Martin Webber's blog

Musings of a social work academic

Applying research in social work practice

November is shaping up to be a good month for applying research in social work practice, a key theme of this blog.

Firstly, the Social Care Elf was launched last week. Joining other elves in the woodland of the National Elf Service, the Social Care Elf sets out on a mission to share social care research, policy and guidance in accessible blogs.

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The Social Care Elf publishes two blogs each week focusing on different aspects of social care. Written by expert reviewers, each blog critically appraises research, policy or guidance of relevance to social workers or social care workers. It helps you to keep up to date with latest developments, a key requirement of professional social work practice. As it carefully selects which research papers to appraise, it will only blog about research which is relevant to practice and will highlight any potential flaws with it. This process helps you to decide what is worth considering, saving you time and hassle.

The Social Care Elf cannot possibly blog about every piece of research which is published, so it is important to use it alongside other sources of social care research to hear about all the latest developments. For example, mental health social workers may be interested in the Mental Elf, who blogs about mental health research. This elf has been busy for the past three years bringing us critical appraisals of mental health research and has recently reached its 1,000th blog.

Secondly, Applying Research Evidence in Social Work Practice is about to be published by Palgrave Macmillan. This book has been written for social work students and practitioners to assist the process of using research in practice. It features contributions from leading social work researchers and analysts and is formed of two parts. The first part takes readers through the steps of locating, appraising and applying research in practice, with a particular focus on decision-making and assessments. The second part of the book explores how research can inform practice in eight practice domains – safeguarding children, looked after children, young people with additional needs, people who experience drug or alcohol problems, people with mental health problems, people with disabilities, offenders and older people.

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It has been a great pleasure to edit this book and I wish to thank all the authors for their fantastic contributions. I’ll blog about it again when it is published, which should be very soon. However, it’s available for pre-ordering on the publisher’s website.

Tour of Yorkshire Day 2

The Vale of York was shrouded in mist as we lined up for the start of day 2 of the Tour of Yorkshire. But it was not raining and there was only a 50% chance of a shower later in the day. I was holding out for the 50% chance of it being dry.

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After a detour for a photo opportunity outside the Minster, we headed north out of York for the North York Moors. As we hit the lanes, the pace picked up considerably until the group was stretched out in single file hanging on to the wheel in front. Whereas the peloton cruising speed was about 20 mph yesterday, it was 25 mph today. Such a high pace for the first 20 miles or so provoked considerable anxiety that the hills would see me dropping out the back, but thankfully the pace eased off when we approached them.

The big climb up to the North York Moors was up Boltby Bank. Instead of snaking around the side of the hill like climbs in the Alps or Pyrenees might do, this one went straight up the side. With gradients of 25% in places, this was the real brute of the Tour and took its toll on the group. Even some of the strongest seasoned riders got off to push. But it was so steep walking was difficult, particularly in cycling shoes. My usual style of weaving across the road to lessen the gradient was hampered by other riders and pedestrians so it was not a pleasant experience. However, I made it to the top without pulling a muscle or falling off! (This YouTube video shows that it can be done without stopping, but it’s not for the faint-hearted!)

By lunchtime, the clouds were breaking up and some hazy sunshine emerged. The humidity remained high and thunderstorms circled us, but we remained dry during the afternoon. The only obstacle on the way back to York was the Howardian Hills. The wide rolling roads near Castle Howard led to some fast descents where 40 mph was reached at one point.

The run-in to the finish was even faster than this morning’s brisk start, with speeds approaching 30 mph on the flat final few miles. This helped to push our average speed for the day up to 18mph which, for a ride of 90 miles, was rather fast for me. At the finish, though, we were greeted by a glass of champagne to celebrate our achievement. We had made it!

20140720_154047[1]Thank you to everyone who has sponsored me. I’m still raising money for the NSPCC and you can still make a donation on my Virgin Money page.

Thank you!

 

Tour of Yorkshire Day 1

The NSPCC Tour of Yorkshire is based at York Sport Village, a new multi-sport complex next to the Heslington East campus of the University of York. Building upon the growth in interest in cycling it has a 1km cycle circuit and an outdoor velodrome. I must admit, though, the indoor pool looked particularly tempting given the weather forecast for today…

The sunglasses were rather optimistic and didn't stay on for long!

The sunglasses were rather optimistic and didn’t stay on for long!

 

The Tour started with a ceremonial lap of the circuit before heading out onto the roads. There were no Red Arrows or royalty cutting ribbons (thank goodness), only a camera drone filming us. But this Tour did provide a taste of professional cycling for amateurs. We had motorcycle outriders, cameramen, domestiques, a soigneur and mechanic in a following car, and an ambulance. All eventualities were catered for. Except for the weather.

Rider briefing

As our group set off at 8.30am a few spots of rain started to fall. For the first couple of hours it was just a few drops of humidity too heavy to stay up in the air. But then the heavens opened and thundery rain set in for the rest of the day. Cycling in the rain is not my idea of fun. Not only do you get the torrent from above you get the dirty spray from the bike in front of you in your face. Fortunately it was not cold, though a chill set in as soon as we stopped.

Putting the weather aside, it was a good day’s ride. The Tour is very well organised and the seeding appeared to work well. We had to submit times of previous rides when we entered for the organisers to put us in matched ability groups. I was in group 3 of 4, which planned to maintain a pace of 16-17 mph. And it did – our overall speed was just over 16 mph.

The group leader did an excellent job at keeping the pace steady and the peloton of about 30 of us riding together as a group. We waited and re-grouped at the top of climbs so no-one was left behind. The group riding was also of a high quality, with no-one making any sudden movements and everyone calling out obstacles and potholes in the road. Most were experienced club riders and knew how to behave in a peloton. Even the shaven legged race-ready crew behaved and didn’t jump off the front of the group (too much!).

A well-earned break for the bike

A well-earned break for the bike

 

The Tour experience of riding in a small peloton was just great. When rolling along at over 20 mph on the flat you get carried along by the riders in front and around you. As there were no rapid accelerations as you get in races, this pace was very easy to maintain. It certainly gave my legs a break in between the climbs.

The course today was rolling, up and down through the Wolds. We climbed a total of 5,800 feet over several short climbs. Some were worse than others. The King/Queen of the Mountains climb, which was timed by little chips stuck to our helmets, was Hanging Grimston.

Hanging Grimston has a reputation as being the toughest climb in East Yorkshire, with a gradient up to 20% and a height gain of 153m. What made it worse for us, though, was that it came over 70 miles into the ride. Once through the six inches of muddy water which had gathered at its foot, the climb rose steeply through farmland. The road surface deteriorated to potholes and gravel which made it difficult for my wheels to get any purchase. But towards the top a group of NSPCC cheerleaders helped us up the final few metres. Pleased to get to the top, it was more-or-less downhill back to York.

I never was any good at this selfie malarky!

I never was any good at this selfie malarky!

 

91 more miles tomorrow. More rain is forecast, though it doesn’t look like the deluge we had today. It’s also a flatter route, though the big climb onto the North York Moors is a real brute. But it’s worth it. So far I’ve raised £375 (£430 including gift aid) for the NSPCC. I’ll be keeping the fundraising page open for a while longer so there’s plenty of time to make a donation. Thank you to everyone who have sent supportive messages and made a donation to the NSPCC.

Live tracking continues tomorrow: watch out for the tweet when I set off tomorrow at 8.30 am and a post on my facebook page with a link to my ride through North Yorkshire.

 

On the eve of the Tour of Yorkshire

My nemesis has finally arrived. The Tour of Yorkshire. 182 miles over two days with thundery rain likely to fall at some stage over the weekend. What on earth have I let myself in for?

I’m riding to raise money for the NSPCC (you can donate here if you like!) and to prove to myself I can do it. I needed a challenge this summer to motivate me to step up the miles on the bike, and this has certainly worked.

The first big step towards this Tour was riding the route of stage 1 of Le Tour de France from Leeds to Harrogate via the Dales on 21st June. I rode the 130 miles to support my colleague Andrew Hill (now on a 3-month cycling trip around the Alps – read more about this here) who had set himself the challenge to get around the route and back to Ripon that night to sing a concert with the Ripon Choral Society. Our groupette of 4 made it in plenty of time, thankfully, and enjoyed the fantastic welcome in towns and villages around the route. The bunting, yellow bikes and Tour decorations spurred us on our way, just as it did the pros a couple of weeks later.

tour de france ride

(I’m the one waving and trying not to fall off!)

 

The second step was riding the Ripon Revolution the following week as a birthday present to myself! This 105 mile sportive was an absolute killer. It packed in two steep climbs early on which my smallest gear ratio of 39×24 (more appropriate for gentle hills than 1 in 5 brutes) couldn’t manage. I really struggled up the two steepest climbs, having to stop on the second to allow the lactic acid in my legs to dissipate a little. The latter part of the course was flat or rolling so as long as I could turn the pedals I was OK. I completed it in a time of 7 hours, but was just pleased to finish it.  My legs were aching so much afterwards, though, that I could hardly walk.

King of the Mountains? Definitely not that day...

King of the Mountains? Definitely not that day…

 

My riding since then has been affected by sore muscles. I’ve had to take it easy and stagger my training more than I would have liked. I did make it up Boltby Bank a couple of weeks ago, though. This nasty climb up onto the North York Moors has 1 in 4 sections which even my new gear ratio of 39×30 struggled with. We’re facing this climb on Sunday in one of the two King/Queen of the Mountains climbs. I just hope that I don’t have to stop half way up again as it’s a real struggle to get going again it’s that steep.

Anyway, I best be getting off to sleep as it’s an early start tomorrow. We’re riding in seeded groups and I’m due to set off at 8.30 am. I’m going to be using the live feed feature on my Garmin for the first time so that anyone interested can follow my progress around the route. It’s linked to my twitter feed and facebook page – just click on the most recent link which gets posted there and it should take you to a Garmin Connect page showing my progress around the route. If it doesn’t work, then I’ve either lost a phone signal or the rain has got into my phone!

If you’re missing the social work blogs, they’ll return after this fundraising weekend!

The birth of the Social Care Elf

I really like the Mental Elf. If you haven’t come across this friendly woodland creature, the Mental Elf selects high quality mental health research of relevance to practitioners, appraises it and writes about it in an accessible way. The blog posts are really engaging and help to reduce the gap between the mental health science and practice. Also available as a mobile app, the Mental Elf is handy whenever you have a few minutes spare to update yourself on the latest research findings.

Elf-line-up

Some time ago I suggested to André Tomlin, Chief Blogger for the Mental Elf, that the National Elf Service could do with a Social Care Elf to help make social care and social work research more accessible for practitioners. After discussions involving the NIHR School for Social Care Research, Personal Social Services Research Unit at the London School of Economics and Political Science (LSE) and the Social Services Research Group, I’m really pleased to join André in announcing the creation of the Social Care Elf. In a joint post on the LSE Social Care Evidence in Practice blog, we announce the imminent arrival of the new elf in the woodland.

The Social Care Elf will be lots of fun and if you can be in London on 25th July, there is an opportunity for you to join in too. Between 10.30am and 1.00pm on 25th July you can pop along to the LSE and help design the Social Care Elf. Each elf in the National Elf Service has its own unique identity and we want to create one for the Social Care Elf with your help. Please email sscr@lse.ac.uk to register your interest in this.

You can find out more about the Social Care Elf on the Social Care Evidence in Practice blog.

Sharing lived experience: how personal is ‘personal’?

Practitioners sometimes share things about themselves with the people they work with; sometimes personal things, sometimes non-personal, everyday things. But which ones are which? How personal is ‘personal’?

The International Centre for Mental Health Social Research and Leeds and York Partnership NHS Foundation Trust are undertaking research on sharing lived experience by mental health practitioners with service users. As part of that, we’d like to know how ‘personal’ different types of information are considered to be. So we are asking volunteers to complete a short questionnaire.

Several other studies have graded disclosures according to how personal the information being shared is. However, some research suggests views change over time, so it may be the case that people nowadays are more open about themselves, and see information about themselves as less personal than they would have done in the past. Since there are no studies that have rated disclosures according to how personal they are in the UK, in recent years, with the professionals that the current study is engaging with, it is necessary to construct a new scale.

If you want to take part, you’ll be asked to rate different things that a practitioner might share with a service user, according to how personal you think they are. If you are involved in social work or social care, whether in mental health services or otherwise, please consider taking part in this survey.

The survey takes approximately five minutes to complete and you could win a £20 Amazon gift voucher.

You can take part on-line by clicking here.

Further information about the study is available from the Chief Investigator, Jonny Lovell, by email: jl1155@york.ac.uk. Also, you can keep up to date with the study by visting Jonny’s blog.

Thank you!

Public launch of International Centre for Mental Health Social Research

We are approaching the end of our first year in the International Centre for Mental Health Social Research (ICMHSR) at the University of York and I would like to share a few aspects of our work and invite readers of this blog to join me on Tuesday 24th June for our public launch.

ICMHSR was provided with start-up funding by the University of York a year ago to bring together collaborators from Australia, India, Europe and the US. The collaboration explores the role of social problems in the cause and course of mental health problems and aims to develop and evaluate innovative ways of tackling them. This includes validating research tools for use in different cultures, supporting local practice-based research, and evaluating approaches such as working with social networks and communities. ICMHSR researchers aim to share knowledge across boundaries with the potential for global impact.

Over the last year, we have:

  • brought together 34 researchers and 9 PhD students from several departments at the University of York who have research interests in this field. More can be found about our internal collaborators here.
  • brought together international collaborators to create the International Inclusion and Connected Communities Collaborative (I2C3). Our activities have included joint conference presentations, drafting of a position paper and grant applications. More about ICMHSR’s international collaborators can be found here.
  • funded a PhD studentship on practitioner disclosure of mental health problems from which we are developing a parallel study in Australia to facilitate international comparison. More information about this study can be found here, including an opportunity to take part in the study.
  • obtained funding from C2D2 and the Maudsley Charity to undertake feasibility and scoping work in Sierra Leone for social intervention training in the country’s nascent mental health services. A recent update on this study can be found here.
  • collaborated with Mindapples and other partners to obtain funding from Guys and St Thomas’ Charity and Comic Relief to evaluate pilots of the Mindapples mental effectiveness training. Our Mindapples tree is still up in the reception of the Department of Social Policy and Social Work if you are in York and would like to share your Mindapples.
  • collaborated with colleagues in the Department of Health Sciences on a C2D2-funded project to develop a measure of psychosocial health for people displaced by humanitarian crisis.
  • obtained additional funding from the NIHR School for Social Care Research to produce training materials for the Connecting People Intervention, which have been viewed and used in many countries. These can be found here.
  • hosted regular seminars and events at the University of York and in collaboration with Making Research Count. Information about our news and events can be found here.

Our priority over the next few years is to continue to submit funding applications for multi- and cross-national research which contributes to the evidence base for practice in the UK and across the world. Updates about our work can be found on the ICMHSR blog, which you can subscribe to if you are interested in finding out more.

Public launch

Lynette Joubert

On Tuesday 24th June at 6.15pm we are holding our first public lecture which will be given by one of our international collaborators Associate Professor Lynette Joubert from the University of Melbourne, Australia – ‘Improving mental health through understanding our social context’. Dr Joubert will discuss recent research that defines and analyses the importance of managing both risk and opportunity in social networks to promote emotional well-being. She will report on a social network intervention (CHIERS) which reduced representations for deliberate self harm at emergency by 58%, suicide ideation by 37% and depression by 25%. This public lecture is free, though you will need to obtain a free ticket online to reserve your place. Please click here for additional information and to book your place.

We will be holding an informal wine reception after the lecture to mark the public launch of ICMHSR. If you are interested in our work and able to come along, it will be great to see you there!

Social work practice and research: Is there a gap to mind?

This blog was initially established to help bridge a perceived gap between the worlds of social work academia and practice. I have used it to reflect on aspects of my work (with the odd post about other things I find interesting, such as cycling, thrown in for good measure!) which demystifies what a social work academic does. I have also used it to explore our proximity to practice and the relevance of our work for practitioners. There is so much more I can say on this – including how I have recently challenged myself to put my own research into practice – but more on that later. However, for a few days this week I’m at the 3rd International Conference on Practice Research which  provides a good opportunity to reflect on where we are up to in bringing social work research and practice closer together.

This conference uses the metaphor of a bridge to represent a two-way connection between research and practice. This is counter-posed with the metaphor of a pipeline, which suggests that research is produced in the ivory towers of a university and ‘piped’ out to practitioners working in ‘the field’ who are meant to uncritically implement it. While the latter does happen, my experience of social work research is one of dialogue, collaboration and co-production with practitioners and service users.

In my talk to the conference on Wednesday I will be using the metaphor of a bridge to explore the shared concerns of social work practitioners and researchers who, let us not forget, are often the same people. I will be reflecting on research which practitioners have conducted whose findings contain important messages for both policy makers and practitioners. I will also explore some of my work which has used a variety of methods to answer different questions but has a coherent aim of articulating and evidencing social work practice to assist the development of the profession. I will celebrate the shared space on the bridge rather than the gap which it crosses.

At this conference there are some presentations about practice-research partnerships between universities and practice agencies which I am interested to find out more about. There is much we can learn from these in the UK. One such partnership is described in a paper I wrote with colleagues which was recently published online by the European Journal of Social Work. In this paper, Aino Kääriäinen, Mirja Satka and Laura Yliruka discuss the Finnish model whereby social work education, practice and research are combined.

They discuss how in Helsinki the university and city authorities both identified the need to bring together social work education, research and practice to enhance the social work profession and reinvigorate practice. They created the Heikki Waris Institute which:

provided a new mediating structure between research, teaching and social work practices … and new knowledge and innovative interventions in urban social issues and skillful practitioners who were able to develop the service provided by the City of Helsinki (p. 9)

The co-location of researchers, educators and practitioners removes physical boundaries to working together, but also changes the nature of both practice and research as collaboration is fundamental to everything they do. This is a model I’d be very interested to see working in the UK.

We put this paper together over a year ago at the 3rd European Conference on Social Work Research in response to the Frontline proposals. We explored the perceived disconnect between the academy and practice experienced by social work students who sometimes find it difficult to integrate their academic and practice learning. We also explored the experiences in nursing and probation, whose professional training has moved in opposite directions in the UK in recent years (nursing has become more professionalised with the requirement to study to degree level whereas probation is being de-professionalised and increasingly privatised). There is no robust evidence that either change has had the desired effect (or undesired effects, for that matter, either).

Our paper was published in early May at the same time as the Think Ahead report proposed to extend the Frontline practice-based model of social work education to mental health social work. We don’t yet know the impact of these training schemes on social work practice or the outcomes for people who use social work services. There is also limited evidence from social work or allied professions about practice-based routes to professional qualification. However, there is a need to find innovative ways to enhance existing partnerships between social work university departments and social work agencies. I particularly like models which co-locate researchers, educators and practitioners so that boundaries are no longer an issue. Practice-research partnerships are one way forward but, as always, we need to evaluate them to identify if they too have an impact on both practice and outcomes.

Webber, M., Hardy, M., Cauvain, S., Kääräinen, A., Satka, M., Yliruka, L. & Shaw, I. (2014) W(h)ither the academy? An exploration of the role of university social work in shaping the future of social work in Europe, European Journal of Social Work,DOI:10.1080/13691457.2014.912202

If you would like a PDF copy of this paper but don’t have access to one, please contact me and I’ll email one to you.

If you are interested in finding out more about the 3rd International Conference on Practice Research its twitter feed @ICPR_2014 has pictures and a flavour of the discussions.

A summer of cycling

With the Tour de France starting in Yorkshire in July, this will certainly be a summer of cycling.

If you know me outside of work, you will be aware that I’m a keen cyclist. Before my family commitments grew I was a member of the Kingston Wheelers cycling club when it only had about 30 members (it now has several hundred). I rode with the club every Sunday morning and took part in the occasional time trial or road race. I still wear their kit, although it is getting rather threadbare now.

 

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Back in my racing days…

 

In recent years the only cycling I have managed is my commute to work. This all changed recently when my colleague Andrew Hill invited me to ride the first stage of the Tour de France with him.

The first stage of the Grand Départ of Le Tour takes riders through fantastic Yorkshire countryside on a 128 mile ride through the Dales from Leeds to Harrogate on 5th July. Seeing a British rider in yellow (the previous winner of Le Tour – Chris Froome – wears the yellow jersey on stage 1) riding the largest cycle race on earth at the end of our road in Ripon will be a truly memorable occasion.

As part of the cultural festival being held in Ripon in the run-up to the Grand Départ, the Ripon Choral Society are giving a concert on Saturday 21st June. As chairman of the Choral Society, Andrew thought it would be fun to ride the first stage of Le Tour on the day of the concert and arrive back in Ripon in time to sing at 7.30pm that evening. This will require a 6am start in Leeds and an anticipated 12 hours of riding to finish in Harrogate with enough time to return to Ripon and prepare for the concert.

I agreed to join the small peloton of riders he’s gathering to support him on the ride. We’ve got a couple of good rouleurs who will help on the flatter sections and I’m aiming to help set the pace on the climbs. It will certainly be a gruelling ride. I’ve never ridden more than 120 miles in a day and the last time I did that was many years ago. So if you’re on the route on 21st June, please give us a shout of encouragement!

I’m using this ride as training for the NPSCC Tour of Yorkshire charity bike ride on 19-20th July. This is a fully-supported ride through North Yorkshire which covers 180 miles over the two days. If I’ve still got anything left in my legs, there’s a 30-minute race on the York Cycle Circuit next to the University of York afterwards!

As well as hopefully having a bit of fun, I’m hoping to raise some money for NSPCC along the way. If you’re able to spare a few pounds, please consider making a donation at virginmoneygiving.com/MartinWebber1.

Thank you!

Sierra Leone: first impressions

I’m in Sierra Leone this week with ICMHSR researcher, Meredith Newlin, to co-design training in psycho-social interventions for psychiatric nurses. This visit builds upon one which Meredith made last year to explore the feasibility of the project. That visit was funded by the Centre for Diseases and Disorders at the University of York and the findings were developed into a short film, which can be viewed here.

Our work here is being conducted in collaboration with the King’s Sierra Leone Partnership (KSLP), Enabling Access to Mental Health and the Mental Health Coalition in Sierra Leone. This phase of the study (the development and delivery of the training) is funded by the Maudsley Charity.

The civil war in Sierra Leone over ten years ago severely damaged health services. Resources are scarce and services are minimal. As far as we can ascertain, there are no trained mental health social workers. Therefore, the focus of our work is with the first cohort of mental health nurses to be trained in the country to evaluate the extent to which additional training in brief psycho-social interventions can enhance their work.  If successful, we will support the integration of this training into their core curriculum. Additionally, a future goal is to work with social work education providers here, and the relevant Ministries (in collaboration with KSLP), to investigate the possibility of providing mental health training to social workers to help develop multi-disciplinary community mental health services.

Our week started with a visit to the Sierra Leone Psychiatric Hospital in Kissy, Freetown, the only psychiatric hospital in Sierra Leone. We spoke to the mental health nurses there to find out more about their work.

Mental health nurses at the Sierra Leone Psychiatric Hospital in Kissy, Freetown

Mental health nurses at the Sierra Leone Psychiatric Hospital in Kissy, Freetown

The lack of resources for mental health care is evident in the hospital. The above picture was taken in Ward 2 which, as you can see, is bare. The patients are in an adjacent room lying on foam mattresses on the floor. About twelve are sharing a room, which is bare except for the mattresses they are resting on. There appears little for them to do on the ward, although there is an occupational therapy department which some attend during the week. However, despite the lack of resources, they are provided with shelter, protection and care from enthusiastic nurses.

The hospital has access to some medication, though mostly older ‘typical’ antipsychotics which produce greater side effects than more modern drugs. Physical restraint is used when necessary, though older seclusion facilities (see below) are being phased out. However, we visited a ward where all the patients were chained to their beds. I was aware of this practice and had expected to see it, but it was still distressing to see. One was held by a neck brace, others were chained by their legs. This practice is being phased out by the hospital but is still used as there are no other effective and available alternatives to managing people who present with violent and aggressive behaviour.

Old seclusion facilities at the Sierra Leone Psychiatric Hospital in Freetown.

Old seclusion facilities at the Sierra Leone Psychiatric Hospital in Kissy, Freetown.

Hospital patients are frequently abandoned here by their families, such is the stigma of mental health problems. Sometimes, families cannot be contacted when it comes to discharge someone, so they are discharged into the neighbourhood of the hospital where they don’t have any home, family or contacts. Many come back, either as out-patients or as in-patients following a relapse. But the hospital is where they are brought (sometimes at great expense to families) from all across Sierra Leone once all other possibilities, including a traditional healer or a health worker, have been tried.

We can see the possibility of brief psycho-social interventions helping. In the absence of mental health social workers working with people in the community, there is some potential for nurses to use the time productively they have with people who return for depot injections or other medication as out-patients. There is some potential for them to enquire about the social environment in which they are living and undertake some brief interventions. If they are accompanied by family members, some work could be conducted with them to help challenge the stigma of mental illness and identify how others can be involved in that individuals’ care. Work within communities is unlikely to be possible for these nurses working in the hospital, but we hope to explore this with other nurses working in more rural areas of Sierra Leone later this week.

This is my first visit to Africa and to come to one of its poorest countries (Sierra Leone was the 8th poorest in the world by one set of indicators) is a challenging experience. The poverty and the challenges the country are facing are stark. There are many NGOs working here, and the economy is growing, so things are moving in the right direction. But the scale of the challenges makes our work appear miniscule. However, if it can make just a little difference it will be worthwhile.