The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

It’s shocking that 12.5% of men in the UK are suffering from one of the common mental health disorders (estimated by The Men’s Health Forum). And men are as much as two and a half times more likely than women to die by suicide each year, with one of the most at-risk groups being men in their 40s to early 50s.

Other key statistics which show the scale of the problem include:

  • three in four deaths by suicide are by men
  • the highest suicide rate in England is among men aged 45 to 49
  • men living in the most deprived areas are ten times more at risk of suicide than those living in the most affluent areas.

Despite this, men are significantly less likely to access mental health services than women. The Mental Health Foundation found that 28% of men had not sought medical help for the last mental health problem they experienced, and 35% of men had waited over two years or have never disclosed a mental health problem to a friend or family member. Another survey, from the Men’s Health Forum, found a majority of men would take time off work to seek medical help for physical symptoms, but less than one in five said they would do the same for anxiety (19%) or feeling low (15%).

It’s clear, then, that there are strong cultural barriers facing men in relation to mental health diagnosis. Perceived stigma and ideas of masculinity can cause them to avoid seeking help or fail to acknowledge mental health issues.

Changing attitudes in changing rooms

We’ve written previously about the success of Men’s Shed projects in providing a safe, social space for men’s mental health issues to be addressed. We were interested, therefore, to hear about another scheme which is also using a community-based approach to explore men’s health.

The Changing Room Initiative is a two year pilot project which sees the Scottish Professional Football League (SPFL) Trust and Hibernian (Hibs) football club working in partnership with the Scottish Association for Mental Health (SAMH) to engage men in their community around issues of mental health and wellbeing. The project uses football and sport as a tool to encourage men to discuss their mental health and wellbeing and to help direct them to additional support and services within their community.

The initiative is part of a wider program from SAMH which is using sport to improve equality and reduce stigma around mental health. In February 2018, SAMH launched Scotland’s mental health charter for physical activity and sport. Signatories of the charter include Sport Scotland, SPFL Trust, Jog Scotland and Glasgow Life.

In October 2018, following the success of the initial pilot scheme, SAMH announced a second changing room initiative was due to be rolled out at another Edinburgh football club, Heart of Midlothian FC (Hearts).

Using sport to engage and improve mental health

There is a lot of research available which highlights the links between positive mental health and physical activity. Even low-level physical activity has been found to have a positive impact on our mood and general wellbeing. Activities like walking, cycling or gardening have been shown to reduce stress improve self-esteem and have a significant positive impact on depression and anxiety. However, research has also shown that people with mental health issues are also more likely to have poor physical health, and often face additional barriers to participating in sport and becoming active.

The Get Set to Go programme was launched with the support of Sport England and the National Lottery in July 2015 to help people with mental health problems benefit from being physically active. An evaluation of the project published in 2017 showed that physical activity has an important role to play in building resilience, enabling and supporting mental health recovery and tackling stigma and discrimination.

New support networks

There is a continuing push among healthcare and third sector professionals to stress that mental health is just as important as physical health. However, funding for mental health is comparatively low and research shows people are far more willing to acknowledge or accept help for physical illness.

With the roll-out of projects like the Changing Room Initiative to promote mental health in familiar environments, it’s hoped that those struggling with poor mental health will receive the support and treatment they need.


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Free access to Social Policy and Practice … only available this November!

Social Policy and Practice is the only UK-produced social science database focused on public health, social care, social services and public policy. It is exclusively available via Ovid – the internationally-recognised leader in medical information services – and this November they are offering librarians and researchers the chance to test drive it for free!

UK-focused evidence and research

Social Policy and Practice is produced by a consortium of key organisations within the UK. Currently these are:

  • Centre for Policy on Ageing
  • Idox Information Service
  • National Society for the Prevention of Cruelty to Children
  • Social Care Institute for Excellence

A valued resource

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.

Social Policy and Practice was also identified by the Alliance for Useful Evidence in a major mapping exercise in 2015, as a key resource supporting evidence use in government and the public sector.

Unrivalled scope

Social Policy and Practice covers all aspects of public health and social care. It is a must-have resource for anyone interested in the following topic areas:

  • Social work and social care services
  • Children and young people
  • Adults and older people
  • Families and parenting
  • Safeguarding
  • Health promotion
  • Health inequalities
  • Community development
  • Physical and mental health
  • Education and special educational needs

It also offers a holistic view of wider policy areas that impact on health, such as homelessness and deprivation.

The database brings together research and evidence that is relevant to researchers and practitioners in the UK. A large proportion of material relates to delivery and policy within the UK and the devolved nations of Scotland, Wales and Northern Ireland, but the database also covers material that is transferable from Europe and across the world.

Social Policy and Practice boasts over 400,000 references to papers, books and reports and about 30% of the total content is hard-to-find grey literature.

The importance of geographical focus

Research studies have shown that people searching for social science evidence tend to neglect the question of geographical and coverage bias within research sources. And that the geographical focus of databases is a potential source of bias on the findings of a research review.

In the last ten years many UK-produced databases have ceased – funding has stopped, publishers have closed or databases have been taken over by international publishers (which reduces the balance of UK content).

So as a UK-produced database, Social Policy and Practice is uniquely placed to provide relevant results for UK-based researchers.


To see for yourself why so many UK universities and NHS bodies rely on Social Policy and Practice as a resource, visit Ovid Resource of the Month for instant access.

To find out more about the history of the database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share.

Tackling health inequalities: what does the data tell us and how can it help?

Health inequalities in Scotland are significant. Every year we hear about how Scotland has some of the biggest gaps in the health and wellbeing of the poorest and richest in society. In some cases, Scotland has the largest gaps in equality in the whole of Europe. And in many instances, they are rising. Scotland also has the lowest life expectancy of all UK countries.

A number of studies and research projects have been commissioned to try to identify the key indicators and factors that are creating and reinforcing these inequalities, and what sorts of interventions would work best to try and reduce or eradicate them altogether. It is hoped that by conducting research, and compiling data, policymakers can use this to identify groups and geographic areas where health inequalities are significant, and to intervene to reduce them, with data to help back up and evaluate the effectiveness of these interventions. In Scotland, work is being done by a number of organisations including the Scottish Government, Glasgow Centre for Population Health (GCPH) and Public Health Innovation Network Scotland (PHINS).

What indicators and factors are being measured?

Income inequality has a related impact on health inequalities, and the scale of low pay is significant. The relationship between health inequalities, poverty and household income is one which has been explored at length and is often highlighted as one of the main factors which influences health inequalities. Studies which look at income, and also at relative levels of deprivation can provide useful comparison points, with comparable datasets on employment status and income readily available at a national and local level. Data also considers trends over time, comparing pre- and post-economic crash data, as well as relative earnings and expenditure relative to inflation and the rising cost of living. Other factors include age (those under 25 and earning a lower minimum wage for example) and by gender, with more women in lower paid, lower skilled and part time or insecure work.

How usable is the research being created?

The research which examines health inequalities explores a whole range of interrelated factors, and highlights just how complex the landscape of inequalities is. Creating a clear and holistic picture of all of the factors which contribute to health inequalities is not easy. Many studies, while detailed and effective, are niche, and focus on a very limited number of factors across a limited demographic source. As a result, questions have been raised about the utility of this research and its applicability and scalability at a national level. In an attempt to tackle this, combined data sets are being produced which provide opportunities for comparison across data from a range of studies.

The “Triple I” tool from NHS Health Scotland is designed to help policy designers to create effective interventions to reduce health inequalities. A second edition of the tool is due to be released in 2018/19. Triple I aims to provide national and local decision makers with practical tools and interpreted research findings about investing in interventions to reduce health inequalities in Scotland. It does this by modelling the potential impact of different interventions and policies on overall population health and health inequalities.

 

What can be done to act on the data?

While the research being produced is high quality, and thorough in relation to findings, the real question is what can actually be done with the research, and what steps can policymakers and practitioners take to use the findings to inform their own practice.

There are, researchers suggest, significant opportunities presented by the recent research which has been done on income inequality. In particular, they cite the public sector and public sector pay as a key way to reduce the income, and therefore the inequality gap, particularly among higher earners and those who would be considered “working poor” or “just about managing”. In Scotland, significantly more people are employed in the public sector than in any other part of the UK, and there is, researchers suggest, an opportunity to better align and increase low wages to help to reduce the gap.

The adoption of new initiatives, such as the “housing first model”, which is due to be rolled out in Glasgow to help homeless people break the cycle of homelessness, are also opportunities not only to address inequalities, but to ensure that long term help and support is in place to prevent any relapse into chaotic or risky behaviour. In relation to housing first, the savings on front line services such as emergency admissions to hospital, or contact with the police after committing a crime are significant, and while more in depth research is needed to create a full cost benefit analysis model of the scheme and its effectiveness, early studies show that the impact on health and wellbeing on those who had previously been homeless is huge in terms of reducing inequalities and improving wellbeing. However further data on homelessness in Scotland shows how far we have to go, and that housing first is only one mechanism which can be used to begin this process of reducing inequalities among the most and least deprived communities in Scotland.

Alternatively, some have suggested a more radical overhaul of how we distribute welfare and wealth within the country. Research has been coming thick and fast on the subject of a “citizens basic income”, particularly following the trial which was rolled out in Finland (the findings of which have not yet been published). Research on how this could impact on inequalities is not widespread yet, as pilots have been small scale, However, it is suggested that a total overhaul of welfare, replacing it instead with a citizen’s basic income would be a more effective way to reduce inequalities across the board, including in health.

Summing up

Health inequalities are significant in Scotland. Much of the research focuses on the impact of deprivation, poverty and low income on health inequalities and how, in order to tackle health inequalities in Scotland we must also tackle some of the other significant social problems within our communities, including low income and insecure work, and the impact of homelessness or chaotic lifestyles on health.

Data can be used in a number of ways to help inform policy decisions, some more radical than others. But creating a complete understanding of inequality in Scotland is challenging. It is up to researchers and policymakers to work together to create a better understanding of the conditions and factors which contribute to inequality, and what can be done to help tackle systemic and entrenched inequalities in our communities through policy levers and evidence based policy making.

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Universal basic income: too good to be true?

A world of evidence … but can we trust that it is any good?

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Creating caring places: placemaking in our town centres

What do caring places look like? How can planners, developers and project organisers contribute to the discourse around creating caring places? And what responsibility do they have to communities to help develop places that put people at their heart?

They are just some of the questions being increasingly raised by organisations in Scotland, trying to identify if there is a new way to focus on place and wellbeing in Scotland’s towns. Projects such as Carnegie Trust’s Kindness, Scottish Towns partnerships’ Town Centres First, or Architecture and Design Scotland’s Creating Caring Places are all exploring the importance of the quality of a place to the wellbeing of people who live there. But what does this mean for people who actually plan these areas, and what could they consider in the future to help develop more caring places?

The 3 P’s: place, people, practice

Many of the discussions around creating places which foster wellbeing and wellness centre around 3 key concepts:

Place: Understanding place and the impact that it has on wellbeing is a significant part of this agenda. The environment in which people live day-to-day has a significant impact on individuals and can be both a positive or negative influence. It can help to facilitate positive community interaction, creating stronger community ties and helping organisations and people to feel more valued within their community.

In order for places to be caring a number of factors have been identified, and these are common across research done by a number of organisations including Architecture and Design Scotland and the Carnegie Trust. These include: a sense of support (from people); a sense of purpose (stuff to do); a sense of place (familiar surroundings); and a sense of worth (feeling wanted).

People: Loneliness or social isolation has the same impact on health and mortality as smoking 15 cigarettes a day. Traditionally, it has often been assumed that older people are most often victims of social isolation (as they are less mobile and less willing or able to participate in community activities). Recently however more research has been produced which highlights the growing isolation of younger people. Understanding the nature of isolation, which impacts across the whole community, can help us to identify effective solutions which benefit and engage multiple groups.

Practice: This particularly relates to care within communities. The process of deciding where and how we care for the old or ill is a vital part of how we function as a society. Effective care extends far beyond the physical act of caring for someone, although this is obviously a key element. It also includes creating more and better jobs within the sector, and encouraging people to enter the profession as a worthwhile career choice; shifting the focus from acute to primary care settings and away from hospital-based emergency care; and giving people greater choice about how and where they receive care through increasing and improved personalisation of services.

There is a responsibility on both spatial and community planners to identify need and to create places which facilitate wellness, choice and care at home. This could be through the building of new infrastructure or more effective transport, or it could be through the creating of a community centre which offers recreational classes to someone who would otherwise have no contact with the outside world. Putting place at the centre of discussions provides an opportunity for a community approach to wellbeing, with strategies on placemaking being linked to other approaches such as asset-based, or strengths-based, planning.

Thinking about people like we think about the environment

Even as little as 10 years ago, the prevalence of environmental impact assessments for development projects was limited. Now we take for granted that we measure the impact of a project on the environment. What if we thought about people and in particular the risk of isolation, in the same way during planning processes? What if developers, planners and project organisers considered the “isolation impact” of a project, how it would impact the people of a local area, and whether it would specifically impact one group more than another (either for good or for bad), and reported on the steps they were taking to mitigate any adverse impact?

It is a striking notion, but creating a set of criteria to measure the social impact of developments, may be hugely useful if we are trying to place an increasing emphasis on inclusion and community within our town centres.

In fact, planners are beginning to realise the critical role they play in connecting services to people, and the necessity of understanding which services are needed in an area and how to make them as accessible for the whole community as possible. And while it is down to the community to use the resources they are given by planners to create connections and networks that help to combat things like poor mental health and social isolation, the decisions that planners make about how and where to plan in services and infrastructure can be the difference between someone leading an active and engaged life, and someone living a life where the only human contact they have in a day is a carer.

Planners can and should recognise the significant role they can play in making someone’s life more livable.

Final thoughts

Creating caring places for people to live and grow old in is vital to the success of our communities. Effective and thoughtful decisions on investments such as infrastructure and community planning projects can have a significant positive impact on wellbeing and reduce loneliness not only among older people, but throughout the community.

Increasingly, policy makers in Scotland are being asked to consider the human element of planning in their work. Creating places that allow people to feel safe, valued and happy is key for planners to help bridge the gap between the creation of places, and the wellbeing of people who live in them.


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City trees: green infrastructure to help cities clear the air

This long, hot summer has certainly been one to remember. But while many of us have enjoyed the sunshine, the soaring temperatures have had a critical effect on air quality, particularly in urban areas. In London and some other UK cities, pollution warnings were issued during the July heatwave.

The hidden killer

Air pollution in Europe is a bigger killer than obesity or alcohol. In the UK, 40,000 deaths a year are attributable to the effects of poor air quality. During the summer months, cities become heat islands that push air pollution to ever more dangerous levels. This summer has seen reports of increased numbers of people, particularly children, admitted to hospital with breathing difficulties, which many have blamed on air pollution.

As we’ve previously reported, in 2017 and 2018, national, regional and city authorities are acting to improve air quality, and around the world urban planners are trying out innovative ideas to combat the heat island effect. Last year, we blogged about Milan’s Bosco Verticale – a ground-breaking project that installed thousands of plants on the balconies of two residential tower blocks. The towers absorb 30 tons of CO2 a year and produce 19 tons of oxygen a day. Noise and heat are also reduced, and the buildings provide habitat for more than 20 species of birds.

Another innovative product, Voyager, has been developed by Idox Transport to enable road users to monitor travel information, including air quality and road accidents. The comprehensive travel information system helps drivers avoid congestion hotspots and takes the stress out of planning a journey.

Clearing the air

One important way of improving urban air quality is to increase the number of trees and plants in towns and cities. But all too often the barriers to tree planting in urban areas can be hard to overcome.

Which is why the “City Trees” project is so significant. Designed by a German startup, a City Tree is a “living wall” of irrigated mosses with the pollution-absorbing power of almost 300 trees. A rainwater-collection unit is built into the City Tree, as well as a nutrient tank and irrigation system, allowing the assembly to water itself.

Berlin, Paris, Amsterdam and Oslo were among the first European cities to install City Trees, and in the UK they’ve appeared on the streets of NewcastleGlasgow and London

There is evidence that green infrastructure can have significant effects on air quality. However, recent studies have indicated that, while vegetation and trees are beneficial for air quality, they cannot be viewed as a solution to the overall problem of poor air quality. That requires a coordinated approach to tackling the causes of air pollution, including diesel emissions from transport.

City Trees may not have all the answers to tackling the hidden killers in our air, but they are helping to blunt the impact of air pollution, helping us all to breathe a little more easily.


You can read more about efforts to tackle air pollution in our previous blog posts:

Idox Transport provides a range of products and services to support strategic and localised transport control. Its solutions are designed to ease congestion, improve air quality, detect and manage incidents and promote ‘green wave’ travel.

Science in the city: applying neuroscience to urban design

Cities have long been considered primarily in terms of their buildings and infrastructure.  However, in recent years, a more ‘human-centric’ view has been adopted – focusing on the people who inhabit the city, and how they perceive and respond to the city that surrounds them.

Research from a variety of disciplines agree that buildings and cities have a significant impact upon the people – from their physical and mental health, cognitive development, and wellbeing to their levels of productivity.

Neuroscience offers a new way to further explore this impact – and by doing so, help urban design professionals to create places that promote human health and wellbeing, whilst mitigating the negative impacts of the city environment as far as possible.

 

What is neuroscience?

But what exactly is neuroscience?  And how does it relate to urban design?

A recent report by FutureCatapult looks at how neuroscience can be used to improve the design of urban places, and thus increase human wellbeing and productivity.

It defines neuroscience as “a multidisciplinary branch of biology and is the scientific study of the brain and nervous system, including its interaction with the other parts of the body”.

There are various ‘scales’ or ‘levels’ of neuroscience – from cognitive psychology, right down to the study of individual cells in the brain.  Each level of neuroscience studies different aspects of how the brain functions, and thus offers different ways to explore and understand how humans perceive, respond to and are affected by their surrounding environments.  It has many applications in real life – and one such application is informing city strategy, design and policy.

 

Applying neuroscience research to urban design

Take mental health, for example.  It is a prime example of an area in which neuroscience can be used by city planners and policymakers to help improve human wellbeing.

As FutureCatapult point out in their report, cities have a greater prevalence of mental health problems than rural areas.

They note that several factors associated with cities have been found to contribute to mental health problems. These include certain toxins (produced by traffic, industrial parks), environmental stressors (noise and light pollution), climate conditions (urban heat islands) and social conditions (isolation).  Neuroscience offers a greater understanding how these factors impact on human health and wellbeing, thus creating an evidence base for the design of healthy places.

There are many other ways in which neuroscience research can inform city design.  For example, it has been found that:

  • poor air quality has serious detrimental effects on the natural developments of children’s brains
  • social isolation can accelerate cognitive decline in older people
  • an increase in noise decreases worker productivity
  • light influences brain function during specific cognitive tasks, especially those requiring sustained attention

Such findings can help inform the decisions made by city planners and policymakers, and help create cities that maximise human health, wellbeing and productivity.

Research into the brain’s ‘wayfinding’ processes – that is, how the brain processes visual information and makes sense of unfamiliar environments – is also of interest.  For example, how do people choose which paths to follow?  Are they influenced by street size, shape, colours, noise, or the number of cars? Such information could be used to inform the design of streets and places that are easier to navigate. This is of growing importance given the drive towards the design of inclusive and dementia-friendly places.

Relatedly, neuroscience offers a way to gain a deeper understanding of how non-neurotypical brains process and respond to different environments – for example, people with dementia or autism.  Understanding these different perspectives and responses is key to the creation of spaces that are truly inclusive.

 

Neuroscience in action

But how exactly does one go about examining how brain cells respond to an urban environment?

There are a variety of neuroscience tools that may be used to gather information about human’s experience of the city.

A key tool is mobile electroencephalography (EEG).  Previously, EEG involved equipment that could only be used in a laboratory.  However, technological advances have seen the development of mobile EEG ‘headsets’ that can be worn as research participants navigate different streets and environments of the city.

Mobile EEG enables researchers to measure brain function and activity, as well as the responses of the autonomic nervous system (heart rate, skin conductivity, endocrinological levels).  This can be used to understand how individuals experience urban environments.

For example, mobile EEG has been used to help understand the urban experiences of people with visual impairments.  Other mobile EEG studies have looked at whether using quiet, low traffic streets has a different effect on pedestrians than using streets busy with shops, traffic and other pedestrians.

Eye tracking machines are another tool providing research findings of interest to urban designers.  They study gaze behaviours and cognition, which are in turn related to attention, memory, language, problem solving, and decision making.  Eye tracking can help researchers to understand which features catch and hold attention, visual preferences and experiences. For example, one eye-tracking study found (perhaps unsurprisingly) that humans prefer lush greenery in urban environments.

As these neurological research and related technologies advance, their application will undoubtedly become more sophisticated and widespread.

 

Building upon evidence

The urban population around the world is expanding rapidly and finding solutions to the mental and physical health challenges that cities present is crucial.

By understanding the insights that neuroscience can provide, city planners, policy makers and others involved in urban design can access a growing evidence base upon which to build future cities that are healthy, attractive and inclusive places to live.


The Knowledge Exchange provides information services to local authorities, public agencies, research consultancies and commercial organisations across the UK. 

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Top research resources for social care and social services

The news in June that the Government’s Green Paper on social care will now be delayed until the autumn (having already been deferred since 2017) brought sighs of weariness rather than real surprise from the sector.

The recent focus on NHS funding, and the NHS’s 70th birthday, has also highlighted ongoing concerns that the funding crisis in other areas, including social care, mental health services and public health is being pushed to the sidelines.

What is clear, is that the need for evidence-based interventions, and proven value for money, is only getting stronger as budgets continue to be stretched.

The value of research

So, what’s the role of research knowledge within social work and social care? The Social Care Institute for Excellence has suggested that research can help practitioners and decision-makers to understand:

  • the social world in which those who use services live
  • why positive and negative events occur in the lives of some and not others
  • the relative success of interventions and their impact on these events
  • the role of the social care practitioner in relationships and interventions with service users
  • how social policies impact on the lives of people using services.

Studies such as cost-benefit analyses or randomised controlled trials are also part of the evidence base although they are less common in social care/social services than in health contexts.

Research takes place in different ways, with different aims. And the outcomes of research can be communicated in different ways. Blogs such as our own at the Knowledge Exchange aim to signpost readers to recent research on particular topics. Other good sources of accessible discussion of research findings include The Conversation blog and Community Care.

Meanwhile, database services such as the Idox Information Service or Social Policy and Practice will provide more comprehensive coverage of issues, bringing together research studies from other parts of the world which are transferable.

Social Policy and Practice

Many NHS Trusts and councils subscribe to the Social Policy and Practice database as part of their package of support for learning and development.

Recent feedback from users has highlighted its strong coverage of many current priority issues in public health, such as:

  • dementia care
  • delayed discharge
  • funding of long term care
  • safeguarding of both children and adults
  • supporting resilience and well-being
  • tackling obesity
  • asset-based approaches

As a UK-produced database, Social Policy and Practice also includes information on topical policy issues such as minimum alcohol pricing, sugar taxes, and the possible impact on the health and social care workforce of Brexit.

The database is produced by a consortium of four organisations: Social Care Institute for Excellence, Centre for Policy on Ageing, Idox Information Service and the National Society for the Prevention of Cruelty to Children.

Idox Information Service

With a wider range of topics covered, the Idox Information Service has been identified as a key database by the Alliance for Useful Evidence. Cross-cutting issues which impact on health and social services, such as poverty, housing, and social exclusion are covered in depth. It also covers management and performance topics.

The Idox Information Service also offers a range of current awareness services and access to a team of expert researchers, in addition to the database. The aim is to support the continuing professional development of hard-pressed frontline staff while also supporting the sharing of research and evidence across the sector.

Meeting the needs of the social care sector

Both Social Policy and Practice, and the Idox Information Service aim to increase the social care sector’s capacity for evidence-informed practice.

As battle lines are drawn over government funding, it’s clear that these will continue to be financially challenging times for public services and that demand for services will carry on growing. Investing in learning and development is one way to ensure that staff are equipped with the skills and tools to be the best that they can be. This in turn will ultimately improve performance and outcomes for the most vulnerable in our society.


To find out more about the history of the Social Policy and Practice database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share. Trials of the database can be requested here.

Read more about the unique support offered by the Idox Information Service. More information on subscriptions can be requested via the online contact form.

How to make people with learning disabilities feel more included in society

Image: Accessible music technology OpenUp Music/Youth Music Network

This guest blog was written by Val Williams, Professor of Disability Studies at the University of Bristol.

People with learning disabilities can often find themselves feeling excluded when it comes to making decisions about their lives. This can range from everything, from shopping to making music or even bringing up a baby. Sometimes this exclusion can be exacerbated by the kind of support that they receive from social services – but it can also be countered by sensitive personal assistance or support.

In a recent research project, which brought together disabled and non-disabled researchers, we looked at ways to improve this – and how to include people with learning disabilities in decisions.

Part of the project found that by taking active roles in the arts, people with learning disabilities can lead the way towards meaningful inclusion. Beth Richards, an actress with learning disabilities, led part of the research about people with learning disabilities on TV. She found that actors with learning disabilities are often limited to roles which depict the “disability”, the tragic or dependent life of the character, or their effect on others around them. A successful actor with learning disabilities, for instance, told her:

“I wish TV makers would think more creatively and give people with learning disabilities any role – romantic, fantasy, comedy, shop assistants, office workers. I’d like to play James Bond, Romeo, Dobby in Harry Potter or a detective or many other roles.”

The Queen’s Birthday Honours in June 2018 include an MBE to the actress with Downs Syndrome, Sarah Gordy, for her “services to the arts and people with disabilities”. As Gordy said upon receiving the award, “diversity is an opportunity, not a problem”. She is good proof of that.

But there is a lack of accessible information. There is no shortage of talented actors and drama companies supporting people with learning disabilities, but the TV industry and its workings are still shrouded in jargon. Processes such as commissioning, auditioning and scriptwriting tend to exclude those who do not have someone to help them navigate all this.

In another part of the research, my colleague Marina Gall looked in detail at how music making can be transformed by the Open Orchestras approach in which young people with multiple and complex needs are enabled to learn musical skills, play in ensembles and become music makers. A new technological instrument – the Clarion – can be played on computers and iPads, using one’s hand, a small sensor on any part of the body, or via a person’s gaze. It can be adapted to suit most students’ physical needs.

One of the co-founders of Open Orchestras, Doug Bott, told our research team, that the approach is “personalised around the individual young person”. But at the same time, it’s trying to ensure that music is an important part of the curriculum for all young people, and has been immensely successful in changing perceptions of people with learning disabilities. This is not therapy, it’s a route to making music and to performance.

Making decisions

People with learning disabilities also face inequalities and problems in the NHS, as well as in a cash-strapped social care system. For instance, since the Mental Capacity Act 2005 came into force, support staff are legally required to support people with learning disabilities to develop their own capacity to make a decision. What we saw in our data was that people with learning disabilities can be proactive in seeking out this support – and we recorded conversations with personal assistants where people wanted to talk about decisions relating to safety, health or simply about future cooking plans. The skills that a personal assistant needs to have are to listen, look out and be responsive to the people they are supporting.

One of the key messages from our project is that health and social care practices sometimes get stuck. We used the word “institutionalised” for those times when professionals stick to a rigid and inflexible way of doing things, leaving the disabled person without the power to have a voice.

These difficult moments were also highlighted by actors with learning disabilities who helped to interpret our data. Our research benefited from a collaboration with the Misfits Theatre Company in Bristol, showing how sensitive interactions between people with learning disabilities and their personal assistants were often the trigger for good decisions, and giving those with disabilities a feeling of control over their own lives.

But quite small comments can create problems, spoiling an empowering relationship. The theatre company made a brilliant video called A Good Match about their own perspectives and experience of managing relationships with a personal assistant. One of the Misfits actors said: “It’s my house … and I don’t want my (personal assistant) telling me what I can and cannot do.”

 

After looking at a range of activities that can exclude or include people with learning disabilities, we concluded that inclusion happens when three things come together. Sometimes people with learning disabilities are included because of changes to technology, as in the Open Orchestras approach. At other times, they are included better because of new ways of doing something, or through new skills that they may learn – as actors, or as TV performers.

The ConversationBut at the heart of all this is a new belief in the equal value of people with learning disabilities. This is why we recommend that social care services need to focus less on what people cannot do, but instead promote a genuine belief in what people with learning disabilities can do – with the right support.


Val Williams is Professor of Disability Studies at the University of Bristol.

This article was originally published on The Conversation website and has been republished with permission under a Creative Commons licence. Read the original article.

Writing and recovery: creative writing as a response to mental ill health

 

“You don’t put yourself into what you write, you find yourself there.”
Alan Bennett

Mental illness, for so long regarded as secondary to physical health, is now being taken more seriously. Media stories about loneliness, anxiety and depression have highlighted increasing concerns about mental ill health, and the issue has also been rising up the political agenda.

In 2017, a survey by the Mental Health Foundation found that only a small minority of people (13%) reported living with high levels of good mental health, and nearly two-thirds of people said that they had experienced a mental health problem.

Prescribed medication is one response to mental health problems, and it’s been reported that the NHS is prescribing record numbers of antidepressants.  But while psychiatric drugs can be of real value to patients, especially those whose condition is very severe, the mental health charity Mind has suggested that alternatives, such as physical exercise, talking therapies and arts therapies, are often more beneficial.

Last month, a conference at the University of Glasgow explored ways in which creative writing is being used to respond to mental ill health, and discussed what makes writing interventions helpful for coping and recovery.

Voices of experience: coping and recovery through writing

“Making and consuming art lifts our spirits and keeps us sane”.
Grayson Perry

Several speakers at the Glasgow conference testified to the effectiveness of writing in dealing with mental ill health and in finding a way to recovery.

In 2012, James Withey experienced a set of circumstances which brought him close to taking his own life. In the darkness of his depression, James felt that he might never recover. But after spending time at Maytree, the UK’s first “sanctuary for the suicidal”, he found that writing about what he was going through offered an antidote to the lies being spun by his depression.

He started a blog, and when he posted a letter to himself, beginning “Dear You.” James found that writing the letter gave him space to express his feelings and to listen to himself.

Before long, readers of James’s blog were responding with their own “Dear You” letters. The word spread that the letters offered a different perspective on recovery, and in some instances, had prevented suicide.

Today, The Recovery Letters project is still going strong, with a website, one published book and another in the pipeline. James is realistic about the project:

The letters are not a cure for a chronic illness, but they do provide support in helping sufferers of depression accept where they are.”

Policy positions: the view from Wales

“If poetry and the arts do anything, they can fortify your inner life, your inwardness.”
Seamus Heaney

Another speaker at the conference was Frances Williams, a PhD candidate at Manchester Metropolitan University, where she is studying arts and health. In her presentation, Frances explored some of the policy frameworks and public discourse surrounding the field of therapeutic writing in Wales.

She highlighted a recent report, Creative Health, The Arts, Health and Well-being, which  makes a case for the healing power of the arts in many different healthcare and community contexts.  In this report, a creative writing tutor explained some of the ways in which writing can help people experiencing bereavement, including keeping a journal, writing unsent letters, describing personal belongings and resolving unfinished conversations:

“Writing can be a valuable means of self-help, with the page as a listening friend, available any time of the day or night, hearing whatever the writer wants to say. The results of this can be powerful, and include people being able to return to work and adjust more effectively after their loss, acquiring skills for their own self-care which will serve them through the rest of their life.”

Frances also noted that the battle of priorities between impact and value-for-money has driven advocates of arts therapy programmes to defend them in terms of cost effectiveness and social value.

A mapping project by the Arts Council of Wales has taken this to heart, producing in 2018 an audit of the principal arts and health activities currently taking place in Wales.

Writing to the rescue

“By writing, I rescue myself”
William Carlos Williams

The Glasgow University conference underlined the health-giving properties of creative activities and the potential for creative writing to support people suffering with mental ill health. There was no pretence that writing offers a quick-fix solution. As James Withey noted, “…writing is just one element in a toolkit of responses to mental ill health.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing fully supports this concept, and has recommended that policymakers recognise its importance:

“…the arts can make an invaluable contribution to a healthy and health-creating society. They offer a potential resource that should be embraced in health and social care systems which are under great pressure and in need of fresh thinking and cost-effective methods. Policy should work towards creative activity being part of all our lives.”


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Joining the digital revolution: social workers’ use of digital media

In January 2018, NHS digital published a report, which highlighted the accessibility and availability of digital platforms to help social workers with their job role. The research, which was compiled from survey data, sought to understand not only how social work could be supported through the use of IT and digital platforms, but also to assess the current level of usage and understanding of digital technologies among the current workforce. While more than half of survey respondents said they had access to a smart phone as part of their role, far fewer were actually able to access case notes and other necessary documents digitally from outside the office.

The survey found there was an appetite for greater and better use of digital media in day-to-day work, which practitioners felt would not only improve their ability to work more flexibly but could also be used to forge better relationships with people who use services. In some instances, respondents to the survey felt improved use of digital media may provide a way to communicate more effectively with those who had previously been unwilling to engage, particularly in relation to social work with young people. The research found that digital technology was used in a range of ways to build and manage positive relationships, particularly with service users, including:

  • communicating with them to gather specific data (as part of assessment);
  • delivering interventions (such as self-guided therapy or telecare); and
  • supporting team work (peer support and online supervision)

Questions around the use of social media

Earlier research around the use of digital media in social care more generally found that it is used in a variety of capacities, such as storing and maintaining records, communications and day-to-day tasks such as booking appointments and scheduling in visits. However, the use of digital technologies by social workers can at times extend beyond simply maintaining records and scheduling visits. Many felt that while digital media in some ways makes their job easier, in other ways it can add to the stress of an already difficult job role.

A lot of the anxiety concerning digital technologies centres around social media. In the most positive of ways, it can be a core platform to allow service users to communicate, and make the social work team appear more accessible to people who may feel uneasy communicating in more formal ways. However, significant challenges around ethics and practice remain. Repeated instances of social workers being reprimanded have made some social workers wary of using social media platforms. In September 2017 HCPC published guidance which encourages practitioners to continue to use social media, but to seek advice and help if they are ever unsure. The guidance suggested that social media, if used responsibly, could support professionals to raise the profile of the profession and network with others nationally and internationally.

Supporting confidentiality and security

For many social workers and social work supervisors many of the challenges around using digital media centre on the necessity for confidentiality and security of information. While much of social work practice within offices is digitised with regard to record and case file keeping and report writing, security issues concerning remote access to files is one of the major challenges. In many cases until digital security can be assured, it will be difficult for social workers to work fully remotely and flexibly without some travel back to the office. GDPR also raises some interesting questions for the profession with regards to storing and accessing data.

An opportunity to improve information sharing and partnership working

It is well recognised that the use of digital media provides an opportunity to improve efficiency and partnership working within social work. If used effectively and supported well, it can allow information to be stored, shared and accessed across a range of different services, which can be particularly useful for increased health and social care integration. However, challenges in practice remain – including the ability of social workers to remotely access notes and information, the need to align working and IT systems, and the ability to access and read data in a number of formats across a number of devices. Research stresses the importance of risk management and appropriate training for staff so that they feel comfortable and confident using media platforms.

A welcome change in the profession?

For many within the profession, the rise of digital platforms as a way to engage with service users and provide increased support and flexibility for social workers themselves has been a positive development. It is a great leveller and can encourage service users who feel comfortable to engage in a much more transparent way with social workers. However, NHS Digital research shows that there are still significant challenges. Overcoming these to successfully integrate digital platforms and interfaces into social work practice has the potential to revolutionise not only how social workers engage with service users, but how they themselves conduct their work. Improved collaboration with other services, increased flexibility, and increased capacity for completing and recording continuing professional development and training to improve practice are just some of the potential fruits of social work’s digital revolution.


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