The latest on SilverCloud - online Cognitive Behavioural Therapy

Becka Williams, Project Manager and Catrin Guest, Project Support Office & Online CBT Coordinator

by guest author Becka Williams

Project Manager, Powys Teaching Health Board

Following the implementation of our Online CBT service, SilverCloud, across Powys in May 2018, there has been a lot of work undertaken to develop the service and upscale it across Powys. 

We have received approximately 1100 referrals into the stand-alone service with referrals beings received from a range of different departments, services and healthcare professionals across the Health Board.

Work has commenced on the translation of the main Space from Anxiety and Depression programme and it is hoped that this will be ready for implementation by the end of 2019.

We were fortunate to win the Powys Teaching Health Board's Staff Excellence Award under the category of ‘Digital First’ in July which is a fantastic achievement. 

Becka Williams – Project Manager, Claire Cartwright – Director Ponthafren Association,
Jackie Jones & Sarah Dowler – Blended Online CBT Practitioners, Ponthafren

Blended Online CBT Service

We have implemented our Blended Online CBT service in partnership with Ponthafren Association in North Powys and the Mind Resource Centres in Mid and South Powys. The blended service offers access to the online platform as well as 6 face to face sessions with our Blended Online CBT Practitioners, during which they will review progress of the platform, signpost certain activities, tools and modules within the programmes and offer encouragement and support. The face to face sessions will be offered from the GP practices in Powys.

We are now ‘live’ with this service across nearly all GP practices, and where we have been unable to offer this from the specific practice, an alternative can be offered for the service users in that area should they wish to access this service.

Clinical referrals are required in to the blended service and these can currently be done through GPs of the Local Primary Mental Health Support Services (LPMHSS) within Powys Teaching Health Board.

We have currently received approximately 190 referrals into this service and are continuing to engage with the GPs and clinical teams to further upscale the blended approach.

Becka Williams, Project Manager & Catrin Guest, Project Support Office & Online CBT Coordinator raising awareness of Positive Body Image with PTHB's Occupational Health & Mental Health department during Mental Health Awareness Week

Positive Body Image

As part of Mental Health Awareness week, with ‘body image’ being the topic for 2019, we implemented our Space for Positive Body Image programme, which is now available for our healthcare professionals to refer in to.

This programme looks at the following topics:

• Improves understanding of body image and the impact on depression and anxiety.
• Focuses on what factors influence body image and how to improve perceptions of body image. 
• Introduces the known risk factors of eating disorders.
• Improves understanding of the effect of the media on understanding of the “ideal body”.
• Encourages reduction of individuals thin-ideal internalisation through analysis of media messages.
• Introduces self-esteem and focuses on where it comes from and how to boost it.
• Introduces the reciprocal relationship between how we feel and how we eat, using the CBT model of Thoughts Feelings Behaviours (TFB) cycle.
• Recognises emotional eating, mindful eating and how to have a healthy relationship with food.
• Recognises negative automatic thoughts and how to challenge them.
• Introduction to Mindfulness.
• Self-esteem enhancement through activities.
• Recognises the importance of social support in staying well.

Self-referral

We have designed, developed and recently implemented a self-referral option to this service. This service is available for all Powys residents and Powys patients that would like to self-refer onto an Online CBT Programme for depression, anxiety or stress. This service aims to offer services to those experiencing symptoms of depression, anxiety or stress who want access to an effective Online CBT therapy without having to first have an appointment with their local GP or other health professional.

People will be required to undertake an initial self-assessment and on successful completion of the self-assessment, immediate access to the online programme will be given. However, if the self-assessment results are not within the appropriate threshold for this service, a clinician from the PTHB Online CBT team will contact the person in due course for a follow up phone call assessment to determine whether the service is suitable for that person.

Sign up to the self-referral service here.

Student Programmes

The referral age for this service has now been lowered and therefore we are now accepting referrals for young people aged 16 years and above.

We have also implemented ‘student’ versions of 3 of our programmes: Space from stress, Space from anxiety and Space from depression which all offer support that relates more specifically to students such as educational stresses, friendships, relationships etc.

We have started to engage with the high schools and colleges across Powys to increase awareness of this availability to students.

Fionnuala Clayton, Psychological Assistant & Online CBT Coordinator & Catrin Guest, Project Support Office
& Online CBT Coordinator

All-Wales Roll-out

One of the key aims of this project was to explore the opportunity of implementing Online CBT across Wales, including the other Welsh Health Boards and third sector organisations.

Work has commenced on this and we went ‘live’ with the Welsh Ambulance Service NHS Trust (WAST) in December 2018 with this service being utilised within their Occupational Health and Staff Wellbeing teams.

We have also started working with Aneurin Bevan University Health Boards (ABUHB) with this service now being piloted within their Primary Care Mental Health Support Services (PCMHSS) and referrals being received since June 2019.

Engagement is still being undertaken with the other Welsh Health Boards, with a view to further roll-out this service across the different health board areas.

For further information on any aspects of the project or service, please check out this Powys Teaching Health Board website, or contact Becka Williams, Project Manager, on 01874 712 444 or becka.williams@wales.nhs.uk.

Welsh Ambulance Service on mental health - Keep Talking

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

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

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

Steve Clarke, Head of Mental Health, WAST

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

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

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

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

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

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

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

Introducing SilverCloud – online Cognitive Behavioural Therapy

Becka Williams, Project Manager, SilverCloud CBT

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

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

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

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

Background

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

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

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

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

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

Project progress 

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

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

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

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

Future development

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

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

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

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

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

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

Feedback about SilverCloud CBT 

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

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

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

Psychoeducation for Bipolar Disorder

We recently found out about a new support initiative in Powys for people diagnosed with bipolar disorder. We asked Paul Gauci, who works at the National Centre for Mental Health in Cardiff, and Julie, a recent participant on the course down there, to tell us more. 

Talking therapies often involve individual, one-on-one sessions, but a programme being run by the National Centre for Mental Health (NCMH) is using group sessions to help improve quality of life for people with bipolar disorder.

Bipolar Education Programme Cymru, or BEPC, is an award-winning group education programme developed by the Centre and their colleagues at Cardiff University.

It aims to help people with bipolar disorder to better understand and manage the condition, identify early warning signs of highs and lows, and develop the skills needed to stay as well as possible.

By delivering the programme in a group setting, people have the opportunity to share their personal experiences of living with bipolar disorder and to learn from each other, as well as from the course. It also gives the programme a more social element, making it more enjoyable and encouraging participants to attend all the sessions.

For many people it might be the first time they’ve ever met anyone else with the condition, so it can be a very positive experience for them to know that they aren’t the only ones affected by it.

There are 10 sessions, in groups of up to 15, each lasting for between two and two and a half hours. These combine presentations, informal group discussions and short exercises. The sessions include:

• Introduction.
• What is bipolar disorder?
• What causes bipolar disorder?
• The use of medication in bipolar disorder.
• Psychological approaches to bipolar disorder.
• Lifestyle issues and bipolar disorder.
• Monitoring mood and identifying triggers.
• Early warning signature.
• Bringing it all together.

Family members and carers of the group participants are also given the option to attend an additional session where they can find out more about bipolar disorder and meet other people in similar situations.

Courses have been delivered throughout Wales, and an estimated 570 people have benefited from taking part, including 65 in 2015 - 16. The model has also been adopted internationally, with healthcare providers as far afield as New Zealand, the Netherlands and Turkey running courses based on BEPC.

A participant’s view...

Julie

I first became unwell in my 20s and I was diagnosed with anxiety and depression. It was the start of a very difficult time in my life where I really struggled with my illness.

I also experienced what I now know were manic episodes, which could be just as devastating as my episodes of depression. I’ve gotten into very dangerous situations and the aftermath can be terrible.

I was diagnosed with bipolar disorder following the birth of my son, and the medication has been helpful although my mood still fluctuates and I can become very unwell. My psychiatrist told me about BEPC and recommended I try it.

The day I started the programme I was really nervous, but the facilitators really made me feel at ease. I found it amazing to meet people with the same diagnosis as me - all from different walks of life - different cultures and ages experiencing the same struggles.

I learned about managing my lifestyle, relapse prevention and early intervention through being aware of triggers and early warning signs. I also completed a manual as we went through the course which was tailored to my needs. I still use it today and it forms the basis of my care plan - I call it my bible.

This programme changed my life and I’m almost certain it has saved my life. I have gone from coping to managing my bipolar disorder.

BEPC in Powys

A new course will be running in Brecon, beginning on Tuesday 27 September, and then running every Tuesday for 10 weeks. There may be an 11th week, depending on whether there is demand for a friends and families session.

For more information contact the NCMH on 029 2068 8399 or email bepc@ncmh.info

About NCMH

The National Centre for Mental Health is a research centre made up of researchers from Cardiff, Swansea and Bangor Universities. It is funded by Health and Care Research Wales, and aims to improve treatment, diagnosis and support for people affected by mental health problems including bipolar disorder.

The Centre is looking for volunteers to take part in its research - it takes under an hour and can take place in your own home. Find out more about taking part.

The latest on MasterMind - computerised CBT in Powys

Powys Teaching Health Board staff at a MasterMind seminar in Odense, Denmark in October 2015.
Front row far right: Dr Wasi Mohamad, PTHB Clinical Director & Consultant Psychiatrist who is the Clinical Lead for MasterMind; next to him: Becka Williams Project Administration Assistant. Back row second from right: Harold Proctor Dementia Lead for PTHB and the MasterMind Project Executive.

Back in August 2014 our friends at Powys Teaching Health Board wrote on Introducing MasterMind - computerised CBT in Powys. 

The MasterMind project is currently being piloted across Europe, including Powys. Some individuals with a diagnosis of low to moderate depression have been able to access the computerised Cognitive Behavioural Therapy course in their own homes. We decided now was a good time for an update and Becka Williams, who works with the team overseeing this project, gives us the latest news.

MasterMind – where are we?

We have just begun the final year of the MasterMind project with the project due close in February 2017.

We went ‘live’ with the online CBT programme in March 2015 and have had 216 referrals since. We have implemented this service into the Local Primary Mental Health Support Service teams (LPMHSS), Pain Management and Occupational Health and in recent weeks have started engaging with the GP practices in Powys to encourage GP direct referrals.

A bit about the programme…

Powys staff opted for Beating the Blues as their software of choice which was developed by our service provider Ultrasis with ownership transferring to 365 Health & Wellbeing.

What does Beating the Blues consist of?

Beating the Blues consists of eight, approximately 1-2 hour sessions recommended to be completed weekly. The programme is interactive. During sessions you can watch video clips, complete exercises and learn CBT techniques that can help with depression and anxiety. Each week tasks will be given to be completed during the time between sessions.

How will it help?

Beating the Blues will help to pinpoint and change unhelpful ways of thinking that can affect how you feel, whilst teaching you more effective ways of solving problems.

How many sessions need to be completed?

It is important to complete as many sessions as possible. When completing the first couple of sessions it may be hard to see how it is relevant to your situation, however the programme is designed to build up your knowledge and skills over the weeks, if you stop too early, you will not get the full benefit of the treatment. The advice is to complete all eight sessions.

Where can the course be completed?

The course can be completed in your home or in a community site such as a library. To do it at home you need a PC or laptop with either speakers or earphones, along with access to a printer as there will also be a need to print material most weeks. Beating the Blues does not run on iPads, Tablets or Smart Phones at present. When doing it at home it is important to set aside enough time to complete your session at roughly the same time each week and ensure you have sufficient privacy to do so. You do not have to complete all sessions from the same location, you may want to complete some from home and some form one of the community sites. 

Feedback from participants

“The sessions were brilliant.”

“The programme was good in many aspects.”

“Most techniques I knew but Beating the Blues helped me put them into action.”

The Mastermind seminar in Denmark, October 2015

Collaborative Care through Videoconferencing (cCVC)

The second part of the MasterMind project is the collaboration of care through videoconferencing (VC) which we are currently implementing. In the initial stages we will be implementing this in the Crisis Resolution Home Treatment Teams (CRHTT) and the Community Mental Healthcare Teams (CMHT). In short, a member of these teams will meet with the patient and together they will have an appointment with the Consultant Psychiatrist through the use of Videoconferencing. The VC software that has been rolled out across the Health Board is Skype for Business.

Our EU Partners

Throughout the project, there have been a number of meetings and events taking place across Europe to get together with our European MasterMind partners to discuss the project, the pros and cons and generally share thoughts and ideas. The project has been a great opportunity for networking, building working relationships and shared learning. 

Many thanks to Becka for the update. Have you had experience of Beating the Blues or other computerised CBT sessions? Let us know what you think in the comments box below.

You can find out more about the MasterMind Project on the project website, and also join the debate on Twitter.

More Harm Than Good

A couple of weeks ago our guest blogger, Anne Watmough, went along to this London conference - More Harm Than Good: Confronting the Psychiatric Medication Epidemic, organised by the Council for Evidence Based Psychiatry (CEP). The CEP website reports: "Global leaders in the critical psychiatry movement met for a one-day conference to address an urgent public health issue: the iatrogenic harm caused by the over-prescription of psychiatric medications." Anne kindly sent in a review of her experience of the day - read on.

I set out on Thursday the day before the conference at 9 o'clock in the morning and boarded the bus direct to London. My journey took five and a half hours. But I didn't mind as the coach was very comfortable.

I arrived at my small hotel to find my room cosy and spotlessly clean. I had a nice meal that evening at a Moroccan restaurant on King Street.

The next morning I rose early and went out to have a full English breakfast at a nice cafe. Where the chips were delicious. I allowed myself to eat this food because I was a traveller.

Then I took a taxi to Whiteland College, part of Roehampton University, over Hampstead Bridge.

I arrived to an empty auditorium - one of the very first people to get there. Then two women came to sit down beside me. These remarkable women both had sons like myself affected by psychiatry and psychiatric medications.

Amy, a most young looking natural blonde lady despite all of the transgressions her life has held, explained she was prescribed psychiatric medications whilst she was pregnant with her son. He was born handicapped and she has had his lifetime to regret what happened to her when she was most vulnerable and carrying him inside her.

She has devoted her life to caring for him.

The second woman I met was Jemima and she explained how she was fighting for her son who had had a bicycle accident when young. He was left disabled and in a wheelchair. She felt that when he was prescribed psychiatric medication his disabilities were made worse. How horrendous for a woman whose son was disabled for her to watch him become more disabled due to side effects of medication that is supposed to keep him healthy.

I listened to the wonderful speaker Peter Gotzsche and how he is fighting for the rights and care of people like myself. To keep us free!

There were several speakers who were educated renowned men.

But one of the speakers who most impressed me was the renowned American journalist Robert Whitaker. He wrote "Mad in America" and "Anatomy of an Epidemic". He has researched and investigated psychiatry and psychiatric medications. And the drug industry. He has a website - Mad in America - and his work is also on this along with that of other people. The epidemic of labelling and drugging is rife in America and also in Europe. More and more people suffering from normal emotional problems are sent to their GPs who go on to prescribe medications like anti-depresssants or refer them to a bio-psychiatrist. These medications do more harm then good. This award-winning journalist can be found also on YouTube.

The main speaker, and a man I totally am devoted to, was Dr. Peter Breggin. He came through from America on Skype. He couldn't attend because his wife Ginger was unwell and he felt he had to be by her side. He gave his talk and as I expected the audience gave him a rapturous applause.

Then he was up for some questions. I was the first to put up my hand to speak. The sound effects were an issue on that day and at first he couldn't hear me but I managed to speak loud enough and clear enough so my question could get through.

First, and this is the first time I ever had a chance to speak to him, I wanted to tell him I have read his books. "Toxic Psychiatry", "Your Drug May be Your Problem", "Withdrawing off Psychiatric Medications" are just a few of his wonderful writings. I have his latest book in front of me -  "Guilt, Shame and Anxiety" - which I think is his best book yet. My favourite being "The Psychology of Freedom" which he wrote in 1980 when my son was born. Which makes it 35 years old. Somehow my question got through to him despite the sound situation. And he answered me giving me hope about my own current brain damage.

Dr. Breggin has been a psychiatrist working in New York for 61 years. He started at the young age of 18 at Harvard University and went on to train. He never prescribes medication or sends off his patients to be incarcerated. He has never had a suicide on his books.

Which in my opinion makes the man incredibly remarkable.

After the joy of speaking to Dr. Peter the conference went on with the panel and people asking questions.

I am afraid my anger got the better of me on that day although I passionately expressed myself and did keep it in check. It is recorded on YouTube under the title of this article.

My son I feel has been damaged by psychiatric medications. And that they stirred in him mania which he may not have suffered from if given talking therapy which was suited to what ailed him emotionally at the time he was in crisis.

I have been in therapy these past two years and I feel I will never have another psychotic episode.

I became aware at the conference of the wonderful Sandra Breakspeare and her dream of starting up a farm called Chy-Sawel in St. Ives, Cornwall. Chy-Sawel is Cornish for ‘House of Health giving.' Sandra's son is incarcerated as we speak and has been in an institution over these past ten years. Which without a doubt makes this remarkable woman even more amazing.

This is an alternative to medication and is the way forward and will help millions. Anyone interested can find details online. Please do all you can to promote this.

I am also aware of Open Dialogue Therapy which is curing, with a 86% result, people who are suffering from first diagnosed psychosis. This is the way forward also. This nursing approach by psychiatrists and psychologists and trained nurses has been working in Lapland, Finland these past 20 years. It is slowly being introduced to the NHS in this country. Sandra is embodying this into her farm. Which is a non-profit making charity.

Open Dialogue UK is holding a conference next February in London. Anyone who wishes to attend can find details online.

I would say that not only has my therapy been a way forward to recovery for myself but attending this conference has also been life changing.

Simply Google Dr. Peter R Breggin psychiatrist, Robert Whitaker American journalist psychiatry, Open Dialogue Therapy Lapland Finland and Chy Sawel. And you will find these people.

Anne Watmough

Many thanks to Anne for telling us about this interesting day. If you want to find out more, you can watch videos of the event on the CEP YouTube channel.

Some names have been changed to protect the privacy of individuals.

Psychological therapies - what's happening about waiting lists in Mid & South Powys?

Jane Cooke of our mental health team recently supported the organisation of a meeting in Llandrindod Wells to look at the long waiting lists for psychological therapies in Mid and South Powys. She reports now on what happened on the day.

The Psychology Services in Mid and South Powys have very long waiting lists. There are also waiting lists, but not so long, to see a counsellor based at GP surgeries. (Psychology Services in Mid and South Powys are provide by Aneurin Bevan Health Board and in the North of Powys are provided by Betsi Cadwaladr University Health Board).

In response to this the Psychology Services, some counsellors who work in GP practices, Powys Association of Voluntary Organisations (PAVO), people on the waiting lists and Public Health Wales worked together to plan and put on an event to talk with people who are on the waiting lists.

Around 30 people who are waiting for psychology services or counselling came on the 3rd February to a meeting in Llandrindod Wells to give their views about what it is like to be on the waiting list, what information people get, or don’t get, and what is it like receiving letters asking if you still want to be on the list.

People also had a chance to find out more about what else is on offer from, for example, Mind groups and other voluntary and third sector groups.

Mr Foxxman and Anna

There was a strong commitment from the Psychology Services to respond quickly to issues raised where possible, for example by changing the wording on letters, thinking through how to better keep in touch and demonstrate that there is concern for people. There were other ideas that will take longer to develop and find funding for around peer and buddying possibilities for support. There is a commitment from PAVO to continue to work with Psychology Services, supporting the participation of people who use services where required and considering the options for developing joint or partnership work. Public Health Wales also stated its support for this process as it develops.

This event is going to be of interest to other services across Wales. The simple act of getting people together and asking their views is not as widespread in the NHS as may be imagined. The fact that this was a positive experience for those who organised the event and those who attended, with some significant improvements resulting, will encourage others to adopt a similar approach.

We will continue to report developments!

What do you think about the waiting lists? Have they affected you? Let us know in the comments box below.

Finally receiving treatment - a personal view

I was speaking to someone in Powys recently about their experience of "going outside of the NHS towards private talking therapy... a really positive step". A positive step seemed like a good subject for a blog post, and our guest author agreed. Read on....

As an individual I have been in contact with mainstream services for over nine years, both in Powys and in other areas of the UK. Over these years, a combination of GPs, psychiatrists and occasionally other staff such as Community Psychiatric Nurses and support staff from Community Mental Health Teams have made efforts to try and alleviate the severe difficulties that go along with a diagnosis of schizophrenia.

I have found that during times of crisis access to support has been available, given that it is asked for in the right way. The problem however, for me and many others, has been with the issue of getting back to being able to live and function on a daily basis and to a level where it would be possible to believe that the goal of full and complete recovery is not only a real thing but something worth pursuing.

Although there can never be a guarantee that severe distress, mental ill health or challenges to wellbeing won’t occur either in someone who has previously had first-hand experience of these things, or in someone who hasn’t, the journey I have been on leads me to believe in one or two controversial things.

Firstly, like many others, and as supported by a growing body of evidence, I have a problem with the medical model of mental ‘illness’. The medical model is not a simple view and advanced neuroscience is often used to highlight areas of the human brain which may sometimes work differently in those who are labelled as ‘schizophrenic’ (to use but one example).

That shouldn’t detain us here, for as well as the causes for this diagnosis being perhaps still largely unknown and certainly not agreed upon amongst medics, the issue of how best to treat the condition is a big problem.

In my experience the first and last option for many practicing psychiatrists has been to prescribe powerful anti-psychotic medication, which especially since the second generation of a-typical anti-psychotics have been used, can and do alleviate or suppress ‘symptoms’ (such as psychosis) and with less pronounced side effects than the original first generation medications.

After talking to a pleasant local GP about the possibility of finding other ways to treat my own condition than medication alone, we loosely agreed that some combination of medication and talking therapy would be a sensible plan. However, in Powys the availability of talking therapy through the NHS is highly limited and the waiting list spans several years. One person I met has waited for more than 6 years already.

There are organisations such as Mid Powys Mind in Llandrindod Wells who are able to offer a free counselling service and having tried a couple of months of weekly sessions with a volunteer counsellor I found that the ability to share problems confidentially and in a non-judgemental setting brought much relief. 

More recently though, the view that a deeper and longer level of talking therapy could bring improvements to the way a person feels and functions is something which I managed to pick up from sources such as this blog and which in turn led me to explore the availability of private psychotherapy in our area.

Despite living on benefits, with advice on Employment and Support Allowance (ESA) and Personal Independence Payment (PIP) from the Citizens Advice Bureau it has finally been possible to find just enough capital to arrange for regular sessions with a practicing psychotherapist. Partly this is enabled by my practitioner’s policy of subsidising out of work patients with a slightly lower rate to those who are in work.

When making the long decision to proceed, the view of my psychiatrist was that for certain conditions which they believe to be entirely inherent or set in stone within a person’s biological constitution, there would be a risk associated with stirring up long lost memories or otherwise suppressed thoughts and feelings. I was glad of the discussion we had but, in the nicest possible way, could not disagree more strongly with any view which maintains it is not worth pursuing.

After the first couple of months of psychotherapy the tangible areas that many doctors ask about such as mood, sleep and appetite showed marked improvement and once more it seemed that the future could hold prospect and possibility rather than simply being a drab and bleak inevitability, where, to put it frankly, death would have been a welcome event.

I can’t speak highly enough of the time and space that I am lucky enough to have found within which help is given by another mind to sort through the problems and issues which we otherwise face on our own. This would include issues that an individual is aware of and also issues which it is almost impossible to be aware of by yourself.

As for ‘symptoms’, although my therapist is mindful of these and very respectful of the view of GP and psychiatrist, the outlet for me to unburden and unpack life’s major and minor worries means that as long as any possible reduction in medication is done gradually and carefully there is someone else to help keep a watch should difficulties arise.

There is still lots to do, but finally having some level of regular support has been a great relief not just to me but to remaining friends and family. As for the financing of this I would make the case to individuals, health professionals, charities and funding bodies to give increased engagement with other therapy some serious thought.

Have you had experience of talking therapies in Powys recently, whether provided by the NHS, by the voluntary sector or privately? Or are you still on the NHS waiting list? Let us know about your experiences in the comments' section below.

Introducing Mastermind - computerised CBT

Tanya Summerfield (left), an ICT (Information & Communication Technology) Project Manager at Powys teaching Health Board, is working to develop an innovative digital project to help support people experiencing depression in Powys. 

She is supported by her colleague Menna Reese (below), who is also helping to promote the roll-out of Mastermind in Powys.

We spoke to Tanya and Menna recently to find out more about Mastermind.

Tell us about your role at the health board 

To facilitate the implementation of two European Union projects, one of which is Mastermind, which is the introduction of the computerised Cognitive Behavior Therapy across Powys by November 2014.

What is the Mastermind Project?

The Mastermind Project aims to make high quality treatment for depression more widely available across Europe through the use of ICT. In Powys the software of choice is ‘Beating the Blues’ developed by Ultrasis.

What is cCBT? 

Computerised Cognitive Behavioral Therapy. 

Tell us about the Powys pilot of the Mastermind project

The pilot aims to facilitate access to cCBT through purchasing licenses and training primary care mental health staff in its application along with provision of video conferencing facilities between ‘GP and Specialist Clinician’ or ‘Specialist Clinician and patient’. 

How do you think it will benefit people who may be experiencing mental distress or be depressed?

The Programme will only be available for people with a diagnosis of low to moderate depression and the benefit will be access to the cCBT in the patient's own home at their convenience.

What is particularly innovative about the project? 

The Programme focuses on how to improve the lives of service users and their families using a recovery and enablement approach through embracing technological advances to date and minimising the need to travel to treatment centres.

Why has the health board decided to offer this type of mental health services in Powys?

In recognition of the rural terrain and the ratio of the primary mental health practitioners to the population, funding was sought through the EU to pilot the scheme prior to it becoming mainstream. In this way, we will be able to make psychological therapies more widely available.

What kind of links is the health board making with mental health services in other European countries as a result of this work, and how could this be beneficial to people in Powys?

Sharing good practice and regularly monitoring reports shared across 11 European sites, taking advantage of networking opportunities sharing experiences.

When will the Mastermind service be made available and who will be eligible to access it and how?

The time schedule identifies November 2014 as the start date and the trial will run for 17 months. Eligibility will depend on the diagnosis of low to moderate depression by the general practitioner, primary mental health clinicians or secondary mental health service.

How does the project tie in with the aims of the Together for Mental Health (Welsh Government strategy) and Powys Hearts & Minds strategy?

Poor mental health and illness have a significant impact on individuals, society and the economy overall. Together for Mental Health (Welsh Government 2012) sets out the Welsh Government's ambitions for improving the mental health service and promoting better mental health wellbeing across the whole population. This project will widen the availability of psychological therapies.

If people want to find out more about the Mastermind Project, who can they contact?

The EU Project Office on 01874 712765 or email Tanya.Summerfield@wales.nhs.uk

Thank you Tanya and Menna for introducing us to the Mastermind Project in Powys. You can find out more about the Mastermind Project on the project website here, and also join the debate on Twitter here, or tell us what you think by commenting below.