Takeaways from the Patient Friendly Mental Health Services: what do they look like? Conference Wrexham
17/05/2024 | Author: Dr Teri Howson-Griffiths
May 14th and 15th saw the Patient Friendly Mental Health Services: what do they look like? conference held at Wrexham University. Read on for an overview and some key takeaways and highlights!
On May 14th and 15th, Wrexham University welcome the Patient Friendly Mental Health Services: what do they look like? Conference, which aimed to address successes, opportunities, barriers, and challenges to creating patient-friendly mental health services through a range of perspectives and viewpoints. Here, I provide some key takeways and highlights from the conference.
The conference advisory group included patient and service users as well as carers, alongside support project services, to inform the focus of the conference to ensure it addressed key issues for those directly affected by and engaged with mental health provision through their lived experience.
On both days, there was a wealth of experience and perspectives in the room and online. Delegates included health professionals including from the Royal College of Psychiatrists, academics, trainees, as well as people with lived experience of mental health conditions accessing services alongside family members and carers, alongside a range of organisations, charities, and teams supporting or involved with providing mental health-related services and support.
Across both days, several workshops, an art exhibition, and informative stands by services and organisations provided insight into tools and activities supporting mental health and provided a positive picture of how charitable, academic, health, and arts organisations are all working towards the goal of improving mental health across Wales, the UK and internationally.
As well as highlighting what is good about current offerings, speakers did not shy away from the difficulties facing those providing mental health services and support. Below are some key thoughts and takeaways from the conference and the engaging, lively, and informative discussions on the topic of mental health services and provisions, that emerged during the two days of the conference.
Key takeaways
Some key themes emerged across the conference, here are my FIVE key takeaways that stood out from the excellent various speakers and talks:
1) There is a clear need for compassionate care that centres the person experiencing challenges with their mental health, bringing back the human and person to the central focus on mental health services and treatment
2) Recommendations for training for all levels of staff not just junior, as senior staff need reminding and support with this too and can help their trainee and junior colleagues
3) More needs doing around transition between Children and Adult Mental Health services to support people between the two and those who are currently being left ‘at a cliff edge’ a phrase used powerfully several times to describe the current situation
4) Taking an early intervention approach important both in terms of the longer-term wellbeing of the person as well as reducing costs to service. There is a need to take a holistic approach to cost savings – doing more in one area might save a huge amount in involuntary and emergency admissions when patients are having long term, continuity of care, particularly in community support – awareness needed that the person might be low risk BECAUSE of the work being done, and taking it away can do harm and worsen outcomes for the person
5) There are several areas for the arts to support in terms of architecture and design of building and services to make them patient friendly, as well as supporting therapeutically and as leisure (boredom came up a lot!) There is value in a range of approaches including community, grassroots, and self-organising arts and creativity, to professional artist interventions and creative therapies –a collective approach is a must for offering what is best for different settings and people.
Programme highlights
Arts and Health presence
We were delighted to be able to infuse the event with arts and creativity contributing a small exhibition of work from our Arts and Minds project across both days, and a workshop on Arts and Health on day one. In the workshop, Rebecca Hardy Griffith, Arts Council Wales Development Officer for Arts, Health and Wellbeing, expertly set out the all-Wales scene and the wealth of projects, activities and partnerships currently taking place across the nation to address a variety of groups and conditions, as well as general support for wellbeing. I was delighted to be able to share some of the work of the North Wales Health Board Arts in Health team, highlighting some of our projects around community and social prescribing, perinatal mental health, preventative and educational resources, enhancing healing environments projects, and ward-based provision. Mike Davies, Lead Occupational Therapist at Ty Llewelyn, presented the Arts and Minds project which is funded by Arts Council Wales and The Baring Foundation, and the successful work that has been taking place in a variety of art forms benefitting the patients currently residing at the unit. Mike also shared the project film and the team shared artwork created by the participants in a display for delegates to both see and hear some of the work generated.
Andrea Davies, Arts, Health and Wellbeing Project Coordinator BCUHB also provided a nature and creativity workshop, giving participants hands on experiencing of responding to nature through making. You could tell the people who emerged from the workshop by a sereness in their person and a smile on their faces, carrying their creations with them!
On day two, Christy Hoskings Patient Experience Lead Officer for Neurodevelopment Services BCUHB shared the 100 Stories project working with young people and families in the children and adult services system to help improve the quality of care, including the voice of those who have contributed stories and supported the project through their lived experience.
Speaker highlights
Day one:
Dyfed Edwards, BCUHB Chairman opened the conference with a warm welcome and provided context and scope for the conference for working together to improve the mental health and wellbeing of all, not only in North Wales, but across the nation and globally.
Dr Lade Smith CBE’s opening plenary lecture on What needs to be done, highlighted the importance of continuity of care to build trust over time and make health a partnership with patients. She suggested that current functional models leave patients navigating complex systems and create barriers that can worsen outcomes for all involved. She argued that continuity of care can reduce readmissions and be preventative, alongside compassionate care. I particularly agreed when she said it’s ‘about putting relationships back into the heart of care again’ and ‘It’s about designing services with people in mind’.
Prof Roberto Mezzina’s talk In memory of Franco Rotelli: the Impact of the Trieste model on services around the world shared the Trieste Model, taking a rights-based approach, he emphasised ‘the importance of freedom as a fundamental premise for care and maximisation of the human being’ and of multi-sectorial working e.g. house, occupation, social inclusion… problems are often interrelated and complex! Tackling crisis early can prevent emergencies, especially involuntary emergencies, and having a 24/7 service are key. He cautioned that the Trieste model has recently been under threat politically, so it is not a given that successful schemes will continue.
Brigid Cowen of Compassionate Mental Health noted how we shouldn't need to put phrases like 'person-centred', 'patient friendly' or 'compassionate' in front of healthcare, it should be centred in how we lead and deliver. She stated that ‘when you traumatize people through your services you destroy trust’, and there is a need to model how safe, kind care looks and feels like. Supporting staff with vicarious trauma is key, alongside a need for emotional intelligence and support, and training. She mentioned the importance of design and that attending to the environment can help.
Day two:
Prof Maria Hinfelaar, Vice Chancellor of Wrexham University, offered a receptive opening, citing the recent OCD report on how to make societies thrive – ‘being fit and healthy in body AND mind links to our wellbeing in multiple ways’, and the ways our economic and social status amongst others can impact our health both in body and mind ‘when one area goes off, often others do too’. She highlighted that the University is working to become a trauma-informed institution and is asking what the university can do to try to play its part so staff and students can be active and full citizens despite some of their challenges. She highlighted several projects which they are partnering on, all which involve creativity and the arts such as: 100 Stories with BCUHB, Children’s University raising aspirations and reaching communities where there are barriers to well-being or aspiration, Social Prescribing encouraging students to spend time outdoors, and the 2025 movement with voluntary services and the local authority asking what we can all do together to address society challenges. It was an uplifting start to the day ahead of several speakers addressing some of the difficulties for the sector.
Dr Chloe Beale’s talk on Exclusion Culture in Mental Health Services was incredibly powerful around challenging toxic cultures and systems and recognising the individual professionals’ contributions to these, sometimes harmful ways of working. She called for professionals to recognise that they have more power than patients to help, challenged the way Healthcare systems seem focused on how to keep people out with extensive exclusions, and questioned who the criteria keep safe, the patients or the professionals? She spoke eloquently on the way that there is a pretense that risk can be predicted when research states that it isn’t done well around intent or impulse or identifying low risk. She highlighted how the third sector is often carrying more risk than trained professionals in statutory care as a result, as they will take on risks that the sector won’t and often do it better because they focus on the care of the person. She also highlighted concern for clinicians' compassion – becoming drained and losing sight of the person behind rejected referrals, a notable quote - ‘A waiting list is not a privilege to sit on’. She called for honesty about individual and systemic limits when speaking with patients, senior staff supporting junior and trainee colleagues in having honest conversations with patients about what is available and when (and what isn’t). Dr Beale’s talk resonated with the audience and in the Q&A there were some profound responses shared including a patient reflecting on their own experiences of coercive care, and professionals accepting the challenge to the sector for improvements.
Prof Swaran Singh of Warwick University’s Journey from child to adult mental health services: a view from the bridge about the MILESTONE project, gave an oversight of this longitudinal European study which followed young people who reached the adult services transition boundary and followed them for 27 months. The research showed how services prioritise differently and look differently across nations. He raised the high numbers who discontinue care, raising queries around the high bar of adult services for young people not considered ‘care worthy’ for adult services, or whether Children’s and Mental Health Service (CAMHS) teams were holding onto certain cases longer than they should be. The findings showed that young people and their families are not well prepared for CAMHS care ending, were not receiving appropriate care, or were put off accessing further care. The study also showed that a managed transition group seemed to get better faster versus a control group, and the cost for this kind of intervention is small, around 23-111 euro per child. Of note, was the quarter of young people experiencing worsening health during this time, and that those with ADHD seem to have a particularly bad transition. Prof Singh offered some helpful recommendations including transition workers astride CAMHS and Adults services teams – and cited Birmingham who are developing a 0-25 youth MH services model, as one to watch.
The debate on whether Current inpatient care is intrinsically abusive, moderated by Prof Catherine Robinson, provided a vigorous, respectful debate and exchange amongst the proposers for each side, Prof. Rob Poole, Prof. Peter Lepping, and the ensuing discussion. It was clear from the polls taken both before and after the debate that there are highly contested opinions on current inpatient care.
The final plenary lecture - Coercion in mental health care in the United Kingdom: how are we doing? - gave an overview of the global picture. Dr Andrew Moloydnski presented that across the globe legislation around mental health varies greatly; citing the Mental Health Atlas 2020 which includes country data for 85% of the world – treatment of Mental Health is tied in to differing social, cultural, familial, and historical approaches and attitudes. Many units in the UK, for example, use air locks, high fences, and special doors, which some see as harmful measures, and yet, by contrast to other countries, he argued that UK services might seem more advanced in comparison. There was a mention for creativity when he highlighted Steiart et al's 2019 framework which includes the importance of therapeutic and leisure time within services – an important area our sector can contribute to by providing meaningful activity and engagement, enjoyment, and stimulus.
Overall, the conference provided useful insight into the current picture of mental health provision, not just in the UK, but globally, and was a balance of seeking to identify and understand the challenges as well as offering solutions and further points of investigation to improve mental health service’s patients’ experiences. It was great to have an arts and health presence across both days and see connections with arts and creativity within some of the plenary lectures and talks. The key takeaways provide insight for our sector for how we can imaginatively intercede with improving mental health services for patients through arts and creativity.
