Thalidomide: Nine things you didn’t know about the ‘poisonous pill’

Thalidomide was marketed to pregnant women as an antidote for morning sickness in the late 1950s, but the results were calamitous. An epidemic of babies born with various disabilities including limb, organ and neural damage led to its withdrawal from sale in November 1961. There were over 5000 known thalidomide survivors living worldwide in 2003, including 500 in the UK.

As a healthcare researcher, I had come to understand the thalidomide catastrophe as a systems failure: the disastrous outcome of an inadequate medications approval process. My dad, Dr Martin Johnson, was Director of the UK Thalidomide Trust between 2000 and 2014, and through him I had come to learn about its terrible impacts upon individuals and their families. I also understood that many survivors were still awaiting justice. However, in 2018, together with his co-authors Professor Ray Stokes and Tobias Arndt, dad published ‘The Thalidomide Catastrophe’, the first and only comprehensive history of thalidomide. Reading it led me to realise I had been seeing through a glass darkly. When laid bare, the thalidomide story is stunning, shocking and almost unbelievable. Here I share with you nine things I learned from the book:

Ed, aged 3

Ed, aged 3

  1. The full number of people affected by the drug reached tens of thousands. It is well known that thalidomide caused babies to be born with disabilities. However, it is highly likely that many other children died in the days and months after birth and that even more were miscarried or stillborn because of thalidomide. Johnson, Stokes and Arndt estimate that altogether, between 87,600 and 275,500 babies were affected.
  2. A single tablet had disastrous effects. Researchers have been able to link the days on which tablets were taken with specific forms of damage. For example, a tablet on days 21-22 after conception could cause damage to, or loss of the eyes. A tablet on day 24 could cause loss of the arms and a tablet on day 29 could cause loss of the legs. The key message from this is that the babies who survived thalidomide were those whose mothers took a tiny amount of the ‘poisonous pill’.
  3. Key players in the development of thalidomide are linked with the Nazi regime. The book explores this issue in meticulous depth and it is hard to summarise the evidence briefly. However, two things are clear. The first is that the Chief Scientist of Chemie Grunenthal, the Germany company who patented the drug, was Dr Heinrich Muckter. Muckter spent World War 2 (WW2) at an institution which tested drugs on Buchenwald concentration camp prisoners. The second is that Otto Ambros was a consultant for the Distillers Company, the British organisation which distributed Thalidomide in the UK. Ambros was sentenced to 8 years for his war crimes during WW2, which included using slave labour from the Auschwitz III-Monowitz concentration camp.
  4. Thalidomide seriously harmed adults too. When taken for more than 2 weeks, thalidomide could cause adults to contract ‘polyneuritis’, nerve damage involving symptoms such as tingling, numbness, excruciating muscle cramping and even partial paralysis. It could affect coordination, balance and the ability to walk. Altogether, around half a million adults were probably affected. “The Thalidomide Catatrophe” provides the response from Chemie Grunenthal to one affected surgeon who used the drug. “Thank you for your letter of 8th March 1960 in which you tell us you are increasingly suffering from paraesthesia and… probable polyneuritis… We wish to advise you that we have received no such reports to date” (p110). This letter was a lie: the company had received several reports and their false reassurance may have caused the surgeon to keep taking the harmful drug. As Johnson, Arndt and Stokes comment, these effects probably cost this surgeon his career.
    TIna Gallagher

    Tina Gallagher in 2002

  5. Warnings the drug was dangerous were ignored. To this date, Chemie Grunenthal claim that they could not have known about the harmful potential of Thalidomide. The evidence presented by Johnson, Stokes and Arndt makes this almost impossible to believe. For example, there is clear evidence Grunenthal’s Chief Scientist, Heinrich Muckter, received warnings a year before thalidomide even went to market from Dr Piacenza, an Italian doctor who undertook trials of the drug. Writing in 1956, Piacenza reported that the drug was unsuitable due to its toxicity. He described side effects in adult patients which included a whole-body rash and peripheral nerve damage. Reports from concerned physicians continued to be sent to Grunenthal, but the drug was not removed from market. Concerns were also raised about the potential harmful effects of thalidomide on unborn babies. For example, in 1959, scientist Dr Randolph Riemschneider raised concerns that thalidomide was causing birth defects in tadpoles he was experimenting with. As he later recorded, “we sent this information with photos to Chemie Grunenthal… Unfortunately, no answer was forthcoming” (p115).
  6. Even when its impact was known, Chemie Grunenthal continued to sell thalidomide. There were warnings that thalidomide was harmful before it even went to market. However, Chemie Grunenthal did not publicly acknowledge its harmful potential until 1961. In a speech on 14th July that year, Heinrich Muckter, Grunenthal’s Chief Scientist told his staff, “if I were a doctor, I would not prescribe Contergan [trade name for thalidomide] any more. Gentleman, I warn you… I see great dangers” (p41). Yet he didn’t withdraw the drug from sale until November that year. If he had pulled it immediately after his speech, more than 25% of the babies who were affected would have been saved.
  7. The impacts of thalidomide are sometimes invisible. Not all survivors were affected by the limb damage which is characteristic of thalidomide. As a toxic nerve agent, it also caused devastating hidden damage. Johnson, Stokes and Arndt report the situation of Julie Lane, whose mother had been supplied with the drug. Outwardly, Julie only had minor hand damage. However, at a young age, she developed epileptic fits. In her teens, she lost the use of her legs and later on, her arms. She also gradually lost her hearing and her sight. As her epileptic brain activity was not typical, her symptoms were misdiagnosed as being psychosomatic, and not of physical origin. This caused her problems to be stigmatised. However, a post-mortem conducted after she died aged 44 showed evidence of major internal damage which had been there since birth.
  8. Survivors still wait for justice. Chemie Grunenthal, the company which patented thalidomide, has never been held to account. A trial was called in 1968 but later suspended, apparently on the basis that “public interest in a continuation of the criminal prosecution no longer exists” (p.131). In the UK, Distillers, the company which distributed the drug paid out some compensation following a lengthy legal battle. However, survivors in some other countries have never received compensation, and all survivors are still waiting for an apology from Chemie Grunenthal.
  9. Some countries protected their populations from thalidomide. Several countries which considered licensing thalidomide denied or significantly restricted the sale of the drug. These included Turkey, East Germany, the USA and France. In Turkey, Dr Aygun undertook tests involving tissue cultures and concluded the drug was unsafe in 1960. In East Germany, the relevant officials had concerns based simply on the information supplied in the patent. They noted that due to the structure of the molecule, an “embryo-toxic effect” (p124) was possible. They refused a license. In the USA, Dr Frances Kelsey resisted significant pressure from the prospective American licensee company (Richardson Merrell) and managed to delay the approval of the drug until it was removed from sale in 1961. Her delay meant that only around 160 babies are estimated to have been affected by thalidomide in the USA. What these countries show is that the toxic properties of thalidomide were possible to identify using the technologies and processes of the time. Those governments which failed to prevent the distribution of thalidomide are partly to blame for the disaster, and should also be held to account.

 

In 2019, the generation of thalidomide survivors is turning 60. What “The Thalidomide Catastrophe” makes clear is this: the international sale of the drug was preventable. Its risks should have been identified by the company which patented the drug, those which distributed it and by the governments which allowed its sale. The damage which was initially caused has been extended over six decades by a failure to acknowledge and apologise for the harm that was caused. The need for an apology remains.

How to start a journal and beat the academic publishing racket

Academic publishing is a multi-billion pound industry, with profit margins reportedly higher than those of Apple, Google and Amazon. It has always struck me as a racket: academics sign over their work to private businesses for free, and then their universities pay the same businesses hefty fees in order to read what they publish. Academics are also responsible for editing these journals and providing the peer-reviews, usually for free.

It hasn’t always been this way. In a remarkable brief history of the academic publishing industry, Stephen Buranyi highlights the key role of Robert Maxwell, a brash business tycoon whose greatest desire was to “be a millionaire”. Maxwell arrived on the scene just after the Second World War, which was a key turning point in academic history. The post-war years saw a huge growth in the number of people attending higher education and also in the academic publishing trade. In 1950, there were 10,000 journals published worldwide, but by 1980, this was had reached 62,000. Robert Maxwell and other businessmen capitalised on this growth and took the opportunity to privatise what had previously been a largely non-profit sector. There is now growing awareness that this industry is both ludicrous and detrimental, unwieldily costly and harmful to the progression of science. However, solutions are slow in coming. While open-access journals are growing, the majority of these charge fees for publication that far outstrip real costs. For these reasons, I have been intrigued and encouraged to see the development of peer-reviewed open access journals which do not charge authors to publish with them. These include Musicology Research Journal (MRJ), whose Chief Editor is Dr James Williams, Senior Lecturer at the University of Derby, and Psychreg Journal of Psychology (PJP), whose Chief Editor is Dennis Relojo-Howell, founder of leading psychology blog Psychreg. These journals offer a solution that previously would have been regarded as impossible: they are both free to the authors and free to readers. I spoke to Williams and Relojo-Howell to understand more about their journals.

Why start a peer-reviewed academic journal?

As both Williams and Relojo-Howell attested, self-publishing an academic journal is a significant amount of work. So why do it? Williams said his motivation arose from his experience as a PhD Student and early career researcher. “Acceptance of manuscripts in current musicology-based journals can sometimes feel a little elitist. Editors and traditional publishers prefer to go with already-known academics, and are less likely to take on manuscripts from early-career scholars”. Williams also described his dissatisfaction with the traditional academic publishing industry, and its money-oriented focus. MRJ meets this gap by focusing on publishing the work of early career researchers, and by managing all copy-editing and manuscript management in-house. Relojo-Howell’s motivation was different. As a psychology blog editor, he had begun to receive blog post submissions that were overly long and technical. These posts weren’t suitable for publication as blog posts, but he could see their importance and academic merit. He created the journal to provide an outlet for these articles, and to broaden the overall scope of Psychreg. 

Ten steps for starting a journal

Whatever the focus of your journal, the steps for setting one up are similar.

  1. Identify the gap. What is the need your journal will meet? How will it improve information sharing in your field? Once you’ve identified this gap, you need to set the scope of your journal. Decide which types of articles you will include, and those you won’t.journal website
  2. Build a website that will home your journal. A full description of this process is beyond the capacity of this article (and my expertise!) but the key parts of this are to buy a domain name, find a web hosting company and then prepare the content within this. Popular web-creation platforms are wordpress.com, wix.com and weebly.com. Relojo-Howell suggested that it’s also worth looking into the Public Knowledge Project: this provides Open Journal Systems (OJS), federally funded software designed to support the set up and management of open access journals.
  3. Set up an editorial board. Both Williams and Relojo-Howell highlighted the importance of this. First, this group can provide the strategic direction and support that can get your journal started and help it grow. Second, this group can provide credibility to the project. As Relojo-Howell said, “When I started, potential contributors were only interested in who was on the editorial board. I have never been asked about the journal’s impact factor”.
  4. Involve associate editors who can provide support. Williams described the importance of including a multi-skilled team. “We have editors with different areas of expertise and varying skillsets, including people who are familiar with copy-editing and academic publishing”.
  5. Call for papers. You can spread the word about your new journal via social media, personal networks and by contacting other relevant university departments. Neither Williams nor Relojo-Howell had found this aspect challenging. As Williams said, “We have only ever advertised the journal in the UK, but we have received submissions from Australia, Canada, the USA and Asia”.academic publishing
  6. Manage your submissions. Traditional journals use manuscript-management software, but this comes with a steep price tag. “I contacted Emerald about their systems”, Relojo-Howell said, “but they asked for £38k”. Open Journal Systems (OJS) provides an alternative, free-to-use alternative, but this isn’t necessary. “I use a spread-sheet to keep on top of submissions”, Williams said. “It works fine”.
  7. Copy-edit and type-set your articles. While this may feel like a challenge, both Williams and Relojo-Howell said it was possible to do using widely available software. Williams said that he uses Word and Adobe programs to provide a professional-looking finish to his articles. Relojo-Howell commented on the fonts he uses: “I use a combination of paid-for fonts and some free Google fonts”.
  8. Apply for an International Standard Serial Number (ISSN). For us in the UK, this involves submitting an application to the British Library. Williams suggested that the British Library will expect to see evidence of around 3-4 previous publications and a commitment to continue publishing on a regular basis.
  9. Plan how to give your articles a Digital Object Identifier (DOI). DOIs are a string of numbers, letters and symbols used to permanently identify an article of document and link it to the web. Relojo-Howell recommends using Zenodo for this purpose. Initially funded by EU project funding, Zenodo is now open to all research outputs and offers its services free of charge for open access publishers.
  10. Wider registration. There are a variety of international platforms with which to register journals, including Web of Science, PubMed and SCOPUS. This type of registration seems to be a longer term process, however. Relojo-Howell said he had contacted both the Directory of Open Access Journals (DOAJ) and Thomson-Reuters, but they indicated that they would expect journals to be up and running for closer to five years before they would register them.

Other considerations

  • Finding peer-reviewers. My colleagues who edit traditional journals have described to me the challenges of finding peer-reviewers. While Williams and Relojo-Howell suggested this could also be challenging with new, open access journals, Williams suggested a personal touch could help support a positive response rate. “We approach academics who are working closely in the field of the article, and send personal requests. 60 or 70 per cent of the time, they agree”.
  • Clarify that you are a genuine academic ground-roots initiative. Unfortunately, at the same time that the genuine open-access field is growing, the number of predatory journals is proliferating at great speed. In a previous post, I clarify the warning signs of academic spam emails. However, if your potential contributors are concerned, let them know that the first clear distinction is that predatory journals ask for large sums of money and usually offer to rush through submissions at great speed. The second clear distinction is your academic board. You can signpost potential contributors to contact your board members for reassurances, if they are concerned.

Is it worth it?

Both Williams and Relojo-Howell admitted that their journals were time consuming and offered no financial benefits. However, what is clear is that starting these journals offers significant job satisfaction. As Williams said, “I saw it as a real problem – I wanted to help other graduating PhD music students… I don’t think I have reaped any rewards for myself, but I do know a lot of people now. It’s great for networking”. Similarly, for Relojo-Howell, the reward lies in contributing towards open science: “I wanted to demonstrate that dissemination of science can be reconstructed to become more democratic – a science that is shared for wider consumption”.

Ten tips for aspiring Clinical Psychologists

The competition to become a Clinical Psychologist is fierce. In the UK, the constituent parts of the training are a three-year undergraduate degree which is accredited by the British Psychological Society (BPS), and a three-year taught Clinical Psychology doctorate. The doctorate is full-time; candidates are employed by the NHS and complete a series of six-month placements in addition to coursework and a research project.

Psychology undergraduate students self-fund their degrees and as such, courses have flexibility about the number of students they can enrol. Psychology is consistently the second most popular degree in the UK, with an estimated 13,000 graduating each year. However, until recently, the only places offered on the doctorate were NHS funded, and therefore carefully regulated. Between 2012 and 2018, doctorate courses enrolled around 590 students per year altogether; just 15% of the total number of applicants. While three courses now include self-funded places, these come with a price tag of £20k+ a year, putting them out of reach of most graduates. 

Here, I offer 10 tips for aspiring Clinical Psychologists:

1. Know the bottom-lineIf you are at the point of applying for the doctorate, look at the particular courses you are interested in on the Clearing House website. What are their non-negotiables? Many courses now stipulate that candidates must have a 2:1 or a score above 65% in their undergraduate degree. Others require that applicants have a year’s clinical experience supervised by a qualified psychological therapist. If you don’t meet their stipulations your application will be automatically excluded, even if it is otherwise strong.  It is therefore worth researching each course’s bottom-lines before you apply.

2. Look into placement-year degrees. Several universities including Aston, Bath and Leeds (where I am based) offer applicants the opportunity to undertake a placement year ‘in industry’ between the second and third year. This means that students can gain relevant clinical experiences which can help them to be competitive applicants for graduate jobs. These placements are overseen by the universities, helping to ensure that they provide students with more useful experiences than they may gain through general volunteering. Some placements also offer a contribution towards expenses or a stipend, which volunteer roles generally do not. 

3. Consider the ‘Increasing Access to Psychological Therapies’ (IAPT) initiative for an alternative career as a psychological therapist. IAPT was launched in 2007 to provide greater access to psychological interventions for people with mild-to-moderate anxiety and depression. It is now planned to expand in order to provide therapies to 1.5million adults per year by 2020/2021. There are two main types of psychological therapists working in IAPT: Psychological Wellbeing Practitioners (PWPs) and High-Intensity CBT Therapists (HITs). PWPs are recruited into training positions with IAPT services on an NHS band 4; once they are qualified, they are paid at band 5 and can progress to band 6 (for information on NHS pay bands, see here). Similarly, HITs apply to train with specific NHS services. They train on band 6 and are paid on band 7 once qualified. Sign up to NHS jobs for alerts about these roles. A follow-up of HITs suggested that 79% stay in IAPT services after qualifying, 61% become CBT supervisors and 23% progress to more senior roles. It also possible to self-fund training to qualify as a CBT therapist, by undertaking a postgraduate course accredited as Level-2 by the British Association for Behavioural and Cognitive Psychotherapies (BABCP). 

4. “Remember at the end of the day, it’s just a job”. This was the best advice I was given before I attended my interviews for the Clinical Psychology Doctorate. A qualified Clinical Psychologist called me to give me some advice, and these words helped remind me that I wasn’t auditioning for the X-Factor: at absolute best, I would become a qualified psychological therapist. Imminent fame, stardom and riches were not around the corner. Being a Clinical Psychologist in the NHS is a wonderful job, but it is not without stress and strain, like any other healthcare related job. So, relax: it’s just a job.

5. Vary your experiences. Working as a research assistant or assistant psychologist will give you great experience for the Clinical Psychology doctorate, but more than a year in any one post will have diminishing returns. While you will always need to balance the opportunity to gain varied experience with the need to pay your rent and bills, it’s worth remembering that having a broad skillset will give you the strongest CV and application.

6. Treat applications like assignments and interviews like exams. You cannot assume that the knowledge and experience you have will naturally shine through: work hard to sell yourself. Consider carefully the range of experiences you have had. For example, what is the range of client groups you have worked with? What experiences have you gathered? Think carefully about the knowledge you have in relation to engaging different client groups, conducting assessments, collecting and storing sensitive data, managing risk, and applying psychological theory to individuals, for example by contributing to formulations or interventions. Also consider carefully the job which you are applying or interviewing for: who is interviewing you, and what is their area of interest? Which client group will you be working with, and what things might you need to be conscious of? Which therapeutic modalities might you be using, such as CBT or psychodynamic approaches? One way to impress your interviewers is to appear prepared for the opportunity they are offering.

7. Consider alternative psychology disciplines. If you have a BPS-accredited undergraduate degree, Clinical Psychology is not your only option for working therapeutically. For example, many posts which are open to Clinical Psychologists are also open to Counselling Psychologists. To train as a Counselling Psychologist, you can either do a self-funded doctorate degree or the BPS qualification in counselling psychology; this involves three years of supervised practice. More information is available here. Alternatively, for psychologists interested in working with forensic populations, Forensic Psychology may offer a fulfilling alternative career to Clinical Psychology. In some secure hospitals, much of the work of Forensic Psychologists involves delivering psychological therapy. To train as a Forensic Psychologist you can either complete a Doctorate in Forensic Psychology or a Masters in Forensic Psychology followed by two years of BPS training and supervised practice. More information on becoming a Forensic Psychologist is available here. It is also worth noting that the University of Birmingham now runs a four-year doctorate which offers candidates a dual qualification in both Forensic and Clinical Psychology (see here). 

8. Look for research opportunities. As an undergraduate I undertook some voluntary work as a research assistant with a professor and lecturer in my department. It was one of the best decisions I made: it paved the way to my Medical Research Council-funded PhD in Resilience to Suicidality and kick-started my love of improvement in healthcare. It also helped me to gather a range of experiences in working with clinical populations, as my PhD involved undertaking psychological assessments with people with psychosis and testing a novel mood-boosting intervention in this group. I would highly recommend seeking research opportunities to aspiring Clinical Psychologists. If you are currently a psychology undergraduate, seek opportunities with clinically-oriented researchers in your department. If you are a psychology graduate, sign up for job alerts at jobs.ac.uk and look for opportunities which would allow you to gain experience working with clinical psychologists and/or researching with clinical populations.

9. Keep your eye on the proposed role for ‘Clinical Associate Psychologists’. This is anticipated to take the form of an apprenticeship which will last 18 months and produce psychology professionals who undertake psychological assessment and formulation, and who deliver psychological interventions. At the moment, it is suggested that each Clinical Associate Psychologist will train on a Band 5 salary and be paid at Band 6 once qualified. The plans are currently in development, but should be in place in the coming year. 

10. Take heart: the need for psychologists is not diminishing. While the sense of competition may feel overwhelming, the demand for psychological therapies is increasing, which is reflected in the introduction of the IAPT initiative and the new role of the Clinical Associate Psychologist. While getting a place on the Clinical Psychology Doctorate may be challenging, if you have a passion for psychological work, the future is bright!

Finally, I want to note that while the cap on funded places for the Clinical Psychology doctorate produces a low success rate at the point of enrolment, I believe it also offers significant benefits. First, the competition that the cap creates means that aspiring Clinical Psychologists need to seek additional experience and training after their undergraduate degrees to strengthen their applications. This experience ensures that all doctoral trainees know the discipline they are working in and can feel confident in their career choice before they sign-up to the three-year course. This is reflected in the high retention rates of courses (99.4%): students rarely fail to complete their doctorate, once they’re on it. Second, it means that once qualified, Clinical Psychologists have good job prospects: 95% are employed in a clinical psychology job within 12 months of graduating. Deregulating the number of doctorate training places could shift this balance, creating the possibility that qualified Clinical Psychologists could become unable to find employment. By ensuring that applicants are experienced and committed, I believe that continuing to fund all forms of postgraduate psychological training offers the best outcome for applicants, healthcare providers and clients.

Seven ways to spot academic spam

This week I read an editorial by Becker and colleagues (2019) which warned against the dangers of “online solicited content journals”. These predatory journals use academic spam emails to elicit contributions from researchers and are fast becoming the dark shadow of the academic publishing industry. While academic publishing is notoriously lucrative, the impact of this has generally been to hold science back, rather than to promote misleading findings. High profile cases of academic misinformation have been thankfully rare, supporting continued public trust in academics. However, Becker and colleagues warn that solicited content journals threaten this. For a fee, these journals offer authors the opportunity to have their work published within weeks; a stark contrast to the months-long, soul-searchingly slow process inherent to most standard academic journals. These journals often purport to be peer-reviewed but the quality of this is highly questionable. Becker and colleagues suggest that authors could be tempted to submit to these predatory journals by the offer of a fast publishing process. They warn that circumventing peer-review risks introducing misinformation to the academic publication process.

However, the biggest problem, I believe, is confusion. These journals approach researchers as soon as they have a single academic publication, presumably lifting their email addresses from the author contact details of published papers. For a new or lay researcher, their invitations can be very confusing. Furthermore, these emails appear to be becoming more sophisticated in their approach. They are not restricted to eliciting journal submissions, either: I now receive about as many spam emails requesting my ‘gracious presence’ at various conferences. Below I offer seven tips for distinguishing academic spam from genuine invitations:

  1. Avoid all invitations that look like a mail shot. Watch out for signs that the email could have been completed with mail-merge software. If your name is back to front (Dear Johnson Judith), your co-authors are also listed, an email address is used in place of your name or a title of one your papers is pasted in its entirety, it is probably not genuine. 
  2. If the invitation requires you to follow a link, it is most likely spam. Any personal invitations to contribute a paper, chapter or conference submission will ask you to respond to the person who emailed you.
  3. Do not agree to read receipts from unknown contacts. Read receipts are usually requested when something is urgent or otherwise a priority. I have never received a genuine invitation to submit a paper, chapter or talk which requested a read receipt.
  4. Don’t be fooled by flattery. If I receive any email that begins, ‘Dear eminent professor’, I delete it. This person clearly does not know me. Spam emails are usually both overly enthusiastic (think, ‘greetings for the day!’) and overly complimentary.
  5. If it sounds too good to be true, it probably is. If they’re offering some limited time, cut price deal on article publishing fees, what they are offering you is not worth any fee. Similarly, if the conference they’re inviting you to is in Valencia, Hawaii or Phuket, be sceptical. I’ve yet to receive an academic spam email inviting me to speak in Birmingham. 
  6. If an unknown contact asks you a stupid question, bin the email. The most sophisticated academic spam I’ve received yet asked me for the contact details of one of my high-profile collaborators. Although I was confused (she’s the first hit on google if you type in her name), I obliged with a response. Having enticed me into a conversation, the spammer then replied saying that my collaborator was hard to get hold of, but they’d be delighted if I could contribute to their journal.
  7. Do your own research on the spammer. Look up the journal you have been contacted about: does its website resemble those of bona fide journals? Who else has published in it? Which databases is it indexed with? Conferences can be even harder to figure out. However, most genuine academic conferences will be aligned with a university, professional organisation or healthcare organisation. In the absence of this, you can look up the conference’s history and their previous and present speakers. After all – the most important thing about any conference is the opportunity to meet with other researchers and professionals in your area.

Reflective practice groups for liaison psychiatry nurses: are they helpful? Our study

Liaison psychiatry nurses have a tough job. They are based in the Emergency Department and work with individuals experiencing acute distress; these patients may have recently self-harmed or attempted suicide and could be at high risk of further harm. Liaison psychiatry nurses contact gatekeepers to other services while under the pressure of national waiting-time targets. They usually have no continuity with patients after they are discharged and may be left wondering how their patients’ situations turned out in the end. Both mental healthcare staff and emergency department staff are high risk groups for burnout (Johnson et al., 2018; Potter, 2006); liaison psychiatry nursing combines each of these elements and so these nurses may experience particularly elevated stress.

In order to provide liaison psychiatry nurses with more support, one hospital introduced reflective practice groups. The groups were a protected hour: the liaison psychiatry nursing team left the department to go to a quiet room in another building where they could not be contacted. The groups were facilitated by a clinical psychologist already employed by the hospital. I particularly liked this feature; too often I hear about outside consultants being paid hefty sums to deliver wellbeing packages with hazy evidence bases, when most healthcare organisations already have a group of highly trained professionals employed in their  psychology department who can do this work. The psychologist enabled dialogue between the team members and facilitated their conversation but did not impose an agenda.

When I was invited to contribute to the evaluation of this intervention I was delighted. We interviewed 13 liaison psychiatry nurses who had attended the group. They identified four main benefits of participating:

  • Sharing and learning. Participants found that sharing their experiences in the group helped them to feel less alone. They realised that other people in their team were experiencing similar challenges and they left the group sessions feeling clearer-minded and lighter.
  • Grounding and perspective. Participants said the group allowed them to take a step back and gain perspective on the difficulties of their work and the risks involved. It reminded them of the value their work has.
  • Space. Participants described the group as a safe space; they felt able to ask for help or to say they were unsure of things and seek advice from their colleagues.
  • Relationships. Participants said the group supported some positive interpersonal experiences between team members. The fact that they had an external facilitator and were guaranteed to be free from interruptions led them to feel they could raise difficult issues with their colleagues, in the knowledge they would be able to resolve these before the conversation ended.

It should be noted that not all nurses found the group beneficial. Some felt that the types of discussions they had during reflective practice were already happening elsewhere and they believed a protected space was not necessary. However, these nurses recognised that some of their colleagues benefited from the group, and were willing to participate in recognition of the overall team benefit.

We weren’t able to quantitatively evaluate the group as the number of participants in the study was too small. However, our qualitative data suggested that overall these groups provided a range of benefits which would have been hard to get from another forum, and some participants believed that sickness absence in the team would have been higher without them.

Practical tips for running reflective practice groups

For anyone wanting to run reflective practice groups, our study suggested a few things should be considered:

  • Groups shouldn’t include managers. The presence of managers changed the nature of the group and inhibited open discussion.
  • Protected time is key. Nurses stated that the groups were the only time they were guaranteed to have a conversation at work without interruption, and this was an absolute necessity for helping them feel able to discuss sensitive issues.
  • The facilitator must be external to the group. Previous research suggests nurses trained in reflective practice can supervise these groups and there can be benefits to having someone of the same discipline provide this facilitation. However, experienced clinical psychologists should be sufficiently trained to offer this in the absence of trained nurses. Our study suggests this is acceptable to nurses and the important thing is that the facilitator works in healthcare but is external to their team.

A practical and cost-effective solution

Further research is needed to establish the effectiveness of reflective practice groups for supporting staff wellbeing. However, the evidence base for burnout reduction interventions in general is still small (see my previous blog on this here), and the best methods for supporting staff are not yet established.  While we wait for evidence-based recommendations, reflective practice groups are a cost-effective form of support for liaison psychiatry nurses: they require no special equipment, no long periods of staff absence from work and can be facilitated by in-house psychologists, so no expensive outside consultants are required.

To read this study please see here