How to keep your kids on the nice list

Christmas with kids is supposed to be one of the best parts of being a parent. But a change of routine, arguing over presents and over-indulgence can all make your child’s behaviour a Christmas nightmare.

Kate Simpson - Early Years Specialist Practitioner, and Fran Breed - Health and Family Support Worker, from Sure Start, gave us their top tips on managing your child’s behaviour at Christmas.

Stick to your routine

It’s difficult with so much going on, but try to stick to your routine as much as possible. This will help you keep a sense of normality and show that your normal rules still apply.

If children are staying with grandparents or with their other parent, have discussions beforehand on how you manage behaviour so that it’s consistent for your child.

Encourage sharing

With all those new toys, there are bound to be disagreements!

It’s natural for young children to think of themselves, so they find the concept of sharing very difficult. Don’t expect young children to want to share their brand new toy – we wouldn’t want to share our Christmas gifts!

Be realistic with your expectations, and give children time to enjoy their gifts before expecting them to share.

You can encourage sharing by setting a time limit using visuals. For example, say ‘when the big hand on the clock gets to the top’, use an egg timer if you have one or set the alarm on your phone. Give lots of praise for sharing and lead by example.

Use praise and positive language

If you only give your child attention for negative behaviour, it’s easy to see why they might want to act up. Try to stay positive, and make sure you notice the good things.

Your time is the best gift

It might sound cheesy, but your presence really is the best present. Children still need quality one to one time, otherwise negative behaviour will present itself.

Choose your battles

Behaviour will be different due to tiredness, being over excited and too much sugar. Keep this in mind and try to have realistic expectations over the Christmas period.

Stay calm and smile!

Don’t put pressure on yourself for everything to be perfect - the things which go wrong can end up being the best family stories!

Try to stay calm and enjoy yourself, and you’ll find everyone ends up in a better mood.


If you’re still struggling with your child’s behaviour after Christmas, you can get advice from your local Sure Start centre. 

A not so merry Christmas

Life can throw up problems at any time of year, but Christmas is a particularly difficult time to be struggling.

Financial problems, too much alcohol and the pressure to have the perfect Christmas can all make the festive period a stressful time.

If the thought of the Christmas season fills you with dread, there is help available.

Issues with alcohol

Alcohol seems to be everywhere at Christmas, and it’s easy to get carried away.

If alcohol is a problem for you or someone in your household, don’t stock up for Christmas – limit what you have at home.

You can get further help and advice from Alcohol Concern.

Money troubles

It sounds cheesy, but remember that the best gift you can give your children is your time.

When you do your Christmas shopping, be careful with credit. Never buy anything on credit until you’ve checked the interest rates and are confident you can afford the repayments.

You should also check that any company you borrow from is the real deal. Loan sharks charge very high interest and often use illegal methods to get the money from you. You can check the financial services register to make sure a company is legitimate.

If you do find yourself in financial trouble after Christmas, most community centres will hold debt management surgeries. They will be able to give information on your local food bank if you need it.

Your local Sure Start centre can also point you in the right direction for debt management advice.

Domestic violence

Domestic violence can happen at any time of year, but more time spent together at home can make things even more difficult.

If you are experiencing domestic violence, you are not alone and there is help out there: 

• Nottinghamshire 24 hour domestic violence helpline: 0808 800 0340 - freephone 
• National 24 hour domestic violence helpline: 0808 2000 247 - freephone 
• Advice line for male victims of domestic violence: 0808 8010 327 – freephone

You can also find advice online at Refuge, Women’s Aid or Men’s Advice Line.

Mental health issues

When everyone seems to be happy and having a wonderful time, experiencing issues with your mental health can feel even more isolating than usual.

If you’re struggling this Christmas, try to talk to family and friends about how you’re feeling. You can also find a listening ear at the Samaritans.

If you need urgent help, visit our help in a crisis page to find the best place to contact.

Get more help

If you’re not sure where to go for help with family problems, your local Sure Start centre can point you in the right direction.

If you’re experiencing issues with your mental health and you’re not in touch with our services, please talk to your GP. If you are using our services, please contact your care co-ordinator for advice.

The power of volunteering

Saturday 5 December is International Volunteer Day. We’d like to say a big thank you to all of the volunteers who help our patients and service users, as well as those who help to shape and improve our services.

Over 250 volunteers and befrienders give up their time to help people at Nottinghamshire Healthcare. There are lots of opportunities available. Our two Involvement Centres are places where people can take part in lots of different activities, from being on interview panels to working on their own personal development.

There are also lots of ways to get involved directly with patients, from helping to collect feedback to serving customers in our tea shops.

Befriending and visiting roles are another important way volunteers help at the Trust. Rampton Hospital has its own befriending scheme, for patients who have little or no contact with the outside world. Befrienders are individually paired up with patients who have similar hobbies and interests.

Befriending is a really important role for patients who don’t have many visitors, as it gives them contact with the outside world and helps to stop them feeling isolated. There are currently 49 befrienders working at Rampton Hospital, as well as befrienders working at some of our other secure hospitals.

Alan Coomes has two voluntary roles with the Trust; supporting patients at Nottingham City Hospital and taking part in ward audits and interview panels as an involvement and experience volunteer. Alan said, “‘I’ve been on my own for a very long time. Volunteering gives me a structure to daily life. I enjoy giving something back.”

“Volunteering lifts me out of the negative feelings and promotes a sense of positivity. It gives me what I describe as the 6 Cs; Care for others, Compassion, Competence, Communication with others, Courage and Commitment.”

Jules is another volunteer, who shares her story with new staff as part of their induction. Jules also volunteers at The Story Shop, a project where people with experience of mental health issues share their stories with others to help raise awareness and reduce stigma.

Jules says: “I like a routine. I like to be with people. Volunteering gives me an opportunity to be with others. It takes me away from my four walls, and I like to think that I make people happy when I volunteer and share my journey as a service user.”

Lots of our volunteers talk about the structure and routine working with us gives them. When people have been unwell and unable to work, volunteering gives them a purpose. Volunteering is of course about giving, but for many people it also gives them something back, too.

If you would like to find out more about volunteering at Nottinghamshire Healthcare, visit the volunteering section of our website.

6 ways to reduce your risk of diabetes

There are currently around 3.9 million people in the UK with diabetes. 90% of these have type 2 diabetes. Sara McKenzie, Diabetes Specialist Dietitian, gave us her advice on reducing your risks and living well with the condition.

Anyone can get type 2 diabetes, and some of the risk factors such as age, ethnic background or family history can’t be changed. The good news is that around 80% of cases of type 2 diabetes can be prevented or delayed by maintaining a healthy weight, eating well and being active. 

If you have been diagnosed with type 2 diabetes, it is important to make changes to your lifestyle, diet, and activity levels. This will help to control your blood glucose levels and reduce the risk of diabetes causing you problems, now and in the future.

If you don’t have type 2 diabetes, making changes now can reduce your risk of developing it.

Here are our top tips:

1. Eat regular meals

Avoid skipping meals to help you manage your hunger and avoid overeating.

2. Include some carbohydrates

Carbohydrates are used for energy, so include some in your diet every day. However, it is important to choose the right type and amount. Try to include wholegrain options and those that are more slowly absorbed (have a lower glycaemic index), such as multigrain or granary bread, oat and bran based cereals, sweet potatoes, pasta and basmati rice.

Other good choices of foods which contain carbohydrates include fruit and vegetables, pulses, wholegrain starchy foods and some dairy foods. Aim for a fist size of carbohydrate as a portion guide.

3. Eat less fat

Most of us know that reducing our fat intake helps with weight loss. Focus on reducing saturated fats such as butter, cheese, processed meat and pastry, which are linked to increasing cholesterol.

4. Try to eat five a day

Fruit and vegetables will give your body the vitamins, minerals and fibre it needs. Aim for at least 5 a day and try to have a variety. A portion is:

• three heaped tablespoons of vegetables

• one piece of fruit like a banana or an apple

• a handful of grapes

• a tablespoon of dried fruit

5. Cut back on sugar

Having diabetes, or aiming to reduce your risk of type 2 diabetes, doesn’t mean you need to eat a completely sugar-free diet – but don’t over-do it. Here are some easy ways to cut back on your sugar intake:

• Choose sugar-free, diet or no-added sugar drinks
• Buy canned fruit in juice, not in syrup
• Cut out the sugar in your tea or coffee 
• Read food labels and reduce your intake of high sugar foods 
• Use sweeteners instead of sugar

6. Be more active

Increasing physical activity levels is important for weight loss and controlling blood glucose levels. Aim for at least 150 minutes of moderate intensity activity each week, such as walking, swimming or cycling. Moderate activity will will raise your heart rate and make you breathe faster and feel warmer.  

If you are diagnosed...educate yourself

The National Institute for Clinical Evidence (NICE) recommends that all people are offered structured education around the time of diagnosis.

DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed), is an NHS education programme for people with type 2 diabetes run by Nottinghamshire Healthcare. DESMOND runs as a small group of people with type 2 diabetes, and is a way of finding out more about managing your condition.

A dietitian can give you personalised dietary advice to help you manage your diabetes. They can give practical guidance to help you make healthy lifestyle and food choices.

Speak to your GP about being referred to DESMOND or being referred to a dietitian.

Think you know about HIV?

It’s been over 30 years since the HIV virus was discovered, and despite huge advances in treatment, there is still stigma and fear surrounding HIV.

While medical breakthroughs mean HIV is now a manageable long-term condition, attitudes have not kept up with these developments.

How does HIV affect someone’s life?

Things have moved on hugely since the virus was discovered in the 1980s. Treatments are now very effective, and although there is still no cure, people with HIV can expect to live long and healthy lives.

Early detection of the virus is best, as it means someone can get the treatment and care they need early. Later diagnosis can affect how poorly someone might become and the impact HIV might have on their life. That’s why it’s really important to get tested if you think you might have been at risk.

Why is HIV still so feared?

In the 1980s, HIV was a new disease and many of the treatments we have now were yet to be developed. Because of this, the outlook wasn’t good. Lots of people remember the shocking TV adverts from around this time. Things have moved on, but many people’s attitudes haven’t.

It may be that there is concern about sending out mixed messages; if we publicise how far we’ve come, people might think they don’t need to worry about HIV. It’s still really important to know the risks, keep yourself safe and to get tested.

How can I get tested?

There are lots of ways people can get tested in Nottingham. The Health Shop offers a friendly and supportive service. We provide pre and post-test discussion. We can also offer the HIV fast test (certain criteria applies) where results are given within the hour.

For people who test positive, we have a clinical psychologist who specialises in working with people with HIV.

There are also other services in Nottingham. The Terrence Higgins Trust is based on High Pavement and offers testing and support. For more information, call them on 0115 882 0121 or email info@tht.org.uk.

Nottingham University Hospitals provide testing at both GUM (at the City Hospital) and Victoria Health Centre on Glasshouse Street. For more information check out nuh.nhs.uk.

Thanks to Lou Wilkins from The Health Shop for providing information for this blog

4 ways to get your child to sleep

If your child has trouble sleeping, it’s an issue which can affect the whole family. Sleep is so important to our wellbeing, and we really feel it when we’re not getting enough.

Sam Parr, Health and Family Support Worker at Carlton Children’s Centre, gave us her advice for a good night’s sleep. So if bed time is a daily battle, or your child isn’t sleeping well, these tips should help:

1. Avoid sugar and caffeine

Caffeine can make it hard to get to sleep, so avoid things like chocolate, coffee and tea.

Sugar filled foods are not helpful either, so biscuits, sweets and cakes should be limited in the run up to bedtime.

If your child wets the bed, it could be because fizzy drinks and cordials can aggravate the bladder. Switch to a small drink of water for a dry night.

2. Switch off

Avoid stimulating activities before bedtime such as watching television or playing computer games.

As well as stopping your child from winding down, light from screens is also known to affect children’s sleep.

Try a relaxing activity instead, such as reading a book or a having a warm bath.

3. Be clear about bed time

Be clear and explain to your child what’s happening. Telling them, “it’s night time, go to sleep” or, “it’s morning, time to wake up” can help them understand what’s going on.

Put your child in their cot or bed when they are still awake and leave them to fall asleep. Staying with them can be a distraction.

4. Stick to your routine

Giving your child a routine is really important for a good night’s sleep. It helps their brain and body clock to know when it’s time to go to sleep, and when it’s time to wake up.

Tips for a good routine:

• Put your child to bed at the same time each day.
• Get them up at the same time each morning, even on weekends.

Clothes and pyjamas are part of a good routine, too. Always change your child’s clothes at night time and make sure that you change them into day clothes in the morning, even if you have nothing planned and a pyjama day would be easier.

Still having problems?

If you need support with your child’s sleep, contact your local Sure Start Centre. You can find more information and contact details on the Sure Start page of our website.

You can also get advice from The Children's Sleep Charity.

Carers rights: Ann's story

"People need to listen to carers. You might hear me, but that doesn't mean you’re listening."

We're sharing Ann's story, to highlight some of the challenges carers face.

Ann, 75, helps to care for her grandson, who was diagnosed with schizoaffective disorder aged 18. He has been an inpatient at Highbury Hospital four times in the last six years.

"Being a carer has taken over my life quite a lot. I've not had the relaxing retirement I planned!"

When he isn't in hospital, Ann's grandson has a flat of his own. "His mum works full-time, as a special needs teaching assistant, so I support him at home if he needs me."

"It can be tiring – there are hospital appointments, reviews. A lot of life is governed by visiting."

"But we have a very good relationship. We enjoy walking together. We go to the cinema and he visits church with me when he can. We volunteer at the Trust together as well; the Involvement Centre has been a tremendous support to us both."

"I want proper care in the community for service users and their carers. I'd also like to see an increase in funding for mental health services, rather than a reduction."

"Carers have to have a voice – and be listened to; we know a lot about who we are caring for."

You can find information about support for carers on our website.

Be pressure ulcer aware - check your skin

Many people are affected by pressure ulcers which can have a devastating effect on people’s lives and their families.

It's estimated that just under half a million people in the UK will develop at least one pressure ulcer in any given year and research suggests 80-95% of all pressure ulcers are preventable. (NHS England)

As part of Worldwide Stop the Pressure Day, we caught up with Geri Reevell, Specialist Nurse Tissue Viability, to find out how to spot the signs and what we all can do to help prevent developing pressure ulcers.

You can also watch our ‘Commitment to Care’ film which talks about the Trust’s ambition to eliminate avoidable pressure ulcers and the commitment by staff to continue to build on the work already done both locally and nationally.

What is a pressure ulcer?
A pressure ulcer or ‘bed sore’ is an area of the skin and underlying tissue which is damaged. This is due to lying or sitting in one position for too long without moving or by prolonged rubbing of the skin.

Are you at risk? 
You may be at risk of developing a pressure ulcer if you suffer from:

• problems with movement
• poor circulation
• moist skin caused by incontinence, sweating or a weeping wound
• previous skin damage
• a poor diet or fluid intake 
• lack of sensitivity to pain or discomfort from conditions such as diabetes, stroke and disorders that affect nerve supply and muscle movement.

What to look for?
Pressure ulcers are most likely to develop over bony areas. The areas most at risk are the heels, bottom, base of the spine, elbows, shoulders and the back of the head.

Red or dark patches of skin which do not disappear within 1-2 hours; discomfort or pain; blistering and any numbness, soreness, swelling or hardening of the skin are all signs that a pressure ulcer may be developing.

How do you know if it's a pressure ulcer?

Redness is the first response to pressure

Press your finger over the reddened area for 5 seconds, then lift up your finger

When you take your finger off the area it should go paler or blanch. If it blanches, it is not the beginning of a pressure ulcer (or stage 1 pressure ulcer). If it stays red, it is.



What can you do to avoid pressure ulcers?

There are simple things you can do while in hospital, community care or in your own home to prevent developing a pressure ulcer:

Look for signs of damage – if you are able, check your skin regularly or ask a relative or carer. Do not continue to put pressure on reddened areas, particularly on areas at risk.

Keep moving – one of the best ways to prevent a pressure ulcer is to relieve the pressure by regularly changing your position.  This can be as simple as standing and walking on the spot for a few minutes every hour. If you are sitting, try and lift your bottom off the seat every hour.  If you are in bed, try and change your position without digging your heels into the bed as this can cause damage.  Try not to slide down the bed as this can damage your skin.

Protect your skin – wash your skin using warm water or pH neutral soap cleansers. Do not rub or massage your skin as this can cause damage.  Do not use heavily perfumed soap or talcum powder.   If you have continence problems, please inform your healthcare team.

Eat a well-balanced diet – aim to eat a balanced diet, which is rich in energy, protein (meat, fish, nuts etc), vitamins and minerals and drink at least 6-8 cups of fluid a day.  Your healthcare team may refer you to the dietician for advice if necessary.

If you suspect that you or someone you care for may have a pressure ulcer, speak to your community nursing team or other health professional.

The Trust’s Tissue Viability Teams operate across Nottinghamshire and provide specialist assessment, expert advice, education and training to health professionals in hospitals and community settings for all ages.

Referrals can be made by community nurses, GPs, practices nurses, inpatient wards/ departments or nursing or residential care homes.  Visit Nottinghamshire Healthcare for more information.

Top tips for living well with COPD

Most of us will know someone affected by COPD. According to NHS England, there are around 900,000 people in the UK with the condition and a further two million are living undiagnosed.

Living with COPD is no easy feat. Many struggle with difficult symptoms such as shortness of breath, wheezing, coughing, phlegm, fatigue and frequent chest infections. And these symptoms are often worse in winter; people with COPD will have regular flare-ups during the colder months which can often lead to a stay in hospital.

The damage to the lungs caused by COPD cannot be reversed. Instead, treatment aims to slow down the progression of the disease and alleviate the symptoms. In addition to medications, there are lots of things someone with COPD can do to help make living with the condition easier.

Vanessa Holmes is a Highly Specialist Respiratory Physiotherapist, helping people with COPD maintain a good quality of life. Here are Vanessa’s top five tips for living well with COPD.

1. Stop smoking
If you smoke, the best way to prevent COPD from getting worse is to stop smoking, to avoid further damage to your lungs. Research has shown that you are up to four times more likely to give up smoking successfully if you use NHS support. Talk to your GP or visit NHS Smokefree.

2. Get vaccinated
Make sure you get vaccinated against flu and pneumonia to avoid getting infections in the winter. The pneumonia vaccination is given just once but you should have a flu vaccination every year.

3. Keep taking your medicine
Take your medicine as instructed by your doctor even if you start to feel better; taking medication continuously can help to prevent flare-ups. You should also visit your GP at least twice a year for a check-up. Talk about your medicines at each visit and, if you’re not sure how to use your inhaler, ask.
 
4. Plan ahead
It’s important you know what to do if your breathing suddenly worsens. Make sure you have telephone numbers handy and information all in one place so you can act fast if you become unwell. If you need an ambulance, make sure you tell the emergency staff that you have COPD.

5. Exercise
Exercising or keeping active helps to improve breathing and lessen symptoms. If you have COPD, you may be eligible for a pulmonary rehab programme which can help you to become more active and manage your condition. Ask your GP, nurse or consultant about being referred.

Need more information? Come along to our COPD awareness stand on 18 November at Mansfield Community Hospital to find out more about COPD and the support that is available in Nottinghamshire.

The British Lung Foundation also has lots of information online about living with COPD.

World COPD Day: Peter's Story

Peter Burrows was 65 when he was diagnosed with COPD, a lung disease where the airways become narrow, making it hard to breathe. There’s no cure. Instead, treatment aims to slow down the disease and ease symptoms.

As part of World COPD Day on 18 November, Peter is sharing his story to encourage others with the condition to access local support and begin living well with COPD.

“Unless you’ve got COPD it’s hard to understand what it’s like to live with" explains Peter. "When I was first diagnosed, it hit me. I didn’t know what to think.”

Shortly after his diagnosis, Peter’s GP referred him to a pulmonary rehab clinic, run by the Trust, and Peter says since then he hasn’t looked back.

“Talking to others with COPD [at the clinic] helped me to adjust and come to terms with my condition. I decided I wasn’t going to let it beat me.

“Pulmonary rehab is all about helping you to take control of your condition. And it works - I’m living proof! We were shown how to control our breathing, how to manage a flare-up. We were given information about medication, taught how to recognise our symptoms, and how to use our inhalers. I learnt why I should exercise and how. Understanding your condition can make such a big difference to your life.”

In addition to volunteering with the Trust’s Respiratory Service, Peter is also treasurer for his local Breathe Easy group, supported by the British Lung Foundation.

“It’s somewhere sociable to go. You’re amongst people with a similar condition. You can talk to each other. And it’s surprising what you pick up and learn.

“I’m not saying it’s easy; there’s no magic pill. You’ve got to do it yourself. But, you get out what you put in. Be positive. I still go caravanning. I enjoy photography. I play with my grandchildren. I just take it a bit slower now. The nurses in Mansfield and Ashfield, I think, are some of the best in the country; they’re supportive in every way.

“I want people to know they can live with COPD. I’m doing it, they can too!”

Specialist nurses are holding a COPD Awareness Stand on Wednesday 18 November at Mansfield Community Hospital. Drop in from 9am - 1pm. Hear from people with COPD; understand what COPD is and its impact; learn ways to live with COPD; and discover local support for people with COPD.

The Trust’s Respiratory / COPD teams operate across Nottinghamshire, helping patients to manage their condition, through exercise and education. Referrals can be made via GP, nurse or consultant. For more information visit Nottinghamshire Healthcare.

Thinking differently about dementia

Robin Williams’ widow revealed last week that the actor was developing a type of dementia before he died. Much of the media coverage has focussed on the despair which often surrounds the disease. Tom Dening, Professor of Dementia Research, spoke to us about thinking differently about dementia.

Developing dementia is dreaded more than any other medical condition, at least by people of middle age and upwards. People often say that they would rather be dead than live like that. Last week the media featured the story of Robin Williams, who was developing dementia with Lewy bodies and took his own life the week before he was due to be admitted for further medical investigations. Given that one in three of us is likely to develop dementia before we die, this is sobering stuff.

In fact, most people with dementia die of natural causes, most of them well into old age. We do know that there is an increased risk of suicide or self-harm around the time of diagnosis. Although the commonest early symptom of dementia is memory loss, there are other changes, including in mood and perceptions, and before the person receives a diagnosis these can be worrying or even frightening as the person and their family may not understand what is happening.

The commonest cause of dementia is Alzheimer’s disease and it tends to present with memory problems and difficulty with language, for example finding the right words for things. Other forms of dementia affect the brain differently and may cause other problems. Dementia with Lewy bodies (often known as DLB) is an example. DLB is a bit like having a mixture of Alzheimer’s disease and Parkinson’s disease, so as well as memory problems there are also difficulties with movement, gait and balance. As well as this, DLB has other distinct features of its own. It has a tendency to fluctuate so that at times a person can be quite confused and then shortly afterwards lucid. People often experience visual hallucinations, for example seeing other people in the room, but they also have other problems perceiving where objects are in space. If you combine all of these features, they can be quite bewildering – especially if you don’t have a diagnosis. In which case, you are just likely to think that you are going stir crazy.

However, dementia is not alone among medical conditions in having no cure, so simply to counsel despair is not good enough. What can we do to help?

First of all, we need to reduce stigma around dementia and encourage everyone to talk about it. Second, we need to encourage people to seek help if they are worried. People who are hiding their symptoms are at far more risk than those who seek help. Then we need to make a proper diagnosis, doing whatever tests and investigations are needed to make this as clear as possible. We then have to give people a good explanation as to why they are having the experiences that they do (e.g. you have difficulty in finding words not because you are stupid but because this part of your brain is not working properly). They need time to absorb the information and to ask questions, as do their families.

Beyond this, we need to discuss how dementia is more like a disability than an illness – like, say, arthritis, it doesn’t get worse from day to day but only very slowly. Most of the time, a person with dementia feels well and feels like their normal self. They can enjoy things, and look forward to pleasurable events, even if they may need reminding. They can be transfixed by emotional or artistic experiences. They can still contribute to their role as a parent or grandparent and as a source of family history. We need to hang on to all of this and celebrate it.

Difficult though it often is, we need to walk alongside people on the road of dementia, holding hands when needed and learning from their experiences as well as offering our support. By this approach we can prevent many people from feeling lonely, isolated and desperate with their condition.

If you’ve been affected by the issues in this blog and would like to speak to someone, call Samaritans on 116 123 (UK).

What is an occupational therapist?

This week is Occupational Therapy Week. We caught up with Sue Richardson, Paediatric Occupational Therapy Pathway Lead and Professional Lead, to find out more.

What is an occupational therapist?

Occupational therapy is about supporting individuals whose health, disability or impairment stops them from doing the activities that they need to do and that matter to them.

We help people to develop skills and maintain, regain or improve their independence by using different techniques, changing their environment and using specialist equipment.

Occupational therapists work with children and adults and can look at all aspects of daily life, from the home to the school or workplace.


What do you do?

As a Children’s Occupational Therapist I work mostly with children and young adults in the sixth form at a special school for children with severe and complex physical and learning disabilities.

As well as my clinical work, I am also Professional Lead and Pathway Lead.

This means that I am responsible for making sure the occupational therapy voice is heard when important decisions are being made and influence changes to improve the service that we provide. I also have to make sure that our service meets the needs of the children that we see.

I am responsible for a team of occupational therapists, and the delivery of our service across three special schools, working with health, education and social care colleagues in both children’s and adult services.

How do you help people?

As an occupational therapist, it is my job to:

• carry out assessments with the children and young adults on all aspects of daily living
• create a treatment plan
• provide individual, group or classroom based support
• give advice and recommendations

An example of the type of support I give is the use of hand splints. This improves wrist posture and use of the young person’s hands to help them grasp and hold everyday objects. This helps with cutlery, pencils, computers or self- propelling their wheelchair. I will monitor the young person, and advise school staff and parents on using the hand splints.

Another part of my role is assessing young people for specialist equipment and establishing its use in school.

What is a typical day like?

A typical day at the special schools starts by liaising with my health and education colleagues. I answer emails and any queries that are waiting for me, as well as managing referrals and supporting staff.

Once the children and young adults have arrived in school, I start my work with them. I might be leading a practical session around personal hygiene or having a meeting to help a young person move in to adult services.

At the end of the day, I’m often involved in training school staff to use specialist equipment or giving advice and support to parents and carers.


What’s the best part of your job?

One of the most rewarding aspects of my job is to know that I have made a difference, however small, to the quality of life of a child or young adult and their family. It might be by providing equipment so that they can use the toilet more easily; or providing practical solutions to help improve a young person’s involvement in their own personal care. The aim is to improve a child or young adult’s independence as much as possible.

Pregnancy and bipolar disorder

Bipolar disorder has been the focus of BBC One’s EastEnders recently, as Stacey Branning tries to manage her condition during pregnancy.  Dr Neelam Sisodia is a Lead Consultant with the Trust’s Perinatal Psychiatric Service, which works to prevent and treat serious mental illness during and after pregnancy.

We caught up with Neelam to find out more about bipolar disorder during pregnancy.

What is bipolar disorder?
Bipolar disorder is a serious mental illness which affects mood. Someone with a bipolar illness will have periods of depression, periods of elation (known as mania) or a mixture of the two. In severe cases, it can also be accompanied by psychotic symptoms, such as hallucinations and/or delusions.

Women are often diagnosed with bipolar disorder in their 20’s or 30’s. A woman who has not previously suffered from it, but has a family history of mood disorder, may develop a bipolar illness for the first time during pregnancy.

Usually bipolar disorder is treated with either a mood stabilising medication or a combination of antidepressant and antipsychotic medication. Some people may also use psychological treatments, such as talking therapy, or find lifestyle changes can help. All women are informed about the risks of conceiving whilst taking medication and are encouraged to discuss plans to become pregnant with their psychiatrist beforehand if possible, so that adjustments can be made to their treatment plan.

How is bipolar disorder managed during pregnancy? 

This can be very complex and challenging. Women who have bipolar disorder are more likely to become unwell during pregnancy or after childbirth, than at any other time in their lives. Some are also at risk of developing a psychosis postpartum (the period immediately after childbirth.)   

Treatment during pregnancy will vary, just as the needs of each woman will vary. An individual treatment plan is developed between the woman, her perinatal consultant psychiatrist and her Community Psychiatric Nurse (CPN). She’ll also be supported by a specialist midwife.

What about medication?
The decision about taking or not taking medication is always difficult. The balance of risk and benefit will vary between medications and will be different for each woman. Some of the mood stabilising medications used to treat bipolar disorder can cause serious foetal abnormalities however a relapse can have a significant impact on the mother’s wellbeing, which could, in turn, also have adverse effects on the unborn baby.

If you become pregnant whilst taking medication for bipolar disorder, it’s very important that you do not stop taking it until you have discussed it with your prescribing doctor. You will then be referred to a perinatal consultant psychiatrist. Suddenly discontinuing medication greatly increases the risk of relapse which is extremely risky for you and your baby.

What are postpartum psychosis and postnatal depression? 
Around the time of childbirth, high and low mood episodes can occur in women with mood disorders, including bipolar disorder. Psychotic symptoms such as hallucinations, delusions and persecutory ideas may also occur and can be very frightening. When symptoms are this severe, it is called postpartum psychosis. Postpartum psychosis is a relatively rare, but serious, illness affecting 1 or 2 women in every 1,000 women who give birth. A woman could develop postpartum psychosis without having had or developing bipolar disorder.

Postnatal depression is a depressive illness like any other, but is called postnatal depression when it occurs after a woman gives birth. It is more common and often more easily treated than postpartum psychosis. For most women, antidepressant medication, along with support from family, a GP and health visitor is enough to help them recover. In severe cases, a woman with postnatal depression may also be referred to her local Perinatal Mental Health Service.

What happens after the baby is born? 
This is a particularly risky time; hormone imbalances, disturbances to sleep and changes to medication can all trigger illness.  The treatment plan agreed during pregnancy will include plans for after birth. A mother who has just given birth will also be monitored closely by her CPN, midwife and health visitor so that if she becomes unwell, she can get treatment quickly.  If she needs admission to hospital, this may be to a Mother and Baby Unit, staffed by mental health nurses and nursery nurses.

What about breastfeeding? 
A mother can breastfeed her baby whilst taking some medications. Your perinatal psychiatrist or CPN will be able to discuss this with you. If a woman has expressed a wish to breastfeed she can usually be supported to continue with breastfeeding, even if she becomes unwell. Medications not suitable in breastfeeding are only used if there really is no other option.

How can a woman minimise the risk of becoming ill during and just after pregnancy?
We offer pre-conception counselling for women with bipolar disorder who are considering having a baby. This helps to manage medication and minimise risk before a woman becomes pregnant. Once pregnant, referral to the specialist Perinatal Psychiatric Service as soon as possible is essential as mental illness can complicate pregnancy and put a woman at higher risk of relapse.

If you have a history of serious mood disorder or other mental illness, be open with your GP and midwife, so they can access the most appropriate services for you. Working with mental health professionals allows for your treatment to be planned and implemented, helping to minimise the risk to you, your child and the rest of your family.

Where can I get more information? 
Open House is a peer support group in Nottingham for those affected by maternal mental health problems. You can also find further information on the NHS Choices and Bipolar UK websites.
Action Postpartum Psychosis (APP) campaign nationally for the development of services for women with serious mental illness related to childbirth.

Above all, don’t be frightened. If you’re concerned about your illness and how it may affect your ability to get pregnant and cope with motherhood, talk to you psychiatrist, CPN or GP. There will be someone locally who can help you access the care most appropriate for you.

The road to employment: a volunteer's story

The stigma attached with mental health can make it really difficult to access volunteering and employment opportunities, and when you don’t have any routine or structured activity for a period of time, it can cause a real set back of confidence and self-esteem.

Danny Parr, from Nottingham, knows exactly how this feels since having mental health issues from the age of fourteen. However, with support from the Social Inclusion and Wellbeing Service and Notts County Football in the Community, Danny managed to take control of his life and would like others to hear about his journey.

“I have suffered with mental health issues from a young age. As with many people, the start of my journey was a harrowing experience which became a lot worse when I was admitted as an inpatient for the first time.

As a teenager with mental health issues, I entered a back and forth, in and out cycle of accessing services for the next five years. It was a negative experience but in spite of this, I overcame what, at the time, seemed to be insurmountable odds and began to take back control of my life. It was a slow process of trial and error with a lot of picking myself up and dusting myself down.

The key opportunity to gain control over my illness and my life, and to give me hope again, came when I began to have contact with the Social Inclusion and Wellbeing Team. Two people in particular from that team, Sangita Dhawan and Ian Kirkpatrick, have, over the years, fought my corner and supported my recovery. The team put me in touch with the Notts County Football in the Community scheme where I met four key coaches: Ian Richardson, Tom Curzon, Dave Ellis and Dave Parrott who have, for the past eight years, supported me and played a major and significant role in my ongoing recovery.

I started by going on a sports leadership award course. Afterwards, I was offered a volunteering placement with one of the junior football clubs as an assistant coach. With support from my coaches and the Nottinghamshire Healthcare team, I did this placement for nearly two years. I left this placement and moved on to do other things including getting involved in the Football in the Community project. This not only enabled me to fulfil my passion for football but also made me aware of my potential as an individual.

I have experienced many setbacks along the way, none more major than the tragic event of 30 August 2014 when I found my dad passed away on the kitchen floor of the family home. However, since this traumatic period I have lost six stone in weight, graduated as a Peer Support Worker and secured a very well paid job with the Care Quality Commission (CQC) which is my first paid employment.

A volunteer co-ordinator from the Social Inclusion and Wellbeing team told me about the position at the CQC, which required someone with lived experience of mental health. I went through the job description and felt very excited. This role as an inspector would give me the opportunity to be someone other than a service user who could perhaps make a difference to the way services are delivered, by making appropriate suggestions for a more responsive service. The role required a lot of travelling and visiting various healthcare set-ups to see if the services were safe, effective, responsive, caring and well led.

Applying for this job was exciting but at the same time, I was worried about how I would perform at the interview and being turned down. But Ian – from the Social Inclusion and Wellbeing team - helped me with the application process and even prepared me for the interview by working on mock questions. The advice and practical support that I received helped me to perform so well at my interview that I was offered the job straight after the interview. It took a while for the news to sink in that I had finally got into paid work and I had another identity apart from being a service user with mental health issues.

I have been working for nearly a year now and continue to greatly enjoy my work. It has given me a sense of self belief and self worth as well as financial independence.    

I have also achieved a few qualifications such as the FA Level 1 Football Coaching badge and, through Notts County, attained the Sports Leaders Level 2 qualification. I was also awarded Disability Player of the Year for two consecutive years when captaining the Notts County Pan-Disability Championship side, managed by Tom Curzon who was the first to spot my potential and to give me a start.

All four coaches mentioned above gave me many pep talks and sound advice along the way and I owe a substantial chunk of my journey forward to both the Social Inclusion and Wellbeing Team, for empowering me to pursue and attain my ambitions, and to Notts County Football in the Community for giving me the opportunity to seize control and to stabilise significantly. Without these two services I wouldn’t be where I am today and they are cornerstones of my support network. I hope that by telling my story I can help empower others to achieve similar success in their lives and to make significant forward steps on their journeys of recovery.”

As part of Nottingham Mental Health Awareness Weeks, the Social Inclusion and Wellbeing Service are holding an Employment and Volunteer Fair on Friday 16 October for service users. For more information, please visit the Trust's website.

You've got a friend in me

Last week we shared Alexandra’s story; a mum helped by her local perinatal support service after struggling with anxiety and depression following her baby’s ill health.

Alexandra’s story isn’t a one-off though, and there are many more families in need of support. Emily, a full-time mum to three boys, is the Perinatal Volunteer Befriender who helped Alexandra to overcome her anxieties.

“I had three very different perinatal experiences” explains Emily. “The baby blues, pinks and a long period of anxiety, brought on by my youngest son’s diagnosis of Down’s Syndrome at three weeks old.

“When I heard Sure Start was looking for perinatal befrienders I jumped at the chance to be involved; it was the kind of support that I’d needed at my lowest periods.

“Alexandra was fantastic to be around and very open about her feelings. We went out and conquered lots of personal challenges together. Today, she is a lot more confident and knows she has great strengths and abilities, especially as a mum. She has overcome a lot in a short period of time. It’s simple but so effective, to know that someone is there for you; especially if they understand how you feel or what you’re dealing with.

“Befriending is great. I get to meet and socialise with lots of lovely new families. I enjoy the work role aspect too; I’ve gained lots of experience from working in the office and completing paperwork.”

“Children's Centres are priceless for mums” says Emily. “They can find out about what services are available that suit their needs and how their families can benefit. Brill!”

If you’re interested in becoming a Perinatal Volunteer Befriender, contact your local Children’s Centre Coordinator.

“Why do I need a Befriender? I’ve got friends, I’ve got family. How can they help me?”

For Alexandra, 31, from Eastwood, the first few months of motherhood didn’t go quite as she’d hoped. However, after finding support from a local befriending service, Alexandra is now sharing her story, encouraging other families who are struggling to access the help that's available.

At six-months-old, Alexandra’s son, Cal, was admitted to hospital as the result of a severe milk allergy; a condition that can cause diarrhoea and vomiting, skin rashes and difficulty breathing. In rare cases, it can also result in anaphylactic shock, a potentially life-threatening allergic reaction. At around the same time as his hospitalisation, Cal also developed a hernia which, after a long wait, eventually led to surgery.

All this took its toll on new mum Alexandra, who was eventually prescribed anti-depressants by her GP. He also suggested she try the Perinatal Befriending Programme, run by Nottinghamshire Children and Families Partnership, part of Nottinghamshire Healthcare.

“I went to my doctor and said ‘I think there’s something wrong with me’” Alexandra explains. “Feeding Cal was like force-feeding. I feared he’d go back into hospital. I was anxious that he wasn’t getting enough milk. Doctors told me ‘try not to let him cry too much, because his hernia may pop out.’ It was exhausting. Mentally, I couldn’t cope.

“I lost the confidence to go out, it was just too stressful. I felt I had no one to talk to. I was really isolated.

“When my doctor first suggested it, I thought: ‘Why do I need a befriender? I’ve got friends, I’ve got family. How is that going to deal with what I’m going through?’ But, I gave it some thought and decided to give it a try."

Soon after, Alexandra was paired with Emily and, from then on, things slowly started improving for Alexandra and Cal.

“After her first few visits, I began to look forward to Emily visiting. She had experienced many of the same issues I had; it was so reassuring to talk to someone who knew how I felt! 

"It was baby steps at first; a walk round the block, then to the local park and, eventually, into town. She went with me to groups so that I wasn’t sitting on my own. She introduced me to other parents. If Cal got upset, she’d remind me ‘it’s ok if he cries.’ She’d recognise if I was struggling and say ‘let’s go.’ She wasn’t too pushy. Some health professionals tend to dictate, but Emily would just suggest ideas. She always let me choose.

“Slowly, my confidence built up. The anxiety, the nerves, all calmed down. And, as soon as I calmed down, so did Cal. Having Emily around helped me to relax.

“Now, things are improving each day. And Cal is eating me out of house and home! Weaning has been a challenge but I’m slowly introducing him to new foods. I’ve started a new job and I’m looking forward to enjoying him this Christmas, without worrying about feeding and hernias! I’ve got a bit more of a spring in my step. I’m slowly coming off my anti-depressants and by next year, I want to be off them completely.”

For more information about Perinatal Support Services, contact your GP, Health Visitor or local Children's Centre Coordinator.