Tuesday, 27 August 2013

Introducing Tim Skelcher of Hafal

Tim Skelcher is a name familiar to us as he was previously a DIY Futures co-ordinator working here at PAVO. Since May this year Tim has worked for the Powys Seibiant Family Support Service for Hafal in Powys, and we talked to him just as he was about to launch a new carers' group for Newtown.

Tell us about your new role
My new role with Hafal is mostly about supporting carers of people with a mental illness in Powys, through both one to one support and through mutual support through carer groups. The service provides carers with news, information and advice; as well as providing short breaks for carers through providing activity based support for those they care for, along with the opportunity to focus on recovery using goals set with either their Care and Treatment Plan or Hafal’s Recovery Programme. The other aspect of my role is representing Hafal across Powys at events and meetings.

How is it going so far?
I think it’s going well. I’ve been busy introducing myself to people who use the service, as well as to lots of agencies around Powys. I’m also enjoying becoming part of the Hafal team, and learning about what makes them so effective in Wales.

What are your aims for Hafal in Powys?
Broadly my aims are to provide support to people in Powys with mental health issues and their carers, and to help them to have their voices heard. I’d like there to be more carer groups focusing on mental health throughout Powys, as there is only currently one Hafal group which is in Brecon. I will be working towards getting one set up again in Newtown as a priority, and will follow that with other groups. I’m also working towards making the Family Support Service cover Powys more evenly, as historically it was based in south Powys, with more support being given in the south.

What do you bring to your new role from your DIY Futures experience?
DIY Futures was where I learned about Recovery. I gained a strong belief in people who feel stuck being able to take control of their lives, make changes and get the lives they want. I’ve taken this with me to Hafal, where these beliefs are shared.

Tell us about some of the highs and lows working in the field of mental health
For me the highs are mostly about seeing people make changes, that before they only hoped and dreamed were possible. Almost without exception these have been achieved by a series of small steps. Also I think it’s inspiring when people develop services to help themselves and others facing similar issues, or when they influence change in services. The lows are simply when people aren’t listened to, or aren’t valued.

Have you been inside that famous Hafal VW campervan yet and what did you think?
Yes, I was at the Royal Welsh Show with Hafal recently, and the campervan was there. It really worked to draw people to Hafal’s stall, and gave us the chance to talk to people about mental health issues who, without the campervan, we may not have reached.

Thank you Tim! The first Newtown carers' group meeting which Tim referred to takes place on Wednesday 25 September 2013, 2 - 4pm, at Ponthafren, Longbridge Street, Newtown, SY16 2DY.

You can contact Tim for further information about the new group in Newtown, or with any other queries about his new role and the work of Hafal, by ringing 07875 373525 or emailing: powys@hafal.org

Thursday, 22 August 2013

Antidepressants in the headlines again

For what seems like the whole of August so far! There are features on news sites, blogs everywhere, the radio... and people are asking questions about the continuing rise in the use of these drugs – in Wales, in the UK, in the “developed” world generally...

You can read online articles by a British GP, in The Huffington Post online newspaper and on the Mad in America blog - here by Scottish writer Chrys Muirhead.

Lots of questions are asked and the debate is fast and furious in many cases, particularly where there are comments sections following the articles. Some of the issues which have arisen include:
  • Could it be that the increase in prescription numbers is because people are often on these drugs for many months and even years, so it is the repeat prescriptions which push the stats up?
  • The medicalisation of life’s many stresses and problems may mean that people actually just require time and space, and possibly therapeutic support, to recover, rather than a (supposed) quick fix.
  • But... this leads many who have experienced and struggled with very serious depression to condemn the suggestion that this kind of debilitating distress can just be addressed with a shout to “get out and exercise,” “change your diet”, or “pull yourself together...” when some people cannot even face emerging from their bed or home for weeks.
  • There is the usual debate about “the chemical inbalance” – whether there is one or not ...(evidence being virtually non-existent so far... although we are always encouraged to look to the future and a miracle medical discovery...)
Perhaps one of the most interesting and relevant topics is – would a readily accessible and affordable talking therapy ensure an appropriate and viable alternative to taking antidepressants? Again, there is strong debate around this area – with many people insisting that drugs alone have contributed to their return to everyday life, whilst others are equally convinced that counselling, for example, is what really helped. Others wish to have access to both. And Mark Easton, in a recent BBC news story, pointed out that those areas of the UK with the lowest incidence of antidepressant prescribing do not actually have good provision of talking therapies either... so it’s a complex issue.

Here in Powys it does seem that there are issues around waiting times for counselling, with there being something of a postcode lottery. In recent years expectations have been raised around mental wellbeing, with national surveys, anti-stigma campaigns and generally increased awareness about mental health and wellbeing, with many famous people (comedians in particular, think Ruby Wax and Stephen Fry) speaking out about their distress (or various "diagnoses...").

Last week I was at a meeting of the Primary Care Mental Health team in South Powys, with counsellors and mental health practitioners (previously called mental health nurses) speaking about some of their frustrations. Generally they seem to be struggling to keep up with the increased demand for counselling, and in some areas of Powys there are long waiting lists (up to 6 months) to see a counsellor or take up another form of talking therapy such as Cognitive Behavioural Therapy (we posted about some of the issues here). Couple counselling and counselling for young people are two areas with a particularly growing demand.

Our own Powys Mental Health Information Service receives an increasing number of enquiries from people seeking counselling... Just recently I was told that there is a 6 month waiting list for bereavement counselling with CRUSE in parts of Powys (so what else could we suggest), and there is a cost implication for Relate counselling... Yet all the time people are becoming increasingly aware that they are entitled to source talking therapies through the GP surgery (see the Welsh Government legislation around this – the Mental Health Measure 2010). So... more and more people ask for help, they want it immediately, not 6 months down the line, and the GP prescribes an anti-depressant because a) it really might help and b) it can be prescribed now. Then, as in this recent BBC Wales video, people can spend not just months and years, but sometimes even decades reliant on these medications, with the prospect of painfully weaning themselves off at some point in the future or... staying on them for life, with all the mental and physical complications that this can involve...

What do you think? Are you on antidepressants? Do they work for you? Would you have preferred the option of a talking therapy? Was counselling or CBT offered by your GP, and if so could you start immediately or did you have to wait? We would be really interested to know.

Meanwhile, for a really interesting take on psychiatric medications, it is worth watching a video of consultant psychiatrist Dr Joanna Moncrieff, author of The Myth of the Chemical Cure, speaking earlier this year.

Friday, 16 August 2013

Our Chief Exec goes "Back to the Floor"

Carl Cooper, who is our Chief Executive Officer at Powys Association of Voluntary Organisations, writes a guest post about his recent experience going ‘Back to the Floor’ – an initiative where senior managers learn from their experiences of finding out how services are delivered locally on the frontline.

Counting the cost of people's involvement -
Carl settles people's expense claims
"As part of the 'Back to the Floor' initiative of Powys Local Service Board, I was privileged to spend a day with my colleague, Freda Lacey (Mental Health Participation Officer), at a national gathering of service users and carers to consider how best to organise involvement in the Welsh Government's new Mental Health Partnership Board.

The use of language was a constant source of discussion and debate. It was clear that some people identify themselves as carers and feel that this label empowers them to get services, respect and support. However, others completely reject the label insisting that they are not "carers" just because services/society want to define them in this way and challenge the label insisting that they are mothers, husbands, daughters, friends etc. Equally, some people accept the label service user for various reasons and, in fact, fight to ensure this term is kept in common use. Alternately, others completely reject the label insisting that those people that have been forced into contact with mental health services (i.e.sectioned and forcibly medicated) don't see themselves as "service users". Recipients of parking tickets don't say that they are using traffic police services!

My first impression was of the very high level of knowledge, experience and ability in the room. Participants contributed to the discussions from an informed and articulate perspective. This gave the contributions an authority and an integrity that was almost palpable.

I was a little surprised at the format of the meeting, which was formal and concentrated on papers and documents. We examined terms of reference, job descriptions, person specifications, and organisational structure diagrams. This way of working would not have been out of place in any board meeting or strategic partnership. I was expecting a meeting about engagement to be much less stuffy and much more participative. Were the organisers reverting to type? On the other hand, the commitment from Welsh Government and others to engage people came across as genuine, open and honest.

Because the day focused on processes and structures, there was consideration of reimbursement of expenses and remuneration. It was this element of the day that surprised me and caused me some concern. Everyone agreed that people that participate in engagement mechanisms should not be out of pocket. However, many viewed this role as a job and spoke of the role as 'working for the government'. As such, some felt that remuneration for participants should be akin to that of, for example, public appointments. I came away reflecting that, if not careful, we were in danger of professionalising engagement and creating an industry of 'engaged voices'. If this were to happen, we would lose the 'raw' voice so vital to decision making. Any commitment to co-production would be seriously damaged.

On a practical level, Welsh Government needs to adopt a consistent approach to how it supports people's involvement. For example, mechanisms are already in place with its Citizens Panel for social services. Should not these be applied to other arena? Developing different packages of support will introduce inequality and inconsistency to public engagement.

The afternoon session was not helped by a confusion within the group regarding how the procedures and mechanisms across Wales were meant to operate. Welsh Government officials and others dealt with this effectively, sensitively and with humility. Clearly, this will need to be addressed again when greater clarity brings about a shared understanding of how the process will work.

All in all, I came away from my 'Back to the Floor' experience having learned a lot and having been inspired and challenged by those I was honoured to meet."

We would be interested to know what you think about Welsh Government's engagement with people in contact with services. Do you agree with Carl, or do you have different ideas? Let us know!

Saturday, 10 August 2013

Unconventional Wisdom? Time To Challenge – Tackling Stigma

As the manager of a mental health voluntary service in Powys that provides a mental health information service, I am asked, in the conditions of our funding contracts, to “tackle mental health stigma”.  The dictionary defines stigma as a mark of disgrace. Goffmen defines stigma as an "attribute that is deeply discrediting".  

The Time To Change Campaign has been running across England since 2008.  It has been responsible for much activity from staff and volunteers across the country, all hoping that their efforts, attempting to tackle stigma, are having a positive impact.  You can look at evaluation reports from their work here.   It was no surprise to me when the Time To Change Campaign moved over the border, to Wales, last year.  The Welsh campaign is led by Mind Cymru, Hafal and Gofal.  

For many in Wales, this hailed a truly positive step forward, Comic Relief, Welsh Government and The National Lottery were willing to invest in mental health and stigma.  We were given a national focus for tackling stigma and surely all of those trying to tackle mental health stigma would get behind this campaign, work and stand together.  The campaigners hope that by tackling this stigma we will ensure that more people will come forward to ask for help.  In our mainstream services that often means getting the “right” diagnosis and then the “right” help based on this.

The easier path for me to take, as a manager of a service tasked to tackle stigma, would be to get in line to champion the campaign across Powys, join forces with others and together surely our efforts would have a positive impact.  However, I can not act in this way, because I do not believe that the main idea that underpins this campaign, and others like it (e.g. Saneline’s Black Dog campaign), is sound. 

So what is the bad idea that I think needs to be challenged?  Simply this, the mainstream idea that mental illness diagnoses are valid.  These campaigns use the terms “mental illness” as if diagnosis is the truth for understanding our behaviours, misbehaviours and distress.  The campaigns aim to see “mental illness” normalised and seen in the same way as physical illness.  This very statement implicitly indicates that the same evidence underpins a mental illness diagnosis as, say, a cancer diagnosis. 

My challenge to the idea of "mental illness" as a valid diagnosis comes in the form of the ideas of Thomas Szasz and his articulation of them.  In my opinion his arguments are based on logic and reason and I can never hope to articulate his ideas better than he.  You can access lots of videos of Thomas Szasz via the Internet, but here are two to get you started, should you be interested. 4 minute video highlighting a series of statements that summarise his position here and secondly a 5 minute video where he shares his opinions of diagnosing children with “mental illness” here.

As well as underpinning it's campaign with the idea of "mental illness", Time To Change uses the approach of statistics that tell us things like - 1 in 4 of us are effected by mental health problems.  In Powys, last month, this approach was challenged at an event, as one that in fact increases stigma, by reinforcing otherness.  Melanie Santorini from the Campaign led a discussion in response to this challenge and there seems to have been some agreement there that perhaps a message of “it's not 1 in 4 it's everyone!" would be more useful.  

Whilst I agree that yes potentially “all of us” could find ourselves experiencing mental distress and exhibiting behaviours that could be perceived as symptoms of “mental illness”, I do not think that all of us, or any of us for that matter, could have a "mental illness". 

All of us are living.  All of us will face things in our lives that are challenging to us (e.g. bereavement, sexual abuse, divorce, redundancy, becoming a victim of crime, illness).  Depending on our life experiences to that point, we will respond in different ways to the challenges that we face, and indeed in different ways depending on the timing of these challenges.  For some that response may be hearing voices, for some it is extreme and debilitating sadness, for some it may be behaviours that challenge our place in “normal society”. So I too would challenge the bold “1 in 4” type statements that many of this type of anti-stigma campaign use because I think these statistics are misleading.  They do not challenge us to understand that any of us, at any point in our lives, could find ourselves struggling to cope and that in response to this we may find that our emotions and actions fall outside of our current society’s understanding of normal behaviour.

And of course society's and individuals' understanding of normal behaviour changes all the time.  For example, I wonder whether I would have accepted a diagnosis of “Female Hysteria” as an illness if I had lived 100 years ago and how I would have responded myself to a women exhibiting “symptoms” like "sexual desire" and "a tendency to cause trouble".  Would I too have seen these behaviours as unacceptable, as symptoms of mental illness?  Would I have wanted “to help” this woman behave normally?  Or would I have asked myself whether her response was perfectly valid given her experience and given the constraints within which she had to live? 

Anyway back to tackling stimga.  The option that I perceive to be the easier one and the one that looks to most people, it seems, like the right thing to do (i.e. act in the name of these campaigns), I am afraid is not one I can take.  I have tried here to explain why.  I think that action, effort and good intentions based on underpinning ideas that are wrong, will produce unforeseen bad consequences. Eleanor Longden clearly articulates the consequences she had to face when her experiences where seen through a “mental illness” lens in this 15 minute video.  

So even though this is not the easiest path for me to follow, I can not support this campaign directly.  A close friend of mine often uses the following quote – I hope he is right...

“The truth will set you free, but first it will make you miserable.”  James A. Garfield

So how do you think we should be using our funding to tackle stigma?  What do you think about these campaigns? What do you think we could do to tackle stigma i.e. the disgrace, the badge of shame that we attribute to our mental distress?

There are many people out there, across Powys and indeed across the world,  challenging the medicalisation of distress and the conventional wisdom surrounding mental health, in our society and within our mental health services.  I would love to hear your thoughts and ideas.  You can comment on this blog, follow me on twitter @powysmh, get in touch with me here or keep up-to-date with events we are running on our website.  Why not join us at our free conference on Sept 19th.  Jacqui Dillon is to be our main speaker to help us continue with this debate.  I hope to hear what you think ...