Active Monitoring - Mind working with Powys GPs

Just last month at the PAVO Conference, which focused on Prevention and Early Intervention, we found out more about a new initiative at Brecon and District Mind when Service Director Val Walker spoke at the Mental Health Conversation. Active Monitoring provides support to people who visit their GP with symptoms of common emotional health needs including stress, anxiety and depression. The service aims to increase wellbeing, self-esteem and confidence, and reduce the likelihood of needing to access further support relating to a person's emotional wellbeing.

The mental health charity Mind describes Active Monitoring as: "a psycho-educational programme designed to provide early intervention provision within the Primary Care arena. With growing demands on Therapeutic Services resulting in increasing waiting lists it is getting more difficult for people to access the help they need in time. This role involves working directly from a GP surgery delivering the Active Monitoring programme. The service complements/replaces the ‘watchful waiting function’ and proactively works with individuals on agreed pathways to support early intervention via a facilitated self-help model."

Elizabeth Bogunovic

Brecon & District Mind works closely with the GP cluster in South Powys and Red Kite Health Solutions CIC (Community Interest Company) to deliver the Active Monitoring service.

Elizabeth Bogunovic is the Mind Active Monitoring Practitioner delivering the service for Brecon & District Mind, and she tells us more about this innovative way of working:

It was when I began volunteering for Merthyr and the Valleys Mind that I became aware of a service called Active Monitoring. The more I heard about it, the more intrigued I became so I sat down with Nicola, one of their practitioners, who explained to me the ethos behind the product so to speak. From that point on I was passionate about the possibilities an early intervention, self help service could offer people and considered the time a few years ago I found myself stuck in my own ‘mental health mess’, and how it may have changed the course I took at that time. I am convinced it would have helped me to recover a lot quicker than I eventually did.

Now I am delighted to be the Wellness Practitioner delivering the service for Brecon and District Mind, based at the Haygarth Surgeries which cover the areas of Hay-on-Wye, Talgarth and rural villages around here. I have been part of the Brecon Team since August 16th where I began by getting to know the area, the people and the surgery set-up, before heading off to Oldham to have some excellent training from Mind which fully prepared me to begin working with patients on September 8th.

The Active Monitoring Service consists of an initial ‘drop-in’ session where I meet the patient referred to me by the clinical team for a brief fifteen minutes and then, a further five more sessions. During the time they spend with me, they complete the GAD7, PHQ9 and Warwick Edinburgh Wellness evaluations at the beginning, middle and end, and choose one of six workbooks or pathways to engage with. These workbooks focus on Managing Anger, Anxiety & Panic Attacks, Stress, Low Self Esteem, Depression and Feeling Alone. To complement these workbooks, I have at my disposal a selection of exercise sheets they can work with and some smaller booklets to help them. The initial feedback I am receiving is on the whole excellent and very positive.

The last few months seem to have flown by and I was surprised to notice today how many of my first patients have had their last sessions with me over recent weeks! It only seems like yesterday I sat with them, full of anticipation both for them and me, describing the service and inviting them to engage in it. I was delighted for one patient at our third session when she completed the same evaluations she did at her first drop in session to see a slight improvement, I remember feeling her pleasure almost as my own!

So far I have worked with 48 people -  all at different points of their journey through the service - many of whom tell me how much more aware of their feelings and emotions they are since starting work with me. This not only gives me some validation that Active Monitoring ‘works’ but an immense sense of achievement when someone starts to notice a change in themselves.

I have amazing support from the staff here at Haygarth, it feels almost like being part of a big extended family which makes it a pleasure to come to what is called work but what I prefer to call ‘doing something I love with financial reward’. Even more than that I am lucky to be part of the team at Brecon & District Mind who also feel passionately that Active Monitoring has the potential to offer people an alternative approach to mental health matters, one that really can make a difference in a person's life.

Brecon & District Mind believes that early Interventions are far more effective than waiting, and that prevention is better than allowing things to linger. "We want people to get help immediately rather than wait to get help, or for things to get worse". 

You can find out more about the Active Monitoring project on the Brecon and District Mind website. Contact Elizabeth by ringing 01874 611529 or email: activemonitoring@breconmind.org.uk

Prevention & Early Intervention - the mental health conversation

The mental health conversation; PAVO's CEO Carl Cooper; Jane & Jackie PAVO mental health team

Last Tuesday 8 November I attended the PAVO AGM and Conference at Cefn Lea Conference Centre near Newtown along with colleagues and respresentatives from voluntary sector groups, the statutory sector, and numerous other individuals. The theme this year was: Prevention & Early Intervention - the Third Sector role in Powys.

The conference invitation stated: "It is widely acknowledged that Third Sector organisations and services have an essential role to play in prevention and early intervention. This conference will explore how these services could be an integral part of a common direction in Powys".

Carl Cooper, our PAVO CEO, opened the conference by saying: "We are delighted to have this as our theme. It is important particularly in light of the Social Services and Wellbeing (Wales) Act which highlights that support and care should be provided at an early stage to those requiring it to prevent worse things happening later in life's journey. The Third Sector has a crucial role to play in that." 

Carl then introduced the first speaker, Dylan Owen, the Head of Social Care Transformation at Powys County Council.

Dylan explained that the Early Intervention and Prevention agenda is driving council services forward to make sure that people's wellbeing is supported in the community. This includes working to support people to re-engage with their communities, and to do what matters to them.

In the past social care planning has followed a path of assessment - providing care - looking at the deficits and weaknesses - and solving problems. Now this approach is being turned on its head, with a duty to support people to make their own decisions. 

Dylan described how the council is already working closely with the PAVO Third Sector Brokers to find alternatives to help people to live independently. Isolation and loneliness are often the first step to becoming dependent on social care services, and other initiatives, such as the Powys Befrienders project, where paid co-ordinators work with trained volunteers across Powys to support people to engage with their communities, (ideally in their own language), have also proved very successful.

Community Wellbeing Co-ordinators and Home Based Support, working from community hubs, were other key services also covered in Dylan's presentation.

Next up was Stuart Bourne, Assistant Director of Public Health at Powys Teaching Health Board.

Stuart referred extensively to the Health Board's Integrated Medium Term Plan (IMTP) which sets out the health priorities for Powys up until 2018 (it is discussed in more detail in our March post Engaging with PTHB to shape future services). The IMTP contains many elements of early intervention and prevention, including approaches which benefit from joint working with the Third Sector.

Stuart emphasised the impact of quick and easy early intervention by referring to "the 30 second chat that can trigger weight loss" as recently reported widely following a University of Oxford trial. Here at PAVO we are already familiar with initiatives such as The Five Ways to Wellbeing and Making Every Contact Count.

The formal presentations were followed by 10 "conversation" groups, of which Mental Health & Wellbeing was one. Jane from our team facilitated, with support from Val Walker of Brecon & District Mind. Those who signed up included Third Sector organisations such as Hafal, Cymryd Rhan, Hay Day Cafe and Ponthafren Association, individuals who have been in contact with mental health services, carers and employees of PTHB. 

The mental health "conversation" gets underway at the PAVO Conference

The group was asked to consider some key questions as part of a larger discussion around the conference theme, including: What will this new approach to Prevention and Early Intervention mean for our organisations and the services we provide?

Some interesting points and questions were raised. There is not the space to outline them all, but here are a few to give a flavour of the session:

• If people have dementia then making cognitive decisions about their future care could be stressful. How would this be handled?
• People want safety and security, particularly as they grow older. Not all people will wish to stay in their own homes. There needs to be a broad range of options made available.
• Community based means person-centred. Learn from the Third Sector who have been working this way for years.
• A lot of community services are being closed down and there is a huge dependence on volunteers. Where is the money coming from to support this volunteering?

It was clear from the conversation that there is a gap in services before people who are distressed seek support around mental health from their GP. What does that look like? Is it more than an Information Service? Is it an additional specific role, and if so doing what?

There is also a huge issue because of the waiting lists for talking therapies in Powys. In many ways talking to someone is a form of early intervention, but if we cannot meet the demand currently what can we do differently?

Good practice around early intervention was identified in pockets around Powys and all agreed that it would be excellent if such activities could be rolled out throughout the rest of the county. We found out a little more about one particular project.

The Active Monitoring project being run by Brecon & District Mind

Val updated us on the progress of this new service which operates out of Hay and Talgarth GP surgeries, and is a joint project between the GPs in that area and Brecon & District Mind. This early intervention service will mean that the practice clinical team are able to refer anyone with symptoms of anxiety, depression, low self-esteem or stress directly to a Mind Practitioner in the surgery to be seen straight away.

To date 29 people have been seen by the Brecon Mind Practitioner in the first 6 weeks of the project. They have progressed through five sessions and the results show a definite improvement in their state of wellbeing. Others have been signposted to other organisations such as Cruse, the bereavement charity, for ongoing support. Val believed further signposting should be instigated so that the massive waiting lists for talking therapies could be addressed.

Active Monitoring is popular in other parts of Wales, including Merthyr Tydfil, and started in North-West England where it is now embedded in Primary Care services after being rolled out in 47 surgeries.

Val Walker, Service Director, Brecon & District Mind

We also heard about a relatively new Hafal pilot project in Bridgend and Swansea "to provide early intervention services to service users and families, focusing on the direct needs of young people (14 - 35) experiencing a first episode of psychosis". Referrals are made by the Community Mental Health Team and picked up by one of three part-time Hafal workers. The staff support individuals through a programme with a view to move on to community engagement or further education using Hafal’s Recovery Programme as the basis for doing this.

Jane summarised the key point to feed back to the conference

We had to pick one key point from the mental health conversation to feed back to the conference. Impossible! We had loads! Eventually we narrowed them down to three as a group, and magically Jane managed to merge them as one!

• A lot more work is required in consultation with the Third Sector.
• Communication is massive.
• A better understanding of mental health is required by all. It needs to be normalised.

If you were not able to attend the PAVO Conference this year, what would you have liked to add to our mental health conversation on Early Intervention and Prevention? Let us know in the comments box below, we always love hearing from our readers.

Adrian Osbourne is Assistant Director, Engagement & Communication, at Powys Teaching Health Board. Read his Twitter Storify summary of the day.