Touchstone Kirklees Mental Health Advocacy Service

Annual Report 2012-2013

EQUAL, HONEST AND COLLABORATIVE WORKING

Introduction
Touchstone began delivering the Advocacy Service in April 2011. A summary of our previous work can be found in the Annual Report for 2011/12. This year, our aim was to strengthen our model of collaboration and co-production, and to demonstrate the quality of what we do, by building on the successes of the previous year. You will find in this report the themes of volunteering, mutual learning and support, as well as a commitment to proving the wider benefits of an approach which encourages citizens to speak up for themselves, to assertively demand their rights, and to support others around them. Our Social Return on Investment exercise was a way of trying to work out the wider benefits of what we do, and attempting to put a price-tag on it. Although we may not all be professionalised advocates we take the quality of our work very seriously indeed. We regularly look at the impact our services have on excluded or marginalised groups (e.g. Black and minority ethnic; lesbian, gay, bisexual and trans people) or people who are under-represented in our service, in order to see how we can make things fairer. We undertook an internal Quality Audit, which was led by people who use Touchstones Services. A group of service users came to inspect the service and demanded we produce evidence that what we do is safe, fair and collaborative, and that we learn from our mistakes and make keep accurate records of what we do. They were very pleased with what they found. Perhaps our greatest challenge this year has been meeting ever increasing demand for what we do. Most people approach our service because they have a pressing need to sort something out to leave hospital, to get their housing sorted or to change the way in which they are supported. However, too much emphasis on helping people 1:1 might mean we give less time to developing and growing our group support work, and the development of Peer Advocacy. As you would expect from a service built on the principles of co-production our solution emerged from discussions with the people who benefit from our service, and the peer advocates (see page 3 for more details). We were pleased to find such a sensible We hope you enjoy the story of our service over the last year, as much as we have enjoyed working to make Kirklees a warmer, friendlier and more supportive place for everyone.

General Developments
Our model of co-productive Advocacy is very different from some other, more traditional models of advocacy where someone seeks help from a professional advocate, who speaks on their behalf, in their best interest. Touchstones way of doing Advocacy delivers a more deeply collaborate experience. We still provide traditional 1:1 advocacy, but we also spend a lot of time trying to help people to find their own voice to advocate for themselves by encouraging them to share their experiences and to support other people with advocacy needs. We think our model promotes collaborative, equal, honest, reciprocal trusting relationship between the service users, their families, friends, peers, and neighbours paid workers, professionals and service providers. The service guided by principles of co-production is cautiously developing coproduction in all aspects of service delivery and design by: Recognising people as assets Building on peoples existing capabilities Promoting mutuality and reciprocity Developing peer support networks Breaking barriers between professionals and recipients Facilitating rather than delivering the service Our self-advocacy and group advocacy sessions meet once a week at our offices in Dewsbury, and at Folly Hall in Huddersfield. These groups combine social activities with learning new skills, or hearing and learning from the experiences of others. We currently support a team of eight peer advocates who help us to deliver more than 58 hours of peer support each week. The peer advocates provide one to one peer support, and support and facilitate group work. Touchstones volunteer co-ordinator provides additional support to these peer advocates offering ongoing training and support with new skills like working with people who dont speak English, or helping to manage risks. Early in 2012 we found that we were facing capacity issues. The service was designed to support a maximum of about 100 people, and we were getting very close to this number. Many of these people were no longer in need of day-to-day advocacy support, but were still fearful of being discharged of losing the support they found in

the peer advocacy groups, and in the ability to pick up a phone and speak with an advocate without having to re-refer themselves. After discussions with individuals, groups, peer advocates and others, we agreed that each person we support would have their case reviewed every 3 months. When people had achieved their agreed outcomes, we would close their file if they wished it to be closed. However, for those people who did not wish for their cases to be closed we decided we would refer to Active members: those who continue to play an active part in peer/group advocacy networks, and Members: people who after receiving advocacy support dot not want to give back to the service but would call the service as and when they require advocacy support. We are pleased to have found a way of describing the status of people who sometimes want a little advocacy support and which allows them to keep a link to our service, without this affecting our ability to receive and act on new referrals. Other achievements of 2012 -2013: We increased the numbers of referrals from Care Management Mental Health teams We increased the numbers of women peer advocates We were successfully underwent a Quality Audit Inspection, led by Touchstone Service Users to ensure we are as good as we say we are We carried out a Social Return on Investment audit with the assistance of people who benefit from our services, referrers and commissioners. We worked out that for every 1 spent on the Advocacy service, we generated a return of 3 We completed an Equality Impact Assessment Appointed a paid female advocate and recruited more relief worker advocates. We expanded the capacity of the services and worked with more than 138 people.

Barriers and Challenges Some of our ongoing challenges include a) Breaking barriers between professionals and recipients Some people still expect mental health services to tell them what to do, and that their involvement is nothing more than ongoing consent. Similarly, some people who work in mental health services still seem to find it easier to present people with plans of care, drawing on their own knowledge and understanding of a persons best interest rather than helping people to work things out for themselves. This day-to-day imbalance of power between Professionals and Patients, however well intentioned, remains an enormous barrier to people taking control of their own lives. b) Demand for one to one advocacy Most of our referrals come from people who need one to one advocacy support with support speaking up for themselves in meetings with Professionals e.g. ward rounds , discharge meetings , managers meetings , tribunals, CPAs etc. As we have explored above this has sometimes put pressure on our small staff team, and impaired their ability to develop the capacity of peer/group advocacy networks. c) Geographical distribution of Kirklees The vast expanse of Kirklees means that the one advocate and relief advocate workers have to travel long distances to reach out to people needing advocacy. This sometimes makes it difficult to see people face to face as soon as they would like. It also makes their participation in peer networks difficult if they do not have access to transport. d) Equal provision and access of the advocacy service People from Black and Minority Ethnic (BME) communities often find getting what they need from mental health services difficult. This can be for lots of reasons such as language barriers or services who find it difficult to responding positively to cultural differences. We are very pleased at the number of people from BME backgrounds who have received our support - about 30% of all the people we have helped.

Outcomes
Social Networks The service has strengthened peer support, group advocacy and peer networks. Service users set up peer advocacy groups to explore areas of particular interest (experience of being on Ward, effective discharge, CPA meetings, managing safety) group advocacy sessions. In these peer advocacy networks, people are free to set their own agendas, and where they are encouraged to to build and sustain relationships new and old and to support one another through shared experiences, expertise and time. Average Improvement: 14%. People experiencing severe mental health problems can sometimes find themselves isolated people from friends and family - through hospital admission or other circumstances. Our groups help people to make rewarding relationships, help others and expand their social networks. I can not imagine where I would be without the peer support I receive from my
friends and two neighbours. They are always there for me as I am for them. We do things together e.g. go shopping, play bingo, volunteer at a local shop and accompany one another to GP appointments and medical reviews. At old age we can continue to live our lived experiences if we can access Self Directed Support (SDS) to fund those activities we enjoy most to remain active and reduce hospital admissions

Supporting each other through peer advocacy, sharing our knowledge, experiences, skills and time. Ours is an equal, honest, reciprocal relationship that keeps us going

Housing The service provides advocacy support to people struggling to maintain their tenancy due to many factors the consequences of mental health difficulties; substance and alcohol abuse; problems with money /bills or harassment; bullying and discrimination. We have provided advocacy support in meetings with housing services, landlords, neighbours, the police and employers. We have also provided advocacy support to enable people to move from residential supported housing to independent living. We try to ensure people have a say in what they want and how they wish to live their lives - and ensuring that due process if followed, and that people are not pressured to live in places they do not want. Average Improvement: 10%: The service continues to successfully support people speak for themselves moving from residential homes to independent living, and those who lost their tenancies, suffered antisocial behaviour from neighbours, lost employment or had benefits and financial difficulties due to mental health difficulties. We are a happy couple who were supported by the advocacy service work through our housing, financial and harassment problems. We are paying back to the service attending peer /group advocacy sessions supporting other people sharing our life experiences as peers who are supporting each other. We successfully completed the Recruitment Selection & Interview training, and now take part in recruiting the best workers for the organisation. The advocacy service is our service which is service user run with support from paid workers

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 9%. People are becoming aware of the relationship between their physical health and mental health and the need to take part in physical activities to keep the mind occupied.

The Advocacy service provides me with Advocacy support in Professionals meetings about my medication, treatment, support and care. They also help in Managers meetings, Ward rounds, and Discharge meetings. But what works for me taking part in physical activities and groups

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: 39%: Although there is a significant improvement in this area, some people are scared of going to formal educational settings to meet new people. We help people voice their concerns, and help them overcome their difficulties.

What works for you in your journey to recovery does not work necessarily for me. For some people Yoga and filming and spirituality are their best therapy but for me art makes me become creative keeping my mind occupied. Its not only about medication: explore the best intervention for you

What is stopping you? Go join an art group close to where you live and develop your talent, build confidence and make friends discovering the beauty of art and how good it is for your mental health and wellbeing.

Self & Peer Advocacy Our peer/group advocacy helps people to learn from each other. We facilitate sessions where people can reflect on their own experiences by helping others to gain the skills to advocate for themselves and others. Our peer advocacy groups meet weekly at Folly Hall in Huddersfield and at our offices in Dewsbury. Average Improvement: 41%: There is a great improvement in this domain. We encourage a culture of giving and getting where as well as receiving advocacy support, people are encouraged to see the value in what they have to offer other people. From the group meetings, people often form friendships and provide informal support to one another. Six people who have used our advocacy service have gone on to completed the Touchstone Volunteering Training programme, and now provide support to other people as peer advocates and advocacy group facilitators. Our peer advocacy volunteers and interpreters training has been so successful that we are now delivering it in Dewsbury. I received advocacy support on my discharge and tribunal meetings, [I] went on to train as an advocacy Touchstone Project. I am There is a lot tovolunteer give sharewith and the learn. I receivedVolunteering advocacy support on my now providing advocacy support other meetings, service users and help out as asan an discharge from hospital andto tribunal [I] went on to train advocacy facilitator advocacy volunteer with the Touchstone Volunteering Project. I am now providing peer advocacy support to other service users and help out as an advocacy facilitator. I am looking forward to become a relief advocacy worker and hopefully progress to gain paid employment

Confidence Many of the people we work with only want advocacy support to help them with their discharge from hospital, or in professionals meetings. On discharge, many do not wish to attend peer/group advocacy activities. Although we respect their views we think theres a lot that they might get out of being with others, and building confidence from their shared experiences and problem solving. 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: 29%: The service supports people by referring them to other services for anger management and confidence building sessions with other service providers like Support 2 Recovery. 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

Speaking Up for Myself One of our primary goals is to support and encourages people to speak up for themselves - by telling other people what they want, making their voices and choices heard, working out what they want and how to organise themselves better. People learn different ways of speaking up for themselves e.g. planning what they want to say, using pictures, and writing out their concerns. Average Improvement 14%: 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 can speak up for myself as an individual and as part of a group to I received advocacy support on my discharge and tribunal meetings, [I] went on defend my rights as long as other people are prepared to listen. to train as an advocacy volunteer with the Touchstone Volunteering Project. I am Unfortunately when I do so I get sectioned by professionals who argue now providing advocacy support to other service users and help out as an that I will be expressing delusionary thoughts advocacy facilitator

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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: 18%. support service

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 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: 56%: 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 as busy as a bee taking part in astructure number of activities my local at area With advocacy support I now have in my week: in I volunteer ranging from volunteering looking after another service user, doing my cleaning the fire station, I attend supporting services, the Dewsbury peer/group job, advocacy going to sessions, see a psychological Pathways and attending the Keep therapist, the parks going clean to project in Wakefield and events in the community. I am well connected and feel occupied and valued actively take part in Touchstone organisational activities I completed which the keeps me going able to Interviewing cope with my& panic attacks and anxiety. one day Selection training course. All this has helped me fight my panic attacks and regain my confidence . Taking part in activities in my local community makes me feel valued and belonging which supports my mental health and wellbeing.

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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: 21%: Advocacy has enabled people to achieve greater dialogue and collaborative arrangements with statutory and voluntary services. 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. Table of Changes, by Advocacy Star domains 2012/13
Social Networks Average 1st Review Average 2nd review Average 3rd review Average current Average change % Improvement -8.3 +11.8 +0.6 +1.4 +1.4 14% Housing Physical Health +0.0 +4.7 +2.0 -3.0 +0.9 9% Education & Training +13.3 -1.4 +2.2 +1.4 +3.9 39% Self & Peer Advocacy +1.6 +11.3 +0.6 +2.7 +4.1 41% Confidence Speaking Up For Myself +6.0 +2.9 -0.4 -2.9 +1.1 14% Emotional/ Mental Wellbeing -1.8 +11.1 -3.5 +1.5 +1.8 18% Community Participation +15.9 +7.4 +0.7 -1.5 +5.6 56% Support Services +4.4 +12.8 -0.2 -8.6 +2.1 21%

-5.6 +9.0 +0.4 -3.8 +0.1 10%

+12.3 +4.4 -0.6 -4.5 +2.9 29%

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Annual Statistics

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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.

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Vision and targets for 2012-2013

In the next year we will Remodel the Touchstone Kirklees Advocacy service to increase overall service activity by 20%. Ensure the service is dementia friendly and provide advocacy opportunities for people living in their own homes experiencing mental health problems related to dementia. Increase access to Self Directed Support/ Peer led Self Directed Support. Promote paid employment opportunities to the people we work with, progressing from being beneficiaries of the service to peer advocacy volunteers and interpreters, to become relief workers and paid staff members. Increase the number of self-advocacy and peer advocacy groups in a wider variety of locations eg Batley, Mirfield. Work co-productively with service users and stakeholders to refine the Kirklees Advocacy risk assessment tool. Ensure a third of the people we work with are from BME groups. Provide a greater array of training and development sessions for advocacy group members, tied to Touchstones wider programme of volunteering opportunities. Make particular efforts to address and boost peoples self-confidence issues. Establish peer/group advocacy for informal patients on ward at Priestly Unit ward 18, Ashdale ward 3, and Wakefield hospital. Seek a better match between volunteers and the wider demographics of Kirklees to ensure more equal representation. 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

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