mental health Archives - Centre for Mental Health Practice Policy and Law Research

The Digital Divide: Virtual Versus In-person Meetings

This blog was written by Kate Fennell. Kate is a professional doctorate candidate, Fellow of the Higher Education Academy, and social work lecturer on the integrated Allied Health Professions and Social Work Masters programme at Edinburgh Napier University.

Whilst information and communication technologies had been adopted in health & social care (H&SC) practice long before the pandemic, the abrupt need to close non-essential workplaces accelerated the use of digital platforms for health consultations and interprofessional meetings. For many services, these online meetings have continued beyond the pandemic. Teleconference, MS Teams etc are convenient for collaborative meetings as a means to manage limited resources and reduce travel for both H&SC staff and people who use services, especially in geographically remote areas. Across the UK and Scotland, tribunal hearings were conducted using audio and video technologies, which helped to avoid significant delays (Byrom & Beardon, 2021) during the pandemic. However, there are also many disadvantages associated with Telecare and other remote IT use, as reported by the Covid Public Inquiry (McKay et al, 2024), with particular groups of people being digitally excluded.

My particular interest in this topic relates to research being conducted as part of a professional doctorate. As many of you will know, I’m undertaking an in-depth system level analysis of meaningful participation within the Adult Support and Protection Case Conferences (ASPCCs). As a reminder, the Adult Support and Protection (Scotland) Act 2007 mandates public bodies to investigate situations of harm and to support and protect adults at risk. One of the fundamental principles of the legislation is to involve the person in the adult protection process. The ASPCC is an interprofessional, multi-agency meeting which is convened to explore risk and develop a support and protection plan. It is now customary practice for the individual at risk to attend these meetings. But attendance does not necessarily equate to meaningful participation and attendance can be tokenistic.

Thirty-one research participants contributed to focus groups and semi-structured interviews conducted across Scotland. The research sample comprised adults at risk of harm, social workers, independent advocacy workers, ASPCC chairs and mental health officers. I am currently at the coding/thematic analysis stage of this research.

What I have learned is that despite an overwhelming view that individuals are better able to participate within face-to-face, in-person meetings, many ASPCCs continue to take place online. There are a number of reasons for this. In some circumstances, virtual case conferences do suit some individuals. Online meetings can provide a safer environment for those who have had previous unpleasant experiences of multi-disciplinary meetings e.g., hospital discharge, child/adult protection case conferences and mental health tribunals. Some people in receipt of services would rather avoid hospital or social work offices. Attending from their own home allows them more choice and control over the degree of their involvement, as they can mute their audio, switch off their camera and leave when they choose. Some people with impaired mobility or who have other difficulties in travelling to health or social work centres, may find remote meetings more accessible. However some research participants with mobility issues said that they would still rather attend these meetings in person.

For many people subject to adult support and protection measures, virtual meetings are inaccessible and exclusionary. For some with sensory loss, cognitive impairment or mental health symptoms, engaging with disembodied faces on a screen is very challenging. It is difficult to read people’s body language on a small screen. Gestures such as nodding, smiling and other forms of non-verbal affirmation signalling are lacking. Digital emojis while useful, cannot replace the in-person contact and the physical presence of being in the room with others. An inability to develop a rapport with others inhibits meaningful participation and engagement. Lack of technological knowledge or equipment and Wi-Fi issues are additional barriers to be considered.

The most frequently acknowledged benefits of remote ASPCCs are related to efficiency and increased attendance by GPs and other healthcare professionals. These points are echoed in Driscoll et al’s (2020) study on multi-agency safeguarding arrangements and in Byrom and Beardon’s (2021) evaluation of the impact of Covid on MH Tribunals in England and Wales. These may be the most compelling reasons for the continuation of on-line ASPCCs.

Without exception, every participant in the current research study said that decisions regarding the optimal platform should be person-centred and determined by the person’s individual circumstances, their needs and preferences. People should be offered the choice of how they wish to attend their meeting. The question remains as to whether virtual meetings can truly offer a psychological safe space in which attendees can meaningfully contribute and participate.

I would be interested to hear people’s views of the virtual vs in-person debate and your experiences of these online H&SC meetings.

References

Byrom, N., & Beardon, S. (2021). Understanding the impact of COVID-19 on tribunals. The Legal Education Foundation.

Driscoll, J., Lorek, A., Kinnear, E., & Hutchinson, A. (2020). Multi-agency safeguarding arrangements: overcoming the challenges of Covid-19 measures. Journal of children’s services, 15(4), 267-274.

McKay, C., Stavert, J., Johnston, L., Murray, J., Rek, J., Breen, C., Zarins, A. Woodrow. A., Anderson, L. & King, M. COVID-19 Public Inquiry: Research Report for Portfolio 3 The Provision of Health and Social Care Services Adult Social Care. Centre for Mental Health Practice, Policy and Law Research, Edinburgh Napier University

Napier Researchers Attend IASSIDD 17th World Congress in Chicago

In August, Natasha Spassiani (Associate Professor in disability and health equity) and Sam Abdulla (Lecturer in learning disability nursing) attended the IASSIDD 17^th world congress in Chicago. Established in in 1960, the International Association for the Scientific Study of Intellectual and Developmental Disabilities is the oldest global association dedicated to understanding and improving the quality of life for people with intellectual disabilities.

Sam presented initial findings from his professional doctorate, which explores the professional development of early career and student learning disability nurses in practice placement and Natasha shared her work understanding the experiences of people with intellectual disabilities accessing emergency care. Together, they also facilitated a roundtable discussion in collaboration with colleagues from the university of Illinois in Chicago – Dr Joy Hemmel (Professor in Disability and Human Development and director of graduate studies) and Robin Jones (Director Great Lakes ADA Centre). Exploring the barriers and supports to achieving deinstitutionalisation for people with learning disabilities, the roundtable drew in a diverse audience – with attendees from Japan, Singapore, the UK, the US, the Czech Republic and Pakistan! Finally, the pair also presented a participatory research project which identified barriers and supports to medicine concordance.

The conference closed with impassioned calls from people with learning disabilities, and attendees from the global south to ensure that we live up to the ideals of inclusion. To ensure that presentations are delivered in a range of languages, that information is accessible, that smaller, less prominent voices aren’t pitched against those esteemed colleagues who can draw in the larger audiences. If we as researcher, clinicians and academics in intellectual disability won’t ensure that intersectional identities are able to take their full space, how can we claim to be working inclusively?

The focus of our discussion was that of deinstitutionalisation, when we think of institutions we immediately go to the physical spaces, to four walls, lack of choice, lack of freedoms, of ways of living and being that aren’t authentic to those who are subjected to the institution. However, when we inadvertently or indirectly create environments where diverse voices do not have space, we create an institution of another kind, where we restrain thoughts and ideas.

Despite this, conferences are an opportunity for us to create connections and to reconnect with friends and colleagues from across the world to create energy, for ideas to spark and maybe, for change to happen.

@NSpassiani @SamAbdulla

Research Project on Trainee Counsellors is Looking for Research Participants

Project: Free Labour and precarity in mental health provision: trainee counsellor’s experiences across the UK.

Researchers: We are Dr Mariya Ivancheva, Strathclyde University and Dr Jennifer O’Neil, Edinburgh Napier University. We are Education, Work and Employment researchers. Mariya has a counselling background and Jennifer has researched/published on counselling practitioners working experiences previously.

Participants: We are interested in interviewing trainee counsellors on accredited postgraduate programmes. You will have the opportunity to discuss your experiences of training, placement and transition to employment and professional career in the UK context. Your views are important in informing this research and shaping future practice.

Research: This project, sponsored by BACP, investigates the structural conditions of counselling placements in the UK through the lived experiences of trainee counsellors and insight into the trainee programmes rationale and structure. We aim to inform future training and placement design in a way that captures trainee counsellors’ voices and illuminates the structural challenges they experience within a dynamically developing professional field.

Data: All data will be anonymised and saved following GDPR protocols. The findings from the interviews will be published as a policy brief, presented at conferences and in journal articles. They will serve as key documents in a knowledge exchange programme with diverse stakeholders to help formulate policy demands for improved funding and placement design in the sector.

Information: Please contact us at J.Oneil@napier.ac.uk and M.Ivancheva@strath.ac.uk if you would like to take part and/or have any further questions.

Ethics: This project has full ethical approval from the University of Strathclyde. For more information, please contact ethics@strathclyde.ac.uk

The Acceptability of Cognitive Behavioural Therapy (CBT) for Autistic adults: A mixed-method study with autistic adults and clinicians.

This blog post was written by PhD student Chloe Kennedy. If you would like to find out more, please contact here.

In the UK, there are around 700,000 autistic people (National Autistic Society). Research shows that autistic people are at increased risk of experiencing a co-occurring disorder, such as anxiety (Hollocks et al., 2019).

Cognitive Behavioural Therapy (CBT) is considered the ideal treatment for such disorders (Clark, 2011), but may be less effective for autistic adults than the general population or autistic children (Weston, Hodgekins & Langdon, 2016).

Acceptability, known as the extent to which people delivering or receiving an intervention consider it to be appropriate (Sehkon et al., 2017), can influence intervention uptake, adherence, effectiveness and implementation. However, our scoping review showed that acceptability is rarely a primary research aim, typically only measured in part and research lacks use of appropriate theory. So, there is need for a theory-driven study focusing on CBT acceptability in real-world practice.

This PhD project thus aims to identify the extent to which CBT for autistic adults is (un)acceptable to autistic adults and clinicians in routine practice, and to understand why it is acceptable/unacceptable to consider potential adaptions to CBT. The study aims to achieve this through an acceptability-specific online survey with optional interviews and focus groups.

The findings from this could help in development of evidence-based adaptions to CBT for autistic adults and improve understanding of CBT acceptability from both sides of the therapy experience. The study is now open for recruitment and we would love to hear from all autistic adults and clinicians with experience of delivering or receiving CBT that can participate to make sure the potential impact of this project becomes a reality.

National Autistic Society. (no date). What is Autism? https://www.autism.org.uk/advice-and-guidance/what-is-autism

Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine, 49(4), 559-572.

Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International review of psychiatry, 23(4), 318-327.

Weston, L., Hodgekins, J., & Langdon, P. E. (2016). Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clinical psychology review, 49, 41-54.

Sekhon, M., Cartwright, M., & Francis, J. J. (2017). Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC health services research, 17(1), 1-13.

The Future of Mental Health Law: A Comparative Analysis of Law Reform Debates in Scotland, Northern Ireland, Ireland, England & Wales

The Convention on the Rights of Persons with Disabilities (CRPD) is an international human rights treaty which came into force in May 2008. It requires that parties to the convention promote, protect and ensure the full enjoyment of human rights by persons with disabilities.

Since the adoption of the Convention, many countries around the world have sought to reform their mental health laws, policies and services so they align with the CRPD. This includes engagement with the principles derived from the CRPD and adoption or amendment of relevant laws and policies. There are differences, however, across countries and authorities with respect to engagement and interpretation of human rights obligations and how mental health law and the promotion of the human right to mental health looks. Human rights arguments, along with rising rates of compulsory mental health treatment, have prompted major reviews of mental health laws across the United Kingdom and beyond.

Professor Penelope Weller is working on a project which will analyse the current law reform debates in Scotland, Northern Ireland, Ireland, England, Wales and the Republic of Ireland. Across these countries, all have reviewed the existing legislation and are at varying stages of reform.

Reform status across the UK and Republic of Ireland

In Scotland, the Scottish mental health law review (Scott review) was completed in 2022 and responded to in June 2023 by Scottish Government.[1] The Scottish Government announced in 2023 a programme to implement the new approach over a period of 10 years.

In England and Wales, following the Independent Review of the Mental Health Act 1983 (Wessely Review), the Reforming the Mental Health Act white paper was published in August 2021. The Government is due to develop a new bill, but the timeframe for this remains unclear.[2]

In Northern Ireland, the Mental Capacity Act (NI) 2016 fuses together mental capacity and mental health law, as recommended by the Bamford Review of mental health and learning disability. [3][4] The Act is yet to be fully implemented.

In Ireland, Assisted Decision-Making (Capacity) Act 2015 came into force in April 2023.[5] An expert review of Mental Health Act 2001 was completed in 2014. In 2021 the government published a Draft Heads of a Bill to amend the Mental Health Act, with reform of the Mental Health Act 2001 due in 2023.

How we realise human rights for those with psychosocial disabilities is to be addressed in mental health law has become the focus of global reform. In October 2023, WHO-OHCHR published its guidance on mental health, human rights and legislation.[6] The guidance recognises that the full implementation of a human rights approach in mental health law may take some time to achieve. While significant change is underway, it is important to assess whether the reforms in each jurisdiction are moving toward the principles espoused by WHO and the United Nations. What is clear is that ongoing reform will be necessary to achieve the paradigm shift in law that is envisaged.

About Professor Penelope Weller

Penelope joined the Centre for Mental Health Practice, Policy and Law Research at the end of August and is at Edinburgh Napier as a Visiting Academic. She is a law professor from RMIT University in Melbourne and an international expert in the field of Human Rights Law, Health Law, Mental Health and Capacity Law and the Convention on the Rights of Persons with Disabilities (UNCRPD).

Whilst here, Penelope is conducting a review in collaboration with Professor Jill Stavert on reform of mental health law across the UK, funded by the British Academy.

References

[1] What are the next steps? – Scottish mental health law review: our response – gov.scot (www.gov.scot)

[2] Reforming the Mental Health Act white paper 2021 | Local Government Association

[3] Mental Capacity Act 2016 | Department of Health (health-ni.gov.uk)

[4] Bamford Review of Mental Health and Learning Disability | Department of Health (health-ni.gov.uk)

[5] gov.ie – Assisted Decision-Making (Capacity) Act 2015 (www.gov.ie)

[6] Mental health, human rights and legislation: guidance and practice. Geneva: World Health Organization and the United Nations (represented by the Office of the United Nations High Commissioner for Human Rights); 2023