1. MAKING THE BIG SOCIETY BIGGER working towards citizenship and connectedness for people with Mental illnesses Anna Croucher (senior Occupational Therapist & service development lead) and Sarah Josefsberg (Senior Occupational Therapist)

2. Overview of the workshop Explore the concept of social inclusion and social exclusion Provide an overview of SHARP Consider services in relation to a traffic light model Practically use an activity to establish values

3. Aim of the SHARP Decrease distressing symptoms Reduce relapse Promote Healthy Living Enable new and innovative practice Increase Social Inclusion

4. So what is SOCIAL INCLUSION ?? Its about lots of things!! Physical and psychological involvement (Labonte 2004) Connectedness, citizenship and belonging (Morgan et al 2007). Temporal, relative and subjective (Le Boutiller and Croucher 2010) The people and places (Hacking & Bates 2008) The opposite of social exclusion? But do people WANT Social lnclusion...

5. Social Inclusion Vs Social Exclusion Exclusion relates to structural barriers that exclude an person: Democratic and legal system The labour Market Welfare state system Family and community system (Commins 1993 ) Inclusion works on individual level The extent to which people are accepted and feel that they belong to different social contexts (Secker 2009)

6. SHARPs definition of social inclusion To support individuals to explore participating in activities that are meaningful to them

7. Developed by NDTi Captures the people and places that a service user has contact with in a two week period of time. THE INCLUSION WEB Voluntary work

8. But how socially included are we? SI is underpinned by the assumption that normal people are themselves socially included... Activity: Talk with your partner and with reference to The Web think about: How socially included do you feel? What areas do you feel you are socially included? What would YOU do to become more socially included?

9. The Web: Case Study 28 year old man. Living with family. Has a history of depression since his teenage years. Never been employed and has poor literacy skills. Explains that he is shy and feels he lacks confidence, especially expressing his needs in one to one situations. Likes art and is interested in computers. SHARP Team

10. The Web Outer circle is places and Inner Circle is people Employment Education Volunteering Arts and Culture Faith and cultural communities Family & neighbourhood Sport & exercise Services PlacesPeople Employment00 Education00 Volunteering00 Arts & Culture00 Faith & Cultural00 Family & Neighbourhood 11 Sports00 Services33 CMHT GP Care Co-coordinator GP SHARP workers Prison Brother Grandmother Uncle Mother & Father Mums house Used to go to galleries SHARP Team, 2007

11. Employment Education Volunteering Arts and Culture/Leisure Faith and cultural communities Services CMHT GP Mother & Father Brother Grandmother Uncle Vocations Matters School Care Co-coordinator Comic Shop Art Therapy Art Therapist Library- Learn Direct Thrive Gardening course Gardening Crew- Supported employment Bookshop Volunteer Option Gym Group Brixton Recreation Centre Clapham Gym Wheels 4 wellbeing YMCA Flaxman centre Healthy Living Group GP SHARP workers Garden crew members Bowling & cinema Friends Pub Art galleries Museum Parks Bowling Photography course Prison Café Common Football Lambeth College Family & neighbourhood Sport & exercise PlacesPeople Employment11 Education50 Volunteering20 Arts & Culture82 Faith & Cultural00 Family & Neighbourhood 11 Sports52 Services33 Mums house The Web Outer circle is places and Inner Circle is people

12. Psychosis Incidence of schizophrenia in Lambeth 4x higher than average (Garety and Rigg 2001) Lambeth PCT spends £60m out of budget of £400m on mental health Cost of relapse £8212 compared to £1899 if no relapse 27% of clients who have engaged with us had a hospital admission or HTT contact in year before referral

13. What does this mean? Working with people who have: high relapse rates Complex needs Disrupted lives due to illness

14. How was SHARP set up? A feasibility study involving stake holders and service users in development Funding from GSTT Charity & reconfigured existing team Provide evidence-based interventions which help clients move on No care coordination Recovery ethos- Social Inclusion Hope and Recovery Project Evaluation of interventions and service Launched May 2007

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

16. How is SHARP different to other services? Easy telephone referral Solution-focused assessment Intervention based on client choice- An opt in service Integrated psychological and social interventions All interventions evaluated by outcome and the service is constantly evolving and improving based on findings i.e. Tea party Recovery oriented: A sense of hope and identity, where people belong and can make sense of their experiences (SHARP, 2010)

17. How do we achieve social inclusion? National Development Team for inclusion- Peter Bates: Traffic light model, how socially inclusive are services? Disability places, with service users and staff Ordinary places, with service user- only groups Shoulder to shoulder, with general public

18. NDTi model views inclusion as Access: Being able to utilise services and places in the community Standard of living: That meets your needs maintains quality of life Relationships: Having support, someone to share things with, knowing someone cares

19. Traffic light system Focus on impact of environment on S.I i.e. Café vs. Hospital Increasing inclusiveness of settings, advocacy in combating stigma- 80% report as biggest barrier i.e. Offering training to staff at Brixton Rec Increasing community links i.e. moving from red to amber i.e. Creative writing group in library

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

21. Case study continued First contact with services Attends SHARP groups Linked in with community based groups A&E CMHT SHARP GYM GROUP HEALTHY LIVING GROUP LAMBETH COLLEGE SPORTS ACTION ZONE

22. Activity: Groups of 4-6 people What services fit into RED/AMBER/GREEN? What are the advantages and disadvantages of services at each level? How do you support people to move on to the next level?

23. Activity Group Feedback

24. Putting the meaning back in meaningful activity!

25. Working out where to start Explore values Address motivation for change Choose achievable things Problem solve Advocate

26. Activity Exploring Values according to an ACT frame of reference

27. ACT model

28. Activity continued Values are desired qualities of ongoing actions. They are a compass that guide and give you direction and can help you stay on track. Goals vs. Values: Marriage vs. Being Loving

29. Activity continued 1. Values are now/ Goals are in the future 2. Values never have to be justified 3. Values often need to be prioritised 4. Values are best held lightly 5. Values are freely chosen

30. Activity Complete PART 1: identifying values What do I stand for as a person? What would they say about me at my eulogy? Complete PART 2: making a commitment Setting a short term goal Taking your thoughts along for the ride

31. Questions?

32. References Hacking, S., Bates, P., (2008) The inclusion Web: a tool for person centred planning and service evaluation. Mental health Review journal, 13 (2) 4-15. Labonte, R. (2004) Social lnclusion/exclusion: dancing the dialectic. Health promotions international, 19 (9) 115-21 Le Boutiller, C., Croucher, A. (2010) Social lnclusion and mental health, British Journal of Occupational Therapy, 73 (3) 136-140. Morgan, C., Burns, T., Fitzpatrick, R., Pinfold, V (2007) Social inclusion and mental health: conceptual and methodological review. British Journal of Psychiatry, 191 (6) 477-83. Secker, J. (2009) Mental health, social exclusion and social inclusion, Mental health review 14 (4) 4-11. Commins, P., (1993) Combating Exclusion in Ireland 1990-1994, A Midway report. Brussels: European commission.