My Opinion Bullied By Liverpool City Council

Guilty by Omission In My Opinion...

2010-09-28T05:11:00.000-07:00

This Is An Opinion You Decide...The Words Hypocrite Springs To Mind....

GUILTY BY OMISSION.....YOU DECIDE

I was extremely disappointed that someone who can treat a fellow human being with a lack of compassion and understanding of their illnesses can have the audacity to have their name associated with mental health issues…. Yet another self-promotion for the Hull…I sent the following letter to Hull in 2007…It apparent from the letter I was suffering from a break down the response to the letter was for one of Hull’s henchwomen (Gill) to respond and threaten me with disciplinary action for breaking Council rules on contacting elected members. No time to heal after major post elective surgery just additional bullying. Then this man promotes the health of the Liverpool people…a very sick joke.

Vicky Gray
xxxxxxxx
xxxxxxx
xxxxx

25 June 2007

Andy Hull
Regeneration
Municipal Buildings
Dale Street
Liverpool
L69 2DH

Dear Andy Hull

Re: Guilty by Omission

I received a letter from Ann Gill on the 14 June 2007 concerning a welfare visit. I found the letter extremely stressful. As Head of Trading Standards and Environmental Health I would point out you have a legal duty of care towards your employees? I am currently off with depression I have stated that I do not feel able to meet Ann Gill, as I have been experiencing panic attacks. My job description states that I work for the Enforcement Co ordinator I have continued both before and during my sickness to ask that Stephanie Hudson to manage my sickness, you have full knowledge of this request. Ann Gill continues to add additional stress by insisting she is the only one who can manage my sickness. As you are aware I never signed the contract, which would make me answer directly to Business Support.

Under the Freedom of Information Act I would like to know why you tried to change my contract so that I answered directly to Business Support, when you knew I had extreme problems with Jacquie Whitefield. You stated in the meeting that I had with yourself Allan Auty and Stephanie Hudson it was what the Chief Executive’s Office wanted. The fact that I had put a Grievance in against Jacquie Whitefield and in the Grievance Jacquie Whitefield produced a job description which was nothing like my job description and claimed it was mine, which stated that I answered directly to Business Support and was similar to the new job description that I have not signed. I emailed you on the 18 January 2007 stating that I was extremely concerned about the new job description that Jacquie Whitefield had emailed to myself and other members of staff and that it had not incorporated the amendments that you had agreed to in the presence of Allan Auty and Stephanie Hudson. It did mention Enforcement Work which the staff that it was sent to have either no or limited knowledge of (myself excluded). You never did respond to that email. I am also curious to know on whose authority Jacquie acted upon when she emailed this new job description? I would like to point out that you can be guilty by Omission. In simple English by failing to act and having knowledge of inappropriate behaviour you will be found guilty in any court of law for oppressive arbitory or unconstitutional actions by members of your staff. Please remember this in all future actions or lack of actions.

Yours sincerely

Vicky Gray

Copies to:   Colin Hilton

                   John J Kelly

                   Berni Turner

                   Warren Bradley

                    Jane Kennedy MP

                    Rt Hon Alistair Darling

_______________________________________________________________________________

In my opinion: I found this website http://www.liverpool.gov.uk/Images/tcm21-160493.pdf A few quotes from the website as I feel they may decide to remove this website…: “Create all the happiness you are able to create: remove all the misery you are able to remove. Every day will allow you to add something to the pleasure of others, or to diminish something of their pains.”

The Joint Strategic Framework

for Public Mental Health 2009–2012

Department of Public Health June 2009

Inspiration

Equality

Independence

Transformation

Picture to come

Banner located in the Main Hall, Blackburne House, Hope Street Liverpool

Mental health is the emotional and spiritual resilience, which enables us to

enjoy life and to survive pain, suffering and disappointment. It is a positive

sense of well-being and an underlying belief in our own and others’ dignity and

worth.

Health Education Authority (1997)

Mental health problems have very high rates of prevalence; they are often of

long duration, and have adverse effects on many areas of people’s lives,

including educational performance, employment, income, personal

relationships and social participation. No other health condition matches

mental ill-health in the combined extent of prevalence, persistence and breadth

of impact.

Mental health problems are more common than asthma. Up to one in six

people suffer from them over the course of their lifetime, while 630,000

people have severe mental health problems at any one time, ranging from

schizophrenia to deep depression. Beyond this, mental health has a far wider

impact on families: there are over 1.5 million carers supporting people with

mental health problems.

Rankin J, (2005) Mental Health and Social Inclusion working paper 2, IPPR/Rethink

In a survey, 84% of people with mental health problems reported feeling

isolated, compared to 29% of the general population.

MIND (2004) Not Alone? Isolation and Mental Distress: www.mind.org.uk

Communities with greater social capital can be shown to have higher levels of

good mental health.

White M, AngusJ (2003) Arts and Mental Health literature review: Centre for Arts and Humanities in medicine

Mental health promotion is both any action to enhance the mental well-being

of individuals, families, organisations and communities, and a set of principles

which recognise that how people feel is not an abstract and elusive concept,

but a significant influence on health.

Friedli L (2000) Mental Health Promotion: rethinking the evidence base Mental Health Review 5 (3) 15–18

It is easy to forget that life is lived in relationships, and the quality of those

relationships has much to do with how life turns out.

Lewis (1998)

Catherine Reynolds (principal author)

With support from the Public Mental Health

Strategy Group:

Andy Kerr

Annette James

Sandra Davies

and with contributions from:

Carole Adebayo

Judy Arslanian

Joan Bennett

Christine Beyga

Chichi Bodart

Tony Boyle

Sue Brennan

Elspeth Bromiley

Maria Cody

Michelle Cox

Jackie Crowley

Julie Curren

John Doyle

Lindsey Dyer

Gary Everett

Susie Gardiner

Julie Hanna

Sue Harvey

Mike Hogan

Louise Holmes

Simon Howes

Teresa Jankowska

Ann Keenan

Tom Knight

Shane Knott

Sarah Lyons

Trish McCormack

Sam McCumiskey

Tesa McGrath

Tommy McIllravey

Lindsey Marlton

John Marsden

Judith Mawer

Clare Mahoney

Irene Mills

Melusi Ndebele

Debbie Nelson

Lisa Nolan

Jackie Patiniotis

Alison Petrie-Brown

Rachel Plant

Taher Qassim

Phil Sadler

Alex Scott-Samuel

Jan Sloan

Gerrilyn Smith

Emma Squibb

Sally Starkey

Julia Taylor

Val Upton

Louise Wardale

Jane Weller

Gary White

Ann Williams

Duncan Young

Particular thanks to:

Jo Nurse

National Lead for Public Mental Health,

Department of Health (DH) in giving

permission to use her ‘Framework for Creating

Flourishing and Well-Being: A Public Mental

Health Approach’ (Nurse J, 2008).

Jonathan Campion

DH, for his feedback on the draft and for his

encouragement.

Jude Stansfield

Public Mental Health and Well-being Lead,

Department of Health/NHS North West; for

being a constant champion for Public Mental

Health across the region.

Andrew Cornes and Linda Richards

Designers, for their inspiration, creativity and

patience in the design of this strategy.

The Public Mental Health Strategy and its aligned Strategic Development Plan has been a

collaborative development drawing upon the strengths, insights and expertise of the following:

Acknowledgements

Foreword 1

Rationale 2

Introduction 2

Strategic Aims 3

Strategic and Operational Integration 3

Underpinning Principles 4

The Social Determinants of Mental Heath and Well-being 5

An Assets-Based approach to mental well-being 8

Mental Well-being Impact Assessment Toolkit (MWIA) 9

Population-based approaches to Mental Health and Wellbeing 10

The Centrality of the Family as a protective factor for mental well-being 11

Young Carers 13

The Economic Case for Investing in Public Mental Health 13

Black and Racial Minorities (BRM) and mental health 15

Framing Public Mental Health Policy and Practice 16

Summary 19

Demographic Trends and Needs Analysis 20

City’s Population Profile and Population Trends 20

Common Mental Health Problems 20

Summary of the Mental Health Equity Profile (2008) 21

Children and Young People 22

Older People 24

Stakeholder Participation 00

Background and context 00

Method 00

Stakeholder Mapping and Analysis 00

Identifying Levels of Participation 00

Identifying methods of participation 00

Resources and implementation 00

Public Mental Health: Commissioning for Health Improvement 00

World Class Commissioning 00

Priorities for Investment 00

Appendices 00

Contents

numbering

This strategic framework is a way of capturing new

and emerging evidence and thinking about the

relationship between individuals and society and

their mental health and well-being. It builds on the

solid foundations laid through the WHO Healthy

Cities initiative through the implementation of

Choosing Health and in the work of Integrated

Commissioning across the city in addressing the

health and social care needs of our population. This

work extends the strategic thinking that was

developed in the Joint Commissioning Strategy for

Adult Mental Health and Well-Being that set out

the relationship between poor mental health and

social exclusion and the challenges that sit with

individuals, families, communities and service

providers in enabling the process of recovery. The

strategy recognises that a consistent and coherent

approach to healthy life expectancy is required

across the life course and over time. It confirms that

for positive mental health and well-being to be a

reality in adult life, the foundations need to laid in

childhood.

Current governmental thinking in health and social

care is increasingly focusing on the need for

preventive approaches to ill health and on the

promotion of well-being. It is timely therefore that

this strategic framework for Public Mental Health is

now able to set out the rationale for building on

the developments already in place and to

strengthen both the resolve and the commitment

of commissioning organisations, their partners and

peer networks to tackle the social determinants of

mental ill-health.

The experience of 2008 has confirmed the

importance of culture in our lives. For Liverpool

residents, and for visitors, the rich variety of cultural

events has been uplifting and has reinforced the

pride Liverpudlians have in their city. The evidence is

growing that engagement in cultural activities is

good for our mental health and well-being and the

developing relationship between Liverpool PCT and

the arts signals the importance of this experience.

The city will continue to embrace change and build

upon its cultural legacy as it moves into 2010,

identified as the ‘Year of Well-Being’ and into 2011

as the ‘Year of Innovation’. The strategy reflects a

growing optimism that we can continue to change

the circumstances that constrain many people’s lives

in this city and that are significant in causing

unhappiness, distress and mental illness. We need

to make effective use of the resources that we

have, to do the things that need to be done, by

supporting people at earlier stages in their lives, by

re-enabling people to engage once more in their

hopes and aspirations and by increasing the

numbers of people who are flourishing and leading

purposeful lives.

This challenge will be met by re-affirming our

commitment to the task by the strong and vibrant

partnerships that exist across this city and by the

growing number of champions that abound in our

communities, organisations and services. Our

endeavour is perhaps best summed up by the

following quote from Ghandi…

Be the change you want to see

in the world…

Gideon Ben-Tovim

Chair LPCT

Paula Grey

Joint Director of Public Health for LPCT and LCC

Andy Hull

Director of Stakeholder Engagement LPCT

Samih Kalakeche

Director of Integrated Adult Health and Social

Care Commisioning for LCC and LPCT

1

“Create all the happiness you are able to create: remove all the misery you are

able to remove. Every day will allow you to add something to the pleasure of

others, or to diminish something of their pains.” 7

7 Bentham J in Layard J (2006) Happiness: Lessons from a New Science. British Journal of Sociology Vol 57 Issue 3 pp535–6

Foreword

This vision statement from the Sainsbury Centre for Mental Health sets a challenging goal for the

direction of this local strategy over the next six years. Promoting mental health for all provides an

opportunity to take a broader view of mental health and to consider the ‘public mental health’ i.e.

the needs of whole communities and that of the city. In particular it is about preventing the onset

of mental ill-health and promoting well-being and enabling a flourishing society. This will require

changes to the levels of investment and commissioning intentions in re-focusing interventions

‘upstream’ and thus reduce the early onset of mental health problems in childhood and their

development into, in some cases, acute mental illness. It will also require commissioning bodies to

consider ways of alleviating the burden of poor mental health that sits within this city’s population

but that remains undiagnosed and unaddressed. In other words, many people are languishing and

are struggling to cope. Current research would suggest that higher levels of the population are

‘languishing’ than was previously estimated with the effect this has on personal and social

functioning and behaviour.

This strategy and the consultation process that supports it, reflects a particular way of working that

is inclusive, empowering, evidence-based and transformational.

2

There is no health without mental health. Mental health is central to the

human, social and economic capital of nations and should therefore be

considered as an integral and essential part of other public policy areas such as

human rights, social care, education and employment. 8

Introduction

The aim of this strategy is to set out an integrated framework for mental health and well-being

for Liverpool that recognises that mental health is a whole-population issue and that it is

everyone’s business.

By 2015, mental well-being will be a concern of all public services.

Undoubtedly there will still be people who live with debilitating mental

health conditions, but the focus of public services will be on mental wellbeing

rather than on mental ill-health. 9

Rationale

Public Mental Health is the art,

science and politics of preventing

mental ill-health and inequalities

through the organised efforts of

society. 10

8 European Ministerial Conference on Mental Health: Facing the Challenges, Building Solutions (2005) WHO, Helsinki

9 The Future of Mental Health: a Vision for 2015 (2008) Sainsbury Centre for Mental Health

10 National Expert Group for Public Mental Health and Well-Being (2008)

Strategic Aims

This strategy aims to promote people’s positive

mental health and ameliorate mental distress,

through the process of earlier intervention and

recovery, by actions that:

_ enhance wellbeing

(i.e. increasing flourishing)

_ prevent mental illness from occurring

_ treat mental illness when it is present

_ enhance wellbeing

i.e. increasing flourishing; and thus

_ improve whole-population mental health;

_ challenge health and wealth inequalities that

impact negatively upon well-being; 11

_ overcome persistent barriers to social

inclusion that continue to affect those with

experience of mental health problems;

_ improve the whole-life outcomes of those

with experience of mental health problems;

_ Support and enable whole system reform.

Strategic and Operational

Integration

The challenge facing the effective

implementation of Public Mental Health is one

of integration. Integration is a key driver within

Liverpool PCT’s Commissioning Plan and relates

to the determination to provide joined up

services. This is a requirement not only of

commissioning within the PCT and City Council

but also of neighbourhood delivery:

This challenge of integrating our services to

best meet need is summed up by the phrase

‘only connect’ 13. It is only through drawing

upon the assets of individuals, groups, peer

networks, agencies and organisations that this

strategy can be made to work and bring

greatest health benefit to the city’s population.

This strategy will draw upon existing national

policy and local strategies across health, social

care and well-being to connect local plans and

commissioning intentions to local needs. In

doing so, it will strengthen strategic

commissioning through Joint Strategic Needs

Assessment and by making clear and explicit

the themes and threads that characterise Public

Mental Health (PMH), namely:

_ The need to focus on positive mental health

and creative health and well-being;

_ The mental health benefits of a healthy

lifestyle;

_ The significance of the family as a protective

factor in children’s lives;

_ The challenges presented by

transition points in people’s lives;

_ The importance of challenging the

experience of stigma and discrimination;

_ The need for advocacy and support for atrisk

individuals and groups;

_ The adoption of the recovery approach

across the spectrum of care;

_ The enabling of self-determination in the

provision of care and support.

3

11 Kagan P (2006) Making a Difference: participation and well-being. RENEW Intelligence Report.

12 A New Health Service For Liverpool: Strategic Commissioning Plan 2009-14, Liverpool PCT, 2009

13 E.M. Forster. (1910) Howards End, Edward Arnold.

It is recognised that we will need to work through local strategic partnerships

(neighbourhood partnerships for health and adult social care) at a level of the

five districts (Alt Valley, City North, Central, Liverpool East and Liverpool

South). The concept is therefore to bring together the existing resources

currently commissioned and delivered by the PCT within a local area to deliver

improved health outcomes particularly in areas where there are issues around

health inequality. 12

Underpinning Principles

The strategy is founded up the principles and

values of the Universal Declaration of Human

Rights. Human rights belong to everyone. They

are a set of basic universal standards that

govern how public authorities treat people.

This human rights-based approach (HRBA)

affirms the importance of a way of working, of

a way of relating and of a way of being that is

predicated upon the following values that

ensure that people are treated with:

_ Fairness

_ Respect

_ Equality

_ Dignity

_ Autonomy

The explicit use of human rights values and

standards in policy, planning and delivery

ensure clear accountability throughout the

strategy and its implementation. It supports

stakeholders in approaches to improving public

mental health that are empowering by

enabling meaningful participation, antidiscriminatory

practice and with specific

attention to vulnerable individuals and groups.

As an underpinning to World Class

Commissioning a HRBA provides NHS Trusts

and their partners with:

_ A practical tool to improve service delivery

_ A framework that can inspire, enthuse and

empower staff and service users

_ Actions that support other health and social

care drivers and targets

This strategy provides a focus for action

through HRB approaches that seek to balance

support for the individual and their families,

the engagement of local communities in selfdetermined

activity, and the re-orientation of

services to best meet individual and collective

needs.

In doing so, the strategy will draw upon

national and local policy drivers15, the insight

and experience of service users and carers,

from community and advocacy groups and

from our partners in the third sector, both

locally and nationally.

4

A HRBA helps to achieve good

practice… but it [also] goes above

and beyond good practice in

providing renewed quality of care

for service users, and staff are

empowered to challenge care

decisions… a HRBA defines a

common shared value base more

effectively than other guidelines

about standards of care. 14

15 Refer to Public Mental Health Strategic Action Plan 2009–12.

16 Choosing health: making health choices easier(2004) DH

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4094550

This approach is essential to promote social

inclusion, the reduction in mental ill-health, the

promotion of positive mental health,

community participation and social cohesion

and is key to the government’s public mental

health agenda16 and is best likely met by actions

and activities that can be undertaken to :

_ Promote and improve mental health through

a focus on increasing key protective factors

and reducing key risk factors. The promotion

of mental health is complementary to

improved physical health, the prevention of

mental illness and physical illness, and to

achieving improvements in the quality of life

of people experiencing mental and physical

conditions and illnesses.

_ Prevent mental health problems, mental

illness, co-morbidity and suicide, with a focus

on key risk and protective factors. This

should include a focus on the prevention of

more common mental illnesses (such as

depression and anxiety), on psychoses, and

in the interaction between mental illness and

other health conditions, such as heart

disease, cancer and diabetes and other longterm

physical conditions.

_ Support improvements in the quality of life,

social inclusion, health, equality and recovery

of people who experience mental illness, to

include further work on addressing stigma

and discrimination, recovery and on

promoting equality of opportunity in areas

such as employment, housing, education,

cultural, sporting and recreational activities.

People with a mental illness are among the

most excluded in our society17.

_ Challenge the stigma and discrimination

faced by people who experience mental

health problems by adopting a social model

of disability that incorporates mental health

problems (including those of a temporary

nature) within the mental health sector,

which refers to human rights, social inclusion

and citizenship.

The Social Determinants of

Mental Heath and Well-being

Any one individual’s mental health sits within

their life experiences of family, friends,

community and broader societal influences. This

is described as an ecological view of health and

wellbeing and is significant to our understanding

of Public Mental Health. It is a way of looking at

the relationship between our individual

experience of health and wellbeing and the

environments in which we live, work and play.

5

17 Towards a Mentally Flourishing Scotland:The Future of Mental Health Improvement in Scotland 2008-11, Scottish

Government, October 2007

18 CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health.

Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.

Risk factors Protective factors

• Low self-esteem

• Low self-efficacy

• Poor coping skills

• Insecure

attachment

in childhood

• Physical and

intellectual

disability

• Abuse and

violence

• Separation

and loss

• Peer rejection

• Social isolation

• Neighbourhood

violence and crime

• Poverty

• Unemployment/

economic

insecurity

• Homelessness

• School failure

• Social or cultural

discrimination

• Lack of support

services

• Positive sense

of self

• Good coping skills

• Attachment

to family

• Social skills

• Good physical

health Positive

experience of

early attachment

• Supportive caring

parents/family

• Good

communication

skills

• Supportive social

relationships

• Sense of social

belonging

• Community

participation

• Safe and secure

living environment

• Economic security

• Employment

• Positive

educational

experience

• Access to

support services

• Faith

These environments can have a potentially positive or negative impact upon our health at a

number of levels from family relationships and community safety to local and governmental policy.

The model by Dahlgren and Whitehead illustrates these social determinants of health and

wellbeing.

These determinants translate into either risk factors or protective factors for mental health (see

table on previous page). Risk factors increase the likelihood that mental health problems and

disorders will develop and their impact can influence the severity and duration of mental ill-health.

Protective factors help to enhance and protect positive mental health and wellbeing and enable

individuals to be resilient in the face of challenging life experiences.

The most significant impediment to good health, and therefore good mental health is poverty and

often the multiple deprivations and disadvantages that are part of that life experience. The WHO’s

recent final report on social determinants18 and the actions necessary to improve health equity have

identified three principles of action to enable the necessary changes to take place, namely:

_ Improve the conditions of daily life – the circumstances in which

people are born, grow, live, work, and age.

_ Tackle the inequitable distribution of power, money, and resources – the structural

drivers of those conditions of daily life – globally, nationally, and locally.

_ Measure the problem, evaluate action, expand the knowledge base, develop a workforce

that is trained in the social determinants of health, and raise public awareness about the

social determinants of health.

Fig 1 Determinants of health

Dahlgren G, and Whitehead M in the Acheson Report (1998)

6

A key focus for Liverpool PCT is to address health inequalities across the city. This determination has

been further strengthened by the Health is Wealth Commission’s report19 on the Liverpool cityregion

which acknowledges that despite recent economic growth the area continues to evidence a

disparity with regional and national comparitors showing a low life expectancy, a high percentage,

chronic illnesses and a disproportionate dependency on Incapacity Benefit. These risk factors have

been increased by the current economic recession with its impact on unemployment, indebtedness

and the cost of fuel and food. Those in the lower income groups are less cushioned against risk and

hardship.20

“Levels of mental distress among communities need to be understood less in

terms of individual pathology and more as a response to relative deprivation

and social injustice, which erode the emotional, spiritual and intellectual

resources essential to psychological wellbeing. While psycho-social stress is not

the only route through which disadvantage affects outcomes, it does appear

to be pivotal.” 21

The experience of many people living in Liverpool is still one of multiple deprivation. Socioeconomic

stress, resulting from material deprivation gives rise to poor mental health. Such stress

can have physical effects but it can have significant psychological consequences22. The evidence

demonstrates that people living in areas of deprivation with little in the way of community activity,

live with the constant experience of hardship, exhaustion and the daily grind of trying to make

ends meet. Families, in particular, that experience multiple forms of deprivation, face the greatest

hardships. In these circumstances people are prone to ill-health, accidents and relationship

breakdown.

7

19 Health is Wealth: The Liverpool City-region Health is Wealth Commission (2008)

20 Green Well Fair: Three Economies of Social Justice (2009) New Economics Foundation (NEF)

21 Friedli, L (2009) Mental health, resilience and inequalities. World Health Organisation, WHO Europe

22 Appendix 1: Socio-economic stress and its impact on health

23 Wilkinson D (1996) Unhealthy Societies. London. Routledge.

To feel depressed, cheated, bitter, desperate, vulnerable, frightened, angry,

worried about debts or job insecurity; to feel devalued, useless, helpless,

uncared for, hopeless, isolated, anxious and a failure: these feelings can

dominate people’s whole experience of life. . . . it is the chronic stress arising

from feelings which matters, not exposure to a supposedly toxic material

environment. The material environment is merely the indelible mark and

constant reminder of the oppressive fact of one’s failure and of the atrophy

of any sense of having a place in a community and of one’s social exclusion

and devaluation as a human being.23

The model provides a way of considering the

different ways in which the impact of

programmes and interventions, designed to

improve mental health and wellbeing, might be

identified and assessed through forms of

capital, namely:

_ Mental Capital24: cognitive ability and

emotional intelligence

_ Identity Capital: positive self-image,

assertiveness and confidence

_ Human Capital: knowledge, skills and

awareness

_ Social Capital: trust, reciprocity, networks

and inter-dependency

_ Economic Capital: employment, investment,

productivity

Adopting an approach to planned

interventions for mental health improvement

based upon these five forms of capital25 enables

us to view health benefit and quality of life as

related to:

_ The emotional pathways through which

deprivation impacts upon health:

_ Health benefits of participation, involvement

and reciprocity26;

_ Social support as a protective factor for both

mental and physical health:

_ An understanding of mental capital and it’s

contribution across the life course27;

_ A more inclusive model of health that

integrates the medical and social;

8

23 A relatively new concept outlined in: Foresight Mental Capital and Wellbeing Project (2008),Final Project Report -

Executive Summary. The Government Office for Science, London

25 CSIP/NIMHE (2005) Making it Possible: Improving Mental Health and Well-Being in England.

26 ‘A Prospectus for Arts and Health’, Department of Health with Arts Council England, 2007, p13–14

http://www.artscouncil.org.uk/publications/publication_detail.php?browse=recent&id=581

27 Reference Appendix 4

An assets-based approach to mental wellbeing

It is important not to frame the work in Public Mental Health solely from a needs or ill-health

perspective, whilst this is nevertheless central to the work in addressing health and wealth

inequalities. It is vital to integrate into this strategic thinking an asset-based approach to individuals

and communities across the city. This can be demonstrated in the model below which draws from

the research on health outcomes.

Public Mental Health Improvement

_ _ _ _ _

Economic Social Mental Identity Human

Capital Capital Capital Capital Capital

_ _ _ _ _

Health Outcomes

The recent report of the Government Office for

Science ‘Mental Capital through Life’28 outlines

the concept of mental capital as “…the totality

of an individual’s cognitive and emotional

resources, including their cognitive capability,

flexibility and efficiency of learning, emotional

intelligence (e.g. empathy and social

cognition), and resilience in the face of

stress.” It therefore captures those elements

that serve to establish how well an individual is

able to contribute effectively to society, cope

with life’s challenges and to experience a high

personal quality of life.

The extensive set of relationships between

mental capital, biology, culture and

environment are experienced uniquely and

individually but are dependent upon our

personal and social interactions, in particular, in

the early years (These interdependencies are

outlined in the models in the Appendix).

These help to frame not only the major

determinants of mental wellbeing and mental

capital but are indicative of the opportunities

for effective intervention and support across

the life course. By considering the various forms

of capital that are integral to individual, family

and community experience it is possible to reframe

our thinking about planned

commissioning interventions to build upon

these human and structural assets. In doing so

it helps to balance the historic needs-based, or

deficit approach, with one that acknowledges

the strengths and capabilities that already

exists within our local population.

Our deepest fear is not that we are inadequate.

Our deepest fear is that we are powerful beyond

measure. It is our light, not our darkness that

most frightens us. We ask ourselves, Who am I to

be brilliant, gorgeous, talented, fabulous?

Actually, who are you not to be? You are a child

of God. Your playing small does not serve the

world. There is nothing enlightened about

shrinking so that other people won't feel insecure

around you.

We are all meant to shine, as children do. We

were born to make manifest the glory of God that

is within us. It’s not just in some of us; it’s in

everyone.

And as we let our own light shine, we

unconsciously give other people permission to do

the same. As we are liberated from our own fear,

our presence automatically liberates others.” 29

Mental Well-being Impact

Assessment Toolkit (MWIA) 30

Within the context of an asset-based approach

it is recommended that commissioning

organisations and partners consider the

application of this approach to planned

developments.

The Toolkit has been developed as a

collaboration of many partners, including

Liverpool PCT, the Liverpool Culture Company

and IMPACT. The explicit intention in

developing this toolkit was to support policymakers,

planners, people delivering

programmes and services and people living in

communities in understanding how they

currently, and have potential to, improve the

mental well-being of those communities. Using

the toolkit will help to identify how a proposal

will impact on mental well-being and what can

be done to ensure it has the most positive

impact.

Liverpool Culture Company was the first

organisation to pilot the use of MWIA applying

this process to its cultural policies and

programmes . Subsequently, Liverpool PCT has

applied MWIA to a number of local community

projects, funded by the Big Lottery, focused on

activity and nutrition. Work has also been

developed in using MWIA in a school and a

park setting. This work is already beginning to

show results in helping to maximise the mental

health impact of these projects for

beneficiaries.

9

28 Kirkwood T, Bond J, May C, McKeith I, The M (2008) Mental capital through life: Future challenges.

Mental Capital and Wellbeing Project. Foresight, Government Office for Science

29 Williamson M (1992) ‘Our Deepest Fear’ in A Return To Love: Reflections on the Principles of A Course in Miracles.

Harper Collins

30 http://tinyurl.com/mwtphd

The process is stakeholder-based and suggests a basic framework for identifying and assessing

protective factors for mental well-being. It prompts participants, as part of the process, to consider

the following key questions in identifying mental health impact:

How does the proposed development impact on people’s control?

How does the proposed development impact on resilience and community assets?

How does the proposed development impact on participation?

How does the proposed development impact on social inclusion?

These questions reflect the essential characteristics of mental health promotion and help create a

platform for organisations to be mental health aware. The toolkit offers a resource to support

those who choose to promote mental health and it provides the business case for doing so.

Population-based approaches to Mental Health and Wellbeing

Research by Keyes 31 indicates that, across the population, the experience of ‘flourishing’ – people

who have good mental health, enthusiasm for life and who are socially engaged, represents about

17% of the population. In contrast, recent population surveys indicate that about 18% of the

population have a diagnosed mental health problem but that an additional 11% are languishing,

that is ‘a person’s life seems empty or stagnant, a life of quiet despair’. People who are languishing

do not have a diagnosed mental illness.

The Mental Health Spectrum

Keyes has also shown that ‘languishers’ are at greatly increased risk of depression and physical

disorders including cardiovascular disease 32. He also suggests that languishing may be highly

prevalent among young people, many of whom are seeking ways to fill the void of their lives. Sex,

drugs and alcohol are often used in this way, but these only deepen the void and make the person

more dysfunctional. The implications of this research for public health in general demonstrate the

understood, but not clearly articulated relationship, between poor mental health and self-injurious

lifestyles.

10

31 Keyes, C.L.M. 2002. Promoting a life worth living: Human development from the vantage points of mental illness and

mental health. In R.M. Lerner, F. Jacobs and D. Wertlieb (Eds). Promoting Positive Child,Adolescent and Family

Development: A Handbook of Program and Policy Innovations, 4:257-274. CA: Sage.

32 Keyes, C.L.M. 2004. The nexus of cardiovascular disease and depression revisited: The complete mental health

perspective and the moderating role of age and gender. Aging and Mental Health, 8:266-274.

The graphs indicate that a population approach to languishing is needed to address the potential

of this population for developing mental health problems. It would be insufficient to simply focus

on support for those already presenting with poor mental health. This demands a reinforcement of

the argument for, and the determination to increase, the range and scope of earlier interventions

across the life course. The graph below illustrates how a small improvement in population wide

levels of wellbeing will reduce the prevalence of mental illness, as well as bringing the benefits

associated with positive mental health, namely:

• by reducing the mean number of psychological symptoms in the population, many more

individuals would cross the threshold to become flourishing;

• a small shift in the mean of symptoms or risk factors would result in a decrease in the number of

people in both the languishing and mental illness tail of the distribution. 33

The rationale for this approach has been substantiated by work on the prevalence of problem

drinking both nationally and internationally 34, where a small reduction in the mean consumption

of alcohol among light or moderate drinkers will result in a substantial decrease in the prevalence

of problem drinking. 35

The effect of shifting the mean of the Mental Health Spectrum

The Centrality of the Family as a protective factor for mental well-being

A positive childhood environment can be a protective factor in a number of ways. Children who

have had a warm and secure relationship with their parents are more likely to be happy and have

better mental health and wellbeing. Early childhood experiences, particularly in the first year, also

influence later life outcomes and ability to cope with hardship and adverse life events. 36

Recent reviews on the combined effect of multiple disadvantages on outcomes for children and

families, present a correlation between the number of parent-based markers of disadvantage

experienced by a family and the impact on the full range of Every Child Matters outcomes for

children (ECM). 2% of families nationally – equivalent to 140,000 – are affected. (FACS 37)

11

33 Huppert F, (2008) State-of-Science Review: SR-X2: Psychological Wellbeing: Evidence Regarding Its Causes and

Consequences in Mental Capital and Wellbeing: Making the most of ourselves in the 21st century, Foresight

34 Rose G. 1992. The strategy of preventive medicine. Oxford: Oxford University Press.

35 Colhoun, H., Ben-Shlomo, Y., Dong, W., Bost, L. and Marmot, M. 1997. Ecological analysis of collectivity of alcohol

consumption in England: Importance of average drinker. British Medical Journal, 314:1164-1168.

36 Stansfield SA, Head J, Bartley M, Fonargy P (forthcoming) Social Position, early deprivation and the development of

attachment.

37 Families and Children Study (2005) in Reaching Out: Think Family: Analysis and themes from the Families at Risk

Review (2008) Cabinet Office. Social Exclusion Task Force.

This experience is supported by the ‘Families

and Children Study’ that focuses on

disadvantages experienced by families across a

range of areas, reflecting the cross-cutting

nature of social exclusion. These include:

_ Poverty

_ No parent is in work;

_ Family lives in poor quality

or overcrowded housing;

_ No parent has any qualifications;

_ Mother has mental health problems;

_ At least one parent has a longstanding

limiting illness, disability

(including learning disability) or infirmity;

_ Parental drug and alcohol misuse

The impact of these life experiences of

disadvantage for children are illustrated below.

Looked after children, represent a particularly

vulnerable group. Most children (62%) become

looked after as a result of abuse or neglect). A

further 20% are looked after because of family

dysfunction or distress. 39

Early care experiences have long-term

consequences for children’s health and social

development. Entering care is strongly

associated with poverty and deprivation (for

example, low income, parental unemployment,

relationship breakdown) and the outcomes

associated with deprivation often persist into

adulthood. 40 Many children and young people

who are looked after experience significant

health inequalities throughout childhood, and

on leaving care experience poor health,

educational and social outcomes.

12

0

2

4

6

8

10

12

14

16

18

Child admits

running away

from home

before

(2004)

Child spent less

than an hour on

physical activity

in last week

(2005)

In trouble

with police

last year

(2005)

Not seen friends

in last week and

never goes to

organised social

activities (2004)

Child

suspended

or excluded

in last year

(2005)

Well below

average at

English

(2005)

■ No family disadvantages

■ 1 or 2

■ 3 or 4

■ 5 or more

Children from the 5% most

disadvantaged households are

more than 50 times more likely to

have multiple problems at age 30

than those from the top 50% of

households. 38

38 Feinstein, L and Sabates, R (2006), Predicting adult life outcomes from earlier signals: Identifying those at risk, Centre

for Research on the Wider Benefits of Learning, Institute of Education, University of London

39 Department for Children, Schools and Families (2007e) Care matters: time to deliver for children in care: an

implementation plan. London: Department for Children, Schools and Families

40 Department of Health (2002) Promoting the health of looked-after children. London: Department of Health.

“Children from families with

multiple problems are at increased

risk of negative outcomes…”

Reaching Out: Think Family, Analysis and themes from

the Families At Risk Review

Multiple disavantage can cast a long shadow

Young Carers

A significant concern is for those families that

are affected by parental mental ill-health. Over

one third of all UK adults with mental health

problems are parents.

Two million children are estimated to live in

households where at least one parent has a

mental health problem but less than one

quarter of these adults is in work. Nevertheless

most parents with mental health problems

parent their children effectively. 41

Studies show that that a quarter of all women

referred for mental health treatment, have a

child under five years old. Older children

sometimes carry the responsibility as ‘young

carers’ 42 for a parent with severe and enduring

mental health problems. The number of young

carers in the UK is estimated (a likely

underestimate) to be 175,000 and of these

nearly one third care for a parent with a

mental health problem. The census evidence

also indicates that within the total population

of young carers 114,000 are between the ages

of 5–15.

The Economic Case for Investing

in Public Mental Health

There are identifiable economic benefits of

improving positive mental health e.g. below.

While the best outcomes are generally

associated with the absence of mental illness,

the presence of positive mental health brings

additional benefit.

The scale of the economic benefits of

preventing mental illness is considerable:

_ Mental health problems have very high rates

of prevalence; they are often of long

duration, and have adverse effects on many

areas of people’s lives, including educational

performance, employment, income,

personal relationships and social

participation;

_ No other health condition matches mental

ill-health in the combined extent of

prevalence, persistence and breadth of

impact;

_ Mental health problems often begin early in

life and cause disability when those affected

would normally be at their most productive

(unlike most physical illnesses).

The cost to

society of

mental ill-health

has been

calculated as

£110 billion in

2006/7. This is

greater than

the total costs

associated

with crime

across the

UK. 44

13

41 Evans J and Fowler R. (2008) Family Minded: Supporting Children in Families affected by mental illness Barnardos

42 Roberts D, Bernard M, Misca G and Head (2008) SCIE Research briefing 24: Experiences of children and young

people

43 Friedli, L & Parsonage, M (2007) Mental Health Promotion: Building an Economic Case, NIAMH

44 Ibid Friedli & Parsonage

Subjective well-being increases life expectancy by 7.5 years, provides a similar

degree of protection from coronary heart disease to giving up smoking,

improves recovery and health outcomes from a range of chronic diseases

(e.g. diabetes) and in young people, significantly influences alcohol, tobacco

and cannabis use. A positive sense of self also predicts pro-social behaviour

e.g. participation, civic engagement and volunteering. 43

Costs are described and evaluated under three

headings:

(i) the costs of health and social care, covering

such costs as the services provided by the

NHS and local authorities for people

suffering from mental health problems and

also the costs of informal care given by

family and friends;

(ii) the human costs of mental illness,

corresponding to the adverse effects of

mental illness on the health-related quality

of life; and

(iii) the costs of output losses in the economy

which result from the negative impact of

mental illness on an individual’s ability to

work.

Estimates prepared by WHO show that in the

UK mental illness now accounts for more

Disability Adjusted Life Years (DALYs) lost per

year than any other health condition. Thus the

figures for 2002, the latest available year,

indicate that 20.0% of the total burden of

disease in the UK was attributable to mental

illness (including suicide), compared with 17.2%

for cardiovascular diseases and 15.5% for

cancer. No other condition exceeded 10%. 45

Mental illness including suicide accounts for less

than 5% of all premature mortality but for over

30% of all morbidity and disability. 46

The case for prevention of mental ill-health and

the promotion of well-being is compelling from

an economic perspective alone. A snapshot of

the national picture of mental ill-health is

demonstrated in the evidence:

14

45, 46 Ibid Friedli & Parsonage

• Unemployed people are twice as likely to

suffer from depression as people in work;

• Children in the poorest households are

three times more likely to experience

mental health problems than those

children in affluent households;

• Half of the women, and a quarter of all

men, will be affected by depression at

some period during their lives;

• People who have been abused, or who

have been victims of domestic violence,

have higher rates of mental health

problems;

• Between a quarter and a half of people

using night shelters or sleeping rough may

have a serious mental health problem, and

up to half may be alcohol dependent;

• Some BRM groups are diagnosed as

having higher rates of mental health

problems than the general population;

refugees and asylum seekers are especially

vulnerable;

• Severe mental health problems such as

schizophrenia are relatively rare, affecting

one in 200 adults each year. But

depression and anxiety can affect up to

one in five of the population at any one

time with the highest rates in the most

deprived neighbourhoods;

• People with drug and alcohol problems

have higher rates of mental health needs;

• People with physical illnesses have higher

rates of mental health problems;

• Lesbian, Gay, Bisexual and Trans people

have at least twice the risk of suicide than

the general population.

Black and Racial Minorities (BRM)

and mental health

6.4 million people in England belong to ethnic

minority communities. This figure represents

about 1 in 8 of England’s population and in

Liverpool about 11.5% of the city’s population.

The ethnic minority communities in England,

as in Liverpool, share a number of features.

Disadvantage and discrimination characterise

their experiences in this country in almost all

walks of life. This is particularly true in the area

of health and health care. 47 Black, Irish and

other minority ethnic groups experience high

levels of social and material deprivation when

compared with the majority white population.

This is particularly the case for refugee and

asylum seekers. The social exclusion of minority

ethnic groups is complex and varies according

to their economic, social, cultural and religious

backgrounds.

Psychiatric illness rates are generally higher in

minority ethnic groups and they also

experience significant social adversity but have

poorer social networks and support. There are

ethnic differences in access to mental health

services. Most tellingly, there are significant

and sustained differences between the white

majority and minority ethnic

groups in experience of mental

health services and the

outcome of such service

interventions. 48

There are a range of issues that

remain challenging to the

mental health and well-being of

BRM communities across

Liverpool:

_ Populations with high rates of

socioeconomic deprivation (such as

Liverpool’s BRM population) are known to

have some of the highest need for mental

health care, but the lowest access to and

uptake of services. 49

_ Stigma against people with mental health

problems is a major problem in the BRM

community. Research has shown that stigma

and discrimination against people with

mental health problems is informed by

perceptions within the communities

themselves that there is no effective

treatment for mental disorders.

Improvements in the mental health and wellbeing

of BRM populations will be strengthened

by approaches that, for example:

_ Increase involvement of BRM communities in

the assessment of public mental health

needs 50

_ Place emphasis on identifying solutions to

community problems based on local

knowledge and priorities

_ Support cultural adaptation and tailoring of

evidence-based programmes

_ enable BRM communities to identify and

develop appropriate recovery based

indicators

15

47 Inside Outside: Improving mental health services for black and minority ethnic communities in England (2003) DH.

48 Cochrane, R. and Sashidharan, S.P (1996) Mental Health and ethnic minorities: a review of the literature and service

implications. In Ethnicity and Health: Reviews of the literature and guidance for purchasers in the area of

cardiovascular disease, mentalhealth and haemoglobinopathies. CRD Report 5 University of York, NHS Centre for

Reviews and Dissemination

49 http://tinyurl.com/211s5c

50 http://www.raceforhealth.org/members/pcts/liverpool/peer_review

Framing Public Mental Health Policy and Practice

The range of governmental policies and drivers that inform, influence and direct PMH are diverse,

and the challenge at a local level, is to create a sense of direction informing purposeful

commissioned services and interventions that strengthen protective factors and reduce risk factors

at various levels across the population.

The Public Mental Health strategy and the linked Strategic Action Plan are informed by the

framework being developed nationally for the guidance on Public Mental Health. 51

The model below demonstrates the interconnectedness of the key strategic interventions

supporting Public Mental Health:

Create Flourishing, Connected Communities

A Public Mental Health Framework for Developing Well-being

Nurse J 2008

16

51 New Horizons (2008) A Vision for Public Mental Health & Well-Being: A Public mental Health Framework for

Developing Well-Being. Working Draft, Department of Health

Promote

meaning and

purpose

......................................

Develop sustainable,

connected communities

......................................................

Integrate physical and

mental health and well-being

.....................................................................

Build resilience and a safe, secure base

...............................................................................

Ensure a positive start in life

This model provides a simple framework for

thinking about the imperatives – the actions

that need to be taken, to tackle the

impediments to people’s mental health and

well-being. It will help to focus attention on

doing more of the things that are known to

really help people cope with the ups and

downs of life.

It is evident that some of this important work

inevitably focuses on the early years where the

need to ‘ensure a positive start in life’ is a huge

protective factor for mental health through

adolescence and into adulthood. But more than

this, there is a need to connect our thinking and

actions to show the relationship between our

physical health and our mental health. It has

been acknowledged that the last governmental

White Paper: Choosing Health did not make

clear the links between how we think and feel,

our behaviour and subsequent lifestyle. The

Public Mental Health Strategic Action Plan

2009–12 will use the current evidence base to

strengthen that relationship and help inform

what still need to be addressed in this key area

of people’s well-being.

This strategic framework and action plan will

connect work being done on regeneration, on

home improvement, on issues to address fuel

poverty and on developments to support social

cohesion to tackle those factors that militate

against mentally healthy communities.

Importantly, it needs to support actions and

service developments that help those people

who may be struggling with personal or family

hardships to find help, advocacy and a listening

ear. In particular, to reach out to more of

the people experiencing distress who

show this through self-harm and for

those who are at risk of losing hope

and taking their own lives.

Ultimately Liverpool PCT and it’s

strategic partners would wish the

citizens of Liverpool to have meaning

and purpose in their lives to have

raised expectations of better health

and well-being, to have aspirations for

achievement and for more enriched

and fulfilled lives.

It is clearly understood and recognised that in

the years leading up to, and during Liverpool

08, strategic partnerships grew and developed

between the public and third sector health and

social care organisations, and the arts and

cultural sectors. ‘08’ provided the conditions for

culture and health to grow, nurturing

innovation, sustained partnerships, positive risktaking

and a willingness to ‘have a go’.

“Liverpool 08 presented a remarkable

opportunity to enable the lives we

lead, our own culture and the

culture of our neighbourhoods as

having the power to enhance our

health and well-being. Well-being is

not something that you get from

elsewhere but it is something we all

contribute to in what we do, where

we are and who we are with. This

work is about how we deliver health

and how we create the conditions

where we are enabled to be

healthy.”

Creative Communities, of which creative health

was a part, was at the heart of Liverpool 08

and the regeneration of the city. Creative

communities contributed to raised aspirations

and hope and contributed to the realisation of

public mental health.

17

18

Summary

This strategy will provide clear guidance and actions to promote positive mental health & wellbeing

52, prevent the onset of mental health problems, the amelioration of distress and the

inclusion of people, who currently, are socially excluded as a result of their experience of mental

distress. It will align strategic thinking across the life-course, for vulnerable individuals and groups,

for our families, workplaces and communities and for the population as a whole.

In summary the Public Mental Health Strategy and the Strategic Development Plan have the

following objectives:

_ To clarify the landscape of Public Mental Health and specify its key elements and their

relationships, in particular, the social determinants of mental health;

_ To adopt a systematic approach that will help to strengthen the relationship between individual

resilience and the resources available to people in securing their mental health and well-being;

_ To integrate and align current strategic needs assessments, health intelligence and plans across

the public health domain into a seamless approach to public mental health;

_ To inform commissioning intentions across the city’s strategic plans that will contribute to the

achievement of a ‘flourishing’ population 53.

_ To build capacity for Public Mental Health within the Primary Care Trust and the City Council

and through our commissioned 3rd sector organisations across the city.

_ To identify and develop those particular dimensions of mental health and well-being, as yet, not

explicitly articulated in other strategic documents for example, ‘Think Family’, health promoting

settings – workplace health 54;

_ To specify a framework for action that includes promotion, earlier intervention, prevention 55

and protection as the collective means to address mental health inequalities across the city;

_ To provide evidence of effectiveness in public mental health, so that good practice can be

acknowledged, celebrated, commissioned and replicated;

19

52 Our health, our care, our say: a new direction for community services (2006)

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4127453

53 Keyes, CLM ( 2008) A perspective from the U.S.: mental health is a complete state and not merely the absence of

mental illness symptoms or diagnoses in NIMHE Mental Health Promotion Update, January 2008, Gateway Reference

No. 9246

54 Mental health promotion involves any action to enhance the mental well-being of families, organisations or

communities. It is essentially concerned with:

• how individuals, families, organisations and communities think and feel

• the factors which influence how we think and feel, individually and collectively and

• the impact that this has on overall health and well being.

55 Prevention can be defined as:

• Primary Prevention aims to improve the mental health of communities so that people do not become ill.

• Secondary Prevention aims to identify people who are developing early signs of mental illness so that more

serious mental illness can be avoided.

• Tertiary prevention aims to prevent people who have become ill from relapsing, or helps them to recover

City’s Population Profile and

Population Trends 56

In 2001 the city’s population stood at 441,900.

Latest 2006 estimates show that this figure has

now fallen to 436,100 a reduction of 5,800

residents representing a percentage loss of

1.3%. This goes against the national trend

which shows population increasing by 2.5%.

With the exception of 2004–05, levels of

internal out migration are responsible for most

of Liverpool’s annual population decline. This

means those people leaving the City for other

locations within the UK.

The latest data now shows that if the present

trends for the City continue there will be a

further population decrease to 421,700 by 2029

a loss of 20,200 persons since 2001.

In planning and housing terms these estimates

and projections could have some major

implications for future policy. In general (and

common to other policy areas), ongoing

decline in population levels will undermine

sustainable communities through, for example,

falling patronage for shops, schools and other

community facilities.

Since 2001 there has been a decrease in the

number of children (0–15) of 11.9% and a

decrease in the retired age group (65M/60F

and above) of 4.2%, while our working age

population has risen by 2.9% (7,900). The

decrease in the child population is repeated

across all the Merseyside authorities, Core Cities

and at a national level.

The total population in 2001 was 441,900 of

which 36,600 (8.3%) was made up of BRM

groups. This has increased to 10,300 in 2005

giving a BRM population of 46.900 (10.7%)

which includes the White Irish population as

shown in Table 5 below. This represents an

increase of 28.1% from the 2001 figure which is

higher than that of England’s and the North

West which are 18.2% and 23% respectively.

The BRM population in Liverpool is the highest

on Merseyside and higher than the North West

level of 9.7%.

Common Mental Health Problems

The public health importance of common

mental health problems is demonstrated by the

finding that low levels of depression resulted in

51% more days lost from work, than major

depression6. Whereas major psychiatric

disorders such as schizophrenia (which has a

community prevalence of less than 1%) are

certainly more disabling to individual sufferers,

are more distressing for their families and

carers, their rarity means that these conditions

place less of a burden on the public health than

common mental health problems.

_ The most common mental health problems

anxiety and depression, have a combined

prevalence rate of about 18% in the

community 57

_ Around 1 in 6 of all adults reported some

form of common mental health problem 58

_ The highest regional prevalence of any

common mental health problems occurred

in the North West, with a rate of 1 in 5

_ Common mental health problems account

for one third of days lost from work due to

ill-health and 1/5 of all consultations with

general practitioners in the UK

20

56 Briefing Note to RMT/Corporate Regeneration Group, LCC, December 2007

57 Meltzer H, Gill B, Petticrew M. (1995). OPCS Surveys of Psychiatric Morbidity in Great Britain.

58 Report No 1. The prevalence of psychiatric morbidity among adults aged 16-64 living in private households in Great

Britain. HMSO: London.

59 Singleton N, Bumpstead R, O’Brien M, Less A, Meltzer H, (2001) Psychiatric morbidity among adults living in private

households, 2000. The Stationery Office: London.

Demographic Trends and Needs Analysis

The prevalence of mental health problems is

greater amongst people with the characteristics

associated with deprivation 60. There is

abundant evidence that mental health

problems tend to be concentrated in socially

disadvantaged groups within the population,

and that these groups of people have relatively

poor access to mental health care. It was also

evident that in areas defined as deprived,

admission rates to secondary care are three

times higher than the national average. In a

survey of the general population, it was found

that poverty and unemployment increase the

duration of episodes of common mental health

problems.

Compared to those with no common mental

health problems, those with common mental

health problems were more likely to:

_ be separated or divorced (twice as likely);

_ be living as a lone parent family unit;

_ be tenants of the local authority or a

housing association;

_ have a long-term limiting illness;

_ come from a lower social class;

_ be economically inactive and

_ have no formal educational qualifications

Summary of the Mental Health

Equity Profile (2008) 61

Data to support the Adult needs assessment

element of the strategy has been taken from

the Mental Health Equity Profile (MHEP) 62. The

purpose of the equity profile was to examine

equity of access to and provision of services to

meet the mental health needs of the adult

population covered by Mersey Care NHS Trust.

This rapid mental health equity profile,

repeated and updated elements of the

Merseyside Mental Health Equity Audit

undertaken in 2004.

The focus of the profile were services provided

by Mersey Care and relates to the geographical

areas served by Liverpool and Sefton PCTs and

the Kirkby area of Knowsley PCT (i.e. the area

covered by Mersey Care NHS Trust).

All levels of care (primary, secondary, tertiary)

were included in the analysis. The profile used

‘readily available’ performance measures, and

the equity analysis included the following

dimensions: geography; deprivation/socioeconomic

factors; ethnicity; age; sex.

The synopsis is provided in a tabular format

with accompanying mapped data and focuses

on the following key areas:

_ Deprivation

_ G.P. Referrals to Adult mental Health

Services

_ Caseloads with complexity (standard and

enhanced CPA)

_ Hospitalised prevalence of mental health

conditions

_ Hospitalised incidence of self-harm

_ Readmissions within 90 days of discharge

_ A & E Episodes of self-harm

_ Suicide and injury undetermined

_ Suicide amongst people under care

21

60 Rankin, J (2005) Mental Health in the mainstream

61 http://tinyurl.com/211s5c

62 Ubido, J & Lewis,C. 2008) Mental Health Equity Profile of the area served by Mersey Care NHS Trust: Interim Report,

Liverpool Public Health Observatory.

Children and Young People

Surveys suggest that clinically significant

emotional or behavioural difficulties are

restricted to a minority of children and young

people, roughly one in ten 63. Trend analysis

identifies the following as patterns in

adolescent behaviour:

_ Adolescent emotional problems (depression

and anxiety) have increased for both boys

and girls since the mid 80’s;

_ Adolescent conduct problems have showed

a continuous rise for both girls and boys for

the period 1974–1999;

_ The strength of associations between these

problems and poor outcomes in later life

have remained similar over time.

This evidence can be aligned with findings from

a collaboration research project between the

New Economics Foundation 64 and Nottingham

City Council (NCC) which undertook to measure

the well-being of young people in Nottingham

This innovative study surveyed over 1,000

children and young people in Nottingham,

aged 7–19.

_ Just over half of young people scored well

on both categories of life satisfaction and

personal development. Twelve per cent,

however, scored poorly on both.

_ In particular, nine per cent of young people

in Nottingham have ‘very low’ life

satisfaction and can be considered at very

high risk of depression. 23% of young

people who scored ‘low’ in life satisfaction

were also at risk from depression, forming a

large group of 32 % of young people in

Nottingham who are, at the very least,

unhappy in life and may be at risk of mental

health problems. 65

_ Well-being falls substantially as children get

older. When comparing 9–11 year-olds with

12-15 year-olds, average scores for life

satisfaction and curiosity fall by five per cent

and ten per cent respectively.

Some children experience a range of emotional

and behavioural problems that are outside the

normal range for their age or gender. These

children and young people could be described

as experiencing mental health problems or

disorders .Mental health professionals have

defined the problems that children and their

families can be faced with as follows:

_ emotional disorders, e.g. social phobias,

anxiety states and depression that may be

manifested in physical symptoms;

_ conduct disorders, e.g. fighting, bullying,

stealing, defiance, aggression and anti-social

behaviour;

_ hyperkinetic disorders e.g. disturbance of

activity and attention;

The symptoms listed are found, to some extent,

in most children. To count as a disorder they

have to be sufficiently severe to cause distress

to the child or an impairment in his/her

functioning.

In 2004 10% of children and young people

aged 5–16 had a clinically diagnosed mental

disorder 66. Boys are more likely to have a

mental disorder than girls. The prevalence of

mental disorders in children and young people

was greater in those who experienced, lone

families, reconstituted families, parents with no

educational qualifications, families with neither

parent working, families on low income,

families in social or privately rented housing,

families living in deprived areas.

22

63 Time Trends in Adolescent well-being (2004). The Nuffield Foundation

64 Marks N, Shah H & Westall H (2004) The power and potential of well-being indicator: Measuring young people’s

well-being in Nottingham. New Economics Foundation (nef) / Nottingham City Council.

http://www.neweconomics.org

65 This would align with findings form Corey Keyes who has identified significant levels of the population who, in terms

of their mental health and well-being, are languishing.

66 Green H, McGinnity A, Ford T & Goodman R (2004) Mental Health of Children and Young People in Great Britain, ONS

Conduct Disorders

Children and young people with conduct

disorder were more likely than other children

to be boys and be in the age range 11–16. Of

children with this disorder 24% found it harder

than average to make friends and a third found

it harder to keep friends. 59% of children with

conduct disorders were assessed as being

behind with their schooling and with 36%

being two years or more behind their peers.

About half of children with this disorder were

considered to have special educational needs.

As with children with emotional disorder,

children presenting with these behaviours had

high rates of absence from school with 22%

having truanted from school. Children’s parents

were likely to have experienced separation,

financial stress, mental illness or trouble with

the police. Similar behaviours were apparent in

these children, as with those children with

emotional disorders, particularly in respect of

substance use and suicidal ideation 67.

Hyperkinetic Disorders (HKD)

The core symptoms of this disorder are

inattention, hyperactivity and impulsivity.

Children with HKD are predominantly boys

(82%). Almost a third of children with this

diagnosis found it harder than average to make

and keep friends and scored low on a scale

measuring social aptitude. Developmental

delay in academic performance was notable

with 18% being three or more years behind

their peers.

Children with HKD were more than 4 times as

likely to have recognised special educational

needs. In common with children with other

identified disorders many had experienced

parental separation (49%), or had a parent

with a serious mental illness that required a

stay in hospital (23%). The proportions for

other children were 31% and 13% respectively.

The correlation with economic deprivation

mirrored children with other disorders with

31% coming from a household with no parent

working compared to 14%v with nondisordered

children.

Similar behaviours were apparent in these

children, as with those with emotional and

conduct disorders, in respect to substance use

and suicidal ideation 68.

Emotional Disorders

Children with emotional disorders are more

likely to be girls (54%) and to be in the age

group 11–16 (62%). Over 2/5ths of children

with an emotional disorder were behind in

their intellectual development with 23% two or

more years behind. Children with generalised

anxiety disorder and depression had the most

days away from school. 55% of children with an

emotional disorder had experienced their

parent’s separation and 28% of parents had a

serious mental illness. Young people aged 11-16

with an emotional disorder are more likely to

smoke, drink and use drugs than other children

and of concern, 28% said that they had tried to

harm or kill themselves 69.

Autistic Spectrum Disorder (ASD)

Children with ASD are predominantly boys

(82%). Unlike children with the more common

disorders, autistic children tend to have more

highly qualified parents than other children

and were slightly less likely to live in low

income families. Parents here have an unusual

combination of high educational status and

low economic activity rates that reflects their

heavy caring responsibilities. 56% of families

with autistic children were in receipt of

disability benefit.

Just under a third of children with ASD had

another recognised disorder – 16% with an

emotional disorder, usually anxiety related and

19% with conduct disorder. Over 2/3rds of

children with ASD found it harder to make and

keep friends 71% and 73% compared with 10%

and 5% of other children. 42% of autistic

children had no friends compared with 1% of

other children.

23

67, 68, 69 Ibid

Similar behaviours were apparent in these

children, as those with emotional and conduct

disorders, in respect to substance use and

suicidal ideation 70.

Findings from the Adverse Childhood

Experiences Study 71, demonstrate the

relationship between the following childhood

experiences, risk behaviours and problematic

health outcomes as a result of childhood

trauma:

_ Recurrent physical abuse

_ Recurrent emotional abuse

_ Contact sexual abuse

_ An alcohol and/or drug abuser in the

household

_ An incarcerated household member

_ Someone who is chronically depressed,

mentally ill, institutionalized, or suicidal

_ Mother is treated violently

_ One or no parents

_ Emotional or physical neglect

The ACE Study has begun to uncover how

childhood stressors are strongly correlated with

the development of poor health and well-being

outcomes throughout the life course. These

childhood experiences are related to increased

prevalence of smoking, obesity, sexual health,

alcohol, drug use depression, suicidal ideation

and attempted suicide in later life.

Older People

Older people’s mental health is an increasingly

important area of public policy.

Those in later life who have mental health

problems face age discrimination, negative

stereotyping, isolation and low income. This

combination of factors maintains their social

exclusion and increases their vulnerability to

poor physical health 72.

For some older people the transition to

widowhood, the adjustment to living alone and

the loss of close family members, friends and

neighbours feature strongly. Other important

life events include the breakdown of family

relationships, the onset of chronic health

conditions, withdrawal from the labour market,

and the experience of crime. People

interviewed in this study 73 appeared to lack

adequate support when such events occurred,

and some continued to struggle with the

impact of life transitions well after their onset.

Loss of a partner may bring in its wake other

problems such as coping with long-term illness,

financial pressures, and feelings of vulnerability

about living alone in the community. This

highlights the potential need for a new type of

preventive social policy geared towards

providing support to individuals at such turning

points in their lives.

Three million older people in the UK experience

symptoms of mental health problems that

significantly impact on quality of life and this

number is set to grow by a third over the next

15 years. 74 The range of mental health

problems experienced in later life includes

depression, anxiety, delirium, dementia,

schizophrenia and other severe mental health

problems and alcohol and drug misuse.

24

70, 71 Ibid

72 Health Education Authority 1997, Roberts et al 2002, McCulloch 2002

73 Multiple Exclusion and Quality of Life amongst Excluded Older People in Disadvantaged Neighbourhoods. Thomas

Scharf, Chris Phillipson and Allison E. Smith, Centre for Social Gerontology, Keele University, March 2004

74 Age Concern, (August 2007), Improving services and support for older people with mental health problems

Nationally:

_ Depression is the leading risk factor for

suicide. Older men and women have some

of the highest rates of all ages in the UK.

_ Delirium or acute confusion affects up to

50% of older people who have operations.

_ There are approximately 70,000 older

people with schizophrenia in the UK.

_ People aged between 55 and 74 have the

highest rates of alcohol-related deaths in the

UK.

The number of people with Alzheimer’s

dementia (AD) currently exceeds 700,000 in the

UK, which is generally considered to be an

underestimation due to under-reporting 75.

The impact of AD on the mental capital and

well-being of its many sufferers is significant.

The disease progressively causes memory to fail

and memories to fade, with eventual complete

loss of identity. The course of the disease is

unpredictable 76. Periods of rapid decline can be

followed by periods of relative stability of

cognitive function during which awareness of

the progression of the disease causes great

distress both for the individual and their

families.

The majority of patients in the UK live at home,

constantly requiring intensive care from their

spouses and children. Such circumstances have

been shown to cause sadness, grief, guilt and

anger and to increase the risk for depression

and related disorders in family members and

caregivers, thus impacting on their mental wellbeing

77.

The number of Liverpool residents aged 65 and

over is projected to grow from 64,200 in 2007

to 63,500 by 2011 and to 84,700 by 2031

(+30.7%) – 2006 based projections. Within

Liverpool the number of older people with

dementia is predicted to grow by 29.3% by

2030 based on 2006 population i.e. from 4,216

people in 2006 to 5,961 in 2030.

Liverpool has an adult BRM population which is

11.5% of the total adult population and 5.5%

of the 65+ population. Although comparatively

small the BRM community is growing and

ageing. The largest ethnic communities are,

White Other, Chinese and Black African. The

largest ageing communities are White Irish,

White other, and Chinese 78.

25

75 Alzheimer’s Society Demography Policy Position Report. 2007.

www.alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200167&documentID=412.

76 Rabheru, K. 2007. Disease staging and milestones. Can J Neurol Sci, 34:S62-66.

77 Mittelman, M.S., Haley, W.E., Clay, O.J. and Roth, D.L. 2006. Improving caregiver well-being delays nursinghome

placement of patients with Alzheimer disease. Neurology, 67:1592-1599.

78 Estimated resident population by ethnic group, age and sex, mid-2006, (experimental statistics).

Background and context

The prominent place of stakeholder

participation in the development of public

mental health and mental health initiatives has

long been supported by both research and

policy. For many it has become a received

wisdom that participation itself can be a major

vehicle for increasing resilience and mental

well-being, as well as being a prerequisite of

health promotion dating back to the Ottawa

Charter of 1983 79. Involvement in governance

is held by many to be the most important way

of building social capital and developing

community cohesion. 80

The participation of stakeholders in the

development of mental health policy is nothing

new in Liverpool 81. A strong tradition of

participative activities has emerged over the

past 10–15 years. This has included:

_ Development of Joint Forum

_ Development of Patients Council

_ Development of mental health and citizen

advocacy

_ Liverpool Mental Health Awareness Project

_ Liverpool Mental Health Consortium

_ Community Empowerment Network

_ Local Involvement Networks

_ Your Community Matters structures

Many of these organisations have taken

the lead in actively promoting mental

health and well being, raising awareness

and challenging myth and stigma before

there was an explicit policy direction

from central government or from local

health and social care services.

Recent evaluations of mental health

promotion and participatory approaches

have shown, however, that the social and

psychological benefits are not always

straightforward to realise.

There is a view, for instance that barriers have

included difficulty in identifying who the

stakeholders are and a reluctance by the public

to engage with a less than popular cause 82. A

more recent study has gone further to suggest

that the social capital generated by community

participation may not be distributed equitably

across the community, creating a network

dynamic of insiders and outsiders 83.

The strategic approach, therefore, is to build on

those initiatives and structures that have

developed locally, to date, by in the light of

recent evaluations in order to find the way

forward.

Method

The degree of complexity regarding existing

networks and the problematising factors

noticed from some evaluative studies make it

necessary to identify a clear method in order to

establish a strategic approach to engagement.

This would be first of all to establish some key

principles in each of the following areas:

_ Stakeholder Mapping and Analysis

_ Identifying Levels of Participation

_ Identifying Methods of Participation

Stakeholder Participation 26

79 http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf

80 Friedli, L (2008), Resilient Relationships: the influence of public sector policy and practice on social support

(unpublished draft briefing paper, CSIP North West)

81 Joint Commissioning Strategy for Adult Mental Health And Well Being in Liverpool, 2008-2011,

Liverpool PCT & Liverpool City Council

82 Stacey, K, Herron, S (2002), Enacting policy in mental health promotion and consumer participation,

Australian eJournal for the Advancement of Mental Health (AeJAMH), Vol 1, Issue 1

83 Skidmore, P, Bound, K, Lownsbrough, H (2006) Community Participation: Who benefits?,

(Joseph Rowntree Foundation)

Stakeholder Mapping and Analysis

Methods of systematically approaching which individuals, groups and communities may have a

stake in policy/service development have already been identified and are outlined in the Joint

Commissioning Strategy for Adult Mental Health and Well Being in Liverpool (see diagram).

The range of stakeholders in a whole population approach must by definition be broad and varied,

but some initial categorisation as follows might be possible.

_ Everyone

_ Neighbourhood representatives

_ Members of marginalised communities

_ People who have experienced mental ill health

_ People who provide health and social care services

_ People who provide other public services (leisure, education, employment)

A systematic analysis of local groups would enable us to decide to what extent which people will

have an affinity to the aims of the strategy and/or will need to have some awareness raising or

education. Current thinking is informed by the idea of growing the ‘core economy’, namely

realising and strengthening human and social assets that belong to individuals and communities 84.

In this way older divisions that separate people and services are re-fashioned and are characterised

by a new relationship between producers and consumers of services. This idea of co-producing

public services 85, allows public service agencies to become catalysts and facilitators, working

through peer support networks, to better define and meet people’s needs.

27

84 Green Well Fair: Three Economies for Social Justice (2009) New Economics Foundation (NEF)

85 Co-production: A manifesto for growing the core economy (2008), New Economics Foundation (NEF)

Keep satisfied

Engage closely

and influence

actively

Monitor

(minimum effort)

Keep informed

High

Power

Low

Low Interest High

Identifying levels of participation

The implementation of any policy will require

action at a variety of levels and settings. In

public health these have been identified as:

_ Information. The least you can do is tell

people what is planned.

_ Consultation. You offer a number of options

and listen to the feedback you get.

_ Deciding together. You encourage others to

provide some additional ideas and options,

and join in deciding the best way forward.

_ Acting together. Not only do different

interests decide together what is best, but

they form a partnership to carry it out.

_ Supporting independent community

initiatives. You help others do what they

want – perhaps within a framework of

grants, advice and support provided by the

resource holder. 86

Accepting that people will engage according to

their interests, circumstances and skills it will be

important not only to provide a range of

engagement activities, but also to evaluate

levels of engagement to ensure that network

dynamics are managed and a system of insiders

and outsiders does not occur. 87

Identifying methods of

participation

Having established the levels of connectedness

of key stakeholders it becomes possible to find

vehicles for engagement that will be

appropriate to their interests and

circumstances, enabling stakeholders to be

involved in a level that is appropriate to them.

Some methods of engagement are summarised

in the recent Rethink 88 campaign report

(although there are a plethora of varied

techniques available to enable communities

and groups to participate in policy

development). 89 The issue will be to connect

people with the appropriate group.

Resources and implementation

As previously observed, there already exist

resources dedicated to community and

stakeholder engagement both within Liverpool

PCT, as well as Local Involvement Networks and

Community Empowerment Networks, as well

as Liverpool Mental Health Consortium, which

specifically focuses on mental health issues.

A strategic approach would be increase the

profile of the public mental health within these

structures in order to:

_ identify any increased levels of capacity

necessary to support co-ordination

_ evaluate the impact that stakeholder

participation will have both on policy

implementation and on the well being of

the citizens of Liverpool.

28

86 http://www.partnerships.org.uk/pres/fitlog/sld007.htm

87 Skidmore, P, Bound, K, Lownsbrough, H (2006), op cit

88 TIME TO CHANGE (2008) Stigma Shout: service user and carer experiences of discrimination Rethink

89 For a full discussion of principles of participation and an A-Z of how to put theory into practice visit

http://www.partnerships.org.uk

This strategy supports whole systems thinking

in the management of change and system

reform and sees this approach as fundamental

to the meeting of population mental health

needs through integrated commissioning.

Whole system reform characterises the mental

health economy and this presents significant

challenges in managing this constant dynamic.

Managing the implementation of government

policy across well-being, health and social care,

community regeneration and social inclusion at

a local level requires an overarching strategic

approach so that change becomes purposeful,

manageable and coherent. The focus according

to Darzi will need to give:

World Class Commissioning

National consultations 90 have confirmed the

importance that mental health and well-being

has for the public and this is strengthened by

the extensive research evidence that supports

this strategy. The introduction of World Class

Commissioning offers many opportunities to

improve the mental health and well-being of

our local population through earlier

interventions.

The determination to intervene earlier confirms

the vision statement from DH that world class

commissioning will be ‘pivotal in shifting the

focus of care from diagnosis and treatment to

prevention and well-being’ 91. Consideration will

need to be given to longer-term commissioning

plans and intentions to realise this objective

and to maintain a developing equilibrium

between newly commissioned services for

earlier intervention and those that provide

treatment, care support and recovery pathways

for those experiencing mental illnesss.

29

A successful public mental health strategy requires long-term commitment,

multi-agency working and co-ordination, as well as a sense of common

purpose from all stakeholders in Liverpool.

Greater emphasis on prevention

and the responsibility individuals

have themselves. Unhealthy choices

and missed prevention

opportunities are in part the cause

of the growth in the prevalence of

conditions such as diabetes,

depression, and chronic obstructive

pulmonary disease. Working with

their local partners, every primary

care trust will commission

comprehensive wellbeing and

prevention services.

Even with optimal services in place

only 40% of the burden of mental

illness is averted – the need and

determination for the commissioning

and implementation of prevention

services is paramount. 92

90 Our Health, Our Care, Our Say (2007) DH

91 Department of Health (2008) DH/Commissioning, World Class Commissioning. Vision Summary

92 O’Hara K, Stansfield J, Crowson T (2008) World Class Commissioning for improved mental health and well-being in

NIMHE Mental Health Promotion Update. April. Gateway No 9700 pp 10–12

Commissioning for Health Improvement

The saving in costs, (both human and

economic) by reducing, for example, conduct

disorder and in promoting positive mental

health in children through earlier intervention

is evidenced below:

_ Preventing conduct disorders in those

children who are most disturbed would save

around £150,000 per case in lifetime costs

_ Promoting positive mental health in those

children with moderate mental health

would yield benefits over the life course of

around £75,000 per case 93

_ In comparison the intervention cost, per

child, for parenting programmes would be

in the range £1,350 to £6,000.

Using the World Class Commissioning

framework of 11 competencies the table on the

next page outlines how these competencies

relate to key actions for Liverpool PCT and for

the role of Public Mental Health specialists and

partners in this field as ‘Agents for Change’

within the local health economy 94. This helps to

clarify organisational, departmental and

individual objectives in support of public

mental health improvement. It recognises that

World Class Commissioning is a collective

endeavour and not a singular activity and as

such is way of working that relates the parts to

the whole.

30

93 Friedli L (2008) mental Health Promotion: The Economic Case for Investment. In in NIMHE Mental Health Promotion

Update. April. Gateway No 9700 pp 13–14

94 O’Hara K, Stansfield J, Crowson T (2008) World Class Commissioning for improved mental health and well-being in

NIMHE Mental Health Promotion Update. April . Gateway No 9700 pp 10–12

95 Feast D (2008) World Class Commissioning in NIMHE Mental Health Promotion Update. April . Gateway No 9700 pp

15–16

It is unlikely that all the skills

required to achieve World Class

Commissioning performance

already fully exist in any one

organisation. PCT’s, Local

Authorities and wider public service

partners need to work together to

maximise each organisations

contribution to commissioning the

best outcomes for people. 95

31

World-class Commissioning

Vision and Competencies

Role of Public Mental Health Specialists

1 World class commissioners are recognised as the

local leader of the NHS.

Provide leadership for mental health improvement

and build capabilities of colleagues and

stakeholders.

2 World class commissioners work collaboratively

with community partners to commission services

that optimise health gains and reductions in

health inequalities.

Engage key partners in the Public Mental Health

Strategy; integrate mental health promotion across

other health & social care programmes e.g.

improving mental health and well-being of people

with physical illness and long-term conditions;

ensure the needs of people with mental health

problems are addressed within Tackling Health

Inequalities strategies and programmes.

3 World class commissioners proactively seek and

build continuous and meaningful engagement

with the public and patients, to shape services

and improve health.

Advise on and facilitate opportunities for

meaningful engagement; support inclusion of

people with mental health problems into

engagement processes.

4 World class commissioners lead continuous and

meaningful engagement with clinicians to inform

strategy, and drive quality, service design, and

resource utilisation.

Facilitate clinical engagement and support service

improvement in mental health promotion and in

services attaining Care Quality Commission public

health core standards.

5 World class commissioners manage knowledge

and undertake robust and regular needs

assessments that establish a full understanding

of current and future local health needs and

requirements.

Provide advice and expertise to designing and

conducting JSNA that incorporates mental health;

facilitate community needs assessment exercises.

6 World class commissioners prioritise investment

according to local needs, service requirements

and the values of the NHS.

Develop, implement and monitor robust public

mental health strategies, based on need and

stakeholder ownership, that identify priorities for

investment.

7 World class commissioners effectively stimulate

the market to meet demand and secure required

clinical, and health and well-being outcomes.

Build capacity and capability of providers of mental

health improvement interventions; build

knowledge and capability of third sector providers

in evaluating service mental health outcomes.

8 World class commissioners promote and specify

continuous improvements in quality and

outcomes through clinical and provider

innovation and configuration.

Keep up-to-date with emerging good practice

nationally and internationally; explore, develop

and evaluate innovative and creative practice.

9 World class commissioners effectively manage

systems and work in partnership with providers

to ensure contract compliance and continuous

improvements in quality and outcome.

Agree local mental health and well-being outcomes

and indicators and methods for measurement.

10 World class commissioners make sound financial

investments to ensure sustainable development

and value for money.

Develop sustainable practice and partnerships;

keep abreast of emerging evidence based practice;

build links with researchers and economists to

identify, support and influence cost effective

solutions.

Priorities for Investment in Public

Mental Health

Evidence from Friedli 96 confirms the following, as

actions and commissioned activities that can

improve population mental health. The WHO

report, re-affirms the significance of mental

health as crucial to our thinking about sustainable

economic growth and in achieving greater social

cohesion in the face of economic change.

1 Social, cultural and economic conditions that

support family life

• systematically work to reduce child poverty

• support parents and the development of

children in early years through parenting

skills training and high quality pre-school

education

• strengthen inter agency partnerships to

reduce violence and sexual abuse

• increase access to safe places for children to

play, especially outdoors

• make the business case for good work/life

balance and provide adequate

• maternity and paternity leave

2 Education that equips children to flourish

both economically and emotionally

• increase uptake of the health promoting

schools approach, involving teachers, pupils,

parents and the wider community

• support parents to improve the home

learning environment (HLE)

• value social, sports and creative

achievements, as well as academic

performance

3 Employment opportunities and workplace

pay and conditions that promote and

protect mental health

• support efforts to improve pay, working

conditions and job security, notably for the

most vulnerable workers

• make the business case for improving job

control, social support and effort/reward

imbalance

• early referral to workplace based support for

employees experiencing psychiatric

• symptoms or personal crises to avert

employment breakdown

4 Partnerships between health and other

sectors to address social and economic

problems that are a catalyst for

psychological distress

• improve access to non medical sources of

support through social

prescribing/community referral or co

production models e.g. timebanking, to

address basic skills, housing/transport

problems, debt, isolation, limitations in daily

living, opportunities for arts, leisure and

physical activity etc.

5 Reducing policy and environmental barriers

to social contact

• policy responses to personal misfortune e.g.

poverty, unemployment and other

• adversity should not stigmatise or blame the

victims

• develop community transport schemes

• promote volunteering and develop ‘social

outcome’ indicators

• work with planners to introduce/re-introduce

‘stop and chat’ public spaces

• ensure that public spaces such as shopping

malls do not exclude specific groups,

• for example teenagers.

These areas for development are reflected, in

part, in both current achievements and

emerging activity detailed in the Public Mental

Health Strategic Action Plan 2009–12. The

action plan is structured around the three key

imperatives of the strategy, namely:

_ enhance wellbeing

(i.e. increasing flourishing)

_ prevent mental illness from occurring

_ treat mental illness when it is present

32

96 Friedli, L (2009) Mental health, resilience and inequalities. World Health Organisation, WHO Europe

In addition a number of themes have been used to organise and support the Action Plan that have

been informed by the following model developed by Nurse 97.

The Action Plan is integral to the strategic framework and will be a ‘living and working document’

that over the next three years will enable the continuous review and refinement of Public Mental

Health priorities and commissioning intentions within the strategic and operational planning

procedures of Liverpool 1st, Liverpool PCT and Liverpool City Council, its third sector partners and

stakeholder groups.

This development process will reflect a history of effective stakeholder engagement that has been

held up as a model of best practice within the North West Region. In doing so, it will continue to

reach out to its various constituencies by demonstrating that ‘mental health is everyone’s business’.

It will affirm that mental health is fundamental to our well-being. It underpins everything we do,

how we think, feel and behave. It is an essential and precious resource that needs to be protected,

promoted and improved. As such, it sits as much with us as individuals as it does with our families,

communities, our services and our civic responsibilities.

It is perhaps fitting, that in conclusion, it is in the brevity of the following statement that our sense

of direction lies:

“Tend to the social and the individual will flourish.” 98

Catherine Reynolds

Strategic Lead: Public Mental Health

Department of Public Health

Liverpool PCT

33

97 Nurse J (2008) ‘Create Flourishing Connected Communities: A Public Mental Health Framework for Developing Wellbeing.

DH

98 Rutherford J (2008) The culture of capitalism. Soundings: journal of culture and politics 38: 8–18.

(http://www.lwbooks.co.uk/journals/soundings/articles/02%20s38%20%20rutherford.pdf).

Promote

meaning and

purpose

......................................

Develop sustainable,

connected communities

......................................................

Integrate physical and

mental health and well-being

.....................................................................

Build resilience and a safe, secure base

...............................................................................

Ensure a positive start in life

Appendix 1 34

35

36

nef’s ‘Five ways to well-being’

37 Appendix 2

Mental Capital and Well-Being: Making the Most of Ourselves in the

21st Century (2008) Foresight, Government Office for Science

Appendix 3 38

39

40

41

42

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____________ _________ _________ _________ _________ _________ _
Dear

The Governments response to the 09Bullying Petition tinyurl.com/374vllf was extremely disappointing. As my elected representative could you please campaign for a change of legislation concerning Bullying in the workplace. As my elected MP could you please raise my concerns in Parliament, by introducing a Private Members Bill or Expanding on the dignity at work Bill.

The action I feel would be beneficial if all Grievances were recorded, i.e tape recorded/video recorded, and an independent employment consultancy, or another independent organisation that had no ties with the perpetrator investigated all Grievances/Appeals pertaining to bullying/harassment . This may sound expensive, if you think of the cost in the long run it will be a lot cheaper than: Sickness; Counselling; Tribunal, etc.

Education is the key as bullying thrives on silence. A zero tolerance to bullying and make information on how to deal with bullying known throughout all industries.

Thank you for your assistance

Yours sincerely
____________ _________ _________ _________ _________ _________ _

Please forward this email on to all networks...Thanks

Vicky

Oak Vale Medical Centre Please Write to MP/Councillor/MEP

2010-01-07T09:35:00.000-08:00

Friend gets local paper and what happens PCT want to close my local surgery down and move it a mile away. http://tinyurl.com/yanp2m7 Hull said: “Although we will take notice of the petition,we would urge anyone who has a strong viewpoint to take part in the consultation." What happened to good old fashioned surgeries. Everything is about cost, what about the human cost. We need local Doctors not faceless Centres. We are people not machines that have to be moved when a jumped up dictator decides it's more cost efficient.

Oak Vale Medical Centre has served the community for over 44 years and yet suddenly the powers that be decide it's time to move. If it is not broke don't fix it. How are elderly and sick people going to get to this new surgery? There will be more request for home visits thus putting a strain on the health service.

I noticed there was no letter in the post informing the patients about this proposed change and the meeting was held at 7 pm when the roads and pavements are icy and the majority of the population are staying in...what a democratic method of implementing a change...perhaps if everyone received a ballot paper...with yes or no would more democratic way of finding out what the patients wants.

Please write to your MP/ Councillors about this http://www.writetothem.com/.

Here are several templates which people may wish to use:

Dear xxx

In a representative democracy, it is important that those who make the rules are also required to abide by them Liverpool Primary Care Trust has failed in it's duty to do this. I feel that Liverpool Primary Care Trust has failed in it's duty of care towards the patients of Oak Vale Medical Centre, by failing to consult with the patients properly over the proposed move of Oak Vale Medical Centre. There has been no written explanation in the post. No offer of a postal ballot for the patients to decide if they wish to move. There was a meeting which was held at 7 pm, when the roads and pavements were icy and the majority of the population would not venture out, as the conditions were treacherous and there was no notification of this meeting except in the Local Newspaper that evening. http://tinyurl.com/yanp2m7

I would also point out that the actions of the Primary Care Trust contravenes the following Human Rights Acts:

Article 2 of the Human Rights Act. (Right to Life). As a consequence of the move Elderly people could die.

Article 8 of the Human Rights Act (Right to respect for private and family life ) As a consequence of the move it will have a derogatory impact on the families of Old Swan.

Article 17 of the Human Rights Act (Prohibition of abuse of rights). Liverpool Primary Care Trust has abused it power by not consulting with the patients of Oak Vale Medical Centre.

Article 18 ( Limitation on use of restrictions on rights) The patients of Old Swan have not been allowed the right to choose the location of Oak Vale Medical Centre.

Oak Vale Medical Centre has served the community for over 44 years and yet suddenly the powers that be decide it's time to move. How are elderly are the elderly, young families and sick people going to get to this new surgery? There will be more request for home visits thus putting a strain on the health service.

As my local elected politician please intervene and stop this regressive move and waste of public money and allow the residents of Old Swan to continue receiving the excellent service provided by the health professions of Oak Vale Medical Centre at Edge Lane not the Fiveways.

Thank you for your assistance

Yours sincerely

________________________________________________________________________________

A template if you are writing on behalf of an elderly relative please remember to alter it...if it is Father/Aunty ...or someone else.

Dear

I am writing on behalf of my Mother who is 90 years old and totally opposed to the move of Oak Vale Medical Centre to Childwall Fiveways as this will have a detrimental effect on her health. As my Mothers elected representative please stop this regressive move and waste of public money and allow the residents of Old Swan to continue receiving the excellent service provided by the health professions of Oak Vale Medical Centre at Edge Lane not the Fiveways.

Yours sincerely

________________________________________________________________________________

Found this website which is quite helpful..until someone upsets you again.

http://moodgym.anu.edu.au/welcome

Only about 2% of bullying cases make it to employment tribunal due to the inadequacy of UK law http://petitions.number10.gov.uk/09Bullying/ When you complete the petition - it will email you a link which you have to click to actually have your name added to the list. Please do remember to check your spam folder if your email doesn't appear and make sure your name is on the list

My Opinion Bullied By Liverpool City Council: Tribunal Gray v Liverpool City Council

2009-10-12T05:41:00.000-07:00

My Opinion Bullied By Liverpool City Council: Tribunal Gray v Liverpool City Council

Tribunal Gray v Liverpool City Council

2009-09-19T09:05:00.000-07:00

The tribunal was not upheld. This is what happened to me, which the Tribunal decided not to believe. Even though my witnesses were Trading Standards Officers whom now have deal with the fallout of telling the truth. I have signed no compromise agreement. I can discuss what happened to me. The council did offer me £15,000 to settle out of court. Which I declined.

The tribunal were slightly critical over the council over certain points. The council came mob handed every day, I asked for separate bathroom break as I felt intimidated by the staff. I actually torn the ligaments in my knee rushing to the bathroom and ended up on crutches. I don't regret going to tribunal I told the truth my conscious is clear. This was the statement that I used in the Tribunal. I did not appeal as it is my word against Andy Hull and Allan Auty and of course they will always believe them. http://tinyurl.com/ldzwcd

In the Liverpool Employment Tribunal Re: Ms V Gray v Liverpool City CouncilCase number 2102709/2008 and 2104673/2008Witness statement of Vicky Gray, Claimant I, Vicky Gray, make the following statement which is true to the best of my knowledge information and belief.1. I became employed with the Council in the late 1980’s, I can’t remember the exact date but it was about 1987. I commenced employment as a Care Assistant. 2. In August 2002 I was re-deployed due to ill health and commenced working as a scale 1/2 Finance/Administration Assistant in Exchequer Management Services, based at Kingsway House Hatton Garden Liverpool. As my background became a source of one of my complaints later, I refer to my letter of appointment, job description and person specification see page 39C 1-5.3. On 2nd February 2004 I took up the position of Assistant Business Support Officer in the Department of Environmental Health & Trading Standards. This was another administrative post. It was a promotion to a scale 2/3. In late 2006 an issue arose about to whom I reported and what my work actually entailed. As this ultimately led to these proceedings I will give some details about my appointment in 2004. 4. I was interviewed for this position of Business Support by Allan Auty, the Enforcement Co-ordinator, and Trevor Samuels, Principal Business Support Officer.

This was for a post in the enforcement function in the Trading Standards and Environmental Health Department. Allan and Trevor informed me that the position entailed working directly for the Enforcement Co-ordinator. The contract I received stated I worked for the Enforcement Co-ordinator see 323-324. When I started working with Trading Standards, we were based in Kingsway House. The Environmental Health Officers (EHO) were located at the front of the office along with Business Support. In February 2006 we all relocated to offices in Brougham Terrace. 5. At Kingsway House I was located with the staff from Trading Standards and Consumer Advice. There were spare seats in Business Support. Had I been classed as part of this team then I would have been located there. I was informed that for booking annual leave I would consult with Allan Auty, I would then pass on to Business Support for administration purposes. Trevor Samuels would manage my PRD’s and occasionally I may be asked to provide administrative support, which never occurred when Trevor was my line manager. I had a good working relationship with Trevor. Ann Gill then took over from Trevor. 6. In Kingsway House I was situated next to Don Smith, Head of Consumer Advice. The Enforcement Co-ordinator and Trading Standards Officers were within close proximity. I answered the phones of Trading Standards and Consumer Advice officers, as my job entailed working in this area. I was not answering phones for EHO’s. Don Smith has prepared a witness statement confirming that I answered the phones see p85. 7. From around early 2005, I began to get involved in preparing Fixed Penalty Notices (FPN’s), in respect of littering and dog fouling. Such notices are legal documents and had to be 100% correct otherwise they would be invalid. There was a six-month deadline. This was in addition to my existing work. I had an excellent working relationship with Allan Auty, Enforcement Co-ordinator, I was always there to remind him of certain deadlines; I made sure Allan kept to them. I considered Allan to be my friend as well as my colleague/manager. 8. I implemented the new administrative arrangements for the FPN’s. I issued the Fixed Penalties to businesses and also to members of the public when I received a statement from Allan (he would give me the statements). I would check the statements for errors and verify that the address matched the name, as frequently false names or address were given. If the statements were correct, I would input the FPN and pass it to the Enforcement Co ordinator for signature. I would then process the FPN through a database, giving a time limit of 21 days for payment. This entailed working closely with the Enforcement Co ordinator and it was very helpful to be in close proximity to him. 9. I’d receive calls from people who did not wish to pay; occasionally they were abusive. If they required extra time to pay I would ensure, within reason, that extra time was given stating that if the perpetrator was late paying, the FPN would be sent directly to prosecution. If a member of the public was late paying, I would refer the case to legal services for prosecution. I would usually have no further involvement but did occasionally go to court to help the Enforcement Co ordinator. 10. If I had any queries I discussed them with the Enforcement Co ordinator, who was my Line Manager, or Don Smith or other Trading Standards (TS) Officers. I would not ask Trevor or Ann Gill in Business Support as they did not know anything about FPN’s, Service Requests (SRU) or Consumer Advice Complaints (CMU) and were not managing my work, only my holiday and sickness absence.11. I also did the admin for the Enforcement Forum – booking rooms, circulating papers and taking the minutes. It was chaired by the Head of Service (Andy Hull). Allan Auty (Enforcement Co-ordinator) would approve the minutes before they were distributed. The information required was on a database, about which Council officers frequently asked for statistics. The statistics for Fixed Penalties were of political interest. My involvement in the Enforcement Forum stopped in early 2006 when a new Chair took over.

12. When we were at Kingsway House, I was responsible for the library, updating periodicals and legal volumes. I usually did that in the mornings about 7.30am and until 9am. I inputted the periodicals onto a spreadsheet, for payment reasons, also to keep up to date. This also applied with the legal volumes. I stopped working in the library when we moved to Brougham Terrace. I also spent more time on the Fixed Penalties as they were increasing, due to an increase in wardens.13. At the start of 2005 a position became vacant in Business Support scale 3/4; I had applied for this position and was going to attend the interview see p329-330. Allan Auty persuaded me not to attend; he stated that he would support me on a re-grading 4/5 in my current post. As I was not part of the Business Support team I was glad to stay with the Enforcement Co ordinator. 14. As I had not heard anything over the re-grading I emailed Human Resources to see what had happened. In December 2005 Allan Auty informed me that the re grading was now going to be a scale 3/4 and that another colleague – Beccy – was also to be included. He informed me that it would take effect after the forthcoming move to Brougham Terrace. He also informed me that there was no room for me in the Trading Standards Room at Brougham Terrace as space was limited. Therefore, I was to be based in the room with Business Support. I was a bit disappointed but thought nothing more of it. The re-grading never happened.15. At Kingsway House, I reported to Ann Gill after Trevor Samuels left, but only in terms of administrative issues, not in terms of any work issues. I had one PRD with Ann Gill. In the first half of 2005, Jacquie Whitfield (to whom I shall refer in this statement as ‘JW’) became the Line Manager for Business Support replacing Ann Gill and therefore became the manager I reported to for administrative issues. I felt nervous in the presence of JW, because of her actions and mannerisms. There was no reason for her to treat me the way she did, as my dealings with JW in 2005 were minimal and I always treated her with respect and courtesy.

16. In the summer of 2005 my relationship with JW became strained. In the absence of the Enforcement Co ordinator on holiday, Jacquie Whitfield instructed me to take on the responsibility of postal duties for Trading Standards. This included opening the mail and inputting the outgoing mail on to a database, which was time consuming. I objected as I was already coping with a heavy workload and other Business Support employees were available to deal with this postal work. 17. My job never entailed opening the Trading Standards post. I explained that with my heavy workload I did not have the time to do the post and I was finding it quite stressful. As it was already, I frequently worked from 7.30am to 6.30pm. These are long hours, especially compared to usual admin or Business Support staff hours. This would usually be if there were prosecution deadlines to be met. 18. When I queried the request from JW to do the post, she asked me to email what my work entailed, which I promptly did. JW told me to continue doing the post until Allan Auty returned from holiday. I told JW the workload was causing me stress but I did it. There were Business Support staff, available to do the post and the people whose position it was to deal with the Trading Standards post were available to do this, so I could not understand why I had to do it. 19. On Allan’s return from holiday I informed him of the situation and he emailed JW and told her any additional work from Business Support had to go directly through him. I stopped doing the post. JW was unhappy with this situation and I believe that she didn’t like the fact that I had challenged her and had ‘won’. I later came to believe that she wanted to get me back. 20. As a manger JW behaviour was over-bearing. I felt her response was that, as a manager, JW had control over me and I would do as JW said, because she was the manger. I felt extremely tired, depressed and found the whole situation stressful. I had so much Fixed Penalty work to do that I even cancelled a day off. Ann Gill said to me ‘what are you going to do when FPN’s increase’. It was a nasty snide comment, not supportive. She also wanted me to do the post at a later time and I said NO. 21. In February 2006, Environmental Health & Trading Standards relocated from the Kingsway offices to offices in Brougham Terrace. My Fixed Penalty workload increased throughout 2006. 22. At Brougham Terrace, I sat at the back of the office. There were about 12 of us, including JW and Ann Gill. As I explained earlier, Business Support staff had worked as a team before the move I did not feel that I was ‘part of the team’.23. I was expected to answer the phones in Business Support. This included calls which were Environmental Health complaints, despite this being an office fully staffed with trained officers. The impact on my work was negative. I felt very uncomfortable trying to deal with Environmental Health queries when my knowledge of this subject was limited. I had not been trained in Environmental Health complaints. I informed JW of this. The situation had a detrimental effect on my health; it caused untold stress, upset and depression. 24. I told JW this but she didn’t seem to listen. I believe that she didn’t like this, as she felt like she was being challenged and of course I had already challenged her once. This was her chance to impose her authority on me and she did. She ignored my concerns. I raised my concerns with Allan Auty, explaining that I felt that my role had changed. I felt physically ill with the pressure. 25. Shortly after arrival at Brougham Terrace I asked for a filing cabinet to file the FPN’s, which had previously been stored in a filing cabinet but it was no longer available. As no filing cabinet was provided, the FPN’s were kept in my desk. As staff had to have access to the FPN’s, this meant I had no privacy. I had personal possessions and medication in my desk. I did keep the desk locked but it meant that my colleagues could not access the FPN’s, although sometimes I gave one colleague a key. JW did not ask for a key for my desk and I did not offer one to her as I was not comfortable with that. 26. We needed a filing cabinet as I was running out of space in my desk and felt that we needed a more formal filing system, especially as these were confidential, legal documents. JW didn’t agree. I don’t think she understood what my workload was and she didn’t like it when I repeatedly asked for a filing cabinet. This made our relationship worse. 27. Between February and April 2006 I frequently complained to JW and Allan Auty that I was required to answer telephone calls for Environmental Health and that this had a detrimental effect on my workload and meant I was to deal with issues about which I had no knowledge or experience. Nothing was ever done to resolve the situation, which caused me further distress and upset. 28. I became increasingly exhausted and anxious. I was off sick for 3 weeks from 6 19th March 2006. This happened in the first couple of months of being situated with Business Support. This was no coincidence. 29. The Council were aware that I was prone to depression. I had been absent from September 2003 to February 2004 with depression (due to something outside of work) and had taken antidepressants. This whole situation in 2006 was harassment by JW and a failure by the Council to discharge its duty of care to me. 30. When I returned to work on 20th March I found it increasingly difficult to cope. I was run down; I was exhausted with walking away from petty disputes. I never documented the disputes. It was all pertaining to the telephones. I felt exhausted, my workload was heavy and I was not being listened to. I felt as though I was constantly being undermined by JW’s actions. It was making me feel exhausted, depressed and so tired all the time; I felt emotionally drained. It was so bad that at one point I actually disconnected the phone, although I know I shouldn’t have. I ended up going off sick again from 17th April until 21st May. 31. On 21st May 2006 I returned from sick leave. I was normally an outgoing person but I had become much more introverted person. I was dreading going back to work but I enjoyed my job and I was good at it. 32. When I came back in May 2006 the situation actually became worse. The person who sat next to me – Danny – was off on long term sick; his phone was not put on divert and I was expected to deal with his calls. I tried to explain to JW that I had to work to deadlines. This would be most days, or so it seemed; it was a constant battle with JW. I frequently put Danny’s phone on divert to JW.

33. On the day I returned to work, I attended a return to work interview with JW. Immediately after that meeting concluded, JW called me to another meeting in the presence of Karen Tyrer. I was advised that Karen Tyrer was, with immediate effect, to be my new Line Manager. I was told that I was to have no dealings with Trading Standards work unless authorised by Ms Tyrer or JW and that all my work had to go through them. 34. Business Support had not been involved with my work with Trading Standards so I found this highly unlikely, as JW’s knowledge and understanding of my work was extremely limited. I was to go to Karen Tyrer and JW with any queries or concerns I had. I was just TOLD. JW did not believe in discussing work issues, I felt as though I was being bullied by JW’s actions and deeds. I said that I felt that I should discuss this with the Enforcement Co ordinator. JW instructed me not to. 35. JW said “No, you don’t understand. Everything goes through either Karen or myself”. I remained calm and polite and said that I would need to discuss this with Allan. I was told that I should not attend Trading Standards core brief meetings. This meeting was intimidating, as I was on my own. This was stressful and I felt very anxious – and of course this was my very first day back after being absent with stress and depression. I made a note of this meeting and refer to it see p39F.36. I spoke to Allan Auty, against JW’s instructions. Allan did not agree with what I had been told. When I told Allan about not attending the Trading Standards Core Brief meetings Allan said “over my dead body” so I did continue to attend Core Brief meetings and continued to work through the Enforcement Co-ordinator. This added to my feelings that I was being harassed by JW. I never classed JW as my manager, in terms of monitoring my work, but Allan never challenged JW about interfering in my Trading Standards work.37.

Over time I continued to frequently express my concern to JW that I was required to provide advice to members of the public who telephoned to raise environmental health issues; and about how this meant taking time out from my already heavy workload with the increasing volume of FPN’s. It made no difference. I felt exhausted, depressed. There seemed to be no point in raising it again with Allan Auty.38. There were a couple of meetings between Allan Auty, JW and Karen Tyrer to discuss the telephones issue. Afterwards, I was given conflicting instructions. On the one hand, Allan Auty said I was not required to answer the environmental health telephone calls if it would affect my work. But he also said that that all colleagues should be answering the telephone calls. That wasn’t clear at all and was actually unhelpful. JW continued to pressure me to answer the Environmental Health telephone calls for the absent colleague. I was asking for help and was not being listened to. A managerial response was required to implement changes into my working environment. There were physically not enough hours in the day to complete my workload. 39. Karen Tyrer didn’t fully understand my work. She was a former secretary, who worked for Emergency Planning, and had limited knowledge of the work of Trading Standards. Karen Tyrer introduced what she called a ‘Job sheet’ and a spreadsheet but they were pointless as the information was already available on a database (known as Flare).This just made the work more confusing and created scope for more errors. 40. To explain the work I did, I refer to a job application for the post of PA to the Interim Chief Executive see p39E1-11: it is undated but the closing date 23rd March 2006 so it would probably have been in March 2006. My work included occasional undercover work for Trading Standards. For example, I went to a sun bed salon (whilst the Trading Standards officer waited in the car). I also participated in other undercover work for Trading Standards, test purchasing fruit and meat. I also hired a sun bed in a covert operation.41. Also, I arranged appointments and meeting rooms for Allan Auty; printed out certificates for PACE (Police and Criminal Evidence Act) courses which Allan lectured on, arranged the bookings of the rooms, dealt with any queries concerning the course; I basically made sure everything went smoothly. I did a lot of photocopying for a case involving pornography as Allan trusted me to be discreet. Allan asked me to go to several banks and try and get a credit card for a hypothetical 15 year-old to see if children were able to find a way to pay for pornography online with their own credit card. It was rare for Business Support to do this kind of work.

42. Ann Gill also had no idea about the nature of my work. She thought all I did was the Fixed Penalties. I also did work for CMU complaints, Consumer Advice referrals to other Local Authority Service Requests, which meant inputting TS complaints on to the system. I also responded to other Local Authorities concerning complaints, e.g. database fraud, there was a standard letter which was sent out concerning various scams. I would track down a company’s registered address to help me deal with complaints from the public, input them into the system and pass on to the Trading Standards Team Leader for allocation. 43. I can’t remember when it was, unfortunately, but one day Karen Tyrer was choking on a sweet and was really struggling. I carried out the HEIMLICH manoeuvre (a first aid procedure like a bear hug from behind) and could see by the expression on her face that the object had been moved. A couple of minutes later JW entered the room. Karen was coughing but others said that she was choking. Thinking that Karen was still choking, JW said that Karen should go to the toilet and splash cold water on her face and that would help. If JW believed that Karen was choking, her advice was totally inappropriate. I really felt that JW should attend a basic first aid course, as next time with that advice – and without wishing to be too dramatic – someone could die. I was familiar with first aid as I had attended a Pre Nursing course in my youth and also from working as a Care Assistant. I’m sure that someone mentioned what I had done to help Karen and I although I can’t be sure I do strongly suspect that this might have made my relationship with JW worse – simply that I knew what to do and she didn’t. I know it sounds unlikely but that was the sort of thing that I believed JW would hold against me.44. I don’t recall when this incident occurred but I did mention it to Paul Farrell after the grievance hearing on 8th November 2006 that I wanted to speak to him about a serious Health and Safety issue so it must have been before then. However, I was too upset after that hearing to discuss anything with Paul. I mentioned this matter in my grievance and appeal. 45. On 16th June 2006 Allan Auty sent an email to myself, JW and Karen Tyrer see p39G-1. He sent this as a result of me going to see him to explain that I did not believe that Business Support knew what my work involved and that I was concerned that it was not being done in my absence and that this was essential work which was being held up by me having to answer Environmental Health telephone calls.46. I decided to keep a record of the calls I received. I do not have a copy but I think I provided a copy in subsequent grievance proceedings. Over a two day period, I think in September 2006, there were between 32-35 telephone calls per day lasting between 3-5 minutes each see p172. To understand the full impact of these calls, you have to take into account the time it takes to settle back into the work you have just been distracted from. So, this was easily taking up a couple of hours a day for me, often more.47. On 4th July 2006 the situation became so unbearable I went in to the Trading Standards room and I was crying. Dave Horsefield and John McHale (Trading Standards managers) asked me what was wrong. I said I couldn’t take it any more I was going to kill JW. John and Dave managed to calm me down. I was then off sick until 28th August 2006; 54 days. 48. I had a viral infection as I was exhausted. Before I went off I went to see Allan Auty and pleaded with him to remove me from that section; his response was that he had his speech to write for the Trading Standards conference and would discuss it afterwards.49.

I went to see the Occupational Health doctor on 20th July see p40-43 and p44-45. 50. JW did a home visit in August. JW arrived at my house; I did not want this woman in my house. I did not have the energy to object. I sat and listened to her gossip. I said “yes” and “no”. I offered no refreshment. I was exhausted, tired, depressed. I remember when I was absent I had sent a Doctors note via the post and JW phoned me at home and said they had not received the note and that I would have to go back to the Doctors if they had not received it within the next week. I can’t remember the date, I was upset, and then she contacted me to say the note had been received. After that incident I asked my Father/Friends/Brother to hand deliver all notes. 51. We had caller ID on our telephone at home and knew JW’s mobile number so I used to tell my family and friends to ignore the phone. One day, my niece was staying with me, and I have always played a major part in her upbringing. The phone rang and it was JW. My niece answered the phone and gave it to me. Afterwards my niece wanted to know why I was not facing up to my problems, when I had always raised her to tell the truth and to face her problems, when here I was not facing my problem. How could I explain to my niece that Aunty, who was strong and confident, who had always faced problems head on was depressed. 52. The day after I returned, I had a return to work interview with JW, who wrote it up see p47. In answer to the question “Is your sickness absence related with problems at work or home?” it states “No problems @ work or home relating to sickness absence”. I felt that JW was bullying me but I did not have the strength to say that my problem was with JW. I was alone and felt intimidated by this person. 53. I hadn’t really realised that I was run down and having viral infections because of JW. The actions and deeds of JW caused me so much distress. The bullying and oppressive behaviour by JW was a constant source of upset and distress.

As an adult it is a truly horrible experience to be on the receiving end of bullying. It is a truly insidious behaviour that no one wants to believe this is actually happening to you. I realised everything was linked to the behaviour of management.54. On my return the situation remained the same. I was still located in Business Support, still having to answer Environmental Health calls and still battling with JW over the phones. The new Enforcement Co-ordinator had started, Stephanie Hudson. Steff was very helpful and supportive towards me. Steff thanked me for the work I did. .Steff decided that I should not use the spreadsheet and Job sheet that Karen had implemented and this made the FPN’s a lot easier. 55. On 25th September 2006 I sent an email to Allan Auty asking him to deal with the phones. This was a brief email as Allan was fully aware of the issue as I had emailed him previously (but do not have a copy) see p51. He responded the next morning see p50. Allan made reference to a new person who would be moving to Julius’s desk, next to me. Allan then said that ‘anyone can (and should) pick up a call (depending on what they are doing of course)’. That was my very point. I was overworked with the Fixed Penalties. Allan failed to accept that I was telling him that I was too busy and that this was causing me additional stress and this was having a detrimental affect on my health. Allan should have been clearer and should have made decisions because clearly JW and I couldn’t agree on the “depending on what they are doing of course” part of his decision in his email.56. In his email he also suggested that Danny’s phone can be diverted when Danny is off. I replied straight away saying that I wanted to discuss the situation see p65A B. 57. I was desperate and could see that Allan was not going to respond. I sent an email to Dave Horsfield, Trading Standards Manager, asking him to discuss the situation with Allan Auty. I had frequently discussed the issues with the phones with Dave. I explained that my workload was too heavy and that I was finding this situation ‘extremely stressful’ and asked for a meeting to resolve the situation, to include JW see p48. 58. Two minutes later, JW sent me an email saying that I should tell her what my issue was. I had been telling JW since we had moved to Brougham Terrace and JW knew the issue. It wasn’t simply answering the phones. It was the fact that this interfered with the legal deadlines for the Fixed Penalties, which caused me to feel anxious, depressed and very upset, and the fact that I did not have the knowledge to answer Environmental Health queries.59. JW asked me not to go to senior managers. I had to, because JW had failed to take action concerning my complaints and I did not feel able to talk to her about the issues I had raised. This caused me stress, depression and anxiety; I felt exhausted. Every time I discussed it with JW, I felt as though I was banging my head against a wall; JW would not listen, she would dictate that I had to answer the phones. 60. As I had already emailed Dave Horsfield I simply forwarded this to him and asked him to deal with it for me see p49.61. I responded to JW, copying it to Dave Horsfield and Allan Auty see p58 (the email at the top of the page at 11.44am). 62. If I were to answer Environmental Health phone calls, I required training. At the same time, I was extremely concerned that if I was absent due to training, the Fixed Penalties would be left and I would have a backlog, as no one else dealt with the Fixed Penalties. 63. The problem was that JW was treating me the same as all other Business Support Officers; I was not the same. I was the ONLY one who was specialising in the Fixed Penalties and Enforcement work. JW was incapable of comprehending that my work was completely different from the rest of the team and constantly tried to compare my work to others without having any knowledge of exactly what my work entailed. That was the problem – JW didn’t appreciate that she had to tailor the Business Support to the Department’s needs. JW did not listen to my requests, causing me further distress and upset. 64. JW replied a few minutes later by email see p61 (bottom of page 12.02pm). JW reinforced that I was the same as all members of Business Support and that Karen Tyrer was my Line Manager and would address my issues, including training. JW also said that they had spoken to Steff Hudson and that she was aware of this and agreed to it. JW had no authority to try and change my contract without consulting me. 65. JW did arrange for a colleague to sit with me with a ‘splitter’ phone connection. But she didn’t address the fundamental issue that I was too busy to take on Environmental Health phone calls – and training – due to the Fixed Penalty work. JW also said that attempts to divert the phones didn’t work. I diverted the phone to JW’s phone a number of times so in fact it did work. 66. I replied to this in an email about half an hour later, see p61 (top 12.30pm). I explained that the phone could in fact be diverted. I re-iterated that my workload was heavy, that the situation was causing me further stress and upset, I did not have the knowledge and was concerned about how my work would be covered whilst I was being trained. 67. JW approached me at my desk. She said “you will answer the phones” and proceeded to mention other members of staff’s work in a tone that everyone in the office could hear. I feel JW did this because as my manger she COULD and it was a form of bullying. The meeting was oppressive and intimidating.68. I have recently seen JW’s note of that conversation see p66. That is generally accurate. I was desperate to have a meeting with someone who would listen to me, as JW was not prepared to openly discuss the issues I had raised. She refused to discuss with me in the presence of my Trade Union representative as support. I asked to meet with Allan Auty and JW refused. If JW had wanted to reach an informal solution why did JW refuse to these meetings? 69. I felt undermined, undervalued, exhausted, I felt no one was listening. That was extremely distressing and in my view it is bullying and harassment. JW just wasn’t listening to me and addressing my workload complaint. I had no option but to either continue in this oppressive and bullying environment – which was on a par with hitting my head against a brick wall – or I would commence formal grievance procedures which I really didn’t want to do as the situation would be made worse. 70. I did not accept that I should not be keeping Trading Standards informed of my workload and my availability. So, I spoke with Allan Auty and told him how concerned I was and about my meeting with JW. He asked me to keep him informed of all Trading Standards work and to let him know if I was falling behind. He did not seem to understand just how upsetting it was that I was being treated this way by JW but at least he did ask me to go through him, not Karen Tyrer.71. I emailed all FOUR of the managers involved to confirm this. I could not face any more misunderstandings which might lead to further over-bearing treatment by JW. I couldn’t believe that so many managers were involved and it STILL was not clear. In fact, looking back on it, that is probably why it wasn’t clear. It only needed one decisive manager and that should have been Allan Auty.72. I confirmed that I was behind with my Fixed Penalty work, due to having to answer the Environmental Health telephone calls. I also confirmed that I had come from Finance, not a manual background, which was in response to JW’s insulting comment see p67.73. JW says in her report that this contradicted what Allan Auty had told her. I was not aware of this see point 8 on p53 (bottom). This was a managerial decision. Looking back on it now, with the benefit of hindsight, this was up to the managers to sort out but they failed and this was negligent; they failed in their duty of care to me.74. I felt that I had no choice but to commence a grievance which I did. The grievance indicated that the stress was making me ‘feel physically ill’. I went home early that day – about 3.45pm – I was upset. I was in work at my usual early time the next morning: about 7.30am see my email at 3.20pm p68-70. 75. I never stated the word ‘bullying’ in the grievance as I knew the reaction would be negative. I wanted to be allowed to continue with the work I was paid to do. I wanted the bullying to stop. I genuinely expected there to be a meeting and that it would all be resolved by Allan Auty but of course it wasn’t.76. The next morning I received JW’s email reply saying she was on leave until 3rd October and would arrange a date once she returned see p71. I was distressed that she felt that SHE should be arranging a hearing for my grievance. I felt this was a conflict of interest. The reason for submitting a FORMAL grievance was that she had refused to allow meetings with the Trade Union present or with Allan Auty. I found that this was totally unacceptable.77. I do appreciate now that that was not what happened but, at the time, I did not know this and it played on my mind continually whilst JW was away. I sent her another email on 28th September. 78. I stated that I wanted a witness present at all future discussion, which should take place in private, not in front of anyone. I also pointed out that JW was wrong to stop me having my Trade Union representative present. This email was copied to Allan Auty, Steff Hudson and Dave Horsefield. I asked JW to send me notes of that conversation which she did see p73.79. I reminded her that I had not come from a ‘manual background’. I was letting her know that I found her comments offensive and derogatory. I explained it was condescending and irrelevant. I knew this was about bullying. I felt very uncomfortable speaking to JW alone. I felt intimidated by JW. by her actions, deeds and behaviour towards me.80. JW was undermining my office experience. I had studied for 3 years at night school, the courses included secretarial course, the ECDL (European Computer Driving Licence), typing and I was at that time studying for a Diploma IN LAW as part of the ILEX qualification. I wanted to work on the Trading Standards prosecutions. I saw my long-term future with the Council. As I had worked for the Council for so long, I had seen people come and go, take courses which were paid by the Council and then move on to the private sector. I actually believed in Liverpool City Council and would have stayed until I retired. 81. I passed one exam and failed the other by eight marks. The exams were in May 2007 and I failed because of the stress of work, I could not concentrate. I was extremely upset as the exams meant a lot to me as I had not studied at school. The Council had paid for one of the Business Support employees to do an ICT qualification. She went on to become an Enforcement Officer. The managers in Trading Standards saw what was happening to me and made her an Enforcement Officer. I would also question why Andy Hull’s former secretary (who could not type) was classed as an Enforcement Officer, as she never carried out any Enforcement work, while I worked for Trading Standards. It was as if you would get what you wanted based on whether ‘your face fitted’, not on whether you were good enough. 82. Whilst JW was on holiday I met with Karen Tyrer. She emailed JW on 3rd October, when she was back at work see p76. I had told Karen that I was fine with taking phone messages. I felt I had no choice but to persevere until the grievance was heard. 83. On 6th October JW wrote to me giving the date of grievance hearing (16th October). I felt this was totally inappropriate. Due to Allan Auty’s holiday, the date changed, and the grievance was heard in Allan’s absence. The papers were JW’s own report see p53 and appendices plus statements from Allan Auty and Don Smith see p85-86.84. On 6th November I emailed Paul Farrell and asked him who would be present at the forthcoming Grievance Hearing and what would be discussed. I was very apprehensive about attending this meeting. He replied with that information and then said that the meeting is not to ‘point fingers or criticise, it is an attempt to achieve resolution if possible’ see p89A. I felt this was incorrect. Paul’s task was to decide a formal grievance. This was not a mediation. It was EXACTLY about criticising JW and having someone support me and say that I had been mistreated. Why was Paul not prepared to ‘criticise’ JW, if he accepted what I was saying was correct. It’s hardly surprising Paul did not uphold my grievance when he did not wish to make a stance. 85. On 8th November 2006 I attended the Grievance Hearing convened by Paul Farrell, Team Leader Environmental Health. My Trade Union representative was present. Alan Auty was unable to attend due to holidays. JW did attend and conducted herself inappropriately; raising her voice, in what could be deemed by any definition as an extremely aggressive tone and manner. At one point Arthur Moss, my Union rep, stood up to walk out and Paul Farrell spoke to JW, saying she had to conduct herself in a more appropriate manner. I think that this was on the topic of my job description, which JW had tried to say was generic and that I had to answer the phones the same as all other Assistant Business Support Officers. I think before this she had provided a new job description for me saying this before this meeting, not reflecting that my work was mainly for the Enforcement Co ordinator.86. Although I was accustomed to JW’s behaviour, I was still extremely nervous, especially treating me in such an inappropriate way in front of others. JW was allegedly the manager, alas JW did not conduct herself in an appropriate manner as one would expect from a manger of a professional organisation. JW’s behaviour without witnesses was oppressive, abrupt and intimidating. I was no longer prepared to speak to JW alone. I told Paul Farrell this. 87. That day, Paul Farrell sent an email to Allan Auty asking him to attend a meeting with him, which happened on 8th December 2006 see p86A. I had access to Allan Auty’s electronic diary. I made a note in the diary for Allan. When Allan came back from his holidays, I could no longer access his diary. Strangely, he told me that it was a ‘technical issue’. If it was a technical issue, it was never fixed. 88. A couple of days later in November I took a telephone call from a pensioner regarding a Fixed Penalty Notice which had been issued to him. During the course of this telephone call it became clear that there was a high probability that the pensioner had been the victim of an identity fraud – he had a FPN in his name with the correct address. I advised him to report this to the Police. As well as dealing with possible identity theft, this would help him to have the Fixed Penalty Notice withdrawn. I felt that he had not fully comprehended the situation and had become confused so I discussed it with the Enforcement Officer and wrote to the pensioner to confirm the advice I had given to him.89. On 10th November JW sent an email to Steff Hudson, Andy Hull and other staff requesting a procedure to be compiled to address this kind of situation. I felt criticised and undermined by JW. If JW had an issues with something concerning me one would of expected a competent manager to broach the subject with me, not discuss the issue with senior management and exclude me from the discussions. I felt undermined, upset as though every action I was doing, JW was waiting to undermine me see p90. 90. In mid-November JW sent an email to two employees in Business Support and me. She attached a job description for a scale 3/4 post within Environmental Health and Trading Standards saying she was ‘inviting expressions of interest’ as there were two posts available and that it was ring fenced to the three of us. However, on 16th November 2006 – the day before JW’s closing date – she withdrew it. This made me feel very suspicious. I was going through a grievance procedure about JW and this was her trying to either get me to agree to report directly to her or it was an attempt to push me out – as there were only 2 jobs for 3 of us. I found this stressful and intimidating. No explanation was ever offered see 91D-E. 91. On 27th November Andy Hull wrote to me supplying me a copy of the contract and saying it took effect from 28th September. I do not know why he chose that date. A reasonable employer would not change your contract so that you answered directly to someone you have submitted a grievance against, before the outcome of the grievance. I felt that Andy Hull was bullying me into accepting the new contract. Andy was the head of EH&TS and I felt he was trying to pressurise me into accepting JW as my manger. This caused me further stress and upset. 92. It had been agreed at the meeting in September that it would be stated in my contract of employment that I would work directly with the Enforcement Co ordinator and would answer directly to Business Support. That was not included so I never signed the contract, as there was no proper consultation or discussion about the job description sent with this letter. I took it to be an OFFER, not a decision see p91A-C. 93. Allan Auty in his witness statement dated 1st November said it wouldn’t work if I was removed from being line-managed by the Enforcement Co ordinator see p86. Andy Hull tried implement a change in my contract, knowing that this would cause me upset and distress. On numerous occasions I have asked Andy Hull for a clear explanation to explain his actions. Andy has always quoted this is what the executives want. I feel this is not an explanation, it is an excuse. Executives are not incompetent and the explanation Andy has given implies they are. Why would the Executives change my contract to answer directly to a person I have submitted a grievance against before the outcome of a grievance? 94. On 8th December 2006 I attended, with my Trade Union representative, a further meeting with Paul Farrell in relation to my Grievance as Allan Auty had returned from holiday. I was upset when Allan denied having a meeting with JW about the telephones issue in May 2006. He put his head in his hands and said he couldn’t remember this meeting. I was absolutely appalled. Allan had several meetings with JW and Karen Tyrer. I knew that the grievance would not be upheld and that JW would have carte blanche to do what she wanted to do. 95. On 11th December 2006 Paul Farrell wrote to me dismissing my Grievance, although Paul did note that management of the issue could have been better. It is irrelevant stating the grievance was dealt with quickly in September 2006; the issues I had raise had been ongoing for months see p92-93. 96. Paul also says that it was confusing that any changes to the job were verbal. I agree. It’s unfortunate that the record of my grievance hearings is also verbal as no minutes were produced.97. I was offered an appeal which I declined as I saw this process as futile, if Allan Auty was going to deny the meeting in May and Andy Hull would be hearing the appeal. I could not understand why Andy Hull tried to change my job description so that I answered directly to JW before the outcome of the grievance. This person had bullied and intimidated me; why did Andy try to do this? Andy has never given me a clear answer to this question despite the fact I have refused to have any dealings with this person without a witness present. 98. Later in December 2006 I had a meeting with Andy Hull, Steff Hudson and Allan Auty to try to resolve the situation. Andy Hull tried to persuade me to agree to the change to my contract set out in his letter and job description dated 27th November. It was a more generic position and had me reporting directly to Business Support. This was a few days after the grievance had been dismissed and it felt totally insensitive and unacceptable even though I was to be re-graded up to a scale 3/4 Business Support Officer. Basically, Andy Hull stated that he would re-grade me if I agreed to be managed by the person I had just submitted a grievance against. Andy Hull said that it was what the Chief Executive’s Office wanted. 99. In the meeting Andy was asking me why I wouldn't sign the contract. He actually stated "it is not as though Karen Tyrer beats you with a stick". I thought that was inappropriate for Andy to say. It proves that Andy’s knowledge of bullying and harassment is extremely limited; Andy just did not comprehend that it is not only physical assault. This puts the failure of ANYONE, in relation to my situation, to refer to a harassment policy or a definition of bullying into perspective. The management had no comprehension of bullying, it was apparent by the lack of response to my pleas for help. 100. It has been brought to my attention that Andy Hull has actually produced a power point presentation for his new employer, Health@Work, with a colleague on the effects of bullying in the workplace, which I find highly ironic as Andy failed to protect me from the bullying behaviour of managers. In fact, at times Andy Hull’s behaviour towards me could by any definition be construed as bullying. 101. Andy actually quotes the following on the Health @ Work presentation: “Many clients initial problems are non-medical, and are related to poor management and lack of support – particularly in large organisations. This can lead to an escalation of minor issues into complex health problems.” Maybe if Andy would have taken heed of what he had written I would still be in employment and not be on anti-depressants see pXXX. 102. Going back to the meeting, after a great deal of discussion it was agreed that the only change to the contract was that I would answer to Business Support and not the Enforcement Officer, but that my work would not change. This was because Andy would not budge and I would not budge and it was literally going round in circles. I wanted a new contract or job description to reflect this and did not sign the one Andy Hull had sent. 103. I remember Andy Hull saying to me that ‘the Council’s Solicitor could fight it in Employment Tribunal’. I referred to this in my later grievance appeal dated 8th November 2007. I felt that this comment was very intimidating and oppressive see p225 (bottom of page).104. As a result of the way I had been treated and due to the risk of having to answer to JW, I requested re-deployment directly after the meeting. I wasn’t going to agree to being managed by JW. I did not SIGN the contract. However, on the advice of my Trade Union representative I later changed my mind as I did not know where I would be located or what position I would be assigned to. I was feeling very vulnerable, depressed and anxious. 105. On 18th January 2007 JW emailed a number of employees in Business Support with a new job description see 93A-B. That afternoon, I emailed Andy Hull about the new job description, objecting as it did not incorporate amendments that we agreed to in the meeting see p93C. Andy Hull never responded to this email. I never signed the contract. I was never re-graded to a scale 3/4 and was never paid at this higher rate of pay. However, subsequently I was treated as if this contract was in force but I never agreed to it and objected to being managed by Business Support.106. I see in the bundle that there is a sick line signing me off from 29th January 2007 for two months due to depression. I am confused by this as I was at work during this period see p310. 107. On 31st January 2007 I sent an email to Karen Tyrer and Steff Hudson advising them that I had a ‘pre op’ appointment on 7th March and a hospital appointment on 14th March, stating that I did not know how long I would be absent for, from 14th March. I knew that if I was absent for longer than 6 weeks there would have to be a home visit in accordance with Council policy. I explained in this email that I did not want to have a visit from anyone “from the office”, which meant Business Support. Instead, I said that I would prefer a member of the Human Resources Department to visit me see p98.108. Between 1st 5th February 2007 there was a series of emails between myself and JW in which JW said that she would be conducting the home visits as she was my manager and she was responsible for managing my absence. I had stated that under no circumstances I wanted any dealings with JW without a witness of my choice present; I had submitted a grievance against this person. I felt intimidated and undermined; under no circumstances did I want a home visit from this person. I knew I needed to finalise whom would manage my sickness absence before I went into hospital as I would be in no condition physically or mentally to challenge the managers. 109. I said I would therefore like any home visits to be undertaken by Steff Hudson, Enforcement Officer. JW kept insisting that, in accordance with Council procedures, it would be herself who would be managing my absence. I found the tone of JW’s emails oppressive and bullying. The very first email replied with big bold letters. This was suppose to be a welfare visit, the tone of the emails made feel anxious, upset and depressed; I also felt as though I wanted to cry all the time. I felt JW’s handling of the situation was extremely aggressive. 110. I objected to JW managing my absence or visiting my home, due to the added stress that this would cause me in what was already a stressful situation, due to the poor relationship with JW. I felt harassed by her correspondence, particularly its tone, and this caused me more anxiety, depression and distress. I wanted my other manager, Steff Hudson, to manage my absence and home visit. Those emails found at pages 98-94, with the email in big bold type at p96.111. On 5th February Steff sent an email to JW saying it was ‘a welfare’ visit not a ‘warfare’ visit see p101. Steff met with JW and Ann Gill on 9th February 2007 and said that she felt that JW was bullying me. 112. I have recently seen JW’s email to Ann Gill about this meeting see p109 110. JW was upset that she was being accused of bullying me. I was hugely relieved that Steff could see the awful oppressive behaviour I had been subjected to. I agree with Steff’s description that things between me and JW were a ‘battlefield’ from the middle of 2006. It seemed that every day JW would come out with comments. I either ignored them or removed myself from the room. This is what led to my grievance. I have to ask: how come Steff could see it was a battlefield yet JW said she wasn’t aware of my issues? I think Steff’s comments in February 2007 put events leading to my grievance in the previous September in a new light, supporting my comments and undermining Paul Farrell’s decision.113. JW’s email shows that either she doesn’t understand, or doesn’t WANT to understand; how I was feeling that she was causing me stress. I would say she might have needed more training, I KNOW that she was being nasty just for the sake of it and the reason for that was because I had challenged her authority and threatened her little empire-building efforts. That’s what happened in 2006 and little did I know but it was about to happen again.114. On 9th February Allan Auty replied to my email to him on 30th January saying that I was no longer on the Trading Standards email list. I was suspicious that I had been removed. I wondered if JW had done this to prove a point or to show that I was Business Support NOT Trading Standards. I didn’t know if it was victimisation but wanted to see what reaction there would be. Allan Auty made no comment, he just put me back on the list see p108. 115. I also asked that no one asked me about my forthcoming hospital absence. I did not wish to discuss my gynaecological health with any of them. That was really insensitive see p107. JW did this on my last day in work, I chose to totally ignore her and spoke to a colleague instead, as I knew if I had listened to JW and responded I would have been extremely angry, to say the least.116. As explained in JW’s email on p110, my Trade Union representative spoke to JW on 12th February asking for someone else to manage my forthcoming absence; again JW refused to change her mind. I had given JW six weeks’ notice and she wasn’t prepared to accept my request and the stress I was feeling, despite requests from me, Steff and Arthur.117. On 12th February 2007 I wrote to Ann Gill by email about a comment she made at a team meeting the previous week. Ann Gill referred to redeployed staff starting in the Department and that one was off with stress. I thought that was highly inappropriate at the time. She mentioned that I had come from ‘re-deployment’ which I felt was not necessary. I felt undermined and offended see p108A. 118. On the afternoon of 13th February I emailed JW as yet another issue between us arose. She had told me that I would have to move to a different desk due an office re organisation. I couldn’t see why I had to move so soon as it was a few weeks before the new desks which had been ordered were due to be delivered. I explained that I needed more desk space for the work I was doing and the temporary move would make it more difficult, so why not wait until the new desks arrived, which would also mean I wouldn’t have to move twice. I was the only one who had to move at that point. JW said that if I needed additional space, a risk assessment would be arranged. No risk assessment was ever arranged. As the Council’s Health and Safety Department are based in Brougham Terrace, JW could have spoken to the staff to arrange an assessment before the move. 119. All mangers were made aware of the events that were unfolding as I included them in every email between JW and myself. This started with a reply from JW within a few minutes insisting I had to move see p116. 120. I felt that, once again, JW was not listening to my concerns or that she was ignoring them. It felt like September 2006 all over again and I was getting distressed at having to go through it all again. The next morning I tried to explain again to her in an email but she simply replied that I was moving that afternoon, without replying to my suggestion see p115. 121. I emailed again an hour later as by then JW had come to speak to me. This was in the Trading Standards room, where others could see and hear us. As I have explained already in this witness statement, I had asked JW only to meet with me when I have a companion and she was not respecting that so I confirmed it in an email, to which JW replied half an hour later denying it was a meeting, saying she had only ‘spoken’ to me. That was being evasive. Anyway, JW did then agree to a meeting where I could be accompanied see p114.122. We had a meeting that morning, 14th February, and I was accompanied by Derek Pennell, Trading Standards Officer who is also a witness in these proceedings. JW had asked Karen Tyrer to be present. It was a short meeting. My point was that, as there was no date for the delivery of the new desks, it was premature for me to move as there would be double the disruption when the new desks did arrive. JW just said it wasn’t open for debate. JW gave no reasons in response to my point about there being no date for the desks and just said that I was to move that afternoon. I felt it was unfair and as I was the only one affected by the move, then it meant that it was only me who was ‘challenging’ JW’s authority. Although she wasn’t aggressive in this meeting, it felt very hostile. 123. I believe JW thought I was just being unreasonable for the sake of it; I wasn’t. I was busy and didn’t want to have unnecessary disruption. I felt that JW was exercising her authority because she felt she could, even if she had no apparent reason. It was bullying in my view.124. I asked JW for a note of the meeting but she refused so I made a note which JW then disagreed with, saying it was inaccurate see p112A-C. 125. I have recently seen JW’s email to Ann Gill and Karen Tyrer about this meeting see p113. It confirms that JW just wasn’t prepared to discuss it with me. It shows that she had a closed mind and in my view it shows that she just didn’t like being questioned by me. I did move desks that morning. I felt awful – angry, harassed anxious and sad, that another human being could be so oppressive. 126. The new desks arrived on 9th March 2007 and, as expected, it was disruptive. We all had to clear our work stations. 127. On 7th March 2007 I was due to attend the pre-operative appointment I had referred to in previous emails. I provided a copy of the appointment letter to Steff Hudson. Approximately one hour before leaving for this appointment I was called to a meeting with JW. I asked if I could be accompanied by a colleague, Jeni Driscol, who I had taken with me. JW initially refused, which I considered to be inappropriate; this made me feel anxious. JW knew I wanted to have a witness and was attempting to prevent this. I felt uneasy and suspicious. JW indicated that she was unhappy at always having to have meetings at which I was accompanied and that she would be taking matters further. I wish JW had as we might never have got as far as this Employment Tribunal hearing. Eventually JW allowed Jeni to remain; she has provided a witness statement for this Tribunal hearing.128. In the meeting JW advised me that she had not received a copy of my hospital appointment letter and that if she did not receive it then my absence would be classed as unauthorised. I told her that I had already given a copy to Steff and that I found it very stressful to have to discuss this with her. She informed me that she was my Line Manager and would be managing my absence. 129. I find it difficult to accept that JW behaved in such an inappropriate manner literally just before I was leaving to attend the hospital for tests. I remember JW saying to me in the meeting “stop saying you’re very stressed”. The behaviour was totally unacceptable and abusive. I was upset and removed myself from this abusive situation before I reacted as badly as I wanted to under this provocation. I made a note of that meeting see p139A.130. Why didn’t JW just ask Steff for the appointment letter? It was difficult enough dealing with JW on a normal day but on days when I was not feeling well or when she was being awful, it was impossible. Again, if this is how she behaves in front of a witness, you can imagine what she’s like when I was alone with her. That’s why I’m so sure she is the reason why I had so many days off work.131. Also, I had had an appointment with the anaesthetist about two weeks before this and had shown Karen Tyrer and Steff Hudson the appointment letter. JW never demanded a copy of the letter on that occasion. 132. After the meeting on 7th March and before leaving for my hospital appointment, I left JW a copy of my appointment letter and emailed her asking for a meeting upon my return see p117A-B see p139 – the letter showing my appointment was at 1pm on 7th March. 133. This is confirmed in JW’s email to Allan Auty which once again demonstrates that the issue really is that management have failed to agree on how I was to be managed see p118.134. This was a stressful time for me, going for a pre-operative appointment, and about an hour before I go I have to have this kind of meeting. It is oppressive, bullying behaviour. The behaviour of JW damaged any possibility of any kind of respectful relationship with JW. I can never forgive Jacquie Whitfield for the oppressive bullying behaviour towards me. 135. The week before I went into hospital my Union representative spoke to me. A member of staff (he did not say who) had expressed concern about my welfare. 136. On 14th March, 2007 I underwent major surgery. I was not a day patient, as has been referred to in Council documents a number of times. I should have stayed in for more than one night, I wanted to go home. I was very distressed and upset. I had no idea that I would, one year later, resign without ever returning to work.137. My GP signed me off due to ‘post op’ from 20th March and subsequently, although not all sick lines seem to be in the bundle see p311-316. From 26th July 2007 this changed to being signed off for work-related depression see p317, depression see p318, work related depression see p320 and then in January 2008 for 6 months with ‘depression – stress, reports bullying at work’ see p322. That was the last sick line and went beyond the date of my resignation. 138. On 14th March I sent an email to management saying how important it was to me that I did not want JW to manage my sickness absence. I made it clear that I did not want any contact with JW whilst I was absent. It’s written in very strong terms at 4 o’clock in the morning. I was very stressed about this operation and about having to discuss my health with JW, when I expected to be off work for a few weeks see p139B. 139. To give a quick summary of what happened over the next few months, I repeatedly asked that Steff Hudson should manage my sickness absence, as set out in my email. The Council did not permit this and insisted on my sickness being managed by Business Support. I became increasingly stressed and consider that this was a very lengthy course of harassment. 140. It started on 2nd May 2007 when Ann Gill wrote to me to arrange an ‘attendance support meeting’, rather than me meeting with JW. It was to take place in the office see p144. I replied on 4th May asking for the meeting to be away from the office and to be accompanied by my Trade Union representative. I needed to know who else was to be present as I was very suspicious and sensitive; I was very anxious at the thought of this meeting. As an alternative, I asked that Steff could instead visit me at home see p145. Ann Gill replied on 15th May by setting a date in a neutral venue and gave me permission to bring my Trade Union representative. She did not seem to have considered my request for Steff to do a home visit see p146. 141. Also, regrettably Ann Gill did not, as I had asked, arrange the date with my Trade Union representative. This meant that I had to write to her again, on 18th May, as he was unable to attend the date she had set see p149. This was all ‘stressful’ as I was concerned that the letter might not get to Ann Gill in time (which I have explained had happened previously), so I had to arrange for it to be hand-delivered as well. This would not have been necessary if she had contacted my Trade Union representative first, as I had requested. I felt that she had been thoughtless and ‘stuck’ in her need to just follow procedure without thinking about me and what I needed. I repeated my request that Steff should make a home visit. 142. I felt that Ann Gill was not being as supportive as she could. I was emotional as this was an extremely private matter. I have had my illness since I was a teenager and going for surgery was a VERY stressful time for me. I have never openly discussed it with strangers or people I did not know well. The impression I received was that I had to fit in with Ann Gill, although it was me who was at home, feeling anxious, depressed, tearful, trying to recuperate from an operation. Ann Gill just wasn’t helpful to me. Ann Gill caused me more upset and distress by her draconian attitude. A home visit is supposed to be about my welfare. No consideration was ever given to my welfare. I was upset and Ann Gill knew I was upset yet she continued to harass me. What about my feelings? Are they not important? I had had major surgery, I had been bullied and Ann Gill quotes procedure. I am a human being not a procedure.143. On 11th May 2007 my sick pay reduced to half pay. This caused me lots of anxiety It wasn’t actually confirmed to me until a letter from payroll dated 22nd June 2007, which is very unfair, but fortunately I was aware of it see p159A.144. On 14th May I went to see the Occupational Health doctor, Dr Roberts. I told him about my operation and my distress at work. When Doctor Roberts told me that it was JW who had sent for the medical, I very upset and screamed at Doctor Roberts “that I would only discuss it with him if he could guarantee that his report would not go to JW.” I think he was quite shocked. He was very supportive and sensitive, which was a great help. He managed to pacify me by asking who I would like the report to go to, so I said the Director, John Kelly. It was as though he was actually trying to work around what I needed, not just what he needed. It is apparent to me that if he can do this, then so can Business Support. Doctor Roberts did offer me counselling; my response was slightly negative, I screamed at the poor Doctor again, “I am not nuts I don’t need a counsellor.” On hindsight I really did need to see a counsellor then. I was extremely manic at the time and Doctor Roberts was lovely, he was just so sweet, really calm and I was so psychotic then. 145. Dr Roberts prepared a report dated 17th May in which he recommended a meeting with management to discuss my long-standing issues with JW and to help to resolve the situation so that I would feel able to return to work. He noted on the report that I objected strongly to it being sent to JW see p147 148. The report was addressed to John Kelly, Executive Director, who it can be seen made a handwritten note on 19th May asking for Andy Hull to report back to Occupational Health. The report was sent to me on 21st May see p148A.146. On 21st May, Ann Gill wrote to confirm a new date for the attendance support meeting which would be with her. Again, there was no reference to Steff making a home visit which was very disappointing; she was simply ignoring this which caused me further upset see p150. On 29th May I emailed Steff and said I wanted her to do a home visit and she said she would try to attend the meeting arranged with Ann Gill on 31st May, but I cancelled it, asking Ann Gill again for Steff to do a home visit. I was feeling very down and depressed at the time and had had severe panic attacks at the thought of meeting with Ann Gill. I emailed the letter to Steff and asked her to print it for Ann Gill see p150A-151.147. In May 2007 – I don’t remember the date – I visited my local Councillor Berni Turner. I was really upset and could not stop crying. This was just so unlike me. I never used to be an emotional person. I did not know what to do, even though I had been told not to speak to Councillors. She said she would speak to Colin Hilton. I gave her copies of correspondence relating to the bullying from September 2006. 148. I decided to try to get a more senior manager to see my point of view and hopefully overrule Ann Gill and allow Steff to visit me. I emailed John Kelly saying that as Steff had returned from holiday, I wanted her to do the welfare visit, pointing out how stressed I was. I did actually send him a bit of a barrage of emails unfortunately, at different time of the day and night. I was desperate and so depressed. 149. I emailed John Kelly on a few dates – in emails marked ‘private’, for his attention only – telling him how upset I was and that I used to come home from work and just cry: 25th and 27th and 31st May see p151A-E. I expected John Kelly to implement some form of mediation. 150. The following week, on 3rd June, I wrote a letter to Regeneration explaining that I was feeling extremely depressed and that my sister had paid for a holiday; I couldn’t face writing to Ann Gill again and hoped that a more senior manager would deal with it, at that time I was depressed see p152.151. Before I received a reply to the letter, I received a letter from Ann Gill dated 4th June see p153. I was reprimanded for having written to the Leader of the Council and other Councillors. I was inconsolable; I couldn’t stop crying. I felt the Council were bullies trying to hide behind procedures. What was I supposed to do? I was trying to get out of a situation where no-one was listening to me. Now they were threatening to discipline me, for raising my concerns with others whom I hoped would help. There was absolutely no understanding of what I was going through or how I was feeling. I cried for help and they responded with a threat to commence disciplinary action. I was at the end of my tether and it felt like I was just spiralling downhill into depression more and more.152. Then I received another letter from Ann Gill, dated 11th June, saying that there would not be a home visit from Steff. I felt Ann Gill was bullying me. It was horrible and I felt very stressed. I can appreciate that she was trying to follow Doctor Roberts’ suggestion about a meeting, but Ann Gill was the wrong person to have this meeting with. It needed to be someone I had trust in, someone who was able to understand my position and treat me with some respect and empathy. As I was jointly managed by Steff I felt it would have been more appropriate to be Steff. Everyone kept stating I was managed by JW only and not Steff, but I had never signed the contract saying my job had changed see p154. 153. Why did I have to meet with Ann Gill? She knew that the prospect of meeting with her in May had caused me panic attacks. The procedure she quotes in the letter states that one purpose of the visit is to ‘show concern’ for me, which they clearly were not. They were CAUSING me concern. Also, the letter states that another reason for the meeting is to ‘ascertain if there is anything the Council can do’ to SUPPORT me during my illness. I had virtually BEGGED for them to arrange for Steff to do a welfare visit at home and it was repeatedly ignored. Ann Gill was causing me additional stress and upset, I felt as though I was being bullied by Ann Gill.154. This was just the same as JW when, at the very outset, she asked what she could do to help see p96. They didn’t want to ‘help’. They wanted me to fit in with THEM. I cannot believe that that is what the policy and procedure they were supposedly following was designed to do. They were not following their own procedure and there is no good reason for that at all. I just could not understand it. It was wrong and it was, I believe, simply an effort to “show who’s the boss” and to put a stop to my complaints. I just can’t find any other possible explanation. I would point out I am human being not a procedure. I think the Council should implement changes to treat staff as human beings not procedures. 155. I wrote to Ann Gill the day I received that letter, 14th June, the contents of which are self explanatory see p157.156. On 14th June Ann Hale from Human Resources replied to my letter about the holiday request, dated 3rd June see p156. This letter just made me feel sick. What an appalling letter. I was so upset, I couldn’t stop crying. This letter made me feel so many emotions; I was angry, depressed, I wanted to scream at the council ‘LEAVE ME ALONE’. Once again, policy and procedure with no humanity at all. It really is enough to make one want to jump in front of a bus, that’s exactly how I felt. This could have been totally avoided if I had met with Steff in May as I had been requesting for months – in fact, since the start of February 2007. It is insensitive in the extreme. This is bullying and oppressive behaviour. 157. My doctor replied in a letter dated 19th June saying I had had several panic attacks in the past few days, despite medication and that she had actually encouraged me to go on holiday see p157A.158. On 15th June I emailed John Kelly complaining about Ann Hale’s letter saying that I felt ‘victimised’, that no-one was listening to me and that I was suffering from depression; I said that it was so serious that I was considering seeing a Solicitor see p157B. 159. On 24th June I emailed the Chief Executive asking him to investigate my complaints. I presumed by then he would have heard from Berni Turner. Mr Hilton replied that it would be ‘dealt with through the appropriate procedures’ which was disheartening, although I didn’t really expect much else see p161B. 160. On 25th June 2007 I had a letter hand-delivered to Andy Hull the contents of which are self-explanatory. I made a request under the Freedom of Information Act as this felt more serious than just a letter, which he would probably have ignored again. It was very stressful to have to write in these terms and I was at that time, as I have explained already, feeling extremely stressed, upset, depressed and angry see p160. I never got a reply from Andy Hull. I have seen the letter in the bundle at p270 from him but I never received it. If I had I would have replied. Anyway, it is dated 14th March 2008, which is 9 months later. 161. I sent a copy of this to John Kelly on 24th June asking him to investigate. I was not feeling very well at the time see p161A. I actually wrote to John Kelly twice that day as I also emailed him separately see p159B. 162. I was imploring management to allow Steff to do the home visit instead of Ann Gill. I cannot comprehend why the Director whom I had emailed did not take the initiative and say “Allow Steff to do the visit and take it from there”. Procedures were adhered to, at the expense of my health and sanity. 163. On 26th June 2007 I emailed John Kelly. I gave it a heading of PRIVATE. I apologised for my letter of 15th June and explained that I was very stressed. I asked him to look into my case as I couldn’t face the prospect of another sham grievance. The email is self explanatory and I was horrified that he immediately, within minutes, simply passed it on to Andy Hull to deal with. That was virtually the last thing I wanted. I was going over Andy Hull’s head and here was John Kelly, with no thought at all, sending it straight back to Andy Hull within minutes. I was so upset; I was in complete despair see p 163-162. 164. I replied to him saying that it’s not right for someone to investigate themselves but it made no difference; he seemed to ignore the conflict of interest I was drawing to his attention see page 163A-B.165. I decided that I had to do something as I could not risk Andy Hull treating the situation superficially or Allan Auty having another ‘memory lapse’. I couldn’t cope with the risk of people following Jacquie Whitfield and Ann Gill because they were managers and because the Department couldn’t risk a grievance being upheld in my favour. How would that look? It would show how incompetent the Department is. I was concerned that as I complained previously I would be treated as a ‘troublemaker’ and the senior managers in the Department wouldn’t take me seriously.166. After a great deal of consideration I decided that if I wanted an official investigation then I would have to submit a formal grievance and I also thought I had to do it before Andy Hull did anything with the email I had sent to John Kelly.167. On 29th June I emailed John Kelly again. I copied it to people whom I thought would intervene and ensure a fair and just grievance would be heard. It had not really sunk in that I shouldn’t email Councillors and I was at the end of my tether and no-one was taking me seriously, including John Kelly himself. This was a formal grievance titled ‘Grievance Bullying and Oppressive Behaviour’. It covered some of the history and added new information. As I stated at the end, I did not want to have to do this but I felt that I had no choice see p165-167. 168. I really wanted John Kelly – or someone else above Andy Hull – to meet with me informally and try to find a way to resolve the situation. It would have been so less stressful. I think that was yet another time that the Council could have transferred me to Steff’s management, which I am now aware that Steff had suggested about 9 months previously.169. Instead, John Kelly replied stating that he would ask Andy Hull to appoint a manager. He appointed Peter Elles, who reports to Andy Hull. Yet again, I was in despair. There was no way anyone in Andy Hull’s Department would criticise Andy. 170. John Kelly ignored my concerns about a conflict of interest and threatened me with disciplinary action if I wrote to a Councillor again see 164. I was so upset when John said this. Why were council so awful? Everything seemed to revolve around procedures. Do the Council not realise human beings are not procedures. 171. I believe that he – and in fact all the managers involved, except Steff – just saw me as a ‘troublemaker’ who was making serial unfounded complaints and that I was not to be taken seriously. John wanted to make sure that the procedures were followed enough to make it LOOK like it was all being done properly. He was just fed up with me and decided that there was no need to take my complaints seriously – and that was because of the complaints I had made. A procedure should be brought in to treat staff with dignity not as a procedure. 172. I replied saying that I was unaware and wouldn’t contact members again. Unfortunately, I did when I was stressed and upset and felt that I had no other options see 167A-B. 173. I did go on that holiday to Mexico although I had been worrying about the grievance hearing. I came home to the letter from Peter Elles, Business Manager, Environmental Health and Trading Standards, dated 9th July arranging a formal grievance hearing. He was to be advised by Ann Hale from Human Resources. I had no confidence in her at all either given her letter to me about the holiday; it quickly felt like I had never been on holiday. I was once again completely stressed see p168. 174. On 19th July, I wrote to Peter Elles confirming that I could attend the hearing and that I would advise him of my witnesses once I had their permission see p169.175. On 27th July 2007 I met with Peter Elles to discuss my grievance. The purpose was to clarify the nature and details of my grievance.176. On 2nd August Peter Elles emailed me with his understanding of what my grievance was and clarifying which aspects he would not be dealing with see p171-175. He refused to go over any of the information dealt with in the previous grievance. I was very disappointed by this. I know I could have appealed in January 2007 but I couldn’t face that. Anyway, there was no point if Allan Auty was going to have a ‘memory lapse’. I really hoped that someone outside of Andy Hull’s Department would look at the whole thing.177. I could not understand why Peter Elles refused to consider the conflict of interests point I had raised. He just said it should be disregarded. This was a crucial part of my grievance see p172 (top). 178. At p174 (top) I am saying that the way Andy Hull dealt with the issue of changing my contract was ‘intimidating’. There was no way on earth that Peter Elles was going to say that about his senior manager. He should have objected to hearing this grievance. I know that Steff Hudson agrees that he shouldn’t have dealt with it and said so at the time.179. Around the same time I received a letter from Ann Gill dated 31st July see p168. She suggested holding an attendance support meeting on Monday 13th August. I couldn’t face it. I had more panic attacks and went to my GP on 8th August. I was signed off as not well enough to attend see p177. 180. On 7th August I sent amendments to Peter Elles. On 22nd August I emailed Peter Elles to chase up the grievance; he had been unwell see p179. He replied with comments on 24th August which I agreed to see p181 and p184-187.181. I wondered how seriously he was taking my grievance. Apart from not seeing a conflict of interests, he initially said that the complaints about the hospital appointments in March 2007 had been covered in the first grievance see p187 (top). As that grievance was submitted in September and concluded in December 2006, I don’t know how Peter could have possibly come to that conclusion. I had little confidence in Peter Elles but didn’t have the courage or strength to argue more. I must admit, I was disappointed with my Trade Union representative with the lack of support he gave; I felt he could have been much more assertive for me. There was nothing more I could do to resolve the situation. 182. On 24th August I emailed Peter Elles telling him about an incident when JW knew I was going in for surgery and started going on about her Hysterectomy at the top of her voice. I felt that the way she did that was really insensitive, when she knew I was upset. I believe this was the action of a vindictive, nasty, insidious woman see p187A.183. On 28th August I emailed Peter Elles telling him about the time when I had been told by JW to do the post and this was overturned by Allan Auty – I’ve described this already in this witness statement – as well as a couple of other incidents see p187B.184. I was painting a picture for him that this was not isolated incidents. This had been going on for years, with the same people and no action had been taken and no-one had listened to me. Peter Elles seemed to be totally disinterested in the details.185. On 4th September I contacted Peter Elles to arrange a date for the grievance hearing see p187C. In emails on 20-21 September we arranged a hearing for the grievance on 4th October 2007 (at p189-188). This date was over 3 months form the date of the grievance (29th June 2007). The date was confirmed in a letter dated 21st September in which Peter Elles said that he would interview any witnesses after he had met me see 192.186. On 21st September I sent an email to Ann Hale, Human Resources, expressing my concerns that my sick pay was about to expire. This was confirmed in a letter from payroll dated 26th September, indicating that my sick pay expired on 11th October see p196A. 187. In my email to Ann Hale I explained that this was due to delays which were not my fault. I felt that I was being forced to return to work and was essentially requesting that my sick pay should be extended. I explained that this was causing me further stress and panic attacks. Ann Hale told me it was ‘not appropriate’ to write to her, yet again quoting procedures at me and criticising and belittling me in an abrupt email see p191. 188. I didn’t know at the time but have now seen on that page that Ann Hale herself immediately sent my email to Ann Gill. This makes Ann Hale’s email to me unnecessary. Ann Hale is adding to my stress unnecessarily and insensitively, despite me having just said that I was having panic attacks and quoting a legal case to her about stress and personal injury (that is, Walker v Northumberland County Council). That is just not acceptable. Ann Hale had missed the point that having Ann Gill manage my sickness absence, and refusing to allow me to see Steff Hudson, had caused me panic attacks. The whole attitude of Ann Hale was oppressive and bullying, causing me additional stress and upset. 189. I replied shortly afterwards to Ann Hale telling her what I thought about just quoting procedures at me and she basically replied telling me the importance of procedures see p191A. 190. I had copied these emails to John Kelly. Nothing was done to extend my sick pay and on 12th October my sick pay became nil. This caused me additional anxiety and distress and left me without income. I became further depressed. 191. On 24th September 2007 I emailed Peter Elles to complaint about Ann Gill’s treatment of me during my sickness absence. I felt that she had been so OPPRESSIVE that, as I was having other issues addressed formally, this should be as well. They were clearly linked. My email says it is a grievance and the contents are self-explanatory. Peter Elles indicated that it would be considered alongside the complaints already under investigation see p193-193A. 192. On 4th October 2007 a Grievance Hearing was convened by Peter Elles, assisted by Ann Hale. He wanted to know why I found the meeting with Andy Hull intimidating. He was trying to imply it was normal procedure, which I was disagreeing with. We were going round in circles I was not articulate, as I was upset and there was no input from my Trade Union representative, which was very disappointing. At one point Peter Elles said “I am started to lose the will to live” which I thought was inappropriate. How can he possibly make a decision if he can’t even ask questions about the issues so that he understands them?193. After the hearing, to try to help him understand the issue, I sent him an email. This was my email to Andy Hull dated 18th January 2007 about the job description sent to me not being an accurate reflection of the meeting where we agreed that I would be working for the Enforcement Co-ordinator see p203-202 with the job description at 204-205; this was the email I had written to Andy Hull about in June pointing out that he had not replied to the January email previously referred to at p160. 194. I wish to re-iterate to the Employment Tribunal that Andy Hull’s failure to deal with this means that I was asking Peter Elles to criticise Andy Hull. Peter Elles was not strong or brave enough to do that. He could, at that point, have stepped down due to this but didn’t.195. On 17th October 2007 Dr Roberts from Occupational Health provided a report following my visit to him a couple of days earlier. He advised that I was not fit enough to attend meetings, even with a representative, but was able to provide written representations. This was because I found it really stressful attending the grievance meeting. When I get stressed and upset, I find it really difficult to think straight and to answer questions. It makes me feel stressed. I have also found this to be the case preparing for this Employment Tribunal hearing as I still feel this way see 206-207A. I have also started to suffer from psoriasis and eczema on my face. 196. I have seen the emails in the bundle dated 18th October between Ann Gill and Ann Hale of HR following receipt of Doctor Roberts’ report see p208. There seems to be an inference that as I was able to attend meetings with Peter Elles about my grievance, I should have been able to attend meetings with attendance support meetings with Ann Gill. That is saying that I was basically telling lies about the panic attacks. 197. That is absolute nonsense. Ann Hale should know better. She saw how difficult it was for me to present myself and refute the comments in the grievance hearing. Also, she has missed the point. I had put in a grievance against Ann Gill. I had wanted to have my welfare visit with Steff Hudson, who would have been supportive and was, as I understood it, MY MANAGER. Ann Hale’s comments I feel should be investigated. I am off with depression am on anti depressants, and this woman has the audacity to question my word about the panic attacks. I hope Ann Hale never experiences them. I think an equality and diversity course may help Ann Hale understand the effects of bullying, harassment and oppressive behaviour on your life. 198. I also want to comment on the suggestion of a phased return to work. In principle, that would have been necessary as I had been off since March 2007. However, the easiest thing in the world would have been to put me temporarily under Steff’s management, I had been requesting this. Steff agreed. Also, it would have meant getting back to a position I enjoyed doing and would avoid the need for me to be trained to do a temporary job, 199. That would have made so much sense for EVERYONE. I think by that time my work had been taken on by Legal Services. I could have moved there as well, at least temporarily. Again, that was not discussed with me. Instead of actually trying to provide solutions, management and HR were stuck in a RIGID, inflexible insistence on policy and procedure. Procedures don’t make decisions about people, PEOPLE do. 200. Management appeared to be totally incapable of resolving the situation with a compromise; everything revolved around procedures. This was incompetence by management. Throughout this period I was absent for months, waiting for my sick pay to expire. This is oppressive and bullying behaviour, by any definition. I want to know WHY the Council treated me in such a derogatory, oppressive, bullying, harassing way, That is why I keep raising these issues, the behaviour towards me was deliberate and down right malicious.201. As well as relocating the Fixed Penalties to Legal Services, I have been informed that the Service Requests and the Consumer Advice Complaints that I once dealt with are now being dealt with by someone who has been brought in by an agency who is located in the Trading Standards room. I was requesting to be moved into the Trading Standards room. It is apparent there was no logical reason for me not to be located in this room. 202. On 25th October Ann Gill sent me an Attendance Support Questionnaire to complete. It is clear from the way I wrote – actually, ranted – over this form that I was depressed and distressed and had extreme concerns about working with Ann Gill and Jacquie Whitfield. I was begging them allow me to be managed by Steff Hudson. Their behaviour implied I had signed the contract in the Autumn of 2006 agreeing to be managed by Business Support. I had not. They still refused to acknowledge that I was not being managed by Ann Gill see 214-216B.203. That is, management STILL failed to clarify the CENTRAL issue that I genuinely believed that I was to be managed by Stephanie Hudson, not Business Support. That needed to be clarified by senior management, namely Andy Hull. Due to Andy failing to make a decisive decision, from 2006, I am the one who has been the victim of petty managerial disputes. I am a victim because of Andy’s incompetent management and his ineffective decisions for ONE WHOLE YEAR. This is incompetence on a grand scale. I should never have been put in a place so DARK and distressing as to scrawl all over that form. These people need to go on an equality and diversity course; they need to learn that actions have consequences. 204. I should say that the temporary relocation was to pest control and I said I was allergic to ‘vermin’. Also, Jacquie Whitefield frequently visited pest control. 205. As my salary was nil, I needed to submit my original sick lines in order to apply to the Department for Work and Pensions for incapacity benefit. I needed to request them from the Council. I was at the stage where I couldn’t even face THINKING about contacting Business Support. I wanted no dealings with Ann Hale in Human Resources because of the way she was treating me. So, I asked Steff. She could tell how upset and distressed I was and she agreed to help.206. On 31st October she emailed Ann Gill and Jacquie Whitfield to ask for my original sick lines for me see p217. JW herself sent them to me with a compliments slip. I didn’t want to hear from her and felt that she did it deliberately, knowing it would upset me see p217A. 207. On 31st October Peter Elles wrote to me with the outcome of my grievance. It was not upheld see p219-221. 208. There were no minutes produced for either of the grievance hearings, by Paul Farrell nor by Peter Elles. I felt that this was extremely unfair. Had I known this, I personally would have taken in a tape recorder, that way there would have been no misunderstandings, perhaps the Council will eventually record all grievances? I emailed my Trade Union representative about it in January 2008 concerning this issue see p259C.209. On 8th November I submitted my appeal the contents of which are self explanatory see p224-226. Jenny Driscoll's statement was provided at the pre grievance meeting to Peter Elles and Ann Hale. I’m not sure about Derek’s. I wasn’t involved; Arthur Moss dealt with this. I discovered later that in his interviews Peter Elles did not ask the witnesses about bullying at all. Strange really, a grievance title called Bullying and Oppressive Behaviour, and no one questioned on bullying. 210. I note from the bundle that Andy Hull was also able to select who heard my appeal see p227. Again, this is Andy Hull choosing his own judge and jury, on the advice of Ann Hale of Human Resources. That is a further CLEAR conflict of interests which makes this procedure unfair. 211. On 3rd December I went to see Doctor Roberts again. His report is at p239-240A. I was saying that I could not risk facing the people I had accused of bullying me but was able to meet with Steff Hudson. Again, this did not happen. I can’t understand why they wouldn’t just arrange for Steff to visit me at home to discuss work. I feel that they – from Business Support managers to senior management – were scared that if they let Steff come to see me now, they would look incompetent for not allowing this to happen sooner. People are human beings not procedures. Had I been treated as a human being, we would not be in this situation. 212. Management should have been flexible, for the benefit of my health. I felt this was continuing punishment for having complained about Jacquie Whitfield from the very beginning and for all my complaints since, about her and others including Allan Auty, Andy Hull and Ann Gill. I could now not even face attending an appeal hearing. That is how badly their mismanagement had affected me.213. On 10th December I emailed Steven Richardson of Human Resources, who was designated to deal with my appeal. I explained that I couldn’t attend the appeal hearing scheduled for 18th December, due to work related depression. I was confident that it would be a farce and had no faith in the procedures. I indicated I would prefer to deal with the appeal hearing in writing. 214. In various emails, it was explained that the manager deciding the appeal would only have written representations from Peter Elles if I was only submitting written representations and not attending. I agreed to this. I did ask for three witnesses to be re-interviewed but they were not: Stephanie Hudson, Derek Pennell and Jennifer Driscoll see pages: 248, 247, 250, 249. 215. On 13th December my Trade Union representative emailed Stephanie Hudson asking for a statement see p248A. He didn’t tell her the deadline and Steff’s statement didn’t arrive until 21st December, after the appeal see p259A. Jeni and Derek did statements in July 2007.216. On 17th December I provided my written representations see 257A-C. Peter Elles’ written representations including appendices are at p251-257. 217. On 18th December the grievance appeal was heard in my absence by Dale Willis, Cemeteries and Crematoria Manager. On 20th December he wrote to me with the outcome of the appeal. I received it by email on 21st December, when I had requested it from Stephen Richardson in HR, because I was very anxious about the outcome see p263. My appeal was not upheld see p258-259. 218. Dale Willis refused to re-interview my witnesses. This I felt was wrong. He didn’t even consider whether Peter Elles had covered the bullying aspect in his investigation. I’ve since discovered just how inadequate Peter Elles’ investigation was and Steff and Derek will give evidence concerning this issue. 219. Mr Willis just didn’t comprehend my points, or has chosen to ignore the issues and points I have raised. I accept that it can be necessary for Line Managers to change and that generally employees cannot ‘nominate who they want to report to or do not want to report to’. However, he has missed the point. There was a PROPOSAL that my contract would change and I would report to JW. It was not a DECISION as far as I was concerned; it was an offer, which I did not accept. What has been totally misunderstood by the Council management is that this suggestion was first made BEFORE my grievance against JW had been heard. No one seems to have understood that I was being offered a job where I would report to the person I had a MAJOR issue with – or if they have understood it, they have ignored it as some kind of punishment for trying to stand up for myself. 220. Dale Willis says my grievance is related to the fact that I “simply cannot report to the person that I feel I should report to”. That is NOT the point. The point is that I should not report to the person I FEEL bullied by. All the managers, every single one of them involved in this with the sole exception of Stephanie Hudson, have missed this point or have chosen to ignore it. How can they miss it when it is so obvious? Good managers manage, bad managers bully. Very few people, when put to the test, have the integrity and moral courage to stand up against bullying. That is why certain managers chose to ignore I was being bullied, they preferred to act as sheep rather than human beings. 221. How can they fail to see I was being bullied, when Stephanie Hudson saw it as long ago as February 2007 and told JW that she was bullying me? She even told Andy Hull that she feared for my mental health so much that she thought I was a suicide risk. She actually told him that. How can they STILL miss the point? It can only be because they chose to. There can be no other explanation. I am on anti-depressants because they failed in their duty of care to me. They wanted to protect JW. The bully is often able to bewitch emotionally needy bystanders into being their easily controlled spokespersons / advocates / supporters / deniers. This is exactly what has happened with JW. 222. How can Peter Elles and Dale Willis make a decision on ‘bullying and oppressive behaviour’ without even referring to a policy and procedure? Dale Willis relied heavily in his letter on references to policies and procedures. Why did he not look at a bullying and harassment policy and procedure? This does not make sense. How can Peter Elles and Dale Willis possibly make a decision on a grievance headed ‘bullying and oppressive behaviour’ without even TRYING to define bullying. I find this very hard to accept.223. I don’t think they comprehend what exactly is entailed in bullying. It doesn’t need to be a ‘stick used to beat someone’ as Andy Hull stated. If he didn’t know what it was, how were they to know and how were they to challenge him. Andy has actually produced a very helpful document on bullying in the workplace in his job after leaving the Council. According to Andy Hull’s Health@work powerpoint presentation – see pXXX – ‘Benefits: Reduction in GP certification, More appropriate use of clinicians and therapists time. Reduced sickness absence and improved staff morale, Improved job retention and rehabilitation; Reduction in flow of IB claimants; Improved networking of and access to advice and support agencies: Engender greater understanding of the links between health and employment with employers and the wider community’.224. I have had access to virtually none of these services, If Andy had practised what he preached I would not be here now. Either he has learnt this in his new post or he knew it at the time and failed in his duty of care to me. Either way, it is not acceptable. 225. Dale Willis calls Liverpool City Council a ‘professional’ organisation. I was not treated professionally. He couldn’t even let that idea enter his head. Dale’s mind was closed. There should have been an investigation at a much higher level. How could Dale Willis call Andy Hull into question? He would never do that and that’s why Andy Hull chose him – and the same applied with Peter Elles. 226. Dale Willis says that when I return to work my senior manager should meet with me and explain my line management structure. That is not what I required. I needed someone to say that Andy Hull and Allan Auty had allowed MASSIVE confusion to continue for MONTHS, at the expense to my health. I did not need to hear that they could keep telling me what they had been telling me for months on end.227. I agree with Dale Willis that contracts can change. I absolutely disagree with him when he says in his letter that “it is not necessary for officers to receive a new contract of employment or conditions of employment each time this occurs”. That is just wrong. I DO have to have written confirmation of a change to my terms and conditions. That’s what contracts are for – or a letter confirming the change. Why change my contract so I answer to a bully; is this the Liverpool Way?228. I was very disappointed and distressed by Dale Willis’s decision. Dale Willis, Peter Elles and Paul Farrell were just not prepared to put the blame on their colleagues and managers: Andy Hull and Allan Auty. 229. I replied on 24th December saying that the grievance was based on Bullying and Oppressive Behaviour but that the witnesses had not been asked about this. It made no difference see page 259B. I feel that management had no I idea how much upset, they actually caused me. Going into hospital is not a nice experience. Being harassed and bullied beforehand is oppressive behaviour. I actually said to John Kelly “I WANT JUSTICE. “ While I have breath in my body I will seek justice from the Council as the behaviour towards me has been atrocious. Every member of the Council that has allowed my treatment should hang their head in shame as they are nothing but bullies of the worst kind. 230. On 1st February 2008 I sent an email to the Chief Executive headed Bullying and Oppressive Behaviour. On 4th February Mr Cosgrove replied that no further investigation would be undertaken. I was very distressed that no-one was being held to account for the way I had been treated see 265C-E.231. On 14th and 18th February 2008 I made further attempts to have my complaints investigated by John Kelly and Human Resources based on there being a flawed grievance investigation. It all came to nothing as they refused to look into it see p267A F. It was as though they assumed I was a troublemaker, making continuous complaints with no foundation and were sweeping the issues of bullying and harassment under the carpet. I just wanted someone to INVESTIGATE all the evidence. 232. On 4th March I emailed Human Resources making a complaint about excessive delay in receiving a response from Andy Hull to my Freedom of Information request which had not been dealt with within the required timescale. 233. On 9th and 10th March I made a number of requests under the Data Protection Act for information regarding the various grievance hearings. There has been no response to these requests. I couldn’t understand how Andy Hull and the Council could just totally ignore my complaints; this caused me additional stress and depression. 234. On 13th March 2008 a Mr Kennedy wrote to notify me that disciplinary proceedings had been commenced due to me contacting Councillors see p269A. This just showed that they didn’t understand that I was making a cry for help, in a very depressed condition. It was cruel and unnecessary to start disciplinary proceedings. All I wanted was someone to listen to my case and hear what my witnesses had to say. 235. They had decided that this was their chance to get rid of the troublemaker, after all these years. For the sake of my sanity I was not prepared to go through more of their flawed and unfair hearings so I resigned see p271. 236. Ann Gill replied on 2nd April see p272-273. Ann Gill was so stuck on procedures she wrote to me on 8th April STILL wanting to meet with me, on 21st April which was only a few days before my employment terminated see p273A. There was no point in having that meeting. This made me feel very distressed. I sought legal advice and declined to attend this meeting see p273B.237. On 29th April Mr Kennedy wrote to me saying he would not be pursuing disciplinary action due to my resignation see p273B. 238. On 22nd July 2008 my representative submitted a grievance on my behalf claiming victimisation for raising concerns at work see p277-282B. There was no reply until 17th December, five months later see p283-286.

I was distressed waiting to hear for this long; that is unacceptable.239. I found out in May 2009 that the Council have employed an agency worker to do some of my work. This includes the complaints and referrals that I used to deal with. This person is based in Trading Standards, not Business Support. I told my representative this in an email dated 13th May 2008. If they can do this now, why couldn’t they do this for me see p345.JOB SEEKING 240. Since my employment with Liverpool City Council ended, I have not worked. I have not been able to work. I am too depressed and upset and my GP has stated this in her report see pXXX.241. Some days I can’t get out of bed, I feel extremely down; other days I am OK. I can’t really plan anything as I don’t know how I am going to feel. I used to be very outgoing, but now have lost a lot of energy and am hardly interested in my social life. A friend asked for the ‘old Vicky’ back, who used to laugh and joke all the time; I told her she’s dead and gone.

242. I really don’t know when I will be able to cope with work. My confidence has completely gone. I think if I ever came across a bully it would be extremely distressing and I worry about how I would be able to cope with that – by harming myself or the bully. I would never go through this again. 243. When I was in hospital in March 2007 I couldn’t stop crying. To cheer myself up I imagined some very dark thoughts about JW or in fact taking my own life and doing this in front Allan Auty and screaming at him ‘you could of stopped all this’. They are quite dark and scary thoughts, even though I am on anti-depressant medication. 244. As my GP says in her report, I will know more about my ability to cope when this is all over but I have no idea how long it will take me to recover and be able to get on with my life.245. To think that Allan Auty and Andy Hull could have stopped this happening makes me feel sick. If they had allowed Stephanie Hudson to be my Line Manager and to manage my sickness, I would still be working there now.

Signed ……………………………………. Dated 5th May 2009

http://petitions.number10.gov.uk/09Bullying/ When you complete the petition - it will email you a link which you have to click to actually have your name added to the list. Please do remember to check your spam folder if your email doesn't appear and make sure your name is on the list!

The action I feel would be beneficial if all Grievances were recorded, i.e tape recorded/video recorded, and an independent employment consultancy, or another independent organisation that had no ties with the perpetrator investigated all Grievances/Appeals pertaining to bullying/harassment. This may sound expensive, if you think of the cost in the long run it will be a lot cheaper than: Sickness; Counselling; Tribunal, etc.

Education is the key as bullying thrives on silence. A zero tolerance to bullying and make information on how to deal with bullying known throughout all services.

Here are some websites which you may find informative:

Very Informative website
http://www.bullyeq.com/
Mental health and gender: Stress agenda
http://tinyurl.com/ohcet6
Bullying Council: http://murdomacleod.wordpress.com/
This is a free course which you may find helpful http://www.skillsoft.com/bullying

Workplace mobbing: Are they really out to get your patient?http://tinyurl.com/ctpcqr

People do commit suicide as a consequence of bullying
http://tinyurl.com/5jxl9p

The words hypocrite spring to mind http://tinyurl.com/yhsdgoy

It still goes on: http://justmyopinion-privateye.blogspot.com/2010/01/fugitive-episode-two-charges.html

http://tinyurl.com/ldzwcd