Darzi – prevention is better than cure – but what does that mean for mental health? MH = Illness not well-being – its got nothing to do with us – MH = SLaM
Link to LAA target Story about shot gun and local police/young people
What we know is that the treatment for mental illness is very different to the “treatment” for well-being. Because people well-being needs are not met in mental health services but in families, schools workplaces and communities. The Foresight Report also commissioned the New Economics foundation to come up with simple messages to promote well being. These are known as the 5 a day to well being and can be promoted individually or through community settings. Connect – the cornerstone of your well-being, connected communities – Putnam bowling along Be active – really strong link – e.g about physical activity in mid life as a protective factor for dementia Take Notice – savour the moment, appreciate what around you and other – gratitude diaries, power of positive emotion – Penn resilience programme Keep learning – for the love of learning – gain a protective factor in later life Give – strong evidence around volunteering and well-being, older people who look after others e.g. grandchildren and life expectancy In Slam we have contact with the 2% of the population who have the most severe mental illness it will not be what we do that promotes and protects mental capital. These are key areas that you have influence over. We see our role as supporting you in this area and in your packs there are some example from around the country and also information about the well being interventions we have developed
We can define it (pleasure meaning and purpose), we can measure it and we have a growing understanding of what impacts on it. 5 ways to Well-being. But how to you apply it. Largely positive psychology has been used with individuals and more recently taught in schools such as Wellington college. But what really interested us was how might you apply this to communities in London. For the next 10 minutes I am going to talk a little about our attempts to do this through our DIY happiness programme. It comes however with a health warning of its own, this is a new programme and although early responses to are very favourable we are a way off being able to categorically say that it works.
2 years ago we were part of a successful bid to the Big Lottery well-being fund called Well London. I am not going to talk much about it , on your tables you will have copies of a leaflet that tells you what, well London is about, who the partners are and what programmes we are running. The particular programme I am going to talk to you about is DIY happiness‘ Well London is working in the so called 20 most deprived communities in London, areas with low levels of physical activity, high levels of obesity and mental illness. And there in lies our challenge. Many of these areas have had a range of health initiatives over the years and we felt generally it is not a knowledge issue in terms of physical health, generally people knew they should eat healthily, take more exercise and drink in moderation but still did not do it. Our challenge was increased by the fact that most people when you talk about mental health don’t think health they think illness, they think schizophrenia or manic depression not mental well-being. Our starting point was that we needed to develop a programme that grabbed people’s attention, a programme that would start a conversation and a dialogue around happiness and well-being,
One of the things that inspired us was a piece of work we were involve in on an estate in Lambeth. Working with the PCT we ran an open space event called what will make Tulse Hill happy? We had a fairly low turn out and the sorts of things that people tallked about were “The community flat needed decorating and was not used very much, there was a herb garden that was started and not finished, the trees needed pruning, there was nothing for young mums to do with their toddlers. There was a real sense of people waiting for the council to do something, a learned helplessness. At the end of the consultation we had about £350 left over which we decided to give to the local residents to address some of the issues themselves. With that £350 they bought art and craft materials and run session for mothers and toddler in the community flat, they bought paint and painted the inside of the flat and worked together to paint a mural on the outside. What was striking was what people could achieve with just a small amount of money, much more than we could.
So the question for us was if you gave local people the money, what would they do with it? Could they buy happiness for themselves, their families and communities? So DIY happiness was born.
This is our wheel of well-being and each workshop looks at one segment of the wheel and each workshop builds on the last. They also relate to the evidence base and we used 5-ways to well-being postcards produced by NEF as part of the Foresight report into mental well-being and capacity as the model. So connect is people, Be active is body, Take notice is place/planet, keep learning is mind and give is spirit. In this way we have a consistency of message. Key to us though was not tell people what to do but for people to explore and work things out for themselves, so each of the workshop is about experiencing the area that we are looking at.
I am going to pick on one area to illustrate our approach. The Mind relates to the keep learning message from the 5 ways to wellbeing, so this workshop was all about learning and the importance of learning.
The first thing we did was make all the rooms look nice, put table cloths on the tables, the room had flowers and bright decorations and we made sure the refreshments were of a high standard, we wanted people to feel valued. To create the right environment. Rather than starting from the point of trying to change the way people think to improve the way they feel we start with trying to improve how people feel to improve their ability to think positively.
We start with one minute cartoons. People are paired off and asked to draw a cartoon of their partner. As you might expect we had lots of “oh I can’t draw” but the exercise has a catch, you have to keep your eyes on your partners as you do the drawing and not look at the paper. This is Mariam, she had not really participated in the first few workshops and generally look pretty glum, but a least she kept coming back. This session was a real break through when she saw the portrait that her partner had drawn of her she could not stop laughing, and it was infectious, everyone join in and it really got people in a good place to start to think about what we were doing. .
The next part of the workshop was learning to flower arrange. Again it started off with one or two people saying they could never learn to do it. But within 20 minutes everyone had produced a beautiful bouquet. The point was not that flower arranging makes you happy but that we can all learn. And if you can learn to flower arrange what else can you do? – A sense of the possible. It lead to a wide ranging conversation about creativity, the enjoyment of learning something new, concentration and a sense of flow and what happened to your cares and worries.
And this is the pattern of all the workshops – undertake and experience an activity that demonstrates one of the 5 a day for mental well-being then have a conversation about how it make us feel. The final workshop is called secret millionaire and people use to this is where people tell each other how they are going to spend their happiness budget based on all they have experienced and learned. And this is the point we have now reached in the first 3 boroughs. Currently the participants of the workshops will spend their happiness budget on the ideas they have developed. The next stage is for people to spend their budgets. We then bring people back together to see whether what people did made them feel any happier, how many other people they involve, to gauge whether they are talking to their friends and families about whether money can buy London happiness . The final part of the programme will be see how we can get the communities to spread the message based on what they have learned. currently we are think about working with communities to develop happiness kits and use the arts and performance as a medium.
Promoting Mental health and well-being Tony Coggins Head of Mental Health Promotion
Foresight Report (2008) “Achieving a small change in the average level of well- being across the population would produce a large decrease in the percentage with mental disorder, and also in the percentage who have sub-clinical disorder (Languishing)”
SLaM’s Core Value“Everything we do is to improve the experience of people using our services and to promote mental health and well-being for all”
To work in Partnership to promote mental well-being• Influencing for mental well-being• Building Capacity and understanding• Developing mental well-being services
Mental Health Promotion ProtectiveRisk factors factors Individual Community Structural
Mental Health Promotion Unemployment Poverty ProtectivePoor education Risk factors factors Inequalities Poor living conditions Individual Community Structural
Mental Health Promotion Control Resilience and Protective communityRisk factors factors assets Participation Inclusion Community Structural
Mental Well-being Impact Assessment (MWIA) A pioneering methodology that enables a wide range of organisations and programmes to understand and demonstrate their impact on mental well- being
MWIA is based on four key factors which promote and protect mental well-being• Enhancing Control• Increasing resilience and community assets• Facilitating participation• Promote inclusion (adapted from DOH 2001)
Indicators - an Example Clapham Park TimeBankFactor Determinant How do you know? Data collection FrequencyControl Control over Through things Percentage of time bank Annual influencing things in happening hours spent influencing your local community. People’s storiesResilience Being involved in People give time Survey Annual your community. Donate talentsParticipation & informal support People support each Percentage of “out of hours” AnnualInclusion friends, groups. other outside of timeBank timeBank credits hours Survey
Achievements and Developments •Over 400 MWIA’s have been completed on a wide range of strategies, programmes and projects •A national MWIA collaborative has been formed to integrate MWIA into public health policy and practice at a national level •An update of the toolkit will be published in 2010 •200 people have been trained to undertake MWIA’s“Use it (MWIA) widely, encourage its use by others and be successful in your desire to improve the mental health of the country.” • Work is currently taking place onChief Executive, NHS Northwest Mike Farrar CBE, a version for young people
Mental Health Promotion What do we do? Connect Be active Protective Risk factors Take notice factors Keep learning Give Individual
Five ways to well-beingCommissioned by theForesight Project tosummarise the evidencefrom the Mental Capital andWellbeing Project into 5 keymessages
“When I was young I used to thinkthat money was the most importantthing in life. Now that I am old Iknow it is” Oscar Wilde.“Money isn’t everything but its wayahead of whatever is in second place” Anon.
“The look of it makes my mind happy” Laila (Tower Hamlets DIY)
“I found I can really draw well when I amfocused on it”
“For that 15 -20 minutes I was actually feelingquite light and felt as though I have no problems in the world”
“I have really enjoyed coming to this workshop. It really is a DIY happiness course”