Memory boxes – the Ystradgynlais story

In July 2016 I posted Memory boxes – connecting with the past – about a new initiative in Brecon run by the local museum. It is aimed at anyone working with, or caring for, older people living with dementia. Across the UK the approach is spreading as more communities decide to become dementia-friendly. A memory box scheme is a relatively easy and fun project to set up. And it is a very practical way to support people to reminisce about the past and thereby improve their wellbeing in the present. 

Sally Richards

Sally Richards, the PAVO Community Connector for Ystradgynlais and District, told me more about the Ystrad scheme. She also updated me about her work in the town, particularly in relation to supporting people living with dementia and those caring for them.

Dr Anja Pinhorn, a Consultant in Health Care of the Elderly at Powys Teaching Health Board, regularly works out of the Ystradgynlais Community Hospital. She initiated this memory box scheme working closely with a number of voluntary sector agencies in the town. Pulling in different groups has resulted in some truly unique memory boxes, with themes ranging from nature and wildlife, to sport and the Abercrave Rugby Football Club, the history of the local area, weddings, sewing, Christmas and cooking. 

Anja told us: "Staff at Ystradgynlais Hospital originally borrowed a couple of memory boxes from the Brecknock Museum Service and were impressed at how it opened up conversations on the ward. This led to the idea of developing our own conversation boxes. Staff have been overwhelmed by the response when we asked for help from diverse individuals and groups including Brecknock Wildlife Trust, the British Red Cross, a photographer based at Craig y Nos and the Ystradgynlais Volunteer Centre. Thank you all and keep the ideas for boxes flowing."

The boxes live on the 20 bedded Adelina Patti Ward at the hospital where they are used to stimulate conversation and memories about patients’ lives. These could include key events and anniversaries, holidays, interests and hobbies, working lives and everyday family activities. The boxes are crammed full of intriguing objects - everything from beer mats to confetti, knitted flowers to shoelaces! All to encourage an exploration not just with the eyes but also by touch, transporting people to their past lives. Sally explained that the benefits are obvious as the boxes can actually help stop people going into a low mood during a long stay in the hospital. Following their success on Adelina Patti Ward she is keen to spread the word and encourage their use in other sections of the hospital.

In her work as a Community Connector Sally regularly supports people living with dementia and those caring for them to make links with organisations that can help. Many practical issues will arise with a dementia diagnosis, including the need for more personal and medical care, and support with finances. However, “one of the hardest things for carers to deal with is losing the person that they fell in love with, or love, to the disease”.

Clients ask Sally about legal aspects relating to a dementia diagnosis such as Lasting Power of Attorney, or benefit payments like Attendance Allowance. However, sometimes what is of crucial importance to mental wellbeing is setting up links with local groups. If someone has had their driving licence revoked and feels their independence is being stifled, it is important to arrange transport so that they can continue to pursue their interests. In Ystradgynlais people are more likely to look south to Swansea, rather than north to Brecon and Llandrindod for activities, so Sally has to be expert in knowing about a wide-range of groups and services. 

A key challenge is trying to explain to people who live right on the Powys border with Neath Port Talbot why they have to access different statutory services from their neighbours.

Sally is based at the Ystradgynlais Community Hospital, where she sits in the Older Persons Integrated Team which is alongside a team of social workers and occupational therapists. “Being in the hospital is ideal as it means I can work in an efficient manner. If I receive a referral for someone who is due in day hospital on a Thursday I’ll nip and see them when they are in rather than make a separate appointment. And I can talk to the medical departments – get regular updates – and build good working relationships with colleagues in the hospital.”

She receives referrals from many of her statutory colleagues, including Community Psychiatric Nurse Assistants based at the community hospital. There is a daily half hour Integrated team meeting that she attends, where she and colleagues are joined by the Ward Sisters, Day Hospital Sisters, Physiotherapists, and District Nurses. Up for discussion - anyone over 65 with complex needs, with staff working together to provide the best care options possible for their patients and deciding who is best placed to provide it. Once Sally has picked up new referrals she works hard to match people up to relevant agencies, but sometimes it is challenging due to the pressures on overstretched voluntary sector services. “I can sometimes wait a long time to speak to someone in a busy charity, and last week at the end of one call instead of one referral I suddenly had four!”

Working closely with Theresa Huykman of Credu (formerly Powys Carers), Dementia Matters, the Alzheimer’s Society, and Christine Finch - the South Powys Dementia Support Worker, is clearly paying off. The partners have already identified gaps in services for carers of those living with dementia. As a result, they are launching a new dementia carers’ group (“a cuppa and a chat”) this Wed 21 February. Future get-togethers will take place monthly on the 3rd Wednesday, 10.30am – 12.30pm, at The Welfare, Ystradgynlais. If you’d like to know more about the group contact Theresa on 0777 334 2128.

If you’re based in the Ystradgynlais area and would like to find out more about helping make the community dementia friendly, check out the Dementia Matters in Powys website for the latest updates and information.

For general enquiries about dementia a good option is the Wales Dementia Helpline, 0808 808 2235 or the Alzheimer’s Society Helpline, 0300 222 1122.

Here in the PAVO mental health team we are loving these Ystradgynlais memory boxes. What theme would you pick if you were making a memory box for family and friends in your local community? Feel free to let us know in the comments section below.

And you can find out how to build a memory box with these easy-to-follow instructions from the Alzheimer’s Society.

Mental Health and the Welsh Ambulance Service Trust

This week’s guest post is from Isobel Jones, who works for the Patient Experience and Community Involvement team for the Welsh Ambulance Service NHS Trust. I first met Isobel at a Welshpool meeting of the Stand up! For emotional health and wellbeing project run by our team where she introduced us to her work. I caught up with Isobel lately and asked her if she would tell us more about her role for the blog. 

What led you to this particular role at Welsh Ambulance Service Trust? 

I come from a Social Care background, and have also worked in the Third Sector, however, throughout my various roles I realised that I was becoming more and more interested in engagement. Involving people in shaping the services they receive can only help develop better services. It just makes so much sense. 

In some of my past roles I had been asked to undertake some projects which had enabled people to be involved in the planning and development of the services they received and I found these projects very insightful and interesting.

I followed this idea further by attending training courses which explored effective participation and engagement skills, and they gave me the tools and techniques to do this.

When the job was advertised within the Welsh Ambulance Service’s Patient Experience and Community Involvement Team I was excited as this was just where I could see myself. I hadn’t looked at it from a Health perspective before so I knew this would be a new challenge.

How do you educate patients and the public about the services provided by the Trust?

We have an extensive engagement model, which allows us to reach different groups and communities. We use our partners in the Health Boards, statutory, third sector and other community links to be able to engage with different people who may have used our broad range of services. It is important to go where people are. We’ll also host information stands at a range of events across Wales that helps us to talk to local people.

We then arrange to go out to meet people in these different groups and talk about our services, which includes awareness about how we respond to and prioritise 999 calls. It is important when we visit groups that we listen to people’s experiences and their stories, and encourage people to give us their feedback.

We make people aware of how they can ‘Choose Well’, by accessing a range of health services available from GP, Out of Hours, Pharmacies, A&E Units and Minor Injury Units. We also talk about self-care, and using services such as NHS Direct Wales for telephone and online advice.

My work involves engaging with mental health groups, older people and people living with dementia. I have also visited learning disability groups, schools, groups with specialist health needs like Chronic Obstructive Pulmonary Disease and other respiratory conditions, Parkinson’s, Multiple Sclerosis and various Black and Minority Ethnic (BME) groups.

We have a continuous engagement model which gives me the opportunity to visit groups again and again, building up trust and encouraging people to stay involved with us as a service as their contribution is so important. 

I was also given the opportunity to train as a Community First Responder for WAST which I completed in March last year. With this training I am equipped to provide awareness sessions for community groups about how to undertake emergency first aid to support saving a person’s life, by learning in basic steps what we all can do to help someone when they face a life threatening emergency like a cardiac arrest, how to use a defibrillator, what to do if someone is choking, or needs to be placed into the recovery position until the ambulance arrives.

If someone being transported by WAST is experiencing mental distress, what support is provided by staff?

All our staff should support such a person with the utmost of dignity and respect, recognising that whilst with physical health conditions these are often visible, not all health conditions are visible, especially mental health and wellbeing.

Our staff will have followed any assessments of need that are in place for mental health, including local pathways which are in place which have been agreed in partnership with local services.

WAST Staff are currently going through a training programme focusing on mental health.

What kind of training do Trust staff have to help them support someone in mental health crisis?

The new WAST Mental Health Strategy which has recently been formed is very clear that there needs to be more training for our staff on the needs of people who experience mental ill health, and for our staff to be more aware of how to treat people who call 999 in crisis. This has come out of the fact that staff have acknowledged there is a need for this, to benefit people with mental health needs.

Tell us more about the Trust’s Mental Health Improvement Plan

People who access mental health services have told us that these things are important:

• Don’t ‘generalise’ mental illness. 
• Consider my communication needs.
• To be seen as a human being.
• Need calming, understanding and polite approach for people experiencing panic. 
• To be respected and treated equally. 
• Be listened to and believed. 
• Listen to carers as well as the person needing medical attention. 
• Staff need knowledge and awareness of mental health issues. 

Our staff have told us:

• We need a “better process for responding to patients in crisis.” 
• We need “up to date evidenced based training.” 
• We need “better links with crisis teams.” 
• There are “inconsistent pathways across Wales.” 
• There is a “variance of support across the localities.” 
• There is a “lack of suitable alternatives to A&E.” 

Our staff need support on how to maintain their own mental health, how to prevent stress and sleep problems, ensure good nutrition avoid substance misuse, etc.

Because of this, these are the priorities we have set for our plan:

Priority 1: Putting you at the centre

• Everybody is different and has different unique needs and experiences of mental health at different ages. 
• Specific work needs to be done around children and young people’s needs. 
• Think about the needs of people with dementia and of people with fluctuating mental capacity. 
• Supporting those who are at risk of suicide and self-harm. 
• Caring for those who may misuse substances. 

Priority 2: Training, awareness and skills for Welsh Ambulance staff

• What do our staff need to know about mental health in terms of training, attitude and approach? 
• Understanding people’s unique mental health needs (and the spectrum of mental health disorders).

Priority 3: Working better with other professionals

• Working better with GPs, hospitals, local community support services, Health Boards, carers, family, social services. 
• Working with trained mental health practitioners to support our frontline teams.
• Developing alternative pathways for people experiencing mental distress. 
• The purpose of these pathways is to make sure you are seen by the right person at the right time. 
• Where possible get appropriate help in the community, rather than a hospital setting. 
• Only considering hospital settings if physical health is at risk.

Priority 4: Caring for the wellbeing of our staff

• Putting support systems in place.
• Having mental health advocates. 
• Helping staff cope after traumatic incidents.

For our staff we need to maintain optimum mental health, sleep, exercise, nutrition, management of alcohol intake, etc.

Priority 5: Dealing with challenging situations

If an ambulance staff member is facing violence in an extreme situation, we will assess the risk and decide when it is appropriate to restrain someone to keep them and staff safe.

Priority 6: Giving necessary guidance and support to teams

• We have people within Welsh Ambulance Service who lead our mental health work. 
• We need to make sure staff are supported and have the right supervision to develop knowledge and skills about mental health.
• This is for the benefit of all people who access mental health services as well as to support Welsh Ambulance Services staff.

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

So far, I have only worked with ‘Stand up! For emotional health and wellbeing’ in Welshpool. I would love the opportunity to network with and meet other groups in Powys so please get in touch!

We have visited many groups that support individuals with mental health and wellbeing concerns across Wales, but we would like more opportunities to speak to people in Powys. Have you used our services and would you like to give us feedback?

We would also appreciate your help to enable us to further develop our services as part of our Mental Health Improvement Plan. If you or your group / organisation are happy to receive a visit or take part in a focus group, please contact me (details below). Your views and experiences are important to us to help shape the way we work and how we support people.

What is the most challenging aspect of the job?

Sometimes it is the amount of travelling, as I travel all across Wales!

But in the main, it is making sure I listen carefully to what people tell me, and make sure I understand what is important to them. The challenge then is to make sure that voices are heard within the organisation in such a way that can make a real difference to the way we do things in the future.

To do this effectively it is very important to be a very open, friendly person, showing kindness and respect for any person who wishes to talk with you. I feel I need to show in my face and my body language that integrity is important, and that I can be trusted.

Sometimes people are angry and hurt, for good reasons, by their experiences.

I know they are not taking this out on me personally, it is important to understand why people say what they say, in the way they may say it. It is important for me to convey in a calming manner, acceptance and acknowledgement of how people are feeling and for people’s hurt feelings to be validated. 

Tell us about some of the most rewarding work you have done at WAST

Over the last year I engaged with a wide range of groups across Wales who supporting people experiencing mental health issues from many backgrounds.

Whilst most people reported positive experiences of having used emergency ambulances and non-emergency services, their suggestions were both insightful and helpful, as were the thoughts and observations from support workers and other professionals. 

I was given the opportunity in July 2017 to attend the WAST Trust Board and provide feedback on all of the engagement work I have undertaken with mental health groups and organisations across Wales. This presentation was well received by executive leads and managers in WAST. I was able to convey thanks to all the individuals with mental health concerns, organisations and staff who have shared their (sometimes very painful) stories with me. This opportunity allowed all of these voices to be heard, which contributes toward improving outcomes for people who use our services.

Another piece of work I found really rewarding was with people from the learning disability community where I was involved in setting up a drama group. This was a group of individuals in Caerphilly who worked in partnership with us to use drama to understand some of the barriers they experience when they ring 999 for an ambulance. During a celebration event in Blackwood, the drama group, which consisted of people with learning disabilities, showcased scenarios with real live call handlers, paramedics and community first responders.

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

I am always totally humbled when people I have only recently met open their heart with sometimes very painful stories to me. I always try to do my best to do justice to what people tell me, so that it really makes a difference. We want to listen to people’s stories and experiences of using our services, and to capture feedback from people to improve our services.

Also since I trained as a community first responder volunteer myself back in March last year going on an emergency ambulance ride out with a crew from Hawthorn Ambulance Station to observe the experts in full flow to help consolidate my training has also formed part of my continuing journey… The day progressed with themes of falls coming up at least twice, sepsis also twice, breathing difficulties and presenting chest pains which may have been related to post traumatic anxiety, stress or other mental health concern. There was a lot to be learned about the needs of carers as well. What if they themselves need medical treatment and to be admitted but they are worrying about what will then happen to loved ones they care for, who may have dementia, a mental health condition, a physical or a learning disability, or in fact any combination of these? Colleagues shared with us about these dilemmas, as sometimes it is not just about the patient, but it was about their family as well.

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

I love cooking, especially making jams, marmalade, herb jellies and chutneys. I gift wrap these and give them as presents. I also sell them to raise funds for charities.

I love walking and the outside world, animals, wildflowers, plants and nature, and especially my garden where I collect and grow loads of plants, shrubs, flowers and herbs. These interests often inspire me to paint watercolour pictures, play the guitar, write, sing and perform songs and poems. So this is just a little bit about me!

Many thanks to Isobel for telling us all about her role. You can contact her by ringing: 01792 776252 Ext. 45444 or emailing: isobel.jones@wales.nhs.uk

From Bermuda to Powys - Problem Oriented Policing

A couple of weeks ago I attended a training event at Dyfed Powys Police HQ in Carmarthen with Penny Price (Service Manager for Adult Mental Health Services in South Powys) and Lisa Hale (Acting Ward Manager, Felindre Ward, Bronllys Hospital). We were there to hear Criminologist Sylvia Chenery (right) speak about Problem Oriented Policing (POP).

“Problem Oriented Policing (POP) has a history of looking at those long term problems; those ‘it’s been there for years...nothing we can do about it’ occurrences. The best strategy for solving a problem depends largely on understanding the situation, learning everything you can about why it’s happening and then using factual knowledge, and sometimes creative use of partners to come up with effective, longer term solutions.” Sylvia Chenery.

I was possibly the only person attending from the voluntary sector (others had been invited), but numerous statutory partners came along, including: Mid & West Fire & Rescue, Trading Standards, Mid Wales Housing, Probation, Health and Mid & West Wales Ambulance. There were also many police officers and managers present, including Chief Inspector Rhiannon Ivens who leads on Partnerships in Powys for the force.

Penny Price, Lisa Hale (Powys Teaching Health Board) and Police Inspector Kathryn Griffiths

The invitation stated “we would really welcome attendance from partner agencies as a joint approach to (POP) will be vital. Problem solving must become everyday business; it needs to be robust and it must be consistent to get to the root causes….The (POP) techniques will assist with our engagement with each other and should not be confined to crime and disorder problems. We can utilise this approach to help manage demand for our services more generally…”

On her recent work with the Bermuda Police (yes, Bermuda the sub-tropical island which is also a British Overseas Territory!) Sylvia commented on the critical importance of partnership working: “The POP philosophy begins with taking problems and working with those who work and live in the area to deal with them. This is about how the police and their professional partners… work alongside the community. Problems are resolved from the group up, with the support of the government and legislation, but actually if you really want to have a sustainable solution, it has to come from within the community and your partners on the ground.”

So, what can Powys learn from the Bermuda experience…? Deputy Chief Constable Darren Davies informed us “all front line Dyfed Powys police officers have received awareness training and this will be followed up with practical application during the early part of 2018.” As partners, we had been invited “for a more localised practitioner approach.” The force, Darren explained, is keen to reduce harm for vulnerable people and stressed communities. The solutions do not rest with one agency. His ‘critical friend’ role allows people with a fresh pair of eyes to look at problems which have been ongoing for a while. Such problems could include anti-social behaviour, neighbourly disputes, or fly-tipping, for example.

Sylvia explained that POP started originally in the States, where police forces adopted the philosophy of Professor Herman Goldstein, a specialist in Criminal Law. Police forces the world over are often called out to situations where they do not actually have the necessary expertise to deal with the problem. In some cases that could be because someone is experiencing mental distress, for example.

Tools and models which Sylvia went on to describe in some detail will provide the police with a more strategic and scientific approach. The key, however, is for officers to ask the question: “How will this work on the person I’m trying to have an impact on?” “Knowing the people you work with – other agencies – that can help you manage that problem that you are working with.”

In this brief space I am just going to pick up on a few more of the key points that Sylvia made in her detailed presentation.

Why are we doing this here? To get the best out of partnership working. Colocation is the way forward.

What do you need to make it work? To have real buy-in – having senior officer support gives a breathing space to look at the problem differently or else otherwise we will always be dealing with it. The more confidence you give to communities, the more they will tell you.

Think creatively. In Dyfed Powys we have Crime Prevention Advisors. In Hertfordshire there are Call Ambassadors. In Northumbria – POP Stars!

Sylvia went on to describe a number of crime theories, available for the police to use to good effect in analysing crimes and offenders. These included the Problem Analysis Triangle, the Routine Activity Theory, the Journey to Crime and the Broken Windows Theory. This last theory also comes courtesy of the US, where former New York Mayor Giuliani postulated that if you don’t repair a broken window in a building then the next time you go back you will find two broken windows. Similarly, if graffiti and fly-tipping are ignored, this spreads the signal to the community that it is not a good place to live, and to offenders – come and do what you want because nothing will be done. “Zero tolerance is the way to solve crime”.

Sylvia pointed out that partners can have quite different remits and priorities. She highlighted Jonathan Shepherd, a surgeon from Cardiff, who introduced plastic containers for night-time drinking because he was forever stitching up faces slashed by broken glass.

“We need to deal with the low level stuff in the same way as a murder inquiry. Start with the victim and build up the facts around the victim to build a better picture of what’s causing the crime to happen.” We like to give labels to people – gangs, drug dealers, beggars… “But there could be a hundred different reasons why people are doing what they do. Break it down from the general to the specific.”

Sylvia spoke in detail about repeat offenders, and about the value of working with family members and friends in providing useful interventions. “Sometimes you need to be more like a doctor in diagnosing what is wrong, or like an engineer – very systematic.” She said that speaking to people who actually cause the problems, and their victims, would give a much greater understanding of why the behaviour is happening.

“The key to being more creative in approaching problems? Innovate. Do something different. Don’t do the same thing over and over again…”

Perhaps the key message I took away from the session was that we should all question ourselves, and others, to become more effective in what we do. As Sylvia says: “Be passionate about what you do and people will believe in you.”

What do you think about Problem Oriented Policing? Would you be willing to work more closely with the police in your area to try to resolve issues that crop up again and again? Let us know in the comments box below.