‘The communities have got to trust you’

Imagine you see a job next week, say at another University. Could you and your work in psychology be transported somewhere else in the UK easily?

Yes, I think so. I moved from Swansea to Sheffield in the 2000s and worked for the Health and Safety Executive in their work psychology section, and I often say to my students that everything for my career has moved from there. I find myself back in Swansea, my hometown, but I do encourage the students to be prepared to move elsewhere when the opportunities arise.

In terms of the more community-focused work that we do, having that Welsh, local identity and an awareness of Swansea certainly helps those conversations. That's not to say you couldn't transfer that somewhere… it's about getting to know your communities. When you're working with community groups who perhaps work with vulnerable individuals, or have particular unique demands, it's always a good starting point if you've got an awareness of the town, the city, the culture, the various challenges.

Do you think those challenges are unique to Swansea?

Probably not unique. But we're doing some work, for example, with the African Community Centre Wales in Swansea, and that's interesting and challenging in lots of ways. We're a smaller city where we don't have these 'cultural quarters' that you would get in larger cities – pockets of different ethnic minorities, cultural groups. So in a way, people who come to Swansea have to be embedded within that wider Swansea culture.

But otherwise, like most cities, it's got the more affluent areas, and it's got the areas that are really struggling. We have some of Wales's largest areas of deprivation. As a university we've always worked closely with those communities, we've always had a presence there, and it's about that connection – being able to say we understand where that history has come from, and we can work with people to build and improve those communities. 

One of your areas is around cancer. Can you talk about that work?

My PhD was originally in the field of cancer genetics. Cardiff University, working in the medical school, so very much trained in psychological interventions, randomised control trials, that kind of MRC framework. Then I came here and started to get more involved in the smaller projects. One that is closest to my heart is the work we did with secondary breast cancer patients. That emerged from a student who was a breast cancer nurse at the time, Ann Baker, she was studying for the counselling practice master's programme that we run here.

She wanted to do a dissertation on patients with an incurable diagnosis of breast cancer. The ethical side is huge, so she came to me as a health psychologist with the expertise.

It evolved into this incredible project, probably one of the most impactful things I've done in my life. We had people coming in, on oxygen cylinders, absolutely determined to share their stories and to have that opportunity. Primary breast cancer patients felt they were having incredible care, very much supported by the entire clinical team. The minute they were diagnosed as incurable, their whole identity changed. They talked about their sense of 'oh, we can't cure you, so we're no longer interested in you as a case'.

Really powerful stuff that was coming through. We used that to argue for somebody with a specialism in this, and as a consequence of the research we did, Ann got a position as the first dedicated secondary breast cancer nurse specialist. And the patients who took part in that focus group went on to form their own support group, Breast of Friends. 10 years ago now, and they still meet every month. Obviously, the membership is changing, and Ann attends a funeral pretty much every other week. It's just incredible what she goes through. She was awarded an OBE a couple of years ago for the work that she's done in that area.

So that's a contrast from the big trial stuff I was doing, to working with smaller groups and making that more personal impact. That's become really important to me. 

Do you find that work traumatic, hearing those stories?

I don't find it traumatic, I feel incredibly privileged to be part of that story. It was similar to the genetics research – I did focus groups of people going through genetic tests, and also the big randomised trials. So, I'm very much from a mixed methods background. When you do the qualitative stuff, you've got these people who are willing to share deeply personal stories, and their emotions, with you. So, I always feel very privileged, that they trust you, to share that story. But then I also feel very responsible for ensuring that that story is conveyed appropriately, as well. 

Do they expect a channel and an audience for that story that academic research can't always provide?

Yes, it's hard, isn't it? You learn a lot from the people that you do the research with, that partnership. With Ann Baker, she was a highly qualified nurse and able to influence the health board and present the research to them. You're right, the paper itself was never going to change the lives of those individuals. But the support group they set up, conferences where they sat in the room with the same clinicians that had been treating them… you can feel the emotion and the tension in the room, and that's what changes, changes people's lives, the chance to get in there.

And that can feed back into the questions you ask in the future?

Absolutely. It's coming back to that on-the-ground approach, of the issues that need to be addressed. That has translated into some of the stuff I'm doing now in the community. With the African Community Centre at the moment, they've had big lottery funding to work with ethnic minorities across the whole region, where young people themselves are driving forward projects on how they see the future of mental health provision for young people. I'm being asked to evaluate it because I've developed a relationship with them, they trust me. But it can be messy. They already know what they want to happen at the end of that project, and I perhaps need to remind them to ask questions neutrally. 

Because then you might find something even more interesting?

Absolutely. It's a skill set, being able to do that, and you need the confidence in yourself, to explain to people who are not research-informed, why asking questions in certain ways is probably going to get them better value.

I really think there's a value for community mentoring around this kind of research literacy. Because it's so important to them, to demonstrate that impact, but they need to be able to do it well.

You did work through Covid, developing resources for the Education Centre in Wales.

Yes, we've been involved in supporting the University's Teacher Education Department, and it's clear there's a huge role for psychologists in supporting evidence-based research in education. For people with a more psychological, theoretical, research-based background to support initiatives.

So, during Covid, the Welsh Government came to us and wanted some rapid professional learning materials to support schools, linked to wellbeing, to coping with Covid, and to adverse childhood experiences. So we submitted materials for that, available for all schools in Wales. From that, we've got more involved with the Welsh Government on applying a more psychological theoretical lens to some of the issues around wellbeing in schools.

In Wales, we have a 'whole schools approach to wellbeing' – everybody from the children to the parents, from senior leaders to staff, work together to embed this framework. But actually, on the ground, that's not particularly happening. The Welsh Government have asked us to get a better understanding of those issues. Using the Behaviour Change Wheel, for example, we can look at the barriers, and why people are not engaged. So that's exciting for us, to see that role for psychology out there in the community, to have a theoretical framework, to intervene and make changes, and to evaluate them. 

I always think health psychology is so interesting as a subdiscipline. I remember talking to Lucie Byrne-Davis about behaviour change and the COM-B model, and she said the people they work with can't get enough of it. Now, I would have thought that people doing that kind of work in the community would know that behaviour change is dependent on having the capability, the opportunity, the motivation. But perhaps we see it as more simple than it actually is.

More people than we realise are just not aware of it. Even our educational colleagues were like, 'Wow, that's amazing. We love it.' This is what the whole Covid response was linked to in a way, but they hadn't necessarily realised it.

I was at a conference at the Swansea Arena last week, the Healthcare Research Wales annual conference. I have this impostor syndrome, you know, 'I just do stuff in the community, not this global stuff, all the trials units, the big medical schools'. But the message at that conference was literally behavioural science – 'people are at the heart of what we do, and unless you get into communities, you're not going to change behaviour'.

I was like 'Yes, I've been saying this for years!' I wish I had been brave enough five years ago to make those statements. People are only realising now, from the pandemic to wider health and social behaviours, if you don't get into your communities, if you don't understand them, you're not going to help them change. You need to speak to them first and find out more about those issues. 

What was stopping you five years ago?

Imposter syndrome. You compare yourself to a 'traditional academic'…all about the Research Excellence Framework, big grants, randomised trials… unless you're part of these huge national research centres, you're never getting the funding. You have to have about 20 collaborators, work closely with the Clinical School, have the trials unit involved. But it's actually quite dull because you're talking about 10-12 years of a programme of work before any change can occur.

What I'm doing is important, it's making change, maybe at a lower level. But that can spread out, can't it? Perhaps as universities, we need to think of our value as academics as also working with the communities and being able to communicate in ways that ordinary people in their communities understand. Because that's essentially what we're interested in. 

With those ordinary people, how is your input received, that 'research mentorship'?

You learn every day, with every community that you work with, there are differences. The dementia hub, for example, they're just a little one-stop in the middle of Swansea, set up to signpost people to all the various forms of help and support. People have been lost on that dementia journey, they don't know who to turn to for help.

They don't know what's available, they don't know, you know, how to even approach these things. So, they asked us to evaluate that, and it was fantastic, such a meaningful thing to do. And the data that we got back was a learning experience for us as researchers going out there into the real world, expecting a bunch of volunteers to handle information and signposting.

They felt that could jeopardise the informality, the importance of that relationship, of saying, 'Hey, come in, sit down, have a cup of tea? How can we help?' Again, perhaps it's about research mentoring, some workshops with organisations around why these things are important, and some strategies.

So we don't always get it right, but as long as you're prepared to learn and reflect on that process, you develop that repertoire of effective community research, and impact as you go. 

It sometimes seems to me that the issue in both physical and mental health is signposting to services, or the transitions from one to another, rather than a lack of services as such. It's in those liminal spaces between that people can feel abandoned?

I totally agree. And again, I think there's a huge role for psychology, in terms of bringing those parties together. The grant we had funded was to do co-production with the cancer professionals and the secondary breast cancer patients. Our ultimate goal was to bring them into the room together to agree on a set of priorities for communicating that transition.

Important stuff, but you can't just get your powerful white coats and your patients in a room and say 'have a chat and figure it out'…it takes that skill set.
I guess your approach also depends upon the environment that you operate in, and become familiar with.

Here, we work closely with counselling colleagues as well, obviously more about those one-to-one communication skills. It's not something everybody can do.

But sometimes, it seems like something that everyone should be able to do. 

We talked about that imposter syndrome… sometimes I think it's actually a good thing to have because it keeps you humble, it makes you question things.

If you go into a community, and you've got all this expert knowledge, it's easy to dictate and say 'Yeah, I get your point, but no'. That doesn't work – the communities have got to trust you. They've got to feel that you're going to support them, or at least be honest about that. It's that element of communication that's a little bit different. It's almost negotiation. 

Talking negotiation, over lunch we were chatting about workplace design through Covid times.

I think it's probably one of the most complex challenges, isn't it? I've tried hard to influence the work pattern here, coming from individual offices to an open-plan environment, that wasn't fully set up perfectly before Covid hit. It's been a real challenge. But we did some interesting work with the Assistive Technologies Innovation Centre, where we set up virtual alternatives of the workspace that staff could experience and navigate around. That was good for those staff who engaged.

The hybrid world is in some ways a solution. But you need to be trusted, and you've also got to be accountable. Ultimately, at the end of the week, you have either achieved a target or you haven't…how and where is less important. We've got staff who have in the last three or four years, settled into a way of working and they don't necessarily need to come back into that environment… they've developed some productive working practices.

Good working practices and good employer-employee relations were good before Covid and will be good after.

Ultimately, it's about culture, isn't it? It goes back to me starting out in occupational psychology. The design of the workplace is really important in the digital world. But the crux is the organisational culture in which people are working.

We've been involved in a project over the last year interviewing local employees and employers about what wellbeing at work means to them. What are the important factors? How should we address it? How should we measure the effectiveness of wellbeing interventions?

And it's coming out that perhaps we shouldn't be trying to measure the effectiveness of wellbeing interventions, that perhaps what organisations need is support to develop a culture of understanding around that. I had a plan – we'll create this outcome toolkit that organisations can use to measure the effectiveness of any kind of wellbeing intervention in the workplace, that'll be really helpful for them.

And now, I'm thinking that toolkit might actually be a communication toolkit around how to have those conversations. From that very scientific objective, we're thinking 'We must measure these things', and people are saying, 'Well, actually, that's less important to us than actually having conversations'.

I've often said, I don't really understand the emphasis on 'happiness' at work. Are you skipping into work, beaming from ear to ear, and if we let you go for a walk at lunchtime on World Mental Health Day, is that enough to make that happen?

Some of those stories were coming through in interviews – things that are seen as a token gesture. Take a chocolate off the wellbeing tree, but how's your workload?

It's those classic HSE job factors, isn't it? Do you have your autonomy, a level of control, do you feel that you're listened to, is there support in the workplace? When I was the head of school here, particularly through Covid, there were times I felt that was the only thing I could do, just be there for the team. There was so much else going on that we couldn't possibly control. But we really pulled together in those times. 

That's the common theme of this conversation isn't it, culture and communication? But also self-care. Sometimes it's a word that can be overused, in the wrong kind of context. But it's massively, whether we're supporting students, working with a community with vulnerable people, going into schools, in leadership positions… we need to recognise that our own self-care is massively important.

That was a big challenge to me in the early days when I was head of school. It wasn't until I realised that when I was overwhelmed, overworked, stressed and tired, I was a poor leader. Going into meetings, I had no headspace and no empathy. I thought, hang on, I've got to look after myself, because then I'm a better leader. So, I bought a horse and went and sat on the sand dunes of Swansea. That's my sanity.