Monthly Archives: August 2021

Lewisham Mental Health Carers forum July 2021

Welcome to the July 2021 update of my Lewisham mental health carers forum. The forum focuses on engagement for families and unpaid carers who care for someone suffering mental ill health. The ‘cared for’ does not actually have to be using mental health services, but it is important there is a platform for unpaid carers to learn about mental health support, understanding mental health and what is available for carers themselves.

Speakers for my July carers forum were:

Phoebe Averill – PHd Student at Kings College
Polly Pascoe – Lewisham CCG
Carla Fourie – SL&M director of social care

  • Phoebe Averill presents on her latest study.

First to speak was Phoebe Averill who is a PhD student at King’s College. She is working with South London & Maudsley NHS Trust (SL&M) on a research study and she wants to hear carer member’s thoughts and also invite anyone that might be interested in taking part in the research study. She is looking at safety of care in the community mental health services. Phoebe gave my forum a bit of background information about what the problem is. Basically safety in general hasn’t really been given much attention in mental health services. Historically, when you compare it to kind of physical health care services, where we’ve now got quite a good idea about how we can make care safer, what types of interventions and strategies might be needed. Still, there is a small kind of body of research and interventions coming out more recently. These are mainly focused on inpatient mental health services and unfortunately community mental health services have been a little bit left behind, even though that’s where the majority of people who are actually receiving care.

In recent figures, people were using community mental health services rather than inpatient services. So it’s really important that safety is kind of better understood in the community context, so that strategies can be developed to make the services safer. And that’s what she is trying to get started with this research research. Pheobe is currently trying to speak to family members and carers of adults who are using community based mental health services, to find out a bit about what they think about what safe and unsafe care means in this context, because it’s not really well understood. This is due to the types of safety issues that the carer is worried about in relation to the person that they support.

The way the study works involves speaking to her in a either a one to one interview or group discussion with other carers if there was interest from several people in taking part. And there aren’t really any right or wrong answers. It’s really just about hearing carer’s point of view. Carers have so much knowledge about the person that they support and their experiences of care. And it’s just really important that their views are incorporated into any efforts to, to make services safer.

  • Questions from carer members.

One question was focused on the issues of patient’s age. The carer felt that a 75 year old patient does not have the same issues you’d have with a 25 year old and they were curious to know, what Pheobe would be doing for older adults when it comes to community work? Especially for the carer because there’s a lot of issues with older carries with physical issues. How will the research be monitoring those patients or those carers?

Pheobe responded that unfortunately for this study, we’re only looking at sort of general adult services. So we’re Other than older adult services, like you mentioned, it’s not because it’s any less important. It’s just that at the moment, there’s the most kind of research knowledge in adult in adult safety. so future studies would be needed to look at older adults, because there’s like you mentioned, there’s lots of really important safety problems there.

  • Statement from myself

After some debate I mentioned that one thing in regards to research is that whatever is found out could lead to recommendations, usually, most research initiatives tend to recommend some findings that will have this influence services. A lot of people feel research is done for either funding on does not solve service issues, but I pointed out researchers are not in charge of mental health services.

  • Polly Pascoe – Lewisham CCG Presents

Polly spoke about her work within Lewisham Borough Council and southeast London CCG. Her role is it was called integrated Commissioner for mental health pathways. In essence, one of her key roles is getting us to use future systems across mental health care, while it’s occurring across healthcare in general, her focus is on mental health especially within Lewisham. This is kind of where we’re hoping to head moving forwards. The previous system, that being health and social care worked separately regarding statutory and voluntary. Such as Provider sectors were working separately and sometimes even competitively where age groups were handled separately, and such services provided different levels of focus and funding. Conditions were often handled separately, and there was a strong focus on outputs as in numbers, rather than changes necessarily. So there used to be a strong focus on reaching particular targets, on how many people were seen and how many people were funded by CCG.

Now Lewisham CCG have made some definite headway in Lewisham to becoming much more integrated in the way we do things. Of course it’s a journey. So we’re certainly not there yet. Still, Polly was sure a lot of people will have experienced a number of different frustrations around how the system’s working. She feels we are becoming a more integrated health and social care system. Where we are working much more closely with our sector providers. It’s not just the big players e.g. (SL&M), Lewisham CCG is also connecting into our community organizations and age groups do remain relatively distinct. Often the way we do things will mirror that which isn’t always appropriate until the impacts of concurrent issues are understood. So we do have a clearer idea of how different conditions work with each other, but they are still seen often as separate conditions.

At Lewisham CCG they are certainly moving towards a focus on improving outcomes, but they do still have quite a heavy target focus. Those targets are becoming more appropriate as Lewisham CCG move forward. What they are heading towards is a future system where health and social care workers one, and Lewisham CCG are focused on the individual rather than on our kind of organizational boundaries, let’s say, Lewisham CCG want to move between statutory and voluntary services. So between the NHS Trust’s and then any services working in community to be visible, Lewisham CCG don’t necessarily want people to feel they’re being handed off to different places all the time. And they want people to have their personalised journey where movements between that journey feels very seamless. They also want to move to an all age approach where the CCG see the individual as experiencing certain things throughout their lifetime.

So this is also moving beyond comorbidity, not just recognizing people’s potential health issues, but understanding wellness, and looking at their life, and how the CCG can ensure that the way of living and that the way people around them, treat them and work with them ensures optimum wellness, rather than just the absence of ill health, which is one of Polly’s key findings on commissioning and delivery. So this is the way that the CCG design and make services happen. Lewisham CCG deliver those services to people where it is outcomes based and focused. So we want to move away from numbers of people, and move towards the difference we make to people. So that’s the kind of very much that future system Lewisham CCG is working towards. Polly admits she has one very small part to play in a really huge system. And, in essence, this is kind of where she sits in and amongst everything else. Her area is primarily adults and older adults. So she continues to do look at these two areas, predominantly for herself and her team.

  • Carla Fourie – SL&M director of social care presents

Carla started off talking a bit about herself and when she was appointed in February this 2021, although some people will say that they sure they saw her prior prior to this year and that’s true. She started on secondment with the trust last year literally just a few weeks before the initial lockdown. Eventually the role was made permanent, and she applied for it. She was then formally appointed in a full time role in February this year. Carla looked at putting the slides together and thinking about how she could describe what her role is at the trust, she decided, looking at kind of the role to group it into four key categories. As the most senior social worker in the trust, she works closely with NHS trust board and she works closely with SL&M senior managers, to bring a social work perspective, to the NHS trust. So when we look at our multi professionals within the trust, we’ve got our doctors or nurses and OTS, etc.

In the end Carla’s role is to bring the social worker perspective at a the senior level, she has also the responsibility to work across the trust with the different local authorities, and to ensure that SL&M avoids working in silos, so there is partnership working, and to ensure that the Social Work offer is provided to people with mental health needs, and to help people become in terms of prevention. Her other role is also that trust wide responsibility for safeguarding so the heads of adult and children’s safeguarding reports to her including the areas for domestic violence and abuse, prevention agenda. She also has a trust wide responsibility for the mental health laws that include areas such as mental health capacity, Human Rights Act, etc. In terms of just tying back to the social work, leadership role, apart from working closely with a board, she also has the responsibility to ensure that our social work workforce, social workers that’s directly employed by the trust, are also professionally well supported.

Carla spoke in terms of support to carers and families, where she thought, were important just to highlight again, on a slide where the work at that the trust is doing overall, in terms of manpower strategy, and that’s very much also founded on the triangle of care, where SL&M sees the carer very much as a partner in the care that SL&M provide. There’s a lot of information that SL&M has developed as a trust and under the leadership of Gabriel Richards, who leads strategically on the carer’s agenda. SL&M has got a carer’s charter that is highlighted. SL&M also provides information in their families and carers Handbook, and also information leaflets, posters shown in the blog regarding carers rights under the care rights, writing, carers assessment. SL&M also has information about confidentiality and sharing of information.

SL&M also provide information to nearest relative where we have useful nearest relative leaflets as well on what is provided to carers. One of SL&Ms duties is to try To ensure that ‘cared for’s relatives are informed and consulted with, particularly when there was a Mental Health Act assessment under Section two of the mental health act. The approved mental health professional has a duty to inform the nearest relative under Section three, where the relative has the power to object to someone being detained to a loved one being detained under the Mental Health Act. The nearest relative can also ask for an IMHA, which is an independent mental health advocate to see the patient and the nearest relative can request a mental health assessment, which she thinks sometimes nearest relatives not everyone is aware of that in certain circumstances where it’s been really difficult or challenging to access for whatever reason. So whilst the local authority is to consider the assessment under the Mental Health Act, or the rights and powers of a nearest relative. The nearest relative can write to the associate hospital managers to request for discharge. Sometimes that’s out here too, but in circumstances where they’re responsible clinician disagrees from a clinical point of view, they can roll that request up to the hospital managers who will review that decision as well.

An nearest relative can also appeal to mental health health tribunal, and they’ll set up some circumstances where nearest relative feel that they are not able to take on this role, because it does have a lot of power and responsibility with it. And sometimes some families feel that if someone that’s been identified as a narrows relative that may impact on relationships with their loved one.

This concludes our Lewisham MH carers update for July 2021

A community that cares is a good one

Welcome to my latest blog. As a reminder my blog posts focus on mental health carers, what I mean about that is highlighting the caring experiences of those caring for someone with mental ill health or mental health needs. This latest blog post is about community, because when all is said and done for health and social care, it is how the outcomes impact the community.

Some would say to test good quality wellbeing and a caring community, you can literally pick an area in town and stand there to observe. If you see run down apartments, no one talking to each other, anti-social behaviour, lots of noise and people seeming unwell, then this is a prime example of a community in trouble. When we notice such things, it does not take long to think to ourselves who is responsible for all of this?

I am not saying that all communities are like this, but it is worthwhile to experience what I am mentioning. Of course don’t do this at night especially if the community is known for trouble. Perhaps you might be thinking to yourself, why is Matthew raising this in his blogsite? What has all this got to do with caring?

Well as you can see by my blog title “A community that cares is a good one”. The thing I am trying to point out is because we focus on caring being a personal and private experience. We make the mistake that caring only exists in small confined spaces. We also tend to think that caring can only be applied to those who are unwell and once that person has recovered, then caring can stop. This again does not take into context the importance of caring.

Caring in itself can be applied to so many things, not just the person in themselves, but to caring about the environment, caring about ourselves as in our own wellbeing, caring for the importance of education and caring for community. Make no mistake I am not saying to care about everything, since we do not care for racism, isolation, blaming others or being a general nuisance to others. It is what we care for that counts.

I am fully aware that caring for others, especially those close to us is not a forgone conclusion, since there are many challenges that needs to be worked upon, especially with the new Health and Care Bill 2021 (see my online carers newsletter for more detail). I urge those who are caring, carer reps and the general public to take interest in such bills because it will affect us all.

Going back to the idea of caring in itself, we must take note that a caring community cherishes the importance of not only strengthening caring for others but in caring overall, where a society brings caring about those close to us towards caring for the good of all of us. This is not a simple tasks and almost seems like a utopia because we all have different aims and agendas and I expect those to clash as people do not often see eye to eye, but not all communities are alike, if we find a bad community, then it cannot be the case ALL communities are bad as some are better off, we cannot also think that it is just down to money and resources, because there are people out there working very hard to bring out the best in their own communities.

What is wrong in wanting to live in a community that will reduce isolation, improve health and wellbeing, easier access to social care, less noise, pollution and anti-social behaviour? All these wants and desires being out the best in ourselves and makes us happier in the long run, but we need to understand this cannot be done without the emphasis on care or our mental wellbeing is at risk.

In the end, we are all responsible.

Bromley, Greenwich & Lewisham BAME Carer Forum June 2021

Welcome to a brief update of my BAME carers forum for June. The BAME carers forum is an online forum aimed at those who care for someone suffering mental illness, except the forum covers ethnic experiences regarding caring along with discussions on how serious mental illness affects minorities and diverse communities.

For June 2021 the speakers were

  • Faith Smith (carer) on her Section 136 project
  • Keisha York from BAME in Psychiatry & Psychology
  • Sharon Jennings of Goldsmiths University
  • Emma James Senior Policy Advisor at Barnardo’s

Faith Smith Presents on her Section 136 project

Faith started off explaining how she became a carer, which led to her being a carer advocate due to being involved at South London and Maudsley NHS foundation trust, which led to her joining their involvement register. She was introduced to the involvement register a care coordinator, which she does interview panels, sit on focus groups, training with staff and joining trust values day, which is a staff induction day.

Faith Smith has now been asked to chair and set up a group that is going to be PAN London group. Its aim is to explore section 136 of the Mental Health Act. Section 136 Mental is where the police have the power to remove a person from a public place, if they appear to be suffering from a mental disorder disorder and move them to a place of safety.

The place of safety could be a hospital, although often the outcomes have not been as they should be, and in past experiences there have been tragic events involving the police and those in mental distress. So the idea is that this group that she is going to be setting up, is going to be a solution focus group. The group is going to be made up of experts by experience to be either carers or service users. Where the aim is going to be to map the journey of Section 136. So if an individual has that map, then the journey will be looking at what improvements could be made. So here we can see what outcomes could have been different along the way at each stage, from being someone first becoming unwell to the police being called to then take the person to a place of safety, the hospital or the police station or wherever? And then the outcome how could that experience have been made better? So it’s to identify improvement. Faith wanted to see if members could be involved or at least spread the word.

A question from a carer member queried if 136 was going to be split into two sections where one is for other people or older adults?

Sharon Jennings from Goldsmith university Sociology course presents

Sharon was excited to hear how carers can set up research groups. This was in regards to Faith’s presentation. Sharon mentioned that at Goldsmiths university also have an experts by experience group. This group is for the Social Work courses, and they do a lot of teaching. The experts are involved in the admissions of students, looking at policies and much more. Sharon was happy to ask if forum members were interested of being part of that group or at least being involved with the group, it’s really about developing terms of new social workers, as in social work students on the awareness of service user/carer issues and understanding how to speak to people that use services.

One of the things Sharon wanted to talk about was on the inequalities of social care and racial inequality in social work, but mainly from the position of practitioners. Sharon wanted to point out the kinds of challenges for black Social Work practitioners. She was not sure if most people at my BAME carers forum would have had some kind of contact with a social workers, either in one way or another good, bad or indifferent. Sharon wanted to start with the importance of social work from the students perspective and the experience of black students or black and ethnic minority students.

Sharon mentioned some research done between 2009 and 2012, which was published in 2014. It was asking black and ethnic minority students about almost about their experiences on social work programs in the UK. People felt like they were in an uninhabitable terrain, being on a course of social work or degree course. It was hard to be themselves. It was hard to breathe, it was hard to relax. It was hard to feel that they belong there. They felt that they were climbing and climbing, but not being appreciated, not being valued.

Sharon felt the students found it really difficult to open up about how they felt. We expect our social experience from day one to start talking about their lives, the backgrounds, family, their relationships, their everything in order to talk about there experiences. People don’t feel comfortable on day one doing that, trust has to build up. So people felt that they weren’t equipped for this, because when they did share their own particular cultural learnings or teachings or their background, it wasn’t understood, it wasn’t valued and sometimes it was criticized.

Sharon feels it’s about what people’s life circumstances are like. So for instance, many black social work students have to continue to work. They can’t wait to take time off. There aren’t any bursaries until the second and third year, so the very first year they don’t have money even if they may have caring responsibilities, family responsibilities. So to conclude social work students have a difficult time especially those from black backgrounds.

You can find more about Sharon’s talk via her Youtube discussion.

Emma James from Barnardo’s presents on BAME young carers

Emma from Barnardo’s started her discussion on questioning on the importance the lives of all children and young people who should be free from poverty, abuse and discrimination. Emma mentioned that young carers are part of the millions of unpaid carers in the UK providing care and support for a relative. Some young carers take on their caregiving responsibilities as young as four years old. Others do over 30 hours of caring a week and on top of attending school or college. Emma stated that firsthand the impact caring has on their mental health and well-being is staggering with many suffering from depression, isolation and anxiety. So the children Barnaro’s work with and many others across the country are sacrificing their childhoods and their futures. All this by having no choice but to drop out of school or actively choosing not to go to university or college due to their caring responsibilities.

Emma also pointed out that the BBC did a survey a couple of years ago, which estimated that there are probably over 800,000 young carers in the UK today. So Barnardo’s runs 20 services across the UK that support young young people care for relatives who have a disability or illness mental health condition or drug or alcohol problem. Last year, Barnardo’s worked with 330 500 young carers and their families. Barnardo’s also support many other children and young people in their services who also have caring responsibilities. So in Barnardo’s mental health services they run domestic abuse support services, which will often uncover if these children also Young carers.

Around five years ago Emma did an indepth research with the young carers they support and found that the impact the caring was having on their lives was really significant. The young carers Barnardo’s supports often spent over 20 hours a week caring for their relatives, most commonly their mothers, they often care for siblings as well as parents. These sorts of things Emma found they were doing was cooking, cleaning, administering medication, washing, shopping, helping the cost of siblings providing mental health support.

Banardos campaigned in 2014 around Children and Families Act in the Care Act, which gave local authorities a duty to assess young carers. So this led to more referrals for young carers, but often there isn’t the support once young carers are assessed. There’s often waiting lists for support and in terms of outcomes for young carers, they’re more likely to be not in education, employment or training (NEET), they’re more likely to be bullied at schools and more likely to have poor mental health, loneliness and isolation. Young carers end up with lower grades in school, and they’re more likely to come from BAME communities. Whilst Emma was doing her research across all of their young carers services, it was really clear something that stood out for her, this was that young carers from minority communities had additional pressures and stresses that statutory services were not aware of and they weren’t being supported.

The most important thing that Barnardos do is they help the family get more support from social services so that young carers don’t have to do so much supportive work. Barnardos talk to young carers school so teachers understand their situation and can be supportive. Plus Barnardo’s give young carers advice and emotional support through counseling sessions.

Here is a link to one of Barnardo’s reports on BAME young carers.

BAME young carers update

Keisha York from BAME in Psychiatry & Psychology presents

Keisha York the founder and director of BAME in Psychiatry & Psychology network (BiPPN) wanted to say is it’s been a pleasure, to be invited to my forum again. She was interested just to hear a lot about how BAME carers and the sort of difficulties carers are experiencing. Keisha was just going to focus on providing updates about what the BIPP network is doing and what they would loved to do. Keisha felt that in hindsight and listening to the group, she would have wanted to give some more data and statistics on some of the issues raised on the colonization of the curriculum or representation, but Keisha felt that might be perhaps a part two or part three, because this is the second time they have been invited to my BAME carers forum.

The BiPPN are a registered social enterprise and low profit organization since September 2019, and they are led by mental health professionals and students in medicine in psychology, who aim to prioritize, lots of representation of black psychology. The BiPPN also provide such a community for individuals from racialized backgrounds, both registered and prospective mentor professionals to acquire social, emotional, psychological and developmental support. Whilst the BiPPN do focus on psychiatry and psychology, they do recognize that actually, this has been a really good source of support space and community for anyone who is a mental health professional. So the BiPPN encourage anyone really to join our network and be a part of it and attend the events that they do. So how do the BiPPN achieve this aim of prioritizing and advancing the representation of racialized groups in those professions?

The BIPPN provide insight, guidance and knowledge on access in psychiatry and psychology. The BiPPN focus on this primarily because they are aware of the issues. Keisha feels as someone mentioned earlier, these issues have been discussed for years around what are the barriers to individuals accessing these careers (Sharon’s presentation on the problems BAME students face studying sociology).

The BiPPN want to learn and focus on how they can equip these aspiring psychologists with the skills to actually navigate through those barriers, and actually be more equipped to address some of them as they progress in their careers. The BiPPN also increase the exposure to learning and discussion of cross cultural and race related psychological theory practices and research.

Keisha is aware about colonized curriculum that only addresses the mental health of white Eurocentric individuals. So what the BiPPN aims to do is increase the exposure of models, approaches and theories which relate more to how black and racialized groups experience the world as reality, plus how they suffer from mental health issues. Lastly, the BiPPN explores the various approaches to addressing black and ethnic monetize groups in mental health and racial disparities and mental health care. So the BiPPN events are attended and are hosted by a range of speakers, both psychiatrists and psychologists. The BiPPN increase exposure to that knowledge to either aspiring or current practitioners. So they know how to address this within the NHS and in their various workforces.

For more information about the BiPPN please see link below.

BiPPN Network website

This concludes the BAME mental health carer forum update for June

SW London MH Carer Forum June 2021

Hello fellow unpaid carers. This blog site is geared towards those who support or look after someone suffering mental ill health. I run a number of carer-led expert by experience forums, which focus on unpaid carers regarding engagement from services. Most forums tend to have speakers to engage members regarding mental health system changes or discussing carer awareness.

For the South West London carers forum the following speakers were

NHS South West London CCG – Understanding health Commissioning for carers
Dolly Sen – Mental Health Patient/Carer champion
Matthew Mckenzie (myself) – The importance of carer peer support

As you might be aware, clinical commissioning groups are merging in their own region as part of NHS England’s long term plan, because my group covers a large area, it made sense for the comissioners to speak to carers from different boroughs in South West London.

South West London CCG presentation

First to speak was Caroline O’Neill who is the Lead Engagement Manager and covers Kingston & Richmond from NHS South West London CCG, we also had John Atherton in attendance who is the Director of Mental Health Transformation for SW London CCG.

John started off the conversation on what the plans are for the rest of the year and going forward. John explained how the 6 CCGs formed in five commissioning groups in South west London. They are responsible for planning, commissioning and buying most of the NHS services in the south west london area. That means hospital care, GP surgeries, rehabilitation clinics, mental health support, learning disabilities and many others.

The boroughs they cover are

Croydon
Kingston
Merton
Richmond
Sutton
Wandsworth

The CCGs have a healthcare budgets of over £2.3 billion, although carers who attended the June’s meeting were interested in the CCGs mental health pathways and how they were going to include families and carers.

John explained the importance of health checks as those with mental ill health often struggle to get physical health checks and support. John mentioned what happened in the past is people were encouraged by their GP go get a physical health check each year. It is important the CCGs continue to push this forward because there are some service users who had not had a good experience in the past, or they don’t believe in health issues, so they are encouraging people to check at their practice.

A carer reminded the CCG representatives about how difficult it is for people have mental health difficulties to travel especially using public transport. They wondered how this will affect people accessing mental and physical health services for check ups.

I also asked a question to the CCGs regarding is there a simple view of the commissioning structure? Because we have got CCGs doing stuff in 6 boroughs, and then you’ve got merged CCG? So how do people sort of feed into each other on what is going on? The representatives spoke about their governing body and who is on it.

Another carer was concerned about those with learning difficulties with poor health accessing recovery colleges and wondered what the South West London commissioners were going to do about it.

The representatives were pleased to hear SW London and St Georges were promoting the carers forum, but the CCGs also wanted to include our group on developments of mental health services, as the group stressed the carers should be consulted and involved when it comes to service provision. All too often CCGs struggle to get a good number of carers interested in what they do. It could be an added benefit that carers poke their noses into what is being comissioned and why. This is because carers have a vested interest in the health of who they care for, plus carers do actually use some CCG services which could be Increasing Access to Psychological Therapies. A carer member of the group was concerned about the number of carers not being identified and referred to carer services and groups.

An interesting point of the discussion was finding out who were the mental health leads from each of the 6 boroughs, although there is a lot of work needed in developing primary care networks, because some members feel some GP surgeries could learn a lot from other GP practicies.

Dolly Sen presents

It was requested by carer members for Dolly Sen to talk with us at the forum. Dolly Sen is a service user survivor and a carer and has been fighting 20 years for human rights. Dolly mentioned that over the years while trying to keep mentally well, she has been using energies to focus on art, film, performance and even talking about her experiences at other events.

Dolly Sen

You can find more of Dolly’s work below.

https://www.youtube.com/user/dozzyangel/videos

A large part of Dolly’s activism is around the treatment of mental health users, especially around the problems with benefit payments or DWP. She is quite busy working to improve the mental health system in another area where she has moved to. Dolly admitts there are times when nothing can be done on someone’s health and situation, she feels sometimes it is best to be a witness.

A number of questions from members at the forum were interested in how their mental health trust is working to involve more carers in their involvement register. They queried with Dolly about involvement and activism.