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: 

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 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.