Mental Health (Wales) Measure – how is it measuring up?

Late on Tuesday afternoon this week I tuned in to the live debate on Improving mental health and wellbeing in the Welsh Assembly’s debating chamber in the Senedd. (You can watch archive video of the debate here 2hr 52min in or read the plenary notes here, at 16.21). In the debate, Assembly Minister Janet Finch-Saunders commented:

Today’s debate on mental health looks at an issue that can affect any member of our society, from the very wealthy to those living in poverty, male or female, young or old. Our mental health is not static and it certainly does not discriminate. Those who have been well all of their lives can suddenly find that a turn of events or a change in circumstances can affect their own mental health wellbeing. It can show itself in a variety of manners, from depression or mild anxiety to post-traumatic stress disorder and/or severe psychotic problems. Minister, I have to say that probably one of the hardest jobs for me as an Assembly Member has been when someone has presented and I find them, quite literally, crying out for help, for support, and yet feeling, you know, that nothing can be done.

Health & Social Services Minister Mark Drakeford introduced the motion, which proposed that the National Assembly for Wales notes Welsh Government action to improve mental health and wellbeing in Wales. He said:

Here in Wales……. change is happening, and it is making a significant and positive difference for those whose lives are affected by mental health problems. The basis for all this is, of course, the Mental Health (Wales) Measure 2010, the Assembly’s groundbreaking legislation.

The Mental Health Measure, which became law in 2010, introduced legislation around mental health for people in Wales which is quite different to that in the rest of the UK. We highlighted 10 interesting facts about the Mental Health Measure in October 2012 and provided further information, including videos, on our website here.

But is it working?

That question is being asked both formally and informally in Powys (and all around Wales) right now. People who have been in contact with services, those close to them, and those providing the services, are being surveyed, are meeting in focus groups, and sometimes contacting politicians such as Assembly Minister Kirsty Williams to represent their views in the Senedd debates (including this one, see 17.09 in, for an update on Brecon).

We thought we would write about elements of this review process on the blog over the coming months to highlight some of the issues that are coming to the fore.

Earlier this year, in April, the Welsh Government published the findings of a review of progress made so far against the aims of the Measure as part of an early Scoping Study carried out by Opinion Research Services (conducting Research to support the Duty to review the Mental Health (Wales) Measure 2010). With regard to Care and Treatment Plans (for people receiving secondary mental health services such as seeing a psychiatrist or community psychiatric nurse) the report highlighted that: Many consultees argued that the Measure persists with a medical model of care which in practice is neither recovery nor outcome focused and which takes little account of the social care needs of service users. To make the recovery process work as embodied in the Measure, there is a need to take positive risks with service users by allowing them to lead the process. However, this requires a complete change of culture.

The Royal College of Psychiatrists had already conducted an independent review looking at the impact of the Measure from the psychiatrists’ point of view, publishing the results of their findings in late 2013. 48.5% of respondents (out of 121 – a 20% response rate for the survey overall) said they noticed a negative change in the care given to patients since the Measure was implemented. They pointed out issues including: increased workload but reduced patient care, potential risks of patients slipping through the net, early discharge of patients, and concerns regarding legal implications of increased bureaucracy.

My colleague Freda Lacey has recently been involved in some local focus group sessions in Newtown and Brecon where people have looked at their experience of changes in provision of mental health services since the Measure became law. This research is again being carried out by Opinion Research Services with Freda’s support and a short report on the focus groups will be available soon.

In the meantime, have you been in contact with mental health services? Perhaps you have attended a GP surgery and tried to access counselling via your Local Primary Mental Health Support Services (LPMHSS)? Or you may have been referred to see a Community Psychiatric Nurse who works as part of a Community Mental Health Team? Do you understand what the Measure means to you, and have you any feedback about the way it’s working? Let us know what you think by commenting below.

Psychiatry beyond the current paradigm

Last week Laura let me out of the office to go to this conference at Nottingham University organised by the Critical Psychiatry Network and Asylum Associates. It was perfect timing, as it meant I had the opportunity to see Jacqui Dillon speak just a week or so before she visits us here in Mid Wales for our own Shaping Services Together event on Thursday 19 September. 

I stayed for two of the three days and found all the speaker and workshop sessions immensely enjoyable. All stimulated some interesting and relevant debate, and I hope to pick up on some of the specific topics in future blog posts (for example, a workshop on an innovative Finnish approach called Open Dialogue, and Clinical Psychologist Steven Coles’ session on the dynamics of power).

Today, though, I just want to give an overview of the conference as a whole to give a flavour – and maybe tempt some local readers to pluck up courage to step outside the county and take part in an event like this – because there are increasing numbers which is great. I say “pluck up courage” because – I went on my own, I didn’t know anyone else before I arrived, and I was a little nervous about how it would be... two days surrounded by strangers at a huge unfamiliar venue (well everywhere outside Mid Wales seems vast)... and people who more than likely knew far more than I did about the subject – even the title of the conference was a bit off-putting! 

But five minutes after arriving at the venue I was deep in conversation with a woman from Wakefield about how difficult it is to find local groups in Yorkshire where people can share experiences about mental distress. And I was telling her about the peer support group based at Ponthafren in Newtown! (It’s a long drive though... better she sets up her own group in Yorkshire...)

The conference was promoted with this blurb: 
“Voices from within psychiatry who are seeking change are beginning to be heard. The Royal College of Psychiatrists’ leading regular publication, The British Journal of Psychiatry, recently carried a paper from the UK Critical Psychiatry Network entitled Beyond the Current Paradigm, which emphasises the importance of services and practitioners working with rather than upon those who seek their help. Perhaps unexpectedly, it received very little criticism from academics and peer psychiatrists.”

The first morning we listened to three keynote speakers, who started to explore this theme. Hugh Middleton (NHS Consultant Psychiatrist and also Associate Professor at the Nottingham University School of Sociology/Social Policy) began. He said that doctors of any sort only have authority to practice if there is clear evidence that it results in good rather than harm, and many now question whether psychiatrists fall into that category. The paper has “disappeared into a cloud of silence,” and Hugh and colleagues interpret that as “assent.” 

Hugh described how psychiatric drugs are trialled, summarising that all evidence to support the use of such drugs is flawed. The evidence around the benefits of psychological therapies is also possibly flawed – it is felt that if there is a positive outcome from such sessions this is down to the success of the supportive/nurturing relationship which is set up with the "client". Hugh said that we have to accept that sometimes something happens to people which profoundly disturbs them and/or the people around them, and that contemporary medicine provides no better solution than the demonisation or incarceration options of the past. He summed up his session by saying, “people want something different to what they get from conventional experiences. What is it? Let’s look for shared solutions.”

Jacqui Dillon followed, responding to the paper from “an activist position.” It is impossible to do justice to her presentation here, but some of the key points raised included:

• Biological (medical model) psychiatry is now trying to incorporate many of the approaches promoted by critical psychiatry groups, such as the impact of trauma on mental wellbeing. “But this is all about outcomes for psychiatrists – what about outcomes for ‘service users’?”
• It is assumed the doctors are the only ones able to do everything – psychological, social, medical – the lot. The message is: “you need us in charge.”
• Vested interests range through pharmaceutical companies, political parties to society in general, families and carers, some ‘service users’ and professionals.
• We locate madness in others – because it makes us feel OK.

So, what can be done? Some of Jacqui’s ideas to whet your appetite for next week:

• Reframe and reclaim ordinary language.
• Take a stand.
• Work in collaboration with people with lived experience.
• Help promote people’s voice.
• Lobby for change.
• Join a group with similar goals.

And what if we phased out psychiatry completely? What would the world look like then? Again, a few of Jacqui’s ideas:

• Develop non-medicated coping strategies.
• Create a range of self-help support (sharing books, setting up groups).
• Survivor-run crisis houses based on the Soteria model.
• Phase out mental health professionals and give basic skills to people – around active listening, being looked after, and sitting with people in distress.

This session was rounded off by Steve Trenchard, Chief Executive of Derbyshire Healthcare NHS Trust. His background is as a mental health nurse, and he said that he wanted to listen and co-produce solutions not yet found. There is “a need to focus on strengths and aspirations.” And he wants to develop ‘listening’ and ‘being with’ skills. 

Again, it’s very difficult to summarise in a short space, and Steve covered a massive range of areas in his talk, but at each point it seemed to me (and others listening as was discussed later) that his approach as a Chief Exec is extremely rare (even perhaps radical) and much needed. He considered new approaches to dementia care, schizophrenia, the use of physical restraint and seclusion rooms (including a pilot to close the latter) and our obsession with risk. He encouraged more self-control for people, which he considered the biggest factor in improving health, and spoke about the Expert by Experience programme – “no decision about me without me.”

Steve took inspiration, in part, from the past. He referred to The Retreat, set up in York in 1813 by a Quaker called William Tuke, a “supportive and healing environment” for people experiencing mental distress, as distinct from the inhumane and squalid asylums of the time. 

In Derbyshire it seems like things could be changing around services as professionals like Steve are listening to and responding to people’s experiences. I really hope that in Powys people who provide or commission mental health services can make that connection so that we see a shift here as well... And on that note, I look forward to continuing this discussion next Thursday at the Shaping Services Together conference at The Pavilion in Llandrindod Wells! See you there!

An update: Jacqui has kindly sent me her presentation and you can now read it here.

The language of mental health: am I a person or a service user?

I wrote a bit about the language of mental health before. Surprise, surprise, there is no getting away from its complexities as seen in recent posts. So, this spurred me to go back to basics and look specifically at the language around the person and mental health. At the end of the post I’ve added our first blog poll to find out what you think.

Step 1 of seeking help and support around mental distress usually involves going to see our GP. At that point we are clearly regarded as the doctor’s patient – the language is so engrained that we barely question it. But that doesn’t mean that a) we like it, or b) we consider ourselves at the start of a medical “journey” - whatever diagnosis that we might have left the surgery with.

Before working in the field of mental health, I didn’t consider the terminology that much. But now the language around the person and mental health is very much to the forefront of my mind. It’s there every day I’m at work (and often outside – because the language of mental health is actually everywhere). At work colleagues and I regularly engage with “people in contact with mental health services” to find out what kind of services they would like. But what do we call them? We think we need some way to distinguish these people from everyone else. And we worry that we might offend or label people unintentionally, yet at the same time we want to make sure we are understood.

Patient is one word. It’s easy and everyone recognises it. Service user – a term increasingly common in the spheres of government, health, social care and even the voluntary sector – is just two. My feeling is that it is increasingly reviled by the people it is used to describe (which is all of us in effect). It hints at other negative terms such as drug user. The words don’t refer in any way to mental distress... the user could be accessing refuse services as far as we know. Other more acceptable descriptions are longer winded. What about – a person with lived experience of mental distress for example? But in a world where language is shortened repeatedly into – OMG – acronyms, never mind just quicker and shorter words.... have we all just become too lazy?

This topic is by no means new, though it certainly has not been resolved – not in Powys or Wales anyway. Research in England from 2010 reported on people’s preferences in The Psychiatrist, journal of the Royal College of Psychiatrists, at the time, and perhaps surprisingly “patient” was actually voted all out favourite term.

According to the Open University, “certain terminology should be avoided, such as the use of labels referring to one aspect of a person, such as calling them 'a schizophrenic', as well as the casual use of words such as mad or crazy. The way in which these terms become accepted as normal conversation is very damaging.” And yet several prominent and very successful organisations have now adopted previously stigmatizing language in their names, eg: Mad in America, and Madness Radio. 

Acceptance, humour and even rebellion are a large part of what has become known as the psychiatric survivor movement – originally the more radical and political side of the mental health arena but now seeping into the everyday at an ever greater pace. A forum member called Apotheosis created his/her own comic definitions, (more general than just about the person but relevant nevertheless), on mentalhealthforum.net – read them and make up your own mind!

So – to the poll. It’s very simple – just choose your favourite term – if you can find one in the list – and let us know. If none of these terms fits the bill as far as you are concerned – that’s fine – either post a comment or email pamhinfo@pavo.org.uk with your suggested alternative. We really would like to know what you think and how we should be referring to ourselves.

What should we call someone who has contact with mental health services?

"

New Year resolutions: food for thought

Well, I rounded off 2012 with a bag of crisps if you recall. I'm starting 2013 with some thoughts on food too. So many New Year resolutions seem to revolve around food - what we eat, how much, when.... This is a photograph of some food I randomly found in my kitchen this lunchtime. To be honest, I haven't eaten any of these things today (yet).  I had bread, cheese and picked onions for lunch actually, but the fact is that some of these items shout "healthy and good" whilst others yell "full of sugar and probably bad..."

As a student years ago I ate a lot of junk food. That Mars-a-day campaign must have made the company a fortune, because I stuck with it for almost the whole three years. I also drank a lot of cola drinks (and others more alcoholic, but that's probably another post....) And I'm convinced that my mental health at the time suffered as a consequence. One way or another I definitely eat a lot more healthily these days, and feel a whole lot better for it. It's just that at Christmas (and birthdays, and holidays, and weekends...) temptation can be just that little bit too much...

Anyway, there are plenty of useful links out there right now to get us started on eating more healthily if that is the way we want to go. 

• The Mental Health Foundation have a New Year Healthy Diet podcast which you can listen to on their site here.
• The BBC website has a diet and fitness plan to follow here.
• The Royal College of Psychiatrists' website has some excellent information on eating well here.

Finally, some people struggle with food addiction, compulsive or emotional eating, and I thought I would point anyone interested in the direction of a new Powys peer support group - Food for Thought - which meets early next week. You can find out more information and download a flyer on our website here. (And thank you for inspiring the title of this blog post!)

Happy New Year to you all, and we look forward to hearing your mental health food and diet-related views.

Can I have some Cognitive Behavioural Therapy please?

I heard a true story last week, about someone going to a GP surgery and specifically asking for CBT (Cognitive Behavioural Therapy). The person was feeling down because of something that had happened in their life, and decided they didn't want to take medication, but they would like to give CBT a go. But no CBT counsellors were available, only online CBT sessions (I'm not quite sure what these would involve). Anyway, online therapy was not what this particular patient wanted. She went away disappointed and still depressed.

We know there are plans and good intentions to increase the number of talking therapies made available to people via their GPs...it says so in the new law, the Mental Health (Wales) Measure. The problem seems to be that currently the supply just doesn't meet the demand.  So people are left feeling a little bit cheated and frustrated (alongside the original mental distress they went to their GP with). When you're feeling depressed, you want help now, not six months or a year later. 

The fact is that CBT does work for some people, according to a recent study in The Lancet.   You can find out more on this BBC webpage. 

I can't help wondering, what are the issues with providing CBT counsellors? Is it about... money to pay for them? Or finding suitably qualified people? Or... just that this is one of a thousand tasks the NHS in Wales have to sort out, and so far it's only at 579 on the list.... (so that comes down to money again....) 

If you've tried to access CBT through your GP surgery - we'd be interested to know how you got on.

Meanwhile, you can find out more and watch a video about CBT here, and read a CBT flyer on The Royal College of Psychiatrists webpage.

For the full report from The Lancet, click here.

Feeling on the edge

Last week whilst driving to see my Mum I heard a short but powerful piece on Radio 4 Woman's Hour about the growing incidence of self-harm amongst younger people.

You can listen to the piece at this BBC website here.

"Feeling on the edge, helping you get through it", is a leaflet produced by the Royal College of Psychiatrists which provides information to people who are self-harming and their carers. It describes what happens to people who are provided specialist mental health support, and gives contact details for other agencies such as The Samaritans, Papyrus and The National Self-Harm Network. And many more too.

You can link to the online leaflet here.