MSC Trailblazer report AB final1 - · PDF fileas an appropriate method. The MSC technique is a...

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Contents

Page

Tributes 2

Foreword 3

Executive summary 4

Introduction 8

Background 9

Programme Planning 10

Evaluation Methodology 12

Evaluation Process 14

Results 15

Stories of Most Significant Change 16

Beyond the Therapy Room:

The ‘Tree of Life’ at the British Museum 24

Promoting Community Awareness: New Hope Ministries Session 24

Promoting Professional Awareness 26

Conclusions and Recommendations 27

References 29

Appendix 1: Guidance for facilitators 31

Appendix 2: Participant Information Sheet 31

Appendix 3: Consent Form 32

Appendix 4: Stories of Most Significant Change 33

Appendix 5: Session Plan for ‘New Hope Ministries’ Session 41

Appendix 6: Evaluation Feedback From ‘New Hope Ministries’

Session 41

Acknowledgments 42

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Tributes To Graham Caren by Naomi Scott The Trailblazer project would not have happened without one of our colleagues who,

sadly, is no longer with us. We would like to make a dedication to Graham Caren our

former Deputy Borough Director in City & Hackney, who passed away in 2011.

Graham was a firm believer in equality of access and was prepared to think

creatively about how to ensure that the services we provide are acceptable to the

people in our local area who are entitled to access them. Graham was instrumental in

securing the funding for the Department of Health Trailblazer project and setting up

the partnership between Mellow, the BME Access Service and Psychotherapy within

which this work was developed. Graham would have been delighted to know what an

incredible impact the Tree of Life had on the service users who participated in the

group, as well as on the Recovery-focused work in the Trust at large.

To Eddie by Angela Byrne We also dedicate this report to our friend and fellow Trailblazer, Eddie, who sadly

passed away in 2011. Eddie generously shared his Tree of Life with the group and

told of the inspiration he had drawn from Marcus Garvey and Bob Marley. He led us

to this statement of Marcus Garvey, which continues to inspire us in our work.

“A people without the knowledge of its past history, origin and culture is like a tree without roots”

To Pastor Segun Olaleye by Sandra Griffiths Pastor Olaleye was a longstanding supporter of Mellow’s work. I met him almost 10

years ago as part of my efforts to make a connection with faith and mental health. I

was met with warmth and understanding. The Pastor described eloquently the

importance of the church supporting its members and the wider community who

experienced Mental health problems. He sought our advice on members of his

congregation who experienced distress, gave presentations to GP students on

mental health issues and on 22nd May 2010 invited us to give a presentation at his

church about the Tree of Life. I remember talking with him about the presentation

earlier that year. He immediately saw a spiritual dimension to the Tree of Life and

helped me further understand the importance of faith as a key ingredient in the

recovery for many of the Trailblazer participants. He was a man that put faith into

action. In the Book of Proverbs, the tree of life is associated with wisdom. Pastor

Olaleye showed wisdom in abundance. We dedicate this report to both his gifts of

wisdom and faith.

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Foreword: Second trailblazers report

A frequent response by the black client is to stop and leave therapy

often silently. Another response is not to enter in the first place –

which is the loudest silence of all. H. Morgan 1998

Over the years I have asked several professionals their views on why certain sectors

of the black British population seek therapy at lower rates than their white

counterparts. Invariably the response is this: that in the 21st century we still don’t

have enough services and programmes that are reaching out in appropriate ways to

encourages ‘non-traditional’ communities to voluntarily think about and use

counselling and psychotherapy as a resource.

The Trailblazer Project plays a very important role in changing this view and only

after a few years it continues to burn a path towards a new and fresh understanding

of the black male psyche in the UK. In Phase 2 we get to hear the previously silent

voices of the men who participated on the programme and their stories are collected

and analysed along with those of other contributors to provide a valuable insight into

their challenges and successes and their views on what is required to get more

African and Caribbean men thinking differently about accessing psychological

therapies.

For example; having therapy in a non-clinical setting or being given the space to

discuss ‘spirituality, culture and wider social and political issues within the therapy’

have proved important to participants, not least those who have kept away from

services in fear of having their concerns and thoughts about these subjects

‘pathologised’.

Others stipulate that what is also important is being given the opportunity to ‘share

experiences and strategies with others’; in other words service users want to be

acknowledged as a potential resource and in turn want their experiences to help

them to become socially responsible citizens in a way that they might not have been

able to be before.

Trailblazers phase 2 provides a wonderful platform for some meaningful, significant

and groundbreaking work in the talking therapies in Britain today.

Rotimi Akinsete

Head of Wellbeing

University of Surrey and Founder of Black Men on the Couch

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Executive Summary This report provides a qualitative appraisal of the second phase of the

Trailblazer project which aims to improve accessibility and acceptability of

talking therapies for African and Caribbean men in City and Hackney. It

followed the original Trailblazer pilot project conducted in 2009 (Carlin, 2009).

As with the earlier project, it involved a series of workshops using the ‘Tree of

Life’ (e.g. Ncube), which is a Narrative Therapy methodology. A total of ten

men participated in the sessions.

The initiative involved a partnership between Mellow, the 4Sight service-user

network, the Black and Minority Ethnic (BME) Access Service (City and

Hackney Department of Psychology) and the Cognitive Psychotherapy

Service (City and Hackney). The aims of the initiative were:

To improve accessibility and acceptability of talking therapies for

African and Caribbean men with mental health problems

To provide opportunities for previous participants to become involved in

the planning and delivery of workshop sessions and the promotion of

talking therapies

To follow the recommendations from the original pilot Trailblazer

project (Carlin, 2009)

To explore the feasibility of a participatory evaluation method (The

‘Most significant change technique, Davies and Dart, 2005)

Context

African and Caribbean men continue to be overrepresented among those

detained under the Mental Act (Care Quality Commission, 2011) and

underrepresented among those receiving talking therapies (Keating, 2007).

African and Caribbean men often report extremely negative experiences in

mental health services, including experiencing institutional racism, being

stereotyped, misunderstood and seen in a narrow limited way (e.g. Sandhu,

2007; Morgan et al., 2009).

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The first Trailblazer pilot project which aimed to improve access to Talking

Therapies for African and Caribbean men in City and Hackney took place in

2009. The project involved a series of workshops introducing Talking

Therapies and using a Narrative Therapy technique called the ‘Tree of Life’

(Ncube, 2006). This approach was positively evaluated by participants (Carlin,

2009). This pilot project generated considerable interest, both within East

London Foundation NHS Trust and beyond, and this approach is now

available in in-patient and community settings. Phase two of the project took

place in 2010 in response to requests from African and Caribbean men to

experience the Tree of Life.

Planning and delivery

The programme partnership of Mellow; the 4Sight Service User Network, the

Psychology Department BME Access Service and the Psychotherapy Service

was responsible for the planning and delivery. Following previous consultation

and evaluation, it was an important principle of the approach to have service

user co-facilitators. Two service users who had been participants in the

previous Trailblazer sessions were recruited as co-facilitators during Phase 2.

Following the recommendations of the previous evaluation report (Carlin,

2009) high priority was given to the physical environment. Sessions were held

at City and Hackney Carer’s Centre – an easily accessible, non-clinical setting

with a large, bright space. As with the pilot project, participants did not have

to be referred but could ‘drop-in’, however recruitment was supported by

extensive outreach activities to encourage and support participants to attend.

Five sessions were held at monthly intervals and the approach used was the

‘Tree of Life’ Narrative therapy technique (e.g. Ncube, 2006). Sessions were

attended by ten men.

Allied activities included presenting the work to a local Church congregation

and at conferences. These activities were intended to raise awareness within

the community and among professionals about the key factors identified by

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African and Caribbean men as important in the provision of Talking Therapies

and to promote the Tree of Life approach.

Evaluation methodology and results

Carlin (2009) recommended that an evaluation plan should be embedded at

the proposal outline stage and should have an emphasis on participatory

methodology. Following consultation with potential participants, the Most

Significant Change (MSC) Technique (Davies and Dart, 2005) was selected

as an appropriate method. The MSC technique is a form of participatory

monitoring and evaluation. It is a story-based technique that looks for changes

in people’s lives as a result of programmes or interventions. Training and

support for this approach was provided by Dr Sevasti Melissa Nolas.

Challenges in data collection included time constraints and limited support for

participants to collect their stories of Most Significant Change. Nevertheless,

30 stories were collected and themes identified included: the contribution of

the programme to recovery journeys; the impact of the ‘Tree of Life’ technique

on the practice of those who have used it, specifically with regard to focusing

on strengths and cultural issues; the importance of outreach and ongoing

engagement of potential participants as well as supporting participants in

between sessions.

Conclusions and recommendations

Drawing on evaluation findings, the following recommendations are made

regarding similar projects and talking therapies service provision for African

and Caribbean men:

There is a place for ‘drop-in’ models introducing Talking Therapies.

Such models may be especially helpful for those who have been wary

of engaging with mainstream services.

Outreach activities are necessary to engage with potential participants,

raise awareness of talking therapies in communities and raise

awareness of community needs and strengths within statutory services.

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Programmes working to a recovery model should provide opportunities

for service users to move into different roles, e.g. as facilitators, where

they can gain skills and experience which may help their employment

prospects.

Service users as can play important roles as co-facilitators of group

sessions and promoters of Talking Therapies. However, such roles

need to be supported by provision of adequate training and support.

Therapeutic interventions should consider the strengths and resources

of African and Caribbean men as individuals and the strengths and

resources of their communities.

The ‘Tree of Life’ is a collective narrative therapy approach that has

been positively evaluated by African and Caribbean men who have

taken part in it. This approach should be offered more widely in

services, evaluated more thoroughly and may be used alongside other

therapeutic approaches.

Projects should consider the use of participatory evaluation methods,

such as the Most Significant Change Technique. However, all those

involved require adequate training and support to participate.

Learning from projects such as Trailblazers should be disseminated

using a variety of methods and accessible resources, such as DVDs

and publications should be developed to raise awareness of Talking

Therapies.

A network of those using Collective Narrative Therapy approaches

such as the ‘Tree of Life’ within East London should be established in

order to share best practice.

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Introduction

This report is an evaluation of Phase 2 of the Trailblazer Project which aims to

improve accessibility and acceptability of talking therapies for African and

Caribbean men in City and Hackney. The main focus of the report is an

evaluation of a series of workshops for African and Caribbean men using the

‘Tree of Life’ (e.g. Ncube, 2006) – a Narrative Therapy approach. This was

the second series of workshops in the Trailblazers project: A partnership

between Mellow, the Psychology and Psychotherapy departments of City and

Hackney.

This report also describes additional activities that formed part of the

Trailblazer project and relate to it’s aims. These included a session at the

British Museum to see their ‘Tree of Life’ exhibition and relate it to our work;

promotion of the work in the community via a presentation to the New Hope

Ministries Congregation and presenting the work to professionals via training

sessions and conference presentations.

The aims of the report are to:

assess the impacts of the project

describe the evaluation method used

identify lessons learned from the planning, delivery and evaluation

make recommendations for future talking therapy initiatives for African

and Caribbean men

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Background

The first series of Trailblazer sessions were conducted as a local pilot

programme in 2008/2009. This consisted of five workshops which aimed to

introduce talking therapies to a group of African and Caribbean men. The

main therapeutic approach used was a narrative therapy technique called the

Tree of Life (e.g. Ncube, 2006). The workshops were attended by 11 men and

the pilot was externally evaluated (Carlin, 2009). This evaluation concluded

that the Trailblazer Project was successful in improving access to talking

therapies for those who attended. It described the ‘Tree of Life’ approach as

acceptable and a positive experience for those who participated and it made a

number of recommendations for future work using this approach.

Following this pilot project, participants and facilitators went on to promote the

Trailblazer project and the ‘Tree of Life’ approach in a number of different

ways. For example, we created a DVD ‘The Tree of Life: Our experience’, with

the aim of promoting talking therapies to African and Caribbean men and

educating professionals. Participants and facilitators of the sessions

presented their experience in various forums, including community events,

training sessions and national and international conferences. This work was

also published in a special edition of the Association of Family Therapy

magazine ‘Context’ (Byrne et al., 2011) and a number of men who

participated in the programme were authors of this article. Furthermore, those

who had participated also promoted the work informally through ‘word of

mouth’ to other 4Sight members.

Presumably as a result of these promotional activities, other 4Sight members

began to approach the 4Sight co-ordinator requesting the opportunity to

experience the ‘Tree of Life’ approach themselves. Therefore, a further

collaboration was agreed between Mellow, and the Psychology and

Psychotherapy departments to provide a further series workshops based on

this approach.

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Programme planning

Following the recommendations of the previous evaluation report (Carlin,

2009) and the requests of potential participants, it was decided to offer further

workshop sessions based on the ‘Tree of Life’ approach. The project was

funded jointly by Mellow and the Psychology Department BME Access

Service.

Venue

The previous evaluation report (Carlin, 2009) recommended giving high

priority to the physical environment. Participants said they preferred a non-

clinical setting and that space was important. We decided on the City and

Hackney Carer’s Centre as an easily accessible, non-clinical setting with a

large, bright space in which to conduct the workshops.

Facilitators

There was a team of five facilitators, representing the partnership. These

included the 4Sight co-ordinator from Mellow; a Clinical Psychologist from the

Psychology Department BME Access service; and a CBT Therapist from the

Psychotherapy service. Following previous consultations with members and

the previous evaluation, it was an important principle of the approach to have

service user co-facilitators. In keeping with the community psychology

approach and recovery orientation of our work, it was decided to recruit two

service user co-facilitators who had been participants in the previous

Trailblazer sessions. They were selected on the basis of their expressed

interest and availability.

Appendix 1 shows the guidance for facilitators prepared in consultation with

the service user co-facilitators. In terms of support and training, eight

meetings were held in order to plan the sessions and introduce the approach.

At the end of each session, the facilitators met to debrief on what went well

and not so well in the session.

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In addition, two half-day training sessions in the evaluation method were

provided.

Content and frequency of sessions

As with the previous Trailblazer Project, five workshops were planned. The

Tree of Life workshop is in four parts. We used the first session to introduce

the approach and find out from the men what they would like to gain from the

sessions. In introducing the approach, we presented the DVD created

following the first Trailblazer programme and the two service user co-

facilitators spoke about their experience of taking part in the Tree of Life. The

remaining sessions were broadly based on the four parts of the workshop:

1. Drawing the Tree of Life and sharing the narratives.

2. The Forest of Life in which the collective strengths, skills, hopes etc.

are considered.

3. The Storms of Life, in which participants use the strengths and

resources identified to think about facing the storms or challenges in

their lives.

4. Certificates and celebrations in which we draw together the learning

from the workshops.

Each session was planned to be two hours long, rather than the previous four

hours. There were a number of reasons for this decision. Firstly, we felt that

some people might be more likely to attend for a half day than a whole day.

Secondly, we had less money available and were, therefore, unable to

provide lunch for participants as we had previously. Cost and time constraints

meant that the sessions were at monthly, rather than fortnightly, intervals as in

the previous Trailblazer sessions.

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Recruitment of participants

The previous evaluation (Carlin, 2009) identified positive aspects of a

dedicated male African and Caribbean group. Therefore, we decided to

promote the workshops to African and Caribbean men only. This was done

primarily through the 4Sight co-ordinator. A flyer was sent to 4Sight members

and this was followed up by phone calls and text reminders. For those who

had difficulty finding the venue, one of the facilitators would meet participants

at a well known venue (the local MacDonalds) and walk with them to the

Carer’s Centre.

Evaluation Methodology

The evaluation of the first set of Trailblazers workshops (Carlin, 2009)

recommended that an evaluation plan should be embedded at the proposal

outline stage and should have an emphasis on participatory methodology. In

order to select an appropriate methodology, a number of consultations were

carried out.

1. A consultation with 4Sight members regarding the potential use of the

Mental Health Recovery Star (MacKeith and Burns, 2008) to assess

outcomes. However, participants felt that the pre-set outcome

categories in this measure did not really capture their experiences of

recovery.

2. A consultation with Dr Sevasti Melissa Nolas of Middlesex University

who is an expert in evaluation of community psychology projects. Dr

Nolas met with facilitators and potential participants to discuss the

project. She recommended the approach we eventually chose: The

Most Significant Change (MSC) Technique (Davies and Dart, 2005).

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Most Significant Change (MSC) Technique (Davies and Dart, 2005).

The MSC technique is a form of participatory monitoring and evaluation. It is a

story-based technique that looks for changes in people’s lives as a result of

programmes or interventions. It is participatory in the sense that various

project stakeholders are involved in deciding what sorts of change to record

and in analysing the data, including the participants in the workshops.

It involves a number of steps. The first step involves fostering interest and

motivation among stakeholders to participate. Then the stakeholders identify

which broad ‘domains of change’ to focus on and define the reporting period.

The stories of significant change are collected from those most directly

involved, such as participants and facilitators. Stories are collected in

response to questions such as:

During the last month/week, what events (big or small) have taken

place in your life?

Which of these events do you consider the most significant?

Why is it significant?

This process should allow for the possibility of negative changes as well as

positive changes and these should also be recorded as they give important

information in the form of ‘lessons learned’. When stories have been collected

and ‘verified’, the selection of the most significant stories by a panel of

stakeholders takes place. The criteria for selection are documented and the

changes are reported. This can be done in a variety of formats and tailored to

the needs of different audiences.

We chose this approach for a number of reasons. Firstly, as recommended by

the previous evaluation (Carlin, 2009), it is a participatory method. Secondly,

the story-based method fits closely with the Narrative Therapy approach used

in the Trailblazers sessions. Thirdly, because it does not impose pre-set

categories of outcome, it does not limit the changes that can be captured.

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Finally, it enables us to consider change on a system level, as well as an

individual level.

Two half-day training sessions were provided by Dr Nolas on Monitoring and

Evaluation and the Most Significant Change Technique. These were attended

by the Trailblazers facilitators.

Evaluation Process

A consultation was held with Dr Nolas, Mellow staff, 4Sight members and

facilitators from the Psychology and Psychotherapy departments. In this

consultation, we decided to focus on the following domains of change:

1. Individual level change: the impact on individual participants and

facilitators of the Trailblazers sessions.

2. System level change: the extent to which the Trailblazer programme

brought about change beyond the confines of the programme itself.

3. Other: this allows for unintended consequences to emerge.

We decided on a monthly reporting period as this matched the frequency of

the Trailblazer sessions. We agreed to collect stories from participants and

facilitators of the programme. It was decided that the stories would be

collected in written narrative form but that other materials, such as

photographs and the Trees of Life could also form part of the data.

Dr Nolas also attended one of the Trailblazer sessions to present the

approach to participants. She prepared a consent form (see Appendix 2) and

information sheet on the approach, which was given to participants (see

Appendix 3).

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Results

Participants

A total of ten men participated in the Tree of Life workshops1. All of the men

identified as African or Caribbean. They were in contact with a range of

mental health services, including CMHTs, the Assertive Outreach Team,

Forensic services and voluntary sector services, such as Irie Mind.

Stories of Most Significant Change

Challenges in data collection

It was initially planned that stories would be collected from participants after

each monthly Trailblazer session. However, in practice, this was not possible

due to time constraints. Therefore, it was agreed that the stories from

participants would be collected by one of the facilitators between sessions;

however, once again this did not prove to be possible due to time constraints.

This highlights some of the challenges in using this method of evaluation. In

addition, one participant provided a story that was very hard to make sense of

and did not appear to relate to the Trailblazer sessions. This raises a further

challenge of how to meaningfully include the stories of people who might be

quite unwell at the time and how to validate such stories. It also highlights the

need for sufficient training and support for those involved in data collection in

being able to elicit the stories.

Therefore, all the stories collected were provided by facilitators, two of whom

were service users and previous participants of Trailblazers. Stories were only

provided by four of the five facilitators. Most of these stories were provided

towards the end of the programme, rather than being collected on a monthly

basis, as initially planned. Therefore, some cover a retrospective period of

one month, while others cover the six month period. A total of 30 stories were

collected. These are all presented in Appendix 4.

1 An additional participant attended the British Museum Visit

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Selection of stories

A selection meeting was held on 29th September 2010. Prior to the meeting,

the collected stories were circulated. The meeting was attended by four

facilitators (two service users, the 4Sight coordinator and clinical psychologist)

and Dr Nolas. We used an iterative voting process, i.e. each person chose

their top three stories. There followed an in-depth discussion about which

stories should be chosen as most significant. The reasons for selection and

explanations for why these stories were significant were documented. Four

stories were selected as being most significant. These will be presented in the

next section together with the reasons for selection, interpretation and

recommendations.

Stories of Most Significant Change

1. CELEBRATE BRIAN

Story collected by Brian Joof, service user co-facilitator

Today the 16th September 2010 me and Mellow staff, my former mentor and

a clinical psychologist had a celebration at the Mango Rooms in Kentish town

with a wonderful dinner for six. It is important because I have celebrated my

recovery, after being given the all clear by doctors of fully recovering

and ready fit for work. It was celebrated with the people who made an impact

to me and my recovery journey and it means a lot to me. We had a wonderful

night and it meant a lot to me, for after so many years in the MH Services it

was not a pleasant experience but despite the odds of making a full recovery,

here I am celebrating and ready to move on to the next in my life.

Domains: Individual level change and system-level change

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Explanation/Interpretation:

It was hard to choose between the two stories ‘Celebrate Brian’ and ‘Clean bill

of health’ – which also tells of Brian’s journey to recovery. This story was

chosen because it brings together a number of important elements. It involves

a group celebration. It is significant because what was being celebrated is the

ultimate goal of what we are doing; because after all the stigma and hard work

it shows that recovery is 100% possible. Brian lists the people who have

made an impact on him and specifically links their impact to his recovery. The

discussion noted that Brian’s story can be an inspiration to others when things

are not going so well and that when sceptical staff have seen service users

presenting they often question whether their situation was ever really that bad

– but Brian’s story shows that things were bad. He was at a very low point but

has made a recovery.

Individual change: Brian’s journey to recovery and how he made the mental

health system work for him.

System change: The story describes a celebratory meal which took place in

the evening, attended by those of us who’ve worked in partnership with Brian.

Staff do not normally do that within their roles, however, this marked Brian’s

journey from service user to colleague. Also, the impact of his words on those

staff who were present - what he said made us feel so humble and reinforced

our commitment to a recovery focused model of working.

Recommendations:



they can gain skills and experience which will help their employment

prospects.

Employing service users in such roles can provide inspiration to others.

They can serve as role models for recovery.

Peer facilitators really enrich the experience and help with the

engagement of participants.

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Programmes aiming to promote recovery should include a mix of staff

and service users working together.

It should also be acknowledged that recovery is a very individual

process, with very individual outcomes. Individuals should be able to

define for themselves when they have achieved recovery.

2. WHAT-A-PALAVER

6th July 2010, Hackney Carer’s Centre. Story collected by Aronda

Warren, 4Sight co-ordinator and Trailblazers co-facilitator

It was a real busy one….had a meeting at 9.30 a.m. with the Afiya Trust,

looking to place 4Sight maybe there as we have been told that our funding is

no more – from there need to get to Seven Sisters to meet and collect one of

our 4Sight members who will be attending the group. He is an individual that I

know if I had more time, we had more time we could have made a real impact

on this young man’s life - I start to now question, how am I going to really let

go and actually move on – make me consider then, how are we expecting

men who have known only one way for so long to just almost throw caution to

the wind and believe in themselves when they have had an experience of

others not doing that!

Meet and collect him and I remember when I first met this young man, it was

in in-patient and I was accompanied with his OT. Sometimes I get the feeling

that 4Sight are asked to work with men that other services just don’t know

how to or maybe what they have been doing hasn’t worked? What do we do

then that is so different. I sat across from this young man, M. we stared at

each other and then I asked to come and sit a little closer. I had him to the

front of me and the OT to my back. I told him who I was and I asked his name,

I held out my hand and took it. I remembered the Tree of Life, ask the

questions that we want to hear, how can you know me if you don’t know

where I am from or about who my parents are or my culture. I asked him

about the food he liked and he told me about when his dad took him to a

restaurant many years ago – he said that he liked it. We laughed! I asked

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where eh was from, that he looked either Somali or Eritrean – he said how did

I know? We then discussed P-Diddy and how his dad was from Eritrea. We

then parted and he said that he wants to be better and I said join 4Sight and

let’s accompany him on his journey. When I got to the office with the OT – she

said that she could not believe it! She has never seen M as animated as he

was on that day!

I met and collected M – however he could not stay and attend the session –

his voices became too much for him on that day! This would have been his

second session as he had his first when we met before.

This was significant because I used all my learning from the 4Sight members

that have been kind enough to allow me to know what actually matters to

them and what they feel matters to their peers – after all, there is a “click” that

we as workers take for granted. A lot of times these men have been living in

quiet close quarters, admittedly not by choice – my learning has provided me

with a skill to be able to almost fast track myself to their inner circle – for that I

am so grateful.

Domains: ‘other’ and system-level change


We chose this story because it shows something about the enormous effort

that goes into the process of outreach, in helping and facilitating people to get

to sessions – that effort is almost invisible – because figures usually show just

who came – and this story shows the important role that the outreach

facilitators play.

It also shows that there can be some impact on the people who have not

attended the sessions. When people have taken part in the Tree of Life

approach it appears to change their way of thinking e.g. thinking of strengths,

and about asking different kinds of questions. It shows that some of the

people in in-patient settings can get help and attend other projects in the

community.

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Domains: Other - because it is more concerned with process than change

(outcome) – it illustrates the process of engaging someone in an intervention

– “we think groups just happen... but it’s blood sweat and tears”

System change – because of the impact of the Tree of Life work on Aronda’s

thinking and ability to engage, and the potential impact on the OT who spoke

about difficulties in working with one man and witnessed a different story of

this man.

Recommendations:

Programmes should give time and thought to the recruitment process

and to potential barriers to attendance. This is especially important with

those who may be reluctant to engage.

Outreach activities are very important in facilitating access to projects

such as these.

Elements of the ‘Tree of Life’ approach can be used to aid initial

engagement with people in talking about their strengths, culture, what

they value etc. rather than beginning with problem-focused talk. These

should be part of training for all staff.

3. A NEW MEMBER FOR TRAILBLAZERS

Story collected by Angela Byrne, Clinical Psychologist and Trailblazers

co-facilitator

We ran a regular Trailblazer session on 1st June 2010 and a new member, D.

attended for the first time. He’d heard about the sessions from another 4Sight

member who lived in the same place. He came early and joined in with us all

setting up the session and introducing himself. He told us that, during his very

long stay in prison or forensic hospitals, he’d had lots of different kinds of

therapy, e.g. motivational interviewing, relapse prevention, anxiety and anger

management and he was curious to know more about the Tree of Life. D.

grasped the Tree of Life approach immediately and went on to produce a

beautiful tree that was rich in stories. When feeding back at the end, he said

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that he found this approach was very ‘deep’, deeper than the other therapies

he’d had before. He likened it to something that people might “do in church”.

He also told a story about how completing the roots of the tree had reminded

him of the book and TV series of ‘Roots’ by Alex Haley and the impact this

had had on himself and his family when he was young boy. This was his first

knowledge about slavery and, over the years, his engagement with this book

and TV series had helped him to think about racism and the experiences of

racism that he had faced in his own life. This made me remember my own

experience as a child and how this book and TV series had affected me too

and probably been my first awareness of slavery and racism. This event was

significant for me because it reminded me of how profound Tree of Life work

can be and I was really pleased to have a new member of the group who was

so open and willing to share his experiences with us all.

Domains: Individual and Other


The same event is captured in the story ‘After all this time you came’. The

4Sight co-ordinator had been writing to that participant for over a year before

he attended any activity. It demonstrates how keeping someone in mind is so

important in engaging potential Trailblazers or 4Sight members.

This participant appeared to be taken aback by the whole process, hence his

comment “I’ve never experienced something like this, this is just deep”. He

explicitly contrasted the ‘Tree of Life’ approach to others he had experienced

and made a link with spirituality or religion ‘like something you do in church’.

This link has been made by other participants who have noted that the fact

that the Tree of Life method respects their religious beliefs is important to

them (e.g. Carlin, 2009)

Individual level change: – the fact that D. came in the first place because he

hadn’t engaged with 4sight for a whole year. The approach appeared to have

a quick impact on him. This was despite the fact that he was not known as an

open or talkative person.

22

Other – discussing experiences of racism. In traditional kinds of therapies,

wider political and social issues and issues of spirituality are rarely discussed.

We cannot say for sure that that this was what D. was referring to when he

talked about the process being ‘deep’, however, it is something that a number

of other participants discussed. In Trailblazers, discussing racism,

discrimination and other political issues are encouraged, but not in a simplistic

way (e.g. as one participant said “okay we know you’re Black so let’s talk

about racism”). We create space for these stories and when they are told we

listen to those stories with a particular intent, for example, to identify how

people survive these experiences. Sharing of stories enables people to feel

more solidarity and develop strategies for tackling experiences of

discrimination.

Recommendations:

Persistence is important in engaging people who may be sceptical

about attending services. It is important to keep them informed about

initiatives and they will come when ready.

Discussing wider social and political issues such as racism and

discrimination should be incorporated into therapeutic work. Space

should be created for participants to share experiences and strategies

with each other in group programmes.

Service users should have access to a greater range of talking

therapies, including those that enable discussion of spirituality, culture

and wider social issues.

4. Ade in his office

Story collected by Ade 21st September

The story happened in my office at the psychotherapy department I was the

only one present. I have been working with an African-Caribbean man who

had been through, and was continuing to go through some very difficult

experiences. I was reflecting over the work we had done, and noticing how

difficult it is for him to stay with discussing vulnerable aspects of himself. For

quite some time I have wondered if it would be easier for this man to stay with

23

these difficulties if we initially paid more attention to his strengths. I was also

reflecting on a similar difficulty experienced by a white British man who had

also been through some traumatic events.

The significance of this story to me is that since using the ‘Tree of Life’, I have

become more curious about the value of focusing on people’s strengths.

Domains: Individual and System


This story shows how taking part can have an impact on people beyond the

Trailblazers sessions and may result in developments that make therapies

more sensitive culturally. The originator of the Tree of Life approach, Ncazelo

Ncube (2006) found that just focusing on the problems was not useful to the

young people she was working with. It was re-traumatising. She developed

the ‘Tree of Life’ to help people approach problems from a position of

strength, having appreciated their individual and collective strengths and

resources. David Denborough (e.g. Denborough 2008) describes this as the

“river bank” position, i.e. helping people onto a firm foundation (the river bank)

to help them survey the challenges they face and the possibilities they have.

Individual level change: – the story illustrates a shift in Ade’s thinking as an

individual therapist and one that is likely to have a ‘knock on’ effect for the

man he is working with and on their engagement in therapy.

System level change: This raises the potential of a more strengths-based

approach becoming more widespread in services.

Recommendations:

This approach can complement other talking therapies traditions.

Training should focus on strengths-based interviewing as a means of

engagement.

The ‘Tree of Life’ approach is one that can be used in individual

therapy as well as in groups, e.g. (Cullen, 2009). Further training in this

approach should be available to therapists.

24

Although the ‘Tree of Life’ was developed in an African context and has

been widely used with BME communities, the emphasis on strengths

and on culture is applicable across cultures.

Beyond the Therapy Room: The ‘Tree of Life’ At the British Museum

Following the initial Trailblazers pilot (Carlin, 2009), participants made a

number of suggestions for future activities they would be interested in. These

included outings in the community and a chance to learn more about African

history and culture. Therefore, on 21st April 2010, we arranged a Trailblazers

outing to The British Museum to see an exhibit by Christian Aid called the

‘Tree of Life’. This is a sculpture made by artists from Mozambique out of

decommissioned weapons handed in after the civil war. It was part of a larger

exhibition of African art. The trip was attended by four Trailblazers and two

members of staff. We held an informal discussion in the gallery in which

participants identified a common theme between this ‘Tree of Life’ and our

narrative therapy ‘Tree of Life’: that is, the idea of turning adversity into

something positive, which is implicit in the recovery focus of our work.

Participants also suggested a similar project that could be conducted in

London with young people affected by gang violence, for example, turning

surrendered knives into a Tree of Life. Participants positively evaluated the

opportunity to go out as a group and to explore cultural resources that they

had not previously accessed.

Promoting Community Awareness: New Hope Ministries Session

One of the important aspects of the Trailblazer Project is to promote Talking

Therapies beyond the sessions. During the course of this phase of the project,

we had a chance to do this by presenting the work to one of the Black Majority

Churches in Hackney. This felt like an important opportunity as one of the

barriers identified among African and Caribbean communities to accessing

mental health services is the fear that spirituality and religious beliefs will not

25

be respected by services, but may be pathologised as part of ‘mental illness’.

Previous feedback from Trailblazer participants indicated that one of the

aspects they valued from the ‘Tree of Life’ approach was the respect and

value accorded to spirituality (Carlin, 2009).

The opportunity to present our work to the congregation of the New Hope

Ministries came about as a direct result of the Trailblazer ‘Tree of Life’

Workshops. One of our participants was a member of this congregation and

his family and Pastor had noted the positive impact of the support provided by

Mellow and his attendance at the ‘Tree of Life’ workshops. Therefore, the

Pastor contacted Mellow to ask if we could present the ‘Tree of Life’ approach

to the congregation.

We agreed to do this and presented a session on Saturday 22nd May 2010.

The session plan is presented in Appendix 5. The session was presented by

eight of those involved in the Trailblazer project (facilitators and participants).

The session was attended by approximately 35 members of the congregation.

In planning this session we chose to give a prominent role to two participants

who have strong religious beliefs. They were able to present the work in a

way that was especially relevant to the concerns of a Church congregation.

Their participation was highly valued by the congregation and especially

inspiring to a young a man who attended and who was struggling with mental

health problems. This young man and his mother subsequently began to

attend 4Sight and Mellow events. We also noted a positive impact on the

Trailblazer participants who presented at this session in terms of their self-

esteem and confidence in presenting in public. This event is described in a

number of the stories – see Appendix 4. Feedback received from

congregation members is presented in Appendix 6.

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Promoting professional Awareness

There has been a great deal of interest in the Trailblazer Project, both locally

and internationally. During the period that this report refers to, we presented

the work at two International Conferences. On 5th May 2010, the work was

presented by Dr Angela Byrne (Clinical Psychologist) at the 15th international

conference of the Association of psychology & psychiatry for adults & children

(A.P.P.A.C.) in Athens, Greece.

On 23rd June 2010, the East London Foundation Trust hosted the first

International ‘Tree of Life’ Conference at Praxis, Bethnal Green, London. The

conference was attended by more than 200 delegates. Presenters included

David Denborough of the Dulwich centre, Adelaide, Australia, who was one of

the originators of the Tree of Life approach. On this occasion, the work was

presented by eight members of the project (four facilitators and four

participants). The conference was very positively evaluated, with a number of

people highlighting the contribution of the Trailblazers. Following the

conference, the Trailblazer Project was profiled by the Dulwich Centre in

Australia (the leading international Narrative Therapy institute) as an example

of Tree of Life work in the UK. This can be viewed at:

http://www.dulwichcentre.com.au/tree-of-life-trailblazers.html

Participants and facilitators of the Trailblazer sessions have also provided

training in the ‘Tree of Life’ approach to staff within the Trust, local voluntary

sector organisations and on the Clinical Psychology Doctoral training

programmes at university of East London, University College London and

University of Hertfordshire.

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Conclusions and Recommendations

This report provides a qualitative appraisal of the second phase of the

Trailblazer project which aims to improve accessibility and acceptability of

talking therapies for African and Caribbean men in City and Hackney.

This phase of the project was developed in response to requests from a

number of African and Caribbean men to have the opportunity to take part in

the ‘Tree of Life’ sessions that they had heard about from the original

Trailblazer pilot project conducted in 2009.

Every effort was made to follow the recommendations of the evaluation report

of the Trailblazers pilot project (Carlin, 2009). For example, the sessions were

held in a non-clinical setting; attention was paid to the development of trust,

respectful relationships and peer support both before and during the

programmes. Activities aimed at developing these relationships included

outreach activities, consultation with potential participants at every stage of

the programme, including consultation about the timing and content of

sessions and the appropriate evaluation method. Two service-user co-

facilitators were recruited from among the previous participants. Following

Carlin’s (2009) recommendation, a participatory evaluation method was used

(The ‘Most significant change technique, Davies and Dart, 2005).

Five sessions were held at the Hackney Carer’s Centre at monthly intervals

and sessions were attended by ten men. Allied activities included presenting

the work to a local Church congregation and at conferences. A number of

factors impacted on the collection of evaluation data, including limited time

and, most notably, the impact of loss of funding for the 4Sight co-ordinator

and Mentoring Project co-ordinator posts. This occurred towards the end of

the project and had a dramatic impact on the participants and facilitators alike,

with many of those affected reporting feelings of loss, disappointment and

demoralisation.

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Despite the difficulties encountered, evaluation data was collected and

themes identified included: the contribution of the programme to recovery

journeys; the impact of the ‘Tree of Life’ technique on the practice of those

who have used it, specifically with regard to focusing on strengths and cultural

issues; the importance of outreach and ongoing engagement of potential

participants.

Drawing on evaluation findings, the following recommendations are made

regarding similar projects and talking therapies service provision for African

and Caribbean men;

There is a place for ‘drop-in’ models introducing Talking Therapies.

Such models may be especially helpful for those who have been wary

of engaging with mainstream services.

Outreach activities are necessary to engage with potential participants,

raise awareness of talking therapies in communities and raise

awareness of community needs and strengths within statutory services.



they can gain skills and experience which will help their employment

prospects.

Service users as can play important roles as co-facilitators of group

sessions and promoters of Talking Therapies. However, such roles

need to be supported by provision of adequate training and support.

Therapeutic interventions should consider the strengths and resources

of African and Caribbean men as individuals and the strengths and

resources of their communities.

The ‘Tree of Life’ is a collective narrative therapy approach that has

been positively evaluated by African and Caribbean men who have

taken part in it. This approach should be offered more widely in

services, evaluated more thoroughly and may be used alongside other

therapeutic approaches.

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Projects should consider the use of participatory evaluation methods,

such as the Most Significant Change Technique. However, all those

involved require adequate training and support to participate.

Learning from projects such as Trailblazers should be disseminated

using a variety of methods and accessible resources, such as DVDs

and publications should be developed to raise awareness of talking

Therapies.

A network of those using Collective Narrative Therapy approaches

such as the ‘Tree of Life’ within East London should be established in

order to share best practice.

References

Byrne, A., Warren, A., Joof, B., Johnson, D., Casimir, C., Hinds, C., Mittee, S.,

Jeremy, J., Afilaka, A. and Griffiths, S. (2011). ‘A powerful piece of work’:

African and Caribbean men talking about the tree of life. Context, 117, 40 -

45.

Care Quality Commission and National Mental Health Development Unit

(2011) Count Me in 2010: Results of the 2010 National Census of Inpatients

and Patients on Supervised Community Treatment in Mental Health and

Learning Disability Services in England and Wales.

Carlin, M. (2009). Trailblazers: An introduction to talking therapies for African

and Caribbean men with mental health problems: An evaluation report.

Mellow. East London NHS Foundation Trust.

Cullen, E. (2010). The application of the ‘tree of life’ to an individual

psychological intervention. Context, 109, 11-15.

Davies, R. and Dart, J. (2005). The ‘Most significant change’ (MSC)

technique: A guide to it’s use.

30

Denborough, D. (2008). Collective Narrative Practice: Responding to

individuals, groups, and communities who have experienced trauma. Dulwich

Centre Publications, Adelaide. www.dulwichcentre.com.au

Keating, F. (2007) African and Caribbean men and mental health Race

Equality Foundation Briefing Paper May 2007.

MacKeith, J. and Burns, S. (2008). Mental health recovery star. Mental Health

Provider’s Forum and Triangle Consulting.

Morgan, R., Khan, A., McFarlane, F., Thomas, L. & Ram du Sautoy, S. (2009).

Access to talking therapies: The views and experiences of people from Black

and minority ethnic communities in secondary care in East London. Clinical

Psychology Forum 196, 37-40.

Ncube, N. (2006). The Tree of Life Project: Using narrative ideas in work with

vulnerable children in Southern Africa. The International Journal of Narrative

Therapy and Community Work, 1, 3-16.

Sandhu, S. (2007). Alternative Pathways Project Report: Action towards

alternatives. London: East London Foundation NHS Trust.

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APPENDIX 1: Guidance for facilitators

Role of service user co-facilitators Talking about personal experiences (in a positive way) Getting people talking: about topics in mental health and about personal

experiences Engaging with people, bringing them into the discussion. Not patronising or

judging people Pointing people in the direction of things that may help (signposting) Giving participants confidence and encouragement Being role models for recovery; giving people hope. Having faith in their

recovery. Helping people believe that things can work. Bridging the gap to recovery

Helping participants create their ground rules and keep to them Participants’ spirituality should be respected and valued within the group

What we as co-facilitators can do to support each other

Helping each other have focus and stay on track Constructive criticism, only within our group, not in front of participants Peer support. Making time for each other if the session has been hard or

brings up personal issues Communication. We need to agree a way for this to happen – by phone/e-

mail etc. Making sure we’re prepared & we all know who is coming etc. Permission to make mistakes, not know and look to each for support during

sessions

Appendix 2: Consent Form Title of project: Trailblazers monitoring and evaluation

Name of evaluator: Dr Sevasti-Melissa Nolas on behalf of Mellow and East London NHS Foundation Trust Psychology Department

Please put your initial next to each statement

1. I confirm that I have read/someone has explained to me and I understand the Trailblazers monitoring and evaluation strategy. I have had the opportunity to consider the information, ask questions and have these answered satisfactorily.

2. I understand that my participation is in the monitoring and evaluation strategy voluntary and that I am free to withdraw at any time without giving any reason, and without my decision to do so effecting my participation in Trailblazers.

3. I understand that the information that I contribute to the Trailblazers monitoring and evaluation strategy is anonymous.

4. I understand that the information will be used for reports, publications, funding bids, and presentations to different audiences.

5. I agree to take part in the Trailblazers monitoring and evaluation strategy. Name of participant Date Signature

Thank you for considering participating in the Trailblazers monitoring and evaluation strategy.

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Appendix 3: Participant Information Sheet

Dr Sevasti Melissa Nolas, Middlesex University

Trailblazers – Thinking about Most Significant Changes. June 1st 2010 We would like to invite you to contribute to our efforts to keep Trailblazers alive, so that we can continue to support other African and Caribbean men with mental health problems. We need to evaluate Trailblazers so that we can demonstrate to others the value of Trailblazers but also to make improvements to Trailblazers where necessary. You can help us by telling us about your experiences of Trailblazers and what Trailblazers means to you. We would like to invite you to tell us your stories about Trailblazers and any other experiences that relate to the aims and objectives of Trailblazers. What questions are we answering?

1. During the last month, what events (big or small) have taken place in your life?

2. Which of these events do you consider the most significant? 3. Why is it significant?

Tell it as a story! You can write it down, take a picture and tell us why you took it, write a poem… What sort of information do I need to include in my story? 1. Key elements to include in your story:

Who is involved? Why did it happen? What happened? How did it happen? When did it happen? Where did it happen?

2. Significance: What are you telling us with this story? 3. Title: What would the title of your story be?

Anonymity and confidentiality All stories will be anonymised. We are mainly interested in the group experience of 4-Sight members who participate in Trailblazers.

The stories collected will be used for reports, funding bids, publications and presentations to different audiences (Trust managers, funding bodies, other interested professionals, and academics/ researchers).

If there is any information in the stories that you feel identifies you as an individual you can ask for that story not to be used for the above or we can change certain identifying features of the story in order to protect your identity.

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Appendix 4: Stories of Most Significant Change

Date Title Where Who reported it

What Happened Why is it Significant

06/04/10 The First of the Second

City and Hackney Carers Centre

AW It’s the first session on the Trailblazer since last March 2009 – the time has really flown. We have met in a new place and I am very apprehensive and this is that part that I don’t like, the waiting for people to arrive

22/04/10 Recovery Star Versus…

Seal Street – Hackney

AW/ 4Sight members

I delivered a Recovery Star workshop to 4Sight members to look at ways in which 4Sight could be evaluated. The workshop was to introduce the Recovery Star and talk about how it could be implement within 4Sight. We looked at RS because it was an evaluation that was being widely used. When I presented it to the men, it was not long before the RS was rejected and many reasons were given. I thought it was used and as documented in the Trailblazer report to ask someone to talk about how he had found the RS and so I posed these questions to a 4Sight Member who had used the RS… How did you find the Recovery Star: was it a useful tool for you? Did it make you focus on your recovery? Did it make you feel listened to and valued? What do you think are the benefits of using the Recovery Star with

4Sight members? Do you think it’s a tool that could be used in a group setting as well

as individually? When do you think the Recovery Star needs to be reviewed?

When we discussed as wider group – most agreed that the RS did not capture what those who engaged with 4Sight experienced. The coming together and sharing experiences within an environment of peers was very important to the group and this as had strong links to me and the experiences that the Trailblazers have previously reported.

Because the members felt that a evaluation tool that was deemed for the a number of services was not appropriate and that the men wanted an evaluation tool, equally robust however that captured their feelings, their experiences and who they wanted to be and are and not some – one size that was and is intended to fit all. Along came the MSC!

24/04/10 No Hope for the New Hope?

AW Its been cancelled – it will happen – in the very near future

22/05/10 All is Hopeful at the New Hope

New Hope Ministries AW We, The Trailblazer team were asked to attend The New Hope Ministries and present the TOL to the congregation. I was really moved as although there were only a few people there to listen, this seemed to increase as went delivered the presentation. The highlight of this particular presentation as I think with a lot is the impact of the TOL on those that participated in it. The audience listened intently as the Trailblazers talked about how the TOL gave them a sense of hope, a sense of history and recognised their spiritual beliefs and respected them.

04/05/10 Where have the Flowers gone?


AW We had 2nd Trailblazer Session and I was taken aback by the attendance. We did the cardinal sin maybe and did not consult the men about what they wanted or did we? They said they wanted Talking

34

Therapies and the TOL however this was the group that we worked with before and this was now a new group that we were engaging with, well and a lot of the men were, had we thought that we could have replicated the success of the first group at Trinity Hall? Is Hackney really the space for the Group?



01/06/10 After all this time you came


AW, DW other 4Sight members and co-facilitators

New member came, however not so new as I had been contacted him over the last year via letters and saying hello as I supported another member who lives in the same place. He was very reflective and I found him very honest as to why he came to the group. His music group was on half term – however don’t feel that he would have had the same experience as what he got in the group. He talked about how deep he felt the TOL was and he said that it supported him to take a look back into his past after completing quiet a long – many years in a many different types of institutions

Because he was so moved by the TOL and that he felt able to say this in a group of peers that he had only known for a limited amount of time – it felt to me like the power of the Tree of Life

23/06/10 Tree of Life Conference

Praxis Centre, Bethnal Green

AW It’s the TOL conference…

23/06/10 TREE OF LIFE CONFERENCE


BJ Delivering the TOL to people and other organisations. Through my recovery journey we have been involved delivering the TOL to other service users at hackney carers centre, to improve the lives of SU who have never been offered talking therapies from a narrative point of view.

It is significant to me because I was one of the ones who champion it in doing it and it did help me through my journey to recovery. It gave me the chance to recollect connect myself from where I was at to where I am at now, and what I wanted to do with my life in the near future. I was able to tell it in a non re-traumatising way.

PEER SUPPORT TRAINING

BJ Training to help patients who are coming out of psychiatric hospital and being discharge to the community. Help them gain control of there lives and there sense of community, after having a disconnecting experience in there lives from the community and social living.

It is important to me because having been a mentee myself I can mentor someone to achieve the things they want in life and reach their goals. To be able to help them live a more independent and meaningful life. So that they could cope better with there own lives.

PR-EMPLOYMENT ASSESMENT

BJ Having the pre-employment assessment, was so important because I wanted to get back to work to full time employment. All through my recovery journey I have worked hard to achieve this. When Human resource directorate, occupational health Doctors wrote to me and gave me the all clear, a clean bill of health to get back to full time employment, I was jubilant.

It is important because after being unwell for so long and out of work, this will give me a sense of wellbeing and that I go back to having a routine and living a meaningful life.

16/09/10 CELEBRATE BRIAN

Mango Rooms, Kentish Town

BJ Today the 16th September 2010 me and Mellow staff, my former mentor and a clinical psychology had a celebration at the MANGO rooms in Kentish town with a wonderful Dinner for Six.

It is important because I have celebrated my recovery, after being given the all clear by doctors of fully recovering and ready fit for work. It was celebrated with the people

35

who made an impact to me and my recovery journey and it means a lot to me. We had a wonderful night and it meant a lot to me, for after so many years in the MH Services it was not a pleasant experience but despite the odds of making a full recovery, here I am celebrating and ready to move on to the next in my life.



BEING SHORTLISTED FOR AN INTERVIEW;

BJ I have started applying for jobs within the NHS and other services dealing with MH. After forwarding my first application to an organisation called Fanon Care for the post of a CDW Trainee, I have been shortlisted for an interview. It makes me very happy and excited that things are beginning to happen.

It is so important that I keep on applying for more jobs of interest, for this is what I was working towards all this years, together with Mellow as a 4sight member. Today it has began to pay off and I am going to take every opportunity that comes along.

07/09/10

Lower Clapton health Centre

AA The story happened during a Trailblazers planning meeting attended by M, A, S, B, L, A and myself. During this meeting I began to feel uncomfortable due to a conflict within myself. Afterwards I began to realize it was something to do with identifying with my colleagues, in Trailblazers, and the men we hade been working with, and at the time not seeing this as compatible with my role as a psychotherapist within a psychotherapy department. Both at the time, and subsequently I felt fully support by the group, who provided positive feedback, and empathy with my situation.

The significance of this story for me was to highlight the importance of supporting staff engaged in working with marginalised groups, particularly those who are members of the group themselves

16/09/10 Mango Rooms, Kentish Town

AA The story happened during a meal to celebrate that B, had now received a clean bill of health. It was attended by L, A, S, A, B, A, and B. At a Caribbean restaurant in Camden. At a point mid-way through the meal B expressed his gratitude for the support he had received from all the people present, and gave a brief account of his journey over the last decade, in relation to his mental health difficulties. Looking around the table I could see that everybody was captivated by what was being said, and also extremely moved. I felt honoured to be able to experience such an event, which seemed so genuine.

The significance to me of this story is that it reinforced the idea that there is always hope, and the value of not simply focusing on the clinical environment. I am sure that having this experience in an informal setting made it a particularly special experience, certainly for me, and I hope for B.

21/09/10 Clifden Road, Psychotherapy Department

AA The story happened in my office at the psychotherapy department I was the only one present. I have been working with an African-Caribbean man. Who had been through, and continuing to go through some very difficult experiences. I was reflected over the work we had done, and noticing how difficult it is for him to stay with discussing vulnerable aspects of himself. For quite some time I have wondered if it would be easier for this man to stay with these difficulties if we initially paid more attention to his strengths. I was also reflecting on a similar difficulty experienced by a white British man who had also been through some traumatic events.

Significance of this story to me is that since using the Tree of Life, I have become more curious about the value of focusing on peoples strengths.

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06/04/10 Back by popular demand: first new Trailblazers session

Hackney Carers’ Centre

AB We met for the first session of the new round of Trailblazers.

This was significant for me because, the sessions were back by popular demand, based on the request of men who hadn’t had the chance to do their Tree of Life before. It was exciting because we had a whole new group of men as well as two new facilitators, who had previously been participants in the tree of life. One of the activities we did in the first session was to show the DVD we’d made from the previous Trailblazers sessions. The new members seemed really griped by the DVD and hearing other men talk about their experiences. I felt proud that we’d produced such a useful and inspiring resource.

05/05/10 APPAC Conference

Athens, Greece AB I was invited to join two colleagues to present at a psychiatric conference in Greece on the work we’d been doing with the Tree of Life. It was significant for me because I was very nervous about how an audience of psychiatrists, who are likely to come from a very different theoretical perspective, would receive it. It was also the first time I’d presented it without any of my fellow Trailblazers although we did have clips of the DVD. However, the tree worked it’s magic, as did the Trailblazers& we got a very positive response. We also got the audience on the floor drawing their own trees. I wished the Trailblazers could have been there to see how their words had touched this international audience.

22/05/10

New Hope Ministries.

New Hope Ministries Church premises

AB We went to present our work with the Tree of Life to the congregation of the New Hope Ministries.

This was significant for me for several reasons – there is often mutual suspicion between the mental health services and black majority churches, so it was real honour and opportunity to be invited. One of the issues we wanted to raise was the fact that the Tree of Life respects and values people’s spirituality. We did the session with two of our members who are especially spiritual and religious – D & J. They were able to speak from a position of real expertise, e.g. their deep knowledge of scriptures etc and the audience addressed most of the questions to them. It was really inspiring to witness their expertise and to see them speak with such confidence. We were also joined by our former facilitator, S.,

37

who read his poem. One of our Trailblazers was a member of this congregation and the pastor acknowledged the work 4Sight and Trailblazers had done for him. The congregation was really appreciative and welcoming and it felt like a really positive start to building trust and better relationships.



01/06/10 A new member for trailblazers

City & Hackney Carers’ Centre

AB We ran a regular Trailblazer session on 1st June & a new member, D. attended for the first time. He’d heard about the sessions from another 4Sight member who lived in the same place. He came early and joined in with us all setting up the session and introducing himself. He told us that, during his very long stay in prison or forensic hospitals, he’d had lots of different kinds of therapy, e.g. motivational interviewing, relapse prevention, anxiety and anger management and he was curious to know more about the tree of life. D. grasped the Tree of Life approach immediately and went on to produce a beautiful tree that was rich in stories. When feeding back at the end, he said that he found this approach was very deep, deeper than the other therapies he’d had before. He likened it to something that people might do in church. He also told a story about how completing the roots of the tree had reminded him of the book and TV series of Roots by Alex Haley and the impact this had had on himself and his family when he was young boy. This was his first knowledge about slavery and, over the years, his engagement with this book and TV series had helped him to think about racism and the experiences of racism that he had faced in his own life. This made me remember my own experience as a child and how this book and TV series had affected me too and probably been my first awareness of slavery and racism.

This event was significant for me because it reminded me of how profound tree of Life work can be and I was really pleased to have a new member of the group who was so open and willing to share his experiences with us all.

09/06/10 Tree of Life at Talking Matters, Orthodox Jewish Community Organisation

Talking Matters, Stamford Hill

AB On 9th June, I went to an experiential Tree of Life session for people in the Orthodox Jewish community in Stamford Hill. This came about following a talk I did there last year. I was invited back by the counsellors who attended to expand on the session. Unfortunately only a couple of people turned up but it was still a good session.

It was significant for me because there was someone there who was a holocaust survivor and I had been thinking about how the Tree of Life would be for someone who had such massive trauma in their history. She found it a really positive exercise to do her tree and tell the stories & she felt it fit with the imperative of bearing witness to the holocaust and the importance of thinking of survival and how Jewish people have carried this through generations and across different locations.

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Date Title Where Who

reported it What Happened Why is it Significant

08/06/10 Straight talking at a Trailblazer planning meeting

Seal St. Offices AB The facilitators met at Seal st. to plan the next session and debrief on the last. It was a good meeting because we spoke very honestly about some of the things that hadn’t gone so well and came up with solutions. E.g. we acknowledged that we were running over time and decided to have a nominated ‘lead’ facilitator to keep us all on track. We also identified the need for more training for facilitators and thought about how to improve attendance. We agreed to go back to consultation when this round of Trailblazers comes to an end.

This was significant for me because it felt like we were really working well as a team of facilitators and able to address difficulties more directly than before.

18/06/10 Conference planning or celebration?: Getting together again

Psychology Offices, Lower Clapton health Centre

AB All the trailblazers who were interested in presenting at the Tree of Life conference got together for a planning meeting at my office in Lower Clapton health Centre on 18th June. We were so pleased to be getting together again after such a long time, that we spent much of the time catching up and weren’t very focused on the task. We were also celebrating the fact that one member had moved on to his own supported flat. We got cake and a card from us all to celebrate this.

This event was significant for me because it made me very anxious about how we would be able to prepare for the conference, but also because it reminded me about the importance of peer support and building a sense of community in our work and this seemed more important that day than just being purely task-focused.

23/06/10 Tree of Life conference


AB A conference was organised at the Praxis centre in Bethnal Green on 23rd June to coincide with a visit to the UK from David Denborough – one of the original developers of the tree of life. The Trailblazers and a number of friends and colleagues of mine were taking part and I also had some involvement in the organisation it was a very fraught process with lots of stress and unhappiness in the lead up to the conference but the Trailblazers really shone on the day. All the men from Trailblazers who attended contributed significantly to the day beyond our presentation, e.g. volunteering to help David with some of his presentations. I think it would have been apparent to everyone that they had a lot of confidence and a deep understanding of the approach and a lot of skills in presenting.

It was significant to me because I cared so much about this approach and being true to it’s origins, also because so many friends and colleagues that I really respect were involved and we were able to dedicate it to one of our original Tree of Life colleagues who had died recently.

28/06/10 Community psychology teaching at UEL

UEL AB On 28th June, I did some teaching with A & B (Trailblazers co-facilitators) at UEL for 3rd year clinical psychology trainees.

It was significant to me because we were specifically invited by the trainees themselves and for their last ever session. This came about because some of them had been to the stereo-hype event where we launched our Tree of Life DVD. I thought we really worked well together in the teaching and it was good to influence people’s thinking at the training stage. I discovered that B & A had knowledge and experience of lots of different areas of community work that I hadn’t known about previously. I learnt

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a lot from them that day. Date Title Where Who

reported it What Happened Why is it Significant

06/07/10 New members and Old & remembering Marcus Garvey

City & Hackney Carers’ Centre

AB We ran our regular Trailblazers session at the Carer’s centre on 6thy July 2010. Having discussed the need for improvements after our last session, this one went much better and it really felt like therapeutic change was happening. We had 5 participants, all at different stages in their Tree of Life journey and we had planned for this – one participant was new, two had just completed their trees and two had completed or begun them last year & came back. The three facilitators divided ourselves up accordingly so we could accommodate where everyone was at.

At the end of the session, everyone wanted to stand up and present their trees to the group. When our new member, E. spoke about his roots, he told us that he was from a Nigerian family but had been very influenced by Caribbean culture growing up. In his roots he put Bob Marley, Marcus Garvey and Daddy Ernie. Everybody started trying to remember what they knew about Marcus Garvey and contributing their knowledge and why he had inspired them. The main themes seemed to about brotherhood between African and Caribbean people and Black people’s self-reliance. These also seemed like prominent themes in our Trailblazers work.

One of our ‘old’ members, C. came back to complete his tree. When he did it in last year’s Trailblazers, it was a very sparse tree with nothing in the roots, nothing on the trunk, no hopes & dreams or important people. It contained just one fruit, suggested by others – the ability to communicate. This time, he added something significant to every bit of his tree. He seemed really energised and excited by the process and told me ‘wait ‘til you see this – It’ll knock your socks off’. He presented his tree to the group and spoke about his significant people, who included Mellow & Aronda. For the first time he spoke about his mother and how he appreciated her words of wisdom. He also took us through his many strengths and hopes & dreams for the future.

27/07/10 Planning our final Trailblazers session and celebration

Lower Clapton Health Centre

AB The facilitators team met on 27th July at lower Clapton health centre to plan the final Trailblazers session in this programme.

It was significant for a number of reasons. It felt sad as it was about an ending and especially sad as we were facing the end of 4Sight and the loss of the 4Sight and mentoring co-ordinator posts. It reminded me that when I first met the men, they said ‘don’t trust the Trust’ and I felt sure that this would just confirm their view that the Trust does not care about what they value. However, in the true spirit of Trailblazers we

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decided that the final session should also be a celebration of all the men have achieved. We planned a party and A decided to cook for everyone.



30/07/10 Tree of Life in Turkish & Kurdish community

Derman Offices AB A local Turkish & Kurdish community organisation heard about our Trailblazers Tree of Life work and invited me to come & talk to them about it. I did this on 30th July at Derman’s office with a trainee who did some research & found that the Tree of Life is an important concept in Turkish and Kurdish cultures too. The staff at the organisation were really interested and invited us back to do some training with them on how to use the Tree of Life in their community.

This was significant for me because it reminded me once again that this approach is one that respects people’s culture and heritage and this is what many communities are asking for. It also reminded me that the Trailblazers programme has been an inspiration to a wide variety of people and continues to bear fruit.

02/08/10 Losing Aronda & Loleta

AB It was finally confirmed that the funding for 4Sight would not be renewed and that Aronda & Loleta would be losing their jobs. I found this out in phone conversation with Aronda. It felt like a devastating blow. I wondered how I would ever be able to carry on this work without Aronda. I kept thinking about the first time I met with the 4Sight members & they suggested the motto ‘Don’t trust the Trust”. I thought that this will just confirm everything they believed about the Trust & that it doesn’t value what they value.

03/08/10 Final Trailblazers session

City & Hackney Carer’s Centre

AB We had our last Trailblazers session at the Carer’s centre. It felt really sad as I knew this would be the last time we would all be together. In the true spirit of Narrative Therapy, it was also a real celebration. Aronda cooked oxtail and we had cake to celebrate the achievements of the past 5 months. We completed certificates with each participant and presented them. Inspired by E. in our previous session, I had found a quote from Marcus Garvey, which I shared with participants: “a people without the knowledge of their past history, origin and culture is like a tree without roots”.

13/08/10 Not the end for 4Sight: hearing about the men’s determination to continue.

Lower Clapton health Centre

AB I met with D. to discuss the article we are writing about Trailblazers. It was a really good meeting and he had lots of good ideas to contribute. At the end of the meeting, he told me he had to rush as he was going to meet a journalist. When I asked him ‘how come?’, he told me that the 4Sight members had formed a committee and were opposing the funding cuts and loss of Aronda & Loleta’s posts. One of their strategies was to go to the press. He also told me that they were producing a newsletter and aiming to keep the projects going. I was stunned and moved by their positive and proactive approach, whereas I had been wallowing in negativity. I was so proud that the committee was made up of Trailblazers.

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Appendix 5: Session Plan for ‘New Hope Ministries’ Session Introductions Tree of Life: It’s roots & history What is the Tree of Life The Trailblazer experience Slideshow Extracts from DVD Panel discussion Q&A o What was your experience of Talking Therapies before the Trailblazer project

and what do think of talking therapies now? o People often say that their faith and spirituality isn’t always valued in mental

health services. How do you feel the Tree of Life connected with or valued your faith?

o What lessons have you learned from the Tree of Life? Q & A Invite reflections/plans for future Poem Close with a prayer

Appendix 6: Evaluation Feedback From ‘New Hope Ministries’ Session What did you like about the event?

Service users sharing their experiences DVD Panel presentation I like the openness and the honesty that the people involve have

spoken – you are fantastic Client involvement is a powerful tool. Listening skills of the facilitators I felt the presentation is informative because there were many real life

experiences, they are brave to do so What did you not like / what would you change:

Nothing There is nothing to change The men talk about their real experience I will not change nothing

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Further comments received via e-mail “I like to say a big thank you to all of you. The programme was a success and highly educative. I really enjoyed the DVD programme, the panel presentation and the experiences shared by the service users. On behalf of the church, I would like to say that the 'Tree of Life' presentation was highly appreciated and hopefully we will be able to share what we have learnt from the programme with people that were unable to attend”. “Thank you for coming to present the Tree of Life to us at New Hope. It was wonderful and I personally enjoyed every bit of it. I am so impressed to hear what the service users have gained. Those who attended spoke highly of it. Our prayer for you all is that the Lord will continue to guide you, uphold you, give you more wisdom and strength to carry on the good work and may God blessings be upon you in all that you do. As you are putting smiles on other people's faces the Lord will in turn do the same for you all. Amen”.

Acknowledgments

All the men who participated in both phases of the Trailblazer Project Those who facilitated Trailblazer sessions: Ade Afilaka, Aronda Warren, Sandra Griffiths, Angela Byrne, Sylvester Mittee, Brian Joof, Leslie Casimir, Loleta Cumberbatch Pastor Segun Olaleye and congregation of the New Hope Ministries Tigist Teferi and Mesha McNeil, Mellow Brigid MacCarthy and Naomi Scott, Psychology Department, City and Hackney Herbert Steiner, Psychotherapy Department, City and Hackney

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BME Access Service (City & Hackney) Department of Psychology, Lower Clapton Health Centre

Lower Clapton Road, London, E5 0PD

Tel: 020 8986 7351

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