The Mind and Body Programme

Rick Bradley Addaction/KCA Persons’ Services

Dr Terence Nice University of Kent, Centre for Professional Practice, Canterbury

Steve ButlerAddaction / KCA Persons' Services

Poppy Harris Primary Mental Health Specialist, ChYPS Sussex Partnership Trust NHS

Overview of presentation

Background to MAB

Programme components

Canterbury pilot

Measuring outcomes

Participant feedback

Evaluation and future plans

Background to MAB

Funded by PHE and commissioned by Canterbury City Council following GP concerns

Targets young people involved in self-harming behaviours but who do not meet specialist MH service thresholds

Incorporates elements of KCA's RisKit Programme - a rare example of evidence-based Early Intervention

Set up to work with young people in group and 1:1 settings

Programme components

Three one-to-one meetings

Four therapeutic group sessions exploring:

• What is self-harm?

• Understanding and managing triggers

• Assertive communication

• Distractions and diversions

Canterbury pilot

Piloted with students from five schools: Simon Langton Girls Grammar, Canterbury Academy, Spires Academy, Herne Bay High and Learning Opportunities

Delivered by practitioners experienced in therapeutic group work

Forty-nine young people will complete the programme of which three received one-to-one support

Measuring outcomes

Timeline Followback

Captures information on self-harm acts and ideation for last 28 days (plus substance use and sexual behaviour)

Teen Star

Holistic tool addressing substance use, wellbeing, safety and security, structure, citizenship and family

Warwick-Edinburgh Mental Wellbeing Scale

Established scaling tool to capture an individual's current thoughts and feelings

OutcomesParticipant data

Completion rate of 95.9% (47 of 49 YP)

Positive changes increased further after sessions ended

Self harming behaviours

67.5% of YP with SH thoughts reported reduced instances at exit

64.5% of YP with SH actions reported reduced instances at exit

26.1% of those who were self harming had stopped completely

Where SH thoughts and actions still continued, there was a significant reduction in the number of occurrences of both

OutcomesMental wellbeing

78.7% of YP registered improved WEMWBS score

Average cohort improvement from 38.5 to 45.8 on WEMWBS

40.4% of YP had statistically significant improvements at exit

Signposting and additional referrals

Four YP referred on for specialist support around eating disorders

Four YP referred for ongoing support from specialist mental health services

Two YP referred for specialist support for substance misuse

Participant feedback

"It really helped and it was surprisingly easy to talk to that many people. It was a really nice atmosphere and the activities were really helpful".

"I have more strategies to deal with things. I'm definitely less likely to cut now than used to".

"It's easier to talk to people now that I know there are other people going through the same things".

"It has helped me to understand other people's views and be open about my own".

"I enjoyed it. You find out more about yourself. It's been a bit scary to realise what I'm doing but it has definitely been helpful".

"It's been challenging but comforting. It's not been about getting sympathy or being pitied and it has been good to achieve things".

Evaluation and future plans

Funding for pilot ran until the end of March 2015

Evaluation being run in conjunction with the University of Kent and specialist mental health services

Encompassing feedback from participants, families, schools and practitioners

Plans to write up the research for journal publication

Very hopeful of continuing an adapted, longer programme

–Mind and Body Programme participant, 2014

“It is better to try and help people earlier. It makes more sense than having an ambulance at the bottom of a cliff.”

Twitter: @RickBrad1eyEmail: Rick.Bradley@addaction.org.ukEmail: Steve.Butler@addaction.org.uk

Qualitative Analysis

• Ten Interviews conducted with female participants at secondary school aged 12-16 years old

• Aim: To capture the attitudes and changes of those undertaking the Mind and Body Programme

• Semi-structured interview (5 questions) • Interviews were transcribed • Interviews subjected to narrative analysis • Phase 1 analysis – emerging themes and narrative constructs • Major & Minor Findings • Next Steps

Jody KCA 1

Text 

Minor Theme Major Theme Story-line/Plot Micro-stories

T Could you tell us just a little bit about what things have been sorted.  J. That bullying’s been sorted; home problems I’m getting help with, friendship groups. T. I just wonder how that feels. J. Feels good.  P. What was it like to stop self harm?  J. It was hard but after a while you kind of get used to it. T. This is an aside I guess, is there anything you did or you thought or felt that helped you to stop.  J Just having people there talking if you have any problems then you think that your gonna do something you got someone to talk to.

Sorting Bullying Feeling Feeling good Stopping SH Hard to stop SH Getting used to stopping

Sorting Bullying Feeling Good Stopping Jody finding ways to stop SH

Sorting things out in order to stop self-harm.

Jody feels good about stopping but it was hard. Having people there to talk to helps with not self-harming

Memo 

Sorting issues out like bullying Home problems Friendship groups Someone to talk to 

Gabby KCA 3

Text 

Minor Theme Major Theme Story-line/Plot Micro-stories

P. Ok the first question is – What changes if any do you think you have made since starting the programme? G. What like within myself? Erm well like since I started doing the programme my actions towards self- harm have decreased. Knowing that I wasn’t so alone there was actually other people that was there. P. So when you say your actions towards self- harm, does that mean the frequency of your self-harm. G. Yeah, don’t get me wrong I still get the thoughts and that but it was just like holding myself back from actually performing the action. P. OK, so you still get thoughts and you still get the feeling and a bit of an urge every now and again? But actually you don’t do it anymore. So that’s a big change. G. Uh huh.P. OK, Have you any idea what helped you to achieve that? G. I think it’s like just the fact that I try and keep myself busy and I remind myself that I’m not only hurting myself I’m hurting the people around me.

First question Actions towards self-harm Knowing that I was not alone Other people there Still get the thoughts Holding back from acting Getting the urge Big change Idea of change Reminding the self Keeping busy Not hurting others

Differential between ideation and action Knowing I was not alone The idea of other people ‘being there’ Being there Holding back Dialogue with the self Keeping busy Not hurting others

Gabby experiences thoughts of self-harm but is able to hold back

Gabby says that her self-harm has decreased and that knowing she was not alone and that there were other people there was helpful. She is able to think about the damage she might be doing to others.

MemoKnowing that I was not alone(self-knowledge) Knowing as opposed to not knowing Other people there Holding back from acting ‘I think it’s like just the fact that I try and keep myself busy and I remind myself that I’m not only hurting myself I’m hurting the people around me’. Keeping busy as a distractionWish to hurt the self is connected with hurting others? – indirectly/directly Consciously/unconsciously

Data Analysis KCA 1-10 Text Minor Theme

Major Theme

Memo Micro-story

Memo Jodie’s Story

Constructs

Jodie’s Story KCA 1

For Jody there has been a behavioural shift from a position of self-harming to no self-harm. She no longer has thoughts of self-harm and has people to talk to. She feels good about stopping self-harming, but it was hard. Jody’s belief that being inside a group and sharing her feelings with others is helpful. Jody is aware that the expression of thoughts and feelings may depend upon who she is telling. The fear of being thought crazy enters her mind frame, but the sharing of experiences, which are common for the group can be helpful. The programme has changed Jody’s ability to talk about her feelings with teachers, parents, friends and relations. There is a shift from keeping it to the self to sharing feelings and thoughts with others through talking. In summing up, Jody points to the importance of the group experience and links prevention and stopping to understanding her behaviour. Jodie cut her wrists just enough to bleed, but not to damage ligaments or go to hospital. Bleeding helps relieve stress. Jody was interested in what brought us to the school. The researcher replied that it was the voice of the young person that needed to be heard, since it is a meaningful and valuable voice to hear.

Modelling The Narrative

J1

Mind and Body

Programme

Bleeding helps relieve stress

Sharing thoughts with

Others

The Group as a Container

Self-harm Actions

Stopping self-harm actions

Being a Member of a

Group

Keeping it to the Self

Talking and sharing feelings

Self-cutting as addictive H2

Major Findings 

• All ten participants interviewed reported that they found the Mind and Body Programme a positive experience and two disclosed that they had ceased self-harming since taking the programme

• Factors that contributed to this positive experience included sharing and talking about thoughts and feelings alongside exchanging strategies with other young people who had the same issues and similar experiences

• The programme assisted participants with resolving issues of self-other relations including friendship groups, school bullying, self-regulation and home problems

• Participants generally found the creation of supportive networks a positive progression

Minor  Findings 

• Participants found that talking to people their own age was helpful and they felt less alone

• Positive identifications with other young people in a group setting contributed to well-being and positive outcome

• Meeting with other people to talk about thoughts and feelings was different to talking to parents or other adults

• One participant reported that she had taken an overdose, but had not reported this to adults or mental health services

• Participants reported diurnal and nocturnal thinking patterns related to suicidal ideations suggesting a shift to self-destructive patterns after the school day

• Some young people had bigger voices than other young people in the group programme

Next Steps • Therapeutic group work should be used to promote

attitudinal and behavioural change • A screening tool should be developed to ensure the most

appropriate young people access the programme• The number of therapeutic sessions should be increased• There should be specialist training for school staff and other

relevant mentors• There should be more information of body image• The programme should be delivered by skilled practitioners• Phase 2 data analysis