Celebrating Side by Side Cymru - mental health peer support in Wales

Artwork by Debbie Roberts engagevisually.co.uk

In March 2019 we lived in a very different world and I attended, in person, the launch of Mid & North Powys Mind’s latest project – Side by Side Cymru. MNPM was one of four local Mind groups in Wales, led by Mind Cymru, to provide this peer support project funded by the Welsh Government.

Here at PAVO we have followed the local project closely and with much interest, as we truly believe peer support to be crucial in the promotion of improved emotional wellbeing for people in Powys. I was, therefore, delighted to be able to attend the virtual celebration of the Mind Cymru project recently to find out more about how this approach had been received across Wales.

What is peer support?

“Peer support is about people using their own experiences to help others. It can happen in a group, on a 1:1 basis and also online as well but for this project we will focus on peer support that takes place face to face in a group situation. It’s about people taking a lead and taking control very much on an equal basis. So it’s a different model from more traditional health and wellbeing models. Through peer support we can feel valued, more connected to others, and more able to take control of our lives.” Mind Cymru, March 2019

“The connection to someone who is interested in similar things to you, or someone who has been through similar experiences, is a connection of equals and really invaluable. It is insightful and totally authentic.” Mid & North Powys Mind, March 2019

Sara Moseley – Chief Executive Officer, Mind Cymru

Peer support is needed more than ever because of what has been happening to us during this pandemic. There’s a huge amount of evidence now about the mental health impact of Covid. Many, many people have been behind closed doors, really feeling low, anxious and lonely. Peer support is about the power of unlocking that through the power of our own experience, kindness and compassion. In its simplest form it’s about using our own expertise and knowledge to support each other emotionally, practically and realise that there are positive, hopeful ways through mental health difficulties.

Covid has also put some of our networks and communities under considerable strain. Younger people in particular are feeling very isolated – being cut off from usual networks has a real detrimental effect on your mental health. As well as the human stories from over the past 3 years of the project we are now in a place to come out of the pandemic stronger than we were before. We have some very practical things that we have to say to decision makers about how we build back stronger and in a way very rooted in communities, and empowering to us as individuals.

Liam Pywell – Senior Peer Support Officer, Mind

Peer support based in the community and led by people with lived experience of mental health issues can be life-changing, and that’s why we believe it should be available to people across Wales.

The project worked with 318 peer support leaders across Wales who in turn supported 3800 people in their communities. We provided over £50,000 in grants to over 221 organisations and groups. We delivered over 100 activities, including training, networking and shared learning.

The hubs facilitated physical and virtual spaces to bring people together to connect, share learning and access some much-needed resources. We wanted the peer leaders to feel more confident, knowledgeable and able to provide peer support to their community and to build on the resources such as our peer support toolkit.

Mind Cymru’s independent evaluator – MEL Research - concluded in their final report that the Side by Side Cymru hub model is an effective way to supportive community based organisations and peer leaders, and that there is a real need for these types of programmes.

The local hub offer centred around three things:

1. Training & shared learning.
2. Funding.
3. Networking opportunities.

Through the evaluation the value of Side by Side Cymru became clear: peer leaders increased their understanding of peer support and the value it provides, and their confidence to deliver improved peer support. The research tells us that peer support improves our sense of wellbeing, increases our sense of hope, and helps us to become more empowered to make decisions and take action.

We also found that peer support can reduce health care costs as people who use less mental health services are often involved in peer support. But peer support is not free – we do need financial resource to support those community groups. Finally, a range of peer support options should be available to support people from all different backgrounds and makes peer support available to all.

Lorna Jones – Peer Support Hub Worker, Mid & North Powys Mind

In a short video Lorna (bottom centre) was joined by one of her volunteers – Lynda (top right), and Bethanie (top left) a peer support leader. Bethanie attended a course with Mind after experiencing post-natal depression and went on to lead a peer support group for parents of children with additional needs. The Side by Side training helped her to be professional, and to learn about specific areas such as safeguarding. She found the toolkit really helpful to refer to for guidance at any time.

Bethanie also said that the training was particularly useful as she made connections with people who could also help her. “It was like peer support for a peer support leader.” We were working with young children but others were in peer support groups for older people who were lonely and vulnerable. We could mix together and create further networks too.

It has also been a lifeline for Bethanie’s own mental health. “It’s something to look forward to, even now with Covid we can still communicate online and it helps us feel less isolated.” The funding paid for the cost of venues.

Lynda helped Lorna massively with the training. She recalled how members of her own family had been dealt with on a very clinical basis in the past, so she felt privileged to be involved with the project which supported people at a community level. “It was great to see the range of people that attended the training – from young Mums, through the age ranges, and a lot of men including a male voice choir.” Lynda realised that they took what they had learnt to all spheres of their life, not just the areas they were representing.

Lorna said that when she read the evaluation report the one thing that really hit her was the huge area that the project had covered in Powys – right from Machynlleth in the north west to the Herefordshire border in the south-east of the county. They worked with 75 groups in total.

“People have said they would be lost without these groups to go to. Our inspiring peer support leaders gave up their time to hold these groups for no other reward other than helping others. They are the unsung heroes in our communities across Britain.”

Bethanie: “Side by Side grew me and my group. It was like the seed we needed.”

Panel discussion

Julian John, CEO of Cwm Taf Mind, chaired the panel discussion with Fateha Ahmed of EYST (Ethnic Minorities & Youth Support team Wales), Zoe King of Diverse Cymru and William Evans – the Young People’s Participation Lead at Mind Cymru. There is only space for very brief sound bites here but they give a flavour of the conversation.

Q1: What does an excellent peer support project look like (and how do you know)?

“It would include a diverse group of people with lived experience who are able to support each other and have empathy. You will see the improved progress in young people if the project is successful.” Fateha Ahmed

“Empathy has to be at the heart of a good peer support project, also coproduction. It’s all about lived experience and shared experience. To know how we did we can consider the distance travelled – how people are before joining the group and how they are since. Have they achieved life goals in certain areas?” Zoe King

“It might look different to different people from different communities / ages. The type of resources and training required will be dependent on someone’s age. It needs to be flexible and accessible, safe and rewarding for a younger person.” William Evans

Q2: What can traditional mental health services learn from community led peer support?

“Lived experience needs to be at the heart of the services they deliver.” Zoe King

“Peer support has a strong bond of friendship. A counselling service may last for 6 – 8 weeks only but friendship may last life long.” Fateha Ahmed

“Traditional mental health experiences are often too rigid and don’t treat people as individuals – young people want the emphasis to be on meaningful connections and a lot less on checklists and criteria.” William Evans

Q3: What roles do organisations like ours have in developing peer support services for the future?

“Many children and young people are fairly creative and innovative in their use of social media to create their own peer support networks. Organisations need to allow them support and resources to enable them to do that safely.” William Evans

“Organisations could connect grassroots’ groups to wider networks with similar aims and goals. Larger organisations could communicate opportunities as well and also provide training.” Zoe King

“EYST has been inviting our volunteers to share their lived experience – how they actually dealt with their anxiety and depression. The young people always say they learn better hearing other people’s stories.” Fateha Ahmed

Q4: How do we connect to the networks of community groups across Wales?

“Doing with and not for. Going into those communities and engaging with people in coproduction and finding out what solutions they have.” William Evans

“We have a community infrastructure (with village halls / groups etc) we also have a County Voluntary Council infrastructure that is supporting those groups across Wales. Is there something we need to do with our CVC partners in reaching community groups?” Julian John

“Yes, absolutely. We work with diverse groups to gain those lived experiences that we then feed back into consultations. CVCs are already well placed to do a lot of this networking.” Zoe King

“We need to find key individuals who are trusted in the community and work with them to provide the best possible service for our young people.” Fateha Ahmed

Angie Darlington, West Wales Action for Mental Health, added – “it is broader than CVCs, mental health development agencies are available across Wales to share out our peer support experiences and reach out into the communities.”

Sarah Moseley said at the end of the session: “It has been a really moving and inspirational afternoon. We want to use this as a spark to think how we sustain, build, grow and strengthen (the peer support approach). One of the most powerful things I have learnt is that there are moments in your life, or things that happen in your life, that make you uniquely ready to connect, share and give support.”

Side by Side resources

Side by Side toolkit and further information

For further information about the Side by Side Cymru Peer Support project email peersupport@mind.org.uk

You can also watch a video about the Side by Side Cymru Peer Support project.

New Eating Disorders' Services for Powys

A Happy New Year to all our readers! 

Just over a year ago one of our Powys citizen reps, Helen Missen, (pictured above) a passionate advocate for improved Eating Disorders' services, wrote about the Eating Disorders’ Service review in Wales which had just taken place.

Roll on twelve months, and so much has developed in Powys as a result of this review (you can read the Executive Summary). At our mental health partnership board meeting just before Christmas we were very pleased to find out more about the new services from our colleagues at Powys Teaching Health Board along with Dr Jacinta Tan (Consultant Child & Adolescent Psychiatrist at Aneurin Bevan Health Board) who led the Review Team, Menna Jones (newly appointed National Clinical Lead for Eating Disorders) and Helen.

The underlying principles which people wanted

• Early detection and intervention. Helping people, like teachers and parents, to identify people who might have an eating disorder to have access to support and help.
• Inclusivity. Never turn people away. Anyone in distress who thinks they are, or a loved one who might have an eating disorder, deserves a response.
• To be person-centred. To have prompt expert help for those who might have eating disorders. Giving people what they need and trying as far as possible to deliver it to them where they are. To provide person-centred and holistic care for the person and the whole family.
• Relationship based.
• Recovery focussed
• Trauma informed.

In total there were 22 recommendations made by Jacinta which the government took on board. 

Where we go from here

Eating Disorders’ services were highlighted, as one of five key areas, for additional funding from the Welsh Government’s Mental Health Improvement Fund. There was a specific focus on Early Intervention as an area which the government wanted to prioritise. The first funding stream came through in Summer 2019 and coincided with a large consultation with clinicians across Wales looking at the response to the recommendations as well as some of the barriers that might come up.

In January 2019 it was announced that there would be a dedicated post created to take some of this work forward – a National Eating Disorders’ Lead in NHS Wales. Menna Jones officially started in this full-time role, the first of its kind for Eating Disorders, on 1 January this year, with the placement due to continue until March 2022. Menna’s role will be to work with clinicians, and those using services, to set up an Implementation Plan which sets long-term goals for improving services based on the Review’s recommendations and also facilitating changes to happen.

Some of the key areas include: early intervention, moving to increased delivery of eating disorder services by specialist teams, creation of physical health clinics within Community Mental Health teams, and to join up Child & Adolescent Mental Health Services (CAMHS) and adult services – looking at transitions but also at what can be learned from each of these services around models used and approaches to work.

The vision of the service review

Jacinta emphasized that the plan will focus on equity of access to specialist and high quality care across Wales, including in rurally isolated areas of large parts of Mid Wales such as Powys. There will also be joined-up working with other teams – patients are complex, they have many needs, they have comorbidities (the presence of one or more conditions at once) and it is important to interface with other services such as Autism services. In promoting specialism Eating Disorders Services will not be pulling away from the rest of the system.

The lived experience view from Helen

"From all mental health conditions eating disorders still have the highest mortality rate of any and that needs to be at the forefront of people’s thinking. I started advocating for families because I just didn’t want them to go through what we went through 11 years ago. I now sit on the Executive Committee for the Royal College of Psychiatrists’ Eating Disorders faculty and the European Board for the Academy of Eating Disorders. I really believe in change. I believe we can get it right in Powys. And I know (from my daughter’s experience) that recovery is possible." 

Plans for Powys 

Sam Shore – Head of CAMHS

Currently CAMHS has an eating disorder element to the service already, including specialist practitioner support and our own CAMHS dietician as well as support from psychology. Each CMHT does have a link eating disorder worker who will give advice to anyone open to adult mental health services and support any new referrals into the service.

Practitioners link with GPs for support in the first instance if someone’s physical health is deteriorating.

Following receipt of additional funds, however, we now are going to develop a specialist Eating Disorder Service, which is going to be an age-less service. We want to address issues such as transition and early intervention. We will be working more closely with GPs in Powys, and looking at our referrals into the service.

Following receipt of funding the following new posts have been created and we will be recruiting very soon:

• Team leader.
• Specialist practitioner.
• Dietician.
• Occupational therapist technician.
  
  

We’ve been working closely with Helen too and listened particularly to her tips and hints on moving forward. So we have an idea of what the new service will look like in terms of family intervention and family work. Menna has also offered to support us in the development of the service.

Whilst normally we would have 4 – 5 on our caseload we are actually working with 20 children and young people at the moment (mid December 2020). Covid has had a massive impact on the referrals and they are very complex – there are significant physical health issues, family dynamic issues and cases of anxiety as well as eating disorders.

Joy Garfitt – Assistant Director Mental Health & Learning Disabilities' Services

The model we’re going for is a small dedicated team of specialists who can link to the national Eating Disorder team. Within our five CMHTs and our CAMHS teams we have a small nucleus of specialism, whilst others practice as general mental health practitioners, so we’re creating a staff team which has a general mental health practice element to their role and a special interest element to their role. The special interest might be eating disorders, or perinatal, or trauma-informed services. This means that community psychiatric nurses, and social workers in the field, can also access that specialist support locally in Powys. We can’t provide an eating disorder service in every CMHT as might happen in a big city, so that’s why we’re looking at a different model. 

All in all it was great to hear the enthusiasm and commitment to reshaping Eating Disorder Services, not just in Powys, but across Wales, and we look forward to receiving further updates as the new team settles in and starts work.

Eating disorders' services review in Wales

by guest author Helen Missen

Powys resident Helen Missen, a passionate advocate and voice in Wales for change in mental health services, particularly those provided to people experiencing eating disorders, has been closely involved on the panel for the recent Welsh Government Eating Disorders’ Review. She tells us more about it. 

Eating disorders continue to have the highest mortality rate of any psychiatric diagnosis, across the world. They are often thought of as difficult to treat, though with early intervention, evidence shows a good chance of recovery. 

In Wales, and especially Powys, early intervention with specialist provision is still underwhelming. After my daughter became ill with Anorexia nervosa in 2009, I realised there was an urgent need for change. As well as a petition to the Welsh Government, I started to learn as much as I could about eating disorders and services, in Powys, Wales, the UK, and internationally.

When you, or a loved one, has something as complex as an eating disorder, the frustration of constantly going to somewhere like Child & Adolescent Mental Health Services (CAMHS), or adult services, where a couple of days of training does not make the staff experts, is demoralising.

It’s a bit like taking someone with a heart attack constantly to the GP and them saying – "I’ve read that in the book, I know this is what you’re supposed to do, but I don’t have any of the skills to do it."

Generally, a referral to the specialist is the norm in physical health. In mental health, a couple of training sessions deems a clinical provider a specialist. That, for parents and carers, and those with a diagnosis, is very frustrating. As well as dangerous.

The 2009 Framework for Eating Disorders was established by the Welsh Government on behalf of services. It was deemed at that time, that there was too little specialist input for eating disorders in adult services. CAMHS were, and are still thought to have enough generic help, something that does need to be changed.

Mental health eating disorder services are tiered from Level 1 - GP / school nurse / health visitor, to Level 4 - inpatient services. As a result of the framework four specialist adult eating disorder teams were set up at tier 3 level across Wales – one in the North and three in South Wales. Powys is covered by both the North and South teams at the moment. £1 million pounds recurring was given to those four teams, which obviously isn’t a great amount.

The four teams are run by psychologists and specialist trained nurses, with a couple of psychiatrists overseeing CAMHS but not necessarily in adult services. Clearly still underfunded, and with too few specialist staff at tiers 1 & 2, the strain on staff and patients continues.

My involvement for change began when I submitted a petition in 2010. The petition called for equal funding for CAMHS provision as there was for adult services.

It is well known that eating disorders generally start in the teenage years, around puberty. Although increasingly they are being diagnosed earlier and occasionally they may not present until later in life.

That petition is still running.

Unfortunately, services in Powys are very similar to how they were 10 years ago when the petition was first submitted, which is very frustrating for me. I have worked very closely with the eating disorder groups across Wales, and sit on Boards nationally and internationally. It grieves me that Powys hasn’t moved on in that time.

However, things are changing! 

In 2016 Public Health Wales was commissioned to do a refresh of the 2009 framework. Out of that came the recommendation that there should be a review of the Eating Disorder Framework.

“There now needs to be another major reconfiguration to move to align the service with the new emphasis on working seamlessly across agencies across Wales in the interests of promoting wellbeing and emphasising timely and effective early intervention. This is also to align with recommendations and directives in the NICE (National Institute for Health & Care) guidelines for eating disorders (2017), the Wellbeing of Future Generations (Wales) Act 2015 as well as multiple documents emanating from the Welsh Government in related arenas." 

The refresh came from Vaughan Gething, Minister for Health & Social Services, who commissioned Professor Jacinta Tan to do the review on behalf of the government. Professor Tan is a child and adolescent psychiatrist as well as an academic. She has a great heart for the children and families who suffer with eating disorder.

I was invited to be on the core team selected by Professor Tan, to help her gather information from the public. 

Unusually, for this type of large piece of government work, Professor Tan decided that to hear from the public first would provide the most important underpinning for the review. By holding four public workshops across Wales, one at each 'corner' of Wales, with a team of lay people who were representative of service users and carers facilitating the days, she was breaking new ground in the pure sense of providing the voice of the people.

The question Jacinta posed each day was: "what would be your ideal service?" which for any carer or person with an illness to be asked was quite monumental; a game changer in a way. Following the question, Professor Tan stood back and the day was run by the core team, with no input from clinicians. Never were the groups led in what to say... it was complete freedom. There were horror stories, and good stories.

Those workshops attracted carers, patients, people with lived experience, and a men’s group to hear partners’/ husbands’ / brothers’ perspectives. It was fascinating to listen to and be involved in.

At last people were given a voice.

By the end, all four workshops illicited very much the same pattern of what they wanted. The themes that ran throughout were: there are things that are really working well and amazing people doing the work, however, there are not enough specialists and very little specialist early intervention.

The underlying principles which people wanted:

1. Early detection and intervention. Helping people, like teachers and parents, to identify people who might have an eating disorder to have access to support and help.
2. Inclusivity. Never turn people away. Anyone in distress who thinks they are, or a loved one who might have an eating disorder, deserves a response.
3. To be person-centred. To have prompt expert help for those who might have eating disorders. Giving people what they need and trying as far as possible to deliver it to them where they are. To provide person-centred and holistic care for the person and the whole family.
4. Relationship based.
5. Recovery focussed.
6. Trauma informed.

There were 22 recommendations made by Jacinta which the government has taken on board. The entire 300 page paper has been sanctioned.

What does this mean for Powys?

The Health Secretary then wrote a letter to all the health boards in Wales, of which Powys Teaching Health Board is one, citing four recommendations to be upheld. Each health board had to give their strategies on how they will enforce the changes he requires:

1. Consider the review, provide feedback and identify where key incremental changes could be made to ensure that longer term service planning can align with the ambition of the review.
2. Work towards achieving the National Institute for Health & Care (NICE) standards for eating disorders within two years.
3. Develop plans to achieve a four week waiting time across adult and child services recommended in the review within two years.
4. Reconfigure services towards earlier intervention.

These submissions had to be on Mr Gething's desk by 8 November 2019.

One of the recommendations from the Health Minister is that the borders between health boards are to be grey areas. As it stands, there is too much financial segregation between health boards. If one health board has a service that may or would benefit patients in another health board, it is not necessarily shared across the invisible (to the public) borders. Therefore, the current system is not not bringing the best care to all members of the public.

Betsi Cadwaladr University Health Board in North Wales, for example, has an early intervention team (SPEED) created specifically for children and adolescents. It is a multi-disciplinary team that assesses and then treats people with very early stages of an eating disorder in that area. This approach ensures substantial financial savings for a health board, and years of suffering could be avoided for the person with a potential eating disorder.

The CAMHS team in Aneurin Bevan University Health Board in south east Wales is also setting up a new SPEED team.

Under the current system in Powys, children are not referred to this vitally important specialist team early enough in the onset of the illnesses. 

I would encourage the CAMHS representatives in Powys to dial into the SPEED teams quickly. To start working without borders.

Early intervention gets people out of an illness, and into recovery, avoiding the entrenched state which can then last a lifetime. It is known that with eating disorders there is always time for recovery.

I know personally, and also from hundreds of people across the world, that to ask for and demand the specialists, to not be frightened to question the system, does bring about better treatment and best practice.

It works both ways!

Don’t be too proud to ask for help from expert sources outside Powys, be you a clinician, carer, or someone living with an eating disorder. Until my daughter got sick I had very little understanding of eating disorders. As with many diagnoses: until you’ve lived it you don’t understand how life changing it can be.

I have become an expert by experience. Though, for all of the experience I now have on both sides of the proverbial table, I do wish I had never come across eating disorders.

Would I do it all again? Without a shadow of a doubt. Changing a system takes time.

A small stone makes a large ripple. 

Further help

F.E.A.S.T is a national organisation providing help and support to parents, carers and significant others in the lives of people who have eating disorders.

BEAT is the UK’s eating disorder charity.

Anorexia and bulimia care is a national UK eating disorder charity.

Together for Mental Health consultation - a Powys view

Individual rep, Sarah Dale, on Llandudno beach

Our Participation Officer, Owen Griffkin, shares a report on the Welsh Government 

Consultation for the ‘Together for Mental Health’ Delivery Plan 2019 - 2022

On a sunny day (with scattered showers) I attended the consultation event for the Together for Mental Health plan 2019-2022. I was there to accompany one of our individual representatives, Sarah Dale, who felt it is was important for Powys to have a voice in one of the live consultations. This all day event was in a beautiful location in Llandudno, Venue Cymru, with a lovely sea view, which almost made the 150 mile round trip worth it.

Together for Mental Health is the Welsh Government's 10 year cross governmental strategy and was published in 2012. This consultation is to inform the last 3 years of the plan and to look at the priorities that have been identified and how they will be implemented.

The day was chaired by Ainsley Bladon, the Mental Health Strategy Lead at the Welsh Government, who is regularly seen at both regional and national partnership events. She introduced the delivery plan with a short presentation and then we moved on to the first question for discussion.

This was looking at the key priorities for the next 3 years and there were a lot of themes arising that we have come across in other engagement events. Some of these included - transition from Child & Adolescent Mental Health Services (CAMHS) to adult services, accessing mental health services with substance misuse issues, difference in service depending on location and funding of third sector (voluntary) organisations.

Also a big point raised was the accessibility of legislation and documents to the ordinary person. There is a lot of jargon and acronyms in the consultation document and this has proved a barrier to some people in disseminating the information. Ainsley said they had heard this a lot and they will look to change this in the future.

Sarah was very vocal about the need to ensure that basic service provision is met in Powys and that locally this is a priority - eg 24 hours crisis care. She also spoke passionately about the Talk to Me 2 suicide and self-harm plan, saying that it didn’t have enough mention of self-harm.

Next we were asked if the cross-cutting workstreams were appropriate to prioritise, which once again prompted some explanation requests about the technical language of the document.

These priority areas can be seen in this photo:

We were able to share some of the findings of the recent care and treatment plan engagement events held by Powys Teaching Health Board in Powys as this is linked to the ‘Core data set’ requirement, and also highlighted some of the specific issues in Powys around engagement.

After lunch, and a very quick stroll along the prom, we returned to look at what the room thought the key impacts would be and how we can increase positive effects whilst mitigating negative effects. The importance of third sector organisations was highlighted again, and a few people spoke about the relationship between staff and service users and the importance of being listened to in that relationship. 

We then ended with a reflective exercise on the effectiveness of the day and an assurance that results of the consultation will be fed back to everyone who attended. We closed with a thank you speech from Tracey Breheny, the fairly-new Deputy Director of Mental Health. It was interesting to hear that she is also responsible for Substance Misuse and Vulnerable Groups which hopefully augurs well for more coordination and understanding of the co-occurring issues of substance misuse and mental health. She also came out with the quote of the day when she said that all the comments would be ‘fed into the sausage machine of the Welsh Government’ and processed into a report.

All in all the day was definitely worth our while going although it is a shame that there isn’t an event closer to Mid Wales. It is vital that Powys has its voice heard in this consultation as we have a lot of issues specific to our county and I therefore urge anybody with an interest in the delivery plan for Mental Health services to fill in the online consultation before August 30th. You can participate by visiting the link on the following webpages:

Welsh

English

There is also another consultation event in Carmarthen on the 28th August that I recommend attending if you have the time.

Venue

Room TL5 (Ground Floor), Teaching and Learning Building, University of Wales Trinity Saint David, Carmarthen Campus, SA31 3EP.

The day will be structured as follows:

Morning 10:00 – 12:30 – Discussion of Priority Areas
Lunch 12:30 - 1:30

Afternoon 1.30 – 4.00pm – Considering Impact and Delivery

To take part please RSVP to Darren Lewis (Darren.lewis@gov.wales) including the following details:

Name, organisation (if relevant) and event you wish to attend (West Wales in this case). Expenses and lunch are provided on the day. 

If you fill in the consultation, or attend the Carmarthen event, please let us know at PAVO. You can email owen.griffkin@pavo.org.uk or ring 01597 822191. We might be able to help you organise lift shares and put you in touch with others attending.

Social prescribing - a pilot project in South Powys

Rhiannon Davies is known to many people as she was, for many years, the very active chair of Brecon Dementia Friendly Community. Recently Rhiannon has moved on to a new role in the voluntary sector in South Powys, as a link worker for a very particular project at Brecon & District Mind. I was interested to find out more, as social prescribing is becoming increasingly recognised as an important service to complement more traditional health services at the local GP surgery.

What is social prescribing?

Social prescribing recognises that people’s lives and health are affected by social, economic and environmental factors and these needs have to be taken into account for our wellbeing. Looking at people holistically and addressing these things takes extra time. So rather than just having a prescription for a medicine, social prescribing can help you to access a wide range of support and activities in the local community to ensure your needs are being met.

Tell us more about your role with Brecon & District Mind

I am a link worker providing a new service, provided by Brecon and District Mind, in Brecon Medical Practice on Thursdays, and Crickhowell Medical Centre on Tuesdays. It’s called Social Prescribing and it aims to help you get the support you need, when you need it, to improve your mental health and wellbeing.

Why might someone need this service?

Maybe big life decisions are making you worry, so you might want to approach the decisions differently. If you are feeling lonely you might like to make new friends. If you have money problems, you might like to be more in control of your finances. If you are feeling stressed, anxious and depressed you would probably like to sleep better and feel more relaxed.

Everyone needs some help from time to time to overcome life’s challenges. The answer lies in finding the right support at the right time.

Who can be referred to the Social Prescribing service and how?

If you are over 18 and registered with either Brecon or Crickhowell Medical Practices you can ask for a Social Prescribing patient pack at the surgery reception and make a self-referral by completing a consent form. 

Sarah James, Link Worker and Helen O'Donovan, Administrator

How does Social Prescribing work?

Once you have completed a consent form, as a link worker, I will contact you to arrange an appointment at the surgery. When we meet, you can then spend time with me, letting me know your circumstances, how you are feeling, what matters to you and what you think might help to improve your wellbeing. 

Using my knowledge of community support and services, I will then help you to connect to the appropriate local community and voluntary groups, activities and advice services. This could range from wellbeing activities in your local community, housing / benefits / financial support and advice, art or music activities, support groups covering things like bereavement, relationship issues, stress or mindfulness, walking or running groups, and peer support from others who have similar experiences. 

After about three months you will have a final follow-up phone call or meeting so we can see the impact the service has had.

Why was this project set up?

This social prescribing service is part of a joint research project between Mind Cymru and local Minds, funded by Welsh Government. Understanding how social prescribing can help people overcome stress and anxiety is really important in deciding how best to develop medical services in the future. So as part of the process you will be asked some questions about how you are feeling, and your experiences before and after you have used the service.

We know that social prescribing has really helped people in other areas. By taking part in this initiative those who participate are contributing to important evidence that will help plan future health services. All collected data is anonymous.

Is this service available in other parts of Powys?

My colleague, Sarah James, is allocated link worker for Hay and Talgarth surgeries, but Brecon and District Mind is still waiting for the green light before setting up the service there. Ystradgynlais Mind is also part of the research project and has two link workers working in a similar way to Brecon and District Mind.

Which organisations do you work closely with in Powys to provide support to people?

These are early days as the service has only been running for a few weeks, but already I have made referrals to a number of local voluntary organisations, housing, Brecon Leisure Centre, Brecon Job Centre, volunteering groups, a walking group, an art group, the Centre for Long-term Condition Management and Brecon Mind Community Wellbeing service to name a few! The list of potential organisations we have collated to date is well over seventy!

What kind of feedback are you getting from people about the project?

So far the feedback has been very positive, and people are genuinely grateful to have access to such a resource. As I said, the service is still in its infancy, so we hope the numbers accessing the service will build as the word gets out.

What are the main challenges of the role?

Not knowing who is going to come through the door, it’s really important to stay open minded and really listen, so you are not just hearing what people say, but what they mean. Because it’s a new service, making sure all the healthcare professionals are aware of what it can offer and its benefits, so they see it as a regular part of their referral pathway in delivering healthcare is a genuine challenge – as is trying to fit everything in in just two working days a week!

Tell us about some of the most rewarding work you have done in the role so far

I have met some fantastic people to date. People who struggle to see their own strengths and just need some encouragement and support to find what they already have within themselves. Being part of that process and seeing them genuinely engage and take responsibility, setting themselves goals and then, with some extra knowledge and understanding, move forward is hugely rewarding and inspiring.

When you are not working for Brecon & District Mind, how do you enjoy spending your time?

Reading, going to concerts and listening to music, walking our dog, gardening, doing volunteer work within my own community, being with friends and family. Juggling and balancing are my two constant challenges, but I’m up for it as long as I’m learning!

If you want to find out more about the Social Prescribing service you can contact Rhiannon by emailing: rhiannon@breconmind.org.uk or ring: 01874 611529 / 07487 523992. Rhiannon is happy to answer individual questions or queries about the service or spread the word by talking to community groups.

Mwy na Geiriau ac y Cynnig Rhagweithiol / More than just Words and the Active Offer

Helo sumai! Gwern dwi, y Swyddog Datblygu’r Iaith Gymraeg newydd yma’n PAVO. Un o fy nyletswyddau yw cefnogi’r iaith Gymraeg o fewn y drydydd sector a thu hwnt ym Mhowys. Rwyf am ffocysu ar ambell i faes, yn cynnwys Iechyd Meddwl.

Ehangwch ar eich rôl

Byddaf yn gobeithio cyflwyno’r Cynnig Rhagweithiol fel strategaeth i geisio cynyddu defnydd y iaith Gymraeg o fewn y setctor.

Beth yw’r Cynnig Rhagweithiol?

Mae’r Cynnig Rhagweithiol yn un o egwyddorion allweddol ‘Mwy na Geiriau…’ sydd yn fframwaith strategol ar gyfer iechyd, gwasanaethau cymdeithasol a gofal cymdeithasol a gyhoeddwyd gan Llywodraeth Cymru er mwyn cefnogi gwasanaethau Cymraeg yn y meysydd hyn.

Sut allith hyn fod yn fuddiol i ddefnyddwyr gwasanaeth iechyd meddwl ym Mhowys?

Wrth drafod materion personol gall defnyddwyr gwasanaeth iechyd meddwl deimlo’n fregus wrth drafod y materion hyn yn eu hail iaith. Dylent allu derbyn gwasanaeth yn eu mamiaith heb orfod gofyn amdano, ac mae’r cynnig rhagweithiol yn galluogi hyn.

Ydy’r Cynnig Rhagweithiol yn hanfodol?

Mae rhaid i fudiadau ar draws y drydydd sector a thu hwnt cydymffurfio â gofynion cyfreithiol a statudol Mesur y Gymraeg (Cymru) 2011 sydd yn ffocysu ar sefydlu hawliau, creu safonau a sicrhau y gall siaradwyr Cymraeg dderbyn gwasanaethau yng Nghymraeg.

Sut byddwch yn gweithio gyda mudiadau i hybu defnydd yr iaith Gymraeg?

Byddaf yn cyflenwi mudiadau yn y drydydd sector gyda gwybodaeth, hyfforddiant a chefnogi unrhyw angen arall ynglŷn â’r iaith Gymraeg. Gwelaf newid agwedd tuag at yr iaith Gymraeg fel blaenoriaeth, felly rwyf yn gobeithio ymwneud â’r mudiadau ar lefel personol fel bod fy angerdd at yr iaith a’r diwylliant yn gallu dylanwadu arnynt i ystyried bod cynyddu defnydd a pharch tuag at yr iaith yn gallu gwneud byd o wahaniaeth.

Beth ydych chi’n mwynhau gwneud tra boch chi ddim yn PAVO?

Tu hwnt i PAVO, fy mhrif ddiddordeb yw cerddoriaeth! Rwyf mewn band gyda fy mrodyr ac rydym yn gigio’n aml. Ein henw yw Casset ac rydym yn canu’n Gymraeg fel arfer ac rwyf yn dilyn y sîn roc Gymraeg. Dwi hefyd yn gweithredu systemau sain, creu celf pan dwi’n gallu ac rwyf yn weddol hyderus yn fy sgiliau coginio.

Ac yn olaf...

Does dim dwywaith amdani fod gennai lot o waith i wneud ond cam dros y trothwy yw hanner y daith ac rwyf yn gobeithio creu newid go iawn yma ym Mhowys!

Os hofffwch ddarganfod mwy am y cynnig rhagweithiol, cysylltwch a Gwern trwy email: gwern.apgwyn@pavo.org.uk neu ffoniwch 01597 822191.
_______________________

Helo sumai! I’m Gwern, the new Welsh Language Development Officer here at PAVO. One of my responsibilities is to support the Welsh Language throughout the third sector and beyond in Powys. I shall be focusing on a number of areas within the sector including Mental Health.

Tell us more about your role

I’m hoping to introduce the Active Offer as a strategy to try and increase the use of the Welsh Language within the sector.

What is the Active Offer?

The Active Offer is one of the key principles of ‘More than just words...’, a strategic framework designed for health, social services and social care that was issued by the Welsh Government to support Welsh services in these fields.

Why could this be beneficial to people using mental health services in Powys?

Mental health service users might feel vulnerable whilst discussing personal matters in their second language. They should be able to receive services in their mother tongue without having to ask, and the active offer enables this.

Is the Active Offer essential?

Organisations across the third sector and beyond have a responsibility to comply with legal and statutory requirements of the Welsh Language (Wales) Measure 2011 that focuses on creating standards and rights being established that will ensure Welsh speakers can receive services in Welsh.

How will you be working with organisations to increase use of the Welsh language?

I shall be supplying third sector organisations with information, training and any other need they have regarding the Welsh language. I believe that changing attitude towards the Welsh language is a priority and so I hope to engage with these organisations on a personal level so that my passion for the language and the culture can inspire them to think more about how increased use and respect for the language can go a long way.

What do you like to do when you’re not working at PAVO?

Outside of work, my main interest is music! I’m in a band with my two brothers and we gig regularly. We’re called Casset and we sing mainly in Welsh and I’m an avid follower of the Welsh music scene.

I also operate sound systems, delve into art as much as I can and I’m quite confident in my culinary skills.

And finally...

No two ways about it, I’ve got my work cut out for me, but every journey begins with a single step and I hope to make some real changes here in Powys!

If you would like to find out more about the Active Offer then do get in touch with Gwern by emailing: gwern.apgwyn@pavo.org.uk or ring 01597 822191.

Powys Patients' Council responds to Smoke-free Premises consultation

John Lilley (PPC volunteer), Owen Griffkin (Participation Officer) & Rhydian Parry (PPC volunteer)

Ever since learning of the Welsh Government's proposal to introduce a ban on smoking in all hospital grounds, Powys Patients' Council has been working hard with current and former patients of the mental health inpatient unit in Powys - Felindre Ward at Bronllys Hospital - to gather feedback. The Council was determined to prepare a formal response to the recent government consultation on the topic. 

Up until now mental health wards have been exempt from the regulations, and designated indoor smoking rooms have been allowed. The new regulations, if agreed, would give hospitals 18 months to close down their indoor provision, and, if appropriate, set up outdoor smoking areas instead. However, as the Council discovered, it is not necessarily straightforward to set up outdoor provision. In the case of Felindre Ward, patients smoking outdoors would require staff supervision due to the nature of the outdoor space. Obviously if already busy nurses have to watch people smoking then they're not able to do much else at the time!

In his Ministerial Forward to the consultation document, Cabinet Social Secretary for Health & Social Services, Vaughan Gething, noted:

"The consultation considers the removal of an exemption that allows designation of a room in which patients and residents of mental health units may smoke and replacing it with a time limited one that would expire 18 months after the new regulations come into force. Smoking prevalence among people with mental illness is substantially higher than the general population and is of great concern. Removing the exemption will bring the law in line with general hospital service users and will aim to address health inequalities for persons with mental heath conditions."

My colleague Owen Griffkin introduced the topic to readers last month when he wrote Powys Patients' Council: Kindles, smoking ban and more. 

Since then he joined PPC volunteers John Lilley and Rhydian Parry to circulate the relevant questions from the consultation to put to current and former patients, along with staff working on the ward. These included:

1. Do you agree with the proposal to remove the exemption that permits the designation of smoking rooms in mental health units? (Regulation 8) (Please note that the removal of the exemption would not prevent the person in charge of the premises from designating outdoor areas as places where patients can smoke).
2. Do you agree that the proposed transition period of 18 months after the 2018 Regulations come into force is sufficient time to allow mental health units to implement indoor smoke-free conditions in a safe and secure way? (Regulation 8(6).

Much feedback was gathered, and the Council pulled together a formal response which was submitted by the deadline earlier this month. Owen has now summarised this response for our readers:

Powys Patients’ Council's response to
The Smoke-free Premises & Vehicles (Wales) Regulations 2018 Public Consultation

A consultation was launched in May regarding changes to the Smoke Free premises and Vehicles' Regulations that will affect mental health wards, including the Felindre Ward in Bronllys Hospital. Rhydian and John from the Patients’ Council attended a meeting on the ward with Ward Manager Lisa Hale and Penny Price, Service Manager for Adult Mental Health Services in South Powys, to ensure that they had a voice in the hospital’s response to the consultations. The Council also responded themselves by completing the consultation form and we have summed up the main points here.

At the moment, the only option for people on the ward is to smoke indoors in a designated smoking area. These new regulations would end this practice and would force people into refraining from smoking for long periods. Some of the people with lived experience on the ward who smoke also used facilities in England where indoor smoking was banned and they said it was a very difficult time that made recovery more complicated. During a time of great distress it could cause extra stress to have an enforced period of nicotine withdrawal. It’s always possible for other hospital patients to leave their beds and ‘sneak out’ for a cigarette but due to the secure nature of mental health wards this will not be possible for Felindre patients. The Council was also concerned on the effect on staff time, with the staff having to accompany smokers to an unsecured outdoor smoking area.

One of the main barriers to giving up smoking in a mental health unit is that patients do not have enough activities to help keep them occupied. Patients have said that they have wanted to smoke more because of the boredom as it gives them something to do. We urged that there be increased funding specifically for activities on mental health wards.

We also want there to be access to a full range of cessation tools on the ward, including vaping/e-cigs, and for staff to be well trained in cessation techniques so that patients can be fully supported.

The consultation closed on 17 August 2018 so we will keep you informed as to the outcomes and findings.

Powys Patients' Council is facilitated by the Health & Wellbeing team at Powys Association of Voluntary Organisations and aims to give a voice to people staying on inpatient wards in Powys. For more information, please contact Participation Officer Owen Griffkin by emailing owen.griffkin@pavo.org.uk or ringing 01597 822191.

Start the conversation, it's good to talk / Dechreuwch y sgwrs, mae’n werth ei chael

Farming Connect campaign helps farm businesses 

navigate their way through succession planning

by guest author Elin Jones

In an ideal world, the older generation would discuss their plans for the future of the farm business openly with other members of the family. They would “start the conversation” long before the time when such a discussion becomes essential.

Unfortunately, that is often not the case which has very serious implications for both families and farms in Wales, according to Einir Davies, mentoring and development manager with Menter a Busnes, which delivers Farming Connect on behalf of the Welsh Government.

“The greatest threat to many farm businesses in Wales is lack of a robust succession plan, which is why Farming Connect launched a new succession campaign at the recent Women in Agriculture forum in Bangor on Dee and are committed to making it the topic of conversation around farm kitchen tables this year,” said Einir.

The new campaign, “Start the conversation, it’s good to talk,” comprises a suite of Farming Connect succession planning support services and guidance tools which will help families navigate their way through what are often challenging and unwelcome discussions.

“Businesses which do not plan ahead risk serious consequences for both family and farm, ranging from the falling out of family members and the loss of homes and livelihoods, to adverse financial consequences and the impact to all if the family farm has to be sold, carved up or divided.

“Succession planning will address when and how best to pass on the assets to the next generation which includes preparing them for what lies ahead and passing on responsibility too,” said Einir.

The starting point for those wanting to know when and from whom they should seek advice is to obtain a copy of Farming Connect’s succession planning booklet. This straightforward A4 booklet sets out what support and guidance is available to help families prepare for those all-important discussions which need to take place. It also contains a ‘succession planning toolkit’, providing templates which enable families to discuss and record the facts, opinions and goals of each family member, saving them valuable time ahead of instructing their own professional experts. Collect a copy from your local development officer or from any agricultural show where Farming Connect has a presence.

The new campaign will signpost farming families towards a team of newly appointed ‘succession’ mentors who have joined Farming Connect’s successful fully-funded mentoring programme. Eligible farmers can now apply for up to 22.5 hours of one-to-one confidential and impartial guidance on ‘succession planning’ from a mentor who has relevant experience or knowledge. Browse the online mentor directory, which also includes mentors on a wide range of business and technical topics, including ‘niche’ diversification enterprises and farm safety experts. A filter system will help you identify the mentor with the skills and knowledge you require before applying for the service.

Farming Connect also arranges succession surgeries when eligible farmers can book a fully-funded one-to-one meeting with a specialist rural solicitor. For information on the next round of dates and locations and to book a place, contact your local Farming Connect development officer.

“You will receive a synopsis of your meeting which you can then discuss with your own professional adviser,” said Einir who added that if any families need further assistance with strategic business planning, they can access 80% funding through Farming Connect’s Advisory Service.

Farming Connect is funded by the Welsh Government and the European Agricultural Fund for Rural Development.

Ymgyrch Cyswllt Ffermio yn helpu busnesau
drwy’r broses o gynllunio olyniaeth

Mewn byd delfrydol, byddai’r genhedlaeth hŷn yn trafod eu cynlluniau ar gyfer dyfodol y busnes fferm yn agored gydag aelodau eraill y teulu. Byddent yn “dechrau’r sgwrs” ymhell cyn i drafodaeth o’r fath fod yn angenrheidiol.

Yn anffodus, nid yw hyn yn digwydd bob amser, ac mae hynny’n arwain at oblygiadau difrifol i deuluoedd a ffermydd yng Nghymru, yn ôl Einir Davies, rheolwr mentora a datblygu gyda Menter a Busnes, sy’n darparu Cyswllt Ffermio ar ran Llywodraeth Cymru.

“Y bygythiad mwyaf i nifer o fusnesau fferm yng Nghymru yw diffyg cynllun olyniaeth gadarn, a dyna pam mae Cyswllt Ffermio wedi lansio ymgyrch olyniaeth newydd yn ystod fforwm Merched mewn Amaeth yn ddiweddar ym Mangor Is-Coed ac wedi ymrwymo i sicrhau ei fod yn bwnc trafod o amgylch bwrdd y gegin eleni,” meddai Einir.

Mae’r ymgyrch newydd, “Dechreuwch y Sgwrs, mae’n werth ei chael” yn cynnwys cyfres o wasanaethau cefnogi a chanllawiau ar gyfer cynllunio olyniaeth a fydd yn cynorthwyo teuluoedd i ganfod ffordd o gynnal trafodaethau sy’n aml yn heriol ac yn anodd.

“Mae busnesau nad ydynt yn cynllunio ymlaen llaw mewn perygl o wynebu goblygiadau difrifol iawn ar gyfer y teulu a’r fferm gan amrywio o anghydfod teuluol a cholli cartrefi a bywoliaeth i sefyllfeydd ariannol anffafriol a’r effaith ar bawb pe byddai angen gwerthu, chwalu neu rannu’r fferm deuluol.

“Bydd cynllunio olyniaeth yn mynd i’r afael â sut a phryd y dylid trosglwyddo asedau i’r genhedlaeth nesaf, gan gynnwys eu paratoi ar gyfer y dyfodol a throsglwyddo cyfrifoldeb hefyd,” meddai Einir.

Cam cyntaf ar gyfer y rhai sydd eisiau gwybod pryd y dylent ofyn am gyngor a chan bwy yw derbyn copi o lyfryn cynllunio olyniaeth Cyswllt Ffermio. Mae’r llyfryn A4 hwn yn hawdd i’w ddefnyddio, ac mae’n amlinellu’r gefnogaeth a’r arweiniad sydd ar gael i helpu teuluoedd baratoi ar gyfer y trafodaethau pwysig sydd angen eu cynnal. Mae hefyd yn cynnwys ‘pecyn adnoddau cynllunio olyniaeth’ sy’n darparu templedi sy’n galluogi ffermwyr i drafod a chofnodi’r ffeithiau, barn a nodau pob aelod o’r teulu, gan arbed amser gwerthfawr cyn cysylltu â’u harbenigwyr proffesiynol eu hunain. Gallwch gael copi gan eich swyddog datblygu lleol neu o unrhyw sioe amaethyddol ble bydd Cyswllt Ffermio yn bresennol.

Bydd yr ymgyrch newydd yn cyfeirio teuluoedd fferm at dîm o fentoriaid ‘olyniaeth’ sydd newydd eu penodi i ymuno â rhaglen fentora lwyddiannus Cyswllt Ffermio sydd wedi’i hariannu’n llawn. Gall ffermwyr cymwys ymgeisio am hyd at 22.5 awr o gyngor annibynnol, diduedd a chyfrinachol wedi’i ariannu’n llawn gan fentor sydd â phrofiad perthnasol neu ddealltwriaeth o gynllunio olyniaeth. Ewch i www.llyw.cymru/cyswlltffermio i edrych ar y cyfeirlyfr mentora ar lein, sydd hefyd yn cynnwys mentoriaid gyda phrofiad mewn nifer o feysydd busnes a thechnegol, gan gynnwys mentrau arallgyfeirio arbenigol, ynghyd ag arbenigwyr diogelwch fferm. Bydd system hidlo yn eich cynorthwyo i ganfod y mentro gyda’r sgiliau a’r wybodaeth sydd arnoch ei angen cyn ymgeisio ar gyfer y gwasanaeth.

Mae Cyswllt Ffermio hefyd yn trefnu cymorthfeydd olyniaeth ble gall ffermwyr cymwys drefnu cyfarfod un i un wedi’i ariannu’n llawn gyda chyfreithiwr amaethyddol arbenigol. Am fanylion y rownd nesaf o ddyddiadau a lleoliadau ac i archebu lle, cysylltwch â’ch swyddog datblygu Cyswllt Ffermio lleol.

Byddwch yn derbyn crynodeb o’ch cyfarfod, ac yna gallwch drafod gyda’ch cynghorydd proffesiynol eich hun,” meddai Einir, ac ychwanegodd y gall unrhyw deuluoedd sydd angen cefnogaeth bellach gyda chynllunio busnes strategol, gallant dderbyn cyllid o hyd at 80% trwy Wasanaeth Cynghori Cyswllt Ffermio.

Ariennir Cyswllt Ffermio gan Lywodraeth Cymru a Chronfa Amaethyddol Ewrop ar gyfer Datblygu Gwledig.