Dyfed Powys Police - Mental Health : Working Together - Part 2

We found out in Part 1 of this post last week how Dyfed Powys Police has been rolling out mental health awareness training sessions for the force's staff and partner organisations over the past few months. I was lucky enough to be able to attend the May session as the PAVO representative. These sessions have focused specifically on Section 136 of the Mental Health Act 1983, and the collaborative nature of the approach to this 72 hour detention which can be instigated by the police. 

The first half of our training covered a look at our needs and expectations, an introduction from the police mental health lead Inspector Brian Jones, setting of context by Lousia Kerr who is Powys Mental Health Partnership and Project Manager, and a consideration of "what is mental health?" by Powys psychiatrist Stephen Novick. Kath Arnold, manager of the Integrated Community Mental Health Team in Brecon, was next up before we ran out of space. In Part 2 we complete the picture. 

Approved Mental Health Professional – Helen Kiteley, Social Worker PCC

Helen described the very specific role of the Approved Mental Health Professional – a social worker who is specially trained to consider when someone may need compulsory admission under the Mental Health Act. “The AMHP is tasked with balancing care v control in the context of managing risk and the Human Rights Act 1998”.

This does not necessarily mean that someone ends up in hospital. They could be managed by the Home Treatment Team (more below) and able to stay at home. The “least restrictive intervention” is the one which has to be used.

Helen also covered a Section 135, the role of the “nearest relative”, and a AMHP’s duty to complete Mental Health Act assessments when required.

Crisis Resolution Home Treatment Teams – Andrew Williams (South), Graham Batha (North)

Andrew Williams

Andrew explained that he was a man with two hats! With his Welsh Government hat on it is his statutory responsibility to gate-keep admissions to hospital, to respond to crisis referrals in 4 hours and review out-of-hours referrals in 24 hours. With his practical hat on Andrew and his team are providing individuals with intensive support in their own homes. Staff work closely with family members and friends to maximise levels of support, and provide psychological and practical help. “Crisis prevention is really key.”

Graham’s view from the North of the county was not dissimilar. He said “we bring many aspects of hospital care to the patient’s home. Currently we have 300 patient contacts per month.”

Both teams work out of hours, though not 24/7. You can read more about the work of the North Powys HTT here.

Brian highlighted the fact that the police are operating in a different place to that of just 2 years ago. “As soon as we are facing a S136 we go out to someone who may harm themselves. But the HTT now arrive and say the police can leave”.

Graham Batha

Felindre Ward, Bronllys Hospital – Richard Rudge, Deputy Ward Manager

Felindre Ward is the designated Place of Safety for Mid and South Powys (except Ystradgynlais) where people can be taken by the police on a S136 for a mental health assessment. Richard talked us through the 12 bedded In-Patient Unit, the specific roles of staff based there, the admissions procedure and then in more detail the role of the nurse in the S136 process.

The team at Felindre works very closely with CMHT teams at Brecon and Llandrindod Wells, as well as the South Powys CRHTT.

Some interesting questions emerged during this session, such as what happens when someone is visiting Powys and is detained on a S136. It was clarified that they are then brought to a Place of Safety within Powys to be assessed, rather than being transported back to where they originally came from.

Emergency Duty Team – Debbie Everett, Social Worker & Michael Dalladay Senior Practitioner EDT

“It is the responsibility of the EDT to respond to social care emergencies where the urgency of the situation requires action at a time when mainstream services are not available.” The team has many varied duties, including undertaking mental health assessments.

Experience of someone in contact with mental health services – Jan Rogers

Regular readers of this blog will no doubt be familiar with Jan Rogers (volunteer and trustee at Ponthafren Association, and now MBE!) who then told her personal story. Jan included her experience of being detained under a Section 136 over 30 times, and her subsequent role in 2014 as a member of the Expert Reference Group which reviewed the Mental Health Act 1983 Code of Practice ( in England).

Jan concluded by saying: "things are not always what they seem. Think before making a decision or acting."

Brian rounded off the day with a number of typical scenarios, some of which we addressed in groups. There was some really useful discussion with partners from all sectors contributing and it was clear that the awareness raising had been of genuine benefit to all concerned. My feeling is that everyone working or volunteering in the field of mental health in Powys would find this session invaluable - long may it remain available to enhance our knowledge and encourage enthusiastic partnership working!

Dyfed Powys Police - Mental Health : Working Together - Part 1

Karen Clarke and Jason Hawkins - Police Community Support Officers in Brecon

Section 136
If it appears to a police officer that you as a person in a public place are:
 “suffering from mental disorder” and are: “in need of immediate care or control”, he or she can take you to a place of safety. 

You will be kept in hospital, or the place of safety you were taken to, so that you can be examined by a doctor and interviewed by an approved mental health professional and any necessary arrangements can be made for your treatment or care.  Mind – About Sectioning.

Over the past six months, Dyfed Powys Police has held regular mental health awareness training sessions for staff and partner organisations in Powys. As PAVO’s representative on the Section 136 sub-group, which was set up to reduce the inappropriate use of Section 136 of the Mental Health Act 1983, I was invited to attend. 

So it was in May I found myself at the Combined Services Centre in Llandrindod Wells with a room packed full of professionals from the Police, Powys Teaching Health Board, Powys County Council, Welsh Ambulance Service and a number of voluntary sector organisations, all gathered to learn more about Section 136. And, specifically, the role of the various agencies involved in working collaboratively to ensure appropriate and sensitive detentions occurred in the county.

It was a really interesting day. Packed full of information and just putting names to faces was invaluable. So it was agreed I could share with a wider audience, albeit very briefly, some of the content from the key speakers, and also highlight the extent of the collaborative nature of this work. 

 

Inspector Brian Jones (photo left), the mental health lead with Dyfed Powys Police, facilitated the session. He updated us on this blog last year about a pilot project in Powys requiring the Police Inspector’s authority before police mental health powers can be used. 

Partnership working – Louisa Kerr (photo right), Mental Health Partnership and Project Manager, PTHB

Louisa outlined the legal framework for delivery of mental health services in Powys, which is overseen by the Powys Mental Health Planning & Development Partnership. Its goal is: “to unlock the benefits of wellbeing in terms of physical health, educational attainment, employment and emotional security”.

Multi-agency partners – Brian Jones, Inspector Dyfed Powys Police

When a person is in crisis, it is increasingly the case that the first port of call – whether it be that person, a friend, family member, stranger or organisation that makes the call – is the police.

Brian spoke about the S136 protocol, incident reviews, the challenge of Powys’s geography, data collection, and his key responsibility as an Inspector with powers to authorise the use of S136. As taking away someone’s liberty is such a serious thing to do there is a lot of work looking for alternative options before a S136 is used. For example, someone could stay with family or friends overnight and then a better option be found the following morning. “Now it is a last resort to use a S136. It was much more usual in the past. (We are talking about) a patient that is not well. Going into custody or out of the area is not the best option.” 

Brian threw a question to the floor: “Why do we need mental health awareness training?” The responses included these comments: 

• We want to know how we can best work with people we come across. We want to put them in the right direction. 
• It is about recognising the problem and realising that partnership organisations are out there. 
• There is a lot more openness and honesty about mental health now and this is a major plus. 
• To improve the partnership approach. To talk to each other more – to look at the bigger picture. We are all working to the same end. 
• We are hoping to achieve a better understanding of what our individual roles are. 
• To find out how we fit in and can support each other. 
• For a better understanding of the S136 process and how it might impact on people we work with. 

The rest of the day was spent looking in more depth at the individual roles of specific agencies and mental health professionals.

What is mental health? – Stephen Novick, Consultant in Adult Psychiatry

Stephen began by telling us about the Rosenhan Experiment from 1973 – “on being sane in insane places”. It proved that it is extremely hard to diagnose mental health illnesses.

“Many people who commit suicide are not known to mental health services or mentally ill. Mental health problem sounds better. Mental health illness suggests some people get it and some don’t. Anyone can have a mental health problem.”

Stephen ran through some of the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, (a diagnostic manual from the United States). However, he said there was very little in the way of hard science except in relation to dementia. “Look at the symptoms, signs, behaviours… what else – drugs and alcohol.”

“People believe all sorts of weird things, but that does not mean they are ill. If they are behaving oddly, it may be a cultural thing.”

With this level of uncertainty around defining mental disorder, it’s not surprising that professionals from different agencies are called upon to agree that certain detentions (sections) are necessary before they go ahead. Stephen went on to describe scenarios when a S136 could be used by the police for a 72 hour detention at a “place of safety”, and to clarify the difference between Sections 2 and 3. 

Brian emphasised at this point that the role of the police is “the protection of life. There’s no getting away from that.”

Community Mental Health team – Kath Arnold, Integrated CMHT manager, Brecon

Kath introduced us to the many and varied roles of professionals employed in the CMHT, including psychiatrists, community psychiatric nurses, social workers, occupational therapists, support workers and clinical psychologists. They support people with “complex/high risk presentations that cannot be managed in primary care.” Primary being the GP surgery, and secondary care the CMHT. I feel the need for a flowchart coming on!

Care and Treatment planning is a key element of the team’s work as a requirement of the Mental Health (Wales) Measure, the legislation which governs provision of mental health services. “This gives you the opportunity to set goals in all areas of your life, create a plan and, in the process, to take more control of your own recovery.” Hafal, A step by step guide.

There followed a brief discussion about the value of Advance Statements for Crisis Planning, a subject covered in a separate post. So far the day was proving very interesting.

Look out for Part 2 of this post next week to find out more about the roles of the Approved Mental Health Practitioner, the Crisis Resolution Home Treatment Teams, staff at Felindre Ward of Bronllys Hospital, and the Emergency Duty Team of Powys County Council Social Services in relation to Section 136 detentions. And, not forgetting, Jan Rogers' powerful personal story of coming into contact with the police during a mental health crisis.

Update: read Part 2 here.

Citizen Power, Active Participation

Blog by Freda Lacey, Powys Association of Voluntary Organisations (PAVO)

The Person in the Arena – Theodore Roosevelt    

"It is not the critic who counts; not the person who points out how the strong …stumbles, or where the doer of deeds could have done them better. The credit belongs to the person who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends themselves in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if they fail, at least fails while daring greatly, so that their place shall never be with those cold and timid souls who neither know victory nor defeat."



24th October 2014.  Left to right, back row;

Rhydian Parry, Neil Saunders, Kate Van Den Ende,

Steve Hails, Liz Hails, Phil Pashley, Meriel Richards,

Phil Moisson.  Front: Freda Lacey, Lotte McGregor,

Ali Lloyd-Jones, Michelle Willingham, Jill Dibling

On Thursday,  24th October, I gave the above quote, a personal favourite of mine (one which has boosted me many times during some of my darker days) to a group of twelve enthusiastic, devoted citizens of Powys, who came together for the day with me to discuss active participation on local and national Mental Health Partnership Boards. 

 

 

 

 

The Road Trip

This meeting was the culmination of a long road trip across Powys over the last few months, engaging with people in local groups, teams, towns and localities.  I gleefully sent out some photos to my family of my journey to work that first day of travel, captioned, “my road to work this morning”.  I feel incredibly lucky to live in a county and drive roads which take me to views like this in the work I do. 

My mission? 
To inform and encourage people to participate at our annual Stronger in Partnership conference, this year entitled, “Shaping Services Together”.  People would get to meet with Jacqui Dillon, a well known activist and public speaker on the de-medicalisation of mental health distress and chair of the “Hearing Voices Network”, actively participate in speaking up about the impact of the UK Welfare Reform (workshop video here) and meet with key decision makers locally and nationally to report on personal experiences (watch out for a subsequent Blog on this topic!). 


Welshpool Outreach - Ponthafren

They would also get to speak directly with members of the relatively new National Partnership Board driving the “Together for Mental Health” strategy and delivery plans across Wales.  People would also learn more about how to actively engage and participate in shaping mental health services (you can access their talk here), locally and through a newly forming National Forum for citizens in contact with mental health services across Wales.  


Llanidloes Outreach - Ponthafren

I combined visits to local mental health voluntary services/groups and statutory mental health staff/teams closely in contact with people who have been diagnosed with "mental illness". 

My journey took me to places such as Machynlleth and visits with Mind Aberystwyth’s “UsMach” and a local counseling services called “The Listening Point”.  To Llanidloes’ Mental Health Outreach Group, Welshpool Mental Health Resource Centre, both managed by Ponthafren Association.  
 

Older People's team, South Powys

Newtown’s Mental Health Resource Centre (managed by Ponthafren Association), Builth Wells Mental Health Outreach Group and Llandrindod Wells Resource Centre, through Mid Powys Mind, Brecon and District Mind’s (note new name), Mental Health Resource Centre.   Bryntirion’s multi-disciplinary team of social workers, community psychiatric nurses and team leaders in Welshpool, multi-disciplinary staff team at Ty Illtyd in Brecon, the older people’s multi-disciplinary staff team gathered at Bronllys Hospital and the multi-disciplinary staff team at The Larches in Ystradgynlais.

This event was also going to uniquely focus on “across all ages” and we actively worked with the Participation Team working with the Powys Youth Forum and Tros Gynnal, who provide Children’s Advocacy, to get their involvement.  Several young people came, with the support of these two local organisations and they worked with Theatr Clwyd on a workshop to put across their points/issues to the audience.  There was also quite a bit of audience participation as you can see in the picture here and below.

We had over 120 people registered for the event here in Powys which happened on September 19th and the momentum for people to get involved in shaping mental health services, both locally and nationally, has continued since then with great interest.  It feels as if a great shift is happening with people really wanting to become more actively involved, raising their voice, campaigning for the rights of individuals (and themselves) to be heard.  People are passionately wanting to help change the way services are delivered so that they have the services they need, when they need them.  It is interesting that this is strongly aligned with the Welsh Government’s drive to involve more citizens in public consultations, engagement and participation at all levels.  For a list of the most recent opportunities to get involved, please visit this page on our website.

This all brings us to last Thursday’s day at Gregynog Hall, where originally, fifteen people had put themselves forward as interested in coming together to discuss active participation and representation on the Powys local Mental Health Planning and Development Partnership and the National Forum. Unfortunately, three people were unable to attend on the day due to unforeseen reasons. 

The local partnership board is a requirement, as part of the strategy for Mental Health across Wales, and each of the seven health boards in Wales need to create such a partnership.  They are also required to have people in contact with services and those close to them as active members on these partnership boards.  There are no minimum or maximum numbers, but most Boards have over four people as active members.  In Powys, we have three people who can participate on the partnership at any one meeting.

There were six people who organically fell out of the day’s selection process, but three others who really wished to participate, but were unsure of their abilities and perhaps lacking in some confidence.  The group, as a whole, really wished to encourage and support these three people to be actively involved and so they wished me to see whether the three people participating on the local partnership could be pulled from a pool of nine people.  The remaining three people all wished to be very actively involved in supporting the local and national engagement process.  Nine people from Powys will actively be part of the National Forum that is forming and this will consist of over 50 people from across Wales.

Jo Mussen (right) Vice Chair Powys teaching Health Board & Jackie Newey, PAVO

The nine people are a good mixture of people who have varied and diverse experiences.

It will be one of the widest, most diverse groups of people to ever come together, with one common purpose.  This is to ensure that those in contact with or close to people who have experience of mental health services in Wales are valued as equals in shaping mental health services for the future, that they are consulted, valued, actively involved through meaningful dialogue, ensuring that this is not tokenistic.  This Forum will also choose the four people who will participate on the National Partnership Board.  Importantly, communication to and from the National Partnership Board on issues affecting people and progress on key areas of interest in terms of service development and action, needs to be whole-heartedly carried through this Forum, by this Forum to local networks, groups and citizens represented from communities across Wales.  In this way, a strong, inter-dependent link will exist between local citizenship and Welsh Government, in relation to mental health and well-being.

Community Mental Health Team, Brecon

The ongoing challenge remains how we actively engage, communicate and dialogue with the silent majority of people, whose voice may not yet have been heard and indeed, who do not wish to participate via membership of a forum or board, but who do want to actively contribute and be heard.  Further development of local groups, local mechanisms for ensuring active participation is facilitated and helping forge meaningful connections are next steps for the group who met at Gregynog, as is utilising the widest and most innovative means possible to engage with people. 

Along with supporting this group, my role requires me to be mindful of linking opportunities for involvement in services with people with particular interests or experiences.  Most recent examples of this include: linking an individual in Newtown with Department of Health, Expert Reference Group meetings in London, reviewing the Mental Health Code of Practice and we’ll ensure that we are involved when/if the Welsh Code of Practice is also reviewed, ensuring individuals who have experience of being detained by the police (in relation to mental health distress) are linked in with a two year research project headed by the University of Bangor into Police practice, linking people with the group overseeing the implementation of the Mental Health Measure (Act) across Wales and seeking to involve people in the formation of the Powys Psychological Therapies Management Committee.

Finally, I shared with the “Twelve” a poem which means a great deal to me.  It is called “To Risk” and you can view it here on our website.  It felt right to hand people this poem before they attend the first meeting of the Powys Mental Health Planning and Development Partnership in December and the National Forum in November.  It may help if you’ve never gotten involved in participating before. 

 
So, if you wish to join in, get actively involved and have particular interests or experience in different aspects of services that makes you think you can make a difference for others and/or for yourself, please email me at Freda.Lacey@pavo.org.uk or ring me on 01597 822191 for further information.

By Freda Lacey