Tuesday, 23 February 2016

Our comedy workshop @ Celf

Yesterday as a team we explored how comedy could inform our work around participation - specifically around engaging with people who have been in contact with mental health services or those close to them - and learned new ways to tell stories or describe experiences.

Who better to enlist to help us than Owen Griffkin of Havin' A Laugh fame. And what better premises for our workshop than the Celf Centre run by the art charity Celf O Gwympas in Llandrindod Wells. The place is stuffed full of weird and wonderful and very inspiring artwork. You only have to look at some of it to find yourself smiling. And, they even have red noses of their very own! Perfect for those of us working on a Comic Relief funded project called Standing up for emotional health and wellbeing (that would be Anne then, far right in the photo).

Artwork at Celf by Dean Warburton
In our very own bespoke Havin' A Laugh workshop Owen took us through a series of games over the course of a couple of hours. We were amazed to discover that there was much humour to be found in our own everyday lives and stories.

Owen Griffkin - the comedy master - and Jane Cooke, our Senior Officer Mental Health
In the first session some of us had travelled billions of miles (think Universe, speed of light, Star Wars kind of community transport) to put the most important question imaginable to The Oracle. Two of us had the slightly challenging task of answering the questions (as a sort of bizarre two-headed Oracle), one word at a time, each after the other... talk about throwing us in at the deep end. 

Questions ranged from the fairly predictable "What is the meaning of life?" to the intriguing "Why is there a colour purple?" to a rather random travel enquiry: "How do I get to Atlantis?" The answer to the latter being, quite obviously: "Atlantis relies upon your soul being attuned to many places including the underneath of your feet exactly." So.... now we know...

Artwork at Celf by Dean Warburton
Next up: Truth and Lies.... Each of us had to tell three facts about ourselves to the others in the group. Simple enough, surely? But, there was a catch. (Of course). One of the facts had to be a lie, and the others had to guess which one... Blimey, we never knew this could be so hard... our colleagues turn out to be masterful liars!

Here are the three facts Jane told us about herself.... which one do you think is the lie...?
  1. All of my three children were born on a Thursday.
  2. I did not start speaking properly until the age of 4.
  3. My childhood ambition was to be a show jumper and a hairdresser.
One of my truths involved attending a Star Trek convention many many light years ago, but perhaps the less said about that the better....

Anne Woods - Participation Officer, and Philip Moisson - Powys Patients' Council facilitator
Further games followed, far too many to mention here, but you get a feel for the state of comedy affairs by this stage of the afternoon...

One of my favourite games was The Interview. We took it in turns to interview each other for a number of job vacancies, including Waste Recycling Operative and Koala Bear Midwife. We were either super-confident or extremely nervous, Owen explained to us. One of the funniest sessions was Anne being interviewed, as a nervous potential Rocket Scientist, by Phil. Here is how it went:

Phil: How are you?
Anne: A bit nervous.
Phil: There's no room for nerves in rocket science.
Anne: Oh. Sorry.
Phil: So, what would you bring to our next expedition?
Anne: Not much. But I'd give it a go.
Phil: What do you know about Rocket Science exactly?
Anne: Just a little. But I could go to the library and read up on it.
Phil: Right....
Anne: The main thing is... well, let's just hope we come back from the expedition.
Phil: D'you think you're confident enough for this type of role?
Anne: I am a worrier. But I do double and triple check things. I might have to restart the countdown... Once we got down to 7 I'd have to go back up to 10...

Anyone out there looking to employ a nervous Rocket Scientist then...?

By the end of the afternoon we were absolutely exhausted we'd all laughed so hard. So we sat down and had a much-earned rest for half an hour. At the same time ('cause we're so good at multi-tasking) we ate a few biscuits, drank coffee and/or water, and chatted about how we might put these techniques to use in our participation work. We started off by acknowledging that some of us had been quite apprehensive about the session, and even a little nervous going into some of the games, but ultimately had found them extremely enjoyable and very rewarding.

We also decided that using funny and engaging ways of looking at life could be a great way of showing the realities of life for people in contact with mental health services. For example, for exploring day-to-day life on a mental health ward, or what it's like waiting to access talking therapies. At the very least some of the games could be used to break the ice at meetings and we all agreed they created a very levelling experience where we are all people together sharing some small details of our lives.

What do you think? Would you like to have a laugh? Find out more about the Havin' A Laugh workshops running at Mid Powys Mind. Or let us know your thoughts in the comments box below.

By the way, the next Stand up for emotional health and wellbeing meeting takes place this coming Monday 29 February in Llandrindod Wells. It will be at the Resource Centre, Mid Powys Mind between 3 - 5pm. If you have been in contact with mental health services, or are close to someone who has, and would like to speak with mental health professionals or give some feedback about your experiences, we would love to see you there. And if you would like to find out more about the project please contact Anne by emailing: anne.woods@pavo.org.uk or ring 01597 822191.

The Cash Cow at Celf - even she has a red nose!

Monday, 8 February 2016

Ymddygiad gwrth-gymdeithasol a iechyd meddwl – beth mae gwasanaethau angen ei ystyried? Anti-social behaviour and mental health – what do services need to consider?

Meddyliau o brosiect ymchwil gan Philip Moisson
Thoughts from a research project by Philip Moisson

Gall ymddygiad a dargedir gan y ddeddfwriaeth ar ymddygiad gwrthgymdeithasol fod yn arwydd o broblemau iechyd meddwl (fel yr ysgrifennwyd amdano yma - efallai y bydd y cynnwys yn peri gofid i rai darllenwyr). Mae'r blog hwn yn ymwneud â phroject ymchwil yr ydym newydd ei gwblhau a oedd yn canolbwyntio ar 'bobl fregus ac ymddygiad gwrthgymdeithasol'. Bu i ni edrych sut yr oedd ymarfer cyfredol yn edrych i bobl â phroblemau iechyd meddwl y mae ymddygiad gwrthgymdeithasol yn effeithio arnynt, naill ai fel dioddefwyr, tramgwyddwyr neu dystion.

Behaviours targeted by the anti-social behaviour legislation can be a sign of mental health problems (as written about here - some readers may find the content upsetting). This blog is about a research project we have just completed that focused on ‘vulnerable people and anti-social behaviour’. We explored what current practice looked like for people with mental health issues who are affected by anti-social behaviour, either as victims, perpetrators or witnesses.

Roedd fy rhan fy hun yn y project hwn fel hwylusydd grŵp ffocws, ac roeddwn i'n un o'r bobl a hyfforddwyd gan academyddion o Brifysgol Bangor i wneud hyn ochr yn ochr â phobl eraill mewn cysylltiad â PAVO ac Unllais yng ngogledd Cymru. Mae'n hynod o bwysig i bobl â phrofiad o hyn fod yn rhan o'r broses o gasglu a mireinio gwybodaeth am y materion hyn, a chwarae rhan wrth ffurfio argymhellion ar gyfer arfer da.

My own involvement in this project was as a focus group facilitator, and I was one of the people trained by academics from Bangor University to do this alongside other people in contact with PAVO and Unllais in North Wales. It is incredibly important for people with lived experience to form part of the process of gathering and refining knowledge on these issues, and in playing a part in forming recommendations for good practice.

Yn ein cyfarfod cyntaf cawsom roi cynnig ar gymryd rhan mewn grŵp ffocws, lle bu i ni drafod un o'r senarios a baratowyd yn ofalus, a oedd yn troi adroddiadau heddlu go iawn ar ffurf hanes ffuglennol bywyd cymeriad. Ar ôl hyn, fe wnaeth ein hyfforddiant ein harwain at gyflwyno'r grwpiau ffocws a chawsom ein gwahodd yn ôl hefyd i drafod y canfyddiadau o'r ymchwil cyn cadarnhau a chyhoeddi pethau. I rywun fel fi sydd ag amser sbâr, mae bod yn rhan o broject fel hwn yn arbennig o ysgogol.

At our first meeting we had a go at taking part in a focus group, where we discussed one of the carefully prepared scenarios which turned real life police reports into the form of a fictional account of a character’s life. After this our training led us onto delivering the focus groups and we were also invited back to discuss the findings from the research before things were finalised and published. For a person like me who has spare time, being involved in a project like this is incredibly stimulating.

Yr hyn yr oeddem ni'n ei wybod o'r cychwyn yw bod yr heddlu'n aml yn cael eu rhoi mewn sefyllfaoedd amhosib wrth ddelio ag ymddygiad gwrthgymdeithasol yn y ffordd fwyaf effeithiol. Er enghraifft, efallai nad ydi'n briodol bob amser gorfodi sancsiynau sifil neu droseddol, a bydd llawer o sefyllfaoedd lle mae dyletswydd gofal yn bodoli yng nghyswllt unigolyn bregus. Hefyd, mae trefnu cydweithio rhwng amrywiaeth o wasanaethau yn aml yn anodd yn yr amgylchiadau hyn.

What we knew from the outset is that the police are often put in impossible situations in dealing with anti-social behaviour in the most effective way – for example it may not always be appropriate to enforce criminal or civil sanctions and there will be many situations in which a duty of care exists to a vulnerable person. Also, organising collaboration between a range of services is often difficult in these circumstances.

Prif amcanion y project yn gyffredinol yw deall y set o broblemau uchod o safbwynt gwasanaethau, ac o safbwyntiau defnyddwyr gwasanaeth a gofalwyr. Roedd y project hefyd yn ceisio tynnu sylw at ffyrdd y gall gwasanaethau gydweithio, a chydnabod yr hyn a allai fod yn rhwystro hyn ar hyn o bryd.

The main aims of the overall project were to understand the above set of problems from the perspectives of services, and from the perspectives of service users and carers. The project also sought to highlight the ways in which services can work together and to acknowledge what might be preventing this at present.

Drwy gyfweld ag amrywiaeth o weithwyr proffesiynol a sgwrsio efo defnyddwyr gwasanaethau a chynrychiolwyr gofalwyr yn ein grwpiau ffocws, mi gasglwyd llawer iawn o ddata i'w dadansoddi. Mae ymddygiad gwrthgymdeithasol ei hun wedi cael ei ddiffinio gan ddeddf seneddol 2014 fel “Ymddygiad sydd wedi achosi, neu sy'n debygol o achosi, aflonyddwch, braw neu ofid i unrhyw un.” 

By interviewing a range of professionals and talking to service user and carer representatives in our focus groups, a large amount of data was gathered for analysis. Anti-social behaviour itself has been defined by a 2014 act of parliament as “Conduct that has caused, or is likely to cause, harassment, alarm or distress to any person.”

Roedd gan lawer o'r rhai a gymerodd ran yn y project wahanol safbwyntiau ar hyn, ac roeddent yn pwysleisio nad oedd pethau bob amser mor glir wrth siarad am bobl fregus. Mae'r heddlu felly'n aml mewn sefyllfa annifyr wrth benderfynu sut i ymdrin efo pobl sy'n achosi problemau heb fod o'u gwirfodd.

Many participants in the project had different views to this, and emphasised that things were not always so clear cut when talking about vulnerable people. The police are therefore often in an awkward position in deciding how to deal with people who are not wilfully causing problems.

Daeth llawer o argymhellion gan ddefnyddwyr gwasanaeth a gofalwyr allan o'r project, a dyma rai ohonynt:
  • Mae ar sefydliadau statudol angen gwybod mwy am waith da'r sector gwirfoddol.
  • Mae ar asiantau angen cydweithio i helpu'r unigolyn mewn angen, yn hytrach na chael ateb wedi'i ddiffinio ymlaen llaw wedi'i seilio ar label, h.y. ‘sgitsoffrenig- angen meddyginiaeth.’
  • Dylai'r heddlu a thimau iechyd meddwl gydweithio mewn timau blaenoriaethu (neu triage) a dysgu swyddogaethau'r naill a'r llall.
  • Mae Eiriolaeth Iechyd Meddwl yn hanfodol.
  • Mae angen cryfhau hyfforddiant i heddlu yng nghyswllt gofid a gwrando.
  • Dylid defnyddio gofalwyr ac aelodau'r teulu bob amser gan fod ganddynt lawer o wybodaeth. Dylai defnyddwyr gwasanaeth a gofalwyr bob amser fod yn rhan o'r cynllunio a gwneud penderfyniadau.
  • Mae cydymdeimlad, parch ac urddas wrth ddelio â phobl i gyd yn hollbwysig
  • Mae tai a ffactorau cymdeithasol eraill yn bwysig iawn.
  • Mae'r system cyfiawnder troseddol yn amhriodol i bobl mewn gofid difrifol
  • Dylid ceisio cael atebion tymor hir yn hytrach na mesurau sy'n datrys pethau'n gyflym ond dros dro.
There were many recommendations from service users and carers that came out of the project, and here are some of them:
  • Statutory organisations need to know more about the good work of the voluntary sector.
  • Agencies need to work together to help the individual in need, rather than have a pre-defined solution based on a label, ie ‘schizophrenic- needs medication.’
  • Police and mental health teams should work together in triage teams and learn one another’s roles.
  • Mental Health Advocacy is crucial.
  • General training for police around distress and listening needs to be bolstered.
  • Carers and family members should always be utilised as they have a lot of knowledge. Service users and carers should always be involved in planning and decision making.
  • Sympathy, respect and dignity in dealing with people are all paramount.
  • Housing and other social factors are very important.
  • The criminal justice system is inappropriate for people in severe distress.
  • Long term solutions should be aimed at rather than quick-fix measures.
Mi wnes i helpu Anne Krayer wrth gyflwyno'r canfyddiadau hyn a chanfyddiadau eraill i grŵp yn cynnwys gweithwyr proffesiynol iechyd meddwl ac uwch swyddog yr heddlu'r wythnos ddiwethaf. I mi'n bersonol, os ewch chi â dim ond un peth o'r ymchwil hon, hynny fyddai ei bod yn hanfodol i'r holl bobl ac asiantau, yn cynnwys yr heddlu, grwpiau yn y sector iechyd, gofal cymdeithasol, tai a gwirfoddol, ddeall ei gilydd, a chyfathrebu'n gyson â'r naill a'r llall i ddatrys materion cymhleth iawn.

I assisted Anne Krayer in presenting these and other findings to a group consisting of mental health professionals and a senior police officer last week. For me personally, if you only take one thing from this research, it would be that it is vital for all of the people and agencies, including the police, health, social care, housing and voluntary sector groups to understand each other and to constantly communicate with one another to solve very complex issues.

Am fwy o wybodaeth, cysylltwch ag Anne Krayer ym Mhrifysgol Bangor: a.krayer@bangor.ac.uk

For further information please get in touch with Anne Krayer at Bangor University: a.krayer@bangor.ac.uk

Cyllidwyd yr ymchwil gan Lywodraeth Cymru trwy Ymchwil Iechyd a Gofal Cymru

The research was funded by the Welsh Government through Health and Care Research Wales

Monday, 1 February 2016

Positive Action for Change in Mental Health Services - Part 2

Last week I posted Part 1 of my report on this one-day conference which took place in November 2015 in Nottingham. It was organised by PCCS Books and looked at how services could try and break out of their medicalised approach to supporting people experiencing mental distress. Many of those in the packed audience worked professionally in psychology or psychiatry departments, and it was heartening to note their interest in the overriding theme and sense a real enthusiasm to drive some of these approaches forward in their own teams.

Clinical Psychologist Lucy Johnstone, and Professor Peter Beresford, had spoken passionately about their work in the morning session. This week I cover talks given by the two afternoon keynote speakers, Professor Sami Timimi and author and educator Pete Sanders. I will also touch on the work of organisations like the Soteria Network who attended to spread the word about their developing and ground-breaking work across the UK.

Sami Timimi – Beyond diagnosis: developing an outcome-orientated approach

Sami is the Visiting Professor of Child and Adolescent Psychiatry at the University of Lincoln. He began by focussing on the genuine issue that, despite the growing spend on mental health services on both sides of the Atlantic, there is a corresponding increase in the number of people classified with severe/enduring mental health illnesses.

He went on to describe the commodification of mental distress. Whilst large pharmaceutical companies are frequently attacked for profiteering from “disease” and “mental illness” through their growing sales of medications, Sami pointed out that psychotherapies are equally as vulnerable to this kind of criticism. Brands of psychotherapy compete, claiming they are the best option for a particular problem – producing associated books, courses, conferences and programmes. In this capitalist world of mental health people’s unhappiness is exploited for profit – even during a recession there is no dent in the profit margin of major pharmaceutical companies.

So, what did Sami advocate in these depressing circumstances? He spoke about differentiating between the relationship and the technique used when supporting a patient. If the relationship is primary, the technical aspects have to be slave to the relationship. So… if one patient who is depressed wants Cognitive Behavioural Therapy, the next, though reporting similar symptoms, may want to talk about what happens to them when they experience domestic violence, for example. “Treat each person on their merits – it is harder to turn (treatment) into a commodity as each person has a unique story and a unique model of change.” Sami calls this approach – Outcomes Orientated Approaches to Mental Health Services, and went on to describe in detail how it works in practice in his team’s service provision. This approach “is better at not creating chronic patients. Patients are leaving us.”

Sami closed by imploring people to go to commissioners with evidence of working in a different way – and showing that outcomes can be better. He believes that change really can be influenced at that level.

Pete Sanders – If therapy could be part of positive action for change, what sort of therapy would it be?

Pete is the co-founder of PCCS Books, and has over 30 years’ experience practising as a mental health nurse, counsellor and educator. He introduced his “unbalanced presentation” with a large dose of humour, warning the audience that he wanted it to be a “rude slap in the face for all helping professions!” If there is one thing I took from his talk, and there was no joking intended here: it is the importance of genuine human kindness – of just being nice. As he said - “do not act like an ‘expert’, be your real self as a helper; fallible, vulnerable, imperfect, not knowing any of the answers.”

He asked us what kind of therapy we would want – one “that pretends to provide a systematised treatment, but is really a placebo?” And shared three separate scenarios with mental distress at their heart and asked “what would you do?” Some of the suggestions were basically the actions of a kind-hearted friend or colleague. How many qualifications do you actually need to take someone for a drink after work? To sit and listen to them talk? Pete said that professionals had conned everyone that caring for others is more complicated than it actually is!

“There is no statutory service of natural kindness… Only a proper expert can interpret this chaos and mend the broken brain.”

In 1974, when Pete was a trainee counsellor, there were only five counselling courses in the country, yet now you can “fall over them on the way to the bus stop!” He supports a person-centred approach and is against the medical model.

Pete left us with 11 pointers for “Therapy for positive action for change…” and because I know you can read the whole presentation I shall just quote the one which particularly resonated with me on the day: “therapy that…. understands that the primary healing force is the client themselves, not the person or techniques of the therapist”.

Also attending the conference were various organisations who are working with what we call in our team the “beyond medical” approach.

Soteria Network

Margaret Turner, Secretary of the Soteria Network
The Soteria Network is: “A network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing 'psychosis' or extreme states. We are part of an international movement of service users, survivors, activists, carers and professionals fighting for more humane, non-coercive mental health services.”

British Association for Person-Centred Approach

Bernard Mooney and Sara Callen of the
British Association for Person-Centred Approach
The British Association for the Person-Centred Approach (BAPCA) is: “An organisation that embraces and promotes the person-centred way-of-being: the striving to create relationships based in genuine acceptance and empathic understanding.”

Critical Mental Health Nursing Network

The Critical Mental Health Nursing Network is: “A network of mental health nurses and others who want to think critically about mental health nursing and related issues.”

Working to Recovery

Working to Recovery are “world renowned for their innovative Recovery based practice, training, writing and service designs, working across the world”.

You can find out more about the conference speakers and link to their presentations on the PCCS Books website.

What do you think about these ideas and approaches? Let us know in the comments box below.