From radio

I’m making a radio programme about erection problems – can you help?

For the past two decades I’ve been researching people’s sexual difficulties, alongside offering them advice through my agony columns. Sexual problems continue to concern many people, who are often unsure what they can do to help themselves.

One way to give/get help is for people to share stories about their experiences. To that end, I am currently making a programme for BBC Radio Four with Loftus Media about erection problems.

The programme producers and I are looking for potential interviewees. We would like to hear your experiences so we can highlight something that is very common but not openly discussed.

The programme will be broadcast in June of this year (2017) and will be 30 minutes long. I will be interviewing contributors for the programme. If you were willing to talk to me, you would not need to reveal your identity.

We are looking to hear from adult men of any age who can talk about erection problems. This might be a current issue, or something you experienced in the past. We are keen to speak to men who have had erection problems related to physical illness (including as a consequence of clinical treatments), as well as those whose erection difficulties might have a psychological cause. Alternatively you may have erection problems but aren’t sure why.

Interviews will take about 20 minutes and will be a very informal conversation. They will be pre-recorded (not live) so you can go back and retake any answer you aren’t happy with or would like to clarify points you have made.

Questions we might cover include….
– What erection problems do you have?
– Do you know what caused your erection difficulties?
– How did having erection difficulties make you feel?
– How did your partner support you (or not)?
– In what way did you seek help yourself?
– What was useful and why? What wasn’t?
– What treatment (if any) has helped?
– How do you accept erection dysfunction if treatment doesn’t work and you don’t want/qualify for surgery?
– Do men find it difficult to talk about this subject? What is key to changing how we discuss erection problems?

If you are interested, or have any questions and would like to chat further before committing to an interview, please get in touch via email with producer Henrietta Harrison henriettaharrison@hotmail.co.uk

We look forward to hearing from you and appreciate any help you can give us and other listeners.

One step on from when you called me

Tree of Hands

In this month’s Lancet Psychiatry I’ve written a comment piece Agony, misery, woe: a new role for media advice columns about the history and purpose of media advice giving, the changing role of the agony aunt/uncle, and the agony aunt as witness to the crisis around austerity and poverty and the harms these bring.

Expanding on the comment piece I am joined by Lancet Psychiatry Editor Niall Boyce and journalist Anna Raeburn in a podcast where we talk about how advice giving has changed (or not), what it can deliver, and why practitioners may be missing this important media resource and the tools and experiences it may hold.

Anna starts the podcast talking about how advice columns have developed, with a particular focus on radio and the power of the voice in reaching out to others. In addition Anna touches on the problems posed to modern media due to financial cuts and a lack of investment in community programming/features and particularly local radio and press. Explaining that the need for advice and information is higher than before but the opportunity for advice givers to work effectively is “significantly less”.

From this Anna moves to talk about advice giving as storytelling, sharing experiences, and how it’s okay to say you aren’t sure about a person’s situation. While discussing the strengths and weakness of advice giving on television, newspapers, magazines and new media.

When asked what role agony aunts fulfill, Anna replies:
“I would describe myself as a bridge….I have a very modest idea of what I can do. I want you to walk over me to the next stage of your life….I want, very modestly, to move you one step on from when you called me”

This is helpful in the context of advice giving as it sets out very simply what advice giving can achieve. And highlights where it may be a bridge between individuals and services but also part of a wider chain of help seeking behaviours people engage in. We don’t assume agony aunts have all the answers, or advice columns can solve all our problems, but if we consider it as a small step forward it reminds us that advice columns should never be excluded or forgotten about in wider conversations on physical or psychological health, help seeking or behaviour change.

In the second part of the podcast Niall asks me about evidence and whether we can we be evidence based around advice giving? This echoes other questions I’m increasingly asked about how agony aunts know they are doing a good job – something I’ll be returning to in future blog posts.

I reflect in the podcast on what agony aunts and audiences think evidence means when it comes to media advice giving. Plus what we already know about media advice giving, what we don’t know, and where we can draw parallels of evaluated work on self-help and public health campaigns. I have a bit of a grumble about how academic and journalistic snobbery can lead to advice giving being overlooked or denigrated – and why this is improvident.

For me the crux of the podcast focuses on the issue of how cuts to benefits, austerity measures, poverty and funding problems within the NHS are leading to staff and patients/service users feeling increasingly pressured, distressed and excluded. This may be an area where agony aunts and mental health services might work together, particularly in poor communities who are far less likely to be able to access and use mental health services. Another agony aunt Denise Robertson had previously suggested to me one role of the agony aunt in modern times was to bear witness to the damage caused by poverty, inequalities, and the blaming and shaming of those in need. The podcast explores more on why this has happened and whether there is a role for advice columnists and NHS staff and patients to work together to highlight theses issues and consider possible solutions.

This brings us to what form advice might take and how the traditional focus of the advice column has often been to refer people to a charity or a GP (Family Practitioner/Doctor), or helpline. But how in these cash-strapped times people are arriving at their conversation with advice columnists by telling them what services they have already tried – and failed – to access. The podcast reflects on why this is and what we might do about it in ways that do not further denigrate either those in need or health/social care staff who are also under huge pressure and struggling to do their job.

Rather than just seeing advice giving as asking for help, reaching out or being supported by others the podcast considers advice giving as advocating models of activism and resistance using the example of Focus E15 Mothers campaigning for housing and rights.

By contrast examples from the global south where advice giving through radio, TV, text and newspapers has had particular success are shared as examples of good practice. Particularly around the ideas of citizen journalism and self-care. I talk about trailblazers such as Hesperian and BBC Media Action within this context (although other examples of good practice can be found within this site).

The podcast ends with a reflection that if services across media, health and social care and the third sector are massively stretched. And where there is no immediate change to the current climate then we need to think about ways to help ourselves

“No-one is going to help us at the moment. That’s quite obvious. So how do we help ourselves and what do we do together to make things a bit easier for those in need where there may not be immediate help available?”

The resources below are ones I use myself within these limitations, and may help those who want to know more about working effectively where barriers exist.

Although broadcast after this podcast the actor Michael Sheen also picks up on some of the problems around the NHS and ways for us to defend and stand up for it.

Further Reading
Psychological First Aid
In or Out?
Community Psychology
Augusto Boal
Paulo Friere
Kerry Frizelle 2011 What is critical community psychology?
Carolyn Kagan et al 2011 Critical community psychology. Critical action and social change

 

Psychological First Aid

Cartoon - giving someone PFA
Cartoon – Giving someone PFA

Psychological First Aid, or PFA, may not be a term you’re familiar with, but it may well be something you’ve given or received. The Australian Psychological Society explain it as a “humane, supportive response to a fellow human being who is suffering and who may need support”. And while developed for people who’ve survived disasters (floods, fires, war, forced migration, earthquakes, mass shootings, or disease) it is effectively a set of tools that may benefit anyone who has experienced trauma. That may include civilians of all ages, journalists, healthcare staff, aid workers or others dealing with disaster.

The aim of PFA is to appropriately respond to another person’s needs to help them, when needed, at any point following a traumatic event. That may be around enabling them to feel safe and supported immediately after a disaster, allowing them to talk if they want to, and to reduce distress at any point following trauma. Importantly the point of PFA is to help people identify what services and facilities may benefit them during and after a crisis, enable them to connect with social support, assist them to feel in control, and empowered to try and recover from what has happened to them. Rather than telling people what they should do or how they ought to feel, the aim of PFA is to allow people to prioritise and address their own needs in their own time.

Following large and small-scale disasters we may focus on the physical injuries and deaths that may occur. We may not consider the impact of trauma on individuals who have lived through an event or the effects this may have on those who are front line or support service staff. PFA is used here to both reduce the likelihood of post traumatic stress disorder (PTSD) developing, and to give people the strength to cope at a time when they may feel bewildered, afraid or angry.

In focusing on words like ‘disaster’ we may assume the only time PFA can be employed is by mental health professionals following something huge and devastating happening to a community or country. Whereas PFA may be used be individuals and smaller groups and following any situation that might result in grief or trauma. That could include a relationship breaking down, following a bereavement, dealing with a chonic illness, if someone’s lost their job, or after a traumatic birth. Or supporting friends, loved ones or strangers in the disaster situations outlined above (e.g. during war, when coping with widespread infections, or if you are a refugee or supporting refugee communities). You don’t have to be a trained professional to deliver PFA.

This is easier to understand by noting the five goals of PFA. To provide people with: safety, calm and comfort, connectedness, self-empowerment, and hope. A practical guide on the steps you might want to cover in delivering PFA can be found here (courtesy of the National Centre for PTSD, US). Not all of these are always possible to deliver at the same time, but being able to provide some of them may still be beneficial.

How can media advice givers make use of PFA?
For agony aunts and uncles, we may often be a first port of call when someone is in crisis, or be expected to provide emotional and practical support to those who want advice. Advice columns and programmes can fill an immediate role following disasters or conflict – particularly in the case of radio. But on a general level for those wanting to provide advice via media, learning about the principles and applications of PFA can greatly help when offering advice that empowers and enables others to manage their situations.

This 40-minute talk from the Australian Institute of Professional Counsellors outlines some of the basics of PFA and how to use it

On being a good Psychological First Aider
Following any crisis we may want to take care of others, and as with physical first aid there’s the chance we could save a life if we administer psychological first aid correctly. And equally that we could cause more harm if we get it wrong. To that end it is worth noting what PFA is not. It isn’t: debriefing; taking details of traumatic experiences and losses; offering any kind of treatment, counselling or therapy; or imposing labels or diagnoses.

You don’t have to be a professional to offer PFA. However whether you’re a professional (in healthcare, media or so on) or offering care to a loved one, friend or family member it is vital to remember not to impose any kind of care without asking first. If someone’s experienced a trauma they may want to deal with it in diverse ways and not everyone affected by an emergency will require assistance from you or any other support service. If you’re reaching out to people who are different to you in terms of age, sexualities, genders, culture, faith etc they may understand and respond to their trauma in ways that are not like yours. That is okay and being respectful of this and not pushing your way of coping onto them is important. Just as it is vital to ensure you’re not excluding people from help because you don’t know what to do with them or don’t particularly like who/what they represent. There is an excellent discussion of how trauma and care differs globally (and what can go wrong when we try and impose Western approaches onto other cultures) covered here.

Given how common traumatic events are, it is worth finding out more about what PFA is and how we could use it in our own lives. Links to useful resources and guides can be found at the end of this post. To read through, listen to and reflect on everything here will probably take 15-20 hours so you may want to set aside time to do this or come back to it as and when time permits. Professionals may already be offered PFA as part of their work or may want to take this free online training from John Hopkins University (I would include agony aunts and uncles in this group). Returning to the idea of who may be included or excluded by care, it is worth critiquing all of the references and support materials here to think about who created them, who benefits from them, what models of care are being promoted, and who may be brought in or left out by the way PFA is discussed.

If you’ve used PFA in your own work please share your experiences in the comments – whether it’s helped you or not been effective or if you’ve examples of good practice I’d love to hear them. Particularly from communities across the world, and especially if you can help others help themselves during and after any kind of trauma.

Further reading
Minnesota Department of Health has a useful website with links to additional support materials and apps for PFA. While the University of Minnesota also has a selection of training options on PFA.

National Centre for PTSD (US) Operations Guide for PFA while the National Centre for Child Traumatic stress have this adapted guide for delivering PFA to children and young people alongside this guide from ready.gov (US) for teachers about working with pupils following trauma, and these multi-language training resources for those working with children and young people by Save The Children.

Vikram Patel’s Where there is no psychiatrist is also worth reading in conjunction with some of the resources listed here.

This paper “The Johns Hopkins Model of Psychological First Aid (RAPID – PFA): Curriculum Development and Content Validation” (starts on p.95) explains more of the evidence base behind PFA teaching. While this one ‘First responders and psychological first aid’ details more of how it works and the history of PFA.

WHO’s Psychological First Aid: A guide for field workers also available in multiple languages. And with a pdf of a talk explaining PFA here.

Alongside these tools, if you are health professional dealing with physical health as well as psychological health following disasters or crises you may find the resources from Evidence Aid and Hesperian may benefit you and the communities you work with.

InSocialWork’s podcast has an episode on psychological capacity building in response to disasters.

New evidence reviewing PFA guidelines suggests that, following a review of existing guidance, there is no strong evidence currently to show the effectiveness of PFA. This does not mean PFA has no place, more that based on the available evidence cannot pinpoint which is the most effective intervention we might use. Given the aims of PFA are about adapting ideas for individual and community support based on circumstance, culture and place it may be sensible for now to critically use and adapt the resources listed above; while noting potential limitations and finding ways to document any interventions and practices so the process of PFA can continue to be improved upon.

Can soap operas solve our problems?

Mark Fowler in Eastenders who was HIV+

The UK television soap opera Eastenders celebrates its 30th anniversary this week. Which is a good an excuse as any to look at how soap operas can be used to give advice.

What’s a soap opera?
I’m guessing you’ll be familiar with, and perhaps a fan of, soap operas. But if you’re not sure what they are they’re a drama on radio, television, or more recently online. Where interlinking stories show the lives of different characters. Often, although not always, based around a particular town, business or area. The name ‘soap opera’ originates from these early dramas being sponsored by soap manufacturers.

Arthur Fowler struggled with mental health problems

What can soaps offer us?
Aside from entertainment and distraction from every day life, the often unrecognized role of soap operas includes company. The characters in a soap opera and their regular scheduling on TV or radio can either fill the role of family or be an addition to your family. This may be of particular benefit to those who are socially isolated, including stay at home parents, carers, older people, or those who are housebound.

When it comes to advice giving, soaps can play an additional role of education, and outreach. They have been used worldwide through television and radio serials to cover anything from farming advice to dealing with landmines or information about immunization programmes and safer childbirth.

 

Teenage pregnancy and paternity issues in Eastenders

The way advice giving via soap operas has developed is either as a serial specifically developed to raise awareness, usually funded by an NGO or charity – for example New Home, New Life in Afghanistan (radio) or Soul City in South Africa (television). Or where an existing soap opera links with a charity or organization to bring in a particular storyline where an issue is focused on.

This can result in highlighting issues that may not always be noticed or talked about. For Eastenders some storyline examples have included:

Mental distress, mental health problems and break down
Gay and lesbian relationships
Teenage pregnancyLittle Mo is a victim of Trevor's abuse
Drug and alcohol abuse
Domestic violence
Historic child sexual abuse
Infant death
Assisted suicide

 

How are issue-based storylines assumed to work?

The reasoning behind covering a particular issue within a soap opera is primarily to raise awareness. Viewers with a problem may feel less lonely or isolated if they see another character going through what they have experienced. It may alert people that help is available and encourage them to make use of support services, charities or healthcare. Particularly if programmes signpost to other sources of help (websites, telephone helplines etc) at the close of each episode.

Kat Slater was abused as a child

People may also be able to model their behaviour based on what they see characters in soaps doing (or decide to do the opposite). While a storyline may make others aware of issues and problems and give them ideas on how to support friends/family who may be in need.

Having characters that audiences relate to going through problems in life may reduce stigma, as viewers or listeners will want their favourite characters to be okay (for example a character to escape a situation of domestic violence). Or familiarize audiences with individuals or issues they may have previously been intolerant about. Such as a gay or lesbian couple, a character with disabilities, a Transgender character, or an ethnic minority family.

Couple Colin and Barry

A storyline on a particular problem also allows charities or other organisations to talk to other news and entertainment media which both raises the profile of an issue and/or those who are best placed to offer support if it affects viewers. Which in turn might also increase support and donation to charities.

 

Yes, but do soap operas really manage this?

Criticisms of soaps are they mix so many issues, cliffhangers and melodrama across storylines that particular problem based themes can get missed out or perhaps not taken as seriously as they should be. It’s no coincidence that all the very worst crises in soaps seem to coincide with important holidays or peak viewing times (in the case of Eastenders the Christmas episodes are usually particularly eventful). And with soaps competing between each other for viewing figures, the pressure to find different problems to bring into storylines can mean audiences are fatigued by or inured against topics they may benefit from paying attention to.

Ethel asks Dot to help her end her life

The impact of soap opera problem-based storylines on our daily lives has mixed results. Some stories appear to have more of an impact than others. Which can be partly based on how they are portrayed, the popularity of the characters, how convincing the actors are, and how sympathetically audiences respond to characters and issues shown.

Some have argued performances can reinforce, rather than challenge stereotypes For example in Eastenders, Arthur Fowler’s breakdown was greeted with mixed reactions as some felt it showed an overly dramatic and frightening portrayal of mental distress, while others believed it realistically showed someone in crisis.

Or in order to boost ratings, storylines can be embellished in ways that could harm those affected by the very issue they’re trying to raise awareness about. In Eastenders this was most recently shown in the storyline where the character Ronnie Branning experienced the death of her child to SIDS later responded to this trauma by abducting another character’s baby. Unsurprisingly viewers, many of them affected by cot death themselves, angrily reacted to the idea that bereaved parents were unstable, dangerous and a risk to children.

Ronnie and baby

Overall the impact of issue-based storylines tends to be short term. These stories will raise awareness during the time they are being aired, but may not be recalled once the drama has moved on. Moreover knowing that an issue has been covered in a soap does not always relate to any meaningful behaviour change. We might be able to say which character’s been through which problem but we don’t necessarily use that to make any useful changes in our own lives.

Driving attention to charities and services can be a beneficial aspect of issue-based storylines but can also increase the burden on services and charities from people wanting their help. While bringing them no additional financial benefits.

Where charities and NGOs are involved with soap opera storylines they may assume this partnership is enough of an activity and do no further work to evaluate impact or sustain public attention or engagement. They may have the noble idea of ‘increasing awareness’ but have no sense of what that awareness might entail, how to measure its impact, or how to support people once they are more aware of a topic.

Phil Mitchell struggles with alcohol and drug addiction

When are they effective?
Although issues-based storylines don’t always ‘work’ it would be wrong to dismiss both the popularity of the soap opera generally, and the impact some storylines have had.

While some organisations and media outlets may prefer short-term storylines and impact, for major issues the best way to bring about greater awareness and behaviour change is through ongoing, sustained messaging. Soul City in South Africa is an example of how this can work. It is highly effective both as an entertaining soap that has run for decades but keeps within it core messaging around HIV. One-off storylines can be effective in the short term but don’t tend to have long-term impact.

If you’re working in media, healthcare, or for an NGO or charity and want to introduce an issue to a soap opera you’ll be more likely to make a difference if you:
– diligently research audiences before storylines are introduced to identify specific issues they might be helped to know more about
– develop characters and storylines to appeal to viewers or listeners so audiences can relate to characters going through/representing particular issues and engage more actively with story lines
– make careful links between those with expert understanding of an issue (patient groups/support networks/charities) and those able to translate this into a believable storyline
– support stories with additional materials – a website, cartoon, links to helplines etc
– have clear outcomes for impact from the outset. What behaviour do you want to change and how do you want to change it? If you want to raise awareness how do you want to do this and for what purpose? How can you build this into programming, enable it further through multimedia platforms, and most importantly how will you assess whatever work you do to see what effect storylines have?

As mentioned previously on this site, bad advice giving tends to tell us what to do not how to do it, which is the trap I’ve fallen into above. So, in the tradition of all good soap operas, all of the ideas on how to actually make an issues-based soap opera will be covered in a future episode….