Maternal Mental Health Awareness Week 2024

 by Jenna West

online CBT co-ordinator, NHS Wales

You’re exhausted, you’re a whirlwind of emotions and your pregnancy or new parenthood aren’t working out exactly how you’d imagined. You’re trying to be happy – because that’s how everyone expects you to feel – but really you’re just worried about how on earth you’re going to cope.

The reality is, it can be totally normal to feel stressed, anxious or low in the perinatal period.  But rest assured, there’s help at hand: Help that fits in with you and your schedule; help you can access 24/7 in the comfort of your own home; help that will teach you lasting skills for taking care of your mental health now and into the future.

SilverCloud Wales is a free, online mental health support service provided by NHS Wales. Anyone aged 16+ living in Wales can sign up without GP referral. The Space for Perinatal Wellbeing programme caters specifically to expectant mums and dads, new parents, surrogates, caregivers and people adopting a child. There’s no waiting list, and you can access it on any computer or mobile device, including your phone, anytime during pregnancy and up to a year after your baby is born.

You’ll have access to the programme and all its content for a year when you sign up, and you’ll be allocated a trained SilverCloud supporter for 12 weeks. They’ll check in on your progress as you work through the six modules at your own pace, giving you fortnightly written feedback. They can also point you to additional support if they feel you need it.

You’ll see that from the get-go the programme normalises what a tough time this can be. It might feel quite taboo to open up about your emotions, or to admit that you’re struggling or not enjoying time with your baby, but Space for Perinatal Wellbeing gives you a safe place to express those feelings, and breaks down some of the different challenges of this period into manageable points for you to work on.

For example, it talks about being flexible around sleeping times, empowering you to step back and create your own habits and routines based on what works for you, rather than what you think everyone expects of you.

There’s some signposting which shows how you can build some community around you, so you don’t feel quite so alone. There are personal stories from other caregivers in there, so you can hear their experiences without necessarily opening up about your own, and there’s a module on learning how to challenge low mood through simple activities for you and for baby.

All the tools and techniques for managing feelings like anxiety or depression are designed with the perinatal period in mind, recognising its very specific demands - it’s not always a simple case of getting up and going out for a walk to make yourself feel better when you’re sleep-deprived and have a newborn baby to care for.

One size certainly doesn’t fit all, so this is about finding what works best in your situation, always remembering that caring for your baby starts with caring for you.

Download the Space for Perinatal Wellbeing guide here.

If you need support and live in Wales, or if you’re registered with a Welsh GP practice, sign up to the service here.

Find out more about Maternal Mental Health Awareness week.

Machynlleth Makerspace – learn, socialise and collaborate

Keys to the new premises in Machynlleth!

Pat Cook has been a volunteer at Makerspace in Machynlleth since the start of 2024. She says: “I can’t even begin to describe how important it has been to find such a welcoming space here and I want to do everything I can to ensure its success and continued growth.”

I asked Pat to tell us more about the work of Machynlleth Makerspace, also called Machspace. Cassian, one of the directors at Machspace, contributes too.

What is a Makerspace?

Pat: It is what it says - a space where there is the room and equipment and advice, if necessary, for members to make, mend or repair. Often people don’t have the room or the equipment they need to make or mend and this lack of facilities contributes further to the amount of waste that our throwaway society produces.

Cassian: There are lots of makerspaces (sometimes called hackspaces) all over the UK and the rest of the world. The Hackspace Foundation is a UK organisation helping people to set up and run makerspaces.

How did Machynlleth Makerspace come about?

Cassian: It was 2021 when Katy Fowler, a former director, suggested the idea in a local WhatsApp group. Me and Avery were immediately interested, because Avery had been a member of Swindon Makerspace and had been wishing for one in Mach since he moved here just before the first Covid lockdown. I went with him a few times as a guest and enjoyed it very much.

Many people were interested at first, but there were four of us who were very dedicated. We met weekly to chat about how to move it forward. None of us had done anything like this before, but in early 2022 we formally founded the Community Interest Company (CIC) - me, (they/them), Avery Rowe (he/him), Katy Fowler (they/them) and Chris Richards (she/her). We met regularly and held semi-regular "open days" at the local Bowling Club's function room, but really struggled to find a venue in Mach to settle full-time.

Then in Summer 2023 there was a sudden flurry of action: we learned about the Social Value Forum Development Fund a month before its deadline at the same time as we found an empty shop that wasn't properly on the market for new tenants yet - it was a very intense month of writing the grant application. Then the grant was awarded, we signed the shop lease, and worked very hard to make the kitchen and bathroom suitable for member use as quickly as possible. The grand opening was on 20 October 2023. The group went from no venue and no money to opening our makerspace in about 3 months!

That was just under 6 months ago. The SVFDF target was 50 members in 18 months, and now at only 6 months we have over 70 members already! It's been a whirlwind. I still haven't caught my balance, but when I stop and catch my breath I feel in awe of what we've achieved.

Pat: I know from personal experience both the emotional and time consuming costs and benefits of such altruism and how exceptional it is to find there are still people who care about the community they live in and want to improve it for everyone’s benefit.

Demolition work to improve the space!

Where is it based?

Pat: It’s in the centre of Machynlleth in the Old Town Hall almost opposite the Clock Tower. The ‘Happy Bench’ is directly outside, a useful space to sit and think and talk to other people.

Tell us how you got involved and about your role

Pat: I moved to Machynlleth two years ago from Brecon. Lockdown was horrendous for me personally, it destroyed what was left of my limited mobility and everyone on the estate was impacted by the open selling of drugs and the resulting fights and antisocial behaviour. Two years earlier I had to have my horse put down and the year before that the Community Art Workshop I had helped to set up and run had to be shut down. I had already applied for a transfer and when my best friend and neighbour died I moved to Machynlleth.

I now live in a beautiful town, with views of the mountains from my living room window, but I didn’t feel ready to be old and wanted more from my life. I found Machspace by accident when, on one of the days I could walk, I was on my way to a Credu Coffee Morning. I couldn’t believe my luck. Here was the opportunity to be involved again with a community of Makers, only this time without the responsibilities.

My physical limitations prevent me from being more active but I have run an Open Day and helped people explore the potential that lino printing offers. It was great to once again see people experimenting with new ideas and techniques and to meet people in such a friendly and sociable space.

What kind of equipment is available for members to use in the space?

Pat: Considering the limitations of space the variety of equipment available is amazing. Woodworking tools, including a mitre saw. It was this that really excited me as now, once I have bought the materials, I can frame the pictures that I’ve painted. Sewing machines, including an industrial one for heavy duty fabrics, a peg loom, a soldering station, lino cutting tools, and a newly acquired laser cutter and 3D printer are available. It really is a Makerspace in being able to provide access to equipment that you wouldn’t have at home, as well as the space to use it.

It’s a members-only space – why, and what are the benefits of membership?

Pat: Machspace is available for members to use 24/7. Because it is a totally free and unsupervised space it is important that both the space, the equipment and any other people present are treated with respect and consideration. It is easy to join as a member. There is a 30 minute induction during which the conditions of membership are made clear, then you sign an agreement to abide by these conditions. After this the new member is given a key fob which means you can access the space at any time that suits you. Especially useful if you’re an insomniac or work antisocial shifts or you’re a night-functioning person.

How is being a volunteer at Machspace different?

Pat: I seem to have spent a lot of my life volunteering for different community groups and organisations. Perhaps the biggest difference is that being a volunteer for Machspace is the inclusivity. There are regular volunteer meetings and a WhatsApp volunteer forum which provides the opportunity for volunteers to be actively involved in the development and plans for Machspace’s activities and growth as an important asset to the community.

What happens at the fortnightly Open Events?

Pat: The Open Events provide an opportunity for anyone who is interested in finding out more about Machspace, the equipment available, how to become a member and to answer any questions. Usually there is a making activity taking place during the 2 hours of the Open Event and anyone is welcome to join in and meet other makers in a friendly and welcoming environment with the added benefit of drinks and snacks.

Roz, Pat and Stu lino cutting

Tell us how being part of Mach Makerspace has impacted on your mental health

Pat: When I found Machspace my head was not in a good place. My GP had referred me for counselling and I had just been for my third session. I was trying hard to overcome my anger, despair and grief at having to accept that I was no longer able to know where my youngest son had been placed by the mental health services.

My youngest son was diagnosed with schizoid-affective disorder in 2000. I haven’t seen him since 2014 when he decided I was not his mother. He took this decision as a result of being able to access amphetamines despite being on a section 3 and under the ‘safe’ care of an inpatient mental health unit.

Previously I was able to accommodate the distress this decision caused me by riding my horse, making pots and printing at the workshop and talking to my neighbour. Now that none of those options were available I didn’t know how to deal with it.

Finding Machspace has provided me with the help I needed to accept the loss of my son. It has provided me with friendship and most importantly made me want to start printing again. It has helped me to begin the process of healing myself and to regain a positive, rather than a negative and anger-filled state of mind. I know that my mental health has improved because I am now able to look forward to making my lino prints. Rather than dwelling on the negativity of grieving for something that cannot be changed I can remember my son’s achievements with admiration for what he managed to do despite his devastating mental illness.

Why is accessibility important at Mach Makerspace

Pat: Everyone is different and has different needs. By being accessible 24/7 and with the wealth of equipment available Machspace caters for the needs of people who might not feel comfortable in a more formal environment and enables the development of individual skills and confidence.

What are the interaction badges and why did you introduce them?

Pat: Not everyone wants to talk to other people, some people want to talk but lack the skills to initiate a conversation with someone they don’t know. The badges provide a clear visual signal to anyone of each individual’s needs and requirements when in a social space so that everyone respects each other without having to endure sometimes painful and difficult discussions.

Cassian: I first encountered interaction badges at Autscape, which is an annual conference run by and for autistic people. It's a neurodivergent-default space, which is to say, it's assumed by default that most of the people there are neurodivergent and the space is primarily designed for neurodivergent people - the opposite of the rest of the world, really! The interaction badges are intended to allow autistic people to clearly and non-verbally self-regulate comfortable social interaction with each other.

We introduced them because they're so helpful and important in neurodivergent spaces like Autscape, and we want to be inclusive of neurodivergent people. I'm autistic and I have ADHD, so it's close to my heart.

Are there currently, or plans for, other Makerspaces in Powys?

Pat: There should be. I believe that physically making, mending and repairing provides an invaluable resource for developing self-confidence and respect for your own and other people’s achievements. Making and developing skills with different equipment and materials is an essential part of what it means to be a social human being. It provides a means to overcome the feelings of negativity that living in such an unequal society can often induce.

Cassian: I definitely agree, every town needs a makerspace as much as it needs a library or a community centre. Humans have been making things together for as long as there have been humans! Creativity and art and problem-solving are all hardwired in us, and humans are an incredibly social species. In makerspaces you can really see that we all inherently understand that sharing skills and materials is good for everyone involved. It comes so naturally to us; we've been doing it for thousands of years.

Many thanks to Pat and Cassian for telling us about the work of Makerspace in Mach. If you want to find out more you can contact the organisation by emailing hello@machspace.org or check out their website – machspace.org

NHS 111 Press 2 - mental health support in Powys

We recently welcomed Marielle Restall, NHS 111 Press 2 Team Lead for Powys Teaching Health Board, to our Health & Wellbeing team meeting to give us an update about this relatively new service in Powys.

What is 111 Press 2?

111 Press 2 is a mental health service available 24 hours a day, 7 days a week, for all ages. People can use the number if they have an urgent mental health concern for themselves or someone they know. It provides access to a mental health professional without the need for a GP referral. It can help people to support mental health crisis and in many cases be an alternative to attending emergency departments or calling the police.

The service can be accessed by calling NHS 111 and selecting option 2. Callers are then transferred to a dedicated member of the mental health team in their locality. The call includes an assessment of needs and a telephone based intervention to reduce stress. Where appropriate individuals can be referred to mental health services, given self-care advice or signposted to other support.

Why do we have 111 Press 2?

It came about following the publication of a report called Beyond the Call. This took a snapshot in Wales of where people presented in mental health crisis. People presented to 17 different places in total, including the police, Welsh Ambulance service, C.A.L.L. Helpline, Psychiatric Liaison Teams and others, which shows that it was not clear how to access mental health services appropriately.

The idea was to provide one number across Wales that’s easily accessible and people know they can rely on to access mental health support. This would then also reduce pressure on police, ambulance and other emergency services.

Beyond the call report, 2020

Who can call 111 Press 2?

Anyone, any age, registered with a Powys GP or visitors to Powys, can call 111 Press 2. If you are calling about someone else the staff can only give advice, they need to speak to the person directly concerned to make referrals to other services.

We take calls from any person registered with a GP in Powys, or visitors to Powys, whether they are known or not to mental health services. 111 Press 2 can refer on to any of the services within mental health. They are encouraging people to call 111 Press 2 as an alternative to attending their GP. People are triaged by a mental health practitioner and onward referral is made if required. Some GPs are actually redirecting people who call in to surgeries to access support. It’s important that the general public know that if they call 111 Press 2 they can be referred anywhere and receive any support. An exception would be if it is a medication query, for example, the person may have commenced medication and want to discuss this further with the GP.

We are working with the Powys Child & Adolescent Mental Health Support (CAMHS) Schools In-Reach team to help spread the word in schools about the service, and CAMHS teams are also promoting it.

There is a separate dedicated Professionals’ Line which is prioritised in the call queue. So far in Powys it is available to GPs, the police and the ambulance service. Currently an average of 2 calls a day are received by this line, so further promotional work is required to spread the word.

The call handlers are using an interpreting service called LanguageLine to provide support to people who speak a language other than English or Welsh. The issue is whether there is a translator available at the time of the call.

There are two Welsh speakers in the team. People can request a Welsh language speaker when they call which would take them directly to a Welsh-speaking call handler.

What can 111 Press 2 do?

• Conduct a mental health triage to assess a person’s needs.
• Provide a therapeutic conversation.
• De-escalate crisis situations (and reduce pressures of A&E and emergency services).
• Give advice on how to improve and maintain your mental wellbeing.
• Signpost to Third Sector services.
• Refer directly into mental health services for a mental health assessment, eg: Local Primary Mental Health team, Community Mental Health team, Crisis Resolution Home Treatment team, Perinatal team, Early Intervention Psychosis, Eating Disorder Services, Child & Adolescent Mental Health Services single point of access.

What 111 Press 2 cannot do

There is no face-to-face or video calling service available. Staff cannot prescribe medication - a referral would be made to mental health services or advice to attend the GP surgery or call ShropDoc out of hours.

111 Press 2 does not call people back at others’ request - the person must call themselves.

Is 111 Press 2 a listening service?

The service is different to CALL Helpline or other listening services. It is a mental health triage service so you would expect a person to ring with a mental health need.

The practitioners will always listen to the person calling and seek to support them with their mental health need whether that be through de-escalation or onward referral to an appropriate service. Callers who are not presenting with a mental health need will be advised to call another helpline or listening service if they wish to.

111 Press 2 seeks to reduce the distress felt by the caller - practitioners use a measure called the Subjective Unit of Distress Scale. It is used as a reflective tool at the end of a call to find out if there has been a change in how people feel from the beginning to the end of the call. If nothing has changed it could be that this highlights areas that have been missed. It gives control over to the person. Nobody’s distress has gone up since the Powys service began. It is about a 50/50 split on - stay the same or decreased. However, not all callers want to engage with this scale, and it is not appropriate for third party callers.

Who’s in the 111 Press 2 team?

7 x Band 5 Wellbeing Practitioners (Support Workers, Psychology graduates, therapists & social care staff).

1 x Band 5 Service Coordinator (administrative).

6 x Band 6 Senior Mental Health Practitioners (with a professional registration in Mental Health Nursing, Social Work or Occupational Therapy).

1 x Band 7 Team Lead (Mental Health nurse).

1 x Band 8 Service Manager (Mental Health nurse).

In a normal shift one of the senior practitioners will be supporting two of the wellbeing practitioners.

Triage scale

Practitioners use a triage scale as a guide to decide how quickly a person needs support.

The majority of the calls (over 60% May 2023 - January 2024) are for advice and information, or advice to contact alternative providers. Emergency responses made up 11% of the calls.

Live Data (May 2023 - January 2024)

We have gathered information about the number and type of calls the team have been receiving since the service started in Powys:

• 3421 calls received in total.
• Calls equally distributed across Powys
• Averaging 19 calls a day.
• On average calls are answered in less than 2 minutes.
• Calls are evenly spread throughout the week, with peak times - 6 - 8pm.
• Age range of callers - 11 years to 95 years.
• Average caller is male, 44 - 65.
• 53% callers active to mental health services, 24% closed to mental health services, and 23% no mental health history.

Highlighting gaps in service provision

The new service has already highlighted the need to the health board of certain gaps in current mental health services, for example out-of-hours crisis care. The Crisis Care team is not available after 9.30pm so by default 111 Press 2 are taking many crisis calls during the night time, as the only out of hours contact for Powys Teaching Health Board.

The team is working closely with other services to identify where the service gaps are so that they can really focus on developing those areas. It’s finding what is working for individuals and what isn’t. 111 Press 2 is in the early stages at the moment but has amazing potential to do great things. In fact, 111 Press 2 is at the forefront of transforming how services are operating!

In summary

111 Press 2 is a single point of access into mental health services for the general public.

111 Press 2 is for everybody.

111 Press 2 provides quick access to a mental health professional 

for advice, support and / or a referral.

Many thanks to Marielle for telling us more about the NHS 111 Press 2 service.

You can find out more about 111 Press 2 on this Welsh Government website.