Tuesday, 28 October 2014

Finally receiving treatment - a personal view

I was speaking to someone in Powys recently about their experience of "going outside of the NHS towards private talking therapy... a really positive step". A positive step seemed like a good subject for a blog post, and our guest author agreed. Read on....

As an individual I have been in contact with mainstream services for over nine years, both in Powys and in other areas of the UK. Over these years, a combination of GPs, psychiatrists and occasionally other staff such as Community Psychiatric Nurses and support staff from Community Mental Health Teams have made efforts to try and alleviate the severe difficulties that go along with a diagnosis of schizophrenia.

I have found that during times of crisis access to support has been available, given that it is asked for in the right way. The problem however, for me and many others, has been with the issue of getting back to being able to live and function on a daily basis and to a level where it would be possible to believe that the goal of full and complete recovery is not only a real thing but something worth pursuing.

Although there can never be a guarantee that severe distress, mental ill health or challenges to wellbeing won’t occur either in someone who has previously had first-hand experience of these things, or in someone who hasn’t, the journey I have been on leads me to believe in one or two controversial things.

Firstly, like many others, and as supported by a growing body of evidence, I have a problem with the medical model of mental ‘illness’. The medical model is not a simple view and advanced neuroscience is often used to highlight areas of the human brain which may sometimes work differently in those who are labelled as ‘schizophrenic’ (to use but one example).

That shouldn’t detain us here, for as well as the causes for this diagnosis being perhaps still largely unknown and certainly not agreed upon amongst medics, the issue of how best to treat the condition is a big problem.

In my experience the first and last option for many practicing psychiatrists has been to prescribe powerful anti-psychotic medication, which especially since the second generation of a-typical anti-psychotics have been used, can and do alleviate or suppress ‘symptoms’ (such as psychosis) and with less pronounced side effects than the original first generation medications.

After talking to a pleasant local GP about the possibility of finding other ways to treat my own condition than medication alone, we loosely agreed that some combination of medication and talking therapy would be a sensible plan. However, in Powys the availability of talking therapy through the NHS is highly limited and the waiting list spans several years. One person I met has waited for more than 6 years already.

There are organisations such as Mid Powys Mind in Llandrindod Wells who are able to offer a free counselling service and having tried a couple of months of weekly sessions with a volunteer counsellor I found that the ability to share problems confidentially and in a non-judgemental setting brought much relief. 

More recently though, the view that a deeper and longer level of talking therapy could bring improvements to the way a person feels and functions is something which I managed to pick up from sources such as this blog and which in turn led me to explore the availability of private psychotherapy in our area.

Despite living on benefits, with advice on Employment and Support Allowance (ESA) and Personal Independence Payment (PIP) from the Citizens Advice Bureau it has finally been possible to find just enough capital to arrange for regular sessions with a practicing psychotherapist. Partly this is enabled by my practitioner’s policy of subsidising out of work patients with a slightly lower rate to those who are in work.

When making the long decision to proceed, the view of my psychiatrist was that for certain conditions which they believe to be entirely inherent or set in stone within a person’s biological constitution, there would be a risk associated with stirring up long lost memories or otherwise suppressed thoughts and feelings. I was glad of the discussion we had but, in the nicest possible way, could not disagree more strongly with any view which maintains it is not worth pursuing.

After the first couple of months of psychotherapy the tangible areas that many doctors ask about such as mood, sleep and appetite showed marked improvement and once more it seemed that the future could hold prospect and possibility rather than simply being a drab and bleak inevitability, where, to put it frankly, death would have been a welcome event.

I can’t speak highly enough of the time and space that I am lucky enough to have found within which help is given by another mind to sort through the problems and issues which we otherwise face on our own. This would include issues that an individual is aware of and also issues which it is almost impossible to be aware of by yourself.

As for ‘symptoms’, although my therapist is mindful of these and very respectful of the view of GP and psychiatrist, the outlet for me to unburden and unpack life’s major and minor worries means that as long as any possible reduction in medication is done gradually and carefully there is someone else to help keep a watch should difficulties arise.

There is still lots to do, but finally having some level of regular support has been a great relief not just to me but to remaining friends and family. As for the financing of this I would make the case to individuals, health professionals, charities and funding bodies to give increased engagement with other therapy some serious thought.

Have you had experience of talking therapies in Powys recently, whether provided by the NHS, by the voluntary sector or privately? Or are you still on the NHS waiting list? Let us know about your experiences in the comments' section below.

Thursday, 16 October 2014

Art in Brecon 2014

This year sees the fourth Art Fair in Brecon. It is a time when both professional and amateur artists, along with groups from Brecon and District Mind, come together in St Mary's Church in Brecon to each have a stand and display their work. This year’s fair takes place on Thursday 16 (6 – 8pm), Friday 17 (10am – 4pm) and Saturday 18 October (10am – 4pm).

We talked to Sue Hiley Harris, a professional sculpture weaver, who has been involved with organising the Art Fair since the first one in 2011 and will have a stand.

Whose idea was the Art Fair and how did it evolve? Tell us more about the early years.

The first art fair came about when some of the members of Brecon and District Mind (then Brecon and District Contact Association) approached me – as chair of
the Friends – to see if the Friends could help them sell their art and craft work. We decided rather than an exhibition we would have a fair where each artist would set up their own stand and be there to talk to the public about their work. There are quite a few professional artists in the Friends and they were happy to get involved. The church was prepared for us be there and to rearrange the seats.

Gleanie II by Victoria Keeble

Is it different this year?

It is on for longer this year. Previously it opened on the Friday evening and was open all day Saturday. This year we were trying to avoid opening on the Friday evening as it clashed with a lecture on art in Crickhowell. I sent a message to the artists and the majority opted for an extra day. It is generally thought that it is a lot of work setting up so it would be good to stay open for longer. So this year we open on Thursday night with wine and jazz, and then will be open all day Friday and Saturday. It is then all hands on deck as we return the church ready for the Sunday morning service. The church has been very supportive.

Another first this year is a raffle. The artists have been asked to contribute and by the sounds of it they have been very generous. 

Allotment Retreat by Veronica Gibson

What do you feels works so well about the Art Fair?

I really like the mixture of professional artists, amateur artists and artist groups that all exhibit together. Contacts and friendships are made. To me this is one of the most important outcomes of the fair. We also have other people, Friends and members, coming in to help – either with the setting up or to give look after stands so that the artists can have lunch or take a break. So generally I would say a sense of community makes it work so well – and of course there are a great number of art and craft work on display and for sale.

Dragon by Anna Lawday

What do you get out of the Art Fair by exhibiting?

I really like to exhibit my work locally and it is an opportunity to see people I might not have seen for a while and introduce more people to my work. I often exhibit abroad or in other parts of the country but I do like to see how people I know react to new work. This is a really nice, safe, unpressured place to do that.

What will you be showing this year?

I am working on new work that is not really in a state to show so I have decided to do something different this year. I received an Arts Council of Wales ‘Creative Wales Award’ last year and my work is definitely changing. I will be showing some life drawings and collages, which has been a very new direction for me. I don’t have my new woven work ready for show so have decided to show a selection of my small woven sculptures from the last fifteen years in what I have called a ‘table retrospective’. Some weavers were at my studio for a visit a few weeks ago and I got out some of my early sculptural pieces. I decided that it would be good for me and for others if I had a little show of these works alongside the drawings. I will also be happy to talk to people about my new work and the direction it is taking me.

Artist Veronica Gibson teaches art classes at Brecon and District Mind. 
Here she is at her stand at last year's Art Fair, with Dave Griffiths, 
one of the members of the Art Group at Mind.

Art Fair Launch: Thursday 16th October 6-8 pm at St Mary's Church, Brecon.

The Art Fair will be opened by Philip Bowen, High Sheriff of Powys, and the Charles Castle Three  (Mike Chappell, Bert Morris and Mike Jones) will be playing live.

The Art Fair will also be open on Friday 17th and Saturday 18th October from 10am to 4pm.

You can find out more about Brecon and District Mind here.

Thursday, 9 October 2014

North Powys Crisis Resolution Home Treatment Team

I first wrote about the introduction of a Crisis Resolution Home Treatment Team for North Powys (Montgomeryshire) in February 2013 (Home Treatment Team for the North) when Mike Shone unveiled the plans for the new team. Earlier this month I met with the team’s manager, Graham Batha, and asked him for an update about the service.

Tell us a bit about your background

I am a registered mental health nurse, and have been registered in this profession for approximately 10 years. I trained at the University of Central Lancashire, and then worked in Preston in an acute inpatient setting before moving to the Preston home treatment team. I later went on to work within the Wrexham home treatment team before moving to this post as the team manager for the Crisis Resolution Home Treatment Team in April 2013. My professional interests include service user involvement in the development of services, and professional education for students.

Tell us more about the service

The CRHT in North Powys opened in May 2013. To date we have received 419 referrals into the team, and our service is open 7 days a week, from 9am to 9pm Monday to Friday, and 11am to 7pm at weekends and Bank Holidays. The objective of the team is to provide an equal alternative to inpatient care, and to facilitate early discharge from hospital when it is safe to do so.

What staff roles do you have on the team?

The team consists of one team manager, one team secretary, one health care support worker and six registered nurses. The team is also having an additional 3 members of staff in the future. The team is also supported by a dedicated Consultant Psychiatrist.

Who can refer people for the CRHT service?

The Community Mental Health Team can refer people into our service, during the hours of 9am to 5pm. Out of hours, the CRHT does accept referrals from ShropDoc, which is the out of hours GP service.

Can people of all ages be referred?

We look after people aged 18 or over with a functional* illness.

What happens if someone experiences a crisis outside of your usual hours?

It can be useful to write a contingency plan with your care coordinator (if you have one), which can be used to highlight what needs to happen in an emergency. I would suggest that you contact your on call GP or in an emergency attend your local Accident and Emergency Department.

What is the nature of the service provided by a Crisis Resolution Home Treatment Team?

The CRHT is a short term but intensive service. The team visits service users on a frequent basis, up to twice a day, providing the same service as you would receive in hospital. When someone is referred into the CRHT team, the team will arrange an assessment as soon as possible. The team will then develop a care and treatment plan with that person, with the aim of supporting and aiding recovery. 

How do you promote a person’s recovery?

Twice a week, the whole team meets in a confidential environment to discuss each person that the CRHT is caring for. This allows the team to do its very best for the people we care for, and to support recovery in a timely manner. People who have used our service have been positive about their experience with us. The team does share the entire CRHT caseload, and people who do use our service can see all members of the team.

As a relatively new service in North Powys, how has the CRHT impacted on provision of mental health services generally?

The CRHT has had huge benefits in supporting those who really don’t want to go into hospital, and would rather stay at home. The team does, however, understand that sometimes hospital is necessary, and the CRHT will try to facilitate an early discharge with our support at the earliest opportunity when it is safe to do so.

Are there any specific needs that can be well-addressed by the CRHT?

The CRHT can help with practical issues such as housing etc, and will do all they can to ensure carers are supported.

Do you refer people on to other services?

When someone has recovered in the CRHT, their care is either referred on to additional mental health services or another appropriate service, or their care is handed back to the GP. In all cases the CRHT writes to the GP to ensure that the GP is aware of our intervention and any changes we may have made to the person’s care or treatment.

What are the challenges for a CRHT in a large rural area like North Powys?

The distance of travel that is required within this area is a challenge for the team, but it does not cause us too many problems once you become familiar with the area.

What are the most rewarding aspects of the work you do?

For me it is rewarding to see people recover at home, within a familiar setting, as opposed to a hospital setting. I feel that you are able to work with people more creatively and independently at home, as hospital can sometimes be restrictive.

How would you like to see mental health services developing in North Powys in the next few years?

From the view of the CRHT we would like to help and support more people to recover at home. We understand that hospital admissions will always be needed at times, but if we can reduce the stress of going into hospital for the client and their family, this may limit the amount of time it takes to recover.

Many thanks to Graham for the update. If you have any queries relating to the Crisis Resolution Home Treatment Team in North Powys, you can comment below.

*This term is defined online on an NHS jargon-busting website: "A term for any mental illness in which there is no evidence of organic disturbance (as there is with dementia) even though physical performance is impaired". 

Thursday, 2 October 2014

Co-producing the Annual Report for Mental Health

L-R: Aled Davies (Powys County Councillor), Sophia Bird (Powys Public Health), Meriel Richards (individual rep National Forum for Service Users & Carers), Seamus O'Doherty (Welsh Ambulance Service), Louisa Kerr (Powys teaching Health Board), Clare Lines (Strategic Lead Mental Health - PtHB), Michelle Forkings (Aneurin Bevan Health Board), Jackie Davies (Children & Young People's Partnership), Steve Pearce (Powys Youth Justice).

Following development of the new Powys mental health strategy – Hearts and Minds: Together for Mental Health – the first annual report was produced by the Powys Mental Health Planning and Development Partnership Board for 2012-13 (you can read it here). This reports on which key elements of the delivery plan had been achieved during that year. As far as I am aware, it was written primarily by staff working for Powys teaching Health Board.

At a recent meeting of the National Partnership Board (minutes available here) the individual representative who is based in Powys, Rhydian Parry, gave feedback from the National Forum for Service Users and Carers. One of the points he made was:

“Service user and carer views need to be clearly and accurately embedded in annual reports.”

“The Chair (of the NPB) responded saying all Local Health Boards and Trusts have been informed of this requirement. A small amount of financial support has been made available to each Partnership Board to support this process. Sian Richards (Welsh Government Mental Health Strategy Lead) will be meeting the Service User and Carer members immediately after this to discuss how they can play an active role in the development of the Welsh Government report.”

I knew that an event had taken place in late September this year, pulling together the members of the Powys Mental Health Planning and Development Partnership (PMHP&DP), including those using mental health services and those close to them, to look at production of this year’s annual report. The work was being described as “co-production” – a word which can mean so many different things to different people. It is defined by the New Economics Foundation “as delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours”.

So, I asked my colleague Freda Lacey for an update about last week’s event.

Freda told me that four of the individual reps – Rhydian Parry, Meriel Richards, Kate Van Ende and Michelle Willingham – had contributed along with people working to provide statutory mental health services, Powys Public Health, a Powys county councillor, Powys Youth Justice Service and the Welsh Ambulance Service. Prior to the event the four individual reps had given feedback first on the structure of the event, and then about the way their contribution would be included in the Annual Report.

The idea of a “timeline” was developed – the journey of an individual’s life from cradle to grave – along which mental health services could be accessed. Feedback was then given about these services.

The completed Annual Report will be signed off by Powys teaching Health Board (PtHB) in October before being passed to the Welsh Minister for Health & Social Services – Mark Drakeford. It comprises two parts – a written section, where the reps have made detailed feedback on the delivery plan and overall report, and an audio version containing real life voices. The voices will include contributions from an all age perspective, including children from the Sparks Project run by Tros Gynnal, an interview with an older couple relating to dementia, and excerpts from the DIY Futures book of stories – it’s the inside that matters, covering adults’ and older adults’ perspectives. Additionally, partners have been asked to give their feedback on how the voices of people in contact with services have helped shape their services. There will be contributions from Dyfed-Powys Police and the Children and Adolescent Mental Health Services team (CAMHS).

Clare Lines, Strategic Lead for Mental Health at PtHB, and chair of the Powys Mental Health Planning and Delivery Partnership, will also speak about the positive impact that the individual reps have made on her work and that of the Partnership.

We will let you know as soon as the Annual Report for 2013 - 14 is published. Watch this space!