Sharing power - in the planning and reviewing of services

Just before Christmas 2019 I attended this training event in Llandrindod run by my two Participation Officer colleagues – Owen Griffkin (Mental Health - above) and Andrew Davies (Health & Wellbeing - below).

The aim of the day was to build the confidence, knowledge and skills of participants, some of whom were already volunteering as citizen or individual reps, so that they could effectively participate in the planning and reviewing of services with public bodies. Citizen reps volunteer their time, energy and passion to make a difference for others and to the services we receive, and are helping influence change at local, regional and national levels.

Some of the participants are citizen reps on the Powys Mental Health Planning & Development Board, whilst others regularly sit on the Powys Regional Partnership Board.

Setting ground rules for the day

The key learning of the day was around: 

• Communicating confidently and effectively in meetings.
• Knowing where to access relevant information.
• Better understanding the process and procedures involved.
• Better understanding the public bodies involved.

As people introduced themselves at the start of the day it was really interesting to hear the views of those in contact with services, and others who had been citizen reps for some time already:

“Although organisations are individually very good, together they shall never meet.”

“I like to become a thorn in people’s sides. I enjoy arguing the point although I can accept both ways. A 360 degree view of services is so much better.”

It’s not possible to cover the full extent of the training in a short blog post, so I shall just highlight some of the particularly interesting discussions which took place on the day.

Representing other people

As a citizen rep you are an equal partner with other professionals in the room - you are an expert by experience. But how do you gain the experience of other people and take their stories to a partnership board?

One of the reps spoke about how he represents his own experience as a carer, but also takes stories with him from local carers’ groups that he attends. “You need to be mindful for it not to be just about yourself but to cast the net and make the representation whole. You are in effect a Citizen Rep (representing a group of people with a common interest) but also a Representative Citizen (giving your own opinions)." 

Another participant said: “It’s really hard to put yourself to one side. Sometimes you might be putting a viewpoint forward that you don’t believe in. It’s about delivering it in way that doesn’t put people off, or bore people, or become too personal.” There are some very polarizing issues about the medicalisation of mental health, for example, but it is important for a rep to balance any views s/he may have and give the other side as well.

Understanding other people’s context

Another experienced citizen rep pointed out that certain things cannot change. 

“There is no point banging your head against a brick wall that can only be changed from the top down.”

When things don’t go well – and when they do

Sometimes it can be easy to ask – “why are we here if we don’t have any influence?” It was felt that some meetings were a waste of time, and only “tick box” exercises. “Sometimes the public body will just move on to the next item on the agenda as if we have not spoken. We have been invited to speak, but it sometimes feels just so that they can tick that box.”

Someone representing a local charity described how it took her three years to be heard within one public body. But eventually her persistence paid off, and the organisation was finally able to achieve some funding for a much needed project.

It was, though, also agreed that sometimes staff within an organisation may also be struggling with the slow rate of change – but sometimes the decision making process, and the accountability attached to it, require that change to go through and be agreed by many different committees.

New reps often have very high expectations in the early days, but these need to be managed from the start.

“Don’t promise the earth. It’s the small steps that are important. And publicising the success stories.”

You said, we did

Everyone agreed on the value of prompt feedback from the boards about progress. “Even if that is – we’re still driving this forward but we haven’t got anywhere yet.” Otherwise there is an understandable tendency for people to think – “what’s the point?”

The mock meeting

In the afternoon we were pleased to welcome our former colleague Freda Lacey, now Partnership Manager Mental Health at Powys Teaching Health Board, to chair a mock meeting designed to put into practice all the learning from earlier in the day. It turned out to be an extremely interesting and valuable exercise.

All those attending agreed that they had benefitted hugely from the day, both from the learning and the opportunity also to network with others who had a similar role.

And finally…

Would you be interested in joining these citizen reps to take grass-root views and opinions to local board meetings where service providers can find out what is working and what needs to change? For further information about becoming a citizen rep, in the field of mental health or health and social care, just get in touch with us by emailing mentalhealth@pavo.org.uk or ringing 01597 822191.

Celebrating the One Powys Connecting Voices project

On a wintery Tuesday in late March, Carl Cooper, the PAVO Chief Executive Officer, spoke at the Powys COVERED (Connecting Our Voices Embracing Real Engagement and Dialogue) event which celebrated the achievements and legacy of the lottery funded One Powys Connecting Voices project. PAVO managed a portfolio of six projects over five years aiming to empower citizens to have a greater influence on the design and delivery of statutory services in Powys.

Over the past five years on this blog we have observed and recorded some of the achievements of one of the portfolio projects in particular: YAPS (Young Adult Peer Support project) run by Ponthafren Association (read The YAPS project at Ponthafren Association, Young Adult Peer Support project @ PAVO AGM and YAPS Sharing the Voice).

Carl summed up some of the achievements of the OPCV project as a whole at the event:

 “About 7 years ago the Big Lottery Fund in Wales had an idea. It wanted to try to support people in getting their voice heard and in influencing decisions that affected them. They then invited County Voluntary Councils such as Powys Association of Voluntary Organisations to put in a bid (it was a competitive process - not every area of Wales was successful), in relation to getting voices heard to make a difference, but also in a way that reflected the local context and local environment.

To be frank, I was surprised we were awarded the money. That’s not because I thought that what we set out to do wasn’t important, but our approach here in Powys has been very unique in that if you were to look at the projects elsewhere in Wales they have a very, very distinct focus. One was focussing exclusively on mental health. Another on learning disabilities and so on. We took a risk I think, in that at the time, together with the council and health board and other partners, we were developing the One Powys Plan. And the OPP was a diverse plan wanting to do lots of things. So we brought together a portfolio of projects to enable voices to have an influence on different aspects of the OPP. So as you will see around the room we have got people supporting carers, people that were focussing on neurological conditions, others that focussed on older people, others that focussed on the environment and sustainability, on younger people, on children and so on. 

My slight nervousness was that the Big Lottery Fund might look at this and say, hmmmnn, not sure about this because it feels a bit fragmented. It doesn’t really hang together very well. Gladly they didn’t, and I think what we have been able to do over the last five years is bring that diversity of people’s voices to bear on planning and decision making here in Powys. And it’s been a delight to work with our partner organisations represented in this room and I want to thank you for working with us so readily, so effectively and in a way that I think has built relationships between ourselves but also within the wider sector and partnership arena.

So what has this project actually done? Well, in one way it’s very simple. We wanted to try to support people in getting their views, observations, comments and concerns heard by Welsh Government, by the commissioners of services, by our statutory partners in the council and health board, by emergency services such as the police and many others. And I’m pleased to say that that was done and it was done well. Nothing is perfect and it would be invidious of me to stand here and pretend that things are ever perfect. But this project has made a difference. And that is crucial.

Barbara Perkins, OPCV Officer and Martin Nosworthy, Chair of the PAVO Board

So when I look at some of the evidence and information from this portfolio of projects, I see some of these things we know are true of Powys, for example how the geography of Powys is a constant challenge, particularly when it comes to access to services. But over the last five years, when you look at what has actually emerged, we now have virtual wards operating in Powys that the voluntary sector, health, social services and so on come together to realise and to run. We have video links, which connect patients to GPs and special consultants, be they local or a further distance away. That’s just the first of a number of examples really. I don’t want to claim that this project was the one and only influence on those decisions, but the crucial thing is that we can evidence that this project influenced those decisions.

You, and the people you represent, not only got your voices heard but your voices were listened to and they made a difference. That is crucial. Also the way in which young carers were brought into contact with social workers. The way in which those young carers were then involved in the training of social workers. So that workforce development, as well as operational delivery, was part of how the voice was mobilised to make things different. The commissioners for older people’s and children’s services have been involved in discussion and dialogue around transport, around social isolation, loneliness, and certainly if you look at some of the initiatives that have been taking place over the last years, and that will continue under the new area plan and wellbeing plans, then again things are different.

We’ve seen lots of other things develop. Again partly influenced by this project, be it around recycling and the involvement of communities and volunteers in recycling. So called upcycling. So, you take what might one time have been discarded and you give it fresh life for new use. We have repair cafes that have emerged over Powys over the last years. Again partly as a result of this project. 

Julia Gorman and Robin Green ran the YAPS Project at Ponthafren Association

Further examples include dementia cafes, and dementia support groups. Children have led campaigns about children’s rights. Young adults have provided services to local employers especially around training and workforce development. We’ve also seen in this project, and because of it, impact around helping people with shopping and making sure that particularly older people who find it difficult, if not impossible, to get out of the house, get affordable goods delivered to them. And we’ve been able to link that with some support around cooking and healthy eating and again that wouldn’t have happened, certainly not in the same way, had it not been for what this project was doing. 

My last example is around digital accessibility. We all know that transport is a perennial intractable problem here in Powys. But crucially we are very aware that people need to be plugged in digitally in the 21st century in order to be able to access health, social and commercial services at all times. And part of what this project has done is to help people in terms of upskilling and training and information when it comes to technology and internet services. Again another example of an accessibility barrier that has been overcome.

So, I’ve just tried to focus on literally ten or so examples of where what we’re doing today is not just saying well done and let’s go home, but well done and you’ve made a difference. Things are not the same in Powys today as they were five years ago because of what you and colleagues have done. And that’s a testimony not just to the project but to the value of participation, the effectiveness of public engagement, and to use a bit of more modern jargon, the importance of so-called co-production. 

And so I'll end my comments by saying that this work does not stop here. During the lifespan of this project we’ve had a so called Issues Log. And each of the projects has added issues to that log and so we have been able to see what issues and what comments people have been presenting with. Over the five years we’ve had thousands of issues. But six hundred of those issues were taken forward in dialogue and engagement and in conversation with local partners and with local agencies. And that will continue. Because PAVO is building a new website and this will be live very soon. And one of the things you will see on the website is an online portal which will be the updated version of our Issues Log. So, although the project is coming to an end it will still be possible for environmental groups, for carers, for children, for older people, for younger people and many others to go to the PAVO website and actually make sure that your issue is logged.

But it doesn’t stop there. We will then regularly collate and analyse that information, and make sure that it continues to influence decisions through our links with partners and strategic partnerships. So it’s not the end today. The end of the project, but things will still continue.”

Mental Health and the Welsh Ambulance Service Trust

This week’s guest post is from Isobel Jones, who works for the Patient Experience and Community Involvement team for the Welsh Ambulance Service NHS Trust. I first met Isobel at a Welshpool meeting of the Stand up! For emotional health and wellbeing project run by our team where she introduced us to her work. I caught up with Isobel lately and asked her if she would tell us more about her role for the blog. 

What led you to this particular role at Welsh Ambulance Service Trust? 

I come from a Social Care background, and have also worked in the Third Sector, however, throughout my various roles I realised that I was becoming more and more interested in engagement. Involving people in shaping the services they receive can only help develop better services. It just makes so much sense. 

In some of my past roles I had been asked to undertake some projects which had enabled people to be involved in the planning and development of the services they received and I found these projects very insightful and interesting.

I followed this idea further by attending training courses which explored effective participation and engagement skills, and they gave me the tools and techniques to do this.

When the job was advertised within the Welsh Ambulance Service’s Patient Experience and Community Involvement Team I was excited as this was just where I could see myself. I hadn’t looked at it from a Health perspective before so I knew this would be a new challenge.

How do you educate patients and the public about the services provided by the Trust?

We have an extensive engagement model, which allows us to reach different groups and communities. We use our partners in the Health Boards, statutory, third sector and other community links to be able to engage with different people who may have used our broad range of services. It is important to go where people are. We’ll also host information stands at a range of events across Wales that helps us to talk to local people.

We then arrange to go out to meet people in these different groups and talk about our services, which includes awareness about how we respond to and prioritise 999 calls. It is important when we visit groups that we listen to people’s experiences and their stories, and encourage people to give us their feedback.

We make people aware of how they can ‘Choose Well’, by accessing a range of health services available from GP, Out of Hours, Pharmacies, A&E Units and Minor Injury Units. We also talk about self-care, and using services such as NHS Direct Wales for telephone and online advice.

My work involves engaging with mental health groups, older people and people living with dementia. I have also visited learning disability groups, schools, groups with specialist health needs like Chronic Obstructive Pulmonary Disease and other respiratory conditions, Parkinson’s, Multiple Sclerosis and various Black and Minority Ethnic (BME) groups.

We have a continuous engagement model which gives me the opportunity to visit groups again and again, building up trust and encouraging people to stay involved with us as a service as their contribution is so important. 

I was also given the opportunity to train as a Community First Responder for WAST which I completed in March last year. With this training I am equipped to provide awareness sessions for community groups about how to undertake emergency first aid to support saving a person’s life, by learning in basic steps what we all can do to help someone when they face a life threatening emergency like a cardiac arrest, how to use a defibrillator, what to do if someone is choking, or needs to be placed into the recovery position until the ambulance arrives.

If someone being transported by WAST is experiencing mental distress, what support is provided by staff?

All our staff should support such a person with the utmost of dignity and respect, recognising that whilst with physical health conditions these are often visible, not all health conditions are visible, especially mental health and wellbeing.

Our staff will have followed any assessments of need that are in place for mental health, including local pathways which are in place which have been agreed in partnership with local services.

WAST Staff are currently going through a training programme focusing on mental health.

What kind of training do Trust staff have to help them support someone in mental health crisis?

The new WAST Mental Health Strategy which has recently been formed is very clear that there needs to be more training for our staff on the needs of people who experience mental ill health, and for our staff to be more aware of how to treat people who call 999 in crisis. This has come out of the fact that staff have acknowledged there is a need for this, to benefit people with mental health needs.

Tell us more about the Trust’s Mental Health Improvement Plan

People who access mental health services have told us that these things are important:

• Don’t ‘generalise’ mental illness. 
• Consider my communication needs.
• To be seen as a human being.
• Need calming, understanding and polite approach for people experiencing panic. 
• To be respected and treated equally. 
• Be listened to and believed. 
• Listen to carers as well as the person needing medical attention. 
• Staff need knowledge and awareness of mental health issues. 

Our staff have told us:

• We need a “better process for responding to patients in crisis.” 
• We need “up to date evidenced based training.” 
• We need “better links with crisis teams.” 
• There are “inconsistent pathways across Wales.” 
• There is a “variance of support across the localities.” 
• There is a “lack of suitable alternatives to A&E.” 

Our staff need support on how to maintain their own mental health, how to prevent stress and sleep problems, ensure good nutrition avoid substance misuse, etc.

Because of this, these are the priorities we have set for our plan:

Priority 1: Putting you at the centre

• Everybody is different and has different unique needs and experiences of mental health at different ages. 
• Specific work needs to be done around children and young people’s needs. 
• Think about the needs of people with dementia and of people with fluctuating mental capacity. 
• Supporting those who are at risk of suicide and self-harm. 
• Caring for those who may misuse substances. 

Priority 2: Training, awareness and skills for Welsh Ambulance staff

• What do our staff need to know about mental health in terms of training, attitude and approach? 
• Understanding people’s unique mental health needs (and the spectrum of mental health disorders).

Priority 3: Working better with other professionals

• Working better with GPs, hospitals, local community support services, Health Boards, carers, family, social services. 
• Working with trained mental health practitioners to support our frontline teams.
• Developing alternative pathways for people experiencing mental distress. 
• The purpose of these pathways is to make sure you are seen by the right person at the right time. 
• Where possible get appropriate help in the community, rather than a hospital setting. 
• Only considering hospital settings if physical health is at risk.

Priority 4: Caring for the wellbeing of our staff

• Putting support systems in place.
• Having mental health advocates. 
• Helping staff cope after traumatic incidents.

For our staff we need to maintain optimum mental health, sleep, exercise, nutrition, management of alcohol intake, etc.

Priority 5: Dealing with challenging situations

If an ambulance staff member is facing violence in an extreme situation, we will assess the risk and decide when it is appropriate to restrain someone to keep them and staff safe.

Priority 6: Giving necessary guidance and support to teams

• We have people within Welsh Ambulance Service who lead our mental health work. 
• We need to make sure staff are supported and have the right supervision to develop knowledge and skills about mental health.
• This is for the benefit of all people who access mental health services as well as to support Welsh Ambulance Services staff.

Which other organisations do you work closely with in Powys to provide support to people? 

So far, I have only worked with ‘Stand up! For emotional health and wellbeing’ in Welshpool. I would love the opportunity to network with and meet other groups in Powys so please get in touch!

We have visited many groups that support individuals with mental health and wellbeing concerns across Wales, but we would like more opportunities to speak to people in Powys. Have you used our services and would you like to give us feedback?

We would also appreciate your help to enable us to further develop our services as part of our Mental Health Improvement Plan. If you or your group / organisation are happy to receive a visit or take part in a focus group, please contact me (details below). Your views and experiences are important to us to help shape the way we work and how we support people.

What is the most challenging aspect of the job?

Sometimes it is the amount of travelling, as I travel all across Wales!

But in the main, it is making sure I listen carefully to what people tell me, and make sure I understand what is important to them. The challenge then is to make sure that voices are heard within the organisation in such a way that can make a real difference to the way we do things in the future.

To do this effectively it is very important to be a very open, friendly person, showing kindness and respect for any person who wishes to talk with you. I feel I need to show in my face and my body language that integrity is important, and that I can be trusted.

Sometimes people are angry and hurt, for good reasons, by their experiences.

I know they are not taking this out on me personally, it is important to understand why people say what they say, in the way they may say it. It is important for me to convey in a calming manner, acceptance and acknowledgement of how people are feeling and for people’s hurt feelings to be validated. 

Tell us about some of the most rewarding work you have done at WAST

Over the last year I engaged with a wide range of groups across Wales who supporting people experiencing mental health issues from many backgrounds.

Whilst most people reported positive experiences of having used emergency ambulances and non-emergency services, their suggestions were both insightful and helpful, as were the thoughts and observations from support workers and other professionals. 

I was given the opportunity in July 2017 to attend the WAST Trust Board and provide feedback on all of the engagement work I have undertaken with mental health groups and organisations across Wales. This presentation was well received by executive leads and managers in WAST. I was able to convey thanks to all the individuals with mental health concerns, organisations and staff who have shared their (sometimes very painful) stories with me. This opportunity allowed all of these voices to be heard, which contributes toward improving outcomes for people who use our services.

Another piece of work I found really rewarding was with people from the learning disability community where I was involved in setting up a drama group. This was a group of individuals in Caerphilly who worked in partnership with us to use drama to understand some of the barriers they experience when they ring 999 for an ambulance. During a celebration event in Blackwood, the drama group, which consisted of people with learning disabilities, showcased scenarios with real live call handlers, paramedics and community first responders.

What is the most valuable thing you have learnt since starting your role?

I am always totally humbled when people I have only recently met open their heart with sometimes very painful stories to me. I always try to do my best to do justice to what people tell me, so that it really makes a difference. We want to listen to people’s stories and experiences of using our services, and to capture feedback from people to improve our services.

Also since I trained as a community first responder volunteer myself back in March last year going on an emergency ambulance ride out with a crew from Hawthorn Ambulance Station to observe the experts in full flow to help consolidate my training has also formed part of my continuing journey… The day progressed with themes of falls coming up at least twice, sepsis also twice, breathing difficulties and presenting chest pains which may have been related to post traumatic anxiety, stress or other mental health concern. There was a lot to be learned about the needs of carers as well. What if they themselves need medical treatment and to be admitted but they are worrying about what will then happen to loved ones they care for, who may have dementia, a mental health condition, a physical or a learning disability, or in fact any combination of these? Colleagues shared with us about these dilemmas, as sometimes it is not just about the patient, but it was about their family as well.

When you are not working for WAST, how do you enjoy spending your time?

I love cooking, especially making jams, marmalade, herb jellies and chutneys. I gift wrap these and give them as presents. I also sell them to raise funds for charities.

I love walking and the outside world, animals, wildflowers, plants and nature, and especially my garden where I collect and grow loads of plants, shrubs, flowers and herbs. These interests often inspire me to paint watercolour pictures, play the guitar, write, sing and perform songs and poems. So this is just a little bit about me!

Many thanks to Isobel for telling us all about her role. You can contact her by ringing: 01792 776252 Ext. 45444 or emailing: isobel.jones@wales.nhs.uk

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.

On the Experts by Experience panel

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

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

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

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

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

  

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

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

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

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

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

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

Team building with a Treasure Hunt

The end is finally in sight! But yew won't need the buoyancy aid to rescue Clue No 8

Take two PAVO staff teams, 8 clues, an amazing outdoor local venue and a dry June afternoon day – and what do you have? Well, as it turns out, a really fun opportunity to find out more about your colleagues’ work whilst exercising and enjoying Nature at the same time! The perfect team building session!

It all started when our mental health team was asked to devise a “walk and talk” style engagement activity – along the lines of the dementia walks which have been taking place in North Powys for the past couple of years and which we wrote about here. The idea is that people in contact with mental health services, and those close to them, will have the opportunity to participate in a walk with people planning and providing those services (this activity is being planned for Autumn 2017). The dementia walks are very successful, as participants feel relaxed and happy to open up in a more informal environment. In other words, walking does prompt talking!

We decided it would be a good idea to stage a pilot event and troubleshoot any issues which may crop up before launching straight into the main gig. For example… when we did a risk assessment we realised a few fundamental things such as…. that at our chosen location – Llandrindod Lake – it is important to have a few twenty pence pieces in your pocket in case you want to use the facilities!

We had been trying to meet up with the new Community Connectors’ team at PAVO for some weeks, without much success, because how do you manage to find one day that all fourteen of us can make it for an office meeting? Tempt people with fresh strawberries and a treasure hunt though… and it’s surprising how quickly they get back to you with a positive response!

With a venue and a date confirmed, two of us walked the route for inspiration and set to writing our clues and picking hiding places. We also set eight questions for the Connectors which would reveal how much/little they knew about our work. On the day we planned to fill in any gaps and answer questions as we walked from one clue to the next.

Llandrindod Lake provided the perfect spot for the activity as it has well-spaced clue-hiding sites, a ready-made circular route, some mature trees for shade, and the stunning dragon fountain as a backdrop. The landowner, Powys County Council, gave us permission to go ahead once we clarified the details of our activity (and produced a copy of our insurance certificate!) We also informed the local police in case anyone reported “suspicious” activity. We bought some cheap sandwich boxes for clues and questions, and translated a couple into Welsh (with some “Emergency English” for non-Welsh speakers).

On the day Jane, our team manager, set up a base at the Capel Maelog stone circle a short distance from the Lake. After the briefest of briefings (no swimming in the Lake, no climbing the trees) and light refreshments we were ready for the off. We split the Connectors’ team into three groups and staggered their start times on the hunt. One of us went with each team to answer questions and help if the clues proved too testing. But mostly they were pretty straightforward…

Clue no 1: Bear left along the pavement towards the Lake: find a guarded question (sword and axe: both fake).

Community Connectors L:R - Suzanne Iuppa, Carla Rosenthal & Sally Richards

And Question no 1: What are the mental health team’s two core activities? (Answer: Information & Participation - just in case you haven't  worked it out already).

Over about the period of an hour and a half the teams then hunted high and low for their next clues and questions, and between clue locations staff chatted about their work, their feelings about their work, and the issues that were coming up regularly that they needed help with. Staff in the Community Connectors’ teams were also given the chance to ask their mental health colleagues one main question at each clue location. The three Connectors in my group paused at the jetty on the Lake (where they didn’t get “stumped or stung”) to ask “what is the biggest barrier to accessing mental health services?” This was where the thorny issue of waiting lists first came into the conversation…

Ella's favourite birdwatching seat sent us here...

Personally I found the activity the perfect way to get to know new colleagues in an informal and friendly yet also focussed way (if our conversations started to stray from the main agenda then the next clue just round the corner soon got us back on track). I had not previously met Sally Richards, the Connector from Ystradgynlais, so I was very pleased to have the chance to get to know her and also learn what was happening (or not) in Ystrad. And another bonus: we all laughed a lot on our way round – and not just because the previous team had sneakily hidden all the sandwich boxes in much less obvious places!

When we all regrouped at the end to talk through the activity, pretty much everyone had found it a positive experience. Several wondered what we would have done if it had poured down… so we need to take that on board when planning future outdoor activities.

Chwiliwch am greadur barfog ddwfn yn ei lyfr / Look for a bearded creature reading a book

When it came to conversation topics it turned out that one of the most popular questions was around counselling. There are currently many cases of counselling waiting lists across the county as we have previously discussed on this blog. However, the Connectors were pleased to discover that we have a Counselling Links page on our website with information about options other than NHS counselling in Powys. And one of the key things all the Connectors really wanted to find more about was: What are the participation opportunities in our team? At this point Anne and Philip were able to tell them all about their respective projects – Stand up! for emotional health & wellbeing, and supporting the individual representatives to feed back to various boards.

So… no blisters. No one stole our PAVO sandwich boxes. No one lost or missing. Just lots of smiley faces! Real faces! Bring on the next staff treasure hunt!

If you have any questions for us and can’t wait for the next treasure hunt activity, just pop them in the comments box below.

Sharing power in the planning and reviewing of services

Last Thursday I attended this training event at our Llandrindod office run by two Participation Officer colleagues – Carla Rosenthal and Carol Hay. As one of the attendees reported later it was “interactive, engaging and full of useful content”.

The session was arranged specifically for people who want to become citizen representatives (and a couple who already are). It is key to our work in the mental health team, and specifically for our Comic Relief funded project Stand up! for emotional health and wellbeing, that reps are recruited and well trained. Citizen reps volunteer their time, energy and passion to make a difference for others and to the services we receive, and are helping influence change at local, regional and national levels. We wrote about the achievements of mental health reps Rhydian Parry and Jan Rogers on this blog in Powys voices count at the top a couple of years ago.

This training session brought together two groups of individuals – those interested in sitting on the Powys Mental Health Planning & Development Partnership and a second cohort who recently started sitting round the table of the Health & Social Care Regional Partnership Board. Their ages and backgrounds were quite varied, with experience of mental health nursing, the Royal Air Force, specific health diagnoses and carers’ views all brought to the session. The module was based on a training package that was co-produced by mental health team volunteers and Participation Cymru, reflecting on the experiences of people who were interacting and engaging with organisations to shape mental health services.

It isn’t possible to cover the entire session in one blog post, so I’ll highlight a couple of areas and also focus on the points made by the two guest speakers, Sue Hughes – Coordinator Regional Partnership Board at Powys County Council, and Louisa Kerr – Mental Health Partnership Manager at Powys Teaching Health Board.

It was fascinating to hear at the start of the day what people thought about the title of the training, and in particular what “sharing power” meant to them. One of the reps’ responsibilities is to attend meetings with service providers, either locally or nationally (or both) and feedback grassroots opinions about current services. Comments included:

• You will be listened to.
• To be working alongside people as equal partners.
• To be part of the process.
• Using personal knowledge and experience to shape services.
• Sharing with other people what I have learnt.
• Being a team player.

Carla and Carol spoke about the importance of first impressions, being prepared and planning well, and emphasised that reps are representing other people – not just themselves and their own views – when sitting on the boards. “It is key to know who you represent, what is important to that group, and the key messages you want partner organisations to hear”. 

There was an interesting discussion about how it felt to sit around the table as a 'service user'. Whilst acknowledging that they brought a valid experience and were viewed as an equal some felt it put them on the back foot. Language, it was agreed, is extremely important. Some people felt comfortable being described as ‘experts’, whilst others said it was difficult being called ‘a carer’: “I’m a Mum. You’re given a label and boxed somehow. I find that really hard. People have masses more to bring other than being a service user.”

Sue and Louisa both emphasised that when individuals express their views passionately they are as important as anyone around the table. Sometimes we can box things in our own minds when actually we are being valued by everyone else there. “Everybody’s the same. There is no distinction between workers, volunteers and individuals. It’s about people coming together to talk informally. Collectively we are experts."

Carla and Carol went on to highlight the importance of researching partner organisations before attending meetings, and then we looked at “facts and assumptions”. “If I see a policewoman I might feel anxious. Guilty. Worried that she might arrest me. But that is an assumption. The only fact is that she is a policewoman, and I have to leave behind all the assumptions or I’ll be a nervous wreck.”

Sue then gave us a brief background to the Social Services & Wellbeing (Wales) Act which sets out the requirements for the Health & Social Care Regional Partnership Boards. Legally it is a requirement for citizens to sit on the boards. There is a need for people to work differently – for culture change – as the Act is all about the citizen’s voice. "We all need to challenge officers working in services to make sure they have involved citizens, but also to give praise where it is warranted".

Sue also spoke about how to use effective questioning at meetings. “Officers don’t encourage passivity as we won’t then have the opportunity to improve things. If you don’t understand a presentation as it’s not in lay language then it doesn’t comply with the Act. It has to be easily understandable language. You can raise this nicely – but the officers need to know.”

Louisa then provided us with an introduction to the Powys Mental Health Planning and Development Partnership Board which has been meeting for 2 years now. Mental health is governed by different legislation to Health & Social Care, so we look to the Mental Health Measure (Wales) for guidance, but there is much crossover. We learnt more about the various subgroups of the PMHPDP, including Engage to Change (looking at issues raised at the Stand up! for emotional health & wellbeing meetings), Performance, a Mental Health Officers’ Group and S136 Criminal Justice. Louisa recalled the first meeting of the board she attended where citizen reps Kate, Meriel and Rhydian spoke. “It was profound, and changed the dynamic of the meeting. Everyone was listening. That is the most important thing.”

By the afternoon we moved on to sessions on assertiveness, getting the most out of a meeting, and the support that Powys Association of Voluntary Organisations can provide to people. There were some intriguing slides on the nature of power, and specifically the 3 Faces of Power as described by Steven Lukes. And finally there were a few tips on building self-confidence – which can help us all in all areas of our lives. 

All in all a thoroughly interesting day, and we managed to have a fair few laughs too as we introduced ourselves early on in fictional roles as “superheroes, tooth fairies, aliens, scarecrows and witches”! 

Would you be interested in joining these citizen reps to take grass-root views and opinions to local board meetings where service providers can find out what is working and what needs to change? For further information about becoming a citizen rep in Powys, in the field of mental health or health and social care, just get in touch with us by emailing mentalhealth@pavo.org.uk or ringing 01597 822191.