YOUR COMPLIMENTARY COPY
KILLING ME SOFTLY
the fiction behind the chic assassin
Run for your Life
All in the Mind
4 THE CHAMPIONS 8 WHO CARES? 11 A DOSE OF LIFE
ALL IN THE MIND
12 I FOUND HOPE ON THE SCHOOL RUN
why practising mindfulness can be much more than a colouring book.
16 RUN FOR YOUR LIFE
BARS ARE NO BARRIER eight out of ten prisoners have a mental health issue or learning disability. Meet the team making a difference.
VEGAN VITALITY a dietitian gives her views on a plant based diet.
22 HOW I FOUND MY IKIGAI 23 SLEEP EASY
24 SPRING INTO A VEGAN LIFESTYLE 26 IT’S ALL IN THE MIND
A DOSE OF LIFE
30 ALLERGIC TO SPRING?
why GPs are prescribing social activities to help people get better.
31 BETTER BY DESIGN
MC Magazine team: Managing Editor: Steve Murphy. Editor: Jackie Rankin. Contributors: Diane Cooke, Emily Williams.
Photography: Joel Goodman, Steve Murphy John Rowbotham. Design: Jo Hadfield. Illustrations: Ella Byworth, Freepik.com.
You can contact us at: email@example.com
18 AFTER KILLING EVE – CAN WOMEN BE PSYCHOPATHS?
34 DAY IN THE LIFE 35 MEET YOUR NEW GOVERNOR MerseyCareNHSFoundationTrust @Mersey_Care @MerseyCareNHSFT Mersey Care NHS Foundation Trust
MEMBERSHIP AND GENERAL DATA PROTECTION REGULATION General Data Protection Regulation (GDPR), is a European-wide law, which governs how organisations can collect, use and transfer personal data. It came into force on 25 May 2018 alongside the new Data Protection Act 2018. As a Foundation Trust, Mersey Care has a statutory requirement to develop and maintain a membership and it is necessary for us to process our members’ personal data to perform this task. Our members are drawn from the public, people who use our services or care for people who use our services and staff. We request and securely hold data on our members, which they provide when joining our membership.The data we hold on our members enables us to show that we are representative of the community we provide services for, to keep members updated through our quarterly MC Magazine via email or post and to invite all members to the Annual General Meeting. We also engage with all members advising when the election for governors will be taking place, giving members the opportunity to nominate themselves to become a governor and to vote in elections for the council of governors. Should you no longer wish to be a member of Mersey Care please email: firstname.lastname@example.org with your details or call 0151 471 2303 asking that your details be removed.
Spring brings expectation of things to come, it’s like a dose of life.
new season stimulates the senses in a profound way spring more so than any other. The change in the air is palpable; we can almost breathe in the difference. There’s an expectation of things to come. It’s like a dose of life. That’s what’s being prescribed by more and more GPs. (Read it on page 11).
springtime health hazards like allergies, sunburn and bites! Have you found your Ikigai? Find out what it means and how one woman found hers! Enjoy this issue.
The MC editorial team.
We talk to people whose lives have got better in the most wonderful ways.
In this issue we talk to people whose lives have got better in the most wonderful ways. For 52 year old single dad Paul Regan serendipity stepped in during the school run. Read his remarkable story on page 12. HMP Liverpool was judged to be among the country’s worst. A unique partnership is transforming care and giving hope to vulnerable men. (Page 4). Caring takes many forms. If you care for someone don’t do it alone. Our feature offers ways to get support. (Page 8). In our Stay Well section we hear how to get a good night’s sleep and combat
THE CHAMPIONS A trio of professionals with a shared passion are leading a revolution in the way vulnerable prisoners are cared for. We go behind bars to see how it’s working.
MP Liverpool has been berated by the media and politicians for both conditions and care of inmates. It regularly made headlines including in 2017, when the prison was described in an inspectorate report as ‘one of the worst inspectors had ever seen’.
DAMNING REPORT One of the most damning aspects of the report, which led to a change of leadership, was the prison’s failure to deal with vulnerable inmates. Inspectors said: “Delivering healthcare is not just about the healthcare provider, but also about the relationship between prisons and healthcare teams at local, regional and national level.”
Since then Mersey Care has taken over the provision of mental healthcare services under an integrated model of care known as; ‘Better Health Liverpool’, working closely with several other healthcare providers commissioned by NHS England.
It’s the strength of their common vision and willingness to be held accountable for what happens next that sets apart both them and the support organisations they’ve brought on board.
The credentials alone of the three people leading the programme on the ground stand to make it work. New prison governor Pia Sinha is a psychologist who has led services in other prisons. Mental healthcare lead Jonathan Drew has been a nurse in Mersey Care’s secure service for 23 years. The head of healthcare is Spectrum’s Stella Hannaway, with 30 years experience in forensic, sustance misuse and secure services.
Delivering healthcare is not just about the healthcare provider, but also about the relationship between prisons and healthcare teams at local, regional and national level.
RIGHT SUPPORT NEEDED On paper their task is huge. Nationally 40 per cent of prisoners have a mental health issue, while 60 per cent are thought to have some sort of learning difficulty. In 2016 there were more than 40,000 incidents of self-harm in Britain’s prisons. As far back as 2009 a report by Lord Bradley called on the Government to establish teams to ensure the right mental health and learning disability support and services are available for people in contact with the criminal justice system. Yet in February 2017, the Royal College of Psychiatrists stated that ‘rising deaths and other harms show there are failures in reaching prisoners who need general medical and specialist mental healthcare’.
At HMP Liverpool mental health, physical health and substance misuse teams were working in isolation. Waits for referrals could mean lengthy delays in getting treatment while the situation worsened.
Nationally 40% of prisoners have a mental health issue, while 60% are thought to have some sort of learning difficulty.
THE BEGINNING OF A REVOLUTION Eighteen months later, a new governor and a new approach are in place. For Pia Sinha it’s the beginning of a revolution. “When I got here everything seemed broken. We had an ‘us’ and ‘them’ philosophy with our partners. The first response to a crisis was ‘who is to blame’ rather than learning from the event. When I heard about Mersey Care’s learning culture to improve I thought ‘this is exactly what I’m thinking we need here in HMP Liverpool’.
Stella Hannaway, Jonathan Drew and Pia Sinha.
We had to do a lot of trust building - but we chose each other.
We all believe patients come first.
But it had to translate into practice. Pia: “Prisoners are invisible. People make judgements about the person’s story. The commonality among the three of us was that we all believe that patients come first.”
makes the difference between rehabilitation and recovery and a ‘revolving door’ where a man comes into prison, serves his time but then reoffends and returns to prison because the root causes haven’t been addressed.
Staff morale was low – an entire culture change would be needed to turn round an environment in which prisoners had taken their own lives while waiting for treatment. The partners wanted an environment where staff could share concerns openly, learn from mistakes and be part of a system change.
UNLESS WE HELP THEY’LL STRUGGLE TO COPE HERE AND OUTSIDE
Mersey Care had adopted a Just and Learning Culture; in the event of a mistake the question is not ‘who is to blame’ but ‘what went wrong and how can we learn from this’? “We had to do a lot of trust building, but we chose each other. We had a common purpose, but most importantly we share the same values and ethos.” When MC Magazine visited, the team was planning a wedding for a terminally ill patient, and arranging a visit for a prisoner to see his new born son. It’s this sort of holistic care, says Stella Hannaway, that
People rarely commit crimes in cold isolation she says. “They come here with historic trauma, conditions that have never been diagnosed. Most men here have enduring physical and mental health or substance misuse problems.” Jonathan Drew agrees. “We impose strict regimes and expect men with chaotic lives to manage. Unless we do something to help they’ll struggle to cope here and outside.” For Pia Sinha success was about securing the right people. “We asked what does Liverpool need from its partners and staff so we develop such a service? Mersey Care knew intuitively that we needed a huge number of skilled people. They had the influence to attract those people.
Staff here were disenfranchised, unskilled, hungry for leadership – it’s been provided in bucket loads.” A dedicated wellbeing wing has recently been created. Here men are supported to achieve their personal wellbeing goals. If a prisoner becomes mentally unwell and needs to be admitted to hospital referral is straightforward, to one of Mersey Care’s own secure hospitals. The clinical team includes psychiatrists and psychologists, mental and physical health care nurses and learning disability nurses. They are supported by an administrative team, social workers, advocacates, a wellbeing practitioner, occupational therapists and a cognitive behavioural therapist. Men are assessed within seven days of admission and the team works closely with prison officers and other agencies to develop a dedicated care plan. Having learning disability nurses means men can be screened on arrival to identify and make colleagues aware of any special needs. Prison officers are now given training to help them to manage and support people with a learning disability.
SPECIAL FEATURE THEY’RE EMBARRASSED THEY CAN’T READ OR WRITE “A learning disability can be mistaken for disobedience and lead to punishment” says Jonathan Drew. “If we know someone needs more time to process an instruction, or help to fill in forms we’ll give that time. They may be embarrassed to say they can’t read or write. By finding out we can help prison officers and other staff gain a better knowledge of the person.” Patients are not only part of planning their care but leading it. A man may chair his own review meetings. His family will be invited, he can have a mental health advocate to help explain his care plan and speak on his behalf. Prisoner peer mentors like Ed (see below) are trained to spot subtle signs of problems and step in to help. Says Jonathan: “People like Ed can often spot a problem before we do. Prisoners are a big part of this partnership.” Planning for release starts well in advance to put support in place. Discharge meetings are attended by mental and physical health nurses and charities such as Shelter to support with housing and other needs. It could be something as simple as putting money on a phone. Even after release the
n the 15 years he’s served so far, he’s become addicted to painkillers, self harmed and attempted suicide twice, first slashing a main artery, then cutting up sheets bit by bit to secretly create a noose. “I woke up from a coma in Ashworth hospital feeling angry. I had arguments, I’d kick things over. My psychiatrist offered me a lifeline – if I could last three months without an incident he’d move me to to a ward where you can walk around the grounds unescorted, and there are more activities. It gave me a purpose, something to look forward to.
team will follow up to make sure things are going well and signpost men to community support such as Life Rooms recovery and wellbeing centres. Staff too say they feel more supported – applications for jobs have increased as word spreads. Pia Sinha says it’s visibly uplifting. “I can see people starting to feel the joy of working here.”
For Stella Hannaway that’s what the partnership is all about. “People here have so many complex issues. Some men tell us they would rather be dead than in prison. They’re someone’s son, father, brother. Someone loves them. Within this partnership there’s a massive bond. Whatever we do we all do together, compassionately.”
Jonathan Drew talks of a community with strong therapeutic relationships between staff and prisoners. He smiles. “Nurses are telling us how happy they are to be able to nurse proactively.”
MEN CAN FLOURISH HERE Mental health nurse Emma Renilson (right) leads the clinical team on the wellbeing ward. The team was named recently Mersey Care’s Team of the Month. It was, says Emma, a ‘massive achievement’. “We’ve never experienced that before – that feeling of being valued.” But while she appreciates recognition, it’s the impact on prisoners of the change that is most important to her. “I’m proud of what men on this wing have achieved. They flourish here, you can see the difference.”
Nurse Emma Renilson says teams are helping men flourish.
FOR MORE INFORMATION... • The Prison Advice and Care Trust (PACT) provides support to prisoners, people with convictions, and their families. prisonadvice.org.uk • NACRO offers support and advice regarding access to employment, housing and education to people with criminal records and professionals working with them. nacro.org.uk
Ed is a gently spoken Scot. He wants to be a psychologist and supports prisoners who are struggling. He can empathise, he’s serving 25 years for murder - his revenge for a serious sexual assault on his young brother. “They gave me a type of therapy that helps you think of ways to deal with things that have happened in other ways than drugs and self-harm. When the time came to come back to prison I was apprehensive but the mental health team told me they would be here for me to speak to anytime and they are. “I’m now drug free – I ask to be tested weekly so I’m not tempted. I haven’t self-harmed for four years. I got a job cleaning and now I’m second head cleaner so I’m trusted to clean offices with confidential stuff. I work in the servery so I’m out of my cell from 7.30am to 8pm every day.
People complain and goad me asking for more food. At one time I would have reacted but now I don’t.“ Ed’s wearing the T-shirt that identifies him to other prisoners as a peer mentor with the Drug and Alcohol Recovery Service. “It’s just talking” he says modestly “I tell them I used to do drugs and self harm, and that the staff are strict but fair. They helped me a lot, now I get my buzz from helping other people…”
aring for someone can be immensely rewarding – and most people would probably say that they are just being a husband, a wife, a mum, a dad, a son, a daughter, a friend or a good neighbour. But it can also affect your life, finance and relationships, and leave you needing support. Ahead of national carers week (10 to 16 June) we explore what it’s like to care for someone and guide you to help and support.
JAN’S STORY Each Monday Jan Evans waves goodbye to her beloved husband George. He’s well cared for at a local day centre, and she values her respite. But Jan is lonely. She tries to stay positive, but his condition is taking its toll on them both. George, a former head teacher, is now having difficulty speaking. “We have so many things to talk about, but we can’t have a conversation.” He can, unknowingly, be difficult with Jan. “Sometime he refuses to get dressed, things go missing a lot – I found the remote in the bin the other day.”
We have so much to talk about but we can’t have a conversation. Jan’s no longer sure George recognises her. “The dementia team say he knows I’m the person who cares for him. But I worry in case we’re somewhere and he wanders off, if he’d be able to describe me.” It’s far from what the bubbly 66 year old imagined when the pair met at work 43 years ago. They’ve since enjoyed a lifetime of extensive travel and a thriving social life.
1 in 8 adults are carers. They save the economy £132 billion per year, an average of £19,336 per carer.
Friendships have also faded since George was diagnosed. “I love to cook and we’d have people round for lunch or dinner. I still see some of them. I say hello. But I realise now they were acquaintances.” Today they enjoy dementia events and groups. Jan has strong bonds with other carers. Holidays may not be as exotic as in years gone by, but she praises the dedicated breaks they enjoy for people with dementia and their carers. It’s a chance for her to relax and take time out knowing George is in good hands.
He looked after me so well before all this. Now it’s my turn.
There are though, precious moments of joy. Jan grins, recalling the pleasure of coming home from a respite session on Saturdays to hear George and his carer, a young man called Michal, whistling along to Bing Crosby musicals on YouTube. She tries, she says, to be philosophical “He looked after me so well before all this. Now it’s my turn. We have so many good times to look back on. I just wish we could look back together.”
Support for you
Every day another 6,000 people take on a caring responsibility By 2037, it’s anticipated that the number of carers will increase to 9 million More than 3 million carers juggle care with work – one in five carers are forced to give up work altogether
She’s most tearful talking about family life. “George retired when the boys were 7 and 9, so he’d look after them while I worked. Now they have to introduce themselves – he doesn’t recognise them. He can’t stand noise so he gets frustrated when our little granddaughter plays. I get upset but our sons say ‘he can’t help it Mum, it’s the disease’.”
POST TRAUMATIC STRESS
Carers Allowance is the lowest benefit of its kind 72 per cent of carers responding to Carers UK’s State of Caring Survey said they had suffered mental ill health as a result of caring 61 per cent said they had suffered physical ill health as a result of caring. Source: Carers UK
FOR MORE INFORMATION... • Local Solutions (Liverpool Carers): 0151 705 2307 localsolutions.org.uk • Sefton Carers: 0151 288 6060 sefton-carers.org.uk • Knowsley Carers: 0151 549 1418 knowsleycarers.co.uk
Support for you
• our self help guides may be helpful for you or someone you know or care for merseycare.nhs.uk
CARERS FEATURE NEED SOME HELP? While you may be someone’s main carer, that doesn’t mean you have to manage all on your own. Social support from friends and family is important not only for the person’s health, but also for your relationship. Get support from friends and family and make sure they know how much caring you do, and how it affects you. Be specific about what they can do to support you. Your local carers’ centre may be able to help you meet other carers and take part in social activities. You can also meet other carers online on Carers Space online community. Catherine Mills supports carers in local communities. She urges professionals and carers themselves to go along to their local carer centre. “They can be a lifeline in preventing the isolation that can happen when someone becomes a carer. They’ll help with financial issues and welfare benefits, but they also offer free services such as counselling and complementary therapies. You may be entitled to carer credit to pay for someone to sit with your loved one while you attend groups or sessions.”
TIME TO CARE
any of the carers Tracy Collard supports face different challenges. Their family member or friend is in one of Mersey Care’s secure hospitals. Most are parents – and many live long distances from their adult children. “It’s a constant dilemma. They might talk on the phone every day, but it’s not the same as being with them. They know their child can’t live with them, and although they can see the person getting better they miss the little things like
calling in for a chat, or giving them a hug when they’re upset. There’s a lot of mutual support within our learning disabilities carer group – they value having someone who knows what they’re going through. We have a lady who was struggling to visit from Manchester because she couldn’t walk to the hospital from the train station but a taxi would be expensive. We arranged for someone to pick her up – it’s made all the difference to her and her son. She can be the mum she wants to be.”
There’s a lot of mutual support... they value having someone who knows what they’re going through. The Matter website has an online community just for young adult carers. Find out more about getting a break on the Carers Trust website.
Source: Carers Trust - Carers.org
A DOSE OF LIFE
How would you feel if your doctor prescribed a course of origami? Or ukulele? Much better apparently. It may not be bottled, to take twice daily - but all the evidence is that this ‘medicine’ is changing lives.
he number of people taking antidepressants has more than doubled in the last 10 years, while reliance on common painkillers has increased by 40 per cent. Yet studies report that demand on GP services drops by almost a third among people referred to a social prescribing service. A course of meaningful activity can have dramatic effects on people with long-term health conditions or social needs, those who need mental health support – or people who are simply lonely and isolated. Six out of ten family doctors think that social prescribing could help reduce their workload.
It’s about helping people before they descend into crisis.
There are much wider implications. Social prescribing is fast being seen as a solution to a range of broader government objectives, such as getting people into learning, volunteering and employment. The Government has just announced the expansion of a link worker programme in which dedicated advisors coordinate the social prescription and support the person on their journey. The plan is to have 1000 more link workers by 2023. On Merseyside GPs can refer their patients to Life Rooms. These dedicated centres for recovery and wellbeing are, says Mersey Care’s Director of Participation and Social Inclusion Michael Crilly, the modern day equivalent of the old matriarchs of generations gone by. “There’s one in every street. She knows everyone, and if she can’t help she’ll know someone who can. It could be anything from a bit of moral support, to finding your lad an apprenticeship.
Michael Crilly Mersey Care’s director of participation and social inclusion
Social prescribing is like the matriarchs of a generations gone by... “At Life Rooms we’ve taken that principle and repackaged it. It’s about helping people recover by getting to them before they descend into crisis. We’re re-engineering the structure of community based health, creating a social model for improving health and wellbeing that compliments and adds value to clinical approaches.” CONTINUED ON PAGE 14.
I FOUND HOPE ON
THE SCHOOL RUN At 48 and a former drug addict, Paul Regan faced a choice of watching his new born son go into care – or fight for sole custody.
e’d met Jack’s mum at an addiction recovery group, but they parted ways when the baby was born. With social services considering taking Jack into care Paul, by then drug free, made his decision. “He was four weeks old when I took him home. I’d never even held a baby. But I couldn’t risk losing him. I was terrified, but I knew I had to take responsibility for my actions. I’d never done that before, but it wasn’t about me now.”
He’s made a home and a life for him and Jack. His long term ambitions were always to help people to avoid the lifestyle that so nearly killed him – and to get a job so he could be a good role model for his son. On the school run one morning he passed Life Rooms at the former Walton Library. “I was feeling lost at home without Jack. I’d heard about it and thought I’d give it a go.”
I was terrified, but I knew I had to take responsibility for my actions. I’d never done that before, but it wasn’t about me now.
FEATURE Paul was empowered by sharing his story. His own childhood was that of a loner who moved around leaving him with no roots and few friends. Gang culture was rife. Paul was ‘befriended’ by older boys and drawn into petty crime and drugs.
I was feeling lost at home I thought I’d give it a go.
I WAS JUST WAITING TO DIE “I didn’t like it but I wanted to please people - and I knew I’d be ridiculed if I refused. None of them were bad kids, we just craved excitement.” As time went on I wasn’t living, I was just waiting to die. The recovery group helped me get clean. But when you stop using drugs you have to look at defects in your character, see who you really are.”
Life Rooms gave him new direction. After taking part in courses he became a volunteer, leading an addictions support group at Walton Life Rooms and volunteering with Mersey Care’s criminal justice team, helping people going through courts, probation or prison.
Now he’s fulfilled his biggest ambition – he’s started work as a peer mentor for the criminal justice team. “It’s what I’ve always wanted. My own dad looked after me. My mum died two days before Jack was born but I feel she’s looking over me. Now my son will have his own role model.”
It’s what I’ve always wanted ... Now my son will have a role model.
I’ve always been active – I was in the Ramblers Association – but I fell and badly damaged my knee, so now I struggle to walk. I’m a sociable person so when I couldn’t get out I began to wonder ‘if I can’t enjoy life what’s the point?’ My GP suggested going to the Life Rooms in Walton. I went because I needed to get out of the house. At first I thought ‘what am I doing here?’ But now I’m grateful. There’s so much positivity at Life Rooms. I come in most days, even if it’s just for a cup of tea, and I’ve never felt better. It’s made me realise that you have to accept your situation and help yourself, but this place gives you the feeling that things will be alright…” John Webster.
YOU GET THE FEELING THAT THINGS
WILL BE ALRIGHT...
CONTINUED FROM PAGE 11. Life Rooms is fast becoming the first port of call for health and social care professionals who are increasingly signposting people to the service for social prescribing support. People are increasingly self referring (often by simply turning up at a Life Rooms recovery and wellbeing centre). The strength of Life Rooms to deliver social interaction and therapeutic activity is not just the plethora of culture on its doorstep – think Tate gallery, world museums, the coast. It’s the number of strong partnerships with voluntary, community and corporate sector organisations. When a referral comes in Life Rooms link workers known as pathways advisors will meet with the person to find out their needs and interests. Together they select a ‘prescription’ from the Life Rooms Recovery College prospectus, or from options provided by one of the 107 partners from voluntary and statutory services that work with Life Rooms. More than 2000 referrals for onward support were made by pathways advisors between during 2017/18.
Six out of ten people who visit are already Mersey Care service users. Doesn’t that smack of preaching to the converted? Not at all says Michael Crilly, because the other four out of ten are completely new. “They’re people who aren’t yet in crisis, and hopefully never will be because we’ve prevented them getting to that point.”
They’re people who aren’t yet in crisis, and hopefully will never will be. Southport Life Rooms, one row back from the promenade, is the second of three centres. The first, an elegant domed ceiling Carnegie library in the inner city suburb of Walton, the latest a 1950s disused church in Bootle, an area with two of the country’s most economically deprived electoral wards. It’s a partnership with Hugh Baird College in a bid to reach young people before they
reach crisis point. The Life Rooms model also happens within Mersey Care’s secure hospitals and there’s work with HMP Liverpool to explore how the Life Rooms can support rehabilitation of the prison population. It’s not about aesthetics, but the pastel colour schemes that run through all three Life Rooms do have a certain appeal. (Think Scandi room set with the informality of your Nan’s parlour}. That’s all fine, but progress relies on proof. Robust and systematic evidence on the effectiveness of social prescribing is still limited. Much of the evidence available is qualitative, and relies on self-reported outcomes. The Trust is leading the way nationally in evaluating, to gain the hard evidence to gain more funding. The roll out of an integrated online referral system will soon allow GPs, district nurses and other health professionals to prescribe instantly via the Trust’s own system. The referral will be picked up by a pathways advisor who will contact the person and start planning their ‘prescription’.
…to discuss problems in my own life, receive advice, support and guidance to other services where necessary, without needing an appointment or needing to see a doctor or other professional…is something I haven’t seen anywhere else I have lived. Mersey Care is working with Derry based digital company Elemental, who helped the Mayor of London Sadiq Khan develop his vision for social prescribing in the capital. Investment in their digital social prescribing platform will better capture individuals’ journeys within the Life Rooms, as well as to more robustly demonstrate the impact of these journeys.
It’s timely. Both GP and psychological services have massive caseloads. The General Practice Forward View emphasised the role of voluntary sector organisations – including through social prescribing specifically – in efforts to reduce pressure on GP services. It won’t replace the traditional clinical model, but it will challenge the notion that the best option is always a prescription for medication or referral to talking therapies. “We’re seeing people leave our services faster with social prescribing than with just other treatments alone. We believe we could significantly reduce mental health outpatient appointments” says Michael Crilly.’ “People have told us their goals are moving away from secondary care and decreasing medication, and no longer needing formal therapeutic interventions. GPs like it because they have something else to offer people over and above clinical support - it could be that the health problems are a symptom of loneliness, isolation and so on. What better than to prescribe company and something meaningful to do?
“Social prescribing isn’t new and we’re not the first to do it - but as momentum and evidence builds both GPs and service users want more of it. You won’t meet anyone who doesn’t think social prescribing is a good idea. “However GPs need a resource and infrastructure that enables them to safely and effectively support people to access community based assets in a way that clearly tracks the impact on health and wellbeing. The Life Rooms is proudly part of the NHS and so we are able to provide the governance and quality assurance systems to support the confidence of health care professionals in making referrals - we’re a safe and trusted pair of hands.”
He’s optimistic and very excited, but realistic. “Success depends on money being made more readily available to cash strapped voluntary and community sector organisations. The Life Rooms offers a platform through which such organisations can demonstrate their effectiveness and so provide them with an evidence basis against which to commission.” There’s also the issue of how the money should be allocated. “Giving money for social prescribing may mean taking it from somewhere else. You could also argue that it costs money to organise an appointment with a clinician who would then prescribe six sessions with a walking group. Is that necessary? Would it not be better and easier for people to refer themselves and direct the funding to providers of these sessions?”
“There’s masses of qualitative data – we have hours of recordings of people saying how much it’s changed their lives. It’s incredibly powerful, but we need hard evidence on the longer term wider impact on whole communities of that intervention. How did it impact on the family, the neighbourhood? Did it reduce costs to the NHS, or the wider economy? It is vital that we can demonstrate a robust evidence base if we are to effect change in the commissioning of social prescribing. “Time has to pass for us to have that sort of evidence. We’re well ahead with it – we started after many others but we’re the only organisation with anything approaching sound economic data.” He won’t be drawn on a six month study of the two cohorts of around 170 service users, one with nothing but clinical contact – and one where clinical contact is supported by social prescription. ‘Time will tell!’ Life Rooms is also doing well for ‘bums on seats’ – 2000 people visit Walton each month with a round 1,500 at Southport. More than 1000 people visited Bootle in its first month of opening. Michael Crilly is cautious but confident. “Opening Walton Life Rooms could have easily been seen as a vanity parade for us. Yet here we are with massive numbers coming through the doors. People self refer – that’s not something that happens in mental health. Better still they often take the next steps by themselves. We ran a wellbeing course – from that people joined a gym and started walking. Since then they’ve signed up for the Couch to 5K. If that’s not success then what is?”
It’s also notoriously difficult to prove effectiveness to secure future funding. That’s why Life Rooms is undertaking research to look at the longer term and wider benefits not just to the individual, but the community and the local economy. *Evidence Review by University of Westminster. Royal College of General practitioners survey: RCGP.org
I’m now fitter, I’ve lost weight and I don’t even mind the inevitable stiffness and aches that come with it.
RUN FOR YOUR LIFE We ask two newcomers to running why they put on their trainers… and how it makes them feel. MYLES:
have great admiration for people with the determination to raise money for charity by running a half marathon. My motives were far less altruistic – I just wanted to see if a 52-year-old man with a dodgy Achilles tendon and a complaining right knee could haul himself around 13.1 miles without stopping.
It has marked benefits and I’m now fitter, I’ve lost weight and I don’t even mind the inevitable stiffness and aches that come with it. It also does wonders for your self esteem – I’ll never forget how good it felt being able to run 10 miles for the first time, knowing what you’ve put in to get to that point.
I’ve been a half-hearted runner for a few years, entering 10km races and turning up bleary eyed for Saturday morning Park Runs. I’d noticed my times increased in line with my waist-line, and decided to challenge myself by entering the Wilmslow Half Marathon. I’ve tried other methods, like going to the gym, cycling and spinning classes. They all have their merits, but running is easy, right? You just put on your trainers and off you go…or so I thought.
I didn’t have time to follow the training programmes suggested online, but I run a couple of shorter runs in the week and a longer one each weekend.
MYLES’ TIPS: Try not to set your
Overcoming my injuries was the first hurdle – my local NHS hospital’s physiotherapy department sorted those out with a few daily stretches. Training was the next challenge, but I genuinely grew to love it.
targets too big. Run regularly but short distances and by gradually lengthening them you’ll soon improve. I’d also recommend running outside rather than in a gym. Fresh air gives you such a lift and you see things you’d never notice normally.
STOP PRESS: I did it! Absolutely one of my life highlights to date. The atmosphere was electric and I finished in just over two hours!
The same route can seem manageable one day and tough the next.
y race number has arrived – the countdown has begun. I’m running the London Landmarks Half Marathon for Tommy’s, the baby charity. I’ve been thinking about it for a while, but it took till now to commit to the challenge. Signing up felt scary, but running is now rooted in my routine. That said each day is different. There’ve been points when I’ve felt invincible. But the same route can seem manageable one day and tough the next. Tackling the elements is hard – putting on my running gear when I get out of bed leaves me with few excuses! Tracking my distance has helped me psychologically plot milestones and keep a sustainable pace. Running podcasts can be inspiring. I listen more to my body now. I’ve noticed new muscles aching, my stamina’s increasing. From a mental perspective, running is like meditation. Just a light jog can instantly
elevate my mood. Even on busy streets, I’m in my own peaceful bubble, reflecting, regaining perspective and connecting with my local surroundings. I didn’t realise how soothing it would be to just focus on my breath and the rhythm of my strides. One of the most rewarding aspects is raising money for my cause. I’m motivated by donations and encouragement from family and friends – and to finish knowing that I’ll make a difference to someone’s life. • Hear more from Myles and Emily on our YouTube channel: Mersey Care NHS Foundation Trust.
EMILY’S TIP: Invest in supportive trainers – it makes a huge difference. Use apps, websites and other free support systems such as the Couch to 5K programme, Parkrun, and running clubs so you’re with like minded people on a similar level.
‘JOG ON’ BY BELLA MACKIE
‘Jog On’ is an honest and personal account of how running helped Bella to alleviate her battles with severe anxiety, heartbreak and grief. Threaded throughout her accessible diary-style chapters are thought provoking case studies, as well as important insights into the complexities of common mental health problems. This uplifting story follows Bella’s step-by-step journey from lying literally at rock bottom, to slowly reopening her world to embrace more than she could ever have imagined. Not only is her bravery empowering for budding runners, but her motivational tips and helpful resources can also point you in the right direction towards your own wellbeing goals. Jog on is published by William Collins and available online or in bookshops.
The BBC TV drama ‘Killing Eve’ introduced us to Villanelle, a nonchalant and apparent psychopathic killer. Her exploits had millions gripped to their screens; but as the second series is launched we ask experts can women be psychopaths?
illing Eve is different. It’s the kind of show that demands you get into the finer details. It centres on two women: Villanelle, a hired assassin, and Eve, the intelligence officer who starts tracking her. The two become mutually obsessed. Liverpool born actress Jodie Comer’s portrayal of Villanelle has, in spite of our best efforts to be appalled, totally fascinated. That (dare we say it?) obsession is shared by Comer’s onscreen adversary the frustrated MI5 officer Eve (Sandra Oh) for whom Villanelle fulfils fantasies of being a spy. Sandra Oh, who won a Golden Globe for her role, said she was struck by their relationship but warned that Eve’s state of mind is ‘pushed to the absolute limit as she tries to contain the feral energy that is Villanelle’. Jodie Comer is a natural actress who is by all accounts extremely nice, and not at all like a psychopathic serial killer (although it seems they can be very charming). But her self-possession makes her a natural fit for a role many seasoned actresses would struggle to pull off.
Her self-possession makes her a natural fit for a role many seasoned actresses would struggle to pull off.
photo: Edd Horder
It’s TV drama at its best. But it begs the question - are there actually women in society like Villanelle? And why in spite of everything she does, do we view her so differently than we would a male psychopath?
I want people to be appalled by Villanelle, but at the same time cheering her on. Luke Jennings, author The Villanelle Diaries
Writer of the first series Phoebe Waller-Bridge thinks it’s because in decades of television it’s always women who are brutalised. I think people are slightly exhausted by seeing women being brutalised on screen,” she told the BBC. “We’re allowed to see women on slabs… and being beaten up, and in some ways that’s important to see because it shows the brutality against women. Seeing women being violent, the flipside of that is refreshing and oddly empowering.” Luke Jennings, author of the thriller turned drama says of his heroine: “I want people to be appalled by Villanelle, but at the same time cheering her on.” Why do we cheer her? YouTube blog site Ideas at Play maintains that we may eventually revile a man who persistently crosses moral boundaries; yet a woman who does the same is alluring. But it’s also Villanelle’s eccentricity and childlike glee that draws us in. A recent blog suggests that ‘we want to see the world as she does, so much so that it’s hard to remember that she’s the villain’. CONTINUED ON PAGE 20.
Killing Eve led this year's BAFTA TV Award nominations, with its stars Sandra Oh and Jodie Comer both up for best actress. The show is also in the running for best drama series, while Phoebe Waller-Bridge is nominated for best drama writer.
I think people are slightly exhausted by seeing women being brutalised on screen.
KILLER QUEEN DO WOMEN PSYCHOPATHS REALLY EXIST? 19
Photo courtesy of BBC
CONTINUED FROM PAGE 18. But it seems art, in this instance, isn’t imitating life. Mersey Care forensic psychiatrist Arun Chidambaram and psychotherapist Simon Graham agree that while the series was highly entertaining, there’s no scientific evidence to prove that female psychopaths exist – the only studies have concentrated solely on men. Society has also changed massively since a checklist of psychopathic traits used to assess patients via an interview, was published in the seventies by Canadian psychologist Robert Hare.
“Psychopathy is a controversial subject,” says Dr Chidambaram (right). “There are those who say it doesn’t exist and is simply a social construct. Others will argue against that. Either way all the evidence is based on a study of male prisoners in Canada, so you can argue whether it truly applies to females.”
Rarely do psychopaths kill, he says, but many use the traits (arrogance, impulsivity, irresponsibility, glibness and superficial charm to name a few) to achieve a high level of success in life. Dr Chidambaram says a glance at Hare’s checklist (other traits include cunning and manipulativeness, lack of remorse or guilt, callousness and lack of empathy), might suggest that notable politicians in some of the world’s most powerful countries display the very symptoms clinicians look for when trying to diagnose psychopaths and sociopaths. There’s also a lot of misconception around diagnosis, says Dr Chidambaram. But we should be pleased to hear that in the general population less than one per cent of people would meet the criteria for a diagnosis of psychopathy. In fact, he says, most people display some symptoms of psychopathy - but it doesn’t turn them into a killer.
Dr Arun Chidambaram
Less than one per cent of people would meet the criteria for a diagnosis of psychopathy.
Photo courtesy of BBC
Dr Simon Graham, an expert in borderline personality disorder says there’s a debate to be had about whether Villanelle was a ‘soldier’, rather than a psychopath.
If she was a patient of mine I would have been interested to discover what had happened in her childhood. Maybe she’d had a major trauma that had shaped her behaviour?”
“There is a very small proportion of women who do harm others – even, very rarely harming children – but it’s almost always the case that a woman would be more inclined to harm herself.”
His theory holds up. Both Villanelle and Eve are fighting their own personal battles and become alternatively victim and perpetrator (no more spoiler alerts – there’s still time to catch up ahead of series 2).
That said he too was intrigued by Villanelle and Eve – and like so many of us, he can’t wait for the second series.
The term psychopath is seldom used by clinicians these days, especially in relation to women, says Dr Graham (right), who heads a programme at Mersey Care dedicated to treating and supporting people diagnosed with borderline personality disorder. “The term antisocial personality disorder is more commonly used now than psychopathy and this is usually applied to males. Women are far more likely to turn their aggression on themselves rather than hurt others and thus be diagnosed with borderline personality disorder.
“TV shows like this allow us to compare ourselves to nasty people; it makes us feel that we’re good and better. But we’re also envious of them. Who wouldn’t want to occasionally ignore the rules of society? This way we can sit back and watch someone else do it from the safety of our living rooms!”
Mersey Care offers services to help people diagnosed with a personality disorder. They include: • Dialectical Behaviour Therapy, a type of talking treatment adapted to help people who self-harm and experience emotions very intensely • The Rotunda service, a therapeutic community group that supports service users to be more independent and take responsibility for their own behaviour which, in turn, empowers them to change • A personality disorder day service using social therapy activities to help provide stability prior to commencing therapy • Mentalisation based treatment, that helps people learn to better understand the intentions of others and see things from new perspectives.
Season 2 will begin on April 7 in the US, with the UK date not yet confirmed. Watch series one now on BBC iPlayer. Dr Simon Graham
STAY WELL FEEL GREAT
I FOUND MY
Zulay Newell moves around the tables at the Southport Life Rooms, giving hints and tips on silk painting. The mood is light, there’s chatting and laughing in between the delicate craftwork. Participants don’t think of it as ‘medicine’ they just know it makes them feel better.
articipant Janeita Belgrave (right) has done many courses like this. She’d brought up a family of five before becoming severely mentally unwell.
“I was always the one who helped people. People outside didn’t get me being ill. At the groups everyone’s in the same boat, you understand each other – you share what worked for you and it makes you feel better. Something like this focuses your mind. You have to concentrate – you forget your problems.” Zulay can empathise – she’s ‘been there’. After graduating from chemical engineering, leaving her native Venezuela to learn English, moving north with her husband and expecting their daughter Ruby, Zulay was truly happy. A few months later and a new mum she was an inpatient in a mental health hospital diagnosed with bipolar disorder. “I had extreme highs and lows. I thought ‘you wanted so much to be a mother, how can you be so unhappy?’ But I didn’t want to live.”
It’s given me a new sense of purpose. On her fourth hospital admission activity worker Chris Kirby gently encouraged her to join in creative arts sessions. “I picked up a piece of paper and started folding. It suddenly brought back happy memories of doing origami as a child with my brother back in Venezuela. I’ll never forget that moment. It was the first clear thought I’d had in a long time. With Chris’s help I began sharing my ideas with other patients. It was an incredible feeling.” Creating became part of her recovery. She’s since set up two social enterprises with fellow service users Helen Pinch and Kate Cottam. “I tell people the story of how I found my ‘Ikigai’ – it’s a Japanese term meaning ‘the thing that makes you want to get out of bed in the morning’. I’m in a good place now and I’m grateful for what happened. It’s given me a new sense of purpose.”
You concentrate and forget your problems. FOR MORE INFORMATION... •
Zulay’s courses run on Wednesdays at Southport Life Rooms (1pm to 3pm). Websites: mobilecraft4u.com origamipulse.com British Origami Society: britishorigami.info Twitter @BritishOrigami Facebook @bosfb
Lack of sleep is more than inconvenient. With links to obesity, weight gain, stress and ageing, getting a decent amount of shut-eye each night needs to be a priority. Sleep times vary from person to person, but 40 per cent of the UK population regularly gets less than six hours a night. There is no optimum number of hours, it’s whatever you need to be alert the next day says sleep expert, Dr Chris Idzikowski.
WHAT IS A GOOD NIGHT’S SLEEP? Good quality sleep means that you typically fall asleep in 30 minutes or less, sleep soundly
through the night with no more than one awakening, and drift back to sleep within 20 minutes if you do wake up. There’s even a robot that performs better when its creators induced it into a ‘sleep’. But lack of sleep can also have serious consequences for your health, including heart disease and diabetes. • If you are experiencing problems with sleep Mersey Care’s Talk Liverpool talking therapies service offers a stress control course that covers sleep issues. Talkliverpool.nhs.uk or call 0151 228 2300
SLEEPING PROBLEMS Support for you
• Our self help guides may be helpful for you or someone you know or care for: merseycare.nhs.uk
BEST POSITION? On your back. It allows your head, neck, and spine to rest in a neutral position. There’s no extra pressure on those areas, so you’re less likely to experience pain. Sleeping facing the ceiling is also ideal for warding off acid reflux.
BE A DREAMER
Researchers from Swansea University Sleep Lab say dreaming helps us process the memories and emotions we experience during our waking lives.
N SPOO est t
With long days and (hopefully) balmy nights ahead, how can we plan for a good night’s sleep?
FF O G N I T JET ARLY? E
Starting a few days before your flight, go to bed 30 minutes earlier than normal and set your alarm to wake up half an hour earlier. By the time the night before your travel day arrives you’ll be able to go to sleep a few hours earlier and get the sleep you need before the alarm goes off.
If you want to know how sleep deprived you are, take the Spoon Test. Officially known as the Sleep Onset Latency Test and recommended by TV doctor Michael Mosley, it involves lying down in a dark room in the early afternoon, holding a spoon over the edge of the bed. Place a metal tray underneath the spoon, check the time, then close your eyes. If you fall asleep within five minutes you can be considered ‘severely’ sleep deprived. Within ten minutes suggests you have issues with sleep – over 15 minutes means you are probably OK. @DrMichaelMosley
Sources include: National Sleep Foundation - sleepfoundation.org and NHS Choices – nhs.uk
STAY WELL FEEL GREAT
VITALITY There’s no easier way to get into vegan cooking than a simple but yummy chilli. It’s about using a combination of spices to give depth and beans and vegetables for texture – they chunk it up! says dietitian Eleri Hughes who created the dish especially for MC Magazine.
Dietitian Eleri Hughes gives hints and tips on a plant-based diet. MC: WHAT DOES BEING TRULY VEGAN MEAN? EH: It’s avoiding eating or using animal foods/products such as meat or dairy – and not using products such as leather – so it affects both diet and lifestyle.
CHUNKY VEGAN CHILLI SERVES TWO LARGE OR THREE SMALLER SERVINGS TIME: 30 TO 45 MINUTES
2 tsp. olive oil 1 red onion, finely chopped 2 carrots, peeled and chopped 1 red pepper, chopped 2 celery sticks, chopped 125g mushrooms, sliced 400g tin chopped tomatoes 400g tin red kidney beans (in tomato or chilli sauce) 400g tin of beans – I’ve used adzuki beans but you can choose any cooked variety 2 tsp. chilli powder 2 tsp. paprika 2 garlic cloves, crushed 25g/1oz piece fresh root ginger, peeled and finely grated/chopped Parsley (to serve) Salt and pepper to taste
1. Heat the oil in a large pan over medium to high heat. Add the onion, stir for 2 to 3 minutes, and then add garlic, ginger, chilli powder and paprika. Cook for 5 minutes, stirring regularly.
Serve with: rice, pasta, jacket potato, as a taco filling or a nacho topping
2. Add the carrots, red pepper, celery and mushrooms. Coat with the spices and cook for 5 to 10 minutes, or until softened 3. Drain the beans if soaked in water and add to the pan, or add straight from the tin if soaked in a sauce. Stir for 2 to 3 minutes then add the chopped tomatoes. 4. Bring to the boil for 5 minutes, lower heat and simmer for 10 to 15 minutes, until thickened and reduced. Add salt and pepper to taste, finishing off with parsley if desired. 5. Serve with your favourite side and guacamole.
Cost (per person): £1.35 Nutrition information (per serving): 315 kcal/4.6g fat/45g carbohydrates /17g fibre/17g protein
MC: IS IT THE ULTIMATE HEALTHY DIET? EH: The promise of perfect health from following a certain diet alone is unlikely to hold true, and could even cause more harm than good. However, the principles of a vegan diet generally include incorporating more fruits, vegetables, legumes and whole grains into our diets. You’ll need meat and dairy alternatives for additional protein and micronutrients such as iron and calcium.
MC: WHERE WILL I FIND THEM? EH: You’ll get protein and calcium from pulses and legumes, such as beans, lentils and chickpeas, tofu, nuts and nut butters. Whole grains, seeds and soybean produce such as soya milk and yoghurt, and fortified breakfast cereal all provide sources of iron, zinc and vitamin B12.
MC: HOW CAN I MAINTAIN A VEGAN DIET AND STAY HEALTHY? EH: There’s no need to label yourself ‘vegan’ or pressure yourself into severely restricting your diet to incorporate vegan principles into your own food choices. Frame it as what you can add into your diet, not what needs to be taken away. It’s up to you to define what it means to you, why you’re pursuing it, and to ensure that you’re not overly restricting your diet.
• An in depth version of this Q&A is on our website dietetics pages – merseycare.nhs.uk • For more information on specific nutrients see the BDA Food Fact sheet on vegetarian diets (bda.uk.com/foodfacts/vegetarianfoodfacts.pdf) • Instagram ideas: @thefoodmedic @rhitrition @laurathomasphd
STAY WELL FEEL GREAT
IT’S ALL IN
THE MIND Has an ancient practice that many view as a hippy hangover, found its place as the perfect antidote to the chaos of modern life?
undreds of schools will this year take part in mindfulness trials, providing new evidence about what approaches work best for students’ mental health and wellbeing.
So why is this ancient Buddhist practice still viewed by many as fluffy and whimsical, unrealistic and unachievable? Has its credibility been diminished by colouring books and Ladybird parodies?
Even politicians are singing its praises. An all party parliamentary group set up to explore its viability, took part in mindfulness programmes and gave a firm thumbs up to its use in workplaces and the public arena.
Consultant Psychologist David King provides management lead for the Mindfulness Initiative in Mersey Care NHS Foundation Trust, which seeks to bring mindfulness and mindful influence to both service users and staff. But he
can see why people brand mindfulness as ‘tree hugging indulgence’.
FIXING THINGS HAS BECOME THE PROBLEM “We live in a culture where we’re pushed to fix, to find solutions. Having a perspective of ‘being’, rather than ‘doing’, is at right angles with so much of our lives.
“But fixing things has become part of the problem. In fact we all need to stand back and take a reckoning about our lives – to realise that constantly spinning plates isn’t normal. We have to get in touch with what our body needs; otherwise we’ll find out the hard way.”
The world is made up of so much beauty – let’s look at it as if we’re seeing it for the first time – as if you’ve landed from Mars!” Occupational therapist Lyndsey Sumner has been involved in the Mersey Care programme from the outset, developing teacher training programmes. She’s seen changes in her own life but the most profound effect has been with her patients.
Mindfulness, says NHS choices, is about paying more attention to the present moment – to your own thoughts and feelings, and to the world around you.
Patients who have been struggling for a long time it’s like a light has gone on.
IT SHOULD BE TAKEN SERIOUSLY David King says the real stuff can be disconcertingly powerful. “I quickly learned how seriously to take it. It’s a mix of something deep and profoundly calming, but it can be upsetting too as the filters come off.” It was introduced in the UK in the 90’s when eminent psychologist Mark Williams adapted the US training to develop Mindfulness-Based Cognitive Therapy for patients with recurrent depression – specifically to help people vulnerable to relapse to stay well and reduce the risk of recurring episodes. It worked. The risks halved. Trials have shown regular practice can be as effective as a maintenance dose of antidepressants, and can prevent relapse in people coming off antidepressants altogether. Liverpool University researcher Catrin Eames supports the development of the Mersey Care programme. “People come to mental health services when they’re in crisis, then again when they relapse. If you’ve experienced suicidal thoughts in the past, this is likely to happen again. That’s not a nice way to live. Taking part in a mindfulness-based cognitive therapy group can change the relationship we have with our thoughts – to step back and notice that ‘this is how I feel now, but it isn’t who I am’ – mindfulness meditation can act as a tool to stay well.” Psychologist Niala Waraich manages the programme and has seen its impact on people who are acutely unwell.
Psychologist Niala Waraich sees the impact in her own life.
“It’s not to be taken lightly, especially for people with mental ill health who have extra difficulties. Being aware can be colourful, vivid and bright, but seeing things as they are can also be difficult and painful. You need to be kind to yourself during these moments and you’ll need support to develop the skills to do that.”
I FELT I WASN’T THERE Niala began practising after realising she wasn’t present in her own life. “I was taken away from the moment so much of the time. Even when I was out walking I felt I wasn’t there.
We’re programmed to think a lot, but we also need to be aware of how we’re feeling. We spend so much time in the future or the past, yet very little in the moment. Children are naturally aware and conscious, but they lose that ability as they begin to understand the demands of life, such as academic targets.” “We’re programmed to think a lot, but we also need to be aware of how we’re feeling, about the emotions going through our minds in any given situation, so we don’t get carried away with what’s happening to us.
“For me personally it’s brought contentment, a sense of joy in things that would have gone unnoticed. But in patients who have been struggling for a long time it’s like a light has gone on – it’s lovely to see.”
HOW DOES IT WORK? Niala Waraich explains: “Perhaps you’re feeling anxious. You may get a twinge in your shoulder. That might make you more anxious, even panicky. You start thinking you may be seriously ill, if that’s the case you might lose your job, can’t pay the bills or play with the kids. Before you know it you’ve added layers of stress and moved far away from the original issue, the shoulder twinge. Mindfulness teaches you to yield to the twinge. To simply sit with the feeling till it passes rather than allow extra worries to come in.” What if you can’t do it? “No-one can be in the present all the time, but you can’t do it wrong. There might be moments when you don’t want to be present. Don’t self judge or try to stop unpleasant thoughts or feelings, but also hold on to positive moments – it could be something as simple as seeing a child smiling. “It’s much more powerful and potent than relaxation, but it’s not simple. You have to practice, build up what is a new relationship with yourself, train yourself to sit with your feelings, experience them. It’s not the be all and end all but it has a firm evidence base and should be available widely within mental health services. We’re seeing incredible results.”
STAY WELL FEEL GREAT
SAVED MY LIFE
She tried lots of medications, with horrendous side effects. “Nothing worked. I was terrified and devoid of any hope of getting better.”
s a mental health occupational therapist Jacqui Conway Ross supported people through difficult times. But a series of personal traumas put strain on her own ability to cope with life. “I’d lost both my mum and dad when I was in my 20s. My husband was diagnosed with multiple sclerosis, then my brother died. My horse was seriously ill. It all built up and I ended up going to hospital.”
When a psychiatrist suggested mindfulness based cognitive therapy Jacqui accepted out of desperation. “I was exhausted and very self critical, but I was also like a sponge, ready to absorb anything that could stop me feeling so bad. Before it was always ‘here we go again’ but I thought ‘this is doing something’. It was quite a miraculous moment. It changed my life – it saved my life. “You’re taught to accept troubling thoughts, rather than trying to get rid of them. With depression or chronic
It takes away a need to solve a problem. pain especially, you try to think your way out of it. Mindfulness teaches you to acknowledge the pain or emotion, knowing that they’ll pass. It takes away a need to solve the problem.” Jacqui is now a pathways advisor at Southport Life Rooms. “Mindfulness takes over your life, but in a good way. The gratitude I feel makes it worth every moment, to know I don’t have to live in misery. For me it was a last resort. I’d tell anyone else not to wait that long…“
When Gareth Roberts left his job as a joiner at the end of the day his workmates thought he was off to the gym. In reality the 28 year old was battling with anxiety and using meditation to help him make sense of the world.
worried about the big things – like ‘why are we here’? It’s not something you talk about on a building site! My practice made me realise I didn’t need to know the meaning of life, it was enough to appreciate the mystery, and that in itself made me feel calmer.” Immersing himself gave Gareth the strength and motivation to apply for university to study mental health nursing. “At one time I’d have struggled just to go into a shop, never mind a lecture theatre, but mindfulness had taught me how to stay in the moment, even if it was unpleasant or scary.” His choice of study, mental health nursing, stemmed from a desire for compassionate practice - to think about people outside your own circle of family and friends. “I see a lot of young men wrestling with questions regarding their existence and
what it means to be human. I think the times we live in discourage this type of enquiry, there seems to be an assumption that science has answered all of these questions leaving just the details to be filled in. People worry that asking these questions will make them appear strange. Lots of young men have these thoughts and I think practising mindfulness can help to make some sense of it. When I was struggling with anxiety I didn’t want to talk about it, but mindfulness lets you be your own therapist. You can just turn up and practise – you don’t have to share your difficulties with anyone.”
A GOOD READ: Mindfulness: A practical guide to finding peace in a frantic world (Penman, Dr Danny, Williams, Prof Mark Little), Brown Book Group.
MY WORKMATES THOUGHT I WAS GOING TO THE GYM Lots of young men have questions about their existence and I think practising mindfulness can help to make some sense of it. 29
STAY WELL FEEL GREAT
SPRING CLEANING good for the soul
Japanese organiser Marie Kondo turned de-cluttering into an art form. Instagram cleaning queen Sophie Hinchcliffe’s new book to ‘help shine your sink and soothe your soul’ was a bestseller even before its release. (mrshinchhome_x_) It seems cleaning doesn’t just feel therapeutic; there’s powerful psychology behind it. A study* found that women with cluttered homes expressed higher levels of the stress hormone cortisol.
Cleaning doesn’t just feel therapeutic; there’s powerful psychology behind it.
Kondo’s principle is keeping only possessions which "spark joy." Mrs Hinch, as she’s known to her 433,000 Insta fans, is a big believer in the idea that a happy home can help create a happy mind. Among them are folk who say tips from ‘Hinch Yourself Happy’ have changed their lives. Organisation and tidying websites abound. Try Apartment Therapy for ideas on creating a calm abode, or Pinterest for checklists to print and hang on your wall – or would that be more clutter? • apartmenttherapy.com • pinterest.co.uk • konmari.com
AND SO IS POLLEN, INSECTS AND UV RAYS!
THE SUN’S HERE
* personality and social psychology bulletin
Spring conjures up sunshine, days out, the smell of freshly cut grass …and if you don’t protect yourself, allergies and sunburn.
alk in centre clinical nurse manager Nicola Gourley says spring time sees a rush of people with runny eyes and noses, and worse still, sunburn. They include young babies, some with burns so bad they are referred directly to plastic surgeons.
COLD OR HAY FEVER? There are still viruses lingering from winter, so it’s worth keeping medicines such as children’s and adult paracetamol and ibuprofen. What you think is a cold may be hayfever, which can trigger asthma. Have antihistamines to hand, and if you’ve had even a single bout of asthma keep your inhaler and medication just in case.
BE SKIN SAFE A child’s skin burnt by sun is vulnerable for five years afterwards. Sunscreen alone isn’t enough, says Nicola. “It’s vital to keep babies and children covered and in shade, especially between 11am and 3pm. Sunscreen should be SPF 50. Re-apply every hour and whenever a child has been dried after swimming. Waterproof sunscreen only works in water.” Most minor ailments or allergies can be treated at home. If you have a child over 2 and are under the care of a Liverpool GP you can sign up to the Care at the Chemist scheme at your local chemist. You won’t need a prescription and some medicines are free. • The NHS website nhs.uk has plenty of information on keeping safe in the sun and common ailments and allergies.
BETTER BY DESIGN Imagine if, when you’re at your lowest, your home is shared with different people every day. There’s no privacy, no place to keep your stuff. You have to ask to charge your phone, or go outside. Yet that place is a mental health hospital.We talk to a man who knows what it’s like. And we ask the people putting service users at the heart of designing Mersey Care’s two new hospitals what they are doing to make people better by design.
ocial enterprise development director and mental health writer Mark Brown (pictured above) spends a lot of time with people who have spent time in hospital for their mental health. He’s vocal at the highest level about the need to let the people who use these spaces take the lead in their design. “Like prisons, immigration centres, detention centres, care homes, mental health buildings are society’s forgotten places, dark corners where people hope they’ll never have to go.” “Wards are built with the notion of containment. So there’s no agreed language about what would make a great design for them. There’s also a cultural stereotype of the way we view the people who live or stay there – we don’t like to think about it. But what are we saying we expect from people if we don’t make their place of healing an amazing place?
As architect, lecturer and author on design for wellbeing, Dr Robert MacDonald has travelled the world. But it’s his experience as a mental health service user and member of Mersey Care’s Design Board* that he’s used to influence designs at Rathbone and Clock View Hospitals.
Would we design a hotel that was easy for staff to manage but with beds made with pallets and other scraps of wood? Of course not. “Even when I was unwell I’d instinctively assess the design. If you were buying or extending a house you’d want to be involved in the design. It’s the same for a factory, an office. And it should be for a hospital.” His special interest is making spaces dementia friendly (he’s written a book ‘Design for Dementia’ and was involved in designing a dementia friendly prototype house in Watford). It’s simple things – like avoiding dark coloured mats – to someone with dementia that mat is a hole.” The Design in Mental Health Network says expert-by-experience feedback is vital in helping care professionals and providers
understand the impact of both good and poor design. (It also recommends involving staff and the local community). For Mark Brown a rethink of the hierarchy of needs is required, with the people who’ll use it at the top. “Design things from the bottom up, to fit the people who’ll use it. The day they enter that place may be the worst day of their life. They may have been brought in by police; they’re often there against their will for days, weeks months, possibly years. “That’s a long journey, what will those very different types of people need along the way to get better? Of course they’ll need different things and you might not be able to do everything – but have a look where their needs diverge and where they overlap and work to that. “Of course we need to consider safety and remove danger. But there’s a tension between safety and comfort where in our homes they come together. CONTINUED OVER.
*Mersey Care Design Board enables service users to contribute towards the design of our hospitals, clinics and Life Rooms.
IT SHOULD BE LIKE VISITING YOUR MATE’S HOUSE “Coming into a mental health hospital should be like visiting your mate. Why not carpets and soft furnishings? Or if there’s money, swimming pools and gyms? Cinemas? If not surely we can design phone chargers that can’t be used as ligatures?
“We’re taking people’s freedom away. The places we build show the level of respect we have for the people who will use them. “Try to dream. What would we want if money was no object? At the moment we say ‘limit your dreams; get back in your lane. Maybe we should say ‘we can’t do it all now but we can do some of it’ – that maybe installing storage lockers for people’s belongings – we can plan for the rest.
“When people tell us how they feel about a space we tell them to make a complaint, but they’re giving us valuable information on how things could change. We’re worried that if we listen to people’s dreams we’ll get demands. It’s actually about reducing anxiety and giving back control.”
Noirin Smith (below) has involved the whole community in designing Southport’s Hartley Hospital
THEY WANT TO LOOK UP AND SEE THE SKY
When she was put in charge of a new hospital for people with acute mental heath problems in the coastal town of Southport, modern matron Noirin Smith relished the chance to offer all the things that, even as a student in big institutions, she knew were crucial to recovery. And that she’d involve the people who would be affected most. 32
We took the dialogue way outside of the design team. We went onto wards; we held events where people could look at ‘spaces’ through virtual reality goggles. Young people especially liked that!
“People wanted the same things that are important when we’re well – quiet spaces for having some ‘me time’ doors opening wide onto outdoor space to sit, lovely views, a café to enjoy coffee with friends… just being able to go outside, look up and see the sky.” “People wanted to be able to open the blinds to let in the light, or close them to be cosy. Strings on blinds are a safety risk
to someone who is very unwell. So we’ve designed opening windows with built in blinds that can be opened and closed – that sense of control over even one small aspect of someone’s life can be a big step in their recovery.”
When much of someone’s life is in disarray, it’s important to give them control of little things.
MORE THAN A WISH LIST Is it a challenge to take direction from people who have a wish list but no skills or knowledge of what’s involved? Karen Flatt, architect for Rowan View, a £60 million medium secure hospital in Maghull says not. “The aspiration to involve service users was there from when we developed the brief. It’s really given us an insight and improved the design.” Service users here chose not just colours – the consensus was pastels for bedrooms, vibrant appetite enhancing red and orange for the communal café – but potentially the sounds – speakers in prominent positions to allow sounds of nature to be heard throughout the building. Architects listened to what patients wanted from their most inner sanctuary – their bedroom. “Traditionally beds in mental health wards are positioned facing a door so staff can look in and check a patient is ok. Service users asked if we could design the room so they could lie in bed and see the world, or watch TV, something we all enjoy. So we’ve installed vision panels on doors so staff are still able to observe.”
We looked for a place that will say to someone who comes in poorly and disempowered “we’re here to help you build a life worth living...” career opportunity and so exciting, there’s a real passion to deliver – it’ll be an incredible place to work.” “We always looked for a healing environment – a place that will say to people who come in very poorly and disempowered ‘your time here is not just to help you recover, but to help you build a life worth living, the life you want when you leave our care.”
Rowan View will be circular – the social and recovery hub is at the centre and bedrooms are around the outside. It’s practical, but also symbolic says Frank. “When someone opens their bedroom door all the things that are vital to their wellbeing will be there, on their doorstep. It’s a centre of inspiration, a focus on someone’s life that gives them hope.” Every ward has a garden. There are dedicated areas where families can spend time together with comfort and dignity. Seclusion rooms, used when a patient is unwell – will no longer be impersonal spaces. Media walls will enable family photographs, letters and other items important to the person to be displayed. “The people who come here will have often had a troubled and turbulent past. Coming into hospital can traumatise them again. We want to give them an environment that makes them value themselves, decide their goals and how to reach them - they’ll be partners in their own care. They’ll have hope and purpose.”
• View videos of Hartley Hospital and Rowan View at merseycare.nhs.uk and search New Generation Hospitals or go to our YouTube channel.
“Windows have been made bigger to give more light and ventilation. Mattresses are soft, low level lighting makes for a cosy ambience. All the things that make us feel better.”
IT WILL BE AN INCREDIBLE PLACE TO WORK Dr Frank McGuire, clinical lead for Rowan View says staff benefit from being in an environment that truly supports them to give the best care.
Services users have helped design signage and will tend the gardens at the new Hartley Hospital in Southport.
“The standard of care is always high regardless of the surroundings, but for the people who will work in the new hospital having input into a design they know makes a huge difference to people is a once in a The courtyard and a bedroom at the new Rowan View Hospital.
A DAY IN THE LIFE...
Getting it right can make a massive difference to someone’s life.
SARAH RAFFERTY PHARMACIST
y background is in IT in pharmacy, so I’m excited that our new electronic prescribing system is being launched. Having everything on one system is safer and it helps us get the right medication to people at the right time. It will help GPs do the same when the person goes home from hospital. I am excited about how much better it will be for staff and how it will help people stay well for longer. Our team works to make sure there’s no delay in getting medicines to people on our wards. Today one of the pharmacists
took a request at 3am – a newly admitted patient dependent on steroids couldn’t afford to miss even one dose so we made sure it was delivered. Prescribing for mental health conditions is often complex. Two people with the same diagnosis may need very different medications, and medicines for mental health can sometimes have an impact on someone’s physical wellbeing. We will look into the person’s history and advise the prescribing doctor. We know that getting it right can make a massive difference to someone’s life.
I’m always thinking about what I can do to make things safer and more efficient. I do on call shifts and also take any opportunity to go on to the wards. I love the chance to talk to patients and it keeps me connected to ward staff – after all their issues are my issues, being medicines safety officer means I get a chance to change processes for the better. I’m always thinking about what I can do to make things safer and more efficient. My husband is a pharmacist too – sometimes we’ll put our little boy to bed then sit and chill, but then a pharmacy related conversation will creep in!
I’M READY FOR FULL
STEAM AHEAD... After 20 years in the maritime industry I know life isn’t plain sailing. But I also learned that if you have good people willing to work together and be open to change, you can do great things.
’ve seen it in my own life. I gave up shipping, the job I’d done since I left school, to be a part time carer for my mum and dad. At the same time I went to university – at 40! Serendipity brought me into the NHS. While studying I took a job driving doctors between patients – they were wonderfully encouraging and persuaded me to apply for a practice manager’s job in Belle Vale Health Centre and later in Cheshire. Even the long commute home to Liverpool didn’t stop me loving every minute. I’ve just retired, but I’ve seen amazing examples over the years of what can happen when community matrons, district nurses, GPs and social workers get together, talking and thinking of ideas
PAUL SMITH together till they come up with a care package that gives a patient what they need at that moment.
together till the end. It’s simple, but what it says to the person is ‘people care about you.’
I recall one local lady with terminal cancer who was nearing the end of her life and needed palliative care. She cared for her husband who had dementia and was distraught at the prospect of being separated from him.
I’ve already seen some great work at Mersey Care. I love the Life Rooms – what a great concept, giving people so many different types of help.
We found a care home willing to put two beds in a room, so the couple could be
How can I help? I’m an ‘insider’ so I’ll try to add my understanding. I think of it as paying back and I’m looking forward to it!
The Annual General Meeting and Members Event will take place at Aintree Racecourse in the Lord Sefton stand on Wednesday 26 June 2019. Invitations will be forwarded to all members in June 2019. The election of Governors closed on 22 March 2019. Details of the successful nominees will be uploaded to the website soon.
Find out more about our membership and governors at: Website: merseycare.nhs.uk. Phone: 0151 471 2303 or 0151 473 2778 Email: email@example.com Write to: Alison Bacon, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, Liverpool L34 1PJ.
PERFECT FIT At Mersey Care we’re recruiting experienced full and part time nurses in a range of physical, mental health and learning disability specialities. You’d be part of one of the largest NHS providers in the region giving you the space, freedom and opportunity to grow and develop.
Find your perfect fit today Visit: Merseycare.nhs.uk Or email: firstname.lastname@example.org
I am incredibly proud of the work we do here at Mersey Care and I know that experienced nurses who want to develop their career could be too.
Contact details Got some news you’d like to share? Contact us at the following address.
Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, Merseyside L34 1PJ Telephone: 0151 473 0303 Email: email@example.com
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