Meet Mandy Pearce - Reablement Worker at Mid Powys Mind

In 2015 Mandy Pearce started as Mid Powys Mind’s new Reablement Worker, funded by the Lloyds Bank Foundation, in a new three year project to help support people in transition from hospital. 

Working originally with patients from Felindre Ward in Bronllys Hospital, South Powys (a ward offering acute inpatient mental health services) the Reablement Service offers much needed support to people coming home after a medium to long term hospital stay.

We caught up with Mandy recently at her Llandrindod base to find out more about the project has evolved since she started last summer.

What does reablement mean exactly?

The reablement approach is well known in physical health. It is newer in mental health. It is short intensive support, usually offered to people in their own homes, after a stay in hospital and during a period of ongoing recovery back in the community.

I have access to patients’ Care Plans, liaise with their Care Co-ordinators and also attend their discharge meetings. Once they have left hospital I then visit them and provide support depending on their needs. This can be very varied depending on individual situations. Two of my first clients had been long-term patients on the ward – one for 12 months. There was a lot of work to be done. People become quite institutionalised and it can be quite scary returning to the community. Even going to the corner shop can be hard.

Some people, meanwhile, are only in hospital for a couple of weeks and then quickly get back on track with their lives once they leave.

How does reablement make people’s lives better?

It provides additional support that hasn’t been there before. It’s about looking at people’s needs. Isolation is a key word really. The hospital reflects that sense of isolation back to the patients. They have been unwell at home for quite a long period, perhaps staying indoors, maybe even in bed. Then they go into hospital and are still quite isolated.

Originally I thought the role would involve carrying out practical tasks such as looking after a pet or going shopping. But people want to talk. That’s often their main need. We have to be flexible in our approach and try and meet people’s needs.

Who is eligible to receive the service?

When I started it was just available to ex-patients of Felindre Ward who are from the Radnorshire area of Powys. However, my remit has now been extended and I work very closely with the Crisis Resolution Home Treatment Team which is based at Bronllys Hospital. Staff in this team support people to remain at home, and when people are discharged from their care they can be signposted to me for further support.

How was the need for your post identified?

Colleagues at Mid Powys Mind originally identified a need through speaking to staff at Felindre Ward and the Crisis Home Treatment Team. They then worked on a funding bid and were pleased to receive an award from the Lloyds Bank Foundation to fund a 3 year project.

Key to my role is my link with Mid Powys Mind. Mind offers a comprehensive service with many different facets, and I can help people understand the service and access the right area. People might just sign up for counselling or go to the art group once a week. It’s whatever works for them. More often than not it puts routine back in to their lives plus it gives them the opportunity to spend time with others who understand.

I can also signpost people to Tim Skelcher, our 1:1 Recovery Worker. 

You mentioned isolation, what are some other typical difficulties that people face upon leaving hospital?

Yes, isolation is a key factor as well as low confidence and, of course, stigma. Living in rural areas is not only a contributing factor to isolation but can make someone feel that all the locals have an idea of what has been going on for them and although things are improving around awareness there still is a certain amount of stigma surrounding mental health issues.

Returning home from hospital can be daunting for patients as it can be a reminder of how unwell they were before their admittance to hospital. Properties have been left and the environment can be reflective of how unwell someone was. So, practical help in sorting and organising can be really helpful. There can also be a backlog of mail that needs attending to. This can be stressful depending on what it is.

How long does your support last?

I work with people for up to eight weeks following their discharge. However, if I feel they need further support I can request an additional four weeks. It can take a long time to get there sometimes.

I visit Felindre Ward regularly so that people know who I am and generally have a chat with the patients. There is not enough talking going on. Interpersonal skills are so important to people’s recovery. When I start working with a patient I often find that they just want to have a good chat.

How do people stay safe, well and independent once the reablement support has finished?

Some clients may already be in receipt of additional support via the Community Mental Health Team and other care organisations. However, as part of my post it is important to try to engage people with the service of Mid Powys Mind and introduce/support them to access possibly outreach groups and many other activities that Mind has to offer.

Tell us how your work fits in with that of other voluntary sector groups

At Mind we have been working hard to create better working relationships with partner organisations that can offer a specialist service to cater for a client’s specific needs. For example - drug and alcohol support, housing and tenancy. Also, doing something meaningful with their time when further along on their recovery journey can play a very valuable role, so volunteering themselves could be an option.

What are some of the hardest things about working on this project?
I suppose one of the hardest things about this job is that time is limited. During my time with a client I can develop a good working relationship and in order to do this there is a certain amount of trust and understanding realised. It is hard when our time comes to an end for them and all clients so far have said they wished it could have been for longer.

The nice things about working on the project?

The nice part of this post is, of course, seeing clients develop and their confidence build and an ability to push their boundaries and try new things.

Any other recent developments at Mid Powys Mind you can update us on?

We are developing a youth peer support group (18 – 25 year olds) which meets weekly on Tuesdays, 1 – 3pm, in the Training Room at the Resource Centre. It is great to be able to put young people in touch with their peer group and signpost them to other services that can be useful to them. We’re planning to work again with Owen Griffkin later in the Spring with more Havin’ A Laugh workshops. And a professional animator will be coming in to bring people from different generations together and interpret their stories using animation, so we’re very much looking forward to that. 

Many thanks to Mandy for telling us about the Reablement Service at Mid Powys Mind. You can contact Mandy by emailing re-able@midpowysmind.org.uk or ringing 01597 824411.

North Powys Crisis Resolution Home Treatment Team

I first wrote about the introduction of a Crisis Resolution Home Treatment Team for North Powys (Montgomeryshire) in February 2013 (Home Treatment Team for the North) when Mike Shone unveiled the plans for the new team. Earlier this month I met with the team’s manager, Graham Batha, and asked him for an update about the service.

Tell us a bit about your background

I am a registered mental health nurse, and have been registered in this profession for approximately 10 years. I trained at the University of Central Lancashire, and then worked in Preston in an acute inpatient setting before moving to the Preston home treatment team. I later went on to work within the Wrexham home treatment team before moving to this post as the team manager for the Crisis Resolution Home Treatment Team in April 2013. My professional interests include service user involvement in the development of services, and professional education for students.

Tell us more about the service

The CRHT in North Powys opened in May 2013. To date we have received 419 referrals into the team, and our service is open 7 days a week, from 9am to 9pm Monday to Friday, and 11am to 7pm at weekends and Bank Holidays. The objective of the team is to provide an equal alternative to inpatient care, and to facilitate early discharge from hospital when it is safe to do so.

What staff roles do you have on the team?

The team consists of one team manager, one team secretary, one health care support worker and six registered nurses. The team is also having an additional 3 members of staff in the future. The team is also supported by a dedicated Consultant Psychiatrist.

Who can refer people for the CRHT service?

The Community Mental Health Team can refer people into our service, during the hours of 9am to 5pm. Out of hours, the CRHT does accept referrals from ShropDoc, which is the out of hours GP service.

Can people of all ages be referred?

We look after people aged 18 or over with a functional* illness.

What happens if someone experiences a crisis outside of your usual hours?

It can be useful to write a contingency plan with your care coordinator (if you have one), which can be used to highlight what needs to happen in an emergency. I would suggest that you contact your on call GP or in an emergency attend your local Accident and Emergency Department.

What is the nature of the service provided by a Crisis Resolution Home Treatment Team?

The CRHT is a short term but intensive service. The team visits service users on a frequent basis, up to twice a day, providing the same service as you would receive in hospital. When someone is referred into the CRHT team, the team will arrange an assessment as soon as possible. The team will then develop a care and treatment plan with that person, with the aim of supporting and aiding recovery. 

How do you promote a person’s recovery?

Twice a week, the whole team meets in a confidential environment to discuss each person that the CRHT is caring for. This allows the team to do its very best for the people we care for, and to support recovery in a timely manner. People who have used our service have been positive about their experience with us. The team does share the entire CRHT caseload, and people who do use our service can see all members of the team.

As a relatively new service in North Powys, how has the CRHT impacted on provision of mental health services generally?

The CRHT has had huge benefits in supporting those who really don’t want to go into hospital, and would rather stay at home. The team does, however, understand that sometimes hospital is necessary, and the CRHT will try to facilitate an early discharge with our support at the earliest opportunity when it is safe to do so.

Are there any specific needs that can be well-addressed by the CRHT?

The CRHT can help with practical issues such as housing etc, and will do all they can to ensure carers are supported.

Do you refer people on to other services?

When someone has recovered in the CRHT, their care is either referred on to additional mental health services or another appropriate service, or their care is handed back to the GP. In all cases the CRHT writes to the GP to ensure that the GP is aware of our intervention and any changes we may have made to the person’s care or treatment.

What are the challenges for a CRHT in a large rural area like North Powys?

The distance of travel that is required within this area is a challenge for the team, but it does not cause us too many problems once you become familiar with the area.

What are the most rewarding aspects of the work you do?

For me it is rewarding to see people recover at home, within a familiar setting, as opposed to a hospital setting. I feel that you are able to work with people more creatively and independently at home, as hospital can sometimes be restrictive.

How would you like to see mental health services developing in North Powys in the next few years?

From the view of the CRHT we would like to help and support more people to recover at home. We understand that hospital admissions will always be needed at times, but if we can reduce the stress of going into hospital for the client and their family, this may limit the amount of time it takes to recover.

Many thanks to Graham for the update. If you have any queries relating to the Crisis Resolution Home Treatment Team in North Powys, you can comment below.

*This term is defined online on an NHS jargon-busting website: "A term for any mental illness in which there is no evidence of organic disturbance (as there is with dementia) even though physical performance is impaired". 

Mental Health (Wales) Measure – how is it measuring up?

Late on Tuesday afternoon this week I tuned in to the live debate on Improving mental health and wellbeing in the Welsh Assembly’s debating chamber in the Senedd. (You can watch archive video of the debate here 2hr 52min in or read the plenary notes here, at 16.21). In the debate, Assembly Minister Janet Finch-Saunders commented:

Today’s debate on mental health looks at an issue that can affect any member of our society, from the very wealthy to those living in poverty, male or female, young or old. Our mental health is not static and it certainly does not discriminate. Those who have been well all of their lives can suddenly find that a turn of events or a change in circumstances can affect their own mental health wellbeing. It can show itself in a variety of manners, from depression or mild anxiety to post-traumatic stress disorder and/or severe psychotic problems. Minister, I have to say that probably one of the hardest jobs for me as an Assembly Member has been when someone has presented and I find them, quite literally, crying out for help, for support, and yet feeling, you know, that nothing can be done.

Health & Social Services Minister Mark Drakeford introduced the motion, which proposed that the National Assembly for Wales notes Welsh Government action to improve mental health and wellbeing in Wales. He said:

Here in Wales……. change is happening, and it is making a significant and positive difference for those whose lives are affected by mental health problems. The basis for all this is, of course, the Mental Health (Wales) Measure 2010, the Assembly’s groundbreaking legislation.

The Mental Health Measure, which became law in 2010, introduced legislation around mental health for people in Wales which is quite different to that in the rest of the UK. We highlighted 10 interesting facts about the Mental Health Measure in October 2012 and provided further information, including videos, on our website here.

But is it working?

That question is being asked both formally and informally in Powys (and all around Wales) right now. People who have been in contact with services, those close to them, and those providing the services, are being surveyed, are meeting in focus groups, and sometimes contacting politicians such as Assembly Minister Kirsty Williams to represent their views in the Senedd debates (including this one, see 17.09 in, for an update on Brecon).

We thought we would write about elements of this review process on the blog over the coming months to highlight some of the issues that are coming to the fore.

Earlier this year, in April, the Welsh Government published the findings of a review of progress made so far against the aims of the Measure as part of an early Scoping Study carried out by Opinion Research Services (conducting Research to support the Duty to review the Mental Health (Wales) Measure 2010). With regard to Care and Treatment Plans (for people receiving secondary mental health services such as seeing a psychiatrist or community psychiatric nurse) the report highlighted that: Many consultees argued that the Measure persists with a medical model of care which in practice is neither recovery nor outcome focused and which takes little account of the social care needs of service users. To make the recovery process work as embodied in the Measure, there is a need to take positive risks with service users by allowing them to lead the process. However, this requires a complete change of culture.

The Royal College of Psychiatrists had already conducted an independent review looking at the impact of the Measure from the psychiatrists’ point of view, publishing the results of their findings in late 2013. 48.5% of respondents (out of 121 – a 20% response rate for the survey overall) said they noticed a negative change in the care given to patients since the Measure was implemented. They pointed out issues including: increased workload but reduced patient care, potential risks of patients slipping through the net, early discharge of patients, and concerns regarding legal implications of increased bureaucracy.

My colleague Freda Lacey has recently been involved in some local focus group sessions in Newtown and Brecon where people have looked at their experience of changes in provision of mental health services since the Measure became law. This research is again being carried out by Opinion Research Services with Freda’s support and a short report on the focus groups will be available soon.

In the meantime, have you been in contact with mental health services? Perhaps you have attended a GP surgery and tried to access counselling via your Local Primary Mental Health Support Services (LPMHSS)? Or you may have been referred to see a Community Psychiatric Nurse who works as part of a Community Mental Health Team? Do you understand what the Measure means to you, and have you any feedback about the way it’s working? Let us know what you think by commenting below.

Introducing Tim Skelcher of Hafal

Tim Skelcher is a name familiar to us as he was previously a DIY Futures co-ordinator working here at PAVO. Since May this year Tim has worked for the Powys Seibiant Family Support Service for Hafal in Powys, and we talked to him just as he was about to launch a new carers' group for Newtown.

Tell us about your new role

My new role with Hafal is mostly about supporting carers of people with a mental illness in Powys, through both one to one support and through mutual support through carer groups. The service provides carers with news, information and advice; as well as providing short breaks for carers through providing activity based support for those they care for, along with the opportunity to focus on recovery using goals set with either their Care and Treatment Plan or Hafal’s Recovery Programme. The other aspect of my role is representing Hafal across Powys at events and meetings.

How is it going so far?

I think it’s going well. I’ve been busy introducing myself to people who use the service, as well as to lots of agencies around Powys. I’m also enjoying becoming part of the Hafal team, and learning about what makes them so effective in Wales.

What are your aims for Hafal in Powys?

Broadly my aims are to provide support to people in Powys with mental health issues and their carers, and to help them to have their voices heard. I’d like there to be more carer groups focusing on mental health throughout Powys, as there is only currently one Hafal group which is in Brecon. I will be working towards getting one set up again in Newtown as a priority, and will follow that with other groups. I’m also working towards making the Family Support Service cover Powys more evenly, as historically it was based in south Powys, with more support being given in the south.

What do you bring to your new role from your DIY Futures experience?

DIY Futures was where I learned about Recovery. I gained a strong belief in people who feel stuck being able to take control of their lives, make changes and get the lives they want. I’ve taken this with me to Hafal, where these beliefs are shared.

Tell us about some of the highs and lows working in the field of mental health

For me the highs are mostly about seeing people make changes, that before they only hoped and dreamed were possible. Almost without exception these have been achieved by a series of small steps. Also I think it’s inspiring when people develop services to help themselves and others facing similar issues, or when they influence change in services. The lows are simply when people aren’t listened to, or aren’t valued.

Have you been inside that famous Hafal VW campervan yet and what did you think?

Yes, I was at the Royal Welsh Show with Hafal recently, and the campervan was there. It really worked to draw people to Hafal’s stall, and gave us the chance to talk to people about mental health issues who, without the campervan, we may not have reached.

Thank you Tim! The first Newtown carers' group meeting which Tim referred to takes place on Wednesday 25 September 2013, 2 - 4pm, at Ponthafren, Longbridge Street, Newtown, SY16 2DY.

You can contact Tim for further information about the new group in Newtown, or with any other queries about his new role and the work of Hafal, by ringing 07875 373525 or emailing: powys@hafal.org