Tonic: surfing for mental health

Every now and again in our team we are lucky enough to meet up with our counterparts in other parts of Wales. Two weeks ago we travelled down to Carmarthen to the office of West Wales Action for Mental Health. We spent an enjoyable and extremely interesting day finding out about the many diverse and innovative projects the staff and volunteers are currently working on. Check out The Recovery Wall project on the organisation’s website, which is using digital media to promote recovery and wellbeing, and Mind Your Heart – a health promotion programme for people living with mental health problems…. not to mention the excellent work with veterans over the past couple of years, which should probably have a separate blog post all of its own – just keep watching this space!

And then there is Tonic – the surfing therapy project…. 

Shôn Devey, the Development Worker leading on Tonic, told us more. He started from a very personal viewpoint.

Ton is Welsh for wave. Staff here realised that they had this fantastic natural environment on their doorstep. Who doesn’t feel better when they go to the beach? Yet some people who live near a beach never go. I ride the waves for my own mental health and wellbeing. It was like a dream come true when Angie Darlington (the WWAMH director) asked me to develop this project.

Tonic was set up 4 years ago. People spend so much time in hideous rooms for their therapy sessions. We thought maybe they’d feel better for being in this great outdoor space. Add an activity as well and you have the extra health benefits of that. Put people into groups – and then you have social interaction. Isolation is a big problem for people locally.

At first people think – “I don’t think I can do this”. It’s a metaphor for other areas of their lives. But engaging with surfers is actually a cool activity. The moment participants enter the water they’re connected with the world’s oceans. It is like putting on a new skin (literally – in the form of a wetsuit). People are suddenly all equal – the teachers, volunteers, participants. We connect with marine mammals - there have been dolphins circling us in the water. Afterwards we’ve had participants volunteering to clean up the beach and engaging with the wider world. 

The programme is open to anyone with mental health problems, a carer of any kind, veterans, and those who’ve experience of substance misuse or alcohol addiction. The current age range is 11 – 72. We have a 72 year old woman who surfs through the winter along with a group of other women. They find that being tumbled and battered in the waves is good for their wellbeing. It’s a really constructive activity for carers and the cared for to take part in together. Children will come along with their parents because it’s “cool!”

All the kit is provided for the 6 week long programme which works out of beaches at Borth, Poppit and Newgale. Participants spend 2 hours in the water, with an hour preparing. So it’s an afternoon each week. Then afterwards we socialise together. We use a lot of volunteers in the water and have developed rigorous health and safety procedures. Volunteers help participants to see their success. Everyone has lots of fun. At the end of each course we have a BBQ and celebration.

People are “wide open” straight after the surfing session so there is a period when it is possible to work on things. We have links to surf therapy projects around the World. In South Africa, working with young people from the townships, after the surfing they run beach school and hold HIV/sexual health sessions. Ultimately we would like to offer a menu of options around engaging with the ocean environment, such as dolphin watching, footpath maintenance and beach clearing. 

This is our fourth season, and there has been a development pathway through the programme. Some participants go on to become project volunteers and then surf instructors. We have trained 12 instructors so far. But the project is not so much about the surfing as about spending time with people in the natural environment. And giving good care and attention to people is key.

It’s also important to help keep people in the water after the programme has finished. One of the volunteer surf teachers runs a Saturday club through the winter which anyone can join. And there is a virtual surf club on Facebook. We are also hoping to develop a physical space at Borth – more information coming soon!

WWAMH is working with Swansea University to evaluate the project. So far across a small sample of people it has been shown to have a significant effect upon people’s mental and physical wellbeing, to the extent that it sits alongside medication as a valid option. Some participants come off a hospital ward, they may be “zombied”, or over-medicated – and then they “wake up” with the first woosh of a wave. It is absolutely incredible. People talk about their new “healthy” addiction.

After tumbling in the waves one of the participants said: “I was brainwashed! I came and my mind was all crumpled and full of anxiety. It was as though someone took my brain out, cleaned it and put it back in my head.”

Tonic has been highly commended in the NHS Awards and is now beginning to be accepted as mainstream, with a 2 year service level agreement being set up with the Child & Adolescent Mental Health Service (CAMHS) team. The project is also in the process of being established as an independent charity with a board of trustees. Future development opportunities include weekend packages for groups – a sort of mental health tourism. Suddenly people really want to be a part of it!

Powys meets West Wales!

Back row: WWAMH - Lewis Phillips - IT Officer, Shon Devey & Charles Macmillan - Development Officers. 

Our team - Freda Lacey (Participation Officer), Jane Cooke (Interim Senior Officer Mental Health), Jackie Newey (Projects Officer) & Glynis Luke (Admin, Information & Communications Officer).

Front row: WWAMH - Marie Wright & Tim Teeling - Development Officers, Angie Darlington - Director, 

Jan Batty - Mind Your Heart programme Development Officer.

Shôn’s enthusiasm for the project is infectious. We all agreed it is an absolutely brilliant project, and wish we had the seaside here in Powys (though Borth is not that far away for some of us)! What kind of physical activity project would you be interested in here? Let us know.

Shakespeare and mental health

Our guest author Philip Bowen runs Shakespeare Link, a highly praised theatre company specialising in the Great Bard’s works which provides a valuable community resource. It is based at the Willow Globe near Llandrindod Wells in Powys – a scaled down living version of The Globe in London.

During 2014 – 2015 Philip also took on the voluntary role of High Sheriff of Powys, and contributed hugely to the work of various voluntary sector mental health organisations. He worked with Powys Patients’ Council to open the Wellness & Recovery Room at Bronllys Hospital in the summer of 2014, presented an award to Ponthafren Association for ‘Recognition of Great & Valuable Services to the Community’ in October 2014 and spoke at the Winter 2014 Powys Mental Health Alliance Open Day in Llandrindod Wells.

As next week (April 23 to be precise) is the anniversary of the playwright’s birth (and death) we decided to catch up with Philip for his take on Shakespeare’s depiction of mental distress.

Tell us about the connection between Shakespeare and mental health

Shakespeare would have been surrounded by mental distress. There was no such thing as “care in the community” in the 17th century. The characters in his plays often go through a fracturing or breaking down followed by a reassembling at the end. This seems to go hand-in-hand with marriage which is often perceived as a healing element. There is a search for harmony within both the characters and the storyline.

In which of Shakespeare's plays do you think mental distress is most evident?

In Macbeth the image of madness or mental ill health is so accurate – it shows the troubles scored into the very inside of a person. I particularly like the quote from the Doctor when he is ministering to the troubled Lady Macbeth. He says “Therein the patient Must minister to himself.”

In the late plays – Cymbeline, Pericles, The Tempest – the characters tell their story and at the end of the play a big part of the healing is “knowing thyself;” “to thine own self be true.”

Cast members from the 2013 production of All's Well That Ends Well

Tell us about some of your own experiences playing Shakespeare's characters who are clearly mentally distressed and how that impacts on you

There is a feeling you cannot escape it. Even in the dressing room you can hear the rest of the play going on over the tannoy. I played Hamlet at the Young Vic – it was an extraordinary experience. Is it assumed madness or genuine madness? Hamlet almost negotiates himself into madness – it infects him more than he realises. Sometimes madness is a privilege.

Love is a form of madness. As Theseus states in A Midsummer Night’s Dream: “The lunatic, the lover, and the poet are of imagination all compact.”

Tell us about your work in the community and what drew you to develop that side of your work

Sue Best and I have used Shakespeare’s plays as a means of training for family therapists. It’s intriguing for us – together we look at the work of the therapists and the scenes from the plays, particularly the characters’ minds. 400 years ago a man was writing about scenarios that the therapists work with today and forming a methodology by writing a story.

The development of character through story was the great development of Shakespeare’s time. Previously characters in drama did not change that much. In Shakespeare they develop, grow and become rounded. This is particularly shown through the soliloquies.

Shakespeare belongs to us all, it is not just the property of academe or the big theatres. It is a major cornerstone of our culture. I have travelled a lot in the Third World, in West/South/East Africa and the Far East. There is a fascination with Shakespeare in these places. He flies in under the radar politically. We worked in Malawi in the 1980s when Hastings Banda was president of the one party state.

Phil working with Celf O Gwmpas

Back in the UK we took The Tempest into Maidstone prison for seven weeks. I played Prospero, and other parts were played by the prison inmates. The work had a huge impact on the inmates and the audiences, which were made up of other inmates and members of the public.

We also did work at the Home Office secure unit at Reaside in Birmingham. There was a lot of interesting discussion about control and restraint – a major theme in The Tempest. A conversation would start up – “remember that first night when we got banged up…?”

There is a recognition and a realisation amongst people that what they are acting has a real relevance within their own lives.

What about your work in Powys more recently?

Last year we did some weekly drama workshops with the patients on Felindre Ward at Bronllys Hospital and the Occupational Therapists there. They were called “Acting Up” and really well received. People said “you’re stopping us having our cigarettes!” (You can read more about the Bronllys workshops and some feedback from participants on page 2 here.)

What does the outdoor performance bring to the experience of Shakespeare?

It’s the Nature side of it – Shakespeare was a country man. London was small then. There was more wildlife in the sky. “Halloo your name to the reverberate hills,” says Viola in Twelfth Night.

At the Willow Globe we have Shakespeare based nature trails with relevant quotes from the plays on slate. It helps people understand what he’s talking about. “Where the bee sucks, there suck I,” sings Ariel in The Tempest. You can find this quote next to the bee hives.

In what way are the words and wisdom of Shakespeare a "fundamental, behavioural and spiritual resource far beyond the preserves of conventional theatre or academe"?

The plays are a fundamental resource. You can learn about human behaviour and spirituality – the connection with the outdoors. Somebody once said about Radnor – “it’s a thin place here…. Because the spirits come through.”

Many thanks to Phil for talking to us. If you'd like to find out more you can watch a YouTube video about the Willow Globe Theatre and Shakespeare Link here.

Mental Health & Missing Person Support Officer - Dyfed-Powys Police

Carina Giannuzzi is the Mental Health & Missing Person Support Officer for Dyfed-Powys Police. 

We recently worked with Carina, and colleagues at West Wales Action for Mental Health, to produce some mental health information cards for use by police officers who come into contact with people experiencing mental distress.

We caught up with Carina recently to find out more about this project and other vital work she is doing in Powys and Ceredigion.

Tell us more about the work you do

I started in my current role as Dyfed-Powys Police’s Mental Health & Missing Person Support Officer on the 1st September 2014, and from the start have been involved in two major projects which are ongoing.

One is the Mental Health Triage Team run in conjunction with Hywel Dda University Health Board and although the project does not cover the county of Powys, it does cover Ceredigion, Pembrokeshire and Carmarthenshire. The other is the Time to Change Wales anti-stigma campaign to tackle the discrimination surrounding mental health where I assisted Hywel Dda with a week of events they held last October.

I am a member of various mental health related groups, both internally and externally, and attend regular meetings relative to these.

I am also responsible for collating data and providing reports; receiving and identifying areas of work that require improvement to deliver change and am involved in multi-agency and partnership working.

What led you to this particular role in the police?

When I read the role profile for the post it sounded so interesting, worthwhile and rewarding that I thought “I want that job!” and thankfully I was successful in my application.

I also have a personal interest in mental health which I feel benefits that side of the role due to my understanding the impact that mental ill health can have on individuals, their family, friends, colleagues and employers.

What is the most challenging aspect of the job?

I would say juggling the two sides of the role as both aspects are equally important and demanding areas of work.

Are there particular issues which arise in rural areas for people experiencing mental distress?

Isolation is probably one of the biggest factors. Many people living in rural areas reside in remote locations and will not have neighbours close by that they can call upon. Their family and friends may not live close by and transport to visit them or just a trip to the shops can cause issues for some people, especially the elderly. Regular contact and communication is key for these people.

Why do you think the police are often the first point of contact for people experiencing mental distress?

When a person is in distress or at crisis point they want immediate assistance. They may not know who else to contact for help and by telephoning the police they know that they will get a response 24 hours a day. Many services are not available out of hours and this is another reason police are contacted.

What is the biggest issue for police officers trying to support people in the community who are mentally distressed?

Accessing the necessary services to provide them care and assistance they require in a timely manner. This is particularly prevalent ‘out of hours’.

Dyfed-Powys Police are working hard to provide better support for people in mental distress (see here for example). Tell us about the latest initiatives and any feedback you have had.

Our Chief Constable Mr Simon Prince has just signed an organisational pledge on behalf of Dyfed-Powys Police to show our commitment to the Time to Change Wales campaign to tackle the stigma and discrimination surrounding mental health. I will be putting plans in place to take this campaign forward.

We are also looking at a safety card for people with mental health, learning disabilities/difficulties and dementia who may come in to contact with the police for any reason, for example, if the person is in crisis, lost or wishes to report a crime. The card will provide the officer with their name and details of their condition. It will also provide the name and details of a person police can contact to assist them dealing with the individual they have come in to contact with. This will be of benefit to both the individual and the officer. Once the design and content have been agreed, we hope to have this in place in the next few months.

Dyfed-Powys Police, in conjunction with Hywel Dda University Health Board, has set up a Mental Health Triage Team to respond to mental health related calls received by police. The scheme commenced at the beginning of January 2015 and initial feedback and statistics are very positive. Although the project has only been running for a few months, it has already been nominated for and NHS award.

How will the mental health information card we worked on together recently help?

The cards will provide an extra 24 hour point of contact for people who do not know where or how to obtain help, with the mental health team at Powys Association of Voluntary Organisations (PAVO) and West Wales Action for Mental Health (WWAMH) providing another line of contact to advise people what is available in their communities. There are so many valuable services in the third sector that people do not know about and it will also help to raise their profiles and that of PAVO and WWAMH.

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

Powys Teaching Health Board is the main organisation. I have recently met with HUTS (Help Us To Survive), Hafal and Noddfa at a Ceredigion Voluntary Group meeting and am hoping to work more closely with all three of them in the near future.

Where do you think the 3rd Sector fit into the picture? Would officers be confident about signposting or referring people to voluntary organisations?

The third sector can and does play a major part in mental health. There is wealth of fantastic work going on that people are not aware of that is assisting so many individuals and their families. Our Triage Team officers and Force Communication Centre staff are already signposting and referring people to voluntary organisations. It is a matter of making our staff aware of what is available throughout the Force area and what services these organisations offer. One of the ways this is being done is by adding these organisations to our internal Force Mental Health Information Page. Many have already been added and as I come across new ones, they are being added to the site.

Is there anything more the 3rd Sector could do to support the police in their work with people experiencing mental distress?

I believe the third sector is already supporting police in their work.

The only suggestion I have that may be useful in raising the profile of voluntary organisations within the police (if not already being done) would be for them to invite local Neighbourhood Policing Teams along to meetings or events they are holding.

What is the most valuable thing you have learnt since starting your role?

I am finding this very difficult to answer! I have learned a great deal, particularly in relation to the third sector and the fantastic work they do. I had no idea until I started in this role and I find it very inspiring.

When you are not working for Dyfed-Powys Police, how do you enjoy spending your time?

I have a wonderful family and friends who I love to spend time with.

I love to read books of all sorts and am keen on history, fashion and art. I also like to sew when I have the time and have just started exercising again to try and gain some level of fitness once more (said through gritted teeth)!

Many thanks to Carina for telling us more about her work. If you have any queries or comments we would love to hear from you.