Safe, Safe, Safe – Standards for Health for mental health organisations

Nicky Morris (Ponthafren Association) receives a Standards for
Health certificate from Lesley at the charity's recent AGM 

My colleague Lesley Austen has been working for the past 12 months at Powys Association of Voluntary Organisations as the Safe Services Officer. Amongst many other things, she has supported organisations in the mental health voluntary sector to engage with the “Standards for Health” quality assurance scheme.

Safe Services is an increasingly important element of supporting the Third Sector to grow and thrive and we wanted to find out more. We caught up with Lesley at her PAVO base at Plas Dolerw in Newtown to ask a few questions.

What does a Safe Services Officer do on a daily basis?

I provide one to one support to organisations to help them comply with the standards. We map the standards against any existing quality assurance which may already be in place to avoid duplications.

Can you give us a bit more background information about the Standards for Health and explain why they are so important?

The ‘Doing Well, Doing Better Standards for Health Services in Wales’ came into force from the 1st April 2010 and replaced the previous standards that were introduced in 2005. The framework of standards (2010) sets out the requirements of what is expected of all health services in all settings.

Engaging with Standards for Health ensures organisations have the quality assurance in place to comply with Welsh Government issued National Minimum Standards for Independent Healthcare Services in Wales and be eligible to apply for Health Board funding, through grants, commissioning and tendering.

How can an organisation and/or service use the Standards?

A ‘How To’ guide has been developed to assist third sector organisations to use the Standards for Health Services. The guide aims not only to support you and your organisation/service to use the Standards, but also help NHS organisations and professionals to assure themselves that third sector partners delivering health services and care meet and use the Standards too.

If organisations do not comply with the Standards what implications does that have?

Current funding may not be renewed; opportunities for commissioning may be closed to them.

If an organisation is unclear about how to achieve the necessary Standards, what can the staff and/or volunteers do?

PAVO provides FREE information and training to help voluntary organisations in Powys comply with the Standards. You can contact me to find out more (see details below) or check out the PAVO website here.

How much work is involved in achieving the Standards?

For established organisations, not very much – most of the policies and procedures are already in place, and unlike some quality assurance system there is no requirement to produce a huge portfolio of evidence.

Organisations are asked to firstly identify which of the 26 standards apply to the service they provide, document what they have in place (on prepared electronic templates) and index where physical evidence (policies, documents, posters etc) are stored or displayed.

Then they identify what if anything they need to do to comply with the standards and develop an improvement plan (again on a prepared template) in order to achieve it.

Talk us through a particularly rewarding aspect to your role

PAVO recently had the great pleasure of presenting a certificate of completed engagement with the Standards for Health Quality Assurance system to Ponthafren Association at the organisation's recent AGM.

Ponthafren Association is the first organisation in Powys supported by PAVO to complete the process and their commitment and diligence will not only act as an incentive to other organisations, their approach will act as a framework of good practice and an aid to working with the Standards.

What are the most challenging aspects of the role?

The geography of Powys – everywhere takes so long to get to – but it also makes the journeys very enjoyable!

Tell us about the most valuable thing you have learnt since starting your role?

The variety and varying needs of the Third Sector in Powys and the untiring commitment of the army of volunteers who sustain it.

How did you come to work at PAVO originally?

Finding too much time on my hands after working for over 20 years in the voluntary sector in Wales, I thought my experience may be of benefit as a volunteer. I was fortunate to find an interesting opportunity at PAVO, and using my previous experience of Quality Assurance implementation I assisted in the achievement of PQASSO (Practical Quality Assurance System for Small Organisations) level 2.

After volunteering for a year, when a part time post became available, I applied, and the rest – as they say – is history!

Of course, you’re not just the Safe Services Officer at PAVO. You’ve had a number of other roles since joining the organisation. Tell us a little about them.

Whilst I was volunteering, I undertook the stakeholder feedback survey for the year, and was both surprised and honoured to be asked to write up the final report; de-duplicated the contacts in our complicated data base system and did preparatory work on other quality assurance systems.

As well as my Safe Service role, I also work as a Community Development Officer 2 days per week, providing advice and training to both new and established voluntary organisations, deliver outreach information sessions, assist with preparing grant applications, constitutions, charities registration etc.

What do you like to do in your own time when you’re not working for PAVO?

Spending time with my family – husband, five children and eight grandchildren - which takes up quite a lot of my time as they are spread between Anglesey, Brighton, Glasgow and Amsterdam!

I love to cook, especially to bake and always enjoy trying something new and the combination of those two activities is great – when my dining table is jam-packed with the people I love and the food that they love to eat. You can watch Lesley’s cookery YouTube channel here.

My other great passion is family history and so far I have traced mother’s maternal ancestry back to the 1600s and my father’s paternal ancestry to the early 1700s – it is an ongoing quest with every answer posing another dozen questions.

I also enjoy spending time in my garden, though my role is more artistic director than using the spade and hoe!  It’s a wild country cottage garden and not everyone’s taste – but I love it.

For more information please contact Lesley Austen, Safe Services Officer, email: lesley.austen@pavo.ork.uk or tel: 01597 822191.

Power and participation Part 2

by Jane Cooke

Last week Jane wrote the first of two blog posts on power and participation. This week we follow up with Part 2.

A long time ago I went on some race equality training. The trainer opened the first day by saying: “You can’t learn from someone who you feel is inferior to you," or words to that effect. That gave me a lot to think about. I wonder if it’s a challenge to lay down now to the many people who make decisions over and about what/who to ‘do to’, and who are also saying, in just about every report one reads, ‘we need to ensure effective participation’.

In our trainings and professional and personal development we don’t give enough time to considering the ‘other’; we gather around ourselves our professional identities, our roles, our pride in our achievements and positions. And, one way and another, we end up thinking about ‘them’ and often how to change and improve ‘them’. What we share, what we can learn from true openness, from open-hearted listening, is rarely in the frame.

In the realm of mental health there is another dimension. Do we question, think about and examine what we feel about the experience of ‘madness’, what we think about people who we categorise as ‘ill’? We are, I believe, still influenced by deep seated ‘folk’ theories about madness. Moral degeneracy had currency not so long ago. If you think that underpinning belief has gone, think about some of the notions that drive the endless, fruitless, search for medical markers, genes for ‘mental illness’. There is often an underpinning assumption that if such things can be found, we will eradicate them, the genes, the carriers, the ‘bad’ foetuses. In my book that’s eugenics. (I’m not anti-abortion by the way or condemning individual decisions about terminations, it’s the broader, unrecognised societal views that I’m saying are not questioned).  Didn’t eugenics die out with the Nazis? No. And it’s not just the domain of the far right, do a search around modern eugenics and you’ll find plenty there. I’m hoping you’ll find it chilling. I do.

We still, as a society, think of those ‘other’ people with characteristics, behaviours, ways of organising thoughts and experiences, as ‘flawed’. Intergenerational shame was (is?) an explanation. Or how about genetic flaws? I heard, about 10 years ago, a senior medical professional declare the view that the explanation for there having been three psychiatric hospitals built around Bridgend was that this was to meet a need generated by a flawed local gene pool. Seriously. As far as I can see there hasn’t been much of a sea change to counter such views.

I hear quite often references to people’s ‘condition’; sometimes there is a reference to someone being a ‘service user’ – a code quite often for ‘difficult’, a way of saying it’s them who is at fault because they are (lowered tone) mentally ill. Not us for having a closed mind, for not being able to manage the discomfort of difference, of challenge to our cherished views.

Many people who use, willingly or otherwise, mental health services have had very difficult life circumstances. Sometimes they, and services, know what these are, sometimes they don’t. Sometimes it is more a case of a slow accretion, many compounding experiences. We know this statistically. We know it anecdotally, we know it empirically. But then there’s a gap in our thinking. We don’t seem to think “How can we adapt ourselves, our views, our ways of working that acknowledges that range of experiences, those various views and understandings of life in order to best share power, to best truly design services with citizens and service users. We say: to join us in our territory you must behave like we do, you must follow our codes (which by the way include the view that you are other, inferior, flawed, suspect). We offer training to ‘them’. Training is very good, personal and professional development is very good; but for all of us. Some people might need to skill up in one area, some in another, whoever they are; everyone brings something of value that others can learn from. There doesn’t, however, seem to be a view that there is a need, let alone a joy, in learning and developing together. There are a bunch of people who are seen as deficient until they know how to play the game. (Then they’ll be seen as a-typical).

Too cynical? Maybe. Let me know some stories to uplift my sometimes jaded optimism.

So, then, to move toward power with? Well first, like that old light bulb, we all need to really want to. And then we need to let go, to feel the discomfort and fear and, together, do it anyway.

Written by Jane Cooke in her capacity as a counsellor and psychotherapist, trainer and facilitator. All views are entirely her own. Email jane.cooke@heartfeltwork.co.uk

Power and participation Part 1

by Jane Cooke

I have been thinking a lot about power recently. Often my trains of thought are prompted by consideration of personal power. Some people assume that they have personal power and that seems to prompt a response in others that confirms this; other people defer, give away their own power. I am not sure that this is good for anyone, but I see a lot of it. Then I wander off into thinking about structural power. Who, as a result of the position that they hold in an organisation, has the power to require or demand certain actions and responses from others?

My experiences over the years have ranged from working with groups and networks of people who use/have used mental health services to working as a counsellor for a year in a prison, to being involved in reviews of NHS mental health trusts. Throughout all of these experiences there has been a theme; that many people, no matter what their position, feel that ‘The Power’ lies elsewhere. Someone else, some other group of people or some structural body, such as a Committee somewhere has ‘power over’ services, chief executives, service users, or the ‘power to’ concede or deny, for example, a place on a joint committee or board, or to close a service or to require that changes to working practices are made, to give or withhold funding or services.

The ‘power to’ sense that individuals and groups of people can take on board themselves seems to be dimmed right now. People working in services who would like to question views and cultures in their services can feel as if they had better not stick their head above the parapet. Organisations can feel limited in their capacity to explore and support challenging ideas (and people!) if they feel that a funder ‘won’t like it’. People who might coalesce around some form of collective action, identity or pressure group can feel that such actions might jeopardise their chances of making progress in the situations where they are involved, or participate.

This feeling that some OTHER has ‘power over’ or ‘power to '(do unto us)’ both stems from and leads to fear – fear of censure, or public criticism, of withdrawal of something valued, of negative comparisons. We live in an age that generates and feeds on fear. Our many forms of communication can spread and heighten fear. Much advertising is based on promoting fear, if you don’t buy this product whether it’s insurance or some sort of ‘germ’ killer, you will be endangering yourself or those you love. Much news coverage is based on fear and a lot of political policies and promotion major on fear; capturing media interest as they do so.

But what if we moved toward a conception of ‘power with’? As far as I know these ideas of power over, power to and power with originated in the peace and non-violent direct action movements. I find them very helpful. So; power with, what would that look and feel like? I wonder if people who are involved as citizens or service users in formal situations, committees and boards, feel as if they are in a ‘power with’ situation? I’d be inclined to imagine that often they don’t. It would be really interesting to hear from those of you in such situations. Do you feel as if you are truly sharing power and if so, what leads to and supports that? In my own experience, which goes back nearly 30 years, people in these situations have been asking for parity in one form or another for at least as long as that: receiving minutes in time, important paperwork circulated in a timely manner, acceptance that agenda items can be added, access to administrative facilities as a right, recognition of the representational time-frame required if people are to be ‘representatives’, meetings at a time and place accessible to all who want to and maybe have been elected to, attend, out of pocket expenses met in cash, broadband and Information Technology (IT) costs met. I would be very interested to hear of examples where there has been ‘up-front’ thinking around these issues before people are invited to the table, before it has been brought up by those ‘reps’, or equally current examples of representatives still finding themselves in these situations.

‘Power with’ requires a shift of mind-set. Power over might appease an ego, I would venture to say that it doesn’t do much good for the soul.

Look out for Part 2 of Jane's piece on Power and participation soon. What are your thoughts? We would like to hear from you. If you have any comments or questions just add them below.

Written by Jane Cooke in her capacity as a counsellor and psychotherapist, trainer and facilitator. All views are entirely her own. Email jane.cooke@heartfeltwork.co.uk

My Recovery

This week we feature a blog post by a new guest author from South Powys. The author writes about the impact of creating art on recovery from heroin addiction, and the invaluable support provided by a number of organisations, including Brecon & District Mind.

I am 49 years young and about 3 – 4 years ago I tried heroin. I had never done any kind of drugs until then and because of the circumstances and one thing and another I got hooked on heroin. It is all true what they say about it, it’s so addictive you would not believe. I would not want my worst enemy to try it.

Anyway back to my journey.

It all started about a year ago. I was told by a friend to “go to Kaleidoscope, they can help you”, so I did. When opening the door of Kaleido I did not know what to expect. I was shocked, it was friendly and had a good feel about the place, not what I thought it would be like.

Anyway, I made an appointment. The first meeting you have is to discuss your addiction and how best to deal with it. After that you have an appointment to see a doctor. Then you have a chat and they will tell you how much methadone to put you on. I started with 50mg which took away any kind of cravings for heroin, gear, brown, smack, whatever you want to call it.

Then it’s back to Kaleidoscope to arrange courses and other things you may be interested in. At the first meeting there were about nine people all with different addictions. A few people I knew, which was good. Did not make me feel as nervous as I may have been. The course was a varied amount of topics. By the end of the course I felt good and more to the point looked good (LOL). And life was starting to look good too.

While on this journey of mine, I was living in sheltered accommodation through Gwalia. They have helped me with items for the flat, trips away for the day and just a chat. I was told about a place in town that would be good for me. So I went, it is called MIND, and that is where I met two painting artists. They got me painting and now I have won competitions and other things with my art work. I do watercolours mainly, I like working with this medium.

So it was thanks to everyone from Gwalia and Kaleidoscope for getting me involved with these activities. Otherwise I would never have known that I had a raw talent for painting, which was a shock to me because I could not even draw before let alone paint. So, just proves that it is worth going to activities and things with Kaleidoscope, Gwalia and Mind.

Even though I was taking my medication there were a few times that I was tempted to have a smoke as they say. Then I think back to how it was when I was on heroin. The sleepless nights, the stomach cramps, sweating and feeling like shit. So you could say that sometimes I do struggle with my addiction. Sobriety can seem like an impossible goal. But with the treatment and support that Kaleidoscope gave me, by addressing the root cause of my addiction - the road to recovery often involves bumps, set backs - but by examining the problem and thinking about change I was already on my way.

Another thing I thought about was the cost and how I looked when I was taking the drug. And believe me I could not believe what I looked like and when people found out I was on drugs, they would not talk to you or give you the time of day. That felt bad.

Addiction affects your whole life, relationships, health, work and psychological well being. And the ways to handle stressful situations.

The other good thing about my recovery is that I was taking a small amount of gear. Because the longer and more intense the heroin use, the longer and more intense the treatment will be. But regardless of the length in weeks, months or even years, the follow up care is crucial to the recovery. Another thing I did was not to bother with anybody that is on drugs. To stay away from some of the boys I used to smoke with. And I do not drink any more. That was down to heroin. Made me sick if I had a drink, so good in a way. I don't even like the smell of beer at all.

One of the main things that has helped me is my art. I paint every day without fail because I love it. Never knew how painting can bring back and raise so many emotions. So I look at life differently now.

Also I would like to say that the staff at Kaleidoscope are an invaluable asset in my recovery. I was very reluctant to turn to my family for help, because I felt I let them down before, so it can be hard. But remember, there is help out there no matter how you feel. Or think that the whole world is against you. All you've got to do is believe. Who knows, maybe you will find you have a raw talent. There are some of my mates that are helping me get back to some kind of life. Some of them know what it’s like to be where I've been, so that can be a great help.

Back to my recovery. Like I said before, I was with Gwalia who helped me get off the streets. You would not believe the help and commitment these people have doing their job. They helped me no end. That is why I have got where I am today. Because of the staff there and other bodies that have helped me.

After discovering this talent for drawing and painting I have not stopped. I am always out walking to see what catches my eye to paint. I can't describe the feeling I get when painting but it’s a good one, and I get lost in my artwork. I spend a lot of my time at my painting table. Well happy.

Without Mind and the staff there, I would never have been able to get where I am today. The staff at Ty Croeso (Brecon & District Mind) are brilliant and friendly. You just feel welcome, safe and at home there. Everybody is brilliant. So thanks to the staff at Mind.

So my recovery journey to now, you would not believe. The transformation from me being a smack head to now an Artist. I owe a lot of it to Kaleidoscope for getting me where I am today with the art and recovery. And the staff of Gwalia and Mind.

So a big thank you to everybody.

I hope your recovery journey is as eventful as mine.

Once again. Thank you all for helping me, on my recovery journey.

You will never know how much you have done for me.

Many thanks to our guest author for writing about a very personal recovery journey. If you want to tell us about your experiences you can comment  below.

Finally receiving treatment - a personal view

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Art in Brecon 2014

This year sees the fourth Art Fair in Brecon. It is a time when both professional and amateur artists, along with groups from Brecon and District Mind, come together in St Mary's Church in Brecon to each have a stand and display their work. This year’s fair takes place on Thursday 16 (6 – 8pm), Friday 17 (10am – 4pm) and Saturday 18 October (10am – 4pm).

We talked to Sue Hiley Harris, a professional sculpture weaver, who has been involved with organising the Art Fair since the first one in 2011 and will have a stand.

Whose idea was the Art Fair and how did it evolve? Tell us more about the early years.

The first art fair came about when some of the members of Brecon and District Mind (then Brecon and District Contact Association) approached me – as chair of the Friends – to see if the Friends could help them sell their art and craft work. We decided rather than an exhibition we would have a fair where each artist would set up their own stand and be there to talk to the public about their work. There are quite a few professional artists in the Friends and they were happy to get involved. The church was prepared for us be there and to rearrange the seats.

Gleanie II by Victoria Keeble

Is it different this year?

It is on for longer this year. Previously it opened on the Friday evening and was open all day Saturday. This year we were trying to avoid opening on the Friday evening as it clashed with a lecture on art in Crickhowell. I sent a message to the artists and the majority opted for an extra day. It is generally thought that it is a lot of work setting up so it would be good to stay open for longer. So this year we open on Thursday night with wine and jazz, and then will be open all day Friday and Saturday. It is then all hands on deck as we return the church ready for the Sunday morning service. The church has been very supportive.

Another first this year is a raffle. The artists have been asked to contribute and by the sounds of it they have been very generous. 

Allotment Retreat by Veronica Gibson

What do you feels works so well about the Art Fair?

I really like the mixture of professional artists, amateur artists and artist groups that all exhibit together. Contacts and friendships are made. To me this is one of the most important outcomes of the fair. We also have other people, Friends and members, coming in to help – either with the setting up or to give look after stands so that the artists can have lunch or take a break. So generally I would say a sense of community makes it work so well – and of course there are a great number of art and craft work on display and for sale.

Dragon by Anna Lawday

What do you get out of the Art Fair by exhibiting?

I really like to exhibit my work locally and it is an opportunity to see people I might not have seen for a while and introduce more people to my work. I often exhibit abroad or in other parts of the country but I do like to see how people I know react to new work. This is a really nice, safe, unpressured place to do that.

What will you be showing this year?

I am working on new work that is not really in a state to show so I have decided to do something different this year. I received an Arts Council of Wales ‘Creative Wales Award’ last year and my work is definitely changing. I will be showing some life drawings and collages, which has been a very new direction for me. I don’t have my new woven work ready for show so have decided to show a selection of my small woven sculptures from the last fifteen years in what I have called a ‘table retrospective’. Some weavers were at my studio for a visit a few weeks ago and I got out some of my early sculptural pieces. I decided that it would be good for me and for others if I had a little show of these works alongside the drawings. I will also be happy to talk to people about my new work and the direction it is taking me.

Artist Veronica Gibson teaches art classes at Brecon and District Mind. 

Here she is at her stand at last year's Art Fair, with Dave Griffiths, 

one of the members of the Art Group at Mind.

Art Fair Launch: Thursday 16th October 6-8 pm at St Mary's Church, Brecon.

The Art Fair will be opened by Philip Bowen, High Sheriff of Powys, and the Charles Castle Three  (Mike Chappell, Bert Morris and Mike Jones) will be playing live.

The Art Fair will also be open on Friday 17th and Saturday 18th October from 10am to 4pm.

You can find out more about Brecon and District Mind here.

North Powys Crisis Resolution Home Treatment Team

I first wrote about the introduction of a Crisis Resolution Home Treatment Team for North Powys (Montgomeryshire) in February 2013 (Home Treatment Team for the North) when Mike Shone unveiled the plans for the new team. Earlier this month I met with the team’s manager, Graham Batha, and asked him for an update about the service.

Tell us a bit about your background

I am a registered mental health nurse, and have been registered in this profession for approximately 10 years. I trained at the University of Central Lancashire, and then worked in Preston in an acute inpatient setting before moving to the Preston home treatment team. I later went on to work within the Wrexham home treatment team before moving to this post as the team manager for the Crisis Resolution Home Treatment Team in April 2013. My professional interests include service user involvement in the development of services, and professional education for students.

Tell us more about the service

The CRHT in North Powys opened in May 2013. To date we have received 419 referrals into the team, and our service is open 7 days a week, from 9am to 9pm Monday to Friday, and 11am to 7pm at weekends and Bank Holidays. The objective of the team is to provide an equal alternative to inpatient care, and to facilitate early discharge from hospital when it is safe to do so.

What staff roles do you have on the team?

The team consists of one team manager, one team secretary, one health care support worker and six registered nurses. The team is also having an additional 3 members of staff in the future. The team is also supported by a dedicated Consultant Psychiatrist.

Who can refer people for the CRHT service?

The Community Mental Health Team can refer people into our service, during the hours of 9am to 5pm. Out of hours, the CRHT does accept referrals from ShropDoc, which is the out of hours GP service.

Can people of all ages be referred?

We look after people aged 18 or over with a functional* illness.

What happens if someone experiences a crisis outside of your usual hours?

It can be useful to write a contingency plan with your care coordinator (if you have one), which can be used to highlight what needs to happen in an emergency. I would suggest that you contact your on call GP or in an emergency attend your local Accident and Emergency Department.

What is the nature of the service provided by a Crisis Resolution Home Treatment Team?

The CRHT is a short term but intensive service. The team visits service users on a frequent basis, up to twice a day, providing the same service as you would receive in hospital. When someone is referred into the CRHT team, the team will arrange an assessment as soon as possible. The team will then develop a care and treatment plan with that person, with the aim of supporting and aiding recovery. 

How do you promote a person’s recovery?

Twice a week, the whole team meets in a confidential environment to discuss each person that the CRHT is caring for. This allows the team to do its very best for the people we care for, and to support recovery in a timely manner. People who have used our service have been positive about their experience with us. The team does share the entire CRHT caseload, and people who do use our service can see all members of the team.

As a relatively new service in North Powys, how has the CRHT impacted on provision of mental health services generally?

The CRHT has had huge benefits in supporting those who really don’t want to go into hospital, and would rather stay at home. The team does, however, understand that sometimes hospital is necessary, and the CRHT will try to facilitate an early discharge with our support at the earliest opportunity when it is safe to do so.

Are there any specific needs that can be well-addressed by the CRHT?

The CRHT can help with practical issues such as housing etc, and will do all they can to ensure carers are supported.

Do you refer people on to other services?

When someone has recovered in the CRHT, their care is either referred on to additional mental health services or another appropriate service, or their care is handed back to the GP. In all cases the CRHT writes to the GP to ensure that the GP is aware of our intervention and any changes we may have made to the person’s care or treatment.

What are the challenges for a CRHT in a large rural area like North Powys?

The distance of travel that is required within this area is a challenge for the team, but it does not cause us too many problems once you become familiar with the area.

What are the most rewarding aspects of the work you do?

For me it is rewarding to see people recover at home, within a familiar setting, as opposed to a hospital setting. I feel that you are able to work with people more creatively and independently at home, as hospital can sometimes be restrictive.

How would you like to see mental health services developing in North Powys in the next few years?

From the view of the CRHT we would like to help and support more people to recover at home. We understand that hospital admissions will always be needed at times, but if we can reduce the stress of going into hospital for the client and their family, this may limit the amount of time it takes to recover.

Many thanks to Graham for the update. If you have any queries relating to the Crisis Resolution Home Treatment Team in North Powys, you can comment below.

*This term is defined online on an NHS jargon-busting website: "A term for any mental illness in which there is no evidence of organic disturbance (as there is with dementia) even though physical performance is impaired".