Thursday, 28 November 2013

Dyfed-Powys Police - Mental Health: The Way Forward

Last Friday Laura and I attended a Dyfed-Powys Police conference at Police Headquarters in Carmarthen. We were there with our PAVO colleague Claire Powell, the Info Engine Officer, to promote the third sector in Powys. Laura also facilitated a session with two people from Powys who had experience of being arrested and detained by the police whilst mentally distressed.

Mental Health: The Way Forward, was promoted as an event which “will explore ways in which the police can work in partnership with statutory and third sector services in responding to people in mental distress.” Dyfed-Powys is obviously a vast chunk of Wales (Carmarthenshire, Ceredigion, Pembrokeshire & Powys), and we were able to network with colleagues from the statutory sector, including Bronllys Hospital and the Welsh Ambulance Service, as well as other voluntary groups and charities such as West Wales Action for Mental Health and Mind Llanelli. But our main role was to inform those police officers present of the mental health third sector groups in Powys, and the support these groups can provide to people experiencing any form of mental distress.

The event was kicked off by Temporary Deputy Chief Constable Carl Langley. He spoke about the recent joint review – “A criminal use of police cells? The use of police custody as a place of safety for people with mental health needs,” in which a police cell had been identified as the worst possible place for someone with mental health issues. Yet, as Carl admitted, cells are still used routinely as places of safety.

The average time taken to assess someone is 8 hours and 48 minutes. As a high percentage of people enter police cells having drunk alcohol, this time could be much longer. Carl then asked – “If that was my mother/daughter/sister who had experienced an episode which presents as mental health initially, how comfortable am I with that?” He went on to explain that as a police service “we don’t want these people in custody – we want to do the best for them… 9 hours is a long time.” Often the period of custody will exacerbate the level of anxiety experienced by someone already in distress. Recent TV programmes such as BBC’s Panorama and press articles have focussed on these issues.

Dyfed-Powys Police want to try things differently going forward. Carl asked if other statutory agencies present would be willing to share information, say from Care Treatment Plans, to help inform officers early on. Less than 10% of people who are detained in this way
are sectioned, but what happens to the other 90%? Where do they receive support? Whilst Carl recognised that some people would benefit from support from the third sector, he said that the force currently underutilises these resources. And now is time to change that.

Temporary Chief Superintendent Andy John, the force Mental Health Lead, spoke with Helen Morgan-Howard, Equality & Diversity Manager, about Mental Health Street Triage (presentation available here). They began by describing “Section 136 of the Mental Health Act 1983 (which) allows a police officer to remove a person they think is mentally disordered and ‘in immediate need of care or control’ from a public place to a place of safety, in the interest of that person or for the protection of others.” Without access to a person’s records a Section 136 was described as “the only option”, despite it making people feel “I was locked up because I was ill.”

Dyfed-Powys Police are now asking:
  • How do we provide better information to officers at the scene of an incident?
  • Is there anywhere else we can take people to?
  • Can we reduce the amount of time people wait to be assessed by mental health practitioners?
  • Can we refer to support elsewhere, eg: third sector?
  • Are there other crisis interventions out there that the police don’t know about? 
Andy described a real appetite to make a difference within the force, and pointed out key areas where change could be made, including staff training, and working more collaboratively with partners, including the third sector.

There was also talk of trialling mental health street triage. In nine force areas in England joint units comprising mental health practitioners and police officers, who have shared access to information, take to the streets together, resulting in better-informed decisions and better outcomes for people experiencing mental distress. There are already plans for a pilot scheme in Carmarthenshire in the lead-up to Christmas, and talks are imminent with Powys teaching Local Health Board about options for 2014. This approach, combined with the creation of new places of safety, away from a police cell, and local to an individual, look like a promising start.

Laura networking at the Dyfed-Powys Police mental health conference
Before leaving the conference for the day I asked someone who had been arrested on many occasions whilst mentally distressed, "where would your preferred place of safety be?" The answer, simply, was “anywhere but a police cell.”

Let’s hope it’s not that hard to arrange.

What do you think of mental health street triage? Let us know your thoughts on this, and any other aspects of policing in relation to mental distress, by commenting below.

Other speakers at the conference included:
Tim Burton, Deputy Police & Crime Commissioner, Dyfed-Powys Police
Tony Thomas, Criminal Justice Link Officer, Hafal
Gareth Coles, Public Services Delivery Officer, Wales Council for Voluntary Action

January 2014 BBC news update - Mental health units to be set up by Dyfed-Powys Police

Saturday, 23 November 2013

Mental distress - who has the power?

“Power is essential to how we make sense of the experience of distress and when considering how to be helpful as service providers.” Steven Coles, September 2013

In Powys there is an ongoing debate around who has power about even the simplest things when someone is in contact with services because of mental distress. Freda wrote recently about the issue in her post Smoking and snacking? Saving lives or life-saving?

When I was at the Nottingham conference, Psychiatry beyond the current Paradigm, in September, I went to a really interesting workshop with Clinical Psychologist Steven Coles, who spoke about “Power Dynamics: Marginalised Voices, Strengthened Voices”. Some of the language and concepts were quite challenging to me as a layperson, but I’m going to do my best to describe the workshop with links to Steven’s presentation and hand-outs. (Apologies in advance to Steven for any oversimplifications!) The workshop content was, though, very relevant to the on-going debate about the medicalisation of mental distress, and I really want to share some of the discussion and resources. Steven’s Twitter page header sums up the situation succinctly: “A Questioning Clinical Psychologist. Interested in why dominant ideas in mental health persist, despite sustained criticism”.

What the workshop was about
The blurb said: “This workshop will use theory, examples, exercises and debate to discuss the dynamics of power in mental health services. Power is central to understanding emotional distress and suffering, and the responses of mental health services. Power can restrict and be repressive, though all of us need power to live in the world. Within mental health services some voices dominate and others are quietened. The workshop will consider: what power is; how power is used in services; how some viewpoints marginalise alternative perspectives; and consider case material of how quietened voices could become louder.”

Power in everyday life
Steven encouraged us to talk first about how we experience power in our everyday lives. We considered this in pairs, and almost every area of life was relevant…So, for example, who tells us what to do at work, which newspaper to read, what we wear day-to-day….? Who says where we can or cannot park or what speed we drive our cars… if we drive or ride a bike or walk, when we get up in the mornings and what we eat..? Is it us, or someone else?

Looking at different sorts of power
Psychologist David Smail developed a way of looking at the different powers that operate in a person’s life. Some of these powers can be negative, whilst others can be positive. He separated them out into two areas:

Proximal powers – these are the powers that are close to home and which we are more likely to have control over, such as beliefs, memories, feelings, abilities (part of the person) and family, work, friends, housing (part of our environment and social life).

Distal powers – these are powers that are generally out of our control, such as economics, politics, and media/culture.

Mapping power
The feeling of helplessness or lack of control or power can play a big part in our lives whether we are distressed or not. “The flow of power is central to the experience of distress. Whilst at times services might be limited in their ability to alter this flow, mapping aspects of power can help people to clarify and understand their predicament. Furthermore, it is more likely to highlight realistic areas for change than an inward focus.”

Steven showed us a model for mapping power developed by David Smail and Teresa Hagan in 1997. The chart is split into four areas – material resources, home & family life, personal resources and social life. Each area is split again, and individuals can then chart how much power they feel they have in any specific area. Once this is logged, they could look and see if there is anything that can be done to change the balance of power, if this is felt to be a good thing. So… as an example, under home & family life – spouse/partner… An individual may have an abusive partner… so what could be done to change or move away from this relationship where power is wielded in an abusive way by one of the partners?

Power dynamics in mental health services
Then Steven spoke about the way in which power can work in the relationship between a service provider and someone experiencing mental distress. He shared a case study – and we looked at how an individual who is distressed is diagnosed with schizophrenia by services. The young man does not believe he has an illness, but is told by his psychiatrist he needs to take medication for a minimum of two years and possibly the rest of his life. His relationships with his family, and other professionals, were discussed, and we looked at whose viewpoints and whose voices dominated. It was clear that the services’ view of the man’s situation dominated to an incredible degree, to the extent that the man’s control over how he tried to resolve the distress was almost completely removed. Then we looked at how the man’s marginalised voice could be heard and a more democratic discussion take place amongst the professionals and the family.

Power in numbers
People coming together in groups with a common interest can work much more successfully to overcome powers imposed on them. Steven gave several examples, including the Hearing Voices Network and the Critical Psychiatry Network. Since the workshop a local example has sprung to mind - individual patients have come together at Powys Patients’ Council and can report many breakthroughs, the most recent success being changing the policy around mobile phone use on the ward at Bronllys Hospital.

Read Steven’s presentation for further information about the workshop – including his slides on Ideas Way Forward and “Tricky” Issues.

Some of my feelings at the end of Steven’s session:
  • That professionals need to look very hard at the power they wield, and why.
  • That the situation can be very complex… for example, a) a nurse may wish to support an individual in his aims (for example, not taking medication but seeking counselling) but feel overpowered by the wishes of the higher-ranking psychiatrist; b) the family members may concur with the psychiatrist that the man has an illness and needs medication in order to “recover” as they find it difficult to deal with his unusual behaviours.
  • Individuals currently have very little power… much power instead resides with professionals, pharmaceutical companies and the government who make laws which state how people who behave in certain ways should be treated and/or detained against their will. 
  • Individuals do, sometimes, have other options if they can access peer support groups and talk to others going through similar experiences. This increases their power, and subsequently their ability to change their lives going forward.
All in all an extremely thought-provoking session, and  I am keen now to read more on the subject. If you have views about power in relation to mental distress, we would really like to hear from you – please make your comments below or email us at

Steven Coles is a Clinical Psychologist working in Adult Mental Health Services in Nottingham. Clinical psychologists aim to reduce psychological distress and to enhance and promote psychological well-being. Steven is co-editor of “Madness Contested: Power and Practice” and a key contributor to the Division of Clinical Psychology’s* position statement: “Classification of behaviour and experience in relation to functional psychiatric diagnoses: Time for a paradigm shift,” (British Psychological Society, 2013). The statement calls for a paradigm shift away from an outdated disease model, towards one which gives much more weight to service user experience and psychosocial approaches.

*The professional organisation for clinical psychologists in the UK.

Thursday, 14 November 2013

You are what you eat: nutrition and its role in mental health

Here at Powys Mental Health Information Service we are really interested in the effects of diet on our mental wellbeing, so when Virginia Cunningham contacted us from California (our readers are spread far and wide it seems...) and offered to write a guest post for us, we asked her to look at this topic. Here is what she wrote for us.

Image courtesy of ShutterStock
The cultural paradigm of healthy eating usually revolves around the body. As we mature, we are taught that our dietary habits will have a big influence over what we look like in the future.

Everything is covered, from how much we weigh to how glowing our skin is. The mental aspect of eating right is often ignored and presented in a simplistic manner that can be defined by the idea that when you eat well, you feel good. 

However, feeling good is only an oversimplified way of putting it. Food is an important aspect of mental well-being and, given that mental health is an integral part of overall vitality, we must investigate the way eating influences the mind if we want to strive for a better life.

The human brain, although it represents only 2% of our body weight, is responsible for at least 25% of our metabolic requirements, which means its function is tightly intertwined with nutrition. In that line of thinking, we are able to observe what the positive nutritional influencers are, and how they affect our mental health in a systematic, rigorous manner. 

This fatty acid has been in the spotlight for a few years, being advocated as a key ingredient in the fight against high cholesterol, high blood pressure and diabetes. Its mental health benefits are various, although less advertised. 

In both children and adults studies show that depression and bipolar syndrome are both improved after three to four weeks of using Omega-3. 

At the same time, scientists at the University of Oxford showed that lower levels of Omega-3 in otherwise healthy children lead to underperforming and behaviour problems, which could be translated into the idea that using Omega-3 might keep learning issues at bay, where no other health problem is involved. 

Furthermore, first-stage schizophrenia patients reacted well to Omega-3 treatments, as a particular study shows. What's more, the same study shows that fatty acids, particularly Omega-3 PUFA, may have a role in preventing schizophrenia. 

Research indicates that the Omega-3 might be better absorbed directly from food than from supplements, with ground flax seeds coming in first as dietary source, closely followed by walnuts. Fresh salmon is next, but keep in mind that smoked salmon provides only a third of what the fresh option delivers. 

Other Omega-3 rich foods include sardines, grass-fed beef, soybeans, halibut, scallops, shrimp and tofu. 

The Gut 

Just like the brain, the gut has a nervous system, which sends information to the brain by means of the vagus nerve. Recent findings show that microbiota are relevant for normal brain function, and they also contribute to keeping stress and anxiety related behavior at bay. 

A new study from UCLA and Danone shows that eating probiotics from fermented milk products can alter human brain activity, which, upon further research, could become important in discovering a way to modulate the gut flora so as to treat patients with stress responses. 

Keeping your gut healthy also involves knowing about bad bacteria, like the ones in the 
Clostridium family. These bacteria thrive on a Western diet of high fat, high sugar and processed foods, and, in turn, produce toxins that can reach our brain and alter its functions. 

Carbs are a wonderful source of energy, and they’re usually found in delicious forms - pasta, rice, wheat; all of these are packed with carbohydrates, which, as we ingest them, are turned into sugar - the energy provider. 

Anxiety and mood changes are known to be affected by fluctuations in in blood sugar, so a good way to escape the sugar high-sugar low vicious circle is to skip simple carbs (white flour, processed sugars and starches) and go for a complex carb diet that is rich in whole grains. 

In particular, selenium, which can be found in pasta and bread, contributes in keeping our mood stable. 

Lean protein is the second-most abundant substance in the body and it contributes to a good mental health. 

Image courtesy of  ShutterStock
Under stress, tyrosine, an important amino acid in lean protein, helps keep your brain more alert, active and enhances mental performance, while also having an effect on depression. 

Tryptophan, another essential amino acid in lean protein, is the basic ingredient in making serotonin, which, in turn, helps to regulate mood. Because the body can’t make its own tryptophan, it must be taken as part of a diet, and meat, eggs, dairy and seeds are all good sources you can go for. 

Opinions of which way is best to get this amino acid in your system are mixed, but supplements are considered by the medical community to be a sure way of doing so. If you’re a vegetarian, this last option is the best for you.

Vitamin B 
Vitamin B was proven to have a positive effect on people with
panic disorders, OCD and depression. Vitamin B1, with its capabilities of controlling blood sugar levels, helps with anxiety, while vitamin B3 helps with serotonin synthesis. 

Vitamin B5 is good for modulating stress, while folic acid (B9) and B12 are important in handling depression. 

Dietary sources for vitamin B include liver, turkey, white and red meats, whole grains, potatoes, bananas, chiles, nutritional yeast and molasses.

There are plenty of studies which show that nutrition is a key element in maintaining good mental health. As the media and the medical community have been focused on promoting nutrition as a valuable aspect of a healthy body throughout the last decade, it seems that the trend for understanding the link between food and the brain is on the rise, which could mean that more knowledge will soon be available to everyone looking for ways to improve their mental health. 

Virginia Cunningham is a freelance writer, mother and health enthusiast in Southern California. With an entire family to care for, she makes it a priority to ensure the best health possible by including the right nutrients her children need to grow, both physically and mentally.

Monday, 4 November 2013

Citizen Power, Active Participation

Blog by Freda Lacey, Powys Association of Voluntary Organisations (PAVO)

The Person in the Arena – Theodore Roosevelt    

"It is not the critic who counts; not the person who points out how the strong …stumbles, or where the doer of deeds could have done them better. The credit belongs to the person who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends themselves in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if they fail, at least fails while daring greatly, so that their place shall never be with those cold and timid souls who neither know victory nor defeat."

24th October 2014.  Left to right, back row;
Rhydian Parry, Neil Saunders, Kate Van Den Ende,
Steve Hails, Liz Hails, Phil Pashley, Meriel Richards,
Phil Moisson.  Front: Freda Lacey, Lotte McGregor,
Ali Lloyd-Jones, Michelle Willingham, Jill Dibling

On Thursday,  24th October, I gave the above quote, a personal favourite of mine (one which has boosted me many times during some of my darker days) to a group of twelve enthusiastic, devoted citizens of Powys, who came together for the day with me to discuss active participation on local and national Mental Health Partnership Boards. 





The Road Trip

This meeting was the culmination of a long road trip across Powys over the last few months, engaging with people in local groups, teams, towns and localities.  I gleefully sent out some photos to my family of my journey to work that first day of travel, captioned, “my road to work this morning”.  I feel incredibly lucky to live in a county and drive roads which take me to views like this in the work I do. 

My mission? 
To inform and encourage people to participate at our annual Stronger in Partnership conference, this year entitled, “Shaping Services Together”.  People would get to meet with Jacqui Dillon, a well known activist and public speaker on the de-medicalisation of mental health distress and chair of the “Hearing Voices Network”, actively participate in speaking up about the impact of the UK Welfare Reform (workshop video here) and meet with key decision makers locally and nationally to report on personal experiences (watch out for a subsequent Blog on this topic!). 

Welshpool Outreach - Ponthafren

They would also get to speak directly with members of the relatively new National Partnership Board driving the “Together for Mental Health” strategy and delivery plans across Wales.  People would also learn more about how to actively engage and participate in shaping mental health services (you can access their talk here), locally and through a newly forming National Forum for citizens in contact with mental health services across Wales.  

Llanidloes Outreach - Ponthafren
I combined visits to local mental health voluntary services/groups and statutory mental health staff/teams closely in contact with people who have been diagnosed with "mental illness". 

My journey took me to places such as Machynlleth and visits with Mind Aberystwyth’s “UsMach” and a local counseling services called “The Listening Point”.  To Llanidloes’ Mental Health Outreach Group, Welshpool Mental Health Resource Centre, both managed by Ponthafren Association.  

Older People's team, South Powys
Newtown’s Mental Health Resource Centre (managed by Ponthafren Association), Builth Wells Mental Health Outreach Group and Llandrindod Wells Resource Centre, through Mid Powys Mind, Brecon and District Mind’s (note new name), Mental Health Resource Centre.   Bryntirion’s multi-disciplinary team of social workers, community psychiatric nurses and team leaders in Welshpool, multi-disciplinary staff team at Ty Illtyd in Brecon, the older people’s multi-disciplinary staff team gathered at Bronllys Hospital and the multi-disciplinary staff team at The Larches in Ystradgynlais.

This event was also going to uniquely focus on “across all ages” and we actively worked with the Participation Team working with the Powys Youth Forum and Tros Gynnal, who provide Children’s Advocacy, to get their involvement.  Several young people came, with the support of these two local organisations and they worked with Theatr Clwyd on a workshop to put across their points/issues to the audience.  There was also quite a bit of audience participation as you can see in the picture here and below.

We had over 120 people registered for the event here in Powys which happened on September 19th and the momentum for people to get involved in shaping mental health services, both locally and nationally, has continued since then with great interest.  It feels as if a great shift is happening with people really wanting to become more actively involved, raising their voice, campaigning for the rights of individuals (and themselves) to be heard.  People are passionately wanting to help change the way services are delivered so that they have the services they need, when they need them.  It is interesting that this is strongly aligned with the Welsh Government’s drive to involve more citizens in public consultations, engagement and participation at all levels.  For a list of the most recent opportunities to get involved, please visit this page on our website.

This all brings us to last Thursday’s day at Gregynog Hall, where originally, fifteen people had put themselves forward as interested in coming together to discuss active participation and representation on the Powys local Mental Health Planning and Development Partnership and the National Forum. Unfortunately, three people were unable to attend on the day due to unforeseen reasons. 

The local partnership board is a requirement, as part of the strategy for Mental Health across Wales, and each of the seven health boards in Wales need to create such a partnership.  They are also required to have people in contact with services and those close to them as active members on these partnership boards.  There are no minimum or maximum numbers, but most Boards have over four people as active members.  In Powys, we have three people who can participate on the partnership at any one meeting.

There were six people who organically fell out of the day’s selection process, but three others who really wished to participate, but were unsure of their abilities and perhaps lacking in some confidence.  The group, as a whole, really wished to encourage and support these three people to be actively involved and so they wished me to see whether the three people participating on the local partnership could be pulled from a pool of nine people.  The remaining three people all wished to be very actively involved in supporting the local and national engagement process.  Nine people from Powys will actively be part of the National Forum that is forming and this will consist of over 50 people from across Wales.

Jo Mussen (right) Vice Chair Powys teaching Health Board & Jackie Newey, PAVO
The nine people are a good mixture of people who have varied and diverse experiences.

It will be one of the widest, most diverse groups of people to ever come together, with one common purpose.  This is to ensure that those in contact with or close to people who have experience of mental health services in Wales are valued as equals in shaping mental health services for the future, that they are consulted, valued, actively involved through meaningful dialogue, ensuring that this is not tokenistic.  This Forum will also choose the four people who will participate on the National Partnership Board.  Importantly, communication to and from the National Partnership Board on issues affecting people and progress on key areas of interest in terms of service development and action, needs to be whole-heartedly carried through this Forum, by this Forum to local networks, groups and citizens represented from communities across Wales.  In this way, a strong, inter-dependent link will exist between local citizenship and Welsh Government, in relation to mental health and well-being.

Community Mental Health Team, Brecon
The ongoing challenge remains how we actively engage, communicate and dialogue with the silent majority of people, whose voice may not yet have been heard and indeed, who do not wish to participate via membership of a forum or board, but who do want to actively contribute and be heard.  Further development of local groups, local mechanisms for ensuring active participation is facilitated and helping forge meaningful connections are next steps for the group who met at Gregynog, as is utilising the widest and most innovative means possible to engage with people. 

Along with supporting this group, my role requires me to be mindful of linking opportunities for involvement in services with people with particular interests or experiences.  Most recent examples of this include: linking an individual in Newtown with Department of Health, Expert Reference Group meetings in London, reviewing the Mental Health Code of Practice and we’ll ensure that we are involved when/if the Welsh Code of Practice is also reviewed, ensuring individuals who have experience of being detained by the police (in relation to mental health distress) are linked in with a two year research project headed by the University of Bangor into Police practice, linking people with the group overseeing the implementation of the Mental Health Measure (Act) across Wales and seeking to involve people in the formation of the Powys Psychological Therapies Management Committee.

Finally, I shared with the “Twelve” a poem which means a great deal to me.  It is called “To Risk” and you can view it here on our website.  It felt right to hand people this poem before they attend the first meeting of the Powys Mental Health Planning and Development Partnership in December and the National Forum in November.  It may help if you’ve never gotten involved in participating before. 

So, if you wish to join in, get actively involved and have particular interests or experience in different aspects of services that makes you think you can make a difference for others and/or for yourself, please email me at or ring me on 01597 822191 for further information.

By Freda Lacey