Memory boxes – connecting with the past

I recently found out about an innovative new dementia-friendly project in Brecon called the Memory Box Loan Scheme, which is run by Brecknock Museum & Art Gallery and funded by the Heritage Lottery Fund.

“This new service is aimed at those working with, or caring for, older people. Each box has a particular theme and is made up of a range of objects from the 1950s, 60s and 70s. The idea behind the boxes is that they can be used to stimulate memory and start conversation. They can be especially useful for talking about the past with a person with a dementia”.

Martine Woodcock, Education Officer at Brecknock Museum & Art Gallery, told me more:

The project was initially set up by our Volunteer Co-ordinator, Emily Tilling, who has since left Brecknock Museum. The project is now co-ordinated by myself and one of our curatorial assistants, Jacqueline Morgan. Emily spent a lot of time setting up the project and worked with a group of our Museum volunteers who were very interested in taking the project further. They were dedicated in their enthusiasm by either donating personal items or frequently visiting charity shops so that we could build up our collection. Local charity shops have been very generous in supporting the project when they hear what we are using the items for.

The service came about as one of the targets on our HLF Activity Plan was to run reminiscence sessions with older people. As we were about to start this we were invited to a Dementia Friendly session by Rhiannon Davies who is one of the Co-Chairs of Brecon Area Dementia Friendly Community. She delivered a fascinating and informative session and we decided that if we started up a Memory Box Loan Service then that would be of great benefit to elderly people whether they had dementia or not.

We have about 12 themed boxes altogether (Leisure, Sewing & Knitting, Men in the 50s & 60s, Transport & Holidays, Childhood, Women’s Fashion, Household, Photography, World War II, Cooking & Baking, and Shopping) and information has been circulated to care homes and day centres. The boxes don’t have an excessive amount in them and we try to put them in relevant containers such as a vanity case for ‘Women’s Fashion’ and a knitting bag for the ‘Sewing and Knitting’. 

We have opted for group rather than individual use at the moment, but that doesn’t mean that that won’t change in the future. The loan service has been very popular with boxes going out most weeks. We usually let organisations have them for about a fortnight so that other groups don’t have to wait too long.

We don’t facilitate the sessions ourselves. We are just the box providers. We send out a feedback form with the boxes so we know where we could improve the contents/service and we also send out discussion prompts and some item information sheets as we appreciate that those facilitating the session may not have come across the things in the boxes before. A prompt from the Sewing & Knitting box might be: “Did you use the phrase ‘make do and mend’? Did you wear darned or patched clothes? What were scraps of material or old clothes used for (rag rugs, cleaning cloths)?” The box contents include knitting needles, thimbles, tape measures, patterns, crochet and knitting samples, cotton reels, velvet, ribbon and an old knitting pattern magazine!

Rhiannon, and the other Brecon Area Dementia Friendly Community Co-chair, Joan Brown, are also very keen to involve the young people of Brecon in raising Dementia Awareness. Joan has been working alongside local Primary Schools. Year 6 pupils regularly visit care home residents and have used some of our boxes at sessions as well as devising their own.

So, as you can see, it really has taken off in Brecon! We are very proud that we can be a part of maybe bringing a little bit of pleasure for someone experiencing dementia. We are of course prepared for the fact that some objects may jolt unhappy memories too.

We have promoted the service well with the assistance of Brecon Dementia Friendly Community. We recently attended the ‘Ageing Creatively’ day as part of Gwanwyn (a festival each May celebrating creativity in older age) which was held at Theatr Brycheiniog where we displayed boxes. We did the same as part of ‘Dementia Awareness Week’ at The Guild Hall, Brecon. I have also done a talk to a group of Alzheimer’s Befrienders about how simple it can be to put a box together.

Rhiannon Davies, of Brecon Dementia Friendly Community (a familiar face on this blog) has used some of these memory boxes several times at the weekly Tea & Chat and Music & Memories sessions, as well as in care home settings. I spoke to her to find out more:

The volunteer co-ordinator at the museum was full of energy and ideas. Staff there could see what was possible and made it happen. Dr Anja Pinhorn, a consultant at the Brecon Memorial War Hospital, has also borrowed memory boxes to take on to the general ward. They have a lot of long-stay patients with physical illnesses, some of whom have dementia. It is really important to keep them interested and stimulated, and this is an excellent way of doing that. I hear that they are going to make “conversation boxes” in Ystradgynlais Hospital for use on the general ward.

At Brecon Dementia Friendly Community we are starting a new activity in the Autumn on the hospital wards – introducing creative activities and supporting the nursing staff with ideas to generate conversations so that people do not become institutionalised. The memory boxes have been used very successfully so far as they have items in them that can trigger memories and conversations. It can, otherwise, sometimes be difficult to start a conversation with a patient.

In one of the care homes I went into with the boxes a vanity case containing fashion items was used. It had things for ladies, including a suspender belt, stockings, lipstick and a powder pack. It was just fantastic! People actually wanted to pick up and handle the items and had a lot of fun. We don’t use some of these things any more but they take people back to the time when they were used often, and can trigger all sorts of memories such as taking people back to an age when they were much younger and getting ready to go to a dance.

The boxes are a very powerful way of stimulating memories and keeping people connected. There is then a collective connection which is lovely and enhances relationships between the staff and the patient or resident. After you have built this relationship you can achieve trust and it makes things much easier for people.

Many thanks to Martine and Rhiannon for telling us about this wonderful scheme. Perhaps you could use their ideas and develop something similar in your community?

The Brecon memory boxes are available to borrow free of charge. However, it is a collection-only service. To book a memory box or for further information call 01874 624121 or email brecknock.museum@powys.gov.uk

Mental health & money – 5 top tips

If you are in the middle of a mental health crisis, or experiencing anxiety or stress, probably the last thing you want to think about is money. But bills still need to be paid. And stuff has to be bought. However much we cut down none of us can survive without the basics of food and shelter. Yet what are the odds it’s not actually the best time to go on a mega spending spree either, whether you have loads of £££ in the bank or hardly any cash at all to line your pocket.

Money and mental health has been in the news recently. So we thought we’d take a look at some of the thinking, support and resources that are out there to help people, particularly when they are distressed or stressed, for whatever reason. It is tailored to help people in Powys, but if you land on this blog post from outside our county a lot of the information will still be of use.

1. Money and Mental Health charity launched

First of all, there’s a brand new charity out there – the Money and Mental Health Policy Institute – set up especially to support people experiencing money difficulties during periods of poor mental health. The charity’s chair is the well-known money expert Martin Lewis: “award-winning campaigning broadcaster, newspaper columnist and author, as well as the founder of Money Saving Expert”. In a Telegraph article he writes about why he was prompted to set up the new charity: "I’ve had some very dark days. During one of the worst of those, where I struggled to cope with leaving the house, I felt so fortunate that I wasn’t paid by the hour, struggling to make ends meet”.

With the help and support of a number of mental health charities, Martin has produced a new guide: 'Mental health & debt 2016: help, info, guidance & support for individuals & carers'. Martin’s key message is that “no debt problems are unsolvable... no matter how bad it seems, while it may not always be easy or quick, there is light at the end of the tunnel.” The guide includes chapters on getting free debt advice, working with the banks, and finding out how friends, family and carers can help. Whether your money problems are low level or potentially very serious (what do you do when the bailiffs call…?), Martin has signposted at every stage to key professionals who can help. There are also some very readable case studies. Basically the guide is packed full of useful information, and is a must-read on the subject!

The new charity is keen to find out your views on money and mental health. It has opened an online survey: In Control – a consultation on regulating spending in periods of poor mental health – “we set out the psychological drivers of increased spending and explore a range of possible solutions, along with a series of questions to which we invite those with expertise in financial services, retail and mental health to respond”.

Money, money, money....

2. National Debtline

Around for over 25 years now, so far from being the newcomer on the block, this charity gives free, impartial and confidential debt advice in all areas of finance; everything from bankruptcy to water rates arrears, and over fifty other fact sheets covering a wide range of subjects in between, can be downloaded from the website. If you want to speak to a person, then trained and experienced debt advisors are only a phone call or click of the mouse away.

3. Powys Citizens Advice - Money Advice Service

Sometimes the best advice comes face-to-face and on your doorstep! Here in Powys we are lucky that CAB provide two Money Advisors – Holly Sissons and Natasha Arthurs – who cover the entire county from Machynlleth in the North down to Ystradgynlais in the South. You can ring or email to make an appointment, tel: 01686 617667, email: mas@powys.cabnet.org.uk

“The Money Advice Service provides free, impartial money advice tailored to individual needs and circumstances. This is done in 45 minute face to face sessions delivered in venues across Powys.

From insurance to pensions, mortgages to borrowing, if people need help putting together a budget or understanding tax and welfare benefits, the trained Money Advisers will go through the options and help draw up an action plan.

Money Advisers are impartial, and won’t try to sell anything but will give clear, in-depth information.”

The service is open to absolutely anyone – it isn’t means tested. And, if even more specialised help is needed, Natasha and Holly can refer people to other areas within CAB for ongoing support, such as the Energy Project, which looks at ways of reducing bills through energy saving measures and tariff switching.

4. Credit Unions in Powys

Credit Unions are different from banks (although they are sometimes called community banks): they are owned by their members. These non-profit-making money cooperatives encourage members to borrow from pooled deposits at low interest rates. They promote thrift, support community development, and aim “to serve people not profit.” Budgeting advice and other financial services are also available to members.

Members are encouraged to save as well as take out loans – it’s all about developing a healthy relationship to cash, and retaining money locally in the community. Most credit unions have volunteer teams, made up of members, who contribute hugely to the day-to-day running of their organisations.

Powys is covered by four credit unions.

1. Hafren Credit Union (North Powys) has recently merged with North Wales Credit Union to become the biggest credit union in Wales – Cambrian Credit Union.
2. The Red Kite Credit Union in Builth Wells: “Save regularly, borrow wisely, repay easily!”
3. Brecon & District Credit Union: “Jasper was fed up with call centres. So he called Brecon & District Credit Union!”
4. Neath Port Talbot Credit Union operates in Ystradgynlais out of the local Mind centre (see below).

5. Money advice at your local Mental Health Wellness & Recovery Learning Centre

Mid Powys Mind holds regular Managing your Money sessions at its Llandrindod Wells base. The next is on Monday 15 August, 1 – 2.30pm. Powys Citizens Advice Bureau advisors (probably either Holly or Natasha – see above) attend and Mid Powys Mind members can access confidential advice in a familiar place. Do call to book a slot if you are interested, tel: 01597 824411.

The mental health charity Ponthafren Association ran these sessions at the Centre’s Newtown base earlier this year. No dates are currently planned, but if this is something that would interest you please get in touch with staff or volunteers at Ponthafren and further sessions can be arranged.

Ystradgynlais Mind taps in to money surgeries provided by Neath Port Talbot CAB, whilst also hosting the local credit union – Neath Port Talbot Credit Union - which is run by its members.

And money advice sessions at Brecon & District Mind are also on the cards, please ring the Centre to register your interest.

So there is a huge amount of support out there! 

If you have any tips or ideas for managing money, particularly if we are struggling because of poor mental health, then please leave a comment in the box below. We would love to hear from you!

Dyfed Powys Police - Mental Health : Working Together - Part 2

We found out in Part 1 of this post last week how Dyfed Powys Police has been rolling out mental health awareness training sessions for the force's staff and partner organisations over the past few months. I was lucky enough to be able to attend the May session as the PAVO representative. These sessions have focused specifically on Section 136 of the Mental Health Act 1983, and the collaborative nature of the approach to this 72 hour detention which can be instigated by the police. 

The first half of our training covered a look at our needs and expectations, an introduction from the police mental health lead Inspector Brian Jones, setting of context by Lousia Kerr who is Powys Mental Health Partnership and Project Manager, and a consideration of "what is mental health?" by Powys psychiatrist Stephen Novick. Kath Arnold, manager of the Integrated Community Mental Health Team in Brecon, was next up before we ran out of space. In Part 2 we complete the picture. 

Approved Mental Health Professional – Helen Kiteley, Social Worker PCC

Helen described the very specific role of the Approved Mental Health Professional – a social worker who is specially trained to consider when someone may need compulsory admission under the Mental Health Act. “The AMHP is tasked with balancing care v control in the context of managing risk and the Human Rights Act 1998”.

This does not necessarily mean that someone ends up in hospital. They could be managed by the Home Treatment Team (more below) and able to stay at home. The “least restrictive intervention” is the one which has to be used.

Helen also covered a Section 135, the role of the “nearest relative”, and a AMHP’s duty to complete Mental Health Act assessments when required.

Crisis Resolution Home Treatment Teams – Andrew Williams (South), Graham Batha (North)

Andrew Williams

Andrew explained that he was a man with two hats! With his Welsh Government hat on it is his statutory responsibility to gate-keep admissions to hospital, to respond to crisis referrals in 4 hours and review out-of-hours referrals in 24 hours. With his practical hat on Andrew and his team are providing individuals with intensive support in their own homes. Staff work closely with family members and friends to maximise levels of support, and provide psychological and practical help. “Crisis prevention is really key.”

Graham’s view from the North of the county was not dissimilar. He said “we bring many aspects of hospital care to the patient’s home. Currently we have 300 patient contacts per month.”

Both teams work out of hours, though not 24/7. You can read more about the work of the North Powys HTT here.

Brian highlighted the fact that the police are operating in a different place to that of just 2 years ago. “As soon as we are facing a S136 we go out to someone who may harm themselves. But the HTT now arrive and say the police can leave”.

Graham Batha

Felindre Ward, Bronllys Hospital – Richard Rudge, Deputy Ward Manager

Felindre Ward is the designated Place of Safety for Mid and South Powys (except Ystradgynlais) where people can be taken by the police on a S136 for a mental health assessment. Richard talked us through the 12 bedded In-Patient Unit, the specific roles of staff based there, the admissions procedure and then in more detail the role of the nurse in the S136 process.

The team at Felindre works very closely with CMHT teams at Brecon and Llandrindod Wells, as well as the South Powys CRHTT.

Some interesting questions emerged during this session, such as what happens when someone is visiting Powys and is detained on a S136. It was clarified that they are then brought to a Place of Safety within Powys to be assessed, rather than being transported back to where they originally came from.

Emergency Duty Team – Debbie Everett, Social Worker & Michael Dalladay Senior Practitioner EDT

“It is the responsibility of the EDT to respond to social care emergencies where the urgency of the situation requires action at a time when mainstream services are not available.” The team has many varied duties, including undertaking mental health assessments.

Experience of someone in contact with mental health services – Jan Rogers

Regular readers of this blog will no doubt be familiar with Jan Rogers (volunteer and trustee at Ponthafren Association, and now MBE!) who then told her personal story. Jan included her experience of being detained under a Section 136 over 30 times, and her subsequent role in 2014 as a member of the Expert Reference Group which reviewed the Mental Health Act 1983 Code of Practice ( in England).

Jan concluded by saying: "things are not always what they seem. Think before making a decision or acting."

Brian rounded off the day with a number of typical scenarios, some of which we addressed in groups. There was some really useful discussion with partners from all sectors contributing and it was clear that the awareness raising had been of genuine benefit to all concerned. My feeling is that everyone working or volunteering in the field of mental health in Powys would find this session invaluable - long may it remain available to enhance our knowledge and encourage enthusiastic partnership working!

Dyfed Powys Police - Mental Health : Working Together - Part 1

Karen Clarke and Jason Hawkins - Police Community Support Officers in Brecon

Section 136
If it appears to a police officer that you as a person in a public place are:
 “suffering from mental disorder” and are: “in need of immediate care or control”, he or she can take you to a place of safety. 

You will be kept in hospital, or the place of safety you were taken to, so that you can be examined by a doctor and interviewed by an approved mental health professional and any necessary arrangements can be made for your treatment or care.  Mind – About Sectioning.

Over the past six months, Dyfed Powys Police has held regular mental health awareness training sessions for staff and partner organisations in Powys. As PAVO’s representative on the Section 136 sub-group, which was set up to reduce the inappropriate use of Section 136 of the Mental Health Act 1983, I was invited to attend. 

So it was in May I found myself at the Combined Services Centre in Llandrindod Wells with a room packed full of professionals from the Police, Powys Teaching Health Board, Powys County Council, Welsh Ambulance Service and a number of voluntary sector organisations, all gathered to learn more about Section 136. And, specifically, the role of the various agencies involved in working collaboratively to ensure appropriate and sensitive detentions occurred in the county.

It was a really interesting day. Packed full of information and just putting names to faces was invaluable. So it was agreed I could share with a wider audience, albeit very briefly, some of the content from the key speakers, and also highlight the extent of the collaborative nature of this work. 

 

Inspector Brian Jones (photo left), the mental health lead with Dyfed Powys Police, facilitated the session. He updated us on this blog last year about a pilot project in Powys requiring the Police Inspector’s authority before police mental health powers can be used. 

Partnership working – Louisa Kerr (photo right), Mental Health Partnership and Project Manager, PTHB

Louisa outlined the legal framework for delivery of mental health services in Powys, which is overseen by the Powys Mental Health Planning & Development Partnership. Its goal is: “to unlock the benefits of wellbeing in terms of physical health, educational attainment, employment and emotional security”.

Multi-agency partners – Brian Jones, Inspector Dyfed Powys Police

When a person is in crisis, it is increasingly the case that the first port of call – whether it be that person, a friend, family member, stranger or organisation that makes the call – is the police.

Brian spoke about the S136 protocol, incident reviews, the challenge of Powys’s geography, data collection, and his key responsibility as an Inspector with powers to authorise the use of S136. As taking away someone’s liberty is such a serious thing to do there is a lot of work looking for alternative options before a S136 is used. For example, someone could stay with family or friends overnight and then a better option be found the following morning. “Now it is a last resort to use a S136. It was much more usual in the past. (We are talking about) a patient that is not well. Going into custody or out of the area is not the best option.” 

Brian threw a question to the floor: “Why do we need mental health awareness training?” The responses included these comments: 

• We want to know how we can best work with people we come across. We want to put them in the right direction. 
• It is about recognising the problem and realising that partnership organisations are out there. 
• There is a lot more openness and honesty about mental health now and this is a major plus. 
• To improve the partnership approach. To talk to each other more – to look at the bigger picture. We are all working to the same end. 
• We are hoping to achieve a better understanding of what our individual roles are. 
• To find out how we fit in and can support each other. 
• For a better understanding of the S136 process and how it might impact on people we work with. 

The rest of the day was spent looking in more depth at the individual roles of specific agencies and mental health professionals.

What is mental health? – Stephen Novick, Consultant in Adult Psychiatry

Stephen began by telling us about the Rosenhan Experiment from 1973 – “on being sane in insane places”. It proved that it is extremely hard to diagnose mental health illnesses.

“Many people who commit suicide are not known to mental health services or mentally ill. Mental health problem sounds better. Mental health illness suggests some people get it and some don’t. Anyone can have a mental health problem.”

Stephen ran through some of the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, (a diagnostic manual from the United States). However, he said there was very little in the way of hard science except in relation to dementia. “Look at the symptoms, signs, behaviours… what else – drugs and alcohol.”

“People believe all sorts of weird things, but that does not mean they are ill. If they are behaving oddly, it may be a cultural thing.”

With this level of uncertainty around defining mental disorder, it’s not surprising that professionals from different agencies are called upon to agree that certain detentions (sections) are necessary before they go ahead. Stephen went on to describe scenarios when a S136 could be used by the police for a 72 hour detention at a “place of safety”, and to clarify the difference between Sections 2 and 3. 

Brian emphasised at this point that the role of the police is “the protection of life. There’s no getting away from that.”

Community Mental Health team – Kath Arnold, Integrated CMHT manager, Brecon

Kath introduced us to the many and varied roles of professionals employed in the CMHT, including psychiatrists, community psychiatric nurses, social workers, occupational therapists, support workers and clinical psychologists. They support people with “complex/high risk presentations that cannot be managed in primary care.” Primary being the GP surgery, and secondary care the CMHT. I feel the need for a flowchart coming on!

Care and Treatment planning is a key element of the team’s work as a requirement of the Mental Health (Wales) Measure, the legislation which governs provision of mental health services. “This gives you the opportunity to set goals in all areas of your life, create a plan and, in the process, to take more control of your own recovery.” Hafal, A step by step guide.

There followed a brief discussion about the value of Advance Statements for Crisis Planning, a subject covered in a separate post. So far the day was proving very interesting.

Look out for Part 2 of this post next week to find out more about the roles of the Approved Mental Health Practitioner, the Crisis Resolution Home Treatment Teams, staff at Felindre Ward of Bronllys Hospital, and the Emergency Duty Team of Powys County Council Social Services in relation to Section 136 detentions. And, not forgetting, Jan Rogers' powerful personal story of coming into contact with the police during a mental health crisis.

Update: read Part 2 here.