Together for Mental Health - Assembly Ministers have their say

Assembly Ministers debated the second Annual Report on Together for Mental Health on Tuesday in the National Assembly for Wales. I watched a large chunk of the debate online on Senedd TV, and you can read the Record of Proceedings here, and dip into video records, to catch up. (Start at 16.26pm, unless you want to find out more about the local government settlement…)

Together for Mental Health sets out Welsh Government ambitions for improving mental health and a vision for mental health services across Wales and was published in 2012. It is the first mental health strategy for Wales that covers people of all ages.

Vaughan Gething, the Deputy Minister for Health, introduced the debate by saying: Mental health services have made real progress throughout 2014. By further embedding the Mental Health (Wales) Measure 2010, we are continuing to make tangible improvements to care whilst ensuring service users’ views are heard. On average, over 2,600 people are now seen locally every month by primary mental health support services. These deliver advice, information and services, including befriending, books on prescription, physical activity and psychological therapies.

His introduction also included a reference to the work around dementia in Brecon’s dementia friendly community which we have previously written about here. A groundswell of interest in dementia support of communities has seen Brecon and Swansea recently gain official ‘working to become dementia-friendly’ status, and I am proud that we are continuing to fund the charity (The Alzheimer’s Society) to continue this important work in Wales.

Darren Millar, AM, who moved several amendments, said that: There’s no doubt that there has been progress, and long may it continue, but the pace of progress, I think, is something that we need to address. He also acknowledged the contribution of the Third Sector: I would like to put on record… the acknowledgement of the fantastic work that the third sector is doing to address mental ill health issues in Wales, whether that is Mind, Gofal, Hafal or the whole host of other organisations—local organisations, as well—that are doing their bit.

Prior to the debate the mental health charity Gofal had carried out a survey of people who had been in contact with services, and circulated the findings to Assembly Ministers. Whilst the survey highlighted some positive changes, there were also concerns expressed in the findings. Darren continued: One in 10 GPs, and a growing proportion of GPs, according to service users, do not understand or are insufficiently empathetic to mental ill health issues. More alarmingly, a quarter of other staff in primary care are insufficiently understanding or empathetic of people’s concerns.

Darren continued: The other issue, of course, as well, is that it appears that a growing proportion of people are simply having pharmaceutical interventions rather than some of the psychological interventions that I know all parts of this Chamber support the need to increase and improve access to.

Kirsty Williams, AM for Brecon and Radnorshire, wanted to know what steps were being taken to ensure parity between physical and mental health services. She pointed out that progress had been made in reducing the stigma associated with mental health, but that this brought its own problems. Members will have heard those problems highlighted in the all-party group this afternoon, where there certainly was a feeling that, perhaps, the report was on the rosier side of how things felt on the ground to those people using the service, to the third sector organisations involved in helping deliver services for people in communities, and to people caring for relatives or friends who are suffering from mental distress and ill health.

David Rees, AM, who had chaired the cross-party meeting on mental health just prior to the debate, said: It was felt that service user and carer representation on the national partnership board needed greater support to actually ensure that the diverse views across Wales could be fed into the board through improved pathways to achieve that engagement. I therefore hope that the Deputy Minister will be able to give reassurances that the individuals who represent the service users and carers on that partnership board will be given that support to engage with a wide range of bodies to allow a wider spectrum of views to be presented in order that services can be shaped to continue the improvements we have seen to date.

Other issues debated included:

• The pressure on Child & Adolescent Mental Health Services.
• The Veterans NHS Wales Service.
• Access to crisis beds.
• Care and treatment plans.
• Mental distress in the workplace.

Vaughan Gething made closing comments to respond to many of the issues raised. There is not space to address all of these here, but I will just pick out his response to David Rees’ point above. Vaughan said: Patient voice and choice in designing healthcare is a core element of our prudent healthcare approach….I want to, in closing, recognise again the contribution of the wider voluntary sector in helping to deliver not just support, both the design and delivery of our services here in Wales.

You can read more about the amendments that were tabled and voted upon and the outcomes on the Record of Proceedings here (from 17.27pm).

The Assembly Ministers have had their say. Do you think Together for Mental Health is working effectively to bring about improvements in the planning and delivery of mental health services in Wales? Let us know in the comments box below.

Power and participation Part 2

by Jane Cooke

Last week Jane wrote the first of two blog posts on power and participation. This week we follow up with Part 2.

A long time ago I went on some race equality training. The trainer opened the first day by saying: “You can’t learn from someone who you feel is inferior to you," or words to that effect. That gave me a lot to think about. I wonder if it’s a challenge to lay down now to the many people who make decisions over and about what/who to ‘do to’, and who are also saying, in just about every report one reads, ‘we need to ensure effective participation’.

In our trainings and professional and personal development we don’t give enough time to considering the ‘other’; we gather around ourselves our professional identities, our roles, our pride in our achievements and positions. And, one way and another, we end up thinking about ‘them’ and often how to change and improve ‘them’. What we share, what we can learn from true openness, from open-hearted listening, is rarely in the frame.

In the realm of mental health there is another dimension. Do we question, think about and examine what we feel about the experience of ‘madness’, what we think about people who we categorise as ‘ill’? We are, I believe, still influenced by deep seated ‘folk’ theories about madness. Moral degeneracy had currency not so long ago. If you think that underpinning belief has gone, think about some of the notions that drive the endless, fruitless, search for medical markers, genes for ‘mental illness’. There is often an underpinning assumption that if such things can be found, we will eradicate them, the genes, the carriers, the ‘bad’ foetuses. In my book that’s eugenics. (I’m not anti-abortion by the way or condemning individual decisions about terminations, it’s the broader, unrecognised societal views that I’m saying are not questioned).  Didn’t eugenics die out with the Nazis? No. And it’s not just the domain of the far right, do a search around modern eugenics and you’ll find plenty there. I’m hoping you’ll find it chilling. I do.

We still, as a society, think of those ‘other’ people with characteristics, behaviours, ways of organising thoughts and experiences, as ‘flawed’. Intergenerational shame was (is?) an explanation. Or how about genetic flaws? I heard, about 10 years ago, a senior medical professional declare the view that the explanation for there having been three psychiatric hospitals built around Bridgend was that this was to meet a need generated by a flawed local gene pool. Seriously. As far as I can see there hasn’t been much of a sea change to counter such views.

I hear quite often references to people’s ‘condition’; sometimes there is a reference to someone being a ‘service user’ – a code quite often for ‘difficult’, a way of saying it’s them who is at fault because they are (lowered tone) mentally ill. Not us for having a closed mind, for not being able to manage the discomfort of difference, of challenge to our cherished views.

Many people who use, willingly or otherwise, mental health services have had very difficult life circumstances. Sometimes they, and services, know what these are, sometimes they don’t. Sometimes it is more a case of a slow accretion, many compounding experiences. We know this statistically. We know it anecdotally, we know it empirically. But then there’s a gap in our thinking. We don’t seem to think “How can we adapt ourselves, our views, our ways of working that acknowledges that range of experiences, those various views and understandings of life in order to best share power, to best truly design services with citizens and service users. We say: to join us in our territory you must behave like we do, you must follow our codes (which by the way include the view that you are other, inferior, flawed, suspect). We offer training to ‘them’. Training is very good, personal and professional development is very good; but for all of us. Some people might need to skill up in one area, some in another, whoever they are; everyone brings something of value that others can learn from. There doesn’t, however, seem to be a view that there is a need, let alone a joy, in learning and developing together. There are a bunch of people who are seen as deficient until they know how to play the game. (Then they’ll be seen as a-typical).

Too cynical? Maybe. Let me know some stories to uplift my sometimes jaded optimism.

So, then, to move toward power with? Well first, like that old light bulb, we all need to really want to. And then we need to let go, to feel the discomfort and fear and, together, do it anyway.

Written by Jane Cooke in her capacity as a counsellor and psychotherapist, trainer and facilitator. All views are entirely her own. Email jane.cooke@heartfeltwork.co.uk

Power and participation Part 1

by Jane Cooke

I have been thinking a lot about power recently. Often my trains of thought are prompted by consideration of personal power. Some people assume that they have personal power and that seems to prompt a response in others that confirms this; other people defer, give away their own power. I am not sure that this is good for anyone, but I see a lot of it. Then I wander off into thinking about structural power. Who, as a result of the position that they hold in an organisation, has the power to require or demand certain actions and responses from others?

My experiences over the years have ranged from working with groups and networks of people who use/have used mental health services to working as a counsellor for a year in a prison, to being involved in reviews of NHS mental health trusts. Throughout all of these experiences there has been a theme; that many people, no matter what their position, feel that ‘The Power’ lies elsewhere. Someone else, some other group of people or some structural body, such as a Committee somewhere has ‘power over’ services, chief executives, service users, or the ‘power to’ concede or deny, for example, a place on a joint committee or board, or to close a service or to require that changes to working practices are made, to give or withhold funding or services.

The ‘power to’ sense that individuals and groups of people can take on board themselves seems to be dimmed right now. People working in services who would like to question views and cultures in their services can feel as if they had better not stick their head above the parapet. Organisations can feel limited in their capacity to explore and support challenging ideas (and people!) if they feel that a funder ‘won’t like it’. People who might coalesce around some form of collective action, identity or pressure group can feel that such actions might jeopardise their chances of making progress in the situations where they are involved, or participate.

This feeling that some OTHER has ‘power over’ or ‘power to '(do unto us)’ both stems from and leads to fear – fear of censure, or public criticism, of withdrawal of something valued, of negative comparisons. We live in an age that generates and feeds on fear. Our many forms of communication can spread and heighten fear. Much advertising is based on promoting fear, if you don’t buy this product whether it’s insurance or some sort of ‘germ’ killer, you will be endangering yourself or those you love. Much news coverage is based on fear and a lot of political policies and promotion major on fear; capturing media interest as they do so.

But what if we moved toward a conception of ‘power with’? As far as I know these ideas of power over, power to and power with originated in the peace and non-violent direct action movements. I find them very helpful. So; power with, what would that look and feel like? I wonder if people who are involved as citizens or service users in formal situations, committees and boards, feel as if they are in a ‘power with’ situation? I’d be inclined to imagine that often they don’t. It would be really interesting to hear from those of you in such situations. Do you feel as if you are truly sharing power and if so, what leads to and supports that? In my own experience, which goes back nearly 30 years, people in these situations have been asking for parity in one form or another for at least as long as that: receiving minutes in time, important paperwork circulated in a timely manner, acceptance that agenda items can be added, access to administrative facilities as a right, recognition of the representational time-frame required if people are to be ‘representatives’, meetings at a time and place accessible to all who want to and maybe have been elected to, attend, out of pocket expenses met in cash, broadband and Information Technology (IT) costs met. I would be very interested to hear of examples where there has been ‘up-front’ thinking around these issues before people are invited to the table, before it has been brought up by those ‘reps’, or equally current examples of representatives still finding themselves in these situations.

‘Power with’ requires a shift of mind-set. Power over might appease an ego, I would venture to say that it doesn’t do much good for the soul.

Look out for Part 2 of Jane's piece on Power and participation soon. What are your thoughts? We would like to hear from you. If you have any comments or questions just add them below.

Written by Jane Cooke in her capacity as a counsellor and psychotherapist, trainer and facilitator. All views are entirely her own. Email jane.cooke@heartfeltwork.co.uk

National Mental Health Partnership Board update

In early November Freda updated us in her post Citizen Power, Active Participation about the process for selecting representatives for the National Mental Health Partnership Board – along with details of the National Forum for Service Users & Carers and the local groups that feed into this board, and representation on those.

 

As stated on the Welsh Government website, the National Mental Health Partnership Board (NPB) will “oversee the delivery and implementation of Together for Mental Health – A Strategy for Mental Health and Wellbeing in Wales and its Delivery Plan; guiding and monitoring progress, and facilitating co-ordination of the cross-cutting approach required across Welsh Government, Statutory agencies, the Third and Independent Sectors.”

Together for Mental Health is the Welsh Government 10 year strategy for improving the lives of people using mental health services, their carers and their families. At the Shaping Services Together conference, which took place on 19 September in Llandrindod Wells, we were introduced to several members of the NPB, see photo below.

We have now received further updates from David Crepaz-Keay, Mental Health National Forum for Service Users & Carers and Sian Richards, Strategy Lead, Mental Health & Vulnerable Groups Division, Welsh Government. 

Let’s start with David:

“Back in the spring the Wales Alliance for Mental Health was asked by 
Welsh Government to oversee the process to identify two service users and two carers to become members of the National Mental Health Partnership Board (NPB) in time for the December meeting. I’m proud to report that we have achieved this.

Junaid Iqbal, Jane Treharne-Davies, Carina Edwards and Rhydian Parry have become members of the NPB; we also have a team of skilled deputies to support them in these roles and to step onto the board when needed. Alan Meudell, Julie Murray, Tracy Elliott and Steve Hails have been selected deputies. All eight people will become members of the Forum and met the other Forum members at the Forum meeting in Swansea (in late November).

The eight people were chosen following an open recruitment process by a panel of Forum members following interviews (in mid November). The process has been a long and challenging one and has only been made possible by the hard work of a few and the good will and support of many.

We now have Forum members from Betsi Cadwaladr, Hywel Dda, Cardiff and Vale, Powys and ABMU. We have also completed selection of the ten national members of the Forum, but this will be revisited once all Local Partnership Board service user and carer members are in place as we already have a number of vacancies.”

And over to Sian:

"I would like to take this opportunity to thank you all for the roles that you have played in establishing service user and carer arrangements for the National Mental Health Partnership Board.

The importance of strong service user and carer engagement at both an individual care level and strategically in the planning and monitoring of services is one of the underpinning goals of Together for Mental Health. The need for a national forum bringing together service users and carers who are active across Wales and the establishment of an open and transparent mechanism to appoint service users and carers on to the new National Partnership Board were clear recommendations from last year’s service user conferences. Earlier in the year Welsh Government asked the Wales Alliance for Mental Health to co-ordinate the process to respond to these requirements. David took on the lead role and has done absolutely sterling work to get us to a position this week where the recruitment process is now complete for the Partnership Board and we had over 40 people from across Wales attending our National Forum meeting in late November.

Every one of you has had a key role in this process and I would very much like to thank you for the energy and enthusiasm that you have shown in helping us to deliver this, and for the time commitment that you have been prepared to put in to it, often at short notice and on top of many other demands.

I think that we are now in a very exciting place in terms of the development of this approach in Wales and it would not have happened without your input.

Many, many thanks and I look forward to meeting with many of you over the coming months.”

Rhydian Parry, one of four people recruited from across Wales to the NPB, is from Powys, as is one of the reserves, Steve Hails. Congratulations to them!

5 of the 9 representatives from Powys attended the first Powys Mental Health Planning and Development partnership as new members of the group on December 5th 2013. 

Over to Freda:

“Wow, what a week it's been! I was really in awe yesterday as we sat around the table at the first Powys Local Partnership Board meeting where we had individuals in contact with services around the table. Laura and I were speaking afterwards and we felt it was the best Local Partnership Board meeting we'd attended. The atmosphere and energy in the room was very different, it really felt like we were coming together, management were listening and your contribution was really valued.”

We’ll keep you updated about how the National Mental Health Partnership Board and National Forum for Service Users & Carers are going. Meanwhile, if you have any questions just get in touch with us or leave a comment below. You can email pamhinfo@pavo.org.uk

Unconventional Wisdom: Exploring The Language We Use Workshop and Poem

Philip, Eleanor and Owen working on the poem

Yesterday, 9th October 2013,  I took part in the Powys DIY Futures Celebration Event in Llandrindod Wells.  I for one really enjoyed the event and the chance to talk to so many people.

I ran a workshop called “Exploring The Language We Use – Mental Health”.  You can read more about this below.  

The following poem, being worked on in this picture, was inspired by the workshop and written by the some of those who took part in it.

The Poem By Philip Moisson, Eleanor Barrow, Freda Lacey, Jill Dibling and Owen (Wordsmith for the Day)  

Der dar ... The Poem

More about the workshop: “Exploring The Language We Use – Mental Health”

Us all ... in action ...

The aim of the workshop was to discuss, explore and raise questions around the mainstream language that we use in the field of mental health.   It was not aiming to search for the right words or the words we think we should be using.  

It was not aiming to judge the words we do use.  Instead the aim of the workshop was just to look more closely at the language we do use and hear often.
 


We did this by taking 4 common sentences and asking two participant actors to speak the words to each other.  

One actor was identified as a psychiatrist, another her patient.  The rest of us bore witness to the sentences being spoken.

We were then asked to explore the simple sentences used by breaking the words that were spoken down into three areas:

• The actual words spoken – explicit meaning
• The context of the words spoken – identifying power, authority, emotions
• The assumptions underpinning the words spoken - the unsaid, the unspoken, the unchallenged facts

12 people took part.  The following pairs of sentences were discussed:

You are a service user.  I am a service user

You have a chemical imbalance of the brain.  I have a chemical imbalance of the brain

I am manic.  You are manic.

I am a carer.  You are a carer.

Feedback from the event!

I felt privileged to work with people who were willing to be so open, enthusiastic, thoughtful and supportive. 

I would like to thank those that took part for their time, their ideas, their kindness and their laughter.   

Laura G