World Suicide Prevention Day 2023

Sunday 10 September 2023 is World Suicide Prevention Day across the globe

It is 20 years since the first World Suicide Prevention Day was launched in 2003 by the International Association for Suicide Prevention in association with the World Health Organisation. The idea was to raise awareness of the problem world-wide, to reiterate the message that “suicides are preventable.”

Taking time to reach out to someone in your community – a family member, friend, colleague or even a stranger – could change the course of another person's life.

"You can help give someone hope by showing that you care. All of us can play a role, no matter how small. We may never know what we do that makes a difference. We all can reach in and ask somebody. You do not need to tell them what to do or have solutions, but simply making the time and space to listen to someone about their experiences of distress or suicidal thoughts can help. Small talk can save lives and create a sense of connection and hope in somebody who may be struggling." International Association for Suicide Prevention.

Powys and suicide

The issue of suicide is as relevant in Powys as it is anywhere else in the world. According to the Samaritans Powys has the highest suicide rate in Wales. “Someone takes their life every 3.5 weeks. We are a remote rural farming community, which tends to get overlooked in terms of funding. Low income, unmanageable debt, unemployment, poor housing & other socio-economic factors contribute to high suicide rates in most disadvantaged communities.”

We wrote last summer about the New Suicide and Self Harm Forum for Powys and the three main areas of work to be followed up by the forum - suicide, self-harm and postvention (activities to support those bereaved by suicide to help with their recovery). 

Welsh Government - Suicide Prevention Cross Party Group

This Suicide Prevention Cross Party Group raises awareness and campaigns on a cross party basis to drive change on suicide prevention in Wales.

National and Mid & West Wales Regional Suicide and Self Harm Prevention Programme

The national suicide and self-harm prevention strategy 2015-2020, ‘Talk to me 2’ was extended to 2022 as a result of the Covid 19 pandemic. The strategy has 6 key objectives, including to: “Further improve awareness, knowledge and understanding of suicide and self harm amongst the public, individuals who frequently come into contact with people at risk of suicide and self harm, and professionals.”

Following a recent public consultation on the strategy work is underway on the development of the new suicide and self harm strategy for Wales which is expected to be published in 2024.

Strategy implementation is guided by a National Advisory Group which is made up of statutory, voluntary and charity agencies who are involved in suicide and self-harm prevention in Wales. Implementation of the Talk to me 2 strategy has been split into 3 regions across Wales with 3 Regional leads:

Laura Tranter is the Mid & West Wales Regional Suicide and Self Harm Prevention Lead.

One of the objectives of the Regional Coordinator role is to support the Mid & West Wales Regional Suicide and Self harm Prevention Forum is to support the development of regional action plans that connect national strategy with more localised strategies and plans, across sectoral boundaries. Over the past year the regional forum has been identifying its priorities for the region and has developed a number of sub groups to coordinate action. These sub groups will focus on:

• Children and young people.
• Prevention.
• Lived experience.

There are also local suicide and self harm prevention forums across the Mid & West Wales region.

The Powys Talk to Me 2 Delivery Group works across organisations to bring together and coordinate actions within Powys to ensure effective local delivery of the T2M2 strategy.

Digital hub

The National Suicide and Self Harm Team have been developing a digital hub where users can explore training options, get the latest updates and find out about future events.

The digital hub currently hosts videos and presentations from the Suicide and Self-harm National Conference held on 2 March 2023 at Cardiff City Hall.

The digital hub also hosts the digitised version of Help is at Hand - a guide for those who are unexpectedly bereaved by suicide or working with someone who has been.

Rapid Response

Across the Mid & West Wales region a Rapid Response Pilot has been being implemented since September 2022. This is a process that engages safeguarding and other partners to determine the impact of a suspected suicide and to ensure there is a support system and resources to support those affected or impacted by the death.

National guidance on how we respond to those affected or bereaved by suicide

A national multi-agency working group has been working in collaboration with the National Suicide and Self Harm prevention Team to develop guidance on responding to people affected by suicide. The draft guidance was published by Welsh Government for consultation. Feedback has been analysed and published by the Welsh Government Policy Team.

Powys Suicide Bereavement Service

This service aims to provide early assistance, practical support and signposting to people bereaved by suicide or suspected suicide within the last two years, e.g. support with arranging a funeral, advice on finance difficulties, advise on the coroner inquest procedure, and referral to specialist counselling.

The service can also provide support to those bereaved by suicide historically, e.g. signposting to specialist counselling. You can find out more on the Powys Teaching Health Board website: Bereaved by Suicide or Suspected Suicide Support.

For further information about suicide and self harm prevention across Mid & West Wales please contact Laura Tranter at sshp.cymru@wales.nhs.uk

Other sources of support

Suicide prevention pledge - Mid & North Powys Mind

The Suicide Prevention Pledge is the initiative of Mid and North Powys Mind - in response to the high rate of suicides in Powys. Suicide is the biggest cause of death in men under 40.

“Talking about suicide can seem scary and some people can feel if they mention suicide it can put the thought in someone’s head. There is NO evidence of this and in fact talking about it actually helps and is one of the easiest ways to prevent suicide.

We need to make a change. We need to say it’s okay to feel sad. It’s okay to cry. It’s okay to not be okay.

We understand it can be daunting to talk to professionals, so the pledge is designed to make it easier to talk to friends and family, as well as to know where to encourage people to get help from."

Sometimes all that’s needed is for someone to listen

The pledge cards can be downloaded from the Mid & North Powys Mind website.

People sign up to support others, and also to contact sources of support if they are struggling.

As well as services such as 1:1 support and counselling, Mid & North Powys Mind also provide courses on Mental Health Awareness and Mental Health First Aid to help people find out more about how they can support people to prevent suicide happening.

Nicki (not her real name) was helped by the 1:1 support service and Mums Matter course at Mid & North Powys Mind after struggling with anxiety and depression. She “also found it very difficult to remember to take medication, and sometimes felt suicidal.” She describes how her life turned round after working with Mind to put coping strategies in place. You can read Nicki’s full account of what happened on the Mind website.

Support after Suicide - North Powys

This is a new support group on Facebook which has been set up by the local mental health charities Ponthafren and Mid & North Powys Mind:

“Many of us have lost a loved one through suicide and we recognise how difficult this can be.

Ponthafren and Mind are helping to deliver a regular support group for people bereaved by suicide."

Face to face meetings are held regularly on the first Tuesday of the month at Hafan yr Afan in Newtown, 7 - 9pm. You can find out more on the Facebook page.

Bereaved by Suicide Walk - South Powys

This bereaved by suicide peer support group walk is on the 3rd Tuesday of every month. If the weather is bad, the group moves to a nearby rugby club for tea and coffee.

This support group is suitable for anyone living in, or around, the Ystradgynlais area, who is over 18, and has been bereaved by suicide. If you are interested in attending you can find out more on the Ystradgynlais Mind Facebook page here.

Papyrus - Prevention of Young Suicide

Suicide is the biggest killer of young people aged 25 - 35 in the UK. Male and female. Every year many thousands more attempt or contemplate suicide, harm themselves or suffer alone, afraid to speak openly about how they are feeling.

The UK-wide charity Papyrus is there to help.

Kate Heneghan, Head in Wales of the charity Papyrus, wrote last year about her work with Papyrus in Wales to support, equip and influence to help prevent suicide in young people.

Other resources

Samaritans provide a helpline 24 hours a day, 365 days a year. And you can find more about the local Brecon & Radnor branch here.

C.A.L.L. Helpline offers a confidential listening and support service. Anyone concerned about their own mental health, or that of a relative or friend, can access the service.

The NHS has a very useful webpage on Help for suicidal thoughts. 

The charity Mind has a range of information on its website relating to suicide, including sections about Suicidal feelings and Creating a support plan to use if someone is feeling suicidal.

Survivors of Bereavement by Suicide is a self-help organisation which exists to meet the needs and break the isolation experienced by those bereaved by suicide.

World Suicide Prevention Day 2023 information.

The NEST / NYTH Framework – supporting babies, children, young people & families

by Sharon Titley

Children’s Commissioning & Transformation Team

Powys County Council

NEST is a planning tool for Regional Partnership Boards across Wales, to support the development of a whole system approach to mental health and wellbeing support services who work with babies, children, young people, and families. The NEST Framework was created in collaboration with children, young people and families, alongside other professionals throughout Wales, ensuring that their voices are at the heart of what we do, and inform us how best to support them.

This video introduces the NEST framework:

Children, young people, and families that worked together to create the Framework adopted the term NEST. This is based on the notion that a NEST has a caring quality and contains many different levels. They liked the notion that all support services adhered to this theme, making sure that they all felt nurturing, empowering, safe, and trustworthy.

Some of the main aims of NEST are to:

• Broaden the conversation around mental health and move away from thinking that only specialist services can provide help.
• Provide access to expertise and advice more quickly and easily.
• Make sure that trusted adults closest to the child understand what they can do to help and give them the skills and confidence to do so.
• A ‘No Wrong Door’ approach to those who might need extra support.
• Giving babies, children, young people, and families the right help, at the right time, in the right way.

This is the NEST framework; the acronym is around the outside of the circle and then the stakeholders in the second circle. The white segments of the circle give us the 6 core principles of NEST. The inner circle contains the underpinning values of NEST which show the expectation of services and their strategic context being psychologically informed, adopting a children’s right based approach in accordance with the United Nations Convention on the Rights of the Child, respecting equality, and inclusion, being values led and being led by a child’s development rather than their age or predetermined stage.

Powys Regional Partnership Board recognises and welcomes the introduction of the NYTH NEST Framework:

“It emphasises that every relationship and every service need to work together to prioritise what is needed most if we are to build the foundations for positive mental health and wellbeing. These qualities are even more important for those who are struggling most, which is why it is about prevention AND intervention. The NEST Framework helps us keep an overview on how everything and everyone works together to achieve the best outcome.”

The RPB's Start Well Partnership is responsible for taking forward the Regional Partnership Board’s work to strengthen and transform services for children and young people in Powys as set out in Powys’ Health and Care Strategy and will therefore be leading on the implementation of NEST in Powys. Partners of the Start Well Board have developed a multi-agency model to respond to and support the emotional health and wellbeing needs of children and young people in Powys.

The Powys model recognises the importance of the community where a child lives, the schools they attend, as well as the important relationships in a child’s life which can be strengthened to support children and young people to prevent their needs from escalating into specialised mental health and statutory services. It also focusses on early intervention and prevention, a whole systems approach, which avoids duplication and allows for integrated access to service.

This model acknowledges that children and young people are more likely to communicate with adults that they know and trust. The need to focus on the adoption and embedding of early help offers has never been more important. It aims to bring about the kind of transformational change that children, young people, and their families tell us they want.

The ambition for every relationship and every environment to feel:

• Safe, nurturing base.
• Enabled to fly the nest.
• Return to the nest if need to.
• Unique to the individual.
• Builds on natural resources.
• Multi-layered.
• Same basic need for every child – but some need additional layers.
• Every interaction is an intervention.
• It is the little things that make the biggest difference.
• Culture shift away from ‘What is wrong with a child?’ towards asking ‘What is a child’s NEST like?’
  
  

How NEST is being implemented nationally

• Community of Practice.
• National Training Programme.
• A Self-Assessment and Implementation Tool.
• Aligning cross policy work.
• Regional Partnership Board Leads' meetings.
• Built into Regional Integration Fund.

How NEST is being implemented in Powys

Start Well Partnership met in October 2022 to develop a Powys Implementation Plan, which includes some of the following actions -

• Coordinating an initial NEST self-assessment across services working with babies, children, young people, and families.
• Supporting a culture change through developing a suite of training opportunities, as well as offering accessible training on values that enhance the framework e.g. Dr Treisman training.
• Defining areas of development e.g. improving coproduction and community engagement.
• A NEST Steering Group has been established to develop a collaborative approach to embedding the NEST Framework in Powys, bringing stakeholders together to develop a shared understanding of the sustainable long-term change that is required.

If you would like to learn more about the NEST Framework in Powys, or would like to discuss any training requirements, then please contact Sharon Titley – sharon.titley@powys.gov.uk

You can read about case studies, including the Development of the Team Around the Cluster Model in Powys, in the recent Welsh Government publication: 

“NYTH / NEST in action - Good Practice Examples of the implementation 

of the NYTH / NEST framework 2023.”

Black and white photographs by Myléne from Pixabay.

A Private Land Project Tir Diarffordd

 

by Susan Adams and Penny Hallas

What is A Private Land?

A Private Land is an art-based research and development project, supported by Arts Council Wales and undertaken in collaboration with community groups, with a central theme of the links between emotional and environmental health. Its funded timeframe is February - October 2023, but it is expected that relationships and processes developed in this R&D phase will inform on-going projects.

How did the project start?

Artists Susan Adams and Penny Hallas share deep interest in inner and outer worlds: the intersections between the visible world and the realm of imagination. In searching for a collaborative project in which we could explore these concerns further, we were drawn to the former Mid Wales Hospital, Talgarth, Powys, Wales. After more than a century, its physical remains are falling into the final stages of dissolution and will most likely soon be demolished. But it is of historic importance to the local community and former patients and continues to be a site of intense and complex emotional resonance for many different communities and groups.

What are the main themes?

Our project references geographical and psychological territories and the nature of the boundaries that may both protect and / or restrict us. Where are we positioned in relation to boundaries: how much choice do we have and can past actions and decisions be reconsidered? Whose voices are heard and who is remembered? Whereas many other former hospitals (e.g. Ely or Whitchurch in Cardiff, Bethlem in London and Glenside in Bristol) have preserved memories and artefacts, patient voices and stories, we've noticed that it is particularly difficult to find accounts from the people who received treatment at Talgarth. So we have tried to enter imaginatively into the Talgarth site and the hidden stories it suggests, and we invite the voices of people who have experienced mental health issues there or do so currently in the community. Culminating in co-produced arts events/installations, we are trying to form new narratives in creative ways before both site and memories are lost to us.

Our project touches on important but sensitive issues and themes, and we are aware of the need for both courage and delicacy to work together with everyone involved to follow the project through with care. Negotiating strong and contradictory feelings evoked by the project themes in participants, communities, organisations and ourselves is a large part of our work. This includes adapting to a wide and sometimes conflicting range of views as to what is or 'should be' private and what can be shared.

Who are your partners?

We are encouraged by the support and involvement of our partners. Arts Council of Wales; Brecon and District MIND; Powys Teaching Health Board; Research partner, writer and historian Dr Bob Adams, BSc, MB BS, FRCPsych, M Psychotherapy; Creative mentor, Mel Brimfield, Royal College of Art. We're particularly grateful to Marie Davies, CEO at Brecon and District MIND and to Lucinda Bevan, Arts in Health Co-ordinator, Powys Teaching Health Board, for the inspiration, experience and ideas that shaped our plans as well as the support in safeguarding, risk assessments, levels of consent and observation of service protocols that gave us confidence to go ahead.

These were our key partners, but one of the pleasures of the project has been the way unexpected alliances have emerged. For example, the arts organisation PEAKcymru have lent us technology that was outside our budget but has been key to engagement. And mid-way through the project, artists, writers and an art psychotherapist responded to our invitation to form a community artist peer discussion group, inspired by Bethlem Gallery's Questions of Care online workshop earlier this year. Together we shared some of the dilemmas and pleasures of community engagement and all agreed this should be an on going group.

In methodology, our project follows the many existing models of good practice in exploring these themes, including artist-led projects, some of which are listed in the resources and links section.

What has been happening in the project so far?

Our activities have included looking inward to our own emotional and artistic journeys, and outward - to historical archives, online resources, other former hospital sites and communities and arts engagement with local community groups.

Research activities have included initial consultation with our research partner and our creative mentor to deepen our understanding of historical context and help identify the shape of our own and collaborative art activities. We visited Glenside Hospital Museum to see how they have turned their former chapel into a lively resource for the local community and a centre of good practice in dealing with historic and current attitudes to mental health.

From the earliest days of the project we knew that a visit to the Mid Wales Hospital archives, held at Powys Archives in Llandrindod Wells, would be vital to getting a sense of hidden stories. We were able to view registers, case notes, maps and other documents that fall outside the 100 year limitation on viewing but it was the personal accounts, letters and photographs that touched our hearts. We're unable to share photos for this research and development project, but this may be possible in any future phase. Both of us have made images inspired by what we saw. This one is by Susan.

Arts engagement has been through a series of arts workshops as well as digital input and engagement to extend reach. Our initial ideas were simply to offer a broad range of options for workshop participation including audio, video, animation, textiles as well as more traditional art media, based on the areas of expertise we have developed in our own practices. We wanted to meet people first though, to find out what they would like to happen so we had three initial meetings, at Brecon, Talgarth and Hay Mind groups. From these meetings we learnt that some people were interested in the Mid Wales Hospital and had memories to share, whilst others made it clear that they preferred to focus on the natural and environmental elements of the project. So we devised four activities that we offered across all three groups: weaving with foraged and natural materials, making simple animations, making slides for projection with flowers and creating a thaumatrope - an optical toy. We hoped that all these activities would allow multiple points of entry so that people could join in to the level that they felt comfortable with. 

There have been six workshops so far and we will be doing a demonstration / workshop at Felindre Ward, Bronllys Hospital too. We've seen amazing levels of engagement and enthusiasm. Quite a few people wanted more time to continue their artworks, so in addition to the workshops we have supplied materials and activity packs. We have welcomed the contribution of people who preferred not to use art materials, but who kept us company and joined in the conversations.

Participants at the Brecon & District Mind workshops told us about the tiny but packed Museum in the Old Post Office in Talgarth which they thought would have artefacts relating to A Private Land. So we made a visit and were surprised and delighted to find objects, images, artworks and records from the Mid Wales Hospital, donated by the community.

We met so many people with fascinating tales to tell. This thread has led us to adapt our plans for final events in order to be part of the Talgarth Festival

What will happen next and how can people get involved?

We'll be having final events to show what we have all done together in the project and to continue to gather stories and memories. We'll be inviting people to bring any artefacts they may have from the old hospital site to help form an archive and preserve memories. The events are free and open to all, so please do come along and spread the word.

We'll be having a stall at Talgarth Festival on Saturday 26th August making contacts, offering more opportunities for sharing stories verbally, through art making and display of objects. We plan a shared walk up to the old hospital site, late afternoon / early evening.

There will be a co-produced exhibition at The Muse, Brecon, 28th and 29th October, with guest artists, a writing / poetry workshop, performers and poetry reading. And of course, more opportunities for people to contribute. Full details of all our events will be posted on A Private Land / Tir Diarffordd Facebook page

We've only been able to give a broad overview of our complex project in this blog, but if you would like to see more we have been keeping a record of most of our activities and engagement on our Artist Information Company blog: https://www.a-n.co.uk/blogs/a-private-land-tir-diarffordd/ Brecon and District Mind suggested we set up a Facebook page (QR code below) to help keep in touch with participants and as a focus for ideas / exchanges so there's lots to see there too and we'd love it if people would like to add comments and posts. We're happy for people to contribute in language of choice. Croeso i chi gyfrannu yn y Gymraeg!

About the artists

Susan Adams lives near Brecon and Penny Hallas lives near Crickhowell, forming a kind of triangle with Talgarth. Both artists have extensive experience of working with communities, in education, health and with a wide range of organisations and institutions. They have exhibited widely in Wales and internationally. You can see more of their work on the links below.

Susan Adams https://susan-adams.co.uk https://www.instagram.com/susan_j_adams/?hl=en

Penny Hallas https://www.pennyhallas.co.uk https://www.instagram.com/pennyhallas/?hl=en

Resources and links

PEAK cymru https://www.peakcymru.org

Talgarth Museum https://www.facebook.com/TalgarthMuseum

Glenside Hospital Museum https://www.glensidemuseum.org.uk

Bethlem Gallery https://bethlemgallery.com

Outside In https://www.instagram.com/outsidein_uk/?hl=en

The restoration Trust Change Minds Project https://restorationtrust.org.uk/change-minds/

Mendip Hospital Cemetery http://www.mendiphospitalcemetery.org.uk

High Royds Hospital website, Talgarth page http://www.highroydshospital.com/resource/mid-wales-hospital-talgarth/

The role of Arts in Improving Health and Wellbeing 

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/929773/DCMS_report_April_2020_finalx__1_.pdf

The Wales Arts Health & Wellbeing Network (WAHWN) https://wahwn.cymru

                     

A busy summer for our mental health reps

by Owen Griffkin, Mental Health Participation Officer

The Mental Health Service User and Carer Representatives have had an enormously busy summer so far this year. I have been with them all over Powys helping them get out and about around the county.

When I first started in my role as Mental Health Participation Officer in 2017 it seemed that I was constantly out and about around Powys. Most of my work involved attending meetings or events either on my own, or accompanying the mental health reps to their meetings. Obviously lockdown meant that much of work life moved online, and one benefit of this was that lots of these work meetings continued online. This allows us to have people from all over Powys, and sometimes Wales, present at a discussion instead of having to travel to Llandrindod, or Newtown or wherever the meeting is. This is really useful in some situations, and it has allowed the reps more access to people working in Mental Health services in Powys.

Unfortunately, there was also a downside, as there was less opportunity for the reps to speak to people in communities which is the most important part of their role. That’s why it has been so refreshing to start running Meet The Rep events all over Powys, and to start attending community events with the reps. I think I have driven more miles in the last month than I did in the previous year.

Sally and Sarah at the Help & Information event in Machynlleth

The current reps - John, Sally, Sarah and Rhydian, decided that they wanted to get back out and make sure people knew who they were, and who they could speak to if they wanted to have a say in the way the Mental Health service is delivered. Therefore in June we held two Meet The Rep events in Newtown and Welshpool Ponthafren, and also attended a community Help and Information event in Machynlleth and a Pride Picnic organised by Credu at Llanfyllin Workhouse.

The reps set up stalls full of information about their roles, and spoke to people about their experiences of mental health services. There were activities as well that were relevant to the event. For example at the Pride Picnic, Sarah made some paper fortune teller origami sets. These were fun and dispensed tips on self-care as well as drawing people to our stall.

Sarah Dale said: "We as reps have been extremely busy in the north of Powys, out meeting people and discussing the work we do and some of you shared your views on the service. I believe as reps we cannot represent mental health service users and carers without gathering feedback. Every piece of information we gather does make a difference. Sometimes we may be able to help get you in touch with other organisations that may be able to help such as community mental health advocates. I understand that from the outside you may not know what happened to your feedback. I want you to know I try my very best to ensure each issue is addressed and actions taken to ensure that the service is fit for purpose.

I really enjoy organising activities for community engagement and meeting different people and networking with local organisations. I like listening to other people's experiences. Just listening can make a person in a difficult situation feel less alone, and talking to someone who has no affiliation with a specific organisation (I am just another service user) makes them feel more heard and understood, and brings that trust that we will ensure that their voice is heard. It can give people hope.

After a long break hopefully you will see us out and about again real soon.”

Sarah and Sally at the Pride Picnic in Llanfyllin

The serious part of the events was making sure that we gathered feedback from people about their experience in Powys and added these to an issues log. This issues log is then taken to a quarterly meeting with the Service Managers for Mental Health in Powys and any actions that are taken due to the feedback are noted and can be reported back to the person who gave the feedback in the first place.

Sally Houghton-Wilson said: “Having attended a few events, it's been really helpful to understand people's opinions, point of view and feedback on how they are finding the services, and what works best for them, what hasn't been helpful, and what their expectations are. It's nice to learn all about their experiences. And gives a clear indication of what's lacking within the system.”

The reps have also been continuing with their normal duties, attending Engage to Change and the Mental Health Planning and Development Partnership, which takes up a lot of their time. In fact, the reps now chair the Engage to Change meeting. (The Engage to Change group has been established to more widely promote the Mental Health Planning and Development Partnership’s activity, to proactively challenge any stigma associated with mental health and to collect service user views / experiences, co-ordinate resolution and feedback on resulting change, to people using services).

There have also been three Patients’ Council meetings where the reps listen to people’s experiences on the Felindre Ward.

Sarah delivered three Self Injury Awareness sessions to foster carers, staff from Child & Adolescent Mental Health Services’ teams and school nurses. These have been very well received and are helping to give people who are likely to come into contact with people who self harm the knowledge they need to have a caring and compassionate conversation, and not judge the people they speak to.

John and Josh at the Wales Mental Health & Wellbeing Forum in Llandrindod

It was also a pleasure for Powys to host the quarterly meeting of the Wales Mental Health and Wellbeing Forum in Llandrindod. This national group is a chance for all the service user reps from around Wales to meet and discuss what is happening in their area, and prepare reports that are sent to the Welsh Government. As Powys was the host, it fell upon John Lilley to chair the meeting. John gave an overview of co-production in Powys Mental Health services and there was a lot of approval from the group in regards to the work we are doing here.

John Lilley said: “Having attended several national forums in the past, and chairing one online during Covid, I knew roughly what was expected when it came to chairing in person. I was still a little nervous when the date came round and was grateful for Josh from Practice Solutions (who facilitates the forum) for co-chairing and Owen’s help in the regional update.

Knowing most of the attendees certainly helped calm the nerves and on the whole, I enjoyed the experience, though being a hybrid meeting I found it challenging to monitor the online screen for hands raised but with help from Josh I managed.

At times it was difficult to keep discussions relevant and on time but with gentle reminders of the agenda this became easier. Would I do it again? Yes and I also recommend people to try it. I found it a great learning opportunity and it boosts one’s confidence.”

Summer is traditionally a quiet time for the reps, a time to reflect on the year so far and plan for the future. However this summer they have really gone above and beyond what is expected of them in their roles, proving how much they deserved to receive the Outstanding Contribution award at this year's Powys Volunteer of The Year Awards.

If you would like to get involved in having your say in services, and be informed when there are future vacancies, then please fill in this expression of interest form here.

The Tipping Point: Where next for health and care in Wales?

On 6 July my colleague Sue Newham and I attended the second day of this Bevan Commission conference at the Celtic Manor Resort in Newport. The Bevan Commission is Wales’ leading health and care think tank - aiming to “challenge, change and champion thinking and practice to ensure sustainable health and care that is fit for the future.”

Celebrating 75 years of the NHS in Wales, the conference was described as the “opportunity for an open and honest conversation about the future of our health service.” It was attended primarily by NHS and social care professionals from across Wales, and perhaps more importantly the organisers asked those attending - “What role will you play in finding ways to influence and make change?”

“We are at a tipping point. It is now time for us to face these challenges together and rebuild our health and social care systems to thrive in tomorrow’s world.” 

Bevan Commission

The day was packed with knowledgeable and inspiring speakers, presentation sessions broken up by break-out workshops where Bevan Exemplars* and others described their ground-breaking work within the NHS and social care sectors in Wales. The previous day our colleague Sharon Healey (PAVO Head of Health, Wellbeing & Partnerships) had spoken on the work of the PAVO Community Connector Service alongside Dr Carolyn Wallace (Director of the Wales School of Social Prescribing Research) in relation to social prescribing.

The key message that came out of the day for me was that the NHS can no longer continue to provide care in quite the same way as it has for the past 75 years. It’s just not sustainable. The NHS employs more people than ever before in its entire history, yet the demand for services is insatiable and cannot be met. It never will be. Because as new treatments are developed, rolled out and information about them shared, people’s expectations and demand for services increases.

The day was a bit of a roller coaster mix of highs and lows. Some of the stats around health inequalities were very concerning. But the enthusiasm for innovation, the stories I heard of good practice already happening around the UK - well, there was plenty to be excited about.

So here is a small dip into Day 2 at the conference. All of the speakers referred to challenges as well as opportunities.

"The world will not be destroyed by those who do evil, but by those 

who watch them without doing anything." 

 Albert Einstein

Frank Atherton - Chief Medical Officer for Wales

Frank spoke about some of the “wicked problems” or constraints to refreshing and carrying out the Welsh Government’s route map of A Healthier Wales - the long term plan for health and social care:

• An ageing and frail population.
• The need for the social care system to mirror the NHS.
• Vacancies in the workforce.
• Capital infrastructure is not fit for current times.

Frank also spoke about the public health agenda. In 2003 Sir Derek Wanless, a banker and health advisor, was asked to identify cost-effective approaches to improving public health, prevention and reducing health inequalities. His final report, Securing good health for the whole population, suggested that a shift in focus was needed away from just caring for the sick and into promoting good health.

Frank believes that our health is shaped by our environment. He described how all our communities are being increasingly exposed to fast food restaurants, gambling and vaping shops, for example. We need to think about how we address some of these concerns and have “deep, deep engagement with our communities.”

After highlighting some of this year’s priorities around redesigning the model Frank said that the “NHS will survive. It needs to grow, transform and develop … with public health at its absolute heart.”

Eluned Morgan - Minister for Health & Social Services

“The very fact that we have an ageing population is a sign of the success of the NHS. But we all know that the system is under strain like never before:”

More people will be living with dementia, cancer, coronary heart disease, vascular challenges, diabetes and poor mental health. And many people will be living with multiple examples of these challenges.

There is a worldwide shortage of health workers.

The vision:

• People live longer and healthier lives.
• They remain active and independent.
• They live in a whole system approach which achieves high quality care for everyone in Wales.
• Focusing not just on physical but on mental health.
• A switch to a system which anticipates health needs and prevents illness.

Eluned was clear that If we want a sustainable NHS to hand on to our children and grandchildren we need to work at managing our own health conditions, and also look at our lifestyles - around healthy diet, increased exercise, and alcohol reduction for example - to help lower the demand on the NHS. We need to listen to what matters to patients, but they also need to listen about the limitations of a sustainable NHS.

Whilst researching the conference I came across an online piece by Marion Foreman, an NHS nurse, who wrote powerfully in 2018 about an individual’s responsibility to look after their own health: Our health, our responsibility.

Prevention is key… but how to ensure that this message is heard and taken on board by the population of Wales…?

“Change will not come if we wait for some other person or some other time. 

We are the ones we’ve been waiting for. We are the change that we seek.” 

Barack Obama 

Professor Sir Michael Marmot - The Marmot Approach

Michael Marmot is Director of the (University College of London) Health Institute of Health Equity, and author of “The Health Gap: the challenge of an unequal world”.

Michael’s concern is with the social determinants of health - “the conditions in which people are born, grow, live, work and age and which can lead to health inequalities.” The 2010 Marmot Review looked at the differences in health and wellbeing between social groups and “describes how the social gradient on health inequalities is reflected in the social gradient on educational attainment, employment, income, quality of neighbourhood and so on”.

“Why treat people and send them back to the conditions that made them sick?”

People in more deprived areas used more NHS services/money than those in less deprived areas. “The UK is a very bad place to be poor.”

The framework for action created at the time of the review is known as the Marmot Principles, of which there are now 8 (the original review was revisited in 2020) - early years development (x 2), employment, living standards, communities, ill-health prevention, discrimination, and environmental sustainability. These principles have been taken on by some health boards and Gwent is the first Marmot region in Wales - Building a fairer Gwent: Why Gwent is a Marmot region.

Derek Walker - Future Generations’ Commissioner for Wales

“Acting today for a better tomorrow” - in essence sums up what the Wellbeing of Future Generations (Wales) Act 2015 is all about. “And that means in practice, for health, a long-term integrated preventative approach to our health system here in Wales.”

One of the five ways of working in the Act is prevention. Everyone agrees that prevention is key, Derek said, but not enough is happening. Derek asked “what is preventing us from putting the focus on prevention?” He pointed out that mental health issues in young people are continuing to rise, and 50% are established by as early as age 14, but there is not enough emphasis on early intervention.

Derek spoke of the 4 levels of prevention that have been developed with the Welsh Government and his predecessor Sophie Howe. Each level can reduce demand for the next. The levels start at Primary prevention - building resilience, and build up to Acute spending - which speaks for itself! “(According to Public Health Wales, mental ill health costs society in Wales £7 billion a year.”) The question now is how we spend more time at Level 1.

“We need to increase our spend on the social determinants of health faster than acute medical care spending.”

Derek noted that the Fire Service has managed to achieve massive change to bring about a 52% reduction in incidents through its investment in prevention and education. Whilst the “example doesn’t transfer automatically across to health care, it is a clear demonstration of where investment in prevention efforts can make a difference.”

A Journey to a Healthier Wales, from the Future Generations’ office, with a big emphasis on prevention and social prescribing, is well worth a read.

Professor Donna Hall - The Wigan Deal

Donna Hall, who is described as a “public service pioneer,” is the Chair of Innovative National Think Tank “Think Local”. She was awarded a CBE in 2009 for innovation in public service.

In this 2018 video she speaks to Chris Ham about what happened in Wigan, where she was Chief Executive of the council in 2011, when £160 million was taken out of their budget. They had to transform services and their relationships with the community, NHS and other providers. One of the elements of The Deal was that people took better care of their health. Amazingly The Wigan Deal improved services and resident satisfaction!

Ashley Gould - The Big Nudge

As part of this inspirational day Sue and I attended a workshop called The Big Nudge on changing people’s behaviours. It was facilitated by Ashley Gould, Programme Director of the Behavioural Science Unit at Public Health Wales. He introduced us to “Improving health and wellbeing: A guide to using behavioural science in policy and practice.”

Here in the mental health team at PAVO we’re more inclined towards the small nudge, and encouraging people to adopt positive behaviours by showing how much difference they have made to other people’s lives, specifically their mental health, be that by walking, gardening, getting active or singing, for example.

We’d like to make more of a difference, of course, and look forward to working more closely with not just the NHS but other organisations in Powys to help make the Prevention agenda key to improving people’s health and wellbeing. (We absolutely want the NHS to be around for another 75 years!) If you have any ideas about how we, and the Third Sector in Powys, could work more collaboratively to help bring prevention to the fore, then please get in touch!

You can watch videos of all the keynote speeches at this conference here.

* Through the Bevan Exemplar Programme, health and care staff across Wales are supported to develop and test their own prudent ideas to improve and transform health and care. Their projects, which are exemplars of innovation and transformation in clinical and community settings, can inform and inspire others to adopt and spread new ways of working across Wales and internationally.

Life at No 27 - growing for wellbeing

Life at No.27 is a leading horticultural therapy and mental health counselling provider run as a social enterprise, built with passion at its core and designed to improve lives. The organisation uses nature, conversation and human connection to support anyone experiencing poor mental health, low confidence, self-esteem, and isolation.

Since our involvement with the Grow, Cook, Share Powys Network has now come to a close, we are keen to find out more about the opportunities in Powys for therapeutic gardening so that we can promote them far and wide. So we got in touch.

Annabelle Padwick, the founder, was more than happy to tell us about Life at No.27.

Why did you set up Life at No. 27? And what is the story behind the name?

I set up the organisation following my own experience with mental ill health and recovery, and the observation that the two things which helped me were private mental health psychotherapy and me getting my allotment. I wanted to create a safe space for others that combined these two therapeutic opportunities into one unique approach that was accessible for everyone. A safe space to talk, explore thoughts and feelings including past trauma, process and heal, alongside a practical outdoor environment to learn new skills, release energy safely, look to the future and believe in myself and my ability with practical tangible evidence.

The name, Life at No.27, came in 2015, when I started a blog about my own allotment and mental health journey. I didn’t want the blog to say mental health or gardening as I didn’t want the title to automatically say what it was about, other than my life. I wanted other people to want to read it. My original personal allotment plot number was 27, and I was also 27 when I started the blog.

Since then, the name has stayed the same and my client allotmenteers have said they like it, especially as it doesn’t say what it is. It gives them more choice on how much they want to tell others about the service.

Tell us briefly about the organisation’s main activities now

We deliver weekly adult group and 1-1 sessions for all ages over 18, where we offer local people their own Life at No.27 allotment, or access to a Life at No.27 therapy garden for a year, as well a mental health counsellor and therapeutic horticulturalist to support them mentally and practically with learning to grow produce. This is at our therapy garden in Craig y Nos Country Park in South Powys. These spaces are free with GP, psychiatrist or social worker referral. We also welcome self-referrals.

We also offer fun and relaxing weekly after school club sessions for children aged five years old and above, as well as 1-1 sessions, school intervention programmes and holiday activity clubs. All children are welcome, but the sessions are designed for children struggling with anxiety, low confidence, difficulty understanding and managing emotions and/or have social and emotional needs.

Why the move to Wales?

We moved to Wales personally, and this area in particular, because we love it and wanted to be closer to where my husband was born and his family are, near Swansea and Carmarthenshire.

The strapline at Life at No.27 is “It’s not what you grow, it’s how YOU grow!” Tell us more

It fundamentally means that it doesn’t matter what you choose to grow, whether that’s flowers, carrots, pumpkins or much bigger life ambitions. We want to support you every step of the way and how you grow as a person in the process is what is important.

What is it about being outdoors, in Nature, that you think has such an impact on positive mental health?

I think it’s the combination of being in nature, learning new skills and having a safe, confidential space to talk and explore feelings that can help create positive mental health.

In terms of being in nature specifically, it’s the most natural and free therapeutic resource for us all. If we slow down and pay attention, nature teaches about patience, resilience, the importance of being present in the moment and the enhanced satisfaction and joy we feel in life when we do slow down and feel every moment. It also teaches us exactly what we need to thrive as well. I always say to people if you forget how to look after yourself, just think about what a plant needs, and if you forget how to look after a plant, think about what you need - it’s the exact same things. Yet at the time it shows our uniqueness, we all have the same but also different needs. We all need food, love, sunshine, nurturing, space to grow, minimal enforced disruption, air, and patience – just in different quantities and ways, and plants are the same.

Layer this with the practical elements of getting our hands in the soil and the sensory play experience of feeling, smelling and seeing different plants. We can then lose ourselves in the moment; the fragrances, the noises of grasses and birds, the textures of bark, furry petals or the mindful process of many gardening activities.

You have a number of projects running at Life at No.27. Tell us more

We have our beautiful therapy garden in Craig-y-Nos, where we offer a range of services for those experiencing mental ill health, isolation, anxiety, low confidence and/or self-esteem.

Here we deliver group adult sessions for up to 6 people on Friday mornings, from 10 – 12. These sessions are part of our year long programme mentioned earlier and are free with referral. We come together relax, have a cuppa or two, chat and garden together in our beautiful surroundings. There is no pressure to chat or share with others unless you want to, as I mentioned earlier, it’s all about coming, for yourself, and giving it a go.

We also offer 1-1 sessions for adults here which are available on request to suit their availability.

Here in Craig-y-Nos, we also offer two-hour adult Seed Sowing and Gardening through the Year workshops every month on Friday afternoons for anyone who just wants to come garden aka play, have a cuppa and relax with others. These sessions are between £15 - £20, with all proceeds going towards our free mental health support services.

How did you get to work with the Prince and Princess of Wales and how’s that going?

We were very fortunate that the team from their charity, The Royal Foundation, contacted us after seeing a recent Crowdfunder fundraising campaign we set up for here in Wales, and were really interested in what we do. Following some conversations, the Prince and Princess of Wales were keen to meet with me, help us grow in the area, build more sites and be able to offer our unique programmes to more people. So, at the beginning of this year they announced they wanted to partner with us and start to create a legacy project, that will hopefully mean that they and their team will be on hand for support or guidance when we need it.

It’s still early days regarding their support, but I really hope it helps us achieve our vision.

Tell us more about your role as an Advisor to the House of Lords

Yes, this was a wonderful surprise invitation and surreal experience. In June this year, I was invited by the Horticultural Sector Committee to advise and give oral evidence regarding the current landscape of horticulture and mental health. This is part of a horticulture wide industry enquiry and report they are carrying out this year, to look at what is happening on the ground and what legislations need to change in the future in order for the industry to remain sustainable and bright.

I spoke about the work we do, the challenges we face, how social prescribing is currently working for us and what legislations we need urgently for safe, professional care. I also shared my experience and knowledge regarding the challenges within the media’s representation of gardening, and the compelling differences between the mental health of hobby gardeners and those who work as professional gardeners, landscapers or large-scale growers.

Are school sessions available in Powys schools now, and what happens at those?

Absolutely! They are available for primary and secondary age school children, across the area.

Our alternative education school programmes for children are designed specifically for those who are struggling with the mainstream school environment. The 6 – 12 week, or ongoing two hour weekly sessions, give selected individuals an opportunity to gain more time, space and attention away from the distractions of the classroom. Pupils who benefit massively from these sessions are those struggling with mental health illnesses, difficult home situations, anxiety and low confidence, including those already with a Child & Adolescent Mental Health team and on the SEND (Special Educational Needs & Disability) register with SEMH (Social, Emotional & Mental Health) needs.

Feedback from students:

“It’s been great! It’s really boosted my confidence.”

“I really enjoyed the programme and I recommend it to anyone else as it’s really fun and a good opportunity to make cool things and meet new people.”

“It has helped me come out of my shell and have more confidence. I have made a new friend and it has helped me deal with my feelings.”

What are the main challenges of your role?

Funding, accessibility and recruiting currently, and trying to work with and juggle all those challenges at the same time is probably a good summary.

Accessibility feels challenging right now for us, especially navigating how to engage with other services locally and GP practices who can refer local people to our services. So, any help would be greatly appreciated!

Tell us about some of the most rewarding work you have done at Life at No.27

It has to be helping children understand and express their emotions freely and safely. Whether that’s talking, running, sitting quietly and noticing wildlife or covering themselves head to toe in soil. Helping teenagers release the pressures and frustrations they feel, so that they can be a child again for the time they are with me, has to be up there with one of the most rewarding parts of our work too.

I will never forget seeing one of our past adult allotmenteers taking home a full family meal worth of home grown produce they had grown with no previous experience and their pride when they cooked and served it for their wife and two children.

I could keep going, but I guess for me the most rewarding work is when I see people being able to be fully themselves, with no restrictions or societal pressures impacting how they feel and behave. As well as teaching people new practical and emotional skills that really help them grow in confidence and self-belief. Those smiles, release in their eyes, the pride in their stance and weight off their shoulders.

“Meeting Annabelle and joining the Life at No.27 programme changed the course of my life, and I will forever be grateful for her and her team for being there for me when I felt unheard and alone. Life at No.27 was pivotal for me. I have a long way to go on my mental health journey, but knowing she will always be there if I ever needed her again, is comfort enough to try to work through life’s challenges.”

You can read their full testimonial here.

When you’re not working how do you enjoy spending your time?

I love anything creative, so painting, drawing and printmaking in my studio, and I spend a lot of my spare time growing my own produce and currently getting ready to welcome our own sheep. 

Many thanks to Annabelle for telling us all about Life at No.27. 

If you would like to find out more, check out the website or contact Annabelle by emailing: annabelle@lifeatno27.com