Dr. Sarah Doyle, Professional Nurse Lead, Queen’s Nursing Institute Scotland.

Homelessness, poverty, trauma, pain, addiction, and loss: Reducing inequalities, sustaining hope, and the value of relational expertise.

This lecture reports the design, delivery, and evaluation of a novel ten-month programme of workshops for community nurses (from all fields of practice) and midwives working in primary care in areas of significant socioeconomic deprivation in Scotland. The programme made contemporary psychodynamic theory accessible to nurses and midwives working in non-psychoanalytical settings and incorporated current understanding of the relational impact of poverty, adversity, and multimorbidity. The clinical context of the participants’ work was striking and entailed providing care for the most vulnerable, in homes without basic amenities, in neglected and underfunded neighbourhoods, and in communities where frightening violence had shaped and continued to shape generations. For the participants, engaging with some of the most difficult challenges of our time, the impact of their work extended far beyond the end of the working day. A core assumption of the programme was that even in the bleakest of circumstances, relationally skilled healthcare encounters can contribute something good. The lecture will outline the programme content, including psychodynamic perspectives on homelessness, poverty, psychological trauma, physical pain, addiction, and loss. The workshops sought to deepen participants’ capacities to tune into another person’s state of mind, to feel something of what they feel, to consider the extremes of vulnerability and distress that might have gone before, and to respond in ways that might help. The programme supported participants to recognise that the work of containing the emotional disturbances of others requires time and space to think, and a level of self-awareness that helps us discern our own fears and feelings. Colleagues elsewhere in the UK facing similar challenges will be interested in the programme design and outcomes. Evaluation showed that even in the face of overwhelming need, participants reported improved understanding of therapeutic relationships, increased compassion satisfaction, reduced burnout, and reduced secondary traumatic stress.

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Dr Celeste Foster, Associate Professor /Reader Mental Health nursing, Salford Uni. 

It is only with the heart that one can see rightly: revealing the nature of children and young people’s mental health nursing.

Children and young people (CYP) are our social capital, the vanguards of cultural revolution and drivers of social justice and progress. This year, the lancet commission on adolescent health highlighted that mental ill-health is the single biggest threat to health, wellbeing and productivity of young people, and the adults they will become. Adolescence is the peak age of onset for severe mental health conditions that persist into adulthood. Globally, youth mental health has deteriorated over the last 15 years. Psychosocial development in the second decade of life sets the neurological, affective and occupational frame in which the rest one’s life and wellbeing is played out, making youth mental health care one of the best long-term buys in health care. Yet, despite vociferous political narratives to the contrary, youth mental health services are and have always been under-funded, neglected and subsumed within an adultist psychiatric paradigm, that is not fit-for our young people’s needs. Mental health nurses make up the largest workforce within CYP mental health services in the UK. They work, innovate and craft their nursing practice in the gaping hole where the evidence-base upon which to build effective, developmentally-informed and growth-promoting mental health service provision for children and young people should be. They struggle under the same weight of adultism and stigma-based neglect as the young people for whom they care. Their role, contribution and the specific relational technicality of CYP mental health nursing is repeatedly made invisible, or hidden from view -  absent from research, policy and service specifications, often only noticed when things go wrong. A case will be made for new approaches to research and practice enquiry to address this epistemic violence. I will draw on my own work and others, to show that when psychodynamic and psychosocial methods of inquiry, that accept the role of intimacy and love in both the emergence and reparation of mental distress, are used to shine a light on the work of CYP mental health nursing, it reveals itself as a highly complex relational process. Central to the process is implementation of the aspects of the primary carer-child relationship that are known to bring emotional and mental resilience to life. CYP mental health nurses occupy unresolvable tensions, symbolic of the uncomfortable psychic space young people and their families must navigate between childhood and adulthood. I will set out the specific personal qualities, values, and sensory-affective-cognitive processing skills used by CYP mental health nurses to manage highly disturbing adolescent emotionality and to create the interpersonal conditions required for recovery from mental distress, alongside the acquisition of the language, mentalisation and regulation capacities that all young people need to manage their own thoughts, feelings and behavioural impulses independently. The wider implications for mental health nursing education, support, interventions and trauma-informed paradigms of care across the life-course, will be laid out.

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Dr Dan Warrender, Lecturer in Mental Health, Abertay University Dundee.

Burning bridges and the potential of ashes: a regeneration for mental health nursing 

Mental health nursing is standing still, if not slipping backwards.  Our profession is marketed to prospective students as an art and science, rooted in human relationships, yet we continue to hear and see examples of poor care, with poor relationships, and more harm than there is help.  Compassion fatigue may arise through the perils of a demanding role where fallible humans reach their limit, however not all poor care can be explained away so easily.  Some mental health nurses dampen the enthusiasm of students and new graduates, with anti-intellectualism and the theory-practice gap still ever present.  Furthermore, there is a theory mismatch between university education and the jobs people will do.  Mental health nurse education is often marginalised, dependent on the permission of a new ‘nursing’ orthodoxy, where the Nursing and Midwifery Council’s church of holism asks for everything, without articulating the specific ethical and relational challenges unique to mental health nursing.  Inside university education, administrators often count the numbers without a worry for quality, with recruitment a financial exercise rather than a robust selection process.  It is not all doom and gloom, yet what is clear is that people who are good mental health nurses, are often so in spite of the systems around them, not because of them.  Imagine how much better it could be. 

Before priding in our role building relationships to help others, we must consolidate our relationship with ourselves, and in doing so, perhaps escape our closest authorities. Two bridges may need to be burned, those which connect us to psychiatry, and perhaps more controversially, to ‘nursing’.  This lecture will be a ceremonial bonfire, acknowledging the failings of mental health nursing, without losing hope, as we recognise potential and celebrate the possibilities of a regeneration, and greater autonomy for the profession, whatever its future holds. 

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JPMHN Lifetime Award Biographies

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Professor Karina Lovell - Professor of Mental health and Senior Investigator (Emeritus) at the University of Manchester. 

Karina Lovell is a mental health nurse, CBT therapist, Professor of Mental health and Senior Investigator (Emeritus) at the University of Manchester. She is passionate about improving mental heath service for both service users and their families. Karina has been conferred several awards for patient and public involvement and engagement. For example, Karina led the EQUIP project (Enhancing the Quality of User Involved Care Planning in Mental Health Services), a major research initiative aimed at improving the involvement of service users and carers in mental health care planning. The EQUIP initiative was part of a broader effort to enhance shared decision-making and user involvement in mental health services, which remains a critical area of research and practice​. One of her key research areas has focussed on developing delivering and evaluating low intensity interventions for anxiety and depression across the age span. She then developed these interventions with long term conditions including Diabetes, Cardiovascular disease, Chronic Widespread Pain, IBS. More recently Karina has been working in Low to Middle Income countries (namely Sub-Saharan Africa, Indonesia, Pakistan, India and Bangladesh International (Indonesia, Pakistan, India, Bangladesh and Sub- Saharan Africa) where she has increased research capacity, helped to develop PPIE and culturally adapted psychological interventions and delivered and evaluated these for depression and anxiety. Karina has also been involved in developing policy for the NHS in England (NICE guidelines and a range of other committees).

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Professor John Keady - Professor of Mental Health Nursing and Older People, a joint position between The University of Manchester (Division of Nursing, Midwifery and Social Work) and Greater Manchester Mental Health NHS Foundation Trust. Professor John Keady started his asylum-based mental health nurse training at Warley Hospital in Brentwood, Essex in February 1983. From the time of qualifying in 1986, he has worked continuously in dementia care in a range of clinical/joint clinical-academic posts. In 1993, whilst a community psychiatric nurse (CPN) in dementia care, he started a part-time PhD at Bangor University, a study that included some of the first interviews ever conducted in the UK with people with dementia about their lived experience. His PhD was awarded in 1999. On moving to The University of Manchester in 2006, John set-up and directed the inter-disciplinary ‘Dementia and Ageing Research Team’ where he led a number of significant research awards. For example, his most recent book [Keady, J. (Ed). ‘Reconsidering Neighbourhoods and Living with Dementia: spaces, places and people’. Open University Press. 2024: ISBN: 13-9780335251728] is the story of the £4.2million, 5-year [2014-2019] ESRC/NIHR funded ‘Neighbourhoods and dementia study’ where John acted as the Chief Investigator to an international programme of work that developed new insights and ways of measuring meaningful outcomes for people with dementia, informed by people with dementia. Since 1991, John has been involved in over 150 peer-reviewed articles and has been the Editor/Co-Editor/Author of 15 books related to dementia care, including two Open University Press Co-Edited texts on CPN practice in dementia care [2003 & 2007]. John was also the Founding and Co-Editor [2002-2018] of the on-going Sage journal ‘Dementia: the international journal of social research and practice’ which, from a standing start, had over 240,000 downloads of articles in 2018 alone. Currently, John is working with Professor James Thompson [theatre and performance studies] at The University of Manchester on an AHRC funded study [2022-2025] on ‘care aesthetics’, bringing a new person-centred language to specialist NHS dementia assessment ward practice.

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Professor Sally Hardy - Professor of Mental Health and Practice Innovation, Director of the Norfolk Initiative for Coastal and Rural health Equalities (NICHE) at University of East Anglia. Sally started her career as a general nurse at Guy’s Hospital where her four week placement at the York Clinic sparked a life long interest in mental health practice. Sally went on to train as a post registered mental health nurse at the Maudsley, and worked there for the next 10 years, establishing a new unit for ‘Sick Health Professionals’. Navigating the boundaries of madness is not for the faint hearted, as all Sally’s work has stretched the limits of her mental health training and practice, in understanding people, their contexts and cultures, as a practitioner, researcher, academic, leader and human ‘becoming’. She has spent time transforming workplace cultures, in UK and in Australia, and has the privilege of working in the Caribbean and Sri Lanka, to innovate mental and maternal wellbeing initiatives with rural, coastal and isolated communities. She has contributed to many textbooks, and publications advocate for shared knowledge  towards sustainable improvements. Her work draws on creativity, (with an ongoing interest in asylum art) blending mind, body and spirit in the pursuit of contemporary concepts of madness in it’s many different contexts. Currently she leads on the Anchor Institute initiative across six HEIs in East of England, working in collaboration as the Eastern Partnership for Innovation in Integrated Care (EPIIC). She has been a Non Executive Director in one of the largest mental health trusts, and is a lifelong advocate of underdogs and scapegoats (i.e. supports Tottenham Hotspur). She finds Yoga helps in the aging process, and in the pursuit of contentment.​​​

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