We are all in it together

This week's guest post is from Philip Moody, who is an Adult Carer Outreach Worker and Carers' Advocate in North Powys for Powys Carers Service.

I was visiting the PAVO offices at Plas Dolerw just to get my post and Jackie Newey, Project Officer PAVO's Powys Mental Health Information Service, waylaid me and asked me if I would write this blog post. Seriously Jackie, thanks for asking me. So here is some information about Powys Carers Services and a few rambled thoughts.

I have worked with Powys Carers Service for 13 years as an Outreach Worker/Advocate in the Montgomeryshire area and support adult carers. I work from home (just outside Newtown) and we have an office in Llandrindod Wells. As a service we endeavour to support unpaid carers, adults, young adults and children alike.

We try to empower these carers and give them support, information, one to one support, advocacy and a lot more. We do believe it is important that everyone’s voice is heard and “carers” voices should be heard as well. Their views should not be lost because we live in a noisy world.

So why did I chose the title for this blog “We are all in it together”? It sounds a bit like a socialist catch phrase. I have had lots of different jobs including Baptist Minister and Trade Union rep! However the reason for the phrase - “We are all in it together” is because of what I experience day in, day out.

I support people who care for folks who may have poor mental health. I also support carers who have mental health issues themselves and care for someone who is physically ill. I work alongside other professionals who struggle sometimes with their own poor mental health and at stressful times in my life have battled with a few “dark days” myself. (Life can be complicated and not fit neatly into a box!) So whether its physical or mental health issues “We are all into together”.

Poor mental health can knock on anyone’s door and often does. When I visit a carer for the first time, they tell me their “story”. I still find it a privilege to be let into their lives. Some carers I visited told me their experiences - they were a couple whose child had gone to university, had returned home and was seriously ill with depression. As I listened they told me about their hopes, fears and challenges both now and in future.

That’s a story I have listened to on more than one occasion with slightly different twists and turns. Stories differ but we try to be there for carers. Powys Carer Service never closes a case until folks are no longer caring or someone asks us to. We will also continue to support people for a few months after they have stopped being carers.

While I do not have a magic wand, Powys Carers Service does seek to make a difference, whether it’s filling in Personal Independent Payments (PIPs) applications, supporting someone in a medical assessment, assisting you to make a complaint/compliment or “just” listening to your story.

We will visit you in your own home or meet you in a café near your home, the choice is yours. Powys Carers Service also works alongside other organisations and values the services they provide - because “We are all in it together”. Together we can provide a better service to carers. We seek to listen to the goals and needs of carers and support them in any way we can.

In addition, the carers I know give so much back to me - it’s a real privilege to know them.

Powys Carers Service has support workers throughout Powys and office staff who have lots of information. If you are a carer, or just want to know a bit more about the work we do - give us a call on 01597 823800 or check out our website.

Good mental health is important for everyone and like it or not “We are all in it together”. 

Many thanks to Philip for telling us about his role at Powys Carers Service. If you have experience as a carer in relation to mental health which you would like to share, we would love to hear from you. Comment below or contact us by email - pamhinfo@pavo.org.uk, tel - 01686 628300 or twitter - @PAVOMH.

Young Adult Peer Support workshop @ PAVO AGM

L-R: Julia Gorman (YAPS co-ordinator), Robin Green (YAPS Assistant Co-ordinator)
 - both with Ponthafren Association, and Sarah Harmon

Just last week I joined colleagues to help at our annual PAVO AGM which took place at the Royal Welsh Showground near Builth Wells. In the Chair's invitation to the AGM, Gloria Jones Powell wrote: "Welsh Government's White Paper, Reforming Local Government: Power to Local People, states that we need to be: 'Putting people at the centre and involving service users in prioritising, commissioning, designing, delivering and accessing services'. Unlike the usual approach to consultation and engagement, the projects within PAVO's One Powys - Connecting Voices portfolio invite commissioners, service providers and others to listen to what's important to them".

The Young Adult Peer Support (YAPS) project, which is one of the One Powys - Connecting Voices projects funded by the Big Lottery Fund, held a workshop at the AGM. It was attended by representatives from Powys teaching Health Board, Powys County Council, and numerous voluntary organisations and individuals, all of whom had an interest in mental health. My role was to support the project facilitators on the day, and so it was I joined Julia Gorman, Robin Green, and Sarah Harmon - one of the young people involved with the project - to capture feedback about mental health services from those attending. 

The YAPS project is delivered by Ponthafren Association, and offers peer support mentoring to young people (16-25 years old) who experience mental health issues, by helping to give them a voice of their own in the development of services. A project volunteer wrote about her experience for us last year, and we featured the project video "I don't let mental health define me" earlier this year.

The YAPS team had devised an intriguing game to carry out for the first half of their workshop. They had raided all the Ponthafren board games for dice! The aim of the game was to try and access mental health services as young people would do in the real world if they were experiencing mental distress. Starting at home, a simple throw of the dice would see the workshop participants on their way to the various services on offer in Powys. How hard could it be!

Martin Nosworthy, PAVO trustee, at the start of the YAPS game

Depending on the throw of the dice participants would be directed to one of various stages around the main hall at the AGM venue. They might be sent to College, a Friend's house, the GP, Ponthafren Association, the Police, or Child & Adolescent Mental Health Services (CAMHS) for example. On the way to their next "station" in the game, they had to negotiate chairs, tables, and numerous other players of the game, all competing to reach their own stage and win the support they so very much needed.

Those lucky enough to reach College/University then had to throw again. 1 = too anxious to go - return home, 2 = bad day - get a Crisis Card, 3 - 5 = good day = go to friends, 6 = pass an exam - take a chocolate and go home. 

The Crisis Card was particularly bad news. It stated: Stop taking your medication, lose a chocolate and go to the GP...

The pile of sweets did go down slowly, but most people, whilst glad to pick up an occasional reward, were starting to feel increasingly frustrated about how often that they had to return home....

Many participants made it to the GP surgery, including Kate van den Ende, one of the reps on the Mental Health National Forum, (who wrote for us very recently about Dual Diagnosis).

However, over at Child & Adolescent Mental Health Services there were very few arrivals...

And at the Police Station whatever the throw of the dice, the news was not good. 1 - 2 = get fined, go home and return a chocolate. 3 - 6 = cautioned, and go home.

After 30 minutes the game was stopped and we gathered the participants together to get their feedback. Everyone expressed frustration at not being able to access the support they needed. They kept "getting caught" or "having to return home". Their frustration escalated significantly when they learnt that one dice roll was equivalent to one whole day! They said that the situation was totally unpredictable and completely out of their control!

Only two players of the game acquired the elusive Mentor Card and were less likely to be trapped at home. They quickly realised that they: 

• Would no longer be sent home.
• Had increased confidence.
• Felt more comfortable. 
• Could do things and get results. 

As Robin explained: "That is what peer support does. This is what YAPS does."

It was a brilliant game. And both a brilliant and fun way to convey to people the increasing frustrations of a young person trying to access services and being passed from one to another without ever getting to the root of their problem.

Barbara Perkins (centre), PAVO One Powys Connecting Voices Officer
with Sarah and Robin

The workshop continued for another half an hour with an animated discussion around the value of the YAPS Project and the many barriers to young people accessing relevant services in Powys. Watch this space for further updates as the One Powys - Connecting Voices Project continues to make a difference to the way in which public services are planned and delivered. Over at YAPS they are listening hard and looking to suggest some very innovative solutions.

The YAPS Project runs its own blog called VOX. Check it out here.

Dual diagnosis - changing times

Dual diagnosis - co-occurrence of a mental health problem with a substance misuse problem.

This week’s post is from our guest author Kate van den Ende. 

Kate is one of three representatives on the National Mental Health Forum in Powys. There are ten such networks across Wales, feeding in to the National Partnership Board – where those using services, carers, professional groups, the statutory and voluntary sector and government departments across Wales meet three times a year to oversee the delivery and implementation of "Together for Mental Health – A Strategy for Mental Health and Wellbeing in Wales".

The bad news

If you live with a mental health problem, you are more likely than the rest of the population to have to manage a problem with substance misuse as well......and vice versa.

The most commonly used 'substance' is alcohol, but, in the world of addiction, the understanding is that, at different times, we use different 'substances' to support us, to self-medicate - a horrible term used by professionals! So alcohol can be interchanged with food, drugs, relationships and/or gambling as the 'substance of choice' at different stages of our lives, depending on which is available or which fills the need at that time.

The double whammy of co-occurrence used to be considered a rarity but, as any of us could have told the professionals, statistics show that it is more like the norm..... and if you have a severe and enduring mental illness like schizophrenia or bipolar disorder, your chances of having to cope with both is considerably increased again.

Assuming that co-occurrence was a rarity meant that the two sides to the problem tended to be treated separately, as if they were symptoms of two completely different, unrelated conditions. People were shunted between the separate services and, surprise, surprise, they fell through the gaps!

Our experience was just that.

An appointment would be made to see the mental health team or psychiatrist. Nervousness and self doubt resulted in large quantities of vodka. The professionals refused to see a drunk patient. An appointment was made to see the drug and alcohol service. Nervousness and self doubt resulted in large quantities of vodka and a failure to attend the appointment. This in turn fed into the 'I'm rubbish, just see how rubbish I am....I can't get help even when it's offered.' Vodka again, with pills this time. A&E admission and a couple of days to check liver function before discharge either directly home to exhausted and lost carers or mental health ward, with or without Section. Medication, escapes to buy vodka, discharge to the even more exhausted and despairing carers.

An appointment would then be made to see the mental health team....vodka.....no change in mental distress......appointment with drugs and alcohol service....vodka......further reason to beat herself up.....vodka and pills.....A&E.....Section.....revolving doors, escalation of the problems.....further desperation for carers....

And so we went on, for 18 months, with the reliance on vodka and the self harming reaching ever higher, dangerous levels. Neither service looking beyond their particular remit. Nobody was looking at the whole distressed person, with all her complexity of problems.

The good news 

Changes are being made to the way help and treatment are offered to people battling with co-occurrence. Indeed, changes are being required by the Welsh Government. If you talk to service providers in Powys, they will tell you that they have already started on a new, joined-up approach. Drug and Alcohol services are provided in Powys by Kaleidoscope and CAIS. They have started to work out ways of joining forces with the local mental health services, to deliver 'seamless' provision.

But the new legislation demands far far more. Seamless delivery is just a start.

It includes:

"It must not be left to the service user to navigate between substance misuse, mental health and other related support services themselves." They and their family will have a nominated, responsible key worker to help them find their way.

There must be "absolute clarity on which agency is leading and coordinating care."

An integrated approach, with clear treatment protocols and care pathways will provide "holistic, person-centred care."

To deliver these improved services, the Welsh Government recognises that:

Professionals on both sides will need considerable training "to overcome institutional and cultural assumptions."

So, from December this year, when Powys teaching Health Board resumes complete control over, and responsibility for, the commissioning and delivery of services to those in mental distress in this area, they have been offered a fine example of the kind of services we want, whether or not we have a co-occurring substance misuse problem.

Integrated, holistic, person-centred and individually tailored to our needs, delivered by teams of well trained professionals who work together and who listen!

That’s the kind of support we need to recover control over our lives.

Bev Clarke - award-winning volunteer counsellor Ystradgynlais Mind

Bev receiving her Outstanding Contribution Award from the
High Sheriff of Powys, Lieutenant Colonel Mike Lewis DL

Bev Clarke has been volunteering at Ystradgynlais Mind for the past 4 years as a Level 6 counsellor / supervisor, enabling the mental health charity to provide a free counselling service to the community. She volunteers 3 days a week. She has enabled the recruitment of 7 further student counsellors, who benefit from her supervision and guidance. Her input both into clients and students is life changing.

In October 2015 Bev was winner of an Outstanding Contribution Award at the Powys Volunteer of the Year Awards. Her nominator said: “Bev has experienced her own difficulties throughout her life and she demonstrates you can overcome anything and give so much to the community despite those difficulties. She inspires all at Ystradgynlais and is loved and respected.”

Carol Stephens, Chief Executive at Ystradgynlais Mind, said: “We are thrilled about Bev's award, it is so well deserved. She's a diamond.”

We talked to Bev to find out more about her invaluable contribution at Ystradgynlais Mind.

What originally motivated you to start volunteering at Ystradgynlais Mind?

I graduated from the University of South Wales at Pontypridd in 2009 (Bachelor of Science (BSc) Hons, Systemic Counselling) and was looking for a counselling placement. I needed 450 hours of supervised counselling for my accreditation. I have 1050 now, 800 of these from counselling sessions at Ystradgynlais Mind.

I first came over to Ystradgynlais looking for plants and saw that there was a Mind centre here. I set up my own counselling practice in Port Talbot with a friend from university and volunteered my services to Ystrad Mind. Carol interviewed me and it went really well. She said – can you start next Wednesday?!

I have bipolar and Carol said “we’re looking for people like you”. It’s been a wonderful experience. I didn’t have to hide my mental health issues, it was like the start of a new beginning.

Carol and I share the same vision – which is to do the best for our clients and also to provide good packages for our student counsellors.

Tell us more about your role as a counsellor at Ystradgynlais Mind

A lot of men come to us for counselling which is unusual. It stands out at about 55%. They have moderate issues as they almost leave it too late to seek help. Women are not afraid to access the service, so their issues are often mild to moderate.

Most of our clients are middle-aged – in their 40s and 50s, with various issues. Often they might be waiting for treatment from the statutory mental health teams so they seek support from the voluntary sector instead. They usually have about 7 – 8 one hour counselling sessions, weekly or fortnightly depending on the complexity of the issues.

How does counselling make people’s lives better?

It is a forum where people can be heard. They take their issues away from their families and share them with someone else who is prepared to listen. They have more clarity with the help of a counsellor and so see things that they couldn’t before.

Who is eligible to receive the counselling service, and for how long can they access support?

The service is available to people 17 +. They can self-refer – some people walk in off the street - or they are referred by the GPs in the Abertawe Bro Morgannwg University Health Board cluster area.

If your role didn’t exist, what would happen to people who needed support with their mental health in Ystradgynlais and district?

I’ve seen mental health care decrease unbelievably in the past 4 – 5 years. There is no help there for people. Mental health isn’t a “sexy” health condition, so there is no investment or focus as with other ailments. It feels as if mental health is the poor relation. This is really obvious when working in the Third Sector.

Tell us more about your work supporting 7 student counsellors

I provide support for them, which includes 1½ hour supervision once a month where we’ll talk about the issues that have been raised with clients and signposting options for people. I also make sure that the counsellors are safe, and don’t take home any issues that could impact on their lives.

We source new student counsellors when we need them from the universities. The students are supposed to complete 100 hours of supervised counselling here, but some have already done 300. We give them an excellent level of support, their insurance is covered and they enjoy the experience here so they stay.

I believe you also provide counselling for GP patients in a neighbouring health board?

Our counselling services have now been taken on by GPs in the Ponterdawe and Neath Valley area so it has been well worth it.

Tell us some of the hardest things about being a volunteer counsellor

Watching how hard it is for those working and volunteering in the Third Sector to apply for grants and funding just to make ends meet. I’m here 2 – 3 days a week, but Carol is here for 5. I know how hard she works and how little she takes. I’ve got a bigger picture as a volunteer.

What is the most rewarding aspect of volunteering at Ystradgynlais Mind?

To see how the clients improve. And most of them give back – for example they give talks on their own mental health which is so enlightening for the student counsellors. It’s great the way that they find it good to say what they’ve been through. Clients also feedback to counsellors in supervision sessions.

What was it like winning the Outstanding Contribution Award at the Powys Volunteer of the Awards ceremony?

Well, at the end when I knew it was me who had won – my first thought was – don’t fall down the steps! There were fifty to get down!

I’m so proud of myself. My daughter was with me and she said – “you’ve set the bar even higher now!” To hear the words Carol had written when she put me forward for the award was wonderful.

The narrative of my own mental health issues was a guilty secret for so many years, it is almost a relief to talk about it now.

It was just a wonderful experience.

What would you say to encourage other people to volunteer to support people experiencing mental distress?

Don’t be afraid. We seek help from a psychiatrist in the same way as someone who is diabetic would go to a medical ward. It’s not like “One Flew over the Cuckoo’s Nest”. We’re working with wonderful people who just have unfortunate mental health issues.

I have enjoyed every minute that I’ve given to Ystradgynlais Mind.

Many thanks to Bev for telling us about her role at Ystradgynlais Mind. You can contact the charity by emailing info@minditv.org.uk or ringing 01597 824411, or visit the Ystradgynlais Mind website.

You can read more about the Powys Volunteer of the Year Awards on the PAVO website.
Outstanding Contribution category: These awards are in recognition of the outstanding contribution and commitment made to voluntary activity. The volunteering undertaken is selfless, a response to local need coming out of the community and is carried out willingly.

The Judges’ Panel was made up of PAVO trustees - Gloria Jones Powell, Ian Charlesworth and Keith Rollinson. The panel felt that Bev stood out because of:

• Her willingness to support others achieve their goals.
• She has overcome huge personal adversity in order to help others.
• Her unyielding commitment to the organisation she volunteers for.
• The difference she has made to the organisation on many levels.
• The difference she has made to the local community.

Claire Sterry, County Development Officer for PAVO, who helped organised the 2015 awards, said: “Bev is truly inspiring, it was an honour to meet her - she is a very special lady, and so unassuming!”