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.