The NHSScotland National Infection Prevention and Control Manual was first published on 13 January 2012. It is an evidence based National Infection Prevention and Control (NIP&C) Manual for Scotland and is intended to be used by all those involved in care provision.
The manual contains information on Standard Infection Control Precautions (SICPs), Transmission Based Precautions (TBPs), Healthcare Infection incidents, outbreaks and data exceedance. It is mandatory for NHS Scotland and considered best practice in all other care settings. It should be adopted for all infection prevention and control practices and procedures
Infection prevention and control powerpoint training slides
National Guidance for Safe Management of Linen in NHS Scotland
This national guidance, is complemented by the National Infection Prevention and Control Manual Chapter 1 – Standard Infection Control Precautions – which covers safe management of linen at care area level. It is a useful resource for care homes when formulating policy and procedures governing safe management of linen within their facility.
HPS compendium of Healthcare Associated Infection Guidance 2019
The HAI Compendium contains links to current national policy and guidance on HAI, antimicrobial prescribing and resistance, decontamination and other related topics. The compendium aims to provide NHSScotland staff with an overview of all up to date guidance from stakeholders/organisations.
The Compendium includes links to the National Infection Prevention and Control Manual (NIPCM) which is the mandatory practice guide for all NHSScotland care settings. As well as the practice guide for Standard Infection Control Precautions, Transmission Based Precautions and HAI Incidents and Outbreaks it includes supporting materials such as literature reviews, tools and posters. The NIPCM can be accessed on a standalone website.
What is an Environmental Control System?
Everyday, people use handsets and remotes to use the telephone, operate TVs and accessing sockets for turning on lights etc. For a few people using these handsets is extremely difficult due to complex physical disabilities. An environmental control is a technical system which can potentially overcome this problem.
What can they control?
Environmental control systems can be set up to operate a huge range of devices, including:
Entertainment – TV, video, HiFi, DVD, Cable TV, Satellite TV, Teletext, Radio
How do Environmental Controls work?
Environmental controls are portable and use wireless signals to send commands to remote appliances.
Depending on the environmental control and the appliance that requires to be controlled, the environment control will send out either radio or infrared signals to operate the appliance remotely.
People can operate this equipment with various physical movements, such as; hand control, chin switch, head switch or voice activation.
Why do I need one?
People usually consider an environmental control to solve the following problems:
Cannot easily operate appliances and equipment around the home
Cannot unlock the door to let carers in
Cannot use ordinary remote control handsets
Spend some time on their own and may need to make an emergency call to a carer
Want to remain independent in their own home
Carer needs to be able to pop out without fear of person getting into trouble and being unable to call for help
Funding – Who will pay for it?
If you meet the NHS eligibility criteria, then you may be prescribed an environmental control system. The NHS will only install and maintain equipment that has been approved.
Some people choose to buy or rent environmental control systems privately. Others may be able to obtain funds from various government sources and have the equipment supplied to them on loan.
Other departments may be applied to for funding in some circumstances. These include Social Services (for Home Adaptation Grants or Disabled Facilities Grants), Local Education Authorities (for Equipment for Education Grants) and Employment Services (for ‘Access to Work’ equipment grants).
What products and services will the NHS provide?
The NHS may contract out the supply and servicing of equipment to an environmental control manufacturer. If so, they will agree with the manufacturer what equipment should be installed and what type of maintenance contract will be required.
Typically the NHS pay for an annual service.
The NHS operate to strict guidelines for provision, so you may find that the NHS will not be able to pay for everything you ask for.
What if I want more equipment that the Health Services will provide?
You may be able to buy equipment direct from the manufacturers, or from one of their approved suppliers. If the environmental control needs to be reconfigured to add in the command functions for the new equipment, then this would need to be agreed with the NHS provider.
Eligibility
A specialist assessment is required to determine a person’s suitability and eligibility. These criteria are available on request. Please contact your GP or Health Professional and ask to be referred:
August 2022 – BBV Patient Risk Assessment Letter and Form is being reviewed, and will be updated soon.
What are Blood Borne Viruses?
Blood borne viruses are transmitted (spread) from person to person via blood and or other bodily fluids for example through sharing of injecting equipment and to varying degrees through sexual activity. The most prevalent BBVs are HIV, Hepatitis C and Hepatitis B.
People can often live for many years without experiencing any symptoms, therefore not knowing they are infected. Unfortunately this can mean that by the time the virus is diagnosed, the impact on an individual’s health are far more serious.
The risk of transmission will depend on a number of factors for example:
route of transmission,
infectiousness of the virus
whether or not the person is receiving treatment for example for HIV.
Hep C
Hepatitis C is a virus that damages the liver. left untreated, hepatitis C can lead to liver disease and liver cancer. People often have no symptoms and therefore the only way to know for sure if someone has hepatitis C is via testing.
In the UK, Hepatitis C is almost exclusively transmitted through sharing of injecting equipment. While possible, it is far less commonly acquired through unprotected sex, mother to baby transmission, blood transfusions abroad, sharing of toothbrushes/razors. Like HIV, it is not passed through social contact with those who are affected.
Although there is no vaccine to protect against the infection, hepatitis C is curable with a short course of tablets, without significant side effects. With new treatments, everyone who is diagnosed positive is eligible for assessment and treatment, regardless of stage of disease or other health and social factors.
While it is important to test those who have ever been at risk, or who are at on-going risk to find undiagnosed infection, if elimination in Scotland is to be achieved, there is also need to re-engage those individuals who were previously diagnosed with hepatitis C, but did not stay in treatment or were not able to engage with the old interferon-based treatment regimes. These individuals should also be offered re-referral to treatment services.
HIV (Human Immunodeficiency Virus) is a blood borne virus that is most commonly passed on through unprotected sex. It can also be transmitted through:
sharing needles, syringes and other injecting equipment,
and from mother to baby during pregnancy, birth or breastfeeding.
If left untreated, a person’s immune system can become severely damaged and they may develop a number of opportunistic infections which can be life threatening. This late stage of HIV infection is referred to as AIDS (Acquired Immune Deficiency Syndrome). There are very effective treatments for HIV which can stop most people from developing AIDS. The earlier someone is tested and diagnosed, the better their outcomes will be.
Adhering to treatment not only means an individual can live a healthy life, it can also stop the onward spread of HIV. This is known as Treatment as Prevention – Those individuals who take their treatment regularly and have an undetectable viral load for 6 months or more, have been shown not to be able to pass the virus to others during sexual intercourse.
The risk of transmitting and/or acquiring HIV can also be reduced through use of
BBV testing and linkage to care is key to improving patient outcomes and reducing the risk of onward transmission to others.
Treatment and care for HIV is provided in NHSGGC via the Brownlee service.
National Data Portal
PHS produce reports which provide up-to-date epidemiological summaries in relation to BBVs and STIs in Scotland, highlighting key trends and identifying areas for priority action. HPS Website – All surveillance reports
The NHSGGC Injecting Equipment Provision service offers sterile needles, syringes and other equipment free of charge to people who inject drugs. The service provides a valuable public health benefit for individuals and communities by reducing the spread of blood borne viruses and other related infections. This service is provided by community pharmacies throughout Greater Glasgow and Clyde NHS area, the Glasgow Drug Crisis Centre some Alcohol and Drug Recovery Services and some third sector organisations for example Waverley Care and the Simon Community may also be able to provide. Community pharmacies provide a wide range of health care information and advice and are important contact points that give immediate access to a health care professional.
To find out where you or someone else can access Injecting Equipment Provision in NHSGCG visit www.needleexchange.scot
Public Health Scotland provides information on the provision of injecting equipment. This includes the number of outlets, attendances and the types of injecting equipment distributed to people who inject illicit drugs (including Novel Psychoactive Substances and Image and Performance Enhancing Drugs) in Scotland.
Patient Information
Leaflet 1 – BBV Testing leaflet – currently being updated
It is important that staff and services who work with anyone who might be at risk are aware of BBVs, key prevention messages and either how to do a test or refer someone for testing.
A range of free BBV training is available to those working within NHSGGC.
The Scottish Drugs Forum also provides both online and in person see Scottish Drugs Forum (SDF) and has a number of resources relating to BBV Staff who require further advice, information or support around HIV/BBV testing or related patient issues should contact the Sandyford BBV Failsafe on 0141 211 8639 or email the professional helpline ggc.sandyfordprofessionalsupport@nhs.scot
For Staff – Occupational Exposure to BBV
If you need to report an incident or require advice, please contact Occupational Health on 0141 201 5610. The line is open Monday – Friday, 8am – 6pm.
Any incidents that occur out with these times should be reported to your local Accident & Emergency unit. Please ensure that you then report your injury to Occupational Health on the next working day.
BBV Guidelines – Occupational Health – Needlestick and other injuries
Patient Group Directions (PGDs) are legal documents that enable healthcare professionals to administer and supply medication in an identified clinical situation where the patient may not be individually identified before presenting for treatment. For most clinical situations the preferred method is for an appropriately qualified healthcare professional to prescribe for an individual patient on a one-to-one basis. In order to comply with the necessary clinical governance arrangements NHS Greater Glasgow & Clyde must be aware of all PGDs in use.
National template PGDs are published by Public Health Scotland (filter by type), and can be accessed for information only – boards are required to have their own approved PGDs for use within their services and NHSGGC PGDs can be obtained by emailing Patient.GroupDirections@ggc.scot.nhs.uk
In September 2019 the HPV was offered to boys in S1, in addition to girls, as part of the routine school based programme.
This follows the Scottish Government announcement in July 2018 to include HPV vaccination of boys in the national vaccination programme based on the advice of the Joint Committee of Vaccination and Immunisation (JCVI). Please see the JCVI statement setting out the recommendation to vaccinate boys against HPV.
Immunisation is the safest and most effective way of protecting children against serious diseases.
The hexavalent vaccine, containing Hep B vaccine, was introduced into the UK Routine Childhood Immunisation Schedule on 1st October 2017 for babies born after 1st August 2017. The vaccine is offered in the routine schedule at 8, 12 and 16 weeks of age. However, those babies at high risk of Hep B will continue to be immunised at birth and at one month of age with the monovalent HepB vaccine before commencing on the routine childhood schedule at 8 weeks. See NHS Scotland Patient Information Leaflet 2018 and the HPS, NHS Scotland, NES Guidance for healthcare practitioners
Please see attached an “Improving Confidence in Vaccines” infographic developed by NES colleagues to support registered healthcare practitioners in discussing vaccination with patients, carers and parents.
NES has produced an infographic “Improving Confidence in Vaccines” to support registered healthcare practitioners in discussing vaccination with patients, carers and parents.
Teenage Immunisation
School Immunisation Programme
In S3 all young people will be offered :
Tetanus, diphtheria and polio
MenACWY
Measles, mumps and rubella (MMR) – if not fully immunised with two doses of MMR as a child
and all young people in S1 will be offered :
HPV vaccine
In the coming academic year (2019/20) the HPV vaccine will be offered to boys in S1, in addition to girls, as part of the routine school based programme.
This follows the Scottish Government announcement in July 2018 to include HPV vaccination of boys in the national vaccination programme based on the advice of the Joint Committee of Vaccination and Immunisation (JCVI). Please see the JCVI statement setting out the recommendation to vaccinate boys against HPV. The CMO letter 2019 is available on the link
Incomplete HPV vaccination in school leavers
Remaining doses may be given by GP practices although there is no payment for this. Practice staff should contact Tina McMichael (tina.mcmichael2@ggc.scot.nhs.uk), Immunisation Programme Manager, for authorisation to obtain the vaccine 0141 201 4917.
Other Immunisations
Young people with medical conditions (for example asthma) may also be offered flu and pneumococcal immunisations at their GP practice
The PHPU organises hospital and community clinics which provide BCG immunisation to over 2000 babies and young children per year in accordance with Green Book recommendations. BCG should be offered to infants with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. Click to view the NHSGGC BCG Leaflet and the high-incidence TB by country list (current in 2022) and low-incidence TB by country list (current in 2021) – these lists are updated annually and available on the Public Health England website.
Please note that there is no requirement for a gap between BCG and MMR or Rotavirus see Chapter 11 Green Book 2019
NHS Health Scotland’s leaflet ‘Protect your baby’ (2023). It is also available in other languages and accessible formats on the Public Health Scotland website.
Please note we currently have a waiting list for BCG vaccination appointments.
Princess Royal Maternity
Babies born at the Princess Royal Maternity are appointed by the hospital for the BCG clinic which is held at the PRM twice a month (Tuesday afternoon). Please note this service is only for babies born in the PRM. Community staff are reminded not to make appointments for babies born at another hospital to this clinic as this may result in double vaccination.
Queen Elizabeth University Hospital
Babies born at the Queen Elizabeth University Hospital are identified before discharge and appointments are sent from PHPU for either Govanhill community clinic (2 clinics per month, Thursday mornings) next to Govanhill Health Centre, Calder Street or New Woodside Health Centre, Garscube Rd/Doncaster St, (2 clinics per month, Monday and Thursday afternoon of the same week).
Royal Alexandra Hospital/Inverclyde Royal Hospital
Mantoux/BCG for older children/travellers/employees
Mantoux testing for young children/travellers/employees is available if required.
GPs, PNs, HVs and members of the public can request appointments as detailed below.
A child of any age who has been referred for BCG but has resided in a high risk country will be risked assessed and may require Mantoux test prior to BCG vaccination.
All children aged 6 or above, will require a Mantoux test prior to BCG vaccination.
How to arrange an appointment
Referrers should complete the BCG Referral form and email it to Bcg.Phpu@ggc.scot.nhs.uk Please state the reason for referral and check if the child has resided in a high risk country in which case, Mantoux will be required.
MSM – Immunisation
HPV
MSM aged up to, and including 45 years of age, who attend sexual health/HIV clinics are eligible for the HPV vaccine as part of a national HPV vaccination programme. Prisoners who identify as MSM will also be able to access the HPV vaccine through prison health services.
The introduction of this programme is based on the advice of the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI recognises that MSM is a group at high risk of HPV infection and associated disease who receive little indirect health benefit from the existing HPV vaccination programme for girls. Since the girls’ programme was introduced in 2008 evidence has emerged that HPV vaccination is likely to provide protection against a wider range of HPV related diseases such as penile, anal and a subset of orophyaryngeal (head and neck) cancers.
Health Protection Scotland issues country specific hepatitis A recommendations for those travelling abroad, and has posted specific advice for MSM travellers attending World Pride events in Europe this summer. This can be accessed via the travel health websites TRAVAX and fitfortrave
Hep B
Men who have sex with men (MSM), are at particular risk of infection and should be offered vaccination against Hepatitis B.
The PHPU has produced a list of the most Frequently Asked Questions about immunisation received by the Health Protection Nurse team. The list covers a range of areas :-
If you can’t find an answer to your query in the list or in the recommended links please email phpu@ggc.scot.nhs.uk
For Staff – Vaccine storage – e learning package for staff
It is important to maintain the cold chain while vaccine is stored in health centres, community clinics and hospitals. A quick 30-minute e-learning package covering the important points is available on http://nhs.learnprouk.com or LearnPro Community.
Once registered, to access the course, search for: GGC: 097 Cold Chain Management
For Staff – Immunosuppressants in pregnant/breastfeeding women and live vaccines in babies
Babies born to mothers who received immunosuppressive biological therapy during pregnancy
Immunisation with live vaccines should be delayed until 6 months of age in children born to mothers who received immunosuppressive biological therapy* during pregnancy. In practice, this means that children born to mothers who were on immunosuppressive biological therapy during pregnancy will not be eligible to receive rotavirus vaccine (and will need to defer BCG, if indicated, for 6 months). Specialist advice should be sought if there is any doubt as to whether an infant due to receive a live attenuated vaccine may be immunosuppressed due to the mother’s therapy. Contact the PHPU or the consultant specialist who is prescribing the medication.
Breast-fed babies whose mothers are receiving immunosuppressive biological therapy
Specialist advice should also be sought for breast-fed babies who require a live vaccine, including MMR, and whose mothers are receiving immunosuppressive biological therapy. Contact the PHPU or the consultant specialist who is prescribing the medication.
* e.g. TNFis therapy such as alemtuzumab, ofatumumab, infliximab, adalimumab, certolizumab, and golimumab and non-TFIis therapy include sarilumab, ustekinumab secukinumab , abatacept, tocilizumab, and rituximab)
For Staff – Vaccination and Systemic Anti-Cancer Therapy (SACT)
The NHSGGC Guidance, developed by NHSGGC Specialist Oncology and Haemato-oncology services, governs vaccination in patients receiving Systemic Anti-Cancer Therapy (SACT), which includes chemotherapy and the newer immunotherapies.
Seasonal influenza vaccine
There are a few patient groups in whom seasonal influenza vaccination cannot be given – see links to tables below:-
National guidance has been issued for Shingles vaccination in those aged > 70yrs. Generally speaking, this vaccine is contraindicated in immunocompromised patients. See NES Guidance (page 6).
Zostavax® is contraindicated in lymphoma, acute and chronic leukaemia, all patients receiving immune suppressive chemotherapy, biological therapies and radiotherapy, including high dose steroids (equivalent of 40 mg Prednisolone per day for more than 1 week) for at least 3 months. Such patients should be at least 6 months after the end of treatment and documented to be in remission before receiving this vaccine. (See SPC for more details).
The PPV SPC advises the following under the section Posology, Special Dosing:
It is recommended that pneumococcal vaccine should preferably be given at least two weeks before elective splenectomy or the initiation of chemotherapy or other immunosuppressive treatment. Vaccination during chemotherapy or radiation therapy should be avoided.
Following completion of chemotherapy and/or radiation therapy for neoplastic disease, immune responses to vaccination may remain diminished. The vaccine should not be administered any sooner than three months after completion of such therapy. A longer delay may be appropriate for patients who have received intensive or prolonged treatment.
For Staff – Vaccination and Systemic Anti-Cancer Therapy (SACT)
The NHSGGC Guidance, developed by NHSGGC Specialist Oncology and Haemato-oncology services, governs vaccination in patients receiving Systemic Anti-Cancer Therapy (SACT), which includes chemotherapy and the newer immunotherapies.
Seasonal influenza vaccine
There are a few patient groups in whom seasonal influenza vaccination cannot be given – see links to tables below:-
National guidance has been issued for Shingles vaccination in those aged > 70yrs. Generally speaking, this vaccine is contraindicated in immunocompromised patients. See NES Guidance (page 6).
Zostavax® is contraindicated in lymphoma, acute and chronic leukaemia, all patients receiving immune suppressive chemotherapy, biological therapies and radiotherapy, including high dose steroids (equivalent of 40 mg Prednisolone per day for more than 1 week) for at least 3 months. Such patients should be at least 6 monthsafter the end of treatment and documented to be in remission before receiving this vaccine. (See SPC for more details).
The PPV SPC advises the following under the section Posology, Special Dosing:
It is recommended that pneumococcal vaccine should preferably be given at least two weeks before elective splenectomy or the initiation of chemotherapy or other immunosuppressive treatment. Vaccination during chemotherapy or radiation therapy should be avoided.
Following completion of chemotherapy and/or radiation therapy for neoplastic disease, immune responses to vaccination may remain diminished. The vaccine should not be administered any sooner than three months after completion of such therapy. A longer delay may be appropriate for patients who have received intensive or prolonged treatment.
For Staff – Aids to Translating Immunisation Records in Other Languages
Primary care staff presented with the foreign immunisation records of overseas children now residing in NHSGGC may find the following resources helpful in aiding their translation. These resources have been created by the CDC (Center for Disease Control and Prevention) and Immunization Action Coalition. Please note that these lists are not comprehensive although both organisations state that sources have been checked but complete accuracy can’t be assured.
Primary care staff are asked to check these lists in the first instance and if they would welcome a second opinion they should email the PHPU and an HPN will assist.
Patient Group Directions (PGDs) are legal documents that enable healthcare professionals to administer and supply medication in an identified clinical situation where the patient may not be individually identified before presenting for treatment. For most clinical situations the preferred method is for an appropriately qualified healthcare professional to prescribe for an individual patient on a one-to-one basis.
In order to comply with the necessary clinical governance arrangements NHS Greater Glasgow & Clyde must be aware of all PGDs in use. National template PGDs are published by Public Health Scotland (filter by type) and can be accessed for information only – boards are required to have their own approved PGDs for use within their services and NHSGGC PGDs can be obtained by emailing Patient.GroupDirections@ggc.scot.nhs.uk
Useful websites for information on immunisation and vaccines
Information on Immunisation
Compendium of Organisational Outputs This compendium contains a list of organisational outputs in relation to Vaccination of Immunocompromised Individuals and specific diseases including, guidance, tools, education resources, literature reviews and research by specialist organisations and any additional documents that are applicable for use in NHSScotland for example, Department of Health and specialist advisory bodies.
It aims to provide NHSScotland staff with an overview of all materials available relating to immunisation of persons with underlying medical conditions and specific diseases.
The Green Book (immunisation against infectious diseases) online Immunisation against infectious disease, also known as the Green book, has the latest information on vaccines and vaccination procedures in the UK. (Please note that The Green Book was last published in 2006, and paper copies are now very out of date and should not be used)
Vaccination of individuals with uncertain or incomplete immunisation status (2020) The PHE immunisation algorithm provides advice on immunising individuals with uncertain or incomplete immunisation status. Some individuals may not have been immunised or there is an unreliable history of their immunisation status. Every effort should be made to clarify what immunisations they may have had however, where there is no reliable history of previous immunisation, it should be assumed that individuals are unimmunised and the full UK recommendations should be followed. Reference: Green Book Chapter 11 Algorithm for vaccinating individuals with uncertain or incomplete immunisation status.
Last updated July 2020
Vaccine Incident Guidance (2019) NHS, Health Protection Scotland vaccine incident guidance which advises on the actions to take in response to vaccine errors and considerations and general principles for revaccination.
Revised recommendations for the administration of more than one live vaccine (2015) Recommendations for giving more than one live attenuated vaccine in current use in the UK. In 2014 the JCVI agreed that the guidance to administer the vaccines on the same day or at four week intervals should not be generalised to all live vaccines and the guidance updated.
World Health Organisation (WHO): Immunisation schedule by country (2018) The WHO has a summary website of immunisation schedules by region and country. This is a very helpful resource when trying to calculate what the routine vaccine recommendations for specific countries are and may help in devising a catch-up vaccine schedule in the UK. To identify the routine vaccines in a specific country select it from the Drop down list, select all vaccines and click OK
WHO Vaccine Safety The WHO Vaccine Safety Net is a programme to help internet users find reliable vaccine safety information tailored to their needs. Websites are reviewed against criteria for good information practices (content, credibility, design/accessibility). This site is particularly useful as it links to vaccine information in multiple languages.
TRAVAX is funded by the Scottish Government Health Department and is provided free to those using the service for NHS purposes in Scotland. It is a very useful resource for Up-to-date travel health information for health care professionals.
Fit for travel is a public access website provided by the NHS (Scotland). It provides general travel health advice and disease prevention information for people travelling abroad from the UK
Email NSS.hpstravelteam@nhs.net forTravel Health General Enquiries at Health Protection Scotlandor call 0141 300 1100.
The Public Health Protection Unit (PHPU) is responsible for key aspects of communicable disease and infection control, emergency planning, waterborne incidents, chemical and microbiological incidents and environmental health work.
We provide specialist advice and support to health staff working in the community (e.g. GPs, practice nurses, health visitors and staff nurses); hospitals; local councils; and other local organisations, and discuss and agree how best to deliver health protection locally.
We investigate and manage a full range of health protection incidents (including outbreaks of diseases such as meningitis and food poisoning) and carry out surveillance, co-ordination, support and the monitoring of certain key national programmes.
We co-ordinate immunisation within the Board area.
Contact Details and Personnel
PHPU West House Gartnavel Royal Hospital 1055 Great Western Road Glasgow, G12 0XH
This page provides information on the NHS Greater Glasgow and Clyde Healthy Minds – Adult Mental Health Improvement and Early Intervention Framework, a tool to enable the public health workforce across Greater Glasgow and Clyde to effectively deliver mental health improvement for the adult population.
Mental health has been defined as a state of wellbeing in which the individual recognises their own abilities and is able to cope with normal daily stresses in life (World Health Organisation, 2005).
It is reported that 1 in 4 adults will experience mental health issues in any given year. Prevention and early intervention are vital and recovery is possible with the right support and resources.
Healthy Minds Framework
The NHS Greater Glasgow and Clyde Healthy Minds – Adult Mental Health Improvement and Early Intervention Framework is a tool to support the delivery of the public mental health agenda. The framework brings together a range of activities that have been demonstrated as having value in the promotion of good mental health for adults.
It is designed to be “read” in a bottom-up way, starting with consideration of the underlying determinants such as socio-economic factors, moving through social environment issues like challenging stigma and discrimination, then considering health promotion and primary preventative activities, with the upper tier of action being secondary preventative and recovery-oriented.
Adult Mental Health Policy Landscape: A useful planning tool to illustrate how the Healthy Minds Mental Health framework links to and supports key adult mental health policy drivers.
Adult Mental Health Apps, Helplines, and websites: A resource directory of mental health apps, helplines, and websites to support staff with signposting and sharing of information that is appropriate to need.
Transforming Adult Mental Health Poster: The resources illustrates what the framework can look like in action to support partners from across sectors to utilise it.
Adult Mental Health Supports Poster: A poster showing the ways in which mental health supports can be accessed; from 1 to 1 support, reading, group work, phone and online. The resources allow anyone working with adults to populate with their own update to date information on an ongoing basis, relevant to their organisation, locality area and wider. It is a reusable, wipe clean resource.
The Framework in Action
Respond Better to Distress
Unfortunately, some people can find it difficult to cope at times in their lives and may harm themselves or think of ending their life. We need to improve our responses to people in distress, both from services and the wider community, including action to prevent suicide and better support for people who self-harm.
If you are concerned about an individual’s mental health and wellbeing and feel they may be in distress, the GP should be their first point of contact, or contact NHS 24 on 111. If you feel the individual is in immediate danger, please call 999.
Resources
There are a range of suicide prevention and self-harm activities underway across Greater Glasgow and Clyde, visit the suicide prevention and self-harm pages to find out more.
Suicide alert Resources: for staff working in the Greater Glasgow and Clyde area to support you if you are talking with someone who may be at risk of suicide. It explains the ‘ALERT’ model and provides some ideas for putting it into practice, as well as useful information about support services and suicide prevention resources. Resources include a briefing note and prompt sheet. A resource directory of mental health APPS, helplines and websites to support staff with signposting and sharing of information that is appropriate to need.
Healthy Minds Pocket Guide – Our mental health and wellbeing card provides details for a mental health support organisation in each of the 6 Health and Social Care Partnerships; Glasgow City, Renfrewshire, Inverclyde, East Renfrewshire, East Dunbartonshire and West Dunbartonshire. It also provides helpful tips for looking after your mental health and wellbeing and who to contact if you feel someone is in distress.
Healthy Minds Basic Adult Mental Health (1): A session from our Healthy Minds Resource that aims to raise awareness of mental health, what can impact mental health, what to look out for if someone is struggling with their mental health, and what we can do to help protect and support mental health.
Promote Wellbeing for People with Long Term Conditions
Long-term conditions are defined as health conditions that last a year or longer, impact a person’s life, and may require ongoing care and support. People with long-term mental health problems have significantly poorer health outcomes with an up to a 20-year gap in life expectancy. Similarly, people with other long-term conditions are at higher risk of mental health difficulties.
It is important to promote holistic health for people with long-term conditions (“healthy body, healthy mind”), promote recovery approaches, and social inclusion. It is also important to include a focus on carers’ wellbeing as part of this agenda. The Healthy Minds Long Term Conditions (no. 6) session can help raise awareness of the impact that long-term conditions can have on mental health and explores strategies to help manage this.
Helplines
Anxiety and Stress Disorders: NHS Living Life provides a free telephone based service for people over the age of 16 feeling low, anxious or stressed. Call 0800 328 9655 lines are open Monday to Friday, 9.00am – 9.00pm.
Diabetes Scotland: Call 0141 212 8710, Monday to Friday, 9.00am – 6.00pm or email helpline.scotland@diabetes.org.uk Confidential helpline (charges apply) that can provide information about the condition and take time to talk through and explore emotional, social, psychological or practical difficulties.
Epilepsy Scotland: provide a free confidential helpline that provides information and emotional support to anyone affected by epilepsy. Call 0808 800 2200, Monday to Friday, 10.00am – 4.30pm.
NHS Inform: provides information on a range of illnesses and conditions and helps people make informed choices about their health and wellbeing.
Promote Wellbeing and Resilience with People & Communities
Resilience is a key factor in protecting and promoting good mental health and is defined as an individual’s ability to successfully adapt to life tasks in the face of social disadvantage or highly adverse conditions.
Being socially connected and resilient, both as individuals and communities, are now recognised to be powerful influences on mental health and wider wellbeing. This can be achieved through developing social connections, tackling isolation, building resilience, strengthening the use of community assets (including social prescribing), and strengthening self-care and peer support.
There are a wealth of initiatives happening across communities to help social connections and reduce loneliness and isolation. The Thriving Places initiative is an example of how communities are bringing people together with a focus on delivering local services, making the best use of the local community assets, and improving quality of life.
Resources
Healthy Minds Pocket Guide – Our mental health and wellbeing card provides details for a mental health support organisation in each of the 6 Health and Social Care Partnerships; Glasgow City, Renfrewshire, Inverclyde, East Renfrewshire, East Dunbartonshire and West Dunbartonshire. It also provides helpful tips for looking after your mental health and wellbeing and who to contact if you feel someone is in distress.
Mental Health in the Workplace: A resource that provides information about the range of resources, supports, websites, and learning opportunities available for staff working across Greater Glasgow and Clyde to support mental health in the workplace.
Adult Mental Health Reading List: A reading list of books has been created to help people self-manage any mental health or wellbeing issues, gain more understanding of mental health and wellbeing, and help people to feel less alone.
Promote Wellbeing and Resilience at Work
Workplaces have a key role to play in improving our nation’s health and quality of life. Good quality work represents an important force in promoting positive mental health, while unemployment and poor quality work are toxic influences.
The business case for supporting the mental health and wellbeing of employees is a strong one. The benefits include:
Fewer days are lost to sickness and absence.
Staff retention and lower staff turnover.
Improved productivity.
Improved team working and staff morale.
Mental Health in the Workplace: A resource that provides information about the range of resources, supports, websites, and learning opportunities available for staff working across Greater Glasgow and Clyde to support mental health in the workplace.
Healthy Working Lives is for employers in Scotland looking for workplace health, safety, and wellbeing information. This includes information on supporting the mental health and wellbeing of employees, what they can do, and access to resources to help with this.
See Me in Work – Supports employers and individuals to tackle mental health stigma and discrimination in the workplace.
Healthy Minds can be used by organisations and employers to raise awareness of mental health and issues that can impact mental health such as sleep, loss and grief.
Promote Positive Attitudes, Challenge Stigma and Discrimination
Despite supportive policies within Scotland, the experience of people with mental health issues in our communities remains poor. Mental health-related stigma and discrimination does not only occur within health and social care, but also within financial inclusion, employability, and education. This is in the context of the social determinants of health and equality issues predominantly amongst those with protected characteristics.
More than two-thirds (71%) of people with mental health problems in Scotland have experienced stigma and discrimination. In addition, 1 in 3 young people in every classroom will experience a mental health problem, and 3 in 4 say that they fear the reaction of their friends.
The impact of stigma and discrimination can be wide-ranging, including making someone’s mental health problems worse and stopping them from getting support.
Resources
Visit the Anti-stigma and discrimination page to find out more about some of the work being taken forward across Greater Glasgow and Clyde.
See Me is Scotland’s Programme to tackle mental health stigma and discrimination funded by the Scottish Government and managed by Scotland’s Association for Mental Health and The Mental Health Foundation.
Healthy Minds Stigma and Discrimination session (no. 15) aims to raise awareness of mental health stigma and discrimination and what can be done to help tackle it.
Tackle Underlying Determinants and Promote Equity
Health inequalities are the unfair and avoidable differences in people’s health across social groups and between different population groups.
To reduce health inequalities, action is needed to address the fundamental causes of social inequality which determine inequalities in income, employment, education, and daily living conditions.
Action is required across a broad spectrum of policy areas, involving a wide range of organisations. Resources and actions need to be reallocated from interventions that are not effective to those focused on reducing health and social inequalities with the prioritisation of social equity and justice.
This page provides you with information about the NHS Greater Glasgow and Clyde Healthy Minds – Children and Young People Mental Health Improvement and Early Intervention Framework.
What is the Child and Youth Early Intervention Framework?
NHS Greater Glasgow and Clyde have developed a Child and Youth Mental Health Improvement and Early Intervention Framework, a tool for anyone working with children and young people across each of the six Health and Social Care Partnerships to effectively deliver mental health improvement for these populations.
Improving children and young people’s mental health is a national priority action area. Evidence demonstrates, however, that there is no single intervention, therapy or programme that delivers mental well-being at a population level. Rather that young people require a number of prerequisites to develop resiliently and that these prerequisites span the school, family and community life of young people. The framework therefore outlines six key elements which the evidence shows us supports children and young people’s mental health and wellbeing. 10 Year Mental Health Strategy for Scotland and Children and Young People’s Mental Health Task Force: Recommendations
Child and Youth Mental Health Policy Landscape: A document illustrating how the framework links to some of the key policy drivers for child and youth mental health and how they interconnect to ultimately Get it Right for Every Child.
Child and Youth Mental Health Supports: A document which maps out the range of available mental health supports for children and young people to access, including websites, apps, and helplines.
Explore Each Section of the Framework
One Good Adult
The concept of ‘One Good Adult’ is to emphasise the importance of a dependable adult who can support and protect the mental wellbeing of a child and/or a young person. The presence of One Good Adult has been found to be a key indicator of how well a young person copes with their struggles. Although it’s important for young people to have One Good Adult, it is equally important to be that One Good Adult.
One of the most interesting pieces of Irish research was the ‘My World Survey’ a national study of youth mental health in Ireland, which revealed a number of findings about the real mental health needs of young people. The report promotes the concept of the ‘One Good Adult’; this is seen as important to the mental wellbeing of young people. Over 70% of young people reported that they received very high or high support from a special adult. The study strongly confirms that the presence of ‘One Good Adult’ is important to the mental health of young people. It has a positive impact on their self-belief, confidence, coping skills and optimism about the future. This ‘One Good Adult’ can be a parent, grandparent, teacher, sports coach or someone who is available to them in times of need.
Helpful Resources
Healthy Minds – One Good Adult Session: The One Good Adult session (number 12) from our Healthy Minds Resource can help raise awareness of the concept and what is means to be that one good adult.
Resilience Toolkit: Contains a One Good Adult activity session for children and young people, to help them identify the qualities a one good adult should have and who theirs might be.
Resilience Development in Schools
Schools play a key role in protecting and supporting the mental health of children and young people. A whole school approach to mental health and wellbeing can help children and young people develop the knowledge, understanding, skills and attributes they need for mental, emotional, social and physical wellbeing for now and in the future.
A whole school approach makes mental health everyone’s business and in doing so helps to eliminate stigma and discrimination and create a more understanding school community and society which values mental health equally alongside physical health.
Mental health and wellbeing should be embedded into all aspects of school life from Improvement Plans to the curriculum, consideration of the physical environment, ethos, resources, facilities, and its partnership working to enhance and extend expertise in the area of mental health and wellbeing.
Helpful Resources
Resources for Early Years, Schools, and Youth Providers: A comprehensive document that offers a range of suggested resources that can be used in early years, schools, by youth providers to help protect, promote, and support the mental health and wellbeing of children and young people. Whilst this is not an exhaustive list, the resources highlighted have been developed by Education and Health colleagues and National Mental Health organisations.
Healthy Minds Resilience Session: The Resilience session from our Healthy Minds Resource (number 13) can help raise awareness of what resilience is, what it means to be resilient, the benefits to mental health and what we can do to help develop resilience.
Resilience Poster: A poster that includes top 10 tips for developing resilience.
Resilience Toolkit: This Emotional Resilience Toolkit provides practical guidance in promoting the resilience of young people as part of an integrated health and wellbeing programme.
Resilience Development in Communities
Many children and young people have links to their communities and opportunities to be involved in various youth groups and clubs. Youth services, voluntary and community organisations are in a very good position to support the mental health and wellbeing of children and young people. For some children and young people they are more accessible than traditional statutory services, often reach the most vulnerable children and young people at risk of poorer mental health and many activities undertaken by community organisations already help support and improve mental health and wellbeing.
It is important that youth services, voluntary and community organisations have access to mental health resources and have a baseline knowledge and understanding of mental health and feel confident to intervene to help children and young people in situations of distress, including self harm and suicide.
Helpful Resources
Child and Youth Mental Health Supports: A document which maps out the range of available mental health supports for children and young people to access, including websites, apps, and helplines.
Healthy Minds Resilience Session: The Resilience session from our Healthy Minds Resource (number 13) can help raise awareness of what resilience is, what it means to be resilient, the benefits to mental health and what we can do to help develop resilience.
Resilience Poster: A poster that includes top 10 tips for developing resilience.
Guiding Through the Service Maze
For children and young people mental health problems can develop as a result of life circumstances like exam stress, transitions, caring responsibilities, relationships, sexual identity, poverty, unemployment, grief, illness and long term conditions and family imprisonment. Many of these mental health problems are mild and temporary and often manageable with help from supportive trusted adults like teachers, youth workers, parents/caregivers and peer groups. The problems pass as the child or young person moves on and finds new solutions. However, some children and young people may require support from an organisation who specialises in the area that is impacting on their mental health, such as bereavement.
It is important that children, families and young people have range of support options for early intervention and can be helped to find their way to appropriate help quickly.
Accessing Mental Health Support – Child and Youth Poster: A poster illustrating the different ways in which mental health supports can be accessed; from 1 to 1 support, reading, group work, phone and online. Anyone working with children and young people can download it to populate it with their own update to date information on an ongoing basis, relevant to their organisation, locality area and wider.
CAMHS Video: Watch this video from Child and Adolescent Mental Health Services (CAMHS) which includes information for referrers.
Still concerned?
For some children and young people they may be finding it difficult to cope and may think of ending their life, if you are concerned about a child or young person’s mental health and wellbeing and feel they may be in distress, their Doctor should be their first point of contact. If you feel the young person’s life in immediate danger please call 999 for assistance.
Responding to Distress
Unfortunately, some children and young people can find it difficult to cope at times in their lives. As a result, they may harm themselves or think of ending their life. It is therefore important that frontline staff working with children and young people are confident and supported to intervene and help children and young people in situations of distress, including self-harm and risk of suicide.
The NHSGGC Self-Harm Forum is a group of trainers who have completed the What’s the Harm: Self-Harm Awareness and Skills Training Course. They play a key role in building capacity across the board area to help standardise understanding of and responses to self harm when used as a coping strategy. If you want to hear more about their work, please contact us at ggc.mhead@nhs.scot.
Helpful Resources
Suicide alert resources: for staff working in the Greater Glasgow and Clyde area to support you if you are talking with someone who may be at risk of suicide. It explains the ‘ALERT’ model and provides some ideas for putting it into practice, as well as useful information about support services and suicide prevention resources. Resources include a briefing note and prompt sheet. A resource directory of mental health APPS, helplines and websites to support staff with signposting and sharing of information that is appropriate to need.
Promoting Children and Young People’s Mental Health and Preventing Self-Harm and Suicide: A series of animations co-produced by NHS Education for Scotland and Public Health Scotland. Developed to support the knowledge and skills of those in health, social care, and the wider public sectors who need to be informed about mental health, self-harm, and suicide prevention in relation to children and young people.
Child and Youth Mental Health Supports: A document which maps out the range of available mental health supports for children and young people to access, including websites and helplines.
Peer Help and Social Media
Love it or loathe it – digital and social media is here to stay. In less than a lifetime, digital devices and the internet have infiltrated every corner of our lives. Digital is the medium by which most young people conduct their lives; nearly all children went online in 2021 (99%), and the majority used a mobile phone (72%) or tablet (69%) to do so.
These young people don’t see a distinction between their online and offline lives. They are familiar with digital tools and know their way around them. In addition, some of the characteristics of the online world – anonymity and privacy – make it easier to talk about sensitive, potentially embarrassing subjects like their own mental health.
Helpful Resources
Aye Mind: We have developed a platform for anyone who works with children and young people to help them embrace digital tools to support their mental health and wellbeing. It includes practical ‘how-to’ guides for implementing digital tools in your local area, a directory of the latest digital tools and technologies, and a range of information on digital tools and technologies.
Online Harms – Useful Websites, Helplines, and Reporting Mechanisms: A document outlining the range of helplines, websites, and reporting mechanisms to support those who have experienced a variety of online harms. This includes cyberbullying, harassment, hate crime, online gambling-related harms, online sexual exploitation and abuse, scams and fraud, and content promoting disordered eating, self-harm, or suicide.
Further Reading
“It’s not safe and consistent”: Read our report sharing the lived experiences of young people using social media who have experience of self-harm, including the potential risks and protective factors social media offers them.
We have developed a range of free mental health planning tools and resources that are available for use. We also share monthly mental health snippets that feature a range of information across the life course; from resources, research articles, reports, events, and learning opportunities.
We will continue to add to this page – please contact us at ggc.mhead@nhs.scot* if you have any questions or would like to make a suggestion.
*Please note that this is a generic admin inbox and not monitored immediately. If you, or someone you know are in distress and need an immediate response call the emergency services on 999 or NHS 24 on 111.
Planning Tools
Listed below is a range of planning tools across the life course to assist with planning and prioritising mental health improvement.
Child and Youth Mental Health Policy Landscape: A policy landscape to highlight how our evidence-based child and youth mental health improvement prevention and early intervention framework links to some of the key policy drivers for child and youth mental health and how they interconnect to ultimately Get it Right for Every Child.
Adult Mental Health Policy Landscape: A policy landscape to highlight how our evidence-based mental health improvement framework links to and supports some of the key adult mental health policy drivers.
Mental Health Snippets
Our team produces and circulates a monthly mental health snippet that provides a range of information across the life course, including resources, research articles, reports, events, and learning opportunities. If you would like to sign up for our snippet, please contact ggc.mhead@nhs.scot.
We have developed a range of free resources on a range of themes that cut across the life course which are available for use:
Perinatal and Infant Mental Health
Resources
Perinatal and Infant Mental Health Good Practice Guide
A resource to support Health Care Workers, Third Sector Partners, and any community organisations that are in contact with, supporting and/or working with new and expectant parents. It is underpinned the nine protected characteristics as set out in the Equality Act (2010).
Greater Glasgow and Clyde Prevention and Early Intervention Guide
The Greater Glasgow and Clyde Prevention and Early Intervention Guide helps staff have conversations with parents about their mental health during the perinatal period and signpost to supports appropriate to their needs to prevent a mental health crisis from developing.
Accessing Mental Health Support – Child and Youth Poster
Accessing Mental Health Support – Child and Youth Poster: A poster illustrating the different ways in which mental health supports can be accessed; from 1 to 1 support, reading, group work, phone, and online. Anyone working with children and young people can download it to populate it with their own update to date information on an ongoing basis, relevant to their organisation, locality area, and wider.
Mental Health and Wellbeing Card
Mental Health & Wellbeing Card: Our Mental Health and Wellbeing Card provides details for mental health support organisations in each of the 6 Health and Social Care Partnerships; Glasgow City, Renfrewshire, Inverclyde, East Renfrewshire, East Dunbartonshire, and West Dunbartonshire. It also provides helpful tips for looking after your mental health and wellbeing and who to contact if you feel someone is in distress.
Child and Youth Mental Health Apps, Helplines, and Websites Supports
Child and Youth Mental Health Supports: A document that maps out the range of available mental health supports for children and young people to access, including websites and helplines.
Resilience Toolkit: This Emotional Resilience Toolkit provides practical guidance in promoting the resilience of young people as part of an integrated health and wellbeing programme.
Resources for Early Years, Schools and Youth Providers
Resources for Early Years, Schools and Youth Providers
Resources for Early Years, Schools, and Youth Providers: A comprehensive document that offers a range of suggested resources that can be used in early years, schools, and by youth providers to help protect, promote, and support the mental health and wellbeing of children and young people. Whilst this is not an exhaustive list, the resources highlighted have been developed by Education and Health colleagues and National Mental Health organisations.
Whole School Approach to Loss and Bereavement
Whole School Approach to Loss and Bereavement: This guidance aims to support practitioners to increase their knowledge and understanding on the subject of bereavement, loss, and change and how to support children and young people through this.
A resource pack for teachers and professionals working with children and young people. It includes teaching support materials and further information in the form of signposting to external resources and advice services, references, and linked where relevant to the Curriculum for Excellence and other national guidance. Download via the links below:
Self-Harm Resources and Supports is a comprehensive document for the wider public health workforce that brings together a range of self-harm information for staff relating to learning, resources and websites, helplines and keeping safe. The information is targeted at the Informed and Skilled levels as set out in the Mental Health Improvement and Suicide Prevention Framework.
Suicide Prevention
Suicide Alert Resources
Suicide alert resources: for staff working in the Greater Glasgow and Clyde area to support you if you are talking with someone who may be at risk of suicide. It explains the ‘ALERT’ model and provides some ideas for putting it into practice, as well as useful information about support services and suicide prevention resources. Resources include a briefing note and prompt sheet. A resource directory of mental health apps, helplines, and websites to support staff with signposting and sharing of information that is appropriate to need.
Transforming Adult Mental Health Poster: The resources illustrates what the framework can look like in action to support partners from across sectors to use it.
Adult Mental Health Supports Poster
Adult Mental Health Supports Poster: A poster showing the ways in which mental health supports can be accessed; from 1 to 1 support, reading, group work, phone, and online. The resources allow anyone working with adults to populate with their own update to date information on an ongoing basis, relevant to their organisation, locality area, and wider. It is a reusable, wipe-clean resource.
Healthy Minds Pocket Guide
Healthy Minds Pocket Guide – Our mental health and wellbeing card provides details for a mental health support organisation in each of the 6 Health and Social Care Partnerships; Glasgow City, Renfrewshire, Inverclyde, East Renfrewshire, East Dunbartonshire, and West Dunbartonshire. It also provides helpful tips for looking after your mental health and wellbeing and who to contact if you feel someone is in distress.
Adult Mental Health Apps, Helplines and Websites
A resource directory of mental health apps, helplines, and websites to support staff with signposting and sharing of information that is appropriate to need.
Self-Harm Resources and Supports is a comprehensive document for the wider public health workforce that brings together a range of self-harm information for staff relating to learning, resources and websites, helplines and keeping safe. The information is targeted at the Informed and Skilled levels as set out in the Mental Health Improvement and Suicide Prevention Framework.
Suicide ALERT resources: for staff working in the Greater Glasgow and Clyde area to support you if you are talking with someone who may be at risk of suicide. It explains the ‘ALERT’ model and provides some ideas for putting it into practice, as well as useful information about support services and suicide prevention resources. Resources include a briefing note and prompt sheet. A resource directory of mental health apps, helplines, and websites to support staff with signposting and sharing of information that is appropriate to need.
Self-Harm Resources and Supports is a comprehensive document for the wider public health workforce that brings together a range of self-harm information for staff relating to learning, resources and websites, helplines and keeping safe. The information is targeted at the Informed and Skilled levels as set out in the Mental Health Improvement and Suicide Prevention Framework.
Suicide Alert Resources
Suicide Alert Resources: for staff working in the Greater Glasgow and Clyde area to support you if you are talking with someone who may be at risk of suicide. It explains the ‘ALERT’ model and provides some ideas for putting it into practice, as well as useful information about support services and suicide prevention resources. Resources include a briefing note and prompt sheet. A resource directory of mental health apps, helplines, and websites to support staff with signposting and sharing of information that is appropriate to need.
Please read the following information and then use the links at the bottom of the page if you are looking for further information or exercise.
Important facts about your elbow
Here is a list of the main problems and concerns when we would recommend you get checked out by a health professional before commencing self-management exercises. These are called Red Flags and may indicate a more serious problem that requires medical assessment.
Symptoms That Are Present After Trauma
If your symptoms are caused by a recent traumatic incident (e.g. a fall, football tackle) and you have any of the following symptoms:
Significant bruising and swelling in the area
Difficulty in moving elbow or seems locked in one position
Looks a different shape to the other side, new lumps and bumps that have appeared since the injury.
Loss of ability to use your hand normally.
Note: If you have an underlying poor bone density (e.g. osteoporosis) smaller amounts of force can cause the problems listed above.
Symptoms Where No Trauma Was Involved
Hot, red and/or swelling of elbow
Tingling, numbness and/ or pins and needles into arm, hand or fingers
Worsening weakness in your arm and/or loss of movement
Unexplained lumps or bumps which are changing/growing
Fever and generally feeling unwell at same time as elbow pain developed
Pain and/ or stiffness in other joints at the same time as elbow pain developed
Constant pain which appears to not change with rest/ activity.
Significant worsening pain at night in bed
Unexplained weight loss and/ or previous history of cancer.
NOTE: Special attention should be taken if you have a history of long-term steroid use/immunosuppressive drugs, recent joint replacement, surgery, steroid injection. Rheumatoid arthritis or other joint disease. Recent infection, intravenous drug use or alcohol misuse.
Here are some specific exercises to help you get your arm moving better. You may need to build these exercises up gradually.
You may be uncomfortable when you start doing these exercises – make sure the level of discomfort feels acceptable to you and that it doesn’t take too long to settle once you are finished.
The exercises should get easier the more consistently you manage to practice them and this may allow you to progress to more difficult exercises.
These are self help exercises:
Try to enjoy the exercises and work at a pace and level that feels safe
Please use a common sense approach when deciding which ones to try
The exercises listed are not designed as an alternative to professional advice.