Reaching into schools – Powys Child & Adolescent Mental Health Services (CAMHS)

Cyrraedd ysgolion – Gwasanaethau Iechyd Meddwl Plant a’r Glasoed (CAMHS) 

Gail, Steve & Tor of the CAMHS Schools In-reach Team | Gail, Steve a Tor o dîm Gwasanaeth Allgymorth CAMHS Powys

by | gan Gail Morris

Powys CAMHS Schools In-Reach Team Lead 
Arweinydd Tîm Mewngymorth Ysgolion Powys CAMHS 

The Powys CAMHS (Child and Adolescent Mental Health Services) School In-Reach Service was developed following Welsh Government direction after several reports highlighted concerns that pupil mental health and wellbeing was deteriorating across Wales. It followed on from the evaluation of a pilot undertaken by the Welsh Government in 2021, where an assigned practitioner offered consultation and training relating to emotional health and wellbeing.

“There was evidence before the Child and Adolescent Mental Health Services (CAMHS) In-Reach to Schools Pilot programme that mental health difficulties, such as feeling low, had increased in Wales, for example:

• The proportion of 15 year old boys reporting feeling low more than once a week increased from less than 10 per cent in 2009 to 15 per cent in 2014; and
• The proportion of 15 year old girls reporting feeling low more than once a week increased from less than 22 per cent in 2009 to 30 per cent in 2014 (Public Health Wales, 2016).”

Evaluation of the Child and Adolescent Mental Health Service (CAMHs) In-Reach to Schools Pilot Programme: Final Report

Datblygwyd Gwasanaeth Mewngymorth i Ysgolion CAMHS Powys (Gwasanaethau Iechyd Meddwl Plant a’r Glasoed) o gyfarwyddyd gan Lywodraeth Cymru ar ôl i sawl adroddiad amlygu pryderon bod iechyd meddwl a lles disgyblion yn dirywio ledled Cymru. Roedd yn dilyn ymlaen o werthusiad o gynllun peilot a gynhaliwyd gan Lywodraeth Cymru yn 2021, lle cynigiodd ymarferydd penodedig ymgynghoriad a hyfforddiant yn ymwneud ag iechyd a lles emosiynol.

“Roedd tystiolaeth gan gyn rhaglen Beilot Mewngymorth i Ysgolion Gwasanaethau Iechyd Meddwl Plant a’r Glasoed (CAMHS) fod anawsterau iechyd meddwl, megis teimlo’n isel, wedi cynyddu yng Nghymru, er enghraifft:

• Roedd cyfran y bechgyn 15 oed sy'n dweud eu bod yn teimlo'n isel fwy nag unwaith yr wythnos wedi cynyddu o lai na 10 y cant yn 2009 i 15 y cant yn 2014; a
• Roedd cyfran y merched 15 oed a nododd eu bod yn teimlo'n isel fwy nag unwaith yr wythnos wedi cynyddu o lai na 22 y cant yn 2009 i 30 y cant yn 2014 (Iechyd Cyhoeddus Cymru, 2016)."

Gwerthusiad o Raglen Beilot Mewngymorth y Gwasanaethau Iechyd Meddwl Plant a’r Glasoed (CAMHS) i Ysgolion: Adroddiad Terfynol

The pilot was undertaken between 2018 - 2020. During this time involvement relating to staff wellbeing was also offered, but on evaluation it was identified this was best delivered in a corporate response, therefore provided by the employer. Like many new and existing initiatives, the Covid-19 pandemic affected the delivery across all of Wales of the pilot service, and how it was evaluated. Schools in South Powys were involved in the pilot.

The Welsh Government’s final evaluation was completed in 2021 and it was decided that services would be rolled out across all health boards in Wales.

“Evidence suggests that (the pilot) has made important contributions to improving staff skills and confidence; access to specialist advice, liaison and consultation; and to improving staff mental health and well-being, which all support Whole-School Approaches to Mental Health and Well-being (Welsh Government, 2021)”.

Evaluation of the Child & Adolescent Mental Health Service (CAMHs) In-Reach to Schools Pilot Programme: Final Report

Cafodd y peilot ei gynnal rhwng 2018 - 2020. Yn ystod y cyfnod hwn cynigiwyd ymwneud â lles staff hefyd, ond ar werthuso nodwyd mai'r ffordd orau i gyflwyno hynny oedd mewn ymateb corfforaethol, wedi’i ddarparu gan y cyflogwr. Fel llawer o fentrau newydd a rhai cyfredol, effeithiodd pandemig Covid-19 ar y ddarpariaeth ym mhob rhan o Gymru lle darparwyd y gwasanaeth peilot, a hefyd sut y cafodd ei werthuso. Roedd ysgolion yn Ne Powys yn rhan o'r cynllun peilot.

Cwblhawyd gwerthusiad terfynol Llywodraeth Cymru yn 2021 a phenderfynwyd y byddai gwasanaethau'n cael eu cyflwyno ar draws holl fyrddau iechyd Cymru.

" Awgryma'r dystiolaeth fod (y peilot) wedi gwneud cyfraniadau pwysig at wella sgiliau a hyder staff; mynediad at gyngor, cyswllt ac ymgynghori arbenigol; ac i wella iechyd meddwl a lles staff, a fydd yn cefnogi Dulliau Ysgol Gyfan at Iechyd Meddwl a Llesiant (Llywodraeth Cymru, 2021)".

Gwerthusiad o Raglen Beilot Mewngymorth y Gwasanaethau Iechyd Meddwl Plant a’r Glasoed (CAMHS) i Ysgolion: Adroddiad Terfynol

Powys CAMHS Schools In-Reach Service | Tîm Mewngymorth Ysgolion Powys CAMHS

Since March 2022 the Powys CAMHS In-Reach Service has been in a period of development, which has included recruitment, staff training, development of a service leaflet, procedures and processes, and raising awareness within internal and external agencies.

The CAMHS Schools-In Reach team at Powys Teaching Health Board | Tîm Gwasanaeth Allgymorth CAMHS Powys

There were 12 recommendations made in the Final Evaluation of the pilot by the Welsh Government 2021. These have been benchmarked with external partners to ascertain and initially position and identify where the focus of priorities should be. This has provided a reassuring position for the initial assessment.

The new service is aligned to other CAMHS services and is designed to be an early identification and intervention service, providing staff in school with the skills to identify and respond timely to issues in a Whole School Approach response. This means that children and young people are supported with their emotional health and wellbeing by someone who knows them.

There is a Task and Finish Group involved in developing a Standard Operational Procedure relating to the nature and scope of the service, involving internal and external key stakeholders. Practitioners have been contacting schools to which they are assigned, and scoping has occurred with schools to understand what their existing knowledge is of the service, and what their identified needs relating to emotional health and wellbeing are in school that can be supported by the Powys CAMHS School In-Reach Service.

Ers mis Mawrth 2022 mae Gwasanaeth Mewngymorth Powys CAMHS wedi bod yn cymryd rhan mewn cyfnod o ddatblygu, sydd wedi cynnwys recriwtio, hyfforddi staff, datblygu taflen wasanaeth, gweithdrefnau a phrosesau, a chodi ymwybyddiaeth o fewn asiantaethau mewnol ac allanol.

Cafodd 12 o argymhellion eu gwneud yng Ngwerthusiad Terfynol y peilot gan Lywodraeth Cymru 2021. Mae'r rhain wedi'u meincnodi gyda phartneriaid allanol i ganfod a hefyd i ddechrau pennu a nodi lle y dylai ffocws y blaenoriaethau fod. Mae hyn wedi rhoi lle calonogol i'r asesiad cychwynnol.

Mae'r gwasanaeth newydd yn cyd-fynd â gwasanaethau CAMHS eraill, a'i fwriad yw bod yn wasanaeth adnabod ac ymyrraeth gynnar, gan roi'r sgiliau i staff yn yr ysgol nodi ac ymateb yn amserol i faterion mewn ymateb Dull Ysgol Gyfan. Mae hyn yn golygu bod plant a phobl ifanc yn cael eu cefnogi gyda'u hiechyd a'u lles emosiynol gan rywun sy'n eu hadnabod.

Mae Grŵp Gorchwyl a Gorffen yn rhan o'r gwaith o ddatblygu Gweithdrefn Weithredol Safonol yn ymwneud â natur a chwmpas y gwasanaeth, sy'n cynnwys rhanddeiliaid allweddol mewnol ac allanol. Mae ymarferwyr wedi bod yn cysylltu ag ysgolion y maent yn cael eu neilltuo iddynt, ac mae ymarferion cwmpasu wedi digwydd gydag ysgolion i ddeall beth yw eu gwybodaeth bresennol am y gwasanaeth, a'r hyn y mae eu hanghenion a nodwyd yn ymwneud ag iechyd a lles emosiynol yn yr ysgol y gellir eu cefnogi gan Wasanaeth Mewngymorth Ysgolion Powys CAMHS.

Support for children and young people | Cymorth i blant a phobl ifanc

If a child or young person is considered in need of support the school makes a referral which is responded to in 5 working days. The consultation should take place within 10 working days. Consultation can be with identity shared, with consent from the parents/young person, or anonymously if not.

All schools have been assigned a practitioner and independent schools in Powys have also been made aware of the service. Staff training relates to Youth Mental Health First Aid, which staff in the team are trained to deliver virtually, and colleagues in Primary Mental Health are trained to deliver face to face. All training can be booked on Eventbrite. 

Furthermore, the team are responding to themes and trends and are developing packages for both school staff and children and young people; these include some existing resources involving resilience and anxiety, and new ones that have been developed including - eating disorders, exam stress, LGBT, self-harm, social media and resilience.

Os ystyrir bod plentyn neu berson ifanc angen cymorth, mae'r ysgol yn gwneud atgyfeiriad a ymatebir iddo mewn 5 niwrnod gwaith. Dylai'r ymgynghoriad gael ei gynnal o fewn 10 niwrnod gwaith. Gall ymgynghoriad gael ei gynnig wrth rannu manylion adnabod gyda chaniatâd y rhieni/person ifanc, neu os na yn ddienw.

Mae ymarferydd wedi’i neilltuo i bob ysgol ac mae ysgolion annibynnol ym Mhowys hefyd wedi cael gwybod am y gwasanaeth. Mae hyfforddiant staff yn ymwneud â Chymorth Cyntaf Iechyd Meddwl Ieuenctid, pa staff yn y tîm sydd wedi'u hyfforddi i'w darparu'n rhithiol, ac mae cydweithwyr mewn Iechyd Meddwl Sylfaenol yn cael eu hyfforddi i ddarparu wyneb yn wyneb. Gellir archebu'r holl hyfforddiant ar Eventbrite. 

Yn ogystal, mae'r tîm yn ymateb i themâu a thueddiadau ac yn datblygu pecynnau ar gyfer staff ysgolion a phlant a phobl ifanc; mae'r rhain yn cynnwys rhai adnoddau cyfredol sy'n ymwneud â gwytnwch a gofid, a rhai newydd sydd wedi eu datblygu gan gynnwys - anhwylderau bwyta, straen arholiadau, LHDT, hunan-niweidio, cyfryngau cymdeithasol a gwytnwch.

Gail and Steve at the Royal Welsh Show 2022 | Gail a Steve yn Sioe Frenhinol Cymru 2022

Partnership working | Gweithio mewn partneriaeth

The team are also represented on subgroups of the Powys Emotional Workstream (which contributes towards supporting good emotional health and wellbeing for Children and Young people across Powys) platforms, including exam stress, bereavement, and peer support, and work regularly with partners from health, education, social care, Youth Services and the voluntary sector.

We support external partners with issues of significance to support children, young people and staff in school. Initiatives such as the wellbeing tent at the Royal Welsh Show support and promote wellbeing with partners.

Cynrychiolir y tîm hefyd ar is-grwpiau Llif Gwaith Emosiynol Powys (sy'n cyfrannu at gefnogi iechyd a lles emosiynol da i Blant a Phobl Ifanc ar draws Powys), gan gynnwys straen arholiadau, profedigaeth, a chefnogaeth gan gyfoedion, ac maent yn gweithio'n rheolaidd gyda phartneriaid o iechyd, addysg, Gofal Cymdeithasol, Gwasanaethau Ieuenctid a'r sector gwirfoddol.

Rydym yn cefnogi partneriaid allanol sydd â phroblemau o arwyddocâd i gefnogi plant, pobl ifanc a staff yn yr ysgol. Mae mentrau fel y babell les yn y Sioe Frenhinol yn cefnogi ac yn hybu lles gyda phartneriaid.

The Powys CAMHS School In-Reach team | Tîm Gwasanaeth Allgymorth CAMHS Powys

The team is currently staffed with a team leader and 3 full-time equivalent posts, whilst an administrator post is currently being advertised and shortly a psychology post. There are plans to develop the team further with additional support roles.

This team has the potential to develop processes in schools to empower and enable staff to identify, in an early intervention approach, children and young people who may be experiencing issues with their emotional health and wellbeing. They are in a privileged position to undertake this. As the staffing complement in the team is built upon, this may give opportunity for the scope of the service to develop so that there is face to face support offered to children and young people, in an early intervention response.

You can read the full Evaluation of the pilot project HERE.

Ar hyn o bryd mae'r tîm yn cael ei staffio gan arweinydd tîm a 3 swydd gyfatebol llawn amser, tra bod swydd gweinyddwr yn cael ei hysbysebu ar hyn o bryd a chyn bo hir swydd seicoleg hefyd. Mae cynlluniau ar y gweill i ddatblygu'r tîm ymhellach gyda rolau cymorth ychwanegol.

Mae gan y tîm hwn y potensial i ddatblygu prosesau mewn ysgolion i rymuso a galluogi staff i adnabod, a defnyddio dull ymyrraeth gynnar, gyda phlant a phobl ifanc a allai fod yn dioddef problemau gyda'u hiechyd a'u lles emosiynol. Maent mewn sefyllfa freintiedig i ymgymryd â hyn. Wrth i'r gwaith o adeiladu tim o staff ddatblygu, allai hyn roi cyfle i sgôp y gwasanaeth ddatblygu fel bod cefnogaeth wyneb yn wyneb yn cael ei gynnig i blant a phobl ifanc, a hynny fel ymateb ymyrraeth gynnar.

Gallwch ddarllen gwerthusiad llawn y prosiect peilot YMA.

Many thanks to Gail for telling us more about this excellent initiative to support the mental health and wellbeing of children and young people in Powys. 

If you want to find out more you can email: Gail.Morris4@wales.nhs.uk

Find out more about the Child & Adolescent Mental Health Service provided by 

Powys Teaching Health Board.

Diolch yn fawr i Gail am ddweud mwy wrthym am y fenter ardderchog hon i gefnogi iechyd meddwl a lles plant a phobl ifanc ym Mhowys. 

Os ydych chi eisiau darganfod mwy, gallwch e-bostio: Gail.Morris4@wales.nhs.uk

Darganfod mwy am y Gwasanaeth Iechyd Meddwl Plant a’r Glasoed a ddarperir gan Fwrdd Iechyd Addysgu Powys.

Eating disorders' services review in Wales

by guest author Helen Missen

Powys resident Helen Missen, a passionate advocate and voice in Wales for change in mental health services, particularly those provided to people experiencing eating disorders, has been closely involved on the panel for the recent Welsh Government Eating Disorders’ Review. She tells us more about it. 

Eating disorders continue to have the highest mortality rate of any psychiatric diagnosis, across the world. They are often thought of as difficult to treat, though with early intervention, evidence shows a good chance of recovery. 

In Wales, and especially Powys, early intervention with specialist provision is still underwhelming. After my daughter became ill with Anorexia nervosa in 2009, I realised there was an urgent need for change. As well as a petition to the Welsh Government, I started to learn as much as I could about eating disorders and services, in Powys, Wales, the UK, and internationally.

When you, or a loved one, has something as complex as an eating disorder, the frustration of constantly going to somewhere like Child & Adolescent Mental Health Services (CAMHS), or adult services, where a couple of days of training does not make the staff experts, is demoralising.

It’s a bit like taking someone with a heart attack constantly to the GP and them saying – "I’ve read that in the book, I know this is what you’re supposed to do, but I don’t have any of the skills to do it."

Generally, a referral to the specialist is the norm in physical health. In mental health, a couple of training sessions deems a clinical provider a specialist. That, for parents and carers, and those with a diagnosis, is very frustrating. As well as dangerous.

The 2009 Framework for Eating Disorders was established by the Welsh Government on behalf of services. It was deemed at that time, that there was too little specialist input for eating disorders in adult services. CAMHS were, and are still thought to have enough generic help, something that does need to be changed.

Mental health eating disorder services are tiered from Level 1 - GP / school nurse / health visitor, to Level 4 - inpatient services. As a result of the framework four specialist adult eating disorder teams were set up at tier 3 level across Wales – one in the North and three in South Wales. Powys is covered by both the North and South teams at the moment. £1 million pounds recurring was given to those four teams, which obviously isn’t a great amount.

The four teams are run by psychologists and specialist trained nurses, with a couple of psychiatrists overseeing CAMHS but not necessarily in adult services. Clearly still underfunded, and with too few specialist staff at tiers 1 & 2, the strain on staff and patients continues.

My involvement for change began when I submitted a petition in 2010. The petition called for equal funding for CAMHS provision as there was for adult services.

It is well known that eating disorders generally start in the teenage years, around puberty. Although increasingly they are being diagnosed earlier and occasionally they may not present until later in life.

That petition is still running.

Unfortunately, services in Powys are very similar to how they were 10 years ago when the petition was first submitted, which is very frustrating for me. I have worked very closely with the eating disorder groups across Wales, and sit on Boards nationally and internationally. It grieves me that Powys hasn’t moved on in that time.

However, things are changing! 

In 2016 Public Health Wales was commissioned to do a refresh of the 2009 framework. Out of that came the recommendation that there should be a review of the Eating Disorder Framework.

“There now needs to be another major reconfiguration to move to align the service with the new emphasis on working seamlessly across agencies across Wales in the interests of promoting wellbeing and emphasising timely and effective early intervention. This is also to align with recommendations and directives in the NICE (National Institute for Health & Care) guidelines for eating disorders (2017), the Wellbeing of Future Generations (Wales) Act 2015 as well as multiple documents emanating from the Welsh Government in related arenas." 

The refresh came from Vaughan Gething, Minister for Health & Social Services, who commissioned Professor Jacinta Tan to do the review on behalf of the government. Professor Tan is a child and adolescent psychiatrist as well as an academic. She has a great heart for the children and families who suffer with eating disorder.

I was invited to be on the core team selected by Professor Tan, to help her gather information from the public. 

Unusually, for this type of large piece of government work, Professor Tan decided that to hear from the public first would provide the most important underpinning for the review. By holding four public workshops across Wales, one at each 'corner' of Wales, with a team of lay people who were representative of service users and carers facilitating the days, she was breaking new ground in the pure sense of providing the voice of the people.

The question Jacinta posed each day was: "what would be your ideal service?" which for any carer or person with an illness to be asked was quite monumental; a game changer in a way. Following the question, Professor Tan stood back and the day was run by the core team, with no input from clinicians. Never were the groups led in what to say... it was complete freedom. There were horror stories, and good stories.

Those workshops attracted carers, patients, people with lived experience, and a men’s group to hear partners’/ husbands’ / brothers’ perspectives. It was fascinating to listen to and be involved in.

At last people were given a voice.

By the end, all four workshops illicited very much the same pattern of what they wanted. The themes that ran throughout were: there are things that are really working well and amazing people doing the work, however, there are not enough specialists and very little specialist early intervention.

The underlying principles which people wanted:

1. Early detection and intervention. Helping people, like teachers and parents, to identify people who might have an eating disorder to have access to support and help.
2. Inclusivity. Never turn people away. Anyone in distress who thinks they are, or a loved one who might have an eating disorder, deserves a response.
3. To be person-centred. To have prompt expert help for those who might have eating disorders. Giving people what they need and trying as far as possible to deliver it to them where they are. To provide person-centred and holistic care for the person and the whole family.
4. Relationship based.
5. Recovery focussed.
6. Trauma informed.

There were 22 recommendations made by Jacinta which the government has taken on board. The entire 300 page paper has been sanctioned.

What does this mean for Powys?

The Health Secretary then wrote a letter to all the health boards in Wales, of which Powys Teaching Health Board is one, citing four recommendations to be upheld. Each health board had to give their strategies on how they will enforce the changes he requires:

1. Consider the review, provide feedback and identify where key incremental changes could be made to ensure that longer term service planning can align with the ambition of the review.
2. Work towards achieving the National Institute for Health & Care (NICE) standards for eating disorders within two years.
3. Develop plans to achieve a four week waiting time across adult and child services recommended in the review within two years.
4. Reconfigure services towards earlier intervention.

These submissions had to be on Mr Gething's desk by 8 November 2019.

One of the recommendations from the Health Minister is that the borders between health boards are to be grey areas. As it stands, there is too much financial segregation between health boards. If one health board has a service that may or would benefit patients in another health board, it is not necessarily shared across the invisible (to the public) borders. Therefore, the current system is not not bringing the best care to all members of the public.

Betsi Cadwaladr University Health Board in North Wales, for example, has an early intervention team (SPEED) created specifically for children and adolescents. It is a multi-disciplinary team that assesses and then treats people with very early stages of an eating disorder in that area. This approach ensures substantial financial savings for a health board, and years of suffering could be avoided for the person with a potential eating disorder.

The CAMHS team in Aneurin Bevan University Health Board in south east Wales is also setting up a new SPEED team.

Under the current system in Powys, children are not referred to this vitally important specialist team early enough in the onset of the illnesses. 

I would encourage the CAMHS representatives in Powys to dial into the SPEED teams quickly. To start working without borders.

Early intervention gets people out of an illness, and into recovery, avoiding the entrenched state which can then last a lifetime. It is known that with eating disorders there is always time for recovery.

I know personally, and also from hundreds of people across the world, that to ask for and demand the specialists, to not be frightened to question the system, does bring about better treatment and best practice.

It works both ways!

Don’t be too proud to ask for help from expert sources outside Powys, be you a clinician, carer, or someone living with an eating disorder. Until my daughter got sick I had very little understanding of eating disorders. As with many diagnoses: until you’ve lived it you don’t understand how life changing it can be.

I have become an expert by experience. Though, for all of the experience I now have on both sides of the proverbial table, I do wish I had never come across eating disorders.

Would I do it all again? Without a shadow of a doubt. Changing a system takes time.

A small stone makes a large ripple. 

Further help

F.E.A.S.T is a national organisation providing help and support to parents, carers and significant others in the lives of people who have eating disorders.

BEAT is the UK’s eating disorder charity.

Anorexia and bulimia care is a national UK eating disorder charity.

Mental health and children, young people & families

By guest author Lucy Taylor

Hello, my name is Lucy Taylor and I am the Children, Young People and Families Officer for Powys Association of Voluntary Organisations (PAVO). 

My role is to support the organisations across Powys that work with children, young people and their families. This involves acting as a conduit between the organisations, for example Action for Children which works with families, and the statutory partners, for example Powys County Council which, in some cases, commissions part of their work. I use a blog, Facebook and network meetings to keep the sector up to date and informed. 

Another part of my work is to support the Play Networks and to raise the awareness of play. We ask: are there enough opportunities, time and space for our children to play in Powys? It was working with organisations looking at what services are available, and what support is needed for children and young people, that the gap or thinning of services that support them when they are having low level mental health worries was noted, hence this blog post.

Listening to young people speaking at the Mental Health Today conference in Cardiff in May this year I was struck by their common sense approach to some of their issues. They knew that life was not always going to be plain sailing - that events or relationships could knock them back. They wanted to be self-reliant, not turn to medical interventions or for the medical community to medicalise their problems. They recognised that in helping and supporting friends through their low patch in life, they may put their own mental wellbeing and stability at risk. Their request – “A toolkit for life, not a bucket of sand to hide from it.”

Mental Health Today conference presentation

This is the issue and where some gaps in support appear. Everyone can experience a wobble in their wellbeing. But, with a few self-help tools, some supportive friends and community, the knowledge of where to go for help early on, we may all take a role in our and our community’s wellbeing, leaving the expertise of medical interventions to those whose condition requires it.

The Young Adult Peer Support Project (YAPS) which was run by Ponthafren Association as part of the One Powys Connecting Voices lottery-funded programme was really excellent. When it wound down recently as the funding came to an end none of the young people (age 16 – 25) involved with the project was happy to see it go. Peer support projects like these are extremely valuable, as the first port of call for a young person struggling with their emotional wellbeing is friends and family.

The Making Sense Report was produced in January 2016 as a response to the Together for Children and Young People programme. It had emerged that referrals to Children & Adolescent Mental Health Services across Wales had increased by over 100% between 2010 – 2014, and four organisations – Hafal, Mental Health Foundation, Bipolar UK and Diverse Cymru – joined together to find out why and consider what could be done to address the situation. Young people themselves, who had been in contact with CAMHS teams in Wales, reported on their health and wellbeing and called for “non-mental health professionals such as education staff, counselling services and youth groups to share responsibility for the emotional needs and development of young people”.

For children, young people and their families to have access to informal and non-medical support, we – the families and communities – need to be able to recognise when we, and our neighbours, need a bit of help. It is also crucial that we know how to source help in our particular locality. Information and connectivity is the key. The PAVO Community Connectors help people in Powys (aged 50+) and their families or carers, to access community-level services and activities, (tel: 01597 828 649) – and Powys People Direct “one number for children, adults and families for information and support services” (tel: 01597 827 666) can also help.

The third sector as a whole plays a huge role in providing services and opportunities for children and families in Powys. From the playgroups and play networks, guides, cadets and St John groups to sports clubs and arts organisations. Then there are the agencies offering more targeted support or drop ins. Think of Action for Children, Mid Powys and Brecon Mind or Ponthafren Association.

Powys Youth Service supports young people around their emotional wellbeing in youth clubs or at school. The service has recently noticed that where it used to work with pupils around exam stress, now stress is more general and anxiety about life and the future prevalent. Online counselling and advice is available via an organisation called Kooth (Xenzone) .

But what of families, education and skilling our young people for life? If “it takes a village to raise a child”, what part do we all play in ensuring the wellbeing of all the children? Can Google or YouTube really teach you everything? The ability to budget, know about nutrition, healthy eating and exercise, or how to cook from scratch? These are the life skills the young people want, alongside how to protect their mental wellbeing, perhaps using such techniques as yoga, meditation or mindfulness.

Would it surprise you to know that a walk in the park or taking time to walk and be around trees can also help? The Japanese call it “Tree Bathing” and have invested in public awareness of the benefits of being outdoors. 

PAVO staff are working with organisations from the mental health and children’s arenas, alongside green or outdoor providers, to look at how best we can work together and bolster our communities and families by making the most of the green resource we have on our doorstep. We will be meeting in the coming months to discuss the support we can all offer. For more information call 01597 822191 and speak to Lucy Taylor or Jane Cooke.

Why not take five minutes out from your busy day to walk in the fresh air, appreciate the sights and sounds of nature? Perhaps grab some friends and all walk together. Take the children to the park or share a picnic with other friends and families. It may not solve any problems but it can help soothe your mind and give you a place to start. Like eating elephants you can take life one bite at a time.

There is currently a Welsh Government consultation on: The Emotional and Mental Health of Children and Young People. If you, or someone you care for, has been in contact with Child and Adolescent Mental Health Services, then you can give feedback up until 29 September 2017.

The Children, Young People and Education Committee’s Inquiry will consider whether the ‘Together for Children and Young People Programme’ is on track to deliver the ‘step-change’ in CAMHS services that is needed. It will also consider how effective the programme has been in promoting the resilience of children and young people, including a focus on the role of education in preventing mental health problems. The Together for Children and Young People (T4CYP) programme is a multi-agency service improvement programme that is aiming to reshape, remodel and refocus the emotional and mental health services provided for children and young people in Wales.

Type 2 anorexia – my experience

This week's guest post is by a young person living in Mid Powys.

Perfectionistic, body dysmorphic, obsessive and depressive are accurate words to describe anorexia. Six months in a psychiatric hospital suffering from the disease has proved this beyond question. However, the experience also revealed to me two different manifestations of the disease - characterised by varying degrees of the traits above:

Type 1, where the sufferer has a severely distorted view of their body and therefore exercises and starves themselves in the pursuit of looking ‘normal’. This is what most people perceive anorexia to be about, but I (and others in hospital) didn’t identify fully with this and hence believe there’s a second type. 

Type 2, where an obsessive routine of eating and exercise develops in order to avoid irrational consequences despite perceiving oneself as normal (perhaps slightly overweight). Here, the consequences could revolve around any aspect of your life but mainly around weight gain where the goal is to be thin - better than normal. Hence, those who identify with the second type are likely more perfectionist, academic and hardworking. However, they’re probably more at risk (due to these underlying personality traits) as it’s probably more dangerous to act on self-perfection than on self-perception.

The obsessive, perfectionistic roots of type 2 affect many aspects of the disease making it clearly distinguishable from type 1. In type 2, food itself isn’t an issue, the calories are (hence half the hospital chose to have liquid supplements and the other half had food despite being equal in calorific intake). Exercise is also more of an issue in type 2 than type 1 as it becomes built into a rigid routine and must be done to relieve anxiety (as opposed to accelerate weight loss). Type 2 anorexics are also more likely to be deceptive and compete with other sufferers to be perfect in other people’s eyes rather than just in their own to become the ‘best’ anorexic they can be. In this respect access to online material and social media create a competitiveness which likely makes many people’s condition worse. Finally, in type 2, anorexia cannot be separated as an entity from the sufferer (hence getting to draw/name it isn’t effective despite working well for type 1 anorexics). This is because for them the disease takes advantage of their personality traits and becomes an extension of them.

We should use our understanding of each type of anorexia to personalise the otherwise universal treatment plans. Personalised medicine is a hot topic in modern medicine. Gene sequencing and editing has allowed us to choose the treatments which we know will work best on patients. Why not extend this to anorexia?

Of course, the line between the two groups is blurred, but there are many instances where placing me into one of these groups would’ve helped mine and other sufferers’ recovery. Catching it early will inevitably reduce the likelihood of the disease worsening but recognising when further intervention (from Child & Adolescent Mental Health Services to psychiatric hospitals) is necessary is just as important. Taking away the choice by involving professionals is often the only way people too far into the disease can recover and increase their weight enough to correct the depression and distorted thinking associated with anorexia. 

Also, the incentives for recovery are blocked by body image or compulsions for type 1 and 2 respectively. We could therefore target these blocks differently for each type. Classical conditioning is used to treat Obsessive Compulsive Disorder (OCD) and involves patients doing what it is that causes anxiety (or not doing it in the case of a ritual). After being in a better mentality to do so, I decided to try it. I went home over a weekend and didn’t sneak off and exercise at all. That weekend was the only time my weight dropped during my whole recovery. My anxieties were practically gone from this point onwards. 

Finally, the qualities associated with type 2 sufferers can be redirected from weight loss to something beneficial. For me, I became very academic which allowed me to preoccupy myself and give enough incentive to remain fully recovered. Incentive is the key to the cure. Access to mental health services is the key to prevention.

After sharing my thoughts on service provision I’d like to talk about what it’s like to have been a male anorexic. I imagine that you’ve pictured a female through reading this blog and hope that you’re somewhat surprised that the author, the sufferer, is male. I wasn’t at all surprised to be told I had anorexia - I knew about the disease and could tell things weren’t right especially after comments from almost everyone I knew expressing their concern. I have a female twin and understandably my mother has since admitted she was always conscious of the fact that she could become anorexic. These were probably unconscious thoughts felt by everyone around me - I wasn’t expected to become anorexic and hence I was allowed to get progressively worse without it crossing anyone’s mind. I’m sure that this allowed my mind set to change and my weight to drop enough that the anorexia had developed into something that couldn’t be solved without professional help.

Unfortunately, I was taken to the GP surgery twice and both times was told that my weight wasn’t low enough to cause major concern. I was, however, referred to CAMHS on the second occasion. To an anorexic this was like being told you’re not thin enough. Furthermore, the naivety of the doctors to accept all that I said (that I eat lunch and have snacks, only exercise every couple of days and am still sociable and happy) prevented them from assessing me on anything bar the weight-age percentile I was in.

As a boy my original motives were also different to those of girls. At 7 and a half stone, I was plump and had innocent comment from friends and family saying the same. I thought I should try and lose some weight and gain some muscle (as mentioned, the muscle gain I wanted was impossible for a 12 year old). I started with cutting out food and exercising more and liked the results so continued doing this to greater and greater extents. The weight loss and routine consumed me - I lost friends and my confidence, my work suffered, my hair began falling out, my skin flaked away, I was constantly cold and remember dreading the thought of standing or walking because of how faint they made me feel - this is certainly a mental and physical disease. 

Waiting almost a month for an appointment with CAMHS gave me the time to rapidly worsen. I was lucky to have an exceptional psychiatrist - the best of many I’ve had since. However, weekly appointments with her were of little benefit and my weight continued to drop. A paper cut in class one day caused me to faint and have a small seizure which prompted my removal from school and a two week bed rest. Another month of this saw little improvement - I didn’t want to get better. My family and I were becoming more and more depressed and with all of us finding life unbearable, I was taken to a psychiatric hospital where I was the only boy. 

By removing the choice of recovery, my weight rapidly gained and I began to see more clearly - food really is the ultimate medicine and choice is its antagonist. After six months I returned to school where everyone supported me through my last steps. It took almost a year of going at my own pace before simply wanting to be normal gave me the incentive to recover - I came off my meal plan, started socialising, working hard and enjoying life again. Once in the healthcare system being male didn’t affect anything, however - expect a man as you would a woman to develop an eating disorder and don’t shy away from talking to them about it. 

There’s a reason anorexia in males is becoming more common. Social media has recently become inundated with pictures and quotes encouraging men to love women with curves and promoting curves by redesigning children's characters (particularly Disney princesses and Barbie) to reflect more realistic figures. Unfortunately, there is no male equivalent. All I ever see are pictures of ripped and good-looking men, one even quoting “women like butts too”. This sends the message out that men must love overweight women but that men must have a knife-sharp jawline, a sculpted body and of course, a peachy bum to be considered equally attractive. Its reasons like this that Body Dysmorphic Disorder is becoming worryingly common especially in males. 

We need equality to favour all genders - encourage everyone to be happy with how they look as long it’s healthy. I’ve gained so much from my experiences and have helped many to overcome their problems but the horror of anorexia and how much of life it affects is only known by sufferers and their families. It’s not a route that social media should inadvertently encourage people to go down  - we’ve ensured this with women but I feel men are increasingly led along this path due to the lack of society expecting them to do so.

Postscript from our guest author:

On the last day of an eventful year, I need to say this. The expectation of men to be strong and brave - to be masculine - is quite literally killing people. It's this expectation that allowed me to fly under the radar when my mental health suffered and it's this expectation that has killed four silently suffering but definitely loved friends in the last month alone. We need to be so much more aware of the hurt that people around us are feeling and not hesitate to talk to them about it. It really can be just a few words, a quick check up or a smile that can break that depression and give someone reason to think about the future which is otherwise non existent in the mind of a depressive. Please, have a Happy New Year and make this your resolution so that in 2017, good people aren't hurt by their mental health.

Many thanks to our guest author for sharing his experiences of anorexia. There are several charities specialising in providing support for people with eating disorders. These include:

B-eat - the UK's eating disorder charity

Anorexia & Bulimia Care

Seed - eating disorder support service

Men get eating disorders too

If you know of others, let us know in the comments box below.

Tonic: surfing for mental health

Every now and again in our team we are lucky enough to meet up with our counterparts in other parts of Wales. Two weeks ago we travelled down to Carmarthen to the office of West Wales Action for Mental Health. We spent an enjoyable and extremely interesting day finding out about the many diverse and innovative projects the staff and volunteers are currently working on. Check out The Recovery Wall project on the organisation’s website, which is using digital media to promote recovery and wellbeing, and Mind Your Heart – a health promotion programme for people living with mental health problems…. not to mention the excellent work with veterans over the past couple of years, which should probably have a separate blog post all of its own – just keep watching this space!

And then there is Tonic – the surfing therapy project…. 

Shôn Devey, the Development Worker leading on Tonic, told us more. He started from a very personal viewpoint.

Ton is Welsh for wave. Staff here realised that they had this fantastic natural environment on their doorstep. Who doesn’t feel better when they go to the beach? Yet some people who live near a beach never go. I ride the waves for my own mental health and wellbeing. It was like a dream come true when Angie Darlington (the WWAMH director) asked me to develop this project.

Tonic was set up 4 years ago. People spend so much time in hideous rooms for their therapy sessions. We thought maybe they’d feel better for being in this great outdoor space. Add an activity as well and you have the extra health benefits of that. Put people into groups – and then you have social interaction. Isolation is a big problem for people locally.

At first people think – “I don’t think I can do this”. It’s a metaphor for other areas of their lives. But engaging with surfers is actually a cool activity. The moment participants enter the water they’re connected with the world’s oceans. It is like putting on a new skin (literally – in the form of a wetsuit). People are suddenly all equal – the teachers, volunteers, participants. We connect with marine mammals - there have been dolphins circling us in the water. Afterwards we’ve had participants volunteering to clean up the beach and engaging with the wider world. 

The programme is open to anyone with mental health problems, a carer of any kind, veterans, and those who’ve experience of substance misuse or alcohol addiction. The current age range is 11 – 72. We have a 72 year old woman who surfs through the winter along with a group of other women. They find that being tumbled and battered in the waves is good for their wellbeing. It’s a really constructive activity for carers and the cared for to take part in together. Children will come along with their parents because it’s “cool!”

All the kit is provided for the 6 week long programme which works out of beaches at Borth, Poppit and Newgale. Participants spend 2 hours in the water, with an hour preparing. So it’s an afternoon each week. Then afterwards we socialise together. We use a lot of volunteers in the water and have developed rigorous health and safety procedures. Volunteers help participants to see their success. Everyone has lots of fun. At the end of each course we have a BBQ and celebration.

People are “wide open” straight after the surfing session so there is a period when it is possible to work on things. We have links to surf therapy projects around the World. In South Africa, working with young people from the townships, after the surfing they run beach school and hold HIV/sexual health sessions. Ultimately we would like to offer a menu of options around engaging with the ocean environment, such as dolphin watching, footpath maintenance and beach clearing. 

This is our fourth season, and there has been a development pathway through the programme. Some participants go on to become project volunteers and then surf instructors. We have trained 12 instructors so far. But the project is not so much about the surfing as about spending time with people in the natural environment. And giving good care and attention to people is key.

It’s also important to help keep people in the water after the programme has finished. One of the volunteer surf teachers runs a Saturday club through the winter which anyone can join. And there is a virtual surf club on Facebook. We are also hoping to develop a physical space at Borth – more information coming soon!

WWAMH is working with Swansea University to evaluate the project. So far across a small sample of people it has been shown to have a significant effect upon people’s mental and physical wellbeing, to the extent that it sits alongside medication as a valid option. Some participants come off a hospital ward, they may be “zombied”, or over-medicated – and then they “wake up” with the first woosh of a wave. It is absolutely incredible. People talk about their new “healthy” addiction.

After tumbling in the waves one of the participants said: “I was brainwashed! I came and my mind was all crumpled and full of anxiety. It was as though someone took my brain out, cleaned it and put it back in my head.”

Tonic has been highly commended in the NHS Awards and is now beginning to be accepted as mainstream, with a 2 year service level agreement being set up with the Child & Adolescent Mental Health Service (CAMHS) team. The project is also in the process of being established as an independent charity with a board of trustees. Future development opportunities include weekend packages for groups – a sort of mental health tourism. Suddenly people really want to be a part of it!

Powys meets West Wales!

Back row: WWAMH - Lewis Phillips - IT Officer, Shon Devey & Charles Macmillan - Development Officers. 

Our team - Freda Lacey (Participation Officer), Jane Cooke (Interim Senior Officer Mental Health), Jackie Newey (Projects Officer) & Glynis Luke (Admin, Information & Communications Officer).

Front row: WWAMH - Marie Wright & Tim Teeling - Development Officers, Angie Darlington - Director, 

Jan Batty - Mind Your Heart programme Development Officer.

Shôn’s enthusiasm for the project is infectious. We all agreed it is an absolutely brilliant project, and wish we had the seaside here in Powys (though Borth is not that far away for some of us)! What kind of physical activity project would you be interested in here? Let us know.