‘Snowflake millennial’ label is inaccurate and reverses progress to destigmatise mental health

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Triggered? Tim Dennell/Flickr, CC BY-NC

Shelly Haslam-Ormerod, Edge Hill University

From the baby boomers of the mid 1940s to the early 60s to Generation X yuppies who came of age in the 1980s – labelling generations is nothing new but as early as 1839 French Philosopher Auguste Comte wrote about the gradual and continuous influence generations have upon each other and how generational stereotypes hold firm.

For today’s millennials, who came of age around the early 2000s, the charge of “snowflake” has been attached to criticise their perceived sensitivity. The British Army even used the name recently to address young people in a recruitment campaign. One of the soldiers featured in the campaign has received hundreds of social media messages mocking his association with the snowflake poster. Despite this reaction from some people, the advert’s intention was to invert the label’s stigma and highlight the value of compassion in millennials.

Use of the term elsewhere has been uniformly negative. The English dictionary defines “snowflake” as a derogatory term to describe an easily offended person, or someone who believes they are entitled to special treatment on account of their supposedly unique characteristics. Members of the so-called “snowflake generation” are typecast as emotionally weak and lacking resilience.

Research has shown that labels such as these create stigma – and stigma’s role in mental health is an age-old problem. Amid the media furore around the poster there remains the disturbing statistic that one in eight children and adolescents and one in four adults in the UK will experience a mental illness.

Flippant stereotyping of a generation as weak based on their mental well-being contradicts efforts to reduce mental health stigma. It also undermines the goal of ensuring society values mental health equally with physical health.

From ‘can-do’ to #MeToo

The “snowflake” label contrasts with early published anticipation for the millennial generation. At the outset, millennials were met with encouragement, as a book published in 2000 by William Strauss & Neil Howe shows. “Millennials Rising” predicted a “can-do youth” which would recast young people from downbeat and alienated to upbeat, engaged and optimistic.

Since then however, global financial recessions, the rising cost of living and education, insecure work, climate change and a turbulent political landscape have all contributed to significant increases in poor mental health among young people. This has created a difficult environment for millennials to meet their potential. Rather than characterise them as weak, society should work together to help young people overcome these challenges.

In the UK, tabloid headlines have fuelled the problem. “Life’s too tough for snowflake worriers who spend six hours a day stressed out” reads one from the Daily Star in 2018. “Sheltered snowflakes with no idea how to survive in the real world are having to pay for ‘adulting classes’”, reads another.

Millennials have inherited difficult career prospects, a febrile international order and an expensive housing market. Fizkes/Shutterstock

A recent Daily Star headline from December 2018 prompted an open letter from mental health campaigner Natasha Devon. She condemned the headline: “Snowflake kids get lessons in chilling” and implored the media to recognise the ongoing mental health crisis and the need to challenge stigma, rather than labelling and stigmatising those in need.

What is perhaps more worrying is the ease with which this label is seeping beyond the millennial generation with the Daily Mail stigmatising even young children as “snowflakes”.

A quick Google image search of “snowflake generation” produces a slew of images that typify a hatred towards millennials, with derogatory jokes and memes. There’s also an association with words such as “weak”, “sensitive”, “triggered” and “entitled”.

Using “snowflake” as an insult was popularised by the alt-right during the 2016 US presidential elections in the US to negate the views of those considered anti-Trump, including liberals and leftists. This legacy does not reflect well on those parroting it in the UK media.

Debunking the ‘weak millennial’ myth

The label’s connotations need to be challenged. In reality, the millennial generation are resilient in bucking legacies left by older generations. Millennials are consuming less drugs and alcohol than previous generations and youth turnout at the 2017 general election in the UK was reported to be the highest in 25 years.

Despite growing insecurity in the job market, unemployment in Britain’s under-25s is among the lowest in Europe. Millennials are also ousting older generations from high-ranking roles.

The emotional intelligence of millennials shines through their continued efforts to oppose injustice. Their resilience is also clear in their efforts to excel despite the challenges they face.

Ultimately, the snowflake label is unfair because it encourages stigma and evokes hatred. The word “snowflake” has lost its wistfulness as the harbinger of winter, replaced by insults to an individual’s capacity to cope in a challenging world. As a society, perhaps we need to ask ourselves – when has stigma and contempt ever helped?The Conversation

Shelly Haslam-Ormerod, Senior Lecturer in Mental Health and Wellbeing, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

“We can’t do this”: A mission impossible to meet the NHS performance targets

As we head into 2019,  the media coverage has intensified with stories of the ‘mayhem’ due to the coming cold snap and the looming crisis in the NHS and the race to combat the “toughest ever” winter crisis and the pressures on the hospitals to meet their targets. This comes on the back of the BBC story, asking public to check how their local hospitals are performing against some key targets . We are now also told that the ministers and the NHS England chief are at loggerhead over targets and demands for specific improvements linked to £20.5bn cash boost for the NHS.

The pursuit of efficiency and use of performance measures  has been a hall mark of the NHS in the last few decades. The management by targets   approach in the NHS has yielded some positive results but cases of ‘hitting the target but missing the point’ are also common.  For instance, in my own research, I have systematically documented a range of unintended consequences  of the ambulance response time targets and have found out that the targets continue to play a significant role in driving behaviours and cultural perpetuation of key values. In my recent opinion piece, I have shown how the ambulance services have been failing to meet their new performance standards faced with various other challenges.

Evidence from the last winter points out the difficulties in meeting the A & performance  standards.  Media stories highlighting delays  on the part of ambulance crews arriving at the scene including deaths of the patient waiting for an ambulance further add to the narrative. Some of these arguments have been rehearsed earlier but in my view there are two key issues which need our attention. These include: the funding situation for the NHS organisations, and the worsening staff shortage exacerbated by the Brexit and current immigration policy.

Address the funding-demand gap

The sustainability of an underfunded and overstretched NHS has been a matter of much  debate , analysis and scrutiny  including emotive calls about unnecessary deaths caused by the funding crisis. The National Audit Office  in its most recent report has concluded that “the additional funding, aimed to help the NHS get on a financially sustainable footing has instead been spent on coping with existing pressures”.

The funding crisis has also been the subject matter of media reports and an ongoing inquiry by the Parliamentary Select Committee. Different sectors of the NHS are facing specific issues. In my research, I have argued  the case for the ambulance service that doing even ‘same with less’ is proving difficult for individual ambulance trusts.

The Carter Efficiency Review , published in February 2016, highlighted concerns about wastage and ‘unwarranted variations’ across different NHS organisations. While it identified areas of improvement and potential savings of £5 billion, it also raised fundamental questions over the need for significant investment in the sector. However, in the current climate of financial austerity, it is difficult to see how its fifteen recommendations can be implemented in order to achieve the desired savings. Notwithstanding any disagreements over the about the scale of the problem, it’s quite clear that the NHS is under serious strain.

Improve staff situation

The NHS Five Year Forward View made a categorical commitment to support a diverse, modern and healthy workforce. However there are huge challenges on this front, not least the additional uncertainty the Brexit ‘deadlock’ brings. A joint report by the Nuffield Trust, Health Foundation and The King’s Fund,  published in November 2018, has issued a stern  warning that the current staff shortages of 100,000 is likely to rise to 250,000 by 2030 and could be more than 350,000 if the “emerging trend of staff leaving the workforce early continues and the pipeline of newly trained staff and international recruits does not rise sufficiently. This should not come as a surprise since the staff shortage crisis was highlighted in the draft NHS Workforce Strategy published in December 2017 for the first time in twenty-five years on back of the worst NHS crisis.  Again, if we were to look at the figures for the ambulance and allied services, out of the 17,000 nurses, midwives and allied health professionals (AHPs) who went on to the professional registers between 2015 and 2017, only 7,000 of them have joined the NHS. The Strategy sadly points out that the primary reason for staff leaving the NHS is the ‘growing pressure’ they are experiencing in the workplace.   Shortage and retention  of staff, accompanied by the highest sickness absence rates in the NHS, dominate the ambulance workforce agenda.

Media reports  are on the rise highlighting cases of harassment and bullying of the NHS staff as a consequence of pressure of meeting performance targets with one in four staff   have reported to have experienced bullying in some way, costing  around £2 billion annually to the NHS. The latest NHS Staff Survey has revealed some shocking statistics about the ambulance staff showing them worst for discrimination and equal opportunities, worst for illness due to work-related stress, worst for team working and worst for staff engagement. Last year, Guardian reported a story that the hospital bosses felt ‘humiliated and bullied’ when they were forced to chant ‘we can do this’ over A&E targets by a senior NHS official in a performance review meeting. CQC Inspection Reports highlighting similar concerns for poor staff morale due to the pressures of meeting performance targets are also not very uncommon.  The issues around dignity and staff retention are still significant owing to the continuing work intensity.

Conclusion

As we enter the cold winter period, there are further signs that the NHS is witnessing an all year round-365 day crisis and the pressures felt by the system are not confined to the busy winter months. A latest report  by Nuffield Trust has suggested that it is “unlikely that this winter is going to be significantly better for patients and the NHS than last year”. NHS figures continue to show that hospitals in England are ‘badly missing’ targets despite mild weather and low flu levels. An independent analysis on the impact of the £20.5 billion extra funding to the NHS has reported fears that it is likely to be used-up by the on-going issues such as the ageing population, pay rises, hospital effects and the rising cost of drugs.

Additionally, the uncertainty resulting from the postponement of the vote on the Government’s EU Withdraw Treaty in the Parliament and the dangers of a ‘cliff-edge’ Brexit is making the already grim situation worse. Such an uncertainty at the onset of what many believe would be a worst winter for the NHS, coupled with the impact of a harsh Brexit on the NHS workforce is likely to have a devastating impact on staff morale.

It is thus becoming clear that the current approach to deal the crisis with emergency cash injection is proving ineffective. It is time to take a fresh look at the targets and to address the fundamental issues of the funding gap and workforce welfare if NHS organisations are to have a fighting chance to meet their performance targets. Unless that happens, it very much looks like a ‘mission impossible’!

The problem with using psychoanalysis on children

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Michael Richards, Edge Hill University

Children with problems or problem children? That is the question often asked by parents and teachers alike. If a child is naughty in school, are they a “bad” child or are they facing mental ill health?

Most analysis focuses on children being the problem – a highly individualistic take which resonates with Sigmund Freud’s theory of psychoanalysis. This is a theory which dates back well over a hundred years, with strong roots in focusing on childhood problems influencing adult behaviour.

Psychoanalysis developed over the course the 20th century, and although the approach has been dismissed by many, we live in a society where there is still an obsession with “psychoanalysing” children. This inevitably labels children as a problem rather than recognising the problems that affect wider society.

What drives behaviour?

Psychoanalysis specifically relates to Freud’s own school of thought, which believes a person’s behaviour is determined by early childhood experiences. According to Freud, a person has instinctive drives within the unconscious that influences their behaviour – unconscious material can be found in dreams and unintentional behaviour.

Freud’s focus was on specific sexual stages of development that influence our personalities as we develop in life. At the oral stage of development for example, (from birth to one year) Freud implied that oral stimulation could lead to an “oral fixation” in later life – such as sucking your thumb in times of stress.

Psychoanalysts believe that therapeutic interventions can bring the effects of this unconscious material into consciousness with the aim of resolving these issues.

Questioning Freud

Freud’s psychoanalytical theory, and other versions of psychoanalysis, are problematic for so many reasons. For a start, Freud’s theories are based on the “unconscious mind”, which is difficult to define and test. There is no scientific evidence for the “unconscious mind”. And it would be difficult to say who would be qualified to make assumptions about this when nobody really knows what the unconscious mind is.

For children, this means teachers, social workers, nurses, psychiatrists and other professionals make assumptions about them based only on their present behaviour – and without considering any wider social issues. This makes psychoanalysis ignorant of difference and diversity, and over-generalised. Particularly so when directed at young children – given that personality and behaviour can change over the course of someone’s life.

There’s no such thing as a ‘good’ or ‘bad’ child. Shutterstock

Research also shows that “naughty” behaviour in schools can be because children lack aspirations and a drive to do well. This can stem from many factors such as low self-esteem and high anxiety – as well as growing up in a low income household. Children who are in care, children with disabilities and children from Afro-Caribbean backgrounds are also more likely to be excluded from mainstream school if they live in deprived areas.

Stop blaming children

It is relatively easy to criticise the use of psychoanalysis, particularly when people are “psychoanalysing” without understanding what it is or isn’t. In this sense, Freud and the general idea of psychoanalysis has become a part of our language – and our analysis of trying to make sense of human behaviour.

And this is not without reason. Freud’s theories still play a role in the teaching and learning of many counsellors, psychologists and psychiatrists today, despite facing much criticism since its inception. Indeed, many types of therapies emerged post-Freud – including transpersonal therapy which is a more humanistic take on therapy – and many people have benefited enormously from these approaches.

But ultimately, the problem with psychoanalysis is that the focus is still primarily on the individual being the problem. And in the case of children, to keep focusing on them as the problem, while ignoring wider, social problems is dangerous.

Labelling a child as a ‘problem’ from a young age can have detrimental consequences. Shutterstock

Psychoanalysis does also not fully acknowledge the power of labelling and stereotyping that takes place within schools and in other aspects of a child’s life. It is almost like there is reassurance in focusing on a “problematic” child because there is always a box to tick, which might provide some idea of the “problem” and then result in a resolution.

But it is impossible to do this properly while ignoring the major issues children face in their world. This includes a lack of resources due to high poverty rates, alongside the increasing levels of mental health issues such as self-harm. Individuality can of course not be ignored but neither can the wider social problems that children face. This is important because ultimately it is these external factors that have the power to really influence the mental health and well-being of children.The Conversation

Michael Richards, Lecturer in Applied Health and Social Care, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Weight monitoring during pregnancy could help save lives

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Hazel Flight, Edge Hill University

There are times in a person’s life when specific events can have long-term implications on their future health. Pregnancy is one of those times – when major and dramatic changes occur within a woman’s body composition in a short period of time.

A key element of a healthy pregnancy is appropriate weight gain. Maternal obesity is thought to be one of the most common factors in high-risk pregnancies. It can cause short and long-term health risks to both mother and child, an increased birth weight and problems with delivery.

It is thought that 20% of pregnant women in the UK are obese, and due to the current obesogenic environment it is likely that this proportion will increase.

Obesity in pregnancy can cause infants to be predisposed to develop childhood obesity, metabolic syndrome and diabetes. For the mother there is also the risk of pre-eclampsia, miscarriage and gestational diabetes.

To combat this, there have been calls for women’s weight to be monitored throughout the course of their pregnancy. This is something which has not been carried out consistently in the UK since the 1990s (when there was a lack of clinical evidence to suggest it was worthwhile).

But we know now that body composition measurements can help predict maternal health and pregnancy outcomes. This monitoring throughout pregnancy may also have an influence on the birth weight of the baby, which in turn is a key determinant of short and long-term health conditions.

Midwives have a unique opportunity to provide advice regarding appropriate nutrition to the women in their care, and health promotion and education are considered among the most important activities they perform. However studies in the UK, Sweden and Australia conclude that many struggle to provide this advice.

One reason for this is that midwives do not have clear guidelines regarding what weight a woman should gain throughout her pregnancy. The National Institute of Health and Care Excellence (NICE) are currently considering a target of 16kg for women of a normal weight and 9kg for those who are obese.

Eating for how many?

It is important to remember that weight gain during pregnancy is not the sole issue with regard to the future health of the baby. If a baby has low weight gain following birth the risk of chronic disease later in life is increased and the child can also be undernourished and suffer stunted growth.

And while the focus is often on obesity and excessive weight gain, there are also serious issues at the other end of the spectrum. Women who do not gain enough weight and are not consuming enough calories are more at risk of giving birth preterm to children with a low birth weight. Babies born under 2.5kg are less likely to survive, and those that do also have an increased risk of long-term health conditions.

The current dietary reference value for a pregnant woman is an extra 200 Kcal per day in the third trimester only. This is all that should be required in order to maintain the healthy development of the foetus.

Counting 200 calories. Shutterstock

The myth that pregnant women are “eating for two” encourages them to feel they can eat whatever they want. The right information about how much and what they should eat during pregnancy is still not reaching many women – potentially putting their health, and that of their unborn babies, at risk.

So who should be providing this information? The weight loss organisation Slimming World has been commended for supporting women to eat healthily and monitor weight increase in pregnancy.

But there also needs to be advice provided to how to increase weight for those who are underweight. Alongside information regarding adequate and appropriate nutritional intake, there is a need for specialist support and education within this area. This could be a valuable role for a nutritionist as part of the care provided to women during their pregnancy.

Management of a healthy weight and subsequent weight gain in pregnancy is becoming increasingly difficult to maintain within modern society. The current advice from NICE is that weight and height are measured at the pregnant woman’s first appointment – but not regularly throughout the pregnancy.

Yet pregnancy is a time when women often have an increased nutritional awareness and the motivation to do what is right for themselves and their baby. Regular weight monitoring would be an effective way of helping them achieve this – while they are hungry for information on how to be as healthy as they can be.The Conversation

Hazel Flight, Programme Lead Nutrition and Health, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Child obesity is linked to deprivation, so why do poor parents still cop the blame?

World Obesity Federation., CC BY

Robert Noonan, Edge Hill University

Childhood obesity has risen ten-fold over the past 40 years. In the UK, roughly 30% of children are overweight or obese. Obesity rates are much higher among children living in deprived communities. In England, there is a clear trend: the wealthier a child’s family is, the more likely the child is to be a healthy weight. And those who are a healthy weight during childhood are much more likely to be a healthy weight in adolescence.

In 2006, then Labour leader and prime minister Tony Blair argued that many public health problems, including obesity, can be solved by getting people to change their lifestyles. But strong evidence from behavioural economics research and weight-loss trials shows that advocating personal responsibility is destined to fail in the long-term.

The fact remains that behavioural interventions alone – such as the NHS five a day and Change4Life campaigns – do little to address child obesity across society, because healthy food is not always easily accessible. In fact, these types of approaches widen socioeconomic health inequalities. Findings from my latest research drive this home: childhood obesity rates in Liverpool – one of England’s most deprived cities – increased by up to 3% between 2006 and 2012.

Lessons from Liverpool

For our study, we analysed data from the National Child Measurement Program (NCMP), which measures the height and weight of children within state schools across England. We examined the data of 25,905 children aged four to five years and 24,220 children aged ten to 11 years, recorded between 2006 and 2012, in order to track changes in childhood obesity and socioeconomic health inequalities over time.

Liverpool is the sixth largest city in England, and up until 2016 it was ranked as the nation’s most deprived, with over 90% of Liverpool’s 470,000 population living in areas of high deprivation. Across the six-year duration of the study, children who lived in deprived communities became overweight or obese at a greater rate than children living in less deprived communities.

As public health and other services across England continue to have their funding cut by central government, it’s more important than ever that the nation takes a new approach to tackling child obesity, and reduce inequalities linked with poor health.

A better way

For too long, behavioural interventions have been used to prompt people – especially parents – to take responsibility for individual instances of child obesity. For example, the national social marketing campaign Change4Life aims to prevent child obesity, by educating and informing families about the benefits of being physically active and eating healthily. And the NCMP informs parents if their child is overweight by means of a letter, reinforcing the idea that it’s the parent’s responsibility to address their child’s weight.

Meanwhile, little attention is paid to the policies or the social and environmental conditions which also shape healthy (or unhealthy) behaviours. Research points to inequality as a primary factor which prevents people from making healthy choices. For example, many deprived communities are “food deserts”, where affordable or high-quality fresh food is hard to come by.

Deprived communities also have few opportunities for physical activity, and typically live in areas where there are lots of fast food outlets. If we take Liverpool as an example, the city now houses over 600 fast food outlets – a figure which has risen by roughly 10% since 2014.

Too great a temptation. Shutterstock.

There is quite a lot of evidence showing that children are more likely to be overweight or obese if there are fast food outlets near their home or school. To reduce access and remove temptation, some councils in England have suggested banning fast food outlets within 400 m etres of schools. But councils’ hands are tied, as they dont’t have the powers to stop new takeaway outlets being built.

People are the product of their environment, and in modern society, the default choice for many people is the unhealthy choice – and for some, the only choice as eating healthy has been shown to be more expensive. To address this major problem, government policies need to address public health priorities. The healthy choice needs to be just as easy as the unhealthy choice, and there needs to be a level playing field, in terms of the accessibility and pricing of decent food.

Placing the responsibility on children and families, without changing their economic and physical environment, will do little to tackle health inequality and reduce weight-related health problems in society. Instead, the government needs to step in and, through policy, create communities which promote and enhance healthy choices and lifestyles. Only this will ensure that the default choice for most people is the healthy choice.The Conversation

Robert Noonan, Senior Lecturer in Physical Education and Children’s Physical Activity, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Knife crime: how former offenders can make great mentors for at-risk teens

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Sean Creaney, Edge Hill University

It’s widely reported that there’s been an increase in street violence, particularly in London – with the number of knife and gun crimes rising. While the causes are complex and multifaceted, victims and perpetrators of serious youth violence often lack a relationship with a trusted adult.

One way to help reduce crime is to use ex-offenders as peer mentors. Those who have overcome adversity and stopped offending can act as positive role models for their peers – especially teenagers who are at risk of committing crime or being drawn into gang activity.

My research found that young people on court orders really value building empathetic and collaborative relationships with professionals who are ex-offenders, and have first-hand experience with the criminal justice system.

When carefully selected, provided with extensive training and given tailored support, former young offenders can be uniquely well-equipped to help their peers in need of support. And they can encourage young people on court orders to engage with criminal justice services and make positive changes in their lives.

Positive peers

Peer mentors can offer advice and support to young people who are experiencing personal, social or emotional difficulties, because they have first-hand experience overcoming such problems themselves. Projects operating around the world offer proof that this can work in practice.

One approach in the US is to recruit ex-offenders as credible messengers who can build trust and inspire change among young people. These mentors, who have transformed their lives, are viewed as assets who can help motivate young people – who are often marginalised and disadvantaged – to make better decisions and desist from crime. The project has been shown to reduce re-offending and improve young people’s self-esteem.

Similarly, the St Giles Trust, based in London, works with young people exposed to or at risk of violence. Their SOS project carefully recruits ex-offenders to engage young people.

The effectiveness of this approach was borne out in my research: in 2016 and 2017, I spoke with 20 young people and 20 professionals from a youth offending service in England, which works with young people who get into trouble with the law. One young person in my study said:

…unless you’ve experienced that, you cannot tell them…you cannot relate to them. Unless it’s happened to you, or someone that you know, there’s no way you can fully understand how they’re feeling.

Teenagers who are at risk of committing crime or being drawn into gang activity may be reluctant to talk to authority figures. But if the person they’re speaking to is an ex-offender themselves, they may be more forthcoming. For example, another of my participants, Anthony (aged 17), spoke passionately about a trusting relationship he had built with one of his workers, who had experience in the care and criminal justice systems.

Anthony said his worker was non judgemental and able to empathise and offer guidance when he was in a difficult situation. He described how he has contacted his worker on many occasions in a state of panic and valued receiving emotional and practical assistance. Anthony described his worker as inspirational, and was keen to follow in his footsteps in the future, by securing a job which involves caring for others.

Another of my participants – Zain, aged 17 – was also inspired by his mentor:

I’d love to do his job. He sort of inspired me. Cos I know about his past, he knows about mine. And it’s pretty similar, do you know what I mean? Grew up on a bad estate, got into drugs.

The right choice

Yet within the justice system there is still some scepticm about whether ex-offenders can steer their peers away from crime.

There are challenges: young people may lack the ability to offer emotional and practical assistance to their peers who are experiencing mental health problems. For this reason, it’s crucial to provide ex-offenders with appropriate training and ongoing support.

What’s more, they may have their own unresolved traumas, which could make it more difficult for them to form constructive relationships with both their peers and professionals. And this is why it’s important for authorities to screen and select the right people.

Yet peer mentoring can be an antidote to the disconnected, unhearing and technocratic criminal justice process. And the young people who engage in mentoring can discover that they have talents and abilities they didn’t know they had.

Because they’re seen as role models, rather than authority figures, young people who are ex-offenders can forge positive and meaningful connections with their peers, to the benefit of both parties. Above all, mentoring gives young people who have overcome their own hardships a chance to help others do the same.The Conversation

Sean Creaney, Lecturer in Psychosocial Analysis of Offending Behaviour, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why you shouldn’t take antibiotics for colds and flu

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And don’t infect everyone else in the office either. Shutterstock

Carol Kelly, Edge Hill University

Winter is well and truly on its way. For many, this conjures up images of log fires, mistletoe and festive feasts. But it can also mean cold, damp mornings, short hours of daylight and the dreaded cold and flu season.

Tickly throats, headaches, fevers and generally feeling rotten are the warning signs that many of us fear. Pressures of work and personal commitments often lead people to seek a quick fix from their GP or other healthcare professional. This usually takes the form of antibiotics.

Evidence suggests the use of antibiotics is on the increase, which is a cause for concern as the overuse of antibiotics has been linked to antimicrobial resistance. This is the ability of microorganisms – such as bacteria and viruses – to evolve so that antimicrobials (antibiotics and antivirals) become less effective at killing or working against them.

Antibiotic resistance results in standard treatments – such as many of the commonly prescribed antibiotics – becoming ineffective. And this leaves people who need antibiotics for serious infections vulnerable.

This issue has been recognised as a problem on a global scale in a UK government commissioned review. These findings led to the National Institute of Clinical Excellence (NICE) publishing quality standards to help clinicians when prescribing antibiotics to slow the rise in antimicrobial resistance.

Antibiotic expectations

The Cochrane review, on which I worked, found that many vulnerable patients have an increased risk of developing microbial resistance. This includes people with chronic respiratory illness – many of whom have “rescue packs” which include antibiotics at home. These repeat prescriptions are often issued without enough education to support their use or highlight their drawbacks – so unnecessary prescribing practices continue.

Beliefs and expectations by patients, healthcare professionals and society have been found to be the main drivers of the overuse of antibiotics. From a patient’s perspective, the desire to get better is often more important than any external considerations such as publicity campaigns. And for healthcare professionals, the greater good of society occurs outside the immediate consultation and is therefore often overlookedalong with existing evidence. This breeds a cycle of expectation and self-interest which serves both clinician and patient but neglects wider societal issues.

It is possible, then, that much antibiotic prescribing, particularly in the flu season, is driven by these expectations – from both patients and healthcare professionals. But this is not unique to antibiotic prescribing. Our previous research found similar behaviours with oxygen therapy. Despite emerging evidence and guidelines, poor prescribing and administration of oxygen therapy persists – and it is often given routinely for breathlessness to patients.

A medical priority

A UK parliamentary health and social care committee report on antimicrobial resistance has called for the issue to be regarded as “top five policy priority” for government – stressing the need to support the pharmaceutical industry to develop new antibiotics.

How Brexit will affect this investment and commitment is unclear. But there remains an urgent need to promote responsible and appropriate prescribing through education, research, guidelines and campaigns.

Current UK prescribing levels are reported as double that of other countries such as Sweden, Netherlands and the Baltic States. This presents a challenge for primary care and hospitals who need to reduce both the number of antibiotics prescribed and the length of time that they are administered.

Antibiotic efficacy

A recent government report has called for the use of rapid diagnostic testing to inform all antibiotic prescriptions. This approach should take the guesswork out of prescribing antibiotics by testing for blood markers that signify the presence of infection. Findings from a large trial based in the UK are expected soon.

Sometimes though, the prescribing of general use antibiotics is not only expected, but cheaper and easier. So it will require a concerted effort to promote responsible prescribing and educate all healthcare professionals, patients and the public to refrain from using antibiotics.

So as winter approaches, rather than rushing out to your doctors at the first sign of a sniffle, try and ride it out. Get lots of sleep, keep stress to a minimum and up your fluid intake – all of which have been shown to help in the treatment and staving off of colds and flu. It’s also worth being extra vigilant with hand washing to help keep those germs at bay and stop them from developing into something more nasty in the first place.The Conversation

Carol Kelly, Reader Respiratory Care, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Winter pressures and the NHS Ambulance Services: ‘Doing more with less’ is not an option

ambulances queuing outside A&E at a North West hospital

Paresh Wankhade, Professor of Leadership and Management and Emergency Services Management Expert discusses the issues the Ambulance Service faces as winter approaches in his latest Comment blog:

With each passing year, the winter crisis puts a massive strain on the NHS ambulance resources with huge bottlenecks in the transfer of patients into the hospital Accident and Emergency (A&E) wards. In 2017, media carried several reports which highlighted delays on the part of ambulance crews arriving at the scene, including deaths of the patient waiting for an ambulance. Some of these arguments have been well rehearsed and have also prompted emotional debates and the cries of “52 weeks of the year crisis” in the Parliament.  I have highlighted four issues which in my view are the key flash points for ambulance services to deal with such recurrent crisis.

Address the funding-demand gap

The sustainability of an underfunded and overstretched ambulance services is though well recognised, but remains unresolved. The National Audit Office reported that between 2009-10 and 2015-16, the number of ambulance calls and NHS 111 transfers increased from 7.9 million to 10.7 million (average year-on-year increase of 5.2 per cent), and income for NHS ambulance trusts’ urgent and emergency care activity increased by 16 per cent from £1.53bn to £1.78bn between 2011-12 and 2015-16, but ambulance activity over this period (NHS ambulance calls and NHS 111 transfers) rose by a massive 30 per cent. This is accompanied by significant shifts in the demand with only 10 per cent of 999 callers having a life threatening emergency despite the average annual increase of five to six per cent in ambulance demand.  Doing even ‘same with less’ is proving difficult for ambulance trusts, something I have argued in my recent piece.

 

Move away from response time targets

Response time targets have been historically used to measure ambulance performance. Since July 2017, performance of NHS ambulance trusts is being benchmarked against four new national standards, based upon patient’s condition, now enshrined in the NHS Constitution.  However, during May-September 2018, ambulance services in England failed to meet  all the standards. A recent Parliamentary Report concluded that ‘ambulance trusts have organised themselves to meet response-time targets, at the expense of providing the most appropriate response for patients’ (p.5).  Another view that ‘commissioners, regulators and providers still place too much focus on meeting response times” reported in the National Audit Report (p.8) is deeply worrying.

Our research points to similar conclusions. We have systematically documented a range of unintended consequences  of response time targets used by the ambulance services.  We have also explored the relationship between cultures, performance measures, and organisational change to understand how organisational culture is perpetuated and found the targets to be a significant factor impeding the process of change. Ambulance services have embarked on the drive for ‘professionalisation’ but our latest research suggests that as ambulance work continues to intensify, ‘issues around dignity, staff retention and the meaning of work are becoming ever more challenging’.

 

Introduce fines/penalty for hospital delays

Ambulance handover delays to hospital A&E departments can have serious implications for patient safety and reduce available ambulance resources. The 30 minute cycle (handover and readiness for next call) is proving difficult to resolve. NAO  figures suggest that in 2015-16, only 58 per cent of hospital transfers met the 15-minute expectation in 58 per cent of cases as against 80 per cent in 2010-11, and only 65 per cent of ambulance crews were then ready for another call within 15 minutes. There are inconsistencies on the part of commissioners to penalise hospitals that do not adhere to the guidance of 15-minute transfers in absence of a fining regime. A quality indicator for measuring hospital performance in meeting the transfer-time target has not yet materialised, notwithstanding the recommendations of the Committee of Public Accounts.

Improve efficiency and productivity

The Carter Efficiency Review, published last month, highlighted concerns about huge variations in the delivery of ambulance services. It suggested potential savings of £300m a year by cutting unnecessary ambulance transfers, along with further £200m through use of more efficient models of operations and procurement.  But the review also raised fundamental questions over the need for significant investment in the ambulance sector. The shortage and retention  of paramedic staff coupled with high sickness absence rates continue to be a problem, an issue highlighted in the draft NHS Workforce Strategy. However, the review raises the clear need for investment since one of the recommendations to reduce high conveyance rates is likely to have cost implications. This will also require high quality staff engagement.

 

Conclusion

There are no easy fixes and addressing the winter pressures will necessitate strong and visionary leadership by ambulance chiefs and cooperation from other health care partners, in a political climate dominated by Brexit. A ‘whole systems’ approach is crucial to deal with this crisis. The Dalton Review called for successful leaders to act as a ‘systems architect’ to use their entrepreneur skills to explore innovative organisational models, as set out under the NHS Five Year Forward View. The Carter Review necessitates ambulance leaders to make right business and spending decisions which will impact the NHS. Devising an effective public education campaign to minimise misuse of ambulance resources and managing public expectation, will be a good starting point.

County lines: the dark realities of life for teenage drug runners

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Jon Tyson/Unsplash., CC BY

Grace Robinson, Edge Hill University; James Densley, Metropolitan State University , and Robert McLean, Northumbria University, Newcastle

“County lines” is a term used by the police to describe a growing practice among criminal gangs: when demand for drugs fails to meet the supply in major cities, gangs travel to remote rural areas, market towns or coastal locations in search of new customers.

The process – referred to as “going cunch” (country) or “going OT” (out there) by those involved – has initiated ugly forms of exploitation. Children as young as 12 are hired as “runners” to transport and sell illicit drugs, while the homes of vulnerable adults are occupied without permission to create a base to sell from – a practice also known as “cuckooing”.

Tackling county lines is now a national priority: the government has launched a new £3.6m National County Lines Coordination Centre, made up of experts from the National Crime Agency. The centre aims to measure the threat of county lines, focus resources on the most serious offenders and work closely with partners in health, welfare and education to reduce the harms associated with the practice.

For our latest research, published in the International Journal of Offender Therapy and Comparative Criminology, we spoke with members of organised crime groups, police, staff on youth offending teams and young people aged between 14 and 17 involved in drugs gangs in Glasgow, Scotland and Merseyside, England, to find out what leads them to get involved in this practice, and how it affects their lives.

Working the lines

Before gangs started using the county lines model, class A drugs such as heroin and crack cocaine were typically supplied in remote areas by user-dealers who would sell to locals from their own supply. Competition in these areas was low, and violence was kept to a minimum.




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But in recent years, gangs have been using experience gained in the big cities to enter into smaller, satellite areas with high demand, good profit margins and low police presence. They are leveraging violent reputations earned in the big cities to intimidate and dominate existing players in the illegal drugs market. Police in picturesque county towns such as Shrewsbury (a town of about 70,000 people close to the Welsh border in Western England) are now dealing with turf wars and homicides.

A costly mistake. Shutterstock.

During our research, we found that one of the root causes of this problem is how normal it is among teenagers to use cannabis – and the monetary cost of this. Young people in our study began smoking weed recreationally with their friends as young as 13. Perhaps more significant than the psychological and physical effects of cannabis use, which are heightened around the time of puberty, was the fact that weed cost money that these adolescents did not have.

The majority of county lines workers we interviewed in Merseyside owed money to a drug dealer. They accrued debt by having their drugs “on tick” – a slang term for a “buy now, pay later” scheme. When they failed to pay, the indebted were forced into working for their dealers. Working the lines meant being deployed anywhere at any time, answering the phone without delay when their masters (or clients) called, and leaving their post only to meet paying customers.

Debt bondage wasn’t the only way people ended up working the lines. Some of our interviewees in Glasgow entered the trade by their own volition. They were willing to travel and simply asked known drug dealers for a job. Owing to boredom, poverty and a sense of hopelessness about their legitimate job prospects, these young people felt they had no choice but to sell drugs.

The experiences of young people who had made a choice (albeit a constrained one) to “go country” didn’t fully concur with the horror stories about the practice portrayed by the media. During their interviews, some young people recalled their experiences as “funny”, especially when they spoke of the exploitative relationships they had formed with vulnerable drug users.

A user-dealer’s flat is taken over by teenage drug runners. Source, Author provided
Young interviewees in both cities recounted how drug users would be “terrored” or intimidated to pass the time between waiting for the phone to ring and completing drug sales. Young people would entertain themselves by getting users to perform sex acts, eat from ashtrays and “shit off the floor” or undergo “challenges” in exchange for “free” drugs.

Removing root causes

Our findings expose a paradox at the heart of county lines – the exploited and the exploiters are often one and the same. Drug dealers, drug runners and drug users form a hierarchical structure, with the most vulnerable – the users – at the bottom. Drug runners look down on drug addicts to make themselves feel better about their own station.

County lines expose that drug prohibition is not working: current laws neither effectively prevent young people from selling drugs, nor protect the most vulnerable in society from consuming them. Positive initiatives such as the National County Lines Coordination Centre are necessary for sharing intelligence between police and social service providers, but constrained by the folly of existing drug policy.

Our research highlights that a criminal justice approach based on tough enforcement and recovering the proceeds of crime is not enough to dissuade dealers from dealing. Unless we tackle demand for illicit drugs, and the root causes of gang culture – namely social and economic marginalisation – county lines will continue to be drawn.The Conversation

Grace Robinson, PhD Candidate and Graduate Teaching Assistant, Edge Hill University; James Densley, Associate Professor of Criminal Justice, Metropolitan State University , and Robert McLean, Lecturer in Criminology, Northumbria University, Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Crime and nourishment – the link between food and offending behaviour

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tiverylucky/shutterstock

Hazel Flight, Edge Hill University; John Marsden, Edge Hill University, and Sean Creaney, Edge Hill University

It is well known that eating a balanced diet is of vital importance for maintaining good health and well-being. It is also one of the great social pleasures of life. Yet, far too many young people in prisons are consuming a poor diet, lacking in nutrition.

Alarmingly, research suggests over half of food items available for purchase in some prisons in the UK and the US are “high in fat or sugar”. It has also been suggested that in the US, prison food has been described as “scant, joyless, and unsavoury”. But it doesn’t have to be like this. Sant’angelo dei lombardi in Italy is said to have one of the best fed prisons in the world, where prisoners work to produce organic fruit and vegetables and leave healthier than when admitted.

Poor nutrition can impact on concentration and learning and may result in episodes of violent or aggressive behaviour. In prison, a bad diet can also contribute to increased rates of poor mental and physical health compared with the general population.

To tackle this problem, a new UK government strategy aims to provide young people with healthy eating advice on arrival in prison. Inmates up to the age of 21 will be provided with nutritional guidance so they can make “informed choices” about their diets.




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Poor diet, aggression and impulsivity

The amount and nutritional value of food available in prisons and the dietary choices prisoners make has a significant influence on the quality of a prisoner’s life. Consuming highly processed and sugary foods can lead to sudden peaks and troughs in the amount of glucose in a person’s blood. This can cause fatigue, irritability, dizziness, insomnia and is even a risk factor for depression – particularly in men. It has been shown that a diet of whole foods can offer protection against depression.

Deficiencies in vitamins and minerals can lead to a number of issues. For example, low levels of iron, magnesium and zinc can lead to increased anxiety, low mood and poor concentration, leading to attention deficits and sleep disturbance. Omega 3 is required to improve cognitive functioning.

Recent government policies have recognised the problem of additives and the high sugar content of food, with the introduction of the sugar tax and moves to address the use of colourings, which have been found to have a negative effect on behaviour and hyperactivity. A recent example of the UK government’s willingness to intervene in the purchasing decisions of young people is the outlawing of energy drink sales to under-16s.

The types of problems associated with a poor diet, such as aggression, attention deficits and hyperactivity can make impulsive behaviour more likely. Studies have shown that “high levels of impulsivity are connected with high and stable levels of offending”.

Addressing the problem

Lucy Vincent – a freelance journalist with a background in both food and fashion – has started a campaign to address the need for better food in UK prisons. She believes that decent nutrition has the power to positively impact self-esteem, health, learning and development. Young people in prison are likely to have struggled with these issues and providing a better diet is an important step in improving their emotional health and well-being.

But there are obvious difficulties in improving the diets of young offenders. For example, Public Health England suggests that providing a balanced diet costs £5.99 per person, per day. Yet some prisons have food budgets as low as £1.87 per person, per day. There are obvious economies of scale to take into account, but providing a balanced diet for young offenders would still be a costly exercise – at a time when other parts of the prison service are starved of funds.

With experienced prison officers leaving the service and their remaining colleagues protesting over unacceptable levels of violence, improving the diet of young people in prison will be difficult to achieve.

But if the UK is to come close to breaking the cycle of reoffending, it needs to meet the basic needs of young people in prison and respect the basic human right of adequate nutrition. Government advice for young inmates is one thing, but those in prison need to have healthy food to choose from if they are to have any hope of staying healthy in jail.The Conversation

Hazel Flight, Programme Lead Nutrition and Health, Edge Hill University; John Marsden, Senior Lecturer in Counselling and Psychotherapy, Edge Hill University, and Sean Creaney, Lecturer in Psychosocial Analysis of Offending Behaviour, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.