Positive Action for Change in Mental Health Services - Part 1

In November last year I attended this one day conference organised by PCCS Books in Nottingham. Two of the keynote speakers – Lucy Johnstone and Sami Timimi – had previously travelled to Powys to speak at a conference organised by our team in March 2014 - Finding Meaning in Psychosis: Early Intervention Services. This conference had highlighted the debate that challenges the validity of ‘mental illness’ diagnosis and raised questions about whether the idea of ‘mental illness’ is useful in driving innovation. However, due to leave I had been unable to attend. So, I was really keen to make the trip across country now to find out more about implementing innovative approaches to mental health distress. And the conference promised not just two but several inspirational speakers.

PCCS Books is an independent mental health publisher dedicated to the demedicalisation of distress, and person-centred, recovery-focused mental health services. The name developed out of a training organisation called ‘Person-Centred Couselling Services’, and at the conference (I think they organise one every couple of years) Director Heather Allan welcomed everyone and set the scene for the day:

“The case for demedicalising mental health services is well rehearsed. The research has been done, the conferences have been held and the intellectual argument all but won. Yet on a day-to-day basis, services continue to operate within the medicalised status quo. One of the aims of this conference will be to look at how we can implement realistic, practical changes in our mental health practice, education and lives, in order to continue the progression from rhetoric to reality.”

Due to limited space I can only touch briefly on the speakers’ presentations with a focus on their practical suggestions for bringing about change in working practice. (Full presentations are available here however).

Lucy Johnstone – Challenging, compromising or colluding? Some thoughts on trying to bring about change in mental health systems

Lucy made regular reference to her own personal situation working as a Consultant Clinical Psychologist at the Royal Glamorgan Hospital for Cwm Taf University Health Board in South Wales. This is the most socially deprived area in the whole of Wales, where 13% of the population are in contact with mental health services. It was a very medicalised service when Lucy arrived.

Lucy has since introduced an approach called “team formulation”. Regular meetings take place involving services in contact with an individual experiencing distress, within Community Mental Health teams, Assertive Outreach teams, rehab services and inpatient wards, to develop an in-depth understanding of that person’s particular difficulties. Staff will then work together to tailor any support to the needs of the individual rather than applying a one-size-fits-all approach. Using a case study of a 17 year old girl hearing hostile voices, Lucy contrasted the medical approach, which resulted in a diagnosis of psychosis/schizophrenia, to the way team formulation drew out the young woman’s story of abuse and bullying over a period of years. The latter approach acknowledges that responses such as hearing voices are survival strategies – “a normal reaction to abnormal circumstances.” 

In Cwm Taf team formulation has spread organically and not aroused much resistance. Lucy explained that her colleagues may not always agree with her approach but they take her stance on board, and some people are shifting away from using diagnostic approaches. The team formulation approach had led to “a change in thinking” and become “part of the culture as a word and a concept.”

“Instead of giving a diagnosis, we need to listen to people’s stories.”

Peter Beresford – From mental health to mad studies: making involvement real

Peter Beresford was introduced as the first “out” mental health service user to become a professor (Professor of Social Policy at Brunel University in London in fact). He spoke knowledgeably about the political background to current mental health service provision, noting politics’ powerful alliance with traditional psychiatry at the expense of those living with mental distress. He believes that “lived experience” is devalued by government, and rather than trying to influence politicians we would be better advised to take the initiative ourselves. Peter’s recommendations included:

• Resisting forced employment and impoverishment.
• Holding on to good participative practice.
• Listening to service users.
• Encouraging service user input in professional training, which has a real impact on service culture.
• Focusing on changing the future for mental health and service users by innovating, by developing our ideas for change and our practice.

Peter also spoke about the value of Mad Studies, and referenced the recent conference Making Sense of Mad Studies which my colleague Anne attended in early October.

“We have to be courageous and rigorous and stop hoping that powerful big voluntary organisations will speak for us.”

Look out for Part 2 of this conference report next week, when I feature the talks of keynote speakers Sami Timimi and Pete Sanders. You can also find out more about the Soteria Network and the British Association for Person-Centred Approach, along with other organisations who attended. Thanks for reading, and let us know your thoughts on these ideas and approaches in the comments box below.

Meet Mandy Pearce - Reablement Worker at Mid Powys Mind

In 2015 Mandy Pearce started as Mid Powys Mind’s new Reablement Worker, funded by the Lloyds Bank Foundation, in a new three year project to help support people in transition from hospital. 

Working originally with patients from Felindre Ward in Bronllys Hospital, South Powys (a ward offering acute inpatient mental health services) the Reablement Service offers much needed support to people coming home after a medium to long term hospital stay.

We caught up with Mandy recently at her Llandrindod base to find out more about the project has evolved since she started last summer.

What does reablement mean exactly?

The reablement approach is well known in physical health. It is newer in mental health. It is short intensive support, usually offered to people in their own homes, after a stay in hospital and during a period of ongoing recovery back in the community.

I have access to patients’ Care Plans, liaise with their Care Co-ordinators and also attend their discharge meetings. Once they have left hospital I then visit them and provide support depending on their needs. This can be very varied depending on individual situations. Two of my first clients had been long-term patients on the ward – one for 12 months. There was a lot of work to be done. People become quite institutionalised and it can be quite scary returning to the community. Even going to the corner shop can be hard.

Some people, meanwhile, are only in hospital for a couple of weeks and then quickly get back on track with their lives once they leave.

How does reablement make people’s lives better?

It provides additional support that hasn’t been there before. It’s about looking at people’s needs. Isolation is a key word really. The hospital reflects that sense of isolation back to the patients. They have been unwell at home for quite a long period, perhaps staying indoors, maybe even in bed. Then they go into hospital and are still quite isolated.

Originally I thought the role would involve carrying out practical tasks such as looking after a pet or going shopping. But people want to talk. That’s often their main need. We have to be flexible in our approach and try and meet people’s needs.

Who is eligible to receive the service?

When I started it was just available to ex-patients of Felindre Ward who are from the Radnorshire area of Powys. However, my remit has now been extended and I work very closely with the Crisis Resolution Home Treatment Team which is based at Bronllys Hospital. Staff in this team support people to remain at home, and when people are discharged from their care they can be signposted to me for further support.

How was the need for your post identified?

Colleagues at Mid Powys Mind originally identified a need through speaking to staff at Felindre Ward and the Crisis Home Treatment Team. They then worked on a funding bid and were pleased to receive an award from the Lloyds Bank Foundation to fund a 3 year project.

Key to my role is my link with Mid Powys Mind. Mind offers a comprehensive service with many different facets, and I can help people understand the service and access the right area. People might just sign up for counselling or go to the art group once a week. It’s whatever works for them. More often than not it puts routine back in to their lives plus it gives them the opportunity to spend time with others who understand.

I can also signpost people to Tim Skelcher, our 1:1 Recovery Worker. 

You mentioned isolation, what are some other typical difficulties that people face upon leaving hospital?

Yes, isolation is a key factor as well as low confidence and, of course, stigma. Living in rural areas is not only a contributing factor to isolation but can make someone feel that all the locals have an idea of what has been going on for them and although things are improving around awareness there still is a certain amount of stigma surrounding mental health issues.

Returning home from hospital can be daunting for patients as it can be a reminder of how unwell they were before their admittance to hospital. Properties have been left and the environment can be reflective of how unwell someone was. So, practical help in sorting and organising can be really helpful. There can also be a backlog of mail that needs attending to. This can be stressful depending on what it is.

How long does your support last?

I work with people for up to eight weeks following their discharge. However, if I feel they need further support I can request an additional four weeks. It can take a long time to get there sometimes.

I visit Felindre Ward regularly so that people know who I am and generally have a chat with the patients. There is not enough talking going on. Interpersonal skills are so important to people’s recovery. When I start working with a patient I often find that they just want to have a good chat.

How do people stay safe, well and independent once the reablement support has finished?

Some clients may already be in receipt of additional support via the Community Mental Health Team and other care organisations. However, as part of my post it is important to try to engage people with the service of Mid Powys Mind and introduce/support them to access possibly outreach groups and many other activities that Mind has to offer.

Tell us how your work fits in with that of other voluntary sector groups

At Mind we have been working hard to create better working relationships with partner organisations that can offer a specialist service to cater for a client’s specific needs. For example - drug and alcohol support, housing and tenancy. Also, doing something meaningful with their time when further along on their recovery journey can play a very valuable role, so volunteering themselves could be an option.

What are some of the hardest things about working on this project?
I suppose one of the hardest things about this job is that time is limited. During my time with a client I can develop a good working relationship and in order to do this there is a certain amount of trust and understanding realised. It is hard when our time comes to an end for them and all clients so far have said they wished it could have been for longer.

The nice things about working on the project?

The nice part of this post is, of course, seeing clients develop and their confidence build and an ability to push their boundaries and try new things.

Any other recent developments at Mid Powys Mind you can update us on?

We are developing a youth peer support group (18 – 25 year olds) which meets weekly on Tuesdays, 1 – 3pm, in the Training Room at the Resource Centre. It is great to be able to put young people in touch with their peer group and signpost them to other services that can be useful to them. We’re planning to work again with Owen Griffkin later in the Spring with more Havin’ A Laugh workshops. And a professional animator will be coming in to bring people from different generations together and interpret their stories using animation, so we’re very much looking forward to that. 

Many thanks to Mandy for telling us about the Reablement Service at Mid Powys Mind. You can contact Mandy by emailing re-able@midpowysmind.org.uk or ringing 01597 824411.

Top mental health vloggers & videos

Happy New Year! Traditionally we start the New Year by recommending some of our favourite blogs. In the past we have covered mental health and also dementia. This year we’re looking at videos and vlogging.

“A vlog (or video blog) is a blog that contains video content. The small, but growing, segment of the blogosphere devoted to vlogs is sometimes referred to as the vlogosphere.”

There are a surprising number of people vlogging about mental health. Many of these are young people around the world who have grasped the opportunity that the video site YouTube provides to talk about their personal experiences online. Many report that they find it therapeutic to do this, and hope that their experiences will also help and support others who are struggling with mental health issues.

A high proportion of these vloggers regard their distress as an illness and their experiences are very much phrased around the medical model relating to mental health. There are, however, some videos which take the social model view, and others where the boundaries are blurred. You can read more about the debate around the medicalisation of mental health on this blog, suffice to say most (though not all) of the recommended vlogs and videos here tend towards the view that mental distress is, as campaigner, writer and speaker Jacqui Dillon states, “a normal response to abnormal stress”, as opposed to an illness. 

And so whilst we’re on the topic of Jacqui, we may as well start the list by highlighting a video of her on our very own PAVO YouTube channel. This was made at the 2013 Powys “Shaping Services” conference.

The channel Crazywise is run by photographer and film maker Phil Borges and features videos questioning how 'Western culture defines and treats severe mental disorders'. Phil is also working on a feature length documentary 'challenging the current mental health system in crisis'. Many of the Crazywise films are interviews with "experts" talking about their experiences in the field, including British psychiatrist Russell Razzaque who has a background in mindfulness meditation and is currently leading a clinical trial into Peer-Supported Open Dialogue.

Rai Waddingham hears voices and sees visions. She is an 'independent trainer specialising in innovative ways of supporting people who struggle with extreme states (including ‘psychosis’, ‘dissociation’ and post traumatic reactions).' This video from her channel focuses on her experiences of hearing voices.

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Laura Delano, an American who also features on the Crazywise channel, has her own independent channel where she vlogs regularly about her own experiences of psychiatry and the psychiatric system. She describes herself as an ‘ex-"Bipolar" patient, (and) discusses life after psychiatric labels and psychotropic drugs’.

Another Laura, Laura Nuttall, vlogs about her experiences in psychiatric hospital with real insight given to the actual experience of being on a mental health ward in the UK.

LikeKristen is a young American vlogger with a very watchable style. Her videos include all kinds of mental health topics, ranging from experiences of self harm, to stigma and practical suggestions to help recovery. Here is a link to her journaling video. 

Fixers is a UK organisation featured previously on our blog. Sarah Harmon, who lives in Powys, talked for Fixers about her experience of mental health issues and the work she does in schools to help combat stigma. Fixers is a project of the Public Service Broadcasting Trust, and uses short film and other media to enable young people have their voices heard and help make positive change. Check out the Fixers website to watch videos relating to mental health and young people in Wales.

Kati Morton is an American therapist who provides information about “conditions” and “treatments” that are very easy to follow. As the National Health Service in the UK uses much of the same terminology it can be helpful to watch these if you want to find out more about treatments such as Cognitive Behavioural Therapy (CBT) that are available to people here too.

And finally, the Spiritual Crisis Network has some excellent videos on its website, including a 5 minute animated film called "Compassion for Voices: a tale of courage and hope", produced by King’s College, London.

We hope you enjoy watching some of these videos and vlogs, and would love to hear about others that you recommend. Let us know in the comments box below.

All the best for 2016 from the mental health team at PAVO – Angharad, Anne, Glynis, Jane and Jackie.