KiVa anti-bullying programme in Powys schools

This week’s guest post is from Dr Sue Evans, a Consultant Child Psychologist working as the Lead for Parenting and Children's Social Competence Programmes at Powys Teaching Health Board. Sue has been leading on work to introduce the KiVa anti-bullying scheme to schools across Powys over the past couple of years. I caught up with her lately to find out more about how it’s going.

What is your role as a Consultant Child Psychologist?

My role is very much about working with agencies and schools across Powys, and also across Wales in using evidence based approaches which promote children’s emotional health and well being and social competence. This involves working with parents, teachers and children using complimentary approaches. I feel very privileged to have been able to train staff from a whole range of agencies in evidence based approaches. I have focussed particularly on the Incredible Years® programme but since 2014 my role has also included rolling out and researching the KiVa anti-bullying programme.

I am also an honorary lecturer at Bangor University and through this post have been involved in supporting training and research across Wales.

How can childhood bullying impact on people, not only at the time but also later in life?

Sadly there is a good deal of evidence about the potential negative impact of bullying both in childhood and on into adulthood. Children who have been bullied may experience anxiety, depression, and loneliness and they may not do as well as they could do academically. There are risks into adulthood for depression, low self-esteem & difficulty sustaining relationships. Children who bully others are at risk of criminal offending in adulthood and may learn to use aggression as a means to get what they want. Children who are both bullies and victims carry the highest risk factors. 

Tell us about KiVa. What is it, and how did you find out about it?

I found out about KiVa through my work at Bangor University. Kiva was developed and researched in Finland, it has a lot of robust research evidence of its effectiveness. It was great to have the opportunity to train as a KiVa trainer in Finland in 2014. After successfully piloting the programme in 2014 with 10 schools we made a decision to offer it to all primary and special schools in Powys through a rolling programme of training,

KiVa includes:

Actions for all in the form of:

• A classroom curriculum for Key Stage Two (pupils aged 7 – 11 years). 
• Whole school assemblies, posters and other material to remind pupils that the school is a KiVa school. 
• Online resources for teachers. 
• Online resources for parents. 
• Online resources for children, including KiVa games, to help pupils build strong and supportive relationships with each other and learn how to deal with bullying. 
• An annual online survey to measure bullying and well being. Pupils complete the survey anonymously online and the University of Turku provide feedback. 

There is also a structured procedure for schools to use if a case of bullying occurs.

Watch this ITV Wales news item which explains the KiVa approach in Powys. 

Why did you want to bring the KiVa anti-bullying scheme to Powys schools?

KiVa is predominantly a personal social education programme for creating a safe and happy school. It is important to understand that schools don’t have to have a specific problem with bullying to introduce KiVa. All schools in Wales are required to have a policy for dealing with bullying and KiVa is one of the best evidence based programmes for tackling bullying. 

What training do staff and pupils undertake to use the KiVa approach?

KiVa should be used as a whole school approach. The first stage is to train senior school staff, usually the head teacher and another member of the school KiVa team. This training takes place over two days and staff who attend the training are given materials to train their whole school staff and ideas and materials for introducing the programme to parents and children. It’s really a cascade model of training with head teachers being responsible for introducing KiVa to their school.

A multi-agency model is used; I provide training on behalf of Powys Teaching Health Board, funding for the training and equipment needed is provided through the Children and Young People’s Partnership and schools implement the programme themselves and pay a registration fee to access the online resources.

Which schools have already signed up to KiVa so far and how is it working for them?

Since 2014 we have trained 50 schools in Powys. This includes all three special schools and 47 primary schools from across the county. Schools are at different stages with KiVa, some have been delivering for three years, and others have been delivering KiVa for one or two years.

The feedback we have had from schools has been very positive. Teachers really like delivering KiVa and most pupils really enjoy it. Head teachers tell us that KiVa is making a real difference in creating a safe and happy school environment. Teachers also tell us that they feel more confident in dealing with bullying when it occurs.

The general feedback from schools has been excellent but we have also got good evidence from research we have carried out. We have a clinical doctoral student researching KiVa outcomes in Powys and she has found significant reductions in pupil reports of bullying for KiVa schools. The great news is that we have found significant effects after just one year, but bullying continues to reduce year on year for schools who continue to use KiVa. 

What has been the most challenging aspect of rolling out the KiVa programme?

The main challenge has been keeping KiVa alive in schools who have trained. Inevitably key staff members change in some schools and we have needed to provide retraining for some schools to ensure continuity.

We know that KiVa works if it is delivered in the way it was intended, so this is the challenge for all schools.

Tell us about some of the most rewarding work you have done with KiVa so far

It has been very rewarding to have great feedback from children and teachers about the impact of KiVa. Here are some of the comments:

“It complements our whole school values and behaviour programme brilliantly, permeating everything we do, and has been embraced by children, staff and parents alike.”

"We initially introduced the programme to the staff to help them to understand what it would be like to be bullied. It enabled them to see the benefit of working together as a team to develop a positive behavioural approach and to develop a culture of anti-bullying. This was cascaded to pupils through a whole school assembly then through in-class KiVa activities which immediately captured the children’s ability to empathise with others. A parents open evening followed in order to give parents the opportunity to understand this approach."

Children now feel empowered to deal with a range of social situations:

“KiVa has made us happy.”

“KiVa has brought us together.”

“It has helped me get along with others, in my old school others were hurting me.”

“It has helped me get new friends.”

“There is no calling names now.”

“We have learnt to recognise what bullying is and how to stop it.” 

Many thanks to Sue for telling us all about the KiVa anti-bullying scheme in Powys. If you would like to contact her, please email: Sue.Evans5@wales.nhs.uk

Powys Patients’ Council - Kindles, smoking ban & more

by Owen Griffkin, Mental Health Participation Officer

I have been facilitating Powys Patients’ Council, with the support of volunteers Rhydian Parry and John Lilley, since early 2018 as part of my role in the Powys Association of Voluntary Organisations (PAVO) mental health team.

Powys Patients' Council aims to give a voice to patients, currently in Felindre Unit at Bronllys Hospital in Powys, who are offered acute in-patient mental health services. Regular patient-only meetings give people an opportunity to express their views on the services they receive whilst they are in hospital. These views are then passed on anonymously to ward and hospital management staff, in addition to senior Powys Teaching Health Board (PTHB) staff, so that solutions can be found.

Owen Griffkin

It was a sweltering day for June’s Patients’ Council meeting and the ward was close to capacity. This was the first Patients’ Council session since we had left a suggestion box on the ward, so there were more issues than usual to deal with. Having the suggestion box means we can address issues or concerns that we might have previously missed from people who have had short stays on the ward. It can also follow that these might have been dealt with already, as was the case with a note about the heating being on in rooms at night.

Another note praised the caring environment and professional staff which the Patients' Council were pleased to pass on to the new permanent Ward Manager, Lisa Hale.

Concerns raised in the meeting included a lack of activities, the annoyance of an office door banging and not being allowed devices with cameras in communal areas due to privacy reasons. As all modern tablets/phones have cameras this unfortunately means no devices can be used in the day room. We have sent out an appeal over Facebook and Twitter to see if anybody has any 1st generation Kindle Fires as these tablets didn’t have cameras, so hopefully we will get some response to this. We are looking into raising some money for activities provided by an external facilitator as this will leave the ward affected less by staff leave and sickness.

Lisa Hale, Felindre Ward Manager

There has been a new advocacy service commissioned by PTHB and delivered by Conwy & Denbighshire Mental Health Advocacy Service (CADMHAS) and this was praised by patients who found it very good and non-judgemental. We spoke to Adrianne Cleverly who provides the service in Powys recently in How can mental health advocacy help you?

Proposed smoking ban in hospital grounds

The Patients’ Council is also attending an extra meeting this month to discuss smoking in the light of the recently announced news about banning smoking on ALL hospital grounds.

As this will include acute mental health in-patient wards such as the Felindre Ward, it is important that people associated with the ward(s) voice their views in relation to this consultation. 

The ban is due to come into force in Summer 2019, and this will give ward managers 18 months from then to ensure there are alternative measures in place to replace existing indoor smoking rooms, and that outdoor areas fall in line with the new rules. One of the proposed rules will prohibit an outdoor smoking area from being within 10 metres of any hospital building. This will mean that if there is no exemption for mental health wards it will be impossible for there to be a secure smoking area that people can use without staff members present and this creates other issues relating to staff health and second-hand smoke. 

I will be working with the Patients’ Council to look at the possible impact of these rule changes, and how the hospital can offset the disruption and distress that it may cause to people on the ward and potentially other wards/mental health facilities across Powys. This will very likely be a contentious issue and it will be interesting to see how other hospitals in Wales deal with it. If you have lived experience of an acute mental health ward, and would like to contribute to the consultation, please email owen.griffkin@pavo.org.uk or ring 01597 822191 with your comments or for more information.

Community Connectors working with Dyfed Powys Police

R - L: PCSO Daryl McWatt, Community Connector Suzanne Iuppa,
 Mental Health Information Officer Jackie Newey, PCSO Geraldine Jones

Llanidloes is a small market town in Montgomeryshire, North Powys. What appear to be thriving voluntary sector groups provide activities for all ages and interests. Friendly faces greet you on the streets and in pubs and cafes. There is a revitalised Saturday market. It is a hub for people living in outlying villages and on even remoter hill farms. Not a place you would regularly associate with law enforcement! But, the local police are busy. Finding out more about their day-to-day work helps throw a light on some of the social problems and issues facing small rural communities in Mid Wales.

In May during Mental Health Awareness Week I met up with Suzanne Iuppa, PAVO’s Community Connector for Llanidloes and District, and two local police community support officers (PCSOs) – Geraldine Jones and Daryl Mcwatt. We wanted to promote sources of information and support around mental health, and decided to base ourselves in the popular Coffee Bean café in the town. At the same time, we also caught up ourselves on some of the recurring themes affecting people locally who are struggling to cope - for whatever reason.

Police working with Community Connectors

If Geraldine or Daryl meet someone who needs support they contact Suzanne and she meets them at Llanidloes Police Station – “she’s in before we know it!” They will have already gained the consent of the individual involved to pass over details. The Community Connectors (a Powys-wide team) help people (18+) and their families or carers, “to access community-level services and activities that will help them maintain independent lives and which help prevent their circumstances deteriorating to a point where they might need higher level health or social care services.”

Suzanne receives referrals from various agencies as well as families and people can also self-refer for support from a Community Connector. At the time we met she had ten clients on her caseload, having closed eight earlier in the week. “The numbers are usually sitting at around twenty. There is always a mix of different cases.”

The PCSOs and Suzanne have made joint visits in the past – “people OK it first.” Then it is up to the individual involved whether they take up offers of support or links with the wider community. “Some people are very isolated and lonely. It is quite sad.” 

Signposting to voluntary sector services

Suzanne liaises closely with staff at the mental health charity Ponthafren Association (there is a weekly outreach session in the town) to support some of her clients. People seeking talking therapies might face a long wait for statutory counselling sessions and even a few weeks to link up with a counsellor at Ponthafren. However, Suzanne explained, if they have a specific condition such as multiple sclerosis that is affecting their emotional wellbeing, she can then call in a specialist service. This works well as often the client does not have to wait. 

Loneliness and isolation in older life

In the Dyfed Powys Police Strategic Equality Plan 2016 – 2020 it states that additional support and collaborative working is vital in order to ensure that the necessary support is provided to “elderly service users”. Older residents are much more likely to be victims of telephone scamming and other crimes and may not be regular users of social media where frequent alerts are posted about such crime.

One of the planned actions in the Equality Plan is to “raise awareness of the ‘ageing population’ and the impact on individuals, families, carers, communities and the increased demand on public services.” So it was no surprise to find Daryl and Geraldine promoting Powys County Council’s Llanidloes pilot Home Support Scheme.

This scheme aims to “provide support and practical assistance an individual may need in their day-to-day life to stay living at home, safely and independently.” As well as offering practical support such as shopping and assistance with prescriptions, the service can help with emotional support, including accessing local community groups and supportive networks. It’s a free scheme, but people need to sign up as a member in order to be able to access support. There are also pilots running in Llandrindod Wells and East Radnor, and a long-running successful Rhayader operation.

The Llanidloes PCSOs and Suzanne recalled instances of how the Home Support scheme had recently supported people, some with physical impairments who use mobility aids, and others struggling with emotional wellbeing and agoraphobia. 

Other issues that came up - in brief

Neighbour disputes – as in all parts of the UK neighbourhood disputes are fairly common in Powys, and the police work with individuals concerned to try and resolve issues. Suzanne’s involvement includes finding distraction activities for people caught up in the disputes and ways to boost their emotional wellbeing.

Hoarding disorder – updates were exchanged so that all were aware that whilst Powys County Council provide a deep cleaning service some people are now being offered Cognitive Behavioural Therapy (CBT) to address the underlying issue.

Domestic abuse – Suzanne has referred clients to Montgomeryshire Family Crisis Centre and the churches locally. The police are also sometimes involved in these cases.

Cultural differences and language barriers – we all agreed how hard it can be to try and find speakers of foreign languages such as Bulgarian and Croatian to provide interpretation when working with some clients.

Dementia – Llanidloes is working towards becoming a dementia friendly community – volunteers meet regularly to move this forward as has happened in other parts of Powys. The police and Community Connectors also receive dementia friendly training through the Dementia Friends’ scheme.

Missing people – individuals may end up in Powys after going missing from a community many miles away where the culture and way of life is very different. Adapting to life in a rural area can be difficult.

And with that it was time for Daryl and Geraldine to return to patrolling the streets of Llanidloes. 

Suzanne, Daryl and Geraldine plan to meet up more regularly in community spaces in Llanidloes so that local people can easily get in touch and voice any concerns they have, or find out more about support services that are in place for them, their family and friends. We at the PAVO mental health team hope to join them on occasion too. If you would like to find out more you can contact Suzanne by emailing: community.connectors@pavo.org.uk or ring 01597 828649.

We Wear The Same Shirt

(L-R) Ruth Fox - Mental Health Campaigner, Sam Morris - Gold Ambassador & Organiser,
 Neville Southall - Welsh Footballing Legend 

Sam Morris is a Sport Powys Gold Ambassador. During Mental Health Awareness Week in May I met Sam briefly at a partnership event we organised in Llandrindod Wells when he attended with colleagues from Sport Wales. 

We have promoted the project Sam is involved with in Newtown on our website events calendar and on social media, but I didn’t think too much more until suddenly the World Cup was upon us! It seemed like the perfect opportunity to ask Sam to tell us all about his involvement with this local football initiative promoting good mental health and combating stigma.

Tell us more about your role as a Sport Powys Gold Ambassador

The Gold Ambassador programme is Sport Wales’s scheme, which operates in the whole of Wales, and I was lucky enough to be selected as the Powys Gold Ambassador for North Powys. The role of a Gold Ambassador is to work closely with the school’s Sports Development Officer and come up with ways of increasing physical activity levels in schools. I didn’t have a Sports Development Officer to work with inside college, so as part of my role I did all of my work outside. I helped run school sports events in Welshpool and Newtown, and ran Silver Ambassador Days with Sport Powys. I then had the mental health programme, which was my main scheme when I applied to become a Gold Ambassador.

How long have you been playing football and what impact has it had on your wellbeing?

I played football from a very young age, joining the local Sunday Soccer, until I was playing U16s when I decided to take on a role as a coach. I played the odd game for the college team as well. I believe that football may be a huge impact on my wellbeing, I have always been a healthy lad, haven’t had any physical health issues, which was mainly down to all the football I played. I played across Wales with the Academy team and was always with a group of lads who I got on with very well and still get on with now.

What is the We Wear The Same Shirt project all about?

Physical activity has proven to be one of the most effective methods of helping improve someone’s mental wellbeing, and statistics show that 1 in 4 people in Wales suffer from mental ill health. With this being the case, the FAW Trust and charity Time to Change Wales, used their skills and knowledge to tackle the stigma, which resulted in the We Wear The Same Shirt Programme (WWTSS). Three clubs within Wales - Newport, Wrexham and Newtown - are all part of the WWTSS programme which started in 2015.

It is a scheme which offers individuals who suffer from mental ill health a place to go and take part in physical activity, but also to meet new people and develop important life skills, as well as football skills. Each club provides weekly sessions, which, due to funding, are free to access and sign onto.

200 people are signed onto the programme within the three clubs but the target is to get over 700 people and more clubs involved in the programme across the country so it has easy access for more mental health sufferers.

Who can sign up to the training sessions in Newtown and how do they do it?

People who suffer from mental ill health, people who feel excluded, lonely, these people can all come down to the sessions and join in. As a club, we want to make it easy for people to join, and all you have to do is come down to one of the sessions on a Wednesday night (5:00pm – 6:00pm) meet up with myself and we will sign you on. And that’s it. It’s simple. Us coaches and current participants aren’t here to judge, but to listen and help, which is the whole reason for the programme.

How does taking part in the We Wear The Same Shirt training sessions help people struggling with their mental health?

As previously mentioned, physical activity has proven to be one of the most effective methods of helping improve someone’s mental wellbeing, because it takes them away from their environment, and lets them have one hour of fun, being with people who suffer from the same issues. Also, doing sport and physical activity releases chemicals in the body and makes the participant feel more positive. They forget what’s going on, as all they are focussed on is the session and what they are participating in.

All our sessions involve important life skills such as communication and teamwork. The participants start to connect with each other and form friendships, which is great to see. Then people keep on turning up every week because of these friendships that they made from the session and as a coach, it’s the best type of reward you can get, seeing your sessions make an impact on people’s lives.

There was a We Wear The Same Shirt tournament in Newtown in March this year. How did it go, and are more planned?

The WWTSS tournament in Newtown was a massive success, more than I expected it to be. The tournament was due to be in January but snow cancelled that, which wasn’t good. However, from it being cancelled more people wanted to know about the tournament and more teams entered. On the day we saw 150 participants and 19 teams arrive at Latham Park for a fun, but competitive tournament. The best news was that Wales Goalkeeping Legend, Neville Southall, attended the event and spent time talking with the participants and also staying to help hand out medals and trophies to the players. The day was great, everything ran smoothly, and raised a lot of awareness around the town about the WWTSS programme and the one run in Newtown, which was the whole purpose in the event. As it was a success, I know that the FAW Trust are planning one for later this year and we are likely to make this event annual in Newtown.

Have there been any challenges setting up the project?

There have been some challenges setting up the project in Newtown, but it’s like every project, there are always challenges. I joined the project at the start of 2017, and only two participants were at the project. But from hard work and spreading the word, plus the tournament, one year on we have about 20 participants signed on. We have been able to reach out to more, but now college has finished I will be working closely with mental health charities in Powys, to provide sessions and try to get more participants down to the project. But, it’s looking up for the project in Newtown.

Tell us about some of the most rewarding work you have done so far with the We Wear The Same Shirt project

Everything about the project and the work I have done is rewarding. From starting the programme back in early 2017, with my college tutor, Gareth Watkins and fellow Coach, Dave Rose, everything about the project has been rewarding. From seeing the project go from 2 to 20, within a couple of months, from the team representing Newtown at a number of events, and seeing players go on to better things within the club. One has become a qualified local referee, one has become a coach, and others have gone on to playing local team football, winning awards, like manager’s players. This small project has made a massive difference to all the participants but has also changed me as a person and as a coach that is what is rewarding.

I hear you're studying Sport at Newtown College. What career do you hope to follow eventually and why?

I have just finished studying Sport at Newtown College, finishing with a triple distinction star. I will soon be studying Football Coaching and Performance at University of South Wales, but the only career work I see myself doing is football related. I have a passion to coach and make a difference and thanks to the college, Newtown FC, Sport Powys and a number of people, including Gareth Watkins and Dave Rose, I will be able to pursue that career.

Which team are you supporting in the 2018 World Cup?

From the start of the World Cup I have always thought that France would be the team to beat, but this year’s World Cup has been very odd and England have a massive chance, but I’m backing France.

Many thanks to Sam for telling us all about the We Wear The Same Shirt programme. If you want to find out more you can contact Owen Durbridge, the Club Secretary at Newtown AFC, by emailing owen.durbridge@sky.com or ringing 07967 979089.

How can Independent Mental Health Advocacy help you?

Last summer we featured Connecting with the mental health advocates in which we found out more about the three different advocacy roles in Powys, and met some of the advocates themselves – in particular those based in Powys. 

Today we talk to Adrianne Cleverly, who works for Conwy & Denbighshire Mental Health Advocacy Services, but actually provides an advocacy service for Powys (which is commissioned by Powys Teaching Health Board). I met Adrianne earlier this year, and we all agreed it was important to try to raise awareness of the advocacy service available in the county.

Tell us what brought you to work in the field of mental health advocacy?

I was fortunate enough, and lucky enough, to fall into the field of mental health advocacy – by complete accident. I was working in child protection; within that role I was working with Child and Adolescent Mental Health Services (CAMHS) and acting as an advocate for some of the children I was working with. The role was so varied that my experiences spread further than I had even realised because when you are doing the job you take those things forgranted and just get on with it. One day someone showed me the job advert for an IMHA (Independent Mental Health Advocate). When I read the job specification, I could not believe a job like this existed. I applied for the job, and what can I say, three years later, I still love the role and still feel lucky enough to work in this position. I love my job! You definitely have job satisfaction when you work as an IMHA. Sometimes the differences you make can seem trivial but the difference you are making to the person is so much more. It is such a rewarding job.

What is your role at CADMHAS and which area do you cover?

My role at CADMHAS is an Independent Mental Health Advocate. Within this role I cover the South Powys hospitals - Ystradgynlais, Bronllys and Brecon. Within the role of IMHA my role means that I visit the hospital wards and meet with qualifying patients (people admitted to hospital for their mental health). I work with them within the remit of accessing their rights under the Mental Health Act and support them with anything to do with medication, treatment and care.

I also deliver awareness raising sessions in North Powys. Those hospitals are Phoenix House, Welshpool, Machynlleth, Newtown, Knighton, Llanidloes and Llandrindod. As part of awareness raising I also work with the community mental health teams which are Ty Illtyd and The Hazels, additionally other professionals that might also be working with the same people as myself, should the scenario require me to.

Many people don’t know about the advocacy service. What are the key benefits of having an advocate?

The benefits of having an advocate will vary for the individual and depend on why they felt they needed/wanted an advocate in the first place. For some people they may have more than one admission to a hospital ward and they may want an advocate on one visit and not another. The beauty of the role is that it is led by the individual. It is not the choice of the professionals or the family, but the choice of the individual.

One main benefit of having an advocate is to ensure that you have a voice when you need it. Also the reassurance of knowing that someone is making sure your voice is heard. Other benefits include empowerment to have a voice. Receiving the knowledge and understanding and being helped and supported to understand your rights when you are in hospital or having some experience of the Mental Health Act (maybe living in the community but being on a Community Treatment Order or Guardianship). Also, having the availability to access those rights. Additional benefits are to feel supported by an independent professional and feeling like someone is on your side.

What key qualities does a good mental health advocate need to have?

The qualities of a good mental health advocate are simple; they will be non-judgemental and listen to what the person is actually saying. An advocate needs to be a good listener, they will be well informed and skilful. They will have confidence in themselves and be comfortable enough to stand up for the person’s rights.

Just for clarity, can you very briefly summarise the three different mental health advocacy roles?

Independent Mental Health Advocate 

An Independent Mental Health Advocacy (IMHA) means the qualifying patient has access to an IMHA which is a statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO). When someone is detained in hospital or on a CTO it can be a very confusing and distressing experience. 

Independent Mental Capacity Advocate 

An Independent Mental Capacity Advocate is available to everyone surrounding the care, treatment and support of people aged 16 and over living in England and Wales who lacks capacity to make all or some decisions for themselves in specific areas. These areas being change in accommodation, care reviews, safeguarding issues and serious medical treatment. An IMCA will also be involved in those detained under a Deprivation of Liberty order. The Mental Capacity Act is designed to protect and restore power to those vulnerable people who lack capacity. 

Community Mental Health Advocate 

Community Mental Health Advocates provide and offer representation and support at meetings and appointments to people who have been treated for their mental health and are now living in the community. An advocate is someone who will listen to your worries and problems and work alongside you to achieve your aims. Advocates are a valuable source of information and can help the people who use their service to feel in control of their own lives – to feel empowered. 

Can an individual be supported by all three types of advocate at once – IMHA, IMCA and Community Mental Health advocate? If so how does that work?

Yes an individual can be supported by all three advocates. All advocates work in different ways so if a person needs support in different areas they will be eligible for different advocates. An IMHA will work with an individual within the remit of medication, treatment and care.

An example of this would be if a patient is on a Community Treatment Order they will be eligible for the support of an IMHA who will support the individual with representation at a managers' hearing or tribunal. They may also have been deemed to lack the capacity to make a decision on their placement so they will then be eligible to have the support of an IMCA as IMCAs will work with the individual around this. They then might need support with things like pension and finances, so they will then require the support of a community mental health advocate.

What happens when a carer refers but the patient/individual does not want to engage?

This goes to the heart of advocacy. The individual is the one that instructs the advocate and decides if they want to work with us. If a person has capacity to understand the role of an IMHA and they don’t want an advocate that is their choice we would not force ourselves on them. The work of an IMHA is client led. If the individual doesn’t want to work with an IMHA, we cannot make them. We can ensure that we give them plenty of choices and just be available for them if they change their mind.

If the person does not have capacity then we can still work with them, but it will be in a non-instructed way. This means that we work with the family and professionals to establish as much information as we can and then work in the person’s best interest.

If someone is placed in a hospital or unit outside Powys, can you still support them? 

Usually our role would stop but we would signpost to other agencies.

If a patient is placed on a Community Treatment Order (CTO) what support can you provide as an advocate?

If a patient is placed on a community treatment order, our role would remain the same as if we were visiting them in hospital, but we would visit them in the community instead. We would still work with them around their medication, treatment and care and we would also attend meetings with them around these themes. We would also still support them with their rights under the mental health act and support them at managers' meeting and appeals.

Which organisations do you work most closely with in Powys? 

As an advocate in Powys there are quite a few organisations we have worked with. The main people we work with are Social Services and Community Mental Health teams. Additionally we also work with organisations like Age Cymru and the Alzheimers Society. We also work with the ward staff, and Best Interest Assessors.

What are the main challenges of your role?

Some of the main challenges experienced are having the ability to manage the expectations of not only the client but also their family. Another challenge is when delays happen and it is completely out of our control but there is an expectation on us to make it happen. Another challenge would be the conflict of interest and other people’s understanding of our role, including professionals.

Tell us about some of the most rewarding work you have done so far with CADMHAS?

For me personally, the most rewarding part of my job is when the client gets what they want! Especially when the work started it was not even a possibility, knowing that you have made that difference to that person. This includes things like making sure the clients are listened to and that there is communication between staff and patients.

When you are not working for CADMHAS, how do you enjoy spending your time?

I love to spend time with my family, doing things like mountain biking, surfing and walking. I enjoy listening to music, reading and cooking. It sounds a bit cliché but I love the ‘normality’ and chaos of family life! 

Many thanks to Adrianne for telling us all about her work as a mental health advocate. If you want to find out more you can contact the Powys Independent Mental Health Advocacy Service managed by CADMHAS by emailing admin@cadmhas.co.uk or ringing 01745 816501.

Small Steps at Rekindle - Three Stories

Recovery Practitioner Kemal with a local police officer outside the Newtown centre

John Scott is the chairman of the mental health charity Rekindle in Newtown. At a recent fundraising concert for the charity, which supports young people aged 16 to 25 who are struggling with mental distress, he said:

“The trustees and staff know from experience that early intervention can help many of these young people avoid or recover from the social dislocation that can result from mental illness.

There are more than 110 active clients, and they are referred by all the various agencies in Newtown. There are two full time recovery practitioners (Diane Williams and Kemal Keeble), one of whom is a qualified mental health nurse, and two regular volunteers. They operate from converted shop premises in the centre of Newtown, which makes them accessible to this client group.

Diane (left) with a client

The stories here are examples of what can be done, and there are many more similar ones. The right help at the right time can stop these young people from a possibly irreversible descent into self-destructive behaviour. It is wonderful to see young people starting to enjoy their lives again.”

Jess Foster

At the age of 18 I was living in a homeless hostel and felt there was no use in living any more. I struggled with the pressures of sixth form and trying to earn a living so attempted suicide multiple times. Initially I was under the care of adult services but didn’t feel as though I actually mattered to them and was made to feel as though my problems weren’t bad enough.

I was lucky enough to be introduced to Diane at Small Steps and I was finally on the road to recovery. I was given all the time I needed, whether it be for just a chat or to help me better my life. Feeling like I mattered and being listened to changed my life around.

I stopped self-harming, returned to sixth form, applied for university with Diane’s help and even began caring about my own wellbeing again. When I got my place at university Diane got me a grant so that I was able to buy everything I needed and to any other person I would then look like a typical student, not someone who had just been homeless. I am now graduating this summer, have a job and strong friendships. My life is now at a good point and it’s thanks to all the help and mentorship I had from Diane and Small Steps.

Megan Tudor

My name is Megan Tudor and I am an associate trustee for Rekindle's Small Steps Project. I began as a client of the project when abuse was identified in my family home. I had to leave home and faced the difficulty of finding a roof over my head. Diane and Kemal worked tirelessly to help me and although they came across many difficulties they never gave up on me. I was in a very dark place and tried to end my life on a daily basis; I couldn't find a reason to carry on. I went from living in a horrific environment to only having the clothes on my back and no roof over my head. I was also suffering from an eating disorder and refused to eat or drink anything.

The Small Steps Project was the only organisation that recognised there was abuse and actually listened. I had seen Child & Adolescent Mental Health Services (CAMHS), 16+ team, social workers and spent a year in a psychiatric hospital and none of them listened to what I was saying. Diane and Kemal let me have as much time as I needed and listened to every word I said and actually did something about it. I was supported on a daily basis to stay alive on top of trying to find stable accommodation.

I was supported by the Small Steps Project to find a reason to live, gain tools to cope and to slowly overcome my eating disorder. They helped me to get back into education and I finally started to feel like I was breaking free from the chains that held me back for so many years. I was no longer walking down the narrow lonely corridors of hospitals or dancing with my demons. I am now living my dream, halfway through my qualification, working part time and offering support to the other clients of the Small Steps Project.

Sam Morgan

I was 16 when I first came to Small Steps. I was living with the fact I had quite a bad temper but didn’t want to admit to it. I didn’t want to feel ashamed. It got to the point where I got pretty hard to live with, my anger was getting worse and simple things would set it off. It got to the point where shouting turned into me deliberately hitting anything hard, just to try and feel something other than anger. I was also damaging my hands. My parents and I realised I couldn’t go on doing what I was doing, so I got in touch with Small Steps.

It took a long time for me to understand that I was adjusting from being a young person being told “what to do” and the new pressures of having to make decisions about life. “Who I want to become” and “what I want to achieve”. Small Steps helped me with this, it was the first time I had someone who I could speak to and someone who understood how I was feeling.

I felt I only had the one overwhelming emotion which was anger. I was always waiting to be challenged and at the first hurdle I would usually just lash out! Over time it become apparent that there was more to life than just this feeling of anger. Things changed for me and now I saw things differently; I could stand back and assess the moment and realise that anger was not the correct response. All of this was only really possible because of the continued support I received from the Small Steps Project.

I am in a different place today. I think more positively about what I would like to achieve. I am now 19 years old and aspiring to be a Royal Marine commando, which is a completely opposite mind-set. My mental and physical toughness has developed through training. I understand how to take care of my body and wellbeing. My relationship with parents is very different today, we are able to talk about things more openly and have become closer as a family. I realise now how I have a lot more to give in life and that it all starts with you allowing these changes to happen.

Jess and Sam's stories also feature in this short video about the Small Steps Project:

Find out more about the work of Rekindle and its Small Steps Project on the organisation’s website. The charity is funded by charitable trusts, local groups, businesses and individual donations. If you can help in any way you can contact the charity by emailing: help@rekindle.org.uk or ring 01686 722222.

Sarah Napper with Diane

Stop press: Rekindle volunteer Sarah Napper was recently nominated for the Powys Volunteer of the Year Award 2018 and reached the shortlist. Sarah has been volunteering for three and a half years and her role involves welcoming clients and professionals to the project. She does this despite having her own bipolar diagnosis. Sarah is around the same age as those seeking help so she has a special empathy and understanding of their problems and is a good listener. Diane said: "Sarah promotes and empowers young people to believe they can achieve anything in life despite any obstacles that come their way."

Veterans NHS Wales – on military mental health

Victoria Williams, Veterans' Lead, Abertawe Bro Morgannwg University Health Board (left)
and Vanessa Bailey, Veterans' Lead Therapist Aneurin Bevan University Health Board (right) 

This week’s guest post is from Victoria Williams, the Lead Veteran Therapist at Veterans' NHS Wales service (VNHSW) based in Swansea's health board - Abertawe Bro Morgannwg University Health Board. The team also covers the Ystradgynlais area of South Powys.

Veterans are defined by Public Health Wales as “anyone who has served for at least one day in HM Armed Forces (Regular or Reserve) or Merchant Navy Seafarers and Fishermen who served in a vessel at a time it was operated to facilitate military operation by HM Armed Forces”.

Veterans' NHS Wales service is there to help ex-service personnel living with service related mental health problems. I caught up with Victoria to find out more about provision of this invaluable service in Powys. 

Tell us more about your role as a Lead Veterans' Therapist and what drew you to the work

I’ve been working for Veterans’ NHS Wales since 2011 for the ABMU health board. Having worked in mental health for over 20 years I recognised that I wanted to work in a service that specialised in working with military veterans and this was an ideal opportunity.

What kind of support is available to veterans in Powys?

Powys enjoys the same level of service from Veterans’ NHS Wales as anywhere in Wales. You can download a map showing the 3 out-patient clinics, based in Welshpool, Neath and Bronllys.

Why might veterans require this service?

Veterans’ NHS Wales is a psychological therapy out-patient service offering therapy for veterans with service related mental health difficulties. This means that anyone who's finding it difficult to cope after they have left the military, if they think their issues might be ‘service related’, are able to self refer to us. We will then offer an initial assessment of their needs and from there a management plan will be put in place.

Mark Birkill, Veterans' Therapist in North Powys

How can Powys veterans access the service? Who can refer a veteran for the service?

VNHSW is the Welsh Government funded NHS mental health service offering therapy for issues related to military service. It’s important to note that ANYONE can refer into the service. We offer an open access policy meaning that people are able to self-refer via the website. We do find a lot of people think they have to go via the GP but this isn’t necessary.

Once referred an opt-in form is sent asking the veteran for extra details and proof of identity. When we have this information we aim to offer an assessment within 4 weeks. The assessment will look at all aspects of the current situation and look at how we can best support you.

The Powys Veterans' service is delivered by neighbouring health boards. How does this work?

VNHSW is a ‘hub and spoke model’. This means we are one service centrally based in Cardiff with our ‘spokes’ throughout the other 6 health boards in Wales. Powys is covered by 3 health boards but because we are ‘one service’ it therefore has no impact on the service a veteran will receive. If there are any doubts as to where your clinic is based then individuals can contact us (see details on the map or go to our website) and we can point the individual in the right direction. For example, if the veteran's GP surgery is based in the Abertawe Bro Morgannwg health board, then the veteran would be seen in our out-patient clinic in Neath.

A Veterans' service is very specialist. What training do Veterans' Therapists undertake?

All veterans' therapists are trained psychotherapists with training in Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Both therapies are what we call ‘evidenced based therapies’ for treatment of a variety of mental health difficulties. In addition we receive additional specialist training in military mental health difficulties.

Oxana Jones, Veterans' Therapist in South Powys

Are there other agencies Powys veterans can contact for support with their mental health or other issues such as debt management or armed forces compensation?

Veterans’ NHS Wales has a network of agencies working throughout Wales offering support for many different issues. We currently have a peer mentor support worker who is able to help veterans link in with the most appropriate agency to help with their needs.

What has been the most challenging aspect of running the Veterans' NHS Wales service?

One of the most challenging but rewarding aspects of the role is the increasing number of referrals we’ve received since we started 10 years ago. Initially this led to an increase in the time veterans were waiting to be seen for therapy. However, with the support of Welsh Government, which has recently increased our funding, this has meant that we’ve been able to extend the input of psychiatrists and administrators can give to the service. We’ve also been very lucky to receive additional funding from the charity Help for Heroes over the next 3 years and this has led to an increase in the number of therapists in the service leading to shorter waiting times.

Tell us about some of the most rewarding work you have done with the Veterans' NHS Wales service so far

Being able to speak to someone who isn’t aware that there is help for the problems they are presenting with. Also helping someone to make sense of why they feel the way they do, and offering an evidenced based psychological therapy to reduce their symptoms and improve their general daily functioning, is pretty rewarding stuff.

When you are not working, how do you enjoy spending your time?

As a mother to two teenage boys and two dogs I tend to be very busy but you can often find me on the beach with my dogs or eating cake, I’m a big fan of cake.

Many thanks to Victoria for telling us about the Veterans' NHS Wales service in Powys. If you would like to contact her, please email: victoria.williams4@wales.nhs.uk