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user and carer-led treatments campaign.......p2
news...................p3
interview: prof. stephen bazire.........p4
interview: benna waites.................p6
Getting the best treatments...............p8
NCMH update.................p10
inside...
campaign: treatments
Service users and carers in
Wales: “Give us choice and quality
in the treatments we receive”
In 2014 service users and carers in
Wales will campaign for improved
choice, increased access and
sustained excellence in the
delivery of treatments for serious
mental illnesses.
A new service user and carer-led
campaign, supported by mental
health charities Hafal, Bipolar UK
and the Mental Health Foundation,
will see the development of a
range of information including:
• a new guide to getting the best
treatments
• advice on making sure that both
psychological therapies and
medications are covered in the
Care and Treatment Plan
• advice on working with health
professionals to get the best out of
treatments
• a comparison of medications for
mental illness looking at sideeffects, management issues and
efficacy
• a comparison of talking therapies
• tips and suggestions from fellow
service users and carers.
“Get the Plan right”
Carina Edwards,
a member of the
campaign's All
Wales Mental
Health Service
User and Carer
Panel, said:
"Both talking
therapies and medication play
important roles in directly treating a
serious mental illness. The tricky
thing is that talking therapies and
medications are dealt with in the
same box in the Care and Treatment
Plan – so it's often the case that the
box can be 'ticked' as long as only
medication is dealt with.
2
"This campaign will empower service
users and carers to insist that both
medications and talking therapies are
addressed in the Plan. I'm especially
interested in how we can overcome
the limited access people with a
serious mental illness have to
therapies. There seems to be an
assumption that talking therapies are
suitable for illnesses such as
depression but that when it comes to
diagnoses such as schizophrenia,
only medication can be useful. But
we know from experience that talking
therapies can be hugely beneficial."
“Give patients choice”
Panel Member
David CrepazKeay said: "A
key part of this
campaign will be
to empower
service users to
exercise as
much choice as
possible.
"If patients are empowered to raise
issues with their doctors then they
will have the opportunity to find the
medication that works best for them."
“Improve access to treatments”
Nigel Griffiths
said: "For me,
one of the key
issues is access
to therapies. I'd
like to have a
series of
Cognitive
Behavioural
Therapy (CBT) sessions but where I
live there is a distinct shortage of
practitioners.
"Over the years I've had various
interventions: for example, I've seen
the practice counsellor in the GP
surgery and I've been referred to the
in-house service with the mental
health team. But I had tea-andsympathy sessions rather than
probing, counselling, move-me-on
sessions.
"With medications we can sometimes
feel compelled to go with the doctor's
decision simply because they have
the medical degree! But the
campaign's message is that
whatever medication you are taking,
it is always worth asking your doctor
or pharmacist if anything might work
better.
"I've done a life coaching course so I
know the sorts of questions that help
people to come up with the answers
that will help them move on. That's
why I would want to choose that
specific type of talking therapy I
receive."
"We want patients to ask themselves:
what side-effects or management
issues of my medication are
unacceptable? Am I really happy
about my weight gain or shaking, for
example? Is a depot really the best
way to evenly administer the drug?
Am I on the minimum effective
dosage of a medication? And what
are the long-term risks?
The treatments campaign is one of
two user and carer-led national
campaigns due in 2014; the other
campaign, “Let’s get physical!”,
will promote physical health for
people with a serious mental
illness and their carers. Both
campaigns will launch later in the
year. For more information please
follow Hafal on Facebook/Twitter
or keep visiting
mentalhealthwales.net
go to www.men talh ealth wale s.ne t
for the lates t infor mati on on trea tmen ts
news...
Talking therapies: a priority for 2014?
Launching the first annual report
on Wales' mental health strategy
"Together for Mental Health" last
December Health Minister Mark
Drakeford said “in the next 12
months, we will build on this work,
with a particular focus on
improving access to psychological
therapies”.
The Strategy's Delivery Plan includes
a number of Key Actions for
improving the delivery of
psychological therapies including
"12.3 To improve access to and
provision of Psychological
Therapies," with each Local Health
Board required to “constitute a
Psychological Therapy Management
Committee to advise on local
mechanisms to take forward and
develop psychological therapy
services in line with Welsh
Government Policy guidance and to
take into account the baseline
review.”
The Welsh Government published its
policy guidance "Psychological
Therapies in Wales" in 2012. The
guidance aims to improve the
availability of psychological
interventions in Wales and integrate
a “psychologically informed
approach” within the delivery of
mainstream care.
However, it seems there is some way
to go in implementing the guidance.
The Minister's announcement in
December followed the publication in
November of a Welsh Government
Review of access to, and
implementation of, psychological
therapy treatments in Wales which
found that "there are differences in
the availability and relative quality of,
and access to, service and treatment
delivery" and that "individuals with
complex needs requiring high
intensity psychological therapy are
often placed on long waiting lists,
which can take up to two years".
The review also found that in many
areas those requiring in-patient
treatment report that there is no
provision of psychological therapy
and that service users do not receive
sufficient information on the range of
therapies available.
Peter Martin, Head of
Public Affairs at Hafal,
said: “People who use
secondary mental
health services tell us
they think more should be done to
provide talking therapies, and that
because there is no ‘one size fits all’,
there should be a range of
psychological interventions available
that are tailored to their individual
needs and where appropriate the
needs of the whole family. We think it
is both sensible and more cost
efficient to ensure that a priority is
given to people who are most
vulnerable and in greatest need, that
Community Mental Health Teams
routinely discuss with clients their
psychological needs and that
psychological interventions are
routinely reflected in people’s Care
and Treatment Plans.”
To read the Welsh Government’s
Review of access to, and
implementation of, psychological
therapy treatments in Wales go to
http://wales.gov.uk/docs/dhss/
publications/131114treatmenten.pdf
since our last issue...
February 2014: A coroner
announced that he is to ask for a
review of mental health procedures
for soldiers following an inquest into
the suicide of Lee Bonsall, 24, who
was found at home in Tenby by his
wife in 2012. Mark Layton said he
intended to write to Defence
Personnel Minister Anna Soubry to
suggest that the procedure for
arranging psychiatric appointments
was reviewed, and that he will ask
UK Health Minister Jeremy Hunt to
highlight the waiting times for
psychotherapy.
January 2014: Christine Wilson,
Hafal Senior Consultant,
attended the World Health
Organisation Collaborating 4th
International meeting in Lille,
France, to promote the
groundbreaking work being
done in Wales to promote
service user and carer
empowerment.
January 2014: Dyfed-Powys Police
announced a £220,000 project to set
up mobile mental health units. The
aim is to decrease mental health
detention figures by 80% and
"provide the most appropriate service
to people in mental distress". The two
new vehicles, which will be staffed by
officers, will have facilities for mental
health nurses to treat people.
January 2014: A new study led by
Chris Dowrick, Professor of Primary
Medical Care at Liverpool University,
found that millions of patients are
wrongly diagnosed with depression
and needlessly given antidepressant
drugs when they are simply sad.
Prof. Dowrick said: “These pills won’t
work for people with mild depression,
or who are sad, but they have side
effects and we are seeing patients
becoming reliant on drugs they do
not need.”
Mental Health Wales is published
by Hafal. If you have any comments,
please contact us at:
Hafal, Suite C2, William Knox
House, Britannic Way, Llandarcy,
Neath, SA10 6EL
Email:
editor@mentalhealthwales.net
Tel: 01792 816 600
Facebook/Twitter: search for Hafal
www. menta lhealt hwale s.net
3
interview
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professor st
Professor Stephen Bazire is Consultant Pharmacist, Norfolk and
Suffolk NHS Foundation Trust; Honorary Professor, School of
Pharmacy, University of East Anglia, and was made a Fellow of the
Royal Pharmaceutical Society of Great Britain in 2006.
His special interests include user and carer information and education on
medicines, and he has been integral in the development of the
groundbreaking www.choiceandmedication.org.uk website.
Here Prof. Bazire talks to us about patient empowerment, how to choose a medication and the
availability of talking therapies...
Tell us about your position as a Consultant Pharmacist. What are your priorities in your role?
It started out as a wider brief but seems to have become dominated by eMMa, who isn’t a lady but our
name for electronic Medicines Management and administration. Calling it electronic prescribing might have
led people to think it was just prescribing rather than prescribing, clinical checking, dispensing and
administration. I also do a lot of teaching and education sessions and answering our medicine telephone
helpline.
Your Choice and Medication website (www.choiceandmedication.org) supports people to make
informed choices about their medications. Do you think patients exercise sufficient choice at the
moment and are they becoming more or less empowered?
I have definitely noticed a more assertive and empowered
atmosphere over the last few years but I suspect this is still very I have definitely noticed a more
patchy. To me the main problem is providing people with the
assertive and empowered
information they need in a usable way. Our long-term aim with
atmosphere over the last few
the website is to move much of the information into a Patient
years but I suspect this is still
Decision Aid, which takes people through all the stages of
very patchy
decision-making. The missing part of the jigsaw is the data on
how to answer the question “what are the chances of getting
better if I have treatment?”. There are so many studies, all different and not comparing different treatments,
many subject to “publication bias” (i.e. studies that show an effect are more likely to be published than
those that don’t show an effect, and the latter often aren’t even written up) and other bias (e.g., people with
vested interests). And as for the long-term effects…
What would your advice be to someone who is not satisfied with their medication (for example,
because of negative side-effects or lack of effectiveness)?
There are a number of options: if a medicine is helping but the side-effects are a problem, then trying to
minimise or manage those side-effects is the first thing to do, e.g. adjusting the dose, the timings of doses,
how they’re spread across the day, and other actions to help the side-effects. If a medicine isn’t working
then look at the options and try to compare them. Ask a professional you trust and who seems to know
what they’re talking about to talk it through with you. I prefer to give people a number of options with the
pros and cons of each, and sometimes put them in a possible order.
4
Do you think that atypical antipsychotics are preferable to typical antipsychotics, and would you
advise someone taking typical antipsychotics to ask to try an atypical?
I have had a long-standing problem with the terms atypical and typical
I have had a long-standing
because they don’t really have a meaning. Atypical was an experimental
problem with the terms
term latched on to by the pharmaceutical industry so all new
atypical and typical
antipsychotics are now “atypical”, which implies they are similar. It’s
illogical to think that clozapine, quetiapine, olanzapine, aripiprazole,
because they don’t really
risperidone and amisulpride are classed together in one group. It makes have a meaning
no sense in terms of side-effects, effectiveness or even how they work.
And as for some drugs being called “partial atypical”… I think that we should consider them to be
antipsychotics in their own right and be thought of as different to each other rather than members of two
distinct groups. Anyway, the newer antipsychotics have different, rather than fewer, side-effects. So it’s
whatever works for you that matters, not the marketing terms. I’ll get off my hobby horse now.
What do you think about the polarisation of talking therapies and medication in the debate about
the treatment of serious mental illnesses?
I really don’t understand this. An open mind will recognise that they are different and frequently
complimentary. As Kay Redfield Jamieson (a well-known figure with bipolar) once said: “lithium helps
control the symptoms, therapy helps me live with them.” I know that many drug studies are criticised as
being biased because the manufacturers did them, but fiddling studies is getting much more difficult and
some failed or negative studies are inevitable. For instance, people have analysed the data on agomelatine
and said that if you include all the studies it isn’t any better than anything else. True, but several of the
studies were before they found out it really only works if taken at night. That’s why people do studies – to
find this sort of thing out. There are only a couple of studies of talking therapies that would be good enough
to get it a license if it was a medicine. I’m sure the evidence can be obtained but you’d never be allowed to
include waiting list controls in a drug trial.
I have a grave concern
about more resources
being poured into crisis care
whereas keeping people well
should be our priority
Recent studies have suggested that antidepressants are
being over-prescribed. Do you agree?
There are numerous studies showing that antidepressants reduce
the suicide rate, e.g. over 20 years (1980-2009) in each of 29
European countries (except Portugal) there was a close
correlation between increasing antidepressant use and reducing
suicide rates. The same has been found in USA, Japan and Scandinavia. I’m sure some people get
prescribed antidepressants when they don’t need them, but with depression frequently unrecognised these
are far outnumbered by the number that ought to but are not.
How would you like to see treatments for mental illness develop and improve in the future?
I have a grave concern about more resources being poured into crisis care whereas keeping people well
should be our priority. I often feel we’re putting lines of ambulances at the bottom of a cliff to help people
who fall off it rather than putting a fence at the top to stop it happening. With so few mental health
medicines reaching the market and then being able to be used (and I think local area prescribing groups full
of people who think they know all about mental health and then block new medicines are a huge factor
here) I think we need more research on the best way to use the medicines we have. Resources such as the
Big White Wall and Berkshire’s SHaRON could well be the key here to help keep people well by
recognising early when wobbles are happening and supporting people early to avoid a full relapse or crisis.
ations for mental illness @
Find out more about medic
p
t/mhw/whole_medication.ph
w w w. m e n t a l h e a l t h w a l e s. n e
5
interview
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Benna Waites BSc (Hons), Dip. Clin. Psych is a Consultant
Clinical Psychologist and Joint Head of Psychology,
Counselling and Arts Therapies in South East Wales.
Here we talk about the importance and availability of talking
therapies in Wales...
What are your priorities in your role?
As professional Head of Psychology, Counselling and Arts Therapies
for Aneurin Bevan University Health Board, a post which I job share
with Dr. Kathryn Walters, I provide professional leadership for around
100 staff within the Health Board. I also sit on the National
Partnership Board representing applied psychologists.
Why are psychological therapies so important for people with a mental illness?
First, we know psychological therapies are really effective. Second, it’s not unusual for psychological
factors to have played a key role in the development of difficulties so addressing those in treatment makes
sense. Third, psychological therapies can equip people with the understanding and skills needed to develop
resilience that they can carry with them throughout their lives, regardless of the challenges life throws at
them. Fourth, psychological therapies can make a key contribution to well-being and thriving, not just
symptom management. I could go on...
Many people with a mental illness find that their treatment is focused on medication and that
psychological therapies are difficult to access. What's your advice to these patients?
I think it’s really important for people to request psychological therapies
in these circumstances, and to continue to do so if their request is not
initially heard. It’s worth bearing in mind that there’s some really good
practice in the third sector, and a range of self-help resources in libraries
and on the internet, so it’s worth being active in figuring out what works
best for you. Part One of the Mental Health Measure promotes increased
access to psychological therapies in primary care and the quality of this
provision is improving all the time.
In an ideal world, I’d like
everyone in mental
health services to have
quick access to a range
of talking therapies
Do you think enough people with a mental illness are offered talking therapies?
In an ideal world, I’d like everyone in mental health services to have quick access to a range of talking
therapies if they feel they need it. We are a considerable way off that currently, but I welcome the growth of
understanding about the level of unmet need in this area.
Do you think there is therapeutic practice in mental health services in general where all staff offer
patients kind and listening contact?
Although there are pockets of good practice, I think there is lots more we could do to ensure that this is the
norm for patients’ experience of mental health settings. In any health setting patients benefit from
6
compassionate care, and this is all the more important in mental health settings. We know from work in the
Sotteria houses that kindness and understanding from staff seems to play a key role in recovery from
mental health crises. Enabling this to be the norm involves a range of strategies including staff training
(people are more likely to be understanding when they have understanding and relevant skills), and staff
support (as we know that staff are more compassionate when they are well cared for by the organization
they work for).
How would you like to see treatments for mental illness develop and improve in the future?
Clearly greater provision of talking therapies is key. I believe we need to
I would like to see more
employ more staff with specialist skills in this area but also to train and
appropriately support the workforce so that being able to offer a basic
peer mentors and staff
level of therapeutic contact is routine. I would like to see more peer
with lived experience
mentors and staff with lived experience employed in the mental health
employed in the mental
workforce. In the Policy Implementation Guidance on Psychological
health workforce
Therapies, issued by Welsh Government in 2012, the concept of
“Psychologically Minded Organizations” is raised, and I’d very much
support that. So as well as an increase in the availability of psychological therapies so that people can
access this kind of support in a timely way from childhood right through to old age, I’d also like our services
to think and behave in ways that are more psychologically informed.
S
MENT
TREAT TE
UPDA
NICE: “Offer talking therapies to people at risk of
psychosis and schizophrenia”
The National Institute for Care
and Health Excellence (NICE)
has issued new guidance on
the treatment and management
of schizophrenia.
The new guidance includes a
number of recommendations
including that:
● talking therapies are offered to
people at risk of psychosis and
schizophrenia
● service users are offered
support from people who have
recovered from psychosis or
schizophrenia
● advice is given to people with
psychosis or schizophrenia by
clinicians to manage their
condition including information
and advice about effective use
of medication, identifying and
managing symptoms,
accessing mental health and
other support services, coping
with stress and other problems,
what to do in a crisis and
preventing relapse as well as
setting personal recovery goals
● carers' needs are assessed to
ensure they get the right level
of support.
The guidance promotes patientcentred care, stating that:
“Treatment and care should take
into account individual needs and
preferences; in Wales services
have a legal duty to meet these
through the Mental Health
Measure. Patients should have
the opportunity to make informed
decisions about their care and
treatment, in partnership with their
healthcare professionals.”
Professor Mark Baker, Centre
for Clinical Practice Director,
NICE, said: “This is the second
update of NICE's very first clinical
guideline. Since the original was
published in 2002 there has been
a new emphasis on how to detect
and treat this condition earlier and
also an increased focus on longterm recovery.”
Professor Elizabeth Kuipers,
Professor of Clinical
Psychology, Institute of
Psychiatry, King's College
London and chair of the
guideline development group,
said: “The updated guideline also
emphasises that people with
schizophrenia generally have
poorer physical health and
recommends routinely monitoring
cardiovascular, obesity,
respiratory and diabetes risk.”
To read the guidance go to:
www.nice.org.uk
therapies @
Find out more about talking
p
t/mhw/whole_medication.ph
w w w. m e n t a l h e a l t h w a l e s. n e
7
In focus:
Treatments
Thanks to the Mental Health Measure secondary mental
health service users in Wales now have the right to a
comprehensive Care and Treatment Plan which covers eight key
areas of life.
One of those areas is “medical and other forms of treatment, including
psychological interventions” – so in one section of the Plan both medical and
talking treatments need to be covered.
Full usual
addres
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releva of
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Teleph
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numbe
r,
addres postal
s,
where and
approp
riate,
Because both medication and other therapies are combined
in this one ‘life area’ of the Plan you need to take extra care
that any non-medical treatment – including psychological
therapy – is covered. Psychological therapies can be very
important for many people with a serious mental illness, but
they can be difficult to access. Our advice is that you ensure
that any need for psychological therapies is recorded in the
Care and Treatment Plan – and that psychological therapies
are kept on the agenda in case any need arises in the
future.
If you require medication our advice is that you should take
account of its effectiveness, side-effects and any management issues when you discuss options with your doctor. If you
are taking older antipsychotic medication the side-effects of
your medication may be a significant issue. An example
outcome might be to reduce the side-effects of your medication by trying a new medication or reducing dosage levels.
We recommend that it is well worth some extra effort to
manage a medication if it gives you the best results (for
example, some medications may require you to take blood
tests).
8
Name
of
Health Local
Local Board or
Author
that appoin ity
care coordi ted the
nator
#
!
!
!
" "
#
Name
of
releva
nt patien
t
email
addres
s
of care
coordi
nator
Getting the right treatment can have a big impact on
your recovery. For many people the goal may be to
achieve a full recovery where no medication or other
forms of treatment are needed. For others the long-term
goal will be to find the minimum level of treatment that is
effective.
Name
of
coordi care
nator
What outcomes should patients aim for in this part of the plan – and who can support
them to achieve those outcomes? Below we provide key tips based on the
suggestions of hundreds of service users and carers from across Wales...
Date plan
was made
date by
must be which the planand
review
ed
Name
of relevan
t patien
t
Services could include:
Advice and guidance on antipsychotic medication or
psychological therapies from a health professional
● Psychological therapy service.
●
Actions/services could include:
● Asking your doctor what psychological therapies are
available and exercising choice
● Finding out about psychological therapies by
accessing information or talking to your doctor
● Booking an appointment with your doctor to review
your medication
● Finding out more about antipsychotic medications by
getting information or talking to a pharmacist
● Choosing a private psychological therapist
● Asking for a different medication, taking account of
efficacy, side-effects and management
requirements
● Arranging for your medication to be reviewed
regularly
● Exploring ways to better manage your medication,
e.g. by developing a strategy for remembering to
take your medications
● Finding out more about complementary therapies.
Where can I get more information on medications and talking therapies?
Medications information: www.choiceandmedication.org/ncmh
This website is aimed at helping service users make a decision about a medication; it
includes a wealth of information on over 150 medicines and each entry has
links to information on the conditions it can be used for.
Talking therapies information: www.bps.org.uk
The British Psychological Society is the representative body for psychology and
psychologists in the UK. Its website provides useful links for sourcing a psychologist.
www.counselling-directory.org.uk
The Counselling Directory offers a support network of UK counsellors and psychotherapists with
information on their training and experience, areas of counselling, fees and contact details.
Put in precise dates
here. Your long-term
outcome (such as
‘reducing my
medication’s side
effects’) may be
achievable in one year;
your immediate shortterm actions (such as
‘discussing options with
my doctor’) could be
achieved within a month.
The main people who can provide
support in this area are your
Psychiatrist, GP, Nurse, Psychologist
and Psychotherapist.
Other supporters include the
following:
● Pharmacist
● Community Psychiatric Nurse
● Counsellor
● Complementary therapist
and/or
● A family member and/or other
carer
● Care Coordinator
● You!
For key tips on what goals you can set
in each of the eight life areas of the
Care and Treatment Plan download
Hafal’s “Care and Treatment Planning”
guide from www.hafal.org or call us
on 01792 816600 for a copy.
Hafal has developed a new course for people with a mental illness
and their carers. “How to get a great Care and Treatment Plan”
gives students the skills they need to achieve an excellent Plan and
uses physical health as an example life area. For more information
visit www.hafal.org or email learningcentre@hafal.org.
w w w. m e n t a l h e a l t h w a l e s. n e
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9
research...
Could you be part of a
mental health revolution?
People in Wales are helping to change the way in which a whole range of mental health
disorders will be diagnosed and treated in the future by taking part in research.
Over 2000 volunteers of all ages from across the country have already worked with the National
Centre for Mental Health based at Cardiff University.
The Centre is examining the causes of conditions including schizophrenia and psychosis,
Alzheimer’s disease, ADHD, PTSD, bipolar disorder and autistic spectrum disorders.
NCMH Director Professor Nick Craddock believes that the people of Wales could be at the
forefront of a revolution in our understanding of mental ill health.
“This is a very exciting time for mental health research, not just because technology and new
ways of thinking have opened up new avenues of investigation, but also because more and more
people are coming forward to talk about mental illness and to help us understand it,” said Prof.
Craddock.
“The network of research volunteers that the NCMH is building up in Wales is unique, and is
providing researchers with important information that will help to develop the treatments of
tomorrow. I firmly believe that the contribution from people in Wales will be felt around the world in
decades to come.”
NCMH is still looking for thousands more research volunteers. Taking part involves meeting with a
trained researcher to answer some questions about yourself and your condition, giving a small
blood sample and completing a series of brief questionnaires. The entire process takes less than
an hour, and can take place at a local clinic or even in your own home.
Partners and family members are also able to take part, as they can
provide useful information for comparison. All the information collected is
stored anonymously and securely.
If you are interested in helping the NCMH, please
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