Author:  Dr. Lucy Perry-Young

Jean stopped in the hallway and suddenly said ‘Do you like books?’ I said yes, I enjoy reading, do you? She walked towards the door to the room I had not yet been in and opened it quickly and widely to dramatically reveal a huge book case the length of the wall. I really wanted to carry on and help her get ready – I kept thinking about how late I was and whether I might get into trouble. But Jean clearly meant for me to be impressed with this so I went in and said what a lot of books she had. She said ‘take any you want’. I said thank you very much but I have a huge pile at home waiting for me to read. She then went through telling me stories about different books and who bought them, which ones belonged to Peter, which needed to be cleared out, which section was cookery, gardening etc. As she was going along one row of books she stopped at one and read from the spine ‘101 ways to improve your memory’. She looked at me and I could sense a joke coming on. She said ‘Now, we could all do with that, couldn’t we?!’ I was pleased that she had said ‘we’ and ‘all’ rather than making the joke about herself and her own memory. Although I wanted to go along with the conversation and show an interest in what Jean was saying, I was also wondering how I could steer the conversation back to what we were doing. I get the impression that she forgets what the purpose of her walking is and so talks about whatever she is seeing on the way. I wanted to move towards the bedroom but Jean was standing in the doorway blocking my exit and so I had to jump on the next gap in the story and suggest going to the bedroom to choose clothes.

(Extract from carer field notes – anonymised)

I’ve been working as a home carer for people with dementia for the past 6 months now. I am part of a research team working on the BOUGH study, which aims to Broaden Our Understanding of Good Home care. As part of this, two researchers (Dr Samantha Wilkinson and myself) are working with a homecare provider as caregivers. We work exactly as the other care workers do, except that, with permission from clients, family members, and other carers, we write up our experiences of each visit in the form of field notes.

Before I started, I had worked as a nurse and so I was not new to caring. I was already familiar with some of the aspects of care work that new carers may find daunting, such as providing personal care and administering medication. Still, I was apprehensive about working in the private sector, mainly because of its poor reputation. I was also worried about visiting people in their own homes who may not remember who I am from week to week. I was aware of the broadly held negative perceptions of care workers and care work and I know that at least some of this perception is not without foundation. I recently watched the Channel 4 Dispatches programme about home care which showed a pretty harrowing picture of visits cut short, medication errors, missed or late meals, and falsified records. The programme also highlighted the lack of training and support and the low pay offered to caregivers; once travel time was factored, the undercover reporter earned just £3.89 per hour. I am pleased I did not see this before starting this role; it must be off-putting to say the least for anyone considering working in this area. The programme also made me think of the perceptions some of my own clients and their families have of care work and of the care that I provide.

So what does good home care look like? What are the stresses and rewards of providing care in the homes of people with dementia? And what key factors influence the quality of care? These are some of the questions we are trying to answer in the BOUGH study. Although we are only part way through the study, we are starting to build a picture of what good quality home care might involve.

Fortunately, my own experiences of working for a home care organisation, and delivering home care to people with dementia, have not reflected the experiences of the Dispatches reporter. I have found the other caregivers to be very caring and highly skilled. I have found the skills and knowledge required of caregivers to be far more varied than I imagined. In just the last 6 months I have; contacted emergency services when a client had fallen and been on the floor all night, found a home in pitch darkness and had to fumble around finding the fuse box, pulled up weeds from the garden, and fixed broken mops and vacuum cleaners. I also regularly prepare meals, listen to and share my own stories, help clients to wash and dress, and manage relationships with clients, relatives and managers.

In addition to our insights of working as home carers, we have also trained some caregivers to keep diaries about their working lives and we will be conducting interviews with carers, commissioners, clients and relatives. If you would like to receive updates about the BOUGH study as it progresses, please sign up to our bi-monthly newsletter by emailing me: lucy.perry-young@nottingham.ac.uk

Dr Lucy Perry-Young, May 2016.

Lucy is working on the BOUGH project as a Research Fellow within the School of Sociology and Social Policy. BOUGH is an NIHR School for Social Care Research-funded study designed to understand the scope and nature of good quality home care for people with dementia, so that it can be more widely implemented. Prior to this Lucy gained her PhD at the University of Exeter Medical School, looking at help seeking for dementia. Specifically addressing how people with dementia and their family and social networks came to recognise the early signs of dementia and how they negotiated acting on them and seeking professional help. Lucy has a background in nursing and gained a strong interest in dementia care throughout her undergraduate studies, and in her subsequent work as a staff nurse in a dementia care home.

Images courtesy of the author.

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The Centre for Dementia, Institute of Mental Health, and the Centre for Applied Social Research, School of Sociology and Social Policy at the University of Nottingham are proud to present:

DEMENTIA: UNIVERSITY CHALLENGE

The speakers will be introduced by Professor Tom Dening, Director of the Centre for Dementia. At the beginning of the seminar Pippa Foster, Alzheimer’s Society, will formally recognise the University of Nottingham as a dementia-friendly community.

Speakers Include:

Jill Manthorpe, Dementia: A Voyage of Discovery

Jill Manthorpe is Professor of Social Work at King’s College London and a Fellow of the Academy of Social Sciences. She is a Trustee of the Centre for Policy on Ageing and Patron of the Greater London Forum of Older People.

As Director of the Social Care Workforce Research Unit at KCL, Jill has particular expertise on issues relating to the employment, satisfaction and training of the people who deliver dementia care in the community and in residential or nursing homes.

Mary Marshall, Dementia-friendly Design

Mary Marshall is a senior consultant with HammondCare, Honorary Professor at the University of Edinburgh and Professor Emeritus at Stirling University. She writes and lectures on dementia care, mainly on design. Her current preoccupation is the impact of design on distressed behaviour.

“Her major contribution has been to champion the right of older people with dementia to be regarded as having partially remediable disabilities … she has taught that it is crucial to develop a style of social work with patients and their families which emphasises respect for the individual’s past and current skills and aptitudes.”

Baroness Elaine Murphy

Date and Time: Thursday 19 May, 5.00pm (refreshments) for 5.30pm start (to finish at 7.00 pm)

Location: B63, Law and Social Sciences Building, University Park

The event is free and open to all, book your place at: www.dementiauniversity.eventbrite.co.uk.

The University of Nottingham is committed to being a Dementia Friendly University.  There are many ways to get involved, including research and befriending initiatives.

Find out more about how you can be involved here.

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Author: Associate Professor Hugh Middleton

The BBC’s recent series on mental health, ‘In the Mind‘ drew mixed reactions. In particular Stephen Fry’s exploration of manic depression was both praised on account of his attempts to destigmatize mental illness, and criticised because it presented a very narrow biomedical understanding of mental illness. Richard Bentall, a respected leader in the field responded in the form of an open letter to Stephen Fry. They were at school together. Amongst other places it was published on the Mad in America website. It challenges some of Fry’s assumptions about mental illness and can be found here.

Earlier this year an independent Mental Health Taskforce assembled by NHS England published a potentially influential report; The Five Year Forward View for Mental Health. It begins with a rounded criticism of NHS mental health services: “The NHS needs a far more proactive and preventative approach to reduce the long term impact for people experiencing mental health problems and for their families, and to reduce costs for the NHS and emergency services”. It goes on to develop this criticism and make a series of recommendations. It is clear from the report that the taskforce is advocating a much less medical and a much more socially oriented approach to mental health difficulties, but the recent history of high level statements like this reveals some of the challenges such a shift in thinking has to confront.

In 2009 the Department of Health published New Horizons. A Shared Vision for Mental Health which was endorsed by the then Prime Minister Gordon Brown and his Secretary of State for Health, Andy Burnham. New Horizons described itself as “a cross government programme of action with the twin aims to: improve the mental health and well-being of the population and improve the quality and accessibility of services for people with poor mental health”. Those keen to see a more socially oriented approach to mental health difficulties found it encouraging. It refers to a need for closer attention to early intervention, to the need to address stigma, for a focus upon life’s transitions, and innovations that could support recovery, personal autonomy and well-being. These were defined not as symptom control, but as “A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment”.

What happened? Nothing. There was a change of government and none of these recommendations saw the light of day.  Over the last seven years mental health services have become more coercive, with a steadily rising proportion of inpatients on a detention order. We have a bed crisis as a result of which individuals might find themselves hospitalised miles from their homes and loved ones. We are seeing more and more suicides. The rate of pointless prescriptions for antidepressants, antipsychotics and so-called mood stabilisers has continued to rise and once again we have falling levels of morale amongst the NHS mental health workforce with consequent difficulties over recruitment and retention.

The [2016] Five Year Forward View for Mental Health makes absolutely no reference to its 2009 predecessor, but it does make very much the same recommendations. It openly acknowledges that current NHS mental health services are unsatisfactory and firmly recommends enhanced crisis care, easier access to psychological therapies and preventive work, especially amongst young people. It encourages attempting to achieve recovery, as in enabling people to lead better lives as equal citizens, and the building of healthy communities through the provision of suitable housing and the reduction of stigma. It has been lauded by the Royal College of Psychiatrists who were party to its authorship and have produced their own briefing paper outlining its implications for the profession. Again there is little here about medication or symptom reduction and much about even better access to psychological therapies, vulnerable minorities and recovery. The central role of services user experiences is respected: “Co-production with clinicians and experts-by-experience will be at the heart of commissioning and service design, and involve working in partnership with voluntary and community sector organisations…” page 5.

These are not the earnest pleadings of a radical minority. These are establishment publications. It is fascinating that the same views are reiterated following a change of government. 2009 was the dying year of the Labour government and 2015 saw the election of a majority Conservative government after a period of transition. Despite these changes at the top, on the face of it, the UK health policy establishment has remained faithful to a vision of NHS mental health services that gives more weight to talking therapies than medicines, appears to understand “recovery”, recognises that well-being is dependent upon opportunities of employment, appropriate housing and acceptance, and that all of this can’t be provided for free. It will be even more fascinating to see what the fate of a renewed commitment to these aims turns out to be. Not only is it a welcome vision for those who would like to see change and improvement in mental health services, it is also a blueprint for a more caring and accepting society.

That is probably where these aspirations run into the sand. It is a widely acknowledged truism, that the way a society responds to its most vulnerable is a reasonably accurate reflection of its core values. It is easy to be charitable and supportive towards people with mental health difficulties if they are seen to be suffering an “illness” that has developed as a result of otherwise inexplicable changes in brain chemistry. It is much more difficult to do so if they are understood as vulnerable because of adverse developmental experiences, suffering the consequences of difficult social circumstances or simply misunderstood. This requires a genuine commitment to others’ welfare across the board and acknowledgment of societal imperfections.

It will be interesting to see whether the establishment figures who have responded to the blindingly obvious in relation to NHS mental health services are really joined up with those who are charged with realising a neo-liberal ideology in other government departments. The medical focus the BBC followed in the form of Stephen Fry’s contribution and the failure of New Horizons to make any palpable different suggests not, but re-iteration of its views in the form of The Five Year Forward View suggests that this is collective blind spot which isn’t going to go away easily.

Hugh Middleton. April, 2016.

Hugh Middleton is both an Associate Professor of the School of Sociology and Social Policy and an NHS Consultant Psychiatrist.  Hugh’s latest book ‘Psychiatry Reconsidered: From Medical Treatment to Supportive Understanding’ was published in May, 2015.

Images courtesy of Pexels.com and UoN.

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Author:  Steven Lucas

Having just submitted my PhD research, this blog has offered an opportunity to reflect on that process and share something of my research experiences. When I put down the PhD, War and Peace came to hand and placed my delusions of epic length in to perspective. I can’t resist sharing the comment in the translators note that the first edition of Tolstoy’s novel had over 2,000 errors. I don’t think that would help me at the Viva though – heaven forbid there should be any typos of course!

It’s a long haul doing a PhD, and certainly a relief to reach submission. On the other hand, when one thing ends another must begin. Replacing the certainty of working on my thesis with searching and applying for jobs, alongside thinking about publications and conferences, still seems to keep me more or less anchored to the computer for long periods doing this or that in pursuit of the next thing. I think when the dust settles I will reflect on the PhD time as having some major ups and downs, but definitely as being a good period. Finally, I had control over my working life, and could do things my own way in my own time – a rare pleasure indeed – even if I have felt broke for more than a year now!

In my research, I carried out a qualitative study of service users experiences of multi-agency assessment and practice in children’s services. I am a social worker, so this was familiar territory. The fieldwork took place in a local authority, not a million miles from where I previously had been employed. Here I interviewed parents, children and young people, who were working with a variety of practitioners, and whose needs and circumstances reflected their diverse life experiences. The motivation for this research was a personal quest to answer questions from my previous life as a practitioner, but also because a review of literature confirmed that service users are rarely asked what they think about how services engage them.

Of course, they do get to tick boxes every so often, like everyone else. At this moment in time it seems we could all spend most of the day giving feedback on everything we buy, on everywhere we go and on every organisation that we find ourselves involved with. But, someone else always decides on what the questions should be, and what kind of answer is acceptable. You can’t argue with a questionnaire. Equally I have to acknowledge that interviewing, and analysing the responses, is in no sense a pure instrument of objective inquiry. However, being asked questions using your own language and answering in your own time, at length, is the most readily accessible and sophisticated way we have of communicating and exploring experiences and concerns with another person. It might not be the only way, but at least this allows interviewees to self-consciously reflect on their experiences and that allows an ethical power as well. I do need to qualify that with an acknowledgement that verbal communication is not so readily available for everyone and thinking about the challenges of communication for particular respondents is clearly important.

So, why am I reviewing a methodological choice at this stage of the research process after it’s over? I think it’s because the most powerful experience in this research process was listening to people tell their stories, and that’s what will live on for me after the organisation of the research recedes into the mists of time. When you are a professional interviewer, which,  amongst other things, is largely what social workers are, there is always a part of you bound by your organisational role and by the responsibility you have to make sound assessments.  Your employer will then be able to understand and process this information, offering a practical professional assessment to service users which forms the basis for a working relationship. Some call it professional distance.

When I began my fieldwork, I was not sure just how different it would feel being a qualitative researcher and not being a social worker. It was certainly liberating listening to the stories and not having to give an official response or advice.  Perhaps it’s partly because you go back and listen to the stories over and over again, but I think I opened up to them in a different way. Even now I only have to read a few short quotes from some interviews and I’m welling up in a way I never used to do. Maybe I’m just getting old, but in a good way. I’ll be thinking about that for a while anyway.

Steven Lucas, March 2016.

Steven has recently submitted his PhD thesis in Social Work at the University of Nottingham.  Following many years as a children and family social worker, Steven’s research explored children and families experiences of multi agency assessment procedures in children’s services.

Images courtesy of Pixabay and author’s own. 

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Author:  Helen Woods

I started my PhD programme in 2014 after a career in social work with young people and their families.  I’d kind of assumed my work experience would set me up for researching the experiences of children and young people. While this has been the case, I wasn’t entirely prepared for the rigor involved in the research process, particularly the depth of debates around ethics, consent, and meaningful participation, to name but a few.  I had of course encountered these considerations in social work.  However, in the often coercive arena of Youth Offending they took up different amounts of space, at different times.

Luckily I discovered I wasn’t alone with these dilemmas, as a post graduate group had been set up as part of the University of Nottingham’s Children and Childhood Network (CCN), enabling those of us researching children and young people to come together.  The purpose is to connect and raise awareness of current research projects among those with similar interests, who may wish to share knowledge, experience and resources.  I found that while the range of projects and experiences are diverse, there is often common ground on issues such as access, confidentiality and the actual experience of talking to children in a various settings.

Over the last 12 months the PG-CCN held regular events, including seminars from a range of disciplines, such as social work, education and law, and an annual conference on ‘Child Participation and Academic Research’.  The conference had an attendance of 40 delegates and received excellent feedback.  I’m hoping to conduct an ethnographic study of children’s Residential Care and was struggling to gain access for my pilot project.  However, at the conference I met a fellow researcher who was able to provide a contact for children’s homes, which enabled my pilot study to go ahead.  Sharing experiences also means we can learn from one another in terms of what has worked, and what we could have done differently, which will hopefully improve the experiences of the children and young people who participate, giving us their time and trust.

There will be a range of events this year run by both the PG-CCN and the CCN.  The next PG meeting will be at the Engineering School Graduate Centre 11-12 on March 8^th where we will have talks from fellow PhD students on their experiences of researching with children.  We are also organising a Conference on the 6^th May, concerning Justice, Rights and Participation.  The CCN will be holding its Annual Lecture on April 20^th, 5-6.30pm at Highfields House, and is also organising a schedule of workshops which will engage with local services such as social care and local schools.  This is aimed at improving the way we work with others in undertaking research and ensuring our findings reach the right audience.

For further information on the (PG) CCN please get in touch.

Email: LQ-PG-CCH-Network@exmail.nottingham.ac.uk

Web: https://www.nottingham.ac.uk/children-and-childhood-network/postgraduate-network/index.aspx

Helen Woods, February 2016.

Helen is a first year Social Work PhD student at the University of Nottingham.  Following 14 years of practice experience,  mainly in the field of Youth Justice, Helen is now undertaking ethnographic research exploring the lived experience of children in Residential Care utilising sociological theories of personhood and belonging, self and environment. 

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Author:  Dr Samantha Wilkinson

Interviews, participant observation, diaries – there are endless methods around to conduct research, but are these methods a culturally credible means of researching with young people?

When conducting my PhD research into the drinking practices of 40 young people living in two suburban areas in the North West of England, I found that mobile phones were important tools of communication for the specific group of young people I was working with. Considering it important to engage with young people ‘on their own terms’, I decided to enroll mobile phones, specifically text messaging, as a research tool.

I found that one of the benefits of text messaging is its ability to update me of events that occur without my presence. For instance, one club was notoriously cautious about allowing groups of young men to enter. When I accompanied the young men during participant observations, they had no problem entering the club; when I was not with this group on another occasion, they texted me telling me that they were not allowed to enter. My presence during the young men’s night out, as a female researcher, appeared to interrupt how they typically experience their nights out, whereas text messaging offered me an insight into the usual proceedings.

Also, text messaging is beneficial because most other methods, including interviews and diaries, require people to remember and recall events. However, the date-and time-stamped text messages provide an ‘experience snapshot’ of young people’s alcohol-related, present-tense, action. Overall, text messaging offers an informal, undemanding, means of understanding young people’s drinking experiences, as they unfold.

This method is not without problems: as young people become increasingly involved in the night’s activities, and as their levels of drunkenness increase, they may forget to send texts, or the language in their texts may become less decipherable. There were also occasions when young people told me their mobile phones ran out of battery, restricting me from understanding how their nights unfolded. Another word of caution, when using this method to explore young people’s drinking experiences, is that young people may send text messages in the mire of drunkenness that, when sober, they may no longer wish to be used as data.

Notwithstanding this, when seeking to find out about young people’s lives, I urge researchers to be creative with the tools they are using, and to make a concerted effort to communicate with young people in ways that the young people deem to be relevant.

Samantha Wilkinson, January 2016.

Samantha is a Research Associate in the School of Sociology and Social Policy, working on the BOUGH project, which aims to broaden understandings of good home care for people with dementia.  Her PhD research was in Human Geography on ‘young people, alcohol and urban life’, exploring young people’s drinking practices using a flexible suite of methods, including: interviews, peer interviews, drawing elicitation interviews, diaries, mobile phone methods, and participant observation.

Main image courtesy of Flickr.

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Author:  Professor Justine Schneider

‘Transforming the culture of care’ is an expression used by well-intentioned people but sadly it seems to be a cliché in danger of losing its power to persuade. I heard it recently here: Alive! – lighting up older people’s lives.

This clip illustrates how a delightful programme of music and dance can make an impact on institutional care settings. Great stuff, as far as it goes, and forgive me for being cynical, but I know – anecdotally, from insiders – that mealtimes, staff preferences and medical interventions easily take precedence over arts activities in care homes. The spaces where music, dance or other creative activities can be held are often dining rooms, and mealtimes therefore limit the availability of the room for such activities.

Care staff sometimes disregard professional artists on their premises by inconsiderate ‘noises off’ or by using the artist’s space as a short cut through the home.  Clinical interventions have the power to interrupt everything going on in a care home, perhaps because nurses and doctors have high status, or because they only come in from time to time.  In some ways these three examples reflect givens in the culture of residential care: regimented meals, powerful care staff and even more powerful medical attendants.

Transforming the culture of care will require more than an afternoon of music and movement each week, because residents are disempowered in so many ways; a radical rethink of care culture has yet to be undertaken.

Some progress has been made, for instance, in terms of the acceptance that individualisation in important.  However, person-centred care can be seen as a relatively minor adjustment in relation to the dominance of routines, staff attitudes and the medicalisation of old age.  Structures and routines, as well as those people who are paid to care, define a culture that limits residents’ potential, but older people are also handicapped by their own expectations of those of society.

Ideas for truly transforming the culture of residential care are welcome!

Justine Schneider, December 2015.

Justine has extensive experience in many aspects of applied health research using a wide range of methodologies and approaches. She has particular expertise in mental health service evaluation, carers, care homes, costs and supported employment for people with any kind of disability or disadvantage. Her current work focuses primarily on dementia and staff development, and she is exploring innovative approaches to knowledge exchange in dementia care through the arts.

Images courtesy of UoN and Flickr.

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Author: Associate Professor Hugh Middleton

Hot topics of the time are the efficacy and safety of psychiatric medicines. These are some of the most widely prescribed drugs in the UK and globally. There is growing concern that their reputations for efficacy may have been inflated by biased trials reporting and their longer term safety underestimated. A prominent voice in this debate is the Council for Evidence-based Psychiatry, which held a one day conference at the University of Roehampton on September 18^th. The event was recorded and can be viewed at https://www.youtube.com/channel/UC8eIK8kuf7tht1gV1HApH0g.

It was packed and energetic. Main speakers included Robet Whitaker, Peter Gøtszche, James Davies, Peter Breggin and John Abraham. We were treated to an expert review of the ways in which the widespread use of what might be considered harmful and barely helpful medicines has become the mainstay of psychiatry’s contribution to society. Speakers’ arguments were compelling and warmly received by an enthusiastic audience. Were medicines of such dubious value and so obvious a set of adverse effects being used in any other field, their use would be much more tightly regulated, but that is not how it is. Why is that?

When people discover I am a psychiatrist at gatherings such as this I often become a lightning rod for anger and frustration. It’s okay; it comes with the job, but a couple of things happened this time which highlighted why, and why this is so much more complicated than the simple black-and-white “Pharma and psychiatry bad, everyone else good”.

The first was when one of the audience interrupted a speaker. They clearly had more on their mind than the programme could accommodate. The interruption wasn’t welcomed and indeed forcible removal was threatened. That didn’t happen and the situation was calmed, but there were a few heated moments. The second was a comment from the floor about the adverse effects of psychiatric medicines from someone who had suffered them. When asked “How did you come to be taking them in the first place?” the answer was of course, “The doctor prescribed them”. When asked “Why did you go to the doctor?” the answer was “I was having difficulty sleeping in the course of difficult personal circumstances.”

Psychiatrists encounter people who want medication as often as they do those who don’t. We can question why and how people come to such different positions but if medicines are what they are seeking that position is commonly difficult to shift and the result is generally a prescription even if one is dubious about the supporting science or the weight of adverse effects. Refusal is likely to result in a request for another opinion.

Many of the distressing stories we heard at Roehampton were from people who had tried one antidepressant after another in the hope of relief … and eventually got nowhere. Where does the belief that somehow, somewhere there is a pill that can safely and reliably relieve human distress come from? What was the person who went to the doctor because they were suffering difficult personal circumstances actually looking for? Acknowledgment and comforting words should have been enough but they weren’t, which is why the doctor became involved. A prescription inevitably followed because   that is all the doctor could do. A prescription is also a powerful symbol of concern and acknowledgment. As a result it brings relief, but then the cycle repeats and something different or stronger is sought. Practitioners reading this will be familiar with the cycle, but what starts it? Why did that person go to the doctor when they were distressed by difficult circumstances? What were they actually looking for? Could it have been found somewhere else, and if so where? How can our institutions mark and respond to the fact that someone might have become overwhelmed and incapacitated by life’s challenges, without having to identify them as “ill” and subject them to potentially toxic “treatment”?

Psychiatrists also have to respond to situations in which a very distressed, disturbed or confused person is a source of concern to others. Many will acknowledge authorising the detention of someone more because others were clamouring for it than because they were firmly convinced that would be the right thing to do, and detaining someone almost always also means medicating them. Put very bluntly, a lot of psychiatric prescriptions are issued (not only to detained patients) because a negotiation has been conducted between the prescriber, the patient and the patient’s associates resulting in “agreement” that the patient should take something to quieten them d own. The dynamics of such negotiations are fascinating and often very compelling expressions of social control.

The gathering at Roehampton on September 18^th was nothing if it wasn’t one of people keen to see a different way of responding to personal distress and confusion than the widespread use of possibly harmful mind-numbing medicines. Thus it was fascinating to see how even a gathering such as that found it difficult to tolerate an episode of social disruption. All credit to the organisers and the frustrated person at the heart of it for settling things down, but those tense moments were a reminder of how powerful expectations of accepted social order can be. It isn’t nice, but very often psychiatrists find themselves powerless conduits of such forces, and understanding what they do and why has to include a recognition of this. We have been drugging and incarcerating inconvenient people for centuries and although this must change, wider expectations remain and they are deeply embedded in our understanding of how an ordered society should conduct itself.

The debate about psychiatric medicines is set to grow louder and psychiatry increasingly put under that uncomfortable spotlight. Already, many psychiatrists do what they do more often because they feel themselves to be powerless servants of wider social pressures than because this or that course of action is truly the best choice. Whether it is the individual seeking a “pill for their ill” or distressed others seeking a solution to a difficult situation, prescribing something which might do more harm than good in the long term, might still be the only option. Before shooting the messenger it is helpful to read the message and clarify where it has come from.

Hugh Middleton. November 2015.

Hugh Middleton is both an Associate Professor of the School of Sociology and Social Policy and an NHS Consultant Psychiatrist.  Hugh’s latest book ‘Psychiatry Reconsidered: From Medical Treatment to Supportive Understanding’ was published in May, 2015.

Images courtesy of Pixabay and UoN.

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Welcome to the CASR Blog!

The Centre for Applied Social Research [CASR] is based in the School of Sociology and Social Policy at the University of Nottingham.   This CASR blog is dedicated to sharing the ideas, research and experiences of centre members and others who contribute to the Centre and share its interests and concerns.  CASR is a home for academics, researchers, and PhD students from a range of disciplines, including sociology, social work, social policy, public policy, and criminology who share an interest in applied social science, state interventions into personal lives and scholarship.

Centre members are actively involved in research into areas such as vulnerable adults, dementia, children in care, child protection, children with disabilities, adult mental health, professional – service user / patient communication in health and social care. The blog will reflect these interests and cover a range of subjects, including: social policy, social work, social care, health, and criminal justice practices, all linked by a core concern with the processes and practices of social regulation, caring and the nature and impact of social interventions.

The Centre has strong links with other Research Centres within the School, including the International Centre for Public and Social Policy, with the School’s Centre for Social Work, and The Ann Craft Trust.  The Centre’s research environment is also enhanced by University research Centres and networks such as the Institute of Mental Health (IMH) and the Children and Childhood Network.

If you’re interested in the Centre’s activities – or joining the centre – you can bookmark our Centre for Applied Social Research website, follow the school on Twitter or email us at casr@nottingham.ac.uk. 

Professor Harry Ferguson

Lisa Warwick, PhD candidate

[Blog Editors]

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