Our Alternative Christmas

For the last few years our December team meeting has morphed into a pre-Christmas mini-binge – turkey and nut roast sandwiches, warmed mince pies, mulled grape juice…. And Havin’ a Laugh.

This year – in the spirit of recognising that Christmas isn’t always an easy time for some of us – we decided to try something completely different.

We thought about surfing at Borth… climbing to the source of the Severn… exploring the sculpture park at Lake Vyrnwy… or kayaking the rapids of the River Wye… In the end we went to Rock Park in Llandrindod Wells (home to a former spa centre established in the Victorian era) and spent 2 hours litter picking and leaf collecting. It was wet. A bit muddy. But also exhilarating. We laughed a lot. We learnt stuff. It was genuinely team building. And the best December team meeting ever.

Amongst other things, we discovered that the leaves of the park’s ginkgo tree contain ginkgolides, which could improve blood circulation to the brain …. And that a lithium well was discovered at Rock Park in 1906 by Mr Heighway… (it's housed in the shed in the photograph).

Afterwards over lunch we exchanged more ideas about how to go about creating the Christmas Festival Fringe at home on the Big Day itself…

Anne: wishing for a festival of light!

For me, Christmas is a trigger for feelings of anxiety, which starts several weeks before with worrying about buying presents that people will like. As a result, I tend to put it off, leaving it to the last minute, which then creates more stress. It’s hard not to get caught up in the commercialisation and put pressure on myself, which doesn’t come from family and friends. So I suppose my fantasy Christmas would have less emphasis on giving and receiving material gifts. Or I’d employ a personal shopper!

I’ve often considered creating spiritual rituals that are meaningful to me at this time of year. My fantasy Christmas might include being outside in nature (weather permitting!), making the most of the light in the day and a bonfire in the evening. One year, I went to Stonehenge at dawn on the Winter Solstice, and then to Avebury Stone Circle, as it felt important to mark the shortest day. I like the idea of a festival of light to counteract the long, dark, winter evenings; something that has a big impact on my mood at this time of year. If money was no object then I would go away somewhere warm and sunny in the winter to top up on vitamin D until the days start getting longer again.

Carla’s No Cooking Christmas!

In our family, we did away with slaving over a hot stove for days on end and have exchanged turkey and trimmings for deli platters and paper plates. Essentially, this means that shopping for Christmas food doesn’t involve battling crowds in the supermarket but does involve spending a leisurely afternoon browsing small independent shops or jamming a queue at a deli counter somewhere. The kids and I pick salamis and cold meats, sample different cheeses before buying, choose which items to splash out on for the special ‘treat’ items (stuffed baby peppers are my favourite) and only have to pop to a big store to buy the fancy paper plates and crackers. I set a budget before we go shopping and when it’s gone - it’s gone.

On Christmas day, everything is put out on the table on throw-away foil platters from the pound aisle, the oven goes on to heat the ‘bake at home’ bread and paper plates are handed out to whoever the guests are - this can change at any point throughout the day as people drift by to say Happy Christmas and have a drink or two!

We eat, we snooze, we drink, we eat again and then all plates are put in the bin, leftovers stuck in the fridge and the next day we can get back to ‘normal’ - or just do it all over again with new plates! No stress, no fuss, no waste, no turkey sandwiches/curry/soup and buying the food can suit even the tiniest of budgets. One year, I bought everything we wanted from our local supermarket on Christmas Eve and it came to about £20.

Christmas doesn’t have to be a chore nor does it have to be the same every year - this year our family are NOT ‘magicing’ our Christmas tree and may have to resort to more conventional methods - but that’s another blog post . . .

Jackie: Digging Christmas!

Ever since moving to our house in the Upper Severn Valley 20 years ago I have been a bit of a mad keen gardener… and tradition now has it that every Christmas Day involves gardening in some form or other. Depending on the weather this could be chipping parsnips out of frozen compost in a style not dissimilar to that used on an archaeological dig… rescuing a willow bean tripod from the top of an ash tree in a gale… or scraping snow off the polytunnel before the metal hoops crumple under the weight….

But the highlight of all Christmas Gardening Days past was the one where I found an old Victorian sixpence dated 1875 in the ground whilst digging out self-seeded holly trees. I would have rushed off to order a metal detector there and then (well in the Boxing Day sales anyway) except the ground all around was found to be full not of treasure but buried refuse – not exactly the Staffordshire Hoard – rather the site of some 1950s fly-tipping…half-bricks galore.

Christmas in our house is a time for planning the gardening season ahead. Full of hope. Anticipation. And some concerns… Will the heritage seed beetroots finally plump up…? The spring frosts stay at bay…? The million hungry rodents be herded up and dispatched by resident cats …? The recycled tin baths moisture retentive and slug-proof for carrots to thrive…? The elusive horse manure finally appear magically at the end of our drive…?

Whatever 2017 brings in the world outside my valley… I can’t wait to get my hands dirty again in the confines of my garden oasis. (If you fancy gardening and don’t have a patch of your own, there are community gardens all around Powys).

Jane: Fantasy Christmas meets Reality!

My fantasy Christmas would be one where I had actually got my act together and was well prepared! Each year I stubbornly refuse to even think about Christmas until December - and then I am surprised by how quickly it seems to arrive! We would book an enormous house so that all the extended family could come, everyone would get on well, there would be harmonious sharing of chores and all the various traditions would miraculously work together so that everyone felt that they had had a part in such a wonderful shared time - so that should show what a general fantasist I am!

I’ve never done anything that out of the ordinary at Christmas myself - last year I was proud of my daughter and husband who took a car-load of donations to the refugee camp in Calais and volunteered there for a few days in between Christmas and New Year.

On balance I think that having a time of coming together and sharing food, gifts and conviviality at the darkest point of the year is a good thing - and if you are a Christian then it’s a good thing to celebrate the birth of Christ too. There isn’t any easy way to balance that with the fact that for a lot of people it is also a very difficult time - I am inclined to think that the gross (to my mind) level of consumerism, the overcomplicating of it all and the relentless emphasis on the fun, party side of Christmas with no mainstream, non-religious acknowledgement of the importance of reflection and quiet thought as a component of the rest of the festive season adds to the sense of isolation and loneliness that some people feel at Christmas.

And finally...

These ideas and approaches may or may not work for you. But perhaps they could kickstart a different way of thinking about the traditional Christmas. And if you opt for the alternative approach, we would love to hear from you in the comments box below.

Most important of all, do something that makes you happy. And if you need extra help over the festive season – it’s out there. Wellness and Recovery Learning Centres around Powys are open at some point over Christmas and the New Year and would welcome your visit. Check their opening times on websites, details here. You can link to national helplines here.

If you need help urgently find information here.

Happy Christmas, whether Traditional or Alternative suits you best. And see you in 2017.

Photos feature Newtown's Christmas-themed town centre in December 2016

World Suicide Prevention Day 2015

Today is World Suicide Prevention Day across the globe. The theme in this 13th year of the Day is “Preventing Suicide: Reaching Out and Saving Lives.”

The issue of suicide is as relevant in Powys as it is anywhere else in the world. In speaking to police officers in the local Dyfed Powys force recently I was made aware that the incidence of attempted suicide and self-harm in the county has been rising over recent months. Police officers are often the first emergency services on the scene in crisis situations, along with those from Health. Here in our team we provide an Information Service, not a Crisis Helpline such as Samaritans or C.A.L.L.Helpline, but nevertheless we are still occasionally called or met by people who are extremely distressed and tell us that they want to kill themselves.

According to the Samaritans Suicide Statistics Report 2015: Male suicides in Wales rose by 23% between 2012 and 2013, and rates are significantly higher than those in England since 2010. The BBC wrote more about these statistics here.

The question has to be asked, why are more people feeling so desperate about the quality of their lives that they consider suicide? The Samaritans Report states: 'The causes of suicide are complex, and we need to encourage people to seek help before they reach a crisis point'.

It seems appropriate then, on World Suicide Prevention Day, to flag up some of the resources and services that are available to people at risk of suicide and those close to them. First, though, a bit about the organisation which established the Day originally.

The International Association for Suicide Prevention (IASP) was founded in 1960 and is: ‘dedicated to preventing suicidal behaviour, to alleviate its effects, and to provide a forum for academicians, mental health professionals, crisis workers, volunteers and suicide survivors’.

The President of IASP, Professor Ella Arensman, introduces us to World Suicide Prevention Day with the words: “Every year over 800,000 people die by suicide (around the world)…. We now know that for many people who survive a suicide their main intent was not to die but to have a different life. This important insight should encourage all of us to become more proactive, to reach out and to support people improving their quality of life.”

Resources

Samaritans provide a helpline 24 hours a day, 365 days a year. And you can find more about the local Brecon & Radnor branch here.

C.A.L.L. Helpline offers a confidential listening and support service . Anyone concerned about their own mental health or that of a relative or friend can access the service.

NHS Choices has a very useful webpage on Offering support to someone who’s feeling suicidal. It starts off: “One of the best things you can do if you think someone may be feeling suicidal is to encourage them to talk about their feelings and to listen to what they say”.

The charity Mind has a range of information on its website relating to suicide, including sections about Suicidal feelings and Creating a support plan to use if someone is feeling suicidal.

Author Matt Haig wrote a blog post last year about the time when he nearly killed himself aged 24. It’s called REASONS TO STAY ALIVE.

Survivors of Bereavement by Suicide is a self-help organisation which exists to meet the needs and break the isolation experienced by those bereaved by suicide.

The BBC has on online guide called How do we talk about teen suicide?

Further information

In July 2015 the Welsh Government published its Suicide and Self Harm Prevention Strategy for Wales 2015-2020 - Talk to me 2. There are 6 priority actions, including:

• The development and delivery of a Wales framework for the training of professionals, individuals who frequently come in to contact with people at risk of suicide and self harm, and the general public.
• To promote staff awareness and improve staff knowledge of where to go for help and support through workplaces.

Applied Suicide Intervention Skills Training (ASIST) is run occasionally in different parts of Wales. It is a 2 day skills building workshop which prepares caregivers of all kinds to provide suicide first aid interventions. There are courses in Blaenau Gwent and Torfaen in November 2015, February, May & August 2016.

If you are urgently looking for help and advice in Powys there is a summary of the main contacts on our Powys Mental Health website.

If you have further suggestions for help and support for people feeling suicidal, then please add in the comments box below.

Finally, there is further research being carried out which aims to understand more about suicide and what can be done to prevent it. If you are interested, find out more about The Quest Study, which has been commissioned by Samaritans and undertaken by psychology researchers at Middlesex University and the University of Westminster.

Advance Statements for Crisis Planning

by Janet Rogers and Derek Turner

Possibly for the first time in history, the new Mental Health Act Code of Practice (April 2015), for England, has included a section that puts a responsibility on Mental Health Practitioners to encourage ‘patients’ to set out their wishes in advance as ‘statements’ or ‘decisions’. While advance statements are not legally binding professionals are advised that they ‘should make all practical efforts to comply with these preferences and explain to patients why their preferences have not been met.’

Within the Code Advance Decisions relate to medical treatments and should be adhered to by practitioners whenever possible, whereas Advance Statements can be used to cover a wide range of factors that might affect the life of a person who experiences difficulties as a result of their mental health, and how other people, as a result, become involved in the person’s life. This article aims to explore the rational for writing an Advance Statement to assist Practitioners in supporting a person who might experience a mental health crisis at some point in the future. The history of psychiatry has been dominated by Practitioners who have tried to design interventions that can be used to control/manage/support/treat a person whose behaviour is deemed to be ‘insane’. It may seem to some pointless, or at best counter-intuitive, to ask someone who is ‘insane’ to plan their own crises, however with some 30 years or so of learning to listen to, and learning from, people planning their own mental health recovery journey, a realisation is slowly beginning to dawn that this is the only sane way forward. The early pioneers of recovery have not only engineered fulfilling lives for themselves but have given new insights that are now at the forefront of what is considered to be ‘best practice’.

The key to ‘recovery based practice’ for Practitioners is developing a capacity to think differently about ‘how’ to use hard earned skills and expertise. Perversely it has been the drive towards ‘evidence based practice’ that has embedded a culture that suggests that ‘what’ Practitioners do is important. Interestingly it has been the Police who, in becoming increasing dissatisfied with ‘what’ they have been doing, have become open to different ways of working that are more concerned with ‘how’ they engage with the person.

More often than not it is the Police who are the front line service when a person is in crisis. The Mental Health Act gives the Police powers to ‘arrest’ the person and ‘remove’ them to a ‘place of safety’ where they can be assessed by other Practitioners. In the past this has often meant that the person has been bundled into a Police van and transported to a Police Cell. The Triage Pilot, currently being run by Dyfed-Powys Police, has already shown that the numbers of people traumatised by such an experience can be dramatically reduced by engaging with the person and their particular circumstances. The Pilot includes a follow-up visit to each person and it is here that the potential for encouraging people to write and agree their Advance Statements could potentially reduce trauma even further.

Advance Statements can be very simple agreements or more complex arrangements. An example of a very simple statement was told to me recently by a lady who has been prone to panic attacks when out shopping. These are very distressing to her and worry people who are near her. Recently a member of the public called the Police and a female Community Constable arrived. The Constable was not fazed by the situation and encouraged the lady to go with her to a local café. With a cup of tea and a bit of a chat the panic subsided. The lady was then able to tell the Constable that if she had been ‘arrested’ and taken to a Police cell she might not have been able to go out shopping again for many months as she would be fearful that this might happen again. They agreed together that a note would be put on her file saying that going to a café and having a cup of tea and a chat was the best way to deal with a situation like this if it happened again in the future. In telling this story the lady was able to say that she now felt more confident going out shopping knowing that, if she had a panic attack and the Police were called, she would be treated in the same way by any Police Constable.

Another situation involved a woman who had had many ‘arrests’ by the Police, some were very traumatic and others were less so. In talking things over with an advocate this woman was very clear why some Police Officers found her very difficult to manage while others treated her as a member of the community who needed some support to get through the current crisis. In trying to manage her distress she needed to move around and she would be aware that her fists were clenched. Police Officers who did not know her often interpreted this behaviour as aggressive while those who knew her allowed her space to work things through. Police Officers were often at a loss to know what to do with her as her thoughts made no sense to them at all. As a consequence she frequently found herself bundled into a van and transported for anything up to 2 hours in order to be assessed by other mental health Practitioners. The woman understood why the Police behaved this way but she was keen to write an Advance Statement that, if agreed, might mean that she could manage the crisis with the help and support of the Police and other important people. She knew that the person who would have the most calming effect on her behaviour was her husband. He was prepared and willing to be contacted by the Police and to come at short notice. She had this agreement with her husband already and so she needed the Police to agree to make the phone call when required. She also recognised that she sometimes needed a ‘place of safety’ but travelling long distances was very difficult for her and her family. She needed a separate agreement with her local Community Mental Health Team if she was to be able to use one of their rooms to fulfil this purpose.

It can be seen from this example how a range of other factors might need to be considered. Each of these may require separate agreements with the people involved if the Advanced Statement is to have the desired outcome.

Even with the full support of the Code of Practice the introduction of Advance Statements is likely to be slow. There are several reasons for this:

• Trust is probably the biggest factor for most people. Survival in the mental health system has, for many people, been closely linked to keeping Practitioners in the dark about the reality of their mental health systems.
• There is a more general scepticism in society about voluntarily sharing personal information with the Police.
• Another survival strategy that many people use is denial: “It won’t happen again.”
• There are currently no support systems in place to help people to make an Advanced Statement.

Developing a culture where people retain control and responsibility for their mental health, even at times of crisis, will take time, experience and evidence. Investment is needed, whether this is investment of time to encourage people who have had a good experience to embed this in future practice, or financial investment in advocacy services, there is now an opportunity, with the backing of the Code of Practice, to build a future where trust is rewarded, where the Police can work cooperatively, where crisis becomes the trigger for ‘recovery’, and where support is common practice.

Janet Rogers is a trustee at the mental health charity Ponthafren Association, and has previously written for this blog on Volunteering whilst getting benefits and Mental Health 1983: Code of Practice - the review (in England). 

Derek Turner worked for the PAVO mental health team for many years. He is now retired, and runs The Thomas Shop in Penybont with his wife Liz.

What if "Restraint" was not an option?

by Freda Lacey

About this time last year the Minister of State for Care and Support, Norman Lamb, wrote about “Positive and safe: reducing the need for restrictive interventions” within health care. Mind’s report from the year before on “physical restraint in crisis” clearly outlined that the use of restraint was used to varying degrees and “face down” (or “prone” restraint as it’s sometimes called) was still being used despite the knowledge that it can cause serious harm and, in some situations, death.  The report made recommendations to the Government that the use of “face down” restraint should never be used in care and treatment settings.

The Mental Health Act Code of Practice, (currently being revised in Wales) devotes an entire chapter to “Managing behaviours that challenge,” and it clearly states that the least restrictive option(s) must be explored and restraint used only as a last resort.

The use of “restraint” and the “how”, when managing patients in hospitals, has been the topic of numerous blogs, reports, white papers, and news articles, particularly over the last few years. The Winterbourne Review spurred a great deal of investigation into the use of restraint, the Care Quality Commission specifically reporting on “Monitoring the Mental Health Act” in 2012/2013” and the use of restraint in hospitals. One of my favourite blogs is written by Mental Health Cop and he has his own views about restraint which may add texture to the topic. I am not going to write about how, when and where restraint is used in mental health settings, this has already been done by people far more knowledgeable than myself.

What I really want to highlight is how I’ve been affected by the topic of “restraint”. During my attendance at the Department of Health’s revision of the “English Mental Health Code of Practice” Expert Reference Group with Jan Rogers, I was privileged to sit in on several of the group meetings discussing changes to “the code”. The chapter called “Safe and therapeutic responses to disturbed behaviour” in the new Code of Practice made the experiences of restraint very real to me.

It was the first time where I listened to people’s direct experiences of being “restrained” in high, medium and acute wards whilst experiencing care under the Mental Health Act. I listened to family members speak of their experiences of witnessing their children’s restraint and the distress this has caused. People openly shared feelings of humiliation, trauma (some of this due to physical injuries they had sustained) and feelings of distrust in the people caring for them. They made direct links to the “way” they were physically restrained, sometimes stating they didn’t know “why” it had happened. I imagined how children or young adults may feel experiencing restraint and the trauma this may hold for them, particularly if abuse has been experienced. What is felt by people with a dementia, what comes up for them as a result of being restrained? As I listened, I wondered what would have happened had restraint never been an option. 

Interestingly around the same time, I caught sight of a national workshop on the management of violence in hospital settings. The workshop was pulled together by the “All Wales Senior Nurse Advisory Group for Mental Health” and their call to action really struck me. “The management of violence and aggression in mental health settings is a key issue for practitioners and educators. The Department of Health have recently consulted on restrictive practices in England along with the Mind publication in 2013; and we want to be at the forefront of planning developments and actions in Wales on behalf of our service users and our staff”. 

Having heard the recent stories from people who had experienced being restrained, I was curious to see and hear how staff approached the subject of restraint. The workshop was well attended by national ward management teams, general nursing staff, senior nurses and senior management.

 

One of the things that became apparent was that a good many staff felt the need to move away from restraining people and advocated “de-escalation” techniques, or “conflict resolution”. Basically, talking people down from a heightened sense of anger. I could see the difficulty experienced by staff when faced with a patient who is throwing punches and hurting them (one nurse spoke of being punched and having to be off work for some time) where the instinct is to restrain the patient so as to prevent being hurt. If restraint had to be used, then the workshop advocated using “supine” restraint or “face up” which is deemed less injurious and safer for the patient.

I volunteered to experience what it felt like to be restrained as in the afternoon we had a demonstration of using various methods of restraint for adults and older adults with dementia, (for example). Whilst the demonstrators were very careful with me (I was held down by two men and one woman), and pinned down so I couldn’t move and injure myself (and/or them), I was not trying very hard to be aggressive. I could imagine that if someone was very angry and aggressive that it may take some time of being held down and spoken with before the situation may diffuse. I was also startled at how quickly I went from standing to down on the floor and wondered if I was really emotional, angry and distressed, what effect the entire process might have on me. Also, if I were to be restrained by male nurses, how might this feel as a woman and similarly for men.

Hospitals are required to have policies on how to “manage” aggressive behaviour and in reading some policies from different areas I was struck by the following list of some of the things that staff should look out for as factors that may provoke disturbed or violent behaviour:       

• boredom and lack of environmental stimulation;
• lack of access to external space;
• personal frustrations associated with being in a restricted environment;
• difficulties in communication;
• emotional distress, e.g. following bereavement;
• antagonism, aggression or provocation on the part of others;
• physical illness;
• and an unsuitable mix of patients. 

It is worth noting that most of the above factors have been encountered by patients we see as part of the Powys Patients’ Council meetings and come up in patients’ feedback to us, so I wonder if these factors will always exist, to some degree, within in-patient units. If they do, then perhaps it’s not a matter of “may” provoke aggression, but that these are constantly having to be managed by staff in ways other than restraining patients.

One staff nurse mentioned that he worked within a high secure unit and that the staff never used restraint, that “conflict resolution” techniques were consistently used successfully. Here in Powys, ward management have mentioned that they don’t use restraint although staff are trained in Safe Physical Intervention Techniques or SPIT as it’s called. In fact, one of the staff on the ward here in Powys is the trainer for all Aneurin Bevan staff (including Gwent) in SPIT.

Another option for all psychiatric patients is to complete what is known as an “advance directive”, or here in Wales: “wishes known in advance” statement (we will be exploring this in more detail in a future blog post). This allows patients to state how they would like to be treated (or not treated) if they are detained by the Mental Health Act. They could quite clearly say that they don’t wish to be physically restrained and whilst an advance directive is not a legally binding document it would be good practice for hospital staff to respect the person’s wishes.

So, what’s the answer to restrain or not to restrain? It may be that while the Mental Health Act (and requisite Code of Practice) results in feelings of deprived liberty by people, there will always exist factors which may provoke people to behave aggressively. If this is the case, then ongoing debate and engagement on this topic will continue to be needed.

Finally, I’m curious to see if people may read something further into the paper outlined from the Department of Health mentioned at the very beginning of this blog post. It states, “This guidance forms a key part of the wider new Positive and Safe programme, which aims to end the unnecessary use of restrictive interventions across all health and adult social care." I wonder….

Top 10 Tips to Survive Christmas

The mental health team here at PAVO would like to wish you all the best for Christmas and New Year 2014. However, we understand that it can be a difficult time for some people, and between us the team have come up with ten (hopefully useful) tips for surviving Christmas. If you have ideas of your own we would really like to hear from you - just add them in the comments box at the end.

1 Get together with other people

If you haven’t got anything planned for Christmas and are worried about being on your own, why not contact someone who may be in a similar situation, and arrange to do something together.

2 Prepare in case of a crisis
Before Christmas make a list of people and places who could support you in a crisis. Make sure you have phone numbers to hand, opening times of places that are important to you, that you have renewed your prescription if you have medication, and have emergency cash if possible for taxis if you really need to get somewhere. If you self-injure and think this is likely over Christmas make sure you have what you need to be safe. (See links below for further support and help).

3 Remember lost loved ones
Christmas can be a difficult time if you have just lost someone. If you have lost someone close maybe acknowledge this and light a candle for them. You might like to give something to an appropriate charity in their memory.

4 Be a Christmas volunteer
What about actually volunteering to do something with a local group or charity? Many organisations would like to hear from you if you have time to help, but contact them in plenty of time so that your offer can be incorporated into the group's plans.

5 Just treat yourself!
Do something nurturing for yourself - get yourself a treat - plan to go to your favourite place or go on your favourite walk, or listen to music that you really like.

6 Celebrate in your own way
If the commercialisation or the religious aspects of Christmas are not for you celebrate the mid winter in your own ways - think of the mid winter as a time for reflection and quiet, a time for beginning to nurture new growth….think of all the things in nature which begin life in a period of dark and quiet - roots start to grow, trees rest before the new leaves of spring, sheep are in lamb ready for spring …...sow some seeds of change for yourself - what can you begin when the days start to get longer again?

7 Have a laugh!
Promise yourself a laugh on Christmas Day - even if you don’t really feel like it. Look at some funny DVDs or ring someone who makes you laugh - find a funny YouTube clip - even if you feel false doing it laughing can definitely help to lift negative feelings.

8 Take the time to be useful
Use the time to do something practical. You may get a sense of achievement for having accomplished something. Perhaps you have been waiting all year to find time to sort out that untidy room or make a new garden bed. Dive in and start now!

9 Create, create, create
Be creative - paint a picture, knit a scarf, design your garden ready for the new season, write a poem, make a fun mask, go for a walk and take some photographs, sing a song.... Perhaps it is an opportunity to try something new. There are lots of groups out there encouraging creative activity, such as Arts Alive in Crickhowell. Or you can search the internet for websites packed full of ideas, like this one.

10 Be a friend to someone else this Christmas
Think about what your neighbours might be doing, and if any of them might need some support, help or companionship at this time. Often helping someone else - even just small gestures such as collecting a newspaper for them from the local shop -  can take your mind off your own struggles and can be a very rewarding way to spend time over the Christmas period.

Wellness and Recovery Learning Centres around Powys are open at some point over Christmas and the New Year and would welcome your visit. Visit their websites to check their opening times, details here. You can link to national helplines here.

If you need help urgently find information here.

We look forward to hearing from you in 2015.

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".