In the immediate aftermath of a major incident our body’s automatic survival reactions will take over and may react in unexpected ways, e.g. we may freeze, run away, push past others, urinate, have an out of body experience.

Sometimes being nearby, knowing someone there, seeing news images, hearing stories about it or being part of the emergency response is enough to trigger a response in us.

In the first few weeks it may be common to:

• Have problems sleeping/feel tired
• Feel irritable/jumpy or numb
• Increase your alcohol intake or smoking more
• Have intrusive images or thoughts
• Feel unsafe or mistrusting
• Avoid places, people etc.
• Feel guilt
• Have poor concentration
• Have fleeting thoughts of harming self or others. 

What can help

• Make sure you get plenty of sleep and rest.
• Establish a routine
• Eat well
• Take a walk or go to a place you feel safe
• Stay connected to people. Share what happened if you want and if not, talk to people about everyday things. Maybe connect with other people who were there, e.g. go to memorial services
• Accept strong feelings, unusual experiences, feeling empty or numb, impaired judgement and clumsiness as normal and reassure yourself on this.
• Be careful at home, when driving or operating machinery – accidents are more likely to happen following a stressful experience

How to know if you need a GP referral for more specialist help, support or therapy

You may want to approach your GP and seek specialist help and support if you experience any of the below:

• Feeling persistently suicidal or want to hurt someone
• If after a month or so: you can’t function at home or work; you are swamped with anxiety, anger or low mood; are having unusual relationship problems; have severe nightmares or still relive the event; feel numb or disconnected; blame yourself or feel ashamed; your drug or alcohol use is out of control.
• People close to you tell you they are worried about you.

How to support someone you know

Connect: The person may need time to be alone but keep trying to connect with them on everyday activities.

Listen: to their feelings but don’t ask for details of what happened and don’t offer advice.

Ask: Don’t assume what they need, it might be different from what we think.

Practical: Make them a meal, offer them a lift. They may also need some flexibility at work.

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Occupational therapy is a treatment and a profession.

Occupational therapists are interested in how people live their lives. They help people to become as able as possible wherever they live, and whatever health issues they may have.

Occupational therapists use ‘doing’ as the therapy. They think with you about all areas of your life; any activities that you do or would like to do that are important to you, school/college/ lifelong learning, leisure, family, friends, and work.

An occupational therapist will discuss with you how your day goes, from first thing in the morning until last thing at night, as well as how you sleep. Then you can come up with a list of things you want to improve, and work out together how this will happen, using activities that you are interested in.

We know that people are ‘doing’ beings and their health is linked to how well they feel they can ‘do’. Occupational therapists really focus on the whole person.

What could an occupational therapist help me with?

• Finding new interests or get back to doing the ones that are important to you
• Developing skills such as coping with problems, getting along with others, looking after yourself, managing your money,
• Getting yourself to school, college, work and leisure activities
• Connecting with your local community
• Doing everyday things such as keeping clean, eating, sleeping, cooking, cleaning, shopping, getting dressed
• They may use equipment that helps you to be more independent (or link you with the best person to do this with you)
• And many more things that they will discuss with you and your family (with your consent)

How will we decide what to work on?

Your occupational therapist will talk with you and you will decide what to work on together.

They will change the way they do this when they need to. This is to make sure you understand each other.

Who is my occupational therapist?

Name …………………………………………………………………….

Contact phone number ………………………………………………

Working hours ………………………………………………………..

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• promote independence in daily living;
• maintain or increase function;
• promote good health;
• improve quality of life;
• encourage self reliance.

For more information:

• What is occupational therapy? trust leaflet
• Health Professions Council website
• British Association of Occupational Therapists and College of Occupational Therapists (BAOT/COT) website

Successful occupational therapy experiences

We have collected a number of stories about our service users experiences of occupational therapy services. These describe how occupational therapy has helped/is helping in their recovery from mental ill health. Read about these successes in our sharing your experience stories.

There are a number of our trust services which are very specialised.

Because of this they are based in one place, and no matter which of our areas you live in, if you’re referred to these services you’ll receive them at that base.

Some of these services also treat people who live outside the TEWV area.

Trustwide services based in one location

• Acute inpatient services, children and young people – Newberry Centre, West Lane Hospital, Middlesbrough
• Adult attention deficit hyperactivity disorder (ADHD) service – provided on Teesside, County Durham and Darlington
• Eating disorders community team, adults – Imperial Avenue, Norton
• Eating disorders inpatient services, adults – Birch Ward, West Park Hospital, Darlington
• Eating disorders inpatient services, children and young people – The Evergreen Centre, West Lane Hospital, Middlesbrough
• Forensic and secure inpatient services – Ridgeway, Roseberry Park, Middlesbrough
• Forensic outpatient service – children and young people
• Low secure inpatient service for children and young people – Westwood Centre, West Lane Hospital, Middlesbrough
• Military personnel inpatient services
• North east mental health and deafness service – provided on Teesside, County Durham and Darlington
• Nutrition and dysphagia – based at West Park Hospital, Darlington
• Prison mental health teams – providing a service to the six HMP Prisons served by the trust

Some of our services are provided by different locality teams, but deliver the same specialist service

• Art psychotherapy
• Cognitive analytic therapy
• Cognitive behavioural therapy
• Crisis service
• Dual diagnosis (substance misuse) service – Durham, Darlington, Teesside, Hartlepool, Scarborough
• Early intervention in psychosis
• Learning disability short break service, children and young people – Teesside and County Durham
• Street triage – in Teesside, Scarborough and North Yorkshire
• Talking therapies
• Veterans services
• Occupational therapy

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What is infection control?

Physical health care

Back care advisory service

Other useful information:

Multi-resistant gram-negative bacteria

Physiotherapists are experts in human movement and function

This could be movement of:

• An individual joint (elbow, wrist, hip, knee etc.)
• A limb (arm or leg)
• A body segment (trunk – including movement required for breathing, head or neck)
• The whole body (how someone walks or gets from one position to another)

They help people affected by injury, illness or disability using movement and exercise, manual therapy such as massage and therapeutic handling, and by giving education and advice.

Physiotherapists in mental health and learning disabilities services have extra skills, knowledge and experience. They can adapt traditional physiotherapy assessment and treatment to the needs of someone with mental ill health or a learning disability who may be unable to access general physiotherapy.

Physiotherapists can help to…

• Manage underlying physical conditions which are more common in people with mental ill health or a learning disability
• Offer expert management of pain, mobility and movement
• Help to prevent ill health and promote healthy lifestyles
• Help manage anxiety by teaching relaxation, breathing techniques and exercise

They can also help with:

• Stroke, multiple sclerosis, Parkinson’s, Cerebral Palsy (Neurological – how the brain and nerves work together)
• Pain, especially back pain, sports injuries, arthritis (Neuromusculoskeletal – how the brain, nerves work with the skeleton and muscles to produce movement)
• Chronic heart disease, rehabilitation after heart attack, management of swelling (Cardiovascular – how the heart and the circulatory system work together)
• Chest complaints such as asthma, cystic fibrosis, chronic bronchitis (Respiratory – how the lungs work)

They also often use alternative and complimentary therapies like acupuncture and reflextherapy. Often physiotherapists working in mental health and learning disabilties services are trained in cognitive behavioural therapy and mindfulness, so that they can give the best possible support to our service users.

Our physiotherapists work with the other people involved in providing someone’s care and treatment as part of a ‘multidisciplinary team’ (or MDT).

The spirituality flower

Trust service users and staff have designed our spirituality flower to help us better understand what your spiritual needs and concerns might be so we can help make you more comfortable while with us.

Our service users say that for them spirituality is not about a particular set of activities or interventions, but something which runs through the core of everything we need to consider in our provision of  care.

Find out more about our spirituality flower in patient and carer information L744 v2 The Spirituality flower.

What do we mean by ‘spirituality’?

Spirituality means different things to different people. It is helpful to understand the difference between religion and spirituality. People, whether they are religious or not, may have different spiritual needs at different times of their life. Spiritual needs and concerns include, but also go beyond, religious ones.

Why bother with spirituality?

To be a human being is to be a spiritual being. Any care which is ‘person-centred’ will attend to spirituality – even if, for some people, that is simply to confirm that they do not wish to discuss it.

Surveys carried out nationally and within the Trust, confirm that many service users wish to have spirituality considered within their care because it helps them to recover and keep well. Spirituality is at the very heart of the ‘recovery model’.

Evidence supports the importance of spirituality and religion in understanding the causes of many mental ill health conditions, and the potential benefits of considering spiritual and religious factors within treatment planning.

The Human Rights Act 1998 and the Equality Act 2010 require us to make sure that service users are able to practice their religion or beliefs and are not discriminated against because of them.

How do we go about it?

Service users say that they would like people who work in mental health services to demonstrate the following qualities:

• ‘start from where I am, not from where you think I am’
• empathy (that means getting inside somebody’s world and understanding what it is like for them)
• quality time (that doesn’t have to mean a lot of time, but does mean time without distractions)
• attention to the somebody’s emotions, culture, identity and dignity
• seeing someone as having strengths as well as needs
• ‘working with’ rather than ‘doing to’ a person.

These qualities are especially important when we are talking about spirituality and the trust would hope that you can expect to find them demonstrated by our staff.

Exploring the petals of the spirituality flower

If you wish, your care team can use the trust spirituality flower with you to explore your spiritual or religious needs. Doing this can help staff find out your spiritual or religious beliefs and practices to help you feel comfortable and properly supported by our teams.

If at any stage in your care you feel it would be helpful to go into some of these themes or questions on the spirituality flower in more depth, then you might want to consider some of the questions that go along with each petal of the flower below.

It might be enough simply to think about some of these questions by yourself, but you might also find it helpful to discuss them with a member of staff, or perhaps with one of the trust chaplains.

Please remember, it is absolutely your choice to decide which, if any, of these questions are relevant to you at the moment.

	what gives your life meaning? what do you believe in? is there a specific aim that is important to you at the moment? are you spiritual or religious? how do your beliefs affect the care you would like to receive from the Trust?
	where do you find hope, strength, comfort? what are the things that make you feel alive,  happy, peaceful? what helps you to feel most yourself? what is there in your life that gives you internal support? has being ill made any difference to any of these?
	what do you hold onto during difficult times? when you are really upset where do you turn for help? what keeps you going? what do you hope for? is your current situation affected your ability to do things that usually help you spiritually?
	is there a person or a group of people you really love, or who are really supportive to you? how are you with other people? what would you like to change about your relationships? are you part of a spiritual or religious community – is this supportive to you? do you believe in God? what kind of relationship do you have with God?
	when do you notice that you are alive? how much time do you spend going over the past or worrying about the future? do you have any personal spiritual beliefs or practices; what are they; do they help; is there anything we can do to support them?

What happens next?

After thinking or talking about some of these questions, you might decide that there are some actions you want to take to help support your spiritual wellbeing. These might include:

• using the spirituality flower to explore your spirituality and spiritual needs in greater depth: a member of staff will be able to help you to do this if you wish.
• making provision for religious practice: you may wish to attend worship or prayers; you may need resources such as scriptures, a prayer mat or a rosary or to ensure that your religious dietary requirements are catered for
• making provision for non-religious spiritual practice: people, whether they are religious or not, may experience spiritual benefit in such things as walking and exercise, having access to nature, creative activities such as art, music, cookery or gardening; practising yoga, meditation or Tai Chi
• referral to the chaplaincy service: the trust’s chaplains are available to talk to anybody about anything and offer support to service users both in hospital and in the community. Chaplains may be from any faith and are recognised and authorised by their faith communities to offer this kind of care. They are certainly not just there for religious people and will never try to impose their own beliefs or morality on you. You can trust a chaplain to listen to you and not to judge you.
• referral to specialist therapies: there are some therapies available which have a particular spiritual dimension to them. One example is Mindfulness Based Cognitive Therapy which can be very effective for people with recurrent depression, anxiety problems or other difficulties. You may wish to have a discussion with your care coordinator about the suitability of one of these for you.
• making contact with a local faith group: you may wish to find out about a particular faith, to begin practising it, or to resume a practice which has been important to you in the past by making contact with a local faith community.
• making contact with a local activity group: It may be that there are local groups which can help you to get involved in some of the non-religious activities mentioned above. Some people also find spiritual benefit in getting involved in some voluntary work.

Seeking further support

There are clinicians of all disciplines around the Trust who have particular experience in this field. If you would like some further advice or support from one of these, please e-mail tewv.chaplaincy@nhs.net.

Other resources

Trust resources

https://www.tewv.nhs.uk/services/chaplaincy/

Recovery College Online: Course in ‘Spirituality and Recovery’ www.recoverycollegeonline.co.uk

The Mental Health Foundation

http://www.mentalhealth.org.uk/a-to-z/s/spirituality

Royal College of Psychiatrists Spirituality Special Interest Group

http://www.rcpsych.ac.uk/workinpsychiatry/specialinterestgroups/spirituality.aspx

The BBC has a comprehensive guide to world religions

http://www.bbc.co.uk/religion/religions/

The National Spirituality and Mental Health Forum

http://www.spiritualitymentalhealth.org.uk/

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Contact our chaplains

We  provide a Trust-wide chaplaincy service.  Chaplains can be contacted on the following telephone numbers where you can leave a non-urgent message:

You can also send an email to the chaplains at tewv.chaplaincy@nhs.net.

More information on the chaplains who work for us can be found here.

What is a chaplain?

Chaplains are employed by the trust to give spiritual and religious care and can be Christian, Muslim, Hindu or from any faith.

Chaplains are recognised and authorised by their faith community as having the knowledge and experience to give this kind of care.

They are there for people of all faiths and none.

Who can see a chaplain?

Anybody can see our chaplains. Chaplains are available to talk to anybody about anything. They offer support to service users, carers and staff and are available to people in hospital and to those receiving services in the community. They are certainly not just there for religious people and they will never try to impose their beliefs or their morality on you.

You can trust a chaplain to listen to you and not judge you.

Why would I want to see a chaplain?

We are all seeking to make sense of our everyday lives and to find meaning and purpose within them. Almost everybody has deep questions about why we are here, what happens after death, whether or not there is a God. There may be smaller everyday concerns and questions to explore.

If you talk to a chaplain about these things, they will not impose their own beliefs on you, but help you to think about the questions for yourself.

Even if you are not religious, there might be a time when you would like somebody to pray with or for you, to bring you Communion, to give you a prayer mat and point you in the direction of Makkah, or make contact with a leader from your own faith.

Maybe you don’t really know why you want to speak to a chaplain, but think it might help. Whatever your reason, please do not hesitate to contact us.

How can I practice my faith when I am in hospital?

If you are a follower of any faith, then it is important that you are able to practice it while you are in hospital. Chaplains hold services in the prayer rooms of our bigger hospitals and on the wards if requested to do so. We can provide holy books, such as the Bible, the Qu’ran or the Vedas. We have prayer mats and compasses. We can put you in contact with faith leaders and talk to other members of staff about your needs.

However, we can only help you if we know what your needs are. Even if you do not follow the same faith as a chaplain, please contact us to let us know what you need and we will endeavour to help you practice your faith.

Is anything I say to a chaplain confidential?

Chaplains will always treat what you say to them with utmost respect and care.

They will not normally record or discuss any of the content of your conversation, unless they believe that there is a risk to yourself or someone else. If, however, you wish them to record any part of your conversation they are happy to do that.

How can I contact a chaplain?

Contact information can be found at the top of this page.

Members of staff can contact a chaplain for you and if you need to talk to somebody urgently, there is a chaplain on call from 8am to 8pm every day of the year. Members of staff can find the list of on call chaplains via the chaplaincy pages of the trust intranet.

However you understand the word of God, here is a prayer you might like to use…

God bring me light in the darkness,

refuge and strength in time of fear.

Give special skills and loving hearts to

those who support and work with me.

Show them how best to assist your

work of healing.

Surround me with your peace.

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Tees, Esk and Wear Valleys NHS Foundation Trust’s pharmacy service advises on and supports the safe and appropriate use of medicines within the trust.

We do this by providing:

• Accurate and independent information and education about medicines to service users and carers
• Information and education for trust staff and other professionals
• Clinical activities to help ensure the optimum use of medicines
• Medicines optimisation to ensure the most cost-effective use is made of resources

Complementing our clinical activities our main hospital sites (Lanchester Road, Roseberry Park and West Park) – have dedicated on-site Lloyds pharmacies, which supply and dispense medication for inpatients as well as service users who are being cared for by our community teams. Opening hours are Monday to Friday, 8.30am to 5.30pm.

An extended hours service in the evenings and at weekends is also provided from designated Lloyds community pharmacies. This has enabled us to improve access to medicines.

Many of the medicines related policies, procedures and guidelines are also available here on our website.

Medication information

You can contact the trust’s pharmacy team on tel: 0191 441 5778.

Choice and Medication website

The trust’s Choice and Medication website offers information about medications used for mental health illnesses to help people make informed decisions about the medicines they need.  Patients can use this site on their own or together with family, a carer, a doctor, nurse or pharmacist.

On the Choice and Medication website you’ll useful information on:

• Commonly asked questions about mental health medicines
• Mental health conditions and the medicines used to treat them
• Comparing the main medications that are usually prescribed for a mental health condition
• Side effects of medicines

Which medicines do we prescribe?

The National Institute of Clinical Excellence (NICE) approves which medicines can be prescribed to patients.

They also carry out ‘technology appraisals’ which give recommendations on the use of new and existing medicines and treatments within the NHS. The NHS is legally obliged to fund and resource medicines and treatments recommended by NICE’s technology appraisals.

The list of approved medication we can prescribe for mental health conditions is called a ‘formulary’.

• Our formulary is listed on the County Durham and Darlington formulary website.  We use this list across all areas of the Trust, not just County Durham and Darlington.  On the formulary website, use the links at the left and click on central nervous system / chapter 4 to see the approved mental health medicines. The formulary also indicates which treatments we use that have been approved by NICE.

What they do

Dietitians interpret the science of nutrition, aiming to improve health and treat conditions by educating and giving practical advice. They work with a variety of people in a variety of settings, using the most up-to-date, evidence-based information on food, health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.

Our Trust has an established dietetic team. The team includes registered dietitians, dietetic assistants and associate practitioners who work in a number of clinical areas throughout Teesside, Darlington, County Durham and North Yorkshire. Clinical areas of work including adult mental health, children and young people, eating disorders, learning disabilities, older people and forensics.

Dietetic team work is extensive and includes individual work with services users, group work, work with families and carers, liaison with staff, liaison with outside agencies, work with catering services, work with pharmacy and many other teams, colleagues and services within the Trust. The dietetic team also has an important role in policy development, menu design and review and pathway development.

Find out more about our:

Adult learning disabilities dietitians

Adult mental health dietitians

Children and young peoples dietitians

Forensic mental health dietitians 

Older peoples dietitians