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Mental Well-being Impact Assessment – St Mungo’s Relationships project DRAFT June 2007

Mental Well-being Impact Assessment on St Mungo’s

Relationships Project

A report of two workshops held on 22nd May and 4th June 2007

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Mental Well-being Impact Assessment on St Mungo’s Relationships Project

A report of two workshops held on 22nd May and 4th June 2007

1 Introduction

St. Mungo’s is a voluntary sector homelessness organisation, providing a range of accommodation and support services including a project working with relationships & parenting. This assessment is born of St. Mungo’s wish to identify the effect it’s Relationships Project has on stakeholders, most notably those who the service aims to benefit, homeless clients. The assessment functions as a complement to required evidence for funding purposes and as a process through which future performance and effectiveness can be measured. The MWIA underpins a commitment to improving areas of weakness and building on identified strengths in the service.

The Project is a three-year scheme (April 05’-March08’) funded by the Department for Education and Skills through its Strengthening Families, Grants Work Programme. The scheme aims to:

Enable people to build and maintain relationships as a couple Enable people to build relationships with their children Ensure a skilled and confident staff team in working with parenting and relationship

needs

These objectives are addressed through the three main components of; a counselling service for individuals and couples, relationships skills development training for clients in groups and staff competency and awareness development through a one day “taster” course and three day team training programme.

To date the counselling service has received approximately 55 referrals and provided over 230 sessions with a 50% engagement rate. Training has been delivered to approximately 90 staff with significantly positive feedback and the client skills workshops have had 19 referrals with a 50% engagement rate.

This report presents the findings and recommendations arising from a Mental Well-being Impact Assessment (MWIA) on St Mungo’s Relationships Project, most notably the counselling service provision. The MWIA toolkit enables people to consider the potential impacts of a policy, service or programme on mental health and well-being and can lead to the development of stakeholder indicators. The toolkit brings together a tried and tested Health Impact Assessment methodology with a robust evidence base around what promotes and protects mental well-being.

The DOH ‘Making it Happen Guidance’ for mental health promotion (2001) identifies four key areas that promote and protect mental well-being:

Enhancing Control Increasing Resilience and Community Assets Facilitating Participation Promoting Inclusion

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The MWIA is based on these four key areas and helps participants identify things about a policy, programme or service that impact on feelings of control, resilience, participation and inclusion and therefore their mental health and well-being. In this way the toolkit enables a causal link to be made between policies, programmes or service and mental well-being, that can then be measured.

“How people feel is not an elusive or abstract concept, but a significant public health indicator; as significant as rates of smoking, obesity and physical activity”

(Department of Health 2001).

The aims of the MWIA were to:

Raise awareness and understanding of mental wellbeing; Enable a range of stakeholders to begin to identify the impact a particular policy,

service, programme or project may be having on mental wellbeing; Encourage stakeholders to explore ways to maximise potential positive impacts and

minimise potential negative ones; Enable stakeholders to explore and develop local indicators to monitor and evaluate

progress on promoting mental wellbeing.

2 MWIA Workshops

Two half-day participative workshops were held two weeks apart to undertake the MWIA in May and June of 2007.

The purpose of the workshops was to work with stakeholders (including staff and service users) to identify from their perspective the key potential impact that St Mungo’s Relationships Project (as described in the introduction) is having on the mental Well-being of the people they are serving – the clients. It also aimed identify actions to maximise positive impacts and minimise potential negative impacts on mental Well-being.

AttendanceStaff at St Mungo’s worked hard to identify and invite a wide range of participants including staff delivering the counselling project and clients using it. A total of 20 people were invited by a written invitation, followed up by telephone or one to one conversation to explain what was involved, why it was important for them to participate and how much participation would be expected from them. Directions, lunch & travel expenses were provided with the sessions start time set at 11am and finish at 3pm in the hope of making them more accessible. Also for more vulnerable clients staff reminded them on the day of the session and staff accompaniment to and from the venue was offered.

The sessions were fairly well attended by staff however it was disappointing that attendance, particularly on the first day, was very poor by service users. Reasons included one client actually being in the process of resettlement to permanent

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accommodation, one had already moved to a flat outside of London & had childcare issues, one stated that they had inadequate foot wear, two remained in bed despite staff reminder, one had work commitments and the remainder could not be contacted.

These problems with attendance highlight that for a highly disengaged client base they find it very hard to understand and believe that their views might count, that anything might change and they have many other basic needs that demand their attention rather than participating in an additional activity such as this. In addition, there are challenges with ‘selling’ the concept of a workshop looking at issues associated with mental health and well-being as this still has stigma attached and it is hard to sell the MWIA as looking at the ‘other’ end of mental illness. However, as ever, experience and word of mouth is the best sales pitch – those that did attend rated the experience highly – “it was much better than I expected and I had lots to say.”

The workshop content

What does mental well-being mean for staff?The participants were invited to consider a number of statements, definitions or facts about mental well-being that were pasted around the room. They discussed their interpretations or understanding of them with each other and then placed green dots on those they liked and red dots on those that were not helpful. There was a high degree of consensus around the room.

Those that were not seen to be helpful because they were seen as simplistic or too jargonistic included:

Being HAPPY is seriously good for you and others around you (NEF)

Mental health is characterised by the ability to love and to create… by a sense of identity based on one’s experience of self as the subject and agent of one’s powers, by the

grasp of reality inside and outside of us, that is, by the development of objectivity and reason. (Source: Fromm, 1956)

The preferred statements had an element of reality or simplicity about them, and reflected the holistic nature of mental well-being i.e. happiness and spirituality are important. Also, that life presents us with challenges and sad times and that our ability to cope with them is a marker of our mental well-being.

Mental health is the emotional and spiritual resilience, which enables us to survive pain disappointment and sadness. It is a fundamental belief in one’s own and others ‘dignity

and worth’ (The Health Development Agency)

‘Well-being is about being emotionally healthy, feeling able to cope with normal stresses, and living a fulfilled life. It can be affected by things like worries about money, work, your

home, the people around you and the environment you live in. Your well-being is also affected by whether or not you feel in control of your life, feeling involved with people

and communities, and feelings of anxiety and isolation’. (Coggins & Cooke, 2004)

This set the scene for considering the potential mental well-being impacts of St Mungo’s Relationships Project.

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Population who are likely to be affected

Public mental health aims to promote and protect the mental health of the whole population, while recognising that (as is the case for physical health) levels of vulnerability to poor mental health will vary among different population groups. Participants were given a handout that outlines the population characteristics impacting on mental well-being to be assessed.

A discussion was facilitated for participants to identify staff groups whom they thought were particularly likely to be affected. The findings are presented in table 1.

TABLE 1 Participants words have been usedPriority population group

affected or targeted by your proposal

The potential age range of clients is 18 – 65 years. Most people are between 25 and 50 years.

80% are men, mostly classified as single although should not assume this, and many have had relationship issues.

Other characteristics include: Un-employed Ex-offenders Substance misuse – alcohol and drugs Mental health Domestic violence Divorce Abused as children Post traumatic stress – newly arrived in this country Parents. Many have never experienced a sense of self-esteem or of belonging other than to other people who are homeless.

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Mental well-being protective factorsThere will be an influence on mental well-being by socio-economic, environmental, cultural and lifestyle factors – the social model of health. In addition, the MWIA toolkit suggests a four-factor framework for identifying and assessing protective factors for mental well-being, adapted from Making it Happen (Department of Health 2001) and incorporates the social determinants that affect mental well-being into four factors that evidence suggests promote and protect mental well-being:

Enhancing control Increasing resilience and community assets Facilitating participation Promoting inclusion.

Enhancing controlA sense of agency (the setting and pursuit of goals), mastery (ability to shape circumstances/ the environment to meet personal needs), autonomy (self-determination/individuality) or self-efficacy (belief in one’s own capabilities) are key elements of positive mental health that are related to a sense of control (Mauthner and Platt 1998; Stewart-Brown et al in press).

Enhancing control is fundamental to health promotion theory and practice, and is identified in the Ottawa Charter as a key correlate of health improvement:

“Health promotion is the process of enabling people to increase control over, and to improve their health”. (Ottawa Charter for Health Promotion. WHO, Geneva,1986.)

Lack of control and lack of influence (believing you cannot influence the decisions that affect your life) are independent risk factors for stress (Rainsford et al 2000). People who feel in control of their everyday lives are more likely to take control of their health (McCulloch 2003). Job control is a significant protective factor in the workplace, and this is enhanced if combined with social support (Marmot et al 2006).

Employment protects mental health; both unemployment and job loss increase risk of poor mental health: financial strain, stress, health damaging behaviour and increased exposure to adverse life events are key factors associated with job loss that impact on mental health (Bartley et al 2006). Job insecurity, low pay and adverse workplace conditions may be more damaging than unemployment, notably in areas of high unemployment (Marmot and Wilkinson 2006)

Impact of St Mungo’s Relationships Project on Enhancing Control

Participants were then invited to work between themselves to identify which of the factors that contribute to a sense of control over their working lives they felt St Mungo’s Relationships Project had the potential to have either a positive or negative impact, and the degree of importance of that impact. The results are presented in table 2.

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TABLE 2 Prioritisation Grid - Enhancing Control –

Having identified these participants were invited to work through their top priorities to identify in more detail the potential impacts and any recommendations that emerged.

The results are presented in table 3.

NoneLow

Medium

High

IMPORTANCE

Very high

HighLow

Low

MediumHigh

POSITIVE IMPACT

Maintaining independence

Self-help opportunities

Influencingdecisions

Financial security

Local democracy

Skills & attributes

Knowledge, skills & resources

NEGATIVE IMPACT

Consultation processes

MediumVery high Very high

EmploymentOptions

Physical environment

Transport options

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TABLE 3

Protective factor: CONTROLThree top priorities

Impact of your proposal on this protective factor Comments

Actions identifiedPositive Negative Unclear

1. Consultation process

Attending counselling sessions, a chance to get feedback. Makes people feel they are being heard, validated and respected. Means they may be more able to interact outside the service – there is anecdotal evidence of changes

Clients have reported that they have made friends at follow up counselling sessions

Staff training – helped and changed the way staff talked with clients

Good ‘consultation’ can enable people to feel valued and heard

Flyers, posters, written word is not best way to reach clients

Clients can be ‘scared’ of going for counselling because they have to talk about issues

Could have done more work to target some clients / residents

‘what’s the point’ ‘is it worth my time and money’ ‘being the token Voluntary sector rep’ – consultation fatigue

People don’t really care about their basic needs ‘once the barn door is shut no-one cares’ attitudes of some clients. Have to make an effort to be heard.

To improve consultation:Be much more clear about what can be changed as result of consultationAvoid the word ‘consultation’Follow up clients with one-to-one discussionsBe clear about the relevance of consultation to individuals experienceHave knowledge about the issues the clients have – need to be professional enough to recognise where people are at.

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Increasing resilience and community assets

Emotional resilience is widely considered to be a key element of positive mental health, and is usually defined as the extent to which a person can adapt to and/or recover in the face of adversity (Seligman; Stewart Brown etc). Resilience may be an individual attribute, strongly influenced by parenting (Siegel 1999), or a characteristic of communities (of place or identity) (Adger 2000). In either case, it is also influenced by social support, financial resources and educational opportunities. It has been argued that focusing on ‘emotional resilience’ (and ‘life skills’) may imply that people should learn to cope with deprivation and disadvantage (Secker 1998). WHO states that interventions to maximise and take advantage of health assets can counter negative social and economic determinants of health, especially among vulnerable groups. The result is improved health outcomes. www.euro.who.int/socialdeterminants/assets/20050628_1

Good physical health protects and promotes mental health. Physical activity, diet, tobacco, alcohol consumption and the use of cannabis and other psychotropic substances all have an established influence on mental well-being. Capacity, capability and motivation to adopt healthy lifestyles are strongly influenced by mental health and vice versa. There is growing evidence of the link between good nutrition, the development of the brain, emotional health and cognitive function, notably in children, which in turn influences behaviour. (Mental Health Foundation 2006; Sustain 2006). Regular exercise can prevent some mental health problems (anxiety and depression), ameliorate symptoms (notably anxiety) improve quality of life for people with long term mental health problems and improve mood and levels of subjective well-being (Grant 2000; Mutrie 2000; Department of Health 2004). Both heavy drinking and alcohol dependence are strongly associated with mental health problems. Substance misuse may be a catalyst for mental disorder. (Alcohol Concern; Mental Health Foundation 2006; Royal College of Psychiatrists 2006)

Although the evidence is limited, spiritual engagement (often, but not necessarily expressed through participation in organised religion) is associated with positive mental health. Explanations for this include social inclusion and participation involving social support; promotion of a more positive lifestyle; sense of purpose and meaning; provision of a framework to cope with and reduce the stress of difficult life situations (Friedli, 2004; Aukst-Margetic & Margeti, 2005) (Idler et al, 2003); Mental Health Foundation 2006.

Low educational attainment is a risk factor for poor mental health; participation in adult education is associated with improved health choices, life satisfaction, confidence, self-efficacy and race tolerance. (Feinstein et al 2003; James 2001)

Communities with high levels of social capital, for example trust, reciprocity, participation and cohesion have important benefits for mental health (Campbell and McLean 2002; Morgan and Swann 2004). Social relationships and social engagement, in the broadest sense, are very significant factors in explaining differences in life satisfaction, both for individuals and communities.

Neighbourhood disorder and fragmentation are associated with higher rates of violence; cohesive social organisation protects against risk, stress and physical illness; (Fitzpatrick and LaGory 2000; McCulloch 2003;

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http://www.euro.who.int/socialdeterminants/assets/20050628_1


Physical characteristics associated with mental health impact include building quality, access to green, open spaces, existence of valued escape facilities, noise, transport, pollutants and proximity of services (Chu et al 2004; Allardyce et al 2005; Jackson 2002). Housing is also associated with mental health - independent factors for increasing risk of poor mental health (low SF36 scores) are damp, feeling overcrowded and neighbourhood noise (Guite et al 2006;HF Guite, Clark C and Ackrill G (2006). Impact of the physical and urban environment on Mental Well-being Public Health supplement in press).

Impact of St Mungo’s Relationships Project on increasing resilience and community assets

Participants were then invited to work between themselves to identify which of the factors that contribute to a sense resilience and community assets they felt St Mungo’s Relationships Project had the potential to have either a positive or negative impact, and the degree of importance of that impact. The results are presented in table 2.

TABLE 4 Prioritisation Grid - Increasing resilience and community assets

NoneLow

Medium

High

IMPORTANCE

Very high

HighLow

Low

MediumHigh

POSITIVE IMPACT

Social Networks Emotional

wellbeingEase of access to services

Arts and Creativity

Cognitive and social functioning

Learning and development

NEGATIVE IMPACT

Spirituality

MediumVery high Very high

Shared public space and green space

Social support

Trust and Safety

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Having identified these participants were invited to work through their top three priorities to identify in more detail the potential impacts and any recommendations that emerged – they chose one main one!

The results are presented in table 5.

TABLE 5 RESILIENCE & COMMUNITY ASSETSProtective factor:RESILIENCE & COMMUNITY ASSETS

Impact of your proposal on this protective factor Comments /


1. Cognitive & social functioning – interpreted as being how we relate to each other, problem solving

Once clients have a +ve experience of the group/s they feel more positive about themselves

Builds trust move into a skills workshop. Feedback from clients suggests an increase in their ‘self worth & self esteem’, & in confidence to build relationships with family, client can then focus on what he needed to do i.e. get a job

Chance to think about what they really want and how to go about achieving it

Not always comfortable with participating in groups

Costly to do one to one work

Counselling can be a ‘stigma’ for people e.g. men – they just want a practical list of tips

Referrals but people not always going to attend

Problems with finding out when residents meetings are happening

45% of counselling clients are men (80% St Mungo’s clients are men), 50/50 split in the group sessions

Not clear about how clients have experienced the confidentiality of the counselling service (their concerns are not followed up by key workers)

Overall – need to review how clients are recruited to the service.

Clients could take their +ve experiences to residents meetings to break down barriers and misunderstanding – ‘word of mouth’ most effective publicity

Offer more options for where the service could be delivered to increase access

Must build/follow up on clients issues after they have finished the counselling sessions

‘Taking the Outside in’ – St Mungo’s consultation strategy is very important

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Workshop 2: Facilitating participation and promoting social inclusionFeeling useful, feeling close to other people and feeling interested in other people are key attributes that contribute to positive mental wellbeing (Stewart Brown et al, Warwick Edinburgh, Measuring Mental Wellbeing Scale forthcoming).

Participation is the extent to which people are involved and engaged in activities outside their immediate household, and includes cultural and leisure activities, as well as volunteering, membership of clubs, groups etc., participation in local decision-making, consultation, voting etc.

Social inclusion is the extent to which people are able to access opportunities, and is often measured in terms of factors that exclude certain groups, e.g. poverty, disability, physical ill-health, unemployment, old age, poor mental health.

Although participation and social inclusion are different constructs, there is some overlap in the literature, and they are therefore considered together here.

Strong social networks, social support and social inclusion play a significant role both in preventing mental health problems and improving outcomes (SEU 2004). Social participation and social support in particular, are associated with reduced risk of common mental health problems and poor self reported health and social isolation is an important risk factor for both deteriorating mental health and suicide (Pevalin and Rose 2003). Similarly for recovery, social participation increases the likelihood, while low contact with friends and low social support decreases the likelihood of a recovery by up to 25% (Pevalin and Rose).

However, social support and social participation do not mediate the effects of material deprivation, which in itself is a significant cause of social exclusion (Mohan et al 2004; Morgan and Swann 2004; Gordon et al 2000).

Anti discrimination legislation and policies designed to reduce inequalities also strengthen social inclusion (Wilkinson 2006; Rogers and Pilgrim 2003).

There is some evidence that informal social control (willingness to intervene in neighbourhood threatening situations, e.g. children misbehaving, cars speeding, vandalism) and strong social cohesion and trust in neighbourhoods, mitigates the effects of socio-economic deprivation on mental health for children (Drukker et al 2006).

Higher national levels of income inequality are linked to higher prevalence of mental illness (Pickett et al 2006). Mental health problems are more common in areas of deprivation and poor mental health is consistently associated with low income, low standard of living, financial problems, less education, poor housing and/or homelessness. Inequalities are both a cause and consequence of mental health problems (Rogers and Pilgrim 2003; SEU 2004; Melzer et al 2004).

Impact of St Mungo’s Relationships Project on Facilitating Participation Participants were then invited to work between themselves to identify which of the factors that contribute to facilitating participation and reducing social isolation they felt St Mungo’s Relationships Project had the potential to have either a positive or negative

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impact, and the degree of importance of that impact. The results are presented in table 6.

Table 6: Prioritisation Grid – Participation

Activities that bring people together

Economics

High

Medium -

Low

Negative Impact

Positive Impact

Very High

IMPORTANCE

Having a Valued Role

Sense of belonging

Feeling involved in the community

Cost

Transport

Opportunities to get involved

Access to goods or servicesProcesses or

delivery that support social contact

Understanding the

process & possible benefits (counselling)

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Table 7: Facilitating participationProtective Factor:

Participation

Impact of your proposal on this protective factor

Comments


1. Understanding the process and possible benefits

The client understands that this is “their space” and someone is listening and giving them time

A simple explanation of the product will enable clients to make an informed decision about whether the service is right for them.

It will enable staff members and the individual to understand how the client may benefit from the service e.g. dealing with anger, substance misuse, relationship issues etc.

Dependency on counselling.

If clients don’t understand it they won’t go.

‘counselling’ as a word has stigma and people won’t take it up.

Language issue when English is not first language

If people can’t read written material doesn’t work –use other methods e.g. videos

Language used to explain counselling is important to aid understanding.

Potential to offer additional ways of obtaining counselling e.g. drop-in session, times when counsellors available to take phone calls.

Staff need to be able to tailor how they describe counselling to the individual client’s needs in order to improve understanding –staff training

Three day training for staff could include a session on their own attitudes to counselling as this could affect how they describe it to clients.

PublicityIncrease awareness among staff of the service e.g. welcome pack at Church Walk.

Review the language used in the service leaflets.

One-to-one relationships important way of publicising service e.g. keyworker & client

Also idea of clients who have used the service attending the residents meetings to promote the service.

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Table 8: Prioritisation Grid: Social Inclusion

IMPORTANCE

Very High

High

Medium

Low

Negative Impact Positive Impact

Conflict Resolution

Tackling inequalities

Feel safe at home

Positive identities

Practical Support

Challenging the stigma of mental illness

Challenging discrimination

Trust others

Low levels of crime

Lifestyles

Culture

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Table 9: Promoting social inclusionProtective factor:SOCIAL INCLUSION

Three top priorities

Impact of your proposal on this protective factor Comments


Tackling Inequalities (health, MH, BME communities, Diversity, Disability, Lifestyle Issues e.g. substance misuse)

The counselling service is serving a higher proportion of BME members than St. Mungo’s

Accessible project

Attending counselling “helped me attend this workshop –two months ago I wouldn’t have” –client

The counselling service offers clients continuity (it may be the only sense of continuity they get), trust & being valued

It is important for staff to get feedback about their clients & see them move on –‘see client blossom’ (& are able to move on).

Referral form that staff fill in for client to attend training is 2-3pages & may act as a barrier to staff filling it in (also interpreting is not necessarily available to help fill this form in)

Language may mean service is inaccessible to some clients. Have used an interpreter for only 3 clients so far.

Project team need to link counselling service more to parents & young children as these are funding priority target groups.

Most clients have to go out of hostel to see children –is there a way the children could come into hostel?

Is counselling available to a client whose relationship is with someone who is not a St. Mungo’s client?

How can counselling be effective in a hostel environment when there are so many other issues?

Unclear why there is a higher representation of BME clients in the counselling project than St. Mungo’s?

Need to understand this more.

Could do more work on how we could link parenting & kinship relationships to the hostel (St. Mungo’s is described as a working with single, homeless people)

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Summary of impact on mental well-being

It is clear that there are a number of positive impacts that the Relationships Project is likely to be having on clients and staff. These are limited to those clients who access and participate in the service, and to those staff who are more actively involved in referring into and delivering it. The Relationships Project is having a direct and indirect positive impact on the four protective factors, as described in detail in the tables above, and is resulting in:

1. Raised self-esteem, sense of self worth and confidence of clients, which in turn is helping them to stabilise their lives and access support services more effectively.

2. A feeling of being heard, valued and respected which helps to build confidence and trust in services.

3. A increase on social relationships – which has a significant impact on mental well-being.

4. An opportunity for clients to have space, stability and support for reflecting on their lives and making changes to improve their situation.

5. Staff experiencing the training are better able to understand how to guide clients into the service, and a positive feeling once clients have a positive experience.

6. A disproportionately higher ratio of black and minority ethnic clients accessing the service which suggests they are getting a high level of satisfaction.

However, there are also a number of potential negative impacts that the Relationships project is likely to be having on clients and staff. These are largely concerned with:

1. How the service is promoted – written material is not always the best medium, some staff do not appear to be familiar with what the service offers and are less motivated to promote on a one to one basis with clients which is what is required.

2. Lack of understanding about what the service offers – the word ‘counselling’ is associated with stigma and distrust, and some clients distrust the confidentiality of the service (because of other experience of ‘authority’ or concerns that partners or other family members might find out about their disclosure of abuse – not based on experience of this service).

3. The complexity of needs of the clients sometimes means that their basic day to day needs are more important than accessing a counselling service (and indeed a workshop such as this!).

4. Once clients have finished their sessions they may need some form of follow up support to enable them to sustain their developments and any changes to their lifestyles they identify.

5. 80% of the clients of St Mungo’s are men yet only 45% of the counselling service are men. (nb: This can be seen as a positive given low take up of counselling services generally by men compared to women)

6. The referral system (forms that need to be filed in by staff) appears to be a barrier for some staff due to workload or lack of motivation to refer people in.

7. English as a second language (despite the counsellors using interpreters effectively), location and lack of family provision of the service, in some instances, is likely to be restricting access to the service.

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3 Recommendations

There are a number of recommendations arising from this MWIA that are presented for consideration:

3.1 Clearly the counselling service is having a positive impact on the mental Well-being of clients and funding should be sought to continue it. The staff training aspect of the project was not considered in depth, however it is clear that more staff need to receive training on what the service offers, attitudes towards counselling and communication with clients.

3.2 The promotion of the service should be reviewed (builds on the previous point) both among staff and with clients. Staff could be doing more in their one-to-one relationships e.g. keyworker & client to promote awareness and understanding of the service – particularly with men. Encourage spreading ‘word of mouth’ experience of clients who have had a positive experience to other clients for example through residents meetings. Increase awareness among staff of the counselling service and how to publicise it to clients e.g. welcome pack at Church Walk includes leaflet.

Consider the development of other materials to use to promote the service such as a video with clients on the counselling service.

Review the language used to describe counselling, bearing in mind the stigma attached by some to counselling / mental health including in written material. Include a section on the 3-day staff training that develops staff members to tailor their description & explanation of counselling and its benefits to an individual client’s needs in order to improve understanding.

Increase awareness among staff and clients that the counselling service can provide interpreters for sessions for clients who require them.

Clarify the protocol for who is eligible to use the counselling service and in what circumstance and promote this among staff and clients. The referral system (form filling) should be reviewed and simplified if at all possible.

3.3 The provision of the service should be reviewed in terms of increasing options for location to increase access, premises that allow for childcare provision or family consultations. Explore the potential to offer counselling through other means e.g. drop-in sessions, and designated times when counsellors available to take phone calls from clients.

3.4 Follow up work with clients once they have completed their sessions should be reviewed with St Mungo’s staff.

3.5 Review the training for staff to include a session in this training on staff’s attitudes to counselling and how this could affect how they describe it to clients. Include feedback from clients on the service as part of this review and include a section in the training on this to break down barriers to understanding and attitudes towards counselling.

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3.5 Explore the reasons why there is a higher representation of BME clients and a lower representation from men using the counselling project than are staying in St. Mungo’s accommodation.

3.6 St Mungo’s could learn from the MWIA feedback in terms of how they can improve consultation and development of services in collaboration with client. Lessons learned for consultation include:

Be much more clear about what can be changed as result of consultation Avoid the word ‘consultation’ Follow up clients with one-to-one discussions Be clear about the relevance of consultation to individuals experience Have knowledge about the issues the clients have – need to be professional

enough to recognise where people are at.

4 Evaluation of workshop experience

Participants were invited to complete an evaluation form at the end of both workshops. The results suggest the workshops were successful in:

Raising awareness and understanding of mental well-being – this was rated very highly

Identifying the characteristics of the client group Identifying mental well-being protective determinants and impacts Final discussion and thinking about recommendations scored highly.

Additional comments included:First workshop‘In view of the low turn-out, it was still very useful’‘Very useful to have a space to look at the project. My thoughts are with those not present as well as those attended’Second workshop‘Good to have the space to look at developments / issues’‘Very interesting process and learned a lot and appreciated everyone’s contributions / perspectives’‘Necessary to get a full grip on what determines well-being, it’s measurement as well as impact’‘Good people – nice to meet them’‘Today has given me a lot to think about’‘Very enabling, thought provoking’‘Thank you Anthea and Lee. Excellent facilitation’‘I have been to many workshops in the past, but this one had a different feeling – only time will tell whether this has had an impact – I would be very disappointed if it did not’.

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