Touchstone

Kirklees Mental Health Advocacy Service

Annual Report 2011-2012

EQUAL, HONEST AND COLLABORATIVE WORKING

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Introduction Touchstone's Advocacy Service in Kirklees helps people who are experiencing problems with their mental health to speak up for themselves, and to use their knowledge and experiences to help other people. We mainly work with people who are in contact with a Community Mental Health Teams (CMHTs), or whose care is being co-ordinated using the Care Programme Approach. We have an office in Dewsbury, but we work across the whole of Kirklees area. By focusing on the strengths people bring, and what they enjoy, we build people’s confidence to tackle some of the things they are not so good at. We want our service to be a place where paid staffs, volunteers and service users collaborate, to find and build on what they are good at, as well as looking at the things they could use help with. The service combine a strengths based assessment of individual needs, 1:1 support, and group activities. These group activities focus on building knowledge, confidence and the ability to offer support to other people seeking advocacy, or support with working out what they want to say. Peer support and opportunities for shared learning enable people using the service to reflect upon their own experiences in ways that will enable them to influence the way services are run and experienced in future. These activities are designed to

recognise people as assets

build on existing strengths

look at what people have to offer as well what they need

build strong networks of peer support

blur the boundaries between who is helped and who gives help

Facilitate changes in all aspects of the mental health system. By adopting this co-productive approach, the service will not only provide advocacy to individuals, but also enable those same individuals to better engage in their treatment and recovery, to offer training and support to others, and equip them to evaluate and assess the effectiveness of the help they receive.

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Developments We started delivering this service in April 2011, so there’s been a lot of setting up to do. After we’d found a place for ourselves at Fusion Housing, we needed to generate publicity and to help people find out what we did and how we might help them. We produced a website, leaflets, posters and other publicity materials to help spread the word. As Touchstone was new to Kirklees, we needed to introduce ourselves to all the mental health support services across the area, to find out how what they did and how we might be able to be helpful. We also needed to “sell” our way of doing advocacy and help people understand how and why it was different to what had gone before. Our model of Advocacy is very different from the one that was used before. It puts less emphasis on people receiving support from professionals, and more on helping people to learn from each other. People with experience of poor mental health often face many barriers to getting their voices heard, or can feel surrounded by people who say they know what’s best for them. We think good advocacy means giving people the confidence to speak up and speak out – either on their own, or with the help of someone they know and trust. This does not always need to be a paid professional. We think people with direct experience of the mental health system can offer this too. So, in the last year we have met with all of the community mental health teams, and hospital wards, as well as holding discussions with Service User groups, and the many voluntary community organisations that also support people with their mental health recovery. These were the five North and South Kirklees CMHTs, North and South Kirklees Assertive Outreach Teams AOTs, IAPT, Crisis Team, Supporting People, ADHD Team Aspergers Syndrome /Autistic Spectrum Assessment Team, Dual Diagnosis, Vocational Team, Pathways day services and the North and South Dialogue groups. We have set up self-advocacy and group advocacy groups which meet once a week in Dewsbury and Huddersfield. These groups combine social activities with learning new skills, or hearing and learning from the experiences of others. We have trained and supported more than six volunteers to assist in the delivery of the service – amounting to more than 995 hours of support. In autumn 2011, we collaborated with the people who use our service to come up with a way of measuring how good we are at helping people. Taking our cue from them,

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and from some of the great work done by St Anne’s Carer’s Team, we produced an Advocacy Star – reflecting the aspirations and priorities of the people we work with. It was important to us that we developed this tool for assessing people’s needs with the people who would be using it, to make sure we got it right. There’s more information on what we did later on in this report. Barriers and Challenges We have a particular interest in helping people take charge of their own recovery and to take advantage of Self Directed Support (aka personal budgets). We have been surprised at how few people currently receive a personal budget, and we are very keen to help people get more choice and control over the care they receive. We would like to do more work in this area. We have also been surprised at how few referrals we have had from community mental health services. Obviously, we are pleased that lots of people make contact with us directly, but we believe that empowered informed self-advocates can really help mental health workers do their job better, too. When people have the kind of support plans that really work and that everyone understands, we believe recovery is more sustainable. So we’d like more referrals from Community Mental Health Teams. People from Black and Minority Ethnic (BME) communities often find getting what they need from mental health services difficult, for lots of reasons. We’ve been very pleased at the number of people from BME backgrounds who have sought support from us - about 36% of all the people we have helped. Although it’s not always been easy, we have managed to provide bilingual advocacy to everyone who has asked for it.

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Outcomes

Social Networks

The service with service users set up peer advocacy groups, group advocacy groups and advocacy networks where people engage in activities they enjoy and are encouraged to build and sustain old and new relationships, support each other, and to share their experiences, expertise and time.

Average Improvement: 7.5%. People experiencing severe mental health problems sometimes relapse and can find it difficult to get out. Our groups help people to make rewarding relationships, help others and expand their social networks.

‘I have reduced my isolation by coming to peer/group advocacy meetings. I have developed confidence to meet new people, strangers to me and make positive steps to establish contacts reaching out to friends and family members I had fallen out with.’

Supporting each other through peer advocacy sharing our knowledge, experiences, skills and time over a cup of tea.

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Housing

The service also helps people to hold on to their homes: people sometimes struggle as a consequence of mental health difficulties, substance and alcohol abuse, problems with money /bills or if they have lost employment. We have provided advocacy support in meetings with housing services, landlords, neighbours, the police and employers.

Average Improvement: 27%: The service successfully advocated for people moving from residential homes to independent living, who lost their tenancies, suffered antisocial behaviour from neighbours, lost employment or had benefits and financial difficulties due to mental health difficulties.

Physical Health

The service provides advocacy support to people whose physical health affects their mental health and wellbeing. We support people to lead healthier life styles e.g. Stop smoking, drinking, drug abuse, conscious of healthy eating by providing them with information, and encouragement and helping them link to services where necessary.

Average Improvement: 7.5% Physical health is directly linked to mental health as a result relapse affects people‘s recovery.

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‘I experienced anti-social behaviour being harassed by my neighbours because of my mental health difficulties. [The advocacy service]. Supported me in meetings with housing department officers, the police…and my neighbours, so as to find an amicable solution. Finally I moved with my family to a new safe property where there is peace and quiet ‘

‘I am now able to understand and listen to my body and able to tell when I am about to relapse and seek treatment. When becoming unwell I turn to gambling’

Are you interested in dog walking? We can support each other in a group doing the things we enjoy most.

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Education & Training and Social skills

Through peer and group advocacy groups people encourage and support each other to return to education and training, volunteering and attend mainstream educational training for basic living skills e.g. computer, art, craft at Pathways.

Average Improvement: 12%: There is a significant improvement but some people are scared of going to educational settings to meet new people. We help people voice their concerns, and help them overcome their difficulties.

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‘I am highly educated to degree level. I lost jobs and my social functioning skills due to mental health problems. I do not need to return to education and what I need is to regain the lost social skills and my housing and financial problems to be sorted.’

Come let’s form a poetry reading group where we can meet new people and help each other with advocacy issues.

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Self & Peer Advocacy

Our peer/group advocacy groups help people to learn from each other. We facilitate sessions where people can reflect on their own experiences by helping others gain self and peer advocacy skills to advocate for themselves and others. By sharing experiences, and challenging the views of others, we reflect on how cases could have been handled differently, and how we might do better next time.

Average Improvement: 40%: There is a great improvement in this domain because people are often motivated to self-advocate and advocate for others when they are discharged from hospital with advocacy support. Four service users have successfully completed the Touchstone Volunteering training programme and are now providing support to other service users as peer advocates and advocacy group facilitators.

‘I received advocacy support on my discharge and tribunal meetings, …[I] went on to train as an advocacy volunteer with the Touchstone Volunteering Project. I am now providing advocacy support to other service users and help out as an advocacy facilitator’

Confidence

Most of the people we work with only want advocacy support to help them with their discharge from hospital, and in professionals meetings. On discharge, many do not come to attend peer/group advocacy or experience confidence building activities. We want this to be different, as many of the people who do find ways to support others through peer/group advocacy report being better able to control their own thoughts, anger, fears, frustrations and anxieties.

Average Improvement: 0%: The service supports people by referring them to other services for anger management and confidence building sessions with other service providers like S2R.

‘While I have the confidence to speak for myself and others I find it difficult to speak out for myself in meetings where there are too many professionals who use medical jargon and tend to decide things for me. When I fall ill again/relapse I lose all the gained confidence’

‘I received advocacy support on my discharge and tribunal meetings, …[I] went on to train as an advocacy volunteer with the Touchstone Volunteering Project. I am now providing advocacy support to other service users and help out as an advocacy facilitator’

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Speaking Up for Myself

The service supports and encourages people to speak up for themselves telling people what they want, making their voices and choices heard, working out what they want and how to organise themselves better. People learn the different ways of speaking up for themselves e.g. planning what they want to say, using pictures, and writing out their concerns.

Average Improvement 22%: Outside the hospital and in everyday life situations people speak out for themselves, but many still have problems in formal settings when surrounded by professionals.

‘I received advocacy support on my discharge and tribunal meetings, …[I] went on to train as an advocacy volunteer with the Touchstone Volunteering Project. I am now providing advocacy support to other service users and help out as an advocacy facilitator’

Emotional/Mental Wellbeing

The service helps people to be in control of their care and support, and ensures that they are listened to and involved in decision making on all matters. Understanding their rights and building confidence enables people to exercise greater control over their mental health difficulties and to trust in what works for them.

Average Improvement: 23%: There is a marked improvement, unfortunately people‘s health deteriorates when readmitted back to hospital after relapse. support service

s are if I need help.’ Community Participation

The services continue to support and encourage people to be involved in taking part in things taking place in their communities so that they meet and help each other feeling valued and appreciated for their contributions.

Average Improvement: 14%: There is a significant improvement. Due to mental health difficulties some people find it a daunting task to be involved in mainstream activities taking place in the community.

‘I am now stable, managing my mental health and wellbeing making positive choices about my mental health and wellbeing. I know where support services are if I need help.’

‘I can speak up for myself as an individual and as part of a group to defend my rights as long as other people are prepared to listen. Unfortunately when I do so I get sectioned by professionals who argue that I will be expressing delusionary thoughts’

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‘I am as busy as a bee taking part in a number of activities in my local area ranging from volunteering looking after another service user, doing my cleaning job, going to see a psychological therapist, going to Pathways and attending events in the community. I am well connected and feel occupied and valued which keeps me going able to cope with my panic attacks and anxiety.’

Support Services

The service continues to promote co-productive working between service users, their friends and families, professionals, agencies and services providers in an open honest and reciprocal way, a collaboration of equals.

Average Improvement: 22%:Advocacy has enabled people to achieve greater dialogue and collaborative arrangements with statutory and voluntary services e.g. Social Care, Children services, CMHTs, Richmond Fellowship, St Anne’s etc.

‘I feel empowered, involved in decision making as an equal partner in services in my treatment, support and care getting the kind of support I want although some professionals want to decide things for me.With advocacy support I was listened to and my views were sort as I went through ECT treatment.’

‘I am as busy as a bee taking part in a number of activities in my local area ranging from volunteering looking after another service user, doing my cleaning job, going to see a psychological therapist, going to Pathways and attending events in the community. I am well connected and feel occupied and valued which keeps me going able to cope with my panic attacks and anxiety.’

With advocacy support I have returned to volunteering and employment and take part in the service user involvement group.

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Table of Changes, by Advocacy Star domains 2011/12

Social Networks

Housing Physical Health

Education & Training

Self & Peer Advocacy

Confidence Speaking Up For Myself

Emotional/ Mental Wellbeing

Community Participation

Support Services

Average 1st Assessment

5.3 5.0 5.0 5.7 4.3 6.0 4.7 4.3 4.7 4.7

Average 2nd assessment

5.7 6.3 5.3 6.3 6.0 6.0 5.7 5.3 5.3 5.7

Average Change

0.3 1.3 0.3 0.7 1.7 0.0 1.0 1.0 0.7 1.0

% Improvement

7.5 27 7.5 12 40 0 22 23 14 22

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Average Changes, by Advocacy Star domain, 2011/12

Future Developments: In future we are looking forward to:

Continue developing the Advocacy outcome star with service users and other mental health services providers in Kirklees.

Make particular efforts to address and boost people’s self-confidence issues.

Continue establishing peer/group advocacy closer to where people live e.g. Wakefield, Batley, Mirfield, and Halifax etc.

Establish peer/group advocacy for informal patients on ward at Priestly Unit ward 18, Ashdale ward 3, and Wakefield hospital.

Match the numbers of people using the service with numbers of advocates, guided by the demographics of people experiencing mental health challenges in Kirklees.

Recruit more female bilingual advocates, in order to provide a culturally sensitive and appropriate service.

Ensure that welcome packs (with information on support services) are readily available and accessible to people on admission.

Continue to develop co-productive working arrangements between service users, professionals and service providers and establish collaborative working as we have done with St Anne’s, Richmond Fellowship and the Independent living Team etc.

Widen the understanding and use of peer and self-advocacy approaches amongst people working with people experiencing poor mental health.

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Annual Statistics Gender of Advocacy clients 2011-2012 (actual numbers)

Ethnicity of Advocacy clients2011-2012 (actual numbers)

Age of Advocacy clients2011-2012 (actual numbers)

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Finance The total value of this contract is £51,295 and comes from both NHS Kirklees and Kirklees Council. This is how we have spent this money. All the figures are in £s.

Expenditure 2011/12

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Vision and targets for 2012-2013

In the next year we will be looking to

Increase numbers of referrals from Community Mental Health Teams

Increase the amount of work being done around Self Directed Support

Increase the number of volunteer advocates (especially women)

Provide opportunities to volunteer advocates to get paid work in mental health support settings

Increase the number of self-advocacy and peer advocacy groups

Continue to refine the Advocacy Outcomes Star

Explore membership of Action for Advocacy, and achieve a quality mark

Provide a greater array of training and development sessions for advocacy group members

Undergo a Quality Audit Inspection by Touchstone Service Users, to ensure we are as good as we say we are.

Undertake a SRO1 evaluation of the service in Quarter 2.

For more information or to find out more, contact us at

Touchstone Kirklees Advocacy Service Dewsbury Business Centre 1st Floor Office 13 Wellington Road Dewsbury WF13 1HF Phone: 01484 490 130 Email: advocacy@touchstonesupport.org.uk Website: www.touchstonesupport.org.uk