18 January 2018

Welcome to LAMPS Latrobe Regional Health, Alfred Health, Monash Health,

Peninsula Health, & Synergy

Training News (LAMPS represents the shining effect of training and education)

Local Training Workshops ................................................................................. 2What’s happening in LAMPS ............................................................................. 7What’s New: Issues and Research? ................................................................... 9What’s New: Issues and Research? (Cont’d) ................................................... 10Compassion Focused-Therapy for Psychosis Workshop .................................. 12

To view the LAMPS Calendar:

http://www.med.monash.edu.au/scs/psychiatry/southern-synergy/workforce/

Look under the heading: Training – click on ‘LAMPS training calendar 2018’.

LAMPS FACEBOOK Page

Full of interesting links to recent relevant research!

“Like” it now at: https://www.facebook.com/LAMPS.Training

Occupational Mindfulness For staff in AGED Mental Health Time: Thurs 2:00pm – 3:30pm for 8 consecutive weeks starting Thursday 1 Feb. Venue: The Hall, Kingston Centre Presenter: John Julian See page 2 for details and registrat ion

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Local Training Workshops

February

1st Feb to

5th Apr

Occupational Mindfulness – 8 week workshop Time: 2.00pm – 3.30pm Venue: Kingston Centre, 400 Warrigal Rd, Cheltenham Presenter: John Julian Cost: Free Register: Louise.Vanbaarle@monashhealth.org

15th

Action over Inertia workshop (OT Study Day) Time: 8:30 (Registrat ions) 9:00 – 4:30pm Venue: The Sandhurst Club, 75 Sandhurst Boulevard, Sandhurst Presenter: Professor Terry Krupa – Canadian Occupational Therapist Cost: $80 (incl. manual and catering) Register: http://spppm-cf.med.monash.edu.au/southernsynergy/form.cfm?workshop_id=2222

March

5th

An introduction to Narrative Therapy with focus on recovery and trauma For Mental Health Clinicians and ward staff only. Registrations: 9.15am Time: 9:30 – 4:30pm Presenter: Ann Fuller Discipline Senior Social Worker Peninsula Health and guest presenter Chanelle Burns. Chanelle is a social worker with a Masters in Narrat ive Therapy. She will share her experience of ut ilizing narrat ive therapy in responding to survivors of trauma. Venue: Frankston Library Community Room, 60 Playne St Frankston Cost: Free Register: Full: A second day will be held later in the year

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March (Cont.)

5th

Advanced Clinical Supervision Time: 9:30 – 4:30pm Venue: Peninsula Health, Training Room. Presenter: John Julian Cost: Free Note: A person attending is required to have undertaken the Introduction and needs to have supervised at least 2 – 3 individuals for reflective clinical supervision. Register: http://spppm-cf.med.monash.edu.au/southernsynergy/form.cfm?workshop_id=2204

8th

Allied Health – Intro to Vic MH Service System – Day 1 Mental Health Service System: The Organisat ion Service Development Time: 9:30 – 12:30pm Presenter: Greg Coman, NEVIL Cost: Free Registration will be through NEVIL using the code SEE.

8th

Allied Health – Mental Health Act – Day 1 Legislat ion and Mental Health Pract ice Internat ional and National Mental Health Policy Time: 1:00 – 5:00pm Presenter: Kylie Boucher, (CPN) Cost: Free Registration will be through NEVIL using the code SEE.

20th

Cultural Responsiveness: Introduction to principles & practices Time: 9:00 – 4:30pm Venue: Latrobe Valley Community Mental Health Service, 20 Washington St, Traralgon Presenter: Victorian Transcultural Mental Health (VMTH) Cost: Free Register: http://spppm-cf.med.monash.edu.au/southernsynergy/form.cfm?workshop_id=2184

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March (Cont.)

21st

Fundamentals of Supervision Training Develop an understanding of the theory and pract ice of being a clinical supervisor Time: 9:00am – 4:30pm Presenter: Southern Dual Diagnosis (SDDS) Cost: $50 Venue: SDDS, Suite 1A, 314-326 Thomas St, Dandenong Registration: sdds@monashhealth.org

April

10th &

11th

Mental Health First Aid (4th Ed.) – 2 day workshop How to provide init ial support to adults who are developing a mental illness or experiencing a mental health crisis. The course curriculum is based on the MHFA Guidelines 4th Edit ion. Most professionals can claim attendance at a MHFA course for Continuing Professional Development (CPD) with their industry body Time: 9:00am – 4:30pm Presenter: SDDS Cost: $100 Venue: Kingston Centre, Educat ion Room A 400 Warrigal Rd, Cheltenham Registration: sdds@monashhealth.org

9th Apr to

28th May

Mindfulness Self-Compassion – 8 week workshop Time: 2:30 – 4:00pm Venue: Monash Health, Suite 1A, 314-316 Thomas Street, Dandenong Presenter: John Julian Cost: Free Register: http://spppm-cf.med.monash.edu.au/southernsynergy/form.cfm?workshop_id=2203

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April (Cont.)

12th

Allied Health – Mental State Exam/ Crisis / Risk Assessment & Management – Day 2 Mental Health Histories and MSE, Risk Assessment and Management, Risk and Protect ive Factors Time: 9:30 – 12:30pm Presenter: Dennis Anson, NEVIL Cost: Free Registration will be through NEVIL using the code SEE.

12th

Allied Health – Assessment / Formulation – Day 2 Time: 1:00 – 5:00pm Presenter: Maria Haydock Cost: Free Registration will be through NEVIL using the code SEE.

12th Apr to 7th

June

Mindfulness-based Stress Reduction(MBSR)/ Occupational Mindfulness – 8 week workshop Time: 1:00 – 2:30pm Venue: Monash Health, Cranbourne Integrated Centre. 140-154 Sladen St CranbournePresenter: John Julian Cost: FreeRegister: http://spppm-cf.med.monash.edu.au/southernsynergy/form.cfm?workshop_id=2223

18th

Mental State Examination Explore an established standardised method for documenting presentat ions with an opportunity to pract ice assessment skills Time: 9:00am – 12:30pm Presenter: Southern Dual Diagnosis (SDDS) Cost: $30 Venue: SDDS, Suite 1A, 314-326 Thomas St, Dandenong Registration: sdds@monashhealth.org

Weekly Mindfulness Sessions Every Wednesday 2:30pm – 3:00pm

Sacred Place, Dandenong Hospital Instructors alternating:

Prof. Graham Meadows, Dr Fran Shawyer & John Julian

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April (Cont.)

18th

New & Emerging Drug Trends These substances have created challenges with some being part icularly toxic. This workshop will provide information to assist in the assessment and treatment of people using these drugs both intent ionally and unintent ionally Time: 1:00pm – 4:30pm Presenter: Southern Dual Diagnosis (SDDS) Cost: $30 Venue: SDDS, Suite 1A, 314-326 Thomas St, Dandenong Registration: sdds@monashhealth.org

19th

Interactions Between Psych Meds and Substances There are challenges working with consumers who are taking both prescribed medicat ions and other substances. Explore a range of information to assist providing information to consumers Time: 9:00am – 12:30pm Presenter: Southern Dual Diagnosis (SDDS) Cost: $30 Venue: SDDS, Suite 1A, 314-326 Thomas St, Dandenong Registration: sdds@monashhealth.org

26th April

to 28th June

Occupational Mindfulness – 8 week workshop Time: 9:30 – 11:00am Venue: Dandenong ART Building, Meeting Rms 1 & 2 Presenter: John Julian Cost: Free Register: http://spppm-cf.med.monash.edu.au/southernsynergy/form.cfm?workshop_id=2185

27th April &

4th May

Intro to Mindfulness & Mindful Self-Compassion – 2-day workshop Time: 9:30 – 4:30pm Venue: Hospital Educat ion Centre (HEC), Building 3, Royal Melbourne Hospital, Royal Park Campus, 34-54 Poplar Rd, Parkville Presenter: John Julian Cost: Free Register: http://www.nwmh.mh.org.au/western-cluster/w1/i1001231/

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What’s happening in LAMPS

Over the past year, as many people are aware, LAMPS has been restructured replacing the previous Steering Committee with two Committees, a Governance Committee and an Advisory Committee. These changes are nearly completed.

This has resulted in some major changes. Some educational programs are now more targeted to public clinical mental health services with a specific number of positions allocated to each service. Secondly, ‘funding rounds’ to develop training will now only be used sparsely, for specific areas, with the dual aim of developing a training package as well as developing that skill by training staff. Thirdly, LAMPS training by John occurred more on location at the health services that make up LAMPS and this proved to be more successful in terms of numbers and was preferred even though it had some increased costs. As such this will occur again during 2018. Lastly, we will be buying in more services for LAMPS area wide training. An example of this will the Blue Knot training for staff on Vicarious Trauma to be run in July across the cluster.

While keeping an eye on training and research, I have been concerned and had confirmed the view that one-day training events, by themselves, may lead to little change. Research has found that a one-day training workshop is often not very effective. Perhaps most importantly, it has been increasingly recognized that workshops and training programs may be of limited benefit in the absence of ongoing consultation and supervision to consolidate and enhance learning post-workshop (Beidas et al., 2012; Lyon et al., 2011). Therefore, some methods will be used that have been shown to enhance the effectiveness of one-day or multi-day workshops (Bennett-Levy & Padesky, 2014).

These methods will include encouraging the use of clinical supervision. Two separate days - basic or introductory supervision, and advanced supervision - training is being offered by both LAMPS and Southern Dual Diagnosis Service (SDDS), who re-developed the package in 2016/2017 with LAMPS funding, into the two-day package. Participants who attend will be surveyed at regularly times to check whether they are supervising staff, and if not, how they are using the skills and what the blockages have been. This information will be considered by both LAMPS committees. However, as we are aware, many staff state they do not have access to reflective clinical supervision. Therefore, another method will be the use of three follow-up reflective exercises emailed to participants at the post workshop one-week, four-week and eight-week stages. Lastly, in some workshops, such as those by the Blue Knot Foundation and, hopefully, at a qualitatively different focus, two workshops later in the year (June and September) by Haley Peckham on ‘Working with people with a trauma history: How understanding neuroplasticity can help in everyday practice’ and the second on ‘Attachment Theory and Affect Regulation Theory: How experience shapes brains, emotions and relationships’ people attending will be expected to brief there work units on

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what they learned. This will then be surveyed, observed and discussed at both LAMPS committees.

Some other points to note include: • The Governance Committee has also requested specific executive leadership training

in some areas and this is currently being explored and organized. • A major focus on trauma will remain with a major developmental project occurring

regarding training, on the Facebook page and in Foundational Counselling Skills for experienced mental health staff.

• All disciplines groups who held a Professional Development day in 2017 and filed a report with LAMPS have had their grants ($2000 per annum) again in 2018.

• Staff welfare, using both mindfulness and compassion focused programs as well as the Blue Know Foundation training on Vicarious Trauma, will remain a focus in 2018.

• Each service will have four days of John’s training time this year – these are currently being organized and will placed on the calendar soon.

The issues around peer workforce training and representation remain unresolved issues at this stage and ways of moving forward are being explored.

References Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63, 660–665. http://dx.doi.org/10.1176/appi.ps.201100401 Lyon, A. R., Stirman, S. W., Kerns, S. E. U., & Bruns, E. J. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38, 238–253. http://dx.doi.org/10.1007/s10488-010-0331-y Bennett-Levy, J., Padesky, C. A., Use It or Lose It: Post-workshop Reflection Enhances Learning and Utilization of CBT Skills Cognitive and Behavioral Practice 21 (2014) 12–19

LAMPS staff LAMPS has two part-time staff, John Julian and Debbie Lang.

John Julian

(.6EFT), Manager and Trainer at LAMPS celebrates 40 years as a health professional in December 2018

Debbie Lang

(.5EFT), Administrator at LAMPS

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What’s New: Issues and Research?

This section is designed to create reflection in how we do things with published papers on newer aspects of therapies and treatments, and issues, in Mental Health.

Avatar therapy 'reduces power of schizophrenia voices’.

Open Access Article Craig, Tom KJ et al. AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. The Lancet Psychiatry , Volume 5 , Issue 1 , 31 - 40

Confronting an avatar on a computer screen helped patients hearing voices to cope better with hallucinations, a UK trial has found.

Patients who received this therapy became less distressed and heard voices less often compared with those who had counselling instead.

Experts said the therapy could add an important new approach to treating schizophrenia hallucinations.

The trial, on 150 people, is published in The Lancet Psychiatry journal.

The findings and interpretation in the Abstract are report as follows:

Findings

Between Nov 1, 2013, and Jan 28, 2016, 394 people were referred to the study, of whom 369 were assessed for eligibility. Of these people, 150 were eligible and were randomly assigned to receive either AVATAR therapy (n=75) or supportive counselling (n=75). 124 (83%) met the primary outcome. The reduction in PSYRATS–AH total score at 12 weeks was significantly greater for AVATAR therapy than for supportive counselling (mean difference −3·82 [SE 1·47], 95% CI −6·70 to −0·94; p<0·0093). There was no evidence of any adverse events attributable to either therapy.

Interpretation

To our knowledge, this is the first powered, randomised controlled trial of AVATAR therapy. This brief, targeted therapy was more effective after 12 weeks of treatment than was supportive counselling in reducing the severity of persistent auditory verbal hallucinations, with a large effect size. Future multi-centre studies are needed to establish the effectiveness of AVATAR therapy and, if proven effective, we think it should become an option in the psychological treatment of auditory verbal hallucinations.

It follows a much smaller pilot study in 2013.

This is an open access article so it is freely available at: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30427-3/fulltext

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What’s New: Issues and Research? (Cont’d)

The Power Threat Meaning Framework Is it time to again place the narrative subject (Frank, 2015) at the heart of good mental health recovery practise?

In 2013 in the UK, the Division of Clinical Psychology (DCP) of the British Psychological Society released a position statement which called for a paradigm shift in mental health ‘towards a conceptual system that is no longer based on a “disease” model’ (Johnstone, L., 2014). At the same time the further development of the consumer movement with concepts such as ‘recovery’ and now ‘well-being’ alongside groups such as Voices Inc. may represent that a “major shift is underway that is changing what counts as lay and professional knowledge of ‘the psychoses’, with the emerging psychosocial paradigm increasingly challenging longstanding biomedical understandings in this area” as noted by Steve Smith and Alec Grant in Nursing Education Today (Steve Smith and Alec Grant, 2016).

A new paper released by the British Psychological Society this month explores an alternative way of working with people with trauma. This may have some relevance to our work. As we are aware there are two broad types of trauma, event-based trauma and persistent trauma, such as that involved in with many people with Adverse Childhood Events (ACES) where the trauma is relational in nature and involves disempowerment of the individual who is the object of the abuse. The ‘The Power Threat Meaning Framework’ (PTM Framework) may be a useful way to start thinking about this.

From the paper is an outline “Summary of the ‘The Power Threat Meaning Framework’” (PTM Framework)

This broad PTM Framework is derived from a wide range of theory and research, across disciplines and research methods. It comprises four interrelated aspects:

1. The operation of POWER (biological/embodied; coercive; legal; economic/material; ideological; social/cultural; and interpersonal).

2. The THREAT that the negative operation of power may pose to the person, the group and the community, with particular reference to emotional distress, and the ways in which this is mediated by our biology.

3. The central role of MEANING (as produced within social and cultural discourses, and primed by evolved and acquired bodily responses) in shaping the operation, experience and expression of power, threat, and our responses to threat.

4. As a reaction to all the above, the learned and evolved THREAT RESPONSES that a person, or family, group or community, may need to draw upon in order to ensure emotional, physical, relational and social survival. These range from largely automatic physiological reactions to linguistically-based or consciously selected actions and responses.

Unlike the more traditional biopsychosocial model of mental distress, there is no assumption of pathology and the ‘biological’ aspects are not privileged, but constitute one level of explanation, inextricably linked to all the others. Equally important, although a tripartite model is a convenient heuristic, the four elements of Power, Threat, Meaning and Threat Response are not independent,

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but evolve out of each other. The individual does not exist, and cannot be understood, separately from his/her relationships, community and culture; meaning only arises when social, cultural and biological elements combine; and biological capacities cannot be separated from the social and interpersonal environment.

Within this, ‘meaning’ is intrinsic to the expression and experience of all forms of emotional distress, giving unique shape to the individual’s personal responses. In summary, this PTM Framework for the origins and maintenance of distress replaces the question at the heart of medicalisation, ‘What is wrong with you?’ with four others:

• ‘What has happened to you?’ (How has Power operated in your life?)

• ‘How did it affect you?’ (What kind of Threats does this pose?)

• ‘What sense did you make of it?’ (What is the Meaning of these situations and experiences to you?)

• ‘What did you have to do to survive?’ (What kinds of Threat Response are you using?)

• Translated into practice with an individual, family or group, two additional questions need to be asked:

• ‘What are your strengths?’ (What access to Power resources do you have?)

• ...and to integrate all the above: ‘What is your story?’

A key purpose of the PTM Framework is to aid the provisional identification of evidence-based patterns in distress, unusual experiences and troubled or troubling behaviour. In contrast to the specific biological causal mechanisms which support some medical disorder categories, these patterns are highly probabilistic, with influences operating contingently and synergistically. However, this does not mean that no regularities exist. Rather, it implies that these regularities are not, as in medicine, fundamentally patterns in biology, but patterns of embodied, meaning-based threat responses to the negative operation of power. The PTM Framework demonstrates how these probabilistic patterns can be described at various levels, starting with the ‘Foundational Pattern in the Power Threat Meaning Framework’.

Appendix Seven provides an interesting example of Trauma Pathways in tow adult mental health services on using this transdiagnostic approach.

The paper is freely available at: https://www1.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/INF299%20PTM%20overview%20web.pdf

1. Frank, A.W., 2015. From sick role to narrative subject: an analytic memoir. Health 1–13, (www.ncbi.nlm.nih.gov/pubmed/26582351. 2015 Nov 18. pii: 1363459315615395 (This paper is freely available).

2. Johnstone, L., 2014. A Straight Talking Introduction to Psychiatric Diagnosis. PCCS Books, Ross-on-Wye. Lakeman, R., Cutcliff, p15 3. Steve Smith and Alec Grant, 2016 The corporate construction of psychosis and the rise of the psychosocial paradigm: Emerging

implications for mental health nurse education Nurse Education Today 39 (2016) 22–25)

COMPASSION-FOCUSED THERAPY (CFT) FOR PSYCHOSISWith international presenters: Dr Eleanor Longden and Dr Charlie Heriot-Maitland

CRICOS Provider: Monash University 00008C. TRSU409136

DATESMonday 19 March – Tuesday 20 March, 2018.

VENUEAbbotsford Convent (Community Room), 1 St Heliers Street, Abbotsford VIC

COST Early Bird – $650 by 31/01/2018

Health Care Card (HCC) – $550 by 31/01/2018

Standard Fee – $695 by 1/3/2018

Last Minute – $730 by 16/3/2018

Price includes morning tea, afternoon tea, and lunch.

REGISTERFor further information please go to: monash.edu/medicine/scs/psychiatry/research/southern-synergy/cft-2018-psychosis-workshop

OBJECTIVESThis workshop is designed for mental health practitioners who are interested in learning about the Compassion-Focused Therapy (CFT) model of compassion, how to apply this model to support clients with psychosis-related difficulties, and the developing evidence base for this approach. It is open to practitioners with or without prior training in CFT.

Participants will learn:

1. how to help clients establish a bodily experience of safeness through direct CFT practices such as soothing rhythm breathing, mindfulness and imagery exercises.

2. how to support their clients to develop a ‘compassionate self’, which is a self-identity that organises the mind and provides a secure base (or grounding) from which to do the therapeutic work.

3. how to encourage their clients to use these compassionate qualities and skills to manage internal conflicts. This is achieved through techniques such as voice dialoguing, imagery, chair work, and letter writing.

4. about the current nature and level of evidence for the CFT approach and how this evidence-base may be developed.

ABOUT THE PRESENTERS

ELEANOR LONGDENEleanor is a research psychologist with lived experience of psychosis who has lectured internationally on recovery-orientated approaches to complex mental health problems, including TED and WHO events. She works at the Psychosis Research Unit in Manchester, and coordinates the research committee of Intervoice.

CHARLIE HERIOT-MAITLANDCharlie is a clinical psychologist, researcher and trainer at King’s College London. He is researching the social context of anomalous experiences and the application of CFT for people experiencing distress in relation to psychosis. He provides psychological therapies in National Health Service psychosis services, and in private practice, and runs compassion training workshops.

KEY RESOURCES‘Compassion for Voices’ (https://www.youtube.com/watch?v=VRqI4lxuXAw)

A 5-minute film which outlines a compassion-focused approach for relating to voices.