Mental health and children, young people & families

By guest author Lucy Taylor

Hello, my name is Lucy Taylor and I am the Children, Young People and Families Officer for Powys Association of Voluntary Organisations (PAVO). 

My role is to support the organisations across Powys that work with children, young people and their families. This involves acting as a conduit between the organisations, for example Action for Children which works with families, and the statutory partners, for example Powys County Council which, in some cases, commissions part of their work. I use a blog, Facebook and network meetings to keep the sector up to date and informed. 

Another part of my work is to support the Play Networks and to raise the awareness of play. We ask: are there enough opportunities, time and space for our children to play in Powys? It was working with organisations looking at what services are available, and what support is needed for children and young people, that the gap or thinning of services that support them when they are having low level mental health worries was noted, hence this blog post.

Listening to young people speaking at the Mental Health Today conference in Cardiff in May this year I was struck by their common sense approach to some of their issues. They knew that life was not always going to be plain sailing - that events or relationships could knock them back. They wanted to be self-reliant, not turn to medical interventions or for the medical community to medicalise their problems. They recognised that in helping and supporting friends through their low patch in life, they may put their own mental wellbeing and stability at risk. Their request – “A toolkit for life, not a bucket of sand to hide from it.”

Mental Health Today conference presentation

This is the issue and where some gaps in support appear. Everyone can experience a wobble in their wellbeing. But, with a few self-help tools, some supportive friends and community, the knowledge of where to go for help early on, we may all take a role in our and our community’s wellbeing, leaving the expertise of medical interventions to those whose condition requires it.

The Young Adult Peer Support Project (YAPS) which was run by Ponthafren Association as part of the One Powys Connecting Voices lottery-funded programme was really excellent. When it wound down recently as the funding came to an end none of the young people (age 16 – 25) involved with the project was happy to see it go. Peer support projects like these are extremely valuable, as the first port of call for a young person struggling with their emotional wellbeing is friends and family.

The Making Sense Report was produced in January 2016 as a response to the Together for Children and Young People programme. It had emerged that referrals to Children & Adolescent Mental Health Services across Wales had increased by over 100% between 2010 – 2014, and four organisations – Hafal, Mental Health Foundation, Bipolar UK and Diverse Cymru – joined together to find out why and consider what could be done to address the situation. Young people themselves, who had been in contact with CAMHS teams in Wales, reported on their health and wellbeing and called for “non-mental health professionals such as education staff, counselling services and youth groups to share responsibility for the emotional needs and development of young people”.

For children, young people and their families to have access to informal and non-medical support, we – the families and communities – need to be able to recognise when we, and our neighbours, need a bit of help. It is also crucial that we know how to source help in our particular locality. Information and connectivity is the key. The PAVO Community Connectors help people in Powys (aged 50+) and their families or carers, to access community-level services and activities, (tel: 01597 828 649) – and Powys People Direct “one number for children, adults and families for information and support services” (tel: 01597 827 666) can also help.

The third sector as a whole plays a huge role in providing services and opportunities for children and families in Powys. From the playgroups and play networks, guides, cadets and St John groups to sports clubs and arts organisations. Then there are the agencies offering more targeted support or drop ins. Think of Action for Children, Mid Powys and Brecon Mind or Ponthafren Association.

Powys Youth Service supports young people around their emotional wellbeing in youth clubs or at school. The service has recently noticed that where it used to work with pupils around exam stress, now stress is more general and anxiety about life and the future prevalent. Online counselling and advice is available via an organisation called Kooth (Xenzone) .

But what of families, education and skilling our young people for life? If “it takes a village to raise a child”, what part do we all play in ensuring the wellbeing of all the children? Can Google or YouTube really teach you everything? The ability to budget, know about nutrition, healthy eating and exercise, or how to cook from scratch? These are the life skills the young people want, alongside how to protect their mental wellbeing, perhaps using such techniques as yoga, meditation or mindfulness.

Would it surprise you to know that a walk in the park or taking time to walk and be around trees can also help? The Japanese call it “Tree Bathing” and have invested in public awareness of the benefits of being outdoors. 

PAVO staff are working with organisations from the mental health and children’s arenas, alongside green or outdoor providers, to look at how best we can work together and bolster our communities and families by making the most of the green resource we have on our doorstep. We will be meeting in the coming months to discuss the support we can all offer. For more information call 01597 822191 and speak to Lucy Taylor or Jane Cooke.

Why not take five minutes out from your busy day to walk in the fresh air, appreciate the sights and sounds of nature? Perhaps grab some friends and all walk together. Take the children to the park or share a picnic with other friends and families. It may not solve any problems but it can help soothe your mind and give you a place to start. Like eating elephants you can take life one bite at a time.

There is currently a Welsh Government consultation on: The Emotional and Mental Health of Children and Young People. If you, or someone you care for, has been in contact with Child and Adolescent Mental Health Services, then you can give feedback up until 29 September 2017.

The Children, Young People and Education Committee’s Inquiry will consider whether the ‘Together for Children and Young People Programme’ is on track to deliver the ‘step-change’ in CAMHS services that is needed. It will also consider how effective the programme has been in promoting the resilience of children and young people, including a focus on the role of education in preventing mental health problems. The Together for Children and Young People (T4CYP) programme is a multi-agency service improvement programme that is aiming to reshape, remodel and refocus the emotional and mental health services provided for children and young people in Wales.

On the Experts by Experience panel

Sarah Dale was recently in contact with the Participation Officers in our team. She expressed an interest in getting more involved with our engagement work, which includes working with individuals who have been in contact with mental health services and supporting them to attend partnership meetings as reps. They are encouraged to give feedback, to represent the views of others, and to help shape future mental health services.

Sarah subsequently agreed to accompany Participation Officer Philip Moisson to a conference earlier this summer, and joined the Experts by Experience panel on the day. We were all really pleased that someone from Powys had been willing to speak up about their experiences, and asked Sarah to give us her take on the day.

The Together for Mental Health conference on 12 July at the Marriott Hotel in Cardiff was organised by Cymorth Cymru, the umbrella body for providers of homelessness, housing-related support and social care services in Wales. The event looked at “the contribution that the Supporting People programme can make to mental health, in the context of the Welsh Government strategy - Together for Mental Health. It brought together service users, providers and academics to consider the difference we can all make to mental health.”

First of all we had a welcome address from Katie Dalton, the Interim Director of Cymorth Cymru. This was followed by an informative session about the Welsh mental health legislation, including a good look at the aim of the Mental Health (Wales) Measure 2010, the difficulties, aims and challenges and the relationship to housing and homelessness. We also looked more closely at the government strategy Together for Mental Health.

Next up we got to listen and pose questions to a panel formed of people who provide the services. The individuals on the panel were the chair: Phill Chick - Assistant Director, NHS delivery Unit (below right); Louise Evans - Director of Services, Gofal; Julian John - Director, Merthyr and the Valleys Mind; Dr Julia Lewis - Consultant Addiction Psychiatrist, Gwent Specialist Substance Misuse Service (below left); and Dr Matthew Sargeant - Executive Committee Member, Royal College of Psychiatrists in Wales. Some very interesting points were raised especially about alcoholism and the services mental health teams provide.

  

 
We then had a presentation about the Housing First programme and the links to mental health and homelessness. I learned that only a few people who become homeless actually have mental health issues, however the longer someone is homeless the greater the risk of them developing mental health issues. Those that are made homeless on more than one occasion are even more likely to develop mental health issues.

After a quick tea break we then had the choice of attending two workshops. One was delivered by Time to Change Wales, and I decided to attend the other which was about supporting people with personality disorders. I found it extremely informative and brilliant even. We had a quick overview of the classification of the 10 personality disorders followed by a closer look at two of the more common personality disorders, borderline and antisocial personality disorders. We looked at the different factors at play that 'cause' these two disorders, such as neurocognitive, life experiences and genetics. We also looked at the different therapies that help cope with these disorders such as Dialectical Behaviour Therapy, Multi Systematic Therapy and the trauma informed approach. I found it very insightful and well presented.

In the next workshop, after lunch, we looked at psychoeducation which is group-based and aims to educate individuals on how to cope with everyday life. Topics included anger management, emotional resilience, and emotional well-being. For example, we did some group work, figuring out how psychoeducation could be fitted into our organisations. It was very interesting.

After a tea break four of us were invited to speak about our experience and the services we have used, highlighting the positives as well as areas for improvement. It was immense and very emotional. All the speakers’ stories were moving and some very important issues and positives were raised. The audience was clearly moved.

After that we wrapped up and closed the day. Overall it was a brilliant opportunity, and a great day.

Many thanks for Sarah for telling us about her day at the Cymorth Cymru conference. If you would like to find out more about volunteering as a mental health “rep” then get in touch with us by emailing mentalhealth@pavo.org.uk or call 01597 822191 and ask to speak to us.

Mums Matter

Mums Matter is a new project being run at two of the Mind centres in Powys – Brecon & District, and Mid Powys Mind in Llandrindod Wells. As the name suggests, the aim is to provide emotional support for new Mums “to manage the everyday, nurture themselves and dispel the many myths of motherhood.”

The project facilitators, Deborah Wilkie in Brecon (left below), and Tracy Lewis in Llandrindod (right below), told me more.

                                        
                                                 
Tell us why you think there is a need for this project in Powys

Deborah: Whilst promoting this programme mums who have had their babies have stated “they wished this sort of course was available to them after they had given birth to their children." They also said “there was no additional support to help mums apart from their GP or health visitor to help them go through such a huge life-changing experience. They felt alone and that they were the only ones suffering and could not fully be honest in how they were struggling with their feelings of anxiety and worries, and feeling very low and isolated”.

Tracy: Powys has the worst access to services and facilities of all 22 principal areas of Wales. There are 30% of households living in poverty in rural Wales. Because of this women can become isolated after childbirth. The stresses of becoming a new mum and all the different advice and opinions can lead mothers to become anxious and worried.

Has Mind rolled out Mums Matter elsewhere in Wales and if so how has it been received?

Deborah: This is the first time this type of support and programme has been rolled out in Wales and we are delighted that Powys has this great opportunity and is leading the way in Wales.

Tracy: This project has been designed by mums with postnatal anxiety and depression who live in deprived and rural areas. The pilot was held in Cardiff and was received very well. Mid Powys Mind is very happy to be rolling this programme out for mums in Mid Powys.

What about motherhood can be different in a largely rural county?

Deborah: Powys is the biggest rural county in Wales covering 2000 square miles with many small country villages and small towns so accessing essential health and social care services for mothers and families can prove to be very difficult especially if they have no transport. The local transport can be infrequent or not at all, leaving a lot of mums and dads trying to cope and do their best for their babies and children. Motherhood can be lonely in these small villages and towns as the population can be very small. They may be the only young family in the area and accessing baby/toddler groups will mean travelling to another area.

Tracy: There are a lack of effective support networks in Powys as its geographic and social isolation is an ongoing problem, mums sometimes don’t feel they can ask for help as it looks like they are a failure in small communities. Many women can struggle to hold on to their identity once becoming a mother.

Tell us about some of the myths around motherhood, and how women can feel in the early days

Deborah: Social media, magazines and TV can portray life is perfect whilst pregnant and after giving birth and concentrates on images of the ideal ‘perfect’ mum. Even when a mum has a quick snapshot of a mum pushing a pram in the street and that mum can seem like they have “got it together” and look like a ‘perfect’ mum in the mind of the viewer, it may not be the case. This programme gives evidence and demonstrates that that’s not the reality and we discuss what motherhood is really like for them. Learning being a ‘good-enough’ mum is essentially a healthy way of bringing up children as it instills realistic expectations in children and teaches them to cope with uncertainties in our realistic world.

Tracy: There are many myths in motherhood and these can lead to self-stigmatising behaviour and negative perceptions of one's self-worth. This can affect any mother of any age and any walk of life.

When women hit a certain age they can feel the pressure to have a baby without being mentally prepared. When you have your baby a mother does not always have the immediate rush of love that you are told you will have as this can be slow to build and can come over time.

There are harmful myths surrounding working mums that they are neglectful and guilty mothers which can add to the pressure and create anxious feelings.

Mums Matter aims to show these women that they are not alone with these feelings, and provide them with the tools they need to overcome these pressures.

How do new mums find out about the project and join in? And when is your next course?

Deborah:  I am running another programme in September 2017 in Brecon during the school term. It's an 8 week course (2 hrs a week) for mums and I provide a crèche for your baby (if you require it) in the same building of the course. If you like to find out more don't hesitate to contact me for a chat….. call or message/text Deborah on 07487 239 150 email deborah@breconmind.org.uk Or ask your health visitor or GP to refer you.

Tracy: The next Mums Matter programme I am running is on the 12 September in Knighton Leisure Centre, 1 till 3 every Tuesday for 6 weeks. There is a crèche available which is run by qualified members of staff. If you would like to book onto this programme please contact me on 07960 271 696 message or text, or you can email me on mums@midpowysmind.org.uk

What kind of support can the sessions provide? 

Deborah:  Being a mum is a very busy role and can be overwhelming and the need to look after yourself is important so we spend time looking at that in a friendly group of mums sharing similar experiences. We explore what it’s really like being a mum and all the feelings of anxieties and worries that go with the role. We look at many coping tools to manage the everyday, looking after yourself and feelings such as negative thoughts and guilt. The aim is to help mums feel much better and more confident in themselves and trusting their own skills and decisions in their role as a mother.

The programme also offers a confidential supporter session for partners and significant others who supports mum, raising their awareness to postnatal depression and anxiety and exploring ways they can support the mum.

Tracy: The sessions will introduce mums to tools such as breathing techniques, meditation and ideas that will help with wellbeing as well as providing an opportunity and space for mums to come together and talk about their experience and feelings. Those in the group, with the help of the Mums Matter Facilitator, will be able to support each other with the changes that becoming a mum demands, and they will realise they are not alone.

There is also a supporters' session for family and friends to attend if they wish.

If appropriate and timely support isn’t provided to new mums what could happen? 

Deborah: I see this programme acting as a prevention as well as an intervention of support to help mums feel stronger in their own well-being. This programme has already prevented some mums going onto anti-depressants and their postnatal depression escalating. I am coming across mums who are still suffering from anxiety and depression some years on from when they first started suffering with these symptoms after giving birth to their child. This programme may have prevented these symptoms escalating into a longer-term health problem so timely intervention is of the utmost importance to mums in their postnatal period. Also, fathers can suffer with postnatal depression too. This programme raises mental health awareness and knowledge also to fathers and carers and other family members.

Tracy: If mums don’t get the support in which they need then depression can take hold and mothers can withdraw completely from all social activities and services that they may need and all relationships will suffer.

If it became clear a mum was experiencing severe postnatal depression what would happen? 

Deborah: I would in discussion and permission from the mum share this information with her GP and health visitor and encourage a referral onto the Community Mental Health Team where there is a specialised perinatal team. I would also refer onto any other services which meets any other identified needs.

Tracy: I would refer that mother back to her health visitor and doctor and help her to seek the professional help that is needed and discuss any other pathways that would help her with her recovery.

Does Mind support continue once the 6/8 week course is complete? Alternatively, what support networks can you recommend to mums? 

Deborah: The mums are encouraged in the 7th & 8th week; which is more of a social meet up with their babies to discuss how they are going to continue supporting each other. My mums from the first programme formed a very strong trusting bond and have a message group chat and plan to set up their own baby/toddler group in September for mums who are experiencing very similar experiences so they can share the realities of being a mum in a supportive, ’good-enough’ environment.

I also refer on to other services for continued support if needed such as counselling, Action for Children amongst others. They also have an information pack. I am also still there for mums to contact me post-programme for any further additional information and sign posting if needed.

Tracy: After 6 weeks there is another meeting in 3 months for the mums to come together with myself to see how everyone has been getting on. There is also a questionnaire to fill out to see which tools the mums have been using and if they are still in contact with each other. Mid Powys Mind also offers counselling, arts and crafts, training and a volunteer programme with information about the Mid Powys Mind services. There are also lists of playgroups, parent and toddler groups and other agencies which the mums may need in their packs.

Tell us what a “Mums Matter Powys” looks like to you personally 

Deborah: I am so thrilled that Brecon Mind has had this opportunity to deliver this programme and I feel privileged to be part of it and I get the opportunity to work with so many wonderful mums. The mums I have worked with so far are amazing and inspirational. I hope this 2 year project can demonstrate to funders and the local government that this is an essential part of the perinatal service provision in Powys for mums and their families.

Tracy: Mums Matter is a programme running in different areas in Powys to help mums who are feeling low and anxious and need some support and tools to help with their mental health at this moment. Mums can talk openly and honestly about how they are feeling without being judged and will feel excepted and not alone.

What are the main challenges of the role? 

Deborah: I hope the word gets about across all the services in Powys that play a part in supporting mums in their prenatal and postnatal period of their lives. I have done my best promoting and advertising and attending service team meetings to-date but there is still lots to do on that.  Also, I would like to see an increase in the referrrals from GPs, I hope they can see and get to know of the benefits. I do get some self-referrals but I think it’s also important individuals know they can refer themselves and contact me direct for a friendly chat to find out more about the programme.

Tracy: Finding available rooms and crèche space and also letting mums know the programme is running and how it can really help.

Tell us about some of the most rewarding work you have done at Mind so far

Deborah: The biggest reward I had was hearing and seeing the progress and achievements of the mums who attended the first programme in believing in themselves as a mum; they were even using the ‘I am’ statement. They left a lot stronger individuals and even accomplished drinking a ‘hot cup a tea’ daily which I was very proud of. Their feedback is the most rewarding and they did it themselves I was just there!

Tracy: Running my first group and seeing the mums bond and support each other whilst learning to grow in confidence was very rewarding.

When you are not working for Mind, how do you enjoy spending your time?

Deborah: I’m a mum of 2 grown up children and a grandmother of 3 gorgeous little ones so my days of running around teenagers have been replaced by choosing when I want to run around after my grandchildren. This has left me with some spare time to indulge in walking coastal paths and cycling. I love our wet and windy land and try and spend most of my time out in it. My husband and I share a passion for classic cars and go on many classic rallies with our restored classic car. My vocation is practicing Reiki in my other spare spare spare time! I love my cats and peace and quiet when I get it, that might mean me just hiding in a corner somewhere for a while.

Tracy: I am a farmer’s wife so I enjoy getting outside and helping my husband and 3 boys on the farm. I also enjoy playing netball and badminton and having a glass of wine with my friends. 

                         

Feedback from some mums who have attended Mums Matter: 

• Amazing idea and support for those who are worried, feeling down or suffering with post-natal depression. There is no need to suffer in silence, there are others too. It was the best thing I ever did. 
• I feel more confident in myself and around people. 
• I could moan and share my feelings without judgment and in a safe place. 
• The creche gave me time to myself to focus on the course… I feel so much better! 
• I never left my baby before, was nervous but he enjoyed it and I enjoyed my space and new-found friendship with lovely mums, felt less alone & more myself. 
• I loved how the course gets you to look at being a realistic mum and not have to stress about being a perfect mum all the time. It’s okay to be a ‘good-enough’ mum! 
• I’ve decided not to take anti-depressants as this course has made me feel so much stronger, confident and happier… I now walk my dog regularly, relax with colouring and drink HOT tea!! 
• The course helped me put things into perspective, the past & the present. Things make more sense now. My heart melts now when I see my kids and that’s not happened in a long time.

Connecting with the mental health advocates

Powys mental health advocates Kirstie Morgan and Lynda Evans

“Advocacy”, it says on a whiteboard opposite my desk, is “taking action to help people: say what they want, secure their rights, and obtain the services they need.”

Many are the times I have signposted people calling our Information Service to the mental health advocates working in Powys. Last week two of them, Lynda Evans (North Powys), and Kirstie Morgan (South Powys), came along to the July team meeting of the PAVO Community Connectors to update them about the advocacy services available in the county. I was lucky enough to join them, and this is what we found out.

The three different advocacy roles in Powys

Independent Mental Health Advocate

This role was introduced in 2007 when the Mental Health Act was revised and advocacy was put on the statute books. Advocates suddenly had rights which they had not enjoyed before, such as advocating for mental health patients in hospital, on a Community Treatment Order, or detained under the Mental Health Act.

The provision is much broader in Wales than in England. Anyone in a hospital bed in Wales who is being treated for a mental health “disorder” is entitled to a mental health advocate. The IMHA can support someone who wants to challenge, for example, their detention under a Section 3 of the MHA.

IMHAs can also go into a ward and observe a patient’s treatment and interactions with staff – they cannot be prevented from doing so except in extreme circumstances – such as if the client is unwell and may present a danger to the advocate. IMHAs may, in addition, interview psychiatrists and social workers in private, access the medical notes with permission and share information with the client.

With her IMHA hat on Lynda ensures that proper process is followed, and that a person’s rights are upheld. “If a patient is told they can’t have leave because they’ve not been good, that is punishment. They can’t do that. There has to be a clinical reason to stop leave.” In another situation, a patient who is not being detained under a section may be told that they will be detained if they don’t behave. “This is wrong and totally illegal. Our job is to challenge on behalf of a patient. The first loyalty is always to the client/patient”.

Independent Mental Capacity Advocate

The Mental Capacity Act 2005 introduced the role of the Independent Mental Capacity Advocate. An IMCA is instructed either by Health or Social Services, not by the patient as they lack capacity. The lack of capacity may be due to a brain injury, mental health issues or dementia. IMCAs can be called on when treatment is about to start or to be withdrawn, and the patient has no family or friends who can be consulted. Or, there could be safeguarding issues which mean that it is not appropriate for the family to act on the best interests of the client.

An IMCA has many roles, including:

1. To support the client whilst a Deprivation of Liberty Safeguards assessment is made. The Alzheimer’s Society states that: “If a care home or hospital plans to deprive a person of their liberty… they must get permission. To do this, they must follow strict processes called the Deprivation of Liberty Safeguards (DoLS). DoLS are a set of checks that are designed to ensure that a person who is deprived of their liberty is protected, and that this course of action is both appropriate and in the person’s best interests.” So, for example, when rehousing someone in a nursing home it is important to consider a person’s preferences (they may previously have preferred the countryside to the town).
2. To support a family member who feels overwhelmed by the whole process of being the “relevant person’s representative” – who must be kept informed about the person’s care and treatment and any changes to it.
3. To visit the nursing home once a month to make sure all is as it should be. 

Community Mental Health Advocate

People in contact with statutory mental health services from age 18 and over in Powys are entitled to receive support from a Community MH Advocate if they wish. Those in receipt of local primary mental health support services (ie: through a GP surgery) have to be screened first as so many people seek support for mental distress from a GP.

The majority of the work in this area is for people supported by secondary mental health such as Community Mental Health Teams and Crisis Resolution & Home Treatment Teams. Kirstie explained that the work is vast and varied. The work could be long or short-term depending on the situation or the nature of the issue. “Quite often people are very poorly before they come to us and have to address a number of issues.”

Clients can self-refer, be referred by a relative or the voluntary sector (Mind centres or Ponthafren Association for example), or via the Community Mental Health Teams. “People see advocates when everything has gone wrong. In cases where the individuals have a dual diagnosis and their mental health is the prominent issue we will advocate. We work alongside many projects and advocacy schemes in Powys. Our aim is to build a good rapport and understanding with the client and there is a high level of professional trust.”

People have an entitlement under the Mental Health Measure (Wales) to access the CMHT duty desk and regain entry to services within 3 years. Advocates can support clients with this process.

Appropriate Adults

Kirstie and Lynda will also sometimes act as Appropriate Adults at police stations in the county to support and advise vulnerable people known to advocacy in police custody. The mental health charity Hafal is the main provider of Appropriate Adults in Powys.

A bit more about our Powys advocates

Lynda has been an advocate for 14 years now She is employed by Powys Teaching Health Board to be an IMCA and a community advocate, and for a small number of hours a week by Conwy & Denbighshire Mental Health Advocacy Service to be an IMHA in North Powys. Her current base is Fan Gorau at the Montgomery County Infirmary in Newtown, tel: 07736 120 924.

Kirstie is employed as a Community Mental Health Advocate by Powys Teaching Health Board, and provides advocacy in Mid and South Powys. She has worked in the field for 13 years now and is currently based at Neuadd Brycheiniog in Brecon, tel: 01874 615996 or mobile: 07967 808 145.

Linda Woodward also provides IMCA services across the county, and community advocacy for over 65s in North Powys. She is based with Lynda at Fan Gorau and can be contacted on 07974 935 355.

CADMHAS employs three other advocates in Powys – John Curtis in the North, and Adrianne Cleverly and Jane Wazir cover the South. You can contact them by ringing: 01745 816501.