World Mental Health Day - researching our treatment

To mark World Mental Health Day Laura Rhodes, Mental Health Practitioner, blogs about her work in the Trust’s Primary Care Mental Health IAPT Partnership (Leeds IAPT) service. You can see more about them on our website.

I’ve worked for Leeds Community Healthcare NHS Trust in the Primary Care mental Health and IAPT Service for six years. Two thirds of my working week is spent as a Mental Health Practitioner, seeing patients for treatment, and the other third of my working week is spent as a Research Practitioner. For World Mental Health week I’m blogging about what I’ve been up to in my research role.

So today, amongst other things, I’ve been busy with recruitment calls.  One study I’ve been recruiting for today is the Coping with Depression study. This study was set up to find out whether the coping style (i.e. our typical ways of managing difficulties in life) affects how well depressed people respond to psychological therapy. We wonder if patients with a particular coping style might respond less well to treatment. If this is the case, it is important to know, and the next logical step would be to identify how we might adapt psychological therapies to make it work better for these patients.

Every week we identify patients who have symptoms of clinical depression and are waiting for ‘high-intensity’ psychological therapies. We send information about the study to these patients and contact them by telephone a week later to see if they are interested in being involved in the study. I made a number of calls yesterday and was able to recruit three new participants to the study. The participants are asked to complete some questionnaires about their typical coping responses during times of adversity before they start therapy.

In the evening I went to Yorkshire Dance in Leeds City Centre to help deliver a pre-therapy training seminar aimed at preparing patients for guided self-help CBT treatment; educating them about how to make the most of treatment.

This seminar was set up earlier this year by my colleague, Martin Groom, and I. There is already some evidence that pre-therapy training helps improve outcomes for traditional psychological therapies. But because the seminar is new for our service, and we weren’t aware of any studies trialling the acceptability and effectiveness of pre-therapy training for guided self-help CBT treatment, it was essential to evaluate whether it actually benefits patients, and is therefore worth continuing with. We are evaluating this seminar in two ways:

1. To establish the acceptability of the seminar to patients. We do this by asking them to complete feedback questionnaires to rate how relevant, how well-delivered, etc. they found the seminar. We compile a feedback report for each seminar, and ratings have been consistently high so we have confidence that the seminars are acceptable.
2. To see whether patients who attended the seminar have improved treatment outcomes compared to a random sample of patients who, earlier this year, were not invited to the seminar. We hope to have the results available for this part of the evaluation ready in the next couple of months.

I always really enjoy doing the seminars and you get a real sense that the seminar helps to enthuse people not only for their treatment sessions, but also to start having a go at using some of the CBT self-help ideas and techniques we talk about in the seminar, to take some steps towards recovery before their treatment sessions even start. 

I finished work at 7.45pm, having started at 8.30am, which makes for a fairly long day!  I’ll be back refreshed for more research work tomorrow.

World Mental Health Day

As part of Mental Health Day on 10 October, we’re continuing in our series of blogs from our Primary Care Mental Health IAPT Partnership (Leeds IAPT) service. You can see more about them on our website.

Dawn Woollin, Clinical Team Manager, talks about an average day…

No two days are ever the same for me and that’s the great enjoyment in my daily work. Although I might have weekly meeting commitments and plans with staff, the daily routine is never identical and needs to be flexible to cope with the changing demands of the day. Whilst I do everything possible to plan, there’s always something that changes and I prepare myself to be adaptable every day.

I did some work on the waiting list management this morning. This has been a large piece of work I’ve undertaken recently to improve the waiting times for clients of the service and has involved regularly meeting with the administrators to trouble shoot problems which affect waiting times. There is a high demand for our service and we need to work out ways in which clients can receive their treatment as quickly as possible. I feel like a “dog with a bone” about the waiting list management. It’s important to me that we see people as quickly as possible and anything that gets in the way of that needs addressing and ironing out so that we continue to be accessible. When I’ve chewed that bone down as far as I can, I’ll be happy.

There was some routine admin to catch up on, of which there seems to be much; it can feel overwhelming at times but I’m someone who works methodically, so prioritising and taking one thing at a time works well. I also did a return to work discussion with a staff member who was ill last week and was glad to have her back in work this week. I do place a great deal of importance on staff welfare and have always held the principle that if you treat staff well and fairly, they in turn do their work to the most effective level possible.

After this I headed over to meet with the Service Manager, the Business Development Lead, and our Performance Officer, regarding our Estates strategy as part of the wider Service Review. Some proposals have been put forward which mean we need to think about how we utilise the rooms we need for both clinical work and administrative purposes. The meeting was extremely helpful in focusing us on what we require and how we sit within the wider organisation. I like thinking creatively and find that solutions to difficulties come more easily if there’s a little thinking time – not something we always have the luxury of, but this meeting did.

There are many facets to being a Manager in PCHM and I hope this has given just a small idea of an average day if indeed there is such a thing as an average day!

World Mental Health Day

As part of Mental Health week we’re publishing a series of blogs from our Primary Care Mental Health IAPT Partnership (Leeds IAPT) service. You can see more about them on our website.
 

Here Anne Briggs – Senior Mental Health Practitioner and IPT therapist trainee talks about a typical day

I started my work day with supervision. This was a good opportunity to discuss two clients. I could reflect on a successful session with a client, and also the great progress she has made during the therapy sessions so far. She told me that whereas previously the world was grey and full of sadness, she can now see colours around her and the sadness has been replaced with hope and joy. The second client talked about in supervision is providing me with much to think about and learn. As always, my supervisor offers encouragement, wise advice as well as specific strategies to use and ways to take the therapy forward. I read a chapter from a book which also outlined the specific treatment strategy, and spent some time planning our next session and how to make the most of it, for both of us.

 I telephoned three clients whom I spoke with four weeks ago. At that time they had completed a telephone screening with myself, and having described their situation and well-being we had agreed on a treatment pathway. The phone call is to follow-up this conversation, to hear if their situation or well-being has changed since then, and if there is any other support they need while they are waiting for their first treatment appointment.

 One of them said that she felt better just knowing that there was a plan for treatment, despite the wait for it to begin. She felt better for talking to someone about how she was feeling, and that the hardest thing to do was to call our service to make the appointment – like facing up to it, moving towards accepting there is a problem. I hear that often in this job, that the hardest thing to do is to acknowledge there is a problem, to accept it. By taking that step, then this is a step in the right direction, that is progress.

World Homeless Day

The other day I was returning to York Street Health Practice from a meeting. On the wall nearby I

Client visiting the GP at York Street

saw a homeless man I know very well. He was sat by himself and waved over. I went over to the man and we started to talk. It was good to just be there. I tried to listen and help. I have often thought many times clients often give us far more than we give them. I looked at this man. His body was under nourished. His clothes poor and not well kept. His face was much older than his years and his beard and hair were not well cut or combed. Yet when he smiled his face lit up and his eyes shone like a child's at Christmas. We talked for a while and then I had to go. I have thought about the man over the last few days. He is the reason why places like York Street exist and he is not alone in this world.

Today is World Homeless Day. It is a day when we remember homeless people everywhere. The aims of the day are

                                             * educate people about homeless issues

                                             * celebrate and support local good works

                                             * highlight local issues  

York Street is the medical team for people who are homeless and in the asylum system. It is part of Leeds Community Healthcare NHS Trust which is 65 services working with people and communities. Leeds as a city has a very dynamic health and wellbeing vision where Leeds will be a healthy and caring city where the poorest improve their healthcare the fastest. This is a vision which we enthusiastically embrace and seek to embed in our work. This vision is lived out by people and services across the city. It is also powerfully and wonderfully supported by Cllr Lisa Mulherim, chair of the Health and Wellbeing Board and Cllr Bill Urry, the lead for homeless issues. York Street receives visits and strong support from the directors of Leeds Community Healthcare and national NHS figures such as Yvonne Coghill, Steve Field, Rob Webster and Aidan Halligan. This illustrates a real coalition of care across our city and country to work for and with the most vulnerable. This is something to really celebrate and spread. So on World Homeless Day we express to all these friends and allies our deep thanks. We also thank our good partners across the city - the Crypt, Simon on the Streets, the Street Outreach Team, the hostels, Housing Options, the faith communities and so many many more. Thanks to you all. We can only do what we do because you do what you do. And that's the way it should be. Partnership is the today, tomorrow and future of our city. Together we make the difference.   

The sign of a civilised society it is often said is how it treats its most vulnerable people. We have in Leeds some great practice, innovation, compassion and vision. We have much to rejoice over and much to do. We owe it to ourselves to create the most humane and caring society we can. We owe it too to our fellow human beings who have fallen on hard times. We also owe it to the man sat on a wall with the shining eyes.

John Walsh. York Street Health Practice

Dancing in Winter

Leeds Beckett University and York Street Health Practice are just starting to plan research on the work, model and care the practice tries to provide to people in Leeds who are homeless or in the asylum system. I met the other day with my good friend and Leeds Beckett colleague Dr Erika Laredo. Erika teaches Youth and Community Studies and has been a key element in the work between York Street, the university and Adult Social Care in working to create the academic and practical space where best practice and theory can emerge. We met for coffee to discuss York Street and I tried to explain how we work, what we do and the model of care we use. In the context of this dialogical exchange I realised more fully and deeply then ever that Erika could not properly understand York Street and neither could I without seeing it in terms of what was happening in the NHS nationally. It was only in the bigger picture that York Street makes so much sense and offers so much possibility. The metanarrative here was this. This bigger theme was the real story of which York Street was both product and response.

 At the end of the day I thought of the people I had spoken to or had contact with that day. The answer was both surprising and charming. There was my great and true colleagues from Leeds Community Healthcare like Steve Keyes, Catherine Hall, Eleanor Wilman, Anne McGee, Jo Speight and Lisa Falkingham. There was Anne Cooper the Lead Nurse For Informatics at NHS England. There was Alicia Ridout from the Health Innovation Services at The University of Leeds, Maxine Craig, OD Lead at South Tees NHS Trust, Becky Malby from the Centre for Innovation in Healthcare Management and the Leeds LAMSOC ( medical students championing quality and caring leadership ). There was Dave Ashton and the inestimable Yvonne Coghill. There was of course my good colleagues at York Street working for the homeless. And there was an inspirational student nurse called Louise Goodyear who is at Wolverhampton University. What struck me was all these people connected with the NHS represented a movement - a force might be a better word that represents what the future of our service could be. Feeling both humbled and proud at the same time I saw how York Street was part of this energy that was working to create new ways of thinking and being a health service. In fact I believe the connections were precisely because people were moved and held by the same visions and hopes.

So what is this movement? What does it mean? What does it seek? What happened at Mid Staffs Hospital is the clue and key here. It  shows us the old system at its worst. Hence the need for fresh thinking and ideas about where we go. Across this service people and movements are working to ask the questions, have the dialogue and seek the solutions we all need. Creative innovative thinking and practice are mushrooming all over the system.

What are the signs of this movement and its people? There are probably many. The following come to mind.

    * Innovation

    * Openness to others and new ideas.

    * Effective and learning / teaching partnerships with the third sector and faith communities

    * Compassion and goodness as central values

    * The use of digital technology to enhance the speed and quality of access to healthcare

    * A move away from 'We know' to 'We offer - let's work together'

    * A real commitment to dialogue

    * A listening to needs and hopes

    * Positive risk taking

    * Seeing gaps and issues and raising them

    * The use of intuition. Einstein's point about the intuitive mind rings so true here. 'The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honours the servant and has forgotten the gift.' This movement celebrates the gift.

    * This movement values systems but sees beyond to people and communities as central and as living and vibrant assets.

When I think in images of the old and new, I see two things. When I think of the old system I think of a great mechanical machine that works to produce something. To be fair much good was done through and in the old system. Yet the image of machine echoes true to me. And this new movement? The image that comes to mind is a dance where the dynamic interchange goes on and on in different forms and shapes. The Hindu faith tradition has a wonderful way of describing the cosmos and life itself. It calls it a  dance - a dance of energy, power, being and opportunity. The symbol of   dance helps understand this move across Health. There may be disagreements and debate but there is a direction. There may be different voices and ideas but there is real vision,potency and participation. 

Mid Staffs probably represented the worst point in the history of the NHS. It was a dark night for our service. The shock, scandal and heartbreak we all saw and felt expressed our devotion and commitment to the NHS. Health had entered a winter season. These new movements, services and people are a counter sign to that. They are the signs of a better and new tomorrow for the NHS. They are the signs of hope and renewal. They are the signs of spring.

John Walsh. York Street Health Practice                      

The good we do

We have wanted to write a blog post about goodness for some time. We have also wanted to write a post about our identity, who and what we really are. Last week gave us the inspiration we needed to try to write. I (John) attended the leaving party of Dave Ashton, the Head of Practice at the NHS Leadership Academy. It was a real joy to join many good colleagues including Dave Thornton. The evening was a toast to Dave on his retirement and a recollection of his unique qualities and presence. I have met a number of people who work or who have worked with Dave. The constant appellation used by them in connection to Dave is the word "good." Phrases such a "such a good man" and 'good people like Dave' pepper the conversations. The same word is used unfailingly of Yvonne Coghill of the Academy too. There is clearly something about Dave and Yvonne that touches, connects and inspires others. The people who have used this appellation come from different levels of the NHS and some don't even know each other.  I sat at the event and heard tribute after tribute to a kind, warm and wise man who had made such an impression on so many.

Goodness is an incredible power. It lifts and lights us up when we are not in a good place. True goodness never makes us feel little, inferior or ashamed. It rather illumines what we are and can be at our best. It draws us to a dimension of being where we know that we are good and can be even better. A dazzling witness to the fragrance of goodness is Anne Frank the young Jewish girl arrested by the Nazis. 60 years ago this month she was arrested by the occupying Nazis in Amsterdam. She died the following year in the camp at Belsen.

Anne Frank in the midst of the darkness that Nazism was holds out a message of what we are all called to be. Anne was an ordinary girl who offers a voice for what really matters. She writes that, "In spite of everything, I still believe that people are really good at heart." This amazing statement should give us hope that all can change and that there is, in the darkest heart, a good spark. That flicker can become a flame and that flame, the light of possibility. Anne actually gives us a living guide in her words to life and a better world. They are a charter for goodness despite the darkness. We will share a selection here.

Anne speaks of "How wonderful it is that nobody need wait a single moment before starting to improve the world." Yes - we don't need a degree or permission. We can start right now where we are. One of the most beautiful services in Leeds is PAFRAS ( Positive Action for Refugees and Asylum Seekers ). It started when one generous person opened up her car boot to give our clothing, food and help to the most destitute. Today it is a thriving and caring service in the city. Right where we are is the place our positive passions and hopes can start to be realised. Anne describes this, "Parents can only give good advice or put them on the right paths, but the final forming of a person's character lies in their own hands."

Anne teaches us that in the darkness we mustn't give into its grip and power. She talks of how her own principles were challenged. She writes "It's really a wonder that I haven't dropped all my ideals, because they seem so absurd and impossible to carry out. Yet I keep them, because in spite of everything, I still believe that people are really good at heart." Her hope was grounded on the fact that good exists in all and who knows when that good will start to flow and happen. She wrote that "Human greatness does not lie in wealth or power, but in character and goodness. People are just people, and all people have faults and shortcomings, but all of us are born with a basic goodness.”

Anne also knew how this approach illumines the world. "Look at how a single candle can both defy and define the darkness." The single candle of a good human candle can shine and bring light to many. This light doesn't burn solely for itself but for others. She knew how goodness is infectious and once started is like a mighty wave. "Whoever is happy will make others happy" she writes in her diary.

Anne's focus on goodness was aligned to kindness. Her words are "In the long run, the sharpest weapon of all is a kind and gentle spirit.” This 14 year old girl going through such a nightmare was possessed no doubt of a deep wisdom. She found her joy in the beautiful things of life. "I don't think of all the misery, but of the beauty that still remains."  Anne mentions her death. "I don't want to have lived in vain like most people. I want to be useful or bring enjoyment to all people, even those I've never met. I want to go on living even after my death!'' And this has happened. A young girl living in an encroaching darkness speaks words of goodness, kindness and light - words that help us along on our daily path today. A child teaches us out of her wisdom what we should know but often don't.

Anne possessed a deep awareness of life, beauty and goodness. This was, we believe, her deep identity; her true self. Goodness is that heart that warms and cheers another. It's those words, actions and even looks actions that connect us and touch us. People like Dave and Yvonne shine with this.

Anne Franks' experience in Amsterdam seems a long time ago. Yet its message burns brightly whenever someone, despite the problems, reaches out to love, care and do good. Out of such actions the hope of a better tomorrow will come and it is those who do so who really make history. It tells us that goodness is our true identity. To fully live is to be fully good. That's the promise what Anne's message offers. It's a clear and bright message to a world that often seems so very lost. It's incredible that in the midst of a system that stood for destruction she pointed to goodness.

John Walsh. York Street Health Practice. Leeds Community Healthcare.

Lisa Falkingham. Service Improvement Team, Leeds Community Healthcare 

Philosophy and the workplace

We have a rich history of philosophy ranging from ancient writers like Plato and Aristole to modern day philosophers like Sartre. Can philosophy have any relevance to a workplace or service? Or is it something mainly for the academic books and university classrooms. In this post I will offer the words of Hegel, the 19th century philosopher, as an insight into some of the problems and challenges we face in our work and life. Philosophy should be something that has relevance in the streets and offices of the world. Indeed the likes of the ancient philosopher Socrates went into the streets to listen and engage on his ideas.

Georg Wilhelm Hegel was a philosopher who died in 1831. He has had a massive impact on philosophy and there are still people today who call themselves 'Hegelians' in honour of this eminent philosophers ideas. What I will present in this post is my understanding of Hegel and what he can teach us as we try to make the best cultures for staff and create the best care for patients. In doing so I offer what I understand the words to mean. It may be that eminent Hegelians may correct me on my understanding. That's fine, I accept that. It's all part of the process. So here we are and here we go.

 “Nothing great in the world was accomplished without passion.”

Passion is the engine and fire that drives work and development. A friend of mine who sometimes delivers talks and speeches often gets the kind compliments such as, 'We felt your passion coming through' and 'Your passion shone through.' This gives us an important clue. Passion connects us with others. It shares with them what matters to us. It is a fire burning brightly in our heart and mind and is capable of enkindling light and flame in others. Hegel tells us we need passion. Without it we will not accomplish anything great.

Passion is actually very common. It's just that we don't always recognise it. We see it when a young mum is battling to get the kids ready for school and gets them there day in day out. We observe it when perhaps after the bereavement of a loved one a person devotes themselves to raising money for a charity. They will offer their time, resources, voice and energy for this to occur. This is all passion and i'm sure we have all seen it and been touched by its presence. The sad thing is where someone has lost their passion. This is also the scary thing. Where did those high ideals, commitment to others and good intentions go? I suppose it's often not a sudden thing but a slow wearing away of vision, values and hope. Andrew Harvey, a writer, talks in one of his books about growing up in a house with his family. One day one of the walls fell in. Termites had been eating away at it for ages and no one know. It then fell. This eating away of our passion and principles takes place whenever we allow cynicism, negativity and nastiness to enter our work and thinking. Passion also need to be kept alive. The furnace needs constant fuel to keep it burning well. Positive and visionary people and networks, a big vision, good reading and the development of a deep and abiding hope are all wonderful helps that ensure the nurturing and sustaining of passion. Hegel's message is so needed because with passion we can do great things.

“Only one man ever understood me, and he didn't understand me.”

This hits on a very true thing which is that we as human beings are or can be,  very complex people. We are not robots or computers ( although we are learning that modern technology sometimes seems to have a mind of its own and what worked well yesterday won't today but will tomorrow ). We may remember at school we would have those puzzles that said 'If it takes three men two days to dig a ditch how long will it take two?' There was a mathematical answer. However, in real life it really depends on the people. There may be two of the best and strongest people and will do it quickly or may be the opposite. Complexity is a feature of humanity. Humanity is actually a mystery. We have so many commonalities and yet such differences. We can sing like angels, paint things that take our breathe away and show world changing compassion. We can also as a race kill, hurt and betray. It seems we have in different human beings such variations of good and bad. Hegel points us to this. We can never really be understood in our depths. We may know lots about our self and others. We may know ourselves and others incredibly well. And yet there are parts of us we do not see or cannot fathom. This bears on work as while we have policies and processes to follow, we should also try always to see through to the human standing in front of us. We may not know, may never know, what the issues are in their life. They may not know fully either. This should lead us to be always polite and professional with all while following whatever process has to be followed. If a chink of light shines through and we see the problem or issue then we can offer help and support.

“The only thing we learn from history is that we learn nothing from history.”

Sometimes in a  work setting a person with an issue repeats the same behaviour again and again. Nothing seems to work. We need to balance this with the fact that people do change and 'we live and we learn.' Work Systems can also be like this. We keep going on with them even when they have stopped working. We even re-invent them and call them by new names! The truth I believe is that if we don't change the way we look at something we just get keep getting the results of the old thinking. Einstein once said that 'No problem can be solved from the same level of consciousness that created it.' This points us to the need to learn from history by transcending the mental boxes the old answers and problems come in. Fresh thinking on old problems will help us avoid that 'Groundhog Day' syndrome.

“The length of the journey has to be borne with, for every moment is necessary.”

Hegel is here telling us a vital truth. We are all on a journey. We walk along a life strewn with lessons and possibilities. To get to where we need to be we need each moment. I remember working with a homeless client at York Street who had so many awful issues going right back to childhood. The recovery and transformation of that man has been incredible. Yet his journey, long, difficult and unpicking so many things, could probably not have occurred in any other way. He could not jump over all the scaring issues and be whole and sorted all at once. That would have been a very nice event but the lessons probably would not be there. It was in the journey that he found himself and meaning and purpose in life.

The good news here is that even the winter seasons of life have purpose and promise. We can even find in these somewhere sometimes the first shoots of spring. Our life is really about discovering who we are and what we are. That is a deep and wonderful journey. We can't achieve it in a day. It takes days and nights and even the tough times can help us grow and live if we can accept and transform them. Sometimes life or others have really hurt us. We might feel cut, hurt and incredibly let down. In this state we actually stand at a precipice. We can either from this become either wounded healers or wounded hurters. Our pain can cause us to somehow become more empathic and caring or make us bitter and project it outwards onto others. The late Henri Nouwen wrote a book about wounded healers. These are the people who themselves bear wounds but don't transmit them. Somehow they have transformed them into service, kindness and vision.

So Georg Wilhelm Hegel tells us some home truths about the need for authentic passion, the complexity of ourselves and others, the need of fresh thinking and the  difficulty and glory of the life journey. If we look at this in terms of a manifesto for work and change we might find the following

        * Be passionate

        * If we have lost our passion we need to re-kindle it

        * Know humanity can be difficult to understand at times and be tolerant 

        * Follow processes but always see the person stood there in front of us

        * Old thinking will create what it already existing as the problem

        * Fresh thinking can bring creative solutions for the future

        * The challenge is to stop reading and own the story. To consciously own our life and make it the best for our self and others.

        * Life can be really tough but even from these dark places we can grow and deepen

I don't think this would be such a bad manifesto for us all. In fact it might even lead us to a re-energised and renewed service. We have much to learn from these giants of history like Hegel. And as someone once said if we stand on the shoulders of a giant we can see for miles and miles.

John Walsh. York Street Health Practice.