YOUR COMPLIMENTARY COPY MC
Bazinga! Busting the OCD myth
Therapy Sweet Dreams Are Prescription Behind Bars Made of This Drug Addiction
Autumn 2016 MAGAZINE MAGAZINEMC 3 WELCOME 4 THERAPY BEHIND BARS 8 PAY ATTENTION! 10 BAZINGA! 12 MAKING A DRAMA OUT OF A CRISIS 14 A SPECIAL TYPE OF CARE 18 THE HIDDEN EPIDEMIC
STREET WISE The man whose soccer skills took him from despair to glory. 21 STAY WELL FEEL GREAT 30 27 SWEET DREAMS ARE 18 MADE OF THIS THE HIDDEN EPIDEMIC Prescription drug abuse.
10 30 STREET WISE MAKING A DRAMA 32 X FACTOR’S GOT 8 OUT OF A CRISIS NOTHING ON MY JOURNEY PAY ATTENTION Anthony Richardson has Rory Bremner talks created a stage production 34 DAY IN THE LIFE... candidly about his life based on his life with 35 ACROSS THE UNIVERSE with ADHD. Obsessive Compulsive Disorder.
MC magazine team: Contributors: Graham Hignett, Myles Hodgson, You can contact us at: Rebecca Kelly. Managing Editor: Steve Murphy. [email protected] Editor: Jackie Rankin. Editorial: Julie Crompton, Joanne Cunningham. Photography: Joel Goodman. MerseyCareNhsTrust Design: Jo Hadfield. Mersey_Care
If you have received this magazine as a member of Mersey Care NHS Foundation Trust, we’d like to be sure that the information we hold for you is current and accurate. If you have moved house, changed your email address, or have a new phone number please email [email protected] with 2 your name, date of birth and details that need to be amended. WELCOME
utumn has a lot going for it. It’s about focusing on what’s important Early autumn landscapes are easy and enjoying what’s around you. Our Stay Aon the eye. Even the light is Well Feel Great feature includes practising different. It’s a novelty to put some layers mindfulness, the art of enjoying the on and get out for a walk. moment. There are ideas to keep your mind and body upbeat and healthy. Granted when the clocks go back we all curl up and it’s much harder to motivate This issue also focuses on a topic yourself to go outside. All the research that affects untold numbers of people – shows it’s worth it, even for a short time. prescription drug addiction. A GPs are even prescribing walks and other heartbreaking wonderful story of a outside activities. woman who overcame her addiction to common over the counter drugs. Here at MC magazine we try to go for a lunchtime walk when we can, just short So let’s all prescribe ourselves a dose of bursts, some of us counting our steps on willpower, a woolly jumper, gloves, sturdy our fit bits. We’re a competitive lot! Focus on shoes, friends and a destination (preferably with a healthy lunch on offer) and we It can be hard though if you’re not feeling what’s important should come home feeling tired but at your best, to motivate yourself. You can energised. read inside what people have told us they and enjoy what’s look forward to in winter – curling up with Here’s to rustling leaves and roaring fires! a good book, letting your thoughts drift, around you. to football and roast dinners. (We’d like to The MC editorial team. hear your winter ideas.)
3 THERAPY BEHIND BARS In a quiet Lancashire village Jim, a 25 year old from Blackpool arrives at Garth Prison to begin a two year stay. When he goes onto the prison wing he’s welcomed by a prison officer, a psychologist and a mental health nurse.
4 Because of how we work here they don’t see me as a ‘screw’. I’m not a clinician but I know that what matters is the interaction. Prison Officer Pete Townson
There to shake Jim’s hand is Danny, a prisoner who knows exactly how Jim THERAPY BEHIND BARS feels - because he’s been there
It’s not a typical prison STRUGGLES they came in. The chances are welcome but this is not a WITH TRUST they’ll offend again because typical situation. Jim has been we haven’t addressed the Around seven in ten prisoners selected to join the Beacon, a underlying problems. Is that nationally are diagnosed with specialist psychological treatment fair on them, their victims or Personality Disorder, a condition programme for convicted men the community?” that can be made worse by who have personality related traumatic life events. They Wouldn’t it be cheaper to needs or who have been have problems in managing treat people within NHS units? diagnosed with Personality their emotions; they can struggle Tony: “It’s much more cost Disorder. to develop trusting positive effective to bring the treatment A report by the Prisons’ and relationships and may often teams into the prison where Probation Ombudsman found use self-harming, violence and the security is already there. that one in five prisoners substance use to cope. We can spend more on the diagnosed with a mental clinical support that’s key to Those selected for Beacon sign health problem receives no the success of the up to receive an intensive care from a mental health programme.” programme including professional while in prison. The psychological and other therapies. To be admitted to the Beacon Beacon has been established as The programme sees the man as a prisoner must demonstrate part of the National Offender an individual and his behaviour some personality related Personality Disorder (OPD) in the context of his life and needs and/or be diagnosed Strategy which seeks to address experiences. with a Personality Disorder; the needs of men and women personality needs must also whose personality difficulties It recognises the strengths of play a part in his offending. contribute to their risk and the men as well as the problems It’s a psychologically led offending behaviour. that led to his offending. Men approach with a focus on work with doctors, nurses and relationships and a man having occupational therapists as well the ability to change and as prison officers. practice new learning and skills Manager Tony Carradice in a supportive therapeutic explains: “There are many environment. A number of people in prisons who have the first cohorts have just a personality disorder; yet we moved on after successfully send them out at the end of completing their programmes. their sentence the same way
There are many people in prison who have a Personality Disorder yet we send them out the same way they came in. 5 CLOSE KNIT COMMUNITY The prison wing that houses Beacon participants is like any other but that’s where the similarities end. In what is a close knit community up to 48 men live on a self contained landing. They sleep in cells but their days are spent undergoing individual and group therapies.
We make every contact count. Asking someone ‘are you ok’ is massive in here; they’ve never had that before.
NHS mental health trust Mersey Care provides a highly specialised clinical team that works shoulder to shoulder with prison officers. The aesthetics of the wing shout ‘prison’ – but talk to those involved He admires men who stick with the violent, even in prison I was in segregation and the message is clear - they want to programme. “It’s the tough option. It and I got kicked out at one point. would be easier to stay on a normal prison make people better. My probation officer told me therapy wing than to be in a group discussing Staff are hand picked for the qualities might be a good thing, but it wasn’t till your past; they really do put themselves needed to cope with this intense I’d had the interview I realised how good through it.” programme. “We are changing people’s it was. A prison officer had come in on his personalities. They need time to grow, For Lynn Russell, 17 years a prison officer, day off to meet me. the approach has its challenges. But she to develop patience and resilience to There isn’t anywhere else like it. I feel like shares her colleagues’ belief that it works. knockbacks. It takes a special kind of I’m taking control, achieving something. person to fix them and in this team we “It can be a juggling act. We have to I’m facing things head on, no-one’s ever told have those people. follow prison procedures, but for many of me I’ve done well. It feels strange but good. these prisoners too much discipline can We make every contact count. Asking I don’t want society to be frightened of cause a setback in their progress. But our someone ‘are you ok’ is massive in here; me, if that means staying in prison two team instinctively knows what’s right for they’ve never had that before. more years I’ll do it. I can’t keep running the situation. We exhaust every avenue. for ever. I’m making a flyer to tell people We don’t give up.” in here who’ve been sexually abused how SHOULD WE WASH OUR to get help. Everyone should have the HANDS OF THESE PEOPLE? support I’ve had. PETER Psychologist Simon Crowther believes it’s I was a weird kid. I was kicked out of our duty as a society to provide services like Peter is from the North East. Well built and home, lost my family and friends and my the Beacon. “We have to ask who is responsible heavily tattooed he was just a month from mind. I ended up doing something silly when a child has an unimaginably horrific parole. and going to Lancaster Farms Prison then life and goes on to become a perpetrator “I’ve served eleven years and I was due for here. The group sessions are good, you of crime? We know it’s not ok – but as a release, but I’d hit a brick wall. I knew if I left don’t feel alone, and you’re not the only society should we wash our hands or try I’d be back in as a lifer. Both my parents one. I’ve got a better relationship with my to help make them better? were alcoholics and I’d been abused as a family now. Going out will be hard but I’ll kid. I dealt with it all by hitting out, being get a place to live and a dog…I think I can be happy. 6 SHAUN My mum had agoraphobia and I They sometimes had ADHD and when I was 16 I got struggle with someone social anxiety – I couldn’t get on a bus. asking how they feel, I self medicated with Diazepam and cannabis. When I came into prison in they’ve never had that, 2011 I was in shock. Being on the and they need to feel Beacon’s made me realise I struggled with relationships and anything ready. We’re changing unfamiliar. I hide from change, being their identities, but here has helped me to balance it with how much better things could be. when they do it’s very powerful.
There isn’t anywhere else like it. I feel like I’m taking control.
The group sessions WHAT IS PERSONALITY • avoiding other people and feeling DISORDER? empty and emotionally disconnected are good, you don’t • difficulty managing negative feelings feel alone, and you’re Personality disorders are conditions in without self harming (for example, which an individual differs significantly not the only one. abusing drugs and alcohol, or taking from an average person, in terms of how overdoses) or, in rare cases, threatening they think, perceive, feel or relate to others. other people Changes in how a person feels and If you would like help for you or • odd behaviour distorted beliefs about other people can someone else contact your GP or lead to odd behaviour, which can be • difficulty maintaining stable and close other health professional. distressing and may upset others. relationships, especially with partners, MIND mind.org.uk children and professional carers Common features include: NHS Choices nhs.uk • sometimes, periods of losing contact • being overwhelmed by negative with reality. Royal College of Psychiatrists feelings such as distress, anxiety, rcpsych.ac.uk worthlessness or anger Source: NHS Choices Rethink mental Illness rethink.org 7 PAY PAY ATTENTION
Rory Bremner talks to MC magazine about living with ADHD, why he’s in good company – and the secrets behind his Strictly dance moves.
ory Bremner is fresh back from Deficit Hyperactivity Disorder. He’s made Bremner, once famous for ‘being’ other a hectic Edinburgh festival and time for our interview but it overruns and people, is now on TV and radio in his Rabout to embark on a short tour, he’s left rushing to pick up his daughter own right and is as entertaining as ever. performing with the likes of John Cleese from school. But there are no quips during this interview, and Barry Cryer. He’s busy and could no random impressions of Tony Blair. Rory “I take on too many things; over commit well be forgiven for momentarily taking Bremner is talking to MC Magazine on a myself without properly planning. I don’t his foot off the pedal and taking a well topic that’s seriously close to his heart. fully appreciate that until I’m doing it. earned rest. But I have to remind myself of what it’s But he can’t. It’s one of the bits he given me.” hates most about having Attention
8 YOU DON’T KNOW YOU CAN’T STEP OUT WHAT IT IS THAT MAKES OF YOUR HEAD YOU DIFFERENT He’s patron of the ADHD Foundation, The condition he describes as both best speaking at its annual symposium last friend and worst enemy first came to year and is worried that the education light – to him at least – during a ‘chaotic’ system, rather than allowing children childhood. Bremner realised what it was with the condition to flourish, simply when a relative was diagnosed and who labels them as disruptive. has had many years of therapy. “Imagine an open plan office, on a busy “There’s a fear. You don’t know what day, big TV screens blaring out, music it is that makes you different. The best playing, and a football commentary. description was told to me by Dr Hyatt Could any of us produce good work in that environment? That’s what it’s like for Williams, an eminent counsellor. He said Michael Phelps is among celebrities and it’s like being made up of patchwork – a child with ADHD in a classroom. And sports people who have ADHD. lots of small bits stuck together.“ you can step out of an office – you can’t step out of your head. The love hate relationship with his condition I MADE UP PHRASES FOR hasn’t changed with age. “I don’t like MY STRICTLY ROUTINES being disorganised and losing concentration. His own coping strategies were never I wonder sometimes that it’s getting more called into play than on Strictly I don’t like worse. But it’s given me the ability to make (Come Dancing) back in 2011 with leaps and bounds out of the ordinary.“ being disorganised partner Erin Boag. He’s proud to go public alongside an elite and losing “As we put the sequence of steps together group of writers, artists, musicians and I’d come up with a phrase that fitted with others. Robbie Williams, Michael Phelps concentration. the tune. It’s similar to using mnemonics and most recently gymnast Simone Biles, to remember things at school. One phrase who took to twitter during the Olympics I dreamed up was ‘Everybody Loves Bruce “The despair and anxiety of finding after her medical records were exposed Forsyth’. (At this point he starts singing things difficult has to affect their self showing her medications. the words to the tune of the Nutcracker esteem. These kids who are blessed; Sugar Plum Fairy dance – better known “They’re pathfinders, the ones that eat creative, energetic, productive people; but to over 50s as the Cadbury’s Fruit and poisoned fruit. You want people like that they are told to conform, be organised Nut advert.) on your team.” – to pay attention. If they don’t they’re excluded. It creates so much despair and Order and sequence still catch him out. some of them will drift from classroom to “I was making a cake for my wife for our Rory with dance partner Erin Boag loved courtroom and onto prison.” wedding anniversary the other week but every minute of his Strictly performances. I’d agreed to help my daughter with her homework. I’ve made the cake before but I wasn’t concentrating and got the ingredients mixed up. It was ok and I got to the homework, but that’s the sort of thing you know that causes problems. They call it attention deficit but in fact it’s attention surplus, hyper enthusiasm.”
WE JUST NEED TO BE UNDERSTOOD Would he change anything? Not at all. “It helps to have an overactive imagination. It’s not always fun living with it but like most ADHD’ers, I’d rather have it than not. People with this condition are special - we just need to be understood.”
9 OCD tends to start in teens and early 20s
BAZINGA!The Big Bang Theory’s Sheldon Cooper has made Obsessive Compulsive Disorder into compulsive viewing. He’s not alone. We get an insight into this enigmatic condition and meet a man who has made a play based on his experiences.
heldon Cooper. Cult figure. panic that you’ve left the iron on, or Highly irritating and a tap running. OCD brings intrusive Ssimultaneously hilarious. thoughts combined with an The quirky housemate whose exaggerated sense of responsibility Sheldon Cooper. mannerisms and scientific rants have should things go wrong. Cult figure. Highly become a trademark in Channel 4’s irritating and Big Bang Theory. simultaneously hilarious. RESISTING IS MORE His propensity to stop just short of PAINFUL THAN CHECKING The quirky housemate spontaneous combustion if it’s not whose mannerisms and the right day to wash clothes, his It could be repeated checking or scientific rants have preoccupation with a certain seat in his obsessive cleaning. Or feeling you may become a trademark flat and his door knocking ritual (knock have said or done something that will in Channel 4’s Big three times quickly, say the person’s name hurt someone, or worse. Once the Bang Theory. – then repeat) make us simultaneously thought is there a person with OCD is chuckle and grit our teeth. forced to give it their attention – or agonise to the point where resisting is It’s great television. But living with more painful than giving in and Obsessive Compulsive Disorder is no checking. laughing matter. It’s not that brief
If you would like help for you or someone else and you are registered with a Liverpool GP or studying at Liverpool University or John Moores University, RESOURCES you can self-refer to Talk Liverpool directly by completing the self-referral OCD Action: ocdaction.org.uk form online on the Talk Liverpool website talkliverpool.nhs.uk or OCD –UK: ocduk.org telephoning on 0151 228 2300. Mental Health Foundation: You can also be referred to the service by any of the following: mentalhealth.org.uk Your GP or any health or social care professional. What is Cognitive Behaviour Therapy? Any voluntary or third sector organisation. nhs.uk Job Centre Plus.
10 The BBT crew on set Alison, an OCD therapist with “OCD tends to start in teens and early HOW DOES THE Talk Liverpool explains: 20s. It’s characterised by obsessions - THERAPY WORK? recurring intrusive thoughts, impulses or images - and compulsions, which “People can come to one of our venues are repetitive urges to counteract the or we can see them at home. It’s very obsession, for example checking or collaborative, we work with them at washing. People with OCD over estimate their pace. The aim is to break the cycle, the importance and threat of these to help them to manage their response thoughts, and also have an over-inflated when they are very gradually exposed to sense of responsibility to prevent harm. the situations that bring on the thoughts The result is intense feelings of anxiety, and anxieties. By rating their response and the only relief from the anxiety is to they can see their progress and their carry out the compulsion, for example confidence increases. It’s using small checking or washing. A vicious cycle is steps that will give people hope – it’s created and the rituals consume large very effective. “ amounts of time, stopping people doing the things they value and enjoy.”
We offer access to talking therapies, practical support and employment advice quickly and easily and help with a variety of problems. Feeling worried?
You must be 16+ and registered Talk to us with a Liverpool city GP.
For more information call: 0151 228 2300 or visit: talkliverpool.nhs.uk 11 Telling people’s stories through theatre comes naturally to Anthony Richardson. With a Masters in Creative Practice he’s writer, director and cast member – the one story he’s never told was his own.
MAKING A DRAMA OUT OF A CRISIS
12 Until now. His struggle with OCD has been played out before a theatre audience in Chester and he hopes to show it further afield to give people hope. My parents brought me up to be a good person, but I took rules and regulations too literally. I started dwelling on things and developing rituals. I became obsessed with checking and cleaning, and worrying what people thought of me. I felt stuck.
After graduating, taking a job thoughts happen. It works, I fighting battles, finding someone and signing up for a Master’s rate how I feel – I’m on 8/10 – who understands you, and learning degree Anthony found his you can see how much control to be your own therapist. Alison symptoms intolerable. I went you have. I held down a job for has taught me these thoughts back to my parents and signed two years and I’ve just completed aren’t real, they don’t mean up for therapy. Alison was great. my Masters. I’ve got my life back.” anything – it’s not what I’ve got She said ‘prepare yourself go into it’s who I am that matters.” The play is semi biographical but the kitchen, do what you would with some twists. “It’s harsh at normally do, feel the anxiety times – it shows the trauma of but put up with it and let the
13 A SPECIAL TYPE OF CARE The table is set with pretzels, The NHS is undergoing radical changes and support people at risk to live in the frankfurter sausages, maps in care for those with learning disabilities, community and not fall into the need so that people receive the right care for detention. and flags. A group of young in the right place. We take a look at Services in the future for people with women gather for a session the service that is preparing some of a learning disability or autism (or both) on German culture. All have the most vulnerable people within the will include things like significantly mental health system to move forward. a learning disability. Their improving community services so that therapists make sure the Mersey Care’s Specialist Learning people can live near their family and therapies are personalised. Disability Services, based in Whalley, friends; and making sure that the right The atmosphere is upbeat and Lancashire cares for adults with a learning staff with the right skills are in place to disability or other developmental support and care for people. happy. These are life skills but disorder, who have complex needs. Deputy Chief Operating Officer Susan not as we know it. Many have committed an offence, Wrathall says there are particular challenges some have come from prison. All are to caring for this group. Many of the vulnerable individuals. people the service supports support have committed criminal offences or TRANSFORMING CARE are a risk to themselves or others. They need highly specialised rehabilitation The new clinical model being proposed and recovery programmes if they are to by experts in forensic learning disability gain the skills and support networks to care aims to prevent offending behaviour cope in society in the future.
14 GETTING INTO Some people don’t have the ability TROUBLE to control their emotions or problem solve. Their disability “We care for people who makes it harder for them to have found difficulty in fitting grasp the coping skills that will into society. They have a prevent them being in situations; learning disability, but many programmes in prison don’t work also have a mental illness or a for them.” personality disorder. They’ve
almost all been excluded,
often abused and bullied. Some become involved with You need to learn criminals because they are to recognise the early vulnerable and they may not warning signs; have had support or guidance in making choices. They but once you have could be a risk to themselves, trust it’s a real or have committed a crime. breakthrough. “But often it’s not the person Damian nurse that’s the problem it’s the situation; the lack of Nurse Damian Entwistle cares for non exploitative. A woman in preventative support, social women with a learning disability crisis can seem unreachable but isolation and poor decision who require medium security. Most they’re expressive. You need to making that often leads to a have been in abusive relationships, learn to recognise the early warning person getting into trouble. Prison mainly with men. How does that signs; but once you have trust it’s is not the answer - most people impact on him providing care? a real breakthrough. It’s so rewarding. with learning disabilities and I like being part of the plans to get “They need to develop relationships mental health problems need people back out there, with with men that are positive and therapeutic support.” support when they need it.“ “In the past people with learning disability would be left to fend for themselves or they’d live out their life in institutions. Our service is very successful and we’re working I’m really looking hard with our partners to transform forward to being care for people with a learning disability so they are cared for in close to my family homes not hospitals.” and having my own furniture. IT’S HARDER FOR SOME TO GRASP COPING SKILLS Nurse Rachel Stott leads the team Medium Secure Unit Clinical Nurse that is helping Paul move on. Manager Julia Musker says service Paul has been in hospital since 2001. same touches to his new home. He users who come from prison are He’s about to move to a house where smiles as he shows off an almost particularly vulnerable. “A sex he’ll be supported by the Trust’s professional level painting he’s done of offender with a learning disability, specialist learning disabilities community his new place. ”I’m really looking for example, will need a carefully team. His room at Whalley is cosy and forward to being close to my family adapted treatment programme. welcoming. Paul is excited to add the and having my own furniture.”
15 MOVING ON
Service user Ken KEN Ken is 52. He was a carer for He is now in the low secure unit at “Now if I get angry or I have bad his his mum. He went into Whalley. “When I got here I was still thoughts I’ll go to my room, play angry I couldn’t see how they were music, meditate. I do breathing exercises prison for an offence but didn’t helping me. I’d kick walls.” – I’ve learnt to chill out. I know there fare well. “Different people are ways I can help myself. I’ve got 18 months later, with the right medication would beat me up, I ended up unescorted leave around the grounds, and therapy, Ken is about to move on it’s giving me freedom. I’m feeling a lot in hospital and I was diagnosed to a unit within the community. with personality disorder. better.”
The drive is stronger than ever to create brand new services that make sure people with learning disabilities and their families are heard, have equal opportunities, are supported to stay out of (or never get into) trouble and are helped to thrive in local communities. Lee Taylor, Chief Operating Officer 16 JOHN After spending the equivalent of a working lifetime in detention John is about to move on. He’s determined to prove himself to those who have helped him address the issues which diverted the course of his life.
John was first admitted “If people had taken me to a secure hospital back on board, there’d have Those with a in the 1970s. “I was living been a less chance that I learning disability in a big city on my own. wouldn’t have offended. I knew what was going The way things are don’t always realise. through my mind was changing there’s going They often endure appalling not right. I contacted to be someone there to treatment by other doctors and told them give that support: a social people – it’s not hard to there were horrible worker, a duty nurse...” see why they end up thoughts going through John is enthusiastic about committing offences. my mind. A doctor came, his new placement. “My We look at the whole picked me up and I went life is still going. My doctor person and help them to hospital and was put said to me: ‘You know develop ways to have to on medication.” what you need to do’ and self control so they can But that was all and it I took notice of him.” have a better life. wasn’t enough. John’s Dr Paul Withers Head of Psychological Treatment Services Paul Withers sad that support wasn’t Head of Psychological there for him as a Treatment Service vulnerable young man.
Transforming Care will give people with learning disabilities the same level of care as people without a learning disability. Psychologist Lianne Franks
They are the same as everyone else, they just have cognitive issues. Our job is to help them with coping strategies to deal with life. Ward manager Stephanie Phillips
17 THE HIDDEN EPIDEMIC
Ten million prescriptions for the most common painkillers are issued each year. Only one million of those are for cancer.
eaths involving prescription or STEPPING STONE over the counter medications is TO HARD DRUGS on the increase, even though D Dr Abbasi, Clinical Director of the number of people using these drugs has stayed the same. addictions services at mental health trust Mersey Care, is worried that To clinical psychiatrist Yasir Abbasi that people who have never touched street means one thing – more people are drugs could be introduced by dealers. addicted “The same people who sell street cocodamol and tramadol are selling heroin and cocaine. It can be a I WAS TAKING IT’S A DANGEROUS stepping stone to hard drugs.” SITUATION Habits almost always start out as a THIRTY “It’s a dangerous situation. There’s medical remedy. In a study published in a whole parallel economy out there the British Medical Journal participants COCODAMOL based on prescribed and over the told researchers that the drugs were counter drug abuse. The most taken originally for genuine medical common are opioid painkillers such A DAY reasons rather than experimentation, as tramadol, oxycodone and blaming themselves for losing control dihydrocodeine. But street sellers over their medicine use. The study offer poor quality tablets and if they’re also revealed that going to different not prepared in the right way, it could pharmacies and buying from internet Businesswoman Natalie became end up being lethal.” suppliers made getting supplies easy. hooked on painkillers after being At the same time the people who buy In 2014 the number of deaths involving drugs from pharmacies, online or on tramadol increased by 9% to a new prescribed cocodamol for a dental the streets don’t see themselves as peak of 240. problem. The 31 year old mother addicts in the way that illegal drug While pharmacists are alert to the of three found it lifted her mood misusers might. They’re less likely to signs: frequent prescription requests, seek help from their GP even though excuses of ‘lost’ prescriptions and and helped her cope with daily the North West has the second highest people becoming aggressive when life. “I was rushing round running regional rate of primary care opiate medication isn’t available, they don’t analgesic prescribing in the country. feel confident to challenge the person. my business and looking after Almost half of GPs and pharmacists the kids including lots of hospital who took part in a survey in Cheshire visits for my eldest son. The and Merseyside say treatment options for this type of addiction are not meeting drugs gave me a sense of patient need, especially for those wellbeing. I could run my life patients who don’t identify themselves as having a drug-related problem. better.”
18 I WAS TAKING THIRTY If the kids passed a pharmacy they’d COCODAMOL stop waiting for A DAY me to go in.
our doses a day turned into eight and 30mg of codeine in each table just to be buprenorphine which acts as a substitute Natalie would go from one pharmacy able to get going each day and look after and stops withdrawal, they then wean you to the next buying top up supplies. the kids properly. I was using my mum’s down.” F“If the kids passed a pharmacy they’d stop arthritis medication. I was constantly Nine months on Natalie is in recovery and waiting for me to go in. I told my GP worrying where the next tablet was feeling positive. “I know it’s not over but I about it but only because I was worried coming from. have a supportive partner. I do think about about liver damage.” the drugs, but it’s a psychological need. I WAS SO EMBARRASSED I’m a strong person and I want to stay well I WASN’T HONEST for my kids. I’ve lost three years - I don’t Persuaded by her family to seek help, want to lose any more.” She agreed to a reduced dose but couldn’t Natalie was referred to the DART team keep to it.” I’m allergic to anti inflammatory at Windsor House. “I was lucky I got an medication so I felt there was no alternative. appointment the next day. They were lovely I was in a corner. I was also buying online but I was so embarrassed. They offered me and getting through 100 tablets in three methadone, but I was so horrified at the days. My partner and family knew - I’d idea. I tried to go ‘cold turkey’ but it was have terrible flu like withdrawal symptoms too severe – ten minutes felt like a day; every morning. I needed 12 tablets with so I took their help and accepted
19 The same people who sell cocodamol and tramadol are selling heroin and cocaine. It can be a stepping stone to hard drugs.
CHALLENGE FOR SERVICES Dr Abbasi agrees. “It’s a real challenge for addiction services, because we don’t know the extent of the problem and there’s little information to advise people. We can treat them on an ad hoc basis, but we need to develop a strategy and clearer understand- ing among clinicians and the public of the problem and solutions.” Background Information source: Mersey Care NHS Foundation Trust Knowledge and review Service based on review of literature.
Dr Abbasi.
SIGNS Signs that someone is misusing or dependent on prescription or over the counter medicines may include: THE FACTS • Running out of medication before expected or ‘losing’ • People often think that prescription and OTC drugs are medication safer than illicit drugs. But they can be as addictive and • Seeking prescriptions from more than one healthcare dangerous and put users at risk for other adverse health professional effects, including overdose, especially when taken along • Requesting a specific drug, claiming that other with other drugs or alcohol medications don’t work for them • The most commonly misused drugs are opioid painkillers. • Appearing intoxicated, sedated or experiencing Others include sedatives and anti-anxiety medications, withdrawal symptoms stimulants used to treat ADHD and certain sleep disorders, • Having mood swings and anticonvulsants and mood stabilising drugs such • Making poor judgements, getting into debt, relationship as gabapentin and pregabalin troubles.
• Most teenagers who abuse prescription drugs are Sources: Royal College of General Practitioners 2013. Prescription and over-the- counter medicines misuse and dependence factsheets. National Institute on Drug Abuse given to them for free by a friend or relative
• Many people are abusing legal and illegal drugs at the If you think you or someone you know may be affected by same time. However many others do not identify with prescription or over the counter drug misuse contact your GP illegal drug misusers. or other health professional. You can find information and advice at: National Institute on Drug Abuse: drugabuse.gov 20 STAY WELL FEEL GREAT
STOP LOOK
Mindful eating is good for you LISTEN
Are you often caught up in your thoughts, living your life in your head? Mindfulness might help. There’s scientific evidence that it I get through winter by not only improves mental and physical wellbeing, it can boosts our trying to see every day as immune system and reduce chronic pain another chance to achieve something or take one step ccupational therapist Lyndsey DOES IT WORK FOR EVERYONE? “It closer to where I want to be. Sumner runs courses for mental may be more suitable for some people That mind-set energises me Ohealth NHS Trust Mersey Care. than others. It’s not always instant and even on the chilliest of days! “Life is fast paced. Mindfulness opens us people tell us they’ve felt like giving up to notice the small pleasurable moments but then it just clicks. During our courses Heavenly Cunliffe support assistant we can often miss. we bring attention and awareness to everything and this includes unpleasant HOW DOES IT WORK? “It teaches us to and difficult things. We’d always give become aware of our present moment by people information help them decide if moment experience, our thoughts, feelings it’s right for them at that time.” and sensations. Mindfulness won’t change life situations but it can help you learn to To find out more about Mersey Care change the way you react and relate by mindfullnesse courses go to liferooms.org being more aware of what’s happening, even to eating a piece of food.
Danish people say hygge (pronounced HAVE YOU GOT HYGGE? “hue-guh and translated as cosiness) is the overlooked ingredient in the recipe for happiness. Could this be the reason why Danes are ranked as the world’s most contented people? You can’t fake it – it’s either there or it isn’t, in cafes, bars, open spaces and homes. It’s a sense of safe space and boundaries.
They’ve even written about it in books. The Little Book of Hygge by FIVE Meik Wiking (subtitled “The Danish way to live well”) has just been TO GIVE AWAY! published by Penguin. penguin.co.uk 21 STAY WELL FEEL GREAT
COOKING UP A HEALTHY MINDSET
Recipes to feed your mind and body through the cold months.
22 TANDOORI CHICKEN & VEGETABLE FRIED RICE
INGREDIENTS METHOD
Chicken breast 500g • Boil the rice until al dente, refresh and Diced red onions 100g drain well Rice 250g • Combine all the ingredients for the masala Frozen peas 100g • Cut the chicken into 2cm dice and add to Sweet corn 100g the masala (leave chilled for at least Diced pepper 100g 6 hours) Green chillies 1 or 2 Chicken stock (Celery) 200ml • Heat some vegetable oil and sweat off Masala the onions and the chillies Garlic puree 2 tsps • Add the marinated chicken, turning Chilli powder ½tsp frequently Turmeric ½tsp • Add the peppers and stir in the rice Coriander powder ½tsp Garam Masala ½tsp • When the chicken reaches a core temperature of 75°c and the rice is Chopped coriander 1 bunch/100g heated through add the peas, corn Yoghurt 150g and chicken stock Lemon juice ½ lemon Cumin ½tsp
QUORN BOLOGNESE PASTA BAKE
INGREDIENTS METHOD
Quorn mince 500g • Cook off the pasta in boiling salted water Pasta twists 500g (al dente) Grated cheddar 250g • In the olive oil sweat off the garlic, Tomato puree 150g add the caraway seeds Vegetable stock 750ml • Stir in the tomato puree and cook out, Caraway seeds ½tsp add the tomatoes Tinned chopped tomatoes 200g Oregano ½tsp • Add vegetable stock to correct the consistency Chopped garlic 2 cloves • Check the seasoning, add the Quorn pieces, Olive oil 1 tblspn pasta and oregano • Transfer into an oven dish, top with cheese • Bake for 20 minutes until a core temperature of 75°c is reached
23 STAY WELL FEEL GREAT
TIPS FOR BEING MINDFUL
Try to see something as if it was for the first time. Playing sports, especially football, keeps
Do it with no purpose me motivated and happy in winter. but to carefully see what is It means I always have something to do happening and accept it. even on cold wet winter days, then I like to go home and spend time with the Try to be aware of one routine activity such as having a cup family round a Sunday roast. of tea or brushing your teeth. Antonio Ditri Occupational therapy assistant
Try not to multi task – see what it feels like to do one thing at a time. WALK THE WALK...
Greg Whyte, Professor in Applied Sport and Exercise Science and Sport Relief celebrity trainer has done endless studies on the effects of being active. His advice is:
• Make a habit of it – habitual physical activity such as walking as part of your normal every day routine.
• Small steps – set several small goals rather than one big one; you’re make more likely to keep your resolution to be more active as it reinforces your sense of achievement as you hit a small target
• But more of them – cleaning the house, taking the kids to school or going to work or On a winter’s day, I like to curl up on the shopping – it all counts. sofa with a good book and forget Summarised from an interview in the Sunday Times about the world for a bit Claire Rotheram mental health social worker
24 Having some fresh flowers in the house can cheer you up.
Turn the radio on – find your favourite station HELP and tune in. yourself Make your bed - fresh sheets are amazing but even climbing into a bed that’s made will Our self help guides cover a wide range make you feel good. of mental health issues from anxiety to post traumatic stress, providing practical advice and support. Download them now: What’s the song that merseycare.nhs.uk makes you smile? Share it on our Facebook page.
SCIENCE SAYS... The act of smiling makes you feel happy and alleviate pain. It’s even more effective when we back it up with positive thoughts, according to an American study by a Michigan State University. But the smile can’t be fake. You won’t get the effects and others can tell!
Study after study shows that time spent with friends and family makes a big difference to how happy we feel, generally.
Scientists have found that helping others makes you feel happier. Two hours is the optimal time we should dedicate to helping others in order to enrich our own lives.
25 Being outside is so good for you that GPs are prescribing it! A shift toward promoting wellness - is the latest approach to getting more people better for longer and reducing illness that come from staying indoors and being inactive. Natural England found that for every £1 spent on establishing healthy walking schemes, the NHS could save £7.18 in the cost of treating conditions such as heart disease, stroke and diabetes. Unlike the gym based exercise on prescription programme which didn’t work for lots of people, there are lots of ways to do your green prescription, GET A DOSE from organised walks to a Sunday afternoon stroll with family or friends. So next time you go to your surgery you may well leave with a prescription for a stroll along OF THE GREAT the canal or the beach, with a pub lunch at the end of it – raise a glass to good health! OUTDOORS
“THE CONFIDENCE THE RECOVERY COLLEGE HAS GIVEN ME HAS HELPED ME BACK INTO FULL TIME WORK”
FREE INTERNET FREE COURSES FIND OUT MANAGING ANXIETY, WHAT’S ON AT SELF ESTEEM, UNDERSTANDING OCD, LIFE CONFIDENCE BUIDING AND MUCHOPEN MORE ROOMS CAFE, LIBRARY Liferooms.org
26 SWEET DREAMS ARE MADE OF THIS ne in three of us has a bad night’s sleep once in a while… Sleep well last night? Or were you staring at the ceiling, willing Oone on ten sleeps badly every night. It’s now being recognised as a your eyes to shut, watching the clock waiting for your alarm? major health risk. Running out of steam and struggling to She explains: “Although it’s online you Your GP will tell you concentrate as the day goes on is not get lots of support. When you sign up whether Sleepio is great, but poor sleep is also linked to you are allocated a therapist who will call available in your area. In obesity, heart disease and cancer. you to welcome you to the programme Liverpool the service is then ring you each week to see how you offered through Talk are doing and make suggestions. In Liverpool. Anyone How you sleep between you can talk to ‘The Prof’ a registered with a virtual psychologist. Liverpool GP or has a major impact studying in the city on your life... can be referred or self refer by going It’s easy to feel along to a FUNDAMENTAL overwhelmed, lack Talk Liverpool venue. For more Sleep isn’t an optional extra in life – of sleep impacts on information visit it’s a fundamental. How you sleep has a talkliverpool.com major impact on your life and your health. your wellbeing. or call Your mental wellbeing suffers through low 0151 228 2300. mood. You may become lethargic, your concentration and memory often worsen and you may become irritable. ”It’s easy to feel overwhelmed, lack of sleep impacts on your wellbeing. So what can you do? Here are some hints Sleepio helps you set your own goals in and tips and links to online resources. If your own time. You complete an online you think your sleep problems are related diary which your therapist can use to to health conditions or pain get in touch give you guidance. There are with your GP. Depending on where you video files, expert articles on live you can also be referred for sleep sleep disorders and a forum so therapy including online therapies. you can share experiences if Sleep therapist Amanda runs Sleepio, a you wish. Your weekly digital self help programme to help telephone call allows you to people overcome sleep problems. off load and ask questions.”
27 Lack of support from a mattress reinforces poor sleeping posture and can prevent you from getting a good night’s sleep. There’s no golden rule on how often – if it’s becoming uncomfortable or looking worn, change it!
Experts say you READY FOR BED? WHAT’S IN YOUR should go to bed at Experts say you should go to bed at BEDROOM? the same time each day and spend the A bed? wardrobes? television? the same time each two hours before you go to sleep computer? It seems electronic gadgets day and spend the preparing and winding down. Here can get in the way of you and your are some tips: sleep – along with light and noise. two hours before you A warm (not hot) bath will help Phones and laptop screens produce go to sleep preparing your body reach the right temperature “blue light” - visible light with relatively for rest short wavelengths known to suppress and winding down. our natural sleep hormones. Using them • Writing “to do” lists for tomorrow for games or movies keeps you awake can organise your thoughts and and alert. If you need to use your clear your mind of distractions phone as an alarm clock switch it onto • Relaxation exercises are great airplane mode. Keep your bedroom • You can survive three times as muscle relaxants dark, quiet and tidy. long without food as you could without sleep. The average adult • Playlists of relaxation music distract sleeps between seven to eight you and make you more sleepy AVOID… hours, but the amount of sleep • Reading is an age old but proven we need varies depending on our • Tea, coffee and energy drinks relaxation method. age and our lives. Some people after lunchtime and eat your can survive on as little as four evening meal a few hours before hours a night, others 10 hours. IF YOU REALLY heading to bed • Websites for sleep and sleep • Alcohol. It’s a sedative so you can CAN’T SLEEP… related conditions: get off to sleep, but it also tends • Turn your alarm clock toward to create a more broken up and Royal College of Psychiatrists: the wall so you’re less aware of unsatisfying sleep rcpsych.ac.uk the time. Try a simple relaxation technique while in bed. If you’re • Exercise late in the day. It can NHS Choices: nhs.uk still awake after twenty minutes, elevate our alertness for several Mind: mind.org.uk get out of bed, read a book or hours; ideally exercise no later magazine or listen to soothing than late afternoon. Sleep Council (for advice on music then go back to bed. beds): sleepcouncil.org.uk
28 Having trouble sleeping? Talk to us
We offer access to talking therapies, practical support and employment advice quickly and easily and help with a variety of problems.
You must be 16+ and registered with a Liverpool city GP.
For more information call: 0151 228 2300 or go online at: talkliverpool.nhs.uk 29 STREET WISE At 20 living in supported accommodation and attempting suicide Derek Goodwin was a broken young man. He was helped to take part in an unusual early intervention service in Liverpool and has just come back from Portugal after representing England in the international street football tournament Futebol de Rua. He talked to MC magazine about the experience and what led him to street football.
30 I didn’t want to be alive; I thought ‘it’s time to go.’ I ended up in and out of hospital seven times.
WHAT IS STREET FOOTBALL? After I came out I lived in supported HOW DOES FOOTBALL HELP? accommodation. This still stays with me – It’s a four-a-side fast paced game played I find it difficult to settle in one place. I was I love football and I’m determined to use it over two halves of seven minutes. It was referred to the Liverpool Early Intervention to help people like me because I know what developed in Argentina and spread across service who saw I liked football and suggested they’re going through. South America and is now popular worldwide. the Imagine Your Goals programme run by Mersey Care NHS Foundation Trust and Everton Football Club. HOW EXCITING TO BE HOW DID YOU GET INTO IT? NOMINATED TO PLAY FOR I was really low, talking to myself, hearing ENGLAND. WHAT WERE I qualified for nomination for trials because voices telling me life wasn’t worth living, THE TRIALS LIKE? I’m a participant and volunteer with a and I was a failure I was reliant on medication, football based charity for people with We had to do “football tango” where a a voice was telling me to store up my mental health issues on Merseyside. professional dance teacher taught us dance tablets and end it – it was evil. steps to practice with a ball between their
feet – it improves co-ordination and WHAT HAPPENED TO YOU? ARE YOU OK NOW? communication between players. I first suffered psychosis when I was 20 and I’m stable, but I have good and bad days. living with my parents. I had a high pitched My care co-ordinator was amazing. I’d ring AND THE EXPERIENCE OF voice; I’d cry when I would hear my own her at stupid times, she saved my life. She PLAYING FOR ENGLAND? voice on video it caused me so much upset. doesn’t understand how much she helped. I got told I could have an operation on my The experience was amazing. It’s not often The people at Imagine Your Goals are like a throat, but by then my confidence was you get to represent your country abroad family. We’re all there for a reason. Johnny already very low, when I was told I was but it’s not just about football it’s about so who is the mental health co-ordinator is unable to have the operation I became much more things you can take into your incredible, he’s stuck with me. A few suicidal and ended up in a mental health future. We won the tournament but I came months ago I was having bad thoughts. inpatient unit. I didn’t want to be alive; I back a more positive and confident person He got me the help I needed and was thought ‘it’s time to go.’ I ended up in and which to me means a lot more than any always ringing to see how I was doing. out of hospital seven times. medal.
31 TRUE LIFE... X FACTOR’S GOT NOTHING ON MY JOURNEY NHS volunteer Danny Ward, talks frankly about the desperation of depression, soppy films…and how life often mimics reality television.
’m the laid back one. Up for anything, not easily hurt. But it was a mask. I’m I’m good at Igood at bottling up my feelings, papering bottling up my over the cracks. feelings, papering I’m 35 married with three kids. During my over the cracks. 20s I’d lost my sister, my child and my beloved grandmother who was like a mum. Run by people who understand you, who Losing someone is still my greatest fear. really care. It’s not a ‘bums on seats’ tick I was diagnosed with depression two years box exercise. There’s a raw honesty, they ago but I think I’ve suffered a lot longer. understand how you feel. My life spiralled out of control, I hurt people It was a revelation. To be able to be truly I loved. I tried to end things but survived. I honest with a group of people and see the acted like nothing had happened. It took a recognition in their faces. To hear their second attempt for me to ask for help stories and to work together to make sense The staff at Clock View Hospital were of it. I found my contributions actually amazing; it was the thought of leaving that helped people. I grew. scared me most. They talked a lot about a It’s been quite a journey. In X Factor terms thing called the Recovery College. They run I got through the audition, went to boot courses… not ones where you’re nodding camp and judges’ homes - I won the live off half way through, but where everyone shows! I’m now a volunteer at the Life thinks and feels the same as you and the Rooms in Liverpool, running courses, subject matter is something that will genuinely talking to people about mental health - for help you with your life. Oh and no-one cuts the first time in my life I feel I’m making you off because they have a slide set to get a difference. I’m still the clown but with through confidence.
HOW COULD A MOVIE I’VE LEARNT SELF BELIEF MAKE ME BETTER? Am I better? It’s a journey, but thanks to the I did the Journeys through Film course but Recovery College I recognise when things being honest I couldn’t see how watching a are going down, and how to cope. Where movie would help me get better. Nevertheless, do I go from here? Hopefully forward THE MERSEY CARE I turned up at FACT cinema and waited for helping others as they have helped me, RECOVERY COLLEGE the lights to go down so I could kick off the and hopefully into paid employment. I’ve Your Future, Your Way shoes and put my feet up. learned self belief, the value of family and It was Christmas. The movie was It’s a the importance of asking for help. For the Wonderful Life. I was hooked! I found other first time in a long time I’m looking to the courses, comedy, drama. Courses to help future, and I can see a light at the end of you understand why you feel like you do. the tunnel. 32 “THE RECOVERY COLLEGE GIVES YOU A THE MERSEY CARE CHANCE TO Find out what’s on at Mersey Care Recovery College call 0151 330 4140 or email: RECOVERY COLLEGE REDISCOVER YOUR [email protected] Your Future, Your Way POTENTIAL” @RC_MerseyCare merseycare.nhs.uk Morgan, Mersey Care Recovery College student Mersey Care Recovery College
33 A DAY IN THE LIFE... LYNSEY BROWN SENIOR STAFF NURSE FORENSIC SUPPORT TEAM
My day begins walking my Sadly events in his life brought him into I visited with a young lady today who dog Bert through Whalley the criminal justice system. The has faced so many challenges in her complex processes can be incredibly young life. She’s at high risk of harming village and along the river. confusing for someone who has herself and those around her, and she’s After the devastation of the difficulty understanding and processing now in prison, but because I know her Boxing Day floods, community information and can often exasperate I’ve been able to design a care plan that the situation; I’ve supported him will help prison officers keep her safe. spirit shone through and it’s through court appearances and now I look forward to our weekly team meeting. work with him, his mum and his care uplifting to see flowers rather It gives a much welcome opportunity team to help him through his probation. than skips in front gardens. to talk about how best to support our patients - and each other. My adage is that of the air stewardess ‘always put on support people in the community. your own mask before helping others’, I’ve spent the morning with a I visited with a in other words make sure you look young man who, at 18, has already young lady today after yourself so you can help those we Iexperienced so much chaos and serve. upheaval. He greeted me with a home who has faced so I leave work happy that’s it’s been a made bun and was eager to start work productive day which has seen positive but he’s often anxious in social situations many challenges in progress for those I support. and his learning disability makes it hard her young life. to convey his thoughts. He’s not missed a single appointment, a triumph in itself for someone with so many anxieties and many hurdles to overcome.
34 ACROSS THE UNIVERSE
NHS chaplain Karen Jobson swapped her dog collar for a backpack, travelling to share her knowledge about mental health with health workers in Nepal. We asked her how mental health care differs between the UK and one of the world’s poorest countries.
YOU’RE A CHAPLAIN BUT WHAT’S DIFFERENT? services and mental health education. YOU WORK FOR THE NHS? Many are not trained and they experience Mental health is the same, people want stigma from the communities for the Yes, I support men at Ashworth High the same things. The difference is the care. work they’re doing. Yet their passion was Secure Hospital in Merseyside, which It’s desperate there. If you’re mentally ill inspirational. They are so determined to cares for some of the most mentally there there’s very little chance you’ll get make a difference and refuse to be unwell men in the country. treatment. If you do it’s unlikely to be by overwhelmed by the task. a nurse with specialist training.
WHY DID YOU GO TO NEPAL? HOW DID YOU FEEL? WHAT DID YOU SEE? The British Methodist Church wanted It was incredibly moving. I was reminded of someone to attend a conference and I visited the Koshish NGO programme the power of individuals to make a difference explore ways to help improve services (Nepali for ‘making an effort’) where a – just like at home. A young man who had for people with mental illness. It was an group of staff provide residential care lived on the streets for more than 17 years opportunity for us to learn from each other. for 60 patients, and advocate for better until Koshish found him sang for us. Many of my patients could have written the same words about just wanting to live a normal life - mental illness is a universal experience.
Karen with Matrika Devkota, the staff of the House of Peace and the House of Hope, Koshish’s short term residential centres.
35 Suicide. Someone close to you could be about to snap...
Suicide. It’s a hard topic to talk about.
Which is why so many people in desperate need of help, don’t seek it. For fear of being shunned, discriminated against, ridiculed or even worse. Worried that there’s no one out there that cares.
Friends, family members, neighbours and colleagues may appear to be strong on the outside but they may be crumbling within.
Desperate for help but afraid to come forward due to fear, discrimination or ridicule.
The aim of our Big Brew campaign is to shatter the stigma of suicide. By arranging your own Big Brew event and talking openly, candidly about mental health and depression, we can help people open up, sharing thoughts and showing support is available.
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MC MAGAZINE is published by Mersey Care NHS Foundation Trust and produced by the communications team, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, Merseyside L34 1PJ T: 0151 473 0303 E: [email protected] W: merseycare.nhs.uk. MC MAGAZINE is available in other formats on request. Please pass on for others to read and recycle.