MAKING THE BIG SOCIETY BIGGER working towards citizenship and connectedness for people with Mental illnesses

1. MAKING THE BIG SOCIETY BIGGER working towards citizenship and connectedness for people with Mental illnesses Anna Croucher (senior Occupational Therapist & service development lead) and Sarah Josefsberg (Senior Occupational Therapist)

2. Overview of the workshop • Explore the concept of social inclusion and social exclusion • Provide an overview of SHARP • Consider services in relation to a ‘traffic light model’ • Practically use an activity to establish values

3. Aim of the SHARP • Decrease distressing symptoms • Reduce relapse • Promote Healthy Living • Enable new and innovative practice • Increase Social Inclusion

4. So what is SOCIAL INCLUSION ?? • Its about lots of things!! • Physical and psychological involvement (Labonte 2004) • Connectedness, citizenship and belonging (Morgan et al 2007). • Temporal, relative and subjective (Le Boutiller and Croucher 2010) • The people and places (Hacking & Bates 2008) • The opposite of social exclusion? • But do people WANT Social lnclusion...

5. Social Inclusion Vs Social Exclusion • Exclusion relates to structural barriers that exclude an person: • Democratic and legal system • The labour Market • Welfare state system • Family and community system (Commins 1993) • Inclusion works on individual level • The extent to which people are accepted and feel that they belong to different social contexts (Secker 2009)

6. SHARP’s definition of social inclusion To support individuals to explore participating in activities that are meaningful to them

7. THE INCLUSION WEB Developed by NDTi Captures the people and places that a service user has contact with in a two week period of time. Voluntary work

8. But how socially included are we? SI is underpinned by the assumption that ‘normal people’ are themselves socially included... Activity: Talk with your partner and with reference to The Web think about: • How socially included do you feel? • What areas do you feel you are socially included? • What would YOU do to become more socially included?

9. The Web: Case Study • 28 year old man. • Living with family. • Has a history of depression since his teenage years. • Never been employed and has poor literacy skills. • Explains that he is shy and feels he lacks confidence, especially expressing his needs in one to one situations. • Likes art and is interested in computers. SHARP Team

10. The Web Outer circle is places and Inner Circle is people Services Employment Prison CMHT GP GP Sport & exercise Care Co-coordinator Education SHARP workers Mother & Father Brother Mum’s house Uncle Volunteering Grandmother Family & neighbourhood Used to go to galleries Arts and Culture Faith and cultural communities  SHARP Team, 2007

11. The Web Outer circle is places and Inner Circle is people Employment Services Gardening Crew- Supported employment CMHT Prison GP Sport & exercise Football GP Flaxman centre School Care Co-coordinator Education YMCA Lambeth College SHARP workers Garden crew members Wheels 4 wellbeing Library- Learn Direct Healthy Living Group Clapham Gym Thrive Gardening course Gym Group BrixtonRecreation Centre Photography course Mother & Father VocationsMatters Brother Mum’s house Uncle Bookshop Volunteer Option Art Therapist Grandmother Family & neighbourhood Bowling & cinema Friends Volunteering Pub Parks Bowling ComicShop CaféCommon Art Therapy Art galleries Faith and cultural communities Museum Arts and Culture/Leisure

12. Psychosis • Incidence of schizophrenia in Lambeth 4x higher than average (Garety and Rigg 2001) • Lambeth PCT spends £60m out of budget of £400m on mental health • Cost of relapse £8212 compared to £1899 if no relapse • 27% of clients who have engaged with us had a hospital admission or HTT contact in year before referral

13. What does this mean? Working with people who have: • high relapse rates • Complex needs • Disrupted lives due to illness

14. How was SHARP set up? • A feasibility study involving stake holders and service users in development • Funding from GSTT Charity & reconfigured existing team • Provide evidence-based interventions which help clients move on • No care coordination • Recovery ethos- Social Inclusion Hope and Recovery Project • Evaluation of interventions and service • Launched May 2007

15. What do SHARP offer? • Social Inclusion Therapy • CBT for Psychosis • Family Intervention • MI for substance abuse • Healthy Living/ Gym/ Football/ Aqua Groups • Gardening/ Creative writing • Mindfulness • ACT • Research activity

16. How is SHARP different to other services? • Easy telephone referral • Solution-focused assessment • Intervention based on client choice- An opt in service • Integrated psychological and social interventions • All interventions evaluated by outcome and the service is constantly evolving and improving based on findings i.e. Tea party • Recovery oriented: ‘A sense of hope and identity, where people belong and can make sense of their experiences’ (SHARP, 2010)

17. How do we achieve social inclusion? • National Development Team for inclusion- Peter Bates: Traffic light model, how socially inclusive are services? ‘Disability places’, with service users and staff ‘Ordinary places’, with service user-only groups ‘Shoulder to shoulder’, with general public

18. NDTi model views inclusion as • Access: Being able to utilise services and places in the community • Standard of living: That meets your needs maintains quality of life • Relationships: Having support, someone to share things with, knowing someone cares

19. Traffic light system • Focus on impact of environment on S.I i.e. Café vs. Hospital • Increasing inclusiveness of settings, advocacy in combating stigma- 80% report as biggest barrier i.e. Offering training to staff at Brixton Rec • Increasing community links i.e. moving from red to amber i.e. Creative writing group in library

20. Case study • Janet is a 19 year old ex college student with a diagnosis of psychosis. She has spent the last 2 years withdrawing and isolating herself. She has been living at home with her mother and 2 younger siblings and has been virtually housebound due to constant paranoid thoughts that a gang in her local area are coming for her.

21. Case study continued Attends SHARP groups Linked in with community based groups First contact with services A&E CMHT SHARP LAMBETH COLLEGE SPORTS ACTION ZONE GYM GROUP HEALTHY LIVING GROUP

22. Activity: • Groups of 4-6 people • What services fit into RED/AMBER/GREEN? • What are the advantages and disadvantages of services at each level? • How do you support people to move on to the next level?

23. Activity • Group Feedback

24. Putting the meaning back in meaningful activity!

25. Working out where to start • Explore values • Address motivation for change • Choose achievable things • Problem solve • Advocate

26. Activity • Exploring Values according to an ACT frame of reference

27. ACT model

28. Values are ‘desired qualities of ongoing actions’. They are a compass that guide and give you direction and can help you stay on track. Goals vs. Values: Marriage vs. Being Loving Activity continued

29. Activity continued • Values are now/ Goals are in the future • Values never have to be justified • Values often need to be prioritised • Values are best held lightly • Values are freely chosen

30. Complete PART 1: identifying values What do I stand for as a person? What would they say about me at my eulogy? Complete PART 2: making a commitment Setting a short term goal Taking your thoughts along for the ride Activity

31. Questions?

32. References • Hacking, S., Bates, P., (2008) The inclusion Web: a tool for person centred planning and service evaluation. Mental health Review journal, 13 (2) 4-15. • Labonte, R. (2004) Social lnclusion/exclusion: dancing the dialectic. Health promotions international, 19 (9) 115-21 • Le Boutiller, C., Croucher, A. (2010) Social lnclusion and mental health, British Journal of Occupational Therapy, 73 (3) 136-140. • Morgan, C., Burns, T., Fitzpatrick, R., Pinfold, V (2007) Social inclusion and mental health: conceptual and methodological review. British Journal of Psychiatry, 191 (6) 477-83. • Secker, J. (2009) Mental health, social exclusion and social inclusion, Mental health review 14 (4) 4-11. • Commins, P., (1993) Combating Exclusion in Ireland 1990-1994, A Midway report. Brussels: European commission.