Mental Health and the Welsh Ambulance Service Trust

This week’s guest post is from Isobel Jones, who works for the Patient Experience and Community Involvement team for the Welsh Ambulance Service NHS Trust. I first met Isobel at a Welshpool meeting of the Stand up! For emotional health and wellbeing project run by our team where she introduced us to her work. I caught up with Isobel lately and asked her if she would tell us more about her role for the blog. 

What led you to this particular role at Welsh Ambulance Service Trust? 

I come from a Social Care background, and have also worked in the Third Sector, however, throughout my various roles I realised that I was becoming more and more interested in engagement. Involving people in shaping the services they receive can only help develop better services. It just makes so much sense. 

In some of my past roles I had been asked to undertake some projects which had enabled people to be involved in the planning and development of the services they received and I found these projects very insightful and interesting.

I followed this idea further by attending training courses which explored effective participation and engagement skills, and they gave me the tools and techniques to do this.

When the job was advertised within the Welsh Ambulance Service’s Patient Experience and Community Involvement Team I was excited as this was just where I could see myself. I hadn’t looked at it from a Health perspective before so I knew this would be a new challenge.

How do you educate patients and the public about the services provided by the Trust?

We have an extensive engagement model, which allows us to reach different groups and communities. We use our partners in the Health Boards, statutory, third sector and other community links to be able to engage with different people who may have used our broad range of services. It is important to go where people are. We’ll also host information stands at a range of events across Wales that helps us to talk to local people.

We then arrange to go out to meet people in these different groups and talk about our services, which includes awareness about how we respond to and prioritise 999 calls. It is important when we visit groups that we listen to people’s experiences and their stories, and encourage people to give us their feedback.

We make people aware of how they can ‘Choose Well’, by accessing a range of health services available from GP, Out of Hours, Pharmacies, A&E Units and Minor Injury Units. We also talk about self-care, and using services such as NHS Direct Wales for telephone and online advice.

My work involves engaging with mental health groups, older people and people living with dementia. I have also visited learning disability groups, schools, groups with specialist health needs like Chronic Obstructive Pulmonary Disease and other respiratory conditions, Parkinson’s, Multiple Sclerosis and various Black and Minority Ethnic (BME) groups.

We have a continuous engagement model which gives me the opportunity to visit groups again and again, building up trust and encouraging people to stay involved with us as a service as their contribution is so important. 

I was also given the opportunity to train as a Community First Responder for WAST which I completed in March last year. With this training I am equipped to provide awareness sessions for community groups about how to undertake emergency first aid to support saving a person’s life, by learning in basic steps what we all can do to help someone when they face a life threatening emergency like a cardiac arrest, how to use a defibrillator, what to do if someone is choking, or needs to be placed into the recovery position until the ambulance arrives.

If someone being transported by WAST is experiencing mental distress, what support is provided by staff?

All our staff should support such a person with the utmost of dignity and respect, recognising that whilst with physical health conditions these are often visible, not all health conditions are visible, especially mental health and wellbeing.

Our staff will have followed any assessments of need that are in place for mental health, including local pathways which are in place which have been agreed in partnership with local services.

WAST Staff are currently going through a training programme focusing on mental health.

What kind of training do Trust staff have to help them support someone in mental health crisis?

The new WAST Mental Health Strategy which has recently been formed is very clear that there needs to be more training for our staff on the needs of people who experience mental ill health, and for our staff to be more aware of how to treat people who call 999 in crisis. This has come out of the fact that staff have acknowledged there is a need for this, to benefit people with mental health needs.

Tell us more about the Trust’s Mental Health Improvement Plan

People who access mental health services have told us that these things are important:

• Don’t ‘generalise’ mental illness. 
• Consider my communication needs.
• To be seen as a human being.
• Need calming, understanding and polite approach for people experiencing panic. 
• To be respected and treated equally. 
• Be listened to and believed. 
• Listen to carers as well as the person needing medical attention. 
• Staff need knowledge and awareness of mental health issues. 

Our staff have told us:

• We need a “better process for responding to patients in crisis.” 
• We need “up to date evidenced based training.” 
• We need “better links with crisis teams.” 
• There are “inconsistent pathways across Wales.” 
• There is a “variance of support across the localities.” 
• There is a “lack of suitable alternatives to A&E.” 

Our staff need support on how to maintain their own mental health, how to prevent stress and sleep problems, ensure good nutrition avoid substance misuse, etc.

Because of this, these are the priorities we have set for our plan:

Priority 1: Putting you at the centre

• Everybody is different and has different unique needs and experiences of mental health at different ages. 
• Specific work needs to be done around children and young people’s needs. 
• Think about the needs of people with dementia and of people with fluctuating mental capacity. 
• Supporting those who are at risk of suicide and self-harm. 
• Caring for those who may misuse substances. 

Priority 2: Training, awareness and skills for Welsh Ambulance staff

• What do our staff need to know about mental health in terms of training, attitude and approach? 
• Understanding people’s unique mental health needs (and the spectrum of mental health disorders).

Priority 3: Working better with other professionals

• Working better with GPs, hospitals, local community support services, Health Boards, carers, family, social services. 
• Working with trained mental health practitioners to support our frontline teams.
• Developing alternative pathways for people experiencing mental distress. 
• The purpose of these pathways is to make sure you are seen by the right person at the right time. 
• Where possible get appropriate help in the community, rather than a hospital setting. 
• Only considering hospital settings if physical health is at risk.

Priority 4: Caring for the wellbeing of our staff

• Putting support systems in place.
• Having mental health advocates. 
• Helping staff cope after traumatic incidents.

For our staff we need to maintain optimum mental health, sleep, exercise, nutrition, management of alcohol intake, etc.

Priority 5: Dealing with challenging situations

If an ambulance staff member is facing violence in an extreme situation, we will assess the risk and decide when it is appropriate to restrain someone to keep them and staff safe.

Priority 6: Giving necessary guidance and support to teams

• We have people within Welsh Ambulance Service who lead our mental health work. 
• We need to make sure staff are supported and have the right supervision to develop knowledge and skills about mental health.
• This is for the benefit of all people who access mental health services as well as to support Welsh Ambulance Services staff.

Which other organisations do you work closely with in Powys to provide support to people? 

So far, I have only worked with ‘Stand up! For emotional health and wellbeing’ in Welshpool. I would love the opportunity to network with and meet other groups in Powys so please get in touch!

We have visited many groups that support individuals with mental health and wellbeing concerns across Wales, but we would like more opportunities to speak to people in Powys. Have you used our services and would you like to give us feedback?

We would also appreciate your help to enable us to further develop our services as part of our Mental Health Improvement Plan. If you or your group / organisation are happy to receive a visit or take part in a focus group, please contact me (details below). Your views and experiences are important to us to help shape the way we work and how we support people.

What is the most challenging aspect of the job?

Sometimes it is the amount of travelling, as I travel all across Wales!

But in the main, it is making sure I listen carefully to what people tell me, and make sure I understand what is important to them. The challenge then is to make sure that voices are heard within the organisation in such a way that can make a real difference to the way we do things in the future.

To do this effectively it is very important to be a very open, friendly person, showing kindness and respect for any person who wishes to talk with you. I feel I need to show in my face and my body language that integrity is important, and that I can be trusted.

Sometimes people are angry and hurt, for good reasons, by their experiences.

I know they are not taking this out on me personally, it is important to understand why people say what they say, in the way they may say it. It is important for me to convey in a calming manner, acceptance and acknowledgement of how people are feeling and for people’s hurt feelings to be validated. 

Tell us about some of the most rewarding work you have done at WAST

Over the last year I engaged with a wide range of groups across Wales who supporting people experiencing mental health issues from many backgrounds.

Whilst most people reported positive experiences of having used emergency ambulances and non-emergency services, their suggestions were both insightful and helpful, as were the thoughts and observations from support workers and other professionals. 

I was given the opportunity in July 2017 to attend the WAST Trust Board and provide feedback on all of the engagement work I have undertaken with mental health groups and organisations across Wales. This presentation was well received by executive leads and managers in WAST. I was able to convey thanks to all the individuals with mental health concerns, organisations and staff who have shared their (sometimes very painful) stories with me. This opportunity allowed all of these voices to be heard, which contributes toward improving outcomes for people who use our services.

Another piece of work I found really rewarding was with people from the learning disability community where I was involved in setting up a drama group. This was a group of individuals in Caerphilly who worked in partnership with us to use drama to understand some of the barriers they experience when they ring 999 for an ambulance. During a celebration event in Blackwood, the drama group, which consisted of people with learning disabilities, showcased scenarios with real live call handlers, paramedics and community first responders.

What is the most valuable thing you have learnt since starting your role?

I am always totally humbled when people I have only recently met open their heart with sometimes very painful stories to me. I always try to do my best to do justice to what people tell me, so that it really makes a difference. We want to listen to people’s stories and experiences of using our services, and to capture feedback from people to improve our services.

Also since I trained as a community first responder volunteer myself back in March last year going on an emergency ambulance ride out with a crew from Hawthorn Ambulance Station to observe the experts in full flow to help consolidate my training has also formed part of my continuing journey… The day progressed with themes of falls coming up at least twice, sepsis also twice, breathing difficulties and presenting chest pains which may have been related to post traumatic anxiety, stress or other mental health concern. There was a lot to be learned about the needs of carers as well. What if they themselves need medical treatment and to be admitted but they are worrying about what will then happen to loved ones they care for, who may have dementia, a mental health condition, a physical or a learning disability, or in fact any combination of these? Colleagues shared with us about these dilemmas, as sometimes it is not just about the patient, but it was about their family as well.

When you are not working for WAST, how do you enjoy spending your time?

I love cooking, especially making jams, marmalade, herb jellies and chutneys. I gift wrap these and give them as presents. I also sell them to raise funds for charities.

I love walking and the outside world, animals, wildflowers, plants and nature, and especially my garden where I collect and grow loads of plants, shrubs, flowers and herbs. These interests often inspire me to paint watercolour pictures, play the guitar, write, sing and perform songs and poems. So this is just a little bit about me!

Many thanks to Isobel for telling us all about her role. You can contact her by ringing: 01792 776252 Ext. 45444 or emailing: isobel.jones@wales.nhs.uk