Tuesday, 19 June 2018

How can Independent Mental Health Advocacy help you?

Last summer we featured Connecting with the mental health advocates in which we found out more about the three different advocacy roles in Powys, and met some of the advocates themselves – in particular those based in Powys. 

Today we talk to Adrianne Cleverly, who works for Conwy & Denbighshire Mental Health Advocacy Services, but actually provides an advocacy service for Powys (which is commissioned by Powys Teaching Health Board). I met Adrianne earlier this year, and we all agreed it was important to try to raise awareness of the advocacy service available in the county.

Tell us what brought you to work in the field of mental health advocacy?

I was fortunate enough, and lucky enough, to fall into the field of mental health advocacy – by complete accident. I was working in child protection; within that role I was working with Child and Adolescent Mental Health Services (CAMHS) and acting as an advocate for some of the children I was working with. The role was so varied that my experiences spread further than I had even realised because when you are doing the job you take those things forgranted and just get on with it. One day someone showed me the job advert for an IMHA (Independent Mental Health Advocate). When I read the job specification, I could not believe a job like this existed. I applied for the job, and what can I say, three years later, I still love the role and still feel lucky enough to work in this position. I love my job! You definitely have job satisfaction when you work as an IMHA. Sometimes the differences you make can seem trivial but the difference you are making to the person is so much more. It is such a rewarding job.

What is your role at CADMHAS and which area do you cover?

My role at CADMHAS is an Independent Mental Health Advocate. Within this role I cover the South Powys hospitals - Ystradgynlais, Bronllys and Brecon. Within the role of IMHA my role means that I visit the hospital wards and meet with qualifying patients (people admitted to hospital for their mental health). I work with them within the remit of accessing their rights under the Mental Health Act and support them with anything to do with medication, treatment and care.

I also deliver awareness raising sessions in North Powys. Those hospitals are Phoenix House, Welshpool, Machynlleth, Newtown, Knighton, Llanidloes and Llandrindod. As part of awareness raising I also work with the community mental health teams which are Ty Illtyd and The Hazels, additionally other professionals that might also be working with the same people as myself, should the scenario require me to.

Many people don’t know about the advocacy service. What are the key benefits of having an advocate?

The benefits of having an advocate will vary for the individual and depend on why they felt they needed/wanted an advocate in the first place. For some people they may have more than one admission to a hospital ward and they may want an advocate on one visit and not another. The beauty of the role is that it is led by the individual. It is not the choice of the professionals or the family, but the choice of the individual.

One main benefit of having an advocate is to ensure that you have a voice when you need it. Also the reassurance of knowing that someone is making sure your voice is heard. Other benefits include empowerment to have a voice. Receiving the knowledge and understanding and being helped and supported to understand your rights when you are in hospital or having some experience of the Mental Health Act (maybe living in the community but being on a Community Treatment Order or Guardianship). Also, having the availability to access those rights. Additional benefits are to feel supported by an independent professional and feeling like someone is on your side.

What key qualities does a good mental health advocate need to have?

The qualities of a good mental health advocate are simple; they will be non-judgemental and listen to what the person is actually saying. An advocate needs to be a good listener, they will be well informed and skilful. They will have confidence in themselves and be comfortable enough to stand up for the person’s rights.

Just for clarity, can you very briefly summarise the three different mental health advocacy roles?

Independent Mental Health Advocate 

An Independent Mental Health Advocacy (IMHA) means the qualifying patient has access to an IMHA which is a statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO). When someone is detained in hospital or on a CTO it can be a very confusing and distressing experience. 

Independent Mental Capacity Advocate 

An Independent Mental Capacity Advocate is available to everyone surrounding the care, treatment and support of people aged 16 and over living in England and Wales who lacks capacity to make all or some decisions for themselves in specific areas. These areas being change in accommodation, care reviews, safeguarding issues and serious medical treatment. An IMCA will also be involved in those detained under a Deprivation of Liberty order. The Mental Capacity Act is designed to protect and restore power to those vulnerable people who lack capacity. 

Community Mental Health Advocate 

Community Mental Health Advocates provide and offer representation and support at meetings and appointments to people who have been treated for their mental health and are now living in the community. An advocate is someone who will listen to your worries and problems and work alongside you to achieve your aims. Advocates are a valuable source of information and can help the people who use their service to feel in control of their own lives – to feel empowered. 

Can an individual be supported by all three types of advocate at once – IMHA, IMCA and Community Mental Health advocate? If so how does that work?

Yes an individual can be supported by all three advocates. All advocates work in different ways so if a person needs support in different areas they will be eligible for different advocates. An IMHA will work with an individual within the remit of medication, treatment and care.

An example of this would be if a patient is on a Community Treatment Order they will be eligible for the support of an IMHA who will support the individual with representation at a managers' hearing or tribunal. They may also have been deemed to lack the capacity to make a decision on their placement so they will then be eligible to have the support of an IMCA as IMCAs will work with the individual around this. They then might need support with things like pension and finances, so they will then require the support of a community mental health advocate.

What happens when a carer refers but the patient/individual does not want to engage?

This goes to the heart of advocacy. The individual is the one that instructs the advocate and decides if they want to work with us. If a person has capacity to understand the role of an IMHA and they don’t want an advocate that is their choice we would not force ourselves on them. The work of an IMHA is client led. If the individual doesn’t want to work with an IMHA, we cannot make them. We can ensure that we give them plenty of choices and just be available for them if they change their mind.

If the person does not have capacity then we can still work with them, but it will be in a non-instructed way. This means that we work with the family and professionals to establish as much information as we can and then work in the person’s best interest.

If someone is placed in a hospital or unit outside Powys, can you still support them? 

Usually our role would stop but we would signpost to other agencies.

If a patient is placed on a Community Treatment Order (CTO) what support can you provide as an advocate?

If a patient is placed on a community treatment order, our role would remain the same as if we were visiting them in hospital, but we would visit them in the community instead. We would still work with them around their medication, treatment and care and we would also attend meetings with them around these themes. We would also still support them with their rights under the mental health act and support them at managers' meeting and appeals.

Which organisations do you work most closely with in Powys? 

As an advocate in Powys there are quite a few organisations we have worked with. The main people we work with are Social Services and Community Mental Health teams. Additionally we also work with organisations like Age Cymru and the Alzheimers Society. We also work with the ward staff, and Best Interest Assessors.

What are the main challenges of your role?

Some of the main challenges experienced are having the ability to manage the expectations of not only the client but also their family. Another challenge is when delays happen and it is completely out of our control but there is an expectation on us to make it happen. Another challenge would be the conflict of interest and other people’s understanding of our role, including professionals.

Tell us about some of the most rewarding work you have done so far with CADMHAS?

For me personally, the most rewarding part of my job is when the client gets what they want! Especially when the work started it was not even a possibility, knowing that you have made that difference to that person. This includes things like making sure the clients are listened to and that there is communication between staff and patients.

When you are not working for CADMHAS, how do you enjoy spending your time?

I love to spend time with my family, doing things like mountain biking, surfing and walking. I enjoy listening to music, reading and cooking. It sounds a bit cliché but I love the ‘normality’ and chaos of family life! 

Many thanks to Adrianne for telling us all about her work as a mental health advocate. If you want to find out more you can contact the Powys Independent Mental Health Advocacy Service managed by CADMHAS by emailing admin@cadmhas.co.uk or ringing 01745 816501.

Monday, 11 June 2018

Small Steps at Rekindle - Three Stories

Recovery Practitioner Kemal with a local police officer outside the Newtown centre
John Scott is the chairman of the mental health charity Rekindle in Newtown. At a recent fundraising concert for the charity, which supports young people aged 16 to 25 who are struggling with mental distress, he said:

“The trustees and staff know from experience that early intervention can help many of these young people avoid or recover from the social dislocation that can result from mental illness.

There are more than 110 active clients, and they are referred by all the various agencies in Newtown. There are two full time recovery practitioners (Diane Williams and Kemal Keeble), one of whom is a qualified mental health nurse, and two regular volunteers. They operate from converted shop premises in the centre of Newtown, which makes them accessible to this client group.

Diane (left) with a client
The stories here are examples of what can be done, and there are many more similar ones. The right help at the right time can stop these young people from a possibly irreversible descent into self-destructive behaviour. It is wonderful to see young people starting to enjoy their lives again.”

Jess Foster

At the age of 18 I was living in a homeless hostel and felt there was no use in living any more. I struggled with the pressures of sixth form and trying to earn a living so attempted suicide multiple times. Initially I was under the care of adult services but didn’t feel as though I actually mattered to them and was made to feel as though my problems weren’t bad enough.

I was lucky enough to be introduced to Diane at Small Steps and I was finally on the road to recovery. I was given all the time I needed, whether it be for just a chat or to help me better my life. Feeling like I mattered and being listened to changed my life around.

I stopped self-harming, returned to sixth form, applied for university with Diane’s help and even began caring about my own wellbeing again. When I got my place at university Diane got me a grant so that I was able to buy everything I needed and to any other person I would then look like a typical student, not someone who had just been homeless. I am now graduating this summer, have a job and strong friendships. My life is now at a good point and it’s thanks to all the help and mentorship I had from Diane and Small Steps.

Megan Tudor

My name is Megan Tudor and I am an associate trustee for Rekindle's Small Steps Project. I began as a client of the project when abuse was identified in my family home. I had to leave home and faced the difficulty of finding a roof over my head. Diane and Kemal worked tirelessly to help me and although they came across many difficulties they never gave up on me. I was in a very dark place and tried to end my life on a daily basis; I couldn't find a reason to carry on. I went from living in a horrific environment to only having the clothes on my back and no roof over my head. I was also suffering from an eating disorder and refused to eat or drink anything.

The Small Steps Project was the only organisation that recognised there was abuse and actually listened. I had seen Child & Adolescent Mental Health Services (CAMHS), 16+ team, social workers and spent a year in a psychiatric hospital and none of them listened to what I was saying. Diane and Kemal let me have as much time as I needed and listened to every word I said and actually did something about it. I was supported on a daily basis to stay alive on top of trying to find stable accommodation.

I was supported by the Small Steps Project to find a reason to live, gain tools to cope and to slowly overcome my eating disorder. They helped me to get back into education and I finally started to feel like I was breaking free from the chains that held me back for so many years. I was no longer walking down the narrow lonely corridors of hospitals or dancing with my demons. I am now living my dream, halfway through my qualification, working part time and offering support to the other clients of the Small Steps Project.

Sam Morgan

I was 16 when I first came to Small Steps. I was living with the fact I had quite a bad temper but didn’t want to admit to it. I didn’t want to feel ashamed. It got to the point where I got pretty hard to live with, my anger was getting worse and simple things would set it off. It got to the point where shouting turned into me deliberately hitting anything hard, just to try and feel something other than anger. I was also damaging my hands. My parents and I realised I couldn’t go on doing what I was doing, so I got in touch with Small Steps.

It took a long time for me to understand that I was adjusting from being a young person being told “what to do” and the new pressures of having to make decisions about life. “Who I want to become” and “what I want to achieve”. Small Steps helped me with this, it was the first time I had someone who I could speak to and someone who understood how I was feeling.

I felt I only had the one overwhelming emotion which was anger. I was always waiting to be challenged and at the first hurdle I would usually just lash out! Over time it become apparent that there was more to life than just this feeling of anger. Things changed for me and now I saw things differently; I could stand back and assess the moment and realise that anger was not the correct response. All of this was only really possible because of the continued support I received from the Small Steps Project.

I am in a different place today. I think more positively about what I would like to achieve. I am now 19 years old and aspiring to be a Royal Marine commando, which is a completely opposite mind-set. My mental and physical toughness has developed through training. I understand how to take care of my body and wellbeing. My relationship with parents is very different today, we are able to talk about things more openly and have become closer as a family. I realise now how I have a lot more to give in life and that it all starts with you allowing these changes to happen.

Jess and Sam's stories also feature in this short video about the Small Steps Project:

Find out more about the work of Rekindle and its Small Steps Project on the organisation’s website. The charity is funded by charitable trusts, local groups, businesses and individual donations. If you can help in any way you can contact the charity by emailing: help@rekindle.org.uk or ring 01686 722222.

Sarah Napper with Diane
Stop press: Rekindle volunteer Sarah Napper was recently nominated for the Powys Volunteer of the Year Award 2018 and reached the shortlist. Sarah has been volunteering for three and a half years and her role involves welcoming clients and professionals to the project. She does this despite having her own bipolar diagnosis. Sarah is around the same age as those seeking help so she has a special empathy and understanding of their problems and is a good listener. Diane said: "Sarah promotes and empowers young people to believe they can achieve anything in life despite any obstacles that come their way."

Monday, 4 June 2018

Veterans NHS Wales – on military mental health

Victoria Williams, Veterans' Lead, Abertawe Bro Morgannwg University Health Board (left)
and Vanessa Bailey, Veterans' Lead Therapist Aneurin Bevan University Health Board (right) 
This week’s guest post is from Victoria Williams, the Lead Veteran Therapist at Veterans' NHS Wales service (VNHSW) based in Swansea's health board - Abertawe Bro Morgannwg University Health Board. The team also covers the Ystradgynlais area of South Powys.

Veterans are defined by Public Health Wales as “anyone who has served for at least one day in HM Armed Forces (Regular or Reserve) or Merchant Navy Seafarers and Fishermen who served in a vessel at a time it was operated to facilitate military operation by HM Armed Forces”.

Veterans' NHS Wales service is there to help ex-service personnel living with service related mental health problems. I caught up with Victoria to find out more about provision of this invaluable service in Powys. 

Tell us more about your role as a Lead Veterans' Therapist and what drew you to the work

I’ve been working for Veterans’ NHS Wales since 2011 for the ABMU health board. Having worked in mental health for over 20 years I recognised that I wanted to work in a service that specialised in working with military veterans and this was an ideal opportunity.

What kind of support is available to veterans in Powys?

Powys enjoys the same level of service from Veterans’ NHS Wales as anywhere in Wales. You can download a map showing the 3 out-patient clinics, based in Welshpool, Neath and Bronllys.

Why might veterans require this service?

Veterans’ NHS Wales is a psychological therapy out-patient service offering therapy for veterans with service related mental health difficulties. This means that anyone who's finding it difficult to cope after they have left the military, if they think their issues might be ‘service related’, are able to self refer to us. We will then offer an initial assessment of their needs and from there a management plan will be put in place.

Mark Birkill, Veterans' Therapist in North Powys
How can Powys veterans access the service? Who can refer a veteran for the service?

VNHSW is the Welsh Government funded NHS mental health service offering therapy for issues related to military service. It’s important to note that ANYONE can refer into the service. We offer an open access policy meaning that people are able to self-refer via the website. We do find a lot of people think they have to go via the GP but this isn’t necessary.

Once referred an opt-in form is sent asking the veteran for extra details and proof of identity. When we have this information we aim to offer an assessment within 4 weeks. The assessment will look at all aspects of the current situation and look at how we can best support you.

The Powys Veterans' service is delivered by neighbouring health boards. How does this work?

VNHSW is a ‘hub and spoke model’. This means we are one service centrally based in Cardiff with our ‘spokes’ throughout the other 6 health boards in Wales. Powys is covered by 3 health boards but because we are ‘one service’ it therefore has no impact on the service a veteran will receive. If there are any doubts as to where your clinic is based then individuals can contact us (see details on the map or
go to our website) and we can point the individual in the right direction. For example, if the veteran's GP surgery is based in the Abertawe Bro Morgannwg health board, then the veteran would be seen in our out-patient clinic in Neath.

A Veterans' service is very specialist. What training do Veterans' Therapists undertake?

All veterans' therapists are trained psychotherapists with training in Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Both therapies are what we call ‘evidenced based therapies’ for treatment of a variety of mental health difficulties. In addition we receive additional specialist training in military mental health difficulties.

Oxana Jones, Veterans' Therapist in South Powys
Are there other agencies Powys veterans can contact for support with their mental health or other issues such as debt management or armed forces compensation?

Veterans’ NHS Wales has a network of agencies working throughout Wales offering support for many different issues. We currently have a peer mentor support worker who is able to help veterans link in with the most appropriate agency to help with their needs.

What has been the most challenging aspect of running the Veterans' NHS Wales service?

One of the most challenging but rewarding aspects of the role is the increasing number of referrals we’ve received since we started 10 years ago. Initially this led to an increase in the time veterans were waiting to be seen for therapy. However, with the support of Welsh Government, which has recently increased our funding, this has meant that we’ve been able to extend the input of psychiatrists and administrators can give to the service. We’ve also been very lucky to receive additional funding from the charity Help for Heroes over the next 3 years and this has led to an increase in the number of therapists in the service leading to shorter waiting times.

Tell us about some of the most rewarding work you have done with the Veterans' NHS Wales service so far

Being able to speak to someone who isn’t aware that there is help for the problems they are presenting with. Also helping someone to make sense of why they feel the way they do, and offering an evidenced based psychological therapy to reduce their symptoms and improve their general daily functioning, is pretty rewarding stuff.

When you are not working, how do you enjoy spending your time?

As a mother to two teenage boys and two dogs I tend to be very busy but you can often find me on the beach with my dogs or eating cake, I’m a big fan of cake.

Many thanks to Victoria for telling us about the Veterans' NHS Wales service in Powys. If you would like to contact her, please email: victoria.williams4@wales.nhs.uk

Tuesday, 22 May 2018

Dementia Action Week 2018

aka Powys Dementia Network event Spring 2018 – Part 2 

Just in time for Dementia Action Week (21 – 27 May) – here is the concluding post covering activities at the recent Powys Dementia Network event in Newtown. The Network is facilitated by Powys Association of Voluntary Organisations and the day was attended by numerous agencies and groups from both the statutory and voluntary sectors in the county.

I wrote about the morning sessions in Part 1, which focused on updates from a number of statutory agencies (including Dyfed Powys Police, Mid and West Wales Fire and Rescue Service, Powys County Council, Powys Teaching Health Board, and Welsh Ambulance Services Trust). All the speakers emphasized the importance of working together to give people living with dementia the best possible life experience. We heard a few scary stories of what could happen in a worst case scenario, we saw some amazing technology, and we learnt that listening to people living with dementia and those close to them can be absolutely key in helping shape effective future services.

The afternoon session featured some truly inspiring and uplifting stories from those in the voluntary sector working closely to support people living with dementia, and also some of those people themselves.

Karen Rodenburg – Alzheimer’s Society, Dementia Friendly Communities Co-ordinator, North & Mid Powys

Karen and her two colleagues (working further south in Powys) have one shared goal: to support communities to become dementia friendly.

“A dementia friendly community is one in which people are empowered to have high aspirations and feel confident, knowing they can contribute and participate in activities that are meaningful to them.”
Karen added: “this is as descriptive as it gets as all communities are different.”

Communities across Powys are all at different stages in their dementia friendly journeys. Karen updated us on progress across the county. Smaller communities such as Guilsfield, Llandinam and Sarn are also now considering becoming dementia friendly. Whilst there may be some crossover with neighbouring towns (Welshpool and Newtown spring to mind), these communities will be completely different in feel and able to respond to the specific needs of the local people.

Karen then put out a call for more Dementia Champions. Is it something you might consider? Champions provide Dementia Friends’ training, and there is a big demand for these sessions particularly during daytime hours when many current Champions are unavailable due to work commitments. Two training sessions coming up soon: Tuesday 5 June at Oriel Davies Gallery in Newtown, and Thursday 14 June in Machynlleth.

Freedom Leisure group has spearheaded a new initiative for Dementia Action Week after discovering that a person living with dementia in Llandrindod Wells wished to play tennis! Two hour taster sessions will be available at sports centres throughout the county, including dementia friendly swimming and walking football.

And if you’re wondering why it’s now Dementia Action rather than Awareness Week, here is the explanation:

“People are already aware. It’s action we now need. It’s help. It’s support. Turning into Action Week is absolutely the best thing I’ve heard.” Chris, a person living with dementia.

Sam Bolam – Chief Officer, Dementia Matters in Powys

Sam began by saying that whilst she’d heard of many valuable services during the morning session, the picture that had been painted of the person living with dementia was – someone who is watched a lot, who might set a fire, murder their wife, and spend time talking to the emergency services about things that had not actually taken place!

“From wanting to help we make them seem very different to us.”

The vision of Dementia Matters in Powys is simply: Powys Communities where people with dementia matter. The organisation’s five priority areas are key to driving change:

  • Giving a voice. 
  • Tackling myths and stigmas. 
  • Promoting independence, choice and control. 
  • Being supportive and inclusive. 
  • Partnership working. 
Sam pointed out that we can get risk averse when developing services. We might say: “It’s really innovative. But it’s never been done before…” She admitted that creativity takes courage. But it needs to be injected into services where things have become “a bit static.”

We learnt about the first Dementia Meeting Centre for Wales in Brecon, and plans for a further four in Rhayader, Llandrindod Wells, Builth Wells and Ystradgynlais. Sam concluded with some challenging questions, including:

  • Can we truly describe a community as being Dementia Friendly when some aspects of basic dementia support are so lacking? 
  • How do we move right away from the seemingly inbuilt tendency to exclude experts by experience in decision making?
Gill and Frances

Gill and Frances – Living with dementia

For the final session we were treated to two truly spirited, funny and extremely articulate presentations from Frances, a person living with dementia, and Gill, who supports a person living with dementia.

Frances described her 20 year high-powered consultancy career. It was only when she retired that her husband noticed she was no longer able to decipher tax law when it had previously been the bread and butter of her work. She forgot dinner invitations. “It was a collection of things.” He encouraged her to go to the doctor’s where she was asked ridiculous questions such as “Who’s the Prime Minister?” “I was already feeling like a fool. I wanted to suggest – isn’t it Mr Gladstone? But I knew I shouldn’t!” Then to Frances’s surprise the doctor asked her things she really couldn’t do, such as name the days of the week and count… but both backwards…

Others that were more intensive followed these initial tests. “The truth eventually settles. When the doctor gives you a hug you know you’re in trouble!” Frances described experiencing cognitive impairment – “I frequently don’t know where I am. Well before I was 70 driving was not a possibility. When I have an episode of cognitive impairment I don’t know who people are. You don’t know what’s hit you. It makes you feel foggy. In shops I have no idea and just come back with tinned tomatoes (we have quite a stock now) or cat litter (we don’t have a cat!) We have laughed about these endless things…. Or else you’ll cry.”

Frances started attending sessions at Bronllys Hospital where she learnt useful coping strategies. “I know there are things I can’t do, but there are things I can do – like talk to you.”

“I also volunteer at Brecon Hospital. We offer patients the opportunity to come out of their rooms and talk. I go to Brecon Meeting Centre. They really understand that people with dementia aren’t mad – we’ve had little bits chipped away. It’s random things… how does that zip work…? How do I make salad dressing…? How do I tie shoe laces…? At the Centre we are helped to find our former selves through games that evoke memories, talking to each other, and doing activities we used to do. I go home tired but uplifted! You can have a whole life. It’s different. But wonderful. I feel I’m at a perpetual party and the cake’s good!”

Gill cared for her father until a few weeks ago – he is now in a care home. She described her experience. “I worked as a Facilities Manager. I am practical. Logical. Think on my feet and react to emergencies. I thought I was well-equipped to be a full-time carer for Dad. Was I wrong! It was such a shock.”

“Dementia does not sit in isolation – people are already being tugged in every direction. You have to make room and it adds to the stresses that you are already feeling. I have good, funny and black days.”

Gill’s lifeline, and that of her Dad’s, is the Brecon Meeting Centre. She told us why:

L is for learning plate. I is for integration. F is for friendship. E is for emotional support. L is for laughter. I is for inspiration. N is for nurture. E is for empowerment. And S! S is for smiles. "A smile is sunshine spreading across a face. The carers played walking football at the meeting centre and were smiling ear to ear afterwards!

And, finally, to Frances for the last word: “I love my coffees at the Brecon Meeting Centre. I go in there and order my coffee in a double D cup!”

Monday, 14 May 2018

Mental Health Awareness Week 2018

Stress, are we coping?

This year the theme for Mental Health Awareness Week (14 – 20 May), hosted by the Mental Health Foundation, is stress. Research has shown that two thirds of us experience a mental health problem in our lifetime, and stress is a key factor in this.

For many people stress is a part of everyday life, but do we really manage our stress effectively? By tackling stress, we can go a long way to tackle mental health problems such as anxiety and depression, and, in some instances, self-harm and suicide.

The Powys Mental Health Planning and Development Partnership, in collaboration with other partnerships across the county, is exploring how we can all tackle stress and help to improve our mental health. Stress is not a mental health problem itself but is a survival response to keep us safe. But it should not become a way of life. The Partnership asked its members what stress looks like for them and how they manage it.

How do you recognise stress?
  • For me it’s about when the day to day things I usually cope with fine start eliciting a greater than normal response. So, maybe I am rushing around and hit my funny bone really hard on the door frame (never funny) and it makes me really anger or want to cry – when usually an expletive muttered under my breath will suffice. Those moments really stand out for me and I know there is something else going on. 
  • Usually when I start to lose patience and things annoy me more than usual, particularly my husband! I know that I have been moaning a lot when he says things like ‘can you not ring your mum?’ which means he has done his best to support me but it I now requires a higher level of management. This ‘intervention’ usually works as I can take a step back and get some great advice from people who know me best however sometimes there are physical signs too.

What does stress look like for you?
  • Personally, a sense of frustration, a loss of sense of humour and feeling powerless are symptoms I look out for.
  • It’s like my emotional cooking pot is full.  There is no room for anything else.  And when something else does happen my emotions can spill over much more easily with less of a filter than they usually have. If I'm stressed I may feel like I have too many things to do and not enough time, so I don’t seem to stop or get any time to myself.  That makes it hard to unwind which can then affect my sleep, making me feel worse in the morning and on the cycle can go unless I do something about it.
  • It usually presents in anger / frustration towards a loved one.

What do you do to combat it?
  • The most important technique for me to combat stress is to recognise the early warning signs and to take immediate action.  I generally use ‘Resilience’ as a coping mechanism.  This can be by taking a short break, speaking with friends and colleagues or exercising.  For me, it’s being able to adapt to changing circumstances.
  • Exercise – specifically going for a cycle ride.
  • Learning how to breathe properly. This sounds weird but if I take a minute to close my eyes, breathe in though my nose for 7 seconds and then slowly out through my mouth for 8 this really helps. Walking the dog in the countryside or at the coast makes me feel good too.
  • In the past exercising whilst listening to loud music (on headphones) has also helped – this is a good standby in the winter when severe cold or rain encourage stresses to multiply because I can’t get outside in the garden. There are loads of NHS exercise classes for beginners on YouTube and they don’t all involve balancing on a yoga mat with hardly any clothes on looking like a Downward Dog.

What shouldn’t you do?
  • Think it will go away if I don’t do anything about it.
  • Bottle up worries / concerns – share with others for discussion / solutions.
  • Panic. Life is hard. There will be stress in life, embrace it as a natural thing, accept it as a part of you and don’t see it as a failure to cope with things.
  • Buy five large chocolate cakes and eat them all at one sitting!! Buy a one way ticket to El Calafate, however tempting it might seem at the time… Scream at your line manager that you hate your job and you’re leaving right now, never to return. In other words…. Don’t be too impulsive. Take time to step back, assess the situation, seek help if that’s appropriate, and then make a plan of action to address the cause of the stress. Then collect empty plastic bottles to turn into mini cloches to keep the mice off the peas and beans…

Do you do any of the Five Ways to Wellbeing to combat stress? If so, which one works for you and why?
  • Connect – unwind with friends and husband – talk things through – doing something nice together. Be active – running and walking. Take notice – being in nature.
  • Be active. Being fortunate to live in Powys, the opportunities for exercise throughout our glorious surroundings is endless. Being able to walk the Black Mountains, Brecon Beacons or the River Wye footpaths. Being able to get away from things through walking either with our dog or with family is calming and fulfilling. I find exercise an important part of my physical and mental well-being.
  • Being creative - More recently I have been getting creative, remembering how much I used to love Art in school I thought I’d give it a go now. Finding the time to paint is good because I’m preparing to make a relaxing bit of space and time. I get everything I want to done and the whole time I’m doing this I’m looking forward to creating something.

What would be your top tips for managing stress?
  • Exercise – it’s hard to motivate yourself to start but if you can find a way to build it into your weekly routine it can be hugely effective.  Particularly if you can get out into Nature.  For many people exercise seems to use up excess emotion leaving you feeling calmer and more in control. Nature has been shown to have many beneficial effects, not just on our mental health, but also on our physical health. We evolved in Nature (green trees and soft curved lines) not urban environments, and we relax and feel better when surrounded by it.
  • Do something you love and get lost in it – be it football, craft, reading…. You will be totally absorbed by it for a while so you don’t think of anything else.
  • As a Police Inspector, I must be accessible to colleagues and a point of contact and support when people are under stress.  I must recognise incidents which could have a negative impact on a person’s well-being and ensure that the correct support intervention is provided.
  • I personally rely on making a list of things to do and I then prioritise what must be done first.  This helps me to turn what appear to be unmanageable tasks into something less formidable.
  • Try and get away from whatever you are working on for 10 – 15 minutes at lunch time – go for a short walk, run or cycle – whatever takes your mind of what you are currently doing!
  • When you wake up in the morning (and go to bed at night) think of 2 – 3 things that you are really grateful for.
  • Be as kind to yourself as you possibly can. Imagine you are another person (or animal if that’s easier) you love and care for. You want to do the best you possibly can for that person/animal. So what would you do? I am often guilty of putting myself under further pressure if I’m stressed, as if it’s all my fault and I need to suffer further! But whilst I might sometimes be responsible (I can’t grow 30 of my favourite vegetables successfully and fit everything else in my life, but maybe 10 would work) sometimes the stress has an external source. Pluck up courage and talk to anyone involved in making your life stressful, or, if that’s not possible, try and stay out of that person’s way!
Any other comment?
  • Laugh. With colleagues. At that very funny radio comedy. At your own jokes even if nobody else thinks they’re the slightest bit funny. When the cat’s head gets stuck in a margarine pot (but do rescue that cat promptly).  When you all try a new sport and end up on your backsides, your head, in fancy dress or covered in apricot jam…. Be weird and wonderful and wacky sometimes, because you can (only if it’s legal though!) Just because life is hard sometimes, remember to take a breather and HAVE FUN!!

Tell us what you do to relieve stress in the comments box below.

Together for Mental Health is the Welsh Government’s 10 year strategy to improve mental health and well-being in Wales.

In Powys, there is a Mental Health Planning and Development Partnership in place to deliver the strategy locally and prioritise activity to meet the needs of Powys communities. One of its main objectives is to build strength and resilience, promoting mental and emotional health and wellbeing of individuals and communities across the county. 

Thank you to Mary Griffiths (Mid Powys Mind), Inspector Brian Jones (Dyfed Powys Police), Louisa Kerr (Powys Teaching Health Board), Jackie Newey (Powys Association of Voluntary Organisations) and Joe Wellard (Powys County Council) for their contributions to this blog post.

Thursday, 10 May 2018

Powys Dementia Network event Spring 2018 – Part 1

Two years ago, I attended a Dementia Supportive Communities event in North Powys at which the idea of the Powys Dementia Network was first mooted. Three meetings subsequently took place through 2016 – 2017, in Knighton and Brecon. In late April this year I actually went to my first meeting of this network at Newtown Rugby Club. It was a brilliant opportunity to find out the latest updates about dementia services and activities across Powys.

The day was packed with speakers and networking opportunities so this summary is split into two blog posts. This first post will focus on the morning session, primarily important updates from a number of statutory agencies. The second will highlight the ongoing work of the voluntary sector, plus the day’s highly entertaining finale “Living with Dementia” from Frances and Jill, who between them have extensive experience of living with, and caring for people, who live with dementia.

Claire Powell, Community Connector at PAVO, and Trish Buchan, PTHB
Trish Buchan – Setting the scene for PAVO

Trish, who previously worked for PAVO as the Health & Social Care facilitator, now represents Third Sector Organisations at Powys Teaching Health Board. She has personal experience of supporting a close family member who lived with dementia, and encouraged all agencies to work together “to support people living with dementia to live well and happy lives.”

Alison Johnstone, Patient Experience & Community Involvement Manager
Alison Johnstone & Dave Coombs – Welsh Ambulance Services NHS Trust

WAST produced its three year dementia plan last year, regularly schedules Dementia Friends’ sessions for staff, and is recognised as a Dementia Friendly Community. The vision: “By 2020 we will be an organisation that responds to both the clinical and emotional needs of people living with dementia, their carers and families.”

Working to achieve this goal, Alison has a key role at WAST as she talks to people about what they think of the ambulance service. Here are some of the issues people living with dementia have raised:

  • I struggle to know when to call 999 and to deal with the process for call handling.
  • It’s complex. Different questions are fired at me. Call handlers need to slow down. To have patience. 
  • I need to be treated with respect – as an adult, not as a child.
  • Get to me quickly. Be calm and compassionate.
  • Realise the key role of carers when I am trying to access services.
Alison reported that WAST works closely with the Alzheimer’s Society putting in place suitable staff training. The other good news is that Ten Dementia Champions have so far been recruited across the service to raise awareness, and more are being sought.

Matt James and Dave Coombs of Welsh Ambulance Services Trust

Dave Coombs (also a volunteer with the dementia friendly Brecon Mountain Rescue Team) introduced us to trauma teddies, which are used to comfort ambulance patients, and the “Message in a Bottle” scheme whereby a person’s brief personal and medical history is stored in a bottle (provided by the UK Lions Clubs) in the fridge.

Neil Evans – Mid & West Wales Fire Service
Neil, Llandrindod Wells Station Manager, described how the fire service works to support people living with dementia who are at a higher risk of experiencing a fire. Staff at all fire stations have been trained as Dementia Friends. Using the Make Every Contact Count (MECC) approach, he and colleagues arrange free home safety checks, prioritizing those living alone, and people who are elderly, infirm, disabled or living with dementia. Neil described a scary scenario where someone who had used an Aga or Rayburn all her life put a plastic kettle onto the hob. 

Fire staff, now skilled in a range of areas, including: winter warmth, crime prevention, scamming, flooding, water safety, arson reduction, smoking cessation, slips, trips and falls, can when appropriate give advice on all topics. Group training is available for organisations as it is recognised that the voluntary sector is likely to have strong links with “the most high risk, hardest to reach” in the community. And – here’s an income generation scheme for groups – there is payment available for those delivering home safety checks.

Inspector Brian Jones – Dyfed Powys Police

After speaking on the importance of reporting hate crime, and introducing us to the force’s Strategic Equality Plan 2016 – 20, Brian asked us to give him some examples of likely incidents that police could be called to around dementia. “Misunderstanding a situation and reacting badly…” “There could be driving issues…” Telephone scams, domestic abuse and public order were also highlighted.

Brian explained that a person might walk over twenty miles in a day (there was discussion around terminology, “wandering” is not an appropriate term as people living with dementia walk with purpose). They could engage with others without anyone necessarily having any concern for them. Yet back home the family would be anxious and concerned for the missing relative. Searching for a missing person is a massive challenge over the large rural area that is Powys.

Police Community Support Officers throughout the county work hard to become known faces in their local areas, including at relevant groups where people living with dementia are supported to lead fulfilled lives. They understand that if people start talking about a different period of their life it is better to work with them. Call handlers are also trained to be aware of dementia as crime reports may not be all they initially seem… Someone may report that their car has been stolen – but it may actually be at the garage for repair, for example.

In South Powys the police are working closely with Brecon Dementia Friendly Community around a Dementia “buddy” scheme also known as Guardian Angels, inspired by a successful project in Wigan. Badges, wristbands or keyrings can be activated by mobile phone apps to display the contact details of close family members if people are found alone and in distress.

Questions to the panel

There is not enough space to cover all the issues the panel covered in any depth. I learnt that Community Connectors are asked to help if pets are left in an empty property, the police can flag repeat callers on their system, and that postal staff receive fire safety check training.

Chris Evans & Derek Johnston – Assistive Technology, Powys County Council

Assistive technology has a key role to play in the modernisation of health and social care services. There is already a vast array of equipment and technology available to support people to continue living at home following a dementia diagnosis (and a needs assessment) but Chris focused on telecare for this session. He described the benefits of technology:

  • It drives down costs.
  • It can prevent hospital admission.
  • It achieves a faster and safer return to home from hospital.
  • It delays admission to care homes.
  • The biggest benefit, which is consistently reported: it gives confidence/assurance to the individual and/or family member.
The Powys Careline “offers a 24 hour, 365 day service giving total peace of mind at the touch of a button”, whether on a neck pendant, watch or wristband. Chris described numerous detectors. Some could cleverly sense smoke or gas, and others a person slowly falling from their chair. Pharmacists refill smart medication dispensers as appropriate. GPS trackers provide links to Google maps to reassure family members of a person’s whereabouts. Different needs? Different kit. The range was overwhelming and very reassuring.

And, for anyone wanting to find out more, there is a fully kitted-out flat in Christchurch Court in Llandrindod Wells where staff are trained and assistive technology open days regularly scheduled.

Heather Wenban & Kate Rayner
Heather Wenban – Dementia Lead, Powys Teaching Health Board

Heather works closely with Welsh Government to ensure that there are improvements in dementia care. A new Powys Dementia Plan will attempt to reduce the stigma around dementia so that more people from an ageing population will not be afraid to access support from their GP around memory issues.

Heather’s other updates:

  • The memory service is undergoing a review to have parity across Powys.
  • There are two Dementia Support Workers in Powys, plus a dedicated Dementia Nurse.
  • Following the closure of the Fan Gorau Dementia Unit in Newtown a Dementia Home Treatment Team has been established.
  • Education programmes are in place – Carer Information & Support Programme (CRISP) and Cognitive Stimulation Therapy (CST).
  • Peer support is available in group settings, with knitting, gardening and Men’s Sheds all proving popular, and there is a dedicated carers’ group in Brecon.
  • Hospital staff are receiving RITA training (I can’t keep up with the acronyms!). This is Reminiscence Interactive Therapies and Activities.
Heather concluded by saying that there is much exciting work still to be done in the future around provision of dementia services.

Carol Hay, Engagement Officer, Health & Social Care, PAVO
with a trauma teddy & a sample "Message in a Bottle"