Monday, 14 November 2016

Prevention & Early Intervention - the mental health conversation

The mental health conversation; PAVO's CEO Carl Cooper; Jane & Jackie PAVO mental health team

Last Tuesday 8 November I attended the PAVO AGM and Conference at Cefn Lea Conference Centre near Newtown along with colleagues and respresentatives from voluntary sector groups, the statutory sector, and numerous other individuals. The theme this year was: Prevention & Early Intervention - the Third Sector role in Powys.

The conference invitation stated: "It is widely acknowledged that Third Sector organisations and services have an essential role to play in prevention and early intervention. This conference will explore how these services could be an integral part of a common direction in Powys".

Carl Cooper, our PAVO CEO, opened the conference by saying: "We are delighted to have this as our theme. It is important particularly in light of the Social Services and Wellbeing (Wales) Act which highlights that support and care should be provided at an early stage to those requiring it to prevent worse things happening later in life's journey. The Third Sector has a crucial role to play in that." 

Carl then introduced the first speaker, Dylan Owen, the Head of Social Care Transformation at Powys County Council.

Dylan explained that the Early Intervention and Prevention agenda is driving council services forward to make sure that people's wellbeing is supported in the community. This includes working to support people to re-engage with their communities, and to do what matters to them.

In the past social care planning has followed a path of assessment - providing care - looking at the deficits and weaknesses - and solving problems. Now this approach is being turned on its head, with a duty to support people to make their own decisions. 

Dylan described how the council is already working closely with the PAVO Third Sector Brokers to find alternatives to help people to live independently. Isolation and loneliness are often the first step to becoming dependent on social care services, and other initiatives, such as the Powys Befrienders project, where paid co-ordinators work with trained volunteers across Powys to support people to engage with their communities, (ideally in their own language), have also proved very successful.

Community Wellbeing Co-ordinators and Home Based Support, working from community hubs, were other key services also covered in Dylan's presentation.

Next up was Stuart Bourne, Assistant Director of Public Health at Powys Teaching Health Board.

Stuart referred extensively to the Health Board's Integrated Medium Term Plan (IMTP) which sets out the health priorities for Powys up until 2018 (it is discussed in more detail in our March post Engaging with PTHB to shape future services). The IMTP contains many elements of early intervention and prevention, including approaches which benefit from joint working with the Third Sector.

Stuart emphasised the impact of quick and easy early intervention by referring to "the 30 second chat that can trigger weight loss" as recently reported widely following a University of Oxford trial. Here at PAVO we are already familiar with initiatives such as The Five Ways to Wellbeing and Making Every Contact Count.

The formal presentations were followed by 10 "conversation" groups, of which Mental Health & Wellbeing was one. Jane from our team facilitated, with support from Val Walker of Brecon & District Mind. Those who signed up included Third Sector organisations such as Hafal, Cymryd Rhan, Hay Day Cafe and Ponthafren Association, individuals who have been in contact with mental health services, carers and employees of PTHB. 

The mental health "conversation" gets underway at the PAVO Conference
The group was asked to consider some key questions as part of a larger discussion around the conference theme, including: What will this new approach to Prevention and Early Intervention mean for our organisations and the services we provide?

Some interesting points and questions were raised. There is not the space to outline them all, but here are a few to give a flavour of the session:
  • If people have dementia then making cognitive decisions about their future care could be stressful. How would this be handled?
  • People want safety and security, particularly as they grow older. Not all people will wish to stay in their own homes. There needs to be a broad range of options made available.
  • Community based means person-centred. Learn from the Third Sector who have been working this way for years.
  • A lot of community services are being closed down and there is a huge dependence on volunteers. Where is the money coming from to support this volunteering?

It was clear from the conversation that there is a gap in services before people who are distressed seek support around mental health from their GP. What does that look like? Is it more than an Information Service? Is it an additional specific role, and if so doing what?

There is also a huge issue because of the waiting lists for talking therapies in Powys. In many ways talking to someone is a form of early intervention, but if we cannot meet the demand currently what can we do differently?

Good practice around early intervention was identified in pockets around Powys and all agreed that it would be excellent if such activities could be rolled out throughout the rest of the county. We found out a little more about one particular project.

The Active Monitoring project being run by Brecon & District Mind
Val updated us on the progress of this new service which operates out of Hay and Talgarth GP surgeries, and is a joint project between the GPs in that area and Brecon & District Mind. This early intervention service will mean that the practice clinical team are able to refer anyone with symptoms of anxiety, depression, low self-esteem or stress directly to a Mind Practitioner in the surgery to be seen straight away.

To date 29 people have been seen by the Brecon Mind Practitioner in the first 6 weeks of the project. They have progressed through five sessions and the results show a definite improvement in their state of wellbeing. Others have been signposted to other organisations such as Cruse, the bereavement charity, for ongoing support. Val believed further signposting should be instigated so that the massive waiting lists for talking therapies could be addressed.

Active Monitoring is popular in other parts of Wales, including Merthyr Tydfil, and started in North-West England where it is now embedded in Primary Care services after being rolled out in 47 surgeries.

Val Walker, Service Director, Brecon & District Mind
We also heard about a relatively new Hafal pilot project in Bridgend and Swansea "to provide early intervention services to service users and families, focusing on the direct needs of young people (14 - 35) experiencing a first episode of psychosis". Referrals are made by the Community Mental Health Team and picked up by one of three part-time Hafal workers. The staff support individuals through a programme with a view to move on to community engagement or further education using Hafal’s Recovery Programme as the basis for doing this.

Jane summarised the key point to feed back to the conference
We had to pick one key point from the mental health conversation to feed back to the conference. Impossible! We had loads! Eventually we narrowed them down to three as a group, and magically Jane managed to merge them as one!
  • A lot more work is required in consultation with the Third Sector.
  • Communication is massive.
  • A better understanding of mental health is required by all. It needs to be normalised.
If you were not able to attend the PAVO Conference this year, what would you have liked to add to our mental health conversation on Early Intervention and Prevention? Let us know in the comments box below, we always love hearing from our readers.

Adrian Osbourne is Assistant Director, Engagement & Communication, at Powys Teaching Health Board. Read his Twitter Storify summary of the day.

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