A busy summer for our mental health reps

by Owen Griffkin, Mental Health Participation Officer

The Mental Health Service User and Carer Representatives have had an enormously busy summer so far this year. I have been with them all over Powys helping them get out and about around the county.

When I first started in my role as Mental Health Participation Officer in 2017 it seemed that I was constantly out and about around Powys. Most of my work involved attending meetings or events either on my own, or accompanying the mental health reps to their meetings. Obviously lockdown meant that much of work life moved online, and one benefit of this was that lots of these work meetings continued online. This allows us to have people from all over Powys, and sometimes Wales, present at a discussion instead of having to travel to Llandrindod, or Newtown or wherever the meeting is. This is really useful in some situations, and it has allowed the reps more access to people working in Mental Health services in Powys.

Unfortunately, there was also a downside, as there was less opportunity for the reps to speak to people in communities which is the most important part of their role. That’s why it has been so refreshing to start running Meet The Rep events all over Powys, and to start attending community events with the reps. I think I have driven more miles in the last month than I did in the previous year.

Sally and Sarah at the Help & Information event in Machynlleth

The current reps - John, Sally, Sarah and Rhydian, decided that they wanted to get back out and make sure people knew who they were, and who they could speak to if they wanted to have a say in the way the Mental Health service is delivered. Therefore in June we held two Meet The Rep events in Newtown and Welshpool Ponthafren, and also attended a community Help and Information event in Machynlleth and a Pride Picnic organised by Credu at Llanfyllin Workhouse.

The reps set up stalls full of information about their roles, and spoke to people about their experiences of mental health services. There were activities as well that were relevant to the event. For example at the Pride Picnic, Sarah made some paper fortune teller origami sets. These were fun and dispensed tips on self-care as well as drawing people to our stall.

Sarah Dale said: "We as reps have been extremely busy in the north of Powys, out meeting people and discussing the work we do and some of you shared your views on the service. I believe as reps we cannot represent mental health service users and carers without gathering feedback. Every piece of information we gather does make a difference. Sometimes we may be able to help get you in touch with other organisations that may be able to help such as community mental health advocates. I understand that from the outside you may not know what happened to your feedback. I want you to know I try my very best to ensure each issue is addressed and actions taken to ensure that the service is fit for purpose.

I really enjoy organising activities for community engagement and meeting different people and networking with local organisations. I like listening to other people's experiences. Just listening can make a person in a difficult situation feel less alone, and talking to someone who has no affiliation with a specific organisation (I am just another service user) makes them feel more heard and understood, and brings that trust that we will ensure that their voice is heard. It can give people hope.

After a long break hopefully you will see us out and about again real soon.”

Sarah and Sally at the Pride Picnic in Llanfyllin

The serious part of the events was making sure that we gathered feedback from people about their experience in Powys and added these to an issues log. This issues log is then taken to a quarterly meeting with the Service Managers for Mental Health in Powys and any actions that are taken due to the feedback are noted and can be reported back to the person who gave the feedback in the first place.

Sally Houghton-Wilson said: “Having attended a few events, it's been really helpful to understand people's opinions, point of view and feedback on how they are finding the services, and what works best for them, what hasn't been helpful, and what their expectations are. It's nice to learn all about their experiences. And gives a clear indication of what's lacking within the system.”

The reps have also been continuing with their normal duties, attending Engage to Change and the Mental Health Planning and Development Partnership, which takes up a lot of their time. In fact, the reps now chair the Engage to Change meeting. (The Engage to Change group has been established to more widely promote the Mental Health Planning and Development Partnership’s activity, to proactively challenge any stigma associated with mental health and to collect service user views / experiences, co-ordinate resolution and feedback on resulting change, to people using services).

There have also been three Patients’ Council meetings where the reps listen to people’s experiences on the Felindre Ward.

Sarah delivered three Self Injury Awareness sessions to foster carers, staff from Child & Adolescent Mental Health Services’ teams and school nurses. These have been very well received and are helping to give people who are likely to come into contact with people who self harm the knowledge they need to have a caring and compassionate conversation, and not judge the people they speak to.

John and Josh at the Wales Mental Health & Wellbeing Forum in Llandrindod

It was also a pleasure for Powys to host the quarterly meeting of the Wales Mental Health and Wellbeing Forum in Llandrindod. This national group is a chance for all the service user reps from around Wales to meet and discuss what is happening in their area, and prepare reports that are sent to the Welsh Government. As Powys was the host, it fell upon John Lilley to chair the meeting. John gave an overview of co-production in Powys Mental Health services and there was a lot of approval from the group in regards to the work we are doing here.

John Lilley said: “Having attended several national forums in the past, and chairing one online during Covid, I knew roughly what was expected when it came to chairing in person. I was still a little nervous when the date came round and was grateful for Josh from Practice Solutions (who facilitates the forum) for co-chairing and Owen’s help in the regional update.

Knowing most of the attendees certainly helped calm the nerves and on the whole, I enjoyed the experience, though being a hybrid meeting I found it challenging to monitor the online screen for hands raised but with help from Josh I managed.

At times it was difficult to keep discussions relevant and on time but with gentle reminders of the agenda this became easier. Would I do it again? Yes and I also recommend people to try it. I found it a great learning opportunity and it boosts one’s confidence.”

Summer is traditionally a quiet time for the reps, a time to reflect on the year so far and plan for the future. However this summer they have really gone above and beyond what is expected of them in their roles, proving how much they deserved to receive the Outstanding Contribution award at this year's Powys Volunteer of The Year Awards.

If you would like to get involved in having your say in services, and be informed when there are future vacancies, then please fill in this expression of interest form here.

Shared Power - an introduction

The Health and Wellbeing Team at Powys Association of Voluntary Organisations is pleased to announce the launch of a new animation film called "Shared Power - An Introduction".

PAVO’s Mental Health Participation Officer, Owen Griffkin, who worked on pulling together the different elements of the film, explains why this was an important subject to make a film about.

For some time now PAVO has delivered training to the service user and carer representatives who sit on the local health and wellbeing partnership boards. These people have a seat on the boards to provide a voice for anyone who uses these services and their input is vital to ensuring a health service that is fit for purpose and effective. We called this training ‘Shared Power’ training and it was designed to give people confidence and knowledge when taking part in high level planning meetings.

When we delivered this training we would often look at the nature of power, and how different types of power interact with each other. One of the theories we discussed was called the POWERCUBE, which expanded on previous theories around the different forms of power. We found that this theory often provoked some interesting discussions, although it could sometimes seem quite daunting when presented in a training session. Therefore, when the opportunity arose to apply for a training grant from the Powys Area Planning Board, we thought that making a short film looking at this theory might be useful in future training courses. 

We also wanted to aim the film at professionals who sit on these boards, so that they could avoid some of the barriers presented by power imbalances that might exclude service users and carers from engaging with co-production opportunities.

We were successful with the funding so we began working with current representatives from the main health and wellbeing partnership boards to get their input on how the film should progress. (These boards include the Mental Health Planning and Development Partnership, the Regional Partnership Board and the Area Planning Board).

We thought an animation might be a good way to highlight the important points, using the opinions and voices of current and past reps, and we hoped to involve the reps in all creative aspects of the film-making process. We worked with Jim Elliott, a Powys-based animator and musician, and I held interviews where possible with the reps so we could use their voices (and likenesses). Unfortunately we were now in the midst of the COVID-19 lockdown so some of the original ideas were hard to do, and the reps weren’t able to be as ‘hands-on’ with the animation as we wanted to, but they still had input into the look and feel of the film.

We had discussed some of the old 1970s Open University graphics as a starting point for the aesthetic of the animation, and decided on a ‘stop-motion’ process to animate the talking head pieces. We also ensured there was a full Welsh version and worked with a local actor from Mid Powys Youth Theatre to provide the Welsh narration.

The initial reaction has been really good, and we plan to use the film in future training sessions as a way to break up the day and provide a break to whoever is leading the training. We hope that other organisations in Wales might want to use the film as well. To help with this we also produced some training materials that can be downloaded from the Powys Mental Health website - Shared Power additional materials.

If you would like to know more about the shared power training please contact mentalhealth@pavo.org.uk

You can view the films in English:

And Welsh:

A look into Borderline Personality Disorder (BPD)

© Sarah Dale

Sarah Dale

Sarah Dale is a citizen rep in Powys – an unpaid volunteer who sits on the Powys Mental Health Planning & Development Partnership to share the voice of lived experience. As a citizen rep Sarah previously sat on the Wales Mental Health & Wellbeing Forum (formerly the National Mental Health Service User and Carers’ Forum).

Sarah has also worked incredibly hard over the past few years as a regular contributor to the Engage to Change group, which is a sub-group of the PMHPDP. This group was established to "more widely promote the Mental Health Planning and Development Partnership’s activity, to proactively challenge any stigma associated with mental health and to collect "service user" views / experiences, co-ordinate resolution and feed back on resulting change to people using services."

And during the Covid-19 pandemic Sarah has also created and delivered a hugely valuable training session on Self-Injury Awareness to many of those working in the provision of statutory mental health services in the county. Sarah is absolutely passionate about raising awareness of mental health issues and brings an honesty and openness to the work which allows greater understanding for all those watching / reading / exploring more about these issues.

© Sarah Dale

Sarah's experience of Borderline Personality Disorder (BPD)

Sarah's latest project is an indepth look into Borderline Personality Disorder to promote during Borderline Personality Disorder Awareness Month this May.

"You are probably wondering... "what is Borderline Personality Disorder? And you are not alone. This is the response I get when I tell people I have BPD, and yet I still haven't been able to accurately explain what the disorder is, and how it affects me. 

The reason you probably haven't heard of the disorder is that most people with (BPD) have experienced a lot of stigma. Often being described as 'manipulative', 'attention seeking' and 'incurable'. You have probably seen over the years, celebrities opening up about their depression, anxiety or bipolar disorder, thus more people are speaking up about their own struggles.

However, no one wants to talk about the more 'scary' or 'shameful' issues like self-injury, eating disorders, psychosis and personality disorders."

After exploring What is BPD? Sarah considers why it has this particular name, what it's like to have BPD, some of the feelings that people with BPD experience such as extreme emotional instability, fear and abandonment, and people's struggles with a sense of identity. Sarah then turns to the positive side of BPD and explores the empathy and compassion that people with the condition experience, plus an often increased creativity. To finish off Sarah debunks some of the commion BPD myths, such as that people with BPD are incurable and / or attention seeking.

You can read the whole piece, A Look into Borderline Personality Disorder (BPD), on our Powys Mental Health website.

If you have any queries for Sarah, or experiences to share, then do pop them in the comments' section below.

© Sarah Dale

Read more from Sarah

Sarah has written for this blog previously on:

The Wales Mental Health & Wellbeing Forum – an update

Together for Mental Health consultation - a Powys view

On the Experts by Experience panel

And on the PAVO Health & Wellbeing blog:

Self Injury Awareness 

You can also catch up with Sarah on her Facebook page - Sarah Mental Health Rep.

Introducing SilverCloud – online Cognitive Behavioural Therapy

Becka Williams, Project Manager, SilverCloud CBT

Last month I was pleased to accept an invitation to attend a Mental Health Partnership Board meeting at our Llandrindod offices, as it gave me the chance to find out more about the new online Cognitive Behavioural Therapy offering in Powys. It is called SilverCloud. 

Becka Williams, the Project Manager overseeing roll out of this new service across the county, gave us some background, an update on project progress and outlined plans for future development.

It was an interesting session to learn more about the new service, as individual representatives attend this quarterly partnership meeting. The reps are people who either have used, or care for somebody who has used, mental health services in Powys. Their role is to make sure user/carer voice is included in the planning of services, and here they were able to voice some immediate thoughts about online CBT.

Joy Garfitt, Assistant Director of Mental Health Services for Powys Teaching Health Board, began by explaining that CBT is a therapy that can help us think differently, particularly if we have unhelpful thoughts.

Background

Some regular readers may remember that we wrote about an earlier provision of online CBT in Powys, which was called Beating the Blues. This 3 year pilot scheme was spearheaded by a European funded project called Mastermind, but unfortunately engagement with this model was not brilliant. Out of 543 referrals to Beating the Blues, only 100 people completed the full course. Many disengaged with the process and some did not even start after being referred. Mastermind’s key aim, however, was to implement online therapies in rural areas across Europe, rather than to monitor the effectiveness of the actual CBT programme. But the project was invaluable in that many lessons were taken from this early work to help inform a new improved provision of online CBT in Powys.

In fact, many benefits of online CBT were identified directly as a result of the Mastermind scheme:

• Online CBT provides care closer to home – anytime, anywhere. 
• It reduces the number of unnecessary appointments. 
• It gives almost immediate access to therapy for people. 
• It reduces the travel time of people using services, carers and healthcare professionals. 
• It supports Prudent Healthcare – an approach at the heart of A Healthier Wales, the Welsh Government's long-term plan for health and care. 

The Welsh Government is now providing funding to continue and upscale online CBT not just in Powys but across the length and breadth of Wales. Powys Teaching Health Board is leading on the roll-out of SilverCloud across the country, starting with Powys. The aim is to:

• Increase options available to people experiencing mild / moderate anxiety and / or depression. 
• Reduce waiting lists / times by improving quicker access to therapies. 
• Improve equality of access to mental health care across both urban and rural areas.

Project progress 

SilverCloud online CBT went live in Powys on 1 May 2018. There are now 8 programmes available, including Space from Anxiety & Depression, Space from Stress and Space from Chronic Pain. Since the launch about 300 people have been referred to the programme, which can be accessed on smartphones and tablets as well as computers. Referrers can be GPs, Occupational Therapists, staff in the Community Mental Health, Local Primary Care and Long Term Conditions teams. In future people will be able to refer themselves onto the programme.

At this point in the meeting the individual reps began asking questions about managing risk. What happens if someone is considering self-harming? If it’s midnight? If someone is extremely lonely and this is all they have been offered to deal with their depression or anxiety? Joy described the online CBT as “adding another tool in the box for people”. It might not be right for those wanting face-to-face talking therapy, but others may prefer to do it privately. It is not aimed at people experiencing severe and enduring mental health issues. If someone has complex needs they will be referred to a different service. They may still access SilverCloud CBT but as an additional therapy to enhance what is already being done by mental health practitioners working to provide care in primary (via GP services) and secondary (via Community Mental Health) teams.

From day one when people register on SilverCloud, they have access to all the programmes for 12 months. Staff closely monitor their engagement with the platform for 3 months, but people can provide feedback for the whole period. Risk alerts are set in place, so that if anyone expresses an intention to self-harm they are contacted straight away and referred to a health care professional as appropriate. The service is monitored between 9am – 5pm during the week, but details of support / help out-of-hours are provided. Online CBT is not designed as an emergency response service.

People can write in journals as part of the programme, and choose to share (or not) the content with the online CBT co-ordinator. Some online content, such as the Mindfulness videos, can be downloaded onto a computer for future use. If access to an online device is not available people can use computers with privacy screens at their local libraries and further options will be available at Job Centres ultimately. Regular online reviews take place with the co-ordinator, and phone conversations are also possible. The whole process is confidential unless policies around safeguarding issues and / or criminal intent are set in motion.

Future development

Work is currently underway to further develop some of the strands of the online CBT, including:

• A combination of online CBT and face-to-face counselling, known as ‘blended’ counselling. The health board will be working with third sector organisations to provide additional support to some people using SilverCloud CBT. 
• The self-referral model for those who do not see their GP or access any other help. This will be the first time in Powys that open access is given to such a service and should be available in the New Year. 

Whilst Welsh translation of relevant forms and help pages has already taken place, the platform as a whole now needs to be translated. The design and roll-out of an All-Wales SilverCloud online CBT platform is then the key next step.

And, importantly, Becka is very keen to receive feedback from people who have used SilverCloud CBT, to help inform future development of the online provision in Powys and further afield.

If you have used SilverCloud online CBT and would like to let us know what you think, you can email us at mentalhealth@pavo.org.uk Alternatively contact Becka Williams directly at becka.williams@wales.nhs.uk

And what are your thoughts on online CBT generally? Let us know in the comments box below.

Feedback about SilverCloud CBT 

I found SilverCloud very easy to use and was surprised at how well developed and researched the platform was. 

I have found SilverCloud hugely useful in teaching me ways to improve my mental health and managing stressful situations. I am excited to continue using the skills I’ve learnt. 

I have been feeling more positive since taking part in this programme. I have been able to do simple things like taking the bus and going for a walk alone a lot more easily than about a month ago.

Mental Health Awareness Week 2018

Stress, are we coping?

This year the theme for Mental Health Awareness Week (14 – 20 May), hosted by the Mental Health Foundation, is stress. Research has shown that two thirds of us experience a mental health problem in our lifetime, and stress is a key factor in this.

For many people stress is a part of everyday life, but do we really manage our stress effectively? By tackling stress, we can go a long way to tackle mental health problems such as anxiety and depression, and, in some instances, self-harm and suicide.

The Powys Mental Health Planning and Development Partnership, in collaboration with other partnerships across the county, is exploring how we can all tackle stress and help to improve our mental health. Stress is not a mental health problem itself but is a survival response to keep us safe. But it should not become a way of life. The Partnership asked its members what stress looks like for them and how they manage it.

How do you recognise stress?

• For me it’s about when the day to day things I usually cope with fine start eliciting a greater than normal response. So, maybe I am rushing around and hit my funny bone really hard on the door frame (never funny) and it makes me really anger or want to cry – when usually an expletive muttered under my breath will suffice. Those moments really stand out for me and I know there is something else going on. 
• Usually when I start to lose patience and things annoy me more than usual, particularly my husband! I know that I have been moaning a lot when he says things like ‘can you not ring your mum?’ which means he has done his best to support me but it I now requires a higher level of management. This ‘intervention’ usually works as I can take a step back and get some great advice from people who know me best however sometimes there are physical signs too.

What does stress look like for you?

• Personally, a sense of frustration, a loss of sense of humour and feeling powerless are symptoms I look out for.
• It’s like my emotional cooking pot is full.  There is no room for anything else.  And when something else does happen my emotions can spill over much more easily with less of a filter than they usually have. If I'm stressed I may feel like I have too many things to do and not enough time, so I don’t seem to stop or get any time to myself.  That makes it hard to unwind which can then affect my sleep, making me feel worse in the morning and on the cycle can go unless I do something about it.
• It usually presents in anger / frustration towards a loved one.

What do you do to combat it?

• The most important technique for me to combat stress is to recognise the early warning signs and to take immediate action.  I generally use ‘Resilience’ as a coping mechanism.  This can be by taking a short break, speaking with friends and colleagues or exercising.  For me, it’s being able to adapt to changing circumstances.
• Exercise – specifically going for a cycle ride.
• Learning how to breathe properly. This sounds weird but if I take a minute to close my eyes, breathe in though my nose for 7 seconds and then slowly out through my mouth for 8 this really helps. Walking the dog in the countryside or at the coast makes me feel good too.
• In the past exercising whilst listening to loud music (on headphones) has also helped – this is a good standby in the winter when severe cold or rain encourage stresses to multiply because I can’t get outside in the garden. There are loads of NHS exercise classes for beginners on YouTube and they don’t all involve balancing on a yoga mat with hardly any clothes on looking like a Downward Dog.

What shouldn’t you do?

• Think it will go away if I don’t do anything about it.
• Bottle up worries / concerns – share with others for discussion / solutions.
• Panic. Life is hard. There will be stress in life, embrace it as a natural thing, accept it as a part of you and don’t see it as a failure to cope with things.
• Buy five large chocolate cakes and eat them all at one sitting!! Buy a one way ticket to El Calafate, however tempting it might seem at the time… Scream at your line manager that you hate your job and you’re leaving right now, never to return. In other words…. Don’t be too impulsive. Take time to step back, assess the situation, seek help if that’s appropriate, and then make a plan of action to address the cause of the stress. Then collect empty plastic bottles to turn into mini cloches to keep the mice off the peas and beans…

Do you do any of the Five Ways to Wellbeing to combat stress? If so, which one works for you and why?

• Connect – unwind with friends and husband – talk things through – doing something nice together. Be active – running and walking. Take notice – being in nature.
• Be active. Being fortunate to live in Powys, the opportunities for exercise throughout our glorious surroundings is endless. Being able to walk the Black Mountains, Brecon Beacons or the River Wye footpaths. Being able to get away from things through walking either with our dog or with family is calming and fulfilling. I find exercise an important part of my physical and mental well-being.
• Being creative - More recently I have been getting creative, remembering how much I used to love Art in school I thought I’d give it a go now. Finding the time to paint is good because I’m preparing to make a relaxing bit of space and time. I get everything I want to done and the whole time I’m doing this I’m looking forward to creating something.

What would be your top tips for managing stress?

• Exercise – it’s hard to motivate yourself to start but if you can find a way to build it into your weekly routine it can be hugely effective.  Particularly if you can get out into Nature.  For many people exercise seems to use up excess emotion leaving you feeling calmer and more in control. Nature has been shown to have many beneficial effects, not just on our mental health, but also on our physical health. We evolved in Nature (green trees and soft curved lines) not urban environments, and we relax and feel better when surrounded by it.
• Do something you love and get lost in it – be it football, craft, reading…. You will be totally absorbed by it for a while so you don’t think of anything else.

• As a Police Inspector, I must be accessible to colleagues and a point of contact and support when people are under stress.  I must recognise incidents which could have a negative impact on a person’s well-being and ensure that the correct support intervention is provided.
• I personally rely on making a list of things to do and I then prioritise what must be done first.  This helps me to turn what appear to be unmanageable tasks into something less formidable.
• Try and get away from whatever you are working on for 10 – 15 minutes at lunch time – go for a short walk, run or cycle – whatever takes your mind of what you are currently doing!
• When you wake up in the morning (and go to bed at night) think of 2 – 3 things that you are really grateful for.
• Be as kind to yourself as you possibly can. Imagine you are another person (or animal if that’s easier) you love and care for. You want to do the best you possibly can for that person/animal. So what would you do? I am often guilty of putting myself under further pressure if I’m stressed, as if it’s all my fault and I need to suffer further! But whilst I might sometimes be responsible (I can’t grow 30 of my favourite vegetables successfully and fit everything else in my life, but maybe 10 would work) sometimes the stress has an external source. Pluck up courage and talk to anyone involved in making your life stressful, or, if that’s not possible, try and stay out of that person’s way!

Any other comment?

• Laugh. With colleagues. At that very funny radio comedy. At your own jokes even if nobody else thinks they’re the slightest bit funny. When the cat’s head gets stuck in a margarine pot (but do rescue that cat promptly).  When you all try a new sport and end up on your backsides, your head, in fancy dress or covered in apricot jam…. Be weird and wonderful and wacky sometimes, because you can (only if it’s legal though!) Just because life is hard sometimes, remember to take a breather and HAVE FUN!!

Tell us what you do to relieve stress in the comments box below.

Together for Mental Health is the Welsh Government’s 10 year strategy to improve mental health and well-being in Wales.

In Powys, there is a Mental Health Planning and Development Partnership in place to deliver the strategy locally and prioritise activity to meet the needs of Powys communities. One of its main objectives is to build strength and resilience, promoting mental and emotional health and wellbeing of individuals and communities across the county. 

Thank you to Mary Griffiths (Mid Powys Mind), Inspector Brian Jones (Dyfed Powys Police), Louisa Kerr (Powys Teaching Health Board), Jackie Newey (Powys Association of Voluntary Organisations) and Joe Wellard (Powys County Council) for their contributions to this blog post.

Back to the Floor: Katie Blackburn, Powys Community Health Council at Newtown Community Mental Health Team

Katie Blackburn (top left) with Newtown Community Mental Health team

In August last year I observed Superintendent Jon Cummins go Back to the Floor at the mental health inpatient unit in Powys, Felindre Ward, and wrote about the idea behind the activity and Jon’s experience on this blog. Put simply the concept is that Chief Officers, Service Directors and other high-level staff have the opportunity to experience a day in the life of a member of staff at the operational end of a service. This gives them the opportunity to find out what is really happening on the ground, and what consequences strategic decision-making can have on people who are in receipt of a service.

In late 2017 I was pleased to observe Katie Blackburn, the Chief Officer of Powys Community Health Council, go Back to the Floor at Newtown’s Community Mental Health Team. The county CHC is the “Healthcare Watchdog for Powys - an independent statutory organisation that represents the interests of patients and the public in the National Health Service in Powys”. Katie has been in post since January 2017.

Lauraine Hamer, Senior Practitioner AMHP (Approved Mental Health Professional) at the CMHT, met us at the start of the morning with details of what she had planned for Katie’s visit. This included chance to find out more about her work and that of her colleagues, plus an opportunity to join a Multi-Disciplinary Team meeting and also to accompany a Community Psychiatric Nurse on a visit to a client. In the event we had to stay flexible as circumstances changed throughout the morning… but such is life at a busy mental health service.

Before the visit: Katie’s view

I had no idea about the work of this particular CMHT in Newtown before my visit. From my previous life, I have an understanding of the roles of CPNs and social workers. I was CEO of a drug and alcohol charity and mental health is an issue there. To a lesser extent with The Prince’s Trust, I was working with vulnerable young people in the care system.

I was very keen to shadow and meet the team and listen. I felt that perhaps I could ask questions that other people were perhaps uncomfortable asking.

The key barrier I am aware of – which I know of from my domestic abuse background – is that whilst aspiring to put individual people at the heart in reality individuals are often bounced from pillar to post. For example, they might have to continually provide their national insurance number, or relate details of stressful events to different people. The journey should be (and could be) much smoother and easier. Sometimes we need to make a decision there and then, which might not fit in with governance and procedure. For example, the question of who pays to get people from A to B often comes up. If there is an individual who needs to be transferred from Brecon to Nottingham……who pays? Agencies can become tied up in which budget is paying for this journey and can lose sight of the individual’s needs.

When it comes to strategic issues, I am not aware of any recent changes within the CMHT, but, I am aware of, and have been involved with the development of the Health & Care Strategy and the intention to align health and social care in Powys. It will be nice to see the operational impact of that.

I am conscious that services are very stretched because of pressures on staff and budgets, and that things can sometimes become more complex and complicated than they need to be.

I hope that Powys’ Health & Social Care Strategy will bring change – whilst recognising that not everyone likes change; there is a risk of unsettling an already stretched workforce.

There will undoubtedly be a growing use of digitisation going forward – however, it’s about putting the individual first. With regard to a future workforce we need to identify what skills Powys needs.

Lauraine Hamer and Katie Blackburn

Back to the Floor exercise

Lauraine is an extremely experienced and knowledgeable Senior Practitioner, and was able to give Katie a very thorough grounding in the work of the team at Newtown CMHT. At the MDT meeting we met CPNs, members of the North Powys Crisis Resolution Home Treatment Team, Admin staff, a trainee AMHP, Social Workers, and a Support, Time and Recovery (STR) worker. Later we learnt more about the Accredited Accommodation Scheme* from the Co-ordinator Wendy Laws, and Katie spoke to Dr Fran Foster, a Consultant Psychiatrist.

Unfortunately, we were unable to shadow CPN Kelle Hall on a home visit to a client. This was due to a last minute change in the person’s circumstances.

After the visit: Katie’s view

When deciding whether my understanding of what the services does is correct, I think “no” is the simple answer. There were elements of it that I knew, however, other elements were new to me. Staff in the MDT meeting worked co-operatively very well together. Particularly when sharing information - the team focussed on the needs of the individual rather than their specific jobs.

The “seeing is believing” approach is very important. It would have been nice to sit in on a visit with an individual using services, but I understand the issues around confidentiality and the vulnerable lives people lead.

My main observation is that the people in this team are doing the best they can in the circumstances. There is clearly an issue around staff capacity. Other obvious issues include – cross-border, cross-boundary provision and the lack of in-county beds for people. In the MDT meeting, the real focus was on the discussion of high-end/vulnerable situations and not on the preventative side of the service. I wonder if there is an opportunity for reflection and discussion on what might have prevented a specific situation and what changes could be made in the future (if any)?

Staff are very much dealing in the here and now. They are not looking at people’s pasts or where they might be in five years’ time. I wonder - is there an opportunity to look at where resources should be channelled?

This experience will definitely mean I’m able to contribute more effectively at times when strategic decisions about services are made. I am a big believer in real-life examples. There are also pressures on recruitment for the CMHT. There appears to be an element of disjoint between strategic and operational. The staff clearly work well as a team, and there are a number of opportunities to build on (and share) existing good practise across Powys. In addition, their working environment is extremely poor, despite this, it strikes me that they are a dedicated, professional team doing their best in the circumstances.

Going forward, I am keen to do something in my role at the CHC around listening to vulnerable voices. There is definitely an opportunity to start with this service - certain groups do not access our service or receive support including young people and young carers. Listening to Vulnerable Voices will be a priority for Powys CHC in 2018-2019.

* Wendy Laws co-ordinates the Accredited Accommodation scheme in Powys, which is the only one of its kind in Wales. People supported by secondary mental health services are entitled to access day visits or overnight stays with registered accommodation providers who have their own lived experience of mental health distress. People accompany their hosts on shopping trips or days out to the seaside, for example, and enjoy a caring and nurturing environment. This service prevents hospital admission and people have described the incredible benefits of feeling part of an extended family.

FIVE on Five Ways to Wellbeing

Have you tried the Five Ways to Wellbeing yet? 

Five members of the Engage to Change sub-group, of the Powys Mental Health Planning & Development Partnership, write about their experiences.

Be Creative and Give: Louisa Kerr, Mental Health Partnership 

Being creative can mean many different things to different people. We are all creative in one way or another whether it be by applying innovative or imaginative solutions to problems at work, to inventing a new recipe for the family to try.

I used to love to draw but a busy life has meant I haven’t picked up a pencil for anything other than work for many years. With the Five Ways to Wellbeing in mind, I decided to have a go at drawing a picture for my sister’s birthday, she has a lovely West Highland Terrier called Gwyn – I attempted a little sketch of him and thought well if it turns out rubbish I can always get her something else!

Finding quiet time to do the drawing was difficult at first. I felt guilty for not doing other things, like housework, but I quickly found that I could do as little as 5 minutes and enjoy it, or on the weekend, get a load of other stuff done and then have an hour to myself without worrying. Thinking about nothing else but the picture was brilliant, very relaxing and I was shocked to find that what I was creating looked like a dog! Thankfully she loved it and it meant a lot because it was personal. I’m glad I gave it a go and would recommend finding time for creative things like this to other people.

Be Creative and Learn: Penny Price, Senior Nurse for Adult Mental Health Services in South Powys, Powys Teaching Health Board 

Continued learning through life enhances self-esteem and encourages social interaction and a more active life.

Anecdotal evidence suggests that the opportunity to engage in work or educational activities particularly helps to lift older people out of depression. The practice of setting goals, which is related to adult learning in particular, has been strongly associated with higher levels of wellbeing.

I belong to 2 am-dram groups in Brecon: Westenders and Brecon Little Theatre. Being part of these groups has offered me so many benefits. I have met a whole range of different people, younger, older and the same age as myself. My friendship group has quadrupled in the time I have been part of these groups.

Westenders is the bigger of the 2 groups with the most members, they have been putting on a yearly pantomime in the theatre in Brecon for over 75 years. Being part of Westenders has built my confidence over the years. Getting up on the stage in front of 400 people, 8 shows a week, is no easy thing, but once you have done it the feeling you get from the audience clapping and cheering is amazing.

Being in the pantomime is a real stress buster, we have rehearsals on a Monday and a Wednesday and sometimes I think I really can’t be bothered with this because I’m tired or work has been busy but I have to go because I don’t want to let people down. Once I get there all of my stress and tiredness disappears because of the atmosphere, the people, the dancing and singing.

Brecon Little Theatre makes me feel more creative. We are a little group with very little money so we have to make all of our props and scenery with very little money. We recently put on a production of Roald Dahl’s ‘The Twits’. For this we needed to design a Roly Poly Bird and other birds. We involved the children who were taking part in the production. I designed the Roly Poly Bird and suggested to use crisp packets for the feathers. Everyone was encouraged to bring in their empty crisp packets (not very healthy I know but a good way to recycle) and together we made the bird by stapling the shredded crisp packets to the frame. Everyone gets involved and there’s a real camaraderie about it. Every production, whether I am acting in it or part of the production team, makes me swell with pride because we have done it ourselves. Our last production of The Twits had such great reviews. I was assistant director and it was amazing, I was so proud of everyone involved.

I have also learnt so much from both groups, from child protection issues around changing rooms and restrictions on the hours of performance, to finance issues around hiring of venues and storage of costumes. I can honestly say joining the groups has been one of the best things I have done.

Connect : Jackie Newey is a Mental Health Information Officer with Powys Association of Voluntary Organisations

There is strong evidence that indicates that feeling close to, and valued by, other people is a fundamental human need and one that contributes to functioning well in the world.

It’s clear that social relationships are critical for promoting wellbeing and for acting as a buffer against mental ill health for people of all ages.

Here I am (standing far right) with fellow trustees at The Quilt Association recently. The charity’s home is The Minerva Arts Centre in Llanidloes not far from where I live. I have been a trustee since 2006, after starting volunteering there in 2003. 

For me it’s all about connecting with people in my community and particularly those with a keen interest in the creative arts. I probably get far more out of volunteering with the charity than I put in. The biggest buzz is seeing the Centre alive with happy, busy people – whether that be at an afternoon quilt documentation workshop, the popular annual World Textile Day or a group of college students being inspired by our latest exhibition. It’s clear to see straight away in these situations that the wellbeing of these individuals is enhanced by the social interaction, creative activity and learning opportunities. But the two words “mental health” never get uttered by anyone!

Be Active: Anne Woods is a Participation Officer in the mental health team at PAVO

Regular physical activity is associated with lower rates of depression and anxiety across all age groups.

Exercise is essential for slowing age-related cognitive decline and for promoting well-being.

But it doesn’t need to be particularly intense for you to feel good - slower-paced activities, such as walking, can have the benefit of encouraging social interactions as well providing some level of exercise.

I play football for Hay St Mary’s LFC and have done for the last two seasons – the team’s first two seasons in competitive football. We play in the Mid West Counties Female Football League and travel to matches as far afield as Worcester and Kidderminster. This photo shows me (in green and white) about to tackle a Kidderminster Harriers player, in a game we went on to lose 3-0; a good result against the team at the top of the table.

I enjoy being active. As well as helping to keep me physically fit, playing football develops mental toughness, determination, resilience and allows me to tap into my competitive spirit. It goes without saying that team work is essential and so connecting with others (another of the Five Ways) on and off the pitch, looking out for each other and good communication is also important. Plus it’s fun! Exercise releases endorphins and makes us feel better (although when we’re losing, and it’s raining, it sometimes makes me wonder…).

Be Active and Take Notice: Tim Williams, Community Safety Officer 
Mid and West Wales Fire and Rescue Service

Reminding yourself to ‘take notice’ can strengthen and broaden awareness.

Studies have shown that being aware of what is taking place in the present directly enhances your well-being and savouring ‘the moment’ can help to reaffirm your life priorities.

Heightened awareness also enhances your self-understanding and allows you to make positive choices based on your own values and motivations.

Next bank holiday weekend, I intend to cycle to Stratford upon Avon and visit Shakespeare’s birthplace. I have never seen or read anything by the bard so I will endeavour to learn something about him.

The ride was a success:

Read more about the Five Ways to Wellbeing on this blog:

Five Ways to Wellbeing with PAVO mental health team

Five Ways to Wellbeing in the workplace

Festivals and the wellbeing scene

Back to the Floor: Superintendent Jon Cummins at Felindre Ward

Superintendent Jon Cummins, Staff Nurse Melanie Fletcher, Dr Frank Medford

Years ago there was a BBC TV documentary series called Back to the Floor, where bosses returned to the shop floor to find out what life was really like as a worker in their company. This turned out to be both intriguing and extremely useful for the managers who took part.

Here in Powys the approach has been adapted by the Powys Mental Health Planning & Development Partnership* to give Chief Officers, Service Directors and other high level staff the opportunity to experience a day in the life of a member of staff at the operational end of a service. They have chance to find out what is really happening on the ground, and what consequences strategic decision making can have on people who are in receipt of a service. For someone experiencing mental distress in Powys, that service could be provided by a voluntary organisation such as a Mind centre or Kaleidoscope, or the statutory sector such as the NHS or the police, for example.

Every couple of months I attend the PMHPDP’s Engage to Change sub-group which focusses on enhancing the Partnership’s communication, participation and engagement activity to support delivery of the Powys strategy Hearts and Minds: Together for Mental Health. The great thing about this role is that it gives me the opportunity to participate in some of the Back to the Floor activity as an observer (I make notes, take photographs and feed back to the Partnership). The Partnership has identified three clear learning opportunities for the exercise: 1. Are we meeting our purpose? 2. What gets in the way? 3. What can we do better?

So it was that in mid-August I observed Powys Divisional Commander, Superintendent Jon Cummins, who is a member of the PMHPDP, go Back to the Floor at the mental health inpatient unit in Powys, Felindre Ward at Bronllys Hospital. Towards the end of our visit Jon also had chance to meet staff from the South Powys Crisis Resolution and Home Treatment Team. It was a brilliant opportunity for both of us to find out more about the workings of the ward and the CRHTT, and for the agencies to build stronger and better working relationships.

Felindre Ward, Bronllys Hospital

Before the visit: Jon’s view

I had been to Felindre Ward before during a Section 136 three years ago when I had a different role in Dyfed Powys Police. At that time I didn’t see beyond the S136 suite. The person was compliant and of no trouble to police or health partners, but in spite of this I could see that the joint working at the time was not quite there. I am keen to see how things have changed.

Throughout my career I’ve only been fleetingly in mental health secure and non-secure units across both England and Wales purely from a policing perspective and they all appear broadly the same. I have an image of rows of beds and people receiving care and attention in a stuffy unwelcoming environment.

I did not make such a visit to a mental health ward during my induction as a newly appointed student police officer a number of years ago when I entered the service. However, I would expect Dyfed Powys police staff to have some understanding of what goes on in Felindre Ward – it is important to have this understanding as part of their training and is something that we are currently working on with partners to implement. As only 11% of demand of what Policing is currently dealing with is crime related, it is even more important today for officers to have that rounded knowledge and perspective on mental health and vulnerability than when I first joined the police service as the nature of our work has changed.

The barriers to this that I am aware of are often around knowledge, training and the sharing of information between partners. Although we are consciously improving, we can be quite parochial and not always create opportunities for joint training and provision of services. And we can sometimes have misunderstood expectations about what the other agencies can do for us and us for them. 

There are also challenges around available resources in the right place at the right time. Powys is such a huge geographical area and the public rightly need the right resource dealing with them. For instance we were once asked by health colleagues to attend the home address and check on an admitted patient’s cat! It’s the little practical things which can make a significant difference, ensuring that both the community and our partners have an understanding of what the police can and should be doing to protect our communities.

When it comes to strategic issues, I am aware that all mental health services in the county have recently returned to be managed by Powys Teaching Health Board, having previously been outsourced to neighbouring health boards. A move to a single place of safety for S136 into Powys is one strategic issue that we will be working on over the coming months.

And I know there are current service gaps around the mental health provision for children – unbelievably they can still currently end up in police custody and then there will be headlines in the media and scrutiny on the police from a number of external partners such as HMIC (Her Majesty's Inspectorate of Constabulary) and the IPCC (Independent Police Complaints Commission). Policing feels that this can be a significant burden to carry when there are service gaps from other partners.

The perception is that people often using services at Felindre Ward are from certain aspects of the community. As we know children are ruled out due to age. I think the profile of service users differs across Wales. Here in Powys we don’t see the high volumes of abuse of drugs/alcohol as in other parts of Wales. Well, people may have a dependency, but they are often more willing to engage with their community as they are smaller and generally known to each other, this also provides services with opportunities to identify people earlier.

And people are less transient in Powys. They are often either from Powys or have moved here. It feels that the majority of service users are unemployed and from the 25 – 40 age group. There seem to be more men than women who are suffering from mental health and who will be engaged with the police and health partners.

Many men who are subject to a S136 have self-harmed, either at the point of contact or previously in their history. There are also some women who are repeat service users who are also very well known to the police, they are smaller in number as a group, but often have a higher individual demand on police and partners' services.

90% of those calling the police around mental distress do so themselves when in crisis. If they are making the call to the service themselves it is often a cry for help and we strive to put the appropriate intervention in place. It is not unusual for people to call police 20 – 30 times and say they are going to kill or seriously harm themselves. What is more concerning is those whom are not known to police or other partners and are suffering in silence, not being comfortable to tell someone they are not ok.

Back to the Floor exercise

Jon and I were shown round Felindre Ward by Staff Nurse Melanie Fletcher. We saw nearly every nook and cranny from laundry rooms to bedrooms, common room to garden space, clinical room to nurses' station. 

En route Melanie introduced us to colleagues and some of the people currently staying on the ward and happily answered our many questions. She explained that staff can voice their opinions at regular team meetings and she felt that there is a “good listening ear”.

We then met and spent a considerable time talking to three members of the South Powys Crisis Resolution Home Treatment Team.

After the visit: Jon’s view

Well, I had hoped to learn more about mental health services and I have absolutely done that! I have made some great contacts within the Mental Health services at an operational and tactical level which mean that I can put processes in place around information sharing, across all of Powys, but particularly in the South Powys area. There is a real opportunity for information sharing and problem solving meetings to be set up between the different services – ambulance/police/mental health.

I learnt that people aren’t necessarily admitted on any form of section, but do need support and that there is problem-solving going on around these individuals which is something police officers will be unaware of.

There appears to be a gap around providing support and/or services for those people who are distressed but have not committed a criminal offence and are not on the ward, but are regularly coming to the attention of police. There needs to be a problem-solving forum around these people who are regularly in contact with police officers but have not passed the threshold for admittance to the ward on a form of section, which is something that I will take forward with the police management team in Powys.

Jon with Sharon Stinson and Laura Charles-Nelson
from the South Powys Crisis Resolution Home Treatment Team

I also now have a much greater understanding of the work of the CRHTT. They seem to act in much the same way as a mental health triage team that operate in other areas of Dyfed Powys. So there is the opportunity and willingness for officers to put in a call to the staff about people we come into contact with and see if the person is known to them and what solutions can be provided or advice given.

Seeing the inner workings of the ward was also very useful. There are a quite a few activities going on in the ward. Everyone currently on the ward seemed happy. They are getting the care and attention that they need and no issues were raised. They seem to have made the ward home, so it was a positive experience in that regard.

The main barrier to service delivery, as it always has been, is around communication. One thing I didn’t realise we had finalised until today was that student police officers are having work experience with mental health staff on the ward, which is hugely positive. And information sharing is starting to happen now with the joint mental health training which takes place.

Following on from the Back to the Floor session I want to put some formal structures in place and circulate information about the various mental health teams and what they can offer to colleagues – what they do and where they are. And finally I would just like to say that it would be extremely useful for all managers within policing to do a similar exercise themselves. Thank you to the staff and all at Felindre Ward for their warm welcome, allowing me to experience what they do and how they do it to benefit the partnership working approach with Dyfed Powys Police.

And finally

Many thanks to Jon for taking part in this Back to the Floor exercise at Felindre Ward. All of the learning from this and subsequent BtTF visits will be fed into the Powys Mental Health Planning & Development Partnership* to share with others and to help with future planning and delivery of the Hearts and Minds: Together for Mental Health Strategy. Over the next six months a number of other members will also be visiting partner agencies to recognise the excellent work staff do and to talk to people using services so watch this space for future blog posts.

*The Powys Mental Health Planning and Development Partnership brings together key stakeholders including Powys County Council, Dyfed-Powys Police, Powys Teaching Health Board, Powys Community Health Councils, Powys Association of Voluntary Organisations, and representatives of people using services and those close to them.