Mental Health Services – What and where

Mental Health is in the news a lot at the moment – and this is a good thing, now we are openly acknowledging our mental health, talking about it and recognising the fact that we all have mental health – just as we all have physical health. The two things are not separate and quite often one will affect the other in some way.

For both – physical and mental health, some days are better than others which means the level of support we need will be different at different times.

Caring for someone with a mental health condition can be emotionally draining as well as physically exhausting. Many mental health conditions do not just go away with treatment or therapy – they can improve, as recovery is possible, but many will return. For carers this can feel like a rollercoaster of a ride and one which they can’t easily get off.

It is likely that you – as the carer, will notice changes in the person you care for and so become the expert in identifying when things are not quite right.

There are a lot of things we still don’t understand about mental health – but one thing we do know is that at least 1 in 4 of us will experience poor mental health at some stage of our lives.

The first person you should speak to if you have any concerns about your own mental health is your GP. They may decide to treat you without the need to refer to mental health services. If they feel you would benefit from specialist support, they can refer you for a mental health assessment.

If it is the person you care for who is presenting with poor mental health you can pass on your worries to the GP even if you don’t have consent from them to share information. The GP cannot discuss any confidential information with you but can make a record of your concerns, which may help to build a picture over time of what is happening for the person you care for.

If, however there is a serious threat to life and you find yourself in an emergency situation.

For example, the person you care for has seriously self-harmed, are threatening to harm others – or are expressing an intension to take their own lives you should call the Emergency services on 999. Please stay with the person if it is safe for you to do so, until the emergency services have arrived. You are likely to have very important information they will need.

Devon Partnership Trust First Response Service

If you are worried about the emotional wellbeing of someone you care for, the First Response Service (previously the Single Point of Access) is available to call 24 hours a day 7 days a week, including weekends and bank holidays. Which is good news for carers as quite often mental distress happens outside of office hours, so if it’s 2am on Sunday you know there is someone you can call.

You will speak to a mental health practitioner, who will listen to your concerns and help you to get the help you need. They will also make a record of your call to pass onto anyone else who may be already working with the person you are worried about, such as their GP or their mental health worker.

The First Response service is also there to help you too if you are experiencing mental distress or if you feel you may be having a mental health relapse. If you can’t make the call someone can make the call for you – if they are aged 18 and above.

So if you have noticed someone has; stopped taking care of themselves, become more isolated or so anxious they physically can’t leave the house, told you they are hearing voices, or having visual hallucinations, please make the call.

The DPT First Response telephone number is 0300 555 5000.

People in the Torbay area can also call this number but for people in Plymouth the telephone number is 01752 434922.

Mental Health Matters – The Moorings:

The Moorings offer out-of-hours mental health support for anyone over the age of 16 who may be feeling distressed, frightened or overwhelmed.

There are three locations in Barnstaple, Exeter and Torquay were trained Mental Health workers will be able to take calls from 6pm – midnight.

Please call:

• Barnstaple on 07850 927064
• Exeter 07990 790902
• Torquay 07483 991848

Mental Health Matters also offer face-to-face support sessions in these locations – addresses can be found on the Mental Health Matters website:

www.mhm.org.uk

Appointments need to be booked in advance and strict Covid 19 measures are in place at the venues.

People using The Moorings will be able to access a 24/7 helpline, which offers emotional support and information even when the venues are closed.

The Samaritans – 24/7 service:

The Samaritans don’t just offer a listening ear to someone who may be feeling suicidal. They are there to listen to carers who may be concerned or worried about the person they care for, or are experiencing loneliness, relationship problems, financial worries or depression themselves.

The Samaritan volunteers undergo extensive training and are available to speak to 24/7 on 116 123. At busy times you may need to leave a message, for someone to return your call as soon as a volunteer is available.

You can also email: jo@samaritans.org or write a letter to Chris, Freepost RSRB-KKBY-CYJK, PO box 9090 Stirling FK8 2SA. All communication is confidential – unless the information you give requires a Safeguarding response. That is to say, if you tell someone you are in immediate danger or you are aware of someone else who is at serious risk of harm. In these instances, the volunteer will take the appropriate action.

The Samaritans also have a Self-Help mobile phone app which tracks your mood, suggest techniques to help manage difficult feelings amongst other things. This might suit carers who may feel uncomfortable talking in front of others or are worried about being overheard.

They may decide you would benefit from a Mental Health Assessment:

There are three Assessment Hubs in Devon which your GP can refer someone to for an assessment of their mental health. If the person you care for is happy for you to go with them as their carer you can go along too. The person just needs to say they would like to have someone with them at the assessment.

• The South and West Devon Assessment Hub is based in Torquay at Torbay Hospital. Tel: 01803 397401/402
• The Exeter and East Assessment Hub is based at Wonford House in Exeter. Telephone: 01392 207799
• The North and Mid Devon Assessment Hub is at ND District Hospital in Barnstaple. Tel: 01271 443230

During the assessment, which can be carried out by a nurse, social worker, psychologist, psychiatrist, specialist pharmacist – (or a combination of any of these professions) a set of questions will be asked to build up an accurate picture of the person’s needs.

The questions will include:

• Feelings, thoughts and actions
• Mental health symptoms and experiences – including past experiences of a similar nature
• Physical health
• Employment, housing and financial situation
• Family relationships, friendships
• Personal strength and skills
• Hopes and aspirations for the future

The person being assessed will only have to answer the questions they want to talk about. The outcome of the assessment will be shared and discussed with them and they will be involved in any decisions that are made and can ask questions. As a carer, you can support them with this.

You might want to sit down with the person before the assessment to make a list of the questions that they would like to ask. The Royal College of Psychiatrists has produced tailored checklists which you can take along to the assessment.

This is the link to the RCPSYCH: https://www.rcpsych.ac.uk/about-us

There are some very good resources including:

MIND:

https://www.mind.org.uk/information-support/legal-rights/sectioning/being-assessed/

NICE – National Institute for Health and Care Excellence:

https://www.nice.org.uk/guidance/cg136/ifp/chapter/what-should-happen-during-an-assessment-at-mental-health-services

Following the assessment you or the person you care for may be referred to Community Mental Health Team for ongoing support or a Crisis Resolution Home Treatment Team – depending on the level and type of support you need.

Community Mental Health Team:

A Community Mental Health Team is often made up of Social Workers, Nurses, Doctors, Occupational Therapists, Support Workers and Psychologists, their aim is to promote recovery.

Recovery in mental health can mean different things to different people, but the initial assessment will include questions about future plans and aspirations and the support needed to work towards achieving these aims.

As a carer you are welcome to attend the first appointment to support the person you care for and to contribute to the plan for recovery. From this initial meeting a Recovery Coordinator/Care Coordinator will be appointment to support the person accessing services throughout their involvement with the team to aim for a time when the person can be discharged from this service.

When it is appropriate to involve carers, it is recognised that they play an important role in the plan for recovery. There can sometimes be issues again around information sharing but, in this instance, carers can still pass on their observations or concerns to the Care Coordinator even if they can’t share all the information with the carer.

Crisis Resolution Home Treatment Teams:

Devon Partnership Trust have produced a leaflet containing information especially for Carers which can be read or downloaded from their website.

The leaflet explains the purpose of a Crisis Resolution Home Treatment Team – to support someone to manage and resolve their mental health crisis in their home environment as an alternative to being admitted into hospital. The CRHTT also support people who have been in hospital following their discharge home.

There are five Crisis Resolution Home Treatment Teams that cover Devon:

• Exeter, East and Mid Devon: 01392 674 988
• North Devon: 01271 443 222
• South Hams and West Devon: 01752 692 692
• Teignbridge: 01392 388 266
• Torbay: 01803 396 562

As a carer you should be encouraged to share your information, knowledge and experience with the team as this will help them in getting to know how best to support the person you care for.

It’s important to recognise that sometimes people do not give consent for their information to be shared with people caring for them and the team have to respect their confidentiality – but this should not stop you from being able to share your expertise with them as they can listen to your concerns and offer general advice.

With consent the team will involve carers with information regarding treatment and update you with care and treatment plans.

The Crisis Resolution Home Treatment Teams and Community Mental Health Teams often work closely together to provide the person accessing services the help they need to stay at home and remain living in their communities.

Sometimes, this may not be the most suitable place for the person to be cared for and so they may need to be admitted into hospital or encouraged to go on a voluntary basis for more intensive support.

There is an emphasis in supporting people in their homes and communities.  In September 2019, the Government published their vision for improved community based mental health services for adults and older adults – called The Community Mental Health Framework for Adults and Older Adults.

This initiative recognised that the model of care introduced over 30 years ago to support people live in their communities and stay in their homes, was in need of a review.

Local community mental health services have been given the opportunity to engage with people with lived experience along with a variety of mental health practitioners and professionals to re-look at the way mental health services are delivered, where they are based and how people would prefer to access them.

Community Mental Health services are, therefore at the heart of the NHS Long Term Plan to develop integrated models of primary and secondary care which will support adults and older adults with severe mental illnesses.

We are likely to see changes in the delivery of mental health services over the next five years, including improved access to Psychological therapies for people with a diagnosis of personality disorder and eating disorders.

We are fortunate to live in an area where our mental health services are open to change and willing to trial new ideas.

One of these initiatives is called:

Peer Supported Open Dialogue:

Open Dialogue is a form of treatment/therapy where a team (sometimes referred to as a network of people) selected by the person using mental health services to meet regularly. There is the opportunity to talk openly about individual  roles in supporting the person and the impact the mental health difficulty has on their lives/relationship in addition to how they can work together to aid recovery and regain independence for the person concerned to achieve their goals.  For the person with lived experience this is very empowering – restoring confidence in their ability to take back control over their mental health.

One carer I met recently told me it gave her the opportunity to be her son’s mum again, rather than trying to be his therapist or expert on his medicine or treatment plan.

Open Dialogue gives everyone a voice and has a mantra ‘Nothing about me – without me’.

There has been one trial of Open Dialogue in the Torbay area which has been so successful funding has been agreed for a second trial in another area of Devon.

DPT have produced two guides for carers which can be found on their website: www.dpt.nhs.uk

• Guidelines to sharing information between carers, family, friends and people using and providing mental health services.
• Our Carers and Families Strategy 2018-2021

Both documents provide very clear information on the policies concerned and give guidance on how carers can work with mental health services for the benefit of everyone involved in providing appropriate care and support.

PALS – Patient Advice and Liaison Service:

Not everyone has a positive experience as a carer who is caring for someone with a mental health diagnosis. If you would like to make a complaint or have your experience looked into as a carer you can call Patient Advice and  Liaison Service on 01392 675868 or email dpt.pals@nhs.net They are also very happy to hear when things go well too!

There are many other mental health organisations and services that carers and people with lived experience can access for support with their mental wellbeing including:

TALKWORKS:

Talkworks offer a type of therapy called Cognitive Behaviour Therapy (CBT) and some other types of therapy to help people manage their mental health difficulties – such as Depression, Anxiety, Panic Disorder, Stress and Specific Phobias to name but a few. More information and how to self-refer to this service can be found on their website: TALKWORKS.dpt.nhs.uk or by calling 0300 555 3344.

Devon Recovery Learning Community:

DRLC is a service provided by DPT that offers opportunities to learn about our mental wellbeing. They offer a huge variety of free courses for carers and the person with lived experience aiming to promote hope, opportunity and choice. Due to the Covid 19 pandemic many of the courses are being delivered virtually, but they are offering opportunities for face-to-face courses and drop-ins where you can enjoy a cup of tea/coffee and sit quietly if you prefer. The drop-ins are held at a few venues throughout Devon. Strict Covid regulations apply at these venues and more information can be found at: www.devonrlc.co.uk

ReThink Mental Illness:

Rethink are a charity provider of mental health services for people living with mental illness and those caring for them. There are several peer support groups throughout Devon who welcome carers and the person with lived experience, however if you would prefer to go without the person you care for that is fine too. The groups provide the opportunity to sit and talk to people who have shared experiences and so understand the challenges you may face as a carer. Rethink also produce easy to understand information sheets on many mental health issues including the Mental Health Act laws and regulations.

For more information and up to date Covid 19 restrictions please go to the website: www.rethink.org

MIND:

Another mental health charity who provide information and support for carers and people with lived experience on a variety of topics including carers rights. Please visit www.mind.org.uk to see all the support and information available.

DPT have made changes in staffing roles: by redeployment of staff to front line work

Restructuring of services: for example how community mental health teams operate. Teams divided into a small team who still carry out essential face to face work and those who are office based to make support calls.

Visiting acute wards: visits are considered on an individual basis, visiting requires careful planning and may be cancelled at the last minute due to circumstances outside of the hospital’s control. DPT have produced a guide for carers during the Coronavirus which can be downloaded from their website.

Shift from face to face support to telephone or digital platforms: like other health and care services face to face contact has been reduced. However, some face-to-face visits are still being carried out where this is the best thing for the person concerned and within all Covid 19 infection prevention and control guidelines.

Not all changes have been received negatively – in fact there have been some very positive responses to the changes in service delivery which have provided significant evidence for future design around how services are accessed and delivered beyond Covid 19.

For further information on mental health services in Devon – call us on 03456 434 435, or email info@devoncarers.org.uk or click on the ‘Ask button’ on our website to chat online with our Helpline. Or visit our webpage:

Mental Health