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YOUR COMPLIMENTARY COPY

MAGAZINE

MC

Winter 2017

NO BARRIER TO THE BLUES

Get Good Vibrations

Stay Well Love Winter

Psychosis – The Perfect Storm


MC

MAGAZINE 3 WELCOME 4 NO BARRIER TO THE BLUES 8 ANOTHER WAY 10 PSYCHOSIS – THE ‘PERFECT STORM’ 16 LIFE THRU’ A LENS

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NO BARRIER TO THE BLUES Superstardom gives no immunity from depression. What is it and why does it happen?

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POLE POSITION

LIFE THRU’ A LENS We look at lives documented through digital imagery.

MC magazine team: Managing Editor: Steve Murphy. Editor: Jackie Rankin.

29 THE POWER OF A CUPPA

The Big Brew

Why we should all wrap up and start Nordic walking.

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21 STAY WELL – FEEL GREAT

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30 NO GOING BACK

STILL LIFE

32 A JUST CULTURE

Psychosis - misunderstood and more common than you think.

35 DAY IN THE LIFE

Contributors: Graham Hignett, Myles Hodgson, John Rowbotham, Faye Sefton, Mike Spencer. Editorial: Julie Crompton, Joanne Cunningham. Photography: Joel Goodman. Design: Jo Hadfield.

You can contact us at: communications@merseycare.nhs.uk MerseyCareNhsTrust Mersey_Care

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If you have received this magazine as a member of Mersey Care NHS Foundation Trust, we’d like to be sure that the information we hold for you is current and accurate. If you have moved house, changed your email address, or have a new phone number please email Membership@merseycare.nhs.uk with your name, date of birth and details that need to be amended.


WELCOME

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Most mental health issues start around 14 years of age. In Liverpool we’ve found a different way of making sure vulnerable young people don’t miss the chance to get the help they need.

inter conjures up feelings of hibernation, curling up on the sofa…and yearning for lighter nights and warmer weather! We should embrace winter, but it’s a good time to start making plans to do things differently this year.

There’s nothing more energising than a good sing along! And as our Supersing feature shows it’s now proven – singing in a choir beats even team sports for making you feel good. Finally our feature on understanding psychosis is a reminder that keeping an eye on and talking to loved ones, friends and colleagues is as important as ever during winter.

Doing things differently is a theme that runs throughout this issue. It’s packed with ways to help people recovering from a mental health issue to live their lives differently, including some inspiring stories. There’s a real emphasis on prevention rather than punishment with the Resettle offender health programme. Prisoners with mental health disorders preparing for discharge get intense support to prevent them reoffending. There’s no other scheme like it nationally and it’s having a massive impact on the lives of prisoners, their families and communities.

...start making plans to do things differently this year.

Embrace the season!

The MC editorial team.

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NO

BARRIER TO THE

BLUES It sneaks up on you, I got to where I didn’t want to get out of bed...

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Rapper Kanye West speaks of depression in his lyrics while singers Lady Gaga and Miley Cyrus have spoken openly about their experiences.

There is possibly no mental health issue as misunderstood as depression. There are those who dismiss it by suggesting ‘pull yourself together’, and others who struggle to understand just how debilitating an illness it can be.

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C magazine looks at high profile musicians who have all been widely reported as having experience of mental health issues. While there is evidence that depression is often triggered by a major change in circumstances, it doesn’t discriminate between the rest of us and those who appear to lead charmed lives - the person with model looks, the comedian, the all star athlete, and the extrovert. People who, on the outside, have everything going for them.

It has no barriers – it doesn’t care whether you have looks, money, talent or opportunity. Bruce Springsteen opened up in his recently published autobiography, ‘Born to Run, about battling through bouts of depression in spite of a sparkling 40 year music career. “It sneaks up on you,” revealed Springsteen. “I got to where I didn’t want to get out of bed, and you’re not behaving well at home and you’re tough on everybody.”

Rapper Kanye West cancelled a tour late last year after being admitted to hospital with exhaustion that has been reportedly linked to mental health issues. While he has not spoken out directly, his lyrics have explored themes of chronic depression and emotional turmoil. A video posted before he was hospitalised in 2016 contains references to depression and anxiety. Social media has been dominated by accusations of attention seeking childlike behaviour and mockery – or diehard fans who encourage his outbursts as cool. Lady Gaga, who has herself spoken out about depression, tweeted a clear message about Kanye West’s plight to those who take a cynical view. “While I don’t agree with everything he does I hope the public shows compassion. It’s not funny to joke about anyone’s possible or not possible mental illness, this is a sensitive time for many. Let’s be kind and loving.”

Pop star Miley Cyrus hit back at those who feel someone with money, a family, friends and a job is indulgent. “So many people look at my depression as me being ungrateful, but that’s not it – I can’t help it.” Dr Yasir Abbasi, Consultant Psychiatrist at Mersey Care agrees mental illness permeates through society. “Some people may have what others perceive as the perfect life, but inside they are struggling to cope. We have cared for successful people who were affected so badly they couldn’t function and I think that’s what is difficult for other people to understand.”

It has no barriers, it doesn’t care whether you have looks, money, talent or opportunity... 5


WHAT IS

DEPRESSION? We asked psychologist Sheila Hamilton to explain the vicious cycle and how to break it.

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epression isn’t just about feeling sad. It can change the way you feel and think, affect how your body functions and the way you behave. It can be difficult to pinpoint when you started to become depressed, but there are some tell-tale triggers to look out for; such as issues at work, unemployment, money troubles, relationship stress or even dealing with a physical illness. Depression affects everything from our behaviour to others, to the way we perceive and react to everyday events in our lives. Often it can become a vicious cycle.

WHERE TO GET HELP If you think you or someone you know may be affected by depression contact your GP or other health professional.

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CYCLE OF DEPRESSION If you feel low all the time there is a high chance you have some form of depression. The cycle begins with feeling tired, your appetite is affected (you may eat more or less than normal), concentrating becomes a struggle, you don’t enjoy things like you used to. You may stop seeing friends, take time off work, stop doing things around your home or spend more and more time in bed. You may start to feel alone and cut off from loved ones and friends. It can feel like you’re letting people down, and feelings of guilt, inadequacy and other

• Download our Self Help Guide – go to merseycare.nhs.uk and search ‘self help guide’

triggers make the situation worse, leading to more depression and anxiety, and so the cycle goes on.

GET HELP No matter how impossible you feel your situation is, help is out there. Talking therapy is one of the most successful ways of breaking the cycle. Cognitive Behavioural Therapy works by helping you to understand the links between how you think and feel, how your body responds and behaves, and your low mood. It will teach you to challenge the negative thinking that’s keeping you stuck in the cycle of depression and help you break it.

• NHS Choices – nhs.uk • Depression UK - depressionuk.org • MIND advice on depression - mind.org.uk


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SIGNS OF

DEPRESSION

It is often difficult to know whether you are just feeling low, or it is more serious and you have depression. Some of the signs that someone may be depressed include: • Continuous low mood or sadness • Having low esteem • Feeling tearful • Feeling guilt-ridden • Feeling irritable and intolerant of others • Having no motivation or interest in things

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• Having suicidal thoughts of harming yourself.

Feeling low? Talk to us

THE FACTS ON

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DEPRESSION

therapies, practical support

• Depression is a real illness and a genuine health condition and not “trivial”, as some people may think

and employment advice quickly

• Around one in 10 people will experience depression at some point in their life

and easily and help with a variety of problems.

• People with a family history of depression are more likely to experience it for themselves, but there are also cases of someone becoming depressed for no obvious reason • Depression can sometimes be triggered by a life changing event like a bereavement, losing your job or having a baby.

We offer access to talking

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You must be 16+ and registered with a Liverpool city GP.

Source: NHS Choices nhs.uk

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For more information call: 0151 228 2300 or go online at: talkliverpool.nhs.uk

HOW TO FIND HELP Mersey Care has produced a series of self help guides to help people get more information. Topics include stress, sleeping problems, post natal depression and depression and low mood. They can be downloaded at: selfhelpguides.ntw.nhs.uk/merseycare

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ANOTHER

WAY

Around half of all mental health problems begin before the age of 14. Yet young people often don’t seek help or fall through the gap between child and adult services.

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eens and early twenties are the formative years; they can also be a time of greatest vulnerability. So much is changing, but paradoxically this age group has the greatest struggle to get help. Young people have experienced the least improvement in health status of any age group in the UK over the last 50 years.

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It’s a dilemma. You’re 17, living on the streets and your mental health is not good. You feel suicidal but don’t know where to turn. You’re registered with the family GP but don’t feel you can confide. Do you turn up at A&E, wait hours to be assessed and then what? Where will you go to from there? In Liverpool, there’s another way.

The evidence is alarming; 14 to 25 year olds are experiencing mental health problems more than ever before.


The lack of focus on young people’s health needs has consequences for us all...

JACOB 16 year old Jacob suffers from anxiety and low mood, so was referred by the Young People’s Advisory Service to Mersey Care’s specialist mental health nurses. The YPAS worker stayed with Jacob for his assessment and although he didn’t need immediate help it was felt he is at risk of developing problems in the future. The mental health team has advised the YPAS worker what to look out for and Jacob’s GP has been informed of the situation so everyone involved in his care understands his needs.

At the Young Persons Advisory Service (YPAS) a quiet revolution is taking place. Young people drop in for a cup of tea and a chat, or a shower and a chance to wash the clothes they may have been wearing for days or weeks (a huge help for those living on the street or in a hostel.) Because they feel comfortable they are more able to talk about their challenging experiences, enabling health and other services to offer vital support. One of the most common issues raised is the trauma caused to young people by having to tell their story time and time again to different professionals; to avoid this they all too often choose to keep things to themselves.

They often feel unable to talk to a family doctor.

Health professionals, including a GP and Mersey Care’s Early Intervention service, come together under one roof, at YPAS, for consultation meetings. With a young person’s consent the GP, mental health nurse, counsellor and children’s psychologist share information, knowledge and expertise to ensure the right support is put in place.

“Most of the people we see here come with mental health difficulties. They often feel unable to talk to their family doctor. I try to give them the confidence to go back to their own GP or maybe change to another practice. Being based at YPAS and having a drop-in arrangement works well. It’s friendly; you have quality time to talk to people.”

Early Intervention practitioner Phil Laing says many young people from YPAS access the early intervention service.

For YPAS Senior Operations Manager Val O’Donnell early intervention and prevention is vital. “The lack of focus on young people’s health needs has consequences for us all. Untreated or poorly recognised health problems not only create difficulties for individuals and their families, they also create long term pressures on an already hard pressed health system and wider costs to the public purse. This approach is about destigmatising mental health services for young people and children and reducing the numbers falling through the bureaucratic gap between agencies, charities and NHS departments.”

“The evidence is alarming; 16 to 25 year olds are experiencing mental health problems more than ever before. If they don’t have a chance to recover at an early stage those mental health difficulties can become chronic, yet many don’t access services when they need support. Having the service where they are is so important.” Liverpool GP Diane Exley runs a surgery every Thursday afternoon at YPAS. The evidence of its success is the growth in the number of young people attending.

Young Person’s Advisory Service (YPAS) offers a safe comfortable space for young people aged 16 to 25. The daily drop-in has an open door policy, young people can have a chat, meet new people, use the computer suite, free internet access, discuss other services or take part in informal education sessions. A member of staff is always available to meet and assist visitors if they need support. ypas.org.uk

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THE PERFECT

STORM It’s hard to tell someone you’re hearing voices. And no wonder. Psychosis, as it’s known, doesn’t generally get a good press. The term itself is widely misused – think about ‘Psycho Ward’ Halloween costumes (rightly causing an outcry.) It’s historic that’s how it was portrayed in days gone by. Yet hearing voices is much more common than you’d think. It’s normal, it can happen to anyone, especially after a period of stress and it’s very treatable. 10


Parents may mistake it for teenage angst.

Clinical Psychologist Claire Seddon.

The Liverpool Early Intervention service’s main purpose is to provide quick access to help for people experiencing psychosis. While for some people the first episode may be the last, all the evidence is that, left untreated, the problem can become much worse. MC magazine asked consultant psychiatrist John Stevens and Claire Seddon, a consultant clinical psychologist with the service, to explain psychosis and the importance of intervening early. Dr Stevens: “It’s a sort of emotional ‘perfect storm’ – an especially bad situation caused by a combination of unfavourable circumstances. It’s subtle. It comes on slowly and can be quite frightening, you hear things, and your thinking becomes muddled. You put two and two together and get five. As it becomes harder to tell what is real from what is not, a person may start hearing or seeing things that other people can’t. They might start to believe things that others around them think are unlikely, for example that people are targeting them, or can hear what they’re thinking. A common example is the feeling that messages are being sent to them, maybe through a television programme, or a song. It can be confusing and scary.” The team works with people to explore the root of the problem and to support families to recover.

WHAT MAKES SOMEONE AT RISK OF HAVING AN EPISODE OF PSYCHOSIS? Dr Stevens: “We can’t always pinpoint one thing, although adverse events as a child or an adult can mean you have a vulnerability that could make it more likely. Eight out of 10 people affected are between 14 and 35, although older people do experience psychosis.”

The team wants psychosis ‘out there’ being openly discussed - so people are less afraid to seek help. Dr Stevens: “We need to normalise it much more. It can happen to anyone but there’s still stigma, it’s a label and people don’t want that.”

WHAT’S THE TREATMENT?

HOW DO YOU KNOW IF IT’S PSYCHOSIS?

Claire Seddon: “We start by offering a space to talk, maybe at home or somewhere else familiar and safe. We help the person and those around them learn more about psychosis, which reduces worry and stress at home.

Claire Seddon: “It’s not black and white, it’s a sliding scale but usually it’s when someone has lost touch with reality, often through developing exaggerated or unfounded beliefs that cause distress and interfere with day to day life. Often it’s not until the unusual behaviour becomes really obvious that people ask for help.

We’ll offer advice around medicines to fit the person’s lifestyle. Talking therapies are also helpful to understand how these experiences came about and rebuilding confidence. It’s not unusual to feel anxious while you’re getting better, so we help people through getting back into work, education and family life.

Parents may mistake it for teenage angst and either ignore it or worry and wrap the young person up in cotton wool. There can be red herrings too; using drugs for example. Cannabis use from an early age while the brain is still developing is a known risk factor, but parents and even professionals put problems down to the drug use alone. In fact it may be a way of trying to cope, even though it’s worsening the situation.”

We try to help people understand who they are and where they’re coming from. We say “lots of people are feeling this way, it’s a response to things that have happened to you and it will get better, it’s not the future.’”

It comes on slowly and is quite frightening...

• Early Intervention in Psychosis teams are mental health professionals including nurses, occupational therapists, doctors, psychologists and support workers. Search NHS Choices to find your local service or ask your GP. Read Nina, Joel and Anastasia’s stories on page 12 to 14.

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I DIDN’T KNOW

WHO I WAS OR WHERE I WAS

After a long labour and an emergency Caesarean section, Nina McCallig just wanted to go home with her newborn daughter Heidi. Eight days later she was an inpatient on an acute mental hospital ward with a diagnosis of postpartum psychosis.

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his gentle Irish woman, with no history of mental illness, had to be restrained by police after punching an officer and destroying the wing mirror of a patrol car. For Nina and her partner Mark it was a terrifying experience. She recalls: “I didn’t know who I was or where I was. I was really confused and forgetful. Everything in the house was really dark. I was fading. I took a picture of a shadow – it represented how I was feeling at the time.”

I was screaming at the flowers... screaming at the sky.

A month after being discharged Nina began taking photographs - initially as a visual record of her recovery, then as a moving, if harrowing, photo-realisation of the psychosis itself - garishly coloured pictures of the GP practice, the fence where she was held by the police. Most hauntingly, perhaps, is the black and white images of baby clothes dancing on a washing line. Floating, vivid, not really ‘here’. Today, thanks to professional help from the Early Intervention Team in Liverpool and the support of her family, Nina is ‘here’ and Heidi is in her words, ’the happiest baby in the world’.

Photo taken by Nina during harrowing times.

Everything in the house was really dark. I was fading.

Nina’s midwife recommended a visit to her GP practice but when she was told that she would need to be referred Nina reacted badly. “I screamed at the doctor and everyone in the waiting room. I kicked the door open and walked out in to this sunny world and went down the street banging on windows, screaming in a pub, knocking on doors. I was screaming at flowers. I was screaming at the sky.” Nina was diagnosed with postpartum psychosis and the following day, after episodes overnight with Mark’s family and her mother (whom Nina didn’t recognise), she was sectioned under the Mental Health Act and taken to hospital.

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I thought the house was evil, that it would hurt us while we were asleep so I called 999.

STILL

LIFE

Anastasia has a box in her wardrobe. In it are pieces of rubbish she picked up off the road at a time in her life when during an episode of psychosis she believed every scrap on every pavement was a message sent to guide her. “I thought I was the last cell on earth and I had vital information.”

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ussian born Anastasia was a 19 year old economics student when she arrived in the UK in 2001 for a two week English language course in Cambridge. “I’d heard there was a Beatles festival so I took a night coach up to Liverpool. I got on a bus to see some of the landmarks, the driver started chatting and we kept in contact for six years before I came back to Liverpool and then a year after married him.“ She‘s naturally bubbly, eloquent and animated - but also sad when she reflects on a life that has taken its toll. After her son’s difficult birth Anastasia split from her husband. Though she couldn’t see them, the signs of psychosis were already evident.

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Briefly reunited with her husband, she fell pregnant with her daughter. He became concerned and persuaded her to go to her GP who referred her to a psychiatrist. But events took over. “I thought the house was evil, that it would hurt us while we were asleep so I called 999.” After four weeks as an inpatient she was discharged and referred to the Early Intervention team. “I was struggling with the kids but my support worker really helped lift my mood. Even having a coffee with her was something to look forward to.” Anastasia was on her way to being a high flyer in her career. After her degree she’d worked as a market research analyst; but her future aspirations are influenced by her experiences.

“When you become ill you lose your trust in people; getting it back is the biggest step. I still have challenges ahead but I have my art and writing; being creative nurtures me and gives me language to express myself and breathing space to recover from daily stress. I’ve done voluntary work as an adviser in a Citizens Advice Bureau and have also had some training in peer advocacy and I’d like to work in mental health. My support worker wasn’t a magician but the things she did made a difference. I’d like to do that.”


THEY HELPED ME DEAL WITH STUFF Joel was 15 and in the middle of his GCSEs when he realised something was wrong. “I didn’t want to go out with my mates, I felt more and more depressed.

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did something that made my mum and dad realise I wasn’t right and they went with me to the doctors. I’m not stupid, I knew I wasn’t ok but I wasn’t bothered about getting help either. That’s how it makes you feel. “I’m an honest person and I was honest with my mum and dad and the doctor. It was good because he kept it confidential even if my mum and dad were there. I could talk to my mum and dad and that helped a lot.

It’s been a long journey but it could have been alot longer.

“I always knew I wanted to work in sport. The Early Intervention team helped me deal with stuff and showed me how I could help myself to reach my goals. I want to be a sports coach, my goal is to get a degree; I’ve got the skills now to prepare and plan ahead. It’s been a long journey but could have been a lot longer.”

HOW YOU CAN HELP SOMEONE • Don’t panic • Go at their pace • Encourage the person to be open… • But don’t get frustrated when they withdraw or are confrontational • Talk about it…talk about it more.

SIGNS AND SYMPTOMS OF PSYCHOSIS • Hallucinations • Seeing, hearing, tasting or smelling things others don’t • Confused beliefs, eg that you’re in danger, that you’re someone very important • Feeling others can access your thoughts • Finding it hard to concentrate or keep a train of thought • More snappy and argumentative with family and friends • Not socialising, avoiding college or work • Thinking things are linked when there is no evidence.

RESOURCES

“I ticked all the boxes for psychosis, so the doctor referred me and I was put on medication. It had to be adjusted because I was tired, but I was OK for a while until the pressure of my GCSEs gave me stress overload. It sent me downhill and I didn’t get the results.

The Mersey Care Early Intervention team developed the Mind Zone Board game for use in secondary schools to help young people understand what their feelings might be and the importance of asking for help early if they feel things aren’t right.

voicecollective.co.uk Peer support site for young people who hear, see and sense things that others don’t. Hearing-voices.org For people who hear voices, see visions or have other unusual perceptions. paranoidthoughts.com Information about anxious and fearful thoughts about others. Mind.org.uk MIND Understanding Psychosis. Rethink.org Resourses from Rethink.

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LIFE THRU’ A LENS Our lives are shared through imagery more than ever before. We look at how people with mental health issues are using photography to give those around them a view of life as they see it. 16


Rebecca Redmond has endured years of physical and mental health issues. She continues to fight her ‘demons’ but discovering photography has given her a route to wellbeing.

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ebecca has had a lot to contend with in her 26 years. Back problems from a serious fall when she was younger, together with an auto immune disorder mean she’s in chronic pain. On her good days Rebecca is a hospital volunteer. But it’s photography that’s been her way of dealing with life, a mindfulness tool to help her appreciate each new experience rather than dwell on her debilitating condition.

I was full of self doubts and had outbursts of emotion. She’s only now able to speak openly about past events. “I fell downstairs when I was 14, crushing vertebrae and fracturing my coccyx. I missed a lot of school and became socially very isolated. I developed obsessive compulsive disorder; I was full of self doubt and had outbursts of emotion.”

Rebecca’s plans to follow a career in counselling came to a halt when she fell ill while studying. “I just didn’t want to live. I was so unhappy.” Her relationship with photography happened by chance. “I started taking pictures with my phone then decided to buy myself a decent camera; I’d take it out with me when I walked my dog. I’d stop for a rest and shoot a photograph. I found it made me become more aware of what was around me. The changing seasons, pollution, even a flower, can be beautiful or thought-provoking.” Therapists from Mersey Care’s Psychotherapy service encouraged Rebecca, even supporting her to secure a college grant. “I’m so grateful to them; they gave me structure and coping strategies. They helped me unlock my potential.” Now under the care of her local community mental health team and feeling ‘nurtured’ Rebecca’s love affair with photography has helped her to see the world in a new light.

“I love experimenting with different techniques and I have a passion for landscapes and architectural photographs such as St George’s Hall and the Empire Theatre - they inspire by their grand design.” Rebecca is repaying her gratitude to mental health service in her own unique way – by presenting a set of her photos of local scenes to South Sefton Neighbourhood Centre. They do say every picture tells a story…

taking photographs made me more aware of what was around me. Rebecca’s photography has given her a way of noticing and connecting with the things around her. Five Ways to Wellbeing (New Economics Foundation) are simple steps that support everyday wellbeing: connect, be active, take notice, keep learning and give. neweconomics.org

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LIFE THRU’ A LENS

GINA 63

EVERY PICTURE... The world can look very different through the eyes of someone with dementia – to help us understand, four members of a service user dementia network group in Liverpool shared their perception with photographer Tadgh Devlin, exhibiting the images at the Open Eye Gallery’s Culture Shifts season. Digital manipulation shows us how the condition can have a dramatic impact on the way even familiar situations are perceived and tells poignant stories.

Four billion photographs per day are uploaded onto social media. Photography is now as important as text or verbal communication in the stories we tell about our own lives. Sarah Fisher, Executive Director, Open Eye Gallery

“WE CAN EASILY GET LOST. It’s just ‘cos we’re wandering about looking for the old Liverpool that we know. We’re never going to find it anymore. So we just stopped going…”

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“I DIDN’T KNOW THERE WAS LIFE AFTER DIAGNOSIS. I just thought it would be pretty dull and a lot of sitting around, maybe watching television. I was very surprised to find that I was still needed, which is a great feeling isn’t it?”


TOMMY 63

LIFE THRU’ A LENS

PAUL 64

I WAS STARTING TO DO THINGS THAT WEREN’T NORMAL. I had two scans and learnt I had early onset Alzheimer’s. I went into denial a little bit. The first two weeks I was just in the pub, drunk day and night. It’s like watching a cartoon, it’s like your life is in another dimension. You’re not in this world; you’re of it but you’re not in it. Just for a split second or a couple of minutes at a time.

YOU’RE LOSING MEMORIES ALL THE TIME so if you don’t bring along new stuff today, it’ll start chipping into yesterday’s memories… and the day before.

I RECORDED SOME OF MY SONGS and we raised £2,000 for the Alzheimer’s Society. I need words when I play live because sometimes I forget. Creatively I think I have gone forward and been more prolific. I wrote a beautiful song yesterday called ‘Stumble and fall’ and it turned out fantastic but this morning I couldn’t remember if it was slow or quick…it can be really frustrating. YOUR SUPERPOWER KICKS IN - YOU BECOME INVISIBLE. They start talking about you, over you, around you but they never speak to you. They don’t want to look at you, in case it’s contagious.

LEFT: SOME TIMES YOU WONDER IF YOU’RE DEAD because when people talk about you in the past tense when you’re in the room. You wonder if you’re back from the dead, listening in and wiping the cobwebs off.

ABOVE: I ALWAYS WALK UP TO SPEKE HALL LAKE. I have a little mantra. I stop and have a little shout. I make sure no one is looking at me first and then I say ‘go on then, throw me in’. Then I start shouting at the top of my head and I reply ‘You can’t, can you? Cos I’ve won, haven’t I?’ and I feel great after I’ve done that. It’s just a little thing that I do and it makes me feel so good. I have my own battle. And I win every day. 19


LIFE THRU’ A LENS

ROY 66. RETIRED NURSE

LEFT: WHEN THE STARTER WAS PRESENTED IN FRONT OF ME I DIDN’T KNOW WHAT TO PICK UP. It’s frustrating because you’re trying to live a normal life and it isn’t normal anymore. It was terrifying. It was like being switched off. Nothing seemed to mean anything. When I showed them my Alzheimer’s Society card it made a big difference. (Roy had a encounter with the police after he struggled with a bowl of soup in a café.)

BELOW: YOU’VE GOT TO KEEP TRYING TO BEAT THE DISEASE. It helps me to think of my past and what’s wrong. You can sit there and just empty your mind and just concentrate on the view. Forget about tomorrow. I’m not bothered about tomorrow. The disease is trying to change me as a person but it’s not. I’m still me.

Mersey Care Service User Research Forum dementia network group acts as a support and advocacy network for those living with or affected by dementia. For more information contact Sarah Butchard: sarah.butchard@merseycare.nhs.uk Get help and advice at: Dementia UK – dementiauk.org NHS Choices – nhs.uk Alzheimer’s Society – alzheimers.org.uk 20


STAY WELL FEEL GREAT

GET GOOD

VIBRATIONS Hearts and pulses beat in unison, levels of the ‘cuddle chemical’ oxytocin rise – is singing in a choir really THAT good for us?

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STAY WELL FEEL GREAT

SUPERSING Supersing group with players from The Royal Liverpool Philharmonic Orchestra.

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ou can sing in the bath, the kitchen, in front of a mirror with a hair brush – but for the feel good factor singing in a choir beats them all! Research by Oxford Brookes University suggests that people who participate in a choir enjoy a greater feeling of togetherness than singing alone – or even being in a sports team.

SENSE OF WELLBEING Although previous research found being in a choir is good for psychological wellbeing this study actually pinpoints why. A sample of 375 people drawn from choral singers, solo singers and sports teams were asked to report back on their sense of wellbeing, how their activity fulfilled their needs and its ability to motivate them.

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MEANINGFUL

SUPER SINGING

The choral singers and team sport players reported significantly higher psychological wellbeing than solo singers. However choral singers also felt their choirs were more meaningful as a social group than team sport players considered their teams.

Royal Liverpool Philharmonic Orchestra and Mersey Care NHS Foundation Trust run Supersing, a course for people who use mental health services. The Trust cultural programme coordinator Berenice Gibson agrees with the research.

There are physical effects too. Gothenburg University researchers found hearts beat in unison and are directly affected by a melody. Pulses rise and fall at the same time when people sing in a group. Choral singing regulates the nerve responsible for emotions. Other studies say group singing boosts oxytocin levels which help control stress and anxiety.

“The sense of togetherness at the sessions is palpable. Standing side by side, playing your part to make a wonderful sound leaves a feeling that stays with people long after the session is over. Friendships develop, we are encouraging people to join a local choir after the course finishes so they can keep on singing for life.”

Oxford Brookes researchers say the findings may have practical implications for the use of choral singing as an intervention for improving psychological well being.

Liverpool Philharmonic and Mersey Care run musical activity sessions for service users in the community. For more information contact Nicola Hopson on 0151 210 2901 or email nicola.hopson@liverpoolphil.com


I SEE PEOPLE

GROW Ian Chesworth (above) is a choral director and singing teacher for the Supersing course. “Singing itself is good for you, it really is a medicine. But it’s the social element of singing in a choir that sets it apart. Working in a group with other people to make a sound. It brings people out of their shell, they are often apprehensive, even scared when they first come along, but they develop confidence from being together. It’s not formal we have a laugh, but I see them grow. We don’t put pressure on

people to perform solos but we like to give them the chance. I asked the Supersing group if anyone would like to be a soloist – almost everyone volunteered, it was very touching.”

The last time I sang was in my school choir but I thought I’d give it a go. When I found out we were performing I was thrilled but it’s being with everyone that makes me feel a part of something, it’s that sense that you’ve achieved something. Supersing member Angela.

I’ve never been as happy as when I go home after a choir session. It’s fabulous, the conductor is great, he tells us about different composers so we’re learning. It’s like a dream come true, I’m so grateful. Supersing member Vivien.

Sign up for the next Supersing course on 0151 330 4140 or go to Liferooms.org Find your nearest choir online at: choirs.org.uk makingmusic.org.uk

FIND OUT WHAT’S ON AT THE LIFE ROOMS "THE CONFIDENCE THE RECOVERY COLLEGE HAS GIVEN ME HAS HELPED ME BACK INTO FULL TIME WORK” LIFEROOMS.ORG

CALL 0151 478 6556

CAFÉ, LIBRARY FREE INTERNET, FREE COURSES, MANAGING ANXIETY, SELF ESTEEM, UNDERSTANDING OCD CONFIDENCE BUILDING AND MUCH MORE

23


STAY WELL FEEL GREAT

CARIBBEAN

SPICE POT Mersey Care chef Graham Daly loves this recipe for turkey or chicken left over from your Sunday lunch. “If you fancy something quick and a little different this will give you lots of energy and is easy and nutritious.�

100g 1 tspn 1 tspn 1 tspn 4 sprays 1 tblspn 200g 400ml 1 250g 1 Tin

Onion, chopped Garlic, crushed Ground ginger Chilli, chopped Frylight Curry paste Pre-cooked turkey breast Reduced- fat coconut milk Mango, diced Cooked brown rice (hot) Kidney beans

Serves 2 METHOD Stir fry the onion, garlic, ginger and chilli in the Frylight for three minutes. Add the curry paste and turkey and stir fry for two minutes. Pour over the coconut milk and simmer for 10 minutes. Add the diced mango and cook for five minutes more. Take the spice pot out of the pan and place into a dish then using the same pan put the kidney beans and rice and stir together until piping hot. Put the rice in a serving dish and put the turkey in its spicy sauce over the top and serve!

24


UPLIFTING IDEAS • Cold weather and central heating combine to dry out our skin. A good walk helps the blood flow - but the antioxidants that give you a healthy glow can also be found in dark chocolate. It also contains fat so eat in moderation! • The BBC Good Food website offers tips for the days when cold weather, long nights and fast dissipating resolve puts motivation at an all-time low. For recipes and tips go to: bbc.org • It’s almost two decades since Author Jane Alexander’s Five Minute Healer book was first published. Her advice on shifting your mood from work to home. Hang up your coat, abandon bags and shoes. Take a refreshing shower with lavender or bergamot oil to wash away the stresses of the day. Get into comfortable clothes, look in the mirror and smile - the author then advises telling yourself ‘I love and approve of myself’ – this may all take some negotiating with the rest of the household, but it’s worth a try!

FOOD FOR THOUGHT Be aware how the ingredients in a

GINGER - soothes the digestive system

BROWN RICE - contains selenium,

recipe can help improve your wellbeing,

and reduces nausea. Contains ginerols

which reduces cancer, heart disease

boost your energy and address health

(anti-inflammatory compounds that

and arthritis), and manganese

issues. The recipe opposite has lots of

can reduce pain levels and improve

(benefits the nervous and reproductive

examples:

mobility for osteoarthritis and rheumatoid

systems). Its healthy fats help normalise

arthritis sufferers).

cholesterol levels and it has antioxidants,

CHILLI - helps to burn fat. Contains capsaicin which lowers blood sugar,

COCONUT MILK - although high in

improves heart health, provides pain

calories it has few carbohydrates and is

relief from auto inflammatory

high in potassium which ensures proper

diseases, acts as a relaxant, clears

heart function.

congestion and limits the spread of prostate cancer.

MANGO - high in antioxidants known to help prevent cancer. Lowers cholesterol,

TURKEY - low in fat and high in

clears skin, contains vitamins A and C

protein. Contains tryptophan, an

which improves eye health and digestion

essential amino acid and natural

and boost the immune system.

anti depressant.

fibre, slow release sugars and whole grain acid, so reduces heart disease and high cholesterol. KIDNEY BEANS - contain manganese for healthy bones, Vitamin K for brain function and bone health, high fibre to stop blood sugar levels spiking and reduce cholesterol. Has levels of protein comparable to meat - great for energy!

Eat well and stay healthy this winter! (Cancer Research Study findings 2006), Lowers the risk of stomach cancer (Yale University of Medicine 1994)

25


STAY WELL FEEL GREAT

POLE

POSITION

It’s walking…but not as we know it. Nordic walking sounds far too energetic for its own good. But although it’s used as a summer training regime for cross-country skiers, it’s actually no harder on the joints than ordinary walking. You move in a similar way and swing your arms from your shoulder with your elbows straight.

W

ith the poles taking the weight off the knees and lower body joints you feel lighter on your feet, making Nordic walking an ideal activity for people with joint conditions or who may be carrying extra body weight. MC magazine caught up with participants at a walk through a park in Liverpool on a particularly brisk morning. Former runner and fitness coach Julie Killen runs sessions across the city, including a beginners’ programme at the Life Rooms in Walton (find out more at liferooms.org). Poles are included. All you need is comfortable waterproof clothing (plenty

26

of layers) and shoes (walking shoes if possible). Every group will be different depending on personal ability, fitness and health conditions. Our group gathers in the cold morning air, poles are handed out and the warm up begins. This established group knows the ropes; they want to be challenged so they do not plateau with personal exercise levels. Julie assures us that in a new group the first four weeks of instruction is gentler, calmer and more informative as new participants learn the technique. “We go at an easy pace, we have a laugh, everyone’s starting off together.”

The poles take the weight off the knees and lower body joints – you feel lighter on your feet.


Paul, Derek and Eileen enjoy a post walk cuppa.

The first step is the biggest.

The pace on our walk is set by 64 year old Eileen. A year ago, still feeling low after losing her husband and feeling the need to lose weight, she was encouraged to come along by friends. “I feel better and fitter than I’ve felt in a long time. Who would come out early on a freezing cold dull morning if there wasn’t a reason? I’ve made a commitment and I wouldn’t let Julie down. She has that effect - she’s so motivating. And I’m always glad I came. You go home smiling.” Julie finishes the hour long walk with a cool down, then it’s coffee and a catch up.

“The first step is the biggest…it can be daunting but if I hadn’t got involved I’d be sitting at home. Instead my family joke that I’m never in!” Paul, 46 began Nordic walking to aid recovery from surgery, but now enjoys the exercise and the friendship. “I’d say to people ‘don’t fear it.’ Everyone in our group knows what it feels like to be at the back of the pack but it doesn’t matter, you’re among friends.”

GET INVOLVED • Find out more about Life Rooms sessions at liferooms.org or call 0151 330 4140 • Search for an instructor on the websites of Nordic Walking UK or British Nordic Walking.

I feel better and fitter than I've felt in a long time. Eileen

Over coffee 73 year old Derek tells how a back injury 11 years ago left him in pain and struggling to cross his street. He says the support from the group keeps him upbeat.

27


STAY WELL FEEL GREAT

MIND THE GAP…AND RELAX Virgin Trains has launched the world’s first on board mindfulness channel. The new ‘Be Mindful’ channel aims to help passengers on its East and West coast routes to relax and unwind. Six meditative films focus on areas of outstanding natural beauty along the routes. Virgin worked with the Mental Health Foundation to develop a range of mindful content on its on board entertainment system. Mentalhealth.org.uk virgintrains.co.uk

KNITTING

IS NOT ONLY BACK IT’S THE NEW BLACK!

WHAT A YARN! Doctor Who’s famously long scarf was depicted as a strong symbol of mental decay and breakdown. Tom Baker tells a wonderful story of Begonia Pope who made his scarf back in 1974. She found the knitting so enjoyable that rather than stopping at a sensible length, Begonia made the neck gear at least 14 feet long, give or take the odd Dalek battle scar. Six years later viewers watched the scarf unravel away into threads as the new Doctor Peter Davison’s mental health deteriorated.

MAKE YOUR

K

nitting is in vogue…but this time round as a stress buster! Nine out of ten knitters in a survey by global fashion brand Wool and the Gang knitters agreed that knitting decreases anxiety levels; seven out of ten feel a sense of happiness after tackling a difficult project or knitting technique. There’s even a knitting hotel! The Westcliffe in Blackpool helps people combine their hobby with making friends and meeting like-minded folk. The itinerary features workshops and visits from yarn shops and local craftspeople. In Brighton you can even stay in a knitted hotel room.

WN

The kitsch Pelirocco hotel has knitted bedcovers, curtains, lampshade and even a knitted telephone cover!

JOIN A KNITTING GROUP Knit Together is a directory of knitting groups and help to set up a new group. knittogether.info • Famous knit one purl one fans include Kate Middleton (who confesses to being ‘quite bad,’) Julia Roberts, Kristen Stewart and Ryan Gosling.

Learn how to personalise phone cases, keyboards and even your headphone leads!

Lucy Hopping, writes quirky books with titles as Handmade Glamping and Dress Your Tech. You can even knit your own touchscreen gloves! Lucy Hopping books are all available on Amazon (amazon.co.uk).

28


We believe that the power of a cuppa to bring people together can be harnessed as a tool to prevent suicide. Reaching out and talking to someone who is suffering may be the turning point they need. If you agree, accept our #brewfie challenge by taking a photo featuring yourself, a loved one - or even a pet with a suitable brew! Upload it to social media using #brewfie to show your support, then nominate three friends to take the challenge, and help us to spread the word of our Big Brew campaign!

BREWFIES

You’ve been nominated for the #brewfie challenge!

1

ACCEPT OUR #BREWFIE CHALLENGE

2

TAKE A ‘MUG-SHOT PICTURE’ WITH YOUR BREW

3

4

UPLOAD THE IMAGE TO SOCIAL MEDIA USING #BREWFIE

NOMINATE THREE FRIENDS TO DO THE #BREWFIE CHALLENGE

The Big w Bre HOLD A BIG BREW EVENT For more information and your FREE BIG BREW pack go to

www.merseycare.nhs.uk 29


We want to show these men that there is a life outside crime.

NO GOING

BACK

In an anonymous looking office block in South Liverpool Merseyside, Police Detective Constable Caroline O’Brien has spent the day helping newly discharged prisoners learn the skills to avoid going back behind bars. In the past she could have been arresting these men. But getting to know the kinds of people she used to apprehend has given her a different perspective on how they came to be in the criminal justice system. It’s part of a unique programme that is giving offenders with a personality disorder a vital link between prison and the outside world. Resettle is a coming together of professionals from mental health, criminal justice and probation services (nowhere else in the UK runs such a scheme). The results speak for themselves. After seven years in operation not one participant on the Resettle programme

30

We see each other as human beings... it changes reactions.

some form of personality disorder.) The outside world can be a hostile and bewildering place. A cell and the routine of prison life offer a strange sense of security.

has committed a serious crime after returning to society.

The service is jointly led by consultant clinical psychologist Dr Vikki Baker, who is seconded from Mersey Care NHS Foundation Trust, and Sandra Oluonye, Assistant Chief Officer with the National Probation Service. We try to create a calmer environment. Dr Baker describes how the programme works: “Starting six months before release means we can develop a relationship with the person. These men often struggle in their family relationships; they’ve committed violent or sexual offences. Participants interact with staff, learning how to cook and other life skills. We try to create a calmer environment, to see each other as human beings – all the evidence is that doing this changes reactions, it takes away the need to react violently.”

DC O’Brien represents Merseyside Police in the partnership: “We want to show these men there’s a life outside crime. When you work with them you start to understand and appreciate why they might have made bad choices. It doesn’t exonerate them but it gives some background and an explanation”.

THE OUTSIDE WORLD IS BEWILDERING It’s notoriously difficult to leave prison. The world, your family, your prospects, can be very different from when you left. It’s even harder with a mental health condition (seven out of ten prisoners are said to suffer from

That’s why the Resettle support begins while participants are still serving their sentence, and can continue in the community for up to two years - longer if needed.


Sandra Oluonye is convinced combined expertise is the key to success. “None of us have all the skills needed to manage men with such complex issues, but together – working in the way we do – the men get the best support.” Offenders from across the North West are brought to Resettle’s base in South Liverpool for range of individual and group interventions based on the person’s individual needs. At first they come by minibus then as they progress they’re encouraged to use public transport. It is part of a schedule that brings a structure to their lives - often for the first time.

They have structure often for the first time.

Dr Baker: “Recall to prison could be seen as a failure on our part, but it demonstrates to society that we are a safe pair of hands; that the system is a success”.

Sandra Oluonye: “When we ask ‘why do you keep coming back?’ the response will often be that we give someone a purpose to get up in the morning.”

Sandra Oluonye agrees. “One man was recalled to prison four times, but each time he came back to us we saw an improvement. He eventually successfully completed his time with us and as far as we know he hasn’t come to the attention of the police since.”

READY TO TRY

BOUNDARIES

It’s a 24/7 service with an out of hours crisis line staffed by the Resettle team, for both prisoners and professionals. If a man steps too far out of line, Resettle will initiate his return to prison. However, this option is viewed as a setback rather than the last word – a way of helping a prisoner concentrate his mind and taking responsibility for his behaviour. Staff will always stay in contact until the person is ready to try again.

Caroline O’Brien agrees. “We’re trying to give the men an opportunity to see the police in another light, whilst maintaining those boundaries so they know what’s acceptable and what is not acceptable”. Participants value the programme’s recognition of human failings and readiness to keep supporting them even if they stumble along the way, as long as they acknowledge their mistakes.

One told us: “When keyworkers think you are lying and being dishonest there is a communication breakdown... but they 100% believe me now as I’ve proved myself.” Another said: “I kept my cocaine use very well hidden for weeks. No-one knew... but eventually, because my keyworkers had been understanding I felt more at ease coming out with it.” Prisons are often in the news for all the wrong reasons. Late last year Justice Secretary Liz Truss announced extra funding for the prison service and the recruitment of more prison officers. In the meantime, the work of Resettle in keeping men out of prison is showing the way for the country as a whole.

Personality disorders are conditions in which someone differs significantly from an average person, in terms of how they think, perceive, feel or relate to others. Find out more at NHS Choices: nhs.uk

Sandra Oluonye and Dr Vikki Baker.

31


In this issue we talk about Mersey Care’s commitment to building a just culture and the importance of staff being able to speak up.

W BECAUSE WE’RE ALL

HUMAN Chief Executive Joe Rafferty explains a Just Culture – and why it’s so important.

e are striving towards ‘Perfect Care’ for people in our care. We’re tackling some of the most complex issues any NHS Trust has ever said it will tackle. We strive to have no one in our care dying by suicide by 2020. Our No Force First initiative, in which physically restraining someone happens only when absolutely necessary, is having a huge impact on the patient experience and staff morale. We know mental and physical wellbeing are linked and we are focusing hard on improving the physical health of our service users, patients and staff. We’re setting more exacting standards for our staff. So it’s really important for them that ours is a just culture, one where people feel that if they see a situation that is not good for the organisation and service users, they can speak up without fear of repercussion. Equally, if they themselves make a mistake a just culture would empower them to be open, it would encourage them to readily question what had happened, why, and, along with colleagues, learn in a way that greatly reduces the risk of anyone in a similar situation repeating actions that

have given rise to harm. A just culture is not finger-pointing, nor blame-seeking. It’s being open and transparent; asking what was responsible, rather than who is responsible”. This is not something we’ve dreamt up – we’re learning from industries such as airlines and nuclear technology, where errors can have a huge impact. And we’re listening to people like Australian academic Sidney Dekker, whose groundbreaking work on human error and safety has gained worldwide acclaim, and says being open is the only way to improve and that sharing a situation can influence what we do to change things. A just culture is not the same as an uncritically tolerant culture in which anything goes - that would be as inexcusable as a blame culture. This new way must be just for patients, carers and their families. It must facilitate early resolution to as many issues as possible. It will make us think and behave differently, which isn’t always easy. But we’re all human after all - we have to ask ourselves ‘what would I expect for myself or my loved ones’?

We have to ask ourselves what would we want for my loved ones?

32


I’LL HELP PEOPLE TO

SPEAK UP

Every NHS organisation now has someone dedicated solely to giving all staff the support freedom to speak up for themselves, their patients and all of us. The role of Freedom to Speak Up guardian, as they are known, was recommended by Sir Robert Francis, following his review and subsequent report into the failings in Mid-Staffordshire. At Mersey Care the Speak Up Guardian is Pat Prescott. We ask what difference the role will make. “Speaking out isn’t easy even if someone thinks it’s right. It’s been seen in the past as whistle blowing; people were afraid of being blamed. But we are moving towards a culture of openness, learning from the experience and changing things for the better.

To do this staff need someone who will support and advise them through what can be seen as a daunting process and be there throughout and afterwards – the door will always be open. The NHS has a freedom to speak up policy? Isn’t that enough? “Having a real person to talk things through, knowing there is someone dedicated to supporting can make it easier to speak up. My role is to break down the secrecy and fear; to empower people to speak up knowing they’ll be supported from start to finish.”

Speaking out isn’t easy even if someone thinks it’s right.

CASE STUDY A nurse witnessed another healthcare worker being disrespectful and rude to an elderly service users family and shared his concerns. Pat explains: “He was very upset about what he’d seen but worried about telling his manager. I arranged a meeting with them and sat in to support him. His manager reassured him that he’d done the right thing. The colleague was given an opportunity to discuss the situation and went on to acknowledge that she’d made a mistake and was able to apologise to the family. Having that support made him feel it was worthwhile speaking up and the problem was resolved at grass roots level quickly rather than it being allowed to fester.”

33


Freedom To Speak Up Guardian

ONE PERSON CAN MAKE

A DIFFERENCE DON’T RELY ON OTHER PEOPLE TO REPORT A RISK, WRONG-DOING OR MALPRACTICE. We encourage and support staff who wish to raise a genuine concern. Freedom To Speak Up Guardian is a new role that encourages staff to share their concerns in a confidential manner if needed.

Mersey Care’s Guardian Pat Prescott call: 07867 341 050 or email: freedomtospeak.guardian@merseycare.nhs.uk 34


A DAY IN THE LIFE...

ANDREW SWINSON LEARNING DISABILITIES SUPPORT WORKER You have to be flexible. I work on a low secure ward for men with personality disorders, they’ve got complex needs but I love the level of interaction. Sometimes people have issues: they can’t mix or may need to be ‘talked down’ from a crisis. We’re well trained in supporting people with behaviour that challenges and we trust each other.

M

ost days I’m on the ward. Although the men are detained because of their forensic histories some have leave to be taken out shopping or for a ramble. Football is a real highlight. Every month there’s a five-a-side tournament with service users from across the region – a proper local league. At nine o’clock the minibus arrives. The lads are always up and eager, there’s a great build up. We’ve a bit of friendly rivalry but there are free transfers to other teams if they are a man short and need to make up numbers. No one’s scored against their own team yet but

sometimes they go in the other side’s nets. It’s good to see people who need order and structure in their lives being adaptable. There’s never any trouble, just a brilliant full day’s play and sometimes a takeaway going back. If I’m not down to work, I’ll come in anyway. The lads are proper appreciative! It’s really special supporting the men on a home visit. It’s great watching them making connections with their families again. Just sharing a meal with one of the lads and his parents, after what they’ve been through, it’s brilliant.

They’ve got complex needs but I love the level of interaction.

35


WHAT’S YOUR VIEW ON OUR SERVICES? Tell us what you think

We will receive another visit from the Care Quality Commission in March. This is part of their regular inspections of all care providers.

The formal inspection will be in March. Following the inspection Mersey Care will be given a rating by the Care Quality Commission.

All parts of Mersey Care were inspected recently, we were awarded Good. Once again, England’s Chief Inspector of Hospitals will be inviting members of the public to tell his inspection panel what they think of the services our Trust provides.

You can give your views

The inspectors will be particularly interested in hearing people’s experiences of care, but will also want them to say where they would like to see improvements made in the future.

Call: 03000 61 61 61

Contact Details

Online: cqc.org.uk/sye-merseycare By post: CQC, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA

MerseyCareNHSFoundationTrust

Got some news you’d like to share?

Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, Merseyside L34 1PJ

Contact us at the following address.

Telephone: 0151 473 0303 Email: communications@merseycare.nhs.uk

MC MAGAZINE is published by Mersey Care NHS Foundation Trust and produced by the communications team, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, Merseyside L34 1PJ T: 0151 473 0303 E: communications@merseycare.nhs.uk W: merseycare.nhs.uk. MC MAGAZINE is available in other formats on request. Please pass on for others to read and recycle.

Jan 17 mag  

MC Magazine Winter 2017

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