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Article citation: Peter Ryan, (2011) "Editorial", Journal of Mental Health Training, Education and Practice, The, Vol. 6 Iss: 2, pp. -
Helen Barnes in an interesting and challenging piece raises a number of issues for mental health services, educators and trainers: does mental illness have a place alongside social and recovery models of mental health in service users’ lived experiences? The paper goes to the heart of the curriculum debate: what should we be teaching mental health professionals, who should teach it and how should such a curriculum be developed? The new DH (2011) initiatives such as the new mental health strategy contain a welcome emphasis on building recovery-oriented practice, and pointing towards more community-oriented approaches emphasising “participation in employment and community networks, self-directed support and cognitive and problem-solving strategies for self-management of symptoms and problems of living“ (Barnes, 2011). However, Barnes quite rightly asks the question of how and in what way can the enduring difficulties associated with mental health problems best be addressed? One of her conclusions is that: “for many service users, symptoms form major concerns and barriers to mainstream life”, again raising the issue of how best and in what context can such concerns best be addressed. This is a complex and well-argued paper and actually asks a number of additional questions. So far as mental health educators are concerned, Barnes concludes that: “Mental health education should, therefore, promote awareness of inequalities and their implications for differential access to influence, and work with students to ensure these voices are heard”.
Jim Chapman and Mervyn Morris’s paper in a way demonstrates how some of the concerns raised in Barne’s overview, can in practical ways be addressed in curriculum design and development, by addressing the issue of how post-qualifying students can develop practice skills acquired from a “hearing voices” module into routine clinical practice. They show how the psycho-social intervention field has itself been profoundly influenced by the “recovery agenda” and is now focusing on working more constructively and openly with service users who hear voices: “far from attempting to eliminate or stop voices from occurring”, the focus now is to “advocate helping people to cope with the experience, make sense of the inter-relationship between the voices and past lived experiences”. Chapman recounts the experience of running a degree level module entitled Recovery Based Working with Voice Hearers, which equips students with the skills and knowledge to work with voice hearers in a recovery-oriented fashion. He addresses the familiar problem of transfer to practice, of however well taught a module might be, students still struggle to find ways to actually implement this in their clinical practice. Chapman invited past students of the programme to a focus group interview and was able to identify a number of themes which whilst themselves familiar, are well described with respect for example to the importance of good supervision, bur raises a further point which has not sufficiently been addressed, namely that “sometimes service users and their families were not ready themselves to embrace recovery focused ways of working”.
Miu Ha Kwong contributes a valuable international perspective to this edition of the journal by sharing American experience of how best to achieve cultural competency in mental health training for nurses; this issue is certainly on the agenda of the many UK nurse training colleges and universities. She states the self-evident proposition:
Given an increasing multicultural and multilingual population, an urgent need for cross-cultural community and health services, as well as for culturally competent practitioners, has emerged in the profession of mental health.
Kwong discusses two important issues: mental health professions need more culturally competent practitioners to work with multicultural service-users; and explores the core cultural components in training mental health practitioners to work with multiethnic groups.
The particular piece of work reported on here by Kwong refers to exploring the core components in achieving cultural competency, by employing qualitative methodology and a snowball sampling method to recruit ten experts knowledgeable in multiculturalism. She organised her findings into four essential components in achieving cultural competency: attitudinal, emotional, intellectual and integrative practice components. She usefully reviews some research on cultural meanings, and considers current research around the use of dominant languages, and the cultural nature of health beliefs. She reviews her findings in an informative and useful way using the four categories of attitudinal, emotional, intellectual and integrative practice, and concludes by proposing an integrative practice model in mental health, again using these four components to anchor her model.
The final two papers in this edition of the journal both have a European component; both focus on the “practice” area of the journal’s agenda, and both deal in different ways with the important issue of occupational stress. Sandra Jeschke, Uta Gaidys and Colin R. Martin report on the results of a German study of psychological stress and “embitterment” with respect to a randomly selected population of German nurses, some of whom had academic qualifications and some of whom did not. The German version of the Bern Embitterment Inventory was applied. The continuing variation among academic and non-academic nursing staff was statistically significant and showed that an academic education with its attendant circumstances had a positive effect on the subjective perception of embitterment (p=0.001). Sandra Jeschke, Uta Gaidys and Colin R. Martin conclude that:
[…] a higher education in nursing is synonymous to better mental health […] It is vital for nurses to retain a solid mental balance and strength, to be able to deal with disappointment at work without becoming embittered. The protective value of an academic education is currently a subject for discussion in Germany and could most certainly have a considerable impact on the presently developing changes within the framework of nurse education.
Nursing education is undergoing huge changes throughout Europe including the UK, and it is gratifying to note that the shift towards a degree level nursing education profile in the UK is, if this German study is taken onboard, to lead to higher levels of mental health for the students concerned.
The final paper this edition of the journal addresses also gives a European flavour to proceedings. Margaret Denny, John Wells and Jennifer Cunningham report on an exploratory study (Reducing Occupational Stress in Employment Project (ROSE)), which focuses on psychosocial job strain amongst support workers in five European countries (UK, Ireland, Italy, Romania, and Austria). ROSE aimed to develop an online multi-model (environmental and individual) stress management intervention in order to improve well-being of staff in these services, available on a 24/seven basis. This paper reports on a preliminary survey of services in the five partner countries in terms of existing levels of occupational job strain. Data were gathered through administration of the job content questionnaire (JCQ) and a series of focus groups. Findings from the JCQ showed that just under 20 per cent of the sample were showing symptoms of job strain, whilst results from the focus groups indicated that the key stressors for workers were balancing work demands with time available to carry out tasks; poor communication within organisations; and feeling unsupported in one’s work. They conclude:
The findings from this exploratory study indicate that in this particular sector a sense of control over one’s work and feeling involved and supported are key variables that impact on a personal sense of occupational stress and that organisations need to consider this in how they organise their working environment and structure working relationships.
These findings are consistent with other research in this area (Sørgaard et al., 2007).
DH (2011), No Health Without Mental Health: A Cross-government Mental Health Outcomes Strategy for People of All Ages, HM Government, London
Sørgaard, K.W., Ryan, P., Hill, R., Dawson, I. and The OSCAR Group (2007), “Sources of stress and burnout in acute psychiatric care: inpatient vs community staff”, Social Psychiatry and Psychiatric Epidemiology, Vol. 42 No. 10, pp. 794–802