History and achievements

How did it all start?

Denise Thomas attended the BDA Study Weekend in Abergavenny in the spring of 1982 and heard Karen Jeffereys give an illuminating talk on feeding frail elderly people. This sparked the idea of a specialist group.

The inaugural meeting of the ‘Mental Illness Nutrition Group’ was in Cardiff in December 1982 under the driving leadership of Denise Thomas; 37 dietitians attended.

At that time there was a small diversity of dietetic specialist jobs; paediatric, community and public health, elderly care. Specialism in Mental Handicap(Learning Disabilities), Mental Health and Eating Disorders were very new.

I think characteristics of these first dietitians were courage and particular insight to take on new dietetic roles among the more vulnerable in the population and this has been manifest in later evolving roles. It was not dipping a toe in to test the waters going to work at Broadmoor High Security Hospital!

In May 1983 the Group held its first official meeting at All Saints Hospital, Birmingham. Denise Thomas was elected as its first chairman and it was agreed to change the name to the ‘Mental Health Group’ in an attempt to cover all areas of psychiatry and ‘mental handicap’. The word group is a very significant one in the title, a group of inter-related areas of practice.

The autumn meeting was held at St Andrew’s Hospital, Northampton, the afternoon session being devoted to ‘Behaviour Modification’. Both meetings were sponsored and attracted an average attendance of 35 members. At the end of the first year there were 47 members and the committee had formulated a constitution to present to the membership at its AGM in March 1984. The Honorary Chairman of the B D A, Carol Bateman recorded the following in her report for 1982/83 “Two new groups ‘Enteral and Parenteral Nutrition’ and ‘Mental Illness’ are emerging and should make a useful contribution to the activities of the Association”. Prophetic words.

The pattern of two day meetings a year was quickly established with one being more northerly, one more southerly and work was always presented by at least one of the members alongside invited speakers.

Working groups were set up for compiling information on the role of the dietitian in mental handicap (1984) and in early 1986 the first post graduate course in mental health for dietitians was successfully organized with 38 registrants.

MHG participated in the Groups’ Day at the B D A Study Conference in Keele in 1985, an opportunity to advertise the group to the BDA membership.

Here is an example of an early MHG meeting programme, terms of address more formal than now :

a) Mrs V Kearney, a representative from the local Hyperactive children’s Support Group

b) Dr Spencer, Consultant Psychiatrist – Classification of Mental Handicap

c) Mrs C Herbert, Social Worker and Mr N Riddell, Resettlement Officer

‘Normalization – Fact or Fiction’

Early meeting topics included Down’s Syndrome, Alcoholism (described as the growing problem of that decade), Anorexia Nervosa, Mental Handicap and Normalization, the already mentioned Behaviour Modification, Obesity. Nothing changes! Because of a spring and autumn meeting and different geography there could be particular focus in one subject area. Morning sessions featured group discussions for sharing ideas. The membership grew quickly and by the beginning of 1986 there were over 80 members and over 100 a year later. Between 35 and 40 members attended each meeting.

At the AGM in 1986 the second chairman, Pip Hewitt (Ms Philippa Hewitt) who worked in Berkshire was elected and some of us will recall this small feisty blond. In that year the group held a joint meeting with NAGE, an idea that has been repeated more recently with DMEG.

The grading of mental health posts was being discussed and the second postgraduate course was planned for Leeds in late 1987.

Denise Thomas was chosen to represent the BDA at the International Congress of Dietitians in Paris 1988.

A reference list of resources was compiled – articles, books and sources of information – and distributed to all members.

Pip was followed by Susan Warren in 1988 during whose term of office a Study Day was organized for basic grade dietitians (now Band 5 but for how much longer?) and mature returners.

Geography is ever with us but in those first years when printed journals, newsletters and telephone were the tools of professional communication and learning, being able to meet was vital. With dietitians employed in Scotland and the far south of England and dotted in between, organizing meetings that did not involve really long journeys (and expense in time and money) was desirable. Besides the chairman, secretary and treasurer, meeting south and meeting north committee members were elected.

Belonging to MHG was a way to see the country. We‘ve been in the grand rooms of St Andrew’s Hospital in Northampton, at Edinburgh University Campus looking out on Arthur’s Seat, an abandoned hospital in Portsmouth being used as a training centre (grim), the delightful Colchester Friends Meeting House, historic York, Caerphilly with its castle. This two meetings per year structure persisted into the early part of this millenium.

Our committees in those years, as now, were very focused on creating and achieving valued meetings for us. Membership lists regularly had to be re-typed – what joy when word processing arrived -, all meeting papers had to be copied and posted, more rapid communication was by telephone. We kept a register and copies of publications or audits by members and these could be borrowed. We also had a resources library that came to every meeting and items could be borrowed in the interim. The committee expanded to incorporate an education officer and a policy development officer.

The introduction of e-mail for nhs staff and into the lives of people outside virtually coincided with failing to get enough people to attend an autumn meeting. The greater ease of communication reduced the paper mailing burden and costs. With internet access to information enhancing education a change to one two day meeting was adopted. That change nurtured the birth of the Leeds-Bradford area as fairly central, accessible cities in which to meet as has been the case since 2006. We’d never had such posh facilities as when we first came to the Carnegie Centre at Headingley. I can remember moving all the papers scattered around the tables up to one end of the room not realizing there were three screens to watch not one!

Significant Achievements of MHSG

1. MHG was an early group to offer a postgraduate course for dietitians working in or aspiring to work in these fields. As already stated the first course was set up within 3 years of the group’s foundation meeting and ran annually until at least 1994. This has been superceded by the day courses provided through the BDA Education Centre and M Sc modules offered by Universities, Leeds Metropolitan and our current chairman, Ursula Philpot, being significant in this activity.

2. In 1995 a working party produced a set of standards for dietetic practice that was taken up and developed for the whole profession.

3 21st millenium we seem to be leading the way with concensus statements:

a) Prader-Willi

b) Autism (with Paediatric group)

c) Weight management in LD

b) Eating disorders

e) Refeeding protocol for seriously ill people with Anorexia Nervosa.

In the ‘Science and Practice of Dietetics’ section in the BDA annual report for 2011, three of the four concensus statements agreed within the profession came from this group.

4. The BDA leaflet ‘Dietitian, Nutrionist, Nutrition Therapist Roles’ was an MHG initiative.

The future: This has been a glance at what has happened since that first, cold December meeting. Karen Jeffereys’ paper at that meeting was a case study featuring multi-disciplinary team-work, a concept unbeknown to most.

There was a blip five years ago when Eating Disorders dietitians considered breaking away but were persuaded by themselves and others that their strength would be to remain part of the group, that three pronged group defined thirty years ago.

We all need to draw on the expertise of other dietetic specialties but, dare I say, I think our roles – though firmly based in dietetics – have a larger, socially sensitive component than others. The understanding of behaviour in more fragile or vulnerable people in society binds us. We have a past to be proud of, a debt of gratitude for the strong foundation we’ve inherited to support the group’s members into the future.

I give you ‘The Mental Health Group’.

By Anne Fenwick