Review: The Mersey Care Annual Mental Health Social Care Conference 2015

Peter Beresford giving a rousing address to the conference

 

The Mersey Care Trust’s annual conference was held in Liverpool on 6^th November 2015. This year the theme was Service Users’ Voice: Change, Rights and Advocacy: What is the Reality?

 

I have reported at length on two previous Mersey Care conferences; I am afraid that this report will necessarily have to be briefer on this occasion.

 

The event was oversubscribed, with well over 200 delegates squeezing into the venue. As ever there was an impressive list of scheduled speakers, including Professor Martin Webber, Professor Peter Beresford, the human rights lawyer Peter Edwards, the Community Care journalist Andy McNicoll, and the erstwhile chair of the mental health steering committee of the now defunct College of Social Work Dr Ruth Allen. Indeed, it appeared as if there were almost as many speakers as there were delegates!

Roger Phillips, a presenter on Radio Merseyside with a keen interest in mental health, opened the conference. Emad Lilo, the intrepid organiser and manager of the Mersey Care Integrated Care Demonstrator Site Project, along with several of the Trust AMHP’s then outlined projects and other development work they had undertaken during the year.

Peter Edwards discussed the thorny issue of whether the rights of service users could actually be exercised, or were in effect illusory, then the Masked AMHP himself presented a case study of an assessment under the Mental Health Act, arguing that the AMHP has an advocacy role, and that an AMHP can successfully take a deliberately low key approach to assessment. A version of this case study was subsequently published in Community Care Magazine. You can read it here.

The morning was rounded off by an extraordinary presentation by members of the People First Merseyside organisation. This is a user led self advocacy organisation for people with learning difficulties. It has been in operation for over 25 years.

The staff and volunteers (most of whom were service users) gave an excellent dramatised presentation on the right (and wrong!) ways to approach people with learning difficulties who require assistance with a health problem, as well as showing exactly what people with learning difficulties can achieve when given encouragement and empowerment. It was entertaining, educational, and moving.

Peter Beresford kicked off the afternoon with an, as ever, eloquent, incisive and stirring dissection of the failings of current mental health policy and practice, tearing into the current Government plans and exposing an apparent deliberate intention to dismantle the NHS and marginalise disadvantaged people.

Ann Williams, Commissioning & Contract Manager for Liverpool City Council, gave a presentation on the roles of the Independent Mental Capacity Advocate and the Independent Mental Health Advocate, followed by Jake Mills.

Jake Mills is a stand up comedian. In 2013, he experienced a severe period of depression, during which he came close to committing suicide. As a result of this, he set up the mental health charity Chasing the Stigma which aims to “normalise and humanise mental illness.” He gave an intensely moving, but also funny account of his experiences.

The last session was Naomi Good, Regional Development & Research Manager of the National Survivor User Network for Mental Health. Her presentation was entitled Survivor Voices: Re-authoring Disrupted Identities. She outlined research she had done into the experiences of mental health service users.

Unfortunately, time constraints meant that some speakers, such as Professor Martin Webber, literally only had five minutes to speak, and of three intended Q&A sessions, only the one featuring Andy McNicoll and Ruth Allen actually went ahead. This meant that a number of prominent people in the mental health field did not have an opportunity to be heard.

I suppose this is a consequence of the popularity of these annual conferences, not just for delegates, but for speakers as well. Emad Lilo, who organises these events, appears to have boundless energy and enthusiasm, and this is reflected in the very real buzz that permeates the day.

 

This was the third Mersey Care Conference I have attended, and I very much hope to have the opportunity to speak at future ones. 

Recovery in Mental Health: the Mersey Care Conference 14th November 2014: Part 2

(This continues and concludes my previous blog post reviewing the 2014 Mersey Care conference.)

The next session, Think Family, outlined the work being done on Merseyside to support young carers. This was partly presented by a group of very articulate young carers.

It was stressed that having a parent with mental disorder has effects on the whole family; everyone in that family is impacted. It is important to change cultures and attitudes to mental health and the needs of families. This involves a journey of recovery involving the whole family.

It was pointed out that a third of UK adults with mental health problems are parents. While most are able to discharge their parental roles effectively, children with parents with mental health problems can nevertheless experience poor outcomes in later life.

The young carers described the impact that having a parent with mental health problems has on them. This covers the necessity to be involved in domestic chores, as well as physical and emotional care giving. Educational needs of young carers can often come second, and result in them missing school, etc, and the leisure and social life of young carers can also suffer.

There therefore needs to be a major cultural change: this needs to involve increased visibility and social inclusion, improved access to support and services, improved means of identification of needs, and a more confident and supported workforce.

One of the major achievements is the creation of family rooms in inpatient facilities. The Trust has resourced 16 of these rooms, which are designed to provide a pleasant and safe environment for children to see their parents.

There needs to be an increasing focus on children within the CMHT’s, and the development of a common perspective in order to provide safer services that include the needs of young carers.

The next session was about Youth Mental Health.

It was stated that current services tend to be designed around professionals rather than need. There is poor access to services for children and young people, even though they experience high levels of depression and social anxiety.

There is a huge difference between child and adolescent mental health services and adult mental health. These include problems with service models, with CAMHS focussing on developmental issues, while adult services focus on the diagnostic, and CAMHS stressing psychological intervention, while adult services have a more pharmacological approach.

It is very important to manage the transition between children’s and adult services, as there is frequently a gap in provision. There are also problems with engagement and disengagement. The evidence shows a high referral rate for 16-25 year olds, but poor subsequent engagement. There is also higher comorbidity, for example young people’s problems being exacerbated by homeless, substance issues, etc.

And that ended the morning session.

Dr Carol Henshaw and Pauline Slade, from the Liverpool Women’s NHS Foundation Trust kicked off the afternoon with a sobering examination of issues in perinatal mental health.

Pauline Slade stated that it is vitally important to address mental health problems that emerge during pregnancy and up to the end of the first year postnatal. This is not just of benefit to the women, but is equally important for their child, their partner and society as a whole. The estimated cost to the country of perinatal mental health difficulties is £8.1 billion per annum, whereas the cost of provision of good services would only amount to £500 million per annum.

The main problems that women encounter are depression and anxiety both during and after pregnancy, post traumatic stress disorder arising from birth trauma, and more rarely, but potentially very dangerous, postnatal psychosis. The focus should be on prevention of serious consequences to mental health if at all possible.

One third of women experience childbirth as being traumatic, and 3-6% of these women will go on to develop symptoms of post traumatic stress disorder, and yet currently the systems are not in place to screen and treat PTSD. Clinical studies of effectiveness of potential interventions are still only planned or small pilot studies.

Pauline suggested that it was important to train midwives to assess and treat early signs of PTSD through brief interventions.

Other important strategies included improving access to support through peer assessment and support, and “if/then” planning, which is a simple way to help people to put intentions into practice.

A Self-help tool has been developed for prevention of PTSD, which includes the provision of basic information and simple exercises.

Carol Henshaw outlined the specific problems women with pre-existing serious mental illness experience. These include an increased risk of other health and social issues, a higher risk of problems with pregnancy and the development of the foetus, stigma and discrimination, disproportionate involvement with children’s services, and dual diagnosis, eg. Drug or alcohol problems.

There is also a high risk of relapse and suicide following the birth of the child.

Strategies to address these problems include preconceptual counselling, identifying women at particular risk, and provision of adequate mother and baby units if these are needed postnatally.

She also observed that misattribution of the cause of symptoms can lead to death in the worst case, and that early symptoms can be non-specific, but can then deteriorate very rapidly into serious and life threatening mental health problems.

Professor Rob Poole, Professor of Social Psychiatry at Bangor University, was next up. He examined the impact of poverty and social exclusion on the incidence and subsequent recovery from mental disorder.

He had some alarming things to say about how the consequences of current national policies create structural inequalities, which in turn leads to worse outcomes and greater incidence of mental illness. Unfortunately, depriving the poorest of the basic means to exist and thrive has the foreseeable consequence of ultimately leading to great expense for society as a whole.

There are significant links between serious mental illness, such as schizophrenia, and poverty and isolation. This is known as the urban effect, where merely living in a city can increase the likelihood of  developing mental illness. There is a high correlation, especially for schizophrenia, with local and national inequalities. Even the fact of growing up as a black British person in the UK can have a serious impact on developing mjor mental illness, as a result of structural racism and disadvantage.

The last speaker, the eminent Professor Peter Beresford, built on this theme. Examining stigma as a barrier to recovery, he gave an eloquent and stirring address dissecting the appalling consequences of government policy on the mental health of the nation.

There is a national crisis in mental health, arising from the government challenging people’s right to a good standard of life. The government speaks of “parity of mental health services”, while at the same time not only cutting back on NHS funding for mental health, but at the same time making mental health service users a particular target of government and media hate campaigns.

It was time to fight back against stigma. Peter particularly condemned such iniquitous NHS constructions such as “clustering”. An understanding and practice of a social approach was much more helpful thatn trying to fit people into specific diagnostic criteria.

Peter suggested that psychiatry as a system supports the government’s neoliberal policy to accept inequality. It was important to challenge this. There is also a serious risk that the policy of applying the “recovery” model to intervention in mental health can be interpreted merely as a way to limit access, duration and quality of mental health services to individuals. Recovery should focus on maximising an individual’s potential, even if there is uncertainty as to how much input would be needed, or how long it would take, for recovery to be effected.

These conferences are crammed. As well as the above speakers, Q&A panel sessions were interspersed throughout the day. This provided an opportunity for conference delegates to ask questions of such luminaries as Professor Rich Moth, Steve Chamberlain, Chair of the AMHP Community of Interest at the College of Social Work, and even The Masked AMHP himself.

My own perception of this conference was that it was not afraid to tackle difficult and awkward issues, such as the severe deficiencies in government policy that leads to chronic bed shortages across the country, holes in service provision, and the effects of policies that unfairly target and exacerbate the problems of mental health service users.

However, at the same time, it offered encouragement to professionals and others to continue to struggle to provide the best services possible, regardless of government imposed strictures.

Emad Lilo organised this and previous conferences. He has the gift, not only of being able to persuade eminent speakers to give up their time to attend, but also of steering a course through the day that culminates in a feeling of hope rather than despondency.

I’m looking forward to attending next year’s conference.

Recovery in Mental Health: the Mersey Care Conference on 14th November 2014: Part 1

The annual Mersey Care Social Care conferences, held in Liverpool each November, are always extraordinary affairs, crammed with eminent and fascinating speakers. This year was no exception.

Roger Phillips, presenter on Radio Merseyside and a staunch advocate for mental health, kicked off the proceedings as ever, with an overview of the conference.

Lyn Romeo, Chief Social Worker for Adults in England, was the first speaker. She pointed out that it is in the nature of social work to have to grapple on a daily basis with risk, uncertainty and anxiety. The issues social workers have to deal with are frequently complex, challenging, and require a sophisticated response.

The role of the social worker should be to empower. Social workers employ the professional use of self to ensure and promote choice and the human rights of the people they work with.

Social work should be focussing on the social model of mental health, and should be working on a shift away from the medical, medication led model of intervention in mental health. What matters most to service users is empowerment, promotion of human rights and allowing them a voice. Hence, it is important to stress the social approach to AMHP practice within the Mental Health Act.

Lyn touched on the integration agenda, stressing the importance of social work integration in overall service provision in mental health services, and that social workers should be providing a model of leadership.

Lyn also spoke about the impact o0f the new Care Act on social care provision, andthat it should also be influencing health provision.

The concept of “eligibility” in the Care Act presents a challenge. There is a major role for social workers in recovery, as well as understanding and evaluating risk, taking into account the individual service user’s own perception of risk.

There followed an inspiring presentation of Mersey Care’s Recovery College programme. The programme was officially launched in September 2013, and it has led to a transformation of the culture of service provision. “Recovery is about having and building a meaningful, satisfying and contributing life”. It is therefore about the development of new meaning and purpose in one’s life.

The key components were identified as a move to person centred “dafety planning”, streamlining the route to employment and meaningful occupation, and empowering selrf management and learning.

The key to the success of a Recovery College is peer support workers. Their job is to create hope, control and opportunity for students of the college, in order to allow them to develop their own expertise in their own recovery. It is about creating a route to recovery from mental illness, rather than a form of therapy.

The Recovery College has managed to obtain funding from the Department for Work and Pensions. The philosophy is that public services are best delivered “with and not “to” people. This requires a shift from the idea of “fixers” to that of “enablers”.

So far, the Recovery College has run 70 courses, involving 600 students. 84% of students attended after enrolment, and 82% of these attended the full course. This is an impressive achievement, and evidence that the Recovery College is providing what service users actually want and need.

The average number of students per course was 7, which was felt to be a good size for participants to feel comfortable. The courses range from half a day to six weeks in duration.

The rest of the presentation was devoted to two service users. First of all was the extraordinary and inspiring Iris Benson, who eloquently and movingly told her own story of recovery against incredible odds. She is an expert by experience. She even had good words to say about the social workers who had helped her during her recovery, describing them as engaging, facilitating, supporting and encouraging.

She stressed the importance in the success of the College as being co-production, co-facilitation and co-delivery of courses, involving both professionals and service users.

Equally extraordinary was Wayne Ennis, another service user, who spoke about his experience of peer support: “You have the answers in yourself”.

David Hewitt was the next speaker. David is a Mental Health Tribunal judge, and also author of The Nearest Relative Handbook. He spoke of Deprivation of Liberty: Is it the start of a service user journey of recovery?

He stressed that as far as the Deprivation of Liberty Safeguards are concerned, there is still a great deal to be done. He examined the recent Supreme Court judgments relating to Cheshire West et al, looking at what this decision establishes, but also what it leaves unsaid. There is still a need for greater clarity. He expressed some concerns about the “acid test” posited by Lady Hale in the judgment, although he felt that overall the judgment had assisted clarity.

[Lady Hale stated: “it is axiomatic that people with disabilities, both mental and physical, have the same human rights as the rest of the human race. It may be that those rights have sometimes to be limited or restricted because of their disabilities, but the starting point should be the same as that for everyone else.” Deprivation of liberty happens whether or not the person is aware of it.]

He also quoted Lady Hale as saying that “DOLS have the appearance of bewildering complexity”, a sentiment with which most who have to grapple with it professionally would agree.

 

David posited that change is the overall determinant, suggesting that change surely cannot be determined when deciding deprivation of liberty. He gave the example of 2 people in a care home. One came from their own home, while the other came there from a high security unit. Comparative to their backgrounds, one was in a more restrictive environment, while the other was in a less restrictive environment. However, the environment they were in was identical.

[However, there is already a challenge to this. On 18th November 2014 Justice Mostyn took issue with the Cheshire West judgment in a Court of Protection judgment [2014] EWCOP 45. He found it “impossible to conceive that the best interests arrangement for Katherine, in her own home, provided by an independent contractor, but devised and paid for by Rochdale and CCG, amounts to a deprivation of liberty within Article 5. If her family had money and had devised and paid for the very same arrangement this could not be a situation of deprivation of liberty. But because they are devised and paid for by organs of the state they are said so to be, and the whole panoply of authorisation and review required by Article 5 (and its explications) is brought into play. In my opinion this is arbitrary, arguably irrational, and a league away from the intentions of the framers of the Convention.”]

David discussed the case of Munjaz v. Mersey Care Trust, which dealt with issues of “residual liberty”. He posed the greater question, what is liberty? And who says what liberty is? There is an assumption that we can all agree what liberty is or is not, but this is not actually true.

David suggested that a law cannot be a law unless a citizen can regulate their conduct according to the requirements of that law, and cited the case of HV V.UK 2004, which concluded that any law should be sufficiently precise to allow the citizen to foresee the consequences of their actions. He appeared to be suggesting that the Cheshire West judgment, and DOLS, does not meet that requirement.

And on that bombshell, I will end this segment. The concluding part of my review will come in the next few days. (There was, as always, a huge amount of fascinating content).

Possibly the best Social Care Conference in the UK? Review of Mersey Care Trust Annual Social Care Conference 22nd November 2013

I was fortunate enough to be ambushed by Emad Lilo, the conference organiser, back in March of this year, when I was appearing at a North Wales and North West AMHP Association Conference in Manchester. He booked me for the Mersey Care Trust annual conference, and I’m very glad he did, because what a memorable day it turned out to be!

The theme of this year’s conference was “Service Users’ Experience – Social and Medical Models: Exploring What Service Users Say”. Over two hundred social workers and social work students, as well as a scattering of other mental health professionals, attended. The programme was crammed with speakers of the highest calibre, including Professor Peter Beresford, Annie Hudson, the Chief Executive of The College of Social Work, and Professor Sue Bailey, Chair of the Royal College of Psychiatrists. There was even an unexpected, but very welcome, appearance at the conference of Lyn Romeo, the Chief Social Worker for adults.

So far, it might look as if I have been hired by the Mersey Care Trust to promote them, but my enthusiasm is entirely genuine, as this was certainly the most stimulating and inspiring conference I have attended. The commitment and concern to promote the needs of mental health service users was palpable from the speakers and the conference delegates.

The programme was crammed, with over a dozen speakers, not to mention an eminent panel that included Professor Michael Lavallette (oh, and The Masked AMHP, but I didn’t get to say much: there were too many others with important things to say.)

Joe Rafferty, the Chief Executive of the Trust, began by stressing that service user involvement is integral to the way the Trust works – and I believe him. He posed the question: if perfect care isn’t the right goal, then what is? He meant that “good enough” was not actually good enough, that mental health services should aim to eliminate suicide, not just to set goals for a reduction in numbers. He pointed out that a 95% perfect safety record for the Mersey ferry would mean that 4 ferries would sink each year.

He was followed by the double act of Jenny Robb, the director of social care and safeguarding in the Trust, and Iris Benson, a service user. Jenny continued the theme of the importance of service user involvement at all levels, while Iris gave the conference an articulate and truly inspirational personal story of recovery, outlining her severely abusive past and her efforts to overcome the mental health problems she experienced as a result.

Iris gave an enthralling account of her journey to recovery, and the many and varied psychiatric diagnoses, ranging from paranoid schizophrenia to depression to dissociative identity disorder, that she had received over the years. It is encouraging to hear from someone who has had positive experiences of mental health services, and is prepared to share that experience, as well as to challenge poor practice.

Neil Allen is a barrister at the legendary Thirty Nine Essex Street Chambers and a lecturer at the University of Manchester. He discussed the implications of living with mental health, including the fact that people with mental disorder have a responsibility to manage their disorder as best they can, including using any support and treatment available, not just for their own wellbeing, but for carers and others as well. He suggested that, while a social model can be usefully applied to improving attitudes to people with physical disabilities, mental disorder does not fit so well into the social model.

Peter Beresford is both Professor of Social Policy at Brunel University and a mental health service user. He continued and extended Neil’s theme of service users’ experience of mental illness, stressing the value of lived experience, and pointing out that the medical model still dominates mental health services. He was wary about the “new idea” of the Recovery Model, suggesting that this could be as potentially limiting and oppressive, and could disable rather than enable. He outlined the movement of “Mad Studies”, and promoted what sounds like a fascinating book called “Mad Matters”, a book published in Canada consisting of writing that “presents diverse critical voices that convey the lived experiences of the psychiatrized and challenges dominant understandings of mental illness."

And then it was lunchtime.

Annie Hudson, Chief Executive of The College of Social Work, started off the afternoon session, touched on the knotty problem of whether or not social workers should be integrated into Mental Health Trusts, or separate from them. My own view is that this is a Good Thing, as long as a social worker’s core role and identity is protected and maintained. She stressed that mental health should be an integral part of all social work training, as it was equally important for social workers in children’s services to have a knowledge of mental health issues. She also considered that good practice arises from a combination of knowledge, skills and research.

She was followed by the Chair of the Royal College of Psychiatrists, Professor Sue Bailey, whose presentation was both entertaining and humorous. She talked about parity of esteem between different professions working in mental health, noting a marked variability of service between different Trusts. She talked about the recovery model needing to address the quality of life for someone with mental illness within the society in which they live.

Sue raised the interesting point that clinicians and cancer pressure groups stimulated intensive research into the causes and treatment of cancer, with the result that there are now many effective treatments for cancer, and a diagnosis of cancer no longer has the stigma attached to it that it did 20 or 30 years ago. Compare that with treatments for mental illness and disorder – there has been comparatively little research into developing more effective drugs for what can be equally debilitating and life threatening illnesses.

Malcolm Jones and Roger Lewis then addressed the question: what can we do about austerity? Both Malcolm and Roger are major advocates for the rights of disabled people. Malcolm is a social worker and AMHP, as well as being a political activist and a member of the Social Work Action Network (SWAN), while Roger, who is visually impaired, is on the steering committee of DisabledPeople Against Cuts (DPAC). Between the two of them, they gave an electrifying performance, cutting through the cant and ideology of the current Coalition Government to expose the hypocrisy and double standards that is currently driving social policy and seeking to marginalise and disempower disabled people.

The afternoon concluded with presentations from two psychiatrists, Sam Vovnik, who gave a presentation on spirituality in psychiatric care, and Manoj Agarwal, who discussed ways of adopting a more holistic approach to psychiatric care. Rather than following reductive psychiatric diagnosis in the manner of the American Diagnostic Statistical Manual, Manoj preferred to use a grid, which was better able to reflect an individual’s mental health problems. I liked this so much, I will reproduce it here:

	Predisposing factors	Precipitating Factors	Perpetuating factors
Biological factors
Psychological factors
Social factors

Catherine Mills, a mental health service user and one of Dr Agarwal’s patients, then gave a moving and illuminating account of her own journey through treatment and recovery.

Delegates left the conference invigorated and encouraged, while recognising that the struggle to maintain and improve services for mental health service users was going to be long and strenuous. We were also under no illusion that the professional status of social work itself is potentially under threat, and the maintenance of social work as a profession has to be fought for.

I hope I am invited to next year’s conference!