Positive Step for carers in North Somerset

Carers are getting tailored help thanks to a thriving talking therapies programme aimed at helping them find the strength to carry on.

The psychological therapies (IAPT) service for Positive Step in North Somerset has helped more than 500 carers with therapy and support since launching three years ago.

Run by Avon and Wiltshire Mental Health Partnership NHS Trust and charity Second Step, Positive Step provides psychological therapies for people with a range of issues including anxiety or panic, trauma, obsessions and depression.

With 35 staff, including 14 high-intensity psychotherapists and 15 wellness advisors, its dedicated carers programme is aimed at building carers’ resilience.

Commissioning manager for mental health at North Somerset CCG, Angela Kell, said: “In North Somerset we’ve got a very elderly population and therefore we’ve got a lot of carers, probably more than the average CCG.

“I think for us it’s about assurance, that we’re meeting the needs of those carers, whose needs are often forgotten.

“Carers often become quite isolated, and they then start suffering anxiety and depression and there’s the stress of being responsible for the person they’re looking after. If you don’t provide services for them the placement breaks down. You may have to find alternative places for people they’re caring for, or have an increased support package.”

The programme was commissioned in 2013 following research which indicated 30 percent of North Somerset’s 20,000 carers were struggling to cope.

Heather Dugmore, a Senior High Intensity Therapist at Positive Step with more than 20 years’ experience as a cognitive behavioural psychotherapist, designed the pathway with colleague Karen Laken which they tested through a pilot organised through Carers Trust Phoenix; the carers support service in North Somerset.

That first year saw 98 referrals to the programme, with 262 in 2014/15. This year, 2015/16, more than 240 had been helped by mid-February and closer ties with local agencies look set increase referral rates further.

As much emphasis is given to how support is offered as the therapy itself. Those who need intensive help receive one-to-one support, by phone or face-to-face.

Group workshops are built upon principles of cognitive behavioural therapy and compassionate mind and organised around specific themes aimed at building carers’ resilience — managing stress, improving how you feel about yourself, managing frustrations, which is their most popular, keeping up your spirits, and coping with change.

Because carers may not be able to come for sessions as regularly as other service users, each workshop participant gets a handout and audio CDs may be provided, with additional information available through a regular newsletter and online.

Workshops can be taken as a course or on an ad-hoc basis which is important for carers who have very little regular time to devote to themselves.

New sessions launched last year through local Alzheimer Society luncheon clubs are helping to increase access and these reduce carers’ anxiety because they can be confident their cared-for person is being looked after at the same time.

Unusually, Positive Step encourages participants to leave their phones on during workshops. “We tell them, ‘if it rings and you need to go, you go’, “ said Heather. “That takes their anxiety away.  If they can stay for an hour, then they stay. It’s all about what they can manage, and being flexible.

“It’s not rocket science and most of it is at the low intensity level but it’s how you deliver it and shape it for carers which can make a huge difference.”

Carers can self refer by contacting Positive Step directly, or referrals can be made through a GP, primary or secondary care, but most people are guided by charities.

Weston Hospice, in Uphill, also refers to Positive Step and, given the immediacy of the issues those people face during their loved one’s last days of life, those carers will receive their first one-to-one session that same week.

Former businessman and ex-Royal Marine reservist Nick, 69, was caring for his wife of 48 years at home when Carers Trust Phoenix put him in touch with Positive Step.

Nick, who was not sleeping or eating, had been doing everything for Sue, 79, who has Alzheimer’s and is now in full-time residential care.

”It came in the nick of time for me, to be honest,” he said. “I’d been looking after her for three years, and it was just completely soul destroying. I was completely mentally, physically and spiritually exhausted.”

With other carers, Nick learned how to manage his anxiety and stress and was taught vital relaxation techniques which helped him to sleep.

“Positive Step gave me the strength I needed to carry on. Even just going along to the workshop for a couple of hours was refreshing. It was very emotional too. The other people were also carers, and had similar problems so we could all share. We knew with empathy where they were coming from, even if they didn’t have the words.”

Tim Kendall, NHS England’s National Clinical Director for Mental Health, said: “Positive Step is really helping to take the pressure off carers in North Somerset.

“Too often we hear of carers struggling to carry the burden of looking after loved ones, and yet a simple scheme such as this with relatively minor changes to how therapies are delivered can make all the difference in the world.”