Participation for Wellbeing Developing a Model

1. Participation for WellbeingDeveloping a Model Jan Thompson Public Health Specialist Northumberland County Council

2. Principles • OT evidence base for meaningful activity • We are what we do • Meaningful activity facilitates autonomy, choice and control • Social beings • Participation builds physical, emotional, social, economic resilience. • Not just an NHS issue • Barriers are greater for some • The arts can provide a vehicle for self determination

3. Who to target • Those with the most to gain are the least likely to engage. • LTC? • MH problems? • OR – those at risk of MH problems

4. Inclusion criteria – at risk of mild to moderate MH problems Not regularly taking part in leisure or cultural activities. Benefits received (or appealing for) – list benefits and allowances Single parents Unemployed Been in hospital in last 2 months Physical or Learning Disability Autism Aspergers syndrome Victim of recent crime Domestic violence Frequent GP attendance – 12x per yr LGBT Pregnant Veteran LAC Had adaptations to home for mobility Receives homecare, personal budget On caseload of OT, SW Drug and Alcohol or Mental Health Team On SMI register In criminal justice system, or probation Arrested in last year, or more than once Been in prison in last 5 years Close family member in the criminal justice system Over 50 – account for the greatest proportion of the health inequalities gap Extracare scheme Not white British Traveller Migrant Asylum Seeker Dementia or cognitive impairment Parent with child under 3 Bereaved can last many years Long Term Condition Smoker Carer Woman aged 45-55 Young parent – Under 23 Alcohol intake +14 units week for women +21units week for men (or binge levels) Fewer that 5 GCSE Grade C or above Worried/Anxious or depressed CYP with SEN Recently separated/divorced/relationship ended Had children before age 19

5. Five evidence-based steps to improve mental wellbeing. • Get active • Connect with others • Keep learning • Be aware of yourself and the world • Give to others

6. A hub to enable participation

7. Social Prescribing • Prescription (medical) v Social Model • Funds from PH, LA and CCG for a hub (medical model). • Single referral point • Triage to match with local suitable activity • Meet the person, participate alongside • Options to change, encourage return • Evaluation – Warwick and Edinburgh Mental Wellbeing Scale – pre and post 10 weeks • Qualitative questionnaire

8. WEMWBS - 14 questions Eg. I’ve been feeling optimistic about the future (useful/relaxed/ thinking clearly/dealing with problems well/feeling close to others……..) • Group mean wellbeing scores. Score of 41–59 is average • Min score 14. Max score 70 • Local area may have average population score available to benchmark. • Average increase 12 points after 10 weeks participation http://www.healthscotland.com/scotlands-health/population/Measuring-positive Mentalhealth.aspx Tool, evidence base, and manuals for use, user guide, FAQs and practitioner guide. Free to use – permission from Frances.Taggart@warwick.ac.uk

9. Mental Wellbeing Impact Assessment Toolkit • Participation/inclusion – Individual: sense of belonging, valued role, respected, involved Community : opportunities, affordability, conflict resolution, practical support 2. Resilience- Individual: emotion, cognition, meaning, learning, lifestyle Community : trust, safety, networks, space, economy, culture 3. Control – Individual:skills, attributes, circumstances Collective: workplace, community, resources Undertake the toolkit with providers and end users. Understand the extent to which the model enhances positive impacts on these factors, minimises negative impacts. Local action plan emerges. 3-4 trained people to deliver a workshop. Reveals really practical top priority actions.

10. Fundamental questions • What does great art do – opens up possibilities, offers hope, freedom, touches something in us we didn’t see before, offers insights into solutions, and narratives. • Transcendental and transformational moments or more basic - resilience and autonomy. • Gives control, time out, safety, companionship, more basic needs. Balances emotions, calm.

11. Entering a state of flow Leslie Owen Wilson 1997, 2004, • Creativity is generally addictive for a very good reason … the sensation of being in a state of full concentration or hyper-concentration is both pleasant and productive. The author MihalyCsikszentmihalyi devotes three works to this and related topics. He describes this state of "flow" as: • Over and over again, as people describe how it feels when they thoroughly enjoy themselves, they mention eight distinct dimensions of experience. These same aspects are reported by Hindu yogis and Japanese teenagers who race motorcycles, by American surgeons and basketball players, by Australian sailors and Navajo shepherds, by champion figure skaters and by chess masters.

12. Creative People and PlacesSE Northumberland • £2.5 million over 3 years – Arts Council • Increase participation in the arts in SE Northumberland. Enable engagement with Great Art • Those at risk of mild to moderate MH problems – least likely to engage • Participate more than once • Change in health behaviours/choices • Participation, Resilience, Control • Improve wellbeing

13. This, that, or the other? • Is solitary confinement better than Big Brother House • Is gardening better for wellbeing than making a cake to share • Read a ‘literary classic’ alone or discussing as part of a book club • In a choir or watch a film, or create a sculpture, or climb a mountain – alone or with others, • Write, direct, act in, or watch a play – or to paint the scenery. • Care for animals or plants • Tell a story or to listen to one • Be in a knit and natter group, dance, ride a horse, swim or take an exercise class Which will most increase wellbeing, increase resilience, enable insight into the possible, ignite hope, optimism, transform or enable transcendence/flow/self actualisation?

14. Final thoughts Focus on the need The person in context is everything – To become agents of their own change people need self-determination…to express…connect…transform…have hope…aspiration To see more than a perceived social reality...feel self worth…and beyond themselves…to the possible The arts provides a vehicle – something for everybody