Censorship, or Duty of Care? “Little Feet”, Blogging on an Acute Mental Health Inpatients Ward.

This blog is inspired by a post I have read today by @Chaosandcontrol, who blogs as Little Feet. Please do read the original post and comments in their entirety, and excuse me for quoting from it in addition.

Here, Little Feet describes her actions in  password protecting her entire blog:

I was readmitted to hospital on 28 December and discharged today (3 January). On 29 December, I was notified by staff that my blog had come to their attention. Staff read through the archives and my phone was confiscated for 24 hours. I made a verbal agreement with staff that I would not blog while I was in hospital.

She then posted about how because of this lack of privacy, she no longer felt safe to continue with her blog. She has currently stopped. I have so many things to say about this short statement. Im afraid they may come tumbling out helter skelter, so please bear with me.

Staff probably defend their actions by claiming they are acting to protect either the organisation (and staff), the patient, or the other patients. Each of these defences relies on slightly different clinical reasoning. Let me go through them.

First, let us consider Maslow’s famous hierarchy of needs.

An individual travels up this pyramid  from a baseline of meeting physiological needs, through safety, then social and emotional needs towards self expression and self actualization. By transferring the principles contained within this model, we can look at the organisation’s equivalent succession of needs within the social space, using a term coined by Jeremiah Owyang at the 2011 Leweb conference in Paris- the ‘Social Business Hierarchy of Needs’

If you haven’t got 20 minutes to watch the video, you could look at the Slideshare presentation.


What we can learn from this is that the hospital in which Little Feet found herself was still concerned with the bottom layers of the pyramid- those regarding security and safety, whilst Little Feet had progressed past these layers in her digital interaction and was performing at a much higher level, concerned with self-exppression and self- actualisation.

We can see  that because of this disconnect in the digital literacy of the staff and organisation, and the population it is serving, the efforts by the staff to take control of the situation by using their power over their patients was (expectedly) experienced as oppressive by Little Feet, and also by the blogging community leaving comments on Twitter and on the blog itself. I am sure this was not the way they wished to be experienced, as I am sure they are good people who are just terrified by this new technology and way of communicating. But actively preventing someone from operating on the higher levels of Maslow’s pyramid is never going to be experienced as anything but oppressive, and services need to wake up to this fact and work out how to deal with their concerns about safety and move along in their own journey with social media.

Learning about patients from sources other than from within the clinical relationship and information from friends and family WITHOUT EXPRESS PERMISSION is not on. We are able to work that out from first principles, because one of the pre-eminent concerns of healthcare professionals is consent. Without consent, we must tread very carefully in what we do, using reflection, interdisciplinary learning, and close regard for the legal and policy framework for what we do (e.g. sectioning, deprivation of liberty). Little Feet did not consent for the staff to read her blog. They did not happen across it as a blog by an unknown individual, they had inside knowledge at the time of reading of Little Feet’s clinical presentation. That’s not cricket.

It’s unethical- In the same way that we would be justifiably angry if we found someone has read a secret diary, EVEN IF WE LEFT IT OPEN ON OUR INPATIENT BED we can have an expectation that clinical staff will form their clinical opinions based on presentation, symptoms, and medical history.

Discovering additional information about our clients is one of the cautionary tales warning clinical staff (and teachers for that matter) off from using SNS. The belief is that learning these insights will damage the therapeutic relationship, and cloud the (supposedly impartial) process of developing a diagnosis or formulation. That’s why your GP probably won’t friend you n Facebook.

It’s not that digital sources of information are irrelevant- but THIS SHOULD BE EXPRESSLY CONTRACTED WITH THE PATIENT.

What we present to the world is a series of faces, like the sides of a prism. None of them entirely explains our essential essence, each one is slightly different. How Little Feet appears in her blog is quite different from how she appears to her clinical team, I’m sure. After all, they are presented with a real life, flesh and blood version, perhaps with tears, anger, occasional incoherence, and frustration with the inherent power imbalance of mental health treatment- just like you or me in a mental health crisis.

The clinical team need to focus on the clinical presentation if they are to avoid bias, prejudice and all sorts of personal opinions from creeping unseen into the clinical situation. That’s why we have such developed conventions for clinical consultation. Contracting to source additional information pertinent to the clinical relationship could be appropriate, but it must be done with consent.

So, we can see that protecting the patient by removing her ability to express herself and self-actualize runs counter to the principles of recovery, which are about supporting progress up Maslow’s pyramid, not forcing someone down it. We have also seen how clinical treatments should not use information gleaned from  relationships outside the clinical arena without consent.

Protecting other patients is a little more difficult, in that we know that they will have a range of digital literacies and understanding of the consequences of being referred to within the blog. They will all occupy different levels of Maslow’s hierarchy. Confidentiality is a complicated issue, becase someone can be identified by a clinical picture (if unusual enough) just as easily as from a photograph. The difference here is that the staff hold the responsibility for protecting confidentiality, service users do not. That is why at the start of clinical group work, protecting confidentiality is generally introduced as a ground rule- to make sure it is in the mind of the participants.

However, what exactly are the patients here being protected from? In fact, there is no difference between Little Feet’s potential to discuss her descriptions and those of other patients. It is the medium of the descriptions that worries the staff.

Where conversations about services are confined to individuals, organisations feel happier because they are perceived as less threatening. What is frightening for the organisation about digital media is related to their lack of understanding of it, as discussed above. The old ‘command and control’ model of communications is so prevalent in health organisations dealing with digital media because they are operating in an unfamiliar medium and are just on the initial steps of Maslow’s pyramid.

There is excellent clinical practice out there, and there are both practitioners and organisations whoa re prepared for the journey they must take in understanding social media. But there are so many others who still haven’t framed the question, never mind worked out an answer.

Little Feet’s blog has served a critical purpose with the final post. It illustrates the difficulties that are facing health organisations who are treating individuals with much higher digital literacy than themselves. It’s time we woke up and started to play catch up in this arena.

What are your experiences of this?

If you would like to know how I can help your organisation or clinical staff move on in their understanding of digital and social media, get in touch at tech4health(at)gmail(dot)com.


I am an Occupational Therapist, who writes about health, particularly mental health. I am interested in social media and Web 2.0, and where these technological advances can support wellness and health.

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Posted in Blogging, Inpatient Services, PTSD, Recovery, Reflection, Risk, Social Media, Society, Web 2.0
28 comments on “Censorship, or Duty of Care? “Little Feet”, Blogging on an Acute Mental Health Inpatients Ward.
  1. Anne Cooper says:

    Hi Claire
    I thought this was a fantastic and thought provoking blog. I have been working with senior nurses and we have been debating the issues around how technology, and patients use of technology, changes the way we need to lead and care but this is a new angle we haven’t considered. I have posted it to the participants of the programme. I have encouraged people to share their thoughts with you, in the spirit of web 2.0!

    • Claire says:

      That’s great to know, Anne! As I said in the post, there are pockets of good practice, but we need to embed that within pathways which our service users travel on. If there is any way I can help you further in your work, by delivering strategic development to this end or providing training, please don’t hesitate to get in touch!

  2. I think you’re right when you point oit that many health & social care workers are uninformed about digital media. I also agree that the ability to express yourself is a vital aspect of personhood and blogging is no different from any other medium in that regard.

    I think though the thing that disturbs me most about this post is the paternalism of the staff team who have taken it upon themselves to cut off communication for reasons that appear much more related to their own sense of security than to any clinical reasoning.

    As I often ask ….

    Who put us in charge?

    We have a role to play in helping people with their mental health needs but not in dictating how or when they use perfectly legal forms of communication.

    Nobody needs our permission to communicate with the outside world. If nurses don’t like what is said about them then maybe they should think more carefully about what they do.

    As to the issue of confidentiality for others on the ward. I can see that point but I’m not sure that removing someone’s link to the outside world (either by confiscation or by coerced contract) really solves anything. As you said it’s not what is communicated that’s at issue here but rather ‘how’ it is communicated.

    That seems rather poorly thought through and ethically/legally dubious as well.



    • Claire says:

      Thanks, Stuart. I agree, I’m not sure that it was in the spirit of our legal framework, although I’m not an expert in the letter of the law. It just highlights, for me, the dangers in organisations becoming reactive in dealing with digital and social media, rather than reaching out and developing a proactive strategy across the service.

  3. Alastair Sutherland says:

    Interestingly enough, I had a little debate with myself about whether to respond openly, or under a pseudonym. Hence all views are entirely my own, apart from the ones I’ve nicked from cleverer people.

    It’s really tempting to dive right in and join in criticising an unfortunate decision which had an even more unfortunate consequence. And I probably will do, in a bit – for in the realms of mental health and wellbeing, someone feeling that they can no longer safely express themselves is never a good outcome. For anyone.

    But there is another side to the dialogue here that is so far missing. I’m not saying that anyone has been misrepresented, or that a statement from the ward would change people’s feelings on it in any way. But without getting a full picture of the justifications for the decision, I think there’s a limit as to how much actual learning can be taken away from this. I’d like to know more about why it happened, and would hope that someone does follow this up via #nhssm or Patient Opinion.

    People using MH services often perceive an imbalance of power (never in their favour) and as you would expect, this is most acutely observed on inpatient wards. So my first thoughts on reading about these events were how would they translate to someone being treated at home, or using community day services? What is the material difference between discouraging someone from blogging while an inpatient and while at home?

    Given that it’s frankly impossible to imagine a Community Psychiatric Nurse telling someone in their own home that they should stop writing about their experiences, in the face of the ward’s decision people could just be facetious; writing entries and saving them as drafts, and then publishing them upon discharge when it’s ‘ok’ to do so. Is this about the additional power that ward staff have, or are perceived to have?

    Setting aside the issues of libel and confidentiality as ones that have been covered elsewhere, it’s difficult to deduce the ward’s motives from their actions. ‘Patient safety’ is a very easy one to trot out, but it’s hard to see how separating someone from a supportive means of expression and communication can be in any way adding to their safety.

    There are also lots of people out there on the internet with beliefs and ideas that I find bizarre, who are not in any way connected with mental health services. Some of them possibly should be. But while I can support the NHS stepping in to prevent an unwell inpatient running up huge credit card bills, I don’t believe this duty of care extends to moderating creative expression.

    True, if the postings were critical then the blog is not the forum for the ward to address or respond to anything. But that’s not a good enough reason to effectively censor it. The internet is full of ways to express your opinion, and not have to listen to any opposing views.

    I’m guessing, although I would love to be wrong, that it’s more to do with organisations’ fear of The Written Word of the Internet, how it’s the end of the world to have anything negative written about you anywhere, and how this fear trickles down to staff. One can envisage a Charge Nurse grabbing a Health Support Worker and shaking them. “They’ve tweeted about the lack of sprouts at the ward Christmas dinner,” he wails, “What if this thing goes VIRAL??”

    I think there’s an institutional issue here, and a personal one, and they may even be linked although I never think more than one paragraph ahead. The institutional one is about the NHS saying, “Right. People are having these conversations, they are posting on forums, they are writing blogs. Not all of them think we’re great. Rather than being scared of that and trying to stop it, how can we harness this avalanche of feedback that people are giving us and do something positive with it?”

    The personal issue is about a service user having an anonymous blog linked back to them, read, effectively taken away from them, and maybe tainted for ever (though hopefully not). One could very easily use ugly words like betrayed, disempowered, censored and silenced, but these are words I’m really not happy casually throwing at NHS staff. I do not believe they fairly describe the confusion, uncertainty and mild panic which probably preceded the unfortunate (and I believe incorrect) decision. Again, I’d like to know more.

    If there is a link between the big picture and the little picture, it is that the NHS is still very much playing catch-up with social media. And until Trusts are institutionally comfortable reading about themselves online and then engaging with service users on equal terms, it’s perhaps not surprising that ward staff (whose primary role is not to be communications experts) make unwise and potentially damaging decisions in this area.

    • Anne Cooper says:

      Wow – what an interesting reply! I think you are right that its easy to get big picture issues mixed up with the individual ones and reacting – sometimes wrongly. In my conversations with nurses generally these debates are new to them and that is my real anxiety; that technology (I include social media in this definition) is going soooo fast and that professionals are not keeping up in this space. We need more open debates like this one where we can discuss these complex issues and help everyone to understand. I believe these will always be challenging issues as they are complex issues relating to the rights of patients and carers and are underpinned by some, sometimes equally complex and unhelpful, law. Let the debates commence! I’m sure Claire will have a view about this too!

  4. Alastair Sutherland says this:

    “Given that it’s frankly impossible to imagine a Community Psychiatric Nurse telling someone in their own home that they should stop writing about their experiences…”

    Alastair may find this hard to imagine but last year a consultant psychiatrist tried to detain me under the Mental Health Act shortly after I did this interview for the regional news programme BBC Look East:

    http://www.bbc.co.uk/news/uk-england-cambridgeshire-12599411 (28 February 2011)

    In this instance I spoke under my own name and made it clear that I was an elected service user governor for Cambridgeshire and Peterborough NHS Foundation Trust. I was speaking for Cambridgeshire service users and in doing so I used my recent experience as an inpatient in a Cambridgeshire acute mental health ward.

    I subsequently obtained a copy of my mental health records and the psychiatrist makes reference to my appearance on BBC Look East on the form for my formal detention. In outline the case for my detention the psychiatrist says that I feel “persecuted” for making my public statement. Well can anyone blame me for feeling threatened given the fact that this psychiatrist was trying to lock me up against my will? This psychiatrist made further statements regarding my mental health but as a matter of fact she was not using first-hand observations. We only met for a few minutes at this time and a good psychiatrist needs more than a few minutes to make a reliable diagnosis. By all means look at the BBC interview and make your own judgment about my mental health but if you cannot be bothered just take my word for it. I looked well on television because I was well.

    I tried to complain about this via my local PALS service but I had no reply so I have gone to the Care Quality Commission and the NHS Ombudsman. In a public blog I am not going to reveal any further details but I say this much in order to voice my support for any one else who faces similar threats from NHS mental health staff.

    I accept that you take knocks if you speak in public but robust debate is one thing. An attempted detention under the Mental Health Act is quite another. I predict this tactic will backfire on Cambridgeshire and Peterborough NHS Foundation Trust so my message to the blogosphere is this. Censorious NHS staff may like to think they look big but in actual fact they are cowards and they are not very bright. We can outwit them.

    • Alastair Sutherland says:

      Hi Beatrice (and apologies to Claire for taking up even more space on her page!)

      It certainly wasn’t my intention to invalidate or challenge people’s individual experiences, and I’m definitely the last person to believe that the NHS is perfect!

      My comment about a CPN trying to prevent someone at home from blogging related more to the fact that it would not be logistically possible to do so, whereas on a ward such restrictions could be enforced. The rhetorical question I was posing was therefore “Was the ward doing it because they believed they should, or simply because they could?”

      I’m really sorry to hear about your experiences, and though I did watch the video in the link I wouldn’t dream of judging anything about you or your mental health based on it. Not because I’m not qualified to (although I’m definitely not!) but simply because I like to think my own experiences have taught me that judging people is ultimately unhelpful and divisive.

      Apologies if you already know about them, but ICAS (the Independent Complaints Advocacy Service) can be helpful in supporting people pursuing complaints about the NHS. Their website is here http://www.carersfederation.co.uk/icas/

      Back to this matter, I suppose my approach is that I’d prefer to work with staff to change situations, rather than force them into it without them understanding why. But I completely accept that sometimes complaints need to be made, and I sincerely hope you get the outcome you want with yours.

      • Any blog may be subject to legal action. That is one consideration. NHS trusts can and do order bloggers to take down posts. NHS trusts can also choose to ignore blogs. I reckon this depends on the circumstances. Sometimes this can be the best thing to do if the blog is truly vexatious but sometimes trusts refuse to engage in debates for less glorious reasons.

        In my case I blogged because my complaint was ignored. My local trust responded by ordering me to take down the blog but the former chief exec refused to answer my concerns so I have now gone to the national regulators. This is silly because this matter should have been settled more swiftly at a local level.

        I am not sure that it is sensible to see social media as a species apart from traditional media because the two are so interlinked. If you have internet access you can be a whistle blower from a ward. You can easily tip off a journalist but you may have to live with staff reaction. You might win some media coverage and pressurise staff into change but there is always a risk that you might face recriminations from unscrupulous staff members. Complainants can be turned into scape goats quite easily.

  5. K991 says:

    As a patient in Southampton General Hospital earlier this year I used my Blackberry to good effect by taking photographs of the filthy environment (ingrained dirt and body fluids on on the floor) and toilets (faeces and urine on the lavatory seat and floor) I was being forced to use, and then telling the charge nurse on duty that I would be emailing them to the Daily Mail at the end of the day if the resources to ensure basic hygiene could not be found. Result? Nurses who were “too busy” to be interested in patient safety suddenly got enthusiastic about it. People were found. One clean room. One spotless toilet.

    Patients should do more of this sort of thing, and so should relatives and visitors. It’s the only way to bring Nurses, OTs and Physios to account when they happily leave vulnerable elderly patients half naked in chairs, on commodes, or laid out in their own filth for hours at a time, without a thought for their privacy or dignity while hundreds of people walk past. They really do get focused when there’s a possibility that the Trust Chief Exec might get a call from the Daily Mail to ask what’s going on!

  6. [...] browsing the comments about this decision (see not only Chaos and Control but also Claire OT’s blog) there seems to be a fairly wide consensus that it’s been poorly thought-out and badly [...]

  7. Zarathustra says:

    My guess is she’s fallen foul of the institutional nervousness that a lot of NHS trusts have about social media these days. Admittedly not all of that nervousness is unjustified – confidentiality, libel, boundaries etc – but sometimes people forget that there are benefits as well as risks.

    I’ve given some of my own thoughts here: http://notsobigsociety.wordpress.com/2012/01/04/laffaire-littlefeet-blogging-and-inpatient-care/

  8. snowqueen says:

    I don’t care what staff thought they were doing they were clearly acting in a way that infringed Little Feet’s right to self expression. The fact that anyone on here is even trying to justify the staff’s action makes me feel unutterably sad. It isn’t until you step back from the nonsensical world of psychiatry that you begin to really wonder why mental health staff still imagine that they have the right to control people’s everyday life to this degree. To accept the ‘help’ offered by psychiatric services shouldn’t mean to have to submit to their every demand but unfortunately that is the way staff and service users tend to get brainwashed into behaving. The historical positioning of mental and emotional distress within medico/custodial institutions has resulted in a completely uncritical compliance with wholly unreasonable constraints mostly on the side of staff who perpetuate these infringements of liberty without a second thought. Once someone becomes a mental health service user they are subjected to labelling, stigma and blatant discriminatory practice against which we would all be expressing outrage should the recipients be any other social group such as black people or gay people. ***Just because someone is experiencing mental or emotional (or eating etc) distress does not make them subhuman, infants or any other excuse for being patronised, controlled or restrained.***

    In case you are wondering I used to be a mental health OT but left 10 years ago because I felt I couldn’t collude any more with such infantilising and dehumanising practices. I was thorn in everyone’s side, frequently accused of ‘colluding with patients’ because I actually listened to them and treated them with respect and equity. Nobody seemed interested in the fact that my clients actually got better and returned to their live most than anyone else’s. Personal health budgets can’t come soon enough in mental health in my opinion. I am lucky enough never to have needed professional help for distress but even if I did I would do anything in my power to stay away from statutory services.

    K991 is spot on. Use your mobiles to record what’s actually going on and let the outside world know.

  9. Claire says:

    Interesting link via @amcunningham on Twitter during the #nhssm chat tonight:


    pages 63-65 deal explicitly with telephone and internet access for mental health inpatients, and recommend privacy, access and maintenance of social networks as key to recovery (as we have all intuited), so it confirms that there would have to be special circumstances for a Trust to ban access to these resources, as I stated in the post.

  10. Claire says:

    Another interesting link via @amcunningham, which relates to Scotland but probably has a corrollory in the rest of the UK:


    If yu click on the second question, about access to communications by mental health service users, it states

    “Section 284 allows for regulations to be made on the use of telephones by patients detained in hospital. The regulations will:

    confer rights on patients to use telephones
    restrict the use of telephones in certain circumstances
    authorise hospital managers to intercept telephone calls made to specified persons
    ensure that records are kept of interceptions
    confer powers on the Mental Welfare Commission to give directions to hospital managers.
    The Act does not refer to text messaging, although the above regulations may apply. Under Section 286, hospitals may write policies to limit patients’ access to mobile phones, among other items. There is no reference to intercepting e-mail communications, although regulations may be made to permit other forms of written communications to be treated like postal packets – e-mails might be included in these regulations.”

    As I read it, this again reinforces the rights of mh inpatients to methods of communicaton with social and support networks, although they do state access to mobile phones can, in some circumstances, be “limited”.

  11. [...] jQuery("#errors*").hide(); window.location= data.themeInternalUrl; } }); } claireot.wordpress.com – Today, 1:15 [...]

  12. [...] jQuery("#errors*").hide(); window.location= data.themeInternalUrl; } }); } claireot.wordpress.com – Today, 5:32 [...]

  13. Amy Gaskin says:

    Hi Claire,

    Your blog has been the highlight of my morning. Strange thing to say I admit – given that it discusses serious concerns about the ignorance of health care staff about digital communication – but your thoughtfulness and insight has helped me to get my head around this fear issue.

    In my role supporting mental health organisations to use Patient Opinion, chiseling away at the institutionally reinforced fear from staff about online communication is a constant struggle. As you say, the fear comes mainly from ignorance but is then often fuelled by organisational reluctance to engage with people through any channel that is not within their control. I find it deeply sad, but am reassured by two things –

    Firstly, the movement towards open online communication is much bigger than the NHS, it’s not something that the NHS can put reins on. Of course, that statement induces even more fear, but at the least it might encourage people to pull their heads from the sand.

    Secondly, when I am at my most disillusioned about it, I am always reinvigorated by meeting someone who gets it, and is tirelessly dragging others into the light.

    I agree with Stuart – “the thing that disturbs me most about this post is the paternalism of the staff team who have taken it upon themselves to cut off communication for reasons that appear much more related to their own sense of security than to any clinical reasoning.” Setting aside the wrongs of forgetting to put the patient first, I am struck by the brutality (for want of a less brutal word) of removing someone’s preferred channel of communication at a time when they are almost certainly feeling their most isolated. I have never been an inpatient but hear plenty from people who have or are currently sectioned, and am sure that as you say Claire, having an outlet to make sense of what’s happening to you in whatever way you see fit is absolutely vital to recovering.

    Power is such a difficult thing to possess, and being in a position of power over others is a huge responsibility. As critical as I sound, I imagine the staff that made this decision did so not in malice (atleast I deeply hope not) but in thinking it was the best thing to do – but like you’ve all said, best for who? I guess often staff just genuinely don’t know how to feel about patients communicating online or what benefits/harm it could have. Instead of learning what this means to the individual, how significant a part of this person’s life their blog (or whatever) is, they revert to doing the ‘safest’ thing – put a stop to it then it’s no longer a cause for concern. In my opinion, nurturing a therapeutic relationship after this ‘punishment’ would be near impossible. Trying to support someone to recover who is a communicator at heart, but is now unable to communicate – a further detachment from reality, their passions, their healthy self expression.

    Little Feet’s situation, and this blog, reminds me that the nature of mental health crisis (and how we’re treated when this unwell) is so unique. It would be ridiculous to think of cutting off someone’s means by which to communicate online if they were admitted for a heart attack or miscarriage. In that circumstance, the benefits of being able to express yourself and keep in touch with friends, family and supportive others through blogging are so crystal clear. I don’t for a second fail to recognise the risks associated with some forms of communication while acutely unwell, with schizophrenia for example, but I do believe that the NHS regularly fails to recognise the benefits for recovery.

    Like you Alastair, I had a little debate with myself as to whether it was appropriate to respond openly, and felt very proud when I realised I work for a team who understand that being a human at work is a damned good thing. My hope is that the NHS, and all of their employees, begin to feel more and more like that themselves.

    I want to write an optimistic conclusive statement, something that a politician would be proud of, but I’m no expert and I don’t think this is a battle that will be easily won. If anything, I feel the divide in digital literacy between patients and the NHS is growing ever more cavernous. I am forever grateful for the people on the ground, staff and patients, who talk sense about digital communication and don’t allow organisational drag to slow them down.

    I’m reassured that the right debates are happening somewhere, if not always on the wards!
    Thanks so much for sparking this one Claire.

  14. Social media in the NHS – worries about Chaos and Control…

    Social media in the NHS – worries about Chaos and Control…

  15. [...] 6, 2012 Leave a Comment As I wrote in an earlier post, blogger @ChaosandControl, or Little Feet, was recently prevented from blogging whilst an Inpatient [...]

  16. [...] has been discussed all over twitter and the blogosphere including at The Not So Big Society and Claire OT’s Blog. It has been very interesting to follow the developments of this case and now Little Feet as [...]

  17. Bristol Michael says:

    The other thing about Maslow that clearly is emerging here (not least in the instance of the Cambridge psychiatrist) is his definition of the Authoritarian Personality, cf DSM-IV Obsessive-Compulsive Personality Disorder,a Billy No-Mates who has no equals but crawls to those (s)he considers to be his/her seniors and treats those (s)he considers to be his/her juniors (eg service users) with contempt. I can remember a time when psychiatry was riddled with this attitude – clearly, there are still pockets of it around.

  18. Claire says:

    This great blog has turned up on Twitter via @PaulBromsford, neatly showing how all the social networks fit into Maslow’s Heirarchy


  19. [...] @claireot on Littlefeet- a case study of the consequences of poor staff digital literacy in a mental health inpatients unit http://claireot.wordpress.com/2012/01/04/censorship-or-duty-of-care-little-feet-blogging-on-an-acute… [...]

  20. jargonaut says:

    This is a great use of Maslow … Do you mind if I use this diagram and expand on the theme for a post of my own?

    • Claire says:

      Of course you may! This is why I blog! Do let me know the link when you blog, I’d be interested to read your development on this theme

  21. […] fellow blogger posted this today, which is well worth a read. I particularly like the use of Maslow’s hierarchy of needs […]

  22. Darren says:

    I blog often and I truly appreciate your content. This article has truly peaked my interest.
    I’m going to bookmark your website and keep checking for new information about once a week.
    I subscribed to your Feed too.

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I'm an OT called Claire. I write about health, particularly mental health, and also about Social Media and Web 2.0 technology. I am particularly interested where these two fields overlap.
I believe that we all hold the potential for Recovery- let's grow together.

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