Norman Lamb at Brecon & District Mind

Roger Williams MP, Norman Lamb MP and Val Walker, Service Director of Brecon & District Mind

Last Thursday Brecon and District Mind hosted an Open Forum on Mental Health with Norman Lamb MP – Minister of State for Care and Support. The session was facilitated by Roger Williams MP for Brecon & Radnorshire. During the hour-long session many important issues were covered, including changing the health system to put mental health on a parity with physical health, the failings of the system for children and young people, concern around funding for vital third sector services in the community such as Brecon Mind, and the needs of carers. Norman’s talk was followed by a Q&A session with Brecon Mind members.

There is not space to cover the entirety of the Open Forum here in one blog post, so we have highlighted some of the points that Norman made during his visit. 

Disparity between services for mental and physical health

I wanted to say something briefly about my complete passion for mental health. 1 in 4 of us at some stage in our life will experience some form of mental ill health. It may be mild depression or anxiety or it may be something more enduring. Most families are touched by it in some way. Our family very much is. What I talk about is not just because I happen to have a job as the Minister for State responsible for mental health. It is something I really care about. The thing that is quite shocking is the disparity between how people with mental ill health are treated by the system despite the great work of people working within the services. But the system, in my view, discriminates against people with mental ill health. I can talk primarily about my experience in England but I suspect it is not much different to here.

In England if you have suspected cancer and are referred by your GP you have a right to see a specialist within two weeks and a right to start treatment within a month of diagnosis. If you suffer from mental ill health, if you perhaps are a youngster who experiences a first episode of psychosis, you have no such right. There is no such entitlement to access treatment on a timely basis. And I just don’t see how that is right. We know there is a wealth of evidence that if you intervene quickly with a youngster who suffers a first episode of psychosis, you can often rescue that person, you can stop the deterioration of condition and give that person the chance of a good life. 

The Open Forum on mental health

So how unacceptable is it that those people don’t have any right to access evidence-based treatment which we know gives the person the chance of recovery. Particularly in mental health the quicker you intervene the greater chance you have of achieving a good result for that individual and potentially rescue someone from a lifetime of a pretty miserable experience for very many people - out of work on benefits, not enjoying things that the rest of us take forgranted. It costs a fortune to deal with the damage and the effects of negligence on that person. So the moral and economic case for proper investment in mental health is overwhelming. If you make the investment you ultimately end up saving money further down the track as a result. That is the central message that I have been trying to get into government, NHS England and also to apply the moral pressure on organisations locally to take mental health more seriously.

I am on a mission to try and change this (the disparity between physical and mental ill health). So in England we are introducing the first ever waiting time standards for mental health so that if you experience a first episode of psychosis the standard will be that you start your treatment in two weeks from referral by your doctor. We start by saying that 50% of youngsters should be seen within two weeks, and then progressively in subsequent years we want to increase the percentage, but you have to increase the capacity in mental health services to be able to do this.

Increasing Access to Psychological Therapies

Kirsty Williams, Assemby Minister Brecon & Radnorshire 

and Harold Proctor of Powys teaching Health Board

We have also got in England the IAPT programme – Increasing Access to Psychological Therapies. It is fantastic for mental health. For the first time we have rich data, information, evidence about how many people are waiting, how long they waiting and whether they are recovering as a result of their treatment. We can monitor the programme to understand which providers are performing well and which are failing people, where access is very poor. The result of this is that in 2010 300,000 got access to psychological therapies. This year it will hit about 900,000, an increase of three times, so it’s a big advance and a programme that is delivering massive results for people. There are thousands of people that have recovered from depression and anxiety. The evidence is very strong; not only of recovery but that if you invest money you achieve a saving in the long-run. You get people off benefits, you get them back into work, you give people a good life with the chance for self-respect and some dignity.

Crisis care

Crisis care is where the disparity between physical and mental health is probably at its greatest. If you suffer from a physical health problem the system may be under pressure but an ambulance will arrive and you will be taken to an Accident & Emergency department and you will have access to a specialist who understands your condition. If you have a mental health crisis it is completely haphazard what happens to you. And you could end up in a police cell. This is intolerable in a civilised society.

So last February we published the Crisis Care Concordat. We got twenty national organisations to sign up to it. It is the first set of standards for crisis care in mental health that we have ever had. It tells you there that there should be a 24/7 helpline available so you can get access to support any time of day and night. There should be proper liaison psychiatry in hospitals, and in A&E if your problem is a mental health problem you will get access to a specialist. It critically says we should end completely the practice of putting under 18s in police cells and halve the number of adults who end up in in police cells this year compared to two years ago. In my view it should become a “never” event. Parts of England have demonstrated it is possible. They don’t get more money, they have just organised themselves better.

The role of carers and the Open Dialogue approach

I am acutely aware (mental ill health) affects the whole family. It can have a massive impact on other people’s lives. Providing support for the whole family is critically important. There is a very interesting development called Open Dialogue. It is the approach they use in Finland. The whole idea is that it is a recognition that mental health is crucially related to relationships with other people, and to try and deal with someone’s mental ill health in isolation is a mistake. Their whole approach is that when crisis occurs you get the whole family engaged straight away.

It’s absolutely the case that a family trying to cope with mental ill health very often has no idea how to handle it, whether what they do has an adverse or positive effect, whether to be tough with the person or gentle and understanding. Getting the balance right is so often incredibly difficult, so to involve the whole family seems a very attractive approach. There are now four trusts in England that have taken this approach and pooled some money between them to train psychiatrists and other health workers to develop the model in this country and critically to evaluate as they go through.

Transition from children’s to adult services

We have a massive issue with this cliff edge at 18. You get to 18 and are then told children’s services come to an end. You’re suddenly told you’re in adult services. 18 years old is a very difficult age for many people. They are going through real transitions in their own lives, maybe going to university, maybe leaving school, it may be all sorts of teenage angst that you are trying to cope with in your own mind, and to suddenly force a complete change of service seems completely daft. I’m trying to force a move away from a one size fits all date for transition. It’s often “abandonment” to be honest. A service needs to stick with someone if that’s the appropriate thing to do. There are several areas, my own county of Norfolk, where they have a youth service that takes you through to 25. Because it is a youth service it is more attuned to what might be more appropriate for you at that point in your life.

I also think third sector organisations working collaboratively with statutory sector organisations are more subtle and pliable in getting the right response for a youngster. So I think a collaboration between statutory and voluntary sector services works more effectively.

Janet Pardue-Wood, Acting Director of Mind Cymru, meets 

Kirsty Williams AM and Roger Williams MP.

Voluntary sector

My view is that the voluntary sector plays a crucial role. When I was at Gofal earlier they were talking about how they had entered collaborations with some of the health boards around Wales. We have this awful problem of people being put into out-of-area placements, often a long way from home. There is no ambition to give them a better life, they are just hidden away from view at enormous cost to the tax payer, it is an extraordinary outrage really. Their role can be to identify these people and find a mechanism to get them back into community and rebuild their life.

Gofal gave a wonderful example of a woman who was a serious alcoholic whose life was in a complete mess, she had been in secure accommodation. She is now living back in her own home and working in a charity shop three days a week. She contributes to local community efforts, she has a life. It’s fantastic. Three or four years ago no one assumed she was capable of that, she would just have been locked up as a risk or threat to everybody. It does not have to be like that.

Roger Williams rounded off the session by complimenting Brecon & District Mind on the work that they do in their community and thanked them for hosting the Open Forum.

Thank you to Freda Lacey and Brecon & District Mind for providing photographs from the day.

Dyfed-Powys Police - mental health: a multi-agency approach

Over the last few months I seem to have read endless articles online (the latest just last week from the BBC here) about the increasing numbers of young people and adults being detained in police cells whilst experiencing mental distress. This is often because there are no suitable places of safety where people can be taken to be assessed, even though it is frequently accepted that a police custody suite is not usually an appropriate place in such circumstances.

In Powys, a multi-agency approach is now working to improve the police response to those with mental health needs. I first found out about this in November 2013 at a Dyfed Powys Police event called Mental Health: the Way Forward. Here we heard, amongst other things, some of the Force’s plans for change in the area of detention under Section 136 of the Mental Health Act.

Inspector Brian Jones

This week we found out more, from Inspector Brian Jones of Neighbourhood Development for Dyfed-Powys Police, about how plans had been progressing since the event. Brian started by addressing the issue of children and adults being placed in police cells due to the lack of mental health beds.

“In Powys, we have not found ourselves in this position during 2014”. The police are often called to assist with situations where someone has expressed concern for a family member, a friend or someone they have seen behaving in a manner which raises concern for their welfare. The police currently have minimal training on how best to deal with incidents where people have mental health needs, but will strive to treat everyone with dignity and respect. “Our first priority is to ensure that persons are safe and then to ensure that persons are cared for by specially trained experts at an agreed place of safety.”

Legislation

The legislation under the Mental Health Act, which is known as a Section 136, stipulates that “if a constable finds a person who appears to him/her to be suffering from mental disorder and to be in immediate need of care or control, in a place to which the public have access, the constable may, if he/she thinks it necessary, in the interest of that person or for the protection of other persons, remove that person to a place of safety.” No one will disagree that a police cell is not a suitable place or environment for someone with mental health needs. However, there are occasions when there is no other suitable alternative and this is when there are signs of violence, substance misuse or criminal offences for investigation with evidence to be preserved.

In order to make every effort to secure the correct and professional support for individuals, as well as avoiding police cells or any inappropriate use of police powers, a procedural pilot was introduced in Powys in March 2014. This pilot requires the Police’s Inspector’s authority before police mental health powers can be used. The Inspector will take an independent overview of the circumstances which have led to consideration being given to utilising the powers under the Mental Health Act.

Exceeding expectation

The pilot is exceeding expectation and the police cells have only been used on three occasions, which was justifiable in the circumstances and not due to having no suitable beds available. At no time have the police powers been inappropriately used and at no time during this period have any youths under the age of 18 been detained. There is a strong partnership approach between the police and health and social care partners, who are working together to raise awareness amongst colleagues, as it has been agreed that training is required for people who come into contact with people suffering from psychological problems.

Thank you to Inspector Brian Jones for his update. Let us know in the comments box below what you think about the new ways of working that the police are trialling in Powys - or elsewhere in the UK.

You can read a recently published report (6 February) from the House of Commons Home Affairs Committee on Policing & Mental Health here.

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.

One to One Recovery Support - Mid Powys

Are you: 

Struggling with your wellbeing? 

Feeling like things are stacking up 

and it’s hard to keep control? 

Feeling stuck? 

Or just feel that things could be better? 

Living in Mid Powys?

One to one support is available, free. 

We met Tim Skelcher last week to find out more about a new service being offered by

Mid Powys Mind.

I’ve recently started working for Mid Powys Mind as a Recovery Support Worker. This is a three year Big Lottery funded service which will work in person centred and holistic ways to address an increased demand for support following the economic downturn and the austerity measures that followed.

The aims of the service are to provide individuals with immediate support with urgent issues, and to offer support to work towards getting a satisfying and meaningful life through identifying goals and making steps towards them. 

Tim and his colleagues at Mid Powys Mind
L - R: Maire McAvinchey (Office Manager), Nic Williams (Senior Support Worker & Outreach Worker), Tim Skelcher (One to One Recovery Support Worker),
Jo Houlsby (Operations Manager), Mary Williams (Development Manager).

As well as one to one work, the funding has enabled us to extend our opening hours, with the Resource Centre basement now open on Tuesday and Thursday evenings from 5 to 8pm, with a focus on recovery. Although it’s early days with this, I expect these sessions to include discussions, films, information and peer support.

We have also been able to fund additional training that helps people to develop coping skills and emotional strengths that can further support people to cope with life’s challenges. We will publicise these courses through the year as they come up.

It feels like we are making progress towards being the wellbeing centre that we aspire to be. A recent members’ day has provided lots of ideas to develop services further, and with more days planned we are becoming increasingly member led.

You can find out more about the One to One Recovery Service on a Mid Powys Mind flyer here.

Contact Tim on: 07947 106 768, or email recovery@midpowysmind.org.uk

YAPS project video - I don't let mental health define me

Last year we wrote about the Young Adult Peer Support project (YAPS) at Ponthafren Association in North Powys, and interviewed Zoe Greenslade, one of the members. YAPS offers peer support mentoring to young people (16 - 25 years old) who experience mental health issues, by helping to give them a voice of their own in the development of services.

Robin Green
YAPS Admin Assistant

The first phase of the project has involved recruiting, training and supporting Youth Peer Mentors and coordinating activities and opportunities for them to advocate for the needs of young people who experience mental health issues.

In Autumn 2014 the group decided they wanted to make a music video using music over still photographs. Previously the group had set up various workshops on song writing, music, photography and mental health awareness. 

Inspired by all their learning the young people worked with the YAPS Administrative Assistant, Robin Green, to achieve their aims, and the video has just been published on YouTube. It addresses the theme of stigma, challenging some of the commonly held myths around mental health issues which particularly relate to young people. 

The YAPS group remains a small but passionate group but those involved would like to encourage more people to join them to develop future projects. These include a public relations event and an audio play.

Meetings are held at Ponthafren Association in Newtown for two hours each week, and anyone aged between 16 - 25 is welcome to join the group. You can find out more by calling 01686 621586 or 07792 346 519 or email: yaps.project@ponthafren.org.uk

So, watch the group's first video and let us know what you think.

YAPS is one of six projects funded by the Big Lottery Fund as part of the One Powys Connecting Voices programme managed by Powys Association of Voluntary Organisations.

You can find out more about Ponthafren Association here.

Together for Mental Health - Assembly Ministers have their say

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

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

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

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

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

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

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

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

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

Other issues debated included:

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

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

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

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

Dementia - who is blogging about it?

For the past couple of years we have greeted the New Year here on the blog with a round-up of some award winning mental health blogs. Some of these bloggers, such as Mental Health Cop, are well-known and have attracted large numbers of readers. The more niche the topic, often the more useful the information/comment provided by these blog authors.

This year, however, we have decided to focus on dementia blogs. With the growing success of dementia friendly communities around Powys, and an increasing awareness around dementia with schemes such as Dementia Friends, it seemed not just appropriate but high time!

So here are some of our favourite dementia blogs, written by people with dementia, those close to them, and others who are working to support them – whether in the statutory, voluntary or private sectors.

We hope you enjoy dipping into their blog pages, and if you know of others you would like to recommend just add a comment below. We would really like to hear from you.

1. Adventures with dementia

“My wife has dementia. She first attended a memory clinic in 2000, aged 52, and suffered a marked decline in the autumn of 2011. Since then there have been some improvements, despite the fact that she has now (after 12 years investigation) been diagnosed with Alzheimer's Disease.
We try to follow the advice of our Guru: 'Live a Good Life'. It's not easy but there doesn't seem to be any better advice around.
I found myself saying to a friend that I would find my wife's condition very interesting if I wasn't so involved. I've realised now that I do find it, and the issues it raises, interesting.”

This blog was started in 2011 and is packed full of useful information. The latest posts focus on A visit to the dentist, Paying GPs £55 for diagnosing dementia, and Disability Living Centres.

2. (Dementia just Ain’t) Sexy

“No photos of wizened hands here! Not a daily care blog or advice site, this is a place to share thoughts about the impact of dementia on those who live with it – who could be any of us.”

3. What I’d have done differently if I’d known my Mother had dementia

“I thought I didn’t know much about dementia until I read a research proposal on unusual experiences of people living with severe dementia – such as confusion, hallucinations and delusions. Suddenly an old and squeaky door opened and I found myself looking into a dark and scary room in broad daylight for the first time.”

A post on the Changing Minds, Changing Lives mental health and learning disability website that has provoked some interesting comments too.

4. Living in the shadow of Alzheimer’s

“This blog is about life with my husband who was diagnosed with Alzheimer's and Frontal Lobe Dementia in 2008. He was 64 at the time although now, knowing more about the disease, Alzheimer's was present many, many years ago, which is why early detection is so important. As you read the blog "Al" represents the way that Alzheimer's is invading our daily lives.”

Daily updates on living with Alzheimer’s from across the Atlantic, but so many of the day-to-day issues are relevant too here in Wales.

5. A dementia voice

“You can still live a life with dementia” is the strapline of this community of bloggers from across the UK, some of them living in remote parts of the Scottish Highlands. Several are members of the Scottish Dementia Working Group.

6. Dementia Journeys

“We aim to share dementia related news and information from around the world as well as sharing your Dementia Journey stories.”

Dipping into recent blog posts we find articles on Activities and stories to share with adults with dementia, Hospices and their ethos of care, and raising awareness of dementia with The Purple Angel – a new symbol emerging from Dementia Action Alliances in Devon.

7. Pippa Kelly

“I write every day about one thing or another, mostly about the elderly, their care and its funding, and about dementia, which stole my mum from her family in a drawn-out 10-year raid.”

Pippa originally wrote an article which appeared in a Sunday newspaper called Dementia: the longest, cruellest goodbye.

In 2014 she received an Older People in the Media Award from John Sargeant.

8. Young Dementia

This site has links to numerous blogs, some written by people with young onset dementia, and others written by the family members of those with this diagnosis.

So, that’s a lot of reading to dip into! We hope you find a blog that can help, inform, interest or inspire you – but if there are others out there you want to let us know about, please comment below.

And if you would like to write about your experience of dementia, especially if you are based in Powys or have a family member or friend who is, please get in touch.