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Transcript of MAKING THE BIG SOCIETY BIGGER working towards citizenship and connectedness for people with Mental...
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)
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
Aim of the SHARP
Decrease distressing symptoms Reduce relapse Promote Healthy Living Enable new and innovative practice Increase Social Inclusion
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...
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)
SHARP’s definition of social inclusion
To support individuals to explore
participating in activities that are
meaningful to them
Employment
Education
Volunteering
Arts and Culture/Leisure
Faith and cultural communities
Family & neighbourhood
Sport & exercise
Services
MotherVocations Matters
STAFF
Brixton RecreationCentre
Healthy Living Group
Bowling & cinemaFriends Pub
Lambeth College
CMHT, SHARP
GP
Local shops
Church Museums
Developed by NDTi
Captures the people and places that a service user has contact with in a two week period of time.
THE INCLUSION WEB
Voluntary work
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?
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
The WebOuter circle is places and Inner Circle is people
Employment
Education
Volunteering
Arts and Culture
Faith and cultural communities
Family & neighbourhood
Sport & exercise
Services
Places People
Employment 0 0
Education 0 0
Volunteering 0 0
Arts & Culture 0 0
Faith & Cultural 0 0
Family & Neighbourhood
1 1
Sports 0 0
Services 3 3
CMHT
GP
Care Co-coordinatorGP
SHARP workers
Prison
Brother
Grandmother
Uncle
Mother & Father
Mum’s house
Used to go to galleries
SHARP Team, 2007
Employment
Education
Volunteering
Arts and Culture/Leisure
Faith and cultural communities
Services
CMHT
GP
Mother & Father
Brother
Grandmother
Uncle
Vocations Matters
SchoolCare Co-coordinator
Comic Shop
Art Therapy
Art Therapist
Library- Learn Direct
Thrive Gardening course
Gardening Crew-Supported employment
Bookshop Volunteer Option
Gym GroupBrixton RecreationCentre
Clapham Gym
Wheels 4 wellbeing
YMCA
Flaxman centre
Healthy Living Group
GP
SHARP workers
Garden crewmembers
Bowling & cinemaFriends
Pub
Art galleriesMuseum
Parks
Bowling
Photography course
Prison
Café Common
Football
Lambeth College
Family & neighbourhood
Sport & exercise
Places People
Employment 1 1
Education 5 0
Volunteering 2 0
Arts & Culture 8 2
Faith & Cultural 0 0
Family & Neighbourhood
1 1
Sports 5 2
Services 3 3
Mum’s house
The WebOuter circle is places and Inner Circle is people
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
What does this mean?
Working with people who have: high relapse rates Complex needs Disrupted lives due to illness
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
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
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)
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
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
Traffic light system Focus on impact of environment on S.Ii.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
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.
Case study continued
First contact with services
Attends SHARP groups
Linked in with community based groups
A&E
CMHT
SHARP
GYM GROUP
HEALTHY LIVING GROUP
LAMBETH COLLEGE
SPORTS ACTION ZONE
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?
Activity
Group Feedback
Putting the meaning back in meaningful activity!
Working out where to start
Explore values Address motivation for change Choose achievable things Problem solve Advocate
Activity
Exploring Values according to an ACT frame of reference
ACT model
Activity continued
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
1. Values are now/ Goals are in the future
2. Values never have to be justified
3. Values often need to be prioritised
4. Values are best held lightly
5. Values are freely chosen
Activity 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 goalTaking your thoughts along for the ride
Questions?
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.