Is grief a treatable illness?

All of us are affected by bereavement at some point in our lives. Whether we lose a parent, grandparent, child, sibling, other family member or friend, it is hard, especially if unexpected. Grief is a natural response, one which affects different people in different ways, hits harder or lasts longer with some of us, but is in the end a perfectly understandable process given what we have lost. Everyone deals with it differently too, perhaps coping after time, with support from loved ones or bereavement counselling, or any number of other ways. When my Dad died, over 10 years ago now, I threw myself into my gardening and that helped me work my way through the grief.

Now, though, it seems that some psychiatric organisations are considering that bereavement and the associated grief could be regarded as a mental illness which might potentially need medical treatment. In a BBC Radio 4 programme called Medicalising Grief earlier today (you can listen here for the next 7 days), Matthew Hill investigates the issues. In May 2013 the American Psychiatric Association will publish the 5^th edition of The Diagnostic and Statistical Manual of Mental Disorders - or DSM – in which new mental disorders will be listed. What this actually means is that with each new edition of the manual, yet more people are potentially labelled as “mentally ill”. And with this edition, this could include those grieving for the loss of a loved one.

The DSM, which is apparently regarded as something of a “bible” by some psychiatrists, contains checklists of symptoms for each disorder. The checklist for grief, according to the programme, includes, at one end of the scale - sadness, insomnia, guilt, loss of pleasure and appetite, with suicidal tendencies rounding off the other end. Five or more of these symptoms, experienced for two weeks or more, would indicate that the person had a serious mental disorder, regardless of the underlying reason.

Some experts say that if people experience grief which leads to serious depression then they should be treated (the implication being – bring on the anti-depressants – more of which in the programme...). Others say that to be normally sad, for however long, does not mean that a person has a medical illness. There is an interesting article in The Lancet called Living with grief which explores the latter view in more detail.

When my father died unexpectedly and I had to cope with the consequences I didn’t consider that I might be ill. I was stressed and anxious, particularly in the first few weeks afterwards. I found it hard to concentrate on reading, I needed time to myself and with my close family, to absorb the finality of what had happened. It hurt, a lot, and for a very long time, but I never expected anything different.

How do you feel about redefining grief as an illness? Should people be prescribed anti-depressants if they feel depressed after losing a loved one? What is the difference between sadness and depression? And who should be responsible for deciding what is, and what is not, a mental illness?

Mindfulness in schools

It's a long time since I was at school, but one thing's for sure, we never had anything like mindfulness training to help us stay calm and focussed when preparing for exams.

Professor Willem Kuyken, who heads Exeter University's mood disorder centre, spoke on Radio 4's Today programme this morning about a recent research project which has shown that using the mindfulness approach in school can indeed improve the young peoples' wellbeing. 

Today in London the International Mindfulness in Schools conference looks at some of the pioneering work which is taking place, particularly in the UK.

Richard Burnett and Chris Cullen, are the co-Founders of the Mindfulness in Schools Project, which was set up in 2007. You can read more on the project's website, but they key question is this:

Question:  When 25 teenagers tumble into your classroom at 11:45 on a wet Tuesday morning, how are you going to interest them in mindfulness? They are tired. They are hungry. They are playing with their phones, and they’d rather be somewhere else. They’ve never heard of mindfulness, it doesn’t sound very exciting, and if you were to tell them that it involved periods of stillness and silence, you’d lose them before you begun. How are you going to convince them that mindfulness is a skill which could make a real difference to their lives?

Answer: .b (Stop, Breathe and Be).

I almost wish I could go back to school and start learning all over again!

If you are a young person studying at school or university, do you think this approach would work for you? Or if you are a parent or teacher - do you think your children would benefit, and would you like to see mindfulness training added to the curriculum as a matter of course? Let us know.

Watch founder Richard Burnett's video here:

What does participation mean to you?

by Freda Lacey

The Powys teaching Health Board (PtHB) pays Powys Association of Voluntary Organisations (PAVO) to promote, enable and facilitate “participation” in the design, planning, delivery and evaluation of mental health services in Powys.  It is my role as the Participation Officer in the mental health team at PAVO to carry out this work. At the end of this past week, I’m questioning whether what I’m doing, after just over a year in my job, is effective.  I’m really not sure.  As I sit here today reflecting on my week, I’m really seeking to understand what is “participation” and more importantly, how we “do” this in relation to mental health.

Last Thursday, I attended a Mental Health Planning and Development Partnership meeting, chaired by the PtHB.  I had been asked to deliver a paper on “participation” at the meeting, as active participation by individuals and carers in this partnership is a requirement under the “Together for Mental Health” strategy and delivery plan for the Mental Health Measure.  This particular meeting has led me to question, “What is participation?” as people in the meeting grappled with and challenged the way I propose “participation”.  What is meant by true participation, what is understood by it?  In many ways, I’m being confronted to define what I understand it to mean, after all, I’m being paid to enable participation to happen.

While there are many organisations which promote and develop participation in Wales, I went online to see what came up when I searched “participation” as if I knew nothing about the subject.  The first link took me to Wikipedia, and says it may refer to, decision making, ownership, philosophy, finance and eparticipation.  I drilled down into decision making and it further says, “for well-informed participation to occur, it is argued that some version of transparency, e.g. radical transparency, is necessary, but not sufficient. It has also been argued that those most affected by a decision should have the most say while those that are least affected should have the least say in a topic”. 

I looked at the rest and “ownership” and “finance” are boringly “money” oriented so not helpful to me (or you) here.  The, “philosophy” link took me to a deep spacey place, I’m not sure I can explain it very well, but when I finally came to, I was thinking of passive vs active participation.  It made me reflect on what happens if we don’t participate, if we’re passive.  This can lead to decisions or action being taken that is “done to us”, rather than us being involved and feeling powerful in the decision making process affecting us.

A common “model” that is often used to define “participation” is that of Sherry Arnstein.  While there are others who’ve developed her model, I think hers is fairly easy to understand.  It looks like this.

I personally think there is a difference between engagement and participation.   For me, engagement means different ways of getting people involved in participating.  For example, you could use a blog to engage with people (hopefully).  There are innovative ways of engaging with people, through the use of eparticipation (electronic) mechanisms, such as Twitter, Facebook, email, websites, electronic surveys, YouTube, etc, but not everyone has access to these and more importantly, there are people in Powys who just don’t want to engage with services in this way.

True participation has to enable all ways of engaging with people, most especially, I feel, in face to face dialogue.  The more we rely on eparticipation as the only way of engaging with people, the more we remove ourselves from that face to face opportunity of conversing, listening, having open (transparent) dialogue with people.  For me, true, active participation, means personal (people) action.  If I look at Sherry Arnstein’s model, it’s the degree of “citizen power” that means true partnership, delegated power and ultimately, citizen control.

The more we enable links of personal contact between decision makers and those who are most affected by the decisions which are made, the more we move towards true partnership with delegated power and control in how mental health services are shaped.

After much reflection, I cannot enable participation without active people (citizen) power.  It is down to me to use the widest engagement tools possible to ensure this happens.  It’s down to me to ensure that I stand firm in promoting individual “participation”.  Who do I ultimately stand for?  It’s the people affected by mental health services in Powys.  If you want to start a movement, now is a good time, let me know?

"Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has." - Margaret Mead.

You can link to the National Principles for Public Engagement here.

Hearts and Minds

Yesterday I drove down through sun and snow flurries to the Royal Welsh Showground near Builth Wells. I was attending an event organised by Powys teaching Health Board (PtHB) to look at the future of mental health services in Powys. The “vision” for future services was developed during late Autumn 2012, and very much informed by feedback from people who use services and their carers at the time. I posted about that here. Then it was christened Hearts and Minds, and included information not just about the vision but how services would be delivered – you can link to more information here.

So, yesterday it was the turn of staff providing services (for the health board, social services, the voluntary sector and other agencies) to say what they thought. There were about a hundred people in total, including (in a bit of a mini A-Z of professions) advocates, nurses, occupational therapists, psychiatrists, social workers, support workers and police officers. And many of them spoke very passionately about their views, and some key themes emerged throughout the day.

Facilitator Dr Les Rudd, of the Centre for Mental Health Services Development, introduced the morning session which started with a series of presentations to inspire and set the mood. 

Jo Mussen

Vice Chair of PtHB, Jo Mussen, spoke first, about the need to give the people of Powys the best possible mental health services that we can, taking into account the many challenges and opportunities that face us. She also referred to the “incredibly vibrant Third Sector” which went down well with some of my colleagues.

Ian Hancock and Les Rudd

Then Ian Hancock gave us a Scottish viewpoint. He has turned round mental health services in the Dumfries & Galloway region in just three years. It is very similar to Powys in many ways, with its rural geography and a population of 147,000 (Powys approx. 133,000). His approach as the General Manager appears to have been both innovative and brave, and the Powys staff were clearly very impressed by the achievements he described.

Richard Bundy from Gofal

After Ian came Richard Bundy of the mental health and wellbeing charity Gofal. He described a service which has “bucked a few trends in Wales” – the Crisis House in Cardiff. The house is an alternative to hospital, with the average length of stay at 7 days. Some of Richard’s stats said it all really, with 95% of people using the house rating it as good or excellent, and 80 – 90% consistently returning home rather than going to hospital. There is more about the project here.

Stephen Hunter, Assistant Medical Director of Aneurin Bevin Health Board (providing mental health services in Mid and parts of South Powys), had sent recommendations which Carol Shillabeer (Director of Nursing) delivered in his absence.  There were some interesting points here, including the need to:

• Consider more cross-sector working (again identifying the Third Sector as a real asset), but involving other organisations too such as Job Centres, social and care services, and other people who are regularly out in the community even (postmen came in for a mention several times).
• Focus on supporting GPs and practice staff to care more for people experiencing mental distress.

The rest of the day was taken up with workshop sessions looking at what a good service would look like for adults, older people, and younger people, in the following three areas:

1.    Community services, primary and secondary care.

2.    In-patient services (crisis and accommodation services).

3.    New services/innovation.

Some of the key themes which I picked up on:

• Services are very different in different parts of Powys. There is certainly something of a postcode lottery going on here. (Services are currently provided by three different out-of-county health boards).
• Everyone wants it made simpler. The police often have to pick up the pieces when the mental health service providers have closed for the day. They would like to see “one procedure, one place, one pathway” for hospital admission, for example.
• More training in psychological therapies is urgently needed – it was suggested this could be “joint” training involving many agencies.
• What can the Third Sector provide? Exploring this topic could form a whole day in itself! (Supported housing and counselling being just two suggestions I picked up on – and the need to “think outside the box”).
• It is crucial to build confidence around mental health issues with other areas of health, eg: health visitors, district nurses and community hospitals. And Third Sector of course! “Mental health is everyone’s business”, as one person said.

Carol Shillabeer and Harold Proctor

So, it was a really interesting and useful day all in all. Harold Proctor, (Planning and Performance General Manager Mental Health and Learning Disability – phew, some job title!), who is leading much of the work for PtHB around transforming mental health services, tells us that this event is the beginning. So, watch out for more updates and events to follow once a proposed new model of services has been put to PtHB in April.

As someone said, summing up towards the end – “we have only just lit the torch paper today… this is very much the start.”

PS: And… did I mention the Third Sector…?!  

In the counsellor's chair

Sorelle White, a Powys based counsellor, talks to us at Powys Mental Health about what therapy is like from the other side of the room – the counsellor’s chair.

Where do you work at the moment?

I work one day a week at Ponthafren Association in Newtown. There’s a fantastic team of counsellors there and it’s a free and accessible service. I also offer sessions for individuals at my private practice in Newtown. Previously I’ve worked at Mid Powys Mind and Wrexham Mind.

Where did you train?

I studied here in Newtown at Coleg Powys. There is a series of courses from Level 1 – 4, with Level 4 qualifying you to practice. I know a lot of people who have studied the Levels 1 & 2 counselling skills and found it really useful both in personal and professional life. I would definitely recommend it.

We mentioned the counsellor’s chair, actually what’s your chair like?

Aha! Joking apart, that’s a really good question because I’m sure people worry that behind that closed door the counsellor might sit towering over them in an enormous chair or even make them lie on a couch. I really don’t know of anywhere that that happens. In reality the counsellor’s chair and the clients chair are usually exactly the same deliberately, so you are meeting the client on equal terms. If they want to lie down and have a nap though, it would be fine by me but that hasn’t happened to me yet!

So what can you tell us about the counselling experience?

Well overall it’s incredibly humbling. It’s a huge step for a lot of people to come and meet a stranger and talk about their personal thoughts and feelings. I feel that my job, when I first meet them is to put them at their ease as best I can. It’s ironic that some people see going to counselling as a sign of weakness because in my experience when the person first walks through that door, it’s an act of intense bravery.

So what actually happens in a session?

There are many different types of counselling available. I work in a Person-Centred way which is a general approach that can address a wide range of problems. It involves listening to each client and understanding and accepting them for who they are. Also gently reflecting back to them the verbal and non verbal signals you’re picking up. For many clients this may be the first time they have felt truly heard without judgement or criticism. As a result, they start to see their situation from a wider perspective and explore their own ideas for moving forward. That’s the magic bit, when you see that shift start to happen.

It sounds very simplistic but it takes discipline to stay right with the client in their unique world and not let your own opinions interfere. At the same time you need to be aware of any practical or ethical issues and bring the session to a safe close on time.

Different people suit different types of therapy. Some may want more focus on goal setting for example. I would recommend the Itsgoodtotalk website if people want to find out more. If you don’t get on with one individual therapist or type of therapy, do try something or someone else.

Thank you Sorelle for talking to us!

Sorelle White (Dip Couns. / MBACP) runs Blue Skies Therapy, offering one-to-one counselling sessions in Newtown.

You can link to Ponthafren Association here.

Hearing the Voice

Saturday was a rare sunny day so it was destined to be a garden day. However, before heading out to attack some really vicious brambles overshadowing the bean poles, I caught an interesting feature on BBC Radio 4’s Saturday Live programme. A programme guest, Adam, was talking about his experience of hearing voices. (The 12 minute segment starts at about 39 minutes in).

“I have another person living inside my head," he said. "I’m not just hearing a voice I’m seeing a person..... the Captain of my universe..... He is dressed as a Second World War German U-boat captain. He looks like me. He has a scraggy beard... " Adam went on to describe the implications of living with the Captain inside his head. "He has cost me relationships, he has cost me money, he has cost me so much.... "

Adam was posted with the Royal Artillery in Iraq in 2003 – 4, but described this experience as “a walk in the park” compared to the Post Traumatic Stress Disorder he experienced stemming from the time he was bullied at school. The Captain is not the friendliest companion in the world, as Adam goes on to describe. "It’s definitely a darker side of me.... it isn’t me, but it is me...”

Adam's experience of hearing voices has led to his involvement with the project Hearing the Voice: "an interdisciplinary project led by researchers at Durham University... (which) ...  aims to help us better understand the phenomenon of hearing a voice no one else can hear (a phenomenon also referred to as auditory verbal hallucinations) its cognitive-neuroscientific mechanisms, its social, cultural and historical significance, and its therapeutic management."

Those participating in the project talk to one another about what they hear, and work with academics, clinicians, healthcare practitioners, and others with "lived experience" as part of the ongoing research. Adam describes it as  "(The Captain's) turn to pay me back." The project website hosts an active blog, newsletters and links to other sources of support, including organisations such as Intervoice and the Hearing Voices Network.

Speaking publicly helps reduce the stigma surrounding voice hearing - "just because someone says horrible things inside my head doesn't mean that I am that person." Yet, if anything, Adam is reluctant to say goodbye to the Captain anyway:  “If he was taken away who would I be then? My identity is a voice hearer - that's who I am.” The main thing he wants people to understand is that the voices will "never ever leave you but you can still have a life.... you don’t have to be a constant prisoner to your thoughts. There are people out there who understand and who will accept you."