Thursday, 8 February 2018

Mental Health and the Welsh Ambulance Service Trust

This week’s guest post is from Isobel Jones, who works for the Patient Experience and Community Involvement team for the Welsh Ambulance Service NHS Trust. I first met Isobel at a Welshpool meeting of the Stand up! For emotional health and wellbeing project run by our team where she introduced us to her work. I caught up with Isobel lately and asked her if she would tell us more about her role for the blog. 

What led you to this particular role at Welsh Ambulance Service Trust? 

I come from a Social Care background, and have also worked in the Third Sector, however, throughout my various roles I realised that I was becoming more and more interested in engagement. Involving people in shaping the services they receive can only help develop better services. It just makes so much sense. 

In some of my past roles I had been asked to undertake some projects which had enabled people to be involved in the planning and development of the services they received and I found these projects very insightful and interesting.

I followed this idea further by attending training courses which explored effective participation and engagement skills, and they gave me the tools and techniques to do this.

When the job was advertised within the Welsh Ambulance Service’s Patient Experience and Community Involvement Team I was excited as this was just where I could see myself. I hadn’t looked at it from a Health perspective before so I knew this would be a new challenge.

How do you educate patients and the public about the services provided by the Trust?

We have an extensive engagement model, which allows us to reach different groups and communities. We use our partners in the Health Boards, statutory, third sector and other community links to be able to engage with different people who may have used our broad range of services. It is important to go where people are. We’ll also host information stands at a range of events across Wales that helps us to talk to local people.

We then arrange to go out to meet people in these different groups and talk about our services, which includes awareness about how we respond to and prioritise 999 calls. It is important when we visit groups that we listen to people’s experiences and their stories, and encourage people to give us their feedback.

We make people aware of how they can ‘Choose Well’, by accessing a range of health services available from GP, Out of Hours, Pharmacies, A&E Units and Minor Injury Units. We also talk about self-care, and using services such as NHS Direct Wales for telephone and online advice.

My work involves engaging with mental health groups, older people and people living with dementia. I have also visited learning disability groups, schools, groups with specialist health needs like 
Chronic Obstructive Pulmonary Disease and other respiratory conditions, Parkinson’s, Multiple Sclerosis and various Black and Minority Ethnic (BME) groups.

We have a continuous engagement model which gives me the opportunity to visit groups again and again, building up trust and encouraging people to stay involved with us as a service as their contribution is so important. 

I was also given the opportunity to train as a Community First Responder for WAST which I completed in March last year. With this training I am equipped to provide awareness sessions for community groups about how to undertake emergency first aid to support saving a person’s life, by learning in basic steps what we all can do to help someone when they face a life threatening emergency like a cardiac arrest, how to use a defibrillator, what to do if someone is choking, or needs to be placed into the recovery position until the ambulance arrives.

If someone being transported by WAST is experiencing mental distress, what support is provided by staff?

All our staff should support such a person with the utmost of dignity and respect, recognising that whilst with physical health conditions these are often visible, not all health conditions are visible, especially mental health and wellbeing.

Our staff will have followed any assessments of need that are in place for mental health, including local pathways which are in place which have been agreed in partnership with local services.

WAST Staff are currently going through a training programme focusing on mental health.

What kind of training do Trust staff have to help them support someone in mental health crisis?

The new WAST Mental Health Strategy which has recently been formed is very clear that there needs to be more training for our staff on the needs of people who experience mental ill health, and for our staff to be more aware of how to treat people who call 999 in crisis. This has come out of the fact that staff have acknowledged there is a need for this, to benefit people with mental health needs.

Tell us more about the Trust’s Mental Health Improvement Plan

People who access mental health services have told us that these things are important:

  • Don’t ‘generalise’ mental illness. 
  • Consider my communication needs.
  • To be seen as a human being.
  • Need calming, understanding and polite approach for people experiencing panic. 
  • To be respected and treated equally. 
  • Be listened to and believed. 
  • Listen to carers as well as the person needing medical attention. 
  • Staff need knowledge and awareness of mental health issues. 
Our staff have told us:
  • We need a “better process for responding to patients in crisis.” 
  • We need “up to date evidenced based training.” 
  • We need “better links with crisis teams.” 
  • There are “inconsistent pathways across Wales.” 
  • There is a “variance of support across the localities.” 
  • There is a “lack of suitable alternatives to A&E.” 
Our staff need support on how to maintain their own mental health, how to prevent stress and sleep problems, ensure good nutrition avoid substance misuse, etc.

Because of this, these are the priorities we have set for our plan:

Priority 1: Putting you at the centre

  • Everybody is different and has different unique needs and experiences of mental health at different ages. 
  • Specific work needs to be done around children and young people’s needs. 
  • Think about the needs of people with dementia and of people with fluctuating mental capacity. 
  • Supporting those who are at risk of suicide and self-harm. 
  • Caring for those who may misuse substances. 
Priority 2: Training, awareness and skills for Welsh Ambulance staff
  • What do our staff need to know about mental health in terms of training, attitude and approach? 
  • Understanding people’s unique mental health needs (and the spectrum of mental health disorders).
Priority 3: Working better with other professionals
  • Working better with GPs, hospitals, local community support services, Health Boards, carers, family, social services. 
  • Working with trained mental health practitioners to support our frontline teams.
  • Developing alternative pathways for people experiencing mental distress. 
  • The purpose of these pathways is to make sure you are seen by the right person at the right time. 
  • Where possible get appropriate help in the community, rather than a hospital setting. 
  • Only considering hospital settings if physical health is at risk.
Priority 4: Caring for the wellbeing of our staff
  • Putting support systems in place.
  • Having mental health advocates. 
  • Helping staff cope after traumatic incidents.
For our staff we need to maintain optimum mental health, sleep, exercise, nutrition, management of alcohol intake, etc.

Priority 5: Dealing with challenging situations

If an ambulance staff member is facing violence in an extreme situation, we will assess the risk and decide when it is appropriate to restrain someone to keep them and staff safe.

Priority 6: Giving necessary guidance and support to teams

  • We have people within Welsh Ambulance Service who lead our mental health work. 
  • We need to make sure staff are supported and have the right supervision to develop knowledge and skills about mental health.
  • This is for the benefit of all people who access mental health services as well as to support Welsh Ambulance Services staff.

Which other organisations do you work closely with in Powys to provide support to people? 

So far, I have only worked with ‘Stand up! For emotional health and wellbeing’ in Welshpool. I would love the opportunity to network with and meet other groups in Powys so please get in touch!

We have visited many groups that support individuals with mental health and wellbeing concerns across Wales, but we would like more opportunities to speak to people in Powys. Have you used our services and would you like to give us feedback?

We would also appreciate your help to enable us to further develop our services as part of our Mental Health Improvement Plan. If you or your group / organisation are happy to receive a visit or take part in a focus group, please contact me (details below). Your views and experiences are important to us to help shape the way we work and how we support people.

What is the most challenging aspect of the job?

Sometimes it is the amount of travelling, as I travel all across Wales!

But in the main, it is making sure I listen carefully to what people tell me, and make sure I understand what is important to them. The challenge then is to make sure that voices are heard within the organisation in such a way that can make a real difference to the way we do things in the future.

To do this effectively it is very important to be a very open, friendly person, showing kindness and respect for any person who wishes to talk with you. I feel I need to show in my face and my body language that integrity is important, and that I can be trusted.

Sometimes people are angry and hurt, for good reasons, by their experiences.

I know they are not taking this out on me personally, it is important to understand why people say what they say, in the way they may say it. It is important for me to convey in a calming manner, acceptance and acknowledgement of how people are feeling and for people’s hurt feelings to be validated. 

Tell us about some of the most rewarding work you have done at WAST

Over the last year I engaged with a wide range of groups across Wales who supporting people experiencing mental health issues from many backgrounds.

Whilst most people reported positive experiences of having used emergency ambulances and non-emergency services, their suggestions were both insightful and helpful, as were the thoughts and observations from support workers and other professionals. 

I was given the opportunity in July 2017 to attend the WAST Trust Board and provide feedback on all of the engagement work I have undertaken with mental health groups and organisations across Wales. This presentation was well received by executive leads and managers in WAST. I was able to convey thanks to all the individuals with mental health concerns, organisations and staff who have shared their (sometimes very painful) stories with me. This opportunity allowed all of these voices to be heard, which contributes toward improving outcomes for people who use our services.

Another piece of work I found really rewarding was with people from the learning disability community where I was involved in setting up a drama group. This was a group of individuals in Caerphilly who worked in partnership with us to use drama to understand some of the barriers they experience when they ring 999 for an ambulance. During a celebration event in Blackwood, the drama group, which consisted of people with learning disabilities, showcased scenarios with real live call handlers, paramedics and community first responders.

What is the most valuable thing you have learnt since starting your role?

I am always totally humbled when people I have only recently met open their heart with sometimes very painful stories to me. I always try to do my best to do justice to what people tell me, so that it really makes a difference. We want to listen to people’s stories and experiences of using our services, and to capture feedback from people to improve our services.

Also since I trained as a community first responder volunteer myself back in March last year going on an emergency ambulance ride out with a crew from Hawthorn Ambulance Station to observe the experts in full flow to help consolidate my training has also formed part of my continuing journey… The day progressed with themes of falls coming up at least twice, sepsis also twice, breathing difficulties and presenting chest pains which may have been related to post traumatic anxiety, stress or other mental health concern. There was a lot to be learned about the needs of carers as well. What if they themselves need medical treatment and to be admitted but they are worrying about what will then happen to loved ones they care for, who may have dementia, a mental health condition, a physical or a learning disability, or in fact any combination of these? Colleagues shared with us about these dilemmas, as sometimes it is not just about the patient, but it was about their family as well.

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

I love cooking, especially making jams, marmalade, herb jellies and chutneys. I gift wrap these and give them as presents. I also sell them to raise funds for charities.

I love walking and the outside world, animals, wildflowers, plants and nature, and especially my garden where I collect and grow loads of plants, shrubs, flowers and herbs. These interests often inspire me to paint watercolour pictures, play the guitar, write, sing and perform songs and poems. So this is just a little bit about me!

Many thanks to Isobel for telling us all about her role. You can contact her by ringing: 01792 776252 Ext. 45444 or emailing:

Thursday, 1 February 2018

From Bermuda to Powys - Problem Oriented Policing

A couple of weeks ago I attended a training event at Dyfed Powys Police HQ in Carmarthen with Penny Price (Service Manager for Adult Mental Health Services in South Powys) and Lisa Hale (Acting Ward Manager, Felindre Ward, Bronllys Hospital). We were there to hear Criminologist Sylvia Chenery (right) speak about Problem Oriented Policing (POP).

“Problem Oriented Policing (POP) has a history of looking at those long term problems; those ‘it’s been there for years...nothing we can do about it’ occurrences. The best strategy for solving a problem depends largely on understanding the situation, learning everything you can about why it’s happening and then using factual knowledge, and sometimes creative use of partners to come up with effective, longer term solutions.” Sylvia Chenery.

I was possibly the only person attending from the voluntary sector (others had been invited), but numerous statutory partners came along, including: Mid & West Fire & Rescue, Trading Standards, Mid Wales Housing, Probation, Health and Mid & West Wales Ambulance. There were also many police officers and managers present, including Chief Inspector Rhiannon Ivens who leads on Partnerships in Powys for the force.

Penny Price, Lisa Hale (Powys Teaching Health Board) and Police Inspector Kathryn Griffiths
The invitation stated “we would really welcome attendance from partner agencies as a joint approach to (POP) will be vital. Problem solving must become everyday business; it needs to be robust and it must be consistent to get to the root causes….The (POP) techniques will assist with our engagement with each other and should not be confined to crime and disorder problems. We can utilise this approach to help manage demand for our services more generally…”

On her recent work with the Bermuda Police (yes, Bermuda the sub-tropical island which is also a British Overseas Territory!) Sylvia commented on the critical importance of partnership working: “The POP philosophy begins with taking problems and working with those who work and live in the area to deal with them. This is about how the police and their professional partners… work alongside the community. Problems are resolved from the group up, with the support of the government and legislation, but actually if you really want to have a sustainable solution, it has to come from within the community and your partners on the ground.”

So, what can Powys learn from the Bermuda experience…? Deputy Chief Constable Darren Davies informed us “all front line Dyfed Powys police officers have received awareness training and this will be followed up with practical application during the early part of 2018.” As partners, we had been invited “for a more localised practitioner approach.” The force, Darren explained, is keen to reduce harm for vulnerable people and stressed communities. The solutions do not rest with one agency. His ‘critical friend’ role allows people with a fresh pair of eyes to look at problems which have been ongoing for a while. Such problems could include anti-social behaviour, neighbourly disputes, or fly-tipping, for example.

Sylvia explained that POP started originally in the States, where police forces adopted the philosophy of Professor Herman Goldstein, a specialist in Criminal Law. Police forces the world over are often called out to situations where they do not actually have the necessary expertise to deal with the problem. In some cases that could be because someone is experiencing mental distress, for example.

Tools and models which Sylvia went on to describe in some detail will provide the police with a more strategic and scientific approach. The key, however, is for officers to ask the question: “How will this work on the person I’m trying to have an impact on?” “Knowing the people you work with – other agencies – that can help you manage that problem that you are working with.”

In this brief space I am just going to pick up on a few more of the key points that Sylvia made in her detailed presentation.

Why are we doing this here? To get the best out of partnership working. Colocation is the way forward.

What do you need to make it work? To have real buy-in – having senior officer support gives a breathing space to look at the problem differently or else otherwise we will always be dealing with it. The more confidence you give to communities, the more they will tell you.

Think creatively. In Dyfed Powys we have Crime Prevention Advisors. In Hertfordshire there are Call Ambassadors. In Northumbria – POP Stars!

Sylvia went on to describe a number of crime theories, available for the police to use to good effect in analysing crimes and offenders. These included the Problem Analysis Triangle, the Routine Activity Theory, the Journey to Crime and the Broken Windows Theory. This last theory also comes courtesy of the US, where former New York Mayor Giuliani postulated that if you don’t repair a broken window in a building then the next time you go back you will find two broken windows. Similarly, if graffiti and fly-tipping are ignored, this spreads the signal to the community that it is not a good place to live, and to offenders – come and do what you want because nothing will be done. “Zero tolerance is the way to solve crime”.

Sylvia pointed out that partners can have quite different remits and priorities. She highlighted Jonathan Shepherd, a surgeon from Cardiff, who introduced plastic containers for night-time drinking because he was forever stitching up faces slashed by broken glass.

“We need to deal with the low level stuff in the same way as a murder inquiry. Start with the victim and build up the facts around the victim to build a better picture of what’s causing the crime to happen.” We like to give labels to people – gangs, drug dealers, beggars… “But there could be a hundred different reasons why people are doing what they do. Break it down from the general to the specific.”

Sylvia spoke in detail about repeat offenders, and about the value of working with family members and friends in providing useful interventions. “Sometimes you need to be more like a doctor in diagnosing what is wrong, or like an engineer – very systematic.” She said that speaking to people who actually cause the problems, and their victims, would give a much greater understanding of why the behaviour is happening.

“The key to being more creative in approaching problems? Innovate. Do something different. Don’t do the same thing over and over again…”

Perhaps the key message I took away from the session was that we should all question ourselves, and others, to become more effective in what we do. As Sylvia says: “Be passionate about what you do and people will believe in you.”

What do you think about Problem Oriented Policing? Would you be willing to work more closely with the police in your area to try to resolve issues that crop up again and again? Let us know in the comments box below.

Thursday, 25 January 2018

Helping our Homeless

Nicky Pugh, Ashley Morris and Sarah Mason
I recently came across this relatively new group in Llandrindod Wells on Facebook. Prior to that I had not realised that there was support for homeless people in Powys, and realised I knew very little about the subject. Homelessness is suddenly very much in the news – particularly in Windsor because of an imminent Royal wedding – but what of the situation in Powys?

Reading on further on the group’s Facebook page I discovered that much fundraising work had taken place locally in the lead up to Christmas 2017. As a result Helping our Homeless had “supported homeless in Swansea, Cardiff and in our local vicinity, most recently supporting local homeless with clothing, essential items of food and toiletries and footwear.”

Keen to find out more, I messaged the group on Facebook, and one of the group’s founders, Sarah Mason, quickly got in touch. She told me how she, Ashley and Kayleigh Morris, Lee Jarvis and Nicky Pugh came together to take action to help homeless people.

Tell us how the group Helping our Homeless came about and why?

Last year I saw a post on Facebook from Ashley, who was going to do a calendar where every day he placed an item in a box to give to the homeless at the end of the time. I messaged Ashley and his wife to offer some donations as she had been collecting items over the past couple of years and donated these. Ashley and Kayleigh accepted my donation, and this led to us talking about possibly going bigger.

During the year I met Lee Jarvis in a local supermarket and we spoke about homelessness and raising money. Lee agreed this was a good way forward and came on board. Another friend, Nicky, joined us soon later.

After September, I contacted all the interested parties and we met in a local pub where we put together a plan of what we would like to achieve. To be honest we have never looked back.

What is the main purpose of the group?

We want to provide practical and emotional support to homeless people and their animal companions. At the same time we hope to raise awareness of homelessness with the general population.

Who is eligible for support from Helping our Homeless?

Anyone who is street homeless in Wales (but not exclusively), and their animal companions.

We also work with agencies and individuals to reduce poverty and prevent homelessness. In particular we are keen to support Shelters across Wales and in surrounding areas.

How many homeless people are there in Powys roughly and how are where are they living?

A lot of homeless people in Powys are not accounted for on the rough sleeping count as unlike the street homeless in the cities, we don’t always see them here. In a large rural county people could be sleeping rough in barns or farm outbuildings, or in woodland, and remain hidden much of the time.

(The National Rough Sleeping Count, produced by the Welsh Government, is “an annual report which includes information on the estimated number of persons sleeping rough over a two week period and the number of persons observed sleeping rough.”)

Why are people homeless in Powys or elsewhere?

There is no one reason why people become homeless. All kinds of factors can lead to homelessness, including health issues, unemployment, and family breakdown. Many homeless people have previously been employed and in a position to pay for their housing, but something suddenly changes and their lives are turned upside down.

Some of the key factors leading to homelessness include: benefit changes, a rise in the cost of living, the loss of employment and a lack of new job opportunities. Also a person’s mental health may deteriorate, they may have drug and alcohol or other addictions, or a completely unexpected change in their circumstances could lead to homelessness.

It is said that most people are just two pay cheques away from poverty and three from homelessness.

What support does Helping our Homeless provide to people?

We provide essentials, care, and face-to-face interaction, whether in Powys or further afield.

On the practical side, we find that the essential items homeless people really do need are food, care packs, toiletries, clothing and some form of shelter for their time on the streets. Tents and sleeping bags are very popular! We will also provide first aid provisions.

We talk to people. We empathise. We guide people to other agencies that can offer support. We spend time engaging and trying to make day-to-day life easier for those on the streets.

Most importantly, we offer face-to-face confidential support without judgment. We are a face that cares.

In other parts of the UK we will work directly with local shelters and help promote the invaluable work they do.

As a group we provide online support to each other.

How does being homeless impact on a person’s mental health?

Hugely. Many homeless people are struggling with low self-esteem. Their confidence and morale have completely dipped. Some people have such low self-worth, and are so lonely, that they resort to self harming, including substance misuse. In worse case scenarios, some people have suicidal thoughts.

Physical health can also deteriorate rapidly when people are sleeping rough. If they are not eating regularly they can experience malnutrition, and, inevitably, they tolerate a deterioration in their personal hygiene.

If people don’t receive the support they need, what can happen to them?

Health can deteriorate rapidly, with the result that homeless people have a lower life expectancy.

They are also far more likely to commit crime. Due to their circumstances they may lack self control, and they may become addicted to drugs and alcohol.

Homeless people are still entitled to claim benefits using the Simple Payment card. However, in reality not everyone receives all the benefits that they are entitled to.

I know you want to grow your group – what are your main aims?

We would really like to register Helping our Homeless formally as a charity – we are working with PAVO development workers to progress this. The next step would be to expand the group, so we will raise awareness of our activities as much as we can with the aim of recruiting more volunteers. Bigger, more permanent premises, with sufficient storage space would be an added bonus!

If people are interested in volunteering for the group, what roles are available (alternatively, what skills do you need)?

Roles that we currently have available include:
  • Collecting donations.
  • Sorting the donations that come to us.
  • Advertising.
  • Distributing.
  • Fundraising.
  • Promoting the cause.
Do get in touch if you are interested! Contact details below.

Which other organisations do you work closely with, either locally in Powys, or in the rest of the UK, to provide support to people?

Quite a few, mainly in Wales. In Swansea these include Unity Group Wales, the Unum Project and Zac’s Place. In Llandrindod Wells – Mid Powys Mind, the local food bank, and the Herb Garden Community CafĂ©.

We also engage with lots of online shelters and organisations.

What are the main challenges of the role?

The big one - not being able to commit as much time as we would like. And feeling so far away as we are remotely based.

On a very practical level, we currently lack long-term storage, and vehicles – we would love a van.

We also have to deal with our own mental challenges as we carry out the work.

Tell us about some of the most rewarding work you have done at Helping our Homeless so far.

Our top 8 most rewarding aspects so far:
  1. Provided shelter to many rough sleepers.
  2. Food and drinks.
  3. Medical aid.
  4. Support and advice.
  5. Support to other shelters.
  6. Time with the street homeless.
  7. Making our street homeless feel wanted.
  8. Learning about the street homeless and building relationships.
When you are not volunteering how do you enjoy spending your time?

We all work full time, so we juggle working with volunteering. Some of our hobbies include bowls, football, pool, art and craft work. And we spend time with our families of course!

Many thanks to Sarah and the rest of the team at Helping our Homeless for telling us more about their work in Mid and South Wales in particular.

If you want to find out more or get involved you can contact Sarah by ringing 07775 851 718 or send a message on the Helping our Homeless Facebook page.

On the BBC website this week two articles feature Homelessness:

Monday, 15 January 2018

Back to the Floor: Katie Blackburn, Powys Community Health Council at Newtown Community Mental Health Team

Katie Blackburn (top left) with Newtown Community Mental Health team
In August last year I observed Superintendent Jon Cummins go Back to the Floor at the mental health inpatient unit in Powys, Felindre Ward, and wrote about the idea behind the activity and Jon’s experience on this blog. Put simply the concept is that Chief Officers, Service Directors and other high-level staff have the opportunity to experience a day in the life of a member of staff at the operational end of a service. This gives them the opportunity to find out what is really happening on the ground, and what consequences strategic decision-making can have on people who are in receipt of a service.

In late 2018 I was pleased to observe Katie Blackburn, the Chief Officer of Powys Community Health Council, go Back to the Floor at Newtown’s Community Mental Health Team. The county CHC is the “Healthcare Watchdog for Powys - an independent statutory organisation that represents the interests of patients and the public in the National Health Service in Powys”. Katie has been in post since January 2017.

Lauraine Hamer, Senior Practitioner AMHP (Approved Mental Health Professional) at the CMHT, met us at the start of the morning with details of what she had planned for Katie’s visit. This included chance to find out more about her work and that of her colleagues, plus an opportunity to join a Multi-Disciplinary Team meeting and also to accompany a Community Psychiatric Nurse on a visit to a client. In the event we had to stay flexible as circumstances changed throughout the morning… but such is life at a busy mental health service.

Before the visit: Katie’s view

I had no idea about the work of this particular CMHT in Newtown before my visit. From my previous life, I have an understanding of the roles of CPNs and social workers. I was CEO of a drug and alcohol charity and mental health is an issue there. To a lesser extent with The Prince’s Trust, I was working with vulnerable young people in the care system.

I was very keen to shadow and meet the team and listen. I felt that perhaps I could ask questions that other people were perhaps uncomfortable asking.

The key barrier I am aware of – which I know of from my domestic abuse background – is that whilst aspiring to put individual people at the heart in reality individuals are often bounced from pillar to post. For example, they might have to continually provide their national insurance number, or relate details of stressful events to different people. The journey should be (and could be) much smoother and easier. Sometimes we need to make a decision there and then, which might not fit in with governance and procedure. For example, the question of who pays to get people from A to B often comes up. If there is an individual who needs to be transferred from Brecon to Nottingham……who pays? Agencies can become tied up in which budget is paying for this journey and can lose sight of the individual’s needs.

When it comes to strategic issues, I am not aware of any recent changes within the CMHT, but, I am aware of, and have been involved with the development of the Health & Care Strategy and the intention to align health and social care in Powys. It will be nice to see the operational impact of that.

I am conscious that services are very stretched because of pressures on staff and budgets, and that things can sometimes become more complex and complicated than they need to be.

I hope that Powys’ Health & Social Care Strategy will bring change – whilst recognising that not everyone likes change; there is a risk of unsettling an already stretched workforce.

There will undoubtedly be a growing use of digitisation going forward – however, it’s about putting the individual first. With regard to a future workforce we need to identify what skills Powys needs.

Lauraine Hamer and Katie Blackburn
Back to the Floor exercise

Lauraine is an extremely experienced and knowledgeable Senior Practitioner, and was able to give Katie a very thorough grounding in the work of the team at Newtown CMHT. At the MDT meeting we met CPNs, members of the North Powys Crisis Resolution Home Treatment Team, Admin staff, a trainee AMHP, Social Workers, and a Support, Time and Recovery (STR) worker. Later we learnt more about the Accredited Accommodation Scheme* from the Co-ordinator Wendy Laws, and Katie spoke to Dr Fran Foster, a Consultant Psychiatrist.

Unfortunately, we were unable to shadow CPN Kelle Hall on a home visit to a client. This was due to a last minute change in the person’s circumstances.

After the visit: Katie’s view

When deciding whether my understanding of what the services does is correct, I think “no” is the simple answer. There were elements of it that I knew, however, other elements were new to me. Staff in the MDT meeting worked co-operatively very well together. Particularly when sharing information - the team focussed on the needs of the individual rather than their specific jobs.

The “seeing is believing” approach is very important. It would have been nice to sit in on a visit with an individual using services, but I understand the issues around confidentiality and the vulnerable lives people lead.

My main observation is that the people in this team are doing the best they can in the circumstances. There is clearly an issue around staff capacity. Other obvious issues include – cross-border, cross-boundary provision and the lack of in-county beds for people. In the MDT meeting, the real focus was on the discussion of high-end/vulnerable situations and not on the preventative side of the service. I wonder if there is an opportunity for reflection and discussion on what might have prevented a specific situation and what changes could be made in the future (if any)?

Staff are very much dealing in the here and now. They are not looking at people’s pasts or where they might be in five years’ time. I wonder - is there an opportunity to look at where resources should be channelled?

This experience will definitely mean I’m able to contribute more effectively at times when strategic decisions about services are made. I am a big believer in real-life examples. There are also pressures on recruitment for the CMHT. There appears to be an element of disjoint between strategic and operational. The staff clearly work well as a team, and there are a number of opportunities to build on (and share) existing good practise across Powys. In addition, their working environment is extremely poor, despite this, it strikes me that they are a dedicated, professional team doing their best in the circumstances.

Going forward, I am keen to do something in my role at the CHC around listening to vulnerable voices. There is definitely an opportunity to start with this service - certain groups do not access our service or receive support including young people and young carers. Listening to Vulnerable Voices will be a priority for Powys CHC in 2018-2019.

* Wendy Laws co-ordinates the Accredited Accommodation scheme in Powys, which is the only one of its kind in Wales. People supported by secondary mental health services are entitled to access day visits or overnight stays with registered accommodation providers who have their own lived experience of mental health distress. People accompany their hosts on shopping trips or days out to the seaside, for example, and enjoy a caring and nurturing environment. This service prevents hospital admission and people have described the incredible benefits of feeling part of an extended family.

Monday, 8 January 2018

Owen's 5 x 5 Ways of Wellbeing: Part 2

Owen & the team learning about Bilberry Bumblebee habitat with
(far right) Barbara Brown, Radnorshire Wildlife Trust

by Owen Griffkin
Mental Health Participation Support Worker

In Part 1 of my blog series I introduced readers to the Five Ways to Wellbeing and wrote in more detail about the first Way - Connect.

This time I am looking at the second Way - Keep Learning.  A great way to start the New Year!

I recently embarked on an Open University course and have found it really improved my self-confidence and wellbeing. Plus there is always the chance that what I learn might actually come in useful one day in my career, and take my life to unexpected places. (I already went to Wrexham for a one-off lecture, so I suppose you could say that was unexpected). Here’s 5 ways you can challenge yourself whilst adding to your knowledge.

1. The Open University

The Open University is known for providing degree level education which you can complete from the comfort of your own home. They now also provide FREE short courses. These short courses are modules from older courses which are no longer available and offer a great stepping stone into further study. The range of subjects on offer is mind-boggling. As I said above I’ve loved my study - jumping from Stalin to Madonna to Cezanne as subjects has really broadened my horizons.

Click here for a full catalogue of the free courses.

2. Learn a language

There are a host of tools, apps and games to help you learn another language. Experiment with them all and see which one suits your learning style. One I enjoyed playing with my 7 year old daughter was ‘Learn Japanese to Survive’ which taught us both how to write and recognise Hiragana characters. 

For a more serious and FREE language course try these links:

  • Say Something in Welsh 
  • Duolingo
  • Busuu - This is a unique way to learn, as you connect with people around the world who want to learn your language, and you can learn their language. 

 3. Traditional ‘classroom’ courses

The internet is a great tool for those wanting to further their education, but sometimes a traditional bricks-and-mortar establishment might be more beneficial for learning. It can be easier to grasp a concept with a real live tutor helping you, plus the social and collaborative benefits of working with other people in a classroom can help with your wellbeing. When I did my Open University Course I went to a lecture in Wrexham, and I learnt more on that day then in my own online sessions, plus I met some very nice fellow students.

One of the options in Powys is NTPC Group of Colleges, who have colleges all over the county that are open to all.

There is also the U3A - University of the 3rd Age - If you are in your ‘3rd age’, eg: retirement or semi-retirement, than maybe the U3A will be suitable for you. It’s a social and fun way to learn and they have a surprising amount of groups in Powys, including Llandrindod, Welshpool, Newtown and Brecon.

4. Learn an instrument

Bob Duke, the director of the Centre For Music Learning in Texas, argues that learning an instrument is one of the best ways to give your brain a workout. He founded the centre to bring psychologists and neuroscientists together with expert musicians to break down the barriers between disciplines and really explore the physiological benefits of learning an instrument. If you want to read more check out this article - Music and the Brain.

I embarked on an online piano course recently called Skoove and it was great fun. Similar to the Japanese learning tool I mentioned, it presented itself like a game, with achievements and goals to reach, and it’s obvious that this sort of ‘challenge’ type learning suits me. Sit me in front of a piano with a book and I don’t want to know. However, call it Mario Piano and have a virtual Italian plumber teach you how to play, and I’m in.

Again there are many different ways to learn an instrument, including one-to-one tutoring, books, and now a wealth of online tools. Check the free Broad Sheep magazine online and distributed around Powys for some music tutor adverts.

Here are a few links to get you started with online training.

5.  Learn a craft

I’m going to say that this one is not for me. I can see the benefits of it. I can see how self-discipline and creativity and perseverance can combine to produce wonderful pieces of work. It must give you a wonderful sense of well-being and satisfaction to spend time crafting a raw material into something new - moulding a piece of lumpy clay into a beautiful ornament, weaving fabrics together to create a quilt, or a knitted item of clothing that you or a loved one can wear over winter.

Whenever I try to do anything crafty however, it ends up looking awful. Like something a five year old would be embarrassed by. I am quite creative generally, but arts and crafts were never my outlet.

People who do craft, however, do get a huge boost to their well-being from their work, and some crafts can be very easy to master, especially with a good teacher. Maybe this year I will set myself a challenge to learn a craft to a reasonable standard. If anyone has any ideas as to what this could be then reply to this post.

For those who are naturally better at arts and crafts than me there are lots of places you can learn crafts here in Powys, and many of these groups/courses are brilliant for socialising as well.
I’ll be back with another set of ideas in my next blog post but if you have any ideas or activities of your own that I haven’t covered please reply to this post with some details.

Monday, 18 December 2017

Favourite walks for Christmas 2017

In the past our festive blog post has featured Our Alternative Christmas, Havin' a Comedy Christmas and Top 10 Tips to Survive Christmas. This year my PAVO finance team colleague Lisa Banfield suggested favourite walks (and a bike ride!)

As I write it's pouring with rain outside after several cold bright days of snow which turned Powys into a winter wonderland. So, stay safe, but if possible take the opportunity over Christmas and New Year to head outdoors, get those leg muscles working, some fresh air in your lungs, and rejoice in some of the amazing scenery right on our doorstep (and a little further afield in one case).

Here are my colleagues' top suggestions:

Owen Griffkin - Mental Health Participation Support Worker

Title: My Dog Walks
Route length: Anywhere between 0.5 - 5 miles
Time: 10 minutes - 2 hours
Start/finish: Llandrindod

The walk
I’ve had my dog Honey Lemon Squash Meringue - Honey for short - a cockapoo - for just over a year now, and although my daughter and partner promised to do the bulk of the walking, it has generally fallen on me to do the early morning and late evening walks. Not that I am complaining, as I get to see some beautiful sunsets, sunrises, and the passing of the seasons and the effect on the landscape. Most of my walks take in Rock Park, so this autumn has been spectacular, with beautiful colours falling from the trees and covering the ground in a different way every day. I also appreciate the different routes you can take from Rock Park - take a walk to Lovers' Leap for great views towards Howey and Newbridge, or venture past the old bakery and up to the Lake. This means no two walks are the same.

The dog loves it too, and frequently jumps into the stream, no matter what I try to do to stop her.

Impact on my wellbeing
Having a dog, and being made to leave the house first thing is a great way to start the day, and definitely helps with at least two of the Five Ways to Wellbeing - Be Active and Take Notice.

Lisa Banfield - Finance Officer

Title: Newtown - Pwll Penarth Nature Reserve by bike (or you could walk)
Route length: 4.6 miles (7.4 kms)
Time: 1 hour approx (longer if walking)
Start/finish: Suspension bridge, Back Lane car park, Newtown

The ride
This is an ideal bike ride to suit a range of ages and abilities (good for confidence building too if you’re new to cycling!) as it is all on a generally flat surface and no roads.

The bike ride starts at the suspension bridge in Newtown by Back Lane car park where you will see a (faded) fingerpost. Follow the path going under the traffic bridge, along the river, up, and over the bridge by the gravel car park. After crossing the bridge turn left down a short bank (Route 81 National Cycle Trail) and follow the path alongside the river. Go through the gate at the end of the path and under the pipe bridge and past the ‘Old Pump House’ on your right.

Continue on the path passing a small parking area near Llanllwchaiarn marked by a finger post.The path follows the line of the old canal and you will soon pass another parking area connected to the Llanllwchaiarn to Aberbechan road and a fingerpost.

Go through a gate passing the sewage works on your right, across the lane and continue along the footpath. Pass the old Dolfor Lock on your left and the Pwll Penarth Nature Reserve is on your right through a gate. The bike ride ends here so turn around and retrace your tracks back to the beginning.

Although you can continue further if you wish, as this is part of the Route 81 National Cycle Trail Aberystwyth – Wolverhampton.

Impact on my wellbeing
I feel this is a nice easy bike ride and gives me time to destress and take in the views and sounds of the lovely surroundings.

Freda Lacey - Senior Officer, Health & Social Care

Title: Crunching the Shells
Route length: About 3 kilometers
Time: 1 hour (depending on how long you spend looking at or for shells, stones, drift wood, slimy seaweed)
Start/finish: Woodstown Beach, Waterford, Ireland, but Ynyslas/near Aberystwyth just as good!

The walk
I grew up the near the sea, it has always been a part of my life. I need to scent seaweed strewn over rocks, crunching the shells walking along the shifting sands, picking up a coloured stone and rubbing it imagining where it has drifted in and landed from, spotting bits of wood re-imaging shapes and faces, the wind battering me from the front and compelling me from the back when I turn around, the sound of crashing waves, or the slurp and swish of gentle tides... The experience of walking along the beach takes me back to childhood and time with family, mostly spent sand digging or tidal pool shopping, but also takes me away now on tides of time, past and present. 

Impact on my wellbeing
The walking activity is for me a side benefit of the experience of beach combing, it’s the draw of the sights, smells, touching, leaning into the stinging wind and relief of the vigorous pushing wind that for me sums up the tingling feeling of wellbeing and renewal once I’m back inside. For me, it’s an activity where I bring the outside in and the inside out…

If you go to Ynyslas, I’d suggest going at ebbing tide, park on the beach, take the “Board Walk” into the sand dunes.

Jane Cooke - Senior Officer, Mental Health

Title: Llanwrthwl to Cwmdeuddwr
Route length: approx 2.5 miles to Cwmdeuddwr
Time: Takes me ages - I’m slow & creaky!
Start/finish: Llanwrthwl (if you catch a bus back)

The walk
From our track you can see the first part of this walk; of the many walks I have done and loved, this is one of the reasons that I like this particular walk, in some ways I keep it in my sights. The walk starts in Llanwrthwl, just off the A470 between Newbridge on Wye and Rhayader, climbs up along a track that on the lower section passes through a bank of Rhododendron. Conservationists of course loath R Ponticum, a thick leaved thug that shades out competition and spreads across hillsides, the leaves shrugging off conventional herbicides. But like many plants that we now demonise, in itself it is beautiful and in the spring when the blowsy purple blooms are at their best, I can see this haze of colour from our track.

Climbing higher the route passes Cefyn, surely one of the highest holdings in the area. Highland cattle and shorthorns are well equipped to tough out the weather here and can often be seen grazing the tough Molinia grass. After the Cefyn the path levels out and before long there is a lichen covered finger post inviting the right hand turn that we always take at this point. This marks the highest part of the walk and I like to linger here. With my creaky knees I no longer do the high and challenging hill walks that I used to love. The experience of being at height, the particular feel of the wind as you approach a high point, standing on a ridge looking in all directions are all joys of upland walking; this walk is manageable for me now and also gives me the chance to experience these moments.

Heading down hill there is a choice of a delightful meander through woods managed by the Woodland Trust, or following the edge of the wood down to a minor road. From there you walk along a short stretch of delightful minor road before crossing the river Wye over the lovely Glyn bridge, a suspension foot-bridge. Passing Glyn Farm you are then on the last leg, along another minor road, dropping down into Cwmdeuddwr and the Triangle Inn. If you have timed things well there is time to stop for lunch and a well earned pint before catching the bus back to Llanwrthwl to pick up the car.

Impact on my wellbeing
It certainly is ‘active’! It enlivens my capacity to take notice as I stop and take in all that is around me and relish the wind and the sounds of the high ground.

Jackie Newey - Information Officer, Mental Health

Title: Llyn Clywedog circular trail
Route length: 2.5 miles
Time: 1 - 2 hours as plenty to stop and look at on the way round.
Start/finish: Take the B4518 from Llanidloes, turn left on the circular road around Llyn Clywedog. Drive up past the dam and 500 metres further to a layby on the right where the walk starts and finishes.

The walk
Llyn Clywedog reservoir was created in 1967 when the River Clywedog was dammed to alleviate flooding in the Upper Severn Valley. This is a short walk around a narrow peninsula of land shooting out into the reservoir. It boasts some incredible views across the reservoir in all directions, to the surrounding mountains soaring high around, and at lower levels the Clywedog Sailing Club on the opposite shore.

The signposted track is up and down dale, but well trodden, though unfortunately not accessible to wheelchairs. We often go with extended family and their children and particularly enjoy resting on the narrow beach half way along where we do a spot of bird watching - identifying buzzards and red kites amongst others. Most times we seem to have the whole peninsula to ourselves - to climb windblown trees and pick up pine cones, to feel the breeze on our faces and watch the clouds scudding for miles into the distance. We always thoroughly enjoy ourselves.

Impact on my wellbeing
This walk is local to me but could be a million miles away! Mother Nature is usually on top form and I feel truly grateful to be alive and experience all she has to offer on the day.

Do you have any favourite walks or bike rides you could recommend? Let us know in the comments section below.

A Merry Christmas and a Happy New Year to all our readers!

Monday, 11 December 2017

Owen's 5 x 5 Ways of Wellbeing: Part 1

by Owen Griffkin
Mental Health Participation Support Worker

If you have been reading our blog recently you will have seen a number of articles about The Five Ways to Wellbeing.

Maybe these have inspired you to undertake an activity or take up a new hobby to improve your wellbeing. I’ve been looking at ways I can implement this in my life, and at the same time maybe provide some ideas for readers of our blog. I’ll provide 5 ways to engage in each of the 5 ways to wellbeing. The best thing about many of these activities is the fact that they straddle more than one ‘Way to Wellbeing’, often combining social activities with creative or active hobbies.

Part 1 - Connect

The advice is to connect with those around you as this will support and enrich you every day. Sometimes in rural areas it can feel hard to connect socially with people so maybe give yourself a jump-start by using an activity or interest to create social relationships.

1. Gaming Hubs

Gaming is a rapidly growing industry, with clubs springing up all over the county. Game designers are releasing board games that are reaching a much wider audience then in the heyday of Dungeons and Dragons. The subject matter and scope of these games is huge - I have played these myself sometimes with friends and strangers, and so far I have re-enacted the 1960 US election (I was JFK obviously and destroyed Nixon), started a railroad company in 1850s America, and pushed the boundaries of taste with the worldwide phenomenon of ‘Cards against Humanity’. Gaming is a great social activity as it allows for pressure free conversation and the fun of friendly competition.

An evening at the gaming hub in full swing

Two local hubs/shops that are very welcoming to newcomers are:

I went to a gaming night at KDM Gaming with my daughter, and whilst she was kept interested by an old version of Pac-man, I was able to have a game and chat with other attendees.

2. Sing!

It’s only natural living in the land of song that we would feature a musical activity. A community choir is a wonderful way to connect, and we are blessed with many friendly and welcoming choirs in Powys.

Your first port of call should be Sing Your Heart Out. This is a purely social choir, and they do not do public performances so there is no pressure to perform. There are weekly sessions in Llandrindod and Meifod. If these aren’t close enough check local noticeboards for info on choirs closer to you. I attended a free taster session and was warmly welcomed and had a lot of fun - even if my vocal gymnastics were more Alan Ball then Michael Ball.

3. Men's Sheds

The Men’s Shed is a movement to create community spaces for men to come together to socialise and to reduce loneliness and isolation. Imagine lots of cups of tea, usage of power tools, and a supportive and welcoming atmosphere. Sounds brilliant! Especially the power tools bit. The local Llandrindod group, aka The Golden Boys, works together on projects commissioned by groups such as Mid Powys Mind.

4. Book Club 

I love reading, but sometimes it’s hard to have the self-discipline to sit down to plough through a lengthy tome - and once you’ve finished the book all you want to do is discuss it with someone. This is where book clubs come in. They have been popular for a few years now and are still one of the most fun and rewarding social activities you can enjoy at your own pace. Like the gaming hubs, book clubs take a lot of pressure out of socialising, as conversation is created by the discussion around the book and you can engage with other club members. Not surprisingly Powys has a plethora of book clubs, lots of which are based at local libraries. Your library is the best starting point, but also check out independent book shops like The Hours in Brecon and the Great Oak Bookshop in Llanidloes.

5. Clubs and Societies 

An early meeting of the United Nations in Builth Wells*

Ok, number 5 is quite vague. That’s because there is probably a club (or society) for whatever activity you would like to engage in. A club is a good way to learn more from other people about one of your interests, share ideas or work, and maybe organise day-trips or social events.

In a quick five minute search I have found active groups in Powys for astronomy, beekeeping and cameras. I then gave up on the ABC approach and also found model railway, community arts, historical societies and not forgetting the excellent Women’s Institute, who have groups all over the county.

Think about what activity you may like to do in a social setting - and if there isn’t a club already - why not set one up. One thing Powys doesn’t lack is space to hold meetings/events. From local church/village halls to rooms in pubs. Some of the largest societies in the world started out as small groups so who knows where it could lead. For example, the United Nations started as a monthly meeting in Builth Wells Village Hall of like-minded people from Powys who wanted to stop all wars and bring about world peace. *

*disclaimer - citation needed. Might not be factually accurate...

Read Part 2 of Owen's blog series here.