LET`s GET PHYSICAL - Scottish Association for Mental Health
Transcription
LET`s GET PHYSICAL - Scottish Association for Mental Health
auTumn 2oo9 ISSUE 29 LET’s GET PHYSICAL Scottish Mental Health Awareness Week 12 ALSO INSIDE THIS ISSUE John Beattie's Talking Points 4 Mental health in the Western Isles 24 2 3 conTenTs Welcome 4 Talking Point: John Beattie 6 News 8 Brain Bomb 10 Living Better 12 Scottish Mental Health Awareness Week 15 Make your Point – Survey 19 To the Point 20 Whose Evidence is it Anyway? 22 Why I Like to Dig Tatties 24 Mental Health in the Western Isles 26 Branching Out 28 The Facts 30 The Stories of our Lives The Point is printed on paper from sustainably managed forests. When you've finished with your copy, please pass it on to someone else or recycle it. ADVERTISE IN THE POINT Call Carolyn Roberts on: 0141 568 7000 or email: [email protected] to discuss options. Discounts may be available for bulk bookings. CONTACT THE POINT Want to comment on something in this issue? You can contact us with views, comments or suggestions for future articles at: THE POINT IS ALSO AVAILABLE ONLINE AT: WWW.SAMH.ORG.UK The Point, SAMH, Cumbrae House 15 Carlton Court, Glasgow G5 9JP Telephone: 0141 568 7000 Email: [email protected] Print: In Position Media Design: haiwyre.com © SAMH 2007 IISN 1740-908x. All rights reserved. If you would like to receive The Point in large text format, please call: 0141 568 7000 3 weLcome Mental Health Awareness Week runs from 4–10 October this year. In my job, it can feel as if it is Mental Health Awareness Week every week of the year. I talk about mental health all day, every day. So do my colleagues, and so do the literally thousands of people who work or volunteer in mental health across Scotland, whether as healthcare staff, service user/carer representatives or support workers. So why bother with an awareness week at all, if it’s already such a hot topic? Because it’s not. People who don’t work in mental health barely talk about it at all. It remains a taboo subject. And the effect of all this silence is that it continues to come as an enormous shock to people when they develop a mental health problem. On top of their illness, they have to deal with fear, uncertainty and often shame: not only their own but often that of their family, friends and employers too. Awareness weeks can sometimes seem a bit devalued. Throughout the year, we are exhorted to devote whole weeks to raising our awareness of subjects including sandwiches, chips and compost. So it’s understandable that people can feel a bit weary of the whole concept. But I urge you not to ignore this one, because it really matters. Too many people are living with the unwanted baggage that comes with a mental health problem – the sudden silences when you walk into a room, the stilted conversations with once-dear friends, the pressure to pretend that everything is fine when that couldn’t be further from the truth. And too many others are living in ignorance, convinced that mental health problems only happen to other people. That’s why, in this issue, we’re delighted to showcase just a few of the events that will be taking place during Mental Health Awareness Week this year. And we’re also delighted to highlight some other beacons of hope that flicker across Scotland, from Catch 23 in the Western Isles to the Forestry Commission’s Branching Out project in Glasgow. Elsewhere, we hear from Mark Fleming, whose recent novel BrainBomb does much to combat the perception that mental health problems don’t happen to “normal” people. Pippa Coutts tells us about the Living Well project which aims to help people living with long-term health conditions to improve their mental health and wellbeing. And former Scotland rugby international John Beattie reflects on his mental health Talking Points. So please join everyone at SAMH in celebrating Mental Health Awareness Week. It’s our once-a-year chance to get everyone talking about mental health: and start to drown out that perilous silence. Carolyn Roberts Editor SAMH produces The Point magazine in order to promote discussion and debate. The views expressed in The Point do not necessarily reflect those of SAMH. 5 Talking Point In this regular feature, we talk to Scottish celebrities about their own experiences of mental health. For this edition, we spoke to the former international rugby player, John Beattie. What does mental health mean to you? Mental health is as important as physical health. It means being relaxed inside my own skin, being at ease with the world, and being able to function. I seem to wake up happy each morning, which infuriates my family, but it gives me an ability to shrug things off. I think I am sane, which might be worrying, but I know that at times I haven’t functioned properly. What do you do to protect your mental wellbeing? I clear my head by exercising. I find that if I go to the gym, or take a walk, or coach my rugby team, or get up on stage with my band or play my guitar, or watch or listen to music or comedy, then I can retune my brain if it has been whizzing. It’s also important to me to talk to people so that I can tell them how I feel at times. I suppose I bottle things up to myself a lot so I do have bits of my life I set aside to recharge. I know I should take more holidays as well because a good break can be wonderful. I was sitting by a lake recently, listening to the waves, and it was so good. I also try to enjoy the work I do. If you have ever experienced a mental health problem (including stress or anxiety), how did you deal with it? I have felt stress a few times as various bits of my work can be stress inducing. If things are going pear shaped in relationships or work then I can have a sleepless night and I have had a few of those. Again, I consciously exercise or take myself into a different environment to clear my head to rationalise things and then come back to sort it. I admit to being a typical man though, in that I often can’t or won’t tell anyone how I really feel. There have been times when I wished I had been able to speak to someone. Is being a celebrity helpful or harmful to your mental health? I am a fourth grade celebrity at best, but one element of slight fame is that my wife gets annoyed when I am recognised. None of the issues get to me – it is, after all, my fault as I wanted to be famous as a rugby player in the first place. Plus, I have to accept that where others can switch off in certain situations, I can’t so I enjoy it anyway. 6 news PSYCHIATRIC CARE UNITS UNDER AUDIT NHS Quality Improvement Scotland is auditing Intensive Psychiatric Care Units (IPCUs) in Scotland. This honours a commitment in the organisation’s 3-year strategic work programme, Improving the Quality of Mental Health Services, and follows a recommendation from Scottish Government research that NHS Boards should standardise their definitions of IPCUs. The audit aims to find out how many IPCUs there are, how they are structured, how they work with other mental health inpatient units and what users and carers think of them. The research group has visited all IPCUs in Scotland and has also visited NHS board areas without IPCUs. A report on local services will be published in October 2009, while a full report and account of users and carers’ views will be issued in spring 2010. Phase two of the work will be informed by the findings in these reports. THE FUTURE OF DISABILITY LIVING ALLOWANCE A recent story circulating the internet has caused anxiety for many disabled people by claiming they have “100 Days to save DLA”. The story is based on a government green paper about how social care is funded in England. The paper does discuss future options including using disability benefits but at this stage there are no plans to abolish DLA. SAMH and other mental health charities in Scotland will be highlighting to the government the value of DLA in promoting recovery and MSPs have also signed a motion on the need to protect disability benefits. STRAW LAUNCHES mENTAL HEALTH COURTS The Justice Secretary for England and Wales, Jack Straw, has launched new “problem-solving courts” for offenders with mental health problems or learning disabilities. Developed using the successful model already in place for domestic violence courts and drug courts, the Ministry of Justice says that mental health courts will help the judiciary and magistrates better respond to offenders with mental health problems by helping provide timely access to health services, offering tailored sentences and ultimately reducing reoffending. 7 LANDmARK RULING IN DEPRESSION CASE A former council chief executive who experienced depression has won her defence against a council which sued her, alleging that she had withheld details of her mental health problem in a job application. Cheltenham Borough Council was suing Christine Laird for £1m in London's High Court. Appointed as Managing Director of the company in 2002, Mrs Laird left in 2005 on an ill-health pension after being off for some time due to depression. The council stated that Mrs Laird had been deceitful in not disclosing her illness in a medical questionnaire which included the question “Do you have a mental impairment?” Mrs Laird argued that she had previously experienced stress-related anxiety and did not consider this to be a mental impairment. She further argued that she had been bullied and harassed at work. The judge ruled that Mrs Laird’s responses in the questionnaire were not false and nor, "given the terms of the questions asked, were they misleading." Campaigners have said the case highlights the difficulties that people who have experienced mental health problems face when deciding whether to disclose their health history in job applications. TWO mAJOR mENTAL HEALTH CONSULTATIONS UNDER WAY The Scottish Government is currently consulting on the future of both the Mental Welfare Commission and the Mental Health (Care and Treat ment) (Scotland) Act 2003. The Mental Welf are Commission consultation follows the Scottish Government’s decision earlier this year to step back from its previous decision to abol ish the Commission and incorporate it into a new body to be created under the Public Services Reform Bill. The consultation puts forward proposals for both the governance and the focus of the Commission, and seeks responses by 25 Septemb er. The Public Services Reform Bill is now being cons idered by two Scottish Parliament Committees: the Bill proposes changes to the scrutiny of health and social care in Scotland, but has rece ived early criticism for appearing to give the Scott ish Government greater powers over scru tiny bodies. Separately, the Scottish Government has issued a consultation in response to the rece nt limited review of the Mental Health Act, led by Professor Jim McManus. The McManus report proposed changes to the Act in areas including named persons, advance statements and the length of time which can elapse between the end of a detention order and the date on whic ha Mental Health Tribunal must be conv ened. This consultation closes on 6 Novembe r. B M BO bra n Scottish author Mark Fleming writes about the facts and the fiction behind his debut novel. BrainBomb is a novel. But its background is real and its protagonist, Neil Armstrong, is mostly me. When I fell ill in 1987 I’d never heard of bipolar. With hindsight I recognise the classic symptoms: anxiety, guilt, isolation, hopelessness, apathy. But my bipolar journey was one I didn’t realise I was undertaking until it was too late to avoid the trainwreck. I was 24. I’d left college with a publishing degree. Waiting for suitable vacancies, I joined an employment agency. My colleagues were mostly youths like myself, out for a quick buck. We worked hard, socialised harder. I got used to this whirlwind lifestyle, living like some rock star. Except I wasn’t: I was a clerk, up at seven every morning, bleary- eyed, hands quivering. I lived at home but went partying straight from work. Late-night pubs and clubs became my second home. My parents saw me as an occasional wraith. I began suffering massive mood swings, from elation to despair. Mostly despair. I hardly slept. Bipolar lurched into top gear. My whole perception became warped. I was signed off work with medical lines euphemistically labelled ‘stress’. I became reclusive. When friends phoned I refused to speak. I had to be dragged to the doctor; then the psychiatrist. I became delusional, convinced my blood was infected and I was dying. Norman Tebbit was on TV, banging on about shirkers. B I was adamant he was talking about me. My doctor was a football thug. At one point I thought I’d slipped through a time warp and was reliving 1967. Friday 13th November 1987. I experienced a lurid panic attack. My parents discovered me taking diving headers towards my bedroom wall. One frantic 999 call later, an ambulance arrived with a police escort. I was taken to the Royal Edinburgh Hospital and sectioned. Within weeks, rest, relaxation, family support and strong medication retrieved something I’d long abandoned. Optimism. I was allowed home for Christmas and discharged at New Year. The employment agency had kept me on their books. Explaining the CV gaps was harder: between January 1988 and March 1989 I worked for a total of 23 days. I eventually got full-time employment, in what was then called the Scottish Office. In 1990 my bipolar graph swung into the red again. I’d moved into my first flat, was enjoying a new job and meeting a lot of new friends, especially girlfriends. I found my confidence soaring. Constantly up, I was unable to concentrate. I had delusions about politics, and especially religion. I embraced a furiously hedonistic social life as if my 1987 experience had been a figment of my imagination. But my parents recognised mania. I was hospitalised for another month. April 2009 marked my 20th anniversary in full-time employment. But bipolar isn’t something I’ve outgrown. I will take Lithium medication for the rest of my life. I have always enjoyed creative writing. In hospital the psychiatrists encouraged me to write poems, stories. But I always shied away from autobiography. A lot of this was to do with the stigma. A recent survey revealed that a majority of people would sooner holiday with a criminal than someone with a mental health issue. Twenty years ago such ignorance was even more rife. But some headway has been made, and mental health features in film storylines, is discussed in internet forums and has its own websites and helpline numbers. What really prompted me to write about my experience was a TV interview (not with Tebbit!) Jason Pegler, after having experienced severe depression, had set up Chipmunka: a charitable foundation and publishing house. With missionarylike zeal, he had established a platform to promote a positive view of mental ill-health. I emailed a synopsis of what was provisionally titled BrainBomb, to Chipmunka. They were extremely supportive, and the novel was commissioned. In BrainBomb we watch Neil burning the candle at both ends. But the bipolar episode is seen in the overall context of his youth. There are other, equally traumatic, incidents. Child abuse. Violence at punk gigs. Experimentation with drugs. Binge drinking. Joy riding. Promiscuity. Rather than a linear diary, events reverberate, triggering flashbacks. During my breakdown I suffered severe insomnia. In BrainBomb, this experience leads to Neil fantasising about parallel lives amidst razor gangs, medieval warfare, Nazi street riots. There is explicit violence but a crucial point: for all that the mentally ill are scapegoats, an infinitely bloodier trail has been left in history by the supposedly “normal”. BrainBomb is about a condition that is many things. But not abnormal. Available from www.chipmunkapublishing.co.uk Living Better Pippa Coutts of the Scottish Development Centre for Mental Health and Dr Edward Donaghy from the University of Stirling look at the mental health of people with physical health problems. Throughout Scotland, the number of people living with a long term condition (LTC) is increasing. Typically, these are conditions that limit what a person can do, are likely to last longer than one year and can affect any aspect of a person’s life. Examples include asthma, diabetes, epilepsy, cancer, coronary heart disease; and various mental health problems. Although physical long term conditions may be more common in older people, they are increasing in all age groups. People from black and minority ethnic communities and people living in deprived areas are more likely to have a long term condition. If you have a long term condition, you are more likely to develop a mental health problem: approximately 30% of people with long term conditions develop anxiety or depression. Arguably, long term conditions have previously been treated in silos with specialist networks for diabetes, heart disease etc, and different routes for mental health and social support. However, recently in Scotland there has been a commitment to take a more holistic approach to the treatment and support of people with long term conditions Focussing on the whole person means that health staff need to pay attention to how people feel, both when individuals are diagnosed with a long term condition and when they are living with it. This is what sparked the Living Better project, which promotes the mental health and wellbeing of people with diabetes, heart disease and chronic obstructive pulmonary disease. The project was developed by the Scottish Primary Care Mental Health Research and Development Programme and The Royal College of General Practitioners Scotland. These partners have developed Living Better with Diabetes UK Scotland, British Heart Foundation, Chest Heart and Stroke Scotland and Depression Alliance Scotland. The project is funded by the Scottish Government until April 2011. The project has a national steering group but works at Community Health Partnership (CHP/CHSCP) level, with physical health service providers, patient groups and people who have diabetes or heart disease. It operates in five pilot areas in Scotland – Angus, North Lanarkshire, South East Glasgow, East Dunbartonshire and the Western Isles. Over the last 10 months the project has held 12 discussion groups on mental health and wellbeing with people living with heart disease and/or diabetes, as well as discussions with over 40 health care staff working with people with diabetes or heart disease. People living with long-term conditions spoke about “frustration”, “strain of lifestyle re-adjustments”, “feelings of stress in lead up to annual or 6 monthly review”. People felt “isolated”, “worried”, and “angry” and some spoke of the stress of “financial concerns” as a result of their condition/s. When asked about the type of support people would like, most expressed a desire for more social support through; “a person to confide in”, “talking with a person who understands what I’m experiencing”, “exercise classes”, “dietary/ cooking classes” (especially for diabetic patients). 11 All people reporting a chronic condition (note, data from 1998 is weighted) 36% 35 35 34% 33 32% 33 31 30% 29 30 31 32 32 2000 2001 28% 26% 24 24% 22% 21 20% 1972 1975 1981 1985 1991 1995 1996 1998 1998 2002 Drivers for Change: The Increase in Long Term Conditions in Scotland 1972 – 2002 (Source: ISD) Asked why they wanted these levels of support, typical responses were; “occupy the mind”, “gets us out the house”, “chance to share experiences”,” the chance to really express how I feel”, “the exercise classes after my heart surgery were great, the people there were all in the same boat, it was good, a cup of tea and a blether after it... the group had a good social side.” The discussions with health professionals revealed that they often don’t feel comfortable asking people with long term conditions about their mental health. Practice nurses and diabetes/heart disease specialist nurses said they’d like to know more about mental health and wellbeing. They said that when they administer a mental health questionnaire and the score indicates depression or risk of depression, they aren’t always sure how to support the individual or what support that person goes on to access. This information is fuel for the Living Better project, which is working to develop an increased understanding of the mental and emotional health issues of people with long term conditions and possible local responses to this. It is supporting local areas to promote holistic care for individuals, for example through joining up mental health and long term condition services. It is promoting the involvement of third sector organisations, including self management and peer support groups, in partnership working at primary care level to integrate services for people with LTCs. For example, the project is providing practice nurses and diabetes or heart disease specialist nurses with more information on mental health and on services. The project aims to implement mental health and long term condition training with practice and specialist nurses, to emphasis the links between physical and mental health problems and that much can be done to support people’s mental health and wellbeing. The partners have produced information leaflets about mental health and wellbeing for people with diabetes and heart disease. For more information on Living Better visit: www.livingbetter-scotland.org.uk 13 What will you be doing in October 2009? Hopefully, you’ll be taking part in one of the many discussions, events and celebrations of mental health that will be going on up and down the country. Mental Health Awareness Week is almost upon us, and from 4-10 October, people across the nation will be taking the opportunity to highlight the importance of mental health. And it is a much-needed opportunity. We know that one in four people in Scotland will experience a mental health problem at some point in their lives. We also know that people with mental health problems are less likely to be employed and are more likely to experience harassment. What’s more, nearly nine out of 10 people with mental health problems have been affected by stigma and discrimination, with two thirds saying they have stopped doing things because of the stigma they face. Mental Health Awareness Week presents a chance to draw attention to mental health and to combat some of this stigma. But it’s also a chance to highlight more positive information: like the fact that most people who experience mental health problems do recover. continued over 14 So if you’d like to play your part in improving Scotland’s awareness of mental health, here are just a few of the events that will be taking place. Wednesday 7 October Safe to Say DVD Launch, Filmhouse, Edinburgh SAMH will be launching a new DVD about adult male survivors of childhood sexual abuse at the Filmhouse in Edinburgh. Thursday 8 October What’s in a Word? 6–8.30pm Clarkston Halls, Clarkston ACUMEN will be looking at the language of mental health, using crafts and workshops to explore the words that best express our individual experiences and identity. Free. Open to the public. Phone or email Aileen or Shena on 0141 887 9103, [email protected] or [email protected] Friday 9 October Let’s Get Physical! SAMH will be holding its biannual Forum in Edinburgh, focusing on physical and mental health. We’ll be discussing the barriers that people with mental health problems may encounter as they become more active and the links between lifestyle and mental health. We’ll ask why people with mental health problems can experience poorer physical health than others and hear from people who have taken steps to become more active. Attendance at this event is free for SAMH members and costs just £40 for non-members. See www.samh.org.uk or email [email protected] for details. Saturday 10 October The Mudlarks Bonar Hall, Dundee Musicians from the SAMH Chrysalis service, will be at Bonar Hall in Dundee as part of World Mental Health Day Celebration. Throughout the week Mental Health Arts and Film Festival Led by the Mental Health Foundation and its partners, the festival will be running from 1–22 October. The full programme is available at www.mentalhealthfestival.dreamhosters.com and will include the winners of the Festival Film Competition, an opening concert on 1 October at the Fruitmarket Gallery in Glasgow and art exhibitions across the country. North Ayrshire libraries SAMH Community Horizons will be contributing to information stalls to be held at libraries in North Ayrshire throughout the week. Check www.samh.org.uk for up to the minute information on events that will be taking place throughout the week. Organising an event? Make sure you let SAMH know, so it can be added to the website. We want to know what you think of The Point magazine. Please take the time to tell us by filling in our survey. If you'd prefer, you can fill it in online, by going to www.samh.org.uk , clicking on publications and following the link beside the most recent edition of The Point. As an added incentive, you can choose to be entered into our prize draw to win a £25 Amazon.co.uk voucher. The closing date for completed reader surveys is 30 October 2009. ABOUT THE POINT 1. Please tell us what you think of the following regular features in The Point. Excellent Good Reasonable Poor Very poor Poor Very poor Welcome (page 3) Talking Point News Letters Whose Evidence is it Anyway? The Facts 2. Please tell us what you think of the articles in this issue of The Point. Excellent Living Well Brainbomb Mental Health Awareness Week Catch 23 Why Gardening is Good for your Mental Health Branching Out The Stories of our Lives Good Reasonable 3. Overall, what do you think of the balance of content in The Point? About right Too much emphasis on certain things (please specify) Not enough emphasis on certain things (please specify) If you said there was too much or not enough emphasis on something, please give details: 4. Please give details of any areas or subjects that you would like to see The Point cover in future. 5. What do you think of the design and layout of The Point? Excellent Good Reasonable Poor Very poor Readability Visual appeal Size of magazine Do you have any comments or suggestions about the design and layout? 6. Would you be prepared to pay for The Point? Yes No 7. If The Point was no longer free, what do you think would be a reasonable price? Less than £1 £1 – £1.50 £1.50 – £2 £2 – £2.50 £2.50 – £3 over £3 ABOUT YOU 8. How did you receive this copy of The Point? Received by post Borrowed it from someone else Picked it up in a library Other (please specify) 9. On average, how many people read your copy of The Point? One Two – four Five – seven More than seven 10. Which of the following terms would you say applies to you? (You can tick more than one answer) Mental health service user Mental health worker Service planner Member of the public Policymaker Other (please specify) 11. We welcome reader contributions to The Point. Would you be interested in contributing to the magazine by writing an article about your experiences, or being interviewed? Yes No If yes, please give details, and provide your contact details at the end of this survey 12. What would you identify as the single most important issue currently facing people with mental health problems in Scotland today? 13. Are you: Male Female Transgender Prefer not to say 15. How would you describe your sexual orientation? Heterosexual Lesbian Gay Bisexual Prefer not to say 16. Are you aged: Under 16 16-18 19-21 22-35 51-65 66-70 Over 70 Prefer not to say 36-50 17. Do you consider yourself to have a disability? Yes No 18. What is your ethnic group? White Scottish White British White Irish White Other (please specify) Mixed (please specify) Asian, Asian Scottish or Asian British - Indian Asian, Asian Scottish or Asian British - Pakistani Asian, Asian Scottish or Asian British - Bangladeshi Asian, Asian Scottish or Asian British - Chinese Asian, Asian Scottish or Asian British - Other Asian background Black, Black Scottish or Black British - Caribbean Black, Black Scottish or Black British - African Black, Black Scottish or Black British - Other Black background Any other ethnic background (please specify) Not known Prefer not to say Other 19. (Optional) If you would like to be entered into our prize draw to win a £25 Amazon.co.uk voucher, please provide your details below: Name Address Town Postcode Email Telephone If you have chosen to provide your name and contact details, SAMH will only use this information for the purposes set out in this survey. We will not share your details with anyone else. Thank you for filling in the survey. Please return it to The Point, SAMH, Cumbrae House, 15 Carlton Court, Glasgow, G5 9JP, before 30 October 2009. Dear Editor considers I am appalled that The Point be banned that cigarette smoking should main The s. ital hosp ric hiat in psyc premature factors which contribute to mental death in those with serious illness are: ed 1. Toxic drugs, i.e. prescrib medications ciated 2. Poverty, with all its asso stresses and limitations close, 3. Social isolation/lack of emotionally supportive relationships. c for I have been severely psychoti me going almost 20 years. What keeps were is smoking cigarettes. If I would prevented from doing this, I my arms almost certainly be slashing totally to ribbons, as well as being ng livi with cope to le unab independently. ss I am aware that smoking to exce ical phys s one’ to tal is detrimen teract health and endeavour to coun smoking this by eating healthy food, using es, rett ciga n grow lly nica orga etc. etc oils l essentia n, In my opinion, organically grow be ld shou es rett ciga e -fre additive for all provided on NHS prescription nding those with severe or long-sta e would mental health problems. Thes than undoubtedly be less damaging c sustained high dosages of toxi proven medications which have been and to ects -eff side re to have seve indeed, shorten one’s lifespan and, g to some psychiatrists are beginnin . work not do t, admi e that I find it extremely offensiv ced the rien expe not have who ons pers – e.g. s hosi psyc of or terr hell and ld consider The Point staff team? – shou decide that they have the right to ring such endu are who us of e thos what with the cope to able be ld shou horrors smoking) not . (i.e of ss additional stre k you know and patronising that you thin what is “best” for us. Yours faithfully B Savage, Edinburgh Editor response sed The article in question focu nt on a recent Scottish Governme arguments the red cove and tion ulta cons smoking on ban a nst agai both for and ough in psychiatric hospitals. Alth , which The Point is produced by SAMH itions supported a ban if certain cond any hold not does t Poin The were met, ric position on smoking in psychiat hospitals. WHAT DO YOU THINK? Want to comment on something in this issue? Send us your views, comments or suggestions for future articles to: The Point, SAMH, Cumbrae House, 5 Carlton Court, Glasgow G5 9JP Email: [email protected] E C N E D I V E E S O H W We often hear th at there is not suffi cient evidence to treatments, but w fund non-drug e think the eviden ce is ou t there in the form experiences. In ea of people’s ch edition, we take a lo ok and ask: just who at a different trea se evidence is it, tment anyway? “Counselling” is a word which is used with increasing frequency in the media, but rarely if There are many counsellors trained in this model ever defined. You could be forgiven for thinking practising throughout Scotland, in GP surgeries, that it describes one uniform approach, but in stress centres and a variety of different projects.” fact there are many different types of counselling. The British Association for Counselling and Psychotherapy defines integrative counselling as an approach in which several distinct models of counselling and psychotherapy are used together in a converging way rather than in “Over the years I have worked with many people with a wide variety of predicaments. It has always been an honour and a privilege to accompany them on their journey to greater self knowledge and self determinism. I have seen people change their relationship with themselves and their lives separate pieces. We spoke to Janice Jamieson, to increase their wellbeing and to enjoy life more. a counsellor who has been practising in both That’s a great experience!” Scotland and Ireland for 15 years, to find out more. So can integrative counselling actually help? She told us, “The particular model of integrative One client talks about their experiences. counselling that I practise is the core capacities I was referred for counselling by my GP as I was model and its goal is to develop the client’s own depressed and suffering from Irritable Bowel capacities and thereby increase their realism and Syndrome (IBS) which my doctor thought was capacity to respond rather than react in their lives. due to stress. If you have a suggestion for a future "Whose Evidence Is It Anyway?" contact us at: [email protected] ? Y A W Y N A T I S I I was unhappy, my relationship with my husband I realised that life and people, including me, was difficult and I had fallen out with my family. are rarely perfect. I still aim high, that’s a part I worked part time but I found it really difficult of me, but now I am able to appreciate the as I felt worn out so much of the time. At home parts that are right and accept that I can’t control I spent most of my time cleaning my house, everything and it’s OK for things not to go to plan. rushing around after other people, or in bed, In fact sometimes that can even be fun or lead exhausted and with digestive problems. to something new. I listen to myself and pay attention to my feelings and now my IBS flares I was nervous about counselling and couldn’t up much less often. When it does I realise that really see how it could help me but I felt so I’m getting stressed and make sure to take desperate that I decided to have a go. At first we some time for myself. focused on how I was feeling and I was shocked to realise that under my depression I felt angry Now, I feel so much better. I have more energy and disappointed and really blamed myself and and am enjoying my job. In fact I’ve recently other people for what was wrong with my life. started my own small business and that’s going Talking about my feelings was hard but it made well too. I’m getting on better with my family a difference and I began to feel less depressed. and my relationship with my husband is much However the biggest change really came when improved. It sounds like a small thing but now I realised that a big part of my problems was my husband and I can sit down on a Saturday caused by my own expectations about how evening with a nice meal and watch a film and everything and everyone should be. I was enjoy ourselves. Before I had counselling that disappointed and angry because I thought if was impossible, I was either rushing around I tried hard enough things should be perfect clearing up or in my bed feeling rotten. and I was continually disappointed when they didn’t turn out like that. At times the counselling was challenging but I always felt supported rfect. rely pe reciate a r e r a app me, able to ything... cluding in m , a I le p r w nd peo f me, but no trol eve a n o e f c li ’t t part o t I can ed tha ept tha I realis high, that’s a c c a d im ht an I still a are rig t a h t s rt the pa and that helped me be honest with myself. David Strathearn provides a personal perspective on mental health, beans and battling aphids. It comes as no surprise to many that gardening is good for your physical health. What could be better than spending time in the fresh air and getting some exercise? Furthermore, if you grow your own vegetables then a healthy diet can follow. Many people also realise that gardening is good for your mental health. Increasingly the connection between good physical and good mental health is being made in the popular media. But is the mental health benefit of gardening limited to the endorphin or adrenalin release from the physical activity or are there more fundamental psychological factors? To answer this you have first to think about what is meant when someone says, “That is good for my mental health”. More and more you will hear people using this type of expression, perhaps as perceived taboos are gradually fading away from the whole subject of mental health. These taboos have probably been brought about largely as a result of confusion between mental health and mental illness. It may, therefore, be helpful to bust some widely held myths and separate out the terms mental health and mental illness. We all have “health”, both physical and mental. Our state of health can be good, bad or indifferent. What makes for good mental health will be explored in a minute, but it helps to distinguish mental illness by thinking of it in terms of specific conditions: depression, bipolar disorder, schizophrenia. So, poor mental health is not necessarily mental illness! Studies and theories abound when it comes to mental health promotion, but I can best understand the concept of mental health promotion when I consider not only what makes for good mental health but also what happens when these factors are removed. Mentally healthy people tend to have a clear sense of belonging – knowing who they are and their place and role in their community. Well, a garden does not tick all these boxes, but people often tell you that their garden is their sanctuary; a place where they belong. Gardens, especially in the case of allotments, and gardeners in general are often a distinct community, sharing a common experience; so perhaps a box is ticked here after all. Mentally healthy people tend not to be too stressed – bearing in mind that challenge and stimulation is good for mental health. On these fronts, gardening definitely scores. Yes, there may be some stress when the aphids demolish your roses, but the benefits of the relaxation and the challenge of the ever changing seasons must surely outweigh any stress. A sense of achievement or the potential to achieve and being in control of your future are all vital for mental healthiness. The opposite is a sense of hopelessness. Gardening meets these positive criteria extremely well. The hope and expectation that the beans will be the best ever and the satisfaction gained when they are, all contributes to your mental health. Add to all this the fact that nature is innately beautiful and humans are programmed to respond to natural shape and form and you can see that really it should not come as a surprise that gardening is good for your mental health. Del Gunn is the Centre Manager at Catch 23 in the Western Isles. When asked to provide a brief biography, Del replied “I would rather give special mention to the volunteer team and all those who have supported the project: they are the real lifeblood of this organisation”. Less than five minutes walk from Stornoway’s town centre is the Catch 23 Drop-in Centre. Catch 23 was set up by the Western Isles Association for Mental Health (WIAMH), a small local charity, just over six years ago. The Association has always prided itself on being led by those who use the service and on making key decisions in full consultation with the groups’ membership. WIAMH was formed in 1996 by a very small number of interested people, most of whom had experienced problems themselves, to promote awareness of the issues surrounding mental health and to break down the barriers and stigma that people in the Western Isles were experiencing. It has been a long struggle to gain full acceptance and recognition of what the service is actually worth to the local community but WIAMH now work in close partnership with both the Local Authority and Health Board. They also receive invaluable financial support from Lloyds TSB Foundation for Scotland and The Robertson Trust. The Centre offers a wide range of activities including: – Arts, digital photography and creative writing sessions – Training – Free internet access – Gardening – Support & representation – Refreshment and meals – Evening events and day trips – Hand, neck and shoulder massage 25 The Centre had almost 170 clients in 2008, which equates to almost 1% of the population of the Isles of Lewis and Harris. This number doesn’t look very high but if a city the size of Glasgow had just one centre experiencing a similar percentage of drop-ins, they would be providing a service to approximately 6500 people! When asked what Catch 23 means to them, the client group give numerous and quite varied responses. Some are quite minor and don’t seem much in the great scheme of things. Others really show the real need for what we provide. “You don’t ask me loads of questions and take me for what I am”. “The company is great, I have made friends through this place”. “Everyone at the Centre listens to what I am saying. I have never experienced this in my life before”. “I can talk about my illness without fear of being judged”. “You see the person not the illness and have helped me get back my confidence”. “You saved my life!”. Living in one of the most remote and rural areas of the UK creates a number of issues that impact on a person’s health. This has been magnified by the recent credit crunch and the knock-on effects. Cost cutting has forced the local authority to reduce bus services to the rural areas, making it difficult for some people to attend the centre. There is also a shortage of available affordable housing and recent government cuts have meant a big reduction in the planned new home building budget. Those who do have their own transport have the highest petrol prices in the UK to think about before they even consider leaving the house. To counter this WIAMH is always looking to assist people to attend Catch 23 where possible and will access funding to enable a client to travel to and from Stornoway. Most of the mental health services are based in and around the Stornoway area due to the fact that half of the Western Isles population live in this small area. Catch 23 has visitors who will often make a 90 mile round trip in order to stay in contact. The Western Isles economy is also recognised as one of the most fragile in Scotland, with one of the lowest levels of average earnings in the UK. The two main employers are the NHS and the Council and to date they have not seen large job losses. Those outside the statutory sector haven’t been so lucky. The fish processing plant in Stornoway which was the biggest non statutory employer shut down with the loss of over a hundred jobs. Woolies, our biggest shop, shut their doors at Christmas and construction work has almost ground to halt. Numerous smaller companies have also paid off staff and many of the travelling offshore workers have also found it harder to gain regular work since the price of oil began falling. Having spoken to other agencies in the Islands, we know reduced income, job losses, associated debt, travel problems, etc will have a knock-on effect on people’s mental health and wellbeing and we have to prepare for new faces dropping in and be ready with a warm welcome. www.wiamh.org Greenspace and Conservation on Referral Kirsty Cathrine has been running the Forestry Commission’s Branching Out project for the last two years. She has a background in both ecology and science communication and previously worked as a ranger in the Cairngorms. Branching Out is an innovative service development offering conservation and greenspace on referral for people experiencing mental health problems in the Greater Glasgow and Clyde area. A range of partners have come together to drive this development, including Forestry Commission Scotland, NHS Greater Glasgow and Clyde, Glasgow and Clyde Valley Green Network Partnership, Glasgow Centre for Population Health and Glasgow City Council. The concept of using greenspace to promote and maintain mental health predates the development of almost all current treatment methods. In the 19th century mental health institutions were often situated in natural green landscapes, which was thought to help people relax and recuperate. More recently, research has found that exposure to greenspace has beneficial effects on our ability to pay attention, stress, aggression, depression, self-esteem and physical health. Branching Out client, “I’m lacking in confidence that’s something that I’m very, very short on at the moment. Coming here is like slowly, but surely, I’m starting to think about things differently.” A recent Mind report advocated ‘ecotherapy’ (interventions involving greenspace) as a clinically valid treatment option for people using mental health services. In response, Branching Out was developed to provide an adjunct form of treatment to improve the quality of life for adults experiencing severe and enduring mental health problems in Greater Glasgow. This free service offers a 12-week programme of activities including health walks, environmental art, conservation, bushcraft skills and relaxation. The sessions are run by an experienced Forestry Commission Ranger, an Assistant Ranger and with the input of sessional workers such as an environmental artist and a tai chi instructor. 27 At the end of the 12-week block groups are brought together for a joint awards ceremony, at which further volunteer and training opportunities are highlighted. Some Branching Out participants have progressed on to further greenspace activities such as walking groups, conservation projects and riding for the disabled. Occupational Therapist, mental health resource centre, “They (Branching Out clients) have noticed that they are capable of things and they’ve now moved on to volunteering, and they are doing that reasonably independently. That’s a big, big step for them.” A typical session involves walking into the woods and building a campfire from tinder gathered nearby. Clients then take part in activities such as tai chi, clearing invasive species or plant identification. After a lunch break further activities could include willow weaving or creating art sculptures. Each session lasts up to three hours and all equipment, including waterproofs and tools, is provided. Staff from the mental health services also attend Branching Out, and are fully involved in all of the activities. Occupational Therapist, mental health resource centre, “I think me being one of them made the team stronger instead of that feeling of ‘them and us’ which there is sometimes... I think people felt very equal and that would be one of the big assets of (Branching Out)”. A wide variety of mental health services have accessed Branching Out over the first two years including forensic services, recreational therapy, employment services, mental health charities and resource centres. SAMH has been highly involved with Branching Out, and has referred 5 groups to the service from Glasgow South Integrated Training, Glasgow North Training and more recently the SAMH Men’s Activity Group in Dumbarton. During the initial 12 months of the project, a full evaluation was carried out to investigate the impact that the service had on those who were referred. The initial literature review that formed part of his has already been published in the Journal of Public Mental Health,Vol 7,no 3,p23-35. The full evaluation report will be available in the next couple of months long with an executive summary. The main findings of the evaluation include: – Low attrition rates (70% of people completing the 12 weeks). – Significant increase in physical activity levels. – Self-reported improvements in confidence and self-esteem. – Strong trends towards improvement in health and wellbeing measures for high severity groups. Funding has been secured from Forestry Commission Scotland and NHS Greater Glasgow and Clyde to continue the project until March 2010. Forestry Commission Scotland is committed to continuing the service development, and is in discussion with both NHSGGC and SAMH to explore future funding options. For more information about Branching Out please contact Kirsty Cathrine, Community and Environment Ranger, on 01698 368 557 or email: [email protected]. In each issue of The Point, we look at one of the most common queries received by the SAMH Information Service. Q. What happens when a young person becomes unwell with mental health problems and has to go into hospital? A. Last year 57 children under the age of fifteen were admitted to psychiatric care in hospital. 2,056 people between the ages of 15-24 were admitted. 1 When a young person has to be admitted either voluntarily or compulsorily there are legalities to be considered. Just as with adults, doctors must respect a young person’s decision to refuse treatment if they have the capacity to make that decision, unless the doctor thinks that the Mental Health (Care and Treatment) (Scotland) Act 2003 should be invoked. Section 2 of the Act makes specific provisions to safeguard the welfare of any child. For the purposes of the Act, a child is any person under the age of 182. If a young person is unable to consent or refuses to give consent to treatment, their parents (if the person is under 16) or guardians can make that decision on their behalf. A parent has a duty to safeguard and promote the health and welfare of his or her child until he or she reaches the age of 163. A young person can be made subject to an emergency or short term certificate and also a compulsory treatment order in just in the same way as an adult. Where possible though, the views and wishes of the child or their guardians should be taken into account: in fact, one of the principles of the Act is that the welfare of a child who is treated under the Act should be paramount. 29 One of the most important issues for the doctor involved with the child is whether he or she is capable of understanding what the treatment is, how it will be administered and what the effects of it may be. If the doctor thinks that the child is able to understand, then his or her consent should be gained first, just as it should for any other treatments, such as dental work. The parents are usually involved in this process. The Age of Legal Capacity (Scotland) Act 1991 would be applied in such cases if the child is twelve or over: a doctor would look for the ability to give consent and would comply with the Act in this respect. Their environment should be carefully considered such as: – A separate room with facilities – Visiting times – Specialised nursing staff If a child is admitted to an adult ward, the Mental Welfare Commission should be notified in order for them to monitor the condition and treatment of the child, when they are likely to be discharged and liaison with children’s services on discharge. One of the most important issues for the doctor involved with the child is whether he or she is capable of understanding what the treatment is, how it will be administered and what the effects of it may be. If the child refused to give consent, the doctor would consider whether the Mental Health (Care and Treatment) (Scotland) Act 2003 should be implemented and compulsory measures taken. A child under sixteen can have a named person be involved in their care and treatment. This is normally the principal carer of the child. If that child is in care, the local authority will be deemed the named person automatically. When a child has to go into hospital, certain provisions have to be made. Local authorities and health boards have a duty to ensure that the particular needs of the child are being met. A child should be admitted to a unit which specialises in child and adolescent psychiatry. If this is not possible and they have to be admitted to an adult ward, risk assessments must be carried out to ensure that the child’s needs are prioritised and they are not at risk. The child should still receive an education whilst unable to attend school and the education authorities should make provisions for this if the child is detained under the Act. Useful contacts The Mental Welfare Commission for Scotland: 0800 389 6809 www.mwcscot.org.uk 1. Admissions to mental illness specialties in Scottish Hospitals, Source: ISD Scotland. 2. Mental Health Care and Treatment (Scotland) Act 2003 code of practice Vo. 1. 3. Mental Health, Incapacity and The Law in Scotland et al H. Patrick. SAMH’s James Dalrymple explains why he spent much of 2008 telling stories. In April 2008 SAMH began working with staff, patients and carers in Dykebar, Royal Alexandria and Ravenscraig Hospitals to create Life Story Books for patients who were about to be discharged. Life Story Books capture the life history of an individual, creating a valuable resource both for the person concerned and for any future carers. Life stories are a simple but powerful mechanism to put the person at the centre and articulate their individual perspective on particular issues. The simplicity of the process and the recovery focus are the key features of this kind of work. The benefits of collecting people’s accounts in this way are that they are unique records which are shaped by the individual and that the methods involved are limitless (dependent on budget obviously), which supports creativity and imagination. There are few restrictions and parameters as to who can participate in narrative projects, which extends the inclusive nature of the project. This obviously has significant advantages for the project manager, the teams involved and the participants. The planning and preparation prior to commencing the work in the hospitals was critical to ensuring that any anticipated problems were identified and systems put in place to tackle them. Where there are people making themselves available to openly talk about potentially sensitive issues, delays and poor processes would not be appreciated and would probably have negative results. This was especially important when working in the wards, as the routines, staffing structures and availability of service users and carers did not allow for much flexibility. 31 I wasn’t sure how we would be received by the patients and staff in the wards. Given that some staff and patients may have been in these wards for 20 years or more, an outside team coming in to talk about people’s lives might not have been appreciated. To tackle this we tried as much as possible to promote the project and involve anyone who was interested. We made a DVD and distributed leaflets for staff and patients/ carers. We also held a launch event at Dykebar, with music and short stories to generate interest. Life stories were created in various formats dependent on the requirements of the individual on the ward. This included compiling and designing photo albums, scrap books and photo frames. The content was based on a template which included prompts on schools attended, first job, romance, hobbies and favourite items, but again it was entirely directed by the person at the centre and/or their family or carers. Working with carers has been especially successful as in some cases people cannot participate fully because of capacity issues. Involving relatives in exploring positive memories from the past has provided an exciting opportunity to re-engage with the person in the ward. The story book project received prestigious recognition in the shape of a good practice award from the Scottish Nursing Forum. It has also been chosen as an example of good practice by NHS QIS (which leads the use of knowledge to promote improvement in the quality of healthcare for the people of Scotland) and features on its Piramhids good practice website. Narratives (especially life stories) are not exclusive to particular client groups or individuals. There has been a positive organisational and personal response to the work undertaken and shared learning between parties. Learning from the project has helped others interested in collecting narratives, either as a care provider or an individual in understanding themselves or others. As well as organisational learning there has been a positive reception from carers’ forums that have attended information sessions about the life story books. Often excluded from meaningful input towards recovery planning, some carers have grasped the integral role that they can play in developing life books for their relative and have sought information about developing this. I believe the work offers a certain freedom and flexibility which is universal and not restricted by resources or bureaucracy, which are often barriers to new projects. SAMH is pursuing opportunities to increase and build on the use of narratives in other areas. Veterans’ stories formed the basis of SAMH’s recently launched Life Force – a Guide for Working with Scotland’s Veterans. Anyone interested in developing life stories to support recovery should contact James Dalrymple at SAMH on 0141 568 7201 or email: [email protected] IF YOU ENJOYED THIS mAGAZINE, wHY NOT GET INVOLVED wITH SAmH? SAMH works to support people who experience mental health problems, homelessness, addictions and other forms of social exclusion. We provide direct services, including accommodation, support, training, employment, outreach and structured day services. good practice in service user involvement, commissions research and challenges stigma and discrimination. The Centre needs your support in order to achieve SAMH’s ambition of mental health and well-being for all. The Point is produced by SAMH’s Centre for Research, Influence and Change. The Centre works to shape and influence mental health legislation, policy and practice. It also provides a national information and welfare benefits service, promotes You can help us to do this: • By making a donation • By getting involved in fundraising • By becoming a member of SAMH For more information, to join SAMH or make a donation, please call: 0141 568 7000, email: [email protected] or visit: www.samh.org.uk
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The Point Issue 28 - Scottish Association for Mental Health
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