Thursday, 4 August 2016

You don't have to be mad to work here, but...

Carla Rosenthal recently joined the mental health team at PAVO to provide maternity cover for Angharad Griffiths. Some readers may know her from her previous role as editor of Headspace magazine for Powys Mental Health Alliance. During that time she organised some very interesting Open Days throughout the county.

Carla has thrown herself with great enthusiasm into her new role at PAVO; you can watch a video of her first Coffee Moaning, which took place in Knighton in May. She works very closely with Anne Woods, a participation colleague focusing on the Stand up! for emotional health & wellbeing project funded by Comic Relief.

With one of her many other hats on Carla is also a Mental Health Act Manager in North Powys. We spoke to Carla at her Llandrindod base to find out more.

Tell us more about your new role in the PAVO mental health team

The job title is Participation Officer and essentially it’s all about community engagement. I spend a lot of time meeting people and talking about Mental Health Services in Powys. All views, opinions and issues are collated and then given to Individual Representatives who take the grassroots voices to Board Level. I grab every opportunity to talk to service users, carers and third sector organisations to discover what is working well and what needs bringing to the attention of the health board and other mental health service providers. And I’m busy organising Coffee Moanings around Powys. (The next one is in Ystradgynlais Library on Friday 7th October 10.30 - 12.30 in the Wedding Room).

How is the new job going so far?

Four months in and I’m busier than ever! Along with supporting Individual Reps, attending Patients' Council at Bronllys Hospital, talking to people at events, and writing emails, there are lots of meetings to attend and new contacts to follow up. When I’m not travelling around Powys, I’m getting used to working in an office (a new experience for me) and I really enjoy the work I do - there’s never a dull moment.

Why should people who have been in contact with services come along to a Coffee Moaning, or a Stand Up! for emotional health & wellbeing session?

The aim of these events is for ANYONE who has interest and experience in mental health services to come along and get their voice heard. The evidence that’s gathered from these events is gold dust to the Individual Representatives who work closely with service providers such as Powys Teaching Health Board and partners on the board like the Police and the Council. It is imperative for those who plan services to hear what is needed from the people who actually use the services.

I believe you are currently looking for people to become new Individual Representatives for the Powys and National Boards. Can you tell us more?

Individual Reps are the voice of the people - it is thanks to them that service users and carers are represented. It’s an opportunity for anyone passionate about planning and developing mental health services to get involved and feel that they are helping to make a difference. Although it is a volunteer role, travel expenses are paid and there’s a fantastic training package being put together which equips Individual Reps to feel confident at strategic board level meetings. 

The partnership meetings are held every two months and there are opportunities to sit on sub-groups which are instrumental in delivering the Mental Health Strategy for Wales. Should an Individual Rep wish to attend the National Partnership Board, I assist in liaising with the Mental Health Foundation who appoint the National Reps and there are National Forums where all the Reps from across Wales get together to share information and good practice.

PAVO's mental health team with Seat 35, L:R - Jane, Anne, Jackie and Carla

What about your other role as a Mental Health Act Manager for Phoenix House Hospital in Welshpool? Tell us about that.

Mental Health Act Managers meet when an in-patient has requested an appeal hearing against their section. The title ‘Manager’ is somewhat misleading as we are all lay-people and come from a variety of backgrounds. My interest is this role came about due to having been a patient under section at a hospital in Surrey several years ago along with a brief spell in Bronllys. I can see things from the perspective of the patient as well as from a professional viewpoint.

As Managers, three of us meet before the hearing and read through the reports compiled by psychiatrists, doctors, lawyers, social workers, nurses etc. We then make a particular point of having an informal chat with the patient first, to help put them at ease and give them the opportunity to put their side across before everyone comes in. The hearing itself can be rather daunting as all professionals involved come together to give their opinion of the future care of the patient. When we have heard everything from everybody and the room has been emptied, we make a decision based on all the evidence presented.

To be held under the Mental Health Act, an individual is deemed to be at harm to self or others and needing treatment in a place of safety to prevent harm happening. If, as managers, we feel that the patient has received appropriate care and treatment and has recovered fully to become a ‘voluntary’ patient and/or even leave hospital straight away, we can lift the section. However, some people need to continue their treatment before they can be released and we then look at how they can work towards becoming a voluntary in-patient. We talk to the outside agencies such as community psychiatric nurses and social workers about what care will be put in place for when the patient leaves hospital. It’s an extremely important and responsible decision which cannot be taken lightly. Having been a patient, I understand how difficult a hospital stay can be but I’m also aware of what it’s like to be ill and needing care. Ultimately, the patient’s welfare is at the heart of our decision.

How did you get involved at Phoenix House?

When I was magazine editor of HeadSpace, I wrote a feature article on Phoenix House and one of my contacts there told me about the Managers' Panel and suggested I applied for the role. I had to complete an application form and have a formal interview before being given the position. In nearly two years, I think I’ve attended 6 hearings.

What qualities should a good MH Act Manager have and why?

As I mentioned earlier, the decisions we make have a direct and immediate impact on a patient and that responsibility is not to be taken lightly. Compassion, understanding and the ability to listen and read through a variety of evidence is essential along with a sound knowledge of the Mental Health Act and maintaining confidentiality. Along with these professional skills, a good Manager is one who genuinely listens to the patient and those working with them because whilst reports have their place, the conversations that happen during the hearing are the key to making the final decision. The Managers are aware that it is quite an emotional and stressful event for the patient and our behaviour and communication needs to reflect this during the hearing. A smile goes a long way :-)

Have you sat on an appeal panel which has discharged a patient from a section? What did it feel like?

Yes, I have and the emotions are mixed. Although seemingly a positive outcome, sometimes you get the feeling that this person is going to need support for while and although not needing a hospital setting, the willingness to engage with outside services has to be there in order for that person to thrive. I’ve worked with people who when they are in hospital they’re aiming for release, but when they’re back at home there’s nothing to aim for and they find themselves relapsing.

If during an appeal panel a patient is discharged from a section, what support has to be in place for the person?

From the moment of discharge, a patient’s status becomes ‘voluntary’ and they are free to leave. Sometimes, the section will be lifted on the proviso (agreed with patient and staff) that they stay for maybe an extra week in order for housing or a support service to be sorted out. In reality, lifting a section is only dependent on a person’s likelihood of harm to self or others so housing, support networks etc, are not part of that decision. However, our duty of care is such that we try to ensure that everyone involved is ready to provide the support as soon as possible.

What are the main challenges of the role?

This directly links with the previous question as there was a situation when if the patient was discharged, they would immediately leave the hospital into unsuitable accommodation and continue a lifestyle which had contributed to their initial ill health; however, there was no legal case to maintain the section. It’s times like this that the panel needs to consider very carefully the future of the individual. It’s all too easy to see a yo-yo effect of the same faces re-appearing in hospital but at the same time, we can’t keep someone detained in hospital just because on their release they want to go down the pub and have a beer and a fag!

Tell us about some of the most rewarding work you have done in the mental health field

On a personal level, I really enjoy going to Felindre Ward at Bronllys Hospital because some of the staff remember me from when I stayed there in 2011. It’s an amazing feeling when I can sit with patients in a Patients' Council meeting and say, I understand, I’ve been here too.

Recently I met some people at the PAVO offices who wanted to discuss a family member’s mental health. I sat across a desk telling them, “It’s ok, I’ve been in the same head-space that your family member is in and my mum has been in a similar situation to the one you’ve found yourselves in.” We all shed some tears. I signposted them to a variety of organisations, offered personal support and generally empathized. They were so reassured that just because someone is experiencing mental ill health, options don’t close down (as some people still think), instead options will open up.

And I still joke about my job: “You don’t have to be mad to work here - but if you put it on your CV, it’s a bonus”.

When you’re not working how do you enjoy spending your time?

I adore reading and devour books from the library - a day without my book time is not good! I’m also studying a Royal Horticultural Society course in horticulture and really enjoy gardening but a recent house move means most spare time is spent unpacking boxes I haven’t quite got round to yet . . . and I’ve got kids and dogs and horrible housework!

Many thanks to Carla for telling us about her various roles. If you would like to find out more about Coffee Moanings, or becoming an Individual Rep, just contact Carla by ringing 01597 822191 or emailing

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