Mental Health Awareness Week 2021 - Nature

Jen Hawkins, PAVO Health & Wellbeing Officer - wild swimming

“Nature is our great untapped resource for a mentally healthy future” The Mental Health Foundation

The theme of this year’s Mental Health Awareness Week (10 - 16 May 2021) is Nature.

The Mental Health Foundation, the charity which has hosted the annual Mental Health Awareness Week since 2000, explains why Nature is the chosen theme:

“Nature is so central to our psychological and emotional health, that it’s almost impossible to realise good mental health for all without a greater connection to the natural world. For most of human history, we lived as part of nature. It is only in the last five generations that so many of us have lived and worked in a context that is largely separated from nature. And it is only since a 1960s study in the United States found that patients who were treated in hospitals with a view of nature recovered faster, that science has started to unpack the extraordinary health benefits.” You can read more here.

Most of us have felt much closer to nature over the past 12 months during the repeated Covid lockdowns, including those of us in our Health & Wellbeing team at Powys Association of Voluntary Organisations. The Mental Health Foundation’s research shows that during the pandemic “45% of us reported that being in green spaces had been vital for our mental health.” During this awareness week they will be showing how “even small contacts with nature can reduce feelings of social isolation and be effective in protecting our mental health, and preventing distress.”

We are particularly lucky in Mid Wales - nature is all around us - sometimes in its grandest forms, but also more subtly on every doorstep, even in the middle of our town centres, nature is always in evidence and there to lift our spirits.

Here’s how we have connected with nature over recent weeks and months.

Jen Hawkins - PAVO Health & Wellbeing Officer

I’ve always loved swimming outdoors, we never called it anything other than swimming when I was growing up but now there are a lot of different names for outdoor swimming as it’s become more popular, especially during the last year with indoor pools and gyms closed. Open water, cold water, wild, are all ways of describing the experience but they don’t really come close. There is something so incredibly peaceful about being totally immersed in water and surrounded by natural beauty. 

The coldness of the water makes sure you are nothing but totally present and in the moment, there simply is no other option. Being aware of the movement of a current or tide, watching falling leaves skim the surface, sharing the space with visiting swallows and swifts in the summer, listening to early morning birdsong, or the drone of a dragonfly next to you, all contribute to the experience. I’ve never swum through the winter before but decided to try this year after reading about the research into mental health benefits.The coldest temperature I’ve managed was 3 degrees, the feeling after coming out from that swim was something close to euphoric. It’s definitely something I’m going to keep up and try as many different locations as possible. It’s lovely to feel that sense of being held and all being well with the world.

Clair Swales - PAVO Head of Health & Wellbeing

This tree outside our house always signals the start of spring and longer, brighter days to come. The pink blossoms always give me so much joy and make me smile. Spring time walks remind me to be grateful for nature, which has its own special way of telling us that no matter what life throws at us we can rejuvenate and renew ourselves. Like the Fifth Step to Wellbeing - pay attention to the present moment. For me it’s paying attention to what nature is telling us at any given time.

Jackie Newey - PAVO Mental Health Information Officer

Every week I go on a local walk in the hills around Llanidloes, or the town itself, and look for wildflowers for the weekly #wildflowerhour challenge on Twitter (also Facebook and Instagram). I’ve learnt so much about wildflowers and nature from the wonderful #wildflowerhour online community. It is one of those unique outdoor-online combos that has proved so successful. 

The walk is an escape from the everyday routine of work, family commitments and the mundane chores of life. It gives me an opportunity to focus purely on the lovely native plants growing all around us at all times of the year. It is as much about my wellbeing as it is about recording nature and learning how to identify the quite subtle differences between wavy and hairy bittercress! Some of my favourite finds have actually been throughout the depths of a hard, cold winter around Llanidloes town, where against all the odds wildflowers such as the beautiful ivy-leaved toadflax, wild strawberry and shepherd’s purse thrive in sheltered nooks at the base of shop doorways, walls and in brownfield sites. Finding these beauties at this time of year (the challenge in winter is to find 10 wildflowers in bloom) is such a boost to my mental wellbeing. I can highly recommend trying this treasure hunt with a difference - and celebrating our feisty yet beautiful nature!

Lucy Taylor - PAVO Startwell Development Officer

Being outside is important for us all, from the fresh air and the feel of freedom it gives, to more measurable benefits in terms of health and activity. Being outside is especially important for children as sometimes the opportunity to go out is not in their hands. Just playing outside, doing what they want to do, is calming, inspiring and healthy.

Playing on the beach on a nice sunny day what could be better for anyone? A lot of adults need to regain the ability to play, to relax and do things that do not have a purpose, but just for their own enjoyment.

Let's go fly a kite!

Owen Griffkin - PAVO Mental Health Participation Officer

It was wonderful to see some new additions on the lake at Llandrindod on a special birthday walk with my dog Honey (5 today!) Along with the Muscovy ducks, terrapins and occasional guinea fowl that have taken up residence there. It has become a really lovely place for a walk.

Sue Newham - PAVO Engagement Officer

Since June last year, I have been walking every morning with my husband, doing a circular route which takes in the riverside in Newtown. It’s been great to see the changes through the seasons. Last week, we saw a goosander doing a flapping/ skating dance across the surface, presumably to panic the fish and enable him to catch one. This morning, so many spring flowers were visible. 

Walking in green spaces has improved my feelings of happiness. The colours in nature seem restful somehow. The other good thing is that we often see the same people out walking, so we have the opportunity to chat and we are getting to know some of them by name. That’s nice too. The picture is from a walk in February - a shadow selfie!

Andrew Davies - PAVO Health & Wellbeing Participation Officer

Me and my wife and my 2 girls try and get out in nature as much as we can, we are very lucky to live in such beautiful surroundings and it helps us reconnect as a family. The girls love to run and play when we are out and about and it is so good for us as parents to see them grow and explore.

We'd love to hear about how you connect with nature. Let us know in the comments below how nature has impacted on your mental health and wellbeing.

Introducing our new Head of Health & Wellbeing - Clair Swales

Clair Swales recently took on a new role at Powys Association of Voluntary Organisations as Head of Health & Wellbeing after previously working as Senior Officer Community Connectors & Info Engine Wales. She originally started work at PAVO in 2016 as a Third Sector Broker & Info Engine Officer and has since overseen the development of the hugely successful Community Connectors’ team within the organisation as well as further developing the online services directory infoengine. We met up with Clair recently to find out more about her new role.

Tell us more about your new role as Head of Health & Wellbeing at PAVO

My role is to facilitate positive relationships between Powys’ Third Sector and the Public Sector in the field of health and wellbeing, enabling third sector involvement in the development of policy and partnerships, championing a joined-up approach to commissioning of services and developing and maintaining effective service user and citizen engagement.

The role incorporates supporting the Health and Wellbeing team, overseeing the work of the Community Connectors and Powys Befriending Service and contributing to the management of PAVO. I also share responsibility with the CEO for the development and delivery of infoengine.

How is the new job going so far?

I began my new post in December 2019 and the first couple of months have been very busy indeed. In January I was delighted to welcome Sharon Healey as the new Senior Officer for the Community Connectors and Powys Befriending Services. It's been fantastic to get to work more closely with a larger team of PAVO colleagues and to continue working with the sector, health and social care colleagues albeit in a new remit.

Clair (2nd from R) & PAVO colleagues saying #HelloYellow on World Mental Health Day 2019

Can you - briefly - sum up the work of the three different PAVO teams you head up - Health & Wellbeing, Community Connectors & Powys Befrienders

Health & Wellbeing - the team supports Third Sector organisations working in the health and social care fields to work closely with the Health Board, County Council and others to develop better services for Powys’ people. It provides an important mental health information service, supports the delivery of health and well-being information via various mediums, and recruits and supports citizen reps for a variety of boards, as well as facilitating networks such as the Powys Advocacy Network.

Community Connectors - The service helps people in Powys (aged 18+) and their families or carers, to access community-level services and activities that will help them maintain independent lives and which help prevent their circumstances deteriorating to a point where they might need higher level health or social care services.

Powys Befrienders Service - Powys Befriending Service helps improve the independence of people over 50 by helping maintain social networks and remain in their own homes for as long as they are able.

Clair with some of the Community Connectors

Why do you think the Community Connectors have, in such a short time, become such key players in supporting some of our most vulnerable Powys residents?

For anyone who may be vulnerable or facing a challenging time, access to the right information at the right time is essential. Often it can be a challenge to keep on top of the latest information about the support that is available. The Community Connectors have become a key link between statutory services, the client and the sector. This has been driven by the Social Services and Wellbeing Act and A Healthier Wales; and the work with the Regional Partnership Board in delivering the Health and Care Strategy for Powys.

What are the main challenges of your new role?

Juggling time and commitments! With a large team and an even larger number of meetings to attend where I represent the sector, it is always a matter of judging the best way I can support the team and the sector in the best way possible. I like the challenge though and always try to ensure that I make time for my own health and wellbeing and ensuring a good work/home life balance.

Why do you think it is crucial that there is a healthy and robust Health & Wellbeing Third Sector in Powys?

There is a huge focus on health and wellbeing at the moment and in particular early help and intervention. Statutory services have changed immensely over the years and the model for delivery, and financial capability of delivering front line services has also changed. The third sector has a crucial part to play in our communities in supporting health and wellbeing but the sector itself needs to be healthy and robust, able to adapt to change and given the freedom to deliver what truly matters to people. Funding is always a challenge but I like to challenge funding bodies such as the local authority and Welsh Government to focus on early help and prevention and how this can be funded in the third sector. Volunteers play a huge role in supporting health and wellbeing in Powys so we must do what we can to look after Powys’ volunteers.

Clair with Andrew Davies, PAVO Health & Wellbeing Participation Officer

If you could change one thing in the Third Sector Health and Wellbeing world here, what would it be?

Ooh wave my magic wand……Other than overcoming funding difficulties within the sector, I would like to see more third sector involvement in the engagement and support of children and young people. Powys’ third sector has lost a lot of capacity in the remit of delivering support for children and young people and I think it is vital we play an active part in this area of health and wellbeing, to help support children and families and play a key role in reducing and preventing issues in the future.

Charities and voluntary groups (including PAVO) increasingly work more closely with statutory providers of health services - how do you think this will affect the sector from the tiniest local groups to the national big charity players?

I think the biggest challenge here is meeting demand. The SSWB Act has a focus on support close to home but we need to ensure that support for these organisations and groups filters right down to the smallest provider. The close work with statutory partners is certainly a positive step forward but I think there needs to be greater understanding of the role of the sector, in particular the smaller groups, that the sector cannot survive on thin air and it shouldn’t be the place to cut funding.

The Social Value Forum is really starting to see small groups and charities benefit from a small amount of funding that can make a big difference in the community. Sustainability of third sector services is always an issue. Powys is heavily reliant on the outstanding work of volunteers but there is only so much volunteers can do and only so much time to give for volunteering as we all work longer. 

Sharon Healey (L)  new Senior Officer for the Community Connectors &
Powys Befriending Services with Clair

How do you see co-production* working successfully in Powys to provide quality health services for all and what is PAVO’s role in this?

We have had some really positive discussions with third sector agencies such as Credu about co-production in Powys. I feel it's really important to include the service user or community’s views to shape services and this needs to be in a constructive and positive manner. To truly enable co-production we have to break down bureaucratic barriers and this can be a big challenge when working with statutory partners as they have their statutory duties to fulfill. Remove the barriers and let the sector work together with communities to shape future services.

PAVO can play an active role in bringing people together, ensuring the citizen and sector’s voices are heard at statutory level, and influence decision making on behalf of the community and third sector. PAVO’s mission is to be a CATALYST of voluntary Action, a legitimate VOICE for the voluntary sector and a HUB of essential information. We are looking at new ways of using the Community Connectors’ community workers’ meetings to co-produce services at community based level as we know in Powys one size does not fit all. It has to come from the community.

Lots of big issues are crowding out the H & W agenda, the Big 4 of Powys’s Health & Care strategy (Cancer, Mental Health, Heart and Respiratory disease), the Loneliness and isolation strategy of the Together for Mental Health new delivery plan. What skills can your PAVO teams bring to the table?

The team has excellent communication skills and the ability to decipher vast amounts of important health and wellbeing information. Using their creative communication skills they make information regarding health policies and wellbeing initiatives easily accessible to the public, and indeed statutory and third sector colleagues. The teams do this through a variety of platforms such as the ebulletins, social media, health lift films, infoengine.wales and by working with people directly; thus meaning there is something for everyone. The team uses a variety of skills to ensure the voice of the citizen and the sector is heard at all levels of the decision making processes. We also benefit from working closely with our colleagues in the development team to support the sector to meet the challenges of an ever demanding, ever changing wellbeing environment.

Clair (2nd from L) at a patient discharge home meeting with colleagues from Third Sector,
Powys Teaching Health Board and Powys County Council

If people identify gaps in mainstream and Third Sector health and wellbeing services - where should they take that information so that the gaps can be addressed?

The Community Connectors’ case management system allows the team to record gaps and unmet need when working with clients. This has proved very useful with our work with the Social Value Forum to identify needs in communities. However this is just one way of recording information, there is a huge amount of information out there and if you speak to residents or people working in Powys communities they know where there are gaps. The challenge is recording it. The team has used the Community workers’ meetings to also record data around gaps and unmet need and if you don’t already attend one of these meetings I would encourage you to do so.

There are a couple of social prescribing pilot projects in Powys. There seems to be a greater appetite for exploring new and innovative ways to tackling some health & wellbeing issues. What are your thoughts?

Firstly I am not sure I like the terminology ‘social prescribing’. We shouldn’t have to be ‘prescribed’ community based third sector services. However people do need to know what’s available to them to support good health and wellbeing. We should encourage and support people to access community based activities where medical intervention is not required. This type of service is designed to support physical activity and promote good mental health.

Have you taken inspiration from others in the fields of health and wellbeing and / or the Third Sector, and if so, who?

I have actually taken my inspiration from my late father. He was very community minded and spent years as a Town and County Councillor always striving to make people’s lives better. Seeing him work so passionately in the community helped shape me and gave me the firm foundations to strive to deliver the very best for people in the work I do today and every day.

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

Supporting the growth if the connector service has been very rewarding and being shortlisted for an NHS Wales award in autumn 2018 was definitely a highlight. But listening to the difference we can make to people’s lives and to the communities of Powys is always heart warming. I am very clear that without the third sector in Powys the county would be less vibrant.

When you’re not working how do you enjoy spending your time?

My spare time is undoubtedly dedicated to my family. I live with my husband (pictured above on my wedding day) and I have three children and two step children. I am normally running around with various items of sporting kit from rugby to football to horse riding gear. I am very proud of the children and enjoy being on the sidelines cheering them on. I also love cooking with my husband. That's my daily de-stress hour when I get home. I enjoy going to concerts (Bruce Springsteen has to be one of my all time favourites along with The Rolling Stones but I would love to see Sir Tom Jones in concert too). I love walking the dog and getting out into the mountains. Getting fresh air into my lungs helps me to feel grounded and reinvigorated.

BIG thanks to Clair for telling us more about her new role. If you'd like to contact Clair then you can ring 01597 822191 or email clair.swales@pavo.org.uk

*Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co‐produced in this way, both services and neighbourhoods become far more effective agents of change.

Definition developed by the New Economics Foundation (NEF) and Nesta, in partnership with the Co-production Practitioners’ Network

Compassionate Communities

Dr Julian Abel and Dr Helen Kingston

Last month I attended a seminar with colleagues from Powys Teaching Health Board, PAVO’s Community Connectors and our Health & Wellbeing team at Bronllys Hospital in South Powys. It was to learn about a new model of Primary Care working to provide health services. Compassionate Communities is its name and it has been operating in Frome in Somerset successfully for the past 3 years.

Dr Helen Kingston, a Senior Partner at Frome Medical Practice, and Dr Julian Abel, Director of Compassionate Communities UK, were travelling throughout Wales to spread the word. 

In brief, the three key messages, which I took away from the session

1. People – you, and me, our families and friends (the actual or potential patients or users of the health service), benefit hugely from this way of working. 
2. People – the ones working to provide the health service, from GPs, nurses and pharmacists – right the way through primary care services – are enthused, reinvigorated and actually enjoying jobs where their actions make much bigger differences to people’s lives. 
3. Money – is saved. Emergency hospital admissions drop drastically. 

The Compassionate Communities' approach is about joined up or “integrated” working. The focus is on people. The community in Frome appears to have been transformed. It looks like a genuinely supportive network. We all hope (but don’t necessarily expect) that people would rally round if we were struggling to deal with not just our health, the unexpected curve ball life had thrown, or even the mundane challenges of day-to-day life. In Frome it appears to actually happen. People help each other within this system. And, as a result, their health and wellbeing improves. 

Maggie Sims (Regional Partnership Board public representative) and
Andrew Evans (Assistant Director of Primary Care, Powys Teaching Health Board) listening to Julian

The original motivation – Julian tells us more

“We asked - how can we do what’s best for people? It’s common sense that if they are lonely they need support. Friendship. Love. Companionship. That’s what’s needed. Not a tablet.”

Julian described the essentials that are required for this kind of approach – specialist care, generalist care, compassionate communities and civic actions – and how these can affect health and wellbeing in local populations. It was all these components, working together, that led to the dramatic impact in Frome.

It is a whole population intervention – equally as valid to a teenager as a frail elderly person. The teenager might be bullied at school, cyberbullied at home, become depressed and have poor educational outcomes. Drug and alcohol misuse could establish leading to life-long problems. The solution in the context of Compassionate Communities is at school – the civic community, and at home – the community.

It is the union of the new model of primary care and the Compassionate Communities approach which brings about change. But, how you implement change is as important as the change itself. We are used to the permissions effect of top down change. This approach requires the people who do the work to implement change in a systematic way, determined by ground up change.

It is also about looking at people rather than the medical conditions they may have. “If someone is suicidal because of loneliness then their chronic lung disease might not matter to them,” said Julian.

It is about not having treatment rather than having treatment. It is about networks of support. Fifty years ago people would rally round to give extra support – but this response has been lost to some extent in local communities. Yet the resources at our fingertips are enormous, and our natural networks can extend up to five hundred people. So much is going on in communities that may be untapped. It makes sense to use that, to have a profound impact on people’s health and wellbeing, and because this is the focus, almost the unintended consequence is that emergency admissions drop. 

Dr Mary Hughes and Dr Sean O'Reilly from Haygarth Doctors' Practice

The Compassionate Communities approach in a little more detail – Helen tells us more

There are three main components to the model:

1. Clinical team and GPs. 
2. Community workers. 
3. Integration across the Health & Social Care sector. 

Previously staff in Frome worked in separate silos depending on the disease they were treating. They wanted to get back to basing care around what the individual needed – to improve care, and also their working lives. Helen described the anguish staff experience sometimes. A human being in need sits in front of them but they can only focus on just one small part of the story and have to ignore the rest. It is about recognising firstly that life is complicated – separating self-esteem from physical issues is not possible; and secondly that human relationships are powerful and in many instances, the most beneficial in maintaining and achieving health and wellbeing.

First on left: Freda Lacey, Senior Officer Health & Wellbeing Team at PAVO

Setting up a hub in Frome

The hub is the single point of access in the community. Staff - the primary care team (GPs and nurses), work alongside the new Health Connectors (akin to our Community Connectors). Volunteer Community Connectors (akin to Community Champions) are out in the community, they can be post people, the hairdresser, local shop keeper, milk person, taxi drivers, sixth form students, but have a route into liaising with primary care staff at the hub, if this is needed.

So, when people call, it’s not just about discussing medical matters, but also other things that are important to them. “We have turned life’s difficulties into a disease and medicalised everything and then use the medical model to manage it,” explained Helen.

There may be a window of opportunity in a crisis situation. It is about empowering staff to take a different approach. But, also, about meeting people where they are. “There’s no point telling someone about community groups if they have to work up courage to go and buy milk”.

Mentors work with staff to help them change their approach. Stories at team meetings can turn hearts and minds and people begin changing their way of working. Helen suggested finding key people in practices who are enthusiastic to work with initially, so the energy goes with the flow.

Mistakes will be made, but we can learn from them. It is about being creative in our approach.

Suzanne Iuppa, PAVO Community Connector, contributing to the discussion

The voluntary sector

In Frome, the paid Health Connectors (now mainstream, funded for three years) work very closely with an “amazing voluntary sector”. Health Connectors offer one-to-one appointments and do care planning (“they are the glue, but not necessarily the experts”). They recognise that 95% of the support that people need is around them in the community, and link them in. Some people may not be ready to accept help immediately, but Helen’s advice is “have courage and be persistent. They will come back when the time is right for them.” Many of people’s problems are solved outside the medical practice in this model.

Over 400 groups and services are listed in Frome’s electronic healthcare recording system so social prescribing is at their fingertips. When patients are signposted this is coded on to the system. The nature of the conversation changes with this website directory immediately to hand. (In Powys we have the online service directory infoengine, and although it is not currently linked in to the GP electronic system here, we are in discussions about this with a provider of this type of technical service).

Then there are over 600 trained volunteer Community Connectors (Community Champions). These are interested members of the public, whose role is not 1:1 work but to raise awareness of the service. In an ideal world, everyone would be a Community Connector or Champion! Each person signposts on average twenty times a year.

Building community resilience

Other options for people:

• Talking Cafés – drop-in sessions run by the Health Connectors. Anyone welcome. Signposting to other resources and places to make friends. 
• Health Connectors’ groups – peer support groups following 1:1 work. 
• Self-sustaining groups – leg ulcer, diabetes, macular degeneration, stroke support… and many more. 

Helen finished the session with a couple of detailed case studies which brought the Compassionate Community approach to life.

“Most small acts of kindness happen with individuals. It’s building that capacity. It’s about face-to-face relationships, and people caring for each other. About having that conversation that might not have happened.”

What do you think about the Compassionate Communities approach? Here in Powys we already have a lot of the elements of this model in place – we have our Community Connectors’ team, an equally amazing voluntary sector, and the online service directory infoengine. And work is well underway to further integrate systems and teams to do what’s best for people here too.

Once we know how this work progresses we’ll update you in another blog post. Watch this space!