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GAME: a board game co-designed by clients at the Psychosis Therapy Project

Not every game has a ball, nor two competing teams; even, sometimes, there is no notion of “winning.” Marvin Minsky, in reference to Wittgenstein’s Philosophical Investigations (1980)

Background

This collaboration was part of a PhD project aimed at understanding the design process and the experiences of participants, clients of the Psychosis Therapy Project, to see if this engagement is beneficial to mental health. The co-design project was not set up with the intention of developing an artefact, and participants were encouraged to engage in the process freely. The process started with activities that aimed to begin to understand and define what design means; for instance by bringing objects and reflecting upon their significance or carrying out short design projects. Through some co-design tools and activities, a broad design purpose emerged, that of expressing a notion of Stewardship, or taking care of, which resulted in the development of GAME.

GAME is a tremendous achievement, stemming from participants unique knowledge and insights on Stewardship, or taking care of, each other and the world, and an intellectual and creative engagement with the meaning and diversity of human experiences.

GAME:

The board game is designed to encourage collaboration over competition, and the exchange of ideas and perspectives in a non-judgmental way. Some players for instance commented ‘I have shared things I wouldn’t have done otherwise’ or ‘I didn’t know I was so self-conscious’.

Game is designed to help participants wonder, get to know themselves and connect with one another and the en­vironment. There are no winners or losers and interaction among participants is the main bene­fit. To achieve this, the board game involves players in addressing questions that relate to different themes, through different forms of interaction.

Game is composed by a set of cards with questions pertaining to the different themes in different colours, and a board offering 3 different ways to address each card. There is also a set of empty cards where players can write their own questions.

The different themes are: green, philosophical, spiritual, mind & body, cre­ativity and (?) which refers to any area not included in the main themes.

Figure 1. Prototype of guidelines booklet (themes descriptions) and cards.

 

Randomly through a wheel, each question can be addressed in three different ways: Tell & share, Think & discuss, and Act & ask.

Figure 2. Prototype of guidelines booklets – ways to address questions and tokens

 

Through sharing opinions, non-judgemental discussions and reflections with others, players may identify areas in which they may want to further reflect and develop themselves, individually or as a group. In order to keep track of these reflections, tokens are distributed among players, which reflect each theme.

Figure 3. Game, box of cards, board and box with tokens corresponding to each theme.

 

Unlike most games, tokens are allocated subjectively. Throughout the game, when the player feels they need help with some area (e.g. spirituality), they can take a token as a reminder of this need (e.g. spirituality token). Tokens can also be given by others, if the player accepts them. At the end of the play session, the number of tokens of each type reflects where the player needs development. Rewards corresponding to each theme are given to those who have most tokens of one type, to motivate them to develop that part of themselves. For instance, if you feel you are not very environmentally aware, fellow players could encourage you to take some green corresponding to­kens. At the end of the game, if you have mostly green tokens, you may be given a reward that encourages you to become more environmentally friendly. These rewards could be created ad hoc by the group or selected from a booklet of ideas.

Step by step – with example:

  • First player randomly picks a card. The card is placed in the middle of the board, and spinned.
  • Where the pointer lands determines the way in which the card needs to be addressed (tell & share, think & discuss or act & ask).
  • Each card has a question (e.g. what colour is your soul?). The same question would be addressed in different ways depending on whether the pointer lands on tell and share (e.g. player expresses first thing that comes to mind ‘my soul is pink’ and others share their views), on think and discuss (players individually think their responses and then discuss with one another) or act and ask ( player acts, addressing the question via mimics or gestures, and others ask, by joining the act or verbally).
  • After discussing each card, the individual or group can reflect on any needs, and distribute tokens.
  • At the end of the game, these tokens are used to distribute the rewards. The participant who has more tokens in one area (e.g. spirituality) will gain the corresponding reward (e.g. meditation event).

Principles of GAME

  • It values diversity of lived experience over accuracy of factual knowledge. As one of the co-designers put it ‘in this game we are all equal’
  • The subjective nature of the token system reflects how people judge, value, as well as support one another and make decisions in everyday life.
  • People who identify themselves, or are helped to recognize, an area where they may want to seek further development, are given rewards to encourage this process. This symbolic gesture also reflects the principles behind peer-to-peer support, recovery and rehabilitation.

Try it any time at the Despard Road centre – feedback and ideas welcome!

Erika Renedo-Illarregi

 

Creative Commons Licence
GAME is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License

Growing numbers of troubled children are having appointments with NHS mental health services cancelled, the organisation’s data show.

Figures obtained by the mental health charity Mind reveal that CAMHS (child and adolescent mental health services) in England cancelled 175,094 appointments with vulnerable patients between August 2018 and July 2019.

That was 25% more than the 140,327 which were cancelled during the same period in 2017-18.

Experts think staff shortages and the growing demand from young people for help with anxiety, depression and other conditions, lie behind the trend.

Although under-18s with mental health problems can pull out of planned sessions, the proportion of appointments cancelled by a CAMHS provider rose as a percentage of all appointments year-on-year, from 3.3% in 2017-18 to 3.7% last year – one in 27 of all consultations.

Mind called the upward trend deeply concerning, especially as some appointments were with young people who were self harming or having suicidal thoughts.

Full story: Guardian

After years languishing in the dark, mental illness is finally getting its moment in the spotlight. Frustrating political football it may be, but one thing can’t be denied – it’s making headlines more than ever. Focus, largely, has been on young people – crises in child and adolescent mental healthcare and in student populations have been both persistent and significant. But mental illness doesn’t end with reaching adulthood – often, in fact, it doesn’t end at all.

New research from the British Journal of Psychiatry into self-harm in older people puts this into stark perspective. A meta-analysis of 40 studies found that yearly self-harm rates were about 65 per 100,000 people, with risk of repetition and of suicide also higher than average. Self-harm is still seen as a problem among younger demographics; and while that remains true, this data proves that the issue is even more complex and diffuse than we thought.

The findings are not wholly surprising. In 2014, the World Health Organization found that suicide rates were highest in people aged over 70 in almost all regions of the world. The Royal College of Psychiatrists (RCP) also found that 40% of older people in GP clinics experience mental ill-health; this rose to 50% in general hospitals and 60% in care homes. And, as the Mental Health Foundation points out, the UK population is ageing rapidly – since 1974, the number of older people in the UK has grown by 47%. By 2027, the Office for National Statistics predicts, 20.7% of the UK population will be aged 65 or over, compared with 15.9% in 2007. The problem, clearly, is not going away.

Full story: Guardian

I would rather tell an employer I have excruciating period pain or terrible diarrhoea than say I need to take a day off for my mental health. Despite the mental health awareness days, mindfulness at work courses and stigma-bashing posters, many of us still feel that our bosses are not open to accommodating mental illness – and we may be right.

Andrew Berrie, employer programme manager at the Time to Change campaign, says nine in 10 people who experience mental health problems report facing stigma and discrimination. More than half say they experience that stigma the most at work, meaning many do not feel they can talk openly with their line manager. Things are improving, says Berrie – but the stigma means that, like me, 95% of employees would prefer to call in sick with a made-up reason, rather than reveal the truth about their poor mental health.

Geoff McDonald is co-founder of minds@work, a network of professionals seeking to build psychologically healthy workplaces. He says: “I think there is still a huge disconnect between what senior leaders think the culture and openness is, and what it actually feels like on the frontline, whether or not you can have those conversations.” He tells of a senior executive who walked into a mindfulness class his company was running, surveyed the room and said: “So, these are the people who can’t cope in my business.” The organisation had ticked a box, but not changed the culture of intolerance that fosters judgment of those who struggle. We are making progress, McDonald says, but we are “still at the foothills of climbing Mount Everest”.

It is not just tokenism we are smelling, but fear, too, he says. “There has been a lot of campaigning, awareness-building, encouraging people to talk – but I think there is still this fear of not knowing what to do or say, even at the simplest of levels.” He says line managers often confess that they are fearful of saying the wrong thing, telling him that if someone came to them saying they were suffering from anxiety, they wouldn’t know how to handle it.

Clinical psychologist Dr Beverley Flint, from Camden and Islington NHS Mental Health foundation trust, runs C&I Wellbeing, offering mental health support training for managers and HR staff. She says many businesses and organisations are blind to the reality of what their employees are going through.

When she meets employers who tell her they “don’t have a problem with mental health” in their workplace, she says she raises an eyebrow. “I tell them: ‘But you do, you just don’t know about it. You will have people in the workplace who have a diagnosis – I’d love to see your staff retention data.’ People get annoyed with me when I say that.”

Full story: Guardian

An elite band of doctors has now come up with a solution to their recurrent occupational hazard. They say a genetic test for schizophrenia should be made available on the NHS. “It can help people understand that they have an illness like any other, just like epilepsy or diabetes, and may also mean that they and their families are more comfortable with the idea of them taking medication,” Professor Kam Bhui explained in the respected British Journal of Psychiatry.

Professor Bhui edits the journal, published on behalf of the Royal College of Psychiatrists, and has long been an influential commentator. His latest suggestion has already been backed by his Queen Mary University colleagues Professor David Curtis and Dr Katherine Adlington. They say the NHS should make the test available “as a matter of urgency.”

There is just one small ethical problem. Schizophrenia has never been shown to be caused by genetics, either wholly or in part. The trio of psychiatrists appear comfortable in advocating that this moral inconvenience should not stand in the way of it being held up as an explainer to patients and families. “We can do a simple genetic test on a patient and, for example, tell them that they have a small piece of chromosome 22 missing and that this is probably the reason why they’ve developed schizophrenia,” Professor Curtis has excitedly argued.

This particular chromosome correlation has been observed in just one percent of patients with schizophrenia, and those without schizophrenia have also been seen to exhibit it, the Royal College of Psychiatrists has told Mental Health Today. Schizophrenia can not currently be genetically explained in the same way as, say, Down’s Syndrome can (where children are born with a third copy of chromosome 21).

If genetic testing becomes routine on all patients diagnosed with schizophrenia, then perhaps in time a commonality will be discovered. If patients are being given a false reason for taking a (currently hollow) test, does the end justify the means?

Let’s start by making a comparison with Down’s Syndrome once again. Since diagnostic testing has become more reliable and less invasive for pregnant mothers, abortions have increased. Parents should not be denied their reproductive rights of course, but campaigners living with the condition have expressed their fears at where that statistical trend will end up, or how such knowledge could be abused by eugenicists.

Just this month Japan agreed to pay compensation to thousands of individuals with mental health conditions, intellectual disabilities and physical disabilities who were sterilised over five decades until 1996. 25,000 people were sterilised under the so-called Eugenics Protection Law. Almost half gave their consent to the procedure.

Professor Peter Kinderman, a clinical psychologist, is dismayed at psychiatry’s latest approach to confronting conversations about schizophrenia. “Biological explanations of mental illness appear to offer people the suggestion that they are not to blame for their difficulties. But in truth the history of both psychology and psychiatry is littered with the debris of eugenics, where biological and genetic explanations are used as justification for harsh, discriminatory, and sometimes even lethal treatment,” he says. “Even if we did have a genetic test for so-called schizophrenia, we should be extremely reluctant to roll out its use. But in truth the notion is scientific fantasy anyway.”

Full story: Mental Health Today

Social media addiction should be considered a disease, MPs have said, in a sign of the pressures facing technology companies and the growing concern over the impact social networks are having on users’ mental health.

The politicians called for further research on the effects of social media but said a report suggested there was good reason to believe sites such as Facebook, Instagram and Twitter – which are constantly competing for users to spend more time on their platforms – could be having a corrosive effect on children.

“It is paramount that we protect young people to ensure they are kept safe and healthy when they are online,” said the MPs, who believe the government should urgently fund long-term studies to see whether a clinical definition for social media addiction should be introduced.

The report was compiled by the all-party parliamentary group on social media and young people’s mental health and wellbeing, made up of MPs who have an interest in the topic. The report was written with the assistance of the Royal Society for Public Health (RSPH) charity, which endorsed its findings following a series of evidence hearings.

Full story: Guardian

A former member of Mind staff has authored a report sharing what he learned during his time at the Department for Work and Pensions (DWP). After working tirelessly on benefits and mental health issues for many years at Mind, Tom Pollard spent 18 months working as Senior Mental Health Policy Advisor for the DWP.

The secondment lasted from November 2016 until April 2018 and culminated with a report – Pathways from Poverty – published by DEMOS. The aim of Tom’s secondment was to advise policy and practice in order to better support people with mental health problems and other disabled people accessing the Government’s controversial welfare system.

This report highlights that progress is being hindered by barriers and resistance to change that are embedded within the DWP’s culture. Rather than challenging specific ideas or policies and looking at issues in isolation, the report calls for radical and institutional reform to a government department that is currently ‘institutionally and culturally incapable’ of supporting disabled people.

Responding to the report, Paul Farmer, Mind’s Chief Executive, said: “We welcome this report, which echoes Mind’s longstanding concerns about the benefits system. We have consistently campaigned for a system which supports, not demonises, those of us with mental health problems. If you are out of work because of your mental health, you need empathy, understanding and financial support, not mandatory activities or the threat of sanctions. This report shines a bright light on fundamental cultural problems within the DWP that are preventing the change we need to see.

“Given the high proportion of people with mental health problems who need support from the benefits system, it’s only right that mental health should be at the heart of every project, reform and policy. In order to properly understand and support people who need support from benefits, there needs to be greater mental health expertise within the DWP, and a willingness to involve people in decisions that affect them. Successive benefits reforms have encountered major problems and have often left people with mental health problems getting the worst deal. This report suggests the need for a fresh approach to welfare policy and delivery.”

Source: National Mind

The independent review of the Mental Health Act 1983 has been published. The Act sets out when people with a mental health problem can be detained and treated in hospital against their will. 

The review was established by Prime Minister Theresa May last year to look at how the legislation is used and what needs to change. Recommendations include minimising the numbers of people being held against their will; strengthening the rights, dignity and wellbeing of people who are in extremely vulnerable situations; and dealing with racial inequality in the use of the Act. 

Mind was part of the steering and working groups for the review and Steven Gilbert, who has lived experience of the Act and is also trustee at Mind, was the vice-chair of the board. 

Responding to the review, Paul Farmer, Chief Executive of Mind, said:

“Mind welcomes the review and the recommendations of the panel. This outdated legislation has seen thousands of people experience poor, sometimes appalling, treatment, who still live with the consequences to this day. We are pleased to see that many of our concerns – and those of the people we represent and have supported to feed into the review – have been heard. 

“The recommendations to strengthen people’s rights, empower them to question decisions about their care, choose their treatment and involve friends and family have the potential to make a real difference to those who are in an extremely vulnerable situation. We back the call for people on mental health wards to have a legal right to an independent advocate and agree that people who have been detained should be able to choose which family members and friends can make decisions about their care and treatment. 

“It’s good to see the review address racial inequalities. We know that black people are disproportionately sectioned, are more likely to be restrained, and are most likely to be put on a Community Treatment Order. These orders have been proven ineffective in reducing hospital readmission. Tightening the rules for imposing them is a small step in the right direction but we are disappointed that the review has not called to scrap them. Likewise, we back the promotion of race equality in mental health services and in the use of the Act but this must come with concrete commitments, including that the NHS builds relationships with local communities. 

“The Government now needs to take this review forward as soon as possible so that people with mental health problems get the support they need. A key test of the recommendations will be their impact on racial inequality and we look forward to the NHS long-term plan which will set out how mental health care will be transformed. These recommended changes are much needed but detentions will only reduce when people have access to quality, culturally relevant and timely care, so that fewer people end up in a mental health crisis.”

Source: National Mind

The word “crisis” comes up a lot whenever children and young people’s mental health is mentioned. Whether it’s youngsters in desperate need of acute care being sent hundreds of miles away for treatment due to local bed shortages, failure to receive help even after their GP has referred them for specialist care, or enduring problems with NHS child and adolescent mental health services (Camhs), patients under 18 find it increasingly difficult to access the support they need.

Today, for the first time, the Office for National Statistics is publishing figures on children and young people’s views and experiences of loneliness and how to overcome it. Separately, NHS Digital figures published last week found that as of the end of August, 213,702 children were referred to or being seen by children and young people’s mental health services. In all, one in eight young people between five and 18 in England has a mental health disorder. While the government has repeatedly said that youth mental health is a priority and has pledged to do more, especially around early intervention, the reality is that for many of those seeking help, long waits and inadequate services are the norm.

“Growing numbers of young people are seeking mental health support, meaning that an already over-stretched system is a long way from meeting demand,” says Emma Thomas, the chief executive of the charity Young Minds. “This can have devastating consequences. Every child who reaches out for support should be able to get the help they need.” We talked to young adults about their experiences of seeking help and accessing mental health services while under 18 and asked them what they feel needs to change.

Full story: Guardian

Over the past decade, social media platforms like Facebook and Twitter have become a central part of everyday life. Despite their massive popularity, however, controversy abounds regarding their impact on mental health and wellbeing. A new research study by the University of Amsterdam (UvA) has now found a correlation between the passive use of social media and depression symptoms like loneliness and fatigue. The findings were recently published in the Journal of Experimental Psychology: General.

For many of us it is a daily habit. Whenever we have a moment to spare, we find ourselves reaching for our smartphones and aimlessly scrolling through social media feeds reading updates or looking at pictures. This behaviour, called passive social media use (PSMU), is often used to relieve boredom and can swallow up large chunks of personal time. While seemingly innocent, PSMU isn’t without controversy – experimental research shows that it can decrease affective wellbeing, a sense of belonging and life satisfaction.

To investigate the link between social media use and depression symptoms, an international research team led by the UvA recruited 125 students and measured their wellbeing and passive social media use seven times daily for 14 days. A special app on their phones prompted participants at fixed times to complete a 12-item depression questionnaire. Their responses were analysed with a novel statistical technique, which was developed/implemented by researchers affiliated with the UvA’s Psychosystems Group (Dr Laura Bringmann and Dr Sacha Epskamp). The analysis focused on three timeframes – short-term (within the same two hours), medium-term (prediction from one prompt to next) and longer-term (across the entire 14 days).

Full story: News Medical

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