Supporting perinatal mental health: from peer-support to specialist services

There is a societal expectation that pregnancy and the arrival of a new baby are happy and exciting times.  However, it may come as a surprise to learn that up to 1 in 5 women develop a mental illness during pregnancy or within the first year after having a baby (also known as the ‘perinatal period’).

Up to 1 in 10 women may develop postnatal depression, however, there are actually a number of other mental illnesses that can affect women during pregnancy or following birth.  These include:

  • Antenatal depression
  • Perinatal anxiety
  • Perinatal obsessive compulsive disorder
  • Post-traumatic stress disorder (PTSD)
  • Post-partum psychosis

These illnesses can range from mild to severe.  Left untreated, perinatal mental illnesses can have a devastating effect on mental and physical health.  In fact, suicide is the leading cause of death for mothers during the first year after pregnancy.

The wider impact on children and families

Perinatal mental illnesses can also impact upon children, partners and significant others.  Research shows links to depression in partners, higher rates of divorces, lower levels of emotional and cognitive development and higher levels of behavioural problems and psychological disorders among children.

As well as the high human cost, there are also a number of economic costs associated with failing to address perinatal mental health needs. Research commissioned by the Maternal Mental Health Alliance found that perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

In comparison, it would cost only an extra £280 million a year to bring the whole pathway of perinatal mental health care up to the level and standards recommended in national guidance.

Access to specialist services is a ‘postcode lottery’

The good news is that most mothers who experience mental ill health can and do make a full recovery.

At present, mild to moderate cases of mental ill health in pregnancy and following birth are treated by the GP through anti-depressants, talking therapies and/or support from a community mental health team.  For more complex or serious illnesses, GPs can make a referral to specialist perinatal mental health services for expert advice and support.  This may involve staying in a specialist psychiatric Mother and Baby Unit (MBU) – where mothers and their baby can be admitted together.

However, despite the high prevalence of, and risks associated with, perinatal mental illness, access to specialist perinatal mental health services across the UK is a postcode lottery.

Maps by the Maternal Mental Health Alliance show that women in around half of the UK have no access to specialist perinatal mental health services.  There are currently no MBUs in Wales or Northern Ireland, meaning mothers with more serious or complex mental illnesses often face either being admitted to a MBU far from home, or being admitted to a general psychiatric ward without their babies, in order to receive treatment.

For those with mild to moderate mental illness, waiting times for NHS talking treatments can be many months.  Lack of awareness means that many cases of mild to moderate mental ill health go undiagnosed and untreated.  There is an urgent need for both greater awareness of mental illness and better access to mental health services across the country.

The role of peer-support

In recognition of and response to the need for better access to mental health support for pregnant and new mothers, a number of local ‘grassroots’ peer-support projects have been established by dedicated volunteers and campaigners.

One such project is Blank Canvas.  Blank Canvas is a creative journaling workshop in Lanarkshire, aimed at women during pregnancy or in the first two years since birth, who are experiencing mental health difficulties.

The project was set up earlier this year by midwife Elaine Connell, together with some of her midwife colleagues, who shared her dedication to improving mental health support for women in the perinatal period.

Elaine was keen to start her own peer support group following her own personal and professional experiences of perinatal mental ill health, and was inspired by the success of other projects focusing on art and creativity, such as Maternal Journal.

As Elaine explains:

It is free… …to access, and each attendee is given their own art kit to keep. We have a different theme each week and have guest speakers coming to do sessions also. During the group they can explore new art materials and create reflections in their journal, whilst chatting over some tea and cake. Each session they will take home a prompt card which can inspire their journalling during the week until the group meets next.”

Blank Canvas is free to access and works on a self-referral basis, with advertising mainly through Facebook.  A local shop and community space (Swaddle in Hamilton) donated a venue space, and all other costs (including materials) have been raised by volunteers committed to the project, through fundraisers such as coffee mornings and participation in the Kiltwalk.

Elaine has conducted an evaluation of the first 10-week block and feedback from participants has been extremely positive.  Word about the project has spread and the next block of Blank Canvas – which started on the 18th September – is fully subscribed (with a waiting list).  As Elaine notes, this is fantastic for the project, but highlights the high level of demand that exists for mental health support among new mothers.

The long term plan is to run 6-week blocks frequently throughout the year, moving to separate antenatal and postnatal sessions in 2020.  Elaine also hopes to start up a creative journaling group aimed at fathers too – noting that father’s mental health is often overlooked.

One of the key things Elaine has learned from the creation of Blank Canvas is that there is a lack of support available for people who want to establish their own peer-support groups:

What has been clear when forming the group, is that there is very little support to establish peer support. There are lots of people who want to help others but who won’t because they don’t know where to begin, or how to access funding, or lack of training opportunities.”

Grassroots peer-support groups are an important source of support for mothers in the perinatal period, particularly in cases of mild to moderate mental ill health, where NHS capacity is strained.

Attending peer-support groups such as Blank Canvas may also have a preventative effect for mums who attend during pregnancy. Statistically, women who experience antenatal anxiety are more likely to develop postnatal depression, and so early intervention could help to reduce that risk.

Urgent need for better access to specialist services

While these projects have been successful, they are aimed predominantly at women experiencing mild to moderate mental ill health.

For those experiencing more complex or serious mental ill health, there remains an urgent need for better access to specialist treatment and support.  The Maternal Mental Health Alliance ‘Everyone’s Business’ campaign calls for all women throughout the UK who experience perinatal mental ill health to receive the care that they and their families need.  Specifically, it demands that:

  • perinatal mental health care should be clearly set at a national level and complied with
  • specialist perinatal mental health teams meeting national quality standards should be available for women in every area of the UK
  • training in perinatal mental health care should be delivered to all professionals involved in the care of women during pregnancy and the first year after birth

Promising signs of progress

There have been some promising signs of progress.  NHS England recently announced their plans to rollout specialist perinatal community services across the whole of England, including the opening of four new Mother and Baby Units.

And in Scotland, the Scottish Government recently announced the rollout of an initial £1 million for perinatal mental health services, as part of a wider £50 million investment in mental health services.  This initial investment will support a range of areas, including supporting the third sector to provide counselling, befriending and peer support for women and their families.  It will also help provide more consistent access to psychological assessment and treatment, by increasing staffing levels and training at Mother and Baby Units, for women with the most serious illnesses.

The Scottish Government also established a Perinatal and Infant Mental Health Programme Board earlier this year.  The PIMH Programme Board aims to help implement the commitments to improving perinatal and infant mental health set out in the 2018/19 Programme for Government and Better Mental Health in Scotland.

Clare Thomson, Everyone’s Business Co-ordinator for Scotland, says “It’s fantastic to see the evidence-based approach to developing community perinatal mental health services and look forward to hearing about the first steps – particularly in the North of Scotland“.

Perinatal mental health is Everyone’s Business

However, there is still much to do, including ensuring that this funding translates into services on the ground.  Wales and Northern Ireland are still without MBUs and there is a pressing need to raise awareness of and address mental illness among fathers.

The cost to the public sector of perinatal mental health problems is 5 times the cost of improving services.  It clearly makes sense to invest in improving this care – not only from an economic perspective, but to help improve the lives of women, their children and families across the country. And while more funding is essential to achieve this, raising awareness of the importance of perinatal mental health really is ‘everyone’s business’.


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Gardens of the dead: cemeteries as spaces for nature

The cemetery is an open space among the ruins, covered in winter with violets and daisies.Percy Bysshe Shelley, Preface to Adonais (1891)

Percy Shelley’s description of the Protestant Cemetery in Rome perfectly illustrates how the cemetery, often negatively associated with death and decay, can in fact be a place where nature flourishes.

In this blog post, we highlight some of the great work being done to promote and conserve biodiversity in cemeteries, and the wider benefits of this.

Cemeteries as ‘green oases’

The importance of cemeteries as urban green spaces is often overlooked.  Relatively untouched by surrounding urban development, cemeteries often act as green oases, providing a range of important natural habitats for many different – and often rare – plant life and animals.

Indeed, as the 2000-01 Select Committee Report on Cemeteries observes:

Cemeteries support a wide range of habitats, including relict grasslands, heath, ancient and secondary woodland, scrub, hedges, ponds and flushes, as well as more artificial features such as high maintenance lawns, stands of trees, ornamental flower beds, and shrubberies. In addition, buildings, monuments, tombs and headstones, made from a variety of rocks, can provide support for lichens, mosses and ferns, as well as providing geological interest. A large number of rare species of trees, plants, fungi, invertebrates, reptiles, birds and mammals are found in cemeteries. Cemeteries are often designated as local Wildlife Sites, and sometimes as Nature Reserves.

Green space such as that provided by cemeteries, churchyards and other burial sites is important for a number of reasons.

From an environmental perspective, green space can help to address the negative effects of climate change, including the catastrophic decline in the number of insects. And from a human perspective, research has consistently shown the health and wellbeing benefits of access to green space.

Thus, cemeteries have an important role to play in both supporting the environment and promoting the health and wellbeing of local people.

Case study: Glasgow Necropolis

The Glasgow Necropolis is an impressive example of a Victorian garden cemetery, designed to be both inspiring and aesthetically pleasing.

Today, it is the second largest greenspace in the centre of Glasgow and provides a diverse range of habitats for wildlife, including sandy slopes, ivy-covered rock, wooded areas and unmown areas of grass and wildflowers.

The Friends of Glasgow Necropolis is a charity staffed entirely by volunteers dedicated to the conservation of the cemetery.

As well important monument conservation and restoration projects, and hosting walking tours to engage and educate the public, they also work to support the cemetery’s role as a space for nature.  One key aspect of this is recording and monitoring the flora and fauna within the cemetery.

Recent surveys have found that the Necropolis supports over 400 species of animals – including a variety of species of birds, bees, butterflies, insects and spiders, as well as deer, foxes, squirrels and rabbits, and a variety of other small mammals. Some of these species are particularly rare, including the aptly-named hoverfly, Eumerus funeralis.

There is also a wide diversity of plant life.  In total, 180 species of flowering plants and trees have been recorded in the Necropolis, and there are also at least 15 species of lichens – including one rare species (Lecania cyrtella).

Other key projects have sought to actively enhance the biodiversity of the cemetery – such as the creation of a wildflower meadow, planted with the help of local school children, and the creation of the ‘Green Man’ – a 3D grass head sculpture, in collaboration with the Glasgow School of Art, Glasgow City Council, Dennistoun Community Council, Dennistoun Conservation Society and Foundation Scotland.

There are also plans underway to create a ‘tree map’ for the Necropolis – a visual representation of the different tree species that exist within the cemetery grounds.

Engaging local communities

Across the UK there are a number of examples of other grassroots projects working to promote, conserve and engage local communities in cemeteries’ rich natural heritage.

Some notable examples include:

There have also larger-scale projects and campaigns to promote the role of cemeteries as havens for wildlife.

Caring for God’s Acre is a charity working to “support groups and individuals to investigate, care for, and enjoy burial grounds”.

For a week in June each year, they run a national ‘Love your Burial Ground’ campaign, which encourages people to connect with and celebrate their local churchyards, cemeteries and burial grounds through a variety of local events.

They are also responsible for running the ‘Beautiful Burial Grounds Project’ – a £600,000 Heritage Lottery Fund project that aims to “inspire, engage and support interest groups, communities and individuals to learn about, research and survey the natural, built and social heritage of their local burial grounds”.

The project includes collecting, collating and disseminating data on the importance of burial grounds for biodiversity, providing training events on recording biodiversity and disseminating a variety of resources such as short films, toolkits and pop ups to encourage communities to value their burial grounds as refuges for wildlife.

The Green Flag Award scheme has also been involved in the promotion of cemeteries as spaces for nature.  The scheme “recognises and rewards well managed parks and green spaces” and at present, over 80 cemeteries have received this award, including Tipton Cemetery in Sandwell, and the new Dumbarton Cemetery – the first cemetery in Scotland to be awarded a Green Flag.

Challenges to address

There are of course a number of challenges to be addressed if the full potential of cemeteries as green spaces are to be realised.

Firstly, there is a lack of data on the plant and animal species that exist within cemeteries.  This lack of ecological awareness can mean that sometimes burial ground management and maintenance can be well-intentioned, but inappropriate or damaging.  Thus, projects to record species – such as those conducted by the Friends of Glasgow Necropolis and other cemeteries’ friends groups – are incredibly important.

There is also a need to find an appropriate balance between allowing nature to flourish and ensuring that the cemetery remains accessible.  For example, there have been complaints that long grass around headstones can make it difficult for some people to visit family graves.  The Select Committee Report on Cemeteries notes that: “conservation must not be confused with neglect. A neglected cemetery does not become a haven for flora and fauna.”

Health and safety is another key consideration.  Unstable memorials can cause serious – and sometimes fatal – injuries.  Any project operating within cemeteries needs to be aware of this risk, particularly if it involves children or young people.  The Scottish Government recently published guidance for local authorities on inspecting and making safe memorials and headstones.

Other potential barriers to the use of cemeteries as green spaces include the lack of onsite facilities, such as toilets and bins, physical constraints, such as steep stairs, lack of vehicle access/wheelchair access, and concerns about visitor safety and anti-social behaviour.  These issues, however, are not insurmountable – for example, the Friends of Glasgow Necropolis have recognised these accessibility concerns and raised funds from grant applications to resurface many of the paths on the lower levels of the cemetery to make it easier for people with mobility problems to get around.

‘Living places’ that inspire

It is worth remembering too that cemeteries were set up not just to bury the dead but to stir the Muses among the living.” Fiona Green, a landscape historian, quotes John Strang‘s Necropolis Glasguensis (1831)

Cemeteries are not just for the dead.  They are in many ways ‘living places’ – havens for a range of plant and animal species in the midst of urban housing and development.  They also have an important role to play in the wider community, providing opportunities for local people to connect with and be inspired by nature.

And hopefully, after reading about the many ways in which people across the country are getting involved with nature at their own local burial grounds, you may be similarly inspired.


If you’ve enjoyed this blog, take a look at some more posts on the subject of biodiversity:

New year, new high street: it’s time to reshape our town centres (part two)

Dunfermline town centre

This is the second of a two-part blog on high streets and town centres.  In our last post, we highlighted some recent publications that have sought to address the challenges facing our high streets and town centres.

We looked at how towns could work to diversify their retail offer, placing greater focus upon developing experiences and services that are not easily replicated online – such as hair and beauty services, gyms, cinema, restaurants and nightlife.

We also highlighted the benefits of identifying a town centre’s unique selling point (USP), capitalising on the opportunities presented by the widespread growth of technology, and offering various forms of support to local businesses and entrepreneurs.

In this post, we consider how community involvement, good quality inclusive urban design, the promotion of healthy environments and the creation of homes on the high street can all provide ways to promote and support town centres to better meet the needs of local people in a changing retail and economic environment.

A community-focused high street

The town centre has long been considered the beating heart of a community.  As such, it makes sense that any attempt to revitalise them would have local people at its heart.

In Dunfermline, a pilot placemaking project has made use of innovative, interactive methods of engagement with young people to help plan and deliver town centre improvements.

Young people were asked to assess the quality of the town centre and to identify areas where improvements could be made, using tools such as the Place Standard and the Town Centre Toolkit.

There are lots of other great community-focused town centre initiatives. ‘Can Do Places’ aims to engage the local community in order to bring empty town centre properties back into use in various ways, for example, by providing spaces for budding entrepreneurs or supporting community arts and crafts.

Stalled Spaces Scotland is another noteworthy project – with a focus on greening derelict, under- or unused outdoor areas.  As well as improving the look and feel of a town centre, this scheme also aims to involve the local community and schools in the development and use of the spaces themselves.

A healthy and accessible high street

It goes without saying that if town centres are to attract both people and businesses then they must be both attractive and accessible – easily walkable, safe, and clean.  Indeed, amongst its findings, the High Street 2030 report highlights “calls for improved accessibility that is more environmentally-friendly, new public spaces or areas, centres that better serve older people”.

There has also been considerable discussion around how the design of town centres (and urban areas in general) impact upon various vulnerable groups.  We have blogged on this subject on various occasions, focusing in turn on the creation of places that address the needs of older people, people with dementia, autistic people and children.

There has also been widespread discussion of the relative advantages and disadvantages of shared space street design – which has been used by many places in the UK in attempt to revitalise their town centre spaces with varying levels of success.

As well as their role in the creation of inclusive, accessible spaces for all, there has been some focus upon the link between high streets and health.

Last year, Public Health England published guidance on the development of ‘healthy high streets’ – high streets that have a positive influence on the health of local people.  It focuses on elements such as air quality, enhanced walkability, the provision of good quality street design, street furniture, and communal spaces. It argues that the development of healthy high streets will support economic growth as well as community cohesion.

It also approaches the subject of diversity on the high street – recommending that there is an adequate number of healthy and affordable food outlets and limiting the number of alcohol, betting and payday loan outlets.

A high street to call home

Another way of bringing people back into the high street is to have them literally live there.

At the end of 2017, the Federation of Master Builders published a report ‘Homes on our high streets’, which argued that “revitalising our high streets through well planned and designed residential units could help rejuvenate smaller town centres”.

For example, Aldershot, as highlighted in the High Streets 2030 report, has been making use of the Housing Infrastructure Fund to promote residential development in the town centre and has undertaken property acquisition in the town centre, most recently acquiring the former Marks & Spencer  store.

Creating additional homes above shops or in former retail units not only helps to make use of vacant properties and regenerate town centres, but may also help to address housing shortages in many areas.

 Looking to the Future

So while 2019 may present high streets and town centres with some of their toughest challenges yet, there is a wealth of research, experiences and innovative ideas on which to draw.  The newly announced Future High Streets Fund will no doubt be of use to help put these ideas into practice.

And perhaps most importantly of all, local people remain enthusiastic about developing their town centres and wish to see them flourish. As the High Streets 2030 project noted:

The workshops and interactions provided real insight into the challenges faced by town centres. That they are worth fighting for was abundantly evident from the enthusiasm of those participating.”


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Autism-friendly cities: making a world of difference

At this time of year, high streets and shops across the country are bustling, decked out with lights and colourful decorations, and of course, the familiar Christmas tunes.

For many, this is part and parcel of the exciting run up to Christmas.  However, for autistic people, the added crowds, lights and noise can turn an already challenging experience into a sensory nightmare.

Indeed, although more than 1 in 100 people in the UK are on the autism spectrum, many still struggle to access local shops and services.  Places that many neurotypical people may take for granted – shops, theatres, cinemas, cafes and restaurants, hairdressers, libraries and museums, public toilets, and public transport – can be particularly challenging environments for autistic people.

Unpredictable and unfamiliar noises, lights, smells, crowds, queues, and other events can be overwhelming, and may cause sensory distress – ultimately leading to a meltdown.  Meltdowns may present as crying, screaming, kicking, biting or lashing out.  A lack of understanding and awareness of autism among the public – including unfriendly looks, judgements and comments – can further enhance the distress experienced.

In 2015, a YouGov poll found that 99.5% of people in the UK had heard of autism. However, there remains a lack of public understanding about how it may present, and the associated challenges autistic people face.  This is perhaps best illustrated by the recent case of a young woman with Asperger’s being forcibly removed from a cinema for ‘laughing too loudly’.  Unfortunately, this experience is not unique.  Research has found that as many as 28% of people have been asked to leave a public space because of behaviour associated with autism.

Indeed, many autistic people and their families have changed their own behaviour to reduce the chance of experiencing intolerance from the public.

It’s perhaps not surprising, then, that social isolation is a common issue – 79% of autistic people and 70% of parents feel socially isolated.  Almost half (44%) sometimes don’t go out because they’re worried about how people will react.

Increasing public understanding

The recent Too Much Information (TMI) campaign, delivered by the National Autistic Society (NAS), aims to increase public understanding of the five core features of autism.

Those five core features are:

  • anxiety in social situations
  • anxiety with unexpected changes
  • sensory overload
  • meltdowns
  • processing time

Creating an autism friendly city

One response has been the drive towards the creation of ‘autism-friendly’ cities.

According to Autism Together and Autism Adventures, an autism-friendly city is one in which autistic people can ‘use public transport, shop for food and clothes, take part in sports and leisure activities, visit cultural and tourist institutions and eat in restaurants.’

The NAS have established an ‘Autism Friendly Award’, which aims to help businesses make the small changes that make the most difference to autistic people.  Their Autism Friendly Awards toolkit sets out a helpful five-point checklist:

  • customer information: providing appropriate information to help support autistic people and their families’ visitor or customer experience
  • staff understanding of autism: developing staff understanding
  • physical environment: making appropriate and reasonable adjustments within the limits of the physical environment
  • customer experience: a willingness to be flexible and providing a clear way for autistic people and their families to provide feedback
  • promoting understanding: committing to helping increase wider public understanding of autism

Examples of good practice

In Glasgow, the council have been working to make the city centre autism-friendly.  The plans have focused initially upon shopping centres, transport hubs, museums, cinemas and key operational staff across the city centre.

The Glasgow Film Theatre (GFT), Scotland’s oldest independent cinema, recently became the first cinema in the UK to achieve an Autism Friendly Award for their work with children and adults.  This includes monthly screenings for autistic adults and children, with the volume slightly lowered, stair lights remaining switched on, house lights dimmed and a chill out zone provided. Trained ‘autism facilitators’ also answer questions at the end of each film.

Other organisations have followed the GFT’s lead. Glasgow Science Centre, for example, has recently introduced autism friendly hours.

In the North East, Aberdeen has also announced its intention to work towards autism-friendly status.

As well as raising awareness and making key shopping locations more accessible for autistic people, Aberdeen also plans to introduce autism-friendly libraries, including pop up sensory sessions designed for autistic children.

Research has shown as many as 40% of people with autism never visit a library – however, 90% have said they would be more likely to visit their local library if some changes were made.

Such adjustments include staff training, increased tolerance of noise and understanding from the public.  Dimensions have released free online training and top tips for libraries looking to become autism-friendly. It notes that while many people with autism need a quiet environment, they may make noise themselves – for example, by talking to themselves or others, becoming excitable or moving around. They highlight the importance of making clear to the public that the library is autism-friendly, which includes a tolerance of certain levels of noise.

Other cities that have been working towards autism-friendly status include: Bristol –  whose airport has won an Autism Friendly Award; Liverpool – where autism champions are being supported to recognise and respond to autism; and Newcastle in Northern Ireland – which has been named as Northern Ireland’s first autism-friendly town. It is anticipated that being autism-friendly will help boost the local economy and tourism.

Other ways to make cities autism-friendly

As well as organisations themselves making adjustments and promoting autism understanding among staff and customers, there are a few other ways in which cities can be made more autism-friendly.

Making public transport more accessible is a key challenge.  More than half of autistic people avoid public transport due to fears of disruption.  There are many things that can be done to help make public transport less distressing for autistic people.

From an architecture and design perspective, there are also many other things that can help to make urban buildings and spaces more accessible, in regard to ventilation, acoustics, heating, lighting, layout and outdoor spaces.

From a town planning perspective – there is currently a lack of research and guidance on the design of places for autistic people per se, however, there may be some transferability of lessons from work on the creation of dementia-friendly and child-friendly spaces.

For example, the provision of clear signage and removal of street clutter may be beneficial for autistic people.  Edinburgh City Council has recently banned on-street advertising structures in order to make streets more accessible for people with disabilities.

There have also been concerns raised that shared spaces – including the removal of road signs, traffic crossings and delineation between roads/walkways – may negatively impact upon autistic people, who may struggle with the uncertainty such schemes deliberately create.  This is an area where more research and guidance is needed.

The way forward

Creating a city that is autism-friendly requires a multi-faceted approach that includes both raising public awareness and understanding, and creating towns and places that allow for the specific challenges that are faced by autistic people and their families.

Many steps that can be taken are low cost and easy to implement – and support is available from a range of national and local autism organisations, such as the NAS.

Even just reacting with kindness and compassion when witnessing a possible autistic meltdown – perhaps offering some solution such as a quiet space – is significant.  The sum of these small changes can make a world of difference to autistic people and their families.

I wouldn’t change my son for the world but I will change the world for my son.” Julie Simpson, Founder of Autism Adventures


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Open access is rapidly rising but is it succeeding?

900px-Open_Access_PLoS.svg

Image by PLoS via Creative Commons

In an increasingly digital world where accessibility is a common goal, it is no surprise that open access (OA) publishing is increasing at a rapid pace. For UK research, there has been particularly notable growth in OA adoption. In 2016, 37% of UK outputs (25% globally) were freely available immediately on publication, up from 20% in 2014. This figure reached 54% within 12 months of publication – the first time the 50% OA barrier has been breached for UK articles in the Scopus database (Elsevier’s peer-reviewed abstract and citation database).

These are among the findings of a recent report from Universities UK (UUK), Monitoring the transition to open access, which illustrates the growth in OA and its implications. While the advancement of OA is generally seen as a positive outcome, this transition is not without its challenges.

What is open access?

OA is fundamentally about making research outputs freely accessible to all with limited restrictions with regard to reuse.

There are two main routes to OA, as highlighted in the UUK report:

  • Gold or immediate OA – this refers to articles published in an OA form in a journal, allowing immediate access to everyone electronically and free of charge. Publishers can recoup their costs in various ways, including through payments from authors called article processing charges (APCs), or through advertising, donations or other subsidies.
  • Green OA – this refers to the posting of a version of the published article so that it is accessible via a website, institutional or subject repository, scholarly collaboration network or other service. Access to the publication can either be granted immediately or after an agreed embargo period.

OA articles can also be published in hybrid journals which are subscription-based but provide some articles as OA, usually for a fee. According to the UUK report, more than half of UK articles in 2016 were published in hybrid journals, the proportion of which were published on immediate Gold OA terms was 28% – up from just 6% in 2012.

Growth

The numbers and proportions of both OA and hybrid journals have continued to rise, while the proportion of subscription-only journals has fallen. The number of articles published on immediate Gold OA terms is also rising, with a high level of take-up in the UK of hybrid OA options. Particularly notable findings from the report include:

  • the proportion of titles published globally offering immediate OA rose from under 50% in 2012 to just over 60% in 2016; and to nearly 70% for journals in which UK authors have published;
  • the proportion of UK-authored articles published on immediate Gold OA terms rose from 12% in 2012 to 30% in 2016, an annual growth rate of over 30% sustained throughout the period;
  • the global proportion of subscription-based articles accessible in some version, on Green OA terms, within 24 months of publication via a non-publisher website, repository or elsewhere, rose from 19% in 2014 to 38% in 2016, while the UK proportion rose from 23% to 48%;
  • OA articles are downloaded on average between twice and four times as much as non-OA articles; and in the UK, where the numbers of full-text articles in UK repositories increased by more than 60% between 2014 and 2016, the number of article downloads more than doubled from 6 to 12 million.

The rapid rate of growth in the UK appears to demonstrate the effects of policies to promote and support OA. The government has long been committed to the transition to OA, particularly since the Finch Report, and these figures show that the UK is world leading in “a significant global movement which is fundamentally changing the way that research is conceived, conducted, disseminated and rewarded.” (UUK)

Rising costs

Most would argue such growth is a positive outcome but the rise in OA has also contributed to other issues, such as the transitional costs to universities and research funders. The findings show that costs are also rising, and at a rate significantly above inflation. The mean average APC payment rose by 16% between 2013 and 2016, compared with a rise of 5% in the Consumer Price Index (CPI).

And the number of APCs paid has grown rapidly, with the ratio between subscription and hybrid APC expenditure falling from roughly 19:1 in 2013 to 6:1 by 2016. There is evidence of various offsetting deals, although these vary significantly and can be complex. The majority of known funding for APCs has however been provided by UK funders. Therefore tools that help universities identify and manage funding, such as RESEARCHconnect, could become even more important.

Concerns have also been raised around the financial implications for learned societies that publish academic journals. Although the findings show that publishing revenues have risen steadily over the period (18%), publishing expenditure has risen by 27%, resulting in falling margins.

A mixed picture is highlighted in terms of societies’ overall financial health, with a sharp rise in the number reporting a loss, although some of the most recent losses arose from strategic decisions or exceptional items. Of course, OA is not the only factor and the wider economic and political uncertainties are recognised as particular risks.

To mitigate the financial risks, societies are diversifying their income streams which could strengthen their role. But despite publishing margins being under increasing pressure, the report identified no evidence of systemic risk to UK learned societies or their broader financial sustainability from OA.

Final thoughts

In terms of the aim of policy in the UK to achieve a shift towards OA, the fast-paced growth can be considered a success. However, as the UUK report shows, there are still a number of challenges that need to be addressed.

According to the Chair of the UUK Open Access Coordination Group, the continued engagement of all stakeholders will be important “to ensure that the transition to open access is maintained, is financially sustainable, and that the benefits to research and to society are maximised.”


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How to make people with learning disabilities feel more included in society

Image: Accessible music technology OpenUp Music/Youth Music Network

This guest blog was written by Val Williams, Professor of Disability Studies at the University of Bristol.

People with learning disabilities can often find themselves feeling excluded when it comes to making decisions about their lives. This can range from everything, from shopping to making music or even bringing up a baby. Sometimes this exclusion can be exacerbated by the kind of support that they receive from social services – but it can also be countered by sensitive personal assistance or support.

In a recent research project, which brought together disabled and non-disabled researchers, we looked at ways to improve this – and how to include people with learning disabilities in decisions.

Part of the project found that by taking active roles in the arts, people with learning disabilities can lead the way towards meaningful inclusion. Beth Richards, an actress with learning disabilities, led part of the research about people with learning disabilities on TV. She found that actors with learning disabilities are often limited to roles which depict the “disability”, the tragic or dependent life of the character, or their effect on others around them. A successful actor with learning disabilities, for instance, told her:

“I wish TV makers would think more creatively and give people with learning disabilities any role – romantic, fantasy, comedy, shop assistants, office workers. I’d like to play James Bond, Romeo, Dobby in Harry Potter or a detective or many other roles.”

The Queen’s Birthday Honours in June 2018 include an MBE to the actress with Downs Syndrome, Sarah Gordy, for her “services to the arts and people with disabilities”. As Gordy said upon receiving the award, “diversity is an opportunity, not a problem”. She is good proof of that.

But there is a lack of accessible information. There is no shortage of talented actors and drama companies supporting people with learning disabilities, but the TV industry and its workings are still shrouded in jargon. Processes such as commissioning, auditioning and scriptwriting tend to exclude those who do not have someone to help them navigate all this.

In another part of the research, my colleague Marina Gall looked in detail at how music making can be transformed by the Open Orchestras approach in which young people with multiple and complex needs are enabled to learn musical skills, play in ensembles and become music makers. A new technological instrument – the Clarion – can be played on computers and iPads, using one’s hand, a small sensor on any part of the body, or via a person’s gaze. It can be adapted to suit most students’ physical needs.

One of the co-founders of Open Orchestras, Doug Bott, told our research team, that the approach is “personalised around the individual young person”. But at the same time, it’s trying to ensure that music is an important part of the curriculum for all young people, and has been immensely successful in changing perceptions of people with learning disabilities. This is not therapy, it’s a route to making music and to performance.

Making decisions

People with learning disabilities also face inequalities and problems in the NHS, as well as in a cash-strapped social care system. For instance, since the Mental Capacity Act 2005 came into force, support staff are legally required to support people with learning disabilities to develop their own capacity to make a decision. What we saw in our data was that people with learning disabilities can be proactive in seeking out this support – and we recorded conversations with personal assistants where people wanted to talk about decisions relating to safety, health or simply about future cooking plans. The skills that a personal assistant needs to have are to listen, look out and be responsive to the people they are supporting.

One of the key messages from our project is that health and social care practices sometimes get stuck. We used the word “institutionalised” for those times when professionals stick to a rigid and inflexible way of doing things, leaving the disabled person without the power to have a voice.

These difficult moments were also highlighted by actors with learning disabilities who helped to interpret our data. Our research benefited from a collaboration with the Misfits Theatre Company in Bristol, showing how sensitive interactions between people with learning disabilities and their personal assistants were often the trigger for good decisions, and giving those with disabilities a feeling of control over their own lives.

But quite small comments can create problems, spoiling an empowering relationship. The theatre company made a brilliant video called A Good Match about their own perspectives and experience of managing relationships with a personal assistant. One of the Misfits actors said: “It’s my house … and I don’t want my (personal assistant) telling me what I can and cannot do.”

 

After looking at a range of activities that can exclude or include people with learning disabilities, we concluded that inclusion happens when three things come together. Sometimes people with learning disabilities are included because of changes to technology, as in the Open Orchestras approach. At other times, they are included better because of new ways of doing something, or through new skills that they may learn – as actors, or as TV performers.

The ConversationBut at the heart of all this is a new belief in the equal value of people with learning disabilities. This is why we recommend that social care services need to focus less on what people cannot do, but instead promote a genuine belief in what people with learning disabilities can do – with the right support.


Val Williams is Professor of Disability Studies at the University of Bristol.

This article was originally published on The Conversation website and has been republished with permission under a Creative Commons licence. Read the original article.

Planning for an ageing population: designing age-friendly environments

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In the UK, increased life expectancy means that people can expect to live longer than ever before.  While this is clearly good news – and has a number of potential economic benefits – the shift in demographic structure towards an increasingly elderly population has a number of significant implications.

Following Wednesday’s blog post on the implications for planning of the ageing society, today we highlight some of the ways in which planners can help support the creation of age-friendly environments by influencing the design of the urban environment, transport, housing and the wider community and neighbourhood.

The importance of an age-friendly environment

Age-friendly environments are underpinned by three key factors:

  • Safety
  • Accessibility
  • Mobility

Such environments impact positively upon the quality of life of older people by enabling and encouraging physical activity and social connection.  This in turn has a beneficial impact upon their physical and mental health, and helps to tackle social exclusion – which can be a particular problem among older people.

Conversely, as the World Health Organisation (WHO) notes, poor design can have a negative impact:

“older people who live in an unsafe environment or areas with multiple physical barriers are less likely to get out and therefore more prone to isolation, depression, reduced fitness and increased mobility problems”

Creating an age-friendly environment

There are a number of areas in which planners may have an influence on the provision of age friendly environments:

  • the design of the urban environment
  • supporting appropriate transport options
  • the provision of age-appropriate housing
  • adequate neighbourhood and community facilities

Urban environment

In terms of the urban environment, green spaces are an integral aspect of age friendly environments.  Access to green spaces supports the physical activity of older people, makes a positive contribution to their health and wellbeing, and provides opportunities for social interaction.

Research has found that green spaces that are poorly maintained, perceived as unsafe, or contain potential hazards resulting from the shared use of parks and walkways are less likely to be used by older people.  Suggestions for improvement include the creation of small, quieter, contained green spaces and improved park maintenance.

Paths, streets and pedestrian areas are also a key planning consideration. Older people have greater reliance on pedestrian travel and are more likely to be physically active in areas that are pedestrian friendly.  The perception of safety also influences use – therefore, lighting and road safety measures can help to enhance this.

Adequate public toilet provision will also become an increasingly important issue.  Recent cutbacks have resulted in many public toilets being closed – in their review of public toilet provision in the UK Help the Aged noted that provision was sporadic. They found that the majority of older people had experienced difficulties in finding a public toilet, and even when toilets were found, they were often closed.

Transport needs

Responding to the transport needs of different groups will also present a key challenge. For example, an analysis of major European cities  by the Arup engineering consultancy found that older people typically make fewer journeys, use private cars less, public transport more (trams and buses in particular) and walk more.  In addition to this, older people’s typical walking speed – as well as the average length of walking trips – were lower than younger people’s patterns.  These differences must be considered when designing age-friendly environments.

The growing population of older people in rural and semi-rural areas, and the reliance on cars in areas with limited public transport options were also identified by Arup as important issues.

Age-appropriate housing

There will be increased demand for age-appropriate housing that meets the needs of older people as the population ages. People are likely to have longer periods of retirement and possibly longer periods of ill-health. As noted by the Future of an Ageing Population Project, unsuitable housing can damage individual wellbeing and increase costs for the NHS.

In order to meet demand, it will be necessary to both adapt existing housing stock, as well as ensure that new housing can adapt to people’s changing needs as they age.  Age-appropriate housing that supports independent living can reduce demand on health and care services, and positively enhance the lives of older people.

Thinking ‘beyond the building’

There is also a need to think ‘beyond the building’. It is thought that interventions that improve homes are likely to be less effective without similar improvements in the neighbourhood.  The ability to socialise and to access services is considered to be particularly important.

Therefore, planning for the provision of local shops and other community facilities such as GP surgeries, post offices and libraries, in tandem with an increased focus on walkable neighbourhoods and public transport provision, will help older people to be physically active and more independent.

Raising awareness

Despite a pressing need for action, the provision of age friendly infrastructure in the UK has been constrained by a lack of resources, and assigned a relatively low priority.  However, there is growing recognition of the need to raise awareness of the potential effects of the ageing population and its implications for the design of cities, towns and villages across the UK.

Planning departments cannot address these implications in isolation.  However, for their part, knowing and understanding the potential implications of the UK’s ageing population is a positive step towards the creation of a successful age-friendly built environment.


For further information, you may be interested in our other blog posts on the creation of age-friendly towns and cities and the economic opportunities presented by an ageing society.

We have also published two members-only briefings on Ageing, transport and mobility and Meeting the housing needs of older people.

Apprenticeships – inclusive and accessible to all?

AZUBI und Ausbildner

By Heather Cameron

The government is “committed to making apprenticeships inclusive and accessible to all”. But, unfortunately, this is not currently the case. Just 10.6% of the starting apprenticeships in England in 2014/15 came from Black, Asian and Minority Ethnic (BAME) backgrounds, compared to 14.6% of the general population. And while women are well represented overall, there are significant disparities across sectors.

In response to a recent Ask a Researcher enquiry, we looked into the topic of diversity in apprenticeships and, in particular, the barriers that face some groups such as women and ethnic minorities.

Occupational gender segregation

Occupational gender segregation in apprenticeships was found to be a particular issue. Research has shown that, despite women apprentices having outnumbered men since 2010, young women miss out on certain opportunities as a result of this issue. For example, women comprise 94% of childcare apprentices but under 4% of engineering apprentices. And these figures have hardly changed in the last decade.

According to recent research, occupational gender segregation contributes to women losing out at every level with apprenticeships:

  • Women tend to work in fewer sectors
  • Women receive lower pay than men
  • Women are less likely to receive training as part of their apprenticeship
  • Women are more likely to be out of work at the end of their apprenticeship

In terms of the barriers facing women specifically, a lack of awareness of the careers advice and information services available, or of the funding available for training; formal entry qualifications; and child care and other caring responsibilities have all been cited.

Under-representation

The other significant issue highlighted by the research is the under-representation of BAME groups. The overwhelming majority (88.5%) of apprenticeship starters in 2014/15 were White and the provisional figures for 2015/16 are similar at 88.1%. This compares to just 10.6% of apprenticeship starts from BAME groups in 2014/15, with provisional figures for 2015/16 down slightly at 10.4%.

Similarly to women, BAME apprentices are also under-represented in specific sectors. Fewer than 3% of apprentices in construction, land based industries, science, engineering and manufacturing, building services engineering, and hair and beauty came from a BAME background.

Barriers facing ethnic minorities include a lack of awareness around the benefits of apprenticeships and parental influence. A study from the Joseph Rowntree Foundation has therefore called for action to increase the awareness of apprenticeships among ethnic minority young people and their parents.

Progress

Despite the issues of occupational gender segregation and ethnic minority under-representation, it should be noted that progress has been made.

The most recent statistics on apprenticeships in England show that: there were 12% more apprenticeship starts in 2015 than in the previous year and that achievements increased by 1% over the same period; overall, between 2013/14 and 2014/15 the number of apprenticeship starts increased across all age groups except for people aged under 16 and those aged 18 to 24; the number of apprenticeship starts for learners with learning disabilities and/or difficulties was up by 12%; and although an overwhelming number of apprenticeship starters were White, the number of non-White apprenticeship starters increased by 17%.

Way forward

The government ambitiously aims to deliver 3 million quality apprenticeships by 2020, to reflect the widest spectrum of society. And it has pledged to increase the proportion of apprentices from black and minority ethnic backgrounds by 20% from 10% to 11.9%. However, no specific targets have been set for gender diversity.

The research suggests that formal entry criteria should be removed where not necessary to encourage better uptake of different apprenticeships by women, and awareness of apprenticeships should be increased with initiatives targeting ethnic minority young people and their parents. Other recommendations include introducing diversity targets within organisations, providing more part-time and flexible apprenticeships and providing better advice and support to apprentices at all stages.

Perhaps if such additional actions are taken, the government will move closer to its commitment of making apprenticeships truly inclusive and accessible to all.


If you enjoyed this post, you may also be interested in our previous blog on higher apprenticeships.

Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

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Planning healthy cities … integration is key

Image from Flickr user Sebastian Niedlich, licensed for reuse under a Creative Commons License

Image from Flickr user Sebastian Niedlich, licensed for reuse under a Creative Commons License

By Dorothy Laing

“The environment in which we live, work and spend leisure time – both the physical nature of places and the social environment of communities – has an enormous impact on our health and wellbeing. Health problems such as obesity, chronic heart disease, stress and mental health issues are intricately linked to the environments in which people live and work”. (RTPI, 2014)

Earlier this month the RTPI published Promoting healthy cities: Why planning is critical to a healthy urban future, the third in a series of Planning Horizons papers launched to mark the RTPI’s centenary. The report looks at how planning can help to create healthy cities – one of its main arguments being that health and wellbeing need to be at the core of city design and development.

With a growing number of people living in urban areas, and health problems such obesity and diabetes on the rise, planning for healthy cities is vital. And interest in the links between planning and urban health is nothing new.

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What’s being done to make our towns and cities age-friendly?

Mobility scooter on cobbled street

Image courtesy of Flickr user stemack_street using a Creative Commons license

By Brelda Baum

European Mobility Week takes place from 16-22 September and is themed around ‘Our streets, our choice’.  But what is being done to make towns and city centres age-and-disability friendly?

According to a recent DWP press release, high street income could be boosted by the £212 billion ‘purple pound’ if disabled people and their families could be attracted back to the high street. While the ‘purple pound’ refers to the spending potential of those with disabilities, the power of the ‘grey pound’ (the disposable income of older/elderly people) should also not be forgotten. Taking these two groups together, many of the reasons that they don’t use town and city centres are the same – urban environments are often not disability or age-friendly.

This also resonates with the ongoing debate about the viability of the high street articulated by Mary Portas and others regarding plans to help address the problem of economic decline on the high street and to help guide future change and development.

But what’s not to like about the current urban environment on offer in the high street? A recent report from Housing LIN ‘A research and evaluation framework for age-friendly cities’ looked at each of the 7 World Health Organisation (WHO) age-friendly domains and offers advice on how to embed them into city strategies.

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