Powys Substance Use Harm Reduction Plan launch

Linda Hutchings, Brecon peer support worker

“Developing a partnership response to Harm Reduction across Powys 

to meet the needs of people with drug and alcohol concerns.”

The first thing I picked up at this Harm Reduction Plan launch recently was a flyer about nitazenes (synthetic opioids known for their potent nature) and the changing face of heroin. I hadn’t even pinned on my attendee badge. The bizarre names of drugs like naloxone (a potentially life-saving medication) and nitazene (an extremely harmful drug) were scattered throughout the day and I realised I had a lot to learn.

Fortunately this highly informative day at the Metropole Hotel in Llandrindod brought together a multitude of statutory and voluntary sector agencies with a wealth of knowledge and experience around substance misuse. But perhaps even more importantly it called upon those with the lived experience of the harm that can be caused by substance misuse - be that alcohol or drugs - and the often catastrophic effects resulting in damaged mental and physical health, relationships, living arrangements (homelessness and debt being extreme but not unusual outcomes) and an increased likelihood of coming into contact with the criminal justice system.

Jan Roberts (Suicide Prevention, Harm Reduction & Postvention Quality Improvement Lead), Joy Garfitt (Interim Executive Director of Operations, Mental Health Services) & Carol Daly (Harm Prevention & Reduction Lead - Substance Misuse)
Powys Teaching Health Board

Joy Garfitt, Interim Executive Director of Operations - Mental Health Services in Powys, and chair of the Area Planning Board, welcomed everyone. She explained that the APB brought together agencies across the county with the shared ambition of reducing harm from substance use. (There is a longer definition in the Welsh Government document Working together to reduce harm). The APB plans, commissions and delivers services and also brings networks together. As Joy explained, Powys is actually as long as the distance between the Severn Bridge and the Marble Arch, so this is quite challenging!

What is harm reduction and how can it benefit Powys - Rick Lines, Public Health Wales, Head of Programmes, Substance Use

Rick described how he was first introduced to harm reduction 30 years ago in his hometown of Toronto in Canada. He worked supporting prisoners who, he explained, were inevitably using drugs. His experience supporting people who had been traumatised by early life events, and went on to use drugs, led him to ask in court: “Have you heard this woman’s story? Why is the state looking at it through the context of drugs?” Rick highlighted that putting this particular woman in prison repeated the trauma she had experienced from authority figures when she was a child.

Rick saw the same scenario play out when he later worked in Eastern Europe. He said 90% of drug use is not problematic (how many people do we know who use alcohol on a regular basis socially…?) and asked what we can do to reduce deaths, to show that we care whether people live or die, and to help reduce the risk of using drugs in a risky fashion. We should be respecting the dignity of people who use drugs by providing services, and reducing feelings of vulnerability and stigma.

Recent concerns are around changes in the drug market whereby synthetic and highly dangerous drugs (like nitazenes) are increasingly coming onto the market. Rick championed the ongoing work in the 3rd sector and community pharmacies to provide harm reduction services - “it is the people on the ground who are making the difference”.

Welsh Government policy is committed to harm reduction, and is unique in the United Kingdom, and rare in the world. This policy influences how the police, prisons and partners regard substance use and filters down to the statutory and community organisations.

Current position in Powys and the focus of Harm Reduction - Carol Daly, Harm Prevention and Reduction Lead (Substance Misuse)

Carol’s aim is to set up a multi-agency Powys Harm Reduction sub-group (one of seven across Wales) to drive action across the county. This would draw on the knowledge of local organisations to deliver the key priorities, including:

Supporting the work of the Health Board in working to the World Health Organisation's global aim of eliminating Blood Borne Viruses by 2030. Powys is rolling out treatment and testing for people at risk of Blood Borne Viruses such as HIV, Hepatitis B and C.

• Training up peer supporters and carers.
• Developing pharmacy services to increase the uptake of Needle and Syringe Provision and Blood Borne Virus Testing.
• Raising awareness of the real risks of synthetic drugs coming onto the market.
• Increasing availability of Naloxone across partner agencies.
• Addressing the stigma (it was again pointed out that most people use some sort of substance, for example, alcohol).
• Prevention - the APB has commissioned services to educate children and young people about drugs, and Carol is working with Child & Adolescent Mental Health Services (CAMHS) to increase knowledge of new synthetic opiates.

This important agenda would save lives - and has saved thousands of lives already with the information and tools to help people who take drugs do so in a safer manner.

During discussion Barry Eveleigh from Kaleidoscope (the local substance misuse service provider) highlighted the financial element - if you can keep someone out of A&E you can save £2000. A liver transplant is £150,000. It costs £1000 a week to keep someone in prison. In comparison to these figures the costs of providing safe drug alternatives are minor.

There were also questions about decriminalising drugs as has happened in other countries such as Portugal, where the person using drugs is regarded as a patient rather than a criminal. Michael Curties from the Welsh Government explained that the criminal justice system is not devolved to Wales so this is not an option open to the Welsh Government.

What’s already being done and what are our priorities? - Neville Brookes, Area Planning Board Manager

Neville asked: “how can co-production work with this agenda?” We need to learn from people with lived experience, and spend time with individuals in the treatment system. “Who better to talk to when waiting for a service than another peer?”

Peers design relapse prevention programmes - they know what works. If people become part of a peer mentor programme they often give back to services and there is an onward pathway to work within the field if they choose.

He also said:

• Harm reduction should be on all our agendas - not just thought of as a clinical intervention.
• Out of hours community support is needed (this was identified by focus groups).
• We need to simplify the service so that individuals have a single pathway.

The overall outcome would be to enhance and improve systems and processes for everyone involved.

How we use peers, with lived experience, to enhance service provision - Elwyn Thomas, Co-production Lead, Kaleidoscope

Elwyn has been in post for 18 months now. He started as a peer on a script in a prison cell. He worked on a Welsh Government peer to peer support project providing the heroin substitute naloxone - over an 8 week period 237 kits were delivered! Amazingly eighty people did not even know that it existed.

There are now seven teams across Wales delivering this important service. Everyone was trained in just a year, and other initiatives have also been put into place including creating pathways to treatment and needle exchange schemes. Elwyn spoke of how people’s esteem and self-worth was raised after having access to the training, with peer uniforms (branded “ask me about Naloxone”) and lanyards breaking barriers.

In 2 years the delivery of harm reduction has changed massively in Wales, from prescribed scripts from nurses to working alongside peers.

Linda Hutchings, a Brecon peer, has lived experience for many years using drugs but is now drug free. She agreed that people can be the best they can be with training and involvement. She is now accepted in her community, not as a drug addict, but as someone with lived experience. “I built up belief in myself as I didn’t have any.” Linda started work with peer mentoring service Cyfle Cymru on 8 February.

Round table discussions & feedback

In round table discussions we looked closely at Powys challenges and priorities. The top three challenges on our table were: rurality, silos and stigma. We were very keen to promote the idea of a support bus which could travel the whole length of the county, the distance from the Severn Bridge to Marble Arch - and back again!

Our priorities were - prevention, communication and collaboration. We agreed that it was important to reach out into the community (it’s that bus again!) rather than expect people to come to us.

Overall it felt that there was a great enthusiasm in the room for genuine collaboration and partnership working to make real change so that people using drugs and alcohol, for whatever reason, could live well in the county.

Closing remarks - Michael Curties, Substance Misuse Policy Team, Welsh Government

Michael raised many relevant and important topics in his summing up in relation to the APB, data sharing, working more closely with GPs and prevention, etc. To finish off I’ll highlight just a couple of his comments that particularly resonated with me:

The Harm Reduction challenge is the same as it is for all other services - we solve it by working together. “How do we get to the point where there is no wrong door? Where people walk in and get a service wherever they are?”

“Coproduction is about learning - what do we say that gets in your way? We need to hear if there are those barriers. Ask - can we do it differently?”

I look forward to finding out more about developing drug and alcohol services in Powys as Carol continues her vital work on the Harm Reduction plan.

You find out more about Alcohol and Substance Misuse resources

on this Powys Teaching Health Board website page.

The Tipping Point: Where next for health and care in Wales?

On 6 July my colleague Sue Newham and I attended the second day of this Bevan Commission conference at the Celtic Manor Resort in Newport. The Bevan Commission is Wales’ leading health and care think tank - aiming to “challenge, change and champion thinking and practice to ensure sustainable health and care that is fit for the future.”

Celebrating 75 years of the NHS in Wales, the conference was described as the “opportunity for an open and honest conversation about the future of our health service.” It was attended primarily by NHS and social care professionals from across Wales, and perhaps more importantly the organisers asked those attending - “What role will you play in finding ways to influence and make change?”

“We are at a tipping point. It is now time for us to face these challenges together and rebuild our health and social care systems to thrive in tomorrow’s world.” 

Bevan Commission

The day was packed with knowledgeable and inspiring speakers, presentation sessions broken up by break-out workshops where Bevan Exemplars* and others described their ground-breaking work within the NHS and social care sectors in Wales. The previous day our colleague Sharon Healey (PAVO Head of Health, Wellbeing & Partnerships) had spoken on the work of the PAVO Community Connector Service alongside Dr Carolyn Wallace (Director of the Wales School of Social Prescribing Research) in relation to social prescribing.

The key message that came out of the day for me was that the NHS can no longer continue to provide care in quite the same way as it has for the past 75 years. It’s just not sustainable. The NHS employs more people than ever before in its entire history, yet the demand for services is insatiable and cannot be met. It never will be. Because as new treatments are developed, rolled out and information about them shared, people’s expectations and demand for services increases.

The day was a bit of a roller coaster mix of highs and lows. Some of the stats around health inequalities were very concerning. But the enthusiasm for innovation, the stories I heard of good practice already happening around the UK - well, there was plenty to be excited about.

So here is a small dip into Day 2 at the conference. All of the speakers referred to challenges as well as opportunities.

"The world will not be destroyed by those who do evil, but by those 

who watch them without doing anything." 

 Albert Einstein

Frank Atherton - Chief Medical Officer for Wales

Frank spoke about some of the “wicked problems” or constraints to refreshing and carrying out the Welsh Government’s route map of A Healthier Wales - the long term plan for health and social care:

• An ageing and frail population.
• The need for the social care system to mirror the NHS.
• Vacancies in the workforce.
• Capital infrastructure is not fit for current times.

Frank also spoke about the public health agenda. In 2003 Sir Derek Wanless, a banker and health advisor, was asked to identify cost-effective approaches to improving public health, prevention and reducing health inequalities. His final report, Securing good health for the whole population, suggested that a shift in focus was needed away from just caring for the sick and into promoting good health.

Frank believes that our health is shaped by our environment. He described how all our communities are being increasingly exposed to fast food restaurants, gambling and vaping shops, for example. We need to think about how we address some of these concerns and have “deep, deep engagement with our communities.”

After highlighting some of this year’s priorities around redesigning the model Frank said that the “NHS will survive. It needs to grow, transform and develop … with public health at its absolute heart.”

Eluned Morgan - Minister for Health & Social Services

“The very fact that we have an ageing population is a sign of the success of the NHS. But we all know that the system is under strain like never before:”

More people will be living with dementia, cancer, coronary heart disease, vascular challenges, diabetes and poor mental health. And many people will be living with multiple examples of these challenges.

There is a worldwide shortage of health workers.

The vision:

• People live longer and healthier lives.
• They remain active and independent.
• They live in a whole system approach which achieves high quality care for everyone in Wales.
• Focusing not just on physical but on mental health.
• A switch to a system which anticipates health needs and prevents illness.

Eluned was clear that If we want a sustainable NHS to hand on to our children and grandchildren we need to work at managing our own health conditions, and also look at our lifestyles - around healthy diet, increased exercise, and alcohol reduction for example - to help lower the demand on the NHS. We need to listen to what matters to patients, but they also need to listen about the limitations of a sustainable NHS.

Whilst researching the conference I came across an online piece by Marion Foreman, an NHS nurse, who wrote powerfully in 2018 about an individual’s responsibility to look after their own health: Our health, our responsibility.

Prevention is key… but how to ensure that this message is heard and taken on board by the population of Wales…?

“Change will not come if we wait for some other person or some other time. 

We are the ones we’ve been waiting for. We are the change that we seek.” 

Barack Obama 

Professor Sir Michael Marmot - The Marmot Approach

Michael Marmot is Director of the (University College of London) Health Institute of Health Equity, and author of “The Health Gap: the challenge of an unequal world”.

Michael’s concern is with the social determinants of health - “the conditions in which people are born, grow, live, work and age and which can lead to health inequalities.” The 2010 Marmot Review looked at the differences in health and wellbeing between social groups and “describes how the social gradient on health inequalities is reflected in the social gradient on educational attainment, employment, income, quality of neighbourhood and so on”.

“Why treat people and send them back to the conditions that made them sick?”

People in more deprived areas used more NHS services/money than those in less deprived areas. “The UK is a very bad place to be poor.”

The framework for action created at the time of the review is known as the Marmot Principles, of which there are now 8 (the original review was revisited in 2020) - early years development (x 2), employment, living standards, communities, ill-health prevention, discrimination, and environmental sustainability. These principles have been taken on by some health boards and Gwent is the first Marmot region in Wales - Building a fairer Gwent: Why Gwent is a Marmot region.

Derek Walker - Future Generations’ Commissioner for Wales

“Acting today for a better tomorrow” - in essence sums up what the Wellbeing of Future Generations (Wales) Act 2015 is all about. “And that means in practice, for health, a long-term integrated preventative approach to our health system here in Wales.”

One of the five ways of working in the Act is prevention. Everyone agrees that prevention is key, Derek said, but not enough is happening. Derek asked “what is preventing us from putting the focus on prevention?” He pointed out that mental health issues in young people are continuing to rise, and 50% are established by as early as age 14, but there is not enough emphasis on early intervention.

Derek spoke of the 4 levels of prevention that have been developed with the Welsh Government and his predecessor Sophie Howe. Each level can reduce demand for the next. The levels start at Primary prevention - building resilience, and build up to Acute spending - which speaks for itself! “(According to Public Health Wales, mental ill health costs society in Wales £7 billion a year.”) The question now is how we spend more time at Level 1.

“We need to increase our spend on the social determinants of health faster than acute medical care spending.”

Derek noted that the Fire Service has managed to achieve massive change to bring about a 52% reduction in incidents through its investment in prevention and education. Whilst the “example doesn’t transfer automatically across to health care, it is a clear demonstration of where investment in prevention efforts can make a difference.”

A Journey to a Healthier Wales, from the Future Generations’ office, with a big emphasis on prevention and social prescribing, is well worth a read.

Professor Donna Hall - The Wigan Deal

Donna Hall, who is described as a “public service pioneer,” is the Chair of Innovative National Think Tank “Think Local”. She was awarded a CBE in 2009 for innovation in public service.

In this 2018 video she speaks to Chris Ham about what happened in Wigan, where she was Chief Executive of the council in 2011, when £160 million was taken out of their budget. They had to transform services and their relationships with the community, NHS and other providers. One of the elements of The Deal was that people took better care of their health. Amazingly The Wigan Deal improved services and resident satisfaction!

Ashley Gould - The Big Nudge

As part of this inspirational day Sue and I attended a workshop called The Big Nudge on changing people’s behaviours. It was facilitated by Ashley Gould, Programme Director of the Behavioural Science Unit at Public Health Wales. He introduced us to “Improving health and wellbeing: A guide to using behavioural science in policy and practice.”

Here in the mental health team at PAVO we’re more inclined towards the small nudge, and encouraging people to adopt positive behaviours by showing how much difference they have made to other people’s lives, specifically their mental health, be that by walking, gardening, getting active or singing, for example.

We’d like to make more of a difference, of course, and look forward to working more closely with not just the NHS but other organisations in Powys to help make the Prevention agenda key to improving people’s health and wellbeing. (We absolutely want the NHS to be around for another 75 years!) If you have any ideas about how we, and the Third Sector in Powys, could work more collaboratively to help bring prevention to the fore, then please get in touch!

You can watch videos of all the keynote speeches at this conference here.

* Through the Bevan Exemplar Programme, health and care staff across Wales are supported to develop and test their own prudent ideas to improve and transform health and care. Their projects, which are exemplars of innovation and transformation in clinical and community settings, can inform and inspire others to adopt and spread new ways of working across Wales and internationally.

Handmade gifts for Christmas

Xmas decorations handmade by Kay Vernon

"Be Creative & Give" (Number 5 of the Five Ways to Wellbeing)

This year colleagues at Powys Association of Voluntary Organisations, plus a couple of invited guests, tell us why they like to make gifts to give at Christmas. 
And never fear, if you’re short of ideas, they have plenty to try! 

Sarah Dale – Mental Health Individual Representative 

Knitted toys & crafts 

Art and craft are a huge part of my life. Creating beautiful things and pictures that inspire other people and bring a smile to their face is awesome! And is a productive use of my time which would otherwise be spent overthinking and worrying about various things in my life. Art and craft to me as a coping mechanism is a way of life :) 

I spend most of my time at home watching tv and knitting. This year I have knitted 6 animal toys to sell for the Samaritans. I also knit cat toys for the Cats Protection every year. Apart from knitting I love my Art. It a way of expressing myself in a nonverbal way as sometimes I struggle to do so. In one of my Art and Craft courses at Ponthafren Association run by Esther I made these cute and effective tea light holders. Drawing the trees on the tissue paper was one of the most relaxing experiences. In my papier mache class I have made some Christmas cat balls just because! It was an interesting but successful experiment! Ready for the ultimate cat Christmas! 

************

Annie Watkins – Admin Support Officer

Christmas socks 

I love to knit. It is my happy place. After a long day there is nothing better than to sit down with my knitting, whether I am making something for me, or a loved one, it gives me joy. The possibilities of working with yarn are endless, the colours, weight and types of yarn means that it is impossible to resist. It is completely absorbing and helps me focus. 

************

Kay Vernon – Senior Finance Officer 

Decorations & gifts 

I like to handmake Christmas presents for family and friends each year. It’s just so personal. I get a lot of fulfilment out of making pressies! I start in January ready for the next Christmas and make a lot of decorations too. Crafting is really relaxing – it keeps me busy and my mind occupied throughout the year. My favourite crafts are card-making, crochet, knitting, parchment craft, art and drawing. A good way to find out ideas and tips for presents and decorations is to join one of the many Facebook groups out there dedicated to your particular craft. 

************

Janet Radford – Senior Officer Internal Services 

Pickled cucumbers 

I love to make presents for people for several reasons - the first one is that I think about the person when I make their gift – it’s bespoke to them - a gift of time as well! The second is that I worry about the impact we are having on the environment - homemade gifts are more sustainable and generally don't have much plastic and the third is related to consumerism and misplaced values - so many people worry about having to buy things they cannot afford and get into debt - homemade gifts by-pass all that completely. Recipe here. 

************

Sue Newham – Engagement Officer, Health & Wellbeing team 

Caramelised red onion relish 

I really enjoy making jams, chutneys and relishes as gifts for people. At this time of year, Caramelised Red Onion Relish is superb with all those Christmas cheeses and cold meats. I used this recipe but adapted it, by leaving out the chilli and adding a glass of red wine too. You may have to cook it for a bit longer because you've added more liquid. Use your computer to design and print a nice looking label, and if you want to dress it up even more, cut a circle of fabric and use a rubber band to fix it to the top of the jar. Your friends and relatives will really appreciate this. Recipe here.

************

Freda Lacey – Senior Officer, Health & Wellbeing team 

Truffles 

I try to make chocolate truffles at Christmas time for friends, family and neighbours. It’s so simple, and yet can be full of adventurousness in creatively adding things in! One year, I made all my family gifts instead of buying things. At the time, I was unemployed and didn’t have a lot of money. I told them they were getting chocolates and/or other things I’d make so asked them what they liked (particularly flavours of chocolate). 

I had requests from chilli chocolate to rum and raisin, to salted caramel… The beauty of this recipe is that anything can go in and hopefully turns out! My family loved them and in an inexpensive box, it made the gift unique. Recipe here. 

************

Sketch for the Aberdyfi painting

Louisa Kerr – Mental Health Partnership Manager, Powys Teaching Health Board 

Artwork

Being creative and giving is one of the ‘5 Ways to Wellbeing’ and having learnt how following the ways can improve wellbeing I have been giving them a try. Thanks to the 5 ways I have rediscovered a long buried passion for being creative so I’m painting a landscape of Aberdyfi for my mum who was born and grew up there. I have really enjoyed painting for someone and whilst my original sketch felt like it could be a difficult task, it’s going well so far – but I know whatever it looks like in the end she will appreciate it. I can’t wait for her to open it! 

************

Jen Hawkins – Information Officer (Health) Health & Wellbeing team 

Bath bombs 

Making your own bath bombs at Christmas can be a lovely way to share a gift of wellbeing. Ingredients for bath bombs are easy to find, all you need is some citric acid, bicarbonate of soda, some flower petals of your choice, a selection of essential oils and a lot of patience! Bath bombs as well as being wonderfully fragrant are a good way to ease any seasonal stress and tension and can help us relax. 

Essential oils of Lavender, (Lavandula angustifolia) Sweet Orange (Citrus sinensis) and Frankincense (Boswellia carteri) not only smell wonderful but have specific properties that help us to unwind and relax, promoting a healthy, balanced peace of mind and sense of wellbeing. 

************

Sophia Bird – Principal Health Promotion Specialist, Powys Public Health team 

The triangle of giving 

This year I am encouraging my children (teenagers) to think about this triangle when planning their Christmas present buying for me. I have suggested they aim to give me a pledge to make a memory with me or make me something. Luckily they are both quite ‘crafty’ and artistic and I think it appeals to them because their money can go further. It appeals to me for the obvious reason – I get something meaningful from them.

************

Parchment bookmark by Kay Vernon

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

Psychological therapies - what's happening about waiting lists in Mid & South Powys?

Jane Cooke of our mental health team recently supported the organisation of a meeting in Llandrindod Wells to look at the long waiting lists for psychological therapies in Mid and South Powys. She reports now on what happened on the day.

The Psychology Services in Mid and South Powys have very long waiting lists. There are also waiting lists, but not so long, to see a counsellor based at GP surgeries. (Psychology Services in Mid and South Powys are provide by Aneurin Bevan Health Board and in the North of Powys are provided by Betsi Cadwaladr University Health Board).

In response to this the Psychology Services, some counsellors who work in GP practices, Powys Association of Voluntary Organisations (PAVO), people on the waiting lists and Public Health Wales worked together to plan and put on an event to talk with people who are on the waiting lists.

Around 30 people who are waiting for psychology services or counselling came on the 3rd February to a meeting in Llandrindod Wells to give their views about what it is like to be on the waiting list, what information people get, or don’t get, and what is it like receiving letters asking if you still want to be on the list.

People also had a chance to find out more about what else is on offer from, for example, Mind groups and other voluntary and third sector groups.

Mr Foxxman and Anna

There was a strong commitment from the Psychology Services to respond quickly to issues raised where possible, for example by changing the wording on letters, thinking through how to better keep in touch and demonstrate that there is concern for people. There were other ideas that will take longer to develop and find funding for around peer and buddying possibilities for support. There is a commitment from PAVO to continue to work with Psychology Services, supporting the participation of people who use services where required and considering the options for developing joint or partnership work. Public Health Wales also stated its support for this process as it develops.

This event is going to be of interest to other services across Wales. The simple act of getting people together and asking their views is not as widespread in the NHS as may be imagined. The fact that this was a positive experience for those who organised the event and those who attended, with some significant improvements resulting, will encourage others to adopt a similar approach.

We will continue to report developments!

What do you think about the waiting lists? Have they affected you? Let us know in the comments box below.