Monday, 19 December 2016

Our Alternative Christmas

For the last few years our December team meeting has morphed into a pre-Christmas mini-binge – turkey and nut roast sandwiches, warmed mince pies, mulled grape juice…. And Havin’ a Laugh.

This year – in the spirit of recognising that Christmas isn’t always an easy time for some of us – we decided to try something completely different.

We thought about surfing at Borth… climbing to the source of the Severn… exploring the sculpture park at Lake Vyrnwy… or kayaking the rapids of the River Wye… In the end we went to Rock Park in Llandrindod Wells (home to a former spa centre established in the Victorian era) and spent 2 hours litter picking and leaf collecting. It was wet. A bit muddy. But also exhilarating. We laughed a lot. We learnt stuff. It was genuinely team building. And the best December team meeting ever.

Amongst other things, we discovered that the leaves of the park’s ginkgo tree contain ginkgolides, which could improve blood circulation to the brain …. And that a lithium well was discovered at Rock Park in 1906 by Mr Heighway… (it's housed in the shed in the photograph).

Afterwards over lunch we exchanged more ideas about how to go about creating the Christmas Festival Fringe at home on the Big Day itself…

Anne: wishing for a festival of light!

For me, Christmas is a trigger for feelings of anxiety, which starts several weeks before with worrying about buying presents that people will like. As a result, I tend to put it off, leaving it to the last minute, which then creates more stress. It’s hard not to get caught up in the commercialisation and put pressure on myself, which doesn’t come from family and friends. So I suppose my fantasy Christmas would have less emphasis on giving and receiving material gifts. Or I’d employ a personal shopper!

I’ve often considered creating spiritual rituals that are meaningful to me at this time of year. My fantasy Christmas might include being outside in nature (weather permitting!), making the most of the light in the day and a bonfire in the evening. One year, I went to Stonehenge at dawn on the Winter Solstice, and then to Avebury Stone Circle, as it felt important to mark the shortest day. I like the idea of a festival of light to counteract the long, dark, winter evenings; something that has a big impact on my mood at this time of year. If money was no object then I would go away somewhere warm and sunny in the winter to top up on vitamin D until the days start getting longer again.

Carla’s No Cooking Christmas!

In our family, we did away with slaving over a hot stove for days on end and have exchanged turkey and trimmings for deli platters and paper plates. Essentially, this means that shopping for Christmas food doesn’t involve battling crowds in the supermarket but does involve spending a leisurely afternoon browsing small independent shops or jamming a queue at a deli counter somewhere. The kids and I pick salamis and cold meats, sample different cheeses before buying, choose which items to splash out on for the special ‘treat’ items (stuffed baby peppers are my favourite) and only have to pop to a big store to buy the fancy paper plates and crackers. I set a budget before we go shopping and when it’s gone - it’s gone.

On Christmas day, everything is put out on the table on throw-away foil platters from the pound aisle, the oven goes on to heat the ‘bake at home’ bread and paper plates are handed out to whoever the guests are - this can change at any point throughout the day as people drift by to say Happy Christmas and have a drink or two!

We eat, we snooze, we drink, we eat again and then all plates are put in the bin, leftovers stuck in the fridge and the next day we can get back to ‘normal’ - or just do it all over again with new plates! No stress, no fuss, no waste, no turkey sandwiches/curry/soup and buying the food can suit even the tiniest of budgets. One year, I bought everything we wanted from our local supermarket on Christmas Eve and it came to about £20.

Christmas doesn’t have to be a chore nor does it have to be the same every year - this year our family are NOT ‘magicing’ our Christmas tree and may have to resort to more conventional methods - but that’s another blog post . . .

Jackie: Digging Christmas!

Ever since moving to our house in the Upper Severn Valley 20 years ago I have been a bit of a mad keen gardener… and tradition now has it that every Christmas Day involves gardening in some form or other. Depending on the weather this could be chipping parsnips out of frozen compost in a style not dissimilar to that used on an archaeological dig… rescuing a willow bean tripod from the top of an ash tree in a gale… or scraping snow off the polytunnel before the metal hoops crumple under the weight….

But the highlight of all Christmas Gardening Days past was the one where I found an old Victorian sixpence dated 1875 in the ground whilst digging out self-seeded holly trees. I would have rushed off to order a metal detector there and then (well in the Boxing Day sales anyway) except the ground all around was found to be full not of treasure but buried refuse – not exactly the Staffordshire Hoard – rather the site of some 1950s fly-tipping…half-bricks galore.

Christmas in our house is a time for planning the gardening season ahead. Full of hope. Anticipation. And some concerns… Will the heritage seed beetroots finally plump up…? The spring frosts stay at bay…? The million hungry rodents be herded up and dispatched by resident cats …? The recycled tin baths moisture retentive and slug-proof for carrots to thrive…? The elusive horse manure finally appear magically at the end of our drive…?

Whatever 2017 brings in the world outside my valley… I can’t wait to get my hands dirty again in the confines of my garden oasis. (If you fancy gardening and don’t have a patch of your own, there are community gardens all around Powys).

Jane: Fantasy Christmas meets Reality!

My fantasy Christmas would be one where I had actually got my act together and was well prepared! Each year I stubbornly refuse to even think about Christmas until December - and then I am surprised by how quickly it seems to arrive! We would book an enormous house so that all the extended family could come, everyone would get on well, there would be harmonious sharing of chores and all the various traditions would miraculously work together so that everyone felt that they had had a part in such a wonderful shared time - so that should show what a general fantasist I am!

I’ve never done anything that out of the ordinary at Christmas myself - last year I was proud of my daughter and husband who took a car-load of donations to the refugee camp in Calais and volunteered there for a few days in between Christmas and New Year.

On balance I think that having a time of coming together and sharing food, gifts and conviviality at the darkest point of the year is a good thing - and if you are a Christian then it’s a good thing to celebrate the birth of Christ too. There isn’t any easy way to balance that with the fact that for a lot of people it is also a very difficult time - I am inclined to think that the gross (to my mind) level of consumerism, the overcomplicating of it all and the relentless emphasis on the fun, party side of Christmas with no mainstream, non-religious acknowledgement of the importance of reflection and quiet thought as a component of the rest of the festive season adds to the sense of isolation and loneliness that some people feel at Christmas.

And finally...

These ideas and approaches may or may not work for you. But perhaps they could kickstart a different way of thinking about the traditional Christmas. And if you opt for the alternative approach, we would love to hear from you in the comments box below.

Most important of all, do something that makes you happy. And if you need extra help over the festive season – it’s out there. Wellness and Recovery Learning Centres around Powys are open at some point over Christmas and the New Year and would welcome your visit. Check their opening times on websites, details here. You can link to national helplines here.

If you need help urgently find information here.

Happy Christmas, whether Traditional or Alternative suits you best. And see you in 2017.

Photos feature Newtown's Christmas-themed town centre in December 2016

Tuesday, 13 December 2016

Active Monitoring - Mind working with Powys GPs

Just last month at the PAVO Conference, which focused on Prevention and Early Intervention, we found out more about a new initiative at Brecon and District Mind when Service Director Val Walker spoke at the Mental Health Conversation. Active Monitoring provides support to people who visit their GP with symptoms of common emotional health needs including stress, anxiety and depression. The service aims to increase wellbeing, self-esteem and confidence, and reduce the likelihood of needing to access further support relating to a person's emotional wellbeing.

The mental health charity Mind describes Active Monitoring as: "a psycho-educational programme designed to provide early intervention provision within the Primary Care arena. With growing demands on Therapeutic Services resulting in increasing waiting lists it is getting more difficult for people to access the help they need in time. This role involves working directly from a GP surgery delivering the Active Monitoring programme. The service complements/replaces the ‘watchful waiting function’ and proactively works with individuals on agreed pathways to support early intervention via a facilitated self-help model."

Elizabeth Bogunovic
Brecon & District Mind works closely with the GP cluster in South Powys and Red Kite Health Solutions CIC (Community Interest Company) to deliver the Active Monitoring service.

Elizabeth Bogunovic is the Mind Active Monitoring Practitioner delivering the service for Brecon & District Mind, and she tells us more about this innovative way of working:

It was when I began volunteering for Merthyr and the Valleys Mind that I became aware of a service called Active Monitoring. The more I heard about it, the more intrigued I became so I sat down with Nicola, one of their practitioners, who explained to me the ethos behind the product so to speak. From that point on I was passionate about the possibilities an early intervention, self help service could offer people and considered the time a few years ago I found myself stuck in my own ‘mental health mess’, and how it may have changed the course I took at that time. I am convinced it would have helped me to recover a lot quicker than I eventually did.

Now I am delighted to be the Wellness Practitioner delivering the service for Brecon and District Mind, based at the Haygarth Surgeries which cover the areas of Hay-on-Wye, Talgarth and rural villages around here. I have been part of the Brecon Team since August 16th where I began by getting to know the area, the people and the surgery set-up, before heading off to Oldham to have some excellent training from Mind which fully prepared me to begin working with patients on September 8th.

The Active Monitoring Service consists of an initial ‘drop-in’ session where I meet the patient referred to me by the clinical team for a brief fifteen minutes and then, a further five more sessions. During the time they spend with me, they complete the GAD7, PHQ9 and Warwick Edinburgh Wellness evaluations at the beginning, middle and end, and choose one of six workbooks or pathways to engage with. These workbooks focus on Managing Anger, Anxiety & Panic Attacks, Stress, Low Self Esteem, Depression and Feeling Alone. To complement these workbooks, I have at my disposal a selection of exercise sheets they can work with and some smaller booklets to help them. The initial feedback I am receiving is on the whole excellent and very positive.

The last few months seem to have flown by and I was surprised to notice today how many of my first patients have had their last sessions with me over recent weeks! It only seems like yesterday I sat with them, full of anticipation both for them and me, describing the service and inviting them to engage in it. I was delighted for one patient at our third session when she completed the same evaluations she did at her first drop in session to see a slight improvement, I remember feeling her pleasure almost as my own!

So far I have worked with 48 people -  all at different points of their journey through the service - many of whom tell me how much more aware of their feelings and emotions they are since starting work with me. This not only gives me some validation that Active Monitoring ‘works’ but an immense sense of achievement when someone starts to notice a change in themselves.

I have amazing support from the staff here at Haygarth, it feels almost like being part of a big extended family which makes it a pleasure to come to what is called work but what I prefer to call ‘doing something I love with financial reward’. Even more than that I am lucky to be part of the team at Brecon & District Mind who also feel passionately that Active Monitoring has the potential to offer people an alternative approach to mental health matters, one that really can make a difference in a person's life.

Brecon & District Mind believes that early Interventions are far more effective than waiting, and that prevention is better than allowing things to linger. "We want people to get help immediately rather than wait to get help, or for things to get worse". 

You can find out more about the Active Monitoring project on the Brecon and District Mind website. Contact Elizabeth by ringing 01874 611529 or email:

Thursday, 1 December 2016

How is telehealth working in Mid Wales?

Clare Clark & Owen Hughes from the Pain & Fatigue Management Service
Over the past few weeks I have attended a number of events where a familiar theme has emerged – the increasing importance of using digital technology to deliver and receive support for people in Powys accessing NHS services, particularly around their mental health. We have already heard the latest about the pilot computerised Cognitive Behavioural Therapy project run by Mastermind in conjunction with Powys Teaching Health Board – so this seemed like a good opportunity to share information about other telehealth initiatives in the county.

On November 10 I attended the Powys Research, Therapies and Health Sciences Conference, where I found out how staff at the Pain & Fatigue Management Centre in Bronllys near Brecon deliver condition management groups by Skype. The team at Bronllys provide help to people who want to live life more fully but are hindered in doing so by symptoms of long term health conditions – these could be conditions relating to physical or mental health or both.

This session was delivered by Owen Hughes, Head of Pain & Fatigue Management, and Clare Clark, Advanced Practitioner – Occupational Therapist – both based in the Pain & Fatigue Management Service in the Centre of Long Term Condition Management. Owen and Clare explained that there is currently a Skype group running from Bronllys, and through their presentation they explored the benefits of working in this way and what to consider when setting up a new Skype group.

Owen started the session by asking why it is important that we consider using software applications such as Skype to have video appointments and group support sessions over the internet. At this point his presentation featured a photograph of a famous actress from the silent movie era – but not a single person in the room recognised her because she had refused to switch to the “talkies” once they came along. (And I’ve forgotten exactly who she was already, though Owen did tell us her name!) The moral from that story being – we must move with the times or be left behind forever…. Owen said “technology is everywhere, and homes are getting smarter.” He asked us to imagine what people’s homes would look like in ten years’ time.

Eleanor Boardman - the forgotten silent movies star...?
How it works

Clare picked up here to detail other issues which affect both patients and the team when trying to engage over a period of time. As we know people living in Powys often have to travel huge distances to see medical professionals even within the county. They may already be anxious and even on a good day people experiencing mental distress may not be ready to take on the long journey, perhaps by public transport, to make an appointment.

Other people may find it inconvenient to take a whole day from work to attend a session every 6 weeks, but would be able to free up an hour in a private room to make the Skype call. The issue of time is a factor for the staff too, who may otherwise have to spend many hours behind the wheel of their cars when they could be talking to more patients. They simply do not have the capacity to deliver all their sessions face-to-face, and Skype has proved an additional extra tool by which they can offer support to people.

Lessons learnt
  • Peer support still works when Skype is used – there is a lot of interaction between the participants on the group sessions.
  • It can be hard to manage group dynamics online – there is no social filter – so if some people are being derogatory this needs to be managed. Now there is a working agreement and boundaries are set at the start.
  • It is important for participants to have a trial one-to-one session at the beginning during a coaching period with a telehealth facilitator, particularly if they are not familiar with the technology. 
  • The maximum number for a group session is probably 8. There were 4 in this group.
  • It should not be forced on people. Generally they self-select.
  • It can be effective for quite complex issues, not just mild anxiety or conditions.
  • It is a transferable skill as it teaches people how to communicate online. It increases their social connectedness.

What people said

"I thought it would encourage isolation – but it made me feel less isolated. If I’m working with levels of anxiety, being at home can be a good place to start".

"I felt it improved my confidence so I was able to go out and socialise".

"I would never have been able to attend a face-to-face session today, but was able to log into the PC and join in".

Then on 22 November I went along to a public session run by the Mid Wales Healthcare Collaborative in Newtown. The MWHC covers North Powys, Ceredigion and South Gwynedd, an area served by three health boards including PTHB, and works with providers and communities “to plan and deliver safe, sustainable, high quality and accessible health and social care services for the population of Mid Wales”. One of its twelve priorities this year (2016 – 17) is to look at Telehealth, Telemedicine and Telecare:

“There should be a coordinated effort by all three Health Boards to identify the opportunities for much greater use of telehealth capacity and a determined drive to hasten its implementation”.

“A 6 month project will be undertaken to ensure that the telemedicine equipment in Mid Wales is working, sited in the best place and that staff are trained to use it”.

At the Newtown session I met Adrian Thomas, Director of Therapies and Health Sciences at Betsi Cadwaladr University Health Board and lead on telehealth for the MWHC, and Emma Pritchard - the Telehealth Project Manager. They described some recent telehealth work developed as a result of this priority which focussed on a teledermatology service in North Ceredigion. We also spoke about other options that could be developed in future, taking into account feedback from the Mastermind Beating the Blues pilot and other initiatives such as those running at the Pain & Fatigue Management Centre. It was emphasized on the table where I was contributing that the telehealth option would not work for everybody - personal choice was key - but it should be offered as an option as it may be preferable for some.

Pages 32 – 38 of the 2016 report “A review of telehealth, telecare and telemedicine in Wales” give some details of recent initiatives in Wales which have used telehealth, including a Veterans’ mental health project in South Wales and the Powys Mastermind project. There are also links to further published research evidence around computerised CBT including that relevant to autism, eating disorders, and veterans.

If you are in contact with mental health services, or have been in the past, have you tried the telehealth option? What was your experience? If not, would you like to try it, particularly if it meant you were able to receive support sooner? Let us know in the comments box below.

Thursday, 24 November 2016

Boxing Shadows - The Welsh Mental Health Arts Festival 2016

Boxing Shadows is an exhibition of over 30 artists made up of sculpture, paintings, drawings, films and ceramics in parallel with artist Stephen Park's Residency Exhibition at Celf o Gwmpas in Llandrindod Wells. It is on until 5 January 2017, and last week I attended a panel discussion and artist talks as part of the second annual Welsh Mental Health Arts Festival. Other activities scheduled at Celf as part of the week long event in partnership with Disability Arts Cymru and Making Minds 'WALLS: MURIAU' included a Comedy Evening and a drop-in workshop with new arts group Celf-Able.

Artist Rachel Dunlop wrote about the year-long Learning and Practice project at Celf o Gwmpas back in the summer, taking an in-depth look at the sessional weekends for artists who have experience or knowledge of the arts and mental health. Artist in residence Stephen Park and Powys artist Blue MacAskill have been engaging and working with artists "who have knowledge and experience of mental ill health from across the county. Working together, they have developed knowledge, practice, experience and creative aspirations and promoted wider understanding of arts and mental health".

Jane Cooke from our team with sculpture by Geraint Edwards
The panel discussion provided a great opportunity for a more in depth discussion around arts and mental health. It was attended by individuals, artists, voluntary organisations and professionals engaged in both the art and mental health sectors.

Stephen Park, a graduate of Goldsmiths College and the Slade School in London, was first up to speak. He told us that for 10 years he had been a mental health support worker, and for 15 years he was on the periphery of the art world working in art colleges. This was the first time, however, that he had spoken to both sectors "in one sentence". 

Artist-in-Residence Stephen Park
He said that in mental health there is the perception that there are lots of different approaches, probably conflicting. "It is a mix-and-match approach to help you. It is the same in art college – people are trying to become themselves and flourish. There are lots of confusing approaches."

Stephen does not feel he belongs to the art establishment – the academic world of art colleges, museums, and critical thinking. He feels the same about mental health. Institutions such as hospitals and charities have their own agenda that does not quite correspond to the internal experience of the person in it with mental health difficulties. Or the novice artist trying to find/identify a way of working.

He said that in mental health there is the idea that art is good for you. Yet staff have no understanding whatsoever what art is. "Art is terribly important. You should do it even if it is bad for you. For artists the worst eventuality is to become a zombie – doing everything to tick a box.... pay a mortgage... Artists see this and are frightened of it".

Stephen explained that he was invited by Celf o Gwmpas to run a workshop with a mental health angle. He did not take the angle of mental illness – he does not have the language for that. He can, however, understand confusion and distress. So he designed a course – having spoken to hundreds of creative people – that is one size fits all.

"If you have a creative impulse it is an infinite space which is very daunting. You need a compass and confidence and faith in what you have done. You don’t rely on other people too much".

Much lively debate ensued. Some of the points raised included:
  • There is always a focus on being positive. Society has an obsession with being happy all the time and there is something wrong with you if you have negative feelings. We should be allowed to be sad. 
  • An acknowledgement of the beauty of this project – it took people as they are and let them express their feelings in art if they wanted to – or not. 
  • The job of the artist is to ask questions. 
  • The job is to make something that was not there before. It might be questioned.

Next on the panel to speak was Sean Burns  a writer, performer and outsider artist whose work has been influenced by his experiences of psychosis. He read some of his poetry and spoke about the politics of mental health.

 “Words are weapons and I’m in a war. The war hasn’t stopped.” Andrew Vachss

A mental health support worker once said to Sean: “What d’you need books for? You’re homeless.”

Artist and poet Sean Burns, with Rachel Dunlop on his right
Sean was the first artist in residence at Celf five years ago. His latest project is Waters of Life – “creative mappings related to mental distress” – a journey along the River Usk from source to sea. His experience of the source – “it was the first time I had seen such wide horizons and it really opened my thinking.”

He spoke about Gwyneth Lewis's book "Sunbathing in the Rain" – a cheerful book about depression. “The cure for depression is the truth… It teaches you slowly to live better.”

Sean read "Gob Squad Arriving" – a poem he wrote after going to his first punk gig in 1981 in Brecon against his psychiatrist’s orders. “Learn to love your madnesses.”

Celf-Able - a new art group
Celf-Able is a new group of disabled artists in Mid Wales, meeting regularly in Newtown and Llandrindod Wells. Amanda Wells (second from left) introduced the group and encouraged people to join. There was a brief discussion on the difference between a disabled artist and a disability artist. Amanda said that the latter looks at issues of disability through art. 

The debate continued - and there was much lively discussion about the values (or not) of receiving funding to pursue artistic aims, whether as an individual or an organisation.

Stephen said that "Art and creativity is not something done by experts elsewhere. It’s done here and now. You dive in. Participate. Resourcefulness is a prime quality for artists. We can either say – they won’t let me in – and just sit there. Or we can do it ourselves. You will feel vulnerable, exposed.... scared even. But it has to be that way. That’s how you become strong and find your voice and participate. Art will always surface regardless of funding. People will use what they have in the time available."

Jane and Jackie: PAVO mental health team
Jane Cooke attended the panel with three hats on – as the Mental Health Senior Officer at PAVO, as a counsellor, and as a trustee of Celf o Gwmpas.

She talked about the language of mental illness, and asked the question – why art and mental health? How do people feel at the end of taking part? Elated? With increased confidence? Courage? Self-esteem? Involvement in other projects such as sport or the environment could attract those words. It is about oneself – referring to oneself and the rest of the world and how you make sense of things like stigma.

She spoke about the work of the PAVO mental health team, and involvement on various boards and partnerships. "When the words mental health are used, people are not referring to feeling great about yourself, "that was terrific, fantastic…" Rather it’s another way of saying mental illness".

"Health is a good thing. The language of mental health is of illness… disorders… conditions. It’s not the truth, it’s a construct. A lot of intelligent people are now challenging that." She likes to think what it would be like to create a project for “well-ordered” people. Jane encouraged us not to use the language of mental illness when writing funding bids or reports. 

She concluded by saying that "projects like Boxing Shadows help people to get beyond their internal difficulties and barriers – so there is a real value to getting funding. It gets people to a place they wouldn’t have done without it".

To find out more contact Celf o Gwmpas, tel: 01597 822777 or email:

Monday, 14 November 2016

Prevention & Early Intervention - the mental health conversation

The mental health conversation; PAVO's CEO Carl Cooper; Jane & Jackie PAVO mental health team

Last Tuesday 8 November I attended the PAVO AGM and Conference at Cefn Lea Conference Centre near Newtown along with colleagues and respresentatives from voluntary sector groups, the statutory sector, and numerous other individuals. The theme this year was: Prevention & Early Intervention - the Third Sector role in Powys.

The conference invitation stated: "It is widely acknowledged that Third Sector organisations and services have an essential role to play in prevention and early intervention. This conference will explore how these services could be an integral part of a common direction in Powys".

Carl Cooper, our PAVO CEO, opened the conference by saying: "We are delighted to have this as our theme. It is important particularly in light of the Social Services and Wellbeing (Wales) Act which highlights that support and care should be provided at an early stage to those requiring it to prevent worse things happening later in life's journey. The Third Sector has a crucial role to play in that." 

Carl then introduced the first speaker, Dylan Owen, the Head of Social Care Transformation at Powys County Council.

Dylan explained that the Early Intervention and Prevention agenda is driving council services forward to make sure that people's wellbeing is supported in the community. This includes working to support people to re-engage with their communities, and to do what matters to them.

In the past social care planning has followed a path of assessment - providing care - looking at the deficits and weaknesses - and solving problems. Now this approach is being turned on its head, with a duty to support people to make their own decisions. 

Dylan described how the council is already working closely with the PAVO Third Sector Brokers to find alternatives to help people to live independently. Isolation and loneliness are often the first step to becoming dependent on social care services, and other initiatives, such as the Powys Befrienders project, where paid co-ordinators work with trained volunteers across Powys to support people to engage with their communities, (ideally in their own language), have also proved very successful.

Community Wellbeing Co-ordinators and Home Based Support, working from community hubs, were other key services also covered in Dylan's presentation.

Next up was Stuart Bourne, Assistant Director of Public Health at Powys Teaching Health Board.

Stuart referred extensively to the Health Board's Integrated Medium Term Plan (IMTP) which sets out the health priorities for Powys up until 2018 (it is discussed in more detail in our March post Engaging with PTHB to shape future services). The IMTP contains many elements of early intervention and prevention, including approaches which benefit from joint working with the Third Sector.

Stuart emphasised the impact of quick and easy early intervention by referring to "the 30 second chat that can trigger weight loss" as recently reported widely following a University of Oxford trial. Here at PAVO we are already familiar with initiatives such as The Five Ways to Wellbeing and Making Every Contact Count.

The formal presentations were followed by 10 "conversation" groups, of which Mental Health & Wellbeing was one. Jane from our team facilitated, with support from Val Walker of Brecon & District Mind. Those who signed up included Third Sector organisations such as Hafal, Cymryd Rhan, Hay Day Cafe and Ponthafren Association, individuals who have been in contact with mental health services, carers and employees of PTHB. 

The mental health "conversation" gets underway at the PAVO Conference
The group was asked to consider some key questions as part of a larger discussion around the conference theme, including: What will this new approach to Prevention and Early Intervention mean for our organisations and the services we provide?

Some interesting points and questions were raised. There is not the space to outline them all, but here are a few to give a flavour of the session:
  • If people have dementia then making cognitive decisions about their future care could be stressful. How would this be handled?
  • People want safety and security, particularly as they grow older. Not all people will wish to stay in their own homes. There needs to be a broad range of options made available.
  • Community based means person-centred. Learn from the Third Sector who have been working this way for years.
  • A lot of community services are being closed down and there is a huge dependence on volunteers. Where is the money coming from to support this volunteering?

It was clear from the conversation that there is a gap in services before people who are distressed seek support around mental health from their GP. What does that look like? Is it more than an Information Service? Is it an additional specific role, and if so doing what?

There is also a huge issue because of the waiting lists for talking therapies in Powys. In many ways talking to someone is a form of early intervention, but if we cannot meet the demand currently what can we do differently?

Good practice around early intervention was identified in pockets around Powys and all agreed that it would be excellent if such activities could be rolled out throughout the rest of the county. We found out a little more about one particular project.

The Active Monitoring project being run by Brecon & District Mind
Val updated us on the progress of this new service which operates out of Hay and Talgarth GP surgeries, and is a joint project between the GPs in that area and Brecon & District Mind. This early intervention service will mean that the practice clinical team are able to refer anyone with symptoms of anxiety, depression, low self-esteem or stress directly to a Mind Practitioner in the surgery to be seen straight away.

To date 29 people have been seen by the Brecon Mind Practitioner in the first 6 weeks of the project. They have progressed through five sessions and the results show a definite improvement in their state of wellbeing. Others have been signposted to other organisations such as Cruse, the bereavement charity, for ongoing support. Val believed further signposting should be instigated so that the massive waiting lists for talking therapies could be addressed.

Active Monitoring is popular in other parts of Wales, including Merthyr Tydfil, and started in North-West England where it is now embedded in Primary Care services after being rolled out in 47 surgeries.

Val Walker, Service Director, Brecon & District Mind
We also heard about a relatively new Hafal pilot project in Bridgend and Swansea "to provide early intervention services to service users and families, focusing on the direct needs of young people (14 - 35) experiencing a first episode of psychosis". Referrals are made by the Community Mental Health Team and picked up by one of three part-time Hafal workers. The staff support individuals through a programme with a view to move on to community engagement or further education using Hafal’s Recovery Programme as the basis for doing this.

Jane summarised the key point to feed back to the conference
We had to pick one key point from the mental health conversation to feed back to the conference. Impossible! We had loads! Eventually we narrowed them down to three as a group, and magically Jane managed to merge them as one!
  • A lot more work is required in consultation with the Third Sector.
  • Communication is massive.
  • A better understanding of mental health is required by all. It needs to be normalised.
If you were not able to attend the PAVO Conference this year, what would you have liked to add to our mental health conversation on Early Intervention and Prevention? Let us know in the comments box below, we always love hearing from our readers.

Adrian Osbourne is Assistant Director, Engagement & Communication, at Powys Teaching Health Board. Read his Twitter Storify summary of the day.

Monday, 7 November 2016

The Blue Boy

Our guest post this week is by a member of the new Llandrindod Autism Support Group which takes place monthly at Mid Powys Mind's Resource Centre in Llandrindod Wells.

Llandrindod Autism Support Group is a place where people are accepted for who they are and can be themselves without being misunderstood or unfairly judged for being "different".

We like to talk about what it's like to see the world in a different way from those around us and how we try to cope with the everyday world.

At the next meeting, on 11 November, we shall be discussing anxiety and what we do to reduce or avoid it. I would encourage anyone who is on the autistic spectrum, or who thinks they may be, to come along and meet others like them.

This is my story…

When I delivered my son Mark on the first of July 1995, I had no idea of the incredible journey I would take in learning about Autism and how differently I’d see the world 21 years later.

There was nothing particularly unusual about Mark’s first year and my wife and I settled into parenting our first child thinking we had it all worked out. The first indication that Mark’s brain was wired differently was when he crawled into the kitchen, put the palm of one hand on the oven door and just left it there. I pulled his hand away and the blisters healed quickly. What we now know are autistic meltdowns became common, especially in shops, and we became accustomed to withering looks directed at us by other shoppers as Mark lay on the floor screaming.

From about age four, it became clear that Mark didn’t understand other children – if they caused problems he would neither try to stop them or walk away. My heart went out to him – deep down I recognised this from my own childhood.

We had already decided to educate Mark ourselves and looking back we all agree this was the best option. It gave Mark the chance to learn with less distractions than in a class room and gave us the chance to make sure Mark’s social life was one he would benefit from.

When Mark was about ten years old, we went along to our own local group for children with Asperger syndrome and met other parents struggling with oppositional behaviour, meltdowns and problems coping with school. The groups supported each other by sharing their troubles and listening without judgement. There were also books to borrow and I read avidly about other parents' experiences bringing up autistic children.

There were unexpected things such as sharing interests in historic architecture and the paintings of Gainsborough with Mark from age six, and reading and discussing philosophy from age ten. Mark developed a passion for Jazz and we played most days until he started college.

What made life so difficult was seemingly compulsive oppositional behaviour which happened many times every day and drove us close to nervous breakdown. For example, he would not get dressed to go out, even to do his favourite things such as spending a day on the local steam railway, and as the time to leave got closer we became more and more frustrated and stressed and Mark got more resistant to our pleas. Imagine this behaviour in almost every situation and you might just begin to understand why autistic children and their parents need all the support and understanding they can get.

Embracing Individuality – a group for those on the autistic spectrum or those who think they may be – takes place on the second Friday of each month, 10.30am – 12.30pm at the Resource Centre, Mid Powys Mind, Llandrindod Wells, LD1 5DH. 

For board games, a chat and a discussion about what you would like to happen next.

For further information please ring Paul on 01686 440716, email or check out the Powys Autism Facebook page.

Wednesday, 2 November 2016

National Stress Awareness Day 2016

The PAVO mental health team’s way of trying to reduce stress in the workplace – 
“Havin’ A Laugh” whilst promoting the elephant in the room recently.

One of the most popular posts on our blog over the past five years is from the very early days and simply called National Stress Awareness Day. In it we highlighted the sad fact that at that time in 2012 stress levels in the UK had doubled in the past four years, and outlined some of the well-known causes of stress. We also listed the Top 10 Tips for addressing stress, and, given the fact this is one of our most popular ever postings, hope these have proved helpful to many readers over the years.

This year the theme for National Stress Awareness Day – Wednesday 2 November – is Workforce Wellness – Your Prime Investment. The International Stress Management Association, the charity which promotes this national day, has drawn up a new list of tips specifically related to the theme:

1. Start to put yourself first
If you eat and drink healthily, schedule regular physical activity that you enjoy, and manage your time effectively, you’ll be in a better position to help others.

2. Start to prioritise tasks
There are only so many things we can do well during each day,so choose your top 3 most urgent tasks each morning and make them your priority. Reschedule, renegotiate your commitments or delegate – you can make it happen!

3. Start to make time to relax and mentally unwind
Relaxation, breathing and meditation exercises have been proven to be effective in reducing stress and anxiety, they are ideal ways to switch off AND they boost your immune system. Just a few minutes a day will pay huge dividends.

4. Start to empathise with others
There are many different behaviour styles that affect how we communicate with each other. Be aware that different people can perceive your words and actions in a way you didn’t always intend. Take time to listen to others and look for solutions.

5. Start to live life to the full
Bring some fun into your life and spend a few minutes each day appreciating the good things you have in your life. This will help you to see opportunities for growth and learning, even from the most challenging situations.

6. Stop ignoring your needs
Know what is expected of you and what is reasonable. Take short breaks throughout the day and know when and how to say ‘No’ both at work and home.

7. Stop getting distracted
If you’re experiencing too much pressure or just have a lot going on in your life, staying focused isn’t easy. It may help to ask for support from colleagues or friends and prioritise urgent, important and non-urgent tasks.

8. Stop allowing others to make you feel inferior

The key to stress-free living is to accept yourself for exactly who you are today, including past mistakes and things you might not be so proud of. Work on your self-belief and confidence and just go for it!

9. Stop being judgemental

Try to adopt a more flexible thinking style which will improve your mental well-being, whilst reducing unnecessary pressure for both you and those around you. Practice being objective and understanding.

10. Stop avoiding the things you least want to do
We often put off tasks that can become a recipe for worry. Take control and promise yourself a reward when you get it done.

The Royal College of Nursing has also produced an excellent guide: Healthy workplace, healthy you. It is aimed at nursing staff, but much of the information about the signs and symptoms of stress, and tips for reducing and managing stress, are relevant to anyone in the workplace.

Finally, if you are reading this in Autumn 2016, feeling stressed and living in Powys, there are other things you can do to help address the situation. Several courses are just about to start up across the county which are looking at stress, anger management, and positive approaches to managing your life including addressing how stress impacts on day-to-day activities and what you can do to reduce it.

Mid Powys Mind
Stress and Anxiety Management course – Llandrindod Wells, Mid Powys
23 & 30 November, 2 December.
Tel: 01597 824411 for further information.

Pain & Fatigue Management Centre
ACTivate Your Life course – Bronllys Hospital, South Powys
28 November, 5, 12 & 19 December.
The 4 week ACTivate Your Life course was developed by Professor Neil Frude, a Clinical Psychologist with over 40 years’ experience of helping people to learn and practice the core principles of Acceptance, Commitment Therapy or ACT. Tel: 01874 712449 for further information.

Ponthafren Association
Anger Management course – North Powys
The charity is currently drawing up a waiting list of people ready to start a new course in the next few months. Please let staff or volunteers know if you are interested by ringing 01686 621586.

Ystradgynlais Mind
Confidence & Assertiveness course 
This 4 weekly course will be starting again in the New Year. Please let staff or volunteers know if you are interested by ringing 01639 841345.

These are just a few examples of courses and activities running in Powys this Autumn and Winter. To find out more check out the Powys Mental Health website events calendar.

Do you have experience of stress in the workplace? And do you have some good tips which you could share with us which may help others? Let us know in the comments box below.

Tuesday, 25 October 2016

YAPS - Sharing the Voice

The Young Adult Peer Support Project, delivered by the mental health charity Ponthafren Association, recently received a welcome opportunity to help spread the word about its vital work. The YAPS project offers peer support mentoring to young people (16-25 years old) who experience mental health issues, by helping to give them a voice of their own in the development of services. You can watch a YAPS project video, and also find out about the amazing game which the young people devised where players try to access mental health services as if in the real world and experiencing mental distress. The team from YAPS tell us more:

Robin Green, YAPS Project
We were fortunate enough to be given a six month extension on the YAPS project with the aim of spreading the feedback we have received from those we have worked with over the last 3 years. In the time leading to the end of the YAPS project we have been focusing, and will continue to focus, on tackling the more sizable and historically challenging issues we have been told about while working with young people: namely that of respect and communication. To address these concerns we have been feeding back to the service providers in the form of presentations and workshops which will be followed by more in the coming weeks and months. The aim is to educate and inform the service providers on the needs and concerns of the vulnerable people the YAPS project has come into contact with. 

Most issues reported to us that are not those of individual circumstance focus on the amount of respect, empathy, and understanding (or lack thereof) that people feel they get from services or the individuals within them. This often comes down to either poor ability to listen to or understand the individual in question, an inability to encourage and support an individual who may struggle to voice their concerns themselves, and/or a restriction on the amount of time any individual can get to explain themselves effectively. More often than not it is a combination of any or all of the above. Our hope is by sharing with other organisations what we have learned from young people’s experiences, we can disseminate their voice out into the community to help change the way services operate and to help make them more accommodating to those vulnerable people who need additional support. 

To try and tackle these seemingly common instances, we hope to speak with as many service providers as possible about the importance of truly listening and giving time to someone who needs it, even if it’s only five minutes extra. We have so far delivered what we’ve learnt to over 120 individuals representing more than 15 organisations and we remind service providers that “...when a young person comes for help, they are often scared: you might know what’s going to happen next, but they don’t.” In response, young people have suggested slightly longer meetings, more invitation for the young person to control the conversation, or a box on a form to tell the organisation in advance of any anxiety or depression that might get in the way of the discussion. Depending on the service being provided, resolutions to these problems may vary but we invite service providers to explore the possibilities. 

The feedback we have received so far from the events we have attended has all been very positive. Several people have come forward to say what we have spoken about has really resonated with them on a personal level and others have enquired about how we can support their organisations further in the future so they can support their own communities more effectively. While for others we were able to offer a perspective perhaps service providers often forget: as one person wrote on twitter, “The YAPS game provides a fascinating insight into the experience of young people needing mental health support.” 

One young person once told us that: “It’s sad that sometimes it’s the services we use that make us feel bad for accessing them.” None of the young people we have met have ever seemed to display any sense of entitlement for a service; instead they often feel scared, embarrassed, or guilty for accessing certain services and this should never be the case when someone needs help. We aim to see several more important service providers before the end of our project to try to reduce the number of young people who feel devalued and not welcome in their search for the help they deserve.

The Young Adult Peer Support (YAPS) project is one of the One Powys - Connecting Voices projects funded by the Big Lottery Fund. You can find out more about these projects by contacting Barbara Perkins, tel: 01597 822191 or email: