Being mindful of your mental health

Stress, depression, anxiety can affect anyone. One in three of us regularly feel stressed. One in four of us feel anxious One in five of us feel depressed.* 

Sabina, Dave and Berni all recognised they were struggling to control their stress. Signs of stress can vary by person but common signs include feeling on edge, angry, unable to switch off, tearful, having poor concentration. 

Each of them reached out to Leeds IAPT, either through their GP or by referring themselves by calling 0113 843 4388. To help manage their stress, anxiety or depression, it was recommended they attended the 'Stress Control' course. This runs for six weeks  at venues across Leeds, at times in the day or evening. Each session has a different focus, from learning to control your thoughts to controlling your body to helping you get a good night's sleep.

In these short films, they have described how the course has helped them:

If you feel like you need help with managing stress, you can get in touch with our Leeds IAPT team on 0113 843 4388. Find out more about Leeds IAPT - www.leedscommunityhealthcare.nhs.uk/our_services_az/leeds_iapt/

*Mental Health Foundation

1001 Critical Days

1001 critical days 

Sue Ranger, consultant clinical psychologist, within our Infants Mental Health team was invited to help develop the  1001 Critical Days Report, which was launched recently. Here she shares details of her experience...

  

"Tim Loughton, MP and former Children’s Minister, said that tackling child mental health issues and maltreatment in the first two years of life should be no less of a priority for politicians as defending the realm.

He made the comments ahead of the launch of an Inquiry conducted by the All Party Parliamentary Groups for Conception to Age 2- first 1001 days into perinatal mental health and child maltreatment. It suggests that the cost of failing to deal with these issues is estimated to be £23 billion, half of annual defence spending of £43billion, and that poor parental / child attachment can be passed down from one generation to the next, creating a vicious cycle and damaging environment in which to grow up.

The report is the culmination of months of inquiry sessions, which took evidence from a committee panels of experts and parliamentarians, to investigate the various factors that affect the emotional and social development of children from conception to age 2. The report was launched on Wednesday 25 February at the Speaker’s House in Parliament where a number of leading academics, clinicians and policy makers in the field were in attendance.

The over-arching inquiry pulls together previous research in the area to offer two main conclusions:

One is that to deliver socially and emotionally capable children at age 2, local policies need to be based on a commitment to primary prevention. The evidence presented in the Inquiry strongly indicates that identification of need should take place before the child is harmed, not after. Therefore, inspection should look closely at primary prevention measures which would deliver this result.

The second conclusion is that, without intervention, there will be in the future, as there has been in the past, high intergenerational transmission of disadvantage, inequality, dysfunction and child maltreatment and the economic value of breaking these cycles will be enormous. In addition, the report offers nine recommendations, which it says are practical, achievable but, above all, the minimum essential if society is to tackle these issues. 

I was lucky enough to be one of those invited to contribute to the process of gathering evidence and opinion to inform the new ‘Building Great Britons’ report on the vital importance of supporting infants and their families in the period from conception to the child’s second birthday. My involvement meant attending a series of several meetings in the beautiful wood panelled meeting rooms in the Houses of Parliament over a period of five months from September 2014 to February 2015 and providing verbal and written comments on the importance of early attachment relationships and support for infants and their families in the earliest days of a child’s life.

A significant and rapidly growing body of research now exists to support the clinical evidence that tells us that an infant’s environment and experiences in utero and in the care they receive in the first months of life will dramatically influence outcomes throughout their lives. If babies have positive and loving care before and after birth from parents who are physically and emotionally healthy then they will grow healthy brains and become secure and resilient children who make good progress and do well in school and beyond. Relationships are a key part of this process and that includes the relationships that parents have with professionals and services to support them in caring for their babies and young children. Proactive and preventative services are less costly in the long term than reactive services to address established difficulties so the policy makes good economic sense too.

I was formally invited to attend the launch of the 1001 Critical Days Report on Wednesday 25 February, along with various others including our local CCG Children’s Commissioner, Jane Mischenko,  by the Rt Hon Frank Field MP and Tim Loughton MP who chaired the APPG meetings. Speakers at the launch included Mr Speaker, The Rt Hon John Bercow MP, The Rt Hon Paul Burstow MP as well as MPs Tim Loughton, Sharon Hodgson and George Hosking OBE, CEO and Research Director of the WAVE Trust. It was quite a line up! The surroundings of the state rooms at Speaker’s House at the House of Commons were equally grand and impressive. Even gaining access to the event required airport style security checks and an escort to the Speaker’s House!

The grandeur of the setting only served to emphasise the importance of the agenda and the significance of this report for me as an Infant Mental Health practitioner in Leeds. Our city is one of few in the UK to have already acknowledged the importance of the first 1001 Critical Days and to already have in place a Best Start Strategy that prioritises proactive and preventative services to support families through pregnancy and the first two years of a child’s life.  Indeed, we held an excellent conference in October 2013 on this very subject at which I was able to present a paper on the ways that Leeds is delivering services for infants and their families to promote infant well-being and outcomes.  We were lucky enough to have several brilliant national speakers on the podium at the conference including George Hosking from the WAVE Trust.

A number of services and initiatives are already in place in Leeds doing sterling work in supporting these families and the infants who are the most vulnerable of our citizens. These include Early Start teams, Family Nurse Partnership Team, Preparation for Birth and Beyond, BabySteps, and the Infant Mental Health Service, to name but a few. An ambitious programme of training and consultation to support practitioners to support families is well underway.

The ‘Building Great Britons’ report is an inspiring and exciting publication that very much endorses the Best Start Strategy in Leeds and the commitment we have made to the first 1001 Critical Days. It has been a privilege to be part of the process of making a little bit of history happen in such an important area of policy. Getting things right for infants produces positive outcomes for them and for society. Truly an investment in the future!"

Sue Ranger

Consultant Clinical Psychologist 

More information can be found at www.1001criticaldays.co.uk

The Stress Umbrella

'Change the way you think'

After my anxiety stepped up to a new notch of feeling shaky every day and wanting to avoid going to work I knew I needed a little bit more help. I went to the GP and told her how bad I was feeling. She referred me to a service in my area run by Leeds Community Healthcare Trust. Completely free on the NHS, the service offers an indispensable six week course which focuses on the stress umbrella. This features depression, anxiety, overcoming fears, sleep, medication, coping mechanisms and more. I was a little sceptical I have to say – an avid reader with two science degrees and a lot of self help books, I wondered what this course could give me that was new information.

However I cannot praise the course enough. It is divided into different modules and each come with fantastic booklets full of advice and activities to last a life time, and useful homework to apply what you have learned to your week. Every week you complete a questionnaire on how your feeling, confidentially, and this is used to assess the improvements or changes in your mood so that you can get further help where necessary and monitor yourself. This course ended with many people hanging round at the end just to sing and shout their praises. I did not know things like this existed on the NHS, but it motivated me to take hold of life by the horns again. Not only am I feeling over the moon now, but the useful pack and CD are for life, I feel I can refer back to it whenever I need!

Here I break down the course with some of my opinions about it and try to answer your potential questions as a service user.

But when could I even attend?

Leading a very busy work and life schedule I was sceptical about when I would even be able to attend. The course organisers are understanding and exceptionally flexible. There are day-time or evening sessions. When I couldn’t attend one of my Thursday night sessions due to work, they easily swapped me on to a Wednesday session who were up to the module I was up to, and there were a variety of convenient locations in Leeds, including the Cosmopolitan hotel in the heart of the city centre and West Yorkshire Playhouse, opposite the bus station with abundant transport options. If you did miss a session there was opportunity to swap, or catch up via the course booklets. However, it is best you do attend all the sessions for your own benefit. As I said, the course was invaluable to me; it gave me a magnificent boost!

Who else was going, will I have to talk?

The course is not like going to group therapy. In fact, I’d liken it most to attending a lecture or classroom lesson. Each session is around 90 minutes to two hours and always features a brain/drink/toilet/chat break of five minutes or so in the middle. There are usually two speakers so as to engage your listening further (we all know focus is near impossible for two hours of just listening!). You can further prepare for each session with the booklets given out in advance of that session, so you can get a good over-view before you attend. But you absolutely do not have to talk at any point if you don’t want to. The shy and anxious among you, please be reassured, there are barely any verbal questions asked that aren’t rhetorical, and no one has any pressure to answer anything. What you do find however is some members start to recognise each other and even make friends through the course. You also have the opportunity at any time to talk to the speakers in private about further questions. There is absolutely nothing intimidating in turning up and you are always greeted to sign in and grab a drink and weekly questionnaire then sit wherever is most comfortable by very friendly experienced faces.

Now I have to be honest, I thought in the original state I was in, “right, I need CBT, I need one-on-one therapy, it’ll cost loads, and I’ll probably need it for the rest of my life, I’m such a mess”. And so I was sceptical about attending a ‘group session’. I realise now, one of the biggest boosts was attending a group session. For a start, it shows that actually there are so many in the same boat. In fact, I could not believe how helpful that was to me or how many people kept attending. The age range was phenomenal, a perfect cross section of age, race and gender in fact. And there were no qualms in me bringing along my partner or a friend (subject to space on the week’s course). This was most helpful in fact, when I couldn’t relax at 3 am in the morning and my boyfriend would wake up and talk me through the relaxation techniques leant like a prize yoga teacher!

I must say, my problems were quite specific, relating to a couple of things that happened to me in my work life that had made me very anxious in work. I was convinced the course would be far too generic to help. How wrong I was! And, it is a tribute ironically to that old proverb ‘your problems are no worse than anyone else’s. Because while I was thinking my problems were worse, or too specific – actually the thinking cycles involved in depression, stress and anxiety are highly generic. By breaking the way I perceived past situations and upcoming problems I have successfully overcome the pessimistic and over-paranoid thinking patterns.

Course Breakdown

As I mentioned, the course is split across six weeks, and each week also comes with a matching booklet in advance with more information and activities. I have taken here the official module descriptions outlined in the invitation letter and added footnotes about my experiences from the course:

Week One: Information about stress

You will find out what stress is and what it is not, the main signs, the vicious circles that keep it alive and how Stress Control works. We will show you a video of people talking about how stress affects them. We will give you a pack to keep future course materials in and encourage you to start to apply the learning between classes.
An introduction to the stress cycle. Here you will realise how low self esteem, depression, anxiety, panic, poor sleep, anger, addictions and phobias can all be linked and feed each other in a powerful cycle. You will learn how to assess your own personal stress cycle and where the points are you can cut it! I left this class feeling so proud of myself for taking a step myself to self-recovery and also feeling so normal surrounded by so many others. You will see the cold hard facts about how many people are suffering, as well as the full room around you. You will also realise, therefore, it is not you, and you are not stuck like this, and you will learn to remove yourself from the stress so it cannot feed itself.

Week Two: Controlling your body

We get down to tackling stress in this session. You will learn how your body signs feed stress. We look at why we get stressed and how the body reacts to it. You will learn three skills – breathing, retraining, exercise and progressive relaxation and look at caffeine. There is a relaxation CD to take away and we would like you to try to start to use this regularly.

I really enjoyed this session; we learnt not only breathing strategies but physical muscle exercises for instant relaxation. We had a go at doing them as a class and also received the invaluable relaxation CD which takes about 30 minutes to complete. The tracks from the CD are also available to download as MP3 online for those who would rather play through their phones or tablets. The strategies to controlling caffeine were very useful to me as it made me aware of my intake, I’m a bit of a coca-cola and tea addict but working out what time to drink it and how to count it is beyond helpful if your prone to sleep issues, nervousness or palpitations. 

Week Three: Controlling your thoughts

You will learn how your thinking feeds stress. We will teach you ways to ‘think your way out of stress’ – first of all by ‘building the foundation– ‘Wait a minute’. Then you will learn ‘The Big 5 Challenges’ and, finally, you will learn a way to nip stress in the bud – ‘Breaking stress up’.

This is quite possible the best feature of the course. Learning to challenge thoughts. You will learn to be able to strip back nervous and sad impulses and begin to think in a clear, logical way. This will vastly improve your ability to make effective decisions, think with a clear head, and remove “tunnel vision”. The key is not to avoid difficult thoughts, but rather to acknowledge them, and challenge them with the cold hard facts. Thus you will overcome self destruction and insecurity. This aids much more than your happiness, it aids your self-esteem and self-belief. 

Week Four: Controlling your actions

This session looks at how the way we act feeds stress. You’ll learn ways to face your fears and a great skill called ‘Problem Solving’. Also we will look at why some people, who seem to be doing all the right things, still don’t get over their stress. We will then teach you how to overcome this (‘Getting out of the Safety Zone’). These skills are really useful for building up self-confidence. You might start to see the big picture in this session – seeing how all the skills you have learned so far fit together.

Again, a great thing about this session is it actually builds on your confidence to go for things. It teaches you behaviours such as avoidance, why it happens, and how to avoid it. Realising this is natural and part of the ‘fight or flight’ response will help you to realise that you are actually well evolved to avoid things. You will realise therefore the behaviour is not strange but instead how to remove yourself from it – you can overcome these feelings. You will also learn about when you’re avoiding things without realising and thus how to combat oncoming factors. This means you can nip a bout of depression in the bud before it spirals out of control.

 Week Five: Controlling your panic, using your breathing to control stress, prevention skills and Medication

Panicky feelings are part and parcel of stress. This session teaches you ways to control them. We will teach you about using your breathing to calm your body and, hence, your mind. We will also look at some great ways to prevent stress. We will look at tablets used for stress and, if you feel these may help you, how to get the best out of them.

Some really useful information here about panic attacks, how to prevent them through both breathing and productive thinking. Various medications are discussed for anxiety and depression, as well as a review of the famous herbal remedy ‘St John’s Wart’, and you can discuss what drugs are incompatible with each other or suit your other problems best.

 Week Six: Controlling your sleep, Wellbeing and Controlling your future

Poor sleep is often a result of stress. It also keeps stress going as you don’t recharge your batteries. So, in this session, we will look at skills to help you get a good night’s sleep. Wellbeing starts the final set of skills as we look at ways of staying on top of stress.

Learning to completely re-set your sleep patterns is invaluable. I used to have every issue; bad dreams, waking at all hours, restlessness, oversleeping, messed up patterns. When I went into shift work this was even more compounded by my ongoing anxiety. The most useful tips in this session are those that teach you how to make your bed a haven for sleep and how to re-set your cycle so you can get back on track. However by this point, you may have found your problems significantly diffused! And to finish there is an overall summary of everything covered, further advice for moving forwards and a plan for further actions with the service and beyond. 

What happens after?

So what happens to you after you complete this course? Well, there is absolutely the option to re-attend any session if you need. But further to that there is the option to go on to one-to –one help if required, and you will have built up a collection of useful information, numbers and websites through the course. If your questionnaires still rate you as at any risk to yourself or your scores are still quite high for depression or your life is being affected you will be automatically rung for a further discussion.

How do I get on to this service?

This service is run by Leeds IAPT. The service is part of the national Improving Access to Psychological Therapies (IAPT) programme – see www.iapt.nhs.uk for more details.

You will need to initially give your details over the phone (number at the end of this blog). You will then be emailed your initial questionnaire. Complete this in your own time and then you ring the service and go through it with them in a bit of detail. This initial screening can take up to an hour but there is an option to visit face to face if you would prefer. This will assess if the course is suitable and fully register you to the service. You can then discuss which sessions you can attend. The service also sends you useful text messages before each session to remind you of the time and location.

Summary

An absolutely fantastic course which is perhaps deserves more promotion. I hope it will successfully undergo re-tender and grow. I wish that people were more aware this time of thing existed. When I first went to my GP I thought I was going to be fighting on my own for a very long time. The course as successfully inspired me to continue to pursue my goals of becoming a teacher, beating past bad experiences and difficulties. I know where ever I go in my life or career this course is invaluable and in fact I would teach it to my staff/ students/ pupils if I was ever in the position to do so. I think if you’ve ever been stressed, you could benefit ten-fold from this course.

References

http://www.leedscommunityhealthcare.nhs.uk/our_services_az/leeds_iapt/

Please visit the official Leeds IAPT site for more information. Or call directly to self-refer:0113 843 4388

I encourage you if you are not from Leeds to discuss with your GP for equivalent services.

Always look on the bright side of life – and yourself!

Do you remember that Monty Python song about looking on the bright side of life?

Here’s a bit of it..

‘Some things in life are bad,
They can really make you mad.
Other things just make you swear and curse.
When you're chewing on life's gristle,
Don't grumble, give a whistle,
And this'll help things turn out for the best, and...’

If you've remembered how the tune goes good luck getting that out of your head for the rest of today! It’s certainly a catchy one. Alternatively if you've never heard the song might be one to YouTube. I think looking on the bright side of life is a useful idea to keep in mind. Let’s face it there’s always plenty of bad stuff going on at any point in time such the state of the economy, Ebola, plight of the elderly, wealth inequalities, etc. It sure is easy to be negative about and focus on many things going wrong in life. If you had to think about five things you don’t like about work how easy would this be? On the other hand, it can be helpful to think how useful it is to focus on all of these realities too much. This is to say whether it helps anyone to feel better, or if you would just worse. Or in fact whether focusing too much on such events can change any of the unpleasantness of these situations.  

Indeed the same can be true for the habits people can sometimes get into of focusing on themselves and on the mistakes they have made at the expense of everyday ‘mini-successes’. This would be considered a thinking bias in cognitive-behavioural therapy (CBT). Let’s have a think about the impact this can have for people. If done often and in all parts of people’s lives, it can easily lower people’s confidence and leave people more vulnerable to depression. After all it’s hard for anyone to feel good about life if they are caught up with seeing the worst in what they have done all the time. This is the sort of problem that we see in CBT here at Leeds IAPT.

One example of this can be seen from a woman who shared this thinking bias and had difficulties with depression. As part of her job she completed a teaching session and evaluated this afterwards in her therapy session as being a ‘disaster’. On discussion of what had happened there was one issue she had not been able to deal with as fully as she would have liked. However, with further exploration many aspects of her performance had gone well. Overlooking the more positive aspects of her behaviour had been a typical thinking bias for her and contributed to a belief of being a failure. This can be the sort of difficulty we deal with through CBT.

Anyone can slip into this habit. Who can really say they have never slipped into this thinking bias to some extent? You know, overlooked the things you have done well in place of some small possibly irrelevant mistake. If we put thinking biases on a scale for everyone, at one end have people who do these less often, and at the other people who make these biases more often. People who make them more often are more likely to develop negative beliefs about themselves and be more vulnerable to depression or stress. Perhaps people who are half way up the scale could find themselves doubting themselves more, and having less energy and motivation to do their job. Where do you think you’d be on the scale?

The way I see it more or less everyone could do with being further towards the ‘good’ end of the scale. Here’s an idea for doing that. How about once a day taking some time to think about something you have done and what has gone well from your actions. Preferably something you wouldn’t normally recognise. Maybe it would be useful for someone you know to try this out. In any case, I hope we can agree there is some value in looking on the bright side of yourself.

Matt Garner, CBT therapist, Leeds IAPT

  

Three ways to get in to helpful thinking

And so we're a month in to the new year already. Whilst you were contemplating your New Year’s resolutions in the run up to 1 January 2015, did you consider doing something that is without a shelf life? Did you have a ponder on some of your thinking styles?

It's easy to get caught up in the hustle and bustle of life and people forget about themselves but why not prioritise something that (unlike most resolutions) is going to last forever…Your mind! 

Often in times of stress or low mood we can begin thinking in a way that is unhelpful for us and this just keeps us in a cycle of anxiety or sometimes low mood.

Three ways to get into helpful thinking are: 

• 1)      Spot unhelpful thinking in its tracks and challenge the thought!

It often feels strange to get into a habit of challenging thoughts as “I’m thinking them so they must be true right??” Not always! Sometimes we can be believing things (generally negative) about ourselves that are just not true, get into a habit of challenging those thoughts and trying to wheedle out the truth.

• 2)      Be in the moment!

Often we make ourselves so busy that we forget to be in the moment and enjoy! All the efforts we put in to making life meaningful can sometimes mean we forget to just… be. Sometimes we can be too busy worrying about the future or caught up in the past, try and shift your attention to the here and now so as not to miss out on the current.

• 3)      Try and let go of worries that we can’t affect.

Often we are worrying about things that may never or have never happened, often they are based in the future and we have no control over them. Think about the time and energy it costs you to think about something you have no effect on, think of all the things you could be doing in the here and now and attempt to make a shift to doing something that really matters to you!

Here’s to a year of HELPFUL thinking!! 

Aimee Robinson, Low Intensity Worker in Leeds IAPT 

Desperately seeking patients...the NHS, really?

The idea of 'marketing' services and seeking out patients for some in the NHS is seen as a bit of a taboo, even for experienced communicators, like myself, who have worked in NHS communications and public relations for over 11 years (and for over 18 years in total).

'Change the way you think' campaign poster

Very often we have great service and staff stories to tell and this can be done very easily through local media and increasingly, through social media.  Sometimes we have an even bigger message that we must tell as many people as possible and we need to turn to marketing tactics to help spread the word.

However when spreading that word is also about a subject such as mental health, it gets trickier again.  For some this is a taboo, something we can't even chat about with mates at the pub.  In fact it's just those people our current mental health campaign is aiming to reach.

Improving Access to Psychological Therapies (IAPT for short in the NHS filled world of jargon and acronyms) exist to help people find ways to cope with emotional stresses and strains, depression and anxiety that just won't go away and the overwhelming feelings some of us can be faced with at one point or another in our lives.

Across the country these services get a poor reputation as they're really hard to access due to waiting times being up to a year in some places. We have great commissioners who have ensured these services have good resources so anyone who needs to can get help the same day - you can even join one of our stress management seminars the following week.

But we just don't think enough people know about this service. So we have enlisted the help of the creative types at DS.Emotion and we've been working together on ideas for a campaign to make people think again about mental health services and to think if they could actually benefit from the help and support of our skilled team.

Put simply ,our campaign says to people with emotional problems, those feeling stressed or anxious, "Time to change the way you think" - and for those who access our service, that's just what we aim to do.

It's been no mean feat; in just around a month we've discussed ideas and concepts to really try and help to change the way people think, reviewed and tested messages, designed and tweaked creative visuals and launched the campaign.  In about a month! We're really proud of the work we've created with DS.Emotion and the support we've had from the experts at Boutique Media and from our colleagues in the IAPT team and others across our organisation.  

As you read this, our really important messages are on local radio in Leeds, on buses around the city, at railway stations and on social media - they'll be dropping through thousands of letter boxes around Leeds in the next couple of weeks too.

Awareness of mental health issues has changed radically in recent years, we have a great service in Leeds to help you or someone you may know, so let's all change the way we think about mental health.  

www.iaptleeds.com

Gillian Neild, Communications, PR and Marketing Manager, Leeds Community Healthcare NHS Trust

@GillianNeild

Champions for health

This is the story of a project that we formally closed last week. It was an initiative called Health Champions and ran for two to three years in Leeds. It started when Jane Willliams, Strategic Development and Commissioning Manager (Mental Health) for NHS Leeds, brought the three of us, Isobel, Charlotte and myself together. We represented the third sector (St Anne's Resource Centre), NHS Leeds Integrated Commissioning Team and a service of Leeds Community Healthcare NHS Trust. Our brief was simple. To reach out to the 13 key non health homeless agencies in the city, bring them together and create a network of health champions. These agencies included St George's Crypt, St Anne's Resource Centre, Holdforth Court, Emmaus and the Street Outreach Team. These health champions would make strong the links with established health services, raise health and wellbeing as a key issue in their organisations and work with the NHS to co-create health solutions to their clients issues.

We had a very successful training session at the old Public Health Resource Centre in Armley. We followed this with seminars on subjects chosen by the health champions and also topical issues. These included dual diagnosis, personality disorder and TB. Some vibrant open days were also held. These were open to people using services and agencies and were all very well attended. In total there were three open days, the first two focusing on mental health and alcohol. The last was an event called 'Making the Links' and brought together housing, health, faith sector, food provision, law, probation, floating support, Public Health, sexual health services and many others. The aim was to have all these services concentrated in one place so services and clients could, as we entered a period of great challenge and change, be able to 'make the links to make the difference'.

The three of us worked hard for and with this project. What were the lessons? What did we see as we tried to build this from the ground up? There were many things we learned. We will try to pinpoint three that we think have real value not just for our personal learning but for the city. The first one was that there is no place where health stops. To explain this it's best to recall that Leeds has three health trusts (Leeds Community Healthcare NHS Trust, Leeds and York Partnership NHS Foundation Trust and Leeds Teaching Hospital NHS Trust) as well as Public Health which is part of the local council. When we did the training we did an exercise to see what health work these 'non health' workers were working with. We saw masses of health and wellbeing work across services and the city from these colleagues. We heard and saw how colleagues were dealing with everything from drug addiction to mental health to physical mobility problems. This shows us we cannot just put up a sign saying 'Not Health' as there is no place where healthcare stops or doesn't exist in the homeless sector. This has especial relevance for the city of Leeds. Its health and wellbeing vision is that we all create a caring and healthy city where the poorest receive healthcare the fastest. In the training we were seeing that this commitment to the poor and sick was something non-health services were already doing and working with. Health and wellbeing should be seen as the work of us all and we should all seek to align ourselves to work with the city and its vision.

The second lesson was how well the three of us worked together. Sometimes partnerships don't actually work together that well. Why did this one? We would venture the following answer. Two of us had already worked together (St Anne's and York Street) and there existed a very positive history of good work and respect.  There was also a real exchange of ideas and listening between the three of us as well as humour. We think the biggest help was that we all sought to give. We didn't focus on what we got but rather on what we could give (and interestingly got so much back from the project). Partnerships sometimes flounder because people may seek to control and not focus on the common good and goal. That didn't happen here. The common vision and this giving attitude made the project a real joy as well as hard work at times.

The last lesson is to use the common parlance - one size doesn't fit all. We could create the framework but we learnt we had to let it develop organically. Different services took the training and work and applied them in different ways in their services. There was something here about how we balanced management and autonomy. Again we would suggest that there is a wider lesson here. Often the best services have this balance and sometimes a tension resulting from this dual reality. Without the leadership and management there would be no steer or direction, Without the autonomy and room for growth there would be no creativity or new life. Sometimes holding this balance can be a challenge but in this tension lies the path of allowing possibility to emerge and making sure things stay on track.

This article has brought the three of us back together to remember and celebrate the Health Champions Programme. But we were not the stars of the show - just its organisers. The real stars were the workers and service users who worked in this programme. They were the people who worked in the centres, hostels and teams responding to need and linking in with health for the best outcomes. It's fitting to end by saying thank you to these good people who made the difference for the better and still do.
 

John Walsh, York Street Health Practice

Charlotte Hanson, Public Health, Leeds City Council
Isobel Worswick, Former Manager, St Anne's Resource Centre

Hearing the homeless - working for best services

We all favour client participation, joint working with key partners, having a strategic vision and making a difference. But how do we do it? How do we make sure one of the key elements is not lost or ignored? Some may say there isn't always an easy answer to this. Some recent work between Healthwatch Leeds and Leeds Community Healthcare / York Street Health Practice offer a good model of how this can happen. In this blog two of the participants describe the work and its lessons.

Healthwatch Leeds is committed to a great vision - 'Healthwatch Leeds gives people a powerful voice on health and social care services in Leeds and beyond. Healthwatch Leeds helps the people of Leeds to get the best out of their local health and social care services, whether it's improving them today or helping to shape them for tomorrow. Healthwatch Leeds is all about local voices being able to influence the delivery and design of local services. Not just people who use them, but anyone who might need to in future'. Healthwatch is the official body that represents patient voice and concerns in the field of health and social care. Its work is vital and everybody in health and social care should actively and positively welcome it. 

Healthwatch Leeds contacted York Street Practice as it needed to produce a report on homeless people and health in Leeds for the Health and Wellbeing Board. The two agencies had already met and were both committed to the provision of the best patient care and experience possible in the city. In the conversation about the report, York Street decided not to host the event for the voice of the homeless to be heard. The reason was we wanted a neutral place where our patients could speak and be as open and honest as possible. We discussed with two key partners in the city - St Anne's Resource Centre and St George's Crypt. They agreed to host the event where Parveen Ayub, Community Project Worker, and volunteers at Healthwatch could meet homeless people and talk to them about health issues and services in Leeds. This work was supported by the agencies involved. It was written into a report that was presented to the Leeds Health and Wellbeing Board. The report looked at difficulties homeless people encounter when accessing health and social care services and the impact it has on their health and well-being. The report supported outcome 5 of the Leeds Joint Health and Well-Being Strategy 2013-15. In this way the voices of those who have few to speak for them was presented to the key strategic health and social care body in Leeds. The homeless were heard! 

To us this linked together many key needs. These include; positive partnerships between health and patient groups, allowing the patient to be heard in neutral but supportive environments that they trust, for patient groups to reach out to where people are, for those without power and a voice to be supported so their voice and needs are heard and for the leading authorities in the city to have this presented to them so they can feature it into their work for the whole city. This circle approach - from patients to strategy - from patient groups to health services - from the creation of positive space where dialogue can occur to changes in the system - all offer great hope and models of how we can work. 

This is how we can make Leeds the best city for health and wellbeing. It's a tremendous thing that we can work to make sure that not only the poorest receive healthcare the fastest but that their voice can be heard quickly through initiatives such as this. This might be the first time in the UK that Healthwatch and a health service have written a joint article celebrating joint great work and offering a key model of how we can work for the vulnerable. If it isn't the first time that's good. If it is, that's something good too. We see what we have tried to describe as best practice for those most in need now and a promise what future work can look like. Hearing the homeless and vulnerable is how we work for best services.

Parveen Ayub -  Healthwatch Leeds

John Walsh - York Street Health Practice

National report

On Wednesday 16 July I represented Leeds Community Healthcare NHS Trust at the National Confidential Inquiry into suicide and homicide by people with mental illness. The event took place at the Manchester Conference Centre and was opened by Niall Boyce, editor of The Lancet Psychiatry.

The first speaker was Stephen Habgood from Papyrus This was the sharing of the story of Stephens' son's death. It was titled ' All the Kings Horses'. When this gentleman spoke there was a total silence in the room as we heard the pain and loss suicide brings. Words from me to describe this story would be a very poor thing. The power of it struck me like lightning. What I can say it is that it was so right to start this event with these powerful and heart touching words. It set the centre and heart of what we were about to hear. I would like to use this space to thank Mr Habgood for his words and sharing. 

The second speaker was Professor Dame Sue Bailey, Consultant Child and Adolescent Forensic Psychiatrist at Greater Manchester West NHS Foundation Trust. This was an impacting speech. Professor Bailey drew from the Francis and Berwick reports to share her thoughts.  What I found so valuable were sentences which really struck and resonated with me. These statements don't need my commentary so I will record them as I scribbled them down. These are my summaries

          - one death - a ripple effect of thousands 
          - the need to listen to parents and families
          - the need for continual learning - all teach, all learn
          - prefix quality with safety. The two go together. If we get safety right quality will follow
         -  the need for intelligent kindness in healthcare
         -  quoting Bill Gates - 'It's fine to celebrate success but it is more important to heed the lessons of failure.'- the duty of candour

These may seem like truisms and obvious value statements. If however we all really lived and sourced them in our practice and services a real transformation could occur. 

The last speaker was Professor Louis Appleby, National Director for Health and Criminal Justice and Professor of Psychiatry at the University of Manchester.  Professor Appleby is Director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. He presented the findings of the report. The findings can be found here. The presentation ended with recommendations. These included: 

       * suicide three days after hospital discharge should be regarded as a 'never event'
       * care planning needs to be careful and effective including for those who self-discharge 
       * adverse situations / events that precede admission should be addressed before discharge
       * the benefits of reducing length of stay in in patient stay should be balanced with risks and should not be an aim in itself
       * in intimate partner homicides, mental health services should play a full role in multi- agency work and case reviews. 
       * Crisis Resolution and Home Treatment might not be suitable for patients with too high risk or who do not have good family and other service support
       * economic factors should be recognised with patient suicides and support offered with housing, debt and employment.
       
There is here a real challenge for our mental health services and other care services. I would suggest it is even a bigger call than that. Three months ago I received a call at work that a friend of mine hadn't shown up at work. A visit by the police and his father to his flat the next day found him there. He had taken his life. This was someone who had a job he liked, lots of friends, a great career future and who did a lot of good to others. I and others still have no real answers as to why our friend took his life. He never had any contact with mental health services and as far as we know showed no signs to any of us of mental illness. The answer to this is bigger than any service. I think it lies in how we create cities, conversations and cultures where people can talk about their feelings and thoughts and where we can support people to find hope in the darkness they may be encountering. This report raises vital questions and recommendations for all us to work with.

John Walsh, York Street Practice

Celebrating Positive Pathways

Positive Pathways celebrated their first year of existence yesterday at St George's Centre in Leeds. Positive Pathways 'supports people who need to find suitable housing or are having difficulty managingwhere they live due to issues connected to their mental health'. The service is led by Community Links and is a partnership with Touchstone, Leeds Mind, Leeds Irish Health and Homes, St Anne’s Community Services and Leeds Federated Housing Association.

The event was opened by Catherine Donnelly, Service Manager at Community Links, who I first met 20 years ago when we both worked for Leeds Shaftesbury Project, the forerunner of Community Links. Catherine epitomizes everything that is good about the work we all try to do -  compassion, professionalism, vision, values, hope and commitment. Catherine introduced the event and the speakers. Chris Dickinson, Head of Commissioning at Leeds City Council spoke first about the work of Positive Pathways and the support of the local council for the scheme to deliver this valuable service to vulnerable people in Leeds. The next speaker was Councillor Bill Urry. Cllr Urry is the new lead for homelessness in Leeds and has already started to go out and meet services and clients. He visited York Street last week and the previous week had been out on the streets with services working with those rough sleeping. Cllr Urry gave a humble and gentle speech. He celebrated the event and asked what he could do for the agencies and service users there. He mentioned his predecessor Cllr John Hardy who worked so hard and so passionately for the homeless. It's a great thing that Leeds has a lead for homelessness and we commit ourselves to work with Cllr Urry to develop the best we can for our people who are homeless.

The third speaker was myself. I spoke about how Leeds can become best city. The day before I had meet with two good colleagues who work with the Health and Wellbeing Board - Peter Roderick and Rob Newton. We had talked about York Street, the passion we all have that Leeds is the best city for health and wellbeing and how we can proceed with this compassionate dynamic vision. I think I was still filled with the hope that meeting gave me as I decided to focus on that theme. I said that we become the best city by creating the best services for clients and the best cultures for staff. The two are not separate - it's all about caring for people. The need and hour for 'Integral Inclusion ' is now. I tried to map out ways for us to make those services that truly care for staff and service users.        

In attending the event and reflecting afterwards many things enter my mind. To pick three key things would not be easy but I'll try. The first was that it was so appropriate that Chris, Bill and myself spoke about what out third sector colleagues were doing. It was so right for the local authority and NHS to publicly acclaim and honour Positive Pathways and by implication third sector work. These three forces - the local authority, health and third sector working together and learning together offer a real hope to this city. This partnership triangle offers a sign and possibility for the future. This work can offer the most potent and supportive options for Leeds and it's people. The event was a microcosm of what we are and where we can go.

This brings me to the second key feature. We heard the voice of the service users. This was so key. That partnership triangle always needs to have that voice at its very centre. If we don't have patient- centred care then we are not offering the best models and practice. To hear the service users and volunteers was so powerful. Their stories, hopes and optimism touched, I think, everyone in the room. Anthony de Mello, the spiritual writer, once said that the shortest distance between a human being and truth is a story. The stories we heard connected us to people's lives and the work of the partners in Positive Pathways - work that helps people change their lives. The great health and wellbeing vision of Leeds mentions as an outcome 'People will be involved in decisions made about them'. This has to be key to our work. We have to make sure service users aren't just consulted but at the heart of what we do and are involved in what affects them.

 

The last thing that touched me was where we are in services locally and nationally. I think we are at a moment where we can do great things but to do this we have to think and act differently. As the events at Mid Staffs unfolded I remember wanting to know more. One Friday night I started to read and watch about what had happened. It was a heartbreaking experience. The next day a strange thing occurred. As I worked around the city centre I was still thinking about what had happened at Mid Staffs. Unbidden into my mind came a quote I had read a long time ago. The quote was, 'The darker the night the brighter the stars'. I didn't know who is was who said this but I knew what it meant. I looked the author up when I went home and it was the Russian novelist Dostoevsky who wrote this. Not that I have read him. I had not and still haven't. The quote however appeared as a real answer. The stars, despite the darkness, were the opportunity for something new and authentic. Not just the opportunity but that this was actually happening in different places. Those of us who want and work for new inclusive cultures for staff and great services for clients - this is our hour. The old cultures and  systems have shown in graphic deadly detail where they can lead. I believe those of us who have new visions, dream brighter pictures and work to make them come true that this is our time. Of course history and life will not automatically deliver these best services and cultures to us. We have to work for them and we have to fight for them. There are many of us in the third and statutory sectors who are sowing the seeds for this future and even seeing it happen before our eyes. If you are part of this work, thank you for what you do. If not, then why not join us? 

Leading when you feel useless

John Walsh speaking to guests at a Men's Health Week
event at the Crypt

Many good leaders - even great leaders can sometimes feel useless or hopeless. The same has happened to me. I remember a while ago I did a leadership development talk and came back to York Street feeling all positive and inspirational. I had a client booked in to see me so I went into the one of the rooms at York Street to see her. After we sat down, she shared some awful news with me. She was devastated and not seeing any hope or way forward. I suddenly felt very useless, having no words or easy options to offer. The positivity and inspiration evaporated very quickly as the story unfolded and I saw in this woman's face and features deep grief. I listened and offered words of support that seemed so weak and ineffective when compared to the anguish this woman bore. We talked for a while and then she left. I left the room feeling of no use at all to a fellow human being in need. 

I have thought about this incident since. I have got to a place where I think feeling useless is actually OK. What isn't OK is not managing it and working to transform it. To feel negative emotions is part of being human - it's what we do with them that makes or breaks us. There are personal and organisational behaviours that facilitate the transformation of these negative states. If we practice these consistently and patiently we start to build good cultures and practice. We also end up better people as we are focused on the positive. The great thing about these things is they cost nothing and can change everything.  So what are these actions or approaches? I'll touch on a few.

The most wonderful thing we can offer someone is not our words or sentiments (although they can be really helpful and powerful). The greatest thing we can offer someone else is our presence, listening and attention. A friend of mine was a psychiatric social worker in Bradford. He's retired now. He told me the story of meeting a homeless man and sitting on a wall in Bradford talking and listening to this man. The man spoke of his story and life. After half an hour my friend explained he had to go and instinctively put his hand in his pocket to offer some change. The man looked at him with deep and sad eyes and said, 'Put your money away my friend. You've given me what I really needed. You gave me yourself'. When my friend described the man, I actually recognised him. I was inwardly surprised as there is no way this man would ordinarily have turned down a 'hand out' but he did. Probably because he found something better - something more healing and helpful. I'm not advising people to approach homeless men on their own in Bradford or any other city, it's always safer to do this work with others through an organisation. What I am saying is we bring to every conversation, meeting and consultation what we are. We can be like my friend - a presence that brought peace and connection or the opposite. That's the power we hold in our hands. It's actually an awesome responsibility. So reflecting on the sort of presence we will be today is no small thing.

Another thing is that we can be a mirror to people struggling. This mirror reflects back to them what they cannot see at the moment or are not hearing. A friend of mine who is a mental health chaplain in a hospital outside Leeds will often talk to the nurses on the wards. The nurses tell him of their work. He tells them they are doing a fantastic job and sometimes he thanks them for all their care for the patients. The nurses tend to light up and are clearly thrilled to hear these words. My friend usually then says, 'Doesn't your manager say these things to you?' The answer is always the same, 'Never.'  This is so sad. We need desperately to re-discover the beautiful art of affirming others. We need to speak truth to feelings of uselessness in ourselves or others. We need to help others see what we see in them. Negative emotional states blind us to what we have and are. We can see so easily the gnat and miss the elephant. I have been very fortunate to have had such great NHS colleagues as Yvonne Coghill at the NHS Leadership Academy, Catherine Hall at York Street and Andrea North at LCH Specialist Services speak to me of my own gifts and qualities in ways that nurture and develop. This really is transformational work. People start to see who they are and what that means. Accepting at times our own feelings of inner poverty is fine as long as we don't stay there. We have to own them to transform them. Own it but go through it. See it but then look up and onwards.

The woman at York Street I mentioned early on in this post got through the incident, we were able to offer support and she moved on to a life and place of recovery. York Street is somewhere where we see again and again people face the worst and somehow get through it. It's incredible how things can turn around and work out as we work it through.

If you are reading this and feeling not too great about yourself and your leadership skills and practice, take heart, good and even world class leaders go though the same. You're in good company! There's an Oscar Wilde quote that says, 'We are all in the gutter, but some of us are looking at the stars.' I hope no one reading this is in the gutter. I also hope next time you feel useless you also look at the stars too. 

 

John Walsh, York Street Practice

Men, Health and Hope

 

Last week saw International Men's Health Week celebrated at St George's Crypt in Leeds (from Monday 9 June to Friday 13 June). The aim was for homeless men in Leeds to receive a week of wellbeing and health actions and events, an idea formed by Kim Parkinson at the Crypt. Kim is the training and housekeeping mentor and a great force for good among homeless people. This idea led to an initial meeting with Andrea North and myself from Leeds Community Healthcare NHS Trust (LCH), Alan White, Professor of Men's Health Studies at Leeds Metropolitan University, Jade, a social work student at Big Issue in the north, and Kim to plan and design the format and spirit of the week. Rob Newton from the Institute of Health and Wellbeing and the Health and Wellbeing Board at Leeds City Council and Karl Whitty, research officer in the Centre of Men's Health at Leeds Met joined us shortly afterwards.

 

We, as a meeting of forces, representing the local authority, health, third sector, faith sector and education, were able to create an amazing week of events. The week included massage, meditation, podiatry, theatre, physical fitness, haircuts, song and pamper bags for the men. Running throughout were a series of positive and yet serious health messages. Health professionals from a variety of LCH services (including Tuberculosis service, Community Dental, York Street, Healthy Lifestyles Service) attended, offering connection and conversation. We deliberately moved away from a model of formal structured consultations to conversations over food and coffee - to share, engage and listen. Age UK Leeds joined the week as did Leeds and York Partnership NHS Foundation Trust. Our Primary Mental Healthcare Service provided information leaflets.

 

The event was opened by Cllr Roger Harrington, Chris Fields, CEO at the Crypt and Professor White. On Thursday, Cllr Lisa Mulherin, the chair of the Health and Wellbeing Board visited the event in support. Lisa has consistently supported these events and we are grateful for her support and voice for the poor and vulnerable of our city. Andrea North and Catherine Hall, two other great supports of these initiatives at LCH also, in their busy work lives, attended to support. A big thank you too to Sarah Elwell, the new communications officer at LCH who did an incredible job managing the photography, press release, partnership agreements, Twitter, Facebook and other media actions in such a professional and helpful manner.

I was in London for the first two days at health events so missed the start of the week. I did attend the last three days and was touched by many things. Three themes shine through. The first was the theme of 'space and place'. The Crypt is an incredible centre of welcome and wellbeing. They are one of York Street's best partners and we always try to support their good work. This brings home to me one of the key aspects we use at York Street as part of our model of work.  The people who come to the Crypt and York Street are those who often have no positive space or place in their lives. From the asylum world, they may be people who have been tortured, imprisoned or raped. In the indigenous homeless world, the vast majority of those we have the honour to try to support have problems going back to childhood. We work to create what the theorists call 'psychologically informed environments', places and spaces where people can feel welcome and accepted. The Crypt and York Street are such places as are many places in this city. The creation and development of these spaces is crucial to the human development and recovery of the homeless and vulnerable.

The second theme was that of the homeless people themselves. On Wednesday when I arrived, I sat down and  looked out at a sea of faces, each etched with stories and I'd guess, in most cases, pain and loss. It was at that moment that a former client of mine came up and gave me a big hug. I had worked with her a number of years ago. As I sat with her and listened to her present story I heard of  the struggles and setbacks as she was trying to build a more positive and healthier life. In the centre of the difficulties and pain there was also hope. This was not someone giving up but keeping on to try to get to where she needed to be. In this woman, there was the courage, the hope and belief that things, including her own life, could get better. This is what inclusion and wellbeing work is all about. It's when people can find their hope and strength that changes can really start to happen. Talking to men over the three days I had the same experience. Sensing the heavy issues people carried yet a not giving up spirit - a hopefulness against so many odds. If we ever lose sight that is what our work is really about, then that will be a really sad day. If we forget the people, we lose our way. Isn't that what the tragedy of Mid Staffs teaches us? On the Monday evening I was at an event in London with the top 50 nurse leaders in the UK, truly amazing people. I was there as guest of my good friend and mentor, Yvonne Coghill, the national lead for inclusion at the NHS Leadership Academy. Yvonne walks the national stage in the NHS. She is one of the leaders in this great service of ours. Although she never mentions it, she also makes time, again and again, to reach out and support people in the most vulnerable positions. If we ever wish to know what 'best leadership' looks like, this is it. Concern for people has to be at the heart of what we do.

The third aspect was how we all working together made a difference. Apart we are little. Together we make a powerful impact. Sometimes people see effective partnership work as some arcane art that 'business gurus' can teach us to generate. The truth is much simpler. Good partnerships happen when people who care connect. This is what happened at Men's Health Week at the Crypt. People who cared enough to put aside time to meet and act came together to do something. My mind fills, as I try to write this, with images of this in practice. Professor White sat with homeless men at a table talking about their health. Alex Hammond and his team from Healthy Lifestyles Service going straight into action connecting with men about how they can make positive changes. Dawn and Gill from the Community Dental Team at Armley smiling and talking about dental care to the men. Urban Spawl and Opera North offering arts, drama and theatre. Dr Phil Commons from Leeds Met with physical fitness. LYPFT were represented by my friend and colleague, Ken Cattle. Ken is a former mental health service user and now has dedicated his life to working with people in the community with mental health problems. Ken was an amazing presence talking to and connecting with the men there. Talking about mental health is not always easy but Ken did it again and again. The week made me proud of what we can do together, what we can be together. We have in Leeds 12 integrated care teams bringing together health and social care. These teams work to provide the best, quickest and most effective responses to those in the community. I saw at the Men' Health Week the same spirit, promise and potency. This city has a great health and wellbeing vision - 'that Leeds will be a caring and healthy city where the poorest receive healthcare the fastest'. I saw that happen at Men's Health Week. It really shows we can do it. If we can build on these experiences we can realise the vision and then Leeds may end up as, not just best city for health and wellbeing in the UK, but in Europe too.

The late Maya Angelou once wrote that, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel." I doubt any of us who participated in the week will forget how we felt in trying to make a difference. I also don't think we'll forget those faces looking to us for support and help.

 

John Walsh, York Street Practice