Tuesday, 4 April 2017

LGBTQ+ - setting up a new Powys group

This week's guest author introduces himself:

My name is Shaun and I am a volunteer at Mid Powys Mind.

I should start by saying that LGBTQ+ (Lesbian, Gay, Bisexual, Transgendered, Questing) is not a mental health condition although it has a huge impact on mental health. Before we decided to have a LGBTQ+ peer support group I read an article that said 70% of people who identify as trans will contemplate suicide, members of the LGBTQ+ community are twice as likely to developed a mental health condition and LGBTQ+ youths are twice as likely to attempt suicide. The reasons for this are isolation, homophobia, biphobia, transphobia and ignorance.

As an openly gay man, who has a diagnosis of borderline personality disorder, this didn't shock me as much as as it should have. What shocked me was how little support there is in Powys; although Powys is the largest county in Wales it doesn't even have a sexual health clinic.

Mid Powys Mind's Wellbeing Coordinator asked me if I wanted to organise and run a LGBTQ+ peer support group and I jumped at the chance. I started by researching and soon found that there were far more sexuality and gender identities than I was aware of. I think it must be so confusing these days for LGBTQ+ youths, coming to terms with their sexuality/gender. We spoke about whether we need to add the Q. Some places will say that Q stands for queer, but I'm now aware that some find this offensive - for a long time queer was used as an insult and although a lot of LGBTQ+ have reclaimed the word queer, if asked I say the Q is for questioning. I have also been taken back how many times I have had to explain what LGBTQ+ stood for, I assumed everyone knew, maybe that is because I am the G in LGBTQ+.

Other things came up that I hadn't thought of since being a teenager. Mainly “coming out” and how we come out as a teenager and think that is it, but the truth is we “come out” through out our lives, friendships, work, socially... there is always that moment when someone says: "Do you have a girlfriend?"

Going around Llandrindod and asking strangers if they would put up a poster to advertise the LGBTQ+ group I was more or less “coming out” in every place I visited. In the back of my mind the same insecurities that plagued me as a teenager came back.... Is this the time I will have to face a negative reaction? And a certain amount of shame. If I feel this way as a confident middle-aged gay man, imagine how a teenager or someone who has low self-confidence may feel?

The group meets on the last Tuesday of each month (5pm - 7pm) in the basement at Mid Powys Mind's Wellbeing Centre in Llandrindod Wells. It is a small, diverse and friendly group. We have guest speakers: so far we have had someone from the Terence Higgins Trust and the Dyfed Powys Police LGBTQ+ Liaison Officer. Future plans for the group include arranging a social evening, a session to raise awareness, trips to the Pride festival and discussions to secure funding.

Anne Woods, one of the PAVO mental health team’s Participation Officers, has been attending the group.

Anne says, “I think it’s very important to be able to get together with people who share similar experiences, especially when we have something in common that can set us apart from others. Although I’ve not experienced much overt prejudice since moving to Powys, I have noticed some and I think it’s vital to have a safe place where we can explore issues around gender and sexuality with people who understand.

As part of the Comic Relief funded project I’m running, we have an opportunity to link up with the Iris Prize community outreach team to produce a short film about issues affecting people from the LGBTQ+ community in Powys and members of the group will be taking part. I would encourage anyone to contact me if they would be interested in taking part.”

For more information about the LGBTQ+ monthly group call Mid Powys Mind on 01597 824411, or email: vo@midpowysmind.org.uk

You might be interested in these links...

Anne Woods wrote about taking part in the 2016 Pride event in London in Taking Pride in Diversity.

At the start of LGBT History Month in February 2017, Sarah Carr, Associate Professor of Mental Health Research at Middlesex University, wrote "Queer in the head"? Do LGB people in the UK have poorer mental health?

Monday, 27 March 2017

When I grow up

by Suzanne Iuppa, Community Connector  Llanidloes (2nd from left)*

I grow old … I grow old … 
I shall wear the bottoms of my trousers rolled. 
Shall I part my hair behind? Do I dare to eat a peach? 
I shall wear white flannel trousers, and walk upon the beach.

The Love Song of J. Alfred Prufrock, by T.S. Eliot

What do you want your older age to feel like, sound like, look like?

I’ve spent much time thinking about this on my long drives working around the very beautiful countryside of Powys. I’ve worked for Powys Association of Voluntary Organisations (PAVO) now for six months as a Community Connector, linking older people in the county with services to improve their health and wellbeing. 

I moved here from Flintshire in September 2016, where I lived for 25 years and raised all three of my children as a single mother. My boys now live in the four corners of the planet and we joke (well, it is my favourite fantasy) that when I get older I will wing in with my Mary Poppins umbrella, all sprightly and fun, right when my beloved daughters-in-law can’t face another meal prep or load of washing, to look after my many grandchildren in turn, in different countries. My loving offspring will have a very small but beautiful granny flat in each of their houses for me to make magic in during my regular, seasonal visits. When I am not on Nainey duty I will be in my stunning but tiny (ie: low maintenance) cottage with the view at the edge of the Snowdonia National Park. I’ll have dinner parties, write stories, make crafts, feed the birds, and still make the long walks to the pub or garden centre. Or perhaps even take my trusty bike. I’ll thrive. I’ll be happy.

That’s if: if in future I’ll be able to travel easily to see my family, if I develop no long-term health conditions which sap my energy, if my children do indeed have children, and if my daughters-in-law will want my help on a regular basis.

I’m good at being flexible, but, with my family living at a distance and most of my friends being a good ten or fifteen years older than me (I was a young Mum, and my friends and I raised our children together) chances are, if my fantasy does not play out, my older age could be at risk of feeling lonely. In Powys there are plenty of places like my village, small tight-knit rural communities where children are living at a distance from parents and many people are of an aging population, all developing complex health problems as their age advances, in tandem. We might all want to be social! But for one reason or other, it may be hard to do. 

I help many people in Powys whose friends are not able to assist and whose family are not present, by linking them to befriending groups or ‘good neighbour’ schemes. It’s very important these schemes are well supported with funding and volunteers. Because — loneliness is not a condition we want to allow in our communities. The Older People's Commissioner for Wales, Sarah Rochira says: "Loneliness is a major Public Health problem here in Wales. We can all help — one day it could be us."

Loneliness has an effect on mortality that is similar to that of cigarette smoking. It is associated with poor mental health and conditions such as cardiovascular disease, hypertension and dementia.

Loneliness has a much wider Public Health impact too: it is associated with a number of negative health outcomes including mortality, morbidity, depression and suicide, as well as increased health service use.

Most of my work is centered around helping people feel listened to, and responding to people’s individual needs, particularly older people living with a sensory loss, cognitive impairment or dementia, those who are carers or who have mobility issues. It seems in Powys these older people are most socially isolated. In addition, the people I have worked with have reported:

  • Loss of trusted relationships.
  • Loss of privacy and dignity.
  • Being a full-time carer with little social mobility.
  • Poor access to a car or public transport.
  • Not being able to run a home by oneself anymore.
The answer is not the NHS to any of these problems; either primary or secondary care. But… quite often that is where lonely older people end up. If we think of primary healthcare, we can also think of primary health and social services for older people. These should be first in line for funding and support for to prevent hospitalisation. These are: appropriate housing (including residential and nursing care) day centres, personal care, befriending, community transport, practical services such as shopping, cleaning and gardening, and social links.

We need to listen better to older people’s life stories and their wishes to create an enabling environment for all, so we can work together to provide the primary social services. Understanding the sense of loss would be a start. Veronica Jarman, day hospital sister at Llanidloes Day Hospital and a Wales Nurse of the Year, explains: "It’s grief — loss of partner, social position, income, friends… the grief can be overwhelming."

Active and reflective listening are keys skills in grief therapy, and could be an early response to people asking for help with loneliness, before accessing NHS services at a crisis moment.

The Royal College of Speech and Language Therapists, for example, has emphasized the link between the ability to communicate clearly with an individual’s ability to make informed decisions, to access services, enjoy their rights and overall, the dignity and respect that they experience.

Of course the older people in our society have lived through unprecedented change. For all the developments in communications and technology, the needs at the start and end of life are still best met through personal interactions. 

Our society is ageist — the only people really admired and in the driving seat in our society are from age 25 
 60 years. Like puberty, older age is a time of radical transformation for many; complete change. Whereas in previous societies elders had specific roles as guides, healers, mediators, correspondents, even dispute resolution specialists, because their amassed life experience was held in great esteem, now we tend to disrobe older people of roles and responsibility, in our families and in society generally. I’ve no doubt this disengagement has an effect on cognitive function. What would happen if we were able to advertise for older people to fill specialist roles in our community  designers, garden and horticulture, childcare, farming practices with wildlife conservation, flood prevention, town planning, holistic healing, dance events, history projects, clothes manufacture, community transport, language classes? What if people 65 years+ were the only ones to fit the bill, because of their wealth of experience, their time and their care?

Perhaps the Nainey duties and the dinner parties could keep me at the top of my game, for longer. I’m joining some craft guilds just in case — oh and my local town choir! I’ve even started an online course in herbal medicine. Still, I wonder if my daughters-in-law will be able to recommend a really good hairdresser in each country? I hope so!

To contact Suzanne for further information about her work as a Community Connector, please email suzanne.iuppa@pavo.org.uk or ring 01597 828649.

* The photograph also features (L-R) Carla Rosenthal — Community Connector in Knighton, and Melissa Townsend  Volunteer Officer PAVO.

Monday, 20 March 2017

Therapeutic gardening in Machynlleth

At the start of a new gardening year we talk to Kate Doubleday, Garden Volunteer Co-ordinator at Gerddi Bro Dyfi Gardens in North Powys. Kate tells us more about this therapeutic open space for people which is also beneficial to local wildlife.

What is the aim of the project?

Gerddi Bro Ddyfi is an organic wildlife community garden in the heart of Machynlleth. It is a people-led project, where the volunteers can choose their own activity. The aim is to create a nurturing, peaceful environment where everyone can feel supported and gain a sense of belonging. Our volunteer days are on Tuesdays and Thursdays between 10.30am - 4pm. We provide refreshments and have a volunteer shelter where people can take refuge in the rain. Throughout the year we also offer a range of one day activity workshops in scything, willow weaving, bird watching, and green woodworking for example.

Tell us more about your role at Gerddi Bro Ddyfi Gardens?

My role is mainly to facilitate a group of volunteers to enjoy and explore the garden. I work with a dedicated volunteer committee, and none of it would happen without their efforts.

My role is multi-faceted, and I go from gardening with the volunteers to liaising with Community Psychiatric Nurses to sitting in fundraising meetings.

I also work with the community nursery group doing wild play and environmental education with Early Years, and I’ve worked with youth clubs, doing outdoor work and graffiti projects with young people. The youth club was instrumental in the design aspect of the garden in the early days.

How long have you worked there and what drew you to the role?

I’ve worked at the gardens since 2008. Myself and a colleague, Leigh Munton, had both previously worked in therapeutic gardening roles and saw a need for this in Machynlleth. We ran short horticultural courses in the community and realised that when people had finished these one-off courses there was no way for people to carry on gardening in a social way.

Having worked at the Martineau Gardens in Birmingham previously I’d seen the value of a permanent therapeutic garden and how much this can provide a community. I’d experienced the incredible power gardening has on our wellbeing.

Tell us about the volunteers at the gardens

They’re fantastic! The garden wouldn’t be what it is without our volunteers, both on the ground and on the committee. We have a dedicated core group, who are all ages and from a variety of backgrounds, who turn up whatever the weather and maintain the garden for the community. Some of them have been coming for years.

What kind of work do they get involved with?

We do a range of activities, from weeding to woodwork, to planting flowers to attract wildlife to maintaining the vegetable beds.

How does a typical day pan out?

The day always starts with a cup of tea and a catch-up, and often some cake too! There’s usually a list of things that need doing, and this depends very much on the season, but people lead their own activities, and they can do as little or as much as they want. You can work alone or in a team – people have their own preferences.

Things always get exciting when we’re preparing for an event. It’s good to have something to work towards.

Who can volunteer to join the project?

Gerddi Bro Ddyfi is open to anyone from the community. We have good wheelchair access and hope to be as inclusive as possible. We’re particularly open to people who may feel excluded or who are having challenging life experiences.

What kind of support do you offer to the volunteers?

I see myself as a facilitator to help people come together in a beautiful space to socialise and connect with one another, and with nature. I aim to always provide a listening ear too. In some cases I signpost people to receive further support.

How does volunteering in a garden environment impact on people’s mental health?

Research shows that the act of looking after plants, as well as being active outdoors, is beneficial for a person’s mental health.

Horticulture as a therapy differs from other therapies in that it works with living entities which have their own needs and requirements. Through nurturing these entities, people become involved in something outside of themselves and this process can help them feel less isolated and more connected with the social and natural world, as well as developing a sense of pride and accomplishment.

Volunteers also interact with visitors from the community and this is clearly beneficial for their confidence, especially if they feel stigmatised.

Tell us how your work fits in with other voluntary sector groups

We work closely with the volunteer bureau, Community Action Machynlleth & District (CAMAD), also based in Machynlleth, which often sends volunteers our way. We’ve recently been building bridges with Ponthafren Association in Newtown, and we’ve done joint events with Edible Mach, Bro Ddyfi Advice Centre, and Mid Wales Housing, under the banner Bwyd Dyfi Partnership.

What are the main challenges of your role?

Fundraising, without a doubt, is the biggest challenge. It’s very difficult to raise funds alongside the work I do on the ground, and obviously with austerity policies things are getting harder. Working with volunteers is extremely rewarding, although sometimes it’s challenging, and I’m learning all the time.

Tell us about some of the most rewarding work you have done at the Gardens

I’ve found it very rewarding to be involved in providing access for people with physical disabilities, enabling them to garden and to take pleasure from outdoor work. The greatest reward is to see the volunteers connecting and growing to support one another, so that my role becomes marginal. Some of them become very close friends. Also it makes me happy to see volunteers go on to find jobs afterwards, with greater confidence, having used the gardens as a stepping stone. Having been a volunteer myself in Birmingham during a difficult time in my life, it gives me pleasure to be able to give something back.

If you would like to get involved at Gerddi Bro Ddyfi Gardens contact Kate on 07941 908 891 or check out the website.

Monday, 6 March 2017

Horsing Around Project

A Horsing Around Project volunteer with a Lluest pony
Previous posts on this blog have featured some of the innovative projects run by West Wales Action for Mental Health, including Tonic – surfing for mental health and Spirituality and Recovery in mental health.

This week our guest author is Marie Rocke, a Mental Health Development Worker at WWAMH. Recently Marie has been working very closely with an animal charity in the Brecon Beacons in Carmarthenshire called Lluest (“Haven” in Welsh). Lluest set up the Horsing Around Project with funding from the Big Lottery Fund and support from WWAMH. Marie tells us more about the project.

It is a well-known fact that Animal Assisted Therapy can support many people to gain confidence, become more self aware and to generally get more out of life. This kind of therapy, especially Equine Therapy, has proven its success repeatedly in supporting individuals on the road to Recovery.

Lluest Horse and Pony Trust, in collaboration with WWAMH, is offering 'Lluest’s Horsing Around Project' to provide Equine based learning for individuals living with mental health problems in Carmarthenshire. The courses are free for participants, and travel costs are covered by the project which is fully funded by the Big Lottery Fund. This is a pilot project incorporating training of staff from both organisations to allow them to collaboratively run future courses over the next few years to create a legacy.

The courses consist of horse care, so participants learn about grooming and mucking out and progress onto horse-watching to learn about body language and horse communication. There is then the opportunity to play games with the ponies, to improve the confidence of the attendee. Games include navigating around an obstacle course within the manège (the enclosed area where horses are trained) and end with games at liberty with the ponies. There is no riding at any point. The courses have been running very successfully for the past 12 months. The last day will run in March and is fully booked. Participants were accompanied by their Occupational Therapists or Community Psychiatrist Nurses in some cases.

Lluest is experienced in providing sessions on Horse and Pony Care and has been doing so for around three years. The staff are trained and well versed and many a young person has learnt what it really entails to keep a horse or pony – before they buy or loan an animal. This is all part of Lluest’s education drive to prevent horses and ponies being abandoned or neglected. We are hopeful that this work will continue at Lluest for the benefit of the attendees and the horses that they support.

What the WWAMH Director and Development Worker say

Lluest staff have had great success in providing training for individuals who wish to know more about Horse and Pony Care. They now wish to extend and offer this course to those individuals living with mental health problems who would normally not find this kind of training accessible for a number of reasons, be that confidence, finances or transport.

Many individuals living with mental health conditions find it hard to attend new and unfamiliar groups unless these are recommended by a trusted advisory service. Also, social isolation, lack of confidence and low self-esteem all inhibit these individuals from gaining valuable experiences, training and positive collaborations which would assist them in reaching their own personal goals.

Lluest wishes to overcome these barriers and believes that by working in collaboration with the West Wales Action for Mental Health, and by having access to the wide variety of groups currently supporting those with mental health problems, that these courses and educational horse and pony experiences, can be widely available to those who may benefit from them the most.

We are proud to be working with Lluest and hope to run many more courses collaboratively in the future.

Angie Darlington - Director of WWAMH
Marie Rocke - Mental Health Development Worker

If you require further information, or live in Carmarthenshire and wish to attend a Horsing Around Day, please contact Lluest on 01550 740661.

And if you live in Powys – do you think a similar project would work well here? Let us know in the comments box below.

Monday, 27 February 2017

What do people ask the Powys Mental Health Information Service?

Recently I was tasked with looking at our stats to identify some of the most common enquiries we receive at our Mental Health Information Service. I thought it would be interesting to share my findings with a wider audience. I’ll also provide some typical responses to the queries and who knows, there may actually be an answer to a question that a reader has wanted to ask for ages!

Enquiries come in to our service via telephone, email or in person – and from absolutely anybody with an interest in mental health in Powys. We also receive a lot of enquiries from people outside Powys surprisingly, but these usually relate to services available within Powys, and are made because Powys residents are currently living away from home, for whatever reason, but still have links with providers of the health services in Powys or family and friends here.

Sometimes we are asked a question which totally throws us – and then in our team we have to don our private eye deerstalker caps and do a little bit of investigative work. But those unusual and often intriguing topics are really probably the subject of another post!

So, without further ado, here are some of our most common enquiries:

I’m concerned about the mental health of a close family member. What should I do?

Whether a mother, sister, son or nephew – or any other relative for that matter – spotting that a close family member is struggling can be upsetting and hard. What can you do to help? The person concerned may not be ready to accept help. They may have received support in the past, recovered and now relapsed. They may already have put mechanisms in place to help themselves, or they may be really struggling and crying out for help in all kinds of ways.

One thing is sure. Families are all different and relationships within any of them can be complex. No two enquiries about families will ever be the same, but there are many common themes:
Where can I find counselling in Powys?

That there are long waiting lists for talking therapies in all parts of Wales is generally well known, but people still need to talk and will go to great lengths to investigate all the options. One of our guest authors wrote Finally receiving treatment – a personal view which documents one journey. We were being asked so often about alternative options that we decided to set up a webpage dedicated just to this – How to find talking therapy or counselling in Powys. Here you can find links to the charities locally offering counselling, plus an extensive list of counselling directories – everything from the Buddhists’ Therapy Database to the Hynotherapy Directory.

I think I need a mental health advocate – what do they do and how do I find one?

If an individual in contact with mental health services feels they’re receiving the wrong treatment, or wants someone to support them at a meeting or tribunal, for example, then they may be eligible for free support from an independent mental health advocate.

Advocacy is all about taking action to help people say what they want, secure their rights and obtain the services that they need. Mental health advocacy in Powys is available to:
  • Those residents who are currently inpatients on a mental health hospital ward. That could be within Powys (Felindre Ward at Bronllys Hospital) or in another county (for example, North Powys residents may be at the Redwoods Centre in Shrewsbury in England). This service is provided by Conwy & Denbighshire Mental Health Advocacy Service. Don’t be put off by their service name – CADMHAS do cover Powys!
  • People in contact with what are known as “secondary” mental health services, so they live in their community but receive support from, for example, a community psychiatric nurse or psychiatrist. There are advocates in the North and South of the county provided by the Powys Independent Mental Health Advocacy Service who can support them.
I’m moving to Powys soon and need mental health support (or my family member does)

Moving is one of the most stressful things we do, so combine that with pre-existing mental distress and understandably people are keen to find out what they can do to make the move easier.
Can you tell me the contact details for the Powys Community Mental Health Team

And to round off this post, one of our all-time top asks! How do you find your local CMHT? Especially when there are five different teams covering this enormous county which is Powys, not just one?

If you didn’t already know, the five teams are based in Welshpool, Newtown, Llandrindod Wells, Brecon and Ystradgynlais.

And the best way to find each CMHT’s contact details is by checking out our webpage Getting help and support in Powys.

And that's the end of this round up of some of our top questions! If you have a question for our Information Service which isn't answered in this blog post, then please get in touch by ringing 01686 628300 or 01597 822191 or email: mailto:mentalhealth@pavo.org.uk 

PS: We have our deerstalker caps at the ready!

Thursday, 16 February 2017

Sharing power in the planning and reviewing of services

Last Thursday I attended this training event at our Llandrindod office run by two Participation Officer colleagues – Carla Rosenthal and Carol Hay. As one of the attendees reported later it was “interactive, engaging and full of useful content”.

The session was arranged specifically for people who want to become citizen representatives (and a couple who already are). It is key to our work in the mental health team, and specifically for our Comic Relief funded project Stand up! for emotional health and wellbeing, that reps are recruited and well trained. Citizen reps volunteer their time, energy and passion to make a difference for others and to the services we receive, and are helping influence change at local, regional and national levels. We wrote about the achievements of mental health reps Rhydian Parry and Jan Rogers on this blog in Powys voices count at the top a couple of years ago.

This training session brought together two groups of individuals – those interested in sitting on the Powys Mental Health Planning & Development Partnership and a second cohort who recently started sitting round the table of the Health & Social Care Regional Partnership Board. Their ages and backgrounds were quite varied, with experience of mental health nursing, the Royal Air Force, specific health diagnoses and carers’ views all brought to the session. The module was based on a training package that was co-produced by mental health team volunteers and Participation Cymru, reflecting on the experiences of people who were interacting and engaging with organisations to shape mental health services.

It isn’t possible to cover the entire session in one blog post, so I’ll highlight a couple of areas and also focus on the points made by the two guest speakers, Sue Hughes – Coordinator Regional Partnership Board at Powys County Council, and Louisa Kerr – Mental Health Partnership Manager at Powys Teaching Health Board.

It was fascinating to hear at the start of the day what people thought about the title of the training, and in particular what “sharing power” meant to them. One of the reps’ responsibilities is to attend meetings with service providers, either locally or nationally (or both) and feedback grassroots opinions about current services. Comments included:

  • You will be listened to.
  • To be working alongside people as equal partners.
  • To be part of the process.
  • Using personal knowledge and experience to shape services.
  • Sharing with other people what I have learnt.
  • Being a team player.
Carla and Carol spoke about the importance of first impressions, being prepared and planning well, and emphasised that reps are representing other people – not just themselves and their own views – when sitting on the boards. “It is key to know who you represent, what is important to that group, and the key messages you want partner organisations to hear”. 

There was an interesting discussion about how it felt to sit around the table as a 'service user'. Whilst acknowledging that they brought a valid experience and were viewed as an equal some felt it put them on the back foot. Language, it was agreed, is extremely important. Some people felt comfortable being described as ‘experts’, whilst others said it was difficult being called ‘a carer’: “I’m a Mum. You’re given a label and boxed somehow. I find that really hard. People have masses more to bring other than being a service user.”

Sue and Louisa both emphasised that when individuals express their views passionately they are as important as anyone around the table. Sometimes we can box things in our own minds when actually we are being valued by everyone else there. “Everybody’s the same. There is no distinction between workers, volunteers and individuals. It’s about people coming together to talk informally. Collectively we are experts."

Carla and Carol went on to highlight the importance of researching partner organisations before attending meetings, and then we looked at “facts and assumptions”. “If I see a policewoman I might feel anxious. Guilty. Worried that she might arrest me. But that is an assumption. The only fact is that she is a policewoman, and I have to leave behind all the assumptions or I’ll be a nervous wreck.”

Sue then gave us a brief background to the Social Services & Wellbeing (Wales) Act which sets out the requirements for the Health & Social Care Regional Partnership Boards. Legally it is a requirement for citizens to sit on the boards. There is a need for people to work differently – for culture change – as the Act is all about the citizen’s voice. "We all need to challenge officers working in services to make sure they have involved citizens, but also to give praise where it is warranted".

Sue also spoke about how to use effective questioning at meetings. “Officers don’t encourage passivity as we won’t then have the opportunity to improve things. If you don’t understand a presentation as it’s not in lay language then it doesn’t comply with the Act. It has to be easily understandable language. You can raise this nicely – but the officers need to know.”

Louisa then provided us with an introduction to the Powys Mental Health Planning and Development Partnership Board which has been meeting for 2 years now. Mental health is governed by different legislation to Health & Social Care, so we look to the Mental Health Measure (Wales) for guidance, but there is much crossover. We learnt more about the various subgroups of the PMHPDP, including Engage to Change (looking at issues raised at the Stand up! for emotional health & wellbeing meetings), Performance, a Mental Health Officers’ Group and S136 Criminal Justice. Louisa recalled the first meeting of the board she attended where citizen reps Kate, Meriel and Rhydian spoke. “It was profound, and changed the dynamic of the meeting. Everyone was listening. That is the most important thing.”

By the afternoon we moved on to sessions on assertiveness, getting the most out of a meeting, and the support that Powys Association of Voluntary Organisations can provide to people. There were some intriguing slides on the nature of power, and specifically the 3 Faces of Power as described by Steven Lukes. And finally there were a few tips on building self-confidence – which can help us all in all areas of our lives. 

All in all a thoroughly interesting day, and we managed to have a fair few laughs too as we introduced ourselves early on in fictional roles as “superheroes, tooth fairies, aliens, scarecrows and witches”! 

Would you be interested in joining these citizen reps to take grass-root views and opinions to local board meetings where service providers can find out what is working and what needs to change? For further information about becoming a citizen rep in Powys, in the field of mental health or health and social care, just get in touch with us by emailing mentalhealth@pavo.org.uk or ringing 01597 822191.

Thursday, 9 February 2017

No such thing as a free lunch? A review of a Review Check


by Carla Rosenthal, Participation Officer

and the PAVO Mental Health team

“No thank you, I do not want to spend six days doing a ‘Vanguard Method System Review Check’ that I know nothing about,” was the common response when I was tasked with the job of organising this event back in March 2016.

“But the results could be used to directly influence housing and mental health services in Powys!” I would counteract when confronted with such replies.

“Great! Tell me what I have to do and I’ll give up six days in my extremely busy working life to come along.”

“Uuuummmm, I’m not quite sure what happens but you have to turn up in Llandrindod, then go to either Welshpool or Brecon, do something there, then come back to Lland’od and it will all make sense.”

“Expenses paid.”
“Lunch provided - every day.”

Eventually, in November last year, individuals working in Third Sector mental health organisations came along to participate in the now legendary, Vanguard Method System Review Check. All I can say is, if you missed it, you missed a goody and despite no-one really knowing what it was all about to start with, by the end of the process, thinking had changed, systems had been unpicked, harrowing tales re-told and sceptical participants left feeling enlightened and in some cases, enriched.

In a nutshell, two teams of 4 - 6 individuals spoke to people we knew in and around Welshpool and Brecon about their experiences of emotional ill health. We examined their contacts with both statutory and voluntary services and found out what had been beneficial and empowering and what had been a waste of time or caused additional distress. The ongoing work was collected on lots and lots of large pieces of paper and got stuck on every available wall in the PAVO offices (white tack only!) then the findings from both teams were collated and clear and simple messages were pulled out.

It came as no surprise to discover that (amongst other things) people across Powys were frustrated by long waiting lists for psychological therapies and fed up with re-telling their story numerous times to a variety of professionals. However, it also became clear that the help, support and advice offered by the likes of MIND and Ponthafren was invaluable and in some cases, life saving.

The six day exercise meant that assumptions weren’t simply what we had heard over the years but provided definitive hard evidence to show service providers who may wish to look at where improvements could be made. The learning that Third Sector providers took away should ensure continuation of people-centred services and a commitment to delivering what matters to those who need it, being at the heart of their service provision - all done without having to spend any extra money.

Following on from the Review Check experience, I tend to question things more and find myself asking, “Why am I doing this? What is the point? Where is the benefit? Could this be done differently or more efficiently?” It’s not a bad way to approach things but sometimes, change needs to come about slowly and not everyone will query things in the same way. Maybe they need the opportunity to go on a Vanguard Method System Review Check . . . ? They might even get a free lunch.


NB: After submitting this blog post, Jackie pointed out that she still didn’t know exactly what the Review Check was all about, so in answer to her questions, please see below:

Why was the Review Check done in the first place?

Information given by Adrian Jones, Supported Housing Manager at Powys County Council:

“At its meeting on 6 January 2016, the Supporting People* Management Board decided to fund an intervention into the housing related support needed for people with mental health issues to live independently in the community with as high a quality of life as possible. The scope of the project was to cover North Powys and South Powys for any person of adult age with mental health issues. The costs of the project would cover the engagement of an external facilitator to use the Vanguard Method of Check and to cover the costs of involvement of staff and volunteers of third sector agencies specialising in mental health, none of whom are (currently) funded by Supporting People.”

* The Supporting People Programme provides the framework by which housing related support services are commissioned and funded within Wales.

Where did Housing fit into all this?

“Housing Related Support plays a key role in the system of early intervention and prevention, which is now being developed through locality-based response by the Council as part of its implementation of the terms of the Social Services and Well-being Act (Wales) 2014. From the point of view of Supporting People, the project was one of co-production to learn about the end-to-end experience of people with mental health issues when they ask for help and to establish a way of working to promote well-being in the lives of people and do the things that matter to people, as is now the requirement by law under the terms of the Act.”

What exactly is the Vanguard Method System Review Check?

Taken from Vanguard Consulting website:

In order to move organisations from a command and control to a systems thinking logic, Vanguard developed a version of Deming/Shewhart’s ‘Plan-Do-Check-Act’ cycle (Deming 1982 p88), with the emphasis on confronting managers starkly with the failings of the current system by starting at ‘Check’.

The first part of check provides a sound understanding of a system as it is and identifies waste and the causes of waste.

‘Check’ asks:

  • What, in reality, is the purpose of this system?
  • What is the nature of customer demand?
  • What is the system achieving?
  • How does the work flow?
  • What is value work and what is waste?
  • Why does the system behave like this?

Can you give some examples of some of the exercises you carried out.

Most of the time was spent talking to people who have had experience of the mental health system and use the services provided by statutory bodies and those provided by organisations such as Gwalia Housing Support, MIND groups or Ponthafren. We would ask them questions such as, “What matters to you? What does a good day look like? What would make your life better?” We then went on to map their flow through the system.

Give an example of something that was unpicked in a system currently used.

An example would be looking at someone’s journey from when they had first gone to see a GP about a mental health issue, to being referred to a psychiatrist for an assessment. Usually, drugs are prescribed and appropriate therapy might be offered. However, the waiting list for psychological therapies is unacceptably long.

What were some of the simple and clear messages that were revealed that we didn't know before?

Most things are common knowledge, but the evidence collected showed that people do not want to be passed from pillar to post, telling their story time and time again to others who take little or no notice. Waiting lists for talking therapies are off-putting, medication is often prescribed with no alternative offered and people want to be able to live their lives in the way they want to without being forced to conform to an unattainable ideal of ‘normal’.

What could change as a result of the Review Check?

One of the great things about this review check was the way that the third sector organisations got to grips with the process. We know that at least some of the groups involved are keen to have their own ‘check’ to make sure that they are really meeting people’s needs in the way that is best for those people.

It showed us how inter-linked everything is and how we can all support each other to make changes. It is certainly a challenge, but we know that at PAVO and in the wider third sector there is a lot of interest in working with statutory bodies to see how our learning can support this kind of thinking at a wider level in the mental health system. We are confident that there would be interest in this from the statutory services too, especially with the developing emphasis on prevention and early intervention. Everyone wants the system to work for people, the Vanguard Review Check process can show how very established systems can sometimes just keep doing what they just keep doing and that a fresh look can show where there are blockages and how to meet people’s needs more effectively, so that more people can be helped, often at lower cost too. 

What will happen now?

We will continue to support this process as an effective way of making changes that start with the people who use (or avoid) the services. Implementing change to deliver the right thing at the right time does need some careful consideration before real benefits can been made. It also needs everyone involved to be united towards the same goals and be willing to look at things with a fresh perspective.

Tuesday, 31 January 2017

Type 2 anorexia – my experience

This week's guest post is by a young person living in Mid Powys.

Perfectionistic, body dysmorphic, obsessive and depressive are accurate words to describe anorexia. Six months in a psychiatric hospital suffering from the disease has proved this beyond question. However, the experience also revealed to me two different manifestations of the disease - characterised by varying degrees of the traits above:

Type 1, where the sufferer has a severely distorted view of their body and therefore exercises and starves themselves in the pursuit of looking ‘normal’. This is what most people perceive anorexia to be about, but I (and others in hospital) didn’t identify fully with this and hence believe there’s a second type. 

Type 2, where an obsessive routine of eating and exercise develops in order to avoid irrational consequences despite perceiving oneself as normal (perhaps slightly overweight). Here, the consequences could revolve around any aspect of your life but mainly around weight gain where the goal is to be thin - better than normal. Hence, those who identify with the second type are likely more perfectionist, academic and hardworking. However, they’re probably more at risk (due to these underlying personality traits) as it’s probably more dangerous to act on self-perfection than on self-perception.

The obsessive, perfectionistic roots of type 2 affect many aspects of the disease making it clearly distinguishable from type 1. In type 2, food itself isn’t an issue, the calories are (hence half the hospital chose to have liquid supplements and the other half had food despite being equal in calorific intake). Exercise is also more of an issue in type 2 than type 1 as it becomes built into a rigid routine and must be done to relieve anxiety (as opposed to accelerate weight loss). Type 2 anorexics are also more likely to be deceptive and compete with other sufferers to be perfect in other people’s eyes rather than just in their own to become the ‘best’ anorexic they can be. In this respect access to online material and social media create a competitiveness which likely makes many people’s condition worse. Finally, in type 2, anorexia cannot be separated as an entity from the sufferer (hence getting to draw/name it isn’t effective despite working well for type 1 anorexics). This is because for them the disease takes advantage of their personality traits and becomes an extension of them.

We should use our understanding of each type of anorexia to personalise the otherwise universal treatment plans. Personalised medicine is a hot topic in modern medicine. Gene sequencing and editing has allowed us to choose the treatments which we know will work best on patients. Why not extend this to anorexia?

Of course, the line between the two groups is blurred, but there are many instances where placing me into one of these groups would’ve helped mine and other sufferers’ recovery. Catching it early will inevitably reduce the likelihood of the disease worsening but recognising when further intervention (from Child & Adolescent Mental Health Services to psychiatric hospitals) is necessary is just as important. Taking away the choice by involving professionals is often the only way people too far into the disease can recover and increase their weight enough to correct the depression and distorted thinking associated with anorexia. 

Also, the incentives for recovery are blocked by body image or compulsions for type 1 and 2 respectively. We could therefore target these blocks differently for each type. Classical conditioning is used to treat Obsessive Compulsive Disorder (OCD) and involves patients doing what it is that causes anxiety (or not doing it in the case of a ritual). After being in a better mentality to do so, I decided to try it. I went home over a weekend and didn’t sneak off and exercise at all. That weekend was the only time my weight dropped during my whole recovery. My anxieties were practically gone from this point onwards. 

Finally, the qualities associated with type 2 sufferers can be redirected from weight loss to something beneficial. For me, I became very academic which allowed me to preoccupy myself and give enough incentive to remain fully recovered. Incentive is the key to the cure. Access to mental health services is the key to prevention.

After sharing my thoughts on service provision I’d like to talk about what it’s like to have been a male anorexic. I imagine that you’ve pictured a female through reading this blog and hope that you’re somewhat surprised that the author, the sufferer, is male. I wasn’t at all surprised to be told I had anorexia - I knew about the disease and could tell things weren’t right especially after comments from almost everyone I knew expressing their concern. I have a female twin and understandably my mother has since admitted she was always conscious of the fact that she could become anorexic. These were probably unconscious thoughts felt by everyone around me - I wasn’t expected to become anorexic and hence I was allowed to get progressively worse without it crossing anyone’s mind. I’m sure that this allowed my mind set to change and my weight to drop enough that the anorexia had developed into something that couldn’t be solved without professional help.

Unfortunately, I was taken to the GP surgery twice and both times was told that my weight wasn’t low enough to cause major concern. I was, however, referred to CAMHS on the second occasion. To an anorexic this was like being told you’re not thin enough. Furthermore, the naivety of the doctors to accept all that I said (that I eat lunch and have snacks, only exercise every couple of days and am still sociable and happy) prevented them from assessing me on anything bar the weight-age percentile I was in.

As a boy my original motives were also different to those of girls. At 7 and a half stone, I was plump and had innocent comment from friends and family saying the same. I thought I should try and lose some weight and gain some muscle (as mentioned, the muscle gain I wanted was impossible for a 12 year old). I started with cutting out food and exercising more and liked the results so continued doing this to greater and greater extents. The weight loss and routine consumed me - I lost friends and my confidence, my work suffered, my hair began falling out, my skin flaked away, I was constantly cold and remember dreading the thought of standing or walking because of how faint they made me feel - this is certainly a mental and physical disease. 

Waiting almost a month for an appointment with CAMHS gave me the time to rapidly worsen. I was lucky to have an exceptional psychiatrist - the best of many I’ve had since. However, weekly appointments with her were of little benefit and my weight continued to drop. A paper cut in class one day caused me to faint and have a small seizure which prompted my removal from school and a two week bed rest. Another month of this saw little improvement - I didn’t want to get better. My family and I were becoming more and more depressed and with all of us finding life unbearable, I was taken to a psychiatric hospital where I was the only boy. 

By removing the choice of recovery, my weight rapidly gained and I began to see more clearly - food really is the ultimate medicine and choice is its antagonist. After six months I returned to school where everyone supported me through my last steps. It took almost a year of going at my own pace before simply wanting to be normal gave me the incentive to recover - I came off my meal plan, started socialising, working hard and enjoying life again. Once in the healthcare system being male didn’t affect anything, however - expect a man as you would a woman to develop an eating disorder and don’t shy away from talking to them about it. 

There’s a reason anorexia in males is becoming more common. Social media has recently become inundated with pictures and quotes encouraging men to love women with curves and promoting curves by redesigning children's characters (particularly Disney princesses and Barbie) to reflect more realistic figures. Unfortunately, there is no male equivalent. All I ever see are pictures of ripped and good-looking men, one even quoting “women like butts too”. This sends the message out that men must love overweight women but that men must have a knife-sharp jawline, a sculpted body and of course, a peachy bum to be considered equally attractive. Its reasons like this that Body Dysmorphic Disorder is becoming worryingly common especially in males. 

We need equality to favour all genders - encourage everyone to be happy with how they look as long it’s healthy. I’ve gained so much from my experiences and have helped many to overcome their problems but the horror of anorexia and how much of life it affects is only known by sufferers and their families. It’s not a route that social media should inadvertently encourage people to go down  - we’ve ensured this with women but I feel men are increasingly led along this path due to the lack of society expecting them to do so.

Postscript from our guest author:

On the last day of an eventful year, I need to say this. The expectation of men to be strong and brave - to be masculine - is quite literally killing people. It's this expectation that allowed me to fly under the radar when my mental health suffered and it's this expectation that has killed four silently suffering but definitely loved friends in the last month alone. We need to be so much more aware of the hurt that people around us are feeling and not hesitate to talk to them about it. It really can be just a few words, a quick check up or a smile that can break that depression and give someone reason to think about the future which is otherwise non existent in the mind of a depressive. Please, have a Happy New Year and make this your resolution so that in 2017, good people aren't hurt by their mental health.

Many thanks to our guest author for sharing his experiences of anorexia. There are several charities specialising in providing support for people with eating disorders. These include:

If you know of others, let us know in the comments box below.

Tuesday, 24 January 2017

To DBT or not to DBT? That was the question...

This was the intriguing title of one of the key presentations at the recent Powys Research, Therapies and Health Sciences Conference: Inspiration and Innovation to Drive Patient Centred Care. I attended the conference last November and subsequently wrote How is telehealth working in Mid Wales? The day was packed full of inspiring talks and workshops on all aspects of innovative health work and research going on in the county – do go this year if it’s on again and you get chance.

Anyway, Dr Kathryn Walters, Consultant Clinical Psychologist and Dr David Pyle, Associate Specialist Psychiatrist, told us all about a relatively new service that has been developed in South Powys, to deliver Dialectical Behaviour Therapy (DBT) for the first time in the county. They were joined by Richard, who has been through the programme in Powys and was able to tell us what it was like for him.

Dr Kathryn Walters
First things first. What exactly is DBT? Over to Kathryn and David: 

“DBT is a cognitive behavioural treatment that was originally developed in the United States to treat chronically suicidal individuals diagnosed with borderline personality disorder and is now recognised as the gold standard psychological treatment for clients with this diagnosis. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post traumatic stress disorder and eating disorders.” 

Apparently 20% of mental health inpatients have been diagnosed with BPD/ Emotionally Unstable Personality Disorder.

And so this is my next question: what is borderline personality disorder? 

We’re not very keen on psychiatric labels on this blog, but this one is used routinely by the mental health services in the UK, including here in Powys. Kathryn referred to the DSM V definition (the Diagnostic and Statistical Manual of the American Psychiatric Association) which is extremely detailed. There is a good description on the mental health charity Mind’s website, where people have also posted about what it feels like for them: “having BPD is like the emotional version of being a burn victim. Everything in the world hurts more than it seems to for everyone else and any 'thick skin' you are supposed to have just isn't there”. First thing on a Monday morning and probably most people would meet the criteria for BPD… but for those where difficulties continue and go on to become very extreme, and when people self harm often or attempt suicide, then they are very likely to come into contact with mental health services.

Kathryn explained more about the biosocial theory of BPD – that some people are born experiencing emotions more acutely, and have difficulties managing their emotions. This could be reinforced by the responses of family, friends and services, and ultimately it can be very difficult to change behaviours.

So, why DBT? Dialectics is about balancing opposites: balancing acceptance and change. It incorporates elements of mindfulness and radical acceptance, and helps people to accept the world as it is rather than battle against it. In other parts of the UK it had already been shown to be successful as a kind of “mental health gym” to improve the lives of people with a BPD diagnosis. A study in South West Wales where DBT is provided by Hywel Dda Health Board highlighted that financial savings could also be achieved. So, three years ago, in recognition of the fact that there was at that time no DBT service available to Powys residents, a bid was submitted to charitable funds to train six multi-disciplinary members of staff in order to set up a DBT service in South Powys.

Dr Kathryn Walters leads this team, which comprises Psychologists, Community Psychiatric Nurses (CPNs), an Occupational Therapist (OT) and a Psychiatrist. If, following assessment, someone is referred for a course of DBT they will join a rolling programme and be offered individual and group therapy, skills training, and phone consultations. (People in secondary mental health care with a care co-ordinator and a diagnosis of BPD can be referred. Care co-ordinators generally make referrals for DBT assessment). Feedback from people who have received DBT indicates that there is a general trend of improvement in people understanding and managing their difficulties better, and most are greatly satisfied with the programme.

Richard was in one of the first cohorts receiving DBT in Powys and spoke very favourably of his experience on the programme. Prior to joining he described his life as very difficult: “meds, meds, and more meds”, and not much support. It was rare for him to think through his thoughts – they were automatic and he would react to them. He was experiencing difficulties with his personal life to the extent that he self-harmed a lot. But this all changed once he started the 14 month DBT course. At first Richard felt that the programme went completely over his head. However, he committed himself to DBT and to the group, and he bonded quickly with fellow participants. It was reassuring to be with others who knew how he was feeling so that he didn’t have to explain all the time.

A third of the way through the DBT programme Richard had an experience which really changed his life. Everything suddenly became clear, and he felt changes within himself. He started to discuss his thoughts. By the end of the course he felt that he was a completely different person from when he had started. It is now 2 years since Richard completed the DBT programme, and he has not tried to self-harm or “do anything crazy” since. In fact, he is now into the third year of running his own business, has a good relationship with his partner, and a new baby.

Kathryn explained that people are encouraged to meet up as a “graduate group” once they have finished the course. There is also an open door for participants to get back in touch if that is what they want. The team stay in contact with annual Christmas cards. Meanwhile, demand for the South Powys DBT service has grown and there is currently a waiting list of 20 clients and three further members of staff have been trained to join the team.

So, in conclusion, it looks like the answer to the original question was definitely: “To DBT”. Which is perhaps not surprising, as much has been written online about the positive effects of DBT, such as: “DBT is not just a form of psychological therapy but a life-programme which patients use, initially to prevent serious self-harm or suicide and ultimately to build fruitful, satisfying lives”.

Do you have any experience of DBT? Whether you have or not, let us know what you think in the comments box below.