NHS 111 Press 2 - mental health support in Powys

We recently welcomed Marielle Restall, NHS 111 Press 2 Team Lead for Powys Teaching Health Board, to our Health & Wellbeing team meeting to give us an update about this relatively new service in Powys.

What is 111 Press 2?

111 Press 2 is a mental health service available 24 hours a day, 7 days a week, for all ages. People can use the number if they have an urgent mental health concern for themselves or someone they know. It provides access to a mental health professional without the need for a GP referral. It can help people to support mental health crisis and in many cases be an alternative to attending emergency departments or calling the police.

The service can be accessed by calling NHS 111 and selecting option 2. Callers are then transferred to a dedicated member of the mental health team in their locality. The call includes an assessment of needs and a telephone based intervention to reduce stress. Where appropriate individuals can be referred to mental health services, given self-care advice or signposted to other support.

Why do we have 111 Press 2?

It came about following the publication of a report called Beyond the Call. This took a snapshot in Wales of where people presented in mental health crisis. People presented to 17 different places in total, including the police, Welsh Ambulance service, C.A.L.L. Helpline, Psychiatric Liaison Teams and others, which shows that it was not clear how to access mental health services appropriately.

The idea was to provide one number across Wales that’s easily accessible and people know they can rely on to access mental health support. This would then also reduce pressure on police, ambulance and other emergency services.

Beyond the call report, 2020

Who can call 111 Press 2?

Anyone, any age, registered with a Powys GP or visitors to Powys, can call 111 Press 2. If you are calling about someone else the staff can only give advice, they need to speak to the person directly concerned to make referrals to other services.

We take calls from any person registered with a GP in Powys, or visitors to Powys, whether they are known or not to mental health services. 111 Press 2 can refer on to any of the services within mental health. They are encouraging people to call 111 Press 2 as an alternative to attending their GP. People are triaged by a mental health practitioner and onward referral is made if required. Some GPs are actually redirecting people who call in to surgeries to access support. It’s important that the general public know that if they call 111 Press 2 they can be referred anywhere and receive any support. An exception would be if it is a medication query, for example, the person may have commenced medication and want to discuss this further with the GP.

We are working with the Powys Child & Adolescent Mental Health Support (CAMHS) Schools In-Reach team to help spread the word in schools about the service, and CAMHS teams are also promoting it.

There is a separate dedicated Professionals’ Line which is prioritised in the call queue. So far in Powys it is available to GPs, the police and the ambulance service. Currently an average of 2 calls a day are received by this line, so further promotional work is required to spread the word.

The call handlers are using an interpreting service called LanguageLine to provide support to people who speak a language other than English or Welsh. The issue is whether there is a translator available at the time of the call.

There are two Welsh speakers in the team. People can request a Welsh language speaker when they call which would take them directly to a Welsh-speaking call handler.

What can 111 Press 2 do?

• Conduct a mental health triage to assess a person’s needs.
• Provide a therapeutic conversation.
• De-escalate crisis situations (and reduce pressures of A&E and emergency services).
• Give advice on how to improve and maintain your mental wellbeing.
• Signpost to Third Sector services.
• Refer directly into mental health services for a mental health assessment, eg: Local Primary Mental Health team, Community Mental Health team, Crisis Resolution Home Treatment team, Perinatal team, Early Intervention Psychosis, Eating Disorder Services, Child & Adolescent Mental Health Services single point of access.

What 111 Press 2 cannot do

There is no face-to-face or video calling service available. Staff cannot prescribe medication - a referral would be made to mental health services or advice to attend the GP surgery or call ShropDoc out of hours.

111 Press 2 does not call people back at others’ request - the person must call themselves.

Is 111 Press 2 a listening service?

The service is different to CALL Helpline or other listening services. It is a mental health triage service so you would expect a person to ring with a mental health need.

The practitioners will always listen to the person calling and seek to support them with their mental health need whether that be through de-escalation or onward referral to an appropriate service. Callers who are not presenting with a mental health need will be advised to call another helpline or listening service if they wish to.

111 Press 2 seeks to reduce the distress felt by the caller - practitioners use a measure called the Subjective Unit of Distress Scale. It is used as a reflective tool at the end of a call to find out if there has been a change in how people feel from the beginning to the end of the call. If nothing has changed it could be that this highlights areas that have been missed. It gives control over to the person. Nobody’s distress has gone up since the Powys service began. It is about a 50/50 split on - stay the same or decreased. However, not all callers want to engage with this scale, and it is not appropriate for third party callers.

Who’s in the 111 Press 2 team?

7 x Band 5 Wellbeing Practitioners (Support Workers, Psychology graduates, therapists & social care staff).

1 x Band 5 Service Coordinator (administrative).

6 x Band 6 Senior Mental Health Practitioners (with a professional registration in Mental Health Nursing, Social Work or Occupational Therapy).

1 x Band 7 Team Lead (Mental Health nurse).

1 x Band 8 Service Manager (Mental Health nurse).

In a normal shift one of the senior practitioners will be supporting two of the wellbeing practitioners.

Triage scale

Practitioners use a triage scale as a guide to decide how quickly a person needs support.

The majority of the calls (over 60% May 2023 - January 2024) are for advice and information, or advice to contact alternative providers. Emergency responses made up 11% of the calls.

Live Data (May 2023 - January 2024)

We have gathered information about the number and type of calls the team have been receiving since the service started in Powys:

• 3421 calls received in total.
• Calls equally distributed across Powys
• Averaging 19 calls a day.
• On average calls are answered in less than 2 minutes.
• Calls are evenly spread throughout the week, with peak times - 6 - 8pm.
• Age range of callers - 11 years to 95 years.
• Average caller is male, 44 - 65.
• 53% callers active to mental health services, 24% closed to mental health services, and 23% no mental health history.

Highlighting gaps in service provision

The new service has already highlighted the need to the health board of certain gaps in current mental health services, for example out-of-hours crisis care. The Crisis Care team is not available after 9.30pm so by default 111 Press 2 are taking many crisis calls during the night time, as the only out of hours contact for Powys Teaching Health Board.

The team is working closely with other services to identify where the service gaps are so that they can really focus on developing those areas. It’s finding what is working for individuals and what isn’t. 111 Press 2 is in the early stages at the moment but has amazing potential to do great things. In fact, 111 Press 2 is at the forefront of transforming how services are operating!

In summary

111 Press 2 is a single point of access into mental health services for the general public.

111 Press 2 is for everybody.

111 Press 2 provides quick access to a mental health professional 

for advice, support and / or a referral.

Many thanks to Marielle for telling us more about the NHS 111 Press 2 service.

You can find out more about 111 Press 2 on this Welsh Government website.

The DPJ Foundation launches vital children’s books

Lawnsiad Sefydliad DPJ o lyfrau plant hanfodol

DPJ founder Emma's children - Trystan, Mali & Erin 
Plant Emma, sylfaenydd DPJ - Trystan, Mali ac Erin

On Tuesday 10 October 2023, World Mental Health Awareness Day, The DPJ Foundation shared their first series of therapeutic children’s picture books the “Dan Y Bont” series with schools across Wales.

The DPJ Foundation, founded in 2016, supports the mental health of agricultural communities across Wales, providing a 24/7 helpline ‘Share The Load’. This includes supporting those who are bereaved and are experiencing grief.

Ar ddydd Mawrth 10fed o Hydref, 2023, Diwrnod Ymwybyddiaeth Iechyd Meddwl y Byd, rhannodd Sefydliad DPJ, gydag ysgolion ledled Cymru, llyfrau “Dan Y Bont”, eu cyfres gyntaf o lyfrau lluniau therapiwtig i blant.

Mae Sefydliad DPJ, a sefydlwyd yn 2016, yn cefnogi iechyd meddwl cymunedau amaethyddol ar draws Cymru, gan ddarparu llinell gymorth 24/7 ‘Rhannwch y Baich’. Mae hyn yn cynnwys cymorth i’r rhai hynny sydd wedi cael profedigaeth ac sy’n galaru.

The idea for this project came from the DPJ Foundation’s charity manager, Kate Miles. Kate recognized the increasing need for bereavement support for children in rural communities, especially those in agriculture and often found parents turning to the DPJ Foundation for assistance when their children were grappling with the complexities of grief. Thanks to a grant from the Welsh Government’s Bereavement Support Fund, the charity was able to create a collection of three books specifically tailored to primary-age children, aiming to provide them with much-needed support during difficult times. Fundraising from within the agricultural community has enabled the DPJ Foundation to place books within schools and libraries across the country. Kate said:

“We know that everyone will experience bereavement at some point, and dealing with this as a child can be difficult. We wanted to support parents, grandparents and teachers to have conversations that can enable their children to deal with often overwhelming feelings. We know that it is hard to support your child whilst trying to face your own loss so we wanted to offer something that may help.”

Lluniwyd y prosiect yn dilyn awgrymiadau Kate Miles, rheolwr elusen Sefydliad DPJ, a oedd wedi adnabod yr angen cynyddol am gefnogaeth profedigaeth i blant mewn cymunedau gwledig, yn enwedig cymunedau amaethyddol. Roedd hi’n aml yn gweld rhieni’n troi at Sefydliad DPJ am help pan roedd eu plant yn brwydro gyda chymhlethdodau galar. Diolch i grant oddiwrth Gronfa Cynnal Profedigaeth Llywodraeth Cymru, fe’m galluogwyd ni i greu casgliad o dri llyfr a deilwrwyd yn arbennig ar gyfer plant oed cynradd, gan anelu at ddarparu’r gefnogaeth sydd mawr ei hangen arnynt yn ystod dyddiau tywyll. Mae gwaith codi arian yn y gymuned amaethyddol wedi galluogi Sefydliad DPJ i osod llyfrau mewn ysgolion a llyfrgelloedd ar draws y wlad. Dywedodd Kate:

“Mae pawb yn dioddef profedigaeth ar ryw adeg. Gall delio â hyn pan yn blentyn fod yn anodd. Roeddwn am gefnogi rhieni, neiniau a theidiau ac athrawon i gynnal sgyrsiau a allai alluogi eu plant i ddelio â theimladau sydd, yn aml, yn gwbl llethol. Deallwn ei fod yn anodd cefnogi’ch plentyn tra’n ceisio wynebu’ch colled eich hun, felly roeddwn am gynnig rhywbeth a allai fod o gymorth”.

Collaborating with the dedicated team at Green Wellies Publishing in Builth Wells, the Charity’s founder, Emma O’Sullivan alongside Kate, worked to lay the foundations for these stories. Anwen Nicholls and Kenneth Rees then skilfully crafted the words and illustrations to bring these ideas to life.

The Dan Y Bont series revolves around the lives of three children in a small village, each of whom has experienced a different type of loss—whether it's the passing of a grandparent, the sudden loss of a sibling, or the tragedy of a parent's suicide. These books approach these sensitive topics with great care and in a child-friendly manner, offering children explanations and suggestions for moving forward while reinforcing the message that it's okay not to feel okay during such difficult times.

Wrth gydweithio’n agos gyda thîm cyhoeddi ymroddgar Green Wellies yn Llanfair ym Muallt, aeth Emma O’Sullivan, sylfaenydd yr elusen, a Kate ati i ddatblygu seiliau cysyniadol y llyfrau hyn. Yna, defnyddiwyd talent creadigol Anwen Nicholls a Kenneth Rees i ysgrifennu a darlunio’r storïau er mwyn rhoi bywyd i’r syniadau hyn.

Troella gyfres Dan Y Bont o gwmpas bywydau tri o blant mewn pentref bach, ac mae pob un ohonynt wedi dioddef colled wahanol - p’un ai bod hynny’n farwolaeth tadcu neu famgu, colli brawd neu chwaer yn sydyn neu hunan-laddiad trasig rhiant. Mae’r llyfrau hyn yn trafod y themáu sensitif hyn gyda gofal mawr ac mewn dull cyfeillgar i blant wrth gynnig esboniadau ac awgrymiadau ynghylch symud ymlaen, tra’n atgyfnerthu’r neges ei fod yn iawn i beidio â theimlo’n iawn mewn cyfnodau mor anodd.

Emma, who is also a primary school teacher, established The DPJ Foundation after losing her husband Daniel Picton-Jones to suicide. Emma's personal experiences with her own children following the loss of Daniel served as inspiration for these books. Emma says:

“I am so proud of what we have achieved with these books, alongside the team at Green Wellies. When Mali and Trystan lost their dad, there was little support for them so to now see these books available for children who are experiencing grief is wonderful. As a teacher, I see the impact of books every day and I’m glad we can now contribute to that with our own books.”

Sefydlodd Emma, sydd hefyd yn athrawes ysgol gynradd, Sefydliad DPJ wedi iddi golli ei gŵr, Daniel Picton-Jones, drwy hunanladdiad. Hysbrydolodd profiadau personol Emma gyda’i phlant ei hun yn dilyn colli Daniel i fynd ati i lunio’r llyfrau hyn. Dyma oedd gan Emma i’w ddweud:

“Dw i mor falch o’r hyn ‘rydym ni, ochr yn ochr â’r tîm yn Green Wellies, wedi’i gyflawni. Pan gollodd Mali a Thrystan eu tad doedd fawr o gefnogaeth ar gael iddynt, felly mae’n hyfryd gweld bod y llyfrau hyn ar gael i blant sy’n galaru. Fel athrawes, gwelaf yn ddyddiol effaith llyfrau a dw i mor falch ein bod yn gallu cyfrannu at hynny gyda’n llyfrau ni’n hunain”.

Books have been distributed to over 160 schools right across the country along with an accompanying assembly that is available in both English and Welsh and which can be delivered to introduce the books and open the conversation around bereavement and mental health. Assemblies will be delivered in some schools by the DPJ Foundation’s Regional Champion volunteers, including one by Mali, Emma’s daughter, who had also fundraised along with her brother Trystan and friends Reuben, Freddie and Isla who are also helping to distribute the books. Mali said:

“When mum told us about the books, we all decided to wanted to fundraise to make sure we could get these books out to schools. We didn’t have anything like this when we lost dad so it’s nice that other children and families can use the books to help.”

Trystan said “I really liked being able to look in a book and see another child who had lost their dad too and was able to get help and understand what happened. I think they will be really good for other children who have been through the same thing as me.”

Mae llyfrau wedi’u dosbarthu i dros 160 o ysgolion ar draws y wlad, ynghyd â gwasanaethau boreuol cyfrwng Cymraeg a Saesneg. Mae modd eu defnyddio i gyflwyno’r llyfrau a dechrau’r sgwrs am brofedigaeth ac iechyd meddwl. Cafodd rhai o’r gwasanaethau eu cyflwyno yn yr ysgolion gan wirfoddolwyr Pencampwyr Rhanbarthol Sefydliad DPJ, gan gynnwys un gan Mali, merch Emma, a oedd hefyd wedi bod yn codi arian yng nghwmi ei brawd Trystan a’i ffrindiau Reuben, Freddie ac Isla, sydd hefyd yn helpu dosbarthu’r llyfrau. Dyma a oedd gan Mali i’w ddweud:

“Pan soniodd mam am y llyfrau, roedd pob un ohonom wedi penderfynu ein bod am godi arian i wneud yn siwr bod y llyfrau hyn yn cyrraedd ysgolion. Doedd dim byd tebyg ar gael i ni pan gollon ni Dad. Felly, mae’n braf bod plant a theuluoedd eraill yn gallu defnyddio’r llyfrau i’w helpu”.

Dywedodd Trystan “Roeddwn wir yn hoffi darllen am blentyn arall a oedd hefyd wedi colli ei dad a chael help yn ogystal â deall yr hyn a oedd wedi digwydd. Dw i’n credu y byddant yn dda iawn ar gyfer plant eraill sydd wedi profi’r un sefyllfa”.

The charity was committed to making the books available in both English and Welsh to ensure widespread accessibility and Welsh books are currently in the print stage.

Anwen Nicholls and Ken Rees of Green Wellies Publishing are proud to have worked on these books. They said:

“We hope that the books offer some support to families when they are facing sadness, and looking to find images and words to help make sense of the challenging times in their lives. It has been an honour and great responsibility working with the DPJ on this project, and we would like to extend our thanks for being tasked with this very important piece of work.”

Roedd yr elusen wedi’i hymrwymo i sicrau bod y llyfrau ar gael yn Gymraeg a Saesneg, fel eu bod yn hygyrch i bawb, ac mae’r fersiynau Cymraeg yn nwylo’r argraffwyr ar hyn o bryd.

Mae Anwen Nicholls a Ken Rees o gwmni cyhoeddi Green Wellies yn falch eu bod wedi gweithio ar y llyfrau hyn. Dyma oedd ganddynt i’w ddweud:

“Rydym yn gobeithio y bydd y llyfrau’n cynnig rhywfaint o gymorth i deuluoedd pan y maen nhw’n wynebu tristwch, ac yn chwilio am luniau a geiriau sy’n helpu gwneud synnwyr mewn cyfnodau heriol yn eu bywydau. Mae wedi bod yn anrhydedd a chyfrifoldeb mawr i weithio gyda DPJ ar y prosiect hwn, ac hoffwn estyn ein diolch iddynt am gael y fraint o weithio ar y darn pwysig yma o waith”.

As the week commencing 10th-16th October was also ‘Ag Mental Health Week’, it’s an important opportunity for the charity to highlight the support available for mental health in agriculture, including around bereavement. Kate was keen to highlight that the books are just one aspect of the support available from the DPJ Foundation:

“We all cope differently with loss and for those that need a bit of extra help, we are here at the DPJ Foundation to listen and to support, including with counselling and other therapy. We have developed some information about the practical aspects of a death in agriculture and hope that this along with these books will help make things if not easier, then a little less hard. We also have developed free training for those in the community who want to support others with their bereavement.”

Gan fod wythnos y 10fed – 16eg o Hydref hefyd yn ‘Wythnos Iechyd Meddwl Amaeth’, mae’n gyfle pwysig i’r elusen i amlygu’r gefnogaeth sydd ar gael ar gyfer iechyd meddwl mewn amaeth, gan gynnwys profedigaeth. Roedd Kate yn awyddus i ddweud bod y llyfrau ond yn un agwedd o’r gefnogaeth sydd ar gael gan Sefydliad DPJ:

“Mae pawb yn ymdopi â cholled mewn gwahanol ffordd ac, i’r rhai hynny sydd angen ychydig mwy o help, rydym yma yn Sefydliad DPJ i wrando a chefnogi, gan gynnwys cynnig cwnsela a therapi arall. Rydym wedi datblygu peth gwybodaeth ynghylch yr agweddau ymarferol yn dilyn marwolaeth ym myd amaeth, ac yn mawr obeithio y bydd hyn, ynghyd â’r llyfrau, yn gwneud pethau’n ychydig llai anodd, os nad yn haws. Rydym hefyd wedi datblygu hyfforddiant am ddim i’r rhai hynny yn y gymuned sydd am gefnogi eraill sydd wedi dioddef profedigaeth”.

To find out more about The DPJ Foundation, their picture book launch and their services, make sure to follow them on social media. You can find them on Facebook, Instagram, LinkedIn, X, Snapchat and TikTok.

If you believe that individual children or families in your school would benefit from their own copy of a book, please contact the DPJ Foundation.

If you need mental health support, you can call them free on 0800 587 4262 or text them on 07860 048 799 (this number doesn’t accept calls).

I wybod mwy am waith Sefydliad DPJ, y lansiad o’i llyfrau lluniau a’n gwasanaethau, gwnewch yn siwr eich bod yn ein dilyn ar gyfryngau cymdeithasol yr wythnos hon. Gallwch ddod o hyd i ni ar Facebook, Instagram, LinkedIn, X, Snapchat a TikTok.

Os ydych o’r farn y byddai plant neu deuluoedd unigol yn eich hysgol yn elwa ar dderbyn copi personol o lyfr, cysylltwch â Sefydliad DPJ os gwelwch yn dda.

Os oes angen arnoch gefnogaeth iechyd meddwl gallwch ein ffonio’n ddi-dâl ar 0800 587 4262 neu anfon neges testun ar 07860 048 799 (nid yw’r rhif hwn yn derbyn galwadau).