Powys Patients’ Council - Growing a Garden

"Time and activity in Nature is good for us."

by Owen Griffkin, Powys Patients' Council Facilitator

One of the requests that comes up regularly when we hold Patients’ Council sessions on the Felindre Acute Mental Health ward in south Powys is gardening activities. Unfortunately until recently this has been difficult to organise due to health and safety reasons but we have been speaking to the occupational therapist on the ward, Millie Griffiths, about ways in which this could be provided.

I am a big believer in the power of gardening to improve mental and physical health and advocate for people to use ‘The Five Ways to Wellbeing’ to do this. In my view it helps you achieve all the goals in the Five Ways, (be active, take notice, keep learning, connect with others and give). It’s a skill that people can take with them when they leave the ward, and maybe join one of the many local groups to help their recovery. At the bottom of this article I have listed some local groups you can get involved with.

This is why we have been so keen to see activities on the ward, and we are delighted that Millie has been working hard to get regular gardening sessions on the ward recently. We asked Millie to give a quick overview of what they have been doing. 

MIllie Griffiths — Mental Health Occupational Therapist

In June 2020 there was an enclosed garden situated between Felindre Ward and Defynnog Ward which was unused. 

The old garden

We had no gardening group on the ward and research published in the Mental Health Journal has shown gardening as being able to “reduce stress and improve mood with a reduction in symptoms of depression and anxiety,” (Thrive - a charity that has been using social therapeutic horticulture and gardening to change people’s lives since 1979). You can read more about why gardening is good for your mental wellbeing on the Thrive website.

Using Sir Captain Tom Moore Covid funds we were able to purchase planters and a plastic greenhouse which has enabled us to facilitate a gardening group for patients on Felindre Ward. We have been able to grow vegetables which we have then used in cooking groups, as well as flowers. This has enabled us to promote healthy living and spending time outside, as well as providing patients with a better outlook when they look out of their window.

From garden to kitchen!

On the ward we have weekly patient meetings, as well as fortnightly Patients' Council meetings, where it has been frequently suggested by patients that we have a gardening group. Due to the expression of interest, unused space, and research into gardening and mental health, we set up the group. I am not a gardener, nor do I know much, however through the use of Google, books and other staff/patients’ knowledge we have been able to set up the group which we hope to continue to develop to create a space patients can enjoy.

Community gardens across Powys

If you would like to get involved in a gardening project near you here are some you can try out:

Brecon & District Mind's Green Minds Project in Brecon Cathedral and other areas in South Powys.

Read more about this project on our separate blogpost - Green Minds Ecotherapy Project - South Powys

Photo credit: Laura Tranter

Llandrindod Community Garden/Transition Project - Runs a community orchard/pomarium and food garden as well as holding regular meetings to improve sustainability in Llandrindod Wells.

Newtown - Cultivate: Cultivate is a cooperative, run by volunteers and employees who are dedicated to supporting a resilient local food economy.

Newtown - Ponthafren: Regular gardening activities - details on their new activities calendar.

Ystradgynlais - The volunteers will be returning to the community garden project that was on the hospital grounds very soon. Watch this space, or keep an eye on local bulletins, for more info.

Machynlleth - Gerddi Bro Ddyfi Gardens provides and promotes a therapeutic community wildlife garden for all people in the Bro Ddyfi area, and especially those at risk of social exclusion. They will be restarting activities after a Covid break soon.

We would love to hear what you think about the benefits of therapeutic gardening and if you have joined in any of the activities at these community gardens. Comment below and also suggest other gardens you know where people could volunteer.

A peaceful patio at Felindre Ward

Welsh Three Peaks challenge: raising morale, money & mental health awareness

 

Jamie Love works for the Newtown-based yacht company Makefast as the Health, Safety and Facilities Manager. Earlier this month he and 23 intrepid colleagues decided to take on the Welsh Three Peaks Challenge to raise money for three nominated charities (raising more than £3,500 so far), one of which is the north Powys-based mental health charity Ponthafren Association.

After spotting details of their adventures on social media, we decided to find out more about the company’s motivation in taking on the challenge, and what they learnt from their experience.

Jamie Love, Makefast's Health, Safety & Facilities Manager

First of all, what is the Three Peaks Challenge?

There are three different Three Peaks Challenges – a national one, a Welsh one and a Yorkshire route. We decided to take on the Welsh challenge which is ascending Snowdon, Cadair Idris and Pen y Fan in the Brecon Beacons. These are the highest peaks in Wales and include a total walking distance of 17 miles (27.4km) and an ascent of 2334 metres (7657ft). We talked about doing it in 24 hours.

What inspired you to take on the Challenge as a group of work colleagues?

After joining the company in October 2020 as Health, Safety & Facilities Manager I realised that because our staff are split between 2 buildings, there was an opportunity to bring people together and connect on a personal level as well as through their working day.

It was all about trying to find an event to get everyone together and this seemed to meet the bill. People have different fitness levels so there was definitely that sense of connection that you get with people supporting each other.

Llyn Llydaw on the route up Snowdon

Did you do much training prior to the Challenge?

As a runner myself I already take part in a lot of different events as do a few of my colleagues. However, the group was predominantly made up of people who went from doing nothing to doing some serious training for the Three Peaks.

Staff members trained at weekends and evenings, mainly by walking. We started initially in November 2020 when the Challenge was first announced. Training really picked up around March this year and when the weather started to improve, and the days were longer, we were able to get out even more.

It brought a lot of families together during the period of the Covid lockdown. People took their kids out walking and explored places that were local to them that they hadn’t seen before.

Tell us about the Challenge. How did it go?

It was hard work! It was really really good though! We set off at 6pm on the free coach (with driver!) provided by Tanat Valley Coaches and headed up to North Wales. Immediately as we started up Snowdon you could see groups forming of different people. Some were faster and headed off ahead with the slower groups at the back with a back marker.

The weather was quite bad - heavy rain and strong winds. Plus, the first ascent was through the night! But we made it! We finally finished at about 2.30am and were back on the coach for something to eat and drink before heading straight down to mountain number two - Cadair Idris.

Success on summiting Snowdon! 

On arrival at Cadair Idris the weather was even worse – the wind was more intense as we set off at 3am. Cadair Idris is not as high as Snowdon but a longer walk and definitely more challenging. It’s a lot more demanding on your body and we’d already done Snowdon. We picked up a few injuries along the way - people’s knees were aching by this point and some had blisters.

We arrived back at the bus after a successful climb and at 9am the driver took us straight down to South Wales to complete Pen Y Fan. Luckily the weather had eased off a lot by then. There was hardly any rain and it’s a bit easier – more of a steady walk. We took the route up from The Storey Arms and headed up over Corn Du to the summit. We talked a few strangers into sponsoring us up there and then took a different route back down to finish at 3.30pm. I had my dog Gilly, a springer spaniel, with me all the way – she runs everywhere with me!

Even with the travel back up to Newtown we’d completed the Welsh Three Peaks Challenge in 23 hours in total. One of the group needed help coming down from Cadair Idris having injured their knee but everyone else made it. Back at base at Makefast we enjoyed celebratory drinks and a hog roast, and handed out medals and certificates.

What was the most challenging part of the Challenge?

Probably Cadair Idris was the hardest part – it was definitely the longest. On a good day it’s one of the best walks to do as the views are amazing. But the weather and the time of day made it the hardest of the lot. Everyone would probably agree – people were cursing me for dragging them out! But at the end everyone was really proud of themselves for completing the climb.

What was the most rewarding part of the Challenge?

For me it was getting off the bus at the end and seeing everyone really happy and positive about what they’d done. Even though there were complaints of sore bodies and tiredness there was no one without a smile on their face.

Now I can see people round the factory walking past and talking to each other where before they just walked past and paid no attention. The Challenge definitely had the effect I wanted it to in bringing people together. Even people who didn’t take part played their part by talking about it and getting involved in it.

They made it! The summit at Pen y Fan

How did you choose the three charities that would benefit?

All three charities were chosen by the people taking part in the event whose lives have been affected in some way and helped by these charities.

Macmillan - a lot of people in the workplace have been affected by cancer – either themselves or their loved ones.

Designability – they make powered wheelchairs for physically disabled children. A small charity that played a big part in one of the team’s lives.

Ponthafren Association – I wanted to do something for a mental health charity. The whole challenge focused around mental health and wellbeing – bringing people together and lifting morale. I’m a mental health first aider – I was in the army and dealt with a different side of mental health in the forces. It’s a huge part of my life and something I’ve been conscious of through my whole working career from the age of 16. Ponthafren being local - and knowing the work they do – it couldn’t have been a better choice for me.

What was it like taking on the Challenge as a large team group?

Harder than I thought! When I first had the idea I thought it be easy – a walk in the hills for few people.

But there was a lot to think about - like making sure people had the right type of kit to cope with the different weather conditions. It was making sure people were aware of that, and checking they had the right food and nutrition.

I gave myself plenty of time to organise things which was good. And I couldn’t have asked for more support from Makefast. All the directors supported us all the way. They paid for all the food and the medals. They did so much.

How does taking part in a Challenge like this help reduce the stigma regarding mental health in our community?

When we started planning we asked people which charities they’d like to support. Many were not aware of Ponthafren. Once you explain it to them it leads on to more conversations about mental health.

Also people realised that doing something can help them feel proud of themselves. Suddenly they’re all talking positively and they know they can talk about mental health. I had my GoPro camera on for about 80% of the walk. Listening back there were lots of conversations that revolved around mental health. People realised that they can talk and that people will listen. It doesn’t need to be a trained counsellor you can talk to anyone about mental health. It’s helped a lot in that way.

What impact did taking on the Challenge have on your own and your colleagues’ mental health & wellbeing?

For myself it made me realise that I can do more than I thought through organising things, by bringing people together. I felt really good about myself. Doing something for so many people.

Everyone else has realised how much of a benefit getting outdoors helps. Lot of people have taken time out for themselves this year which has really benefitted them. Taking just half an hour a day to yourself can really help. You don’t have to shut yourself away from your family you can go for a walk. That’s all we really did was go for a walk.

Do you have any tips for other organisations or companies planning to take on a similar challenge?

Do it! Just don’t think about it. Just do it. Pick a challenge. Set a date. Go for it!

We’ll be doing something every year now with a focus on mental health.

I’ve had a few ideas about possible walks / challenges / camping trips / boat themed ideas to tie in with the company’s work. And we’ll be working on it for 2022’s challenge. So watch this space!

Big thanks to Jamie Love for telling us all about Makefast’s experience taking on the Welsh Three Peaks Challenge. You can still donate on the Makefast Sponsor Me page and see more photographs on the Makefast Facebook page.

Managing mental health as lockdown restrictions ease this summer

It’s officially summer and we’re easing out of lockdown and into ‘normal’ life. But if you need help managing your mental health and wellbeing during this period of change, you’re not alone, as the SilverCloud Wales Online Cognitive Behavioural Therapy (CBT) team can explain.

SilverCloud Wales is an Online CBT service designed to help people aged 16+, experiencing mild to moderate anxiety, depression or stress, manage their mental health and wellbeing.

CBT works by encouraging you to challenge the way they think and behave so you’re better
equipped to deal with life’s problems.

There’s no need to be referred by a GP – you can sign-up for and access SilverCloud Wales anytime, anywhere, on your smartphone, tablet, laptop or desktop computer.

SilverCloud Wales is an NHS Wales service, run by Powys Teaching Health Board, and offers help for anxiety, depression, stress, sleep, money worries and more.

Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive fortnightly feedback from a qualified SilverCloud Supporter, one of the mental health professionals whose role is to support users of the service.

SilverCloud Supporter Alexandra Birrell, explains why, if you need support managing your mental health and wellbeing, particularly with anxiety, as lockdown restrictions ease this summer, you’re not alone…

“The past 15 months have been unprecedented. None of us have ever experienced anything like this so no-one could have possibly known what to expect.

“At the core of anxiety is often a difficulty in dealing with uncertainty, and at the core of low mood is often feelings of powerlessness and lack of control.

“We were instructed to stay home, which impacted our interaction with our social support networks, which usually serve to protect us from difficult feelings. However, 15 months later and for many these conditions have become the new normal. Now, being able to venture out of the house and managing social interactions is what brings up feelings of uncertainty.

“Of course, people will have different feelings about this, depending on their situation.

"Some people are naturally cautious whereas others are embracing the opportunity to reconnect with loved ones. The difficulty is that these differences in boundaries are now something that we must learn how to communicate and navigate.

“The way that people navigate boundaries is often related to their self-esteem. People who struggle with their self-esteem tend to wonder whether their needs are important and may struggle to communicate them. If we struggle to communicate our needs, our needs may not be met which can then confirm the feeling that one’s needs are not important.

“SilverCloud Wales users choose one online programme to complete over 12 weeks, with fortnightly feedback from a SilverCloud Supporter. SilverCloud Supporters can give users access to additional modules if we feel they need more support in certain areas. The Communications and Relationships module is a popular one…

“The Communication and Relationships module starts out with a quiz to identify your unique communication style. For example, do you see your needs as more important, of equal importance, or less important than the needs of the people around you? Do other people know what you want and need?

“If you are struggling with communication, it may be that over the years you have learned to communicate in a way that is either too aggressive or too passive to get your needs met. This module offers support and advice around learning to communicate in an assertive, yet respectful way. It also focuses on strategies that may support you in improving the relationships in your life and making sure that you have a healthy support network to lean on when you start to struggle.

“The Self-Esteem module is another one that clients find useful and relevant to their experiences. This module looks at ‘self-talk’ - the way that we speak to ourselves.

“When we are struggling with low mood or anxiety, a common symptom is negative self- talk. We may find that we tend to berate ourselves or judge ourselves in a way that we never would with a loved one who was struggling. The Self-Esteem module offers support around building a practice of self-compassion by learning to offer ourselves kindness, support, understanding and tenderness rather than beating ourselves up, which only serves to make us feel worse.

“If we can improve our self-esteem and our belief that our feelings and our needs matter, this can also support us in navigating these end of lockdown boundaries with the people around us.

“The Relaxation module features a number of exercises that can be really beneficial. Users learn helpful relaxation techniques that can be used in day-to-day life to unwind and de-stress…

“In order to change longstanding habitual patterns or tendencies, we have to be able to slow down enough to notice those patterns. Many people struggling with anxiety feel that their mind is running a mile a minute, and that one thought seems to lead into the next which leads into the next and so on. These worries may be paired with physical sensations of anxiety such as a racing heart, difficulty breathing or a tight chest.

“When practising relaxation, many people report that as their body returns to a state of rest, their mind will slow down as well. It is from this place that we can catch what difficult thoughts are coming up, notice those patterns so we can start to challenge and change them.

“My advice for maintaining positive mental health and wellbeing for people trying to adjust to the ‘new normal’ over summer is…

“Each person will need to weigh up how they feel about the restrictions lifting and what is most beneficial for their own mental health. For some, seeing their loved ones will be supportive, whereas for others it will be a source of stress and will bring up feelings of awkwardness when trying to communicate this.

“Often, people find that their mental health starts to spiral and they don’t understand why it’s happening - they just know that they’re feeling increasingly distressed, low, or anxious, or a combination of all of these feelings.

“CBT provides a framework for understanding how some of the natural and automatic ways that human brains and bodies respond to uncertainty can actually serve to make us feel worse. In that sense, the journey of recovery can be about learning to focus on that which is still within our control, and finding empowerment through identifying coping strategies and ways of better managing our feelings.”

ONE SERVICE - THREE WAYS TO ACCESS

1.  SilverCloud Wales – The flagship service, available across Wales. 

This is a self-referral service which means that you can sign-up directly, without having to be referred by your GP or other healthcare professional. Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive fortnightly feedback from your online SilverCloud Supporter, one of the mental health professionals whose role is to support users of the service. Find out more and sign-up here.

2.  SilverCloud Blended – A tailored version of SilverCloud for Powys residents. 

Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive six face-to-face* sessions with an Online CBT practitioner whose role is to support users of the service. To find out more and signup, please contact: Ponthafren Association covering North Powys and Brecon & District - https://www.ponthafren.org.uk; Mid and North Powys Mind covering Mid Powys - https://mnpmind.org.uk/; or Ystradgynlais Mind - https://minditv.org.uk/.

*These may be telephone and email support sessions, depending on Covid restrictions.

3.  SilverCloud Workforce – A tailored version of SilverCloud specifically for NHS staff  

     and keyworkers. 

You'll have access to four online mental health and wellbeing programmes: Space for Resilience; Space from Stress; Space from COVID-19; Space for Sleep. This is an unsupported service so you will work your way through your programme of choice on your own, at your own pace. Sign up directly for the service without needing to be referred by your GP or other healthcare professional.

Visit https://cymru.silvercloudhealth.com/signup/ and enter access code WALES2020.

For more information about SilverCloud Wales online CBT

- If you have any queries, please email Silver.Cloud@Wales.nhs.uk or call 01874 712 428.

- Find us on Twitter: https://twitter.com/SilvercloudW

- Find us on Facebook: https://www.facebook.com/SilverCloudWales

A new Powys Suicide and Self Harm Prevention Co-ordinator

Jan Roberts recently started work as the first Powys Suicide and Self Harm Prevention Co-ordinator. She previously headed up the Crisis Resolution & Home Treatment Team in South Powys which she originally joined in 2012. Jan recently spoke at a meeting with some of the individual reps who champion improved mental health services in Powys and we found out more about her role.

The new post is funded for 18 months by Welsh Government alongside three regional Suicide and Self-harm Co-ordinators for Wales. Shaun Morris recently stepped into this role to cover Mid & West Wales. The lead within Welsh Government is Claire Cotter - National Co-ordinator for Suicide & Self-harm Prevention – NHS Wales Health Collaborative. The driver behind much of this work is the government strategy on suicide prevention – Talk to me 2: suicide and self-harm prevention action plan for Wales 2015 – 2020.

One of Jan’s first tasks is to understand the Powys picture so that an intelligence led service can be developed in response to identified needs and gaps. This level of intelligence gathering and research into suicide and self-harm has never been done within the health board or the council before.

Jan is working closely with colleagues at Powys Teaching Health Board, including Andrew Mason - the Harm Prevention & Reduction Officer for Substance Misuse, and Freda Lacey - the Mental Health Partnership Officer.

Three key areas of work

1. Analysing Coroner data for Powys residents who have ended their lives by probable 

   suicide between 2015 and 2019

This provides 5 years’ worth of data to understand if there is any particular demographic, or any particular geographical area in Powys, where these suicides may have happened, with the aim of trying to target services to prevent suicides in future, and in particular looking at gaps in service provision.

Powys wavers between the highest and second highest county in Wales for suicides (taking into account population size). The initial findings are interesting as they highlight a difference from the rest of the UK in that there were more deaths in the over 60s in 2019, whereas UK wide there were higher numbers of deaths from the 35 – 49-year-old age group. It will be interesting to see if this trend is also reflected in the analysis of the data from other years.

2. Improving the support available to those bereaved by suicide in Powys

In her previous role Jan had looked for 1:1 or face to face peer support for those bereaved by suicide and discovered that the nearest available group was either Cardiff or Chester. She is now working with colleagues to consider a support pathway which starts within 48 hours of the suspected suicide.

The proposal is that individuals bereaved by possible suicide would be linked in to both the practical advice they might need, as well as the emotional support. This will be in line with the suicide surveillance work being done in both Wales and England currently, which will enable the sharing of information on deaths by suicide at the time, rather than retrospectively, thus enabling appropriate responses to need and prevention being enacted both locally and nationally.

The idea is in its early stages, but the intention is that the family or person would be offered practical and emotional support with regular check ins, where they have consented; it’s about checking in and asking what support they need at that particular time. Peer led support is another option being considered in conjunction with the voluntary sector. Health board staff and partners in the voluntary sector are receiving suicide bereavement training to better equip everyone to work together to progress this in Powys.

3. Self-harm project

Finally, Jan is undertaking a data collation project in order to build an understanding regarding self-harm and self-injury in Powys, looking at prevalence, trends, pockets of particular need, and understanding the various pathways encountered to access support. It is hoped that this data will provide intelligence that will inform service development to maximise early intervention and prevention and reduce any barriers to accessing the right support at the right time.

It is more complex in Powys because of the distance people can travel to receive support, and further complicated due to the fact there are no district general hospitals or psychiatric liaison teams in Powys. Powys residents use approximately 5 or 6 different psychiatric liaison teams if they self-injure or self-poison and seek support, two of which are outside of Wales, so data collection is a challenge.

Many studies on self-injury and self-harm focus on the data from psychiatric liaison services but it’s difficult to get a full picture. A 12-year study from Swansea University into young people under 25 who self-harm in Wales showed only 50% had ever been to a psychiatric liaison service. Jan is looking at how we can source the best data to capture the trends and areas of need.

There is also a need to understand the pathways to service provision across Powys. For example, someone may live an hour and a half away from their nearest psychiatric liaison service and have no way of getting there so they could decide not to attend. Jan will be working with patients and staff to understand the pathways to receiving the right support at the right time – what works well and what could be better.

It is important that Powys residents are offered what is recommended by the NICE (National Institute for Health & Care Excellence) guidelines: a mental health assessment, a psycho-social assessment and referral on to an appropriate service.

Sarah Dale, a mental health rep, has recently delivered some awareness training on self-injury with the Minor Injury Units’ staff which was really well received and further training is indicated for MIU staff, in particular focusing on referral pathways.

Harm reduction programme – substance misuse

Another area of work taking place is the harm reduction programme from a substance misuse perspective. Harm Prevention & Reduction Co-ordinator, Andrew Mason, is focussing on the non-fatal drug overdoses across Powys, looking to learn lessons and identify areas for improving services with the ultimate aim of providing targeted support and intervention for people.

For more information on this ongoing work please contact Jan Roberts, Powys Suicide & Self-harm Prevention Co-ordinator, by emailing jan.roberts3@wales.nhs.uk

Bereaved by suicide – support organisations & resources

Survivors of bereavement by suicide

Papyrus – prevention of young suicide

Support after suicide

Powys Cruse Bereavement Care

Help is at Hand – a resource for people bereaved by suicide

It’s Infant Mental Health Awareness Week 2021

© Daniel Thomas

The theme for Infant Mental Health Awareness Week 2021 is including infants in 

children and young people’s mental health.

The Parent-Infant Foundation says “The goal of this year’s IMHAW theme is to encourage everyone working in children and young people’s mental health policies, strategies and services to think about and include babies. Children and young people’s mental health should refer to the mental health of all children from 0-18 and beyond, but too often it is focussed on older children.

There is a “baby blindspot”. We are encouraging everyone to think and talk about infant, children and young people’s mental health, and to consider how babies’ mental health needs can be met.

We will be using the hashtags #IMHAW21 and #IncludingInfants

Early relationships influence a baby’s brain, and in particular their social and emotional development. This early development plays an important role in how well a child will go on to achieve many of the key outcomes that parents, the public, professionals and policy makers care about.

For example, babies who have had good early relationships start school best equipped to be able to make friends and learn. This increases the chances that they will achieve their potential in later life and contribute to society…..”

Here at Powys Association of Voluntary Organisations we decided to focus on sharing information about some of the key activities going on in Powys around improving infant mental health and wellbeing.

Lucy Taylor – Startwell Development Officer, PAVO

Lucy works closely with colleagues from the Health and Statutory sector under the Emotional Health and Wellbeing workstream in Powys to build a good start for all babies from pre conception onwards in the home and community up to support and health services for those who need them.

These goals sit under the Startwell element of the Powys Health & Care strategy.

You can contact Lucy by emailing lucy.taylor@pavo.org.uk or ringing 01597 822191.

© Kelly Sikkema

Jolene Duggan – Chair of the Powys Perinatal Mental Health Steering Group

“Healthy, social and emotional development during the first 1001 days lays the foundations for lifelong mental and physical health. At least 15% of children in the general population experience a disorganised attachment and this figure is higher for children facing adversity.” Parent Infant Foundation

Jolene says: “Attachment is the process, as well as the quality, of the relationship an infant forms with caregivers. Attachment can occur with biological and adoptive mothers, fathers, step-parents, grandparents and any other consistent caring person in the child’s life. A baby’s initial relationship experiences with primary caregivers creates the infrastructure for subsequent relationships, how the child views connection, how she experiences herself, and the world around her, is influenced by her early relationships. With repeated experiences of predictable care, the infant learns about trust and security. Growing up in an environment infused with safety and intentionality ensures healthy social and emotional development.

Here in Powys we are proactively trying to raise the awareness of the importance of Perinatal and Infant Mental Health by delivering the Institute of Health Visiting (IHV) Multi-Agency Champion training Programme. Prevention and early intervention are fundamental, and every professional working with families should be observing the interaction between a parent and infant.”

“It is easier to build strong children than repair broken men.” Frederick Douglass.

You can read more about the work of the Perinatal Mental Health Steering Group in our blog post: Perinatal Mental Health Services in Powys from 2019.

Mums Matter courses from Mind

Ros Sandhu is a Mums Matter Facilitator and Children & Young People Practitioner at Brecon & District Mind which offers the Mums Matter courses (as do Ystradgynlais Mind and Mid & North Powys Mind). Ros told us: “Infant mental health starts with maternal mental health, and as such it is mums who need support. In a recent article in The Guardian, Eliane Glaser put it succinctly when she wrote: “women are trying too hard and society isn’t trying hard enough.”

The Mums Matter Project aims to support mums who are at risk of, or suffering from, mild to moderate postnatal depression. Covid has left a larger number than ever of new mums feeling isolated and unsupported as they start their journey into motherhood, and in Brecon Mind we have been delivering the project using the online platform Zoom throughout the pandemic.

At the heart of the project is the idea that happy, contented, supported and confident mums produce mentally healthy, happy and secure infants and then children.

The insights of Donald Winnicott, a paediatrician and child psychoanalyst in the 1950s, provide a useful place to start the course and mums gain enormous comfort from his observations and teachings. His widely accepted theory is that mums need to learn to feel ok with being, “good enough” rather than striving for perfection. This takes the pressure off mums; none more so than mums living through a pandemic and surrounded by unrealistic images of motherhood on social media and little else! The concept of “good enough” can help to allow a greater sense of ease in their lives, which their babies will benefit from.

Winnicott also found that infants need to observe and experience the full array of human emotions within a warm, secure and loving environment. As such mums are reminded that’s its ok to be fully (at times even a bit messily) human so that their babies and children learn that it is ok to be the same.”

You can read more about the Mums Matter courses from Mind:

Mums Matter in a Changing World

Support for new mums in lockdown

A look into Borderline Personality Disorder (BPD)

© Sarah Dale

Sarah Dale

Sarah Dale is a citizen rep in Powys – an unpaid volunteer who sits on the Powys Mental Health Planning & Development Partnership to share the voice of lived experience. As a citizen rep Sarah previously sat on the Wales Mental Health & Wellbeing Forum (formerly the National Mental Health Service User and Carers’ Forum).

Sarah has also worked incredibly hard over the past few years as a regular contributor to the Engage to Change group, which is a sub-group of the PMHPDP. This group was 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 feed back on resulting change to people using services."

And during the Covid-19 pandemic Sarah has also created and delivered a hugely valuable training session on Self-Injury Awareness to many of those working in the provision of statutory mental health services in the county. Sarah is absolutely passionate about raising awareness of mental health issues and brings an honesty and openness to the work which allows greater understanding for all those watching / reading / exploring more about these issues.

© Sarah Dale

Sarah's experience of Borderline Personality Disorder (BPD)

Sarah's latest project is an indepth look into Borderline Personality Disorder to promote during Borderline Personality Disorder Awareness Month this May.

"You are probably wondering... "what is Borderline Personality Disorder? And you are not alone. This is the response I get when I tell people I have BPD, and yet I still haven't been able to accurately explain what the disorder is, and how it affects me. 

The reason you probably haven't heard of the disorder is that most people with (BPD) have experienced a lot of stigma. Often being described as 'manipulative', 'attention seeking' and 'incurable'. You have probably seen over the years, celebrities opening up about their depression, anxiety or bipolar disorder, thus more people are speaking up about their own struggles.

However, no one wants to talk about the more 'scary' or 'shameful' issues like self-injury, eating disorders, psychosis and personality disorders."

After exploring What is BPD? Sarah considers why it has this particular name, what it's like to have BPD, some of the feelings that people with BPD experience such as extreme emotional instability, fear and abandonment, and people's struggles with a sense of identity. Sarah then turns to the positive side of BPD and explores the empathy and compassion that people with the condition experience, plus an often increased creativity. To finish off Sarah debunks some of the commion BPD myths, such as that people with BPD are incurable and / or attention seeking.

You can read the whole piece, A Look into Borderline Personality Disorder (BPD), on our Powys Mental Health website.

If you have any queries for Sarah, or experiences to share, then do pop them in the comments' section below.

© Sarah Dale

Read more from Sarah

Sarah has written for this blog previously on:

The Wales Mental Health & Wellbeing Forum – an update

Together for Mental Health consultation - a Powys view

On the Experts by Experience panel

And on the PAVO Health & Wellbeing blog:

Self Injury Awareness 

You can also catch up with Sarah on her Facebook page - Sarah Mental Health Rep.

Citizens Advice Powys - supporting mental health inpatients

Yasmin Bell is the Chief Officer at Citizens Advice Powys, the charity which “provides the advice people need for the problems they face and improves the policies and practices that affect people's lives.”

The charity recently launched a new pilot project to benefit the inpatients on the mental health Felindre Ward at Bronllys Hospital in South Powys. We spoke to Yasmin to find out more about this important work.

Tell us more about the project

Owen Griffkin, the Powys Patients’ Council facilitator, and the Occupational Therapy (OT) team on Felindre Ward, had been talking to us over the last year about setting up an inpatient advice service. We want to support patients with various issues which are acting as barriers for them wanting to return home and on their recovery process generally. We will continue supporting them once they are at home.

One of the OTs said that some patients, escorted to their homes on day release, had become more anxious upon arriving at a freezing cold home and finding a huge amount of mail / bills. It’s not a very welcoming scenario!

In the long term we would ideally provide support so that people don’t go on the ward in the first place.

How does the support work?

We did a similar project on Felindre Ward about 10 years ago and staff remembered how useful that was supporting people on their recovery journey. At that time a Citizens Advice advisor from Brecon went onto the ward to see people. With Covid we are using video appointments. The ward has iPads available and supports patients to access the platform and then we take it from there.

There’s quite a lot of work we do with the team before we meet the client – every individual can be different. Some people can be uncomfortable about speaking to someone about their issues. In that case the OT will work closely with us to find out what kind of help is available before going back to the person to give a flavour of the advice that could be provided. This usually results in the person then taking an appointment and with a better insight of what help can be provided.

Some of the original project outcomes included – less hospital staff time spent on advice issues, improved patient engagement with treatment, reduced barriers to patient discharge, clients feel more able to stay in their own home and in control of their lives, and improved mental health. The support enables independence, self-management and clients receiving all benefits they are entitled to.

Why was the work of Powys Patients’ Council invaluable in setting up this project?

Owen and the PPC volunteers had been speaking to people on the ward and through this helped identify the need for a direct advice service to support people.

We’ve had a lot of positive comments. One patient said: “I had an appointment with Citizens Advice today and they were excellent. They were able to help with my pet and some money issues.”

How is the project funded and for how long?

This pilot project is funded by a recent Powys Teaching Health Board Small Grants scheme. It lasts for 4 months so will end at the end of May. Through this pilot we will determine the level of demand and the feasibility of the service.

Tell us about some of the everyday issues facing people on the ward and how your service can help?

We identified that it was particularly important to help patients report their change of circumstances with regard to any benefits. Once discharged their benefits can be reinstated with our help. Citizens Advice Powys can also take responsibility for contacting any third parties and putting a hold on any action pending, for example, debt repayments, until that person is able to deal with them. It’s also important to inform the third party that Citizens Advice is helping the person.

We also make sure people are getting all the right benefits – we carry out an Income Maximisation Check – looking at the person’s whole situation. In many cases it can be quite complex – other benefits can be triggered or stopped. We act to make sure there is no detrimental impact on the person.

What is Attend Anywhere?

That is the video platform we use – it is used by the NHS across Wales for consultations with specialists. It’s similar to Zoom or Microsoft Teams but it’s almost like an office set up with a reception, and five interview rooms. It does mean people can have a family member or support person with them in the interview. Language interpreters, including British Sign Language interpreters, can also be included as part of the free service we provide.

Has Covid had an impact on people’s concerns / issues?

There has been a huge increase in people receiving Universal Credit which is a very complex benefit – so people do need support with this. Employment enquiries have also gone up. We are encountering people who have never had to claim benefits or ever had financial difficulties before – so people could become patients on a mental health ward because they’ve never had to deal with that level of poverty before.

Issues are much more complex than they were ten years ago. For example, with a debt client, the level might be the same but the client may owe debts to numerous different creditors where previously it would have been one or two. Then there is the added issue where creditors sell the debt on and on – and trying to unpick it all is a lot of work.

Covid has also added a level of frustration through not being able to get through to departments they need to speak to like the Department for Work & Pensions and energy providers. We can help speed up the process.

We also support people on three-way video or telephone calls with the Citizens Advice advisor doing all the necessary work whilst the client sits in the call. There is no cost to the person themselves for this support.

If people don’t receive the support they need, what could happen to them?

People who have been stressed previously can feel much more optimistic and calm about the situation. Long term if we receive continuation funding we would like to start looking at whether people go back into the hospital if they have received support. If issues have been going on too long it is harder to resolve them so we want to do more preventative work, help people understand what we do and just basically say – don’t be scared about getting in touch.

If we are supporting someone with a Personal Independence Payment (PIP) claim we have to talk about their physical and mental health. We also support people through tribunals and hearings. People open up and perhaps admit for the first time some of the issues facing them which can be very traumatic for them to accept.

What are Citizens Advice Powys’s main priorities outside Felindre Ward?

It’s about early intervention, about making sure our services are accessible and available to everybody in different ways and working out the different access options. We want to build a service where we don’t assume everyone wants face to face or telephone. So we offer video also, some web chat, and contact by email. We want to raise awareness and stop people getting to really complex situations – it’s about averting a crisis.

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

This is happening more than ever before. We’re working with Accessibility Powys to facilitate appointments and advice sessions that are accessible to people with physical or sensory impairments – trying out different methods and equipment. There are a lot of people out there who, if not in receipt of this service, would not have had any advice. There are people who have been shielding and isolating who have not had any support for the past year or so.

In the last 3 months we have had a 20% increase in formal referrals (statutory and third sector agencies) and also seen a 50% increase from mental health teams. So we’ve done a lot of raising awareness sessions – every Wednesday we invite someone to come and talk to our team about the work they do which has been really beneficial – this means we can signpost to other services confidently too.

What are the main challenges of the project?

Client engagement is one of the biggest challenges generally if someone is struggling with their mental health. Sometimes people feel less anxious if they can turn their video off. So it can be small things that help. We try and think outside the box constantly to come up with a solution that works best for that person.

Some of the appointments can be lengthy so we split them into two sessions. If it’s a complicated PIP application you could spend up to 3 hours on that – so it’s managing the length of the appointment to suit the person.

Another challenge is ensuring we have all the right consent forms and paperwork completed. The OT team on the ward have been acting as our administrators in respect of these. It’s still a benefit to them though as they can then concentrate on the work they do best and leave the advice for us. It’s all about team work! So that’s a positive really!

Tell us about some of the most rewarding aspects of this project

The feedback from patients has been very rewarding: for example, one man said after receiving support he felt he was able to go home and contact the utility company and sort out the issue himself. (We would, of course, follow up afterwards to ensure it all worked out).

Knowing that people understand where they can seek help and are better able to manage.

One person was helped to reinstate a PIP claim and said of the advisor: “She was very kind, clear and helpful about my concerns. I found this extremely helpful over a subject I have been worrying about over the last years.”

When you are not working for Citizens Advice Powys how do you enjoy spending your time?

I do a lot of coastal path walking. My aim is to walk the whole coastal path of Wales. So far I’ve done a third of it.

I also volunteer as a Cadet Leader for Newtown Police Cadets and assist the cadets doing their Duke of Edinburgh Award. I recently completed my DoE expedition assessor qualification.

If you want to find out more about Powys Citizens Advice you can contact Yasmin by ringing 01686 617641 or email: manager@powyslca.org