My 2022 journey with Ponthafren

 

Here in Powys our mental health charities do some absolutely amazing work!

For our final post this 2022 we find out more about the impact of Ponthafren’s One to One Recovery Project from a recent client.

Where do I start? Maybe a bit of background?

In 2019 I was diagnosed with a Traumatic Brian Injury (TBI) and advised to medically retire by the Neuropsychologist. I didn’t feel ready at that time and the Neuropsychologist himself retired leaving me to negotiate my diagnosis and progression myself.

Fast forward to 2021. Having worked through the pandemic as a Diabetes Specialist Nurse, providing support and training to staff as well as initiating new protocols and treatments, I was finding things more and more difficult. I was feeling the effects of my TBI and was afraid of making a mistake or killing a patient.

At the age of 55, having worked as a nurse for 26 years, I made the difficult decision to retire and in December 2021 I was awarded a Level 2 medical retirement on 31.12.2021. This had two effects. First, it confirmed I had made the right decision but secondly, it also meant that I was no longer a nurse, had no purpose and no support to help me navigate the TBI effects and how my life was changing. I was a failure.

During early 2022 I was struggling to obtain my pension from the NHS due to a previous employer who had not completed the appropriate paperwork. I was unaware of any benefits I was entitled to, and I was also unable to navigate the communication with the pensions department, ex-employer, etc, due to my poor cognitive abilities and labile emotions. (Basically, I just fell apart when trying to talk to anyone).

After 3 months of trying to navigate everything on my own my mental health had deteriorated to such an extent that I thought the world would be a better place without me in it. I had nowhere to go and no one to turn to for advice or support. The Neuropsychologist was never replaced in our area, and whilst the GP was supportive he was unable to provide any help. I couldn’t talk to my family as I didn’t want to be a burden. I cried if anyone talked to me, I felt a failure and worthless, I didn’t know how to negotiate my own life, who I was or who I wanted to be. I was withdrawn, lonely and felt a failure.

I was aware of Ponthafren, the mental health charity in North Powys, as I had provided some training there in the past. However, I really didn’t feel they were for me as I had some preconceived ideas as to the clientele. I certainly wasn’t sure what they could do - if anything - to help me, but I had to try something or I would not have been able to go on.

So I contacted Ponthafren and within a few weeks they had offered me an appointment to discuss my needs and see if they could offer support. I wasn’t hopeful! Then I met my One to One Recovery Worker. I don’t think I got through the first few meetings without being a complete mess! Crying, unable to find the words I needed and being withdrawn.

Over time my One to One Worker helped me to navigate the pensions; she also spoke/emailed the ex-employer and helped support me to apply for benefits. She gave me the reassurance that I was not beyond help and provided emotional as well as practical support. I could not have done it without her.

Through my One to One Worker’s support and encouragement I was able to access some counselling and to attend a gardening group. Initially being part of the group was difficult. I was unable to concentrate fully on what was happening as I struggled in a group, especially if more than one person was talking. I was unable to keep up with processing the information and I felt I didn’t belong. Also I cried… a lot! But I persevered.

When we transferred to volunteer at another large local garden overseen by a charity I couldn’t even get out of the car! I couldn’t work out how to park…. I didn’t know how to find the toilets. I didn’t know anyone and felt out of place. Every time I saw one of the other volunteers I broke down and cried, but still I persevered.

Slowly, with encouragement, I was able to attend other groups and not fall apart. I still have mini meltdowns and get fatigued, and my emotions overwhelm me on occasion, but I now have a purpose. I feel welcomed by all at Ponthafren and would be lost without them.

Fast forward 9 months

I am now a regular volunteer with Ponthafren. I also attend Mindfulness once a month, Singing for Well-being on a Tuesday, Yoga on a Wednesday, and Gardening on a Thursday.

Recently I was asked to facilitate the gardening group to enable it to carry on as Adult Learning Wales were unable to continue providing support. I didn’t think I could do it, but with the encouragement and support I have received, and continue to receive, I have become a volunteer for the charity’s garden as well as for Ponthafren. I can converse with the group effectively; I have attended meetings with regards to the group, and although there were a few teething problems initially I feel I am now able to steer the group and help it to grow for other members of Ponthafren and people just like me because of my One to One Worker and the rest of the team at Welshpool.

Don’t get me wrong, I still have meltdowns and cry on occasion, but I am generally better able to recognise when I need to step away and when I need to ask for help from others. This is without doubt a definite growth for me. I have a purpose, I have somewhere that people ‘see me’ and accept me for all my faults along with some strengths that I have been able to develop along this journey.

I really can’t put into words how much finding Ponthafren has helped me and changed my life this year. If it wasn’t for my One to One worker and the amazing team at Welshpool, I wouldn’t be here in December 2022.

I hope to be able to continue to give back to Ponthafren and be an asset to them, to be able to help and support others in my own slightly broken way as a volunteer. Ponthafren is for everyone who needs a little support or has been a little bit damaged just because of life! If I could change one thing it would be the misguided pre-conceptions that some people have, myself included, around what Ponthafren is, who it can help and what they can offer. I sing their praise from the roof top when able and have pointed a couple of people in their direction already.

Finally, I would like to say THANK YOU, you really do not know how you have saved me and enhanced my life. Keep doing what you all do so well.

Find out more about Ponthafren’s One to One Recovery project.

New Eating Disorders' Services for Powys

A Happy New Year to all our readers! 

Just over a year ago one of our Powys citizen reps, Helen Missen, (pictured above) a passionate advocate for improved Eating Disorders' services, wrote about the Eating Disorders’ Service review in Wales which had just taken place.

Roll on twelve months, and so much has developed in Powys as a result of this review (you can read the Executive Summary). At our mental health partnership board meeting just before Christmas we were very pleased to find out more about the new services from our colleagues at Powys Teaching Health Board along with Dr Jacinta Tan (Consultant Child & Adolescent Psychiatrist at Aneurin Bevan Health Board) who led the Review Team, Menna Jones (newly appointed National Clinical Lead for Eating Disorders) and Helen.

The underlying principles which people wanted

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

In total there were 22 recommendations made by Jacinta which the government took on board. 

Where we go from here

Eating Disorders’ services were highlighted, as one of five key areas, for additional funding from the Welsh Government’s Mental Health Improvement Fund. There was a specific focus on Early Intervention as an area which the government wanted to prioritise. The first funding stream came through in Summer 2019 and coincided with a large consultation with clinicians across Wales looking at the response to the recommendations as well as some of the barriers that might come up.

In January 2019 it was announced that there would be a dedicated post created to take some of this work forward – a National Eating Disorders’ Lead in NHS Wales. Menna Jones officially started in this full-time role, the first of its kind for Eating Disorders, on 1 January this year, with the placement due to continue until March 2022. Menna’s role will be to work with clinicians, and those using services, to set up an Implementation Plan which sets long-term goals for improving services based on the Review’s recommendations and also facilitating changes to happen.

Some of the key areas include: early intervention, moving to increased delivery of eating disorder services by specialist teams, creation of physical health clinics within Community Mental Health teams, and to join up Child & Adolescent Mental Health Services (CAMHS) and adult services – looking at transitions but also at what can be learned from each of these services around models used and approaches to work.

The vision of the service review

Jacinta emphasized that the plan will focus on equity of access to specialist and high quality care across Wales, including in rurally isolated areas of large parts of Mid Wales such as Powys. There will also be joined-up working with other teams – patients are complex, they have many needs, they have comorbidities (the presence of one or more conditions at once) and it is important to interface with other services such as Autism services. In promoting specialism Eating Disorders Services will not be pulling away from the rest of the system.

The lived experience view from Helen

"From all mental health conditions eating disorders still have the highest mortality rate of any and that needs to be at the forefront of people’s thinking. I started advocating for families because I just didn’t want them to go through what we went through 11 years ago. I now sit on the Executive Committee for the Royal College of Psychiatrists’ Eating Disorders faculty and the European Board for the Academy of Eating Disorders. I really believe in change. I believe we can get it right in Powys. And I know (from my daughter’s experience) that recovery is possible." 

Plans for Powys 

Sam Shore – Head of CAMHS

Currently CAMHS has an eating disorder element to the service already, including specialist practitioner support and our own CAMHS dietician as well as support from psychology. Each CMHT does have a link eating disorder worker who will give advice to anyone open to adult mental health services and support any new referrals into the service.

Practitioners link with GPs for support in the first instance if someone’s physical health is deteriorating.

Following receipt of additional funds, however, we now are going to develop a specialist Eating Disorder Service, which is going to be an age-less service. We want to address issues such as transition and early intervention. We will be working more closely with GPs in Powys, and looking at our referrals into the service.

Following receipt of funding the following new posts have been created and we will be recruiting very soon:

• Team leader.
• Specialist practitioner.
• Dietician.
• Occupational therapist technician.
  
  

We’ve been working closely with Helen too and listened particularly to her tips and hints on moving forward. So we have an idea of what the new service will look like in terms of family intervention and family work. Menna has also offered to support us in the development of the service.

Whilst normally we would have 4 – 5 on our caseload we are actually working with 20 children and young people at the moment (mid December 2020). Covid has had a massive impact on the referrals and they are very complex – there are significant physical health issues, family dynamic issues and cases of anxiety as well as eating disorders.

Joy Garfitt – Assistant Director Mental Health & Learning Disabilities' Services

The model we’re going for is a small dedicated team of specialists who can link to the national Eating Disorder team. Within our five CMHTs and our CAMHS teams we have a small nucleus of specialism, whilst others practice as general mental health practitioners, so we’re creating a staff team which has a general mental health practice element to their role and a special interest element to their role. The special interest might be eating disorders, or perinatal, or trauma-informed services. This means that community psychiatric nurses, and social workers in the field, can also access that specialist support locally in Powys. We can’t provide an eating disorder service in every CMHT as might happen in a big city, so that’s why we’re looking at a different model. 

All in all it was great to hear the enthusiasm and commitment to reshaping Eating Disorder Services, not just in Powys, but across Wales, and we look forward to receiving further updates as the new team settles in and starts work.

Eating disorders' services review in Wales

by guest author Helen Missen

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

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

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

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

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

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

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

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

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

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

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

That petition is still running.

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

However, things are changing! 

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

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

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

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

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

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

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

At last people were given a voice.

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

The underlying principles which people wanted:

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

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

What does this mean for Powys?

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

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

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

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

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

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

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

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

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

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

It works both ways!

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

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

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

A small stone makes a large ripple. 

Further help

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

BEAT is the UK’s eating disorder charity.

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

Powys Patients' Council - a new approach

John Lilley (Patients' Council Volunteer), Owen Griffkin (Participation Officer) 
& Rhydian Parry (Patient's Council Volunteer)

by Owen Griffkin - Mental Health Participation Officer

There is a quote that used to rattle around in my mind when going through difficult times that goes something like:

"In the depth of winter, I finally learned that within me there lay an invincible summer."   Albert Camus

I was reminded of this quote attending the latest Powys Patients’ Council meeting at Bronllys Hospital’s Felindre Ward recently, where the weather flipped between a Powys winter and an Indian summer throughout the afternoon. It’s obviously a well-written quote about resilience and recovery, and when a person is staying on an acute mental health ward the ‘invincible summer’ can seem like a long way in the distance. 

This is why it is hugely beneficial for the Patients’ Council to be staffed by volunteers who have experience themselves of staying on Felindre. The patients often express surprise when told that John or Rhyd, our amazing volunteers, were once patients themselves. 

People are more likely to open up and share their experiences on the ward, and to see other people who are further along in their recovery can give them hope for their own future journey. John had several personal discussions with people about his own experience on the ward, and this can be as much an important part of our visits as raising housekeeping issues.

A new approach

We experimented with a new format for the meeting this month, and also a new venue, as the recovery room was temporarily out of action. This meant we sat in the main common space which led to more group discussions. The tray of cupcakes helped as well! 

The recovery room being out of action was one issue raised, and this is hopefully in hand and back in use by now. We had requests around WiFi connection and access to devices so we will be looking at how this develops.The health board has a strong firewall, as you would expect from a large organisation that is reliant on Information Technology, and this can cause restrictions to content that people on the ward can access. Maybe as mobile WiFi becomes more advanced we can look at an independent network.

Another issue was a request for bird feeders out in the front. We had added some with the help of the League of Friends' committee at Bronllys so we were surprised to hear they had gone. We were told this was due to concerns from previous patients about vermin, so we are researching a solution to this age-old problem.

There were also concerns about the set times for smoking (currently 15 minutes every hour) and the response was that this is due to health and safety and staffing issues. We will have to monitor if this will change once the new indoor smoking ban comes into being and how smoking breaks will work then.

There were two other maintenance issues raised, one of which was being fixed as we left, which is a quick turnaround. The Occupational Therapy kitchen issues, which had led to it being out of use for a few months, have now been fixed.

We will be back for the next Patients’ Council meeting at the end of October, when there is likely to be a new Occupational Therapist in position on a permanent basis. We hope this role will mean that there is a quality programme of activities on the ward and will help to support this in any way that we can.

Find out more

I post regular updates about the Patients' Council meetings on our mental health website. If you would like to find out more, or volunteer for Powys Patients' Council, then you can contact me by emailing owen.griffkin@pavo.org.uk or ringing 01597 822191.

Welsh Ambulance Service on mental health - Keep Talking

This New Year we start by promoting the theme that talking is vital when our mental health is low and particularly when we feel things are heading out of control and into crisis. Sometimes we forget that staff working in the emergency services, and intervening to help people in the middle of a crisis, may well be struggling with their own mental health issues. 

Here at PAVO Mental Health we honestly believe that any of us, not just 1 in 4 of us, could potentially struggle with mental health issues at any point in our lives. But that aside, we agree with everything else Steve tells us, and are particularly keen to share an extremely powerful film. It features WAST colleagues speaking out about their own mental health struggles, and explaining what really helped them, when life's challenges began to feel too overwhelming. Over to Steve at WAST:

I’m Steve Clarke and I’m Head of Mental Health for the Welsh Ambulance Service. I joined the Welsh Ambulance Service in April 2018, having previously held positions in London mental health trusts, and in mental health charities, and I was previously Deputy Director of Mental Health for England. 

Steve Clarke, Head of Mental Health, WAST

As Head of Mental Health for the Welsh Ambulance Service, my role entails the delivery of the Mental Health Improvement Plan for the Welsh Ambulance Service, which has three broad areas: 

1. The mental wellbeing of our staff. 
2. Our mental health practice. 
3. Our mental health pathways. 

This involves ensuring that our staff have access to the right treatment and the right care at the right time, ensuring that they are equipped to deal with people that have mental health problems in whatever environment they are working in, and to make sure that we work in concert with our partners in the health boards to make sure that we’ve got referral routes-on for people so we don’t just convey them to an Emergency Department. 

Since joining WAST I have been working to raise awareness of mental health problems within our workforce, and in particular to highlight the importance of talking about our mental health as an important step in de-stigmatising the subject. It is estimated that 1 in 4 people will experience a mental health condition at some point in their lives, and many of the people we work with every day will be experiencing mental illness, crisis and distress. However, some of us find it difficult to talk about our own experiences, for fear of being judged or that our employment will somehow be affected. 

Our staff made this film to try and break through some of these challenges. Talking frankly about their own experiences, people from across the Welsh Ambulance Services NHS Trust (WAST) wanted to let others know that talking to someone really helps, that support is available and your colleagues, managers and families will support you. You can view our film below – please share it, encourage others to watch it, and above all listen....

Steve's piece was originally published in the Winter 2018/19 edition of Network News, the Welsh Ambulance Service's Patient Engagement & Community Involvement team newsletter.

Read more about mental health and the Welsh Ambulance Service Trust in a post by Isobel Jones, who works for the WAST Patient Engagement & Community Involvement team.

Powys Patients’ Council - Kindles, smoking ban & more

by Owen Griffkin, Mental Health Participation Officer

I have been facilitating Powys Patients’ Council, with the support of volunteers Rhydian Parry and John Lilley, since early 2018 as part of my role in the Powys Association of Voluntary Organisations (PAVO) mental health team.

Powys Patients' Council aims to give a voice to patients, currently in Felindre Unit at Bronllys Hospital in Powys, who are offered acute in-patient mental health services. Regular patient-only meetings give people an opportunity to express their views on the services they receive whilst they are in hospital. These views are then passed on anonymously to ward and hospital management staff, in addition to senior Powys Teaching Health Board (PTHB) staff, so that solutions can be found.

Owen Griffkin

It was a sweltering day for June’s Patients’ Council meeting and the ward was close to capacity. This was the first Patients’ Council session since we had left a suggestion box on the ward, so there were more issues than usual to deal with. Having the suggestion box means we can address issues or concerns that we might have previously missed from people who have had short stays on the ward. It can also follow that these might have been dealt with already, as was the case with a note about the heating being on in rooms at night.

Another note praised the caring environment and professional staff which the Patients' Council were pleased to pass on to the new permanent Ward Manager, Lisa Hale.

Concerns raised in the meeting included a lack of activities, the annoyance of an office door banging and not being allowed devices with cameras in communal areas due to privacy reasons. As all modern tablets/phones have cameras this unfortunately means no devices can be used in the day room. We have sent out an appeal over Facebook and Twitter to see if anybody has any 1st generation Kindle Fires as these tablets didn’t have cameras, so hopefully we will get some response to this. We are looking into raising some money for activities provided by an external facilitator as this will leave the ward affected less by staff leave and sickness.

Lisa Hale, Felindre Ward Manager

There has been a new advocacy service commissioned by PTHB and delivered by Conwy & Denbighshire Mental Health Advocacy Service (CADMHAS) and this was praised by patients who found it very good and non-judgemental. We spoke to Adrianne Cleverly who provides the service in Powys recently in How can mental health advocacy help you?

Proposed smoking ban in hospital grounds

The Patients’ Council is also attending an extra meeting this month to discuss smoking in the light of the recently announced news about banning smoking on ALL hospital grounds.

As this will include acute mental health in-patient wards such as the Felindre Ward, it is important that people associated with the ward(s) voice their views in relation to this consultation. 

The ban is due to come into force in Summer 2019, and this will give ward managers 18 months from then to ensure there are alternative measures in place to replace existing indoor smoking rooms, and that outdoor areas fall in line with the new rules. One of the proposed rules will prohibit an outdoor smoking area from being within 10 metres of any hospital building. This will mean that if there is no exemption for mental health wards it will be impossible for there to be a secure smoking area that people can use without staff members present and this creates other issues relating to staff health and second-hand smoke. 

I will be working with the Patients’ Council to look at the possible impact of these rule changes, and how the hospital can offset the disruption and distress that it may cause to people on the ward and potentially other wards/mental health facilities across Powys. This will very likely be a contentious issue and it will be interesting to see how other hospitals in Wales deal with it. If you have lived experience of an acute mental health ward, and would like to contribute to the consultation, please email owen.griffkin@pavo.org.uk or ring 01597 822191 with your comments or for more information.

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