MAKING THE BIG SOCIETY BIGGER

working towards citizenship and connectedness for people with Mental illnesses

Anna Croucher (senior Occupational Therapist & service

development lead)and

Sarah Josefsberg (Senior Occupational Therapist)

Overview of the workshop

Explore the concept of social inclusion and social exclusion

Provide an overview of SHARP Consider services in relation to a ‘traffic

light model’ Practically use an activity to establish

values

Aim of the SHARP

Decrease distressing symptoms Reduce relapse Promote Healthy Living Enable new and innovative practice Increase Social Inclusion

So what is SOCIAL INCLUSION ??

Its about lots of things!! Physical and psychological involvement (Labonte 2004)

Connectedness, citizenship and belonging (Morgan et al 2007).

Temporal, relative and subjective (Le Boutiller and Croucher 2010)

The people and places (Hacking & Bates 2008)

The opposite of social exclusion?

But do people WANT Social lnclusion...

Social Inclusion Vs Social Exclusion

Exclusion relates to structural barriers that exclude an person:• Democratic and legal system

• The labour Market

• Welfare state system

• Family and community system (Commins 1993)

Inclusion works on individual level • The extent to which people are accepted and feel that

they belong to different social contexts (Secker 2009)

SHARP’s definition of social inclusion

To support individuals to explore

participating in activities that are

meaningful to them

Employment

Education

Volunteering

Arts and Culture/Leisure

Faith and cultural communities

Family & neighbourhood

Sport & exercise

Services

MotherVocations Matters

STAFF

Brixton RecreationCentre

Healthy Living Group

Bowling & cinemaFriends Pub

Lambeth College

CMHT, SHARP

GP

Local shops

Church Museums

Developed by NDTi

Captures the people and places that a service user has contact with in a two week period of time.

THE INCLUSION WEB

Voluntary work

But how socially included are we?

SI is underpinned by the assumption that ‘normal people’ are themselves socially included...

Activity:

Talk with your partner and with reference to The Web think about:

How socially included do you feel? What areas do you feel you are socially included? What would YOU do to become more socially included?

The Web: Case Study

28 year old man. Living with family. Has a history of depression since his teenage

years. Never been employed and has poor literacy

skills. Explains that he is shy and feels he lacks

confidence, especially expressing his needs in one to one situations.

Likes art and is interested in computers.

SHARP Team

The WebOuter circle is places and Inner Circle is people

Employment

Education

Volunteering

Arts and Culture

Faith and cultural communities

Family & neighbourhood

Sport & exercise

Services

Places People

Employment 0 0

Education 0 0

Volunteering 0 0

Arts & Culture 0 0

Faith & Cultural 0 0

Family & Neighbourhood

1 1

Sports 0 0

Services 3 3

CMHT

GP

Care Co-coordinatorGP

SHARP workers

Prison

Brother

Grandmother

Uncle

Mother & Father

Mum’s house

Used to go to galleries

 SHARP Team, 2007

Employment

Education

Volunteering

Arts and Culture/Leisure

Faith and cultural communities

Services

CMHT

GP

Mother & Father

Brother

Grandmother

Uncle

Vocations Matters

SchoolCare Co-coordinator

Comic Shop

Art Therapy

Art Therapist

Library- Learn Direct

Thrive Gardening course

Gardening Crew-Supported employment

Bookshop Volunteer Option

Gym GroupBrixton RecreationCentre

Clapham Gym

Wheels 4 wellbeing

YMCA

Flaxman centre

Healthy Living Group

GP

SHARP workers

Garden crewmembers

Bowling & cinemaFriends

Pub

Art galleriesMuseum

Parks

Bowling

Photography course

Prison

Café Common

Football

Lambeth College

Family & neighbourhood

Sport & exercise

 

Places People

Employment 1 1

Education 5 0

Volunteering 2 0

Arts & Culture 8 2

Faith & Cultural 0 0

Family & Neighbourhood

1 1

Sports 5 2

Services 3 3

Mum’s house

The WebOuter circle is places and Inner Circle is people

Psychosis

Incidence of schizophrenia in Lambeth 4x higher than average (Garety and Rigg 2001)

Lambeth PCT spends £60m out of budget of £400m on mental health

Cost of relapse £8212 compared to £1899 if no relapse

27% of clients who have engaged with us had a hospital admission or HTT contact in year before referral

What does this mean?

Working with people who have: high relapse rates Complex needs Disrupted lives due to illness

How was SHARP set up? A feasibility study involving stake holders and

service users in development Funding from GSTT Charity & reconfigured

existing team Provide evidence-based interventions which

help clients move on No care coordination Recovery ethos- Social Inclusion Hope and

Recovery Project Evaluation of interventions and service Launched May 2007

What do SHARP offer? Social Inclusion Therapy CBT for Psychosis Family Intervention MI for substance abuse Healthy Living/ Gym/ Football/ Aqua Groups Gardening/ Creative writing Mindfulness ACT Research activity

How is SHARP different to other services? Easy telephone referral Solution-focused assessment Intervention based on client choice- An opt in

service Integrated psychological and social

interventions All interventions evaluated by outcome and the

service is constantly evolving and improving based on findings i.e. Tea party

Recovery oriented: ‘A sense of hope and identity, where people belong and can make sense of their experiences’ (SHARP, 2010)

How do we achieve social inclusion?

National Development Team for inclusion- Peter Bates: Traffic light model, how socially inclusive are services?

‘Disability places’, with service users and staff

‘Ordinary places’, with service user-only groups

‘Shoulder to shoulder’, with general public

NDTi model views inclusion as

Access: Being able to utilise services and places in the community

Standard of living: That meets your needs maintains quality of life

Relationships: Having support, someone to share things with, knowing someone cares

Traffic light system Focus on impact of environment on S.Ii.e. Café vs. Hospital

Increasing inclusiveness of settings, advocacy in combating stigma- 80% report as biggest barrier

i.e. Offering training to staff at Brixton Rec

Increasing community links i.e. moving from red to amber

i.e. Creative writing group in library

Case study

Janet is a 19 year old ex college student with a diagnosis of psychosis. She has spent the last 2 years withdrawing and isolating herself. She has been living at home with her mother and 2 younger siblings and has been virtually housebound due to constant paranoid thoughts that a gang in her local area are coming for her.

Case study continued

First contact with services

Attends SHARP groups

Linked in with community based groups

A&E

CMHT

SHARP

GYM GROUP

HEALTHY LIVING GROUP

LAMBETH COLLEGE

SPORTS ACTION ZONE

Activity:

Groups of 4-6 people

What services fit into RED/AMBER/GREEN?

What are the advantages and disadvantages of services at each level?

How do you support people to move on to the next level?

Activity

Group Feedback

Putting the meaning back in meaningful activity!

Working out where to start

Explore values Address motivation for change Choose achievable things Problem solve Advocate

Activity

Exploring Values according to an ACT frame of reference

ACT model

Activity continued

Values are ‘desired qualities of ongoing actions’. They are a compass that guide and give you

direction and can help you stay on track.

Goals vs. Values: Marriage vs. Being Loving

Activity continued

1. Values are now/ Goals are in the future

2. Values never have to be justified

3. Values often need to be prioritised

4. Values are best held lightly

5. Values are freely chosen

Activity Complete PART 1: identifying values

What do I stand for as a person?What would they say about me at my

eulogy?

Complete PART 2: making a commitment

Setting a short term goalTaking your thoughts along for the ride

Questions?

References Hacking, S., Bates, P., (2008) The inclusion Web: a tool for person

centred planning and service evaluation. Mental health Review journal, 13 (2) 4-15.

Labonte, R. (2004) Social lnclusion/exclusion: dancing the dialectic. Health promotions international, 19 (9) 115-21

Le Boutiller, C., Croucher, A. (2010) Social lnclusion and mental health, British Journal of Occupational Therapy, 73 (3) 136-140.

Morgan, C., Burns, T., Fitzpatrick, R., Pinfold, V (2007) Social inclusion and mental health: conceptual and methodological review. British Journal of Psychiatry, 191 (6) 477-83.

Secker, J. (2009) Mental health, social exclusion and social inclusion, Mental health review 14 (4) 4-11.

Commins, P., (1993) Combating Exclusion in Ireland 1990-1994, A Midway report. Brussels: European commission.