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 

Meet our members: Lynda Cooper

Lynda is one of our members who has been volunteering at the tea parties at both South Leeds Independence Centre (SLIC) and the Community Intermediate Care Unit (CICU). Lynda wrote this post as she has been particularly struck by her involvement and the work that those at the centres do.  

Andrew and Lynda

"I can remember my first visit to SLIC so clearly.  I was welcomed by Chloe, membership and involvement officer, who introduced me to Andrew, the centre manager.  Andrew chatted about the set up of the building and very kindly took us on a tour.  The facilities were excellent and very much aimed at making the patients stay as comfortable as possible, whilst also maintaining a positive environment to enable improvement in their physical wellbeing.

 The staff are amazing, they are very busy individuals but they never let it get in the way of keeping a cheerful persona.  The patience and care given is beyond anything I have seen in hospital wards for the elderly in the city.

I personally find it very enjoyable talking to the patients at the tea parties and it gives us all the  chance to chat to someone new, even if only for a short while.  I feel we are being given an opportunity to make a difference to the patients stay by introducing new interests.  The Steering Group is soon to meet at the centre to discuss what initiatives might be welcomed by both staff and patients to improve their stay.

I think there is an opportunity to involve members of LCH and the community to spend some time visiting the centre.  There are surely a lot of people out there who would enjoy and indeed benefit from visiting the patients.  I also think the time is right to give the local community encouragement to become involved.  Perhaps children at the local schools could in agreement with the Head of the school be asked to visit the centre, both age groups could benefit from the visits and it would ensure that the young ones realise how valuable, knowledgeable and entertaining elderly people can be. 

Maybe there is a need for climate change in the way the elderly are perceived, people now go on about how people are living longer and therefore increasing the cost to the NHS. Perhaps people need to start talking about our elderly who have worked hard all their lives in much less lugubrious surroundings and circumstances, with far less opportunities, and yet seem to be ignored and undervalued by the younger generations."

Lynda Cooper

Enabling partnerships for change

We live in a simultaneously challenging and encouraging time. It is challenging as economic austerity impacts on public services and we are faced with growing social and health problems which cannot be simply diagnosed or easily solved. These problems have multiple causes and complex inter-relationships. It is encouraging as we see new energy, ideas, movements and initiatives emerging as innovative ways forward. In this era of constant challenge and change we must keep positively focused on seeing new possibilities and co-creating new futures. Fundamental to making this happen is the notion of effective partnerships. hence our reference to 'co-creation' of new futures. How can we bring together existing expertise and services in effective, authentic and supportive partnerships to make the difference?

This post is co-authored (partnership working in action!)  by Professor Ieuan Ellis, Dean and Pro-Vice Chancellor at Leeds Beckett University and John Walsh, Practice Manager at York Street Health practice, part of the Leeds Community Healthcare NHS Trust (LCH). In this post we outline some elements of partnerships established between York Street Practice and Leeds Beckett University, and reflect of how partnership working has happened and the dynamics that stimulate its work and life.

Leeds Beckett is a modern, professional regional university with a population over 2,900 staff, 28,000 students and with a firm commitment to be a catalyst for social and economic progress in and for the region as well as making its contribution and impact nationally and internationally. The university has been estimated to contribute over £450m to the local economy every year. The Faculty of Health and Social Sciences is one of the four university faculties and plays a key role in establishing and enabling partnership working 

Leeds Community Healthcare NHS Trust is a family of 65 community health services. This includes services  such as community dental, prison healthcare, district nursing and health visiting. Within the trust, York Street Health Practice is the health team for people who are homeless and in the asylum system.

The partnership between our two organisations has grown over the past two years. It embodies a number of different facets, themes and partnership links with other organisations which include the following examples;

  * A partnership between York Street and academics from social work, social care and youth and community studies to create best theory and practice in working with the marginalised, vulnerable and bringing street work perspectives. This is part of a wider international partnership with the universities of Amsterdam, Prague and Barcelona and involving Leeds Adult Social Care Services and so has an integrated care approach to the teaching and development of the work. Last year colleagues from Leeds Beckett, Leeds Adult Social Care and York Street attended a conference in Prague with students and colleagues from these universities and offered teaching and joint collaboration on academic perspectives. This partnership has resulted in funding for research into York Street Practice and its model of care and how adult social care works in addressing homelessness from a street perspective in Leeds.

* Funding has been acquired to hold an international conference in Leeds on new themes in inclusion. This conference will bring together managers, academics, organisational development specialists, practitioners and service users to look at how we create best culture for staff and best care for patients and carers. The conference will highlight international, national and local ideas and practice.

   * The development of a new undergraduate course at Leeds Beckett on youth, communities and society has York Street as key advisory partner. York Street is presently talking to key NHS figures and organisations about ensuring this course achieves recognition for best innovative practice and transformational change.

   * York Street is working with Alan White, Leeds Beckett Professor in Men's Health, looking at how we reach out to some of the most vulnerable people in the city. This partnership work was celebrated during Men's Health week last year in partnership with St George's Crypt. This brought wellbeing practice and health intervention to homeless men. It offered a move away from traditional model of health consultations to one of health conversations over food and dialogue. Health workers from LCH and other health services took part in this holistic and co-delivered event.

   * York Street is presently discussing some mental health and wellbeing research work with Professor White. York Street is also in discussions with Michelle Briggs, Professor of Nursing and Jane South, Professor of Healthy Communities at Leeds Beckett, to develop ideas and map out joint-working for the future

   * Paul Mackreth, a senior lecturer in community nursing at Leeds Beckett, is working with York Street. The team will be offering teaching on leadership this year for student district nurses.

The tripartite partnership of Leeds Beckett, York Street and St Georges Crypt has helped inform the work of CommUNity, a Leeds Beckett community campus partnership. This is an initiative that builds sustainable partnerships between voluntary/community organisations and Leeds Beckett with an emphasis on projects focused on health and wellbeing. The overarching goal is to find new, more effective ways to improve health and reduce health inequalities in communities. Combining the resources and knowledge of community organisations with those of the university creates benefits for both partners: it improves knowledge exchange and gives staff from both sectors access to different sources of expertise, widens participation and opens up opportunities for students and research.

In reflecting how and why this work happens, a number of key elements come through, three of them described here.

To start with there is a shared purpose and vision. The key people involved have moved beyond 'silo' thinking and working to what Kate Cowie, the social change specialist, would term 'a world centric view'. This view is panoramic. This vision is one that respects different disciplines and seeks to create a meeting point for them to develop and learn together. It is an explicit recognition that we work better together and can only deeply learn from and each other in listening dialogue. It looks outward and is open to the new. This provides the framework and field for the work and ideas to appear. The focus has always been on something bigger than ourselves. It has been what can support best health and care interventions with homeless and vulnerable people.

The second key to this successful partnership is that it is capable of creating positive and creative space. We may all have attended meetings where there is no freshness or innovation or inspiration. The joint meetings between Leeds Beckett and York Street have been places of trust, openness and clarity. They have been where it is possible to test and sift ideas and options. We would venture that one key ingredient here has been that the participants haven't seen partnerships as what we can get but more about what we can all contribute to the common good.

A third key aspect of this fruitful partnership has been the human element. Support, kindness, humour and respect have marked the work and tell us that partnerships are fundamentally not just about what we do but who we are. They offer the possibility to bring our best gifts to the present.

As this new year of 2015 starts we will continue on this road of trying to create a health and education partnership that makes the difference in our city and beyond. This post is a sign and witness to that commitment. We believe we are only at the start of a journey that offers potent and engaging models of how we can all work and learn together. This offers something for all of us. It also offers a future. 

John Walsh, Practice Manager, York Street Health Practice

john.walsh@nhs.net @johnwalsh88

Professor Ieuan Ellis,  Dean Faculty of Health and Social Sciences & Pro-Vice Chancellor, Leeds Beckett University

i.ellis@leedsbeckett.ac.uk  @Prof_IeuanEllis

Inspiration and the way forward

The NHS and social care along with other services face major challenges. There are financial, economic and social issues affecting the care people need. In this difficult period we are faced with different views and options for the future. In this post, myself and Pria will reflect on two themes which seem to us so vital. They are our vision and the tools to help us make it real.

The future will be decided not only by what we do, it will be shaped by what we see now. Our vision will create what appears and generate the ideas to realize it. The author, Joel Barker, says it well: "Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world." We need to elaborate a vision of how social care, health and other sectors can come together to create new ways of working. How silos can fall and new integrated solutions be created to meet need in the fastest and most effective caring manner. This vision would enthusiastically embrace co-learning and co-work with patients and carers. It could in alliance with people and communities work on a holistic approach to those in need. The Maori people speak of well being. This is a fascinating word as it is not well arm or well house or well mind but the whole person. The Maori vision sees well being as a house with four walls; the physical, the mental / emotional, the social and the spiritual ( in terms of meaning and purpose ). This holistic vision offers the possibility of circular care where all the four walls reverberate and work off each other. It is also circular as it can only be delivered by different people and services working together in a circle with and around the person. This vision could focus on the person first and foremost. The phrase 'person centred care' is used a great deal today and rightly so. However, we can only really have people centred care if we move away from seeing people as problems. The challenge is to look through the problem to the person and their gifts. This is a move to the person and their potential.

We live in a complex period. The words of Charles Dickens in 'Tale of Two Cities' about another historical period has an echo with us today. He writes, "It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness....it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us." This period includes austerity but also great opportunities to really breakthrough old system thinking and make a shift to better more humane perspectives and practice. Today is not a time for despair but vision and action. The road will not be easy but we can build or rather grow cultures and care that offer best solutions for all. However we can only do this by thinking and doing what's needed in new innovative and potent ways.

There are many tools to support this journey. We will touch on two key skills that support the way forward. The first is to see that the future lies all about us in the present. It is found wherever people care and have passion. This folk represent what the future of our services could be. Recently I met an inspirational Doncaster GP who works in a poor area. He shared the work that he was doing. He said he shook hands with everyone who came into his surgery to welcome them and connect. He said one Saturday a month he would have clinics for carers to reach out and be there for them. The GP also shared that he visited the well as the sick. This was well being work. This GP was creating the forms of the future. These positive practices of really connecting with patients, making space and support for carers and promoting wellness in the community are a sign of what could be done and is being done. We need to capture these wonderful innovative works and share them and ask what they say to us.

The second help is the use of creative space and dialogue. This is where people come together and develop a safe space where trusting and listening discourse can occur. From these transformational hot spots come ideas, inspiration , actions and positive changes. Are the meetings we attend or set up creative dialogical spaces? If we are not learning in them or finding creative energy and visions there then probably not. We need to develop the art of dialogical exchange. Our good NHS colleague, Dr Maxine Craig, speaks of dialogic change. This is where change and creativity occurs in the locus of authentic and open sharing. It's amazing how fresh thinking and practice flow from deep dialogue and connection. When we experience it we feel inspired and caught up in possibility.

The future offers us many challenges and openings. We believe that the need of a vision that positively infects us all and calls forth clear and courageous actions is central to where we need to go. We also affirm that people of passion and vision and the power of dialogue are mechanisms for the vision to become visible. To us the choice seems pretty clear. We are will either be people of purpose and passion who make a great future that works or we won't. That's the crossroads we stand at.

John Walsh, York Street Health Practice, Leeds Community Healthcare NHS Trust  
Pria Bhabra, Leeds Adult Social Care Commissioning, Leeds City Council 

Stress Control - is it for me?

When I first saw the flyer I remember thinking what a great opportunity for staff to have that kind of support. Having worked in the NHS for over twenty years I am aware that the pressures staff are working under are unprecedented and I could think of a few friends and colleagues who might want to access the classes. I didn’t immediately think it was for me.

 As I reflected on the fact that I was experiencing a number of difficult things at work, namely increased work load and lacking the job security that I had always taken for granted I began to realise that a number of things on the flyer really did apply to me. I was feeling anxious, not sleeping and intermittently struggling to eat (not me at all!) and I was worrying about what the future held for me and my family. It struck me that I could possibly benefit from the stress control classes. It struck me again and again but for some reason I didn’t ring.

I am really fortunate that I have some great colleagues and friends that I can confide in and I was able to share with a trusted friend, that I felt I would benefit from going to the classes, but was worried about ringing. My friend is a very intuitive honest and caring person and she just asked, ‘what’s really stopping you?’. I became quite tearful which was a surprise and when I really thought about it there were two things; that I felt like I was saying I couldn’t cope and the ‘stigma’ of accessing a mental health service. I have been a nurse for over 20 years and to hear myself say that was quite something, a revelation. If I could think like that as someone who has been supporting patients and their families for many years, then how difficult might it be for someone without the insight and experience I have had to access the service? It really made me think.

And what I thought was, that the things that were causing me stress were not going away and the ways I normally managed difficulties didn’t seem to be helping, so I would have to do something different. I picked up the phone and made the call. It was lovely to speak to someone on the end of the line who was sensitive and explained that they needed to take some details before putting me through to someone else. I was treated with care and respect by both the people I spoke to and I was offered a place on a six week stress control course.

That was 3 weeks ago and I have now just completed the first session of the course. I was a little apprehensive and I guess slightly anxious as I made my way to the West Yorkshire Playhouse but I was also looking forward to it. As I arrived I was greeted warmly by the two course facilitators who explained how the course would run. The clear informative delivery was interesting, engaging and inclusive. There was real acknowledgement that taking the steps to get to the session was achievement in itself particularly when you are feeling stressed. I think there were a few metaphorical pats on the back at that point!

What I saw and experienced was a group of people of different age’s genders and race sitting together and beginning to understand an ever present issue of life. It was good to know that I wasn’t on my own. We’ve only just started but I left with a real sense of anticipation (not anxiety!) and I am looking forward to relaxation in week 2. I know that the things I learn and refresh will help not only me, but my colleagues’ friends and family.

I feel fortunate to be able to access the group and while it doesn’t change the situation that may have precipitated my feeling stressed, I hope that this positive input will help me build my resilience to cope with what’s in front of me. I’ll keep you posted!

LCH Staff member December 2014

Change The Way You Think

Recently I went along to one of our Improving Access to Psychological Therapies (IAPT) service’s stress management classes to see for myself what they were about and see if I could change the way I think. After all, we have pre-conceived ideas about things especially if it is something unknown. The service said to me that people have misconceptions about the classes; that people will expect you to speak as though you’re at an Alcoholics Anonymous class i.e. ‘Hello my name is Andrew and I’m stressed’ – you don’t.  And nor do you have get on a sofa and talk about your childhood.

The session I went to took place during the evening at Leeds college of music. On arriving, there was a discrete sign by the front desk and a friendly receptionist directed me to the first floor room where the session was held.

The start of the class felt like any training I have been to in my professional life. The two facilitators, who led the session, greeted people as they arrived, checked them in and passed on an evaluation form. There was some nice gentle guitar music playing and jugs of water were available if you wanted to grab a drink.

With the session being the sixth course in the series there was a brief re-cap of what had been covered so far by Jake, one of the facilitators. The main theme for this session was sleep, and how to get a better night. There were lots of practical tips like not using laptops and phones just before bed to help you drop off (something I maybe need to remember).  We were also given advice on the things like the temperature of the bedroom and having blackout blinds. One of the interesting tips that the other facilitator, Alice, gave was setting aside worry time. This is the idea that if you are a worrier you stop yourself from doing it all the time and set aside 30 minutes to reflect on your problems and stop worry from dominating other things.

There are more details of who’d benefit from the courses and how to access them online at LeedsIAPT.com. The courses run on a regular basis so new ones are starting all the time.

Andrew Carver, Communications officer, Leeds Community Healthcare NHS Trust

Unfreezing the brain - recovering from post traumatic stress

Monday mornings are a morning of EMDR (Eye Movement, Desensitisation and Reprocessing), my favourite. As an EMDR therapist my job is to work with people who are struggling with PTSD (Post Traumatic Stress Disorder) – as a result of any kind of trauma: being in a war zone; rape; accidents; assaults; torture; really any kind of trauma that can happen to you as an adult. 1 in 3 people after a traumatic event can develop PTSD, it’s a horrible thing to have to live with – flashbacks to the events, nightmares about the trauma, feeling constantly anxious and like you’re under attack. Like a walking, talking burglar alarm, always on alert for danger. And sometimes not being able to face certain things related to the trauma e.g. can’t go to the place where it happened, and then this escalates and can stop you getting out of the house, can’t stay in your house… You get my drift. 

The clients I am seeing this morning don’t really fit the norm for our bread and butter EMDR work. The first lady I’ve been seeing for a couple of months and she’s doing really well, we’re almost done. As a result of a number of traumas through childhood and adulthood, she has a phobia of choking and hasn’t eaten solid food for six months, living off Complans, you know liquid food drinks. We’ve been working through a long list of ‘small’ traumas (these don’t feel small to her of course) and now cheesy chips and bacon are featuring prominently in her recovery.

Because life is never straight forward, this client also has checking behaviours (Obsessive Compulsive Disorder) and if I thought about it hard, would also fit the diagnostic criteria for GAD (Generalised Anxiety Disorder) and as we treat the traumas / phobia these other issues are also getting better. Working with this case has been an absolute joy for me, the client is so lovely, we have a good laugh although we are dealing with some difficult stuff and I get the pleasure of watching someone recover, enjoy eating again (what’s not to like about that) and also make other positive changes in her life.

So to EMDR. Eye Movement, Desensitisation and Reprocessing, it’s a bad title I know and it’s hard to spell. Let me try and explain what it is us EMDR therapists do. Most of the time your body copes with new information and experiences without you being aware of it. It is believed that this happens whilst we are asleep, particularly during rapid eye movement sleep. When something out of the ordinary occurs you can become traumatised by the event or by being repeatedly subjected to distress.

These experiences then become frozen in the brain and are stored in the limbic system, which is the primitive bit of our brain that deals with senses, emotions and it’s all raw. It’s the caveman / cavewoman bit of our brain – fight, flight, freeze. And when information gets stuck here – it gets re-triggered all the time usually with the symptoms of PTSD. I think of this bit of our brain as our downstairs brain (above the back of your neck). Your ‘upstairs brain’ is where we process information and experiences so they become a memory or part of our past, also known as the pre frontal lobe, (front / top of your head) which deals with reasoning, problem solving, emotional intelligence, all that kind of thing.

EMDRs job is to help move the information from a trauma from downstairs to upstairs in your brain, which given we normally do this whilst asleep, is a natural healing process. There’s some controversy at times in the world of psychology / research about how EMDR actually does work. I really don’t care, it just does and I get to see it happen.

We start off with a thorough assessment, then prepare for treatment. Then we ask specific questions about a particular disturbing memory and use either eye movements or theratappers (which buzz alternately in either hand) to replicate what happens whilst we are asleep. With repeated sets of this, the memory tends to change so it loses the distress associated with it and becomes a neutral past memory. Sometimes this can happen in one session, other times it takes longer but what is great is seeing people not only get rid of those negative symptoms of PTSD but also seeing positive benefits for clients in other areas of their lives as well. It’s a real privilege. 

Enough theory, my next client is struggling with Obsessive Compulsive Disorder (OCD) and I am seeing her as part of a research trial. She is doing well, although she has had OCD for years and years and years, not been able to work, and has been stuck in her flat, not seeing many people. She struggles to see sometimes how well she is doing and today was one of them days. I was (hopefully) top cheerleader today and she managed to achieve something in the session today, that in our first session she told me she could never even contemplate doing. Go Girl! 

Afternoon is being on duty for the service. Psychological Wellbeing Practitioners (PWPs) are on the phones taking self-referrals as they come in. My job is to be on call to give advice and support them in making decisions about treatment options etc., deal with any other new referrals coming into the service from other professionals, crisis calls, whatever. I think there’s a bit of snobbery sometimes from other professionals about PWPs, but I’ll tell you they do a really hard job really well and I’m always impressed by how good they all are on the phones.

Zoe Marsden – Senior Mental Health Practitioner and EMDR Therapist, Leeds Community Healthcare NHS Trust