Well-being Promotion and Stigma Reduction in

Calderdale

Objective one: More people will have good mental healthObjective six: Fewer people will experience stigma and discriminationNo Health Without Mental Health (2011)

Development• This document has been developed jointly between SWYPFT and the local

commissioners, at their request, and is undergoing review (by the Local Authority and Clinical Commissioning Group). Today we are inviting stakeholder and partner comments and contributions, as well as developing the accompanying action plan.

The document is a direct response to the National Mental Health Strategy, ‘No Health Without Mental Health’ (2011) and focuses on two of the six objectives it outlines.

Objective one: More people will have good mental health Objective six: Fewer people will experience stigma and discrimination

• The document helps provide a common understanding of well-being and prevention definitions. Individual projects and organisations will be supported in contributing to the action plan, which will be structured using a life course approach and be based on the 5 building blocks.

“It is proposed that achieving a small change in the average level of wellbeing across the population would produce a large decrease in the percentage with mental disorder, and also in the percentage who have sub-clinical disorder (those “languishing”)” (Foresight Mental Capital and Wellbeing Project, 2008).

Aims

“The local population report and demonstrate a higher motivation to look after their own well-being needs and have accepting, helpful attitudes to mental health difficulties in others.

These outcomes are aligned with objectives 1 and 6 of ‘No Health without Mental Health’ (2011)”.

“Wellbeing is: A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment” (Director of Public Health Annual Health Report for Calderdale, 2011).

The desired outcome of implementing this approach over the next 5 years is:

Accountability and Ownership

• The document will be owned by the Mental Health Partnership Board

• Support and development of the document and action plans will be taken forward by the Mental Health Promotion Alliance

• www.southwestyorkshire.nhs.uk/mhpa

www.calderdale.gov.uk

“Mental illness is the single largest cause of disability in the UK, contributing up to 22.8% of the total burden, compared to 15.9% for cancer and 16.2% for cardiovascular disease. The wider economic cost of mental illness in England has been estimated at £105.2 billion each year. This includes direct costs of services, lost productivity at work, and reduced quality of life. The cost of poor mental health to businesses is just over £1,000 per employee per year, or almost £26 billion across the UK economy (NHS Choices website, 2013).

“The direct financial cost to the state of the treating people with mental health problems is however the tip of an iceberg when it comes to the impact of mental health problems. Most of those experiencing problems are adults of working age, who have caring and family responsibilities. The economic and emotional impact on families when a main earner and carer experiences mental health problems can impact across generations.Successful interventions of any sort which have an impact on preventing mental health problems arising, or reducing their severity and duration by timely targeted support will have substantial social and cost benefits” (Calderdale JSNA website, 2013)

The Business Case for Well-being Promotion

The local population• The population figures for children and young people will rise, with

an additional 3,600 children aged 15 and below expected. The proportion of children of South Asian ethnicity will rise from 10% to 15%.

• In the Calderdale area, the ageing population (65+) is set to experience the biggest increase in the next few years, with rapid growth in the numbers aged 65-74: a rise of 5,600 by 2018.

• Calderdale has a higher unemployment rate and a higher percentage of young people classified as NEET (not in education, employment or training) than the average for England.

• The estimated prevalence of depression among adults (18+) in Calderdale, as calculated from General Practice records, was 14.89% in 2011/12, which is significantly higher than the England rate of 11.68%.

• In 2010, 21% of the population of Calderdale were living in the 20% most deprived areas of England.

In Calderdale we strive to see….

Increased mental and physical health literacy in all sections of all of the communities in Calderdale through a Five Ways to Wellbeing campaign, and

improved cross-referrals between healthy weight/smoking cessation/physical activity services and mental health services.

Parents and care-givers with the capacity and knowledge to meet the social and emotional needs of themselves and their families through interventions which promote parenting skills, family mental health and address childhood conduct

disorder.

A reduction in mental-health related absence and unemployment through the expansion of delivery of workplace well-being, Five Ways to Well-being and Mental

Health First Aid training, and implementation of best-practise across Calderdale employers.

A reduction in mental ill-health amongst jobseekers and long-term unemployed, and an increase in motivation to adopt protective healthy behaviours through

targeted interventions for jobseekers and promotion of the Five Ways to Well-being and physical health improvements such as increased exercise and smoking

cessation.

An increase in the number of people exhibiting early symptoms or higher-risk groups engaging in community-based activities which uphold good mental health and well-being through raising awareness of the availability of these activities and organisations, and increasing signposting at the first signs of vulnerability to stress, anxiety, depression or social isolation.

Older adults who feel secure in their communities and homes, who feel their mental capital is valued and who increase their uptake of opportunities for social and physical activities through targeted anti-stigma campaigning, ensuring community facilities and public transport are accessible to older people and used in safety and confidence, and an expansion of the resources aimed at this age group.

Reduced inequalities in access to support through targeted promotion of these services to BME communities, and peer- and professional-support to make initial contact with a service or intervention to reduce anxiety or non-attendance.

Increased networking and referrals between projects, programmes and services through utilising opportunities for cross referrals.

In Calderdale we strive to see….

Preventative Interventions and Health Promotion Measures

When we talk about ‘preventative measures and interventions’ we mean:

• The maintenance of mental and overall well-being as protective factors against the development of symptoms of mental ill-health; building individual resilience and coping skills to rise to meet life’s challenges, and to reduce risk factors (primary prevention and mental health promotion).

• Preventative interventions amongst identified higher-risk groups in the community to promote well-being, self-esteem and early-access to services should a problem begin to develop (primary and secondary prevention).

• Comprehensive, holistic approaches to treatment for those developing early symptoms of mental ill-health and distress (secondary prevention).

Early Sympto

msPreventi

on

Identified High-Risk Populations Selective preventive

interventions

Universal Preventative MeasuresTargeted to the general public or to a whole population

group

Starting well: pregnancy, families and young children under five

Developing well: children and young people under 18

Living well: adults in their community and home settings

Working well: workplaces and employment related issues/services including the unemployed and jobseekers.

Ageing well: older people 50+

Resilient Individuals, Families and Communities

Positive Attitudes and Behaviour towards Mental Health

Funded and Supported Activities

Well-being Literacy

Comprehensive Strategies, Action Plans and Evaluation

A Life-Course approach to Well-being: Provision for all Calderdale residents at every age and time of life.

Building Blocks for Calderdale’s

Well-being

These building blocks are a visual graphic to

accompany the statements of results

below.

R

P F

W C L

These building blocks are statements of the outcomes we wish to see in Calderdale; the results of activities by third sector and statutory organisations.

Resilient Individuals, Families and Communities

R

Resilience-building encompasses the skills and attributes which enable individuals to effectively cope with life stressors and events. It also takes account of the risk factors which increase the likelihood of mental ill health or less than optimum well-being and the measures which reduce these risks.

Activities which contribute to this result include:Neighbourhood Schemes Community Health ChampionsThe Family Nurse PartnershipWorkplace Health ProgrammesRelaxation Skills TrainingBehavioural Interventions for young peopleWorkplace Stress TrainingParenting Skills Training

Positive Attitudes and Behaviour towards Mental Health

PTime to Change campaign (National and Local level)

In Calderdale, achievement of this result would involve:

•Workplaces which are sympathetic and supportive towards staff experiencing stress and well-being issues

•Individuals with increased motivation to take care of their mental health and engage in healthy behaviours

•Positive experiences of community involvement, workplace environments and statutory services for those with mental health problems, free from stigma or discrimination

Funded and Supported Activities

FThis result will be achieved through community groups’ use of funding to run and expand their programmes of activities, and having training and resources available to improve the service they provide.

Advice for creating a funding bid or fundraising activities as provided by organisations such as north bank forum and Community Voluntary Action Calderdale.

Groups and Projects have access to training for staff and volunteers and are informed of networking and referral opportunities.

Increased networking and referrals between projects, programmes and services

Well-being Literacy

W

Mental Health First Aid and Mental Health First Aid for Young People Training

A public campaign centred on the Five Ways to Wellbeing, including suggestions for helpful actions and pursuits which contribute to well-being and physical health.

Educational material around maintaining the conditions for positive mental health

In Calderdale, people will be empowered to make positive choices about their own health and well-being, and to take full advantage of the variety of activities on offer.

Comprehensive Strategies, Action Plans and Evaluation

C

Once approved, the Well-being Promotion and Stigma Reduction Strategy for Calderdale will be in place for 5 years.

Each contributing organisation can create a yearly action around these five building blocks.

Improvements in the public mental health of Calderdale residents will be seen:

• When strategies are written in mutually-understood terms and clear language, accompanied by specific, measurable actions.

• Interventions and activities are appraising their impact

• Smaller projects are equipped with tested measures to quantify their effects on participants

Developed by the new economics foundation as part of the Foresight

Mental Capital and Wellbeing project , the Five ways to Wellbeing are:

Example graphics from Five

Ways to Wellbeing campaigns

in other areas

Connect…With the people around you. With family,

friends, colleagues andneighbours. At home, work, school or in

your local community. Think ofthese as the cornerstones of your life and

invest time in developingthem. Building these connections will

support and enrich you every day.

Be active…Go for a walk or run. Step outside. Cycle.

Play a game. Garden. Dance.Exercising makes you feel good. Most

importantly, discover a physicalactivity you enjoy and that suits your level

of mobility and fitness.

Take notice…Be curious. Catch sight of the beautiful.

Remark on the unusual. Noticethe changing seasons. Savour the

moment, whether you are walking towork, eating lunch or talking to friends. Be

aware of the world aroundyou and what you are feeling.

Reflecting on your experiences will helpyou appreciate what matters to you.

Keep learning…Try something new. Rediscover an old

interest. Sign up for that course.Take on a different responsibility at work.

Fix a bike. Learn to play aninstrument or how to cook your favourite

food. Set a challenge you willenjoy achieving. Learning new things will

make you more confident aswell as being fun.

Give…Do something nice for a friend, or a

stranger. Thank someone. Smile.Volunteer your time. Join a community

group. Look out, as well as in.Seeing yourself, and your happiness, linked

to the wider communitycan be incredibly rewarding and creates

connections with the peoplearound you.

Creating an Action Plan

• We designed the building blocks using an Outcomes Based Accountability approach (an overview of which follows this slide)

• Today’s workshop activity will focus on the actions from all partner organisations which will contribute to the achievement of our aims for Calderdale.

Outcome Based Accountability: 2 Ends and 2 Means

• Results/Outcomes – A population level condition of well-being for Calderdale residents -

• Indicators – Measures that help quantify the achievement of a result

• Strategy – A collection of actions and reasoning about what will work

• Performance measures- How well a programme, agency or service is working

Baselines and Turning the curve

Adults Accessing NHS Specialist Mental Health Services

3200

3400

3600

3800

4000

4200

April 2008-March 2009

April 2009-March 2010

April 2010-March 2011

Calderdale

Men

tal H

ealth

Ser

vice

Use

rs

Tot

al (

Per

sons

)

Source: The NHS Information Centre for Health and Social Care

This dataset is produced from the Mental Health Minimum Dataset (MHMDS) and provides data on the number of people aged 18 and above who were in contact with NHS specialist mental health services in a year. These services include not only in-patient services, but also services provided in the community or through outpatient clinics.

Baselines and Turning the Curve

Seven questions to guide action planning

• Who are our clients and service users? • How can we measure if our clients and service users are

better off?• How do we measure if we are delivering services well?• How are we doing on the most important of these

measures? (Baseline of historical performance and a forecast of where we will be in the future if services stay exactly the same)

• What partnerships have a role in improving performance?

• What works? Including low cost and no cost ideas. • What do we propose to do?

Evaluation and Performance MeasuresQuantity Quality

Effort

How much did we do?# clients served

# activities by type

# staff received additional training

How well did we do it?% of activities well-attended

% of actions completed on time

% customer satisfaction Did we treat you well?

Effect

Is anyone # of people

# of people with improved skills/knowledge

# reporting a change in attitude/opinion

# behaviour change

# change in circumstances

better off?receiving service

% of people with improved skills/knowledge

% change in attitude/opinion including customer satisfaction Did we help you with your problem/s?

% behaviour change

% change in circumstances

Measuring Self-reported Improvements

Well-being:

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

The Recovery star

The Office for National Statistics ‘Subjective Well-being Questions’ (which have formed part of the Integrated Household Survey since April 2011)

The Social Trust Question

Attitudes and Behaviour:

Mental Health Knowledge Schedule (MAKS)

Community Attitudes towards Mental Illness (CAMI)

Reported and Intended Behaviour Scale (RIBS)

Conclusion

Workshops

• Resilient individuals, families and communities (OBA)

• Positive attitudes and behaviours towards mental health (OBA)

• Well-being literacy (OBA)

• Funding and evaluation

• Well-being Promotion and Stigma Reduction Strategy for Calderdale