How can Independent Mental Health Advocacy help you?

Last summer we featured Connecting with the mental health advocates in which we found out more about the three different advocacy roles in Powys, and met some of the advocates themselves – in particular those based in Powys. 

Today we talk to Adrianne Cleverly, who works for Conwy & Denbighshire Mental Health Advocacy Services, but actually provides an advocacy service for Powys (which is commissioned by Powys Teaching Health Board). I met Adrianne earlier this year, and we all agreed it was important to try to raise awareness of the advocacy service available in the county.

Tell us what brought you to work in the field of mental health advocacy?

I was fortunate enough, and lucky enough, to fall into the field of mental health advocacy – by complete accident. I was working in child protection; within that role I was working with Child and Adolescent Mental Health Services (CAMHS) and acting as an advocate for some of the children I was working with. The role was so varied that my experiences spread further than I had even realised because when you are doing the job you take those things forgranted and just get on with it. One day someone showed me the job advert for an IMHA (Independent Mental Health Advocate). When I read the job specification, I could not believe a job like this existed. I applied for the job, and what can I say, three years later, I still love the role and still feel lucky enough to work in this position. I love my job! You definitely have job satisfaction when you work as an IMHA. Sometimes the differences you make can seem trivial but the difference you are making to the person is so much more. It is such a rewarding job.

What is your role at CADMHAS and which area do you cover?

My role at CADMHAS is an Independent Mental Health Advocate. Within this role I cover the South Powys hospitals - Ystradgynlais, Bronllys and Brecon. Within the role of IMHA my role means that I visit the hospital wards and meet with qualifying patients (people admitted to hospital for their mental health). I work with them within the remit of accessing their rights under the Mental Health Act and support them with anything to do with medication, treatment and care.

I also deliver awareness raising sessions in North Powys. Those hospitals are Phoenix House, Welshpool, Machynlleth, Newtown, Knighton, Llanidloes and Llandrindod. As part of awareness raising I also work with the community mental health teams which are Ty Illtyd and The Hazels, additionally other professionals that might also be working with the same people as myself, should the scenario require me to.

Many people don’t know about the advocacy service. What are the key benefits of having an advocate?

The benefits of having an advocate will vary for the individual and depend on why they felt they needed/wanted an advocate in the first place. For some people they may have more than one admission to a hospital ward and they may want an advocate on one visit and not another. The beauty of the role is that it is led by the individual. It is not the choice of the professionals or the family, but the choice of the individual.

One main benefit of having an advocate is to ensure that you have a voice when you need it. Also the reassurance of knowing that someone is making sure your voice is heard. Other benefits include empowerment to have a voice. Receiving the knowledge and understanding and being helped and supported to understand your rights when you are in hospital or having some experience of the Mental Health Act (maybe living in the community but being on a Community Treatment Order or Guardianship). Also, having the availability to access those rights. Additional benefits are to feel supported by an independent professional and feeling like someone is on your side.

What key qualities does a good mental health advocate need to have?

The qualities of a good mental health advocate are simple; they will be non-judgemental and listen to what the person is actually saying. An advocate needs to be a good listener, they will be well informed and skilful. They will have confidence in themselves and be comfortable enough to stand up for the person’s rights.

Just for clarity, can you very briefly summarise the three different mental health advocacy roles?

Independent Mental Health Advocate 

An Independent Mental Health Advocacy (IMHA) means the qualifying patient has access to an IMHA which is a statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO). When someone is detained in hospital or on a CTO it can be a very confusing and distressing experience. 

Independent Mental Capacity Advocate 

An Independent Mental Capacity Advocate is available to everyone surrounding the care, treatment and support of people aged 16 and over living in England and Wales who lacks capacity to make all or some decisions for themselves in specific areas. These areas being change in accommodation, care reviews, safeguarding issues and serious medical treatment. An IMCA will also be involved in those detained under a Deprivation of Liberty order. The Mental Capacity Act is designed to protect and restore power to those vulnerable people who lack capacity. 

Community Mental Health Advocate 

Community Mental Health Advocates provide and offer representation and support at meetings and appointments to people who have been treated for their mental health and are now living in the community. An advocate is someone who will listen to your worries and problems and work alongside you to achieve your aims. Advocates are a valuable source of information and can help the people who use their service to feel in control of their own lives – to feel empowered. 

Can an individual be supported by all three types of advocate at once – IMHA, IMCA and Community Mental Health advocate? If so how does that work?

Yes an individual can be supported by all three advocates. All advocates work in different ways so if a person needs support in different areas they will be eligible for different advocates. An IMHA will work with an individual within the remit of medication, treatment and care.

An example of this would be if a patient is on a Community Treatment Order they will be eligible for the support of an IMHA who will support the individual with representation at a managers' hearing or tribunal. They may also have been deemed to lack the capacity to make a decision on their placement so they will then be eligible to have the support of an IMCA as IMCAs will work with the individual around this. They then might need support with things like pension and finances, so they will then require the support of a community mental health advocate.

What happens when a carer refers but the patient/individual does not want to engage?

This goes to the heart of advocacy. The individual is the one that instructs the advocate and decides if they want to work with us. If a person has capacity to understand the role of an IMHA and they don’t want an advocate that is their choice we would not force ourselves on them. The work of an IMHA is client led. If the individual doesn’t want to work with an IMHA, we cannot make them. We can ensure that we give them plenty of choices and just be available for them if they change their mind.

If the person does not have capacity then we can still work with them, but it will be in a non-instructed way. This means that we work with the family and professionals to establish as much information as we can and then work in the person’s best interest.

If someone is placed in a hospital or unit outside Powys, can you still support them? 

Usually our role would stop but we would signpost to other agencies.

If a patient is placed on a Community Treatment Order (CTO) what support can you provide as an advocate?

If a patient is placed on a community treatment order, our role would remain the same as if we were visiting them in hospital, but we would visit them in the community instead. We would still work with them around their medication, treatment and care and we would also attend meetings with them around these themes. We would also still support them with their rights under the mental health act and support them at managers' meeting and appeals.

Which organisations do you work most closely with in Powys? 

As an advocate in Powys there are quite a few organisations we have worked with. The main people we work with are Social Services and Community Mental Health teams. Additionally we also work with organisations like Age Cymru and the Alzheimers Society. We also work with the ward staff, and Best Interest Assessors.

What are the main challenges of your role?

Some of the main challenges experienced are having the ability to manage the expectations of not only the client but also their family. Another challenge is when delays happen and it is completely out of our control but there is an expectation on us to make it happen. Another challenge would be the conflict of interest and other people’s understanding of our role, including professionals.

Tell us about some of the most rewarding work you have done so far with CADMHAS?

For me personally, the most rewarding part of my job is when the client gets what they want! Especially when the work started it was not even a possibility, knowing that you have made that difference to that person. This includes things like making sure the clients are listened to and that there is communication between staff and patients.

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

I love to spend time with my family, doing things like mountain biking, surfing and walking. I enjoy listening to music, reading and cooking. It sounds a bit cliché but I love the ‘normality’ and chaos of family life! 

Many thanks to Adrianne for telling us all about her work as a mental health advocate. If you want to find out more you can contact the Powys Independent Mental Health Advocacy Service managed by CADMHAS by emailing admin@cadmhas.co.uk or ringing 01745 816501.

Small Steps at Rekindle - Three Stories

Recovery Practitioner Kemal with a local police officer outside the Newtown centre

John Scott is the chairman of the mental health charity Rekindle in Newtown. At a recent fundraising concert for the charity, which supports young people aged 16 to 25 who are struggling with mental distress, he said:

“The trustees and staff know from experience that early intervention can help many of these young people avoid or recover from the social dislocation that can result from mental illness.

There are more than 110 active clients, and they are referred by all the various agencies in Newtown. There are two full time recovery practitioners (Diane Williams and Kemal Keeble), one of whom is a qualified mental health nurse, and two regular volunteers. They operate from converted shop premises in the centre of Newtown, which makes them accessible to this client group.

Diane (left) with a client

The stories here are examples of what can be done, and there are many more similar ones. The right help at the right time can stop these young people from a possibly irreversible descent into self-destructive behaviour. It is wonderful to see young people starting to enjoy their lives again.”

Jess Foster

At the age of 18 I was living in a homeless hostel and felt there was no use in living any more. I struggled with the pressures of sixth form and trying to earn a living so attempted suicide multiple times. Initially I was under the care of adult services but didn’t feel as though I actually mattered to them and was made to feel as though my problems weren’t bad enough.

I was lucky enough to be introduced to Diane at Small Steps and I was finally on the road to recovery. I was given all the time I needed, whether it be for just a chat or to help me better my life. Feeling like I mattered and being listened to changed my life around.

I stopped self-harming, returned to sixth form, applied for university with Diane’s help and even began caring about my own wellbeing again. When I got my place at university Diane got me a grant so that I was able to buy everything I needed and to any other person I would then look like a typical student, not someone who had just been homeless. I am now graduating this summer, have a job and strong friendships. My life is now at a good point and it’s thanks to all the help and mentorship I had from Diane and Small Steps.

Megan Tudor

My name is Megan Tudor and I am an associate trustee for Rekindle's Small Steps Project. I began as a client of the project when abuse was identified in my family home. I had to leave home and faced the difficulty of finding a roof over my head. Diane and Kemal worked tirelessly to help me and although they came across many difficulties they never gave up on me. I was in a very dark place and tried to end my life on a daily basis; I couldn't find a reason to carry on. I went from living in a horrific environment to only having the clothes on my back and no roof over my head. I was also suffering from an eating disorder and refused to eat or drink anything.

The Small Steps Project was the only organisation that recognised there was abuse and actually listened. I had seen Child & Adolescent Mental Health Services (CAMHS), 16+ team, social workers and spent a year in a psychiatric hospital and none of them listened to what I was saying. Diane and Kemal let me have as much time as I needed and listened to every word I said and actually did something about it. I was supported on a daily basis to stay alive on top of trying to find stable accommodation.

I was supported by the Small Steps Project to find a reason to live, gain tools to cope and to slowly overcome my eating disorder. They helped me to get back into education and I finally started to feel like I was breaking free from the chains that held me back for so many years. I was no longer walking down the narrow lonely corridors of hospitals or dancing with my demons. I am now living my dream, halfway through my qualification, working part time and offering support to the other clients of the Small Steps Project.

Sam Morgan

I was 16 when I first came to Small Steps. I was living with the fact I had quite a bad temper but didn’t want to admit to it. I didn’t want to feel ashamed. It got to the point where I got pretty hard to live with, my anger was getting worse and simple things would set it off. It got to the point where shouting turned into me deliberately hitting anything hard, just to try and feel something other than anger. I was also damaging my hands. My parents and I realised I couldn’t go on doing what I was doing, so I got in touch with Small Steps.

It took a long time for me to understand that I was adjusting from being a young person being told “what to do” and the new pressures of having to make decisions about life. “Who I want to become” and “what I want to achieve”. Small Steps helped me with this, it was the first time I had someone who I could speak to and someone who understood how I was feeling.

I felt I only had the one overwhelming emotion which was anger. I was always waiting to be challenged and at the first hurdle I would usually just lash out! Over time it become apparent that there was more to life than just this feeling of anger. Things changed for me and now I saw things differently; I could stand back and assess the moment and realise that anger was not the correct response. All of this was only really possible because of the continued support I received from the Small Steps Project.

I am in a different place today. I think more positively about what I would like to achieve. I am now 19 years old and aspiring to be a Royal Marine commando, which is a completely opposite mind-set. My mental and physical toughness has developed through training. I understand how to take care of my body and wellbeing. My relationship with parents is very different today, we are able to talk about things more openly and have become closer as a family. I realise now how I have a lot more to give in life and that it all starts with you allowing these changes to happen.

Jess and Sam's stories also feature in this short video about the Small Steps Project:

Find out more about the work of Rekindle and its Small Steps Project on the organisation’s website. The charity is funded by charitable trusts, local groups, businesses and individual donations. If you can help in any way you can contact the charity by emailing: help@rekindle.org.uk or ring 01686 722222.

Sarah Napper with Diane

Stop press: Rekindle volunteer Sarah Napper was recently nominated for the Powys Volunteer of the Year Award 2018 and reached the shortlist. Sarah has been volunteering for three and a half years and her role involves welcoming clients and professionals to the project. She does this despite having her own bipolar diagnosis. Sarah is around the same age as those seeking help so she has a special empathy and understanding of their problems and is a good listener. Diane said: "Sarah promotes and empowers young people to believe they can achieve anything in life despite any obstacles that come their way."

Veterans NHS Wales – on military mental health

Victoria Williams, Veterans' Lead, Abertawe Bro Morgannwg University Health Board (left)
and Vanessa Bailey, Veterans' Lead Therapist Aneurin Bevan University Health Board (right) 

This week’s guest post is from Victoria Williams, the Lead Veteran Therapist at Veterans' NHS Wales service (VNHSW) based in Swansea's health board - Abertawe Bro Morgannwg University Health Board. The team also covers the Ystradgynlais area of South Powys.

Veterans are defined by Public Health Wales as “anyone who has served for at least one day in HM Armed Forces (Regular or Reserve) or Merchant Navy Seafarers and Fishermen who served in a vessel at a time it was operated to facilitate military operation by HM Armed Forces”.

Veterans' NHS Wales service is there to help ex-service personnel living with service related mental health problems. I caught up with Victoria to find out more about provision of this invaluable service in Powys. 

Tell us more about your role as a Lead Veterans' Therapist and what drew you to the work

I’ve been working for Veterans’ NHS Wales since 2011 for the ABMU health board. Having worked in mental health for over 20 years I recognised that I wanted to work in a service that specialised in working with military veterans and this was an ideal opportunity.

What kind of support is available to veterans in Powys?

Powys enjoys the same level of service from Veterans’ NHS Wales as anywhere in Wales. You can download a map showing the 3 out-patient clinics, based in Welshpool, Neath and Bronllys.

Why might veterans require this service?

Veterans’ NHS Wales is a psychological therapy out-patient service offering therapy for veterans with service related mental health difficulties. This means that anyone who's finding it difficult to cope after they have left the military, if they think their issues might be ‘service related’, are able to self refer to us. We will then offer an initial assessment of their needs and from there a management plan will be put in place.

Mark Birkill, Veterans' Therapist in North Powys

How can Powys veterans access the service? Who can refer a veteran for the service?

VNHSW is the Welsh Government funded NHS mental health service offering therapy for issues related to military service. It’s important to note that ANYONE can refer into the service. We offer an open access policy meaning that people are able to self-refer via the website. We do find a lot of people think they have to go via the GP but this isn’t necessary.

Once referred an opt-in form is sent asking the veteran for extra details and proof of identity. When we have this information we aim to offer an assessment within 4 weeks. The assessment will look at all aspects of the current situation and look at how we can best support you.

The Powys Veterans' service is delivered by neighbouring health boards. How does this work?

VNHSW is a ‘hub and spoke model’. This means we are one service centrally based in Cardiff with our ‘spokes’ throughout the other 6 health boards in Wales. Powys is covered by 3 health boards but because we are ‘one service’ it therefore has no impact on the service a veteran will receive. If there are any doubts as to where your clinic is based then individuals can contact us (see details on the map or go to our website) and we can point the individual in the right direction. For example, if the veteran's GP surgery is based in the Abertawe Bro Morgannwg health board, then the veteran would be seen in our out-patient clinic in Neath.

A Veterans' service is very specialist. What training do Veterans' Therapists undertake?

All veterans' therapists are trained psychotherapists with training in Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Both therapies are what we call ‘evidenced based therapies’ for treatment of a variety of mental health difficulties. In addition we receive additional specialist training in military mental health difficulties.

Oxana Jones, Veterans' Therapist in South Powys

Are there other agencies Powys veterans can contact for support with their mental health or other issues such as debt management or armed forces compensation?

Veterans’ NHS Wales has a network of agencies working throughout Wales offering support for many different issues. We currently have a peer mentor support worker who is able to help veterans link in with the most appropriate agency to help with their needs.

What has been the most challenging aspect of running the Veterans' NHS Wales service?

One of the most challenging but rewarding aspects of the role is the increasing number of referrals we’ve received since we started 10 years ago. Initially this led to an increase in the time veterans were waiting to be seen for therapy. However, with the support of Welsh Government, which has recently increased our funding, this has meant that we’ve been able to extend the input of psychiatrists and administrators can give to the service. We’ve also been very lucky to receive additional funding from the charity Help for Heroes over the next 3 years and this has led to an increase in the number of therapists in the service leading to shorter waiting times.

Tell us about some of the most rewarding work you have done with the Veterans' NHS Wales service so far

Being able to speak to someone who isn’t aware that there is help for the problems they are presenting with. Also helping someone to make sense of why they feel the way they do, and offering an evidenced based psychological therapy to reduce their symptoms and improve their general daily functioning, is pretty rewarding stuff.

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

As a mother to two teenage boys and two dogs I tend to be very busy but you can often find me on the beach with my dogs or eating cake, I’m a big fan of cake.

Many thanks to Victoria for telling us about the Veterans' NHS Wales service in Powys. If you would like to contact her, please email: victoria.williams4@wales.nhs.uk