PMHN Meeting – 16th July 2019, 9:30 pm @ William Sutton Memorial Hall

Agenda Item Brief Notes

Present Vicky Shipway (VS) (Chair), Stacy Matheson (SM) (Minute Taking), Annette Roberts (AR), Tracey White (TW), Emma Marlow (EM), Sarah Hill (SHI), Nick Pennell (NP), Rachel Marriott (RM), Lottie Ballinger (LB), Jane Waite (JW), Mike Freeman (MF), Claire Whiter (CW), Shawnie Lee (SL), Derrick Taylor (DTA), Carole Edwards (CE), Trevor Griffiths (TG), Marian Langsford (ML), Lucy Weaver (LW), Rose Taylor (RT), Hollie Cullen (HC), Si Parham (SP), Dot Throssell (DTH), Simon Hardwick (SHA)

1. Welcome/ Apologies

Apologies: Heather White, Jenny Barnicoat, Stuart Talmage

VS welcomed new and returning faces to the meeting.

Small introduction regarding the background to Plymouth Mental Health Network.

VS notified that the meeting will finish early due to venue commitments.

2. Matters Arising There were no matters arising. Previous Minutes were approved.

3. PART 1

Member Updates

Mike Freeman @ Improving Lives – Improving Lives run services to help people with physical and mental conditions. A new programme named ‘My Health, My Way’ will begin in September which is designed for over 18s who have a long-term health condition. Also involved in the ‘Active for All’ service which encourages people with mental and physical disabilities to get involved in regular activities in the community, such as walks, yoga and Boccia.

Jane Waite @ Plymouth Options – Offers a variety of services to people who are experiencing common mental health problems. They are accepting self-referrals and run a series of four-week courses to help to treat problems, such as stress, anxiety and depression. After the course concludes, there are a series of follow ups. Also available are free one-hour workshops which are designed to help improve the mental health and wellbeing of a person.

Lottie Ballinger @ Plymouth Options – Works alongside JW, but also deals with the more complex and longer-term aspects.

Dot Throssell @ Heads Count Steering Group – Co-producing on a project with Livewell South West at the moment. Head Space is running well. In regard to the triangle of care work, Plymouth University are looking to embed the process into the university. The video of DT talking about her experience with the justice system is now widely available to view and is being included in police training across multiple counties, such as Devon and Cornwall.

Nick Pennell @ Healthwatch Plymouth – Healthwatch Plymouth’s Annual Report has recently been released which includes the highlights

Plymouth Mental Health NetworkE: info@plymouthmhn.org W: http://www.plymouthmhn.org/

of the year and Healthwatch’s plans for next year. Alongside this, there is a focus on issues such as the improving the discharge flow through Derriford Hospital; encouraging engagement in the long-term plan for health services; and working with Livewell on their transition service. A network model similar to PMHN is potentially being introduced in York.

Rachel Marriott @ Mind – Lots of work being done on the PATH Project which involves perinatal mental health. The project aims to help prepare parents for parenthood pre-birth, while also helping healthcare professionals to address perinatal mental health more effectively. They are also looking to introduce focus groups into the discussion.

Sarah Hill @ Pregnancy Crisis Care – Helps women and their partners in all pregnancy crisis matters through support and counselling. Some of the areas they provide support for include loss, traumatic births and post-abortions. The service is accepting self-referrals and referrals from other sources.

Claire Whiter @ Insight Team – Insight work with over 18s who are possibly experiencing first episode psychosis. They work alongside care co-ordinators who can help those experiencing psychosis and make referrals elsewhere. It is a service open to all. Recently, they have put together a carer’s group to give advice and support to those caring for someone who is experiencing psychosis. There is also an aim to become more of a trauma service which is why attendance to this meeting is important.

Tracey Whiter @ Insight Team – As well as working alongside CW, TW works with adult survivors of sexual abuse which is also a self-referral service.

Annette Roberts @ SeAp – Is an Independent Mental Health Advocate and works with people who have been sectioned under the Mental Health Act to ensure they know why they have been detained and what their rights are. Furthermore, AR also does home visits and deals with health complaints.

Rose Taylor @ Routeways – Mental health lead. Has been working a lot with young people with Autism and other mental health issues, while also aiming to work with the parents of young children. Routeways are also running information services to help families with holiday opportunities during the school summer break.

Shawnie Lee @ Rethink – Working alongside Derrick and currently involved in a lot of one-to-ones in the community.

Derrick Taylor @ Rethink – Rethink is a short-term advice, care and support service. At the moment, Rethink are looking at ways to help clients know what to do after work with the client has ended.

Carole Edwards @ CASSplus – Independent charity who are working closely with the magistrates’ court. Due to the nature of working with offenders and victims, many can relate to mental health experiences and issues. CASSpluss have recently begun a new partnership with Harbour which has led to a Volunteer Coordinator being put in post to work with both services. This has led to time being spent to get the partnership running smoothly.

Trevor Griffiths @ Emotional Logic Centre – Have been working with a lot of schools lately. Emotional Logic offer lifelong services within

the family structure. Have been involved in a project known as ‘Safer Plymouth’ which will hold training workshops next Autumn to introduce how emotions overlap with each other and create new perspectives. Plymouth University have invited them to distribute information and give people a better idea of the services they can provide.

Marian Langsford @ Emotional Logic Centre – Showcased a series of seven children’s books on the topic of processing loss. It is designed to be a three generational project with parents and grandparents reading to the children, but also learning themselves while reading. At the moment, they are running in coffee shops.

Lucy Weaver @ Cornwall College – Provides pastoral support to higher education pupils. Cornwall College have recently appointed a new Principal/CEO. As such, a new strategy has to be created and mental health will be a very important subject on the agenda for this.

Vicky Shipway @ Colebrook SW – In terms of Colebrook support, a new project will hopefully be set up in the City. Colebrook are also looking at the possibility of regaining a foothold in Cornwall with the opening of new tenders. Head Space are seeing up to 22 people per shift at the moment. Within the first quarter, 600 people have been seen, yet the overall aim for the year was 720. Head Space will be looking at more paid staff to cover the demand. One question that is being asked is whether the right people are visiting?

4. PART 2

Procurement / Integrated Care Partnership

VS: Mental health services will be up for tender in a new look service. There will be a discussion on the new provision taking a different approach to how things are currently done.

There could be a new focus on prevention. However, there are some caveats to this contract. The main condition is the requirement of the provider working in partnership with the third sector. This leads to the question of whether there is a role for the Network to play in the new mental health services tender.

NP: Healthwatch have chaired some engagement sessions which may shape the future of health and care in Devon through gaining public views. It was impressive to see four questions guide the wider question of “what do you want?”.

VS: Do enough people know what an integrated care model is as there are people who are a little confused or do not know what is meant by the term?

DTH: There are a series of questions that need to be evaluated and this will happen through a monitoring session.

VS: Not sure how far along the procurement process is at this stage, it appears that procurement is only asking for initial ideas at the moment.

5. Trauma Enforced Practice – Simon Hardwick

Inspector Simon Hardwick, who works for Devon and Cornwall Police, used a Powerpoint entitled “Envisioning Plymouth as a Trauma Informed City” throughout the discussion – the link can be found here.

There was a brief round of names and organisation introductions around the room for the SHA.

SHA introduced himself as a Partnership Inspector who goes to multi-organisation events, usually on behalf of the Trauma Informed Plymouth Network. There was also a short outline of the origins and motivations for the Trauma Informed Plymouth Network which has seen the network identify the importance of close working relationships with individuals and organisations to promote how to understand and innovate methods to address trauma.

Presentation:

There is a now an opportunity to create a significant change in culture through addressing what can be considered ‘hearts and minds’. This could be due to a link between physical and mental wellbeing. Increasingly, the question has to be asked about whether we should continue with our existing approach to people in crisis, even if there is a deeper understanding of some concepts involving trauma. There is also a link between physical and mental wellbeing that can be explored.

Defining trauma can be difficult as it can mean something different to many people. However, one of the most encompassing definitions comes from The Substance Abuse & Mental Health Services Administration (SAMHSA) who define trauma as: “Physical and emotional harm which impacts upon an individual’s functioning and their mental, physical, social, emotional or spiritual wellbeing”.

SHA introduced the concept of Adverse Childhood Experiences (ACEs) which are negative experiences faced in childhood which may lead to trauma-like behaviours. The concept was developed in America during a study on weight loss which led to the discovery of a link between ACEs and the chances of maintaining lost weight. As such, there appears to be a link between adversity and the likelihood of negative outcomes later on in life. The police are an example of an ACE as the process of being in custody can be seen as a traumatising event. Therefore, how does this process change?

Some slides with studies by the Welsh ACE Survey and the World Health Organisation (WHO) were shown to highlight the relationship between ACEs, adversity and health issues.

ACES are not a predictive model of behaviour as the Resilience Model highlights that there are stressors and protective factors that impact ACEs. Dr. Karen Treisman outlined the interlinking nature of factors which can influence trauma with one of the biggest factors being how much relationships matter. As the causes appear to be layered and overlapping, the solution should reflect this by also being layered. To combat Adverse Childhood Experiences, such as physical and emotional neglect or mental illness, people may turn to the community environment to provide relief. Yet, the community can sometimes provide adversities like poverty or disruption, therefore meaning that it can be difficult when both areas are adverse.

Violence, abuse, neglect and exploitation are more likely to be experienced within the family and the community. Trauma is not an event itself; it is a response to be an event and the emotional legacy of this. As a result, traumatic experiences in childhood can impact your development.

SHA outlined three categories of stress: positive, tolerable and toxic. Positive stress is the body’s manageable response to a tense or unusual

situation or event, for example: the first day of school. Tolerable stress is the body’s response to a serious situation or event which may have longer term impacts. Toxic stress is a prolonged response to frequent, intense situations and events. All three have varying degrees of impact on how someone develops and acts.

Developmental trauma of fight, flight or freeze are the longer-term behaviours which someone may develop when previously exposed to trauma. Some behaviours include increased fear, hyperactivity and being unable to distinguish between safety and fear. Sometimes the language in the field can be unhelpful in these situations. For example, when someone is not doing something, they might not necessarily be “refusing” or “unable”. Each time, it is about encountering a story and the journey towards damaged mental health so to look at this issue, trauma informing needs to become a movement.

There are 5 R’s which help to create trauma sensitivity. These are: Realises, Recognises, Responds, Resists and Resilience. Overall, they should help someone become more aware and take better measures in dealing with trauma. This is backed up by core values of being safe, person centred, compassionate, collaborative and empowering, which shape the sensitivity of trauma.

The next step is to move towards a collaborative approach and be more alive to people’s experiences. There is a need to be kind by being non-judgemental. People still need to be held to account for their actions, but we need to be mindful of someone’s situation.

Comments:

LW – There is a divide between support and academic staff which means a culture change is needed to create a more harmonious relationship between the two sets of staff.

CE – Communication is key in any role and the language is beginning to change which has opened up discussions across the field.

TG – Found that when training on the subject of loss, the most common themes that people display are wanting to be loved and being heard.

SHA – After 10:00 pm, when many services have closed, the police can become a default mental health service. Offering someone the chance to talk can be a vital step. Studies have found that putting a bit of an enquiry into routine doctor appointments can reduce sickness and ill health.

ML – The important issue is creating a safe space and not beginning with the hardest, biggest bit of trauma. It is about being sensitive and not always asking the direct questions.

MF – Is there any research into adult trauma? There are triggers that could be found in events, such as job loss.

6. AOB

7. Date of next meeting

Meeting date has been confirmed as 19th of September at 1:00 pm. Still looking for a host for the meeting.