YOUR COMPLIMENTARY COPY
LOOKING FOR AN ADVENTURE INSIDE Cook Well Feel Great
Striking A Chord
Be Kind To Your Mind
3 WELCOME 4 LOOKING FOR AN ADVENTURE 7 MORE THAN BABY BLUES
I DIDN’T THINK I’D GET TO 21 Student Zoe has battled mental illness since she was 12. Who cares when a child with a mental health issue becomes an adult?
12 I CRAVE NORMALITY 14 LIFE CHANGER 16 I DIDN’T THINK I’D GET TO 21
TOTALLY DEVOTED When ill health ravages a family who can they call on to keep them together?
Art is mimicking life for Amanda.
24 STAY WELL FEEL GREAT 30 DOCTORS MAKING A DIFFERENCE 32 WHERE THERE’S HOPE
The free training that helps you talk to someone about suicide. MC magazine team: Managing Editor: Steve Murphy. Editor: Jackie Rankin.
21 TOTALLY DEVOTED 28 STRIKING A CHORD
THE ONLY THING I CRAVE NOW IS NORMALITY
17 COULD YOU TALK TO SOMEONE ABOUT SUICIDE?
Contributors: Mark Hudson, Graham Hignett. Editorial: Julie Crompton. Photography: Joel Goodman, Steve Murphy. Design: Jo Hadfield.
34 I’M GIVING SOMETHING BACK 35 A DAY IN THE LIFE
You can contact us at: firstname.lastname@example.org MerseyCareNHSFoundationTrust @Mersey_Care
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WELCOME We most need faith in other people when we’re at our lowest.
The risk of suicide among women is at its highest during pregnancy and six weeks after giving birth. They often show few signs, but with swift help they respond well to treatment. In this issue you can read how mental health nurses and midwives are working together.
t’s getting lighter – slowly but surely. It’s hardly noticeable, just a couple of minutes every day, but the certainty that winter is coming to an end can put a spring in your step. It’s often what keeps us going. We take a leap of faith. This issue features people who’ve done that in lots of ways. On page 4 former Coronation Street star Debbie Rush talks of anxieties about leaving the programme, but also a sense of new adventures to come. For a young person in children’s mental health services leaving the security of people who’ve cared for them, often for years, to go into adult services can be overwhelming. We speak to two young women who are thriving after putting their faith in a service dedicated to a smooth transition.
We need faith in other people most when we’re at our lowest. But would you know what to say to someone who you think may be suicidal? A new alliance, launched at Westminster, is mobilising businesses, charities and ordinary people to work towards a target of zero suicides. They want one million people to take training to equip them with the skills to talk to someone they think is at risk.
Now may be the time to take a chance on something new – we met people who did just that at Mersey Care’s Liverpool and Southport Life Rooms. What better than to be treated to a foot tapping morning at the Making Music course and a tasty healthy lunch at the Cook Well course. Get the recipe on page 25 and be warmed at how these courses are making a difference to those who take a leap and sign up. Enjoy!
The MC editorial team. 3
IN CONVERSATION WITH...
LOOKING FOR AN ADVENTURE 4
Debbie Rush, aka Coronation Street star Anna Windass, talks to Mark Hudson about life, love and the highs and lows of leaving the ‘Street’.
he first thing you notice about Debbie Rush is that she looks nothing like Anna Windass, the outspoken, hard done to, often hard faced matriarch of the rough round the edges Coronation Street family first seen back in 2008. “Anna didn’t have time to care about how she looked, she always had too much going on.” They do however have some things in common, both fiercely protective of those closest to them, stubborn, kind and with a family first attitude. “It’s what you do when you grow up in a working class northern family, you look out for each other and just get on with it, what’s the alternative?” You can’t help but feel Debbie’s pride in her northern working class roots. Her glowing admiration for her mum who did the very best for her and the family growing up. “It was tough, but the house was always full of love. My problem was that I knew that I was different. I didn’t want what anyone else around me wanted. I wanted to perform, to sing and act and that seemed impossible. I could see all these strong women who were living the same lives that their mothers had done, the same jobs, living in the same street, and I knew that that wasn’t for me, I knew that I was different. I loved Bette Davies and watching old black and white films with my mum; it was our special time.”
It is never ending and for the actors often emotionally draining. “I must have done twenty or more YTS schemes when I left school. Selling makeup, makeup demonstrations, telesales, selling mobile phones when mobile phones were the size of house bricks, I just couldn’t settle. I got a job as a cleaner in a hotel and fell in love with the owner’s son, Andrew. We married and we’ve been together ever since. Andrew made me feel safe and encouraged me to pursue my dream to perform.” I love spending time with Debbie and Andrew and their three lovely, now grown up children because it feels like home, the perfect family unit, loving, supportive and real. Debbie and I first met when she became a student at my school, the Manchester School of Acting. She was full of ambition, passion, drive
and an honest eagerness to be the best she could. She had a lot of time to catch up on. By now in her late thirties she was starting out on a career that most started in their early twenties. Debbie isn’t good at taking no for an answer. She worked hard and in a relatively short time started to get work. Then an opportunity came along to audition for Coronation Street. There was such a lot of competition for the part. Strong female roles in their forties were few and far between in 2008 and any time served actress with a CV longer than their arm wanted it. “I went for the casting and it seemed to go alright and then they asked me back again to screen test with other actors auditioning to make up a family. That was a very strange experience because there were so many famous actresses there auditioning for the same part. I got it, I couldn’t believe it. Coronation Street, a programme that I’d grown up watching had chosen me over these other women to play Anna Windass. I was in shock.” Not only is Coronation Street the longest running television drama anywhere in the world, it’s regularly watched by millions of people and the cornerstone of ITV’s television schedule since 1960. It is also a huge machine that generates hundreds of hours of drama each year. It is never ending and for the actors often emotionally draining. CONTINUED ON PAGE 6.
I’m having sleepless nights and suffering from anxiety, but I don’t want to get to 70 and wonder what it might have been like if I’d been brave enough to go on another adventure. 5
CONTINUED FROM PAGE 5 “It’s a fantastic place to work, wonderfully welcoming, friendly people but you have to learn very quickly that everyone there has a job to do and they do it and then go home, because tomorrow you’ll be doing the same again, and the day after, and the day after that. You might occasionally wear different clothes but the wheel keeps turning and you do your very best not to fall off. Coronation Street has changed my life, it has taught me so much and given me the opportunity to do that thing that I always wanted to do from being a very small child, perform.”
Debbie decided last year that 2017 would be her last as Anna Windass “I just need to try to play someone else. I hope that doesn’t make me sound ungrateful because I will be eternally grateful to Coronation Street. I came into acting so late that I have so much catching up still to do. I want to tell different stories, play period drama, modern drama, futuristic drama, I just want to push myself out of my comfort zone.” I remind Debbie of the enormity of this decision, “You don’t need to tell me, I know, it terrifies me, I’m having sleepless nights and suffering from
anxiety, but I don’t want to get to 70 and wonder what it might have been like if I’d been brave enough to go on another adventure. When Andrew and I and the kids were starting out and we had no money, we used to play a game where we’d visit new places and have what we called an adventure. That’s what I want for me now, a new adventure.” If you could give some advice to your younger self what would it be? “It’s never too late to start something new. Stay true to yourself and your dreams and don’t ever take no for an answer. That’s three things I know.”
FEELING ANXIOUS? TRY THESE TIPS:
• Take time out - distract yourself from the worry for 15 minutes
Try these tips to prepare for a restful night:
• And breathe - feel the panic without trying to distract yourself • Face your fears - the anxiety should start to fade
• Set a specific time for getting up and don’t take a daytime nap • Exercise, but not too close to bedtime • Avoid big meals, tea, coffee, alcohol and smoking for a few hours before bed
• Visualise a happy place - let the positive feelings soothe you
• Only go to bed when you’re feeling tired
• Don’t try to be perfect - life is messy! Bad days and setbacks happen
• Don’t use televisions, phones, tablets and computers before bed
• Talk about it to a partner, friend or family member, or call a helpline such as the Samaritans (116 123, open 24 hours a day). If the anxiety doesn’t go away contact your GP who may refer you for counselling, psychotherapy or online help.
• Create a relaxing bedtime routine - bath, music and a warm, milky drink • Get a comfy mattress, pillow and thick curtains or blinds • If you can’t sleep get up for 20 minutes and try again.
DOWNLOAD OUR FREE SELF HELP GUIDES FOR ANXIETY AND SLEEPING PROBLEMS AT MERSEYCARE.NHS.UK 6
BABY BLUES Women are at their highest risk for suicide and admission to hospital in the first six weeks after they give birth. We look at the issues and the team offering specialist help.
Announcing a pregnancy or the birth of a new baby is traditionally a time for celebration. While fingers are crossed for no physical complications and a trouble free birth, few of us would ponder the possibility of a woman taking her life at this time.
et evidence shows women are at their highest risk for suicide and admission to hospital in the first six weeks after delivery and also higher risk during the year after delivery. Suicide is the leading cause of all maternal deaths. ‘Friends’ star Courtney Cox revealed how, depressed after the birth of daughter Coco she was unable to sleep and had ‘urges to drive off a cliff’. Fellow actress Gwyneth Paltrow has shared on television how she struggled to bond with her new baby and how husband Chris Martin helped her realise the cause. ‘I couldn’t connect with my son... I felt like a zombie. I felt very detached. I just didn’t know what was wrong with me. I couldn’t figure it out.” She only realised after her husband, Coldplay frontman Chris Martin suggested her feelings may be postnatal depression. One in five women will experience mental health problems during pregnancy or postnatal. They can become unwell very quickly and require specialist assessment and treatment. Untreated mental illness can also lead to miscarriage, preterm labour, pre-eclampsia, low birth weight and mental health problems in later life for babies.
Consultant perinatal psychiatrist Dr Mark Barsoum (pictured far right) says cases can be more difficult to detect because usual risk factors for suicide are not always present. “Confidential enquiries into maternal suicides show that in the majority of cases women had a stable home life, good support from partner and family, and little or no history of mental illness. It can affect anyone from all backgrounds so we need to be vigilant.” The Mersey Care perinatal team is part of the Strategic North West Coast Perinatal network that delivers training to doctors, midwives, mental health teams, health visitors and GPs.
treatment and involving our specialist service early.” He wants families to be aware of symptoms and know when to seek help. “Women and families can be scared to admit symptoms; there’s the stigma of mental illness and a fear of social services becoming involved; but it’s vital they get in touch right away. “We may only get one chance to do something, but the good news is these women tend to respond well to treatment, so every contact counts. We are here to help and support women and their families as a whole.”
Dr Barsoum says ensuring professionals are equipped to provide up to date evidence based advice on treatments is vital. “The risks from untreated illness often greatly outweigh risks from medication. Training can increase knowledge, understanding and awareness among professionals of the importance of not delaying
In the majority of cases women had a stable home life, good support from partner and family, and little or no history of mental illness. 8
FACTS • the mind changes as well as the body during and after pregnancy1 • between 10 and 20% of women develop a mental illness during pregnancy or within the first year after having a baby2 • nine women per 100,000 died up to six weeks after giving birth or the end of pregnancy in 2011 – 133 • almost a quarter of women who died between six weeks and one year after pregnancy died from mental health related causes. One in seven died by suicide4 • the average cost to society of one case of perinatal depression is around £74,000, of which £23,000 relates to the mother and £51,000 relates to impacts on the child5 • perinatal mental illnesses cost the NHS around £1.2 billion for each annual cohort of births6.
Source: 1.3.4 Mothers and Babies: Reducing Risk through audits and confidential enquiries across the UK (MBRRACE- UK) Saving Lives, Improving Mothers’ Care report 2015. npeu.ox.ac.uk/mbrrace-uk 2.5.6. The Costs of Perinatal Mental Health Problems (centreformentalhealth.org.uk/perinatal)
It can affect anyone…we need to be vigilant. Actress Country Cox has revealed her urges to ‘drive off a cliff’ after the birth of her daughter. Fellow actress Gwyneth Paltrow (left) has spoken on televsion about how she ‘couldn’t figure out’ why she was unable to bond with her son.
Dr. Mark Barsoum, Consultant perinatal psychiatrist
FEATURE Nurse Noreen Clarke has spent 14 years banging a drum for a specialist perinatal mental health service – a dedicated team of psychiatrists, psychologists and specialist nurses who can support a woman even before she becomes pregnant through to the baby’s first birthday.
ack then, her vision on hold, she developed a service based at Liverpool Women’s Hospital on a shoestring. More recently a government call for 350,000 women to have access to specialist perinatal mental health support has seen the launch of a new specialist perinatal services across Merseyside and Cheshire. For Noreen (back row second left) it’s a welcome development. “All the evidence is that this type of service is essential. Many women suffer from mental health issues during and after pregnancy; it can affect the whole family. Although post natal depression is the most well known, some women are already unwell and worry about the effect of medications on their unborn baby; others become unwell during pregnancy or after giving birth. “Thankfully women, their families and professionals are now more aware. By getting help early we can reduce the risk of women and their children experiencing problems in the future.” She recalls the early days: “We had a psychiatrist, a mental health nurse, an obstetrician and midwife for one day a week and myself as lead nurse and manager.
MUM’S THE WORD We would assess and provide treatment to women and also refer to their local community health team for ongoing treatment and therapies if needed. There was a system and it worked well, but my vision was always a dedicated team managing its own caseload, where women would find all they need in one place and not have to wait.
WE INTERVENE EARLY “We’ve always worked closely with midwives, training them to recognise the signs of mental illness. We’re a preventative service; our aim is to reach women before they get to crisis point. It’s vital we intervene before things escalate.”
It’s often simple solutions that prevent catastrophic outcomes. “One lady had given birth in Bangor and been transferred to Liverpool because of health issues with the baby. She was exhausted, hallucinating and at risk of becoming psychotic. The whole family stayed in hospital and while midwifes and obstetricians cared for the baby, the perinatal team assessed the mother’s health. Getting the right treatment and plenty of sleep knowing someone was caring for the baby was the start of their road back to being a family.“ The new team is now in place after endless rounds of interviews. “Perinatal nursing can be emotionally draining.
LOOK OUT FOR • Rapidly changing mood or symptoms • New violent thoughts of suicide • Wanting to distance themselves from their baby • Severe guilt and feelings of being a bad mother
WHERE TO FIND HELP NHS Choices pregnancy and baby guide helps women and their families understand the difference between the baby blues and more serious conditions such as postnatal depression or postpartum psychosis nhs.uk Maternal Mental Health Alliance, a national charity and consortium on all mental illnesses in the perinatal period maternalmentalhealthalliance.org A woman in mental health crisis may decide to terminate the pregnancy. There are safeguarding issues to consider. An asylum seeker who doesn’t speak English and has already been moved around the country many times may be taking a brand new baby back to a hostel with no family to support her; it can also be traumatic admitting a mum and her new born into hospital. “We were honest with candidates about how tough a role they’d be taking on and the intensive training they’d need. We know we have the right people. They’re a great team.“ What now for Noreen? “The vision is reality – I jokingly say my work here is done…but it’s only the beginning and I’m proud to be part of it.”
Action on Postpartum Psychosis supports mums and families affected by postpartum psychosis app-network.org Maternal OCD offers peer support for perinatal obsessive compulsive disorder maternalocd.org Tommy’s supports women who have suffered the loss of a baby as well as support for those who have had a difficult or traumatic pregnancy, birth or postnatal period tommys.org
We’re taking part in a study that compares outcomes for women receiving care from psychiatric mother and baby units compared with inpatient services and/or home treatment teams in the first year after having a baby. By taking part you would help us to understand which services provide the best experiences and outcomes for women suffering from mental health difficulties following childbirth. Contact Kelly Palethorpe at Mersey Care NHS Foundation Trust: email@example.com
THE ONLY THING I CRAVE IS NORMALITY 12
Amanda Edgar has had the highs and the lows of drug use. At 49 she’s just starting to get the feeling she craves most – normality.
he’s spent the past few months helping transform a railway underpass at Bootle’s Oriel Road railway station. It’s part of moving on from a life where cannabis, then heroin, was used to block out emotions from an abusive relationship. After 15 years in Bristol she came back up North for her dad’s funeral and never went back. The relationship was over but the addiction was harder to leave behind. “I’m a strong person but I was under my partner’s control. He cut off all outside connections. I lost the ability to communicate; I felt lost. The drugs helped get the thoughts from my head but then darker thoughts come in. You don’t eat, I was running on empty – I still am.” For all she’s been through there’s no self pity, more a sense of pride that even at her most desperate she didn’t take what wasn’t hers to support her habit. “I’d rather cold turkey than steal. I used to make tea from wild lettuce to stave off the withdrawal symptoms and calm me down. It didn’t change me as a person; I still had the same morals.”
The drugs helped get the thoughts from my head but then darker thoughts come in.
Now Amanda is concentrating on her own home. “The drugs drained every ounce of positivity from me, now it’s time for me to do some groundwork and find my direction.”
Amanda and fellow volunteers worked to revamp the public walkway between Oriel Road
Ambition Sefton has helped her get back to reality. “I understand now that you need certain things to grow like a plant needs light and water. I’m taking a heroin substitute called Subutex which doesn’t give you a high – I don’t want the highs, I want to feel normal.” It was her key worker Louise who suggested Amanda joined the underpass project. It’s something of a metaphor for Amanda’s life. “Before I did the work I always dreaded walking through because it was so dark and dank, you always had the feeling something bad might happen. There were times when it was cold, rainy and I didn’t want to be there but I wanted to see it through and now it’s bright and a good place to be.“
and Canal Street with Well Sefton, which brings organisations together to improve the environment and wellbeing of people living and working in Bootle. They cleaned and stripped graffiti from the tunnel walls before repainting and decorating with unique designs under the direction of a creative artist at Safe Regeneration. Each piece of artwork tells a story and shares an experience of the volunteers and artists involved in the project. To watch a video of the work go to YouTube and search Oriel Road underpass clean-up project.
Most young people who need children’s mental health services can be discharged before their eighteenth birthday. A small number with ongoing or complex problems will be transferred to adult services. Studies show that the experience of moving services can affect a young person for the rest of their life, yet after two decades of policy change and debate, transition support still differs across the country.*
NOW MERSEY CARE IS AT THE CUTTING EDGE IN CHANGING THINGS… The move from children’s to adult mental health services can affect vulnerable young people for the rest of their lives. They can become lost, overwhelmed. Some may simply disappear unable to cope with the change, and then re-emerging down the line with entrenched problems. The difficulties in bridging the two services are partly down to the way they’re set up and there can be a vast difference in the way care is delivered. Children’s services tend to be less focussed on diagnosis when they see young people emotionally distressed unless there is a clearly defined mental illness. On the other hand adult services are usually
The experience can be make or break. diagnostically led and this difference can create additional challenges on what can often be a tricky pathway. At the same time research shows that the transition experience can be ‘make or break’ for a young person with on-going mental health difficulties. A study by Warwick University reported that while transition protocols identify the service user as central to the transition process, none specify ways of preparing the person for transition. At the time of the
study only one in five mental health services in the UK had specific arrangements in place.* A successful outcome is possible – but it needs strong links between the young person and both sets of services. A dedicated practitioner with a foot in both camps. Adult mental health nurse Phil Laing (pictured) is employed jointly by Mersey Care and Alder Hey Children’s hospital which runs Children and Adolescent Mental Health services (CAMHS) for the area covered by Mersey Care. He begins working with young people identified as needing adult services long before they are discharged. When they come to the end of their care with CAMHS and make the move, they are already familiar with the service they are going to and who will care for them.
FEATURE It can be incredibly daunting for for some young people who have emotional difficulties and don’t feel ready to move to an adult service. “They lose the security of key staff they have built relationships with and are faced with a new and different world. The future can look bleak and frightening. They may cope by engaging in self harm. If we don’t step in to make the transfer as smooth as possible and explain and involve them there’s a chance their problems will escalate; or they’ll vote with their feet, disengage completely and then they may come back into services later. They need to be ready, fully informed of where they’re going next and understand the process. They need to be included, not ‘done to’.” The partnership is based on agreed goals between the two services. Around six months before the young person ‘graduates’ from children’s services Phil begins working with them and their CAMHS key worker and any other agencies involved. The
transition pathway can be complicated and Phil acts as a systems navigator.
THEY CAN BE SCARED “It’s important to get to know the person so they trust what we say. They’ve heard myths about adult services, for instance think they’re going to go straight onto a hospital ward; but in almost all cases they’ll be in the care of community teams.” The young person is supported to set transition goals which guide the type of ongoing support offered. A goal may be to find alternative less harmful ways to overcome stress, with support. It could be to take their medication, explore activities or educational opportunities. The goals are their own, they have to be achievable and they can change with time.
The success of this approach is measured by questionnaires designed and approved by young people who have gone through transition. The young person completes a questionnaire before and after the transfer to adult services. This allows them to share their experience and level of satisfaction with the process. Phil: Young people value good information, consistent support from a key worker, and flexible, non-stigmatising communitybased services appropriate for their age group. If we can provide those things and the transition goes well the person tends to do well. If it goes wrong some people can end up in adult services for years – It’s a missed opportunity that will have repercussions all their lives and put more demand on services.” *
REAL LIFE STORY
Jenny’s busy painting her new flat and looking after two kittens she’s rescued and brought back to health. At 18 she’s clear about a career that will see her working with animals, she’s studying animal welfare at college and has a weekend job in an animal sanctuary.
he’s a young person who’s going places. Three years ago, badly affected by events at her family home, she packed a bag, went to school and never went home. Family life was nomadic; she lived with a sister with a learning disability who was often violent towards Jenny and a mum who ‘buried her head in the sand’. It left Jenny in turmoil: “I was so unhappy I wanted to go into care. I was staying back at school - they knew how bad things were and they could see the scars on my arms from attacks by my sister.”
Jenny went to live with her beloved Nan with whom she’s still incredibly close. The child and adolescent mental health services team at Alder Hey Children’s Hospital saw her through difficult times - she had dropped out of school and was self harming. She had her own social worker and case manager who she says helped her cope through the teenage years and she attended the hospital school. Earlier this year Jenny approached her eighteenth birthday – the point where it can all go badly wrong for a young person.
Phil Laing: “Jenny was doing well but we felt she has unresolved issues and wasn’t ready to be discharged to her GP. Her goals were to live independently and stay in education. We used our connections with partners to help her. The community mental health team referred her to a housing association who allocated the flat where she now lives. She was allocated a support worker while she needed it and she’s in the care of a psychiatrist. She’s at college and doing brilliantly but if she ever takes a step back we’re all there in the background ready to help.”
Read Zoe’s story on page 16. 15
REAL LIFE STORY
THINK I’D GET TO 21 I DIDN’T
oe was looking forward to her 21st birthday celebrations when MC magazine met her. She’s endured years of mental torment, self harming and in and out of hospitals from an early age.
Zoe moved to a different school and things got a bit better but at 16 she was sectioned (under the Mental Health Act) after taking an overdose. She was diagnosed with personality disorder and spent the next three years in adolescent units.
“I was bullied through school because I didn’t fit in. I self harmed from 12. I wanted it to stop but it was the only thing that made me feel better. I was referred to CAMHS by my GP at 14, I went to group therapy but by then it was too late. I was self harming every day; I had suicidal thoughts. It was scary but it was something I couldn’t control.
She felt stuck, a sense of hopelessness deeply embedded. Even so she was worried about going into adult services. “I’d heard such negative things, but my community mental health coordinator Salome came in before I left hospital, I felt someone was listening to me. I had new assessments, my diagnosis and medication was changed; I started feeling much
better. I didn’t think I’d ever be discharged and if I was it would be to another unit. But after nine months I went home to my mum and dad.” Two years on Zoe is about to embark on a mental health nurse training course in Chester. She hasn’t self harmed for a year and has made new friends. I didn’t think I’d reach 21. All I wanted to do was kill myself. I didn’t want to go into adult services but they did all the right things and I’ve been inspired to be a nurse. I know this will affect me all my life, but I’ve had help and learnt to deal with it. You have to have faith.”
At some time in our lives we’ll all know someone who has problems mounting up and who may need help. You could make the difference to what they do next.
You can do it in the time it takes to do the office coffee round, or put on a family washing cycle at home. There are stories of real people who have experienced the impact of suicide on their lives and real life scenarios.
simple 20 minute online training session will help you identify when someone is having suicidal thoughts. You’ll have the skills to approach them, have difficult conversations and support and signpost them to the right services or help.
SAVE A LIFE
Pledge your support and take the training at zerosuicidealliance.com
Steve Mallen wants everyone trained to identify the signs of mental illness.
A FATHER’S PROMISE
he businessman became the driving force for The Zero Suicide Alliance, which wants to see best practices from mental health Trust’s shared and implemented; and whole communities - from parents to dinner ladies in schools to know how to approach someone they think may be contemplating suicide. “My dear son was desperately ill by the time he sought professional help and it could so easily have been averted. We need to make sure we are not only producing more emotionally intelligent and resilient people, but also that we have a system that is able to detect difficulty much earlier.”
After his 18 year old son Edward took his life on railway tracks near his home Steve made a promise to fight to prevent the same thing happening to others.
LIKE MINDS The Zero Suicide Alliance, a coalition of like-minded partners determined to work together and share best practice to help rid the UK of suicide was launched at Westminster in 2017. Health secretary Jeremy Hunt, the Liberal Democrat’s Norman Lamb and former shadow mental health minister and Liverpool Wavertree MP Luciana Berger, joined representatives of charities, major employers, clinical commissioners and politicians, all united to address the challenge of preventing suicides.
WHAT IS ZERO SUICIDE? The concept is inspired by the Henry Ford healthcare system in Detroit, which began a programme of screening for every patient for risk of suicide, not just those with mental health issues, in 2001. Within four years the suicide rate within its patient population fell by 75%. Seven years later it had eliminated suicides among people in its care.
Because ONE life lost is ONE too many 17
PICTURE THE SCENARIO...
CAB DRIVER STEVE PICKS UP A FEMALE PASSENGER.
SHE’S DISTRAUGHT, HAS NO POSSESSIONS AND ASKS TO BE DROPPED AT THE DOCKS.
STEVE FEELS SOMETHING’S WRONG.
HE’S WORRIED ABOUT INTERFERING. WHAT SHOULD HE DO?
OUR TRAINING PROGRAMME COULD HELP STEVE. IT COULD HELP YOU.
IT COULD SAVE A LIFE.
FIND OUT WHAT STEVE DID NEXT...
...AND TAKE THE TRAINING HERE zerosuicidealliance.com 19
If not ZERO then WHAT? Mersey Care Chief Executive Joe Rafferty talks about how Mersey Care is committed to eliminating suicides among people in its care and why he wants everyone to take the training.
Every suicide is another person who either felt unable to ask for help or did not know how to access it. It’s a tragedy that has an incalculable impact on those who knew the person; and on society, the local community and its resources.
OUR SOCIAL MEDIA THUNDERCLAP REACHED 11 MILLION PEOPLE!
If zero isn’t the right number, then what is? No As a suicide attempt survivor I thought this death by was an excellent suicide resource…everyone should can spare 20 minutes. ever be It could mean the regarded difference between life and death… as either @beverleyheeley acceptable or inevitable. If 20 British long haul aeroplanes crashed every year, there would be a national outcry, demands for change, a long hard look at systems and processes and funds diverted to things that would quickly make the most difference to the problem. We’ve trained 4,000 of our own staff to talk about suicide at work and at home. If a million people take the suicide awareness training package we’ve developed with the Zero Suicide Alliance; and encourage friends, colleagues or
family members to do the same then finally we are equipping people to have a real conversation and help to prevent the heartbreak of suicide for people in this country.”
I’m in New Zealand… It made me cry – crazily part of that was the sheer joy of watching such a stunning resource… @Tony Southall2!
YOU DON’T HAVE TO HAVE THE PERFECT WORDS…
Jane Boland, Suicide Prevention Lead and Angela Samata developed the training with our partner Relias.
We’ve given people some secret knowledge; that there’s not a typical person, time or place, but there are some typical feelings, worthlessness, feeling a burden. We’ve introduced a way people can recognise those signs and know that by asking quite directly whether someone is thinking about hurting or killing themselves you will make things better, you won’t make it worse. By having that conversation you will help that person recover.”
Jane Boland, Suicide Prevention Lead at Mersey Care, and Angela Samata who lost her Angela: “You never know when you’re going husband to suicide, worked with our to have the conversation that will change training partner Relias a leading global somebody’s life. One of the main things is provider of online learning solutions that suicide isn’t an inevitability, and for health and social care, to that a conversation can make a develop the online training “I like the fact that Zero Suicide is saying it’s a difference. As someone who programme. widely shared responsibilhas been bereaved by suicide Jane: “I really believe ity, that sense that society it’s exciting to work with a is tackling the problem… people will find the clinician to bring a free that is a very important training an empowering resource that is usually message. resource. It says you Professor Louis Appleby, reserved for people with don’t have to have the Director of National Confiaccess to a clinician, into the perfect words, just the dential Enquiry. public domain.” goodwill to make a difference. Take the training
REAL LIFE STORY
DEVOTED A daughter tells of the family bonds that ill health can’t break and the team they know they can rely on.
I was blessed with a wonderful upbringing, in a really happy home…
y mum is a tough little Irish lady with a wicked sense of humour. She’s had more than her fair share of illness, including kidney and lung cancer but nothing has been as scary as what’s happening now. Mum got diagnosed with early stage mixed dementia a few years ago but this last year it’s changed her – each day we lose a little more. It’s the most heart breaking illness to witness and it’s incredibly frightening at times. Watching my mum run outside shouting for help, making accusations that she truly believes are true. She’s become increasingly confused – it affects her speech, she has mood swings. I’m a really positive person
and I’ll never give up, but at times you feel hopeless. I was blessed with a wonderful upbringing, in a really happy home. There was always laughter and love, there still is! Mum and dad have been married 64 years. They make a great team and have never been apart, so when dad was admitted to the Woodlands Hospice earlier this year, mum couldn’t cope without him. She ended up getting sectioned (under the Mental Health Act) and spent some time in Clock View Hospital, which was totally heart breaking for us all. Dad always said, “I took my wedding vows serious and I’ll look after Maud till the end.” But it’s taking its toll on
him. The South Sefton community team is incredible; they do a fantastic job and always go that extra mile. Our community matron Jacqui has been there from the outset, looking after both mum and dad and helping me too. Carla Wilson our mental health nurse has been amazing with my mum and helps me to understand this awful illness. Lois Nash from Social Services fills in all the pieces inbetween. To have a team of professionals who help when you’re out of your depth is so reassuring, to be able to pick up the phone and know they’ll be there. They understand… they make a difference. Meet the team on page 22.
Community mental health nurse Carla Wilson with Maud and Ted.
What happens when someone who has led an active life, brought up a family and run a business has a health crisis? We meet the team who step in to help.
aud and Ted have led what many would describe as a charmed life. Their busy greengrocer store made them almost local celebrities in their home town of Maghull. He’s gentle, engaging; she’s a strong Irish matriarch with a wide grin. When ill health struck they turned to each other, as they’ve done all their lives, for strength and support. But in November 2016 Ted, now 85, developed prostrate cancer; it has since spread to his bones
leaving him in constant pain. By then Maud was in the early stages of dementia. She was unpredictable, he was struggling to cope. Sarah Gibson co-ordinates Maghull community care team; her role is to identify which services someone needs and bring them together, all the time monitoring to ensure they work together to provide people with the right help at the right time.
They’d reached crisis point. Ted was in chronic pain.
CRISIS POINT “Their daughter Nicky was holding down a full time job while caring for her own family and her mum and dad. Strong family bonds were being torn apart. They needed help in so many ways.” Community matron Jacqui Martin agrees. “They were at crisis point. Ted was in chronic pain – you could see it in his face - yet still trying to look after his wife with no care package.” Jacqui arranged for Ted to go into Woodlands Hospice for respite and a review of his pain relief so he could manage his back pain, while helping Nicky manage Maud and working with district nursing, palliative care and physiotherapy teams. Sarah knew Maud needed psychological support for her dementia needs so called South Sefton community mental
health team. Nurse Carla Wilson and her colleagues have helped her stay at home. “If Maud becomes physically unwell she can deteriorate fast and watching that can be distressing, even for us. Many people would say ‘I’ve had enough now’ but Ted never complains. Maud really needs 24 hour care but Ted wants to care for her at home and we’re helping him to do that.” Community pharmacist Grace Harris goes to the couple’s home to check they understand why changes are being made and monitor for adverse effects. She recalls the visible sense of relief when she arranged for medicines to be put into blister packs. “Ted always had a smile on his face but it had started to disappear. It’s been a struggle but he idolises her and wants to look after her himself.”
Community matron Jacqui Martin has been with the couple from the start.
HELP IS OUT THERE The team contacted Social Services to secure carers so Ted can get some respite and independence. Jacqui: “Helping Ted with his pain and giving him a few hours independence has helped him regain control – he’s a different person. They’re like so many older people in this community, reluctant to ask for help. They worry about needing to go into care, they fear losing their house. Yet the help is out there. We can now Care coordinator Sarah Gibson identifies the services people need and brings them together.
watch and step back in when they need us.“
MORE HELP • Carers UK – help advice and campaigning: carersuk.org Community pharmacist Grace Harris goes to the couple’s home to check they understand why changes are being made and monitor for adverse effects.
• Carers’ Trust – champions the role of carers. carers.org • Age UK – for people who care for an older person: ageuk.org.uk • Carers Allowance – gov.uk/carers-allowance
STAY WELL FEEL GREAT
Nothing brings people together like cooking good food!
APPLE AND BLACKBERRY CRUMBLE Preparation time: 15 minutes
Community cook Kristina Tischendorf loves creating winter dishes. “Stews risottos and soups bring in ingredients that can feel hard to prepare…”
Cooking time: 40 minutes
One of her personal favourites is bacon, kale and butternut squash hotpot. “It’s flavoursome and aside from roasting the squash for 40 minutes it’s quick. You can do the roasting bit any time during the day, then complete the dish at teatime. Finish off with apple and blackberry crumble made with oats – it’s loaded with goodness.”
WHAT YOU NEED
BACON, KALE AND SQUASH HOTPOT WHAT YOU NEED 1 pack 8 slices cooking bacon trimmed and chopped 1 onion peeled and sliced 1 x 200g bag of kale, washed with large stalks removed 1 medium butternut squash Good handful chopped parsley Preparation time: 20 minutes Cooking time: 1 hour (including squash roasting time)
125 ml vegetable stock (made with a stock cube) Pinch black pepper
Serves: 4 to 6
WHAT TO DO • Cut the squash in half and scoop out the seeds • Drizzle with a little olive oil and rub some paprika into the flesh • Roast in a pre-heated oven for 40 mins • Meanwhile dry fry the bacon (or in a little olive oil if needed) until brown and crispy • Add the onion and fry gently until starting to colour • Add the stock and bring to the boil
Serves: 4 Preheat oven to 180Oc /Gas Mark 4
450g cooking apples small punnet or two handfuls blackberries 75g granulated sugar 2 tbsp water 1½ tsp ground cinnamon For the crumble: 125g plain flour 125g porridge oats 75g low fat spread or butter 50g brown sugar 50g chopped pecan or hazelnuts WHAT TO DO • Peel and slice the cooking apples • Stew in a saucepan with the 2 tbsp of water, sugar and cinnamon till soft and sweet (about 20 mins) • In a clean bowl rub the spread or butter into the flour, oats and sugar mix till it resembles breadcrumbs. Sprinkle in the chopped nuts and mix • Add the blackberries to the stewed apples and stir gently, Spread the fruit in the bottom of a baking dish • Sprinkle on the crumble and bake in the oven till the topping is golden and crisp.
• Stir in the kale, cover and simmer for 5 minutes until tender • Scoop the flesh from the roasted squash and cube
• Stir the cubed squash and parsley through the dish, heat till piping hot, adjust seasoning and serve.
The nuts are optional but give a lovely flavour and texture to the crumble and they’re full of minerals and fibre!
STAY WELL FEEL GREAT
At a cookery course in Liverpool people with a mental health issue are coming together to share more than recipes.
t Walton Life Rooms just outside Liverpool city centre former community cooks Kristina Tischendorf and Carol Soutar share out the ingredients for a Bacon, Kale and Squash Hotpot to participants on a course run by Mersey Care health and community NHS Trust recovery college.
but the medical situation means I have to follow a low residue diet. It’s a daily battle. Outside of the group people are living in their own world with their own problems, but here we share our concerns, we support each other. There’s a realisation that you’re not on your own.”
The pair, who run community interest company Homecooked see how food has the power to bring people together and break down social barriers. “Just the simple act of talking about what we’d all like to cook is a real ice breaker. It’s informal but inclusive. We do everything together; choose each week’s dish, preparing the ingredients round the table, then eat what we’ve cooked together. It’s informal, communal, people talk as they work – it may be about making good nutritious food achievable, but the conversation almost always moves on to other things as well.” For Paul (pictured bottom right) food preparation has to be an exact science – he lives with a digestive condition where eating skin or pulp can cause an adverse reaction. It can be hard to live with but the course is helping him
The simple act of talking about what we’d all like to cook is a real ice breaker.
learn new ways to vary his diet. The class is also a chance to share experience with other people. “Choosing the correct food can be hard. My consultant has told me to lose weight,
Dan (pictured bettom left) agrees. He’s now a volunteer with the Recovery College after coming to Life Rooms following depression.“ When you’re not feeling strong and you tell ‘normal’ people it can feel like they’re talking down to you, even though they don’t mean to. I was dubious about doing courses but it’s comfortable. It’s less about the content – though that’s great – it’s sitting in a room and when someone does choose to talk about their mental health people nod – you know it’s the same for them – that this for them is ‘normal’.
Just sitting round a table chopping the food together really brings people together. Cook Well participant Claire.
It’s up to us to develop a kind mind – the equivalent of a good friend. Donna Gardiner.
KIND TO YOUR MIND BE
It’s good to have a friend who can help us cope, get things off our chest and say positive things. But if there’s no-one there when unpleasant thoughts, memories or feelings can sometimes come up out of the blue can you do it on your own?
elf soothing sessions, developed by Mersey Care psychologist Dr May Sarsam are being used within mental health/wards to challenge feelings of worthlessness, self-blame, and low self esteem left by negative life experiences.
• develop an image – something that reminds you of happy times • notice when your inner critic appears and question it there and then • go to your image think of your good qualities
But we can all benefit from the technique. Psychologist Donna Gardiner explains.
• do something relaxing and soothing, light a scented candle, get into comfy clothes, listen to relaxing music, walk near nature.
“We all have an inner critic, a voice in our heads that leaps on any chance to give us a hard time. It’s up to us to develop a kind mind – the equivalent of a good friend whose words or actions stop the negativity, accept us for who we are and make us feel worthwhile again.
• Read more about Kind Minds on our website – merseycare.nhs.uk search for Centre for Perfect Care case studies Psychologist Donna Gardiner
COULD YOU BE A SAMARITAN?
amaritans are seeking people with the ability to listen with empathy whilst not judging or offering advice. In Liverpool alone more than 50,000 calls for help were responded to by Listening Volunteers during 2017 – a rise of 17,000 in two years. Callers to the charity get in touch by telephone, email and text.
Branch director David Ashton said: “Volunteers undergo more than ten weeks of training before taking their first calls. There’s a lot of support available, you’re never alone.” Visit samaritans.org/Liverpool or call 0151 709 1100.
STAY WELL FEEL GREAT
This course has been so good for me.
There’s a sense of anticipation in the air in the rehearsal room at Southport’s Life Rooms, right in the centre of town. The resident band prepares to belt out its own unique rendition of the country classic ‘Copperhead Road.’ The drum beat gets toes tapping; people come in from other parts of the building peeking round the door to see what’s going on.
nd then it comes, the sound of individual instruments coming together as one. Except that this band had never met until a month ago when they signed up for a Making Music course.
AN INTEREST IN MUSIC IS ENOUGH The Life Rooms offers people from the local community opportunities to take part in activities and courses to meet new people and develop new skills. To do this course you don’t have to read music or even play an instrument; an interest in music is enough. Group leader Dave Hall is better known as a member of melancholic rock band Antimatter. Here though he’s gentle in his approach to people of differing abilities – the chap on the drums hadn’t touched a drum kit before beginning the course. But that doesn’t matter here.
“It’s not about being an amazing musician it’s using music as a tool to develop confidence and enjoy yourself. We all choose the songs and the arrangements; people can even just come and watch.” The Making Music course runs at Life Rooms Walton and Southport. For dates of this and other courses go to liferooms.org or call 0151 478 6556 or 01704 383 198.
lan Marshall became dependent on over the counter sleeping aids after a debilitating bout of pancreatitis which left him with depression.
makes it hard to get up in the morning, when I did I was in pain so I’d take more. It got to the point where I’d sit in my room playing video games.
“I struggled to sleep so I got the tablets from the chemist with no idea they could be addictive, they have a sedative effect that
I went to Life Rooms and saw this course. I’m not a musician, but I like bass guitar, so I decided to give the course a go. Now I’m trying other courses. It’s been so good for me. I wanted to do things; work, finish my studying, look after my parents, but it was just too difficult. Doing this has given me back my motivation.”
Course leader Dave Hall is a member of rock band Antimatter. Photograph: Cristel Brouwer
WHAT’S YOUR FAVOURITE TOE TAPPING SONG? Here’s MC magazine team’s top five: • New Rules – Dua Lipa • Thriller – Michael Jackson • Summer of ’69 – Bryan Adams • Stuck in the Middle With You – Steelers Wheel • Up Town Funk – Bruno Mars
DOCTORS MAKING A DIFFERENCE We’re recruiting doctors to help us create the best future medical leaders. And right now it’s a great place to live and work.
There are no limits to the range of opportunities for psychiatrists to develop and influence their field of practice.
Dr Naidoo is particularly proud of the Trust’s Centre for Perfect Care, an evidence base that collates research, innovations and experience from across the world. centreforperfectcare.com
DEVELOPING TOGETHER Dr David Fearnley, medical director.
t’s a great place to be a doctor” says Dr David Fearnley the Trust’s Medical Director. “The work here is incredibly varied. There are no limits to the range of opportunities for psychiatrists to develop and influence their field of practice. And in terms of personal and family wellbeing it’s a great place to live.”
Support for staff to take on external posts is important to Dr Kuben Naidoo, a consultant psychiatrist specialising in adult ADHD. He is the chairman of the board of trustees for the ADHD Foundation and an examiner for the Royal College of Psychiatrists.
Our well developed appraisal system ensures all doctors revalidate and develop professionally through their career. We’re proud of our track record in providing excellent training to doctors in their undergraduate and postgraduate years, throughout foundation, core and speciality training, and beyond into consultant life.
Mersey Care’s ambitious building programme includes extensive refurbishment across its estate and the building of a £20 million state of the art hospital in Southport. “We’re using our experience and success to expand and create even more clinical opportunities. We’ve recently added a specialist learning disability division to our portfolio, together with a range of community physical health services. There are now many more leadership and management roles for doctors and we encourage them to develop special interests and to contribute towards the successful growth of the Trust; we want them to be a part of our long term plan.”
Dr Kuben Naidoo, consultant psychiatrist.
Our doctors contribute to national NHS policy and publish regularly in peer reviewed journals, blogs, invited articles and social media.
Merseyside has many excellent road and rail links. Commuting in from the suburbs is fast and easy and London trains run several times daily. You can fly from Liverpool airport to more than 200 worldwide destinations.
BEST FOR WORK LIFE BALANCE Liverpool has been voted as one of the best cities in the UK for work-life balance. Its waterfront is a World Heritage site and the city has the largest collection of museums and art galleries outside London including Tate Liverpool. Consultant psychiatrist and director of education, Dr Indira Vinjamuri lives outside the city in St Helens. “It’s a lovely place to bring up a family – house prices are very reasonable, there’s a big choice of good state and independent schools, and childcare is much easier to arrange than it would be in London and the south east.”
EDUCATION The city is home to 149 state funded schools, 13 independent schools, several further education colleges and three universities.
HOUSING House prices on Merseyside are among the lowest of any UK. Last year semi detached properties sold for on average £167,399. Terraced properties sold for an average price of £106,173, while detached properties fetched £297,065 (source Rightmove).
For more information, please contact: Dr David Fearnley: 0151 471 2459/ firstname.lastname@example.org Dr Arun Chidambaram: 0151 431 5152/ email@example.com
Dr Indira Vinjamuri, consultant psychiatrist and director of education.
It’s a lovely place to bring up a family. Dr Indira Vinjamuri
I went on a counselling course and went back as a volunteer.
WHERE THEREâ€™S HOPE INTRODUCING...
Sarah Wilson is part of a close knit ‘family’ of dedicated staff at Liverpool’s new Hope Centre. She supports people who come in for intensive and often life changing drug and alcohol detox programmes.
he 56 year old nursing assistant turns back the clock every time she walks through the doors. Sarah has put a life blighted by drugs misuse behind her; but it’s that experience of walking in their shoes that enables her to empathise. She can recall vividly walking into what was then the Kevin White Unit on Smithdown Health Park. “If it wasn’t for the services available and the support of the staff back then I wouldn’t be here.” Sarah began using drugs at 17 while living in Blackpool. “I had a good job in a big department store but my self esteem was low and the group of people I seemed to fit in with were all taking drugs.”
Barbiturates and prescription drugs led to heroin. By 23 she was in a spiral of descent that would ultimately lead to broken relationships and her young children going into care. It was only when she moved to Liverpool and went into treatment that she quit drugs for good. “I remember my psychiatrist asking back then what I wanted to do with my life. I said: ‘work here as a support worker.’ They advised me to get some qualifications, so I went on a counselling course and went back as a volunteer.
If it wasn’t for the services available and the support of the staff back then I would not be here.
“I learned a lot about myself in those years. You can never get back lost time so when this job came up I jumped at the chance; it was my way of putting some things to right. I know what people have been through. I want to give them hope.”
WHAT IS THE HOPE CENTRE? Hope Centre offers inpatient recovery focused detoxification and stabilisation programmes to people with complex needs, such as multiple drug and substance use, physical or mental health issues and complex social needs. Treatment programmes are as unique as the person, helping them prevent a relapse, set goals, improve their self esteem and make plans in readiness for discharge. Former service users often take part, sharing their stories, their own development and how they are maintaining a drugs free lifestyle.
COUNCIL OF GOVERNORS
We meet new governor Paul Taylor at World Museum Liverpool. He loves the place, it’s a favourite haunt since the days when, as a teenager he’d spend Saturday mornings at archaeology classes.
aul is also a philanthropist at heart. While in business he was co-founder of aofcharity that supported a charity that supportedvulnerable vulnerable older people. He and colleagues developed a simple security system involving a mirror and a door chain that was adopted nationwide and has given peace of mind to thousands of senior citizens. His own life took an unexpected turn when a brain injury left him with memory loss and panic attacks. He underwent psychotherapy and began volunteering, first on a dementia ward and befriending a patient at Ashworth High Secure
I’d realised just how much somewhere like Life Rooms can impact on people’s lives.
Hospital which he still enjoys. He sits on recruitment panels and mentors nursing students.
Paul’s bid to become a service user governor came from a desire to see ‘how the machine works’ at strategic level.
Today Paul is also a welcoming and support volunteer at Life Rooms. “I’m humbled to see such dedication to everyone who walks through the doors. It’s become a passion – and if I’m honest it’s given me a kick up the bum. It’s little things; recently someone I’d helped to search on employment websites came back to tell me he’s starting a job... it’s helped him but it’s also part of my own recovery.”
“I’d realised just how much somewhere like Life Rooms can impact on people’s lives and how people like me could help. But I needed to know where the ideas come from. It was daunting but it’s another role I’ll relish. I’m a great believer in giving something back…” To learn more about our council of governors, go to merseycare.nhs.uk
A DAY IN THE LIFE...
SENIOR FORENSIC SOCIAL WORKER AND CARERS’ LEAD SECURE SERVICES
Today I’ve been planning our next carers’ forum. We set it up two years ago with carers; they wanted somewhere they could come together, learn and feel supported. People travel hundreds of miles – I’m privileged to be involved.
We’ve helped them stay close as a family – that’s the way we work.
Having somewhere to be themselves is really important. As clinicians we focus on the patient, but I’m passionate that carers should have their story heard. Some people have told us this just wouldn’t be possible in a local carers group. It could be that the case may have attracted media interest, or it is just too traumatic to share. In our group they are among people who can empathise. Meeting new families is a highlight of my day. They sometimes arrive worried and unsure. I sit down with them, give them a big smile and some refreshments.
I stress the important role they play and that we’ll listen and be there for them. You can see them relax as they realise we’re together in this. I was never more proud of our carer support programme than when I co-presented a workshop in London with a patient’s mum. It was full to the brim! We shared all the things we’ve done that carers told us will make their lives better – more involvement; education about mental health conditions and treatments so they feel empowered in meetings – and to break down barriers and tackle the stigma of being in a secure hospital. Our hospital tour gives people a real insight into where their loved one is being cared for. Today a family told me it’s really helped them reconnect with their relative. I was delighted. We’ve helped them stay close as a family that’s the way we work.
END THE SILENCE END SUICIDE
Because ONE life lost is ONE too many
Over the course of a year 6,188* people died by suicide in the UK, that’s nearly 17 people EVERY day.
Because ONE life lost is ONE too many
Save a life, take the training. Find out what you can do at zerosuicidealliance.com *
Source Samaritans Suicide Statistics Report 2017
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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: email@example.com W: merseycare.nhs.uk. MC MAGAZINE is available in other formats on request. Please pass on for others to read and recycle.
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