Tuesday, 30 April 2013

Grants - a bit of a lottery

The DIY Futures project is coming to an end*. It was a four year lottery funded Powys project (funded by the Mental Health Matters programme of the Big Lottery Fund). It was set up to “support people experiencing mental distress which led to them being unable to achieve their personal goals, have hopes for a fulfilling future or explore how they could remain in control.”

So, it was a great idea, a bunch of really committed people worked incredibly hard to raise the money, equally enthusiastic and dedicated people were employed to the key posts, and the 1:1 service was developed and rolled out across the county. As is usually the case with such projects it took a little while to spread the word, but once it was up and running it became clear that the service filled a gap. People wanted to fulfil their potential in life, and working 1:1 with a DIY Futures co-ordinator was clearly helping them achieve this.

This is a fairly typical scenario. By this stage lots of people know about the project, expectations have been raised, an excellent service is being delivered…. and then, the years fly by …. the funding is due to run out, workers have to look for new jobs… and before you know it, the project is coming to an end.

Sometimes groups and organisations believe that if they prove a need and that their project can satisfy it, that the council or health board will fund the ongoing work. Often there is a media campaign towards the end of a project for funds. And sometimes there will be a trickle of money… for a while. However, in my experience it is more likely that the project stutters to a halt leaving people despondent and frustrated.

Organisations and projects have to constantly reinvent themselves, using valuable time and energy, in order to bid for new funds. Even then they may not be successful.

What can we learn from these experiences? What could be done differently? The Big Lottery Fund and other funders can’t just fund the core costs of successful projects – then there would be no money to develop new ones (you can read the mission statement for the Big Lottery Fund here).

Perhaps there should be more work when projects are developed to show a realistic exit strategy (rather than that which is common – “more fundraising”). For example, a commitment in writing could be made by the statutory sector to continue the funding if all the outcomes are met.

Something needs to change. A debate is needed with the funders. Have you got any ideas about how to improve the current situation, or stories of projects that have been successfully continued once the initial funding has come to an end?

*The 1:1 service ended on 31 March 2013; the project has been extended until October 2013 to carry out some specific activities around evaluation and a legacy for the project currently being developed by project staff.

Tuesday, 23 April 2013

Caring for dementia patients: what's best?

We are regularly bombarded with news stories about the aging population and inevitable increase in people with dementia (44% predicted increase by 2021 in Powys), and I wondered what services were available in North Powys. Just a short walk from where I am based, here at Ponthafren in Newtown, is the Fan Gorau older people’s assessment unit, a modern compact building based in Newtown hospital grounds. The unit allows a short term admission of people over 65 who need an assessment in order to provide future care, be it at home or a suitable home that is able to meet the individual’s needs. The focus is on people with dementia and related illnesses whilst those experiencing mental distress because of depression or schizophrenia, for example, are cared for through The Redwoods Centre at Shrewsbury Hospital.

A few days ago I met two of the staff at the unit – Nicki Sayce, Memory Clinic Nurse and Julie Jones, Ward Manager. I wanted to find out more about what is actually provided at Fan Gorau, and I had heard there were some changes in the way Memory Clinic services were being delivered. (You can find out more about Memory Clinics here).

Julie and Nicki are clearly passionate about the work they do, providing support not only to the people staying at Fan Gorau but their families. “Husbands and wives of those at the unit are often left at home without their partner for the first time in many years which can make it very difficult.”  There are support mechanisms in place, be that The Alzheimer’s Society locally, or the Dementia Advisor Heather Lewis (based at Welshpool), but it can still be tough.

People are assessed and diagnosed initially by doctors when referred, and all efforts are made to admit them to Fan Gorau. However, occasionally people may have to be admitted elsewhere, such as Wrexham, or even further afield. The staff explained that “Fan Gorau is a small assessment unit and relatives need to be aware that once the assessment process is completed, then the unit does not provide long term care. If the individual is not able to return home then care placements need to be made, potentially in a home which is not the first choice whilst a place is awaited in that first choice home.”

The new initiative I had heard about was the creation of a Memory Clinic nurse post. Whilst the move to provide these services in North Powys is excellent news, and in line with the Welsh Government's dementia action plan, it is just one post. In South Powys there is apparently a whole team providing this service.

I gave an update recently on the new Home Treatment Team in North Powys (again, a case of catching up with the South), and both Nicki and Julie spoke enthusiastically about the need for an equivalent service for older people with dementia. (The new HTT will provide crisis support for older people with mental health conditions but not dementia). They believe that many people with dementia should continue to live at home with their families if a strong support network is in place, including crisis support as required. However, resources for the service are focused on the inpatient service with nothing spare to resource a community service.

The irony is that in 2009 the local community fought to keep Fan Gorau open when it was threatened with closure. The Accident and Emergency Unit in the main hospital building at Newtown had already been lost… and instinct seems to keep people fighting for buildings… but listening to Julie and Nicki I had to wonder -  perhaps the best outcome for people with dementia and their families lies in developing more community based services…?

Increasingly mental health and dementia services in North Powys are focussing on community rather than inpatient services - including a Young Onset Dementia post and a new Senior Practitioner post. And then there’s the new Home Treatment Team. Should this trend continue? What do you think?

Wednesday, 17 April 2013

Stress down on the farm

Last week the Welsh Government Minister for Natural Resources and Food, Alun Davies, visited farmers in Trefeglwys in north Powys, to speak to them about the impact of the recent severe weather when hundreds of animals had perished in snowdrifts. The farmers had been hopeful, I suspect, of some financial support. But their hopes were quickly dashed. No money was to be made available to bail them out during this particular crisis. They just had to get by.

As one of them commented to the newspaper reporter – “some farmers are at breaking point over the situation.”

Since then, however, there appear to have been a few developments.
In a press statement yesterday the Minister announced that £500,000 will go to farm charities “to help address problems caused by severe weather conditions.”

The charities concerned are the Farming Community Network (previously the Farm Crisis Network), the Royal Agricultural Benevolent Institution and the Addington Fund.

But not all struggling farmers will seek the support they need. In 2005 the Health & Safety Executive produced a report on Farmers, Farm Workers and Work-Related Stress, following research in five counties including Powys.

It reported that: “The difficulty for support organisations was in creating a climate where farmers felt comfortable discussing worries and concerns with outside agencies at a point before they became unmanageable, and required more intensive support....

[Other studies] uncovered a reluctance to seek specialist help, reflecting the stigma these communities associated with mental illness, their worries about anonymity, and appearing not able to cope.”

I wonder how much has changed since the report was produced? Farming crises are never going to go away. Foot & Mouth Disease, the vagaries of the weather, a rise in feed costs, a fall in market price for produce... Some help at this time of crisis came eventually, but only reluctantly, with the Minister rounding off his offer of support with frank words – “for the long-term resilience of the industry it needs to move away from a dependence on public support...”

Do you know any farmers who have struggled with work-related stress in this recent crisis? Are you a farmer, what do you think? What kind of support, other than financial, is really needed?

Thursday, 11 April 2013

Prozac: highs and lows

Well, I seem to have started reading Laura's recommended reads in reverse order. Robert Whitaker's Anatomy of an Epidemic looks at the relationship of psychiatric drugs to the increase in mental illness in the United States. Whilst reading I became aware that the anti-depressant or SSRI (selective serotonin reuptake inhibitor) drug known as Prozac - the "happiness pill" - has only been around for 25 years (my old friend BBC Radio 4 broadcast Prozac Economy two days ago to "celebrate" the birthday). 25 years, a mere youngster.... sometimes it feels as if it has been around forever.

Prozac must be one of the most fiercely marketed and well-known drugs in the world. The brand name has made it into the language of popular culture (just like Sellotape, Hoover and Velcro did before it...) People readily refer to a Prozac fix. Elizabeth Wurtzel's book Prozac Nation had been made into a film by 2001, 7 years after publication. There is a whole industry out there dedicated to Prozac gifts (a quick Google search reveals all...)

But the big question is still, 25 years after its creation, does Prozac actually work?

On the radio broadcast writer Will Self interviewed Dr Robert Baker, a psychiatrist working at Eli Lilly, the pharmaceutical company responsible for creating Prozac. Dr Baker reported that Prozac had a "great impact on depression and helped many people, but had fallen short of helping everyone..."  Will himself had been offered Prozac by his GP when trying to give up smoking. He suggested to the GP that "perhaps we're just meant to be unhappy... we'd be better of if we acknowledged it rather than papering over the gaps." The GP though believed that "anti-depressants don't just blot out the problem, they help you to cope with the problem."

But others are not so convinced, and there are some very outspoken critics of Prozac. Dr David Healy, the author of Let them eat Prozac, and Professor of Psychological Medicine at Cardiff University, is convinced that taking Prozac increases a person's suicide risk. And clinical psychologist Irving Kirsch questions whether anti-depressants like Prozac work any better than a placebo in The Emperor's New Drugs.

Of course, Prozac is regularly prescribed by the NHS to treat depression. I don't have any figures for Wales, but according to the programme in 2011, in England, 46.7 million people were prescribed anti-depressants at a cost of about £120 million. Clearly it's not just Will Self's GP that believes they work. What do you think?

Friday, 5 April 2013

Top mental health books: Part 1

I've been on holiday this week - the plan was to sow all my veg for the coming season. But it's been so cold that not a single seed has gone in!

So, plan B. Reading. I asked my colleague Laura (she is much more well-read than me!) to recommend some of her favourite mental health books - which she has. And then I thought - it would be good to share them with a wider audience. So, here it is, the first of an occasional series of top reads on mental health:

Living with Voices: 50 Stories of Recovery 
Published by PCCS books in association with Birmingham City University. There is a range of contributors, including Professor Marius Romme, Dr Sandra Escher, Jacqui Dillon and Professor Merwyn Morris. 
Laura says: I think this is a great book, I couldn’t put it down. It gives so much insight into people's experiences and in my opinion shows how questionable the level of medicalisation that we do around these behaviours, thoughts and emotions is (i.e. the view of voice hearing as a sypmtom of mental illness). A bit like your grief post - the people’s stories in this book tell us about personal trauma and stress and in my opinion their very human responses (e.g. hearing voices) to these adversities rather than a symptom of an illness.

Thinking About Suicide: Contemplating and comprehending the urge to die 
By David Webb, published by PCCS books. 
The author completed the world’s first PhD on suicide by someone who has attempted it. 
Laura says: I found this book really interesting and it really made me question just how dangerous some of our knee jerk responses to people talking about wanting to die might be. It also made me think more deeply about responsibility and confidentiality. Could our reactions (i.e. individuals and services) and actions (e.g. sectioning, treatments) stop people from being able to openly and honestly talk about their feelings of wanting to die? How valuable is it for people considering suicide to be able to talk about these feelings without fear of what others might do in response? 

The Myth of Mental Illness by Thomas Szasz and Szasz under Fire edited by Jeffery A Schaler
Published by Harper Collins and Open Court Publishing respectively. 
Thomas Szasz was a psychiatrist and academic who criticised the medical approach to treating mental distress. 
Laura says: I can honestly say that Thomas Szasz changed my life by changing my ideas. When I first read The Myth of Mental Illness I found it hard going, his views were so alien to everything I had ever understood about mental illness since my first experiences of psychiatry in my early teens. Szasz’s ideas challenged everything. My issues with the book are not though a reflection on his writing, he is one of the most clear and logical authors I have every come across.  As I read other books about these ideas my understanding became clearer and I particularly found the book Szasz Under Fire useful.

Anatomy of an Epidemic
By Robert Whitaker, published by Broadway Books. 
This award-winning journalist explores why with every passing year so many more Americans are labelled as "mentally ill", and considers whether the increasing use of psychiatric medicines could be contributing to this rise. 
Laura says: Robert Whitaker would be a must for me. I cannot recommend this highly enough.

Trauma - From Lockerbie to 7/7: How trauma affects our minds and how we fight back
By Gordon Turnbull and published by Bantam Press.

Laura says: This book was my introduction to the subject of post traumatic stress disorder in any detail and I became interested in the similarities between this diagnosis and other "mental illness" diagnosis. I also found it fascinating to read the journey of PTSD as a "mental illness" diagnosis in and out (and in again) of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Gordon’s use of people’s live experiences alongside his own clinical knowledge journey are really thought provoking. His insight into why two people might experience the same external trauma and yet respond and cope very differently is also in my opinion very relevant to our wider understanding of mental health.

So, this should get us started! We'll post again in future with more recommended reads, and also include some fiction works.  In the mean time we will be ordering copies of these books at our local Powys libraries, so if you want to get hold of a copy why not get in touch with your library, details of which you can find here.

If you have any reading recommendations that you think we should share then please do get in touch.
Happy reading from all at Powys Mental Health!

PS: for those still troubled about the gardening... you could always try Cold Climate Gardening by Lewis Hill....