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The SEEDS OF HOPE Project

A BIG LOTTERY-funded programme of vocational rehabilitation offering mental health support

Year 1 Report

Dr J R Hegarty

Chartered Psychologist

May 8, 2014

CONTENTS page

1.0 Preface and acknowledgements 2

2.0 Executive summary 2

3.0 Introduction 3

4.0 The Seeds of Hope Programme 4

5.0 Results 12

6.0 Discussion 14

7.0 Conclusions 15

8.0 References 15

9.0 List of Appendices 16

1.0 PREFACE (HOW THIS REPORT WAS COMPILED) and ACKNOWLEDGEMENTS

To compile this report, I attended 5 team meetings of the Seeds of Hope project, spent 3 days participating in activities at the farm and chatting to project attendees and staff, and interviewed 5 staff members and 2 attendees about their perceptions of the project. I was also in email contact with the team.

I read the detailed records compiled by the team for each client attending and prepared a spreadsheet showing age, sex, referring agency, time spent on project, attendance, and STAR scores (a spreadsheet compiled separately by Lorraine Longmore was extremely helpful).

I am most grateful to everyone at Seeds of Hope and the GrowWell Project for their enthusiasm for the project and for the help they have given me over the past year. The support of the Big Lottery is gratefully acknowledged.

John Hegarty

2.0 EXECUTIVE SUMMARY

The origins, process and outcomes of the Seeds of Hope three-year project (funded by Big Lottery) are described and evaluated in its first year of operation .

Seeds of Hope was built on experience providing vocational support to people with mental health challenges by the registered charity The GrowWell Project. Based at Beaudesert Park Farm in the Cannock Chase area of the English midlands, Seeds of Hope provides a one day per week opportunity for people with long-term mental health diagnoses to gain confidence and skills in a supportive environment which is also geared to specific outcomes and progression towards employment. It is founded on the accepted value of a structured programme in the natural setting that a farm can provide (“care farming” or “green care”).

Details of the process of referral, admission and progress review are provided.

Statistics are given on 37 people who undertook the project during Year 1. Seeds of Hope collectively met or surpassed all the outcomes anticipated for the Project which were specified in the Big Lottery bid, showing increase in skills and confidence for the majority of clients.

The report concludes that the Seeds of Hope Project has been very successful in its first year of operation, meeting its expected outcomes and managing to overcome a number of challenges that beset new charitable-sector initiatives in the mental health field. It is a distinctive programme offering new opportunities to people with mental health diagnoses that could valuably be implemented widely in the UK and overseas.

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3.0 INTRODUCTION

The Seeds Of Hope Project is designed to assist individuals with mental health diagnoses who are presently unable to undertake paid employment. It is based at Beaudesert Park Farm in Longdon, near Rugeley, on the edge of Cannock Chase, in a purpose-built building designed for food preparation and confidence-building activities. Individuals also can work on the Farm tending to the animals and doing work on the land. Operating one day per week, the project is open to men and women who would like to gain confidence and skills and achieve important personal goals and move on to more challenging work-related settings. Seeds of Hope (SoH) is funded by the Big Lottery Fund (Reaching Communities Fund) for three years, and is one of several projects run by the The GrowWell Project (Registered Charity Number: 105880) which helps people in South Staffordshire which helps people with mental health conditions to achieve their vocational potential.

There are very few services for this client group in the South Staffordshire (Rugeley, Cannock, Lichfield and Tamworth) and indeed, nationally. Services that seek to offer sustained support to people with mental health needs as they progress towards vocational goals are rare, anywhere in the UK. Centres formerly run by Health and Social Services agencies have closed and current provision by the independent sector is focussed exclusively on people able to enter open employment. Seeds of Hope was designed to cater for people who would like to move forward in their lives and who would welcome the opportunity to develop personal confidence and work-related skills (often, initially, in volunteering capacities) in a supportive social and and therapeutic setting.

Experience with a pilot project, started in 2011, based on a conventional arable farm offering“care farm” programmes (Beaudesert Park Farm), for one day per week, showed the therapeutic potential of the care farming approach (also called “green care”). Care farming / green care is the structured use of the various natural experiences (such as the open air, landscape, animals, farming work and activities) available on farms to achieve therapeutic outcomes. There is also recognition of the importance of the social contact with other service users, volunteers and staff members which creates a “therapeutic community” atmosphere (Haigh, 2012) during such projects. Green care/ care farming ejoys a substantial research and evidence base (summarised in the report of a three-year EU-funded scientiic programme on the evaluation of green care: Sempik, Hine and Wilcox, 2010).

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Figure 1: Graphic on Seeds of Hope Facebook page

https://www.facebook.com/photo.php?fbid=548289045189511&set=pb.223541364330949.-2207520000.1398763441.&type=3&theater

accessed 29.04.2014

This report outlines how the Seeds of Hope project has developed in its first year of operation, details its modus operandi, summarises the achievements of the clients who have attended and discusses the Projec in the light of challenges such projects face.

4.0 THE SEEDS OF HOPE PROGRAMME

4.1 The farm setting

Seeds of Hope runs on Tuesdays for 45 weeks of the year at Beaudesert Park Farm. The farm enjoys superb views over the surrounding countryside and is a working farm with rare-breed cattle, arable and pasture fields and a firewood business. The farm owners erected a purpose-built “classroom” five years ago for educational visits under the Natural England Higher Level Stewardship Scheme (see photos later in this report) with a spacious kitchen, meeting room and adjoining toilet block. Housing for poultry (chickens and turkeys) are nearby and there are vegetable plots. There is access from the farm to excellent walks through adjoining woodland. The farm is owned by the Cope family and Mrs Mary Cope oversees and manages the care farming programme on the farm. The Project is fully funded by a grant from the Big Lottery Reaching Communities Fund. There is no charge to programme members and volunteers can receive travelling expenses.

4.2

Programme aims

The following statement of the overall project rationale is taken from the Big Lottery bid

“People with mental health conditions …”

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Seeds of Hope venueRow 1: Farm view with veg beds; poultry house and runs;Row 2: new dog kennel made by members; the meeting room;

Our target group is people who are living independently (or semi-independently, with a carer), who have a diagnosed mental health condition that prevents them from seeking employment, and for which they are likely to be receiving medication through a GP and may have been assigned to a Community Psychiatric Nurse (CPN) – though not everyone with a condition will have received a proper diagnosis, may not be on appropriate medication and may have no support from the NHS. This complex and muddled picture is often part of the need.

“…to find confidence …”

Lack of confidence may be a contributory factor to their condition, a consequence of their condition or a side effect of the medication. It tends to lead to social isolation, lack of self-care, and inability to engage with care and support services.

“… to begin their own recovery programme.”

Our aim is to offer people attractive and engaging activities that will rebuild their social confidence and increase their life skills to manage their condition as they begin to feel part of a “therapeutic comm unity”. We will then encourage them to pursue a series of self-set goals so that they have positive experiences to set against (what has often been a catalogue of) failure, and thirdly to lead them through a supported programme of voluntary work, that gives them hope of return to a “normal” life.

Based on the above and from Project reading documentation, observing the Project in operation and talking to staff and project members, eight aims can be specified

1. To provide a supportive, social environment with support, empathy and understanding for the needs of people with mental health conditions.

2. To give opportunities to learn and practice vocationally-relevant skills, with a view to helping people become more active members of their community.

3. To offer inspirational actvities and experiences designed to promote self confidence, personal development and skills for everyday life, such as Positive Mental Health, and First Aid, which could lead to recognised qualifications.

4. To offer counselling and personal support from project staff.5. To promote possibilities to graduate from the Programme, towards volunteering and

employment.6. To encourage welbeing through contact with the natural world.7. To provide a nutritious and health midday meal and foster awareness of healty

eating and lifestyles.8. To increase physical activity levels.

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4.3 Staffing

The weekly sessions are able to cater for up to 15 clients. Staff include Mrs M. Cope (farm owner and programme manager), Mrs Lorraine Longmore (support worker, trained psychiatric nurse), Mrs Ellen Minor (Vocational and rehabilitation counsellor, resigned January 2014, post to be filled), Mrs Anna Otton (counsellor and teacher) and several volunteers who run photographic and other sessions. External organisations provide craft and training courses. In the course of the year some clients improved so greatly that they became volunteers themselves on the Programme.

All farm staff involved with delivery of the project are, in addition to their personal qualifications, CRB-checked and have either CEVAS (Countryside Education Visits Accreditation Scheme) or PTTLS (Preparing to Teach in the Lifelong Learning Sector) and have experience of working with those suffering from disability and mental health needs. Other training includes: First Aid at Work, Dynamic Risk Assessment, Rural Education Action Programme and Skills for Care Farming. Staff also have professional qualifications and long experience in teaching and mental health nursing, and farming and countryside management.

4.4 What happens on Tuesdays at the farm? – a typical Tuesday programme

Members are collected from pre-arranged pick up points close to their homes and taken to and from the farm by a minibus from the local Community Transport Scheme. The costs of getting people to the voluntary work sessions outside the farm, and for travel expenses for volunteers who may be needed to assist with this volunteering activity, are met by the Big Lottery grant.

A typical day at SoH starts at 10 am with staff, volunteers and programme users meeting for a hot drink. Possibilities for activities during the day are outlined and members then move into activity groups, having chosen what they want to do. Typically, a group will stay “inside” and prepare the hot midday meal, with support and supervision, whilst others will choose to work “outside”, again with staff members and volunteers. Regular tasks outside include, according to the season, mowing grass, ground maintenance, cleaning out chicken houses, work in the adjoining woodland, or tending to flowerbeds and the vegetable allotment. A list of the many different kinds of activities offered and participated in during Year 1 is shown in Appendix 9.

Lunch is available at midday, a cooked main course, with options of salad, and a hot dessert, as well as fruit juice, tea or coffee. This is of course also a social occasion with people chatting to one another as they wish.

A “Positive Mental Health Workshop Programme” was offered to all clients attending the Seeds of Hope Programme. This comprised a series of 8 workshops each lasting about an

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hour, and were designed to be engaging and participatory whilst also helping clients become more aware of mental health problems and how to manage them. See Box 1 below.

After lunch on other days, there may be a craft session on offer (see list in Appendix 9), and there have been various courses such as First Aid and IT skills. On some days, some people may choose to go on a walk, and a keen photographer has led photography sessions.

Review meetings (see below) and one-to-one counselling sessions also take place during the day in a room set aside from the main building.

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BOX 1: DETAILS OF THE POSTIVE MENTAL HEALTH COURSE

Workshops were held on :

1. Sleep Hygiene 2. Mood Foods 3. Physical Health 4. Medication 5. Stigma and Discrimination

6. Signs and Symptoms, triggers and timelines 7. How to access support networks

8. Mindfulness and Meditation

Lorraine Longmore, the project support worker who facilitated the workshops said:

We work from the whiteboard, with the group shouting out their symptoms and signs of illness episodes. They can also do this in private if they choose. This tags on to the next week, where we draw a timeline and look at what events may have triggered their mental health condition (this is optional as it can be distressing for some). Workshop 7 is regarding identifying what support system an individual has around them and where they can go for help at each point of their condition. i.e a few worrying signs and symptoms to needed crisis care. This information has been provided by The South Staffordshire Network for Mental Health,

Examples of activitiesRow 1: gardening, off for a walk in the woods, baking.Row 2: spray-painting new dog kennel; solar tunnel (polytunnel); newly-hatched chick.

NB More views of the farm, and of activities undertaken in year 1, can be seen on the Seeds of Hope Facebook page.

4.5 Participants

4.5.1 Referrals: SoH has been advertised widely in the Lichield, Burntwood, Cannock and Rugeley areas and the project vocational counsellor (EM) and project support worker (LL) have liaised widely with community psychiatric nurses (CPNs), occupational therapists (OTs), staff at Job Centre Plus and other local organisations. The “Programme Criteria”, “Referrals Process” and “Referrals Form” are shown in Appendices 1 – 3.

At the end of Year 1 (31.3.2014), 47 people had been referred to the Seeds of Hope Programme. 37 had started the programme and had an initial assessment interview. Ages ranged from 20 - 63 years, average 44 years. Two thirds were men. Psychiatric diagnoses included bipolar, schizophrenia, anorexia, acute bereavement, stress related mood disorder, depression, alcohol abuse, and many others, although most clients had multiple psychiatric conditions, and of course were also challenged by a range of adverse life-history events. Most (23) were referred by community psychiatric nurses. Other referring agencies included a further education college, CRUSE Bereavement Care, CHANGES mental health services and Job Centre Plus (one client from each agency). Three clients had also attended the “Common Care Project”, a conservation project run by the Forest of Mercia in conjunction with the Seeds of Hope parent organisation, The GrowWell Project.

4.5.2 Admission: Referred clients are invited to meet project staff. The aims and nature of the programme are explained and it is stressed that people wishing to join the Project must commit themselves to it. Appendix 4 shows the Code of Conduct that prospective programme members are asked to abide by. There is an assumption that clients will benefit from the programme with increased confidence and skills, gained from participating actively, and that they will be encouraged to progress if possible, to volunteering in the programme, to offsite volunteering, or to other vocationally-related positions; that, in short, the programme is not a “drop-in centre”.

4.5.3 Admission Assessment Interview: During the admission process, a support worker (LL) discusses with the prospective programme member their mental health history, completes a Recovery Star chart (Appendix 5), and a form designed by the programme team, the Personal Outcomes Record (Appendix 6). Age, medication, diagnosis, referral source, and dietary requirements are also noted for the client’s personal case notes. Goals are discussed and agreed.

Box 2 shows excerpts from an anonymised example of a completed admission assessment interview record. It will be noted that:

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BOX 1: DETAILS OF THE POSTIVE MENTAL HEALTH COURSE

Workshops were held on :

1. Sleep Hygiene 2. Mood Foods 3. Physical Health 4. Medication 5. Stigma and Discrimination

6. Signs and Symptoms, triggers and timelines 7. How to access support networks

8. Mindfulness and Meditation

Lorraine Longmore, the project support worker who facilitated the workshops said:

We work from the whiteboard, with the group shouting out their symptoms and signs of illness episodes. They can also do this in private if they choose. This tags on to the next week, where we draw a timeline and look at what events may have triggered their mental health condition (this is optional as it can be distressing for some). Workshop 7 is regarding identifying what support system an individual has around them and where they can go for help at each point of their condition. i.e a few worrying signs and symptoms to needed crisis care. This information has been provided by The South Staffordshire Network for Mental Health,

(a) the STAR has ten areas of wellbeing and skills (Managing mental health, Physical health and self care etc)

(b) that each has a score assigned to it by the client in conjunction with the staff member (the maximum possible score for each area being 10) and

(c) a narrative is also completed describing four “areas of focus” that is expected the client and staff will work on specifically during the next few months. These represent the “goals” that the project reports to BIG LOTTERY in line with the Project Bid.

4.5.4 Progress reviews: Three months after admission and at six-monthly interviews thereafter, clients are invited for a review meeting. The STAR chart is completed again and shows progress in the 10 areas. It also indicates what progress towards achieving their four individual goals the client feels they have made since their last review.

The client is then asked to complete the Personal Outcomes Record in which they record on a four-point scale (0,1,2,3) what progress they have made in physical confidence, social confidence, increased life skills, expectation of achieving things, and prospects of finding employment. The client is requested to give one or more examples of each area as well as a numerical rating.

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Box 2: Anonymised example of information recorded on admission assessment interview form

SOHXXX GENDER: MALE AGE:45 ETHNICITY: White English DIAGNOSIS: Depression/anger issues MEDICATION: [details given] JOINED DATE:XX REFERRAL SOURCE: XXXSTAR RESULTS

(RETROSPECTIVE):Managing mental health 6Physical health & self-care 5Living skills 5Social networks 1Work 1Relationships 5Addictive behaviour 3Responsibilities 7Identity & self-esteem 1Trust & hope 5It was assessed and discussed with the participant that the 4 areas of focus would be work, social networks, identity/self-esteem and addictive behaviour. By attending the programme, it is hoped he will learn skills from the opportunities that the farm staff offer. He will be encouraged to try new experiences. A regular attendance of 90% will help him make new social connections. He will be encouraged to work as a team with others. Staff will offer positive reinforcement to him, to help with self-esteem and confidence. He has agreed to attend the POSITIVE MENTAL HEALTH (PMH) workshops to help educate him on the harmful effects of drinking. He recognises that alcohol fuels his anger and he will talk to Lorraine about how he can manage this.

Examples are shown in Boxes 3 and 4

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Box 3: Example of initial and first progress review assessments for a 30-year old male client on the Seeds of Hope programme. Goals selected at initial assessment and reviewed at “1st review” are shown in bold type. New goals set, and later assessed as “2nd review” are asterisked

STAR RESULTS

INITIAL ASSESSMENT 1ST REVIEW 2ND REVIEW

Managing mental health 5 5 5Physical health & self-care 4 3 4*Living skills 4 4 6*Social networks 5 6 8Work 1 3 4*Relationships 7 7 8Addictive behaviour 5 6 7Responsibilities 4 6 7Identity & self-esteem 4 3 6Trust & hope 3 3 3*

4.5.5 Action plans: During each assessment interview an “Action Plan” is agreed with the client. This details four goals that the client expects to achieve by the next progress review. In the example of the review shown in Box 3, the client has met two of his four goals (noted as 50% achievement towards goals in the client’s record) and four new goals are agreed and set,

4.5.6 Programme co-ordinator: Each client is allotted a staff member who oversees his or her programme and is a primary point of contact (although project members can request a confidential chat with any staff member at any time).

4.5.7 Implementation of action plans and participation record: A staff member (usually LL) records each week, for each client whether or not they attended, reasons for non-attendance, and brief details of activities that they participated in on a particular day. Box 5 shows examples.

5.0 RESULTS: PROJECT OUTCOMES AND ACHIEVEMENTS (YEAR 1)

5.1 Client participation

During the first year, 47 clients were referred to the programme and 37 had started. 5 of the people referred never started (usually for mental health reasons) and the others were temporarily not attending because of mental health, phyical illness , on the waiting list, or on temporary trial. At the time of writing this report (May, 2014) 17 were actively attending the programme (15 on the farm and 2 offsite) and a waiting list was in operation because the project was full.

5.2 Reasons for discharge from programme

19 clients left the programme during the year. Two clients moved into employment , one into a work placement and six took up volunteering positions in a variety of settings. Physical or mental ill-health were the reasons for other 7 clients leaving, and 3 other clients left because the programme did not suit them.

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5.3 Attendance statistics

From the client records, the number of weeks clients spent on the Project between their admission and discharge was calculated. This ranged from 2 weeks to the maximum of 46, average 27.

Time on the project’s books is not necessarily helpful in understanding the benefit gained. Clients leaving after only a few weeks included one individual who found the project did not suit him, and one who rapidly moved on to employment, setting up his own business. This middle-aged man wrote a letter saying that the help he had received from the project staff not only saved his life (he was contemplating suicide) but was also a catalyst for change.

The percentage attendance ranged from 33% to 100% with an average of 74%. Reasons for non-attendance included deterioration in mental or physical health and a range of personal circumstances such as family responsibilities. If clients have not contacted staff to explain their absence, staff will telephone or text project members who did not attend on a particular day to find out the reason both to help if possible and to maintain encouragement to attend. Persistent non-attendance leads to discussion about whether a client should leave the programme.

5.4 Outcomes / Goals achieved:

Table 1: Outcomes/goals achieved during Year 1 of the Seeds of Hope Programme(Indicators Table in Lottery Bid section 3.3.

Outcomes expected in Big Lottery Bidby the end of Year 1, Year 2 or Year 3

Outcome achieved?

1 Total mental health clients starting Seeds of Hope

37 Not specified in Bid n/a

2 Completed Positive Mental Health Workshops course

30 30 (Year 1) YES

3 Completed 8 or more sessions on the Programme

24 4 (Year 1) YES

4 Reported increased physical confidence

17 45 (Year 3)(physical and social confidence are not distinguished in the Project bid)

(prorated for Year 1= 15)YES

5 Reported increased social confidence

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6 Reported increased confidence in life skills

20 60 (Year 3) (prorated for Year 1 = 20)YES

7 Reported increase in expected achievement

19 50 (Year 3) (prorated for Year 1 = 17)YES

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8 Achieved 3 or more goals in STAR assessments

19 14 (Year 1) yes

9 Reported increase in employability

19 40 (Year 3) Prorated=14YES

10 Total in Programme for more than 6 months

19 Not specified in bid n/a

11 Active on Programme at end of year 1

19 Not specificied in Bid n/a

The Seeds of Hope BIG Lottery bid identified the expected outcomes of the Seeds of Hope project, together with estimates of specific targets that would be reached by the end of Year 1.

The relevant data (returned in the end of year report to Big Lottery) are shown in Tables 1 and 2. Figures were obtained from client records maintained by LL as described above.

Table 2: Estimated and actual outcomes – Section 4.1 in Seeds of Hope Lottery Bid in Year 1ESTIMATED OUTCOME ACTUAL ACHIEVED?

30 members will have taken part in the Positive Mental Health Programme

30 YES

14 members will have set and achieved at least 3 personal goals 14 YES

4 members will have completed 10 sessions of voluntary work on the farm

12 YES

Tables 1 and 2 show that the expected outcomes have been achieved or surpassed in Year 1 the Seeds of Hope Project.

5.5 Comments from Seeds of Hope Project members

Comments made by clients during progress reviews (25 clients were in the programme long enough for a progress review meeting at which the Personal Outcomes Record (POR) was completed (see above) were collated and are listed in Appendix 7. 114 comments were made, covering the five areas of whether clients felt they had : Increased physical confidence, increase in social confidence, increased confidence in life skills, increased expectation of achieving things, increased prospects of finding employment. They give a flavour of what clients feel they are gaining from their time with Seeds of Hope.

The final question on the POR was “What would you be doing on a Tuesday if you were not coming here?”. Answers are listed in Appendix 9. The general tone of the comments is that

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clients would have done very little “purposeful activity” if they had not gone to the project, passing the day away in bed, in the pub, or visiting friends.

5.6 Activities on the Tuesday programme

The detailed case records of each attendee maintained by the project team show in detail the activities that clients enjoyed during the days they attended the Seeds of Hope project. These are linked to the agreed goals for each client, but there is free choice. How activities have contributed to goal achievement and improvements noted on the STAR chart is discussed at the review meetings and new goals are agreed in relation to possible activities. For one client “the only time he exercises is at the farm. Pain is a barrier but he will walk for 20 minutes on a Tuesday when attending the programme.” (Male, aged 30). A lady “enjoyed food preparation and went for a walk in the afternoon, which can be difficult for her [because of physical disability]” (Female, 47). Another client “helped prepare rhubarb in the morning and did photography in the afternoon” (Male, 59). On other days, this client did IT skills, participated in the Postiive Mental Health workshops, made “an amazing bread and butter pudding”, worked outside weeding, harvested pumpkins, beans and tomatoes, painted outside windows, and helped make sausage rolls.

The nature of the available activities is varied, and so allows clients to choose indoor or outdoor activities, whether to work alone or in a group, which group to choose, and which staff member to be with. An underpinning principle of Seeds of Hope is that people with mental health challenges can find it difficult to motivate themselves to do things; offering a range of activities, therefore, and linking them to individual goals makes it more likely for people to want to do something and find it therapeutic.

5.7.Case vignette

Box 5 gives a snapshot of just one client who attended the project since it began, with 86% attendance and who has progressed to working offsite on a conservation project.

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Box 5: Case vignette of “BRIAN”

“Brian” (not his real name) was referred by a community psychiatric nurse. He had suffered family breakdown and has a physical disability, with frequent pain. He said that he lacked confidence. His areas of focus would be work, trust and hope, physical health and self-care and responsibilities. He agreed to participate in the Postiive Mental Health workshops and to buddy new members to help with responsibilities. In the first three months, Brian enjoyed the project and joined in with many sessions. He assembled a cupboard, did the PMH workshops, acquired photography skills, made bread and enjoyed preparing lunches.

At first review, Brian agreed he had achieved two of his goals and his total STAR score increased from from 42 to 49. He had formed new friendships, learned new skills and felt he has made a contribution to the project by buddying new members. New goals were set.

At the second review his STAR total increased to 57 and he agreed to volunteering off-site on a conservation project. He has returned on Tuesdays to make bird boxes, help build the new polytunnel and participated in first aid training. At the time of writing this report he has visited outside agencies for specific advice and returns to the Tuesday project for workshops (such as printing ) that interest him.

His comments included: “I am now going fishing with friends”,” I enjoy making and preparing food” and he wanted “To try more volunteer work.” He rated his improvement in

5.8 STAR RECOVERY CHART RESULTS:

25 clients were on the programme long enough to have a second progress review (9 months after commencing). Their TOTAL STAR ratings were calculated. At their first review (after 3 months) these ranged from 29 - 71, average 48. (The minimum possible is 10 and the maximum possible 100). At the second progress review, scores now ranged from 22 - 90, average 54. 21 clients had increased their STAR totals, and for 4 clients, the total score had gone down. Improvements ranged from 4 - 44, and deterioration from -28 to -7. The average change was 8 points. This analysis offers a slightly different way of looking at the achievements of the Project.

6.0 DISCUSSION

This report has aimed to give a profile of the Seeds of Hope Project in its first year of operation. The process of client referral, admission, attendance, review meetings and discharge has been described, as well as examples of activities and client progress. Essential statistics about the number of clients referred, on the programme and discharged have been given and the specific goals and outcomes achieved have been analysed. The Project has more than achieved the goals and milestones anticipated when the Big Lottery bid was put together, and agreed with Big Lottery, and it is worth reflecting on its successes, only one year into its operation, in the light of the challenges this kind of project can face.

Challenge 1: Referrals. Any new project faces acceptance by current services who may be referral agencies. SoH was lucky to have an experienced vocational counsellor (EM) who worked hard during the pilot projects for the SoH and in its early stages to develop links. This has resulted in suitable referrals for the aims of the project (principally from community psychiatric nurses). As the success of the project has become apparent, there is a mutually beneficial relationship in that the project helps professionals to achieve their own aims for individual clients and increases the quality of the service they can offer. It is evident from the client case records that the project, through its support worker (LL), maintains very active and close links with the referring CPN for a client, which is vital if the client needs to leave the project or if additional signposting to other agencies is needed for clients experiencing additional social and emotional issues.

Challenge 2: Maintaining attendance. It is one thing to get referrals but another to provide a programme of activities that is valued by clients and, more broadly a general ambience and atmosphere that feels friendly, supportive and positive to recovery. Very few clients found the project to be not for them, and many were on the project long enough to have a

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Box 5: Case vignette of “BRIAN”

“Brian” (not his real name) was referred by a community psychiatric nurse. He had suffered family breakdown and has a physical disability, with frequent pain. He said that he lacked confidence. His areas of focus would be work, trust and hope, physical health and self-care and responsibilities. He agreed to participate in the Postiive Mental Health workshops and to buddy new members to help with responsibilities. In the first three months, Brian enjoyed the project and joined in with many sessions. He assembled a cupboard, did the PMH workshops, acquired photography skills, made bread and enjoyed preparing lunches.

At first review, Brian agreed he had achieved two of his goals and his total STAR score increased from from 42 to 49. He had formed new friendships, learned new skills and felt he has made a contribution to the project by buddying new members. New goals were set.

At the second review his STAR total increased to 57 and he agreed to volunteering off-site on a conservation project. He has returned on Tuesdays to make bird boxes, help build the new polytunnel and participated in first aid training. At the time of writing this report he has visited outside agencies for specific advice and returns to the Tuesday project for workshops (such as printing ) that interest him.

His comments included: “I am now going fishing with friends”,” I enjoy making and preparing food” and he wanted “To try more volunteer work.” He rated his improvement in

3-month and subsequently a 9-month review. A wide range of activities has been provided, and the contrast with what clients said they would have been doing on a Tuesday and what they were doing is noticeable.

Challenge 3: Achieving therapeutic outcomes. Having a pleasant time, getting on with others and feeling supported is vital, but a major rationale for charitable support for such a project as SoH is that it makes a signficant difference to people’s lives. Implicit in SoH is the offer to clients that they will be encouraged to move on in their lives – to achieve greater wellbeing through support to learn skills and gain confidence. The STAR assessment records show the specific gains that have been made for most clients in their mental health recovery, and clients have been able to progress to volunteering work in the project or outside.

Challenge 4: Record keeping. Many projects in the independent sector fail to keep detailed records. This may be through pressure of simply keeping the day-to-day activities going or generally insufficient attention to this aspect of management. It is a great credit to the SoH project that really detailed records are maintained (and written up in word-processed form) by the team.

Challenge 5: Maintaining a clear therapeutic rationale. It can be difficult for a project to articulate just why it does what it does. SoH is fortunate to have been built on the experience of the established GrowWell Project over many years in offering vocational programmes to people with mental health issues and of two pilot projects. These have demonstrated the importance of accepting only on to the programme people with a clear commitment to progressing in their lives, and of maintaining frequent dialogue with members about progress and expected goals.

7.0 CONCLUSIONS and IMPLICATIONS

Seeds of Hope has proved an extremely successful project in its first year of operation, with a steady stream of appropriate referrals from local agencies. Clients have set and achieved a range of goals and clearly progressed in their mental health recovery. The expected outcomes and goals of the project have been achieved or surpassed.

One feature of Seeds of Hope which has not been highlighted in this report so far is that two-thirds of the attendees are men. It is a generally-accepted problem for any kind of day service to attract and keep male clients. Yet this project has done just that.

Seeds of Hope is a distinctive service for mental health clients. At a time of severe financial restraint, with both statutory and independent sector services cut, the Seeds of Hope Project, with its companion programmes run by GrowWell, offers an innovative opportunity for men and women with severe mental health conditions to make a real change in their

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lives. The Project offers a wide variety of opportunities for people to build skills and confidence, done within a supportive and caring but structured and purposeful framework aimed at people moving on. Very few similar projects exist in the UK. Seeds of Hope represents a model that could be copied elsewhere, and make a significant difference to local communities.

8.0 REFERENCES

Haigh, R. (2012) The philosophy of greencare: why it matters for our mental health Mental Health and Social Inclusion 16, 3, 127-135 Sempik, Hine and Wilcox, 2010 Green care: A conceptual framework. Loughbourough UK: Loughborough University http://www.umb.no/statisk/greencare/green_carea_conceptual_framework.pdf accessed 6.5.2014

9.0 LIST OF APPENDICES

Appendix 1: Programme criteria. 19

Appendix 2: Programme referrals process and Procedure 20

Appendix 3: Seeds of Hope Referral Form` 21

Appendix 4: SEEDS OF HOPE'S Code of conduct 23

Appendix 5: STAR RECOVERY CHART 24

Appendix 6: Personal Outcomes Record form 25

Appendix 7: Comments made by 37 clients on the Personal Outcomes Record form during Year 26

Appendix 8: What would you be doing on a Tuesday? (Replies to Question on Personal /Outcomes Record (24 clients) 30

Appendix 9: List of courses and skills development activities undertaken in Year 1 31

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Appendix 1: SoH Programme Criteria

GROW WELL PROJECTPROGRAMME CRITERIA

1.The participant will be diagnosed with mental health condition. Secondary issues will be discussed using a treatment team approach.

2.A fully completed and signed Seeds of Hope Project Referral Form will be transferred to the appropriate GrowWell staff.

3.There must be participation in an Intake review and an exhibited desire to participate in a Seeds of Hope goal oriented vocational programme.

4.The prospective participant must be treatment compliant including medications, physician appointments and any other treatment modalities.

5.The participant should express dedication to a regular Seeds of Hope programme participation with a goal of maintaining an 80% attendance rate.

6.The referring agency and the referral must be able to assure the treatment team that the participant is not a danger to themselves or to others and will follow the health and safety regulations of the specific programme they will be attending.

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APPENDIX 2: Programme referrals process and procedure

GROWWELLPROGRAMME REFERRALSPROCESS AND PROCEDURE

Assigned GrowWell staff will receive formal referrals by hand, post or electronically.Assigned GrowWell staff shall discuss the referral with the referee and other staff, if deemed necessary.An intake will be set up to be attended by two (2) GrowWell staff and any additional treatment team members, as deemed appropriate by GrowWell staff.When prospective participant and staff, along with appropriate treatment team members, agree on programme appropriateness for referral, a STAR (see guidance on STAR usage and administration) shall be completed and a start date will be agreed upon. In the case of a full complement of programme participants, the treatment team and referral will be advised of the Wait List and the approximate number of the referral on such a list.

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Appendix 3: Seeds of Hope Referral Form

PLEASE PRINT

SEEDS of HOPE

By

GrowWell

REFERRAL FORM

NAME: _________________________________________ DOB: _____________________

ADDRESS: _________________________________________________________________

HOME, MOBILE NOS.: _______________________________ EMAIL: __________________

PHYSICIAN/PSYCHIATRIST: ___________________________ PHONE: __________________

DIAGNOSIS: _________________________ MEDICATION: __________________________

COUNSELOR/CPN: _________________________ CARER: __________________________

FAMILY/NEXT OF KIN: _______________________________________________________

EMERGENCY NUMBERS: _____________________________________________________

ALLERGIES/MEDICAL CONDITIONS: ____________________________________________

_________________________________________________________________________

TRANSPORTATION: _________________________________________________________

DIETARY REQUIREMENTS: ____________________________________________________

ETHNICITY: ________________________________________________________________

REFERRAL SOURCE AGENCY: __________________________________________________

PERSON REFERRING: ________________________________________________________

PHONE NUMBER(S): ________________________________________________________

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PAGE 2

COMMENTS: ________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

__________________________________________ _______________________________

SIGNATURE OF REFERER DATE OF REFERRAL

__________________________________________

SIGNATURE OF PARTICIPANT

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Appendix 4: SEEDS OF HOPE'S CODE OF CONDUCT

Please take time to read and remember

• KEEP CONFIDENTIALITY

• RESPECT EACH OTHER

• BE AWARE OF TRIGGERS

• LISTEN TO EACH OTHER

• WE CONSIDER THE FOLLOWING BEHAVIOURS AND LANGUAUGE UNACCEPTABLE: VIOLENCE -AGGRESSION – BULLYING – INTIMIDATION – THREATS – RACISM – SEXISM

• NO DISCRIMINATING LANGUAGE OR BEHAVIOURS

• NO SEXUAL HARRASSMENT

• NO DRUGS OR ALCOHOL

• KEEP TO TIME

• SMOKE ONLY IN THE DESIGNATED AREA (the farm is a highly flammable environment)

Any violation of the above could mean the participant may be asked the leave the programme. Thank you for abiding by the code of conduct.

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Appendix 5: STAR RECOVERY CHART

Please see examples of STAR chart and recovery plan model at:

http://www.outcomesstar.org.uk/mental-health/  

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Appendix 6: Personal Outcomes Record form

PERSONAL OUTCOMES RECORD:

Scores: Not at all = 0 Just a little = 1 Quite a lot = 2 A great deal = 3

Q1. By how much do you feel your physical confidence has increased?

Score:

Please give one or more examples:

Q2. By how much do you feel your social confidence has increased?

Score:

Please give one or more examples:

Q3. By how much do you feel you have experienced increased confidence in your life skills?

Score:

Please give examples:

Q4. How much do you feel you have increased your expectation of achieving things?

Score:

Please give examples:

Q5. How much do you feel you have increased your prospects of finding employment?

Score:

Please give examples:

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Appendix 7: Comments made by 37 clients on the Personal Outcomes Record form during Year 1

Compiled by Lorraine Longmore. March 15, 2014

1. “It is nice to talk to others about yours and theirs problems. I enjoy talking to others in the group.”

2. “I can deal with things better now.”3. “I do feel that I can achieve the goals I set.”4. “My health is still not that good.”5. “I am now going fishing with friends.”6. “Meeting with friends and having them visit me at home. Family visits.”7. “I enjoy making food and preparing food.”8. “Setting new goals in volunteering at another project.”9. “Try more volunteer work. I have good attendance.”10. “Beginning to make new friends and having a laugh and joke with clients too.”11. “I think I have improved because I am able to say no now.”12. “I have been able to give up booze and keep control of it on holiday. I have not self-

harmed since February either.”13. “When I started I was a size 26, now I'm a size 18/20.”14. “I'm making more friends, having conversations with and learning to have fun also.”15. “I have improved to the stage where I'm saying “no” but also standing up for

myself.”16. “I have had one blip but am back on course to keep straight and narrow.”17. “I can volunteer to do work.”18. “I have made new friendships on the farm. I am isolated living on my own.”19. “I like making people laugh.”20. “I’m too old to work but it has pushed me in the right direction for volunteering.”21. “My physical balance has got worse. I am going to go to my GP.”22. “It varies. Sometimes I can be confident, other times introvert.”23. “I will try to volunteer more. I now volunteer for the drop in at the church. I will go

to Open door Of Hope and ask to volunteer there. I do House groups at the church and I go to Art for Life”

24. “Routines in place (big factor).”25. “I have made new friends. I am socialising more. “26. “Cooking skills, I.T.”27. “Improvements at home.”28. “On income support due to young children.”29. “Love helping in the garden.”30. “Doing the workshops.”

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31. “Doing IT workshop.”32. “The workshops help a lot.”33. “Doing gardening for friends and family.”34. “Helping people at Seeds of Hope.”35. “I put more thought into what I am doing by increasing my physical activity.”36. “By meeting new people in the group and mostly seeing different people.”37. “More thought going into physical activity and changing my eating.”38. “I have no expectations.”39. “I would like to work in Horticulture.”40. “I am getting out more – looking up to the world and not down.”41. “Voluntary work – meeting new people.”42. “Knowing that life can go on, just have to take small steps to achieve this.”43. “I would like to work with animals/horses.”44. “Walking as a hobby.”45. “Meeting more people.”46. “Being able to pass on my skills.”47. “Teaching skills.”48. “Because of my age, the prospects are not great.”49. “I have more experience of working and sticking to a regime.”50. “Looking with diet more.”51. “By coming to project, has made me think outside the box.”52. “I am able to talk to all of the members of the project.”53. “Retired but volunteering.”54. “Managing diabetes with eating the correct food.”55. “Seeds of Hope gives me the confidence to increase my general skills in a safe way.”56. “By engaging myself in areas of the project, it has given me a lot more confidence.”57. “I have difficulty in this area because I can become manic and obsessional on

occasions.”58. “This is a very difficult area, as medically I have been informed I will never be able to

work.”59. “I have been physical with using the tools and I am exercising more.”60. “I can now talk to others and search for work. Before I was too shy.”61. “Able to do more.”62. “I still worry about my eyesight and how it will stop me getting a job.”63. “Not worried, just deal with it.”64. “It is hard because of my eyesight.”65. “I am out and about more. I am physically fitter.”66. “I have met new people. I have spoken to different people. I will keep in contact with

someone.”67. “I can give instructions, work as a team, I have leadership qualities.”68. “I have the ability to learn new things.”

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69. “I have new prospects now I have a work placement.”70. “Stopped smoking, lost weight. Going out for a walk (short) once per day.”71. “Easier to speak out at meetings.”72. “Saved up, bought new fridge, planning on saving more in the future.”73. “Medication completely cuts out heavy or light machinery, because of sedating

effects, cutting out all major life skills.”74. “More happier in myself and more relaxed.”75. “Going out more and meeting new friends.”76. “Given me more confidence getting into work mode.”77. “By coming to volunteer, it has helped me build new skills like cleaning the

chickens.”78. “I don’t feel anxious all of the time. More happier.”79. “I talk to people more. I can get out and about without feeling anxious.”80. “Cleaning my flat all the time, getting out of bed, learning to cook new things. I make

sure my clothes are clean.”81. “I feel a lot more confident about my maths because I have passed my exam entry

level 2.”82. “By coming to the farm, I have learned new skills that could help me find work.

Learning about different volunteering options.”83. “I feel more able to do more physical jobs around my home and garden.”84. “I feel more confident to talk to people.”85. “I feel more confident in preparing food for other people and myself.”86. “I am more able to complete the things I have started.”87. “Overall more confidence to approach my boss and ask for more hours.”88. “I feel more able to do physical jobs better. I’m not too worried about if I do things

wrong or I’m not physically able to lift something, it does not worry me so much.”89. “I’m able to go out to more places on my own and to be able to make important

phone calls.”90. “My confidence is growing in preparing meals for others, not so worried about

making people ill from my cooking.”91. “I’m getting more confident and seeing my ability that I can do things and

recognising my achievements and feeling proud of myself.”92. “I’ve gained more hours at work to do, after finding the courage to ask my boss for

more.”93. By doing the washing up.”94. “No chances given for disabled people because of health and safety.”95. “No point because they can’t see past my disabilities.”96. “I will never work because of my disabilities.”97. “Walking more”.98. “Can talk to staff and others.”99. “Organised my transport arrangements by myself.”

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100. “Coming on transport. I also have a horse riding certificate.”101. “I like gardening and chickens.”102. “Meeting more people.”103. “Cleaning chickens.”104. “Helps with time keeping.”105. “I can meet people at the group without anxiety now.”106. “I can talk to people in the group better.”107. “I have learnt new skills like gardening.”108. “I have learnt new skills that I can use in the future.”109. “I can manage time better.”110. “Cutting down on smoking.”111. “Made new friends.”112. “Workshops with Lorraine.”113. “Coming on the bus.”114. “By getting up and attending.”

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Appendix 8: What would you be doing on a Tuesday? (Replies to Question on Personal Outcomes Record (24 clients)

1. I would be climbing the walls. It is the only thing I do all week and it breaks my week up

2. I sat curled up in bed. I forget to eat. I put on a CD to try and block out the voices.3. I go to the shops and then to the pub so I can be with people4. I would get up with the children take them to school visit a relative and be bored5. I help out around the house hoover around the wife and do some gardening6. I would get drunk and stoned. That is all I do.7. I would stay in bed all day8. Gardening or walking.9. Probably in bed most of the day and go to the pub.10. I would either be at home or with Changes I like to keep busy.11. It is hard because of my eyesight.12. I would usually just walk my dog and not much else.13. I stay in my bedsit. I do nothing. I find it hard to go outside and shop for food. This is

the only place I go.14. Not a lot, play on my computer, go for a walk to the library.15. Stay in doing housework or visit my father.16. Cleaning, shopping doing odd jobs or riding my pushbike.17. Stay at home.18. Watch TV, play on computer, or go to the pub.19. Cleaning my house, seeing my dad.20. Nothing, get up late, undressed, watch TV (1).I have been doing more and seeing my

friend. Every day (2) (Two review meetings).21. Stay at home, a little gardening, perhaps a walk.22. Well I do like my sleep.23. Not a lot, stay in bed.24. Stay in watch TV

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Appendix 9: List of activities undertaken at Seeds of Hope Project during Year 1

A. CoursesPhotography Positive Mental Health – mood foods – sleep hygiene -physical health – medication – stigma and discrimination -meditation – mindfulness – accessing mental health support -recognising signs, symptoms, triggers and timelines Art and creativityIT skills workshopChanges workshop – Self-esteem, assertivenessThe South Staffordshire Network for Mental Health -

The ladder of power – Jigsaw – User involvementWillow weavingPrint workshopMaking Christmas decorationsMaking hay rings

B. Horticulture, animal care, maintenance and conservation skillsMowing of lawns Building Poly tunnel - Sowing seeds Planting plants -Cleaning out chickens/turkeys Walks Painting outside windows/doors Painting chicken pens Making bird feeders Clearing brambles Mowing Weeding Working on the allotment Brash clearingFencing (both new and repairs)StrimmingPath layingHedge trimmingWoodwork Bird box making Chicken pen makingBuilding cupboardsDog kennel making Harvesting vegetables & fruitForming Invertebrate habitatsMaking Bird boxesBedding cattle pensFeeding goat and cowChicken care including wing trimmingLooking after baby chicksBuilding ring feeder for cattlePainting trailers

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C. Domestic and culinary skillsCakes and decorating Making pastry Pumpkin Pie Blackberry and apple pie Cauliflower & broccoli bakeChicken piesFish pieCottage pieChristmas mealQuicheFrittataRye breadBaked potatoes and fillingsSausagesFruit saladMarmalade bread and butter puddingPasta bakeFruit CobblerPlanning menusPea, mint and courgette soupPumpkin soupVegetable soupHam, pea and mint soupSausage rollsStuffed marrowsPasta BolognaiseRice PuddingLasagneBBQ chicken kebabsVegetable kebabsVegetable tartsGarlic breadFruit mousseStewed rhubarbCustardBudgeting for Healthy Diet

D. Office skillsOffice SkillsPhotocopyingWord documentsPhotoshop skillsTyping Recipes for bookletBasic accounting

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