Monday, 5 July 2021

Managing mental health as lockdown restrictions ease this summer


It’s officially summer and we’re easing out of lockdown and into ‘normal’ life. But if you need help managing your mental health and wellbeing during this period of change, you’re not alone, as the SilverCloud Wales Online Cognitive Behavioural Therapy (CBT) team can explain.

SilverCloud Wales is an Online CBT service designed to help people aged 16+, experiencing mild to moderate anxiety, depression or stress, manage their mental health and wellbeing.

CBT works by encouraging you to challenge the way they think and behave so you’re better
equipped to deal with life’s problems.

There’s no need to be referred by a GP – you can sign-up for and access SilverCloud Wales anytime, anywhere, on your smartphone, tablet, laptop or desktop computer.

SilverCloud Wales is an NHS Wales service, run by Powys Teaching Health Board, and offers help for anxiety, depression, stress, sleep, money worries and more.

Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive fortnightly feedback from a qualified SilverCloud Supporter, one of the mental health professionals whose role is to support users of the service.

SilverCloud Supporter Alexandra Birrell, explains why, if you need support managing
your mental health and wellbeing, particularly with anxiety, as lockdown restrictions ease this summer, you’re not alone…


“The past 15 months have been unprecedented. None of us have ever experienced anything like this so no-one could have possibly known what to expect.

“At the core of anxiety is often a difficulty in dealing with uncertainty, and at the core of low mood is often feelings of powerlessness and lack of control.

“We were instructed to stay home, which impacted our interaction with our social support networks, which usually serve to protect us from difficult feelings. However, 15 months later and for many these conditions have become the new normal. Now, being able to venture out of the house and managing social interactions is what brings up feelings of uncertainty.

“Of course, people will have different feelings about this, depending on their situation.

"Some people are naturally cautious whereas others are embracing the opportunity to reconnect with loved ones. The difficulty is that these differences in boundaries are now something that we must learn how to communicate and navigate.

“The way that people navigate boundaries is often related to their self-esteem. People who struggle with their self-esteem tend to wonder whether their needs are important and may struggle to communicate them. If we struggle to communicate our needs, our needs may not be met which can then confirm the feeling that one’s needs are not important.


“SilverCloud Wales users choose one online programme to complete over 12 weeks, with fortnightly feedback from a SilverCloud Supporter. SilverCloud Supporters can give users access to additional modules if we feel they need more support in certain areas. The Communications and Relationships module is a popular one…

“The Communication and Relationships module starts out with a quiz to identify your unique communication style. For example, do you see your needs as more important, of equal importance, or less important than the needs of the people around you? Do other people know what you want and need?

“If you are struggling with communication, it may be that over the years you have learned to communicate in a way that is either too aggressive or too passive to get your needs met. This module offers support and advice around learning to communicate in an assertive, yet respectful way. It also focuses on strategies that may support you in improving the relationships in your life and making sure that you have a healthy support network to lean on when you start to struggle.

“The Self-Esteem module is another one that clients find useful and relevant to their experiences. This module looks at ‘self-talk’ - the way that we speak to ourselves.

“When we are struggling with low mood or anxiety, a common symptom is negative self- talk. We may find that we tend to berate ourselves or judge ourselves in a way that we never would with a loved one who was struggling. The Self-Esteem module offers support around building a practice of self-compassion by learning to offer ourselves kindness, support, understanding and tenderness rather than beating ourselves up, which only serves to make us feel worse.

“If we can improve our self-esteem and our belief that our feelings and our needs matter, this can also support us in navigating these end of lockdown boundaries with the people around us.

“The Relaxation module features a number of exercises that can be really beneficial. Users learn helpful relaxation techniques that can be used in day-to-day life to unwind and de-stress…


“In order to change longstanding habitual patterns or tendencies, we have to be able to slow down enough to notice those patterns. Many people struggling with anxiety feel that their mind is running a mile a minute, and that one thought seems to lead into the next which leads into the next and so on. These worries may be paired with physical sensations of anxiety such as a racing heart, difficulty breathing or a tight chest.

“When practising relaxation, many people report that as their body returns to a state of rest, their mind will slow down as well. It is from this place that we can catch what difficult thoughts are coming up, notice those patterns so we can start to challenge and change them.

“My advice for maintaining positive mental health and wellbeing for people trying to adjust to the ‘new normal’ over summer is…

“Each person will need to weigh up how they feel about the restrictions lifting and what is most beneficial for their own mental health. For some, seeing their loved ones will be supportive, whereas for others it will be a source of stress and will bring up feelings of awkwardness when trying to communicate this.

“Often, people find that their mental health starts to spiral and they don’t understand why it’s happening - they just know that they’re feeling increasingly distressed, low, or anxious, or a combination of all of these feelings.

“CBT provides a framework for understanding how some of the natural and automatic ways that human brains and bodies respond to uncertainty can actually serve to make us feel worse. In that sense, the journey of recovery can be about learning to focus on that which is still within our control, and finding empowerment through identifying coping strategies and ways of better managing our feelings.”

ONE SERVICE - THREE WAYS TO ACCESS

1.  SilverCloud Wales – The flagship service, available across Wales. 

This is a self-referral service which means that you can sign-up directly, without having to be referred by your GP or other healthcare professional. Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive fortnightly feedback from your online SilverCloud Supporter, one of the mental health professionals whose role is to support users of the service. Find out more and sign-up here.

2.  SilverCloud Blended – A tailored version of SilverCloud for Powys residents. 

Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive six face-to-face* sessions with an Online CBT practitioner whose role is to support users of the service. To find out more and signup, please contact: Ponthafren Association covering North Powys and Brecon & District - https://www.ponthafren.org.uk; Mid and North Powys Mind covering Mid Powys - https://mnpmind.org.uk/; or Ystradgynlais Mindhttps://minditv.org.uk/.

*These may be telephone and email support sessions, depending on Covid restrictions.

3.  SilverCloud Workforce – A tailored version of SilverCloud specifically for NHS staff  
     and keyworkers. 

You'll have access to four online mental health and wellbeing programmes: Space for Resilience; Space from Stress; Space from COVID-19; Space for Sleep. This is an unsupported service so you will work your way through your programme of choice on your own, at your own pace. Sign up directly for the service without needing to be referred by your GP or other healthcare professional.

Visit https://cymru.silvercloudhealth.com/signup/ and enter access code WALES2020.

For more information about SilverCloud Wales online CBT

- If you have any queries, please email Silver.Cloud@Wales.nhs.uk or call 01874 712 428.

- Find us on Twitter: https://twitter.com/SilvercloudW

- Find us on Facebook: https://www.facebook.com/SilverCloudWales

Thursday, 24 June 2021

A new Powys Suicide and Self Harm Prevention Co-ordinator


Jan Roberts recently started work as the first Powys Suicide and Self Harm Prevention Co-ordinator. She previously headed up the Crisis Resolution & Home Treatment Team in South Powys which she originally joined in 2012. Jan recently spoke at a meeting with some of the individual reps who champion improved mental health services in Powys and we found out more about her role.

The new post is funded for 18 months by Welsh Government alongside three regional Suicide and Self-harm Co-ordinators for Wales. Shaun Morris recently stepped into this role to cover Mid & West Wales. The lead within Welsh Government is Claire Cotter - National Co-ordinator for Suicide & Self-harm Prevention – NHS Wales Health Collaborative. The driver behind much of this work is the government strategy on suicide prevention – Talk to me 2: suicide and self-harm prevention action plan for Wales 2015 – 2020.

One of Jan’s first tasks is to understand the Powys picture so that an intelligence led service can be developed in response to identified needs and gaps. This level of intelligence gathering and research into suicide and self-harm has never been done within the health board or the council before.

Jan is working closely with colleagues at Powys Teaching Health Board, including Andrew Mason - the Harm Prevention & Reduction Officer for Substance Misuse, and Freda Lacey - the Mental Health Partnership Officer.




Three key areas of work

1. Analysing Coroner data for Powys residents who have ended their lives by probable 
   suicide between 2015 and 2019

This provides 5 years’ worth of data to understand if there is any particular demographic, or any particular geographical area in Powys, where these suicides may have happened, with the aim of trying to target services to prevent suicides in future, and in particular looking at gaps in service provision.

Powys wavers between the highest and second highest county in Wales for suicides (taking into account population size). The initial findings are interesting as they highlight a difference from the rest of the UK in that there were more deaths in the over 60s in 2019, whereas UK wide there were higher numbers of deaths from the 35 – 49-year-old age group. It will be interesting to see if this trend is also reflected in the analysis of the data from other years.

2. Improving the support available to those bereaved by suicide in Powys

In her previous role Jan had looked for 1:1 or face to face peer support for those bereaved by suicide and discovered that the nearest available group was either Cardiff or Chester. She is now working with colleagues to consider a support pathway which starts within 48 hours of the suspected suicide.

The proposal is that individuals bereaved by possible suicide would be linked in to both the practical advice they might need, as well as the emotional support. This will be in line with the suicide surveillance work being done in both Wales and England currently, which will enable the sharing of information on deaths by suicide at the time, rather than retrospectively, thus enabling appropriate responses to need and prevention being enacted both locally and nationally.

The idea is in its early stages, but the intention is that the family or person would be offered practical and emotional support with regular check ins, where they have consented; it’s about checking in and asking what support they need at that particular time. Peer led support is another option being considered in conjunction with the voluntary sector. Health board staff and partners in the voluntary sector are receiving suicide bereavement training to better equip everyone to work together to progress this in Powys.




3. Self-harm project

Finally, Jan is undertaking a data collation project in order to build an understanding regarding self-harm and self-injury in Powys, looking at prevalence, trends, pockets of particular need, and understanding the various pathways encountered to access support. It is hoped that this data will provide intelligence that will inform service development to maximise early intervention and prevention and reduce any barriers to accessing the right support at the right time.

It is more complex in Powys because of the distance people can travel to receive support, and further complicated due to the fact there are no district general hospitals or psychiatric liaison teams in Powys. Powys residents use approximately 5 or 6 different psychiatric liaison teams if they self-injure or self-poison and seek support, two of which are outside of Wales, so data collection is a challenge.

Many studies on self-injury and self-harm focus on the data from psychiatric liaison services but it’s difficult to get a full picture. A 12-year study from Swansea University into young people under 25 who self-harm in Wales showed only 50% had ever been to a psychiatric liaison service. Jan is looking at how we can source the best data to capture the trends and areas of need.

There is also a need to understand the pathways to service provision across Powys. For example, someone may live an hour and a half away from their nearest psychiatric liaison service and have no way of getting there so they could decide not to attend. Jan will be working with patients and staff to understand the pathways to receiving the right support at the right time – what works well and what could be better.

It is important that Powys residents are offered what is recommended by the NICE (National Institute for Health & Care Excellence) guidelines: a mental health assessment, a psycho-social assessment and referral on to an appropriate service.

Sarah Dale, a mental health rep, has recently delivered some awareness training on self-injury with the Minor Injury Units’ staff which was really well received and further training is indicated for MIU staff, in particular focusing on referral pathways.




Harm reduction programme – substance misuse

Another area of work taking place is the harm reduction programme from a substance misuse perspective. Harm Prevention & Reduction Co-ordinator, Andrew Mason, is focussing on the non-fatal drug overdoses across Powys, looking to learn lessons and identify areas for improving services with the ultimate aim of providing targeted support and intervention for people.

For more information on this ongoing work please contact Jan Roberts, Powys Suicide & Self-harm Prevention Co-ordinator, by emailing jan.roberts3@wales.nhs.uk

Monday, 7 June 2021

It’s Infant Mental Health Awareness Week 2021

© Daniel Thomas
The theme for Infant Mental Health Awareness Week 2021 is including infants in 
children and young people’s mental health.

The Parent-Infant Foundation says “The goal of this year’s IMHAW theme is to encourage everyone working in children and young people’s mental health policies, strategies and services to think about and include babies. Children and young people’s mental health should refer to the mental health of all children from 0-18 and beyond, but too often it is focussed on older children.

There is a “baby blindspot”. We are encouraging everyone to think and talk about infant, children and young people’s mental health, and to consider how babies’ mental health needs can be met.

We will be using the hashtags #IMHAW21 and #IncludingInfants


Early relationships influence a baby’s brain, and in particular their social and emotional development. This early development plays an important role in how well a child will go on to achieve many of the key outcomes that parents, the public, professionals and policy makers care about.

For example, babies who have had good early relationships start school best equipped to be able to make friends and learn. This increases the chances that they will achieve their potential in later life and contribute to society…..”

Here at Powys Association of Voluntary Organisations we decided to focus on sharing information about some of the key activities going on in Powys around improving infant mental health and wellbeing.

Lucy Taylor – Startwell Development Officer, PAVO


Lucy works closely with colleagues from the Health and Statutory sector under the Emotional Health and Wellbeing workstream in Powys to build a good start for all babies from pre conception onwards in the home and community up to support and health services for those who need them.

These goals sit under the Startwell element of the Powys Health & Care strategy.

You can contact Lucy by emailing lucy.taylor@pavo.org.uk or ringing 01597 822191.

© Kelly Sikkema
Jolene Duggan – Chair of the Powys Perinatal Mental Health Steering Group

“Healthy, social and emotional development during the first 1001 days lays the foundations for lifelong mental and physical health. At least 15% of children in the general population experience a disorganised attachment and this figure is higher for children facing adversity.” Parent Infant Foundation

Jolene says: “Attachment is the process, as well as the quality, of the relationship an infant forms with caregivers. Attachment can occur with biological and adoptive mothers, fathers, step-parents, grandparents and any other consistent caring person in the child’s life. A baby’s initial relationship experiences with primary caregivers creates the infrastructure for subsequent relationships, how the child views connection, how she experiences herself, and the world around her, is influenced by her early relationships. With repeated experiences of predictable care, the infant learns about trust and security. Growing up in an environment infused with safety and intentionality ensures healthy social and emotional development.

Here in Powys we are proactively trying to raise the awareness of the importance of Perinatal and Infant Mental Health by delivering the Institute of Health Visiting (IHV) Multi-Agency Champion training Programme. Prevention and early intervention are fundamental, and every professional working with families should be observing the interaction between a parent and infant.”

“It is easier to build strong children than repair broken men.” Frederick Douglass.

You can read more about the work of the Perinatal Mental Health Steering Group in our blog post: Perinatal Mental Health Services in Powys from 2019.


Mums Matter courses from Mind

Ros Sandhu is a Mums Matter Facilitator and Children & Young People Practitioner at Brecon & District Mind which offers the Mums Matter courses (as do Ystradgynlais Mind and Mid & North Powys Mind). Ros told us: “Infant mental health starts with maternal mental health, and as such it is mums who need support. In a recent article in The Guardian, Eliane Glaser put it succinctly when she wrote: “women are trying too hard and society isn’t trying hard enough.”

The Mums Matter Project aims to support mums who are at risk of, or suffering from, mild to moderate postnatal depression. Covid has left a larger number than ever of new mums feeling isolated and unsupported as they start their journey into motherhood, and in Brecon Mind we have been delivering the project using the online platform Zoom throughout the pandemic.

At the heart of the project is the idea that happy, contented, supported and confident mums produce mentally healthy, happy and secure infants and then children.

The insights of Donald Winnicott, a paediatrician and child psychoanalyst in the 1950s, provide a useful place to start the course and mums gain enormous comfort from his observations and teachings. His widely accepted theory is that mums need to learn to feel ok with being, “good enough” rather than striving for perfection. This takes the pressure off mums; none more so than mums living through a pandemic and surrounded by unrealistic images of motherhood on social media and little else! The concept of “good enough” can help to allow a greater sense of ease in their lives, which their babies will benefit from.

Winnicott also found that infants need to observe and experience the full array of human emotions within a warm, secure and loving environment. As such mums are reminded that’s its ok to be fully (at times even a bit messily) human so that their babies and children learn that it is ok to be the same.”

You can read more about the Mums Matter courses from Mind:



Thursday, 20 May 2021

A look into Borderline Personality Disorder (BPD)

© Sarah Dale
Sarah Dale

Sarah Dale is a citizen rep in Powys – an unpaid volunteer who sits on the Powys Mental Health Planning & Development Partnership to share the voice of lived experience. As a citizen rep Sarah previously sat on the Wales Mental Health & Wellbeing Forum (formerly the National Mental Health Service User and Carers’ Forum).

Sarah has also worked incredibly hard over the past few years as a regular contributor to the Engage to Change group, which is a sub-group of the PMHPDP. This group was established to "more widely promote the Mental Health Planning and Development Partnership’s activity, to proactively challenge any stigma associated with mental health and to collect "service user" views / experiences, co-ordinate resolution and feed back on resulting change to people using services."

And during the Covid-19 pandemic Sarah has also created and delivered a hugely valuable training session on Self-Injury Awareness to many of those working in the provision of statutory mental health services in the county. Sarah is absolutely passionate about raising awareness of mental health issues and brings an honesty and openness to the work which allows greater understanding for all those watching / reading / exploring more about these issues.

© Sarah Dale

Sarah's experience of Borderline Personality Disorder (BPD)

Sarah's latest project is an indepth look into Borderline Personality Disorder to promote during Borderline Personality Disorder Awareness Month this May.

"You are probably wondering... "what is Borderline Personality Disorder? And you are not alone. This is the response I get when I tell people I have BPD, and yet I still haven't been able to accurately explain what the disorder is, and how it affects me. 

The reason you probably haven't heard of the disorder is that most people with (BPD) have experienced a lot of stigma. Often being described as 'manipulative', 'attention seeking' and 'incurable'. You have probably seen over the years, celebrities opening up about their depression, anxiety or bipolar disorder, thus more people are speaking up about their own struggles.

However, no one wants to talk about the more 'scary' or 'shameful' issues like self-injury, eating disorders, psychosis and personality disorders."

After exploring What is BPD? Sarah considers why it has this particular name, what it's like to have BPD, some of the feelings that people with BPD experience such as extreme emotional instability, fear and abandonment, and people's struggles with a sense of identity. Sarah then turns to the positive side of BPD and explores the empathy and compassion that people with the condition experience, plus an often increased creativity. To finish off Sarah debunks some of the commion BPD myths, such as that people with BPD are incurable and / or attention seeking.

You can read the whole piece, A Look into Borderline Personality Disorder (BPD), on our Powys Mental Health website.

If you have any queries for Sarah, or experiences to share, then do pop them in the comments' section below.

© Sarah Dale

Read more from Sarah

Sarah has written for this blog previously on:

You can also catch up with Sarah on her Facebook page - Sarah Mental Health Rep.

Monday, 17 May 2021

Citizens Advice Powys - supporting mental health inpatients

Yasmin Bell is the Chief Officer at Citizens Advice Powys, the charity which “provides the advice people need for the problems they face and improves the policies and practices that affect people's lives.”

The charity recently launched a new pilot project to benefit the inpatients on the mental health Felindre Ward at Bronllys Hospital in South Powys. We spoke to Yasmin to find out more about this important work.


Tell us more about the project

Owen Griffkin, the Powys Patients’ Council facilitator, and the Occupational Therapy (OT) team on Felindre Ward, had been talking to us over the last year about setting up an inpatient advice service. We want to support patients with various issues which are acting as barriers for them wanting to return home and on their recovery process generally. We will continue supporting them once they are at home.

One of the OTs said that some patients, escorted to their homes on day release, had become more anxious upon arriving at a freezing cold home and finding a huge amount of mail / bills. It’s not a very welcoming scenario!

In the long term we would ideally provide support so that people don’t go on the ward in the first place.

How does the support work?

We did a similar project on Felindre Ward about 10 years ago and staff remembered how useful that was supporting people on their recovery journey. At that time a Citizens Advice advisor from Brecon went onto the ward to see people. With Covid we are using video appointments. The ward has iPads available and supports patients to access the platform and then we take it from there.

There’s quite a lot of work we do with the team before we meet the client – every individual can be different. Some people can be uncomfortable about speaking to someone about their issues. In that case the OT will work closely with us to find out what kind of help is available before going back to the person to give a flavour of the advice that could be provided. This usually results in the person then taking an appointment and with a better insight of what help can be provided.

Some of the original project outcomes included – less hospital staff time spent on advice issues, improved patient engagement with treatment, reduced barriers to patient discharge, clients feel more able to stay in their own home and in control of their lives, and improved mental health. The support enables independence, self-management and clients receiving all benefits they are entitled to.

Why was the work of Powys Patients’ Council invaluable in setting up this project?

Owen and the PPC volunteers had been speaking to people on the ward and through this helped identify the need for a direct advice service to support people.

We’ve had a lot of positive comments. One patient said: “I had an appointment with Citizens Advice today and they were excellent. They were able to help with my pet and some money issues.”

How is the project funded and for how long?

This pilot project is funded by a recent Powys Teaching Health Board Small Grants scheme. It lasts for 4 months so will end at the end of May. Through this pilot we will determine the level of demand and the feasibility of the service.



Tell us about some of the everyday issues facing people on the ward and how your service can help?

We identified that it was particularly important to help patients report their change of circumstances with regard to any benefits. Once discharged their benefits can be reinstated with our help. Citizens Advice Powys can also take responsibility for contacting any third parties and putting a hold on any action pending, for example, debt repayments, until that person is able to deal with them. It’s also important to inform the third party that Citizens Advice is helping the person.

We also make sure people are getting all the right benefits – we carry out an Income Maximisation Check – looking at the person’s whole situation. In many cases it can be quite complex – other benefits can be triggered or stopped. We act to make sure there is no detrimental impact on the person.

What is Attend Anywhere?

That is the video platform we use – it is used by the NHS across Wales for consultations with specialists. It’s similar to Zoom or Microsoft Teams but it’s almost like an office set up with a reception, and five interview rooms. It does mean people can have a family member or support person with them in the interview. Language interpreters, including British Sign Language interpreters, can also be included as part of the free service we provide.

Has Covid had an impact on people’s concerns / issues?

There has been a huge increase in people receiving Universal Credit which is a very complex benefit – so people do need support with this. Employment enquiries have also gone up. We are encountering people who have never had to claim benefits or ever had financial difficulties before – so people could become patients on a mental health ward because they’ve never had to deal with that level of poverty before.

Issues are much more complex than they were ten years ago. For example, with a debt client, the level might be the same but the client may owe debts to numerous different creditors where previously it would have been one or two. Then there is the added issue where creditors sell the debt on and on – and trying to unpick it all is a lot of work.

Covid has also added a level of frustration through not being able to get through to departments they need to speak to like the Department for Work & Pensions and energy providers. We can help speed up the process.

We also support people on three-way video or telephone calls with the Citizens Advice advisor doing all the necessary work whilst the client sits in the call. There is no cost to the person themselves for this support.

If people don’t receive the support they need, what could happen to them?

People who have been stressed previously can feel much more optimistic and calm about the situation. Long term if we receive continuation funding we would like to start looking at whether people go back into the hospital if they have received support. If issues have been going on too long it is harder to resolve them so we want to do more preventative work, help people understand what we do and just basically say – don’t be scared about getting in touch.

If we are supporting someone with a Personal Independence Payment (PIP) claim we have to talk about their physical and mental health. We also support people through tribunals and hearings. People open up and perhaps admit for the first time some of the issues facing them which can be very traumatic for them to accept.

What are Citizens Advice Powys’s main priorities outside Felindre Ward?

It’s about early intervention, about making sure our services are accessible and available to everybody in different ways and working out the different access options. We want to build a service where we don’t assume everyone wants face to face or telephone. So we offer video also, some web chat, and contact by email. We want to raise awareness and stop people getting to really complex situations – it’s about averting a crisis.

Which other Powys organisations do you work closely with to provide support to people?

This is happening more than ever before. We’re working with Accessibility Powys to facilitate appointments and advice sessions that are accessible to people with physical or sensory impairments – trying out different methods and equipment. There are a lot of people out there who, if not in receipt of this service, would not have had any advice. There are people who have been shielding and isolating who have not had any support for the past year or so.

In the last 3 months we have had a 20% increase in formal referrals (statutory and third sector agencies) and also seen a 50% increase from mental health teams. So we’ve done a lot of raising awareness sessions – every Wednesday we invite someone to come and talk to our team about the work they do which has been really beneficial – this means we can signpost to other services confidently too.

What are the main challenges of the project?

Client engagement is one of the biggest challenges generally if someone is struggling with their mental health. Sometimes people feel less anxious if they can turn their video off. So it can be small things that help. We try and think outside the box constantly to come up with a solution that works best for that person.

Some of the appointments can be lengthy so we split them into two sessions. If it’s a complicated PIP application you could spend up to 3 hours on that – so it’s managing the length of the appointment to suit the person.

Another challenge is ensuring we have all the right consent forms and paperwork completed. The OT team on the ward have been acting as our administrators in respect of these. It’s still a benefit to them though as they can then concentrate on the work they do best and leave the advice for us. It’s all about team work! So that’s a positive really!

Tell us about some of the most rewarding aspects of this project

The feedback from patients has been very rewarding: for example, one man said after receiving support he felt he was able to go home and contact the utility company and sort out the issue himself. (We would, of course, follow up afterwards to ensure it all worked out).

Knowing that people understand where they can seek help and are better able to manage.

One person was helped to reinstate a PIP claim and said of the advisor: “She was very kind, clear and helpful about my concerns. I found this extremely helpful over a subject I have been worrying about over the last years.”

When you are not working for Citizens Advice Powys how do you enjoy spending your time?

I do a lot of coastal path walking. My aim is to walk the whole coastal path of Wales. So far I’ve done a third of it.

I also volunteer as a Cadet Leader for Newtown Police Cadets and assist the cadets doing their Duke of Edinburgh Award. I recently completed my DoE expedition assessor qualification.




If you want to find out more about Powys Citizens Advice you can contact Yasmin by ringing 01686 617641 or email: manager@powyslca.org

Monday, 10 May 2021

Mental Health Awareness Week 2021 - Nature

Jen Hawkins, PAVO Health & Wellbeing Officer - wild swimming

“Nature is our great untapped resource for a mentally healthy future” The Mental Health Foundation

The theme of this year’s Mental Health Awareness Week (10 - 16 May 2021) is Nature.

The Mental Health Foundation, the charity which has hosted the annual Mental Health Awareness Week since 2000, explains why Nature is the chosen theme:

“Nature is so central to our psychological and emotional health, that it’s almost impossible to realise good mental health for all without a greater connection to the natural world. For most of human history, we lived as part of nature. It is only in the last five generations that so many of us have lived and worked in a context that is largely separated from nature. And it is only since a 1960s study in the United States found that patients who were treated in hospitals with a view of nature recovered faster, that science has started to unpack the extraordinary health benefits.” You can read more here.


Most of us have felt much closer to nature over the past 12 months during the repeated Covid lockdowns, including those of us in our Health & Wellbeing team at Powys Association of Voluntary Organisations. The Mental Health Foundation’s research shows that during the pandemic “45% of us reported that being in green spaces had been vital for our mental health.” During this awareness week they will be showing how “even small contacts with nature can reduce feelings of social isolation and be effective in protecting our mental health, and preventing distress.”

We are particularly lucky in Mid Wales - nature is all around us - sometimes in its grandest forms, but also more subtly on every doorstep, even in the middle of our town centres, nature is always in evidence and there to lift our spirits.

Here’s how we have connected with nature over recent weeks and months.

Jen Hawkins - PAVO Health & Wellbeing Officer

I’ve always loved swimming outdoors, we never called it anything other than swimming when I was growing up but now there are a lot of different names for outdoor swimming as it’s become more popular, especially during the last year with indoor pools and gyms closed. 
Open water, cold water, wild, are all ways of describing the experience but they don’t really come close. There is something so incredibly peaceful about being totally immersed in water and surrounded by natural beauty. 

The coldness of the water makes sure you are nothing but totally present and in the moment, there simply is no other option. Being aware of the movement of a current or tide, watching falling leaves skim the surface, sharing the space with visiting swallows and swifts in the summer, listening to early morning birdsong, or the drone of a dragonfly next to you, all contribute to the experience. I’ve never swum through the winter before but decided to try this year after reading about the research into mental health benefits.The coldest temperature I’ve managed was 3 degrees, the feeling after coming out from that swim was something close to euphoric. It’s definitely something I’m going to keep up and try as many different locations as possible. It’s lovely to feel that sense of being held and all being well with the world.

Clair Swales - PAVO Head of Health & Wellbeing


This tree outside our house always signals the start of spring and longer, brighter days to come. The pink blossoms always give me so much joy and make me smile. Spring time walks remind me to be grateful for nature, which has its own special way of telling us that no matter what life throws at us we can rejuvenate and renew ourselves. Like the Fifth Step to Wellbeing - pay attention to the present moment. For me it’s paying attention to what nature is telling us at any given time.

Jackie Newey - PAVO Mental Health Information Officer


Every week I go on a local walk in the hills around Llanidloes, or the town itself, and look for wildflowers for the weekly #wildflowerhour challenge on Twitter (also Facebook and Instagram). I’ve learnt so much about wildflowers and nature from the wonderful #wildflowerhour online community. It is one of those unique outdoor-online combos that has proved so successful. 

The walk is an escape from the everyday routine of work, family commitments and the mundane chores of life. It gives me an opportunity to focus purely on the lovely native plants growing all around us at all times of the year. It is as much about my wellbeing as it is about recording nature and learning how to identify the quite subtle differences between wavy and hairy bittercress! Some of my favourite finds have actually been throughout the depths of a hard, cold winter around Llanidloes town, where against all the odds wildflowers such as the beautiful ivy-leaved toadflax, wild strawberry and shepherd’s purse thrive in sheltered nooks at the base of shop doorways, walls and in brownfield sites. Finding these beauties at this time of year (the challenge in winter is to find 10 wildflowers in bloom) is such a boost to my mental wellbeing. I can highly recommend trying this treasure hunt with a difference - and celebrating our feisty yet beautiful nature!

Lucy Taylor - PAVO Startwell Development Officer


Being outside is important for us all, from the fresh air and the feel of freedom it gives, to more measurable benefits in terms of health and activity. Being outside is especially important for children as sometimes the opportunity to go out is not in their hands. Just playing outside, doing what they want to do, is calming, inspiring and healthy.

Playing on the beach on a nice sunny day what could be better for anyone? A lot of adults need to regain the ability to play, to relax and do things that do not have a purpose, but just for their own enjoyment.

Let's go fly a kite!

Owen Griffkin - PAVO Mental Health Participation Officer


It was wonderful to see some new additions on the lake at Llandrindod on a special birthday walk with my dog Honey (5 today!) Along with the Muscovy ducks, terrapins and occasional guinea fowl that have taken up residence there. It has become a really lovely place for a walk.

Sue Newham - PAVO Engagement Officer


Since June last year, I have been walking every morning with my husband, doing a circular route which takes in the riverside in Newtown. It’s been great to see the changes through the seasons. Last week, we saw a goosander doing a flapping/ skating dance across the surface, presumably to panic the fish and enable him to catch one. This morning, so many spring flowers were visible. 

Walking in green spaces has improved my feelings of happiness. The colours in nature seem restful somehow. The other good thing is that we often see the same people out walking, so we have the opportunity to chat and we are getting to know some of them by name. That’s nice too. The picture is from a walk in February - a shadow selfie!

Andrew Davies - PAVO Health & Wellbeing Participation Officer


Me and my wife and my 2 girls try and get out in nature as much as we can, we are very lucky to live in such beautiful surroundings and it helps us reconnect as a family. The girls love to run and play when we are out and about and it is so good for us as parents to see them grow and explore.


We'd love to hear about how you connect with nature. Let us know in the comments below how nature has impacted on your mental health and wellbeing.

Thursday, 29 April 2021

Celebrating Side by Side Cymru - mental health peer support in Wales

Artwork by Debbie Roberts engagevisually.co.uk

In March 2019 we lived in a very different world and I attended, in person, the launch of Mid & North Powys Mind’s latest project – Side by Side Cymru. MNPM was one of four local Mind groups in Wales, led by Mind Cymru, to provide this peer support project funded by the Welsh Government.

Here at PAVO we have followed the local project closely and with much interest, as we truly believe peer support to be crucial in the promotion of improved emotional wellbeing for people in Powys. I was, therefore, delighted to be able to attend the virtual celebration of the Mind Cymru project recently to find out more about how this approach had been received across Wales.

What is peer support?

“Peer support is about people using their own experiences to help others. It can happen in a group, on a 1:1 basis and also online as well but for this project we will focus on peer support that takes place face to face in a group situation. It’s about people taking a lead and taking control very much on an equal basis. So it’s a different model from more traditional health and wellbeing models. Through peer support we can feel valued, more connected to others, and more able to take control of our lives.” Mind Cymru, March 2019

“The connection to someone who is interested in similar things to you, or someone who has been through similar experiences, is a connection of equals and really invaluable. It is insightful and totally authentic.” Mid & North Powys Mind, March 2019

Sara Moseley – Chief Executive Officer, Mind Cymru


Peer support is needed more than ever because of what has been happening to us during this pandemic. There’s a huge amount of evidence now about the mental health impact of Covid. Many, many people have been behind closed doors, really feeling low, anxious and lonely. Peer support is about the power of unlocking that through the power of our own experience, kindness and compassion. In its simplest form it’s about using our own expertise and knowledge to support each other emotionally, practically and realise that there are positive, hopeful ways through mental health difficulties.

Covid has also put some of our networks and communities under considerable strain. Younger people in particular are feeling very isolated – being cut off from usual networks has a real detrimental effect on your mental health. As well as the human stories from over the past 3 years of the project we are now in a place to come out of the pandemic stronger than we were before. We have some very practical things that we have to say to decision makers about how we build back stronger and in a way very rooted in communities, and empowering to us as individuals.

Liam Pywell – Senior Peer Support Officer, Mind


Peer support based in the community and led by people with lived experience of mental health issues can be life-changing, and that’s why we believe it should be available to people across Wales.

The project worked with 318 peer support leaders across Wales who in turn supported 3800 people in their communities. We provided over £50,000 in grants to over 221 organisations and groups. We delivered over 100 activities, including training, networking and shared learning.

The hubs facilitated physical and virtual spaces to bring people together to connect, share learning and access some much-needed resources. We wanted the peer leaders to feel more confident, knowledgeable and able to provide peer support to their community and to build on the resources such as our peer support toolkit.

Mind Cymru’s independent evaluator – MEL Research - concluded in their final report that the Side by Side Cymru hub model is an effective way to supportive community based organisations and peer leaders, and that there is a real need for these types of programmes.

The local hub offer centred around three things:
  1. Training & shared learning.
  2. Funding.
  3. Networking opportunities.
Through the evaluation the value of Side by Side Cymru became clear: peer leaders increased their understanding of peer support and the value it provides, and their confidence to deliver improved peer support. The research tells us that peer support improves our sense of wellbeing, increases our sense of hope, and helps us to become more empowered to make decisions and take action.

We also found that peer support can reduce health care costs as people who use less mental health services are often involved in peer support. But peer support is not free – we do need financial resource to support those community groups. Finally, a range of peer support options should be available to support people from all different backgrounds and makes peer support available to all.

Lorna Jones – Peer Support Hub Worker, Mid & North Powys Mind


In a short video Lorna (bottom centre) was joined by one of her volunteers – Lynda (top right), and Bethanie (top left) a peer support leader. Bethanie attended a course with Mind after experiencing post-natal depression and went on to lead a peer support group for parents of children with additional needs. The Side by Side training helped her to be professional, and to learn about specific areas such as safeguarding. She found the toolkit really helpful to refer to for guidance at any time.

Bethanie also said that the training was particularly useful as she made connections with people who could also help her. “It was like peer support for a peer support leader.” We were working with young children but others were in peer support groups for older people who were lonely and vulnerable. We could mix together and create further networks too.

It has also been a lifeline for Bethanie’s own mental health. “It’s something to look forward to, even now with Covid we can still communicate online and it helps us feel less isolated.” The funding paid for the cost of venues.

Lynda helped Lorna massively with the training. She recalled how members of her own family had been dealt with on a very clinical basis in the past, so she felt privileged to be involved with the project which supported people at a community level. “It was great to see the range of people that attended the training – from young Mums, through the age ranges, and a lot of men including a male voice choir.” Lynda realised that they took what they had learnt to all spheres of their life, not just the areas they were representing.

Lorna said that when she read the evaluation report the one thing that really hit her was the huge area that the project had covered in Powys – right from Machynlleth in the north west to the Herefordshire border in the south-east of the county. They worked with 75 groups in total.

“People have said they would be lost without these groups to go to. Our inspiring peer support leaders gave up their time to hold these groups for no other reward other than helping others. They are the unsung heroes in our communities across Britain.”

Bethanie: “Side by Side grew me and my group. It was like the seed we needed.”

Panel discussion


Julian John, CEO of Cwm Taf Mind, chaired the panel discussion with Fateha Ahmed of EYST (Ethnic Minorities & Youth Support team Wales), Zoe King of Diverse Cymru and William Evans – the Young People’s Participation Lead at Mind Cymru. There is only space for very brief sound bites here but they give a flavour of the conversation.

Q1: What does an excellent peer support project look like (and how do you know)?

“It would include a diverse group of people with lived experience who are able to support each other and have empathy. You will see the improved progress in young people if the project is successful.” Fateha Ahmed

“Empathy has to be at the heart of a good peer support project, also coproduction. It’s all about lived experience and shared experience. To know how we did we can consider the distance travelled – how people are before joining the group and how they are since. Have they achieved life goals in certain areas?” Zoe King

“It might look different to different people from different communities / ages. The type of resources and training required will be dependent on someone’s age. It needs to be flexible and accessible, safe and rewarding for a younger person.” William Evans

Q2: What can traditional mental health services learn from community led peer support?

“Lived experience needs to be at the heart of the services they deliver.” Zoe King

“Peer support has a strong bond of friendship. A counselling service may last for 6 – 8 weeks only but friendship may last life long.” Fateha Ahmed

“Traditional mental health experiences are often too rigid and don’t treat people as individuals – young people want the emphasis to be on meaningful connections and a lot less on checklists and criteria.” William Evans

Q3: What roles do organisations like ours have in developing peer support services for the future?

“Many children and young people are fairly creative and innovative in their use of social media to create their own peer support networks. Organisations need to allow them support and resources to enable them to do that safely.” William Evans

“Organisations could connect grassroots’ groups to wider networks with similar aims and goals. Larger organisations could communicate opportunities as well and also provide training.” Zoe King

“EYST has been inviting our volunteers to share their lived experience – how they actually dealt with their anxiety and depression. The young people always say they learn better hearing other people’s stories.” Fateha Ahmed

Q4: How do we connect to the networks of community groups across Wales?

“Doing with and not for. Going into those communities and engaging with people in coproduction and finding out what solutions they have.” William Evans

“We have a community infrastructure (with village halls / groups etc) we also have a County Voluntary Council infrastructure that is supporting those groups across Wales. Is there something we need to do with our CVC partners in reaching community groups?” Julian John

“Yes, absolutely. We work with diverse groups to gain those lived experiences that we then feed back into consultations. CVCs are already well placed to do a lot of this networking.” Zoe King

“We need to find key individuals who are trusted in the community and work with them to provide the best possible service for our young people.” Fateha Ahmed

Angie Darlington, West Wales Action for Mental Health, added – “it is broader than CVCs, mental health development agencies are available across Wales to share out our peer support experiences and reach out into the communities.”


Sarah Moseley said at the end of the session: “It has been a really moving and inspirational afternoon. We want to use this as a spark to think how we sustain, build, grow and strengthen (the peer support approach). One of the most powerful things I have learnt is that there are moments in your life, or things that happen in your life, that make you uniquely ready to connect, share and give support.”

Side by Side resources

Side by Side toolkit and further information

For further information about the Side by Side Cymru Peer Support project email peersupport@mind.org.uk

You can also watch a video about the Side by Side Cymru Peer Support project.