Friday, 21 February 2014

Update from Nottinghamshire Veterans and Families Partnership (NVFP) meeting 19 Feb 2014

Before I write my report I need to make a point about my involvement in this group.

I see my role as taking issues forward and contributing towards the involvement of care programmes for Veterans and civilians.  It's important to understand that this group also looks at the issues of partners and dependents of Veterans - which includes loved ones acting as carers.

I will share information here to keep you aware of developments and issues that arise.  I am not a politician ... and have absolutely no interest in becoming one.  The point of sharing the information here is to give YOU a voice.  If you feel that you're not happy about something or if you can come up with ideas and initiatives to help us to achieve the key objectives ... or if you feel there is a better way to do something ... then please comment on the blog.  If you have any concerns about being identified, please contact me via Facebook on https://www.facebook.com/Wolf.Photographer and I can keep your identity confidential and still pass on your contribution towards the work of the group.  This initiative cannot succeed without your involvement.  Your contribution will help us to get the issues right ... but most importantly it may go a long way towards lessening your suffering as well as those people coming down the line after us that are carrying invisible wounds.

Thank you.


Introduction
There was clear frustration expressed by most of the Voluntary Veteran led groups in attendance.  There was a general feeling that we were taking one step forwards and two steps back.  We felt it was inexcusable that the group has been meeting for three years or so now and that there was still not any branding, leaflets, posters or a website that is publicly viewable.

We also felt that this was now an NHS led group facilitating NHS funding objectives rather than seeing to the holistic issues surrounding the care and well being of Veterans.

The Chair's response was as follows:
He felt our frustration and understood our concerns.  The group is not NHS specific in any way.  If we want items discussed, we should contact the group secretary and have them placed on the agenda.  He recognised that some of us wanted this group to be able to lobby the NHS and the Government for change but that this wasn't the remit of this group. 


Funding
The Chair made it clear that all of the partner organisations in the NVFP will be eligible for some funding for their own projects.

Re-diagnosis of Patients transferring from other counties
I've asked for this item to be placed on the agenda.  I and some of my colleagues will be making it clear that it's not necessary where a patient transfers with up-to-date medical reports, as it's a very distressing thing to go through when you've already had all your scars opened up for the original diagnosis.  It's one thing to build up a relationship between patient and practitioner ... it takes time and effort on both sides.  To force someone to go through it all again with a stranger is emotional rape.

If patients are not transferring with up-to-date reports as a matter of course then this is something that the NHS needs to pick up as a National issue ASAP.  Transfer of care for long term ill patients depends on clear communication between the different services caring for the patient.

Guidelines for Interviewing Veterans
Two group members from the Criminal Justice System and myself were meeting and working on a document.  The purpose of the meeting was to identify ways to facilitate a mental health review appointment for patients who are ex-service personnel with a diagnosis of Post-Traumatic Stress Disorder (PTSD). This included pre-meeting preparation, the review and subsequent follow up appointments.  The issue has had no further work done on it for the last two months or so.  I've asked for this to be an agenda item for the next meeting.


Organisational Updates
Organisational Updates are back on the agenda in a formal way and will be minuted but will take place after the main meeting.  The Chair said that he didn't have the time to sit in that part of the meeting because of other commitments.

What came out of this part of the meeting was that we need a lobbying group that is independent of the NVFP, so that we can push certain issues forward.

I felt that we could use Nottingham City Council to produce our own leaflets and have them fund our printing costs.  To that end I've asked all the groups that would like a presence on the poster to email me a logo, email address, weblink and telephone number together with a brief sentence about what they offer.  I'll design it and take it to the next meeting as an agenda item if I have their requested data.

There was some discussion around why Veteran's don't access services for themselves as soon as they get a hint of something being wrong within themselves.

The reasons we came up with were as follows:
Some are in denial of their own problems
Veteran's are used to being the dependable ones at the sharp end and coping
People don't always understand a Veteran's language (service slang)
Veterans can swear a lot when talking about issues that they find painful, this can be a barrier for some GPs
They're programmed to keep going until they drop
They have little trust of a society that sent them to war and then discarded them when they came 'home'
They don't fit into 'civvy street', people don't understand their their ways
Service life is black and white - civvy street is shades of grey
Being made to feel vulnerable and then mistreated
Many GPs are ignorant of mental health issues
Some GP's attitudes are appalling towards people with PTSD or other mental health issues
There is a lot of stigma attached to people with mental health problems and it ruins their difficult lives

We discussed how we could make GPs  aware.  A couple of the groups have been trying to make contact with GP's Surgery Managers over the years and have never received replies to their communications.  I feel that we should mail shot them carefully in a recorded way and build up an image of their attitudes based on their responses or lack of them.  I would go so far as having a recommendation list based on their responses as to whether they are capable of looking after the needs of people with mental health problems.


The NVFP have a link in already and can start the ball rolling on raising more awareness with GPs.  I also feel that we should be targeting Patient Liaison Groups as well as GPs and practice managers.  we may achieve better results.

Future posts
As well as continuing to report on the progress of the group, I'll be writing specific blog posts on the other organisations that form the NVFP, as well as any key documents, in the hope that you or a Veteran may find the information useful ... or that you have a template for beginning your own group in your area.

Regards

Villayat 'Wolf' Sunkmanitu

Nottinghamshire Veterans and Families Partnership - Terms of Reference


Part of my work is to be involved with agencies that provide care for people Living with PTSD.  My involvement isn't limited just to the care of Veterans but this particular groups aims are.  I felt that it would be useful to start sharing certain documents so that you can be aware of what's going ... and perhaps share ideas that you may find useful to adopt for other groups in other areas.

Nottinghamshire Veterans and Families Partnership Group Terms of Reference Draft v1.1

1.      Introduction

The Nottinghamshire Veterans Partnership group is hosted by Nottinghamshire Healthcare Trust. It is a forum where all organisations that have an interest in Veterans integrated mental, physical and social care can meet to form a strategic alliance to share information and support a virtual team approach to comprehensive care aimed at ex-service personnel and their families.

Membership of the group is underscored by the commitment by the partner organisations to sign up and fully support the NHS armed services covenant.

The purpose of the group is to:

·         Form a strategic alliance of Nottinghamshire County and Nottingham City statutory and third sector providers of services who focus on the physical, mental health and social care needs of ex-service personnel and their families.

·         Support the development of an ex-service personnel’s health and social care virtual team.

·         Steer the implementation/use of resources specifically commissioned to support the development of pathways and support for ex-service personnel and their families.

·         Provide a focal point for discussion and support of the strategic development of services and care pathways aimed at improving health and social care outcomes for ex-service personnel and their families.

·         Provide a space/forum for local providers to network, share good practice, and enhance governance and quality to support an integrated service offer for the benefit of ex-service personnel and their families.

2.      Membership

Chair:
·         The group will be chaired by the Clinical Director of Specialist Services for Nottinghamshire Healthcare Trust.

 And will include in its membership representatives from:

·         Royal British Legion.
·         Combat Stress.
·         Criminal Justice agencies including probation and magistrates.
·         Ex-service personnel who have experience of using services.
·         Nottingham Healthcare NHS Trust Service Managers.
·         NHCT Veterans peer support staff from a broad range of trust services.
·         SSAFA (Soldiers, Sailors and Airmens’ Families Association)
·         Forces for Their Future
·         Representatives from Armed Force establishments in Nottinghamshire City and County
·         National Veterans Mental Health Network
·         Administrative Support provided by PA to Clinical Director.
·         DCMH (Chilwell)

By Invite as required:

·         Trust Communications team
·         Any other representatives deemed appropriate to support the business of the group.

3.      Quoracy

The group shall be considered quorate where 40% of the membership is present and this includes:

Chair (or nominated deputy).

4.      Meeting frequency

The group will meet monthly. Dates will be confirmed annually.

5.      Objectives

·       Agree strategic priorities for the partnership.
·       Develop and disseminate information on integrated care pathways for ex-service personnel and their families.
·       Share good practice.
·       Develop a programme of work to be shared by group members.
·       Support the development of the Defence National Rehabilitation Centre in Nottinghamshire (DNRC).

Support and dissemination:
Ensure that the work of the group is adequately supported and effectively communicated.

Review Date:
To be reviewed annually.
DM 01/14

Background ...

I felt that it would be useful to enter the last PTSD related blog entry from the main project page as a bit of background re this particular part of the project.




Wednesday, 12 February 2014

Nottinghamshire Veterans and Families Partnership ...

Liaising with Statutory and Voluntary Agencies
One of the objectives of the 'Living with PTSD' project is to get involved with the NHS and other organisations/companies to help make changes in some areas of policy and to raise awareness of what PTSD feels like for Veterans from the perspective of the Veteran seeking help.

To further the objectives laid out above, I was invited onto the Nottinghamshire Veterans and Families Partnership (NVFP) last October (2013) but I haven't had a chance to report on its activities yet because I've had my hands full taking care of the exhibitions.

So, for those of you interested in Veterans affairs, I'll be sharing progress reports from the group.

Background of the NVFP
The group's been meeting for three years or so and has representatives from Combat Stress, The Royal British Legion, SSAFA, local regiments and Cadet groups, the Prison Service, Probation Service, Nottinghamshire Constabulary, The Courts, The Service and Veterans Personnel Agency, The NHS and other local organisations.  I'll post the groups terms of reference later.

Updates re issues raised
In October 2013 I gave a brief presentation about my experiences, the work of Wolf Photography and made some recommendations for change in the way some of the NHS staff conduct themselves when delivering mental health care/support.  I also raised my concerns about the fact that people transferring into this County's care shouldn't have to go through the hoop of being re-diagnosed when they have documentary evidence to support their transfer of care.  Forcing people to go through a further diagnosis is like being emotionally raped.  It's unhealthy, causes further scarring and destroys coping mechanisms.

A working party was set up consisting of three people to look at providing a document of guidance to all mental health professionals in the local NHS Trust.  The draft document has been compiled and we're waiting for the group to adopt it and make it available to trust staff.

Nothing has been mentioned about re-diagnosis of transferring patients yet and the issue seems to have been swept under the rug. The NHS always seem to be crying about a lack of resources.  It would therefore seem sensible to not waste time and resources by re-diagnosing patients that have been under the care of similarly qualified professionals in other areas of the country.  The implications of pushing Veterans with PTSD into opening up about their feelings and symptoms, when they're not ready to do so, is that you risk arming a ticking time bomb that can explode in the worst possible way ... the results of which could be physical violence or suicide.

On a positive note, Nottinghamshire Police have flicked the switch on their system to identify Veterans that come to their attention as a result of incidents.  The aim is to provide avenues of support for Veterans should they need it.

Networking
One of the most beneficial aspects of this group are the 'Organisational Updates'.  It's where we get to find out what initiatives the other groups are working on and share that news on our own networks, thus helping the news to go further.  There were a couple of interesting items at the last meeting but Organisational Updates have been changed and shifted so that they're no longer part of the main meeting.  I tried to find out why but was ignored by the group Chair (a reaction that would have dire consequences with some Veterans).  I'll be bringing the issue up at the next meeting later this month. To see if we can have it placed back on the main agenda.  If we can't, there's no point in being there, as it will just be an unbalanced token group to satisfy NHS bosses rather than a balanced group that is supposed to be forming a pathway to benefit Veterans and their dependents.

Allied to the last paragraph is the issue of networking information about related and relevant issues through social media networking.  It's a fantastic, cost effective way to share information and needs to be done on a local level by all the agencies/groups involved.  From what I've seen so far, it seems to be smaller projects that are sharing local advice and information.

Funding the NHS Mental Health Services and Identifying Veterans' Needs
At the last meeting the group was steered in the direction of funding.  It was suggested that if what the groups seeks to achieve is successful, we'll need more funding to provide the service.

However, awareness was raised of some issues:

Most Veterans access appropriate mental health support as a result of their coming to notice for some other problem.  In my case it was a serious Road Traffic Accident, for others it might be a relationship breakdown or perhaps an issue of bullying or harassment at work (there are many more reasons).  If my GP wasn't switched on and hadn't recognised my symptoms and then made the appropriate referral ... I would probably still be living in ignorance of the fact that I have Post Traumatic Stress Disorder.

Group discussion
The following information was shared and corroborated by other members of the group:

Veterans, generally speaking, will not go to a GP and say 'Help, I have PTSD', or 'Help, I think I have problems after serving in the armed forces'.  They're conditioned to survive and carry on until they drop.

The majority of GPs are ignorant of mental health issues and this needs to change as GPs are the people that can make referrals to other services through existing funding streams.


Some serious effort needs to be put into identifying why Veterans aren't accessing appropriate services, rather than seeking funding for a purpose that can't be realised, only to have that money moved to a different budget when it isn't being used for the target group.

The group have had a website authorised for their use.  I'm hoping that some content will be agreed upon at the next meeting, as there's no reason why it can't go live to provide some basic information to Veterans and their families.  It can be updated and adapted as other needs are identified.

Stigma
Stigma is another serious consideration and one that the NHS mental health teams in Cornwall took very seriously; to the end that mental and physical health records were kept separate.  When I asked practitioners there about the issue I was told that some staff, including senior managers, were judgemental about employees with mental health problems, so the records were kept separate to protect people, employees and the public from those that may seek to stigmatise or discriminate against them on the grounds of mental health disabilities.

That's about it for this update.  I hope that you have found it useful and informative. Next time I hope to provide some actual ways to access support, apart from the general route of GPs.  You can find some basic information and assistance on my website under 'Help' and 'PTSD'.

If you'd like to know more about how PTSD can feel, please pop along to one of my rolling exhibitions.  You can see the activity schedule on www.living-with-ptsd.org.uk.

All the best

Villayat 'Wolf' Sunkmanitu

Wednesday, 19 February 2014

Living with PTSD

This is a new blog.

The aim is to share experiences of Living with PTSD ... for Veterans and civilians.

Please keep an eye on the blog.

I hope you'll find it useful.

Regards

Villayat 'Wolf' Sunkmanitu