World Mental Health Day 2022 – Make mental health & well-being for all a global priority

This year we celebrate World Mental Health Day on Monday 10 October. 

The World Federation for Mental Health is the driver behind this important awareness day.

“World Mental Health Day aims to raise awareness in the global community about the critical mental health agendas – with a unifying voice through collaboration with various partners – to take action and to create lasting change through the messages we promote.”

The theme this year is “Make mental health & well-being for all a global priority”.

"The COVID-19 pandemic has created a global crisis for mental health, fuelling short- and long-term stresses and undermining the mental health of millions. Estimates put the rise in both anxiety and depressive disorders at more than 25% during the first year of the pandemic. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened."   

World Health Organisation

What can we learn from the rest of the world about good mental health services?

Open Dialogue in Finland

The name Open Dialogue was first used in 1995 to describe two key features of the approach: the use of open family / network meetings and a set of principles for organising the whole psychiatric system that made dialogue possible.

The Open Dialogue approach was originally developed in Western Lapland in Finland by Jaakko Seikkula and colleagues. They wanted to create a crisis service in which families and mental health services worked closely with the person experiencing the crisis and generate better outcomes for patients experiencing psychosis than those resulting from use of antipsychotic medication.

According to the Open Dialogue UK website: “If the family / team can bear the extreme emotion in a crisis situation, and tolerate the uncertainty, in time shared meaning usually emerges and healing / recovery is possible.”

The results of this approach are clear from the statistics – about 75% of those who experienced psychosis return to work or study within 2 years and only about 20% are still taking antipsychotic medication at 2 year follow-up.

As American journalist Robert Whitaker concluded in his book Anatomy of an Epidemic: “Western Lapland in Finland has adopted a form of care for its psychotic patients that has produced astonishingly good long-term outcomes.”

Read more here.

The Italian Trieste mental health model inspired by Franco Basaglia

The mental healthcare model in the port of Trieste, in north east Italy, is based on the theories of the reforming psychiatrist Franco Basaglia. Franco believed that psychiatry in large institutions unfairly ostracised people with mental problems and the area has seen a radical switch to community based care over the years. It is often called a “whole system – whole community” approach.

Basaglia died prematurely in 1980, but his team continued to develop and support his innovative approach to mental health care over the next three decades. The approach includes looking at the whole person and also their social background when considering what support someone needs.

“Historically, Trieste pioneered the shift from relationships based on domination / control to the therapeutic relationship seen as reciprocal, based on rediscovering the whole person.” Roberto Mezzino, MD

“While it is not without controversy, supporters of the Trieste system in Italy and around the world say that it is more humane, more effective, and even economically more viable.”

Political upheavals in recent years have reportedly put the approach at risk and people have organised petitions as recently as 2021 to try and protect the Trieste model.

Read more here.

Norway medication free mental health services

In 2016 regional health authorities in Norway were instructed by health minister Bent Hoie to provide medication-free treatment wards as an option for mental health patients. This followed years of forced treatment and forced isolation in mental health facilities. For some time, there had been considerable debate in Norway about the effectiveness and adverse effects of using antipsychotic medication, and individuals had long campaigned for change. While medication-free treatment is available in some other countries, Norway became the first country in the world to embed it as an option in the state-run mental healthcare system.

Dr Magnus Hald took on the job of running the new drug-free hospital in Tronsko in North Norway. "The idea of evidence-based medicine is difficult within mental health as a whole, although it's of course an aim that we should have. At the same time, we know that diagnoses in psychiatry are just a classification system. Even though you give a person a diagnosis of schizophrenia, you do not see any malfunction in the brain besides what you experience by engaging in a conversation with the person. You cannot see anything on the CT or the MRI images."

Whilst the debate continues in Norway about the pros and cons of medication free treatment, there is more patient choice now and according to research greatly improved trust between people seeking support and their therapists which can result in better outcomes.

Read more here.

Making mental health a priority in Wales – what’s happening now

Young people and mental health

Mental health and wellbeing will be one of the main focuses of the Welsh Youth Parliament over the next two years as the parliament stands up for the issues that matter most to young people in Wales.

Together for Mental Health

Together for Mental Health is a cross-government strategy setting out Welsh Government’s goals for improving mental health and mental health services in Wales. It is the first Mental Health Strategy that covers all ages; children and young people, adults of working age and older people.

This strategy is currently being evaluated nationally, and a new updated strategy will then be produced.

A Powys priority

Until such time as the new Together for Mental Health National Strategy is produced, Powys will continue to drive on its stated priorities. These priorities are identified in this document – T4MH Priorities.

Mental Health is also one of the Big Four health issues facing the county as identified in the Powys Health & Care Strategy. Powys Teaching Health Board says: “We will develop effective services to treat and support people suffering from the four main causes of ill health and premature mortality in Powys (which includes mental health problems).”

If you know of an interesting mental health initiative or approach from somewhere around the globe, we’d love to hear from you. Comment below or send us an email at mentalhealth@pavo.org.uk

The Wales Mental Health & Wellbeing Forum – an update

by guest author Sarah Dale 

Sarah Dale is a citizen rep – an unpaid volunteer who sits on regional and national partnership boards, including the Wales Mental Health & Wellbeing Forum (formerly the National Mental Health Service User and Carers’ Forum) – “the voice of lived experience”.

“I became a rep because I don't want others to have to fight for years just to be diagnosed to get the treatment they need. I strongly believe we all have the responsibility to do what we can to change and improve the mental health services that we all use.” 

In the summer of 2020 Sarah attended the latest meetings of the Forum, which took place online over the course of two days (28 July and 12 August). It was Powys’ turn to host and Sarah chaired one of the sessions. Sarah recently reported back to the Engage to Change partnership board (sub-group of the Powys Mental Health Planning & Development Board) about what took place over the course of the two days.

We had a general update and I did a long Powys update because we have done so much. There was a lot of feedback from the other reps that they were surprised how much work we actually do in Powys as reps. Someone said “now that is real co-production!” A lot of the other health boards haven’t actually done a lot during Covid, for example, having meetings or involving reps.

Then we had a quick session on the logo, looking at the new name and design. That was all approved. This was followed by a session on the Terms of Reference which were also approved, including the Easy Read version which I had gone through and amended. I don’t like the term Easy Read, I call it “Sarah readable!”

We looked at the new member roles which were also approved. Some people who have exceeded their term of office are now able to stay on in the Forum. We have other working groups – so there’s a Diversity and Equality Working Group – and we are looking at people we want to include in these groups, so we send out “About Us” emails to organisations.

A representative from Welsh Government updated us. They have asked us to become involved in reviewing some of the Public Health documents. Ministers have invested £5 million towards ending homelessness and are supporting local authorities to provide longer term housing solutions. The three regional Suicide Prevention Coordinators have been appointed and an announcement about suicide prevention grant funding will be made soon. Welsh Government is working with the voluntary sector to develop a framework for better engagement in recognition that there is not enough work in partnership with smaller mental health charities in particular.

The Welsh Government is reviewing the Together for Mental Health and Talk to Me 2 delivery plans to strengthen areas which have been particularly impacted by Covid and to review timescales for delivery on one year actions. The revised plans will be presented at the National Partnership Board and the National Advisory Group in September for feedback. Equalities is one area where there will really be a focus, along with housing and homelessness, wellbeing and public health, and financial impacts. A number of Tier 0 interventions such as online self-help resources have been established. There have been some rapid reviews to changes made during lockdown which are being coordinated by the NHS – on what works based on user surveys and staff feedback.

One thing which Ainsley Blaydon (Mental Health Strategy Lead for Welsh Government) would like is feedback about what it has been like as a “service user” under Covid so I mentioned to her that we had done a survey of people under services in Powys.

Sarah on an interview panel for mental health services at the health board

Previously I have not been able to access the Forum working groups as they have been in South Wales and I don’t like to travel because of my anxiety. Covid has meant that a lot of these meetings are on Zoom so I have been able to join a couple which is really exciting. From each health board you have two service user and two carer reps and they are automatically invited to the Forum. Because of the number of health boards in the South there feels more of a South Wales representation – sometimes it feels like we are forgotten in the North. If I was in the working groups I felt I would have more of a sense of belonging so I joined the Equality and Diversity Group because that is my strong suit and also because there is inequality in representation.

In the group they have identified people they want to join – these are people from travelling communities, those experiencing homelessness, LGBTQIA, digitally excluded and Welsh language speakers. So I asked – do you even know who in the Forum fits into these categories? I’m here, I fit into the homelessness one because I’ve been made homeless. So I made them look inwards at the start – and now I’m doing some of that work. I was assigned the LGBTQIA list, so I did a lot of Google searching on all the different groups – most of them are Facebook groups and very hard to find, which is something we need to tackle, but I have compiled a list.

When I joined the Forum I just turned up, there was no Equality & Diversity form, so I’m creating a form I’ve dubbed the “Diversity Form”. It’s optional whether people fill out the details about their gender, sexuality, race – the usual equal opportunities but extended so that we can identify specific groups like people who use Personality Disorder Services or Eating Disorder Services or have been homeless. At the end of the document we explain that we are looking for people from these specific groups to talk about their experiences if they are comfortable with that.

I then joined the Future Planning group – one of the questions they have posed is – “Why are we losing so many members? Why can’t we get people to join?” So I explained that there are a lot of people from South Wales and if you’re not from there you feel left out, plus some of the topics don’t really apply to us in Powys. 

At the last Forum meeting the special topic was “Alternative to inpatient care,” which is good but as I said it would be nice to have the basics in Powys. We do not have a 24-hour crisis team – all the other areas do. When I was an outpatient at the Child & Adolescent Unit in Bridgend I missed out on the therapies, treatments and groups that are available to people who live locally. As a Powys resident I saw two different people who came up to Powys for two days a week for half a day by comparison. So one of the suggestions I made was to make it more welcoming to people so there isn’t that divide.

Locally I’ve been invited to join interview panels which I’ve really enjoyed – I did the Suicide & Self Harm Coordinator’s role, a Harm Reduction role and a Crisis Team Practitioner. My thoughts were totally taken into consideration and it was a really good experience. 

Many thanks to Sarah for telling us about the Forum meetings. If you would like to find out more about volunteering as a mental health “citizen rep” in Powys then get in touch with us by emailing mentalhealth@pavo.org.uk or call 01597 822191 and ask to speak to Owen Griffkin.

Together for Mental Health consultation - a Powys view

Individual rep, Sarah Dale, on Llandudno beach

Our Participation Officer, Owen Griffkin, shares a report on the Welsh Government 

Consultation for the ‘Together for Mental Health’ Delivery Plan 2019 - 2022

On a sunny day (with scattered showers) I attended the consultation event for the Together for Mental Health plan 2019-2022. I was there to accompany one of our individual representatives, Sarah Dale, who felt it is was important for Powys to have a voice in one of the live consultations. This all day event was in a beautiful location in Llandudno, Venue Cymru, with a lovely sea view, which almost made the 150 mile round trip worth it.

Together for Mental Health is the Welsh Government's 10 year cross governmental strategy and was published in 2012. This consultation is to inform the last 3 years of the plan and to look at the priorities that have been identified and how they will be implemented.

The day was chaired by Ainsley Bladon, the Mental Health Strategy Lead at the Welsh Government, who is regularly seen at both regional and national partnership events. She introduced the delivery plan with a short presentation and then we moved on to the first question for discussion.

This was looking at the key priorities for the next 3 years and there were a lot of themes arising that we have come across in other engagement events. Some of these included - transition from Child & Adolescent Mental Health Services (CAMHS) to adult services, accessing mental health services with substance misuse issues, difference in service depending on location and funding of third sector (voluntary) organisations.

Also a big point raised was the accessibility of legislation and documents to the ordinary person. There is a lot of jargon and acronyms in the consultation document and this has proved a barrier to some people in disseminating the information. Ainsley said they had heard this a lot and they will look to change this in the future.

Sarah was very vocal about the need to ensure that basic service provision is met in Powys and that locally this is a priority - eg 24 hours crisis care. She also spoke passionately about the Talk to Me 2 suicide and self-harm plan, saying that it didn’t have enough mention of self-harm.

Next we were asked if the cross-cutting workstreams were appropriate to prioritise, which once again prompted some explanation requests about the technical language of the document.

These priority areas can be seen in this photo:

We were able to share some of the findings of the recent care and treatment plan engagement events held by Powys Teaching Health Board in Powys as this is linked to the ‘Core data set’ requirement, and also highlighted some of the specific issues in Powys around engagement.

After lunch, and a very quick stroll along the prom, we returned to look at what the room thought the key impacts would be and how we can increase positive effects whilst mitigating negative effects. The importance of third sector organisations was highlighted again, and a few people spoke about the relationship between staff and service users and the importance of being listened to in that relationship. 

We then ended with a reflective exercise on the effectiveness of the day and an assurance that results of the consultation will be fed back to everyone who attended. We closed with a thank you speech from Tracey Breheny, the fairly-new Deputy Director of Mental Health. It was interesting to hear that she is also responsible for Substance Misuse and Vulnerable Groups which hopefully augurs well for more coordination and understanding of the co-occurring issues of substance misuse and mental health. She also came out with the quote of the day when she said that all the comments would be ‘fed into the sausage machine of the Welsh Government’ and processed into a report.

All in all the day was definitely worth our while going although it is a shame that there isn’t an event closer to Mid Wales. It is vital that Powys has its voice heard in this consultation as we have a lot of issues specific to our county and I therefore urge anybody with an interest in the delivery plan for Mental Health services to fill in the online consultation before August 30th. You can participate by visiting the link on the following webpages:

Welsh

English

There is also another consultation event in Carmarthen on the 28th August that I recommend attending if you have the time.

Venue

Room TL5 (Ground Floor), Teaching and Learning Building, University of Wales Trinity Saint David, Carmarthen Campus, SA31 3EP.

The day will be structured as follows:

Morning 10:00 – 12:30 – Discussion of Priority Areas
Lunch 12:30 - 1:30

Afternoon 1.30 – 4.00pm – Considering Impact and Delivery

To take part please RSVP to Darren Lewis (Darren.lewis@gov.wales) including the following details:

Name, organisation (if relevant) and event you wish to attend (West Wales in this case). Expenses and lunch are provided on the day. 

If you fill in the consultation, or attend the Carmarthen event, please let us know at PAVO. You can email owen.griffkin@pavo.org.uk or ring 01597 822191. We might be able to help you organise lift shares and put you in touch with others attending.

On the Experts by Experience panel

Sarah Dale was recently in contact with the Participation Officers in our team. She expressed an interest in getting more involved with our engagement work, which includes working with individuals who have been in contact with mental health services and supporting them to attend partnership meetings as reps. They are encouraged to give feedback, to represent the views of others, and to help shape future mental health services.

Sarah subsequently agreed to accompany Participation Officer Philip Moisson to a conference earlier this summer, and joined the Experts by Experience panel on the day. We were all really pleased that someone from Powys had been willing to speak up about their experiences, and asked Sarah to give us her take on the day.

The Together for Mental Health conference on 12 July at the Marriott Hotel in Cardiff was organised by Cymorth Cymru, the umbrella body for providers of homelessness, housing-related support and social care services in Wales. The event looked at “the contribution that the Supporting People programme can make to mental health, in the context of the Welsh Government strategy - Together for Mental Health. It brought together service users, providers and academics to consider the difference we can all make to mental health.”

First of all we had a welcome address from Katie Dalton, the Interim Director of Cymorth Cymru. This was followed by an informative session about the Welsh mental health legislation, including a good look at the aim of the Mental Health (Wales) Measure 2010, the difficulties, aims and challenges and the relationship to housing and homelessness. We also looked more closely at the government strategy Together for Mental Health.

Next up we got to listen and pose questions to a panel formed of people who provide the services. The individuals on the panel were the chair: Phill Chick - Assistant Director, NHS delivery Unit (below right); Louise Evans - Director of Services, Gofal; Julian John - Director, Merthyr and the Valleys Mind; Dr Julia Lewis - Consultant Addiction Psychiatrist, Gwent Specialist Substance Misuse Service (below left); and Dr Matthew Sargeant - Executive Committee Member, Royal College of Psychiatrists in Wales. Some very interesting points were raised especially about alcoholism and the services mental health teams provide.

  

 
We then had a presentation about the Housing First programme and the links to mental health and homelessness. I learned that only a few people who become homeless actually have mental health issues, however the longer someone is homeless the greater the risk of them developing mental health issues. Those that are made homeless on more than one occasion are even more likely to develop mental health issues.

After a quick tea break we then had the choice of attending two workshops. One was delivered by Time to Change Wales, and I decided to attend the other which was about supporting people with personality disorders. I found it extremely informative and brilliant even. We had a quick overview of the classification of the 10 personality disorders followed by a closer look at two of the more common personality disorders, borderline and antisocial personality disorders. We looked at the different factors at play that 'cause' these two disorders, such as neurocognitive, life experiences and genetics. We also looked at the different therapies that help cope with these disorders such as Dialectical Behaviour Therapy, Multi Systematic Therapy and the trauma informed approach. I found it very insightful and well presented.

In the next workshop, after lunch, we looked at psychoeducation which is group-based and aims to educate individuals on how to cope with everyday life. Topics included anger management, emotional resilience, and emotional well-being. For example, we did some group work, figuring out how psychoeducation could be fitted into our organisations. It was very interesting.

After a tea break four of us were invited to speak about our experience and the services we have used, highlighting the positives as well as areas for improvement. It was immense and very emotional. All the speakers’ stories were moving and some very important issues and positives were raised. The audience was clearly moved.

After that we wrapped up and closed the day. Overall it was a brilliant opportunity, and a great day.

Many thanks for Sarah for telling us about her day at the Cymorth Cymru conference. If you would like to find out more about volunteering as a mental health “rep” then get in touch with us by emailing mentalhealth@pavo.org.uk or call 01597 822191 and ask to speak to us.

Dual diagnosis - changing times

Dual diagnosis - co-occurrence of a mental health problem with a substance misuse problem.

This week’s post is from our guest author Kate van den Ende. 

Kate is one of three representatives on the National Mental Health Forum in Powys. There are ten such networks across Wales, feeding in to the National Partnership Board – where those using services, carers, professional groups, the statutory and voluntary sector and government departments across Wales meet three times a year to oversee the delivery and implementation of "Together for Mental Health – A Strategy for Mental Health and Wellbeing in Wales".

The bad news

If you live with a mental health problem, you are more likely than the rest of the population to have to manage a problem with substance misuse as well......and vice versa.

The most commonly used 'substance' is alcohol, but, in the world of addiction, the understanding is that, at different times, we use different 'substances' to support us, to self-medicate - a horrible term used by professionals! So alcohol can be interchanged with food, drugs, relationships and/or gambling as the 'substance of choice' at different stages of our lives, depending on which is available or which fills the need at that time.

The double whammy of co-occurrence used to be considered a rarity but, as any of us could have told the professionals, statistics show that it is more like the norm..... and if you have a severe and enduring mental illness like schizophrenia or bipolar disorder, your chances of having to cope with both is considerably increased again.

Assuming that co-occurrence was a rarity meant that the two sides to the problem tended to be treated separately, as if they were symptoms of two completely different, unrelated conditions. People were shunted between the separate services and, surprise, surprise, they fell through the gaps!

Our experience was just that.

An appointment would be made to see the mental health team or psychiatrist. Nervousness and self doubt resulted in large quantities of vodka. The professionals refused to see a drunk patient. An appointment was made to see the drug and alcohol service. Nervousness and self doubt resulted in large quantities of vodka and a failure to attend the appointment. This in turn fed into the 'I'm rubbish, just see how rubbish I am....I can't get help even when it's offered.' Vodka again, with pills this time. A&E admission and a couple of days to check liver function before discharge either directly home to exhausted and lost carers or mental health ward, with or without Section. Medication, escapes to buy vodka, discharge to the even more exhausted and despairing carers.

An appointment would then be made to see the mental health team....vodka.....no change in mental distress......appointment with drugs and alcohol service....vodka......further reason to beat herself up.....vodka and pills.....A&E.....Section.....revolving doors, escalation of the problems.....further desperation for carers....

And so we went on, for 18 months, with the reliance on vodka and the self harming reaching ever higher, dangerous levels. Neither service looking beyond their particular remit. Nobody was looking at the whole distressed person, with all her complexity of problems.

The good news 

Changes are being made to the way help and treatment are offered to people battling with co-occurrence. Indeed, changes are being required by the Welsh Government. If you talk to service providers in Powys, they will tell you that they have already started on a new, joined-up approach. Drug and Alcohol services are provided in Powys by Kaleidoscope and CAIS. They have started to work out ways of joining forces with the local mental health services, to deliver 'seamless' provision.

But the new legislation demands far far more. Seamless delivery is just a start.

It includes:

"It must not be left to the service user to navigate between substance misuse, mental health and other related support services themselves." They and their family will have a nominated, responsible key worker to help them find their way.

There must be "absolute clarity on which agency is leading and coordinating care."

An integrated approach, with clear treatment protocols and care pathways will provide "holistic, person-centred care."

To deliver these improved services, the Welsh Government recognises that:

Professionals on both sides will need considerable training "to overcome institutional and cultural assumptions."

So, from December this year, when Powys teaching Health Board resumes complete control over, and responsibility for, the commissioning and delivery of services to those in mental distress in this area, they have been offered a fine example of the kind of services we want, whether or not we have a co-occurring substance misuse problem.

Integrated, holistic, person-centred and individually tailored to our needs, delivered by teams of well trained professionals who work together and who listen!

That’s the kind of support we need to recover control over our lives.

World Mental Health Day 2015

Saturday 10 October 2015 is World Mental Health Day, which is organised by the Mental Health Foundation in partnership with the World Federation of Mental Health and the World Health Organisation. This year’s theme is Dignity in Mental Health. The MHF states:

“We believe that effectively supporting people experiencing mental health problems is on target to become one of the greatest public health challenges of our time. Stigmatising and discriminatory treatment can be particularly distressing when a person is experiencing a health crisis.

We all have mental health, and by failing to treat people with mental health problems with dignity we make it more difficult to ensure that everyone takes steps to safeguard their wellbeing and to seek help, as it can lead to self-stigma, low confidence, low self-esteem, withdrawal and social isolation.”

The World Federation for Mental Health has published a collection of papers under the heading "Dignity in Mental Health" from "expert authors who show that dignity in the mental health context can have many meanings and can be applied to every aspect of care." There are contributions from all around the world - including for the UK - Professor Mike Pringle CBE on "Mental Health for All: Mental and physical health parity - the role of General Practice".

The definition of dignity, according to one of those handy online dictionaries, is: “being worthy of honour or respect”. In our day-to-day lives we all expect to be treated with dignity, and it follows on from that – so we would too if in contact with any services we seek in relation to our mental health.

But provision of mental health services is complex and linked in to the laws of the land. Staff are often desperately firefighting due to cuts and increased paperwork, sometimes they barely have time to even talk to their patients…. The very fact that this theme has been chosen for World Mental Health Day 2015 suggests that there are issues around being treated with dignity whilst distressed.

Mental Health Foundation Tea & Talk initiative
for World Mental Health Day

What does it feel like, not being treated with dignity? It might feel that:

I am not being listened to

My colleague Jane Cooke says: “I think the fundamental thing for me is the quality of listening - and acknowledging that I am saying what I am saying - I think my dignity is affected when people reply with something like “So it’s about…” and then telling me what I said. It means that I am not heard - I’ve been put into a box.”

I have been labelled

Perhaps I have been told I have a specific diagnosis or disorder. I might not agree, but I might need the diagnosis to access further support or other services. I have to compromise to make a step towards recovery. In North Powys young people are fighting back against being labelled – those involved in the Young Adult Peer Support project at Ponthafren Association made a video called – “I don’t let mental health define me” in which young people challenge stigma with the powerful message: “Everyone has mental health.”

I am just a number, an entry on a list, without individuality or identity

It is all-too-common anywhere in Wales, not just in Powys, to be on a waiting list for psychological or talking therapies if support of this kind is considered appropriate. People in this situation can feel isolated, forgotten, and helpless. They don’t know where to turn. But just communicating with people can be helpful, as Jane found out at an event she helped organise earlier this year specifically to look at issues relating to the waiting lists.

I might lose my freedom

I no longer have control over my life – perhaps I am forced to take medication against my wishes or engage in activities which don’t interest me. Ultimately I may lose my freedom if I am detained under the Mental Health Act. Derek Turner and Jan Rogers wrote about the value of Advance Statements for crisis planning recently, whereby people are able to make their wishes clear in a written statement which could be referred to in times of mental health crisis. In this way someone experiencing mental distress in a public place could be supported with dignity rather than arrested and perhaps “bundled into a police van.”

I am not valued – by family, friends or staff with whom I come into contact… My self-esteem has hit rock bottom…

On Maple Ward at the Longley Centre, Sheffield Health & Social Care NHS Foundation Trust has developed ‘Dignity Steps’ which translate the views of people using the service into actions for improvement. It’s a lot like the approach taken by Powys Patients Council here, where mental health inpatients meet with experienced volunteers to talk about improvements they would like to see on Felindre Ward at Bronllys Hospital in South Powys. Rhydian Parry, who is a rep on the National Mental Health Partnership Board, wrote about his experience of volunteering on Powys Patients’ Council.

Together for Mental Health is the Welsh Government strategy for improving mental health and a vision for mental health services across Wales. Objective 13 of the national outcomes states:

“Service user experience is improved, and safety, protection and dignity are ensured and embedded in sustainable services.”

The ambition is there, but what is the reality actually like? Identifying the problem, in some ways, is easy. Much harder is thinking of solutions… but there are lots of ideas on the Social Care Institute for Excellence website – take a look and see what you think.

If you have been in contact with mental health services, do you feel you were treated with dignity? If yes, great, tell us about it and we can spread the news of some good practice! If not… why do you think this was so, and what could be done to improve things?

Brecon & District Mind is hosting a Mental Health Awareness Morning to mark World Mental Health Day this Saturday 10 October, 10am - 2pm at Brecon Guildhall. Tea and coffee available. All welcome.

Shaping mental health services: a Powys update

AKA my “Mental Health Awareness Week” blog post! 

At two PAVO events, (in Brecon and Newtown) a couple of weeks ago we invited people in contact with mental health services and those close to them to join us. It was billed as “your opportunity to come and meet your individual representatives, learn what’s new with mental health services across Powys and give your opinions.” I went along to the event in the North and enjoyed a day of debate and information sharing (not to mention some amazing art exhibits and a Laughter Workshop) at the Maesmawr Arts Centre in Caersws.

Freda Lacey, PAVO’s Participation Officer, introduced the day and gave an overview of the mechanisms through which people can feed in their views about mental health services in Powys. Feedback is taken to the Powys Mental Health Planning & Development Partnership run by the health board, also to the National Service Users & Carers Forum, and finally to the National Partnership Board. You can read more about the structure here.

Freda went on to explain that there are currently 5 vacancies on the National Service Users & Carers Forum – opportunities for people in Powys to get involved and help shape future mental health services. If you are interested then please get in touch.

National Partnership Board - behind the scenes

Rhydian Parry from Powys, who has previously written on this blog about his experience as a volunteer on Patients’ Council, is one of four people with lived experience sitting on the National Partnership Board. He spoke enthusiastically to us next about what it’s really like to be a rep at that level.

At a recent NPB meeting Rhydian gave a presentation about a questionnaire around crisis services. He received a good reaction, and crisis services were subsequently discussed at each of the local partnership meetings. Rhydian described this as: “A step forward. Progress.” He and the other reps are often invited to do other things. They recently attended a talking therapies conference in Cardiff. “We are able to speak to reps from all the health board areas and find out the waiting times across Wales. If someone is now waiting 6 months to see a psychotherapist that is good – it used to be a 2 year wait.” Rhydian also spoke about his work with the police around detaining people under a Section 136.

Meriel Richards and Kate van den Ende, the two other Powys reps on the NSUCF, also contributed to the update. Meriel said that “at the last meeting it really felt as if we were part of the forum. It’s chipping away.” Kate added: “It states in legislature that they have to listen to us.” She described the slow process of winning influence. “There is now a good chance to say that this is the way it should be.”

Issues that are raised by the reps can be taken by mental health commissioners at Powys teaching Local Health Board to service providers and further information requested. The reps are clearly making a difference. Even so, it was identified that the task is huge. Someone from the audience said: “like trying to move a mountain with a wheelbarrow and a hand shovel”.

Not everyone likes to attend meetings to have their voice heard. Other suggestions for encouraging people to contribute their opinions included using social media and email, encouraging feedback in GP surgeries, and putting up posters on school noticeboards.

Freda opened up the discussion to ask people attending to tell us what they believed to be the current gaps in services. The key areas were well familiar to us all, and included the long waiting lists for psychological therapies, and the failure of Children & Adolescent Mental Health Services (CAMHS) to meet all young people’s needs. It seemed as if some agencies struggled to signpost people to support services in the voluntary sector. One carer of a young person said: “I would feel empowered if I had the information I need – not completely on my own having to deal with things.”

There was also a real appetite for finding out more and trying alternative approaches (what we have called Beyond Medical) such as the Soteria House promoted by the Soteria Network and the Finnish Open Dialogue approach.

Louisa Kerr updates us

Louisa Kerr, Partnership & Project Support Officer for the Powys Mental Health Planning & Development Partnership, was next welcomed to the event to speak about upcoming priorities for the health board. These include:

- Enhanced Primary Care services;

- Acute Care in the community;

- Repositioning for older people;

- Integration of services.

Louisa is also working on rolling out two other projects – updating the health board website with more information about mental health services, and developing a crisis house in Powys.

Recommissioning of voluntary sector mental health services in Powys

Louisa spoke at length about this process. The Hearts & Minds Strategic Plan – vision for mental health services, commits the voluntary and statutory sectors to work together to achieve the best outcome for individuals. All services are being looked at in line with the strategy. The health board is now seeking equity of services across Powys, which means that to be fair a commissioning process will take place (see the “commissioning cycle” for a diagram showing the nuts and bolts of the process). Formal events are being arranged in the near future, and the health board will engage with "all ages" around services to make them the best that can be commissioned.

In response to questions from the audience, Louisa clarified that “price is not the driver. It is having the best service in place.” The Welsh Government guidelines on tendering will be followed.

Those present went on to express concern about the process which can cause stress for both volunteers and people in receipt of their service. This was acknowledged, and Louisa said she would be going back to speak to the procurement team for clarification on any questions raised. It was also made clear that PAVO (Powys Association of Voluntary Organisations) can be called upon to provide support to voluntary sector agencies around commissioning.

How to be a Two-headed monster
 in Owen's Laughter Workshop!

The discussion could have gone on all day, but a delicious Maesmawr Arts Centre lunch beckoned, followed by a tour of the grounds and the sculpture trail, and an amazing Laughter Workshop with Owen Griffkin. All in all a brilliant day.

Jill Ball (Powys Befrienders) & Glynis Luke
 (PAVO mental health team) on the tour
at Maesmawr Arts Centre, Caersws

What do you think? Would you be interested in finding out more about becoming a “service user & carer rep” for the National Forum? Let us know! Your voice needs to be heard!

Together for Mental Health - Assembly Ministers have their say

Assembly Ministers debated the second Annual Report on Together for Mental Health on Tuesday in the National Assembly for Wales. I watched a large chunk of the debate online on Senedd TV, and you can read the Record of Proceedings here, and dip into video records, to catch up. (Start at 16.26pm, unless you want to find out more about the local government settlement…)

Together for Mental Health sets out Welsh Government ambitions for improving mental health and a vision for mental health services across Wales and was published in 2012. It is the first mental health strategy for Wales that covers people of all ages.

Vaughan Gething, the Deputy Minister for Health, introduced the debate by saying: Mental health services have made real progress throughout 2014. By further embedding the Mental Health (Wales) Measure 2010, we are continuing to make tangible improvements to care whilst ensuring service users’ views are heard. On average, over 2,600 people are now seen locally every month by primary mental health support services. These deliver advice, information and services, including befriending, books on prescription, physical activity and psychological therapies.

His introduction also included a reference to the work around dementia in Brecon’s dementia friendly community which we have previously written about here. A groundswell of interest in dementia support of communities has seen Brecon and Swansea recently gain official ‘working to become dementia-friendly’ status, and I am proud that we are continuing to fund the charity (The Alzheimer’s Society) to continue this important work in Wales.

Darren Millar, AM, who moved several amendments, said that: There’s no doubt that there has been progress, and long may it continue, but the pace of progress, I think, is something that we need to address. He also acknowledged the contribution of the Third Sector: I would like to put on record… the acknowledgement of the fantastic work that the third sector is doing to address mental ill health issues in Wales, whether that is Mind, Gofal, Hafal or the whole host of other organisations—local organisations, as well—that are doing their bit.

Prior to the debate the mental health charity Gofal had carried out a survey of people who had been in contact with services, and circulated the findings to Assembly Ministers. Whilst the survey highlighted some positive changes, there were also concerns expressed in the findings. Darren continued: One in 10 GPs, and a growing proportion of GPs, according to service users, do not understand or are insufficiently empathetic to mental ill health issues. More alarmingly, a quarter of other staff in primary care are insufficiently understanding or empathetic of people’s concerns.

Darren continued: The other issue, of course, as well, is that it appears that a growing proportion of people are simply having pharmaceutical interventions rather than some of the psychological interventions that I know all parts of this Chamber support the need to increase and improve access to.

Kirsty Williams, AM for Brecon and Radnorshire, wanted to know what steps were being taken to ensure parity between physical and mental health services. She pointed out that progress had been made in reducing the stigma associated with mental health, but that this brought its own problems. Members will have heard those problems highlighted in the all-party group this afternoon, where there certainly was a feeling that, perhaps, the report was on the rosier side of how things felt on the ground to those people using the service, to the third sector organisations involved in helping deliver services for people in communities, and to people caring for relatives or friends who are suffering from mental distress and ill health.

David Rees, AM, who had chaired the cross-party meeting on mental health just prior to the debate, said: It was felt that service user and carer representation on the national partnership board needed greater support to actually ensure that the diverse views across Wales could be fed into the board through improved pathways to achieve that engagement. I therefore hope that the Deputy Minister will be able to give reassurances that the individuals who represent the service users and carers on that partnership board will be given that support to engage with a wide range of bodies to allow a wider spectrum of views to be presented in order that services can be shaped to continue the improvements we have seen to date.

Other issues debated included:

• The pressure on Child & Adolescent Mental Health Services.
• The Veterans NHS Wales Service.
• Access to crisis beds.
• Care and treatment plans.
• Mental distress in the workplace.

Vaughan Gething made closing comments to respond to many of the issues raised. There is not space to address all of these here, but I will just pick out his response to David Rees’ point above. Vaughan said: Patient voice and choice in designing healthcare is a core element of our prudent healthcare approach….I want to, in closing, recognise again the contribution of the wider voluntary sector in helping to deliver not just support, both the design and delivery of our services here in Wales.

You can read more about the amendments that were tabled and voted upon and the outcomes on the Record of Proceedings here (from 17.27pm).

The Assembly Ministers have had their say. Do you think Together for Mental Health is working effectively to bring about improvements in the planning and delivery of mental health services in Wales? Let us know in the comments box below.

Co-producing the Annual Report for Mental Health

L-R: Aled Davies (Powys County Councillor), Sophia Bird (Powys Public Health), Meriel Richards (individual rep National Forum for Service Users & Carers), Seamus O'Doherty (Welsh Ambulance Service), Louisa Kerr (Powys teaching Health Board), Clare Lines (Strategic Lead Mental Health - PtHB), Michelle Forkings (Aneurin Bevan Health Board), Jackie Davies (Children & Young People's Partnership), Steve Pearce (Powys Youth Justice).

Following development of the new Powys mental health strategy – Hearts and Minds: Together for Mental Health – the first annual report was produced by the Powys Mental Health Planning and Development Partnership Board for 2012-13 (you can read it here). This reports on which key elements of the delivery plan had been achieved during that year. As far as I am aware, it was written primarily by staff working for Powys teaching Health Board.

At a recent meeting of the National Partnership Board (minutes available here) the individual representative who is based in Powys, Rhydian Parry, gave feedback from the National Forum for Service Users and Carers. One of the points he made was:

“Service user and carer views need to be clearly and accurately embedded in annual reports.”

“The Chair (of the NPB) responded saying all Local Health Boards and Trusts have been informed of this requirement. A small amount of financial support has been made available to each Partnership Board to support this process. Sian Richards (Welsh Government Mental Health Strategy Lead) will be meeting the Service User and Carer members immediately after this to discuss how they can play an active role in the development of the Welsh Government report.”

I knew that an event had taken place in late September this year, pulling together the members of the Powys Mental Health Planning and Development Partnership (PMHP&DP), including those using mental health services and those close to them, to look at production of this year’s annual report. The work was being described as “co-production” – a word which can mean so many different things to different people. It is defined by the New Economics Foundation “as delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours”.

So, I asked my colleague Freda Lacey for an update about last week’s event.

Freda told me that four of the individual reps – Rhydian Parry, Meriel Richards, Kate Van Ende and Michelle Willingham – had contributed along with people working to provide statutory mental health services, Powys Public Health, a Powys county councillor, Powys Youth Justice Service and the Welsh Ambulance Service. Prior to the event the four individual reps had given feedback first on the structure of the event, and then about the way their contribution would be included in the Annual Report.

The idea of a “timeline” was developed – the journey of an individual’s life from cradle to grave – along which mental health services could be accessed. Feedback was then given about these services.

The completed Annual Report will be signed off by Powys teaching Health Board (PtHB) in October before being passed to the Welsh Minister for Health & Social Services – Mark Drakeford. It comprises two parts – a written section, where the reps have made detailed feedback on the delivery plan and overall report, and an audio version containing real life voices. The voices will include contributions from an all age perspective, including children from the Sparks Project run by Tros Gynnal, an interview with an older couple relating to dementia, and excerpts from the DIY Futures book of stories – it’s the inside that matters, covering adults’ and older adults’ perspectives. Additionally, partners have been asked to give their feedback on how the voices of people in contact with services have helped shape their services. There will be contributions from Dyfed-Powys Police and the Children and Adolescent Mental Health Services team (CAMHS).

Clare Lines, Strategic Lead for Mental Health at PtHB, and chair of the Powys Mental Health Planning and Delivery Partnership, will also speak about the positive impact that the individual reps have made on her work and that of the Partnership.

We will let you know as soon as the Annual Report for 2013 - 14 is published. Watch this space!