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Summer 2019



Does Love Island make us hate our bodies?

My Monster and Me

Can Your Doodle Do You Good?

Don’t Say the S Word







Nadiya Hussein was crippled by her anxiety – are you? Find out how to get help.




Better to love your own body say the experts.





Being creative really does lift your spirits.

Why young people don’t talk about sexual health.


MC Magazine team: Managing Editor: Steve Murphy. Editor: Jackie Rankin. Contributors: Diane Cooke, Charlotte Hadfield. Page 4




Cover shot:



Photography: Joel Goodman, BBC, ITV, Rick Gem Steve Murphy. Design: Jo Hadfield. Illustrations: Ella Byworth. You can contact us at: communications@merseycare.nhs.uk


MerseyCareNHSFoundationTrust @Mersey_Care @MerseyCareNHSFT Mersey Care NHS Foundation Trust

MEMBERSHIP AND GENERAL DATA PROTECTION REGULATION General Data Protection Regulation (GDPR), is a European-wide law, which governs how organisations can collect, use and transfer personal data. It came into force on 25 May 2018 alongside the new Data Protection Act 2018. As a Foundation Trust, Mersey Care has a statutory requirement to develop and maintain a membership and it is necessary for us to process our members’ personal data to perform this task. Our members are drawn from the public, people who use our services or care for people who use our services and staff. We request and securely hold data on our members, which they provide when joining our membership. The data we hold on our members enables us to show that we are representative of the community we provide services for, to keep members updated through our quarterly MC Magazine via email or post and to invite all members to the Annual General Meeting. We also engage with all members advising when the election for governors will be taking place, giving members the opportunity to nominate themselves to become a governor and to vote in elections for the council of governors. Should you no longer wish to be a member of Mersey Care please email: membership@merseycare.nhs.uk with your details or call 0151 471 2303 asking that your details be removed.


his issue was inspired by thoughts of trips to the beach and al fresco dining – it’s about making memories.

We’ve met some wonderful people – it’s talking, sharing stories and exchanging ideas that create the memories we also turn to when things aren’t going so well. A BBC study has proved the links between being creative and emotional wellbeing. We met artists and poets whose lives have been enhanced – meeting them enhanced ours.

There’s some criticism of celebrities jumping on the mental health bandwagon – but in our view there’s no better way of sharing the message

that talking saves lives. Nadiya Hussein’s candid documentary talks of the anguish caused by her anxiety and how therapy helped. Our experts give advice on getting help and what we can do to help ourselves. Did you think Avatar was a science fiction film? Us too. We tell how people who are unable to talk openly about trauma in their lives are finally able to deal with the issues by creating their situation through a virtual scenario on screen. At the other end of the tech spectrum is our new website developed to guide you through the maze of health related apps – it’s tech for wellbeing and it’s changing the way we think about solutions forever.

Finally we go behind the scenes at a Walk-In-Centre. We think you’ll agree that the staff are up there in the NHS unsung hero stakes.

The MC editorial team. If you received this copy by post you may have noticed the wrapping has changed. It’s now made of environmentally friendly potato starch film and can be put straight into your compost bin. Please give us your thoughts and ideas to improve your magazine? Email: communcations@merseycare.nhs.uk

Being creative really does improve our wellbeing...



By Diane Cooke


OUR BODIES? In a social media dominated society which exposes young people to constant scrutiny about their appearance, do TV programmes like Love Island promote body negativity?


t’s one of the most popular series on TV, but could it be making young people, who avidly follow every coupling and rejection, feel unhappy with their own appearance? You can see near naked bodies on any Mediterranean beach. So is it the series’ message that may be the underlying issue? That the best looking contestants get the girl or boy, or at least until somebody better looking comes along? 2017 finalist Gabby Allen is grateful for the boost to her career from being on last year’s show and understands the need for glamour. But in the podcast ‘No Really I’m Fine’ she says her body confidence took a huge blow. ”I was completely happy with my shape but I felt completely left out. I felt less feminine. I started to believe the reason no-one was attracted to me was because I didn’t have big boobs and hair extensions. It makes people want to be like those people. I’m lucky I have great friends and family and after I left I got loads of mail from girls like me saying I’d given them confidence.”

Jameela is not the first celebrity to speak out about the media’s obsession with perfection. Demi Lovato, Ferne Cotton, Lorde, Jennifer Lawrence and singer Sam Smith have all voiced their concerns about the need for body positivity. But, although things are slowly changing, magazines that advocate for self love and acceptance are still filled with articles on how to get a sexy summer bod, a better booty and toned abs and arms. Is it really surprising that the number of young people suffering with severe body image issues is on the rise? Mersey Care Consultant Liaison Psychiatrist, Dr Qaiser Javed, says as much as 2.4 per cent of the population, equally male and female, is seriously affected by body negativity.

Actress and body activist Jameela Jamil has been stoic in her campaign against idealised images of flawless bodies making the rest of society feel unworthy. She tweeted about a contestant on this year’s show: “The producers of Love Island think this slim woman counts as their new token ‘plus size’ contestant. Are they drunk?”



Hear Gabby Allen’s interview at play.acast.com and search Gabby Allen.

Gabby Allen, 2017 Love Island contestant. 2019Anderson Love Island contestant Laura (right) Tommy Fury




But he insists that the media plays a positive as well as a negative role. “Undoubtedly social media and apps that change appearance can impact the younger generation. But I’ve also seen YouTube videos and articles promoting positive body image.”

Being a perfectionist puts you at high risk. So where’s the line between feeling angry and uncomfortable because you don’t look as slim as an airbrushed celebrity, and wanting to cut off your own flesh? (Some people diagnosed with Body Dysmorphic Disorder attempt their own DIY surgery).


“A healthy body image is about feeling good in your own skin and how we feel about ourselves is very important because it impacts physical, mental, social, and spiritual wellbeing.

“Negative self image has the reverse effect. Body Dysmorphic Disorder (BDD) – when people spend a lot of time worrying about their perceived flaws which others may not notice – can become the next stage. It causes severe distress, social anxiety, depression and even suicidal thoughts. Ultimately it becomes a mental health condition which requires treatment.” BDD has been described as a hidden disease. Those affected often present to dermatologists or plastic surgeons who will refer them on to psychiatrists. It could be that the person has been referred for psychology therapy for depression, anxiety, Obsessive Compulsive Disorder, substance abuse or eating disorders; after in depth questioning by a clinician BDD is diagnosed.

A healthy body image is about feeling good in your own skin.

Dr Qaiser Javed

One man assessed by Dr Javed was so obsessed with the shape of his genitals that he talked about buying surgical instruments off the internet to carry out surgery on himself. The man was admitted to a mental health hospital for treatment. Risk factors for BDD include genetic predisposition (if a family member has it), childhood adversity, poor peer relationships, physical and sexual abuse.


The producers of Love Island think this slim woman counts as their new token ‘plus size’ contestant. Are they drunk? Jameela Jamil




“If you’re bullied or teased at school about your appearance. Or if you’re a perfectionist or have an anxious temperament, or even if you don’t like the colour of your skin. All these factors could put you at high risk,” says Dr Javed, who works for the 24 hour mental health service based in Aintree University Hospital’s A&E department. If BDD is diagnosed early it can be controlled with cognitive behavioural therapy (CBT), or if it’s more severe, with a combination of CBT and anti-depressants. Medical intervention helped one of Dr Javed’s patients, a young woman in her 20s who believed that she had a deformed nose. It was impacting her ability to function at work and socially as she was constantly gazing in the mirror and spending hours trying to hide her nose with make up. She was referred to the mental health team after pursuing cosmetic surgery. Says Dr Javed:“I did not consider her nose to be too big or deformed, but she was constantly seeking reassurance. We treated her for depression and she responded well.

She agreed to seek help from the mental health team rather than a plastic surgeon.”

• Preoccupation with physical appearance, similar to anorexia nervosa and bulimia

Indeed, those who do seek plastic surgery and are suffering with undiagnosed BDD are rarely happy with the results and the condition can be made worse the longer it is left untreated.

• Belief that you have an abnormality or defect in appearance that makes you ugly

If BDD is diagnosed early it can be controlled with cognitive behavioural therapy. So if you’re obsessing about your appearance and it’s causing you to withdraw from society, seek the help of a mental health expert, not a plastic surgeon.

• Frequently looking in the mirror or avoiding mirrors • Believing that others take special notice of your appearance in a negative way • Frequent cosmetic procedures with little satisfaction • Excessive grooming, such as hair plucking • Feeling extremely self conscious • Refusing to appear in pictures • Skin picking • Comparing appearance with that of others

• For more information on the issues in this feature go to nhs.uk

• Avoiding social situations

• If you or someone you know is affected by the issues in this feature contact your GP for help.

• Wearing excessive make up or clothing to camouflage perceived flaws.




BACK TO THE FUTURE Futuristic tech helping mental health patients to ‘open up’


hat advice would you give your younger self? It’s a question people often ask themselves when experiencing guilt or remorse about past experiences. But what if there was a way to revisit that younger person, relive that bad experience and rewrite history to escape a lifetime of regret – or more damaging consequences?

“The programme resembles a 3D video game which allows the user to create a cyber alter ego of themselves and other characters. Avatars can express internal thoughts on screen and be put into a posture to convey defensiveness, anger or excitement. Props are available to create scenarios and build up a picture of past events.”

It all sounds very Matrix like, but psychologists at Mersey Care’s secure hospitals for people who have committed serious offences as a result of mental health issues, are using a pioneering therapy to help patients who struggle to open up about a traumatic past.

Principal clinical psychologist Elisabeth Hansen says results have been astounding. “We knew it was something special when Jules Carlisle our senior psychologist came back from a technology event excited at its potential for our patients.”

Avatar therapy involves patients designing and interacting with an avatar of themselves on a computer.

She explains why it’s valuable: “When something bad happens we process our feelings. But many of the people we care for have endured such terrible traumas that they cut themselves off mentally from painful emotions.

Mersey Care uses a programme developed by Oxford based company ProReal. The approach is part of a wider Global Digital Exemplar – the Trust is among only a handful of NHS organisations chosen to lead technical advancements to improve patient care. GDE project manager, Richie Harkness, who helped Mersey Care clinicians to use the ProReal software explains:


“Traditional therapies help people revisit their past, explore how they feel now and discuss how they want the future to look. But they can feel one dimensional. Through the avatar the person creates a 3D world on screen that they can control. They can channel their emotions through the avatar – if they express anger the avatar

clenches its fists, showing them what their angry behaviour looks like to someone else. They can introduce symbols to represent their hopes and fears. Clinical psychologist Greta McGonagle agrees: “It allows patients to think about how it feels to move away from situations. They become less inhibited… it gives them that permission to open up.” Patients say it gives them a vision of their future. One man with paranoid schizophrenia and in secure hospitals for seven years, struggles to develop relationships. He said: “I like putting my family close to me on screen, realising how valuable people are to me and how much I miss them.” Another said:“I feel elated afterwards, so fresh. I lie down afterwards because I don’t want to disturb the thoughts it gives me.” Careful supervision is needed, says Dr Hansen, as long buried emotions rise to the fore. “Such a visual way of reflecting, sometimes for the first time, can be unsettling. But when a picture of what your future could be like is there in full colour in front of you it becomes exciting. Patients can see what they need to do, they start setting goals. There’s a sense of hope – some people have never felt that before.”


FELT VERY REAL Reporter Jackie Rankin enters a world of castles, hills and scary thoughts…


’d been prepped for my ProReal taster. Or at least that’s what I thought. Dr Elisabeth Hansen would take me through a scenario in my life and we’d use avatars to recreate it. To protect the innocent I won’t go into detail about the issue, but if I’m honest, I was clutching at straws to find something that could evoke such emotions as to make the experience as meaningful as was needed for the purposes of authentic reporting. What I hadn’t appreciated was how engrossing it all becomes once your ‘world’ is a scenic landscape, lush rolling hills and castles. And the impact of looking at your inner self in widescreen.

I hadn’t planned for the slight shock when thoughts present themselves on the screen (you’ve created them yet it’s still unsettling); and when your avatar is placing itself on the edge of a river (again self imposed) preparing to swim away from a source of confrontation. I tell Elisabeth my fear. She invites me to look at the props. I choose to drag a key onto the screen. I’m not even sure I want to share my thoughts with her. I feel tearful. She supports me through the moment. It’s a taster so we stop there. I press delete. The landscape, the avatar, the thoughts are all gone – but not from my head. I’m still thinking about it, even now…” Dr Elisabeth Hansen.

• Watch the Avatar film on Youtube – search ‘ProReal in health and wellbeing’.





‘APPY WITH ORCHA Comparison website rates best and worst in digital health tech.


moking cessation – there’s an app for that. Healthy eating – there are lots of apps for that.

Mindfulness, meditation, stress busting, alcohol awareness, yes, you’ve got it, they all have apps, dozens of them. In fact so many of them, it’s difficult to know which one to choose, or more importantly, which ones are fit for purpose. Despite four million health apps being downloaded every day, with more than 325,000 to choose from, it’s hard for the best apps to be spotted by consumers, health professionals or national health bodies.

It’s hard for the best apps to be spotted by consumers, health professionals or national health bodies. Enter Orcha, (Organisation for the Review of Care and Health Apps – merseycare.orcha.co.uk) which is working with Mersey Care as part of the Global Digital Exemplar (GDE) programme to get more people using, and more importantly, trusting great digital health products and services. According to Richie Harkness, the Trust’s GDE project manager, anyone with programming skills can create a health app. Therein lies the problem as some apps can be as unreliable as searching symptoms online and drawing the wrong conclusions. “Whilst app stores have reviews, anybody can write one, or even be paid to write one,” warns Richie.“Orcha realised that there was no real gauge as to whether the apps were safe or useful, so they formed a review team of clinicians and software experts who came up with stringent testing criteria.”

Mersey Care’s Orcha website allows clinicians and service users to search for an app, via subject or name. All apps are scored for clinical assurance, data security and user experience. Orcha is the only reviewer for the NHS apps library and uses a combination of manual and automated assessment processes to scour mobile app marketplaces for applications that can be safely used within clinical settings.

Ben Towell

“But there are so many apps out there for all sorts of conditions and it’s been difficult to know what to recommend or if they’re even reliable. Orcha for Mersey Care has given me the confidence of a professional to prescribe our apps to service users and they’re being very well received.” Health and wellbeing manager Ben Towell (pictured) says Orcha is proving popular with Mersey Care staff. “There is increasing pressure on staff and getting that work life balance is very important particularly for people working in mental health. Orcha is helping people to be accountable for their own health and wellbeing by selecting the best apps for their needs. “We do a lot for our staff in terms of counselling and occupational health and support, but this is a great way to help them look after themselves.

Community physical health nurse Linda Lubertino says Orcha has given her the confidence to prescribe certain apps to patients knowing that they’re the best available.

According to Ben, the most popular apps with staff focus on mindfulness, relaxation, meditation, sleep and anxiety issues.

She says:“I see a lot of patients in the clinic for routine health checks and I give them a leaflet and then see them littered all over the place outside. People just aren’t interested in seeing leaflets any more, but they are interested in mobile technology.

“We are creating a lot of national noise saying it’s good to talk, but there isn’t always the provision of people to speak to, so sometimes you have to interact with technology instead. All these apps can help guide and prompt you to look after yourself properly.

Orcha has given me the confidence to prescribe certain apps to patients knowing that they’re the best available.

“We’re looking after other people but we need to be looking after ourselves first. It’s the oxygen mask on a flight analogy, you must put on your own before you can help anyone with theirs.” And ‘appen, there’s an app for that. View apps at merseycare.orcha.co.uk




DOODLE DO YOU GOOD? It seems painting, piano playing and poetry help you face up to life. We look at the research and meet the people who have found joy in creativity.



BBC survey of 50,000 people has found being ‘hands on’ creative has a genuine impact on our mood and wellbeing. Even better news is you don’t have to be good at it – it’s the taking part that counts. And you only have to do it for a brief spell to see the effects. The Great British Creativity Test, the largest ever study of its kind showed creativity as a distraction tool to avoid stress, contemplate and reassess problems in our lives, and face challenges. At The Life Rooms centres for wellbeing on Merseyside, a social model of health means you can do a different creative activity every day, ranging from arts and craft to ukulele for beginners (instruments provided).

The research agrees. While regular engagement has a cumulative effect even a single session of creativity has an impact. Interaction with other people evokes the strongest emotions, more so than virtual creative experiences. Berenice is not surprised.“People might come in with the idea that they can’t draw, sing, play an instrument. Maybe they’ve never tried. But none of that matters. The joy comes from the feeling that, in that session, in that moment, you’ve done something positive. That’s what matters.”

TEST... 12

• Painting, drawing, printmaking or sculpture • Gardening • Reading novels, stories, poetry or plays • Playing a musical instrument • Cookery or baking • Crafts such as knitting and embroidery • Creative writing • Dancing

Find out more about The Life Rooms activities at: merseycare.nhs.uk

Arts and Wellbeing programme support manager Berenice Gibson says: “The benefits are on so many levels, but what strikes me is the sense of being uplifted that so many people say they feel at the first session.”


• Singing

The Great British Creativity Test findings are being used to help people identify which of the three coping mechanisms they use and this year, as part of the Get Creative Festival 2019, you can take the Feel Good Test. You’ll get personalised advice on how to get the health benefits. bbc.co.uk

• Photography. The BBC research shows that creativity can be used as: • A distraction tool – using creativity to avoid stress • A contemplation tool – using creativity to give us the mind space to reassess problems in our lives and make plans • A means of self development to face challenges by building up self-esteem and confidence.

Source: BBC




Poet Pauline Rowe is what most of us would call ‘well read’ (she has a Masters in Creative Arts and a PhD in Creative Writing).*


ut it’s her own life experiences, including living with depression for most of her adult life, that allows for empathy and understanding in her often powerful workshops with people who had never thought of themselves as bards.

the language they use. If it’s something they can relate to, it’ll be meaningful for them. My teenage son listens to hip hop and rap music. I don’t always get the language but I can still listen. If it resonates strongly with young people then that’s their poetry.”

“We’re all poets, it’s rooted in all of us – words are our deepest human currency. People think it has to be on some higher level, or it has to rhyme, but poetry can be a letter, or a song. It can be a sentiment on a card, a word game, or a journal – they’re all types of poetry.

Pauline is modest about her own achievements, but the mother of six who started out studying law was first published as a teenager.

How does she inspire confidence?“It’s about listening to the person, recognising what’s at the heart of their thoughts and

Isn’t there a bit of ‘them and us’, a snobbery among poets?“Maybe, but there are also many groups where the focus is on being listened to, making friends, building up relationships and sharing experiences. To see people listening to others and being kind to each other is humanity at its most vulnerable.”

One of Pauline’s most memorable workshops was with men at Ashworth high secure hospital. “We used well known song lyrics that everyone would know. As the session developed a few men began singing the lyrics out loud, then more joined in… soon we were all singing. These very vulnerable men were unwell – yet simply singing gave them a sense of joy. It was incredibly powerful to be there with them hearing the Beatles song ‘In My Life’, you couldn’t fail to be moved.”

We’re all poets, it’s rooted in all of us.

* Pauline was awarded a John Lennon Memorial scholarship from Liverpool University






ill was a trawler man. When he left through ill health he ‘did what all sailors do’, he headed for a bar. Forty years later the man who moved to Southport ‘to be near the sea’ is using art for recovery. That said he’s pretty good and inspires members of his therapeutic art group, which debates as well as creates art. “Leaving the sea was like being bereaved, I had to have counselling. I walked past The Life Rooms, called in and I’ve been coming here ever since. I’ve always loved art. Being


able to share that with other people and see your work displayed is important.” Linda agrees. After 10 years in rehabilitation for addictions from a traumatic childhood, she comes to the sessions ‘come hell or high water’. She finds it difficult to talk about the details but says the group makes her feel safe. “I’ve tried every therapy but this keeps me focused. I feel the same freedom I felt when I was at school and art was my passion.”

I’ve tried every therapy but this keeps me focused.



Jim is a natural poet. He’s funny and self deprecating. ‘Oh yes those’ he grins when mention is made of the poems in Yarraagh – his published book of verse. ‘A couple aren’t too bad’.

My poems affiliate to my life… I’m the boy on the beach. I don’t go out any more, but I’m content.


e’s intuitively poetic, even when describing how he’s accepted his terminal diagnosis of lung cancer.

Although Jim did well academically and harboured a subconscious desire to be a writer, he followed his mates into the building trade. Even back then he loved reading classics, cherishing the only books he owned, a hardback collection of Dickens novels. ”I had always had literary ideas in my head; I’d jot down ideas but then do nothing with them.” Years later, a recovering alcoholic with a broken marriage, Jim picked up a leaflet for North End Writers group workshops. He was confronted with words he couldn’t understand let alone compete with – yet he kept going back. Poet Pauline (Rowe) encouraged me and someone at the group gave me a book of poems. I’d come home at night and start writing. I felt a strong sense of ‘this is what I ought to be doing’. When I wrote it was as if I was just the medium”. He chuckles at his lyrical description. “That sounded a bit flash didn’t it?” When Jim became ill, Pauline supported him to publish his eclectic collection. Many of the poems are reflective of good times – childhood beach outings – others regretful of his choices. My poems affiliate to my life… I’m the boy on the beach. I don’t go out any more, but I’m content.” SAVE THE DATE: This year’s national poetry day is Thursday 3 October. Everyone is invited to join in, whether by organising events, displays, competitions or by simply posting favourite lines of poetry on social media using #nationalpoetryday nationalpoetryday.co.uk






ersey Care service user Tim Williams’ intricate woodcarvings have helped keep him mentally positive .“I’ve been really unwell in the past and the carving became the thing that would make me get up in the morning. I’d go into my dad’s shed and use any old piece of wood and tools I could find to create

the form I wanted. Getting a piece right has become my goal. It’s so fulfilling when someone is happy with something I’ve made. I’d encourage anyone to have a go at something they enjoy; it has a big impact on how you feel. It’s exhilarating, it makes you come alive.”

It’s so fulfilling when someone is happy with something I’ve made.


DO IT Spontaneous creativity can be great fun. Try these: • Pick a song and write or sing it with new lyrics • Take a pad and pen outside and draw something you see. Look at clouds and imagine them as things like you did as a kid


• Buy some modelling clay and spend ten minutes making a sculpture (why should kids have all the fun?) •

Make a Lego model of your dream house

Are you feeling better? Sign up for a class or course near you. Your local authority or arts centre will have details.

JOIN A CLASS OR A COURSE Liverpool brings together services under: Thelivewelldirectory.com The Life Rooms has three centres with activities every week day: merseycare.nhs.uk


A TASTE OF CYPRUS NHS patient safety officer Christiana Vasiliou has fond memories of this dish from her home in a tiny Cypriot village. “Kleftiko means ‘stolen’. It’s served at special occasions such as weddings. I love cooking it for friends and family, not only because it’s ridiculously delicious, but because it’s easy and it cooks slowly so doesn’t take me away from guests!”


INGREDIENTS: 2kg lamb with bones 6 to 8 large potatoes (small potatoes will dissolve) 1 to 2 tsps cumin 2 to 3 bay leaves (optional) 1 tsp black pepper Pinch of salt

METHOD: 1. Cut the lamb into large chunks and wash under cold water. Without straining too much, transfer to a large bowl. 2. Peel and half the potatoes and add to the bowl. 3. Add the cumin, bay leaves, pepper and salt and mix with your hands. 4. Transfer everything in a deep oven pot, making sure you seal well with aluminium before you close the lid. (I use a deep clay oven pot but any oven pot will do). You don’t need to add any more water. The water from washing the meat and the moisture of the potatoes will do. 5. Slow cook at 150 degrees for 5 to 6 hours. 6. Serve with Greek salad and yoghurt.



MY MONSTER AND ME I might seem happy, relaxed, but that’s not how I feel – the worry, the panic, is always there…Nadiya Hussein.


re you constantly on edge? Do you struggle to relax – or even remember the last time you did? Do you spend your life pretending everything’s


You’re not alone. A quarter of us will suffer with anxiety at some point – and it’s often not detected. We look at the lives affected and talk to an expert about ways to combat this debilitating disorder. Anxiety is not uncommon, nor is it selective about who it affects. TV celebrity Nadiya Hussein appears to be living the dream since winning Bake Off in 2015. Yet she goes to great lengths to hide the anxiety and panic attacks she’s suffered since childhood. In the BBC documentary ‘Anxiety and Me’, she shared her journey through her first course of cognitive


behavioural therapy (CBT), hoping to find an escape from what she calls ‘my monster’. She revealed: “I worry about the most ridiculous things …I can feel my heart beating in my chest then it goes up to my head, I have a panic attack and feel like I’m going to die…it’s screaming and shouting at me.” Therapist Danielle Burns runs a CBT based psychological wellbeing course for Talk Liverpool talking therapies service. Many of her clients are equally desperate to find a way to stop the feelings which dominate their life. “It’s very distressing but once you find ways to cope you can manage situations as they arise. The course teaches that and you can practice at home. The results can be impressive.”




I worry about the most ridiculous things.


In the documentary Nadiya talks candidly to her sisters about feeling anxious as a child.

HOW DOES ANXIETY DEVELOP? “It’s when the normal worrying that we all experience becomes excessive,” says therapist Danielle Burns. You begin to over think things; every situation becomes worse case scenario. As soon as one anxious thought is resolved, another may appear about a different issue – it’s invasive. “You go to bed tense and on edge, your sleep suffers – and you worry about that. It becomes overwhelming.” Nadiya ended the programme saying she had a long way to go but her CBT had given her hope. Danielle sees the impact on clients. ”Anxiety is often about situations that haven’t happened – we call them hypothetical worries. The person has the same fight or flight feelings as they would if it was real – they still feel as if they’re going to have a heart attack or worse still die. We support them to feel the uncertainty, to imagine


the situation even if it causes them to be anxious, so they can learn to tolerate that level of anxiety and come through it.” Among Nadiya’s anxieties was facing her audience – in the past she would take off her glasses so everything was blurred, but the programme showed her putting them on before a 2,000 strong crowd, to thunderous applause. Danielle’s clients are encouraged to try different approaches then review what works. “Worry is behaviour; it’s a symptom of anxiety. It takes time and managing it is a skill we have to learn. It might be focusing for 30 minutes on the worry so it’s been and gone; or by changing your focus and doing something different. It’s whatever works for you.”

• restlessness • a sense of dread • feeling constantly “on edge” • difficulty concentrating • irritability.

PHYSICAL SYMPTOMS INCLUDE: • dizziness • tiredness • a noticeably strong, fast or irregular heartbeat • muscle aches and tension • trembling or shaking • dry mouth • excessive sweating • shortness of breath • stomach ache • feeling sick.



Support for you

If you are affected by any of the symptoms here speak to your GP for referral to a talking therapies service near you.

Nadiya’s new six part TV series Time To Eat starts Monday 15 July 2019 on BBC 2.

• our self help guides may be helpful for you or someone you know or care for merseycare.nhs.uk



Mo Hammond has suffered with mild to moderate depression and anxiety for over 30 years. “I stopped socialising, I couldn’t remember the last time I felt happy.


y family are supportive and medication helps me function but I was constantly feeling low and often tearful. When my GP told me about the course, I was sceptical – I thought it was just a means of getting people off the waiting list! At first I thought ‘what have I got myself into?’ But as it went on I began to feel it was really helping. I like how it was structured, you weren’t pressurised to contribute in sessions, but you could if you wanted to. It was reassuring being with people in the same situation. The focus was on things I could change rather than on the past, and how even small changes could make a difference to how I felt.

We were encouraged to make small challenges for ourselves after each session – one of mine was to join a running group. My GP had suggested one he was setting up to help his patients with their physical and mental wellbeing. I decided to take the challenge and, to my surprise I actually enjoyed it! Without the course, I would never have had the confidence to do that. Some of the other challenges didn’t work out, but the course has given me the tools to be able to cope when things don’t go as planned. I’m so grateful to Danielle and the Talk Liverpool team and to Dr Lee and the running group. I can’t say I am cured from depression, but I have made a start on the road to recovery.”

Feeling anxious? Talk to us

Dr Lee and Mo with the running group.

It was reassuring being with people in the same situation.

If you’re feeling overwhelmed, anxious, or stressed our Skills for Wellbeing course could help.

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





Mind over matter plays a big part in managing pain


our years ago American stand-up comic Nicole Arbour was contemplating taking her life because the constant excruciating pain she lived with was intolerable. An ex dancer and cheerleader, Nicole had been rendered disabled after a traffic accident crushed nerves in her spine. She spent most of her 20s in bed, in agony and contemplated suicide to stop the pain. But emotional videos of her distress resonated with the public, attracting 700 million views. Internet fame helped Nicole switch her mind set to positive. After therapies, nerve block injections and medicinal marijuana, she fought her way back and was made an honorary star on the Hollywood Walk of Fame for “Special Achievement in Social Media.”

It’s not time to give up; it’s time to get up. “As a cheerleader we were always taught if you fall on your face, you pick yourself up and finish the routine. I had Denzel Washington saying in my head ‘it’s not time to give up; it’s time to get up’. I decided to become my own cheerleader and cheer for myself.”


Changing the way we think about a distressing condition can help us cope with it, according to Marcia Alldis, cognitive behavioural therapist with Talk Liverpool talking therapies service. Marcia sees first hand the physical and psychological impact of chronic pain. Many of her clients live with anxiety and depression as a result of a physical condition. CBT is the nationally recommended treatment. “A woman living with fibromyalgia or chronic fatigue may have headaches, IBS, dizziness, vertigo, poor memory. She may have lost her job, be unable to do household chores. She may feel reliant on other people, or that she’s failing as a parent. It’s easy to see how she can become anxious or depressed.” Talk Liverpool runs courses to support people suffering with chronic pain to help improve low mood, relieve stress and anxiety, and to give people coping strategies. Marcia explains: “We help the person set realistic goals, help them develop a structure to their day, and offer strategies to help them sleep and relax, to deal with their worry and solve problems as they arise. Being with other people for the sessions helps them realise they’re not on their own.”

Nicole was inspired by Denzel Washington’s motivational words.

Nicole Arbour

We help the person set realistic goals and offer strategies to help them sleep and relax. Evidence says that CBT can complement other treatments such as physiotherapy for chronic pain management. Specialist community physiotherapist Gie Peneche’s patients range from those with orthopaedic, musculoskeletal and neurological conditions, to those needing palliative care. Contrary to popular opinion, chronic pain isn’t just for the elderly – one of Gie’s patients is just 30. Graded exercise therapy with a trained physiotherapist is very effective, she says. But people are often reluctant to take part. “Our challenge is to help them change their psychological state – to alter their mind set. People think it’s going to hurt or they don’t have the energy, so we keep going till we find a way that works for them.” It seems mind over matter can have a huge impact, when it comes to managing pain.



Pain management consultant Dr Nick Fraser says the medical profession is adopting a more holistic approach in an effort to reduce the long term use of medications such as opioids, Gabapentin and Pregabalin in persistent non cancer pain.


r Fraser, who is based at the Macclesfield Community Pain Service, recommends an opioid awareness leaflet produced by the Faculty of Pain Medicine to help patients understand more about how to safely use medication in persistent pain. (www.rcoa.ac.uk/faculty-of-painmedicine/patient-information). He says: “Pain doctors are trying to demedicalise the management of long term pain. A lot of people think it is a medical condition that needs ongoing drug treatment, but pain is often caused by permanent changes to the central nervous system and drugs won’t fix this. “Most pain medicines stop working quickly and the pain returns, so patients get stuck on the drugs and the doses increase, which can make them physically and mentally ill. We actually think opioids only work for a very small group of people long term.

“All of us experience pain at some point. Initially it needs investigating and may lead to treatment such as surgery, but a few unfortunately won’t recover and may stay in pain long term.” Dr Fraser says the answer lies in helping these patients to change their mindset. “Pain affects us psychologically. It can cause low mood, anxiety, and depression, which can massively increase the burden of pain. Pain management programmes can educate people about their condition, how it affects them, and how to better adapt and cope with long term pain. “We teach patients to use their pain medication safely and more effectively, by finding out what works when and what doesn’t. We encourage paced exercise, mindfulness, engaging with friends and family and becoming more self-efficacious. It’s an effective, evidenced based holistic approach that improves peoples’ lives.’’

• Your GP can advise on talking therapies. Talk Liverpool is a talking therapies service for people with a Liverpool GP. You can be referred by your GP or another health professional. You can also self refer. Call: 0151 228 2300 Visit: talkliverpool.nhs.uk

Do you have chronic pain? Talk to us If your pain is causing you to feel overwhelmed, anxious, or stressed our Skills for Wellbeing course could help.

For more information call: 0151 228 2300 or go online at: talkliverpool.nhs.uk 23





Words: Charlotte Hadfield Illustrations: Ella Byworth

Why – in a world where it seems nothing is taboo are teenagers scared to talk openly about the thing that worries them most – sex.

The stigma surrounding sexual health starts from a young age because of lack of confidence and self esteem.


oung people talk about sex in general but they struggle to talk openly about their own personal experiences says Karen Hampson, coordinator with Mersey Care’s So To Speak sexual health service. “They get involved with conversations without having factual information and are happy to just take on what their friends are saying and that is not always right.” There’s also a huge stigma around having a sexually transmitted infection (STI). New Department of Health figures reveal a 22 per cent decline in the number of young people aged 15 to 24 getting tested for chlamydia over the last five years.

Some choose to take risks over protection or saying no. “Even though sexual health education covers the different types of infections and the risks some young people still choose to take sexual risks, over using protection – or saying no.” “The stigma surrounding sexual health starts from a young age because of lack of confidence and self esteem. I’ve worked with young adults who are still too embarrassed to go for cervical screening. Body awareness and personal hygiene for the genital area is vital education needed from a young age, says Karen. “Young girls are causing infections and irritations by washing their genital area with perfumed soaps because they think they’re dirty.”

Yet finding accurate, easy to understand information, and local services, is not always straightforward. Young people are fearful of friends seeing them searching for sexual health advice on apps or mobiles. Karen delivers sessions in schools, colleges and universities and to children from vulnerable backgrounds living in care homes and hostels. She believes there’s a need for the focus to shift from the ‘end result’ – a pregnancy or an STI – to wider sexual health knowledge, confidence and self esteem. “If someone doesn’t learn about feelings and emotions, and what makes a healthy relationship, they won’t develop the confidence to talk with a partner about using a condom, or they’ll be afraid to ask for contraception for fear of being judged. She says early advice is crucial.“In schools healthy relationships are not addressed until year 9 (age 13 and 14) but from our experience young people need to know early on how to form relationships; and what to do – or not do – when you’re in one. “We’re very up front at our sessions, but participants know it’s confidential. Their readiness to learn shows – within five minutes they’re completely engaged and asking questions. “I get them talking about themselves in a positive way and identifying their strengths. Often their issues are more about not believing in themselves and wanting to fit in with everybody else. Or they may already be in an unhealthy relationship but aren’t able to recognise the warning signs. “I’ve had young girls saying ‘I love it when people are possessive with me because you feel dead wanted and needed’. That’s a

It’s all about being honest and saying it as it is. warning to me that there are issues around confidence and self esteem that need to be addressed. We’d use a card game with them to spell out the dangers of being in a possessive relationship.” “It’s all about being honest and saying it as it is. It’s great to have feedback afterwards where what we’ve done has had an impact. Where a child has opened up, or a young person has been empowered to leave a partner who had pressured them to do things that made them feel uncomfortable. We offer chlamydia testing and condoms afterwards – there’s always a large proportion of the group staying for that.” Karen’s convinced that in spite of social media and television programmes that bare all, young people are still shy and naive. “It’s up to us to equip them with what they need to have healthy relationships throughout their lives.”

MORE INFORMATION The C-Card/R U READY initiative provides young people in Liverpool with access to free condoms, sexual health information and advice at young people friendly sites: merseycare.nhs.uk search ‘C Card’. So To Speak accepts referrals from professionals who work with young people: 0151 247 6500






It’s 8.30am on a sunny Monday morning. The waiting room at South Liverpool Walk-In-Centre is already filling up. Many are returning for wound dressings. It’s busy but calm. The previous week had seen ten whiplash cases – and two victims of knife attacks.


atalie Davies heads the team. You’d think her years in high dependency care units and surgical wards would prepare her for extreme events. But, she says, nothing can quite prepare you for a young person coming in with a stab wound.

Behind the swing doors at Garston nurses are ready in their treatment rooms. They can’t anticipate what the day will bring, but experience and skill sets them up well. Even as the doors swing constantly and the patients start to flow through there’s a calmness.

“You don’t know how deep the wound is, how much time you have or the circumstances. You just have to go with your judgement. This isn’t what we’re set up for but we’d never turn anyone away.” The young patient reluctantly agreed to go to hospital. An ambulance was called. The team carried on. People wanted their turn – life goes on.

THEY SAVED MY LIFE Today’s first patient is Rachel who has cut herself cooking. She says a previous visit to a Walk-In-Centre saved her life. “I felt unwell and my lower leg was aching. I thought they’d say it was a virus. I was transferred to Old Swan Walk-In-Centre which has point of care testing facilities and they diagnosed a suspected blood clot. A few hours more and it could have killed me.” The South Liverpool Centre in Garston is one of four, including Smithdown where children’s advanced nurse practitioners offer services solely for children.

Nothing can quite prepare you for a young person coming in with a knife wound. 27




randmother Louise Maxwell arrives holding up a floppy finger – it was clearly damaged but she’d come to the Walk-In-Centre because she knew she’d be bottom of the list at A&E. “I love this place; it’s so clean and efficient. But I know when I should come here, I wouldn’t come if I was sick, I’d go to my GP, or with a broken bone. It’s common sense.” Louise was x-rayed – there was no fracture. A ruptured tendon was diagnosed and a mallet splint applied, she left within the hour. In the past week the team has dealt with three cases of sepsis – when an infection gets into the bloodstream – and performed resuscitation on a man who had a cardiac arrest within the treatment centre. Natalie is concerned that as ambulance services come under more pressure critically ill people are presenting at the Walk-InCentre. “Some say they don’t want to bother the GP or go to hospital so they come to us – we see around 120 people every day. Probably half should really be going to their GP or to A&E.”



MENTAL WOUNDS It’s hard to believe bullying would bring someone to a Walk-In-Centre. But Natalie says many young women who come in with cuts reveal they have self harmed. “They talk about suicidal thoughts, about bullying and social media targeting. We’ll treat the physical wounds then refer them to the mental heath teams.” Often people will come in simply looking for reassurance that what they have can be managed at home. Natalie: “Insect bites is a perfect example. Redness with no other symptoms may be just a normal stage of inflammatory process. But people think the bite is infected. We give advice and reassurance but it’s something they can care for themselves.“ The team no longer prescribes over the counter painkillers, instead referring people to the Care at the Chemist scheme. Neither do they do routine blood tests, or write sick notes – ‘yes we do get requests for those – I wish I was a doctor!’ laughs Natalie.

Services include suturing, dressing reviews, treatments for minor ailments and illness - and they prescribe the morning after pill. Sadly it’s used all too often as contraception but that offers the team a chance to flag up risk of sexually transmitted infections and signpost people to sexual health services. Chlamydia screening is offered to under 25s. They also offer lower limb x-rays (carried out by radiographers from Royal Liverpool and Broadgreen hospitals) but not chest, abdomen, shoulder and knee. Natalie’s predecessor Anne Twist says public expectation is much higher two decades on from the first wave of services in primary care treatment centres. “We’d have a handful of patients and people expected to see a doctor. Now their expectations of us as nurses are much higher. But it’s very rewarding; you get a lot of thanks.”




t’s mid morning, there’s been a steady flow of patients. Mum of three Launa hobbles in with a swollen foot after tripping over her son’s toy train track. It’s kept her awake all night. She’s trying to smile but she’s clearly in pain. An x-ray confirms the view that there’s no fracture and less than two hours later Launa leaves sporting an elastic bandage and instructions to take medication to reduce the swelling. She’s still grimacing but happy at both the result and the speed of treatment. “That was really quick, I’d have been in A&E for hours.”

WE’RE LIKE A FAMILY It’s lunchtime – staff have a rare chance to sit together and enjoy banter. “We’re a dynamic team, we work together well and

complement each other. We do a lot of reflection and we have some really good team players. We’re like a family” says Natalie. As Walk-In-Centres prepare to offer enhanced services next year a public consultation will ask people what they want. For the people who visited today it’s feeling secure, being treated quickly by expert staff so they can go back to their lives.

LIVERPOOL WALK-IN-CENTRES are open 8am to 8pm seven days a week. The service is self referral. No appointment is necessary. However, the department can become busy and you may be signposted to another service. You can also contact the NHS on 111; 24 hours a day, 365 days a year for any medical help which is needed fast, but is not a 999 emergency. Calls are free from landlines and mobile phones. The team of qualified healthcare professionals at your local pharmacy can offer clinical advice to safely and effectively manage minor health concerns.




WHAT YOU NEED TO KNOW Children’s nurse Tanya Downes tells why it’s important to immunise – and gives the facts.

MC: Why do we need to vaccinate? TD: All diseases that are on the vaccination schedule can cause serious complications.

MC: Surely diphtheria and polio are diseases of the past? TD: They were eradicated in the UK because of mass immunisation and vaccination – but they’re still prevalent in other countries and people die or are affected for life. As we travel further afield the chances of them returning increase.


MC: Isn’t it a personal choice? TD: It is, and I’d always advise parents or carers to speak to a health professional to get the full facts then decide what’s best for them. When a child contracts a disease because they haven’t been immunised parents are sometimes unaware of what the disease is and the possible complications. We want people to have the information and know the risks of not immunising before they make their choice.

MC: One child doesn’t make a difference – does it? TD: For us all to be protected we need what’s known as herd immunity. If fewer people choose to immunise that disappears. So every child that is vaccinated gives protection to their families and communities too.

FEATURE MC: Why are some people choosing not to vaccinate? TD: It’s often based on second hand information from friends, or on social media. The MMR (measles, mumps and rubella) vaccination study by Andrew Wakefield, which linked the vaccine to autism, impacted greatly on its uptake, yet was proved false by hundreds of subsequent research studies.

MC: What’s the most common immunisation concern? TD: For most people it’s the MMR, because of the publicity. The result is that there are more and more cases of measles with all the complications that brings.

MC: Are we at crisis point?


TD: Not at the moment, but we could be if people stop having vaccines.

Measles is a highly infectious viral disease. In some cases it can lead to serious complications such as pneumonia and encephalitis.

MC: What advice would you give to parents or carers either way?

Those most at risk include: • babies under one year old

TD: I’d say:

• children with a poor diet

• before you decide to immunise, or not, find out as much as you can about the immunisation, the diseases it protects against and their effects and all the risks

• children with a weakened immune system (such as those with leukaemia)

• use a reliable source such as the NHS website for an overview. nhs.uk


• talk to your midwife, health visitor or practice nurse, who will direct you to more in depth information and research.

• Teenagers and adults

If 95 per cent of a community is immunised incidences of infections reduce. This protects those who aren’t able to be vaccinated and are therefore vulnerable. Sources: nhs.uk and england.nhs.uk

For us all to be protected we need what’s known as herd immunity.

Tanya Downes is an advanced children’s nurse practitioner for Mersey Care.



SECURE CARE YOUR PERFECT FIT It’s exciting to think you’re helping someone build a life again...


’m looking forward to working in the new medium secure unit Rowan View. It’ll give staff the chance to achieve things that haven’t been possible before and give patients the quality of life they deserve. There’ll be things like virtual reality headsets for people who can’t go outside, and touch screens in their rooms so they can stay connected with their families. Many of our patients have got to the point where they can’t see past the awful things that have happened to them. They may have resorted to violence or self harm as a coping strategy. It’s exciting to think that we’ve helped them to manage challenging feelings in other ways and start to build a life again… Eve Mousley Ward Manager Medium Secure Unit



Join us in secure nursing - we’re recruiting now Call: 0151 472 7557 or go to: jobs.merseycare.nhs.uk

I’m lucky to work with a fantastic team. I can understand why people might be apprehensive – I was myself until I came on a placement. That’s when the story changed for me. Now I say ‘don’t worry. You don’t start driving efficiently the day you pass your test and you’ll have vastly experienced people to help you’. Oladayo Bifarin Mental Health Nurse, Medium Secure Unit


No matter what happens I know I can talk to someone. I work with a great team, there’s a sense of security, no matter what happens I know I can talk to someone. It can be challenging, I might have a moan after a long day, but I always go home excited that I’m coming back tomorrow...” Kyle Gornell Nurse Associate Low Secure Unit

I go home with a sense of pride. My background is teaching but becoming a nurse is the best decision I ever made. I go home with a sense of pride, of having contributed to someone’s life in a meaningful way, and that brings me joy. We’re lucky to work somewhere peaceful, tranquil, with beautiful grounds, but it’s when you begin to explore the people and the culture that you’re really blown away. Chen Shoko Clinical and Nursing Improvement Lead Secure Services

I see people every step of the way. I see people every step of the way, from when they arrive to starting a life out in the community. It can be challenging, but I get to see where they were at the beginning and watch them developing relationships with their families, going to college, taking up volunteer roles. It’s because they’ve had the right support that they’ve been able to do it and I’m proud of the role I’ve played. John Morrison Deputy Manager Forensic Outreach Service








HEALTH CARE ASSISTANT, NORTH SEFTON COMMUNITY CARDIAC TEAM I visit people in heart failure who are housebound. Some are still young; their heart failure is often the result of other conditions.


hey need constant monitoring, so having someone to visit them at home to do routine checks and tests can keep them out of hospital and really improve their quality of life. I feel very lucky, I’m valued by my team, I couldn’t ask for more. I get a lot of satisfaction from getting to know my patients and trying to bring positivity and reassurance when they need it most. One lady makes me gammon soup every time I visit and had a guardian angel musical ornament made and sent all the way from Scotland! When I arrived at one very anxious patient’s house he was in the midst of a panic attack. I used what I’d learnt on an anxiety management course and explained how he could breathe his way through it. When I went back today he was relaxed and smiling. His wife said the advice had really made a difference. Another chap was saying very strange things today about spiders invading his house! I realised he was hallucinating and reported back to the team – it turned out his kidneys were not functioning properly. I was glad we’d reached him quickly and prevented things getting worse. My patients often compliment me on my phlebotomy skills – they say I can get blood out of a stone! The people I see are often very ill and will sometimes open up about their feelings. I feel privileged to be the person they talk to. It can be sad; you have to accept and try not to take it home, (I don’t always manage that), but I hope I also make them smile.





MATT COPPLE I lived life in the fast lane, a workaholic trying to fulfil my ambitions and my dad’s expectations. Then, one day, I crashed.


y wife and family saw it coming, but I wouldn’t listen. I wanted to be that perfect person, always delivering the goods. I refused to accept my limitations. Depression was followed by psychosis. My thoughts were dark, my actions were totally out of character. I know now it wasn’t me, it was my illness. I got help from Mersey Care. Recovery takes time and I wasn’t the most patient of people, but I eventually came out of hospital with new priorities. I re-proposed to my partner 20 years after I’d first proposed – she’s the love of my life and we’ve since remarried. However it wasn’t long before work tapped into my ambitious streak

once more. I was promoted, and within a year I’d crashed again. I REFLECT A LOT MORE… When I got a diagnosis of Bipolar Disorder everything began to make sense. I’d had a good childhood but my mum had bipolar disorder and I watched her break down. I thought it was my job to keep her safe – she wouldn’t admit she was ill but I knew all the signs. Looking back, I bottled it up and hid it through work. Through medication, therapies, mindfulness and the support of my family I’m able to reflect. I’m trying my hardest and I’m self aware. I thought I was a machine, but now I recognise I can only do so much.

I bottled it up and hid it through work. I’m bringing my experiences as a service user, a mental health ambassador, and my life experiences to my governor role. I still can’t control my energy – but now I’m channelling it into something that can influence change.

Matt and wife Jacqui remarried after 20 years together.



Because ONE life lost is ONE too many

Over the course of a year 5,821* people died by suicide in the UK, that’s nearly 16 people EVERY day. 20 minutes is all it takes.

Because ONE life lost is ONE too many

Save a life, take the training. Take the training at zerosuicidealliance.com Source Office for National Statistics (2018)


Contact details Got some news you’d like to share? Contact us at the following address.


Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, Merseyside L34 1PJ Telephone: 0151 473 0303 Email: communications@merseycare.nhs.uk


MC MAGAZINE is published by Mersey Care NHS Foundation Trust and produced by the communications team. MC MAGAZINE is available in other formats on request. Please pass on for others to read and recycle.

Profile for Mersey Care NHS Foundation Trust

MC Magazine - Summer 2019