Light box The Happiness Project
Evaluation Report Written by Lucy Duggan, Lucy Barfoot and Kathryn john
October 2011
This evaluation was undertaken by light box and advised by the willis newson/ uwe knowledge transfer partnership
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Drawing tops used in the Vitality 2: Movement workshop
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Contents Page
1. Introduction 3
2. Background
2.1. Description of the project 5 2.2. Positive Psychology foundation 6 2.3. Project team 7
2.4. Rationale for the project 9
2.5. Pilot project 11
2.6. Funding and finance 12
3. People
3.1. Stakeholders 14 3.2. Partnerships 15
3.3. Volunteers 16
3.4. Participants 17
4. Project evaluation
4.1. Background 19
4.2. Rationale 20 4.3. Approach (Internal evaluation) 21 4.4. Project aims 22
4.5. Data collection methods (to include appreciative inquiries and steering groups) 23 4.6. Data analysis 25 4.7. Results 26
4.8. Discussion (to include achievement of aims; observations; steering group 40 influence; sustainability and future financial considerations)
4.9. Recommendations 42
5. The Happiness Project: next instalment 43
6. Conclusion 47 7. References 48 8. Appendices 49
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1. Introduction
This is a report on the Light Box Happiness project. It describes the rationale for the project, identifies key stakeholders, and presents the findings of the project evaluation. The report was written by Lucy Duggan, Lucy Barfoot and Kathryn John of Light Box. We are grateful for the training and mentoring provided by Meg Attwood and Professor Norma Daykin through the Willis Newson/ UWE Knowledge Transfer Partnership (KTP).
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2 Background
The Gratitude Tree in THE LIGHT BOX SHOP IN THE GALLERIES, BROADMEAD.
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2.1 Description of the project
Light Box is a Community Interest Company, that provides ‘Happiness Workshops’ for the wider Bristol community. These two-‐hour workshops are free to attend. They invite participants to examine 10 themes that are
connected to the promotion of mental well-‐being: Gratitude / Goals / Appreciation of Beauty / Savouring and Flow / Confidence / Character Strengths / Savouring
and Flow / Nurture and Kindness / Humour and Playfulness / Vitality 1: Food and Mood / Vitality 2: Movement In each of the 10 workshops, facilitators present research findings that relate to well-‐being. During the group
discussions and creative art activities that follow, participants generate ideas for Recommended Actions that they are encouraged to implement into their daily lives. They also create an object to be used as a visual reminder to
engage in actions that promote their well-‐being. The Happiness Workshops are designed to reduce the stigma associated with mental health issues, increase
resilience, and to help people make tangible improvements to their lives. Rather than focusing on illness, The Happiness Project presents mental health in a positive light: as an exciting, empowering social phenomenon and on a continuum on which we are all placed.
Between April 1st and June 30th 2011, 51 workshops and two 10-‐week courses were held in Light Box’s shop, located in The Galleries in Broadmead, Bristol.
Workshop timetables are included as Appendix A.
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“How refreshing to come across a place like this. An oasis in a busy world. May it prosper and many weary people come through its doors to be refreshed in body, mind and spirit.” Participant
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2.2 Positive Psychology foundation
The evidence base for positive psychology informs much of the workshop’s content. Light Box has received informal consultancy from University of East London Master’s graduates in Applied Positive Psychology, Cassie
Robinson and Lucy Ryan. Direct guidance and encouragement were also provided by Acacia Parks and Martin Seligman; both positive psychologists from the University of Pennsylvania, and Tal Ben Shahar who lectures in applied positive psychology at Harvard University.
Positive psychology is a branch of psychology that emerged in the 1990s. Its purpose was summed up in 1998 by Martin Seligman and Mihaly Csikszentmihalyi. "We believe that a psychology of positive human functioning will arise, which achieves a scientific understanding
and effective interventions to build thriving in individuals, families, and communities." (Seligman & Csikszentmihalyi. 2000, p.5)
Positive psychologists seek "to make normal life more fulfilling", not simply to treat mental illness (Compton, 2005, p.19). The field is intended to complement, not to replace traditional psychology. It has a positive focus, emphasising the importance of understanding the determinants of well-‐being rather than the causes of mental
illness. /
“Thank you for the workshops. Coming to them has made a big difference. I don’t take life as seriously now and I feel much better for it.” Participant
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2.3 The project team
The project is run by a staff team of three, who are supported by a group of nineteen volunteers.
Lucy Duggan and Lucy Barfoot co-‐founded Light Box in April 2009. Lucy Duggan is responsible for Project Development and a workshop facilitator. She received a 2:1 in Sociology
and Politics from the University of Bristol in 2003. She has since obtained an OCN level 3 award in Creativity in Social Care in 2009 and been awarded a level 5 in Social Enterprise Leadership from Plymouth University in 2011. Lucy is a practising artist and has lived experience of bipolar disorder and recovery.
Lucy Barfoot is Light Box’s Creative Director and a workshop facilitator. She received a 2:1 Bachelor of Fine Arts
degree from the University College for the Creative Arts in 2008. Lucy is a practising artist, holds a creative interest in sculpture installation exploring themes of vulnerability, ephemerality and economy. She has wide experience of facilitating public art workshops.
Kathryn John is the project’s Volunteer and Project Coordinator and a workshop facilitator. She graduated from Aberystwyth University in 2006 with a 2:1 in Art History. She achieved a Distinction grade Further Education PGCE
at Cardiff University in 2008 and has worked as a teacher in a range of educational contexts. She is also a practicing artist. Kathryn began as a Light Box volunteer in 2009 and joined the staff and directing team in 2011.
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“I just wanted to say what you are doing here is amazing. Good luck.” Participant
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2.4 Rationale for the project
Mental health Mental health problems are extremely common: in Great Britain, 1 in 6 adults will have a mental health problem at any one time (Sainsbury Centre for Mental Health, 2003).
Estimates put the full economic cost of poor mental health at around £77 billion per annum, mostly due to lost productivity (Sainsbury Centre for Mental Health, 2003).
Good mental health is fundamental to everyone’s quality of life; however there is limited public awareness of the actions that support good mental health and well-‐being.
National Context Action for Happiness
Action for happiness, a national initiative to promote investment in mental health, was launched in 2011. This has raised the public profile of well-‐being. No Health without mental health The latest cross-‐governmental mental health strategy shifts the focus of services towards promotion of mental health, prevention of mental illness, and early identification and intervention as soon as mental illness arises (HM Government, 2011). The strategy calls for the fostering of innovative practice, supporting research and ensuring the quality of evaluation. Arts and Health
The role of arts based activities in supporting healthcare delivery and contributing to health outcomes is widely recognised (Cayton 2007; Department of Health with Arts Council England, 2007; Clift et al, 2009). A national
study found significant improvements in empowerment, mental health and social inclusion following participation in arts activity, with greater improvements in empowerment and mental health for participants with ‘clinically significant’ mental health problems (Secker et al, 2007).
Local Context NHS Bristol and Bristol City Council work in partnership to develop mental health strategies. Their priorities lie in the areas of strengthening positive mental health promotion, tackling stigma and discrimination and also
improving access to psychological therapies. These are addressed by the Local Implementation Team’s strategy ‘Vision for the Future’ (Hunt and Lyle, 2008) and the ‘Promoting Positive Mental Health in Bristol Strategy, 2008 – 2011’ (Robertson, Gray and Bramley, 2008).
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Vision for the Future The key recommendations in the Local Implementation Team’s strategy include the following:
Services to be integrated within mainstream facilities for increased accessibility and reduced exclusion
Focus to be moved towards health promotion, prevention and mental well-‐being Innovative solutions to be used A greater choice of self-‐help resources and talking therapies to be made available
The report also anticipates an increased role for voluntary sector organisations as service providers: ‘We welcome partnerships with a range of organisations that can demonstrate to us that they are able to provide the type and quality of services we – and service users -‐ want to see. We expect that commissioners will routinely consider the voluntary sector when planning new services’ (Hunt and Lyle, 2008, p.31). Promoting Positive Mental Health in Bristol Strategy, 2008 - 2011
This strategy supports the development and delivery of preventative interventions and positive mental health promotion. Two key objectives are:
To raise awareness of current research and good practice in mental health promotion To support the creation of a ‘mentally healthy’ city
Social participation is highlighted in the report as a means of achieving these objectives, with particular mention being made of the role creativity and participation in the arts has to play in improving mental health at
community level.
Project Aims The aims of Light Box’s Happiness Workshops are closely aligned to the national and local mental health agenda:
Promoting mental health Preventing mental illness
Providing an early intervention facility Supporting people with mental health problems
Light Box adheres to a person-‐centered philosophy, as advocated by humanist psychologist Carl Rogers. It understands participants to have ‘self actualizing tendency’ -‐ an innate desire and ability to improve their well-‐being. As such, the creation of a safe, relaxing and respectful space is paramount, engendering an atmosphere of
trust, empathy and unconditional positive regard. The Light Box premises are centrally located, accessible and visually appealing; this provides an atmosphere
conducive to relaxation, trust and the fostering of positive relationships. The project aims to champion inclusion, with workshops suitable for participants of diverse backgrounds, ages
and abilities. It also seeks to tackle stigma by addressing mental health away from clinical settings. In this way, it provides an appropriate facility for prevention and early intervention.
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2.5 Pilot project
In March 2010, 282 members of the public participated in 44 pilot, open-‐access, workshops of the Happiness Project in a former shop on Union Street, Broadmead, Bristol. Internal evaluation of the pilot showed a positive
response to the workshops, with case studies reporting tangible improvements in well-‐being following participation.
For a project report on the pilot see: http://wearelightbox.co.uk/page/wp-‐content/uploads/2010/12/Light-‐Box-‐PDF-‐Project-‐Report.pdf
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“Coming here has helped me cope with a very difficult time.” Participant
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2.6 Funding and Finance
Funding for the 2011 3-‐month Happiness Project was received from the following charitable trusts:
Arts Council England The Lankelly Chase Foundation Big Lottery Fund
Payment was received from Artshine, NHS Bristol’s arts on referral scheme, in exchange for the provision of workshops to General Practice patients.
Statements of income and expenditure are included as Appendix B.
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“I find the workshops very enjoyable and calming. It helps me relax and get in touch with a creative side I thought I didn’t have.” Participant
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People
Participants using drawing inks and letterpress stamps to decorate their hand-bound gratitude journals
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3.1 Stakeholders
Light Box has engaged with the following stakeholders:
Third sector organisations including Second Step and Bristol Mind. Avon and Somerset Probation Services Bristol City Council
NHS Bristol General Practice Surgeries in the Bristol area Avon and Wiltshire Mental Health Partnership NHS Trust
Representatives from the majority of these organisations attend Light Box’s stakeholder meetings twice a year.
These meetings update stakeholders on recent progress, and invite them to contribute ideas as to how Light Box could best develop to meet their clients’ needs. These meetings make use of an Appreciative Inquiry approach.1
1 An asset based approach to performance appraisal.
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3.2 Partnerships
Light Box has worked with several referring partners, including:
Happy City Initiative ArtShine arts on prescription scheme Early Intervention in Psychosis Team
Eden House Project The Happy City Initiative promotes Light Box to the broader community, encouraging self-‐referral. Art Shine refers
General Practice patients to take part in Light Box workshops designed for the general public. The Early Intervention Team and Eden House Project refer their clients (young people and women in the offender
management system) to take part in closed 10-‐week courses. /
“I like the colours in here. I like how there ‘s a big table for lots of people to sit around and also corners to stand in and have smaller chats.” Participant
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3.3 Volunteers Light Box has a team of 19 volunteers from diverse backgrounds, ranging in age from 19 to 60+ years of age. 9 volunteers are ex-‐workshop participants. The volunteer role is dynamic. Volunteer tasks include but are not limited to:
IT -‐ technical support Web design Social media Sourcing workshop materials Reception duties Promotion and public relations Assisting with workshop facilitation Assisting with workshop development General housekeeping Evaluation
Light Box holds quarterly volunteer steering group meetings. Here volunteers input ideas about the development of their role and the organisation as a whole. All volunteers receive induction training, which covers safeguarding vulnerable adults, evaluation, health and safety, boundaries, active listening and positive psychology. They receive ongoing supportive supervision.
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“I enjoyed the practical part of the workshop as I’ve got results from it as it’s very nurturing.” Participant
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3.4 Participants
From April 1st to June 30th, general workshops were attended by:
201 members of the public 11 General Practice patients enrolled on ArtShine, the arts on referral scheme
And 10-‐week courses were attended by:
14 clients referred by Avon and Wiltshire Partnership’s Early Intervention in Psychosis Team 14 Women enrolled with Avon and Somerset Probation Services Eden House Project
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“This is brilliant, and needed” Participant
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4 Project evaluation
part of The Monitoring station
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4.1 Background
In October 2010, Willis Newson, an arts and health consultancy, agreed to provide evaluation services through the company’s Knowledge Transfer Partnership (KTP) with the University of the West of England (UWE). The
evaluation model adopted was that of a guided internal evaluation, with Meg Attwood (Willis Newson) and Norma Daykin (UWE) providing training and mentoring in evaluation design and implementation of an evaluation protocol, as well as assistance with data analysis. Overall project management of the evaluation was undertaken
by The Happiness Project. /
“I was on my last legs and found this experience more than just refreshing. God bless you and your project.” Participant
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4.2 Rationale
Light Box wanted to achieve the following objectives in evaluating their Happiness Workshops:
To consistently apply a robust evaluation framework To produce evidence to support the programme
To inform best practice
To ensure they were in line with the current health policy agenda, i.e. delivering evidence based practise and evidencing outcomes
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“I feel stronger.” Participant
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4.3 Approach
The internal evaluation framework was developed in partnership with the Light Box team to ensure that it would support evaluation activity that was appropriate, feasible to implement and sustainable. Evaluation capacity was developed through a day of team training and a guided evaluation cycle with supervision from Willis
Newson/UWE. /
“Light Box has opened my eyes to my own creative potential” Participant
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4.4 Project aims
At the start of the evaluation process, a priority-‐setting meeting was held with a group of key stakeholders in order to explore the aims of the evaluation. Based on this discussion the following evaluation priorities were
identified:
To assess the impact of the activity on participants’ mental health and well-‐being
To assess the impact of the activity on participants’ take up of further creative occupational activity
To explore the impact of the project on participants’ empowerment and level of self care
To assess the impact of the project on reducing stigma surrounding mental health
To assess the impact of the project on the community’s understanding of happiness
To assess awareness and perception of the project as a resource
To identify and develop best working practices within the organisation /
“I’m so glad I found this.” Participant
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4.5 Data collection methods
Monitoring Monitoring information was gathered at each workshop including: gender, age, disability and ethnic background.
Session feedback forms All participants were asked to complete a feedback form upon completion of each workshop. The form was
devised by the evaluation team and included quantitative questions on issues such as subjective impact on well-‐being, uptake of creative pursuits, feelings of empowerment and understanding of happiness, as well as qualitative questions to explore planned actions and any other comments regarding the workshops.
A sample feedback form is attached as Appendix C.
Case study interviews All of the workshop participants were invited to be case studies. Sixteen case studies were selected to represent participants of varying age and gender, and to represent both those who had attended the ten-‐week courses and the general workshops. Case study interviews were conducted over the phone and the interviewer, a project
volunteer who had undergone evaluation training, took notes. Questions covered themes including participants’ experience of mental health and mental health services, any changes they had made as result of the workshops
and whether they had felt empowered to look after and improve their mental well-‐being.
Warwick-Edinburgh Mental Well-being Scale (WEMWBS) The Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS) is a 14 item scale of mental well-‐being. All of the items are worded positively and cover aspects of positive mental health, such as feeling optimistic about the
future, feeling close to other people and being interested in new things.
Each of the 14 statements in the scale are scored from 1 (none of the time) to 5 (all of the time) and the respondents’ total score is calculated by adding the 14 individual scores. The minimum possible score is 14 and the maximum, 70. This scale was completed by case studies and closed group participants at the beginning and end of their attendance, in order to track changes in well-‐being.
Comments box A comments box was used to gather spontaneous feedback from passers-‐by and participants. Respondents gave their feedback voluntarily and were advised that it would be used as part of the evaluation.
Consultation Throughout May, all of the Happiness Workshop’s participants were invited to join a steering group, which 12 participants from both the general workshops and closed groups joined. Steering group meetings take place twice yearly and provide an opportunity for participants to make recommendations about the project’s improvement.
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Weekly team meetings with volunteers are also held to discuss and respond to any issues that were flagged up by the feedback forms and participant steering groups.
Ethical guidelines As the Light Box team undertook a service evaluation and not a research study, formal ethical approval was not
needed for the evaluation. However, ethical principles including respect for participants’ rights, safety, privacy and dignity were adhered to and all evaluation activities conformed to current legal requirements surrounding
data protection. Participants provided written informed consent for all information gathered including feedback forms, WEMWBS and case study interviews.
When completing evaluation forms participants were asked to use a pseudonym, which they retained throughout the project, enabling the project team to match participants’ data at the same time as keeping participants’ identities anonymous.
All of the data were stored securely in a locked filing cabinet and identifying biographical information was kept separate from responses. When photos were taken during the workshops the participants provided verbal
consent for them to be used as part of the project evaluation.
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“Many thanks. Marvelous idea, great! Keep up the good work you lovely people.” Participant
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4.6 Data analysis Quantitative analysis
Simple quantitative data analysis was performed on the monitoring and feedback information, as well as the WEMWBS responses. This analysis produced total scores, percentages, frequencies and average values.
Qualitative analysis Thematic analysis was used to identify the key themes that emerged from the case study interviews and the responses to the qualitative questions in the feedback form.
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“Thank you. You have made a big difference to my life.” Participant
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4.7 Results Quantitative results
Monitoring General public workshops
201 members of the public attended the workshops. Of these, 11 were referred through ArtShine. 57 members of the public attended more than one workshop and this resulted in a total of 416 attendances over the duration of
the workshop programme, with an average attendance of 2 workshops per person.
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Of the total number of participants who attended the course of general public workshops, 16% were male and
82% were female (2% did not respond to this question).
In terms of the ethnic monitoring data, 93% of participants were White British, White Irish or White other; 6% were from black and minority ethnic groups and 1% didn’t respond.
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43% of the participants had a disability, 45% did not, 10% preferred not to say and 2% did not provide a response.
A range of ages was represented with 4% of participants between 0-‐19, 28% between 20-‐29, 27% between 30-‐39,
16% between 40-‐49, 17% between 50-‐59, 6% 60 plus and 2% not responding.
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Monitoring
Closed group workshops
28 participants came to the closed group workshops. 10 participants attended more than one workshop. This resulted in a total of 71 attendances over the 10-‐week course, with an average attendance of 2 workshops per
person.
Of the total number of participants who attended the course of closed group workshops, 37% were male and 63%
were female.
In terms of the ethnic monitoring data, 93% of participants were White British, White Irish or White other and 7%
were from black and minority ethnic groups.
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39% of the participants had a disability, 41% did not and 20% preferred not to say.
The age range of participants was as follows: 11% of participants were between 0-‐19, 48% between 20-‐29, 17% between 30-‐39, 14% between 40-‐49, 6% between 50-‐59, 1% 60 plus and 3% not responding.
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Feedback 412 feedback forms were completed by members of the public. The response rate to the feedback forms was extremely high at 99%.
67 feedback forms were completed by closed group participants. The response rate to the feedback forms was again high at 94%.
Participants’ responses to the feedback forms are presented below. Impact on well-being
In the general public workshops, 96% of respondents found the workshops enjoyable and 93% found the workshops either useful or very useful.
In the closed group workshops, 100% of respondents found the workshops enjoyable and 97% found the workshops either useful or very useful.
‘I don't know what I would have done this morning if I could not have come here because I was very distressed but now I feel much better.’ ‘As usual, life affirming, brilliant and positive, thanks.’
Take up of creative and occupational activity
80% of the general public respondents and 81% of the closed group respondents planned to spend more time on creative pursuits.
‘I played the violin for the first time in a year last night.’ ‘Be more creative and get out there and do, not just think about it.’
Empowerment
In the general public workshops, 75% of respondents felt empowered by the experience of participating and 89% planned to take action as a result of attending. In the closed group workshops, 78% of respondents felt empowered by their participation and 94% planned to take action.
‘I’m glad I came to this workshop again as it has given me the inspiration to carry forward with what I intend to do.’
‘It was great to come to this workshop again. It would be nice to volunteer if I can.’ ‘Make a new start that can make me different.’
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Stigma
79% of the general public respondents and 69% of the closed group respondents felt that the workshops had helped them see how mental health applies to all of us.
‘Very refreshing approach to mental health. More please!’ Understanding of happiness
71% of the general public respondents and 60% of the closed group respondents had improved their understanding of happiness.
‘Excellent! A brilliant, fun way of bringing the benefits of positive psychology to a broader audience.’
The project as a resource
97% of both the general public and closed group respondents said they would recommend the workshops.
‘These workshops should be more available, they are really good for everyone.’
‘Great initiative that deserves to continue and grow throughout the city and beyond.’
‘It’s fantastic that it’s free.’
Successful working practices
In the general public workshops, 77% of respondents said that the workshop length was just right and 94% felt that the information was clear. In the closed groups, 81% of respondents found the workshops length to be just
right and 100% said that the information was clear. ‘I am so impressed with your ability to communicate complex and potentially life changing ideas in a simple and powerful way.’ ‘You guys are so eloquent in the way you explain such a wonderful project.’
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Warwick Edinburgh results
Case study participants were asked to fill in an initial WEMWBS on selection as case studies. The second
WEMWBS was collected at the end of participant’s engagement with workshops.
All of the 13 case study participants showed an improvement in their well-‐being scores, as measured by the Warwick-‐Edinburgh Mental Wellbeing Scale (WEMWBS) at the beginning (pre-‐test) and the end of their workshop attendance (post-‐test). The average WEMWBS score changed from 42.1 at pre-‐test to 49.8 at post-‐test, indicating
an average change in score of 7.8. The average pre-‐test score of the case studies (42.1) is below the population mean (50.7). This suggests that the
project is reaching people within the general public who have lower than average well-‐being. (Stewart-‐Brown and Janmohamed, 2008).
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We initially planned to collect WEWBS scores at 3 time points; the beginning, the middle and at the end of the 10-‐week course. Due to the attrition and sporadic attendance of some participants, WEWBS scores were collected at 2 time points; near the beginning and at the end of the workshop attendance.
Of the 28 participants in the closed groups, 8 returned both the pre-‐ and post-‐measures. 7 of these 8 participants
showed an improvement in their well-‐being scores, while one participant’s score decreased at post-‐test. The average WEMWBS score changed from 40.3 at pre-‐test to 46 at post-‐test, indicating an average change in score of 6.
The average pre-‐test score of the closed group participants (40.3) is below the population mean (50.7). This suggests that the closed groups targeted people with lower than average well-‐being.
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Qualitative Results The themes that emerged from the session feedback forms under the categories ‘planned action’ and ‘comments’ are presented below.
I plan to.. . Engagement in Creative activities Several participants stated an intention to engage with a range of creative activities in general life as a consequence of attending the workshops. Examples included: journaling, photography, gardening, sewing, knitting, joining art groups and attending concerts and dance classes. Promoting well-being Plans to invest more in physical well-‐being were a recurring theme. Examples included: Increasing levels of physical activity with an emphasis on ‘green exercise’ such as walking and cycling, making positive changes to diet and upping daily intake of water. Improving social relationships People attending often viewed coming as an opportunity to meet and mix with new people. Much of the feedback demonstrated an increased resolve to nurture existing relationships, using kindness and gratitude, and to develop new ones by mixing more socially. A number of participants expressed a desire to share the information they had acquired from the workshops with others in their social network, and nine joined the volunteer team that helps run the project.
‘Excellent! A brilliant, fun way of bringing the benefits of positive psychology to a broader audience.’ Purposeful actions Specific intended actions arising from the workshops included setting and pursuing meaningful goals; seeking beauty in the natural and man-‐made environment; employing the senses to savour more experiences in daily life; taking up meditation; and making extra time for activities that induce flow states2. The time and effort involved in habit creation and change was noted by case studies. The roles of enjoyment and awareness of personal character strengths were identified as helpful tools in this process of change.
2 A term used to describe the emotional equilibrium experienced when engaged in a task demanded a level of skill at the top end of your capability (Csikszentmihalyi, 1990).
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Comments Positive experience Participant feedback predominantly indicated pleasure in attending: friendly, relaxed, joyful, playful and fun were all used as descriptions of the experience. A sense of having one’s ability recognised was cited and there was a general acknowledgement that the approach taken by the workshops was ‘new’ or ‘refreshing’. One participant described their experience as life affirming. It was reported that the workshops presented an opportunity to think clearly about their well-‐being. Participants described the workshops as providing inspiration, insight and motivation that facilitated their taking action to invest in good mental health. Participants also described improvements in mood as an immediate effect of attending.
‘I don't know what I would have done this morning if I could not have come here because I was very distressed but now I feel much better.’
The workshop environment Feedback variously described the shop space as welcoming, safe and accessible, with a good atmosphere. The selection of music played in the shop met with general approval, although a participant did report that the music coming in from the gallery outside was distracting. Communication Participants described the workshop content as informative and credible. Appreciation was expressed for the scientific detail, and the way in which practical application of the theory and research was made clear. The opportunity to discuss concepts in a group setting was also reported as enjoyable and beneficial. A small number of participants said they would have liked to receive more instruction during the creative activity and had it presented in a more structured way.
‘I am so impressed with your ability to communicate complex and potentially life changing ideas in a simple and powerful way.’
‘It’s nice to focus on the good things in life.’
‘Excellent! A brilliant, fun way of bringing the benefits of positive psychology to a broader audience.’
Challenges While most of the comments were positive, some participants identified challenges, reflection on which will guide future project development. For example, some participants felt that some activities were rushed; they would have liked more time to spend on discussion and artistic activity. Others found the experience challenging, with a small number of participants finding being in a large group a source of anxiety. One participant fed back that they experienced the workshop as simplistic and patronising, but went on to note – ‘the atmosphere was cheerful however.’ Two participants who had physical impairments (for example limited mobility in the hands) found it difficult to take part in all aspects of the creative activity and reported feelings of exclusion while attending.
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Case study interviews Some case studies self-‐referred after walking past the shop front, picking up leaflets or seeing the project advertised in Spark magazine. Others were referred by ArtShine at their GP surgeries or the Early Intervention in Psychosis team. Initial impressions of the project ranged from curiosity to scepticism, with some having little to no expectation regarding outcome. Participants widely commented that the project offered a new and alternative approach to gaining insight on mental health, and experienced the approach as enjoyable, playful, fun and light-‐hearted. All of the case studies had an existing knowledge or experience of mental health. Some participants reported lived experience of mental health difficulties including depression, bipolar disorder and anxiety. Case studies talked about their experience of existing drug treatments, and talk therapies including stress management training, cognitive behavioural therapy and anxiety support groups. In some cases support previously received was felt to have been useful and in others less so. Over-‐use of diagnostic labelling and not being treated as a whole person or individual was a common observation. Lengthy waiting lists were also cited as a problem.
‘I find the Light Box creative; it makes you feel like somebody. Whereas in my opinion other services, like with hospitals or medication, you can feel like a puppet.’
During the interviews, some participants talked about the challenging circumstances and traumatic life events that they felt had played a precipitating role in the mental health difficulties they experienced. Interviewees referred to single-‐parenthood, relationship breakdown and job loss as contributing factors. Thematic analysis identified the following themes from the case study interviews. Balance The positive, solution-‐focused approach of the workshops was praised as a useful counterbalance to the more clinical, diagnostic approaches of conventional treatments. The fact that the workshops felt ‘less serious’ and normalised mental health was seen as a benefit. Placing emphasis on well-‐being rather than illness was also welcomed and case studies described this aspect as empowering. One case study observed that rather than fixing people, this was a method of building strength and resilience. The project’s personalised and supportive approach was mentioned as a strength, and its tendency to recognise and encourage the individual’s ability to take action themselves was also found to be of benefit. Participants liked the combination of science-‐based theory and creative activity within the workshops and found the practical application, i.e. the take-‐home reminders and actions, especially helpful.
‘I like that the sessions are scientifically based and also fun. I enjoy doing the practical exercises, I think that they are absolutely fantastic.’
Social element Case studies felt that attending helped build confidence and group skills and present them with social opportunities, a chance to meet and be around happy people and build supportive relationships and networks.
‘Light Box is aimed at mental health but actually you also build group skills, which are helpful.’
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Unlocking creativity A number of case studies felt that having the opportunity to be creative and explore the creative process using methods of art, craft and photography, encouraged them to continue exploring and developing creative aspects of their lives beyond the workshops.
‘It has empowered me to build on the creativity I already have in myself.’ Personal development Several of the case studies described a shift in outlook which they attributed to attending. Feeling more in control and taking things less seriously were examples given, as was an increased ability to ‘live in the present’ and be focused on the future rather than the past.
‘Booking into the workshops has made me more proactive.’ Developing resilience, facing challenge and disappointment and becoming more able to cope were aspects of personal growth that case studies felt attendance had assisted with. Receiving encouragement to identify existing strengths and develop new skills was seen to play an important role in the confidence building aspect of the workshops. Increased self-‐knowledge and self-‐awareness were also reported consequences of taking part. Taking action One case study reflected on the challenge of putting the recommendations from the workshops into action and becoming proactive after a long period of depressed mood and inactivity. Attaching importance to doing enjoyable things with the understanding that they are a means of investing in good mental health was an insight another case study described taking from the workshop.
‘Light Box gives you things that you can take away and use on yourself. It is logical, it makes sense. The practical ideas have really helped.’
Consciously cultivating gratitude, appreciating beauty, and performing extra kind acts and smiling more were reported as actions that case studies had found particularly useful as tools for investing in well-‐being. 11 of the 13 case studies said that since attending the workshops they felt better able to actively improve their own mental health. Holistic
The two Vitality Workshops, which examine the role of food and physical activity in mental well-‐being were reported to have made a particular impact in terms of case studies’ behaviour change. Increased exercise and improvements to diet were reported by six of the thirteen respondents.
‘I have changed my diet and am particularly drinking a lot more water.’ Positive responses Case studies’ overall response to the workshops was a positive one. They were described as helpful, welcoming, fun, enjoyable, clear and as making a big difference.
‘I would like to commend the people involved in the workshops. I found them to be professional, and they gave me assurance.’
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Challenges and areas for improvement
Case study feedback drew attention to the fact that the majority of workshops being scheduled during weekdays raised an issue of accessibility for those in full-‐time employment
One respondent felt that the facilitators’ lack of professional training ought to be highlighted
Having more opportunity to share and discuss experiences with other participants was suggested as a
potential improvement
One case study experienced a panic attack during a workshop that involved dismantling and cutting up old toys, and questioned the appropriateness of this workshop activity for vulnerable adults
The explanation of hedonic adaptation theory 3during the workshop introduction seemed like too big a
generalisation, and counter-‐intuitive to one of the case studies, who felt it should be dropped from the content
Others cited the need to leave the shop to use the public toilets as an inconvenience
Actions to be taken on these points are discussed under Recommendations
/
3 A term used to describe the emotional equilibrium experienced when engaged in a task demanding a level of skill at the top end of your capability (Csikszentmihalyi, 1990).
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4.8 Discussion
Evaluation process The evaluation framework developed in partnership with Willis Newson and UWE has shown itself to be an effective and sustainable means of gathering data that will inform the project’s development. Before the second
evaluation cycle begins in autumn 2011, minor alterations will be made to the session feedback forms and methods of data entry to increase their efficiency.
Aims The workshops have been shown to provide an effective, solution focused approach to supporting mental health
and well-‐being. Participants found the workshops engaging, enjoyable and of practical benefit. Following attendance, the majority of participants felt empowered to take action to improve their well-‐being, and
participants saw the project as a useful resource. This supports the case for the project’s continuation.
Observations The monitoring data has highlighted the fact that the majority of participants in both the general public and
closed groups were female, and that participants from BME groups were underrepresented. A range of ages was represented and the programme showed itself to be accessible for people with disabilities. There were near-‐equal percentages of participants with and without stated disabilities.
Attendance on the closed group workshops was lower than expected and participants tended not to be regular attendees, dropping in to sessions, rather than attending for the duration of the 10-‐week programme.
The increase in the WEWBS scores suggests an improvement in participants’ well-‐being over the course of their workshop attendance, but as the sample size is limited, and it was not always possible to collect the scores at the
planned pre-‐ and post-‐ intervals, this finding should be interpreted with caution. Considerations of group size and physical disability as a barrier to participation, that were raised by case studies are also of concern.
The measures to be taken in response to these issues are discussed below as recommendations.
Participant involvement
9 participants became volunteers, showing there was opportunity for workshop participants to become actively involved in the project’s delivery.
A number of suggestions put forward by the participant and volunteer steering groups, and obtained through case study and session feedback, were implemented for the next instalment of workshops. This demonstrates there was opportunity for participants to input into the project’s planning.
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Funding and finance Additional income sources are necessary for the continuation of the project. At the time of writing, all core staff posts are un-‐salaried. Light Box is seeking to develop a financially sustainable approach to working whereby it is
paid by the local authority and health bodies for its services. This has been shown to effectively support the public promotion of mental health and well-‐being in Bristol. /
“….Had a fantastic time and discovered all sorts of useful new thoughts and activities.” Participant
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4.9 Recommendations The following actions will be taken forward, as a result of the project evaluation:
Light Box will target future promotional and marketing activities in order to engage BME populations, and increase the number of male participants. Initial action should include making direct contact with BME community representatives in the third sector, in order to offer outreach introductions to their clients
From 2012, Light Box will make 2 weekend workshops available each month to help those in full time employment access the service
The professional background of facilitators will be stated in every workshop
Participant catch-‐up groups will be held fortnightly, providing participants with additional opportunities to discuss their experiences of implementing the recommended actions with each other
People booking onto all future workshops will be asked if they have any physical access needs, and will be
advised on the appropriateness of various workshops where necessary
Publicity materials will highlight maximum group size, and the option of small group bookings for workshops will be presented to Social Anxiety West
Reference to hedonic adaptation theory in the introduction will be re-‐worded
More time will be spent introducing potential closed group participants to the course, its structure and outcomes they can expect. A broader range of support agencies that work with these client groups will make referrals
Light Box will continue to gather data from the closed group participants and case studies using the WEWBS. This will ensure that they are able to add to their existing data set and begin to build a stronger case for improvements in well-‐being for participants during the programme.
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5
The Happiness Project: next installment
Group discussion: thinking of ideas in the Vitality 2: Movement workshop
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5.1. Autumn workshops An Autumn timetable of workshops has been scheduled to run from September 19th, 2011. Following the summer programme, all 10 workshops underwent revisions, as a result of participant feedback. The following suggestions from the participant steering group meeting in June have also been integrated into the timetable and workshops:
• Away-‐days have been added to the timetable. These will assist with participants’ exploration of broader
artistic practices and themes. Land-‐art exercises where a group art work is created using natural materials in green space, and guided trips to art exhibitions will feature as away-‐day activities
• The shop will be open in a drop-‐in capacity for 2 days a week, in addition to scheduled workshops. As a drop-‐in space, activities such as ping-‐pong, collage and stop motion animation will be available to the public without pre-‐booking
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“It’s just so much fun” Participant
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5.2 On from Autumn In January 2012, a new set of 10-‐week courses for women at risk of offending and young people experiencing mental health difficulty will commence. Existing partners Eden House Project and the Early Intervention Team as well as other organisations in the third sector will refer their clients to take part in these courses. /
“Well done you all, a real inspiration about what can be achieved.” Participant
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6. Conclusion This report highlights the success of the project in achieving its aims, as well as identifying areas for improvement. Key recommendations will be taken forward into the next installment of the project.
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8. References Cayton, H (2007). The report of the review of arts and health working group. London: Department of Health. Available from: http://www.dh.gov.uk/en/Home Accessed: 19 September 2011. Clift, S. et al. (2009) The state of arts and health in England. Arts & Health.1(1): pp.6-‐35. Compton, W. C. (2005) An Introduction to Positive Psychology. Connecticut: Wadsworth Publishing. Csikszentmihalyi, M. (1990) Flow: The Psychology of Optimal Experience. New York: Harper and Row. Department of Health with Arts Council England. (2007) A prospectus for arts and health. Available from: http://www.artscouncil.org.uk/documents/publications/ Accessed: 19 September 2011. Duggan, L. / Light Box. (2010) Light Box Project Report. Available from: http://wearelightbox.co.uk/page/wp-‐content/uploads/2010/12/Light-‐Box-‐PDF-‐Project-‐Report.pdf Accessed: 19 September 2011. HM Government. (2011) No Health without Mental Health: A cross government mental health outcomes strategy for people of all ages. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124058.pdf Accessed: 21 September 2011. Hunt, L. and Lyle, R. (2008) Bristol Mental Health Services -‐ A Vision for the Future. Bristol Mental Health Local Implementation Team. Available from: http://www.avon.nhs.uk/bhsp/Services/mental_health/pro/080201_Mental_Health_Services_Vision.pdf Accessed 2 September 2011. NRES ETHICS CONSULTATION E-‐GROUP (2007) Differentiating research, service evaluation and audit. Available from: http://www.nres.npsa.nhs.uk/applications/guidance/research-‐guidance/?entryid62=66988 Accessed: 12 October 2011. Robertson, B., Gray, C. and Bramley, S. (2008) Promoting positive mental health in Bristol: Strategic framework 2008 – 2011. NHS Bristol: Public Health Directorate. Available from: http://www.bristolpct.nhs.uk/publichealth/mentalhealth/Promoting_positive.pdf Accessed: 3 September 2011. Sainsbury Centre for Mental Health. (2003) The Economic and Social Costs of Mental Illness. Available from: www.scmh.org.uk/pdfs/cost_of_mental_illness_policy_paper_3.pdf Accessed: 15 September 2011. Secker, J. Hacking, S., Spandler, H., Kent, L. and Shenton, J. (2007) Mental Health, Social Inclusion and the Arts, Developing the Evidence Base. Available from: http://www.socialinclusion.org.uk/publications/MHSIArts.pdf Accessed: 12 October 2011.
Seligman, M.E.P. and Csikszentmihalyi, M. (2000) Positive Psychology: An Introduction. American Psychologist. 55 (1): pp. 5–14. Stewart-‐Brown, S. and Janmohamed, K. (2008) Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS). User Guide: Version 1. Available from: http://www.healthscotland.com/uploads/documents/7551-‐WEMWBS%20User%20Guide%20Version%201%20June%202008.pdf Accessed: 23 November 2011.
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7
Appendices
Collaging during the goals session
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Appendix A Workshop time table, April – June 2011
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Appendix B Income and Expenditure April -‐ June 2011
Artshine Arts Council Llankelly Chase AFA Lottery
Total Budget £35,000.00 £5,000.00 £10,000.00 £10,000.00 £10,000.00
Area Budget Spent
Staff Salaries 12,800.00 12,800.00 Volunteers 120.00 49.30 Art Materials 5,970.00 4,317.98 Capital Expenditure 1,250.00 1,261.69 Premises Fixtures Fittings 3,212.00 2,889.50 Evaluation 6,300.00 6,300,00 Advertising Marketing 1,218.00 1,010.80 Exhibitions 600.00 448.99 Printing Postage Stationery 500.00 397.28 Transport 400.00 399.12 Refreshments 300.00 113.61 Financial 620.00 1,177.60 Contingency 1,710.00 1,836.18 35,000.00 25,312.38
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Appendix C Feedback form
