Stress Awareness Week 2022 & Powys Cost of Living Hub

This week, 7 - 11 November, is International Stress Awareness Week which is organised by the International Stress Management Association (ISMA).

Stress is defined by the Mental Health Foundation as “the degree to which you feel overwhelmed or unable to cope as a result of pressures that are unmanageable”.

The theme of Stress Awareness Week this year is “Working Together to Build Resilience & Reduce Stress”. Organisations throughout Powys are currently working very closely together to help support people through the Cost of Living Crisis - there is further information in the second half of this blog post.

Meanwhile, to start us off with some top tips about how to relieve stress, we spoke to one of our Powys Mental Health Individual Representatives*, John Lilley. He told us what has worked for him when dealing with stresses in his day-to-day life.

*The Individual Representatives are people who have either used, or care for somebody who has used, mental health services. These unpaid volunteers sit on regional and national partnership boards, alongside professionals who are involved in the delivery of services. 

The reps are there to make sure user / carer voice is included in the planning of services and they are always on hand to listen to your experiences and issues so that they can feed this back to the partnership groups. You can contact the reps by emailing the Participation Officer Owen Griffkin on owen.griffkin@pavo.org.uk or calling 01597 822191.

John Lilley - Powys Individual Representative Mental Health

I found the 8 week Mindfulness course I took with Mid & North Powys Mind very helpful. There is a new online course currently on offer - An Introduction to Quantum Consciousness Therapy which starts on 14 November and runs for 4 weeks with John Paul.

There is also a half-day session on the Five Ways to Wellbeing - which includes reflection and creating personal goals to put the Five Ways into practice in your own life. You can also find out more about the Five Ways to Wellbeing on the Powys Mental Health website.

Previously I benefited from taking exercise classes in Rhayader as part of the Welsh National Exercise Referral Scheme. Clients of the Community Mental Health team can be referred for safe and effective community-based exercise opportunities. This includes:

• Healthy lifestyle advice as appropriate in partnership with the CMHT.
• Promoting and improving the mental and physical well-being of clients.
• Increasing clients’ physical activity on a long-term basis.

I also want to raise awareness of the excellent work that is being done to support 

children and young people with positive mental health in Powys. 

Here are three initiatives I want to highlight:

Thinking about options for younger age groups, Mindfulness is now offered to children and young people in Powys schools. You can find out more about this from Linda Gutierrez, Emotional Health & Wellbeing Lead in the Powys County Council Pupil Referral Service, by watching this short video.

Ysgol Calon Cymru - the school at the heart of Wales - has two campuses - in Builth Wells and Llandrindod Wells. Earlier this year the school won a Wellbeing Award for achieving A National Standard for Positive Mental Health & Emotional Wellbeing for their wellbeing support and helpful resources for both pupils and parents / carers.

Kooth, the online mental wellbeing community for children and young people, offers a lot of good online support, with a mental wellbeing community.

Children and young people across the whole of Mid and West Wales can now access Kooth’s service as both Powys Teaching Health Board and Hywel Dda University Health Board work with Kooth to provide an online counselling and emotional wellbeing service for this age group. Kooth provides a blended approach of online counselling, support, and advice to young people, which is free, safe, and anonymous by friendly counsellors.

Finally, I also like this edited list of tips from Peter Beresford’s* book "Being a Mental Health Service User”:

• One thing at a time.
• Try to live day by day, one step at a time.
• Don't anticipate troubles and problems (living in the moment).
• Give yourself the same advice you'd give others.
• All things pass - including the bad things.
• No one is less than me. I am not less than them.
• We can get real help and support from others. But the people we can feel closest to, and who offer the most natural understanding and mutual aid, are people who have 'been there' like us.

* Peter Beresford OBE is a long-term user of mental health services and Co-Chair of Shaping our Lives, the national independent service user-controlled organisation and network. He is also Professor Emeritus of Social Policy at Brunel University London and Visiting Professor at Edge Hill University and the University of East Anglia.

Cost of living crisis and your mental health

Here are some links to other services / online resources that could be of help at this difficult time.

Mental Health & Money Advice

Mental Health & Money Advice is a UK-wide online advice service designed to help you understand, manage and improve your financial and mental health. Difficulties in resolving financial matters can exacerbate mental health distress leading to a vicious cycle of increased stress and worry. Find online support, expert advice, tools and calculators, template letters, real life stories and much more on the website.

Mental Health & Money Advice has been developed by Mental Health UK, a UK-wide charity that represents its four member charities; Rethink Mental Illness in England, Adferiad Recovery in Wales, Support in Mind in Scotland and MindWise in Northern Ireland.

Welsh Government

On the Welsh Government website Get help with the cost of living you can find out more about living costs, housing, financial help, benefits entitlement, school and childcare expenses, and health & wellbeing.

Powys County Council - Cost of living hub

Powys County Council has launched a campaign to help support residents and businesses with the rising cost of living.

The council has worked closely with local partner organisations to pull together a wide range of information in one place to ensure people know what help is already available and how to access it.

The online hub, which can be found at www.powys.gov.uk/costofliving, has been created to offer as much advice as possible to those in Powys who may need it during this time.

The #CostOfLiving campaign aims to provide information and advice on:

• Household energy advice.
• Money, benefits and debt advice.
• Powys foodbanks.
• Support with household utility bill.
• Support for businesses.
• Support for families with children.

Powys Family Information Service

The Powys Youth and Family Information Service is a one-stop shop where parents, carers, young people and professionals can obtain a range of information for children and young people aged 0-25 years and their families. The team recently produced an excellent guide to support available to people on a range of issues in relation to the cost of living crisis.

Citizens Advice

Citizens Advice, the independent information and advice service, has extensive information on its website relating to the cost of living crisis.

If you have any tips and ideas about how to deal with stress and the current cost of living crisis then please let us know in the comments section below.

Stress Awareness Week 2019

This week is International Stress Awareness Week which is organised by the International Stress Management Association (ISMA).

Stress is defined by the Mental Health Foundation as “the degree to which you feel overwhelmed or unable to cope as a result of pressures that are unmanageable”.

The theme of Stress Awareness Week this year is Resilience, so we decided to ask a few PAVO colleagues what stress looks like to them (be that work-related or personal stress) and the strategies they use to bounce back from a period of stress.

How do you know you are stressed?

• I start organising things and get really “stressy” busy. I tidy in a manic fashion.
• I can’t sleep at night for ruminating. My mind wanders back to the stress. I can’t enjoy any leisure time.
• I start to talk quickly, my speech really speeds up.
• I get anxious. My heartbeat is faster. I’m sometimes short of breath. And my stomach plays up something chronic. At work I’m completely unfocused and rush from one task to another.
• I don’t sleep and I usually find it very easy to sleep.
• I eat more. And some of the stuff that’s not good for me like cake. And I drink more.
• I go into manic mode first and then my sleep’s disturbed. My skin can erupt and I get snappy.
• I can’t think straight. I can’t prioritise.
• I get irritable and snappy.
• I get impatient with people and / or things because I need to get on and deal with whatever’s causing me stress.

What helps you deal with stress?

• Keeping busy. I get more stressed if I overthink things. If I distract myself with busyness I can process things in a more rational fashion.
• I make lists. I can transfer the stress from my head to the paper and it’s parked. I do it for work and home.
• I like to go for a walk by the sea, listen to the waves and feel the sea breeze. I love it.
• I’m mindful that I need to take time out. An alarm bell will ring and I know I need to get out of the stressful situation and deal with it or I know it’s a slippery slope.
• I have a “happiness box” to look through when I’m feeling down. It contains little items that make you happy. It could be anything. A picture of your family. Something in your favourite colour. A poem. A magazine. It doesn’t have to be expensive, but it’s very personal to you.
• I like my guided meditation app. It really helps me sleep - it clears your mind.
• Offloading. You should never go home from work with the worries of the day. 99% of the time that gets rid of any stress before I go home.
• Simply looking out of the window for a moment or popping out for a walk in the beautiful Dolerw Park.
• Being outside. Walking. Exercise. Healthy eating. Time to myself. Essential oils. And saying no.
• Cutting off from what I’m doing and distracting myself with something non work-related for a few minutes.
• Time out. Having a rant and then I’m fine after that.
• Exercise. Fresh air. Dogs.
• I make a decision to get up at 6am and into my routine of yoga and meditation followed by breakfast. I also make my lunch which means I’m not skipping meals or snacking. And I feel more in balance before I even get into work.

Look local

There are many sources of support if you are feeling stressed, and here in Powys you can look locally to find some of them.

Invest in Your Health is a free NHS course delivered over 5 sessions which is designed to provide practical tools and techniques to improve your quality of life and wellbeing. It is a modular course, so once you have completed the first one, Building Better Health, you can choose up to four more, such as Mindfulness, Focusing on the Positive and Follow up & Solution finding. The courses take place at venues around Powys or the sessions can be done via Skype.

Brecon and District Mind is running free Mindfulness taster sessions on 7 & 28 November. “It can be easy to rush through life without stopping to notice much. Paying more attention to the present moment – to your own thoughts and feelings, and to the world around you – can improve your mental wellbeing”.

Open Minds is a new Mid & North Powys group meeting in Llandrindod Wells on the 1st and 3rd Mondays for people experiencing stress, depression or anxiety. Socialising is combined with tips and exercises.

Ponthafren Association in North Powys runs regular Stress Management courses. To find out more and sign up to the next course you can ring 01686 621586.

These are just a few examples of courses and activities running in Powys this Autumn and Winter. To find out more check out the Powys Mental Health website events calendar.

Singing has long been recognised as a way of reducing stress. You can find out about local singing groups and choirs on infoengine, the online services directory for Powys.

Surfing online for stress solutions

There are literally thousands of websites / organisations / services out there with ideas to help you deal with your stress. Some of our favourites:

The Mental Health Foundation’s Stress page - in 2018 Stress was the main theme of Mental Health Awareness Week.

ACAS has a useful page on workplace stress with documents you can download.

The Woodland Trust has a page on the benefits of exercising in nature which can help ease stress.

The National Trust has a beginner’s guide to forest bathing - research shows that two hours of mindful exploration in a forest could lower cortisol (stress hormone) levels.

Read on our blog the Top 10 Tips for Workforce Wellness - the theme of National Stress Awareness Day in 2016.

And if you have any good tips to share with our readers about how to deal with stress, let us know in the comments’ box below.

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.

Active Monitoring - Mind working with Powys GPs

Just last month at the PAVO Conference, which focused on Prevention and Early Intervention, we found out more about a new initiative at Brecon and District Mind when Service Director Val Walker spoke at the Mental Health Conversation. Active Monitoring provides support to people who visit their GP with symptoms of common emotional health needs including stress, anxiety and depression. The service aims to increase wellbeing, self-esteem and confidence, and reduce the likelihood of needing to access further support relating to a person's emotional wellbeing.

The mental health charity Mind describes Active Monitoring as: "a psycho-educational programme designed to provide early intervention provision within the Primary Care arena. With growing demands on Therapeutic Services resulting in increasing waiting lists it is getting more difficult for people to access the help they need in time. This role involves working directly from a GP surgery delivering the Active Monitoring programme. The service complements/replaces the ‘watchful waiting function’ and proactively works with individuals on agreed pathways to support early intervention via a facilitated self-help model."

Elizabeth Bogunovic

Brecon & District Mind works closely with the GP cluster in South Powys and Red Kite Health Solutions CIC (Community Interest Company) to deliver the Active Monitoring service.

Elizabeth Bogunovic is the Mind Active Monitoring Practitioner delivering the service for Brecon & District Mind, and she tells us more about this innovative way of working:

It was when I began volunteering for Merthyr and the Valleys Mind that I became aware of a service called Active Monitoring. The more I heard about it, the more intrigued I became so I sat down with Nicola, one of their practitioners, who explained to me the ethos behind the product so to speak. From that point on I was passionate about the possibilities an early intervention, self help service could offer people and considered the time a few years ago I found myself stuck in my own ‘mental health mess’, and how it may have changed the course I took at that time. I am convinced it would have helped me to recover a lot quicker than I eventually did.

Now I am delighted to be the Wellness Practitioner delivering the service for Brecon and District Mind, based at the Haygarth Surgeries which cover the areas of Hay-on-Wye, Talgarth and rural villages around here. I have been part of the Brecon Team since August 16th where I began by getting to know the area, the people and the surgery set-up, before heading off to Oldham to have some excellent training from Mind which fully prepared me to begin working with patients on September 8th.

The Active Monitoring Service consists of an initial ‘drop-in’ session where I meet the patient referred to me by the clinical team for a brief fifteen minutes and then, a further five more sessions. During the time they spend with me, they complete the GAD7, PHQ9 and Warwick Edinburgh Wellness evaluations at the beginning, middle and end, and choose one of six workbooks or pathways to engage with. These workbooks focus on Managing Anger, Anxiety & Panic Attacks, Stress, Low Self Esteem, Depression and Feeling Alone. To complement these workbooks, I have at my disposal a selection of exercise sheets they can work with and some smaller booklets to help them. The initial feedback I am receiving is on the whole excellent and very positive.

The last few months seem to have flown by and I was surprised to notice today how many of my first patients have had their last sessions with me over recent weeks! It only seems like yesterday I sat with them, full of anticipation both for them and me, describing the service and inviting them to engage in it. I was delighted for one patient at our third session when she completed the same evaluations she did at her first drop in session to see a slight improvement, I remember feeling her pleasure almost as my own!

So far I have worked with 48 people -  all at different points of their journey through the service - many of whom tell me how much more aware of their feelings and emotions they are since starting work with me. This not only gives me some validation that Active Monitoring ‘works’ but an immense sense of achievement when someone starts to notice a change in themselves.

I have amazing support from the staff here at Haygarth, it feels almost like being part of a big extended family which makes it a pleasure to come to what is called work but what I prefer to call ‘doing something I love with financial reward’. Even more than that I am lucky to be part of the team at Brecon & District Mind who also feel passionately that Active Monitoring has the potential to offer people an alternative approach to mental health matters, one that really can make a difference in a person's life.

Brecon & District Mind believes that early Interventions are far more effective than waiting, and that prevention is better than allowing things to linger. "We want people to get help immediately rather than wait to get help, or for things to get worse". 

You can find out more about the Active Monitoring project on the Brecon and District Mind website. Contact Elizabeth by ringing 01874 611529 or email: activemonitoring@breconmind.org.uk

National Stress Awareness Day 2016

The PAVO mental health team’s way of trying to reduce stress in the workplace – 

“Havin’ A Laugh” whilst promoting the elephant in the room recently.

One of the most popular posts on our blog over the past five years is from the very early days and simply called National Stress Awareness Day. In it we highlighted the sad fact that at that time in 2012 stress levels in the UK had doubled in the past four years, and outlined some of the well-known causes of stress. We also listed the Top 10 Tips for addressing stress, and, given the fact this is one of our most popular ever postings, hope these have proved helpful to many readers over the years.

This year the theme for National Stress Awareness Day – Wednesday 2 November – is Workforce Wellness – Your Prime Investment. The International Stress Management Association, the charity which promotes this national day, has drawn up a new list of tips specifically related to the theme:

1. Start to put yourself first
If you eat and drink healthily, schedule regular physical activity that you enjoy, and manage your time effectively, you’ll be in a better position to help others.

2. Start to prioritise tasks
There are only so many things we can do well during each day,so choose your top 3 most urgent tasks each morning and make them your priority. Reschedule, renegotiate your commitments or delegate – you can make it happen!

3. Start to make time to relax and mentally unwind
Relaxation, breathing and meditation exercises have been proven to be effective in reducing stress and anxiety, they are ideal ways to switch off AND they boost your immune system. Just a few minutes a day will pay huge dividends.

4. Start to empathise with others
There are many different behaviour styles that affect how we communicate with each other. Be aware that different people can perceive your words and actions in a way you didn’t always intend. Take time to listen to others and look for solutions.

5. Start to live life to the full
Bring some fun into your life and spend a few minutes each day appreciating the good things you have in your life. This will help you to see opportunities for growth and learning, even from the most challenging situations.

6. Stop ignoring your needs
Know what is expected of you and what is reasonable. Take short breaks throughout the day and know when and how to say ‘No’ both at work and home.

7. Stop getting distracted
If you’re experiencing too much pressure or just have a lot going on in your life, staying focused isn’t easy. It may help to ask for support from colleagues or friends and prioritise urgent, important and non-urgent tasks.

8. Stop allowing others to make you feel inferior
The key to stress-free living is to accept yourself for exactly who you are today, including past mistakes and things you might not be so proud of. Work on your self-belief and confidence and just go for it!

9. Stop being judgemental
Try to adopt a more flexible thinking style which will improve your mental well-being, whilst reducing unnecessary pressure for both you and those around you. Practice being objective and understanding.

10. Stop avoiding the things you least want to do
We often put off tasks that can become a recipe for worry. Take control and promise yourself a reward when you get it done.

The Royal College of Nursing has also produced an excellent guide: Healthy workplace, healthy you. It is aimed at nursing staff, but much of the information about the signs and symptoms of stress, and tips for reducing and managing stress, are relevant to anyone in the workplace.

Finally, if you are reading this in Autumn 2016, feeling stressed and living in Powys, there are other things you can do to help address the situation. Several courses are just about to start up across the county which are looking at stress, anger management, and positive approaches to managing your life including addressing how stress impacts on day-to-day activities and what you can do to reduce it.

Mid Powys Mind
Stress and Anxiety Management course – Llandrindod Wells, Mid Powys
23 & 30 November, 2 December.

Tel: 01597 824411 for further information.

Pain & Fatigue Management Centre
ACTivate Your Life course – Bronllys Hospital, South Powys
28 November, 5, 12 & 19 December.
The 4 week ACTivate Your Life course was developed by Professor Neil Frude, a Clinical Psychologist with over 40 years’ experience of helping people to learn and practice the core principles of Acceptance, Commitment Therapy or ACT. Tel: 01874 712449 for further information.

Ponthafren Association
Anger Management course – North Powys
The charity is currently drawing up a waiting list of people ready to start a new course in the next few months. Please let staff or volunteers know if you are interested by ringing 01686 621586.

Ystradgynlais Mind
Confidence & Assertiveness course – Ystradgynlais

This 4 weekly course will be starting again in the New Year. Please let staff or volunteers know if you are interested by ringing 01639 841345.

These are just a few examples of courses and activities running in Powys this Autumn and Winter. To find out more check out the Powys Mental Health website events calendar.

Do you have experience of stress in the workplace? And do you have some good tips which you could share with us which may help others? Let us know in the comments box below.

Terrible things happen to other people

This week's guest post is from PC Owen Griffiths of Dyfed Powys Police. I met Owen in May during Mental Health Awareness Week, where he spoke to colleagues and partner organisations about his own experience of mental distress. He kindly agreed to share his story with a wider audience. Over to Owen.

Bad things always happened to other people - faces on the news and names in the paper - or so I thought. My life was good and right and nothing was going to change that, of that I was sure. All that changed for me on the 22 May 2004. Let me tell you about it.

My name is Owen Griffiths. I am a 43 year old serving Police officer who currently works in the training department for Dyfed Powys Police. On the 22 May 2004 I was involved in an incident whilst on duty - one which I was very lucky to leave with my life intact. I can clearly remember being quite badly injured and standing at the side of the road. I was bruised and bleeding badly and although these injuries hurt me greatly they were nothing compared to the pain that hit me in my mind.

Before this incident I always believed that “stress” was feeling a little angry or perhaps snapping at people whilst being a little rushed or busy. I could not have been more wrong. The feeling that came upon me at that moment was something far more than this - it was a distinct all prevailing physical sensation that hit me as if I had run into a brick wall. At that moment I can clearly remember thinking “everything has changed”.

The next few days I spent recovering from the physical injuries I had sustained. My body was in pieces but it was my mind that was really hurting. Even though I was told to rest, it’s the last thing I wanted to do. I spent those early days walking around in a daze, my mind a constant stream of negative and anxious thoughts. It was at this time that I realised that I was very ill. No matter how much I tried I couldn’t concentrate on anything other than my own situation and what would become of me.

Because of the nature of the incident I had been involved in there was a procedure and as a Police officer I knew all too well that there would be an investigation into the events of that night and that my colleagues and I would be involved. Looking back now with the benefits of a clear mind and the comfort of hindsight it’s easy to see that I had done nothing wrong and it was just an unfortunate set of circumstances that would have to be looked into. Sadly this new me, a me tortured with racing thoughts, had thoughts that led to catastrophic conclusions with no possible endings other than my own imprisonment for the rest of my days. Again, looking back it seems silly that I even contemplated this happening, but what I didn’t realise is that I was now deep in the troughs of a severe episode of anxiety, one which would not leave me for over a year.

Days turned into weeks, and weeks into months, and all this time was spent in a haze of catastrophic thoughts. Sleep became almost non existent and I staggered from one horrendous fantasy of what my future was to another. I went to my GP on an almost weekly basis begging to be sectioned or given something that would relieve me of the torture that my life had become. Pills made me worse and I started to self harm and even contemplated ending it all but I kept going, unable to talk about anything other than my own problems or think about anything other than my own situation. There would on occasion be small windows of hope, perhaps I would get some good news or be cheered by the friendly words of family and friends. These moments of non worry became an incredible phenomena, a brief time when I felt for just a few moments like the “old me.” This feeling was more than just a lift of mood, more than a feeling of a weight lifted from my shoulder, it was like peering out of a cave on a summer's day. 

These were difficult times for my family. Having always been a big character I think it was difficult for them to accept this new me.  They gave their all to help me and I will be forever grateful. Like the pills that could not cast a spell and make me better I became frustrated and could not see any future for myself. Things looked really bleak. They had to change.

During the early days of my illness I had been referred by the GP to the local psychiatric services. Time had gone by and I had heard nothing (I would eventually get my first appointment almost two years to the day that I was referred). Seeking help but finding little I started to try different ways of helping myself. Of course getting myself out of the gloom and into helping myself was actually the last thing I wanted to do but little did I know it was actually the best thing for me.

Exercise was something I was sort of doing without realising it. Unable to sit and relax I was in the habit of walking miles, usually round in circles in my garden totally preoccupied. But when I started to give myself small goals like walking my dog to the old ruin a few miles from home, or cycling to Tesco to buy a chocolate bar or anything else that I may need, something started.  I would suddenly go, first seconds then minutes and then maybe ten minutes, without thinking of my problems. These little breaks from the pain became a lifesaver. Now I run regularly taking part in my local Parkrun every Saturday morning and being a regular runner in local 10k races. Exercise above any medication became a lifesaver.

Meditation and Body scanning. Helped by the force's occupational health department and counsellor I was steered in the direction of mindfulness and body scanning. This again became and has become an essential part of my day. I found it difficult at first to stop the swirling voices of doom but slowly over time I managed to shut them down for a few seconds at a time. This was priceless in the long run. 

My road to recovery was rocky and long and has taken a few detours along the way. I will be forever grateful to the Police rehabilitation centre in Flint House. The meagre amount deducted from my monthly pay could never hope to pay them back for the help they gave me. Even now I get my moments but it gives me great pleasure to talk to people who are going through a similar thing and sometimes can’t see that there is a way out. I can honestly say that at its worst it was the darkest time of my life. It affected me more than I could possibly imagine but I refuse to let it define who I am. From it I grew, I started to find my love for performing again and lost a lot of the inhibitions that were holding me back in life. Now under the name Owen Staton I can often be found performing and storytelling or acting all over the country. It’s not easy sometimes but Life isn’t a bed of roses and sometimes it's better for it I feel.

Mental illness can sometimes be a gift. It makes you appreciate being well, it helps you realise the battles that people are fighting and makes your victories ever sweeter. Do I wish I had never been ill? Yes I do, but I don’t for one minute regret being the person it made me. I am better and stronger and you can be too.

God Bless

Owen

You can follow Owen on Twitter @owenstaton

Many thanks to Owen for sharing his story. We love to hear from our readers, and welcome any comments in the box below.

Hello, and welcome: Terrence Higgins Trust in Powys

A few weeks ago I found out that the Terrence Higgins Trust - the charity promoting a healthy and stigma-free life for people with HIV - had set up a Community Liaison and Participation Project in Powys.  People who have been diagnosed with HIV often experience stress, anxiety and depression, and can feel particularly isolated in a rural county like Powys. The Trust provides support and advice for them and also anybody affected by these issues, such as family members and partners. Andrea Taylor, Support Service Coordinator of the HIV and Hepatitis Action for Wales, kindly agreed to answer a few questions about her work for the Trust, and the support that is available.

Tell us more about the work you are doing

Our Community Liaison Project is a Wales-wide service which can help if you are living with HIV and/or viral hepatitis. We can help if you are feeling isolated or lonely by increasing your access to a wide range of services in the local area. We can also help with some of the day-to-day issues of living with HIV and/or viral hepatitis and how they impact on your life. We can also help if you would like to make your organisation more knowledgeable and welcoming people with these conditions.

What is HIV and Hepatitis Action Wales?

It is a Wales-wide service which can help with any aspect of living with HIV and/or viral hepatitis. If you have questions about your treatment, your test results or day-to-day issues such as employment, housing and welfare benefits we can help support you. We can also provide emotional support and counselling. All our services can be delivered on a face-face basis locally, by phone or via our online support services.

Why is there a need for your work?

Despite the huge progress in care and treatment for people living with HIV/HepC in the last three decades, reducing the stigma around HIV/HepC has taken longer and proven more difficult to address.

HIV is still a stigmatised illness and discrimination and prejudice remain issues of concern to people living with HIV. Fear of discrimination and actual experiences of injustice can have a profound effect on individuals mental health and self esteem, which in turn can have significant implications for society as a whole.

Stigma often prevents people being open about their condition and it inhibits the kind of open discussions that is needed to challenge society’s lack of knowledge and understanding about HIV/HepC.

How do you know about the ongoing stigma associated with HIV?

A 2010 survey found that 66 per cent of the public agree that there is still a great deal of stigma around HIV. A similar number also believe more needs to be done to prevent discrimination. However, general awareness and knowledge levels among the public can still be startlingly low. People living with HIV/HepC regularly report being treated badly, receiving poor service or being discriminated against because of their status. Sadly, a high level of discrimination still occurs within some organisations.

A 2008 survey of people with HIV in London found that one third of people encountered discrimination because of their HIV status. Of those reporting discrimination, half said it had come from a healthcare worker, one in four from a dentist, one in five from a GP and one in ten from hospital staff.

We have supported people who have been bullied, intimidated and even threatened with violence because of their condition. Stigma and prejudice can compromise people's personal relationships and fear of disclosure can prevent them getting the kind of basic support that other people living with long term conditions can expect from family and friends.

How does the stigma of HIV affect people’s emotional wellbeing?

The fear and isolation this creates can have a profound effect on a person’s physical and emotional health. In many instances, people living with HIV/HepC can require more support in dealing with the stress and anxiety caused by the stigma, than with the physical impact of the infection. Mental health and in particular depression is a common experience for people living with HIV and a 2012 study showed that one in four had a current depressive disorder. Despite these figures, depression is not an inevitable aspect of HIV infection, but it could be triggered if you feel anxious or uncertain about your future. It is possible that people living with HIV are suffering from depression without realising it.

What about discrimination against people with HIV seeking employment?

People living with HIV/HepC are often fearful of disclosing their status in employment or recruitment settings and many people face barriers to securing or remaining in employment as a result. Similarly, many people are reluctant to disclose in settings such as with their GP or dentist and this in turn compromises the level of support they can expect from public services.

The public sector is the UK’s largest employer, with the NHS the largest single employer, so it holds considerable potential to not only improve the delivery of services to people living with HIV/HepC, but to also increase HIV awareness and tackle discrimination.

What is happening in Powys and Ceredigion?

A great deal more could be done within the health service in particular in terms of training staff on HIV related stigma rather than focusing on simply HIV infection control. Our projects in Powys and Ceredigion involve working in partnership with people living with HIV and representative agencies. We will continue to fight to challenge HIV stigma and increase awareness in public services and within our community.

If you would like to speak to your local Terrence Higgins Trust support worker either to request training, arrange an appointment, or simply have a chat on how we might be able to support you, please contact:

Andrea Taylor, Support Service Coordinator - HIV and Hepatitis Action for Wales

 mobile: 07824 809 779 email: andrea.taylor@tht.org.uk

Joshua Hall, Community Liaison Project Manager - 
Community Liaison & Participation Project
tel: 02920 666 465  email: josh.hall@tht.org.uk

Unconventional Wisdom: Organic Reasons for Depressive Symptoms

As many readers will know by now, I think we need to be challenging and debating the logic that accepts “mental illness” as a valid concept.  I am concerned that our mainstream acceptance of the idea of “mental illness”, within our health and social care services, our mental health laws and our society, leads us to act in ways that, although well intentioned, cause bad consequences.  Ultimately this may result in more harm than good for people affected by the idea that experiences and actions can be diagnosed as "symptoms" of “mental illness”. 

Last Thursday, in our “Shaping Services Together” Conference, I think that we succeeded in furthering this debate in Powys.  With the help of Jacqui Dillon and Jo Mussen the morning started with us being asked to consider the following question:  

“Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?” 

In this vein, I want to continue the theme from my last blog about organic reasons for psychosis by exploring organic reasons for depressive symptoms, again to try and make sure that:

In our drive to suggest that people are asked "what has happened to you" rather than “what is wrong with you”, let's not miss the question “is there anything physically/organically wrong with you?” 

Map of Medicine, which is the NHS system that claims to provide access to comprehensive, evidence-based guidance and clinical decision support, lists the following as typical symptoms of depression:

• an unusually sad mood that does not go away 
• loss of enjoyment and interest in activities that used to be enjoyable 
• tiredness and lack of energy 
• crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation 
• chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, irregular menstrual cycle, loss of sexual desire, unexplained aches and pains

A diagnosis of depression by a medical professional (in the case of depression, most often made by GPs) will be based on the number of these symptoms that you are experiencing/exhibiting, and whether you have experienced the symptoms for at least two weeks.

What are the known organic causes of these typical depressive symptoms?

Firstly let me try and clarify that by organic causes of depression I mean where the depressive symptoms are the direct result of an organic cause.  I do not include conditions where it is the actual coping with the organic condition, such as  cancer, dementia, heart disease, that results in us experiencing emotional stress and natural feelings of hopelessness, despair, loss of enjoyment and tiredness, feelings that could be diagnosed as “depression”.  Instead I am trying to find out about organic/biological conditions that cause a change in our physiological functioning that lead to the symptoms of depression that I  listed above. 

The Clinical Knowledge Summary from the National Institute for Health and Social Care Excellence (NICE) lists the following as organic reasons for depressive symptoms:

• Carbon monoxide poisoning   
• hyperthyroidism and hypothyroidism – state in which the thyroid gland production of thyroid hormones, thyroxine and triiodothyronine, is abnormal
• Rare side effects of prescription medication, such as: 
• antihypertensives used to treat high blood pressure 
• lipid-soluble beta used to treat a number of conditions including heart disease and high blood pressure 
• central nervous system depressants used to slow down brain activity prescribed for conditions including insomnia, muscle tension, pain, epliespy, anxiety and mood “disorders” 
• Opioid analgesics, generally uised for pain management 
• Isotretinoin primarily used for acne

However,as with my blog on organic reasons for psychosis, other organic reasons for depressive symptoms are to be found elsewhere on NHS sites.  These include:

• Cushing's syndrome, caused by very high levels of a hormone called cortisol 
• Hypercalcemia caused by abnormal levels of serum calcium concentration.  Also a complication of Pagets Disease 
• Hyponatremia where sodium ion concentration in the plasma is lower than normal 
• Diabetes when the pancreas does not produce enough insulin to maintain a normal blood glucose level, or your body is unable to use the insulin that is produced 
• Neurologic disordera such as Epilespy, Stroke, subdural hematoma, multiple sclerosis, brain tumors (especially frontal), Parkinson's disease, Huntington's disease, epilepsy, syphilis, dementias 
• Nutritional disorder such as Vitamin B12 deficiency, pellagra caused by a chronic lack of niacin (vitamin B3) 
• Other disorders such as viral infection and carcinoma

How do these organic/biological causes result in us experiencing depressive symptoms?

In many different ways it seems.  Some of the physical conditions listed above result in an imbalance of the hormones that we need to keep our bodily process working efficiently (e.g. thyroid hormones, insulin, cortisol).  When our hormone production or our ability to effectively use these hormones goes wrong, then a direct result can be symptoms of low mood, lack of enjoyment, tiredness, mood swings and lethargy.

Some of the conditions listed above cause damage to our brains in the areas that are know affect our mood so again the effect of this damage results directly in depressive symptoms. 

When someone experiencing depressive symptoms presents to a health care professional, what investigations will occur to determine whether there is an organic cause?

So back to the NHS Map of Medicine then.  It states that people presenting to health professionals with suspected depression may, “depending on the judgment of the clinical professional of the nature of their presentations”, expect to have medical investigations done to rule out an organic cause for their depressive symptoms.  The investigations are listed on this site but they include biochemistry tests, such as blood glucose, liver function tests, thyroid function tests and hematology tests such as full blood count.

Can depressive symptoms be misdiagnosed as a "mental illness" in this case “depression” when they are actually caused by organic/physical conditions? 

Unfortunately it seems that the answer to this is yes, again as it was with psychotic symptoms.  It is not difficult to find examples of organic problems being misdiagnosed as “depression” from across the academic world, the press and from people’s stories.    So examples where someone is diagnosed with "depression" and treated for this first, rather than the organic reason being found and appropriate treatment for the biological condition being given (e.g. removal of brain tumor, treatment for Hyperthyroidism).  

How often can the psychological symptoms we experience actually be explained by organic/physical/medical reasons? 

There is of course a lot of information about this on the internet but I really am not sure we know the definite answer to this.  It seems that a conservative estimate that about 10% of all psychological symptoms may be due to medical reasons, as this study suggests.   However the results of one study suggest that about 50% of individuals with a “mental illness” diagnosis actually have general medical conditions that are largely undiagnosed that may cause or exacerbate psychiatric symptoms.

So over to you again. Can you help me answer these questions?  Are they questions worth asking?  Tell me what you think ...

• Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?
• In our drive to ensure that people are asked "what has happened to you" rather than “what is wrong with you”, lets not miss the question “is there anything physically/organically wrong with you”.
• What are the known organic causes of typical depressive symptoms and how do these organic causes make us feel “depressed”?
• When someone experiencing depressive symptoms presents to a health care professional, what investigations will occur to determine whether there is an organic cause?
• Can depressive symptoms be misdiagnosed as a "mental illness" in this case “depression” when they are actually caused by organic/physical conditions?
• How often can the psychological symptoms we experience actually be explained by organic/physical/medical reasons?