ms Silvia Gallagher
Researcher - Health Research Board
| Poster |
| This paper investigates the prevalence of Internet use in Ireland, and provides an analysis of the demographic and self-reported mental health characteristics of respondents who had searched for health information online. The willingness of respondents who had not used the Internet as a source of information on health to potentially do so was also explored. A representative sample (n=2,711) aged 18 years and over, living in private households in Ireland was surveyed via telephone. Initial results show that over half of the respondents (58%) had used the Internet (at some stage for any purpose) and 49% of these respondents had used it as a source of information on health. Significant differences were found between age groups, geographical areas, educational levels and employment status, supporting the concept of a ‘digital divide’ in both general Internet usage and searching for health information online. A high willingness to use the Internet for health information by respondents who had never done so was also shown, which is a encouraging result for the Internet being used more fully in future health promotion. Furthermore, findings revealed that a high percentage of respondents surveyed (60%), who had experienced a mental, nervous or emotional problem, had used the Internet as a source of information on health. More research needs to be conducted into the specific activities of online health information seekers in order to properly provide for their needs. A up-to-date review of Irish health websites should also be undertaken to ascertain the quality of their content. |
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| Irish Voices |
Mr Brian Hartnett
Manager of Hearing Voices Ireland (HVI) & Regional Peer Advocate Irish Advocacy Network
| Presentation |
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I first started hearing voices around 1990 in London. It crept into my life slowly – a bit like the Martians in War of the Worlds - insidious. By the time I realised I had a problem it was too late to turn back. I was immersed in it up to my neck and sometimes I felt I was drowning in a sea of confusion. Of course I had many ideas about how it worked. Telepathy, drugs & alcohol, spirits, madness…one thing for sure it was here to stay and I had to go through a lot dark tunnel to come out the other side and get back to reality. I did the best I could with coping but I became more and more alienated from family and friends. Eventually I came back to Ireland in the mid 90s. My dad suggested I go to a psychiatrist. I had no knowledge of Schizophrenia so it came as a shock when I was diagnosed with the illness. I was advised to take my pills and get on with it. There was no information given or any further advice. I was just lucky I didn’t end up in a psychiatric ward. Mum and Dad looked after me for a while before I moved into a flat in town. I still had my design degree behind me and my Dad who was working in the area was able to keep a stream of work coming in. I was still hearing voices during this time. I kept it to myself because I didn’t think it was something that could be talked about. When my Dad retired the work stopped coming in. I wasn’t able to get the work in myself so I decided to do a masters in multimedia so I could update my skills and get into website design. When I finished the masters I tried freelancing for a while but it didn’t work out and I ended up doing security work in a Dell factory. This was very depressing and I though I was never going to get back to being a designer. But help was on the way… I had heard of Schizophrenia Ireland and I went along to a meeting of a self help group. I knew nothing about Schizophrenia. It had been ten years since the voices started and five since I was diagnosed and put on medication. I have never met someone with the same or similar experiences. I was amazed when I found out the no one at the meeting heard voices – I thought that everybody with schizophrenia did. The group really helped and I made new friends. I began to open up about my inner world. One night a man visited the group from and organisation called the Irish Advocacy Network (IAN). Paddy McGowan explained about peer advocacy in metal health and explained that training for advocates was coming up. I did the training and became a full time advocate with IAN in the midlands. I am four years in the job now and I love my job. I visit psychiatric facilities in my are providing a confidential, non advisory, non judgemental listening ear to my peers who have mental health difficulties like voice hearing. I even got to make use of my design skills by doing the IAN website and literature. In my spare time I have set up an organisation called Hearing Voices Ireland (HVI). I have received a lot of support and good will in setting up a network of self help groups for people who hear voices and their carers. We are currently seeking funding for this venture. I am no longer ashamed or guilty about my voices. They have guided me on my journey – one which continues today.
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| It’s good go talk: Distress disclosure and psychological wellbeing |
Mr Mark Ward
Researcher
| Presentation |
| This paper investigated the relationship between levels of distress disclosure and psychological wellbeing in the general population. Two measures of psychological wellbeing were used – the 12–item General Health Questionnaire (GHQ12) and a self–reported rating of participants’ mental health in the previous 12 months. Distress disclosure was measured using a 12–item Likert scale called the Distress Disclosure Index. Distress disclosure was defined as an individual’s willingness to disclose distressing personal information to others. A nationally representative sample of 2,711 adults aged 18 years and over living in private households in Ireland was surveyed. Four socio–demographic determinants of levels of distress disclosure were explored including gender, age, marital status and geographic location. The association between distress disclosure and psychological wellbeing was investigated. The Distress Disclosure Index was found to be a statistically valid, unidimensional measure. Statistically significant differences were found in levels of distress disclosure in terms of the four socio–demographic variables and significant correlations were found between levels of distress disclosure and psychological wellbeing. Those most willing to disclose distressing information to others were females and those in the younger age groups. Furthermore a greatest willingness to disclose distressing information was related to better mental health. The findings have important implications for the promotion of psychological health and wellbeing and help seeking behaviour. |
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| Music in mental health settings - a social language |
Mr Kevin O'Shanahan
Musician in Residence - Waterford Healing Arts Trust
| Workshop |
Since March 2007, Kevin O’Shanahan, a musician and psychiatric nurse, has been working as Musician in Residence with the Waterford Healing Arts Trust where he facilitates social interaction between mental health clients in acute and community contexts through participatory music workshops. Kevin’s residency and proposed workshop is based on a recognition of the efficacy of music as a therapeutic tool, particularly in the area of mental health, where other forms of verbal communication are not always effective. It is based on a belief that for many service users, the issues of social exclusion and the need for a more holistic approach to emotional distress needs to be given greater priority within the health system. Kevin is drawing upon his experience of working on a European Music in Hospitals Exchange Programme in UK and France and a recent pilot music project in Uganda. Kevin will host a music workshop which aims to:
• Explore the potential of music making as a means of communication in the provision of holistic healthcare
• Demonstrate the relationship between music, creativity and psychosocial health Give an insight into the growing international movement around music in healthcare settings
• Make a case for the place of music within current psychiatric care.
• Participants will: Understand the role of Music in Hospitals as a practice, which is distinct from Music Therapy Experience the social benefit of music making in a group setting. Explore opportunities for the use of Music in mental health settings |
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| NPIRSCOMCAR: A database to capture both inpatient and community care mental health services activity in Ireland |
Mr Derek Beattie
Research and Information Analyst - Health Research Board
| Poster |
| The aim of this poster presentation is to outline details of NPIRSCOMCAR, the new mental health information system that is currently being developed by the Mental Health Research Unit (MHRU) of the Health Research Board (HRB). The MHRU manages and maintains the National Psychiatric Inpatient Reporting System (NPIRS) which collects data on all admissions and discharges to inpatient services nationally. In response to changing patterns of patient care, the HRB developed a Microsoft Access database called COMCAR (COMmunity CARe) in 2003. COMCAR was designed to record activity at community care level. In 2005, a decision was taken to combine both COMCAR and NPIRS into a single integrated web-based application. NPIRSCOMCAR will record and report data in real time on mental health activity in both hospital and community care facilities. It is envisaged that NPIRSCOMCAR will be implemented in approximately 56 psychiatric hospitalsunits and up to 1000 community care facilities. The Health Research Board is working in collaboration with the Health Service Executive (HSE) on the NPIRSCOMCAR project and it has been agreed that the first pilot site for the project will be in Donegal beginning in early 2008. End-users of NPIRSCOMCAR will be able to create reports on activity in all community settings, including day hospitals, day centres, outpatient clinics, community residences and in psychiatric liaison services which can be used for service monitoring, policy and planning, clinical decision making, health promotion and research purposes. The MHRU will also have access to anonymised national data for research and analysis. |
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| Ordinary psychotherapy with extraordinary experience |
Mr Richard Lakeman
Lecturer - Dublin City University
| Workshop |
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People who may be considered 'psychotic', 'disordered' or 'deluded' are often excluded from formal psychotherapy. Nevertheless, the everyday interactions between people can be helpful and therapeutic. This workshop focuses on introducing and practicing a basic model of empathic communication at the supportive end of the psychotheraputic continuum that might be employed when people express
bizarre or contrary ideas.
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| Partners in Words or Deeds? Evidence of Strategic and Therapeutic Partnerships in Mental Health. |
Ms Liz Brosnan
Research & Resource Officer, Western Alliance for Mental Health
| Presentation |
| Working in Partnership is the cornerstone of advances in person centred psychiatric care and treatment. Indeed, a core component of current policy (‘Vision for Change’) is working in partnership. Little is known about the current level of partnership working, nor the types of partnerships that exist in the Irish mental Health services. This study aimed to examine partnership practice from a service users’ and carers’ perspective. Four focus groups of service users and one of carers were convened to elicit their experiences of partnerships. We asked how people were involved in planning services (strategic partnerships) and how people were involved in their own care (therapeutic partnership). Discussions were thematically analysed. For presentational purposes, narrative text highlighting the themes was digitally recorded using actors to demonstrate their significance. No evidence emerged of involvement by service users or carers in the planning of services. The term partnership was not clear to the participants or relevant to their experiences. Although some reported involvement in their care, an overall lack of equal relationships was evident in terms of communication, consultation, and being treated with dignity and respect. We need to translate words into deeds if true partnership is to be achieved. Partnerships should be the cornerstone of mental health service development. Recommendations included developing strategic partnerships at all levels, therapeutic partnerships as a core element of the care planning process, the allocation of a key worker for service users, promoting the support that voluntary groups offer, and training for staff on recovery focused practice. |
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| Partnership and Participation in the Mental Health Services: Facilitating Service User Involvement |
Ms Shari McDaid
Equality Studies Centre, UCD
Ms Liz Brosnan & Ms Louie Maguire | Workshop |
Partnership and participation are key elements of the recovery approach to mental health care and are essential to changing power relations in the mental health system. This workshop will explore user involvement in the mental health services from a service user perspective. The workshop will demonstrate the obstacles faced by service users participating in advisory committees. There will be an opportunity for open discussion on the process of user involvement and on whether user involvement in the mental health services is an effective way for service users to achieve their aims. As part of the discussion, two service users will share their personal experience of involvement.
The workshop will consist of:
1) a role play exercise to demonstrate the obstacles faced by service users in advisory committees;
2) discussion on the types of obstacles faced by service users and the positive outcomes of involvement, during which service user members of the team will share their experiences of being involved on committees;
3) an open discussion;
4) a brief presentation of results of research conducted in the Republic of Ireland on user involvement.
This research showed that through participation, service users can experience equality, respect and a sense of being able to have an impact. However, service users face potential barriers to participation in terms of cultural resources, respect and recognition, economic resources, mental and physical resources, and skills deficits. Recommendations from the research on how to support service users to participate on committees will be shared. |
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| Promoting and Supporting Recovery: The Scottish Experience |
Ms Taryn Carlton
Information Support Officer - Scottish Recovery Network
| Presentation |
| The Scottish Recovery Network is part of the Scottish Executive’s National Programme for Improving Mental Health and Wellbeing. The vision of the National Programme is to improve mental health and well-being for everyone living in Scotland and improve the quality of life and social inclusion of people experiencing a mental health problem. The Scottish Recovery Network (SRN) works to achieve the fourth key aim of the National Programme to promote and support recovery from long term mental health problems. SRN are involved in a number of areas of work, including the development of a Scottish Recovery Indicator tool, a recovery training framework for mental health nurses and the promotion of formalised peer support. We also develop resources and offer considerable support to local areas working to promote recovery at the same time as leading research around recovery. SRNs Narrative Research Project is one of the key areas of work. In 2005 SRN travelled around Scotland and interviewed 67 people about their experiences of recovery and the things that helped and hindered them on their journeys. This presentation will offer an introduction to the Scottish Recovery Network and its work with a particular focus on the Narrative Research Project and the initial findings. It will look at some of the opportunities and challenges of promoting recovery through a national network approach. |
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| Re-admissions to Irish Psychiatric Units and Hospitals 2001-2005 |
Ms Antoinette Daly
Research Officer - Health Research Board
| Poster |
Background: The re-admission rate has been proposed as one indicator of the effectiveness of the transition from in-patient to community care (Lien, 2002) with some studies proposing that the increasing number of re-admissions to psychiatric hospitals is a consequence of the policy of deinstitutionalisation and the resulting transition to community care (May, 1976; Kastrup, 1987a; Kastrup, 1987b). Several factors have been found to be predictors of re-admissions. The aim of this study was to identify factors which may predict re-admissions to Irish psychiatric units and hospitals and to attempt to identify the specific characteristics (demographic and clinical), if any, of those who were frequently re-admitted. Secondly, it attempted to identify ‘frequent users’ (ie those with four or more re-admissions) of the in-patient services as a subgroup of all re-admissions.
Method: First admissions (N=3,473) to the National Psychiatric In-patient Reporting System (NPIRS) were extracted for 2001 and followed retrospectively for the five-year period 2001–2005.
Results: Thirty-seven per cent (n=1,274) of first admissions in 2001 (N=3,473) had one or more re-admissions during the study period while 7% (n=246) were identified as ‘frequent users’. The strongest predictors of re-admission were gender, age, hospital type, primary diagnosis and having a secondary diagnosis. Significant predictors of frequent use included gender, age, marital status, socio-economic group and length of stay.
Conclusions: Patients with severe psychotic illnesses, because of the nature of their illnesses, will require frequent in-patient admissions and thus re-admissions will continue to be a feature of in-patient services regardless of any future any expansion in community-based services. Resources invested in community psychiatric facilities need to be examined given the apparent insignificant impact of investments to date in reducing in-patient re-admissions |
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| Re-defining Empowerment in Mental Health: The connection to ‘Power to’ |
Ms Shari McDaid
Equality Studies Centre, UCD
| Presentation |
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Power and empowerment reverberate across the field of mental health. Yet often the term ‘empowerment’ is used without relating it to a proper conception of power. This has resulted in confusion between empowerment and practices that focus on the individual. The danger of individualising ‘empowerment’ has long been recognised (see Ward & Mullender 1991, Riger 1993, Baistow 1995, Anderson 1996, Ryles 1999, Barnes & Bowl 2001, Fondacaro & Weinberg 2002). However, rarely has empowerment been critiqued on the basis of a theory of ‘power to’ or generative power. There is a need to re-connect empowerment to the idea that the powerless can become powerful, and to spell out how such a rise in power occurs. In this paper, I aim to critique the individualising conception of empowerment and to re-define empowerment as rooted in collective action. I will use Hannah Arendt’s power theory to define empowerment as a process where power is generated by a social group who engage in collective action (Arendt 1958, 1965, 1972). Further, I will draw on Axel Honneth’s ‘struggles for recognition’ (Honneth 1991 & 1995) to argue that empowerment in relation to people with a diagnosis of mental illness refers distinctively to their action to make public claims for respect and recognition. Defining empowerment on the basis of a theory of generative politicalcultural power clarifies why it cannot refer to personal development; empowerment can only refer to what people with a diagnosis of mental illness do together to claim equality, respect and recognition in society.
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| Relationship of Social Comparison Processes to Physical and Mental Adjustment and Levels of Depression Among Stroke Support Group Attendees |
Ms Claire Tobin
Trinity College Dublin
| Presentation |
| 10,000 people experience a stroke each year in Ireland. Volunteer support-groups constitute one of the few community resources available to survivors to aid rehabilitation. These groups provide a social outlet and access to therapeutic services in an emotionally supportive setting. Feelings of vulnerability and uncertainty post-stroke influence an individual’s ability to make objective self-evaluations. Patients may compare themselves with similar others to get a foothold for their self-perception. Support-groups fit the prototype environment for such social comparisons to occur. Stroke survivors may increase their well-being through selectively seeking and interpreting social comparison information. Forty-one support-group attendees were interviewed to examine the prevalence of 4 social comparison strategies: upward-identification (perceiving better-off others as a potential future), upward-contrast (perceiving better-off others negatively), downward-identification (perceiving worse-off others as a potential future), and downward-contrast (perceiving worse-off others positively). The relationship of these strategies to physical adjustment, mental adjustment, and levels of depression was examined. Positive social comparison strategies were more prevalent than negative strategies. In regression models, upward-identification significantly predicted physical adjustment, whereas upward-contrast and downward-identification significantly predicted mental adjustment. Furthermore, upward-contrast comparisons were significantly related to levels of depression. While positive social comparison strategies increased levels of physical well-being, mental and emotional well-being were adversely affected by the use of negative social comparison strategies. This is the first study that has found that positive and negative interpretations may have an independent influence on separate aspects of health outcomes. Modification of social comparison strategies may offer opportunities for rehabilitation to improve stroke patient outcomes. |
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| Research for the Community: Science shop |
Ms Nora Shovelin
Academic Theme Leaders' Office: Internationalisation, Interculturalism & Social Development theme - Dublin City University
| Presentation |
| This presentation will outline the aims and achievements of science shops internationally and at Dublin City University. Science shops are places where community organisations can commission research that will be of benefit to society. Many science shops are located in universities and much of the research is carried out by students who receive credits for this work as part of their courses. Because the research is intended to benefit society it is expected that it should have clear outcomes and that these outcomes should be publicised. This service is non-profit making and is aimed at community groups rather than at individuals. The European Commission is currently promoting the establishment of science shops which it views as having two useful functions. They provide answers to research questions for the public and they upskill researchers by providing them with real-life research opportunities. These shops originated in the Netherlands in the 1970s as a way of democratising science and changing practices within universities. Originally the shops offered research in natural sciences but the areas of research on offer now cover the social sciences and other areas that individual shops may be able to offer. DCU is in the process of setting up a science shop. We currently have one EU-funded project underway in partnership with Cairde, an NGO working to reduce health inequalities among ethnic minorities and with the Science Shop at Queen’s University, Belfast, a well-established science shop that specialises in undergraduate research. The project which will run over 18 months consists of an analysis of mental health needs among immigrant communities. |
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| Risk factors that influence suicidal behaviour in men |
Ms Elizabeth McAdam
Ms Susan Hourican | Poster |
| The rate of suicide in Ireland among men aged 15-34 has steadily been increasing over the past decade. According to the Central Statistics Office, male suicides in Ireland accounted for 18 per 100,000 population in 2003 (Central Statistics Office 2007). The World Health Organisation has compiled a list of the suicide rates for each country. In Ireland the rate of suicide among males in 2005 was 21.4 per 100,000. This is in comparison to a rate of 10.8 per 100,000 in the United Kingdom (World Health Organisation 2007). It is an area that has attracted lots of interest from the media and from suicide support groups who are calling for more research into the area of suicide. A review of the literature sheds some light on the reasons why young males may contemplate or carry out suicide. |
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| Supporting parents and carers of young people with deliberate self-harm |
Ms Carole Boylan
Clinical Nurse Specialist (Mental health)
Dr Sophia Morgan, Ms Sinead Byrne, Prof Carol Fitzpatrick, Dr Hilary Graham, Ms Julie Howley, Ms Sinead Crowley | Presentation |
Background:
Being the parent/carer of a young person who has engaged in suicidal behaviour is a frightening experience. There is little ‘evidence-based practice’ to guide professionals in how best to provide support for such parents/carers. This project set out to seek the views and needs of parents/carers of young people with suicidal behaviour, and to develop and evaluate a programme incorporating these.
Methods:
The parents/carers of all young people who had attended The Children’s University Hospital with self-harm over a three year period were invited to participate in qualitative focus group discussions about their support needs. Discussions were recorded, transcribed and submitted to thematic analysis. An eight week group programme covering the emergent themes was then developed for parents/carers of young people with self-harm. Participants for this programme were recruited from Child and Adolescent Mental Health Services and Family Support Services across Dublin. The programme will be evaluated using both quantitative and qualitative measures.
Results:
The main themes to emerge from the focus group discussion included needs for: peer support for parents/carers; information about suicidal behaviour in young people; skills for parenting an adolescent; help re-establishing family structures/boundaries after an incident of self-harm; advice on handling threats or further incidents of self-harm.
Preliminary results of the first programme have shown significant benefit to participants.
Conclusion:
Given the international endorsement of the importance of involving service users and carers in service development, we adopted a qualitative research approach to developing a programme informed by the needs of parents and carers. The first two programmes involving thirty parents/carers have already run since January 2007, with initial results being available for the Conference. |
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| Surviving being suicidal: What money can't buy and statistics can't tell us |
Mr Richard Lakeman
Lecturer - Dublin City University
| Presentation |
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Increasing prosperity has not led to a reduction in suicide in most countries and neither has investment in epidemiological / risk factor focused research. Suicide is a pressing public policy issue and social concern but it also reflects an intensely personal struggle. This paper presents a review of the very limited literature examining the suicidal experience from the point of view of the suicidal person. It considers how people live with being suicidal.
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| The Body in Process |
Mr John Keane
Postgraduate Student, DCU, School of Nursing
| Presentation |
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This paper has its genesis in the corporeal intentionality of Merleau-Ponty. I will develop this sense of corporeal intentionality through the work of the pragmatists (such as Dewey and James), using Gendlin’s theory of the body to develop a sense of an interactional body that resists the reductionism implicit in materialistic and instrumentalist notions of the body. The theme of stoppages as a means of considering the body in process will be developed. All of this will be contextualised through the narrative case studies of people who have experienced chronic illness in their lives. I will then ask what this "kind" of interactional concept of the body can contribute to contemporary discourse.
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| The concept of 'Hopelesness' in Mental Health |
Ms Fiona Horgan
Clinical Placement Co-ordinator - St John of God Hospital, Stillorgan
| Poster |
| Hope is central to life and is a construct which is central to nursing (Miller, 2007). Many definitions exist however in its simplest form, hope is the belief that things can be different and for those experiencing mental distress, it lies at the very heart of their willingness and ability to take on the challenge of rebuilding their life (Basset and Repper, 2005). Within the literature, hopelessness is significantly correlated with depression and has been identified as a significant risk factor for suicide. Edwin Schneidman (1987) referred to the sense of powerlessness; and impotence underlying feelings of hopelessness in suicidal individuals. Although it is only one of a number of risk factors for suicide, hopelessness is a psychological variable which is subject to direct clinical intervention, unlike many demographic variables. The literature refers to two linked, interpersonal processes which are key in intervening with hopelessness in the suicidal client; engagement and inspiring hope (Cutcliffe and Barker, 2002). Basset and Repper (2005) suggest that workers as well as users need to have hope if there is to be recovery following mental illness and this presentation will consider the crucial role of hope both for those with mental health problems and for those working in mental health services. It will also embrace approaches to engaging with hopelessness and inspiring hope and tools available to measure hope e.g. the Miller Hope Scale (MHS) will be presented. |
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| The Dish of Your Discourse: A Carer's Perspective on 'Treatment, Language and Empowerment |
Dr Tess Maginess
Senior Teaching Fellow - School of Education, Queen's University, Belfast
| Presentation |
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The themes of this conference usher a new approach towards how we might consider evidence based practice, in relation to current policies and theoretical models of person-centered, psychosocial ‘interventions’. The foundation of this paper will be an ‘evidence based’ evaluation of the ‘positive risk’ and ‘recovery model’ praxis of the new Southern Trust Home Treatment and Crisis Response Service, from the perspective of a carer (the author), and will proceed to relate this experiential learning to current policy and theory.. The paper will consider research and policy in the field of mental health but will also refer to broader contexts including Social Model approaches to disability, extended to a rights based model through Equal Opportunities and Disability legislation in the two parts of the island and the sometimes contravening Corpratist model of Consumer Choice. The paper will examine how it is that ‘traditional routes’ characterised by medical, academic and policy jargon may fail to engage service users and carers, due to its hermeneutic character. The paper will argue that this idiolect becomes a foreign and ‘imperial’ language, rooted in an unquestioning power dynamic and suggests how .the power imbalance can be challenged and interrogated by the ‘subverted’ and subversive language of people directly affected by mental distress. The patronising dichotomy between ‘real’ (objective) research and ‘worthy’ (subjective) research, often modelled as ‘story’ will be examined. The paper will conclude by suggesting an empancipatory learning paradigm, led by users and carers and co-negotiated within a psychosocial, person-centered framework with ‘professionals’.
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| The Divided Self and the Good Enough Psychiatric Nurse |
Prof Tony Warne
Professor in Mental Health Care - Institute of Health and Social Care Research, University of Salford
Ms Sue McAndrew (University of Leeds) | Discussion |
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Like other professional groups, mental health nurses will often find themselves entangled or seduced by paradoxical polarities. These polarities are revealed in claims of fiduciary versus self-interest or between the practical and the ‘technical’, the holistic and the fragmented and the ‘art’ or ‘science’ of nursing. Nurses are not just required to work between such polarities, they are also systematically pinned down in terms of different types of knowledge, stages of development, and typologies of role. These various characterisations and emplotments imply different sorts of denouement which mental health nurses are regularly consigned to, threatened with, or rescued from. The story of the harassed and divided mental health nurse is a familiar one, and so too are the narratives of redemption, whereby ‘substantive selves’ and ‘core moral purposes’ are preserved via ethical codes and professional regulation.
This presentation explores the impact for the individual nurse and on mental health nursing practice of two competing registers: the ‘economy of performance’ (manifest by the audit culture) and various ‘ecologies of practice’ (professional dispositions and commitments individually and collectively engendered). In particular we are concerned with the exploration of questions about the relation of ‘self’, ‘identity’ and ‘professionalism’ within these two registers. Our concern is that in the oscillations set up by these registers many mental health nurses retreat to a position of being a good enough psychiatric nurse, rather than addressing their personal and professional consequences of the divided self. Approaches for providing organisational ‘containing’ and ‘holding’ responses are highlighted and discussed.
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| The dream catcher: Dying to escape the sado-masochistic fag machine |
Ms Sue McAndrew
Nurse Lecturer - University of Leeds
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The essence of mental health nursing lies within the therapeutic relationship. Integral to this process is giving recognition to the significance of the unconscious. One way of accessing the unconscious both in the therapeutic and research encounter would be to use free association and dream reconstruction, sometimes referred to as the dramaturgical approach. This paper explores the early lived experiences of Carl, a 35 year old gay man. His history has been characterised by periods of suicidality linked to coming to terms with his homosexuality. Free association narrative interviewing was used to explore Carl’s early intimate family experiences. However, the catalysis for Carl’s story is his re-occurring dream of being trapped in a cigarette vending machine, full of blades which, at the whim of his family pressing a button, will cut him up whilst they watch. For Carl, his dream was the manifestation of what it felt like to begin to comprehend his difference in terms of the acceptability of his sexuality by an all pervading culture of heterosexism. Carl’s self blame is metaphorically represented by his entrapment in the machine, a sado-masochistic dream, whereby he was trapped in his sexual sense of self and where his family have the potential to destroy him. This paper explores the way free association narrative interviewing, and more specifically dreams, can be used to provide important opportunities for practitioners to better understand and give meaning to the unconscious intra, inter and extra-personal conflict that can lead to suicidality.
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| The impact of supported employment on quality of life and mental health of people with intellectual disabilities: What happens when the job breaks down? |
Dr Pauline Banks
Senior Research Fellow (HealthQWest)
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| Background: Supported employment is seen as a central means of improving the social and economic position of people with intellectual difficulties (PwID), and is thought to have a positive effect on their health and well being. However, research in the general population has shown that although unemployment is associated with deteriorating mental health and a greater risk of suicide, work can also be stressful. Aims: To examine the impact of the transition to supported employment on the quality of life and mental health of PwID. Methods: The study adopted a longitudinal approach, interviewing participants (n=49) who had entered supported employment, 3+ hours per week within three months of starting work and again nine months later. Where possible a family member or support worker, was also interviewed. PwID were involved in advising the research team in the development stages, and throughout the study. Findings: Analysis of scores derived from standardised scales measuring quality of life, anxiety and depression, loneliness, and social comparison found no association, positive or negative, with employment. However, analysis of the qualitative data painted a rather different picture. Thirteen of the 49 jobs secured broke down between times 1 and 2. One of the most striking findings from this study was the significance that participants associated with employment in terms of the gap that job breakdown created in their lives. Conclusion: The findings of this study have significant implications for supported employment providers in terms of the way in which they prepare people for employment and the level of support they provide following breakdown. |
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| The Labyrinth as a Tool for Psychosocial Healing |
Mr Tony Christie
Labyrinthireland
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| This presentation looks at the modern uses of the labyrinth, and in particular its use as a complementary and alternative approach to personal development and psychosocial wellbeing. The labyrinth is an ancient symbol that benefits the user by quieting the mind, promoting relaxation, and helping people to tap into their creative energy. When walked (as a form of walking meditation), the labyrinth is centering and balancing, and facilitates the user to access their innermost emotions and feelings as regards themselves and others. The labyrinth is a symbol for our journey in life. It consists of a circuitous path from the outside to the centre. The user is central to their labyrinth experience. People can walk the labyrinth on their own, or with a group. Communities can build their own labyrinth to walk. The labyrinth is a microcosm of our lives. It is an indicator of our psychosocial wellbeing. When we walk individually, we can experience those parts of ourselves that need healing. When we walk in a group we experience ourselves as regards others, where everything that happens can be seen as a metaphor for what happens in our wider lives. Labyrinths are emerging in places where people need both personal and psychosocial healing. Labyrinths are now found in prisons, healthcare settings, hospitals, hospices, churches and schools. The presentation will also consider the emerging research that is being carried out into the physiological and psychosocial effects of using the labyrinth.
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| The Labyrinth: A Pathway to Healing and Growth |
Mr Tony Christie
Labyrinthireland
| Workshop |
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The labyrinth is re-emerging in society as a place where people can find balance and peace, and where they can relax and restore balance to their lives. The labyrinth is a symbol of our journey in life. Everything that happens on the labyrinth can be seen as a metaphor for life. Thus, as people walk and work with the labyrinth, Aims: The aims of this workshop are to:
• Increase awareness of the labyrinth as a tool for personal growth and psychosocial wellbeing
• To familiarize participants with the labyrinth through a guided labyrinth walk
• To allow participants to interact with a labyrinth, and experience the labyrinth for themselves.
• Consider Settings in which they might use the labyrinth as a tool for psychosocial healing
Outcomes: Participants will gain knowledge of the labyrinth, and the many uses for the labyrinth as a tool for improved psychosocial health. Participants will also experience for themselves how walking a labyrinth can help identify current issues in their lives, and how to use it to address these issues. Healthcare settings will consider installing labyrinths to complement their existing facilities and services.
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| The Psychological Consequences of Perceived Stigma in a Non-Clinical Sample |
Ms Maeve Proctor
Mr Roger Woodward | Poster |
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Research over the past number of decades indicates that individuals with mental health difficulties are likely to encounter discrimination and stigma in their lives. Modified labelling theory suggests that expectations of rejection may work to generate negative outcomes for these individuals. It has been noted that in this way stigma can act as a barrier to recovery and rehabilitation. Through the use of a postal questionnaire this study aimed to explore the psychological consequences for individuals who experience stigma. Ninety-four volunteers from the general public completed a battery of questionnaires. Results indicate that perceived experiences of stigma and discrimination were related to higher levels of shame, lower levels of positive mood and poor self-esteem. Expectations of rejection were found to mediate the relationship between stigma and psychological outcomes in some cases. The clinical implications for those working with individuals experiencing stigma and directions for future research are also discussed.
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| The 'Recovery Context Inventory': A personal recovery environment audit tool |
Mr Tom O'Brien
Principal Psychologist - Eve Limited
| Presentation |
| The ‘Recovery Context Inventory’: a personal recovery environment audit tool. The idea of 'recovery' from serious mental distress illness is emerging as a core construct in the consumer / survivor movement and the field of psychiatric rehabilitation. Concurrently, the results of longitudinal outcome studies support the view that people can achieve considerable recovery of psychosocial well-being. Developments in these areas have challenged the traditional belief that serious mental health difficulties are both intractable and beyond the control of the individual. Internationally, mental health systems are working to promote 'recovery-oriented' systems and benchmark mental health services against a recovery framework that will support the unique personal process of recovery. This paper will outline progress to date on the development of a ‘Recovery Context Inventory’. This context measure will provide a validated tool to assess the degree to which interpersonal, service and wider community aspects of a person’s environment support or inhibit their recovery. The instrument will be underpinned by an ecological conceptualisation of the personal recovery process and is being developed with key stakeholder groups from Ireland and the United Kingdom, using a mixed methods approach. Information will be provided on the utility and innovative features of the proposed instrument. Relevance to Theme: the RCI is a context measure, underpinned by a rigorous consensus-based ecological understanding of the person's recovery process, that will facilitate personally directed and tailored recovery-oriented action planning. |
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| The Role of Advocacy in Promoting Recovery in Mental Health |
Mr Joe Keane
Irish Advocacy Network
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The Irish Advocacy Network (IAN) is an island wide organisation made up of consumers and survivors of the mental health services in Ireland, carrying a wealth of experience and empathy to their clientele. It has been in existence since 2001 and has steadily grown. IAN has advocates operating in most of the acute psychiatric units in the country, as well as the Central Mental Hospital and provides a peer support advocacy service to people who request it. This consists of listening ear, information provision and promoting choice for mental health consumers enabling people to have their voices heard within the mental health service. The ultimate goal is that people would become empowered to take back control of their life situation and achieve recovery. This notion also stretches to encouraging people to be active citizens. IAN has conducted audits of the mental health services for the HSE (formerly the Regional Health Boards) as well as conducting research for Amnesty International, around human rights within the acute psychiatric units. The organisation works closely with the Mental Health Commission and the Inspector for Mental Health Institutions submitting reports around peoples experiences of the mental health service. This workshop will include:
- Discussion on advocacy, self-advocacy and how it supports and encourages recovery from mental difficulties.
- Small groups exploring how people can practically engage in advocacy and self-advocacy as well as supporting people towards recovery.
- General feedback to the larger group on outcomes from discussion and chart these on a flip-chart.
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| Therapy in the 21st century: Wounded healers, suffering and the psychotherapeutic process |
Ms Benig Mauger
Psychotherapist, writer, and lecturer
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Over half a century after Jung, in an increasingly fragmented world, man is still in search of his soul, and the demand for therapy is on the increase. Despite being told that wholeness lies within and that living soulfully involves accepting our wounds as our greatest gifts, in our ‘quick fix’ society, we either look for answers and speedy resolutions outside of ourselves, or we remain trapped in our wounds. In this context, what is the role of the psychotherapist? Are we healing hurts or promoting dependency and a culture of ‘woundology’? Is there a middle ground? Revisiting the myth of Chiron, the Wounded Healer and outlining the importance of creative suffering in the development of consciousness and the healing process, the author suggests that the capacity to endure and transcend is an essential part of adult life, the healing process and the psychotherapeutic model involving both therapist and client. Presenting suffering as a training in healing, the author proposes that therapy in the 21st century is about creating a model of psychotherapeutic care that is empowered yet still vulnerable. This presentation explores the mythical, emotional and spiritual dimensions of therapy and healing and its relevance to our lives today as both
practitioners and 'service users'.
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| Waiting for a kidney transplant: The experience of being a patient on haemodialysis therapy. |
Ms Aoife Moran
HRB Clinical Nursing & Midwifery Fellow
Prof Anne Scott (DCU), Prof Philip Darbyshire (Flinders University, Australia) | Poster |
| Haemodialysis is one form of renal replacement therapy for patients with end stage renal disease (ESRD). It requires the person to comply with a strict regime of dialysis, medications, and dietary and fluid restrictions. These patients are also dependent on the haemodialysis machine for survival, and must accept frequent interaction with the healthcare team. The lifestyle disruptions caused by haemodialysis therapy can make it difficult for some patients to adapt to the treatment. The aim of the study is to provide a detailed description of the experience of being a patient on haemodialysis therapy. Methodology The methodology employed is interpretive phenomenology. The setting for the study is a haemodialysis unit based in the Republic of Ireland. A purposive sample of sixteen participants, aged from 20-70 years was recruited. Two qualitative interviews were conducted with each participant. Interpretive data analysis was used to analyse the data. Findings The findings indicate that the experience of waiting for a kidney transplant is significant for the participants in the study. Their experience of waiting for a transplant was found to have two themes: living in hope, and uncertainty. This paper highlights that the experience of waiting for a transplant was significant for the participants in the study. The findings provide a new insight into the experience of being a patient on haemodialysis therapy. The patient’s experience is the most appropriate starting point for providing effective, patient-centred care. It is anticipated that the findings from this study could be used to improve existing healthcare strategies and contribute to evidence-informed practice. |
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| Ways of living in the moment |
Ms Mary Maddock
Director of MindFreedom Ireland and board member of ENUSP (European Network of UserSurvivors of Psychiatry)
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Mary is a former nun and psychiatric survivor. Believing in the myth of ‘mental illness’, for 20 years she was, as she describes herself, a psychiatric slave chemically lobotomised by the drug treatment which deprived her of her humanity. With the help of people like Dr.Peter Breggin and Dr. Terry Lynch and MindFreedom International, she had her eyes opened and today is a liberated drug-free woman and active campaigner for a non-violent revolution in psychiatry.
She is a founder member of MindFreedom Ireland and a member of the Boards of MindFreedom International and ENUSP (European Network of Users/Survivors of Psychiatry). She is also a member of INTAR (International Network Towards Alternatives for Recovery), Cork Advocacy Network and Sli Eile. She has spoken widely in the media and is co-author with her husband Jim of their recently published book ‘Soul Survivor – A Personal Encounter with Psychiatry’ which coincides with the Campaign to Abolish the Schizophrenia label (CASL).
Her dream would be to see: a) an end to forced ‘treatments’ and guardianship b) for people labelled with ‘mental illness’ to be recognised as citizens by the law c) for many Soteria-type communities to be established d) that people like herself who are destroyed and crippled by psychiatric drugs will have safe supported havens to detox and recover and e) that a human model of recovery will become the norm rather than the exception.
Mary has two grown up daughters, teaches piano and lives in Cork
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Download a detailed programme (includes abstracts)
